Many people in developing countries lack access to health technologies, even basic ones. Why do these problems in access persist? What can be done to improve access to good health technologies, especially for poor people in poor countries?

This book answers those questions by developing a comprehensive analytical framework for access and examining six case studies to explain why some health technologies achieved more access than others. The technologies include praziquantel (for the treatment of schistosomiasis), hepatitis B vaccine, malaria rapid diagnostic tests, vaccine vial monitors for temperature exposure, the Norplant implant contraceptive, and female condoms. Based on research studies commissioned by the Bill & Melinda Gates Foundation to better understand the development, adoption, and uptake of health technologies in poor countries, the book concludes with specific lessons on strategies to improve access. These lessons will be of keen interest to students of health and development, public health professionals, and health technology developers—all who seek to improve access to health technologies in poor countries.

Do people of differing ethnicities, cultures, and races view medicine and bioethics differently? And, if they do, should they? Are doctors and researchers taking environmental perspectives into account when dealing with patients? If so, is it done effectively and properly?

In African American Bioethics, Lawrence J. Prograis Jr. and Edmund D. Pellegrino bring together medical practitioners, researchers, and theorists to assess one fundamental question: Is there a distinctive African American bioethics?

The book's contributors resoundingly answer yes—yet their responses vary. They discuss the continuing African American experience with bioethics in the context of religion and tradition, work, health, and U.S. society at large—finding enough commonality to craft a deep and compelling case for locating a black bioethical framework within the broader practice, yet recognizing profound nuances within that framework.

As a more recent addition to the study of bioethics, cultural considerations have been playing catch-up for nearly two decades. African American Bioethics does much to advance the field by exploring how medicine and ethics accommodate differing cultural and racial norms, suggesting profound implications for growing minority groups in the United States.

Public silence in policymaking can be deafening. When advocates for a disadvantaged group decline to speak up, not only are their concerns not recorded or acted upon, but also the collective strength of the unspoken argument is lessened—a situation that undermines the workings of deliberative democracy by reflecting only the concerns of more powerful interests.

But why do so many advocates remain silent on key issues they care about and how does that silence contribute to narrowly defined policies? What can individuals and organizations do to amplify their privately expressed concerns for policy change?

In Healthy Voices, Unhealthy Silence, Colleen M. Grogan and Michael K. Gusmano address these questions through the lens of state-level health care advocacy for the poor. They examine how representatives for the poor participate in an advisory board process by tying together existing studies; extensive interviews with key players; and an in-depth, first-hand look at the Connecticut Medicaid advisory board's deliberations during the managed care debate. Drawing on the concepts of deliberative democracy, agenda setting, and nonprofit advocacy, Grogan and Gusmano reveal the reasons behind advocates' often unexpected silence on major issues, assess how capable nonprofits are at affecting policy debates, and provide prescriptive advice for creating a participatory process that adequately addresses the health care concerns of the poor and dispossessed.

Though exploring specifically state-level health care advocacy for the poor, the lessons Grogan and Gusmano offer here are transferable across issue areas and levels of government. Public policy scholars, advocacy organizations, government workers, and students of government administration will be well-served by this significant study.

Just Care is Akemi Nishida’s thoughtful examination of care injustice and social justice enabled through care. The current neoliberal political economy has turned care into a business opportunity for the healthcare industrial complex and a mechanism of social oppression and control. Nishida analyzes the challenges people negotiate whether they are situated as caregivers, receivers, or both. Also illuminated is how people with disabilities come together to assemble community care collectives and bed activism (resistance and visions emerging from the space of bed) to reimagine care as a key element for social change.

The structure of care, Nishida writes, is deeply embedded in and embodies the cruel social order—based on disability, race, gender, migration status, and wealth—that determines who survives or deteriorates. Simultaneously, many marginalized communities treat care as the foundation of activism. Using interviews, focus groups, and participant observation with care workers and people with disabilities, Just Care looks into lives unfolding in the assemblage of Medicaid long-term care programs, community-based care collectives, and bed activism. Just Care identifies what care does, and asks: How can we activate care justice or just care where people feel cared affirmatively and care being used for the wellbeing of community and for just world making?

The last fifteen years have seen a tremendous growth in the number of health rights cases focusing on issues such as access to health services and essential medications. This volume examines the potential of litigation as a strategy to advance the right to health by holding governments accountable for these obligations. It includes case studies from Costa Rica, South Africa, India, Brazil, Argentina and Colombia, as well as chapters that address cross-cutting themes.

The authors analyze what types of services and interventions have been the subject of successful litigation and what remedies have been ordered by courts. Different chapters address the systemic impact of health litigation efforts, taking into account who benefits both directly and indirectly—and what the overall impacts on health equity are.

“I’m covered—why should I foot the bill for somebody who isn’t?”

This question, unspoken but simmering at the center of the debate over universal health care coverage, comes in for a thoughtful hearing—and, perhaps, gentle corrective—in Larry Churchill’s timely book. Churchill, whose Rationing Health Care in America put the nation’s health care crisis into perspective, here does the same for our crisis of conscience over health care coverage. As Clinton and Congress spar over the financing and organization of a national health system, the true debate, this book reveals, is about moral and political values, about the meaning and ethics of health care reform.

Churchill begins by cutting through the confused discussion about rationing health care. Concerns about rationing, with all the moral and political questions they raise, deflect our attention from a more important issue, which this book brings into focus. Arguing that care is already rationed by ability to pay, Churchill suggests that the proper question is not whether to ration but how to do so fairly, and that answering requires a clear sense of the aims of a health care system. In pursuit of this necessary understanding, Churchill explores values and concepts such as security and solidarity, self-interest and social affinity, rights and responsibilities. Drawing on philosophical ideas of justice and individual responsibility, rendered here with remarkable clarity, he shows that universal care is morally as well as economically comprehensible and that a truly inclusive health care system should be seen as a common civic purpose rather than as a supply of services to be consumed. Accessible, deeply felt, and cogently argued, this book should revise the terms of the national debate over health care reform.