Artikler

Indhold : Nr. 4 : Årgang 8 : 2005

 

Tema

Sygdom som stigma

af Inge Kryger Pedersen

Strukturreformens udfordringer for sundhedssektoren

af Karsten Vrangbæk

Livsstil og ansvar

af Michael Norup og Peter Rossel

For den enkelte eller samfundet? Magtudøvelsens mål og midler i folkesundhedspolitikken

af Signild Vallgårda

Lægemiddelindustriens indflydelse på klinisk forskning

af Mats Lindberg

 

Artikler

Fra Saul til Kronprins Frederik

af Benito Scocozza

Dronningerunder og regeringsdannelser

af Tim Knudsen og Rebecca Adler-Nissen

Royal Succession - Royal Success: Endurance of an Arab Monarchy

af Rasmus Alenius Boserup

 

Bøger

Thomas C. Schelling: Eller hvordan jeg lærte at elske nuklear strategi

Review essay af Sten Rynning 

Kære læser. Er du sund? Altså sådan rigtigt sund? Jeg mener…Har du ondt i ryggen? Museskader? Ryger du? Hvad med alkoholindtaget? For slet ikke at snakke om dine madvaner. Ja hvordan er de egentlig? Har du tvangstanker af en art? Føler du dig ensom af og til? Stresset? Har du et sundt kæresteforhold? venner? Hvis du føler dig usund, så er det ikke så underligt. World Health Organization definerer sundhed som værende ”ikke blot frihed for sygdom, men størst muligt fysisk, psykisk og socialt velbefindende”. Citatet er eksemplarisk til at belyse, hvordan forestillingen om sundhed har ændret sig. Sundhed er ikke blot negativt defineret som frihed fra sygdomme som infektioner og vira, men defineres derimod positivt som størst muligt velbefindende. Der er således ikke blot tale om en veldefineret patologisk tilstand, der skal undgås, men om en udefinerbar ideel tilstand, der skal forfølges. WHO’s brede sundhedsdefinition illustrerer på glimrende vis, hvordan stadig flere dimensioner af hverdagens praksis sættes under sundhedens ubønhørlige lys. Sundhed er vigtigt.

Det er således paradoksalt, at den samfundsvidenskabelige forskning på sundhedsområdet i en vis grad har været forsømt og har været forbeholdt sundhedsvidenskaberne. Inden for de seneste år er forskningen i sundhedspolitiskeproblemstillinger dog øget. Det er vigtigt, at samfundsvidenskaben åbner forsundhedens sorte boks og belyser hvordan det patologiske skabes i forhold tildet normale. Beskrevet i tal er sundhedsområdets vigtighed også tydelig. I 2004 udgjorde de samlede sundhedsudgifter 91,3 mia. kr. eller 5,8 procent af BNP. Det er vigtigt at se bag om sundhedsvæsenets aura af uforståelig medicinskekspertviden og analysere økonomisk prioritering og organisationsformer.Med dette nummers tema om sundhedspolitik ønsker Tidsskriftet Politikat bidrage til at åbne sundhedens sorte boks og stille samfundsvidenskabelige spørgsmål til sundhed.

 

Abstracts:

 

Sygdom som stigma

Inge Kryger Pedersen, Associate Professor, Institute of Sociology, Copenhagen University

 

This article seeks to demonstrate that certain notions of illness can imply stigmatisation. It is not only notions of illness that are grounded in common sense that can expose for example diseases connected with obesity to stigma. Also scientific approaches can facilitate stigmatisation. Medical as well as sociological definitions of illness as deviance are discussed in the article. In particular, four main approaches in sociology of illness are presented in order to raise the problem of how to explain illness sociologically and to mirror the diversity of theoretical approaches, which has characterised this field during several decades. It is argued that whether illness is understood as a medical process or a social one such as social role, an indicator of the capitalist society sui generis, intersubjectively constructed reality, or scientific construction is not without implications for enacted or felt stigma.

 

 

Strukturreformens udfordringer for sundhedssektoren

Karsten Vrangbæk, Associate Professor, Institute of Political Science, Copenhagen University

 

This article discusses possible consequences of the current structural reform for the administration and management of the Danish health system. Changes in structure, tasks and financing for the three main administrative levels (state, regions and municipalities) are discussed in the light of general governance theoretical concepts.

 

 

Livsstil og ansvar

Michael Norup, doctor, ph.d. Associate Professor, Department of Medical Philosophy and Clinical Theory, Institute of Public Health, Copenhagen University and Peter Rossel, mag. art., Head of Department and Associated Professor, Department of Medical Philosophy and Clinical Theory, Institute of Public Health, Copenhagen University

 

During the last years there has been a growing interest in the question about personal responsibility for health and the possible consequences of such responsibility. In this article we argue that although normal adults, who have the powers of reflective self-control, are generally responsible for their health, there are also people who lack these abilities. Either totally or to some degree. The latter may be true for people who are addicted, but also for people with constrained choices due to social circumstances. This is relevant for the discussion of responsibility in relation to health policy. After having presented some serious objections to holding people accountable for the effect of their choices in relation to actual treatments, we discuss taxation as a means to holding people responsible for their risky behaviour. We conclude that although taxation might be fair in a world where people were rational and had equal opportunities, it is not fair in the actual world.

 

 

For den enkelte eller samfundet? Magtudøvelsens mål og midler i folkesundhedspolitikken

Signild Vallgårda, Associated Professor, Institute of Public Health, Copenhagen University

 

The topics of the paper are the development in the reasons given for and the means utilised in the efforts to improve the health of the population in Denmark from 1930 to 2000. In spite of the adherence to choice and autonomy an increase in the governing ambitions is observed. The governing technologies are similar, but the reasons given for the interventions are more often that the policy should create better lives for the citizens and more seldom that society will benefit

 

 

Lægemiddelindustriens indflydelse på klinisk forskning

Mats Lindberg, Staff Specialist in Internal Medicine and Rheumatology and Senior Hospital Physician at King Christian X´s Hospital for Rheumatic Diseases at Graasten.

 

By sponsoring clinical trials the drug industry get considerable influence on the medical research agenda, directing research towards areas of commercial interest to the sponsor. The designs of the drug industry funded trials may be influenced by the commercial needs of the sponsor, for instance by using suboptimal comparators to the sponsor’s drug. Also the reporting of results and conclusions seem to respect a commercial agenda. Finally the sponsor may suppress or delay publication of trial results, which may bias the results of meta-analyses. As the kinds of clinical trials most valuable to commercial firms may not be those most valuable to the public, there is an increasing need for industry-independent funds for clinical research.

 

 

Fra Saul til Kronprins Frederik

Benito Scocozza, retired Associated Professor in history, Copenhagen University

 

At the beginning of the third millennium there are not many monarchies left but historically the monarchy has played a vital political role with its emperors, kings, absolute rulers and constitutional monarchs. The article provides a historical description of the emergence of the Danish monarchy while drawing lines to the development of monarchy in Europe.

 

 

Dronningerunder og regeringsdannelser

Tim Knudsen, professor, Department of Political Science, Copenhagen University and Rebecca Adler-Nissen, Ph.D.- student, Department of Political Science, Copenhagen University

 

In accordance with the constitution, Queen Margrethe II of Denmark plays an active role in Danish government-formation negotiations. The change of government in 1993 gave rise to accusations against the Danish monarchy for influencing the political process. However, the queen is not interested in giving up her constitutionally secured rights to appoint new governments. The article calls for a clarification of the Danish constitution in order to avoid new charges against the Danish monarchy for playing a political role in the government-formation process.

 

 

Royal Succession – Royal Success: Endurance of an Arab Monarchy

Rasmus Alenius Boserup, Ph.D.- student, the Carsten Niebuhr Department, Copenhagen University

 

The article addresses the question of how the monarchs in the Arab World assure regime endurance. The article is based on two main hypotheses. Firstly, that monarchy as a regime type is a useful variable for analyzing politics in the Arab World. Secondly, that a succession between two kings is a structural problem in the Arab monarchies, and that processes of royal succession therefore provide particularly interesting cases for studying the monarchs' strategies for assuring regime endurance.