La salud pública en Colombia (1991-2021). Promoción de la salud y prevención: una revisión

Objetivo Este artículo se propone realizar un balance de la promoción de la salud durante el desempeño del sistema de salud, a partir de la reforma constitucional de 1991. Métodos Se parte de una revisión temática, en bases de datos de PubMed, SciELO, Google Scholar, a través de los términos y operadores booleanos (“promoción de la salud” or “prevención”) and (“Colombia”), en los últimos 10 años (2011-2021); y la legislación sobre promoción de la salud de los últimos 30 años en Colombia, seleccionando la más relevante. Discusión Se analiza la trayectoria regulatoria de la salud pública, derivada de la Ley 100 de 1993, destacando la confusión que entre promoción y prevención se dio en el sistema. Se discuten varias fases de desarrollo de la salud pública en este período, con grandes falencias en la primera década de la reforma, mejorando después del 2005, pero sin lograr su cometido, dadas las contradicciones con el modelo de mercado que rige el sistema. No se logran desarrollar los niveles colectivos y comunitarios de la promoción de la salud, como tampoco la perspectiva estratégica de la atención primaria en salud (APS). Conclusión La promoción de la salud y la prevención no lograron ser desarrolladas de manera cabal en Colombia, a pesar del entorno internacional proclive a su implementación mediante la atención primaria en salud. Muchos de los postulados teóricos de la legislación se han quedado en la retórica y pendientes de aplicación, muy a pesar del amplio marco regulatorio que se dio en estos treinta años.

La salud bucal, entre la salud sistémica y la salud pública

Introducción: A pesar de la implementación de diversas estrategias para atender la problemática en salud bucal, aun esta adolece de una visión de integralidad del ser humano y la práctica sanitaria. Objetivo: Analizar desde una perspectiva interpretativa y crítica la salud bucal, con énfasis en el caso colombiano, como práctica sanitaria y profesional, siguiendo la lógica de su relación con la salud sistémica y la salud pública. Materiales y métodos: Se realizó una revisión narrativa de tipo documental, mediante la búsqueda en las bases de datos Pubmed y Google escolarship (GS) en los últimos 5 años con los términos booleanos (periodontitis or oral pahology) and (systemic diseases), para la pregunta guía: ¿Cómo la patología bucal influye en las enfermedades crónicas no transmisibles? Resultados: Se identificaron asociaciones de la patología bucal con la salud sistémica, con las ECNT (diabetes, enfermedades cardiovasculares, embarazo y eclampsia, enfermedad perinatal, alzheimer), entre otras. Conclusiones: Es consistente en la literatura la relación biunívoca de la enfermedad periodontal con las enfermedades crónicas no transmisibles, aunque no se concluye sobre relaciones de causalidad. Se proponen algunas estrategias de salud pública y articulación de la práctica sanitaria interprofesional.

[Models for public health policy analysis reported in scientific publications]

OBJECTIVE

To summarize public health policy models reported in studies published between 2002-2017.

METHOD

Using MesH vocabulary, we systematically searched articles in English, Spanish and Portuguese in the PubMed, Scielo, Jstor, ProQuest and Google Scholar data-bases. The quality of the articles was assessed using the tool for understanding a qualitative study by CASPe.

RESULTS

A higher proportion of scientific studies were conducted in the African continent. The policies relating to health care were most frequently investigated. Walt and Gilson's model and Kingdon's multiple streams framework were more frequently reported.

CONCLUSIONS

The articles set out the public policy analysis model, but not the approach to guide it. A more robust theoretical body needs to be built to enable discussion about the approaches and models for the analysis of public policies. Its distinction is relevant, since it can order methodological proposals for the study of policies.

[Global health: a Latin American vision]

This article presents a Latin American vision of global health from a counterhegemonic perspective, applicable to various countries of the world in similar circumstances. It begins by reviewing several concepts and trends in global health and outlining the differences between conventional public health, international health, and global health, but without seeing them as antagonistic, instead situating them in a model that is based on global health and also includes the other two disciplines. It is understood that global factors influenced earlier theories, schemes, and models of classic international health. The article emphasizes the importance of several aspects of world-geopolitics and economic globalization that impose constraints on world health; it also underscores the theory of social and environmental determinants of the health-disease spectrum, which have impacts beyond those of epidemiologic risk factors. The suggested approach is based on cosmopolitanism and holism: global philosophical and political currents that allow for a better interpretation of world phenomena and are more relevant because they give rise to lines of action. Structurally, the theoretical foundations of global health are presented in three analytical areas: global justice and equity, governance and the supranational protection of rights, and holism and a new global consciousness. The article concludes by underscoring the need to construct an approach to the existence and praxis of global public health that is based on the Latin American perspective, an approach that highlights grassroots social movements as an alternative way to secure a new order and global awareness of rights and to redefine the architecture of global health governance.

[Review of food policy approaches: from food security to food sovereignty (2000-2013)]

Food policies have attracted special interest due to the global food crisis in 2008 and promotion of the Millennium Development Goals, leading to approaches by different fields. This thematic review aims to describe the main theoretical and methodological approaches to food security and food sovereignty policies. A search was performed in databases of scientific journals from 2000 to 2013. 320 complete articles were selected from a total of 2,699. After reading the articles to apply the inclusion criteria, 55 items were maintained for analysis. In conclusion, with the predominance of food security as a guiding policy, food sovereignty has emerged as a critical response to be included in designing and researching food policies. Food policies are essential for achieving public health goals. Public health should thus take a leading role in linking and orienting such policies.

Assessment of the association of health with the liberalisation of trade in services under the World Trade Organisation

Background

The liberalisation of trade in services which began in 1995 under the General Agreement on Trade in Services (GATS) of the World Trade Organisation (WTO) has generated arguments for and against its potential health effects. Our goal was to explore the relationship between the liberalisation of services under the GATS and three health indicators - life expectancy (LE), under-5 mortality (U5M) and maternal mortality (MM) - since the WTO was established.

Methods and Findings

This was a cross-sectional ecological study that explored the association in 2010 and 1995 between liberalisation and health (LE, U5M and MM), and between liberalisation and progress in health in the period 1995–2010, considering variables related to economic and social policies such as per capita income (GDP pc), public expenditure on health (PEH), and income inequality (Gini index). The units of observation and analysis were WTO member countries with data available for 2010 (n = 116), 1995 (n = 114) and 1995–2010 (n = 114). We conducted bivariate and multivariate linear regression analyses adjusted for GDP pc, Gini and PEH. Increased global liberalisation in services under the WTO was associated with better health in 2010 (U5M: −0.358 p<0.001; MM: −0.338 p = 0.001; LE: 0.247 p = 0.008) and in 1995, after adjusting for economic and social policy variables. For the period 1995–2010, progress in health was associated with income equality, PEH and per capita income. No association was found with global liberalisation in services.

Conclusions

The favourable association in 2010 between health and liberalisation in services under the WTO seems to reflect a pre-WTO association observed in the 1995 data. However, this liberalisation did not appear as a factor associated with progress in health during 1995–2010. Income equality, health expenditure and per capita income were more powerful determinants of the health of populations.

[The latest reform of the Colombian healthcare-related social security system]

OBJECTIVE

This essay was aimed at exploring and analysing the challenges and opportunities arising from reforming Colombian law 1438/2011 dealing with the healthcare-related social security system.

METHODS

Some outstanding issues from the reform introduced by Law 100/1993 were reviewed and then compared to the 2011 regulations; they were also contrasted (in market model conditions) with some public health strategies which were inoperative during the reform stage.

RESULTS

This second reform phase was discussed in relation to the scope of the right to health, access and overall equity. Progress regarding important issues such as benefit package equalisation, primary healthcare attention, integrated healthcare service networks was recognised; however, its failure to change core aspects of the system was discussed, i.e. financial sustainability and the economic rationale imposed on the aforementioned strategies which curtailed its responsiveness to keep the model introduced by law 100/1993 intact.

CONCLUSION

The crucial points necessary for major structural reform of the Colombian healthcare system based on the right to health and equity were then outlined.