Supreme Court v. Necropolitics: The Chaotic Judicialization of COVID-19 in Brazil.

Worldwide, governments have reacted to the COVID-19 pandemic with emergency orders and policies restricting rights to movement, assembly, and education that have impacted daily lives and livelihoods in profound ways. But some leaders, such as President Jair Bolsonaro in Brazil, have resisted taking such steps, denying the seriousness of the pandemic and sabotaging local control measures, thereby compromising population health. Facing one of the world's highest rates of COVID-19 infections and deaths, multiple political actors in Brazil have resorted to judicialization to advance the right to health and other protections in the country. Responding to this litigation has provided the country's Supreme Court an opportunity to assertively confront and counter the executive's necropolitics. In this article, we probe the malleable form and the constitutional basis of the Supreme Court's decisions, assessing their impact on the separation of powers, on the protection of human rights (for example, on those of prisoners, indigenous peoples, and essential workers), and relative to the implementation of evidence-based interventions (for example, lockdowns and vaccination). While the court's actions open up a distinct legal-political field (sometimes called "supremocracy")-oscillating between progressive imperatives, neoliberal valuations, and conservative decisions-the capacity of the judiciary to significantly address systemic violence and to robustly advance human rights remains to be seen.

Right-to-Medicines Litigation and Universal Health Coverage: Institutional Determinants of the Judicialization of Health in Brazil.

Over the past three decades, Brazil has developed a decentralized universal health system and achieved significant advances in key health indicators. At the same time, Brazil's health system has struggled to ensure equitable and quality health services. One response to the broad promises and notable shortcomings has been a sharp rise in right-to-health litigation, most often seeking access to medicines. While much has been written about the characteristics of patient-plaintiffs and the requested medicines in right-to-health litigation in Brazil, little research has examined potential community-level and institutional drivers of judicialization and their role as mechanisms of accountability. To explore these dimensions, we used a mixed-effects analytical model to examine a representative sample of lawsuits for access to medicines filed against the state of Rio Grande do Sul in 2008. We found that the presence of a Public Defender's Office was associated with a sevenfold increase in the likelihood of a municipality having a medicine-requesting lawsuit. This effect was maintained after controlling for a series of municipality characteristics. As low- and middle-income countries seek to achieve universal health coverage within the framework of the Sustainable Development Goals, Brazil's experience may be illustrative of the challenges that health systems will face and the institutional mechanisms that will emerge, advancing accountability and individual patients' interests in response.

Judicialization 2.0: Understanding right-to-health litigation in real time.

Over the past two decades, debate over the whys, the hows, and the effects of the ever-expanding phenomenon of right-to-health litigation ('judicialization') throughout Latin America have been marked by polarised arguments and limited information. In contrast to claims of judicialization as a positive or negative trend, less attention has been paid to ways to better understand the phenomenon in real time. In this article, we propose a new approach-Judicialization 2.0-that recognises judicialization as an integral part of democratic life. This approach seeks to expand access to information about litigation on access to medicines (and health care generally) in order to better characterise the complexity of the phenomenon and thus inform new research and more robust public discussions. Drawing from our multi-disciplinary perspectives and field experiences in highly judicialized contexts, we thus describe a new multi-source, multi-stakeholder mixed-method approach designed to capture the patterns and heterogeneity of judicialization and understand its medical and socio-political impact in real time, along with its counterfactuals. By facilitating greater data availability and open access, we can drive advancements towards transparent and participatory priority setting, as well as accountability mechanisms that promote quality universal health coverage.

The books of the dead revisited: mortality and morbidity in the German colonies of southern Brazil, 1850-1880 / Revisitando os livros dos mortos: mortalidade e morbidade nas colônias alemãs do sul do Brasil, 1850-1880

Abstract Examines mortality and morbidity in São Leopoldo/RS (1850-1880). Our interdisciplinary study is based on the Gemeindebücher (parish registers) produced by Lutheran communities. These "community books" reveal high rates of fertility and premature death. Infant mortality and maternal death assailed everyday life. Over half of all deaths were of infants and children. Of ten funerals, seven were for children and adults of reproductive and military age. This article contributes to debates over environmental, social and political determinants of mortality and people's arts of living and healing in proto-statistical Brazil.

Resumo Trata de morbidade e mortalidade em São Leopoldo/RS (1850-1880). Nosso estudo interdisciplinar se baseia nos Gemeindebücher (registros paroquiais) de comunidades luteranas. A análise deles revela altos índices de fertilidade e de mortes prematuras. Elevadas taxas de mortalidade materna e infantil marcavam o cotidiano. De todas as mortes, mais da metade delas eram crianças (0-14 anos). Sete em cada dez funerais eram de crianças (0-14 anos) e de adultos jovens (15-39 anos), retrato da precariedade das condições de vida. O artigo contribui para debates sobre os determinantes sócio-políticos e ambientais da mortalidade em áreas rurais. Por fim, trata das artes de viver e curar no Brasil proto-estatístico.

The books of the dead revisited: mortality and morbidity in the German colonies of southern Brazil, 1850-1880.

Examines mortality and morbidity in São Leopoldo/RS (1850-1880). Our interdisciplinary study is based on the Gemeindebücher (parish registers) produced by Lutheran communities. These "community books" reveal high rates of fertility and premature death. Infant mortality and maternal death assailed everyday life. Over half of all deaths were of infants and children. Of ten funerals, seven were for children and adults of reproductive and military age. This article contributes to debates over environmental, social and political determinants of mortality and people's arts of living and healing in proto-statistical Brazil.

The Judicialization of Health and the Quest for State Accountability: Evidence from 1,262 Lawsuits for Access to Medicines in Southern Brazil.

The impact of increasing numbers of lawsuits for access to medicines in Brazil is hotly debated. Government officials and scholars assert that the "judicialization of health" is driven by urban elites and private interests, and is used primarily to access high-cost drugs. Using a systematic sample of 1,262 lawsuits for access to medicines filed against the southern Brazilian state of Rio Grande do Sul, we assess these claims, offering empirical evidence that counters prevailing myths and affirms the heterogeneity of the judicialization phenomenon. Our findings show that the majority of patient-litigants are in fact poor and older individuals who do not live in major metropolitan areas and who depend on the state to provide their legal representation, and that the majority of medicines requested were already on governmental formularies. Our data challenge arguments that judicialization expands inequities and weakens the universal health care system. Our data also suggest that judicialization may serve as a grassroots instrument for the poor to hold the state accountable. Failing to acknowledge regional differences and attempting to fit all data into one singular narrative may be contributing to a biased interpretation of the nature of judicialization, and limiting the understanding of its drivers, consequences, and implications at local levels.

[Legal remedies: therapeutic markets and the judicialization of the right to health]. / Tratamentos jurídicos: os mercados terapêuticos e a judicialização do direito à saúde.

This study draw on the struggle of parents of children with mucopolysacchar idosis to access expensive drugs in the name of universal right to health. The work explores how, in Brazil, right-to-health litigation became an alternative pathway to access health care and shows that several public and private stakeholders dispute the judicialization of health. Biotechnology is, therefore, understood to remake human and social worlds as it opens up new spaces of ethical problematization, desire, and political belonging.

Tratamentos jurídicos: os mercados terapêuticos e a judicialização do direito à saúde / Legal remedies: therapeutic markets and the judicialization of the right to health

Resumo Esse estudo mostra a luta de pais para que filhos portadores de mucopolissacaridose tenham acesso a medicamentos caros, em nome do direito universal à saúde. O trabalho explora como, no Brasil, o litígio pelo direito à saúde tornou-se um caminho alternativo de acesso à saúde e evidencia a disputa de diferentes atores dos setores público e privado no processo de judicialização da saúde. Entende-se, portanto, que a biotecnologia recria valores humanos e mundos locais à medida que abre novos espaços de problematização ética, desejo e pertencimento político.

Abstract This study draw on the struggle of parents of children with mucopolysacchar idosis to access expensive drugs in the name of universal right to health. The work explores how, in Brazil, right-to-health litigation became an alternative pathway to access health care and shows that several public and private stakeholders dispute the judicialization of health. Biotechnology is, therefore, understood to remake human and social worlds as it opens up new spaces of ethical problematization, desire, and political belonging.

How Can Urban Policies Improve Air Quality and Help Mitigate Global Climate Change: a Systematic Mapping Review.

Tackling climate change at the global level is central to a growing field of scientific research on topics such as environmental health, disease burden, and its resulting economic impacts. At the local level, cities constitute an important hub of atmospheric pollution due to the large amount of pollutants that they emit. As the world population shifts to urban centers, cities will increasingly concentrate more exposed populations. Yet, there is still significant progress to be made in understanding the contribution of urban pollutants other than CO2, such as vehicle emissions, to global climate change. It is therefore particularly important to study how local governments are managing urban air pollution. This paper presents an overview of local air pollution control policies and programs that aim to reduce air pollution levels in megacities. It also presents evidence measuring their efficacy. The paper argues that local air pollution policies are not only beneficial for cities but are also important for mitigating and adapting to global climate change. The results systematize several policy approaches used around the world and suggest the need for more in-depth cross-city studies with the potential to highlight best practices both locally and globally. Finally, it calls for the inclusion of a more human rights-based approach as a mean of guaranteeing of clean air for all and reducing factors that exacerbate climate change.

Tratamentos jurídicos: os mercados terapêuticos e a judicialização do direito à saúde / Legal remedies: therapeutic markets and the judicialization of the right to health

Esse estudo mostra a luta de pais para que filhos portadores de mucopolissacaridose tenham acesso a medicamentos caros, em nome do direito universal à saúde. O trabalho explora como, no Brasil, o litígio pelo direito à saúde tornou-se um caminho alternativo de acesso à saúde e evidencia a disputa de diferentes atores dos setores público e privado no processo de judicialização da saúde. Entende-se, portanto, que a biotecnologia recria valores humanos e mundos locais à medida que abre novos espaços de problematização ética, desejo e pertencimento político. (AU)

Peopling Global Health / A Saúde Global centrada nas pessoas

The field of Global Health brings together a vastly diverse array of actors working to address pressing health issues worldwide with unprecedented financial and technological resources and informed by various agendas. While Global Health initiatives are booming and displacing earlier framings of the field (such as tropical medicine or international health), critical analyses of the social, political, and economic processes associated with this expanding field — an “open source anarchy” on the ground — are still few and far between. In this essay, we contend that, among the powerful players of Global Health, the supposed beneficiaries of interventions are generally lost from view and appear as having little to say or nothing to contribute. We make the case for a more comprehensive and people-centered approach and demonstrate the crucial role of ethnography as an empirical lantern in Global Health. By shifting the emphasis from diseases to people and environments, and from trickle-down access to equality, we have the opportunity to set a humane agenda that both realistically confronts challenges and expands our vision of the future of global communities...

O campo da saúde global articula um diversificado leque de atores que trabalham para resolver problemas prementes de saúde em todo o mundo, com recursos financeiros e tecnológicos sem precedentes e munidos de agendas das mais variadas. Apesar das iniciativas em saúde global estarem crescendo de forma expressiva e deslocando enquadramentos anteriores do campo (como a medicina tropical ou saúde internacional), as análises críticas dos processos sociais, políticos e econômicos associados a essa expansão ainda são escassas. Neste artigo sustentamos, a partir de uma perspectiva que leva em conta os sujeitos, que o campo da saúde global é uma “anarquia de código aberto”. Em geral, perdem-se de vista os supostos beneficiários das intervenções, que aparecem como tendo pouco a dizer e nada a contribuir. Argumentamos por uma abordagem mais abrangente e centrada nas pessoas, demonstrando o papel crucial da etnografia como lanterna empírica na saúde global. Ao mudar a ênfase das doenças às pessoas e seus contextos e do acesso de cima para baixo para a equidade, temos a oportunidade de definir uma agenda humana que simultaneamente confronta realisticamente os desafios que enfrentamos e expande nossa visão sobre o futuro das comunidades globais...

Between the court and the clinic: lawsuits for medicines and the right to health in Brazil.

BACKGROUND: The Brazilian Constitution states: "Health is the right of all persons and the duty of the State." Yet individuals in Brazil frequently face barriers to health prevention and treatment. One response to these barriers has been a "judicialization" of the right to health, with an increasing number of patients suing the government for access to medicines. OBJECTIVE/METHODS: This study uses a mixed methods approach to identify trends in lawsuits for medicines in the southern state of Rio Grande do Sul (RS) and to characterize patient-plaintiffs. Electronic registries were used to determine the number of health lawsuits filed between 2002 and 2009. In-depth interviews were conducted with thirty patient-plaintiffs, and 1,080 lawsuits for medicines under review between September 1, 2008 and July 31, 2009 were analyzed to assess socio demographic, medical, and legal characteristics of patient-plaintiffs. RESULTS: Between 2002 and 2009, the annual number of health-related lawsuits against the state of RS increased from 1,126 to 17,025. In 2009, 72% of lawsuits sought access to medicines. In-depth interviews revealed that patients are desperate to access medicines for chronic and advanced diseases, and often turn to the courts as a last resort. Among the 1,080 lawsuits examined, patient-plaintiffs were more likely to be older than 45 years (68%), retired or unemployed (71%), and low-income (among those who reported income, 53% (n=350) earned less than the national minimum wage). Fifty-nine percent of all cases were represented by public defenders. Plaintiffs reported 1,615 diseases and requested 2.8 drugs on average (range 1-16). Sixty-five percent of the requested drugs were on government pharmaceutical distribution lists; 78% of the 254 drugs on these lists were requested. In 95% of the cases analyzed, district courts ruled in favor of plaintiffs. Among the 917 cases with a final state high court ruling, 89% were in favor of the plaintiff. In justifying their rulings, judges most frequently cited the government's obligation under the Constitution's provision of a right to health. DISCUSSION: Right-to-health litigation is a widespread practice in southern Brazil. Government pharmaceutical programs are struggling to fulfill their goal of expanded access and rational use of medicines, and poor patients are leveraging public legal assistance and a receptive judiciary to hold the state accountable to their medical needs. "Judicialization" is an alternative pathway for accessing health care, increasingly understood as access to medicines of all kinds. Tracking the health outcomes and budgetary impacts of right to-health court cases could help inform adequate treatment policy and evaluate trends in access.

Antropologia no campo da saúde global / Anthropology in the field of global health

Neste artigo, eu exploro os limites de abordagens baseadas em balas mágicas para os problemas de saúde global e mostro como as iniciativas centradas nas pessoas desafiam as ortodoxias econômicas e dos direitos humanos e ampliam nossa percepção daquilo que é socialmente possível e desejável. Utilizo o meu estudo etnográfico de longo prazo sobre a resposta terapêutica brasileira ao HIV/AIDS e suas repercussões nos âmbitos de governo, mercados, sistemas de saúde e vida pessoal. Faço também o relato de um novo projeto comparativo sobre as consequências de grandes intervenções farmacêuticas em contextos com recursos limitados. Considerando tanto os processos mais amplos quanto as singularidades humanas, o artigo abre uma janela crítica para os valores e os resultados de intervenções farmacêuticas e humanitárias contemporâneas na vida real. Ao criticar as práticas institucionais de produção de evidência, também reconsidero as noções de responsabilidade e cuidado dentro da antropologia e da medicina.

Drugs for all: the future of global AIDS treatment.

I am interested in the arts of government that accompany economic globalization and in the remaking of populations as market segments (specifically therapeutic markets). Using the Brazilian response to AIDS as an ethnographic baseline, I examine the systemic relations between pharmaceutical commerce and public health care and the value systems that underscore global AIDS treatment initiatives. The pharmaceuticalization of governance and citizenship, obviously efficacious in the treatment of AIDS, nonetheless crystallizes new inequalities.