Reframing urban health, reconnecting public health and contextualizing HIV. Lessons from South Africa

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Gobernanza y salud: significado y aplicaciones en américa latina

El término gobernanza es cada vez mas utilizado en la formulación, implementación y evaluación de políticas públicas. El propósito de este artículo es de clarificar su significado y de estudiar su utilidad en el estudio de las recientes políticas de salud de la América Latina. Después de discutir de las diferencias existentes entre gobernanza y los conceptos conexos de gestión, gobernabilidad y gobierno, proponemos la noción de la dualidad de la estructura social de Giddens para una mejor comprensión de los procesos de gobernanza. Utilizamos después este marco teórico para discutir de las implicaciones conceptuales y empíricas del grupo de trabajos sobre la gobernanza en salud en América Latina incluidos en el presente número de la Revista de Salud Pública. Reconociendo que el debate sobre gobernanza aun no está cerrado, terminamos nuestro texto subrayando las contribuciones más importantes de los trabajos revisados, a saber la importancia de la equidad en el proceso de toma de decisiones, el reconocimiento de la naturaleza política de la gobernanza, y las ventajas y limitaciones del modelo de clan en la regulación de las interacciones entre los actores implicados en la toma de decisiones políticas en salud

Rights, Knowledge, and Governance for Improved Health Equity in Urban Settings

All three of the interacting aspects of daily urban life (physical environment, social conditions, and the added pressure of climate change) that affect health inequities are nested within the concept of urban governance, which has the task of understanding and managing the interactions among these different factors so that all three can be improved together and coherently. Governance is defined as: “the process of collective decision making and processes by which decisions are implemented or not implemented”: it is concerned with the distribution, exercise, and consequences of power. Although there appears to be general agreement that the quality of governance is important for development, much less agreement appears to exist on what the concept really implies and how it should be used. Our review of the literature confirmed significant variation in meaning as well as in the practice of urban governance arrangements. The review found that the linkage between governance practices and health equity is under-researched and/or has been neglected. Reconnecting the fields of urban planning, social sciences, and public health are essential “not only for improving local governance, but also for understanding and addressing global political change” for enhanced urban health equity. Social mobilization, empowering governance, and improved knowledge for sustainable and equitable development in urban settings is urgently needed. A set of strategic research questions are suggested

Special Report: Health for All - from Alma Ata to Almaty

The global health policy landscape has changed considerably over the past decade. There is more money available to allocate to health initiatives than ever before, a large percentage of which has come from private funds and public private partnerships (PPPs). Some experts have welcomed these changes, while others have had considerable reservations. Despite positive developments, such as increased access to antiretroviral therapy for patients with HIV/AIDS, the health situation in poor countries and for the poor communities of rich countries remains abominable. It is often in the world’s poorest countries that the highest percentage of health costs is met with private, out-of-pocket spending. This creates poverty traps that can be impossible for people to escape

Sistema de salud en Argentina

Área de Economí

Erratum:Integrated approaches to address the social determinants of health for reducing health inequity (Journal of Urban Health DOI: 10.1007/s11524-007- 9173-7)

The social and physical environments have long since been recognized as important determinants of health. People in urban settings are exposed to a variety of health hazards that are interconnected with their health effects. The Millennium Development Goals (MDGs) have underlined the multidimensional nature of poverty and the connections between health and social conditions and present an opportunity to move beyond narrow sectoral interventions and to develop comprehensive social responses and participatory processes that address the root causes of health inequity. Considering the complexity and magnitude of health, poverty, and environmental issues in cities, it is clear that improvements in health and health equity demand not only changes in the physical and social environment of cities, but also an integrated approach that takes into account the wider socioeconomic and contextual factors affecting health. Integrated or multilevel approaches should address not only the immediate, but also the underlying and particularly the fundamental causes at societal level of related health issues. The political and legal organization of the policy-making process has been identified as a major determinant of urban and global health, as a result of the role it plays in creating possibilities for participation, empowerment, and its influence on the content of public policies and the distribution of scarce resources. This paper argues that it is essential to adopt a long-term multisectoral approach to address the social determinants of health in urban settings. For comprehensive approaches to address the social determinants of health effectively and at multiple levels, they need explicitly to tackle issues of participation, governance, and the politics of power, decision making, and empowerment