andreeva_tia_nauchnyi_angliiskii_iazyk_vypusk_13_retsenziia
.pdfand helps overcome the agency problemsarising from the separation of ownership and control. Some of the costs, how ever, are low liquidity and reduced possibilities for risk diversi fication. While dispersed ownership brings higher liquidity it may not provide the right incentives to encourage long-term relationships that are required for certain types of investment. Therefore, one of the challenges facing policy makers is how to develop a good corporate governance framework which can se cure the benefits associated with controlling shareholders act ing as direct monitors, while at the same time ensuring that they do not impinge upon the development of equity markets by expropriating excessive rents.
T e x t 7
Psychology and Health
Genest M, Genest Sh. Psychology and Health. Research Press, Illinois 61821. S. 1., s. a.
Until the last few years when we have become more health conscious, staying healthy meant one thing - going to see the doctor when we got sick. We expected some medicine, and usually our expectations were fulfilled. Whether we took the drug properly or took it at all, we usually got better and in variably attributed our improved health to the visit to the doc tor's office. Few of us considered that measures beyond these were necessary for our good health. Despite growing aware ness of the importance of healthy lifestyles in staying well, this archaic, treatment-oriented view still underlies our attitude to ward health.
It is not surprising that this attitude lingers. With fears of polio epidemics and first-hand knowledge of frequent pneumo nia deaths still fresh in their minds, parents of those of us who
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missed these events firmly believed in the miracle of modem medicine. If something went wrong, the doctor could fix it. And if the problem could not be fixed right now, discovery of the method for "repair" was just around the comer.
As children of those awestruck parents, we are sadly disil lusioned to leam that when things of consequence go wrong with bodies, they often cannot be fixed. We have trouble be lieving that cures for cancer, multiple sclerosis, diabetes, ath erosclerosis, and other modem diseases are not imminent. As a consequence of our inherent faith, we endorse medical research as enthusiastically as did our parents, but with far less reason for optimism. The health and longevity of the general popula tion in North America and Europe has improved only insignifi cantly over the last several decades (National Center for Health Statistics, 1983) and most of the improvement seems due to nonmedical factors. For example, U.S. mortality rates from stomach cancer have fallen considerably during the 20th cen tury (Silverberg, 1985), but the decline cannot be attributed to medical intervention (Goldman & Cook, 1984). The fatality rate for carcinoma of the stomach has not changed for several decades (Green & O'Toole, 1982). Rather, changes in diet or cooking habits seem to be responsible for a decline in the inci dence of the disease (Urquhart & Heilmann, 1984). Richard Peto, a British epidemiologist and author of a major study of cancer mortality for the Congressional Office of Technology Assessment, was quoted by Boffey (1984) as saying that "there has been disappointingly little progress in curative treatment since the middle of the century" (p. Cl) and that he saw no rea son to expect substantial progress for the rest of this century.
In our complex Western culture, the health problems are also complex: too complex for answers from one source. Can
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cer-causing toxins in our air, water, and food produce tumors that may not be completely eradicated by medical treatment. A baby bom with fetal alcohol syndrome is already sick and pos sibly permanently damaged before medical care can intervene. Stress may induce high blood pressure, which could lead to a fatal or damaging heart attack if an individual does not learn to cope with the stress. For the improvements to health we avidly seek, an extensive, liberal examination of the physical, social, and psychological environment is necessary. We need to know what makes us sick and how to avoid getting sick, because when we become ill, we too often cannot get better by going to the doctor. Even when a visit to the doctor can help us, we may ignore prescriptions for life-saving drugs or fail to alter our lifestyles to improve chronic conditions because of anger at long waits to see our doctors, confusion about the information and advice given, and, occasionally, alienation by the aloof professionalism we have encountered. The focus of biomedical research and the traditional practice of clinical medicine are clearly not broad enough to encompass all aspects of the cause of disease and the maintenance of health.
Psychologists first found a place in health treatment as an adjunct to standard medical practice when some of the unmet needs of patients were recognized: Illnesses that did not seem to have physiological bases were turned over to psychiatrists and psychologists for psychotherapy. In other instances, psy chologists were asked to deal with the residual problems of medical treatment: Some patients were not taking their medi cine and anxious children in hospitals were a problem for the busy medical staff. From these beginnings, a new area of spe cialization has evolved, best known as health psychology, or behavioral medicine.
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A definition of the field of health psychology is provided by the Public Information Committee of the 3000-member Health Psychology Division of the American Psychological Association (1985):
Health Psychology is the aggregate of the specific educa tional, scientific, and professional contributions of the disci pline of psychology to the promotion and maintenance of health, the prevention and treatment of illness, and the identifi cation of etiologic and diagnostic correlates of health, illness, and related dysfunctions, and to the analysis and improvement of the health care system and health policy formation.
As the Public Information Committee noted, "Many disci plines can aid this effort, but psychology, owing to its empha sis on the study of behavior, has a unique contribution to make".
Psychologists have become part of the health-care team in medical settings and in nonmedical settings concerned with heaith, where they provide services, teach, and carry out re search. In fact, the largest single placement area of psycholo gists over the past decade has been in medical centers, where they work in rehabilitation medicine, pediatrics, cardiology, dentistry, family medicine, pain centers, cancer clinics, and other specialty centers. In these settings, they confront prob lems such as how to encourage a diabetic to exercise, to eat properly, and to administer insulin safely - problems quite dif ferent from the psychopathology that clinical psychologists have traditionally been trained to assess and treat. Training medical staff (for example, nurses, physiotherapists, and nutri tionists) to carry out specific psychotherapeutic interventions for specific problems is probably the most visible contribution of psychologists in many medical settings.
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One idealistic part of the psychologist's role in health in volves attempts to build into the system an awareness of the complexities of the patient and health-care system interaction. Part of this task is alerting other health-care professionals to the emotional component in becoming ill, being ill, and being treated for illness. Some progress has been made in this area. Health-care professionals are increasingly recognizing that many of the problems patients present for medical solutions are emotionally based and they are referring these patients more frequently for psychological intervention. Further, clinical psy chologists have generally received training in research methodol ogy and can therefore undertake an assessment of the effective ness of medical practice and the health-care system itself.
Thus, health psychology has developed out of an awareness of the psychological components of illness and of the interplay of human experiences and illness. As a result, the role of psy chologists both within medical settings and as health-care pro fessionals outside the medical system has expanded. As the complexities of illnesses are slowly unraveled, the role of hu man behavior is seen in a much broader perspective. The way people live, that is, whether they smoke cigarettes or consume alcohol excessively, exercise regularly, consume foods high in cholesterol, use seatbelts, or live in an industrial area, for ex ample, influences their health. It is increasingly clear that con tinued expansions of purely medical treatments will offer fewer general benefits to health. Instead, it is recognized that there is a need to identify behaviors that increase the risk of ill-health and to assist people in altering thefr behaviors to be more health promoting. As a result, health research is no longer syn onymous with biomedical research: Health psychologists have
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expanded the investigation of health maintenance to include the crucial role of human behavior.
This volume will examine the contributions of health psy chologists and other psychological researchers in studying the parameters of healthy behavior, lifestyle change, maintenance of change, and development of the groundwork for effective programs of prevention and treatment. The fundamental issues of treatment of illness versus prevention of illness, factors in fluencing adherence to medical or lifestyle-change interventions, and social and cultural attitudes that have shaped the health-care system will be explored. Empirical literature and the behavioral applications of research on the following disorders will be pre sented: spinal cord injury, tension headache, hypotension, essen tial hypertension, chronic pain, acute stress (arising from invasive medical procedures), and chronic stress and its relation to peptic ulcers, cardiovascular disease, and cancer. Suggestions for lifestyle changes related to smoking, obesity, fitness, and substance abuse on an individual and community level conclude the volume.
Some areas of concern could not be discussed within the scope of this volume, among them birth control, dental care, prevention of accidents in the workplace, the roles of allied professionals in promoting health, psychological contributions to the treatment of many diseases, issues concerning minority groups and different social clusters, and the role of various risk factors with reference to specific diseases (e.g., lung disease, multiple sclerosis, venereal disease, diabetes). Succeeding vol umes in this series will provide more detailed information on specific health psychology topics. Our goal here has not been encyclopedic; rather, we have attempted to illustrate the prob lems and solutions that are represented in health psychology, to provide glimpses of the action. Glimpses are all that are possi-
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ble in a field expanding so rapidly. In 1984, Agras found that two-thirds of all the existing health psychology research had been published since 1973, and that the trend showed no signs of reaching a plateau.
Health promotion requires teamwork on a grand scale. Policy and funding from governments, cooperation of the me dia and educational institutions, and research and implementation by large numbers of people in a great many professions are fun damental to developing the knowledge base for change and influ encing people toward positive, healthy lifestyles. We hope that readers will share our optimism for the future of the field, and will have been stimulated to continue its advance.
T e x t 8
Health and Economics
Sir Barry G., Dr. Bronowski J., Fisher J., Sir Huxley J. Health and Economics. Garden City; N. Y.: Doubleday & Company Inc., s. a.
At the time of Christ the human species had been, for some hundreds of thousands of years, the most successful animal on earth. But only in parts of China, Asia, and along the eastern end of the Mediterranean had he reached true civilization. Since those days civilization has taught him to control envi ronment and take house and services with him so that with the necessary wealth and technology he can live happily anywhere from Assam to Alaska. Man can even live in space for a few days, though his ticket costs his government millions of dollars, and each flight is monitored or accompanied by highly trained and talented medical men. But as he orbits the earth a spaceman passes over populations of his own kind whose standards of living are scarcely better than those of the Stone Age.
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That poverty lives on this planet next door to plenty is ob vious. Equally obvious is the fact that many of the factors con tributing to human well-being are linked with human wealth. (The word "wealth" actually comes from an Old English word that means well-being.) Wealth brings good living conditions and good food and allows a community to look after its non productive members: the young, the old, the sick. In this book we present a picture of the conditions in which people are likely to be strong and healthy and wise; give an account of the func tioning of the healthy human body and mind; and describe some of the hazards which may impair or destroy health, and how they may be guarded against or reversed.
Our understanding of how healthy minds and bodies work has enormously expanded during this century. The theory and practice of medicine has altered more during the last 150 years than in the millennium before that. Though modem medical treatment is still based partly on traditional empirical knowl edge, it rests more and more on scientific analysis and discov ery. To take an example, the general effect of many potent and useful drugs on the body as a whole, in health or illness, is clearly recognized, but their effect within the body at the level of molecular activity is often unknown. As science explores living cells at this level, the causes and effects of diseases can be understood much more exactly. It then sometimes becomes possible to design the chemical shape of drugs and tailor-make them for particular actions within the cells. At present most medicines are purified natural products or synthetic chemicals made in imitation of costly natural ones, but already an in creasing number are being designed out of an understanding of their chemical effects.
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Advance in medicine, then, flows from a combination of pure research (designed to discover the very nature of living matter and its complex chemical, physiological and mental mechanisms) and of practical research designed to solve im mediate health problems. Advance in economics comes in the same sort of way, though as a science, economics scarcely ex isted two centuries ago.
For most of man's time on earth, the majority of human beings have been poor and underfed, with only a meager sup ply of the good things of life; man's economics has been the economics of poverty. Then in the last 200 years a few coun tries made an economic breakthrough. In these countries man has revolutionized the whole process by which he produces and distributes the goods he needs.
The industrial and commercial revolution gave birth to its own science: economics. A young science's first function is to describe and state problems rather than to solve them. It need occasion no surprise, then, that today's wealthy societies origi nated in two great schools of economic theory. One taught lais sez-faire: let each man find his own place in the economy. If he is a business man, let him produce what he chooses, and sell it at what price he can; and, if he is a laborer, let him work where he has a mind to. The other advocated fully centralized control of production, prices, and plans for future progress. The first countries to make the breakthrough followed laissez-faire prin ciples. As time passed, however, all more or less adulterated the pure milk of laissez-faire doctrine, and allowed some de gree of government intervention - mainly because a completely laissez-faire industrial economy proved to be unstable, swing ing violently down into unemployment and up into inflation. Moreover, those countries which have consistently embraced
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and advocated the techniques of central planning have also moderated their practice, with time, and allow some place to certain laissez-faire principles, such as the free working of the price mechanism.
It is our belief that both approaches to economics may, from their peaceful competition and collaboration, produce new and rapid solutions to the problems of the underprivileged majority of mankind. To a certain extent the science of eco nomics stands outside their dispute, as measurer and critic. Tensions and apparent contradictions resolve themselves, sometimes violently and sometimes not. There will be no occa sion for violence if those who have the know-how and are the masters of wealth act as servants, not masters, of humanity. They can take as their models the masters of medicine, who have for a long time been such servants. Without health, men earn little wealth; without wealth, men seldom attain full health.
This statement may appear a little far-fetched to the vast majority of readers of this book, who belong to established civilizations: to countries which for a century and more, ap palling wars notwithstanding, have on the whole enjoyed a rising spiral of income and property, and of social, educational, medical, and public health services.
But more than half the peoples of the world are still in what Professor Ritchie Calder describes (p. 324) as the Misery-Go- Round.. With their industrial and social revolutions more or less behind them, the rich nations are now beginning to recog nize the extent of their global task, and to help the rest of the world out of its misery - and through the poverty and sickness barrier. Some of them think this is a moral duty, others a good investment. It does not much matter why they think they must do something. The point is: they must.
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