“We Never was Happy Living Like a Whiteman” : Mental Health Disparities and the Postcolonial Predicament in American Indian Communities

In the context of increasing attention to disparities in health status between U.S. ethnoracial groups, this article examines the dilemma of divergent cultural practices for redressing disparities in mental health status in American Indian communities. Drawing upon an ethnographic interview with a tribal elder from a northern Plains Indian reservation, a prototypical discourse of distress is presented and analyzed as one exemplar of the divergence between the culture of the clinic and the culture of the community. Situated in the context of continuing power asymmetries between tribal nations and the U.S. federal government, the implications of this cultural divergence for the efforts of mental health professionals, practitioners, and policymakers are identified as a predicament that only the conventions and commitments of a robust community psychology have the potential to resolve.     

Community types and mental health: a multilevel study of local environmental stress and coping

Research has found that neighborhood structural characteristics can influence residents' mental health. Few studies, however, have explored the proximal reasons behind such influences. This study investigates how different types of communities, in terms of environmental stressors (social and physical disorder and fear of crime) and social resources (informal ties and formal organizational participation), affect well-being, depression, and anxiety in adult residents. Data are from a survey of 412 residents nested in 50 street blocks. Block stressors and resources were cluster analyzed to identify six block types. After controlling for several individual- and block-level characteristics, results from multilevel models suggest that in communities facing relatively few stressors, higher levels of formal participation are associated with better mental health. Because high levels of formal participation were not found in communities with higher levels of stressors, the impact of participation in such contexts could not be examined. However, results suggest that in communities where stressors are more common, isolation from neighbors may have a protective effect on mental health.     

Neighborhood Social Conditions Mediate the Association Between Physical Deterioration and Mental Health

This study investigates how neighborhood deterioration is associated with stress and depressive symptoms and the mediating effects of perceived neighborhood social conditions. Data come from a community survey of 801 respondents geocoded and linked to a systematic on-site assessment of the physical characteristics of nearly all residential and commercial structures around respondents’ homes. Structural equation models controlling for demographic effects indicate that the association between neighborhood deterioration and well-being appear to be mediated through social contact, social capital, and perceptions of crime, but not through neighborhood satisfaction. Specifically, residential deterioration was mediated by social contact, then, social capital and fear of crime. Commercial deterioration, on the other hand, was mediated only through fear of crime. Additionally, data indicate that the functional definition of a “neighborhood” depends on the characteristics measured. These findings suggest that upstream interventions designed to improve neighborhood conditions as well as proximal interventions focused on social relationships, may promote well-being. At the time of this study, Dr. Gee was at the University of Michigan.     

Civic community and violent behavior in Italy

The aim of this study was to examine to what extent community characteristics counterbalance propensities towards homicide and robbery. Data were obtained for each of the 95 Italian provinces on homicide rate and robbery rate from 1992 to 1995. Multiple regressions were used to predict these homicide and robbery rates from a measure of civic engagement (Civicness) assessed during the same period, and from other socioeconomic variables: unemployment, family break up, and geographical characteristics. The predictors explained 77% of the variance among the Italian provinces for robbery, and 61% of the variance for homicide. The predictive patterns were somewhat different for homicide and robbery, but in each case civicness interacted with territorial variables. In the case of homicide, civicness had a preventive impact only in the southern provinces. For robbery, the protective impact was limited to provinces which were urbanized and had large metropolitan areas.     

试论卫生与法律的关系

卫生是人类重要的社会实践活动。卫生也是保护人体健康的重要社会事业,需要法律的保护和导向。卫生法为卫生发展提供了良好的社会环境,并控制医药卫生无序、失控及异化带来的社会危害性,造福人类,促进经济发展和社会进步。     

城镇职工医疗保险改革面临的问题与对策

我国政府已明确提出城镇职工基本医疗保险制度的改革目标,虽然改革已取得了一些进展,但距改革目标仍有相当差距。采用政治分析方法,分析了目前医改所面临的主要问题与原因,并在借鉴国际医疗保障制度改革启示的基础上,进一步探讨解决问题和推进改革进程的思路。     

The Paradoxes and Promise of Community Coalitions

Community coalitions, as they are currently applied, are unique organizations whose ability to promote community change is different from other types of community organizations. This article explores those differences and elaborates how community coalitions can use those differences to transform conflict into greater capacity, equity, and justice. Concerns are also raised in this article about how community coalitions can intentionally and unintentionally protect the status quo and contain the empowerment of grassroots leadership and those of marginalized groups. There is a need for more theory, research, and discourse on how community coalitions can transform conflict into social change and how they can increase the power of grassroots and other citizen-lead organizations.     

Building Collaborative Capacity in Community Coalitions: A Review and Integrative Framework

This article presents the results of a qualitative analysis of 80 articles, chapters, and practitioners' guides focused on collaboration and coalition functioning. The purpose of this review was to develop an integrative framework that captures the core competencies and processes needed within collaborative bodies to facilitate their success. The resulting framework for building collaborative capacity is presented. Four critical levels of collaborative capacity—member capacity, relational capacity, organizational capacity, and programmatic capacity—are described and strategies for building each type are provided. The implications of this model for practitioners and scholars are discussed.     

Conceptualizing ‘social capital’ for health promotion in small local communities: a micro‐qualitative study

This paper reports on a micro‐qualitative case study of peoples' experiences of local community life in a south‐east English town. This material is used as the basis for a critical discussion of the suitability of Putnam's notion of social capital as a conceptual tool for the design and evaluation of ‘community strengthening’ policies and interventions. The study was motivated by a concern that too much debate about social capital has been conducted by academics and policy‐makers in a top‐down manner, with inadequate attention to the realities of life in the local communities that they refer to. Three‐hour semi‐structured interviews were conducted with 37 residents in two less affluent wards in our town of interest. Informants—half men and half women, and spread across the 15–75 age group—were encouraged to talk about their personal experiences of local community life. Interview findings are presented within the ‘norm’ categories of trust, neighbourliness and reciprocal help and support, and the ‘network’ categories of participation in informal networks, voluntary groupings and community activist groupings. Our case study points to a number of ways in which Putnam's concept needs to be refined if it is to inform ‘community strengthening’ policies and interventions in England. Far more notice needs to be taken of the role played by informal networks of friends and neighbours in the construction of local community life. Attention also needs to be given to the complex and shifting geographical spread of peoples' significant social networks. Putnam's conceptualization of cohesive local communities and his unitary notions of trust and local identity may also be unduly essentialist. In our particular communities of interest, they failed to capture the fluidity of local community norms and networks in a rapidly changing society. They also failed to do justice to the extent to which social distinctions—such as age, gender, ethnicity and housing tenure—shape and constrain the way in which people create, sustain and access social capital. Copyright © 2001 John Wiley & Sons, Ltd.