Novel Coronavirus (COVID-19): telemedicine and remote care delivery in a time of medical crisis, implementation, and challenges.

The novel Coronavirus (COVID-19) caused by the SARS-CoV-2 virus has led to many challenges throughout the world, one of which is the delivery of health care to patients while they remain home. Telemedicine, or the use of electronic information and telecommunication technologies to support and promote long-distance clinical health care, has been utilized by health care providers for many years, but its widespread implementation did not occur until the onset of the COVID-19 pandemic. Currently, it has become the primary mechanism of care delivery for patients during the COVID-19 pandemic. While obstacles are present for hospitals and providers to establish these services, most barriers exist with patient access. Patients require advanced technical support, translator services, and other measures to become comfortable engaging in a telemedicine encounter. In addition, appropriate follow-up must be provided for chronic medical illnesses and malignancies, helping to prevent the evolution of these conditions during the COVID-19 crisis. Finally, we must ensure equity for all patients seeking to access health services, including those of lower socioeconomic status. Many of these patients rely on public hotspots or library computers for their internet connectivity, but this is likely not conducive to a clinical encounter. These barriers must be addressed to ensure health equity for all patients seeking care. Telemedicine can connect patients and providers during this time of crisis and hopefully will serve as a model for continued use after the pandemic has abated.

Cancer Disparities and Health Equity: A Policy Statement From the American Society of Clinical Oncology.

ASCO strives, through research, education, and promotion of the highest quality of patient care, to create a world where cancer is prevented and every survivor is healthy. In this pursuit, cancer health equity remains the guiding institutional principle that applies to all its activities across the cancer care continuum. In 2009, ASCO committed to addressing differences in cancer outcomes in its original policy statement on cancer disparities. Over the past decade, despite novel diagnostics and therapeutics, together with changes in the cancer care delivery system such as passage of the Affordable Care Act, cancer disparities persist. Our understanding of the populations experiencing disparate outcomes has likewise expanded to include the intersections of race/ethnicity, geography, sexual orientation and gender identity, sociodemographic factors, and others. This updated statement is intended to guide ASCO's future activities and strategies to achieve its mission of conquering cancer for all populations. ASCO acknowledges that much work remains to be done, by all cancer stakeholders at the systems level, to overcome historical momentum and existing social structures responsible for disparate cancer outcomes. This updated statement affirms ASCO's commitment to moving beyond descriptions of differences in cancer outcomes toward achievement of cancer health equity, with a focus on improving equitable access to care, improving clinical research, addressing structural barriers, and increasing awareness that results in measurable and timely action toward achieving cancer health equity for all.

Successful Strategies to Address Disparities: Insurer and Employer Perspectives.

Disparities in cancer have been documented for decades and continue to persist despite clinical advancements in cancer prevention, detection, and treatment. Disparate cancer outcomes continue to affect many populations in the United States and globally, including racial and ethnic minorities, populations with low income and education, and residents of rural areas or low socioeconomic neighborhoods, among others. Addressing cancer disparities requires approaches that are multilevel. Addressing social determinants of health, such as removing obstacles to health (e.g., poverty, discrimination, access to housing and education, jobs with fair pay, and health care) can reduce cancer disparities. However, to achieve cancer health equity, multilevel approaches are required to ensure that access to high-quality cancer care and equitable receipt of evidence-based services can reduce cancer disparities. Policy, health system interventions, and innovative delivery and health care coverage approaches by private and public payers, employer-based payers, and labor union organizations can assist in ensuring access to and receipt of high-quality cancer care while addressing the high costs of care delivery. Partnerships among patients, caregivers, employers, health care providers, and health care payers can make impactful changes in the way in which cancer care is delivered and, in turn, can assist in reducing cancer disparities.

Universal Pharmacare in Canada: A Prescription for Equity in Healthcare.

Despite progressive universal drug coverage and pharmaceutical policies found in other countries, Canada remains the only developed nation with a publicly funded healthcare system that does not include universal coverage for prescription drugs. In the absence of a national pharmacare plan, a province may choose to cover a specific sub-population for certain drugs. Although different provinces have individually attempted to extend coverage to certain subpopulations within their jurisdictions, out-of-pocket expenses on drugs and pharmaceutical products (OPEDP) accounts for a large proportion of out-of-pocket health expenses (OPHE) that are catastrophic in nature. Pharmaceutical drug coverage is a major source of public scrutiny among politicians and policy-makers in Canada. In this editorial, we focus on social inequalities in the burden of OPEDP in Canada. Prescription drugs are inconsistently covered under patchworks of public insurance coverage, and this inconsistency represents a major source of inequity of healthcare financing. Residents of certain provinces, rural households and Canadians from poorer households are more likely to be affected by this inequity and suffer disproportionately higher proportions of catastrophic out-of-pocket expenses on drugs and pharmaceutical products (COPEDP). Universal pharmacare would reduce COPEDP and promote a more equitable healthcare system in Canada.

Unique challenges for health equity in Latin America: situating the roles of priority-setting and judicial enforcement.

Overcoming continuing polarization regarding judicial enforcement of health rights in Latin America requires clarifying divergent normative and political premises, addressing the lack of reliable empirical data, and establishing the conditions for fruitful inter-sectoral, inter-disciplinary dialogue.

Realizing the right to health in Brazil's Unified Health System through the lens of breast and cervical cancer.

BACKGROUND: Health is recognized as a fundamental right in Brazil's constitution. In the absence of a clearly defined benefit packages of healthcare services that are financed under the Unified Health System (Sistema Único de Saúde, SUS), courts have become important in adjudicating coverage decisions. Empirical assessments of equity and the right to health tend to focus on simple measures of access. However, these empirical perspectives belie the significant inequalities and rights violations that arise in the case of more complex health needs such as cancer. To shed light on these issues, this paper focuses on the care pathways for breast and cervical cancer and explores access and quality issues that arise at different points along the care pathway with implications for the realization of the right to health in Brazil. METHOD: A mixed method approach is used. The analysis is primarily based on a quantitative analysis of national representative administrative data principally from the cervical and breast cancer information systems and the hospital cancer registry. To gain more insights into the organization of cancer care, qualitative data was collected from the state of Bahia, through document analysis, direct observation, roundtable discussions with health workers (HWs), and structured interviews with health care administrators. RESULTS: The paper reveals that the volume of completed screening exams is well below the estimated need, and a tendency toward lower breast cancer screening rates in poorer states and for women in the lowest income brackets. Only 26% of breast cancer cases and 29% of cervical cancer cases are diagnosed at an early stage (stage 0 or I), thereby reducing the survival prospects of patients. Waiting times between confirmed diagnosis and treatment are long, despite new legislation that guarantees a maximum of 60 days. The waiting times are significantly longer for patients that follow the recommended patient pathways, and who are diagnosed outside the hospital. CONCLUSION: The study reveals that there are large variations between states and patients, where the poorest states and patients fare worse on key indicators. More broadly, the paper shows the importance of collecting data both on patient characteristics and health system performance and carry out detailed health system analysis for exposing, empirically, rights violations and for identifying how they can be addressed.

Two Threats to Precision Medicine Equity.

In January 2015, President Barack Obama unveiled the "Precision Medicine Initiative," a nationwide research effort to help bring an effective, preventive, and therapeutic approach to medicine. The purpose of the initiative is to bring a precise understanding of the genetic and environmental determinants of disease into clinical settings across the United States.1 The announcement was coupled with $216 million provided in the President's proposed budget for a million-person national research cohort including public and private partnerships with academic medical centers, researchers, foundations, privacy experts, medical ethicists, and medical product innovators. The Initiative promises to expand the use of precision medicine in cancer research and modernize regulatory approval processes for genome sequencing technologies. In response, Congress passed the 21st Century Cures Act in December 2016, authorizing a total of $1.5 billion over 10 years for the program.2 Although the Precision Medicine Initiative heralds great promise for the future of disease treatment and eradication, its implementation and development must be carefully guided to ensure that the millions of federal dollars expended will be spent equitably. This commentary discusses two key threats to the Precision Medicine Initiative's ability to proceed in a manner consistent with the United States Constitutional requirement that the federal government shall not "deny to any person . . . the equal protection of the laws."3 In short, this commentary sounds two cautionary notes, in order to advance precision medicine equity. First, achieving precision medicine equity will require scientists and clinicians to fulfill their intellectual, moral, and indeed legal duty to work against abusive uses of precision medicine science to advance distorted views of racial group variation. Precision medicine scientists must decisively denounce and distinguish this Initiative from the pseudo-science of eugenics - the immoral and deadly pseudo-science that gave racist and nationalist ideologies what Troy Duster called a "halo of legitimacy" during the first half of the 20th century.4 Second, to combat the social threat to precision medicine, scientists must incorporate a comprehensive, ecological understanding of the fundamental social and environmental determinants of health outcomes in all research. Only then will the Precision Medicine Initiative live up to its potential to improve and indeed transform health care delivery for all patients, regardless of race, color, or national origin.

Judicialização da Saúde: argumentos utilizados nas ações judiciais em desfavor do Sistema Único de Saúde, no Tribunal de Justiça do Distrito Federal e dos Territórios, pelos atores processuais / Judicialization of Health: arguments used in the lawsuits against the SUS, in the Court of Justice of the Federal District and Territories, by the procedural actors

Objetivo: Analisar os discursos dos atores processuais em processos no Tribunal de Justiça do Distrito Federal e dos Territórios em que tramitam ações em desfavor das políticas públicas de saúde, no período entre os anos de 2012 e 2013, a fim de conhecer os argumentos mais comumente utilizados para o julgamento dessas ações. Metodologia: Realizou-se uma pesquisa descritiva, analítica, de base documental e bibliográfica, utilizando dados secundários. Os dados foram coletados através de uma pesquisa sobre judicialização no Brasil, nos anos de 2012 e 2013. Os dados quantitativos disponibilizados já se encontravam tratados em tabelas e gráficos e os dados qualitativos foram disponibilizados sem o devido tratamento, o que foi realizado a partir do método da Análise Idiossincrática. Resultados: Os três atores analisados autor, réu e juiz, tratam de questões lógicas que ocorrem no sistema e que podem ocorrer discrepâncias. Cada autor tem o seu ponto de vista, experiência e suas particularidades que não devem ser descartadas, podendo assim, haver conflitos visíveis, mas, em tratando de saúde, o ponto em comum é a melhor decisão para o usuário. Os pedidos a serem judicializados não condizem diretamente com as doenças que mais acometem os pacientes. Conclusão: É possível aferir, a partir dos discursos, a imprudência acometida com os pacientes que estão no processo e percebesse que muitas das prestações de serviços procuradas ainda estão em déficit com seu atendimento, sendo que o estado brasileiro ainda não é garantidor universal dos usuários em suas necessidades. (AU)

Objective: To analyze the speeches of the procedural actors in lawsuits in the Court of Justice of the Federal District and Territories in which they prosecute actions in detriment of the public health policies, in the period between 2012 and 2013, in order to know the arguments most commonly used for the judgment of these actions. Methodology: A descriptive, analytical, documentary and bibliographic research was carried out using secondary data. The data were collected through a research on judicialization in Brazil in the years of 2012 and 2013. The quantitative data available were already treated in tables and graphs and the qualitative data were made available without due treatment, which was done from the method of Idiosyncratic Analysis. Results: The three actors analyzed author, defendant and judge, deal with logical issues that occur in the system and that discrepancies may occur. Each author has his or her points of view and experience and their particularities that should not be discarded, so that there may be visible conflicts, but if it comes to health, the common ground, is the best decision for the user. The requests to be judicialized do not directly correspond to the diseases that most affect the patients. Conclusion: It is possible to gauge from the discourses the imprudence with the patients that are in the process and it is perceived that many of the services rendered are still in deficit with their care, being that the Brazilian state is not yet universal guarantor of the users in your needs. (AU)

Objetivo: Analizar los discursos de los actores procesales en procesos ante el Tribunal de Justicia del Distrito Federal y de los Territorios en que tramitan acciones en desfavorable de las políticas públicas de salud, en el período entre los años 2012 y 2013, a fin de conocer los argumentos más comúnmente utilizados para el juicio de estas acciones. Métodos: Se realizó una investigación descriptiva, analítica, de base documental y bibliográfica, utilizando datos secundarios. Los datos fueron recolectados a través de una encuesta sobre judicialización en Brasil, en los años 2012 y 2013. Los datos cuantitativos disponibles ya se encontraban tratados en tablas y gráficos y los datos cualitativos fueron disponibilizados sin el debido tratamiento, lo que fue realizado a partir del día el método del análisis idiosincrásico. Resultados: Los tres actores analizados autor, reo y juez, tratan de cuestiones lógicas que ocurren en el sistema y que pueden ocurrir discrepancias, cada autor tiene sus puntos de vista y experiencia y sus particularidades que no deben ser descartadas, pudiendo así existir conflictos visibles, pero si se trata de la salud, el punto en común, es la mejor decisión para el usuario. Los pedidos a ser judicializados no concaten directamente con las enfermedades que más afectan a los pacientes. Conclusión: Es posible aferir a partir de los discursos la imprudencia acometida con los pacientes que están en el proceso y se percibe que muchas de las prestaciones de servicios buscadas, aún están en déficit con su atención, siendo que el estado brasileño aún no es garante universal de los usuarios en sus necesidades. (AU)

Why Are Some Population Interventions for Diet and Obesity More Equitable and Effective Than Others? The Role of Individual Agency.

Jean Adams and colleagues argue that population interventions that require individuals to use a low level of agency to benefit are likely to be most effective and most equitable.

Legal Innovations to Advance a Culture of Health.

As conceptualized by the Robert Wood Johnson Foundation and its partners, a culture of health centers on a society in which health flourishes across all populations and sectors. Law, among other tools, is critical to advancing a culture of health across multiple arenas. In this manuscript, Network for Public Health Law colleagues illustrate how legal innovations at all levels of government contribute to societal health. Examples include modern laws that promote healthy and safe low-income housing, telemedicine reimbursement, paid sick and safe time, healthy food and beverages, reduced smoking rates, child vaccinations, universal pre-k, adolescents' healthy sleep, overdose prevention, and medical-legal partnerships.

Globalizar la salud / Globalize health

En este artículo se exploran diversos aspectos de la relación entre salud y globalización. Se consideran diferentes dimensiones de la globalización (económica, tecnológica, cultural y política) y se discuten sus consecuencias sobre la salud en términos epidemiológicos, éticos, sanitarios, ambientales y en relación con la distribución del poder y la equidad. Se analizan datos que evidencian la globalización de los riesgos y las enfermedades, atribuibles al actual modelo de relaciones internacionales y a la movilidad entre países. En el artículo se defiende la propuesta de globalizar la salud, integrando conceptos renovados y adelantos en las ciencias afines a la salud pública con nuevas estrategias políticas, sociales y organizativas de la práctica sanitaria. Finalmente, se reconocen las oportunidades que nos brinda la globalización, desde mediados del siglo pasado, para redefinir la gobernabilidad mundial y desarrollar movimientos locales, basados en la solidaridad y en una nueva concepción política que favorezcan la universalización de la salud.

In this article diverse aspects of the relationship between health and globalization are explored. Different dimensions of globalization (economic, technological, cultural and political) are considered. Aspects of its effects on health (epidemiological, ethical and environmental), as well as its relationship with public health, power distribution and equity are discussed. Data that demonstrate the globalization of risks and of diseases, due to the current model of international relations and geographical mobility, are analyzed. The article defends the globalization of health and integrates renewed concepts and scientific advances in public health with politics, social strategies and new organizational forms of the practice of public health. Finally, we discuss the opportunities that have been provided by globalization since the middle of the last century for redefining world government and for developing local movements, based on solidarity and a new concept of politics, which could favor the universalization of health.