ABSTRACT
The article analyzes the fight against COVID-19 in three Latin American countries: Argentina, Brazil, and Mexico. A multiple case study was carried out in a comparative perspective, based on a bibliographic review, documentary analysis, and secondary data, considering characteristics of the countries and the health system, evolution of COVID-19, national governance, containment and mitigation measures, health systems response, constraints, positive aspects and limits of responses. The three countries had distinct health systems but were marked by insufficient funding and inequalities when hit by the pandemic and recorded high-COVID-19 mortality. Structural, institutional, and political factors influenced national responses. In Argentina, national leadership and intergovernmental political agreements favored the initial adoption of centralized control measures, which were not sustained. In Brazil, there were limits in national coordination and leadership related to the President's denialism and federative, political, and expert conflicts, despite a universal health system with intergovernmental commissions and participatory councils, which were little used during the pandemic. In Mexico, structural difficulties were associated with the Federal Government's initial reluctance to adopt restrictive measures, limits on testing, and relative slowness in immunization. In conclusion, facing health emergencies requires strengthening public health systems associated with federative, intersectoral, and civil society coordination mechanisms and effective global solidarity mechanisms.
Subject(s)
COVID-19 , Health Policy , Pandemics , COVID-19/prevention & control , COVID-19/epidemiology , Humans , Brazil/epidemiology , Argentina/epidemiology , Mexico/epidemiology , Pandemics/prevention & control , SARS-CoV-2 , PoliticsABSTRACT
Abstract: The article analyzes the fight against COVID-19 in three Latin American countries: Argentina, Brazil, and Mexico. A multiple case study was carried out in a comparative perspective, based on a bibliographic review, documentary analysis, and secondary data, considering characteristics of the countries and the health system, evolution of COVID-19, national governance, containment and mitigation measures, health systems response, constraints, positive aspects and limits of responses. The three countries had distinct health systems but were marked by insufficient funding and inequalities when hit by the pandemic and recorded high-COVID-19 mortality. Structural, institutional, and political factors influenced national responses. In Argentina, national leadership and intergovernmental political agreements favored the initial adoption of centralized control measures, which were not sustained. In Brazil, there were limits in national coordination and leadership related to the President's denialism and federative, political, and expert conflicts, despite a universal health system with intergovernmental commissions and participatory councils, which were little used during the pandemic. In Mexico, structural difficulties were associated with the Federal Government's initial reluctance to adopt restrictive measures, limits on testing, and relative slowness in immunization. In conclusion, facing health emergencies requires strengthening public health systems associated with federative, intersectoral, and civil society coordination mechanisms and effective global solidarity mechanisms.
Resumen: El artículo analiza la lucha contra el COVID-19 en tres federaciones latinoamericanas: Argentina, Brasil y México. Se realizó un estudio de casos múltiple en perspectiva comparada, basado en revisión bibliográfica, análisis documental y de datos secundarios, teniendo en cuenta: las características de los países y del sistema de salud, la evolución del COVID-19, la gobernanza nacional, las medidas de contención y mitigación, la respuesta de los sistemas de salud, los factores condicionantes, los aspectos positivos y los límites de las respuestas. Los tres países tenían sistemas de salud diferentes, pero marcados por financiación insuficiente y desigualdades, cuando afectados por la pandemia, y registraron una alta mortalidad por COVID-19. Las respuestas nacionales se influyeron por factores condicionantes estructurales, institucionales y políticos. En Argentina, el liderazgo nacional y los acuerdos políticos intergubernamentales favorecieron la adopción inicial de medidas de control centralizadas, que no se sustentaron. En Brasil, hubo límites en la coordinación y liderazgo nacional, relacionados con el negacionismo del presidente y los conflictos federativos, políticos y con expertos, a pesar de existir un sistema de salud universal que tiene comisiones intergubernamentales y consejos participativos, poco utilizados en la pandemia. En México, las dificultades estructurales se asociaron con la renuencia inicial del gobierno nacional en adoptar medidas restrictivas, límites en las pruebas y relativa lentitud en la vacunación. Se concluye que para enfrentar emergencias sanitarias hay que fortalecer los sistemas públicos de salud asociados con mecanismos de coordinación federativa, intersectorial y con la sociedad civil, así como mecanismos efectivos de solidaridad global.
Resumo: Este artigo analisa o enfrentamento da COVID-19 em três federações latino-americanas: Argentina, Brasil e México. Realizou-se um estudo de casos múltiplos em perspectiva comparada, baseado em revisão bibliográfica, análise documental e de dados secundários, considerando: características dos países e do sistema de saúde, evolução da COVID-19, governança nacional, medidas de contenção e mitigação, resposta dos sistemas de saúde, condicionantes, aspectos positivos e limites das respostas. Os três países apresentavam sistemas de saúde distintos, porém marcados por financiamento insuficiente e desigualdades quando atingidos pela pandemia, e registraram alta mortalidade por COVID-19. As respostas nacionais foram influenciadas por condicionantes estruturais, institucionais e políticos. Na Argentina, a liderança nacional e acordos políticos intergovernamentais favoreceram a adoção inicial de medidas centralizadas de controle, que não se sustentaram. No Brasil, houve limites na coordenação e liderança nacional, relacionadas ao negacionismo do presidente e a conflitos federativos, políticos e com especialistas, apesar da existência de um sistema de saúde universal que têm comissões intergovernamentais e conselhos participativos, pouco acionados na pandemia. No México, dificuldades estruturais se associaram à relutância inicial do governo nacional em adotar medidas restritivas, limites na testagem e relativa lentidão na vacinação. Conclui-se que o enfrentamento de emergências sanitárias requer o fortalecimento dos sistemas públicos de saúde associados a mecanismos de coordenação federativa, intersetorial e com a sociedade civil, bem como mecanismos efetivos de solidariedade global.
ABSTRACT
Los Institutos Nacionales de Salud (INS) miembros de la Red Regional Latinoamericana de la Asociación Internacional de Institutos Nacionales de Salud Pública, reunidos en forma presencial en la sede del Instituto Nacional de Salud Pública de México, en la Ciudad de Cuernavaca, los días 5 al 7 de octubre de 2022, contando con la participación de los directores o representantes de los INS de (...).
ABSTRACT
Viability CRISPR screens have proven indispensable in parsing genome function. However, their application in new, more physiologically relevant culturing systems like patient-derived organoids (PDOs) has been much slower. To probe epigenetic contribution to gastric cancer (GC), the third leading cause of cancer-related deaths worldwide, the first negative selection CRISPR screen in GC PDOs that faithfully preserve primary tumor characteristics is performed. Extensive quality control measurements showing feasibility of CRISPR screens in primary organoid culture are provided. The screen reveals the histone lysine demethylase-1A (KDM1A) to constitute a GC vulnerability. Both genetic and pharmacological inhibition of KDM1A cause organoid growth retardation. Further, it is shown that most of KDM1A cancer-supporting functions center on repression of N-myc downstream regulates gene-1 (NDRG1). De-repression of NDRG1 by KDM1A inhibitors (KDM1Ai) causes inhibition of Wnt signaling and a strong G1 cell cycle arrest. Finally, by profiling 20 GC PDOs, it is shown that NDRG1 upregulation predicts KDM1Ai response with 100% sensitivity and 82% specificity in the tested cohort. Thus, this work pioneers the use of negative selection CRISPR screens in patient-derived organoids, identifies a marker of KDM1Ai response, and accordingly a cohort of patients who may benefit from such therapy.
Subject(s)
Stomach Neoplasms , Humans , Stomach Neoplasms/genetics , Stomach Neoplasms/metabolism , Stomach Neoplasms/pathology , CRISPR-Cas Systems/genetics , Cell Line, Tumor , Histone Demethylases/genetics , Histone Demethylases/metabolism , Organoids/metabolism , Organoids/pathologyABSTRACT
Effective management of a pandemic due to a respiratory virus requires public health capacity for a coordinated response for mandatory restrictions, large-scale testing to identify infected individuals, capacity to isolate infected cases and track and test contacts, and health services for those infected who require hospitalization. Because of contextual and socioeconomic factors, it has been hard for Latin America to confront this epidemic. In this article, we discuss the context and the initial responses of eight selected Latin American countries, including similarities and differences in public health, economic, and fiscal measures, and provide reflections on what worked and what did not work and what to expect moving forward.
Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Public Health/methods , Betacoronavirus , COVID-19 , Contact Tracing , Humans , Latin America/epidemiology , Pandemics , SARS-CoV-2 , Socioeconomic FactorsSubject(s)
Betacoronavirus , Coronavirus Infections , International Cooperation , Pandemics , Pneumonia, Viral , COVID-19 , Coronavirus Infections/economics , Coronavirus Infections/prevention & control , Global Health/trends , Humans , Pandemics/economics , Pandemics/prevention & control , Pneumonia, Viral/economics , Pneumonia, Viral/prevention & control , SARS-CoV-2 , Socioeconomic Factors , South AmericaABSTRACT
[RESUMEN]. La dimensión internacional de los determinantes sociales, económicos y ambientales de la salud y sus manifestaciones impulsa a los países a emprender cada vez más negociaciones entre sí y a participar activamente en la gobernanza de la salud global y en la gobernanza global por sus inequívocas relaciones con la salud. Los ministerios de salud necesitan personal capacitado para ello. En este informe se reflexiona sobre el fortalecimiento de esa función de los ministerios de salud por medio de procesos de capacitación en diplomacia de la salud y se analiza la experiencia del Programa de Fortalecimiento de la Cooperación para el Desarrollo Sanitario (CCHD), desarrollado por el Departamento de Relaciones Externas, Alianzas y Movilización de Recursos de la Organización Panamericana de la Salud (OPS) y el Centro de Relaciones Internacionales en Salud de la Fundación Oswaldo Cruz (CRIS/FIOCRUZ). Esta reflexión parte de los participantes y de los facilitadores y coordinadores del CCHD, y se basa en la construcción de los conceptos a partir de la experiencia como soporte de la reflexión para explicar la realidad y pensar en las concepciones y prácticas de los procesos de gobernanza en salud y cooperación de los ministerios de salud. Como la diplomacia de la salud es un concepto en construcción, las experiencias de capacitación en diplomacia de la salud deben promover la reflexión crítica y dar cuenta de la identidad a partir de las concepciones y prácticas de los actores involucrados en los procesos de gobernanza global y cooperación de los ministerios de salud. En este artículo también se identifican los requisitos y los procesos de formación de recursos humanos en diplomacia de la salud.
[ABSTRACT]. Given the international dimensions of the social, economic, and environmental determinants of health and their manifestations, countries are increasingly negotiating with each other and actively participating in global health governance and global governance in general, which is unequivocally linked to health. This implies that health ministries need trained staff. This report is a reflection on how to strengthen this function in health ministries through training in health diplomacy. It analyzes the experience of the Program for Strengthening Cooperation for Health Development as part of Cooperation among Countries for Health Development (CCHD), developed by the Department of External Relations, Partnerships and Resource Mobilization of the Pan American Health Organization and the Center for International Relations in Health of the Oswaldo Cruz Foundation (CRS/FIOCRUZ). This analysis is based on feedback from participants and from facilitators and coordinators of CCHD, and it attempts to develop concepts stemming from their experiences, with the aim of explaining the current situation and reflect on the concepts and practices of health governance and cooperation between health ministries. Since health diplomacy is a concept still in construction, training experiences in health diplomacy should promote critical analysis and reflect identity, based on the conceptions and practices of stakeholders in the processes of global governance and cooperation between health ministries. This article also identifies the requirements and processes of human resources training in health diplomacy.
[RESUMO]. Diante da dimensão internacional dos determinantes sociais, econômicos e ambientais da saúde e das suas manifestações, os países cada vez mais negociam entre si e participam ativamente da governança da saúde global e da governança global em geral, que está incontestavelmente relacionada com a saúde. Os ministérios da Saúde precisam ter pessoal capacitado para exercer estas atividades. Este artigo examina como fortalecer esta função dos ministérios da Saúde por meio da capacitação em diplomacia da saúde e analisa a experiência obtida com o Programa de Fortalecimento da Cooperação para o Desenvolvimento da Saúde (CCHD), desenvolvido em conjunto pelo Departamento de Relações Externas, Parcerias e Captação de Recursos da Organização Pan-Americana da Saúde (OPAS) e Centro de Relações Internacionais em Saúde da Fundação Oswaldo Cruz (CRIS/FIOCRUZ). A análise parte da perspectiva dos participantes, facilitadores e coordenadores do CCHD e busca elaborar os conceitos a partir das experiências deles visando explicar a realidade atual e pensar nos conceitos e práticas dos processos de governança em saúde e cooperação dos ministérios da Saúde. Como a diplomacia da saúde é um conceito em evolução, as experiências de capacitação nesta área contribuem para estimular uma reflexão crítica e conferir identidade a partir de conceitos e práticas dos atores envolvidos nos processos de governança global e cooperação dos ministérios da Saúde. Também são abordados os requisitos e os processos de formação de recursos humanos em diplomacia da saúde.
Subject(s)
Health Diplomacy , Health Diplomacy , International Cooperation , Health Workforce , Technical Cooperation , Pan American Health Organization , International Cooperation , Technical Cooperation , Pan American Health Organization , Health Diplomacy , International Cooperation , Technical Cooperation , Health Workforce , Pan American Health OrganizationABSTRACT
Given the international dimensions of the social, economic, and environmental determinants of health and their manifestations, countries are increasingly negotiating with each other and actively participating in global health governance and global governance in general, which is unequivocally linked to health. This implies that health ministries need trained staff. This report is a reflection on how to strengthen this function in health ministries through training in health diplomacy. It analyzes the experience of the Program for Strengthening Cooperation for Health Development as part of Cooperation among Countries for Health Development (CCHD), developed by the Department of External Relations, Partnerships and Resource Mobilization of the Pan American Health Organization and the Center for International Relations in Health of the Oswaldo Cruz Foundation (CRS/FIOCRUZ). This analysis is based on feedback from participants and from facilitators and coordinators of CCHD, and it attempts to develop concepts stemming from their experiences, with the aim of explaining the current situation and reflect on the concepts and practices of health governance and cooperation between health ministries. Since health diplomacy is a concept still in construction, training experiences in health diplomacy should promote critical analysis and reflect identity, based on the conceptions and practices of stakeholders in the processes of global governance and cooperation between health ministries. This article also identifies the requirements and processes of human resources training in health diplomacy.
Diante da dimensão internacional dos determinantes sociais, econômicos e ambientais da saúde e das suas manifestações, os países cada vez mais negociam entre si e participam ativamente da governança da saúde global e da governança global em geral, que está incontestavelmente relacionada com a saúde. Os ministérios da Saúde precisam ter pessoal capacitado para exercer estas atividades. Este artigo examina como fortalecer esta função dos ministérios da Saúde por meio da capacitação em diplomacia da saúde e analisa a experiência obtida com o Programa de Fortalecimento da Cooperação para o Desenvolvimento da Saúde (CCHD), desenvolvido em conjunto pelo Departamento de Relações Externas, Parcerias e Captação de Recursos da Organização Pan-Americana da Saúde (OPAS) e Centro de Relações Internacionais em Saúde da Fundação Oswaldo Cruz (CRIS/FIOCRUZ). A análise parte da perspectiva dos participantes, facilitadores e coordenadores do CCHD e busca elaborar os conceitos a partir das experiências deles visando explicar a realidade atual e pensar nos conceitos e práticas dos processos de governança em saúde e cooperação dos ministérios da Saúde. Como a diplomacia da saúde é um conceito em evolução, as experiências de capacitação nesta área contribuem para estimular uma reflexão crítica e conferir identidade a partir de conceitos e práticas dos atores envolvidos nos processos de governança global e cooperação dos ministérios da Saúde. Também são abordados os requisitos e os processos de formação de recursos humanos em diplomacia da saúde.
ABSTRACT
A Fundação Oswaldo Cruz desde sua criação desenvolveu grande capacidade de captação de assistência técnica internacional que permitisse expandir a cooperação no âmbito norte-sul. Mais tarde, essa experiência associada a uma perspectiva de ampliação da capacidade de cooperação técnica também entre países em desenvolvimento, que ampliou os contatos da instituição com outros países do sul, levou à criação, primeiro de uma Assessoria de Cooperação Internacional que evoluiu depois para o atual Centro de Relações Internacionais em Saúde, conhecido no exterior como Fiocruz Global Health Center. O texto tece reflexões acerca da governança das relações internacionais em saúde, ciência e tecnologia,, planos e agendas como estratégia para cooperação estruturante, o intercâmbio acadêmico e científico, financiamento e atividades de cooperação internacional em saúde.(AU)
Subject(s)
International Cooperation , Health Systems , International Educational ExchangeABSTRACT
La dimensión internacional de los determinantes sociales, económicos y ambientales de la salud y sus manifestaciones impulsa a los países a emprender cada vez más negociaciones entre sí y a participar activamente en la gobernanza de la salud global y en la gobernanza global por sus inequívocas relaciones con la salud. Los ministerios de salud necesitan personal capacitado para ello. En este informe se reflexiona sobre el fortalecimiento de esa función de los ministerios de salud por medio de procesos de capacitación en diplomacia de la salud y se analiza la experiencia del Programa de Fortalecimiento de la Cooperación para el Desarrollo Sanitario (CCHD), desarrollado por el Departamento de Relaciones Externas, Alianzas y Movilización de Recursos de la Organización Panamericana de la Salud (OPS) y el Centro de Relaciones Internacionales en Salud de la Fundación Oswaldo Cruz (CRIS/FIOCRUZ). Esta reflexión parte de los participantes y de los facilitadores y coordinadores del CCHD, y se basa en la construcción de los conceptos a partir de la experiencia como soporte de la reflexión para explicar la realidad y pensar en las concepciones y prácticas de los procesos de gobernanza en salud y cooperación de los ministerios de salud. Como la diplomacia de la salud es un concepto en construcción, las experiencias de capacitación en diplomacia de la salud deben promover la reflexión crítica y dar cuenta de la identidad a partir de las concepciones y prácticas de los actores involucrados en los procesos de gobernanza global y cooperación de los ministerios de salud. En este artículo también se identifican los requisitos y los procesos de formación de recursos humanos en diplomacia de la salud.
Subject(s)
Humans , Global Health , Health Diplomacy/trends , Health Workforce , Technical CooperationABSTRACT
Do encontro entre saúde e relações internacionais se originam os conceitos e práticas contemporâneos da saúde global e da diplomacia da saúde. Mas tal encontro só se estabeleceu em função do processo de globalização. A crise econômica sistêmica e global, expondo as brechas estruturais do capitalismo global, aprofundou as desigualdades preexistentes e, desde então, só vem se ampliando, com consequências sociais, econômicas e sanitárias gravíssimas, particularmente para os países pobres e para os pobres de todos os países. A crise abateu-se sobre os países da América Latina, e muitos progressos alcançados estão agora ameaçados, inclusive as conquistas no campo da saúde, que vem sendo profundamente afetada. Este livro procura explicar a saúde no cenário global; o que a molda social e economicamente; como o global dialoga com o regional e o local; como a governança global exerce impacto sobre a saúde; como transcorre a governança da saúde global; e que papel desempenha a diplomacia aplicada em prol de uma situação de saúde mais equitativa. A complexidade internacional tem colocado novos objetos e desafios sobre os quais os autores desta coletânea buscam refletir, na perspectiva da América Latina e Caribe: as desigualdades sociais e sanitárias profundas entre países e no interior destes; as crises humanitárias relacionadas com conflitos armados em diversas partes do mundo; as correntes migratórias na América Latina; as transformações nos padrões culturais que desafiam a visão do 'normal' em medicina e saúde pública; o comprometimento ambiental em escala planetária; e a proliferação de instituições multilaterais que incluem os problemas de saúde entre seus programas de cooperação, sem entretanto solucioná-los.
Subject(s)
Global Health , Health Workforce , Health Systems , International Cooperation , Population DynamicsABSTRACT
The present article analyzes the role of the Union of South American Nations (UNASUR) national institutes of health since their creation at the beginning of the 20th century up until the present time. It postulates that the national institutes of health are in a position to play a strategic role in generating knowledge and evidence to facilitate decision-making through monitoring and research on the social determinants of health and health inequities. To explore this hypothesis, the national institutes of health are analyzed in the context of the current global scenario, which is generating increased social inequalities, thus leading in turn to serious inequities in health conditions. The article proposes a new model of health promotion, disease prevention, and health care, where necessary, as well as policies and intersectoral actions that address these social determinants. In this new stage, the UNASUR national institutes of health should play a significant strategic role in identifying and analyzing correlations between patterns of production and consumption, social divisions that exist in the territory, conditions of development, and the health of their populations. These national institutes of health are members of the UNASUR Network of National Institutes of Health (RINS-UNASUR). The literature on their creation, drawn from the Network's websites and the proceedings of its meetings and seminars, is reviewed. Given that the current globalized development model is generating enormous social inequalities, by definition, the proposed hypothesis is that the national institutes of health should assume a much broader role in addressing the consequent inequities in the health of the population, complementing their traditional activities with this new strategic role. Without a major reduction in the existing social inequalities and economic inequities, it will be impossible to make significant improvements in health in a democratic manner.
Subject(s)
Academies and Institutes , Epidemiology/organization & administration , International Agencies , Social Determinants of Health , Developing Countries , Economic Development , Health Promotion/organization & administration , Healthcare Disparities , Humans , South America , United StatesABSTRACT
El presente artículo analiza el papel que desempeñaron los institutos nacionales de salud de la Unión de Naciones Suramericanas (UNASUR) desde su creación a inicios del siglo hasta la actualidad, para luego postular como hipótesis que pueden tener un papel estratégico en la generación de conocimientos y evidencias que faciliten la toma de decisiones mediante el monitoreo y la investigación de la determinación social y las inequidades en salud. Para dar cuenta de esa hipótesis, se analizan los institutos nacionales de salud en el escenario actual global, generador de crecientes desigualdades sociales que determinan graves inequidades en las condiciones de salud y donde es necesario un nuevo modelo de promoción, prevención y atención de la salud, además de políticas y acciones intersectoriales que aborde su determinación social. En esta nueva etapa, los institutos nacionales de salud de la UNASUR deberán desempeñar un papel estratégico significativo al identificar y analizar las relaciones entre la estructura de producción y consumo, la división social del territorio y las condiciones de desarrollo y salud de las poblaciones. Los institutos nacionales de salud analizados son miembros de la Red de Institutos Nacionales de Salud de UNASUR (RINS-UNASUR). Se revisa aquí la bibliografía sobre su creación, se consultan sus sitios web y las actas de las reuniones y seminarios de la propia Red. La hipótesis postulada es que, en el actual contexto de globalización de un modelo de desarrollo que genera, por definición, enormes desigualdades sociales y sus consecuentes inequidades en la salud de la población, los institutos nacionales de salud deberían asumir un papel mucho más amplio para la salud complementando sus acciones tradicionales con un nuevo rol estratégico, entendiendo que, sin una reducción significativa de las desigualdades sociales e inequidades económicas, será imposible mejorar la salud de forma significativa y democrática.
The present article analyzes the role of the Union of South American Nations (UNASUR) national institutes of health since their creation at the beginning of the 20th century up until the present time. It postulates that the national institutes of health are in a position to play a strategic role in generating knowledge and evidence to facilitate decision-making through monitoring and research on the social determinants of health and health inequities. To explore this hypothesis, the national institutes of health are analyzed in the context of the current global scenario, which is generating increased social inequalities, thus leading in turn to serious inequities in health conditions. The article proposes a new model of health promotion, disease prevention, and health care, where necessary, as well as policies and intersectoral actions that address these social determinants. In this new stage, the UNASUR national institutes of health should play a significant strategic role in identifying and analyzing correlations between patterns of production and consumption, social divisions that exist in the territory, conditions of development, and the health of their populations. These national institutes of health are members of the UNASUR Network of National Institutes of Health (RINS-UNASUR). The literature on their creation, drawn from the Network's websites and the proceedings of its meetings and seminars, is reviewed. Given that the current globalized development model is generating enormous social inequalities, by definition, the proposed hypothesis is that the national institutes of health should assume a much broader role in addressing the consequent inequities in the health of the population, complementing their traditional activities with this new strategic role. Without a major reduction in the existing social inequalities and economic inequities, it will be impossible to make significant improvements in health in a democratic manner.
Subject(s)
Socioeconomic Factors , Social Determinants of Health , Latin AmericaABSTRACT
El presente artículo analiza el papel que desempeñaron los institutos nacionales de salud de la Unión de Naciones Suramericanas (UNASUR) desde su creación a inicios del siglo hasta la actualidad, para luego postular como hipótesis que pueden tener un papel estratégico en la generación de conocimientos y evidencias que faciliten la toma de decisions mediante el monitoreo y la investigación de la determinación social y las inequidades en salud. Para dar cuenta de esa hipótesis, se analizan los institutos nacionales de salud en el escenario actual global, generador de crecientes desigualdades sociales que determinan graves inequidades en las condiciones de salud y donde es necesario un Nuevo modelo de promoción, prevención y atención de la salud, además de políticas y acciones intersectoriales que aborde su determinación social. En esta nueva etapa, los institutos nacionales de salud de la UNASUR deberán desempeñar un papel estratégico significativo al identificar y analizar las relaciones entre la estructura de producción y consumo, la división social del territorio y las condiciones de desarrollo y salud de las poblaciones. Los institutos nacionales de salud analizados son miembros de la Red de Institutos Nacionales de Salud de UNASUR (RINS-UNASUR). Se revisa aquí la bibliografía sobre su creación, se consultan sus sitios web y las actas de las reuniones y seminarios de la propia Red. La hipótesis postulada es que, en el actual contexto de globalización de un modelo de desarrollo que genera, por definición, enormes desigualdades sociales y sus consecuentes inequidades en la salud de la población, los institutos nacionales de salud deberían asumir un papel mucho más amplio para la salud complementando sus acciones tradicionales con un nuevo rol estratégico, entendiendo que, sin una reducción significativa de las desigualdades sociales e inequidades económicas, será imposible mejorar la salud de forma significativa y democrática.
The present article analyzes the role of the Union of South American Nations (UNASUR) national institutes of health since their creation at the beginning of the 20th century up until the present time. It postulates that the national institutes of health are in a position to play a strategic role in generating knowledge and evidence to facilitate decision-making through monitoring and research on the social determinants of health and health inequities. To explore this hypothesis, the national institutes of health are analyzed in the context of the current global scenario, which is generating increased social inequalities, thus leading in turn to serious inequities in health conditions. The article proposes a new model of health promotion, disease prevention, and health care, where necessary, as well as policies and intersectoral actions that address these social determinants. In this new stage, the UNASUR national institutes of health should play a significant strategic role in identifying and analyzing correlations between patterns of production and consumption, social divisions that exist in the territory, conditions of development, and the health of their populations. These national institutes of health are members of the UNASUR Network of National Institutes of Health (RINS-UNASUR). The literature on their creation, drawn from the Network’s websites and the proceedings of its meetings and seminars, is reviewed. Given that the current globalized development model is generating enormous social inequalities, by definition, the proposed hypothesis is that the national institutes of health should assume a much broader role in addressing the consequent inequities in the health of the population, complementing their traditional activities with this new strategic role. Without a major reduction in the existing social inequalities and economic inequities, it will be impossible to make significant improvements in health in a democratic manner.
Subject(s)
Social Determinants of Health , Health Status Disparities , Social Determinants of Health , Health InequitiesABSTRACT
O livro traz um panorama completo dos Sistemas de Saúde na América do Sul, com dados sobre, por exemplo, a cobertura e financiamento. A partir daí, pode-se estabelecer diretrizes para a cooperação estruturante em saúde no continente.
Subject(s)
Humans , Comprehensive Health Care , Universal Health Insurance , Health Equity , Public Health , Health Systems , South AmericaABSTRACT
El trabajo está focalizado en las políticas hospitalarias y su repercusión en los modelos de gestón, tomando el caso de um hospital de la Provincia de Buenos Aires; el Hospital Zonal de Agudos Manuel Belgrano. El mismo se posiciona sobre tres principales dimensiones que son: la política de reforma hospitalaria de la provincia de Buenos Aires; el modelos gestión de los hospitales; y la participación. La hipótesis central es que la política de reforma hospitalaria formulada por la Provincia de Buenos Aires resulta ser una oportunidad para la descentralización hospitalaria, permitiendo que nuevos actores se incorporen a la toma de decisiones y haciendo más eficaz su modelo de gestión.