Confronting health disparities: Latin American social medicine in Venezuela.
OBJECTIVE
We explored the emergence and effectiveness of Venezuela's Misión Barrio Adentro, "Inside the Neighborhood Mission," a program designed to improve access to health care among underserved residents of the country, hoping to draw lessons to apply to future attempts to address acute health disparities.


METHODS
We conducted our study in 3 capital-region neighborhoods, 2 small cities, and 2 rural areas, combining systematic observations with interviews of 221 residents, 41 health professionals, and 28 government officials. We surveyed 177 female and 91 male heads of household.


RESULTS
Interviews suggested that Misión Barrio Adentro emerged from creative interactions between policymakers, clinicians, community workers, and residents, adopting flexible, problem-solving strategies. In addition, data indicated that egalitarian physician-patient relationships and the direct involvement of local health committees overcame distrust and generated popular support for the program. Media and opposition antagonism complicated physicians' lives and clinical practices but heightened the program's visibility.


CONCLUSIONS
Top-down and bottom-up efforts are less effective than "horizontal" collaborations between professionals and residents in underserved communities. Direct, local involvement can generate creative and dynamic efforts to address acute health disparities in these areas.
Briggs
Charles L
CL
Department of Anthropology, University of California, Berkeley, CA 94720-3710, USA. clbriggs@berkeley.edu
Mantini-Briggs
Clara
C
D005260:Female; D006291:Health Policy; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D011203:Poverty; D012935:Social Justice; D012959:Socioeconomic Factors; D014687:Venezuela