Jasmine Gideon

Accessing economic and social rights under neoliberalism: gender and rights in Chile

Abstract There is now a general consensus regarding the importance of social and economic rights within development and, recently, the language of womens human rights has been adopted by organisations that focus on gender and development and draw mainly upon economic and social analysis. Despite some limitations from a gender perspective, human rights instruments such as the International Covenant on Economic, Social and Cultural Rights (icescr) can offer an important focus for such groups to claim these rights. Nevertheless, the challenge of upholding treaty obligations and guaranteeing rights to all citizens remains, particularly within the context of the neoliberal reforms that have been widely implemented in both the North and the South. Drawing on the case of Chile, this paper will consider how access to certain rights, including the rights to social security and health, can be made more difficult for some women and men as a consequence of processes following trade liberalisation and health sector reforms. An analysis of power relations is central to understanding the failure of states to guarantee an enabling environment for womens enjoyment of their social and economic rights, as many women remain excluded from decision-making processes within policy arenas.

Gender, Globalization, and Health in a Latin American Context

Book synopsis: Using a political economy of health, Gender, Globalization, and Health in a Latin American Context demonstrates how the development of health systems in Latin America was closely linked to mens participation in formal labor. This established an inherent male bias that continues to shape health services today. While economic liberalization has created new jobs that have been taken up mainly by women, these jobs fail to offer the same health entitlements. Author Jasmine Gideon explores the resultant tensions and gender inequalities, which have been further exacerbated in the context of health care commercialization.

Understanding differences in access and use of healthcare between international immigrants to Chile and the Chilean-born: a repeated cross-sectional population-based study in Chile

IntroductionInternational evidence indicates consistently lower rates of access and use of healthcare by international immigrants. Factors associated with this phenomenon vary significantly depending on the context. Some research into the health of immigrants has been conducted in Latin America, mostly from a qualitative perspective. This population-based study is the first quantitative study to explore healthcare provision entitlement and use of healthcare services by immigrants in Chile and compare them to the Chilean-born.MethodsData come from the nationally representative CASEN (Socioeconomic characterization of the population in Chile) surveys, conducted in 2006 and 2009. Self-reported immigrants were compared to the Chilean-born, by demographic characteristics (age, sex, urban/rural, household composition, ethnicity), socioeconomic status (SES: education, household income, contractual status), healthcare provision entitlement (public, private, other, none), and use of primary services. Weighted descriptive, stratified and adjusted regression models were used to analyse factors associated with access to and use of healthcare.ResultsThere was an increase in self-reported immigrant status and in household income inequality among immigrants between 2006 and 2009. Over time there was a decrease in the rate of immigrants reporting no healthcare provision and an increase in reporting of private healthcare provision entitlement. Compared to the Chilean-born, immigrants reported higher rates of use of antenatal and gynaecological care, lower use of well-baby care, and no difference in the use of Pap smears or the number of attentions received in the last three months. Immigrants in the bottom income quintile were four times more likely to report no healthcare provision than their equivalent Chilean-born group (with different health needs, i.e. vertical inequity). Disabled immigrants were more likely to have no healthcare provision compared to the disabled Chilean-born (with similar health needs, i.e. horizontal inequity). Factors associated with immigrants’ access to, and use of, healthcare were sex, urban/rural status, education and country of origin.ConclusionThere were significant associations between SES, and access to and use of healthcare among immigrants in Chile and a higher prevalence of no health care provision entitlement among poor and disabled immigrants compared to the Chilean-born. Changing associations between access and use of healthcare and SES among immigrants in Chile over time may reflect changes in their socio-demographic composition or in the survey methodology between 2006 and 2009.ResumenIntroducciónLa evidencia internacional indica menor acceso y uso de servicios de salud por parte de inmigrantes, pero sus factores desencadenantes varían significativamente dependiendo del contexto. Algunas investigaciones se han desarrollado en este tema en América Latina, desde una perspectiva cualitativa. Este estudio cuantitativo exploró el auto-reporte de acceso y uso de servicios de salud de inmigrantes en Chile y los comparó con la población chilena.MétodosAnálisis secundario de datos de encuesta nacional CASEN 2006 y 2009. Inmigrantes fueron comparados con chilenos en características demográficas (edad, sexo, urbano/rural, composición del hogar, etnia), estatus socioeconómico (educación, ingreso, situación contractual), tipo de previsión (pública, privada, otra, ninguna), y uso de varios servicios de atención primaria. Análisis descriptivo, estratificado, y modelos de regresión ponderados para entender factores asociados al acceso y uso de servicios de salud en STATA 11.0.ResultadosSe observó un aumento de reporte de inmigrantes y de la desigualdad en el ingreso de inmigrantes entre 2006 y 2009. Hubo una disminución en la tasa de inmigrantes sin previsión y un aumento en el acceso al sistema privado. Los inmigrantes usaron más frecuentemente la atención prenatal y ginecológica, y menos la atención del niño sano. No hubo diferencia en el uso de citología vaginal o el número total de atenciones recibidas en comparación con los chilenos. Los inmigrantes en el quintil inferior de ingresos reportaron 4 veces más la ausencia de prestación de salud que los chilenos (inequidad vertical). Similares resultados se observaron al comparar inmigrantes con discapacidad con chilenos con discapacidad (inequidad horizontal). Los factores asociados con el acceso y uso del servicio de salud por parte de los inmigrantes fueron el sexo, urbano/rural, educación y país de origen.ConclusiónSe observó una asociación significativa entre estatus socioeconomico, migración y acceso y uso de asistencia sanitaria. Los resultados de este estudio pueden deberse a verdaderos cambios en la composición de los inmigrantes y sus patrones de uso del sistema de salud chileno, pero también pueden deberse a cambios en la metodología y recolección de datos entre encuestas 2006 y 2009. Este aspecto requiere mayor análisis y debate en la región.

A Gendered Analysis of Labour Market Informalization and Access to Health in Chile

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.

Unpacking ‘women’s health’ in the context of PPPs: A return to instrumentalism in development policy and practice?:

There has been a significant increase in funding for health programmes in development over the last two decades, partly due to the formation of public–private partnerships. This article examines the impact of public–private partnerships from the perspective of women’s health, asks whether the current culture of funding has led to an increased instrumentalism in women’s health programming and what effects this has on how women’s health is addressed at the level of practice. The article is based on research carried out with UK-based non-governmental organisations (NGOs), and its conclusions raise further challenges for improving women’s health policies and programmes in development.

Exploring migrants' health seeking strategies: the case of Latin American migrants in London

Purpose – The objective of this paper is to examine the health seeking strategies of Latin American migrants in London.Design/methodology/approach – The paper draws on a small case study analysis conducted with Latin American migrants in London and relevant stakeholders.Findings – The paper highlights that even where Latin American migrants do have entitlements to use the NHS, a series of informal barriers limits their access. As a consequence many employ a range of transnational health‐seeking strategies in order to seek resolution to their health problems. These findings repeat those identified in other studies and point to the need to gain a better understanding of migrants exclusion and marginalisation in relation to formal health care providers. At the same time, the findings point to the lack of long‐term resolution many migrants experience in relation to their health care needs, raising important questions about health inequalities.Research limitations/implications – Latin Americans represent a hu...

What is hindering progress? The marginalization of women's sexual and reproductive health and rights in Brazil and Chile

The paper draws on the cases of Brazil and Chile to consider the lack of progress towards securing better health outcomes for women in the field of sexual and reproductive health and rights (SRHR). At first glance, these poor outcomes for women appear surprising, given that both countries represent middle-income countries where significant developments have occurred towards ensuring universal access to healthcare services. Yet, a more nuanced analysis uncovers the historically constructed gender regimes and policy legacies within relevant institutions that act to limit progress. The discussion in the paper specifically focuses on the evolution of the health sector in the two countries, the role of the medical profession and the influence of the Catholic Church, which, we argue, have been key to constraining womens SRHR in Brazil and Chile.

Gendering activism, exile and wellbeing: Chilean exiles in the UK

Abstract Drawing on the case of Chilean exiles in the UK this article looks at the experiences of exiles through a gender lens. The analysis argues for the need to recognise the gendered nature of spaces of political activism in order to highlight the contribution made by many Chilean women to life in exile. Using a gender lens sheds light on the multiple ways in which many women were indirectly the victims of abuse under the military regime and how this impacts on their mental health and wellbeing. The analysis also provides new insights into how forced migration impacts on gender roles and norms among those living in exile. The article primarily focuses on the experiences of women who arrived in the UK as the ‘wife of’ political activists, a group whose needs have been frequently overlooked.

Exploring public private partnerships in health and education: a critique

The landscape of partnerships in international development has been changing rapidly over the past decade, with significant realignment of roles between the state, private and third sectors. Public Private Partnerships (PPPs) have emerged as a key form through which healthcare and education are defined, delivered, and, evaluated in developing countries. PPPs are deemed to offer potential for addressing inequalities in provision and access to public services across the Global South, ensuring that resources are targeted equitably and effectively. The articles in this themed section review some of the evidence on PPPs considering whether and in what ways they deliver on addressing intersecting inequalities. PPPs have been promoted as an important development financing mechanism in support of the Sustainable Development Goals (SDGs). SDG 17 outlines a vision for partnerships between governments, private sector and civil society, and delineates these as ‘inclusive partnerships built upon principles and values, a shared vision, and shared goals that place people and the planet at the centre, are needed at the global, regional, national and local level.’ (UN, 2015). The goal envisages these partnerships as an effort ‘to mobilize, redirect and unlock the transformative power of trillions of dollars of private resources to deliver on sustainable development objectives’ (UN, 2015). Under Goal 17, there is an explicit target on PPPs: ‘Encourage and promote effective public, public-private and civil society partnerships, building on the experience and resourcing strategies of partnerships’ (UN, 2015). PPP is a loose term that covers a wide range of arrangements across different sectors and it is open to a diverse range of interpretations (see Languille, this issue). Nevertheless, common to all, is the notion of some shared financial and governance arrangement between the public, that is the state sector, largely financed by revenue, and sometimes aid, and the private sector, which may comprise local or global capital. When PPPs have a significant transnational element they are referred to Global Public Private Partnerships (GPPs). One of the central justifications made by supporters of GPPPs is that they have led to large increases in the amount of money that is available for health and education interventions, which was not forthcoming from national revenue collection or aid budgets. However, this same observation comprises one of their major critiques, in that the financialization of the means of social reproduction in sectors such as health and education, skews the direction of policy and practice in the direction of enhancing

Public-private partnerships in sexual and reproductive healthcare provision: establishing a gender analysis

ABSTRACT The past few decades have seen the growing popularity of public-private partnerships (PPPs) across the health sector – a catch all term used to encompass diverse activities involving both public and private sector entities in areas of global and domestic health. In the article we consider the factors that have led to this proliferation of PPPs in the healthcare delivery field and consider the link to the process of ‘scientization’ of healthcare. With a focus on sexual and reproductive health the article also considers two commonly used mechanisms employed in SRH service delivery that have been used in PPPs – social franchise and health voucher schemes. We then reprise key points from the existing critical literature on gendered health systems and go on to consider their application to such service provision-oriented PPPs, using an exploratory analysis of a case study of the use of maternal health vouchers in India.