Dissertation Title:  "Priority Setting for HIV and Mental Health in Mexico: Historical, Quantitative and Ethical Perspectives"

Mexico's innovative health reforms have attracted scholarly attention beyond its own borders, making it a valuable case to study how countries set priorities. This dissertation examines the multifaceted topic of priority setting through a multidisciplinary approach: each of the three papers of this dissertation employs one of three disciplinary perspectives: historical, quantitative or normative. The dual focus on mental health and HIV--two highly stigmatized diseases with almost opposite histories of prioritization--further underscores the social and historical aspects of health priority setting. Paper 1, "Outrage and Evidence: Julio Frenk and the Politics of Mental Health Advocacy in Mexico, 1968-2006," examines the recent history of mental health advocacy efforts in Mexico. Tracing the career of Julio Frenk, a contemporary global health leader as well as Mexico's Minister of Health from 2000 to 2006, demonstrates that mental health advocacy moved from a focus on human rights abuses to a statistical-based advocacy that emphasized the burden of mental illness. Paper 2, "Beyond Universal Treatment Access: A Multi-level Study of Mental Health Care in Public HIV Clinics in Mexico," represents the first study of the availability and usage of mental health services among HIV+ individuals in Mexican HIV clinics. This paper uses multi-level modeling of a cross-sectional survey from Mexico's National Institute of Public Health to explore factors associated with patients receiving mental health care. The results indicate that clinic-level factors account for much of the observed variation in mental health care for HIV+ individuals. Paper 3, "'What Magic is there in the Pronoun `My'?' The Role of Patient and Disease Advocates in Public Deliberations about Priority Setting for Health Policy," analyzes the risks and benefits of recent, and often controversial, attempts by countries like Mexico to include this specific class of stakeholder in public deliberation for health. Patient participation does bring the risk of bias due to their partiality. However, by drawing on deliberative democratic theory, this paper argues that such partiality confers epistemic advantages to deliberation, such that, if certain procedural and substantive constraints are met, the benefit of their participation may offset the risks.