Achievements and Challenges 20 Years after Beijing: A View from Switzerland

Despite being one of the world’s wealthiest countries and most modern economies, in Switzerland gender equality remains an elusive challenge. Paid maternity leave, legal abortion and an increase in women’s educational attainment are some of the milestones achieved since 1995, when the country was one of 189 states to adopt the Beijing Declaration and Platform for Action at the Fourth World Conference on Women. But while legal gender equality may be nearly achieved, much remains to be done to achieve gender equality in practice. Rigid gender stereotypes, wage discrimination, women’s heavy care burden, segregation in the workplace, violence against women, under-representation of women in political and economic decision making, and structural obstacles to reconciling family duties with employment still stand in the way of gender equality. In order to realize gender equality, government, employers, politicians and civil society all need to take concrete and coordinated actions. These range from changes in the educational sector, in the labour market and in the social security system to an active foreign policy that promotes women’s human rights.

Securing one's livelihood. Philanthropy in a mixed economy of welfare in the early 20th century

Since the late 19th century different social actors have played an important role in providing social security in Switzerland. Cooperatives, philanthropic organisations, social insurances, and the poor relief of the communes were all part of a "mixed economy of welfare". This article examines how the different actors in this "mixed economy" worked together, and asks what forms of help they supplied. It raises the question of whether a dichotomy between public and private forms of relief can be traced in the Swiss case. Did democratically legitimised processes of redistribution shape the social security system? Or was social security rather funded by private relief programs? The author argues that in the early 20th century, a complex public-private mix structured the Swiss welfare state and the poor often depended on both public and private funding. In this system, financially potent philanthropic organisations successfully contested the legal power of public actors.

Isotone Recursive Methods for Overlapping Generation Models with Stochastic Nonclassical Production

Based on an order-theoretic approach, we derive sufficient conditions for the existence, characterization, and computation of Markovian equilibrium decision processes and stationary Markov equilibrium on minimal state spaces for a large class of stochastic overlapping generations models. In contrast to all previous work, we consider reduced-form stochastic production technologies that allow for a broad set of equilibrium distortions such as public policy distortions, social security, monetary equilibrium, and production nonconvexities. Our order-based methods are constructive, and we provide monotone iterative algorithms for computing extremal stationary Markov equilibrium decision processes and equilibrium invariant distributions, while avoiding many of the problems associated with the existence of indeterminacies that have been well-documented in previous work. We provide important results for existence of Markov equilibria for the case where capital income is not increasing in the aggregate stock. Finally, we conclude with examples common in macroeconomics such as models with fiat money and social security. We also show how some of our results extend to settings with unbounded state spaces.

Health, education and community: Assets and needs of a small urban community in north east Tamaulipas, Mexico: A community based participatory research assessment

This study explored the health, education, social assets, needs, attitudes, and behaviors of residents of Ferrocarril #4, a small urban community in Tamaulipas, Mexico. A collaborative Participatory Action Research approach was used to emphasize community involvement. Using Triangulation to ensure validity, qualitative methods included key informant in depth interviews, participant observation and participatory discussion groups with women and men. A personal interview with a probability sample of women was done. The median age of interviewees was 37 years. The majority was married or had a partner. Over half of respondents completed grades 6-9. Employed women (25%) earned a median weekly salary equivalent to ∼56 USD. Women with health insurance (67.7%) were covered mainly through Social Security and Seguro Popular. One in 5 reported bad health. Barriers to care were primarily money and transportation. To improve health care, women wanted a full service clinic in or close to the community and affordable health care. Socially, 28% of respondents had no close friends in the community and most did not participate in beneficial community activities. Many women did not socialize with others and help from neighbors was situational. Primary school teachers lacked parental support and it interfered with classroom efforts. Healthy community discussion groups focused on personal and environmental hygiene and safety. Valuable assets exist in the community. To date, collaborative efforts resulted in a school First Aid station, a school nurse visit weekly, posting of emergency contact phone numbers in the school and community center, and development of a student health information form. ^

The welfare state determinants of health: Implications of regimes and pathways

Background. Population health within and between nations is heavily influenced by political determinants, yet these determinants have received significantly less attention than socioeconomic factors in public health. It has been hypothesized that the welfare state, as a political variable, may play a particularly prominent role in affecting both health indicators and health disparities in developed countries. The research, however, provides conflicting evidence regarding the health impact of particular regimes over others and the mechanisms through which the welfare state can most significantly affect health.^ Objective. To perform a systematic review of the literature as a means of exploring what the current research indicates regarding the benefits or detriments of particular regimes styles and the pathways through which the welfare state can impact heath indicators and health disparities within developed countries.^ Methods. A thorough search of the EBSCO, Pubmed, Medline, Web of Science, and Scopus electronic databases was conducted and resulted in the identification of 15 studies that evaluated the association between welfare state regime and population health outcomes, and/or pathways through with the welfare state influences health. ^ Results. Social democratic countries tended to perform best when infant mortality rate (IMR) was the primary outcome of interest, whereas liberal countries performed strongly in relation to self perceived health. The results were mixed regarding welfare state effectiveness in mitigating health inequities, with Christian democratic countries performing as well as social democratic countries. In relation to welfare state pathways, public health spending and medical coverage were associated with positive health indicators. Redistributive impact of the welfare state was also consistently associated with better health outcomes while social security expenditures were not.^ Discussion/Conclusions. Studies consistently discovered a significant relationship between the welfare state and population health and/or health disparities, lending support to the hypothesis that the welfare state is, indeed, an important non-medical determinant of health. However, it is still fairly unclear which welfare state regime may be most protective for health, as results varied according to the measured health indicator. The research regarding welfare state pathways is particularly undeveloped, and does not provide much insight into the importance of in-kind service provision or cash transfers, or targeted or universal approaches to the welfare state. Suggestions to direct future research are provided.^

Child Welfare Waivers: The Stakes for Families

Congress has restored the authority of the U.S. Department of Health and Human Services to issue “waivers” from rules restricting the use of some funds under Title IV-E of the Social Security Act. The waivers allow funds now restricted to foster care to be used for prevention, family preservation and other services as well. This paper discusses the benefits of waivers and estimates the amount of money that a waiver would cover in each state.

Ethnographic and epidemiologic approaches for the programming of prenatal and birth services in Mesa los Hornos, Mexico

The investigator conducted an action-oriented investigation of pregnancy and birth among the women of Mesa los Hornos, an urban squatter slum in Mexico City. Three aims guided the project: (1) To obtain information for improving prenatal and maternity service utilization; (2) To examine the utility of rapid ethnographic and epidemiologic assessment methodologies; (3) To cultivate community involvement in health development.^ Viewing service utilization as a culturally-bound decision, the study included a qualitative phase to explore women's cognition of pregnancy and birth, their perceived needs during pregnancy, and their criteria of service acceptability. A probability-based community survey delineated parameters of service utilization and pregnancy health events, and probed reasons for decisions to use medical services, lay midwives, or other sources of prenatal and labor and delivery assistance. Qualitative survey of service providers at relevant clinics, hospitals, and practices contributed information on service availability and access, and on coordination among private, social security, and public assistance health service sectors. The ethnographic approach to exploring the rationale for use or non-use of services provided a necessary complement to conventional barrier-based assessment, to inform planning of culturally appropriate interventions.^ Information collection and interpretation was conducted under the aegis of an advisory committee of community residents and service agency representatives; the residents' committee formulated recommendations for action based on findings, and forwarded the mandate to governmental social and urban development offices. Recommendations were designed to inform and develop community participation in health care decision-making.^ Rapid research methods are powerful tools for achieving community-based empowerment toward investigation and resolution of local health problems. But while ethnography works well in synergy with quantitative assessment approaches to strengthen the validity and richness of short-term field work, the author strongly urges caution in application of Rapid Ethnographic Assessments. An ethnographic sensibility is essential to the research enterprise for the development of an active and cooperative community base, the design and use of quantitative instruments, the appropriate use of qualitative techniques, and the interpretation of culturally-oriented information. However, prescribed and standardized Rapid Ethnographic Assessment techniques are counter-productive if used as research short-cuts before locale- and subject-specific cultural understanding is achieved. ^

COSTS AND EFFECTS OF ARKANSAS' LONG-TERM CARE DEMONSTRATION PROJECT (MEDICAID, CHANELLING, COMMUNITY ASSESSMENT)

The purpose of this study was to assess the impact of the Arkansas Long-Term Care Demonstration Project upon Arkansas' Medicaid expenditures and upon the clients it serves. A Retrospective Medicaid expenditure study component used analyses of variance techniques to test for the Project's effects upon aggregated expenditures for 28 demonstration and control counties representing 25 percent of the State's population over four years, 1979-1982.^ A second approach to the study question utilized a 1982 prospective sample of 458 demonstration and control clients from the same 28 counties. The disability level or need for care of each patient was established a priori. The extent to which an individual's variation in Medicaid utilization and costs was explained by patient need, presence or absence of the channeling project's placement decision or some other patient characteristic was examined by multiple regression analysis. Long-term and acute care Medicaid, Medicare, third party, self-pay and the grand total of all Medicaid claims were analyzed for project effects and explanatory relationships.^ The main project effect was to increase personal care costs without reducing nursing home or acute care costs (Prospective Study). Expansion of clients appeared to occur in personal care (Prospective Study) and minimum care nursing home (Retrospective Study) for the project areas. Cost-shifting between Medicaid and Medicare in the project areas and two different patterns of utilization in the North and South projects tended to offset each other such that no differences in total costs between the project areas and demonstration areas occurred. The project was significant ((beta) = .22, p < .001) only for personal care costs. The explanatory power of this personal care regression model (R('2) = .36) was comparable to other reported health services utilization models. Other variables (Medicare buy-in, level of disability, Social Security Supplemental Income (SSI), net monthly income, North/South areas and age) explained more variation in the other twelve cost regression models. ^

The role and impact of transitional care utilization in colorectal cancer

BACKGROUND Although one out of every five gastrointestinal cancer patients needs transitional care (home-based skilled care or placement in skilled nursing or rehabilitation facilities) following treatment, few studies have examined outcomes in this population compared to patients who return home without assistance. This study has two primary goals: 1. To evaluate long-term cancer-specific outcomes in colorectal cancer patients utilizing transitional care compared to those that return home without assistance following therapy 2. To compare results using standard regression techniques and propensity scores. ^ METHODS Patients undergoing curative surgery for colorectal adenocarcinoma will be identified using data from a tertiary care Veterans Administration hospital. Survival and recurrence will then be determined from VA records and the Social Security Death Index. ^ The association between transitional care utilization and overall and disease-free survival will be evaluated using Cox proportional hazards regression to adjust for confounding factors. Predictors of transitional care utilization will be assessed using multiple logistic regression to generate a propensity score which will also be used to assess differences in survival based on transitional care use. ^ POTENTIAL SIGNIFICANCE If transitional care utilization is associated with worse survival and recurrence following therapy then it will be important to subsequently assess the mechanism in order to target interventions to improve outcomes. If there is no difference in cancer-specific outcomes, then this project can potentially highlight benefits of supportive therapy following colorectal cancer resection.^

Policy analysis of shifting to the state-run Texas women's health program

During the 82nd Texas legislature, state leaders passed a provision stating that healthcare providers, who perform, promote, or affiliate with providers who perform or promote elective abortion services may not be eligible to participate in the Texas Medicaid Women's Health Program (WHP). The federal government reacted to this new provision by vowing to eliminate its 90% share of program support on the grounds that the provision violated a patient's freedom to choose a provider; a right protected by the Social Security Act. Texas leaders stated that the Women's Health Program would continue without federal support, financed exclusively with state funds.^ The following policy analysis compares the projected impact of the current Medicaid Women's Health Program to the proposed state-run program using the criteria-alternative matrix framework. The criteria used to evaluate the program alternatives include population affected, unintended pregnancy and abortion impact, impact on cervical cancer rate, and state-level government expenditures. Each criterion was defined by selected measures. The population affected was measured by the number of women served in the programs. Government expenditures were measured in terms of payments for program costs, Medicaid delivery costs, and cervical cancer diagnostic costs. Unintended pregnancy impact was measured by the number of projected unplanned pregnancies and abortions under each alternative. The impact on cervical cancer was projected in terms of the number of new cervical cancer cases under each alternative. Differences in the projections with respect to each criterion were compared to assess the impact of shifting to the state-only policy.^ After examining program alternatives, it is highly recommended that Texas retain the Medicaid WHP. If the state does decide to move forward with the state-run WHP, it is recommended that the program run at its previous capacity. Furthermore, for the purpose of addressing the relatively high cervical cancer incidence rate in Texas, incorporating HPV vaccination coverage for women ages 18-26 as part of the Women's Health Program is recommended.^

Comparing the quality of three models of postabortion care in public hospitals in Mexico City

artículo publicado en la revista Int Fam Plan Perspect. 2003 Sep;29(3):112-20

La etapa formativa de la Secretaría de Trabajo y Previsión (1943-1946) : Primeros pasos organizativos y figuras relevantes

A través del análisis de distintas fuentes estatales, biografías y publicaciones especializadas, entre otras, este artículo reconstruye los primeros pasos en el armado del área de Trabajo y Previsión durante el gobierno militar de 1943-1946, momento en el que tras varias décadas de actuación del viejo Departamento Nacional de Trabajo, se resolvió la jerarquización de los asuntos del trabajo en el organigrama estatal. En este lapso, se estableció la base de la organización interna de la nueva Secretaría de Trabajo y Previsión, de la mano de los aportes de varios personajes que procuramos recuperar aquí y que han quedado eclipsados por el peso de los nombres del propio Juan Perón y de sus colaboradores más conocidos y cercanos.

Evolución del mercado de trabajo y de la estructura del empleo en la Provincia de Buenos Aires desde la convertibilidad (1991-2009)

El artículo aborda la evolución del mercado de trabajo y de la estructura del empleo en la provincia de Buenos Aires durante el período 1991-2009. El análisis recurre a la articulación de una multiplicidad de fuentes de información para dar cuenta de los diferentes aspectos de los fenómenos laborales. A partir de la Encuesta Permanente de Hogares, se analizan los indicadores básicos de los mercados de trabajo urbanos en los principales aglomerados de la provincia y se lleva a cabo una caracterización de sus respectivas estructuras de empleo, considerando dimensiones tales como la categoría ocupacional, la composición público-privado, la condición de registro del empleo (registrado y no registrado) y el sector de actividad. Por otra parte, a nivel del total provincial, se analiza la evolución el empleo privado registrado y su composición sectorial. Para este tipo de análisis se utilizan datos procedentes de los registros administrativos que surgen de las declaraciones juradas de personal en relación de dependencia que realizan mensualmente los contribuyentes ante la AFIP. Estos datos permiten tratamientos muy desagregados de la información, de suma importancia para el análisis sectorial detallado. También a nivel del total provincial, se caracteriza al empleo público en sus distintos niveles de gobierno (nacional, provincial y municipal) a partir de fuentes presupuestarias y de otras, menos difundidas, elaboradas por distintos organismos públicos. El artículo ofrece análisis descriptivos de las variables mencionadas y un pormenorizado detalle metodológico respecto de las fuentes y el tratamiento de la información.

La etapa formativa de la Secretaría de Trabajo y Previsión (1943-1946) : primeros pasos organizativos y figuras relevantes

A través del análisis de distintas fuentes estatales, biografías y publicaciones especializadas, entre otras, este artículo reconstruye los primeros pasos en el armado del área de Trabajo y Previsión durante el gobierno militar de 1943-1946, momento en el que tras varias décadas de actuación del viejo Departamento Nacional de Trabajo, se resolvió la jerarquización de los asuntos del trabajo en el organigrama estatal. En este lapso, se estableció la base de la organización interna de la nueva Secretaría de Trabajo y Previsión, de la mano de los aportes de varios personajes que procuramos recuperar aquí y que han quedado eclipsados por el peso de los nombres del propio Juan Perón y de sus colaboradores más conocidos y cercanos.

La etapa formativa de la Secretaría de Trabajo y Previsión (1943-1946) : Primeros pasos organizativos y figuras relevantes

A través del análisis de distintas fuentes estatales, biografías y publicaciones especializadas, entre otras, este artículo reconstruye los primeros pasos en el armado del área de Trabajo y Previsión durante el gobierno militar de 1943-1946, momento en el que tras varias décadas de actuación del viejo Departamento Nacional de Trabajo, se resolvió la jerarquización de los asuntos del trabajo en el organigrama estatal. En este lapso, se estableció la base de la organización interna de la nueva Secretaría de Trabajo y Previsión, de la mano de los aportes de varios personajes que procuramos recuperar aquí y que han quedado eclipsados por el peso de los nombres del propio Juan Perón y de sus colaboradores más conocidos y cercanos.