Evolución de la estructura de clases y el bienestar material en la Ciudad Autónoma de Buenos Aires contemporánea (2004-2015) / Evolution of class structure and material well-being in the contemporary City of Buenos Aires (2004-2015)

En este artículo analizamos los rasgos que asumió la estructura de clases de la Ciudad Autónoma de Buenos Aires (CABA) en el período 2004-2015. Utilizando como fuente de datos, principalmente, la Encuesta Anual de Hogares (EAH) relevada anualmente por la Dirección General de Estadística y Censos del Gobierno de la CABA, nos preguntamos acerca de cómo han evolucionado las clases sociales en términos de tamaño y composición, y cuánto se han distanciado o acercado respecto al bienestar material de los hogares que las conforman. Del análisis de los datos se desprende que la estructura de clases mantiene la configuración signada durante los años noventa, aunque con una relativa composición de la clase obrera calificada y la clase directivo-profesional. Por otro lado, el estudio de los ingresos y el acceso a la vivienda, en tanto dos activos del bienestar material de los hogares, muestra cierta reducción de la desigualdad respecto al primero, pero un fortalecimiento en las brechas respecto a la propiedad de la vivienda. (AU)

Changing Systems of Social Protection in the Context of the Changing Political Economies since the 1980s / Mudanças nos Sistemas de Proteção Social no Contexto de Transformações das Economias Políticas desde os anos 1980

Abstract This article provides an overview of the profound changes in the more advanced welfare states in Europe and Latin America over the past 35 years. Deindustrialization, informalization, and the rise of unstable employment, combined with aging populations rendered traditional employment-based models of social protection less effective and at the same time increased demands on the welfare state. The two main responses to these challenges were efforts at cost containment and inclusion in non-contributory social protection schemes and health services of those in marginal labor market positions. The mix of these two responses and the depth of the changes were shaped by the intensity of the economic and demographic pressures, policy legacies, the partisan preferences of governing parties and coalitional constraints, the strength of groups in civil society, the presence of veto points in the political system, and in Latin America the process of democratization, along with the international context. A broad comparison between Latin America and Europe highlights the importance of the international context in the form of a relentless pursuit of neoliberal models by the International Financial Institutions in Latin America in contrast to the model of Social Europe promoted by the European Union.

Resumo O artigo apresenta um panorama das profundas mudanças nos Estados de Bem-Estar Social mais avançados da Europa e da América Latina nos últimos 35 anos. Desindustrialização, informalização e o aumento dos empregos instáveis, associados ao envelhecimento populacional, tornaram os modelos de proteção social baseados no emprego menos efetivos e, ao mesmo tempo, aumentaram as pressões sobre os Estados de Bem-Estar Social. As principais respostas para esses desafios foram esforços de contenção de custos e de inclusão em esquemas de proteção social e de saúde não contributivos das pessoas em posições precárias nos mercados de trabalho. A combinação dessas respostas e a profundidade das mudanças foram moldadas pela intensidade das pressões econômicas e demográficas, legados das políticas, preferências dos partidos no governo e constrangimentos pelas coalizões de poder, força dos grupos da sociedade civil, presença de pontos de veto no sistema político e, na América Latina, o processo de democratização e o contexto internacional. A comparação entre América Latina e Europa destaca a importância do contexto internacional expressa em pressões das instituições financeiras internacionais pela adoção de modelos neoliberais na América Latina, em contraste com o modelo de Europa Social promovido pela União Europeia.

O Welfare State resiste? Desenvolvimentos recentes do estado social nos países da OCDE / Is the Welfare State resisting? Recent developments of the social state in OECD countries

Resumo Neste artigo buscamos analisar alguns dos principais indicadores da evolução do estado de bem-estar social em países da OCDE entre 1980 e 2016. Em particular, buscamos avaliar se a crise iniciada em 2007-2008 teria implicado em contração do estado social. Nossa análise se desdobra no estudo do comportamento de três dimensões: o gasto social, seu financiamento tributário e sua efetividade. Nossa investigação revela que o século XXI tem sido um período de expansão, com gastos crescentes e "catch up" de países retardatários. Em particular, todas as grandes áreas de política social sofreram aumentos, ao lado de apostas ainda incipientes em políticas sociais "ativas". O gasto social tem sido financiado por um esforço tributário crescente, não de todo indiferente à progressividade, e tem se traduzido em crescente esforço de redistribuição. Contudo, desigualdades e pobreza avançam em ritmo superior.

Abstract In this paper an attempt was made to analyze some of the main indicators of the evolution of the welfare state in OECD countries between 1980 and 2016. In particular, an assessment was made to evaluate if the so-called Great Recession starting in 2008 led to a contraction of the social state. The analysis focused on three dimensions: social expenditure, funding, and effectiveness. The conclusion drawn was that the twenty-first century has been a period of expansion, both in terms of social expenditure and the catch-up of the latecomers. In particular, all traditional areas of social policy have expanded in tandem with a slight increase in "active" social policies. The rise in social expenditure has been financed by increasing taxation not thoroughly alien to progressivity principles. Overall, it has been translated into an increased effort for redistribution. However, inequality and poverty are advancing at a higher rate.

Adolescent health promotion based on community-centered arts education / Promoción de la salud del adolescente basada en el arte/educación y centrada en la comunidad / Promoção da saúde do adolescente baseada na arte/educação e centrada na comunidade

ABSTRACT Objective: To evaluate the contribution of arts education to health promotion of adolescents in situations of urban social vulnerability. Method: Participatory evaluative research, with a qualitative approach, using as a reference the theoretical constructs of Paulo Freire's Conscientization and the Empowerment Evaluation as a method of collecting with adolescents and teachers of an arts education program in the field of the Family Health Strategy. Results: Participants constructed a collective mission that represented the concept of adolescent health promotion. Arts education activities were prioritized and ranked with a mission focus, and over a three-month period, the program implemented health goals through art. In the reevaluation, the group presented a broad look at the implementation of activities and self-determination for change. Final considerations: Arts education is a potential space for nurses to act in the conscientization and empowerment of adolescent health in Primary Health Care.

RESUMEN Objetivo: evaluar las contribuciones del arte/educación para la promoción de la salud de adolescentes en situación de vulnerabilidad social urbana. Método: pesquisa evaluativa, participativa, abordaje cualitativa, que utilizó como referencial los constructos teóricos de Concientización de Freire y como método de colecta a Evaluación de Empoderamiento con adolescentes y profesores de un programa de arte/educación en el territorio de la Estrategia de Salud de la Familia. Resultados: los participantes construyeron una misión colectiva que representó el concepto de promoción de la salud del adolescente. Las actividades de arte/educación fueron priorizadas y clasificadas con foco en la misión y durante un período de tres meses el programa implementó metas en la salud por medio del arte. En la reevaluación, el grupo presentó una mirada ampliada acerca de la ejecución de las actividades y autodeterminación para cambios. Consideraciones finales: el arte/educación fue un potencial espacio para actuación del enfermero en la concientización y empoderamiento en salud del adolescente en Atención Básica a la Salud.

RESUMO Objetivo: Avaliar as contribuições da arte/educação para a promoção da saúde de adolescentes em situação de vulnerabilidade social urbana. Método: Pesquisa avaliativa, participativa, abordagem qualitativa, que utilizou como referencial os constructos teóricos de Conscientização de Freire e como método de coleta a Avaliação de Empoderamento com adolescentes e professores de um programa de arte/educação no território da Estratégia de Saúde da Família. Resultados: Os participantes construíram uma missão coletiva que representou o conceito de promoção da saúde do adolescente. As atividades de arte/educação foram priorizadas e classificadas com foco na missão, e, durante um período de três meses, o programa implementou metas na saúde por meio da arte. Na reavaliação, o grupo apresentou um olhar ampliado acerca da execução das atividades e autodeterminação para mudanças. Considerações finais: A arte/educação foi um potencial espaço para atuação do enfermeiro na conscientização e empoderamento em saúde do adolescente na Atenção Básica à Saúde.

Austerity and its implications for immigrant health in France.

The ongoing economic crisis in France increasingly has affected immigrant rights, including access to health care. Consistent with a 2014 League Against Cancer survey, we identify the ways in which sickness produces a "double penalty" for immigrants with serious illness. Immigrants with chronic illnesses such as cancer, diabetes, and other debilitating conditions divert vital funds from daily needs to deal with sickness and loss of work while at the same time national austerity measures shred the state's traditional safety net of social services and support. We examine how immigrants strategize to manage financial exigencies, therapeutic itineraries and social relations in the face of these converging pressures. We base our findings on two studies related by this theme: an investigation of health inequalities in the Médoc region, in which 88 women, 44 of North African and Eastern European origin, were interviewed over a three-year period (2010-2013); and a three-year study (2014-2017) of West African immigrant women with breast cancer seeking treatment in the greater Paris region, 70 members of immigrant associations, and clinical personnel in three hospitals.

Health reform in Finland: current proposals and unresolved challenges.

The Finnish health care system is widely respected for its pilot role in creating primary-care-led health systems. In the early 1990s, however, a severe economic downturn in Finland reduced public funding and weakened the Finnish system's deeply decentralized model of health care administration. Recent Bank of Finland projections forecasting several decades of slow economic growth, combined with the impact of an aging population, appear to make major reform of the existing public system inevitable. Over the last several years, political attention has focused mostly on administrative consolidation inside the public sector, particularly integration of health and social services. Current proposals call for a reformed health sector governance structure based on a new meso-level configuration of public administration. In addition, Finland's national government has proposed replacing the current multi-channel public funding structure (which includes health insurance subsidies for occupational health services) with a single-channel public funding structure. This commentary examines several key issues involved in reforming the delivery structure of the Finnish health care system. It also explores possible alternative strategies to reform current funding arrangements. The article concludes with a brief discussion of implications from this Finnish experience for the wider health reform debate.

An exploratory qualitative assessment of factors influencing childhood vaccine providers' intention to recommend immunization in the Netherlands.

BACKGROUND: Under the Dutch national immunization program (NIP), childhood vaccination is not mandatory, but its recommendation by childhood vaccine providers (CVP) is important for maintaining high vaccination coverage. We therefore examined factors related to providers' intentions to recommend vaccinations to parents of young children. METHODS: We conducted four focus group discussions with nurses and physicians who provide vaccines to children 0-4 years old in diverse regions of the Netherlands. Three groups represented CVPs at child welfare centers (CWCs) serving the general population, with the fourth representing anthroposophical CWCs. Elements of the Theory of Planned Behaviour (TPB) were used to design the groups; thematic analysis was used to structure and analyze the dataset. RESULTS: Four main themes emerged, including 1) perceived responsibility: to promote vaccines and discuss pros and cons with parents (although this was usually not done if parents readily accepted the vaccination); 2) attitudes toward the NIP: mainly positive, but doubts as to NIP plans to vaccinate against diseases with a low perceived burden; 3) organizational factors: limited time and information can hamper discussions with parents; 4) relationship with parents: crucial and based mainly on communication to establish trust. Compared to CVPs at standard CWCs, the anthroposophical CWCs spent more time communicating and were more willing to adapt the NIP to individual cases. CONCLUSIONS: Our qualitative assessment provides an overview of beliefs associated with providers' intention to recommend vaccinations. They were motivated to support the NIP, but their intentions to recommend vaccinations were affected by the perceived relevance of the vaccines, practical issues like limited time and by certain types of resistant parents. These results will inform future studies to test the magnitude and relative impact of these factors.

Nos meandros da saúde: desafios e apostas para uma atenção integral no acompanhamento das condicionalidades do Programa Bolsa Família / In meadros health: challenges and stakes to an integral monitoring of conditionality of Bolsa Família

O presente trabalho tem como objetivo refletir sobre o acompanhamento das condicionalidades do pRogrma Bolsa Família na saúde. Parte-se do princípio de que este acompanhamento ocorre de forma burocrática, sem considerar as necessidades de saúde das famílias e a perspectiva da seguridade social e atenção integral. Par metodologia, utilizamos o grupo focal com os trabalhadores, pesqwuisa bibliográfica e documentos institucionais. A pesquisa foi realizada com dados dos relatórios de acompanhamentos das condicionalidades do Programa Bolsa Família noperíodo de agosto de 2011 a fevereiro de 2012. Torna-se premente a rediscussão da saúde enquanto direito, potencializando os preceitos do Sistema Único de Saúde e das temáticas que o atravessam. Além disso, o trabalho também oferece a proposta de uma atenção diferenciada, que aqui chamaremos de consulta ampliada. Para tanto, utilizaremos os impasses e possibilidades oriundos do processo de trabalho de uma equipe de saúde da família de Manguinhos, no município do Rio de Janeiro. Deste modo, defende-se que o acompanhamento das famílias assistidas deve extrapolar as condicionalidades, ofertando ações alicerçadas no princípio da integralidade.

Caregiving and volunteering among older people in Sweden--prevalence and profiles.

This study examines the role of older people in Swedish society by exploring the prevalence of their informal caregiving and volunteering and by analyzing the profiles of these contributors of unpaid work. Data were collected by means of telephone interviews in a Swedish representative survey conducted in 2005. Our analysis reveals three distinct profiles of people involved in unpaid activities. One of these consists of those involved both in informal help giving and volunteering, a group that has been labeled "super helpers" or "doers" in earlier research. It is important for social policy planners to recognize these groups of older people and better understand the dynamics of their unpaid work in order to ascertain whether they might need support as providers and to enhance their well-being. There does not seem to be any simple contradiction between the parallel existence of a universal welfare model of the Swedish kind and an extensive civil society in which older people play important roles as active citizens.

A visibilidade dos escondidos / The invisibility of the hidden ones

Este artigo aborda as manifestações da precarização do trabalho como uma nova e complexa questão social. Procuramos descrever as dimensões humanas implicadas nesse processo de trabalho, traduzindo o nível de exploração de suas relações precárias. Dentre os resultados, destaca-se a relação que esses trabalhadores fizeram de seus sintomas de saúde com seu vínculo de trabalho. A relação precária de trabalho associada à baixa remuneração pode ter manifestações físicas de insônia e medo, refletindo a perda da autoestima. Discutimos a atual reorganização social da produção, em virtude da crise e reestruturação do capitalismo, no último quartel do século XX, que repercutiu no mundo do trabalho, desordenando as relações que conformaram o Estado de Bem-Estar Social e reordenando-as sob a égide da regulação pelo mercado. Concluímos que o trabalhador, frente à sua relação precária de trabalho, tem como preocupação central a ausência de garantias sociais, e suas consequências no longo prazo, quando não mais será útil a esse modelo de exploração da força de trabalho. A pesquisa foi realizada junto a 112 trabalhadores terceirizados por cooperativa, lotados no Serviço de Enfermagem de uma unidade pública de saúde localizada na cidade do Rio de Janeiro, vinculada ao Ministério da Saúde.

This paper discusses the symptoms of the precariousness of work as a new and complex social issue. We seek to describe the human dimensions involved in the work process, reflecting the level of exploitation of their poor relations. Among the results, we highlight the relationship that these workers made of their health symptoms with their work link work. The precarious work relation associated with low incomes may bring physical manifestations of insomnia and fear, reflecting the loss of self-esteem. We discussed the current social reorganization of production due to the crisis and restructuring of capitalism in the last quarter of the 20th century, which affected the world of work, scrambling relations that have shaped the state of Social Welfare and rearranging them under the market regulation. We conclude that the employee, in face of his precarious work relationship, is mainly concerned with the lack of social guarantees, and its consequences in the long run, when he will be no more useful for this type of workforce exploitation. The research was conducted with 112 workers contracted by a cooperative, in a Nursing Service of a public health center of the Health Ministry, located in Rio de Janeiro city.

Envelhecimento, ciclo de vida e mudanças socioeconômicas: novos desafios para os sistemas de seguridade social / Ageing, life cycle and socioeconomic changes: new challenges for social security systems

O processo de envelhecimento populacional, ainda que amplamente reconhecido como uma das principais conquistas do século XX engendra o desafio de assegurar que o processo de desenvolvimento ocorra com base em princípios capazes de garantir a dignidade humana e a eqüidade entre os grupos etários na partilha dos recursos, direitos e responsabilidades sociais. Além dos desafios impostos aos já tradicionais programas constantes dos atuais sistemas de seguridade social, o envelhecimento populacional acrescenta uma nova questão ou risco social: os cuidados de longa duração, demandados pelos idosos com perda de capacidade instrumental e/ou funcional para lidar com as atividades do cotidiano. Por capacidade instrumental pode-se entender a capacidade para a realização de atividades relacionadas a, por exemplo: preparar refeições, fazer compras no mercado, ir ao banco, cuidar da casa etc. Capacidade funcional, por sua vez, refere-se às seguintes atividades: alimentar-se, banhar-se, caminhar distâncias curtas, vestir-se etc. A preocupação com os cuidados de longa duração dos idosos nos países desenvolvidos, onde o processo de envelhecimento populacional já se encontra mais avançado, surgiu como uma necessidade de se separar os custos crescentes com o tratamento dos idosos dos demais gastos com saúde. Os custos, tangíveis ou não, envolvidos na atividadede cuidar/assistir aos idosos tendem a aumentar em função da entrada maciça das mulheres no mercado de trabalho e das mudanças nos contratos de gênero, sugerindo crescentes dificuldades para que as famílias arquem com a responsabilidade pelo cuidado de seus idosos. Em países em desenvolvimento, como o Brasil, essa questão é agravada por se somar a uma ampla lista a ser respondida pelos sistemas de seguridade social, tais como a pobreza, a exclusão de crescentes contingentes da população e o nível de desigualdade vigente...

The changing face of voluntary welfare provision in New Zealand.

This paper contributes a micro-level analysis of voluntary welfare providers, an under explored avenue of geographical research. It analyses the localised social impacts of the macroeconomic restructuring of the Welfare State in New Zealand in the 1980s and 1990s on the work of voluntary service organisations (VSOs) and drop-in centres (DICs) as spaces of care in Dunedin, a small South Island city. We document differences among VSOs and DICs in terms of funding, clientele, and adjustments to service provision to satisfy increasing numbers of patrons and the changing composition of demand. Our findings suggest policy recommendations which, we believe, would do much to enhance the ability of both DICs and smaller VSOs to meet client needs.

Poverty rates in Venezuela: getting the numbers right.

This article looks at household and individual poverty rates in Venezuela over the past seven years. For more than a year, the statement that poverty in Venezuela has increased under the government of President Hugo Chávez has appeared in scores of major newspapers, on major television and radio programs, and even in publications devoted to foreign policy. There are no data to support such statements, and in fact the available data show a decline in poverty for both individuals and households over the seven-year period: the percentage of people in poverty declined from 50 percent in the first quarter of 1999 to 43.7 percent in 2005. Further, there is no evidence to suggest any change in the methodology for measuring poverty during this period, as has been alleged in a number of reports. The article also examines briefly the impact of significant changes in non-cash benefits such as free health care, which are not taken into account in the measured poverty rate, on poor people in Venezuela. Finally, the authors look at how the mistakes in reporting on Venezuela's poverty rate were made; an appendix gives examples of mistakes in major media and foreign policy publications.

The return on investment in health care: from 1980 to 2000.

OBJECTIVE: To estimate the return on US investment (ROI) in overall health as well as four specific conditions. METHODS: The study utilized three distinct approaches to "triangulate" the evidence as related to ROI in health care: 1) an estimation of the average ROI in additional health-care service expenditures in the United States for the year 2000 compared with the year 1980, based on US summaries of health expenditures and health outcomes; 2) an estimate of the ROI in Medicare services for the period from 1985 to 2000 for treatment of heart attack, stroke, type 2 diabetes, and breast cancer, based on National Long-term Care Survey data and Medicare claims; and 3) an estimate of the ROI for selected major treatment innovations for the same four conditions during the period from 1975 to 2000. RESULTS: We calculated that each additional dollar spent on overall health-care services produced health gains valued at Dollars 1.55 to Dollars 1.94 under our base case assumptions. The return on health gains associated with treatment for heart attack, stroke, type 2 diabetes, and breast cancer were Dollars 1.10, Dollars 1.49, Dollars 1.55, and Dollars 4.80, respectively, for every additional dollar spent by Medicare. The ROI for specific treatment innovations ranged from both savings in treatment costs and gains in health to gains in health valued at Dollars 1.12 to Dollars 38.00 for every additional dollar spent. CONCLUSION: The value of improved health in the US population in 2000 compared with 1980 significantly outweighs the additional health-care expenditures in 2000 compared with 1980.

Economic gains and health benefits from a new cigarette tax scheme in Taiwan: a simulation using the CGE model.

BACKGROUND: This study evaluates the impact of an increase in cigarette tax in Taiwan in terms of the effects it has on the overall economy and the health benefits that it brings. METHODS: The multisector computable general equilibrium (CGE) model was used to simulate the impact of reduced cigarette consumption resulting from a new tax scheme on the entire economy gains and on health benefits. RESULTS: The results predict that because of the new tax scheme, there should be a marked reduction in cigarette consumption but a notable increase in health benefits that include saving between 28,125 and 56,250 lives. This could save NTD 1.222 approximately 2.445 billion (where USD 1 = NTD 34.6) annually in life-threatening, cigarette-related health insurance expenses which exceeds the projected decrease of NTD 1.275 billion in Gross Domestic Product (GDP) because of reduced consumption and therefore tax revenue. CONCLUSION: Overall, the increased cigarette excise tax will be beneficial in terms of both the health of the general public and the economy as a whole.