Int J Health Serv
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The ambitious and comprehensive Transatlantic Trade and Investment Partnership Agreement (TTIP/TAFTA) agreement between the European Union and United States is now being negotiated and may have far-reaching consequences for health services. The agreement extends to government procurement, investment, and further regulatory cooperation. In this article, we focus on the United Kingdom National Health Service and how these negotiations can limit policy space to change policies and to regulate in relation to health services, pharmaceuticals, medical devices, and health industries. The negotiation of TTIP/TAFTA has the potential to "harmonize" more corporate-friendly regulation, resulting in higher costs and loss of policy space, an example of "trade creep" that potentially compromises health equity, public health, and safety concerns across the Atlantic.
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Mineral mining is among the world's most hazardous occupations. It is especially dangerous in southern Africa, where mining activity is a leading cause of HIV and tuberculosis epidemics. Inside mines, silica dust exposure causes long-term pulmonary damage. ⋯ Miners in high-income countries, working for the same transnational companies, do not experience elevated rates of death and disability. Cost-effective interventions can reduce HIV incidence through social housing, curb trafficking of high-risk groups, stop tuberculosis spread through screening and detection, and reduce drug resistance by standardizing cross-border care. Urgent action is needed to respond to mining's staggering, yet avoidable disease toll in sub-Saharan Africa.
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There is a growing interest in health policy in the social determinants of health. This has increased the demand for a paradigm shift within the discipline of health economics from health care economics to health economics. While the former involves what is essentially a medical model that emphasizes the maximization of individual health outcomes and considers the social organization of the health system as merely instrumental, the latter emphasizes that health and its distribution result from political, social, economic, and cultural structures. ⋯ Especially is this the case in Africa and other low- and middle-income regions. This article seeks to provide empirical evidence from sub-Saharan Africa, including Ghana and Nigeria, on why such inequalities exist, arguing that these are in large part a product of hangovers from historically entrenched institutions. It argues that there is a need for research in health economics to embrace the social determinants of health, especially inequality, and to move away from its current mono-cultural focus.
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The southern provinces of Mozambique have some of the world's highest recorded levels of HIV and tuberculosis (TB). They are also characterized by high levels of cross-border migration, particularly to mines in South Africa. Through the Declaration on Tuberculosis in the Mining Sector in August 2012, heads of state of the Southern African Development Community showed an increased commitment to addressing TB and HIV among migrant mine workers, but there is much left to do. ⋯ We report new research from 2011-2012 on health-related attitudes and behaviors of Mozambican mine workers and their families and present an estimate of the financial burden of disease related to migrant mine work for Mozambique's public services and migrant-sending communities. We recommend that the Declaration be operationalized and enforced. Practical measures should include training of health workers in migrants' right to health; user-friendly health information in Portuguese and local languages; building the advocacy capacity of mine workers' representatives; and more attention to social, cultural, and economic factors that affect migrant mine workers' health, including better access to health information and services and livelihoods for wives, widows, and orphans in communities of origin.
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In an era of economic crisis in Greece and with many uninsured citizens, the Troika (lenders of Greece) suggests reforms and promotes the internal market, resulting in a public-private system becoming more privatized. This article contradicts these proposals and attempts to suggest the necessary reforms to achieve equity of access for all and to promote efficiency, taking into account the existing needs of the population and the recession of the Greek economy.