Global Acceleration and Dispossesion: Regression in the Right to Life and Public Health during Ecuador’s Neoliberal Decades

The present essay’s central argument or hypothesis is, consequently, that the mechanisms accelerating a wealth concentrating and exclusionary economy centred on the benefit and overprotection of big business—with a corresponding plundering of resources that are vital for life—generated forms of loss and regression in the right to healthcare and the dismantling of institutional protections. These are all expressed in indicators from 1990-2005, which point not only to the deterioration of healthcare programs and services but also to the undermining of the general conditions of life (social reproduction) and, in contrast to the reports and predictions of the era’s governments, a stagnation or deterioration in health indicators, especially for those most sensitive to the crisis. The present study’s argument is linked together across distinct chapters. First, we undertake the necessary clarification of the categories central to the understanding of a complex issue; clarifying the concept of health itself and its determinants, emphasizing the necessity of taking on an integral understanding as a fundamental prerequisite to unravelling what documents and reports from this era either leave unsaid or distort. Based on that analysis, we will explain the harmful effects of global economic acceleration, the monopolization and pillaging of strategic healthcare goods; not only those which directly place obstacles on the access to health services, but also those like the destructuration of small economies, linked to the impoverishment and worsening of living modes. Thinking epidemiologically, we intend to show signs of the deterioration of broad collectivities’ ways of life as a result of the mechanisms of acceleration and pillage. We will then collect disparate evidence of the deterioration of human health and ecosystems to, finally, establish the most urgent conclusions about this unfortunate period of our social and medical history.

The Ethics of Ethics Reviews in Global Health Research: Case Studies Applying a New Paradigm

With increasing calls for global health research there is growing concern regarding the ethical challenges encountered by researchers from high-income countries (HICs) working in low or middle-income countries (LMICs). There is a dearth of literature on how to address these challenges in practice. In this article, we conduct a critical analysis of three case studies of research conducted in LMICs.We apply emerging ethical guidelines and principles specific to global health research and offer practical strategies that researchers ought to consider. We present case studies in which Canadian health professional students conducted a health promotion project in a community in Honduras; a research capacity-building program in South Africa, in which Canadian students also worked alongside LMIC partners; and a community-university partnered research capacity-building program in which Ecuadorean graduate students, some working alongside Canadian students, conducted community-based health research projects in Ecuadorean communities.We examine each case, identifying ethical issues that emerged and how new ethical paradigms being promoted could be concretely applied.We conclude that research ethics boards should focus not only on protecting individual integrity and human dignity in health studies but also on beneficence and non-maleficence at the community level, explicitly considering social justice issues and local capacity-building imperatives.We conclude that researchers from HICs interested in global health research must work with LMIC partners to implement collaborative processes for assuring ethical research that respects local knowledge, cultural factors, the social determination of health, community participation and partnership, and making social accountability a paramount concern.

Starting well: Gender, care and health in the family context

In this article we present a critique of a series of public policy documents that aim at improvement in health for the general population, particularly families, but fail to recognize or appreciate the implications of gender for the everyday and the long-term experiences of family members. Drawing upon considerations of gender, families, health time and space and previous theoretical work (McKie et al, 2002), we propose the concept of healthscapes to aid the analysis and development of public policies. A healthscapes approach allows analysis of health policy within the diverse and multi-dimensional notions of time, space and gender that infuse the lifecourse. We assert that consideration of the gendered and generational project of caring particularly in relation to the (re)production of health, should involve a reflective inter-play between theory research and policy.

Inequality and GM crops: a case study of Bt cotton in India

Critics of genetically modified (GM) crops often contend that their introduction enhances the gap between rich and poor farmers, as the former group are in the best position to afford the expensive seed as well as provide other inputs such as fertilizer and irrigation. The research reported in this paper explores this issue with regard to Bt cotton (cotton with the endotoxtin gene from Bacillus thuringiensis conferring resistance to some insect pests) in Jalgaon, Maharashtra State, India, spanning the 2002 and 2003 seasons. Questionnaire–based survey results from 63 non–adopting and 94 adopting households of Bt cotton were analyzed, spanning 137 Bt cotton plots and 95 non–Bt cotton plots of both Bt adopters and non–adopters. For these households, cotton income accounted for 85 to 88% of total household income, and is thus of vital importance. Results suggest that in 2003 Bt adopting households have significantly more income from cotton than do non–adopting households (Rp 66,872 versus Rp 46,351) but inequality in cotton income, measured with the Gini coefficient (G), was greater amongst non–adopters than adopters. While Bt adopters had greater acreage of cotton in 2003 (9.92 acres versus 7.42 for non–adopters), the respective values of G were comparable. The main reason for the lessening of inequality amongst adopters would appear to be the consistency in the performance of Bt cotton along with the preferred non–Bt cultivar of Bt adopters—Bunny. Taking gross margin as the basis for comparison, Bt plots had 2.5 times the gross margin of non–Bt plots of non–adopters, while the advantage of Bt plots over non–Bt plots of adopters was 1.6 times. Measured in terms of the Gini coefficient of gross margin/acre it was apparent that inequality was lessened with the adoption of Bunny (G = 0.47) and Bt (G = 0.3) relative to all other non–Bt plots (G = 0.63). Hence the issue of equality needs to be seen both in terms of differences between adopters and non–adopters as well as within each of the groups.

Essays on labour market dualisation in Western Europe: active labour market policies, temporary work regulation and inequality

European labour markets are increasingly divided between insiders in full-time permanent employment and outsiders in precarious work or unemployment. Using quantitative as well as qualitative methods, this thesis investigates the determinants and consequences of labour market policies that target these outsiders in three separate papers. The first paper looks at Active Labour Market Policies (ALMPs) that target the unemployed. It shows that left and right-wing parties choose different types of ALMPs depending on the policy and the welfare regime in which the party is located. These findings reconcile the conflicting theoretical expectations from the Power Resource approach and the insider-outsider theory. The second paper considers the regulation and protection of the temporary work sector. It solves the puzzle of temporary re-regulation in France, which contrasts with most other European countries that have deregulated temporary work. Permanent workers are adversely affected by the expansion of temporary work in France because of general skills and low wage coordination. The interests of temporary and permanent workers for re-regulation therefore overlap in France and left governments have an incentive to re-regulate the sector. The third paper then investigates what determines inequality between median and bottom income workers. It shows that non-inclusive economic coordination increases inequality in the absence of compensating institutions such as minimum wage regulation. The deregulation of temporary work as well as spending on employment incentives and rehabilitation also has adverse effects on inequality. Thus, policies that target outsiders have important economic effects on the rest of the workforce. Three broader contributions can be identified. First, welfare state policies may not always be in the interests of labour, so left parties may not always promote them. Second, the interests of insiders and outsiders are not necessarily at odds. Third, economic coordination may not be conducive to egalitarianism where it is not inclusive.

Health in Brazil 6 Health conditions and health-policy innovations in Brazil: the way forward

Brazil is a large complex country that is undergoing rapid economic, social, and environmental change In this Series of six articles, we have reported important improvements in health status and life expectancy, which can be ascribed largely to progress in social determinants of health and to implementation of a comprehensive national health system with strong social participation. Many challenges remain, however. Socioeconomic and regional disparities are still unacceptably large, reflecting the fact that much progress is still needed to improve basic living conditions for a large proportion of the population. New health problems arise as a result of urbanisation and social and environmental change, and some old health issues remain unabated. Administration of a complex, decentralised public-health system, in which a large share of services is contracted out to the private sector, together with many private insurance providers, inevitably causes conflict and contradiction. The challenge is ultimately political, and we conclude with a call for action that requires continuous engagement by Brazilian society as a whole in securing the right to health for all Brazilian people.

Managerial leadership for research use in nursing and allied health care professions : a narrative synthesis protocol

BACKGROUND: Nurses and allied health care professionals (physiotherapists, occupational therapists, speech and language pathologists, dietitians) form more than half of the clinical health care workforce and play a central role in health service delivery. There is a potential to improve the quality of health care if these professionals routinely use research evidence to guide their clinical practice. However, the use of research evidence remains unpredictable and inconsistent. Leadership is consistently described in implementation research as critical to enhancing research use by health care professionals. However, this important literature has not yet been synthesized and there is a lack of clarity on what constitutes effective leadership for research use, or what kinds of intervention effectively develop leadership for the purpose of enabling and enhancing research use in clinical practice. We propose to synthesize the evidence on leadership behaviours amongst front line and senior managers that are associated with research evidence by nurses and allied health care professionals, and then determine the effectiveness of interventions that promote these behaviours.Methods/design: Using an integrated knowledge translation approach that supports a partnership between researchers and knowledge users throughout the research process, we will follow principles of knowledge synthesis using a systematic method to synthesize different types of evidence involving: searching the literature, study selection, data extraction and quality assessment, and analysis. A narrative synthesis will be conducted to explore relationships within and across studies and meta-analysis will be performed if sufficient homogeneity exists across studies employing experimental randomized control trial designs. DISCUSSION: With the engagement of knowledge users in leadership and practice, we will synthesize the research from a broad range of disciplines to understand the key elements of leadership that supports and enables research use by health care practitioners, and how to develop leadership for the purpose of enhancing research use in clinical practice.

Inequality and economic growth in Latin

Latin America is the region that bears the highest rates of inequality in the world. Deininger and Squire (1996) showed that Latin American countries achieved only minor reductions in inequality between 1960 and 1990. On the other hand, East Asian countries, recurrently cited in recent literature on this issue, have significantly narrowed the gap in income inequality, while achieving sustained economic growth. These facts have triggered a renewed discussion on the relationship between income inequality and economic growth. According to the above literature, income inequality could have an adverse effect on countries’ growth rates. The main authors who spouse this line of thinking are Persson and Tebellini (1994), Alesina and Rodrik (1994), Perotti (1996), Bénabou (1996), and Deininger and Squire (1996, 1998). More recently, however, articles were published that questioned the evidence presented previously. Representatives of this new point of view, namely Li and Zou (1998), Barro (1999), Deininger and Olinto (2000) and Forbes (2000), believe that the relation between these variables can be positive, i.e., income inequality can indeed foster economic growth. Using this literature as a starting point, this article seeks to evaluate the relation between income inequality and economic growth in Latin America, based on a 13-country panel, from 1970 to 1995. After briefly reviewing the above articles, this study estimates the per capita GDP and growth rate equations, based on the neoclassical approach for economic growth. It also estimates the Kuznets curve for this sample of countries. Econometric results are in line with recent work conducted in this area – particularly Li and Zou (1998) and Forbes (2000) – and confirm the positive relation between inequality and growth, and also support Kuznets hypothesis.

Inequality of opportunity in daycare and preschool services in Brazil

In this paper we measure inequality of opportunity in daycare and preschool services in Brazil. For this purpose, we construct an opportunity index that modifies the human opportunity index proposed in the literature and used in Barros et al. (2009) to measure inequality in basic opportunities in Latin America and the Caribbean. Specifically, we construct an opportunity measure that includes not only attendance but also parental choice not to enroll children in daycare or preschool, using data from a supplementary questionnaire included in the 2006 version of Pesquisa Nacional por Amostra de Domicílios (PNAD). The results show that there are large differences between our opportunity index and the human opportunity index for children aged 0-3 years old and considerably smaller differences for children aged 4-6 years old, which suggests that preschool may be closer to a basic opportunity than daycare.

Health and development with imperfect capital markets

This paper investigates the interaction between investment in education and in life-expanding investments, in a simple two-period model in which individuaIs are liquidity constrained in the first period. We show that under low leveIs of health and capital, investments in human capital and in health are complement: since the probability of survival is small, there is littIe incentive to invest in human capital; therefore the return on health investment is also low. This reinforcing effect does not hold for higher leveIs of health or capital, and the two investments become substitute. This property has many consequences. First, subsidizing health care may have dramatically different effects on private investment in human capital, depending on the initial leveI of health and capital. Second, the assumption that mortality is endogenous induces an increase in inequality of income: since health investment is a normal good, the return on education is also lower for poor individuaIs. Third,in a non-overlapping generation madel with non-altruistic agents, the hea1th leveI of the population has strong consequences on growth. For a very low leveI of hea1th, mortality is too high for the investment on education to be profitable. For a higher, but still low, levei of hea1th the economy grows on1y if the initial stock of capital is high enough; bad health and low capital create a poverty trapo Fourth, we compare redistributive income policies versus public hea1th measures. Redistributing income reduces both static and dynamic inequality, but slows growth. In contrast, a paternalistic health policy that forces the poor to invest in hea1th reduces dynamic inequality and may foster growth.

The effectiveness of community-based interventions to improve maternal and infant health in the Northeast of Brazil

EMOND, Alan et al. The effectiveness of community-based interventions to improve maternal and infant health in the Northeast of Brazil. Revista Panamericana de Salud Pública/ Pan American Journal of Public Health , v.12, n.2, p.101-110, 2002

Quality of life and its association with cardiovascular risk factors in a community health care program population

OBJECTIVE: To evaluate quality of life in a population that attended a specific community event on health care education, and to investigate the association of their quality of life with the presence of cardiovascular risk factors INTRODUCTION: Interest in health-related quality of life is growing worldwide as a consequence of increasing rates of chronic disease. However, little is known about the association between quality of life and cardiovascular risk factors. METHODS: This study included 332 individuals. Demographics, blood pressure, body mass index, and casual glycemia were evaluated. The brief version of the World Health Organization Quality of Life questionnaire on quality of life was given to them. The medians of the scores obtained for the physical, psychological, emotional, and environmental domains were used as cutoffs to define higher and lower scores. A multinomial logistic regression model was used to define the parameters associated with lower scores. RESULTS: Diabetes mellitus, dyslipidemia, and obesity were associated with lower scores in the physical domain. Dyslipidemia was also associeted with lower scores in the psychological domain. Male gender and regular physical activity had protective effects on quality of life. Aging was inversely associated with decreased quality of life in the environmental domain. CONCLUSION: The presence of cardiovascular risk factors is related to a decreased quality of life. Conversely, male gender and regular physical activity had protective effects on quality of life. These findings suggest that exercising should be further promoted by health-related public programs, with a special focus on women.

Millennium development goals: progress towards the right to health in Latin america and the Caribbean

Includes bibliography

Social dimensions of economic development and productivity: inequality and social performance

Includes bibliography

Modernization and foreign trade in the health services

Includes bibliography