Social Medicine / Medicina Social (E-Journal)
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La medicina social en Timor Oriental
Get PDF‘“Social medicine”, a concept notably developed in Latin America by Salvador Allende in the 1930s, links up a broader model and ethos of public health with processes of social transformation. In recent years that influence has spread to Timor Leste, through a very large Cuban health cooperation and training program. This paper considers to what extent an endogenous “social medicine” might be developing in Timor Leste. Such a development would require transition away from the existing model based on small, private clinics.
The paper accepts Guzmán’s observation that Latin American social medicine is a wider, more dynamic and participatory model than that presented from European epidemiology – the ‘social determinants’ approach – but asserts that there are different forms of social medicine, conditioned by distinct histories and cultures. If earlier Chilean social medicine was a key element of that country’s radical social democracy, and Cuban social medicine expressed revolutionary solidarity and internationalism, what might be the character of an East Timorese social medicine?
This paper traces the idea of ‘social medicine’ from Chile, through Cuban solidarity aid, to the synthesis emerging in Timor Leste. This is an interpretive history, making use of past analyses, contemporary information on the Cuba-Timor Leste health program and the East Timorese responses. It includes a number of interviews and direct observations of pedagogy and practice. It concludes that a transition to social medicine in Timor Leste has some advantages: the large scale of the new training program; a sympathetic culture; and potential leadership. Less certain is the exact form of East Timorese social medicine. However the ideas seem set to be absorbed into a domestic culture of community solidarity, inclusive Christianity, and an independent spirit.La medicina social vincula modelos holísticos de salud pública con procesos de transformación social. En 2003, un muy amplio programa cubano de ayuda y formación de talentos humanos en salud puso tal enfoque en contacto con Timor Oriental. Este texto analiza hasta qué punto puede estar desarrollándose una forma de medicina social endógena en este país. Tal evolución requeriría un alejamiento del modelo existente, basado en pequeñas clínicas privadas. Partimos de aceptar la idea de Guzmán (2009) de que la medicina social latinoamericana es un modelo más amplio, más dinámico y participativo que el que se presenta en la epidemiología social europea (el enfoque de los determinantes sociales de la salud), pero afirma que existen diferentes formas de medicina social que están condicionadas por historias y culturas definidas. Si la antigua medicina social chilena constituyó un elemento clave de la democracia social radical de ese país y la medicina social cubana expresó solidaridad revolucionaria e internacionalismo, ¿Cuál podrá ser el carácter de una medicina social propia en Timor Oriental? El presente trabajo aborda la idea de la medicina social desde Chile y la ayuda solidaria cubana, hasta la síntesis emergente en Timor Oriental
El consumo de cigarros y su promoción: escribir editoriales no es suficiente
Get PDFThis article was originally published in The New York State Journal of Medicine, Volume 83, Number 13, pp. 1245 – 1247, 1983. It is reprinted here with permission. This article should not be reproduced without permission of the Medical Society of the State of New York.
-- INTRODUCTION --
This issue of the Journal marks the 20th anniversary of the first report on smoking and health by the Surgeon General of the United States Public Health Service. Preparations for the issue began one year ago with a letter to the present Surgeon General, C. Everett Koop, MD, requesting an interview on the subject of juvenile-onset cigarette smoking. Dr Koop's encouraging reply inspired other letters to individuals around the world who have been deeply committed to ending the cigarette pandemic.Texto clásico sobre el papel de los medios y la publicidad en la pandemia de tabaquismo
Convocatoria a publicar: "Guerra contra las drogas y salud"
Get PDFCall to publish: War on Drugs and Healt
Asociación Latinoamericana de Medicina Social. Plataforma de Trabajo 2009 – 2011
Get PDFFrom the 14th to the 19th of November 2009 we spent five intense days during the Congress developing this electoral platform with the input offered by national delegations to all candidates for the General Coordinator position. The contributions by the national delegations demonstrated their interest in the future of ALAMES. It was an intensive learning experience for us made up of conversations with delegations and participants, the challenge and effort of incorporating the various mandates given to us by the pre-Congress courses, the round table discussions, the commission, the plenary and multiple conversations in coffe breaks and the corridors. We have also attempted to incorporate those declarations which seemed to generate the most enthusiasm and those commentaries which we heard over and over again in our conversations. Finally, we congratulate all those who have made this Congress so productive, so moving, and so diverse; the presence of social movements has expanded the diversity and wealth of voices heard at the Congress.
We know from previous experiences that elections are often associated with tension. Yet elections can also serve to stimulate discussion at a Congress. In our case, the election has encouraged us to create this proposal. This is a proposal which could not have been developed prior to the Congress since it is the outcome of dialogues, expectations, and discoveries made during our conversations. We offer it to the members and institutions associated with ALAMES as a roadmap for their commentary, discussion, and criticism.Plataforma de trabajao presentada para contender por la coordinación general de ALAMES, Bogotá, Colombia, 19 de noviembre de 2009
Factores históricos y contemporáneos que contribuyen a la difícil situación de los trabajadores agrícolas inmigrantes en los Estados Unidos
Get PDFMigrant farmworkers provide an essential service and perform jobs that many Americans are unwilling to do. Immigration practices and policies dictate the extent to which undocumented migrant farmworkers have access to governmental health and social services, and are ever-changing based on the political climate. This paper reviews historical and contemporary United States government policies relevant to migrant farmworkers. It refutes some of the common myths regarding documented and undocumented immigrants and migrant farmworkers, such as "U.S. public health insurance programs are overburdened with immigrants," "undocumented immigrants are taking advantage of the American system by 'free riding' and are a 'drain on the economy,'" and "undocumented immigrants take American jobs." Even though their jobs involve significant occupational hazards, undocumented migrant farmworkers are ineligible for government services, and employers generally do not provide these workers with health insurance. Migrant farmworkers also face food insecurity, poor housing conditions, impaired access to education for their children, and even human rights violations. These conditions, as well as the nature of their work, affect the health of undocumented migrant farmworkers and their children. This paper analyzes these inequities and calls for a more just and equitable system that treats migrant farmworkers fairly and provides them and their families with social services and health care.Los trabajadores agrícolas inmigrantes proveen un servicio esencial y desempeñan empleos que muchos estadounidenses no están dispuestos a realizar. Las prácticas y las políticas de inmigración dictan la extensión del acceso que los trabajadores agrícolas inmigrantes indocumentados tienen a los servicios gubernamentales sociales y de salud. Tal alcance es cambiante y está basado en el clima político. Este artículo revisa las políticas gubernamentales (históricas y contemporáneas) en los EUA concernientes a los trabajadores agrícolas inmigrantes. Además, rebate algunos de los mitos comunes sobre los trabajadores agrícolas documentados e indocumentados, tal como que “los programas de seguros de la salud pública están sobrecargados con inmigrantes”, “los inmigrantes indocumentados se aprovechan del sistema estadounidense 'gorreándolo' y constituyen una fuente de drenaje de la economía” y “los inmigrantes indocumentados ocupan los empleos en los EUA”. A pesar de que sus labores implican peligros importantes, los trabajadores agrícolas indocumentados no tienen derecho a los servicios gubernamentales y, por lo general, los empleadores no les otorgan seguro médico. Los trabajadores agrícolas inmigrantes enfrentan también inseguridad alimentaria, malas condiciones de vivienda, dificultades en el acceso a la educación para sus hijos e, incluso, violaciones a sus derechos humanos. Estas circunstancias (así como también la naturaleza de su trabajo) afectan su salud y la de sus hijos. El presente artículo analiza estas inequidades y hace un llamado a favor de un sistema más justo y equitativo, que trate a los trabajadores agrícolas inmigrantes de manera justa y les otorgue a ellos y a sus familias servicios sociales y de atención médica
La privatización de la salud y la defensa del sistema público en Québec, Canadá
Get PDFThe Canadian health care system – known as “Medicare” or “Assurance-maladie” in Quebec – was created to ensure Canadians free access to health care services and medications. The health system is both publicly funded and administered. It has been built on five principles laid out in the Canada Health Act (1984); these are: Public Administration, Comprehensiveness, Universality, Portability, and Accessibility. In sum, the right to health has been at the organizational core of the Canadian health system.
Provinces and territories administer and deliver most of the health services in Canada. This is done through provincial and territorial health insurance plans which are required to follow the national principles set out in the Canada Health Act. Since its creation, the Canadian health care system has undergone important changes and reforms. However, until a few years ago each major reform of the system retained the principles of justice and equity as core values.
Quebec adopted the Health and Social Services Act in December 1971. The Quebec health care system was established with a mandate to maintain, improve, and restore the health and well-being of the entire Quebec population, making health and social services accessible to all. Health and social services in Quebec are administered jointly. This specificity, which has been adopted by other health care systems, has the advantage of allowing a comprehensive response to the health and social needs of the population. Since the 80s there has been a worldwide trend towards the privatization of public services.
In order to describe developments in the Quebec health care system, we interviewed Dr Marie-Claude Goulet (M-CG), chair of the organization Médecins québécois pour le régime public (MQRP) [Quebec Physicians for a Public System] , an organization campaigning against the commercialization of health care in Quebec. The MQRP is an umbrella organization made up of various groups from Quebec province; it is part of the larger Canadian Doctors for Medicare (CDM) network. CDM was created in May of 2006 because of physician concerns about the trend towards privatization of the country’s health care services.
As a member of ALAMES North America, I was interested in hearing the perspective of a Latin American working in the Quebec health care system. How did the experience of privatization in a Latin American country compare to what is currently taking place in Quebec? To this end I interviewed Dr Fernando Álvarez (FA), an Argentinian pediatrician who had worked in the Children’s Hospital in Buenos Aires. For the past 18 years he has been part of the Quebec health system and is currently head of Gastroenterology, Hepatology, and Nutrition services at Montreal University’s Sainte-Justine Hospital.Entrevista a la Dra. Marie-Claude Goulet, presidente de la organización Médecins Québécois pour le Régime Public(Médicos Quebequenses por el Régimen Público), que es una organización que lucha contra la mercantilización de la salud en Québec
Determinantes sociales del perfil de tuberculosis pulmonar en familias de migrantes pertenecientes al Programa de Trabajadores Agrícolas Temporales México – Canadá en Guadalupe Zaragoza
Get PDFObjective: To analyze the social determinants of pulmonary tuberculosis in the families of migrant laborers registered in the Seasonal Agricultural Workers Program (SAWP) and residing in Guadalupe Zaragoza Tlahuapan, Puebla, México. Methods: An exploratory cross-sectional study of the interaction between migration, social determinants, and pulmonary tuberculosis. Results: In this poor and patriarchal community, the SAWP offers financial opportunities for the men of Guadalupe Zaragoza. The remittances of these migrant workers have enabled their families to live in adequate housing, but their health situation is still vulnerable. Only half of the families have access to public health services or the special health programs for migrant worker families. 13% of migrant family members were infected with pulmonary tuberculosis as measured by the Quantiferon-TB test. The female partners of migrants typically do not study past elementary school, become housewives with no pay, are forced to take on added work in the household, and experience subjective symptoms of stress and fatigue. The children of Guadalupe Zaragoza are also vulnerable; the number of children in this community who can regularly attend school is below the national average because many children have to work. These families end up paying more for education, housing, and health services than the average Mexican family. Conclusions: In the families of SAWP migrant workers, the prevalence of latent pulmonary tuberculosis was found to be lower than the national average based on studies using the tuberculin test; this may be due to the greater specificity of the Quantiferon-TB Gold test. There is a significant risk of reactivation tuberculosis in these families due to the inequity in the social determinants of health.Analizar los determinantes sociales del perfil de tuberculosis pulmonar en familias de migrantes pertenecientes al Programa de Trabajadores Agrícolas Temporales (en adelante PTAT) en Guadalupe Zaragoza, Tlahuapan, Puebla, México. Se trata de un estudio analítico transversal exploratorio sobre la relación migración - determinantes sociales de la salud -prevalencia de tuberculosis pulmonar. Los resultados arrojan que el 13% de familiares de migrantes padecen tuberculosis pulmonar latente. Guadalupe Zaragoza es una comunidad pobre y patriarcal, lo que propicia la migración de varones a Canadá a través del PTAT, cuyas remesas han permitido a sus familias habitar en viviendas adecuadas, pero su situación de salud es vulnerable, ya que apenas la mitad de ellas accede a servicios públicos de salud y se encuentra cubierta por programas de salud. Vulnerable también está su niñez, porque en relación a la media nacional hay menos niños que asisten regularmente a la escuela porque trabajan; además, gastan más en educación, servicios de la vivienda y salud que las familias promedio a nivel nacional. Las mujeres parejas de migrantes se desenvuelven en relaciones patriarcales, expresadas en que estudien hasta nivel básico, se dediquen al trabajo doméstico no asalariado, realicen dobles jornadas y, además, padezcan síntomas subjetivos de estrés y fatiga. En las familias de migrantes pertenecientes al PTAT se encontró una prevalencia de tuberculosis pulmonar latente menor a la nacional, porque se usó una técnica más específica que la tuberculina: la cuantificación de interferón gamma por test QuantiFERON-TB Gold. Lo significativo es la gran posibilidad de activación de la enfermedad en estas familias, debido a la inequidad de los determinantes sociales que las rodean
Participación multisectorial en la respuesta nacional para la prevención y atención a la epidemia del VIH/SIDA, República de Cuba, 2007-2008
Get PDFThe development of a strong national response involving multiple sectors—including civil society—is an essential aspect of the social management of the HIV/AIDS epidemic. The goals of this response are to control the epidemic and improve the quality of life for people living with HIV/AIDS; this includes combating stigma and discrimination, as well as ensuring due compliance with the law. Cuba has a national program to prevent and control HIV/AIDS. Since 2003 Cuba’s national program has received material and financial support from the Global Fund to Fight AIDS, Tuberculosis and Malaria. Program evaluation is carried out by an independent team at ENSAP (National School of Public Health). This paper reports on results of one part of that evaluation: an assessment of the agencies and sectors who made up the organized social and national response to the HIV/AIDS epidemic. The evaluation primarily used qualitative analyses of the activities and tasks proposed by sectors in their 2006-2008 work plans. Visits were made to the provinces of Ciudad de la Habana, Matanzas, and Holguín. Qualitative techniques included in-depth interviews, semi-structured interviews, observation, and review of documentary evidence of all kinds (videos, reports, minutes, protocols, results of social research, and radio broadcast messages) and varied depending on the particular features of each sector. We noted improvements in multi-sector participation in the prevention and response to the national HIV/AIDS epidemic. Conscious of their role, sectors generally carried out their programmed activities and had improved their organization, planning, and systematization; integration among the sectors was also better. These local initiatives provided evidence of a multi-sector response characterized by autonomy, emotional involvement, and an identification with the goals of the project; this went beyond simply meeting targets. Cross-sector work showed a marked increase and a qualitative leap in management compared with the previous evaluation. Interviewees from different sectors all considered discrimination and stigmatization of people living with HIV to have decreased, both within their organizations and in the general population.El fortalecimiento de la respuesta nacional a través de la participación multisectorial y de la sociedad civil cubana, constituye un componente esencial de la gestión social encaminada al control de la epidemia del VIH/sida y al mejoramiento de la calidad de vida de las personas que la padecen, incluida la disminución del estigma, la discriminación y el cumplimiento racional y oportuno de la legalidad. Cuba cuenta con un programa nacional para desarrollar las acciones de prevención y control de éste flagelo. Desde el año 2003 cuenta además con el apoyo material y financiero del Fondo Global, el cual acompaña este proceso de evaluaciones independientes a cargo de un equipo de investigadores de la Escuela Nacional de Salud Pública. La investigación se corresponde con los resultados parciales (por solo desarrollar uno de los objetivos de la evaluación independiente). El objetivo central del estudio consistió en evaluar los resultados alcanzados por los organismos y sectores involucrados en el proyecto mencionado, como expresión de la respuesta social y nacional organizada ante la epidemia del VIH/sida. La metodología se enfocó principalmente en los análisis cualitativos de las actividades y tareas propuestas por los sectores en sus respectivos planes de trabajo para el período 2006-2008. Fueron visitadas las provincias Ciudad La Habana, Matanzas y Holguín. Las técnicas cualitativas utilizadas para la recogida de información fueron: entrevistas a profundidad, entrevistas semiestructuradas, observación y revisión de evidencias documentales de todo tipo (videos, informes, actas, guiones de programas, resultados de investigaciones sociales, mensajes radiales según las particularidades del sector). Entre las conclusiones principales se constató un fortalecimiento de la participación multisectorial en la prevención y atención de la epidemia del vih/sida a nivel nacional. En sentido general, los sectores cumplieron las actividades programadas y progresaron en organización, planificación, sistematicidad e integración entre ellos. Se logró la sensibilización y concientización de su contribución a la prevención y control de la epidemia. La pertinencia de las iniciativas locales puso de manifiesto una participación sectorial con mayor autonomía, involucración emocional y de apropiación del proyecto, más allá del cumplimiento de las metas. El trabajo intersectorial mostró un incremento notable y un salto de calidad en la gestión respecto a la evaluación anterior. Los entrevistados de los sectores coincidieron en valorar como disminuida la discriminación y la estigmatización de las personas con vih, tanto dentro de sus organizaciones como en la población civil
A diez años del Foro Social Mundial: ¿Vamos por el camino correcto?
Get PDFEl pasado enero, Porto Alegre (donde nació el FSM hace diez años) fue sede de otro Foro. Sin embargo, la efusiva celebración de la esperanza de que un mundo mejor es posible (destacada en 2001, 2003 y 2005) este año fue notablemente más tenue. Ciertamente, después de ésta, la más reciente edición del FMS (llevada a cabo en muchas ciudades distintas alrededor del mundo) no cabe más que preguntarse si el Foro no está en declive como estrategia, como un símbolo de resistencia y, sobre todo, como una plataforma para la acción. Esta pregunta acecha incluso a aquéllos que todavía creen vehementemente en la visión de que “otro mundo es posible” y es e tema de esta reflexión