Rama Baru

Critical perspectives on the NIMH initiative “Grand Challenges to Global Mental Health”.

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Understanding health systems, health economies and globalization: the need for social science perspectives

The complex relationship between globalization and health calls for research from many disciplinary and methodological perspectives. This editorial gives an overview of the content trajectory of the interdisciplinary journal ‘Globalization and Health’ over the first six years of production, 2005 to 2010. The findings show that bio-medical and population health perspectives have been dominant but that social science perspectives have become more evident in recent years. The types of paper published have also changed, with a growing proportion of empirical studies. A special issue on ‘Health systems, health economies and globalization: social science perspectives’ is introduced, a collection of contributions written from the vantage points of economics, political science, psychology, sociology, business studies, social policy and research policy. The papers concern a range of issues pertaining to the globalization of healthcare markets and governance and regulation issues. They highlight the important contribution that can be made by the social sciences to this field, and also the practical and methodological challenges implicit in the study of globalization and health.

Global Social Policy Forum: Introduction: Reclaiming Primary Health Care - Why Does Alma Ata Still Matter? Or Can We Still Speak of the Relevance of Alma Ata?

The last three decades have seen far reaching changes in health service systems across the globe. Rampant commercialization and health sector reforms have reshaped health services and have adversely affected the principles of equity and universality. There is growing evidence of increasing inequalities within and across countries in terms of health status and access to health services. This has contributed to the re-emergence of interest and focus on a primary health care approach that was articulated 30 years ago. Although the strategy was reversed by the selective primary health care approach, the idea has continued to be important both as a concept and a design for health systems. The Alma Ata declaration has thus provided a basis for the mobilization of peoples’ health movements that have been actively contesting the growing inequalities in health. In recent meetings on primary health care in Argentina in 2007 and in the context of development of primary health care in Africa there is a growing recognition of the importance of the primary health care approach for national health systems. This forum brings together the voices of two generations of public health researchers and activists. These include those who were involved with agenda setting and the process of conceptualizing and designing the primary health care approach, and also those who have kept the idea alive in the networks from both the North and the South. We are pleased to have contributors Professor Debabar Banerji from India and Professor Vicente Navarro bring a critical perspective on the priorities and processes of the last 30 years. They recount the process that led to Alma Ata, and also analyse the politics of its G S P F O R U M 147

Globalisation and neoliberalism as structural drivers of health inequities

In this paper, we draw upon and build on three presentations which were part of the plenary session on ‘Structural Drivers of Health Inequities’ at the National Conference on Health Inequities in India: Transformative Research for Action, organised by the Achutha Menon Centre for Health Science Studies in Trivandrum, India. The three presentations discussed the influential role played by globalisation and neoliberalism in shaping economic, social and political relationships across developed and developing countries. The paper further argues that the twin process of globalisation and liberalisation have been important drivers of health inequities. The first segment of the paper attempts a broader conceptualisation of neoliberalism beyond the economic realm. Using Stephanie Lee Mudge’s conceptualisation (Soc Econ Rev 6:703–3, 2008) we have analysed how the political, bureaucratic and intellectual domains of neoliberalism have intersected and redefined the role of state and commercialised health services leading to inequities. Neoliberal ideas have reconfigured the role and changed the priorities of non-governmental organisations resulting in a fracture within this movement. n the second segment, we focus on the rise of American philanthro-capitalism, and how the two major foundations, the Rockefeller Foundation (early twentieth century) and the Bill and Melinda Gates Foundation (twenty-first century), have shaped the ideology of institutions engaged in international health and influenced the global health agenda. We discuss how the activities of philanthro-capitalists have transformed the architecture of health governance through their top-down organisational culture and deficit of structures to ensure accountability. The third and final segment of the paper focuses on how neoliberalism as a political project and cultural movement has forged alliances with conservative politics and religious fundamentalisms, resulting in negative consequences for women and other marginalised groups. These alliances have resulted in the control of women’s bodies and contributed to the reversal of hard-won rights for health and gender justice in many parts of the world.

Regulating recognition and training for new medical specialties in India: the case of emergency medicine

Regulation is essential to health systems and is central to advancing equity-oriented policy objectives in health. Regulating new medical specialties is an emerging, yet underexplored, aspect of health sector governance in low- and middle-income countries (LMICs), such as India. Limited research exists regarding how regulatory institutions in India decide what specialties should be formally recognized and how training programmes for these specialties should be organized. Understanding these regulatory functions provides a lens into how policymakers envision the role of these specialties in the broader health system and how they view the linkages between medical education, health system needs and equity. Drawing upon the recent development of emergency medicine in India, the goal of this study was to understand how recognition and training for new medical specialties are regulated in India. Building on previous frameworks, we examined the institutions, functions, enforcement, mechanisms and institutional relationships that make up the regulatory architecture, and situated our analysis in historical context. Two data sources were iteratively utilized: document review (n = 93) and in-depth interviews (n = 87). Our analysis reveals a plurality of institutions involved in regulating recognition and training for new medical specialties in India, characterized by a lack of coordination, limited collaboration and weak accountability. We also found an absence of clear responsibility for the systematic, planned development of specialties, particularly in terms of health system in strengthening and achieving health equity. As medical specialization continues to shape health systems in LMICs, further streamlining and coordination in the regulatory system will enable policymakers, researchers, practitioners and civil society to proactively plan for how these specialties can better integrate with health systems, and to advance their contribution to improving health outcomes.

Epidemics as Markers of Socio-economic Inequalities

The last two decades have been marked by sustained economic growth with the persistence and in some cases widening of regional and socio-economic inequalities. The resurgence of infectious diseases is a marker of these growing inequalities and poor public health services in India.

Regional Perspectives from South Asia

This issue of Global Social Policy sees the introduction of a new element – Regional Perspectives. The Regional Perspectives section is a space for our Regional Editors to report on key developments or issues from their regions of the world. The substance of each piece will vary according to the perspective of the Regional Editors from different parts of the world. We are very pleased to have the first Regional Perspectives piece written by our colleague Rama V. Baru, who has been instrumental in developing the journal in South Asia. We look forward to all future contributions. R E G I O N A L P E R S P E C T I V E S 355