Health and medicine 20 years after the Soviet Union

Health and medicine 20 years after the Soviet Union

This article is part of the series: Twenty years after the Soviet Union

Nearly two decades have now passed since the dissolution of the Soviet Union. Over the next several months we will be running a series of articles which consider a specific issues related to health and medicine in the former Soviet Union. The articles comprising “20 Years After the Soviet Union” will highlight research by anthropologists and other social scientists on topics including psychiatric deinstitutionalization, HIV/AIDS, disability rights and population health.

By way of introduction, I’d like to mention a recent special issue of the open-access journal, the Anthropology of East Europe Review on “Health and Care Work in Postsocialist Eastern Europe and the Former Soviet Union.” A number of the authors in this issue will also be contributing posts to our series, so look for them in the weeks and months ahead. (For those articles which do not have abstracts, I have selectively quoted from introductory paragraphs).

“Health and Care Work in Postsocialist Eastern Europe and the Former Soviet Union,” a special issue of Anthropology of East Europe Review

Maryna Y. Bazylevych, Ema Hresanova, Introduction: Health and Care Work in Postsocialist Eastern Europe and the former Soviet Union

Michele Rivkin-Fish, Health, Gender, and Care Work: Productive Sites for Thinking Anthropologically about the Aftermaths of Socialism

Anthropological approaches to the study of health open up a range of questions and ways of conceptualizing social processes that are particularly valuable for understanding the transformations underway in the aftermath of state socialism. While public health and demographic analyses capture important macro-level shifts—from the dire spikes in Russia‘s male mortality and sexually transmitted infection rates that began in the early 1990s, to reductions in fertility and abortion that have continued throughout the region for over twenty years—public health scholars‘ efforts to understand these shifts are fraught with methodological and theoretical limitations that too rarely go unexamined. Anthropologists’ contributions to the study of health are thus important in several ways. First, they bring together attention to macro-level changes with ethnographic-based inquiry into what such shifts mean to the various persons and institutions involved in them. Second, the anthropological lens requires us to reflect continuously upon the assumptions and interests that guide our research in light of the meanings, practices, and contradictions we encounter in the field. This iterative, reflexive, and critical attention to our own analytical processes serves, ideally, as a safeguard against unwittingly projecting our own assertions of the real or the important onto others‘ lives. At the very least, we need to articulate and justify our perspectives and our questions, and clarify their relevance vis-a-vis the concerns of local actors.

In this brief essay, I propose that questions related to health after socialism help explain the trajectories and trials of life (and death) in former socialist contexts by revealing how daily life is embedded in shifting formations of citizenship, practices of distinguishing public and private, and changing notions of personhood. I also suggest that anthropological aims to understand the complex changes in this region critically—that is, through the continual questioning of our own assumptions and paradigms as outsiders—may require us to engage more closely with scholars from the region. If anthropologists have done much to consider health as a situated and historical practice, we have perhaps done less to examine our own production of knowledge about health and postsocialism in this light. I will conclude by arguing the need to enrich our analyses through more systematic processes of dialogue and debate with our colleagues in Eastern Europe and Eurasia.

Kate Schecter, The Privatization of the Georgian Healthcare System

This article will examine the dramatic changes that have occurred in Georgian healthcare since the Rose Revolution of 2003. What were the motives for the abrupt privatization of the Georgian economy, including the healthcare sector? The research for this article draws on interviews with Georgian physicians and healthcare administrators, the few reports that have been written about the attempts at privatization, lectures by Georgian politicians who have come to the US to explain the reform processes in Georgia, and my own observations working for the American International Health Alliance in Georgia over the past decade.

Jennifer Carroll, A Woman Among Addicts: The Production and Management of Identities in a Ukrainian Harm Reduction Program

When HIV first appeared in Ukraine in the mid-1990s, it spread like wildfire through users of injected narcotics. By 2008, Ukraine was estimated to be home to 29% of all reported cases of HIV in Eastern Europe and Central Asia, making it the nation with the highest infection rate per capita in the region (UNAIDS 2008:24)…. In response to this, many non-governmental organizations have formed to implement prevention efforts among drug users specifically…In this article, I share a few insights about drug use as a social marker and women’s access to prevention programs, which were gained through several weeks of observations and interviews at [a non-profit HIV-prevention program in southern Ukraine]….

I argue that the daily interactions of both current and former injection drug users at [the program] are mediated by this social and biomedical identity in a way that shapes not only their behaviors and relationships, but also affects their access to different social roles and physical spaces. Furthermore, I argue that this social construct that defines who and what an injection drug user is has primarily incorporated masculine tropes of identity. Simply put, drug users are generally assumed to be male. This puts female addicts, who already suffer greater social and logistical obstacles in accessing preventative and therapeutic health care (Pinkham and Shapoval 2010), in an even more difficult position.

Shelly Yankovsky, Neoliberal Transitions in Ukraine: The View from Psychiatry

This paper will explore how mental health reforms in Ukraine—specifically the push for community mental health services—are playing out on the ground through provider and patient perspectives. I focus especially on the human rights discourse that is often utilized by mental health activists as a way to package these issues. I argue that the international agenda promoted in Ukraine, which pushes for western neoliberal-based political and economic reforms, has produced cultural and structural discrepancies and tensions which can be seen in the mental health field. Amid these cultural and structural changes, moreover, the neoliberal agenda forces Ukrainians to replace deeply rooted cultural tenants shaped by socialism with those of western capitalism. Human rights discourse has been adopted by a non-governmental organization (NGO) called ―Human Rights for Psychiatric Patients‖ or HRPP, as a way to mediate these processes of cultural change induced by transformations in political economy. I use psychiatry and mental health as a window into this struggle.

Rosie Read, Humanising Healthcare: Volunteered caring and the free gift in Czech hospitals

The past decade has seen a marked proliferation of volunteering programs in Czech hospitals. These have been established with the help of national and international funding and take various organisational forms. For the most part, these programs enable lay citizens to provide hospitalized patients with company and social support for a few hours per week. This article considers the ways in which hospital volunteering is promoted and understood as a free gift, in anthropological terms (Parry 1986, Laidlaw 2000). Specifically, I probe why it is possible and desirable for participants on volunteering programs to think about volunteering in this way. I argue that the social construction of volunteering as a free gift promotes a particular ideology of autonomous personhood, which, when considered alongside other political and economic developments in Czech healthcare over the past two decades, can be thought of as part of its neoliberal transformation.

Inna Leykin, Population Prescriptions: (Sanitary) Culture and Biomedical Authority in Contemporary Russia

Russia’s population has been rapidly decreasing for several decades. Political fears over falling birthrates and growing mortality rates have recently reemerged as a staple in every conversation concerning the future of the Russian nation. In May 2006, in his annual address to the Federal Assembly, President Vladimir Putin identified Russia’s decreasing population as the most acute issue facing the country. Later that year, the government launched a new, high-priority policy to address the “demographic problem,” which was built around monetary incentives for women to have multiple children. As the state made an effort to revise and implement its new policy measures, different groups of experts took part in the debate about the demographic future of the nation. Alongside demographers and social scientists, medical and public health experts became visible as playing a crucial role in this debate.

To address the role of this community of experts in Russia’s most heated debate, this paper examines how a group of obstetricians and gynecologists in the large provincial city of Yekaterinburg, Russia appropriate existing discourses of the “crisis of underpopulation” and demographic policies, and assign new cultural and social meanings to them in their clinical and research practices. An ethnographic study I conducted among these medical professionals demonstrates how they negotiate their power not only through individual patient care (Rivkin-Fish 2005), but also outside their clinics as they participate in the demographic debate and in the development of regional family planning programs.

Elianne Riska, Aurelija Novelskaite, Professionalism and Medical Work in a Post-Soviet Society: Between Four Logics

The relationship between the state, the market and professions has been in focus of sociological theories on professions. This study explores how Lithuanian physicians perceive these three sectors, called logics in sociological theories, to influence their work in a health care context which has experienced a rapid change.

The results show that the physicians perceived the state regulated health care system as a limitation to their professional identity and practice. Market elements of care did not seem to work and instead two other mechanisms bridged the provision of services between the client and the physician: peer referrals and gift-giving. The peer referral system enabled physicians to directly refer patients to a professional colleague outside the formal referral system and thereby to improve access to health services that the state directed system could not handle efficiently. Gift-giving and gratitude payments provided some consumer influence in the delivery of health services in a failing market system. The conclusion is that in a post-socialist health care system physicians are often operating in a system guided by four logics: the state, the market, professional culture, and the informal economy of peer referrals, gift giving, and extra payments.

Heidi Bludau, Producing Transnational Nurses: Agency and subjectivity in global health care labor migration recruitment practices

Globally, healthcare worker shortages are increasing, giving rise to a need for a migratory healthcare labor population (Buchan 2006; Choy 2003; Kingma 2006; Ross, et al. 2005; Võrk, et al. 2004; Zulauf 2001). Countries such as India and the Philippines have long-term experience with this practice, often operating state-run placement services to place nurses in countries such as the United States, United Kingdom, and Saudi Arabia. Recently, new origin countries have entered the global market. Healthcare workers from Central and Eastern Europe are being recruited for this work and are increasingly discovering the opportunities available to them as in-demand, mobile professionals. However, entering this labor market is not simple and workers often need recruitment firms to mediate the complex process of transnational skilled labor. Negotiating between the different labor and cultural environments, these staffing firms must ensure that the laborers they represent will be successful on the job market. They train them accordingly, essentially ―producing migrants. This article uses the Czech Republic as a case study to explore this phenomenon.

Larisa Jasarevic, Lucid dreaming: Revisiting medical pluralism in postsocialist Bosnia

Starting with th[e] basic premise that economism and cosmology do not explain the new health practices in post-socialism, I bring an ethnographic attention to plural forms of health care that tend to the experience of barely living, to invite a rethinking of the relationship between embodiment—local forms of bodily being in the world—and economic forms. Anthropology and critical political economy have long questioned the assumptions that body and economy are separate domains. Medical anthropology has shown pluralism to be the norm rather than an exception in health care the world over, notwithstanding the global dominance of biomedicine and pharmaceuticals. My inquiry into the relation of market and health, however, shifts the focus from symbolic anthropology and local cosmologies to plurality and materiality of bodies. Following the local medical travels, bodies emerge as ontologically plural, inasmuch as they lend credence to multiple forms of diagnostic assessment of the same aches and complaints. Bodies also respond to therapeutic management along divergent maps of organs, fluids, or energies or treat a physical ill or well being as extending beyond the bodily limits and accessible to spiritual entities and other incorporeal extensions, such as thoughts, looks, and wishes of benevolent or envious others. The aim of this paper is to revisit theories of medical pluralism with an eye on the Bosnian lived reality and efficacy of experience, to ask whether bodily ontology, not only medical epistemology, might not be plural.

Dorian Singh, Attitudes and Praxis of Traditional Forms of Health Care in a Post-Communist Romanian Romani Community

Prior to the communist period most Romanian Romani communities depended mainly on traditional healing methods as a primary source of health care. After its ascension to power, the Romanian communist government introduced a universal, Semashko-style health care system. The implementation of these requirements dramatically disrupted the traditional health care patterns for Romani communities for over 40 years. Since the collapse of communism these constraints have been lifted and social health insurance (SHI) has been adopted in Romania. Insurance coverage is based on formal participation in the labour market. It is well established that the Roma have fared poorly during the transition to liberal democracy and have suffered particularly in the labour market. Consequently, many Roma are unable to qualify for SHI and remain uninsured and in poverty. Understood within this context, it could be expected that a resurgence in and reclamation of traditional healing methods in the Romani community might be found. This paper draws upon qualitative data from Romani groups in Bucharest and explores the practice, perceptions, and attitudes toward traditional health care in a socially liberalized and increasingly market-driven Romania.

Steve Jobs has died

Image via Wikipedia

Steve Jobs has died. From the NYT

By JOHN MARKOFF

Published: October 5, 2011

Steven P. Jobs, the visionary co-founder of Apple who helped usher in the era of personal computers and then led a cultural transformation in the way music, movies and mobile communications were experienced in the digital age, died Wednesday. He was 56.

Steve Jobs’s Patents

Apple’s iPad Tablet

Jobs’s Stanford Address, 2005: Video (youtube.com) | Text

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The death was announced by Apple, the company Mr. Jobs and his high school friend Stephen Wozniak started in 1976 in a suburban California garage.

Mr. Jobs had waged a long and public struggle with cancer, remaining the face of the company even as he underwent treatment. He continued to introduce new products for a global market in his trademark blue jeans even as he grew gaunt and frail.

He underwent surgery for pancreatic cancer in 2004, received a liver transplant in 2009 and took three medical leaves of absence as Apple’s chief executive before stepping down in August and turning over the helm to Timothy D. Cook, the chief operating officer. When he left, he was still engaged in the company’s affairs, negotiating with another Silicon Valley executive only weeks earlier.

“I have always said that if there ever came a day when I could no longer meet my duties and expectations as Apple’s C.E.O., I would be the first to let you know,” Mr. Jobs said in a letter released by the company. “Unfortunately, that day has come.”

By then, having mastered digital technology and capitalized on his intuitive marketing sense, Mr. Jobs had largely come to define the personal computer industry and an array of digital consumer and entertainment businesses centered on the Internet. He had also become a very rich man, worth an estimated $8.3 billion.

Eight years after founding Apple, Mr. Jobs led the team that designed the Macintosh computer, a breakthrough in making personal computers easier to use. After a 12-year separation from the company, prompted by a bitter falling-out with his chief executive, John Sculley, he returned in 1997 to oversee the creation of one innovative digital device after another — the iPod, the iPhone and the iPad. These transformed not only product categories like music players and cellphones but also entire industries, like music and mobile communications.

During his years outside Apple, he bought a tiny computer graphics spinoff from the director George Lucas and built a team of computer scientists, artists and animators that became Pixar Animation Studios.

Starting with “Toy Story” in 1995, Pixar produced a string of hit movies, won several Academy Awards for artistic and technological excellence, and made the full-length computer-animated film a mainstream art form enjoyed by children and adults worldwide.

Mr. Jobs was neither a hardware engineer nor a software programmer, nor did he think of himself as a manager. He considered himself a technology leader, choosing the best people possible, encouraging and prodding them, and making the final call on product design.

It was an executive style that had evolved. In his early years at Apple, his meddling in tiny details maddened colleagues, and his criticism could be caustic and even humiliating. But he grew to elicit extraordinary loyalty.

“He was the most passionate leader one could hope for, a motivating force without parallel,” wrote Steven Levy, author of the 1994 book “Insanely Great,” which chronicles the creation of the Mac. “Tom Sawyer could have picked up tricks from Steve Jobs.”

“Toy Story,” for example, took four years to make while Pixar struggled, yet Mr. Jobs never let up on his colleagues. “‘You need a lot more than vision — you need a stubbornness, tenacity, belief and patience to stay the course,” said Edwin Catmull, a computer scientist and a co-founder of Pixar. “In Steve’s case, he pushes right to the edge, to try to make the next big step forward.”

Mr. Jobs was the ultimate arbiter of Apple products, and his standards were exacting. Over the course of a year he tossed out two iPhone prototypes, for example, before approving the third, and began shipping it in June 2007.

To his understanding of technology he brought an immersion in popular culture. In his 20s, he dated Joan Baez; Ella Fitzgerald sang at his 30th birthday party. His worldview was shaped by the ’60s counterculture in the San Francisco Bay Area, where he had grown up, the adopted son of a Silicon Valley machinist. When he graduated from high school in Los Altos in 1972, he said, ”the very strong scent of the 1960s was still there.”

After dropping out of Reed College, a stronghold of liberal thought in Portland, Ore., in 1972, Mr. Jobs led a countercultural lifestyle himself. He told a reporter that taking LSD was one of the two or three most important things he had done in his life. He said there were things about him that people who had not tried psychedelics — even people who knew him well, including his wife — could never understand.

Decades later he flew around the world in his own corporate jet, but he maintained emotional ties to the period in which he grew up. He often felt like an outsider in the corporate world, he said. When discussing the Silicon Valley’s lasting contributions to humanity, he mentioned in the same breath the invention of the microchip and “The Whole Earth Catalog,” a 1960s counterculture publication.

Apple’s very name reflected his unconventionality. In an era when engineers and hobbyists tended to describe their machines with model numbers, he chose the name of a fruit, supposedly because of his dietary habits at the time.

Coming on the scene just as computing began to move beyond the walls of research laboratories and corporations in the 1970s, Mr. Jobs saw that computing was becoming personal — that it could do more than crunch numbers and solve scientific and business problems — and that it could even be a force for social and economic change. And at a time when hobbyist computers were boxy wooden affairs with metal chassis, he designed the Apple II as a sleek, low-slung plastic package intended for the den or the kitchen. He was offering not just products but a digital lifestyle.

He put much stock in the notion of “taste,” a word he used frequently. It was a sensibility that shone in products that looked like works of art and delighted users. Great products, he said, were a triumph of taste, of “trying to expose yourself to the best things humans have done and then trying to bring those things into what you are doing.”

Regis McKenna, a longtime Silicon Valley marketing executive to whom Mr. Jobs turned in the late 1970s to help shape the Apple brand, said Mr. Jobs’s genius lay in his ability to simplify complex, highly engineered products, “to strip away the excess layers of business, design and innovation until only the simple, elegant reality remained.”

Mr. Jobs’s own research and intuition, not focus groups, were his guide. When asked what market research went into the iPad, Mr. Jobs replied: “None. It’s not the consumers’ job to know what they want.”

Early Interests

Steven Paul Jobs was born in San Francisco on Feb. 24, 1955, and put up for adoption by his biological parents, Joanne Carole Schieble and Abdulfattah Jandali, a graduate student from Syria who became a political science professor. He was adopted by Paul and Clara Jobs.

The elder Mr. Jobs, who worked in finance and real estate before returning to his original trade as a machinist, moved his family down the San Francisco Peninsula to Mountain View and then to Los Altos in the 1960s.

Mr. Jobs developed an early interest in electronics. He was mentored by a neighbor, an electronics hobbyist, who built Heathkit do-it-yourself electronics projects. He was brash from an early age. As an eighth grader, after discovering that a crucial part was missing from a frequency counter he was assembling, he telephoned William Hewlett, the co-founder of Hewlett-Packard. Mr. Hewlett spoke with the boy for 20 minutes, prepared a bag of parts for him to pick up and offered him a job as a summer intern.

Mr. Jobs met Mr. Wozniak while attending Homestead High School in neighboring Cupertino. The two took an introductory electronics class there.

The spark that ignited their partnership was provided by Mr. Wozniak’s mother. Mr. Wozniak had graduated from high school and enrolled at the University of California, Berkeley, when she sent him an article from the October 1971 issue of Esquire magazine. The article, “Secrets of the Little Blue Box,” by Ron Rosenbaum, detailed an underground hobbyist culture of young men known as phone phreaks who were illicitly exploring the nation’s phone system.

Mr. Wozniak shared the article with Mr. Jobs, and the two set out to track down an elusive figure identified in the article as Captain Crunch. The man had taken the name from his discovery that a whistle that came in boxes of Cap’n Crunch cereal was tuned to a frequency that made it possible to make free long-distance calls simply by blowing the whistle next to a phone handset.

Captain Crunch was John Draper, a former Air Force electronic technician, and finding him took several weeks. Learning that the two young hobbyists were searching for him, Mr. Draper appeared one day in Mr. Wozniak’s Berkeley dormitory room. Mr. Jobs, who was still in high school, had traveled to Berkeley for the meeting. When Mr. Draper arrived, he entered the room saying simply, “It is I!”

Based on information they gleaned from Mr. Draper, Mr. Wozniak and Mr. Jobs later collaborated on building and selling blue boxes, devices that were widely used for making free — and illegal — phone calls. They raised a total of $6,000 from the effort.

After enrolling at Reed College in 1972, Mr. Jobs left after one semester, but remained in Portland for another 18 months auditing classes. In a commencement address given at Stanford in 2005, he said he had decided to leave college because it was consuming all of his parents’ savings.

Leaving school, however, also freed his curiosity to follow his interests. “I didn’t have a dorm room,” he said in his Stanford speech, “so I slept on the floor in friends’ rooms, I returned Coke bottles for the 5-cent deposits to buy food with, and I would walk the seven miles across town every Sunday night to get one good meal a week at the Hare Krishna temple. I loved it. And much of what I stumbled into by following my curiosity and intuition turned out to be priceless later on.”

He returned to Silicon Valley in 1974 and took a job there as a technician at Atari, the video game manufacturer. Still searching for his calling, he left after several months and traveled to India with a college friend, Daniel Kottke, who would later become an early Apple employee. Mr. Jobs returned to Atari that fall. In 1975, he and Mr. Wozniak, then working as an engineer at H.P., began attending meetings of the Homebrew Computer Club, a hobbyist group that met at the Stanford Linear Accelerator Center in Menlo Park, Calif. Personal computing had been pioneered at research laboratories adjacent to Stanford, and it was spreading to the outside world.

“What I remember is how intense he looked,” said Lee Felsenstein, a computer designer who was a Homebrew member. “He was everywhere, and he seemed to be trying to hear everything people had to say.”

Mr. Wozniak designed the original Apple I computer simply to show it off to his friends at the Homebrew. It was Mr. Jobs who had the inspiration that it could be a commercial product.

In early 1976, he and Mr. Wozniak, using their own money, began Apple with an initial investment of $1,300; they later gained the backing of a former Intel executive, A. C. Markkula, who lent them $250,000. Mr. Wozniak would be the technical half and Mr. Jobs the marketing half of the original Apple I Computer. Starting out in the Jobs family garage in Los Altos, they moved the company to a small office in Cupertino shortly thereafter.

In April 1977, Mr. Jobs and Mr. Wozniak introduced Apple II at the West Coast Computer Faire in San Francisco. It created a sensation. Faced with a gaggle of small and large competitors in the emerging computer market, Apple, with its Apple II, had figured out a way to straddle the business and consumer markets by building a computer that could be customized for specific applications.

Sales skyrocketed, from $2 million in 1977 to $600 million in 1981, the year the company went public. By 1983 Apple was in the Fortune 500. No company had ever joined the list so quickly.

The Apple III, introduced in May 1980, was intended to dominate the desktop computer market. I.B.M. would not introduce its original personal computer until 1981. But the Apple III had a host of technical problems, and Mr. Jobs shifted his focus to a new and ultimately short-lived project, an office workstation computer code-named Lisa.

An Apocalyptic Moment

By then Mr. Jobs had made his much-chronicled 1979 visit to Xerox’s research center in Palo Alto, where he saw the Alto, an experimental personal computer system that foreshadowed modern desktop computing. The Alto, controlled by a mouse pointing device, was one of the first computers to employ a graphical video display, which presented the user with a view of documents and programs, adopting the metaphor of an office desktop.

“It was one of those sort of apocalyptic moments,” Mr. Jobs said of his visit in a 1995 oral history interview for the Smithsonian Institution. “I remember within 10 minutes of seeing the graphical user interface stuff, just knowing that every computer would work this way someday. It was so obvious once you saw it. It didn’t require tremendous intellect. It was so clear.”

In 1981 he joined a small group of Apple engineers pursuing a separate project, a lower-cost system code-named Macintosh. The machine was introduced in January 1984 and trumpeted during the Super Bowl telecast by a 60-second commercial, directed by Ridley Scott, that linked I.B.M., by then the dominant PC maker, with Orwell’s Big Brother.

A year earlier Mr. Jobs had lured Mr. Sculley to Apple to be its chief executive. A former Pepsi-Cola chief executive, Mr. Sculley was impressed by Mr. Jobs’s pitch: “Do you want to spend the rest of your life selling sugared water, or do you want a chance to change the world?”

He went on to help Mr. Jobs introduce a number of new computer models, including an advanced version of the Apple II and later the Lisa and Macintosh desktop computers. Through them Mr. Jobs popularized the graphical user interface, which, based on a mouse pointing device, would become the standard way to control computers.

But when the Lisa failed commercially and early Macintosh sales proved disappointing, the two men became estranged and a power struggle ensued, and Mr. Jobs lost control of the Lisa project. The board ultimately stripped him of his operational role, taking control of the Lisa project away from, and 1,200 Apple employees were laid off. He left Apple in 1985.

“I don’t wear the right kind of pants to run this company,” he told a small gathering of Apple employees before he left, according to a member of the original Macintosh development team. He was barefoot as he spoke, and wearing blue jeans.

That September he announced a new venture, NeXT Inc. The aim was to build a workstation computer for the higher-education market. The next year, the Texas industrialist H. Ross Perot invested $20 million in the effort. But it did not achieve Mr. Jobs’s goals.

Mr. Jobs also established a personal philanthropic foundation after leaving Apple but soon had a change of heart, deciding instead to spend much of his fortune — $10 million — on acquiring Pixar, a struggling graphics supercomputing company owned by the filmmaker George Lucas.

The purchase was a significant gamble; there was little market at the time for computer-animated movies. But that changed in 1995, when the company, with Walt Disney Pictures, released “Toy Story.” That film’s box-office receipts ultimately reached $362 million, and when Pixar went public in a record-breaking offering, Mr. Jobs emerged a billionaire. In 2006, the Walt Disney Company agreed to purchase Pixar for $7.4 billion. The sale made Mr. Jobs Disney’s largest single shareholder, with about 7 percent of the company’s stock.

His personal life also became more public. He had a number of well-publicized romantic relationships, including one with the folk singer Joan Baez, before marrying Laurene Powell. In 1996, a sister, the novelist Mona Simpson, threw a spotlight on her relationship with Mr. Jobs in the novel “A Regular Guy.” The two did not meet until they were adults. The novel centered on a Silicon Valley entrepreneur who bore a close resemblance to Mr. Jobs. It was not an entirely flattering portrait. Mr. Jobs said about a quarter of it was accurate.

“We’re family,” he said of Ms. Simpson in an interview with The New York Times Magazine. “She’s one of my best friends in the world. I call her and talk to her every couple of days.”

His wife and Ms. Simpson survive him, as do his three children with Ms. Powell, his daughters Eve Jobs and Erin Sienna Jobs and a son, Reed; another daughter, Lisa Brennan-Jobs, from a relationship with Chrisann Brennan; and another sister, Patti Jobs.

Return to Apple

Beginning in 1986, Mr. Jobs refocused NeXT from the education to the business market and dropped the hardware part of the company, deciding to sell just an operating system. Although NeXT never became a significant computer industry player, it had a huge impact: a young programmer, Tim Berners-Lee, used a NeXT machine to develop the first version of the World Wide Web at the Swiss physics research center CERN in 1990.

In 1996, after unsuccessful efforts to develop next-generation operating systems, Apple, with Gilbert Amelio now in command, acquired NeXT for $430 million. The next year, Mr. Jobs returned to Apple as an adviser. He became chief executive again in 2000.

Shortly after returning, Mr. Jobs publicly ended Apple’s long feud with its archival Microsoft, which agreed to continue developing its Office software for the Macintosh and invested $150 million in Apple.

Once in control of Apple again, Mr. Jobs set out to reshape the consumer electronics industry. He pushed the company into the digital music business, introducing first iTunes and then the iPod MP3 player. The music arm grew rapidly, reaching almost 50 percent of the company’s revenue by June 2008.

In 2005, Mr. Jobs announced that he would end Apple’s business relationship with I.B.M. and Motorola and build Macintosh computers based on Intel microprocessors.

By then his fight with cancer was publicly known. Apple had announced in 2004 that Mr. Jobs had a rare but curable form of pancreatic cancer and that he had undergone successful surgery. Four years later, questions about his health returned when he appeared at a company event looking gaunt. Afterward, he said he had suffered from a “common bug.” Privately, he said his cancer surgery had created digestive problems but insisted they were not life-threatening.

Apple began selling the iPhone in June 2007. Mr. Jobs’s goal was to sell 10 million of the handsets in 2008, equivalent to 1 percent of the global cellphone market. The company sold 11.6 million.

Although smartphones were already commonplace, the iPhone dispensed with a stylus and pioneered a touch-screen interface that quickly set the standard for the mobile computing market. Rolled out with much anticipation and fanfare, iPhone rocketed to popularity; by end of 2010 the company had sold almost 90 million units.

Although Mr. Jobs took just a nominal $1 salary when he returned to Apple, his compensation became the source of a Silicon Valley scandal in 2006 over the backdating of millions of shares of stock options. But after a company investigation and one by the Securities and Exchange Commission, he was found not to have benefited financially from the backdating and no charges were brought.

The episode did little to taint Mr. Jobs’s standing in the business and technology world. As the gravity of his illness became known, and particularly after he announced he was stepping down, he was increasingly hailed for his genius and true achievement: his ability to blend product design and business market innovation by integrating consumer-oriented software, microelectronic components, industrial design and new business strategies in a way that has not been matched.

If he had a motto, it may have come from “The Whole Earth Catalog,” which he said had deeply influenced him as a young man. The book, he said in his commencement address at Stanford in 2005, ends with the admonition “Stay Hungry. Stay Foolish.”

“I have always wished that for myself,” he said.

Steve Lohr contributed reporting.

La noticia pudiera ir en otro lugar, creo que se merece estar aquí.

Steve Jobs, fundador de Apple y creador de productos como el Mac, el iPod, el iPhone o el iMac ha fallecido a los 56 años, víctima de un cáncer de páncreas que le obligó el pasado agosto a dejar la máxima responsabilidad en la compañía de la manzana en uno de sus mejores momentos.

La compañía norteamericana ha confirmado la noticia mediante un comunicado en su web. “La brillantez, la pasión y la energía de Steve fueron la fuente de incontables innovaciones que enriquecen y mejoran nuestras vidas. El mundo es enormemente mejor debido a Steve”, versa la nota. Además invitan a los internautas a dejar un mensaje de condolencia en la dirección de e-mail: rememberingsteve@apple.com

Jobs había superado un tumor de páncreas en 2004 y un trasplante de hígado. Pese a una mejoría inicial, en sus apariciones públicas cada vez se le veía más delgado. Finalemente el pasado mes de agosto había abandonado máxima dirección de la compañía. Precisamente éste martes su sucesor, Tim Cook, presentó el iPhone 4S en su primera key note como máximo responsable de la mítica compañía.

Category: History