RESUMO
BACKGROUND: In 2008, Ecuador introduced Plan Nacional para el Buen Vivir (PNBV; National Plan for Good Living), which was widely recognized as a promising example of Health in All Policies (HiAP) due to the integration of policy sectors on health and health equity objectives. PBNV was implemented through three successive plans (2009-2013, 2013-2017, 2017-2021). In a time of widening global health inequities, there is growing interest in understanding how politics and governance shape HiAP implementation. The objective of this study was to test specific hypotheses about how, why, to what extent, and under what circumstances HiAP was implemented in Ecuador. METHODS: An explanatory case study approach (HiAP Analysis using Realist Methods on International Case Studies-HARMONICS) was used to understand the processes that hindered or facilitated HiAP implementation. Realist methods and systems theory were employed to test hypotheses through analysis of empirical and grey literature, and 19 key informant interviews. This case study focused on processes related to buy-in for a HiAP approach by diverse policy sectors, particularly in relation to the strong mandate and transformative governance approach that were introduced by then-President Rafael Correa's administration to support PNBV. RESULTS: The mandate and governance approach of the HiAP approach achieved buy-in for implementation across diverse sectors. Support for the hypotheses was found through direct evidence about buy-in for HiAP implementation by policy sectors; and indirect evidence about allocation of governmental resources for HiAP implementation. Key mechanisms identified included: influence of political elites; challenges in dealing with political opposition and 'siloed' ways of thinking; and the role of strategies and resources in motivating buy-in. CONCLUSION: In Ecuador, political elites were a catalyst for mechanisms that impacted buy-in and government funding for HiAP implementation. They raised awareness among policy sectors initially opposed to PNBV about the rationale for changing governance practices, and they provided financial resources to support efforts related to PNBV. Specific mechanisms help explain these phenomena further. Future studies should examine ways that PNBV may have been an impediment to health equity for some marginalized groups while strengthening HiAP implementation.
Assuntos
Promoção da Saúde , Formulação de Políticas , Equador , Governo , Política de Saúde , HumanosRESUMO
Pesticide-related health impacts in Ecuador's banana industry illustrate the need to understand science's social production in the context of major North-South inequities. This paper explores colonialism's ongoing context-specific relationships to science, and what these imply for population health inquiry and praxis. Themes in postcolonial science and technology studies and critical Latin American scholarship guide this exploration, oriented around an ethnographic case study of bananas, pesticides and health in Ecuador. The challenge of explaining these impacts prompts us to explore discursive and contextual dynamics of pesticide toxicology and phytopathology, two disciplines integral to understanding pesticide-health linkages. The evolution of banana phytopathology reflects patterns of banana production and plant science in settings made accessible to scientists by European colonialism and American military interventions. Similarly, American foreign policy in Cold War-era Latin America created conditions for widespread pesticide exposures and accompanying health science research. Neocolonial representations of the global South interacted with these material realities in fostering generation of scientific knowledge. Implications for health praxis include troubling celebratory portrayals of global interconnectedness in the field of global health, motivating critical political economy and radical community-based approaches in their place. Another implication is a challenge to conciliatory corporate engagement approaches in health research, given banana production's symbiosis of scientifically 'productive' military and corporate initiatives. Similarly, the origins and evolution of toxicology should promote humility and precautionary approaches in addressing environmental injustices such as pesticide toxicity, given the role of corporate actors in promoting systematic underestimation of risk to vulnerable populations. Perhaps most unsettlingly, the very structures and processes that drive health inequities in Ecuador's banana industry simultaneously shape production of knowledge about those inequities. Public health scholars should thus move beyond simply carrying out more, or better, studies, and pursue the structural changes needed to redress historical and ongoing injustices.
Assuntos
Agricultura/história , Colonialismo/história , Disparidades nos Níveis de Saúde , Musa , Praguicidas/história , Agricultura/estatística & dados numéricos , Antropologia Cultural , Países em Desenvolvimento , Equador/epidemiologia , Meio Ambiente , Saúde Global , História do Século XX , Humanos , Praguicidas/efeitos adversos , Saúde Pública , Sociologia MédicaRESUMO
Pesticide exposure in Ecuador's banana industry reflects political economic and ecological processes that interact across scales to affect human health. We use this case study to illustrate opportunities for applying political ecology of health scholarship in the burgeoning field of global health. Drawing on an historical literature review and ethnographic data collected in Ecuador's El Oro province, we present three main areas where a political ecological approach can enrich global health scholarship: perceptive characterization of multi-scalar and ecologically entangled pathways to health outcomes; critical analysis of discursive dynamics such as competing scalar narratives; and appreciation of the environment-linked subjectivities and emotions of people experiencing globalized health impacts. Rapprochement between these fields may also provide political ecologists with access to valuable empirical data on health outcomes, venues for engaged scholarship, and opportunities to synthesize numerous insightful case studies and discern broader patterns.
La exposición a agroquímicos en la industria bananera del Ecuador evidencia procesos de ecología y economía política interactuando en diferentes escalas y que terminan afectando a la salud humana. Este estudio de caso ilustra como la ecología política de la salud puede aportar al creciente campo de la salud global. A partir de una revisión histórica de literatura y de datos etnográficos recopilados en la provincia de El Oro, Ecuador, presentamos tres áreas principales donde la perspectiva de ecología política puede enriquecer el campo de la salud global: caracterización perspicaz de trayectorias multiescalares y ecológicamente relacionadas que afectan a la salud; valoración crítica de dinámicas discursivas tales como las narrativas escalares contrapuestas; y apreciación de subjetividades y emociones relacionadas con el ambiente entre personas que viven impactos de salud global. El acercamiento entre estos dos campos también puede proporcionar a los ecólogos políticos acceso a valiosos datos empíricos sobre salud, espacios para la praxis y oportunidades para sintetizar numerosos estudios de casos perspicaces para discernir patrones más amplios.