Suchergebnisse

La afirmación de Foucault: "la medicina es una estrategia biopolítica", suscita las preguntas: ¿qué es la biopolítica?, ¿cómo se relacionan medicina con biopolítica?, ¿la medicina una estrategia de la biopolítica? Para responderlas, indago los significados de biopolítica, dispositivo de seguridad y discurso; describo la genealogía de la medicina social como dispositivo biopolítico y presento sus expresiones en el discurso sobre salud luego de la Segunda Guerra Mundial; muestro algunas recepciones de ese discurso en el pensamiento panamericano sobre salud en la primera mitad del siglo XX y, en el discurso legislativo ecuatoriano acerca de salud en la segunda mitad del siglo XX.

Background Selective vertical programs prevailed over comprehensive primary health care in Latin America. In Bolivia and Ecuador, socialist governments intend to redirect health policy. We outline both countries' health system's features after reform, explore their efforts to rebuild primary health care, identify and explain policy gaps, and offer considerations for improvement. Methods Qualitative document analysis. Findings Earlier reform left Bolivia's and Ecuador's population in bad health, with limited access to a fragmented health system. Today, both countries focus their policy on household and community-based promotion and prevention. The negative effects on access to care of decentralization, dual employment, vertical programming and targeting are largely left unattended. Neglecting care is understandable in the light of particular interpretations of social medicine and social determinants, international policy pressures, reliance on external funding and institutional inertia. Current policy choices preserve key elements of selective care and consolidate commodification. It might not improve health and worsen poverty. Interpretation Care can be considered as a social determinant on its own. Key to the accomplishment of primary care is an integrated application of family medicine, taking advantage of individual care as one of the ways to act on social determinants. It deserves a central place on the policy-makers' priority list, in Bolivia and Ecuador as elsewhere.