The Milbank Memorial Fund quarterly. Health and society最新文献

The impact upon health of changes in public policy regarding health services has not been systematically assessed. The long-term, and largely irreversible, effects of reduced support for health services to children present special challenges to collaborative research between clinical and public health approaches. Preliminary evidence from such a collaborative study of a variety of illnesses and interventions is persuasive of real benefit from prompt access to medical care.

Improvement in survival at advanced ages suggests that important changes in health and the natural history of disease processes may be occurring concurrently. a general model based upon cohort and life-course perspectives describes the changing relation of morbidity, disability, and mortality over time. Variability across different social and economic conditions is examined among institutionalized and non-institutionalized elderly, and between the United States and Japan. Future policy must take account of the qualitative, as well as the quantitative, changes in aging.

Improvements in the medical/technical ability to transplant human organs have led to similar--yet importantly different--societal and organizational responses among the nations of the "Atlantic Community." The highly decentralized system of organ procurement in the United States yields greater numbers; centrally directed European systems reflect lower wastage rates. An emerging convergence of the two approaches promises significant benefits and efficiencies in organ transplantation.

Questions surrounding withholding treatment from severely impaired newborns have elicited three significantly different substantive and procedural responses: from the Reagan administration's Department of Health and Human Services through the Carter President's Commission on Ethical Problems, and subsequent congressional legislation on child abuse. Movement from a rigid and simplistic application of medical imperatives to ambiguous and abstract criteria of the child's "best interest" represented limited progress. A new legislative compromise principle is an imperfect but practical accommodation to moral and medical realities.

Little is known about the health problems of the fastest-growing segment of the population. Three major community-based studies present prevalence information on physical and mental disabilities among the oldest old. These data also illustrate the limitations of interpretations in cross-sectional studies, and emphasize the value of prospective investigations of populations aged 85 and older. Although more costly and time-consuming, such prospective longitudinal studies are indispensable to sound policy planning.

The general public, physicians, and policy makers have all come to accept constraints on public expenditures for medical care as a reasonable means to redirect resources to competing sectors of national life, and to reflect changing political and social values. "Rationing" of facilities and services by explicit and implicit methods seems inevitable; the poor and disabled must not bear the brunt of stringency. The politics of competition and altered power relationships among providers offer new opportunities for system-wide reform.

The past 25 years have seen the development of a wide variety of sample surveys dealing with the nature and distribution of illness and disability, and with the utilization of health care services. The sample survey is currently the most widespread and influential instrument for judging the health status of the nation and for guiding health policy. The knowledge, beliefs, and attitudes of survey respondents "subjectively" affect what the survey seeks to "objectively" measure. Even as statistical sampling has been refined, so is it important to reexamine what the cognitive sciences have to offer for survey interview structure and content.

Persons aged 85 years and over have been the most rapidly growing group for some time, although their numbers are yet relatively small. However meager the official data, they do reveal striking differences from other Americans, including a unique sex ratio, higher rates of institutionalization, and lower family income. Examination of recent demographic trends portends the direction of future changes among the oldest old.