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E. Richard Brown. Rockefeller medicine men: medicine and capitalism in America This book tells the hidden story of the financial, political, and institutional manipulations whereby a diverse and eclectic range of healing modalities available to the North American public was summarily pared down to a singular style of medicine that would become the predominant medicine of the Western world and a major force in global medical culture during the 20th century. This was brought about largely by the collaboration of the American Medical Association, the philanthropies of Andrew Carnegie and John D. Rockefeller, and the development of a revolutionary curriculum by the Johns Hopkins School of Medicine. Brown documents the story of how a powerful professional elite gained virtual hegemony in the Western theatre of healing by effectively taking control of the ethos and practice of Western medicine. E. Richard Brown describes how, in 1905, the American Medical Association's new Council on Medical Education funded by Carnegie and Rockefeller commenced serious activity. They employed the services of Abraham Flexner who proceeded to visit and "assess" every single medical school in the US and Canada. Within a short time of this development, medical schools all around the US began to collapse or consolidate. By 1910, 30 schools had merged, and 21 had closed their doors. Of the 166 medical schools operating in 1904, 133 had survived by 1910, and 104 by 1915. Fifteen years later, only 76 schools of medicine existed in the US. And they all followed the same curriculum. Brown shows how both social and political processes were consciously manipulated by a medical elite acting in concert with immense corporate wealth to create a system of medicine that better served economic and hegemonic intentions than social or humanitarian needs. -- Goodreads review ; https://digitalcommons.rockefeller.edu/the-rockefellers/1031/thumbnail.jpg

Individually and collectively, the five chapters that make up this report present a grim portrait of life in South-Central Los Angeles and other places like it, and they constitute a remarkable indictment of mainstream society for its indifference and neglect. The chapters lay out a detailed bill of specifics as to the nature and causes of the crisis in South-Central Los Angeles, together with various policy recommendations for dealing with some of the most troubling aspects. In Chapter 1, Ong describes the depth and range of economic deprivation in both South-Central Los Angeles and other parts of the wider metropolitan area. Leavitt and Heskin then take up the issue of the housing situation in South-Central. Brown, et al. describe a number of alarming failures of public health and health care delivery in Los Angeles. Darby, et al. point to the striking breakdown of education in Los Angeles in general and South-Central in particular. In Chapter 5, Estrada and Sensiper bring the proceedings to a conclusion with a discussion of the many different social cross-currents and the concomitant difficulties of political mobilization that mark South-Centra

The 1982 Medi-Cal reforms and reductions established selective contracting with hospitals for inpatient care of Medi-Cal beneficiaries. The legislation established a special negotiator and criteria to be used in selecting contract hospitals. We report the findings of a study that analyzed the characteristics of contract and noncontract hospitals in Los Angeles County to assess how well these criteria were reflected in the outcome of the contracting process. We examine issues of beneficiary access to general inpatient care and to specialized services, the efficiency of contract hospitals compared with noncontract ones and quality-related issues.

This article examines the impact of public and private health insurance on the use of medications for California adults with any of four chronic diseases: heart disease, high blood pressure, diabetes, and asthma. The data set used is the 2001 California Health Interview Survey. Multivariate analyses were conducted on individuals who had been diagnosed with each of these diseases. Controlling for various demographic, health status, and employment characteristics, the authors find that the uninsured are far less likely to be taking medications for each of the conditions than those with private insurance. Interestingly, those with Medicaid coverage are even more likely than those with private insurance to be taking such medications. The results of this study underscore the importance of health insurance for all persons with chronic conditions and the benefits of Medicaid in particular for low-income adults with chronic conditions.

Where Californians live within the state plays an important role in determining their access to health care. This policy brief uses data from the 2001 California Health Interview Survey (CHIS 2001) to examine differences in four key measures of access to care related to the county in which a person with low- to moderate-household income resides. These measures are the percent of the county population who: 1) have a usual source of care, 2) use community or government clinics as their usual source of care, 3) are uninsured for all or part of a year, and 4) delayed any type of care because of cost or insurance issues. The study also found that health insurance played a major role in determining access to care. The study's findings have significant implications for the ongoing political debate over potential cutbacks in the Medi-Cal and Healthy Families programs. These findings demonstrate that, for moderate-to-low income children and adults, counties differ in the levels of access experienced by their low- and moderate-income populations. Additionally, both persistent uninsurance and intermittent coverage reduce access to care and place a larger burden on community, public, and hospital-based clinics. The demands on this already-stretched safety net will likely rise with any increase in the number of uninsured people, whether that lack of coverage is short-term or long-term.

This paper considers the impact of community-level variables over and above the effects of individual characteristics on healthcare acess for low-income children and adults residing in large metropolitan statistical areas (MSAs). Further, we rank MSAs' performance in promoting healthcare access for their low-income populations. The individual-level data come from the 1995 and 1996 National Health Interview Survey (NHIS). The community-level variables are derived from multiple public-use data sources. The out-come variable is whether low-income individuals received a physician visit in the past twelve months. The proportion receiving a visit by MSA varied from 63% to 99% for children and from 62% to 83% for adults. Access was better for individuals with health insurance and a regular source of care and for those living in communities with more federally-funded health centers. Children residing in MSA

Afin de mieux comprendre la réticence chez beaucoup de travailleurs et de syndicats à appuyer les politiques antitabac et les programmes d'éducation sur les lieux de travail, les auteurs ont fait enquête auprès des membres d'un syndicat national de travailleurs dans des industries à haut risque. L'article présente les résultats de deux enquêtes. Quatre répondants sur dix se sont déclarés fumeurs, mais neuf sur dix fumeurs ont déclaré qu'ils aimeraient arrêter de fumer. Quoique les non-fumeurs ont montré une tendance plus forte à appuyer des restrictions antitabac sur les lieux de travail, trois sur quatre fumeurs ont aussi appuyé des restrictions. Le pourcentage des répondants qui appuyait la préoccupation de l'entreprise et du syndicat pour l'usage du tabac en dehors du milieu du travail et le pourcentage qui s'y opposait était à peu près égal. En général, les répondants qui croyaient que l'employeur et le syndicat travaillaient pour améliorer la santé et la sécurité au travail ont montré une tendance plus forte à appuyer des politiques antitabac. Les auteurs discutent des implications de ces résultats pour leurs hypothèses et pour les programmes d'éducation antitabac sur les lieux de travail.

Abstract Background Health systems face challenges in using research evidence to improve policy and practice. These challenges are particularly evident in small and poorly resourced health systems, which are often in locations (in Canada and globally) with poorer health status. Although organizational resources have been acknowledged as important in understanding research use resource theories have not been a focus of knowledge translation (KT) research. What resources, broadly defined, are required for KT and how does their presence or absence influence research use? In this paper, we consider conservation of resources (COR) theory as a theoretical basis for understanding the capacity to use research evidence in health systems. Three components of COR theory are examined in the context of KT. First, resources are required for research uptake. Second, threat of resource loss fosters resistance to research use. Third, resources can be optimized, even in resource-challenged environments, to build capacity for KT. Methods A scan of the KT literature examined organizational resources needed for research use. A multiple case study approach examined the three components of COR theory outlined above. The multiple case study consisted of a document review and key informant interviews with research team members, including government decision-makers and health practitioners through a retrospective analysis of four previously conducted applied health research studies in a resource-challenged region. Results The literature scan identified organizational resources that influence research use. The multiple case study supported these findings, contributed to the development of a taxonomy of organizational resources, and revealed how fears concerning resource loss can affect research use. Some resources were found to compensate for other resource deficits. Resource needs differed at various stages in the research use process. Conclusions COR theory contributes to understanding the role of resources in research use, resistance to research use, and potential strategies to enhance research use. Resources (and a lack of them) may account for the observed disparities in research uptake across health systems. This paper offers a theoretical foundation to guide further examination of the COR-KT ideas and necessary supports for research use in resource-challenged environments. ; Peer Reviewed