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AnthroPolitique

International Development and Affairs, Culture, and Cross-Disciplinary Topics

Universal Health Coverage (UHC): Cuba, Politics, and the Economics of Illness

There is no doubt that with the assistance of technology, great strides have been made in healthcare. As our world has become even more closely connected, universal health interests are of even greater importance, especially when considering the impact of global health threats as seen in the recent Ebola and Zika outbreaks.

 

An Introduction to Universal Health Coverage (UHC)

Recognizing the need for stronger health systems on a global level, the concept of Universal Health Coverage (UHC) was born. UHC was also developed by the World Health Organization (WHO) in consideration of the impact of health outcomes on social and economic development, as well as poverty reduction.  

In the words of WHO, “Universal health coverage is defined as ensuring that all people have access to needed promotive, preventive, curative and rehabilitative health services, of sufficient quality to be effective, while also ensuring that people do not suffer financial hardship when paying for these services.” 

 

The Politics of Health Coverage

Under the WHO Sustainable Development Goal 3, Universal Health Coverage includes access to safe, effective, quality and affordable healthcare. As with any other mandates stemming from international organizations such as WHO, the effectiveness of implementing such changes relies on the governance and reform in-country.  However, healthcare reform globally, including the United States and other developed countries falls far behind this goal.

For Universal Health Coverage to move beyond the conception stage and into practice, health, must be treated as a necessity, not a luxury. This ideology is particularly important in regard to health care expenses for patients.

 

Prevention, Health, and the Economics of Illness

It is easier to prevent people from getting sick than it is to cure people who are ill. Similarly, more money goes into healthcare from those that are sick than those that are healthy.

Why is this? Routine health care visits in combination with regular prevention and wellness outside of the health system, by the patient themselves, reduces the amount of money said patient will generate in health care costs.

Why is this important? Care for chronic, preventable illnesses such as diabetes, obesity, hypertension, etc. is expensive. Unnecessary urgent care visits are also expensive. However, in the eyes of economics, spending is good. Likewise, for those that generate profit from health care expenses, illness generates more money. This does not necessarily mean that health care providers actively want for people to be sick, nor does this mean our system is setup to encourage illness. What it does mean is that illness, at least the cost of health care related to illness, results in economic expenditure. While health and wellness reduces the economic burden of healthcare, it does not pay into the system. This is what we mean by the “economics of illness”.

While Universal Health Coverage is important in relation to health care, there must also be a focus on the health and well-being of populations, in addition to just caring for their illness. While this may not be so popular economically, prevention and wellness is a more sustainable approach to reducing morbidity and mortality than caring for illness alone.

 

Lessons learned from Cuba

While much can be said about Cuba, both negative and positive, there is much to say about the Cuban healthcare system. In fact, the Cuban healthcare system has been recognized by WHO as a model for the world, placed far ahead of that of the United States and other developed countries. Not only is the Cuban healthcare system efficient and effective, but it is one that is operating in a low-resource setting.

What makes the Cuban system so great? Two key component of the effectiveness of the Cuban system are 1) the support of the government in keeping the system strong and 2) a focus on prevention rather than cure. Healthcare in Cuba is free for citizens, yet providers are some of the best trained in the world. At the very least, perhaps we can look to the Cuban healthcare system for tips on how to use prevention to more sustainably provide low cost, high-quality healthcare services and maintain a well-trained health workforce.  

 

For more on the Cuban Health System:

Cuba’s Health Care System: a Model for the World

http://www.huffingtonpost.com/salim-lamrani/cubas-health-care-system-_b_5649968.html

How Cubans Live as Long as Americans at a Tenth of the Cost

https://www.theatlantic.com/health/archive/2016/11/cuba-health/508859/

Fidel Castro’s Health Care Legacy

http://www.commonwealthfund.org/publications/blog/2016/nov/fidel-castros-health-care-legacy

 

Featured post

Cartel Mexico: Continued Violence in 2017

Even after a two-year hiatus, the situation of violence in Mexico has continued. For those readers that have returned, thank you. For those who are just reading the “Cartel” series on AnthroPolitique, Welcome. “Cartel” is a series within AnthroPolitique that provides an overview of social, cultural, economic, and political situations surrounding organized crime networks, both present and past.

This week, we will return again to Mexico, taking a look only at the events that have occurred in the month of July 2017. “We are not even halfway through the month”, you may say. Unfortunately, in 2017, violence has left record murder rates in Mexico, with 2,186 murder investigations in the month of May 2017 alone and 9,916 in the first five months of 2017. As of today, July 11th, 2017, the following events have made headlines in relation to the ongoing drug and gang violence in Mexico:

In Mexico, massacre of family underlines surging violence
3 bodies found in condo parking lot in Mexico resort town

 

What does this mean?

Well first, it does not appear that either direct or indirect cartel violence has shied away from targeting families, religious leaders, students, and other innocent bystanders, in addition to any others that may be directly involved. What these particular headlines represent is the targeting of innocents – those that have either resisted the violence or are in some way linked indirectly to the events that have ravished Mexico since the crackdown on drugs under former President Felipe Calderon in 2006. While the rates of murder soar in Mexico, what is more, alarming is the number of “disappearances” that have continued since the disappearance of 43 students in September 2014.

As a glimpse of hope, I would like to highlight another article from the Los Angeles Times this week titled “One Mexican town revolts against violence and corruption. Six years in, its experiment is working”.

Inspired by this Cheran town example, next week we will take a look at how violence and terror from cartel conflict can be countered by breaking the link between crime, drugs, and politics.

 

For more information and alerts on Criminal Violence in Mexico, take a look at the Council on Foreign Relations (CFR) Global Conflict Tracker: https://www.cfr.org/global/global-conflict-tracker/p32137#!/conflict/criminal-violence-in-mexico. Note that the current conflict status has been noted as “unchanging”.  

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Preparing for Zika: Planning versus Prevention

The consequences and outcomes of the 2014 Ebola epidemic are still fresh in the minds of public health, medical professionals, and the general public, worldwide.

Now in 2016, we are faced with the fear of a potential epidemic stemming from the Zika virus, which has made its way to 25 countries (and counting) in 2016.  The question the world must now pose, once again, is: are we prepared?

There are two ways to view this question. One concerns the capacity for a proper international response to epidemics. The other concerns our ability to prevent epidemics by preventing the spread of our modern “germs”. This second matter involves not only containing and combating disease, but developing a means of a stable international system for prevention.

Fortunately, the threat of the spread of Zika has emerged with recently-learned lessons from the 2014 Ebola epidemic. To answer the first aspect of this question, the Ebola epidemic quickly revealed the failures of local, national, and transnational health systems. WHO has responded to this issue by developing a bigger and better arsenal against disease: international cooperation for an effective response to international health crisis.

The WHO response to Zika is detailed as the following:

  • Define and prioritize research into Zika virus disease by convening experts and partners.
  • Enhance surveillance of Zika virus and potential complications.
  • Strengthen capacity in risk communication to help countries meet their commitments under the International Health Regulations.
  • Provide training on clinical management, diagnosis and vector control including through a number of WHO Collaborating Centres.
  • Strengthen the capacity of laboratories to detect the virus.
  • Support health authorities to implement vector control strategies aimed at reducing Aedes mosquito populations such as providing larvicide to treat standing water sites that cannot be treated in other ways, such as cleaning, emptying, and covering them.
  • Prepare recommendations for clinical care and follow-up of people with Zika virus, in collaboration with experts and other health agencies.

WHO’s Zika response has no doubt been presented much more quickly than in the case of Ebola. However, as in 2014, we are quickly learning that a swift “response” to crisis is not enough. Planning for enhanced surveillance, capacity-building, training, and clinical care after in a state of emergency does not provide for effective containment and management of disease.

Within the international duty to protect, is the duty to prevent. The only way to properly prepare for the next epidemic in an effective and timely manner is through prevention. Viruses and bacteria are not new. Neither are their consequences.  Similar to Ebola, the presence of Zika is not unknown. As noted on the WHO Fact Sheet for Zika, the virus has been recorded in humans since 1952 in Uganda – over six decades ago. As mentioned in Why International Issues Must be Addressed with Cross-Disciplinary Responses: The Case of Ebola, many of the public health issues now of international concern are not newly discovered, but instead have received inadequate attention.

The lack of attention in addressing potential public health concerns such as Ebola, and now Zika, has undoubtedly resulted in missed opportunities for prevention. Without an effective international plan for prevention, we will remain consistently behind in combating global public health issues. The lesson learned from Ebola was how to plan and prepare for a proper response. Zika now teaches us that in order to reach a proper and effective response, a transition must take place: to properly prepare for emergency, we must do our best to prevent it from happening in the first place.

 

 

 

Defining Human Rights: Turning Standards into Action

As the world’s leading international entity, the United Nations (UN) has set a precedence for defining human rights. The act of defining human rights and basic freedoms as inherent and for all human beings is a first step in making the protection of human rights a reality. However, despite introducing a lengthy list of “rights” in the thirty Articles of The Universal Declaration of Human Rights (UNHR), the UN, as have other international organizations, has only hinted as to how such rights will be effectively safeguarded. Coining the concept of “human rights” is a great feat, but one that places much responsibility on the international community if such rights are to be recognized. In light of very current issues such as the plight of immigrant and stateless individuals, one can only wonder how the world will take a stand to support the rights of all individuals, both in times of peace and in times of crisis.

Not considering the effectiveness of the UN in ensuring the human rights of all people (which will be discussed in a separate post), the questions that are left unanswered by the UNHR, among others, are:

  1. Given that rights are intangible, what really can be considered a “right” and where is the line to be drawn?
  2. Who is considered part of the “human family” in our international system as it stands and why are all humans not included?
  3. What can be done to make sovereign states act to secure human rights for all individuals?
  4. What role must the UN play in making Universal Human Rights a reality?

Stabilizing Haiti in 2015: Approaching Elections and Protecting Citizens

“The roots of discontent in these countries lie in their poverty”. – Daron Acemoglu and James A. Robinson, Why Nations Fail

With elections less than a week away, Haiti’s progress amidst decades of extreme poverty and corruption may be on the horizon. This is not to say that the state’s stabilization will be an easy feat. Woefully dependent on UN and foreign assistance, Haiti remains one of the world’s poorest countries. With unemployment hovering around 40%, a literacy rate of less than 50%, and 80% of the Haitian population living below the poverty line, tens of thousands of Haitians have fled to neighboring Dominican Republic in search of work and opportunities. What Haitians have found instead is a status of statelessness. Due to various social and political issues that have emerged as a result of mass Haitian migration to Dominican Republic, Dominican Republic has increasing refused to recognize the citizenship of many Haitians who have migrated to the country, whether legally or illegally.

Keeping in mind the importance of political rights as essential for state development and citizen opportunities, reviving Haiti’s democratic institutions is a necessary move in order to take a step towards progress. Haitian elections to be held on Sunday, 9 August 2015 will be the first elections held since the devastating 2010 earthquake which left the country in shambles. Efforts to stabilize Haiti in 2015 will require the restoration of necessary infrastructures and democratic institutions in Haiti, following successful democratic elections.

A state unable to provide for its citizens within its territory is unable to protect the rights of its citizens outside of its borders. A successful Haiti will be a Haiti that can protect and provide rights to its citizens, within Haiti in the hopes of mitigating emerging issues of citizenship and deportation of Haitian nationals living abroad. With 2015 elections quickly approaching, the post-election period must be characterized by an international commitment to Haiti’s stability and a Haitian commitment to development in upcoming years.

Relevant articles:

Altholz, Roxanna and Laurel E. Fletcher. “The Dominican Republic Must Stop Expulsions of Haitians”. 05 July 2015. The New York Times.

Knox, Richard. “5 Years After Haiti’s Earthquake, Where Did The $13.5 Billion Go?”. 12 January 2015. NPR.

Identifying Victims of Mexican Drug Cartel Violence

For those who have taken even a slight notice to the media and affairs in Mexico, our neighbor to the south has been fighting a long-standing battle with ending drug cartels, and is facing a losing streak. As the case in any organization, criminal or otherwise, the use of violence is an option reaching a significant goal: obtaining power. Violence is an effective means of obtaining power and is frequently used to obtain strength through fear and coercion.

Closely related to U.S. pressure on Mexico to eradicate drug cartels, drug cartel violence increased dramatically, particularly against those outside of the drug cartel network. Despite U.S. anti-drug policy towards Mexico, the U.S. has directly exacerbated cartel activity and violence, such as in the ATF botching of Operation Fast and Furious. Failed efforts by U.S. organizations, which resulted in the release of assault weapons directly into the hands of Mexican crime organizations, have directly contributed to increased power and reach within the cartel network. Failed foreign intervention, in combination with a weak regulatory institutions both within Mexico and along the U.S.-Mexican border have left Mexico vulnerable to cartel influence via drug related violence and terrorism.

The “Cartel” series, within the Current Affairs section of AnthroPolitique seeks to provide readers with a snapshot of social, cultural, economic, and political situations surrounding global organized crime networks, both present and past. Rather than look at the role of states and governments in responding to cartel networks across the U.S.-Mexican border, this introductory post seeks to understand the situation in Mexico from the view of those effected: the victims.

Recognizing the role of the victim is essential  because as in the case of terrorism, the role of the victim plays a significant role in the ability of a group to obtain power through their “channel of violence”. The victims of Mexican drug cartel violence are therefore a key to understanding the extent of drug cartel power. The key to understanding the role of the victim as subjects of violence and terrorism can be understood through the following:

1. the means of murder

2. victim selection, and

3. victim identification following the act

For instance, the method of killing has switched from assault weapons to beheading. The use of beheading as a means of committing murder is not only horrific, but displays the deliberateness and calculated control of the killing itself. Furthermore, through beheading and mutilation of the bodies of their victims, the means of murder itself has prevented identification by both law enforcement officials and loved ones of the victims. Finally, victims subjected to cartel violence are increasingly innocent members of the society. The selection of innocent victims, as in more “traditional” terrorist attacks, represents absolute control at the hands of the cartel – with no one safe from it’s reach.

Keeping an eye on U.S.-Mexico relations and the fate of Mexico under uncontrolled cartel violence, we must not forget the victims who have lost their lives as a result.

Inspired by Marlon Bishop’s “Hello, I’m Calling from ‘La Mafia’” (NPR)

Balancing Russia in Ukraine: U.S. Policy One Year following 2014 Annexation of Crimea

palm flag crimeaWith continued Russian control of Crimea over a year after the February 2014 annexation of the peninsula, the U.S. must decide whether or not to take further action in the conflict. On March 10, 2015, a hearing will be held by the United States Senate Committee on Foreign Relations regarding “U.S. Policy in Ukraine: Countering Russia and Driving Reform”, following a similar hearing in the House Committee on Foreign Affairs on March 4, 2015. Russia’s appropriation of Crimea from Ukraine has forced U.S. policy decisions to be made regarding U.S. positioning in the Ukrainian crisis.

What will be significant about the upcoming hearing is not whether the United States will become involved in the Ukrainian crisis against Russia. Instead, the question will be the extent to which the U.S. will back the torn state against Russia. While we no longer live in a bipolar U.S. versus U.S.S.R world, tension between these two states will continue as long as power balancing is in play. Referring back to a 2011 writing on Russia and Soft Balancing, which on Russia’s status in a post-Cold War world in relation to the U.S., it is important to note that while Russia has declined as a bipolar power, Russia holds significant influence in our multipolar world as a balancing power. Russia’s annexation of Crimea from Ukraine, a sovereign state, demonstrated that Russia’s strength is very much present in the international community.

Even with a ceasefire in place, more than an estimated 6,000 people have been killed in conflict since the Russian annexation of Crimea. Idealistically, the U.S. role in Ukraine should focus on protecting Ukrainian civilians from the violence that has emerged since annexation. This sentiment has been voiced by many since the beginning of the conflict in light of the thousands that have been displaced, injured, and killed due to the conflict. However, one substantial fact exists: war is costly. In this delicate position, too much pressure on Russia can result in further armed conflict. Furthermore, involvement in Ukraine does not appeal to immediate interests of the US. Such intervention would result in significant military expenditure on the part of the U.S. in or to successfully expel Russia from Crimea – and Russia is prepared to fight.

This is not to say that Ukrainian opposition groups will be left without U.S. support. U.S. foreign policy plays a careful hand at providing indirect support to groups opposing “enemies” of U.S. interests. In this case, the U.S. will continue to provide backing of groups as a means of countering Russia, but not to the extent of implicating a U.S.-Russian war over Crimea. Although it is objectionable that humanitarian interests are still ignored in our era of globalism, tomorrow’s hearing will be indicative of how the U.S. will maintain this careful balance as a countering power to Russia in the post-Cold War rivalry.

Unhappy Marylanders: High Expectations, Low Voter Turnout in 2014 Gubernatorial Election

With the new inauguration of Governor of Maryland, Lawrence J. Hogan, Jr., post-election day woes and questions have become high profile. Low voter turnout in the recent election has resulted in an unhappy public response to the actions taken by Governor Hogan. Governor Hogan’s unfavorable strategies are reflective in slashing budgets and reversal of existing policies using a purposefully “political” approach to state affairs.

A relatively accurate argument could be made that Governor Hogan’s actions can be placed along with the number of other politicians that no longer fulfill their promises. The consistent bickering between the two prime political parties and lack of opposing parties due to lobbying and power politics makes major change is unlikely to come – and if a change in policy is effectively agreed upon, it will be limited to non-effective in scope as with the case of Obamacare.

Before I begin on the rant of the “failed dreams” left by US politicians, I would like to point out the following: the actions of Governor Hogan cannot be considered anything but expected. Although Hogan attacked the administration of former governor Martin O’Malley-Brown as one that “has crushed the middle class with record tax increases that we don’t need, don’t want, and simply cannot afford”, his campaign made it clear that Hogan was not one familiar with the actual needs of the middle class. If one chose to “meet Larry“, it becomes clear that the now current Governor of Maryland hinged his campaign on his experience in politics. Upon further reading, it seems that the only connection Larry Hogan has made with the common middle class Marylander is that he has a family and is “fed up with policies as usual” as described on his Change Maryland website. Governor Hogan did not make clear any key action plan towards change in favor of middle class interests. Instead, the success of his campaign relied on “relating” to Marylanders through a common frustration with the status quo of Maryland politics.

Recognizing that Governor Hogan’s campaign was hardly convincing, one may ask, how did Governor Hogan get elected? With posing this question, we must now center attention on the Maryland voter. According to the Maryland State Board of Elections reports, a total of 1,655,375 of 3,701,834 registered voters (44.72% ) voted in the 2014 Gubernatorial election, as opposed to the  50.38% of 3,468,287  registered voters in 2010 recorded to have voted in the polling place, not to mention provisional or absentee voters.

Low voter turnout in the 2014 Maryland Gubernatorial elections is representative of the lack of public involvement in US politics on a national level. Without voter involvement, the disheartening reality is that
polls no longer reflect the public view and politicians no longer support individual needs of the general middle class society. To make matters worse, in many cases, those who do vote select a candidate based off of propaganda and media, not based off of the knowledge of what that candidate will provide to them.

What messages does that leave for our society? – don’t ask questions, don’t expect change, don’t hold your politicians accountable, there is no worth in educating yourself on politics. US citizens have made it a habit to vote only if there is a pressing reason to do so (such as in the Obama election) and have adopted a culture of complacency with current politics. In a system in which politicians will not necessarily act in the interest of the general public, the trend of low voter turnout and public ignorance of one’s role in government must be eliminated. No change will come if it is left in the hands of people who have the power to vote for change and choose not to do so.

A Government “For the People”: Populism and Democratization

Since the end of World War II, the spread and support of democracy has, quite literally become a focus and key initiative of the international community. However, attempts to democratize has in a number of cases only been partially successful, contributing in the long-run to the further decline of once aspiring democratic states. Failures of democratic implementation can, among other situational factors, be linked to lack of public support for the new government and instability. Each of these factors prevents successful democratization following democratic implementation. Even with the involvement of international organizations in supporting democratic implementation on a global level, key elements of democracy have all but vanished and have prevented prospects for stable and successful democracies. Populism is one such element.

Populism is the idea that a government should act to serve the interests of its people, or in other words, populism “appeals to the masses”. This should not be misconstrued to mean that populism is necessarily associated with communism, leftism, or any of the like. In political science and international relations, it is commonly said that states act first in the interest of the state itself. The reality is that states often fail to address or even acknowledge the interests of the people within its borders. The shifting of focus to a state’s people is key in developing policy that allows for stability and can win over the support of its citizens.

Yes, there are flaws in populism. Populism has been associated with violence and instability due to the rise of action amidst public mobilization which in some cases leads to high tension and aggression. However, even the United States, a state that prides itself on its economic, social, and political might, faces a cycle of unaddressed social issues, obscured and media, and a spiraling decline in public knowledge and activism that have the potential to lead to social instability.

Today, even the world’s greatest democratic states exist as a democracy only in theory – the democracy of power politics, not democracy for the people. The US is therefore a powerful figure of stable “democracy” but by no means the symbol of a successful democracy. The key to developing successful democracies in a world centered on democratization in addition to issues of human rights and social progress lies in the following: in order for democracy and stability to be sustainable to successful, the system implemented must be one that appeals to the needs of the people it has been developed to serve.

For a more in-depth view of the “power of populism” in social stability, see Maintaining Balance in the US-Venezuelan Relationship after Chávez  for the Venezuelan example.

An opposing opinion:

“Pitchfork Politics.” Foreign Affairs. 3 Feb. 2015. Web. 3 Feb. 2015. <http://www.foreignaffairs.com/articles/141733/yascha-mounk/pitchfork-politics&gt;.

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