Wars in Gaza and Beyond: Why Protecting the Sacredness of Health Matters.

This Viewpoint discusses the importance of safeguarding health access in times armed conflict worldwide and the need to bolster compliance with international humanitarian law.

Vaccination Mandates-An Old Public Health Tool Faces New Challenges.

This Viewpoint discusses how federal vaccine requirements have helped thwart vaccine-preventable diseases as well as how growing public resistance to vaccines and judicial and legislative limits to vaccination mandates may change that.

Chapitre 3. Perturbateurs endocriniens : un enjeu sanitaire, environnemental et scientifique, éthique et juridique.

Endocrine disruptors are substances capable of interfering with our hormonal system, leading to deleterious effects. Given the many sources of exposure, the challenge is to understand the role played by these substances in the development of certain pathologies. Assessing their effects on health is therefore a scientific challenge and an important public health issue.

The Supreme Court Is Harming Public Health and the Environment.

This Viewpoint looks back at the US Supreme Court's 2021 and 2022 terms and forward to the 2023 term and beyond with a focus on decisions that affect health care, public health and safety, environmental policy, and social equity.

Fix the backlash against public health.

Societies generally have reacted to deadly epidemics by strengthening health systems, including laws. Under American federalism (the constitutional division of power between states and the federal government), individual states hold primary public health powers. State legislatures have historically granted health officials wide-ranging authority. After the anthrax attacks in the United States in 2001, the US Centers for Disease Control and Prevention (CDC) supported the Model State Emergency Health Powers Act, which granted public health officials even more expansive powers to declare a health emergency and respond swiftly. But all that ended with COVID-19, as state legislatures and courts gutted this authority. The next pandemic could be far deadlier than COVID-19, but when the public looks to federal and state governments to protect them, they may find that health officials have their hands tied behind their backs.

Navigating complex trade-offs in public health interventions.

Public health, just as any policy-related field, faces the evergreen problem of turning knowledge into action. Among other problems, there is a clash between the inherent complexity of public health problems and the inevitable push, by decision-makers and the public, to simplify them. The Covid-19 pandemic has shown the insufficiencies of our current epistemological, methodological and normative apparatus to handle such crises in a timely manner. Despite this, several authors have been arguing for the importance of engaging global crises such as Covid-19 in ways that do not oversimplify key dimensions of the issues involved. In this paper, we contribute to this emerging scholarship. Building on existing work in the field of environmental problem-solving, we propose an integrative approach to navigating complex trade-offs in public health interventions. Briefly put, we propose that decision making should be informed by an analysis of any given problem from four distinct, but interrelated, lenses: (i) values and valuation, (ii) process and governance, (iii) power and inequalities and (iv) scientific evidence, methods and concepts. This normative framework, we argue, can help with spelling out the complexity of public health problems and with spelling out the rationale behind public health decision making to non-specialists and the general public. We illustrate our approach using the controversy over wearing face masks in the Covid-19 pandemic.

Strategies to approach the judicialization of health in Brazil: an evidence brief. / Estratégias para abordar a Judicialização da Saúde no Brasil: uma síntese de evidências.

This article seeks to identify and discuss evidence-informed options to address the judicialization of health. The Supporting Policy Relevant Reviews and Trials Tools were used to define the problem and the search strategy, which was carried out in the following databases: PubMed, Health Systems Evidence, Campbell, Cochrane Collaboration, Rx for Change Database, and PDQ-Evidence. Selection and assessment of methodological quality was performed by two independent reviewers. The results were presented in a narrative synthesis. This study selected 19 systematic reviews that pointed out four strategies to address the judicialization of health in Brazil: 1) Rapid response service, 2) Continuous education program, 3) Mediation service between the parties involved, and 4) Adoption of a computer-based, online decision-making support tool and patient-mediated interventions. This study therefore presented and characterized four options that can be considered to address the judicialization of health. The implementation of these options must ensure the participation of different actors, reflecting on different contexts and the impact on the health system. The availability of human and financial resources and the training of teams are critical points for the successful implementation of the options.

A fim de identificar e discutir opções informadas por evidências para abordar a judicialização da saúde no Brasil, utilizou-se as Ferramentas SUPPORT (Supporting Policy Relevant Reviews and Trials). A busca foi realizada nas bases PubMed; Health Systems Evidence; Campbell Collaboration; Cochrane Library; Rx for Change Database e PDQ-Evidence. A seleção e avaliação da qualidade metodológica foi feita por dois revisores independentes. Os resultados foram apresentados numa síntese narrativa. Dezenove revisões sistemáticas apontam quatro opções: 1) Serviço de respostas rápidas; 2) Programa de educação permanente; 3) Serviço de mediação entre as partes envolvidas; e 4) Adoção de ferramenta online (baseada em computador) de suporte à decisão e de intervenções mediadas por pacientes. Conclusões: Apresentamos e caracterizamos quatro opções que podem ser consideradas para abordar a judicialização da saúde. A implementação dessas opções deve garantir a participação de diferentes atores, refletindo sobre variados contextos. Recursos humanos e financeiros, capacitação das equipes, são os principais pontos críticos.

Impacto de la legalización del consumo recreativo del cannabis / Impact of the legalisation of recreational cannabis use

En los últimos años se han producido importantes cambios legislativos en numerosos países respecto al consumo de cannabis con fines medicinales y/o recreativos, que han facilitado su accesibilidad. Actualmente, Uruguay, Canadá y algunos estados de EE.UU. han legalizado el consumo recreativo, aplicando distintos modelos legislativos. El objetivo de la presente revisión es analizar los efectos que ha tenido la legalización del cannabis recreativo sobre su consumo y sus consecuencias. En general, las evidencias indican que la legalización se ha asociado a un descenso en el precio, mayor concentración de THC (potencia), mayor diversidad de presentaciones para su consumo, una menor percepción de riesgo y un incremento en el consumo en adultos y de forma moderada en adolescentes (aunque sea ilegal el consumo para ellos), así como un aumento de las consecuencias adversas derivadas del consumo en la salud pública. Se ha producido un descenso en los arrestos relacionados con el consumo, pero el mercado ilegal sigue utilizándose de forma habitual. No se ha detectado un incremento de la demanda de tratamiento por este consumo. Por el momento, estos cambios legislativos no han conseguido alcanzar sus objetivos principales que eran suprimir el mercado ilegal y proteger a los grupos más vulnerables, mientras que, por el contrario, parecen implicar un incremento de algunos aspectos negativos asociados al consumo de cannabis. Sin embargo, teniendo en cuenta que la mayoría de estos cambios legislativos han entrado en vigor hace relativamente poco tiempo, se requiere un periodo de seguimiento mayor para poder extraer conclusiones definitivas. (AU)

In recent years, there have been important legislative changes in many countries regarding the use of cannabis for medicinal and/or recreational purposes, which have facilitated access to it. Uruguay, Canada and some of the US states are the only jurisdictions that have legalised recreational consumption, applying different legislative models. The aim of this review is to analyse the effects that the legalisation of recreational cannabis has had on its use and its consequences. In general, the evidence accumulated to date indicates that the legalisation of cannabis has been associated with a decrease in the price of the substance, higher concentration of THC (potency), greater diversity of presentations for consumption, lower risk perception and an increase in consumption in adults and moderately in adolescents (even though it is illegal for them to consume), as well as an increase in the adverse consequences derived from cannabis consumption on public health. There has been a decrease in drug-related arrests, but the illegal market continues to be frequently used. No increase in the demand for treatment due to cannabis consumption has been detected. Therefore, these legislative changes have so far failed to achieve their main objectives, which were to suppress the illegal market and protect the most vulnerable groups, while on the contrary, they seem to imply an increase in some of the negative aspects associated with cannabis consumption. However, taking into account that most of these legislative changes have entered into force relatively recently, a longer follow-up period is required to be able to draw definitive conclusions. (AU)