G20’s commitment to telehealth for reducing global health disparities: from a global commitment to regional actions

[ABSTRACT]. The G20, representing the world’s largest economies, plays a critical role in shaping global health policies, initiatives and innovative solutions. As these nations navigate the complexities of digital transformation in the health sector, engagement with the Global Initiative on Digital Health (2), aligned with the Pan American Health Organization ́s (PAHO) eight guiding principles for the digital transformation of the health sector (3), becomes imperative not only for advancing technology adoption but also for promoting health equity and universal access to health and universal health coverage. The inclusion of telehealth in the G20 agenda, championed by Brazil’s presidency, underscores the group’s commitment to leveraging digital innovations to improve health outcomes in G20 countries and globally, as telehealth is a key area of the digital transformation of the health sector. Because countries worldwide vary widely in the capacity of their digital health infrastructure and their development stages, there lies a unique opportunity to foster international collaboration, share knowledge and drive global standards that support the widespread adoption of telehealth solutions for leaving no one behind. This strategic focus is predicated on the understand- ing that telehealth serves as both a catalyst for health equity and a critical tool for reinforcing health systems grounded in primary health care (PHC). The scientific rationale behind this concerted effort is clear: by enhancing digital infrastructure and fostering the adoption of telehealth solutions, there is potential to bridge the global digital divide and democratize access to health services. The G20, representing the world’s largest economies, plays a critical role in shaping global health policies, initiatives and innovative solutions (1). As these nations navigate the complexities of digital transformation in the health sector, engagement with the Global Initiative on Digital Health (2), aligned with the Pan American Health Organization ́s (PAHO) eight guiding principles for the digital transformation of the health sector (3), becomes imperative not only for advancing technology adoption but also for promoting health equity and universal access to health and universal health coverage. The inclusion of telehealth in the G20 agenda, championed by Brazil’s presidency, underscores the group’s commitment to leveraging digital innovations to improve health outcomes in G20 countries and globally, as telehealth is a key area of the digital transformation of the health sector. Because countries worldwide vary widely in the capacity of their digital health infrastructure and their development stages, there lies a unique opportunity to foster international collaboration, share knowledge and drive global standards that support the widespread adoption of telehealth solutions for leaving no one behind. This strategic focus is predicated on the understand- ing that telehealth serves as both a catalyst for health equity and a critical tool for reinforcing health systems grounded in primary health care (PHC). The scientific rationale behind this concerted effort is clear: by enhancing digital infrastructure and fostering the adoption of telehealth solutions, there is potential to bridge the global digital divide and democratize access to health services. In envisioning the future of global health, the fourth pillar of the vision of PAHO’s Director emerges with critical importance: the construction of resilient national health systems is firmly rooted in the implementation of the PHC strategy. This vision is not just an aspiration but a necessary evolution, with PAHO standing ready to guide countries towards achieving this goal. PAHO’s commitment involves supporting countries in the organization of health services networks based on PHC, targeting public financing to foster universal access and coverage, and bolstering governance in health under the leadership of health ministries. Moreover, it calls for the rapid deployment of technological innovations such as telehealth and also broader digital transformation initiatives (4). Digital transformation, emerging as a key innovative strategy, offers significant improvements to the strengthening of PHC. Through the adoption of inclusive digital health solutions, it is possible to enhance the delivery of health services, ensuring they become more accessible, efficient and equitable for everyone, everywhere (5, 6). Among the priorities leading this transformation, telehealth emerged at the G20 as a key opportunity in the mission to leave no one behind and as a cornerstone of the digital transformation of the health sector. Telehealth improves access to care and health information, thereby empowering individuals and communities (7). It effectively extends health services to underserved populations, encourages collaborative practices among health professionals, and broadens access to health for the wider community. It can support reduced waiting times and costs through efficiencies in care management. Through telehealth, the transition to a new era of PHC can be accelerated through technological advancements that drive us towards a more inclusive and accessible health care system for all. Concrete efforts should be focused on modernizing normative and legislative frameworks, investment in digital infrastructure, prioritizing the development of robust digital health infrastructures while ensuring that reliable internet access and digital tools are available across urban and rural areas alike. Enhancing digital literacy and telehealth competencies among health professionals and the population will maximize the utilization and effectiveness of digital health services. However, the lack of standardized policies and frameworks for telehealth is a significant barrier to its global adoption and, therefore, G20 nations can lead by example, working towards (a) developing international telehealth guidelines that consider ethical, privacy and security standards for telehealth services to facilitate cross-border healthcare delivery and secure data exchange; and (b) promoting interoperable telehealth platforms that can seamlessly exchange information, thus enhancing the continuity and quality of care. The G20’s leadership and commitment to integrating telehealth into the global health agenda can set an unprecedented opportunity for international cooperation in digital health. G20 countries can significantly impact global health outcomes by integrating telehealth at all levels of care and health service delivery networks, impacting the lives of billions around the world. Equity must remain central to our efforts as telehealth services are integrated into the model of care. This means ensuring the adoption of differentiated approaches in digital health based on (a) the characteristics of a territory (geographical dis- persion, status of infrastructure), (b) the beneficiary population to be served (their health needs, and cultural, racial and ethnic considerations) and (c) the health system capacities and organization (the health services network, coverage capacity and availability of multiprofessional teams). Health outcomes can be significantly positively impacted by undertaking bottom-up planning processes that take into account the latter considerations and by adapting the model of care to leverage the capacity of digital health. Embracing the Regional Roadmap for the Digital Transformation of the Health Sector in the Region of the Americas is imperative for countries aiming to develop expansive, resilient and inclusive health systems based on PHC (8,9). This comprehensive framework, backed by lessons learned and suc- cessful experiences, underscores the significant potential that digital transformation holds for improving health outcomes. Brazil's commitment to the consolidation of the Unified Health System (the Sistema Único de Saúde, or SUS) and its well-established Family Health Strategy as the foundation for the health and well-being of its population is being expressed through the rapid deployment of telehealth, and serves as a model of innovation and effectiveness, showcasing the transformative impact of digital health solutions on accessibility, efficiency and quality of care (10). This editorial, jointly prepared by rep- resentatives of the government of Brazil and PAHO advocates for global standardization of telehealth practices that ensures the scalability and sustainability of health interventions while addressing the core determinants of health equity.

[RESUMEN]. Sin resumen disponible Texto completo en inglés

[RESUMO]. Não existe resumo disponível Texto completo em inglês

From Bolsonaro to Lula: The opportunity to rebuild universal healthcare in Brazil in the government transition.

This paper takes the government transition that took place between 2022 and 2023 in Brazil as a case study and aims to analyse how a cycle of radical right-wing populist government acted to dismantle Brazil's national health system foundations. It describes how governance was built based on political-clientelism and market-privatising interests and on the adoption of long-term fiscal austerity policies, whose results are public defunding and weakening and disorganisation of the country's national health system, with a significant worsening of health indicators and the capacity to respond to the population health needs. The lessons from recent experience in Brazil should serve as learning and a source of academic and political reflection, since there is an ongoing international movement and signs of rise of radical right-wing populist regimes in several countries, which endanger the Democratic Rule of Law, institutions, and social policies. It allows putting into perspective how political cycles of this nature can affect national universal health systems, including those that have experienced substantial progress towards universal access and universal health coverage. Keeping in mind the Brazilian experience, it was possible to observe the progressive structuring of a radical right-wing neo-populism and in the sanitarian.

The history of Chagas disease: reflections on science in action.

Approaching from the perspective of the history and social studies of science, the article analyses some aspects of the early history of Chagas disease, from its discovery through initial research. It is our goal to show that historians of science can explore this topic as a way not only of remembering and narrating past events but also of examining the processes through which science is produced. To this end, we present five basic precepts that have guided historical and sociological studies of "science in action": science as a collective endeavor, as a social activity, as a set of practices, as a process that involves controversies, and as a formative process. By examining the topic in the light of these five points, we demonstrate how the history of this successful research tradition can lead us to broader reflections about the complex dynamics interweaving science and society.

Safeguarding people living in vulnerable conditions in the COVID-19 era through universal health coverage and social protection.

The COVID-19 pandemic is unprecedented. The pandemic not only induced a public health crisis, but has led to severe economic, social, and educational crises. Across economies and societies, the distributional consequences of the pandemic have been uneven. Among groups living in vulnerable conditions, the pandemic substantially magnified the inequality gaps, with possible negative implications for these individuals' long-term physical, socioeconomic, and mental wellbeing. This Viewpoint proposes priority, programmatic, and policy recommendations that governments, resource partners, and relevant stakeholders should consider in formulating medium-term to long-term strategies for preventing the spread of COVID-19, addressing the virus's impacts, and decreasing health inequalities. The world is at a never more crucial moment, requiring collaboration and cooperation from all sectors to mitigate the inequality gaps and improve people's health and wellbeing with universal health coverage and social protection, in addition to implementation of the health in all policies approach.

The history of Chagas disease: reflections on science in action

Approaching from the perspective of the history and social studies of science, the article analyses some aspects of the early history of Chagas disease, from its discovery through initial research. It is our goal to show that historians of science can explore this topic as a way not only of remembering and narrating past events but also of examining the processes through which science is produced. To this end, we present five basic precepts that have guided historical and sociological studies of "science in action": science as a collective endeavor, as a social activity, as a set of practices, as a process that involves controversies, and as a formative process. By examining the topic in the light of these five points, we demonstrate how the history of this successful research tradition can lead us to broader reflections about the complex dynamics interweaving science and society.

Pandemia e interdisciplinaridade: desafios para a saúde coletiva / Pandemic and interdisciplinarity: challenges for collective health

RESUMO Este artigo discute o papel da interdisciplinaridade na análise e no enfrentamento da crise sanitária e social global suscitada pela pandemia de Covid-19. Defende-se a necessidade de se repensarem as divisões entre mundo natural e sociedade, com destaque para a questão ambiental, e a nova conformação do campo da informação e comunicação e seus impactos na sociedade contemporânea. Entende-se a pandemia de Covid-19 como um fenômeno inteiramente novo que põe em evidência, por vezes em aceleração, uma série de tendências, mas que pode implicar inflexões e mudanças cujo rumo não está dado. Destaca-se a centralidade da área de saúde coletiva no esforço interdisciplinar para a definição de agendas científicas e, também, de propostas de políticas públicas. Conclui-se que o fortalecimento de pesquisas interdisciplinares especialmente atentas às interrelações de sistemas naturais e sociais são e serão essenciais para a superação da crise atual e das prováveis emergências sanitárias futuras.

ABSTRACT This article discusses the role of interdisciplinarity in analyzing and dealing with the global health and social crisis caused by the COVID-19 pandemic. It defends the need to rethink the divisions between the natural world and society, with emphasis on the environmental issue, and the new conformation of the field of information and communication and its impacts on contemporary society. The COVID 19 pandemic is understood as an entirely new phenomenon that highlights, sometimes accelerating, a series of trends, but which may imply inflections and changes whose direction is not given. The centrality of the field of collective health in the interdisciplinary effort to define scientific agendas and also public policy proposals is highlighted. It is concluded that the strengthening of interdisciplinary research, especially attentive to the interrelationships of natural and social systems, is and will be essential for overcoming the current crisis and probable future health emergencies.

An analysis of actions taken by Fundação Oswaldo Cruz for the communication and popularization of science. / Uma análise das ações de divulgação e popularização da ciência na Fundação Oswaldo Cruz.

An analysis is presented of actions taken by the Brazilian research institution Fiocruz for the communication and popularization of science, from two perspectives. The aim was to investigate how a system for the communication and popularization of science is organized at a large scientific institution and how it is articulated with the institutional discourse. A brief review is presented of how the topic has developed over the history of Fiocruz, followed by a discussion of the way it has been addressed in its official planning documents. The science communication/popularization actions undertaken in 2015 and 2016 were mapped out and classified according to how they interact with the public, giving a better understanding of this area.

Neste trabalho apresentamos uma análise das ações de divulgação e popularização da ciência na Fiocruz a partir de duas perspectivas. O estudo tem por objetivo investigar como se organiza um sistema de divulgação e popularização da ciência em uma instituição científica de grande porte e como esse sistema se articula com seu discurso institucional. Além de fazer uma breve revisão da evolução do tema na história da Fiocruz, realizamos um levantamento de como o mesmo tem sido tratado nos documentos oficiais de planejamento. Com o mapeamento das ações realizadas em 2015 e 2016, foi possível compreender melhor esse universo e classificá-lo de acordo com suas características junto ao público.

Uma análise das ações de divulgação e popularização da ciência na Fundação Oswaldo Cruz / An analysis of actions taken by Fundação Oswaldo Cruz for the communication and popularization of science

Resumo Neste trabalho apresentamos uma análise das ações de divulgação e popularização da ciência na Fiocruz a partir de duas perspectivas. O estudo tem por objetivo investigar como se organiza um sistema de divulgação e popularização da ciência em uma instituição científica de grande porte e como esse sistema se articula com seu discurso institucional. Além de fazer uma breve revisão da evolução do tema na história da Fiocruz, realizamos um levantamento de como o mesmo tem sido tratado nos documentos oficiais de planejamento. Com o mapeamento das ações realizadas em 2015 e 2016, foi possível compreender melhor esse universo e classificá-lo de acordo com suas características junto ao público.

Abstract An analysis is presented of actions taken by the Brazilian research institution Fiocruz for the communication and popularization of science, from two perspectives. The aim was to investigate how a system for the communication and popularization of science is organized at a large scientific institution and how it is articulated with the institutional discourse. A brief review is presented of how the topic has developed over the history of Fiocruz, followed by a discussion of the way it has been addressed in its official planning documents. The science communication/popularization actions undertaken in 2015 and 2016 were mapped out and classified according to how they interact with the public, giving a better understanding of this area.

Overview of snakebite in Brazil: Possible drivers and a tool for risk mapping.

Snakebite envenoming affects close to 2.7 million people globally every year. In Brazil, snakebites are reported to the Ministry of Health surveillance system and cases receive antivenom free of charge. There is an urgent need to identify higher risk areas for antivenom distribution, and to develop prevention activities. The objective of this study is to provide an overview of the epidemiological situation of snakebite envenoming in Brazil and explore possible drivers; as well as to create a flowchart tool to support decision-makers identify higher risk areas. An ecological-type study was carried out using data by municipality (2013-2017). Study parts: 1) Create a geocoded database and perform a descriptive and cluster analysis; 2) Statistical analysis to measure the association of snakebite and possible environmental and socioeconomic drivers; 3) Develop a flowchart to support decision-makers and the application of this tool in one state (Rio Grande do Sul) as an example. An average of 27,120 snakebite cases per year were reported at the country level. Clusters of municipalities with high numbers of snakebites are mostly found in the Amazon Legal Region. The negative binomial regression model showed association with the snakebite case count: the type of major habitat, tropical or non-tropical; temperature; percentage of urbanization; precipitation; elevation; GDP per capita; a weaker relation with forest loss; and with venomous snake richness. The state where the instrument was applied reported 4,227 snakebites in the period. Most municipalities were considered as medium risk and 56/496 as high risk according to the tool created. Snakebite cases are distributed across the entire country with the highest concentration in the Legal Amazon Region. This creates a complex situation both for better understanding of the association of environmental and socioeconomic factors with snakebites and for the distribution and maintenance of antivenom to remote areas. Research into types of antivenom with a longer shelf life without the need for refrigeration is needed.