Litigation in access to universal health coverage for children and adolescents in Brazil.

Background: Brazil's Unified Health System (SUS) ensures universal, equitable, and excellent quality health coverage for all. The broad right to health, supported by the Constitution, has led to excessive litigation in the public sector. This has negatively impacted the financial stability of SUS, created inequality in children and adolescents' access to healthcare, and affected communication between the healthcare system and the judiciary. The enactment of Law Number 13.655 on 25 April 2018, proposed significant changes in judicial decisions. This study aimed to investigate decision-making changes in health litigation involving children and adolescents following the implementation of the new normative model. Methods: The study is cross-sectional, analyzing 3753 national judgment documents from all State Courts of Brazil, available on their respective websites from 2014 to 2020. It compares regional legal decisions before and after the promulgation of Law Number 13.655/2018. Data tabulation, statistical analysis, textual analysis, coding, and counting of significant units in the collected documents were performed. The results of data cross-referencing are presented in tables and diagrams. Results: The majority (96.86%) of legal claims (3635 cases) received partial or total provision of what was prescribed by the physician. The Judiciary predominantly handled these cases individually. The analysis indicates that the decisions made did not adhere to the norms established in 2018. Conclusion: Regional heterogeneity in health litigation was observed, and there was no significant variability in decisions during the studied period, even after the implementation of the new normative paradigm in 2018. Technical-scientific support was undervalued by the magistrates. Prioritizing litigants undermines equity in access to Universal Health Coverage for children and adolescents.

"My Health, My Right:" There Is More to It than Meets the Eye.

The WHO's World Health Day 2024 slogan, "My health, my right," has been unpacked through the lens of an evolving social epidemiological understanding. The operative part of the theme merely reiterates international positions that have been established for a long and is unable to adequately incorporate advances in the understanding of the central role that structural determinants play in the production of ill-health. Given the urgency of addressing Sustainable Development Goal and Universal Health Coverage goals, the reduction of health inequities through the promotion of social justice is as much a governance imperative as moral.

[The right to health goes through the right to a home.] / Il diritto alla salute passa per il diritto a una casa.

Unhealthy housing is bad for your health. This was recently pointed out by the report Left out in the cold: the hidden health costs of Britain's cold homes by the UCL Institute of Health Equity and a The Lancet editorial. Those who suffer most are the poorest and most disadvantaged households due to determinants of gender, ethnicity or disability. Although the World health organisation guidelines on housing and health promote adequate housing as a key factor to improve health, many governments are slow to act. Supporting policies that restore the right to housing - and to a safe home - should be a priority for governments. Not least because it would be an investment: improving housing conditions reduces inappropriate access to emergency departments and hospital admissions. Health workers can play a key role as privileged observers of the individuals and families who would benefit most from public institutional support.

Paths and inter-mediations between Brazilian Health Services and Youth Detention Centers. / Caminhos e intermediações entre serviços do Sistema de Saúde e da Socioeducação.

Socio-education is an educational and (re)socialization proposal for young people having troubles with the law, a law which also includes the right to health care guaranteed by the Unified Health System (SUS). This study aims to investigate the relationship between health services and socio-educational units in Paraná state, from the perspective of service workers and managers. The qualitative and exploratory research consisted of sixteen semi-structured interviews in five municipalities in the state, with subsequent categorization of the narratives based on hermeneutic analysis. As a result, there was considerable weakness in the coordination between the network's facilities to promote overall health care, specifically the mental health of young people. Security issues have a strong influence on the regulation of actions, even health actions, in socio-education. The current policy of comprehensive health care in socio-education, implemented in Brazil in 2014, is, however, an important counterpoint for the reordering and nudging policies in this area.

A socioeducação é proposta educacional e de (re)socialização do jovem em conflito com a lei, na qual se prevê, igualmente, o direito à atenção à saúde garantido pelo Sistema Único de Saúde (SUS). O presente trabalho visa investigar como se dá a relação entre os serviços de saúde e as unidades socioeducativas no estado do Paraná a partir da perspectiva de trabalhadores e gestores dos serviços. A pesquisa qualitativa e de cunho exploratório consistiu na realização de dezesseis entrevistas semiestruturadas em cinco municípios do estado, com posterior categorização das narrativas a partir de análise hermenêutica. Como resultado evidenciou-se considerável fragilidade na articulação entre os equipamentos da rede para promoção da assistência à saúde em geral e, mais notoriamente, à saúde mental dos jovens. Os quesitos de segurança exercem forte influência na regulação das ações, até mesmo de saúde, na socioeducação. A política atual de atenção integral à saúde na socioeducação, implantada no Brasil em 2014, representa, contudo, um importante contraponto na reordenação e na indução das ações nesse âmbito.

Laboratório de Inovação em Educação Alimentar e Nutricional: Uma Celebração dos 10 anos do Marco de Referência de Educação Alimentar e Nutricional para as Políticas Públicas

A Educação Alimentar e Nutricional (EAN) integrada à estratégias mais amplas de proteção e promoção da alimentação adequada e saudável contribui para melhorar a qualidade de vida das pessoas e do planeta, sendo essencial principalmente no cenário complexo em que 33 milhões de brasileiros estão em situação de fome, com maior impacto nos grupos e regiões mais vulneráveis, e 61,7% estão com sobrepeso ou obesidade. O Laboratório de Inovação em Educação Alimentar e Nutricional (LIS-EAN) celebra os 10 anos do Marco de Referência de Educação Alimentar e Nutricional para as Políticas Públicas (MREAN), que posicionou a EAN de forma intersetorial no Brasil e estabeleceu um campo comum de reflexão e prática. A EAN também é transversal às diretrizes da Política Nacional de Alimentação e Nutrição (PNAN), sendo reco nhecida como essencial para a promoção da alimentação adequada e saudável tanto no Sistema Único de Saúde (SUS) como nos demais setores. Neste sentido, o LIS-EAN é inovador desde a sua essência, já que proporcionou a identificação de experiências de diversos setores além do setor saúde, como educação e assistência social. Celebrar os 10 anos do Marco com a realização do LIS-EAN é uma oportunidade para refletir sobre as potencialidades e desafios da agenda para os próximos anos. Os desafios são complexos e, a EAN é um elemento fundamental para a garantia do direito à saúde e do direito humano à alimentação adequada. Espera-se que as experiências sistematizadas no LIS-EAN inspirem, contribuam e apoiem o desenvolvimento e aprimoramento das ações de EAN para a garantia do direito à saúde e do direito humano à alimentação adequada, sem deixar ninguém para trás.

Enforcing the right to health in private health systems through Judicialization what can we learn from the scoping review of the cross-national perspective?

BACKGROUND: Private sector acting in healthcare does not remove the public nature of a health system, nor mitigate the right to health as a human right. METHODS: This scoping review aims to answer the question: what factors influence the pattern of lawsuits seeking to enforce the right to health in private healthcare systems? The search was carried out in Pubmed, SciELO, DOAJ and Scopus. RESULTS: Out of 464 articles found, after inclusion and exclusion criteria, 30 articles were included. The survey covered 36 different countries and four main factors were identified. The socioeconomic context, the health system model, the incorporation of the right to health in legislation, and the model of regulation of private health. CONCLUSIONS: Understanding these patterns help understanding the difficulties of implementing and guaranteeing universal health. Health systems must be based on responsibility, solidarity, equity, and distributive justice, since the sum of these values generates mutualism. Judicial decision-making regarding to health access must be reasoned on equity and distributive justice, scientific evidence and ethical factors. Even private health systems must be funded in a well-defined ethical platform and social moral valuation.

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.

Facilitating Safe Access to Health Care through Legislative Reform - The Australian Experience.

The realisation of the right to health is vulnerable to the interventions of strangers, acting on the belief that certain health care should not be permissible under the law or accessible in practice. In Australia, the key arena for such interventions has been abortion services. Drawing on empirical research undertaken by the authors, this article examines the impact of these interventions and the effectiveness of "safe access zone" laws that now operate nationwide to constrain them. After examining the unsuccessful constitutional challenge to these laws in the High Court of Australia, it considers whether safe access zones may have utility in other health care contexts.

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.