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Life, Death, and Social Policy
Health care spending in the United States today is approaching 20 percent of GDP, yet levels of U.S. population health have been declining for decades relative to other wealthy and even some developing nations. How is it possible that the United States, which spends more than any other nation on health care and insurance, now has a population markedly less healthy than those of many other nations? Sociologist and public health expert James S. House analyzes this paradoxical crisis, offering surprising new explanations for how and why the United States has fallen into this trap. In Beyond Obamacare, House shows that health care reforms, including the Affordable Care Act, cannot resolve this crisis because they do not focus on the underlying causes for the nation’s poor health outcomes, which are largely social, economic, environmental, psychological, and behavioral.
House demonstrates that the problems of our broken health care and insurance system are interconnected with our large and growing social disparities in education, income, and other conditions of life and work, and calls for a complete reorientation of how we think about health. He concludes that we need to move away from our misguided and almost exclusive focus on biomedical determinants of health, and to place more emphasis on addressing social, economic, and other inequalities.
House’s review of the evidence suggests that the landmark Affordable Care Act of 2010, and even universal access to health care, are likely to yield only marginal improvements in population health or in reducing health care expenditures. In order to rein in spending and improve population health, we need to refocus health policy from the supply side—which makes more and presumably better health care available to more citizens—to the demand side—which would improve population health though means other than health care and insurance, thereby reducing need and spending for health care. House shows how policies that provide expanded educational opportunities, more and better jobs and income, reduced racial-ethnic discrimination and segregation, and improved neighborhood quality enhance population health and quality of life as well as help curb health spending. He recommends redirecting funds from inefficient supply-side health care measures toward broader social initiatives focused on education, income support, civil rights, housing and neighborhoods, and other reforms, which can be paid for from savings in expenditures for health care and insurance.
A provocative reconceptualization of health in America, Beyond Obamacare looks past partisan debates to show how cost-efficient and effective health policies begin with more comprehensive social policy reforms.
Cultural History and Developmental Psychology
In 1900, Ellen Key wrote the international bestseller The Century of the Child. In this enormously influential book, she proposed that the world's children should be the central work of society during the twentieth century. Although she never thought that her "century of the child" would become a reality, in fact it had much more resonance than she could have imagined.
The idea of the child as a product of a protective and coddling society has given rise to major theories and arguments since Key's time. For the past half century, the study of the child has been dominated by two towering figures, the psychologist Jean Piaget and the historian Philippe Ariès. Interest in the subject has been driven in large measure by Ariès's argument that adults failed even to have a concept of childhood before the thirteenth century, and that from the thirteenth century to the seventeenth there was an increasing "childishness" in the representations of children and an increasing separation between the adult world and that of the child. Piaget proposed that children's logic and modes of thinking are entirely different from those of adults. In the twentieth century this distance between the spheres of children and adults made possible the distinctive study of child development and also specific legislation to protect children from exploitation, abuse, and neglect. Recent students of childhood have challenged the ideas those titans promoted; they ask whether the distancing process has gone too far and has begun to reverse itself.
In a series of essays, Beyond the Century of the Child considers the history of childhood from the Middle Ages to modern times, from America and Europe to China and Japan, bringing together leading psychologists and historians to question whether we unnecessarily infantilized children and unwittingly created a detrimental wall between the worlds of children and adults. Together these scholars address the question whether, a hundred years after Ellen Key wrote her international sensation, the century of the child has in fact come to an end.
Essays of Henri F. Ellenberger in the History of Psychiatry
Henri F. Ellenberger, the Swiss medical historian, is best remembered today as the author of The Discovery of the Unconscious (1970), a brilliant, encyclopedic study of psychiatric theory and therapy from primitive times to the mid-twentieth century. However, in addition to this well-known work, Ellenberger has written over thirty essays in the history of the mental sciences. This collection unites fourteen of Ellenberger's most interesting and methodologically innovative historical essays, many of which draw on new and rich bodies of primary materials. Several of the articles appear here in English translation for the first time.
The essays deal with subjects such as the intellectual origins of psycho-analysis, the work of the French psychological school of Jean-Martin Charcot and Pierre Janet, the role of the "great patients" in the history of psychiatry, and the cultural history of psychiatry. The publication of these writings, which corresponds with the opening in Paris of the Institut Henri Ellenberger, truly establishes Ellenberger as the founding figure of the historiography of psychiatry. Accompanying the essays are an extensive interpretive introduction and a detailed bibliographical essay by the editor.
Originally published in 1993.
The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These paperback editions preserve the original texts of these important books while presenting them in durable paperback editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905.
Illness and the Limits of Expression
“Kathlyn Conway opens primordial questions about the shattering events of illness through close readings of selected illness narratives, proposing that only writing of a daring kind can utter the knowledge of the self-telling body. Wielding her ferocious intellect and braving exposure to self and other, Conway makes original discoveries about writing and illness and, more stunningly, about writing and life. Not a book about illness, this is a book about writing and being. It is taut, brave, unequalled in our scholarship, and true. Conway joins our most powerful investigators of the human predicament of mortality, helping us to see, helping us to live.”—Rita Charon, Columbia University, Program in Narrative Medicine
Published accounts of illness and disability often emphasize hope and positive thinking: the woman who still looked beautiful after losing her hair, the man who ran five miles a day during chemotherapy. This acclaimed examination of the genre of the illness narrative questions that upbeat approach. Author Kathlyn Conway, a three-time cancer survivor and herself the author of an illness memoir, believes that the triumphalist approach to writing about illness fails to do justice to the shattering experience of disease. By wrestling with the challenge of writing about the reality of serious illness and injury, she argues, writers can offer a truer picture of the complex relationship between body and mind.
Story of Sensitivity Training and the Encounter Movement
Sensitivity training, T-Groups, and encounter groups have become a way of life. Beyond Words traces the history of this movement, the background of its successes, its varieties, and its failures. Dr. Back's approach is neither one of wide-eyed admiration nor hostility. Instead, he has written a book that provides the first long, hard look at sensitivity training as a social phenomenon.
From its fortuitous beginnings the movement is followed through its developments at Bethel, its growth across the country, its new centers in California, its spread to Europe. The novelty of this movement, an almost religious exercise based on the scientific ethos, is related to the peculiar conditions of the last quarter century. The movement has acquired its own mythos. Dr. Back examines the interplay of the conflicting aims of self-expression and change, and shows how these contradictory aims have affected the ramifications of the movement in theory, in management, in recreation, and in education. Results emerging from studies on effects of sensitivity training indicate a recurrent pattern of great immediate emphasis followed by little permanent beneficial effect.
Finally, Beyond Words assesses the overall impact of the movement, its relation to science, its possible changes, and its portent as a symptom of the state of society.
Dr. Back examines the interplay of the conflicting aims of self-expression and change, and shows how these contradictory aims have affected the ramifications of the movement in theory, in management, in recreation, and in education.
A View from the Southeast
Investigations of skeletal remains from key archaeological sites reveal new data and offer insights on prehistoric life and health in the
The shift from foraging to farming had important health consequences for prehistoric peoples, but variations in health existed
within communities that had made this transition. This new collection draws on the rich bioarchaeological record of the Southeastern United States
to explore variability in health and behavior within the age of agriculture. It offers new perspectives on human adaptation to various geographic and
cultural landscapes across the entire Southeast, from Texas to Virginia, and presents new data from both classic and little-known sites.
The contributors question the reliance on simple cause-and-effect relationships in human health and behavior by addressing such key bioarchaeological issues as disease history and epidemiology, dietary composition and sufficiency, workload stress, patterns of violence, mortuary practices, and biological consequences of European contact. They also advance our understanding of agriculture by showing that uses of maize were more varied than has been previously supposed.
Representing some of the best work being done today by physical anthropologists, this volume provides new insights into human adaptation for both archaeologists and osteologists. It attests to the heterogeneous character of Southeastern societies during the late prehistoric and early historic periods while effectively detailing the many factors that have shaped biocultural evolution.
Contributors include: Patricia S. Bridges, Elizabeth Monaham Driscoll, Debra L. Gold, Dale L. Hutchinson, Keith P. Jacobi, Patricia M. Lambert, Clark Spencer Larsen, Lynette Norr, Mary Lucas Powell, Marianne Reeves, Lisa Sattenspiel, Margaret J. Schoeninger, Mark R. Schurr, Leslie E. Sering, David S. Weaver, and Matthew A. Williamson
Combining cognitive and evolutionary research with traditional humanist methods, Nancy Easterlin here demonstrates how a biocultural perspective in theory and criticism opens up new possibilities for literary interpretation. Easterlin maintains that the goal of literary interpretation is still of central intellectual and social value. Taking an open yet judicious approach, she argues, however, that literary interpretation stands to gain dramatically from a fair-minded and creative application of cognitive and evolutionary research. This work does just that, expounding a biocultural method that charts a middle course between overly reductive approaches to literature and traditionalists who see the sciences as a threat to the humanities. Easterlin applies her biocultural method to four major subfields within literary studies: new historicism, ecocriticism, cognitive approaches, and evolutionary approaches. After a thorough review of each subfield, she reconsiders it in light of relevant research in cognitive and evolutionary psychology and provides a textual analysis of literary works from the romantic era to the present, including William Wordsworth’s “Simon Lee” and the Lucy poems, Mary Robinson’s “Old Barnard,” Samuel Taylor Coleridge’s “Dejection: An Ode,” D. H. Lawrence’s The Fox, Jean Rhys’s Wide Sargasso Sea, and Raymond Carver’s “I Could See the Smallest Things.” A Biocultural Approach to Literary Theory and Interpretation offers a fresh and reasoned approach to literary studies that at once preserves the central importance that interpretation plays in the humanities and embraces the exciting developments of the cognitive sciences.
A Study in Culture, Ethnography, and Religion
"Dr. Farhat Moazam has written a wonderful book, based on her extraordinary first-hand study.... [S]he is an exceptionally gifted and evocative writer. Her book not only has the attributes of a superb piece of intellectual work, but it has literary artistic merit." -- Renee C. Fox, Annenberg Professor Emerita of the Social Sciences at the University of Pennsylvania
This is an ethnographic study of live, related kidney donation in Pakistan, based on Farhat Moazam's participant-observer research conducted at a public hospital. Her narrative is both a "thick" description of renal transplant cases and the cultural, ethical, and family conflicts that accompany them, and an object lesson in comparative bioethics.
An Introduction to Natural Law Bioethics
Bioethics and the Human Goods offers students and general readers a brief introduction to bioethics from a "natural law" philosophical perspective. This perspective, which traces its origins to classical antiquity, has profoundly shaped Western ethics and law and is enjoying an exciting renaissance. While compatible with much in the ethical thought of the great religions, it is grounded in reason, not religion. In contrast to the currently dominant bioethical theories of utilitarianism and principlism, the natural law approach offers an understanding of human flourishing grounded in basic human goods, including life, health, friendship, and knowledge, and in the wrongness of intentionally turning against, or neglecting, these goods.
The book is divided into two sections: Foundations and Issues. Foundations sketches a natural law understanding of the important ethical principles of autonomy, non-maleficence, beneficence, and justice and explores different understandings of "personhood" and whether human embryos are persons. Issues applies a natural law perspective to some of the most controversial debates in contemporary bioethics at the beginning and end of life: research on human embryos, abortion, infanticide, euthanasia, the withdrawal of tube-feeding from patients in a "persistent vegetative state," and the definition of death. The text is completed by appendices featuring personal statements by Alfonso Gómez-Lobo on the status of the human embryo and on the definition and determination of death.
The Political Framework of Bioethics Decision Making
Issues concerning patients' rights are at the center of bioethics, but the political basis for these rights has rarely been examined. In Bioethics in a Liberal Society: The Political Framework of Bioethics Decision Making, Thomas May offers a compelling analysis of how the political context of liberal constitutional democracy shapes the rights and obligations of both patients and health care professionals. May focuses on how a key feature of liberal society—namely, an individual's right to make independent decisions—has an impact on the most important relational facets of health care, such as patients' autonomy and professionals' rights of conscience. Although a liberal political framework protects individual judgments, May asserts that this right is based on the assumption of an individual's competency to make sound decisions. May uses case studies to examine society's approach to medical decision making when, for reasons ranging from age to severe mental disorder, a person lacks sufficient competency to make independent and fully informed choices. To protect the autonomy of these vulnerable patients, May emphasizes the need for health care ethics committees and ethics consultants to help guide the decision-making process in clinical settings. Bioethics in a Liberal Society is essential reading for all those interested in understanding how bioethics is practiced within our society.