Shifting discourse on health in Canada: from health promotion to population health

This paper argues that discourse on health are products of the particular social, economic and political context within which they are produced. In the early 1980s, the discourse on health in Canada shifted from a post-Lalonde Report lifestyle behaviour discourse to one shaped by the discourse on the 'social determinants of health'. In Canada, we are currently witnessing the emergence of another discourse on health-'population health'-as a guiding framework for health policy and practice. Grounded in a critical social science perspective on health and health promotion, this paper critiques the population health discourse in terms of its underlying epistemiological assumptions and the theoretical and political implications which follow. Does it matter whether we talk about 'heterogeneities in health' or 'inequities in health'? This paper argues that it does, and concludes that population health is becoming a prevailing discourse on health at this particular historical time in Canada because it provides powerful rhetoric for the retreat of the welfare state. This paper argues further that it is health promotion's alignment with the moral economy of the welfare state that makes it a countervailing discourse on health and its determinants.     

Towards an economic model of the Dutch health care sector

This paper describes the construction of a model of the Dutch health care sector. It discusses the behaviour of patients, general practitioners, medical specialists and hospital managers. It also analyses the various ways the actors interact, such as general practitioners supplying the services demanded by patients, specialists dispatching referrals made by general practitioners or hospital managers boosting output to match an increasing amount of specialist services. Numerical simulations illustrate the various mechanisms in the model. © 1997 John Wiley & Sons, Ltd.     

政府在农村公共卫生领域的职责与经济政策

《中共中央、国务院关于进一步加强农村卫生工作的决定》(以下简称《决定》)指出：“农村卫生工作是我国卫生工作的重点，关系到保护农村生产力、振兴农村经济、维护农村社会发展和稳定的大局，对提高全民族素质具有重要意义”。《决定》要求：加强农村公共卫生工作，推进农村卫生服务体系建设，加大农村卫生投入力度，建立和完新型善农村合作医疗制度和医疗救助制度，依法加强农村医药卫生监管，加     

The health care sector as economic driver: an economic analysis of the health care market in the city of Berlin

Taking the German capital Berlin as an example, the role of the health care sector in terms of employment, revenues and growth is empirically assessed. The article is based on the authors study Gesundheitsmarkt Berlin—Perspektiven für Wachstum und Beschäftigung (Henke et al. 2002) (The Berlin Health Care Market—Growth and Employment Prospects). For this purpose, the authors collected data for the years 1998, 1999 and 2000 on turnovers and employment in the various sectors of the local health care market. Results indicate that 177,781 persons, or almost one out of eight persons, are employed in health-related areas in Berlin, which is more than in the German average. The gross value added of Berlins health care market has been estimated at €6.8 billion, corresponding to 10% of the gross value added of Berlins overall economy in 1999. Health expenditures are estimated at 11.9%, which is higher than the German average at 10.8%. Taking these figures as a basis, suggestions to strengthen and further develop this potential are derived. This article demonstrates that health care can be an important economic factor in the regional context and thus should not only be regarded as a cost factor but should be developed.

Colombia: in vivo test of health sector privatization in the developing world.

The reform of the Colombian health sector in 1993 was founded on the internationally advocated paradigm of privatization of health care delivery. Taking into account the lack of empirical evidence for the applicability of this concept to developing countries and the documented experience of failures in other countries, Colombia tried to overcome these problems by a theoretically sound, although complicated, model. Some ten years after the implementation of "Law 100," a review of the literature shows that the proposed goals of universal coverage and equitable access to high-quality care have not been reached. Despite an explosion in costs and a considerable increase in public and private health expenditure, more than 40 percent of the population is still not covered by health insurance, and access to health care proves uncreasingly difficult. Furthermore, key health indicators and disease control programs have deteriorated. These findings confirm the results in other middle- and low-income countries. The authors suggest the explanation lies in the inefficiency of contracting-out, the weak economic, technical, and political capacity of the Colombian government for regulation and control, and the absence of real participation of the poor in decision-making on (health) policies.     

市场经济与卫生改革对不同性别人群卫生服务可及性的影响

该文采用定性研究方法,描述和分析了南通、淄博两市在市场经济条件下医疗保健制度改革对不同性别人群卫生服务可及性的影响.研究发现不同性别人群的卫生服务可及性与疾病种类、个人与家庭的经济实力、可享有的社会福利、以及社会地位/关系等直接相关;性别差异对卫生服务可及性无直接影响;在职女工的妇女保健服务基本可及.但个人与家庭抗慢性重大疾病风险的能力不足;非在职职工的医疗保险和保健工作需要大,但落实难;社会政策的制定还应为女性劳动者创造公平的竞争条件,并为其生儿育女的再生产过程提供风险保障.     

Utility of the public health approach for the world population strategy

OBJECTIVE: The populations of developing countries have so dramatically increased over the past two centuries that it has tended to undermine sustained economic growth and development. The population growth rate in the Philippines, in particular, remains at 2.0%, one of the highest in the other southeastern Asian countries. This has exacerbated problems of economic disparity and deterioration in development so that the Philippine Government has declared it a political priority to address the population problem and for this purpose has asked the Japan International Cooperation Agency (JICA) for assistance. METHOD: Based on past experience with the world population issue, the International Conference on Population and Development in Cairo (ICPD) declared that the population strategy should be merged into socio-economic development strategies that aim to achieve basic human needs, such as, education, public health and gender equality. JICA assistance to improve maternal and child health status and promote community health initiatives in the Philippines is based on this new paradigm; the ICPD plan. OUTPUT AND CONCLUSION: JICA has supported a diverse range of public health activities, such as the establishment of a comprehensive maternal and child health care system, advocacy of reproductive health, performance of adolescence health education and assistance for participatory community action. The efforts were generally geared towards sustainable implementation of health activities in the community. The JICA project employed the public health approach that gained a global consensus at Cairo to challenge the problem of a continuously high rate of population growth.     

Tobacco or health in the Third World: a political economy perspective with emphasis on Mexico

In response to declining cigarette sales in the United States and Europe, transnational tobacco conglomerates have turned to the underdeveloped world to promote their unhealthy products for consumers who are at best only vaguely aware of the health risks associated with cigarette smoking. While cigarette sales in the Third World are growing "healthily," the consumers of these cigarettes generally are not. Along with the already difficult problems of malnutrition and communicable diseases, underdeveloped countries are facing the probability of a smoking epidemic, which is directly related to the penetration of capitalist tobacco interests into new markets. While the tobacco companies are quick to suggest that these people who can least afford cigarettes (both financially and in terms of health risks) are exercising their "free choice" as consumers in an "open marketplace," the author suggests that political and economic factors are central. Aided by two months of fieldwork in Mexico in 1986, the author examines smoking behavior and perceptions of associated health consequences. In addition, the influence of the tobacco companies and the Mexican government on tobacco production and consumption is analyzed.     

The shift from entrepreneurial to political power in the Canadian health system

The Canadian health system has moved from an entrepreneurial focus to a public service emphasis in which political power has emerged as a dominant influence. No rational national policy has yet evolved. Critical decisions are based on immediate exigencies. The process of negotiation is seen as a series of short term bargains between power groups, similar to the British process of “muddling through”.     

The economic rationale of public and private sector roles in the provision of animal health services

In the changing market environment of livestock products, the delivery of animal health services is emerging as an important priority area for enhancing the competitiveness of poor livestock producers. At the same time, governments are continuing to face serious budgetary difficulties and are finding it difficult to expand the reach of these services or improve service quality. In this context of a changing environment and dwindling public resources, this paper revisits the economic framework that has thus far guided thinking about public and private sector roles in the provision of animal health services and examines the ongoing debate on livestock service delivery for the poor. The paper highlights the importance of strong institutions and appropriate legislation for regulating behaviour and enforcing contracts and re-emphasises the idea, which is supported by economic theory, that there is a need for task sharing between the public and private sectors. The paper further emphasizes the need for: a) integrating the debate on livestock service delivery with the larger debate on political economy and institutional development, and b) ensuring service access in poor marginal areas by working through membership organisations, self-help groups and civil society organisations, and by promoting the use of para-professionals and community-based animal health delivery systems.     

Community health centers' impact on the political and economic environment: the Massachusetts example

Since their inception in 1965, community health centers have thrived against tough odds, including patchwork funding, an unpredictable public policy environment, and a volatile healthcare marketplace. Much of this long-term success has been attributed to the centers' ability to affect their economic and political environment. Massachusetts provides an excellent example of this outward orientation. It was here that the centers first took hold, grew rapidly as a result of grassroots activity, and came together as a group for advocacy and mutual assistance. This article examines the Massachusetts experience in light of the health centers' ability to survive and grow.     

The economic and political determinants of human (including health) rights

This paper presents an analysis and critique of the U.S. government's current emphasis on human rights; and (a) its limited focus on only some civil and political components of the original U.N. Declaration of Human Rights, and (b) its disregard for economic and social rights such as the rights to work, fair wages, health, education, and social security. The paper discusses the reasons for that limited focus and argues that, contrary to what is widely presented in the media and academe: (1) civil and political rights are highly restricted in the U.S.; (2) those rights are further restricted in the U.S. when analyzed in their social and economic dimensions; (3) civil and political rights are not independent of but rather intrinsically related to and dependent on the existence of socioeconomic rights; (4) the definition of the nature and extension of human rights in their civil, political, social, and economic dimensions is not universal, but rather depends on the pattern of economic and political power relations particular to each society; and (5) the pattern of power relations in the U.S. society and the western system of power, based on the right to individual property and its concomitant class structure and relations, is incompatible with the full realization of human rights in their economic, social, political, and civil dimensions. This paper further indicates that U.S. financial and corporate capital, through its overwhelming influence over the organs of political power in the U.S. and over international bodies and agencies, is primarily responsible for the denial of the human rights of the U.S. population and many populations throughout the world as well.