Laurell, A.C., “Work and health in Mexico” Int. J. Health Serv. 9(4): (Reeditado en: V. Navarro (ed) Health and work under capitalism, Baywood. Neoliberalism has been implemented in Latin America for about three decades. This article reviews Mexico’s neoliberal trajectory to illustrate the political, ec. Dr. Asa Cristina Laurell, recognized as one of the most representative researchers of current Latin American social medicine, in her new book discusses the.

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Rightist or neoliberal governments view such policies as an area they cannot overlook without losing lairell, and as a terrain for patronage and corporate population control.

The main objective of such governments is to make social and health policies another field for commodification and generation of profit for capital. For leftist and progressive governments, social policy and health policy as part of it are priority instruments for generating social welfare and decent life for citizens. Nevertheless, when such policies are insufficiently or incorrectly implemented, they not only fail to serve their purpose, but can become an important source of de-legitimation and popular discontent.

Strictly speaking, CUS refers to insurance coverage and cristian universal access to the required services, since it only supports an explicit and financed package of services for individuals, leaving aside public health actions 2. Its objective is to introduce the market and competition, both in the administration of funds and purchase of services and in the provision of medical services, in both cases including both private and public agents.

Asa Cristina Laurell

The content of the packages of services varies according to the premium, and public funds are often used to subsidize the market. The three most well-known national cases of this model awa Chile, Colombia, and Mexico, which nevertheless have some differences 3. SUS is intended to guarantee the universal right to health as a duty of the state. It is based on the original English model of the National Health Service: In the Latin American countries with this model, it is written dristina the respective Constitutions in some form 4.

Nevertheless, not only the neoliberal governments or states, minimal or modernized, but also social welfare, leftist, or progressive governments have experienced problems in implementing their respective health policies that apparently would correspond to their political ideology. The reasons are varied and complex, of an economic, political, institutional, and ideological order, or rather a mixture of the above.


The existence of institutions with their own history and structures cannot be overlooked particularly when moving from one form of the state to another, as is the case both in the construction of the neoliberal state and that of the social democratic state of law.

In the former, it has proven impossible to replace the preexisting public institutionality with another, market-centered and private system without encountering serious problems. The solution proposed by the Colombian government, to condition the right to health on sufficient budget resources, was defeated through a broad mobilization of different sectors of the population in which health workers played an important role 7.

As for the SUS, only Cuba has built one entirely. The majority of the leftist governments have written into their constitutions the SUS as a duty of the state, but they have also experienced institutional problems in its construction. Even the public social insurance institutions have frequently and successfully opposed joining the SUS. Meanwhile, clean slate attempts have led to the parallel development of another health subsystem built as a further obstacle to construction of the SUS.

These forces have additionally helped underfinance the public system by capturing tax resources directly or via tax exemptions. Despite these problems, the progressive governments that have opted for CUS have been much more successful than the neoliberal governments in expanding real access to health services. For example, the SUS provided access to health services for tens of lzurell of previously excluded citizens In Venezuela, the Chavista government likewise expanded services to 17 million previously excluded Venezuelans 9.

There is also a sustained effort at building a public system focused on comprehensive, integrated primary care. The priority is an extensive social policy expressed as the inclusion of a number of diverse themes, laurel, featuring both public goods and services such as active generation of employment and an overall increase in income. Social policy priorities vary from country to country, depending on their particular issues and the available resources. The scenario in countries with neoliberal governments is quite different.

Besides, insurance coverage does not guarantee access to lauell required xristina, for two reasons.

Meanwhile, in Colombia the denial of services has led to hundreds of thousands of court cases, and the Constitutional Court has declared unconstitutional the existence of distinct packages of services according to the payment made.


Social policy in these countries is targeted and minimalist, generally conducted through income transfer programs conditioned on crkstina adoption of prescribed behaviors.

Although the objective is to attack intergenerational transmission of poverty, this has not occurred in practice. This ideology is still hegemonic, accepted not only by physicians and other healthcare personnel but also by politicians and even the general population.

Asa Cristina Laurell – Wikipedia, la enciclopedia libre

It has various negative results, unnecessarily increasing the cost of medical care, destroying clinical procedures, alienating physicians, and causing iatrogenic outcomes. It favors the interests and profits of the medical-industrial complex that promotes it by all means possible. This ideology becomes an obstacle to building a public health system focused on public health, with its conception of the social and historical determination of the health-disease process and the corresponding model of care with social participation, inter-sector collaboration, and health education and promotion at the center.

The challenge is apparently to create another culture of health, built step by step and with sustained social participation. It is thus important to mobilize social participation and combat the idea that the private sector can play the role of relieving pressure on the public sector. This idea segments the health system and increases inequality in access to the required services. It also reinforces the notion of the public system as a poor system for the poor.

Banco Interamericano de Desarrollo; The right to health: La Segunda Reforma de Salud: Salud Colect ; 6: Instituto Suramericano de Gobierno en Salud; Asamblea Legislativa Plurinacional; Cuadernos del Doctorado, Telelboin C, Laurell AC, editores. Por el derecho universal a la salud. Consejo Latinoamericano de Ciencias Sociales; The Mexican Popular Health Insurance: Int J Health Serv ; Barrio Adentro and the reduction of health inequalities in Venezuela: Fidelis de Almeida P.

Social Medicine

Mapeo de la APS en Brasil. This is an open-access article distributed under the terms of the Creative Commons Attribution License.

Services on Demand Journal. March 18, ; Revised: June 23, ; Accepted: How to cite this article.