Problem dtfimtion isfiindamerUal to public poticymaldng, intertwined as U is with the poUtical process throughottt the activities of issue initiation, program design, and legislative enactment. YetprcAlem definition remains an immature analytic construct, productive cf only a modest amount of sch (Aarship that is lacking a coherent skaredframework. Seeking to address this deficiency, this article systematically examines the origins, elements, and consequences of problem definition, relating this discussion to previous literatttre in the area, current policymaking developments, and future research needs.

The number of inpatients in US public mental hospitals declined from 559,000 in 1955 to approximately 110,000 at present. Reductions resulted from release or transfer of long-term inpatients and from entrance barriers to new admissions. The timing and pace of deinstitutionalization substantially varied by state, but three quarters of the national reduction followed the expansion of welfare programs in the middle 1960s. The establishment of community care alternatives was highly inadequate, leaving many severely and persistently mentally ill people without essential services. Problems of care were exacerbated by the contraction of welfare programs in the 1980s, which resulted in serious neglect and homelessness. Plagued by underfinancing and fragmentation of care, new strategies in developing mental health care systems include capitation, case-management approaches, and the development of strong local mental health authorities.

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National health systems throughout the world face a number of pressures in common related to demography, epidemiology, developments in science and technology, medical demand, and rising public expectations. These pressures are producing convergence in the objectives and activities of these systems in several key areas, including cost-containment, health promotion, expansion of access, primary health care, patient choice, and the linkage between health and social services. At the same time, it is also necessary to recognize the role of political and governmental processes, as well as clinical and professional variables, in shaping different societal responses to health care challenges.

Part and parcel of the conventional wisdom about rural publics in Africa is that populations on the periphery will accord ethnic solidarity greater significance than national consciousness. A survey of neighboring Hausa villages on different sides of the Niger-Nigeria boundary counters this myth. Probing issues of self-identity and ethnic affinity, we found that most Hausa villagers on the frontier did not place their Hausan ethnic identity above their national one as citizens of Nigeria or Niger and expressed greater affinity for non-Hausa cocitizens than for foreign Hausas. However, expressed attachments to ethnic, national, and other social identifications (such as religion) varied according to village: citizenship does make a difference in the political consciousness of villagers on the geographic margins of the state. More survey research in other transborder regions should shed further light on processes of state penetration and national integration in developing countries.