Gender and non-communicable diseases in Mexico: a political mapping and stakeholder analysis.

BACKGROUND: Mexico and other low- and middle-income countries (LMICs) present a growing burden of non-communicable diseases (NCDs), with gender-differentiated risk factors and access to prevention, diagnosis and care. However, the political agenda in LMICs as it relates to health and gender is primarily focused on sexual and reproductive health rights and preventing violence against women. This research article analyses public policies related to gender and NCDs, identifying political challenges in the current response to women's health needs, and opportunities to promote interventions that recognize the role of gender in NCDs and NCD care in Mexico. METHODS: We carried out a political mapping and stakeholder analysis during July-October of 2022, based on structured desk research and interviews with eighteen key stakeholders related to healthcare, gender and NCDs in Mexico. We used the PolicyMaker V5 software to identify obstacles and opportunities to promote interventions that recognize the role of gender in NCDs and NCD care, from the perspective of the political stakeholders interviewed. RESULTS: We found as a political obstacle that policies and stakeholders addressing NCDs do not take a gender perspective, while policies and stakeholders addressing gender equality do not adequately consider NCDs. The gendered social and economic aspects of the NCD burden are not widely understood, and the multi-sectoral approach needed to address these aspects is lacking. Economic obstacles show that budget cuts exacerbated by the pandemic are a significant obstacle to social protection mechanisms to support those caring for people living with NCDs. CONCLUSIONS: Moving towards an effective, equity-promoting health and social protection system requires the government to adopt an intersectoral, gender-based approach to the prevention and control of NCDs and the burden of NCD care. Despite significant resource constraints, policy innovation may be possible given the willingness among some stakeholders to collaborate, particularly in the labour and legal sectors. However, care will be needed to ensure the implementation of new policies has a positive impact on both gender equity and health outcomes. Research on successful approaches in other contexts can help to identify relevant learnings for Mexico.

Combining mHealth Technology and Pharmacotherapy to Improve Mental Health Outcomes and Reduce Human Rights Abuses in West Africa: Intervention Field Trial.

Background: In West Africa, healers greatly outnumber trained mental health professionals. People with serious mental illness (SMI) are often seen by healers in "prayer camps" where they may also experience human rights abuses. We developed "M&M," an 8-week-long dual-pronged intervention involving (1) a smartphone-delivered toolkit designed to expose healers to brief psychosocial interventions and encourage them to preserve human rights (M-Healer app), and (2) a visiting nurse who provides medications to their patients (Mobile Nurse). Objective: We examined the feasibility, acceptability, safety, and preliminary effectiveness of the M&M intervention in real-world prayer camp settings. Methods: We conducted a single-arm field trial of M&M with people with SMI and healers at a prayer camp in Ghana. Healers were provided smartphones with M-Healer installed and were trained by practice facilitators to use the digital toolkit. In parallel, a study nurse visited their prayer camp to administer medications to their patients. Clinical assessors administered study measures to participants with SMI at pretreatment (baseline), midtreatment (4 weeks) and post treatment (8 weeks). Results: Seventeen participants were enrolled and most (n=15, 88.3%) were retained. Participants had an average age of 44.3 (SD 13.9) years and 59% (n=10) of them were male. Fourteen (82%) participants had a diagnosis of schizophrenia and 2 (18%) were diagnosed with bipolar disorder. Four healers were trained to use M-Healer. On average, they self-initiated app use 31.9 (SD 28.9) times per week. Healers watched an average of 19.1 (SD 21.2) videos, responded to 1.5 (SD 2.4) prompts, and used the app for 5.3 (SD 2.7) days weekly. Pre-post analyses revealed a significant and clinically meaningful reduction in psychiatric symptom severity (Brief Psychiatric Rating Scale score range 52.3 to 30.9; Brief Symptom Inventory score range 76.4 to 27.9), psychological distress (Talbieh Brief Distress Inventory score range 37.7 to 16.9), shame (Other as Shamer Scale score range 41.9 to 28.5), and stigma (Brief Internalized Stigma of Mental Illness Scale score range 11.8 to 10.3). We recorded a significant reduction in days chained (1.6 to 0.5) and a promising trend for reduction in the days of forced fasting (2.6 to 0.0, P=.06). We did not identify significant pre-post changes in patient-reported working alliance with healers (Working Alliance Inventory), depressive symptom severity (Patient Health Questionnaire-9), quality of life (Lehman Quality of Life Interview for the Mentally Ill), beliefs about medication (Beliefs about Medications Questionnaire-General Harm subscale), or other human rights abuses. No major side effects, health and safety violations, or serious adverse events occurred over the course of the trial. Conclusions: The M&M intervention proved to be feasible, acceptable, safe, and clinically promising. Preliminary findings suggest that the M-Healer toolkit may have shifted healers' behaviors at the prayer camp so that they commit fewer human rights abuses.

[Transform children and adolescents into protagonists of their health care]. / Transformar a niños, niñas y adolescentes en los protagonistas de su atención en salud.

More and more naturally we recognize children and adolescents (NNA) as social actors capable of managing for themselves, according to their age and level of development, specific aspects of their lives; spaces in which we gradually and correlatively grant them greater scope for personal action. This paradigmatic change in the understanding of children and adolescents has been influenced by the adoption of the Convention on the Rights of the Child (CRC) in 1989. It meant moving forward from a until then welfare perspective that observed children and adolescents as subject objects of protection, as passive subjects, to the guardianship of responsible adults (doctrine of guardianship protection), to their consideration as subjects of law, that is, as holders and main agents in the exercise of their rights, with respect to which adults have duties of protection. orientation and guidance (doctrine of comprehensive protection). Reviewing the terms of the Convention and the adjustments made to the national legal framework, this article explores how this new model, based on human rights, is extended and in what terms, to the healthcare space.

Advancing disability-inclusive climate research and action, climate justice, and climate-resilient development.

Globally, more than 1 billion people with disabilities are disproportionately and differentially at risk from the climate crisis. Yet there is a notable absence of climate policy, programming, and research at the intersection of disability and climate change. Advancing climate justice urgently requires accelerated disability-inclusive climate action. We present pivotal research recommendations and guidance to advance disability-inclusive climate research and responses identified by a global interdisciplinary group of experts in disability, climate change, sustainable development, public health, environmental justice, humanitarianism, gender, Indigeneity, mental health, law, and planetary health. Climate-resilient development is a framework for enabling universal sustainable development. Advancing inclusive climate-resilient development requires a disability human rights approach that deepens understanding of how societal choices and actions-characterised by meaningful participation, inclusion, knowledge diversity in decision making, and co-design by and with people with disabilities and their representative organisations-build collective climate resilience benefiting disability communities and society at large while advancing planetary health.

The effects of parental respect for children's decision-making and respect for human rights on depression in early adolescents: The mediating effect of self-esteem.

This study investigated the structural relationships among parental respect for children's decision-making, respect for human rights, and self-esteem, and their impact on depression in early adolescents. The study utilized data from 2,747 middle school students who participated in the 2020 Survey on the Current Status of Korean Children's and Youth's Rights conducted by the National Youth Policy Institute. The data were analyzed using a structural equation model based on partial least squares with SmartPLS 3.0. The analysis revealed that both parental respect for children's decision-making and respect for human rights perceived by middle school students had a significant positive impact on self-esteem and a significant negative impact on depression. Furthermore, self-esteem was found to have a significant negative effect on depression. Importantly, self-esteem also played a significant mediating role in the relationship between parental respect for children's decision-making and depression, as well as the relationship between respect for human rights and depression. Therefore, in order to manage depression, it is necessary to develop strategies that encourage parental respect for children's decision-making, promote respect for human rights, and foster self-esteem in early adolescents.

Cultivating Vital Conditions For Perinatal Well-Being And A Sustained Commitment To Reproductive Justice.

Perinatal mental illness is a leading cause of death during pregnancy and the first postpartum year in the United States. Although better acute care services for mental health conditions are desperately needed, urgent services alone cannot create the conditions to thrive. Cultivating well-being requires a sustained commitment to reproductive justice, "the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities." To support reproductive justice for pregnant and birthing people, the Rippel Foundation's Vital Conditions for Health and Well-Being framework offers a holistic approach comprising seven domains: a thriving natural world; basic needs for health and safety; humane housing; meaningful work and wealth; lifelong learning; reliable transportation; and, central to all of these, belonging and civic muscle. Here we review the evidence for each of the vital conditions as key drivers of perinatal mental health, and we outline how this public health approach can advance well-being across generations.

Cuerpos desgener[iz]ados: rescatando las experiencias de personas intersex como usuarias del sistema de salud público Chileno / Corpos desgener[iz]ados: resgatando as experiências de pessoas intersexuais como usuárias do sistema público de saúde chileno / Desgener[iz]ated bodies: rescuing the experiences of intersex people as users of the Chilean public health system

Introducción: La intersexualidad comprende condicionesinfrecuentes donde una persona nace con una anatomíasexual diferente del binario hombre-mujer; esto suponehabitar un cuerpo fuera de lo inteligible y estigmatizado.Históricamente, desde la heteronorma, el modelo biomédicoha buscado normalizarles quirúrgicamente para asignarprecoz y arbitrariamente un sexo-género armónico con lagenitalidad. Desde los Derechos Humanos, estas prácticasson cuestionadas por colectivos Intersex.Materiales y método: Estudio de caso, entre años 2019 y2020; técnica de entrevista en profundidad a dos usuariosadultos de los Policlínicos de Urología y Endocrinología de unhospital público en Santiago, Chile; se utilizó la fenomenologíade Husserl para comprender la experiencia en el sistema desalud de las personas intersex. El análisis de la informaciónse basó en la propuesta de Colaizzi.Resultados: Se reconocieron unidades de significado principalese imbricadas, cuyas esencias permitieron describir el fenómenode: ser niño y habitar el espacio hospitalario, vivir con lacondición actualmente, y la experiencia de utilizar el sistemade salud siendo adulto.Conclusiones: Se identificaron diversas estrategias de agenciatanto en el espacio hospitalario como el cotidiano, medianteun proceso personal y silencioso de aprendizajes sobre lasimplicancias de ser intersexual.(AU)

Introduction: Intersexuality includes extremely rareconditions where a person is born with a sexual anatomydifferent from the male-female binary; this supposesinhabiting a body outside the intelligible, configuringa stigma. Historically and from the heteronorm, thebiomedical model has sought to surgically normalizethem in order to precociously and arbitrarily assigna gender in harmony with genitality. From HumanRights, these practices have been questioned byIntersex groups.Materials and method: During the years 2019 and2020, case studies were carried out through in-depthinterviews with two adult users of the Urology andEndocrinology Polyclinics of a public hospital atSantiago, Chile; Husserl's phenomenology was usedto visualize the phenomenon according to how it isexperienced by the subjects who carry it, using theprocedure described by Colaizzi as an informationanalysis plan.Results: Main and overlapping units of meaning wererecognized, whose essences allowed describing thephenomenon of: being a child and inhabiting thehospital space, currently living with the condition,and the experience of using the health system as anadult, with new and own meanings.Conclusions: Various agency strategies were identifiedboth in the hospital space and in everyday life, througha personal and silent process of learning about theimplications of being intersex.(AU)

Introdução: Intersexo compreende condições rarasem que uma pessoa nasce com uma anatomia sexualdiferente do binário masculino-feminino; Isso significahabitar um corpo fora do que é inteligível e estigmatizado.Historicamente, a partir da heteronormação, o modelobiomédico buscou normalizá-los cirurgicamente paraatribuir precoce e arbitrariamente um sexo-gêneroharmônico com a genitalidade. A partir dos DireitosHumanos, essas práticas são questionadas por gruposintersexuais.Materiais e método: Estudo de caso, entre os anos de2019 e 2020; técnica de entrevista em profundidadecom dois usuários adultos das Policlínicas de Urologiae Endocrinologia de um hospital público de Santiago,Chile; A fenomenologia de Husserl foi utilizada paracompreender a experiência de pessoas intersexuaisno sistema de saúde. A análise das informações foibaseada na proposta de Colaizzi.Resultados: Reconheceram-se unidades de significadoprincipais e sobrepostas, cujas essências permitiramdescrever o fenômeno de: ser criança e habitar oespaço hospitalar, viver atualmente com a condição e aexperiência de usar o sistema de saúde na fase adulta.Conclusões: Foram identificadas várias estratégiasde agenciamento tanto no hospital como na vidaquotidiana, através de um processo pessoal e silenciosode aprendizagem sobre as implicações de ser intersexo.(AU)

Chapitre 5. Articuler nature et culture : le modèle juridique des AOP et IGP face au changement climatique, à la durabilité et aux droits bioculturels.

The impact of climate change on PDO and PGI production can provide an excellent laboratory for verifying precisely whether, and to what extent, climate risks are perceived in a sector so closely linked to territories and climate; whether climate change requires a modification of the agricultural production model and the legal model to enable production to adapt to climate risks and sustainability requirements, particularly in the light of new « sui generis » human rights such as biocultural rights.

Chapitre 4. Le droit à un environnement propre, sain et durable : un vecteur indispensable à la transition des systèmes alimentaires.

This article discusses the right to a clean, healthy and sustainable environment (hereinafter “right to a healthy environment”) within the framework of a “food systems approach” and from the perspective of the three main functions of law in the transition to sustainable and equitable food systems (hereinafter “SAD”). The article aims to demonstrate that the right to a healthy environment is an indispensable right for achieving the transition to SADs through the building blocks of food systems, namely food supply chains, food environments and consumer behavior. First of all, the article notes that the right to a healthy environment has been at the heart of SAD since it was recognized as a human right by Resolution 48/13 of the Human Rights Council and Resolution 76/300 of the United Nations General Assembly. As well as underpinning the sustainability and equity of food systems, the right to a healthy environment is inseparable from the realization of other human rights, most notably the right to adequate food, itself at the heart of food systems. Secondly, the article argues that the operationalization of the right to a healthy environment by States would benefit from a “food systems approach” to ensure the transition to SADs. In this perspective, the right to a healthy environment constitutes a genuine vector for the development and adoption of legal and policy measures that improve the sustainability and equity of food systems, and the implementation of the CFS Voluntary Guidelines on Food Systems and Nutrition adopted in 2021.

Effect of health rights accessibility on the urban integration of minority rural migrants in China: a cross-sectional study.

BACKGROUND: Accessing health rights is an integral component of people's aspirations for a better life. Existing discussions and evaluations regarding the accessibility of health rights for minority rural migrants are insufficient. In comparison to objective health conditions, inequalities in health rights lead to chronic and long-term depletion of human capital among minority rural migrants. This study aimed to assess the overall impact, heterogeneity effects, and mechanisms of health rights accessibility on the urban integration of minority rural migrants. METHODS: Based on the 2017 China Migrants Dynamic Survey Data (CMDS), this study employs OLS models, 2SLS models, conditional mixed process (CMP) methods, and omitted variable tests to estimate the impact of health rights accessibility on the urban integration of minority rural migrants. Additionally, from the perspectives of migration scope and illness experience, this study explored the heterogeneity in the relationship between health rights accessibility and urban integration. Finally, using the Karlson-Holm-Breen (KHB) model, this study dissects the mechanisms through which health rights accessibility influences the urban integration of minority rural migrants. RESULTS: Health rights accessibility significantly enhances the urban integration of minority rural migrants. Moreover, compared to minority rural migrants who move across provinces and who have no history of illness, those who migrate within the same province and who have experienced illness are more sensitive to the positive impact of health rights accessibility. However, the enhancing effect of health rights accessibility does not significantly differ between the new and old generations of minority rural migrants. Furthermore, health rights accessibility can indirectly improve the urban integration of minority rural migrants by elevating health levels, improving health habits, and reinforcing health behaviors. Among these, the indirect effects mediated by health habits are more pronounced. CONCLUSION: The research conclusions underscore the issue of health accessibility and urban integration among minority rural migrants, providing a reexamination and clarification of the policy effects of health rights in promoting the urban integration of minority rural migrants. Relevant policy design should commence with improving the health rights of minority rural migrants, enhancing their health integration capabilities, and effectively boosting their ability to integrate into urban life.

Gender norms in a context of legal pluralism: Impacts on the health of women and girls in Ethiopia.

To achieve Sustainable Development Goal 5 for gender equality by 2030, it is crucial for health and development professionals and governmental officials to understand how legal systems empower or oppress populations on the basis of gender worldwide, including opportunities and challenges of statutory provisions created by legal pluralism. Using Ethiopia as a case study, this paper examines how local laws applied in Sharia and Customary Dispute Resolution courts impact gender equality and the health of women and girls inspite of the inculcation of human rights statutes into national legislation, including the Constitution. We identify several key issues with the substantive law and its enforcement. First, laws which have been instituted at the national level to improve gender equally have been poorly enforced at the local level. Second, there is a sustained enforcement of laws that oppress women and that protect male perpetrators of gender-based violations. Third, local courts limit female representation and uphold patriarchy. To improve the health of women and girls, stakeholders must take into consideration the ways in which legal systems uphold harmful gender norms and obstruct and/or advance progress towards equal representation, opportunities, and constitutionally-mandated protections for all.

Unlocking the impact of the CRPD on Swedish mental health law.

The Convention on the Rights of Persons with Disabilities (CRPD) sets out a new vision for mental health care with equality and self-determination as its core standards. The CRPD fundamentally challenges long-standing practices in Sweden including the use of involuntary hospitalization, treatment without consent, and the use of restraints. This article discusses the impact of this new vision on Swedish mental health law and policy. An examination of mental health law inquiries from 2008 to 2023 reveals a notable lack of attention from policymakers towards the CRPD. Nevertheless, the Convention has emerged as a vital advocacy instrument for disability organizations and others opposing proposals that seek to broaden doctors' authority to employ coercion. In addition, the many efforts undertaken to reduce the use of coercion and to enhance the involvement of individuals with psychosocial disabilities in policy development align seamlessly with the principles of the Convention. This article concludes with a reflection on why the CRPD has not assumed a more prominent role in shaping mental health law in Sweden and calls on the government to seriously consider the CRPD's call for equality.

Abuse of right during application of coercive medical measures in criminal proceedings.

OBJECTIVE: Aim: To determine the problematic issues of ensuring the rights and freedoms of persons suffering from mental disorders and to whom CMM are applied in criminal proceedings under the legislation of Ukraine and the legislation of the states that adhere to the modern concepts of international standards of human rights ensuring to a person the CMM are applied to. PATIENTS AND METHODS: Materials and Methods: Legal positions of the ECHR, criminal procedural legislation of a number of states, and a survey of scientists and practitioners conducted by the authors are used in this paper (total number of respondents was 168). A set of general scientific and special methods are used to achieve the aim of the study. CONCLUSION: Conclusions: The practice of applying СMM to persons suffering from mental disorders in criminal proceedings in Ukraine and other states does not fully meet international standards and needs improvement. It was suggested to make changes to the legal acts on the use of CMM in criminal proceedings.