Marco teórico para la gestión descentralizada de las políticas de salud
Keywords:
centralización, descentralización, salud pública, ciudad saludableAbstract
Se analiza la relación que hay entre centralización y descentralización como herramientas político-administrativas para la gestión de los asuntos públicos, teniendo en consideración el concepto de unidad territorial del Estado, y cómo esa relación debe tenerse en cuenta cuando se definen políticas de descentralización para el sector salud, de tal manera que la búsqueda de mayor eficiencia institucional no contradiga el concepto de integralidad con el que deben orientarse las variables determinantes del proceso salud-enfermedad de las comunidades.
Se hace una revisión de la articulación entre disposiciones centralistas y descentralistas en algunas legislaciones consideradas hitos históricos en el desarrollo de la salud pública, tales como la Ley de Salud Pública, de 1848 en Gran Bretaña, el modelo bismarckiano de seguridad social instaurado en Alemania en 1883, el modelo socialista de aseguramiento de la salud en la Unión Soviética Nacional de Salud en funcionamiento en el Reino Unido en 1948.
Se propone asumir en la ciudad de Medellín la política de Ciudad Saludable como mecanismo para afrontar integralmente los problemas de salud de la comunidad.
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