International Journal of Health Services, Volume 34, Number 2 / 2004, 229 -
243
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IS THE CANADIAN HEALTH CARE SYSTEM FISCALLY SUSTAINABLE?

Ardeshir Sepehri and Robert Chernomas

Abstract:

Current concerns over escalating health care costs and the sustainability
of the Canadian health care system are based on analytical concepts and
models that have their own limitations and deficiencies. Measuring health
care costs across subsectors over the long-term period, the authors argue
that Canada's health care costs, especially those under the direct control
of provincial governments, are relatively stable. Using appropriate
measures of sustainability, there is no indication that Canada's public
health care expenditure is unsustainable. Nor is there any indication that
Canada's public health care expenditures are out of line with those of its
main trading competitors, including the United States.

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  Volume 34, Number 2 / 2004 ,185 - 227

IS GLOBALIZATION UNDERMINING THE WELFARE STATE? THE EVOLUTION OF THE
WELFARE STATE IN DEVELOPED CAPITALIST COUNTRIES DURING THE 1990s
Vicente Navarro, John Schmitt, Javier Astudillo

Abstract:

The authors analyze the evolution of macro-indicators of social and
economic well-being during the 1990s in the majority of developed
capitalist countries, grouped according to their dominant political
traditions since the end of World War II. Their analysis shows that,
despite the economic globalization of commerce and finance, "politics still
matters" in explaining the evolution of the welfare states and labor
markets in these countries; the impact of the globalization of financial
capital in forcing reductions in the financial resources available for
welfare state purposes has been exaggerated.

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Volume 34, Number 2 / 2004,  255 - 269

UNHEALTHY EUROPEAN HEALTH POLICY

Pol De Vos, Harrie Dewitte, Patrick Van der Stuyft

Abstract:

The European Union claims that the defense of its welfare state is one of
today's most important challenges. This article analyzes whether the
European governments and the European Union really pursue a policy that
strengthens their health and social security systems, or one that is in
itself a threat to health and social security. After a summary of the
origin and evolution of the European health systems, the authors pinpoint
underlying reasons for reform and demonstrate how, since the 1990s, the
European Union has built a strict financial and political straitjacket,
forcing these systems to carry out privatization and cutbacks. Reform
measures can be divided into three interdependent categories: (1) the
increasing influence of governments on health care organization, to enable
restructuring; (2) measures aimed at reducing public expenses, including
higher financial contributions by patients and restrictions on the range of
services provided; and (3) measures that establish competition and hidden
or open privatization of services and insurance systems. Through these
mechanisms public expenses are reduced while private health care expenses
(and private profits) rise freely. Ongoing European health care reforms
thus struggle with the contradictions between responding to growing
collective needs and securing or increasing private profits.

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Volume 34, Number 2 / 2004, 305 - 311

RAW DEAL FOR WORKERS: WHY HAVE U.S. WORKERS EXPERIENCED A LONG-TERM DECLINE
IN PAY, BENEFITS, AND WORKING CONDITIONS?

Chris Tilly

Abstract:

Pay, opportunities, and job quality have worsened for most U.S. workers
over the past 30 years, across most sectors of the economy. This decline is
related to fundamental changes in the economy and society, including
sluggish productivity growth and employer assaults on workers' rights and
protections. Productivity growth has slowed as companies no longer invest
as much in equipment and training. Businesses have attacked workers'
protections; unionization is down, and the minimum wage is worth about
two-thirds as much as at its high point in the late 1960s. The National
Labor Relations Board, other federal agencies, and the courts are stacked
with anti-labor appointees. And businesses have pushed more and more risk
onto workers, with a growth in temporary work and much reduced work-related
benefits.
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Volume 34, Number 2 / 2004 ,  323 - 339

POLITICAL DEVOLUTION AND THE HEALTH SERVICES IN GREAT BRITAIN


Kevin J. Woods

Abstract:

This article reviews the effects of political devolution on health care in
the countries of Great Britain at the end of the first term of the new
political institutions created in 1999. In the light of the powers
transferred, an assessment is made of the nature and extent of policy
autonomy exercised by the devolved administrations. The author considers
the question of whether political devolution is leading to local variations
in health care provision that threaten established concepts of equity in a
U.K. National Health Service. Policy areas discussed include the personal
care of older people, mental health, governance, competition, the role of
the private sector, and the health care workforce. Also discussed are the
dynamics of intergovernmental relations in the longer term, including the
effects of the developing European Union. The article concludes by
assessing the extent to which the individual countries within Great Britain
are likely to develop health care systems with distinctive identities.

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Volume 34, Number 1 / 2004,  1 - 10

THE WORLD HEALTH SITUATION

Vicente Navarro

Abstract:

This article, based on a speech given at the Sixth IUHP European Conference
on Health Promotion and Education, describes the consequences of the
concentration of economic, political, and cultural power in the world today
(in the countries of both North and South) for the health and well-being of
the world population. The author stresses that the current world disorder
is based on a set of alliances between the dominant classes (and economic
and financial groups) of the North and the dominant classes (and groups) of
the South against redistributional policies that would adversely affect
their interests. This situation hurts the health and well-being of the
dominated classes and other social groups of both North and South.

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Volume 34, Number 1 / 2004,  87 - 99

THE POLITICS OF HEALTH INEQUALITIES RESEARCH IN THE UNITED STATES

Vicente Navarro

Abstract:

In this article, based on a speech to the European Association of Health
Policy, the author discusses the political context in which health
inequalities research has historically operated in the United States. The
discussion focuses on the limitations of research that uses income,
consumption, and status as the primary categories of research practice, and
demonstrates these limitations by critically analyzing The Health of
Nations (by Kawachi and Kennedy). The author concludes that it is essential
to use categories of analysis that focus on class relations as well as race
and gender relations and their reproduction through the international and
national institutions, to study their impact on the health and well-being
of populations.

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Volume 34, Number 1 / 2004 143 - 153

RECONCEPTUALIZING THE NATURE AND HEALTH CONSEQUENCES OF WORK-RELATED
INSECURITY FOR THE NEW ECONOMY: THE DECLINE OF WORKERS' POWER IN THE
FLEXIBILITY REGIME


Heather K. Scott

Abstract:

This article aims to reconceptualize job insecurity in a manner relevant to
shifts in the power relations of work that have accompanied globalization,
in order to assess the implications for workers' health. The linkage
between job insecurity and health has been well established, but little
formal theorizing has analyzed the mechanisms responsible. Implicitly,
however, the assumption remains that its role as a stressor is limited to
the realm of job strain, whereby workers lack control over a threatened
employment situation. Within this framework, job insecurity and related
dimensions of power remain locked in the "box" of the standard employment
relationship, precluding an analysis of work-related insecurity in the new
context of globalization. In contrast, the author constructs a model of
work-related insecurity that takes into account current shifts in the
balance of power toward employers, which in turn has undermined the
fundamental quid pro quo associated with the standard postwar model of
employment. She proposes that job insecurity is no longer a mere temporary
break in an otherwise predictable work-life pattern but rather a structural
feature of the new labor market. Emerging contingencies associated with the
New Economy, "flexibilized" employment relationships, and diminution of
workers' power have constituted work-related insecurity as a chronic
stressor with several implications for long-term health outcomes at the
individual and societal levels.

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