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BMC Public Health ; 19(1): 1468, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694606


BACKGROUND: It has been suggested that poor health has influenced vote for Brexit and the US presidential election. No such research has been published regarding the 2017 French presidential election. METHODS: We performed a cross-sectional analysis using a comprehensive set of socioeconomic and health indicators, to be compared with voting outcome at the first round of the 2017 French presidential election. The 95 French departments were selected as the unit of analysis. Data were obtained from publicly available sources. The linear model was used for both univariate and multivariate analysis to investigate the relation between voting patterns and predictors. Sensitivity analyses were done using the elastic-net regularisation. RESULTS: Emmanuel Macron and Marine Le Pen arrived ahead. When projected on the first factorial plane (~ 60% of the total inertia), Emmanuel Macron and Marine Le Pen tended to be in opposite directions regarding both socioeconomic and health factors. In the respective multivariate analyses of the two candidates, both socio-economic and health variables were significantly associated with voting patterns, with wealthier and healthier departments more likely to vote for Emmanuel Macron, and opposite departments more likely to vote for Marine Le Pen. Mortality (p = 0.03), severe chronic conditions (p = 0.014), and diabetes mellitus (p < 0.0001) were among the strongest predictors of voting pattern for Marine Le Pen. Sensitivity analyses did not substantially change those findings. CONCLUSIONS: We found that areas associated with poorer health status were significantly more likely to vote for the far-right candidate at the French presidential election, even after adjustment on socioeconomic criteria.

Doença Crônica/psicologia , Governo Federal/história , Indicadores Básicos de Saúde , Nível de Saúde , Política , Adulto , Estudos Transversais , Feminino , França , História do Século XXI , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Adulto Jovem
Med J Aust ; 211(11): 490-491.e21, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31722443


The MJA-Lancet Countdown on health and climate change was established in 2017 and produced its first Australian national assessment in 2018. It examined 41 indicators across five broad domains: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. It found that, overall, Australia is vulnerable to the impacts of climate change on health, and that policy inaction in this regard threatens Australian lives. In this report we present the 2019 update. We track progress on health and climate change in Australia across the same five broad domains and many of the same indicators as in 2018. A number of new indicators are introduced this year, including one focused on wildfire exposure, and another on engagement in health and climate change in the corporate sector. Several of the previously reported indicators are not included this year, either due to their discontinuation by the parent project, the Lancet Countdown, or because insufficient new data were available for us to meaningfully provide an update to the indicator. In a year marked by an Australian federal election in which climate change featured prominently, we find mixed progress on health and climate change in this country. There has been progress in renewable energy generation, including substantial employment increases in this sector. There has also been some progress at state and local government level. However, there continues to be no engagement on health and climate change in the Australian federal Parliament, and Australia performs poorly across many of the indicators in comparison to other developed countries; for example, it is one of the world's largest net exporters of coal and its electricity generation from low carbon sources is low. We also find significantly increasing exposure of Australians to heatwaves and, in most states and territories, continuing elevated suicide rates at higher temperatures. We conclude that Australia remains at significant risk of declines in health due to climate change, and that substantial and sustained national action is urgently required in order to prevent this.

Mudança Climática , Política Ambiental , Planejamento em Saúde , Política de Saúde , Saúde , Austrália , Economia , Exposição Ambiental , Governo Federal , Financiamento da Assistência à Saúde , Humanos , Governo Local , Mosquitos Vetores , Política , Energia Renovável , Governo Estadual , Incêndios Florestais
Am J Law Med ; 45(2-3): 130-170, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31722626


In many areas of innovation, the United States is a leader, but this characterization does not apply to the United States' position in assisted reproductive technology innovation and clinical use. This article uses a political science concept, the idea of the "democratic deficit" to examine the lack of American public discourse on innovations in ART. In doing so, the article focuses on America's missing public consultation in health care innovation. This missing discourse is significant, as political and ethical considerations may impact regulatory decisions. Thus, to the extent that these considerations are influencing the decisions of federal agency employees, namely those who work within the U.S. Food and Drug Administration, the public is unable to participate in the decision-making process. This lack of a public discourse undermines the goals of the administrative state, which include democratic participation, transparency, and accountability. The United Kingdom, on the other hand, has had a markedly divergent experience with assisted reproductive technology innovation. Instead of ignoring the various ethical, social, and legal issues surrounding assisted reproductive technology innovation, the United Kingdom engaged in a five-strand public consultation on the topic of mitochondrial transfer, a form of assisted reproductive technology that uses genetic modification in order to prevent disease transmission. This article argues that after a multi-decade standstill in terms of the public discourse related to ethical issues associated with assisted reproductive technology and germline modification, it is time for the United States to institute a more democratic inquiry into the scientific, ethical, and social implications of new forms of assisted reproductive technology and ultimately, forthcoming medical innovations that involve genetic modification.

Democracia , Invenções/legislação & jurisprudência , Formulação de Políticas , Técnicas de Reprodução Assistida/legislação & jurisprudência , Participação da Comunidade , Governo Federal , Fertilização In Vitro/ética , Fertilização In Vitro/legislação & jurisprudência , Política de Saúde/legislação & jurisprudência , Humanos , Invenções/ética , Técnicas de Reprodução Assistida/ética , Responsabilidade Social , Participação dos Interessados , Governo Estadual , Inquéritos e Questionários , Reino Unido , Estados Unidos , United States Food and Drug Administration/legislação & jurisprudência
Am J Law Med ; 45(2-3): 106-129, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31722633


Beginning on inauguration day, President Trump has attempted an executive repeal of the Affordable Care Act. In doing so, he has tested the limits of presidential power. He has challenged the force of institutional and non-institutional constraints. And, ironically, he has helped boost public support for the ACA's central features. The first two sections of this article respectively consider the use of the President's tools to advance and to subvert health reform. The final two sections consider the forces constraining the administration's attempted executive repeal. I argue that the most important institutional constraint, thus far, is found in multifaceted actions by states - and not only blue states. I also highlight the force of public voices. Personal stories, public opinion, and 2018 election results - bolstered by presidential messaging - reflect growing support for government-grounded options and statutory coverage protections. Indeed, in a polarized time, "refine and revise" seems poised to supplant "repeal and replace" as the conservative focus countering liberal pressure for a common option grounded in Medicare.

Pessoal Administrativo , Reforma dos Serviços de Saúde/legislação & jurisprudência , Patient Protection and Affordable Care Act/legislação & jurisprudência , Política , Governo Federal , Financiamento Governamental/legislação & jurisprudência , Financiamento Governamental/organização & administração , Regulamentação Governamental , Reforma dos Serviços de Saúde/história , História do Século XX , História do Século XXI , Humanos , Reembolso de Seguro de Saúde/legislação & jurisprudência , Jurisprudência , Medicaid/legislação & jurisprudência , Medicaid/organização & administração , Medicare/legislação & jurisprudência , Medicare/organização & administração , Patient Protection and Affordable Care Act/organização & administração , Cobertura de Condição Pré-Existente , Opinião Pública , Governo Estadual , Estados Unidos
J Leg Med ; 39(2): 177-211, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31503531


The federal government subsidizes the research and development of prescription medications. Thus, a captivating critique of expensive medications is that prices are too high because of taxpayer co-financing. This critique is often framed in terms of "paying-twice"-first for the research and second through the above market pricing of resulting products. Reasonable pricing clauses-which place some kind of pricing limitation on the exercise of license or patent rights governing a federally funded medication-are one proposed policy tool for addressing the pay-twice critique. This article provides increased analytical clarity as well as historical context to present-day debates about the privatization of federally funded research and prescription drug pricing. It makes three arguments. First, despite its pervasiveness and intuitive plausibility, the pay-twice critique is subject to differing interpretations which has important implications for the appropriateness of proposed solutions. Second, despite their initial attractiveness, the costs, necessity, and effectiveness of reasonable pricing clauses render the wisdom of this policy tool uncertain. However, third, given continued interest in reasonable pricing clauses, the NIH's previous experience with such a policy offers some useful lessons.

Custos de Medicamentos/legislação & jurisprudência , Controle de Medicamentos e Entorpecentes/economia , Controle de Medicamentos e Entorpecentes/legislação & jurisprudência , Legislação de Medicamentos/economia , Medicamentos sob Prescrição/economia , Honorários por Prescrição de Medicamentos/legislação & jurisprudência , Custos e Análise de Custo/economia , Custos e Análise de Custo/legislação & jurisprudência , Governo Federal , Financiamento Governamental , National Institutes of Health (U.S.) , Pesquisa Farmacêutica/economia , Pesquisa Farmacêutica/legislação & jurisprudência , Privatização/economia , Privatização/legislação & jurisprudência , Estados Unidos
Licere (Online) ; 22(3): 537-578, set.2019. ilus
Artigo em Português | LILACS | ID: biblio-1046738


O estudo teve como pano de fundo as políticas públicas destinadas à garantia do esporte e do lazer como direitos sociais. Seu objeto de análise girou em torno da descentralização da gestão pública, por meio da institucionalização local das políticas de esporte e lazer. Sob esse prisma, o objetivo da pesquisa foi identificar as concepções teóricas, no campo das políticas públicas, relacionadas à descentralização como estratégia de ação governamental nas áreas do esporte e do lazer. Para isso, foi desenvolvida uma pesquisa bibliográfica, que sinalizou a presença de relações diretas entre descentralização e municipalização, sobretudo no que tange aos mecanismos que legitimam e institucionalizam as ações públicas.

The study had as background public policies aimed at guaranteeing sports and leisure as social rights. Its object of analysis revolved around the decentralization of public management, through the local institutionalization of sports and leisure policies. In this perspective, the objective of the research was to identify the theoretical conceptions, in the field of public policies, related to the decentralization as strategy of governmental action in the areas of sport and leisure. For this, a bibliographical research was developed, which signaled the presence of direct relations between decentralization and municipalization, especially about mechanisms that legitimize and institutionalize public actions.

Humanos , Adulto , Política Pública , Esportes , Administração Municipal , Governo Federal , Direitos Socioeconômicos , Institucionalização