Suchergebnisse

While discretion has been studied in systems of distribution which are governed by rules, or in those where there is a crucial gatekeeper, there remain many informal and diffuse systems where little is known about the discretion used. An example is the allocation of community services. In such cases, a useful strategy is to analyze the informal rationing system along lines which are discussed, and by this means to identify as discretionary the cases which emerge as anomalous.Possibilities are outlined for comparing the amount of discretion used and its bias, in areas with different resource levels or degrees of regulation; and the paper concludes with a detailed illustration, drawn from an area study of community services for the elderly, of changes in the use of discretion with increasing pressure on resources.

There is increasing interest in the concepts through which lay people identify states of health - in their cultural origins and in their connection with preventive or remedial behaviour. A study of the concepts used by elderly Aberdonians is reported, exploiting two data sources: an intensive study of two social networks, and a random sample survey. Concepts of health as the relative absence of disease are distinguished from health as a dimension of strength, weakness and exhaustion, and from health as functional fitness. In this Scottish material, functional fitness is dependent on freedom from disabling disease and not on strength, but strength is an important concept logically distinct from both disease and functional fitness. The `strength' dimension is poorly represented in scientific research on health indicators; but on the other hand lay concepts tend not to acknowledge pain as a dimension in itself. A comparison with a similar French study suggests that while these three lay dimensions of health are present in both cultures, in France functional fitness is dependent on strength as well as on freedom from disabling disease, and this difference seems to be related to the practice of medical consultation.

A weighted total of 630 pupils aged 14–15 in Glasgow schools, about
evenly divided between pupils of South Asian and non-Asian (overwhelmingly
British) background, were measured for height and weight and compared with
previous results for a similar Glasgow sample aged 30–40. Among
14–15-year-olds, British Asians were not so short compared with non-Asians as
among 30–40-year-olds, especially females. Among 30–40-year-old Glasgow Asians
only 7% were born in the UK, while among 14–15-year-old Glasgow Asians 86%
were so born, indicating that they are the children of migrants. Generational
differences in these comparisons cannot be due to positive selection of the
migrant generation for height, and are attributed to improved environment,
including nutrition and public health measures. This suggests the possibility
of corresponding improvements in coronary and diabetic risk.

The lifecourse perspective on adult health and on health inequalities in particular, is one of the most important recent developments in epidemiology and public health. This book brings together, in a single volume, the work of one of the most distinguished academics in the field. It is the first to specifically take a lifecourse approach to health inequalities and will be essential reading for academics, students and policy makers with an interest in public health, epidemiology, health promotion and social policy