The accomplishments of Latin American social medicine remain little known in the English-speaking world. In Latin America, social medicine differs from public health in its definitions of populations and social institutions, its dialectic vision of "health-illness," and its stance on causal inference. A "golden age" occurred during the 1930s, when Salvador Allende, a pathologist and future president of Chile, played a key role. Later influences included the Cuban revolution, the failed peaceful transition to socialism in Chile, the Nicaraguan revolution, liberation theology, and empowerment strategies in education. Most of the leaders of Latin American social medicine have experienced political repression, partly because they have tried to combine theory and political practice--a combination known as "praxis." Theoretic debates in social medicine take their bearings from historical materialism and recent trends in European philosophy. Methodologically, differing historical, quantitative, and qualitative approaches aim to avoid perceived problems of positivism and reductionism in traditional public health and clinical methods. Key themes emphasize the effects of broad social policies on health and health care; the social determinants of illness and death; the relationships between work, reproduction, and the environment; and the impact of violence and trauma.
This piece presents and analyzes a number of issues related to social medicine: the context of the emergence of social medicine; the differences between social medicine and public health; the theories, methods, and debates in social medicine; the main subjects or problems considered in social medicine; and the difficulties of disseminating the concepts of social medicine among English-speaking persons and among medical and public health professionals in general. Latin American social medicine has challenged other views by contributing to an understanding of the determinants of the health-disease-health care process and by using theories, methods, and techniques that are little known in the field of public health. Introducing Latin American social medicine, especially among English speakers, will be difficult due to the conceptual complexity of this field for persons who are accustomed to the theoretical framework of public health and medicine and also due to skepticism concerning research coming from the Third World. A multidisciplinary team is facing this challenge through two primary initiatives: 1) the creation of an Internet portal and database where there are structured abstracts in English, Portuguese, and Spanish of books, book chapters, and articles on social medicine and 2) the electronic publication of two journals on Latin American social medicine.
Capital financiero versus complejo médico-industrial: los desafíos de las agencias regulatorias
BackgroundWe utilized our previous studies analyzing the reforms affecting the health sector developed in the 1990s by financial groups to frame the strategies implemented by the pharmaceutical industry to regain market positions and to understand the challenges that regulatory agencies are confronting.MethodsWe followed an analytical approach for analyzing the process generated by the disputes between the financial groups and the pharmaceutical corporations and the challenges created to governmental regulation. We analyzed primary and secondary sources using situational and discourse analyses. We introduced the concepts of biomedicalization and biopedagogy, which allowed us to analyze how medicalization was radicalized.ResultsIn the 1990s, structural adjustment policies facilitated health reforms that allowed the entrance of multinational financial capital into publicly-financed and employer-based insurance. This model operated in contraposition to the interests of the medical industrial complex, which since the middle of the 1990s had developed silent reforms to regain authority in defining the health-ill-care model. These silent reforms radicalized the medicalization. Some reforms took place through deregulatory processes, such as allowing direct-to-consumer advertisements of prescription drugs in the United States. In other countries different strategies were facilitated by the lack of regulation of other media such as the internet. The pharmaceutical industry also has had a role in changing disease definitions, rebranding others, creating new ones, and pressuring for approval of treatments to be paid by public, employer, and private plans. In recent years in Brazil there has been a substantial increase in the number of judicial claims demanding that public administrations pay for new treatments.ConclusionsWe found that the dispute for the hegemony of the health sector between financial and pharmaceutical companies has deeply transformed the sector. Patients converted into consumers are exposed to the biomedicalization of their lives helped by the biopedagogies, which using subtle mechanisms present discourses as if they are objective and created to empower consumers. The analysis of judicialization of health policies in Brazil could help to understand the complexity of the problem and to develop democratic mechanisms to improve the regulation of the health sector.
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