Global trade, public health, and health services: stakeholders' constructions of the key issues.
Global trade, public health, and health services: stakeholders' constructions of the key issues.
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全球贸易、公共卫生和卫生服务：利益相关者对关键问题的构建。
DOI：
10.1016/j.socscimed.2005.01.010
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发表时间：
2005
期刊：
影响因子：
--
通讯作者：
Mountain,Carolyn
中科院分区：
文献类型：
--
作者：
Waitzkin,Howard;Jasso-Aguilar,Rebeca;Landwehr,Angela;Mountain,Carolyn
以美国和拉丁美洲为主要对象，研究了参与全球贸易、公共卫生和医疗服务政策辩论的主要利益相关者对社会现实的理解。在一个多方法，定性设计，我们使用了三个来源的数据：研究和档案文献，1980-2004年;采访代表主要组织参加这些辩论，2002-2004年的关键线人;和组织报告，1980-2004年。我们针对几种类型的组织：政府机构、国际金融机构和贸易组织、国际卫生组织、跨国公司和倡导团体。拉丁美洲许多国家政府将健康界定为一项权利，将保健服务界定为一种公益。因此，政府对这一权利负有责任。与此相反，美国政府的自由贸易和促进市场经济的哲学假设，通过扩大私营部门，改善经济条件将改善整体健康，政府提供最低限度的医疗保健。美国政府机构也将促进全球健康视为服务于美国利益的一种手段。国际金融机构强调的改革包括减少公共部门服务和将其私有化。国际卫生组织倾向于采纳国际金融机构和贸易组织的政策观点。倡导团体强调国际贸易协定对公共卫生和保健服务的有害影响。组织利益攸关方对贸易、公共卫生和卫生服务的现实有着广泛不同的理解。关于贸易和健康的社会结构反映了关于市场进程影响的广泛意识形态。这种结构体现了“信条”的特征，即市场在促进人类目的和满足人类需求方面的作用。在贸易和健康的结构上的差异限制了处理全球贸易所产生的深刻变化的政策。
Focusing mainly on the United States and Latin America, we aimed to identify the constructions of social reality held by the major stakeholders participating in policy debates about global trade, public health, and health services. In a multi-method, qualitative design, we used three sources of data: research and archival literature, 1980–2004; interviews with key informants who represented major organizations participating in these debates, 2002–2004; and organizational reports, 1980–2004. We targeted several types of organizations: government agencies, international financial institutions (IFIs) and trade organizations, international health organizations, multinational corporations, and advocacy groups. Many governments in Latin America define health as a right and health services as a public good. Thus, the government bears responsibility for that right. In contrast, the US government's philosophy of free trade and promoting a market economy assumes that by expanding the private sector, improved economic conditions will improve overall health with a minimum government provision of health care. US government agencies also view promotion of global health as a means to serve US interests. IFIs have emphasized reforms that include reduction and privatization of public sector services. International health organizations have tended to adopt the policy perspectives of IFIs and trade organizations. Advocacy groups have emphasized the deleterious effects of international trade agreements on public health and health services. Organizational stakeholders hold widely divergent constructions of reality regarding trade, public health, and health services. Social constructions concerning trade and health reflect broad ideologies concerning the impacts of market processes. Such constructions manifest features of “creed,” regarding the role of the market in advancing human purposes and meeting human needs. Differences in constructions of trade and health constrain policies to address the profound changes generated by global trade.
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