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J Frenk

Publications and source records attributed to J Frenk.

At least 37 records · Page 2Linked to original sources
PubMed1994

[The epidemiological transition in Latin America].

The changes in health conditions that have occurred in most of the countries of Latin America in the second half of the twentieth century are analyzed. "This paper analyzes the main mechanisms involved in the epidemiologic transition, which are: changes in risk factors, fertility decline and improvements in health care technology." The authors use a mortality profile ratio, obtained by dividing the mortality rate due to infectious and parasitic diseases over the mortality rate due to cardiovascular diseases and neoplasms, to analyze trends in 15 countries. "Three distinct groups can be recognized. Each of them represents a different transitional experience. Such experiences are discussed in detail, including a new 'protracted polarized model' of the epidemiologic transition, which characterizes several Latin American countries. Finally, evidence is provided to illustrate the relationship among economic development, fertility change, and mortality profiles." (SUMMARY IN ENG)

Birth Rate↗
PubMed1993

The public/private mix and human resources for health.

This paper examines the general question of the public/private mix in health care, with special emphasis on its implications for human resources. After a brief conceptual exercise to clarify these terms, we place the problem of human resources in the context of the growing complexity of health systems. We next move to an analysis of potential policy alternatives. Unfortunately, a lot of the public/private debate has looked only at the pragmatic aspects of such alternatives. Each of them, however, reflects a specific set of values--an ideology--that must be made explicit. For this reason, we outline the value assumptions of the four major principles to allocate resources for health care: purchasing power, poverty, socially perceived priority, and citizenship. Finally, the last section discusses some of the policy options that health care systems face today, with respect to the combinations of public and private financing and delivery of services. The conclusion is that we need to move away from false dichotomies and dilemmas as we search for creative ways of combining the best of the state and the market in order to replace polarized with pluralistic systems. The paper is based on a fundamental premise: The way we deal with the question of the public/private mix will largely determine the shape of health care in the next century.

Delivery of Health Care↗
PubMed1993

The new public health.

Explore the source record for details and available documents.

Decision Making, Organizational↗
PubMed1992

Corporatism and health care: a comparison of Sweden and Mexico.

Up to now, the Swedish health care system has been used as a model for comparisons with other developed nations, chiefly in Northern Europe and the United States. This article departs from the mainstream and poses that similarities along the political factor of corporatism warrant a comparative analysis between the Swedish and Mexican cases. The most widely accepted definitions and typologies of corporatism are reviewed. The arena of manpower policy is used to illustrate the effects of alternative modes of interest representation on health care organization. The final aim of this comparative exercise is to enrich the empirical basis required to build a theory about the complex determinants of health care systems. State corporatism has acted in Mexico largely unchecked by geographical interest representation, in contrast with Sweden where centralist and decentralist forces are more balanced. This finding helps to understand why Sweden and Mexico mark extreme points along the health equity continuum. The comparison underscores the need for Sweden to avoid the risk of weakening the equity basis of its health care system as it moves along its current reform. The importance of these transformations go beyond Sweden, since they will undoubtedly offer new models of thinking and acting for the rest of the world.

Cross-Cultural Comparison↗
PubMed1992

Balancing relevance and excellence: organizational responses to link research with decision making.

Research faces the challenge of balancing relevance to decision making and excellence in the strict adherence to the norms of scientific inquiry. This paper examines the organizational responses that can be undertaken to promote integration of these potentially conflicting goals. We posit that there seem to be structural barriers to effective communication between researchers and decision makers, such as differences in priorities, time management, language, means of communication, integration of findings and definition of the final product of research. These barriers must be overcome through solutions aimed at the organization of research. In this respect, there are three possible models to approach the tension between excellence and relevance: academic subordination, segregation and integration. Only the latter makes it possible to reconcile the advantages of proximity to decision making with the procedures to assure academic quality. In addition to organizational design and institutional development, a strategy to promote research must include a set of incentives to prevent the 'internal brain drain', that is, the tendency of researchers to move to managerial positions. There are four guiding principles to address this problem: parallel careers, academic autonomy, administrative sacrifice and inverted incentives. The complexities of health problems demand that we create new organizational formulas to finally balance relevance and excellence in research.

Communication↗
PubMed1992

Primary care and reform of health systems: a framework for the analysis of Latin American experiences.

The article first proposes a framework within which to assess the potential of health sector reforms in Latin America for primary health care (PHC). Two dimensions are recognized: the scope of the reforms, content, and the means of participation that are put into play. This framework is then complemented through a critique of the often-sought but little-analyzed PHC reform strategies of decentralization and health sector integration. The analytical framework is next directed to the financing of health services, a chief aspect of any reform aiming toward PHC. Two facets of health service finance are first distinguished: its formal aspect as a means for economic subsistence and growth, and its substantive aspect as a means to promote the rational use of services and thus improvement of health. Once finance is understood in this microeconomic perspective, the focus shifts to the analysis of health care reforms at the macro, health policy level. The article concludes by positing that PHC is in essence a new health care paradigm, oriented by the values of universality, redistribution, integration, plurality, quality, and efficiency.

Financing, Government↗
PubMed1992

Key issues in public health surveillance for the 1990s.

In this paper, we have proposed a wider scope for public health surveillance in order to incorporate demographic and health-system monitoring, along with activities conventionally associated with epidemiologic surveillance. This new conception stems, in turn, from a revised definition of public health, which describes, not a sector of activity or a type of health service, but a level of aggregation based on the population at large. In our review of the ideas that lead to the institutionalization of health surveillance, we have stressed the broad concepts developed by such pioneers as Graunt and Petty. Their original concepts emerged from their active concerns for the public's health at a time when no scientific theory of contagion was available, let alone any knowledge about how to treat persons for the major diseases. Later on, largely as the result of impressive advances in biomedical knowledge, public health surveillance tended to specialize and to concentrate predominantly on disease outbreaks and on salient adverse health conditions. Health surveillance became closely associated with epidemiologic surveillance, which in turn became associated with the ability to respond promptly to adverse health outcomes. Recently, we have witnessed a gradual broadening of both the concepts and the practice of health surveillance. Paradoxically, the new currents tend to recapture some of the spirit and scope of the early definitions, prompted perhaps by grave historical parallels--we face newly emerging health problems for which we have no clear-cut solutions. If one element needs to be stressed to promote the objectives of health surveillance today, it is that we need the ability to anticipate health outcomes and not just respond to them. This, in turn, requires that we give more weight to the surveillance of risk factors and that we increase our understanding of the complex causal interrelationships that link exposure to risk factors--including behavioral, life-style, and environmental ones--with adverse health conditions and disability. Needless to say, the first and foremost aim of health care--and modern surveillance is one of the tools needed to achieve this aim--is to promote the well-being of individuals while improving their health.

Humans↗
PubMed1992

[Integration of the delivery of health services].

In Mexico the Constitution defines the right to health care as a social right and, as such, confers to the state the guiding role in the access of the population to health services. Unfortunately, this constitutional principle has not been fully met. One of the reasons for this is the fragmentation of public action in health and the continuous postponement of the integration of health services. In this paper the conceptual and practical limits of integration of health services are discussed, using as starting point a brief diagnosis of inequity and fragmentation of the health system in Mexico. The doctrinaire principles of integration are also described, as well as its practical advantages and disadvantages. Finally, a typology of forms of integration and previous integration experiences in Mexico are discussed. In the concluding remarks the integration prospects for Mexico are analyzed.

Decision Trees↗
PubMed1991

International health in transition.

The need for a transition towards a new concept of international health is emphasized and a paradigm for making the transition is proposed. The challenge of building a vigorous intellectual and academic tradition of international health which supports its efforts to generate knowledge and leads to its practical application is recognized and addressed. It is argued that the development of such an intellectual field is based on four elements: conceptual base, production base, reproduction base, and utilization base. The Unit for International Studies in Public Health (UISPH) of Mexico is presented as one example of efforts to consolidate an academic tradition in this field.

Education, Medical↗
PubMed1991

Patterns of medical employment: a survey of imbalances in urban Mexico.

This article quantifies the magnitude and correlates of the major imbalances affecting the employment of physicians in the urban areas of Mexico. Since the early 1970s the country has experienced a rapid increase in the supply of doctors, which its health system was unable to absorb fully. In 1986, we conducted a survey in the 16 most important cities based on a probability sample of households where someone with an MD degree lived. A total of 604 physicians were interviewed for a response rate of 97 percent. The unemployment rate was 7 percent of potentially active physicians; 11 percent held a nonmedical job, and another 11 percent exhibited low productivity and/or income. All in all, we project that 23,500 physicians in these cities were either unemployed or underemployed. This medical employment pattern was analyzed against five independent variables: generation (i.e. the year in which the physician started medical school), gender, social origin, medical school quality, and specialty. Apart from generation, type of specialty exhibited the strongest correlation with the employment situation of a physician. The results suggest that higher education and health care in Mexico may be producing rather than correcting social inequalities. Policy alternatives are discussed to restore a balance between the training of physicians, their gainful employment, and the health needs of the population.

Education, Medical↗
PubMed1991

Elements for a theory of the health transition.

This article presents the basic elements for developing a theory of the health transition. Such elements include the definition of concepts, the specification of a framework on the determinants of health status, the analysis of the mechanisms through which health change occurs in populations, the characterization of the attributes that allow us to identify different transition models, and the enumeration of the possible consequences of the transition. The propositions are presented with a sufficient level of generality as to make them applicable to different contexts; at the same time, an attempt is made to provide them with the necessary specificity to account for different national experiences, thus opening a space for future comparative research efforts. Through the systematization exercise presented in this article, we hope to contribute to the progress of a topic that has grown in importance during recent years. Such importance is due to the enormous potential that health transition theory has for understanding and transforming the growing complexity of our times.

Demography↗
PubMed1991

[The epidemiologic transition in Latin America].

The concept of health transition is considered to include two interrelated processes: transition of health care and epidemiological transition. The latter encompasses three basic processes: (a) replacement of the common infectious diseases by noncommunicable diseases and injuries as the leading causes of death; (b) a shift in peak morbidity and mortality from the young to the elderly; and (c) change from a situation in which mortality predominates in the epidemiological panorama to one in which morbidity is dominant. Latin America is characterized by a heterogeneous health profile in which different countries are in various stages of epidemiological transition. However, in most of them, the transition experience is unlike that of the developed countries and is distinguished by: (a) a simultaneous high incidence of diseases from both the pre- and post-transitional stages; (b) a resurgence of some infectious diseases that had previously been under control; (c) a lack of resolution of the transition process, so that the countries appear to be caught in a state of mixed morbidity; (d) a peculiar epidemiological polarization, not only between countries but also in the different geographical areas and between the various social classes of a single country. This experience is called a "prolonged polarized model."

Adolescent↗