Culture counts has long been a rallying cry among health advocates and policymakers concerned with racial disparities in health care. A generation ago, the women s health movement led to a host of changes that also benefitted racial minorities, including more culturally aware medical staff. Many health professionals would now agree that cultural competence is important in clinical settings, but in what ways? Shattering Culture provides an insightful view of medicine and psychiatry as they are practiced in today s culturally diverse clinical settings.Shattering Culture shows the human face of health care in America. Building on over a decade of research led by Mary-Jo Good, the book delves into the cultural backgrounds of patients and their health care providers, as well as the institutional cultures of clinical settings, to illuminate how these many cultures interact and shape the quality of patient care. Co-editor Sarah Willen explores the controversial practice of matching doctors and patients based on shared race, ethnicity, or language and finds a spectrum of arguments challenging its usefulness, including patients who fear being judged negatively by providers from their own culture. Seth Hannah introduces the concept of cultural environments of hyperdiversity describing complex cultural identities. Antonio Bullon demonstrates how regulations meant to standardize the caregiving process such as the use of templates and check boxes instead of narrative notes have steadily limited clinician flexibility, autonomy, and the time they can dedicate to caring for patients. Elizabeth Carpenter-Song looks at positive doctor-patient relationships in mental health care settings and finds that the greates successes in relationships are based on mutual recognition patients who can express their concerns and clinicians who validate them. In this book s final essay, Hannah, Good, and Lawrence Park show how navigating the maze of insurance regulations, financial arrangements, and paperwork compromises the effectiveness of mental health professionals seeking to provide quality care to minority and poor patients.
Few opportunities exist to enter the world of medical and mental health clinics and see how diversity on one hand and bureaucratic regulations on the other are influencing patient care. Shattering Culture provides a rare look at the day-to-day experiences of psychiatrists and other clinicians and offers multiple perspectives on what culture means to doctors, staff, and patients and how it shapes the practice of medicine and psychiatry.
While most existing theoretical and experimental literatures focus on how a high probability of repeated play can lead to more socially efficient outcomes (for instance, using the result that cooperation is possible in a repeated prisoner’s dilemma), this paper focuses on the detrimental effects of repeated play—the ‘‘dark side of the future.’’ I study a resource division model with repeated interaction and changes in bargaining strength. The model predicts a negative relationship between the likelihood of repeated interaction and social efficiency. This is because the longer shadow of the future exacerbates commitment problems created by changes in bargaining strength. I test and find support for the model using incentivized laboratory experiments. Increases in the likelihood of repeated play lead to more socially inefficient outcomes in the laboratory.
Estimating the mechanisms that connect explanatory variables with the explained variable, also known as “mediation analysis,” is central to a variety of social-science fields, especially psychology, and increasingly to fields like epidemiology. Recent work on the statistical methodology behind mediation analysis points to limitations in earlier methods. We implement in Stata computational approaches based on recent developments in the statistical methodology of mediation analysis. In particular, we provide functions for the correct calculation of causal mediation effects using several different types of parametric models, as well as the calculation of sensitivity analyses for violations to the key.
Identifying causal mechanisms is a fundamental goal of social science. Researchers seek to study not only whether one variable affects another but also how such a causal relationship arises. Yet commonly used statistical methods for identifying causal mechanisms rely upon untestable assumptions and are often inappropriate even under those assumptions. Randomizing treatment and intermediate variables is also insufficient. Despite these difficulties, the study of causal mechanisms is too important to abandon. We make three contributions to improve research on causal mechanisms. First, we present a minimum set of assumptions required under standard designs of experimental and observational studies and develop a general algorithm for estimating causal mediation effects. Second, we provide a method for assessing the sensitivity of conclusions to potential violations of a key assumption. Third, we offer alternative research designs for identifying causal mechanisms under weaker assumptions. The proposed approach is illustrated using media framing experiments and incumbency advantage studies.
Informal payments are a frequently overlooked source of local public finance in developing countries. We use microdata from ten countries to establish stylized facts on the magnitude, form, and distributional implications of this “informal taxation.” Informal taxation is widespread, particularly in rural areas, with substantial in-kind labor payments. The wealthy pay more, but pay less in percentage terms, and informal taxes are more regressive than formal taxes. Failing to include informal taxation underestimates household tax burdens and revenue decentralization in developing countries. We discuss various explanations for and implications of these observed stylized facts.
This book applies an established analytical framework for health sector reform (Getting Health Reform Right, Oxford, 2004) to the performance problems of the pharmaceutical sector. The book is divided into three sections. The first section presents the basic ideas for analysis. It begins by insisting that reform start with a clear understanding of the performance deficiencies of the current system. Like all priority setting in the public sector, this 'definition of the problem' involves both ethical choices and political processes. Early chapters explain the foundations of these ideas and apply them to the pharmaceutical sector. The relationship of ultimate outcomes (like health status or risk protection) to classic health systems concepts like efficiency, access and quality is also explored. The last chapter in the first part is devoted to 'diagnosis'—explaining how to move from the definition of a problem to an understanding of how the functioning of the system produces the undesirable outcomes in question.
The second part of the book devotes one chapter to each of five 'control knobs': finance, payment, organization, regulation and persuasion. These are sets of potential interventions that governments can use to improve pharmaceutical sector performance. Each chapter presents basic concepts and discusses examples of reform options. Throughout we provide 'conditional guidance'—avoiding the approach of a 'one size fits all' model of 'best practices' in these five arenas for reform. Instead we stress the need for local knowledge of political systems, administrative capacities, community values and market conditions in order to design pharmaceutical sector policies appropriate to a country’s particular circumstances.
The last part of the book is a set of teaching cases. Each is preceded by questions and is followed by a brief note on the lessons to be learned. The goal is to help readers develop the skills they need to deal effectively with pharmaceutical sector reform problems in their own countries.
In this Series in The Lancet, we review the past 50 years of Japan’s universal health coverage, identify the major challenges of today, and propose paths for the future, within the context of long-term population aging and the devastating crises triggered by the March 11 earthquake. Japan is recognised internationally for its outstanding achievements during the second half of the 20th century, in both improving the population’s health status and developing a strong health system. At the end of World War 2, in Japan, life expectancy at birth was 50 years for men and 54 years for women; by the late 1970s, Japan overtook Sweden as the world’s leader for longest life expectancy at birth. Japanese women have remained in the number one slot for 25 years, reaching a life expectancy of 86.4 years in 2009 (while Japanese men slipped to fifth longest living that year, at 79.6 years).In 2011, Japan celebrates 50 years of kaihoken: health insurance for all. Universal health insurance was achieved in 1961, assuring access to a wide array of health services for the whole population. Since then, benefits have become more egalitarian while health expenditures have remained comparatively low: 8.5% of the gross domestic product and 20th out of countries in the Organisation for Economic Co-operation and Development in 2008. This achievement is all the more remarkable because the percentage of the population aged 65 years or older has increased nearly four-fold (from 6% to 23%) over the past 50 years.
Surveying three centuries of economic history, a Harvard professor argues for a leaner global system that puts national democracies front and center.From the mercantile monopolies of seventeenth-century empires to the modern-day authority of the WTO, IMF, and World Bank, the nations of the world have struggled to effectively harness globalization's promise. The economic narratives that underpinned these eras—the gold standard, the Bretton Woods regime, the "Washington Consensus"—brought great success and great failure. In this eloquent challenge to the reigning wisdom on globalization, Dani Rodrik offers a new narrative, one that embraces an ineluctable tension: we cannot simultaneously pursue democracy, national self-determination, and economic globalization. When the social arrangements of democracies inevitably clash with the international demands of globalization, national priorities should take precedence. Combining history with insight, humor with good-natured critique, Rodrik's case for a customizable globalization supported by a light frame of international rules shows the way to a balanced prosperity as we confront today's global challenges in trade, finance, and labor markets.
This study identifies how country differences on a key cultural dimension—egalitarianism— influence international investment flows. A society’s cultural orientation toward egalitarianism is manifested by intolerance for abuses of market and political power and a desire for protecting less powerful actors. We show egalitarianism to be based on exogenous factors including social fractionalization, dominant religion circa 1900, and war experience from the 19th century. We find a robust influence of egalitarianism distance on cross-national flows of bond and equity issuances, syndicated loans, and mergers and acquisitions. An informal cultural institution largely determined a century or more ago, egalitarianism exercises its effect on international investment via an associated set of consistent contemporary policy choices. But even after controlling for these associated policy choices, egalitarianism continues to exercise a direct effect on cross-border investment flows, likely through its direct influence on managers’ daily business conduct.
In Cases about Redefining Global Strategy Pankaj Ghemawat and Jordan Siegel have assembled 26 full-length case studies as a resource for active learning about the nature of cross-border differences and strategies. As technology innovation globalizes markets and firms, management education must adopt a truly modern perspective on globalization-one that illuminates differences across borders rather than emphasizing similarities and imposing local models onto far-flung cultures. A new generation of managers and innovators who must compete in a "flat" world cannot succeed while following a one-size-fits-all approach to global strategy. Pankaj Ghemawat, Professor of Strategy at Spain's IESE Business School and author of World 3. and Redefining Global Strategy, and Harvard Business School Professor Jordan Siegel represent a new era of thinking in global strategy. This carefully chosen selection of classics and new material from Harvard Business Publishing also includes an introduction and six introductory module notes that identify key themes and strategic concepts explored in the cases. Though attuned to the format of an MBA course, the cases and text may also be used individually or in programs outside the strategy curriculum.
During the past decade, a variety of intermediaries have emerged to facilitate the trading of patents: brokers, non-practicing entities (NPEs), defensive aggregators, online platforms, auctions and unique entities such as Intellectual Ventures. We discuss the fundamental causes for the lack of liquidity in the IP market and analyze the merits and shortcomings of the various business models used by patent intermediaries. A key conclusion is that platform-type intermediaries (who facilitate transactions without taking possession of assets) have struggled, whereas merchant-type intermediaries (who acquire patents and seek to monetize them directly) have reached significant scale and influence in the technology industries that fall under the incidence of their assets. We also discuss some efficiency issues raised by the growing prominence of patent merchants.
Scholars in science and technology studies (STS) have recently been called upon to advise governments on the design of procedures for public engagement. Any such instrumental function should be carried out consistently with STS’s interpretive and normative obligations as a social science discipline. This article illustrates how such threefold integration can be achieved by reviewing current US participatory politics against a seventy-year backdrop of tacit constitutional developments in governing science and technology. Two broad cycles of constitutional adjustment are discerned: the first enlarging the scope of state action as well as public participation, with liberalized rules of access and sympathetic judicial review; the second cutting back on the role of the state, fostering the rise of an academic-industrial complex for technology transfer, and privatizing value debates through increasing delegation to professional ethicists. New rules for public engagement in the United Sates should take account of these historical developments and seek to counteract some of the anti-democratic tendencies observable in recent decades.
The rise to global predominance of Western civilization is the single
most important historical phenomenon of the past five hundred years.
All over the world, an astonishing proportion of people now work for
Western-style companies, study at Western-style universities, vote for
Western-style governments, take Western medicines, wear Western clothes,
and even work Western hours. Yet six hundred years ago the petty
kingdoms of Western Europe seemed unlikely to achieve much more than
perpetual internecine warfare. It was Ming China or Ottoman Turkey that
had the look of world civilizations. How did the West overtake its
Eastern rivals? And has the zenith of Western power now passed? In Civilization: The West and the Rest,
bestselling author Niall Ferguson argues that, beginning in the
fifteenth century, the West developed six powerful new concepts that the
Rest lacked: competition, science, the rule of law, consumerism, modern
medicine, and the work ethic. These were the "killer applications" that
allowed the West to leap ahead of the Rest, opening global trade
routes, exploiting newly discovered scientific laws, evolving a system
of representative government, more than doubling life expectancy,
unleashing the Industrial Revolution, and embracing a dynamic work
ethic. Civilization shows just how fewer than a dozen Western
empires came to control more than half of humanity and four fifths of
the world economy. Yet now, Ferguson argues, the days of Western
predominance are numbered-not because of clashes with rival
civilizations, but simply because the Rest have now downloaded the six
killer apps we once monopolized-while the West has literally lost faith
in itself. Civilization does more than tell the gripping
story of the West's slow rise and sudden demise; it also explains world
history with verve, clarity, and wit. Controversial but cogent and
compelling, Civilization is Ferguson at his very best.
On February 19, 2009, CNBC commentator Rick Santelli delivered a dramatic rant against Obama administration programs to shore up the plunging housing market. Invoking the Founding Fathers and ridiculing "losers" who could not pay their mortgages, Santelli called for "Tea Party" protests. Over the next two years, conservative activists took to the streets and airways, built hundreds of local Tea Party groups, and weighed in with votes and money to help right-wing Republicans win electoral victories in 2010.In this penetrating new study, Harvard University's Theda Skocpol and Vanessa Williamson go beyond images of protesters in Colonial costumes to provide a nuanced portrait of the Tea Party. What they find is sometimes surprising. Drawing on grassroots interviews and visits to local meetings in several regions, they find that older, middle-class Tea Partiers mostly approve of Social Security, Medicare, and generous benefits for military veterans. Their opposition to "big government" entails reluctance to pay taxes to help people viewed as undeserving "freeloaders"—including immigrants, lower income earners, and the young. At the national level, Tea Party elites and funders leverage grassroots energy to further longstanding goals such as tax cuts for the wealthy, deregulation of business, and privatization of the very same Social Security and Medicare programs on which many grassroots Tea Partiers depend. Elites and grassroots are nevertheless united in hatred of Barack Obama and determination to push the Republican Party sharply to the right.
The Tea Party and the Remaking of Republican Conservatism combines fine-grained portraits of local Tea Party members and chapters with an overarching analysis of the movement's rise, impact, and likely fate.
Agriculture on the American Great Plains has been constrained by historical water scarcity. After World War II, technological improvements made groundwater from the Ogallala aquifer available for irrigation. Comparing counties over the Ogallala with nearby similar counties, groundwater access increased irrigation intensity and initially reduced the impact of droughts. Over time, land-use adjusted toward water-intensive crops and drought-sensitivity increased; conversely, farmers in water-scarce counties maintained drought-resistant practices that fully mitigated higher drought-sensitivity. Land values capitalized the Ogallala's value at $26 billion in 1974; as extraction remained high and water levels declined, the Ogallala's value fell to $9 billion in 2002.
NEBR Working Paper #17625.Co-Author Pinar Keskin is a Professor of Economics at Wellesley College.Download PDF
This paper measures “debt disputes” between governments and
foreign private creditors in periods of sovereign debt crises. We
construct an index of government coerciveness, consisting of 9
objective sub-indicators. Each of these sub-indicators captures
unilateral government actions imposed on foreign banks and
bondholders. The results provide the first systematic account of
debt crises that goes beyond a binary categorization of default
versus non-default. Overall, government behavior and rhetoric
show a strong variability, ranging from highly confrontational to
very smooth crisis resolution processes. In a preliminary analysis
on the determinants of coercive behavior, we find political institutions
to be significant, while economic and financial factors play
a lesser role. These results open up an agenda for future research.
In 1959 South Korea was mired in poverty. By 1979 it had a powerful industrial economy and a vibrant civil society in the making, which would lead to a democratic breakthrough eight years later. The transformation took place during the years of Park Chung Hee’s presidency. Park seized power in a coup in 1961 and ruled as a virtual dictator until his assassination in October 1979. He is credited with modernizing South Korea, but at a huge political and social cost.South Korea’s political landscape under Park defies easy categorization. The state was predatory yet technocratic, reform-minded yet quick to crack down on dissidents in the name of political order. The nation was balanced uneasily between opposition forces calling for democratic reforms and the Park government’s obsession with economic growth. The chaebol (a powerful conglomerate of multinationals based in South Korea) received massive government support to pioneer new growth industries, even as a nationwide campaign of economic shock therapy—interest hikes, devaluation, and wage cuts—met strong public resistance and caused considerable hardship.This landmark volume examines South Korea’s era of development as a study in the complex politics of modernization. Drawing on an extraordinary range of sources in both English and Korean, these essays recover and contextualize many of the ambiguities in South Korea’s trajectory from poverty to a sustainable high rate of economic growth.