Health Education Policy - Ok

Health Education Policies
INTRODUCTION TO THE SUBJECT
Health and work are two rights that we all have but that, Unfortunately not all
the inhabitants of the world can have it. More and more people have health problems
because of work.
On the one hand, there are the unemployed, who although they do not have a
job, live in anguish because they do not have one, and this causes them to have
psychological illnesses and there have even been suicides due to lack of work.
On the other hand we have the over-busy, those who work more than
necessary. commendable, but for various reasons they must do it, and they take them
to themselves relevant and impressive stress situations, which ends up losing their
job or only working part-time.
Today there is a very interesting technology that allows us to cure diseases

that previously led to absolute death.
This is how we are, some good, some bad, some rich and many poor. This is
the world reality of the 21st century.
ACHIEVEMENT EXPECTATIONS
That the student:

• Understand the concept of health in order to be able to assume prevention
techniques for possible diseases.
• Analyze and know the differences between the different levels of care tion.
• Understand the possible actions to implement in health education.
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• Learn about the different situations in our country and Latin America.
That is why we developed the following outline of the Unit:
To promote these achievements, you will address these contents:
CONCEPTUAL CONTENTS
• Science and health. Different conceptions of the health-disease process.

Health as a social historical process. cultural history root of the disease. Public
health. The universe of public health. National, provincial and municipal health
policies. Decentralize tion and health regionalization. Systems of health. Levels
of health care. Highly complex studies. sa strategies lud: primary care (PHC)
as a strategy.
• Specific top-level actions. Health research methodology. Diagnosis. Items.

Social history: history of the co community, social organizations, habits and
customs of the standard of living.
• Ecological: pollution and environmental sanitation.
• Demographic: population pyramid, temporal growth: inesta work ability.

Demography. Causes of disordered population growth. The consequences of
accelerated growth. Trans demographic situations.
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PROCEDURAL CONTENTS
• Preparation and interpretation of the population pyramid to know how society is

composed.
• Analyze the concepts of health and illness to be able to take disease

prevention measures.
• Find out which official health care organizations you have near you so you can
have periodic check-ups.
CURRENT CONTENT
• Take responsibility for regular check-ups to prevent illness.

• Stand in solidarity with needy and sick people to develop a collaborative spirit.
UNIT 1
Health, the ideal state to develop our daily lives, requires disease prevention
mechanisms and public organizations in charge of caring for people deprived of
health.
These organisms, unfortunately, today are so unprotected by the State that

sometimes they do not even have the necessary requirements to fulfill their duty to
heal.
For this, we are going to analyze the essential basic concepts to know what we
should do if we need to go to a health establishment.
What student:
• Learn about the functional structure of health care, both public and private
mo.
We can then present the following unit diagram:
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CONCEPTUAL CONTENTS
• Science and health. Different conceptions of the health-disease process.

Health as a social historical process. natural history root of the disease. Public
health. The universe of public health. National, provincial and municipal health
policies. Decentralize tion and health regionalization. Health systems Levels of
care tion of health. Highly complex studies. sa strategies lud. Primary care
(PHC) as a strategy. Analysis of your com speakers.
PROCEDURAL CONTENTS
• Analyze in a coherent manner the definition of health, disease with its

corresponding historicity to be able to clearly differentiate each concept.
• Understand how public health works, so you can know how to resort if you
need it.
CURRENT CONTENT
• Interest in knowing and studying the structure of public health bad and highly
complex.
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1.1 .-Science and Health
Definition of health: "The state of complete physical, mental and social well-
being, and not merely the absence of disease."
We do not consider the state of health only as the absence of self. shots or
physical discomfort. It means having harmony, internal balance, self-knowledge and a
deep desire to live.
If we have these conditions, our body resists environmental aggression better

and recovers better from any condition it may have.
Hand in hand with the surprising and accelerated advances in medicine,

prevention programs, based on the discovery of the so-called risk factors, constitute
the two pillars that have revolutionized, and will continue to do so, the health of
humanity. Discoveries that mark a before and after in the history of medical science do
not leave in the shadow the proven importance and effectiveness of a modern
protagonist in the world of health: prevention.
Medical advances must be considered from two perspectives: one mo

milestones of knowledge, and another as scientific and technological advance. For
example, organ transplants are an achievement of extraordinary scientific, but also
human, importance. With the discovery of the genome, pers very optimistic prospects,
with new diagnostic and therapeutic procedures, especially to treat cancer.
On the other hand, these advances represent a great advantage for some countries.
cients, however, very frequently its impact on the epidemiology of the 6
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health damage is very discreet, and if compared with actions to prevent tion, its scope is much
smaller in terms of cost-effectiveness. With the cost of a liver transplant, thousands of children
can be vaccinated, and at the same time the need to resort to transplants is reduced.
Therefore, for public health, the most significant advances must be made primarily
mainly to the very judicious and well-planned incorporation of technological achievements such
as vaccines. In this way, health systems have made great progress in the eradication and
control of infectious diseases, such as smallpox, measles, and polio during the 20th century.
Another fundamental aspect is the discovery since the 1960s of the so-called
multifactorial risks, especially of disease. non-communicable diseases such as cancer,
cardiovascular diseases and those produced by incidents.
In the mid-20th century, cancer was practically a disgrace with po few therapeutic
possibilities, with few early diagnostic possibilities, and no possibilities for prevention. Today it
is considered that 80 percent of cancers are predictable, essentially through changes in
lifestyle. There are studies carried out in populations that demonstrate this conclusively.
Around the sixties, from the Framing studies ham, in the United States, the very concept
of risk factors arises, such as high cholesterol, high blood pressure, smoking, obesity, and their
influence on the appearance of certain cancers and cardiovascular diseases. From then on,
several experiences demonstrated the importance and effectiveness of prevention through
changing unhealthy lifestyle habits.
The WHO and PAHO launched programs to carry out a set of actions aimed at
combating the multifactorial risks of non-communicable diseases. In Latin America the
programs are called CARMEN. And decreases of up to 60 percent in the incidence of this type
of disease have been obtained.
Although this type of campaign demands long-term education work zo, the intervention is
cheaper and the results more impressive. for the king PAHO presenter, the challenge for the
new millennium is being able to save, I through effective prevention plans, and thus derive
funds to invest in new technologies and therapeutics, of proven usefulness. In this way, it is
sought ca democratize the access of the entire population to both traditional drugs and those
that will emerge from recent discoveries in molecular biology.
The discoveries of medicine from 1900 to the present were formidable. From penicillin
and vaccines, to new technology and cons Exciting discoveries of the human genetic map
predict a very promising future for health. Every day hopeful news emerges, it is
difficult to make a selection that does justice to them all, the following are some of these
milestones of modern medical science.
• 1900. Discovery of blood groups: the transformation of blood transfusions, which became a routine procedure, is due
to the work of Karl Landsteiner, who in 1900 he covered three of the major blood groups and invented techniques to
identify them. Checking the compatibility between the blood group of the donor and that of the recipient made
transfusions a safe method.
• 1907. Psychoanalysis. The creator of the revolutionary method for the treatment of neurosis was Sigmund Freud. His
bold theory on libido opened the doors to a freer treatment of sex and human consciousness, and announced to the
world that the sexual impulse manifests itself in children from early childhood. In 1907 the first psychoanalytic
society was formed, when Freud had already developed and disseminated, not without effort in the intellectual
environment, a large part of his theory.
• 1916. X-rays. They had already been discovered in 1895, but the American William David Coolidge had universal
success with this discovery that allowed solid bodies to be violated. Ra Doctors quickly took advantage of this
discovery to explore the interior of human bodies, bones and lungs. But currently diagnostic imaging has evolved
towards me all that are not dangerous for the patient and offer the possibility of accurate and early diagnoses. ces,
such as computed tomography (1973) and nuclear magnetic resonance (1979).
• 1920. Insulin. The Canadian doctors Frederick Banting and C.H. Best, they begin to become interested in diabetes
and obtain the active substance, called insulin. In 1922 it was carried out with excellent results two the first clinical
administration of the extract. Recently it has been possible to transplant pro cells insulin producers in the liver of
diabetic patients.
• 1927. BCG vaccine. A fundamental advance to control one of the most deadly infectious diseases, endemic at that
time, tuberculosis. Its creators were the biologists Calmette and Camille Guerín. The polio (1953) and rubella (1962)
vaccines followed.
• 1928. Penicillin. A fundamental milestone, an almost magical remedy discovered by scientist Alexan der Fleming: a
simple fungus, similar to mold, killed infectious germs. The success sparked a wave of research to develop other
antibiotics.
• 1952. The discovery of DNA was one of the great feats of the 20th century. This year, the bioqui The American
scientist James Watson and the English biophysicist Francis Crick, working at the Cambridge University Laboratory,
determined that the function of DNA was the basic material of heredity.
• 1967. Heart transplant. Dr. Christian Barnard, in South Africa, shocked the world by performing the first heart
transplant. Currently, tissue engineering promises to improve the shortage of organs for transplantation through in
vitro cultivation.
• 1970. The laser. Its application in medicine provides infinite satisfaction: to repair loose retinal detachments and
make incisions that do not bleed. In certain circumstances, such as operations on hemophiliac patients, this possibility
is of vital importance.
• 2000. The map of the human genome is completed, the first step for an explosive advance in research. gations in the
fields of medicine. Now the ambitious goal of knowing exactly my sion of each gene in the functioning of the human
organism, for which it will be necessary to reconstruct the proteome, that is, the map of the proteins responsible for
the different functions of the metabolism, and eventually for its abnormalities. In this way, the predisposition to
certain diseases could be identified and attacked before they occur (such as cancer or Alzheimer's disease). mer).
Gene therapies tailored to each patient would also be found.
1.2 Different Conceptions of the Health-Illness Process.
45 centuries ago the Assyrian Babylonian people believed that

the Disease was a moral or spiritual impurity caused by the gods as a
response to a moral transgression. "Fault" (from the Latin culpa: fault,
sin) was sought in the biography of the patient.
For the Greeks, the disease was also of divine origin, but the
impure za was no longer moral, but physical, and therefore treatable with
purifying baths.
This was an enormous conceptual leap since if the disease was
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caused by the gods and meant an impurity of the soul, man did not have access to it
(something of the gods), that is, he could not be cured by other men, only by the forgiveness of
a god. But if the impurity was in the physical, (a thing of men), a man who knew the laws of
nature (physis) could cure others.
The Greeks thought that nature (physis) was guided by laws, which there was an order,
a harmony (Pythagorean idea). Thus, if they knew the laws of the nature of the organism,
physiology, when a man fell ill another man could help, accompany nature in the process of
restoring harmony (health). Caring for others, making medicine (from the Greek medein: taking
care of).
The concept of disease derives from three basic ideas:

1) Intrinsic : it is generated by an internal imbalance of the individual.
2) Extrinsic : it is generated outside the individual and he incorporates it.
3) Mixed : the individual has a predisposition that sensitizes him to certain agents external tees.
Intrinsic:
Almeon of Crotona (520 BC), doctor of the Pythagorean school, said that HEALTH was
the balance of powers.
- the wet and the dry; the cold and the warm; the bitter and the sweet.-
The predominance of one of these powers (monarkia) would be disease. Almeon places
the origin of the disease in the individual himself, the cause is internal, it is a disharmony (a
term very dear to the Pythagoreans), a disorder, an imbalance. brio in the physis of the person.
This model of explaining the disease is the one adopted by most medical conceptions:
excess or deficiency of chemical substances; alterations is structural or functional that
unbalance other structures or functions.
In short: the intrinsic model of disease says that everyone can fall as a result of an
imbalance.
Extrinsic:
This model has its roots in magical-religious postures, where it was Forces or external
influences affect man and make him sick.
As we mentioned above, not following religious precepts, generally raged the anger of
the gods who punished the transgressor with illness. A
idea related to this, already in magic, supports that certain objects, perso things, animals or
circumstances can influence a person and make them sick. This ancient idea is deeply rooted
in humanity, and when they learn it done rationally suffers enough, they appear fresh and
luxuriant even in the minds of the most "logical" (examples abound of atheists and rationalists
who they turn to holy hands as a last resort in the face of a terminal illness).
The magical bursts forth with the breakdown of order (of the logical, the coherent, the
cohesive). known, expected). It is the loss of confidence (security) in established, legal, officially
recognized knowledge, when these no longer help, they are no longer useful.
In magic there is a nuance of rebellion against what is presented as reality. dad: it is the
"I do not accept this as it is, there must be another way." It is a hypertrophy of desire that tries
to break limitations, overloading emotional mind what "has to be" with respect to what "is",
exercising will and faith, in search of a balance at another level (irrational, belief), of a refuge.
Popu Unfortunately, the idea of illness as punishment is usually expressed with the well-known
"What did I do to deserve this!"
The idea of influence is also exemplified by people who have "good or bad vibes",
"strong looks" (evil eye), jettatores, etc. In psychiatry, this model takes the influence of
circumstances and people on the individual. Thus psychoanalytic theory speaks of
circumstances that produce conflict cough, an oppressive environment, parental influences on
the genesis of neuroses, etc.
In short: we can all get sick if we are subjected to certain infections. flows or
circumstances.
Despite the different points of view with which the various concepts on these topics were
developed, the unity of criteria necessary to have operational principles useful for everyday
psychiatric practice has not been achieved. This is one of the cases in which the pragmatic
greatly surpasses the theoretical. The average person can determine with relative ease when
someone is abnormal (when this abnormality is moderate or severe). Likewise, hospital practice
with the mentally ill, after a while, creates in the therapist "the sense of smell", the intuition,
which allows him to detect when an examinee is, for example, a psychotic To do this without
being able to explain exactly what has led him to differentiate it. Of course, what we mentioned
goes beyond ordinary semiological analysis.
There is a global grasp of what is normal, of what is sick, that one incorporates going
throughout their entire lives as insertion and implicit learning in the cultural environment. It is a
common experience for any primary teacher, and even kindergarten, how children who suffer
from abnormalities (physical or intellectual) are marginalized and mocked by the rest of the
children; sometimes, long before the teacher, and even the parents, become aware of this
abnormality. This gives rise to the
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suggestive idea that there could be, for normality, a species memory and another
derived from learned models.
1.3 Health as a Social Historical Process
Health, both in its individual and collective conception, is the product of complex
interactions between biological, cultural, ecological and ecological processes. nomic-social that
occur within society.
Therefore, it is determined by the structure and dynamics of society, by the degree of

development of its productive forces, by the type of relationships it is. tablece, by the economic
model, by the form of organization of the State and its Policies, by the conditions in which
society develops such as the climate, the soil, the geographical characteristics, its available
natural resources, and by the forms of distribution and access to them.
Thus, conceptually, Health is defined as an incessant

process whose essential idea lies in its historical-social characteristics.
Not defining it well is to silence its essence, to

enclose In an abstract a-historical-social definition, don of
words such as physical, mental, biological, environment,
are forms or aspects of its existence and where modes of
domination are perpetuated under the justification of the
scientific, a-historical, a-political, a-ideological, etc.
The concept of health as a pro is necessary cess

with a historical and social character, basing it on the reality
that dominates its determination.
It is not a universal
concept since it must be developed for each particular mode
and relations of production, for each area. historical-social identity. It is socially constructed,
collectively, with a complex logic and is not the same for all humanity, therefore it is an
evolutionary concept. tive and dynamic.
Health is also constituted as a social product to the extent that it is a result and depends
on those actions carried out for or against the various social and political actors that intervene in
the living conditions of the populations.
The contemporary living conditions of human societies have changed radically in relation
to those in which man was adapted on a genetic basis throughout evolution.
It is well known that morbidity has changed since primitive times and that primitive man
suffered from fewer diseases than modern man. Modern diseases began to appear in the
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Neolithic, when man changed his lifestyle and diet and became sedentary. The first in diseases
that our ancestors suffered were dental diseases.
Throughout human history, a constant relationship is observed in between the mode of

production and consumption (economy) and the quantity and quality of human morbidity and
mortality.
These types of changes still occur because living conditions continue to evolve a lot:
they exist, due to industrialization and exploitation. uncontrolled destruction of nature, in the
form of “negative factors” of societies modern realities: contamination of the environment and
food, malnutrition, demographic growth, urbanization, wars, violence and, above all, poverty.
Under these conditions, contemporary human societies find themselves They are
entering new and critical social and health situations, this situation affects both developed and
less developed countries; It is a global health crisis situation.
1.4 Natural history of disease
The natural history of a disease or evolution of a disease is the sequence or course of events
that occur in the human organism in between the sequential action of the component causes
until the en disease and the outcome occurs (healing, transition to chronicity or death).
The natural history of a disease is the evolution of a disease without medical

intervention, as opposed to the clinical course that describes the evolution of the disease under
medical care.
Thanks to knowledge of the natural history of a disease, it is possible to know the cause
or etiology of a disease, the means of prevention, diagnosis, treatment and prognosis of a
disease. The objective and subjective data concerning the natural history of a disease are
reflected in the clinical history of the patient or patient.
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Most diseases have a prepathological or preclinical phase, where the individual is

asymptomatic, but it is possible to detect the disease, and a pathological or clinical phase
where it is possible to diagnose the disease.
1.5 Prevention
In recent years, the definitions of Health Policies have come to especially consider the
value of Prevention practices. These have been defined above all "as those activities that allow
people to have healthy lifestyles and empower communities to create and consolidate their
environment." tes where health is promoted and the risks of disease reduced. They foresee it
tion involves developing anticipatory actions. The efforts made to "anti "cipate" events, in order
to promote the well-being of human beings and thus avoid undesirable situations, are known as
prevention.
Prevention in the field of Health implies a scientific conception of work, it is not just a way
of doing, it is a way of thinking. It is also a way of organizing and acting, an essential organizer
in the conception of a Health System. A Health System is more effective to the extent that it
prevents more than cures. It is more effective from the social point of view - socially, a society
with qualitative and quantitative advances in terms of health indicators is not the same, which
implies the well-being of its members and greater socioeconomic development. It is more
economically effective - curing involves investment sion of a greater amount of economic
resources, of greater expenses. The most important thing is that it is more effective because, as
noted in the specific field of professional actions of the psychologist, prevention pursues "the
identification of those factors that allow promoting health and the implementation of different
interventions, in order to keep people healthy" and it is precisely The level of health of people is
the maximum indicator of efficiency of any health system.
It is difficult to think about prevention without thinking about the essential changes in the
structure of a Health System, but above all in the changes in the two ways of thinking, the
starting theoretical models, the epistemologies, philosophies and even belief systems so
strongly rooted in the professionals who work in the field of health and in the different scientific
disciplines on which they base their actions. These changes, which in our opinion should be
stated in general principles of health prevention actions, would be those that could lead
prevention tasks on a well-directed path.
Prevention is, above all, defined as protection against risks and environmental threats,
which inevitably means joint action. nothing from the Health Institutions, from the communities,
and from the people who establish them rather than integrating them. At the First International
Conference on Health Promotion, held in Ottawa in 1986 with the sponsorship of the WHO, it
was pointed out that it is necessary to facilitate the process according to which "people can be
mobilized to improve your control over your health and improve it…to achieve an adequate
state of physical, mental and social well-being…be able to identify and realize your aspirations
to satisfy their needs and to change or adapt to the environment. To truly achieve this, it is
essential to understand that the development of Health cannot be reduced to the fight against
disease, to clinical practices. traditional cases.
Prevention practices cannot therefore remain tied to Friday. problems and schemes,
insisting fundamentally and only on what These are called "healthy behaviors", which are
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associated with various aspects, including bits and vital processes of the human being but seen
very punctually, and have also been, at least partially, vitiated by formalisms and conceptual
deficiencies. fundamental tuals. Opening new perspectives in this sense implies the realization
tion of a critical analysis that goes through the conceptual, technical and instrumental support
that these practices have supported.
The image that prevention actions are health actions "po "bres" or of second importance.
This is reinforced firstly because there is a representation that the problems it addresses are
those of marginality or subjectivity, and secondly because it is the only thing that can be done
when there are no other resources.
On the other hand, the "alien" or distant nature of prevention actions for the most favored
social groups, with a higher cultural level, intellectual and also of greater social status (perhaps
they are partially saved from this more like smoking, hypertension and more recently AIDS).
These gr Because they do not feel involved in the prevention actions that are carried out, and
worse still, in reality it is not them who are usually thought of.
The failure to consider the existing needs of the population groups in which we work,
which in recent times has tried to be remedied with "Prevention based on evidence" (which is
the diagnosis of the needs of the groups on which we are going to work, and on the basis of this
preventive programs are developed).
Finally, on behalf of many specialists who have dedicated themselves to the ta

prevention areas, there is a certain quite generalized view that when working on prevention you
have to "lower the level", you have to forget about the ability to abstract tion, of intellectual
complexity. You have to do things very superficially, almost childishly.
The last obstacle in reference is the concentrated attention that prevention practices
have had on extreme groups or extreme symptomatology. trema.
This is something of utmost importance when we think about the extent and im pact of
health prevention practices. The idea would be: if the carriers of "anti-health behavior" are
important for prevention, more important are those who have not yet developed this type of
behavior, nor the favorable one, the "prose lud". These would be the risk groups in the correct
sense of the word, those who are not yet there but can be. If the educational purpose of
prevention is to promote the emergence and development of a healthy way of life, we must
work with the most prone segments of the population, those who are found in those groups at
probable risk. They are "waiting" to see what they do, if they are called upon and given access
to a healthier and more enriching way of life, they will probably, very likely, join this company.
A way of thinking with conceptual references in accordance with models that must live up
to the development contained in the concept of prevention.
The consistent organization of a Health System in accordance with the general principles
of Prevention, applicable in all links of the system.
Carrying out professional actions aimed at fulfilling the objective vo Prevent.
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Carrying out these professional actions involves rigorous observation of certain

elements. Among the most important we can point out:
The execution of preventive health actions is not the responsibility of a single scientific
discipline. It is everyone's land and no one's property. There may be specialists in the matter,
but all health specialists must carry out preventive actions. It is multidisciplinary in its application
and interdisciplinary in its conception.
1.6 Prevention Levels.
There are three levels of prevention:

1. Primary prevention: that which tries to prevent the appearance of the disease. The vacuum none of the
flu. The actions carried out are actions aimed at reducing the incidence of the disease. Incidence is
the number of new cases of disease. The role of the social worker in primary prevention is to increase
protective factors. tion and reduce risk factors. Example: vaccination, awareness campaigns tion, etc.
2. Secondary prevention: tries to stop the disease process once it has appeared. The actions that we carry
out in secondary prevention are actions that tend to reduce the prevalence of the disease, or total
number of cases, reducing its evolution and its duration. The main role of the social worker is to
promote learning dissemination of behaviors, aimed at detecting different health problems. Example:
early diagnosis and treatment, periodic health examination, etc.
3. Tertiary prevention: it is about avoiding the consequences of the disease, especially relapses. Actions
are actions aimed at reducing the prevalence or number of those in chronic diseases. The role of the
social worker is to teach the user the behaviors to to prevent relapse of the disease.
1.7 Public health
In 1990, Milton Terris proposed a new definition of this discipline that states: "Public
health is the science and art of preventing disease and disability, prolonging life, and promoting
health and physical and mental efficiency." such, through organized community efforts to clean
up the environment te, control infectious and non-infectious diseases, as well as injuries;
educate the individual in the principles of personal hygiene, organize services for the diagnosis
and treatment of diseases and for rehabilitation, as well as develop the social structure that
ensures each member of the community provide a standard of living adequate for the
maintenance of health.
Recently, a more comprehensive point of view on the concept of Public Health has
emerged. This maintains that the adjective "public" does not mean a particular set of services,
nor a form of ownership, nor a type of problems, but rather a specific level of analysis, a
population level. Unlike clinical medicine, which operates at an individual level, and biomedical
research, which analyzes the sub-individual level, the essence of Public Health is to adopt a
perspective based on groups of people or populations. This population perspective inspires its
two applications, as a field of knowledge and as a field for action.
The main task of public health is the transformation of health sciences into health care
for the entire population, and for this it requires the organization and administration of the health
system.
The success of the new Public Health will require actions at the organizational level.
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ganization. In this regard, the three "D's" of organizations must be addressed: ca capacity of
design, development and institutional performance. In the case of Public Health, modernization
must be understood as an opening in at least seven directions.
• The first is towards decision making: research must provide information Scientifically
validated training that is relevant to the problems of decision-makers at all levels.
• The second opening is towards the University: research and higher education Priority in
Public Health must promote excellence and to do so it must be linked closely to university
spaces.
• Thirdly, Public Health must open up to other health fields, so that its population focus finds
support in individual processes. This effort to integrate levels of analysis must be
accompanied by another by vin cular disciplines.
• The fourth opening is towards the social, biological and behavioral sciences.
• The temporal and spatial specificity of many health phenomena requires a comparative
approach that can only be achieved through two other openings:
• One towards the international level.
• Towards the future, to adopt a strategic vision that allows us to anticipate the problems and
not just react to them when they have already occurred.
• Finally, all of the above must be subject to the fundamental attitude that gives meaning to
Public Health: the permanent concern to capture the ever-changing health needs of the
population, learn from them and provide an adequate response.
1.8 National, Provincial and Municipal Health Policies
Currently, in Argentina health policies are being oriented towards intersectoral action. It
is the coordinated work of representative institutions from different social sectors, through joint
interventions aimed at transforming the health situation and contributing to the well-being and
quality of life of the population. blation
The health situation of a population is the result of the interaction of a series of

conditions that determine its real and potential degree of well-being. Health problems and
deficiencies have a multiplicity of causes and must be addressed. given with various skills and
resources, apart from those provided by the sector itself.
Therefore, a coordinated effort is required from the different sectors of social and
economic development.
Therefore, the following objectives are proposed:
• Provide treatment in primary care

• Ensure the availability of psychotropic medications.
• Provide assistance in the community.
• Involve communities, family and consumers.
• Establish policies, programs and legislation at the national level.
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• Develop human resources.

• Establish links with other sectors.
• Public education.
• Monitor the mental health of communities.
• Support new research.
Different health programs:
• Mother and Child Program

• National Support Program for Humanitarian Actions for Indigenous Populations (ANAHI)
• National Quality Assurance Program
• National Doctors Program for Primary Health Care.
• National Cancer Prevention Program
• National Diabetes Prevention and Control Program
• National Program for the Prevention and Control of Cardiovascular Diseases
• National Chemical Risk Program
• National Healthy Prisons Program
• Carmen Program - CINDI (PAHO/WHO)
• Leprosy Control Program
• Aedes Aegypti Surveillance and Control Program
• National Malaria Control Program
• Chagas Control Program
• Program to combat human retroviruses HIV-AIDS and STDs
• Immunization Program
• Tobacco Prevention and Control Program
• Poison Prevention and Control Program
• Secondary Breast Cancer Prevention Subprogram
• Cervical Cancer Early Detection Subprogram
• National Bank of Antineoplastic Drugs Subprogram
• National Epidemiological Surveillance System Program
• Worker Health Program
• Healthy Behavior Promotion Program
• Accident Prevention Program
• Prevention of Accidents in Childhood
• Road safety.
• Health Education Program
• Health Promoting Schools
• Prevention of Family Violence
• Environmental Health Program
• Oral Health Program
• National Genetic Data Bank
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1.9 Health Decentralization and Regionalization
Health Regionalization is understood as a way of organizing care. medical tion,

establishing different levels of complexity with all the available resources of an area, for a
defined population and with a coordinating body unique dor.
It is appropriate to clarify some concepts included in the previous definition:
: it is the one that conditions and to which the actions are directed tions,
Defined population
therefore they must adapt in their form to the socio-eco characteristics nomic and cultural
aspects of it.
Medical care activities will initially aim to so address specific problems in the area as a
priority.
The demographic study and the morbidity and mortality study, in addition to those
indicated res of the socioeconomic-cultural area will determine the type and complexity of the
beings vices.
The classification of the population according to risk levels will make it advisable to
concentrate greater resources on the group considered "high risk."
Geographic Area : the health region must aim to be self-sufficient in the provision of all
types of medical services, and to this end the existence of important healthcare centers will be
taken into account for its design and extension, the concentration tion of the population in
numerous centers and fundamentally the communication routes intra- and inter-regional
nication.
The road, railway, area and radio or telephone communication infrastructure constitutes
the key element to delimit its extension.
What really matters is not the distance that separates the different healthcare centers,
but the time it takes to locate the patient at the level of care. tion that corresponds to you
according to the complexity of your pathology.
the regionalized care system must encourage and increase the

Single Coordinating Body:
adhesion of the different medical care subsystems. ca existing in the area, integrating their
actions under a single coordinating authority nator, than assigning the corresponding levels of
complexity. (Subsystem Na tional, Provincial, Municipal, public welfare entities, development
societies, etc.) In this way, the use of resources is optimized to avoid waste and underuse of
them.
: three levels are usually accepted for the regionalized system:

Levels of Complexity
1) Regional Level : it must be capable of covering any type of benefit, both for Medical Care and
Environmental Sanitation, that is, it must be self-sufficient.
2) Subregional Level : be trained to provide care from the four basic clinics sicas: Medical Clinic,
Surgical Clinic and Obstetric Clinic. It may also include those specialties considered essential for the
area.
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3) Local Level : represented by outpatient consultation services mainly; A minimum number of

beds can also be available for short-term hospitalizations. Regionalization in the Argentine Republic:
according to Law 16,964 of March 21, 1967, it divides the country into eight development regions, on
which initiatives were implemented or attempted. implement health regions.
1.9.1 The Process of Transfers and Decentralization of the '70s
The process of transferring public health providers began in the seventies with the
transfer to the provinces of existing national organizations and functions in national territories
through national laws, which is established the Decentralization of hospital and healthcare
establishments to the provinces and Municipality of Buenos Aires. In 1974, the National
Integrated Health System (SNIS) was created and the National State assumed the
responsibility of making this right effective, without any type of discrimination, using the
instruments provided by this law and setting as a goal based on the principle of national
solidarity, its responsibility as financier and economic guarantor of the direction of the system
that will be unique and equal for all Argentines.
1.9.2 The Neoliberal State (1976-83)
There was a dismantling of social services in the hands of the Es ted and its transfer to
private activity. Hospital decentralization deepened laria, transferring the conflict to the
provincial sphere, freeing the fiscal budget from all responsibility for the health of the
population, including the support of the public hospital.
1.9.3 The Ministry of Health and Social Action (1983 )
The democratized State. Incorporates into the reformulation of services the premise of
promoting social participation in the field of health. Influence of the Alma Ata declaration in
1979.
1.9.4 Transfers in the '90s .
At the beginning of the nineties, one of the main objectives for the health area was made
explicit to design a policy that integrated the public hospital with other local healthcare
networks, so that it would operate as the ultimate guarantee that no one would be deprived of
your right to proper medical care, transfer performing the functions of direct provision to the
provincial states. The MINIST RIVER OF HEALTH. By Decree No. 227/94, the structure of the
Ministry of Health and Social Action is modified, separating the functions and resources of
“Health” from those of “Ac Social Development” and the Secretariat of Social Development is
created, dependent on the Presidency. dence of the Nation. The reform of the State. This
circumstance would become an unavoidable opportunity to redefine the role of the Ministry of
Health of the Na tion in the new context of the so-called “State Reform”, as well as the policy
priorities of the sector. By Decree No. 1269/92 (7/20/92) it is approved ron the National Health
Policies, which formed an important precedent in the explanation of public policies. The 21st
century and the crisis. Through the issuance of Decree 455/00, the “Strategic Political
Framework for the Health of the Argens” was approved. tinos.” An attempt was made to
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strengthen the primary health care model in a context adjustment and deep economic and
social recession. This translated into a serious financing crisis in the health sector. Despite this,
the Ministry remained has been acting as a regulator and supervisor of the functions it had
previously been performing, but its limited role even led to the development of cies that
maintained the need for its disappearance and its replacement by a health agency 2002.
1.9.5 The National Health Emergency and the Generalized Systemic Crisis
The problems raised by one of the deepest crises experienced by the Argentine
Republic implied the need for urgent intervention in the cor The State's term to strengthen the
public institutions of the sector.
The crisis and emergency situation unleashed in December 2001 was presented as an
opportunity that provided the propitious field to make profound changes and recover the public
capacity to reformulate the health system, based on the construction of the necessary
consensus and recognition. - of their leadership in this process, on the part of the social,
political and sectorial actors. torials, reflected in the achievements of the Argentine Health
Dialogue Table.
The development of the State's capacity to counteract reducible damages and reduce
health differences between the country's jurisdictions has been accompanied by marred in this
last stage by the redefinition of the benefit model, through measures aimed at strongly
strengthening primary care and pre health care.
1.10 Health Systems
Concept: This is the name given to the organized social response to the health and
disease conditions of the population.
The health system as a member of the social system recognizes as a speaker to any
sector, institution or social actor that at a given moment can contribute to the development of
the health of a community; starting with the population that must be the main actor or
protagonist of its own health.
There are four categories of health systems:

• The global social system, constituted by the whole of society and culture, with its forms of
social organization, all framed in a set of value res, beliefs and patterns of behavior that
form a particular way of life.
• The health system: all those elements of the social system that have an influence directly
or indirectly on the health of the population. Sectoral and extra-sectoral institutions or
organizations, so they can be institutional political, economic, cultural, educational, etc.
• The health care system: those components of the social system that have been formally or
informally differentiated to provide health actions. The institutional system of health
services has three components; the sis traditional community theme (folk medicine) and
the popular system (behavioral patterns, attitudes and responses of the population)
• The health services system: hospitals, clinics in the state or private sector do.
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1.11 Levels of Health Care
Health has different levels of care. The gateway or the first step are the health centers
staffed by general doctors and nurses who seek to solve simple and frequent health problems
that do not require special infrastructure; The second step is represented by the hospita the
zones that have diagnostic and treatment facilities and auxiliaries; and on the third step we find
the inter-zone hospitals staffed by specialists who work with numerous teams and special
facilities for treatment. ment of complex pathologies.
To arrive at the diagnosis of your disease, we begin with elementary studies; the
results of these will tell us if it is necessary to continue climbing the complexity ladder.
It is important that the stages of this study ladder are respected. In this way we will
avoid subjecting the patient, from the beginning, to a great strain. number of practices that
involve procedures, waiting, long lines and inconveniences that They may not be strictly
necessary.
Primary Health Care is a strategy that comprehensively conceives the health-

disease problems of people and the social community, through the integration of care,
disease prevention, health promotion and rehabilitation. It is an effective instrument,
recommended by the Organization World Health tion and already applied by the public
health systems of Cuba, Spain, Canada and Costa Rica, among other countries.
It is based on the appropriate use of available resources and gives priority to social
needs, deconcentration and optimization of services. Fa It favors geographical and
administrative accessibility, avoiding long lines, waiting or complex procedures. It is an
intervention with a high healthcare impact with adequate resources and in search of
maximum effectiveness.
The APS proposes an organization of health services at different levels care, which
must involve the participation of the community to solve problems through accessible,
high-quality services in a continuous and comprehensive manner. The first level of health
care within the framework of Primary Care can solve 80 percent of the health problems of
the indigenous population. giving them in an interdisciplinary way, within the family and
social perspective.
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In this way, general acute hospitals and specialized hospitals They will focus on
their specific function: the care of patients who require pressure. tions of a higher level of
complexity.
Second Level Specialties.
All modalities of health recovery are covered, in the pa outpatient or inpatient.
Specialties covered:
Allergy Nephrology Pathological anatomy

Pneumonology Cardiology Neurology and
Surgery Ophthalmology Dermatology
Oncology and Oncohematology Endocrinology Orthopedics and
Gastroenterology Otorhinolaryngology Gynecology and Obstetrics
Pediatrics Hematology Proctology
Hemotherapy Psychiatry Immunology
Radiant therapy Physiatry and Rehabilitation Urology
High Complexity Studies
The following are some of the studies that can be carried out at the Hospital:
General ultrasound. Color Doppler. Echocardiography.

Digestive video endoscopy and endoscopic Electrophysiological and abla computed axial tomography and
procedures. studies radiofrequency tions. procedure ments under tomography.
Hemodynamics - Diagnostic and pro studies
Laparoscopic surgery Arthroscopy and arthroscopic surgery
therapeutic procedures
Electromyography and evoked
Hemodialysis Bronchoscopy
potentials
Ophthalmology: laser and
High complexity laboratory practice
retinofluoresceinography
1.12 Health Strategies: Primary Care (PHC) as a Strategy
Health is a social fact whose promotion cannot be clearly separated. dez from other
social and economic spheres. Therefore, it cannot be limited to an administrative sector of
the State. Achieving the highest possible level of health is, above all, a complex social
fact: it requires an even more complex social process, and a political process within which
it is necessary to make political decisions, not only sectoral but also State, capable of
obligatorily and without exceptions to engage all sectors.
Within this context, PHC must allow the people to be protagonists of their health
process. Health, understood as a right, requires citizens who can and want to exercise
their citizenship; requires that people stop being passive recipients of specific activities
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provided by institutional services restorative or disease-oriented medical care.
PHC implies "health care", a notion that has a much broader and more
comprehensive connotation than "care." While "attention" or "asis "care" is vertical,
asymmetrical and non-participatory in its social sense, care im applies horizontal,
symmetrical and participatory relationships; It is not isolated to a specific program or
service, but is intersectoral.
1.12.1 Analysis of its Components
We can agree that APS is the set of activities, educational, of course. trition,
promotion, prevention, control of epidemics, treatments of diseases and health problems.
All of which is carried out with a strategy that allows accessibility, multisectorality,
comprehensiveness and participation tion, whose philosophical bases are based on
shared responsibility, justice, solidarity and the broad acceptance of the concept of health
as a glue and axis around which our actions must revolve.
It is not difficult to accept that 90% or more of the problems are attended to by the
interested party themselves or even family or friends, nor is it difficult to accept very easily
merges primitive attention with primary attention and this with primary attention Maria of
health.
The AP, has a limited focus, although confusion with APS is frequent, it focuses on
the disease and its healing as an individual and sectoral act with a practice attached to the
passive reception of individuals.
The basic pillars of APS are participation, intersectorality and equity. Many of the
principles of APS were accepted thinking that they were intended exclusively for the third
world and that they would have no relevance in other countries. developed, however we
see how the ecumenical diffusion of its need ity is becoming more and more evident.
In accordance with the difference between PA and APS, we see that the former
must necessarily be converted into APS, this being the appropriate scope of application of
family medicine. Despite the extension that we accept that the APS has, it is appropriate to
remember that what it is to us; It is not a health program for the poor, nor is it only first
level and in no way is it reduced to the level of prevention.
Since PHC is the scope of application of family medicine, let us remember some
criteria regarding what the family doctor is.
It is the fundamental figure of the health system and its task is of an international
nature. graded and continuous, it studies not only the individual but also the family group
in a community context, as generators of health or illness.
Its mission does not admit age limits, sex, race or diagnosis, which does not mean It
is important to work alone, on the contrary, you should know when and how to request
permission. course from other professionals and not just doctors, in accordance not only
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with the need but also with the availability of resources of all kinds. The family doctor lia
faces a high prevalence of symptoms related to lack of well-being and low prevalence of
disease.
Its permanence as such will depend on having fully understood that it must be a
repairer of the disintegration between clinical medicine and co-health. community,
evidence of the importance of their task.
In this framework, its action must generally develop, in addition to its curative task,
an important educational action generating a sense of res responsibility in people towards
their health, working as a team with the community ity and not neglecting the tasks of
prevention and rehabilitation.
In the doctor-patient relationship, he will know how to listen and inform, also
providing serenity to both the patient and the family.
Its integrity must be sustained with continued training that allows it aim to resolve
80% of queries with the minimum acceptable complementary procedures.
The main features are:
• Accessibility at all levels
• Maternal-child assistance
• Vaccination
• Promotion of proper nutrition
• Referral of complex cases
• Increase in preventive actions
• Teamwork and community involvement
• Adequate and low-cost technology
• Training and qualification of personnel
• Basic environmental sanitation.
VOLUNTARY ACTIVITY N° 1
1) Name the most relevant diseases today.

2) Collect data on the diseases mentioned above das (newspapers, magazines,
Internet) and mentions in them the causes and consequences ciations of these
diseases.
3) There is a healthcare center in the area where you live. Explain your benefits flaws
and shortcomings.
4) Make a visit to a private and another public medical center. Then give highlight the
similarities and differences between them.
SELF APPRAISAL
1) Complete with True (T) or False (F), as appropriate, if false, justify:

a) Disease is the only physical alteration of the body.
b) Intrinsic disease is generated outside the individual.
c) Prevention is not a health system.
d) Diseases that require highly complex studies belong to the second level of care.
e) APS is highly complex specialized assistance.
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2) What does the WHO say about the meaning of Health?

3) What is the mission of Public Health?
MANDATORY FINAL EVALUATION ACTIVITY
1) Gives different concepts of health.

2) What is disease?
3) What does mixed disease mean? Give five examples.
4) Investigate what the WHO says about the social processes of health.
5) What is prevention in health? Give five examples.
6) Defines Public Health.
7) Investigate the Maternal and Child Program, implemented by the Ministry of Sa Lud
and Environment.
UNIT 2
In order to adapt to the requirements of modern medicine and to be able to respond
satisfactorily to new diseases, a product of the exi current agencies and environmental
pollution, scientists must be conti constantly investigating to be able to comply with the
above.
The diagnoses provided by professionals are sometimes not accurate. ted by the
lack of means and training that professionals have.
In order to have more knowledge of what happens day to day with respect to the
current labor market and its corresponding influence on the human organism, we are
going to study the next unit.
That the student:

• Understand the risks that today's job market presents to human health.
• Understand that the professional must continually conduct research nes and
training to be able to respond to current health demands tuals.
We can then present the following outline of the Unit:
1ST
LEVEL
2ND
LEVEL
3rd
LEVEL
4TH
LEVEL
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CONCEPTUAL CONTENTS
• Health research methodology. Diagnostic elements.

• Social history. History of the community. Social Organizations. Habits and customs.
Indicators of the standard of living. Poverty. Acti you in front of her.
• Demographics . Population pyramid. Temporary growth. Agnes job stability. Causes
of disordered population growth. Consequences of accelerated growth.
Demographic transitions ficas.
PROCEDURAL CONTENTS
• Investigate the conduct of research in human health.

• Relate work activity and environmental pollution to recently known diseases.
CURRENT CONTENT
• Respect and understanding towards professionals who, like others, We can give a
wrong diagnosis.
• Assessment of health in all its aspects.
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2.1 SPECIFIC ACTIONS OF THE FIRST LEVEL OF CARE:

• Primary prevention:
• Health promotion: aims to raise the level of individual health. duo and the
community.
• The activities it carries out are: Nutrition; education; personal hygiene; gee netics;
recreation; job; life habits; environmental sanitation.
Specific Protection:
It aims to maintain the health levels achieved. Improve guest conditions. Protect the
host from the action of agents. The actions The activities they carry out are: Specific
immunization, protection against: occupational risk, accidents, infections and parasitosis
and control of risk factors.
2.2 Health Research Methodology
Research should be understood as the process dedicated to responding to

a question. What this answer aims to do
is clarify the uncertainty of our
knowledge. It is not about storing data
indiscriminately It is defined as a
systematic, organized and objective
process tried to answer a question. The
word "systematic" means that from the
formulation of a hypothesis or work
objective, data is collected according to a
pre-established plan that, once analyzed
and interpreted two, they will modify or
add new knowledge to existing
knowledge.
The scientific method starts from the observation of a reality, an explanatory

hypothesis is developed, the hypotheses are contrasted and said hypothesis is accepted
and realized. zan propositions that form scientific theory.
General outline of the approach to an investigation;
• Work hypothesis
• Goals
• Study design
• Variable selection
• Definition of variables
• Measurement scale
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• Data collection protocol

• Sample selection (How many? - Who is it?)
• Data Collect
• Data automation
• Data cleaning
• Analysis
• Results
• Conclusions
Epidemiology and statistics are essential instruments for carrying out this process.
In general we can say what usually happens is that a sample is extracted from a
population, on which an experiment is carried out riment or measurement and the results
of the same are extrapolated again to the po blation by making an estimate with a defined
security, thus completing the inference.
It must inevitably be developed through the use of the scientific method to achieve a
degree of valorization within the spectrum of the set of sciences that act within health
(medical, social sciences, etc.)
2.3 Diagnosis. Items
The community health diagnosis: what is the exhaustive study and its thematic of a
community with the description and analysis of its needs and the factors that determine or
favor it.
How do we make that Diagnosis?

Let's measure:
• Community health level.
• Conditioning factors of the community and the environment.
Health level of the community, for this we use negative indicators you (how many
are sick in the sample and from what?).
We are based on 2 variables:

• Mortality: has the advantage that death is a known fact and everyone fails foundations are
recorded through death certificates from the hospital and I before civil registry. It has one
drawback and that is finding a death certificate that clearly states the reason for death.
• Morbidity: there are 2 problems and that is that what can be studied is the satisfied demand
cha, but not those who are sick and do not go to the doctor.
Conditioning factors of the community: they are demographic factors, that is, when
the health diagnosis of the community is made, we must see the pi population, the data is
obtained from the municipal registers and censuses of the immunization status of the
population to know what percentage of it is vaccinated.
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Conditioning factors of the environment: see geography, education, transportation,

climate, pollution, green areas, ... resources, accessibility of cities give us to the program
and the accessibility of us to the citizens, iden tify the problems through the health survey,
explain the health situation which consists of relating the identified health problems with
the conditioning factors discovered in our community, prognosis and prioritization, and
evaluation.
Prioritization is done taking into account 3 things:
• The importance of the problem.
• Solvability of the problem.
• Intervention capacity.
Participatory Diagnosis
It is the process through which people from the community and the health team
collect and share information that allows them to know the health situation of the
population, their priorities, the strengths and weaknesses they have to face their problems,
the resources existing ones and the problem they want to address re or must act.
What is it for?
• Know reality better; the living conditions and interests of the population, their health
situation, perceptions and expectations
• Know the different resources and tools that exist in the community
• Work together looking for and proposing possible solutions
The different social actors; people, organizations and institutions of the local space,
health teams.
There are different stages to carry out the diagnosis:

•Identification of problems : make a list of the different recognized health problems
•Hierarchy of the identified problems: order them according to the mo ment in which
they will be addressed, their level of urgency, etc.
•Account of the resources available to address the problems. Re human, material,
financial course
• Proposal of solutions: clearly imagine the situation you want to achieve gar (target-
image). This task requires maximum creativity, with maximum proposal mo
The means to carry out the participatory diagnosis must allow the broad appeal to
the population; collect qualitative information; the way in which the processes occur in the
population, their perceptions.
The means that are frequently used are: direct observation, interview, survey,
various group work techniques.
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2.4 Social History. Study Elements

Demographic Indicators
•
Total population 2001 Census: inhabitants (Population Year 1991: inhabitants.)
• Numbers of live births:
• Percentage of population under 15 years of age:
• Percentage of population aged 65 and over:
• Percentage of urban population:
Socioeconomic Indicators
•Percentage of population with NBI:
•Percentage of population aged 10 and over who are illiterate, both sexes:
•Percentage of total population with running water:
•Percentage of total population with sewage drains:
Mortality Indicators
• Gross general mortality rate (per thousand inhabitants):
• Maternal and child health indicators
• Gross birth rate (per thousand inhabitants):
• Maternal mortality rate expressed per 10,000 live births:
• Infant mortality rate expressed per thousand live births:
• Mortality rate from 1 to 4 years expressed per thousand children from 1 to 4 years:
Support Programs for Local Development

•Social action:
•Local development promotion activities:
•Other commissions, councils and organizations of a social and productive nature, NGOs,
religious entities, etc.:
2.4.1 Social History

Social historians or integral history: They treat it from the point of view of the actions
of society and explain the phenomena taking into account all aspects of life: political,
military, economic, cultural, religious, technological, etc.
2.4.2 Community History

1. Social Organizations: As a cause of neoliberalism, the values of the working class, such as
solidarity, fraternity and mutual aid, are destructured as are their social spaces of reference:
the factory, the neighborhood. As southern response generate new alternatives, re-creation -
which takes as an example the experiences of Zapatismo and the Landless -, a new culture of
the oppressed that strives to give birth to a subject to be autonomous individually and
collectively. Diversity converges in a project of resistance and alternative, which is based on
supportive, ecological and socially sustainable self-determination in the face of
neoliberalism, which turns out to be the new mask of the old impulse of domination.
2. Media: a look at communication as a tool that recovers the social role of information, and,
with this perspective, facilitates the community give the construction of their own story as a
way of exercising citizenship. We talk about social intervention , because we believe that
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communication is a facilitating tool for the community to intervene, in organizations. formal

and non-formal, in the construction of their own space for communication and expression
sion, around the problems that go through it.
3. Habits and Customs: One of the main classifying dimensions of identity tity is gender.
Very early in the development of personal identity, subjects think of themselves as either
women or men. We understand the identity of a subject as a system of self-representations
developed throughout life, through which a subject recognizes himself and is recognized by
others as a particular subject and as a member of distinctive social categories. .
4. Standard of Living Indicators: social indicators suffered a notable deterioration ro. More
than half of the population is today below the poverty line and the unemployment rate is
around 20%. In this scenario, the informal sector of the economy and also solidarity actions
multiply. Despite the regret ble situation, Argentina can still boast a good educational
system (education primary education, for example, is free and mandatory for children
between 6 and 14 years old), a low illiteracy rate, among other favorable indicators.
Main social indicators:
Life expectancy at birth: 75 years (men 72, women 79) (2001)
Fertility rate: 2.44 children per woman (2001)
Infant Mortality: 17.75 per thousand live births (2001)
Illiteracy rate : 3.7% (2000)
( Definition : people 15 years old or older who do not know how to read and write)
Public universities: 37 (1999)
Private universities: 49 (1999)
5. Income : National accounting is an accounting system that allows knowing the state of the
economy and the dynamics of the activities that are developed therein te of the public and
private sector. Knowing the performance of the different areas of the economy, their impact
on it and the relationships that exist between them, allows us to make
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an assessment of existing needs and defining the policies to be implemented learn about
economic matters towards the future. Likewise, it is an important reference point for various
historical investigations.
6. Migrations : One of the phenomena associated with globalization is multiethnicity, that is,
the coexistence in the same territory or city of people from different areas of the world. It is
not new, we know that in all large cities cities and the great empires of antiquity, people
from different places coexisted gares very far from each other. But if migratory phenomena
are nothing new, they are currently occurring with non-stop intensity and generality. gon in
history. Migrations are movements of human groups that take them away from their usual
residences. This definition allows us to encompass phenomena of very diverse
demographics, it can refer to peaceful or aggressive movements, volun voluntary or
involuntary
2.5 Ecology - Pollution and Environmental Sanitation
Since the late 1980s the national government has progressed in stable foundation
of responsibilities in environmental matters, at the level of the executive, the legis lative
and of the provinces and municipalities of the country. To solve problems inter-institutional
bientals, the Federal Environmental Council (COFEMA) was created in 1990, which in
addition to coordinating environmental policies and legislation, provides an institutional
framework for trilateral decision-making.
At the beginning of the 90's (1991) the Secretariat of Natural Resources and
Human Environment was created (Law No. 2419). The Undersecretariat of Natural
Resources, within the Secretariat, carries out environmental management activities; The
Undersecretariat of Human Environment organizes the registry of pollutants and their
emitters, and is in charge of publishing environmental standards and developing
educational activities. tionals to promote environmental preservation. The Secretariat,
through a support program to strengthen its environmental management (IDB Financing),
was consolidated into three Undersecretaries: Institutional Relations, Natural Resources
and Human Environment.
It is worth mentioning that currently there is no Environmental Impact Assessment

(EIA) procedure carried out by the Ministry of Natural Resources and Am Human Asset,
which requires proponents of infrastructure projects to pre- sit and obtain approval of an
EIA. However, international financial organizations such as the World Bank and the Inter-
American Development Bank require compliance with this obligation based on specific
guidelines regarding format and content.
The entity in charge of the conservation of natural areas in the na tional is the
National Parks Administration, which, through its Directorate of the National System of
Protected Areas, controls natural reserves throughout the country.
The environmental issue acquired citizenship in the last two decades of the recently
concluded century, when governments of different countries included in their agenda the
concern for the growing deterioration of the essential conditions of existence of the human
species. Previously, the matter had been dealt with individually.
viduals and organizations grouped in a "green movement" of a contested nature tary and
spontaneous with little audience and less resonance due to the ostracism to which it was
subjected.
The first warning bell was given by the Club of Rome in 1971 when it published the
report "The limits to growth" in which the possibility of a profound crisis that would
endanger the survival of humanity during the 21st century was foreseen; the same
organization under the title "Beyond the limits of growth" would ratify 20 years later that,
due to the dominant patterns of production and consumption, environmental problems are
growing rapidly: new diseases deities, extinction of species, desertification, famine, water
pollution, destruction of cultural heritage, depletion of resources, atmospheric pollution,
etc. It would also be revealed that, unlike what happened in previous crises, the new
trance acquires compelling speeds and dimensions hitherto ignored.
That the development of ecological crises is interconnected with economic activities
is evident when examining that the first of these crises occurred It was with the invention
of agriculture, just over 10 thousand years ago. Such transforms tion revolutionized not
only the relations of primitive man with the nature that surrounded him, leaving its mark on
biological systems and altering the "paradise" ecosystems of which it was a part, but also
produced profound modifications in the relationships of men themselves; to the point that
society Egalitarian equality, until then existing, gave way to a new type of society: society
divided into classes. With the Industrial Revolution and the subsequent increase in energy
consumption, natural resources increasingly acquired the condition tion of goods; incipient
capitalism thus reveals its essence, what is the substitution tution of collective subsistence
by the predominance of individual interests dual.
The so-called "Globalization", nonsense of contemporary society, to soca changing
economies, tearing down traditions, imposing the culture of disposable goods and profit at
all costs, has aggravated the situation, generating the worst environmental catastrophes.
them until now registered.
However, the matter does not end here because, as UNESCO warns, "¨ The
environmental crisis we face represents, in addition to the collapse of biogeochemical
cycles at the planetary level, a crisis of knowledge and more of knowledge. It is, as has
been repeated many times, a civilized crisis ra, since it questions the myths of indefinite
progress and unlimited economic growth... it affects, in this sense and mainly, Western
culture, incapable of escaping the values of consumption and utilitarian and
anthropocentric hedonism. "
Stockholm in 1972, Tibilisi (the now destroyed capital of Georgia) in 1977, Moscow
in 1987, Rio de Janeiro in 1992, Talloires in 1994 were some of the scenarios in which
Environmental Education was proposed as a safeguard of the environment, convinced that
the appropriation of knowledge, experiences, com skills and values will contribute to
individuals and communities acquiring a global understanding of the environment and
assuming attitudes of conservation and correct use. zation of resources.
The research carried out in the UTS was planned as a pilot test, to the extent that it
serves as a test for studies aimed at determining in the inhabitants of a population the
knowledge, attitudes, practices and disposition to incorporate take action to protect the
environment. Establishing these characteristics is essential to enrich the prior knowledge
that educators must build. be on communities and to improve the impact so far obtained
with environmental education.
2.6 Demographics: Population pyramid. Temporary Growth. Job instability.
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The population is constantly increasing. In 1650, the world population was 520
million; in 1850, 1.16 billion; in 1900, 1.6 billion; in 1920, 1.8 billion. In 1980, 4,500 million,
in 1990, 5,500 million, and it is estimated that in the year 2000, humanity will reach
approximately 6,000 million inhabitants, expecting an increase of almost 100 million per
year in each successive year until 2025. and 60 million per year between 2025 and 2050.
From 1958 to 1965, humanity increased at a rate of 50 million people per year and then
rose to 65 million.
But the annual growth rate varies according to the countries and thus, while in 1974
an increase of 1% was recorded in Holland, in Argentina it was 1.5%. It is estimated that
by the middle of the 21st century, the total population of the planet will be 10 billion people.
More than half of this growth will correspond to Africa (with 1/3 of the total) and South Asia
(with 1/5), with urban population growth prevailing.
2.6.1 Causes of Disordered Population Growth
The growth of the world population has occurred at a disproportionate rate

swimming, perhaps accelerating excessively as a consequence of the development of
medicine, hygiene, etc. This uncontrolled growth, and the dangers that according to some
it implies, has led to thinking about an optimal population compatible with the increase in
the standard of living. Thus, in Spain, for example, that optimum would be 40 million,
taking into account the industrial increase that is expected. Of all mine Two, the notion of
overpopulation requires a certain interpretative rigor. In cri sis, for example, unemployment
is often due more than to human saturation to economic infrastructure. In those cases
what usually happens is what defines The French economist Sauvy described it as an
excess of men in relation to the existing means of production.
2.6.2 Population Pyramids
The population pyramid is a graph in which males appear on the left and women
appear on the right. For each age (or age group), there are rec horizontal tangles that are
proportional to the real population amounts.
The graphic representation of a normal population takes the form of a pyramid for a
simple reason: not all the people who make up a certain age group will become part of the
next step, due to the death of some of its members. Other modifying facts of these
regulations are the rules rras, epidemics, floods, migrations, etc.
Population pyramids can be classified into two large groups:
• Rhythmic : with evident balance between the sexes and normal decrease in numbers
corresponding to each age group.
• Arrhythmic : with marked imbalances between the sexes or between ages.
2.6.3 The US Population Explosion
One of the largest demographic explosions was recorded in the United States: in
just 6 decades, the number of inhabitants has more than doubled, pa going from 120
million in 1928 to 250 million in 1990. This enormous expansion recorded in two or three
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generations can alone explain a multitude of changes in the social and economic
institutions of a society.
Due to this disproportionate increase in the number of inhabitants was the
considerable number of immigrants who arrived in America. In the 6 decades After 1982, it
quadrupled, turning the post-Civil War society, mostly restricted to the nation's eastern
region, into a cosmopolitan world power whose influence spanned the entire continent.
2.6.4 The Consequences of Accelerated Growth
As a result of the population explosion, humanity must face the greatest problem
ever presented. The most immediate consequences of this problem are global warming of
the atmosphere, the destruction of coal and oil reserves, the loss of fertile soils, hunger;
the earth is The amount used will not be able to feed future generations, and fights will
ensue for the spaces that provide food and water. The closest solution is demographic
control, either through the promotion of contraceptive methods, family planning, or, at the
other extreme, controversial abortion, always taking into account the country and its
socioeconomic situation.
A clear example of effective demographic control is that carried out in the Re
People's Public China, which in fact, has become the most successful in the world: the
Chinese government, recognizing that rapid population growth was impeding
development, established an intensive program of planning of the na foundations. Through
an extensive system of health services, doctors and assistants Social groups were
responsible for distributing information, contraceptive pills, intrauterine devices, condoms,
diaphragms, foams, spermicidal creams, and the technique of aspiration abortion.
2.6.5 Demographic Transitions
The demographic transition is the passage of high levels of mortality and na quality
at lower levels close to replacement levels. This occurs in relation tion with progress or
economic development represented by advances in education cation, medicine and
hygiene and increasing urbanization and industrialization. Exis There are five stages in
demographic evolution, they are:
• Traditional demographic regime stage: very high birth rate and high mortality. Low
vegetative growth due to wars, epidemics or famines. Generalmen te, in
underdeveloped countries with serious economic and health problems. Today it
corresponds to most of Africa and Asia.
• Initial stage of the demographic transition: high birth rate and progressive decline
sive mortality (due to better sanitary conditions). It is characteristic of most of Latin
America, in developing countries.
• Final stage of the demographic transition: It is characterized by decreased birth rates
or low mortality. It occurs in developed countries. It currently corresponds to
Europe, North America and Russia.
• Equilibrium stage: low birth rate and low mortality. It is characterized by a
progressive aging of the population (due to an increase in the average life span of its
members). It exists in some European countries, such as Denmark, Hungary and
Germany.
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• Final stage of demographic evolution: low birth rate and relative mortality high given
the aging of the population. It is called the zero growth stage, and it corresponds to a
few European countries, and, in a few more years, also to China.
2.7 Morbi - Mortality indices
The standardization of rates is a technique that allows the level of health of various
populations or of a population in different periods to be compared with each other, since it
"equalizes" in an artificial way, the populations that are compared, with respect to one or
more factors. that you want to control and that act as confounding factors Zion. If two
populations (or the same population in different periods) can be considered equal with
respect to one of these factors, it can be concluded that the differences observed are not
due to the factor in question. Through standardization, adjusted indices are obtained that
have no other value than allowing comparison.
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Adjustment methods are classified as direct and indirect. The choice of the type of
method depends on the nature of the data available at the time of conducting the
research:
1. The direct method is applied when the specific mortality (or morbidity) rates for each
of the categories are known in each population group. of the variable(s) you wish to
control (usually age). It's ne It is also necessary to know the distribution of this
variable(s) in a reference population (standard population). It is about calculating,
from the distribution tion of the standard population, the expected distribution in the
population of interest rs with respect to the control variable(s) and subsequently
calculate the number of affected people expected if the population of interest exactly
reproduced the distribution. taxation of the standard population.
2. The indirect method is applied when these specific indices are known only in the
reference population and it is also necessary to know the distribution of the control
variable(s) in each of the groups to be compared. rar. It is about obtaining the
number of expected cases in each of the populations. tions that are compared if the
specific indices of the pre-standard population were valuable in them. When death is
the outcome of interest, it allows calculation lar the standardized mortality ratio
(SMR), a useful instrument to compare match a sample drawn from a population of
interest with the general population ral, and is interpreted in percentages above or
below 100, since 100 is the (standard) mortality rate that corresponds to the standard
population.
2.7.1 Sources of Differences or Changes in Rates
The differences observed in incidence, mortality, prevalence or lethality ity may be a

consequence of real changes or differences in the method of assessment of the disease
considered. The latter implies that although there is a difference, it could be due to:
. NO observed deaths RM E =-------------------------X1 □ □
Expected number of deaths 40
1. Changes in the ability to identify the disease as a consequence of advances in diagnostic

techniques.
2. Changes in efforts to diagnose a disease early: program more screening.
3. Changes in the definition of disease. Thus in Spain AIDS rates increase artificially
starting in 1994 due to the inclusion of pulmonary tuberculosis monar as a diagnostic
disease of AIDS.
If any of the previously mentioned sources do not intervene or are not important
enough in the observed differences, we must think that the changes are real and explain
why they have occurred. First of all, we must ask ourselves if they reflect a change in
incidence rates, prevalence, or fatality or a combination of these health indicators.
If what is observed is a variation in rates over time, a recent change may have
predictive significance for future changes in the rate. ma direction or are influenced by two
phenomena:
Regression to the mean: This statistical principle states that the values in usual are
rare by definition and that the probability is against a su rare event repeats itself twice
consecutively. It is likely that just by chance the average tion next is closer to the average
value.
Cohort effect: this effect occurs when one or more cohorts of a population have
been subjected to an exposure or experience that has made them especially susceptible
to a disease. The rates in an age group of finished that includes the susceptible cohort
may increase temporarily and can be expected to decrease again as time passes and the
susceptible cohort moves to the next age group.
Regression to the mean and the cohort effect are two reasons why it is It is
dangerous to predict disease rates from direct extrapolation. record of your recent
changes.
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When data from groups are used and their rates are compared to generate
hypotheses, care must be taken not to establish an association between individuals, since
the only thing that is demonstrated is a group association, otherwise we will be co making
an error known as ecological fallacy.
2.8 Epidemiological. Statistics. Epidemiological Investigations
Epidemiology is, in the most common sense, the "study of epidemics." "that is, of
the "diseases that temporarily affect many people." "you are in a certain place"
Its meaning derives from the Greek Epi (about) Demos (People) Logos (science). A
technical definition is the one that proposes that epidemiology is "the study of the
distribution and determinants of diseases in human populations.
Both definitions correspond to the meaning that the discipline has had in two very
different historical moments.
This is how the first definition corresponds to the conceptualization that emerged at
the dawn of epidemiology, when it focused its interest on the study of transmissible
infectious processes (pests) that affected large human groups. us. These diseases, called
epidemics, resulted in a large number of deaths against which medicine at that time had
nothing effective to offer.
Scientific literature recognizes the Englishman John Snow as the father of the
epidemic. myology. Snow, masterfully using the scientific method, contributed important
advances to the knowledge of the cholera epidemic that, at that time, affected the city of
London. Snow's correct conclusions about the etiology, form of transmission and control of
the disease anticipated the progress made in this regard by microbiology, infectious
disease and clinical medicine.
The second definition constitutes a more updated one and in that sense of greater
breadth and specificity. It is possible to affirm that the scientific, technological evolution
logic and the change in the standard of living of the populations, modified the type of
diseases that affected the population in greater numbers and more seriously.
This modification highlighted non-infectious diseases whose high frequency of
appearance was not a consequence of the classic transmission mechanisms. known
mission for communicable infectious diseases. You are sick These diseases are known
today as chronic non-communicable diseases (NCDs). Non Communicable Diseases
(NCD in English) and are also important subject
of study in modern epidemiology.
In accordance with the above, today we accept the following definition of epi as the
most simplified and complete:
Epidemiology is the discipline that causes disease in human populations.
From there, its implicit implications
are mentioned: day is
demiology
study the
beginning
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• Epidemiology is a medical or health sciences discipline.

• The subject of study of epidemiology is a group of individuals (collecti vo) that
share some characteristic(s) that brings them together.
• The disease and its study take on the broadest connotation in this definition.
Health and illness are one and in that sense they must be understood. The with
concept or notion of illness does not exist in the absence of health and vice versa.
However, this statement, seemingly simple, encounters serious limitations when
materializing concepts.
Traditional medicine has operated considering health as the absence disease and
in that consideration has lost the identity of health.
On the other hand, health has more imprecise limits and more erratic meanings.
cos. Epidemiology conceives the phenomenon of health and disease as a dynamic
process. The individual passes from one state to another, repeatedly, throughout his life
and in this continuum, identifying the limits of one or the other becomes a problem.
technical problem.
Epidemiology addresses itself as a scientific challenge, to study the sa lud-disease
in its broadest conceptualization.
Object of Study of Epidemiology.
• Health status of the population

• Causes of diseases and states of health conservation
• Health promotion, prevention and disease control
• Evolution of the dominant interest in Epidemiology over time
#, ldentfiqaqin of nonsense
“• Identification of priorities in Health
4, klenttioccicn of as Q=c1 of an evero
Mediin de iraesges a Te e< coscones pekaroecn
Applications - ■ Ewaafónde:
■ The election of a measure of presence or a ■ ment
of v the knowledge and facts of Eos Seirkc -of Health
Epidemiology ■ The time of 1 aevdads reczdde sow EU 5, the environment and the conditions of * day
1) What is the population problem in the area where you live? Explain it.
2) Do you think that the different specific actions are implemented in the health center
where you go?
3) The authorities of your commune carry out activities in order to implement the
different specific actions. Justify your answer.
4) What are the steps to follow if your family suffers from an epidemic even tual?
5) Proposes different options to promote the benefits of public health war
SELF APPRAISAL
1) Complete with True (T) or False (F), as appropriate, if false, justify:

a) The population has decreased considerably in the last decade.
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b) Health promotion is a primary specific action.

c) Epidemiology is not a science.
d) Epidemics are diseases that temporarily affect humans. bre.
e) The population pyramid of the City of Buenos Aires is decreasing.
2) Investigate infant mortality rates in Argentina.
1) What do specific first-level actions consist of?

2) What are the health research methodologies?
3) Briefly explain each of them.
4) What is a diagnosis?
5) What is a Population Pyramid?
6) What are the causes of population growth messy?
7) What are the morbi-mortality rates? ofthe ProvinceFrom Buenos
Aires
res in the year 2003?
8) What is an epidemic? Give two examples of major Ar epidemics. gentina in the
last two centuries.
UNIT 3
The different Health Education Policies have proposed Health promotion as one of
the responses to the needs of the population and those of commands of the current social
epidemiological profile of the country.
Health Promotion aims to optimize Health and reduce its determinants. nantes,
focusing on quality of life and well-being, the development of healthy lifestyles and
environments and the construction of communities and a healthier society that promotes
fundamental values of trust and solidarity.
Guarantee access for all citizens to quality healthcare ity is one of the main
aspirations of Health Education Policies. Equality in health matters requires, first of all,
continuing to apply this system, which allows everyone to have the best health care when
their health status makes it necessary. Consequently, a policy must be adopted that
simultaneously favors the provision of quality medical care, a development development of
public health and rigorous use of social financing.
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that the student

• Understand the different health actions and their promotion.
• That you understand how health education interacts with the devices
red prevalence problems.
• Know which are the different health equipment that can be
implemented.
CONCEPTUAL CONTENTS
• Execution of health actions with emphasis on promotion and pro health protection.
Health education in health care most prevalent problems. Interdisciplinary: health
teams. Ac specific tions of the second and third level of care: the pro motion,
prevention and health protection in the hospital.
PROCEDURAL CONTENTS
• Investigate the different actions carried out in different areas of health.

• Use the available resources provided by the different organizations. official views on
this issue.
CURRENT CONTENT
• Having a critical and objective attitude on the different issues raises two in this Unit.
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3.1 Execution of Health Actions in Promotion and Protection of the Sa lud
The Ministry of Health and Environment tells us about this topic:

Intuitively, the concept of Health is usually associated with Well-being, and yet the
association is not necessarily real: temporary states Feelings of discomfort can actually be
expressions of good health, and being able to express pain (being able to express
discomfort) can often be a healthy attitude. Well-being-discomfort, normality-abnormality,
health-disease, are not binomials with interchangeable meanings.
The concept of Health is also associated with that of Medical Care, when in reality
this is often a function of the disease, and not of Health.
In 1986 around 50 countries met in Ottawa, Ca nothing, to bring forward a proposal
that would more closely define the term Health. From then on we tried to see health as a
process, rather than as a state. A process in which factors and conditions other than those
indicated as direct causes of a disease also intervene. Among these factors, it relates two
with ethical and aesthetic conditions of the ecological and social environment that
surrounds us.
In this document, these concepts are incorporated in a situation of unequivocal
interrelation with the possibility of good Health, and among them, the links that each
society establishes with chemical risks to which it can be exposed directly or through the
environment that surrounds it. Expressly, the Charter proposes establishing a strong
commitment to "oppose the pressures exerted to favor agricultural products." harmful
coughs, unhealthy environments and living conditions, poor nutrition and the destruction of
natural resources.
We consider the importance of facilitating access to the contents of this Charter for Health
Promotion to the population, through this medium, with the intention of incorporating the
topic into community debate and discussion. . At the same time, to frame the approach to
chemical risks in a theoretical framework in line with the Promotion and Protection Health
tion Ottawa Charter for health promotion.
The first International Conference on the Promotion of Sa lud meeting in Ottawa on
November 21, 1986 issues this letter aimed at achieving the objective "Health for All in the
year 2000." This conference was, above all, a response to the growing commands a new
conception of public health in the world. Although the discussions focused on the needs of
industrial countries ized, the problems that concern the more regions. The conference took
as its starting point the progress achieved as a consequence of the Alma Ata Declaration
on primary care, the document "The Goals of Health for All" of the World Health
Organization, and the debate on inter sectoral approach for health recently held at the
World Health Assembly.
3.1.1 Promote Health
Health promotion consists of providing people with the necessary means to improve
their health and exercise greater control over it. To achieve an adequate state of physical,
mental and social well-being, an individual or group must be able to identify and realize
their aspirations, satisfy their needs and change or adapt to the environment. Health is
therefore perceived not as the objective, but as mo the source of wealth of everyday life. It
is therefore a positive concept that accentuates social and personal resources as well as
physical abilities. Therefore, since the concept of health as well-being transcends the idea
of healthy lifestyles, the promotion tion of health does not exclusively concern the health
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sector.
3.1.2 Health Requirements
The conditions and requirements for health are: peace, education, housing, food,
income, a stable ecosystem, social justice and equity. Any improvement in health must be
based on closely on these requirements.
3.1.3 Promote the Concept of Health
Good health is the best resource for personal, economic and social progress and an
important dimension of the quality of life. Political, economic, social, cultural,
environmental factors good, behavioral and biological can intervene either in favor of or
against trim of health. The objective of action for health is to make these conditions
favorable in order to promote health.
3.1.4 Provide the Means
Health promotion focuses on achieving health equity. Its action is aimed at reducing
the differences in the current state of the sa lud and to ensure equal opportunities and
provide the means that allow the entire population to develop their potential health to the
maximum. cial. This involves a firm foundation in a supportive environment, access to
information, and having the skills and opportunities to make health choices. People will not
be able to achieve their full health potential unless they are able to take control of
everything that determines their state of health. This applies equally to men and women
3.1.5 Act as Mediator
The health sector cannot by itself provide the conditions prior tions nor ensure
favorable prospects for health and, what is more, health promotion requires the
coordinated action of all two parties involved: governments, health and other social and
economic sectors, charities, public authorities, cals, industry and the media. People from
all walks of life are involved as individuals, families and communities. munities. It is
especially up to social and professional groups and health personnel to assume the
responsibility of acting as mediators between antagonistic and pro-health interests.
Health promotion strategies and programs must adapt be tailored to local needs
and the specific possibilities of each country and region and take into account the diverse
social, cultural and economic systems.
3.1.6 Active Participation in Health Promotion
To promote health we must go beyond mere health care. Health must be part of the
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agenda of those responsible for the development of political programs, in all sectors and at
all levels, in order to make them aware of the consequences. consequences that their
decisions may have for health and thus lead them to assume the responsibility they have
in this regard.
Health promotion policy must combine different approaches verses, although
complementary, including legislation, fiscal measures, the tax system and organizational
changes. It is coordinated action that leads us to practice a health, income and social
policy that allows for greater equity. Joint action with It contributes to ensuring the
existence of healthy and safe goods and services. Greater hygiene in public services and
a more pleasant and clean environment.
Health promotion policy requires identifying and eliminating obstacles that prevent
the adoption of political measures that promote health in those sectors not directly
involved in it. The objective should be to ensure that the healthiest option is also the
easiest to make for those responsible for developing the programs.
3.1.7 Creating Favorable Environments
Our societies are complex and interrelated in such a way that health cannot be
separated from other objectives. The ties that inextricably unite the individual and his
environment constitute the basis of a socio-ecological approach to health. The principle
that must guide the world, nations, regions and communities must be the ne need to foster
reciprocal support, to protect each other, as well as our communities and our natural
environment. It must be emphasized that the conservation of natural resources around the
world is a global responsibility.
The change in ways of life, work and leisure, affects very significant to health. Work
and leisure must be a source of health for the population. The way society organizes work
jo must contribute to the creation of a healthy society. The promo Health management
generates rewarding, pleasant, safe and stimulating working and living conditions.
It is essential that a systematic evaluation be carried out of the impact that
environmental changes produce on health, particularly te in the sectors of technology,
work, energy, production and urban planning. This evaluation must be accompanied by
measures that guarantee the positive nature of the effects of these changes on public
health. The protection of both natural and artificial environments Officials, and the
conservation of natural resources, must be part of the priorities of all health promotion
strategies.
3.1.8 Strengthening Community Action
Health promotion lies in the effective participation and with community in setting
priorities, making decisions and developing and implementing planning strategies to
achieve a better level of health. The driving force of this process It comes from the real
power of the communities, from the possession and control they have over their own
endeavors and destinies.
Community development is based on the human and material resources that the
community itself has to stimulate independence. pendency and social support, as well as
to develop flexible systems that strengthen public participation and control of health
issues. you would This requires full and constant access to information and health
education, as well as financial aid.
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3.1.9 The Development of Personal Skills
Health promotion promotes personal and social development by providing

information, health education and improving the skills essential for life. In this way, the
options available are increased for the population to exercise greater control over their
own health and the environment and to opt for everything that promotes health.
It is essential to provide the means so that, throughout their lives, the population
prepares for the different stages of life and confronts chronic diseases and injuries. This
must be made possible through across schools, homes, workplaces, and the community.
community, in the sense that there is active participation on the part of professional,
commercial and charitable organizations, oriented as both externally and internally of the
institutions themselves.
3.1.10 The Reorientation of Health Services
The responsibility of health promotion on the part of beings health vices are shared
by particular individuals, groups community workers, health professionals, institutions and
health services citizens and governments. Everyone must work together for the follow-up
of a health protection system.
The health sector must play an increasing role in the pro movement of health in a
way that transcends the mere responsibility of providing clinical and medical services.
These services must sea a new orientation that is sensitive to and respects the cultural
needs of individuals. They should also promote the communities' need for a healthier life
and create avenues of co communication between the health sector and the social,
political and economic sectors.
The reorientation of health services also requires greater attention to health
research, as well as changes in education and vocational training. This must necessarily
produce a change in attitude and organization of health services. rios so that they revolve
around the needs of the individual as a whole.
3.1.11 Break into the Future
Health is created and lived within the framework of daily life: in educational, work
and recreational centers. Health is the result of the care that one gives to oneself and to
others, of the layer ability to make decisions and control one's life and to ensure that the
society in which one lives offers all its members the possibility of enjoying good health.
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Caring for others, as well as the holistic and ecological approach logic of life, are
essential in the development of strategies for health promotion. Hence those responsible
for the implementation Ethics and evaluation of health promotion activities must take into
account the principle of gender equality in each of the planning phases.
3.1.12 The Commitment in Favor of Health Promotion
To achieve success in health promotion actions it is necessary It is necessary to

make a commitment to: intervene in the field of public health policy and advocate for a
clear political commitment regarding health and equity in all sectors to oppose pressures
to favor harmful products, unhealthy environments and living conditions, poor nutrition and
the destruction of natural resources. Likewise, commit to focusing your attention on public
health issues such as pollution, occupational risks, housing and the population of
uninhabited regions. to eli undermine differences between and within different societies,
and take measures against inequalities in terms of health lud, which result from the norms
and practices of those societies recognized cer that individuals constitute the main source
of health; to support and train them at all levels so that they and their families and friends
gos remain in good health; in the same way it commits begin to accept that the community
is the fundamental spokesperson in matters of health, living conditions and well-being in
general. To reorient the beings sanitary vices and their resources in terms of health
promotion; to share power with other sectors, with other disciplines and, even more
importantly, with the people themselves, to recognize that health and its maintenance
constitute the best possible goal and investment and to address the global ecological
issue that our life forms.
3.1.13 International Call to Action
The Conference calls on the World Health Organization and other international
organizations to advocate for health in all appropriate forums and to provide support to
individual countries to achieve establish programs and strategies aimed at health
promotion.
The Conference is firmly convinced that if the people,
the organizations
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governmental and non-governmental, the World Health Organization and all other
interested organizations unite their efforts around health promotion and in accordance with
social values morals, the goal "Health for all by the year 2000 will be realized dad.
3.2 Health Education in the Care of Most Prevalent Problems
Health is a consecrated right, but it is also a social good. cial resulting from a series
of actions linked to biological factors, the conditions and way of life, the environment and
the interrelationships actions that people make with health services.
For the community, the possibility of accessing these services is emblematic since it
presupposes the possibility of exercising the universal right. versal to health.
The population that demands benefits in health services are people who feel
affected by specific ailments. Although 90% do so for minor conditions, many can be cured
with family care and others with responses from the first level of care.
90% of the actions that preserve Health are linked to extra-hospital actions, such as
water fluoridation, control in ru tas, health education, water purification, sewage services,
access to drinking water within the home, control and treatment of industrial effluents,
bromatological controls, vector control, plants urban nification, etc.
In this scheme, the basic function of the health system must be to maintain the
health of the population, protecting it from diseases, improving it by resolving a high
percentage of problems. health problems and making appropriate referral in the special
field ized, when health problems are not resolved at the First Level.
The basic strategy to meet demand in a framework of equity is Primary Health Care
(PHC).
Illness and health are two internal concepts of each culture. ra. To gain a better
understanding of the prevalence and distribution of health and disease in a society, an
integrated approach is needed. general that combines sociological and anthropological
issues in addition to biological and medical knowledge about health and illness.
From an anthropological point of view, health is linked to fac political and economic
factors that guide human relations, shape ma to social behavior and condition collective
experience.
Traditional Western medicine has always considered that health was equal to the
absence of disease, based on Public Health, it will mean influencing the causes of health
problems and preventing diseases. many problems through healthy and healthy
behaviors.
From medical anthropology to understand diseases, this ecological - cultural
approach emphasizes the fact that the environment and the health risks it has mainly
create two for culture.
Culture determines the socio-epidemiological distribution of diseases in two ways:
• From a local point of view, culture shapes people's behavior, which predisposes the
population to certain diseases.
• From a global point of view, political-economic forces and cultural practices cause people to
act towards the environment in ways that can affect health.
Some habits that condition our health are the following:
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• The organization of work time and rest time.

• Feeding.
• Personal hygiene.
• Home cleaning.
• Home ventilation.
• The way and conditions in which we travel to work.
• The way we organize ourselves in our work.
• Fun and leisure time.
All the activities of our daily lives are conditioned culturally given. Culture models
our behaviors by homogenizing social behaviors.
Human beings act based on a certain culture of health; we share a series of basic
healthy principles that allow us to integrate into the closest social system. Social
acceptance involves respecting these principles and making them visible to others.
Culture is a variable that is used to explain health inequalities. The most important
theories in this regard are:
Cultural or behavioral: Part of a set of beliefs, values, norms, ideas and behaviors of the most
disadvantaged social groups, as the origin of disadvantages. equality in their health status. It is also
designated as "cul "ture of poverty" (the poor have a preference for unhealthy behaviors, unhealthy
lifestyles). From the behavioral sciences it has been considered that individual behavior and freely
chosen personal lifestyles mind constitute one of the main determinants of health, and of the
different differences between individuals and between groups that make up society.
Materialist or structural: Questions the idea of the power of free choice and that this is the origin
of health inequalities. Highlights the importance of facts res related to involuntary exposure to a
poor social environment that is risky for health.
3.2.1 Culture and society
It is important to differentiate between two complementary and inter concepts.

dependents: Society and Culture. Society is the set of relationships social conditions that
occur in a habitat and culture is what shapes and surrounds that society.
In a culture, different criteria can be moved, within ca In the social context, some
values may be more important than others. Adaptation to the culture and values of a given
society will depend on the socioeconomic and personal circumstances of each individual.
individual or social group.
Culture is a social construct, and therefore the habits that constitute cultural and
socially accepted patterns also change. More or less healthy behaviors acquire different
different dimension depending on the social significance they have at a given moment.
Health education is essential in societies to:
• Modify unhealthy behaviors.
• Promote healthy behaviors.
• Provoke processes of social change.
Lifestyles cannot be ignored when making decisions. nes on the health of the
population.
The patient's own perception of their health must be taken into account. It is the
subjective component of health.
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The culture-health relationship is complex and constitutes a challenge for ra

societies: how we understand health from different cultures that coexist in a territory, how
we understand illness, what value is given to healthy behaviors, what health risks mean to
us, etc.
3.3 Interdisciplinary: Health Team
Primary Health Care is basic outpatient care. based on scientifically sound practical
methods and techniques and social acceptable, accessible to the community, with
emphasis on individuals duos, family and environment.
Includes at least eight components:

• Maternal and child health care
• Immunizations
• Basic sanitation
• Nutrition
• Essential medicines
• Health education (health promotion)
• Control of common diseases and injuries
• Prevention of local endemic diseases
Primary Care is carried out by a group of people who have They have common
health goals and objectives and form the Health Team. lud.
The objectives are determined by the needs of the community ity and each member
of the team contributes to its achievement according to their competence and in
coordination with the functions of the others.
The formation of a health team is a complex process. whereby a group of people
with a wide variety of values individual res, aptitudes and inhibitions for participation in
groups, are molded into a productive group with common health objectives.
The teams are made up of nurses, pediatricians, clinicians, obstetricians and
generalists, administrative and auxiliary personnel. bundle: sometimes nutritionists and
social workers; all led by a chief physician. They have informal meetings during the work
day, and formal meetings with all staff at an intermediate time one day a week; functioning
as a group with its own dynamics.
Each individual brings to the health team certain characteristics that constitute his
"personality", such as the profession first and then his interests, abilities, desires or
tendencies, blockages and frustrations. trations, with the consequent psychophysical
adjustment to them.
In a long process of adaptation among its members, little by little the health team
begins to understand and use the basic principles. physical aspects of human
relationships, in relation to the psychological and social behavior of the group, and can
apply it to their basic problems of daily life. Democratic groups are thus formed composed
of people who act reciprocally in an atmosphere of tolerance and respect, whose action is
based on general consensus, achieved through due to the participation of all its members.
A series of elements are important in the formation of the group. sitives for action,
among which the following stand out:
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• The values of the individual, which are the basis of his actions because they give him his
orientation, his philosophy of life.
• Recognition from the community and health authorities.
• Safety in your work and in the health team.
And there are negative elements for the internal dynamics of these teams. health
benefits, such as:
• Lack of adequate physical space.

• The isolation.
• The lack of clear rules.
• Smoking in the health team.
3.3.1 Regulation
Constitution of the City of Buenos Aires

• Article 22: "The city exercises its non-delegable function as health authority. Re gluttony, enables,
supervises and controls the entire production circuit, commercializes tion and consumption of food
products, medicines, medical technology, the practice of professions and the accreditation of health
services and which want another aspect that has an impact on it. "It coordinates its activity with
other jurisdictions."
Basic Health Law No. 153

• Article 41: "The enforcement authority exercises the regulation and supervision of the social and
private security subsectors, the exercise of health-related professions, the accreditation of services,
matters relating to medicines, food, health technology , environmental health and everything else
effect that affects health".
• Article 42.- Private subsector providers are supervised and controlled two by the application
authority in aspects related to conditions of qualification, categorization, accreditation, operation and
quality of care of health establishments; and conditions of exercise of the sa equipment lud acting.
• Article 44 The providers of the social security subsector are fis qualified and controlled by the
application authority in aspects related to conditions of authorization, accreditation, operation and
quality of care of health establishments; and conditions of exercise of the sa equipment lud acting. "
• Article 48.- Specific legislation. This law is complemented by legislation specific lation.
National Legislation
Authorization of Health Establishments

• National Resolution No. 2385/80. Resolution No. 423/87 (Ref. by Res.794/97) Minimum standards
for the authorization of healthcare establishments and services medical transfer costs.
• Resolution No. 365/99. transfusion medicine standards.
• Resolution No. 861/93 Treatment in coronary unit.
• Resolution No. 255/94 Reuse of biomedical products.
• Resolution No. 801/94 Organization and operation of the kinesiology and physiatry areas of
healthcare establishments according to risk levels.
• Resolution No. 194/95 Organization and operation of nursing services in health care establishments.
• Resolution No. 285/95 Standards for Habilitation, Rehabilitation and Operation of
Histocompatibility Laboratories.
• Resolution No. 201/98 Drug Dependence.
• Resolution No. 996/98 Minimum standards for nursing offices.
• Resolution No. 196/99 Standards of organization and operation of pediatric ophthalmology.
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• Beef. No. 252/99 and Res. No. 222/99 Toxicology.

• Resolution No. 126/98 Authorization of vaccination centers.
3.4 Specific Actions of the Second Level and Third Level of Care
The World Health Organization (WHO) has published the "Infor me on World Health
2003: Shaping the Future", which states that health care services in most developing
countries urgently require investment and international support tea. According to this new
global report, in order to achieve the objectives Global health goals agreed upon by the
international community will require strengthening health care systems through country-
specific measures.
The Medical Care Model defines the form of organization of the resources of the
provision of benefits and the technical-administrative procedures intended to relate the
demand with the specific services that must be adopted to satisfy the need for care.
movement, maintenance and recovery of the health of the beneficiary population.
Health policies constitute a chapter of social policies and can be defined as a
systematic effort to reduce health problems. A health policy involves the definition of the
health lud as a public problem in which the State assumes an active and explicit role.
Defining health policies is deciding what role the State plays. do in health. Health policies
are recent developments. In the MA In most countries, true health policies were not
detected before the 1950s. Evidence of this is obtained when the weight of health
spending within public budgets is examined. Since although “health spending” does not
mean “health policy”, in most cases So the execution of the programs requires an
allocation of resources you are A health policy may or may not alter the health status of
the population. blation, as well as it may or may not modify the health system. In principle,
health policies have their genesis in the identification of problems in the state of health,
such as the growth rate of the population, its aging, spatial distribution, diseases, new
technologies. guides, etc. which is the input of political propositions. Especially have The
use of means and resources to solve existing problems in the health-disease continuum
(or organization, financing, access and use of services). But not all Every time a health
problem is identified, it is included in the government agenda as the object of a policy.
The health status of the population constitutes a dimension of the quality of life of
the people. Contrary to what it would seem at first At first glance, the health of the
population depends to a small extent on health policies and systems. It is a consequence
of a set of combined factors, such as behaviors and lifestyles, the environment well-being,
genetics and, finally, the health system. The health of the po Blation can be measured
through indicators such as death rates. quality and morbidity, life expectancy at birth and
epi more sophisticated demiological measures such as YLPL - Years of Potential Life mind
Lost- or quality of life indicators associated with health - AVISA, Qualys, Daylis, etc.
The health system encompasses all the actions that society ity and the State
develop in health The health system can be defi nest as an organized social response to
health problems. The definition of this last concept shows its connection with the previous
two at the same time that it follows that there may be a social response to the health
problems of the population that does not include commit to the State. The term health
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system refers to a set of actors and actions more comprehensive than the health care
system. Strictly speaking, the health system includes all the functions that the State and
society perform in health.
In summary, according to the above, it can be postulated that the pri The first step
in analyzing the health sector in a country is to identify Carry out the strengths and
weaknesses in the three central dimensions: health status, health policies and health
system.
In studies focused on health systems, different components have been identified.
For example, when a socio-political perspective is privileged, legal and organizational
components stand out. you, interest groups, etc. Every health system can be thought of as
the articulation of three components
a) political,
b) economical and
c) technical.
The problem of care models is strictly medical. co - sanitary. In other words, it is the
technical dimension plus it is specific to the sector. The criteria that establish how it is
organized and divided of medical work. The issues involved are those linked you find:
I. What to cover? What type of actions, benefits or services should be provided to the population? II. Who to cover?
What are the eligibility6 or inclusion criteria for the system?
III. How to lend? what providers? With what criteria or standards?
IV. Where to lend? (In what places and in what way should the offer be distributed?
LEVELS OF CARE
It would be convenient to organize care according to levels of complexity. ity, in
order to optimize patient access to the system and the use of resources.
Each health provider must have sufficient and timely resources for prevention,
diagnosis and treatment according to what is established for their level of care.
First level of care

Operational capacity:
• Resolve outpatient pathology through early diagnosis and treatment timely treatment, which
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will make it possible to reduce hospitalizations.

• Compensate for the emergency for its appropriate referral to the corresponding level of care.
• Carry out adequate follow-up of counter-referred patients from other levels.
• Train the community in recognizing warning symptoms and raise awareness about the value
of early consultation.
Second level of care

• Resolve the emergency.
• Manage the hospitalized patient (including surgery)
• Refer to 3rd level. Counterrefer to 1st level.
• Perform complementary tests (laboratory, radiology and etiological diagnosis).

• Physical plant: That corresponding to pediatric services in general hospitals neral
(undifferentiated hospitalization).
• Equipment: It must have the same elements referred to in the item corresponding to the first
level of care, in addition to those necessary to provide adequate care to hospitalized patients,
especially.
Third level of care

• Resolve the emergency
• Conduct consultations with specialists
• Access to specialized complementary examinations (endoscopy, computed axial
tomography, biopsies, etc.)
• Manage rare pathology and chronic patients
• Counter-refer to other levels.
• Physical plant: have intensive therapy.
• Equipment: You must have all the necessary elements to must fully develop the specified
operational capacity, including mechanical respiratory assistance.
• Personnel: trained Specialists (pulmonologists, endoscopists, infectious disease specialists,
intensivists, anatomopathologists, etc.) Trained nursing staff nal radiology, laboratory and
kinesiology with permanent access.
Care network. The maximum aspiration of a care program is to implement a care

network between the different levels according to their respective operational capacities.
Said network should be connected through a system that allows fluid communication
between the different members, in addition to having an entity or center that coordinates
referrals.
It would be important for there to be a unified registration system that would allow
the real magnitude of the problem and its distribution to be assessed. The pineapple lysis
of the information collected will allow efficient planning, op Timing the allocation of
resources.
3.4.1 Promotion, Protection, Prevention of Health in the Hospital
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Since 1946, the World Health Organization (WHO) established that the hospital is
an integral part of a medical organization. ca and social whose mission is to provide the
population with assistance complete medical and health care, both curative and
preventive, and whose services reach the family environment; being also a center of
mation of health and research personnel.
In our country, until a few years ago, special attention was being devoted to the
individual development of selective programs that did not offer adequate characteristics to
fully satisfy the needs of the individual. health issues of the individual, family, community
and environment well.
Therefore, the need to integrate these programs was imposed in order to increase
the level of health of the population, and continue to improve. do its statistical indicators.
For this, it was necessary that the integrality not be fragmented into independent and
annoying actions, keeping present the principle of the multicausality of the disease. ity in
different population groups.
The Pan American Health Organization (PAHO) has been carrying out activities
aimed at promoting a broad concept of health as the basis of human development and an
acceptable quality of life. To this end, he has urged Member States to work in the five
fields of action. tion or health promotion strategies: the establishment of policy healthy
public houses,
• Creating environments conducive to health
• The empowerment of communities
• The acquisition of personal skills
• The reorientation of health services
According to this holistic conception of health, this is not the same as the absence
of disease, but rather a state of general well-being of the person; it implies the promotion
of health as a vehicle towards a better health science that transcends concern for cure and
includes prevention, information, and knowledge for a healthy life.
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“Health promotion is a process, not an easy solution,” states the report of the PAHO
Health Promotion and Protection Division to the 43rd Directing Council of the
Organization. And he adds that its purpose is to achieve a concrete result in the long term,
but with medium and short-term effects. Specific results vary, but include citizen and
community participation and contributions. They aim to improve the quality of life.
“More and more countries in the Region recognize the importance of health
promotion as a powerful public health strategy and have incorporated many of these fields
of action into their plans and programs.” national health programs," says the text Health
Promotion in the Americas.
3.4.2 The Argentine Federal Law says

Federal Commitment on Coverage and Access
The provinces and the Nation will assume a commitment to achieve equity in the coverage and
access of their population to promotion programs, they provide tion and medical care and treatment services.
Through this commitment, the entire Argentine population will have explicit coverage of a set of benefits.
appropriate medical care. Those who have coverage from national or prepaid social works already have it
through the PMO, but those who depend exclusively on public services or provincial social works do not yet.
The actions promised will allow each citizen of the country to have a card that defines na your obligations
and rights in health, the types of care you must receive and assume, the benefits and the providers
responsible for their provision in each case. quality of the country.
The Federal Commitment to Coverage and Access would constitute the highest level of health
agreement since:
a) It will establish the basic level of benefits (NBP) that all jurisdictions must provide to their beneficiaries. To
guarantee equity in health, it is essential that all provinces, with deci voluntary sion, together with the national
government, commit to guaranteeing its population access to mandatory benefits. This NBP must be reviewed and
redefined periodically and based on tos: ^ Epidemiological (include coverage of the main prevalent pathologies)
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Guaranteeing its actuarial sustainability (evaluate the risks involved in each benefit for each age group) Establishing
inclusion priorities through Evidence-Based Medicine criteria and cost - effectiveness (measure the impact of the
inclusion of each benefit in terms of disease burden and costs cough to then establish a ranking)
b) It will involve the transfers of resources from the Nation to the provinces and all or part of the vertical grasses.
c) It will redefine priorities in the allocation of provincial resources. Benefits not included in the list of explicit health
guarantees will not have priority in financing. For this reason, services that do not involve these benefits will not be
created or strengthened.
d) Its provision will be monitored and evaluated by the national government. On the one hand, it will involve the
highest priority in terms of health information systems and statistics. On the other hand, the national government will
have audit mechanisms and complaint systems that allow deviations and non-compliance to be detected. ments of these
explicit health guarantees.
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1) Are promotion and protection actions carried out efficiently in the Province? what
do you reside? Give some examples.
2) Do you think that the second level of care in the health center that you Curres is
efficient? Justify.
3) Give your point of view on how you would implement the different pro actions.
motion, using as an example the closest Hospital to where you live.
SELF APPRAISAL
1) Mark on a map of Argentina the areas with the highest rate of most prevalent health
problems.
2) Conduct a brief investigation of the public health center closest to your home.
Specialties served. Population served. Partner indices them and marginality.
1) What is a health education policy?

2) Investigate the different health teams proposed by the Ministry of Health and
Environment.
3) Give a brief review of the first Argentine Hospital.
4) Make a comparative table with the most prevalent health problems lence in
Argentina.
5) What are the health promotion and protection actions in the hospi What is currently
done in the town where you live? Investigate.
UNIT 4
The region of Latin America and Argentina has made notable progress bles in the
field of health in recent years, but inequality and exclusion remain major challenges to
further improve results. ted and help the region achieve the millennium development
goals boy
Improve the performance of health systems in a super way ar inequality in access to
health and achieve better results in that sector in Latin America.
Since 1950, life expectancy at birth in Latin America has increased He was 20 years
old, and is now approximately 71 years old. The mortal Infant rate fell from 37 to 25 per
thousand live births since 1980. The reduction The increase in infant mortality in Brazil, of
almost 20 points in a decade, constitutes one of the most accelerated among developing
countries.
However, health indicators in Latin America are affected by the historically high
degree of inequality. A recent World Bank study revealed that one tenth of the oldest
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population One tenth in the region earns 48 percent of total income, while the poorest
tenth earns less than 2 percent. Access to health often reflects this uneven distribution, so
that the poor and groups such as indigenous people suffer much more than groups.
pursuit of higher incomes against diseases that could be easily prevented.
Inequality and exclusion are the results of low performance of many countries in
their efforts to achieve development goals ll of the millennium with respect to health. The
poor in Latin America die at an earlier age,” said Ana María Arriagada, World Bank
Director for Human Development in Latin America. In Brazil, children born into families that
belong to the poorest fifth of the population are four times more likely to die before
reaching the age of 5, compared to children from homes in the wealthiest fifth. In Bolivia,
this figure is four times higher.”
One of the key factors contributing to inequality in the coverage and quality of health
care services in the region gion is the segmentation of health systems, which increased
their spending levels but did not yield, however, satisfactory results. tories. When
compared to the rest of the world, spending on services health services is comparable to
developing countries only in a few two Latin American countries, but the results are not
proportional.
The increase in health expenditures by governments is necessary, but it is not
sufficient to achieve health goals.
Improving policies and institutions – within and beyond the health sector – is crucial
to accelerate progress towards the goals. millennium development objectives. Likewise,
health spending requires better selection of objectives with respect to the poor and
marginalized groups. ginated if extreme inequalities in health provision are to be reduced.
That the student:

• Understand the different health situations in Latin America.
• Know what the health situation is in Latin America.
• Know how to express the differences in health between developed
countries llated and undeveloped.
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CONCEPTUAL CONTENTS
• The health situation in Argentina and Latin America. Historical evolution of public
health in Argentina. Overview of the health situation in Argentina and Latin America.
Health in developed and dependent countries. Pathology of industrialization see
their pathologies of poverty.
PROCEDURAL CONTENTS
• Investigate the different actions carried out in different areas of health.

• Use the available resources provided by the different organizations. official views
on this issue.
CURRENT CONTENT
• Having a critical and objective attitude on the different issues raises two in this Unit.
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4.1 THE HEALTH SITUATION IN ARGENTINA AND LATIN AMERICA

4.1.1 Argentina
The birth rate in Argentina in 1996 was 12.9 births per thousand inhabitants, while
the average for the five-year period 1975-1980 was 25.7‰. By province, the highest birth
rates are re recorded in Formosa (27.9‰), Misiones (26.9‰), La Rioja (26.1‰) and Co
currents (26.0‰); On the contrary, the entities that registered a lower birth rate were the
Federal Capital (13.4‰), Santa Fe (18.5‰) and Tucumán (18.7‰).
The national infant mortality rate per thousand live births was 20.9 in 1996, while in
1990 it was 25.6. The lowest infant mortality rate was recorded in Tierra del Fuego (9.7‰)
and the ma yores in Chaco (34.4‰), Formosa (31.4‰) and Tucumán (28.8‰).
The general mortality rate for that same year per one hundred thousand inhabitants
was 762.9 (803.4 in 1990); By sex, the mortality rate among men (857.7‰) is higher than
that of women (657.8‰). The main causes of death identified were heart disease,
malignant tumors and cerebrovascular diseases; Deaths from accidents of all types
represent 3.6% of the total.
General Mortality Rate Per 100,000 Inhabitants, According to Main Causes of Death in 1996.
Main causes Cases Rate Men Women
Total 268.715 762,9 148.197 118.019
Heart disease 76.940 218,5 41.067 35.109

Malignant tumors 51.650 146,7 28.124 23.200
Cerebrovascular diseases 22.936 65,1 11.528 11.193

Accidents 9.785 27,8 6.881 2.801
Mellitus diabetes 6.812 19,3 3.320 3.421
Conditions originating in the perinatal period 6.764 19,2 3.926 2.820
Pneumonia and influenza 9.198 26,1 4.829 4.285

Septicemia 6.884 19,5 3.426 3.372
Rest of causes 77.746 220,7 45.096 31.818
Source: Ministry of Health
Of a total of 16,085 health care establishments there are Tents in Argentina in 1995
(12,775 without boarding school and 3,310 with boarding school), 6,971 belong to the
public sector, 222 to social works and the rest to the sec
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private tor. 19 mixed-type healthcare establishments are incorporated into the

general total.
CARE ESTABLISHMENTS, BY SECTOR AND TYPE OF PROVISION
Concept 1980 1995 (1)
Country total Without boarding 6.038 12.775

school With boarding school 3.013 3.310
Public sector Without boarding
school 3.471 5.740
With boarding school 1.177 1.231
Social works Without boarding
school 251 167
With boarding school 113 55
Private sector Without boarding 2.316 6.852

school With boarding school 1.723 2.022
(1) Mixed type establishments are included in the general total for 1995. Source:
Ministry of Health
By province, Buenos Aires has the largest number of healthcare centers in the
country (3,825), followed by Santa Fe (2,232) and Córdoba (1,561). Regarding the private
sector, Buenos Aires also has the largest number of centers (2,122), followed by Santa Fe
(1,615) and Córdoba (828).
Data from the Ministry of Health provide the figure of 155,822 beds in healthcare
establishments as a general total for the country, of which 84,094 correspond to the public
sector and 76,243 to the private sector. For its part, in the sector that depends on the
various social works, there are 4,403 beds.
BEDS IN CARE ESTABLISHMENTS BY SECTOR, ACCORDING TO POLITICAL-TERRITORIAL DIVISION Year 1995.

Province Grand total (1) Official Social works Private sector
sector
Total 155.822 84.094 4.403 67.243
Federal capital 23.152 11.166 1.679 10.307

Buenos Aires 50.155 26.582 857 22.674
Catamarca 1.344 841 ... 503
Cordova 17.958 8.816 448 8.694
Currents 3.433 2.155 ... 1.238
Chaco 4.184 1.837 ... 2.347
Chubut 1.976 960 78 938
Between rivers 6.650 4.548 25 2.077
Formosa 1.689 997 ... 692
Jujuy 3.169 1.891 ... 1.278
The Pampa 1.189 835 ... 354
The Rioja 1.231 711 ... 520
Mendoza 4.646 2.750 328 1.568
Missions 2.985 1.463 ... 1.522
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Neuquén 1.393 902 77 414

Black river 1.989 1.217 ... 772
Jump 4.014 2.569 137 1.308
San Juan 1.750 1.238 210 302
saint Louis 1.256 827 ... 429
Santa Cruz 1.188 648 ... 540
Santa Fe 12.148 5.706 564 5.878
Santiago del Estero 4.271 2.996 ... 1.275
Land of Fire 222 184 ... 38
Tucuman 3.830 2.255 ... 1.575
(1) The general total includes the “other mixed” category. Source: Ministry
of Health
According to the 1991 Population Census, almost 37% of the country's population
does not have health coverage provided by social works, mutual funds or "prepaid"
systems. This fact means that an im A large portion of the Argentine population depends
exclusively on the public sector to meet their health needs. As has already been noted for
other indicators, the contrasts between the various provinces are very marked: thus, this
percentage is less than 20% in the Federal Capital, but exceeds 50% of the population of
Formo. sa, Santiago del Estero and Chaco.
The most affected sectors in terms of health coverage are those under 15 years of
age (42%), while for people aged 60 or over this is reduced to only 15%. This situation is
repeated in all jurisdictions and is possibly associated with the presence of ins
qualifications such as PAMI or the National Institute of Retirees and Pensions two, entities
intended to provide benefits primarily to the population of that age group.
The average number of inhabitants per doctor is 346 and the number of bed-days
available in healthcare establishments in the official subsector is 2.2, according to 1995
data from the Economic Commission for Latin America. Tina and the Caribbean.
Regarding public spending on health, in 1995 Argentina allocated 4.8% of the gross
domestic product to this sector, only behind Costa Rica (7.1%).
Between 1982 and 1997, a total of 12,258 cases of AIDS were reported. The
highest number of cases occurred in 1996 (2,288), while the average for the
aforementioned period is 4.1 male cases for every female, although this proportion has
been balancing since in 1988 the proportion was 14.5 cases. masculine for every
feminine. By age groups, the highest percentage of reported cases corresponded to the
25-29 year old group (26.5%), both in men and women. Among the causes of contagion,
44.2% of the total risk factor occurred among intravenous drug addicts, followed by
homosexuals with 21.2%.
4.1.2 Latin America
Almost half of Latin America's population, still mired in poverty despite years of
economic reforms, does not have health insurance to cover their health expenses,
according to a study.
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The report of the Pan American Health Organization (PAHO) is It points out that 240
million people, out of a general population of more than 500 million, do not have public or
private health insurance.
The figure is an estimate based on a more comprehensive survey done in 1995,
according to PAHO. The report indicates that a large number of people do not have
access to health centers due to poverty and geographical factors.
"Despite health systems during the last 15 years, a large percentage of the
inhabitants of Latin America and the Caribbean have been excluded from social security
mechanisms in the field of health lud," the report states.
Political analysts have said that poverty and income inequality remain a big problem
in Latin America after a decade of free markets in many countries there.
The health and social security conditions of a country are part of the standard of
living of its inhabitants, as are their economic, educational, urban planning, labor and other
conditions. If development is considered as the improvement of living conditions, the
different variables that make up each of the sectors that influence den in the level of life
constitute indicators of the level of development and, as such, can be very useful both for
diagnosis and for making consequent decisions.
Of course, development, like life, is a complex field; For this reason, it resists
simplistic diagnoses and solutions. Each of the sectors that comprise it involves a wide
range of factors, some of which resist simplistic measurements and others escape all
measurement.
Life expectancy at birth indicates the number of years that a child hundred born
would live if the mortality patterns prevailing in the world ment of his birth would remain the
same throughout his life. In the period between 1970 and 1995, the number of years of life
expectancy in Latin America and the Caribbean increased from 65 to 69 years; what it
represents feels an increase of 6.2%. In high-income countries as a whole (those with a
GNP per capita of $8,956 or more) life expectancy increased from 74 to 77 years in the
same period, with an increase ment of 4.1%; Throughout the world the increase
experienced was 4.7%, going from 64 to 67 years in the same period.
Among the most populated countries in Latin America and the Caribbean, there are
several that registered, in the aforementioned period, increases much higher than the
average for the region, especially:
Bolivia 30.4%, Nicaragua 27.1%, Honduras 26.4%, Guatemala 25.7%, Peru 22.2%,
Dominican Republic 20.3%
In the last year considered 1995, approximately half of di Two countries had an
average life expectancy equal to or greater than 70 years and the other half had less than
this figure.
In Latin America and the Caribbean, in the period between these two years, the
average number of inhabitants per doctor went from 2,020 in 1970 to 1,603 in 1990, which
represents a decrease of 20.6%. In the same period, the number of inhabitants per doctor
in high-income countries cough went from 71 0 in 1970 to 420 in 1990, with a favorable
variation of 40.8%.
Several Latin American countries recorded percentages of decrease tion of
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inhabitants per doctor much higher than the average.

In 1990, of the twenty-one Latin American countries included in this variable:
^ Two countries had fewer than 500 inhabitants per doctor
^ Seven countries had between 500 and 1,000
^ Four countries, between 1,000 and 1,500
^ Six countries, between 1,500 and 3,000
^ Two countries had more than 3,000 inhabitants per doctor
The population with access to drinking water is the percentage of inhabitants that
has an acceptable supply of drinking water. In urban areas, the supply may come from a
public water source or intake located no more than 200 meters from homes; in the ru
rales, means that they are not forced to spend most of the day carrying water.
In Latin America and the Caribbean, between 1980 and 1995, the percentage of the
population with access to drinking water increased by 20.6%. This increase is much higher
than the 8.9% experienced by developing countries. high income in the same period.
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It is worth noting that two Latin American countries showed a ble descent:
Trinidad and Tobago -16.3%
Haiti -15.2%
In 1995, of the twenty Latin American countries that reported on the matter, the
percentages of the population with access to drinking water were re they summed like this:
COUNTRIES PERCENTAGE
Costa Rica 100.0%
Chile, Colombia and Brazil 90.0% or more
Argentina, Venezuela, Mexico, Uruguay, Panama and Trinidad and Tobago 80.0% to 89.0%
Dominican Republic, Ecuador, Honduras and Jamaica 70.0% to 79.0%
Guatemala, El Salvador, Bolivia, Peru, Nicaragua and Haiti 69.0% or less
The average for Latin America in 1995 was 76.0%; that of the country high-income
groups was 98.0%.
Access to drinking water
PERIOD POPULATION URBAN POPULATION RURAL DIFFERENCE
1985-88 82,3% 46.7% 36.6 points
1990-96 84.9% 50.8% 34.1 points
Also in this particular the differences between countries are very noticeable; In
some, especially Cuba, Costa Rica, Trinidad and Tobago, Chile and Venezuela, the
percentages of the rural population with access to drinking water are very similar to those
of the urban population; On the contrary, in others, the differences are high.
Access to health services refers to the percentage of the population ation that has
at least adequate disposal facilities tion of excreta that allow contact with people to be
avoided, encouragement les and insects with such waste.
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Bolivia 144.4%
Guatemala 136.7%
The Savior 108.6%
The increase recorded by high-income countries in the same The period was 8.0%,
going from 87.0% in 1980 to 94.0% in 1995. In 1995, of the twenty Latin American
countries that reported on the matter, the percentages of the population with access to
health services were summarized men like this:
COUNTRIES PERCENTAGE
Costa Rica 99.0%
Argentina, Panama, Dominican Republic and Uruguay 80.0% to 89.0%
Jamaica, El Salvador, Brazil, Guatemala, Chile, Mexico and Co lombia 70.0% to 79.0%
Honduras, Ecuador, Trinidad and Tobago and Venezuela 55.0% to 69.0%
Peru, Bolivia, Paraguay and Haiti Less than 55.0%
The average for Latin America in 1995 was 67.0%; that of the country high-income
groups was 94.0%.
Access to health services

PERIOD POPULATION URBAN POPULATION RURAL DIFFERENCE
1985-88 86.8% 47.4% 39.4 points
1990-96 85.9% 52.3% 38.5 points
Also in this particular the differences between countries are very noticeable; In
several of them, the percentages of the rural population with access to health services are
very similar to those of the urban population. bana; On the contrary, in others, the
differences are high.
Population immunized against tuberculosis. The data refer to the year 1981 and the
period 1992-95.
This is the percentage of the total population of each country that has received
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complete immunization against this disease.

In 1981, only 61.0% of the population of Latin America and the Caribbean was
immunized against tuberculosis; the average for the period 1990-96 rose to 94.0%. As a
point of comparison, the percentages rates in high-income countries, for the same dates,
were 79.0% and 78.0% respectively. By country, for the period 1992-95, most countries
recorded immunization data against this disease greater than 90.0% and only Haiti had a
percentage lower than 70.0%.
Population immunized against poliomyelitis. The data refer to the same dates: year
1981 and average for the period 1992-95.
At this point we also refer to the percentage of the population of each country that
has received complete immunization against this disease. medity.
In 1981, the proportion of the population of Latin America and the Caribbean
immunized with poliomyelitis was 48.8% and for the period 1992 95, rose to 84.5%. The
percentages for high-income countries were 71.3% and 92.3%, respectively.
For this last period, eleven countries registered higher percentages less than 90.0%
of the immunized population; seven countries had between 80.0% and 90.0%, and the
remaining four countries had less than 80.0%.
Population immunized against measles. The data refer to the year 1981 and the
period 1992-95.
Measles immunization rates, as average Latin America and the Caribbean, went
from 43.5% in 1981 to 83.3% in the period 1992-95, with an increase of 91.5%. For the
same dates, the percentages corresponding to high-income countries were 68.0% and
79.8% respectively.
By country, in the period 1992-95, the majority showed high rates of percentages:
eight countries, between 90.0% and 100.0%, another nine countries, between 80.0% and
90.0%. The countries with relatively low percentages were:
Argentina 76.0%
Guatemala and Paraguay 75.0%
Venezuela 67.0%
Haiti 31.0%
Population immunized against diphtheria, pertussis or whooping cough and tetanus.

Data referring to the year 1981 and the period 1992-95.
The immunization percentages against these diseases, as an average for Latin
America and the Caribbean, were 41.6% in 1981 and 84.0% co average of the period
1992-95, which represented an increase of 101.9% from 1981. For the same dates, the
percentages correspond The proportions to high-income countries were 79.3% and 83.5%
respectively. vally.
By country, in the period 1992-95: only four registered ci Relatively low rates of immunization:
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Venezuela 68.0%
Argentina 66.0%
Guatemala 59.0%
Haiti 34.0%
Population immunized against dehydration (ORT). The data refer to the year 1981
and the period 1992-95.
Refers to the proportion of all cases of diarrhea in children under five years of age
treated with oral rehydration salts or a so suitable solution prepared at home.
The percentages of diarrhea cases, duly treated in the indicated manner, rose, as
an average for Latin America and El Ca ribe, to 43.5% in 1981 and to 83.3% in the period
1992-95, with an increase to 91.5% as of 1981. For the same dates, the percentages co
rresponding to high-income countries were 68.0% and 79.8%, respectively tively.
By country, in the period 1992-95: there is a complete range that ranges between a
minimum of 10.0% for Jamaica and a maximum of 96.0% for Uru cool.
Total Fertility Rate
The total fertility rate represents the number of children you have. What would a
woman do if she lived to the end of her reproductive period and you saw children at each
age according to the prevailing rates of faith age-specific quantity.
From 1970 to date the total fertility rate has decreased occurred in Latin America in
a very significant way, as can be seen in the following summary:
Fertility Rate
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YEAR TO. LATINA AND THE CARIBBEAN DEVELOPED COUNTRIES
1970 5.2% 2.3%
1980 4.1% 1.9%
1995 2.8% 1.7%
2000 (projection) 2.7% 1.8%
Relationship 1995/1970 0.52% 0.78%
The relationship between 1970 and 1995 indicates that the fertility rate in Latin
America was reduced by 1995 to practically half the rate recorded in 1970.
We point out that Latin American countries will continue to register high total fertility
rates in the year 2000, especially:
Bolivia 144.4%
Guatemala 136.7%
The Savior 108.6%
Other countries will register rates very close to or higher than 3.0%:
Paraguay 3.7%
The Savior 3.4%
Peru 3.0%
Venezuela 2.8%
Colombia and Dominican Republic 2.7%
Health spending as a percentage of GDP and total public spending. The data used
corresponds to the years 1990 and 1993.
"Total health expenditure" means the sum of expenditures made in a country, jointly
by the public and private sectors, measured as a percentage of its Gross Domestic Product.
We also analyze well, "public spending on health" as a percentage of "public spending on
such".
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In Latin America and the Caribbean, "total health expenditure" represents ba, in
1990, 4.5% of the gross domestic product (GDP). The percentage that high-income
countries devoted to total health spending was almost double: 9.4% of GDP.
In Latin America, in 1990 they dedicated to health expenses:
COUNTRY PERCENTAGE OF GDP COUNTRY PERCENTAGE OF GDP
Nicaragua 8.6% Ecuador 4.1%
Haiti 7.0% Colombia 4.0%
The Savior 5.9% Bolivia 4.0%
Costa Rica 5.6% R. Dominican 3.7%
Chili 4.7% Guatemala 3.7%
Uruguay 4.6% Venezuela 3.6%
Honduras 4.5% Peru 3.2%
Argentina 4.2% Mexico 3.2%
Brazil 4.2% Paraguay 2.8%
Regarding "public health spending" as a percentage of total public spending, only

nine countries present data. In five of them the gas health represents less than 10.0% of
total public spending (El Salva dor, Paraguay, Bolivia, Uruguay and Brazil). In two of them, it
represents between 10.0% and 20.0% (Chile and Nicaragua) and in the remaining two
(Panama more and Costa Rica), between 20.0% and 30.0%.
Social Security Coverage
Data from the years 1990 to 1993, corresponding to eleven countries: Argentina,
Bolivia, Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Panama, Peru and
Venezuela. The data refer to active contributors as a percentage of the EAP, affiliated with
the pension regime or, in the case of Chile, contributors to the AFPs and the old pension
regime. sions.
The average coverage for all of these countries, except Chile, was 35.6% in 1990,
35.7% in 1991, 35.2% in 1992 and 35.4% in 1993.
As an average of the 4 years recorded, only Chile over passes 50.0% coverage
(53.0%); Peru and Panama range between 40.0% and 50.0%; Argentina, Venezuela and
Mexico, between 30.0% and 40.0%; Guatemala, Ecuador, Colombia and Honduras,
between 20.0% and 30.0%. Bolivia has coverage ture of 13.1%.
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4.2 Historical Evolution of Public Health in Argentina
The idea of hospitals as a place to care for the sick does not have a univocal
meaning, so to understand the meaning a little better role and functions of Argentine public
health and how this was changed As society also changed, we decided to start with a brief
tour of history:
^ 1580 D. Juan de Garay carries out the second founding of Buenos Aires and dedicates the man zana 36 (delimited
by the current streets Corrientes, 25 de Mayo, Reconquista and Sar ment) for the hospital. But it takes a long
time until the project comes to fruition. The hospital had to be near a church, have the city's patron as its patron,
and be cos designed and attended by the Cabildo. For its support, the King had allocated "a no ven and a half of
the tithes."
^ 1605 It was decided to create the San Martín Military Hospital, dedicated to caring for sick soldiers. First smallpox
epidemic when a squad of soldiers arrived. A doctor named Francisco Bernardo Jijón lived in Buenos Aires.
Francis also performed co de Villabéñez, Juan Cordero and Gerónimo Miranda for a total of 300 inhabitants.
^ 1611 The Cabildo considered that the block destined for the hospital (Hospital de San Martín de Tours) was not the
most suitable and chose a block on the Riachuelo road (acts Balcarce, Defensa, México and Chile streets).
Construction work does not have a certain start date. The first years were poor, without a doctor and in charge of
a nurse. A storm ended their precarious existence. The Cabildo was responsible for public health: it had to
maintain hospitals, hire doctors, and apothecaries.
^ 1620 Juan Escalera, Andrés Navarro, Juan de Vargas, Lorenzo Menagliotto and the teacher Jacques Nicola acted in
Buenos Aires as doctors between 1612 and 1620. A Franciscan layman, Cristóbal Gómez Pelaino, arrives from
Spain, authorized to use his titles as a doctor and surgeon. In 1621, a large smallpox and typhoid epidemic
occurred in Bue us Aires. Poor conditions of water available in the city.
^ 1625-1642 By 1625 only one doctor was recorded in Buenos Aires: Francisco Peña In Between 1632 and 1642
three doctors were known in Buenos Aires: Alonso Garro, Gaspar Ace vedo (author of a book on anatomy and
another on surgery) and Manuel Álvarez, "Médico ciru Janus, examined ", Portuguese, who appeared on August
22, 1605 to offer his services. In 1641, a great epidemic of smallpox and consumption broke out in Buenos Aires.
^ 1670 The San Martín de Tours hospital was rebuilt, which, in reality, functioned as an asylum. Only around 1700
did the Bethlemite fathers (religious congregation) take over. goddess dedicated to the care of the sick) and her
name was changed to Saint Catherine. It was closed in 1822 by order of Rivadavia.
^ 1687 New smallpox epidemic in Buenos Aires
^ 1700 The population of Buenos Aires reached 6,000 inhabitants
^ 1740 The English doctors Roberto Young and Roberto Fontai acted in Buenos Aires ne and the Scotsman Juan
Eliot. The brotherhood of Santa Caridad, founded by neighbor Juan Alonso González, built a room with twelve
beds for poor women who received patients since 1743, although they did not regularize their situation until
1774, when they expanded the number of rooms and created the list of insane people to women. This hospital,
known as the Charity or Women's Hospital, functions precariously thanks to the two nations. The assets of this
brotherhood became dependent on the Benefi Society ncence in 1823.
^ 1750 Buenos Aires offered notable sanitary deficiencies at this time:
a. Lack of competent doctors,
b. Lack of public hygiene habits
c. Periodic epidemics
d. Domestic animals that added dirt to the city
e. Insects and vermin, street garbage and swamps, dead animals and waste
f. Poor quality water taken from river wells
^ 1760 Buenos Aires has 10 doctors. The city had 15,000 inhabitants.
^ 1778 Mayor Sanz imposes a cleaning campaign on the streets. Viceroy Vertiz assumed his position in 1778 and
among his many measures to improve the quality of life In the Viceroyalty, he monitored the practice of
medicine, the quality of medicines, and in 1779 created the foundling home and the hospice for the homeless.
Buenos Aires had 24,750 inhabitants in the city and about 13,000 in the countryside.
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^ 1779 Following an initiative by the Prior General Trustee, alarmed by the number of abandoned children in the
streets and vacant lots of the city, Viceroy Vertiz inaugurated on August 7, 1779, the Casa Cuna or also called
Casa de Expósitos at the intersection tion of the current Alsina and Perú streets, where years later the
Protomedicato would operate. His first doctor was Dr. Juan de Dios Madera.
^ 1780 Court of Medicine established. Buenos Aires only had nine doctors. cos and two military surgeons, among
whom were:
a. Miguel O'Gorman
b. Francisco Argerich
c. Juan Dupont
d. Angel Castelli
e. Juan Torreros
f. Pedro Cristobal de Amarita
g. José Antonio Lámota Lagosta
h. Matías Grimau
i. Juan de Dios Madera
^ 1790 In 1790, professionals in the art of healing were requested from Spain. Around this time the women Jeres
gave birth at home assisted by a neighbor or family member. The first “carers of parturients or mothers” begin to
arrive in Buenos Aires from Spain. “madronas”
^ 1798 Buenos Aires had about 40,000 inhabitants, with serious deficiencies in ma health issues due to the lack of
hygiene habits (garbage dumps and street swamps) and the lack of competent doctors. Mayor Sanz imposes a
street cleaning campaign and Viceroy Vertiz creates the Protomedicato whose objective was to regulate and
control medical practice, revalidate titles and take competency exams for the midwives who attended to women
in childbirth (in the regulation is made with (i.e. due to the shortage of doctors, the issue of childbirth should be
relegated to a group of women authorized for this purpose). At this time in Buenos Aires, doctors Miguel
O'Gorman (first professor of Medicine in Buenos Aires) and Agustín Fabre (who was considered the first
obstetrician in the city) had an outstanding performance, who established the cell of what would be the teaching
of medicine na in Buenos Aires, presenting to Viceroy Avilés a six-year study plan where It is provided that in
the fifth year the subject “Operations and childbirth” will be taught. O'Gorman appoints the doctors Francisco
Argerich, Benito Gon to constitute the protomedicato zález Rivadavia and Mr. José Alberto Capdevila. By Royal
Decree of 1798 of Viceroy Olaguer Feliú, the beginnings of the Faculty (School) of Medicine were founded,
appointing Miguel O'Gorman as Professor of Medicine on January 21, 1779. later held by Cosme Mariano
Argerich who was the son of the colonel and surgeon of the king's armies, D. Francisco Argerich Professor of
Surgery to José de Capdevila, who resigned shortly after for health reasons and was replaced by Dr. Agustín
Eusebio Fabre. Cosme Mariano Argerich was born in Buenos Aires on September 26 September 1758. After
completing his basic education he was sent to Spain, to es He studied medicine at the University of Cervera,
where he received his doctorate in 1783, and returned to Buenos Aires in 1784 when he was appointed doctor at
the College of Orphans. Fabre and Argerich were the true promoters of the School of Medicine, which with He
was in his first course with 15 students. Fabre taught anatomy, clinical surgery and childbirth, to start the first
Chair of Obstetrics in the country in 1805.
^ 1801 Viceroy Joaquín del Pino creates the chairs of Anatomy and Medicine in the Protomedicato (Dr. Cosme
Argerich was its holder) The first fifteen young South American men Canos began their first medical course in
Buenos Aires on March 2, 1801 and five years later the first Creole doctors graduated. Among them was Fran
cisco Cosme Argerich, who was the son of Cosme Mariano Argerich and grandson of Francisco Argerich, both
of outstanding performance in the medical environment of Buenos Aires in so He studied at the Colegio de San
Carlos where he was a classmate of Bernardino Rivadavia and in 1801 he began his medical career in the first
year of the Protomedicato where he had his own father as a teacher. But the institution had a very precarious
existence, there was a lack of resources and a shortage of teachers, and in 1812 it practically became extinct. gue
^ 1805 Viceroy Nickname spreads the smallpox vaccine discovered by Jenner. A Royal Decree is printed that refers
to the way of performing the cesarean section after the death of the mother, the only way in which the
performance of said intersection was approved. vention
^ 1810 Between 1810 and 1830 almost 200 doctors worked in Buenos Aires. Infectious-contagious diseases were in
first place (tuberculosis, tetanus, typhoid fever, etc.) There were three hospitals in Buenos Aires. The patients at
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these three hospitals were me homeless people, homeless people, alcoholics or prostitutes without social
protection Hospital Santa Catalina In the current streets Defensa and México. Only attended Hospi emergencies
such as the Residence or Men's In the San Telmo neighborhood: it had 200 beds and only received men. It was
located on the current Humberto Primo street in the San Telmo neighborhood; It was built on land expropriated
from the Jesuits and in 1770 it was land to other land (also seized) known as the Residence. Charity or Women's
Hospital Near the Chapel of Saint Michael. Exclusively for women, it had 70 beds.
^ 1812 Measles epidemic in Buenos Aires
^ 1813 The General Constituent Assembly entrusts Cosme Mariano Argerich with the re dation of a project for a
Surgical Medical Faculty, intended to replace the an old medical school. The Military Medical Institute is
created, a medical school dedicated to training surgeons for the army.
^ 1814 Medical School classes begin at the Military Institute. Under the direction of Cosme Mariano Argerich, his
first students are: Xavier Muñiz, Miguel Rivera, José María Gomez de Fonseca, Agustín Favre, Pedro Martinez,
Victoriano Sanchez, Diego Sanchez, Francisco de Paula Almeyra, Celedonio Fuentes and Benito San Martín.
^ 1817 Typhus epidemic in Buenos Aires
^ 1820 Director of the Medical School of the Military Medical Institute, Dr. Co, dies sme Mariano Argerich. He is
replaced by Cristóbal Martín de Montúfar who is later replaced by Francisco Argerich. But the Institute ends its
activities this year.
^ 1821 Governor Martín Rodríguez and his minister Bernardino Rivadavia founded the University of Buenos Aires,
made up of the departments of Exact Sciences, Ju risprudence, Medicine, First Letters, Sacred Sciences and
Preparatory Studies. At the head was a rector (later supported by a vice-rector) and each of the departments in
charge of a prefect.
^ 1822 On August 12, the inauguration ceremony takes place in the Temple of San Ignacio tion of the University of
Buenos Aires. Grace scholarships were created to facilitate the influx of young people from the interior so that
access to the University is not restricted. sent to Buenos Aires. The first rector was the priest Antonio Sáenz. Dr.
Sáenz was replaced after his death by Dr. Valentín Gómez in 1825. Doctorates such as Medicine are created.
The teaching activity of the Department of Medicine begins in
^ 1823, with a four-year plan. The prefect was Dr. Cristóbal Martín de Montúfar and his teachers:
a. Juan Antonio Fernández in medical institutions
b. Francisco Cosme Argerich in surgical institutions
c. Francisco de Paula Rivero in medical and surgical clinic
^ 1822 Until this year the recipes were written in Latin, from here on they began to give melt the use of Spanish.
Buenos Aires had 55,416 inhabitants. The Academy of Medicine is created, founded by Rivadavia, which
brought together the most distinguished doctors. Creole and foreign doctors who practiced in Buenos Aires. It
was headed by Doctor Justo García Valdés, the second and last protomedic of Buenos Aires. The School of
Midwives is created under the direction of a police doctor, Dr. Carlos Durand, and it is urged the first
"Maternity" since three beds in the Women's Hospital are allocated for parturients
^ 1823 The first issue of his Annals is published, which was the first Argentine publication tina in the scientific
journalistic press. Because the Protomedicato had been dissolved, all its functions (care of public hygiene,
surveillance in the exercise of the profession and the registration of titles) became exclusive to the Academy.
^ 1825 Measles epidemic in Buenos Aires. The anatomical amphitheater in Medicine is built.
^ 1827 A university reform in Medicine is carried out with the establishment of a six-year study plan, with expansion
of professorships.
^ 1831 Scarlet fever epidemic repeated in 1833, 1836 and 1837. Little progress at the University of Buenos Aires due
in part to the French blockade and in part to the cut in state funding due to the internal political upheavals that
the country was experiencing; Almost no doctors graduate and the budget allocated for this purpose is reduced.
^ 1833 The government of the University is taken over by a Board of Directors made up of Dr. Cosme Argerich in
the Medical area (Medical Nosography). The French Philanthropic Society, origin of the French Hospital of
Buenos Aires, begins to operate.
^ 1834 Governor Viamonte imposes the obligation on graduates of Medicine and Surgery tion of serving three years
in the campaign. Pedro José Otamendi graduates with his thesis “Cán cer of uterus” and Ramón Ellauri with
“Accidental hydrocele of the tunica vaginalis”. It was stopping the Pharmacy degree from the Medicine degree.
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^ 1836 A decree by Rosas provides that “no one may be conferred at the University the degree of Doctor or issued
the title of Lawyer or Doctor without having previously accredited to the Government the declaration of having
been and being notoriously addicted to the national cause of the Federation” They move away from the Faculty
of Medicine for political reasons ticas Drs. Francisco Cosme Argerich, Juan Antonio Fernández and Juan José
Montes de Oca. They were replaced by doctors Saturnino Pineda, Ireneo Pórtela and Clau gave M. Basin.
^ 1843 Dr. Teodoro Álvarez, who was in charge of the Chair of Nosography and Surgical Clinic from the death of
Dr. Fonseca in 1843 until after the battle of Caseros, obtained his medical degree. It was Rosas's surgeon whom
he operated on for a bladder stone around 1850. He was a professor at the Faculty of Medicine for 32 years,
resigning in 1875. He died in 1889.
^ 1844 Dr. Guillermo Rawson, born in 1821 in San Juan, obtained his medical degree. He was a provincial deputy
and minister of President Miter. He retired from political life in 1876. Professor of Hygiene at the Faculty
presented a titled work in 1876 in Philadelphia. side “Vital statistics in the city of Buenos Aires” where he
maintains the need to fi create a sanitation plan for the city since this has a direct impact on the health of its
residents.
^ 1846 Dr. Carlos Durand became a doctor, who would acquire great fame as a midwife in the Buenos Aires of that
time and would also be politically active at the time, being elected deputy by the campaign in 1859. He married
in 1869, at the age of 44, with 15-year-old Amalia Pelliza Pueyrredón (granddaughter of General Pueyrredón).
Upon his death in 1904 he left a will in which he ordered that most of his assets be allocated to the creation of a
hospital that should bear his name.
^ 1848 The English surgeon John W, Mackenna applies ether as a general anesthetic on June 18, 1848 for the first
time in Argentina in an operation he performed at the British Hospital located on current Uruguay Street
(between Viamonte and Córdoba)
^ 1849 Gil José Méndez graduates with the thesis “Diagnosis of uterine pregnancy”
^ 1852 1830-1852: 223 professionals graduated throughout the University of Buenos Aires beef. Starting in 1852, the
University began to recover and obtained its first headquarters: the building of the old Colegio de San Carlos.
The government of the province of Buenos Aires issued a decree on April 15, 1852 by which the School of
Medicine was organized separately from the University and with full autonomy (a situation it maintained until
1874). The supervision of studies was in charge of Juan A. Fernández, Juan José Montes de Oca and Teodoro
Álvarez The medical activity was distributed into three sections, corresponding to the functions of the
protomedicato: Public Hygiene Council: espe cie of health police Faculty of Medicine: taught medicine, surgery
gy and pharmacy. Academy of Medicine: brought together professionals to promote ade lance of medical
science. The leaders of the three areas formed a Ge Directorate neral who was in communication with the
Government.
^ 1853 The Faculty was installed in the Men's Hospital, opposite the Church of Saint Tel mo, which had been the
Hospital of the Betlemite Fathers. Its first dean was Dr. Juan Fernández. Dr. Ventura Bosch founded the San
Buenaventura hospice, named after Las Mercedes on the old grounds of the Convalescence. The Hos is created
Spanish pital or House of Mercy that would serve as an asylum for indigent Spaniards; It had its headquarters at
600 Alsina Street today.
a. Dean of the Faculty of Medicine 1852-1855
b. Juan Fernández 1855-1862
c. Francisco Muñiz 1862-1874
d. Juan Montes de Oca 1874-1884
e. Manuel Porcel de Peralte 1884-1887
f. Pedro Antonio Pardo 1887-1889
g. Cleto Aguirre 1889-1893
h. Mauricio González Catan 1893-1897
i. Leopoldo Montes de Oca 1897-1901
^ 1857 A house for the insane is created for men next to the one for women, which is enabled in 1863.
^ 1863 A room for army officers is created in the Men's Hospital and later transformed into the first military Hospital
and in the northwest part of La Convalcencia the doors are opened for the Hospital for Insane Men, which would
later take the name bre of Las Mercedes.
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^ 1867 Buenos Aires residents endured a cholera epidemic that claimed 1,500 lives. On January 7, 1867, María
Josefa del Pino, granddaughter of the Viceroy, presented the Society of Beneficiary fiction, the project to found a
Children's Hospital in the City of Buenos Aires
^ 1869 The Hospice for Invalids is created due to the war with Paraguay, which would be the origin of the Rawson
Hospital in 1889. A lazaretto (El lazareto San Roque) is enabled for contagious patients and in this way relieve
the Men's Hospital; It was located in a country house far from the center whose limits coincide with those of the
current Ramos Mejía Hospital. It was made up of two barracks with twenty beds each. The municipality ity
began works for its reconstruction and months before the start of the same it would be transformed into a
hospital that provided important services during the yellow fever epidemic.
^ 1870 During these years, tuberculosis devastated the population and “ai” were recommended res” from Córdoba
and then Tucumán for the recovery of the sick. I condition them Sanitary conditions of the city were really very
deficient: there were no sewers or running water. Currently, only a few benefited from the water that the Western
Railway took from the river, which was diverted to a 43-meter-high tank located in Plaza Lorea. The rest
obtained water from wells, cisterns or by buying it from water vendors. The waste was thrown in the street or
piled up in multiple garbage dumps. Terrible epidemic of yellow fever that in 1870 left about 200 victims and
that in the summer of 1871 began in San Telmo and spread to the entire city, leaving 563 fatalities in a single
day. “Those who were able to leave the city did so and even the government was left headless for a few days. “A
commission made up of neighbors and some doctors took charge of the situation.” As a result of this emergency,
the Cha cemetery was created. carita and there was an exodus of the wealthy people to the Northern Quarter of
the city, near La Recoleta, a place considered higher and healthier. The epidemic left almost 15,000 dead,
including Dr. Muñiz.
^ 1872 The Italian Hospital is inaugurated on December 8 on the corner of the current ca lles Caseros and Bolívar.
The foundation stone of the new building of the Spanish Hospital is laid in its current location in Belgrano and
Rioja.
^ 1874 Mrs. Dolores Lavalle de Lavalle assumes the presidency of the Benevolent Society with the condition that
everyone undertakes to fulfill the wishes of Mrs. del Pino, who had died in the yellow fever epidemic of 1871, to
build the Children's Hospital for Buenos Aires.
^ 1875 The San Luis Gonzaga Children's Hospital is inaugurated on the current Hipólito Yrigoyen Street 3420. The
first director (Dr. Rafael Herrera Vegas) is appointed in a tranquil manner history until the return of Dr. Ricardo
Gutiérrez who was in Europe, who upon his return assumes his presidency that lasts for a period of 25 years. A
year yes Next moves to a new headquarters in Arenales 1462. Period 1853-1875: graduates There were 140
professionals at the University of Buenos Aires.
^ 1877 Construction of a new hospital begins to replace the men's hospital. It was called Buenos Aires or Nuevo and
was located in the block currently delimited by Córdoba, Paraguay, Junín and Uriburu streets. Construction
ended in 1881 with capacity for 250 beds.
^ 1879 The Hospital de Clínicas is founded at the request of the Academy of Medicine in the block located between
Córdoba, Junín, Paraguay and Andes (Azcuenaga) streets, but before the work was completed the construction
had to be used as a rifle barracks, concentrating the wounded from the fighting in Olivera, Puente Alsina,
Corrales and Barra cas. Dr. José Penna graduates from the Faculty of Medicine of Buenos Aires.
^ 1882 Infections constitute 40% of general mortality in Buenos Aires. A smallpox epidemic is advancing at an
alarming rate; the San Roque lazaretto, infected with tagiosos, had been converted into a common Hospital
because the Buenos Aires Hospital (Clínicas) was not enough to cover the needs of the growing population of
the city. dad. The old Men's Hospital was about to be closed. It opens to the pu The Municipal Isolation House
was destroyed by the war (when the lazaret was closed to be transformed into a hospital). The smallpox patients
were housed in a house on Paraguay and Azcuénaga streets known as Quinta de Leinit and which had been used
as a lazaret in previous times (cholera in 1869 and yellow fever in 1871). It was called Casa Munici Isolation
pallet. It had 40 beds but at one point it housed 95 smallpox patients. Severe overcrowding, overcrowded
infections and overflowing of the city's hospital capacity led the government to consider the imminent
insurgency. new felling for this Isolation House.
^ 1883 Men's General Hospital was demolished. The Buenos Aires or Nuevo Hospital becomes the domain of the
Faculty of Medicine and its name is changed to Clinics. The San Roque Hospital is inaugurated, the first in the
municipality and which today bears the name of Ramos Mejía Hospital. Its director was Dr. Enrique Revilla. The
Benevolent Society of Buenos Aires creates the first Santa Lucía Ophthalmological Hospital that joined an eye
disease clinic that the sisters had established. nas Daughters of Mary and was attended on an honorary basis by
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Dr. Pedro F. Roberts and the student Eduardo Ovejero, it first operated on 900 Moreno Street, it was later moved
to the Women's General Hospital and in 1883 it was transferred to Maipú and Lavalle and then to Arenales
Street until 1992. Dr. Cecilia Grierson does her first internship professionals at the Women's Hospital and
completed his graduation thesis on “hysteroovariotomies”. Actively participating in the Obstetric Society that
fought for the education of midwives3.
^ 1884 The San Buenaventura Hospice for Invalids is given Hospital status but with the condition that the invalids of
the Hospice could remain there. It was a mixed hospital, the first in the city with these characteristics and in
1889 it was given the name by Guillermo Rawson.
^ 1885 The rector and former president Nicolás Avellaneda established the principle of autonomy of the University,
the appointment of professors by the Executive Branch and the creation of a university fund.
^ 1886 Given the poor functioning of the Isolation House and pressure from Dr. Penna, in April of this year the
definitive transfer was made to land occupied by It was an entire 5 blocks where three large rooms had been built
at the beginning and gradually it was equipped and equipped with a sanitary station. In this year's cholera
epidemic the new Isolation House served to isolate the sick, and co The first crematory oven began to operate.
^ 1887 Dr. Carlos Malbrán, chief bacteriologist of the Department Laboratory. From Hygiene, he is sent by the
government to combat a cholera outbreak in Mendoza.
^ 1887 On April 27, 1887, the Women's Hospital became the Rivadavia Hospital: it was moved to the current
location (Avenida Las Heras 2670) under the name nation of “Rivadavia Women's General Hospital The French
Hospital of Buenos Aires begins to operate at its headquarters on Rioja and Urquiza streets. Dr. Telémaco Susini
founded the Institute of Pathology at the Faculty of Medicine.
^ 1889 The name Guillermo Rawson is given to the mixed Hospital, which from 1894 begins to acquire surgical
fame. On December 15, the foundation stone of the new Italian Hospital is laid in the Almagro area where it
currently operates. The edi office was inaugurated in 1901
^ 1890 In Belgrano the creation of the relief house on the current Monroe Street is authorized, gradually the project
was modified and it was decided to build a hospi First called Belgrano, its name was later changed to Pirovano.
In view of Before 1900, the Flores and Del Norte Hospitals had been created, which later changed They changed
their names to those of Teodoro Álvarez and Juan Antonio Fernández respectively. tea. Land is purchased where
the Tornú Hospital currently stands and construction begins on a building to house infectious patients in order to
solve the problems of the Isolation house, arguing that it should be outside the city. But Penna's opposition
prevents this idea from being put into practice. the conditions tions of life have fundamentally changed since the
beginning of the century, especially in health matters. Life expectancy rose from 38 years in the 1820s to 46
years. Preventive vaccination is introduced.
^ 1892 The construction of the maternity ward of the San Roque Hospital called Eliseo Cantón is completed
^ 1893 The foundation stone is laid for the construction of the new headquarters of the Hospi Tal de Niños (the part
of the building that faces the current Gallo Street) that would later be called Ricardo Gutiérrez.
^ 1894 The foundation stone is laid for the construction of 18 rooms on the grounds of the Isolation House that would
be transformed into what is today the Muñiz Hospital. The idea was to form 3 hospitals isolated from each other,
with provision and storage services ment located in the middle. Since its inauguration it was attached to the
Faculty of Me dicine and seat of the Chair of Clinical Epidemiology.
^ 1895 When the city of Buenos Aires was federalized, the Faculty of Medicine, which depended on the provincial
government, passed to the national authorities. The Hospi was given to him such Buenos Aires (today Hospital
de Clínicas) and the land opposite destined for the construction of the future building that was inaugurated in
1895. Currently this building is the headquarters of the Faculty of Economic Sciences.
^ 1896 The new Children's Hospital building is inaugurated, but Dr. Ricardo Gutiérrez cannot witness it because he
dies a few months before.
^ 1943 The social-care model of the '40s: the National Directorate of Public Health and Social Assistance (1943) and
the Secretariat of Public Health (1946): The need for the existence of a ministry of health is founded for the first
time public.
^ 1957 The Ministry of Social Welfare (1957): Centralist State. The sis is consolidated issue of social works linked to
solidarity financing systems: the public sphere grows exponentially.
Last Three Decades
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That the Argentine Republic is a country inhabited, throughout its history, by

contradictions, it would be unnecessary to mention it; except because in the issue of health
– which concerns us as a whole in society – it is one of the segments in which it is shown,
unfortunately, with more yor veracity. And this is so since, if we stick to a superficial and
why not say "interested" view of the statistics on the matter, it could be thought that the
health levels of Argentina have worked in the last decade of the last century.
Although it is true that Argentina's health indicators have experienced an
improvement in recent years (life expectancy at birth went from 71 years in 1990 to 73.3
years in 1998, which represents an average increase of 2 .3 years of life for each individual
in the population blation, infant mortality fell from 26.6 per thousand in 1987 to 18.8 per
thousand in 1997 and maternal mortality fell from 4.9 per ten thousand to 3.8 per ten
thousand in the same years); It is no less true that this trend, towards higher levels of
health, occurred in most countries in the region and the world and has been attributed to
changes in social, cultural, technological, economic, environmental and availability and
accessibility factors. to health services. However, the changes experienced mentioned in
the health situation have not compensated for the inequalities in the health conditions of the
populations, which in many cases remain or have increased. Recognizing the existence of
these differences constitutes a fundamental step on the path to their correction.
Without a doubt, the health conditions of a population are the result of the joint effect
of genetic factors and contextual factors. where the life of this population takes place.
Although the factors ge genetics can have a relevant weight on health at the individual
level. dual, at the level of populations it is the socioeconomic, demographic, cultural,
environmental and political factors that play the most important role. yor as determinants of
health levels, overcoming the old crite He said that HEALTH is the "mere absence of
disease."
The uneven development achieved by the different provinces of Argentina - and in

some cases the involution and disappearance of the economies regional mines - is the
palpable proof of what we affirm, and that information equity to which we referred in the
preceding paragraphs is pa It is difficult if one considers, for example, the Unmet Basic
Needs Index (NBI), in 1991 the percentage of the population living at home res with NBI,
went from 7% in the Federal Capital to a proportion 5.5 times higher in Chaco, (38.3%).
Even greater differences occurred in the proportion of the population that did not have
drinking water, from 0.1% in the federal capital to 60.6% in Misiones, and in the proportion
of the population that did not have sewage systems, 3 % to 92.5% in the same provinces. A
similar situation occurred at the INS level. truction of the population with illiteracy ranges
ranging from 0.7% in the Federal Capital to 1 1.3% in the Chaco, a situation that is
currently This reality has not been reversed, but on the contrary has worsened with the
consequences of the social exclusion model applied and its most notable results: a society
in dismemberment, sickness and, consequently, sadly, violent. Concluding, the provinces
with lower income have They have a greater proportion of illiterates, a population without
drinking water and without sewage drains and fewer health services and accessibility to
them, consequently, less health and greater inequality.
Since 1997, the general mortality rates of the total population and that of each sex
have presented important differences between provinces, sex and when considering income
groups. Premature mortality is more frequent and total mortality increases as income
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decreases. income. However, when considering rates by sex, the increase in rates in poor
provinces is much more noticeable in the female population.
By considering deaths of both sexes separately, it was evident that the tendency to
increase the loss of years of life occurs in the lower income groups, as in the case of
general mortality, is more accentuated in the female population, which implies that in the
female population of the provinces of the lower income group These people would be losing
54% more years of potential life than in higher-income provinces.
But we could not advance in the analysis of health if we did not previously mention
(even if only briefly) the circumstances and characteristics that, beyond the economic-
political issues that our country - and the rest of the world - are going through, affect cultural
values and conceptions in a profound way and - in some cases - in a definitive and highly
damaging way, as a consequence of what has been called, generically, and often without
further foundations, as the process of "globalization" of the markets.
Indeed, in recent years there has been a profound cultural change in Argentine
society. To the modification of models of re presentation and collective action is added to
the change in the set of attitudes, behaviors and beliefs related to the public and the State.
The constant recessions and social fragmentation lead to a decisive transformation of
the cultural meanings related to the State and social actors that are directly related to it.
This is the case of health workers, for whom the eco changes global economic changes in
recent decades have caused a strong transformation not only as a consequence of
innovations in the technological aspects of the environment, but also supports changes that
are intended to be definitive in the very nature of the activity of the same mo.
In this time of change, forms of technical exercise and characteristic values and
attributes of health practices are questioned. Power is resized; Technical authority is
reoriented and areas of competence are redistributed. Worker relationships are
transformed health workers with knowledge and its technological use, as well as
relationships with the patient in the work team.
The liberal market model, applied to health, throughout its evolution, never managed
to equate the individual care of those who could pay for it with the needy or working
populations. That is why when social security emerges and becomes established in our
country, conflicts are constant between health considered as a simple market equation and
solidarity systems. The comprehensive concept of health, as conceived by the WHO
Currently, it plays a secondary role, we could say that of a "decorative complement" to the
activities. lives of state entities and large and medium-sized health care companies in
almost all places, which, clinging to the values of "autonomy and free choice", in their
various variants of the liberal enterprise, manifest economic and ideological ones that are
difficult to reconcile with the precepts of universal coverage that Little by little they have
been consecrated, in all countries, with advances and setbacks according to the prevailing
ideology in their conduct and the health policies consistent with it.
The causes that produce changes in health are narrow mind related to the changes
that were taking place since the each of the '70s throughout the world, although they hatch
during the decade each of the '80s. The reconstitution of the structural power of capital,
which clearly began to occur in the mid-1970s, is related to the change in capitalist
production worldwide and the way this transformation affects this country.
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In the '80s a circle determined by the logic of growth closed. ment of the market
throughout Latin America, and therefore, the actors cials associated with it are forced to
modify their behaviors lies. At the same time as altering the economy, the coalitions of the
dominant sectors that control the State apparatus, in the '70s in almost all of Latin America,
left it in a situation of deep fiscal crisis, thus making its intervention unmanageable for the
state. in the economy and its social intervention as a redistributive agent. Immersed in
depth two financial crises, emptied of resources, indebted, destroyed their functional
relationships with society, they go from being a powerful ins trument in the social dispute, to
a problematic apparatus in itself.
Along with these difficulties that the states, after the dictates harsh military forces,
they have acquired, there is their structural problem, which is the new modality of the
capitalist regime that is beginning to emerge, and that is the prevailing one today.
The analysis of the basic motivations that supported the military regime of 1976
reveals the persistence of a fundamental objective: to structurally refound Argentine society
both in economic, political and social terms, consolidating a new dominant project. To
achieve it, initiatives of different content were implemented that were redefined over time, in
an external context marked by an economy in crisis in which financial valorization
predominated. capital and an internal situation where the "developmental" project had
apparently reached its maximum possibilities of expansion.
To do this, it was first necessary to attack an economic-social structure established
over several decades within the framework of the different stages of substitution
industrialization; in second term No, and due to the very solidity of the economic-social
structure of Argentina, and to the contradictions and needs of the capitalist economy, this
restructuring necessarily had to occur through a crisis and not through a phase of economic
expansion, to to achieve the marginalization of certain social sectors, the redefinition of
others and therefore the predominance of a few remaining. Finally, the changes produced in
the fundamental pillars from the industrial substitutive zation and the features of the new
pattern of accumulation should become irreversible, as the aim was not to move from a
"distributionist" variant of industrialization to another "concentrated" one of income, but
rather to remove the very economic and social bases of that model. it.
The reconstitution of the conditions of social domination advances through a sharp
fall in real wages and a growing dispersion of them among the different categories of
employees and activities. economic facts. This policy could be carried out despite the action
of the union entities - not always united and with clear concepts about the situation, also a
consequence of the so-called "national reorganization process" that hit the entire structure
hard without dical filling it with "disappeared", dead, tortured and persecuted - and the
suppression of collective agreements, and the right to strike.
The political and social defeat of the military dictatorship did not reach modi
substantially ify the results of the redefinitions produced in the accumulation process that,
considered from the perspective of any progressive project, constitute restrictions of a
profound nature. unprecedented size and magnitude. The mere statement of them prevents
confection tion a long list of current problems: the magnitude of the debt, social
marginalization, unemployment, job insecurity, the meager level of popular income, the
destruction of the production apparatus tive.
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The process of liberalization of the economy - begun in the '70s throughout the world
- was delayed in Argentina by the appearance of the first democratic government in 1983,
which assumed silent social demands. ceded by military governments and cannot, does not
know or does not want to satisfy face them, since, in the attempt to prevent being checked
by economic-business interests, it failed to make the situation of international markets
compatible with the obligations of the then the Welfare State is in force. After 1990, through
the dere gulation, assimilation into the international economy begins. at the dinner At the
end of the economic process, a new "social block" consisting of national and foreign capital
is installed; economic groups and companies transnational dams.
As a product of a project and a policy that was highly centralizing, excluding and
marginalizing, there was the emergence of a new economic power made up of some
capitals that had long existed in the country but that today occupy the center of the
adaptation process. mulation (economic groups), in turn transferred or associated with
external groups, becoming the centrality of their actions in the country and their financial
investments abroad, which enables them to condition tion the national economic process
and at the same time protect its interests and profits, within the economic situation
generated in the global sphere. bal.
In this framework, then, a change occurs in the type of State: from the Welfare State
we move to an exclusive and fleeing State. He is tado distances itself from its social
responsibilities as a direct manager of social balance. The adjustment produces a split in
the classes me days, producing increasing impoverishment.
It is a cultural political change that occurs in stages. with the dict Such a discourse is
imposed in the "free market" society, it is the rupture of statism, for that of "consumer
sovereignty." in the sis health issues, a subject is emerging that tries to replace the concept
of patient: it is the concept of "institutional client", a change that is identified with the
conception of society, which is not presented so as a community of meaning, but as a
community of service cios, of more pragmatic and competitive exchanges. In the new mode
The individual becomes the center, as he is a consumer; It is less linked to the fate of
collective actors, more oriented to the market, only to the cost-benefit calculation.
The growing influence of the market guides competition and profit, exponentiating the
deepening of an instruc rationality. mentality in strict cost-benefit terms. From the
configuration tion of the business model in the organization of work in the field of health, is
that several sources of problematization arise: the consumption costs of medical care; the
dissociation between the degrees of specialization of desirable work or those technically
indicated and those institutionally possible; the inter-institutional variants of the efi cacia of
the medical act; the ability of the system as a whole to fulfill respond equally to consumer
demand, and also the forms and appearance frequency of technological transformations
within services.
With this, private capital, public companies and health policies, structured or absent,
will increasingly regulate the insertion of health workers in the labor market, both in terms
of It affects specialized practices, as well as the types of link between them and health
institutions with direct consequences on the health of the population. A polarization of trends
between the most general practices and ultra-specializations, in the same way that the
polarization, in the case of professionals, between salary and property, is permeated,
crossed, by very different work situations. : in the more or less routine nature of the work; in
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the greater or lesser intensification of the work day; in the forms and value of remuneration;
while on the other hand, for the majority of health workers, the de-laborization of the re
worker-company relationship, fostering commercial-civil relationships (self-employment-self-
employed worker).
Through institutionalized production and with business modalities that respond to a
"free" or neoliberal market, there was a clear distribution of the rights and duties related to
health care. tion of health and segments of the population were instituted with external
access exclusive to the qualities of care and differentiated therapeutics, in addition to not
allowing direct correspondence between one quality and the other. The basis for regulating
the contract will be the purchasing power of each "clientele"; which is incessantly stimulated
by the current technological model of intervention and, at the same time, progressively
elitist. It goes through several components, such as the cost of attendance. It is through the
consumption capacity allowed by the consumer's income that those same qualities are
delimited.
We can affirm that Latin America has not finished traveling its difficult path of
democratic reconstruction. The political and social gains obtained are being threatened by a
long-term economic crisis. nomic and by the adjustment policies that are uniformly executed
in most countries. The current development model cannot make the objectives of stability
and economic growth compatible with the social requirements of well-being. Thus the
constitution of the sea ced as the dominant force of the economic-social dynamics and its
ex universal pansion, consolidates the process of globalization of the economy, rebuilding
economic and power blocks on a global level. There is a progressive decrease in the role of
the State in social development, especially in the fields of health and education, with a
tendency tendency to transfer fundamental responsibilities to the private sector without the
necessary guarantee of equity in the supply of services.
In institutional terms, for more than 50 years the State has been the largest employer
of the health workforce: an aspect of great importance in the context of the neoliberal
policies currently followed in the country according to which the Re form of the state. During
recent years, the policy that has been followed in relation to personnel working in state
institutions has been to encourage voluntary resignations: either through an increase due to
compensation, or due to salary freezes, or due to the lack of professional and scientific
incentives. This has ensured that the most qualified human resources, especially doctors
and nurses, hundred to their work in the public sector, particularly in hospitals. In general,
the doctors who have retired are those with higher qualifications, higher hierarchical levels
and with possibilities in established private activity, often leaving low-qualified personnel in
the State.
In the country, the privatization of health services is a point still not defined. So far the
indication is that health services should seek to "self-manage" (self-finance). This means
that the State is not going to increase, but rather decrease, its contribution and that each
unit must look for "creative ways to obtain financing." This has been understood this way by
health service officials, especially te in hospitals where they have set and increased rates
for care tion, thus seeking to increase the percentage participation of the "in own income"
within the budget. Obviously marginalizing and adding even more attention to the most
humble sectors and nore resources.
Added to this is a marked deterioration in the already insufficient services. health
services with the corresponding decrease in accessibility to them by large sectors of the
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population. This impact has been much greater due to the dominance of a health care
model focused on the disease and the individual, and with the application of technology.
high-cost procedures, without a basic rationale that favors the equitable use of services.
Simultaneously, there is a significant increase in the participation of various social forces in
the defense of their citizen rights, which poses a challenge to the traditional political system
in order to articulate the action of civil society to its management processes.
Simultaneously, the convergence of technological development with market
pressures - especially for instruments and medicines - and the demands of certain social
sectors, have established high standards. tions of technological incorporation even in the
simplest procedures. This generates requirements for greater training and technological
availability. logic and higher costs in the procedures, and adjusts to the hypothesis that the
specialist or ultra-specialist who works in private institutions vadas, with multiple and
complex auxiliary technologies and serving the sectors with the highest economic
resources, is today the model that – according to free market practitioners – should be
imitated.
Specializations have a long history in health activities, but recently they have become
even more diversified, reaching to a stage of ultra-specialization. Professional and social
pressure has increased towards the need to specialize with the consi subsequent
deterioration in the social valuation and recognition of the concept of health as a general
good of society. The impact of economic and technological development on health must be
highlighted.
Due to the technological innovation associated with development, which pro moved a
progressive availability of new means of diagnosis and treatment, in recent years intense
modifications were made in the work activity of health workers, generating a need additional
ity –generally not covered by the State, nor by the private sabers - to train in the application
of this new equipment ment, since it also generates a lower use of unskilled labor, which
also increases performance. employment in the sector.
The public or official subsector provides services through the public network of
establishments. The long-standing process of hospital decentralization culminated in 1991.
Hospital management is decentralized tax and administrative flexibility is granted to the
directors. The authors local authorities have privatized service activities (food, cleaning
piece, etc.) and self-management has allowed them to charge the Partner Works them for
the services provided to their members or to individuals with ca payment pacity. But it
should also be noted that this situation begins to enter into crisis, first of all because the
State stops contributing collect sums based on adjustments that exceed the ability to
collect dation of the entities, and, on the other hand, they stop providing equivalent service
tative and egalitarian to the most needy and unprotected to try to "raise" some income and
thus be able to barely survive.
Regarding the restructuring of the sector towards federalization and decentralization,
the Ministry of Health and Social Action has proceeded to transfer to the provinces and
municipalities the Medical Care Services that still remained under its jurisdiction. Although
the action of said Mi nisterio is oriented more towards central planning and evaluation,
improving in the areas of: planning, statistics, information analysis mation, data banks,
computerization of systems and communication nes between the provinces and the central
level; It is also true that, by not jointly transferring the necessary funds, since the federal co-
participation of national taxes of the As a consequence of the proposed adjustments, the
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crisis in the poorest provinces becomes even more acute, since most of the regional
economies have been destroyed.
Union Social Works

The Employment Equity Instrument for Health Care
The origin of Social Works is profoundly and fundamentally

SOLIDARY. They were born at the initiative of the first immigrants who arrived in our
country and were conceived as a way to find answers to the daily problems that workers must
face. res, especially in the field of health. Of course, its origin has nothing to do with a
commercial conception of services.
Since that beginning, the Social Works are, strictly, associated tions of consumers
who are grouped on the basis of a principle of social solidarity where they contribute what
they have to receive what they need. However, currently it is intended to destroy this system
to impose another where the worker could access care. tion of their illness, but not to the
comprehensive protection of their health. The Social Works serve all workers equally
without distinction of age, number of family members, pre-existing illnesses, salary for which
the worker contributes.
For several years, various proposals for re form, although all with an enormous anti-
worker, anti-organization load union and antisocial tion. Absolutely individualistic.
In these projects, everything is considered from a strict point of view highly
economical, distorting the essence of the Social Security System, that is, the solidarity and
unity of many to achieve a solution nes to the problem of who or who needs it. It is simply
intended "privatize" health resources by handing them over to private capital roots that have
no history, nor a culture of solidarity, much less a social concern for health problems, an
aspect so important as well as the well-being of the working population and their families.
Sim simply an attempt is made to transfer the resources of the current system leading to
economic concentration, to the detriment of health.
What they are trying to impose is to replace a mane solidarity system set and
administered by the members themselves, without intermediation, through a system of
absolute parasitic and commercial intermediation. In this regard, it is necessary to clarify
that prepaid or insurance companies are intermediary entities that obtain income from this
mediation, that is, to provide the health service, they have to hire other institutions, public or
private, which in turn will impose a certain percentage of profit. In this way, the only thing
that is achieved is an increase in the cost of the entire system, since the greater the
intermediation, the increased business for third parties and the benefits for affiliates are
reduced.
Consequently, any change that is based on economic and "free market" criteria does
not have the real objective of ensuring health well-being, prevention and social assistance,
but rather its only objective is to return profits to the companies or companies that own
them. a purpose unrelated to the health of the worker, the retiree and the Argentine family.
Between 1990 and 1998 the population in our country increased by 11%, but the
Social Works reduced their list of contributors by 12%, which means that there are fewer
resources to attend to a greater number of jobs. descenders with your family group.
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Unemployment increased the number of beneficiaries of each family group to social works,
with less re Caudation.
In our country, affiliation to Obra Social is mandatory by law for all employees in a
dependency relationship and for retirees. two through PAMI. In the case of the unemployed,
social works They cover the worker up to three months after his dismissal or re-
employment. announce. Thus, with the increase in unemployment and the fall of those
employed in a dependency relationship, many people have lost their social work. Addition
Due to informal employment that does not contribute and therefore prevents access to
social coverage for these workers, we have to only 4 out of every 10 workers. people have
complete Social Security coverage in our country.
Social works are a structure for the protection, prevention and recovery of the health
of Argentine workers that has been re known worldwide for being absolutely supportive and
equitable. Their "deregulation" is simply handing over internal capital funds tional the
collection of approximately 4,000,000 million dollars annually. Resources belonging
exclusively to the workers, pro coming from contributions from their salaries and employer
contributions that form part, in turn, of the deferred salary of each worker.
There are around three hundred entities (Obras Sociales syndica them and
management personnel). With around 10% of the total contributions, the Redistribution
Fund has been created, managing by the ANSSAL, which subsidizes entities with lower
contributions. We must emphasize that this system is also in crisis, oca fundamentally
caused by unemployment, undeclared employment, wage freezes, etc. –some analysts
consider that Argenti na has a "black economy" that far exceeds 40% of the total such of the
country's productive activity -, and by the diversion of genuine ANSSAL resources towards
General Revenues of the Nation's Budget, or for the financing of State programs that, due to
their absolute inefficiency, they cannot sustain.
The private subsector is made up of two large groups: professionals who provide
independent services to private patients res associated with Obras Sociales or private pre-
medicine systems pay and the assistance establishments contracted by the Works So cials.
There are also a few non-profit entities. In recent years, large service providers have joined
forces and Some firms disappeared due to the impossibility of achieving economies of
scale. Private providers are primarily focused two in big cities. A few years ago the transfer
began business transfer of Argentine capital to health multinationals, thus provoking a new
form of health management and a new category estuary of providers and professionals. The
privatization of retirement systems through pension funds (AFJP) also promoted the
development development of related services, linking health - retirement and life insurance.
The health coverage of the population, between Social Works, medical or mutual
plans, is difficult to estimate given the overlap of categories and double, in some cases, or
scarce and absolutely defi cient in others, existing coverage. However, according to the
National Census nal of Population and Housing of 1991, around 62.2% of the population
enjoys some type of coverage, with important inter-juris differences dictionaries. The highest
values of lack of coverage were in Formosa (56.39% of the uncovered population), Santiago
del Estero (54.08%), Chaco (51.23%), Misiones (48.96%), Salta (47.83%) and Corrientes
(47.53%); and at the lower end are Capital Federal (19.49%) and Santa Cruz (22.94%). As
noted before, it coincides with the pro vinces that present indices of unsatisfied basic needs
also much higher.
8
4
In the decade that is ending, it developed, erroneous and interesting sadly, the belief
that the free play of the laws of the market It would highlight the great inefficiencies and
social inequities that our country suffers from. This conception was applied to the entire
society and it was even planned to be used widely in health care and in other social
obligations that the State assumed. At the same time that produced profound changes in
the State, it was proposed from various sectors tors the transformation of the Health sector.
The objectives were: to widely introduce the game of supply and demand in this area, to
optimize save resources, lower "expenses" and reduce all inefficiencies. The is Formulated
burns were similar to those that were developed intensively. ity in the USA and in Margaret
Thatcher's England.
At first glance each of them appeared to be reasonable. If it were not an inalienable
right that we have due to our sole condition as human beings and citizens, and if it were not
an absolute responsibility of the State, which is the one that must guarantee our health, that
of all citizens. Even more so if we take into account the great social contribution that
workers in general make with importance. such high consumption levels, and when we
endure so much lack of control and lack of care in the majority of the effectors administered
by the pro pio State, including the defunding caused to Science and Research in our
country.
Is it possible to resolve inefficiencies in health care with the development of the laws of the market, of
supply and demand, with the growth of competition? Tension of the effectors?
This is one of the great topics that must be debated. For COM To understand some
questions about this problem, we found it interesting to analyze certain works that were
recently done in the United States. In the '80s and '90s, many private hospitals in the non-
profit sector tive, belonging to universities, religious congregations, institutional charitable
tions, etc. - were acquired by companies engaged in various investments, which also
included health care. This is how large hospital chains were formed that went on the market
as ask.
The study shows that for Medicare care (it is the security disease rate for those over
65 years of age, US equivalent (taking the corresponding distances, from the Argentine
PAMI) the costs of for-profit institutions (companies whose objective is nancy) were much
higher than the costs of nonprofit institutions (this sector included public and private
nonprofit hospitals). This work illustrates a question already exhaustively repeated: the laws
of the free market are not applicable to health care. Competition in the health area does not
increase efficiency or lower costs, but on the contrary, it can increase the latter without
producing an improvement in efficiency. Furthermore, it is verified that the weight of the for-
profit sector in health care not only increases the differences cies between the various
sectors of society, but also produces increased costs.
An editorial in the New England Journal of Medicine states that market medicine,
based on the dogma of optimizing care and minimizing costs, in its application has given
clear evidence that it not only increases health expenditures but also decreases efficiency.
Steffie Wollhandler and David Himmelstein -authors of this article-, affirm that "the dogma"
of market medicine - profit motivates optimization. zation of care and minimizes costs -
appears to be indifferent to evidence that contradicts it. For decades, studies have shown
that for-profit hospitals are 3% to 1 1% more expensive than hos non-profit pitals. The
8
5
simplest explanation is that the free, competitive market described in the manuals, for
various reasons, does not exist in health care.
An informed choice by consumers, resulting in greater efficiency, according to market
theory, is a mirage in reality. tion of health. Many of the patients (for example patients year
sos, and those who are seriously ill, who are the largest proportion of health care) cannot
compare the offer, reducing They decrease their demand for services when providers raise
prices, or do not accurately evaluate quality. Patients trust the advice of their doctors.
If a buyer cannot evaluate a product accurately, they cannot determine whether its price is fair.
Wollhandler and Himmelstein add: "But our main objective tion to care provided by
investors is not a waste of taxpayer money or causing a decline in quality. Pro The most
serious problem with such care is that it includes a new value system that separates
community roots and Samaritan traditions from hospitals, turning doctors and nurses into
instruments. of investors, and thus seeing patients as commodities.
To resolve inefficiency and cost reduction, the participation of the private sector and
competition is proposed. The experience reported both in the United States and in other
parts of the world shows that the results They are totally different.
This measure was not adopted to improve the quality of life of Argentines, much less
of workers. There is no talk of the lack of supplies in numerous hospitals in various areas of
our country, nor of the lack of appointments for certain practices or specialized surgeries, or
of the long lines to obtain an appointment at a hospital in any large city, nor of the very high
costs of medications and medical supplies. All Health is in crisis in Argentina. And the
solution is not to "throw it" at the market, but to assume responsibilities and promote and
lead all the necessary debates.
In this sense we make our own the words of those investigated previously cited: "In
our society, some aspects of life are beyond commerce. We prohibit the sale of children and
the pra of women, juries and kidneys. Like blood, the attention of the sa lud is too precious,
intimate, and corruptible to be entrusted to the market. do".
Health equity: a goal to achieve. It is necessary to debate the effects that the introduction
of a significant number of international for-profit companies will have on efficiency and
health spending. They began to be installed in the last five years in the country with the
purpose of acting not only in the social works and prepaid subsectors, but also aspiring to
"keep" the care of patients in the public subsector.
The meanings of equality and equity in health are not similar. It is a fact that not all
individuals are the same, there are different cultural, ethnic, religious, gender, generational,
etc. This diversity is part of the heritage of human beings, it enriches us and it is desirable
that it be preserved. Equity in health would imply that all individuals have the possibility of
achieving living conditions that allow us to achieve maximum health potential. The search
for equity instead implies the reestablishment of a lost balance. Although reaching a
situation of total equity may seem like a utopian situation, the distance between the current
situation and that ideal situation is such that its mere reduction would mean avoiding
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6
thousands of disparities. capabilities and premature deaths.

It is imperative and necessary to carry out a legislative discussion tive to organize a
National Health System, develop its gradual application and its operation with levels of
administrative decentralization; with the participation of local communities, organizations
representing the social collective (including social works and organizations). union
organizations), managing and planning their health needs, with the support of policies
aimed at guaranteeing and sustaining this democratic participation.
The search for equity in health can be addressed by trying to achieve greater equity
in the living conditions of the population. nes and/or developing promotion, prevention and
control programs for the most vulnerable or higher risk groups. This involves the
development call for more and better health actions in response to the worst conditions
tions of life, and ultimately, a profound change in eco models nomic and social applied in
our country.
In our country we are in an atypical situation. The conditions are met tions to be able
to solve the major health problems, both from the point of view of the training of health
personnel, the education of the population, as well as the technological possibilities. logical.
However, when we compare our reality with that of other countries in the world, even in
Latin America, we observe that our situation is one of relative backwardness. We have
many anomalous circumstances and the factors that determine them are multiple and it is
likely that we do not know them completely or in depth. However, some data stand out that
catch our attention. We reach the end of the century with a fragmented health system: the
public hospital must meet a growing demand, with resources that are not proportional. tional
to this increase. In many provinces, the public hospital is It is underfunded and facing great
economic difficulties in resolving the purchase of basic supplies. Despite all the difficulties,
this public hospital faces the health problems of the population and mitigates pain and
suffering.
Atypically (in contrast to the health systems of developed countries) a high
percentage of health spending depends on people's pocket money. It is evident that the
Argenti health network na, which has had difficulties for several decades, has not been able
to bear the 10 years of adjustment that we have gone through. The renunciation of the State
to assume its social and health responsibilities, the growth of unemployment, the process of
increasing the gap between the highest and lowest income sectors, produced a situation
that in health concerns us. went to the brink of collapse. This comes at a time when the
system health care faces new challenges. In Argentina there is leading to the growth of
morbidity and mortality from cardiovascular diseases, the increase in cancer cases (breast
cancer is one of the examples). But at the same time, old problems persist: infectious
diseases such as tuberculosis or AIDS appear and reappear, bacteria with resistance to
antibiotics spread, etc. These new challenges require the responsibility of the State to
confront them.
4.3 Vision on the Health Situation in Argentina and Latin America
For the last 20 years, a marked decline in the health system has been observed in
Argentina. The lack of clear and pro-health policies gresistas, numerous budget cuts,
successive administrations inefficient tions and above all things the progressive withdrawal
of the Es ted from their traditional functions, they have obtained as a result the co lapse of
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7
the health system.

The current crisis has its roots in the fragmentation of the health system, in which
there are three subsectors - the public, social works and prepaid medicine companies -,
sometimes overlapping, that do not so little but, on the contrary, they do not distribute their
resources adequately. In this context, the deterioration of the care system based on the
Public Hospital and Social Security must be understood. the sis The issue has collapsed
due to the increase in demand in recent years. years due to the increase in poverty, now
aggravated by the supply of all types of inputs, ranging from lack of guan sterilization
materials and materials to the provision of oxygen. This point This highlights the
seriousness of the situation and the urgency in providing a response.
On the other hand, the collapse of social security is notorious and obe says to several
causes. One is unemployment and black labor, which caused the percentage of the
population affiliated with social works to fall from 70% to 40%. Another lies in the 15,000
million dollars that – between 1994 and 1999 alone – were lost due to the reduction of
employer contributions, company defaults and tax evasion.
The third is the increase in the costs of medical care for a population with a longer life
expectancy and with pathologies that affect tually can be treated. Finally, it points to the
incidence of mismanagement of the Solidarity Redistribution Fund, payment for loan nes as
costly as they are useless and the excess in the use of social works.
The health crisis fundamentally and acutely deteriorates patient care and leaves
promotion, prevention and rehabilitation without real coverage. bilitation of the health of the
entire population. The critical situation is worsened by the expansion of poverty and social
exclusion (both causes autonomous causes of illness, especially in children and the
elderly), the definancing and bankruptcy of numerous social and mutual works that have
limited their contributions as a consequence of the very high levels of unemployment, the
increase in the prices of hospital supplies and medicines (a consequence of the devaluation
of the peso and the culation), the crisis of prepaid medicine that brings, as with sequence
the departure of 800,000 users who now resort to the state system and the insufficient
budget for state health (especially for The public hospital, in which demand has increased
by 50%, with a shortage of professional and technical personnel and a shortage of supplies,
medicines, food and technology)
Latin America
The health situation in the Americas, based on basic data from the Organization's
Basic Health Data and Country Profiles initiatives Pan American Health Organization.
Demographic and Urbanization Trends
During the latter part of the 20th century, an important demographic transition
significant occurred in the Region of the Americas. The decline in mortality and fertility rates
over the past thirty years, with its impact on population growth and structure, has motivated
demographers to use the term "demographic transition." In 1950, the population of the
Americas was 331 million inhabitants; In 1999, it was estimated at 823 million inhabitants, a
figure that represents almost 14% of the world population. About a third of that population
resides in the Es United States, while another third is distributed between two countries:
Mexico and Brazil. The remaining third is distributed among the other 45 countries and
8
8
territories of the Region.

The demographic transition in the Americas and, in particular, Latin America and the
Caribbean, began with a decrease in infant and child mortality. Between the periods 1980-
1986 and 1990-1996, most countries halved their mortality rates from communicable
diseases in children under 1 year of age.
In Latin America, the average life expectancy at birth is For the period 1995-1999 it
was 70 years, which corresponds to the goal set for the end of the century in the strategy of
health for all in the year 2000. There is, however, great diversity between countries and
within each country. In the Region, the interval is 54.1 to 79.2 years. There is a difference of
more than 25 years between the countries that occupy the two extremes mos of the interval.
In many countries, internal subnational rates reflect larger gaps, reflecting substantial
differences in risk. relative and absolute risk of dying prematurely.
Between 1950-1955 and 1995-2000, the difference between the hope of vi day of
men and that of women increased from 3.3 to 5.7 years in Amé rich Latin America, from 2.7
to 5.2 years in the Caribbean, and from 5.7 to 6.6 years in North America. This change in
the demographic profile has led to aging ment of the general population, with a concomitant
increase in chronic and degenerative diseases and disabilities, which affect women more
frequently.
The level of population growth, the result of varied mortality and fertility rates,
characterizes the demographic transition in the Americas. To determine the level of this
transition in the corresponding countries, the following classification into four groups is used.
• Group 1. Incipient transition (high birth rate, high mortality, cre moderate natural foundation
[2.5%]): Bolivia and Haiti.
• Group 2. Moderate transition (high birth rate, moderate mortality da, high natural growth
[3.0%]): El Salvador, Guatemala, Honduras, Nicaragua and Paraguay.
• Group 3. Complete transition (moderate birth rate, moderate mortality derated or low,
moderate natural growth [2.0%]): Brazil, Colombia, Costa Rica, Ecuador, Guyana, Mexico,
Panama, Peru, Dominican Republic cana, Suriname, Trinidad and Tobago, and Venezuela.
• Group 4. Advanced transition (moderate or low birth rate, mortality moderate or low growth,
low natural growth [1.0%]): Argentina, Baha plus, Barbados, Canada, Chile, Cuba, United
States, Jamaica, Martinique, Puerto Rico and Uruguay.
Health Situation and Epidemiological Polarization
Most analyzes of the health situation in the countries of the Americas have
highlighted the notable progress achieved during the 20th century in the postponement of
death and the longer duration of healthy life. ble for certain population groups. On the other
hand, these analyzes have also highlighted the great disparities that still exist between the
pro national average of expected length of life and the observed value in disadvantaged
groups. Although important advances have been made in the control of infectious and
parasitic diseases, these remain important causes of death, with rates similar to those of
non-communicable diseases.
Towards the end of the 20th century, mortality rates have decreased in practically all
American countries. The average length of life in Latin America has increased by 18 years
in four decades. However, a unique mortality profile has emerged in the Region that reflects
8
9
an epidemiological polarization, which is characterized by the co prolonged existence of two

patterns of mortality: one that is characteristic teristic of developed societies (chronic and
degenerative causes vas) and another that is associated with socially deficient living
conditions (infectious and parasitic causes), coupled with a high mortality from ac incidents
and acts of violence. The relative contribution of diseases chronic diseases to the mortality
profile is as important as that of the communicable diseases. This profile indicates the
persistence of large health gaps between different social groups and areas within countries.
Not all population subgroups have achieved full access not to the adequate sanitary and
living conditions that are needed to to maintain the marked changes in the causes of death.
I gave them growing differences in income and social inequalities They continue to raise
concerns due to its effect on the increase in mortality gaps in the Region.
Taking into account national averages, between 1980 and 1999 a decrease was
observed in the number of years of potential life lost. two (AVPP) in the entire Region. While
some of this change can be attributed to the aging of the population, the main cause was
the dis reduction in mortality in the first years of life. However, the intensity and speed of this
decline was not the same in all countries. ses, not even in different areas of the same
country.
Inequalities in the risk of getting sick and dying prematurely They are clearly
correlated with inequalities in the distribution of resources. For example, infant mortality
rates vary from country to country and within a given country. In several countries with a
relatively high level of income, this indicator varies from 13.4 to 109.8 per 1,000 live births at
the national level. Consequently, making a subnational breakdown of the information is very
important and pertinent, since, as previously indicated, the national averages of health
indicators do not reflect the heterogeneity that exists in the distribution of fre frequency of
such indicators within a given country. The unequal Observed regional and national health
problems are repeated with greater intensity at the subnational and local levels.
Non-communicable diseases represented 49.7% of the deaths ity of the adult
population in the Americas, while external causes represented 13.8% of deaths. In the
period 1990 In 1995, 89% of homicide victims were men, reported in a considerable number
of countries. This represented a 65% increase over the 1980-1985 level for men; for
women, the increase was 30%. In all subregions, almost three times more men More than
women died in car accidents between 1980 and 1996. Information from different countries
should be used to formulate health policies. different population groups and not just national
averages. Ade Furthermore, the local breakdown of information for health analysis needs to
be promoted in a sustained manner. There is an urgent need to improve empirical public
health information that facilitates periodic evaluation. dica of the health situation and the
analysis of its trends in all population groups and geographic levels, and not only with
national averages.
4.4 Health in Developed Countries
In the last 50 years, average life expectancy at birth has increased in global terms by
nearly 20 years, going from 46.5 to 65.2 years between 1950--1955 and 2002. This
represents in the pla net an average increase in life expectancy equivalent to four months
per year during said period. On average, life expectancy increased by nine years in
developed countries (e.g. in Aus tralia, European countries, Japan, New Zealand and North
America), in 17 years in developing countries with high levels of mortalityi ity of children and
9
0
adults (most African countries and the poorest countries in Asia, the Eastern Mediterranean
Region and Latin America na) and in 26 years in developing countries with low mortality. As
shown in Figure 1 .1, the large difference in the 1950s between the life expectancies of
developed and developing countries development has become today a big difference
between developing countries with high mortality and other countries.
In 2002, life expectancy at birth ranged from 78 years for women in developed
countries to 46 years for men in sub-Saharan Africa; That is, in total terms it was 1.7 times
higher for the former than for the latter. Life expectancy has improved rated in the last 50
years in practically all regions of the world do, with the important exception of Africa and the
Eastern European countries formerly belonging to the Soviet Union. In the latter case, life
expectancy at birth, for both men and women, decreased throughout the period 1990-2000,
respectively, by 2.9 years and 1 year.
9
1
The increases in life expectancy recorded in the first mi of the 20th century in
developed countries were the result of a rapid I ask for a decrease in mortality rates,
particularly maternal and child mortality and mortality attributable to infectious diseases in
childhood and early adulthood.
Access to housing, sanitation services and an education better quality education, the
tendency to form smaller families, increasing incomes and the adoption of public health
measures, such as immunization against various infectious diseases, contribute They
greatly appreciated this epidemiological transition. In many developed countries, that
change began approximately 100--150 years ago. In some places, for example Japan, the
9
2
transition began less long ago, but then proceeded at a faster pace, and in many developing
countries it began even later and is not yet complete. In developed countries, current
improvements in standards The increase in life expectancy is mainly due to the reduction in
mortality rates among adults.
9
3
4.5 Pathology of Industrialization versus Pathology of Poverty
Throughout history, and until the 70s of this century, diseases Infectious diseases
have been the most important in the area of morbidity and mortality. From the decade of
the seventies onwards piece to highlight the importance of diseases of origin non-
infectious gene.
In this change, a difference is made between developed countries and
underdeveloped countries. In developed countries there is a high prevalence of chronic
and degenerative diseases, pa keeping infectious diseases at a lower level. In sub-
countries developed infectious diseases continue to maintain their im importance (25% of
its mortality). Circulatory diseases and tumors are 3 times less common than in
industrialized countries. In Spain the trend of developed countries is followed, I buy fact
that chronic diseases are the first cause of demand for care in health centers.
SO YOU DON'T FORGET ANYTHING

Exercises for everyday life.
Do hobbies every week , alternating writing, such as word search, with mathematical
calculations .
Futérth E aboración propis MG
O
The health systems of

underdeveloped countries are They are Prarticerejar
souvenirs : movies,
Practice
writing daily :
affected by the lack of investment and television programs letters,
and menus. shopping list
planning. and messages to
remember. is.
Perform
information T Read newspapers and news frequently
retention files. . Then, play the ones that have caught your
For example, attention. sleep it, » 12 tell them to other
when -2 the people. Exercises L“- of
patient walks focused atancán .
around In this way, For example, take a
burning- they comprehension text and mark a
pee at the and verbal certain letter.
prices/ that exercises are
Thus, the World Health Organization (WHO) estimates that with a reasonable increase in
investment in health, at least 8 million deaths annually could be avoided since 2015.
Diseases such as AIDS, pa Luddism and tuberculosis, as well as nutritional deficiencies and
conditions linked to smoking, wreak havoc in poor countries. My This is the case with
maternal and perinatal diseases, which cause an increase in infant mortality. The same thing
happens in our country, where infant mortality increased in 10 provinces, according to the
latest available figures, which correspond to 2001. One of the causes of the pro The problem
is the lack of budget for the health of children's countries 109
income and the financial and operational insufficiency of foreign aid. To these ends,
the summit of Health Ministers recently held in Geneva, convened by the WHO, has
promoted dialogue with sectors that can eventually help and donate funds.
But in order to meet the aforementioned minimum objective of reducing
deaths, an increase of around 27 billion dollars should be recorded to support
programs, medicines and medicines. mation of human resources in the health area of
the most poor countries bres.
The goal is not unattainable but, equally, it will not be achieved if aid and
investments in the area are not increased and if the deficiencies are not corrected.
sciences—which are repeatedly denounced—in the administration of funds in aid-
recipient countries.
Health systems in poor countries are affected by lack of resources and
planning. These could improve your health situation would be if external aid were
increased and resources were managed more efficiently.
9
5
1) Do you think that the health situation in Argentina has already passed its
state of emergency? Justify.
2) The economic differences between developed and non-developed countries
Two, they influence your health depending on your point of view. Justify.
3) Why do you think health in Cuba is so prestigious?
4) What are the differences and similarities that you think exist between public
and private health?
SELF APPRAISAL
1) Mark on a map of Argentina the areas with the highest poverty rate. What are
the health consequences?
2) What is the current situation of the public Hospitals of the City of Bue us
Aires?
3) Give five examples of Pathology of Poverty. Explain them.
1) Prepare a monograph on Public Health today in Argentina.
2) Mark on a map of South America the countries that suffer from the
pathologies of industrialization. Explain this phenomenon.
3) Make a comparative table between Argentina – Cuba – USA, with their

differences and similarities in their current health systems.
Self-Assessment Correction Keys
9
6
Unit 1:
a) Fake
b) TRUE
c) Fake
d) TRUE
e) Fake
Unit 2:
a) Fake
b) TRUE
c) Fake
d) TRUE
e) Fake
9
7
BIBLIOGRAPHY
• Aavv . Bioethics and Environment. Bios and Ethos Collection. El Bosque
2000 Editions.
• Agudelo, C. (2000) "How to approach the analysis of health systems and

their reform?
• Alvarez-Dardet, C. ( s/f). The bases of health promotion.
• Balassa, B. (1995). Theory of economic integration. Mexico: Hispanic

American.
• Bentham, J: Introduction to the principles of morality and legislation.

Madrid Alliance 1980.
• Bengoa, R. (2000). "Recent trends and reforms in Health Systems lud.

Internal markets with competition and without competition and In Systems
degrees of Health". Public Health and Health Administration.
• Bernardez , M. (2000). Integration and globalization. Performance Improve

ment Global Network.
• Brailovsky, Antonio Green memory Ecological History Argentina, Sudame

ricana 1991
• CEAS/OPS . Unconventional epidemiological surveillance and social

participation cial. 1993.
• Escobedo , E. C. ( 1998). Socioeconomic environment of Mexico. Mexico:

Insti National Polytechnic tutor.
• Lagos, Ricardo . (2000) "Ethics and Globalization" Master Class by the

author at the Reception of the Honoris Causa Doctorate that was awarded to
him by the National University of Buenos Aires, on May 19, 2000.
• Ianni, O. (1996). Theories of globalization. Mexico: 21st Century
9
8
• Grandchildren. J. (1995). Fundamentals and policies of the European Union.

Mexico: 21st Century
• WHO . (2000) Health: "Health systems underuse their resources"
• WHO , SIT819; The hospital in rural and urban districts; Geneva, 1992.
• PAHO /WKKellogg Foundation; Volume IV., HSP-UNI Series/Ope

Manuals ratives, 1996.
• Servaes, J. (s/f) Cultural freedom, cultural globalization and participatory

action.
• Vargas-Aguirre , M. (s/f). Some reflections on globalization.
9
9
INDEX
INTRODUCTION TO THE SUBJECT 1
UNIT 1 3
UNIT 2 24
UNIT 3 40
UNIT 4 57
BIBLIOGRAPHY 97
2.1
2.2 Social History: Community History.
Social Organizations. Media.
Habits and Customs. Living Standard Indicators. 32
2.3 Ecology. Pollution and Environmental Sanitation. 34
2.4 Demographics: Population Pyramids Growth
Temporary. Job instability 35
2.5 Morbi – Mortality indices 38
2.6 Epidemiological: Statistics. Research
INTRODUCTION TO THE SUBJECT 1
UNIT 1 3
UNIT 2 24
UNIT 3 40
UNIT 4 57
BIBLIOGRAPHY 97
BIBLIOGRAPHY 109
1
0
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Health Education Policies

INTRODUCTION TO THE SUBJECT

Today there is a very interesting technology that allows us to cure diseases

That the student:

That is why we developed the following outline of the Unit:

To promote these achievements, you will address these contents:

• Science and health. Different conceptions of the health-disease process.

• Specific top-level actions. Health research methodology. Diagnosis. Items.

• Ecological: pollution and environmental sanitation.

• Demographic: population pyramid, temporal growth: inesta work ability.

• Preparation and interpretation of the population pyramid to know how society is

• Analyze the concepts of health and illness to be able to take disease

• Take responsibility for regular check-ups to prevent illness.

These organisms, unfortunately, today are so unprotected by the State that

We can then present the following unit diagram:

To promote these achievements, you will address these contents:

• Science and health. Different conceptions of the health-disease process.

• Analyze in a coherent manner the definition of health, disease with its

1.1 .-Science and Health

If we have these conditions, our body resists environmental aggression better

Hand in hand with the surprising and accelerated advances in medicine,

Medical advances must be considered from two perspectives: one mo

1.2 Different Conceptions of the Health-Illness Process.

45 centuries ago the Assyrian Babylonian people believed that

This was an enormous conceptual leap since if the disease was

The concept of disease derives from three basic ideas:

1.3 Health as a Social Historical Process

Therefore, it is determined by the structure and dynamics of society, by the degree of

Thus, conceptually, Health is defined as an incessant

Not defining it well is to silence its essence, to

The concept of health as a pro is necessary cess

Throughout human history, a constant relationship is observed in between the mode of

1.4 Natural history of disease

The natural history of a disease is the evolution of a disease without medical

Most diseases have a prepathological or preclinical phase, where the individual is

Finally, on behalf of many specialists who have dedicated themselves to the ta

Carrying out professional actions aimed at fulfilling the objective vo Prevent.

Carrying out these professional actions involves rigorous observation of certain

There are three levels of prevention:

1.7 Public health

1.8 National, Provincial and Municipal Health Policies

The health situation of a population is the result of the interaction of a series of

Therefore, the following objectives are proposed:

• Provide treatment in primary care

• Develop human resources.

Different health programs:

• Mother and Child Program

1.9 Health Decentralization and Regionalization

Health Regionalization is understood as a way of organizing care. medical tion,

It is appropriate to clarify some concepts included in the previous definition:

the regionalized care system must encourage and increase the

: three levels are usually accepted for the regionalized system:

3) Local Level : represented by outpatient consultation services mainly; A minimum number of

1.9.1 The Process of Transfers and Decentralization of the '70s

1.9.2 The Neoliberal State (1976-83)

1.9.3 The Ministry of Health and Social Action (1983 )

1.9.4 Transfers in the '90s .

1.10 Health Systems

There are four categories of health systems: