Personal and political histories in the designing of health reform policy in Bolivia.

While health policies are a major focus in disciplines such as public health and public policy, there is a dearth of work on the histories, social contexts, and personalities behind the development of these policies. This article takes an anthropological approach to the study of a health policy's origins, based on ethnographic research conducted in Bolivia between 2010 and 2012. Bolivia began a process of health care reform in 2006, following the election of Evo Morales Ayma, the country's first indigenous president, and leader of the Movement Toward Socialism (Movimiento al Socialism). Brought into power through the momentum of indigenous social movements, the MAS government platform addressed racism, colonialism, and human rights in a number of major reforms, with a focus on cultural identity and indigeneity. One of the MAS's projects was the design of a new national health policy in 2008 called The Family Community Intercultural Health Policy (Salud Familiar Comunitaria Intercultural). This policy aimed to address major health inequities through primary care in a country that is over 60% indigenous. Methods used were interviews with Bolivian policymakers and other stakeholders, participant observation at health policy conferences and in rural community health programs that served as models for aspects of the policy, and document analysis to identify core premises and ideological areas. I argue that health policies are historical both in their relationship to national contexts and events on a timeline, but also because of the ways they intertwine with participants' personal histories, theoretical frameworks, and reflections on national historical events. By studying the Bolivian policymaking process, and particularly those who helped design the policy, it is possible to understand how and why particular progressive ideas were able to translate into policy. More broadly, this work also suggests how a uniquely anthropological approach to the study of health policy can contribute to other disciplines that focus on policy analysis and policy processes.

Are "armchair socialists" still sitting? Cross sectional study of political affiliation and physical activity.

OBJECTIVE: To examine the validity of the concept of left wing "armchair socialists" and whether they sit more and move less than their right wing and centrist counterparts. DESIGN: Secondary analysis of Eurobarometer data from 32 European countries. SETTING: The study emanated from the authors' sit-stand desks (rather than from their armchairs). PARTICIPANTS: Total of 29,193 European adults, of whom 1985 were left wing, 1902 right wing, 17,657 political centrists, and 7649 politically uncommitted. MAIN OUTCOME MEASURES: Self-reported political affiliation, physical activity, and total daily sitting time. METHODS: Linear models were used to examine the relation between physical activity, sitting time, and reported political affiliation. RESULTS: The findings refute the existence of an "armchair socialist"; people at the extremes of both ends of the political spectrum were more physically active, with the right wing reporting 62.2 more weekly minutes of physical activity (95% confidence interval 23.9 to 100.5), and the left wing 57.8 more minutes (20.6 to 95.1) than those in the political centre. People with right wing political affiliations reported 12.8 minutes less time sitting a day (3.8 to 21.9) than the centrists. It is those sitting in the middle (politically) that are moving less, and possibly sitting more, both on the fence and elsewhere, making them a defined at-risk group. CONCLUSIONS: There is little evidence to support the notion of armchair socialists, as they are more active than the mainstream in the political centre. Encouraging centrists to adopt stronger political views may be an innovative approach to increasing their physical activity, potentially benefiting population health.

Welfare state regimes and population health: integrating the East Asian welfare states.

Epidemiological studies have consistently shown that population health varies significantly by welfare state regime. However, these studies have focused exclusively on the welfare states of Europe, North America and Australasia. This focus ignores the existence of welfare states in other parts of the world, specifically in East Asia. This study therefore investigates whether the association between population health (Infant Mortality Rates and Life Expectancy at birth) and welfare state regimes is still valid when the welfare states of East Asia are added into the analysis. It also examines whether population health is worse in the East Asian welfare states. Infant Mortality Rates and Life Expectancy at birth as well as GDP per capita and social and health expenditures as a percentage of GDP were examined in 30 welfare states, categorised into six different regimes (Scandinavian, Anglo-Saxon, Bismarckian, Southern, Eastern European and East Asian). ANOVA analysis showed significant differences by welfare state regime in the magnitude of IMR, LE, SE, HE and GDP per capita. However, when controlling for GDP per capita in the ANCOVA analyses, only Life Expectancy (R(2)=0.58, adjusted R(2)=0.47, p<0.05) and Social Expenditure (R(2)=0.70, adjusted R(2)=0.61, p<0.05) differed significantly by welfare state regime. 47% of the variation in Life Expectancy was explained by welfare state regime type. Further, the East Asian welfare states did not have the worst health outcomes. The study concludes by highlighting the need to expand comparative health analysis both in terms of the range of countries examined and also in terms of incorporating other societal and public health factors-towards a 'public health regime' analysis.

Changes in the proximate determinants of fertility decline in post-socialist Mongolia.

Mongolian fertility decline has received only limited analysis in the demographic literature. Using the 2003 Reproductive Health Survey of Mongolia the classical proximate determinants of fertility framework proposed by Bongaarts is applied here in order to analyse which factors shape period fertility. The results indicate that the fertility-inhibiting effect of contraception contributed to reduce period fertility by 54.2% from its theoretical maximum, while induced abortion accounted for only 6.1% of the reduction in fertility. Compared with previous studies made in the early 1990s, these results show that important changes in the control of reproduction took place in Mongolia during the fertility transition. In order to assess the changes implied by the transition to democracy and market economy, the proximate determinants of fertility are estimated for the year 1994. The results show that the importance of induced abortion in the determination of fertility level has reduced and that the use of modern contraception has increased progressively and contributed most in determining fertility level in 2003.

Manpower of neurologists in the post-socialist countries of Central and Eastern Europe.

BACKGROUND AND PURPOSE: Manpower of neurologists from the post-socialist countries of Central and Eastern Europe differs very much from the number of neurologists in most of the countries of Western Europe. With the enlargement of the European Union (EU), it is necessary to consider the tendencies of manpower evolution amongst the 'new' European countries to be able to consider future developments, particularly in regard to education and migration. METHODS: A survey was performed to study distribution and tendencies to migrate amongst neurologists from the post-socialist countries of Central and Eastern Europe. RESULTS: The number of neurologists per 10,000 inhabitants varies from one country to another, but is higher in the countries of Central and Eastern Europe than in most Western European countries. There are almost no available positions for neurologists in Eastern Europe, and the majority of neurologists are keen to migrate to EU countries -- for further education and for financial reasons. CONCLUSIONS: The number of neurologists in the 'reforming and transition' countries is considerably higher than in the countries of the EU. Many neurologists from these countries would like to migrate to countries of the EU or USA, but the existing barriers are difficult to overcome.

Social democratic government and spatial distribution of health care facilities. The case of hospital beds in Germany.

BACKGROUND: In this paper, the hypothesis that the spatial distribution of hospital beds is more even in countries with socialist or social democratic governments than in countries with conservative or Christian democratic governments was tested. To avoid the confounding influences of historical and institutional differences between countries, we used the Federal Republic of Germany as a case study. The German federal states have their own governments who play an important role in creating structures for the planning of hospital facilities. METHODS: The test of the hypothesis was largely quantitative. At the level of federal states the rank correlation was computed between the weighted number of years of left-wing government participation and the coefficient of variation in the number of hospital beds per 1000 inhabitants. In addition to this, the hospital plans of two federal states were studied. RESULTS: The hypothesis was supported by the data, showing a positive association between the number of years of left-wing government participation and regional variation in the number of hospital beds. A comparison of the hospital plans of two contrasting federal states showed less government interference in hospital planning in the state with a tradition of right-wing government. CONCLUSION: There seems to be a relation between left-wing government participation in West German states and a more equal distribution of the number of hospital beds per 1,000 inhabitants.