GLOBALIZATION, HUMAN RIGHTS, AND THE SOCIAL DETERMINANTS OF HEALTH

Globalization, a process characterized by the growing interdependence of the world's people, impacts health systems and the social determinants of health in ways that are detrimental to health equity. In a world in which there are few countervailing normative and policy approaches to the dominant neoliberal regime underpinning globalization, the human rights paradigm constitutes a widely shared foundation for challenging globalization's effects. The substantive rights enumerated in human rights instruments include the right to the highest attainable level of physical and mental health and others that are relevant to the determinants of health. The rights stipulated in these documents impose extensive legal obligations on states that have ratified these documents and confer health entitlements on their residents. Human rights norms have also inspired civil society efforts to improve access to essential medicines and medical services, particularly for HIV/AIDS. Nevertheless, many factors reduce the potential counterweight human rights might exert, including and specifically the nature of the human rights approach, weak political commitments to promoting and protecting health rights on the part of some states and their lack of institutional and economic resources to do so. Global economic markets and the relative power of global economic institutions are also shrinking national policy space. This article reviews the potential contributions and limitations of human rights to achieving greater equity in shaping the social determinants of health.     

Strategic citizens of America: transnational inequalities and transformation of citizenship

This article analyses the process whereby ‘natural' citizens of one country mobilize their resources so that their children receive by birthright, the citizenship of a rich liberal democracy. Utilizing the case of Turkish upper classes, who give birth in the USA in order to benefit from the jus soli principle, we trace the emergence of new inequalities at the intersection of multiple citizenship regimes. We show that, by mobilizing resources in markets of health care, travel, and real estate, those with means can acquire US citizenship for their children in expectation of future benefits. Because they are able to access ‘valuable' citizenships, these actors can strategically combine privileges within nation states with inequalities between citizenship regimes at the global level for the children. Their differential access to citizenship enhances the gate-keeping functions of citizenship. Based on these observations, we draw an analogy between citizenship and property regimes, understood broadly.     

Access to health services for immigrants in the USA: from the Great Society to the 2010 Health Reform Act and after

Abstract

Over the last fifty years the nature of the provision and financing of health services, and the composition of the foreign-born population in the USA have both evolved significantly. The rapid growth of Mexican immigration in the last fifteen years has created new challenges. Ironically, the Patient Protection and Affordable Care Act of 2010, the sweeping legislation designed to ensure that almost all Americans can obtain health insurance, may reduce access to care for many immigrants by isolating them from the general, formerly uninsured, population. Bi-national and cross-border initiatives between the USA and Mexico along the lines of some developments in Europe are worth encouraging to help ease the current and future barriers to health care for immigrants.     

From "Rights" to "Ritual": AIDS Activism in South Africa

In this article, I investigate how the moral politics of HIV/AIDS activism in South Africa is contributing toward new forms of citizenship that are concerned with both rights-based struggles and with creating collectively shared meanings of the extreme experiences of illness and stigmatization of individual HIV/AIDS sufferers. I argue that it is precisely the extremity of the "near death" experiences of full-blown AIDS, and the profound stigma and "social death" associated with the later stages of the disease, that produce the conditions for HIV/AIDS survivors' commitment to "new life" and social activism. It is the activist mediation and retelling of these traumatic experiences that facilitates HIV/AIDS activist commitment and grassroots mobilization. It is also the profound negativity of stigma and social death that animates the activist's construction of a new positive HIV-positive identity and understanding of what it means to be a citizen–activist and member of a social movement.     

HEALTH AS FREEDOM: ADDRESSING SOCIAL DETERMINANTS OF GLOBAL HEALTH INEQUITIES THROUGH THE HUMAN RIGHT TO DEVELOPMENT

In spite of vast global improvements in living standards, health, and well-being, the persistence of absolute poverty and its attendant maladies remains an unsettling fact of life for billions around the world and constitutes the primary cause for the failure of developing states to improve the health of their peoples. While economic development in developing countries is necessary to provide for underlying determinants of health – most prominently, poverty reduction and the building of comprehensive primary health systems – inequalities in power within the international economic order and the spread of neoliberal development policy limit the ability of developing states to develop economically and realize public goods for health. With neoliberal development policies impacting entire societies, the collective right to development, as compared with an individual rights-based approach to development, offers a framework by which to restructure this system to realize social determinants of health. The right to development, working through a vector of rights, can address social determinants of health, obligating states and the international community to support public health systems while reducing inequities in health through poverty-reducing economic growth. At an international level, where the ability of states to develop economically and to realize public goods through public health systems is constrained by international financial institutions, the implementation of the right to development enables a restructuring of international institutions and foreign-aid programs, allowing states to enter development debates with a right to cooperation from other states, not simply a cry for charity.     

‘I'm American,not Japanese!’: the struggle for racial citizenship among later-generation Japanese Americans

Abstract

As one of the oldest Asian American groups in the USA, most Japanese Americans are of the third and fourth generations and have become well integrated in mainstream American society. However, they are still racialized as foreigners simply because of their Asian appearance. Their Asian phenotype continues to have a foreigner connotation because of large-scale immigration from Asia and an American national identity that is racially defined as white. This paper analyses how later-generation Japanese Americans are racialized as outsiders in their daily interaction with mainstream Americans, which is often accompanied by essentialized assumptions that they are also culturally foreign. In response, they engage in everyday struggles for racial citizenship by demanding inclusion in the national community as Americans despite their racial differences. It is uncertain whether such attempts to contest their racialization will cause current mono-racial notions of American identity to be reconsidered in more inclusive and multiracial ways.     

EPIDEMIOLOGY AND SOCIAL JUSTICE IN LIGHT OF SOCIAL DETERMINANTS OF HEALTH RESEARCH

The present article identifies how social determinants of health raise two categories of philosophical problems that also fall within the smaller domain of ethics; one set pertains to the philosophy of epidemiology, and the second set pertains to the philosophy of health and social justice. After reviewing these two categories of ethical concerns, the limited conclusion made is that identifying and responding to social determinants of health requires inter-disciplinary reasoning across epidemiology and philosophy. For the reasoning used in epidemiology to be sound, for its scope and (moral) purpose as a science to be clarified as well as for social justice theory to be relevant and coherent, epidemiology and philosophy need to forge a meaningful exchange of ideas that happens in both directions.     

Muslim community organizations – sites of active citizenship or self-segregation?

Ethno-religious community organizations in Western countries have often been described as being disconnected from mainstream society, and Muslim community groups have been a special focus of such critique. This article offers a counter-narrative to these widespread allegations. It draws on a synthesis of emerging research on the citizenship-enhancing effects of mosque involvement and on an explorative study involving thirty in-depth interviews with civically active Muslims in Australia and Germany. The article examines the potential of Muslim community organizations to mobilize their member into performing their citizenship through civic and political participation. It offers empirical evidence that many Muslim community organizations, rather than promoting social segregation, act as accessible entry point for Muslims’ civic participation, facilitate cross-community engagement and provide gateways to political involvement. These civic potentials of Muslim community organization have remained underestimated in the public and political discourse on cohesive societies and healthy democracies.     

Bringing the Moral Economy back in … to the Study of 21st-Century Transnational Peasant Movements

James Scott's The Moral Economy of the Peasant (1976) appeared at a time when "peasant studies" had begun to occupy an important place in the social sciences. The book's focus on Vietnam, as well as its novel argument about the causes of rural rebellion, attracted widespread attention and unleashed acerbic debates about peasants' "rationality" and the applicability of concepts from neoclassical economics to smallholding agriculturalists. In this article, I analyze E. P. Thompson's notion of "moral economy" and Scott's use of it to develop an experiential theory of exploitation. I then discuss other influences on Scott, including Karl Polanyi, A. V. Chayanov, and the Annales historians. "Moral economy" and "subsistence crisis" are concepts that Scott elaborated mainly in relation to village or national politics. In the final section of the article, I outline changes affecting peasantries in the globalization era and the continuing relevance of moral economic discourses in agriculturalists' transnational campaigns against the WTO.     

Globalization and Migration: Post-Colonial Dutch Antillean and Aruban Immigrant Political Incorporation in the Netherlands

For much of its colonial history, the Netherlands experienced little contact with its island possessions in the Caribbean. Subsequent Dutch policy was formulated in the shadow of the Netherlands primary concern with its prosperous colony of Indonesia. The 1985 closing of the oil refineries in Aruba and Curacao, Netherlands Antilles and Aruba’s “status aparte” in 1986 triggered a mass migration from those Dutch “overseas countries” to the Netherlands. These recent migrations of thousands of Dutch post-colonial citizens have added to the Dutch reevaluation of its colonial past and debates about its multicultural democratic future.     

英国健康服务整合进展及对中国的启示

通过万方、知网、PUMED和谷歌学术搜索,查阅获取近年来有关英国健康服务整合的文献和政策文件,分析了健康服务整合的内涵,归纳总结了英国健康服务整合实践的政策历程,目前的整合实践模式,并归纳分析了英国健康服务整合的应对策略,最后结合中国实际,提出对健康和社会保健相关职能部门进行整合,对中央和地方的责权利进行合理划分,从而落实健康服务的整合供给,通过信息化和多媒体,建立以患者为中心的健康保健提供的激励约束机制,建立现代化的健康和社会保健服务的人才保障机制。     

Different subjects: the health care system's participation in the differential construction of the cultural citizenship of Cuban refugees and Mexican immigrants

This paper explores the public health system's differential construction of Mexican and Cuban immigrants' "deservingness" of citizenship benefits and its preparation of them for different roles in U.S. society. Civic institutions such as the public health care system are charged with inculcating normative behavior in immigrants and instilling in them different conceptions about their rights and responsibilities. Faced with limited resources under the implementation of Medicaid managed care, hospital administrators created new categories of "deserving" and "undeserving" immigrants based on neoliberal standards of individual responsibility and self-discipline. As a result, hospital policies construct different types of "cultural citizenship" for Cuban and Mexican immigrants, preparing the former to be active citizens and discouraging the latter from pressing demands on American civil institutions. I show that this negative construction of Mexican immigrants' moral worth leads to unmet health needs and poor health outcomes.     

The social determinants of mental health and disorder: evidence,prevention and recommendations

People exposed to more unfavourable social circumstances are more vulnerable to poor mental health over their life course, in ways that are often determined by structural factors which generate and perpetuate intergenerational cycles of disadvantage and poor health. Addressing these challenges is an imperative matter of social justice. In this paper we provide a roadmap to address the social determinants that cause mental ill health. Relying as far as possible on high-quality evidence, we first map out the literature that supports a causal link between social determinants and later mental health outcomes. Given the breadth of this topic, we focus on the most pervasive social determinants across the life course, and those that are common across major mental disorders. We draw primarily on the available evidence from the Global North, acknowledging that other global contexts will face both similar and unique sets of social determinants that will require equitable attention. Much of our evidence focuses on mental health in groups who are marginalized, and thus often exposed to a multitude of intersecting social risk factors. These groups include refugees, asylum seekers and displaced persons, as well as ethnoracial minoritized groups; lesbian, gay, bisexual, transgender and queer (LGBTQ+) groups; and those living in poverty. We then introduce a preventive framework for conceptualizing the link between social determinants and mental health and disorder, which can guide much needed primary prevention strategies capable of reducing inequalities and improving population mental health. Following this, we provide a review of the evidence concerning candidate preventive strategies to intervene on social determinants of mental health. These interventions fall broadly within the scope of universal, selected and indicated primary prevention strategies, but we also briefly review important secondary and tertiary strategies to promote recovery in those with existing mental disorders. Finally, we provide seven key recommendations, framed around social justice, which constitute a roadmap for action in research, policy and public health. Adoption of these recommendations would provide an opportunity to advance efforts to intervene on modifiable social determinants that affect population mental health.