RESUMEN
In Brazil, the judicialization of public health for access to medications has resulted in significant challenges to the management of public policies, especially at the municipal level. To evaluate the profile of drug litigations against the Campinas municipal health system from 2017 to 2021, this study analyzed the characteristics of litigants, medicine dispensation, and the timing of court decisions. A quantitative, analytical, and comparative cross-sectional study was conducted using data on the dispensation of 506 types of medications and 493 court cases. The analysis included sociodemographic, procedural, medical-sanitary, and pharmaceutical assistance management variables. The time of court decisions was assessed using the KruskalâWallis test complemented by the Dunn test. The plaintiffs were predominantly adults, females, and self-declared students, and some cases involved nonresidents. Most of the lawsuits were represented by private lawyers, gratuitousness of justice and with decisions favorable to the plaintiff. However, only 43% of the patients obtained a preliminary injunction or early tutelage. The median time needed for a court decision from the date of case filing was 12 days until the granting of a preliminary injunction or early tutelage and 6.5 months until a judgment or dismissal without a decision on the merits. Approximately 32.4% of the medications dispensed by the judicial pharmacy already belonged to the list of the Brazil's Unified Health System in 2020; 46.3% were prescribed by their generic name; 75.5% had therapeutic equivalents, and 94.9% had marketing authorization from the Brazilian National Health Surveillance Agency. Judicialization in Campinas is an alternative way of accessing medications, but it is time-consuming and benefits only a small portion of the population (0.068%). The characteristics of the plaintiffs and judicialized medicines highlight the need to review health policies to promote equitable and efficient access to essential treatments for the population.
Asunto(s)
Salud Pública , Humanos , Brasil , Femenino , Masculino , Estudios Transversales , Adulto , Salud Pública/legislación & jurisprudencia , Persona de Mediana Edad , Atención a la Salud/legislación & jurisprudenciaRESUMEN
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.
Asunto(s)
Política de Salud , Salud Pública , Humanos , Brasil , Salud Pública/legislación & jurisprudencia , Negociación , Toma de Decisiones , Sistemas de Apoyo a Decisiones ClínicasRESUMEN
INTRODUCTION: COVID-19 is a severe respiratory syndrome caused by the SARS-CoV-2 virus. In Brazil the highest infection rates are associated with socially vulnerable populations. This study therefore sought to analyze the spatial distribution of the disease and its relation with geographic, socioeconomic and public health policy characteristics associated with quilombola communities in Salvaterra municipality, state of Pará, for the period of March to September, 2020. METHODOLOGY: This cross-sectional and ecological study used data from the Disease Notification System and the National Registry of Health Establishments of the Ministry of Health, the Income Transfer Registry of the Ministry of Citizenship and the 2010 census of the Brazilian Institute of Geography and Statistics. Statistical and spatial analysis of the data was done through percentages of cases and Flow and Kernel map techniques. RESULTS: Seventy-five notified cases of COVID-19 distributed among 7 quilombola communities in the municipality were analyzed. The epidemiological profile followed a national trend, with a higher percentage of cases among persons who were female, adults with low schooling levels, working as family farmers and with an outcome ending in recovery. The spatial distribution of the disease was not homogenous and showed clusters of cases and high incidence rates, especially in communities close to the municipal seat or to highways. CONCLUSIONS: The use of data analysis techniques was satisfactory for providing an understanding of the socioeconomic production of the disease in the areas studied. Accordingly, the need for intensifying epidemiological survey actions in the quilombola communities of the municipality is emphasized.
Asunto(s)
COVID-19/epidemiología , Salud Pública/estadística & datos numéricos , Factores Socioeconómicos , Poblaciones Vulnerables/estadística & datos numéricos , Brasil/epidemiología , Estudios Transversales , Femenino , Humanos , Incidencia , Masculino , Salud Pública/legislación & jurisprudencia , Investigación Cualitativa , Factores de Riesgo , Análisis EspacialRESUMEN
Peru has a commodities-based economy where agriculture plays an essential role in the nation's development. Among agricultural products, fruits and vegetables are foundational to Peruvian culture and a healthy and nutritious diet. Produce is also the primary income source for thousands of small-scale farmers and producers throughout the country. Peru has significant potential to export agricultural and value-added products. Nevertheless, the Peruvian food chain has weak food safety and quality standards, limiting access to international markets. The inherent lack of food safety surveillance and management systems negatively affects public health. In the past decade, fresh and raw produce has been associated with several foodborne outbreaks worldwide, resulting in significant health and economic losses. This alarming situation for public health officials and regulators has called for the strengthening of produce safety standards and food safety risk management for safer food and to reduce the incidence of foodborne illnesses. This review summarizes the current status of produce safety in Peru and explores opportunities (e.g., policy, university capacity development) toward a safer food system.
Asunto(s)
Microbiología de Alimentos , Inocuidad de los Alimentos/métodos , Agricultura/métodos , Contaminación de Alimentos/prevención & control , Enfermedades Transmitidas por los Alimentos/epidemiología , Enfermedades Transmitidas por los Alimentos/prevención & control , Humanos , Perú , Salud Pública/legislación & jurisprudencia , Salud Pública/normasRESUMEN
Despite the positive response of Colombia's health system to the arrival of Venezuelan migrants, the new challenges that accompany the COVID-19 pandemic have triggered a closed-borders response that runs the risk of encouraging a negative view of migrants and increasing their health risks. This manuscript discusses the recommendations that could be proposed in the case of a country with limited resources such as Colombia to respond to the needs of the Venezuelan mixed migrant flows.
A pesar de la respuesta positiva del sistema de salud de Colombia a la llegada de migrantes venezolanos, los nuevos desafíos que acompañan la pandemia de COVID-19 han desencadenado una respuesta de fronteras cerradas, con lo que se corre el riesgo de alentar una visión negativa de los migrantes e incrementar sus riesgos en salud. Este manuscrito discute las recomendaciones que podrían proponerse en el caso de un país con recursos limitados, como Colombia, para responder a las necesidades de una población vulnerable como la conformada por los flujos de migrantes mixtos venezolanos.
Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/prevención & control , Emigración e Inmigración/legislación & jurisprudencia , Pandemias/prevención & control , Neumonía Viral/prevención & control , Migrantes , COVID-19 , Colombia/epidemiología , Infecciones por Coronavirus/epidemiología , Desinfección de las Manos , Disparidades en Atención de Salud , Humanos , Neumonía Viral/epidemiología , Salud Pública/legislación & jurisprudencia , Política Pública , Cuarentena , SARS-CoV-2 , Venezuela/etnología , Poblaciones VulnerablesRESUMEN
OBJECTIVE: We identified mechanisms for addressing and/or managing the influence of corporations on public health policy, research and practice, as well as examples of where these mechanisms have been adopted from across the globe. DESIGN: We conducted a scoping review. We conducted searches in five databases on 4 June 2019. Twenty-eight relevant institutions and networks were contacted to identify additional mechanisms and examples. In addition, we identified mechanisms and examples from our collective experience working on the influence of corporations on public health policy, research and practice. SETTING: We identified mechanisms at the national, regional and global levels. RESULTS: Thirty-one documents were included in our review. Eight were peer-reviewed scientific articles. Nine discussed mechanisms to address and/or manage the influence of different types of industries; while other documents targeted specific industries. In total, we identified 49 mechanisms for addressing and/or managing the influence of corporations on public health policy, research and practice, and 43 of these were adopted at the national, regional or global level. We identified four main types of mechanisms: transparency; management of interactions with industry and of conflicts of interest; identification, monitoring and education about the practices of corporations and associated risks to public health; prohibition of interactions with industry. Mechanisms for governments (n=17) and academia (n=13) were most frequently identified, with fewer for the media and civil society. CONCLUSIONS: We identified several mechanisms that could help address and/or manage the negative influence of corporations on public health policy, research and practice. If adopted and evaluated more widely, many of the mechanisms described in this manuscript could contribute to efforts to prevent and control non-communicable diseases. TRIAL REGISTRATION DETAILS: The protocol was registered with the Open Science Framework on 27 May 2019 (https://osf.io/xc2vp).
Asunto(s)
Política de Salud , Industrias/legislación & jurisprudencia , Salud Pública/legislación & jurisprudencia , Comercio/legislación & jurisprudencia , Conflicto de Intereses , Humanos , Política , Salud Pública/normasRESUMEN
BACKGROUND: The present study provides a countrywide perspective of the malaria situation in Panamá over a long-term framework, with the purpose of identifying historical malaria resurgence events and their potential causes. METHODS: A descriptive-ecological study was conducted by analysing demographic and epidemiological annual malaria time series data in Panamá (1884-2019) using several data sources. Malaria intensity indicators were calculated during the study period. The effects of El Niño Southern Oscillation on malaria transmission were also analysed using a retrospective analysis of malaria cases between 1957 and 2019. RESULTS: Several factors were identified responsible for malaria resurgence in Panamá, mostly related with Malaria Control Programme weakening. During the past 20 years (2000-2019) malaria has progressively increased in prevalence within indigenous settlements, with a predominance of male cases and a high proportion (15% of total cases) in children less than 5 years old. During this period, a significant and increasing proportion of the Plasmodium falciparum cases were imported. Retrospective analysis (1957-2019) evidenced that ENSO had a significant impact on malaria transmission dynamics in Panamá. CONCLUSIONS: Data analysis confirmed that although authorities have been successful in focalizing malaria transmission in the country, there are still neglected issues to be solved and important intercultural barriers that need to be addressed in order to achieve elimination of the disease by 2022. This information will be useful for targeting strategies by the National Malaria Elimination Programme.
Asunto(s)
El Niño Oscilación del Sur , Política de Salud/legislación & jurisprudencia , Malaria Falciparum , Malaria Vivax , Salud Pública/legislación & jurisprudencia , Humanos , Malaria Falciparum/prevención & control , Malaria Falciparum/transmisión , Malaria Vivax/prevención & control , Malaria Vivax/transmisión , Panamá , Plasmodium falciparum/fisiología , Plasmodium vivax/fisiología , Estudios RetrospectivosRESUMEN
OBJECTIVE: The objective of this study was to map and describe the different corporate political activity (CPA) strategies used by the sugar-sweetened beverage (SSB) industry to influence public health policymaking geared toward decreasing the consumption of SSB in Mexico. METHODS: We applied an existing approach to identify and monitor the CPA of the SSB industry. A documentary analysis was conducted for two main actors in the SSB industry, for the period 2017-2019, and was triangulated with eleven semi-structured interviews with key informants in public health nutrition and from the SSB industry. The information was analyzed using an existing framework for categorizing the CPA. RESULTS: Although data were found for six CPA strategies, the SSB industry mainly highlighted its economic importance and spoke openly against the 2014 SSB tax. We documented the industry's relationships with governmental bodies and civil society actors to promote corporate social responsibility and gain public support. CONCLUSIONS: The SSB industry in Mexico uses a variety of strategies, directly or through third parties, to influence public policies related to the prevention and control of obesity and non-communicable diseases.
Asunto(s)
Industria de Alimentos/legislación & jurisprudencia , Maniobras Políticas , Formulación de Políticas , Política , Salud Pública/legislación & jurisprudencia , Política Pública/legislación & jurisprudencia , Bebidas Azucaradas/legislación & jurisprudencia , Humanos , MéxicoRESUMEN
Mexico recently voted to implement front-of-pack warning labels on food and beverage products deemed high in calories, sugar, saturated fat, trans fat, and sodium, and those containing non-caloric sweeteners. Research shows that warning labels allow consumers to quickly identify healthy and unhealthy products. Supporters claim these labels can help people make healthier decisions and combat growing rates of obesity and diet-related diseases. Warning labels will replace the Guideline Daily Amount (GDA) nutrition labels, which were implemented in 2014 against the guidance of public health leaders who argued the GDA was hard to understand and ineffective at conveying health risks. Conflicting interests between public health, government, and food industry slowed efforts to adopt a new nutrition label. Actions by academia and civil society to change the GDA were met with common strategies used to interfere in public health policies. However, in 2019, several factors came together to create favorable conditions for the approval of warning labels. The new leftist government's public promises to fight corruption fit well with labeling advocates' calls for transparency. Civil society and academia developed a highly coordinated response thanks to international funding, which propelled extensive marketing campaigns around the country and supported research efforts. These actions helped make the topic visible and place it strategically in the political and public agendas. Despite this legislative victory, the opposition has been strong and there are struggles ahead. Only time will reveal how effectively the law is implemented and to what extent it is upheld and defended.
Asunto(s)
Etiquetado de Alimentos/legislación & jurisprudencia , Política Nutricional/tendencias , Política , Industria de Alimentos/legislación & jurisprudencia , Etiquetado de Alimentos/tendencias , Calidad de los Alimentos , Humanos , México , Salud Pública/legislación & jurisprudencia , Salud Pública/métodosRESUMEN
The Family Educational Rights and Privacy Act of 1974 is the federal law that protects the privacy of personally identifiable information from student education records and applies to all education entities that receive funding under any program administered by the U.S. Department of Education. The Health Insurance Portability and Accountability Act of 1996 is the federal law that establishes privacy requirements for patients' protected health information. Together these privacy laws establish rules that guide school nurses in the sharing of student information, even in times of public health emergencies. The U.S. Department of Education and the U.S. Department of Health and Human Services have issued special updates to privacy laws in response to the Novel Coronavirus Disease providing certain waivers of typical privacy requirements and direction to allow the sharing of information during this public health emergency. The purpose of this article is to briefly review the privacy laws as they relate to schools, as well as to provide an overview of the recent waivers to assist school nurses, school administrators, healthcare professionals, and public health agencies in protecting the health and safety of students during this current public health emergency.
Asunto(s)
Betacoronavirus , Confidencialidad/legislación & jurisprudencia , Infecciones por Coronavirus , Difusión de la Información/legislación & jurisprudencia , Pandemias , Neumonía Viral , Privacidad/legislación & jurisprudencia , Servicios de Enfermería Escolar/legislación & jurisprudencia , Servicios de Enfermería Escolar/normas , COVID-19 , Urgencias Médicas , Guías como Asunto , Humanos , Salud Pública/legislación & jurisprudencia , Salud Pública/normas , SARS-CoV-2 , Estados UnidosRESUMEN
Background: Some scholars and global health advocates argue that litigation is a strategy to advance public health care, especially in those countries that do not have specific legislation to guarantee access to basic health care services. However, strategic litigation has another side, known as judicialization of the right to health, particularly present in the Latin American region where most countries incorporate the right to health into their constitutions, but their citizens still struggle with health disparities. Objectives: Considering these two perspectives on litigation in health care, this paper examines the phenomenon of litigation in health care and its impact on public health in Brazil, where there is an ambiguous process of litigation in health care. Methods: Comparing the literature of both the use of strategic litigation for advancing public health and the judicialization of the right to health, this paper develops an ethical analysis of the impacts of strategic litigation for individuals and societies, using Brazil's public health care system and its policies as case-study of the impact of court decisions on the management of the system. Findings: Supporters of strategic litigation present experiences in African countries using this strategy to access a specific medical service led to enforce the creation of health-related policies by authorities and policymakers. However, in Brazil, a country with the right to health guaranteed by its Constitution, strategic litigation creates access to health care for some individuals, but also results in complex sociomedical challenges with significant impact for public administration and distributive justice. Conclusions: Strategic litigation can lead to ambiguous results, which will depend on the local context and the existence or not of public health services and health-related policies. When this strategy is considered, ethical analysis helps to understand how litigation can both benefit and damage individuals' health and the public health system in the complex context and diverse reality of Brazil. As a result, strategic litigation must be considered from an ethical perspective of prudence and discernment in a close interaction with the local reality, its particular circumstances, culture, policies, and laws.
Asunto(s)
Salud Global/legislación & jurisprudencia , Política de Salud , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Jurisprudencia , Salud Pública/legislación & jurisprudencia , Derecho a la Salud/legislación & jurisprudencia , África , Brasil , Constitución y Estatutos , Humanos , Formulación de PolíticasRESUMEN
The Report on Carcinogens (RoC), from the National Toxicology Program of the USA, is one of the world-leading programs for the identification and acknowledgment of substances that represent a hazard of cancer to humans. RoC covers several essential topics concerning environmental, occupational, and pharmaceutical agents that are known to be, or reasonably anticipated to be carcinogenic to humans. To promote the highest exploitation by its potential users, several RoC aspects and features were put together into one article. For doing so, a comprehensive description is provided regarding RoC history, scope, general features, listing criteria, contents, handbook, and website. Secondary and tertiary aims for this work were (a) to point out some improvement opportunities for the RoC, and (b) to discuss pending issues in regulatory science and cancer hazard assessments. In this regard, for agents classified as probably, likely, reasonably anticipated, possibly or suspected to be a human carcinogen, there is a lack of quantitative knowledge concerning the likelihood of those agents actually being carcinogenic to humans. Elucidating these probabilities is necessary, because the duration of current regulations and the arrival of new acts may depend on it. On the other hand, there is a dramatic imbalance in priorities toward carcinogens, compared with non-carcinogens, in current cancer hazard identification programs. That vision may ignore that the availability on the market of chemicals classified as probably not carcinogenic to humans can also be important for the employment, alimentation, economy, quality of life of consumers, and human health.
Asunto(s)
Pruebas de Carcinogenicidad , Carcinógenos/toxicidad , Transformación Celular Neoplásica/inducido químicamente , Exposición a Riesgos Ambientales/efectos adversos , Publicaciones Gubernamentales como Asunto , Neoplasias/inducido químicamente , Salud Pública , United States Public Health Service , Animales , Carcinógenos/clasificación , Exposición a Riesgos Ambientales/legislación & jurisprudencia , Regulación Gubernamental , Humanos , Formulación de Políticas , Salud Pública/legislación & jurisprudencia , Medición de Riesgo , Factores de Riesgo , Estados Unidos , United States Public Health Service/legislación & jurisprudenciaRESUMEN
Chile has experienced rapid epidemiological transitions characterized by decreasing infant mortality, population aging, and a shift towards obesity with an increase in noncommunicable diseases (NCDs). Today, tobacco, alcohol, and ultraprocessed foods are the main risk factors for these diseases. Based on Chile's experience in tobacco control, we discuss paths to make progress in population evidence-based strategies to improve overall community health.
Asunto(s)
Bebidas Alcohólicas , Enfermedad Crónica , Alimentos , Política de Salud , Legislación como Asunto , Enfermedades no Transmisibles , Salud Pública , Productos de Tabaco , Bebidas Alcohólicas/legislación & jurisprudencia , Bebidas Alcohólicas/normas , Chile , Enfermedad Crónica/epidemiología , Enfermedad Crónica/prevención & control , Alimentos/normas , Política de Salud/legislación & jurisprudencia , Humanos , Enfermedades no Transmisibles/epidemiología , Enfermedades no Transmisibles/prevención & control , Salud Pública/legislación & jurisprudencia , Salud Pública/normas , Ciencia , Productos de Tabaco/legislación & jurisprudencia , Productos de Tabaco/normasRESUMEN
As infectious disease outbreaks emerge, public health agencies often enact vaccination and social distancing measures to slow transmission. Their success depends on not only strategies and resources, but also public adherence. Individual willingness to take precautions may be influenced by global factors, such as news media, or local factors, such as infected family members or friends. Here, we compare three modes of epidemiological decision-making in the midst of a growing outbreak using network-based mathematical models that capture plausible heterogeneity in human contact patterns. Individuals decide whether to adopt a recommended intervention based on overall disease prevalence, the proportion of social contacts infected, or the number of social contacts infected. While all strategies can substantially mitigate transmission, vaccinating (or self isolating) based on the number of infected acquaintances is expected to prevent the most infections while requiring the fewest intervention resources. Unlike the other strategies, it has a substantial herd effect, providing indirect protection to a large fraction of the population.
Asunto(s)
Enfermedades Transmisibles/transmisión , Brotes de Enfermedades/prevención & control , Cooperación del Paciente/psicología , Conducta de Reducción del Riesgo , Vacunación/psicología , Conducta de Elección , Enfermedades Transmisibles/epidemiología , Política de Salud/legislación & jurisprudencia , Humanos , Medios de Comunicación de Masas , Prevalencia , Distancia Psicológica , Salud Pública/legislación & jurisprudenciaRESUMEN
Resumo Este artigo objetiva identificar novas fontes de receitas para a alocação adicional de recursos para o atendimento das necessidades de saúde da população fixadas nas despesas do orçamento federal, no contexto do processo de subfinanciamento do Sistema Único de Saúde e dos efeitos negativos da Emenda Constitucional 95/2016 para esse processo - queda verificada na proporção da receita corrente líquida federal destinada para o SUS. Nessa perspectiva, é preciso enfrentar o problema do subfinanciamento vinculando à busca por recursos adicionais junto a novas fontes de financiamento com as ações e serviços públicos de saúde que serão aprimoradas, ampliadas e criadas, cujos critérios são: quanto às fontes, exclusividade para o SUS, não regressividade tributária e revisão da renúncia de receita; e, quanto aos usos, priorização da atenção básica como ordenadora da rede de atenção à saúde e valorização dos servidores. O resultado calculado para as fontes variou entre R$ 92 bilhões e R$ 100 bilhões, superior aos R$ 30,5 bilhões apurados para os usos nos termos descritos. Foi realizada pesquisa documental para o levantamento de dados junto a fontes secundárias, especialmente nos relatórios encaminhados ao Conselho Nacional de Saúde pelo Ministério da Saúde.
Abstract This paper aims to identify new sources of revenue for the additional allocation of resources to meet the population's health needs fixed in the federal budget expenses, in the context of the Unified Health System (SUS) underfunding process and the negative effects of Constitutional Amendment 95/2016 for this process - verified decrease in the proportion of federal net current revenue destined to SUS. From this perspective, it is necessary to address the problem of underfunding by linking the search for additional resources with new sources of funding with actions and public health services that will be improved, expanded and created, of which criteria are: regarding sources, exclusivity for SUS, non regressive taxing and review of revenue waiver; and, regarding uses, prioritization of primary care as reference of the health care network and appreciation of civil servants in the health area. The result calculated for the sources ranged from R$ 92 billion to R$ 100 billion, higher than the R$ 30.5 billion calculated for uses under the described terms. A documentary research was conducted to collect data from secondary sources, especially in the reports sent to the National Health Council by the Ministry of Health.
Asunto(s)
Presupuestos/legislación & jurisprudencia , Salud Pública/legislación & jurisprudencia , Asignación de Recursos/legislación & jurisprudencia , Financiación de la Atención de la Salud , Financiación Gubernamental/legislación & jurisprudencia , Programas Nacionales de Salud/legislación & jurisprudencia , Impuestos/economía , Brasil , Salud Pública/economía , Asignación de Recursos/economía , Financiación Gubernamental/economía , Programas Nacionales de Salud/economíaRESUMEN
This paper aims to identify new sources of revenue for the additional allocation of resources to meet the population's health needs fixed in the federal budget expenses, in the context of the Unified Health System (SUS) underfunding process and the negative effects of Constitutional Amendment 95/2016 for this process - verified decrease in the proportion of federal net current revenue destined to SUS. From this perspective, it is necessary to address the problem of underfunding by linking the search for additional resources with new sources of funding with actions and public health services that will be improved, expanded and created, of which criteria are: regarding sources, exclusivity for SUS, non regressive taxing and review of revenue waiver; and, regarding uses, prioritization of primary care as reference of the health care network and appreciation of civil servants in the health area. The result calculated for the sources ranged from R$ 92 billion to R$ 100 billion, higher than the R$ 30.5 billion calculated for uses under the described terms. A documentary research was conducted to collect data from secondary sources, especially in the reports sent to the National Health Council by the Ministry of Health.
Este artigo objetiva identificar novas fontes de receitas para a alocação adicional de recursos para o atendimento das necessidades de saúde da população fixadas nas despesas do orçamento federal, no contexto do processo de subfinanciamento do Sistema Único de Saúde e dos efeitos negativos da Emenda Constitucional 95/2016 para esse processo queda verificada na proporção da receita corrente líquida federal destinada para o SUS. Nessa perspectiva, é preciso enfrentar o problema do subfinanciamento vinculando à busca por recursos adicionais junto a novas fontes de financiamento com as ações e serviços públicos de saúde que serão aprimoradas, ampliadas e criadas, cujos critérios são: quanto às fontes, exclusividade para o SUS, não regressividade tributária e revisão da renúncia de receita; e, quanto aos usos, priorização da atenção básica como ordenadora da rede de atenção à saúde e valorização dos servidores. O resultado calculado para as fontes variou entre R$ 92 bilhões e R$ 100 bilhões, superior aos R$ 30,5 bilhões apurados para os usos nos termos descritos. Foi realizada pesquisa documental para o levantamento de dados junto a fontes secundárias, especialmente nos relatórios encaminhados ao Conselho Nacional de Saúde pelo Ministério da Saúde.
Asunto(s)
Presupuestos/legislación & jurisprudencia , Financiación Gubernamental/legislación & jurisprudencia , Financiación de la Atención de la Salud , Programas Nacionales de Salud/legislación & jurisprudencia , Salud Pública/legislación & jurisprudencia , Asignación de Recursos/legislación & jurisprudencia , Brasil , Financiación Gubernamental/economía , Humanos , Programas Nacionales de Salud/economía , Salud Pública/economía , Asignación de Recursos/economía , Impuestos/economíaRESUMEN
Objetivo: analisar as novas hipóteses permissivas para a dispensação de medicamentos sem registro na Agência Nacional de Vigilância Sanitária pelo poder público por meio de ação judicial após o julgamento do Tema de Repercussão Geral nº 500 pelo Supremo Tribunal Federal. Método: foi utilizado o método de análise dedutivo para compreender o alcance do julgamento do Tema 500, além de pesquisa da legislação prévia existente e artigos correlatos. Resultado e discussão: duas novas hipóteses foram criadas pelo Supremo Tribunal Federal em que será permitido demandar a União Federal para fornecer medicações sem registro, quais sejam, mora na apreciação do pedido de registro do medicamento pela Anvisa e casos de drogas órfãs. Há vulneração ao princípio da segurança jurídica em virtude da falta da modulação para uniformizar a aplicação de seus efeitos nos processos judiciais em curso. Conclusão: apesar da necessidade de pronunciamento definitivo pelo STF, em virtude das decisões conflitantes, tecnicamente não havia um vazio legislativo apto a justificar a intervenção do Poder Judiciário.
Objective: to analyze the new permissive hypotheses for the dispensation of drugs without registration with the National Health Surveillance Agency by the government through a lawsuit after the judgment of General Repercussion No. 500 by the Supreme Court. Method: The deductive analysis method was used to understand the scope of the Item No. 500 judgment, in addition to researching existing prior legislation and related articles. Result and discussion: two new hypotheses were created by the Federal Supreme Court in which it will be allowed to sue the Federal Union to provide unregistered medications, namely, the consideration of Anvisa's application for registration of the drug and cases of orphan drugs. There is a violation of the principle of legal certainty due to the lack of modulation to standardize the application of its effects in ongoing judicial proceedings. Conclusion: despite the need for definitive pronouncement by the Supreme Court, due to the conflicting decisions, technically there was no legislative void to justify the intervention of the Judiciary.
Objetivo: analizar las nuevas hipótesis permisivas para la dispensación de drogas sin registro en la Agencia Nacional de Vigilancia Sanitaria por parte del gobierno a través de una demanda después de la sentencia del Tribunal Supremo sobre el Tema de Repercusión General No. 500. Método: el método de análisis deductivo se utilizó para comprender el alcance del juicio del Tema 500, además de investigar la legislación anterior existente y los artículos relacionados. Resultado y discusión: el Tribunal Supremo Federal creó dos nuevas hipótesis en las que se le permitirá demandar a la Unión Federal para proporcionar medicamentos no registrados, a saber, la consideración de la solicitud de Anvisa para el registro del medicamento y los casos de medicamentos huérfanos. Existe una violación del principio de seguridad jurídica debido a la falta de modulación para estandarizar la aplicación de sus efectos en los procedimientos judiciales en curso. Conclusión: a pesar de la necesidad de un pronunciamiento definitivo por parte de la Corte Suprema, debido a las decisiones en conflicto, técnicamente no hubo un vacío legislativo capaz de justificar la intervención del Poder Judicial.
Asunto(s)
Salud Pública/legislación & jurisprudencia , Agencia Nacional de Vigilancia Sanitaria , Registro de Productos , Judicialización de la Salud/legislación & jurisprudenciaRESUMEN
Mexico has one of the highest overweight and obesity rates in the world. Our objective is to describe the tendency of overweight and obesity by sex, health service affiliation, and socioeconomic tertile (T1,2,3), and to give examples of public policies derived from the results of the Mexican National Health and Nutrition Surveys (ENSANUT). Data come from the 2006, 2012, and 2016 ENSANUTs, which are probabilistic surveys that allow us to make inferences at the national level, on urban and rural strata and regions; their coverage includes all the population age groups. We assessed overweight and obesity (OW + O) in all population groups. The prevalence of OW + O in preschool children was lower in T1 in all the surveys, and shows an increase by year of survey, according to the health service affiliation. In school-age women, prevalence increased over the 10 years of evaluation, in spite of the high prevalence in both genders in T3. Adolescent behavior is similar and, in adults, the prevalence of OW + O shows an increase by year of survey, gender, and affiliation, with the differences not explained by socioeconomic tertile. In conclusion, the ENSANUT series represents a surveillance system that allow us to observe the changes in overweight and obesity prevalence over the time, showing a high prevalence of OW + O in the population, and has contributed to public policy enhancement.