All posts tagged Health Care

The Zika Virus and a New Debate on Reproductive Rights

By Rachel Nadelman*

Zika Women

Photo Credit: Day Donaldson and PresidenciaRD / Flickr / Creative Commons

The call by half a dozen Latin American and Caribbean governments for women to put off pregnancies – as the World Health Organization warns the feared Zika virus is “spreading explosively” – is stimulating a new debate on reproductive rights in the region.  El Salvador’s Health Ministry has urged women to “avoid becoming pregnant this year and next,” and Brazil, Jamaica, Colombia, and others are issuing similar advisories.  A mosquito-borne disease spreading rapidly in the Western Hemisphere for the first time, Zika is blamed for causing devastating neurological birth defects in newborns whose mothers contract the virus during pregnancy.  The U.S. Center on Disease Control has advised pregnant women to avoid travel to the more than 20 Latin American and Caribbean countries now hosting the disease.

Named for the Uganda forest where it was discovered in the late 1940s, Zika is carried and transmitted by the Aedes Aegypti mosquito, best known as the vector for life-threatening viruses like yellow fever and dengue.  Within the Western Hemisphere, the Aedes population has increased drastically in recent years, linked by scientists to changes in climate.  Yet Zika’s arrival in Latin America last year, first documented in Brazil, and subsequent expansion did not attract major attention until the pattern of birth defects emerged.  Zika’s symptoms are sometimes imperceptible or typically mild, including fever, joint aches, and conjunctivitis, so health officials did not consider it a major threat to the general population.  Although definitive clinical proof is still lacking, Zika is now linked to microcephaly, a rare neurological condition that causes children to be born with small heads because of abnormal brain development in the womb or immediately after birth.  The emergence of Zika in Latin America has coincided with a more than 20-fold increase in the incidence of microcephaly.  (Brazil has reported 4,000 cases in the past year, a drastic increase from just 150 in 2014).  The babies suffer from poor brain function and reduced life expectancy.  Doctors are finding traces of the virus in the brains of microcephaly-inflicted babies who were stillborn or died soon after birth.

Warnings and advisories offer no help to the millions of women who live in afflicted countries.  Governments are launching fumigation programs to reduce the Aedes mosquito population and thereby limit disease transmission.  Asking populations to refrain from having children appears a bit facile, if not cynical, in a region with low levels of access to birth control for reasons that range from religious dictates to economic obstacles.  Severely restrictive abortion laws also complicate potential parents’ options.  Five Latin American countries (including Honduras and El Salvador, hard hit by Zika) ban abortion without exception, even to save the mother’s life.  Others criminalize abortion with few allowances.  According to the Guttmacher institute, 95 percent of abortions in Latin America are unsafe, contributing to high maternal mortality rates. It’s not surprising, therefore, that Zika’s link to these devastating birth defects has generated unprecedented public discussion throughout Latin America about women’s and families’ rights and responsibilities for taking control of reproduction.  It is far too early to know if the health advisories will have practical impact on the incidence of microcephaly – or on attitudes toward reproductive rights over the longer term.   

February 1, 2016

* Rachel Nadelman is a PhD candidate in International Relations at the School of International Service.  Her dissertation research focuses on El Salvador’s decision to leave its gold resources unmined.

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by clalsstaff on February 1, 2016  •  Permalink
Posted in Regional Snapshot
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Posted by clalsstaff on February 1, 2016

https://aulablog.net/2016/02/01/the-zika-virus-and-a-new-debate-on-reproductive-rights/

Latin America’s Emerging Burden of Chronic Non-Communicable Diseases

By Fernando De Maio*

Photo credit: FLICKR.com/diapositivasmentales / Foter.com / CC BY

Photo credit: FLICKR.com/diapositivasmentales / Foter.com / CC BY

Despite significant improvements over the past 30 years in some of the most crucial health indicators – including increases in life expectancy and decreases in infant mortality – Latin America faces an impending epidemic of chronic non-communicable diseases such as heart disease, stroke, cancer, chronic respiratory diseases and diabetes.  The region has avoided the worst effects of the HIV/AIDS epidemic.  Brazil, for example, is now widely accepted by health policy analysts as offering the world valuable lessons for combating the spread of HIV and in ensuring access to life-saving antiretroviral medicine.  But chronic non-communicable diseases are now stretching under-funded and fragmented health care systems, revealing deep lines of social inequality.

The World Health Organization (WHO) has warned of an impending epidemic of such ailments, which are already the leading causes of death in all areas of the world except for sub-Saharan Africa.  In Latin America, chronic diseases account for more than 60 percent of deaths, with some variance between countries (more than 70 percent in Uruguay, more than 60 percent in Argentina and Chile, but less than 40 percent in Bolivia and Paraguay).  The latest data indicate that this burden is growing across the region, driven by increases in some of the most important risk factors (physical inactivity and obesity in particular).  Surveys in the region allow us to disaggregate national data, revealing the social inequalities underlying the problem.

In Argentina, we have used the National Risk Factor Surveys from 2005 and 2009 to examine how social gradients are changing:

  • Physical inactivity – an important risk factor for cardiovascular disease – has increased substantially (from 46 to 55 percent).  The further down we go in the socioeconomic hierarchy, the more this important risk factor seems to be increasing.
  • Obesity has also increased in this four-year period (from 14 to 18 percent), with a steepening social gradient for women.
  • Data on diabetes from these surveys are mixed.  The percentage of the adult population told they have diabetes or high blood sugar has risen (8.4 to 9.6 percent), but experts believe the increase reflects both increases in diabetes in the population and an in access to health care resulting in more cases being detected.
  • Some good news may be found in preventive cancer screening: rates of mammograms and pap smears have increased, and social gradients for mammograms are decreasing, raising the hope of diminished inequalities in cancer mortality in the future.

The WHO’s Commission on the Social Determinants of Health recently concluded that “reducing health inequalities is… an ethical imperative.  Social injustice is killing people on a grand scale.”  Among its recommendations is a call for the routine monitoring of health inequalities.  The growing body of data documents the linkage between inequality and the occurrence of chronic non-communicable diseases – demonstrating that, fundamentally, it is a question of social justice.  Social inequalities in physical inactivity, obesity, diabetes – and, crucially, tobacco consumption – are not natural but socially and politically produced.  Empirical research in the coming years will need not only to document the rise of chronic non-communicable diseases in aggregate terms, but also to closely monitor the inequalities embedded in national figures.  Policy analysis will likewise need to examine not just the national-level effects of new initiatives, such as new taxes on tobacco products or new standards for salt consumption, but, at a disaggregated level of analysis, examine how new initiatives affect people across the socioeconomic spectrum.

* Dr. De Maio is a professor in the Department of Sociology at DePaul University.

 

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by clalsstaff on October 31, 2013  •  Permalink
Posted in Regional Snapshot, South America
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Posted by clalsstaff on October 31, 2013

https://aulablog.net/2013/10/31/latin-americas-emerging-burden-of-chronic-non-communicable-diseases/

Health Reforms in Latin America: Lessons for the U.S.?

Photo credit: World Bank Photo Collection / Foter / CC BY-NC-ND

Photo credit: World Bank Photo Collection / Foter / CC BY-NC-ND

While Washington struggles to implement modest health care reforms, a number of Latin American countries over the past decade have been changing their health systems in ways that may offer encouragement to advocates of progressive change in the United States.  Reforms in Brazil, Chile, Colombia, Mexico and others strive to provide universal care in circumstances that are, in some cases, much tougher than those facing proponents of Obamacare.  Some challenges and accomplishments include:

  • In Chile, after years of investment, about 73 percent of the population now uses the public health care system.  A Family Health Plan in Brazil, which accounts for US$2 billion of the US$3.5 billion of the government’s health budget each year, has contributed to expansion of health care participation to 70 percent of the population.  When Colombia passed a health care law in 1993, only 24 percent of its citizens had coverage; in 2007, it had reached 80 percent.  Mexico has gone from 40 percent in 2004 to about 70 percent.  (In the U.S., about 83 percent had access to health insurance as of 2010.)
  • Latin American elites, like their U.S. counterparts, have long resisted providing the resources needed to cover health care costs, either through workplace insurance or through paying taxes to support state provision of health services.  But Latin American experience shows that this reticence can be overcome.  Substantial taxes have been levied in recent years – such as a 7 percent health care tax in Chile – and, according to various databases, health-related spending has grown to almost 7 percent of GDP in Mexico, about 7 percent in Colombia, about 7.5 percent of GDP in Chile, and around 8 or 9 percent in Brazil.  (Health care spending accounts for about 18 percent of the U.S. GDP – about half from public spending.)

These Latin American governments have demonstrated that, Sí, se puede when it comes to reforming health care and challenging entrenched interests wary of change.  Spending is rising as a percentage of GDP, but expenditures remain a fraction of those in the U.S. – and the gap in quality of care is narrowing.  Latin Americans have expanded coverage at a time that access to good care in the United States remains a challenge for tens of millions of people.  The U.S. economy generates more than sufficient resources to guarantee health care for the entire population, but the Obama administration seems too weak to implement its tepid reforms on schedule – recently postponing an important mandate that large employers provide insurance coverage.  Health care providers in Latin America appear to be adapting to the new playing field, but their U.S. counterparts are lagging.  If Latin American leaders had advice for their U.S. counterparts on how to slay this dragon, it would probably involve taking note that reforms in the region invariably emerged from decisive leadership from the executive branch and, with the exception of Mexico, a willingness to increase tax burdens to expand coverage.  They would also note that, much like is evident in public opinion polling of Latino populations in the U.S., citizens of Latin American countries are overwhelmingly in favor of public guarantees of health services for all.

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by clalsstaff on July 31, 2013  •  Permalink
Posted in United States
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Posted by clalsstaff on July 31, 2013

https://aulablog.net/2013/07/31/health-reforms-in-latin-america-lessons-for-the-u-s/

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