Judicialization of the right to health with a focus on neglected tropical diseases: dimensions and challenges in Piauí State, Northeastern Brazil, 2000-2020. / Judicialização do direito à saúde com foco em doenças tropicais negligenciadas: dimensões e desafios no Estado do Piauí, Nordeste do Brasil, 2000-2020.

This article aims to analyse the magnitude and profile of legal demands for public health goods and services, also verifying the presence of legal demands for neglected tropical diseases (NTDs) in the State of Piauí between 2000-2020. Cross-sectional descriptive study based on the databases of the Court of Justice of Piauí on lawsuits demanding from the Direct Public Administration, goods and health services. A total of 6,658 lawsuits were initially identified. After eligibility analysis, 1,384 cases (20.8%) were analysed, with an increase in demand from 2017. We highlight the characteristics: origin in the capital Teresina (614; 44.4%), 40 to 59 years of age (372; 26.9%), female (761; 55.0%), farmers (123; 8.9%), public legal assistance (1,063; 76.8%), upheld (594; 42.9%). Five (5; 0.4%) lawsuits for NTDs, one visceral leishmaniasis requesting transportation, with granting, four for leprosy (two medicines, one granted, other extinguished without resolution of the merit, one consultation and one exam granted). The judicialization of the right to health is expressive and growing in the State of Piauí. The low demand related to NTDs may translate into limited access not only to health care, but also to the judiciary.

O objetivo deste artigo é analisar a magnitude e o perfil das demandas judiciais por bens e serviços de saúde pública, verificando também a presença de demandas judiciais para doenças tropicais negligenciadas (DTNs) no Estado do Piauí entre 2000-2020. Estudo transversal descritivo a partir de bases de dados do Tribunal de Justiça do Piauí acerca de processos judiciais demandando bens e serviços de saúde à administração pública direta. Foram identificados inicialmente um total de 6.658 processos judiciais. Após análise de elegibilidade, 1.384 processos (20,8%) foram analisados, verificando-se aumento da demanda a partir de 2017. Ressalta-se as características: origem na capital Teresina (614; 44,4%), 40 a 59 anos de idade (372; 26,9%), sexo feminino (761; 55,0%), agricultores (123; 8,9%), assistência jurídica pública (1.063; 76,8%), julgados procedentes (594; 42,9%). Cinco (5; 0,4%) demandas judiciais para DTNs, uma leishmaniose visceral solicitando transporte, procedente; quatro para hanseníase (dois medicamentos, um concedido, outro extinto sem resolução do mérito, uma consulta e um exame, ambos concedidos). A judicialização do direito à saúde é expressiva e crescente no estado do Piauí. A baixa demanda relacionada a DTNs pode traduzir limitação de acesso não apenas à saúde, mas ao Poder Judiciário.

[Human Health Rights: Discussing Health Inequality for Taiwanese Indigenous Peoples and the Appropriateness of Current Epidemic Policies].

Many studies from around the world demonstrate that COVID-19 has had significantly higher rates of infection, hospitalization, and mortality among indigenous and other vulnerable groups than among mainstream population groups. This situation has exposed and reinforced pre-existing health inequalities. This article investigates the rates of infection and mortality among different cultural groups during the COVID-19 pandemic, and then deconstructs the key elements related to systemic or structural racism. The impacts on the human rights and health of indigenous peoples and issues of policy formulation and resource equity during the epidemic are also mentioned. Based on the identified root causes of health inequality, suggestions for reducing health inequality for Taiwanese indigenous peoples are proposed. Further, during epidemics, policymakers must design and implement culturally appropriate epidemic prevention policies, systems, and strategies for indigenous and other disadvantaged populations.

COVID-19 Vaccination in Pediatric Population: A Necessity or Obstruction to the Protection of the Right to Health? Biojuridical Perspective.

One of the most recently debated topics worldwide is the mass vaccination of children against coronavirus disease 2019 (COVID-19). Next, the risk/benefit ratio of COVID-19 vaccination and infection in children are compared. Nonetheless, the real question in this debate is as follows: Does the vaccine represent a necessary tool or is it an obstacle in protecting the right to health? From a public health point of view, the Supreme Court of Nova Scotia, in Canada, recommends COVID-19 vaccination in the pediatric population. Based on Article 25 of the Draft Articles on State responsibility, vaccination can be considered a social act necessary for protecting the individual's right to health. The 1989 New York Convention on the Rights of the Child and the European Regulation number 219/1111 state that the opinion of a minor aged >12 years is considerable. However, this validity of opinion is related to age and degree of discernment. The onset of adverse events following the administration of the COVID-19 vaccine may lead to compensation in the near future. Recent studies have identified a new COVID-19-related pediatric pathology, known as multisystem inflammatory syndrome. Other studies have demonstrated that myocarditis in the pediatric population might occur following COVID-19 vaccine administration. In June 2021 in the USA, the Center for Control and Prevention of Infectious Diseases Advisory Committee on Immunization Practices declared that the benefits of vaccination against COVID-19 in the pediatric population outweighed the risks. In the meantime, whereas the bioethical debate remains open, monitoring the real risk/benefit ratio of vaccination in the pediatric population is crucial.

Centering the Right to Health of Childbearing People in the US During the COVID-19 Pandemic.

Childbearing people in the US have experienced the double burden of increased risks from infection and significant disruptions to access and quality of essential health care services during the COVID pandemic. A single person could face multiple impacts across the course of their reproductive trajectory. We highlight how failure to prioritize this population in the COVID-19 policy response have led to profound disruptions from contraception services to vaccination access, which violate foundational principles of public health, human rights and perpetuate inequities. These disruptions continued through the omicron surge, during which many health systems became overwhelmed and re-imposed earlier restrictions. We argue that an integrated pandemic response that prioritizes the healthcare needs and rights of childbearing people must be implemented to avoid deepening inequities in this and future pandemics.

A legal-realist assessment of human rights, right to health and standards of healthcare in the Malawian prison system during COVID-19 state disaster measures.

PURPOSE: The first case of COVID-19 in the Malawi prison system was reported in July 2020. Human rights organisations raised concerns about the possibility of significant COVID-19 outbreaks and deaths in the prison system, because of the poor infrastructure, lack of healthcare and adequate COVID-19 mitigation measures, existing co-morbidities (tuberculosis, HIV and hepatitis C), malnutrition and poor health of many prisoners. DESIGN/METHODOLOGY/APPROACH: The authors conducted a legal-realist assessment of the Malawian prison system response to COVID-19 during state disaster measures, with a specific focus on the right to health and standards of healthcare as mandated in international, African and domestic law. FINDINGS: The Malawi prison system was relatively successful in preventing serious COVID-19 outbreaks in its prisons, despite the lack of resources and the ad hoc reactive approach adopted. Whilst the Malawi national COVID plan was aligned to international and regional protocols, the combination of infrastructural deficits (clinical staff and medical provisions) and poor conditions of detention (congestion, lack of ventilation, hygiene and sanitation) were conducive to poor health and the spread of communicable disease. The state of disaster declared by the Malawi Government and visitation restrictions at prisons worsened prison conditions for those working and living there. ORIGINALITY/VALUE: In sub-Saharan Africa, there is limited capacity of prisons to adequately respond to COVID-19. This is the first legal-realist assessment of the Malawian prison system approach to tackling COVID-19, and it contributes to a growing evidence of human rights-based investigations into COVID-19 responses in African prisons (Ethiopia, South Africa and Zimbabwe).

Gender medicine as a tool for implementing the right to health.

BACKGROUND: The COVID-19 pandemic has increased the interest in the right to health, which represents a relatively new concept brought about by progress in medical science and the evolution of societies. The Italian Constitution, in article 32, states the right to health without specifications about the parameter of sex, assuming that this fundamental right is property of women and men indiscriminately. OBJECTIVE: To assess whether the right to health has actually been achieved in an equal way from the standpoint of sex, and whether a hypothetically "neutral" approach is actually convincing and profitable in this context. METHODS: This paper analyzes the topic of gender medicine from a scientific and legal perspective, based on current medical literature and its implementation in the Italian and European legal systems. RESULTS: Gender medicine is the only credible response to sex- and gender-based inequalities affecting the right to health, as it provides tools to address persisting inequalities in prevention and treatment, thus pursuing health for all: women and men. CONCLUSIONS: The importance of this path was underlined also by the Summit and the Rome Declaration of 21 May 2021, acknowledging that the topic of sex and gender can no longer be overlooked in focusing a correct and equal healthcare approach.

What is the added value of incorporating pleasure in sexual health interventions? A systematic review and meta-analysis.

Despite billions of dollars invested into Sexual and Reproductive Health and Rights (SRHR) efforts, the effect of incorporating sexual pleasure, a key driver of why people have sex, in sexual health interventions is currently unclear. We carried out a systematic review and meta-analysis following PRISMA guidelines across 7 databases for relevant articles published between 1 January 2005-1 June, 2020. We included 33 unique interventions in our systematic review. Eight interventions reporting condom use outcomes were meta-analyzed together with a method random effects model. Quality appraisal was carried out through the Cochrane Collaborations' RoB2 tool. This study was pre-registered on Prospero (ID: CRD42020201822). We identified 33 unique interventions (18886 participants at baseline) that incorporate pleasure. All included interventions targeted HIV/STI risk reduction, none occurred in the context of pregnancy prevention or family planning. We find that the majority of interventions targeted populations that authors classified as high-risk. We were able to meta-analyze 8 studies (6634 participants at baseline) reporting condom use as an outcome and found an overall moderate, positive, and significant effect of Cohen's d = 0·37 (95% CI 0·20-0·54, p < 0·001; I2 = 48%; τ2 = 0·043, p = 0·06). Incorporating sexual pleasure within SRHR interventions can improve sexual health outcomes. Our meta-analysis provides evidence about the positive impact of pleasure-incorporating interventions on condom use which has direct implications for reductions in HIV and STIs. Qualitatively, we find evidence that pleasure can have positive effects across different informational and knowledge-based attitudes as well. Future work is needed to further elucidate the impacts of pleasure within SRHR and across different outcomes and populations. Taking all the available evidence into account, we recommend that agencies responsible for sexual and reproductive health consider incorporating sexual pleasure considerations within their programming.

Why catastrophic events, human enhancement and progress in robotics may limit individual health rights.

Despite the fact that people usually believe that individual health rights have an intrinsic value, they have, in fact, only extrinsic value. They are context dependent. While in normal conditions the current societies try to guarantee individual health rights, the challenge arises in emergency situations. Ones of them are pandemics including current covid-19 pandemic. Emergency situations challenge individual health rights due to insufficient medical resources and non-random criteria of selection of patients. However, there are some reasons to assume that societal and technological processes in the near future will threaten permanently individual health rights in normal conditions. Such processes include progress in commonly available human enhancement technologies, and progress in robotics and automation. In this paper I show how individual health rights will be challenged in both scenarios including catastrophic events and future technological progress. In both cases, the idea of assisted dying is discussed as possibly the unique healthcare principle available for people whose individual health rights will be limited or canceled due to catastrophes or technological and financial exclusion. The special case of future space missions is also discussed as an example of an extreme environment affecting the way moral norms are viewed in health care ethics.

Renu Khanna: giving women a voice in health and health care.

Renu Khanna talks to Andréia Azevedo Soares about implementing feminist-inspired health interventions and encouraging women to make themselves heard on matters of health policy.

Global health without sexual and reproductive health and rights? Analysis of United Nations documents and country statements, 2014-2019.

INTRODUCTION: The initial International Conference on Population and Development in 1994 contains the first reference to sexual and reproductive health and reproductive rights (SRHR). It has been considered agreed language on SRHR in future United Nations (UN) documents. However, opposition to SRHR in global forums has increased, including in conjunction with an increase in religious, far-right populist politics. This study provides an empirical analysis of UN documents to discover whether opposition to SRHR has resulted in changes in the language on SRHR between and what these changes are. METHODS: This is a qualitative policy analysis in which 14 UN resolutions, 6 outcome documents from the Commission on the Status of Women (CSW) and 522 country and group statements and 5 outcome reports from the Commission on Population and Development were collected from the organisations websites from 2014 to 2019. Framework analysis was used. The text from documents was charted and indexed and themes developed from these. RESULTS: The results demonstrated a disappearance of the language on abortion in the CSW outcome documents from 2017 and a change in the language on comprehensive sexuality education in the CSW as well as the UN General Assembly resolutions from 2018. This change included a removal of 'sexuality' to an increased emphasis on the role of families. Furthermore, documents showed an inability of some states to accept any mention of sexual and reproductive health at all, expanding from the usual contestations over abortion. CONCLUSION: Our findings suggest that the global shift in politics and anti-SRHR actors at UN negotiations and conferences have removed previously agreed on language on SRHR from future UN resolutions and outcome documents. This is a concern for the global realisation of SRHR.

Big Data Technology Applications and the Right to Health in China during the COVID-19 Pandemic.

Individuals have the right to health according to the Constitution and other laws in China. Significant barriers have prevented the full realisation of the right to health in the COVID-19 era. Big data technology, which is a vital tool for COVID-19 containment, has been a central topic of discussion, as it has been used to protect the right to health through public health surveillance, contact tracing, real-time epidemic outbreak monitoring, trend forecasting, online consultations, and the allocation of medical and health resources in China. Big data technology has enabled precise and efficient epidemic prevention and control and has improved the efficiency and accuracy of the diagnosis and treatment of this new form of coronavirus pneumonia due to Chinese institutional factors. Although big data technology has successfully supported the containment of the virus and protected the right to health in the COVID-19 era, it also risks infringing on individual privacy rights. Chinese policymakers should understand the positive and negative impacts of big data technology and should prioritise the Personal Information Protection Law and other laws that are meant to protect and strengthen the right to privacy.

Immigration Detention in the United States: Identifying Alternatives That Comply With Human Rights and Advance Public Health.

Under international law, the United States is obligated to uphold noncitizens' fundamental rights, including their rights to health. However, current US immigration laws-and their enforcement-not only fail to fulfill migrants' health rights but actively undermine their realization and worsen the pandemic's spread. Specifically, the US immigration system's reliance on detention, which precludes effective social distancing, increases risks of exposure and infection for detainees, staff, and their broader communities. International agreements clearly state that the prolonged, mandatory, or automatic detention of people solely because of their migration status is a human rights violation on its own. But in the context of COVID-19, the consequences for migrants' right to health are particularly acute. Effective alternatives exist: other countries demonstrate the feasibility of adopting and implementing immigration laws that establish far less restrictive, social services-based approaches to enforcement that respect human rights. To protect public health and realize its global commitments, the United States must shift away from detaining migrants as standard practice and adopt effective, humane alternatives-both amid COVID-19 and permanently.

[Vaccine against covid-19: an open question.] / Vaccino contro la covid-19: una questione aperta.

For covid-19, a disease that has proved fatal in many cases, a specific therapy has not yet been found, but the vaccine. This has triggered a further series of issues. Who to vaccinate first, how to achieve the so-called "herd immunity", especially if it is right, as it is being done, start with the medical staff and immediately after safeguard the elderly which also involve the problem of a clear explanation and acceptance, through informed consent, which it can be particularly difficult to illustrate.