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Health care systems, irrespective of how they are financed, present the paradox that to some observers they appear as a major component of social benefits, while to other observers they seem both excessively costly and limited in their effectiveness. These differing perceptions may be explained in part by the diversity of the determinants of health and disease, only some of which are amenable to those preventive or therapeutic measures encompassed in a health care system--the majority of determinants being genetic, societal, or else uninfluenced by those interventions at present available within a health service. The share of national resources which should be devoted to health care, and the method of raising resources, are primarily matters for political decision; but a national system has advantages both of economy and of comprehensiveness. But when it comes to allocation of resources within the established health budget, the knowledge and skills of health professionals are essential to informed decision-making. The possibilities depend critically on the 'state of the art' at a given time, as is illustrated by the radical changes over time in what could be done for patients with renal failure; and health professionals are likely to be most aware of current options, and of how to choose between them. More speculatively, they are also less likely to confuse the attitudes appropriate to providing a service with those required to run a business.

THE LITERATURE ON CANADIAN FOREIGN POLICY HAS OFTEN BEEN CHARACTERIZED S OVERLY DESCRIPTIVE AND THEORETICALLY WEAK. THIS TYPE OF CHARACTERIZATION, ADVANCED MOST RECENTLY BY MAUREEN MOLOT, IS NO LONGER WHOLLY ACCURATE. BY REVIEWING SEVERAL RELATIVELY RECENT CONTRIBUTIONS AND DEBATES IN THIS LITERATURE, IT IS DEMONSTRATED THAT IN POCKETS, THE SUBFIELD HAS ADVANCED SUBSTANTIALLY IN THEORETICAL SOPHISTICATION. NEVERTHELESS, IN CONTINUES TO MANIFEST IMPORTANT GAPS IN LIMITED CUMULATION. THE ARTICLE SPECULATES ON WHY THIS SHOULD BE SO, AND ON HOW THE THEORETICAL CONDITION OF THE SUBFIELD CAN BE ADVANCED. APPROACHES WHICH INCORPORATE THE INTERPLAY OF INTERNAL AND EXTERNAL INFLUENCES ON POLICY, WHICH BORROW FROM IMPORTANT DEVELOPMENTS IN THE WIDER FIELDS OF INTERNATIONAL RELATIONS AND COMPARATIVE POLITICS, AND WHICH ENGAGE IN COMPARISON ACROSS ISSUE-AREAS, COUNTRIES AND TIME ARE ADVOCATED. APPLICATION DRAWINGS ON "HISTORICAL MATERIALIST," REGIME, AND EPISTEMIC COMMUNITY LITERATURES ARE SPECIFICALLY PROMOTED.

AbstractThe paper outlines some of the actions taken by Severn Trent Water to achieve compliance with consent limits since the implementation of the Control of Pollution Act (Part II) in 1985.Prior to and since 1985, Severn Trent Water has undertaken an extensive programme to analyse the reasons for failure and carry out remedial work. A major feature of this programme, which has been further stimulated by privatization, has been the need to reduce the lead time for carrying out improvements.The paper discusses the means by which this has been achieved, including the introduction of the 'fast‐track'initiative and the 'process matrix'.Other aspects are outlined including initiatives to develop more robust processes, computerized work scheduling, extensive training programmes and best practice studies.

Depression is a substantial global health problem with implications for public health policy, planning of social programs and medical spending. Empirical evidence shows that chronic disease and functional limitation lead to depression among older adults. Few studies have attempted to understand the impact of functional limitations on the association between chronic disease and depression in low-income countries. Our study begins this investigation with a comparison study between India and the US. This study examines the effects of chronic disease conditions and functional limitations on depressive symptoms controlling for other measures including age, race, education and marital status. These associations are investigated with data from the 2012 wave of the Health and Retirement Study for the United States (HRS) and 2010 Longitudinal Aging Studies of India (LASI), harmonized for comparability. Preliminary findings suggest the association between chronic disease and depression is partially mediated by functional limitations in the United States. However, different results are present within the LASI dataset. The presence of chronic disease conditions does not predict depression, whereas there is a positive association between functional limitations and depressive symptoms (p<.0001) that does not alter the relationship between chronic conditions and depressive symptoms. We discuss the cultural and policy differences that are likely behind this observed difference and further discuss the implications of our findings for future research.