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[Economics, politics, and public health in Porfirian Mexico (1876-1910)].

The article examines the scientific, political, and economic elements that permitted the birth of modern public health in Mexico under the Porfirio Díaz administration (1876-1910). Firstly, a portion of Mexican physicians were open to the discoveries of microbiology, immunology, and epidemiology. Secondly, the State's growing concentration of power in public health matters ran parallel to its concentration of disciplinary political power and enabled this new knowledge to be placed at the service of collective health problem prevention. Lastly, both imperialism and the Porfirian elite needed to protect their business interests. The article evaluates public health achievements and limitations during the Porfirian period, abruptly interrupted by the revolution begun in 1910.

Economics↗

[Business, politics, science, and visa versa: an institutional history of Brazilian medical journalism between 1827 and 1843].

This analysis of Brazil's first medical newspapers - Propagador das Ciências Médicas (1827-28); Semanário de Saúde Pública (1831-33); Diário de Saúde (1835-36); Revista Médica Fluminense (1835-41); Revista Médica Brasileira (1841-43) - shows how Rio de Janeiro's socio-cultural context made it possible for this type of publication to emerge within the city's dynamic, troubled environment of the 1820s and 30s. I argue that the distinguishing feature of Brazil's early medical journalism was a symbiosis between business (local publishing houses' commercial interests), politics (struggles for political hegemony during the consolidation of the Imperial State), and science (the movement to institutionalize medicine and affirm it as a science).

Brazil↗

[New challenges and opportunities in a globalized world: a political analysis of the response to HIV/AIDS in Mexico].

This work is a synthesis of an investigation into the political economics of HIV/AIDS in Mexico within the context of globalization. It is based on a distinction between what is defined as neo-liberal globalism (an ideological and overwhelmingly economic agenda) and globalization (a worldwide, multidimensional phenomenon). The core argument is that the existence of real alternatives to the neo-liberal paradigm results from a series of political, economic and social circumstances which are very real in Mexico today in the context of globalization, which have given rise to a rather more inclusive policy-making process. Special emphasis is given to the contrast between exclusive public policy systems, such as those seen in the process of structural economic reforms or the re-structuring of the financing of healthcare systems, and public policy systems which work with HIV/AIDS, which tend to be more inclusive and democratic. Both types of system operate in Mexico and in other parts of the world.

Acquired Immunodeficiency Syndrome↗

Mexican immigration and health care: a political economy perspective.

This paper examines the case of Mexican immigrants in the United States and their access to medical services within a political economy of health framework. Such an approach stresses that the provision of health care is independent of health factors per se and that access to health care is not equally distributed throughout a population. The first section reviews the three major concepts influencing medical anthropologists working within a political economy framework: the social origins of illness; the allocation of health resources; and fieldwork in Third World countries. The analysis then focuses upon the reasons for limiting immigrants' access to health care, followed by an examination of the socioeconomic characteristics of Mexican immigrants, including an undocumented immigration status, which limit their access to health care. Finally, the consequences of limited access to health services are suggested, including a low utilization of preventive health services resulting from the high cost of care combined with the immigrants' generally low income, lack of medical insurance and fear of using U.S. health services.

California↗

Use of newsletters to promote environmental political action: an experimental analysis.

The managers of beach businesses were randomly assigned to receive no intervention or two newsletters per week for 6 weeks that presented economic consequences of damage to coastal water quality and how to contact politicians. The percentage of proenvironmental political contacts was significantly greater in the experimental (newsletter) group than in the control group. Logistical regression showed that contacts in the newsletter group were more than five times that of controls after adjusting for history of contacts and predisposition to take such action. Results suggest that the intervention can promote political action that could influence environmental policies and human health.

Conservation of Natural Resources↗

The limits of thresholds: silica and the politics of science, 1935 to 1990.

Since the 1930s threshold limit values have been presented as an objectively established measure of US industrial safety. However, there have been important questions raised regarding the adequacy of these thresholds for protecting workers from silicosis. This paper explores the historical debates over silica threshold limit values and the intense political negotiation that accompanied their establishment. In the 1930s and early 1940s, a coalition of business, public health, insurance, and political interests formed in response to a widely perceived "silicosis crisis." Part of the resulting program aimed at containing the crisis was the establishment of threshold limit values. Yet silicosis cases continued to be documented. By the 1960s these cases had become the basis for a number of revisions to the thresholds. In the 1970s, following a National Institute for Occupational Safety and Health recommendation to lower the threshold limit value for silica and to eliminate sand as an abrasive in blasting, industry fought attempts to make the existing values more stringent. This paper traces the process by which threshold limit values became part of a compromise between the health of workers and the economic interests of industry.

Health Personnel↗

Burmese political dissidents in Thailand: trauma and survival among young adults in exile.

OBJECTIVES: This study assessed the self-reported mental health, physical health, and social functioning of young adult political exiles and relates their psychiatric symptoms to their trauma and survival strategies. METHODS: A 1992/93 survey of Burmese who fled to Bangkok, Thailand, after participating in a 1988 uprising against Burma's government elicited information on employment, education, disability, trauma, survival strategies, and depressive and posttraumatic stress symptoms. RESULTS: The 104 participants reported a mean of 30 trauma events, including interrogation (89%), imprisonment (78%), threats of deportation (70%), and torture (38%). Many reported poor health and lack of social supports, but few reported substantial social disability. The prevalence of elevated symptom scores was 38% for depressive symptoms and 23% for criterion symptoms of posttraumatic stress disorder. Symptoms of avoidance and of increased arousal were the most strongly related to cumulative trauma. Two survival strategies, camaraderie and a Buddhist concept of self-confidence (weria), were associated with somewhat reduced levels of both classes of symptoms. CONCLUSIONS: Burmese political exiles in Thailand are young adults adversely affected by severe trauma. Their psychosocial well-being may deteriorate further without legal protections to reduce the continuing stress and violence.

Adaptation, Psychological↗

The invisibility of public health: population-level measures in a politics of market individualism.

This paper models the prevailing political attack on government as a heuristic, a judgmental strategy that simplifies complex phenomena by applying simple tests to a limited set of relevant data. The heuristic of market individualism offers three tools for analyzing the problems of governing: the supremacy of the free market as a regulatory device, a belief in individual freedom of choice and personal responsibility, and the elevation of individual satisfaction as the chief goal of society. Because public health is inherently concerned with the health of the population rather than individual health, because the market itself is a major source of ill health, and because individual choice is socially mediated, use of the heuristic precludes the recognition of the value of public health work. Although some degree of accommodation to current political realities is a practical necessity, public health advocates must not neglect the task of fashioning radically different alternative visions over the long term.

Choice Behavior↗

The House of Falk: the paranoid style in American health politics.

The onset of the Cold War had a blighting effect on the campaign for a national health insurance program in the United States. In the highly charged atmosphere of the late 1940s, proponents of social insurance spent considerable time and energy denying that they were agents of foreign powers. In one widely promoted conspiratorial formulation, some on the right traced the origins of subversion not only to Moscow but also to Geneva, Switzerland, home of the International Labor Organization. In the fractiously partisan context of the period, conservative political leaders amplified concerns over disloyal bureaucrats' manipulating the levers of legislative politics as well as the design of health policy. One federal official in particular, I. S. Falk, became the object of outright demonization. The paranoid attacks took their toll on the drive to extend social protection. The reformers' difficulties suggest the limitations of heavy dependence on bureaucratic expertise in the pursuit of health security.

Health Policy↗

Policy without politics: the limits of social engineering.

The extent of coverage provided by a country's health services is directly related to the level of development of that country's democratic process (and its power relations). The United States is the only developed country whose government does not guarantee access to health care for its citizens. It is also the developed country with the least representative and most insufficient democratic institutions, owing to the constitutional framework of the political system, the privatization of the electoral process, and the enormous power of corporate interests in both the media and the political process. As international experience shows, without a strong labor-based movement willing to be radical in its protests, a universal health care program will never be accepted by the US establishment.

Capitalism↗

The science and politics of medicines control.

Drug development and regulation are often presented as purely matters of technical science. In this paper it is argued that, in principle, toxicology, clinical pharmacology and pharmacovigilance in drug testing and regulation are necessarily a combination of science and politics. This has important implications for how one attempts to make progress in drug regulation, such as in interpreting technical evidence and in the setting of regulatory standards with which evidence should be evaluated. In practice, drug testing and regulation are shown to be hybrids of science and politics. Moreover, drawing on existing empirical evidence, it is suggested that this mixture currently, and for some time, has had the wrong ingredients for optimal drug safety and public health outcomes. For example, too often the balance of the scientific doubts about drug safety are weighed to the interests of manufacturers rather than to those of patients and public health, while some scientific standards with which drug safety is to be interpreted are being reshaped in ways that give insufficient priority to the protection of public health. Finally, it is proposed that: drug regulation should include comparative efficacy testing; regulatory agencies should conduct some key tests, charging the costs to industry and without duplication; and the regulatory system should be less secretive and more accountable to public scrutiny. Greater efforts should be made to eliminate experts' conflicts of interest within the regulatory process.

Animals↗

Risk as moral danger: the social and political functions of risk discourse in public health.

Risk is a concept with multiple meanings and is ideologically loaded. The author reviews the literature on risk perception and risk as a sociocultural construct, with particular reference to the domain of public health. Pertinent examples of the political and moral function of risk discourse in public health are given. The author concludes that risk discourse is often used to blame the victim, to displace the real reasons for ill-health upon the individual, and to express outrage at behavior deemed socially unacceptable, thereby exerting control over the body politic as well as the body corporeal. Risk discourse is redolent with the ideologies of mortality, danger, and divine retribution. Risk, as it is used in modern society, therefore cannot be considered a neutral term.

Australia↗

Examining the "liberal media" claim: journalists' views on politics, economic and social policy (including health care), and media coverage.

The conservative critique of the news media rests on two general propositions: journalists hold views that are to the left of the public, and journalists frame news content in a way that accentuates these left perspectives. Previous research has revealed persuasive evidence against the latter claim, but the validity of the former claim has often been taken for granted. This research project examined the supposed left orientation of media personnel by surveying Washington-based journalists who cover national politics and/or economic policy at U.S. outlets. The findings include: (1) On select issues from corporate power and trade to Social Security and Medicare to health care and taxes, journalists are actually more conservative than the general public. (2) Journalists are mostly centrist in their political orientation. (3) The minority of journalists who do not identify with the "center" are more likely to identify with the "right" when it comes to economic issues and to identify with the "left" when it comes to social issues. (4) Journalists report that "business-oriented news outlets" and "major daily newspapers" provide the highest quality coverage of economic policy issues, while "broadcast network TV news" and "cable news services" provide the worst.

Health Policy↗

Privatization in French health politics: few projects and little outcome.

The author presents the main features of the organization of the French health care system, revealing an important mixture of public and private actors and institutions and a large number of political restraints that oppose resistance to privatization. In spite of traditional references to "liberal medicine" and recurrent debates opposing public and private intervention, neither the doctors nor the political decision makers have really supported the few projects that have been proposed for privatization or liberalization of health care. On the contrary, the cost-control policy introduced growing State intervention and new management methods into the health care sector, whose actors were not used to it. The privatization and liberalization debates appear as a rhetoric necessary to accommodate these difficult changes.

Cost Control↗

Politics, social welfare policy, and the population problem in Latin America.

This paper examines the interaction between social welfare policies and the "population problem" in Latin America. It demonstrates that social security programs, by reinforcing highly unequal patterns of stratification, have had a largely negative effect on population issues in the region. Social security policy in turn is analyzed as a particular political adaptation to the realities of dependent capitalist development. As a result, the population problem in Latin America is viewed less as a product of mindless demographic forces than as a politically induced reality stemming from the accumulated impact and negative consequences of a variety of consciously formulated public policies.

Health Status↗

A multivariate comparison of elderly African Americans and Caucasians voting behavior: how do social, health, psychological, and political variables effect their voting?

No study until now has examined the impact of the physical and psychological condition on voter turnout among elderly African Americans and Caucasians. Utilizing data from a national survey (Aging in the Eighties) and using multiple logistic regression, the present study examines the impact of health rating and life satisfaction as well as other socio-psychological characteristics on voting turnout among elderly Caucasian and African Americans. The results provide some empirical evidence that the pattern of election participation can be significantly influenced by the self-assessment of health and life satisfaction. For elderly Caucasians self-assessment of health is significantly related to voting behavior, whereas among elderly African Americans life satisfaction shows significant impact on turnout. Elderly African Americans who identified their personal political philosophy as "liberal" were more likely to vote, while among elderly Caucasians, those who identified their personal political philosophy as "conservative" were more likely to vote. In addition, SES, age, and organizational activity proved to have significantly independent impact on elderly Caucasian turnout, whereas among elderly African Americans, education was detected as a significant predictor.

Black or African American↗

Do social policies and political context matter for health in the United Kingdom?

This U.K. case study combines lessons from historical assessments with new empirical analyses of trends over the last decade to inform an appraisal of the impact of social actions on health. The empirical analyses examine life expectancy in the 354 local government councils in England by first identifying those that have better or worse health than expected fromtheir socioeconomic profile, and then selecting paired sets of "overachievers" and "underachievers" for more in-depth analysis. The findings taken as a whole provide evidence that social policies and political context do indeed matter for health. The historical material from the first industrial revolution, in particular, provides some of the most compelling evidence for this proposition. The empirical analyses over the last decade found a very powerful inverse association: the more deprived the local council, the lower the life expectancy of the population within that locality. However, even for the same level of deprivation and socioeconomic characteristics, some councils were doing much better than others in terms of health: for example, more than three years difference in life expectancy for carefully matched "urban fringe" councils. The article then examines the councils' political makeup and hence their likely policy perspective.

Health Services Research↗

The politics of health care reform in the United States, 1992-1994: a historical review.

In an analysis of the sociopolitical context of the debate on health care reform in the United States, the author focuses on the political events that led to the election of a Democratic administration in 1992; the evolution of the White House task force on health care reform and the interests and positions it represented; the connection between economic and political power in the United States; and the reasons for the defeat of the health care reform proposal. This historical analysis questions some of the dominant interpretations of the failure to reform health care, which assume that the U.S. population was not yet ready for these reforms.

Health Care Reform↗