Álvaro Franco-Giraldo

Bio: Álvaro Franco-Giraldo is an academic researcher from University of Antioquia. The author has contributed to research in topics: International health & Right to health. The author has an hindex of 11, co-authored 27 publications receiving 292 citations.

Democratisation and health after the fall of the Wall

Abstract: Objectives: The fall of the Wall in 1989 can be seen as a natural experiment in the epidemiological sense to further examine the relation between democracy and health. Design and setting: Ecological study in the 23 post-communist countries, during the last decade of the 20th century, exploring the relations between the level of democratisation and health, taking into account as relevant confounders wealth and the level of inequality. Main results: A significant correlation (p 2 values of 0.336 for life expectancy, 0.575 for infant mortality, and 0.529 for maternal mortality. Conclusions: These findings add pieces of evidence to the previously reported cross sectional association between democracy and health.

[The effect of structural adjustment on health conditions in Latin America and the Caribbean, 1980-2000].

Abstract: OBJETIVO: Evaluar el impacto del ajuste estructural sobre los indicadores de salud en America Latina y el Caribe durante el periodo de 1980-2000. METODOS: Se trata de un estudio ecologico. Los datos del gasto publico y del producto interno bruto per capita (PIBpc) se tomaron del Banco Mundial y los de la esperanza de vida (EV) y mortalidad infantil (MI), de la Organizacion Mundial de la Salud. El ajuste estructural (adelgazamiento del Estado) se evaluo mediante el cambio en el consumo de gobierno (la reduccion del gasto publico) en los paises de America Latina y el Caribe en la decada de 1980-1990. El cambio en los indicadores de salud se midio por la variacion porcentual de la EV y la MI. Se compararon estas variaciones en America Latina y el Caribe con las observadas en diferentes grupos de paises de otras regiones del mundo durante el periodo de 1980-2000. Se determinaron las asociaciones entre la reduccion del gasto publico y los indicadores de salud mediante la prueba de Pearson. Para estimar el efecto de los cambios sobre la salud se construyo un modelo de regresion lineal multifactorial ajustado segun el PIBpc. RESULTADOS: Se observo una ralentizacion del incremento de la EV y del descenso de la MI en America Latina y el Caribe, especialmente en la decada de 1980-1990. Se encontraron asociaciones significativas entre la variacion de los indicadores de salud y el cambio del gasto publico en todos los grupos de paises analizados. Al ajustar el modelo de regresion multiple, las asociaciones solo se mantuvieron en America Latina y el Caribe. CONCLUSIONES: En la decada de 1980, el ajuste de las politicas macroeconomicas tuvo un efecto negativo sobre los indicadores sociales, especificamente sobre los relacionados con la situacion de salud en America Latina y el Caribe. Estos efectos se siguieron observando durante la decada siguiente.

Salud pública global: un desafío a los límites de la salud internacional a propósito de la epidemia de influenza humana A

Abstract: This article comes from the intense international pressure that follows a near-catastrophy, such as the human influenza A H1N1 epidemic, and the limited resources for confronting such events. The analysis covers prevailing 20th century trends in the international public health arena and the change-induced challenges brought on by globalization, the transition set in motion by what has been deemed the "new" international public health and an ever-increasing focus on global health, in the context of an international scenario of shifting risks and opportunities and a growing number of multinational players. Global public health is defined as a public right, based on a new appreciation of the public, a new paradigm centered on human rights, and altruistic philosophy, politics, and ethics that undergird the changes in international public health on at least three fronts: redefining its theoretical foundation, improving world health, and renewing the international public health system, all of which is the byproduct of a new form of governance. A new world health system, directed by new global public institutions, would aim to make public health a global public right and face a variety of staggering challenges, such as working on public policy management on a global scale, renewing and democratizing the current global governing structure, and conquering the limits and weaknesses witnessed by international health.

State Downsizing as a Determinant of Infant Mortality and Achievement of Millennium Development Goal 4

Abstract: The aim of this study was to evaluate the worldwide effect of state downsizing policies on achievement of U.N. Millennium Development Goal 4 (MDG4) on infant mortality rates. In an ecological retrospective cohort study of 161 countries, from 1978 to 2002, the authors analyzed changes in government consumption (GC) as determining exposure to achievement of MDG4. Descriptive methods and a multiple logistic regression were applied to adjust for changes in gross domestic product, level of democracy, and income inequality. Excess infant mortality in the exposed countries, attributable to reductions in GC, was estimated. Fifty countries were found to have reduced GC, and 111 had increased GC. The gap in infant mortality rate between these groups of countries doubled in the study period. Non-achievement of MDG4 was associated with reductions in GC and increases in income inequality. The excess infant mortality attributable to GC reductions in the exposed countries from 1990 to 2002 was 4,473,348 deaths. The probability of achieving MDG4 seems to be seriously compromised for many countries because of reduced public sector expenditure during the last 25 years of the 20th century, in response to World Bank/International Monetary Fund Washington Consensus policies. This seeming contradiction between the goals of different U.N. branches may be undermining achievement of MDG4 and should be taken into account when developing future global governance policy.

Epi + demos + cracy: Linking Political Systems and Priorities to the Magnitude of Health Inequities—Evidence, Gaps, and a Research Agenda

Abstract: A new focus within both social epidemiology and political sociology investigates how political systems and priorities shape health inequities. To advance-and better integrate-research on political determinants of health inequities, the authors conducted a systematic search of the ISI Web of Knowledge and PubMed databases and identified 45 studies, commencing in 1992, that explicitly and empirically tested, in relation to an a priori political hypothesis, for either 1) changes in the magnitude of health inequities or 2) significant cross-national differences in the magnitude of health inequities. Overall, 84% of the studies focused on the global North, and all clustered around 4 political factors: 1) the transition to a capitalist economy; 2) neoliberal restructuring; 3) welfare states; and 4) political incorporation of subordinated racial/ethnic, indigenous, and gender groups. The evidence suggested that the first 2 factors probably increase health inequities, the third is inconsistently related, and the fourth helps reduce them. In this review, the authors critically summarize these studies' findings, consider methodological limitations, and propose a research agenda-with careful attention to spatiotemporal scale, level, time frame (e.g., life course, historical generation), choice of health outcomes, inclusion of polities, and specification of political mechanisms-to address the enormous gaps in knowledge that were identified.

Reproductive governance in Latin America.

Abstract: This paper develops the concept of reproductive governance as an analytic tool for tracing the shifting political rationalities of population and reproduction. As advanced here, the concept of reproductive governance refers to the mechanisms through which different historical configurations of actors - such as state, religious, and international financial institutions, NGOs, and social movements - use legislative controls, economic inducements, moral injunctions, direct coercion, and ethical incitements to produce, monitor, and control reproductive behaviours and population practices. Examples are drawn from Latin America, where reproductive governance is undergoing a dramatic transformation as public policy conversations are coalescing around new moral regimes and rights-based actors through debates about abortion, emergency contraception, sterilisation, migration, and assisted reproductive technologies. Reproductive discourses are increasingly framed through morality and contestations over 'rights', where rights-bearing citizens are pitted against each other in claiming reproductive, sexual, indigenous, and natural rights, as well as the 'right to life' of the unborn. The concept of reproductive governance can be applied to other settings in order to understand shifting political rationalities within the domain of reproduction.

Politics, welfare regimes, and population health: controversies and evidence

Abstract: In recent years, a research area has emerged within social determinants of health that examines the role of politics, expressed as political traditions/parties and welfare state characteristics, on population health. To better understand and synthesise this growing body of evidence, the present literature review, informed by a political economy of health and welfare regimes framework, located 73 empirical and comparative studies on politics and health, meeting our inclusion criteria in three databases: PubMed (1948-), Sociological Abstracts (1953-), and ISI Web of Science (1900-). We identified two major research programmes, welfare regimes and democracy, and two emerging programmes, political tradition and globalisation. Primary findings include: (1) left and egalitarian political traditions on population health are the most salutary, consistent, and substantial; (2) the health impacts of advanced and liberal democracies are also positive and large; (3) welfare regime studies, primarily conducted among wealthy countries, find that social democratic regimes tend to fare best with absolute health outcomes yet consistently in terms of relative health inequalities; and (4) globalisation defined as dependency indicators such as trade, foreign investment, and national debt is negatively associated with population health. We end by discussing epistemological, theoretical, and methodological issues for consideration for future research.