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Revista Cubana de Salud Pública

versión impresa ISSN 0864-3466versión On-line ISSN 1561-3127


LLAMBIAS WOLFF, Jaime. Los desafÍos inconclusos de la salud y las reflexiones para el futuro en un mundo globalizado. Rev Cubana Salud Pública [online]. 2003, vol.29, n.3, pp.236-245. ISSN 0864-3466.

Some decades ago, it was taken for granted that infectious diseases would be erradicated in 2000 by medicine and science. Reality has been different: the emergence and reemergence of infectious diseases show all the contrary. Microorganisms have globalized, modernized and adapted, as a result of human intervention on the environment and of the indiscriminate use of antibiotics. It was also considered that the extension of public health and the curative services was the answer to the health needs of the population. However, the fiscal crisis of the benefactor State makes more difficult the public system’s capacity to meet the health care requirements. On the other hand, the skyrocketing costs of modern medicine do not solve 90 % of the health problems and the private model has led to a strong privatization and to an increasing mercantilist conception of the health services. The ideological, political and economic bases of this model are the partial withdrawal of the State, the formation of a market for the private sector and the growth of the structures for the autonomy and income-yield capacity of the private sector in the health area. Health globalization faces a double and recurrent debate and dilemma: the first is of economic and managerial nature and it is related to the organization of the medical and health services, whereas the second is epistological, conceptual and of principles, which orientate the health policies. Health cannot be invulnerable to changes and should adapt itself with originality to the new global reality. Globalizing health about alternative policies in the dominant model requires to go beyond a revisionism of the benefactor State, or a reengineering of the curative and preventive services so as to democratize them and guarantee equity. The challenges are rather in the capacity of promoting paradigmatic changes allowing to implement policies in relation to a reconceptualization of health as an integrating part of the social and economic development, turning it into a value and ethical indicator of modernity


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