Ética de la Salud Pública: propuesta sobre los principios fundamentales que guían las responsabilidades éticas del estado en el contexto pandemia COVID-19

On March 11, 2020, the World Health Organization (WHO) stated that the number of cases of COVID-19 multiplied by 13 outside China, with a threefold increase in the number of affected countries. The WHO expressed its concern about the alarming levels of spread and severity of the outbreak, declaring the pandemic. This pandemic context is generating a social pact that seeks to ensure collective protection over individual freedoms. To meet the challenge, Governments must make decisions based on the principles that govern the State- These should consider the differences and particularities of those affected, without diverting attention from collective social protection. The following is a proposal on the ethical principles that should guide a State that makes decisions in public health emergencies.

Tendencia de las defunciones ocurridas en mayores de 1 año según lugar de ocurrencia y su relación con características sociodemográficas, Chile 1997-2014 / Temporal variation in the place of death in Chile from 1997 to 2014

Background: The place of death is a fundamental indicator for the debate on equity and access to health care. Aim: To describe the place of death of the deceased population over 1 year of age in Chile between the years 1997 and 2014. To analyze tendencies in this variable and its association with socio-demographic characteristics. Material and Methods: Time series study covering deaths occurred between 1997 and 2014 in Chile. National death records were used, provided by the Department of Health Statistics and Information (DEIS) of the Chilean Ministry of Health. The following variables were chosen: place of death (home, hospital, other), sex, marital status, age, level of education, activity and area of residence. Temporal trends were evaluated using Prais Winsten regressions. Logistic regression was used to assess the association of the place of death with socio-demographic characteristics. Results: Between 1997 and 2014 there were 1,576,392 deaths, at a mean age of 69 years (p25-p75:60-83 years). No temporal variations in the place of death were observed with the Prais Winsten regression, hospital (P-W coefficient (coef) = 0.06 (confidence intervals (CI): −0.30; 0.19), p = 0.64), home (P-W coef = −0.03 (CI: −0.15; 0.09), p = 0.57), and other places (P-W coef = 0.07; (CI: −0.08 - 0.22), p = 0.32). The multivariate analysis showed that being women under 70 years of age, being married or widowed, having a higher educational level, being inactive and living in a rural area were factors associated with a greater chance of dying at home. Conclusions: No significant temporal variation in the place of death was observed.