El martes 16 de junio se reunieron en la ciudad rusa de Ekaterimburgo los líderes de Brasil, Rusia, India y China. Esta "cumbre" no ha tenido hasta ahora mucha resonancia en la prensa mundial pero, no por ello, ha pasado desapercibida.Consideradas como las cuatro economías más poderosas de los países emergentes, este grupo fue bautizado como "BRIC" allá por el año 2001 por un analista financiero norteamericano con algún talento para pergeñar siglas pero, en realidad, el grupo comenzó a adquirir cierto sentido recién hacia 2004-2005.Aunque ya se han realizado varias reuniones informales entre los líderes de estos cuatro países, lo cierto es que el martes, probablemente gracias a un fuerte liderazgo del anfitrión, realizaron su "presentación oficial en sociedad".Las razones por las cuales muchos analistas consideran la concreción de este grupo de países emergentes como un hito de importancia son, por lo general, de corte meramente cuantitativo. Nos dicen que los países del BRIC constituyen, según el Banco Mundial, el 27% del PBI mundial (siendo Rusia la economía No. 11, Brasil la No 10, China la No. 5 y la India la No. 12, en el ranking del FMI), que su población supera el 40 % de la población mundial, que disponen en este momento de aproximadamente el 40% de las reservas monetaria, que ocupan el 25 % del territorio mundial, etc., etc.En suma, nadie puede negar que se trata de países que son altamente significativos en el mundo contemporáneo y que, muy probablemente, seguirán adquiriendo importancia creciente en el futuro inmediato (toda vez que varios de ellos están atravesando la crisis en bastante mejores condiciones que otras potencias) y también en el mediano plazo surgirán como referentes internacionales de peso.Resulta importante señalar que la emergencia de este grupo puede ser revelador de un fenómeno que todos percibimos con bastante claridad: la globalización, (al contrario de lo que sostienen sus eternos detractores en los países subdesarrollados) ha sido una estupenda oportunidad de crecimiento para muchos de los países emergentes. Es más: en varias oportunidades se ha considerado si países como Sudáfrica, México o Pakistán no podrían formar parte del mismo grupo. Si no ha sido así, es por razones políticas específicas que, en cada caso, se considera que los inhabilitan por el momento.En otros términos, para muchos, el BRIC aparece como un nuevo "player global" potencial y, en algún sentido eso es así si planteamos la cuestión a la inversa: el "espacio" político internacional ocupado por los EE.UU., la UE y el Japón se ha reducido, relativamente, y ello de manera independiente de esta crisis económica por la que estamos atravesando, por lo que otros países o grupos de países tienden a ocupar ese nuevo "margen" que aparece como vacante.Pero ¿es precisamente esta configuración "BRIC", de los nuevos "players globales", la fórmula mas idónea para ocupar esos nuevos espacios y desafiar a los 3 centros de poder establecidos?Cuando uno revisa la temática tratada en la reunión por Medvédev, Hu Jintao, Manmohan Singh y Lula da Silva, lo que llama la atención es que se trató, esencialmente de una plataforma reivindicatoria, si no es que de una lista de quejas. El dólar y el euro ya no serían suficientes como monedas de reserva, el peso de sus países en los organismos multilaterales no es equitativo, hay que recordar las responsabilidades de los países desarrollados en el terreno energético y en la cuestión ambiental, se requiere reformar las Naciones Unidas, etc. En otros términos: más allá de que algunas de estas cuestiones puedan resultar pertinentes, la reunión no parece haber generado una sola propuesta concreta -(si no es la de volver a reunirse en Brasil en el 2010)- y se centró en el archi-conocido "lamento" contra EE.UU. y el "establishment" internacional existente.Desde esa perspectiva, la reunión de Ekaterimburgo dejó una impresión más bien pobre. El Presidente Medvédev declaró: "Nuestra cumbre inicial ha justificado las expectativas" y, luego, que "La cumbre del BRIC debe crear condiciones para la formación más justa de un medio favorable que permita resolver tareas actuales de envergadura mundial" lo que en principio, si uno logra identificar algún sentido coherente a estas declaraciones, parece ser una declaración de satisfacción y, simultáneamente, la proclamación de la necesidad de afirmación de un principio de justicia en el ámbito de la política internacional.Nadie puede discrepar con el principio de la justicia pero, lo que primero salta a la vista es que este nuevo paladín de la justicia tiene un doble problema de credibilidad.El primer problema es que, como grupo, constituye un nucleamiento demasiado disímil -(desde lo cultural hasta lo militar)- como para liderar, o siquiera prohijar, un funcionamiento más justo del mundo internacional. Es más, con la excepción del Brasil, los otros tres actores tienen entre sí un pasado relativamente reciente de fuertes enfrentamientos, incluso militares. Sus lazos comerciales son escasos y los que se han desarrollado son más bien recientes. Desde el punto de vista cultural: ¿que tienen que ver Rusia que, desde Catalina la Grande hasta la fecha, está por decidir si es occidental o asiática, con la China, "El Imperio del Medio" del Oriente? ¿Que tienen que ver la milenaria India colonizada por Gran Bretaña y liberada por Gandhi, con el imberbe Brasil luso-afro-americano cuya historia independiente no llega a 200 años?Pero, en segundo problema de credibilidad reenvía todavía a problemas más álgidos y concretos. ¿Es la Rusia de Putin la que clama por la justicia y el multilateralismo equilibrado y ponderado? ¿Cómo ven este nuevo papel las decenas de países actualmente sometidos a la presión constante de un país compulsivamente expansionista? ¿Esa China de Hu Jintao no es la misma que sostiene el gobierno de Sudán responsable, en altísima medida, de la tragedia de Darfur? ¿Es "otra" China la que ha sometido al Tibet? ¿No es la India la potencia que mantiene subyugada a Cachemira? Y este Presidente Lula que declara, con tono "izquierdista" que "…la sociedad moderna debe revisar un sistema que…condena a millones de personas a la pobreza y a la desesperación", ¿no pertenece al país más expansionista de América del Sur que hace y deshace, dentro de Mercosur, cerrando y abriendo fronteras, sacando y poniendo aranceles a su antojo? Seguramente que ya revisó los precios que paga por la energía que le vende obligadamente el Paraguay de la represa binacional de Itaipú, como clama el Presidente Lugo. También pide Lula que los países desarrollados cubran: "…los costes de la adaptación tecnológica necesaria para que…los países en desarrollo se beneficien del progreso científico sin hacer daño al medio ambiente." ¿No es el mismo Presidente que no ha detenido el proceso de desforestación de la Amazonia? ¿O la culpa de ello es del "imperialismo" y es este último el que debe pagar la factura?Vamos, …que tampoco nos tomen por tontos!¿ China, Rusia, India y el Brasil en el papel de defensores de la justicia y de redentores del mundo internacional?Bienvenido el BRIC como un potencial actor de importancia en la escena internacional si es que, en sus políticas, se va a mostrar efectivamente más coherente y apegado a los principios de derecho que las actuales superpotencias. !Pero hay de nosotros si estos cuatro recién llegados se suman, efectivamente, a las superpotencias existentes y a sus prácticas! En la mayoría de los casos, su "record" de conducta internacional es bastante más dudoso que el de las conocidas grandes potencias actuales. Y más vale lidiar con tres potencias que, con esas mismas tres, más estas "nuevas cuatro", que, además, llegan con sus apetitos intactos.
2006/2007 ; Il presente lavoro di ricerca prende particolarmente in esame una regione situata in Kenya, il Mbeere. Il motivo di questa scelta è semplice. In questa regione keniana si è sviluppato per diversi decenni un significativo intervento umanitario da parte della città di Trieste, specialmente attraverso la sua diocesi, i suoi missionari, l'organizzazione non governativa ACCRI, i volontari laici, il coinvolgimento di tante persone della città giuliana, e non solo, ma anche di altre parti d'Italia, attraverso donazioni, sostegni materiali e morali di vario genere e, da ultimo, anche di organismi associativi come i Rotary Clubs di Trieste e del Friuli Venezia Giulia. Uno slancio quindi che è stato ad un tempo civile, sociale, religioso, intrapreso da varie componenti della città e volto a promuovere una parte certamente delimitata, ma molto rappresentativa, della vasta nazione keniana. Si è ritenuto maturo così il tempo di un'adeguata riflessione su questa esperienza, per svolgervi un'analisi dettagliata, non solamente da un punto di vista storico, vale a dire della cronologia degli eventi che hanno contrassegnato questa esperienza in quasi quarant'anni, a partire dal 1970, ma anche per comprendere meglio il territorio su cui è insistita questa esperienza. Comprendere le peculiarità di quella regione in termini fisici, economici, antropologici, sociali. In sostanza uno studio di geografia umana, forse nel senso classico del termine, teso cioè a comprendere la presenza dell'uomo in una determinata porzione di territorio, in rapporto ai fenomeni più pregnanti dell'ambiente che lo circondano e come questi influenzano la sua esistenza. Inoltre, poiché emerge con immediatezza quanto ci si muova in un contesto socio-economico molto arretrato, il presente studio geografico assume anche le caratteristiche di una ricerca condotta sui contenuti e le modalità del sottosviluppo di questa zona, inserendosi, probabilmente, nel filone tipico degli studi di geografia dello sviluppo. La regione considerata è infatti quella che si estende sul versante sud orientale del monte Kenya, il massiccio centrale principale della nazione keniana, a cui da lo stesso nome. Un territorio molto particolare da un punto di vista geografico perché varia dalla sommità montuosa dell'ex cratere, costituita oggi dai due picchi principali Batian e Nelion entrambi di un'altitudine superiore ai 5000 metri, per scendere gradualmente, in tipico ambiente afro-montano, costituito da lande e pietraie, poi da umide foreste alpino-tropicali, quindi da foreste di bambù, falde montuose e declivi collinari, fino alle quote più basse di 800-1000 metri, ricoperti di savana arbustiva in clima semiarido. Questa enorme varietà di paesaggio condiziona moltissimo l'esistenza dell'uomo, le sue scelte esistenziali, le produzioni agricole, gli assetti sociali e culturali delle comunità. Questa grande varietà umana ed ambientale è stato possibile studiarla da vicino anche perché l'intervento umanitario triestino, non è partito subito dalla regione del Mbeere ma, in realtà, ha iniziato proprio sulle pendici più alte, ancora abitate, del monte Kenya, vale a dire nell'Embu superiore, territorio montuoso, circondato dalla foresta tropicale, a quote altimetriche che raggiungono tranquillamente i 2000 metri. Qui, nella piccola località di Ngovio, si è svolta la prima fase della missione triestina, dal 1970 al 1984. Successivamente, a completamento di un ciclo molto positivo e ricco di risultati concreti, l'intervento umanitario di Trieste ha scelto di riposizionarsi in un ambiente naturale ed umano molto più svantaggiato e sofferente, quello definito dell'Embu inferiore o, appunto, del Mbeere, dal nome dell'etnia che lo abita e che diverrà, infatti, la sua denominazione ufficiale allorché le autorità governative, nel 1996, decideranno di costituirlo in distretto amministrativo autonomo, al pari degli altri distretti in cui è suddiviso il Kenya. Riconoscimento tardivo, segno evidente della marginalità con la quale esisteva ed era percepita questa zona, in effetti molto trascurata anche dai colonizzatori inglesi, cosa che non le ha mai consentito uno sviluppo degno di questo nome, ma che, allo stesso tempo, l'ha preservata lungamente dalle caotiche trasformazioni tipiche della modernità. Un pezzetto d'Africa rimasto quindi intonso, con i suoi grandi pregi, ma anche con il peso delle sue arretratezze e difficoltà esistenziali. Un piccolo microcosmo molto significativo dal punto di vista dello studio di un Africa rurale che non riesce ancora ad emanciparsi, pur se attraversata tutto attorno e trasversalmente dalle grandi correnti dei cambiamenti sociali e culturali che spazzano l'intero continente nero. In questo territorio marginale si insediano nuovamente nel 1984 i sacerdoti e volontari triestini. Tale insediamento avviene proprio in concomitanza con una delle più gravi carestie degli ultimi decenni, quella conseguente alle annate gravemente siccitose del 1983 e 1984. Vengono quindi avviate varie iniziative atte a sostenere la popolazione del luogo fortemente provata dalla penuria alimentare ed idrica. Nella ricerca vengono esaminate queste tipologie di intervento. Lo studio di questo territorio è inoltre significativo per altre ragioni. La prima è rappresentata dalle conseguenze prodotte dalla riforma agraria e dalla suddivisione delle terre, Land Adjudication Programme, che sconvolge l'assetto tradizionale della ripartizione dei terreni fra i clan della popolazione Mbeere e si riflette pesantemente sugli stessi archetipi di produzione agricola. Altro elemento peculiare da considerare è l'attività esogena su questo territorio, promossa dal Governo keniano, mediante la costruzione di grandi sbarramenti idroelettrici sul corso del fiume Tana, il principale del Kenya quanto a lunghezza e portata d'acqua, che sconvolge il basso Mbeere con grandi lavori, nuove infrastrutture, mutamento dell'ambiente tipico fluviale, arrivo di manodopera straniera dall'Europa orientale, nuove strade asfaltate mai viste prima, grandi automezzi, in una parola un notevole quanto improvviso impatto con la modernità. Quindi è significativo comprendere i processi di sostegno alla popolazione avviati in questo articolato contesto proprio dall'intervento umanitario preso in esame, a cosa effettivamente esso mirava, l'entità e tipologia degli aiuti realizzati, quali riscontri si sono avuti sull'evoluzione economica, agricola, perfino sociale della gente del luogo. Ad esempio, il favorire il diffondersi della produzione della frutta tropicale fra le coltivazioni locali, l'introduzione delle piante foraggiere idonee all'ambiente arido, la creazione di vivai orto-frutticoli, la ripresa della raccolta del miele, la trasformazione artigianale di alcuni di questi prodotti. Per non dimenticare l'opera di sistemazione di strade o piste all'interno della savana, la realizzazione di dighe, invasi, pozzi, cisterne, serbatoi nonché di importanti centri di aggregazione sociale, costituiti dalle piccole chiese o cappelle, dispersi nel fitto della boscaglia. Diviene quindi importante l'esame del progetto di Kamurugu, il centro agrario dimostrativo-sperimentale avviato dalla cooperazione triestina e che rappresenta l'esempio più riuscito e significativo dal punto di vista della cooperazione allo sviluppo svolta in questa zona, ma anche in tutto il Kenya, tanto che nel 2002 le Nazioni Unite, con sede a Nairobi, lo proclameranno l'intervento più riuscito di riduzione della povertà in Kenya. Una serie di analisi quindi che consentono di capire meglio non solo la realtà di un ben delimitato territorio, ma anche di comprendere i complessi meccanismi legati allo sviluppo, le correlazioni fra le tipologie di produzione agricola e la povertà rurale, lo stato della sanità pubblica, la carenza dell'approvvigionamento idrico, la precaria scolarizzazione, le deboli infrastrutture, il loro impatto complessivo sui processi di sviluppo in atto, ma che faticano alquanto a realizzarsi. Ecco perché una sezione di questo studio è dedicata anche a comprendere il problema della povertà e del sottosviluppo in tutto il Kenya, per poi poterlo meglio declinare al livello dei piccoli distretti rurali come il Mbeere. Infine si è dovuto provvedere a svolgere un doveroso aggiornamento sulla situazione politico-economica del Kenya quale realizzatasi all'indomani delle elezioni presidenziali e parlamentari del 27 dicembre 2007, il cui esito, com'è noto, ha precipitato il paese in un rovente clima di scontri etnici e sociali. Scontri che hanno avuto pesantissime ripercussioni sull'economia, la quale era in piena crescita da diversi anni e che ora sarà invece seriamente messa alla prova. Fortunatamente la mediazione dell'ex segretario generale delle Nazioni Unite, Kofi Annan, ha avuto successo, ha riavviato il dialogo istituzionale interrottosi ai massimi livelli e ha ridato concrete speranze di pace al popolo keniano. ; XX Ciclo
ABSTRACT In the present work the criteria for determining the amount of civil reparation in the application of the Principle of Opportunity by the Provincial Criminal Prosecutors of San Martin - Tarapoto during the years 2014 - 2016 have been investigated in order to determine what are those Criteria when evaluating the amount of civil damages. This research was carried out by conducting surveys of judges, prosecutors and lawyers who have applied the Opportunity Principle in the Tarapoto prosecutors during the years 2014 - 2016; Obtaining the following results, in the table No. 01 before the question: During the time in which you are in the position, you have applied the Principle of Opportunity, solving, promoting or requesting, according to your position, before any case that is Judges answer YES that means 50%, prosecutors respond YES which means 28.6% and lawyers respond YES with 13.3%, then their answer is NO in judges with 50%, prosecutors answer NO with a 71.4% % And lawyers respond NOT with 86.7% In Table Nº 2 we can observe that 100% of Sample 1 (Criminal Judges) indicated that the percentage of usefulness that the Principle of Opportunity has obtained in the criminal proceedings in which they have participated Has been low; On the other hand, 14.3% of Sample 2 (Provincial Prosecutors) indicated that the percentage of utility has been high, 28.6% indicated that it was average, another 28.6% indicated that it was low and the remaining 28.6% indicated that it has Been very low; Likewise, it is observed that only 8.3% of Sample 3 (Lawyers) indicated that the percentage of their utility has been medium, whereas 66.7% indicated that it has been low and 25% that it has been very low. Table 3 shows that 100% of Sample 1 (Criminal Judges) considers that the application of the Opportunity Principle in criminal proceedings is good; On the other hand, only 57% of Sample 2 (Provincial Prosecutors) consider that its application is good, 14% consider it regular, another 14% that is bad and the remaining 14% consider it bad; Likewise, only 36% of Sample 3 (Lawyers) consider that the application of the Opportunity Principle in criminal proceedings is good, 42% consider it regular and 22% that it is bad. In Table 4 we can see that 50% of Sample 1 (Criminal Judges), in study, believes that the reason why the Opportunity Principle is not effectively applied in criminal proceedings is because of ignorance of the norm, and The other 50% believe it is because their application is not mandatory. In Table 5 we can see that 71% of Sample 2 (Provincial Prosecutors), in study, points out that the reason why they do not frequently solicit or promote the application of the Opportunity Principle in criminal proceedings that are susceptible of Its application is because its application is not mandatory, and 29% indicate that other reasons. In Table 6 we can observe that 19% of Sample 3 (Lawyers), under study, points out that the reason why they do not frequently request the application of the Opportunity Principle in the criminal proceedings they sponsor and that they are susceptible of Its application is due to ignorance of the norm, 28% indicate that it is because its application is not mandatory, 17% indicates that it is because the rule is not clear and complete for its application in criminal proceedings, 6% Because it requires a lot of processing or a long time in its execution, another 17% indicates that it is because the effects that its application produces are beneficial or favorable and a last 14% indicates that it is for other reasons. The objective of this thesis was to establish the criteria that juridical operators take into account to establish the amount of civil reparation during the years 2013 - 2014 in the district of Tarapoto. This research is based on four chapters, so chapter I denominated Criminal Action analyzes concepts; Chapter II is called The Opportunity Principle; Chapter III explains Comparative Law where the German, North American, Argentine, and Colombian legislation is analyzed; Chapter IV is called the Principle of Opportunity in Peruvian legislation. ; RESUMEN En el presente trabajo se ha investigado los criterios para la determinación del monto de la reparación civil en la aplicación del Principio de Oportunidad por las Fiscalias Provinciales Penales Corporativas de San Martin – Tarapoto durante los años 2014 – 2016 con el propósito de determinar cuáles son esos criterios al momento de evaluar el monto de la reparación civil. Esta investigación se llevó a cabo realizando encuestas a jueces, fiscales y abogados que hayan aplicado el Principio de Oportunidad en las fiscalías de Tarapoto durante los años 2014 – 2016; obteniendo los siguientes resultados, en el cuadro N° 01 ante la pregunta: ¿Durante el tiempo que se desempeña en el cargo, Ud. ha aplicado el Principio de Oportunidad, resolviendo, promoviendo o solicitándolo, según su cargo, ante algún caso que se encontraba en instancia judicial?, jueces responden SI que significa el 50%, fiscales responden SI que significa el 28.6% y abogados responden SI con el 13.3%, luego su respuesta es NO en jueces con un 50%, fiscales responden NO con un 71.4% y abogados responden NO con un 86.7% En el cuadro Nº 2 podemos observar que el 100% de la Muestra 1 (Jueces Penales) indicó que el porcentaje de utilidad que el Principio de Oportunidad ha obtenido en los procesos penales en los cuales han participado ha sido bajo; de otro lado, un 14.3% de la Muestra 2 (Fiscales Provinciales) indicó que el porcentaje de utilidad ha sido alto, un 28.6% indicó que ha sido medio, otro 28.6% indicó que ha sido bajo y el restante 28.6% indicó que ha sido muy bajo; de igual manera, se observa que sólo un 8.3% de la Muestra 3 (Abogados) indicó que el porcentaje de su utilidad ha sido medio, en cambio un 66.7% indicó que ha sido bajo y un 25% que ha sido muy bajo .En el cuadro Nº 3 podemos observar que el 100% de la Muestra 1 (Jueces Penales) considera que la aplicación del Principio de Oportunidad en un proceso penal es buena; en cambio, sólo un 57% de la Muestra 2 (Fiscales Provinciales) considera que su aplicación es buena, un 14% considera que es regular, otro 14% que es mala y el restante 14% considera que es pésima; de igual manera, sólo un 36% de la Muestra 3 (Abogados) considera que la aplicación del Principio de Oportunidad en un proceso penal es buena, un 42% considera que regular y un 22% que es mala. En el cuadro Nº 4 podemos observar que el 50% de la Muestra 1 (Jueces Penales), en estudio, cree que el motivo por el cual no se aplica eficazmente el Principio de Oportunidad en los procesos penales es por desconocimiento de la norma, y el otro 50% cree que es porque su aplicación no es obligatoria. En el cuadro Nº 5 podemos observar que el 71% de la Muestra 2 (Fiscales Provinciales), en estudio, señala que el motivo por el cual no solicitan o promueven con frecuencia la aplicación del Principio de Oportunidad en los procesos penales que son susceptibles de su aplicación es porque su aplicación no es obligatoria, y el 29% señala que son otros los motivos. En el cuadro Nº 6 podemos observar que un 19% de la Muestra 3 (Abogados), en estudio, señala que el motivo por el cual no solicitan con frecuencia la aplicación del Principio de Oportunidad en los procesos penales que patrocinan y que son susceptibles de su aplicación es por desconocimiento de la norma, un 28% señala que es porque su aplicación no es obligatoria, un 17% señala que es porque la norma no es clara ni completa para su aplicación en un proceso penal, un 6% señala que es porque requiere mucho trámite o mucho tiempo en su ejecución, en cambio otro 17% señala que es porque los efectos que produce su aplicación son beneficiosos ni favorables y un último 14% señala que es por otros motivos. El objetivo de esta tesis era establecer los criterios que tienen en cuenta los operadores jurídicos para establecer el monto de la reparación civil durante los años 2013 – 2014 en el distrito de Tarapoto. Esta investigación se sustenta en cuatro capítulos, así el capítulo I denominado La Acción Penal se analizan conceptos; en el capítulo II se denomina El Principio de Oportunidad, en el capítulo III se explica El Derecho Comparado en donde se analiza la legislación Alemana, Norte América, Argentina y Colombia; en el capítulo IV se denomina el Principio de Oportunidad en la legislación Peruana. ; Tesis
Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods: We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings: Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation: Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. ; Bruce Bartholow Duncan and Maria Inês Schmidt have received additional funding from the Brazilian Ministry of Health (Process No 25000192049/2014-14). Benjamin O Anderson is supported by the Susan G Komen Leadership Grant Research Project, award number SAC160001. Itamar S Santos reports grants from FAPESP (Brazilian public agency), outside the submitted work. Carl Abelardo T Antonio reports grants, personal fees and non-financial support from Johnson & Johnson (Philippines), Inc, outside the submitted work. Kunihiro Matsushita reports personal fees from Mitsubishi Tanabe Pharma, Kyowa Hakko Kirin, and MSD outside of the submitted work. Rafael Tabarés-Seisdedos and Ferrán Catalá-López are supported in part by grant PROMETEOII/2015/021 from Generalitat Valenciana, and Rafael Tabarés-Seisdedos is supported by the national grant PI14/00894 from ISCIII-FEDER. Walter Mendoza is currently employed by the Peru Country Office of the United Nations Population Fund, an institution which does not necessarily endorse this study. Bradford D Gessner reports grants from Crucell, GSK, Hilleman Labs, Novartis, Pfizer, Merck, and Sanofi Pasteur, outside the submitted work. Ai Koyanagi's work is supported by the Miguel Servet contract financed by the CP13/00150 and PI15/00862 projects, integrated into the National R + D + I and funded by the ISCIII—General Branch Evaluation and Promotion of Health Research—and the European Regional Development Fund (ERDF-FEDER). Aletta E Schutte is funded by the Medical Research Council of South Africa, and the South African Research Chair Initiative by the National Research Foundation. Dariush Mozaffarian reports ad-hoc honoraria or consulting from Boston Heart Diagnostics, Haas Avocado Board, AstraZeneca, GOED, DSM, and Life Sciences Research Organization; and chapter royalties from UpToDate. Amador Goodridge would like to acknowledge funding for me from Sistema Nacional de Investigadores de Panamá-SNI. Donal Bisanzio is supported by Bill & Melinda Gates Foundation (#OPP1068048). Jost B Jonas reports personal fees from Consultant for Mundipharma Co (Cambridge, UK); from patent holder with Biocompatibles UK Ltd (Franham, Surrey, UK) (Title: Treatment of eye diseases using encapsulated cells encoding and secreting neuroprotective factor and / or anti-angiogenic factor; patent number: 20120263794), from patent application with University of Heidelberg (Heidelberg, Germany) (Title: Agents for use in the therapeutic or prophylactic treatment of myopia or hyperopia; Europäische Patentanmeldung 15 000 771.4), outside the submitted work. Rodrigo Sarmiento-Suarez receives institutional support from Universidad de Ciencias Aplicadas y Ambientales, UDCA, Bogotá Colombia. Juan A Rivera reports personal fees from Tres Montes Lucchetti, outside the submitted work. Stefanos Tyrovolas's work is supported by the Foundation for Education and European Culture (IPEP), the Sara Borrell postdoctoral programme (reference no CD15/00019 from the Instituto de Salud Carlos III (ISCIII - Spain) and the Fondos Europeo de Desarrollo Regional (FEDER). Beatriz Paulina Ayala Quintanilla would like to acknowledge the institutional support of PRONABEC (National Program of Scholarship and Educational Loan), provided by the Peruvian Government, while studying for her doctoral course at the Judith Lumley Centre of La Trobe University funded by PRONABEC. Manami Inoue is the beneficiary of a financial contribution from the AXA Research fund as chair holder of the AXA Department of Health and Human Security, Graduate School of Medicine, The University of Tokyo from Nov 1, 2012; the AXA Research Fund has no role in this work. Sarah C Darby would like to acknowledge Cancer Research UK (grant no C8225/A21133). Yogeshwar Kalkonde is a Wellcome Trust/ DBT India Alliance Intermediate Fellow in Public Health. Heidi Stöckl is funded by a British Academy Postdoctoral Fellowship. Tea Lallukka reports funding from The Academy of Finland, grant #287488. Charles D A Wolfe's research was funded/supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London. Simon I Hay is funded by a Senior Research Fellowship from the Wellcome Trust (#095066), and grants from the Bill & Melinda Gates Foundation (OPP1119467, OPP1093011, OPP1106023, and OPP1132415). ; Peer-reviewed ; Publisher Version
Transport has been identified as one of the biggest sectors that contribute to climate change (23%) due to its energy demand and polluting emissions and therefore one of the sectors that needs to take action to mitigate its impact. A few countries in Latin America (Brazil, Chile, Mexico and Colombia) have started their transport NAMA development and are at different stages in the process. Peru has started this process more recently and this report aims at facilitating the NAMA development and a strategy for its implementation. A key issue in the Peruvian case is the need to set a wave of change in the way transport is usually perceived and addressed in Peru. Thus this report considers both the requirements and changes needed in order to implement a successful and appropriate transport NAMA. What is a NAMA? A NAMA (Nationally Appropriate Mitigation Actions) is a concept that originated under the Conference of the Parties (COP) in Bali 2007, as a mechanism to engage "Nationally appropriate mitigation actions by developing country Parties in the context of sustainable development, supported and enabled by technology, financing and capacity-building, in a measurable, reportable and verifiable manner;". With two years of application; NAMAs have managed to attract transport sector decision-makers due to their alignment with national priorities and potential large financial and technical support to implement them. Overall Vision of a Transport NAMA in Peru The overarching aim for the transport NAMA in Peru is the achievement of the minimum optimum mobility required to stimulate economic growth and thus improve the quality of life. This report suggests that three areas of priority should be tackled in order to achieve the overarching aim – Urban Mobility, Energy Efficiency and the role of land use and planning – in the development and implementation of carbon emissions targets. In order to reduce emissions by any significant amount, it is necessary to devise measures for each of these priorities. For Urban Mobility, the measure to be adopted is the development of an integrated mobility system; for Energy Efficiency, the measure is the development of a programme to increase the energy efficiency of vehicles; for Land use and planning, the measure is to develop demonstrator Green Zones to show how low carbon living might work in reality. Each measure amounts to a set of interventions and each intervention has a set of Actions. The Actions are measurable, reportable and verifiable. In the draft NAMA, there are 16 Interventions and 51 Actions explained in Chapter 4 and some suggestions for indicators of successful outcomes (See chapter 4 intervention time frame tables). The dominance of the capital city of Lima and Callao in relation to the rest of the country means that significant effort needs to be made in the capital in order to influence the success of the policy at the national level. Many of the actions will therefore apply to and be developed in Lima and Callao. Most can be repeated elsewhere in the country as appropriate. A major finding is that to achieve the aim, it is crucially important to ensure coherent, consistent and comprehensive governance over the transport system, without which environmental and operational actions will fail. Therefore a major Mobility Reform must be put in place – some initial steps have already been taken but the path is longer than the political cycle; therefore in the case of Lima and Callao this reform could be facilitated by the creation of a Unified Technical Authority (UTA). This will incorporate all government bodies involved in transport in the capital city; to oversee the overall transport system in the city in order to have a low carbon means to provide the urban mobility required by the community. The UTA can then develop actions to optimise mobility for the population and improve the energy performance of the transport system by implementing the interventions. Some of the Actions suggested in the draft transport NAMA are substantive – designed to achieve the NAMA objectives. Other Actions are facilitative – intended to set up the governance and contextual situations required for successful implementation of the substantive actions. The report presents the arguments to support the choice of these outcomes, objectives, measures, interventions and actions and a suggested initial timescale for implementation. The 16 Interventions are (Please see Table 28 in appendix IV for summary of all actions): 1. Creation of a Unified Technical Authority 2. Mobility Reform for Lima and Callao 3. Creation of a Multi-institutional Transport NAMA Committee 4. Revision of draft Transport NAMA 5. Development of Travel Plans for commercial activity and employees 6. Development of an energy-efficient Mobility Plan 7. Support for education and training 8. Development, design and implementation of new infrastructure to encourage low energy mobility 9. Seek international finance for the implementation of the transport NAMA 10. Implement a vehicle labelling system and a compulsory system to achieve energy efficiency in light duty vehicles 11. Ensure that fuel quality is improved 12. Adopt mechanisms to achieve the declared emissions target 13. Design and Planning 14. Governance and Delivery 15. Carbon accounting and sustainability 16. Tendering and Feasibility Key Concepts Institutional Structure The overarching aim for the future of the world s citizens is the improvement in the quality of life – and Peru is no exception in this respect. This aim is so overarching that it extends beyond the limitations of political ideas and preferences: it is hard to imagine a political party not wishing to improve the quality of life of the population. It therefore extends beyond the political cycles of elections and terms of office, but requires commitment from all parties so that the initial actions are started immediately and there is a continuity of purpose – even if the methods and priorities change as one political philosophy is exchanged for another. The nature and scale of the problem (long term) transcends political differences, therefore it is necessary to have the right institutional structures in place in order to ensure that the technico-political discussions can take place in a meaningful way. A decision to implement a transport NAMA will require actions which will only return results beyond the current political cycle and this requires bold political action Technical Leadership Politicians have a duty to bring the societal consensus to the heart of government decision-making but sometimes this will conflict with the practical, technological and methodological requirements of the implementation of their decisions. However important and beneficial the political desire might be, the occasion does arise when it is simply not possible to put it into practice. Therefore there is a need to ensure that there is a body of technical wisdom at the disposal of the politicians. This wisdom includes the knowledge of what is possible, what happened before and an understanding of how to improve the predictions of what could happen in the future. This wisdom needs to be independent of political influence because its role is to provide advice that is independent of political wishes and, in effect, to provide the knowledgeable intelligence that enables politicians to be able to act in a responsible way with society s resources. It should be the norm that a politician turns to the technical leadership for objective advice of the highest order so that all decisions are made on the basis of the best evidence, advice and support. This requires technical leadership that is independent of the political process and therefore free from the changes that often occur as a result of the political cycle. Therefore continuity and leadership is also required at the technical level. Analytical Tools Three main tools have been selected to support the draft NAMA process; (1) the Outcome-based Strategy (OBS) which is a tool that formalises and facilitates the decision-making process; (2) the RED (Reduce, Exchange and Decarbonise) strategy which aims to drive and guide priorities increasing carbon reduction and improving quality of life; and (3) Multi-Criteria Analysis (MCA) which is an alternative method to cost-benefit analysis (CBA) enabling more effective assessments of strategic actions. Final remarks Further work is required in order to transform this draft transport NAMA into a NAMA proposal and this entails firstly the adoption and, if necessary, adjustment of the suggested interventions, followed by assessment of financial and incremental costs, development of appropriate metrics of success (including measurement, calculation, reporting and verification) and achievement of suitable GHG projections. Peru is currently recognised as a very promising emerging economy attracting international investment and the transport system plays a vital role in this economic development (transporting goods and people). Initial steps have already been taken to improve Mobility in the Metropolitan city (Lima and Callao), however more work needs to be done to ensure Peru s growth reaches its maximum potential. The large technical and financial support available and the potential social cobenefits that can be achieved, make a Transport NAMA the ideal tool to facilitate this goal.
In this thesis in terms of observable reality has examined the binding decisions in matters of amparo issued by the Constitutional Tribunal (TC) of Peru in 2005-2009, in order to identify in which there is a direct order judiciary. Of a total of twenty-four binding decisions were taken as a random sample of six of them, selected statements were compared, looking for similarities, differences and contradictions criteria. As for the background was considered the various doctrinal positions developed by national and foreign authors, which served us for the discussion of the results. Justification are understood by referring to determine whether to legislate limits the jurisdiction of the Constitutional Court as an autonomous body, as well as rethink the role of the judge as part of an autonomous and independent judiciary. For practical purposes, the formulation of the problem is: What are the effects of binding precedent imposed by the Constitutional Court to the exercise of fuzzy control of the judiciary? The definition of the conceptual framework is divided into five chapters, understood by the first: The Constitutional Precedent: 1. The binding constitutional precedent, 2. Previous dimensions, 3. The binding force of precedent. 4. Precedent setting, 5. Institutional classification of judicial precedents, 6. Judicial precedent and legal reasoning and 7. An approach to the fundamentals of binding. As chapter two courts: 1. Courts charged with resolving the constitutional process. With regard to Chapter Three: Fuzzy Control and concentrated control: 1. Scope of fuzzy control, 2. Limit to the work of fuzzy logic, 3. Fuzzy control and control concentrated in the Peruvian system of constitutional justice. In Chapter Four: The Constitutional Court: 1. Types of Constitutional Court rulings, 2. Sentences "ordinary" (not performing), judgments, interpretations and judgments additive 3. Binding precedent of the Constitutional Court of Peru, 4. The Constitutional Court as a supreme interpreter of the Constitution, 5. The definition of a constitutional case law and precedent, 6. Constitutional court and law, then 7. Formality of binding precedent. Finally we have the Chapter Five: The Judiciary: 1. Independence of the Judiciary and 2. The Constitution as a source of law, 3. Independent court or judge bureaucrat dimensions of judicial precedent, 4. Judicial precedent and constitutional precedent and 5. Linking to the previous judges. But the development of the hypothesis is worded as follows: The legal effect of binding precedent process of the Constitutional Court of Peru to the autonomy and fuzzy control of the judiciary in their judicial decisions from 2005 to 2009 are: denial of freedom and humanist philosophical interpretation of law, the restriction on doctrinal legal reasoning , limiting the discretion of the judge ordinary and mechanization in the administration of justice. The objective of this research is: To demonstrate the approach of binding precedent contained in the Constitutional Court's ruling on amparo, determines the performance of fuzzy control of the judiciary. Materials and methods used are: On the research material is taken into account the universal population comprised of 24 sentences under binding on the Constitutional Court issued during the period 2005 to 2006., The sample population is made up of 6 judgments on under chosen at random. The methods are: Universal Methods, General Methods and Special Methods; To conclude in regard to these techniques are: Observation Technique, Technique of Data Collection, and design used in research. In terms of results and discussion of this study these are: No. 1 "Ban The Judicial Branch of inapplicability Tax Regulations on Casinos and Slots whose constitutionality has been confirmed." No. 2 "The rule of constitutional precedent," No. 3 "Control and limits to the Constitutional Court," No. 4 "From the foregoing Immediate Change," No. 5 "limits on freedom of assembly", N º 6 "Unprecedented Precedent" In terms of conclusions and recommendations arrived a Constitutional Court ruling on amparo can not be binding in its entirety but only the beginning, aphorism or criteria contained in it. It is recommended that the binding decisions, the Constitutional Court to pinpoint the foundation, principle or criterion is the quality of ratio decidendi. Finally we completed the presentation of the research literature and relevant attachments. ; En la presente tesis en cuanto a la realidad observable se han examinado las sentencias vinculantes, en materia de amparo, expedidas por el Tribunal Constitucional (TC) peruano en el periodo 2005-2009, con el propósito de identificar en cuáles existe una orden directa al poder judicial. De un total de veinticuatro sentencias vinculantes, se tomó como muestra de manera aleatoria seis de ellas; se comparó las sentencias seleccionadas, buscando las semejanzas, diferencias, criterios y las contradicciones. En cuanto a los antecedentes se consideró las diversas posiciones doctrinarias desarrollada por autores nacionales y extranjeros, las que nos sirvió para la discusión de los resultados. Entendida por la justificación están referidas a determinar si es necesario legislar sobre los limites a la competencia del Tribunal Constitucional como órgano autónomo; así como reformular el rol del juez como miembro de un poder judicial autónomo e independiente. Para fines prácticos, la formulación del problema es el siguiente: ¿Cuáles son los efectos del precedente vinculante impuesto por el Tribunal Constitucional con el ejercicio del control difuso del Poder Judicial? La delimitación del marco conceptual se encuentra dividida en cinco capítulos, entendido por el primero: El Precedente Constitucional: 1. El precedente constitucional vinculante, 2. Dimensiones del precedente, 3. La fuerza vinculante del precedente judicial. 4. Establecimiento de los precedentes, 5. Clasificación institucional de los precedentes judiciales, 6. El precedente judicial y el razonamiento jurídico y 7. Una aproximación a los fundamentos de vinculatoriedad. En cuanto al capítulo Dos Órganos Jurisdiccionales: 1. Órganos jurisdiccionales encargados de resolver los procesos constitucionales. En cuanto al capitulo Tres: Control Difuso y control concentrado: 1. Alcances del control difuso, 2. Límite a la labor de control difuso, 3. El control difuso y el control concentrado en el sistema peruano de justicia constitucional. En el capitulo Cuatro: El Tribunal Constitucional: 1. Tipología de las sentencias del Tribunal Constitucional, 2. Sentencias "ordinarias" (no interpretativas), sentencias interpretativas y sentencias aditivas, 3. Del precedente vinculante del Tribunal Constitucional Peruano, 4. El Tribunal Constitucional como supremo intérprete de la Constitución, 5. La definición de jurisprudencia y precedente constitucional vinculante, 6. Tribunal constitucional y ley. 7. Formalidad del precedente vinculante. Finalmente tenemos el capitulo Cinco: El Poder Judicial: 1. Independencia del Poder Judicial 2. La Constitución como fuente de Derecho, 3. Juez independiente o juez burócrata dimensiones del precedente judicial, 4. El precedente judicial y el precedente constitucional y 5. Vinculación de los jueces al precedente. Ahora bien el desarrollo de la hipótesis queda redactado de la siguiente forma: Los efectos jurídicos procesales del precedente vinculante del Tribunal Constitucional del Perú en relación con la autonomía y control difuso del poder judicial en sus decisiones jurisdiccionales del 2005 al 2009 son: la negación de la libre interpretación filosófica y humanista del derecho, la restricción a la argumentación jurídica doctrinaria, limitación discrecional del juzgador ordinario y la mecanización en la administración de justicia. El objetivo de la investigación es: Demostrar el criterio de precedente vinculante contenida en la sentencias del Tribunal Constitucional en materia de amparo, condiciona el ejercicio del control difuso del Poder Judicial. El Material y Métodos empleados son: En cuanto al material de investigación se toma en cuenta la población universal comprendida por 24 sentencias vinculantes en materia de amparo expedidas por el Tribunal Constitucional durante el periodo 2005- 2006., la población muestral esta constituida por 6 sentencias en materia de amparo elegida de manera aleatoria. Los métodos empleados son: Métodos Universales, Métodos Generales y Métodos Especiales; Para culminar en lo que se refiere a las técnicas estas son: La Técnica de Observación, la Técnica de Recolección de Datos, y diseño utilizado en la investigación. En cuanto a los resultados y la discusión de la presente investigación estos son: Nº 1 "Prohibición Al Poder Judicial De Inaplicar Normas Tributarias Sobre Casinos y Tragamonedas Cuya Constitucionalidad Ha Sido Confirmada.", Nº 2 "La regla del precedente constitucional", Nº 3 "Control y Limites Al Tribunal Constitucional", Nº 4 "Variación Inmediata Del Precedente", Nº 5 "Limites a La Libertad De Reunión", Nº 6 "Precedentes sin Precedente" En materia de conclusiones y recomendaciones arribamos que una sentencia del Tribunal Constitucional, en materia de amparo no puede ser vinculante en su totalidad sino tan solo el principio, aforismo o criterio contenido en ella. Por lo que se recomienda que en las sentencias vinculantes, el Tribunal Constitucional señale con precisión el fundamento, principio o criterio tiene la calidad de ratio decidendi. Finalmente culminamos la presentación de la investigación con la bibliografía y los anexos pertinentes.
IMPORTANCE: Generalized anxiety disorder (GAD) is poorly understood compared with other anxiety disorders, and debates persist about the seriousness of this disorder. Few data exist on GAD outside a small number of affluent, industrialized nations. No population-based data exist on GAD as it is currently defined in DSM-5. OBJECTIVE: To provide the first epidemiologic data on DSM-5 GAD and explore cross-national differences in its prevalence, course, correlates, and impact. DESIGN, SETTING, AND PARTICIPANTS: Data come from the World Health Organization World Mental Health Survey Initiative. Cross-sectional general population surveys were carried out in 26 countries using a consistent research protocol and assessment instrument. A total of 147 261 adults from representative household samples were interviewed face-to-face in the community. The surveys were conducted between 2001 and 2012. Data analysis was performed from July 22, 2015, to December 12, 2016. MAIN OUTCOMES AND MEASURES: The Composite International Diagnostic Interview was used to assess GAD along with comorbid disorders, role impairment, and help seeking. RESULTS: Respondents were 147 261 adults aged 18 to 99 years. The surveys had a weighted mean response rate of 69.5%. Across surveys, DSM-5 GAD had a combined lifetime prevalence (SE) of 3.7% (0.1%), 12-month prevalence of 1.8% (0.1%), and 30-day prevalence of 0.8% (0). Prevalence estimates varied widely across countries, with lifetime prevalence highest in high-income countries (5.0% [0.1%]), lower in middle-income countries (2.8% [0.1%]), and lowest in low-income countries (1.6% [0.1%]). Generalized anxiety disorder typically begins in adulthood and persists over time, although onset is later and clinical course is more persistent in lower-income countries. Lifetime comorbidity is high (81.9% [0.7%]), particularly with mood (63.0% [0.9%]) and other anxiety (51.7% [0.9%]) disorders. Severe role impairment is common across life domains (50.6% [1.2%]), particularly in high-income countries. Treatment is sought by approximately half of affected individuals (49.2% [1.2%]), especially those with severe role impairment (59.4% [1.8%]) or comorbid disorders (55.8% [1.4%]) and those living in high-income countries (59.0% [1.3%]). CONCLUSIONS AND RELEVANCE: The findings of this study show that DSM-5 GAD is more prevalent than DSM-IV GAD and is associated with substantial role impairment. The disorder is especially common and impairing in high-income countries despite a negative association between GAD and socioeconomic status within countries. These results underscore the public health significance of GAD across the globe while uncovering cross-national differences in prevalence, course, and impairment that require further investigation. ; The WHO WMH Survey Initiative is supported by National Institute of Mental Health (NIMH) grant R01 MH070884; the John D. and Catherine T. MacArthur Foundation; the Pfizer Foundation; US Public Health Service grants R13-MH066849, R01-MH069864, and R01 DA016558; Fogarty International Center grant FIRCA R03-TW006481; the Pan American Health Organization; Eli Lilly and Company; Ortho-McNeil Pharmaceutical, Inc; GlaxoSmithKline; and Bristol-Myers Squibb. The 2007 Australian National Survey of Mental Health and Wellbeing is funded by the Australian Government Department of Health and Ageing. The São Paulo Megacity Mental Health Survey is supported by the State of São Paulo Research Foundation Thematic Project grant 03/00204-3. The Bulgarian Epidemiological Study of common mental disorders Epidemiology and Bulgaria is supported by the Ministry of Health and the National Center for Public Health Protection. The Chinese WMH Survey Initiative is supported by the Pfizer Foundation. The Shenzhen Mental Health Survey is supported by the Shenzhen Bureau of Health and the Shenzhen Bureau of Science, Technology, and Information. The Colombian National Study of Mental Health is supported by the Ministry of Social Protection. The Mental Health Study Medellín–Colombia was carried out and supported jointly by the Center for Excellence on Research in Mental Health (CES University) and the Secretary of Health of Medellín. The European Study of the Epidemiology of Mental Disorders project is funded by European Commission contracts QLG5-1999-01042, SANCO 2004123, and EAHC 20081308 (the Piedmont Region [Italy]); Fondo de Investigación Sanitaria; Instituto de Salud Carlos III, Spain grant FIS 00/0028; Ministerio de Ciencia y Tecnología, Spain, grant SAF 2000-158-CE; Departament de Salut, Generalitat de Catalunya, Spain; Instituto de Salud Carlos III grants CIBER CB06/02/0046 and RETICS RD06/0011 REM-TAP; and other local agencies and by an unrestricted educational grant from GlaxoSmithKline. Implementation of the Iraq Mental Health Survey (IMHS) and data entry were carried out by the staff of the Iraqi Ministry of Health and Ministry of Planning with direct support from the Iraqi IMHS team, with funding from both the Japanese and European Funds through United Nations Development Group Iraq Trust Fund. The Israel National Health Survey is funded by the Ministry of Health with support from the Israel National Institute for Health Policy and Health Services Research and the National Insurance Institute of Israel. The WMH Japan Survey is supported by grants H13-SHOGAI-023, H14-TOKUBETSU-026, and H16-KOKORO-013 for Research on Psychiatric and Neurological Diseases and Mental Health from the Japan Ministry of Health, Labour and Welfare. The Lebanese Evaluation of the Burden of Ailments and Needs of the Nation is supported by the Lebanese Ministry of Public Health, the WHO (Lebanon), National Institute of Health/Fogarty International Center grant R03 TW006481-01, anonymous private donations to Institute for Development Research Advocacy and Applied Care, Lebanon, and unrestricted grants from Algorithm, AstraZeneca, Benta, Bella Pharma, Eli Lilly, GlaxoSmithKline, Lundbeck, Novartis, Servier, Phenicia, and Union Pharmaceutique d'Orient SAL. The Mexican National Comorbidity Survey is supported by The National Institute of Psychiatry Ramon de la Fuente grant INPRFMDIES 4280 and by the National Council on Science and Technology grant CONACyT-G30544-H, with supplemental support from the Pan American Health Organization. Te Rau Hinengaro: The New Zealand Mental Health Survey is supported by the New Zealand Ministry of Health, Alcohol Advisory Council, and the Health Research Council. The Nigerian Survey of Mental Health and Wellbeing is supported by the WHO (Geneva), the WHO (Nigeria), and the Federal Ministry of Health, Abuja, Nigeria. The Northern Ireland Study of Mental Health was funded by the Health & Social Care Research & Development Division of the Public Health Agency. The Peruvian WMH Study was funded by the National Institute of Health of the Ministry of Health of Peru. The Polish project Epidemiology of Mental Health and Access to Care–EZOP Project grant PL 0256 was supported by Iceland, Liechtenstein, and Norway through funding from the European Economic Area Financial Mechanism and the Norwegian Financial Mechanism; the EZOP Project was cofinanced by the Polish Ministry of Health. The Portuguese Mental Health Study was carried out by the Department of Mental Health, Faculty of Medical Sciences, NOVA University of Lisbon, with collaboration of the Portuguese Catholic University, and was funded by Champalimaud Foundation, Gulbenkian Foundation, Foundation for Science and Technology and Ministry of Health. The Romania WMH Survey Initiative study projects Policies in Mental Health Area and National Study Regarding Mental Health and Services Use were carried out by the National School of Public Health & Health Services Management (formerly the National Institute for Research & Development in Health), with technical support of Metro Media Transilvania, the National Institute of Statistics–National Centre for Training in Statistics, Societatea Comerciala Cheyenne Services SRL, and Statistics Netherlands and were funded by the Ministry of Public Health (formerly the Ministry of Health) with supplemental support from Eli Lilly Romania SRL. The South Africa Stress and Health Study is supported by US NIMH grant R01-MH059575 and the National Institute of Drug Abuse, with supplemental funding from the South African Department of Health and the University of Michigan. The Psychiatric Enquiry to General Population in Southeast Spain–Murcia Project has been financed by the Regional Health Authorities of Murcia (Servicio Murciano de Salud and Consejería de Sanidad y Política Social) and Fundación para la Formación e Investigación Sanitarias of Murcia. The Ukraine Comorbid Mental Disorders During Periods of Social Disruption study is funded by US NIMH grant R01-MH61905. The US National Comorbidity Survey Replication is supported by NIMH grant U01-MH60220 with supplemental support from the National Institute of Drug Abuse, the Substance Abuse and Mental Health Services Administration, Robert Wood Johnson Foundation grant 044708, and the John W. Alden Trust. Preparation of this manuscript was supported by grant R01 MH094425 from the NIMH (Dr Ruscio).
BACKGROUND:The treatment gap between the number of people with mental disorders and the number treated represents a major public health challenge. We examine this gap by socio-economic status (SES; indicated by family income and respondent education) and service sector in a cross-national analysis of community epidemiological survey data. METHODS: Data come from 16 753 respondents with 12-month DSM-IV disorders from community surveys in 25 countries in the WHO World Mental Health Survey Initiative. DSM-IV anxiety, mood, or substance disorders and treatment of these disorders were assessed with the WHO Composite International Diagnostic Interview (CIDI). RESULTS: Only 13.7% of 12-month DSM-IV/CIDI cases in lower-middle-income countries, 22.0% in upper-middle-income countries, and 36.8% in high-income countries received treatment. Highest-SES respondents were somewhat more likely to receive treatment, but this was true mostly for specialty mental health treatment, where the association was positive with education (highest treatment among respondents with the highest education and a weak association of education with treatment among other respondents) but non-monotonic with income (somewhat lower treatment rates among middle-income respondents and equivalent among those with high and low incomes). CONCLUSIONS: The modest, but nonetheless stronger, an association of education than income with treatment raises questions about a financial barriers interpretation of the inverse association of SES with treatment, although future within-country analyses that consider contextual factors might document other important specifications. While beyond the scope of this report, such an expanded analysis could have important implications for designing interventions aimed at increasing mental disorder treatment among socio-economically disadvantaged people. ; The World Health Organization World Mental Health (WMH) Survey Initiative is supported by the US National Institute of Mental Health (NIMH; R01 MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical Inc., GlaxoSmithKline, and Bristol-Myers Squibb. We thank the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork, and consultation on data analysis. The São Paulo Megacity Mental Health Survey is supported by the State of São Paulo Research Foundation (FAPESP) Thematic Project Grant 03/00204-3. The Bulgarian Epidemiological Study of common mental disorders EPIBUL is supported by the Ministry of Health and the National Center for Public Health Protection. The Chinese World Mental Health Survey Initiative is supported by the Pfizer Foundation. The Shenzhen Mental Health Survey is supported by the Shenzhen Bureau of Health and the Shenzhen Bureau of Science, Technology, and Information. The Colombian National Study of Mental Health (NSMH) is supported by the Ministry of Social Protection. The Mental Health Study Medellín – Colombia was carried out and supported jointly by the Center for Excellence on Research in Mental Health (CES University) and the Secretary of Health of Medellín. The ESEMeD project is funded by the European Commission (Contracts QLG5-1999-01042; SANCO 2004123, and EAHC 20081308), (the Piedmont Region (Italy)), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE), Departament de Salut, Generalitat de Catalunya, Spain, Instituto de Salud Carlos III (CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP), and other local agencies and by an unrestricted educational grant from GlaxoSmithKline. Implementation of the Iraq Mental Health Survey (IMHS) and data entry was carried out by the staff of the Iraqi MOH and MOP with direct support from the Iraqi IMHS team with funding from both the Japanese and European Funds through United Nations Development Group Iraq Trust Fund (UNDG ITF). The Israel National Health Survey is funded by the Ministry of Health with support from the Israel National Institute for Health Policy and Health Services Research and the National Insurance Institute of Israel. The World Mental Health Japan (WMHJ) Survey is supported by the Grant for Research on Psychiatric and Neurological Diseases and Mental Health (H13-SHOGAI-023, H14-TOKUBETSU-026, H16-KOKORO-013, H25-SEISHIN-IPPAN-006) from the Japan Ministry of Health, Labour and Welfare. The Lebanese Evaluation of the Burden of Ailments and Needs Of the Nation (L.E.B.A.N.O.N.) is supported by the Lebanese Ministry of Public Health, the WHO (Lebanon), National Institute of Health / Fogarty International Center (R03 TW006481-01), anonymous private donations to IDRAAC, Lebanon, and unrestricted grants from, Algorithm, AstraZeneca, Benta, Bella Pharma, Eli Lilly, Glaxo Smith Kline, Lundbeck, Novartis, OmniPharma, Pfizer, Phenicia, Servier, UPO. The Mexican National Comorbidity Survey (MNCS) is supported by The National Institute of Psychiatry Ramon de la Fuente (INPRFMDIES 4280) and by the National Council on Science and Technology (CONACyT-G30544- H), with supplemental support from the PanAmerican Health Organization (PAHO). Te Rau Hinengaro: The New Zealand Mental Health Survey (NZMHS) is supported by the New Zealand Ministry of Health, Alcohol Advisory Council, and the Health Research Council. The Nigerian Survey of Mental Health and Wellbeing (NSMHW) is supported by the WHO (Geneva), the WHO (Nigeria), and the Federal Ministry of Health, Abuja, Nigeria. The Northern Ireland Study of Mental Health was funded by the Health & Social Care Research & Development Division of the Public Health Agency. The Peruvian World Mental Health Study was funded by the National Institute of Health of the Ministry of Health of Peru. The Polish project Epidemiology of Mental Health and Access to Care – EZOP Project (PL 0256) was supported by Iceland, Liechtenstein and Norway through funding from the EEA Financial Mechanism and the Norwegian Financial Mechanism. EZOP project was co-financed by the Polish Ministry of Health. The Portuguese Mental Health Study was carried out by the Department of Mental Health, Faculty of Medical Sciences, NOVA University of Lisbon, with the collaboration of the Portuguese Catholic University, and was funded by Champalimaud Foundation, Gulbenkian Foundation, Foundation for Science and Technology (FCT) and Ministry of Health. The Romania WMH study projects 'Policies in Mental Health Area' and 'National Study regarding Mental Health and Services Use' were carried out by National School of Public Health & Health Services Management (former National Institute for Research & Development in Health), with technical support of Metro Media Transilvania, the National Institute of Statistics-National Centre for Training in Statistics, SC. Cheyenne Services SRL, Statistics Netherlands and were funded by Ministry of Public Health (former Ministry of Health) with the supplemental support of Eli Lilly Romania SRL. The South Africa Stress and Health Study (SASH) is supported by the US National Institute of Mental Health (R01-MH059575) and National Institute of Drug Abuse with supplemental funding from the South African Department of Health and the University of Michigan. The Psychiatric Enquiry to General Population in Southeast Spain – Murcia (PEGASUSMurcia) Project has been financed by the Regional Health Authorities of Murcia (Servicio Murciano de Salud and Consejería de Sanidad y Política Social) and Fundación para la Formación e Investigación Sanitarias (FFIS) of Murcia. The Ukraine Comorbid Mental Disorders during Periods of Social Disruption (CMDPSD) study is funded by the US National Institute of Mental Health (RO1-MH61905). The US National Comorbidity Survey Replication (NCS-R) is supported by the National Institute of Mental Health (NIMH; U01-MH60220) with supplemental support from the National Institute of Drug Abuse (NIDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Robert Wood Johnson Foundation (RWJF; Grant 044708), and the John W. Alden Trust. Dr Evans-Lacko currently holds a Starting Grant from the European Research Council (337673). Dr Thornicroft is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London at King's College London Foundation Trust. GT acknowledges financial support from the Department of Health via the National Institute for Health Research (NIHR) Biomedical Research Centre and Dementia Unit awarded to South London and Maudsley NHS Foundation Trust in partnership with King's College London and King's College Hospital NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. GT is supported by the European Union Seventh Framework Programme (FP7/2007–2013) Emerald project. A complete list of all within-country and cross-national WMH publications can be found at http://www.hcp.med.harvard.edu/wmh/.
Comúnmente se señala a América Latina como un verdadero crisol de razas y culturas. Esa afirmación no es banal. Si algo distingue al sub-continente es justamente la conjugación de diversas herencias culturales y de disímiles grupos étnicos que, aunque no sin ciertas dificultades, han convenido en coexistir con relativa harmonía.No hace falta recordar que los componentes étnico-culturales que conforman la pluralidad latente de nuestro continente son básicamente tres: el nativo indígena, el europeo y finalmente el africano. Como es sabido, este último grupo acompañó la historia post-descubrimiento de nuestro sub-continente casi que de inmediato, debido al flujo esclavista que trajeron los europeos consigo a partir del siglo XVI. En ese momento se produciría el primer contacto poblacional entre el África Negra y la América Latina Indigenista. Fantis, Ashautis, Carabalí y los Yoruba fueron los grupos negros, provenientes de la costa occidental del África, más comunes en llegar. La concentración de estas poblaciones se produjo en mayor cantidad tanto en las Antillas como, en general, en las áreas tropicales. Lo que hoy conocemos como Colombia Venezuela, las Guayanas y especialmente Brasil fueron los puntos neurálgicos de recepción de negros esclavos. Además de su trabajo, los negros contribuyeron con sus costumbres, lenguas, música y religiones, forjando así una parte sustancial del patrimonio cultural latinoamericano.Con la sucesiva manumisión de los esclavos en nuestro sub- continente durante el siglo XIX, culminando con la de Brasil en 1888, los negros pasarían a integrarse en la sociedad como hombres libres, conformándose como un grupo étnico de suma importancia, que hoy llega a configurar el 30% aproximadamente de la población total latinoamericana (claro que con realidades variables dentro de cada país).Pese a la importancia de los afro-descendientes, las relaciones con el África no tendrían mayor desarrollo, ya sea porque los países latinoamericanos se abocaron a consolidar a sus respectivos Estados, o ya sea por el posterior proceso de "ensimismamiento" que experimentaría África, para la segunda parte del siglo XX, buscando emanciparse del coloniaje europeo.Esto cambiaría a partir de los 90', cuando se comienza a registrar un aumento considerable en los volúmenes de intercambio entre ambas orillas del Atlántico.Parece ser que en un mundo globalizado no existen los socios no-estratégicos, de esta manera en los últimos tiempos hemos asistido a una reavivación de las relaciones inter-continentales. A partir del 2000, y a modo de ejemplo, se ha iniciado un proceso de cooperación académica entre ambos continentes (así como también con Asia), realizándose diversas conferencias y reuniones, para revisar los puntos en común. Este tipo de aproximación tuvo su último encuentro en Buenos Aires, en 2005, que culminó con la aprobación y financiamiento de un programa de cooperación, con duración de tres años. Entre los objetivos principales del programa está el de subrayar la producción de conocimiento vinculado al desarrollo, a la cuestión de la paz y de la democracia. Además su buscó construir una visón conjunta para temas críticos, como el de la alimentación.No obstante, el hito más importante en este acercamiento multilateral fue, sin dudas, la primera Cumbre África-Latinoamérica, realizada en 2006, en la capital de Nigeria, Abuja. Impulsada por Brasil y Nigeria, dicha Cumbre buscaría originar una unión entre los países del Sur. La participación fue multitudinaria, ya que contó con la presencia de los 12 países miembros de Comunidad Sudamericana de Naciones y con 53 países pertenecientes a la Unión Africana. Con el pretensioso objetivo de desarrollar la cooperación económica y política, los temas tratados fueron desde la asistencia mutua en temas científicos hasta las estrategias comunes a adoptar en el escenario internacional, pasando por los derechos humanos. En materia económica, se trabajó sobre diversos puntos, entre ellos, temas tales como el comercio e inversiones, la lucha contra la pobreza, las políticas energéticas y sobre todo, los asuntos referidos a la agricultura y al combate del hambre. También se buscó generar un alineamiento en el ámbito de las negociaciones en la OMC; sin embargo, la empresa fue motivo de divergencias. Todos estos pasos en pro del acercamiento de los dos continentes, se plasmaron en el Plan de Acción de Abuja que, si bien su ejecución ha sido lenta, deja asentado las buenas disposiciones de trabajar en una alianza Sur-Sur.En esa misma Cumbre se fijó la fecha para un próximo encuentro. Éste fue programado para el 2008 pero finalmente se postergó para noviembre del presente año. El anfitrión, esta vez, será Venezuela. El pintoresco presidente caribeño, Hugo Chávez, ha anunciado ya cuatro propuestas para esa cumbre: una energética (Petrosur), una financiera (el Banco del Sur), una académica (la Universidad del Sur) y otra en cuanto a telecomunicaciones (Telesur). Ya se anunció, además, que se pretende llegar, en dicha Cumbre, a acuerdos concretos y que comiencen a dar resultados de inmediato en múltiples materias, como la cooperación social (salud, educación, etc.), tecnológica, cultural, de turismo, y en materia de intercambio comercial y de agricultura principalmente.Amén de los acercamientos multilaterales, se destacan también los esfuerzos individuales por conquistar al África Negra. Existen acuerdos bilaterales entre Colombia y Nigeria, Angola y Argentina, Brasil con Ruanda y Kenya, y Uruguay quien ha cerrado con Angola un Memorándum de Entendimiento. México también ha profundizado su relación con el continente africano. Recientemente, la canciller mexicana, firmó un acuerdo con Sudáfrica para Evitar la Doble Tributación y Prevenir la Evasión Fiscal y que decididamente impulsa el intercambio comercial y, principalmente, de inversiones. Argentina hizo lo propio visitando, el año pasado, a Argelia, Túnez, Libia y Egipto. Su objetivo: diversificar mercados e intensificar el flujo comercial con esos países que ya había alcanzado la nada despreciable cifra de U$S4000 millones de dólares.Sin embargo, los que llevan claramente la delantera en cuanto al relacionamiento con el África Negra son Brasil y Venezuela. El primero ha incrementado su intercambio económico con los países africanos considerablemente, pasando de cerca de U$S5 billones de dólares, en 2002, a aproximadamente unos U$S15000 billones para el 2006. Esta intensificación es el producto exclusivo de la política de Lula da Silva que, desde su asunción, se ha mostrado sumamente interesado en estrechar lazos con dicho continente, además de llamar a un cambio de perspectiva en el relacionamiento Sur-Sur. Esa preocupación se materializó con numerosas visitas a África que el mandatario brasilero ha efectuado durante su gobierno.Por su lado Venezuela, si bien no ha descuidado la reciprocidad económica, ha optado por emprender una verdadera "expedición" diplomática por el continente negro. Como es harto conocido, este gusto por lo diplomático caracteriza definitivamente al presente gobierno venezolano. Es así que las misiones diplomáticas venezolanas se duplicaron, así como también la presencia de embajadas en suelo africano, que hoy totalizan 47 de los 53 países que componen al continente. De esta manera, Venezuela ya cuenta con un marco jurídico que permite los mecanismos de consultas políticas así como la celebración de comisiones mixtas. Por si fuera poco, el país caribeño ya ha hecho saber que, para el presente año, y con la cumbre como disparador, tiene planeado agudizar la cooperación cultural con aquella región del mundo.Habiendo hecho este brevísimo vistazo a las relaciones entre América Latina y África, no sería errado afirmar que, pese a las significantes diferencias que existen entre ambos continentes, es del todo factible la coordinación de políticas comunes, sobre todo, a la luz de los puntos y desafíos compartidos por las dos orillas del Atlántico. Lo primero, el desarrollo, el combate al hambre y a la pobreza y el mejoramiento de la distribución de la riqueza, tema pendiente en los dos continentes. A veces, la imagen casi caricaturesca que tenemos del continente africano, nos hace olvidar no sólo de que es uno con grandísimas posibilidades y fortalezas, potencialmente explotables, -sobre todo, en materia de recursos minerales, hídricos e hidrocarburos- sino de que existen países, como Sudáfrica, con un nivel de desarrollo destacable. Por lo pronto, me parece que este acercamiento, sano y juicioso, puede traer grandes beneficios para las dos partes tanto en lo que hace a la complementariedad económica como, y especialmente, al desarrollo humano tan necesario y buscado por estas dos regiones, históricamente unidas. También me parece un signo positivo el hecho de que los países latinoamericanos, en su gran mayoría, hayan aprendido las lecciones del pasado y han entendido que lo más sano para el desarrollo de sus economías no es el aislamiento del resto del mundo sino la liberalización del comercio, y cuanto más diversificados los mercados, mejor. * Estudiante de la Licenciatura en Estudios Internacionales. Depto de Estudios Internacionales. FACS - ORT Uruguay.
In my postgraduate formation during the last years of the 80's, we had close to thirty hospital beds in a pavilion called "sépticas" (1). In Colombia, where abortion was completely penalized, the pavilion was mostly filled with women with insecure, complicated abortions. The focus we received was technical: management of intensive care; performance of hysterectomies, colostomies, bowel resection, etc. In those times, some nurses were nuns and limited themselves to interrogating the patients to get them to "confess" what they had done to themselves in order to abort. It always disturbed me that the women who left alive, left without any advice or contraceptive method. Having asked a professor of mine, he responded with disdain: "This is a third level hospital, those things are done by nurses of the first level". Seeing so much pain and death, I decided to talk to patients, and I began to understand their decision. I still remember so many deaths with sadness, but one case in particular pains me: it was a woman close to being fifty who arrived with a uterine perforation in a state of advanced sepsis. Despite the surgery and the intensive care, she passed away. I had talked to her, and she told me she was a widow, had two adult kids and had aborted because of "embarrassment towards them" because they were going to find out that she had an active sexual life. A few days after her passing, the pathology professor called me, surprised, to tell me that the uterus we had sent for pathological examination showed no pregnancy. She was a woman in a perimenopausal state with a pregnancy exam that gave a false positive due to the high levels of FSH/LH typical of her age. SHE WAS NOT PREGNANT!!! She didn't have menstruation because she was premenopausal and a false positive led her to an unsafe abortion. Of course, the injuries caused in the attempted abortion caused the fatal conclusion, but the real underlying cause was the social taboo in respect to sexuality. I had to watch many adolescents and young women leave the hospital alive, but without a uterus, sometime without ovaries and with colostomies, to be looked down on by a society that blamed them for deciding to not be mothers. I had to see situation of women that arrived with their intestines protruding from their vaginas because of unsafe abortions. I saw women, who in their despair, self-inflicted injuries attempting to abort with elements such as stick, branches, onion wedges, alum bars and clothing hooks among others. Among so many deaths, it was hard not having at least one woman per day in the morgue due to an unsafe abortion. During those time, healthcare was not handled from the biopsychosocial, but only from the technical (2); nonetheless, in the academic evaluations that were performed, when asked about the definition of health, we had to recite the text from the International Organization of Health that included these three aspects. How contradictory! To give response to the health need of women and guarantee their right when I was already a professor, I began an obstetric contraceptive service in that third level hospital. There was resistance from the directors, but fortunately I was able to acquire international donations for the institution, which facilitated its acceptance. I decided to undertake a teaching career with the hope of being able to sensitize health professionals towards an integral focus of health and illness. When the International Conference of Population and Development (ICPD) was held in Cairo in 1994, I had already spent various years in teaching, and when I read their Action Program, I found a name for what I was working on: Sexual and Reproductive Rights. I began to incorporate the tools given by this document into my professional and teaching life. I was able to sensitize people at my countries Health Ministry, and we worked together moving it to an approach of human rights in areas of sexual and reproductive health (SRH). This new viewpoint, in addition to being integral, sought to give answers to old problems like maternal mortality, adolescent pregnancy, low contraceptive prevalence, unplanned or unwanted pregnancy or violence against women. With other sensitized people, we began with these SRH issues to permeate the Colombian Society of Obstetrics and Gynecology, some universities, and university hospitals. We are still fighting in a country that despite many difficulties has improved its indicators of SRH. With the experience of having labored in all sphere of these topics, we manage to create, with a handful of colleagues and friend at the Universidad El Bosque, a Master's Program in Sexual and Reproductive Health, open to all professions, in which we broke several paradigms. A program was initiated in which the qualitative and quantitative investigation had the same weight, and some alumni of the program are now in positions of leadership in governmental and international institutions, replicating integral models. In the Latin American Federation of Obstetrics and Gynecology (FLASOG, English acronym) and in the International Federation of Obstetrics and Gynecology (FIGO), I was able to apply my experience for many years in the SRH committees of these association to benefit women and girls in the regional and global environments. When I think of who has inspired me in these fights, I should highlight the great feminist who have taught me and been with me in so many fights. I cannot mention them all, but I have admired the story of the life of Margaret Sanger with her persistence and visionary outlook. She fought throughout her whole life to help the women of the 20th century to be able to obtain the right to decide when and whether or not they wanted to have children (3). Of current feminist, I have had the privilege of sharing experiences with Carmen Barroso, Giselle Carino, Debora Diniz and Alejandra Meglioli, leaders of the International Planned Parenthood Federation – Western Hemisphere Region (IPPF-RHO). From my country, I want to mention my countrywoman Florence Thomas, psychologist, columnist, writer and Colombo-French feminist. She is one of the most influential and important voices in the movement for women rights in Colombia and the region. She arrived from France in the 1960's, in the years of counterculture, the Beatles, hippies, Simone de Beauvoir, and Jean-Paul Sartre, a time in which capitalism and consumer culture began to be criticized (4). It was then when they began to talk about the female body, female sexuality and when the contraceptive pill arrived like a total revolution for women. Upon its arrival in 1967, she experimented a shock because she had just assisted in a revolution and only found a country of mothers, not women (5). That was the only destiny for a woman, to be quiet and submissive. Then she realized that this could not continue, speaking of "revolutionary vanguards" in such a patriarchal environment. In 1986 with the North American and European feminism waves and with her academic team, they created the group "Mujer y Sociedad de la Universidad Nacional de Colombia", incubator of great initiatives and achievements for the country (6). She has led great changes with her courage, the strength of her arguments, and a simultaneously passionate and agreeable discourse. Among her multiple books, I highlight "Conversaciones con Violeta" (7), motivated by the disdain towards feminism of some young women. She writes it as a dialogue with an imaginary daughter in which, in an intimate manner, she reconstructs the history of women throughout the centuries and gives new light of the fundamental role of feminism in the life of modern women. Another book that shows her bravery is "Había que decirlo" (8), in which she narrates the experience of her own abortion at age twenty-two in sixty's France. My work experience in the IPPF-RHO has allowed me to meet leaders of all ages in diverse countries of the region, who with great mysticism and dedication, voluntarily, work to achieve a more equal and just society. I have been particularly impressed by the appropriation of the concept of sexual and reproductive rights by young people, and this has given me great hope for the future of the planet. We continue to have an incomplete agenda of the action plan of the ICPD of Cairo but seeing how the youth bravely confront the challenges motivates me to continue ahead and give my years of experience in an intergenerational work. In their policies and programs, the IPPF-RHO evidences great commitment for the rights and the SRH of adolescent, that are consistent with what the organization promotes, for example, 20% of the places for decision making are in hands of the young. Member organizations, that base their labor on volunteers, are true incubators of youth that will make that unassailable and necessary change of generations. In contrast to what many of us experienced, working in this complicated agenda of sexual and reproductive health without theoretical bases, today we see committed people with a solid formation to replace us. In the college of medicine at the Universidad Nacional de Colombia and the College of Nursing at the Universidad El Bosque, the new generations are more motivated and empowered, with great desire to change the strict underlying structures. Our great worry is the onslaught of the ultra-right, a lot of times better organized than us who do support rights, that supports anti-rights group and are truly pro-life (9). Faced with this scenario, we should organize ourselves better, giving battle to guarantee the rights of women in the local, regional, and global level, aggregating the efforts of all pro-right organizations. We are now committed to the Objectives of Sustainable Development (10), understood as those that satisfy the necessities of the current generation without jeopardizing the capacity of future generations to satisfy their own necessities. This new agenda is based on: - The unfinished work of the Millennium Development Goals - Pending commitments (international environmental conventions) - The emergent topics of the three dimensions of sustainable development: social, economic, and environmental. We now have 17 objectives of sustainable development and 169 goals (11). These goals mention "universal access to reproductive health" many times. In objective 3 of this list is included guaranteeing, before the year 2030, "universal access to sexual and reproductive health services, including those of family planning, information, and education." Likewise, objective 5, "obtain gender equality and empower all women and girls", establishes the goal of "assuring the universal access to sexual and reproductive health and reproductive rights in conformity with the action program of the International Conference on Population and Development, the Action Platform of Beijing". It cannot be forgotten that the term universal access to sexual and reproductive health includes universal access to abortion and contraception. Currently, 830 women die every day through preventable maternal causes; of these deaths, 99% occur in developing countries, more than half in fragile environments and in humanitarian contexts (12). 216 million women cannot access modern contraception methods and the majority live in the nine poorest countries in the world and in a cultural environment proper to the decades of the seventies (13). This number only includes women from 15 to 49 years in any marital state, that is to say, the number that takes all women into account is much greater. Achieving the proposed objectives would entail preventing 67 million unwanted pregnancies and reducing maternal deaths by two thirds. We currently have a high, unsatisfied demand for modern contraceptives, with extremely low use of reversible, long term methods (intrauterine devices and subdermal implants) which are the most effect ones with best adherence (14). There is not a single objective among the 17 Objectives of Sustainable Development where contraception does not have a prominent role: from the first one that refers to ending poverty, going through the fifth one about gender equality, the tenth of inequality reduction among countries and within the same country, until the sixteenth related with peace and justice. If we want to change the world, we should procure universal access to contraception without myths or barriers. We have the moral obligation of achieving the irradiation of extreme poverty and advancing the construction of more equal, just, and happy societies. In emergency contraception (EC), we are very far from reaching expectations. If in reversible, long-term methods we have low prevalence, in EC the situation gets worse. Not all faculties in the region look at this topic, and where it is looked at, there is no homogeneity in content, not even within the same country. There are still myths about their real action mechanisms. There are countries, like Honduras, where it is prohibited and there is no specific medicine, the same case as in Haiti. Where it is available, access is dismal, particularly among girls, adolescents, youth, migrants, afro-descendent, and indigenous. The multiple barriers for the effective use of emergency contraceptives must be knocked down, and to work toward that we have to destroy myths and erroneous perceptions, taboos and cultural norms; achieve changes in laws and restrictive rules within countries, achieve access without barriers to the EC; work in union with other sectors; train health personnel and the community. It is necessary to transform the attitude of health personal to a service above personal opinion. Reflecting on what has occurred after the ICPD in Cairo, their Action Program changed how we look at the dynamics of population from an emphasis on demographics to a focus on the people and human rights. The governments agreed that, in this new focus, success was the empowerment of women and the possibility of choice through expanded access to education, health, services, and employment among others. Nonetheless, there have been unequal advances and inequality persists in our region, all the goals were not met, the sexual and reproductive goals continue beyond the reach of many women (15). There is a long road ahead until women and girls of the world can claim their rights and liberty of deciding. Globally, maternal deaths have been reduced, there is more qualified assistance of births, more contraception prevalence, integral sexuality education, and access to SRH services for adolescents are now recognized rights with great advances, and additionally there have been concrete gains in terms of more favorable legal frameworks, particularly in our region; nonetheless, although it's true that the access condition have improved, the restrictive laws of the region expose the most vulnerable women to insecure abortions. There are great challenges for governments to recognize SRH and the DSR as integral parts of health systems, there is an ample agenda against women. In that sense, access to SRH is threatened and oppressed, it requires multi-sector mobilization and litigation strategies, investigation and support for the support of women's rights as a multi-sector agenda. Looking forward, we must make an effort to work more with youth to advance not only the Action Program of the ICPD, but also all social movements. They are one of the most vulnerable groups, and the biggest catalyzers for change. The young population still faces many challenges, especially women and girls; young girls are in particularly high risk due to lack of friendly and confidential services related with sexual and reproductive health, gender violence, and lack of access to services. In addition, access to abortion must be improved; it is the responsibility of states to guarantee the quality and security of this access. In our region there still exist countries with completely restrictive frameworks. New technologies facilitate self-care (16), which will allow expansion of universal access, but governments cannot detach themselves from their responsibility. Self-care is expanding in the world and can be strategic for reaching the most vulnerable populations. There are new challenges for the same problems, that require a re-interpretation of the measures necessary to guaranty the DSR of all people, in particular women, girls, and in general, marginalized and vulnerable populations. It is necessary to take into account migrations, climate change, the impact of digital media, the resurgence of hate discourse, oppression, violence, xenophobia, homo/transphobia, and other emergent problems, as SRH should be seen within a framework of justice, not isolated. We should demand accountability of the 179 governments that participate in the ICPD 25 years ago and the 193 countries that signed the Sustainable Development Objectives. They should reaffirm their commitments and expand their agenda to topics not considered at that time. Our region has given the world an example with the Agreement of Montevideo, that becomes a blueprint for achieving the action plan of the CIPD and we should not allow retreat. This agreement puts people at the center, especially women, and includes the topic of abortion, inviting the state to consider the possibility of legalizing it, which opens the doors for all governments of the world to recognize that women have the right to choose on maternity. This agreement is much more inclusive: Considering that the gaps in health continue to abound in the region and the average statistics hide the high levels of maternal mortality, of sexually transmitted diseases, of infection by HIV/AIDS, and the unsatisfied demand for contraception in the population that lives in poverty and rural areas, among indigenous communities, and afro-descendants and groups in conditions of vulnerability like women, adolescents and incapacitated people, it is agreed: 33- To promote, protect, and guarantee the health and the sexual and reproductive rights that contribute to the complete fulfillment of people and social justice in a society free of any form of discrimination and violence. 37- Guarantee universal access to quality sexual and reproductive health services, taking into consideration the specific needs of men and women, adolescents and young, LGBT people, older people and people with incapacity, paying particular attention to people in a condition of vulnerability and people who live in rural and remote zone, promoting citizen participation in the completing of these commitments. 42- To guarantee, in cases in which abortion is legal or decriminalized in the national legislation, the existence of safe and quality abortion for non-desired or non-accepted pregnancies and instigate the other States to consider the possibility of modifying public laws, norms, strategies, and public policy on the voluntary interruption of pregnancy to save the life and health of pregnant adolescent women, improving their quality of life and decreasing the number of abortions (17).
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Earlier this month, Democratic Texas congressman Henry Cuellar was indicted by the U.S. Department of Justice on charges of "bribery, unlawful foreign influence, and money laundering." The accusations revolve around a set of deals in which Cuellar allegedly accepted money from a state-owned Azerbaijani oil company and a Mexican bank in exchange for an agreement to push U.S. foreign policy in their favor.As concerning as this may be, it's not even the first such indictment against a sitting member of Congress this year. In March, Sen. Bob Menendez (D-N.J.) received a superseding indictment which expands further upon earlier accusations that the former Senate Foreign Relations Committee chairman took bribes to advocate on behalf of the Egyptian and Qatari governments. These cases make it clear that foreign bribery, in which representatives of one country pay money to manipulate the representatives of another, is still a serious problem in the United States. As the world's most powerful and interventionist nation, no other government has more influence over the rest of the world's affairs — influence which can be bought. The recent charges against Rep. Cuellar and Sen. Mendendez show how significant of a problem bribery and undue influence has been for the U.S. congress, while also drawing attention to the ongoing efforts to prevent this corruption from continuing.Bribes offered in exchange for political favors are nothing new in Congress. The first congressional bribery investigation on record took place in 1854, when a lobbyist attempted to bribe members of Congress into extending the patent for the Colt revolver handgun. The question of bribery across borders, however, did not receive much attention in Congress until fairly recently. Concerns about foreign bribery emerged most forcefully in the mid-1970s as a result of the Watergate investigation and the Church Committee, which investigated abuses by U.S. intelligence agencies. These investigations identified slush funds run by large companies that could be used for illegal political donations and undisclosed foreign payments, including several U.S.-based corporations with overseas operations. In the words of then-committee chairman Sen. Frank Church (D-Ida.), the Church Committee was "concerned with the foreign policy consequences of these payments by U.S.-based multinational corporations… It is no longer sufficient to simply sigh and say that is the way business is done. It is time to treat the issue for what it is: a serious foreign policy problem."There are two types of foreign bribery: attempts by foreign figures to bribe U.S. officials, and attempts by U.S. figures to bribe foreign officials. The Church Committee began by looking into the latter, focusing on political contributions that U.S.-based oil and defense companies had made abroad. What they found was shocking: oil companies were funding politicians in South Korea and Italy; Northrop was paying off a Saudi general; and Lockheed spent millions on bribes to foreign officials in Japan, the Netherlands, Indonesia, and more. Lockheed even sought to claim tax deductions for its bribes, a practice which was legal until 1975.These and other revelations caused major scandals abroad. Congress was rattled by the way that some countries reacted to the corruption, including the Peruvian government's expropriation of assets belonging to a corrupt U.S. oil company. Combined with the American public's disgust towards the corruption of the Watergate scandal, conditions were ripe for serious reform. In 1977, the Foreign Corrupt Practices Act (FCPA) was signed into law, making it illegal for U.S. citizens to bribe foreign officials. Until this rule was turned into a treaty 20 years later, the U.S. was alone in the world in adopting this form of anti-corruption policy.For much of the U.S.'s history, political corruption was both common and partially normalized, explained away as a necessity to achieve political and business goals. When a corrupt middleman helping U.S. weapons companies make deals in Saudi Arabia explained his role to Pentagon officials in 1973, one official present described the activities as "an inexpensive economic aid program." It was the fallout from Watergate and the Church Committee that turned bribery into a proper taboo. This sharp cultural change caught some off guard: one key Lockheed executive who was ejected from the company due to the bribery scandal complained that "all of a sudden, there's a different set of standards… I looked at these payments as necessary to sell a product. I never felt I was doing anything wrong." The public's attention next turned to the flip side of foreign bribery: foreign representatives paying off U.S. officials. While the FCPA criminalized foreign bribery committed by U.S. citizens, it did not fully criminalize foreign bribery aimed at U.S. citizens. New investigations into bribes directed at members of the U.S. congress helped to demonstrate the scale of this issue.In the "Koreagate" scandal of the late 1970s, a well-connected South Korean businessman offered bribes to U.S. members of Congress in exchange for favorable treatment of the nation's dictatorship. Many lawmakers were implicated, and one was sent to jail. Congress launched investigations into alleged bribery campaigns by Iranian and South African officials in 1979 and 1980, respectively, but ultimately found "no evidence of intentional misconduct." Little did they know that something much larger was brewing beneath the surface.In 1980, NBC News revealed that the Federal Bureau of Investigation had conducted a large-scale sting operation against corrupt politicians. "Abscam," short for "Arab scam," involved FBI agents posing as the agents of a wealthy Middle Eastern sheikh and offering bribes to seven members of Congress, all of whom were eventually convicted. This investigation, controversial for the use of tactics which many might consider entrapment, formed the basis of the 2013 comedy film "American Hustle."Abscam was the last major entry in this burst of investigations, but new scandals continued to emerge over the years. After congressman Jay Kim (R-Cal.) narrowly won his 1992 reelection campaign, it was revealed that more than a third of his campaign contributions were illegal, including money with its origins in South Korea and Taiwan. Five years later, Rep. Corrine Brown (D-Fla.) pressured Turkemenistan's ambassador to the U.S. on behalf of a Florida-based company seeking a natural gas deal with the country; the same company had previously paid for her trips overseas. She also was accused of accepting a car from a Malian businessman as a gift for her daughter.The next large scandal came in the form of congressman William J. Jefferson (D-La.), who was convicted of a litany of crimes in 2009. Jefferson accepted large bribes from U.S. companies in exchange for promoting their business interests across western Africa. He was finally caught after accepting a $100,000 cash bribe from a woman who instructed him to pass it on to the vice president of Nigeria. What he didn't know was that the woman was an FBI asset wearing a wire; the Bureau raided his Capitol Hill apartment days later.These issues have continued into the 2020s, even before the bombshell indictments of Rep. Cuellar and Sen. Menendez. In 2022, congressman Jeff Fortenberry (R-Neb.) was convicted of lying to the FBI about illegal campaign money which originated from a Nigerian billionaire. His conviction was later reversed on technical grounds, but new charges were filed against him earlier this month.Recent efforts have helped to strengthen U.S. laws against foreign bribery. President Biden signed the Foreign Extortion Prevention Act into law late last year, making it illegal for foreign officials to demand or accept bribes from U.S. citizens. This reform directly addresses the "demand side" of the bribery issue which the FCPA left untouched. In addition, the Securities and Exchange Commission has stepped up its enforcement of the FCPA ever since creating a "specialized unit" to enforce the law in 2010. However, there is more that can be done to strengthen the law. For example, Congress could repeal the 1988 amendment to the law which creates an exception for "facilitating or expediting payments."Other reforms can help in fighting corruption. Congressional ethics committees need to be strengthened in order to identify and address ethics violations more quickly. Stronger enforcement of the Foreign Agents Registration Act could make it harder for middlemen acting as agents of foreign governments to hide in the shadows.Members of Congress must also have a zero tolerance policy for their colleagues who are caught engaging in foreign bribery. Senator Menendez has already faced calls for resignation from the majority of senators from his own party; although he gave up his leadership role on the Senate Foreign Relations Committee, he continues to cling to office. Rep. Cuellar, on the other hand, has faced little opposition from his Democratic colleagues so far.Finally, these scandals should lead Washington to reconsider U.S. foreign policy more generally. The United States frequently intervenes in the affairs of other nations, even in contexts where it makes little sense. Members of Congress can use this global reach to line their own pockets; simultaneously, this same power makes them prime targets for foreign interests who wish to manipulate the way that the United States interacts with the rest of the world. A foreign policy that turns away from coercive interventionism while still encouraging international cooperation would provide fewer opportunities for foreign bribery to occur in the first place.U.S. foreign policy should be dictated by the interests of the American people, not the personal financial interests of politicians, wealthy businessmen, and foreign governments. The cases of Rep. Cuellar and Sen. Menendez are only the most recent in a substantial history of such behavior. To fix U.S. foreign policy, we need to clean up Congress and put an end to foreign bribery.
La investigación aborda desde un enfoque de derechos humanos y de género, el proceso de liderazgo seguido por las mujeres en la organización social. Analiza su precaria incorporación a la Población Económicamente Activa (PEA) y su posterior integración al movimiento sindical más representativo del país como es la Confederación General de Trabajadores del Perú (CGTP). El trabajo analiza 16 años de vida orgánica de la CGTP, visibilizando la flexibilización laboral de los años 90, que provoca despidos masivos de trabajadores y trabajadoras, donde las mujeres se incorporan como nuevas actoras en el campo del trabajo. Pero que no resuelve la desigualdad laboral entre las mujeres y los hombres sino que la acrecienta convirtiendo a las mujeres en mano de obra barata, confinándola a condiciones laborales precarias, en un contexto donde la demanda fundamental como es la estabilidad laboral es puesta en peligro. La investigación observa como la reforma laboral del gobierno de Alberto Fujimori marca el retroceso de un Estado que abdica de su papel regulador y fiscalizador y que más bien despoja a los trabajadores de sus derechos laborales fundamentales. Señalando como un hito trágico el asesinato de Pedro Huilca Tecse por el grupo Colina el 18 de diciembre de 1992, a nueve meses de haber sido elegido secretario general de la CGTP. Situación y hechos que considera influyen en el debilitamiento de la confederación, reflejada en la disminución de sus afiliados, que en la década previa a los años noventa era de 21.9 % y que entre 1995 y 2006 disminuye a 8 % y 5 %. La tesis toma en cuenta que en el 2003 bajo la dirección de Juan José Gorriti, siendo responsable Susan Portocarrero de la secretaría de la mujer y defensa del niño trabajador, se registran hechos importantes con relación a la participación cualitativa y cuantitativa de las mujeres. Proceso que es fortalecido por la reestructuración orgánica de la central, donde las secretarías se transforman en departamentos sindicales y en el que también se implementa la afiliación sindical directa. En este contexto, la secretaría de la mujer y defensa del niño trabajador, elabora su Manual de Organización y Funciones y la I Plataforma Laboral de Género y los presenta al XII Congreso Nacional de la CGTP en noviembre de 2006. Donde siete mujeres son incorporadas al consejo directivo nacional. Y que elige después de 78 años de vida orgánica a Carmela Sifuentes Inostroza como la primera presidenta mujer de su historia y a Gloria Pérez Saavedra como secretaria de la mujer. Durante el análisis se resalta que con una CGTP reconstituida y con un nuevo discurso centrado en la recuperación de la democracia y los derechos perdidos, el trabajo de la mujer adquiere mayor presencia a través del acciones del reestructurado departamento de la mujer, que consigue incorporar a más mujeres en sus comisiones de trabajo, elabora los sustentos teóricos y políticos de la estrategia de transversalización del enfoque de género, que logra más mujeres con un discurso argumentado, que disponen de herramientas como la escuela sindical para mujeres y también mixtas para hombres y mujeres con este enfoque, donde se visibiliza la importancia de una afiliación sindical con esta visión. Logrando que sus derechos y los de otras mujeres de los sectores más precarios del ámbito laboral, se incluyan como temas específicos en los pliegos y convenios colectivos a través de la Agenda Laboral de las Mujeres Trabajadoras, lo que dinamiza la participación de más mujeres en todas las instancias de la CGTP, particularmente en sus asambleas nacionales. La investigación valora como factores decisivos que contribuyen a la inclusión de la Agenda de Género dentro de la CGTP, las acciones realizadas por las mujeres del consejo nacional, por las del departamento de la mujer y por sus comisiones de trabajo, así como por el apoyo recibido de parte del secretariado ejecutivo. Todo lo cual permite que en noviembre de 2011 presenten al XIII Congreso Nacional Ordinario la moción de Cuota de Género sustentada por la responsable del departamento. La misma que pese a requerir la reforma de los estatutos, se aprueba en la Comisión No.4: Situación Orgánica y Fortalecimiento de la CGTP, ratificada por la plenaria y que está pendiente de ser revalidada por un congreso estatutario. La investigación concluye en que estos 16 años de la CGTP marcan la promoción, negociación y aprobación de acciones afirmativas inspiradas en el modelo sindical europeo13, adaptadas al modelo peruano y a los intereses colectivos de las mujeres trabajadoras. Y que a partir de 2011 comienza una nueva historia para el movimiento sindical de la CGTP sobre este tema. ; --- The Women's Leadership in organizations such as the Trade Union's, is analyzed from the perspective of human rights and gender in the present investigation. Since its intervention in the workplace: the precarious action and its subsequent integration into the most representative trade union movement in the country, such as the General Confederation of Workers of Peru - CGTP. We traveled through 16 years of the organic life of the CGTP, making visible the labor reform of the 90's that marks the start of labor flexibility, causing massive layoffs of workers and secondly incorporating more strongly to new actors to the world Labour: Women. This addition does not respond to public policy to equip participation and working conditions of women and men in this area and therefore bridge the gaps that support discrimination; This situation reflects the demand for cheap labor in poor working conditions, backed by labor unrest, thus losing the main feature of unionized workers or workers / as: "Job Stability." The labor reform of A. Fujimori government marks the beginning of the retreat of the state not only in its role as regulator, but also to oversight of compliance with labor standards as part of the same government specifically the December 18, 1992, nine months into the General Secretariat, Peter Huilca was killed by the Colina group, both heavy blows to the unions originate the weakening of the most visible of the Country confederation, this is reflected in the declining share of national affiliation in the decade before the nineties was approximately 21.9% and between 1995 and 2006% the percentage fluctuated between 8% and 5%. In 2003, under the direction of Juan José Gorriti, important findings were made in relation to the qualitative and quantitative participation of women, the responsibility of the Ministry of Women and Child Worker fell on Susan Portocarrero. In that same year, the organizational restructuring process starts, from Secretaries to Departments and Trade also implementing direct affiliation. The Ministry of Women and Child Workers, adopted its Manual of Organization and Functions and the First Labour Platform Gender, which was taken to the XII Congress of the CGTP in November 2006, where 7 women join the National Executive Council, and after 78 years of organic life, the first female president is elected in its history; it also chooses Gloria Perez Saavedra as the new Secretary for women, and it is from this year that the CGTP reconstituted and a new discourse centered on the struggle for restoration of democracy and rights lost, becomes more incident now called the women's Department of the CGTP, calling women on the commission structure work. Begin the theoretical and political underpinnings for developing strategy mainstreaming gender in CGTP, which translates into: women with a speech argued; tools such as union school for women and mixed for men and women develop the gender issue; visible the importance of union membership with gender; building proposals for collective bargaining rights for women in the specifications and detailed collective agreements on a work schedule of working women; promoting the participation of more women in the functional activities organized by the CGTP as National Assemblies; promoting the union agenda includes those most precarious sectors of the workplace, which are mostly made up of women. The development of planned and promoted by the women of the CN of the CGTP and the department including its working committees, had the political backing of the national leadership represented by the executive secretariat actions, so that in November 2011, arriving at XIII National Ordinary Congress proposing as its core proposal "gender quota" involving the reform of its statutes, this proposal was presented as a motion supported by the head of department and approved by the Commission number four: "Organic status and Strengthening CGTP "and later in the plenary, being willing to be ratified in the Statutory Congress. They were 16 years leading the most representative trade union confederation in the country, focusing on promotion, negotiation and approval of affirmative action that inspired the European union model applied to the Peruvian model. In these periods the collective interests of many working women is one of the main reasons for the trade union movement there were more important. From the year 2011 begins a new story written for the motion of the CGTP union on this issue. ; Tesis
La investigación aborda desde un enfoque de derechos humanos y de género, el proceso de liderazgo seguido por las mujeres en la organización social. Analiza su precaria incorporación a la Población Económicamente Activa (PEA) y su posterior integración al movimiento sindical más representativo del país como es la Confederación General de Trabajadores del Perú (CGTP). El trabajo analiza 16 años de vida orgánica de la CGTP, visibilizando la flexibilización laboral de los años 90, que provoca despidos masivos de trabajadores y trabajadoras, donde las mujeres se incorporan como nuevas actoras en el campo del trabajo. Pero que no resuelve la desigualdad laboral entre las mujeres y los hombres sino que la acrecienta convirtiendo a las mujeres en mano de obra barata, confinándola a condiciones laborales precarias, en un contexto donde la demanda fundamental como es la estabilidad laboral es puesta en peligro. La investigación observa como la reforma laboral del gobierno de Alberto Fujimori marca el retroceso de un Estado que abdica de su papel regulador y fiscalizador y que más bien despoja a los trabajadores de sus derechos laborales fundamentales. Señalando como un hito trágico el asesinato de Pedro Huilca Tecse por el grupo Colina el 18 de diciembre de 1992, a nueve meses de haber sido elegido secretario general de la CGTP. Situación y hechos que considera influyen en el debilitamiento de la confederación, reflejada en la disminución de sus afiliados, que en la década previa a los años noventa era de 21.9 % y que entre 1995 y 2006 disminuye a 8 % y 5 %. La tesis toma en cuenta que en el 2003 bajo la dirección de Juan José Gorriti, siendo responsable Susan Portocarrero de la secretaría de la mujer y defensa del niño trabajador, se registran hechos importantes con relación a la participación cualitativa y cuantitativa de las mujeres. Proceso que es fortalecido por la reestructuración orgánica de la central, donde las secretarías se transforman en departamentos sindicales y en el que también se implementa la afiliación sindical directa. En este contexto, la secretaría de la mujer y defensa del niño trabajador, elabora su Manual de Organización y Funciones y la I Plataforma Laboral de Género y los presenta al XII Congreso Nacional de la CGTP en noviembre de 2006. Donde siete mujeres son incorporadas al consejo directivo nacional. Y que elige después de 78 años de vida orgánica a Carmela Sifuentes Inostroza como la primera presidenta mujer de su historia y a Gloria Pérez Saavedra como secretaria de la mujer. Durante el análisis se resalta que con una CGTP reconstituida y con un nuevo discurso centrado en la recuperación de la democracia y los derechos perdidos, el trabajo de la mujer adquiere mayor presencia a través del acciones del reestructurado departamento de la mujer, que consigue incorporar a más mujeres en sus comisiones de trabajo, elabora los sustentos teóricos y políticos de la estrategia de transversalización del enfoque de género, que logra más mujeres con un discurso argumentado, que disponen de herramientas como la escuela sindical para mujeres y también mixtas para hombres y mujeres con este enfoque, donde se visibiliza la importancia de una afiliación sindical con esta visión. Logrando que sus derechos y los de otras mujeres de los sectores más precarios del ámbito laboral, se incluyan como temas específicos en los pliegos y convenios colectivos a través de la Agenda Laboral de las Mujeres Trabajadoras, lo que dinamiza la participación de más mujeres en todas las instancias de la CGTP, particularmente en sus asambleas nacionales. La investigación valora como factores decisivos que contribuyen a la inclusión de la Agenda de Género dentro de la CGTP, las acciones realizadas por las mujeres del consejo nacional, por las del departamento de la mujer y por sus comisiones de trabajo, así como por el apoyo recibido de parte del secretariado ejecutivo. Todo lo cual permite que en noviembre de 2011 presenten al XIII Congreso Nacional Ordinario la moción de Cuota de Género sustentada por la responsable del departamento. La misma que pese a requerir la reforma de los estatutos, se aprueba en la Comisión No.4: Situación Orgánica y Fortalecimiento de la CGTP, ratificada por la plenaria y que está pendiente de ser revalidada por un congreso estatutario. La investigación concluye en que estos 16 años de la CGTP marcan la promoción, negociación y aprobación de acciones afirmativas inspiradas en el modelo sindical europeo13, adaptadas al modelo peruano y a los intereses colectivos de las mujeres trabajadoras. Y que a partir de 2011 comienza una nueva historia para el movimiento sindical de la CGTP sobre este tema. ; --- The Women's Leadership in organizations such as the Trade Union's, is analyzed from the perspective of human rights and gender in the present investigation. Since its intervention in the workplace: the precarious action and its subsequent integration into the most representative trade union movement in the country, such as the General Confederation of Workers of Peru - CGTP. We traveled through 16 years of the organic life of the CGTP, making visible the labor reform of the 90's that marks the start of labor flexibility, causing massive layoffs of workers and secondly incorporating more strongly to new actors to the world Labour: Women. This addition does not respond to public policy to equip participation and working conditions of women and men in this area and therefore bridge the gaps that support discrimination; This situation reflects the demand for cheap labor in poor working conditions, backed by labor unrest, thus losing the main feature of unionized workers or workers / as: "Job Stability." The labor reform of A. Fujimori government marks the beginning of the retreat of the state not only in its role as regulator, but also to oversight of compliance with labor standards as part of the same government specifically the December 18, 1992, nine months into the General Secretariat, Peter Huilca was killed by the Colina group, both heavy blows to the unions originate the weakening of the most visible of the Country confederation, this is reflected in the declining share of national affiliation in the decade before the nineties was approximately 21.9% and between 1995 and 2006% the percentage fluctuated between 8% and 5%. In 2003, under the direction of Juan José Gorriti, important findings were made in relation to the qualitative and quantitative participation of women, the responsibility of the Ministry of Women and Child Worker fell on Susan Portocarrero. In that same year, the organizational restructuring process starts, from Secretaries to Departments and Trade also implementing direct affiliation. The Ministry of Women and Child Workers, adopted its Manual of Organization and Functions and the First Labour Platform Gender, which was taken to the XII Congress of the CGTP in November 2006, where 7 women join the National Executive Council, and after 78 years of organic life, the first female president is elected in its history; it also chooses Gloria Perez Saavedra as the new Secretary for women, and it is from this year that the CGTP reconstituted and a new discourse centered on the struggle for restoration of democracy and rights lost, becomes more incident now called the women's Department of the CGTP, calling women on the commission structure work. Begin the theoretical and political underpinnings for developing strategy mainstreaming gender in CGTP, which translates into: women with a speech argued; tools such as union school for women and mixed for men and women develop the gender issue; visible the importance of union membership with gender; building proposals for collective bargaining rights for women in the specifications and detailed collective agreements on a work schedule of working women; promoting the participation of more women in the functional activities organized by the CGTP as National Assemblies; promoting the union agenda includes those most precarious sectors of the workplace, which are mostly made up of women. The development of planned and promoted by the women of the CN of the CGTP and the department including its working committees, had the political backing of the national leadership represented by the executive secretariat actions, so that in November 2011, arriving at XIII National Ordinary Congress proposing as its core proposal "gender quota" involving the reform of its statutes, this proposal was presented as a motion supported by the head of department and approved by the Commission number four: "Organic status and Strengthening CGTP "and later in the plenary, being willing to be ratified in the Statutory Congress. They were 16 years leading the most representative trade union confederation in the country, focusing on promotion, negotiation and approval of affirmative action that inspired the European union model applied to the Peruvian model. In these periods the collective interests of many working women is one of the main reasons for the trade union movement there were more important. From the year 2011 begins a new story written for the motion of the CGTP union on this issue. ; Tesis
AIMS: To examine cross-national patterns of 12-month substance use disorder (SUD) treatment and minimally adequate treatment (MAT), and associations with mental disorder comorbidity. DESIGN: Cross-sectional, representative household surveys. SETTING: Twenty-seven surveys from 25 countries of the WHO World Mental Health Survey Initiative. PARTICIPANTS: A total of 2446 people with past-year DSM-IV SUD diagnoses (alcohol or illicit drug abuse and dependence). MEASUREMENTS: Outcomes were SUD treatment, defined as having either received professional treatment or attended a self-help group for substance-related problems in the past 12 months, and MAT, defined as having either four or more SUD treatment visits to a health-care professional, six or more visits to a non-health-care professional or being in ongoing treatment at the time of interview. Covariates were mental disorder comorbidity and several socio-economic characteristics. Pooled estimates reflect country sample sizes rather than population sizes. FINDINGS: Of respondents with past-year SUD, 11.0% [standard error (SE) = 0.8] received past 12-month SUD treatment. SUD treatment was more common among people with comorbid mental disorders than with pure SUDs (18.1%, SE = 1.6 versus 6.8%, SE = 0.7), as was MAT (84.0%, SE = 2.5 versus 68.3%, SE = 3.8) and treatment by health-care professionals (88.9%, SE = 1.9 versus 78.8%, SE = 3.0) among treated SUD cases. Adjusting for socio-economic characteristics, mental disorder comorbidity doubled the odds of SUD treatment [odds ratio (OR) = 2.34; 95% confidence interval (CI) = 1.71-3.20], MAT among SUD cases (OR = 2.75; 95% CI = 1.90-3.97) and MAT among treated cases (OR = 2.48; 95% CI = 1.23-5.02). Patterns were similar within country income groups, although the proportions receiving SUD treatment and MAT were higher in high- than low-/middle-income countries. CONCLUSIONS: Few people with past-year substance use disorders receive adequate 12-month substance use disorder treatment, even when comorbid with a mental disorder. This is largely due to the low proportion of people receiving any substance use disorder treatment, as the proportion of patients whose treatment is at least minimally adequate is high. ; The World Health Organization World Mental Health (WMH) Survey Initiative is supported by the United States National Institute of Mental Health (NIMH; R01 MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the United States Public Health Service (R13‐MH066849, R01‐MH069864 and R01 DA016558), the Fogarty International Center (FIRCA R03‐TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho‐McNeil Pharmaceutical Inc., GlaxoSmithKline, and Bristol‐Myers Squibb. We thank the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork and consultation on data analysis. None of the funders had any role in the design, analysis, interpretation of results, or preparation of this paper. The views and opinions expressed in this report are those of the authors and should not be construed to represent the views of the World Health Organization, other sponsoring organizations, agencies, or governments , and do not necessarily represent the views, official policy or position of the US Department of Health and Human Services or any of its affiliated institutions or agencies. M.D.G.'s role in this study is through his involvement as a Science Officer on U01‐MH60220. He had no involvement in the other cited grants. The 2007 Australian National Survey of Mental Health and Wellbeing is funded by the Australian Government Department of Health and Ageing. The Argentina survey—Estudio Argentino de Epidemiología en Salud Mental (EASM)—was supported by a grant from the Argentinian Ministry of Health (Ministerio de Salud de la Nación). The São Paulo Megacity Mental Health Survey is supported by the State of São Paulo Research Foundation (FAPESP) Thematic Project Grant 03/00204–3. The Bulgarian Epidemiological Study of common mental disorders EPIBUL is supported by the Ministry of Health and the National Center for Public Health Protection. The Chinese World Mental Health Survey Initiative is supported by the Pfizer Foundation. The Colombian National Study of Mental Health (NSMH) is supported by the Ministry of Social Protection. The Mental Health Study Medellín—Colombia was carried out and supported jointly by the Center for Excellence on Research in Mental Health (CES University) and the Secretary of Health of Medellín. The ESEMeD project is funded by the European Commission [Contracts QLG5–1999‐01042; SANCO 2004123, and EAHC 20081308) (the Piedmont Region (Italy)], Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAF 2000–158‐CE), Generalitat de Catalunya (2017 SGR 452; 2014 SGR 748), Instituto de Salud Carlos III (CIBER CB06/02/0046, RETICS RD06/0011 REM‐TAP) and other local agencies and by an unrestricted educational grant from GlaxoSmithKline. Implementation of the Iraq Mental Health Survey (IMHS) and data entry were carried out by the staff of the Iraqi MOH and MOP with direct support from the Iraqi IMHS team with funding from both the Japanese and European Funds through the United Nations Development Group Iraq Trust Fund (UNDG ITF). The Israel National Health Survey is funded by the Ministry of Health with support from the Israel National Institute for Health Policy and Health Services Research and the National Insurance Institute of Israel. The World Mental Health Japan (WMHJ) Survey is supported by the Grant for Research on Psychiatric and Neurological Diseases and Mental Health (H13‐SHOGAI‐023, H14‐TOKUBETSU‐026, H16‐KOKORO‐013, H25‐SEISHIN‐IPPAN‐006) from the Japan Ministry of Health, Labour and Welfare. The Lebanese Evaluation of the Burden of Ailments and Needs Of the Nation (L.E.B.A.N.O.N.) is supported by the Lebanese Ministry of Public Health, the WHO (Lebanon), National Institute of Health/Fogarty International Center (R03 TW006481–01), anonymous private donations to IDRAAC, Lebanon and unrestricted grants from Algorithm, AstraZeneca, Benta, Bella Pharma, Eli Lilly, Glaxo Smith Kline, Lundbeck, Novartis, OmniPharma, Pfizer, Phenicia, Servier and UPO. The Mexican National Comorbidity Survey (MNCS) is supported by The National Institute of Psychiatry Ramon de la Fuente (INPRFMDIES 4280) and by the National Council on Science and Technology (CONACyT‐G30544‐ H), with supplemental support from the Pan American Health Organization (PAHO). Te Rau Hinengaro: the New Zealand Mental Health Survey (NZMHS) is supported by the New Zealand Ministry of Health, Alcohol Advisory Council, and the Health Research Council. The Nigerian Survey of Mental Health and Wellbeing (NSMHW) is supported by the WHO (Geneva), the WHO (Nigeria) and the Federal Ministry of Health, Abuja, Nigeria. The Northern Ireland Study of Mental Health was funded by the Health and Social Care Research and Development Division of the Public Health Agency. The Peruvian World Mental Health Study was funded by the National Institute of Health of the Ministry of Health of Peru. The Polish project Epidemiology of Mental Health and Access to Care—EZOP Project (PL 0256) was supported by Iceland, Liechtenstein and Norway through funding from the EEA Financial Mechanism and the Norwegian Financial Mechanism. The EZOP project was co‐financed by the Polish Ministry of Health. The Portuguese Mental Health Study was carried out by the Department of Mental Health, Faculty of Medical Sciences, NOVA University of Lisbon, with the collaboration of the Portuguese Catholic University, and was funded by Champalimaud Foundation, Gulbenkian Foundation, Foundation for Science and Technology (FCT) and Ministry of Health. The Romania WMH study projects 'Policies in Mental Health Area' and 'National Study regarding Mental Health and Services Use' were carried out by National School of Public Health and Health Services Management (former National Institute for Research and Development in Health), with technical support from Metro Media Transilvania, the National Institute of Statistics–National Centre for Training in Statistics, SC, Cheyenne Services SRL, Statistics Netherlands and were funded by Ministry of Public Health (former Ministry of Health) with supplemental support of Eli Lilly Romania SRL. The Psychiatric Enquiry to General Population in Southeast Spain—Murcia (PEGASUS–Murcia) Project has been financed by the Regional Health Authorities of Murcia (Servicio Murciano de Salud and Consejería de Sanidad y Política Social) and Fundación para la Formación e Investigación Sanitarias (FFIS) of Murcia. The US National Comorbidity Survey Replication (NCS‐R) is supported by the National Institute of Mental Health (NIMH; U01‐MH60220) with supplemental support from the National Institute of Drug Abuse (NIDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Robert Wood Johnson Foundation (RWJF; Grant 044708) and the John W. Alden Trust. J.M. is supported by NHMRC Project grants (APP 1007677, APP 1099709) and a John Cade Fellowship (APP1056929). J.M. was supported by a Niels Bohr Professorship from the Danish National Research Foundation. L.D. is supported by an NHMRC Senior Principal Research Fellowship (no. 1135991) and NIDA NIH grant R01 DA044170‐02. L.D. and C.B. are supported by an Australian National Health and Medical Research Council (NHMRC) project grant (no. 1081984). NDARC is supported by funding from the Australian Government Department of Health under the Drug and Alcohol Program. A complete list of all within‐country and cross‐national WMH publications can be found at http://www.hcp.med.harvard.edu/wmh/.
