En los primeros veinticino años de ALAMES

Twenty five years ago, in a peaceful rural corner of Ouro Preto, Brazil, twenty people decided to establish the Latin American Association of Social Medicine (ALAMES). We were searching for new theoretical horizons and better health conditions for the people of our region. Twenty of us signed the declaration, but there were hundreds at the Ouro Preto meeting and thousands more who were committed to and interested in the new organization. We were cognizant of what had preceded this event. We knew that 140 years before us a group of German revolutionaries had undertaken a radical reform of thinking and practice in health services and education. Their ideas had not disappeared; they remained alive in several countries and were embodied in the work of thinkers like Giovanni Berlinguer. We knew that in our continent, recently hit by the systemic crisis of capitalism in the 1970’s and burdened by a massive external debt, the countries of the southern cone were struggling to emerge from dark and bloody military dictatorships. Revolutionary winds were sweeping across Central America and the Caribbean. We were also conscious that a social science component – intentionally functional and instrumental in character – had recently been introduced into the curriculum for training health care professionals. Nonetheless the training and practice of health care professionals remained dominated by a disease-centered theoretical perspective and a bio-centric logic. Teaching was more concerned with the interests of the established powers than those of the impoverished majorities.Discurso pronunciado en la ceremonia inaugural del XI Congreso Latinoamericano de Medicina Social y Salud Colectiva, Bogotá, Colombia, 15 de noviembre de 2009

Lincoln Hospital: the decline of health care

“Lincoln Hospital: the decline of health care”was broadcast on WBAI radio in New York City onApril 22, 1971, roughly a year after the communitytakeover of Lincoln Hospital (see Fitzhugh Mullan’sarticle “Seize the Hospital to Serve the People” onpage 98 of this journal)

Las consecuencias en la salud de denunciar

People who speak out in the public interest, known as whistleblowers, often threaten vested interests. When whistleblowers suffer reprisals, as frequently occurs, the consequences for their health can be serious. Interviews with members of Whistleblowers Australia reveal that whistleblowers can experience a range of adverse psychological and physical effects, some of them quite serious. Whistleblowers use various methods to cope with these consequences, including telling their stories and seeking support from counsellors and others. Key words whistleblowing; health; coping; well-beingLas personas que denuncian irregularidades por el interés público se conocen en inglés como whistleblowers [no existe un término equivalente en español] y con frecuencia amenazan intereses creados. Cuando los que denuncian sufren represalias, como frecuentemente ocurre, las consecuencias en su salud pueden ser muy serias. Los que denuncian utilizan varios métodos para hacer frente y manejar estas consecuencias, lo que incluye contar sus historias y buscar apoyo de consejeros y otros. De estas experiencias trata este artículo.

La reforma de la salud en los Estados Unidos: una visión socialista

At first glance, it doesn't seem as though socialism and health-care reform have a whole lot to do with each other. After all, the most visible "left" position in the current discussion of health-care reform merely advocates for the government to assume the function of national insurer, leaving the delivery of health care - from its often-questionable content to its hierarchical relationships - firmly in place. As such, a single payer, Medicare-for-All insurance program is a modest, even tepid reform. Those of us on the left who have been active in the single payer movement have always seen it as a steppingstone toward health-care justice: until the question of access to care is solved, how do we even begin to address not only health care but also health inequities? How, for example, can working-class Americans, Americans of color, and women demand appropriate, respectful, humane, first-rate care when our ability to access any health-care services at all is so tightly constrained?Reflexiona sobre la reforma del sistema médico en los Estados Unidos

Una crítica punto por punto a la ropuesta de la Fundación Rockefeller sobre la “Supervisión pública responsable de proveedores privados en sistemas de salud mixtos”

The 2010 World Health Assembly (WHA) tabled, but did not manage to discuss, a resolution on regulating the private health care sector. 1  With hindsight, it seems fitting to thoroughly review an earlier 2008 Rockefeller Foundation (RF) report on the same issue: “Public Stewardship of Private Providers in Mixed Health Systems.” The key weakness of the RF document – and also of the above WHA draft resolution – is that both fail to provide the necessary empirical evidence to show that better ‘stewarding’ regulation in low and middle income countries (LMICs) has worked to provide quality, accessible, and affordable health care for all in mixed public-private health systems. In this article, we voice our skepticism about whether public stewardship can work in mixed systems in LMICs. Moreover, the RF report does not address the access to quality health care from a human rights perspective. The right to quality health care is simply overlooked.  The report prescribes “new solutions” to well known regulatory problems and fails to offer any evidence of their benefit. It argues that regulation of mixed public-private health systems can be successful without providing any evidence even at local level. This lack of evidence is striking since we have a good 20 years of experience with such regulation. We conclude that a) private providers will never be effectively controlled in LMICs with regulation alone, and b) that the report reflects RF’s ideological bias against single payer, universal coverage public health care systems. We argue that the “regulation alternative” is simply not a substitute for strengthening the public sector. Many of the measures proposed by the Rockefeller Foundation report are not necessarily wrong, but they are applied to a private sector enjoying an established position that has given them access to deliver health care as a privilege and not as a right. Indeed, we remain convinced that if some of the proposed measures were applied to the public health sector with adequate long-term government and donor financing, they would go a longer way to achieve Health Care For All. The past experiences of Costa Rica and Sri Lanka suggest that LMICs private health markets have only effectively been controlled in countries where the public sector was effective in competing with the private sector. A well organized and funded public health system, delivering comprehensive health care (not restricted to vertical disease control programs and not treating health as a commodity) is the only alternative to reign-in the excesses of LMIC private providers in mixed health systems.En 2010, la Asamblea Mundial de la Salud (WHA, por sus siglas en inglés) propuso, pero no logró discutir, una resolución sobre la regulación del sector privado de salud.1 En retrospectiva, parece adecuado hacer una revisión extensiva del informe (2008) de la Fundación Rockefeller (FR) sobre el mismo tema: “La gestión pública de los proveedores privados en los sistemas de salud mixtos”. El punto débil del documento de la FR (y de la resolución de la WHA antes mencionada) es que ninguno brinda la evidencia empírica necesaria para mostrar que una mejor regulación “gestadora/administrativa” en países de ingresos medios y bajos (LMICs, por sus siglas en ingles) ha logrado proveer atención de calidad, accesible y asequible para todos en sistemas de salud mixtos público-privados. En este artículo damos voz a nuestro escepticismo sobre la posibilidad de que la gestión pública funcione en sistemas mixtos dentro de LMICs. Además, el informe de la FR no revisa el acceso a la atención en salud de calidad desde una perspectiva de derechos humanos; el derecho a servicios de calidad simplemente es pasado por alto. El informe recomienda “nuevas soluciones” (lo que en la práctica significa “soluciones aún por demostrarse” a problemas en la regulación bien conocidos y no proporciona ninguna evidencia de sus ventajas. Por ejemplo, sostiene que la regulación de sistemas de salud mixtos público-privados puede ser exitosa sin brindar evidencia alguna; ni siquiera a nivel local. Esta falta de evidencia resulta sorprendente ya que tenemos unos buenos 20 años de experiencia con tal regulación.

El acoso laboral y la afectación a la salud de los trabajadores. Balance de la mesa "Mobbing y salud"

This paper reports the experience of the symposium “Mobbing and health”, held at the First Ibero American Conference on Workplace and Institutional Mobbing. Based on original research, the authors agreed that mobbing is harmful to physical and mental health, to social life and the relationship with the partner. Symptoms range from sleeping problems, food habits, mood, psychoactive substance use, anxiety, depression, fatigue and deterioration of sexual life, to headaches, hypertension, fibromyalgia and suicide, in extreme cases. The authors also agreed that family support, social support at work and psychotherapeutic intervention are key ways to help the victims. Harassment is recognized as a serious public health problem particularly, though not exclusively, in economically disadvantaged countries. This refers to the fact that mobbing, like other forms of violence, is one of the great evils resulting from the economic crisis that increased social inequality. The authors also said that phenomena such as mobbing should be made clear to the general society in seeking solutions. Thus it is important to target appropriate forums and opportunities to influence public policies and to encourage politicians to legislate and regulate comprehensive health protection of workers. Key words: mobbing, health, workplacesSe reporta la experiencia del I Congreso Iberoamericano sobre Acoso Laboral e Institucional, realizado en ciudad de México en el 2011. De manera sucinta, se hace un balance de los temas discutidos en la mesa acoso y salud. Con productos de investigación, los autores coinciden en que el mobbing, ocasiona daños a la salud física, mental, social y de pareja, que van desde trastornos del sueño, de la alimentación, del estado de ánimo, consumo de sustancias psicoactivas, ansiedad, depresión, fatiga y deterioro en la vida sexual, hasta cefalea, hipertensión, fibromialgia y suicidio en el peor de los casos. Asimismo, surge acuerdo en que la familia, el apoyo social en el trabajo y la intervención psicoterapéutica, se bosquejan como recursos que pueden ayudar a la víctima. Se reconoce al acoso laboral, como un grave problema de salud pública, de dimensiones exorbitantes, particularmente -aunque no exclusivo-, de países económicamente desfavorecidos, esto alude a la idea de que el fenómeno del acoso, al igual que otras formas de violencia, es uno de los grandes males derivados de las condiciones de crisis económica y del consiguiente incremento en la desigualdad social. También se alude a la idea de que fenómenos como el aquí tratado, se deben hacer evidentes y buscar como sociedad, soluciones que contribuyan a su disminución, buscando los foros adecuados y las posibilidades de incidir en políticas y legislación que ayude en su regulación y en la protección a la salud integral de los trabajadores. 

Crisis, condiciones de vida y salud en México. Nuevos retos para la política social

In the last 30 years, Mexico has faced major crises in its political, economic, and social life. These crises have affected living conditions and health. With the implementation in the 1980's of structural adjustment and economic stabilization policies, Mexico saw a rapid growth of poverty accelerating trends toward social polarization and social division. The current crisis, fueled by deregulation of the global financial markets, only deepens the tendency towards economic stagnation. It has led to an increase in unemployment, worsening income inequalities, and generalized inflation. The increase in food prices, in particular, has made life more difficult for the Mexican population. The crisis has had a palpable and concrete impact on living conditions, health status, and food security for diverse social groups.México tiene una historia reciente de crisis económico-financieras que han tenido efectos negativos en las condiciones de vida y en la salud de amplios grupos poblacionales. Con la implementación de políticas de ajuste y estabilización económica durante la década de los 80, el país registró un crecimiento acelerado de la pobreza, la sociedad se polarizó y se incrementó la desigualdad social. La crisis actual, resultado de la desregulación financiera de las economías globales, profundiza la tendencia observada en la disminución de la actividad económica, lo que se traduce en un aumento del desempleo, pérdida acelerada del ingreso y una mayor inflación general que, en conjunto, deterioran aún más las condiciones de vida, la salud y la alimentación de la población, particularmente, de los grupos sociales subalternos. Estos procesos estructurales de la economía mexicana plantean retos para pensar las políticas sociales desde una óptica que ubique las causas (y el combate) de la desigualdad en las formas de producción, consumo y distribución de la riqueza y no en programas focalizados de administración de la pobreza

Después de la revolución: un modelo fantaseado de la atención sanitaria

After the revolution: a Fantasied Model of Health CareDespués de la revolución: un modelo fantaseado de la atención sanitari