Preface vii
Part 1 Empire Past
Chapter 1 Empire's Historical Health Component 2
Philanthropic Foundations 2
International Financial Institutions and Trade Agreements 4
International Health Organizations 5
A Countervailing Viewpoint 8
Chapter 2 Illness-Generating Conditions of Capitalism and Empire 9
How This Viewpoint Emerged 9
Friedrich Engels 10
Rudolf Virchow 13
Salvador Allende 16
Capitalism, Empire, Illness, and Early Death 21
Chapter 3 The International Market for Health Products and Services 25
Methods to Address the Falling Rate of Profit 25
The Political Economy of Coronary Care 26
Early History of Coronary Care Units 26
Explaining the Diffusion of Coronary Care Units 29
The Corporate Connection 29
The Academic Medical Center Connection 33
Private Philanthropies 35
The Role of the State 37
Changes in the Health-Care Labor Force 39
Technological Innovation and the International Capitalist System 40
Chapter 4 Paths of Resistance to Empire in Public Health and Health Services 43
Chile: A Transformation Thwarted by Empire 44
Cuba: A Transformation Thwarting the Advance of Empire 52
Comparative Changes in the Context of Empire 59
Part 2 Empire Present
Chapter 5 Neoliberalism and Health 64
Neoliberalism and the Dismantling of the Public Sector 65
The Transnational Capitalist Class and Multinational Corporations 66
The Nation-State, Sovereignty, and Health 68
Chapter 6 International Trade Agreements, Medicine, and Public Health 72
Trade Rules 72
Trade Enforcement and National Sovereignty 73
Trade Agreements and Health 74
NAFTA 75
Free Trade Area of the Americas (FTAA) 77
General Agreement on Trade in Services (GATS) 78
Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) 80
Overview of International Trade Agreements and Health 81
Actions by Health Professionals and Advocates 81
Chapter 7 Macroeconomics and Health 86
Enhancing Empire by Enhancing Health 86
An Influential Example of "Investing in Health": The Report on Macroeconomics and Health 87
The Meanings of "Investing in Health" 88
Financing Versus Reform 90
"Close-to-Client" Systems: Public Funding for Private Providers 91
The Meanings of Prepayment 92
Donor Financing: Unspoken Options 93
The Value of Life: Disability-Adjusted Life Years (DALYs) 94
Trade Agreements Versus Corporate Responsibility 95
Recycling Public Health Interventions to Facilitate Investment 96
Chapter 8 The Exportation of Managed Care 99
Economic Conditions That Fostered Exportation 100
The Managed Care Market and Social Security Funds in Latin America 102
The Rising Trajectory of Managed Care in Latin America 105
The Falling Trajectory That Followed 108
Challenges to Public Health and Medical Services 109
Resistance to Managed Care and the Emergence of Alternative Proposals 110
Chapter 9 Corporations, International Financial Institutions, and Health Services 113
"Reform" in Mexico 114
"Reform" in Brazil 116
Penetration by Multinational Corporations 117
Effects of Reform in Mexico 118
Effects of Reform in Brazil 120
Vicissitudes of Privatization and Corporatization 121
Chapter 10 The "Common Sense" of Health Reform 123
Ideological Underpinnings of Health Reform 124
Ideological Assumptions in a Silent Process of Reform 125
A Transformation of Common Sense 126
Ideology and the Reconstruction of Common Sense 127
Chapter 11 Stakeholders' Constructions of Global Trade, Public Health, and Health Services 131
Government Agencies 131
International Financial Institutions 134
International Health Organizations 136
Multinational Corporations 137
Advocacy Groups 140
Social Constructions of Trade and Health 142
Chapter 12 Militarism, Empire, and Health 145
The Physical and Psychic Impact of War on Military Personnel 146
Civilian Services for Military Personnel 147
GIs' Physical and Mental Health Problems 148
Themes from Encounters Between Military Personnel and Civilian Clinicians 150
The Economic Draft 150
Deception 150
Ethical Dilemmas and Violence Without Meaning 151
Barriers to Care 151
Privatization of Services 151
Torture and Human Rights Abuses 151
The Changing Health Effects of Militarism 152
Part 3 Empire Future
Chapter 13 Health and Praxis: Social Medicine in Latin America 156
Productivity and Danger 156
History of Latin American Social Medicine 159
The "Golden Age" of Social Medicine in Chile and the Role of Salvador Allende 159
Social Medicine Versus Public Health Elsewhere in Latin America 161
The 1960s and Later 163
Political Repression and Work Challenges 164
Theory, Method, and Debate 165
Emerging Themes 167
Social Policies, Empire, and Health 167
Social and Cultural Determinants of Health and Illness 168
Relations Among Work, Reproduction, the Environment, and Health 168
Violence, Trauma, and Health 169
The Future of Social Medicine 169
Chapter 14 Resistance and Building an Alternative Future 171
The Struggle Against Privatization of Health Services in El Salvador 172
Resistance to Privatization of Water in Bolivia 174
Social Medicine's Coming to Power in Mexico City 177
Other Examples of a New Vision: Venezuela, Uruguay, and Brazil 180
Struggles for National Health Programs in the Heart of Empire 182
The End of Empire? 186
Sociomedical Activism in the Post-Empire Era 188
Notes 190
Index 220
About the Author 228