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BACKGROUND: This paper estimates spatial inequalities of Rheumatoid Arthritis (RA) in Colombia and explores correlates of those disparities from a health system perspective. METHODS: We apply descriptive epidemiology to healthcare administrative records for estimation of crude and age-standardized prevalences, and health systems thinking for identification of barriers to effective access in RA diagnosis. RESULTS: The crude and age-standardized RA prevalence for Colombia in 2018 is estimated at 0.43% and 0.36%, respectively. In the contributory regime, the binding constraint is effective access to rheumatologists in rural and sparsely populated areas; this constraint in workforce affects service delivery, and ultimately comes from the lack of a differentiated model for effective provision of healthcare in those areas (governance). CONCLUSIONS: There are opportunities for implementation of public health policies and health system interventions that would lead to a better identification of RA patients and the subsequent more precise estimation of RA prevalence, and most importantly, to reduce exposition to risk factors and accurate diagnosis and treatment of RA patients.

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Resumo Este ensaio se propõe a analisar em que medida a pandemia de covid-19 e a abordagem a ela conferida afetam a dinâmica do tráfico de pessoas, da exploração sexual, dos abusos laborais, e o atendimento recebido pelas vítimas. O tráfico de pessoas é contextualizado em um cenário de fragilidade global, estabelecendo riscos adicionais relacionados à realidade migrante, à classe social, ao gênero e à idade, e adquirindo agravantes próprios em decorrência da covid-19, considerando-se a redução da investigação e da oferta de assistência aos afetados. As medidas de isolamento repercutem gravemente sobre tais indivíduos, na medida em que deixam de gerar lucros para seus algozes e permanecem em ambientes precários, em um cenário propício à exploração laboral e outras formas de violência. A exploração sexual passa a ser ainda mais clandestina, expondo a vítima a novas formas de pressão e à contaminação. A informação em saúde e a possibilidade de prevenção e tratamento é modesta ou inexistente para as pessoas traficadas, comumente apartadas das estratégias referentes à emergência sanitária, sem acesso aos protocolos de proteção, em meio à ausência de autonomia. Realça-se a necessidade de um modelo sociossanitário inclusivo, em constante observação às demandas relacionadas aos grupos marginalizados.

Abstract This essay aims to analyze to what extent the covid-19 pandemic and the approach given to it affect the dynamics of human trafficking, sexual exploitation, labor abuse, and the care received by victims. Human trafficking is contextualized in a scenario of global fragility, establishing additional risks related to the migrant reality, social class, gender and age, and acquiring its own aggravating factors as a result of covid-19, considering the reduction in investigating and offering assistance to those affected. Isolation measures have a serious impact on these individuals, as they fail to generate profits for their tormentors and remain in precarious environments, in a scenario conducive to labor exploitation and other forms of violence. Sexual exploitation becomes even more clandestine, exposing the victim to new forms of pressure and contamination. Health information and the possibility of prevention and treatment are modest or non-existent for trafficked people, who are commonly cut off from strategies related to health emergencies, without access to protection protocols, amid a lack of autonomy. The need for an inclusive socio-sanitary model, constantly observing the demands related to marginalized groups, is highlighted.

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The Covid-19 pandemic has reached almost every corner of the world. Despite the historical development, approval, and distribution of vaccines in some countries, non-pharmaceutical interventions will remain an essential strategy to control the pandemic until a substantial proportion of the population has immunity. There is increasing evidence of the devastating social and economic effects of the pandemic, particularly on vulnerable communities. Individuals living in urban informal settlements are in a structurally disadvantaged position to cope with a health crisis such as the Covid-19 pandemic. Estimates of this impact are needed to inform and prioritize policy decisions and actions. We study employment loss in informal settlements before and during the Covid-19 pandemic in Chile, using a longitudinal panel study of households living in Chile's informal settlements before and during the health crisis. We show that before the pandemic, 75% of respondents reported being employed. There is a decrease of 30 and 40 percentage points in May and September 2020, respectively. We show that the employment loss is substantially higher for individuals in informal settlements than for the general population and has particularly affected the immigrant population. We also show that the pandemic has triggered neighborhood cooperation within the settlements and that targeted government assistance programs have reached these communities in a limited way. Our results suggest that individuals living in informal settlements are facing severe hardship as a consequence of the pandemic. In addition to providing much-needed support, this crisis presents a unique opportunity for long-term improvements in these marginalized communities.

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