title: Sociopolitical determinants of international health policy.
abstract: For decades, two opposing logics have dominated the health policy debate: a comprehensive health care approach, with the 1978 Alma Ata Declaration as its cornerstone, and a private competition logic, emphasizing the role of the private sector. We present this debate and its influence on international health policies in the context of changing global economic and sociopolitical power relations in the second half of the last century. The neoliberal approach is illustrated with Chile's health sector reform in the 1980s and the Colombian reform since 1993. The comprehensive "public logic" is shown through the social insurance models in Costa Rica and in Brazil and through the national public health systems in Cuba since 1959 and in Nicaragua during the 1980s. These experiences emphasize that health care systems do not naturally gravitate toward greater fairness and efficiency, but require deliberate policy decisions.
authors: Institute of Tropical Medicine, Nationalestraat 155 2000 Antwerp, Belgium PDVos@itg.be.
authors: Pol
authors: P
authors: De Vos
authors: Institute of Tropical Medicine, Nationalestraat 155 2000 Antwerp, Belgium University of Ghent, B-9000 Ghent, Belgium.
authors: Patrick
authors: P
authors: Van der Stuyft
mesh_terms: D018166:Health Care Reform; D006291:Health Policy; D006801:Humans; D038622:Internationality; D011057:Politics; D011634:Public Health; D012959:Socioeconomic Factors; D013222:State Medicine / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration*
keywords: Alma Ata; Brazil; Chile; Colombia; Costa Rica; Cuba; Nicaragua; health care system; international health policy; social and political determinants