RESUMEN
Since late 2010, the Arab world has entered a tumultuous period of change, with populations demanding more inclusive and accountable government. The region is characterised by weak political institutions, which exclude large proportions of their populations from political representation and government services. Building on work in political science and economics, we assess the extent to which the quality of governance, or the extent of electoral democracy, relates to adult, infant, and maternal mortality, and to the perceived accessibility and improvement of health services. We compiled a dataset from the World Bank, WHO, Institute for Health Metrics and Evaluation, Arab Barometer Survey, and other sources to measure changes in demographics, health status, and governance in the Arab World from 1980 to 2010. We suggest an association between more effective government and average reductions in mortality in this period; however, there does not seem to be any relation between the extent of democracy and mortality reductions. The movements for changing governance in the region threaten access to services in the short term, forcing migration and increasing the vulnerability of some populations. In view of the patterns observed in the available data, and the published literature, we suggest that efforts to improve government effectiveness and to reduce corruption are more plausibly linked to population health improvements than are efforts to democratise. However, these patterns are based on restricted mortality data, leaving out subjective health metrics, quality of life, and disease-specific data. To better guide efforts to transform political and economic institutions, more data are needed for health-care access, health-care quality, health status, and access to services of marginalised groups.
Asunto(s)
Gobierno , Estado de Salud , Mundo Árabe , Atención a la Salud/organización & administración , Salud Global , Humanos , Medio Oriente/epidemiología , Mortalidad/tendencias , Política , Mejoramiento de la CalidadRESUMEN
The "Arab Spring" has touched almost all countries in the Middle East and North Africa. While most attention has focused on security and political developments, there are significant consequences for population health. These include immediate problems, such as violent deaths and injuries, population displacement, and damage to essential infrastructure, but also longer term vulnerabilities not yet addressed by the political changes, including high unemployment, the low status of women, erosion of already weak welfare systems, and rising food prices. It will be important to tackle these underlying issues while not repeating the mistakes made in other countries that have undergone rapid political transition.
Asunto(s)
Política , Salud Pública/tendencias , Problemas Sociales/tendencias , Guerra , África del Norte/epidemiología , Árabes , Brotes de Enfermedades/economía , Femenino , Abastecimiento de Alimentos , Humanos , Medio Oriente/epidemiología , Salud Pública/economía , Refugiados , Problemas Sociales/economía , Desempleo/tendencias , Derechos de la Mujer/tendencias , Heridas y Lesiones/complicaciones , Heridas y Lesiones/epidemiologíaAsunto(s)
Política de Salud , Salud , Cooperación Internacional , Justicia Social , Responsabilidad Social , HumanosAsunto(s)
Árabes , Miedo , Personeidad , Política , Guerra , Conflicto de Intereses , Humanos , Israel , Medio Oriente , TorturaRESUMEN
This paper presents a brief history of Palestinian mental health care, a discussion of the current status of mental health and health services in the occupied Palestinian territory, and a critique of the biomedical Western-led discourse as it relates to the mental health needs of Palestinians. Medicalising distress and providing psychological therapies for Palestinians offer little in the way of alleviating the underlying causes of ongoing collective trauma. This paper emphasises the importance of separating clinical responses to mental illness from the public health response to mass political violation and distress. Palestinian academic research reframes the mental health paradigm utilising an approach based on the broader framework of social justice, quality of life, human rights and human security. Recognising social suffering as a public mental health issue requires a shift in the emphasis from narrow medical indicators, injury and illness to the lack of human security and human rights violations experienced by ordinary Palestinians. Such a change in perspective requires a parallel change in mental health policies from short-term emergency humanitarian aid to the development of a sustainable system of public mental health services, in combination with advocacy for human rights and the restoration of political, historical and moral justice.
Asunto(s)
Árabes/psicología , Violaciones de los Derechos Humanos , Trastornos Mentales/etnología , Servicios de Salud Mental/historia , Calidad de Vida/psicología , Estrés Psicológico/psicología , Árabes/historia , Árabes/estadística & datos numéricos , Colonialismo/historia , Femenino , Historia del Siglo XX , Historia del Siglo XXI , Hospitales Psiquiátricos/historia , Hospitales Psiquiátricos/normas , Humanos , Incidencia , Israel/epidemiología , Masculino , Trastornos Mentales/etiología , Trastornos Mentales/historia , Servicios de Salud Mental/normas , Servicios de Salud Mental/provisión & distribución , Política , Factores Sociológicos , Estrés Psicológico/etnología , Estrés Psicológico/etiología , Reino Unido , GuerraRESUMEN
The International Monetary Fund's recent claims concerning its impact on public health are evaluated against available data. First, the IMF claims that health spending either does not change or increases with IMF-supported programs, but there is substantial evidence to the contrary. Second, the IMF claims to have relaxed strict spending requirements in response to the 2008-9 financial crisis, but there is no evidence supporting this claim, and some limited evidence from the Center for Economic Policy Research contradicting it. Third, the IMF states that wage ceilings on public health are no longer part of its explicit conditionalities to poor countries, as governments can choose how to achieve public spending targets; but in practice, ministers are left with few viable alternatives than to reduce health budgets to achieve specific IMF-mandated targets, so the result effectively preserves former policy. Fourth, the IMF's claim that it has increased aid to poor countries also seems to be contradicted by its policies of diverting aid to reserves, as well as evidence that a very small fraction of the Fund's new lending in response to the financial crisis has reached poor countries. Finally, the IMF's claim that it follows public health standards in tobacco control contrasts with its existing policies, which fail to follow the guidelines recommended by the World Bank and World Health Organization. The authors recommend that the IMF (1) become more transparent in its policies, practices, and data to allow improved independent evaluations of its impact on public health (including Health Impact Assessment) and (2) review considerable public health evidence indicating a negative association between its current policies and public health outcomes.
Asunto(s)
Administración de los Servicios de Salud/economía , Política Pública , Asignación de Recursos/economía , Naciones Unidas/economía , Países en Desarrollo , Salud Global , Humanos , Asignación de Recursos/organización & administración , Naciones Unidas/organización & administraciónRESUMEN
Despite optimism about the potential for a "new economic order," the outcomes of the G20 summit of April 2009 do not deviate from the neoliberal path. The main outcome, the G20's commitment to the International Monetary Fund (IMF), does not change the lending practices and core economic assumptions of the IMF. Further, this new funding commitment will do little to help the poorest countries, as it is not available to them and comes with high interest. Institutions that more actively consider health, such as the World Bank and World Health Organization, may have failed to win resources and authority because they have not demonstrated how they could expand or modify their activities, and because of broader ideological debates pitting social protection against economic stimulus. Reforms in IMF practices and economic assumptions may provide some limited protection of health spending. These reforms can allow for inclusion of the benefits of health programs in economic forecasting, dismissal of the assumption that aid will be short-term, and removal of indirect limits on public sector health spending. These reforms in IMF practices are urgently needed, but fall short of making health and social protection an integral component of efforts promoting economic stability.
Asunto(s)
Apoyo Financiero , Disparidades en el Estado de Salud , Cooperación Internacional , Pobreza , Naciones UnidasRESUMEN
We describe the threats to survival, development, and wellbeing in the occupied Palestinian territory using human security as a framework. Palestinian security has deteriorated rapidly since 2000. More than 6000 Palestinians have been killed by the Israeli military, with more than 1300 killed in the Gaza Strip during 22 days of aerial and ground attacks ending in January, 2009. Israeli destruction and control of infrastructure has severely restricted fuel supplies and access to water and sanitation. Palestinians are tortured in prisons and humiliated at Israeli checkpoints. The separation wall and the checkpoints prevent access to work, family, sites of worship, and health-care facilities. Poverty rates have risen sharply, and almost half of Palestinians are dependent on food aid. Social cohesion, which has kept Palestinian society intact, including the health-care system, is now strained. More than US$9 billion in international aid have not promoted development because Palestinians do not have basic security. International efforts focused on prevention of modifiable causes of insecurity, reinvigoration of international norms, support of Palestinian social resilience and institutions that protect them from threats, and a political solution are needed to improve human security in the occupied Palestinian territory.
Asunto(s)
Árabes , Derechos Humanos , Desórdenes Civiles , Salud , Medio Oriente , Seguridad , Saneamiento , Condiciones Sociales , GuerraRESUMEN
To address the gap between health investments and financial flows worldwide, we identified the patterns in allocation of funds by the four largest donors--ie, the World Bank, Bill & Melinda Gates Foundation (BMGF), the US Government, and the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria--in 2005. We created a disbursement database with information gathered from the annual reports and budgets. Funding per death varied widely according to type of disease--eg, US$1029.10 for HIV/AIDS to $3.21 for non-communicable diseases. The World Bank, US Government, and Global Fund provided more than 98% of their funds to service delivery, whereas BMGF gave most of its funds to research. BMGF grants in 2005 were given largely to private research organisations, universities, and civil societies in rich countries, whereas the US Government and Global Fund primarily disbursed grants to sub-Saharan Africa. Publicly available data for global health disbursements is incomplete and not standardised. Continued attention is needed to develop country ownership, particularly in planning and priority setting.
Asunto(s)
Organización de la Financiación/organización & administración , Salud Pública/economía , Asignación de Recursos/organización & administración , Salud Global , Servicios de Salud/economía , Investigación sobre Servicios de Salud/economíaRESUMEN
Despite the publication of high-profile reports and promising activities in several countries, progress in mental health service development has been slow in most low-income and middle-income countries. We reviewed barriers to mental health service development through a qualitative survey of international mental health experts and leaders. Barriers include the prevailing public-health priority agenda and its effect on funding; the complexity of and resistance to decentralisation of mental health services; challenges to implementation of mental health care in primary-care settings; the low numbers and few types of workers who are trained and supervised in mental health care; and the frequent scarcity of public-health perspectives in mental health leadership. Many of the barriers to progress in improvement of mental health services can be overcome by generation of political will for the organisation of accessible and humane mental health care. Advocates for people with mental disorders will need to clarify and collaborate on their messages. Resistance to decentralisation of resources must be overcome, especially in many mental health professionals and hospital workers. Mental health investments in primary care are important but are unlikely to be sustained unless they are preceded or accompanied by the development of community mental health services, to allow for training, supervision, and continuous support for primary care workers. Mobilisation and recognition of non-formal resources in the community must be stepped up. Community members without formal professional training and people who have mental disorders and their family members, need to partake in advocacy and service delivery. Population-wide progress in access to humane mental health care will depend on substantially more attention to politics, leadership, planning, advocacy, and participation.