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Why do resource-constrained countries make costly commitments to universal health coverage and AIDS treatment after transitioning to democracy? At a time when the world’s wealthiest nations struggle to make healthcare and medicine available to everyone, this book explores the dynamics that made landmark policies possible in Thailand and Brazil but which have led to prolonged struggle and contestation in South Africa. While conventional wisdom suggests that democratization empowers the masses, this book draws attention to an underappreciated dynamic: that democratization empowers elites from esteemed professions – frequently doctors and lawyers – who forge progressive change on behalf of those in need in the face of broader opposition at home and from abroad. The relative success of professional movements in Thailand and Brazil and failure in South Africa highlights critical differences in the character of political competition. Whereas fierce political competition provided opportunities for professional movements to have surprising influence on the policymaking process in Thailand and Brazil, the unrivaled dominance of the African National Congress allowed the ruling party the luxury of entertaining only limited healthcare reform and charlatan AIDS policy in South Africa. The book offers lessons for the United States and other countries seeking to embark on expansive health reforms.

This book provides a penetrating historical analysis of why countless studies show that Americans are far less healthy than their European counterparts. The book argues that Europeans are healthier than Americans because beginning in the late nineteenth century, European nations began construction of health systems that focused not only on medical care but the broad social determinants of health: where and how we live, work, play, and age. European leaders also created social safety nets that became integral to national economic policy. In contrast, US leaders often viewed investments to improve the social determinants of health and safety-net programs as a competing priority to economic growth. This book compares the United States to three European social democracies — France, Germany, and Sweden — in order to explain how, in differing ways, each protects the health of infants and children, working-age adults, and the elderly. Unlike most comparative health system analyses, the book draws on history to find answers to our most nettlesome health policy questions.

In 2009, an influential panel of medical experts ignited a controversy when they recommended that most women should not begin routine mammograms to screen for breast cancer until the age of fifty, reversing guidelines they had issued just seven years before when they recommended forty as the optimal age to start getting mammograms. While some praised the new recommendation as sensible given the smaller benefit women under fifty derive from mammography, many women's groups, health care advocates, and individual women saw the guidelines as privileging financial considerations over women's health and a setback to decades-long efforts to reduce the mortality rate of breast cancer. This book notes that this episode was only the most recent controversy in the turbulent history of mammography since its introduction in the early 1970s. The book shows how pivotal decisions made during mammography's initial launch made it all but inevitable that the test would be contentious. It describes how, at several key points in its history, the emphasis on mammography screening as a fundamental aspect of women's preventive health care coincided with social and political developments, from the women's movement in the early 1970s to breast cancer activism in the 1980s and 1990s. At the same time, aggressive promotion of mammography made the screening tool the cornerstone of a huge new industry. The book addresses both the benefits and risks of mammography, charting debates that have weighed the early detection of aggressively malignant tumors against unnecessary treatments resulting from the identification of slow-growing and non-life-threatening cancers.

This book tells the story of the author's decision to donate a kidney to a stranger. The book takes readers through the complex process by which such donors are vetted to ensure that they are physically and psychologically fit to take the risk of a major operation. The story is also placed in the larger context of the history of kidney transplantation and the ethical controversies that surround living donors. The book helps readers understand the discoveries that made transplantation relatively safe and effective as well as the legal, ethical, and economic policies that make it feasible. The book explores the steps involved in recovering and allocating organs. It analyzes the differences that arise depending on whether the organ comes from a living donor or one who has died. It observes the expertise — and the shortcomings — of doctors, nurses, and other professionals and describes the burdens that we place on people who are willing to donate. It asks us to consider just how far society should go in using one person's healthy body parts in order to save another person. The book provides an account of organ donation that is both personal and analytical. A combination of perspectives leads to a profound and compelling exploration of a largely opaque practice. The book pulls back the curtain to offer readers a more transparent view of the fascinating world of organ donation.

Primary care medicine is in crisis. While policymakers, government administrators, and the health insurance industry pay lip service to the personal relationship between physician and patient, dissatisfaction and disaffection run rampant among primary care doctors, and medical students steer clear in order to pursue more lucrative specialties. Patients feel helpless, well aware that they are losing a valued close connection as health care steadily becomes more transactional than relational. The thin-margin efficiency, rapid pace, and high volume demanded by the new health care economics do not work for primary care, an inherently slower, more personal, and uniquely tailored service. This book offers a cool critique of the “market model of medicine” while vividly illustrating how the seemingly inexorable trend toward specialization in the last few decades has shifted emphasis away from what was once the foundation of medical practice. It addresses the complexities of modern practice—overuse of diagnostic studies, fragmentation of care, increasing reliance on an array of prescription drugs, and the practice of defensive medicine. The book shows how changes in medicine, the family, and society have left physicians to deal with a wide range of geriatric issues, from limited mobility to dementia, that are not addressed by health care policy and are not entirely amenable to a physician's prescription. It contends that the very survival of primary care is in jeopardy at a time when its practitioners are needed more than ever.