Consequences of the North American Free Trade Agreement for health services: a perspective from Mexico

Indicadores de gobernanza para el desarrollo de estrategias binacionales deprotección social en la salud de los migrantes

Este artículo presenta resultados de un estudio cuyo principal objetivo fue identificar los actores clave, sus roles, coaliciones y los espacios de interacción para el desarrollo de protección social en la salud de los migrantes. Se identificaron 10 categorías de actores clave para estrategias de salud para emigrantes, así como metas de política y estrategias binacionales de salud con diferentes niveles de factibilidad y efectividad. Un seguro público binacional de salud para emigrantes indocumentados es factible pero requiere una gran inversión y movilización de recursos públicos. Para ello se deberán desarrollar nuevas iniciativas dirigidas a resolver los problemas de equidad y acceso en la salud de los migrantes.

The North American Free Trade Agreement (NAFTA) and Mexican nursing

In the context of nurse migration, experts view trade agreements as either vehicles for facilitating migration or as contributing to brain-drain phenomena. Using a case study design, this study explored the effects of the North American Free Trade Agreement (NAFTA) on the development of Mexican nursing. Drawing results from a general thematic analysis of 48 interviews with Mexican nurses and 410 primary and secondary sources, findings show that NAFTA changed the relationship between the State and Mexican nursing. The changed relationship improved the infrastructure capable of producing and monitoring nursing human resources in Mexico. It did not lead to the mass migration of Mexican nurses to the United States and Canada. At the same time, the economic instability provoked by the peso crisis of 1995 slowed the implementation of planned advances. Subsequent neoliberal reforms decreased nurses' security as workers by minimizing access to full-time positions with benefits, and decreased wages. This article discusses the linkages of these events and the effects on Mexican nurses and the development of the profession. The findings have implications for nursing human resources policy-making and trade in services.

Ciencias sociales y salud en México: movimientos fundacionales y desarrollos actuales

En este trabajo se describen algunos de los principales desarrollos de las ciencias sociales aplicadas a la salud en México en los últimos 25 años. El artículo inicia con una breve descripción de las tres corrientes fundacionales que han hecho de la salud su objeto de estudio: la antropología médica, de larga tradición en este país; la medicina social, impulsada principalmente desde la Universidad Autónoma Metropolitana-Xochimilco; y la sociología de la salud pública, impulsada desde el Instituto Nacional de Salud Pública. Tras revisar los principales aportes de cada corriente, así como los debates que entre ellas ha tenido lugar; describe los desarrollos recientes en este campo, mismos que constituyen una suerte de "segunda generación" de la sociología médica mexicana. La revisión se centra en los aportes en el campo de lo teórico, lo conceptual, y las áreas con más producción actual. Concluye señalando la importancia de este campo en México y la necesidad de reactivar los intercambios académicos entre las diferentes corrientes de pensamiento, como mecanismo para elevar la calidad de los trabajos.

The potential impact of the North American Free Trade Agreement on American dental licensure: a European community model

Appropriate licensure is a significant barrier to entry to the practice of dentistry. The history of dental licensure in the United States is briefly examined, and current dental licensure requirements in the United States and Mexico are noted. The impact that establishment of the European Community had on dental licensure in Europe is examined, noting that changes were the result of political, rather than professional, input. Requirements of NAFTA are examined to see how they will impact current American dental licensure requirements. Some migration of dental professionals between the United States and Mexico is expected as a result of NAFTA.

Our health paradigm in peril

Health care systems are rapidly shifting attention from providing health care to producing health, profoundly altering how and which services are provided. To free up individual and collective resources for investment in activities with a greater impact on health, less care will be given. This paper posits that the current model--increased health resources make for better health care make for better health status--is too simplistic a system. Structural problems inherent in this model are being observed as the boundaries of the paradigm are pushed. Resources are limited, and health outcomes are no longer being improved despite the application of large percentages of Gross National Product. A new health paradigm is emerging, one with increased focus on health prerequisites such as housing, minimum decent income, food, education, and good social and physical environment.