PubMed Health⌕ Search

Biomedical subjects

R Illsley

Publications and source records attributed to R Illsley.

At least 19 recordsLinked to original sources
PubMed1993

Regional inequalities in mortality.

STUDY OBJECTIVE: To examine the hypothesis of sustained and persistent inequalities in health between British regions and to ask how far they are a consequence of using standardised mortality ratios as the tool of measurement. DESIGN, SETTING AND PARTICIPANTS: Data are regional, age specific death rates at seven points in time from 1931 to 1987-89 for the British regions, reconstructed to make them comparable with the 1981 regional definitions. Log variance is used to measure inequality; regional rankings are also used. MEASUREMENTS AND MAIN RESULTS: There has been a substantial convergence in age specific death rates between regions in younger but not in older age groups. In younger age groups the historic north/south gradient has disappeared; it persists in older groups. CONCLUSIONS: Use of standardised mortality ratios obscures differences in the convergence rates of age specific death rates between regions. Simple conclusions about the persistence of a north/south divide are not justified. Different processes of change seem to be at work in different age groups.

Adolescent↗
PubMed1993

Today or in the past? The origins of ischaemic heart disease.

Recent studies have suggested that regional differences in death rates from ischaemic heart disease (IHD) may result from exposure to poverty in foetal and early infant life. The suggestion is that such influences 'permanently set structures and metabolic processes, so-called programming'. On this theory, current falls in IHD death rates reflect much earlier reductions in poverty. If the theory were correct, the fall in rates would begin with younger age groups and be reinforced only at the pace at which each new birth cohort reached adult life. There is no evidence of such a cohort effect. Rates fell simultaneously over a very brief period in each country and region examined. The results are more compatible with theories involving contemporary lifestyle changes.

Adult↗
PubMed1991

Contextual variations in the meaning of health inequality.

The meaning of inequality in health is contextually determined; it changes both within and between countries and over time. This paper points to the limited ability of the classic class-based analyses of inequalities in health to explain such change. An alternative form of analysis, based on the interaction between age, gender and cause of death is proposed. Within this framework, intercountry (European) comparisons of life expectancy and age-specific mortality for both sexes are used to illustrate a shift over time in the social aetiology of disease from economic to behaviourally based causality. Implications for the British experience and for British social policy are discussed.

Cause of Death↗
PubMed1990

Non-market economies in health. Introduction.

This paper introduces analyses of the state of health and of the health-care system in four Eastern European countries. The analyses focus on the issue of inequality in countries which share many characteristics including non-market economies, rapid urbanization and industrialization, and health systems which formally aim to provide equal access and treatment to all citizens. The measurement of social inequality in a non-market economy dominated by the state economy cannot be based on traditional class divisions; nor is income a good indicator of class position, salaries for professional and non-manual workers being lower than the average. Major relevant variables for which data are available are occupation, educational level and area of residence. Despite many system similarities the countries differ sharply in the level of resources devoted to health care and in health status based on mortality rates.

Adult↗
PubMed1990

International comparative analysis: main findings and conclusions.

This paper compares the experience of health and inequality reviewed in the Bulgarian, Hungarian, Polish and Soviet profiles. With health systems very similar in formal organization and stated aims, health status based on death rates has followed very similar tendencies in each country. Sharp post-war falls in infant death slowed down from the 60s onwards, but continued to fall. Life expectancy also increased but again from the late 60s began to fall, particularly for middle-aged men. Inequalities in health-care provision and access have been paralleled by inequalities in health outcome between areas and socio-economic groups. Comparative analysis, however, suggests that the dysfunctions of the health system have only been contributing factors to more fundamental causes stemming from socio-economic conditions, cultural and collective behaviour and the priorities of the political and economic system. Written before the transforming political events of late 1989, the reviews emphasise the need for change and a search for more effective and equitable systems and policies.

Bulgaria↗
PubMed1987

Pathways into and through services for the elderly in Europe: a research design.

Services for the elderly fall short of demand in all European countries. Resources are clearly inadequate. But are they most effectively used? This contribution presents the research design being used to study these questions in eight countries of the European Community. It postulates that shortage of shortage of services is aggravated by fragmentation between organisations and professions, by associated inflexibility in planning, transfer of resources and adaptation to changing needs, and by over-concentration of resources and influence upon medical and residential institutions. The study involves the observation of cohorts of patients/clients entering and passing through the health and social services and the relationship between this experience and the expectations of the clients, their relatives and their service providers. The key question is how far structural features of each health and social service system facilitate or hinder the effective delivery of care. Methodological problems of cross-national research are discussed.

Aged↗
PubMed1984

Public preferences for the care of dependency groups.

In the context of the continuing debate about how responsibility for the care of the disabled, chronically sick and elderly (collectively termed dependency groups) should be allocated as between the family and state and informal and formal caring agencies, this paper reports the basic findings of a survey of care preferences advocated by the public in three locations in Scotland, an urban metropolis, a large city and a small town in a rural setting. The results show that while there is little difference in preference patterns between the locations the public is discriminating in its support for care arrangements for patient/client groups with age-related physical and mental impairment. Overall, there is considerable support for a range of services termed community based professional care--day care centres, day hospitals and in respect of the elderly, sheltered housing. Residential care is less often preferred with the notable exception of senile dementia. Similarly, there is only limited support for informal care without professional involvement. The public, it seems, are not inclined to allocate the major responsibility for the care of dependency groups to the family and close kin preferring instead a continued policy of partnership between informal care systems and the welfare state in which the former does not replace the latter.

Aged↗
PubMed1979

Why we are the harlot in reverse.

What does nurse management stand for and where is it going? Author looks at the question in the light of the Salmon Report, reviews the progress made in ten years following the report and puts forward her views on what is required in the future.

Nursing Service, Hospital↗
PubMed1976

Psychosocial aspects of abortion. A review of issues and needed research.

The literature on psychosocial aspects of abortion is confusing. Individual publications must be interpreted in the context of cultural, religious, and legal constraints obtaining in a particular society at a given time, with due attention to the status and availability of alternatives to abortion that might be chosen by a woman with an "unwanted" pregnancy. A review of the literature shows that, where careful pre- and post-abortion assessments are made, the evidence is that psychological benefit commonly results, and serious adverse emotional sequelae are rare. The outcome of refused abortion seems less satisfactory, with regrets and distress frequently occurring. Research on the administration of abortion services suggests that counselling is often of value, that distress is frequently caused by delays in deciding upon and in carrying out abortions, and by unsympathetic attitudes of service providers. The phenomenon of repeated abortion seeking should be seen in the context of the availability and cost of contraception and sterilization. The place of sterilization with abortion requires careful study. A recommendation is made for observational descriptive research on populations of women with potentially unwanted pregnancies in different cultures, with comparisons of management systems and an evaluation of their impact on service users.

Abortion, Induced↗