Approaches to Health Inequalities

Approaches to Health Inequalities HEALTH INEQUALITIES AND SOCIAL DIVISIONS Introduction Today, it seems to be an obvious truth that â€Å"social and environmental factors account for a substantial portion of health inequalities between and within countries.†[1] The ubiquitous nature of economic and social inequalities is noted by all scholars.[2] This is a truth that seems well-enough established both in the professional literature and in the consciences of the laity. The questions that occupy scholars’ time, therefore, have centrally to do with what might be done about such health inequalities and whether social divisions are more the causal origins of the inequalities or whether they are the result.[3] As the literature reflects an ongoing investigation into all the matters addressed within this paper, definitive conclusions will have to wait until more is positively settled by the broader research community. But, certainly several pertinent issues can be explored at this time and the ongoing questions raised. The Realities of Inequality, Poverty and Societal Issues As is widely acknowledged, there is a relation between relative poverty and social issues. Regarding social ways in which it is difficult for those in relative poverty to be like others around them, it is often found to be difficult for an impoverished person to â€Å"participate fully in the social life of a community or country,† which will often lead to feelings of powerlessness.[4] Such social issues lead naturally into considerations of health inequality, as those who are impoverished often experience a great lack in education and access to resources normally available to those who are not in a state of relative poverty (e.g., healthcare, clean water, good nutrition, shelter, etc.).[5] It has also been noted that these types of relative health inequalities (i.e., between social groups) may be getting worse.[6] Health Inequalities There are at least two ways in which the discussion of health inequality can be broached. First, there can be shown to exist an inequality in healthfulness between classes. That is, one social group exhibits more health than does another, whatever the causal origin of this may be. Regarding the connection between a lack of healthfulness and social division, it has been noted that â€Å"A social class gradient is most pronounced for long-standing illnesses that limit activity.†[7] That is, such illnesses occur within certain social classes. Second, it is possible to explore the relation between being socially challenged and not having access to healthcare. This latter issue may be the simplest to deal with as the reasons for it are more readily seen. If one simply does not have access to that which will provide him with health, then clearly inequity between his group and those of another will be readily apparent. What Can Be Done about Access to Health? In their editorial, Jeanette Vega and Alec Irwin explore some possible responses to such health inequalities. They note that in the past there has been enacted, what might be called a â€Å"Pro-Poor† approach. This takes into account the fact that the poor often simply do not have the means in terms of finance or education to bring it about that they have access to much in the way of health resources or medicine. So, interventionist groups are formed in order to try and ensure that they have some access to medicine and health care. These types of interventionist methods are important, write the authors. But, they are inadequate by themselves. First, they only tend to focus on providing access to one type of group, and this is merely an issue of inequity in unfairness. Second, and perhaps more importantly, they do not attempt to address many of the core reasons why such inequalities arise in the first place, which include â€Å"gender and ethnicity† among other reasons.[ 8] A more comprehensive approach is both necessary and desirable in the effort to combat health inequalities. More must be done to combat the social divisions that exist, both along monetary lines and other ethnic lines.[9] There has been some progress made in a few countries, like Sweden wherein the approach has been comprehensive and on the cooperation between government agencies on high levels. Sweden has developed a national health policy that focuses on what determines health at the â€Å"societal level.† In this model, government agencies work alongside significant social sectors (e.g., education, transportation, environmental protection) and they are all required together to work toward the improving of â€Å"population health and narrowing health equity gaps.†[10] Also, in the United Kingdom recent efforts at accomplishing these same goals have seen success in targeting, not an ethnic or social group, but an age group. That is, collaborative efforts have been engag ed which have targeted mothers of children in early education and child care and have attempted to integrate these services with those of assistance to families and that of general health.[11] More to Be Done on the Research Level In a recent article Stuart Logan asked the hypothetical question of whether research was still important to be carried out in the area of child health inequality.[12] If it is obvious to all, as he argues it is, that â€Å"the relationship between poverty and poor health has been demonstrated so often and for such a wide range of conditions,† then the question naturally arises as to why any such investigative research into the relationship between socioeconomic status and child health should be carried out. Logan believes there are two important reasons that this endeavor is crucial in the overall attempt to overcome health inequalities and social divisions. First, we must continue to advocate for those who cannot advocate for themselves, and children are the first that come to mind in this category. Furthermore, there is simply not a â€Å"differential in health outcomes between those who are poor and those who are wealthy.†[13] Secondly, to continue such research may shed light on the crucial area of etiology, which, in medicine, is that branch that attempts to determine the causal origins of disease. An example of this latter would be the putative relation between the age of first pregnancy and the cause of breast cancer later in life.[14] Without further research, this suggestion may remain indefinitely putative. Robert Beaglehole agrees with these reasonable suggestions by Logan. Although everyone seems to know the general truth about health inequalities and a correlation with social distinctions, â€Å"an appropriate response is hampered by our poor understanding of their underlying causes.†[15] This is a difficult reality, but it only seeks to illustrate and support the contentions made by Logan with regard to the specific case of child health inequality. Without the proper amount and type of research to be done, it seems difficult to see how this situation of inequality might be improved. Without knowing the prior causes that lead to various ill effects among some social classes, there would seem to be no good way of making forward progress in this regard. Concluding Thoughts As Beaglehole notes in his book review, health inequalities are plainly offensive. They may be most offensive to those who work in the medical profession who have the know-how and skills necessary to help any and all (if they could only access any and all), but who are frustrated by a lack of governmental efforts to improve the persistent situation involving a lack of health and access to healthcare. Some steps of various governments (notably in Europe) have been taken to improve the situation, as we have explored briefly in this essay. Yet, as the writers of the brief appearing in the World Health Organization note, more strategic planning and (more importantly) implementation on the parts of governments working alongside various other national organizations may go a long way yet toward improving the overall situation of health inequality. Without significant progress in this area, it is likely that social divisions between classes, races, and ethnic groups will persist. Bibliography Beaglehole, Robert. â€Å"The Challenge of Health Inequalities† (book review) in The Lancet, London, Feb. 18-24, 206, vol. 367, issue 9510, p. 559-60. â€Å"Poverty and Health.† In Oxford Illustrated Companion to Medicine. Oxford: Oxford University Press, 2001. Logan, Stuart. â€Å"Research and Equity in Child Health.† In Pediatrics. Vol. 12, no. 3, Sept. 2003. Vega, Jeanette and Alec Irwin. â€Å"Tackling Health Inequalities: New Approaches in Public Policy.† In Bulletin of the World Health Organization (WHO), July 2004, 82 (7). 1 Footnotes [1] Jeanette Vega and Alec Irwin, â€Å"Tackling Health Inequalities: New Approaches in Public Policy,† in Bulletin of the World Health Organization (WHO), July 2004, 82 (7). [2] Robert Beaglehole, â€Å"The Challenge of Health Inequalities† (book review) in The Lancet London, Feb. 18-24, 206, vol. 367, issue 9510, p. 559-60. [3] Or a third alternative is whether they could be reciprocal-mutually contributing to the origin and subsistence of each other over time. [4] â€Å"Poverty and Health,† in Oxford Illustrated Companion to Medicine, (Oxford: Oxford University Press, 2001), pp. 665-9. [5] Ibid., p. 665. [6] Robert Beaglehole, â€Å"Health Inequalities,† p. 559. [7] â€Å"Poverty and Health,† p. 665. [8] Vega and Irwin, â€Å"Tackling Health Inequalities,† p. 7. [9] Ibid. [10] Ibid. [11] Ibid. [12] Stuart Logan, â€Å"Research and Equity in Child Health,† in Pediatrics, vol. 12, no. 3, Sept. 2003, p. 759. [13] Ibid. [14] Ibid., p. 760. [15] Beaglehole, p. 559.

A Game of Thrones Chapter Thirteen

Tyrion The north went on forever. Tyrion Lannister knew the maps as well as anyone, but a fortnight on the wild track that passed for the kingsroad up here had brought home the lesson that the map was one thing and the land quite another. They had left Winterfell on the same day as the king, amidst all the commotion of the royal departure, riding out to the sound of men shouting and horses snorting, to the rattle of wagons and the groaning of the queen's huge wheelhouse, as a light snow flurried about them. The kingsroad was just beyond the sprawl of castle and town. There the banners and the wagons and the columns of knights and freeriders turned south, taking the tumult with them, while Tyrion turned north with Benjen Stark and his nephew. It had grown colder after that, and far more quiet. West of the road were flint hills, grey and rugged, with tall watchtowers on their stony summits. To the east the land was lower, the ground flattening to a rolling plain that stretched away as far as the eye could see. Stone bridges spanned swift, narrow rivers, while small farms spread in rings around holdfasts walled in wood and stone. The road was well trafficked, and at night for their comfort there were rude inns to be found. Three days ride from Winterfell, however, the farmland gave way to dense wood, and the kingsroad grew lonely. The flint hills rose higher and wilder with each passing mile, until by the fifth day they had turned into mountains, cold blue-grey giants with jagged promontories and snow on their shoulders. When the wind blew from the north, long plumes of ice crystals flew from the high peaks like banners. With the mountains a wall to the west, the road veered north by northeast through the wood, a forest of oak and evergreen and black brier that seemed older and darker than any Tyrion had ever seen. â€Å"The wolfswood,† Benjen Stark called it, and indeed their nights came alive with the howls of distant packs, and some not so distant. Jon Snow's albino direwolf pricked up his ears at the nightly howling, but never raised his own voice in reply. There was something very unsettling about that animal, Tyrion thought. There were eight in the party by then, not counting the wolf. Tyrion traveled with two of his own men, as befit a Lannister. Benjen Stark had only his bastard nephew and some fresh mounts for the Night's Watch, but at the edge of the wolfswood they stayed a night behind the wooden walls of a forest holdfast, and there joined up with another of the black brothers, one Yoren. Yoren was stooped and sinister, his features hidden behind a beard as black as his clothing, but he seemed as tough as an old root and as hard as stone. With him were a pair of ragged peasant boys from the Fingers. â€Å"Rapers,† Yoren said with a cold look at his charges. Tyrion understood. Life on the Wall was said to be hard, but no doubt it was preferable to castration. Five men, three boys, a direwolf, twenty horses, and a cage of ravens given over to Benjen Stark by Maester Luwin. No doubt they made a curious fellowship for the kingsroad, or any road. Tyrion noticed Jon Snow watching Yoren and his sullen companions, with an odd cast to his face that looked uncomfortably like dismay. Yoren had a twisted shoulder and a sour smell, his hair and beard were matted and greasy and full of lice, his clothing old, patched, and seldom washed. His two young recruits smelled even worse, and seemed as stupid as they were cruel. No doubt the boy had made the mistake of thinking that the Night's Watch was made up of men like his uncle. If so, Yoren and his companions were a rude awakening. Tyrion felt sorry for the boy. He had chosen a hard life . . . or perhaps he should say that a hard life had been chosen for him. He had rather less sympathy for the uncle. Benjen Stark seemed to share his brother's distaste for Lannisters, and he had not been pleased when Tyrion had told him of his intentions. â€Å"I warn you, Lannister, you'll find no inns at the Wall,† he had said, looking down on him. â€Å"No doubt you'll find some place to put me,† Tyrion had replied. â€Å"As you might have noticed, I'm small.† One did not say no to the queen's brother, of course, so that had settled the matter, but Stark had not been happy. â€Å"You will not like the ride, I promise you that,† he'd said curtly, and since the moment they set out, he had done all he could to live up to that promise. By the end of the first week, Tyrion's thighs were raw from hard riding, his legs were cramping badly, and he was chilled to the bone. He did not complain. He was damned if he would give Benjen Stark that satisfaction. He took a small revenge in the matter of his riding fur, a tattered bearskin, old and musty-smelling. Stark had offered it to him in an excess of Night's Watch gallantry, no doubt expecting him to graciously decline. Tyrion had accepted with a smile. He had brought his warmest clothing with him when they rode out of Winterfell, and soon discovered that it was nowhere near warm enough. It was cold up here, and growing colder. The nights were well below freezing now, and when the wind blew it was like a knife cutting right through his warmest woolens. By now Stark was no doubt regretting his chivalrous impulse. Perhaps he had learned a lesson. The Lannisters never declined, graciously or otherwise. The Lannisters took what was offered. Farms and holdfasts grew scarcer and smaller as they pressed northward, ever deeper into the darkness of the wolfswood, until finally there were no more roofs to shelter under, and they were thrown back on their own resources. Tyrion was never much use in making a camp or breaking one. Too small, too hobbled, too in-the-way. So while Stark and Yoren and the other men erected rude shelters, tended the horses, and built a fire, it became his custom to take his fur and a wineskin and go off by himself to read. On the eighteenth night of their journey, the wine was a rare sweet amber from the Summer Isles that he had brought all the way north from Casterly Rock, and the book a rumination on the history and properties of dragons. With Lord Eddard Stark's permission, Tyrion had borrowed a few rare volumes from the Winterfell library and packed them for the ride north. He found a comfortable spot just beyond the noise of the camp, beside a swift-running stream with waters clear and cold as ice. A grotesquely ancient oak provided shelter from the biting wind. Tyrion curled up in his fur with his back against the trunk, took a sip of the wine, and began to read about the properties of dragonbone. Dragonbone is black because of its high iron content, the book told him. It is strong as steel, yet lighter and far more flexible, and of course utterly impervious to fire. Dragonbone bows are greatly prized by the Dothraki, and small wonder. An archer so armed can outrange any wooden bow. Tyrion had a morbid fascination with dragons. When he had first come to King's Landing for his sister's wedding to Robert Baratheon, he had made it a point to seek out the dragon skulls that had hung on the walls of Targaryen's throne room. King Robert had replaced them with banners and tapestries, but Tyrion had persisted until he found the skulls in the dank cellar where they had been stored. He had expected to find them impressive, perhaps even frightening. He had not thought to find them beautiful. Yet they were. As black as onyx, polished smooth, so the bone seemed to shimmer in the light of his torch. They liked the fire, he sensed. He'd thrust the torch into the mouth of one of the larger skulls and made the shadows leap and dance on the wall behind him. The teeth were long, curving knives of black diamond. The flame of the torch was nothing to them; they had bathed in the heat of far greater fires. When he had moved away, Tyrion could have sworn that the beast's empty eye sockets had watched him go. There were nineteen skulls. The oldest was more than three thousand years old; the youngest a mere century and a half. The most recent were also the smallest; a matched pair no bigger than mastiff's skulls, and oddly misshapen, all that remained of the last two hatchlings born on Dragonstone. They were the last of the Targaryen dragons, perhaps the last dragons anywhere, and they had not lived very long. From there the skulls ranged upward in size to the three great monsters of song and story, the dragons that Aegon Targaryen and his sisters had unleashed on the Seven Kingdoms of old. The singers had given them the names of gods: Balerion, Meraxes, Vhaghar. Tyrion had stood between their gaping jaws, wordless and awed. You could have ridden a horse down Vhaghar's gullet, although you would not have ridden it out again. Meraxes was even bigger. And the greatest of them, Balerion, the Black Dread, could have swallowed an aurochs whole, or even one of the hairy mammoths said to roam the cold wastes beyond the Port of Ibben. Tyrion stood in that dank cellar for a long time, staring at Balerion's huge, empty-eyed skull until his torch burned low, trying to grasp the size of the living animal, to imagine how it must have looked when it spread its great black wings and swept across the skies, breathing fire. His own remote ancestor, King Loren of the Rock, had tried to stand against the fire when he joined with King Mern of the Reach to oppose the Targaryen conquest. That was close on three hundred years ago, when the Seven Kingdoms were kingdoms, and not mere provinces of a greater realm. Between them, the Two Kings had six hundred banners flying, five thousand mounted knights, and ten times as many freeriders and men-at-arms. Aegon Dragonlord had perhaps a fifth that number, the chroniclers said, and most of those were conscripts from the ranks of the last king he had slain, their loyalties uncertain. The hosts met on the broad plains of the Reach, amidst golden fields of wheat ripe for harvest. When the Two Kings charged, the Targaryen army shivered and shattered and began to run. For a few moments, the chroniclers wrote, the conquest was at an end . . . but only for those few moments, before Aegon Targaryen and his sisters joined the battle. It was the only time that Vhaghar, Meraxes, and Balerion were all unleashed at once. The singers called it the Field of Fire. Near four thousand men had burned that day, among them King Mern of the Reach. King Loren had escaped, and lived long enough to surrender, pledge his fealty to the Targaryens, and beget a son, for which Tyrion was duly grateful. â€Å"Why do you read so much?† Tyrion looked up at the sound of the voice. Jon Snow was standing a few feet away, regarding him curiously. He closed the book on a finger and said, â€Å"Look at me and tell me what you see.† The boy looked at him suspiciously. â€Å"Is this some kind of trick? I see you. Tyrion Lannister.† Tyrion sighed. â€Å"You are remarkably polite for a bastard, Snow. What you see is a dwarf. You are what, twelve?† â€Å"Fourteen,† the boy said. â€Å"Fourteen, and you're taller than I will ever be. My legs are short and twisted, and I walk with difficulty. I require a special saddle to keep from falling off my horse. A saddle of my own design, you may be interested to know. It was either that or ride a pony. My arms are strong enough, but again, too short. I will never make a swordsman. Had I been born a peasant, they might have left me out to die, or sold me to some slaver's grotesquerie. Alas, I was born a Lannister of Casterly Rock, and the grotesqueries are all the poorer. Things are expected of me. My father was the Hand of the King for twenty years. My brother later killed that very same king, as it turns out, but life is full of these little ironies. My sister married the new king and my repulsive nephew will be king after him. I must do my part for the honor of my House, wouldn't you agree? Yet how? Well, my legs may be too small for my body, but my head is too large, although I prefer to think it is just large eno ugh for my mind. I have a realistic grasp of my own strengths and weaknesses. My mind is my weapon. My brother has his sword, King Robert has his warhammer, and I have my mind . . . and a mind needs books as a sword needs a whetstone, if it is to keep its edge.† Tyrion tapped the leather cover of the book. â€Å"That's why I read so much, Jon Snow.† The boy absorbed that all in silence. He had the Stark face if not the name: long, solemn, guarded, a face that gave nothing away. Whoever his mother had been, she had left little of herself in her son. â€Å"What are you reading about?† he asked. â€Å"Dragons,† Tyrion told him. â€Å"What good is that? There are no more dragons,† the boy said with the easy certainty of youth. â€Å"So they say,† Tyrion replied. â€Å"Sad, isn't it? When I was your age, used to dream of having a dragon of my own.† â€Å"You did?† the boy said suspiciously. Perhaps he thought Tyrion was making fun of him. â€Å"Oh, yes. Even a stunted, twisted, ugly little boy can look down over the world when he's seated on a dragon's back.† Tyrion pushed the bearskin aside and climbed to his feet. â€Å"I used to start fires in the bowels of Casterly Rock and stare at the flames for hours, pretending they were dragonfire. Sometimes I'd imagine my father burning. At other times, my sister.† Jon Snow was staring at him, a look equal parts horror and fascination. Tyrion guffawed. â€Å"Don't look at me that way, bastard. I know your secret. You've dreamt the same kind of dreams.† â€Å"No,† Jon Snow said, horrified. â€Å"I wouldn't . . . â€Å" â€Å"No? Never?† Tyrion raised an eyebrow. â€Å"Well, no doubt the Starks have been terribly good to you. I'm certain Lady Stark treats you as if you were one of her own. And your brother Robb, he's always been kind, and why not? He gets Winterfell and you get the Wall. And your father . . . he must have good reasons for packing you off to the Night's Watch . . . â€Å" â€Å"Stop it,† Jon Snow said, his face dark with anger. â€Å"The Night's Watch is a noble calling!† Tyrion laughed. â€Å"You're too smart to believe that. The Night's Watch is a midden heap for all the misfits of the realm. I've seen you looking at Yoren and his boys. Those are your new brothers, Jon Snow, how do you like them? Sullen peasants, debtors, poachers, rapers, thieves, and bastards like you all wind up on the Wall, watching for grumkins and snarks and all the other monsters your wet nurse warned you about. The good part is there are no grumkins or snarks, so it's scarcely dangerous work. The bad part is you freeze your balls off, but since you're not allowed to breed anyway, I don't suppose that matters.† â€Å"Stop it!† the boy screamed. He took a step forward, his hands coiling into fists, close to tears. Suddenly, absurdly, Tyrion felt guilty. He took a step forward, intending to give the boy a reassuring pat on the shoulder or mutter some word of apology. He never saw the wolf, where it was or how it came at him. One moment he was walking toward Snow and the next he was flat on his back on the hard rocky ground, the book spinning away from him as he fell, the breath going out of him at the sudden impact, his mouth full of dirt and blood and rotting leaves. As he tried to get up, his back spasmed painfully. He must have wrenched it in the fall. He ground his teeth in frustration, grabbed a root, and pulled himself back to a sitting position. â€Å"Help me,† he said to the boy, reaching up a hand. And suddenly the wolf was between them. He did not growl. The damned thing never made a sound. He only looked at him with those bright red eyes, and showed him his teeth, and that was more than enough. Tyrion sagged back to the ground with a grunt. â€Å"Don't help me, then. I'll sit right here until you leave.† Jon Snow stroked Ghost's thick white fur, smiling now. â€Å"Ask me nicely.† Tyrion Lannister felt the anger coiling inside him, and crushed it out with a will. It was not the first time in his life he had been humiliated, and it would not be the last. Perhaps he even deserved this. â€Å"I should be very grateful for your kind assistance, Jon,† he said mildly. â€Å"Down, Ghost,† the boy said. The direwolf sat on his haunches. Those red eyes never left Tyrion. Jon came around behind him, slid his hands under his arms, and lifted him easily to his feet. Then he picked up the book and handed it back. â€Å"Why did he attack me?† Tyrion asked with a sidelong glance at the direwolf. He wiped blood and dirt from his mouth with the back of his hand. â€Å"Maybe he thought you were a grumkin.† Tyrion glanced at him sharply. Then he laughed, a raw snort of amusement that came bursting out through his nose entirely without his permission. â€Å"Oh, gods,† he said, choking on his laughter and shaking his head, â€Å"I suppose I do rather look like a grumkin. What does he do to snarks?† â€Å"You don't want to know.† Jon picked up the wineskin and handed it to Tyrion. Tyrion pulled out the stopper, tilted his head, and squeezed a long stream into his mouth. The wine was cool fire as it trickled down his throat and warmed his belly. He held out the skin to Jon Snow. â€Å"Want some?† The boy took the skin and tried a cautious swallow. â€Å"It's true, isn't it?† he said when he was done. â€Å"What you said about the Night's Watch.† Tyrion nodded. Jon Snow set his mouth in a grim line. â€Å"If that's what it is, that's what it is.† Tyrion grinned at him. â€Å"That's good, bastard. Most men would rather deny a hard truth than face it.† â€Å"Most men,† the boy said. â€Å"But not you.† â€Å"No,† Tyrion admitted, â€Å"not me. I seldom even dream of dragons anymore. There are no dragons.† He scooped up the fallen bearskin. â€Å"Come, we had better return to camp before your uncle calls the banners.† The walk was short, but the ground was rough underfoot and his legs were cramping badly by the time they got back. Jon Snow offered a hand to help him over a thick tangle of roots, but Tyrion shook him off. He would make his own way, as he had all his life. Still, the camp was a welcome sight. The shelters had been thrown up against the tumbledown wall of a long-abandoned holdfast, a shield against the wind. The horses had been fed and a fire had been laid. Yoren sat on a stone, skinning a squirrel. The savory smell of stew filled Tyrion's nostrils. He dragged himself over to where his man Morrec was tending the stewpot. Wordlessly, Morrec handed him the ladle. Tyrion tasted and handed it back. â€Å"More pepper,† he said. Benjen Stark emerged from the shelter he shared with his nephew. â€Å"There you are. Jon, damn it, don't go off like that by yourself. I thought the Others had gotten you.† â€Å"It was the grumkins,† Tyrion told him, laughing. Jon Snow smiled. Stark shot a baffled look at Yoren. The old man grunted, shrugged, and went back to his bloody work. The squirrel gave some body to the stew, and they ate it with black bread and hard cheese that night around their fire. Tyrion shared around his skin of wine until even Yoren grew mellow. One by one the company drifted off to their shelters and to sleep, all but Jon Snow, who had drawn the night's first watch. Tyrion was the last to retire, as always. As he stepped into the shelter his men had built for him, he paused and looked back at Jon Snow. The boy stood near the fire, his face still and hard, looking deep into the flames. Tyrion Lannister smiled sadly and went to bed.

The McMansion Is the Big Mac of Suburbia

McMansion is a derogatory term for a large, showy neo-eclectic architectural style home, usually built by a developer without the guidance of an architects custom design. The word McMansion was coined in the 1980s by architects and architecture critics in response to the many over-sized, poorly designed, expensive homes being built in American suburbs. The word McMansion is cleverly derived from the name McDonalds, the fast food chain restaurant. Think about what is offered under the golden arches of McDonalds  Ã¢â‚¬â€ big, fast, tasteless food. McDonalds is known for mass producing super-sized everything in huge quantities.  So, a McMansion is the Big Mac hamburger of architecture — mass produced, quickly built, generic, bland, and unnecessarily large. The McMansion is part of the McDonaldization of Society. Features of a McMansion A McMansion has many of these characteristics: (1) over-sized in proportion to the building lot, which is usually a defined space in a suburban neighborhood; (2) poorly proportioned placement of windows, doors, and porches; (3) excessive use of gabled roofs or a bizarre mixture of roof styles; (4) poorly planned mixture of architectural details and ornamentation borrowed from a variety of historical periods; (5) abundant use of vinyl (e.g., siding, windows) and artificial stone; (6) unpleasing combinations of many different siding materials; (7) atria, great rooms, and other grand open spaces that are rarely used; and (8) quickly constructed using mix-and-match details from a builders catalog. McMansion is a snarky word used to describe a certain type of house, for which there is no absolute definition. Some people use the word to describe an entire neighborhood of overly large houses. Other people use the word to describe an individual house of new construction, more than 3,000 square feet, that has replaced a more modest house on the same lot. A very large house in a neighborhood of mid-century modest homes would look disproportional. A Symbol of Economic Status Is the McMansion anything new? Well, yes, sort of. McMansions are unlike the mansions of yesteryear. In the Gilded Age of America, many people became very wealthy and built opulent homes — usually a city dwelling and a country house, or cottage as the Newport, Rhode Island mansions are called. In the early 20th century, large, rambling homes were built in Southern California for people in the movie industry. No doubt, these homes are objects of excess. Generally, however, they are not considered McMansions because they were individually built by people who really could afford them. For example, Biltmore Estate, often called the largest private home in the United States, was never a McMansion because it was designed by a well-known architect and built by moneyed people on many, many acres of land. Hearst Castle,  William Randolph Hearsts estate in  San Simeon, California, and Bill and Melinda Gates 66,000 square foot house, Xanadu 2.0, are not McMansions for similar reasons. These are mansions, plain and simple. McMansions are a type of wannabe mansion, built by upper-middle class people with enough down payment money to show off their economic status. These homes are usually highly mortgaged to people who can afford the monthly interest payment, but who have obvious disregard for architectural aesthetics. They are trophy homes. The leveraged McMansion becomes a status symbol, then — a business tool that depends on property appreciation (i.e., natural price increase) to make money. McMansions are real estate investments instead of architecture. Reaction to McMansions Many people love McMansions. Likewise, many people love McDonalds Big Macs. That doesnt mean theyre good for you, your neighborhood, or society. Historically, Americans have rebuilt their communities every 50 to 60 years. In the book Suburban Nation, Andres Duany, Elizabeth Plater-Zyberk and Jeff Speck tell us that its not too late to untangle the mess.  The authors are pioneers in the rapidly growing movement known as New Urbanism. Duany and Plater-Zyberk launched the groundbreaking Congress for the New Urbanism which strives to promote the creation of pedestrian-friendly neighborhoods. Jeff Speck is the director of town planning at Duany Plater-Zyberk Co. The firm is noted for designing pristine communities such as Seaside, Florida, and Kentlands, Maryland. McMansions are not in their visions for America. Old-fashioned neighborhoods with walkable roads and corner shops may seem idyllic, but New Urbanist philosophies are not universally embraced. Critics say that pretty communities like Kentlands, Maryland, and Seaside, Florida, are as isolated as the suburbs they try to replace. Moreover, many New Urbanist communities are considered pricey and exclusive, even when they arent filled with McMansions. Architect Sarah Susanka, FAIA, became famous by rejecting McMansions and the notion of what she calls starter castles. She has created a cottage industry by preaching that space should be designed to nurture the body and soul and not to impress the neighbors. Her book, The Not So Big House, has become a textbook for 21st-century living. More rooms, bigger spaces, and vaulted ceilings do not necessarily give us what we need in a home, writes Susanka. And when the impulse for big spaces is combined with outdated patterns of home design and building, the result is more often than not a house that doesnt work. Kate Wagner has become the go-to critic of the McMansion form. Her commentary website called McMansion Hell is a clever, snarky personal assessment of the house style. In a local TED talk, Wagner rationalizes her animosity by suggesting that in order to avoid bad design, one must recognize bad design — and McMansions have a plethora of opportunities to hone ones critical thinking skills. Before the economic downturn of 2007, McMansions proliferated like mushrooms in a field. In 2017 Kate Wagner was writing about The Rise of the McModern -  McMansions persist.  Perhaps its a byproduct of a capitalistic society. Perhaps its the notion that you get what you pay for — small houses can cost as much to build as larger houses, so how do we rationalize living in tiny homes?   I believe, concludes Sarah Susanka, that the more people put their money where their hearts are, the more others will realize the validity of building for comfort, and not prestige. Source The Not So Big House by Sarah Susanka with Kira Obolensky, Taunton, 1998, pp. 3, 194

The Scandal Of Healthsouth Corporation Scandal - 1419 Words

Introduction Organizational misconduct is the chief cause behind corporate accounting scandals. The trusted executives of the corporation participation in actions during a scandal are corrupt, unethical, and illegal. In the United States, the Securities and Exchange Commission (SEC) is typically the government agency that investigates such scandals. One of the most notorious corporate accounting scandals in the United States is the HealthSouth Corporation scandal of 2003. HealthSouth Corporation is one of the United States largest healthcare providers with locations nationwide. A deeper inspection of the HealthSouth scandal is needed to understand how it transpired by assessing how it was executed, the accounting issues and root of the issue, how it was exposed, the results to the company and its main contributor, and ramifications as an outcome of the scandal. Scandal Overview In 1984, Richard Scrushy founded HealthSouth in Birmingham, Alabama. Scrushy was the company’s Chairman and Chief Executive Officer (CEO) when the company went public in 1986. HealthSouth grew quickly over the next several years. Shortly after HealthSouth went public, it is alleged that Scrushy instructed senior staff to materially inflate the company’s earnings to match expectations. In 2002, the first sign of troubles occurred when Scrushy sold $75 million of HealthSouth stock days before HealthSouth announced a large loss. After this the SEC began to investigate if any insider trading laws hadShow MoreRelatedThe Scandal Of Healthsouth Corporation Scandal1391 Words   |  6 Pagesmisconduct is the chief cause behind corporate accounting scandals. The trusted executives of the corporation participation in actions during a scandal are corrupt and illegal. In the United States, the Securities and Exchange Commission (SEC) is typically the government age ncy that investigates such scandals. One of the most notorious corporate accounting scandals in the United States is the HealthSouth Corporation scandal of 2003. HealthSouth Corporation is one of the United States largest health care providersRead MoreCase Study: Healthsouth Corporation Scandal1521 Words   |  7 PagesAnna James Case Study: HealthSouth Corporation Scandal Week3 Forensic Accounting: Ethics and Legal Environment Professor Erskine Hawkins HealthSouth Corporation is a large, public healthcare company that operates 93 inpatient rehabilitation hospital, 49 outpatient rehabilitation satellites, six long-term acute care hospitals, and 25 home health agencies. 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It operates in 26 states in the United States of America and in Puerto Rico. HealthSouth provides rehabilitation hospitals, long term heightened care hospitals, outpatient rehabilitation satellite clinics and home health agencies. HealthSouth was found by Richard Scrushy in the year 1984 and was calledRead MoreThe Sarbanes Oxley Act Of 20021423 Words   |  6 PagesThe audit world was transformed more than ten years ago due to a series of accounting scandals. This change took place when The Sarbanes–Oxley Act of 2002, otherwise known as SOX, was passed affecting not only business entities but also the firms that audit those companies (Thomas). One of the companies whose fraud was unmasked by the passage of SOX was HealthSouth Corporation. A company in the healthcare industry who had overstated about $2.7 billion dollars in earnings since 1996. The company’sRead MoreHealthsouth1309 Words   |  6 PagesINTRODUCTION HEALTHSOUTH Corporation (HEALTHSOUTH) began its rise in 1984 when Richard Scrushy, Aaron Beam, and other close associates formed the HEALTHSOUTH Empire with venture capital from New Enterprise Associates of Baltimore. In the beginning, Richard Scrushy was the chief executive officer (CFO), Aaron Beam was named the chief financial officer (CFO) and William Owen, an accountant from Ernst and Young, assumed the position of comptroller. HEALTHSOUTH went public in 1986 and began rapidlyRead MoreHcs 4051142 Words   |  5 Pagesaudit conducted by PricewaterhouseCoopers concluded that HealthSouth Corporation s cumulative earnings were overstated by anywhere from $3.8 billion to $4.6 billion, according to a January 2004 report issued by the scandal-ridden health-care concern. HealthSouth acknowledged that the forensic audit discovered at least another $1.3 billion dollars in suspect financial reporting in addition to the previously estimated $2.5 billion. The scandal s postmortem report f ound additional fraud of $500 millionRead MoreThe Sarbanes Oxley Act Of 20021530 Words   |  7 Pagesthe Enron scandal the government had created a new law called the Sarbanes-Oxley Act of 2002. This law was put into place to put more responsibility onto the public accounting firms and not letting company executives violate any information for investors (Larry Bumgardner). The law also allows the Securities and Exchange Commission to oversee more corporate governance of company’s financial records. The Securities and Exchange Commission was given the power to freely investigate corporations or accountingRead MoreThe Anatomy Of Corporate Fraud Essay845 Words   |  4 Pagescomparative Analysis of High Profile American and European Corporate Scandals. The abstract discusses the analysis conducted on the three major American accounting scandals; Enron, WorldCom, and HealthSouth, and compares to the three major European accounting scandals; Parmalat, Royal Ahold, and Vivendi Universal. Bahram Soltani (2014), also discusses within the abstract the different areas reviewed regarding why the accounting scandals occurred; ethical climate, tone at the top, bubble economy and marketRead MoreEthical And Legal Perspectives, What Do You Feel Business? Learned From The Scrushy Situation?972 Words   |  4 Pagescheating happening and who is heading the deception? Behind every crime, there is a ringleader or a group of individuals calling the shots. In this case, Scrushy was the one who told his family meeting members to fix financial records, so HealthSouth to meet or exceed the business financial goals. A person from the beginning may have the objective to cheat; others get sucked into the whirlpool of white-collar crime. Corporate fraud is rampant, and it is becoming a part of our culture. We expect