Asa Cristina Laurell

Market Commodities and Poor Relief: The World Bank Proposal for Health

Investing in Health is the World Banks blueprint for a new health policy within the context of structural adjustment. While this document includes a broad range of arguments, its implicit premises are neoliberal as can be deduced from its “agenda for action.” Health is defined as a private responsibility and health care as a private good. This leads to a health policy based on two complementary principles: the reduction of state intervention and public responsibility, and the promotion of diversity and competition (i.e., privatization). Thus, public institutions should provide only a limited number of public goods and narrowly defined, cost-efficient forms of relief for the poor. All other health-related activities are considered private duties, to be resolved by the market, NGOs, or families. The World Bank policy provides a pragmatic contribution to efforts to achieve fiscal balance. However, it also pushes to recommodify health care and to turn health into a terrain for capital accumulation through the selective privatization of health-related financial and “discretionary” services. The proposal implies large-scale experimentation and dismantling of public institutions which are the only alternative now accessible to the majority. It rejects health as a human need and a social right, and violates basic values by claiming that life and death decisions can be justly made by the market or through a cost-effectiveness formula.

Health Reform in Mexico: The Promotion of Inequality

The Mexican health reform can be understood only in the context of neoliberal structural adjustment, and it reveals some of the basic characteristics of similar reforms in the Latin American region. The strategy to transform the predominantly public health care system into a market-driven system has been a complex process with a hidden agenda to avoid political resistance. The compulsory social security system is the key sector in opening health care to private insurance companies, health maintenance organizations, and hospital enterprises mainly from abroad. Despite the governments commitment to universal coverage, equity, efficiency, and quality, the empirical data analyzed in this article do not confirm compliance with these objectives. Although an alternative health policy that gradually grants the constitutional right to health would be feasible, the new democratically elected government will continue the previous regressive health reform.

Disease and Rural Development: A Sociological Analysis of Morbidity in Two Mexican Villages

It is suggested that the problem of the social causes of disease should be analyzed on the basis of the significant social processes of a given society. In this theoretical framework, a comparative study of two Mexican rural villages at different degrees of development is presented in order to clarify two related questions: what is the impact on morbidity of the rural development process, and what is the influence of socio-economic conditions on the distribution of disease in the population? It was found that morbidity was significantly higher in the more “developed” village than in the one characterized by a predominantly subsistence economy. This finding is ascribed to the character of Mexican rural development, similar to that of other subordinated countries, which implies a change from subsistence agriculture to cash-crops in an unstable market, a massive conversion of peasants into wage laborers with unstable employment, and substantial migration; these phenomena give rise to new, unfavorable living and working conditions for large parts of the rural population. It is argued that it is not development as such that is responsible for the increase in morbidity, but the particular form that it assumes in the dependent countries. It was also found that socioeconomic characteristics such as peoples position in production, the sector of economic activity, and migration patterns define groups of high and low morbidity more clearly than do sanitary conditions and access to professional medical care. These results suggest that the success of public health activities depends on the possibility to plan the process of change.

Work and Health in Mexico

It is suggested that the relationship between work and health and disease traditionally has been analyzed in a limited way in that work has been considered only as a situational factor which puts workers in contact with environmental risks. It is proposed that work is an essential category for the understanding of disease, if one tries to study disease not as an individual biological phenomenon but as a social (and biological) phenomenon that occurs to the collectivity. Furthermore, it is suggested that the relation between disease and work should be analyzed in terms of the elements of the work process, understood as a technical and social process, and the capacity of different social groups to realize their interests. Reviewing the general trends of development of the work process in Mexico, it is shown that a transformation in the causes of death among men of working age has occurred during the last 20 years and there has been an increase in the number and the rate of work accidents and occupational diseases, despite a significant under-registration factor. Finally, the labor legislation on health and safety is contrasted with its actual implementation. This problem is interpreted in the context of traditional Mexican trade unionism. It is shown that trade unions which have become democratic and have gained their independence have struggled more vigorously on occupational health and safety issues.

Do Poverty Programs Alleviate Poverty? The Case of the Mexican National Solidarity Program

In recent years, compensatory poverty programs have been adopted in several countries in response to the social and political effects of structural adjustment programs implemented by most Latin American and African countries. The authors analyze the Mexican National Solidarity Program “Pronasol,” often cited as an exemplary social compensation program, by inquiring into its impact on poverty. The authors first investigate the relationship between structural adjustment and the process of impoverishment, in order to establish the dynamics and magnitude of poverty in Mexico. They find that the structural adjustment program has considerably increased poverty, mainly through a sustained wage decrease and job losses. The authors next discuss whether Pronasol complies with the requisites of a program that warrants a social minimum for the poor, and whether the resource allocation complies with objective criteria of the sociogeographic distribution of poverty. The data suggest that Pronasol cannot be considered to guarantee a social minimum for the poor, given the magnitude of poverty, the scarce resources allocated, the orientation of the subprograms, and the regional distribution of funds. Nor does it qualify as a social compensation program of any importance. Finally, an alternative interpretation of Pronasol is offered in the field of legitimation and political control.

Mortality and working conditions in agriculture in underdeveloped countries

The search for information and analysis of the mortality of agricultural workers in underdeveloped countries shows that there exists hardly any research on this subject. What little information that can be found is incomplete and scattered, making it difficult to gain systematic empirical knowledge of the problem. In addition, data are not collected for the purpose of explaining the patterns of mortality observed. It therefore seems necessary to generate a theoretical framework permitting the analysis of mortality among agricultural workers. This paper intends to point out the close relationship that exists between the mortality and the dynamic of the social and economic process of agriculture in the underdeveloped countries. By doing so, we hope to show that the problems of health, disease, and death of socially defined groups are not simply a matter of biology, but of the interrelation between biology and the historical process of which these groups are a part.

The free trade agreement and the Mexican health sector

This article presents a discussion of the probable implications for the Mexican health sector of the Free Trade Agreement (FTA) between the United States, Canada, and Mexico. The authors argue that the FTA should be seen as part of neoliberal policies adopted by the Mexican government in 1983 that are based on large-scale privatization and deregulation of labor relations. In this general context the health sector, which traditionally has been dominated by public institutions, is undergoing a deep restructuring. The main trends are the decapitalization of the public sector and a selective process of privatization that tends to constitute the private health sector in a field of capital accumulation. The FTA is likely to force a change in Mexican health legislation, which includes health services in the public social security system and recognizes the right to health, and to accelerate selective privatization. The U.S. insurance industry and hospital corporations are interested in promoting these changes in order to gain access to the Mexican market, estimated at 20 to 25 million persons. This would lead to further deterioration of the public institutions, increasing inequalities in health and strengthening the private sector. The historical trend toward the integration of a National Health Service in Mexico would be interrupted in favor of formation of a dual private-public system.

Three Decades of Neoliberalism in Mexico: The Destruction of Society

Neoliberalism has been implemented in Latin America for about three decades. This article reviews Mexico’s neoliberal trajectory to illustrate the political, economic, and social alterations that have resulted from this process. It finds that representative democracy has been perverted through fear, putting central political decisions in the hands of power groups with special interests. The border between the state of law and the state of exception is blurred. Economic structural adjustment with liberalization and privatization has provoked recurrent crisis, but has been maintained, leading to the destruction of the national productive structure in favor of supranational corporations, particularly financial capital. The association between criminal economy and economic criminality is also discussed. The privatization of social benefits and services requires state subsidies and allows the privatization of profits and the socialization of losses. The social impact of this process has been devastating, with a polarized income distribution, falling wages, increased precarious jobs, rising inequality, and extreme violence. Health conditions have also deteriorated and disorders associated with violence, chronic stress, and a changing nutritional culture have become dominating. However, in Latin America, massive, organized political and social mobilization has broken the vicious neoliberal circle and elected progressive governments that are struggling to reverse social and economic devastation.