Who's afraid of national laws? Pesticide corporations use trade negotiations to avoid bans and undercut public health protections in Central America

The agrochemical industry is using trade agreements to block proposed bans on pesticides identified as the worst occupational health hazards by a multi-country illness surveillance program in Central America. Through privileged access to closed-door negotiations, industry inserted deregulatory mechanisms, including a regional pesticide registry that invalidates national laws, investors' rights protection, and increased intellectual property protections, into the draft Central American Customs Union and the Central American Free Trade Agreement. These agreements undermine health-based national pesticide registration requirements; weaken health ministries' role in pesticide control; block marketing of cheaper, less toxic pesticides; and have a chilling effect on future pesticide regulatory activity. So long as corporations have privileged access to the trade negotiations and civil society is excluded, the resulting agreements will benefit special interests at the expense of public health.     

Occupational health in Central America

The 12.4 million economically active population (EAP) of the seven Central American countries includes a large informal sector. Social security covers only 14-60%. No surveillance of occupational safety and health (OSH) hazards or accidents exists. Extrapolating the incidence of occupational accidents among insured Costa Rican workers to the Central American EAP yields two million accidents yearly, still a gross underestimate. Occupational diseases are underreported, misdiagnosed, and not recognized as such. A number of regional OSH programs aim at modernization of the labor administrations and address the formal sector, in particular textile maquila, in connection with free trade agreements. The weak role of the ministries of health is expected to strengthen under the Pan American Health Organization OSH program. Employers largely influence new policies. Workers' influence on OSH policies has been weak, with only about 10% unionization rate and scarce resources and OSH knowledge. Informal workers, however, are getting organized. OSH research is underdeveloped and not linked to policy making. Construction, agriculture, and general un/underemployment are considered priorities for intervention. The informal sector needs to be included in national and regional OSH policies. Regional collaboration and international development support are of strategic importance to achieve sustainable improvement in OSH.     

Occupational Health in Central America

Abstract

The 12.4 million economically active population (EAP) of the seven Central American countries includes a large informal sector. Social security covers only 14–60%. No surveillance of occupational safety and health (OSH) hazards or accidents exists. Extra polating the incidence of occupational accidents among insured Costa Rican workers to the Central American EAP yields two million accidents yearly, still a gross underestimate. Occupational diseases are underreported, misdiagnosed, and not recognized as such. A number of regional OSH programs aim at modernization of the labor administrations and address the formal sector, in particular textile maquila, in connection with free trade agreements. The weak role of the ministries of health is expected to strengthen under the Pan American Health Organization QSH program Employers largely influence new policies. Workers' influence on OSH policies has been weak, with only about 10% unionization rate and scarce resources and aSH knowledge. Informal workers, however, are getting organized. OSH research is underdeveloped and not linked to policy making. Construction, agriculture, and general un/underemployment are considered priorities for intervention. The informal sector needs to be included in national and regional OSH policies. Regional collaboration and international development support are of strategic importance to achieve sustainable improvement in OSH.     

Meeting minority health needs through special MCH projects

The maternal and child health programs of the Public Health Service have always been directed to minority populations; however, the recent surges of immigrants from Asian and Central American countries have caused the agency to appraise its efforts to meet the special health needs of these people. Through grants for special projects of regional and national significance (SPRANS), the Office of Maternal and Child Health is funding projects to break down language, culture, and access barriers to health services for pregnant women, infants, and children. Recent and current SPRANS projects have taken innovative approaches to solving the special health problems of the minority populations. They range from a breastfeeding initiative in the Commonwealth of the Northern Mariana Islands to an areawide genetic service program in the Virgin Islands. Examples of projects that have been conducted are presented.     

Revising antimalarial drug policy in Central America: experience in Panama

Panama is the first country in the Central American region that has officially discarded chloroquine as a first-line drug to treat Plasmodium falciparum cases. Here we describe the clinical and molecular findings from autochthonous P. falciparum fatal cases, and the epidemiological situation that led to a change in the national antimalarial drug policy. Our results illustrate the potential pathogenicity of the strain of P. falciparum circulating in the country and provide molecular evidence of parasite resistance to chloroquine and antifolate drugs. The public health threats of these findings for the Central American region are discussed.     

An innovative faith-based healthy eating program: from class assignment to real-world application of PRECEDE/PROCEED

The Fostering African American Improvement in Total Health! (FAITH!) Nutrition Education Program is a theory-based, multicomponent health intervention developed and operated in partnership with an East Baltimore church. The program aims to improve eating habits, as well as knowledge and beliefs about healthy eating, among African American adults in order to prevent diseases related to dietary choices. This article addresses the development, design, and formative research that informed the FAITH! program. The main program components are also discussed. Program design used a framework for strategic intervention planning (PRECEDE-PROCEED), and health education theories informed the evaluation process. Formative research was conducted to incorporate the needs and assets of the priority population. The main program components are culturally tailored educational materials, lectures and discussions on diet and related diseases, video presentations on healthy eating, healthy cooking demonstrations/food samples, evaluation, and a church-run healthy food pantry.     

Measuring acculturation among Central American women with the use of a brief language scale

The purpose of this study was to test the reliability and validity of a brief language usage scale as a measure of acculturation in 197 Central American immigrant women. This study presents an analysis of cross-sectional survey data collected during face-to-face interviews conducted in Spanish as part of the program evaluation of the Infant Feeding for Hispanic Supplemental Nutrition Program for Women, Infants, and Children (WIC) Populations a Peer Education Model. The Short Acculturation Scale, a four-item language usage scale exploring the participants' language preferences, was used as a measure of acculturation. The participant's age, length of time in the United States, and perceived social support for breastfeeding were used as validation measures. Results demonstrated good internal reliability for the acculturation summary scale. Consistent with previous studies, significant correlations (p < 0.01) were found between acculturation and mother's age, perceived social support for breastfeeding, and mother's length of time in the United States. The reliability and validity data from this group of Central American immigrants support the continued use of this brief measure of acculturation in diverse Latino subpopulations when multidimensional measures are neither practical nor feasible.     

Can Community Health Center funding enhance health services for Native American tribes and organizations?

This paper reports on the applicability of the Public Health Service Act (42 USC, 254b) Section 330 Community Health Center program to Arizona Native American tribes and organizations. Data review and analysis consisted of a review of two federal government documents concerning the funding of Community Health Center applications and a review of questionnaire responses received from the Arizona Native American health care community. Findings indicate a general lack of knowledge among the Arizona Native American health care community about the program as well as a need for capacity building among Arizona Native American tribes and organizations. As currently designed, the program has built-in barriers that prevent Native American tribes and organizations from applying for funding. Changes must be made to the existing program and local-level seminars must be offered to make this program and funding more readily available to Arizona Native American tribes and organizations.     

Health in Andean regional integration

Despite their shared history, the Andean countries are socially and politically diverse, with heterogeneous health realities and complex integration processes. General developments such as the Latin American Free Trade Association and Latin American Integration Association have existed for decades, along with others of a regional scope, like the Andean Community of Nations, Caribbean Community, and Central American Common Market. The health field has a specific instrument in the Andean Region called the Hipólito Unánue Agreement, created in 1971. Integration processes have concentrated on economic aspects, based on preferential customs agreements that have led to an important long-term increase in trade. Less progress has been made in the field of health in terms of sharing national experiences, knowledge, and capabilities. Analysis of experiences in health has shown that integration depends on the countries' respective strengths and to a major extent on national political processes.     

Translating ethics: researching public health and medical practices in Nepal

Conducting anthropological research into situations where public health interventions are ongoing raises a number of complex ethical issues. This paper addresses this by focusing on recent debate around questions of informed consent in research situations into health care in the 'developing' world. Two issues are developed: firstly, that of anthropological engagement with medical research trials; and secondly, how medical ethics debates have impinged upon and influenced anthropological ideas of ethics. Drawing on personal anthropological research into the implementation of the WHO prescribed tuberculosis control programme (DOTS) in the context of Nepal, I outline a number of ethical dilemmas and issues that arose. This research context included other ongoing research into DOTS implementation, as well as the local culture of health care provision. It involved moving between a number of sites and subject positions while interacting with heath professionals and patients. In conclusion, rather than prescribing ethical norms for researchers in such situations, I argue that we need more ethnographic examples and case studies as a means of thinking through the issues. I suggest that we need to reflect on both the ethical issues that arise when undertaking research into multifaceted public health interventions and into the situations where ethical guidelines and stipulations are formulated. The best place for this may be the Internet, where we increasingly see the conditions emerging for open dialogue.     

The Wire and Urban Health Education

As urban health has emerged as a distinct field, experts have collaborated to develop models for interdisciplinary education to train health professionals. Interdisciplinary learning is an important yet challenging imperative for urban health education. This paper explores lessons learned from a 2010 speaker series at the Johns Hopkins Bloomberg School of Public Health. The television show, The Wire, was used as a teaching tool to illustrate the context of health disparities in American cities and to explore the complex factors perpetuating urban health outcomes. We suggest that individuals interested in developing interdisciplinary teaching models can learn from both the form and the content of The Wire. As a popular televised serial narrative, The Wire prompts an investigation into the forms and circulation of academic research in a fractured and specialized media landscape. The formal narrative structure of the show provides mental scaffolding from which epidemiological, historical, geographical, anthropological, and other relevant disciplinary learning can build. The Wire encourages critical reflection among public health professionals about the forces that shape public health training, research, and practice and offers creative expansions to existing urban health educational efforts.     

Cuba's international cooperation in health: an overview.

In the first years after Cuba's 1959 revolution, the island's new government provided international medical assistance to countries affected by natural disasters or armed conflicts. Step by step, a more structural complementary program for international collaboration was put in place. The relief operations after Hurricane Mitch, which struck Central America in 1998, were pivotal. From November 1998 onward, the "Integrated Health Program" was the cornerstone of Cuba's international cooperation. The intense cooperation with Hugo Chávez's Venezuela became another cornerstone. Complementary to the health programs abroad, Cuba also set up international programs at home, benefiting tens of thousands of foreign patients and disaster victims. In a parallel program, medical training is offered to international students in the Latin American Medical School in Cuba and, increasingly, also in their home countries. The importance and impact of these initiatives, however, cannot and should not be analyzed solely in public health terms.     

An integrated program to train local health care providers to meet post-disaster mental health needs.

This paper describes a post-disaster mental health training program developed by the International Section of the Department of Psychiatry at Dalhousie University (Halifax, Canada) and delivered in Grenada after Hurricane Ivan struck the country in September 2004. This train-the-trainer program used an integrated community health model to help local health care providers develop the necessary skills for the identification and evidenced-based treatment of mental disorders occurring after a natural disaster. The approach also provided for ongoing, sustainable mental health care delivered in the community setting, as advocated by the World Health Organization and the Pan American Health Organization. This approach is in contrast to the largely ineffective and costly vertical whole-population psychosocial counseling activities that have often been used in the Caribbean following natural disasters.     

Physical disability and social liminality: a study in the rituals of adversity

Sociological research on the disabled has for the past 25 years made extensive use of a social deviance model to characterize the status of the physically impaired. The present article, which is based on a three-year anthropological investigation of the social relations of paraplegics and quadriplegics in the New York metropolitan area, argues that there are shortcomings in the deviance model and offers, instead, a model taken from the anthropological study of ritual. The disabled are viewed as being in a 'liminal' state, as in the liminal phases of rites of passages. They are persons having an undefined status: they are neither ill nor well, neither socially alive and active nor socially expunged and removed. The status of the disabled in American society and the symbolism of disability in American culture are reexamined within this framework. This perspective is extended to other types of deep adversity, such as acute loss of income and status or catastrophic illness.     

International Code of Conduct (Ethics) for Occupational Health and Safety Professionals

Abstract

This communication summarizes the available data on work-related determinants of health in Central America. The Central American working population is young and moving from agriculture toward industry and services. Ethnicity, gender, migration, subemployment and precarious work, informality, rural conditions, low-level educational, poverty, ubiquitous worksite health hazards, insufficient occupational health services, low labor inspection density, and weak unions define the constellation of social determinants of workers' health in Central America. Data are, however, scanty both for hazards and work-related illnesses and injuries. Governments and industries have the responsibility of opening decent work opportunities, especially for those facing multiple inequalities in social determinants of health. A first step would be the ratification and implementation of the ILO Convention (187) on occupational safety and health by the seven national governments of the region.     

Social determinants of workers' health in Central America

This communication summarizes the available data on work-related determinants of health in Central America. The Central American working population is young and moving from agriculture toward industry and services. Ethnicity, gender, migration, subemployment and precarious work, informality, rural conditions, low-level educational, poverty, ubiquitous worksite health hazards, insufficient occupational health services, low labor inspection density, and weak unions define the constellation of social determinants of workers' health in Central America. Data are, however, scanty both for hazards and work-related illnesses and injuries. Governments and industries have the responsibility of opening decent work opportunities, especially for those facing multiple inequalities in social determinants of health. A first step would be the ratification and implementation of the ILO Convention (187) on occupational safety and health by the seven national governments of the region.     

The epidemiology of HIV and AIDS among Central American, South American, and Caribbean immigrants to Houston, Texas

A retrospective study with respect to demographics and clinical parameters was conducted of all HIV/AIDS patients born in Central America, South America, and the Caribbean region, presenting to the Harris County Hospital District (public facilities) between 1994 and 1998. The original case definition criteria were fulfilled by 240 patients, 168 (70.0%) of whom were from Central America (including Panama), 42 (17.5%) of whom were from the Caribbean, and 30 (12.5%) of whom were from South America. The Central America group contained the highest proportion of women (37.5% compared with 20.8% among the group from the Caribbean and South America, P = 0.01, chi-square). The mean age was significantly lower among those born in Central America (32.4 vs. 38.8 for those born in the other two areas). The most commonly observed opportunistic infections were toxoplasmosis (14.8%), pneumocystosis (19.9%), and tuberculosis (12.1%). These data confirm the distinct epidemiologic parameters among Central American residents compared to the non-Central American populations as the Central American patients present with HIV infection to our health care system at a younger age and are more often women. The high rate of toxoplasmosis, pneumocystosis, and tuberculosis among those immigrants from the areas assessed in this study are a reminder of the need for intensified prophylaxis against these infections when working with patients from these populations.