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J Glob Health ; 10(1): 010702, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32257162


Background: Many global health organisations have adopted formal strategies to integrate gender in their programming. In practice, few prioritise the issue. Institutions with considerable global power therefore largely overlook fundamental drivers of adverse health outcomes: gender inequality and harmful gender norms. We analyse the factors shaping attention to gender in organisations involved in global health governance. Methods: Drawing on scholarship from the fields of organisational behavior and management, sociology, international relations and the policy process, we undertook a thematic analysis of peer-reviewed scholarship and organisational documents. We also conducted 20 semi-structured interviews over Skype with individuals working at the cross-section of gender and health. Results: In seeking to reform the policies and practices of global health organisations, gender proponents confront patriarchal organisational cultures, hostile political environments and an issue that is difficult to address as it requires upsetting existing power structures. Proponents also face three linked challenges internal to their own networks. First, there is little cohesion among champions themselves, as they are fragmented into multiple networks. Second, proponents differ on the nature of the problem and solutions, including whether reducing gender inequality or addressing harmful gender norms is the primary goal, the role of men in gender initiatives, which health issues to prioritise, and even the value of proponent cohesion. Third, there are disagreements among proponents on how to convey the problem. Some advance an instrumental case, while others believe that it should be portrayed as a human rights issue and using any other argument undermines that fundamental justification. Conclusions: Prospects for building more gender-responsive global health organisations will depend in part on the ability of proponents to address these disagreements and develop strategies for negotiating difficult organisational cultures and political environments.

Actitud del Personal de Salud , Salud Global , Política de Salud , Derechos Humanos , Política , Humanos , Entrevistas como Asunto , Formulación de Políticas , Investigación Cualitativa
RECIIS (Online) ; 14(1): 111-125, jan.-mar. 2020.
Artículo en Portugués | LILACS | ID: biblio-1087268


A informação pública, garantida por lei no Brasil, é base para a geração de conhecimento adaptativo em situações adversas, como a extrema vulnerabilidade socioambiental e seus impactos na saúde humana. O presente artigo avalia a transparência da informação pública nas áreas de saúde humana (com foco no Sistema Único de Saúde ­ SUS), mudanças produtivas (uso do solo) e mudanças climáticas (chuva e temperatura), utilizando dados de 5.570 municípios brasileiros, ao longo dos últimos 20 anos. A experiência da construção de uma base nacional de dados (Data Lake) a partir de informações disponibilizadas em bases públicas (ou público-privadas) ­ DATASUS, MapBiomas, Instituto Nacional de Meteorologia (Inmet) e Hidroweb da Agência Nacional de Águas (ANA) ­ confirmou que, na prática, a acessibilidade da informação pública no Brasil apresenta entraves importantes. Incluímos recomendações sobre como ela pode ser aprimorada para tornar os direitos de acesso à informação uma realidade mais concreta para o cidadão brasileiro.

The transparency of public information, a right that is entitled by law in Brazil, is the basis to generate adaptive knowledge in adverse situations, such as extreme socio-environmental vulnerability and its impacts on human health. This article evaluates the transparency of public information in three areas ­ i) human health, focusing on the Sistema Único de Saúde ­ SUS (Unified Health System); ii) productive changes (land use indicators); and iii) climate changes (rain and temperature indicators) ­ using data from all the 5,570 Brazilian municipalities over the last 20 years. The experience of building a national database (Data Lake) from available information in public (or public-private) databases ­ DATASUS, MapBiomas, Instituto Nacional de Meteorologia ­ Inmet (National Institute of Meteorology), and Hidroweb of the Agência Nacional de Águas ­ ANA (National Water Agency) ­ confirmed that, in practice, the accessibility of public information in Brazil suffers from significant shortcomings. We include some recommendations for and how it could be improved so that the access rights to information becomes a more concrete reality for the Brazilian citizen.

La información pública, garantizada por ley en Brasil, es la base para la generación de conocimiento adaptativo en situaciones adversas, como la extrema vulnerabilidad socioambiental y sus impactos en la salud humana. Este artículo evalúa la transparencia de la información pública en las áreas de salud humana (dirigindo la atención hacia el Sistema Único de Saúde ­ SUS (Sistema Único de Salud), cambios productivos (uso del suelo) y cambios climáticos (lluvia y temperatura), con datos de los 5.570 municipios brasileños, durante los últimos 20 años. La experiencia de la construcción de una base nacional de datos (Data Lake) a partir de informaciones disponibles en bases públicas (o público-privadas) ­ DATASUS, MapBiomas, Instituto Nacional de Meteorología (Inmet) e Hidroweb de la Agência Nacional de Águas ­ ANA (Agencia Nacional de Aguas) ­ confirmó que, en la práctica, la accesibilidad de la información pública en Brasil presenta obstáculos importantes. Incluimos recomendaciones acerca de como la transparencia puede ser perfeccionada para hacer de los derechos de acceso a la información una realidad más concreta para el ciudadano brasileño.

Humanos , Cambio Climático , Acceso a la Información/legislación & jurisprudencia , Toma de Decisiones , Medio Ambiente y Salud Pública , Macrodatos , Sistema Único de Salud , Brasil , Información Pública , Vulnerabilidad Social , Sistemas de Información Geográfica , Políticas Públicas de Salud , Sistemas de Información en Salud
Sex Reprod Health Matters ; 28(1): 1741496, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32254002


As right-wing populist movements make electoral gains around the world, one might expect that resultant policy and legislative reversals against sexual and reproductive health and rights (SRHR) would be mirrored by a similar backlash in United Nations (UN) human rights negotiations. Yet the past five years have seen unprecedented advances for SRHR within the UN Human Rights Council (HRC), treaty bodies, and special procedures. In this article, we provide an overview of SRHR gains and setbacks within the HRC and analyse their broader significance, particularly as socially conservative nation states and non-governmental organisations seek to challenge them. We analyse how states have advanced SRHR in the HRC and examine efforts that states which oppose SRHR have undertaken to limit these advances. In an increasingly hostile political climate, the inter-related legal, technical, and political mechanisms through which human rights are advanced within the UN has helped to mitigate the effects of rapid political reversals. Additionally, the HRC's emphasis on previously agreed language helps dampen significant changes in resolutions on SRHR.

Derechos Humanos , Cooperación Internacional , Salud Reproductiva , Derechos Sexuales y Reproductivos , Derecho a la Salud , Cambio Climático , Humanos , Política , Conducta Sexual , Salud Sexual , Naciones Unidas
RECIIS (Online) ; 14(1): 225-246, jan.-mar. 2020. ilus
Artículo en Portugués | LILACS | ID: biblio-1087311


O uso dos resultados da pesquisa e do conhecimento bem como a aplicação das descobertas científicas no mundo real não ocorrem de forma natural. Instituições acadêmicas e governos têm definido que a translação da pesquisa é uma prioridade para a saúde: as evidências científicas devem embasar as decisões para melhorar a saúde. Porém, a lacuna entre ciência e prática, os entraves naturais e criados entre elas mostram que a translação do conhecimento é um processo que precisa ser implementado. As formas de fazê-lo requerem atitudes do meio acadêmico e do ambiente político e de gestão, algo complexo e de difícil solução. Este artigo busca compreender o tema por meio da leitura de autores da área de saúde. Detémse com especial atenção na conceituação e nos modelos disponíveis, além de analisar como se dá essa passagem de evidências entre o campo da ciência e os responsáveis pelas tomadas de decisão e como estas são utilizadas.

The use of research results and knowledge as well as the application of scientific discoveries in the real world do not occur naturally. Academic institutions and governments have defined that the research translation is a priority for health: decisions should be based on scientific evidence to improve health. However, the gap between science and practice, the natural and created barriers between them show that the knowledge translation is a process that has to be implemented. The ways to do it involve attitudes in both academic, managerial and political environment, which are a issue quite complex and difficult to solve. This paper proposes to understand the topic by reading some authors of the health field. We give a special attention to the concepts, the available models and we analyze how the exchange of evidence between science and decision makers takes place and how the evidence is used.

El uso de los resultados de la investigación y el conocimiento, así como la aplicación de descubrimientos científicos en el mundo real, no ocurren naturalmente. Instituciones académicas y gobiernos han definido que la traslación de la investigación es una prioridad para la salud: las evidencias científicas deben respaldar las decisiones para mejorar la salud. Sin embargo, el intervalo entre ciencia y práctica, los obstáculos naturales y creados entre ellas muestran que la traslación del conocimiento es un proceso que necesita ser implementado. Las formas de hacerlo implican actitudes del medio académico y del ambiente político y de gestión, algo complejo y de difícil solución. Este artículo propone entender el tema por medio de la lectura de autores del área de salud. Nos detenemos en la conceptualización, los modelos, y analizamos la manera de intercambiar evidencias entre el campo de la ciencia y los responsables de la toma de decisiones y el modo como estas son usadas.

Humanos , Conocimiento , Acceso a la Información , Toma de Decisiones , Investigación Científica y Desarrollo Tecnológico , Investigación en Medicina Traslacional , Difusión de la Información , Política Informada por la Evidencia , Política de Salud
BMJ ; 368: m1139, 2020 03 23.
Artículo en Inglés | MEDLINE | ID: mdl-32205335
Lancet ; 395(10222): 390, 2020 02 08.
Artículo en Inglés | MEDLINE | ID: mdl-32035531
Am J Public Health ; 110(3): 339-344, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31944845


The detention of immigrants inside US borders is not a new phenomenon. However, a dramatic shift has occurred in both the number and treatment of immigrants in detention.We examine recent changes in immigration policies that have systematized the mistreatment of children and pregnant immigrants, including a ban on abortion for unaccompanied minors in immigration detention, the neglect and mistreatment of pregnant immigrants in detention, and the separation and prolonged detention of parents and children in unsafe facilities.We employ the reproductive justice framework to demonstrate how these policies violate all 3 primary values of reproductive justice: the right to have children, the right not to have children, and the right to parent children in safe and secure environments. We argue that, when analyzed through the lens of reproductive justice, these policies can be seen as manifestations of a single targeted strategy to control the reproductive autonomy of migrants as a tool of immigration enforcement. We conclude with a call to action to the public health community.

Emigración e Inmigración/legislación & jurisprudencia , Embarazo , Justicia Social , Aborto Inducido/legislación & jurisprudencia , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , México , Responsabilidad Parental , Padres , Política Pública , Refugiados/legislación & jurisprudencia , Estados Unidos
Sex Reprod Health Matters ; 28(1): 1-14, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31928329


The vulnerability of lesbian, gay, bisexual and transgender (LGBT) persons in Africa to public health and other risks is heightened by their exclusion from socio-economic opportunities and services. We analysed existing regional-level legal and policy instruments and treaties for the opportunities they offer to tackle the exclusion of LGBT persons in Africa. We identified seven key living legal and policy instruments, formulated and adopted between 1981 and 2018, by the African Union (AU) or its precursor, the Organization of African Unity. These treaties and instruments do not only highlight the region's challenges related to inclusion, most of them are binding and enforceable, and all enshrine the responsibility of AU member-states to safeguard and ensure the inclusion and protection of citizens, their gender or sexual orientation notwithstanding. The instruments set forth strong and ambitious agendas of inclusion and recognise and affirm the rights of the region's citizens to sexual and reproductive health (SRH), equality, freedom and opportunities, regardless of their sexual orientation. Their language is generally universalist and their rejection of discrimination, criminalisation, and denial of socio-economic opportunities and services to the region's sexual minorities is forthright. However, the instruments do not explicitly mention LGBT persons and lack clear and effective mechanisms for answerability among member-states. Accountability and commitment among member-states towards these instruments and policies will improve national legal and policy environments and propel forward the agenda of LGBT inclusion, SRH and wellbeing in the region.

Bisexualidad , Homosexualidad Femenina , Homosexualidad Masculina , Derechos Humanos , Cooperación Internacional , Política Pública , Transexualidad , Femenino , Humanos , Masculino , Salud Reproductiva , Derechos Sexuales y Reproductivos , Derecho a la Salud , Minorías Sexuales y de Género , Poblaciones Vulnerables
Artículo en Inglés | MEDLINE | ID: mdl-31395317


In May 2018, the Irish electorate voted to remove from the Constitution one of the most restrictive abortion bans in the world. This referendum followed 35 years of legal cases, human rights advocacy, feminist activism and governmental and parliamentary processes. The reframing of abortion as an issue of women's health rather than foetal rights was crucial to the success of law reform efforts. The new law, enacted in 2018, provides for access to abortion on a woman's request up to 12 weeks of pregnancy and in situations of risk to the life or of serious harm to the health of the pregnant woman and fatal foetal anomaly thereafter. Abortion is now broadly accessible in Ireland; however, continued advocacy is needed to ensure that the state meets international human rights standards and that access to abortion care and abortion rights is fully secured within the law.

Aborto Inducido/legislación & jurisprudencia , Derechos Humanos/legislación & jurisprudencia , Derechos Sexuales y Reproductivos/legislación & jurisprudencia , Derechos de la Mujer/legislación & jurisprudencia , Aborto Legal , Femenino , Humanos , Irlanda , Política , Embarazo , Mujeres Embarazadas , Salud Reproductiva
Artículo en Inglés | MEDLINE | ID: mdl-31281015


Canada decriminalized abortion, uniquely in the world, 30 years ago. We present the timeline of relevant Canadian legal, political, and policy events before and since decriminalization. We assess implications for clinical care, health service and systems decisions, health policy, and the epidemiology of abortion in the absence of criminal legislation. As the criminal abortion law was struck down, dozens of similar private member's bills, and one government bill, have been proposed, but none were passed. Key findings include that initially Canadian provinces attempted to provide restrictive regulations and legislation, all of which have been revoked and largely replaced with supportive policies that improve equitable, accessible, state-provided abortion service. Abortion rates have been stable over 30 years since decriminalization, and a falling proportion of abortions occur late in the second trimester. Canada demonstrates that abortion care can safely and effectively be regulated as a normal component of usual medical care.

Aborto Criminal , Aborto Inducido , Aborto Legal , Política de Salud/legislación & jurisprudencia , Derechos de la Mujer/legislación & jurisprudencia , Canadá , Femenino , Humanos , Legislación como Asunto , Embarazo , Segundo Trimestre del Embarazo
Artículo en Inglés | MEDLINE | ID: mdl-31300212


The World Health Organization (WHO) Safe abortion: technical and policy guidance for health systems states that regulatory, policy, and programmatic barriers that hinder access to and timely provision of safe abortion care should be removed. Although some regulatory requirements facilitate access, where they act as barriers, they can deter women from seeking safe abortion care. We use data available in the Global Abortion Policies Database as of February 2019 to review policies related to regulatory requirements identified as access barriers in the Safe abortion guidance. We include only countries where such policies apply, i.e., where abortion is lawful on the woman's request, with no requirement for justification and/or for one or more legal grounds. The results demonstrate the variation that exists in regulatory requirements, but little remains known about how they are implemented in practice and the implications on how women access and how providers offer safe abortion services.

Aborto Inducido/legislación & jurisprudencia , Aborto Legal/legislación & jurisprudencia , Política de Salud , Derechos Humanos/legislación & jurisprudencia , Derechos Humanos/normas , Salud de la Mujer/legislación & jurisprudencia , Bases de Datos Factuales , Femenino , Salud Global , Accesibilidad a los Servicios de Salud , Humanos , Embarazo , Organización Mundial de la Salud
Artículo en Inglés | MEDLINE | ID: mdl-31501010


Latin America hosts the most restrictive abortion legislation globally. In 2007, Mexico, the second largest Catholic country in the world, decriminalized elective abortion within the first twelve weeks of pregnancy in the capital: Mexico City (also known as Federal District of Mexico). Following the reform, the Mexico City Ministry of Health (MX-MOH) implemented safe and legal services. Free services are provided to Mexico City residents and a sliding fee of up to $100 is applied to women from other Mexican states. Conscientious objection (CO) was addressed and included in service provision guidelines. Since 2007, 18 of 32 states amended their penal codes to restrict abortion. The road toward increasing access to abortion services at the MX-MOH included a shift from dilation and curettage (D&C) to medical abortion (MA), first with the misoprostol-alone regimen, followed by the combined mifepristone-misoprostol regimen. Manual vacuum aspiration is offered to out-of-state-women or to those beyond the gestational age where MA is less effective. Contraceptive uptake among abortion seekers is high (up to 95% of them prefer a free method of their choice). The Legal Interruption of Pregnancy program at the MX-MOH continues to provide effective, safe, reliable, and free services. However, women from indigenous groups residing in rural areas, those with low schooling, and adolescents with an unintended pregnancy who live in rural, urban, peri-urban districts, and at the state level are underserved despite being legally eligible to receive abortion services. Therefore, information and services for the disadvantaged groups need to be strengthened.

Aborto Inducido/legislación & jurisprudencia , Aborto Legal/legislación & jurisprudencia , Anticoncepción Postcoital , Política de Salud/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud , Derechos Sexuales y Reproductivos/legislación & jurisprudencia , Derechos de la Mujer/legislación & jurisprudencia , Adolescente , Femenino , Humanos , México , Mifepristona , Misoprostol , Embarazo , Legrado por Aspiración
Anesthesiology ; 132(1): 44-54, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31789635


There is intense debate around the use of altered and waived consent for pragmatic trials. Those in favor argue that traditional consent compromises the internal and external validity of these trials. Those against, warn that the resultant loss of autonomy compromises respect for persons and could undermine trust in the research enterprise.This article examines whether international ethical guidelines and the policy frameworks in three countries-the United States, England, and Australia-permit altered and waived consent for minimal-risk pragmatic trials conducted outside the emergency setting. Provisions for both are clearly articulated in U.S. regulations, but many countries do not have equivalent frameworks. Investigators should not assume that all consent models permitted in the United States are legal in their jurisdictions, even if they are deemed ethically defensible.The authors summarize ethical and regulatory considerations and present a framework for investigators contemplating trials with altered or waived consent.

Investigación Biomédica/ética , Investigación Biomédica/legislación & jurisprudencia , Política de Salud/legislación & jurisprudencia , Consentimiento Informado/ética , Consentimiento Informado/legislación & jurisprudencia , Sujetos de Investigación/legislación & jurisprudencia , Australia , Inglaterra , Humanos , Internacionalidad , Riesgo , Estados Unidos
Gesundheitswesen ; 81(12): 967-971, 2019 Dec.
Artículo en Alemán | MEDLINE | ID: mdl-31816645


The speech deals with the role of health/health care as a human right in Germany in the 21st century and the resulting consequences for current personal and political actions.

Prestación de Atención de Salud , Derechos Humanos , Alemania , Humanos , Política