Int J Health Serv
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Historical Article
Health personnel training in the Nicaraguan health system.
The "Unified National Health System" of Nicaragua was established in 1979, in an attempt to transform some of Latin America's worst health indices. This system, based on the stated principles of planning, regionalization, public participation, and primary care, has prioritized the development of health professions training programs appropriate to its special needs and principles. Public Health and Epidemiology training was inaugurated in 1982. ⋯ Training for allied health personnel has been formalized in several fields, with the establishment of the Polytechnical Institute of Health. The rapid increase in number and size of training programs has created a tremendous need for educational resources both human and material. This article reviews the status of health personnel training in Nicaragua today, the integration of these programs into planning for the health system, and problems arising from their rapid appearance.
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Historical Article
Medical aid provided by American, Canadian and British Nationals to the Spanish Republic during the Civil War, 1936-1939.
During international or civil wars, private citizens of noncombatant nations often provide medical aid to one of the contending factions, particularly when they support a participant not favored by their own government. This paper details and analyzes the prominent campaign in the United States, Canada and Great Britain to provide medical aid to the Republicans during the Spanish Civil War (1936 to 1939). ⋯ Whether it be in Republican Spain, Vietnam or El Salvador, even a successful medical aid campaign to people in a military conflict may save some lives but may not affect substantially the course of the conflict. Those who are primarily interested in influencing political or military developments, hoping to advance the cause of a particular contending faction, may find tactics other than medical aid campaigns more useful in accomplishing their goals.
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This paper analyzes the implications of the rightward shift currently underway in the advanced capitalist world for the future of the welfare state. The Thatcher government in Britain is examined as a paradigm case of this new conservatism. The quantitative cuts in social spending as well as the quantitative shifts in social policy and ideological reversals of recent years are detailed, and the contradictions of both Thatcherism and its predecessor--social democratic reformism--are exposed from the perspective of Marxist political economy. A postscript attempts to explain the continuing popularity of Thatcherism in contemporary Britain despite the devastating effects of its policies.
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Comparative Study
Inequalities in health and disease: the case of mortality rates for the city of Johannesburg, South Africa, 1910-1979.
This article analyzes crude death and infant mortality rates for the different population groups in Johannesburg, the largest city in the Republic of South Africa. The analysis is based on official statistics collected by the Department of Health between 1910 and 1979. Over this period, death rates have declined for white, black, Colored, and Asian citizens. However, the present situation reflects the gross inequalities in the health status of the different population groups in South Africa, a country where disease patterns and access to medical resources are as stratified as any other index of social class.
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In August 1980 the United Kingdom Department of Health and Social Security published the Report of the Working Group on Inequalities in Health, also known as the Black Report (after chairman Sir Douglas Black, President of the Royal College of Physicians). The Report showed in great detail the extent of which ill-health and death are unequally distributed among the population of Britain, and suggested that these inequalities have been widening rather than diminishing since the establishment of the National Health Service in 1948. The Report concluded that these inequalities were not mainly attributable to failings in the NHS, but rather to many other social inequalities influencing health: income, education, housing, diet, employment, and conditions of work. ⋯ These findings and recommendations were virtually disowned by the then Secretary of State for Social Services, very few copies of the Report were printed, and few people had the opportunity to read it. The Black Report is an important document that deserves wide attention and debate. This summary and comment is intended to give greater access to its evidence, arguments, conclusions, and recommendations.