Cuidado de la vida y salud pública / Life care and public health

Entre los días 17 y 19 de noviembre de 2022 se realizó el 18° Coloquio de Investigación en Salud Pública en el Centro de Estudios en Salud de la Universidad de Nariño (CESUN) de la Universidad de Nariño. Este es un evento anual que se lleva a cabo por iniciativa del Doctorado Interfacultades en Salud Pública de la Universidad Nacional de Colombia, pero cada vez más participan escuelas de formación de investigadores(as) en el campo de la salud pública de todo el país y, recientemente, algunas de México.

Fractured lives in fractured cities: Towards a critical understanding of urban violence in the context of market-driven urban restructuring processes in Bogotá and Rio de Janeiro.

Based on a comparative case study on two neighborhoods in Bogota and Rio de Janeiro (2017-2019) and a comprehensive literature review, this article proposes a critical Public Health approach to urban violence and makes a case for understanding the phenomenon in the context of market-driven urban territorial restructuring processes that assume specific qualities in cities of the Global South. The case studies are based on focus groups and semi-structured interviews with residents, specialists and community leaders. It is argued that urban violence is a key public health challenge, particularly in Latin America, given its dimensions and its impact on the populations' life and health. In this regard it configures "fractured lives" in what urban scholars have termed "fractured cities" - essentially unequal and polarized cities that are not merely sites of urban violence but, as we argue in this article, fundamentally shape urban violence, its qualities, dynamics and dimensions. The study is informed by a unique theoretical articulation between Latin American Social Medicine and Collective Health, critical (Latin American) geographical theory and authoritarian neoliberalism literature and shows how urban violence is directly implied in the territorial making and un-making of the cities, driven by commodification as well as both legal and illegal capitalist market logics, that include but are not limited to drug trade. The cases reflect the violence implied in permanent threats of eviction and displacement, "necropolitical" police/military interventions and what is described as a silent imposition of a "slow death" on infrastructure, the neighborhood and ultimately also its residents, which "fracture" the lives of significant parts of the urban population, produce "ill-being" and bring about health consequences that are rarely considered in relation to urban violence.

Situación de salud en una comunidad afrocolombiana sobreviviente a la masacre de Bojayá, Chocó / Health Status within an Afro-Colombian Community Survivor of the Bojayá Massacre, Chocó / Situação de saúde em uma comunidade afro colombiana sobrevivente ao massacre de Bojayá, Chocó

Resumen Objetivo: En el marco del proyecto de extensión solidaria universitaria "Laboratorio de salud rural e intercultural comunidad de Bojayá, Chocó", este artículo presenta los resultados correspondientes a la fase de diagnóstico individual y la aproximación inicial al diagnóstico colectivo de la situación de salud presente en un colectivo afrocolombiano sobreviviente a una masacre emblemática ocurrida en Colombia. Metodología: Exploración preliminar y elementos de diagnóstico comunitario con 66 sobrevivientes de la masacre del 2 de mayo de 2002 en el poblado de Bellavista, en el municipio de Bojayá, Chocó. Resultados: Se identificaron condiciones socioeconómicas deficientes, diagnósticos clínicos desatendidos, y se efectuó la aproximación inicial a potencialidades disponibles para el afrontamiento de las necesidades en salud individuales y colectivas de la población abordada, representadas en saberes comunitarios y posibilidad de acceso a programas y servicios institucionales en salud para víctimas. Conclusiones: Pese a que transcurrieron más de 15 años desde el momento de ocurrencia de la masacre de Bojayá hasta nuestro trabajo con la comunidad, se encontró persistencia de múltiples necesidades insatisfechas que afectan negativamente la situación de salud individual y colectiva, sin adecuada ni oportuna intervención. Cualquier acción futura que se plantee para atender tales asuntos debe tomar en cuenta las condiciones histórico-sociales que configuran los procesos de salud-enfermedad-cuidado en dicha comunidad.

Abstract Objective: Within the framework of the project of solidary continuing education "Laboratory of rural and intercultural health community of Bojayá, Chocó", this paper presents the results of the individual diagnostic phase and the initial approach to the collective diagnosis of the health status diagnosis presented in an Afro-Colombian group surviving to a notorious massacre occurred in Colombia. Methodology: Preliminary exploration and community diagnosis elements with 66 survivors of the massacre occurred on May 2, 2002 in the Bellavista village, in the municipality of Bojayá, Chocó. Results: Deficient socio-economic conditions and neglected clinical diagnosis were identified. An initial approach to the available potentialities to face the individual and collective health needs of the approached population was made, represented by community knowledge and accessibility to institutional programs and health services for victims. Conclusions: Although more than 15 years have passed from the occurrence of the Bojayá massacre until our work with the community began, the persistence of numerous unsatisfied needs that negatively affect the individual and collective health status, without adequate and timely intervention, was found. Any further action looking to address such matters should take into account the socio-historical conditions that define the health-illness-care process in that community.

Resumo Objetivo: No âmbito do projeto de extensão solidária universitária "Laboratório de saúde rural e intercultural comunidade de Bojayá, Chocó", este artigo apresenta os resultados correspondentes à fase de diagnóstico individual e a aproximação inicial ao diagnóstico coletivo da situação de saúde presente num coletivo afro colombiano sobrevivente a um massacre emblemático ocorrido na Colômbia. Metodologia: Exploração preliminar e elementos de diagnóstico comunitário com 66 sobreviventes do massacre de 2 de maio de 2002 no povoado de Bellavista, no município de Bojayá, Chocó. Resultados: Foram identificadas condições socioeconômicas deficientes, diagnósticos clínicos negligenciados e efetuou-se a aproximação inicial a disponíveis potencialidades para o enfrentamento das necessidades em saúde individuais e coletivas da população abordada, representadas em saberes comunitários e possibilidade de acesso a programas e serviços institucionais em saúde para vítimas. Conclusões: Apesar do fato de que se passaram 15 anos do acontecimento do massacre de Bojayá até o nosso trabalho com a comunidade, foi encontrada a persistência de múltiplas necessidades insatisfeitas que afetam de forma negativa a situação de saúde individual e coletiva, sem intervenção adequada e oportuna. Qualquer ação futura planejada para atender tais assuntos, deve considerar as condições histórico-sociais que caracterizam os processos de saúde-doença-cuidado em tal comunidade.

Characterization of the number, distribution and pertinence of pediatricians in Colombia. 2017 / Caracterización de la cantidad, distribución y pertinencia de los pediatras en Colombia. 2017

Abstract Introduction: Health human resources estimation and planning in the country require analyzing the relationship between socio-demographic and epidemiological aspects of the population and the supply of health services in different territories. Objective: To analyze the number, distribution and pertinence of pediatricians in Colombia. Materials and methods: Cross-sectional study. Data obtained from different sources were aggregated and refined to obtain a single database that allowed conducting an analysis of the number and distribution of pediatricians in Colombia and, this way, make an approximation of the census of Colombian pediatricians. Results: By 2017, there were 3 398 pediatricians in Colombia. Most pediatricians worked in Bogotá D.C. (35.96%) and in the departments of Antioquia (12.30%) and Valle del Cauca (9.59%). In contrast, in the departments of Vichada and Vaupés, there were no pediatricians and this service was not available. Conclusion: The distribution of pediatricians in Colombia depends more on the dynamics of healthcare service providers than on the health care needs of children in the different regions of the country. Therefore, the implementation of new policies aiming at achieving a better distribution of the available resources is required to strengthen local authorities and to regulate the provision of pediatric care services throughout the country according to the multiple health needs of each region.

Resumen Introducción. La estimación y planificación del recurso humano en salud a nivel nacional requiere analizar las relaciones entre la situación sociodemográfica y epidemiológica de las diferentes poblaciones y la oferta de servicios de salud en los territorios que ocupan. Objetivo. Analizar la cantidad, la distribución y la pertinencia de pediatras en Colombia. Materiales y métodos. Estudio trasversal. Los datos obtenidos de distintas fuentes fueron agregados y depurados para obtener una base de datos única que permitió analizar la cantidad y distribución de pediatras en el país y, de esta forma, realizar una aproximación del censo de pediatras en Colombia. Resultados. Para 2017 había 3 398 pediatras en Colombia. Además, la mayoría ejercía en Bogotá D.C. (35.96%) y en los departamentos de Antioquia (12.30%) y Valle del Cauca (9.59%), mientras que en los departamentos de Vichada y Vaupés no se reportó la presencia de estos especialistas o la prestación de sus servicios. Conclusión. La distribución de pediatras en Colombia responde más a la dinámica de los prestadores de servicios de salud que a las necesidades de la población infantil en los diferentes territorios, por lo que es necesario plantear nuevas políticas que permitan una mejor redistribución de los recursos disponibles y, de esta forma, fortalecer a los entes territoriales y regular la prestación de los servicios pediátricos en todo el país de acuerdo a las múltiples necesidades en salud de las diferentes regiones.

Flu pandemic, world power, and contemporary capitalism: building a historical-critical perspective.

OBJECTIVES: To present a historical-critical analysis of the configuration process of the 2009-2010 flu pandemic in order to show the relationships between this process and the organization of world power, and to promote social and political mobilization. METHODS: Primary and secondary sources on the dynamics of the 2009-2010 flu pandemic were studied. The sources were validated by plausibility assessment and historiographical analysis. From a historical-territorial and critical approach, the relations between the world configuration of the pandemic and the economic, political, and ideological power relations of contemporary capitalism were identified. RESULTS: It is revealed that the expanding monopoly of the pig industry provided favorable conditions for the evolutionary explosion of the influenza A(H1N1) virus. The World Health Organization (WHO) made decisions that were inclined toward the economic interests of the pig and pharmaceutical industries within the framework of financial-cognitive capitalism. CONCLUSIONS: The modes of conduct of these institutions and companies materialized the world relations of economic, political, and ideological power of our time, which determined the configuration process of the pandemic. The worldwide spreading of the virus is barely a trail of the process.

Universal health coverage and capital accumulation: a relationship unveiled by the critical political economy approach.

OBJECTIVES: To analyze the fundamentals of the global health agenda from 1944 to 2018, especially regarding Universal Health Coverage, in order to unveil its relations with capital accumulation in health services and to contribute to world social mobilization to change this tendency. METHODS: A historical study was carried out based on a purposeful selection of primary sources on the global health agenda from multilateral organizations and secondary sources about the changes of capitalism from the study period. RESULTS: The global health agenda changed from the state responsibility for health to an insurance healthcare system based on markets. The medical-industrial complex pressured national economies, broke postwar pacts, and urged economic globalization. The neoliberal, neoclassical, and neo-institutional discourse that promoted a new state-market relationship eased the new capital accumulation in healthcare into financial and cognitive capitalism. CONCLUSIONS: Understanding these relationships allows us to provide elements for social mobilization geared to transform the healthcare sector toward a new vision of health with a nature-society relationship that contributes to socially constructing human and environmental health, rather than gaining profits based on illness and chronic suffering.

Capacidades de investigación sobre determinantes sociales de la salud en Brasil, Colombia y México / Research capacities on social determinants of health in Brazil, Colombia and Mexico / Capacidades de investigação sobre determinantes sociais da saúde no Brasil, Colômbia e México

RESUMEN Objetivo: analizar las capacidades de investigación sobre determinantes sociales y determinación social de los procesos saludenfermedad (DSS) en Brasil, Colombia y México con base en los sistemas nacionales de ciencia, tecnología e innovación (SNCTI) y la producción científica sobre DSS (2005-2012) de cada país. Metodología: se realiza un estudio exploratorio a partir de revisión de literatura, consulta de plataformas nacionales de cada SNCTI, entrevistas y foros de consulta, contemplando las siguientes categorías de estudio para analizar las capacidades de: 1. Producción científica, formación de investigadores y políticas relativas a capacidades de investigación; 2. Redes de colaboración; 3. Infraestructura para la investigación y 4. Producción y apropiación social del conocimiento. Resultados y Discusión: la investigación sobre DSS se divulga principalmente en revistas científicas de circulación nacional, en Brasil y Colombia, mientras que en México se publica principalmente en revistas extranjeras. Los tres países cuentan con SNCTI consolidados, sin embargo, son escasos los montos de financiamiento para investigación sobre DSS. Conclusiones: es necesario articular acciones de fortalecimiento de capacidades de investigación, fortaleciendo redes y posicionando los DSS en agendas estratégicas.

ABSTRACT Objective: to analyze the research capacities on social determinants and social determination of the health-disease process (SDH) in Brazil, Colombia and Mexico based on the characteristics of the National Systems of Science, Technology and Innovation (SNCTI) and the scientific production on SDH between 2005 and 2012. Methodology: an exploratory study was conducted. Data were obtained from literature reviews, the national platforms for each SNCTI, interviews and forums. The following categories of study were taken into account when analyzing capabilities: 1. Scientific production, training of researchers and policies concerning research capabilities. 2. Collaborative networks; 3. Infrastructure for research and 4. Production and social appropriation of knowledge. Results and discussion: research on SDH is primarily published in scientific journals. In Brazil and Colombia, findings are primarily published in national journals, while the majority of research on SDH from Mexico is published in international journals. All three countries have solid SNCTI. However, funding for research on SDH is scarce. Conclusion: it is necessary to coordinate actions to strengthen the capacities for research on SDH in order to strengthen networks and position SDH on strategic agendas.

RESUMO Objetivo: analisar as capacidades de investigação sobre determinantes sociais e determinação social dos processos saúdedoença (DSS) no Brasil, Colômbia e México com base nos sistemas nacionais de ciência, tecnologia e inovação (SNCTI) e a produção científica sobre DSS (2005-2012) de cada país. Metodologia: Se realiza um estudo exploratório a partir da revisão de literatura, consulta de plataformas nacionais de cada SNCTI, entrevistas e foros de consulta, contemplando as seguintes categorias de estudo para analisar as capacidades: 1. Produção científica, formação de investigadores e políticas relativas a capacidades de investigação; 2. Redes de colaboração; 3. Infraestrutura para a investigação e 4. Produção e apropriação social do conhecimento. Resultados e discussão: A investigação sobre DSS se divulga principalmente em revistas científicas de circulação nacional, em Brasil e Colômbia, entanto que no México se publica principalmente em revistas estrangeiras. Os três países contam com SNCTI consolidados, mas, são escassos os montantes de financiamento para investigação sobre DSS. Conclusão: È necessário articular ações de fortalecimento de capacidades de investigação, fortalecendo redes e posicionando os DSS em agendas estratégicas.

Uma análise crítica da abordagem dos Determinantes Sociais da Saúde a partir da medicina social e saúde coletiva latino-americana / A critical analysis of the social determinants of health approach from the perspective of the latin american social medicine and collective health

O enfoque dos Determinantes Sociais da Saúde tem tido ampla difusão e foi aparentemente bem acolhido globalmente. Este artigo assume uma visão crítica desse enfoque, buscando sistematizar as críticas principalmente provenientes de debates no interior da medicina social e saúde coletiva latino-americana, que se articularam ao redor da diferenciação entre Determinantes Sociais da Saúde e a determinação social dos processos saúde-doença. Pretendemos examinar estas diferenças para problematizar a aparente unanimidade retórica em prol da equidade. Ainda que a abordagem dos Determinantes Sociais da Saúde marque um enorme avanço na mobilização pela equidade em saúde, em nossa avaliação ela não consegue ser mais do que um avanço incompleto.

This article seeks to critically analyze the Social Determinants of Health approach and proposes a synthesis of the critique that has shaped the debate and particularly found expression in the differentiation between SDH and the Latin American Social Medicine and Collective Health 'social determination of the health-disease processes' approach. Reexamining the apparent rhetoric unanimity that defined the agenda of the mobilization around the Social Determinants of Health, we seek to address the differences between these approaches and conclude that the Social Determinants of Health approach marks an important but incomplete advance in the mobilization towards the reduction of health inequities.

La reforma sanitaria en la Colombia definales del siglo xx: aproximación histórica desde el análisis sociopolítico / The health care reform in Colombia in the late twentieth century: historical approach from the socio-political analysis / Reforma sanitária na Colômbia dos finaisdo século xx: aproximação histórica desde a análise sociopolítica

El artículo busca estudiar, desde un enfoque sociopolítico, el proceso de reforma del sistema de salud en Colombia que tuvo lugar en la última década del siglo xx. El estudio recurre alanálisis documental para reconstruir el proceso de cambio, caracterizar las diferentes propuestas agenciadas por los actores políticos y mostrar las tensiones que se plantean al concretar y poner en práctica las propuestas de cambio. Se muestran algunos momentos del proceso de cambio normativo, y también tendencias discursivas y polémicas entre actores, con el fin de evidenciar la complejidad de un proceso de reforma que si bien aparenta ser muy técnico, en su esencia es eminentemente político...

The article aims to study, from a sociopolitical approach, the process of health reform in Colombia, which took place in the last decade of the twentieth century. The study draws on documentary analysis to reconstruct the process of change, characterize the different proposed agency foundpolitical players and displays the tensions that arise when specifying and implementing the proposed changes. The study show some moments in the process of regulatory change, trendsand controversial discourse among actors in order to evidence the complexity of a process of reform although appears to be exclusively technical is in its essence eminently political...

O artigo procura estudar, desde um enfoque sociopolítico, o processo de reforma do sistema de saúde na Colômbia que teve lugar na última década do século xx. O estudo recorre à análise documental para reconstruir o processo de mudança, caracterizar as várias propostas agenciadaspelos atores políticos e mostrar as tensões que se esboçam ao concretizar e pôr em prática as propostas de mudança. Mostram-se alguns momentos do processo de mudança normativa,mesmo que tendências discursivas e polemicas entre atores, com a finalidade de evidenciar a complexidade de um processo de reforma que, se bem, aparenta ser muito técnico, na sua essência é eminentemente político...

Equidad de etnia en el acceso a los servicios de salud en Bogotá, Colombia, 2007 / Ethnic equity in accessing health services in Bogotá, Colombia, 2007

Objetivo Identificar inequidades en el acceso a los servicios de salud derivadas de la pertenencia étnica en Bogotá. Metodología En el 2007 se realizaron 39 entrevistas a profundidad y seis grupos focales con integrantes de los grupos étnicos. Los hallazgos cualitativos se contrastaron con los resultados del procesamiento estadístico de datos provenientes de la Encuesta Calidad de Vida 2003 y la ficha de caracterización de la estrategia de Atención Primaria en Salud, denominada Salud a su Hogar en Bogotá, discriminando variables demográficas, socioeconómicas, de necesidades, acceso y resultados en salud. Resultados Se caracterizaron las siguientes etnias: indígenas, negros, raizales isleños y gitanos. Se documentaron diferencias a nivel socioeconómico, educativo, laboral, en el acceso al aseguramiento, utilización de servicios y resultados en salud, que se consideran inequidades relacionadas con las siguientes condiciones determinantes: 1.Discriminación étnica y racial. 2. Diferencias en el estatus social, económico y político y violación de derechos. 3. Interacciones entre inmigración, aculturación y asimilación. Conclusiones Existen inequidades derivadas de la pertenencia étnica en Bogotá en el acceso a los servicios de salud expresadas en desigualdades en el acceso según las necesidades, indicios de violación de derechos, discriminación negativa y falta de adecuación y reconocimiento de las diferencias étnicas.

Objective Identifying inequalities in gaining access to health services resulting from ethnicity in Bogota. Methods 39 in-depth interviews with focus groups and six members of ethnic groups were conducted during 2007. Qualitative findings were contrasted with the results from statistically processing data from the Quality of Life Survey 2003 and characterising the Primary Health Care strategy called "Health in your Home in Bogota", discriminating the following variables: demographic, socio-economic, needs, access and health outcomes. Results The following ethnic groups were characterised: indigenous people, black people, gypsies and islanders. Differences in socioeconomic status, education, employment, access to health insurance, use of health services and outcomes were documented as these were considered to be inequities related to the following determinants: ethnic and racial discrimination, differences in social, economic and political status and violation of rights, interactions between immigration, acculturation and assimilation and differentials exposure. Conclusions There are ethnic inequities in gaining access to health services because there is no adequate access as required; there is violation of rights, discrimination, a lack of adaptation and appreciation of differences. These situations are considered to be examples of cultural and distributive injustice. Ethnicity determines levels of social vulnerability and takes specific forms regarding life, health and disease, thereby becoming a structural determinant of studying ethnic-equity in gaining access to health services.

El concepto de equidad y el debate sobre lo justo en salud / The concept of equity and the debate about fairness in health

El ensayo presenta la propuesta de entender la equidad en salud en el marco de la discusión ético-política de la justicia, para lo cual se revisa el debate actual y se muestran las implicaciones en la definición de políticas públicas y en la organización de los sistemas de servicios de salud. En segunda instancia se presenta la idea de la historicidad del debate y de sus realizaciones en las sociedades contemporáneas, de manera que el predominio de una u otra posición es un resultado histórico que depende de las relaciones de poder y la correlación de fuerzas en el interior de cada sociedad, en el marco de la interdependencia global. Con base en lo anterior, se sugiere un proceso de construcción democrática para avanzar en una nueva configuración de la equidad en salud para los países latinoamericanos.

This work deals with understanding equity in health within the framework of an ethical-political discussion of justice; current debate on this issue is reviewed and the implications in defining public policy and organising health service systems are shown. The debate’s historicity and how it is carried out in contemporaneous societies is presented so that one or another position’s predominance is a historical result depending on power relationships and correlating efforts within each society, within the framework of global interdependency. A process of democratic construction is thus suggested, based on the foregoing, for advancing towards a new configuration of equity in health for Latin-American countries.

[Ethnic equity in accessing health services in Bogotá, Colombia, 2007]. / Equidad de Etnia en el Acceso a los Servicios de Salud en Bogotá, Colombia, 2007.

OBJECTIVE: Identifying inequalities in gaining access to health services resulting from ethnicity in Bogota. METHODS: 39 in-depth interviews with focus groups and six members of ethnic groups were conducted during 2007. Qualitative findings were contrasted with the results from statistically processing data from the Quality of Life Survey 2003 and characterising the Primary Health Care strategy called 'Health in your Home in Bogota', discriminating the following variables: demographic, socio-economic, needs, access and health outcomes. RESULTS: The following ethnic groups were characterised: indigenous people, black people, gypsies and islanders. Differences in socioeconomic status, education, employment, access to health insurance, use of health services and outcomes were documented as these were considered to be inequities related to the following determinants: ethnic and racial discrimination, differences in social, economic and political status and violation of rights, interactions between immigration, acculturation and assimilation and differentials exposure. CONCLUSIONS: There are ethnic inequities in gaining access to health services because there is no adequate access as required; there is violation of rights, discrimination, a lack of adaptation and appreciation of differences. These situations are considered to be examples of cultural and distributive injustice. Ethnicity determines levels of social vulnerability and takes specific forms regarding life, health and disease, thereby becoming a structural determinant of studying ethnic-equity in gaining access to health services.

[The concept of equity and the debate about fairness in health]. / El Concepto de Equidad y el Debate sobre lo Justo en Salud.

This work deals with understanding equity in health within the framework of an ethical-political discussion of justice; current debate on this issue is reviewed and the implications in defining public policy and organising health service systems are shown. The debates historicity and how it is carried out in contemporaneous societies is presented so that one or another positions predominance is a historical result depending on power relationships and correlating efforts within each society, within the framework of global interdependency. A process of democratic construction is thus suggested, based on the foregoing, for advancing towards a new configuration of equity in health for Latin-American countries.

Diseño de un observatorio de Equidad en Calidad de Vida y Salud para Bogotá / Design of an observatory of equity as life and health for Bogota

El artículo recoge los resultados del trabajo realizado por el Grupo de Protección Social del Centro de Investigaciones para el Desarrollo (CID) de la Facultad de Ciencias Económicas de la Universidad Nacional de Colombia, en el marco del Convenio interadministrativo con la Secretaría Distrital de Salud (SDS), para la elaboración de una propuesta de diseño de un observatorio de equidad en calidad de vida y salud para Bogotá. Con tal propósito se realizó una revisión minuciosa del debate internacional y nacional sobre el tema de la equidad en salud, como punto de partida para la formulación de un enfoque teórico para el observatorio. Adicionalmente se revisó la experiencia de los observatorios de equidad en salud de las ciudades de Londres, Bruselas y Montreal, como referentes internacionales para el diseño. Con base en lo anterior, se elaboró una propuesta de diseño del observatorio que incluye el enfoque teórico adoptado, los objetivos, los procesos centrales, los métodos y la estructura básica de operación. Tratándose de un diseño, la operación del observatorio será el resultado de nuevas decisiones institucionales, si se considera que la propuesta presentada aquí tiene lugar, importancia y viabilidad para el futuro de la ciudad.

The article summarizes the results of the work done by the Social Protection Group of the Development Investigation Center (CID) of the Faculty of Economic Sciences of the National University of Colombia, according to the interadministrative agreement with the District Secretary of Health (SDS), for the elaboration of a design proposal for an observatory for equity in quality of life and health in Bogotá. With this in mind, they undertook a minute review of national and international debates on the subject of equity in health, as a point of departure for the formulation of a theoretical basis for the observatory. Additionally they reviewed the experiences of such equity in health observatories in cities such as London, Brussels, and Montreal, as international referents for the design. Based on the above, they created a design proposal for the observatory that includes the adopted theoretical focus, the objectives, the central processes, the methods and the basic structure of the operation. Speaking of this design, the operation of the observatory will come about through new institutional decisions, if the present proposal is considered to be important and viable for the future of the city.

El enfoque sociopolítico para el análisis de las reformas sanitarias en América Latina

Tomando en cuenta el informe sobre la salud mundial 2000, de la Organización Mundial de la Salud, se analiza el porqué el resultado presentado en el mismo es contraproducente, y no concuerda con lo que aprecian la mayoría de los sanitaristas que lo estudian. Se trata entonces de un análisis de contenido del informe sobre la salud mundial 2000 y de otros documentos sobre reforma sanitaria, utilizando el enfoque sociopolítico como método y recurso heurístico o una manera de ver el problema. El debate sobre los sistemas de salud se ha concentrado en el dilema entre equidad y eficiencia. Las posiciones van desde los que consideran que no existe tal dilema, en la medida en que el mercado resuelve directamente la distribución mientras se respete la elección individual, hasta los que piensan que es necesario priorizar la opción política por la equidad para luego desarrollar estrategias de manejo eficiente de los recursos. Así piensa el autor. Profundizando en el caso colombiano, nacionalidad del autor, se afirma que el diseño de la reforma en su país y otros latinoamericanos no logra una garantía de derecho a la salud, como se promete. Son componentes de la reforma del sistema en Colombia: aseguramento obligatorio con un fondo único administrado por el Estado, establecer un plan mínimo obligatorio de beneficios, contratar a los administradores del seguro de pólizas individuales ajustadas a riesgo y desarrollar mecanismos de focalización del gasto público para incorporar al mercado a los extremadamente pobres. Para el análisis de las reformas sanitarias, la perspectiva de las redes de poder organizadas y superpuestas permite explorar la articulación entre las políticas estatales, como las de salud y seguridad social, y las relaciones económicas, sociales y políticas en una sociedad particular. Los estados se construyen en el conflicto entre las fuerzas sociales. Tal conflicto resulta de la relación entre las diferentes órdenes posibles, construidos, vividos e imaginados por las distintas formas de organización social. Se trata entonces de conflictos normativos, sustentados en relaciones sociales y económicas. En el caso de la asistencia médica moderna los sistemas de valores se confrontan para tratar de establecer lo que se considera justo. Esto es, a que se tiene derecho. Allí se ubican los modelos diseñados por la tecnocracia, pero siempre existem muchos más, los que los actores sociales ...AU)