This publication considers the final reports of three research projects that explored how investing in health can benefit economic growth, household productivity, and poverty reduction in Latin America and the Caribbean. It contains case studies of health systems and policies in a number of countries including Brazil, Jamaica, Mexico and Peru; as well as a review of experiences from other regions in the world regarding health inequalities and poverty alleviation.
En las ultimas tres decadas, muchos pafses en America Latina y el Caribe han reconocido el tema de la salud como un derecho humano. Desde inicios de la decada del 2000, 46 millones de personas adicionales, de los pafses estudiados, gozan de la protecci6n de programas de salud con explfcitos derechos a recibir atenci6n. Las reformas han venido acompafiadas por un incremento en el gasto publico del sector salud, financiado en gran pa rte por los ingresos fiscales generales que priorizan o estan dirigidos explfcitamente hacia las poblaciones sin capacidad de pago. Los compromisos polfticos se han traducido en general en presupuestos mas elevados yen leyes aprobadas que circunscriben los fondos destinados al sector salud. En la mayorfa de los pafses se ha priorizado la atenci6n primaria en salud por su costo efectividad y han adoptado metodos de adquisici6n que incentivan la eficiencia y la transparencia en los resultados y que les dan a los administradores del sector salud un mayor apalancamiento para dirigir a los proveedores hacia la . consecuci6n de las prioridades de salud publica. Sin embargo, a pesar de los avances. aun subsisten las disparidades en el financiamiento y calidad de los servicios de los subsistemas de salud. Cumplir con el compromiso de la cobertura universal de salud exigira esfuerzos concertados para mejorar la generaci6n de los ingresos fiscales de manera sostenible y de elevar la productividad y efectividad del gasto. En el re po rte Hacia la cobertura universal en salud v la equidad en America Latina v el Caribe: Evidencia de poises seleccionados. los autores sefialan que la evidencia tomada de un analisis de 54 encuestas de hogares corrobora que las inversiones en la ampliaci6n de la cobertura estan generando resultados. A pesar que los pobres aun presentan los peores fndices de salud en comparaci6n con los ricos, las disparidades se han reducido en gran medida, especialmente durante las primeras etapas de vida. Los pafses han alcanzado elevados niveles de cobertura y equidad en la utilizaci6n de los servicios de salud maternoinfantil. El panorama se torna mas lleno de matices y no tan positivo cuando se trata de la salud en adultos y de la prevalencia de condiciones y enfermedades cr6nicas. La cobertura de las intervenciones de enfermedades no transmisibles no es muy alta y la utilizaci6n de los servicios se inclina hacia aquellos que gozan de una mejor posici6n. La prevalencia de las enfermedades no transmisibles no ha mostrado el comportamiento esperado en vista de la cafda en las tasas de mortalidad: un mayor acceso a los servicios de diagn6stico por pa rte de los segmentos mas ricos podrfa encubrir cambios en la prevalencia real. Los gastos de salud provocados por situaciones catastr6ficas han ido en descenso en la mayorfa de los pafses. El panorama en torno a la equidad, sin embargo es mixto, apuntando hacia limitaciones en la medida. Si bien la tasa de empobrecimiento a causa de gastos de salud es baja, con tendencia decreciente en terminos generales, entre dos y cuatro millones de personas en los pafses estudiados aun caen por debajo de la lfnea de la pobreza despues de haber incurrido en gastos de salud. Los esfuerzos para darle un seguimiento sistematico a la calidad de la atenci6n en la region, apenas dan sus primeros pasos. Sin embargo, un repaso a la literatura revela graves deficiencias en la calidad de la atenci6n de salud, asi como sustanciales diferencias entre los diversos subsistemas. Elevar la calidad de la atenci6n y asegurar la sostenibilidad de las inversiones en salud siguen siendo una agenda inconclusa.
This book explores the scope of reforms and changes in the social protection systems in Latin America that have started at the beginning of the 21st century. It describes how and to what extent changes in social protection systems and social policies have occurred in the region in recent decades. Taking a comparative approach, the volume identifies the triggers for the transformations and how such pressures are received by the welfare regime, or a specific policy sector, to finally yield a given type of reform. The analysis is characterized by the presence of certain factors that explain the development of social protection systems in Latin America, such as economic growth, the consolidation of democratic political regimes, and the region’s Left Turns. The book also examines to what extent common challenges and processes induced by international institutions have led to convergence among countries or welfare regimes, or whether each maintains its own identity.
The 21st century Latin American developmental welfare state model is based on a new public-private alliance, where state-led developmental social policy relies for its implementation mainly on proactive, emerging regional entrepreneurs and a growing middle class. This volume illustrates where innovative development strategy may be in the making.
The 2002 edition of this quadrennial publication presents a regional analysis of the health situation and trends in the Americas region, as well as for each of the 47 countries and territories in the region. It is published in two volumes and covers mainly the years from 1997-2000. This edition focuses upon the inequalities in health. Volume One looks at issues dealing with leading health and health-related indicators, ranging from mortality and changes in life expectancy to the relationship between health and income distribution. It also considers current health conditions and trends including disease prevention and control, health promotion and environmental protection. Volume Two examines each country's overall health conditions, including institutional organisation, health regulations and the overall operation of health services.
This book analyzes various important aspects of methodology and substance regarding economic, social, and political policy in Latin America directed toward achieving more effective, efficient, and equitable societal institutions. The chapters are authored by experts from within Latin America and also from Latin America research institutes elsewhere. The book combines practical policy significance with insightful causal and prescriptive generalizations. The emphasis is on the role of governmental decision-making and the important (but secondary) role of the marketplace, social groups, and engineering.
This book critically analyses the influence of international policies and guidelines on the performance of interventions aimed at reducing health inequities in Latin America, with special emphasis on health promotion and health in all policies strategies. While the implementation of these interventions plays a key role in strengthening these countries’ capacity to respond to current and future challenges, the urgency and pressures of cooperation and funding agencies to show results consistent with their own agendas not only hampers this goal, but also makes the territory invisible, hiding the real problems faced by most Latin American countries, diminishing the richness of local knowledge production, and hindering the development of relevant proposals that consider the territory’s conditions and cultural identity. Departing from this general analysis, the authors search for answers to the following questions: Why, despite the importance of the theoretical advances r egarding actions to address social and health inequities, haven’t Latin American countries been able to produce the expected results? Why do successful initiatives only take place within the framework of pilot projects? Why does the ideology of health promotion and health in all policies mainly permeate structures of the health sector, but not other sectors? Why are intersectoral actions conjunctural initiatives, which often fail to evolve into permanent practices? Based on an extensive literature review, case studies, personal experiences, and interviews with key informants in the region, Globalization and Health Inequities in Latin America presents a strategy that uses monitoring and evaluation practices for enhancing the capacity of Latin American and other low and middle-income countries to implement sustainable processes to foster inclusiveness, equity, social justice and human rights. p/pp
This comprehensive Handbook provides a unique overview of the key issues and challenges facing society and social policy in the twenty-first century, discussing how welfare is conceptualised, organised and delivered in contemporary global society. Chapters engage with specific areas of social policy as well as with the social divisions and institutional infrastructures that underpin them. The Handbook also considers how social policy should respond to the challenges posed by austerity, human migration and the climate crisis.
