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INFORME ALTERNATIVO SOBRE LA SALUD EN AMERICA LATINAnot considered as "highly profitable". Within the sameevent, an international commission put forward a"combined approaches matrix" [Ghaffar; De Francisco;Matlin, 2004] to prioritize investments in research basedevidences. The flaws of the model depicted cannotbe fully discussed here; I can only underline that,albeit the cited matrix proposes a broader analysisfield that acknowledges the impact of macroeconomicpolicies, the health system, and other sectors such aslabor, legal standards, education, and ecological problemsas health determinants. It nevertheless reproducesthe conventional reduction of interventions to theinstitutional sphere, without putting forward any seriouscritique of the consequences of social dominanceand the associated inequitable power structure.The Alternative Report:Critical Thinking and Liberating ActionThe Alternative Health Report for Latin Americapresupposes a critique of the pathogenic effects of socialinequity and the need to transform the prevailingpower structure as a way to achieve a healthy and dignifyingquality of life for our people, and as a basis forsustainable institutional and technical changes in thehealth field.Thus, the construction of an authentic alternativeapproach presupposes a critical knowledgeparadigm and transforming view of intervention inhealth.To fulfill its commitment, in its first part the AlternativeReport penetrates the devastating effects ofthe economic accumulation model applied within LatinAmerica in the last decades. The idea is not merelyto speak of globalization, as there is no contemporaryforum in which problems are not interpreted and justifiedalluding to globalization, as an issue of worldwideeconomic and market system relations.The idea isto visualize the new characteristics of our social systemwhich distinguish it from other epochs that haveimmense weight and influence on health.In late capitalism, the technological basis of digitalcommunication and other technical resources arecrucial. Even if it is important to acknowledge the significanceof this technological revolution, we must notdisregard the fact that the roots of present social dominationreside rather in the structural processes of anew capital accumulation system, defined by Harvey asthe accumulation by dispossession [Harvey, 2003]. Accordingto this author, contemporary capitalist logicnot only exerts itself through the extraction of surplusvalue from workers and the traditional market mechanisms,but it now depends heavily on truly predatoryforms of practice, fraud and violent exaction, whichare imposed by taking advantage of inequalities andpower asymmetries to dispossess weaker countries orvulnerable groups directly.Case studies rendered throughout the differentchapters of section I ("El Modelo de Acumulación porDespojo y la Salud" - Accumulation Model by Dispossessionand Health) examine the extreme impoverishmentof peoples, the destruction of their living conditions,and the deterioration of environmental integrity.They illustrate how the logic of large corporationsoperate, whose profit increases demolishing livingconditions, while social mobilization struggles creativelyto defend human rights and health. Distinct chaptersinterweave to illustrate the expansion of monopoliesthat permanently reinvent mechanism of socialand cultural subordination and inequity; the institutionalizationof violence; the cases of deregulation of laborand social protection laws, with the ensuing degradationof working and living conditions; the gradualtransformation of human rights into commodities; thecases of cultural aggression; and the varied manners ofbiodiversity destruction.In section II ("Esa Otra Salud Posible" - That OtherHealth Which is Possible), a more optimistic or18
Observatorio Latinoamericano de Salud.progressive side of Latin American health is presentedregarding the advances accomplished by national andlocal governments of humane social nature, in spite ofthe previously cited adverse conditions.Workers’ victoriesin defense of justice and living conditions aredocumented and illuminated, like the case of recuperatedfactories in Argentina and successful self-managedcommunity driven proposals are explained. Evenfields conventionally considered as tangent to healthare taken into account, like the case of emancipatorysports programs in Brazil. And finally, experiences ofintercultural relations that tender bridges among peoples’different knowledge bases and the liberating academicknowledge that is resultant to this interchangeis illustrated.Creating this report from design to completionin a short five month period, with Spanish and Englishversions simultaneously prepared, CEAS (Health Studiesand Advisement Center, Quito-Ecuador) defined afast moving strategy, identifying key issues and callingfor the contribution of specialists and social organizationswith which it had developed fraternal work duringits two and a half decades of institutional strugglefor collective health. Overall, our summon was positivelyresponded to by 60 individual authors from tenseparate countries, and more than 30 organizations ofthe region (among the most representative academicnucleus or peoples’ organizations). Obviously, an effortof this magnitude could not achieve in such a short timeall the desirable characteristics of a complete LatinAmerican Report; however, its representativenessand authenticity are supported and justified by thescientific and political relevance of the work its authorsand their organizations have accomplished. TheAlternative Report coming from such a diverse set ofexperiences attains unity in the emancipatory natureof their resistance against the irrational, genocidal, andinhumane social system in which we live.We sincerely hope that the Alternative Reportwill accomplish the two basic goals that inspired its devising:to become part of our collective memory in theprogressive sense that the celebration of memory acquireswhen, as Subcommander Marcos stated, memoryfaces tomorrow and "…that paradox makes itpossible to avoid the same nightmares and thus recreatehappiness"; and secondly, to make clear the differencethat Brecht established between conservativerhetoric and emancipatory cultural works: not being "asimple mirror held up to reality but a hammer withwhich to shape it".The Alternative Health Report reaffirms ourright to build our collective memory, without mediationsof the powerful, as the peoples´ memory is onlyliberating when it registers the substantial side of theirpains and happiness, when it nourishes and celebratesa different tomorrow.REFERENCES● BREILH, JAIME & AL (1990). Deterioro de la Vida: Un Instrumentopara Análisis de Prioridades Regionales en lo Social y la Salud.Quito: Corporación Editora Nacional.● BREILH, JAIME (2002) El Asalto a Los Derechos Humanos y elOtro Mundo Posible. Quito: Espacios, 11: 71-82.● HALL, GILLETTE; PATRINOS,ANTHONY (2005) Pueblos Indígenas,Pobreza y Desarrollo Humano en América Latina.Washington:Banco Mundial.● GHAFFAR, ABDUL; DE FRANCISCO, ANDRÉS; MATLIN, STEP-HEN (2004) The Combined Approach Matrix: A Priority SettingTool for Health Research. Geneve: Global Forum for Health Research.● HARVEY, DAVID (2003) The New Imperialism. Oxford:The OxfordUniversity Press● WAITZKIN,HOWARD; IRIART, CELIA; ESTRADA, ALFREDO;LAMADRID, SILVIA (2001) . Social Medicine Then and Now: Lessonsfrom Latin America.American Journal of Public Health, October,Vol91, No. 10 1592-160119
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