NAFTA, American Health, and Mexican Health: They Tie Together

Abstract

At first glance, the North Atlantic Free Trade Agreement (NAFTA) seems to have little to do with health social work in America. The treaty was widely publicized as a pact that opens the economies of industrialized nations (United States and Canada) to a major Third World country (Mexico). It is a type of Marshall Plan in reverse. By liberalizing the movement of goods, services, and capital, NAFTA would help Mexico pay back its debt to these nations. But closer scrutiny of the treaty unveils another scenario. Two years after the implementation of NAFTA, it is clear that the treaty will have major health and social consequences for people living in this hemisphere. Indeed, history may judge NAFTA as one of the most important social policy decisions of the United States this century. Although NAFTA brings many risks, the treaty also offers great opportunities for international healing and partnerships. Both are long overdue, especially between citizens of the United States and citizens of Mexico. Many American social workers in health care and other fields have begun the healing process already by forming coalitions and networks with Mexican colleagues and organizations. They know firsthand that American health and Mexican health are inextricably tied. This was evident at the Third International Conference of Social Work, sponsored last summer by the National School of Social Work in Mexico. Appropriately titled Civil Society: Catharsis or Mobilization? the conference was strikingly different from most recent social work conferences. The major issues were not managed care, budget cutbacks, and block grants, but democracy, social justice, and society. CIVIL SOCIETY AND HEALTH Although seldom gets mentioned in American social work literature, the quest for it has much to do with recent changes in health and social services. In the United States, the term civil society was established most effectively by Berger and Neuhaus (1977) in the classic To Empower People, which entered into the vernacular of policymakers and professionals. Mediating structures are institutions such as families, churches, synagogues, voluntary associations, and neighborhoods that come between individuals and the state. Berger and Neuhaus argued that these structures are essential for a vital democratic and that public policy should foster and protect these institutions to achieve social goals. A generation of policymakers was later influenced by this view. They believe that mediating structures can, and should, play a pivotal role in social welfare. Hence, decentralization, localism, and nongovernment interventions rivet their policy-making agendas, which have achieved some success in recent years. Indeed, the movement of many health social workers from institution-based to community-based services stems, in part, from the quest of these policymakers to strengthen in America. They want government to do less and mediating structures to do more in the delivery of services to individuals and families. But the quest for holds special significance for Mexican health social workers. Because the Mexican constitution explicitly recognizes the civic right to health protection, the national health system is largely governmental. Only 4 percent of the country's population of 90 million people purchase health care through the private sector; everyone else gets care at government hospitals and public clinics (Frenk et al., 1994). As a result, virtually all Mexican health social workers are public employees. Being employed by the government can put health social workers in a tough position. The Mexican political system cannot be considered democratic. It operates largely as a centralized, one-party state with an extremely powerful presidency and subordinate legislative and judicial branches. The party in power, the Institutional Revolutionary Party (PRI), has run the national government since 1928 and is often charged with vote-rigging and rights violations (Heredia, 1994). …