Raquel Gallego

¿Quién se opone a la prevención?: Un mapa de los actores pro tabaco en España

Objetivos: Para poder realizar un abordaje integral de las politicas referidas al tabaquismo hay que conocer el mapa de los actores relacionados con el tabaco y sus vinculos politicos. En este trabajo se pretende presentar una primera aproximacion en Espana. Metodos: Analisis de la prensa, publicaciones de la industria y entrevistas con personas clave. Se identifican los actores pro tabaco activos en Espana, que se han podido clasificar segun su naturaleza, la esfera en que se mueven y su ambito territorial preferente. Resultados: Se identifican las empresas tabaqueras, entre las que destacan Altadis y Philip Morris por su dominio del mercado, las organizaciones del comercio minorista (estanqueros), las organizaciones «pantalla» creadas por la industria (Club de Fumadores por la Tolerancia), las de cultivadores y las empresas de transformacion. La distribucion esta dominada por Logista, filial de Altadis. Hay que tener en cuenta tambien las empresas de vending y de productos complementarios (mecheros, fosforos y papel). Se identifican los vinculos de estos actores con la Administracion publica, donde destaca el papel que desempena el Comisionado para el Mercado de Tabacos, asi como los Ministerios de Agricultura, Hacienda y Economia. Se identifican tambien las relaciones con la patronal, algunos partidos politicos y sindicatos, asi como con otros sectores empresariales con gran influencia social, como los medios de comunicacion y la publicidad. Conclusiones: El mapa de los actores pro tabaco en Espana es complejo y supera los limites de la estricta industria tabaquera. La comprension de este entramado es fundamental para poder plantear politicas integrales de prevencion.

A democratic public administration

In political theory public administration does not appear as a defining element of democracy. Moreover, traditional public administration is by definition a non-democratic organization. This paper argues that the democratisation of public administration is both necessary and appropriate. It is necessary in order to overcome some of the theoretical and empirical limitations of the politics/administration dychotomy. It is appropriate because it allows us to tackle these limitations and the difficulties derived from it by helping improve the efficiency and effectiveness, as well as the institutional performance, of administrations. First, the paper addresses, from a conceptual perspective, the question of ‘Why democratise public administration?’. Second, it explores the mechanisms through which democratisation may be achieved both in public administrations internal and external relations – that is, ‘How can public administration be democratised?’. The conclusions point out some implications for traditional models of administrative efficiency and political responsiveness – that is, for democratic politics.

Introducing Purchaser/Provider Separation in the Catalan Health Administration: A Budget Analysis

This article examines the extent to which the Catalan reform launched in 1990 effectively introduced the purchaser/provider separation within the public health administration. The reform had two formulation sources: a law passed by the Catalan Parliament, which left this principle vague, and a further ‘new public management’ discourse, which interpreted the law in terms of a clear purchaser/provider separation. This study uses Dunleavy’s (1991) analytical model of agency types to compare the impact of the reform on the budget structures of the health administration agencies affected — namely, the Department of Health and Social Security, the Catalan Health Service and the Catalan Health Institute. The data show that while the provider role was clearly defined and implemented, the purchaser role was not. Instead, the role of the health authority embodied the complex blend of functions established by the text of the law, which was also reflected in its budget structure, and which blurred the separation between purchaser and provider.

Community action for health in socioeconomically deprived neighbourhoods in Barcelona: Evaluating its effects on health and social class health inequalities

BACKGROUND The aim of this study was to analyse trends in several health-related indicators in socioeconomically deprived neighbourhoods in Barcelona with strong community action for health (CA), and compare them to neighbourhoods without such community action. A secondary goal was to analyse trends in socioeconomic inequalities in health in both types of neighbourhood. METHODS We performed a quasi-experimental pre-post study using data from the Barcelona Health Surveys of 2001 and 2011. Our dependent variables were self-perceived health, mental health, previous drug use, and smoking cessation. We used Poisson regression with robust variance to calculate prevalence ratios (PR) and 95% Confidence Intervals (95% CI). RESULTS The percentage of men who had ever used drugs decreased over time in neighbourhoods with strong CA (PR = 0.48; 95% CI:0.25-0.92, from 2001 to 2011), but not in neighbourhoods without CA (PR = 1.02; 95% CI:0.74-1.40). However, the prevalence of poor mental health among men increased more in neighbourhoods with strong CA than in neighbourhoods without CA (p-value = 0.025). Among women, social class inequalities in poor mental health and smoking cessation decreased over time in neighbourhoods with strong CA but not in neighbourhoods without CA. CONCLUSIONS Our study shows promising results regarding the effect of community action on health, particularly in terms of inequalities. Our results highlight the importance of allocating resources to implement and continuously evaluate CA initiatives.