RESUMO
The Mexican health reform can be understood only in the context of neoliberal structural adjustment, and it reveals some of the basic characteristics of similar reforms in the Latin American region. The strategy to transform the predominantly public health care system into a market-driven system has been a complex process with a hidden agenda to avoid political resistance. The compulsory social security system is the key sector in opening health care to private insurance companies, health maintenance organizations, and hospital enterprises mainly from abroad. Despite the government's commitment to universal coverage, equity, efficiency, and quality, the empirical data analyzed in this article do not confirm compliance with these objectives. Although an alternative health policy that gradually grants the constitutional right to health would be feasible, the new democratically elected government will continue the previous regressive health reform.
Assuntos
Reforma dos Serviços de Saúde/legislação & jurisprudência , Programas Nacionais de Saúde/legislação & jurisprudência , Política , Privatização/legislação & jurisprudência , Previdência Social/legislação & jurisprudência , Fatores Socioeconômicos , Fidelidade a Diretrizes , Reforma dos Serviços de Saúde/economia , Reforma dos Serviços de Saúde/normas , Setor de Assistência à Saúde , Prioridades em Saúde , Acessibilidade aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Seguro Saúde , Pessoas sem Cobertura de Seguro de Saúde , México , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/tendências , Objetivos Organizacionais , Privatização/economia , Privatização/tendências , Previdência Social/economia , Previdência Social/normas , Seguridade Social/tendênciasRESUMO
A frequent practical problem of research in developing countries is the lack of reliable records on occupational hazards. To improve this situation, this article suggests and evaluates a two-phase method for estimating particle exposure. The first phase uses the focal group, or homogeneous group, technique to reconstruct the production process and estimate the level of dust exposure. The second phase applies the technique of individual history of exposure to hazards at work, an index that accumulates current and previous exposure. This method was introduced in a Portland cement plant to assess the dust-exposure levels of workers and to evaluate its usefulness in the association between estimated exposure levels and the frequency of health effects--particularly respiratory effects--that occurred as a result of such exposures. The results obtained from the analysis of the production process and of the exposure levels determined by the cement workers showed that it is possible to reconstruct the history of exposure to cement dust during each worker's occupational history. The results also showed that estimated exposure is related to respiratory damage; higher exposure resulted in more serious diseases. This supports the usefulness of the suggested methodology.
Assuntos
Poluentes Ocupacionais do Ar/efeitos adversos , Materiais de Construção/efeitos adversos , Países em Desenvolvimento , Poeira/efeitos adversos , Doenças Profissionais/etiologia , Doenças Respiratórias/etiologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Doenças Profissionais/prevenção & controle , Doenças Respiratórias/prevenção & controle , RiscoRESUMO
The social security counterreform, initiated in 1997, forms part of the neoliberal reorganization of Mexican society. The reform implies a profound change in the guiding principles of social security, as the public model based on integrality, solidarity, and redistribution is replaced by a model based on private administration of funds and services, individualization of entitlement, and reduction of rights. Its economic purpose is to move social services and benefits into the direct sphere of private capital accumulation. Although these changes will involve the whole social security system--old-age and disability pensions, health care, child care, and workers' compensation--they are most immediately evident in the pension scheme. The pay-as-you-go scheme is being replaced by privately managed individual retirement accounts which especially favor the big financial groups. These groups are gaining control over huge amounts of capital, are authorized to charge a high commission, and run no financial risks. The privatization of the system requires decisive state intervention with a legal change and a sizable state subsidy (1 to 1.5 percent of GNP) over five decades. The supposed positive impact on economic growth and employment is uncertain. A review of the new law and of the estimates of future annuities reveals shrinking pension coverage and inadequate incomes from pensions.
Assuntos
Pensões , Privatização , Previdência Social/legislação & jurisprudência , Idoso , Custos e Análise de Custo , Emprego/economia , Humanos , Cobertura do Seguro , México , Previdência Social/organização & administraçãoAssuntos
Saúde Ocupacional , Pesquisa , Humanos , Cooperação Internacional , Itália , Sindicatos , América Latina , México , Projetos de Pesquisa , Suécia , Estados Unidos , ZimbábueRESUMO
In recent years, compensatory poverty programs have been adopted in several countries in response to the social and political effects of structural adjustment programs implemented by most Latin American and African countries. The authors analyze the Mexican National Solidarity Program "Pronasol," often cited as an exemplary social compensation program, by inquiring into its impact on poverty. The authors first investigate the relationship between structural adjustment and the process of impoverishment, in order to establish the dynamics and magnitude of poverty in Mexico. They find that the structural adjustment program has considerably increased poverty, mainly through a sustained wage decrease and job losses. The authors next discuss whether Pronasol complies with the requisites of a program that warrants a social minimum for the poor, and whether the resource allocation complies with objective criteria of the sociogeographic distribution of poverty. The data suggest that Pronasol cannot be considered to guarantee a social minimum for the poor, given the magnitude of poverty, the scarce resources allocated, the orientation of the subprograms, and the regional distribution of funds. Nor does it qualify as a social compensation program of any importance. Finally, an alternative interpretation of Pronasol is offered in the field of legitimation and political control.
Assuntos
Pobreza , Emprego , Renda , México , Política , Pobreza/economia , Pobreza/legislação & jurisprudência , Seguridade Social/economia , Seguridade Social/legislação & jurisprudênciaRESUMO
The concern for workers' health has increased in Latin America during the last decade both on the part of research institutions and trade unions. A special emphasis has been given to active participation of workers not just in the transformation of working conditions to improve health but also in generation of knowledge. This paper presents an action oriented participatory research methodology based on a collective questionnaire that permits the recollection of data on characteristics of the labour process, risks and health damage. A comparison between the information on risks, health damage and the relationship risks-damage obtained with this methodology and those of an individual questionnaire applied at the same steel factory shows that the results produced are very similar. In view of these findings it is concluded that the participatory methodology has some important advantages over traditional methodologies since it provides qualitative information on the labour process, a precise picture of the main risks and how they are produced and semi-quantitative data on health damage, and at the same time, generates a process of consciousness and organization among workers that enables them to promote health oriented action.
Assuntos
Etnologia/métodos , Indicadores Básicos de Saúde , Saúde Ocupacional , Projetos de Pesquisa , Inquéritos e Questionários/normas , Etnologia/normas , Estudos de Avaliação como Assunto , Humanos , México , Modelos Teóricos , Reprodutibilidade dos Testes , Pesquisa/normasRESUMO
This article presents a discussion of the probable implications for the Mexican health sector of the Free Trade Agreement (FTA) between the United States, Canada, and Mexico. The authors argue that the FTA should be seen as part of neoliberal policies adopted by the Mexican government in 1983 that are based on large-scale privatization and deregulation of labor relations. In this general context the health sector, which traditionally has been dominated by public institutions, is undergoing a deep restructuring. The main trends are the decapitalization of the public sector and a selective process of privatization that tends to constitute the private health sector in a field of capital accumulation. The FTA is likely to force a change in Mexican health legislation, which includes health services in the public social security system and recognizes the right to health, and to accelerate selective privatization. The U.S. insurance industry and hospital corporations are interested in promoting these changes in order to gain access to the Mexican market, estimated at 20 to 25 million persons. This would lead to further deterioration of the public institutions, increasing inequalities in health and strengthening the private sector. The historical trend toward the integration of a National Health Service in Mexico would be interrupted in favor of formation of a dual private-public system.
Assuntos
Comércio/economia , Atenção à Saúde/economia , Cooperação Internacional , Canadá , Comércio/legislação & jurisprudência , Atenção à Saúde/organização & administração , Atenção à Saúde/tendências , Acessibilidade aos Serviços de Saúde , Humanos , Seguro Saúde/economia , Seguro Saúde/tendências , México , Privatização , Previdência Social/legislação & jurisprudência , Estados UnidosRESUMO
The Mexican case represents an orthodox neoliberal health policy in the context of the structural adjustment adopted by the Mexican government in 1983. The social costs of this strategy are very high, including an increase in unemployment, wage depression, regressive redistribution of wealth, and profound changes in social policies. These transformations are reflected in the health sector, where the four main axes of neoliberal policy--expenditure restrictions, targeting, decentralization, and privatization--have been implemented. This represents a change in social policy from a model based on citizens' social rights and the state's obligation to guarantee them, to a model characterized by selective public charity. This strategy has been imposed on society as a result of the Mexican corporative political regime based on a state party system. Since 1985, however, there has been a growing process of independent organization of civil society. This led in the presidential elections of 1988 to the defeat of the candidate of the governing party by the candidate of a popular-democratic opposition front. Although the government party imposed its candidate through electoral fraud, social mobilization against neoliberal policies continues in the midst of an important political crisis that can only be resolved by profound democratization of Mexican society.
Assuntos
Política de Saúde/economia , Política , Direitos Civis , Democracia , Emprego/estatística & dados numéricos , Promoção da Saúde , Humanos , México , Pobreza , Privatização , Salários e BenefíciosRESUMO
In this article, the author analyzes the struggle for workers' health in Mexico, emphasizing the importance of the general and specific political context. In an overview of the legislation on industrial health and safety, the state institutions involved in the issue, and the characteristics of union organization in Mexico, the author shows that the limited activities related to workers' health have more to do with the relative political weakness of the Mexican working class than with the formal structures of legislation, state institutions, and unions. The second part of the article deals with the four most important struggles for health and safety in Mexico during the last ten years, which show some similarities. These struggles are consistently linked to processes of union democratization and tend to decline when union democracy is lost. The strategies of the companies show a common pattern: removing health issues from collective bargaining and putting them in the hands of state institutions. When workers have opposed this solution, management has used selective repression to solve the conflict. The state institutions subordinate their position to the companies' by postponing action or by doing a technically poor job. Changing the existing situation involves the social legitimation of the workers' health issue, since this would have an impact on the political processes involved, i.e., corporate control over workers, authoritarian labor relations and professionalism, and resources of the state institutions.
Assuntos
Democracia , Sindicatos/organização & administração , Serviços de Saúde do Trabalhador , Negociação Coletiva , Planos de Assistência de Saúde para Empregados , Política de Saúde , Humanos , México , Segurança , Indenização aos TrabalhadoresRESUMO
It is suggested that the relationship between work and health and disease traditionally has been analyzed in a limited way in that work has been considered only as a situational factor which puts workers in contact with environmental risks. It is proposed that work is an essential category for the understanding of disease, if one tries to study disease not as an individual biological phenomenon but as a social (and biological) phenomenon that occurs to the collectivity. Furthermore, it is suggested that the relation between disease and work should be analyzed in terms of the elements of the work process, understood as a technical and social process, and the capacity of different social groups to realize their interests. Reviewing the general trends of development of the work process in Mexico, it is shown that a transformation in the causes of death among men of working age has occurred during the last 20 years and there has been an increase in the number and the rate of work accidents and occupational diseases, despite a significant under-registration factor. Finally, the labor legislation on health and safety is contrasted with its actual implementation. This problem is interpreted in the context of traditional Mexican trade unionism. It is shown that trade unions which have become democratic and have gained their independence have struggled more vigorously on occupational health and safety issues.