Furthermore, we lack mechanisms for identifying and addressing these problems. Monitoring also has revealed instances where patients are denied care for not speaking enough Spanish or not being ‘clean’ enough [33]. People with the greatest access to financial resources are more likely to use private insurance and services, while salaried workers are covered by a separate system of facilities and services financed primarily through payroll taxes. One-third of the respondents encounter social exclusion compared to 22% of their non-LGBTQ colleagues. Francke P. Peru’s comprehensive health insurance and new challenges for universal coverage. View HTML Send article to Kindle. Social exclusion and isolation are associated with a higher risk of death and poor health; this is regardless of whether a person feels ‘lonely’. Rumbold B, Baker R, Ferraz O, Hawkes S, Krubiner C, Littlejohns P, et al. These charges are contrary to Guatemalan law which stipulates that all public services are free of charge at the point of delivery. Meanwhile, a significant percentage of the country’s population remains in need of quality publicly provided health services. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Socially excluded groups are given fewer rights and entitlements than other segments of society. Flores W, Samuel J. Grassroots organisations and the sustainable development goals: no one left behind? If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Int J Equity Health. We use case studies concerning two citizen-led accountability initiatives in two Latin American countries to explore how social exclusion can negatively influence health coverage, and thereby inform broader debates about progress towards UHC. International Journal for Equity in Health, https://www.who.int/choice/documents/making_fair_choices/en/, https://researchonline.lshtm.ac.uk/id/eprint/2157, https://www.odi.org/publications/10352-politics-uhc-universal-health-coverage-political-settlements-analysis-political-economy-analysis, http://bulletin.ids.ac.uk/idsbo/article/view/2963, https://carnegieendowment.org/files/Civil-Society-Legitimacy_FINAL.pdf, http://accountabilityresearch.org/publication/how-can-evidence-bolster-citizen-action-learning-and-adapting-for-accountable-public-health-in-guatemala/, https://accountabilityresearch.org/publication/defending-the-right-to-health-in-guatemala-reflections-of-two-indigenous-women-on-the-frontlines/, https://insights.careinternational.org.uk/publications/citizen-monitoring-to-defend-maternal-health-rights-in-peru, https://www.icefi.org/sites/default/files/contamos_boletin_25_byn.pdf, https://namati.org/resources/cronicas-no-ficcion-no-1-guatemalas-public-health-defenders/, https://phr.org/our-work/resources/deadly-delays/, https://larepublica.pe/sociedad/2019/12/05/minsa-venezolanos-en-peru-pueden-acceder-gratuitamente-al-sis-seguro-salud/, https://iapewec.org/wp-content/uploads/2020/08/IAP2020Report_web_sp.pdf, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s12939-020-01308-y, Inequities in health and health systems in Latin America and the Caribbean. This paper discusses information systems in community development contexts through the perspective of social exclusion. In addition, research in Canada and the U.S. shows that factors such as stereotyping and bias by medical practitioners contribute to persistent racial and ethnic disparities in health care [24,25,26]. Does information and communication technology add value to citizen-led accountability initiatives in health? Washington D.C: The National Academies Press; 2003. Once communities learned of these rules, they increasingly reported violations to community health defenders [35]. Lancet. 2016;9(1):33355. Molyneux M. The ‘neoliberal turn’ and the new social policy in Latin America: how neoliberal, how new? These initiatives seek to promote change by building citizen power and civic engagement. Flores W. Legitimacy from below: supporting indigenous rights in Guatemala. Health Syst Reform. In the mental health literature, social exclusion is poorly defined and measured. As a result, to date, much of the literature seeks to inform decisions about how to allocate scarce resources, define priorities, and overcome barriers to extending coverage. Cheltenham: Edward Elgar Publishing; 2016. p. 419–35. New York: CRC Press; 2015. Interventions in LICs and LMICs to improve air quality and/or mitigate its impacts, Monitoring Air Quality in Low- Income and Lower Middle-Income Countries, Prevalence of health impacts related to exposure to poor air quality among children in Low and Lower Middle-Income Countries. Available from: http://accountabilityresearch.org/publication/how-can-evidence-bolster-citizen-action-learning-and-adapting-for-accountable-public-health-in-guatemala/. Lima: GRADE; 2007. p. 603–55. 2017;16(1):26. Little empirical research exists focussing on the explicit relationship between social exclusion and health inequalities. Also, despite official discourses of citizenship and equality, powerful ideologies circulate in which socially excluded people are defined as undeserving, and are often cast as the recipients of charity rather than as people entitled to health and other social rights [39, 53]. 2000;15(2):215–32. PubMed  In one study, a nurse explained that her colleagues had collected these kinds of unauthorized charges not for themselves but to pay for informal and unbudgeted costs such as gas for the health centre motorcycle and customary gifts when health workers are asked to take on special roles such as godparents [39]. This shift does not adequately alter the dysfunctional character of the system. We conclude that efforts to promote UHC cannot stop at increasing health systems financing. Google Scholar. Social exclusion influences health directly through its manifestations in the health system and indirectly by affecting economic and other social inequalities that influence health. The challenges to realizing UHC in health care systems in Guatemala and Peru are complex. PubMed  Patients of the state: an ethnographic account of poor People’s waiting. Frisancho A, Goulden J. Rights-based approaches to improve people’s health in Peru. Due to the negative work environment, some LGBTQ employees suffered health and wellness challenges within the past year. Examining civil society legitimacy. [40] Objectives: Homelessness and poverty are extreme forms of social exclusion which extend beyond the lack of physical or material needs. Pal 1. These inequalities are also reflected in health and nutrition outcomes. 2019;365:l2269. However, a deeper struggle continues to be waged that seeks to counter racialized, ethnic and other hierarchies that were formed long ago in the colonial period and still persist in updated forms in both the state and society [56]. eBook Shop: Dunedin Academic Press: Homelessness, Social Exclusion and Health von Fiona Cuthill als Download. James SA. Some social rights to coverage are expanded but the quality, accessibility and reliability of that coverage continues to be compromised. Exclusion involves the creation and reproduction of stigmatized social categories, and “[d] isrespect, discrimination and degradation are as much at work as are monetary poverty and physical need” [17]. Economic Commission for Latin America and the Caribbean (ECLAC). This briefing explores the relationship between poverty, social exclusion and health and what health systems can do to respond. Social exclusion increased aggressive behaviour and hostile perception of other’s ambiguous actions (DeWall, Twenge, et al., 2009; DeWall, Deckman, Pond & Bonser, 2011). There is increasing understanding about the links between poor mental health and social exclusion. Manila: Asian Development Bank; 2000. These kinds of efforts entail substantial challenges when moving from civil society engagement to actions that lead to substantive changes in publicly provided health systems. For example, extensive research has demonstrated that racialized and ethnic minorities in the U.S. receive lower quality of health services than white Americans, even after disease status, socioeconomic differences and other health care access related factors are taken into account [22, 23]. One-third of the respondents encounter social exclusion compared to 22% of their non-LGBTQ colleagues. : 1. Experiences such as the National Health Assembly (NHA) model in Thailand are instructive. Along with access issues, monitoring has also highlighted concerns about the low quality of health service provision in these areas [37]. 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