Diana Chapman Walsh

Massachusetts Institute of Technology | MIT · Corporation

The unanticipated and unwelcome detour precipitated by the economic recession comes at a time of vulnerability for American higher education. Questions of educational purpose have been raised with increasing urgency over the last quarter century, and they have catalyzed promising new thinking and new experimentation. Recent years have seen encourag...

In her keynote address, “Trustworthy Leadership,” President Diana Chapman Walsh of Wellesley College offered five ways that educational leaders could assume morally responsible leadership.

Asserts that an intellectual community is called upon to educate students to become morally sophisticated and to take their moral reasoning capacity into a society with complex pressures. Explores key questions that must be addressed to create a space where such learning can happen. (EV)

The development of healthy schools to support and nature the well-being of students, teachers, and staff is proposed as a first step toward the goal of comprehensive health education. A focus on healthy schools incorporates elements of an expanded concept of comprehensive health education that demands careful consideration of the physical, psycholo...

Purpose of Proposal A consolidated framework is proposed to highlight modifiable factors in work organizations that may contribute to alcohol-related problems. This research model serves to organize existing knowledge, highlight pathways for new research initiatives, and offer insights into the design of primary and secondary preventive strategies....

Marketing techniques and tools, imported from the private sector, are increasingly being advocated for their potential value in crafting and disseminating effective social change strategies. This paper describes the field of social marketing as it is used to improve the health of the public. A disciplined process of strategic planning can yield pro...

In Reply. —The letter from Volk et al is very much in the spirit of our article. In the context of a study conducted for altogether different purposes, we found a somewhat serendipitous blend of bad and good news: many physicians missed the drinking problems of seriously impaired patients who were ultimately identified on the job, but when they di...

To study whether alcoholic workers had seen physicians during the year they were identified by their company, whether they recalled physicians' warnings about drinking, and whether such warnings affected outcomes 2 years later. Workers were interviewed at intake and 2 years later: subgroups who did and did not see physicians and who did and did not...

Objective. —To study whether alcoholic workers had seen physicians during the year they were identified by their company, whether they recalled physicians' warnings about drinking, and whether such warnings affected outcomes 2 years later.Design. —Workers were interviewed at intake and 2 years later: subgroups who did and did not see physicians a...

A corporate health ethic, forged in U.S. industry in the 20th century, clearly demarcated boundaries between private and workplace health concerns. This article advances evidence that the boundary is blurring, and argues that trends in workplace initiatives, including employee assistance, wellness programs, and drug screening, are giving shape to a...

Employee-assistance programs sponsored by companies or labor unions identify workers who abuse alcohol and refer them for care, often to inpatient rehabilitation programs. Yet the effectiveness of inpatient treatment, as compared with a variety of less intensive alternatives, has repeatedly been called into question. In this study, anchored in the...

Increases in cocaine use have created a new and challenging cohort of problem drinkers with dual or multiple addictions. As part of a randomized trial comparing alternative alcoholism treatments at a 10,000-employee industrial plant, we interviewed 224 new alcoholic clients of an employee assistance program (EAP); 40% used cocaine during the 6 mont...

The "second public health revolution" targets factors in the environment, together with lifestyle, to prevent illness and untimely death. Yet the growth of the "wellness movement" has driven a wedge between public health advocates who argue for environmental solutions and those whose major focus is individual behavior. This tension is nowhere more...

For a polyglot society like the United States, cultural factors such as these create a pastiche of competing definitions and values that frustrate attempts to build consensus or comprehensive policy. Americans therefore can learn much from a cross-cultural exploration of styles of alcohol use, perceptions of associated problems, and attitudes towar...

The indirect costs of illness include costs of recruitment, training, and other accomodations to temporary, long-term absence or permanent loss of a skilled worker. In theory, these work-force management costs ought to sit more squarely within management's control than the costs of medical services. In this article, we call attention to the importa...

This paper briefly reviews the evolution of worksite smoking policies and programs, beginning with the goals and objectives from which they have sprung. Workplace smoking deterrents are shown to involve three different types of strategies: 1) legalistic approaches use policies and rules to restrict or foreclose smoking on the job; 2) economic strat...

This paper develops two divergent views of occupational medicine. The first holds that the field has a major contribution to make in the prevention of disease and the stabilization of health care costs. The second sees in it all the worst characteristics of contemporary medical practice. Consideration of the special difficulties of occupational phy...

Although employee assistance programs appear to be spreading rapidly, much remains to be discovered about how they should proceed. A critical review of the literature undergirding these programs reveals wide gaps in knowledge about the relative efficacy of a variety of alternative strategies. In particular, empirical data on the question of where t...

The relationship between alcohol use and accidental injury was examined in an anonymous telephone survey of 1740 randomly sampled employed adults (49% men) residing in four New England states in 1982 and 1983. Respondents reported 383 accidents requiring medical attention during the year prior to the interview, 34 involving hospitalization. Of the...

Employee assistance or counseling programs have proliferated rapidly in American industry. They originated during the 1940s to help problem-drinking employees, and expanded in the 1970s in efforts to assist with a range of personal problems interfering with performance on the job. Existing programs vary widely on strategic and structural dimensions...

The subject of this volume has been passed through three successive filters in an effort to distill and clarify the problems it entails. The issues relate specifically to health, to the health of women, and, more particularly, to the health of women employees. These three qualifiers do narrow the field of reference with respect to sheer numbers. Ye...

Pressures on the health insurance industry emanates from the federal and state governments, from policyholders, from competitors and from rising inflation. The health care cost crisis presents the industry with major public relations problems. Health insurance firms are responding to pressures and problems in different ways.

As the principal payer for the health care used by employees and their families, large industrial corporations in the United States have the leverage—and the incentive—to bring about change in the health care delivery system. Previous volumes in the Industry and Health Care series have examined this thesis and the evidence that some companies are a...

This article has no abstract; the first 100 words appear below. In this issue of the Journal, Havighurst and Hackbarth take up the cudgels for market-oriented approaches to the problem of health-care costs. Their cause has much to commend it. They deliberately keep the discussion on an abstract plane, asserting that to do otherwise would "plunge us...

The funding alternatives available for an employee health care plan range from conventional insurance with the carrier or service plan bearing the risk, holding full reserves, and administering the claims, to an entirely uninsured or self-insured plan, where the employer or union assumes all these functions. Between the two poles lies a wide spectr...

The costs of an employee health benefit are like an iceberg: administrative service costs are the tip above the water, and paid claims the far more critical bulk hidden below the surface. In recent years, benefits managers have begun to reorient their attention from the administrative costs to the less obvious but much larger cost-saving potential...

A gradual but accelerating change is taking place in the relationships between carriers of health insurance and their industrial clients. Fiscal arrangements that were nearly universal twenty years ago—conventional insurance coverage with the carrier holding full reserves and administering the plan—have given way to a wide range of alternatives. “C...

How much money should a firm or health and welfare fund expect to save by moving away from full insurance? This sounds like a straightforward question that ought to yield to a fairly objective answer, based on a range of experiences. Instead, the answer seems strangely elusive and tangled in individual opinion. One problem is time and the press of...

This article proposes to take a critical look at the relationhip of motivation to family planning and at some of the accepted methods for instilling motivation. It reviews the stages in the development of family planning programs and focuses on motivational programs designed when family planning programs have reached a plateua of acceptance. It con...

Any doubts that may have lingered about the place of health care costs on the national agenda were officially laid to rest by President Carter’s cost-conscious national health insurance principles, outlined in late July 1978 by Secretary of Health, Education, and Welfare, Joseph Califano.1 Costs now stand out as the most immediate problem of nation...

Prompted by concern over the accelerating costs of employee health benefits, executives in scores of large corporations are wondering whether they might gain more efficient management of those dollars by sponsoring one or more HMOs for employees of the firm and their dependents. Some firms are actively studying the option on the way to an immediate...

The defeat of the administration’s hospital cost containment legislation by private sector advocates of “voluntary controls,”1 coupled with the general message against government spending embodied in Proposition 13, might seem to herald the demise of the regulatory forces aligned against health care costs and an opportunity for providers to return...

Occupational health hazards pose a separate set of problems from those related to finding a health care provider or selecting a system of care. At the ends of the spectrum, occupational health hazards are either acute and obvious, demanding nothing short of immediate and intense effort to remove them from the workplace, or entirely unsuspected, lea...

While the medical profession struggles with the possibility that medicine is really part “business,” and necessarily entails subtle or even overt competition for patients, health maintenance organizations are forging ahead with a direct marketing approach. Competition among alternative delivery systems is the watchword of the “HMO strategy”; solici...

Ethical strictures against advertising are deeply rooted in the history and traditions of the professions. In its June 1977 decision upholding the right of attorneys to advertise, the United States Supreme Court at once acknowledged these historical roots and dismissed them as anachronistic: It appears that the ban on advertising originated as a ru...

The first volume in this series, which was both overview and preview of volumes to come, concluded that “private industry—both management and labor—plays a multidimensional and complex role in health care, with rising costs a precipitating factor and with concern for quality, equity, and access also very much in mind.”1 That role was divided into t...

Industry will constitute the key force over the next several years capable of restructuring the health care delivery system. Congress, the Executive Branch and the public do not seem to want the government to run the health system, and no workable scheme exists for enlisting sufficient numbers of physicians within a reasonable number of years as ac...

This article has no abstract; the first 100 words appear below. Drawing on two decades of experience in the United States with controlled fluoridation, Dunning¹ reported in 1965 that few public-health measures are so unequivocally effective against widespread disease. Fluoridation of community water supplies is safe, practical, economical and benef...

The essential dilemma of forecasting, particularly when change is sought, is to make constructive use of experience without becoming captive of the past. The Hill-Burton formula used existing demand without regard for its origins or appropriateness. Knowing now that supply in the health sector creates demand, health planners are developing normativ...

Mandated by Congress in 1969,1 Periodic Medical Review (PMR) is a state-run program of external peer review of the care rendered Medicaid-supported patients in skilled-nursing facilities (SNF). In Massachusetts the Department administers PMR on behalf of the Department of Public Welfare, which is the State Medicaid agency. Based upon observations o...

Deficiencies in the gold-plated U.S. health care delivery system suggest the necessity for caution in exporting U.S. concepts and methods to less developed countries. American medical education and a penchant for high technology have created a system which, though rich in resources, has serious shortcomings. Although inefficiencies, irrationalities...

The authors of this Comment note recent trends rigidifying the enforcement of building and safety codes for health care facilities and compare the estimated costs (in terms of dollars spent) of those trends with their anticipated benefits (in terms of potential years of human life saved). They estimate that for each potential year of life saved, st...

Conditioned to some extent by developments in employee health benefits, but often surprisingly separate, industry’s role as a provider of health services has been secondary to the payer role in the resources it has commanded internally and the influence it has wielded externally. But federal legislation and mounting cost pressures in recent years h...

Through industry’s window onto the health care system it is possible to see most of the urgent policy choices confronting us, along with many of the built-in conflicts that confound those choices: How much money does society wish to channel into health care and by implication away from other goals? How do we reconcile the need to curtail runaway in...

From the dilemmas arising out of industry’s expanded responsibilities as financer and provider of health care, it is a short step to a more active role in efforts at the community level to improve the delivery system and, at the level of individual decision-making, to assist workers in becoming better informed consumers of health care. Exploring pi...

On concluding its year-long study of rising health care costs, the President’s Council on Wage and Price Stability issued a strong challenge to the private sector: The American people generally are becoming increasingly unwilling to devote an ever larger portion of their personal income to health care. Although the full extent of the cost escalatio...

Of the three capacities in which industry can influence the medical marketplace, the role of payer or purchasing agent is perhaps the most complex. Yet industry as payer is a logical place to start, in part because it is here that industry feels the direct impact of rising health care costs, in part because some economists attribute to this role fu...

1. Introduction: Industry Confronts Health Care Costs.- 2. Industry as Payer: Employee Health Benefits.- Assuming a Broader Role.- An Expanding Benefit Package.- Some Causes and Effects of Rising Costs.- Approaches to Cost Containment.- 3. Industry as Provider: Health Programs Sponsored by Employers or Unions.- Early History.- Occupational Medicine...

This article has no abstract; the first 100 words appear below. The nursing-home industry in the United States is, on paper, the most closely regulated sector of the health-care system. Owing in part to the dependency of many patients¹ and their inability to exert the pressure of active consumers, in part to massive public financing, which pays abo...

This article has no abstract; the first 100 words appear below. Motor-vehicle accidents in Massachusetts last year claimed on the order of 31,000 years of potential life¹ (Table 1), second for that dubious distinction only to ischemic heart disease. Accidents in general rank fourth among major causes of death in Massachusetts¹ and the United States...

Although relatively new to the health planning armamentarium, the regulation of capital expenditures through certification of need (CON) is now well established. Analyzing the results of the first 19 months' experience with a State CON statute in Massachusetts, the authors commented on the formidable hinderances to assessment of CON and concluded t...

To the Editor: I noted with some interest the articles in the May 15 issue on the certificate-of-need laws. I am the only psychiatrist working in a corner of the country that happens to have approximately 200,000 people. I have been in practice in this area for approximately two years, and during the entire time, I have been working hard to convinc...

Massachusetts, like 22 other states, regulates its health-care industry in part through a certification and changes in service. As a basis for assessing the program's impact, data from the first 19 months are aggregated. A total of 209 determinations were made during the period, 21 involving beds in general hospitals, and 107 beds in long-term-care...

A new agenda has been coalescing for residential liberal arts education in the United States. At its core are various forms of experiential learning that had long been relegated to the margins of institutions in which pure intellectual achievement was largely separated from, and prized above, practical application of knowledge. Recent years have br...

Thesis (M.S.)--Boston University, 1971.