Archive for the 'Globalization and Health' Category
Add a comment February 4th, 2010 by bronxdoc
Our friends from the National Physicians Alliance (see prior postings) have passed on an invitation to their 5th annual meeting to be held March 13-15, 2010 in Long Beach, Califonia. For information and registration, please click on this link. To give readers of the Portal a sense of what some physician activists are up to, we are reprinting some of the conference schedule:
Leadership Development: Developing Skills to Lead as the Landscape of Health Care Changes
From national health care reform to community advocacy to clinical practice, physician leadership and engagement has never been more vital to the health of the nation. Recent successful examples have also demonstrated the benefits of physician leadership, advocacy, and engagement with community partners. This track will provide resources for communication, management and advocacy skills, civic engagement, community collaboration, and other tools that physicians can apply in a variety of settings. Community members are welcome to join and learn more about physician engagement. Session to include:
Advancing Health Care Through Civic Engagement
Kim Alexander, President, California Voter Foundation Carmela Castellano-Garcia, President CEO, California Primary Care Association Marc Wetherhorn, National Advocacy Director, National Association of Community Health Centers
Messaging, Media & Communications
Bob Crittenden, MD, MPH , Executive Director, The Herndon Alliance
Effectively Engaging with Your State Legislatures & Its Members
Progressive States Network – Speaker TBA
Educating State Legislators, Advancing Health Care Reform: Tools Physicians Can Use to Engage & Inform State Legislators About Federal HC Reforms
Progressive States Network – Speaker TBA
Models for Physician Leadership and Community Engagement
Bill Jordan, MD, MPH, NY Action Network – National Physicians Alliance
Aaron Fox, MD, MPH, NY Action Network – National Physicians Alliance
Issues on the Horizon: 2010 & 2012 Elections
Kim Alexander, President, California Voter Foundation
Serena Kirk, Senior Policy Advocate, California Primary Care Association
Practice Innovations: Practicing Medicine in a Changing World
What will the practice of medicine look like in ten years? How will reform change the way the average physician will practice medicine? This will be an instructive and interactive track will address these complex questions and many others by focusing on the following three areas: 1) Evidence Based Medicine (EBM), 2) Practice structure and financing, and 3) Information and Communications Technology. Sessions to include:
Evidence-based Medicine & Clinical Guidelines
Colin Kopes-Kerr, MD, JD, MPH, The Permanente Medical Group
Healthcare Planning and Strategy
Kevin Fickenscher, MD, CPE, FACPE, FAAFP, Perot Systems
Approaches in Chronic Disease Management
Susan Snyder, MD
High Quality Care for Disadvantaged Populations
L. Gordon Moore, MD
National Health Policy: Avenues for Involvement in Advocacy to Enhance our Country’s Health
With the potential passing of federal health care reform legislation a “wave of change” will alter the landscape of public health and healthcare in America. The National Health Policy Track aims to educate and mobilize physicians on the healthcare reform debate of 2009 and future directions for reform. Sessions to include:
Reforms that Reduce Costs Without Reducing Quality of Care
Thomas Rice, PhD, Professor, Department of Health Services; Vice Chancellor, Academic Personnel
UCLA School of Public Health
Political Solutions to the Obesity Epidemic
Deborah Cohen, MD, MPH, Senior Natural Scientist, Rand Corporation
Outcomes of Health Care Reform: Review of the Policy Debate
Josh Derr, Manager, Mayo Clinic Health Policy Center
Health Care Reform: Impact on Women
National Women’s Law Center – Lisa Codispoti, Senior Counsel
Federal Health Care Reform: How Physicians Can Help Their States Access Upcoming Opportunities & Resources
Progressive States Network – Speaker TBA
Global Health: Workforce Issues in an Ever-Evolving Global Health Landscape
The world has never been smaller, nor have global issues of health been more of a concern for physicians and advocates alike. With health care workers migrating to the Unites States for better opportunities, a shortage in these critical areas ensues. What can physicians do to ensure that we are thinking globally in our efforts to improve the health of our patient, our community and our world? Sessions to include:
The Global Workforce Crisis-Is US the Problem or Solution?
Richard Scheffler, PhD, University of California, Berkeley
Kate Tulenko, MD, MPH, Deputy Director at Capacity Plus/ IntraHealth
Health Policy Specialist at World Bank
International Health Workforce Issues
Amy Hagopian, MHA, PhD, Health Alliance International, University of Washington
In the Wake of the Storm: On the Ground in Haiti
Susan Partovi, MD, Professor UCLA School of Medicine
Director Homeless Healthcare Los Angeles
Trade and Health: The Impact of Health Worker Migration
Michelle Forzley, JD, MPH
Nuclear Non-Proliferation: The Physicians Role in Advocating Peace
Bob Dodge, MD, Physicians for Social Responsibility, Los Angeles
California Health Policy: Experiences & Experiments in State Policy and its Nationwide Influence
California has long been at the forefront of the ever-changing face of healthcare. Its struggles are often those of other states around the country, and the innovations and experiments in health care delivery have offered guidance to the rest of the nation, whether in success or in failure. With the ongoing budget crisis in the state and the potential impact of impending national health legislation, adding to other internal debates about border health, malpractice, medical marijuana, and disaster preparedness, now as ever, California will be watched by the nation. In the California health track we hope to stimulate learning, debate and exchange of ideas around these and other issues relevant to patients, providers, and policy-makers. Sessions to include:
Issues facing Community Health Clinics and the Underserved & Minority Populations
Michael R. Cousineau, PhD, Director Community Health and Family Medicine University of Southern California Castulo de la Rocha, JD, President & CEO AltaMed Medical Services
A ‘Reformed Single Payer’ in the Current Reform Era
E. Richard Brown, PhD, Director, UCLA Center for Health Policy Research Professor, UCLA School of Public Health, Principal Investigator, CHIS
Border States and the Uninsured: Immigration Issues for Health Care Reform
Michael Rodríguez, MD, MPH, Sr. Researcher, UCLA Center for Health Policy Research Professor, UCLA Department of Family Medicine
Krysten Sinema, MSW, Arizona State Legislator
Progressive States Network – Speaker TBA
Addressing Disparities Through Health Reform
National Women’s Law Center
Healthcare Crisis in a Bankrupt State: Can California Still Lead?
Herb Schultz, MPP, Senior Health Policy Advisor to the Governor
Sara Rogers, Health Legislative Advisor to Senator Mark Leno
Coordinating Across State Lines: Opportunities Presented by Health Care Reform
Progressive States Network – Speaker TBA
posted by Matt Anderson, MD
Add a comment December 31st, 2009 by lanny
Gold, Pacific Rim and “The Salvador Option” in El Dorado, Cabanas, El Salvador
A few years back, when the US was worrying about opposition groups in Iraq operating out of Syria, the proposal was made to attempt “The Salvador Option” (Newsweek, 1/10/05, see also The New Statesman at http://www.newstatesman.com/200501310012). Ah, what was that? Why, just as the USA did in El Salvador (and Honduras, under John Negroponte’s watch), a plan to create rogue death squads in Iraq with a license to kill. What was done from that suggestion, I don’t know, but the fact that it was even considered and that it was called “The Salvador Option” says so much about US foreign policy (during its proposal, John Negroponte was US Ambassador to Iraq) that we must highlight that plan and keep its consideration fresh to prevent such atrocities.
Tragically, the (El) Salvador Option has, for community environment activists, returned to the site of its name, this time with the unhappy association of a transnational mining company based in Canada and the United States by the name of Pacific Rim. For an interview covering the tragedies, please see Democracy Now (http://www.democracynow.org/2009/12/29/ ).
The summary is that on 26 December a 32 year old, 8 month pregnant environmental activist named Dora Alicia Sorto Recinos was shot while carrying another of her children (also shot, but who survived), making her death the second within one week of an environmental activist opposed to Pacific Rim reopening the currently closed mine of El Dorado, and the third this year. See www.cispes.org for details of Ms. Sorto Recinos’ death and that of Ramiro Rivera, vice-president of the local Environmental Committee, who was killed on 20 December in front of his daughter, despite the police escort with him since he was shot 8 times last August. A 52 year old woman riding with him was also killed.
The first environmental and community activist killed was Marcelo Rivera (no relation to Ramiro Rivera), a teacher and cultural center director who was abducted 18 June 2009 and found dead a few weeks later in a well, his body showing signs of torture. See “The Mysterious Death of Marcelo Rivera” on Youtube, http://www.youtube.com/watch?v=yvXm52BhSHQ .
Pacific Rim, with golden tongue, has denied having anything to do with the death of Marcelo (see its official statement at http://pica-blog.blogspot.com/2009/09/pacific-rim-responds-to-report-about.html and its official plan of exploitation of El Dorado at http://www.pacrim-mining.com/s/Eldorado.asp ).
Pacific Rim, which was denied its permit to extract gold in El Salvador in April 2009, largely due to the efforts of Marcelo Rivera, has since applied for arbitration under the US-Central America Free Trade Agreement (CAFTA) to obtain millions of dollars in compensation for the closing of the mine. You can read the report that drew the Pacific Rim denial, published on13 August 2009 by Real News, available at http://therealnews.com/t/index.php?option=com_content&task=view&id=31&Itemid=74&jumival=411 For deeper exploration of corporate greed and how trade trumps health and the environment in international treaties, see NOW with Bill Moyers on “Trading Democracy” at http://www.pbs.org/now/transcript/transcript_tdfull.html
“The Salvador Option” is an unhealthy one for all concerned, including for environmental and community activists in Cabanas, El Salvador, which is contiguous with Honduras. Authorities from El Salvador, Canada and the USA must work to get to the bottom of who is killing environmentalists in Cabanas, and stop the killing. If this is happening in El Salvador, it is happening to all of us, everywhere.
Add a comment October 7th, 2009 by bronxdoc
Social Medicine, our open-access, online academic journal has just published its latest issue. Here is a brief summary of the articles all of which are available for free at www.socialmedicine.info and www.medicinasocial.info (in Spanish).
Children in post-Civil War Nepal singing revoutionary songs
Special Theme: Social Medicine & War
For this special theme issue on Social Medicine & War, Dr. Vic Sidel served as guest editor. His lead editorial (co-authored with Dr. Barry Levy) examines the diversion of resources to war and the preparation for war.
Quoting from their introduction to the three original research articles about war, Drs. Sidel and Levy write: ”Dr. Andrea Angulo Menasse, a researcher from Mexico City’s Autonomous University, documents the very personal story of how the violence of the Spanish Civil War affected one family. In her case study the trauma suffered by Spanish Republicans is traced through three generations and crosses the Atlantic Ocean as the family moves is exiled in Mexico. Dr. Sachin Ghimire from the Centre of Social Medicine and Community Health of the Jawaharlal Nehru University reports on his fieldwork in Rolpa, Nepal, the district from which the Nepal Civil War (also called the People’s War) originated in 1996. Based on 80 interviews, he documents the difficulties faced by health care workers as they negotiated the sometimes deadly task of remaining in communities where control alternated between Nepalese Special Forces and the Maoist rebels. Finally, Colombian researcher, Carlos Iván Pacheco Sánchez, from the University of Rosario in Bogota, brings an epidemiologist’s tools to examine the impact of the ongoing armed conflict in the border Department of Nariño. His discussion is informed by the current debate over health care in Colombia where a recent Constitutional Court decision has found that the current health care system violates the right to health.”
Closing the Gap: Where are we one year later
In August of 2009, the WHO’s Commission on the Social Determinants of Health issued a bold call to eliminate health disparities within a generation. Three articles in this issue look at what has – and has not – happened in the intervening year. Our second editorial examines the international response to the Commission’s call. José Carlos Escudero explores the meaning of the report for the WHO and underscores the report’s limitations. A detailed critique of the report, along with an alternative approach to addressing health inequities, is offered by Dr. Anne-Emanuelle Birn. Dr. Birn’s critique is especially important for offering important historical background by exploring how Europeans in the 19th century – notably Louis-René Villermé, Edwin Chadwick, and Friedrich Engels – each approached the social disparities that arose during the Industrial Revolution.
The Peckham Experiment
We are also very pleased to publish three classic texts describing the Peckham Experiment, an innovative community center built in England during the Depression. The Pioneer Health Center was designed around the idea of studying (and fostering) what makes people healthy, rather than what makes them sick. Imagine that!
Please visit the journal and explore the breadth, depth and scope of social medicine past and present. Along with some suggestions for the future.
posted by Matt Anderson, MD
1 Comment August 23rd, 2009 by bronxdoc
Washington DC readers of the Social Medicine Portal may be interested in attending the release of a report by the Center for Policy Analysis on Trade and Health (CPATH) on the effect of CAFTA-DR (the Central America – Dominican Republic US Free Trade Agreement) on access to medications. This is a topic we have covered previously on the Portal (see: Trade & Health at 2008 American Public Health Association Meeting).
The release will take place on Wednesday, August 26 from noon to 2PM at the University of California DC Washington Center, 1608 Rhode Island Ave. NW. A light lunch will be served. Speaking at the release will be Ellen R. Shaffer, PhD MPH and Joe Brenner, MA, co-Directors of the Center for Policy Analysis on Trade and Health.
Please RSVP, acceptances only, to Joseph R. McGhee at the IGCC Washington office: Phone (202) 974-6295; Fax (202) 974-6299; email: joseph.mcghee@ucdc.edu . For more on IGCC, see http://www-igcc.ucsd.edu.
We will post links and commentary about the report when it is released on Wednesday.
posted by Matt Anderson, MD
2 Comments August 11th, 2009 by claudio
States do not have friends, only interests. (Charles de Gaulle)
1. As we have it now, foreign aid is instrumental in decreasing constructive social, economic, and political tensions and internal contradictions that would tend, sooner or later, redress or resolve the growing imbalances and injustices of the prevailing internal exploitative system in many a recipient country.
2. In the best of cases, donors give their aid in a well-intentioned, but nevertheless vain and futile attempt to mitigate or remedy this ongoing internal economic exploitation.
3. In the worst of cases, as we all know, donors channel their aid through ruling national elites, most often fully aware of how these elites are instrumental in perpetuating this state of affairs: therefore, do the donors become accomplices in the process of exploitation?
4. Local governments channel their own development funds often to urban and more prestigious projects, resting assured that foreign aid will assume a sizable fraction of rural development costs for them.
5. To top things off, foreign aid often attempts to impose Western (Northern) models of development, e.g. cash-crop support or large irrigation schemes, which carry not only the seeds of the further exploitation of those supposedly aided, but also the continuing enrichment of the ruling elites.
6. The difficult to take truth is that, if current type Western (Northern) foreign aid does not cease or is drastically reoriented, it will never achieve its stated aims and objectives – a fact that is already widely recognized, but for which all kinds of excuses are found. If donors do not begin to look at macro-economic parameters, their “good will” will be used facetiously to perpetuate the status quo. (Chances are strong that many of the donor countries would not mind being used in such a way, as long as their public image looks good to the rest of the world, especially to the other members of the club of donors).
7. Most countries face quite a number of problems in managing to absorb all the foreign aid efficiently and clearly lag behind in that task. The bottlenecks that explain this are related among other factors, to shortages of trained manpower, serious limitations in infrastructure, and a slow-paced bureaucracy.
8. Instead of asking ourselves how much foreign aid poor people need, we must ask ourselves whether Western (Northern) tax dollars are being used to shore up the economic and political power of a few who make the powerlessness of the many inevitable. Do these tax dollars go to regimes who sustain themselves in power by repression against the poor? Statistics cannot help us answer such questions. Only identifying with needless human suffering will.
9. Foreign aid is rightly accused of many things: being based on a false logic: doing more harm than good; maintaining (and protecting) the status- quo in Third World countries; undermining food autonomy; being a political weapon of the rich countries; perpetuating underdevelopment. There is no indication that policies regarding this aid –both in donor and recipient countries– are changing drastically despite mounting evidence for the above claims.
10. Short of a call for an overall discontinuation of all aid, foreign aid can play a role in fostering development, but not just any kind of aid. In this context, it is important to determine which kind of aid would be needed, for whom, and under what circumstances.
11. But foreign aid has its own politics. Simply denouncing its deleterious effects is not enough. Some political actions need to be taken.
12. The mere thought that foreign aid can automatically bring mutual benefits is simply a political fiction. Moreover, the assumption that this aid can be neutral is as shaky as the now-discredited notion of a value-free education. Present day aid policy makers, therefore, have to be confronted with the pressing questions regarding the relevance of their own work. Development assistance cannot automatically be considered as well-suited to developing countries. In the international development community, it has actually gotten a rather bad image as a resource that has been poorly used. Mostly, the way it has been used is what has given it its bad reputation.
13. The fact that most formulas for using aid moneys were actually developed to expedite rapid disposal with minimal financial and political costs has conditioned the current drawbacks that have been pointed out. The result is that there are serious deficiencies in the operation and theoretical foundation of Northern foreign aid projects. These projects are often not implemented as planned and ultimate impacts remain unrealized.
14. Aid is extremely vulnerable to political pressures and is an area in which ‘politics-literally-stands-directly-between-the-life-and-death-of-millions’.
15. Some seem to believe that without foreign aid, the present development crises would be even worse. If this view were correct, there would be no reason to alter present development strategies and one should simply spend a great deal more money on them. The basic problem, however, is that these present strategies do not adequately address the issue of Human Rights violations, the issue of redistribution of assets and income, the issue of income generation for the poor and of adequate expenditures for public services for the poor.
16. Therefore, for alternative development strategies to become a cornerstone of genuine development (such as the Human Rights-based approach), policy cannot be usefully discussed outside a broader geo-political and socio-economic framework. Much more far-reaching steps must be taken to avoid the catastrophic failures of the past.
17. Moreover, the sad reality is that aid given with one hand as a soft loan is actually being taken away with the other. The debt trap in which many a developing country is caught makes it necessary to service the debt in hard currency, this directly undermining the whole idea of foreign aid.
18. Another valid criticism voiced about aid is that it gets too involved in looking at improving the system’s management, ignoring the need for the system’s drastic reform. Donor agencies somehow avoid raising the issues of structural changes, because of the conflict of interests this inherently raises for them. For many, aid is actually still coupled with a strong belief in the (discredited) trickle-down process despite the evidence that the actual value of the net transfers from most foreign-funded development projects is often less than 30% of the budgeted funds; a big proportion of it, donors spend at home in procuring goods and in expensive consultants (the latter often far removed from the realities in the South).
19. Further, there has also been a trend away from aid to the lower-income countries. The concentration of US aid on only a few countries, for example, shows that its objectives are strategic rather than humanitarian. But the US is not alone in this.
20. On another political note, donors actually agree that aid can discourage local production, increase dependency, alter people’s habits, encourage corruption, and does not reach the more needy. Nevertheless, they contend that none of these problems need happen under ‘proper’ safeguards. They genuinely seem to believe that aid, when used for ‘strict’ developmental purposes, can be made to have none of the above drawbacks. How this is going to come about is seldom elaborated upon.
21. In addition, the same aid often causes severe budgetary and logistic problems to the recipient countries since donors often pay for only some (or none) of the local recurrent costs.
22. According to Susan George, the following postulates are generally true for most countries receiving foreign aid:
- A strategy that benefits the least well-off groups will not be acceptable to the dominant groups unless their own interests are also substantially served.
- A strategy that benefits only poor classes will be ignored, sabotaged, or otherwise suppressed by the powerful, insofar as possible.
- A strategy that serves the interests of elites, while doing positive harm to the poor, will still be put into practice and, if necessary, maintained by violence so long as no change occurs in the balance of social and political forces.
23. So, to be more effective, foreign aid should:
-generate a multiplier effect on the amount of resources allocated for other disparity-reduction programs in the recipient country;
-primarily meet the transitional needs and costs of such disparity-reduction policy adjustments, acting mainly as a catalyst; aid is good only when used as a vehicle of transition;
-in some way, help increase the bargaining power of the poor and the politically marginalized. For this to occur, peasants, workers and women must be helped to form or strengthen their own representative associations.
24. If a recipient government cannot agree to these basic conditions –which will necessarily alter the internal balance of power– a simple syllogism would indicate that it would be better for the donor to withhold aid.
25. But perhaps aid needs to be rethought and restructured, not necessarily withdrawn. Centering it around the human rights-based framework is an option rapidly gaining ground. That will require fostering the political and economic changes necessary in the recipient country to make it possible for aid to really make a difference. The risk is for the latter effort to become another area for the donors being (rightly or wrongly) accused of neo-colonial interference.
26. The real commitment to the eradication of Human Rights violations, such as hunger, malnutrition, ill-health plus all the other, implies a massive assault on the roots of underdevelopment and poverty Foreign aid thus only adds false hopes to the prospects of poverty alleviation. At best, aid treats the symptoms of poverty, not its causes.
Anybody moved to react?
Claudio Schuftan, Ho Chi Minh City
cschuftan@phmovement.org
2 Comments July 15th, 2009 by cameron
I know the exciting stuff these days is healthcare reform, but I happen to be in Uganda for a month, taking care of the female ward at Kisoro hospital.
I was recently called away from rounds for an urgent admission. I arrived to find a thin woman in her 50s, dressed in swaths of colorful fabric. She was carrying one of the little black plastic bags that people use to bring vegetables home from market. Before I could ask her anything she coughed, hard and wet. Then she spit a mouthful of bright red blood into the bag. She had a fever of 101F and had a big right side infiltrate. I didn’t need a laboratory to tell me this woman likely had TB.
This woman is a cardiac patient in the chronic care clinic. There are several pages of notes documenting her heart condition, which is known as endomycocardial fibrosis. She’s been seen by the legendary Jerry Paccione, who politely rebutted the previous resident’s opinion of hypertension with a “not likely” scribbled in the margin.
We talked for a while, and eventually I thought I had a pretty complete history. I started to finish up, and sent my mind back across the most likely diagnosis. Why did this woman get TB?
“Have you ever been tested for HIV?” I asked her.
The way her eyes went left and right, scanning for nosy ears, immediately told me the answer. I stepped forward so she could whisper, and motioned my translator to do the same. The words she muttered were barely audible.
“She has HIV,” my translator said.
I looked down at the five pages of “Chronic Care Management” notes I was holding. They went back as far as 2006, and she’d never mentioned the fact that she had HIV.
“Do you have a doctor taking care of your HIV?” I asked. She said she went to the HIV clinic in this hospital for her care.
So she wasn’t telling her heart doctor that she had HIV. And she wasn’t telling her HIV doctor that she had a heart condition. The two sets of doctors were a hundred yards away from each other, and for three years this duplicity had been maintained.
It makes me angry. I can’t help it. You don’t want to talk about HIV? You don’t want to bring it into the open? Fine. But other societies have been down this road before. I was just a kid when the HIV epidemic started in the U.S., but even I remember that Silence = Death.
(more about my time in Uganda at whougandabelieve.blogspot.com)
Add a comment July 13th, 2009 by bronxdoc
We have just published a new issue of Social Medicine/Medicina Social, our bilingual, online journal. It is available in both English and Spanish. Our 13th issue touches on several important issues in world health including the current economic crisis and the WHO Commission’s on the Social Determinants of Health. And, of course, the stories of activists like the young US students (shown below) studying medicine at the Latin American Medical School (ELAM) in Havana. They will be traveling in the Southwest US this summer to discuss their experiences with the American Indian community:
The Economic Crisis and Public Health
Barry S Levy, Victor Sidel
The current global economic crisis seriously threatens the health of the public. Challenges include increases in malnutrition; homelessness and inadequate housing; unemployment; substance abuse, depression, and other mental health problems; mortality; child health problems; violence; environmental and occupational health problems; and social injustice and violation of human rights; as well as decreased availability, accessibility, and affordability of quality medical and dental care. Health professionals can respond by promoting surveillance and documentation of human needs, reassessing public health priorities, educating the public and policymakers about health problems worsened by the economic crisis, advocating for sound policies and programs to address these problems, and directly providing necessary programs and services. Full Text: PDF
An Interview with Sir Michael Marmot
The Editors
In August of 2008 the WHO Commission on the Social Determinants of Health concluded its work with the publication of a report entitled: “Closing the gap in a generation: Health equity through action on the social determinants of health.” The Commission’s chair, Sir Michael Marmot, was kind enough to answer our questions about the Commission’s recommendations. This interview was conducted by email in May of this yea
Social Medicine: We congratulate the Com-mission on its excellent work in bringing attention to the social determinants of health and the Commission’s call for health equity. We appreciated the Commission’s recognition that: “Social Justice is a matter of life and death.” We were also happy that the Commission included representatives of civil society in their work. This was an important affirmation of democratic values.
When thinking about health inequalities people often use the analogue of the ladder to show how the gradient of worsening health outcomes affects all people in society except (presumably) those at the very top. Thinking about the ladder leads us to pose the following question: Is making the ladder shorter (i.e. reducing inequalities) the only approach to inequalities or is it possible to imagine making the ladder disappear entirely?
Sir Michael Marmot: All societies have hier-archies. It is not conceivable, therefore, to have a society with no ladder. The conceptual framework of the Commission on Social Determinants of Health leads us to think of at least two (linked) ways to address the relation between position on the ladder and health: act at the societal level to reduce social inequalities, and break the link between position in the social hierarchy and health.
The first argues for reducing the slope of the social gradient. To see this, suppose, just for a moment, that the ladder were defined on the basis of years of education. People who had three years or fewer had life expectancy of 50 years, those who had 13 years or more had life expectancy of 80 and the rest were ranged in between in a graded way: the social gradient in health. Now if we had a societal change so that everyone had at least 10 years of education, and better health followed as a result, the magnitude of health inequity would be reduced. We have reduced inequities by making the ladder shorter. [...]Full Text: PDF
Participation and empowerment in Primary Health Care: from Alma Ata to the era of globalization
Pol De Vos, Geraldine Malaise, Wim De Ceukelaire, Denis Perez, Pierre Lefèvre, Patrick Van der Stuyft
With the 1978 Alma Ata declaration, community participation was brought to the fore as a key component of primary health care. This paper describes how the concepts of people’s participation and empowerment evolved throughout the last three decades and how these evolutions are linked with the global changing socio-economic context.
On the basis of a literature review and building on empirical experience with grass roots health programs, three key issues are identified to revive these concepts: The recognition that power, power relations and conflicts are the cornerstone of the empowerment framework; the need to go beyond the community and factor in the broader context of the society including the role of the State; and, considering that communities and society are not homogeneous entities, the importance of class analysis in any empowerment framework. Full Text:
PDFLatin American Social Medicine and the Report of the WHO Commission on Social Determinants of Health
RAFAEL GONZALEZ GUZMAN
In October 2008 the Latin American Social Medicine Association (ALAMES) organized an international workshop entitled “The Social Determinants of Health.” Representatives of ALAMES’ seven regions participated in discussions of the various consultative papers prepared by the working groups of the WHO Commission on the Social Determinants of Health as well as the Commission’s final report. The workshop considered how ALAMES should respond to the work of the Commission. In this paper we summarize the main points outlined in the position paper prepared by the Organizing Committee1 as well as a synopsis of the main contributions made by each of the workshop’s study sections. Full Text: PDF
For the full Table of Contents visit: http://journals.sfu.ca/socialmedicine/index.php/socialmedicine/issue/view/38/showToc
posted by Matt Anderson, MD
8 Comments July 11th, 2009 by bronxdoc
From our Friends at the People’s Health Movement: USA Circle
PHM and IPHU are pleased to announce the upcoming IPHU courses in India (September 21-30, 2009), Morocco (September 21-30, 2009) and Cuba (November 4-14, 2009). For details and registration, go to http://phmovement.org/iphu/. US health activists are encouraged to attend.
The International People’s Health University (IPHU) is one of the major programs of the People’s Health Movement. IPHU is a global university providing short courses and other resources for health activists. Courses are of a high academic standard and are documented for academic credit from established universities. IPHU short courses enable younger health activists, in particular, to make new connections, share experiences and study together. IPHU short courses strengthen the global network of people’s health activists.
Morocco – http://phmovement.org/iphu/en/morocco, in French and Arabic, Fes, Morocco
India – http://phmovement.org/iphu/en/bangalore/announcement, in English, Bangalore. This course is focused on Health and Equity.
Cuba – http://www.phmovement.org/iphu/en/CubaAnnounce, in Spanish and English, Havana
1 Comment June 11th, 2009 by lanny
In late 2006 I saw Dean Allan Rosenfield for the last time, in his office of the Columbia University School of Public Health, where he had served as dean since 1986. Diagnosed with ALS, he was breathing with supplemental oxygen. His presence—always inspiring to me in its lucidity of what is necessary and possible in the struggle for health and social justice—now showed unmistakably a quality which I realize had been there since long before I met him in 1993: the determination to make every minute alive count positively toward the lives of others.
Maternal Mortality—A Neglected Tragedy: Where is the M in MCH?” he shouted in an article in 1985 The Lancet 2 (8446): 83–85, with Deborah Maine startling and shaming a public health world which had since 1980 been reducing primary care to ever more selective programs targeting children and ignoring others, including those who give children birth and all who rear them, young and old. Alas, the question still stings and will until a comprehensive health approach to all humans, including mothers, comes with health acknowledged, planned and effectively funded globally as a basic human right.
According to Maternal Mortality in 2005: Estimates Developed by WHO, UNICEF, UNFPA and The World Bank (http://www.unfpa.org/upload/lib_pub_file/717_filename_mm2005.pdf), the United States has an MMR (Maternal Mortality Rate, i.e. maternal deaths for 100,000 live births) of 11 (11.5 according to the CDC, while for African-American women it is cited as 29.6, see http://www.cdc.gov/od/oc/media/pressrel/r010511.htm), putting the USA at number 41 in the world (the best is Ireland with an MMR of 1). Sierra Leone has an MMR of 2,100, while several other countries in Sub-Saharan Africa have rates above 1000 (examples: Niger 1,800; Angola 1,400; Rwanda 1,300; Burundi 1,100; Malawi 1,100). In short the numbers are atrocious, the realty of pregnancy as a risk for death around the world (even in the USA) evident to anyone who has worked with pregnant women outside the industrialized world and to many who have worked with pregnant women within the USA. The fifth Millennium Development Goal, MDG, is to decrease Maternal Mortality “by 75% by 2015 (starting in 1990).” Alas, even that would leave a terribly high number of women dying preventable deaths. Currently, the lifetime risk of a woman dying in childbirth in Africa is 1:26, with Niger having a lifetime risk of 1:7. (Ireland’s lifetime risk is 1:48,000, a demonstration of what is possible.
It was his characteristic kindness that led Dean Rosenfield to accept my invitation to write the Introduction to Women’s Global Health and Human Rights, WGHHR (http://www.jbpub.com/catalog/9780763756314/), “Global Women’s Health and Human Rights,” together with Caroline Min and Joshua Bardfield. He had always been kind to me, serving at the birth of Doctors for Global Health, DGH on the Advisory Council, and eventually becoming a major donor to DGH through a mechanism that doubled his donations. I have since learned that his kindness as author and co-author spurred many a renowned health professional to publish her or his first paper—one being the Director of the Residency Programs in Primary Care and Social Medicine at Montefiore Medical Center, Dr. Hillary Kunins, co-founder of Medical Students for Choice, MSFC (http://medicalstudentsforchoice.org/), with “Abortion: A Legal and Public Health Perspective” (Annual Review of Public Health, 1991; 12: 361-82).
In a recent lecture (1 June 2009) for the Global Health Course of Montefiore Medical Center and Albert Einstein College of Medicine, Dr. Joia Mukherjee, Medical Director of Partners in Health (www.pih.org) and an author in WGHHR, made the point that any woman who has had a C-section, received antibiotics or gotten blood during delivery or post-partum would likely have died in most parts of the world and consequently should, along with her partner and anyone else who loves her, be fighting for and demanding access to adequate birth-care for women worldwide as a matter of personal to global solidarity
I am certain that Dean Rosenfield would have affirmed that logic of sharing good fortune. His actions, literally to his dying day, embodied and encouraged such solidarity. In addition to his work promoting women’s health, he dedicated much of his professional life to fighting the AIDS epidemic. His vision extended to health equity for all, health in its largest sense of wellbeing including education—especially for women. “People should have access to the same care in a poor country as in a rich country,” he stated in an interview with Charlie Rose in 2006 (http://www.charlierose.com/view/interview/325), also saying: “I think it’s obscene that in our country 15-18% of people are uninsured.”
Dean Rosenfield enhanced Women’s Global Health and Human Rights, the book and the concept, by direct action throughout his professional life. Alas, the health and human rights reality worldwide for women—and thus for all persons–remains abysmal. In terms of global Maternal Mortality we have Ireland’s example as a target–why not? Equity, not just diminished misery, should be our goal—for women, for every human, anywhere in the world. That goal is Dean Rosenfield’s legacy. Making that goal happen is his challenge for all of us, now.
2 Comments May 15th, 2009 by Claudia Chaufan
The following news (brought to my attention by my dear friend Cristina), from today’s Amy Goodman’s Democracy Now radio show, provides a good exercise in critical thinking: finding the flaws in president Obama’s argument (invalid inferences, false assumptions, etc) that ” it is best to build on the health care system we have”, rather than presumably adopt too radical solutions like single payer (I myself could find four flaws in two minutes! For a fuller argument for why it is misguided at best to build on “the health care system we have” read “Not Change We Can Believe In“).
According to the president, “the vast majority” of Americans get coverage from their jobs, and presumably are satisfied with it.
Another interesting accompanying headline is “Health Industry Says Obama Overstated Pledge to Cut Costs” (surprise surprise!). It looks like, after all, companies “never agreed to specific yearly cuts, but only vague voluntary goals”.
For both clips, click here.
Obama Questioned on Single Payer
At a town hall-style event in Rio Rancho, New Mexico, Thursday, local resident Linda Allison asked President Obama why the White House and the Democratic-led Congress have ruled out single payer.
Linda Allison: “My question is, so many people go bankrupt using their credit cards to pay for healthcare. Why have they taken single payer off the plate? And why is Senator Baucus on the Finance Committee discussing healthcare, when he has received so much money from the pharmaceutical companies? Isn’t it a conflict of interest?”
President Obama: “If I were starting a system from scratch, then I think that the idea of moving towards a single-payer system could very well make sense. That’s the kind of system that you have in most industrialized countries around the world. The only problem is that we’re not starting from scratch. We have historically a tradition of employer-based healthcare. And although there are a lot of people who are not satisfied with their healthcare, the truth is, is that the vast majority of people currently get healthcare from their employers, and you’ve got this system that’s already in place. We don’t want a huge disruption as we go into healthcare reform, where suddenly we’re trying to completely reinvent one-sixth of the economy.”
Obama did not address the second part of Linda Allison’s question about Democratic Senator Max Baucus, who has excluded single-payer advocates from Senate Finance Committee hearings. Allison says she was partly inspired to ask the question after viewing Democracy Now!’s coverage on Wednesday of single-payer advocates who disrupted Baucus’s hearing.
