The intertwining of discourses in the diagnostic construction of cystic fibrosis: a perspective on access and barriers. / A tessitura dos discursos na construção diagnóstica da fibrose cística: uma perspectiva sobre acesso e barreiras.

The complexities referred to in the search for "accuracy" in the diagnosis of cystic fibrosis (CF) point to reflections around "what is needed" in the current situation of "precision medicine". We analyzed the discourses of 19 social actors belonging to the community of specialists in cystic fibrosis, exploring the semantic meanings of the word "precision", and the barriers to diagnosis and innovations in therapeutics. We adopted the critical discourse analysis (CDA) of Norman Fairclough in order to achieve the discursive constructions around the integrality of care, the guarantee and equitable supply of basic social needs. Access was identified as an emic category when in the social arenas of dispute are health needs and the right to life.

As complexidades referidas na busca pela "exatidão" no diagnóstico da fibrose cística (FC) apontam para reflexões em torno de "o que é preciso" na atual conjuntura da "medicina de precisão". Analisamos os discursos de 19 atores sociais pertencentes à comunidade de especialistas na fibrose cística, explorando as acepções semânticas do vocábulo "precisão" e as barreiras ao diagnóstico e às inovações na terapêutica. Adotamos a análise crítica do discurso de Norman Fairclough a fim de alcançar as construções discursivas em torno da integralidade do cuidado, da garantia e oferta equitativa dos básicos sociais. O acesso foi identificado como categoria êmica quando nas arenas sociais de disputa estão as necessidades de saúde e o direito à vida.

An analysis of Nepal's Draft Mental Health Acts 2006-2017: competing values and power.

This qualitative study maps the process of drafting and consulting on Nepal's mental health legislation from 2006 to 2017. A total of 14 people were interviewed and interviews were analysed thematically. These themes were subsequently interpreted in light of Shiffman and Smith's policy analysis framework, as the process was found to be at the agenda-setting stage. Two groups of actors were identified with different views on appropriate policy content and how the policy process should be conducted. The first group included psychiatrists who initiated and controlled the drafting process and who did not consider people with psychosocial disabilities to be equal partners. The psychiatrists viewed forced detention and treatment as upholding people's right to health and lobbied the Ministry of Health and Population (MoHP) to pass the draft acts to parliament. The second included the rights-based civil society actors and lawyers who saw the right to equality before the law as of utmost priority, opposed forced detention and treatment, and actively blocked the draft acts at the MoHP. There is no clear legal definition of mental health and illness in Nepal, legal and mental capacity are not differentiated, and people with mental and behavioural conditions are assumed to lack capacity. The analysis indicates that there were few favourable conditions to support the progression of this policy into law. It is unclear whether the drafters or blockers will prevail in the future, but we predict that professionals will continue to have more input into content than service users due to national policy dynamics.

Analysing governments' progress on the right to health.

Objective: To examine the influence of varying articulations of the right to health under domestic constitutions, legislation and jurisprudence on the scope of legal protection for health. Methods: We investigated legal recognition of the right to health, by conducting a three-level search. First, we searched databases containing constitutional texts. Second, we did a thematic analysis of those constitutional texts with explicit constitutional recognition of health rights, employing NVivo for coding. For the 54 World Health Organization (WHO) Member States without explicit constitutional provisions, we explored statutory paths, judicial constructions and instances where both methods contributed to the acknowledgement of health rights. Lastly, we confirmed evidence of jurisprudence constructing a right to health based on a combination of domestic law and international human rights norms incorporated directly into the text. Findings: We identified 140 WHO Member States with a constitutionalized right to health. Our analysis suggests there are notable variations in the legal scope of protection for health, including breadth of entitlements and the possibility of enforcing these rights through the legal system. We also highlight the critical importance of constitutional acknowledgement, legislative measures, and judicial interpretations in shaping the legal entitlements to health-care services, affecting their accessibility and financial support. Conclusion: The analysis offers insights for policy-makers to assess different approaches to health-related entitlements, with implications for health financing and the evaluation of Member States' strides towards universal access to comprehensive care. This analysis also illuminates how distinct formulations of the right to health have varied effects on reducing health disparities.

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.

Direito e Controle do Tabagismo: Introdução

O controle do tabagismo não envolve somente os profissionais da área da saúde. O paradigma mudou. Outros profissionais têm sido demandados, como operadores do Direito, profissionais da área de comunicação e economistas, pela multiplicidade de fatores envolvidos nessa epidemia. O tema envolve medidas preventivas para a redução da prevalência do consumo e a proteção contra a exposição à fumaça do tabaco, e a referência é a Convenção Quadro para o Controle do Tabaco (CQCT) – internalizada no ordenamento jurídico brasileiro com a ratificação do Decreto nº 5.658/2006, assim como as Diretrizes para sua implementação.

La judicialización de la salud: Entrevista a Víctor Abramovich, Procurador Fiscal ante la Corte Suprema de Justicia de la Nación / The judicialization of health: care Abramovich Interview

La presente entrevista se realizó en el marco de dos proyectos en curso, que tienen entre sus ejes de análisis el derecho a la salud y las diversas formas bajo las cuales el Estado, tanto a nivel administrativo como judicial, responde e interviene ante el incumplimiento de este derecho. Conversamos con el procurador fiscal Víctor Abramovich acerca de la judicialización de la salud y su impacto en el sistema de salud argentino, del rol y el alcance que podría tener esta para la producción de cambios hacia un mejor desempeño del sistema de salud, del papel que han tenido y tienen las Cortes Constitucionales en otros países de la región, de la relevancia de pensar mecanismos de reclamo y participativos para generar instancias previas a la judicialización, entre otros temas, para reflexionar sobre la reforma de salud en nuestro país.

Visibilizar la salud internacional en los territorios / Make international health visible in the territories

La pandemia del Coronavirus puso nuevamente en el centro de las agendas políticas a lo sanitario. No obstante, las Dimensiones Internacionales de la Salud y su expresión cotidiana en los ámbitos subnacionales latinoamericanos se encuentran invisibilizadas (Róvere, 1992). Este trabajo primero se propone enmarcar en términos históricos a la Salud Internacional y al Complejo Médico Industrial y Financiero (Herández, 2019: Iriart, 2008). En segundo lugar, confrontar las concepciones de salud internacional frente a la de salud global, al tiempo que describir los conceptos de filantrocapitalismo, territorio, Salud como Asunto Internacional y las Dimensiones Internacionales de la Salud (Róvere, 1992). Seguidamente, se analizarán publicaciones académicas con diferentes perspectivas sobre las barreras de acceso a la salud, enunciando las principales características que las sustentan. Finalmente se buscará problematizar y visibilizar las categorías antes expuestas a nivel local-territorial, indagando sobre las barreras de acceso que de ellas derivan.

Protección constitucional del derecho a la salud en la República del Paraguay / Constitutional protection of the right to health in the Republic of Paraguay

Con la sanción de la Constitución Nacional en 1992 de la Repúblicadel Paraguay, se declara en sus artículos 68 y 69 "que el Estado protegerá y promoverá el derecho a la salud como fundamental, proveyendo las condiciones dentro del Sistema Nacional de Salud, recursos, planes y políticas integradas al desarrollo". Este marco constitucional ha sido la base y el fundamento de la Ley 1.032/96, que crea el Sistema Nacional de Salud, el cual está compuesto por los subsectores públicos, mixtos y privados, caracterizado por un modelo segmentado y fragmentado, reglamentado por el Decreto Ley N°21.376 del año 1998 bajo la rectoría del Ministerio de Salud Pública y Bienestar Social, actualmente la salud paraguaya está fundamentada en los ejes estratégicos basados en la creación e implementación de unidades de salud familiar y se define con un enfoque basado en la atención primaria de la salud. Palabras clave: Paraguay; derecho a la salud; sistemas nacionales de salud; constitución y estatutos; atención primaria de salud

With the enactment of the National Constitution of the Republic of Paraguay in 1992, articles 68 and 69 state that "the State will protect and promote the right to health as fundamental, providing the conditions within the National Health System, resources, plans and policies integrated to development". This constitutional framework has been the basis and foundation of Law 1.032/96, which creates the National Health System, which is composed of public, mixed and private subsectors, characterized by a segmented and fragmented model, regulated by the Decree Law No. 21,376 of 1998, under the Ministry of Public Health and Social Welfare, Paraguayan health is currently based on strategic axes based on the creation and implementation of family health units and is defined with an approach based on primary health care. Key words: Paraguay; right to health; national health systems; constitutionand bylaws; primary health care

The ubiquity of 'self-care' in health: Why specificity matters.

Despite increased interest in self-care for health, little consensus exists around its definition and scope. The World Health Organization has published several definitions of self-care, including in a 2019 Global Guideline rooted in sexual and reproductive health and rights (SRHR), later expanded to encompass health more generally. To establish a robust understanding of self-care, this exploratory study inventorises, consolidates, presents and analyses definitions of self-care beyond the SRHR field. A pragmatic review identified definitions and conceptualisations of self-care from peer-reviewed and grey literature published between 2009 and 2021. The search identified 91 definitions of self-care from 116 relevant publications. Data extraction informed analysis to identify recurring themes and approaches, revealing three key areas of variation: self-care being: (1) defined directly or descriptively; (2) situated within individual, interpersonal or structural contexts; (3) defined broadly or topic-specifically. A multilevel conceptualisation can guide a more broadly applicable understanding of self-care: first, as an aspect of healthcare; second, as a concept operating at individual, interpersonal and institutional levels; third, as a concept that impacts specific health fields and contexts differently. A comprehensive but adaptable framework works in service of improving health and wellbeing for all, acknowledging the linkages between self-care and health-related human rights.

Minimally good life and the human right to health.

In Global Health Impact: Extending Access to Essential Medicines, Nicole Hassoun argues that the concept of a minimally good life grounds the human right to health, which in turn implies the human right to access essential medicines in developing countries. This article argues that Hassoun's argument must be revised. If the temporal unit of a minimally good life is identified, her argument faces a substantive problem, which undermines an important part of her argument. This article then proposes a solution to this problem. If this proposed solution is accepted, Hassoun's project turns out to be more radical than her argument is supposed to be.