[Program for Integral Assistance to Women's Health, 40 years of history: interview with Ana Maria Costa]. / Programa de Assistência Integral à Saúde da Mulher, 40 anos de uma história: entrevista com Ana Maria Costa.

The interview marks the 40th anniversary of the Programa de Assistência Integral à Saúde da Mulher (Program for Integral Assistance to Women's Health), and aims to revisit the history of this innovative health policy, the context in which it was created and the generation that took it forward, from the narrative of a key person, Ana Maria Costa, who played a leading role in the process of its creation, from conception to the elaboration of its final text. Launched in 1983, the policy was a pioneer in proposing and incorporating the principles of universality, equity and integrality, which would be the foundations of the Sistema Único de Saúde, and introducing the perspective of women's reproductive rights.

A entrevista marca os 40 anos do Programa de Assistência Integral à Saúde da Mulher e tem como objetivo revisitar a história dessa política de saúde inovadora, do contexto em que foi criada e da geração que a levou adiante, a partir da narrativa de uma pessoa-chave, Ana Maria Costa, que protagonizou o processo de sua criação, desde a concepção até a elaboração de seu texto final. Lançada em 1983, a política foi pioneira em propor e incorporar os princípios de universalidade, equidade e integralidade, que seriam os fundamentos do Sistema Único de Saúde, e introduzir a perspectiva dos direitos reprodutivos das mulheres.

Universal health coverage and equal access in Sweden: a century-long perspective on macro-level policy.

BACKGROUND: When today's efforts to achieve universal health coverage are mainly directed towards low-income settings, it is perhaps easy to forget that countries considered to have universal, comprehensive and high-performing health systems have also undergone this journey. In this article, the aim is to provide a century-long perspective to illustrate Sweden's long and ongoing journey towards universal health coverage and equal access to healthcare. METHODS: The focus is on macro-level policy. A document analysis is divided into three broad eras (1919-1955; 1955-1989; 1989-) and synthesises seven points in time when policies relevant to overarching goals and regulation of universal health coverage and equal access were proposed and/or implemented. The development is analysed and concluded in relation to two egalitarian goals in the context of health: equality of access and equal treatment for equal need. RESULTS: Over the past century, macro-level policy evolved from the concept of creating access for the neediest and those reliant on wages for their survival to a mandatory insurance with equal right to healthcare for all. However, universal health coverage was not achieved until 1955, and individuals had to rely on their personal financial resources to cover the cost at the time of care utilization until the 1970s. It was not until 1983 that legislation explicitly stated that access to healthcare should be equal for the entire population (horizontal equity), while a vertical equity-principle was not added until 1997. Subsequently, ideas of free choice and privatization have gained significance. For instance, they aim to increase service access, addressing the Swedish health system's Achilles' heel in this regard. However, the principle of equal access for all is now being challenged by the emergence of private health insurance, which offers quicker access to services. It can be concluded that there is no perpetual Swedish healthcare model and various dimensions of access have been the focus of policy discussion. The discussion on access barriers has shifted from financial to personal and organizational ones. Today, Sweden still ranks high in terms of affordability and equity in international comparisons: although not as well as a decade ago. Whether this marks the beginning of a new trend intertwined with a decline in Sweden's welfare 'exceptionalism', or is a temporary decline remains to be assessed in the future.

The U-Shaped Curve of Health Inequalities Over the 20th and 21st Centuries.

This article examines historical trends in health inequalities over the 20th and 21st centuries. Drawing on studies from the United States, United Kingdom, Sweden, and Western Europe, it concludes that there is evidence of a u-shaped curve in (relative) health inequalities. These trends in health inequalities broadly parallel those identified by economists with regards to the u-shaped curve of income and wealth inequalities across the 20th and 21st centuries. The article argues that-as with income inequalities-health inequalities generally decreased across the twentieth century through to the early 1980s. They then started to increase and accelerated further from 2010, particularly in the United Kingdom and the United States. The article sets out four distinct policy periods that shaped the evolution of trends in health inequalities: the Interbellum Era, 1920-1950; the Trente Glorieuse, 1950-1980; Neoliberalism, 1980-2010; and the Crisis Age, 2010-present. The u-shaped curve of health inequalities over this period suggests that social policies, health care access, and political incorporation have driven changes over time. Taking this long view of changes in health inequalities emphasizes the importance of politics and policy for future health improvement.

Whose experts? How federalism shaped psychiatry in the late Habsburg monarchy.

The late Habsburg period (1867-1918) created a constitutional dual monarchy of Austria-Hungary. This paper discusses the role of psychiatry in Cisleithania, both as a developing profession and as a distinct 'policy field'. Tension between psychiatry's academic professionalisation and the creation of public institutions as signature projects by individual crownlands created complex relationships between psychiatry and politics. In federalist Cisleithania, psychiatrists became very 'political': whether employed by the state or a crownland influenced their position on policy, despite claiming that their expert knowledge was 'scientific' and 'objective'. The conflicts between asylum-based and academic psychiatrists mirrored those between the central state and the crownlands. This led to intractable delays in mental health law reform, eventually resolved by Imperial decree in 1916.

Lessons From the Wrong Isolation Policy Violating Human Rights for Leprosy in Japan.

Leprosy, caused by Mycobacterium leprae , is one of the so-called "neglected tropical diseases" and is found today mainly in Africa, Asia and South America. Although oral antibiotics capable of curing leprosy are now available, the disease is still misunderstood and feared by the public because of the unsightly deformities that it may cause. In Japan, leprosy has been present since the 8th century and was regarded as a hereditary disease; people avoided marrying into a family with a member affected by leprosy. At the beginning of the 20th century, the Japanese government instituted a policy of lifetime quarantine of individuals with leprosy to eradicate the disease, thereby purposely disseminating negative and inaccurate perceptions of the disease as deadly and highly contagious and fostering a long-lasting prejudice among the general public towards those affected. Even after effective treatments became available, the government continued quarantining patients until 1996. The government has since then apologized to the patients for violating their constitutionally guaranteed human rights. Children with leprosy and children born to parents with leprosy were also victims of the policy and prejudice created. We describe herein the history of leprosy-related policies in Japan to emphasize the importance of balancing public health policy with human rights.

Policy Agenda Setting in Public Health Dentistry: Implementing North America's First Universal School-Based Dental Program in Saskatchewan.

The Saskatchewan Dental Plan in Canada was the first universal dental care plan for children in North America. Based on a similar New Zealand program, it would take over two decades from the time that the provincial government first considered the New Zealand policy until a final decision was made to implement the program. This article reviews the reasons for the long gestation of the policy, including the hostility of organized dentistry in Saskatchewan and Canada and the caution of the government's bureaucracy. It would take until a social democratic government was elected in 1971 before the political stream joined with the pre-existing problem and policy streams to open the policy window. Established in 1974, the program was terminated in 1987 due to opposition of organized dentistry combined with the pro-market ideology of a newly elected government.

Résumé. La Saskatchewan a été la première à instaurer un régime de soins dentaires universels pour les enfants en Amérique du Nord, le Saskatchewan Dental Plan. S'inspirant d'un programme semblable établi en Nouvelle-Zélande, le gouvernement provincial allait mettre vingt ans, entre le début de l'évaluation de la politique néozélandaise et sa décision, à implanter son programme. Cet article passe en revue les raisons de cette longue gestation, notamment l'hostilité du milieu bien organisé de la médecine dentaire en Saskatchewan et au Canada et la prudence des fonctionnaires gouvernementaux. Il allait falloir l'élection d'un gouvernement social-démocrate, en 1971, pour que le milieu politique s'empare du problème et des politiques existantes et que s'ouvre une fenêtre d'opportunité politique. Établi en 1974, le programme a été aboli en 1987, renversé par l'opposition combinée de la dentisterie organisée et de l'idéologie du libre marché prônée par le gouvernement nouvellement élu.

Los inicios de la bacteriología en Buenos Aires en el siglo XIX: transformaciones institucionales y políticas sanitarias / [The beginnings of bacteriology in Buenos Aires in the 19th century: institutional transformations and health policies]

En este trabajo se analiza el comienzo de la incorporación de la bacteriología a la política sanitaria en Buenos Aires durante las décadas de 1880 y 1890, y las transformaciones que este proceso implicó en el plano institucional y de la intervención estatal. En particular, indagamos en estos cambios a través de la creación y los primeros años de funcionamiento de dos espacios orientados a la producción y enseñanza de conocimientos bacteriológicos: el Laboratorio Bacte-riológico de la Asistencia Pública y la Sección Bacteriológica de la Oficina Sanitaria Argentina. A través del estudio de las trayectorias de los creadores y primeros integrantes de ambos espacios, un grupo de la élite médica agrupada en el Círculo Médico Argentino, y de los conocimientos que circularon al interior de ambas instituciones, reconstruimos el inicio del desarrollo de la bacteriología en Argentina y el modo en que se incorporó a las agendas gubernamentales. (AU)

La respuesta a las epidemias en los siglos XIX y XX: un estudio comparado entre Portugal y Chile / [The response to epidemics in the 19th and 20th centuries: a comparative study between Portugal and Chile]

En tiempos de crisis sanitarias como las que ocurrieron en Portugal en 1854-56, 1899 y 1918, especialmente en Oporto, donde el cólera morbus, la peste bubónica, el tifo exantemático, la gripe neumónica y la viruela mataron a un alto porcentaje de la población, las imágenes de las epidemias en los periódicos y en la literatura científica de la época nos permiten conocer el estado de la ciencia y las respuestas de las autoridades para controlar su difusión. La comparación de estas epidemias en Portugal con las de Chile —cólera 1886-88, peste en Valparaíso y Iquique en 1903 y gripe en 1918— en la bibliografía y en algunos periódicos de época nos muestran las semejanzas del conocimiento científico y de las medidas sanitarias aplicadas. Esto nos confirma la circulación del conocimiento médico y farmacéutico y el alto nivel de especialización de los médicos y científicos. (AU)

A historical analysis of the policy on intractable diseases in Japan and its peculiarity

This article examines the history of the policy concerning a class of diseases called intractable diseases in Japan with a particular focus on the roles of patient support groups in firstly legitimizing the grouping of such diseases and then shaping the nature of the support that the Japanese Ministry of Health and Welfare provided to the patients and their families affected by them. The Ministry started its policy on intractable diseases in 1972, predating the enactment of the 1983 Orphan Drug Act in the United States, which is known to be one of the most important events for the international rare diseases community. This policy decision was triggered by the emergence of subacute myelo-optic neuropathy (SMON) as a social problem in the country in the late 1960s. The Ministry first made its support available to patients with this particular disease and, as a result of a series of actions from patient support groups and their medical and political supporters, the same support was made available to those considered to be in similarly difficult circumstances. The way in which the support was arranged, however, turned out to be structurally divisive, inviting the patient groups to negotiate with the national and local governments separately depending on subject matters, and for about three decades since the start of the policy, they struggled to present their unified voice in the country. The governmental support for intractable diseases was finally revised in the mid-2000s, but as this article demonstrates, that became possible only after the patient groups came to realize the need of presenting a unified voice in their effort to improve the lives of those affected (AU)

Historia de las políticas de salud mental en Brasil: implicaciones para la identidad profesional de la enfermera / History of mental health policies in Brazil: implications for the nurse's professional identity

Los cambios ocurridos a lo largo de la historia en el campo de la Enfermería en Salud Mental están directamente ligados a las reformulaciones en los campos político-ideológico y social de cada época, que redundan en la reconfiguración continua de sus procesos de trabajo. Del período del asilo al movimiento de Lucha Anti-Asilo, pasando por el momento actual reconocido como movimiento de contrarreforma psiquiátrica, el trabajo de las enfermeras ha sido llamado a reformularse constantemente, en un campo conflictivo de disputas entre modelos antagónicos de salud mental [Fragmento de texto] (AU)

La Enfermería en Argentina de fines del siglo XIX: los aportes de Cecilia Grierson / Nursing in Argentina at the end of the 19th century: the contributions of Cecilia Grierson

A través de décadas, la Enfermería en Argentina progresó y fue cambiando sus conceptos y definiciones. Se estableció como campo científico y se describió en numerosas oportunidades como una serie de tareas y técnicas (subordinadas a la medicina); como un servicio humano amplio, como una vocación aprendida, hasta que en la actualidad es considerada una disciplina en el área de la salud, que maneja el cuidado de ésta durante el transcurso del ciclo vital [Fragmento de texto] (AU)

[Historical milestones for the control of severe infections and sepsis in pediatrics. Approach through medical philately]. / Hitos históricos para el control de las infecciones graves y la sepsis en pediatría. Aproximación a través de la filatelia médica.

Medical philately, with its diverse themes, is a faithful testimony of the historical events that have affected humanity. Likewise, it allows us to evidence its role as a diffuser of diverse prevention cam paigns carried out to control and eradicate serious infections, together with other achievements of health policy in the child population. Nowadays, the knowledge and collection of postage stamps is an increasingly unusual pastime. On the other hand, sometimes there is a marked historical ignoran ce and lack of appreciation of the effective actions for the control of infectious diseases, forgetting the enormous effect of these on the daily life of the current society. Through the visual testimony offe red by the postage stamps, we review the sanitary, educational, and therapeutic actions destined to control the infections in the pediatric patient, with emphasis on our country. In addition, we discuss the new populations at risk for the appearance of septic episodes. Even today, serious infections and sepsis represent an important public health problem.

Las epidemias en La Pampa (Argentina), en perspectiva histórica* / The epidemics in La Pampa (Argentina), from a historical perspective

Resumen Este artículo describe el inicio de las preocupaciones sanitarias vinculadas a las epidemias ocurridas durante el siglo XX en La Pampa, provincia argentina. Las epidemias, como las de la viruela, fueron un estímulo para estas políticas que frecuentemente tuvieron origen en Buenos Aires, la capital del país. El contagio de muchas epidemias dependía de carencias de infraestructura: agua, desagüe y desecho adecuado de basuras, de la ausencia de un número suficiente de trabajadores de salud, de la presencia de vectores transmisores de enfermedades como los mosquitos y, en última instancia, de la pobreza. La experiencia histórica descrita en este texto resalta la importancia de analizar el impacto del SARS-CoV-2 más allá de las grandes ciudades.

Abstract This article describes the emergence of health concerns relating to the epidemics that occurred during the twentieth century in La Pampa, a province in Argentina. Epidemics such as smallpox drove such policies, which frequently originated in Buenos Aires, the country's capital. The spread of many epidemics was due to shortages: water, sewage and adequate refuse disposal, an insufficient number of health care workers, the presence of disease transmission vectors such as mosquitos, and, ultimately, poverty. The historical experience described in this text highlights the importance of analyzing the impact of SARS-CoV-2 beyond the big cities.

[The epidemics in La Pampa (Argentina), from a historical perspective]. / Las epidemias en La Pampa (Argentina), en perspectiva histórica.

This article describes the emergence of health concerns relating to the epidemics that occurred during the twentieth century in La Pampa, a province in Argentina. Epidemics such as smallpox drove such policies, which frequently originated in Buenos Aires, the country's capital. The spread of many epidemics was due to shortages: water, sewage and adequate refuse disposal, an insufficient number of health care workers, the presence of disease transmission vectors such as mosquitos, and, ultimately, poverty. The historical experience described in this text highlights the importance of analyzing the impact of SARS-CoV-2 beyond the big cities.

Este artículo describe el inicio de las preocupaciones sanitarias vinculadas a las epidemias ocurridas durante el siglo XX en La Pampa, provincia argentina. Las epidemias, como las de la viruela, fueron un estímulo para estas políticas que frecuentemente tuvieron origen en Buenos Aires, la capital del país. El contagio de muchas epidemias dependía de carencias de infraestructura: agua, desagüe y desecho adecuado de basuras, de la ausencia de un número suficiente de trabajadores de salud, de la presencia de vectores transmisores de enfermedades como los mosquitos y, en última instancia, de la pobreza. La experiencia histórica descrita en este texto resalta la importancia de analizar el impacto del SARS-CoV-2 más allá de las grandes ciudades.

Early colorectal cancer detection-Current and evolving challenges in evidence, guidelines, policy, and practices.

The understanding at the beginning of the last century that colorectal cancer began as a localized disease that progressed and became systemic, and that most colorectal cancer arose from adenomatous polyps gave rise to aggressive attempts at curative treatment and eventually attempts to detect advanced lesions before they progressed to invasive disease. In the last four decades, steadily greater uptake of screening has led to reductions in colorectal cancer incidence and mortality. However, the fullest potential of screening is not being met due to the lack of organized screening, where a systems approach could lead to higher rates of screening of average and high risk groups, higher quality screening, and prompt followup of adults with positive screening tests. ABSTRACT: Since the beginning of the 20th century, there has been a general understanding that colorectal cancer is a clonal disease that progresses from a localized stage with a favorable prognosis through progressively more advanced stages which have progressively worse prognosis. That understanding led first to determined efforts to detect and treat early stage symptomatic disease, and then to detect pre-symptomatic colorectal cancer and precursor lesions, where there was hope that the natural history of the disease could be arrested and the incidence and premature mortality of colorectal cancer averted. Toward the end of the last century, guidelines for colorectal cancer screening, growth in the number of technical options for screening, and a steady increase in the proportion of the adult population who attended screening contributed to the beginning of a significant decline in colorectal cancer incidence and mortality. Despite this progress, colorectal cancer remains the third leading cause of death among men and women in the United States. Screening for early detection of precursor lesions and localized cancer offers the single most productive opportunity to further reduce the burden of disease, and yet nearly four in five deaths from colorectal cancer are associated with having never been screened, not recently screened, or not followed up for an abnormal screening test. This simple observation is a call to action in all communities to apply existing knowledge to fulfill the potential to prevent avertable incidence and mortality.