Health and Agriculture in Africa

The writer is an agriculturist who taught botany for many yearsat Achimota.     

TRIPS and the Primacy of Public Health

The 1984 Uruguay round of trade negotiations was criticized by many as discriminating against developing countries. On the issue of intellectual property, the contentious issue was that of the patent protection given to the drugs manufacturers, mostly based in developed countries. In this article, Shinzo Kobori, distinguished research fellow at the Institute for International Policy Studies, explores the issues surrounding the dilemma: the drugs need to be provided for many people in the developing world but, on the other hand, adequate compensation needs to be given to pharmaceutical companies producing the medicine. Focusing on pharmaceutical patents of anti-AIDS/HIV drugs, he examines the barriers to access to essential drugs in developing countries. Kobori goes on to scrutinize the various policy options including compulsory licensing and parallel imports, and describes the potential hurdles facing global drug companies in light of the challenges from Brazil, South Africa and the US.     

Health Risks for Poultry Workers in Brazil in the COVID-19 Pandemic

This article discusses labour relations in the poultry industry in Brazil in the context of the COVID-19 pandemic. In the meat production and processing industries there have been many complaints about abusive practices that put workers' health at risk. In several small cities across the country, slaughterhouses already act as pandemic contagion risk hotspots. We present an overview of the demeaning treatment of workers and the risks to public health associated with Brazil's poultry industry.     

Excluded from Health? Informal Workers’ Access to Health Care in Chile

The Pan American Health Organisation recently highlighted the increased exclusion of low income households in Latin America from health care. The rise in informal employment and sub‐contracting of workers means that many employees lack formal contracts and are excluded from health insurance programmes. Feminist research suggests low income women are often most at risk of exclusion. Simultaneously, deeply entrenched inequalities within health systems across the region have not been addressed by health sector reforms. Drawing on the case of Chile, this paper examines the extent to which informal workers have indeed been excluded and how far these processes are gendered.     

Bedouin Health Services in Mandated Palestine

Amos Elon, Tne Israelis, Founders and Sons, pp. 359, bibliography and index, Weidenfeld and Nicolson, £2·50.     

Health Policy in Chile: The Return of the Public Sector?

Health policy in Chile has mirrored the main changes in economic policy in recent times. The 1950s and 1960s witnessed centralisation of public health care into a National Health Service. Neoliberal policies in the 1970s and 1980s refocused health policy onto extending the scope for private insurance and provision in health care. The return to democracy in 1990 has produced a reappraisal of health policy, with the emphasis on strengthening and improving public health insurance and care. This paper examines the extent to which recent changes in health policy signal a reappraisal of the private-public mix in the provision of basic services, and argues that a model for health care and financing built around a strong, modern, and efficient, public health care sector is more likely to succeed in addressing the health needs of the population in Chile and Latin America.     

Health Care Reform in Vietnam: Chasing Shadows

The purpose of this paper is to analyse and assess health care reforms in Vietnam since the late 1980s. It will argue that shortcomings of the reforms centre on three related sets of measures: substitution of budgetary allocation with user charges, expansion of social insurance and promotion of decentralisation. Reduction in fiscal support for providers offered them the motive to concentrate on revenue-generating activities while user charges provided them with the means to do so. With both the motive and the means for maximising revenues in place, providers vigorously pursued income-maximisation which had the effect of raising overall expenditures while reducing access. To deal with the problem of declining access due to rising user charges, the government is in the process of vigorously expanding social insurance. However, social insurance does not deal with the root causes of the problem of rising expenditures which lie in paying providers on a fee-for-service (FFS) basis. The paper will further argue that decentralisation has aggravated the adverse effects of FFS by diluting control and accountability.     

机制设计与国际卫生合作中的困境

本文运用情景结构主义分析工具对传染性疾病国际通报合作长期止步不前这一问题进行了研究。尽管《国际卫生条例》将传染性疾病的国际通报合作塑造成具有良好合作前景的"猎鹿游戏",但由于国际合作的专业性与主权国家利益的复合性之间存在矛盾,国家往往将贸易利益的考虑置于健康的价值之上,从而使得合作陷入相互背叛的僵局。通过改善机制的设计,这一困境可以得到缓解。     

When the Poor Need Health Care: Ethnography of State and Citizenship in Turkey

This article is mainly about the everyday workings of the Green Card Scheme in Turkey, which is a social assistance mechanism providing free health care services to the poor. Through a scrutiny of interactions around the Green Card Scheme in the city of Ad?yaman in south-eastern Turkey, the article explores how the categories of state and citizenship substantiated at the local level by means of various discourses and practices and in the process of citizens' encounters with the Green Card bureaucracy.     

奥巴马政府的医疗改革及其前景

奥巴马总统上台后启动的医疗改革是一场规模空前、任务艰巨、争论激烈、过程曲折的重大社会改革,其主要目标是抑制急速膨胀的医疗保健费用及其导致的巨额财政赤字,扩大医疗保险覆盖面,提高医疗服务质量,让医疗保健体系适应21世纪美国加强国家竞争力的要求。迄今为止,改革取得的主要成果是美国国会参众两院通过的医疗改革议案及其修正案,距离最后的成功仅一步之遥。尽管改革过程和方案存在重大缺陷,改革的前景也充满变数和挑战,但奥巴马政府已经创造了历史,初步实现了美国医疗改革的百年梦想,奥巴马也将由此形成他最重要的政治遗产。     

Explaining Policy Stability and Change in Swiss Health Care Reforms

The article investigates recent health reforms and reform attempts in Switzerland. A substantial reform, the revision of the health insurance law in 1994, is followed by a long period of refused reform proposals and incremental change. In order to explain policy change and policy stability in health policies, we apply veto‐player theory to partisan and parliamentary debates on reform proposals of the health insurance from the end of the 1980s until today. Shifts in ideological positions of parties, especially with regard to the objective of solidarity, allowed for a new win‐set in the 1990s that was at the base of the law revision. Since then, the win‐set is empty as parties did not change their preferences. New and substantial reforms will only be possible, it is concluded, if the pivot player, the Christian‐democratic party, changes its ideological positions to a significant extent.     

Contradictions and Constraints in Chile's Health Care and Education Decentralization

Proponents of social service decentralization often claim that transferring service administration to lower levels of government facilitates increases citizen participation and governmental accountability while improving allocative efficiency and equity in service distribution. Using the cases of health and education decentralization in Chile, this article evaluates whether and under what conditions social service decentralization programs are likely to deliver on these promises. It discusses the tensions between equity and efficiency goals and how these may play out given different accountability mechanisms in local public choice, principal-agent, and real-world "hybrid" decentralization models. The case studies illustrate the difficulty of balancing the need for central standards and funding with local autonomy, but suggest that accountability mechanisms that emerged following Chile's transition to democracy in 1990 led to improvements in both equity and efficiency in decentralized service administration.     

The New Left and Health Care Reform in El Salvador

After a decade of civil war and four consecutive conservative administrations, El Salvador's leftist FMLN won its first presidential election in 2009. How has public policy changed under this New Left government, and why? This article addresses the question in the area of public health care. An alliance of health sector leaders with both technocratic and diplomatic abilities capitalized on the policy window opened by the FMLN's electoral victory and worked within the parameters set by President Mauricio Funes, the FMLN, and civil society to universalize health care. The new minister of health, a professional highly esteemed inside and outside the country, was able to engage both a large social movement protesting neoliberal policy and an energetic health diplomat sent by the Pan American Health Organization. In designing its reform, this alliance benefited from international as well as “bottom‐up” policy diffusion.     

新冠肺炎疫情下的韩国公共卫生外交研究

自新冠肺炎疫情出现以来,韩国作为最早出现感染病例的国家之一,迅速采取了科学、透明、民主的防疫政策与措施,及时控制住了疫情,一时成了全球各国争相模仿的抗疫典范,树立了 K-防疫模式.韩国政府及社会各界借此机会,在国际社会积极开展公共卫生外交,提高了国家软实力,大大提升了其国际形象.具体来说,在新冠肺炎疫情下,韩国采取了与周边国家及国际社会联合抗疫的公共卫生合作措施,向国际社会提供防疫物资与技术,实行宽松、温和、人道的出入境管理等措施,疫情下的韩国公共卫生外交体现了韩式特点,除与国际社会在传统物理外交空间加强合作外,还积极利用智能技术拓展数字外交空间,利用文化价值因素构建对外话语体系.同时,韩国积极促进公共卫生外交主体的多元化与全民化,体现了双向、互动、合作的新特点.