Health care reform and reform for health: creating a health system for communities in the 21st century

If we are to improve the health of the population and reduce the inequalities in health that plague our communities and our planet, we will have to give greater attention to the determinants of health. The reform of the health care system, necessary though it is, will never be sufficient; we need to reform our whole society and in particular to focus on human rather than economic development. At the community level we need to create healthy communities that are “health-creating systems” of environmental, social and human development, as well as health care systems that focus first on improving and maintaining health. Such a “bottom-down” health care system would see the hospital become once again the place of last resort (but still a potentially important partner in creating healthier communities) and would focus instead on how to provide health promotion and health care from the household level up.     

Measuring progress in agricultural sustainability to support policy-making

The concept of sustainability is one of the forefront issues in discussions of the challenges facing global agriculture, given the mounting pressure to increase food production in both socially responsible and environmentally friendly ways. From the perspective of Irish agriculture, sustainable intensification is of particular relevance, given ambitious targets to increase milk production in the context of European Union (EU) milk quota removal in 2015. A series of farm-level sustainability indicators are developed here using the Teagasc National Farm Survey FADN (Farm Accountancy Data Network) data for Ireland from 2012. Three dimensions, reflecting the multifaceted nature of sustainability (environmental, economic and social) are considered. Given the environmental challenges inherent in the sustainable intensification of agriculture, it is encouraging to observe that the more intensive, top performing farms (in an economic sense) emit relatively less greenhouse gases when compared to their less intensive counterparts. Conversely, the better performing farms in economic terms tend to have a higher nitrogen surplus per hectare on average. This is consistent with their higher rates of production intensity, but poses a challenge in terms of sustainable intensification and expansion. That said this analysis demonstrates that the nitrogen use efficiency of milk production is positively correlated with economic performance, with more intensive farms producing relatively more milk per kilogram of nitrogen surplus. From the perspective of social sustainability, demographic traits also tend to be positively correlated with economic performance. Given a growing recognition of the need for interconnected policy in the area of sustainability, this research should help inform policy debates and provides a guide for the undertaking of similar assessments elsewhere.     

Leadership in your midst: tapping the hidden strengths of minority executives

All companies value leadership-some of them enough to invest dearly in cultivating it. But few management teams seem to value one engine of leadership development that is right under their noses, churning out the kind of talent they need most. It's the complicated, overburdened but very rich lives of their minority managers. Minority professionals-particularly women of color-are called upon inordinately to lend their skills and guidance to activities outside their jobs. Sylvia Ann Hewlett, who heads the Center for Work-Life Policy, and her coauthors, Carolyn Buck Luce of Ernst & Young and Cornel West of Princeton, present new research on the extent to which minority professionals take on community service and other responsibilities outside the workplace and more than their share of recruiting, mentoring, and committee work within the workplace. These invisible lives, argue the authors, can be a source of competitive strength if companies can learn to recognize and further cultivate the cultural capital they represent. But it's hard to convince minority professionals that their employer respects and values their off-hours responsibilities. A lack of trust keeps many people from revealing much about their personal lives. The authors outline four ways companies can leverage hidden skills: Develop a new level of awareness of minority professionals' invisible lives; appreciate the outsize burdens these professionals carry and try to lighten them; build trust by putting teeth into diversity goals; and, to finish the job of leadership development, help minorities reflect on their off-hours experiences, extract and generalize the lessons, and apply what's been learned in other settings.     

Postal Surveys of Doctors’ Careers: Who Writes Comments and What do they Write About?

This study aimed to characterise the doctors who wrote comments at the end of a postal questionnaire about their careers, to quantify the frequency of negative comments, and to study relationships between the questionnaire content and the topics of comment. Graduates of all UK medical schools in 1999 were surveyed at the end of their pre-registration year. Structured questions about career intentions, current jobs and attitudes were accompanied by an invitation to write comments about any aspect of training, career choices or work. Comments were transcribed and coded according to theme and whether they were positive, negative or neutral. Numbers of comments on each theme, and of positive and negative comments, were counted. Bivariate analyses based on respondents answers to structured questions were used to characterise those who wrote comments on each theme. The survey response rate was 65%, and 40% of respondents wrote comments. Sixteen themes were identified. Ninety-four percent of those who commented said something negative or critical. Respondents who wrote comments differed in some characteristics from the whole cohort. The structured content of the questionnaire, particularly certain attitude statements, prompted the writing of comments on related themes, although not all attitudinal items acted in this way.     

Research Notes

Research Notes

Research Notes