Suchergebnisse

IDRF fellows discuss Alex Nading's book Mosquito Trails: Ecology, Health, and the Politics of Entanglement, based on his International Dissertation Research Fellowship research on waste management and disease ecologies in urban Nicaragua.

AbstractSince its initial conception in 2017, the University of Denver Ethnography Lab (DUEL) has aimed to catalyze collaborations between students, faculty, and community organizations. Inspired by community–campus partnerships implemented in the past across the United States, DUEL seeks to cultivate a community of practice centered on ethnography in action, and to draw on strengths and opportunities specific to our university. In this article, we present the process that channeled the energies and ideas of 30 faculty and students from 10 different departments into the creation of DUEL, we share examples from our experience so far, and we identify challenges and opportunities for DUEL's future.

Background: Regulation of the medical tourism and public health sectors overlap in many instances, raising questions of how patient safety, economic growth, and health equity can be protected. The case of Guatemala is used to explore how the regulatory challenges posed by medical tourism should be dealt with in countries seeking to grow this sector. Methods: We conducted a qualitative case study of the medical tourism sector in Guatemala, through reviews and analyses of policy documents and media reports, key informant interviews (n = 50), and facility site-visits. Results: Key informants were critical of the absence of effective public regulation of the emerging medical tourism sector, noting several regulatory gaps and the importance of filling them. These informants specifically expressed that: 1) The government should regulate medical tourism in Guatemala, thought there was disagreement as to which government sector should do so and how; 2) The government has not at this time regulated the medical tourism sector nor shown great interest in doing so; and 3) International accreditation could be used to augment domestic regulation. Conclusions: The intersection of domestic and international regulation of medical tourism has been largely unexplored. This case study advances new research in this area. It highlights the need for and dearth of regulatory protections in Guatemala and lessons for other, similarly situated countries. National regulatory models from Israel and Barbados could be adapted to the Guatemalan context. Global governance could help to protect national governments from any competitive disadvantages created by regulation. Underlying the concerns over growth in medical tourism, however, is how it contributes to the ongoing privatization of health care facilities worldwide. This trend risks undermining efforts to reach targets for Universal Health Coverage and exacerbating existing inequities in the global distribution of health and wealth.

Background Medical tourism has attracted considerable interest within the Latin American and Caribbean (LAC) region. Governments in the region tout the economic potential of treating foreign patients while several new private hospitals primarily target international patients. This analysis explores the perspectives of a range of medical tourism sector stakeholders in two LAC countries, Guatemala and Barbados, which are beginning to develop their medical tourism sectors. These perspectives provide insights into how beliefs about international patients are shaping the expanding regional interest in medical tourism. Methods Structured around the comparative case study methodology, semi-structured interviews were conducted with 50 medical tourism stakeholders in each of Guatemala and Barbados (n = 100). To capture a comprehensive range of perspectives, stakeholders were recruited to represent civil society (n = 5/country), health human resources (n = 15/country), public health care and tourism sectors (n = 15/country), and private health care and tourism sectors (n = 15/country). Interviews were transcribed verbatim, coded using a collaborative process of scheme development, and analyzed thematically following an iterative process of data review. Results Many Guatemalan stakeholders identified the Guatemalan-American diaspora as a significant source of existing international patients. Similarly, Barbadian participants identified their large recreational tourism sector as creating a ready source of foreign patients with existing ties to the country. While both Barbadian and Guatemalan medical tourism proponents share a common understanding that intra-regional patients are an existing supply of international patients that should be further developed, the dominant perception driving interest in medical tourism is the proximity of the American health care market. In the short term, this supplies a vision of a large number of Americans lacking adequate health insurance willing to travel for care, while in the long term, the Affordable Care Act is seen to be an enormous potential driver of future medical tourism as it is believed that private insurers will seek to control costs by outsourcing care to providers abroad. Conclusions Each country has some comparative advantage in medical tourism. Assumptions about a large North American patient base, however, are not supported by reliable evidence. Pursuing this market could incur costs borne by patients in their public health systems.

Background: Medical tourism, which involves cross-border travel to access private, non-emergency medical interventions, is growing in many Latin American Caribbean countries. The commodification and export of private health services is often promoted due to perceived economic benefits. Research indicates growing concern for health inequities caused by medical tourism, which includes its impact on health human resources, yet little research addresses the impacts of medical tourism on health human resources in destination countries and the subsequent impacts for health equity. To address this gap, we use a case study approach to identify anticipated impacts of medical tourism sector development on health human resources and the implications for health equity in Guatemala. Methods: After undertaking an extensive review of media and policy discussions in Guatemala's medical tourism sector and site visits observing first-hand the complex dynamics of this sector, in-depth key informant interviews were conducted with 50 purposefully selected medical tourism stakeholders in representing five key sectors: public health care, private health care, health human resources, civil society, and government. Participants were identified using multiple recruitment methods. Interviews were transcribed in English. Transcripts were reviewed to identify emerging themes and were coded accordingly. The coding scheme was tested for integrity and thematic analysis ensued. Data were analysed thematically. Results: Findings revealed five areas of concern that relate to Guatemala's nascent medical tourism sector development and its anticipated impacts on health human resources: the impetus to meet international training and practice standards; opportunities and demand for English language training and competency among health workers; health worker migration from public to private sector; job creation and labour market augmentation as a result of medical tourism; and the demand for specialist care. These thematic areas present opportunities and challenges for health workers and the health care system. Conclusion: From a health equity perspective, the results question the responsibility of Guatemala's medical education system for supporting an enhanced medical tourism sector, particularly with an increasing focus on the demand for private clinics, specific specialities, English-language training, and international standards. Further, significant health inequalities and barriers to care for Indigenous populations are unlikely to benefit from the impacts identified from participants, as is true for rural-urban and public-private health human resource migration.

Background Many governments and health care providers worldwide are enthusiastic to develop medical tourism as a service export. Despite the popularity of this policy uptake, there is relatively little known about the specific local factors prospectively motivating and informing development of this sector. Objective To identify common social, economic, and health system factors shaping the development of medical tourism in three Central American and Caribbean countries and their health equity implications. Design In-depth, semi-structured interviews were conducted in Mexico, Guatemala, and Barbados with 150 health system stakeholders. Participants were recruited from private and public sectors working in various fields: trade and economic development, health services delivery, training and administration, and civil society. Transcribed interviews were coded using qualitative data management software, and thematic analysis was used to identify cross-cutting issues regarding the drivers and inhibitors of medical tourism development. Results Four common drivers of medical tourism development were identified: 1) unused capacity in existing private hospitals, 2) international portability of health insurance, vis-a-vis international hospital accreditation, 3) internationally trained physicians as both marketable assets and industry entrepreneurs, and 4) promotion of medical tourism by public export development corporations. Three common inhibitors for the development of the sector were also identified: 1) the high expense of market entry, 2) poor sector-wide planning, and 3) structural socio-economic issues such as insecurity or relatively high business costs and financial risks. Conclusion There are shared factors shaping the development of medical tourism in Central America and the Caribbean that help explain why it is being pursued by many hospitals and governments in the region. Development of the sector is primarily being driven by public investment promotion agencies and the private health sector seeking economic benefits with limited consideration and planning for the health equity concerns medical tourism raises.

Global Kidney Exchange (GKE) is a program aimed at facilitating trans-national kidney donation. Although its proponents aim at reducing the unmet demand of kidneys in the United States through the trans-nationalization of kidney exchange programs, the World Health Organization (WHO) and The Transplantation Society (TTS) have expressed concerns about its potential effect on black markets of organs and transnational organ trafficking, as well as on low- or middle-income countries health systems. For GKE to be implemented, it would need to be permitted to operate in at least some low- or middle-income countries. Should a low- or middle-income country allow GKE's implementation? With the aim of answering this question, the eighteen University of Denver students in the Medical Anthropology course I [Alejandro Cerón] taught in autumn 2017, identified and researched the different aspects that would affect this issue, and delved in a holistic analysis we present in this report. Based on our analysis, health authorities in low- or middle-income countries faced with decisions about GKE need to consider the following aspects: the country's current and projected needs related to kidney transplant, as well as the capacity for addressing those needs; the country's current situation related to organ trafficking, transplant tourism and black markets of organs; the current and projected legislation related to both organ donation and human trafficking; the prevailing ethical considerations that inform the practice of all professionals related to organ transplant in the country; analyze end-stage renal failure as a preventable disease needing public health measures; and the sociocultural aspects that surround organ donation in the country. We consider that the concrete configuration of these aspects would influence the effects of implementing GKE. Additionally, we identified some issues of concern that are beyond the level of influence of local authorities: the unmet demand of kidneys in high-income countries is a reality that incentivizes organ trade and transplant tourism, and this is a problem in need of solutions; transnational organ trafficking as well as human trafficking with the purpose of organ donation are problems that need more visibility; for a global exchange of organs to be implemented, it would need to rely on supranational or transnational regulation and oversight; and the global epidemic of chronic kidney disease needs to be addressed through a public health perspective that emphasizes prevention.

Las ponencias reunidas en este libro ofrecerán al lector una primera visión panorámica sobre algunos de los rasgos más importantes de la realidad estadounidense. Se trata apenas de un comienzo, con toda la expectativa de que los resultados de esta primera etapa sirvan de aliciente para la incorporación de nuevos miembros al grupo de trabajo y para la creación de otros equipos que, en los diferentes centros y unidades académicas de la región, emprendan con entusiasmo idéntica tarea. El grupo de trabajo sobre Estados Unidos de Clacso privilegió el concepto de hegemonía para tratar de penetrar el grueso tejido que recubre la sociedad estadounidense y descubrir algunas de las causas de su aparente crisis. Una crisis que se puede medir desde el pinto de vista económico (tasa de ganancia y participación global) y también desde la perspectiva política (control militar global). El concepto de hegemonía también se refiere a la capacidad para crear símbolos que atraviesan formaciones. El grupo de CLACSO asumió que la crisis de hegemonía de Estados Unidos es global, pero que se deben analizar también sus efectos al interior de la formación social estadounidense. Los trabajos que se publican en este volumen abordan la crisis de hegemonía global de ese país, así como la aparente pérdida de su legitimidad interna.

El presente libro, Estados Unidos. Mas allá de la crisis, está integrado por 20 capítulos resultantes de la investigación realizada por el grupo de trabajo Estudios sobre Estados Unidos del Consejo Latinoamericano de Ciencias Sociales (CLACSO). El libro analiza la crisis capitalista actual, su carácter y efectos sobre Estados Unidos, así como sus relaciones con América Latina y el resto del mundo. La recesión, que afectó sobre todo a Estados Unidos, tiene por lo menos dos interpretaciones. La primera, que sostiene que el ciclo económico debe contrarrestarse con políticas que garanticen la recuperación del sector financiero mediante políticas de austeridad. La segunda interpretación de la crisis tiene como eje lo que los analistas consideran el colapso de la "economía real" que ha cerrado centros de producción y ha lanzado al desempleo a decenas de millones de trabajadores. El problema no es una cuestión de cómo recuperar los flujos financieros, sino establecer patrones productivos que pudieran generar una nue- va dinámica capaz de incrementar el empleo y, sobre todo, la tasa de ganancia. El libro se estructura en tres secciones temáticas. La primera, enfatiza sobre el significado y el carácter de la crisis económica actual y sus consecuencias para Estados Unidos y el resto del mundo en el mediano y largo plazos. La segunda recoge un conjunto de trabajos enfocados a mostrar la pérdida de he- gemonía de Estado Unidos respecto a la correlación de fuerzas internacionales, los cambios tecnológicos y el entorno de deterioro de las condiciones sociales —acentuadas con la crisis—, su impacto sobre el empleo y las condiciones de vida, así como sobre el sistema de creencias y valores que dieron sentido político y coherencia simbólica al llamado "sueño americano". La tercera sección es sobre la nueva geopolítica de Estados Unidos, la política exterior hacia América Latina y los escenarios posibles para esta región. ; ÍNDICE PRESENTACIÓN por Theotonio Dos Santos 7 PRÓLOGO por John Saxe-Fernández 13 INTRODUCCIÓN. ESTADOS UNIDOS EN LA ENCRUCIJADA GLOBAL por Dídimo Castillo Fernández y Marco A. Gandásegui, Hijo 23 CRISIS MUNDIAL O CRISIS DEL CAPITALISMO 39 CRISIS ESTRUCTURAL Y CRISIS DE COYUNTURA EN EL CAPITALISMO CONTEMPORÁNEO por Theotonio Dos Santos 41 LA TEORÍA DE LA CONYUNTURA Y LA CRISIS CONTEMPORÁNEA por Carlos Eduardo Martins 61 CRÍTICA A LA INTERPRETACIÓN FINANCIERA DE LA CRISIS por Orlando Caputo Leiva 81 CRISIS GENERAL CAPITALISTA ¿CRISIS FINAL DEL NEOLIBERALISMO? por Jaime Ornelas Delgado 112 SISTEMA MUNDO, CRISIS ECONÓMICA Y AMÉRICA LATINA por Marco A. Gandásegui, Hijo 137 CRISIS DE HEGEMONÍA Y DECADENCIA INTERNA EN ESTADOS UNIDOS 161 ESTADOS UNIDOS EN LA ENCRUCIJADA DE LA CRISIS CAPITALISTA por Adrián Sotelo Valencia 163 LA POSICIÓN DE ESTADOS UNIDOS EN EL ORDEN MONETARIO Y FINANCIERO INTERNACIONAL por Katia Cobarrubias Hernández 186 EL DÉFICIT FISCAL DE ESTADOS UNIDOS Y EL FUTURO DEL DÓLAR por Daniel Munevar 210 CRISIS SISTÉMICA ESTRUCTURAL DE ESTADOS UNIDOS: LA AGENDA SOBRE CIENCIA Y TECNOLOGÍA por Fabio Grobart Sunshine 233 ESTADOS UNIDOS: CRISIS ECONÓMICA, REESTRUCTURACIÓN PRODUCTIVA Y NUEVA PRECARIEDAD LABORAL por Dídimo Castillo Fernández 258 LA INMIGRACIÓN LATINOAMERICANA FRENTE A LA CRISIS ECONÓMICA EN ESTADOS UNIDOS. PRECARIZACIÓN SIN RETORNO por Alejandro I. Canales 288 LAS BURBUJAS DEL SIGLO xxi: ¿EL FIN DEL SUEÑO AMERICANO? por James Martin Cypher 316 ESTADOS UNIDOS: REDEFINICIONES IDEOLÓGICAS Y GEOPOLÍTICA MUNDIAL BAJO LA ADMINISTRACIÓN OBAMA por Jorge Hernández Martínez 339 NUEVA GEOPOLÍTICA DE ESTADOS UNIDOS. ESCENARIOS PARA AMÉRICA LATINA 363 ESTADOS UNIDOS: SEGURIDAD Y DEFENSA EN LAS NUEVAS RELACIONES HEMISFÉRICAS por Darío Salinas Figueredo 365 OBAMA CONTRA NUESTRA AMÉRICA: LO NUEVO Y LO VIEJO por Luis Suárez Salazar 384 DEMOCRACIA, SEGURIDAD Y DESARROLLO: LA POLÍTICA DE "ASISTENCIA" DE ESTADOS UNIDOS HACIA AMÉRICA LATINA por Silvina M. Romano 416 CAMBIOS EN LA POLÍTICA DE SEGURIDAD DE ESTADOS UNIDOS Y SU INCIDENCIA EN AMÉRICA LATINA por Jaime Zuluaga Nieto 440 CENTRALIDAD DE AMÉRICA LATINA EN LA ESTRATEGIA DE SEGURIDAD HEMISFÉRICA DE ESTADOS UNIDOS por María José Rodríguez Rejas 462 LA POLÍTICA EXTERIOR ESTADUNIDENSE PARA LA AMÉRICA ANDINA EN LA TRANSICIÓN REPUBLICANODEMÓCRATA. CONTINUIDADES Y DISCONTINUIDADES por Catalina Toro Pérez 483 SEGURIDAD NACIONAL, RECURSOS NATURALES Y DEPENDENCIA ESTADUNIDENSE. MINERALES ESTRATÉGICOS EN LA AGENDA ESTADOS UNIDOSAMÉRICA LATINA por Gian Carlo Delgado Ramos 505 LOS AUTORES 526