Suchergebnisse

La epidemiología ocupa ya un papel relevante en la definición de políticas públicas y corporativas, tanto en España como en otros países desarrollados, especialmente en los últimos años, en que como consecuencia de la entronización por la Organización Mundial de la Salud de la noción de determinantes sociales de la salud, la conexión entre la salud y lo construido socialmente se ha hecho más evidente. El uso de la epidemiología, sin embargo, suele verse restringido al desarrollo y la evaluación de políticas originadas en burocracias sanitarias y con la mejora de la salud como único objetivo social; son las llamadas políticas directas de salud. Esto supone una visión reduccionista del tema, ya que la salud se gana y se pierde por políticas extrasanitarias primordialmente. Para ampliar el papel de la epidemiología como herramienta para las políticas, necesitaríamos tener una visión de las exposiciones y los efectos más allá de la esfera sanitaria y de los factores de riesgo –biológicos y conductuales– propuestos por el paternalismo médico. Hay que tener una actitud más participativa que prescriptiva, desarrollar más estudios de evaluación del impacto en salud y empezar a valorar también el efecto sobre la salud de las decisiones de las instituciones que derivan del poder político. Es decir, construir una epidemiología política. Para esta tarea, quizás clave para desarrollar la salud pública que necesitamos, los salubristas deberían ser más visibles y más creíbles, tender más a la independencia del poder político, y suministrar información directamente a la población y otros interesados (transparencia), desarrollando su profesionalización plena (competencia) más como redes de profesionales que como pirámides burocráticas. ; Epidemiology already plays a substantial role in the definition of public and corporate policies in Spain as well as in other developed countries. The World Health Organization reinforced the position of epidemiology by enshrining the notion of social health determinants and, as a result, the connection between health and social constructs has become more visible. However, the use of epidemiology is usually restricted to the development and evaluation of policies originating in health bureaucracies with health improvement as the only public objective; these are called direct health policies. This view is somewhat reductionistic insofar as health gains and losses occur mainly due to policies outside the health sector. To expand the role of epidemiology as a tool to shape policies, we need a view of exposures and effects beyond healthcare and the biological and behavioral risk factors proposed by medical paternalism. Also required are an attitude that is more participative than prescriptive and the development of more health impact assessments. In addition, the health effects of the decisions taken by politically-empowered institutions should be included in the epidemiologist's tool kit. In other words, a political epidemiology should be constructed. For this endeavor, which may be crucial to attain the public health required, public health practitioners should be more visible and credible, have greater independence from political power, provide information directly to the public and other stake holders (greater transparency), and further develop the professionalization of public health (greater competence) by working increasingly in networks of professionals rather than in bureaucratic pyramids.

This article comes from the intense international pressure that follows a near-catastrophy, such as the human influenza A H1N1 epidemic, and the limited resources for confronting such events. The analysis covers prevailing 20th century trends in the international public health arena and the change-induced challenges brought on by globalization, the transition set in motion by what has been deemed the "new" international public health and an ever-increasing focus on global health, in the context of an international scenario of shifting risks and opportunities and a growing number of multinational players. Global public health is defined as a public right, based on a new appreciation of the public, a new paradigm centered on human rights, and altruistic philosophy, politics, and ethics that undergird the changes in international public health on at least three fronts: redefining its theoretical foundation, improving world health, and renewing the international public health system, all of which is the byproduct of a new form of governance. A new world health system, directed by new global public institutions, would aim to make public health a global public right and face a variety of staggering challenges, such as working on public policy management on a global scale, renewing and democratizing the current global governing structure, and conquering the limits and weaknesses witnessed by international health.

Los derechos humanos perfilan de mejor manera el escenario para las políticas públicas en salud, siguiendo un enfoque intersectorial e interdisciplinario. Este artículo hace hincapié en la perspectiva de las políticas públicas en salud, basada en los derechos humanos, aclara la relación de las políticas públicas con el ejercicio de los derechos humanos, más allá del derecho a la salud, y reconoce la necesidad de implementar mecanismos participativos y genuinamente democráticos. Considera la Declaración Universal de los Derechos Humanos y otras expresiones institucionales como el Pacto Internacional por los Derechos Económicos, Sociales y Culturales. Debate la jerarquización de éstos y defiende su integralidad en torno a los determinantes de la salud y su cohesión mediante el factor político. Se constituye un marco de actuación en salud pública y derechos humanos que propende por el afianzamiento de los derechos sociales y define algunas líneas de acción, basadas en las políticas públicas para enfrentar los determinantes de la salud. Defiende la justicia social y trasciende la esfera sanitaria y los factores de riesgo biológicos y conductuales hacia las decisiones derivadas del poder político, rebasando las soluciones médicas y de acceso a servicios. En conclusión, promueve el respeto de los derechos humanos mediante una mayor comprensión de éstos, refuerza la importancia de las políticas indirectas en salud (alimentos, medioambiente y salud, violencia de género, entre otras) y el papel de las políticas internacionales en la globalidad. ; Human rights outlined a better scenario for public policies in health. For it requires intersectoral and interdisciplinary approach. This article emphasizes the perspective of public health policies based on human rights, clarifies the relationship of public policies with the exercise of human rights, beyond the right to health. It recognizes the need to implement genuinely democratic and participatory mechanisms. It considers the universal declaration of human rights and other institutional expressions about the same as the international covenant on economic, social and cultural rights, discusses the ranking of the same and defend its entirety on the determinants of health through its cohesion and political factor. It defines a framework for public health and human rights that trend by strengthening social rights, as a new area of operation, based on public policies to address the determinants of health, upholding social justice, beyond the health field and the biological and behavioural risk factors to decisions arising from political power, exceeds medical solutions and access to health services. In conclusion, it promoting respect for human rights by greater understanding of them and strengthens the importance of indirect health policies (such as food, environment and health, violence gender) and the role of international policies in the global world.

Objectives: The fall of the Wall in 1989 can be seen as a natural experiment in the epidemiological sense to further examine the relation between democracy and health. Design and setting: Ecological study in the 23 post-communist countries, during the last decade of the 20th century, exploring the relations between the level of democratisation and health, taking into account as relevant confounders wealth and the level of inequality. Main results: A significant correlation (p,0.01) was found of the democratic deficit of the countries with the health indicators circa 2000, with values of Pearson's coefficient of 20.629 for life expectancy, 0.760 for infant mortality, and 0.555 for maternal mortality. These associations remain significant after adjustment by lineal regression for GNP per capita and the Gini coefficient, with R2 values of 0.336 for life expectancy, 0.575 for infant mortality, and 0.529 for maternal mortality. Conclusions: These findings add pieces of evidence to the previously reported cross sectional association between democracy and health. ; Observatory of Public Policies and Health (OPPS)

Although no systematic causal review has yet been done, the evidence of a relation between democracy and health is increasingly convincing. In The Lancet Global Health, Hannah Pieters and colleagues report a an innovatively designed study and a novel application of the synthetic control method to investigate the issue of democracy and infant mortality. They investigated whether political transition into democracy that had lasted for at least 10 years affected child mortality, as a proxy for health. Among 24 countries with good counterfactuals, changes in 15 were not significant but nine (38%) showed significant reductions in infant mortality after democratisation. Among these nine countries the average reduction was 13%. Interestingly, the effect increased over time, suggesting that there is an induction period for change while services and organisation are improved. Of note was that the benefits of democratisation increased with increasing child mortality before political change.

Debido a la importancia económica del sector servicios y a su potencial comercial, en 1995 entró en vigor el Acuerdo General sobre el Comercio de Servicios (AGCS) de la Organización Mundial del Comercio (OMC), cuyos objetivos son liberalizar el comercio de servicios y establecer las normas y disciplinas que lo rijan. Sin embargo, hasta el momento el acuerdo ha generado poca jurisprudencia sobre sus normas, y algunas de ellas están en proceso de elaboración, lo que le da un carácter ambiguo a la vez que dificulta precisar sus implicaciones. No obstante, algunos analistas consideran que ciertas características y disposiciones representarían una amenaza a los mecanismos de financiación de los servicios públicos, así como a la autonomía reglamentaria gubernamental. Además, el acuerdo llevaría a la formalización de compromisos de carácter irreversible, que impedirían el restablecimiento de condiciones previas, en caso de que fallasen los sistemas de mercado y la participación privada; por otra parte, estaría en oposición a los monopolios y proveedores exclusivos y, en cierto grado, afectaría a los subsidios de los proveedores locales. La capacidad del Tribunal de Justicia de las Comunidades Europeas para forzar la implementación de medidas competitivas en los servicios públicos genera incertidumbre por sus implicaciones para los sistemas sanitarios. El acuerdo de España con la OMC tiene muchos aspectos aún por consolidar, lo que abre una oportunidad política para el debate y la participación desde el sector salud en sucesivas rondas de negociación. ; Due to the economic importance of the service sector and its trade potential, in 1995 the World Trade Organization (WTO) launched the General Agreement on Trade in Services with the objective of liberalizing trade in services worldwide and of establishing rules and disciplines to regulate it. Until now, the Agreement has produced few case laws on its rules and some of them are in the process of being developed, which makes the Agreement ambiguous and hampers accurate forecasting of its implications. Nevertheless, some analysts consider that certain characteristics and rules represent a threat to the funding mechanisms of public services and to the sovereignty of governments to generate their own rules. Moreover, the Agreement would lead to irreversible formalization of commitments, without the possibility of returning to previous conditions in the case of failure of the market and/or private participation. In addition, the Agreement acts against exclusive monopolies and providers and to a certain extent this will affect subsidies to local providers. The ability of the European Communities Court of Justice to enforce the implementation of competitive measures in public services has produced uncertainty because of the implications for health services. The Spanish Agreement with the WTO contains many questions that remain open, representing an opportunity for the participation of the health sector in the next negotiation rounds.

Objetivos: Explorar la distribución temporal de la mortalidad por violencia del compañero íntimo (VCI) e identificar posibles agrupamientos temporales en la ocurrencia de muertes por VCI en España. Métodos: Estudio epidemiológico descriptivo basado en las muertes de mujeres por VCI incluidas en el registro de la Federación de Mujeres Separadas y Divorciadas (1998-2003). Se calculó la razón entre las muertes por VCI sucedidas en el mes correspondiente y la mediana de muertes del quinquenio anterior (índice epidémico) desde enero hasta julio de 2003. Se aplicó el modelo de Poisson para contrastar las diferencias observadas por años (1998-2002), por estaciones, por meses y por días de la semana, y se realizó un análisis de regresión simple con la media trimestral de muertes por VCI. Por último, se realizó un análisis de agrupamientos temporales. Resultados: Se observó un índice epidémico (IE) elevado en la mortalidad por VCI en los meses de enero (IE = 1,6), marzo (IE = 1,2), mayo (IE = 1,5), junio (IE = 2) y julio (IE = 2,4) de 2003. Teniendo como referencias el año 1998 y el día de la semana domingo, respectivamente, la mortalidad por VCI resultó significativamente mayor en 2001 (riesgo relativo [RR] = 1,52; intervalo de confianza del 95% [IC del 95%], 1,05-2,20) y los lunes (RR = 1,77; IC del 95%, 1,13-2,76). El análisis de regresión confirmó la tendencia creciente entre el primer trimestre de 1998 y el último de 2001 (p = 0,022). No se observaron diferencias estadísticamente significativas ni por meses ni por estaciones. No se dieron agrupamientos temporales en la distribución de las muertes por VCI. Conclusiones: La violencia del compañero íntimo es en la actualidad una epidemia creciente en España en la que no se detecta un patrón temporal definido. Los esfuerzos políticos y legales de la sociedad para aminorar este problema no parecen estar teniendo éxito. ; Objectives: To analyze the temporal distribution of mortality due to violence by intimate partners (VIP) and to identify possible temporal clusters in women deaths by VIP in Spain. Methods: We performed a descriptive epidemiological study based on the VIP deaths included in the database of the Federation of Divorced and Separated Women (1998-2003). The epidemic index (EI) was calculated as the ratio between the actual number of VIP deaths in a given month from January to July 2003 and the median number in the same month in the five preceding years. A Poisson model was used to analyze the distribution by years (1998-2002), seasons, months, and days. Simple regression analysis was performed with three monthly means. A temporal cluster analysis was also carried out. Results: In 2003, the EI of VIP mortality was high in January (EI = 1.6), March (EI = 1.2), May (EI = 1.5), June (EI = 2), and July (EI = 2.5). Compared with 1998 and Sundays, respectively, mortality due to VIP was significantly increased in 2001 (relative risk, RR = 1.52; 95% confidence interval [CI], 1.05- 2.20) and on Mondays (RR = 1.77; 95%CI, 1.13-2.76). The regression analyses confirmed an increase between the first three-month period of 1998 and the last three-month period of 2001. There were no differences between seasons and months. No temporal clusters of deaths were detected. Conclusions: VIP is currently an increasing epidemic in Spain with no clear temporal pattern. Political and legal efforts to reduce this problem do not seem to be successful. ; Instituto de la Mujer, Ministerio de Trabajo y Asuntos Sociales, ISC-III.

Can political regimes be singled out as a factor affecting health? Rating countries by the extent of their freedom is a useful proxy for measuring the effects of democracy on health related variables

This study aims at understanding how scientific evidence to substantiate nutrition and health claims in food commercial communication is regulated in Europe and the USA. A literature review was performed on the scientific evidence required by the European Food Safety Authority and the US Food and Drug Administration to substantiate food nutrition and health claims. Studies published in Scopus, Medline, Scirus, and Google Scholar from 2007 to 2012 were reviewed as well as documents released by both agencies. A total of 38 documents met our inclusion criteria out of 743 documents initially identified during our search. These agencies provide general guidelines on how to conduct food and health studies, intended to demonstrate a cause‐and‐effect relationship between a given food and a benefit to health. Despite this, they need to broaden the depth and scope of the guidelines provided to companies seeking to substantiate their claims and to provide further and more precise information concerning the evaluation of studies and application processes. No review has hitherto specifically focused on the subject of scientific evidence required by EU and US food agencies to substantiate health claims. This research thus leads to significant recommendations on how to improve current food industry guides. ; This research was conducted under the R&D&i project "Reclamos de salud en la publicidad de alimentos y comprensión del consumidor" ("Health claims in food advertising and consumer understanding"- GV/2016/088), funded by the Generalitat Valenciana, Spain and directed by Cristina González Díaz.

Fundamento: la violencia del compañero íntimo contra las mujeres (VCI) ha recibido especial dedicación de la agenda política española. A pesar de la importancia de las intervenciones desarrolladas, la evidencia empírica sobre su efectividad es todavía escasa. El objetivo de este estudio es explorar la distribución temporal de las denuncias y muertes por VCI e identificar posibles cambios de tendencia en las muertes y denuncias por VCI a partir de la Ley española contra la violencia de género de diciembre de 2004. Métodos: estudio descriptivo de denuncias y muertes por VCI (1998-2006) basado en las estadísticas del Instituto de la Mujer y la Federación de Mujeres Separadas y Divorciadas. Cálculos: Tasas de mortalidad ajustadas por edad y tasa de denuncias por años y periodos en torno a la ley (1998-2004 vs. 2005-2006); Regresión de Poisson; e, Índices epidémicos mensual –razón entre casos mensuales y mediana de casos de los meses correspondientes al quinquenio anterior al mes para el que se calcula el índice– y subyacente –media anual de las puntuaciones del índice epidémico mensual– de denuncias y muertes. Resultados: Desde 2005, las puntuaciones de los índices epidémicos muestran una tendencia decreciente. Sin embargo, la posibilidad de denunciar VCI entre 2005 y 2006 es 1,6 veces superior que entre 1998 y 2004. El riesgo de morir por esta causa no muestra cambios estadísticamente significativos. Conclusión: con el paso del tiempo se ha incrementado la posibilidad de denunciar VCI en España. Sin embargo, el riesgo de morir se mantiene. Aunque todavía es pronto para la evaluación del impacto de la ley en esta epidemia, puede decirse que su eficacia para la reducción de la mortalidad por VCI parece limitada. ; Background: Intimate Partner Violence (IPV) has received special attention in the Spanish political agenda. Despite the importance of developed interventions, empirical evidence about their effectiveness is scarce. The aim of this study is to explore the temporary distribution of Intimate Partner Violence (IPV) reports and murders and to identify possible changes in the risk of dying and reporting by IPV from the Spanish law against gender violence of December of 2004. Methods: We performed a descriptive study based on statistics of The Woman's Institute and The Divorced and Separated Women Federation. Calculations: IPV mortality and reports rates by years and periods around the law (1998-2004 vs. 2005-2006); Poisson Regression; and, Epidemic index by months –Ratio between the actual number of IPV murders and reports in a given month and the median number of cases in the same month in the five preceding years– and underlying epidemic index –annual average of the scores of the epidemic index of reports and murders. Results: The epidemic index trends permit us to observe that the problem has decreased since 2005. Nevertheless, the posibility of reporting IPV between 2005 and 2006 is 1.6 times upper that between 1998 and 2004. The risk of dying by this cause does not show statistically significant changes. Conclusion: The posibility of reporting IPV has been increased in Spain throughout the time. However, the risk of dying stays. Although still it is soon for the evaluation of the impact of the law in this epidemic, we could say that its effectiveness for the reduction of IPV mortality seems limited. ; Observatorio de Salud de las Mujeres del Ministerio de Sanidad y Consumo de España.

Objetivo: Determinar la relación entre el tamaño del Estado (medido como el gasto público) y los indicadores de salud en una muestra de países de todas las regiones del mundo, en la década 1990-2000. Métodos: Se realizó un estudio ecológico a partir de datos sobre gasto gubernamental central (GGC) y producto interior bruto (PIB) per cápita, obtenidos del Fondo Monetario Internacional, y de esperanza de vida, mortalidad materna y mortalidad infantil, de la Organización Mundial de la Salud. Se construyó un modelo de regresión lineal múltiple para estimar el efecto del GGC sobre salud, introduciendo también el PIB per cápita y la región. Resultados: El GGC varía poco durante el período estudiado y converge alrededor de una media del 28%, pero aún dentro de un amplio rango (7,80-53,0%); los países con economías altas (según PIB per cápita) presentan mayor GGC. Su efecto tiene especial importancia en la mortalidad infantil (r= 0,40; beta = –1,327; EE = 0,237; t = –5,590; p < 0,001). También el PIB per cápita y la ubicación regional se asocian con los cambios en la salud y coinciden con el empeoramiento de los indicadores de salud en algunos países pobres de África y Asia. En el modelo ajustado, el GGC mantiene la asociación estadística con la mortalidad infantil y materna. Conclusión: El estudio sugiere un efecto importante del tamaño del Estado en la situación de la salud, específicamente en la mortalidad. Aunque tienen limitaciones, dada la reducida ventana temporal utilizada, estos resultados deben ser considerados en el debate político y epidemiológico actual. ; Objective: To determine the relationship between central government expenditure (CGE), as an expression of the size of the state, and a selection of health indicators in a sample of states worldwide from 1990 to 2000. Methods: An ecological study was performed using data on CGE and per capita gross national product (GNP), obtained from the official statistics of the International Monetary Fund, and data on life expectancy, maternal and infant mortality, obtained from the World Health Organization. We fitted a multiple regression model to adjust for the effect of CGE on health. Per capita GNP and region were also introduced into the model. Results: The CGE varied little during the study period, converging around a mean of 28%, but within a wide range (min.7.80%, max. 53.50%). The countries with high income economies (according to per capita GNP) showed greater CGE. The size of the state had a strong influence on infant mortality (r = 0.40; beta = –1.327; EE = 0.237; t = –5.590; p < 0.001). Per capita GNP and region (especially Africa) were also associated with changes in health, coinciding with the worsening of health indicators in some poor countries of Africa and Asia. In the adjusted model, CGE maintained the statistically significant association with infant and maternal mortality. Conclusion: The study suggests that the size of the state has a strong influence on health, especially on mortality. Although this study has certain limitations, given the reduced time window used, the results should be taken into consideration in the current political and epidemiologist debate.

The Millennium Development Goals (MDG) progress targets have not been met. Nevertheless, the United Nations (UN) has not yet undertaken in-depth review in order to discover the reasons behind this lack of progress in achieving the MDG. From a political epidemiology perspective, the intention here is to identify the political elements affecting the social factors impeding MDG fulfilment and, at the same time, to suggest future public policies and appropriate proposals that are both more coherent and supported by broader, empirical knowledge of the relevant issues.

Objetivo. Evaluar el impacto del ajuste estructural sobre los indicadores de salud en América Latina y el Caribe durante el período de 1980–2000. Métodos. Se trata de un estudio ecológico. Los datos del gasto público y del producto interno bruto per cápita (PIBpc) se tomaron del Banco Mundial y los de la esperanza de vida (EV) y mortalidad infantil (MI), de la Organización Mundial de la Salud. El ajuste estructural (adelgazamiento del Estado) se evaluó mediante el cambio en el consumo de gobierno (la reducción del gasto público) en los países de América Latina y el Caribe en la década de 1980–1990. El cambio en los indicadores de salud se midió por la variación porcentual de la EV y la MI. Se compararon estas variaciones en América Latina y el Caribe con las observadas en diferentes grupos de países de otras regiones del mundo durante el período de 1980–2000. Se determinaron las asociaciones entre la reducción del gasto público y los indicadores de salud mediante la prueba de Pearson. Para estimar el efecto de los cambios sobre la salud se construyó un modelo de regresión lineal multifactorial ajustado según el PIBpc. Resultados. Se observó una ralentización del incremento de la EV y del descenso de la MI en América Latina y el Caribe, especialmente en la década de 1980–1990. Se encontraron asociaciones significativas entre la variación de los indicadores de salud y el cambio del gasto público en todos los grupos de países analizados. Al ajustar el modelo de regresión múltiple, las asociaciones solo se mantuvieron en América Latina y el Caribe. Conclusiones. En la década de 1980, el ajuste de las políticas acroeconómicas tuvo un efecto negativo sobre los indicadores sociales, específicamente sobre los relacionados con la situación de salud en América Latina y el Caribe. Estos efectos se siguieron observando durante la década siguiente. ; Objective. To assess the impact of structural adjustment on health indicators in Latin America and the Caribbean during 1980–2000. Methods. This was an ecological study. Public spending and per capita gross domestic product (pcGDP) figures were obtained from the World Bank, and life expectancy (LE) and infant mortality (IM) figures were obtained from the World Health Organization. Structural adjustment (government downsizing) was assessed by looking at the change in the amount of spending taken up by the government (or the reduction in public spending) in Latin American and Caribbean countries during 1980–1990. Changes in health indicators were measured in terms of the percentage variation in LE and IM. The variations found in Latin America and the Caribbean were compared to those seen in different groups of countries in other parts of the world during 1980–2000. Pearson's chi squared test was used to explore the associations between the decrease in public spending and health indicators. In order to estimate the health effects of such changes, a multivariate linear regression model was created, with adjustments for pcGDP. Results. A deceleration in the rise of LE and in the decline of IM in Latin America and the Caribbean was noted, especially over the period from 1980 through 1990. Significant associations were observed between health indicators and the change in public spending in all groups of countries included in the study. When adjustments were introduced into the multiple regression model, the only associations that remained were seen in Latin America and the Caribbean. Conclusions. In the decade of 1980, adjustments in macroeconomic policies had a negative effect on social indicators, specifically those that had to do with health conditions in Latin America and the Caribbean. Such an effect lasted throughout the following decade.

Objetivo: Explorar la intensidad del debate parlamentario sobre el Acuerdo General de Comercio de Servicios (AGCS) asumido por España ante la Organización Mundial del Comercio (OMC), y compararla con la del Acuerdo General de Bienes (GATT). Métodos: Búsqueda sistemática y análisis del contenido de todas las iniciativas parlamentarias sobre AGCS y GATT realizadas entre 1979 y 2004 en el Congreso de los Diputados y el Senado. Se calculó la frecuencia y porcentaje de iniciativas parlamentarias de ambos temas, resultado de su tramitación y tipo de iniciativa. Resultados: Se presentaron 185 iniciativas parlamentarias sobre los acuerdos multilaterales de bienes y servicios, de las que 120 se referían al GATT, 8 al AGCS y 57 a ambos acuerdos. La mayoría de las iniciativas no fueron discutidas (GATT, 71%; GATS, 55,4%) o fueron sujeto de un debate político en el que apenas se dieron intervenciones por parte de los grupos parlamentarios. Conclusiones: A pesar de las implicaciones del acuerdo multilateral de servicios para la política sanitaria española, éste se ha asumido con escaso debate parlamentario previo, incluso menos que en el caso de su homólogo sobre bienes. Se requiere en este tema una intensificación de la función de control al gobierno. ; Objective: To explore the intensity of the debate in the Spanish Parliament on the General Agreement on Trade of Services (GATS) developed by Spain and the World Trade Organization, and to compare it with the debate on the General Agreement on Tariffs and Trade (GATT). Methods: A systematic search and content analysis were performed of all parliamentary initiatives on GATS and GATT undertaken from 1979 to 2004 in the Spanish Parliament and Senate. The frequency and percentages of initiatives on both issues were calculated, and the final result and kinds of initiative were analyzed. Results: A total of 185 initiatives were presented in the Spanish Parliament on these agreements, of which 120 were on GATT, 8 were on GATS and 57 were on both agreements. Most of these initiatives were not discussed in parliament (GATT, 71%; GATS, 55.4%) or were the subject of political debate with low participation among parliamentary groups. Conclusions: Despite the implications of the GATS for Spanish health policy, the agreement was developed with little prior political debate, which was even less intense than that on GATTS. The parliamentary function of controlling the government should be reaffirmed in Spain.

Can political regimes be singled out as a factor affecting health? Rating countries by the extent of their freedom is a useful proxy for measuring the effects of democracy on health related variables. Although the influence of democracy in preventing famines has been reported, there have been no empirical studies on the relation between the extent of freedom allowed by political regimes and the effect on a nation's health. We explored the effect of democracy on life expectancy and maternal and infant mortality in most countries, taking into account a country's wealth, its level of inequality, and the size of its public sector. ; Centro de Estudios Mario Benedetti and Observatory of Public Policies and Health