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Collaborative care can support the treatment of depression in people with long-term conditions, but long-term benefits and costs are unknown.
To explore the long-term (24-month) effectiveness and cost-effectiveness of collaborative care in people with mental-physical multimorbidity.
A cluster randomised trial compared collaborative care (integrated physical and mental healthcare) with usual care for depression alongside diabetes and/or coronary heart disease. Depression symptoms were measured by the symptom checklist-depression scale (SCL-D13). The economic evaluation was from the perspective of the English National Health Service.
191 participants were allocated to collaborative care and 196 to usual care. At 24 months, the mean SCL-D13 score was 0.27 (95% CI, −0.48 to −0.06) lower in the collaborative care group alongside a gain of 0.14 (95% CI, 0.06-0.21) quality-adjusted life-years (QALYs). The cost per QALY gained was £13 069.
In the long term, collaborative care reduces depression and is potentially cost-effective at internationally accepted willingness-to-pay thresholds.
The relationship between morality and economy has been muddied in the course of disciplinary specialization. While dominant paradigms in economics abstract from the moral dimension, recent approaches to morality and ethics in anthropology neglect the material economy. E. P. Thompson’s “moral economy” has been an influential bridging concept in recent decades, but recent inflationary usage has highlighted shortcomings. Following an overview of the disciplinary debates, the moral dimension of economic life is illustrated in this paper with reference to work as a value between the late 19th and early 21st centuries in Hungary. Contemporary workfare is explored with local examples. It is shown how discourses of work and fairness are being extended into new ethical registers to justify negative attitudes towards a new category of migrants.
Anthropology, the relativizing countercurrent to Enlightenment notions of civilization and progress, has long challenged notions of backwardness. By contrast, Marxist-Leninist regimes had no doubts about the world-historical backwardness of the largely agrarian societies in which they came to power, which they sought to transform through rapid industrialization. According to some indicators, this socialist civilizing mission was rather successful. Yet memories are mixed, and complicated by the reappearance of typical features of backwardness in the postsocialist era. This article explores changing political economies and the spatiotemporal imaginaries of elites and villagers in Hungary. Historical and theoretical insight is drawn from Ferenc Erdei (1910–1971), a left-leaning populist whose analysis of rural Hungary has more general relevance. Case materials are presented from a region of the Great Plain that in the longue durée exemplifies the “development of underdevelopment” on the margins of Western capitalism. Civilizational transformations were instigated from the east in the socialist decades, but their vehicle was a collectivist ideology that remained alien. The politics and economics of time now render villagers susceptible to populist imaginaries entirely different from those of Erdei.
“Nineteenth century civilization has collapsed,” declares Karl Polanyi in the opening sentence of The Great Transformation. His ensuing analysis focuses on the emergence of the self-regulating market as a world-historical aberration, contrasting both with the great agrarian empires and with the non-literate societies studied by anthropologists. Yet the work remains full of ambiguity: did Polanyi mean the “self-regulating” as a realistic descriptor or did he mean the idea of such a market? It is in any case a very Eurocentric narrative. It is concerned in particular with Britain, where Polanyi conceived his study of “the political and economic origins of our time” in the late 1930s.
“Our time” today is quite different. It is tempting now to proclaim the collapse of twentieth-century civilization, but this collapse demands a more complex explanation than the Polanyi prototype. Such an account would need to address, first, the attrition of that “embedded liberalism” (Harvey 2005a, following Ruggie 1982) which came to characterize the advanced capitalist countries in the decades after Polanyi's dramatic indictment of pre-welfare state “disembedding.” As Keith Hart and I point out in our Introduction to this volume, this metaphor has been a continuous source of confusion. I distinguish here between general moral embedding and political embedding. Polanyi shows in his magnum opus that the conditions for the catastrophic existential moral and social disruption of human communities in industrial communities were the work of the capitalist state.
Markets are networks constituted by acts of buying and selling, usually through the medium of money. For most of history they were kept marginal to the mainstream institutions on which societies were built. But not long ago, and at first only in some parts of the world, markets came to be accepted as central to society, leading to a vigorous political debate, which is ongoing, about the appropriate relationship between the two. It is widely acknowledged that the publication of Adam Smith's The Wealth of Nations in 1776 provided a charter for “the market” (now often singular) to assume its place as the dominant institution of modern societies. The idea of economy, which started out as a principle of rural household management, now became closely identified with markets, as did the profession of economics which grew up to study them. One man, however, made the modern history of the relationship between market and society his special concern: Karl Polanyi (1886–1964), whose The Great Transformation, published during the Second World War, remains the most powerful indictment of what he considered to be the utopian and ultimately destructive attempt to build society on the basis of self-regulating markets. Our authors therefore consider the relevance of this Central European polymath for their work.