Archive for 23 julio 2008

El Fondo Monetario Internacional es malo para la salud

julio 23, 2008

The Effects of International Monetary Fund Loans on Health Outcomes

Megan Murray*, Gary King

Ver también http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050143

Funding:The authors received no specific funding for this article.

Competing Interests: The authors have declared that no competing interests exist.

Citation: Murray M, King G (2008) The Effects of International Monetary Fund Loans on Health Outcomes. PLoS Med 5(7): e162 doi:10.1371/journal.pmed.0050162

Published: July 22, 2008

Copyright: © 2008 Murray and King. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abbreviations: IMF, International Monetary Fund; RCT, randomized clinical trial; TB, tuberculosis

Megan Murray is Associate Professor of Epidemiology at the Harvard School of Public Health, Boston, Massachusetts, United States of America. Gary King is the David Florence Professor of Government in the Department of Government, Faculty of Arts and Sciences, Harvard University, Cambridge, Massachusetts, United States of America. He also serves as Director of the Institute for Quantitative Social Science at Harvard University (http://gking.harvard.edu/).

* To whom correspondence should be addressed. E-mail:mmurray@hsph.harvard.edu


Founded in the wake of the Great Depression of the 1930s, the International Monetary Fund (IMF) was established in 1945 when government representatives met and agreed on a “framework of international economic cooperation” (http://www.imf.org/external/index.htm) designed to prevent future economic crises. Its mission was threefold: to ensure the stability of the exchange rate, to promote economic growth, and to provide financial assistance in the form of short-term loans to countries experiencing balance-of-payments difficulties. When countries borrow from the Fund, they are required to agree to conditions set by the organization, a process that the IMF refers to as “conditionality.” These conditions entail the adoption of economic policies or “structural adjustment programs” that are meant to redress the problems that led to the need for the loan and therefore to enable prompt repayment. While the conditions vary for different loans, most impose some regimen of fiscal austerity through reduced government spending, removing barriers to international trade, cutting government subsidies, and privatization.

IMF Conditionalities and Health

What kind of impact might IMF loans, and their conditionalities, have upon health outcomes? A new study in this issue of PLoS Medicine attempts to address this question by examining IMF programs and tuberculosis (TB) outcomes in post-communist countries [1].

Critics of the IMF charge that IMF conditionalities have helped undermine the health of some of the world’s most vulnerable populations. They argue that health outcomes suffer from reduced government spending on health care and on other inputs to health, such as food, as well as from the capping of public sector wages. IMF policies are also cited as having led to the diversion of foreign aid intended for health to the repayment of domestic debt. Such an outcome could serve as a strong disincentive for external funders to increase future health financing [2].

Linked Research Article

This Perspective discusses the following new study published in PLoS Medicine:

Stuckler D, King LP, Basu S (2008) International Monetary Fund programs and tuberculosis outcomes in post-communist countries. PLoS Med 5(7): e143. doi:10.1371/journal.pmed.0050143

David Stuckler and colleagues show that, in Eastern European and former Soviet Union countries, participation in International Monetary Fund economic programs have been associated with higher mortality rates from tuberculosis.

Other critics point to the indirect effects of macroeconomic changes that reduce income and increase prices. Rural poverty leads to urban migration and an attendant rise in prostitution, which may fuel the transmission of HIV, and rising urban poverty increases crime and incarceration, which in turn promotes the transmission of infectious diseases [3].

Gathering Evidence on the Health Impacts of IMF Loans

Given the often vituperative debate between the IMF and its critics about the health impacts of IMF loans, the need for evidence in support of charges and counter-charges becomes ever more apparent. But what kind of evidence would shed light on these health impacts?

Much of the current debate focuses on the effect of conditionalities on health spending, rather than on specific health outcomes. A recent report from the Center for Global Development asks, “Does the IMF constrain health spending in poor countries?” [4]. Although the report found that broad trends in government health spending were similar in countries with and without IMF involvement, it also recognized that little could be inferred from the small differences found. Nonetheless, the authors noted that “the nature of many health interventions makes them especially sensitive to fiscal decisions…Because of the imperative of ensuring continuity in services and drug supply for HIV/AIDS [and] tuberculosis…any temporary interruptions in funding can have very serious consequences for health outcomes” [4]. These findings suggest the need to directly compare actual health outcomes in countries with and without the intervention.

Such measurements are complicated by a number of daunting methodological problems. IMF loans are not randomly assigned by an investigator, as are medical treatments in clinical studies. Instead, countries receive IMF loans because of pressing financial problems that may affect both short- and long-term health status, quite apart from the conditionality imposed by the IMF. If the indication for an intervention is itself associated with an outcome, the results of a study assessing that intervention may be biased, leading to what is termed “confounding by indication” in epidemiological studies. Furthermore, IMF loans and conditions come in different sizes and shapes, and the short-term outcomes of these programs often provoke mid-course policy corrections that make it hard to detect consistent effects. Finally, the effect of broad reductions in health care may lag many years behind the actual intervention and may therefore be missed in an analysis that does not capture late events. And, although an observational study is of course necessary, a valid control group—such as countries that qualify for IMF loans but do not receive them—may not exist.

The New Study

In the new study, David Stuckler and colleagues delve into this difficult methodological terrain [1]. They provide new evidence linking IMF loans to the enormous increases in TB incidence, prevalence, and mortality that occurred in some former Soviet Union and Eastern European countries during the post-communist period of the early to mid-1990s. After controlling for a host of variables, they find that IMF loans are associated with a 16.6% rise in annual TB mortality. This estimate did not change after adjusting for factors expected to mediate the impact of the loans, such as HIV prevalence, incarceration rates, and variables reflecting macroeconomic policy changes. Although IMF loans were associated with a fall in directly observed therapy (DOTS) population coverage levels, controlling for this variable had no effect on the strength of the association between loans and TB deaths. This result emphasizes the complex and confusing pathways by which macroeconomic policies lead to specific health effects.

Study Limitations

The new study raises many important issues, particularly related to the policy implications of the conclusions. But are the study findings correct? Should we regard them as meeting the evidence-based standards of the best clinical research?

The study has at least five limitations. First, the IMF loans were not randomly assigned. In addition to this lack of randomization, the investigators included all of the Eastern European and former Soviet Union countries in their study, rather than comparing countries that received an IMF loan with, say, otherwise similar countries that just missed the threshold to qualify for a loan. Second, IMF loans are highly heterogeneous, and each type of loan may have massively different effects across countries and time periods. Third, the size of these loans is at best an imperfect proxy for conditionalities, and so the link to the extent of macroeconomic policy change that might have led to health changes is undocumented and likely variable. Fourth, the authors use special “robust standard errors”; however, if this approach makes a difference, it also indicates that an aspect of their model was misspecified, in which case we should probably have less confidence in the rest of their model, which was not similarly tested. Fifth, the similarity and dependence in their data measured over time means that they have many fewer independent pieces of information than the raw number of observations reported.

Observational Studies Versus Randomized Trials

Although these limitations seem stark by the standards of a randomized clinical trial (RCT), we should not necessarily discount the study’s policy implications. If the assumptions underlying this work are correct, the authors are estimating a causal effect among all “subjects” (i.e., countries) and time periods of interest. In contrast, the patients included in RCTs are typically not representative of, and certainly not randomly selected from, the populations to which the treatment would be applied. This leaves us with a key question: is the potential for bias larger when random assignment to treatment is impossible, as in Stuckler and colleagues’ study and other observational studies, or when random selection of trial participants from the target population is impossible, as with most RCTs? Failure to either randomly assign or randomly treat can lead to biases of any size. As a result, one type of study should not be automatically favored over the other [5,6]. RCTs themselves are prone to many weaknesses, such as problems of compliance, missing data, measurement error, and post-treatment bias, all of which require modeling assumptions of their own and lead to substantial uncertainties of other kinds.

Moreover, many RCTs produce valuable scientific knowledge about a subset of potential patients, but do not speak to the effect of a public policy that might be constructed with this knowledge. Knowing the biological effect of a drug or risk factor is one thing; designing and evaluating a large-scale public policy program involves a whole range of different issues [7]. One cannot infer the effects of a public policy on the basis of a drug trial or even solid biological knowledge of a problem; otherwise, we should now regard obesity, diabetes, alcoholism, and lung cancer as solved problems. Indeed, most large-scale public policy evaluations entail uncertainties of similar types and sizes as those that attend Stuckler and colleagues’ study. It is true that the conclusions of this observational study required many statistical assumptions, any one of which could lead to substantial inferential biases, and so the scientific status of the authors’ conclusions necessarily remains uncertain. But we are convinced that at least the authors went very far in testing assumptions and mitigating uncertainties, and so the study and its conclusions should be taken seriously.

References

  1. Stuckler D, King LP, Basu S (2008) International Monetary Fund programs and tuberculosis outcomes in post-communist countries. PLoS Med 5: e143. doi:10.1371/journal.pmed.0050143. Find this article online
  2. Ooms G, Schrecker T (2005) Expenditure ceilings, multilateral financial institutions, and the health of poor populations. Lancet 365: 1821–1823. Find this article online
  3. Peabody JW (1996) Economic reform and health sector policy: Lessons from structural adjustment programs. Soc Sci Med 43: 823–835. Find this article online
  4. Center for Global Development (2007) Does the IMF constrain health spending in poor countries? Evidence and an agenda for action. Available: http://www.cgdev.org/doc/IMF/IMF_Report.pdf. Accessed 20 June 2008.
  5. Imai K, King G, Stuart E (2008) Misunderstandings among experimentalists and observationalists about causal inference. J R Stat Soc [Ser A] 171: 481–502 Available: http://gking.harvard.edu/files/abs/matchse-abs.shtml. Accessed 20 June 2008. Find this article online
  6. Vandenbroucke JP (2008) Observational research, randomised trials, and two views of medical science. PLoS Med 5: e67. doi:10.1371/journal.pmed.0050067. Find this article online
  7. King G, Gakidou E, Ravishankar N, Moore RT, Lakin J, et al. (2007) A ‘politically robust’ experimental design for public policy evaluation, with application to the Mexican universal health insurance program. J Policy Anal Manage 26: 479–506 Available: http://gking.harvard.edu/files/abs/spd-abs.shtml. Accessed 20 June 2008. Find this article online

Un nuevo número de Medicina Social/Social Medicine

julio 17, 2008

Vol 3, No 2 (2008)

Reformas Progresistas en Salud en América Latina
Editora Invitada: Asa Cristina Laurell

Edmundo Granda, Cuenca, Ecuador
[1946-2008]
Poeta de la medicina social y la salud colectiva

Tabla de contenidos
Editoriales

Semblanza de Edmundo Granda †
PDF

Los Editores

Sacando de la sombra a las reformas progresistas de salud en América Latina
PDF

Cristina Laurell

Sección Especial: Reformas progresistas en Salud en América Latin

La reforma sanitaria brasileña: la victoria sobre el modelo neoliberal
Resumen PDF

Amelia Cohn

A reforma sanitária brasileira: a vitória sobre o modelo neoliberal
Resumen PDF

Amélia Cohn

Cambio social y política de salud en Venezuela
Resumen PDF

Carlos H. Alvarado H. Alvardo, María E. Martínez, Sarai Vivas-Martínez, Nuramy J. Gutiérrez, Wolfram Metzger

La salud en Uruguay: avances y desafíos por el derecho a la salud a tres años del primer gobierno progresista
Resumen PDF

Fernando Borgia

La política de salud en Bogotá, 2004-2008. Análisis de la experiencia de atención primaria integral de salud
Resumen PDF

Román Vega Romero, Naydú Acosta Ramírez, Paola Andrea Mosquera Méndez, Maria Ofelia Restrepo Vélez

La reforma de salud en la ciudad de México, 2000-2006
Resumen PDF

Asa Cristina Laurell

Investigación Original

Comportamiento reproductivo de una población de mujeres inmigrantes latinoamericanas en España
Resumen PDF

Paula Acevedo Cantero

Actitudes públicas sobre el SARS y sus implicaciones en la preparación social para otras enfermedades infecciosas emergentes
Resumen PDF

Sing Lee, Shui-shan Lee, Shui-shan Lee, Corina Shuk-ching Fung, Corina Shuk-ching Fung, Kathleen Pik-san Kwok, Kathleen Pik-san Kwok

Medicina Social en la Práctica: Estudios de Casos de Activismo en Salud

Entrevista a Víctor Toro Ramírez, activista de los inmigrantes a los Estados Unidos
PDF

Clyde Lanford Smith

Una perspectiva estudiantil de la Escuela Latinoamericana de Medicina y su programa educativo
PDF

Razel Remen, Lillian Holloway

Temas y Debates

Algunas reflexiones a los veinticuatro años de la ALAMES
Resumen PDF

Edmundo Granda

Noticias y eventos

II Congreso Nacional de Medicina Social y Salud Colectiva (México)
PDF

El Comité Organizador

Salió el Diccionario Latinoamericano de Bioética

julio 11, 2008

Un equipo multiautoral, bajo la dirección de Juan Carlos Tealdi y con el esfuerzo editorial de la Universidad Nacional de Colombia, la UNESCO y la Red Latinoamericana y del Caribe de Bioética ha publicado el Diccionario Latinoamericano de Bioética. Puede pedirse on-line

a http://tinyurl.com/6535eh

 

Tabla de contenido

Introducción
América Latina

1. Pensamiento latinoamericano

Pensamiento crítico latinoamericano, Ricardo Salas Astraín (Chile)
Filosofía latinamericana, Celia Lectora (Argentina)
Ética social, calores y liberación, Adriana Arpini (Argentina)
Pedagogía de la liberación, María Luiza Angelim (Brasil)
Tecnología de la liberación, Marcio Fabri dos Anjos (Brasil)
Pensamiento alternativo, Hugo Biagini (Argentina)
2. Comunidad y contexto

Comunitarismo e individualismo, Cristina Solange Donda (Argentina)
Alteridad/otro, Mónica Cragnolini (Argentina)
Contexto histórico, José Álvarez (Argentina)
Contexto social, Fabio Álvarez (Argentina)
Comunidades campesinas, Javier Luna Orozco (Bolivia)
Aboriginalidad y nación, Claudia Briones (Argentina)
Contexto, familia y crisis, Jorge Aceves y Patricia Safa Barraza (México)
3. Diversidad cultural y ligüistica

Pluralismo, Adriana Arpini (Argentina)
Valores culturales, Celina Létora (Argentina)
Etnias y lenguajes, María Luisa Rubinelli (Argenina)
Diversidad lingüística y sistemas de significación, Frida Villavicencio Zarza (México)
Tradición oral indígena, José Antonio Flores Farfán (México)
Interpretación moral en arte y literatura, María Herrera Lima (México)
Ética y literatura, Silvana Rabinovich (México)
Literatura de la negritud y el esclavismo, Dina V. Piccotti C. (Argentina)
Diversidad cultural y biopolíticas, Augusto Pérez Lindo (Argentina)
Bienestar
1. Dolor y sufrimiento

Bienestar, dolor y sufrimiento, Miguel Ktto (Chile)
Antropología del dolor, Reinaldo Bustos (Chile)
Cuidados ante el dolor y el sufrimiento, Lucilda Selli (Brasil)
Acceso al tratamiento del dolor severo, Rosa Mertnoff (Argentina)
2. Atención de la salud

Atención individual y atención colectiva, Abraham Sonis (Argentina)
Análisis de la situación de salud, María del Carmen Amaro (Cuba)
Atención primaria de salud, María del Carmen Amaro (Cuba)
Atención clínica y contexto social, Jorge Otero Morales (Cuba)
Seguridad social, Jorge Mera (Argentina)
Atención integral de la salud, José R. Acosta Sariego (Cuba)
3. Cuidados en salud

Cuidados prolongado, Ismael Serna, Fernando Cano, Garbiñe Saruwateri (México)
Cuidados paliativos, Gustavo de simona (Argentina)
Principios éticos en ciudados paliativos, Ismael Serena, Fernando Cano, Garbiñe Saruwatari (México)
Cuidados espirituales, Ludwing Schmidt (Venezuela)
Bioética
1. Conceptos éticos

Bien y mal, Maria Luisa Pfeiffer (Argentina)
Origen y presencia del mal en el mundo, Leandro Pinkler (Argentina)
Norma, Juan Carlos Tealdi (Argentina)
Intuición, Diego Parente (Argentina)
Preferencia y elección, Luisa Monsalve Medina (Colombia)
Consenso y persuasión, José Roque Junges (Brasil)
Emociones morales y acción, Olga Elizabeth Hansberg torres (México)
Amor-Odio, Dalmiro Bustos (Argentina)
Altruismo y egoísmo, Luisa Ripa (Argentina)
Compasión, Celina Létora (Argentina)
Convicción, Patricia Digilio (Argentina)
Esperanza, Julia V. Iribarne (Argentina)
Tolerancia, Juliana González Valenzuela (México)
Conciencia moral, Ricardo Salas Astraín (Chile)
Intención y responsabilidad, Agustín Estévez (Argentina)
Injerencia-asistencia-solidaridad, Claude Vergés (Panamá)
Legitimidad, María Luisa Pfeiffer (Argentina)
2. Teoría tradicional

Valores éticos, juliana González Valenzuela (México)
Fenomenología, Julia V. Iribarne (Argentina)
Virtudes y conducta, Cristina Solange Donda (Argentina)
Éticas Descriptivas y prescriptitas, Germán Calderón (Colombia)
Deontologismo y obligación, Mario Heler (Argentina)
Justificación por principios, Miguel Kattow (Chile)
Teorías, principios y reglas 1. Los filósofos modernos
Rodolfo Vázquez (México)
Teorías, principios y reglas 2. Los filósofos ambiciosos
Rodolfo Vázquez (México)
Teorías, principios y reglas 3. Los filósofos de la tercera vía
Rodolfo Vázquez (México)
3. Crítica latinoamericana

América Latina y bioética, Hernán Neira (Chile)
Ética Instrumental, Susana Barbosa (Argentina)
Bioética de intervención, Volnei Garrafa y dora Porto (Brasil)
Bioética de protección, Miguel Kottow (Chile)
Bioética narrativa, José Alberto Mainetti (Argentina)
Bioética jurídica, Eduardo Luis Tinant (Argentina)
Ponderación de principios, Rodolfo Vázquez (México)
Bioética y complejidad, Pedro Luís Sotolongo (Cuba)
Bioiética de los derechos humanos, Juan Carlos Telado (Argentina)
Ciencia y tecnología

Filosofía de la práctica científica, Jorge Bacallao Gasellestey (Cuba)
Razón estratégica, Dorando Michelini (Argentina)
Norma técnica, León Olové (México)
Eficacia tecnológica, Rodolfo Gaeta (Argentina)
Explicación y determinismo en ciencias de la vida, Gustavo Caponi (Brasil)
Ciencias biológicas y bien común, Agustín viñedo Torney (Cuba)
Conocimiento y verdad

Construcción mítica de la realidad, Leandro Pinkler (Argentina)
Perspectiva y verdad, Claudio Cohen (Brasil)
Probabilidad, Silvia Rivera (Argentina)
Pragmatismo, Daniel Kalpokas (Argentina)
Verdad y apariencia, Silvia Rivera (Argentina)
Autenticidad y alienación, Fermin Roland Schramm (Brasil)
Consentimiento

Consentimiento 1. Información, Sandra Wierzba (Argentina)
Consentimiento 2. Capacidad, Sandra Wierzba (Argentina)
Consentimiento 3. Voluntad, Sandra Wierzba (Argentina)
Consentimiento en atención clínica, José Eduardo de Siquiera (Brasil)
Consentimiento comunitario, Javier Luna Orozco (Bolivia)
Cuerpo humano

Somatología, José Alberto Mainetti (Argentina)
La experiencia del cuerpo propio, María de la Luz Casas Martínez (México)
Cuerpo y corporeización, Miguel Kottow (Chile)
Derecho al cuerpo propio, Dora Porto (Brasil)
Plasmaféresis: la sangre como mercancía, Melba Barrantes Monge (Nicaragua) y Juan Carlos Tealdi (Argentina)
Transplantes de órganos, Alexander Mármol Sóñora (Cuba)
Derecho a la salud

La salud como derecho humano, Horacio Cassinelli (Uruguay)
Derecho a la protección de la salud, Ingrid Brena Sesma (México)
Derecho a la asistencia médica, Jesús Armando Martínez Gómez (Cuba)
Derechos de los pacientes, Óscar Ernesto Garay (Argentina)
Los hospitales en América Latina en función de la moral pública, Constanza Ovalle (Colombia)
Comités hospitalarios de ética, Juan Carlos Tealdi (Argentina)
Género y sexualidad

Justicia y género, Natalia Gherardi (Argentina)
Derechos humanos de las mujeres y derecho penal María del Rosario Velásquez Juárez (Guatemala)
Sexo y sexualidad, Miguel Sauazo (República dominicana)
Sexismo, Eva Giberti (Argentina)
Homofobia, Eva Giberti (Argentina)
Violencia sexual y femi(ni)cidio, Patricia Blancas y Héctor Domínguez (México)
Globalización

Globalización y progreso humano, María Josefina Regnasco (Argentina)
Globalización y cambio religioso, Renée de la Torre Castellanos (México)
Globalización y mercado de la alimentación, Jorge Eduardo Rulli (Argentina)
Hambre y desnutrición

Nutrición, Hécrtor Bourges (México)
Desnutrición infantil y pobreza, Alejandro O´Donell (Argentina)
Crisis de seguridad alimentaria, Patricia Aguirre (Argentina)
Derecho a la alimentación, Sebastiao Pinheiro (Brasil)
Identidad

Identidad personal, Gonzalo Serrano (Colombia)
Identidad genética, Genoveva Keyeux (Colombia)
Identidad familiar y derecho a la identidad, Nelly Minyersky y Lili Flah (Argentina)
Identidad social, Alejandro Serrano Caldera (Nicaragua)
Identidad comunitaria, María Margarita Ruiz (Colombia)
Derecho a la imagen y confidencialidad, Carlos Valerio (Costa Rica)
Integridad

Derecho a la integridad, Alfredo Kraunt (Argentina)
Tortura y tratos inhumanos, Juan Carlos Tealdi (Argentina)
Vulnerabilidad y protección, Miguel Kottow (Chile)
Integridad comunitaria, Antonio José Sánchez Murillo (Colombia)
Epidemiología y vulnerabilidad social, Zulma Ortiz (Argentina)
La sociedad del riesgo, Cristina Ambrosini (Argentina)
Principio de precaución, Roberto Andorno (Argentina)
Investigación en salud

Progreso científico y desarrollo social, Carlos R. Gherardi (Argentina)
Experimentación con animales, Roberto de la Peña Pino y Ángel Concepción Alfonso (Cuba)
Investigación médica básica, Alina Alerm González
Ensayo clínico, Virginia Rodríguez Funes (el Salvador)
Investigaciones científicas en niños, Joaquin Antonio César Mora (Brasil)
Investigación participativa, Luís Justo (Argentina)
Sistemas de revisión ética, Claudio Fortes Lorenzo (Brasil)
Comites estándar, Direceu Greco (Brasil)
Justicia y derechos humanos

1. Justicia, igualdad y equidad

Idea de justicia, Fernando Aranda Fraga (Argentina)
Igualdad y diferencia, Patricia Digilio (Argentina)
Derecho y moral, Rodolfo Vázquez (México)
Sistemas normativos indígenas, María Victoria Chenaunt González (México)
Justicia y tecnología moral, Humberto Miguel Yánez (Argentina)
Bien Colectivo y decisión judicial, Eduardo Luis Tinant (Argentina)
Derecho de familia, Mauro Machado do Prado (Brasi)
Equidad en salud, Dámaso Gómez Plasencia (Cuba)
2. Sistema de Derechos Humanos

Sistema Interamericano de Derechos humanos, Hector Gros Espiell (Uruguay)
Defensoria del Pueblo (Nacionales), Eduardo Mondito (Argentina)
Defensoría del Pueblo (Provinciales), Carlos Niccolini (Argentina)
Acceso a la justicia e impunidad, Horacio Ravenna (Argentina)
Asistencia humanitaria en América Latina, Carlos E. Zaballa (Argentina)
Capacidades, Proyecto de vida y sistema de derechos, Jorge Iván Bula (Colombia)
Terrorismo de Estado, Juan Carlos Tealdi (Argentina)
Libertad

Libertad y necesidad, Ubaldo González Pérez (Cuba)
Esclavitud y servidrumbre, Armando Raggio (Brasil)
Desplazamiento (Refugiados internos), Ana Lucía Rodríguez (Colombia)
Autonomía individual, Marco Segre (Brasil)
Directivas anticipadas, Luis Guillermo Blanco (Argentina)
Objeción de conciencia, Luis Guillermo Blanco (Argentina)
Huelga de hambre, Luis Guillermo Blanco (Argentina)
Medicina y profesiones de la salud

Orígenes del conocimiento médico, Juan Carlos Tealdi (Argentina)
Crisis de la razón médica, José Alberto Mainetti (Argentina)
Medicina natural y tradicional, Eduardo Freyre Roach (Cuba)
Relación médico-paciente, Jorge Luís Manzini (Argentina)
Paternalismo médico, Freddy García (Venezuela)
Toma de desiciones médicas, Daniel Lew (Argentina)
Psicología, Ana Claudia Machado y Eliane Seidl (Brasil)
Modelos de atención de enfermería, Dalgis Ruiz Reyes (Cuba)
La enfermería en la atención primaria de salud, Katiuska Navarro Bustamante (Cuba)
Educación en enfermería, Beatriz Peña (Colombia)
Trabajo social, Carlos Eroles (Argentina)
Consulta en ética clínica, Miguel Chávez Zambrano (Argentina)
Medicina y difusión masiva, Marcelo Ocampo (Argentina)
Conflicto de intereses, Teresa Rotondo (Uruguay)
Medio ambiente

Naturaleza y artificio, Alejandro Rosas López (Colombia)
Población, Marlene Braz (Brasil)
Trabajo y medio ambiente, Fernando Cano y Garbiñe Saruwatari (México)
Agricultura y agrotecnologías, Eduardo Freyre Roach (Cuba)
Modelos de producción rural, Adolfo Boy (Argentina)
Salud de los animales, Juan Garza Ramos (México)
Ambiente, sustentabilidad y riesgos, Walter Alberto Pengue (Argentina)
Manipulación del genoma y medio ambiente, José Ramón Acosta Sariego (Cuba)
Muerte y morir

La muerte y sus símbolos, Ricardo Holdelín Tablada (cuba)
Mortalidad materna, María Clara Albuquerque (Brasil)
El morir del niño, Rafael Torres Acosta (Cuba)
Matar niños y niñas, Eva Giberti (Argentina)
Enfermedad Terminal, Andrés Peralta (República Dominicana)
La muerte y el morir por VIH/sida, Juan Carlos Tealdi (Argentina)
Suicidio, aspectos filosóficos, Julio Cabrera (Brasil)
Suicidio, abordajes empíricos, Julio Cabrera (Brasil)
Muerte, mortalidad y suicidio, Julio Cabrera (Brasil)
Homicidio piadoso consentido, Luís Guillermo Blanco (Argentina)
Eutanasia, Leo Pessini (Brasil)
Morir con dignidad, Luis Guillermo Blanco (Argentina)
Pena de muerte, Juan Carlos Tealdi (Argentina)
Genocidio, Juan Carlos Tealdi (Argentina)
Pobreza y necesidad

Responsabilidad en contextos de pobreza, Jutta Wester (Argentina)
Necesidades en salud, Susana Vidal (Argentina)
Enfermedades de la pobreza, Rubén Storino (Argentina)
Doctrina social de la Iglesia, Marcio Fabri dos Anjos (Brasil)
Poder

Ética y política, volnei Garrafa (Brasil)
Poder e injusticia, Marcio Fabri dos Anjos (Brasil)
Imperialismo moral, Volnei Garrafa (Brasil)
Dominación y hegemonía, José Portillo (Uruguay)
Bioporatería, Ana María Tapajós (Brasil)
Control Social, Paulo Antonoio de Carvalho Fortes (Brasil)
Paz, Juan Carlos Tealdi (Argerntina)
Salud reproductiva

Salud reproductiva, Mariana Romero (Argentina)
Contracepción, Luís Guillermo Blanco (Argentina)
Embarazo en la adolescencia, Mónica Cogna (Argentina)
Diagnóstico prenatal, Araceli Latingua Cruz (Cuba)
Asesoramiento genético, Marta Escurra de Duarte (Paraguay)
Aborto inseguro, Susana Rance (Bolivia)
Salud y enfermedad

Lo normal y lo patológico, Reinaldo Bustos (Chile)
Enfermedades agudas, Horacio García Romero (México)
Estado de Afección múltiple, Carlos R. Gherardi (Argentina)
Salud integral, Elma Zolboli (Brasil)
Modos de enfermar y conceptos de enfermedad, Miguel Kottow (Chile)
Experiencia de enfermedad y narración, Isabel del Valle (Argentina)
Espacios arquitectónicos para la salud, Carlos Quaglia (Argentina)
Sociedad

Aspectos sociales de la bioética, Francisco Maglio (Argentina)
América Latina y la vida económica, Aldo Etchegoyen (Argentina)
Contrato social, Fernando Aranda Fraga (Argentina)
Norma social, Celina Lértora (Argentina)
Exclusión social, Fermín Roland Schramm (Brasil)
Disparidad, Carlos Eroles (Argentina)
Espacio Público, Nora Rabotnikof (México)
Vida y vivir

1. Ciclos vitales

Crecimiento y desarrollo, Horacio Lejarraga (Argentina)
Salud del neonato, Sergio Cecchetto (Argentina)
Infancia, José Portillo (Uruguay)
Antropología y niñez, Andrea Szulc (Argentina)
Construcción social de la vejez (Urbana-rural), Felipe r. Vázquez Palacios (México)
Derecho a la vida: aspectos sociales y comunitarios, Mabel Gutierrez (Argentina)
Desaparición forzada de personas, Juan Carlos Tealdi (Argentina)
2. Estados vitales

Vida saludable, Jaime Escobar Triana (Colombia)
Vida en estado crítico, Carlos R. Cherardi (Argentina)
Vida en mínima conciencia, Facundo Manes (Argentina)
Vida en estado vegetativo persistente, Ricardo Hodelín Tablada (Cuba)
Vida Buena, María Luisa Pfeiffer (Argentina)

Coherencia

julio 11, 2008

Mientras el primer ministro inglés insta a hacer las compras con prudencia para ahorrar en las casas, y el G8 (países más industrializados) se reúne para considerar la crisis alimentaria, he aquí como se alimentan ellos en sus reuniones.

Summit that’s hard to swallow – world leaders enjoy 18-course banquet as they discuss how to solve global food crisis

By James Chapman
Last updated at 12:27 AM on 08th July 2008

Just two days ago, Gordon Brown was urging us all to stop wasting food and combat rising prices and a global shortage of provisions.

But yesterday the Prime Minister and other world leaders sat down to an 18-course gastronomic extravaganza at a G8 summit in Japan, which is focusing on the food crisis.

The dinner, and a six-course lunch, at the summit of leading industrialised nations on the island of Hokkaido, included delicacies such as caviar, milkfed lamb, sea urchin and tuna, with champagne and wines flown in from Europe and the U.S.

Enlarge G8 leaders discussing the world food crisis in Japan raise their glasses ahead of an 18-course dinner

G8 leaders discussing the world food crisis in Japan raise their glasses ahead of an 18-course dinner

But the extravagance of the menus drew disapproval from critics who thought it hypocritical to produce such a lavish meal when world food supplies are under threat.

On Sunday, Mr Brown called for prudence and thrift in our kitchens, after a Government report concluded that 4.1million tonnes of food was being wasted by householders.

He suggested we could save up to £8 a week by making our shopping go further. It was vital to reduce ‘unnecessary demand’ for food, he said.

Last night’s dinner menu was created by Katsuhiro Nakamura, the first Japanese chef to win a Michelin star. It was themed: Hokkaido, blessings of the earth and the sea.

Enlarge Lunch and dinner menu