La máquina de guerra capitalística en el contexto de la pandemia: Lo público, lo estatal, lo privado y lo común

O artigo problematiza conceitos chaves para repensar a situação que a pandemia colocou em evidência de maneira explícita. Tal é o caso das inequidades intra e inter países, as vidas que têm valor e as que não têm, a destruição de Gaia com crises climáticas e ambientais cada vez mais intensas, entre muitas outras. Isto nos levou a analisar as limitações de certos conceitos para avançar nos caminhos que nos permitam valorar a vida de todes, humanes e não humanes, deter a destruição de Gaia e apontar a construção de um mundo mais solidário onde todes tenham o mesmo direito de viver plenamente. Estes conceitos são os do estado em sua concepção ligada ao estado de bem-estar e o de soberania nacional, para desde aí redefinir o público, o estatal, o privado e o comum. Termos cujo significados têm se naturalizado segundo conceitos e contextos históricos, que pouco tem a ver com os processos instaurados pelo neoliberalismo há mais de quatro décadas. A transnacionalização das corporações e o poder que acumularam, ainda maior que os dos países mais ricos, deve nos levar a repensar o mundo que vivemos na direção de buscar linhas de fuga, que apontem ao reconhecimento das potências dos movimentos sociais urbanos, dos povos originários, das mulheres, dos grupos LGBTQIA+ e outros grupos que tem mostrado capacidade para enfrentar a pandemia ante a ausência do estado na defesa de qualquer vivente e de sua ação necropolítica.

Impact of Health Care and Socioeconomic Needs on Health Care Utilization and Disease Management: The University of New Mexico Hospital Care One Program.

Understanding how unmet basic needs impact health care in patients with complex conditions is vital to improve health outcomes and reduce health care costs. The purpose of this observational study was to explore the association between health care and socioeconomic needs and health care utilization and disease management among patients with chronic conditions at an intensive, patient-centered, office-based program. The study used a cross-sectional design and a convenience sampling approach. Data were collected through a patient questionnaire and medical records. Analysis included descriptive and inferential statistics. Data from 48 established patients were analyzed. Financial and lack of transportation were the 2 most frequently reported unmet needs. More than 65% of participants had their chronic condition(s) under control. Sex and ethnicity were the only 2 demographic variables that yielded significant differences (P ≤ 0.01) on visits to the emergency room and having chronic condition(s) under control. Those who reported having unmet transportation needs were more likely to have a condition uncontrolled and to have lost medical appointments compared to those who had this social need met (P ≤ 0.05). Statistically significant differences in terms of missing medical appointments also were found between those whose overall financial and housing needs were unmet and those who had those needs met (P ≤ 0.05). Results indicate that participating patients generally had good control of their conditions. The study adds evidence in support of the call for health care to address patients' socioeconomic needs, and the health care benefits of intensive case management programs. The model may be considered for adoption throughout New Mexico, and nationally.

Disputas inter-capitalistas, biomedicalización y modelo médico hegemónico / Disputas inter-capitalistas, biomedicalização e modelo médico hegemônico / Inter-capitalistic disputes, biomedicalization and hegemonic medical model

Este artículo se sitúa en el campo de estudio de los procesos productivos y de la transición tecnológica en el cuidado de salud. Examina la entrada del capital financiero en el sector salud y sus disputas con el complejo médico-industrial. Avanza en la comprensión de cómo los sectores capitalistas, que lideran la reestructuración productiva en salud, apuestan a la potencia de los procesos de creación de nuevas subjetividades en la transformación y consolidación del actual modelo médico hegemónico y en la producción/reproducción de modos de agenciamientos capitalísticos. Usamos el concepto de biomedicalización para entender la radicalización del proceso de medicalización, concepto que se viene mostrando insuficiente para comprender los cambios observados. Comprender estos fenómenos facilita reconocer resistencias y líneas de fuga que posibilitan apuestas no mercantilistas en salud, creadoras de autonomía y valorización de la vida individual y colectiva.

Este artigo situa-se no campo de estudo dos processos produtivos e da transição tecnológica da produção do cuidado em saúde. Examina a entrada do capital financeiro no setor saúde e suas disputas com o complexo médico-industrial. Avança na compreensão de como os setores capitalistas, que lideram a reestruturação produtiva na saúde, apostam na potência dos processos de criação de novas subjetividades na transformação e consolidação do atual modelo médico hegemônico e na produção/reprodução dos modos de agenciamentos capitalistas. Usamos o conceito de biomedicalização para entender a radicalização do processo de medicalização, que vem se mostrando insuficiente para compreender as mudanças observadas. A compreensão desses fenômenos facilita reconhecer resistências e linhas de fuga, que possibilitam apostas não mercantilistas na saúde, criadoras de autonomia e valorização da vida individual e coletiva.

This paper is situated on the field of study of the working/productive process and the technological transition in health care. It examines the entrance of financial capital groups in the health sector and their struggles with the medical-industrial complex. It puts forward a comprehension of how the capitalist sectors, leaders of the restructuration of the working process in health, bet on the power of the creation of new subjectivities in order to transform and consolidate the current hegemonic medical model and the production/reproduction of the ways of the capitalism's agency role. We use the concept of biomedicalization to understand a radical stage of medicalization, a commonly used concept, albeit insufficient to understand the observed changes. The comprehension of these phenomena allows the recognition of resistances and "lines of flight" that could allow for non-mercantilist options in health, which may create autonomy and reinforce the value of individual and collective life.

El sistema de salud de los Estados Unidos: mitos y realidades (Parte II) / O sistema de saúde dos Estados Unidos: mitos e realidades (Parte II) / The United States health care system: myths and realities (Part II)

Objetivos: Analisar o sistema de saúde dos Estados Unidos da América (EUA) considerando a complexa rede que oculta o conceito de um sistema baseado na ideologia do livre mercado, no financiamento administrado substancialmente por companhias de seguro e administradoras de medicamentos, e na provisão de serviços pelos privados (lucrativos e não lucrativos) e estatais altamente comercializados. A importância no desenvolvimento desta análise é radicada no pouco conhecimento que se tem, nos outros países, de como funciona este sistema e na admiração que é produzida, no imaginário coletivo, em especial em quanto grupos economicamente interessados o presentam como uma solução, em países com sistemas baseados no acesso universal e oferta pública de serviços (total ou parcial), do suposto "déficit fiscal" do setor saúde, e a possibilidade de ampliação de acesso às tecnologias de alta complexidade e aos medicamentos de última geração. Métodos: Analíticointerpretativos de dados secundários. Fonte de dados: Majoritariamente fontes governamentais ou artigos baseados nelas. Resultados: Nesta segunda parte analisam-se os gastos e resultados em saúde comparando com outros países, em que se gasta, quem paga, quem administra (e lucra com) os diversos seguros privados e governamentais, e a prestação de serviços. Conclusões: É preciso compreender o impacto para os usuários e trabalhadores que o setor saúde esteja administrado por grupos financeiros, provedores de serviços e produtos (medicamentos, equipamentos, dispositivos e insumos) altamente concentrados, cuja finalidade é o lucro. Temos que compreender os mecanismos que usam em cada pais para penetrar o setor saúde, extrair rentabilidade dos aportes coletivos, e mover-se para outros setores da economia o para outros países, enquanto pensam que o negocio esgotou-se. (AU)

Objetivos: Analizar el sistema de salud de los Estados Unidos (EUA) considerando la compleja red que oculta el concepto de sistema basado en la ideología del libre mercado, el financiamiento administrado sustancialmente por compañías de seguro y administradoras de medicamentos, y la provisión por proveedores privados (lucrativos y no lucrativos) y estatales altamente comercializados. La importancia de desarrollar este análisis radica en lo poco que se conoce en otros países cómo funciona este sistema y en la admiración que produce en el imaginario colectivo, en especial, cuando grupos de interés lo muestran como la solución para supuestos déficits fiscales del sector salud y la ampliación de la oferta de alta complejidad y medicamentos de última generación en países con sistemas basados en acceso universal y provisión pública (total o parcial). Métodos: Analíticointerpretativos de datos secundarios. Fuente de datos: Mayoritariamente fuentes gubernamentales o artículos basados en ellas. Resultados: En esta segunda parte se analizan los gastos y resultados de salud en comparación con otros países, en qué se gasta, quién paga y quién administra (y lucra con) los múltiples seguros privados y gubernamentales, y la prestación de servicios. Conclusiones: Es imperioso entender las consecuencias que tiene para usuarios y trabajadores que el sector salud este administrado por grupos financieros y proveedores de servicios y productos (medicamentos, equipamientos, dispositivos e insumos) altamente concentrados, cuyo objetivo central es el lucro. Debemos entender los mecanismos que utilizan en cada país para penetrar el sector salud, extraer ganancias de los aportes colectivos y moverse a otros sectores de la economía u otros países cuando consideran el negocio agotado. (AU)

Objectives: Analyze the US health care system considering the complex network that is hidden under the concept of a system based on the ideology of free market, on the financial management by insurance companies and by those that manage medical drug benefits, and on the provision of services by private (for-profit and not-for-profit) and highly commercialized governmental services. The importance of developing this analysis resides on the lack of knowledge in other countries in regards to how the system works and the fascination created in the collective vision by interest groups. These groups show this type of system as a solution to reduce supposed fiscal deficits and expand access to high technology and the most advanced medical drugs in countries with systems based on universal access and public provision of services (total or partial). Methods: Analyticalinterpretative, based on secondary data. Data sources: Mostly governmental sources and articles based on them. Results: In this second part, the analysis focuses on health expenditures and outcomes in comparison with other countries, the most important expenditures, and who are those managing (and taking profit of) the various private and governmental insurances, and health care provision. Conclusions: It is imperative to understand the consequences for the health care users and workers that the sector is managed by financial groups and for-profit health care providers and companies that produce goods (medicines, equipment, devices and supplies) highly concentrated. We must understand the mechanisms that these economic groups use in each country to entering the health care sector, extract profit from the collective contributions, and move to other economic areas or countries when they believe that the business is over.

El sistema de salud de los Estados Unidos: mitos y realidades (Parte I) / O sistema de saúde dos Estados Unidos: mitos e realidades (Parte I) / The United States health care system: myths and realities (Part I)

Objetivos: Analizar el sistema de salud de los Estados Unidos (EUA) considerando la compleja red que oculta el concepto de sistema basado en la ideología del libre mercado, el financiamiento administrado sustancialmente por compañías de seguro y administradoras de medicamentos, y la provisión por proveedores privados (lucrativos y no lucrativos) y estatales altamente comercializados. La importancia de desarrollar este análisis radica en lo poco que se conoce en otros países cómo funciona este sistema y en la admiración que produce en el imaginario colectivo, en especial, cuando grupos de interés lo muestran como la solución para supuestos déficits fiscales del sector salud y la ampliación de la oferta de alta complejidad y medicamentos de última generación en países con sistemas basados en acceso universal y provisión pública (total o parcial). Métodos: Analítico-interpretativos de datos secundarios. Fuente de datos: Mayoritariamente fuentes gubernamentales o documentos basados en ellas. Resultados: Los datos analizados contextualizan a nivel socio-demográfico, laboral y económico la reforma del sistema de salud aprobada en el 2010, analiza las desigualdades en acceso a seguro médico, así como las dificultades de obtener servicios debido a los altos costos que deben pagar asegurados y no asegurados. Conclusiones: Es imperioso extraer lecciones de la reforma de los EUA que obliga a que individuos y empleadores deban comprar seguros a empresas privadas que dan cobertura según la capacidad de pago de los contratantes. La ausencia del derecho a la salud deja a los usuarios librados a reclamar derechos en tanto consumidores, no como ciudadanos de pleno derecho.

Objetivos: Analisar o sistema de saúde dos Estados Unidos da América (EUA) considerando a complexa rede que oculta o conceito de um sistema baseado na ideologia do livre mercado, no financiamento administrado substancialmente por companhias de seguro e administradoras de medicamentos, e na provisão de serviços pelos privados (lucrativos e não lucrativos) e estatais altamente comercializados. A importância no desenvolvimento desta análise é radicada no pouco conhecimento que se tem, nos outros países, de como funciona este sistema e na admiração que é produzida, no imaginário coletivo, em especial em quanto grupos economicamente interessados o presentam como uma solução, em países com sistemas baseados no acesso universal e oferta pública de serviços (total ou parcial), do suposto "déficit fiscal" do setor saúde, e a possibilidade de ampliação de acesso às tecnologias de alta complexidade e aos medicamentos de última geração. Métodos: Analítico-interpretativos de dados secundários. Fonte de dados: Majoritariamente fontes governamentais ou documentos produzidos pelas instâncias governamentais. Resultados: Os dados analisados contextualizam o nível sóciodemográfico, do trabalho e econômico a reforma do sistema de saúde, aprovada em 2010, analisa as desigualdades de acesso aos seguros médicos, assim como as dificuldades na obtenção dos serviços de saúde pelo alto custo que os segurados e não segurados devem pagar. Conclusões: É fundamental tirar lições da reforma dos EUA, que obriga os indivíduos e os empregadores comprarem seguros de saúde de empresas privadas, que dão cobertura de acordo com a capacidade de compra dos contratantes. A ausência do direito à saúde coloca os usuários como meros consumidores e como tal reclamarem direitos enquanto tais e não como cidadãos plenos de direitos sociais.

Objectives: Analyze the US health care system considering the complex network that is hidden under the concept of a system based on the ideology of free market, on the financial management by insurance companies and by those that manage medical drug benefits, and on the provision of services by private (for-profit and not - for- profit) and highly commercialized governmental services. The importance of developing this analysis resides on the lack of knowledge in other countries in regards to how the system works and the fascination created in the collective vision by interest groups. These groups show this type of system as a solution to reduce supposed fiscal deficits and expand access to high technology and the most advanced medical drugs in countries with systems based on universal access and public provision of services (total or partial). Methods: Analytical-interpretative, based on secondary data.Data sources: Mostly governmental sources and documents based on them. Results: The analyzed data contextualizes the health care system reform approved in 2010, at socio-demographic, labor and economic levels, and it analyzes the inequities in medical insurance access, as well as the difficulties in obtaining health care services as a consequence of the high costs that must be paid by insurer, underinsured and uninsured populations. Conclusions: It is imperative to extract lessons of the US health care reform, which requires that individuals and employers purchase insurance from private companies that provide coverage based on payment capacity. The absence of health rights leaves the users of health care services with only the option of demanding consumer rights, not citizenship (in ample sense) rights.

Obesity and malnutrition among Hispanic children in the United States: double burden on health inequities.

OBJECTIVE: To examine important micronutrient deficiencies related to child health and growth outcomes for all weight statuses to 1) better understand other potential nutritional problems and inequities that may be masked by focusing solely on BMI percentiles and overweight/obesity, and 2) draw attention to the need for more studies focused on the nutritional well-being of children at all weight statuses, including healthy weight. METHODS: A sample of children (ages 2-19 years) old from the National Health and Nutrition Examination Survey (NHANES) 2003-2010 was analyzed. Prevalence of stunting, folate, vitamin D, iron, iodine, and anemia, was considered. Comparisons were conducted between non-Hispanic whites and Hispanics, and within Hispanics, based on socio-demographic and economic characteristics. RESULTS: Hispanic children experienced significantly higher prevalence of stunting (6.1% versus 2.6%), and the prevalence of stunted Hispanic children in the healthy weight category was higher than those in the overweight/obese category. Comparable percentages were observed by ethnicity for most analyzed micronutrients, although girls had consistently higher prevalence of nutritional deficiencies than boys, especially girls reaching reproductive age. CONCLUSIONS: The results of this article draw attention to the need for more specific and differentiated analyses of child obesity and nutritional status among and within ethnic, sex, and age groups. Appropriate public health interventions need to consider the entire range of weight statuses and micronutrient deficiencies to eliminate inequities among minority children, especially girls.

Obesity and malnutrition among Hispanic children in the United States: double burden on health inequities / Obesidad y desnutrición en niños hispanos de los Estados Unidos: doble carga en materia de desigualdades de salud

OBJECTIVE: To examine important micronutrient deficiencies related to child health and growth outcomes for all weight statuses to 1) better understand other potential nutritional problems and inequities that may be masked by focusing solely on BMI percentiles and overweight/obesity, and 2) draw attention to the need for more studies focused on the nutritional well-being of children at all weight statuses, including healthy weight. METHODS: A sample of children (ages 2-19 years) old from the National Health and Nutrition Examination Survey (NHANES) 2003-2010 was analyzed. Prevalence of stunting, folate, vitamin D, iron, iodine, and anemia, was considered. Comparisons were conducted between non-Hispanic whites and Hispanics, and within Hispanics, based on socio-demographic and economic characteristics. RESULTS: Hispanic children experienced significantly higher prevalence of stunting (6.1% versus 2.6%), and the prevalence of stunted Hispanic children in the healthy weight category was higher than those in the overweight/obese category. Comparable percentages were observed by ethnicity for most analyzed micronutrients, although girls had consistently higher prevalence of nutritional deficiencies than boys, especially girls reaching reproductive age. CONCLUSIONS: The results of this article draw attention to the need for more specific and differentiated analyses of child obesity and nutritional status among and within ethnic, sex, and age groups. Appropriate public health interventions need to consider the entire range of weight statuses and micronutrient deficiencies to eliminate inequities among minority children, especially girls.

OBJETIVO: Analizar las carencias importantes de micronutrientes relacionadas con la salud del niño, y los resultados de crecimiento para las distintas situaciones en cuanto a peso, con objeto de 1) comprender mejor otros posibles problemas y desigualdades nutricionales que podrían quedar ocultos al adoptar un enfoque exclusivo en los percentiles de índice de masa corporal, y el sobrepeso y la obesidad, y 2) hacer hincapié en la necesidad de llevar a cabo más estudios que se centren en el bienestar nutricional de los niños en las distintas situaciones en cuanto al peso, incluido el peso saludable. MÉTODOS: Se analizó una muestra de niños (de 2 a 19 años) de la Encuesta Nacional de Salud y Nutrición (NHANES) 2003-2010. Se consideraron las prevalencias del retraso en el crecimiento, de las deficiencias de folato, vitamina D, hierro y yodo, y de la anemia. Se establecieron comparaciones entre blancos no hispanos e hispanos, y entre los mismos hispanos, con base en las características sociodemográficas y económicas. RESULTADOS: Los niños hispanos mostraron una prevalencia significativamente mayor de retraso en el crecimiento (6,1 frente a 2,6%), y la prevalencia del retraso en el crecimiento en los niños hispanos clasificados como de peso saludable fue mayor que en los incluidos en las categorías de sobrepeso u obesidad. Se observaron porcentajes comparables por grupos étnicos en cuanto a los micronutrientes más analizados, aunque las niñas mostraron sistemáticamente una mayor prevalencia de carencias nutricionales que los niños, especialmente las que se acercaban a la edad fecunda. CONCLUSIONES: Los resultados hacen hincapié en la necesidad de llevar a cabo estudios más específicos y diferenciados sobre la obesidad y el estado nutricional de los niños entre y dentro de los distintos grupos étnicos, de sexo y de edad. Las intervenciones de salud pública, para que resulten apropiadas, deben considerar las distintas situaciones en cuanto a peso y las carencias de micronutrientes, con objeto de eliminar las desigualdades en niños de grupos minoritarios, especialmente en niñas.

Biomedicalización e infancia: trastorno de déficit de atención e hiperactividad / Biomedicalization and childhood: attention deficit hyperactivity disorder / Biomedicalização e infância: transtorno de déficit de atenção de hiperatividade

El artículo analiza críticamente el aumento de los niños diagnosticados y tratados por el Trastorno de Déficit de Atención e Hiperactividad (TDAH). Los análisis vinculan este creciente fenómeno con las estrategias de la industria farmacéutica para reposicionarse en el liderazgo de la conceptualización del proceso salud-enfermedad-atención y en el mercado de salud. Utilizamos métodos analítico-interpretativos para estudiar datos primarios y secundarios, y realizar una extensa revisión bibliográfica. A la luz del concepto de biomedicalización analizamos los mecanismos subjetivo-ideológicos que facilitaron que este discurso se instituya como una nueva verdad sobre este trastorno y sea legitimado por los organismos gubernamentales y las organizaciones de la sociedad civil. La biomedicalización del sufrimiento infantil dificulta que se pongan en evidencia los profundos cambios socioeconómicos, políticos e ideológico-culturales que han transformado radicalmente nuestras sociedades en las últimas décadas.

The article critically analyzes the increasing number of children diagnosed with and treated for Attention Deficit Hyperactivity Disorder (ADHD). The analysis links this growing phenomenon with the strategies of the pharmaceutical industry to attain leadership in the health-illness-care process as well as in the health market. We utilized analytical and interpretive methods to study primary and secondary data and conducted an extensive literature review. In light to the concept of biomedicalization, we analyzed the ideological and subjective mechanisms that facilitated the institutionalization of this discourse as a new truth concerning this disease as well as its legitimization by governmental and civic organizations. The biomedicalization of children's suffering facilitates the concealment of deeply rooted socio-economic, political, ideological and cultural changes that have radically transformed our societies over the past few decades.

O artigo analisa criticamente o aumento das crianças diagnosticadas e tratadas por Transtorno de Déficit de Atenção de Hiperatividade (TDAH). As análises vinculam este crescente fenômeno às estratégias da indústria farmacêutica para se reposicionarem na liderança da conceituação do processo saúde-doença-atenção e no mercado de saúde. Utilizamos métodos analítico-interpretativos para estudar dados primários e secundários, e realizar uma extensa revisão bibliográfica. À luz do conceito da biomedicalização, analisamos os mecanismos subjetivo-ideológicos que facilitaram que este discurso se institua como uma nova verdade sobre este transtorno e seja legitimado pelos organismos governamentais e organizações da sociedade civil. A biomedicalização do sofrimento infantil dificulta que se revelem as profundas mudanças socioeconômicas, políticas e ideológico-culturais que têm transformado radicalmente nossas sociedades nas últimas décadas.

Chronic malnutrition among overweight Hispanic children: understanding health disparities.

Obesity may be masking other health problems such as height deficit, or stunting. Stunting may reflect the cumulative effect of chronic malnutrition especially in underserved immigrant communities. Exploratory analysis of a sample of children 2-19 years old from the 2007-2008 NHANES was used to assess the relationship between chronic malnutrition and overweight/obesity in Hispanic children. Overall, overweight/obesity prevalence was nearly 1 in 3 children and stunting prevalence was 3.1%. The prevalence of stunting varied significantly across race/ethnicity, with prevalence among Hispanics of 6.6%. Prevalence of stunting varied significantly by socio-economic characteristics within the Hispanic population. Our exploratory study showed differences in the prevalence of stunting across racial/ethnic groups and highlighted that overweight/obese Hispanic children have a higher prevalence of stunting compared with Non-Hispanic White overweight/obese children. More studies are needed to better understand the phenomenon and the implications for health inequities.

The creation of the health consumer: challenges on health sector regulation after managed care era.

BACKGROUND: We utilized our previous studies analyzing the reforms affecting the health sector developed in the 1990s by financial groups to frame the strategies implemented by the pharmaceutical industry to regain market positions and to understand the challenges that regulatory agencies are confronting. METHODS: We followed an analytical approach for analyzing the process generated by the disputes between the financial groups and the pharmaceutical corporations and the challenges created to governmental regulation. We analyzed primary and secondary sources using situational and discourse analyses. We introduced the concepts of biomedicalization and biopedagogy, which allowed us to analyze how medicalization was radicalized. RESULTS: In the 1990s, structural adjustment policies facilitated health reforms that allowed the entrance of multinational financial capital into publicly-financed and employer-based insurance. This model operated in contraposition to the interests of the medical industrial complex, which since the middle of the 1990s had developed silent reforms to regain authority in defining the health-ill-care model. These silent reforms radicalized the medicalization. Some reforms took place through deregulatory processes, such as allowing direct-to-consumer advertisements of prescription drugs in the United States. In other countries different strategies were facilitated by the lack of regulation of other media such as the internet. The pharmaceutical industry also has had a role in changing disease definitions, rebranding others, creating new ones, and pressuring for approval of treatments to be paid by public, employer, and private plans. In recent years in Brazil there has been a substantial increase in the number of judicial claims demanding that public administrations pay for new treatments. CONCLUSIONS: We found that the dispute for the hegemony of the health sector between financial and pharmaceutical companies has deeply transformed the sector. Patients converted into consumers are exposed to the biomedicalization of their lives helped by the biopedagogies, which using subtle mechanisms present discourses as if they are objective and created to empower consumers. The analysis of judicialization of health policies in Brazil could help to understand the complexity of the problem and to develop democratic mechanisms to improve the regulation of the health sector.

Capital financiero versus complejo médico-industrial: los desafíos de las agencias regulatorias / Financial capital versus medical-industrial complex: challenges for the regulatory agencies

Se presentan los procesos estructurales consolidados en los 90s bajo la hegemonía del capital financiero; las pujas distributivas generadas con el complejo médico-industrial; las estrategias que éste usó para reposicionarse; y los desafíos que enfrentan las agencias regulatorias estatales. Dos procesos son fundamentales para ubicar la problemática que enfrentan las agencias regulatorias: 1) La hegemonía alcanzada en los 90s por el capital financiero en el sector salud, vía las reformas destinadas a desregularlo; y 2) el reposicionamiento del complejo médico-industrial desde mediados de los 90s, a través de radicalizar la medicalización. Este artículo se basa en varias investigaciones conducidas por la autora en las que se usaron métodos cualitativos y datos secundarios cuantitativos para la contextualización histórico-situacional. El abordaje teórico se basó en Marx, Gramsci, Benasayag, Badiou, Testa y Merhy. El análisis de las reformas más recientes impulsadas por el complejo médico-industrial es producto de una investigación bibliográfica y documental.

This article presents the structural processes that consolidated under the hegemony of the financial capital in the 90s; the dispute between the financial capital operating in the health sector and the medical-industrial complex; the strategies used by the medical-industrial complex for regaining positions; and the challenges all these processes pose for the regulatory agencies. The problems the regulatory agencies are facing lie in two central processes: 1) the hegemony the financial capital reached in the 90s in the health sector through reforms aimed at deregulating the sector in order to facilitate its entrance; and 2) the repositioning of the medical-industrial complex since the mid 90s by radicalizing medicalization. This article is based on several studies conducted by the author using qualitative methods and quantitative secondary data for understanding the historical-situational context. The theoretical approach was based on Marx, Gramsci, Benasayag, Badiou, Testa and Merhy. The analyses of the most recent reforms induced by the medical-industrial complex were the result of a bibliographic and document review.

[Financial capital versus medical-industrial complex: challenges for the regulatory agencies]. / Capital financiero versus complejo médico-industrial: los desafíos de las agencias regulatorias.

This article presents the structural processes that consolidated under the hegemony of the financial capital in the 90s; the dispute between the financial capital operating in the health sector and the medical-industrial complex; the strategies used by the medical-industrial complex for regaining positions; and the challenges all these processes pose for the regulatory agencies. The problems the regulatory agencies are facing lie in two central processes: 1) the hegemony the financial capital reached in the 90s in the health sector through reforms aimed at deregulating the sector in order to facilitate its entrance; and 2) the repositioning of the medical-industrial complex since the mid 90s by radicalizing medicalization. This article is based on several studies conducted by the author using qualitative methods and quantitative secondary data for understanding the historical-situational context. The theoretical approach was based on Marx, Gramsci, Benasayag, Badiou, Testa and Merhy. The analyses of the most recent reforms induced by the medical-industrial complex were the result of a bibliographic and document review.

Privatization of health services in less developed countries: an empirical response to the proposals of the World Bank and Wharton School.

Academics and World Bank officials argue that, by reducing out-of-pocket expenditures, expanded private insurance may improve access to needed health services in less developed countries. In this empirical response, the authors examine this recommendation through observations from their research on privatization of health services in the United States, Argentina, Chile, and Mexico. Privatization, either through conversion of public sector to private sector insurance or by expansion of private insurance through enhanced participation by corporate entrepreneurs, generally has not succeeded in improving access to health services for vulnerable groups. Although the impact of privatization has differed among the Latin American countries studied, expansion of private insurance often has generated additional co-payments, which have increased rather than decreased out-of-pocket expenditures, thereby worsening access to needed services. Privatization usually has improved conditions for private corporations and has led to higher administrative costs. To address the devastating problems of access to services worldwide, we must find ways to enhance the delivery of public sector services and must move beyond conventional wisdom about market-based policies such as privatization.

Argentina: no lesson learned.

This article examines the political, ideological, social, and economic processes by which the Argentinean economy was transformed, the structural consequences, and the policies responsible for dismantling the welfare state. The health care system reform during the 1990s was an important component in accomplishing the last objective. Analyses of the policies adopted after the crisis of 2001 reveal that, despite the discourse against international financial institutions, President Nestor Kirchner, elected in 2002, followed the same approach by accepting and applying the second generation of health reforms recommended by the World Bank and the Inter-American Development Bank with additional pressure from the World Trade Organization and several free trade agreements. This "new reform" furthered business opportunities for multinational corporations while further shrinking the state administration's role in supplying health, education, and other social services to people who need them more than ever. Social movements have emerged that are developing alternative projects and showing that, when the base is solidarity, "another world is possible."

The Latin American Social Medicine database.

BACKGROUND: Public health practitioners and researchers for many years have been attempting to understand more clearly the links between social conditions and the health of populations. Until recently, most public health professionals in English-speaking countries were unaware that their colleagues in Latin America had developed an entire field of inquiry and practice devoted to making these links more clearly understood. The Latin American Social Medicine (LASM) database finally bridges this previous gap. DESCRIPTION: This public health informatics case study describes the key features of a unique information resource intended to improve access to LASM literature and to augment understanding about the social determinants of health. This case study includes both quantitative and qualitative evaluation data. Currently the LASM database at The University of New Mexico http://hsc.unm.edu/lasm brings important information, originally known mostly within professional networks located in Latin American countries to public health professionals worldwide via the Internet. The LASM database uses Spanish, Portuguese, and English language trilingual, structured abstracts to summarize classic and contemporary works. CONCLUSION: This database provides helpful information for public health professionals on the social determinants of health and expands access to LASM.

Increasing access to Latin American social medicine resources: a preliminary report.

PURPOSE: This preliminary report describes the development and implementation of a project to improve access to literature in Latin American social medicine (LASM). METHODS: The University of New Mexico project team collaborated with participants from Argentina, Brazil, Chile, and Ecuador to identify approximately 400 articles and books in Latin American social medicine. Structured abstracts were prepared, translated into English, Spanish, and Portuguese, assigned Medical Subject Headings (MeSH), and loaded into a Web-based database for public searching. The project has initiated Web-based publication for two LASM journals. Evaluation included measures of use and content. RESULTS: The LASM Website (http://hsc.unm.edu/lasm) and database create access to formerly little-known literature that addresses problems relevant to current medicine and public health. This Website offers a unique resource for researchers, practitioners, and teachers who seek to understand the links between socioeconomic conditions and health. The project provides a model for collaboration between librarians and health care providers. Challenges included procurement of primary material; preparation of concise abstracts; working with trilingual translations of abstracts, metadata, and indexing; and the work processes of the multidisciplinary team. CONCLUSIONS: The literature of Latin American social medicine has become more readily available to researchers worldwide. The LASM project serves as a collaborative model for the creation of sustainable solutions for disseminating information that is difficult to access through traditional methods.

Medicina social latinoamericana: aportes y desafíos

Este artículo presenta el contexto en el que surgió la medicina social, las diferencias entre ella y la salud pública, sus teorías, métodos y debates, los principales temas o problemas considerados, y los desafíos que supone su difusión entre los anglohablantes y los profesionales de la medicina y la salud pública.

[Latin American social medicine: contributions and challenges]. / Medicina social latinoamericana: aportes y desafíos.

This piece presents and analyzes a number of issues related to social medicine: the context of the emergence of social medicine; the differences between social medicine and public health; the theories, methods, and debates in social medicine; the main subjects or problems considered in social medicine; and the difficulties of disseminating the concepts of social medicine among English-speaking persons and among medical and public health professionals in general. Latin American social medicine has challenged other views by contributing to an understanding of the determinants of the health-disease-health care process and by using theories, methods, and techniques that are little known in the field of public health. Introducing Latin American social medicine, especially among English speakers, will be difficult due to the conceptual complexity of this field for persons who are accustomed to the theoretical framework of public health and medicine and also due to skepticism concerning research coming from the Third World. A multidisciplinary team is facing this challenge through two primary initiatives: 1) the creation of an Internet portal and database where there are structured abstracts in English, Portuguese, and Spanish of books, book chapters, and articles on social medicine and 2) the electronic publication of two journals on Latin American social medicine.