On shaping expectations of "new normals" for living in a post-COVID-19 world.

I begin with my impressions of a narrative of redemption that is caught up in the formation of new environmental, social, and political aspirations for the aftermath of the COVID-19 pandemic. I then reflect on, first, pre-pandemic scholarship on "biosecurity" and, second, taking up a variation of the syndemic approach to understanding the COVID-19 pandemic. I end by arguing that we should not expect to live with "new normals" for living in a post-COVID-19 world that leaves intact "old normals" that have historically contributed to the rise of anthropogenic environmental harms and inegalitarian social arrangements in the world today.

Development of a national conceptual framework and measuring tool for Organisational Social Responsibility and Accountability for Health (OSRAH).

Organisations can have a significant impact (positive or negative) on society through their actions and decisions. Given this reality, it is important that they are held responsible and accountable for the consequences of their actions. This concept is often referred to as 'social responsibility'. However, 'social responsibility', as currently conceived in the literature, neglects a specific focus on health as a social goal. Additionally, there are no practical tools to capture this concept in a holistic way to facilitate implementation and monitoring of organisational improvement. This paper reports on the process of developing a more holistic conceptual framework and tool for assessing organisational social responsibility and accountability for health (OSRAH). We conducted a review of the published and grey literature and engaged in expert consultation and focus group discussions. The initial OSRAH framework and the self-assessment tool were finalised for implementation and used by 95 organisations at a national event in Iran in February 2017. The results of the assessment data collected at the event showed organisations scored lowest in the domain of community health and highest in the domain of employee health. The OSRAH framework and assessment tool represents a new understanding of health and its determinants in organisations outside the health sector. It integrates health within the existing Corporate Social Responsibility (CSR) culture of organisations. The process of creating the tool and implementing it at the national festival of OSRAH in Iran created momentum for intersectoral action. This experience can inspire researchers and practitioners in other countries, especially in developing countries, to develop their own local definition and practical assessment framework for responsibility and accountability.

Humanismo, sociedad y medicina / Humanism, society and medicine

El humanismo de los tiempos antiguos estaba asociado a la religión cristiana. Filosóficamente hay cuatro humanismos: 1) racionalista, 2) existencialista, 3) marxista, 4) cristiano. Concepto de la "vida buena" basado en la racionalidad, la autonomía, el afecto y la ética hacia los otros seres humanos. Humanismo y evolución. Humanismo, ciencia y medicina en relación al desarrollo de la ciencia y la tecnología. Humanismo de la medicina cotidiana.

The humanism was associated, at the early times, with the Christian religion. Philosophically there are four humanisms: 1) rationalistic, 2) existentialistic, 3) Marxist and 4) Christian. Concept of "good life" based in rationality, fellowship, and ethics to the other human beings. Humanism and evolution. Humanism, science and medicine in relation to the scientific and technological development. Humanism and daily medicine.

Capabilities and the Definition of Health: Comments on Venkatapuram.

Sridhar Venkatapuram's Health Justice argues that health is a 'metacapability' - specifically, as the metacapability of having the ten 'central human capabilities' described by Martha Nussbaum. This cannot be right, as it provides no basis for distinguishing health from education, riches, or love. An amendment correcting this problem is suggested, namely that health is the involuntary, bodily aspect of the metacapability for the central capabilities. This amendment is defended against the objection that it fails to capture some important aspects of mental health.

Capabilities and Incapabilities of the Capabilities Approach to Health Justice.

This first part of this article critiques Sridhar Venkatapuram's conception of health as a capability. It argues that Venkatapuram relies on the problematic concept of dignity, implies that those who are unhealthy lack lives worthy of dignity (which seems politically incorrect), sets a low bar for health, appeals to metaphysically problematic thresholds, fails to draw clear connections between appealed-to capabilities and health, and downplays the importance/relevance of health functioning. It concludes by questioning whether justice entitlements should pertain to the capability for health versus health achievements, challenging Venkatapuram's claims about the strength of health entitlements, and demonstrating that the capabilities approach is unnecessary to address social determinants of health.

Normality, therapy, and enhancement.

According to human enhancement advocates, it is morally permissible (and sometimes obligatory) to use biomedical means to modulate or select certain biological traits in order to increase people's welfare, even when there is no pathology to be treated or prevented. Some authors have recently proposed to extend the use of biomedical means to modulate lust, attraction, and attachment. I focus on some conceptual implications of this proposal, particularly with regard to bioconservatives' understanding of the notions of therapy and enhancement I first explain what makes the proposal of medicalizing love interesting and unique, compared to the other forms of bioenhancement usually advocated. I then discuss how the medicalization of love bears on the more general debate on human enhancement, particularly with regard to the key notion of "normality" that is commonly used to define the therapy-enhancement distinction. This analysis suggests that the medicalization of love, in virtue of its peculiarity, requires bioconservatives to reconsider their way of understanding and applying the notions of "therapy" and "enhancement." More in particular, I show that, because a non-arbitrary and value-free notion of "therapy" cannot be applied to the case of love, bioconservatives have the burden of either providing some new criterion that could be used for drawing a line between permissible and impermissible medicalization, or demonstrating that under no circumstances-including the cases in which love is already acknowledged to require medical intervention-can love fall within the domain of medicine.

Gestos de formação: experiências de integração ensino-serviço em saúde + arte literária / Gestures of training: experiences of service-learning health + literary art

Este trabalho, fruto de uma iniciativa de mestrado profissional, combinou pesquisa científica com arte literária, especialmente com o romance Ensaio Sobre a Cegueira, de José Saramago. O objetivo desta pesquisa: elaborar um ensaio baseado em um processo de argumentação para pensar a minha formação em saúde a partir de diferentes experiências. Para desenvolvê-lo, uso o seguinte argumento: as minhas experiências no Programa de Educação pelo Trabalho para a Saúde (PET-Saúde) são um diferencial na minha formação em Educação Física. Para demonstrar a validade desse argumento, levantei premissas e discorri sobre elas a fim de concluir esse processo de argumentação. São elas: (1) diversificação do cenário de ensino-aprendizagem; (2) aproximação de

estudantes com o ambiente de trabalho; (3) vivência interprofissional com vistas ao exercício da integralidade; (4) abertura para outros modos de pensar o corpo na formação em Educação Física. A propósito das experiências dos participantes da pesquisa, foi feito um encontro no qual conduzi duas atividades: narrativas individuais escritas e roda de conversa nos moldes de um grupo focal. Como resultado, apresento experiências de integração ensino-serviço de estudantes de Educação Física na atenção primária/atenção básica em saúde a partir do PET-Saúde no Projeto da USP-Capital, versão de 2010-2012. A partir delas, destacamos que houve mudanças nos modos de pensar e de operar as práticas de saúde, além de transformar o profissional a ponto de ele se interessar e defender o SUS como espaço de trabalho. É interessante enfatizar que as experiências produziram o que denomino gestos, movimentos que poderão inspirar ou instigar estudantes e profissionais da saúde na reflexão a respeito da formação.

This work results of a professional master's initiative and combined scientific research with literary art, especially the novel Blindness, by José Saramago. The objective of this research: developing a essay based on a argumentation process to think about my health trainig from different experiences. To develop it, using the following argument: my experiences in the Programa de Educação pelo Trabalho para a Saúde (PET-Saúde) are an difference in my Physical Education training. To demonstrate the validity of this argument, I raised premises and I discussed about them in order to complete this process of argument. They are: (1) diversification of service-learning scenario; (2) students approach with the work environment; (3) interprofessional experience with a view to the exercise of integrality; (4) openness to other ways of thinking the body in Physical Education training. The purpose of the experiences of research participants,

was made a meeting with two activities: written individual narratives and conversation circle like a focus group. As a result, presents experiences of service-learning of Physical Education students in primary care / primary health care from the PET-Saúde Project in the USP-Capital, version 2010-2012. From these, we point out that there have been changes in ways of thinking and operating health practices, beyond transform the professional at way of make him interested in defends the SUS as workspace. It is interesting to emphasize that the experiences have produced what I call gestures, movements that may inspire or instigate students and health professionals in reflection about the training.

Uso racional de medicamentos por agentes comunitarios en atención primaria de salud en los ambulatorios rurales del municipio Atures, estado Amazonas, Venezuela, año 2011 / Rational drug use by community workers in primary health care in the rural clinics of the municipality Atures, Amazonas State (Venezuela), year 2011

Venezuela cuenta con los auxiliares de medicina simplificada (AMS) y los agentes comunitarios para la atención primaria en salud (ACAPS), personal no profesional, capacitado para el diagnóstico y tratamiento de enfermedades frecuentes; brindando atención en áreas de difícil acceso y en zonas rurales dispersas. En este trabajo se describió el uso racional de medicamentos por el AMS/ACAPS en los ambulatorios rurales (AR) del municipio Atures, estado Amazonas, Venezuela, en el 2011. Para ello, se realizó un estudio no experimental, de campo, descriptivo, de corte transversal; utilizando los indicadores básicos del uso de medicamentos de la OMS. Se evaluaron 12 de los 16 AR tipo I y el AR tipo II del municipio; registrándose 830 consultas y 1.238 prescripciones de medicamentos durante el segundo trimestre del 2011. El AMS/ACAPS prescribió 1,51 medicamentos por consulta. Del total de las prescripciones, 86,92% se hicieron con su nombre genérico, 11,26% como un medicamento inyectable, 23,88% fueron un antibiótico y solo el 52,51% de las prescripciones estuvieron acordes al primer nivel de atención. De los 13 AR visitados, nueve tenían la lista de medicamentos, cuatro el formulario terapéutico nacional y ocho contaron con otra fuente de información (guías de formación del AMS o ACAPS). La disponibilidad de medicamentos clave tuvo un promedio crítico de 48,72%. La prescripción de medicamentos por el AMS/ACAPS resulta inadecuada debido a que se utiliza una lista de medicamentos que no es acorde para el primer nivel de atención.

Venezuela has simplified medical assistants (AMS) and non-professional community workers for primary health care (ACAPS), trained in the diagnosis and treatment of common diseases; providing care in inaccessible and remote rural areas. In this paper the rational use of drugs by the AMS/ACAPS in rural clinics (AR) of the municipality Atures, Amazonas state (Venezuela) in 2011, was described. For this, a descriptive, non-experimental, field and cross sectional study took place; using the WHO basic indicators of drug use. We evaluated 12 of the 16 type I ARs and the type II AR in the municipality; recording 830 consultations and 1,238 drug prescriptions during the second quarter of 2011. The AMS/ACAPS prescribed 1.51 drugs per consultation. Of all prescriptions, 86.92% were by generic names, 11.26% as an injectable drug, 23.88% were an antibiotic and only 52.51% were in accordance to the primary care level. Of the 13 ARs visited, 9 had the drug list, 4 the national therapeutic formulary and 8 had another source of information (AMS or ACAPS training guides). The availability of key drugs had a critical average of 48.72%. The prescription of drugs by the AMS/ACAPS is inadequate because a list of drugs, which is not according to the first level of care, is used.

Health as normal function: a weak link in Daniels's theory of just health distribution.

Drawing on Christopher Boorse's Biostatistical Theory (BST), Norman Daniels contends that a genuine health need is one which is necessary to restore normal functioning - a supposedly objective notion which he believes can be read from the natural world without reference to potentially controversial normative categories. But despite his claims to the contrary, this conception of health harbors arbitrary evaluative judgments which make room for intractable disagreement as to which conditions should count as genuine health needs and therefore which needs should be met. I begin by offering a brief summary of Boorse's BST, the theory to which Daniels appeals for providing the conception of health as normal functioning upon which his overall distributive scheme rests. Next, I consider what I call practical objections to Daniels's use of Boorse's theory. Finally I recount Elseljin Kingma's theoretical objection to Boorse's BST and discuss its impact on Daniels's overall theory. Though I conclude that Boorse's view, so weakened, will no longer be able to sustain the judgments which Daniels's theory uses it to reach, in the end, I offer Daniels an olive branch by briefly sketching an alternative strategy for reaching suitably objective conclusions regarding the health and/or disease status of various conditions.

Health as a property of engineered living systems.

This article considers naturalistic analyses of the concepts of health and disease in light of the possibility of constructing novel living systems. The article begins by introducing the vision of synthetic biology as the application of engineering principles to the construction of biological systems, the main analyses of the concepts of health and disease, and the standard theories of function in artefacts and organisms. The article then suggests that reflection on the possibility of artefactual organisms amounts to a challenge to the functional theories of health and disease proposed by Wakefield and Boorse. More specifically, Wakefield and Boorse's theories are reconstructed as responses to a dilemma concerning how to allow for the ascription of health and disease to artefactual organisms without at the same time opening up the possibility of diseased nonliving artefacts such as cars and computers. It is argued that neither response will enable us to ascribe health and disease to artefactual organisms, because both theories, in order to rule out the possibility of ascribing health and disease to nonliving artefacts, make such ascriptions conditional on having a natural-selection history or being part of a species which has been designed by evolution.

The state of the research for health environment in the ministries of health of the Economic Community of the West African States (ECOWAS).

BACKGROUND: An assessment of the state of the Research for Health (R4H) environment can provide relevant information about what aspects of national health research systems needs strengthening, so that research output can be relevant to meet national priorities for decision-making. There is limited information on the state of the R4H environment in the Economic Community of West African States (ECOWAS). This article describes the state of the R4H environment within the Ministries of Health of the ECOWAS member states and outlines of some possibilities to strengthen health research activities within the ECOWAS region. METHODS: Information on the national-level R4H environment (governance and management; existence of a national policy; strategic and research priorities documents; ethics committees; research funds; coordination structures; monitoring and evaluation systems; networking and capacity building opportunities) was collected from the Ministries of Health research units in 14 ECOWAS countries using self-administered questionnaires. A workshop was held where country report presentations and group discussions were used to review and validate responses. Data from the discussions was transcribed using Nvivo, and strengths, weaknesses, opportunities and threats (SWOT) analysis of the functioning of the units was done using Robert Preziosi's organisational diagnosis tool. RESULTS: The findings indicate that as of January 2011, 50% of ECOWAS countries had established directorates for health research with defined terms of reference. The existing funding mechanisms were inadequate to support the research structures within and outside the MoHs, and for building the capacity of researchers. Networking and monitoring activities were weak and only 7% of the directors of research units were trained in research management. The majority (85.7%) of countries had broader national health policies, and 57% of the countries had some form of policy or strategic document for research development. Half of the countries had developed national research priorities. CONCLUSIONS: These results call for urgent action to improve the research environment in the Ministries of Health in the West African sub-region.

Health as a basic human need: would this be enough?

Although the value of health is universally agreed upon, its definition is not. Both the WHO and the UN define health in terms of well-being. They advocate a globally shared responsibility that all of us - states, international organizations, pharmaceutical corporations, civil society, and individuals - bear for the health (that is, the well-being) of the world's population. In this paper I argue that this current well-being conception of health is troublesome. Its problem resides precisely in the fact that the well-being conception of health, as an all-encompassing label, does not properly distinguish between the different realities of health and the different demands of justice, which arise in each case. In addressing responsibilities related to the right to health, we need to work with a more differentiated vocabulary, which can account for these different realities. A crucial distinction to bear in mind, for the purposes of moral deliberation and the crafting of political and legal institutions, is the difference between basic and non-basic health needs. This distinction is crucial because we have presumably more stringent obligations and rights in relation to human needs that are basic, as they justify stronger moral claims, than those grounded on non-basic human needs. It is important to keep this moral distinction in mind because many of the world's problems regarding the right to health relate to basic health needs. By conflating these needs with less essential ones, we risk confusing different types of moral claims and weakening the overall case for establishing duties regarding the right to health. There is, therefore, a practical need to reevaluate the current normative conception of health so that it distinguishes, within the broad scope of well-being, between what is basic and what is not. My aim here is to shed light onto this distinction and to show the need for this differentiation. I do so, first, by providing, on the basis of David Miller's concept of basic needs, an account of basic health needs and, secondly, by mounting a defense of the basic needs approach to the right to health, arguing against James Griffin who opposes the basic needs approach.

[Health of immigrant population of consultants at the Baudelaire outpatient clinic in Saint-Antoine hospital in Paris, France]. / La santé des migrants consultant la policlinique Baudelaire de l'hôpital Saint-Antoine à Paris, France.

Social and health data on the immigrant population remain scarce in France, especially concerning those in irregular situation. The Baudelaire outpatient clinic in Saint- Antoine hospital in Paris (PASS, i.e. specific free medicosocial care for the poor, the uninsured or the undocumented patients) treats a majority of immigrants, a lot of them being in an irregular residence status. The objectives of this study were to describe the social and health status of the immigrant consultants, to compare regular and undocumented migrants and to describe their main reasons for migration. A cross-sectional, descriptive, survey among the immigrant consultants has been performed among this outpatient clinic in April and May 2009. In total, 536 patients were included. Their age mean was 45 years, 62% are male, 49% are in an irregular situation and they have been in France for 12 years in average (19 years for the regular immigrants and 5 years for the undocumented). More than 20% had no health insurance. A majority (55%) of patients were suffering from a chronic disease. The more frequent ones were hypertension (20%), type 2 diabetes (11.6%), chronic infectious diseases - HIV, HBV, HCV - (7%). Reasons for immigration were mostly economical (39%), family (19%) and political (17%). Health reasons were at the 4th rank and concerned 9% of the patients. The main chronic diseases observed among this population are similar to those of the general population of consultants in primary health care, except for the chronic infectious diseases, which are more frequent. Immigration for health reasons represents only a small proportion of all immigration reasons. For this population, free clinics like the one investigated here constitute unique, irreplaceable, access points in the French healthcare system.

[Ethics, equity and social determinants of health]. / Ética, equidad y determinantes sociales de la salud.

The evidence shown by studies on the social determinants of health has changed the relationship between ethics and medicine. The evidence shown by studies on the social determinants of health has changed the relationship between ethics and medicine, and between a normative and a descriptive approach. Studies on the social determinants of health have also modified the traditional concept of equity, necessary health policies and the future of bioethics. More specifically: 1) the boundary between medicine and ethics has become much fuzzier, especially in the field of epidemiology, whose objectives are now inseparable from ethical considerations; 2) the concept of health equity traditionally defined as access to healthcare should be corrected or expanded to incorporate unfair health inequalities that occur before patients reach the healthcare system; and 3) the traditional autonomy bias of bioethics should be replaced by a primary concern for social justice and its relationship with health.