Search

Breast cancer is a serious threat to the health of women globally and an unrecognized priority in middle-income countries. This paper presents data from Mexico. It shows that breast cancer accounts for more deaths than cervical cancer since 2006. It is the second cause of death among women aged 30 to 54 and affects all socioeconomic groups. Data on detection, although underreported, show 6000 new cases in 1990 and a projected increase to over 16500 per year by 2020. Further, the majority of cases are self-detected and only 10% of all cases are detected in stage I. Mexico s social security systems cover approximately 40 to 45% of the population and include breast cancer treatments. Since 2007 the rest of the population has had the right to breast cancer treatment through Seguro Popular. Despite these entitlements, services are lacking and interventions for early detection, particularly mammography, are very limited. As of 2006 only 22% of women aged 40 to 69 reported having a mammography in the past year. Barriers exist on both the demand and supply sides. Lobbying, education, awareness building and an articulated policy response will be important to ensure extended coverage, access to and acceptance of both treatment and early detection.

Despite having achieved an average life expectancy of 75 years, much the same as that of more developed countries, Mexico entered the 21st century with a health system mared by its failure to offer financial protection in health to more than half of its citizens; this was both a result and a cause of the social inequalities that have marked the development process in Mexico. Several structural limitations have hampered performance and limited the progress of the health system. Conscious that the lack of financial protection was the major bottleneck, Mexico has embarked on a structural reform to improve health system performance by establishing the System of Social Protection in Health (SSPH), which has introduced new financial rules and incentives. The main innovation of the reform has been the Seguro Popular (Popular Health Insurance), the insurance-based component of the SSPH, aimed at funding health care for all those families, most of them poor, who had been previously excluded from social health insurance. The reform has allowed for a substantial increase in public investment in health while realigning incentives towards better technical and interpersonal quality. This paper describes the main features and initial results of the Mexican reform effort, and derives lessons for other countries considering health-system transformations under similarly challenging circumstances.

During the past six years, Mexico has undergone a large-scale transformation of its health system. This paper provides an overview of the main features of the Mexican reform experience. Because of its high degree of social inequality, Mexico is a microcosm of the range of problems that affect countries at all levels of development. Its health system had not kept up with the pressures of the double burden of disease, whereby malnutrition, common infections, and reproductive health problems coexist with non-communicable disease and injury. With half of its population uninsured, Mexico was facing an unacceptable paradox: whereas health is a key factor in the fight against poverty, a large number of families became impoverished by expenditures in health care and drugs. The reform was designed to correct this paradox by introducing a new scheme called Popular Health Insurance (Seguro Popular). This innovative initiative is gradually protecting the 50 million Mexicans, most of them poor, who had until now been excluded from formal social insurance. This paper reports encouraging results in the achievement of the ultimate objective of the reform: universal access to high-quality services with social protection for all.

Fairness in finance is an intrinsic and challenging goal of health systems. Mexico recently devised a structural reform that responds to this challenge. Through a new system of social protection in health that will offer public insurance to all citizens, the reform is expected to reduce catastrophic and out-of-pocket spending while promoting efficiency, more equitable resource distribution, and better-quality care. This paper analyzes the reform, focusing on financial features, expected benefits, and future challenges. It also highlights aspects of relevance for other countries that are striving to formulate and implement health policies to promote universal social protection and fair financing.

The shift of human affairs from the nation-state to the vast theater of planet Earth is changing the nature of health challenges. In addition to their own domestic problems, all countries must now deal with the international transfer of risks. These new challenges are demanding novel forms of international cooperation, which, if developed, may also help to reconcile general national self-interest with international mutual interest. This paper discusses the possibility of using health as an instrument of foreign policy and of developing new forms of cooperation around three key elements: exchange of experiences around common problems, evidence on alternatives, and empathy.

The literature on quality has often focused on process indicators. In this paper we outline a framework for describing and measuring the quality of health systems in terms of a set of desirable outcomes. We illustrate how it can be measured using data collected from a recent evaluation of health system performance conducted by the World Health Organization (WHO). We then explore the extent to which this framework can be used to measure quality for all components of the system; for example, regions, districts, hospitals, and providers. There are advantages and disadvantages to defining quality in terms of outcomes rather than process indicators. The advantage is that it focuses the attention of policy makers on whether systems are achieving the desired goals. In fact, without the ability to measure outcomes it is not possible to be sure that process changes actually improve attainment of socially desired goals. The disadvantage is that measuring outcomes at all levels of the system poses some problems particularly related to the sample sizes necessary to measure outcomes. WHO is exploring this, initially in relation to hospitals. The paper discusses two major challenges. The first is the question of attribution, deciding what part of the outcome is due to the component of the system under discussion. The second is the question of timing, including all the effects of current health actions now and in the future.

The gender composition of the medical profession is changing rapidly in many parts of the world, including Mexico. We analyze cross-sectional and longitudinal data on sex differences in physician employment from household employment surveys. The results suggest that Mexico is a particularly interesting example of the feminization of physician employment. Female enrollment in medical school increased from 11% in 1970 to about 50% in 1998. The increased participation of women in medicine seems to be accompanied by differences in employment patterns that could generate significant reductions in the total supply of physician hours of service. Women physicians are unemployed at a much higher rate than men and hence account for half of underused physician human capital. The results suggest that improved educational opportunities do not translate automatically into equal employment opportunities.

Health systems vary widely in performance, and countries with similar levels of income, education and health expenditure differ in their ability to attain key health goals. This paper proposes a framework to advance the understanding of health system performance. A first step is to define the boundaries of the health system, based on the concept of health action. Health action is defined as any set of activities whose primary intent is to improve or maintain health. Within these boundaries, the concept of performance is centred around three fundamental goals: improving health, enhancing responsiveness to the expectations of the population, and assuring fairness of financial contribution. Improving health means both increasing the average health status and reducing health inequalities. Responsiveness includes two major components: (a) respect for persons (including dignity, confidentiality and autonomy of individuals and families to decide about their own health); and (b) client orientation (including prompt attention, access to social support networks during care, quality of basic amenities and choice of provider). Fairness of financial contribution means that every household pays a fair share of the total health bill for a country (which may mean that very poor households pay nothing at all). This implies that everyone is protected from financial risks due to health care. The measurement of performance relates goal attainment to the resources available. Variation in performance is a function of the way in which the health system organizes four key functions: stewardship (a broader concept than regulation); financing (including revenue collection, fund pooling and purchasing); service provision (for personal and non-personal health services); and resource generation (including personnel, facilities and knowledge). By investigating these four functions and how they combine, it is possible not only to understand the proximate determinants of health system performance, but also to contemplate major policy challenges.

This paper proposes an approach to conceptualizing and operationalizing the measurement of health inequality, defined as differences in health across individuals in the population. We propose that health is an intrinsic component of well-being and thus we should be concerned with inequality in health, whether or not it is correlated with inequality in other dimensions of well-being. In the measurement of health inequality, the complete range of fatal and non-fatal health outcomes should be incorporated. This notion is operationalized through the concept of healthy lifespan. Individual health expectancy is preferable, as a measurement, to individual healthy lifespan, since health expectancy excludes those differences in healthy lifespan that are simply due to chance. In other words, the quantity of interest for studying health inequality is the distribution of health expectancy across individuals in the population. The inequality of the distribution of health expectancy can be summarized by measures of individual/mean differences (differences between the individual and the mean of the population) or inter-individual differences. The exact form of the measure to summarize inequality depends on three normative choices. A firmer understanding of people's views on these normative choices will provide a basis for deliberating on a standard WHO measure of health inequality.

Objectives: This study examined the extreme medical unemployment and underemployment in the urban areas of Mexico. The conceptual and methodological approach may be relevant to many countries that have experienced substantial increases in the supply of physicians during the last decades., Methods: On the basis of 2 surveys carried out in 1986 and 1993, the study analyzed the performance of physicians in the labor market as a function of ascription variables (social origin and gender), achievement variables (quality of medical education and specialty studies), and contextual variables (educational generation)., Results: The study reveals, despite some improvement, persistently high levels of open unemployment, qualitative underemployment (i.e., work in activities completely outside of medicine), and quantitative underemployment (i.e., work in medical activities but with very low levels of productivity and remuneration). The growing proportion of female doctors presents new challenges, because they are more likely than men to be unemployed and underemployed., Conclusions: While corrective policies can have a positive impact, it is clear that decisions regarding physician supply must be carefully considered, because they have long-lasting effects. An area deserving special attention is the improvement of professional opportunities for female doctors.

Both health inequalities and social group health differences are important aspects of measuring population health. Despite widespread recognition of their magnitude in many high- and low-income countries, there is considerable debate about the meaning and measurement of health inequalities, social group health differences and inequities. The lack of standard definitions, measurement strategies and indicators has and will continue to limit comparisons--between and within countries, and over time--of health inequalities, and perhaps more importantly comparative analyses of their determinants. Such comparative work, however, will be essential to find effective policies for governments to reduce health inequalities. This article addresses the question of whether we should be measuring health inequalities or social group health differences. To help clarify the strengths and weaknesses of these two approaches, we review some of the major arguments for and against each of them.

To improve the performance of international health organisations, their essential functions must be agreed. This paper develops a framework to discuss these essential functions. Two groups are identified: core functions and supportive functions. Core functions transcend the sovereignty of any one nation state, and include promotion of international public goods (eg, research and development), and surveillance and control of international externalities (eg, environmental risks and spread of pathogens). Supportive functions deal with problems that take place within individual countries, but which may justify collective action at international level owing to shortcomings in national health systems-such as helping the dispossessed (eg, victims of human rights violations) and technical cooperation and development financing. Core functions serve all countries, whereas supportive functions assist countries with greater needs. Focus on essential functions appropriate to their mandate will better prepare international health organisations to define their roles, eg for WHO to focus on core functions and for the World Bank to focus on supportive ones.

Health systems throughout the world are searching for better ways of responding to present and future challenges. Latin America is no exception in this innovative process. Health systems in this region have to face a dual challenge: on the one hand, they must deal with a backlog of accumulated problems characteristic of underdeveloped societies; on the other hand, they are already facing a set of emerging problems characteristic of industrialized countries. This paper aims at analyzing the performance of current health systems in Latin America, while proposing an innovative model to promote equity, quality, and efficiency. We first develop a conceptualization of health systems in terms of the relationships between populations and institutions. In order to meet population needs, health systems must perform four basic functions. Two of these-financing and delivery-are conventional functions performed by every health system. The other two have often been carried out only in an implicit way or not at all. These neglected functions are 'modulation' (a broader concept than regulation, which involves setting transparent and fair rules of the game) and 'articulation' (which makes it possible to organize and manage a series of transactions among members of the population, financing agencies, and providers so that resources can flow into the production and consumption of services). Based on this conceptual framework, the paper offers a classification of current health system models in Latin America. The most frequent one, the segmented model, is criticized because it segregates the different social groups into three segments: the ministry of health, the social security institute(s), and the private sector. Each of these is vertically integrated, so that it performs all functions but only for a particular group. As an alternative, we propose a model of 'structured pluralism', which would turn the current system around by organizing it according to functions rather than social groups. In this model, modulation would become the central mission of the ministry of health, which would move out of the direct provision of personal health services. Financing would be the main function of social security institutes, which would be gradually extended to protect the entire population. The articulation function would be made explicit by fostering the establishment of 'organizations for health services articulation', which would perform a series of crucial activities, including the competitive enrollment of populations into health plans in exchange for a risk-adjusted capitation, the specification of explicit packages of benefits or interventions, the organization of networks of providers so as to structure consumer choices, the design and implementation of incentives to providers through payment mechanisms, and the management of quality of care. Finally, the delivery function would be open to pluralism that would be adapted to differential needs of urban and rural populations. After examining the convergence of various reform initiatives towards elements of the structured pluralism model, the paper reviews both the technical instruments and the political strategies for implementing changes. The worldwide health reform movement needs to sustain a systematic sharing of the unique learning opportunity that each reform experience represents.

This article discusses the future of commercial trade in personal health services in North America within the context of the North American Free Trade Agreement (NAFTA) and the latter's potential influence on health care for the Mexican people. It begins by defining concepts related to international trade of services, particularly health services, and then proceeds to analyze elements of NAFTA that affect the delivery, regulation, and financing of such services, as well as their future trade within the NAFTA area. It concludes with some recommendations directed at helping Mexico's national health care system confront the risks posed while taking advantage of the opportunities offered by the Mexican economy's entry into a broader market.

This paper describes a unique system through which health care-related human rights are now being monitored and protected in Mexico. Based on the ombudsman concept, the system focuses on identifying and responding to violations of human rights and dignity which may occur in the context of health care delivery. Experience thus far has been encouraging; the Mexican population has identified and used the National Commission of Human Rights as a forum for a variety of health-related complaints. The Mexican system, while requiring strengthening and expansion, is an effort to integrate the monitoring and protection of health-related human rights into the broader field of human rights work in Mexico.

A study was carried out in 1970 on the distribution of medical personnel in Mexico. At that time an unequal distribution of physicians was detected, but not emphasized given the general shortage of physicians in the country. At the present time, the situation has changed. In this article the analysis of the 1990 census data using traditional indicators of availability of physicians in the country, as well as indirect criteria of physician requirements is presented. In the year of reference there were 157,407 physicians in the country, with a national average of 673 persons per physician. The distribution of physicians by state showed a great deal of variation in the number of persons per physician. For example, the state of Chiapas has 1,642 inhabitants per physician, whereas the Federal District has 292. The relation between trained and employed physicians shows another important phenomenon: there is a high percentage of physicians that do not practice clinical medicine (19.4%). Nevertheless, the number of physicians almost tripled the growth experienced by the general population, and important differences among and within states do persist. Furthermore, a new paradoxical effect has emerged, the presence of underemployment and unemployment of physicians, even in communities with greater needs for medical care. This indicates that the strategy of training more physicians has not solved the problems of accessibility and coverage, but in fact has fostered new problems and perhaps greater inequalities.

The changes in health conditions that have occurred in most of the countries of Latin America in the second half of the twentieth century are analyzed. "This paper analyzes the main mechanisms involved in the epidemiologic transition, which are: changes in risk factors, fertility decline and improvements in health care technology." The authors use a mortality profile ratio, obtained by dividing the mortality rate due to infectious and parasitic diseases over the mortality rate due to cardiovascular diseases and neoplasms, to analyze trends in 15 countries. "Three distinct groups can be recognized. Each of them represents a different transitional experience. Such experiences are discussed in detail, including a new 'protracted polarized model' of the epidemiologic transition, which characterizes several Latin American countries. Finally, evidence is provided to illustrate the relationship among economic development, fertility change, and mortality profiles." (SUMMARY IN ENG), (excerpt)

Objectives: The purposes of the study were to assess the potential impact of the North American Free Trade Agreement (NAFTA) on medical care in Mexico and to identify internal measures Mexico could take to increase the benefits and minimize the risks of free trade., Methods: The dual nature of the health sector is examined; the Mexican, Canadian, and US health care systems are compared; and modes and consequences of international exchange of health services are analyzed., Results: Four issues require immediate attention: accreditation of health care facilities, licensing and certification of professionals, technology assessment, and financial equity., Conclusions: NAFTA offers opportunities for positive developments in Mexico, provided risks can be anticipated and preventive measures can be taken to avoid negative impacts on the health system. Medical services, like other elements of the Mexican economy, must be modernized to respond to the demands of global competition. The Mexican National Academy of Medicine has recommended to the Mexican government (1) internal strengthening of the Mexican health care system to improve its ability to respond to the new conditions created by NAFTA and (2) a gradual process to facilitate equitable and mutually beneficial interactions among the three countries.

In this paper we propose a wider scope for public health surveillance in order to incorporate demographic and health systems monitoring along with activities conventionally associated with epidemiologic surveillance. This new conception stems, in turn, from a revised definition of public health, which describes--not a sector of activity or a type of health service--but a level of aggregation based on the population at large. In our review of the ideas that lead to the institutionalization of health surveillance, we stress the broad concepts developed by such pioneers as Graunt and Petty. Their original concepts emerged from their active concerns for the public's health at a time when no scientific theory of contagion was available--let alone any knowledge about how to treat persons for the major diseases that affected them. Later on, and largely as the result of impressive advances in biomedical knowledge, surveillance activities tended to specialize and to concentrate predominantly on disease outbreaks and on salient adverse health conditions. Health surveillance became closely associated with epidemiologic surveillance, which in turn became associated with the ability to respond promptly to adverse health outcomes. Recently, we have witnessed a gradual broadening of both the concepts and the practice of health surveillance. Paradoxically, the newer proposals tend to recapture part of the spirit and scope of earlier definitions, prompted perhaps by such thoughtful historic parallels as the newly emerging health problems for which we have no clear-cut solution. If one element has to be stressed to promote the objectives of health surveillance today, it is the need to anticipate health outcomes and not just respond to them. This, in turn, requires an increased attention to the surveillance of risk factors, and a greater understanding of the complex causal relationships that those factors--including behavioral, lifestyle, and environmental ones--with adverse health outcomes and disability. Needless to say that, the first and foremost aim of health care--and of modern surveillance--is to promote the well-being of individuals by improving their health.

This paper examines the general question of the public/private mix in health care, with special emphasis on its implications for human resources. After a brief conceptual exercise to clarify these terms, we place the problem of human resources in the context of the growing complexity of health systems. We next move to an analysis of potential policy alternatives. Unfortunately, a lot of the public/private debate has looked only at the pragmatic aspects of such alternatives. Each of them, however, reflects a specific set of values--an ideology--that must be made explicit. For this reason, we outline the value assumptions of the four major principles to allocate resources for health care: purchasing power, poverty, socially perceived priority, and citizenship. Finally, the last section discusses some of the policy options that health care systems face today, with respect to the combinations of public and private financing and delivery of services. The conclusion is that we need to move away from false dichotomies and dilemmas as we search for creative ways of combining the best of the state and the market in order to replace polarized with pluralistic systems. The paper is based on a fundamental premise: The way we deal with the question of the public/private mix will largely determine the shape of health care in the next century.

In this paper, we have proposed a wider scope for public health surveillance in order to incorporate demographic and health-system monitoring, along with activities conventionally associated with epidemiologic surveillance. This new conception stems, in turn, from a revised definition of public health, which describes, not a sector of activity or a type of health service, but a level of aggregation based on the population at large. In our review of the ideas that lead to the institutionalization of health surveillance, we have stressed the broad concepts developed by such pioneers as Graunt and Petty. Their original concepts emerged from their active concerns for the public's health at a time when no scientific theory of contagion was available, let alone any knowledge about how to treat persons for the major diseases. Later on, largely as the result of impressive advances in biomedical knowledge, public health surveillance tended to specialize and to concentrate predominantly on disease outbreaks and on salient adverse health conditions. Health surveillance became closely associated with epidemiologic surveillance, which in turn became associated with the ability to respond promptly to adverse health outcomes. Recently, we have witnessed a gradual broadening of both the concepts and the practice of health surveillance. Paradoxically, the new currents tend to recapture some of the spirit and scope of the early definitions, prompted perhaps by grave historical parallels--we face newly emerging health problems for which we have no clear-cut solutions. If one element needs to be stressed to promote the objectives of health surveillance today, it is that we need the ability to anticipate health outcomes and not just respond to them. This, in turn, requires that we give more weight to the surveillance of risk factors and that we increase our understanding of the complex causal interrelationships that link exposure to risk factors--including behavioral, life-style, and environmental ones--with adverse health conditions and disability. Needless to say, the first and foremost aim of health care--and modern surveillance is one of the tools needed to achieve this aim--is to promote the well-being of individuals while improving their health.

Research faces the challenge of balancing relevance to decision making and excellence in the strict adherence to the norms of scientific inquiry. This paper examines the organizational responses that can be undertaken to promote integration of these potentially conflicting goals. We posit that there seem to be structural barriers to effective communication between researchers and decision makers, such as differences in priorities, time management, language, means of communication, integration of findings and definition of the final product of research. These barriers must be overcome through solutions aimed at the organization of research. In this respect, there are three possible models to approach the tension between excellence and relevance: academic subordination, segregation and integration. Only the latter makes it possible to reconcile the advantages of proximity to decision making with the procedures to assure academic quality. In addition to organizational design and institutional development, a strategy to promote research must include a set of incentives to prevent the 'internal brain drain', that is, the tendency of researchers to move to managerial positions. There are four guiding principles to address this problem: parallel careers, academic autonomy, administrative sacrifice and inverted incentives. The complexities of health problems demand that we create new organizational formulas to finally balance relevance and excellence in research.

We compared the results of the educational policies of public versus private medical schools and traditional versus module-based medical programs. The comparison centers on the political value of equality. The hypotheses are the following: a) Public and module-based schools offer more equality of opportunities for enrollment, permanence and graduation of students than private and traditional schools; b) medical schools maintain their educational policies over time. The value of equality was operationalized with the Equality Index (EI). To test the proposed hypotheses we used Wilcoxon's rank sum test and Mann-Whitney "U" test. We studied an intentional sample of 21 medical school in Mexico. The median of the EI for public schools between 1980 to 1989 was 4; 2 for private schools, 2 for traditional schools, and 3 for module-based schools. The only significant difference found was that between public and private schools (p < 0.05). We conclude that in public schools there is more equality of opportunities than in private ones. The results are consistent during the decade of the 80's.

The article first proposes a framework within which to assess the potential of health sector reforms in Latin America for primary health care (PHC). Two dimensions are recognized: the scope of the reforms, content, and the means of participation that are put into play. This framework is then complemented through a critique of the often-sought but little-analyzed PHC reform strategies of decentralization and health sector integration. The analytical framework is next directed to the financing of health services, a chief aspect of any reform aiming toward PHC. Two facets of health service finance are first distinguished: its formal aspect as a means for economic subsistence and growth, and its substantive aspect as a means to promote the rational use of services and thus improvement of health. Once finance is understood in this microeconomic perspective, the focus shifts to the analysis of health care reforms at the macro, health policy level. The article concludes by positing that PHC is in essence a new health care paradigm, oriented by the values of universality, redistribution, integration, plurality, quality, and efficiency.

In Mexico the Constitution defines the right to health care as a social right and, as such, confers to the state the guiding role in the access of the population to health services. Unfortunately, this constitutional principle has not been fully met. One of the reasons for this is the fragmentation of public action in health and the continuous postponement of the integration of health services. In this paper the conceptual and practical limits of integration of health services are discussed, using as starting point a brief diagnosis of inequity and fragmentation of the health system in Mexico. The doctrinaire principles of integration are also described, as well as its practical advantages and disadvantages. Finally, a typology of forms of integration and previous integration experiences in Mexico are discussed. In the concluding remarks the integration prospects for Mexico are analyzed.

The concept of health transition is considered to include two interrelated processes: transition of health care and epidemiological transition. The latter encompasses three basic processes: (a) replacement of the common infectious diseases by noncommunicable diseases and injuries as the leading causes of death; (b) a shift in peak morbidity and mortality from the young to the elderly; and (c) change from a situation in which mortality predominates in the epidemiological panorama to one in which morbidity is dominant. Latin America is characterized by a heterogeneous health profile in which different countries are in various stages of epidemiological transition. However, in most of them, the transition experience is unlike that of the developed countries and is distinguished by: (a) a simultaneous high incidence of diseases from both the pre- and post-transitional stages; (b) a resurgence of some infectious diseases that had previously been under control; (c) a lack of resolution of the transition process, so that the countries appear to be caught in a state of mixed morbidity; (d) a peculiar epidemiological polarization, not only between countries but also in the different geographical areas and between the various social classes of a single country. This experience is called a "prolonged polarized model."

This article presents the basic elements for developing a theory of the health transition. Such elements include the definition of concepts, the specification of a framework on the determinants of health status, the analysis of the mechanisms through which changes in health occur in populations, the characterization of the attributes that allow us to identify different transition models, and the enumeration of the possible consequences of the transition. The propositions are presented with a sufficient level of generality as to make them applicable to different contexts; at the same time, an attempt is made to provide them with the necessary specificity to account for different national experiences, thus opening a space for future comparative research efforts. Through the systematization exercise presented in this paper, we hope to contribute to the progress of a topic that has gained growing importance during recent years. Such importance is due to the enormous potential that health transition theory has for understanding and transforming the growing complexity of our times.

International health is becoming an important field of study and practice due mainly to the increasing complexity of international relationships which imply both changes in the epidemiologic profile of the population, and transformations of health care delivery systems. At the same time, the character of health problems does not recognize the geographical boundaries of nations; instead, it may open or reinforce new areas of cooperation or conflict in the international arena. The many interactions between international relations and health impose the need to build and consolidate an academic and intellectual tradition of international health, which supports its efforts to generate knowledge and leads its practical applications. International health is experiencing important conceptual and strategic changes which have to be taken into account if educational programs, research projects, and national, binational and multinational health actions are to be comprehensive in their approach, scope, and focus. This article identifies those conceptual and strategic changes, proposes basic definitions, the universe for action, and the disciplinary base of the new international health. In short, the article proposes the transition towards a new international health concept and practice.