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Calls have been issued for understanding the 'contexts' or 'environment' shaping the causes and consequences of health and health care. Existing efforts raise concerns about how a panorama of influences can be considered simultaneously. Sociology's view of contexts as social network structures that shape and are shaped in social interaction offers one key to resolving this dilemma. Because social network have become central in the social, natural, and physical sciences, this perspective provides a common platform for bringing in sociology's rich theoretical and methodological insights. Yet, to do this well, three conditions must shape our response. First, all levels relevant to health and health care must be considered, separated out, and linked by network mechanisms. The genetic-biological level, perhaps the most foreign level to sociologists, represents the greatest need and best prospect for advancing a sociologically based solution. Second, room must be made to tailor models to populations, whether defined socially or medically. Third, sociologists must find a voice within 'big science' to address problems from social construction to social causation that contribute to basic social processes as well as health. I trace developments in the Network-Episode Model as one theoretical starting point.

Objective The Integrated Management of Childhood Illness (IMCI) strategy is designed to address the five leading causes of childhood mortality, which together account for 70% of the 10 million deaths occurring among children worldwide annually. Although IMCI is associated with improved quality of care, which is a key determinant of better health outcomes, it has not yet been widely adopted, partly because it is assumed to be more expensive than routine care. Here we report the cost of IMCI compared with routine care in four districts in the United Republic of Tanzania. Methods Total district costs of child care were estimated from the societal perspective as the sum of child health-care costs incurred in a district at the household level, primary health-facility level and hospital level. We also included administrative and support costs incurred by national and district administrations. The incremental cost of IMCI is the difference in costs of child health-care between districts with and without IMCI, after standardization for population size. Findings The annual cost per child of caring for children less than five years old in districts with IMCI was US$ 11.19, 44% lower than the cost in the districts without IMCI (US$ 16.09). Much of the difference was due to higher rates of hospitalization of children less than 5 years old in the districts without IMCI. Not all of this difference can be attributed to IMCI but even when differences in hospitalization rates are excluded, the cost per child was still 6% lower in IMCI districts. Conclusion IMCI was not associated with higher costs than routine child health-care in the four study districts in the United Republic of Tanzania. Given the evidence of improved quality of care in the IMCI districts, the results suggest that cost should not be a barrier to the adoption and scaling up of IMCI. Keywords Child health services/economics; Child care/economics; Health care costs; Delivery of health care, Integrated/economics; Child, Preschool; Costs and cost analysis; Comparative study; Evaluation studies; United Republic of Tanzania (source: MeSH, NLM). Mots cles Service sante infantile/economie; Puericulture/economie; Cout soins medicaux; Distribution integree soins/economie; Enfant age pre-scolaire; Cout et analyse cout; Etude comparative; Etude evaluation; Republique-Unie de Tanzanie (source: MeSH, INSERM). Palabras clave Servicios de salud infantil/economia; Cuidados del nino/economia; Costos de la atencion en salud; Entrega integrada de atencion de salud/economia; Preescolar; Costos y analisis de costo; Estudio comparativo; Estudios de evaluacion; Republica Unida de Tanzania (fuente: DeCS, BIREME)., Introduction More than 10 million children die each year before they reach their fifth birthday, and 70% of these deaths are caused by five conditions: diarrhoea, pneumonia, malaria, measles and [...]

In keeping with the neo-liberal emphasis on privatization, international aid has been increasingly channeled through non-governmental organizations (NGOs) and their expatriate technical experts to support primary health care (PHC) in the developing world. Relationships between international aid workers and their local counterparts have thus become critical aspects of PHC and its effectiveness. However, these important social dynamics of PHC remain understudied by social scientists. Based on three years of participant-observation in Mozambique, this paper presents an ethnographic case study, of these relationships in one central province. The Mozambique experience reveals that the deluge of NGOs and their expatriate workers over the last decade has fragmented the local health system, undermined local control of health programs, and contributed to growing local social inequality. Since national health system salaries plummeted over the same period as a result of structural adjustment, health workers became vulnerable to financial favors offered by NGOs seeking to promote their projects in turf struggles with other agencies. It is argued that new aid management strategies, while necessary, will not be sufficient to remedy the fragmentation of the health sector. A new model for collaboration between expatriate aid workers and their local counterparts in the developing world is urgently needed that centers on the building of long-term equitable professional relationships in a sustainable adequately funded public sector. The case study presented here illustrates how the NGO model undermines the establishment of these relationships that are so vital to successful development assistance. Keywords: NGOs; Mozambique; International aid; Primary health care; Social inequality

In the context of current concerns about health inequalities among minority ethnic groups in the UK, this paper addresses perceptions of mental health services among members of an African-Caribbean community in a South England town. Efforts to reduce health inequalities must take account of the views of local community members on the sources of those inequalities and on local health services. The statistical existence of inequalities in diagnosis and treatment of African-Caribbeans in the UK is well-established, supported by sociological explanations of these inequalities which centre on social exclusion in a variety of forms: institutional, cultural and socio-economic. However, detailed studies of the perspectives of local communities on mental health issues and services have received less attention. In this case study of community perceptions of mental health services, we find that social exclusion comprises an explanatory framework which is repeatedly invoked by community members in describing their interaction with mental health services. Interviewees assert that experience and expectation of racist mis-treatment by mental health services are key factors discouraging early accessing of mental health services, and thereby perpetuating mental health inequalities. We conclude that participation and partnership are vital means by which to generate both the objective and subjective inclusion that are requirements for an accessible and appropriate health service. Keywords: African-Caribbean; Social exclusion; Health inequalities; Ethnic minorities; Mental health services; UK

The article, originally published in the journal in 1988 and currently available in online-only format, provides strategies for providing effective and economical home- and community-based long-term medical care. These include prestratifying patients based on expected benefits, the use of prospective budgeting, and joining home and community care interventions with housing interventions.

The development and implementation process of the program, which emphasizes the effectiveness of rural generalist practice in enhancing service delivery in the rural environment, is described. The generalist social worker is skilled in providing opportunities for preventative supports, education to clients and health care professionals regarding behavioral health needs, stressors, and systems, and early intervention and treatment options.

Employers and health insurance providers are increasingly providing networks of disease management programs, using nurses to telephone persons at home and advise about health problems. This private-sector effort has been largely successful, yet Medicare has not adopted this approach to preventive health care.