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... Liberalization and integration were different in different social classes and between males and females [42]. It is well ascertained that increased foreign investments have been related to an increased presence of females in the work force [43], with a consequent impoverishment of the productive conditions [44]. Moreover, the rapid change in employment status of men and women has influenced a different ability to pay services. ...
... Gender analysis of policies suggests they can differently affect women in comparison to men, because of different needs, different social and cultural integration, economic vulnerability and larger participation of women as health care providers [43, 66, 67,7374757677. However, reforms, strategies and interventions introduced in the last two decades, have obtained limited results towards a better gender equality on health [77]. ...
To synthesize the determinants of gender inequalities through a narrative review that: (i) describes gender related variables that can create different levels of health; (ii) describes key points that may assist in policy development and its reorientation towards gender differences; (iii) debates potential approaches in understanding gender issues.
Review of the international literature through online databases (Pubmed), search engines, publications and documents from "grey literature". Inclusion criteria: publications from 1997, English language; keywords used: gender based analysis; gender and public policy; women's health; gender differences; health policy; gender impact assessment. Among the 300 papers retrieved, 55 were selected for relevance.
We performed a narrative synthesis of the included literature, regarding: (i) gender differences and their determinants; (ii) elements for the changing; (iii) possible approaches; (iv) gender influences the pursuit of health and health care access through specific variables; (v) health policies can modify these variables only by a minimal percentage. These interventions should guarantee equity and allow efficient resources allocation. The gap between political announcements and real policy implementation remains unchanged. (vi) Standard approaches to the topic are not feasible due to the scarcity of a specific literature and the numerous cultural differences.
. Gender analysis of policies suggests they can differently affect women in comparison to men. However, reforms, strategies and interventions introduced in the last two decades, have achieved a limited success towards better gender equality in health. The main aim is to attack the structural sources of gender inequity in the society.
... Nevertheless, in recent years a small but growing body of work has emerged to address some of these issues. Within this literature there is a general consensus about the main dimensions of globalization that are likely to have a gendered impact on human well-being (Benería, 2001;Doyal, 2002;Evers and Juárez, 2001;Harcourt, 2001). In particular two specific concerns have emerged. ...
Health sector reforms across Latin America are replacing the concept of risk-sharing across the population with more individualized approaches to accessing health care, and health insurance schemes have been advocated by the World Bank as a means of helping poor people overcome the risk of ill health. Yet at the same time the lowering of labour standards and the growth of informal workers means that for an increased number of workers, contributing to a health insurance scheme is not feasible. Drawing on evidence from Chile this article examines the gendered dimensions of these processes and highlights the ways in which the gender division of labour means that women are more adversely affected than men.
... This debate is framed by a broader issue: has globalization benefited most people in the world or not? A different debate concerns the relationship between globalization, public health, and the epidemiologic transition [1]. In this context, globalization affects public health in a variety of ways because it has unleashed profound changes that have redefined how institutions at many levels-nation states, government agencies, transnational corporations, multilateral organizations, non-governmental organizations, public and private health care providers, community-based and other affinity-based organizations, communities, and households-operate and interact with one another. ...
Third World countries are confronted by a complex overlay of two sets of health problems. Traditional maladies, including communicable diseases, malnutrition, and environmental health hazards coexist with emerging health challenges, including cardiovascular disease, cancer, and increasing levels of obesity. Using Ecuador as an example, this paper proposes a conceptual framework for linking epidemiologic overlap to emerging social structures and processes at the national and global levels.
Epidemiologic trends can be seen as part of broader processes related to globalization, but this does not imply that globalization is a monolithic force that inevitably and uniformly affects nations, communities, and households in the same manner. Rather, characteristics and forms of social organization at the subnational level can shape the way that globalization takes place. Thus, globalization has affected Ecuador in specific ways and is, at the same time, intimately related to the form in which the epidemiologic transition has transpired in that country.
Ecuador is among neither the poorest nor the wealthiest countries and its situation may illuminate trends in other parts of the world. As in other countries, insertion into the global economy has not taken place in a vacuum; rather, Ecuador has experienced unprecedented social and demographic change in the past several decades, producing profound transformation in its social structure. Examples of local represent alternatives to centralized health systems that do not effectively address the complex overlay of traditional and emerging health problems.
This chapter argues that despite the silences, health sector reform models are implicitly gendered: that is, they have gender built inaudibly into their assumptions. The chapter explores analytical approaches the gendered nature and impacts of health sector reform: gender equity, women’s health needs and gendered health systems frameworks. Our objective is conceptual: to examine health sector reform through a gender ‘lens’, considering how the reform framework is gendered and the extent to which that gendered process may operate to the detriment of women, especially poor women. We illustrate our arguments with empirical evidence drawn largely but not exclusively from Africa, and consider implications of the analysis particularly for the African context.
El objetivo de mejorar la salud materna, cuya meta es la reducción de la mortalidad materna en tres cuartas partes entre 1990 y 2015, depende directa o indirectamente de otros Objetivos del Milenio, tales como la mejoría de la educación (especialmente de las madres y las niñas, pero también de los hombres), el acceso a agua potable, el combate de las enfermedades transmisibles, la mejoría de las condiciones nutricionales, la equidad de género y el acceso a medicamentos esenciales. Por otro lado, la mejoría de los indicadores de salud materna es también importante para el logro de otros ODM, tales como promover la equidad de género, reducir la mortalidad infantil y prevenir las enfermedades transmisibles, especialmente el SIDA. La experiencia de muchas décadas en iniciativas para mejorar la salud pública y las condiciones de salud materno-infantil, tanto en países desarrollados como en países en desarrollo, ha brindado muchas lecciones que pueden ser compartidas para lograr la meta de mejorar la salud materna. La lección más importante es la necesidad de una mayor focalización de los recursos públicos en los más pobres y en los grupos socialmente excluidos por razones de género, edad o etnia. Para ello, se debe cambiar la estructura y la organización de las políticas de salud. Además, es necesario crear una cultura de medición, monitoreo y evaluación permanente de los servicios de salud materna, enfocada en resultados y en la implementación de acciones costo efectivas basadas en la evidencia. En otras palabras, hay que hacer que la mejoría de la salud materna sea parte de un proceso de creación de una cultura de desarrollo económico y social.
La ética médica es considerada entre los profesionales de salud como la disciplina que proporciona las bases para brindar una atención adecuada a los pacientes. En los últimos años, los conceptos de calidad de atención y derechos humanos así como sus diversos discursos acompañantes se han sumado al concepto de ética médica entre los paradigmas a tener en cuenta en la atención de las personas, tanto a nivel individual, así como a nivel de políticas de salud. El presente trabajo busca analizar tales paradigmas, utilizando como estudio de caso las políticas de salud sexual y reproductiva que se dieron en Perú en los últimos 10 años.
The Pan American Health Organisation recently highlighted the increased exclusion of low income households in Latin America from health care. The rise in informal employment and sub-contracting of workers means that many employees lack formal contracts and are excluded from health insurance programmes. Feminist research suggests low income women are often most at risk of exclusion. Simultaneously, deeply entrenched inequalities within health systems across the region have not been addressed by health sector reforms. Drawing on the case of Chile, this paper examines the extent to which informal workers have indeed been excluded and how far these processes are gendered.
Medical ethics has long been considered the framework that guides the way in which health professionals should provide care. In recent years, the concepts of quality of care and human rights—and the discourses they entail—have been added to medical ethics as paradigms to consider with respect to the delivery of health care, both at the individual and health policy level. Using a case study of the sexual and reproductive health policies in Peru in the last ten years, the current essay analyzes the implications of these paradigms in a world in which health and the delivery of care have increasingly globalised dimensions.
Health professionals view medical ethics as a discipline that provides the basis for more adequate patient care. In recent years the concepts of quality of care and human rights - with their attending discourses - have joined the concept of medical ethics among the paradigms to consider in care for humans both at the individual and health policy levels. The current study seeks to analyze such paradigms, based on a case study of sexual and reproductive health policies in Peru in the last 10 years.
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