Social Medicine / Medicina Social (E-Journal)
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La salud en Uruguay: avances y desafíos por el derecho a la salud a tres años del primer gobierno progresista
Get PDFUsing a social medicine perspective, this article describes the Frente Amplio [Broad Front] government strategies for creating a more social, productive, democratic, innovative, and culturally integrated Uruguay. This nation will recognize health as a basic human right, is concerned about the general well being of its population, and understands the need for public health reform.
The present health reform is at the heart of Uruguay’s current social, economic and political transformations, changes which have a moral-ethical and social justice dimension. The health proposal calls for substantive transformation, requiring three parallel progressive changes: in health care delivery, in health care management and in health care financing.
The current reform has created a mixed private-public Integrated National Health Care System and an increasingly well funded National Health Insurance program. The process is new and evolving, transcendent, democratic, and participatory.
Keywords: social medicine, right to health, human rights, reform, Integrated National Health Care System.En un análisis desde la medicina social se intenta mostrar cómo se articulan las estrategias del programa del gobierno del Frente Amplio -hacia un Uruguay: social, productivo, democrático, innovador, integrado y cultural- con el reconocimiento de la salud como derecho y como bien público, así como el proceso de la reforma sanitaria. Así, la reforma en curso se ubica en el centro de las transformaciones sociales, económicas y políticas, pero también ético-morales y de justicia social. Es una propuesta de cambio de fondo, que implica tres cambios complementarios y progresivos: cambio de modelo de atención, cambio de modelo de gestión y cambio de modelo de financiamiento. La reforma crea un Sistema Nacional Integrado de Salud (mixto público-privado), un Fondo Nacional de Salud (con financiamiento progresivo) y un Seguro Nacional de Salud (universal e integral). El proceso es reciente e incipiente, trascendente, democrático y participativo
Comportamiento reproductivo de una población de mujeres inmigrantes latinoamericanas en España
Get PDFThe present study analyzes fertility patterns among a group of Latin-American female immigrants examining the impact of decade of birth, educational level, and migration on reproductive behavior. The study group was composed of 138 Latin-American women, aged 18 to 59 years, and residing in Spain. Menarche occurred at a mean age of 13.6 years old (sd 1.8) and the social initiation of fertility, as determined by age of first cohabitation, occurred at a mean age of 21.4 years (sd 0.4). Neither of these variables was affected by decade of birth. However, there were significant educational influences on age at first cohabitation. Women with a higher educational level showed delayed cohabitation and decreased fertility rates. On the other hand, there was in increase in the number of induced abortions after immigration to Spain seen among the youngest women. In conclusion, age at first cohabitation is an important indicator for the analysis of community demographic dynamics, although this age is conditioned by educational level. Likewise, adaptation to new social structures and situations is associated with changes in reproductive behaviors and may lead to practices among women that put their health at risk.El objetivo de este trabajo es analizar el patrón de fertilidad de un grupo de mujeres inmigrantes a España, provenientes de países latinoamericanos, en relación con la influencia generacional, educativa y migratoria sobre su comportamiento reproductivo. Se ha estudiado una población de 138 mujeres de 18 a 59 años. Los resultados del estudio muestran que el comienzo fisiológico del ciclo fértil se produce a una edad media entre 13,6 años (sd 1,8) y que el inicio social de ese ciclo, marcado por la edad de la mujer al inicio de su vida sexual, se produce, en promedio, a los 21,4 años (sd 5,4), ambas variables no presentan variaciones generacionales. Sin embargo, en función del nivel de estudio sí se observan diferencias significativas. Esto va a suponer, entre las mujeres de mayor nivel académico, un retraso del inicio de la fecundidad y una disminución de ésta. Por otra parte, se ha comprobado que, tras la migración, existe un aumento del número de abortos provocados entre las más jóvenes. En conclusión, se obtiene que la edad al matrimonio es un indicador importante en el análisis de la dinámica demográfica de las comunidades, pero esa edad está condicionada por el nivel educativo. Asimismo, la adaptación a nuevas situaciones y estructuras sociales conlleva la modificación de pautas reproductivas y puede conducir a prácticas de riesgo para la salud de las mujeres.
Los determinantes sociales del tráfico de órganos: una reflexión sobre la inequidad social
Get PDFOrgan trafficking has become evident in its global scope and consequences. Poverty, vulnerability, destitution and a system of exploitative transplant practices are social determinants for commercial living organ donation. Guided by the WHO resolution on organ transplants and the Istanbul Declaration, transplant practices can advanced standards of greater social equality rather than exploit social determinants of poverty, vulnerability and destitution by way of exploitative health systems.El alcance y las consecuencias del tráfico de órganos se han vuelto mundiales. La pobreza, la vulnerabilidad, el despojo y un sistema con prácticas de trasplante explotadoras, forman el contexto social de la donación comercial de órganos vivos. Guiados por la resolución de la Organización Mundi de la Salud (OMS) sobre el trasplante de órganos y la Declaración de Estambul, las prácticas de trasplante pueden promover estándares de mayor equidad social, en vez de aprovecharse de aquellos que son pobres, vulnerables y que están en una situación exclusión social
Las políticas neoliberales y su impacto sobre la formación en salud pública
Get PDFThis article discusses the impact of neoliberal policies on the training of specialists in Public Health and describes the Venezuelan experience. In Venezuela, like other countries of the American continent, Public Health Schools had been transformed from institutions under the direction of the Ministry of Health to a model in which training took place under market conditions. Education in Public Health became a private good for individual consumption, and schools, lacking official funding, survived by offering courses in a market that did not necessarily respond to a country’s health needs. The conclusion discusses the currrent Venezuelan experience, in which the State has resumed control of the training of specialists in public health, making it more democratic, and adoptng an educational model centered around practice and whose purpose is the mass training of leadership teams to bolster the National Public Health System.
In order to comment on the impact of neoliberal policies on training in public health we must first briefly review the following themes:
1. Basic concepts such as neoliberalism, globalization, and health systems.
2. The impact of neoliberal reforms on health.
3. The Venezuelan situation: basic principles for the training of professionals and technicians in health within the framework of a model of independent and sovereign national development.
4. Final reflections: challenges for the coming years.En este artículo se comenta el impacto de las políticas neoliberales sobre la formación de especialistas en Salud Pública, y se relata la experiencia venezolana, en la cual, con muchas similitudes a lo sucedido en otros países del continente, las Escuelas de Salud Pública pasaron de un modelo en el cual concertaban o estaban bajo la direccionalidad de los Ministerios de Salud, a un modelo en el cual la formación se hace en el marco del mercado. Se plantea que la educación en Salud Pública se ha convertido en un bien privado, de consumo individual, y las Escuelas, carentes de financiamiento oficial, sobreviven ofreciendo cursos en un mercado que no necesariamente responde a las necesidades de salud de los países. Para finalizar, se comenta la experiencia Venezolana, en la cual el Estado retoma la dirección de la formación de especialistas en Salud Pública, democratizándola, en el marco de un modelo educativo centrado en la práctica y con el propósito de formar masivamente cuadros de dirección para la consolidación del Sistema Público Nacional de Salud
Latin American Association of Social Medicine (ALAMES) XI Congress, November 17-21, 2009, Bogota, Colombia
No full text“Barrio Adentro” en Venezuela: democracia participativa, cooperación sur-sur y salud para todos
Get PDFPreface In the 1990s Latin American countries, with the exception of Cuba, undertook reforms in their health systems. In general, they followed a pattern similar to that adopted in other parts of the world by pursuing a neoliberal agenda that included the promotion of changes designed to achieve greater participation of the private sector in the funding and delivery of health services. Despite the different modes of reform, all strengthened the view of health as a consumer commodity and favored abandonment of the concept of health care as a right guaranteed by the state. Most of the changes implemented corresponded to the policies of structural adjustment, in accordance with the neoliberal paradigm recommended by international financial institutions with the aim of guaranteeing payments of the external debt (1-4). After several years of application, the negative impact of neoliberal health policies has been demonstrated by its inability to improve coverage or access to health services. These consequences coincide with the general failure of neoliberalism to improve quality of life; thus, Latin America remains the region of the world with the greatest inequalities between social classes. These persistent inequalities have motivated a variety of political responses in Latin America, including proposals advocated by liberal left-wing sectors in various countries of the region that are contrary to neoliberalism and include the promotion of policies to reverse privatization of health care while asserting it as a right guaranteed by the state. The amendments to the Venezuelan health system are one of the earliest examples of this type of reform. From 1999 onward, after a decade of implementing neoliberal policies, a marked adjustment in the health system was initiated to establish health as a fundamental right guaranteed by the state in a context of broad participation of organized communities and international (“South-South”) cooperation. This article describes the primary health care reforms in Venezuela, formalized as “Misión Barrio Adentro” (Inside the Neighborhood) from 2003 onwards. We begin with an analysis of the neoliberal model that existed in Venezuela at the time changes in health policy were initiated. This is followed by an explication of Barrio Adentro in its historical, political and social context, pointing to the central role played by popular resistance to neoliberalism. We continue with a description of its operation, consolidation, analysis of the first indicators of the program’s impact on health, and the discussion of the main challenges to a guarantee of sustainability. We conclude by suggesting that Barrio Adentro not only provides a model for health care reform in other countries of the region, but that it also offers important lessons for countries throughout the world, including those with the most powerful economies.Prefacio En la década de 1990 los países latinoamericanos, con excepción de Cuba, emprendieron reformas en sus sistemas de salud. En general, siguieron un patrón similar al adoptado en otras partes del mundo al perseguir una agenda neoliberal que incluía la promoción de cambios diseñados para lograr una mayor participación del sector privado en la financiación y prestación de servicios de salud. A pesar de los diferentes modos de reforma, todos fortalecieron la visión de la salud como un bien de consumo y favorecieron el abandono del concepto de atención médica como un derecho garantizado por el Estado
Los determinantes sociales de la salud: una perspectiva desde el Taller Latinoamericano de Determinantes Sociales sobre la Salud, ALAMES
Get PDFIntroduction The recent discussion of the social determinants of health, which has been promoted by the WHO as a way to approach global health conditions is neither a new nor a foreign subject for Latin American social medicine or collective health. Indeed, this approach to health derives from the principles of 19th century European social medicine which accepted that the health of the population is a matter of social concern, that social and economic conditions have an important bearing on health and disease, and that these relationships should be subjected to scientific enquiry. (Rosen, 1985:81) The specific socio-historical conditions of Latin America in the 1970’s fostered the development of an innovative, critical, and socially-based based health analysis, which was seen in an evolving theoretical approach with deep social roots. (Cohn, 2003) This analysis calls for scientific work which is committed to changing living and working conditions and to improving the health of the popular classes. (Waitzkin y col. 2001; Iriart y col. 2002). From its beginning, this school of socio-medical thought recognized that collective health has two main areas of research: 1) the distribution and determinants of health and disease and 2) the interpretation, technical knowledge, and specialized practices concerning health, disease, and death. The goal is to understand health and disease as differentiated moments in the human lifecycle, subject to permanent change, and expressing the biological nature of the human body under specific forms of social organization, all this in such a way as to allow discussion of causality and determination. (Breilh y Granda,1982; Laurell, 1982). Latin American social medicine criticized biomedical and conventional epidemiological approaches for isolating health and disease from social context, misinterpreting social processes as biological, conceptualizing health phenomena in individualistic terms, and adopting the methodological procedures of the natural sciencesLa reciente discusión sobre los determinantes sociales de la salud, que ha sido promovida por la OMS como una forma de abordar las condiciones de salud globales, no es un tema nuevo ni extraño para la medicina social o la salud colectiva latinoamericana. De hecho, este enfoque de la salud deriva de los principios de la medicina social europea del siglo XIX, que aceptaba que la salud de la población es una cuestión de interés social, que las condiciones sociales y económicas tienen una influencia importante en la salud y la enfermedad, y que estas relaciones deben ser objeto de investigación científica
