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.

How Can Law Support Development of Genomics and Precision Medicine to Advance Health Equity and Reduce Disparities?

There is growing recognition that the genomic and precision medicine revolution in health care can deepen health disparities. This has produced urgent calls to prioritize inclusion of historically underrepresented populations in research and to make genomic databases more inclusive. Answering the call to address health care disparities in the delivery of genomic and precision medicine requires a consideration of important, yet understudied, legal issues that have blocked progress. This article introduces a special issue of Ethnicity & Disease which contains a series of articles that grew out of a public conference to investigate these legal issues and propose solutions. This 2018 conference at Meharry Medical College was part of an NIH-funded project on "LawSeqSM" to evaluate and improve the law of genomics in order to support appropriate integration of genomics into clinical care. This conference was composed of presentations and interactive sessions designed to specify the top legal barriers to health equity in precision medicine and stimulate potential solutions. This article synthesizes the results of those discussions. Multiple legal barriers limit broad inclusion in genomic research and the development of precision medicine to advance health equity. Problems include inadequate privacy and anti-discrimination protections for research participants, lack of health coverage and funding for follow-up care, failure to use law to ensure access to genomic medicine, and practices by research sponsors that tolerate and entrench disparities. Analysis of the legal barriers to health equity in precision medicine is essential for progress. Progressive use of law is vital to avoid worsening of health care disparities.

La idea de solidaridad en la ética de la salud pública / The idea of solidarity in public health ethics

Tradicionalmente, la solidaridad ha pasado inadvertida en ética de la salud pública. Sin embargo, algunos autores están reivindicando actualmente la necesidad de tener en cuenta a la solidaridad como un principio rector. Dawson y Jennings son unos de esos autores, pero su concepción de la solidaridad presenta al menos tres contradicciones: en ella, se confunde lo descriptivo con lo normativo, el papel motivacional con el papel justificador de una acción, y el lugar que la solidaridad debe ocupar en una teoría de la justicia en salud. Hace falta resolver estas contradicciones para conceptualizar adecuadamente la idea de solidaridad en la ética de la salud pública si queremos que tenga un rol relevante y deje de ser un valor meramente testimonial

Traditionally, solidarity has gone unnoticed in public health ethics. However, some authors are currently demanding the need to take into account solidarity as a guiding principle. Dawson and Jennings are one of those authors, but their concept of solidarity has at least three contradictions: in it, the descriptive with the normative are confused, as the motivational role with the justifier role of an action, and also the place which solidarity must occupy in a theory of justice in health. We need to resolve these contradictions to properly conceptualize the idea of solidarity in public health ethics if we want that it to have a relevant role and no longer a purely testimonial value

Eliminating Behavioral Health Disparities and Improving Outcomes for Racial and Ethnic Minority Populations.

Integrated care holds promise for reducing mental health disparities for racial and ethnic minority groups, but studies are lacking. The authors consider critical components of effective integrated models for minority populations, including cultural and linguistic competence and a diverse workforce, and describe emerging best practices. To successfully implement integrated models into practice with minority populations will require guidance from communities, consumers and family members, and national experts.