Political factors and arrangements influencing primary health care financing and resource allocation: A scoping review protocol.

INTRODUCTION: Primary health care is a key element in the structuring and coordination of health systems, contributing to overall coverage and performance. PHC financing is therefore central in this context, with variations in sufficiency and regularity depending on the "political dimension" of health systems. Research that systematically examines the political factors and arrangements influencing PHC financing is justified from a global and multidisciplinary perspective. The scoping review proposed here aims to systematically map the evidence on this topic in the current literature, identifying groups, institutions, priorities and gaps in the research. METHODS AND ANALYSIS: A scoping review will be conducted following the method proposed by Arksey and O'Malley to answer the following question: What is known from the literature about political factors and arrangements and their influence on and repercussions for primary health care financing and resource allocation models? The review will include peer-reviewed papers in Portuguese, English or Spanish published between 1978 and 2023. Searches will be performed of the following databases: Medline (PubMed), Embase, BVS Salud, Web of Science, Scopus and Science Direct. The review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Inclusion and exclusion criteria will be used for literature screening and mapping. Screening and data charting will be conducted by a team of four reviewers. REGISTRATION: This protocol is registered on the Open Science Framework (OSF) platform, available at https://doi.org/10.17605/OSF.IO/Q9W3P.

Stigmatisation and resistance processes: Reflections on the field of HIV research and an agenda for contemporary stigma studies.

Stigmatisation processes constitute key barriers to effectively addressing the HIV pandemic. In this article, we provide a critical overview of this field's current state of the art, highlighting some key emerging issues that merit greater research attention in the future to ensure that contemporary research on stigmatisation and resistance processes continues to engage with changing social and political circumstances. We look at how resistance to stigma has developed in the context of HIV and highlight some of the most important programmatic strategies that have emerged over the history of the pandemic. We present the key concepts of 'moral panics' and 'necropolitics', and we articulate them in relation to new global phenomena that deepen the processes of stigmatisation. Moreover, we identify an agenda for investigation which merits greater attention in future research, intervention, and advocacy: 1) changing political environments, neoliberalism, growing political polarisation, and the rise of political extremism; 2) the rise of the information age, technological change, and social media; and 3) rebuilding civil society and governmental responses to stigma.

The postmodern subject from a psychopolitical perspective: An analysis from logotherapy. / El sujeto posmoderno desde una visión psicopolítica: análisis desde la logoterapia.

From a hermeneutic interpretation, this article analyzed the new psychic pandemic configuring a typology of psychopolitical man, provided by digital swarms and mass psychology, that, from logotherapy, can be perceived as a postmodern collective neurosis. We also analyze a self's hyper-reflection as a social phenomenon of psychopolitics, suffering as repression, and the love of narcissistic consumption. Consolidating a sense of life as a social ethos is the answer to finding compromises and responsibility for the individual mission that every human being has as a member of a community and society.En este ensayo se abordó la nueva pandemia psíquica desde una interpretación hermenéutica. Esta pandemia configura una tipología de persona psicopolítica, dada por enjambres digitales y una psicología de masas que, desde la logoterapia, se puede percibir como neurosis colectivas postmodernas. También se puede analizar como fenómenos sociales de la psicopolítica. Esta es una hiperreflexión del propio yo, el sufrimiento como represión y el amor de consumo narcisista. El consolidar un sentido de vida como ethos social, es la respuesta para hallar compromisos y responsabilidad ante la misión personal que tiene cada ser humano como miembro de una comunidad y sociedad.

Perspectives for Primary Health Care public policy in South America. / Perspectivas para las políticas públicas de Atención Primaria en Salud en Suramérica.

We aim to conduct a comparative analysis of the implementation of PHC in nine South American countries. Three dimensions were highlighted from documentary sources: political commitment, leadership, and governance; care model; and engagement of communities and other stakeholders. The results indicate a formal commitment that places PHC at the center of efforts to achieve universal access. The following can be observed: revitalization processes in public subsystems, based on guaranteeing preventive, promotional, curative and rehabilitation actions; PHC as gatekeeper; emphasis on family and community; assigned population and territory; multidisciplinary teams; and, in some cases, the accent on interculturality expressed in the concept of "buen vivir" (good living). The PHC revitalization processes were affected by political changes. Between progress and setbacks, the segmentation of coverage was not overcome. The current moment seeks to recover more inclusive and broad public policies in the context of the return of the progressive and democratic fields. The dissemination of country experiences can contribute to the development of a comprehensive, integrated, and quality approach to PHC in the Region.

El objetivo es realizar un análisis comparativo de la implementación de la APS en nueve países de Suramérica. A partir de fuentes documentales fueron destacadas tres dimensiones: compromiso político, liderazgo y gobernanza; modelo de atención; involucramiento de comunidades y otros actores. Los resultados indican la existencia de compromiso formal que localiza la APS en el centro de los esfuerzos para lograr el acceso universal. Se observan procesos de revitalización en los subsistemas públicos, basados en la garantía de acciones preventivas, promocionales, de cura y rehabilitación; puerta de entrada; enfoque familiar y comunitario; población y territorio adscriptos; equipos multiprofesionales, y, en algunos casos, énfasis en la interculturalidad expresada en la concepción de "buen vivir". Los procesos de revitalización de la APS fueron afectados por cambios políticos. Entre avances y retrocesos, no se logró superar la segmentación de cobertura. El momento actual es de rescate de políticas públicas más inclusivas y amplias, en el contexto de recomposición de los campos progresistas y democráticos. Difundir experiencias de los países puede contribuir para el desarrollo de un enfoque de APS integral, integrada y de calidad en la Región.

The Perfect Storm: Applying the Multiple Streams Framework to Understand the Adoption of a WHO Framework Convention on Tobacco Control-Based Policy in Mexico.

BACKGROUND: The aim of this study was to document how Mexico adopted a WHO Framework Convention on Tobacco Control (FCTC)-based national tobacco control law. METHODS: We analyzed publicly available documents and interviewed 14 key stakeholders. We applied the Multiple Streams Framework (MSF) to analyze these findings. RESULTS: Previous attempts to approve comprehensive FCTC-based initiatives failed due to a lack of political will, the tobacco industry's close connections to policymakers, and a lack of health advocacy coordination. Applying the MSF reveals increased attention towards collecting and sharing data to frame the severity of the problem (problem stream). The expansion of a coordinated health advocacy coalition and activities led to increased support for desired FCTC policy solutions (policy stream). The election of President López Obrador and legislative changes led to a deep renewed focus on tobacco control (politics stream). These three streams converged to create a policy window to secure a strong FCTC-based initiative on the political agenda that was ultimately passed. CONCLUSIONS: The Mexican experience illustrates the importance of continued health advocacy and political will in adopting FCTC-based policies. Other countries should follow Mexico's lead by collecting and sharing data through coordinating efforts in order to be prepared to seize political opportunity windows when strong political will is present.

The response to COVID-19 in Argentina, Brazil, and Mexico: challenges to national coordination of health policies.

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.

[The life path of Irma Carrica: An approach to the political and health debates of the 1960s and 1970s using the biographical method]. / La trayectoria de vida de Irma Carrica: una aproximación a los debates político-sanitarios de las décadas de 1960 y 1970 desde el método biográfico.

We reconstruct the life path of the Argentine nurse and popular activist Irma Carrica, understood as a political-professional experience tied to her social networks and marked by conflicts and contradictions inherent to her historical context. From this analytical perspective and considering the precautions suggested by the biographical method of social sciences, we delve into the political and health debates of the 1960s and 1970s, particularly concerning disputes over the meaning of "community" in the health field. Specifically, we focus on the contributions of a collective historical actor - heterogeneous and plural, yet identifiable in its various forms - that we have termed the Peronist Left in health. By analyzing their professional and intellectual networks, we emphasize the role played by Irma Carrica as a representative of this Peronist Left in health, in constructing alternative dynamics for community health approaches, which challenged the dominant epistemological and pedagogical paradigms.

Reconstruimos la trayectoria de vida de la enfermera y militante popular argentina Irma Carrica, entendida como una experiencia político-profesional ligada a sus redes de sociabilidad y atravesada por conflictos y contradicciones inherentes a su contexto histórico. Desde ese recorte analítico y teniendo en cuenta los recaudos sugeridos por el método biográfico de las ciencias sociales, nos adentramos en los debates político-sanitarios de las décadas de 1960 y 1970, principalmente en lo relativo a las disputas por el sentido de la "comunidad" en el campo de la salud. En particular, nos enfocamos en las contribuciones de un actor histórico colectivo ­heterogéneo y plural, pero identificable en sus distintas modulaciones­ que hemos denominado izquierda peronista en salud. Al analizar sus redes profesionales e intelectuales, hicimos hincapié en el rol que desempeñó Irma Carrica como referente de esa izquierda peronista en salud, a la hora de construir dinámicas alternativas para el abordaje comunitario en salud, que pusieron en tela de juicio los paradigmas epistemológicos y pedagógicos dominantes.

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.

When dissident bodies proclaim their places as dissonant bodies. / Quando corpos dissidentes proclamam seus lugares como corpos diz-sonantes.

This essay aims to present the concept of dissonant bodies and give visibility to these bodies in the field of public health from anti-colonial and queer perspectives. These bodies are often considered dissidents. Their existence is considered abject, disposable, and marginalized by neoliberal and necropolitical society. It is presented as another possibility in the face of the logic and political strategies of hegemonic reproduction of capital-life and health policies. It debates tensions of new possibilities and alternatives of other modes of existence and inclusive worlds, in which all lives are considered, in their singularities and differences, radically equal in the validation of their ways of living.

O objetivo deste ensaio é apresentar o conceito de corpos diz-sonantes e dar visibilidade a esses corpos no campo da saúde coletiva, a partir de perspectivas anti-coloniais e queers. São corpos muitas vezes considerados dissidentes, cujas existências consideradas abjetas, descartáveis e marginalizadas, pela sociedade neoliberal e necropolítica são apresentadas como outras possibilidades frente às lógicas e estratégias políticas de reprodução hegemônica da vida-capital e nas políticas de saúde. Debate tensionamentos de novas possibilidades e alternativas de modos outros de existências e de mundos inclusivos, em que todas as vidas sejam consideradas, em suas singularidades e diferenças, radicalmente iguais na validação dos seus modos de viver.

Squeezed from the top: "Social Outburst" (2019) and elite overproduction. A study of the dynamics of Chilean political instability from the approach of Structural Demographic Theory.

On October 18, 2019, Chile experienced the most important social upheaval since the country regained democracy in the late 1980s. The "Social Outbreak" surprised economic and political elites and seemed paradoxical to the international community who had often praised Chile as a model of successful development. In this paper, we used structural-demographic theory to analyze the interaction between the overproduction of elites and the stagnation in the relative income of the population as the underlying structural cause of Chilean political instability. This theory was able to predict the three most significant instances of political tension in the recent history of Chile: the crisis of the late 1960s that culminated in the coup d'état of 1973, popular mobilizations during the 1980s, and the recent student mobilizations and social upheaval. Our results suggest that, at least during the period 1938-2019, Chilean sociopolitical dynamics is determined by the same structural drivers.

The influence of political disagreements and corruption on state health leader turnover during the COVID-19 pandemic in Brazil.

PURPOSE: Governments faced formidable challenges in coordinating public health responses to the COVID-19 pandemic. This study aims to enhance the understanding of effective organizational leadership during crises by investigating the factors influencing the turnover of health leaders during the COVID-19 pandemic in Brazil. DESIGN/METHODOLOGY/APPROACH: Using primary data encompassing all appointments and dismissals of federal and state health secretaries, this paper conducted a quantitative analysis of the relational and reputational factors that contributed to leader turnover during the COVID-19 pandemic. This paper also examined whether leaders' management and public health experience increase the duration of tenure. FINDINGS: States encountered significant challenges in retaining experienced and effective leadership during the health emergency, primarily due to political conflicts in policymaking and, to a lesser extent, allegations of corruption. Furthermore, leaders with expertise in public health were found to be less likely to be removed from office. However, managerial experience did not prolong the tenure of state health secretaries during the emergency. RESEARCH LIMITATIONS/IMPLICATIONS: Since most health leaders have public health and management experience, the contributions of each factor to the duration of a secretary's tenure are difficult to separate and analyze separately. PRACTICAL IMPLICATIONS: This study provides empirical insights into what factors drive health leader turnover during major health emergencies. SOCIAL IMPLICATIONS: During major health emergencies, health leaders often strongly disagree with elected officials on the response. This paper test how crisis leadership theories help explain state health leaders' duration in one of the world's largest public health systems during the COVID-19 pandemic. This paper find that policy disagreements contributed to significant turnover. ORIGINALITY/VALUE: To the best of the authors' knowledge, this paper is the first that are aware of that uses novel primary data on public health executive leader characteristics and turnover causes in the context of the COVID-19 pandemic. It provides empirical evidence contributing to the crisis leadership literature by examining health leader turnover in one of the world's largest public health systems.

Research in Latin America from a decolonial perspective: Challenges of producing socially situated knowledge.

The developmental science literature predominantly originates from WEIRD (Western, Educated, Industrialized, Rich, and Democratic) countries. This bias perpetuates colonial power imbalances and marginalizes non-WEIRD societies' knowledge. This special issue addresses this gap by focusing on Latin America, emphasizing the region's diverse socioeconomic, cultural, and political contexts. This commentary contextualizes research in Latin America, and then presents and discusses the articles. Finally, it presents some of the challenges researchers in Latin America face.

Presidential election results in 2018-2022 and its association with excess mortality during the 2020-2021 COVID-19 pandemic in Brazilian municipalities.

We evaluated the hypothesis of an association between excess mortality and political partisanship in Brazil using municipal death certificates registered in the Brazilian Ministry of Health database and first-round electoral results of Presidential elections in 2018 and 2022. Considering the former Brazilian President's stance of discrediting and neglecting the severity of the pandemic, we expect a possible relationship between excessive mortality rates during the COVID-19 health crisis and the number of municipal votes for Bolsonaro. Our results showed that, in both elections, the first-round percentage of municipal votes for Bolsonaro was positively associated with the peaks of excess deaths across Brazilian municipalities in 2020 and 2021. Despite the excess mortality during the pandemic, the political loyalty to Bolsonaro remained the same during the electoral period of 2022. A possible explanation for this is linked to the Brazilian political scenario, which presents an environment of tribal politics and affective polarization.

[Germinal Rodríguez: public health, politics and medical popularization in the first person, Argentina, 1922-1960]. / Germinal Rodríguez: salud pública, política y divulgación sanitaria en primera persona, Argentina, 1922-1960.

This article examines the career of Argentine doctor Germinal Rodríguez, situating it within the context of social history of medicine and the recent trend of medical biographies. Using a qualitative documentary analysis methodology, we analyzed various sources, including official records from the University of Buenos Aires, journalistic articles, and books by Rodríguez himself. Our analysis reveals that Rodríguez's enjoyed a successful academic career in university teaching, while concurrently engaging in active socialist activism between 1920-1930. Beyond academia, Rodríguez served as a science popularizer, a policy consultant for his party, and even a public official during the Peronist era.

Este trabajo reconstruye la trayectoria del médico argentino Germinal Rodríguez en diálogo con la historia social de la salud y la enfermedad y con una reciente corriente historiográfica de biografías médicas. En base a una metodología cualitativa de análisis documental, analizamos expedientes oficiales de la Universidad de Buenos Aires, fuentes periodísticas, libros de Rodríguez y otras fuentes secundarias. Como resultado, podemos afirmar que su vida profesional estuvo marcada por la enseñanza universitaria y una exitosa carrera académica, así como por su intensa militancia socialista entre 1920-1930. Rodríguez fue también un divulgador, un experto de consulta en políticas públicas para su partido y funcionario estatal en los años del peronismo.

Bubble reachers and uncivil discourse in polarized online public sphere.

Early optimism saw possibilities for social media to renew democratic discourse, marked by hopes for individuals from diverse backgrounds to find opportunities to learn from and interact with others different from themselves. This optimism quickly waned as social media seemed to breed ideological homophily marked by "filter bubbles" or "echo chambers." A typical response to the sense of fragmentation has been to encourage exposure to more cross-partisan sources of information. But do outlets that reach across partisan lines in fact generate more civil discourse? And does the civility of discourse hosted by such outlets vary depending on the political context in which they operate? To answer these questions, we identified bubble reachers, users who distribute content that reaches other users with diverse political opinions in recent presidential elections in Brazil, where populism has deep roots in the political culture, and Canada, where the political culture is comparatively moderate. Given that background, this research studies unexplored properties of content shared by bubble reachers, specifically the quality of conversations and comments it generates. We examine how ideologically neutral bubble reachers differ from ideologically partisan accounts in the level of uncivil discourse they provoke, and explore how this varies in the context of the two countries considered. Our results suggest that while ideologically neutral bubble reachers support less uncivil discourse in Canada, the opposite relationship holds in Brazil. Even non-political content by ideologically neutral bubble reachers elicits a considerable amount of uncivil discourse in Brazil. This indicates that bubble reaching and incivility are moderated by the national political context. Our results complicate the simple hypothesis of a universal impact of neutral bubble reachers across contexts.

Mental health in Brazil in times of neoliberalism and pandemic: retrogression and resistance.

This study analyzes aspects of mental health in Brazil as an active political field involving a range of social segments and actors from opposing fields in a context of advancing neoliberalism and pandemic. The analysis begins in 2016, when fiscal austerity entered the national agenda, and proceeds through the pandemic until the present day, when both phenomena continue to prevail, even if the intensity of the pandemic is now reduced. In the ambit of mental health, the national policy based on the principles of the psychiatric reform has suffered severe setbacks. Nonetheless, despite state-sponsored efforts to discourage social control and public participation, important sectors of society are engaged in active resistance.

Decentralization of the health system - experiences from Pakistan, Portugal and Brazil.

BACKGROUND: Decentralization of a health system is a complex and multidimensional phenomenon that demands thorough investigation of its process logistics, predisposing factors and implementation mechanisms, within the broader socio-political environment of each nation. Despite its wide adoption across both high-income countries (HICs) and low-and-middle-income countries (LMICs), empirical evidence of whether decentralization actually translates into improved health system performance remains inconclusive and controversial. This paper aims to provide a comprehensive description of the decentralization processes in three countries at different stages of their decentralization strategies - Pakistan, Brazil and Portugal. MAIN BODY: This study employed a systematic analysis of peer-reviewed academic journals, official government reports, policy documents and publications from international organizations related to health system decentralization. A comprehensive search was conducted using reputable databases such as PubMed, Google Scholar, the WHO repository and other relevant databases, covering the period up to the knowledge cutoff date in June 2023. Information was systematically extracted and organized into the determinants, process mechanics and challenges encountered during the planning, implementation and post-decentralization phases. Although decentralization reforms have achieved some success, challenges persist in their implementation. Comparing all three countries, it was evident that all three have prioritized health in their decentralization reforms and aimed to enhance local decision-making power. Brazil has made significant progress in implementing decentralization reforms, while Portugal and Pakistan are still in the process. Pakistan has faced significant implementation challenges, including capacity-building, resource allocation, resistance to change and inequity in access to care. Brazil and Portugal have also faced challenges, but to a lesser extent. The extent, progress and challenges in the decentralization processes vary among the three countries, each requiring ongoing evaluation and improvement to achieve the desired outcomes. CONCLUSION: Notable differences exist in the extent of decentralization, the challenges faced during implementation and inequality in access to care between the three countries. It is important for Portugal, Brazil and Pakistan to address these through reinforcing implementation strategies, tackling inequalities in access to care and enhancing monitoring and evaluation mechanism. Additionally, fostering knowledge sharing among these different countries will be instrumental in facilitating mutual learning.

Material informativo: no cuidado em saúde mental de pessoas em conflitos com a lei / Informative material: in the mental health care of people in conflict with the law

Tem como objetivo familiarizar as equipes da RAPS com os atores e fluxos existentes na assistência das pessoas com questões de saúde mental em conflito com a lei. (AU)

Structuralizing Culture: Multicultural Neoliberalism, Migration, and Mental Health in Santiago, Chile.

The arrival of Afro-descendant migrants, mainly from Haiti and the Dominican Republic, has led to the emergence of new discourses on migration, multiculturalism, and mental health in health services in Chile since 2010. In this article, I explore how mental health institutions, experts, and practitioners have taken a cultural turn in working with migrant communities in this new multicultural scenario. Based on a multisited ethnography conducted over 14 months in a neighbourhood of northern Santiago, I focus on the Migrant Program-a primary health care initiative implemented since 2013. I argue that health practitioners have tended to redefine cultural approaches in structural terms focusing mainly on class aspects such poverty, social stratification, and socioeconomic inequalities. I affirm that this structural-based approach finds its historical roots in a political and ideological context that provided the conditions for the development of community psychiatry experiences during the 1960s and 1970s, as well as in multicultural and gender policies promoted by the state since the 1990s. This case reveals how health institutions and practitioners have recently engaged in debates on migration and intersectionality from a structural approach in Chile.