Impact of underinsured working class. As inexperienced political leaders tried to stimulate industrialization and address poverty, their economic development was largely underwritten by loans from multilateral banks and bilateral support from states. This external development assistance was called upon to build infrastructure and obtain equipment for vertical programs to combat major diseases, to support health projects, and to provide technical assistance until national staff could be trained to take over. Those funds were available directly, and exclusively, to state governments.
For experimental treatment of water supplies, health services research, environmental pesticides, nutritional supplementation of everyday foods, and similar broad-scale interventions, individual consent may not be feasible. Entire communities may be randomized to experimental or control status. The decision to undertake the research must be made by responsible authorities on behalf of the community. Attitudes vary among human populations about the treatment of children, women, the handicapped, the elderly, and members of certain ethnic minorities and societal subgroups. The activities of health workers may conflict with locally established attitudes and cultural practices regarding abortion, family planning, the position of women, or a host of other conventions. In such cases the terms of reference of any bilateral agreement must be spelled out in particular detail and the scope of work of specific project activities of workers must be carefully described and monitored to maintain respect for the ethical precepts of the host country. In extreme situations, official policy or habitual practice results in systematic abuse of groups of people ethically unacceptable to health workers who must cancel or terminate their programs. The growth of modern biomedical science has led to increasing pressure for sites for studies such as clinical trials of new pharmaceutical products and vaccines.
As these studies and trials are conducted among local populations with varying cultural norms, the question has arisen whether it is ever justifiable to apply different ethical standards to different populations. Approval from research or human subjects review boards of local participating institutions should be obtained. if such boards do not exist, their establishment should be encouraged. Formal authorities should sign off on any study, and it would be well to coordinate with local medical societies or similar groups. Impact of Underinsured Working Class 4III.Financial Impact. Public money is spent on health interventions of low cost-effectiveness for uninsured and underinsured, such as surgery for most cancers, at the same time that critical and highly cost-effective interventions such as treatment of tuberculosis and sexually transmitted diseases (STDs) remain under-funded.