Democracy, citizenship and health in Brazil: challenges to strengthening the Unified Health System (SUS). / Democracia, cidadania e saúde no Brasil: desafios para o fortalecimento do Sistema Único de Saúde (SUS).

Relations among democracy, citizenship and health have shaped the Unified Health System (SUS) over the past four decades. Until 2016, democracy was strengthened and social rights extended, despite structural difficulties, conflicts between projects, and unevenly over time. The SUS has allowed advances in access and improvements to health conditions. Between 2016 and 2022, there were significant reversals in economic, social, and health policies. Since 2020, the situation has been aggravated by the multidimensional crisis associated with the COVID-19 pandemic. The work of the SUS, universities and public scientific institutions was fundamental in tackling the crisis. From 2023 onwards, Brazil has faced enormous challenges in restoring a democratic national project focused on social welfare. Strengthening the SUS depends on the character of social policies and democracy, and on transforming relations among State, market and society, to overcome constraints that have persisted even during progressive governments. The SUS, a universal policy rooted in a broad concept of health and democratic values, is fundamental to establishing a pattern of development aimed at reducing inequalities and building a more just society.

As relações entre democracia, cidadania e saúde permearam a conformação e a trajetória do Sistema Único de Saúde (SUS) nas últimas quatro décadas. Em que pesem dificuldades estruturais, conflitos entre projetos e diferenças entre momentos, até 2016 observou-se o fortalecimento da democracia e a expansão de direitos sociais. O SUS permitiu avanços no acesso e melhorias nas condições de saúde. Entre 2016 e 2022, os retrocessos nas políticas econômicas, sociais e de saúde foram expressivos. A situação foi agravada pela crise multidimensional associada à pandemia de COVID-19 a partir de 2020. A atuação do SUS, de universidades e de instituições científicas públicas foi fundamental para o enfrentamento da crise. A partir de 2023, os desafios de retomada de um projeto nacional democrático e voltado ao bem-estar social são imensos. O fortalecimento do SUS depende do caráter das políticas sociais e da democracia, e de transformações nas relações Estado-mercados-sociedade, para superar limites que persistiram mesmo durante governos progressistas. O SUS, como política universal ancorada em uma concepção ampla de saúde e em valores democráticos, é um pilar fundamental para a consolidação de um padrão de desenvolvimento orientado para a redução das desigualdades e a construção de uma sociedade mais justa.

Social participation in Anvisa's regulations: hybrid, colloquial, and scientific evidence for democratic decision-making. / Participação social na regulamentação da Anvisa: evidências híbridas, coloquiais e científicas para decisão democrática.

Anvisa's public consultation (PC) is the most widely used social participation mechanism in current health regulations, which was based on antagonistic movements: the democratization of decision-making and State counter-reformation. Starting from the concept of social participation, defined as various actions from society related to public decision-making, which values diversity and the exercise of citizenship, the present article discusses the possibility of PCs configuring a democratic regulation process by considering popular beliefs and colloquial evidence, and promoting the creation of hybrid evidence in an evidence-moderated model. Despite the different interests, the PCs open the door to opportunities for democratic deliberation by society in the search of understanding, where it is expected that the State will make the best decision and justify it. In this sense, the role of evidence in clarifying complex issues is defined as a space where dissent, believed to democratize society, is important in revealing the limits of scientific evidence in an environment of information asymmetry. Finally, this article aims to refute technocracy as an instrument of power in health regulations, thereby achieving the greatest democratic potential of Anvisa's regulations.

A consulta pública (CP) da Anvisa é o mecanismo de participação social mais usado na regulamentação, consolidada com base em movimentos antagônicos: democratização da tomada de decisão e contrarreforma do Estado. Diante do conceito de participação social como várias ações relacionadas à decisão pública com valorização da diversidade e como exercício da cidadania, o artigo discute a possibilidade de as CPs configurarem um processo de regulamentação democrático ao considerar saberes populares e evidências coloquiais, além de promover a criação de evidências híbridas em um modelo moderado de evidências. Apesar dos diferentes interesses, as CPs abrem oportunidades para deliberação democrática da sociedade na busca do entendimento, onde se espera que o Estado escolha a melhor decisão e a justifique. Dessa forma, delimita-se o papel das evidências a esclarecer questões complexas em um espaço em que o dissenso, visto como caminho para a democratização da sociedade, é importante para revelar as limitações das evidências científicas em um ambiente de assimetria de informações. Por fim, espera-se refutar a tecnocracia como instrumento de poder na regulação sanitária e assim alcançar o maior potencial democrático da regulamentação da Anvisa.

Solidarity as politics: Global Health and democracy. / Solidariedade como política: Saúde Global e democracia.

Ensuring democracy in establishing Global Health (GH) requires including health perspectives and actions of what is conventionally called "local". Edging closer to the references of the Meeting of Knowledges to those of Coloniality, we address the implementation of Solidary Greengrocers by the initiative of small-scale fishermen in the South of Bahia, Brazil, in facing socioeconomic and health issues related to the COVID-19 pandemic. The triangulation of methods characterized the fieldwork based on ethnography, action research, and partnership with local stakeholders in analyzing the material. The search for simultaneous health, socioeconomic, environmental, and educational effects allowed for overcoming the risks in GH actions such as humanitarianism, controlism, neoliberalism, and colonialism. The initiative was managed by the political organization of the residents of the reserve, who raised and managed State and civil society resources with autonomy and solidarity, combining traditional knowledge with institutional and technological knowledge of the territory. So-called local experiences contain a complete vision of the world that should not be submitted to a totalizing category. Global Health can benefit from considering the several worlds underlying its object.

Garantir a democracia na constituição do campo da Saúde Global (SG) requer a inclusão de perspectivas e ações sanitárias do que se convencionou chamar de "local". Aproximando os referenciais do Encontro de Saberes ao de Colonialidade, abordamos a implementação de Quitandas Solidárias por iniciativa de pescadores artesanais, no sul da Bahia, no enfrentamento de questões socioeconômicas e de saúde ligadas à pandemia de COVID-19. A triangulação de métodos caracterizou os trabalhos de campo, baseados na etnografia, pesquisa-ação e parceria com agentes locais na análise do material. A busca de efeitos simultaneamente sanitários, socioeconômicos, ambientais e educativos possibilitou relativa superação dos riscos presentes nas ações de SG como os de humanitarismo, controlismo, neoliberalismo e colonialismo. A iniciativa foi gerida pela organização política dos moradores da reserva, que captaram e manejaram recursos do Estado e da sociedade civil com autonomia e solidariedade, aliando os saberes tradicionais aos conhecimentos institucionais e tecnológicos do território. As experiências ditas locais contêm uma visão completa de mundo que não devem ser submetidas a uma categoria totalizante. A Saúde Global pode se beneficiar da consideração dos diversos mundos que constituem o seu objeto.

A facilitator's reflection on the democratizing potential of emancipatory practice development.

Emancipatory practice development (ePD) is a practitioner-led research methodology which enables workplace transformation. Underpinned by the critical paradigm, ePD works through facilitation and workplace learning, with people in their local context on practice issues that are significant to them. Its purpose is to embed safe, person-centred learning cultures which transform individuals and workplaces. In this article, we critically reflect on a year-long ePD study in an acute care hospital ward. We explore the challenges of practice change within systems, building collective strength with frontline collaborations and leadership to sustain new learning cultures. Our work advances practice development dialogue through working closely with the underpinning theories. Our critique analyses how ePD can enact and sustain change within a complex system. We argue that ePD works to strengthen safety cultures by challenging antidemocratic practices through communicative action. By opening communicative spaces, ePD enables staff to collectively deliberate and reach consensus. Their raised awareness supports staff to resist ways of working which conspire against safe patient care. Sustainability of practice change is fostered by the co-operative democracies created within the frontline team and meso level enablement. We conclude that the democratising potential of ePDt generates staff agency at the frontline.

Exploring perceived challenges, adoption, and assessment of Western values of democracy and human rights in Palestine in the 2023 War on Gaza.

This study delved into the dynamics of perceived challenges, adoption, and assessment of Western values of democracy and human rights among university students in Palestine, particularly in the aftermath of the 2023 War on Gaza. A mixed-methods strategy was used in the research, with a participant pool of 384 students representing a range of demographics. By exploring the impact of geopolitical events, the results revealed a positive link between perceived challenges and the assessment of Western values. Although there is a notable gender and geographic difference in the assessment and adoption of Western values, females and those living in cities and villages are shown to have greater perceived challenges with these values. The qualitative component, including interviews with 12 students, provided valuable insights into the postwar evolution of Palestinian perspectives, highlighting a notable shift in attitudes, initially characterized by belief in the superiority of Western values, followed by a decline in faith during the war. This decline is attributed to traumatic events, biased media narratives, and the contradiction between idealized standards and harsh realities. In conclusion, the study emphasizes the need for a comprehensive understanding of the multifaceted influences on Palestinian perceptions of Western values.

Social media use and vaccination among Democrats and Republicans: Informational and normative influences.

Our objective was to determine whether social media influences vaccination through informational and normative influences among Democrats and Republicans. We use a probability-based longitudinal study of Americans (N = 1768) collected between December 2022 and September 2023 to examine the prospective associations between social media use and vaccination as well as informational and normative influence as mediating processes. Greater social media use correlates with more frequent vaccination (cross-lagged coefficients: COVID-19 = 0.113, p < 0.001; influenza = 0.123, p < 0.001). The underlying processes, however, vary between Democrats and Republicans. Democrats who use social media more are more likely to vaccinate because they encounter information about new pathogens. In contrast, Republicans who use social media more are more likely to vaccinate because they think that people who are important to them receive the recommended vaccines. Our findings underscore the potential for social media campaigns to promote vaccination, among both Democrats and Republicans by paying attention to the specific processes in each audience.

Mobilizing grievances in the internet age: The case of national online petitioning in South Korea, 2017-2022.

Which kinds of grievances garner support from the public on online platforms? Focusing on national online petitioning, one of the forms of direct democracy in contemporary politics, we examine the content and characteristics of petitions that succeeded in attracting public attention and support. Using our comprehensive data on online petitions that were submitted to the executive office between 2017 and 2022 in South Korea, our analysis yields three important findings. First, a mix of post-materialist topics such as human rights and gender equality and materialist topics such as safety and environment turn out to be salient among petitions that meet the signature threshold. Second, online petitions the contents of which reveal either moral emotions or Confucian attitudes are more likely to gain public support compared to others. Third, keywords that are related to moral claims asking for the apprehension of perpetrators on behalf of victims, such as 'victim,' 'perpetrator,' 'kid,' and 'punishment,' appear most frequently inside the petitions that cross the signature threshold. Such findings provide implications for understanding both the potentials and limitations of national online petitioning in contemporary democracies.

How to Design a (Cybernetic) Revolution: Chileans Remember Salvador Allende's Techno-Utopian Project.

The recent commemoration of the fiftieth anniversary of the military coup led by General Augusto Pinochet offered an opportunity to explore unknown aspects of daily life before and during the dictatorship. This essay focuses on one particular exhibition (How to Design a Revolution: The Chilean Road to Design), which featured a complete reconstruction of the Cybersyn operation room. Based on participant observation, the essay argues that the interaction between visitors and the re-creation in such a particular moment is an invitation to reflect on how technology, socialism, and democracy sought to reinforce each other during the Cold War. The Cybersyn project, one of the most globally recognizable pieces of technology designed in the Global South, still resonates five decades after its implementation (and further destruction by the military), prompting new questions in an era of artificial intelligence and new threats to democracy.

When liars are considered honest.

This article introduces a theoretical model of truth and honesty from a psychological perspective. We examine its application in political discourse and discuss empirical findings distinguishing between conceptions of honesty and their influence on public perception, misinformation dissemination, and the integrity of democracy.

Democratic quality and excess mortality during the COVID-19 pandemic.

The aim of this study is to analyse the relationship between democratic quality and excess mortality produced in the year 2020 before COVID-19 vaccinations were generalised. Using cross-sectional data from 80 countries on five continents, multiple linear regression models between excess mortality, the general democracy index and its disaggregation into five categories: electoral process and pluralism, government functioning, political participation, political culture and civil liberties were estimated. The analysis also considered, public health spending per capita, overweight inhabitants, the average temperature of the country, population over 65 years of age, The KOF Globalisation Index, and the Gross National Income per capita as control variables. It was possible to establish a strong inverse association between excess mortality per million inhabitants and the general democracy index and four of its five categories. There was a particularly strong relationship between excess mortality and the political culture dimension (-326.50, p < 0.001). The results suggest that the higher the democratic quality of the political institutions of a State and particularly of their political culture the more improved the response and management of the pandemic was in preventing deaths and protecting their citizens more effectively. Conversely, countries with lower democracy index values have higher excess mortality. Quality democratic political institutions provide more effective public health policies in the face of the COVID-19 pandemic.

European Technical Democracy? How Consumer Associations Did-or Did Not-Shape the 1980s Automotive Environmental Standards.

Did the 1980s automotive standards reflect the European Economic Community's move toward a "technical democracy" or a broader democratic deficit? In the early 1980s, Europe's automotive sector faced multiple challenges: the European Commission's desire to harmonize technical standards and achieve greater European integration, intense competition between manufacturers, and environmental issues like acid rain. Debates on reducing air pollution focused on unleaded petrol and catalytic converters. Two associations representing civil society in Brussels responded to the increase in environmental concerns with a 1982 joint campaign. Despite a rich historiography on pollutant emission standards, highlighting the strategies of governments and companies, no study has dealt with the role nongovernmental organizations played. Based on public and private archives, particularly those of the European Bureau of Consumers' Unions, this article argues the new regulations did not result from the EU's consultation with civil society organizations like consumer groups but rather with the automotive industry.

Correlation of geopolitics, education, democracy with COVID-19 vaccination rate.

INTRODUCTION: Vaccine hesitancy is an ongoing problem and determining the factors that increase the vaccination rate in various countries of the world might be useful for further implementation of efficient public health policies and negating anti-vaccination campaigns. MATERIALS AND METHODS: Human Development Index (HDI), Education Index (EI), Democracy Index (DI), COVID-19 vaccination rates, COVID-19 data were collected from public sources such as UNDP - Human Development Reports, UNESCO - Education Index, Economist Intelligence, WHO- COVID-19 Dashboard, Our World In Data, The Financial Times COVID-19 Dashboard. Statistical analysis such as Pearson correlation, and linear regression analyses were done to determine a relation between the above-mentioned indices and COVID-19 vaccination rates (1-dose, 2-dose, booster, and combined). RESULTS: HDI had the strongest positive correlation with the vaccination rates (1-dose- r (181) = 0.632, p < 0.001, 2-dose- r (181) = 0.671, p < 0.001, booster- r (181) = 0.718, p < 0.001, combined- 0.703, p < 0.001). EI (1-dose- r (177) = 0.560, p < 0.001, 2-dose- r (177) = 0.599, p < 0.001, booster- r (177) = 0.642, p < 0.001, combined- 0.626, p < 0.001), DI (1-dose- r (163) = 0.445, p < 0.001, 2-dose- r (163) = 0.479, p < 0.001, booster- r (163) = 0.534, p < 0.001, combined- 0.508, p < 0.001), as well as Geographic location (1-dose- η (Eta) = 0.610 p < 0.001, 2-dose- η (Eta) = 0.633 p < 0.001, booster- η (Eta) = 0.657, p < 0.001, combined- η (Eta) = 0.645, p < 0.001) had positive correlation with vaccination rates. CONCLUSION: There is a strong positive correlation of COVID-19 vaccination rates with HDI and EI.

Future governance of the RCVS: democracy or oligarchy?

Bruce Vivash Jones argues that the recent announcement from the RCVS that it is moving to 'scrap elections to council' raises many questions and concerns.

Democracy's limited impact on innovation: Panel data evidence from developing countries.

This study investigates the relationship between democracy and innovation across 61 developing countries from 2013 to 2020, utilizing data from Global Innovation Index. Employing the Freedom House Index and Polity2 indicators as proxies for democracy, research employs Ordinary Least Squares (OLS), Fixed Effects and SystemGMM techniques to analyze their impact on innovation. The findings of the study reveal no statistically significant relationships between democracy and innovation in developing nations within specified timeframe. Through empirical analysis, including various econometric approaches, it is observed that the level of democracy as measured by these indicators, does not appear to exert a discernable impact on the innovation landscape of these countries. These results carry important implications for public policy. While the promotion of democracy remains a crucial goal, especially for societal development and political stability, this study suggests that solely focusing on enhancing democratic institutions might not necessarily yield immediate direct improvements in the innovation capacities of developing nations. Policymakers and stakeholders involved in fostering innovation ecosystems in these regions may need to consider a more nuanced approach, encompassing factors beyond the scope of democratic governance to effectively spur innovation. Understanding the nuanced relationship between democracy and innovation in developing countries has significant implications for designing targeted policies aimed at enhancing innovation capacities, economic growth and overall societal development in these regions.