Ian Shaw

How Lay Are Lay Beliefs

The article explores and problematizes the concept of lay beliefs. The article undertakes this using an example of ‘good practice’ in lay beliefs research – an article by Ilka Kangas recently published in health: (2001 vol. 5(1)) – to illustrate how fundamental problems with the concept still arise. The article argues that lay beliefs are extremely difficult, if not impossible, to study because they are tied up with the certainty of diagnosis and the legitimacy that is afforded by taking on medical rationality. Moreover, ‘commonsense’ views are themselves based upon understandings within expert paradigms. Implications for research are considered and the author calls for a shift of focus from lay beliefs to illness accounts where individual understandings can be appreciated.

The international applicability of “new” public management: lessons from Turkey

One of the central tenets of “new public management” is that it is universally applicable. Indeed the European Union advocates the adoption of such management approaches for countries seeking entry to the EU. This paper questions this position with reference to the introduction of change in public services in Turkey. From this study it is argued that management change in public services may be more to do with cultural factors which are embedded in the form of public administration of that country. One of the central factors of Turkish life is the state dominance over civil society, including the private sector. In the UK private sector values enter the public sector, whereas in Turkey public service values enter the private sector. The paper concludes that changes in public sector management have to consider the cultural factors of public services and management models cannot be imposed unchanged.

Distinguishing mental illness in primary care. We need to separate proper syndromes from generalised distress.

Two studies in the BMJ last year make challenging reading set alongside one another. Kessler et al reported that over half the patients attending general practice surgeries are depressed,1 and the Norwegian naturalistic treatment study of depression in general practice concluded that the best treatment for depression in primary care is a combination of antidepressant medication and counselling.2 Read uncritically, these findings imply that half of all general practice patients should be taking antidepressants and undergoing counselling. Clearly few people would agree with this, but the apparent folly does draw attention to a gap in our understanding of mental ill health in primary care.3 Uncertainties about the best way to provide for such patients, and indeed questions about the propriety of doing so at all within the NHS, have a long history. These uncertainties largely revolve around differences between medical and sociological approaches to psychological distress. The medical approach argues that such distress reflects an underlying illness which merits treatment. The sociological perspective argues that it is the consequence of a failure to respond adaptively to social challenge. The former focuses …

Social Policy in South Korea: Cultural and Structural Factors in the Emergence of Welfare

There are a number of features that make South Korea an interesting place to study social policy. First, it has experienced rapid economic development with the associated changes in urbanization and demography. This change has created social problems, which the state has had to address. Second, the country retains a strong cultural tradition and repeated affirmation of the values and practices of Confucianism. In this paper, these two features are considered in relation to the way social policy has been addressed. The thrust of the paper will be on the policy responses to perceived social problems and the way in which other social problems are individualized within families. These policies are informed and shaped by Korean politics and culture.

Doctors, “Dirty Work” Patients, and “Revolving Doors”:

Using information from research into the phenomenon of “revolving-door” psychiatric patients, the author explores general practitioners’ perceptions of difficult patients and the consequences for patient management. He first considers the concept of “good and bad” as a possible subtype of dirty work. He then presents the evidence of medical irritation with patients from interview data and explores the rationalizations for the way in which patients are subsequently managed. In line with previous studies, the author argues that the construction of patients as difficult and the subsequent dynamics of exclusion lie in the breakdown of the “normal” doctor-patient relationship coupled with the doctor’s need to get on with the day’s workload. Moral judgments formed a part of the exclusion process.

A Letter of Consequence: Referral Letters From General Practitioners to Secondary Mental Health Services

The referral letter is a key instrument in moving patients from primary to secondary care services. Consequently, the circumstances in which a referral should be made and its contents have been the subject of clinical guidelines. This article is based on a project that demonstrated that physicians do not adhere to clinical guidelines when referring patients to secondary mental health services. This research supports earlier findings into noncompliance with guidelines by general practitioners (GPs). The authors briefly note possible reasons, which have been the subject of some debate. They also present a content analysis of referral letters to demonstrate the important ways in which they differ from guideline criteria. However, their central argument is that the role of the referral letter in relation to the GP’s repertoire of treatments has not been understood fully. Such understanding implies the need for a reexamination of the support available for GPs.

Consumerism, Health and Social Order

The concept of consumerism has multiple meanings, many of which are heavily value-laden; similarly, there are conflicting stereotypes of ‘the consumer’. After exploring the key dimensions of debates about consumerism and the consumer, this paper addresses some paradoxical consequences of the discourse of consumer empowerment in the field of health promotion and specifically in the ‘new public health’ movement.

Turkey and the European Union: Modernizing a Traditional State?

This paper discusses the difficulties encountered when reforms are attempted to the administration of public policy in Turkey. This discussion is timely, since Turkey has recently stepped up its modernization agenda in its drive to gain membership of the European Union. The paper briefly examines the political and administrative structure of Turkey before discussing the influence of the EU on the countrys modernization agenda.

Theory, Like Mist on Spectacles, Obscures Vision:

This article reflects upon the choice of theory in theory-driven evaluation. While theory is helpful in focusing evaluators attention and facilitating investigation, it also excludes evidence that does not fit within its framework. The argument is that evaluators need to be aware of all theories that may impinge upon a programme and to defend the theory of choice. They also need to be explicit about what may be excluded from their investigation. Governments aim at change at a macro-level, often using macro-theory, whereas evaluators often concerned with the implementation of programmes may use theory that is at a different, usually the micro-level. Theories at these two levels are not always compatible. The article briefly outlines the development of the theory-driven approach before focusing upon evaluation in health promotion as a case study to highlight the issues.

Did pandemic preparedness aid the response to pandemic (H1N1) 2009? A qualitative analysis in seven countries within the WHO European Region

BACKGROUND Although the 2009-2010 influenza A (H1N1) pandemic was of low severity compared with other pandemics of the 20th century, this pandemic was the first opportunity for countries to implement a real-life pandemic response. The aim of the project was to review the extent to which these plans and planning activities proved useful and to identify areas of pandemic planning that require further strengthening. METHODS We randomly selected seven countries within the WHO European Region to participate in a comprehensive, qualitative study to evaluate the pandemic preparedness activities undertaken prior to March 2009 compared with the subsequent pandemic responses mounted from May 2009 onwards. Research teams visited each country and interviewed stakeholders from health and civil response ministries, national public health authorities, regional authorities and family and hospital doctors. RESULTS The following six consistent themes were identified as essential elements of successful pandemic preparedness activities: communication, coordination, capacity building, adaptability/flexibility, leadership and mutual support. Regarding future pandemic preparedness activities, an emphasis on these areas should be retained and planning for the following activities should be improved: communication (i.e., with the public and health professionals); coordination of vaccine procurement and logistics; flexibility of response and hospital surveillance. CONCLUSIONS Pandemic preparedness activities were successfully undertaken in the WHO European Region prior to the 2009 pandemic. These activities proved to be effective and were generally appropriate for the response provided in 2009. Nevertheless, consistent themes also emerged regarding specific areas of under planning that were common to most of the surveyed countries.