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2.
J Infect Dev Ctries ; 14(9): 968-970, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-33031082

RESUMO

The COVID-19 pandemic has created new challenges on multiple fronts including a few ethical concerns. Timely and appropriate access to health services and the need to protect vulnerable people are some of them. An important aspect to consider, at the global level, is the frailty of health systems in many developing countries and the constant threat of these collapsing due to shortage of resources and medical supply. Special attention should be placed towards protecting the health of care workers who are highly exposed to SARS-CoV-2 infection. Research and clinical trials involving COVID-19 patients and healthy human volunteers must be done in strict adherence to the fundamental principles of bioethics, even if finding a solution is an urgent need. Shared responsibility must be assumed as we collectively face a common problem and ethical conflicts must be resolved using, as reference, the guidelines developed by the World Health Organization and other relevant international and national organizations. This would allow responsible action in the face of the pandemic without harming human rights, the individual and collective well-being.


Assuntos
Betacoronavirus , Saúde Global/ética , Pandemias/ética , Ensaios Clínicos como Assunto/ética , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Países em Desenvolvimento , Pessoal de Saúde/ética , Disparidades em Assistência à Saúde/ética , Direitos Humanos/ética , Humanos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Triagem/ética
3.
Ann Glob Health ; 86(1): 114, 2020 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-32944511

RESUMO

Solidarity in the general sense means unity or agreement of feeling or action, especially among individuals with a common interest; or mutual support within a group. There are different ways of standing in solidarity in different kinds of literatures. One of the most important ways is to advocate. Advocacy is a win-win strategy and a process of supporting and enabling people to express their views and concerns. In the end, I think sharing different types of solidarity can be one of the drivers that stimulate the solidarity itself, and I call on everyone to contribute to this sharing. I hope that this solidarity, which began in the world with the beginning of COVID-19, will not end with its end and will last forever because our world needs coexistence. This may be the only gift to the world from COVID-19.


Assuntos
Infecções por Coronavirus , Saúde Global , Cooperação Internacional , Pandemias , Pneumonia Viral , Justiça Social , Betacoronavirus , Comportamento Cooperativo , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Saúde Global/ética , Saúde Global/tendências , Humanos , Pandemias/ética , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Justiça Social/ética , Justiça Social/tendências , Responsabilidade Social
4.
OMICS ; 24(11): 645-648, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32986539

RESUMO

Health futures are not preordained, nor are they entirely predictable by extrapolation from the past. This is particularly relevant in an era of unprecedented uncertainties converging from the COVID-19 pandemic, multiple zoonotic outbreaks for the past two decades, and the climate crisis currently unfolding. Moreover, the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services cautioned in 2019 that around one million animal and plant species are threatened with extinction. Human existence and medical innovations are closely intertwined with preservation and sustainability of biodiversity. COVID-19 is a "dry run" for future ecological crises in the 21st century. We need new frames and ways of conceptualizing planetary health, biodiversity futures, and their principled governance post-COVID-19. In this article, I propose "One Nature" as a critically informed planetary health governance frame, and outline its key conceptual pillars. One Nature aims to transcend the socially constructed binaries between humans versus nature, humans versus nonhuman animals or inanimate objects in nature, among other false binaries, and thus, envisions nature as an overlapping, interdependent, and co-constitutive continuum among life forms and ecosystems. One Nature also recognizes animal sentience and agency of nonhuman animals. In doing so, the One Nature governance frame places a firm emphasis on the internal levers of social change and the human values essential to cultivate collective action to curb unchecked extraction of nature that placed human societies in harm's way for future health crises. One Nature is a governance frame and reflexive value system that can be transformative to correct the astigmatism we have long suffered, from the ways in which we have conceived, enacted on, and extracted the natural systems over the centuries. All in all, One Nature supports planetary health and biodiversity through a new vocabulary and post-anthropocentric critical governance lens, and shall help formulate progressive policies to prevent zoonotic outbreaks and future ecological crises.


Assuntos
Infecções por Coronavirus/epidemiologia , Assistência à Saúde/tendências , Saúde Global/tendências , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Telemedicina/tendências , Zoonoses/prevenção & controle , Animais , Betacoronavirus/patogenicidade , Biodiversidade , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Ecossistema , Saúde Global/ética , Humanos , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Política , Justiça Social/tendências , Teoria Social , Terminologia como Assunto
10.
Glob Health Action ; 13(sup1): 1694744, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32194010

RESUMO

Background: As called for by the Sustainable Development Goals, governments, development partners and civil society are working on anti-corruption, transparency and accountability approaches to control corruption and advance Universal Health Coverage.Objectives: The objective of this review is to summarize concepts, frameworks, and approaches used to identify corruption risks and consequences of corruption on health systems and outcomes. We also inventory interventions to fight corruption and increase transparency and accountability.Methods: We performed a critical review based on a systematic search of literature in PubMed and Web of Science and reviewed background papers and presentations from two international technical meetings on the topic of anti-corruption and health. We identified concepts, frameworks and approaches and summarized updated evidence of types and causes corruption in the health sector.Results: Corruption, or the abuse of power for private gain, in health systems includes bribes and kickbacks, embezzlement, fraud, political influence/nepotism and informal payments, among other behaviors. Drivers of corruption include individual and systems level factors such as financial pressures, poorly managed conflicts of interest, and weak regulatory and enforcement systems. We identify six typologies and frameworks that model relationships influencing the scope and seriousness of corruption, and show how anti-corruption strategies such as transparency, accountability, and civic participation can affect corruption risk. Little research exists on the effectiveness of anti-corruption measures; however, interventions such as community monitoring and insurance fraud control programs show promise.Conclusions: Corruption undermines the capacity of health systems to contribute to better health, economic growth and development. Interventions and resources on prevention and control of corruption are essential components of health system strengthening for Universal Health Coverage.


Assuntos
Fraude/ética , Fraude/prevenção & controle , Saúde Global/ética , Programas Governamentais/ética , Responsabilidade Social , Cobertura Universal do Seguro de Saúde/ética , Cobertura Universal do Seguro de Saúde/organização & administração , Fraude/estatística & dados numéricos , Saúde Global/estatística & dados numéricos , Programas Governamentais/organização & administração , Programas Governamentais/estatística & dados numéricos , Humanos , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos
11.
Glob Health Action ; 13(sup1): 1701327, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32194013

RESUMO

Policy-makers, implementing organizations, and funders of global health programs aim to improve health care services and health outcomes through specific projects or systemic change. To mitigate the risk of corruption and its harmful effects on those initiatives, health programs often use multiple anti-corruption mechanisms, including codes of conduct, documentation and reporting requirements, and trainings. Unfortunately, the introduction of anti-corruption mechanisms tends to occur without an explicit consideration of how each mechanism will affect health services and health outcomes. This may overlook potentially more effective approaches. In addition, it may result in the introduction of too many controls (thereby stymying service delivery) and a focus on financial or procurement-related issues (at the expense of service delivery objectives). We argue that anti-corruption efforts in health programs can be more effective if they prioritize addressing issues according to their likelihood and level of harm to key program objectives. Recalibrating the anti-corruption formula in this way will require: (i) extending responsibility and ownership over anti-corruption from subject experts to public health and health system specialists, and (ii) enabling those specialists to apply the Fraud Risk Assessment methodology to develop tailored anti-corruption mechanisms. We fill a documented gap in guidance on how to develop anti-corruption mechanisms by walking through the seven analytical steps of the Fraud Risk Assessment methodology as applicable to health programs. We then outline best practices for any anti-corruption mechanism, including a focus on quality health delivery; the alignment of actors' incentives around the advancement of health objectives; and being minimally corruptible by design.


Assuntos
Assistência à Saúde/ética , Assistência à Saúde/organização & administração , Fraude/ética , Fraude/prevenção & controle , Saúde Global/ética , Saúde Pública/ética , Responsabilidade Social , Humanos
12.
Glob Health Action ; 13(sup1): 1695241, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32194014

RESUMO

Background: Pharmaceutical corruption is a serious challenge in global health. Digital technologies that can detect and prevent fraud and corruption are particularly important to address barriers to access to medicines, such as medicines availability and affordability, stockouts, shortages, diversion, and infiltration of substandard and falsified medicines.Objectives: To better understand how digital technologies are used to combat corruption, increase transparency, and detect fraud in pharmaceutical procurement systems to improve population health outcomes.Methods: We conducted a multidisciplinary review of the health/medicine, engineering, and computer science literature. Our search queries included keywords associated with medicines procurement and digital technology in combination with terms associated with transparency and anti-corruption initiatives. Our definition of 'digital technology' focused on Internet-based communications, including online portals and management systems, supply chain tools, and electronic databases.Results: We extracted 37 articles for in-depth review based on our inclusion criteria focused on the utilization of digital technology to improve medicines procurement. The vast majority of articles focused on electronic data transfer and/or e-procurement systems with fewer articles discussing emerging technologies such as machine learning and blockchain distributed ledger solutions. In the context of e-procurement, slow adoption, justifying cost-savings, and need for technical standards setting were identified as key challenges for current and future utilization.Conclusions: Though there is a significant promise for digital technologies, particularly e-procurement, overall adoption of solutions that can enhance transparency, accountability and concomitantly combat corruption, is still underdeveloped. Future efforts should focus on tying cost-saving measurements with anti-corruption indicators, prioritizing centralization of e-procurement systems, establishing regulatory harmonization with standards setting, and incorporating additional anti-corruption technologies into procurement processes for improving access to medicines and to reach the overall goal of Universal Health Coverage.


Assuntos
Fraude/prevenção & controle , Saúde Global/ética , Invenções , Preparações Farmacêuticas/economia , Preparações Farmacêuticas/provisão & distribução , Cobertura Universal do Seguro de Saúde/ética , Cobertura Universal do Seguro de Saúde/organização & administração , Humanos , Estudos Interdisciplinares , Responsabilidade Social
14.
Acad Med ; 95(1): 37-43, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31436624

RESUMO

As interest in global health education continues to increase, residency programs seeking to accommodate learners' expectations for global health learning opportunities often face challenges providing high-quality global health training. To address these challenges, some residency programs collaborate across medical specialties to create interdisciplinary global health residency tracks or collaborative interdisciplinary global health tracks (CIGHTs). In this Perspective, the authors highlight the unique aspects of interdisciplinary tracks that may benefit residency programs by describing 3 established U.S.-based programs as models: those at Indiana University, Mount Sinai Hospital, and the University of Virginia. Through collaboration and economies of scale, CIGHTs are able to address some of the primary challenges inherent to traditional global health tracks: lack of institutional faculty support and resources, the need to develop a global health curriculum, a paucity of safe and mentored international rotations, and inconsistent resident interest. Additionally, most published global health learning objectives and competencies (e.g., ethics of global health work, predeparture training) are not discipline specific and can therefore be addressed across departments-which, in turn, adds to the feasibility of CIGHTs. Beyond simply sharing the administrative burden, however, the interdisciplinary learning central to CIGHTs provides opportunities for trainees to gain new perspectives in approaching global health not typically afforded in traditional global health track models. Residency program leaders looking to implement or modify their global health education offerings, particularly those with limited institutional support, might consider developing a CIGHT as an approach that leverages economies of scale and provides new opportunities for collaboration.


Assuntos
Saúde Global/educação , Estudos Interdisciplinares/normas , Internato e Residência/normas , Educação Baseada em Competências/métodos , Currículo , Estudos de Viabilidade , Saúde Global/ética , Aprendizagem/fisiologia , Motivação , Desenvolvimento de Programas , Estados Unidos/epidemiologia
16.
Interface (Botucatu, Online) ; 24: e180722, 2020.
Artigo em Português | LILACS | ID: biblio-1101229

RESUMO

A hemofilia é uma doença rara, hereditária e caracterizada pela falta de fatores de coagulação, o que provoca sangramentos espontâneos e artropatias incapacitantes. O componente mais dispendioso em seu tratamento é a reposição do fator de coagulação. O presente ensaio examina, a partir da perspectiva da Bioética Crítica, modelo teórico baseado na articulação da Teoria Crítica com os Estudos da Colonialidade, o panorama do acesso global ao tratamento e o programa brasileiro. Demonstrou-se um quadro marcado por extremas disparidades de acesso em nível tanto global quanto nacional, cujas causas estão diretamente relacionadas com a formação histórica de um sistema-mundo baseado na dominação dos meios materiais, ideias e instituições pelos países centrais. Para seu enfrentamento, concluiu-se pela necessidade de contínuas pressões sociais, estímulo a uma produção científica e regulação tecnológica verdadeiramente comprometida com o cumprimento do direito fundamental à saúde.(AU)


Hemophilia is a rare, hereditary disease characterized by a lack of clotting factors, which causes spontaneous bleeding and disabling arthropathy. The most expensive component in its treatment is clotting factor replacement therapy. This essay examines, based on the perspective of Critical Bioethics - a theoretical model based on the articulation between Critical Theory and Coloniality Studies -, the panorama related to the global access to that treatment and the Brazilian program. A scenario marked by extreme disparities of access was found, both in the global and in the national levels, whose causes are directly related to the historical formation of a world system based on the domination of material means, ideas and institutions by central countries. To face this situation, a continuous social pressure is needed, as well as incentive to scientific production and technological regulation truly committed to the enforcement of the fundamental right to health.(AU)


La hemofilia es una enfermedad rara, hereditaria, caracterizada por la falta de factores de coagulación, lo que provoca sangrados espontáneos y artropatías discapacitantes. El componente más caro de su tratamiento es la reposición del factor de coagulación. El presente ensayo examina, a partir de la perspectiva de la Bioética Crítica, un modelo teórico basado en la articulación de la Teoría Crítica con los Estudios de la Colonialidad, el panorama del acceso global al tratamiento y el programa brasileño. Demostró ser un cuadro marcado por disparidades extremas de acceso, tanto en nivel global como nacional, cuyas causas están directamente relacionadas con la formación histórica de un sistema de mundo basado en la dominación de los medios materiales, ideas e instituciones por los países centrales. La conclusión para enfrentarlo fue la necesidad de continuas presiones sociales y estímulo a una producción científica y regulación tecnológica verdaderamente comprometidas con el cumplimiento del derecho fundamental a la salud.(AU)


Assuntos
Humanos , Bioética/tendências , Saúde Global/ética , Acesso aos Serviços de Saúde/ética , Hemofilia A/tratamento farmacológico , Brasil , Fatores de Coagulação Sanguínea/uso terapêutico , Saúde Pública/ética
17.
Indian J Med Ethics ; 4 (NS)(4): 294-297, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31791935

RESUMO

During the last five years, globally, cases of polio caused by vaccine viruses have outnumbered those of polio caused by natural (wild) polioviruses, posing a moral dilemma. Public health ethics should ensure the best interests of the community, with equity in sharing benefits and risks irrespective of socioeconomic disparities. Vaccine viruses in oral polio vaccine (OPV) cause vaccine-associated paralytic polio (VAPP), while paralytic polio is also caused by vaccine-derived polioviruses (VDPVs). By its policy of the use of OPV in low and middle-income countries, while rich countries use the safe inactivated polio vaccine (IPV), the Global Polio Eradication Programme has been responsible for social injustice. In 2017 and 2018, there were outbreaks of polio in Syria and Papua New Guinea due to circulating VDPVs, after many years of these countries remaining free of polio due to wild polioviruses. The only ethical way forward for global polio eradication is to replace OPV with IPV in all countries.


Assuntos
Erradicação de Doenças/métodos , Saúde Global/ética , Vacinação em Massa/ética , Princípios Morais , Poliomielite/induzido quimicamente , Poliomielite/prevenção & controle , Vacina Antipólio de Vírus Inativado/efeitos adversos , Humanos , Índia
20.
AMA J Ethics ; 21(9): E715-721, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31550217

RESUMO

Service learning trips can be a powerful means of fostering cultural competency as well as an opportunity for students to expand their clinical skill set. However, if not planned and executed thoughtfully, they might not provide lasting benefit to the communities they seek to serve. Through analysis of a case in which participants question the value of their short-term international service learning trip, we argue that such trips should be designed with the community's needs in mind, preferably as identified by the community. Ideally, both the service group and the community should seek opportunities for teaching and exchange in order to expand the community's ability to provide care to the local population long after the service learning group has left.


Assuntos
Competência Cultural , Pessoal de Saúde/educação , Intercâmbio Educacional Internacional , Competência Cultural/ética , Currículo , Saúde Global/educação , Saúde Global/ética , Pessoal de Saúde/ética , Necessidades e Demandas de Serviços de Saúde/ética , Humanos , Missões Médicas/ética
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