The World Health Organization was born as a normative agency: Seventy-five years of global health law under WHO governance.

The World Health Organization (WHO) was born as a normative agency and has looked to global health law to structure collective action to realize global health with justice. Framed by its constitutional authority to act as the directing and coordinating authority on international health, WHO has long been seen as the central actor in the development and implementation of global health law. However, WHO has faced challenges in advancing law to prevent disease and promote health over the past 75 years, with global health law constrained by new health actors, shifting normative frameworks, and soft law diplomacy. These challenges were exacerbated amid the COVID-19 pandemic, as states neglected international legal commitments in national health responses. Yet, global health law reforms are now underway to strengthen WHO governance, signaling a return to lawmaking for global health. Looking back on WHO's 75th anniversary, this article examines the central importance of global health law under WHO governance, reviewing the past successes, missed opportunities, and future hopes for WHO. For WHO to meet its constitutional authority to become the normative agency it was born to be, we offer five proposals to reestablish a WHO fit for purpose: normative instruments, equity and human rights mainstreaming, sustainable financing, One Health, and good governance. Drawing from past struggles, these reforms will require further efforts to revitalize hard law authorities in global health, strengthen WHO leadership across the global governance landscape, uphold equity and rights at the center of global health law, and expand negotiations in global health diplomacy.

Achieving and Maintaining Equitable Health Outcomes for all, Including for Future Generations.

Sustainable health equity means achieving and maintaining equitable health outcomes for all people, including for future generations. It encompasses realizing the right to health, setting the conditions for leading a healthy life, and fulfilling the full range of human rights. Achieving sustainable health equity requires that public services be designed and provided, and public policies be developed through empowering, inclusive, participatory, accountable, and democratic processes and mechanisms.

The global health and care worker compact: evidence base and policy considerations.

BACKGROUND: During the COVID-19 pandemic, and recognising the sacrifice of health and care workers alongside discrimination, violence, poor working conditions and other violations of their rights, health and safety, in 2021 the World Health Assembly requested WHO to develop a global health and care worker compact, building on existing normative documentation, to provide guidance to 'protect health and care workers and safeguard their rights'. METHODS: A review of existing international law and other normative documents was conducted. We manually searched five main sets of international instruments: (1) International Labour Organization conventions and recommendations; (2) WHO documents; (3) United Nations (UN) human rights treaties and related documents; (4) UN Security Council and General Assembly resolutions and (5) the Geneva Conventions and Additional Protocols. We included only legal or other normative documents with a global or regional focus directly addressing or relevant to health and care workers or workers overall. RESULTS: More than 70 documents met our search criteria. Collectively, they fell into four domains, within which we identified 10 distinct areas: (1) preventing harm, encompassing (A) occupational hazards, (B) violence and harassment and (C) attacks in situations of fragility, conflict and violence; (2) inclusivity, encompassing (A) non-discrimination and equality; (3) providing support, encompassing (A) fair and equitable remuneration, (B) social protection and (C) enabling work environments and (4) safeguarding rights, encompassing (A) freedom of association and collective bargaining and (B) whistle-blower protections and freedom from retaliation. DISCUSSION: A robust legal and policy framework exists for supporting health and care workers and safeguarding their rights. Specific human rights, the right to health overall, and other binding and non-binding legal documents provide firm grounding for the compact.However, these existing commitments are not being fully met. Implementing the compact will require more effective governance mechanisms and new policies, in partnership with health and care workers themselves.

The Global Health Architecture: Governance and International Institutions to Advance Population Health Worldwide.

Policy Points Global health institutions and instruments should be reformed to fully incorporate the principles of good health governance: the right to health, equity, inclusive participation, transparency, accountability, and global solidarity. New legal instruments, like International Health Regulations amendments and the pandemic treaty, should be grounded in these principles of sound governance. Equity should be embedded into the prevention of, preparedness for, response to, and recovery from catastrophic health threats, within and across nations and sectors. This includes the extant model of charitable contributions for access to medical resources giving way to a new model that empowers low- and middle-income countries to create and produce their own diagnostics, vaccines, and therapeutics-such as through regional messenger RNA vaccine manufacturing hubs. Robust and sustainable funding of key institutions, national health systems, and civil society will ensure more effective and just responses to health emergencies, including the daily toll of avoidable death and disease disproportionately experienced by poorer and more marginalized populations.

Title 42 Exclusions of Asylum Seekers-A Misuse of Public Health Powers.

This JAMA Forum discusses the harms of Title 42 on health, the lack of public health justification for its use in the US and how it violates international law, and the proposed reforms to promote public health instead of border control.

Human rights and the COVID-19 pandemic: a retrospective and prospective analysis.

When the history of the COVID-19 pandemic is written, the failure of many states to live up to their human rights obligations should be a central narrative. The pandemic began with Wuhan officials in China suppressing information, silencing whistleblowers, and violating the freedom of expression and the right to health. Since then, COVID-19's effects have been profoundly unequal, both nationally and globally. These inequalities have emphatically highlighted how far countries are from meeting the supreme human rights command of non-discrimination, from achieving the highest attainable standard of health that is equally the right of all people everywhere, and from taking the human rights obligation of international assistance and cooperation seriously. We propose embedding human rights and equity within a transformed global health architecture as the necessary response to COVID-19's rights violations. This means vastly more funding from high-income countries to support low-income and middle-income countries in rights-based recoveries, plus implementing measures to ensure equitable distribution of COVID-19 medical technologies. We also emphasise structured approaches to funding and equitable distribution going forward, which includes embedding human rights into a new pandemic treaty. Above all, new legal instruments and mechanisms, from a right to health treaty to a fund for civil society right to health advocacy, are required so that the narratives of future health emergencies-and people's daily lives-are ones of equality and human rights.

Occupational and Environmental Hazards of Correctional Settings: A Scoping Literature Review From ACOEM's Presidential Task Force on Correctional Institutions.

OBJECTIVE: Maintaining healthful, safe, and productive work environments for workers in correctional settings is a matter of deep consequence to the workers themselves, the institutions they serve, the incarcerated individuals with whom they share space, and inevitably, to our wider community. We hypothesized that an examination of the academic literature would reveal opportunities for an improved approach to research in these settings. METHODS: We performed a scoping literature review using search terms related to the occupational and environmental health of workers in correctional environments, limited to studies performed in the United States. RESULTS: A total of 942 studies underwent title and abstract screening, 342 underwent full-text review, and 147 underwent data extraction by a single reviewer. The results revealed a body of literature that tends strongly toward analyses of stress and burnout of correctional staff, largely based on self-reported data from cross-sectional surveys. Those studies related to physical health were predominantly represented by topics of infectious disease. There were few or no studies examining exposures or outcomes related to diagnosable mental health conditions, musculoskeletal injury, environmental hazards, medical or mental health staff, immigration detention settings, or regarding incarcerated workers. There were very few studies that were experimental, longitudinal, or based on objective data. DISCUSSION: The National Institute for Occupational Safety and Health (NIOSH) has promulgated a research strategy for correctional officers that should guide future research for all workers in correctional settings, but realization of these goals will rely upon multidisciplinary collaboration, specific grants to engage researchers, and an improved understanding of the barriers inherent to correctional research, all while maintaining rigorous protection for incarcerated persons as an especially vulnerable population.

Radiology Medical Student Education 2020: Surveys of the Alliance of Medical Student Educators in Radiology and Medical Students.

RATIONALE AND OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has resulted in significant changes to medical student education by disrupting clinical rotations, licensing exams, and residency applications. To evaluate the pandemic's impact and required modifications of radiology medical student courses, the authors developed and administered surveys to Alliance of Medical Student Educators in Radiology (AMSER) faculty and enrolled medical students. The surveys requested feedback and insight about respondents' experiences and innovations. MATERIALS AND METHODS: Anonymous twenty-question and seventeen-question surveys about the pandemic's impact on medical student education were distributed via email to AMSER members and medical students. The surveys consisted of multiple choice, ranking, Likert scale, and open-ended questions. Differences in the Likert score agreement was performed using one-sided Wilcoxon-Mann-Whitney tests. Survey data were collected using SurveyMonkey (San Mateo, California). This study was IRB exempt. RESULTS: The AMSER survey indicated 96% of institutions cancelled medical student courses and 92% resumed with virtual courses, typically general radiology. A total of 64% of faculty enjoyed online teaching, although 82% preferred on-site courses. A total of 62% of students felt an online radiology course was an excellent alternative to an on-site rotation, although 27% disagreed. A total of 69% of students who completed both on-site and online courses preferred the on-site format. Survey-reported innovations and free response comments have been collated as educational resources. CONCLUSION: Faculty were able to adapt radiology courses to the online environment utilizing interactive lectures, self-directed learning, flipped classroom sessions, and virtual readouts, which were effective for student respondents. Hybrid rotations with on-site and online elements may offer the best of both worlds.

[Planning for health equity in the Americas: an analysis of national health plansPlanejamento para equidade em saúde nas Américas: uma análise dos planos nacionais de saúde]. / Planificación para la equidad en la salud en la Región de las Américas: análisis de los planes nacionales de salud.

There is growing recognition that health and well-being improvements have not been shared across populations in the Americas. This article analyzes 32 national health sector policies, strategies, and plans across 10 different areas of health equity to understand, from one perspective, how equity is being addressed in the region. It finds significant variation in the substance and structure of how the health plans handle the issue. Nearly all countries explicitly include health equity as a clear goal, and most address the social determinants of health. Participatory processes documented in the development of these plans range from none to extensive and robust. Substantive equity-focused policies, such as those to improve physical accessibility of health care and increase affordable access to medicines, are included in many plans, though no country includes all aspects examined. Countries identify marginalized populations in their plans, though only a quarter specifically identify Afro-descendants and more than half do not address Indigenous people, including countries with large Indigenous populations. Four include attention to migrants. Despite health equity goals and data on baseline inequities, fewer than half of countries include time-bound targets on reducing absolute or relative health inequalities. Clear accountability mechanisms such as education, reporting, or rights-enforcement mechanisms in plans are rare. The nearly unanimous commitment across countries of the Americas to equity in health provides an important opportunity. Learning from the most robust equity-focused plans could provide a road map for efforts to translate broad goals into time-bound targets and eventually to increasing equity.

É cada vez mais aceito que os avanços em saúde e bem-estar não são partilhados por todas as populações nas Américas. Neste artigo são analisadas 32 políticas, estratégias e planos nacionais de saúde em 10 áreas distintas de equidade em saúde com o objetivo de entender, de uma única perspectiva, como a equidade está sendo contemplada na região. Existem diferenças consideráveis na forma e conteúdo do enfoque dado a esta questão nos planos de saúde. Quase todos os países estabelecem explicitamente a equidade em saúde como uma meta clara e a maioria aborda os determinantes sociais da saúde. O processo participativo documentado na elaboração dos planos também é variável, desde inexistente a amplo e decidido. Muitos planos contêm políticas concretas com foco central em equidade, por exemplo, políticas para melhorar a acessibilidade física à assistência de saúde e o acesso a medicamentos a preços razoáveis, mas nenhum país inclui todos os aspectos aqui examinados. Os países identificam as populações marginalizadas nos seus planos, porém, apenas um quarto distingue especificamente os afrodescendentes e mais da metade não contempla os povos indígenas, mesmo onde as populações indígenas são em grande número. Quatro países consideram a atenção aos migrantes. Embora existam metas de equidade em saúde e dados relativos a iniquidades de base, menos da metade dos países incorpora em seus planos metas com prazos definidos para reduzir as desigualdades absolutas ou relativas em saúde. Instrumentos claros de responsabilidade como educação, prestação de contas ou respeito aos direitos são raramente vistos. O compromisso praticamente unânime dos países das Américas com a equidade em saúde oferece uma oportunidade importante. Os planos mais bem fundados com enfoque em equidade poderiam servir de exemplo para guiar os esforços de converter metas gerais em metas com prazos definidos e, em última instância, aumentar a equidade.

Planificación para la equidad en la salud en la Región de las Américas: análisis de los planes nacionales de salud

[RESUMEN]. Cada vez más se reconoce que las mejoras en la salud y el bienestar no se han registrado por igual en las poblaciones de la Región de las Américas. En este artículo se analizan 32 políticas, estrategias y planes nacionales del sector de la salud en diez áreas diferentes de la equidad en la salud para comprender, desde una perspectiva, cómo se está abordando el tema de la equidad en la Región. Se encontraron variaciones significativas en la sustancia y estructura de la manera en que los planes de salud manejan el problema. Casi todos los países incluyen explícitamente la equidad en la salud como un objetivo claro y la mayoría de los países abordan los determinantes sociales de la salud. Los procesos participativos documentados seguidos en la formulación de estos planes abarcan desde inexistentes hasta extensos y bien concebidos. Muchos planes incluyen políticas sólidas centradas en la equidad, como las destinadas a mejorar la accesibilidad física de la atención de salud y aumentar el acceso asequible a los medicamentos, pero ningún país incluye todos los aspectos examinados. Los países consideran a las poblaciones marginadas en sus planes, aunque solo una cuarta parte incluye específicamente a los afrodescendientes y más de la mitad no abordan a los pueblos indígenas, incluso algunos con grandes poblaciones indígenas. Cuatro incluyen atención a los migrantes. A pesar de que incluyen objetivos sobre la equidad en la salud y datos sobre las inequidades como parámetros de referencia, menos de la mitad de los países se fijan objetivos con plazos específicos para reducir las desigualdades absolutas o relativas en el ámbito de la salud. Rara vez se encuentran en los planes mecanismos claros de rendición de cuentas, como la educación, la presentación de informes o mecanismos para hacer respetar los derechos. El compromiso casi unánime entre los países de la Región de las Américas con la equidad en la salud ofrece una oportunidad importante. Aprender de los planes más sólidos centrados en la equidad podría proporcionar una hoja de ruta para los esfuerzos tendientes a traducir las metas amplias en objetivos con plazos definidos y, finalmente, aumentar la equidad.

[ABSTRACT]. There is growing recognition that health and well-being improvements have not been shared across populations in the Americas. This article analyzes 32 national health sector policies, strategies, and plans across 10 different areas of health equity to understand, from one perspective, how equity is being addressed in the region. It finds significant variation in the substance and structure of how the health plans handle the issue. Nearly all countries explicitly include health equity as a clear goal, and most address the social determinants of health. Participatory processes documented in the development of these plans range from none to extensive and robust. Substantive equity-focused policies, such as those to improve physical accessibility of health care and increase affordable access to medicines, are included in many plans, though no country includes all aspects examined. Countries identify marginalized populations in their plans, though only a quarter specifically identify Afro-descendants and more than half do not address Indigenous people, including countries with large Indigenous populations. Four include attention to migrants. Despite health equity goals and data on baseline inequities, fewer than half of countries include time-bound targets on reducing absolute or relative health inequalities. Clear accountability mechanisms such as education, reporting, or rights-enforcement mechanisms in plans are rare. The nearly unanimous commitment across countries of the Americas to equity in health provides an important opportunity. Learning from the most robust equity-focused plans could provide a road map for efforts to translate broad goals into time-bound targets and eventually to increasing equity.

[RESUMO]. É cada vez mais aceito que os avanços em saúde e bem-estar não são partilhados por todas as populações nas Américas. Neste artigo são analisadas 32 políticas, estratégias e planos nacionais de saúde em 10 áreas distintas de equidade em saúde com o objetivo de entender, de uma única perspectiva, como a equidade está sendo contemplada na região. Existem diferenças consideráveis na forma e conteúdo do enfoque dado a esta questão nos planos de saúde. Quase todos os países estabelecem explicitamente a equidade em saúde como uma meta clara e a maioria aborda os determinantes sociais da saúde. O processo participativo documentado na elaboração dos planos também é variável, desde inexistente a amplo e decidido. Muitos planos contêm políticas concretas com foco central em equidade, por exemplo, políticas para melhorar a acessibilidade física à assistência de saúde e o acesso a medicamentos a preços razoáveis, mas nenhum país inclui todos os aspectos aqui examinados. Os países identificam as populações marginalizadas nos seus planos, porém, apenas um quarto distingue especificamente os afrodescendentes e mais da metade não contempla os povos indígenas, mesmo onde as populações indígenas são em grande número. Quatro países consideram a atenção aos migrantes. Embora existam metas de equidade em saúde e dados relativos a iniquidades de base, menos da metade dos países incorpora em seus planos metas com prazos definidos para reduzir as desigualdades absolutas ou relativas em saúde. Instrumentos claros de responsabilidade como educação, prestação de contas ou respeito aos direitos são raramente vistos. O compromisso praticamente unânime dos países das Américas com a equidade em saúde oferece uma oportunidade importante. Os planos mais bem fundados com enfoque em equidade poderiam servir de exemplo para guiar os esforços de converter metas gerais em metas com prazos definidos e, em última instância, aumentar a equidade.

Prevalence of myocardial infarction among patients with chest pain and cocaine use: A systematic review and meta-analysis.

BACKGROUND: Cocaine abuse is a public health burden. Cocaine is known to cause vasospasm and acute myocardial infarction (AMI). The prevalence of AMI in patients presenting with chest pain and concurrent cocaine use (CPCC) varies among studies. We performed a systemic review and meta-analysis to assess the current literature for the prevalence of AMI in patients with CPCC. METHODS: We performed a literature search of PubMed, EMBASE, and Scopus from its beginning to May 18, 2020 and updated this search on February 18, 2021. Full-text studies that assessed the primary outcome (AMI) specifically among patients with CPCC who presented to the emergency department (ED) were included. We excluded studies that were not in English, did not take place in the ED, and case reports, which only reported positive cases and not incidence of AMI. Random effect meta-analysis was performed to assess the prevalence of primary outcome and to examine correlations between risk factors and AMI. Heterogeneity was assessed by I-square value. We also performed subgroup analysis to identify potential sources of heterogeneity. RESULTS: We identified 2178 studies and screened 102 full-text studies to include 16 studies (3269 patients) in our final analysis. The pooled prevalence of AMI was 4.7% (95% CI 0.8-23), I-square of 84%. However, rates among studies of low risk patients were lower (1.1% 95% CI 0.2-5) compared to studies of mixed risk patients (7.7%, 95% 5-11). A meta-regression was used to look at correlation between risk factors and AMI and found that AMI was positively correlated in patients with a history of CAD (correlation coefficient [Corr. Coeff.] 5.6, 96% CI 2.3-8.7), HTN (Corr. Coeff. 2.9, 95% CI 0.9-4.9), DM (Corr. Coeff. 8.0, 95% CI 2.4-14), HLD (Corr. Coeff. 5.9, 95% CI 2.4, 9). Sources of potential heterogeneity included patients' risk as defined by the authors, study designs, publication year, and study sample size. CONCLUSION: The overall prevalence of AMI and death among patients with cocaine-associated chest pain was relatively low, although high risk patients were still associated with high prevalence of AMI. Clinicians should consider risk-stratify these patients and treat them accordingly.

Safety Matters: A Meta-analysis of Interhospital Transport Adverse Events in Critically Ill Patients.

OBJECTIVE: Interhospital transport (IHT) is common among critically ill patients. Our meta-analysis investigated the prevalence and possible factors associated with adverse events (AEs) during IHT. METHODS: Searching PubMed, Embase, and Scopus databases until February 12, 2021, we included studies that a priori defined AEs for adult medical patients. We excluded case reports, non-full-text, and non-English language studies. We performed a random effects meta-analysis and moderator analyses. RESULTS: We identified 554 studies and included 19 studies (14,969 patients) in our final analysis. The mean patients' (standard deviation) age was 60 (13.7). The pooled medical AEs for IHT was 1,059 (11%, 95% confidence interval, 7.5%-16%). The most common AE (n, %) was hypotension (424, 2.8%). Moderator analyses and meta-regressions suggested that conditions (P < .001) such as respiratory failure from coronavirus infection (88%), stroke (19%), and the need for extracorporeal membrane oxygenation (40%) were associated with higher AE prevalence. Transport by nurses (31%) and physicians (11%) was associated with a higher AE prevalence, whereas transport type did not influence AE prevalence. CONCLUSION: Our study suggests the prevalence of AEs of critically ill patients during IHT is low and likely due to patients' disease severity. Further studies should focus on interventions to mitigate AEs to improve patients' outcomes.

Planning for health equity in the Americas: an analysis of national health plans.

There is growing recognition that health and well-being improvements have not been shared across populations in the Americas. This article analyzes 32 national health sector policies, strategies, and plans across 10 different areas of health equity to understand, from one perspective, how equity is being addressed in the region. It finds significant variation in the substance and structure of how the health plans handle the issue. Nearly all countries explicitly include health equity as a clear goal, and most address the social determinants of health. Participatory processes documented in the development of these plans range from none to extensive and robust. Substantive equity-focused policies, such as those to improve physical accessibility of health care and increase affordable access to medicines, are included in many plans, though no country includes all aspects examined. Countries identify marginalized populations in their plans, though only a quarter specifically identify Afro-descendants and more than half do not address Indigenous people, including countries with large Indigenous populations. Four include attention to migrants. Despite health equity goals and data on baseline inequities, fewer than half of countries include time-bound targets on reducing absolute or relative health inequalities. Clear accountability mechanisms such as education, reporting, or rights-enforcement mechanisms in plans are rare. The nearly unanimous commitment across countries of the Americas to equity in health provides an important opportunity. Learning from the most robust equity-focused plans could provide a road map for efforts to translate broad goals into time-bound targets and eventually to increasing equity.

Cada vez es mayor el reconocimiento de que las mejoras en cuanto a la salud y el bienestar no han llegado por igual a todos los segmentos de la población en la Región de las Américas. En este artículo se analizan 32 políticas, estrategias y planes nacionales del sector de la salud con respecto a diez áreas distintas relativas a la equidad en la salud. El objetivo es comprender, desde una perspectiva, cómo se está abordando la equidad en la Región. Se ha encontrado una variación significativa, tanto en sustancia como en estructura, sobre la manera en que se maneja el tema en los planes de salud. Casi todos los países incluyen explícitamente la equidad en la salud como una meta clara y la mayoría abordan los determinantes sociales de la salud. En la formulación de estos planes se ha documentado desde ningún proceso participativo hasta procesos participativos exhaustivos y sólidos. En muchos planes se han incluido políticas sustantivas centradas en la equidad, como aquellas para mejorar la accesibilidad física a la atención de salud y el acceso a medicamentos asequibles, pero en ningún país se incorporan todos los aspectos analizados. Si bien los países contemplan a los grupos marginados en sus planes, solo una cuarta parte identifica específicamente a las personas afrodescendientes y más de la mitad de los países no considera a las personas indígenas, incluso en el caso de algunos países con una población indígena grande. Cuatro países contemplan la atención médica a los migrantes. A pesar de que existen metas sobre la equidad en la salud y datos de línea de base sobre las inequidades, menos de la mitad de los países incluyen metas con plazos para reducir las inequidades en la salud absolutas o relativas. No son habituales tampoco en los planes los mecanismos de rendición de cuentas claros, como educación, presentación de informes o cumplimiento de los derechos. Los países de la Región de las Américas muestran un compromiso casi unánime con la equidad en la salud, lo cual brinda una oportunidad importante. Aprender de los planes para la equidad más sólidos podría proporcionar una hoja de ruta para las iniciativas que tratan de traducir algunas metas amplias en metas con plazos específicos que puedan eventualmente mejorar la equidad.

É cada vez mais aceito que os avanços em saúde e bem-estar não são partilhados por todas as populações nas Américas. Neste artigo são analisadas 32 políticas, estratégias e planos nacionais de saúde em 10 áreas distintas de equidade em saúde com o objetivo de entender, de uma única perspectiva, como a equidade está sendo contemplada na região. Existem diferenças consideráveis na forma e conteúdo do enfoque dado a esta questão nos planos de saúde. Quase todos os países estabelecem explicitamente a equidade em saúde como uma meta clara e a maioria aborda os determinantes sociais da saúde. O processo participativo documentado na elaboração dos planos também é variável, desde inexistente a amplo e decidido. Muitos planos contêm políticas concretas com foco central em equidade, por exemplo, políticas para melhorar a acessibilidade física à assistência de saúde e o acesso a medicamentos a preços razoáveis, mas nenhum país inclui todos os aspectos aqui examinados. Os países identificam as populações marginalizadas nos seus planos, porém, apenas um quarto distingue especificamente os afrodescendentes e mais da metade não contempla os povos indígenas, mesmo onde as populações indígenas são em grande número. Quatro países consideram a atenção aos migrantes. Embora existam metas de equidade em saúde e dados relativos a iniquidades de base, menos da metade dos países incorpora em seus planos metas com prazos definidos para reduzir as desigualdades absolutas ou relativas em saúde. Instrumentos claros de responsabilidade como educação, prestação de contas ou respeito aos direitos são raramente vistos. O compromisso praticamente unânime dos países das Américas com a equidade em saúde oferece uma oportunidade importante. Os planos mais bem fundados com enfoque em equidade poderiam servir de exemplo para guiar os esforços de converter metas gerais em metas com prazos definidos e, em última instância, aumentar a equidade.

Silently Suffering: A Pediatric Black Widow Spider Envenomation.

BACKGROUND: Black widow spiders are distributed worldwide and, although rarely fatal, account for significant morbidity. Diagnosis can be challenging, and children are at risk of increased morbidity due to their small size. CASE REPORT: We present a case of a 3-year-old boy who was brought to our emergency department because of sudden ear pain followed by labored breathing, abdominal pain, refusal or inability to speak, and grunting respirations. A black widow spider bite was suspected based on additional history obtained, and the spider was found in his helmet, confirming the diagnosis. The patient had progressive respiratory distress and somnolence and was intubated and transferred to a local pediatric intensive care unit. Antivenom was not initially available and eventually declined by the family. The child received supportive care and recovered after several days. Why Should an Emergency Physician Be Aware of This? This case illustrates the potentially deadly effects a black widow envenomation could cause in a child, and that bite location can affect the constellation of symptoms. It is a reminder that toxins, including that of the black widow spider, should be on the differential for acute abdominal pain, especially with autonomic features.

Planning for health equity in the Americas: an analysis of national health plans

[ABSTRACT]. There is growing recognition that health and well-being improvements have not been shared across populations in the Americas. This article analyzes 32 national health sector policies, strategies, and plans across 10 different areas of health equity to understand, from one perspective, how equity is being addressed in the region. It finds significant variation in the substance and structure of how the health plans handle the issue. Nearly all countries explicitly include health equity as a clear goal, and most address the social determinants of health. Participatory processes documented in the development of these plans range from none to extensive and robust. Substantive equity-focused policies, such as those to improve physical accessibility of health care and increase affordable access to medicines, are included in many plans, though no country includes all aspects examined. Countries identify marginalized populations in their plans, though only a quarter specifically identify Afro-descendants and more than half do not address Indigenous people, including countries with large Indigenous populations. Four include attention to migrants. Despite health equity goals and data on baseline inequities, fewer than half of countries include time-bound targets on reducing absolute or relative health inequalities. Clear accountability mechanisms such as education, reporting, or rights-enforcement mechanisms in plans are rare. The nearly unanimous commitment across countries of the Americas to equity in health provides an important opportunity. Learning from the most robust equity-focused plans could provide a road map for efforts to translate broad goals into time-bound targets and eventually to increasing equity.

[RESUMEN]. Cada vez es mayor el reconocimiento de que las mejoras en cuanto a la salud y el bienestar no han llegado por igual a todos los segmentos de la población en la Región de las Américas. En este artículo se analizan 32 políticas, estrategias y planes nacionales del sector de la salud con respecto a diez áreas distintas relativas a la equidad en la salud. El objetivo es comprender, desde una perspectiva, cómo se está abordando la equidad en la Región. Se ha encontrado una variación significativa, tanto en sustancia como en estructura, sobre la manera en que se maneja el tema en los planes de salud. Casi todos los países incluyen explícitamente la equidad en la salud como una meta clara y la mayoría abordan los determinantes sociales de la salud. En la formulación de estos planes se ha documentado desde ningún proceso participativo hasta procesos participativos exhaustivos y sólidos. En muchos planes se han incluido políticas sustantivas centradas en la equidad, como aquellas para mejorar la accesibilidad física a la atención de salud y el acceso a medicamentos asequibles, pero en ningún país se incorporan todos los aspectos analizados. Si bien los países contemplan a los grupos marginados en sus planes, solo una cuarta parte identifica específicamente a las personas afrodescendientes y más de la mitad de los países no considera a las personas indígenas, incluso en el caso de algunos países con una población indígena grande. Cuatro países contemplan la atención médica a los migrantes. A pesar de que existen metas sobre la equidad en la salud y datos de línea de base sobre las inequidades, menos de la mitad de los países incluyen metas con plazos para reducir las inequidades en la salud absolutas o relativas. No son habituales tampoco en los planes los mecanismos de rendición de cuentas claros, como educación, presentación de informes o cumplimiento de los derechos. Los países de la Región de las Américas muestran un compromiso casi unánime con la equidad en la salud, lo cual brinda una oportunidad importante. Aprender de los planes para la equidad más sólidos podría proporcionar una hoja de ruta para las iniciativas que tratan de traducir algunas metas amplias en metas con plazos específicos que puedan eventualmente mejorar la equidad.

[RESUMO]. É cada vez mais aceito que os avanços em saúde e bem-estar não são partilhados por todas as populações nas Américas. Neste artigo são analisadas 32 políticas, estratégias e planos nacionais de saúde em 10 áreas distintas de equidade em saúde com o objetivo de entender, de uma única perspectiva, como a equidade está sendo contemplada na região. Existem diferenças consideráveis na forma e conteúdo do enfoque dado a esta questão nos planos de saúde. Quase todos os países estabelecem explicitamente a equidade em saúde como uma meta clara e a maioria aborda os determinantes sociais da saúde. O processo participativo documentado na elaboração dos planos também é variável, desde inexistente a amplo e decidido. Muitos planos contêm políticas concretas com foco central em equidade, por exemplo, políticas para melhorar a acessibilidade física à assistência de saúde e o acesso a medicamentos a preços razoáveis, mas nenhum país inclui todos os aspectos aqui examinados. Os países identificam as populações marginalizadas nos seus planos, porém, apenas um quarto distingue especificamente os afrodescendentes e mais da metade não contempla os povos indígenas, mesmo onde as populações indígenas são em grande número. Quatro países consideram a atenção aos migrantes. Embora existam metas de equidade em saúde e dados relativos a iniquidades de base, menos da metade dos países incorpora em seus planos metas com prazos definidos para reduzir as desigualdades absolutas ou relativas em saúde. Instrumentos claros de responsabilidade como educação, prestação de contas ou respeito aos direitos são raramente vistos. O compromisso praticamente unânime dos países das Américas com a equidade em saúde oferece uma oportunidade importante. Os planos mais bem fundados com enfoque em equidade poderiam servir de exemplo para guiar os esforços de converter metas gerais em metas com prazos definidos e, em última instância, aumentar a equidade.

Planning for health equity in the Americas: an analysis of national health plans / La planificación para lograr la equidad en la salud en la Región de las Américas: un análisis de los planes nacionales de salud / Planejamento para equidade em saúde nas Américas: uma análise dos planos nacionais de saúde

ABSTRACT There is growing recognition that health and well-being improvements have not been shared across populations in the Americas. This article analyzes 32 national health sector policies, strategies, and plans across 10 different areas of health equity to understand, from one perspective, how equity is being addressed in the region. It finds significant variation in the substance and structure of how the health plans handle the issue. Nearly all countries explicitly include health equity as a clear goal, and most address the social determinants of health. Participatory processes documented in the development of these plans range from none to extensive and robust. Substantive equity-focused policies, such as those to improve physical accessibility of health care and increase affordable access to medicines, are included in many plans, though no country includes all aspects examined. Countries identify marginalized populations in their plans, though only a quarter specifically identify Afro-descendants and more than half do not address Indigenous people, including countries with large Indigenous populations. Four include attention to migrants. Despite health equity goals and data on baseline inequities, fewer than half of countries include time-bound targets on reducing absolute or relative health inequalities. Clear accountability mechanisms such as education, reporting, or rights-enforcement mechanisms in plans are rare. The nearly unanimous commitment across countries of the Americas to equity in health provides an important opportunity. Learning from the most robust equity-focused plans could provide a road map for efforts to translate broad goals into time-bound targets and eventually to increasing equity.

RESUMEN Cada vez es mayor el reconocimiento de que las mejoras en cuanto a la salud y el bienestar no han llegado por igual a todos los segmentos de la población en la Región de las Américas. En este artículo se analizan 32 políticas, estrategias y planes nacionales del sector de la salud con respecto a diez áreas distintas relativas a la equidad en la salud. El objetivo es comprender, desde una perspectiva, cómo se está abordando la equidad en la Región. Se ha encontrado una variación significativa, tanto en sustancia como en estructura, sobre la manera en que se maneja el tema en los planes de salud. Casi todos los países incluyen explícitamente la equidad en la salud como una meta clara y la mayoría abordan los determinantes sociales de la salud. En la formulación de estos planes se ha documentado desde ningún proceso participativo hasta procesos participativos exhaustivos y sólidos. En muchos planes se han incluido políticas sustantivas centradas en la equidad, como aquellas para mejorar la accesibilidad física a la atención de salud y el acceso a medicamentos asequibles, pero en ningún país se incorporan todos los aspectos analizados. Si bien los países contemplan a los grupos marginados en sus planes, solo una cuarta parte identifica específicamente a las personas afrodescendientes y más de la mitad de los países no considera a las personas indígenas, incluso en el caso de algunos países con una población indígena grande. Cuatro países contemplan la atención médica a los migrantes. A pesar de que existen metas sobre la equidad en la salud y datos de línea de base sobre las inequidades, menos de la mitad de los países incluyen metas con plazos para reducir las inequidades en la salud absolutas o relativas. No son habituales tampoco en los planes los mecanismos de rendición de cuentas claros, como educación, presentación de informes o cumplimiento de los derechos. Los países de la Región de las Américas muestran un compromiso casi unánime con la equidad en la salud, lo cual brinda una oportunidad importante. Aprender de los planes para la equidad más sólidos podría proporcionar una hoja de ruta para las iniciativas que tratan de traducir algunas metas amplias en metas con plazos específicos que puedan eventualmente mejorar la equidad.

RESUMO É cada vez mais aceito que os avanços em saúde e bem-estar não são partilhados por todas as populações nas Américas. Neste artigo são analisadas 32 políticas, estratégias e planos nacionais de saúde em 10 áreas distintas de equidade em saúde com o objetivo de entender, de uma única perspectiva, como a equidade está sendo contemplada na região. Existem diferenças consideráveis na forma e conteúdo do enfoque dado a esta questão nos planos de saúde. Quase todos os países estabelecem explicitamente a equidade em saúde como uma meta clara e a maioria aborda os determinantes sociais da saúde. O processo participativo documentado na elaboração dos planos também é variável, desde inexistente a amplo e decidido. Muitos planos contêm políticas concretas com foco central em equidade, por exemplo, políticas para melhorar a acessibilidade física à assistência de saúde e o acesso a medicamentos a preços razoáveis, mas nenhum país inclui todos os aspectos aqui examinados. Os países identificam as populações marginalizadas nos seus planos, porém, apenas um quarto distingue especificamente os afrodescendentes e mais da metade não contempla os povos indígenas, mesmo onde as populações indígenas são em grande número. Quatro países consideram a atenção aos migrantes. Embora existam metas de equidade em saúde e dados relativos a iniquidades de base, menos da metade dos países incorpora em seus planos metas com prazos definidos para reduzir as desigualdades absolutas ou relativas em saúde. Instrumentos claros de responsabilidade como educação, prestação de contas ou respeito aos direitos são raramente vistos. O compromisso praticamente unânime dos países das Américas com a equidade em saúde oferece uma oportunidade importante. Os planos mais bem fundados com enfoque em equidade poderiam servir de exemplo para guiar os esforços de converter metas gerais em metas com prazos definidos e, em última instância, aumentar a equidade.

Global Health in the Age of COVID-19: Responsive Health Systems Through a Right to Health Fund.

We propose that a Right to Health Capacity Fund (R2HCF) be created as a central institution of a reimagined global health architecture developed in the aftermath of the COVID-19 pandemic. Such a fund would help ensure the strong health systems required to prevent disease outbreaks from becoming devastating global pandemics, while ensuring genuinely universal health coverage that would encompass even the most marginalized populations. The R2HCF's mission would be to promote inclusive participation, equality, and accountability for advancing the right to health. The fund would focus its resources on civil society organizations, supporting their advocacy and strengthening mechanisms for accountability and participation. We propose an initial annual target of US$500 million for the fund, adjusted based on needs assessments. Such a financing level would be both achievable and transformative, given the limited right to health funding presently and the demonstrated potential of right to health initiatives to strengthen health systems and meet the health needs of marginalized populations-and enable these populations to be treated with dignity. We call for a civil society-led multi-stakeholder process to further conceptualize, and then launch, an R2HCF, helping create a world where, whether during a health emergency or in ordinary times, no one is left behind.

Transitioning Out of the Coronavirus Lockdown: A Framework for Evaluating Zone-Based Social Distancing.

In the face of elevated pandemic risk, canonical epidemiological models imply the need for extreme social distancing over a prolonged period. Alternatively, people could be organized into zones, with more interactions inside their zone than across zones. Zones can deliver significantly lower infection rates, with less social distancing, particularly if combined with simple quarantine rules and contact tracing. This paper provides a framework for understanding and evaluating the implications of zones, quarantines, and other complementary policies.

55-year-old Male with Exertional Dyspnea.

INTRODUCTION: Dyspnea is a common presenting complaint for many patients in the emergency department. CASE PRESENTATION: A 55-year-old man with type I diabetes presented to the emergency department with one month of intermittent palpitations and dyspnea. His lungs were clear to auscultation, and his chest radiograph was normal. DISCUSSION: This case takes the reader through the differential diagnosis and systematic work-up of dyspnea with discussion of the diagnostic study, which ultimately led to this patient's diagnosis and successful treatment.

Health Inequalities.

Health inequalities are embedded in a complex array of social, political, and economic inequalities. Responding to health inequalities will require systematic action targeting all the underlying ("upstream") social determinants that powerfully affect health and well-being. Systemic inequalities are a major reason for the rise of modern populism that has deeply divided polities and infected politics, perhaps nowhere more so than in the United States. Concerted action to mitigate shocking levels of inequality could be a powerful antidote to nationalist populism. A basic yet critical start to addressing health inequalities is to recognize them, which demands improving data collection and analysis. Certainly, global indicators show vast progress in reducing poverty and extending life. Yet aggregate health data mask a deeper reality: health gains have disproportionately benefited the well-off, leaving the poor and middle-class behind.