Int J Health Serv
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Since independence in 1971, a large number of health programs run by local and foreign voluntary organizations have been started in Bangladesh. This paper is the result of a survey undertaken on behalf on the Oxford Famine Relief Committee of ten of the most interesting of these projects. ⋯ A basic premise of this analysis is that ill health in particular communities is not simply a result of local conditions; rather, the structural determinants of ill health are frequently national and even international in scope. The effect of these structural determinants of the presence and funding policies of the many voluntary agencies in Bangladesh is assessed by analyzing the performance of the Oxford Famine Relief Committee, one of the more enlightened of these agencies.
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This study is an historical analysis of food consumption and nutrition in Chile emphasizing the influence of political and economic factors on nutritional standards. It attempts to document and explain the persistence of malnutrition as a widespread social problem in Chile even as the country achieved a relatively advanced state of economic development and boasted an unusually progressive record of social legislation. The major findings of the study were: (a) Chile's pattern of development, social reform efforts notwithstanding, consistently discriminated against low-income groups, and (b) this discrimination perpetuated low standards of nutrition and low levels of food consumption among the country's poor and undermined the effectiveness of specific measures to alleviate malnutrition.
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Historical Article
The transfer of care: U.S. mental health policy since World War II.
Recent criticism of mental health policy has raised many questions about the so-called "mental health revolution." Following World War II, the federal government and the growing mental health lobby planned the first nationally oriented system of psychiatric treatment, rehabilitation, and prevention. The rapidly expanding National Institute of Mental Health coordinated that policy, particularly through its Community Mental Health Centers program. Custodial state hospitals were depopulated and their patients "dumped" in nursing and boarding homes, which now constitute the largest arena for and most expensive form of psychaitric care. ⋯ They, and many others, are maintained on psychiatric drugs, another source of profit as well as a dangerous technology. Community mental health programs have maintained psychiatry's traditional class, race, and sex biases, and have incurred widespread intrusion into communities. This article shows that such problems are part of an interconnected system in which the driving forces are fiscal crisis, ideological justifications for dumping patients, attempts to pass responsibility from state governments to federal and local bodies, restrictions on government and insurance reimbursements, the free enterprise economics of the nursing home and drug industries, and the professionalist practices of the mental health field.
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Our objectives are to describe the pattern of abuse associated with battering and to evaluate the contribution of the medical system and of broader social forces to its emergence. A pilot study of 481 women who used the emergency service of a large metropolitan hospital in the U. S. shows that battering includes a history of self-abuse and psychosocial problems, as well as repeated and escalating physical injury. ⋯ Although secondary problems such as depression, drug abuse, suicide attempts, or alcoholism derive as much from the intervention strategy adopted as from physical assault or psychopathology, they are treated as the primary problems at psychiatric and social service referral points where family maintenance is often the therapeutic goal. One consequence of this referral strategy is the stabilization of "violent families" in ways that virtually insure women will be abused in systematic and arbitrary ways. The use of patriarchal logic by medical providers ostensibly responding to physical trauma has less to do with individual "sexism" than with the political and economic constraints under which medicine operates as part of an "extended patriarchy." Medicine's role in battering suggests that the services function to reconstitute the "private" world of patriarchal authority, with violence if necessary, against demands to socialize the labors of love.