Medicine and Public Health at the End of Empire

The recent financial meltdown has brought notable changes to the global practice of health care changes that have often escaped the American news media. Although Western managed-care corporations previously had strengthened their influence abroad, now many countries are considering new approaches to health care for their citizens.The untold story of how corporations have influenced global health care and the impacts now in America as the system rapidly shifts is Dr. Waitzkin s subject in his provocative new book. We now live in a new era in which the prospects for more humane approaches to health care are taking root. Strengthening access and improving public health are at the heart of the many previously little-noted struggles and actions by individuals, groups, and whole nations to put control back in the hands of patients and practitioners, as Americans of many political stripes seem to universally seek. The impacts of these changes in the United States are considerable, and they are amply illustrated by Dr. Waitzkin as the United States attempts to reorient its own system of care.Selected as the 2012 winner of the Freidson Outstanding Publication Award by the American Sociological Association for its'bold and timely analysis of the global political economy of contemporary crises in health and medical care. By presenting the lessons learned from social medicine (past and present), [it] outlines a macro-sociologically informed response to these crises.'' Cover 1 Title Page 2 Dedication 3 Copyright Page 3 Table of Contents 4 Preface 8 Part One: Empire Past 14 Chapter 1 Empire’s Historical Health Component 15 Philanthropic Foundations 15 International Financial Institutions and Trade Agreements 17 International Health Organizations 18 A Countervailing Viewpoint 21 Chapter 2 Illness-Generating Conditions of Capitalism and Empire 22 How This Viewpoint Emerged 22 Friedrich Engels 23 Rudolf Virchow 26 Salvador Allende 29 Capitalism, Empire, Illness, and Early Death 34 Chapter 3 The International Market for Health Products and Services 38 Methods to Address the Falling Rate of Profit 38 The Political Economy of Coronary Care 39 Early History of Coronary Care Units 39 Explaining the Diffusion of Coronary Care Units 42 The Corporate Connection 42 The Academic Medical Center Connection 46 Private Philanthropies 48 The Role of the State 50 Changes in the Health-Care Labor Force 52 Technological Innovation and the International Capitalist System 53 Chapter 4 Paths of Resistance to Empire in Public Health and Health Services 56 Chile: A Transformation Thwarted by Empire 57 Cuba: A Transformation Thwarting the Advance of Empire 65 Comparative Changes in the Context of Empire 72 Part Two: Empire Present 76 Chapter 5 Neoliberalism and Health 77 Neoliberalism and the Dismantling of the Public Sector 78 The Transnational Capitalist Class and Multinational Corporations 79 The Nation-State, Sovereignty, and Health 81 Chapter 6 International Trade Agreements, Medicine, and Public Health 85 Trade Rules 85 Trade Enforcement and National Sovereignty 86 Trade Agreements and Health 87 NAFTA 88 Free Trade Area of the Americas (FTAA) 90 General Agreement on Trade in Services (GATS) 91 Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) 93 Overview of International Trade Agreements and Health 94 Actions by Health Professionals and Advocates 94 Chapter 7 Macroeconomics and Health 99 Enhancing Empire by Enhancing Health 99 An Infl uential Example of “Investing in Health”: The Report on Macroeconomics and Health 100 The Meanings of “Investing in Health” 101 Financing Versus Reform 103 “Close-to-Client” Systems: Public Funding for Private Providers 104 The Meanings of Prepayment 105 Donor Financing: Unspoken Options 106 The Value of Life: Disability-Adjusted Life Years (DALYs) 107 Trade Agreements Versus Corporate Responsibility 108 Recycling Public Health Interventions to Facilitate Investment 109 Chapter 8 The Exportation of Managed Care 112 Economic Conditions That Fostered Exportation 113 The Managed Care Market and Social Security Funds in Latin America 115 The Rising Trajectory of Managed Care in Latin America 118 The Falling Trajectory That Followed 121 Challenges to Public Health and Medical Services 122 Resistance to Managed Care and the Emergence of Alternative Proposals 123 Chapter 9 Corporations, International Financial Institutions, and Health Services 126 “Reform” in Mexico 127 “Reform” in Brazil 129 Penetration by Multinational Corporations 130 Effects of Reform in Mexico 131 Effects of Reform in Brazil 133 Vicissitudes of Privatization and Corporatization 134 Chapter 10 The “Common Sense” of Health Reform 136 Ideological Underpinnings of Health Reform 137 Ideological Assumptions in a Silent Process of Reform 138 A Transformation of Common Sense 139 Ideology and the Reconstruction of Common Sense 140 Chapter 11 Stakeholders’ Constructions of Global Trade, Public Health, and Health Services 144 Government Agencies 144 International Financial Institutions 147 International Health Organizations 149 Multinational Corporations 150 Advocacy Groups 153 Social Constructions of Trade and Health 155 Chapter 12 Militarism, Empire, and Health 158 The Physical and Psychic Impact of War on Military Personnel 159 Civilian Services for Military Personnel 160 GIs’ Physical and Mental Health Problems 161 Themes from Encounters Between Military Personnel and Civilian Clinicians 163 The Economic Draft 163 Deception 163 Ethical Dilemmas and Violence Without Meaning 164 Barriers to Care 164 Privatization of Services 164 Torture and Human Rights Abuses 164 The Changing Health Effects of Militarism 165 Part Three: Empire Future 168 Chapter 13 Health and Praxis: Social Medicine in Latin America 169 Productivity and Danger 169 History of Latin American Social Medicine 172 The “Golden Age” of Social Medicine in Chile and the Role of Salvador Allende 172 Social Medicine Versus Public Health Elsewhere in Latin America 174 The 1960s and Later 176 Political Repression and Work Challenges 177 Theory, Method, and Debate 178 Emerging Themes 180 Social Policies, Empire, and Health 180 Social and Cultural Determinants of Health and Illness 181 Relations Among Work, Reproduction, the Environment, and Health 181 Violence, Trauma, and Health 182 The Future of Social Medicine 182 Chapter 14 Resistance and Building an Alternative Future 184 The Struggle Against Privatization of Health Services in El Salvador 185 Resistance to Privatization of Water in Bolivia 187 Social Medicine’s Coming to Power in Mexico City 190 Other Examples of a New Vision: Venezuela, Uruguay, and Brazil 193 Struggles for National Health Programs in the Heart of Empire 195 The End of Empire? 199 Sociomedical Activism in the Post-Empire Era 201 Notes 203 Index 233 About the Author 241 The recent financial meltdown has brought notable changes to the global practice of health carechanges that have often escaped the American news media. Although Western managed-care corporations previously had strengthened their influence abroad, now many countries are considering new approaches to health care for their citizens. The untold story of how corporations have influenced global health careand the impacts now in America as the system rapidly shiftsis Dr. Waitzkins subject in his provocative new book. We now live in a new era in which the prospects for more humane approaches to health care are taking root. Strengthening access and improving public health are at the heart of the many previously little-noted struggles and actions by individuals, groups, and whole nations to put control back in the hands of patients and practitioners, as Americans of many political stripes seem to universally seek. The impacts of these changes in the United States are considerable, and they are amply illustrated by Dr. Waitzkin as the United States attempts to reorient its own system of care. Empire's historical health component Illness-generating conditions of capitalism and empire The international market for health products and services Paths of resistance to empire in public health and health services Neoliberalism and health (with Rebeca Jasso-Aguilar) International trade agreements, medicine, and public health Macroeconomics and health The exportation of managed care Corporations, international financial institutions, and health services The "common sense" of health reform Stakeholders' constructions of global trade, public health, and health services Militarism, empire, and health Health and praxis : social medicine in Latin America Resistance and building an alternative future (with Rebeca Jasso-Aguilar).