Revista Panamericana de Salud Pública/Pan American Journal of Public Health

La salud mental y los procedimientos reglamentarios en las Américas: la protección de los derechos humanos de las personas recluidas y retenidas en hospitales psiquiátricos contra su voluntad

En muchos países de la región de las Américas, las personas con discapacidades mentales pueden ser recluidas en centros psiquiátricos contra su voluntad, indefinidamente, sin apenas justificación, y con poca supervisión o ninguna. Estas circunstancias son una clara violación de derechos humanos, tales como el derecho a la libertad, y del derecho al procedimiento reglamentario con todas las garantías judiciales, tal como establecen los tratados de derechos humanos con fuerza vinculante en los niveles internacional y regional. Además, muchos países de América Latina y el Caribe no han adoptado leyes específicas en materia de salud mental ni han interpretado los dictámenes constitucionales en el contexto de la salud mental de una manera acorde con los principios y recomendaciones que rigen actualmente en materia de derechos humanos. Los mecanismos de vigilancia y monitoreo del Sistema Interamericano de Derechos Humanos pueden constituir un instrumento jurídico eficaz y de utilidad para promover y proteger los derechos humanos y las libertades fundamentales de las personas con discapacidades mentales; en este sentido pueden suplementar las leyes nacionales o servir como fuente de regulación en aquellos lugares donde no existen leyes nacionales. Los países deben promulgar leyes nacionales que confieren una protección básica, de acuerdo con las garantías legales, a aquellas personas que hayan sido recluidas en centros de salud mental en contra de su voluntad. Esto ayudaría a garantizar que las personas no sean internadas y retenidas de forma arbitraria, que la discapacidad mental sea lo bastante grave como para justificar su internamiento involuntario, y que la decisión de internar y retener a la persona sea revisada periódicamente, de manera eficiente, por un tribunal independiente e imparcial. Consideramos necesaria una aplicación más rigurosa de las normas de los derechos humanos por parte del Sistema Interamericano de Derechos Humanos, a fin de lograr que los estados se responsabilicen de la manera como tratan a las personas con discapacidades mentales y que promulguen leyes para proteger los derechos de aquellas que hayan sido recluidas en centros psiquiátricos contra su voluntad.

El derecho a la salud en Colombia: una propuesta para su fundamentación moral

Palabras clave: justicia social, prestación de atención de salud, recursos en salud, asignación de recursos, derechos humanos, reforma en atención de la salud, Colombia.

The right to health in Colombia: a proposal for laying down its moral foundations

The health system reform that was carried out in Colombia in 1993 was based on neoliberal doctrine. That reform increased the inequity in the allocation of resources, access to health services, and the distribution of spending on health. Societal organizations, academic groups, health workers, and some members of the political sector in Colombia have opposed the neoliberal reform, and they have supported the right to health as an alternative for dealing with the inequities in the health sector. According to liberal theories, only civil and political rights are fundamental, and liberty is assumed to be only the freedom of process and the absence of coercive mechanisms. However, there are arguments that support the viewpoint that health is a fundamental human right. This piece analyzes some ethical and moral principles that can help establish the moral foundations for the right to health. Among these principles are equality of opportunity, that part of being free is for people to have the right to develop themselves as human beings, that the right to health is connected to the right to life, that all people deserve equal respect (which requires the equal distribution of goods and of societal responsibilities), and that liberty is the opportunity that all persons should have to carry out the plans that they have for their lives, as chosen from a variety of socially useful alternatives.

Key words: social justice, delivery of health care, health resources, resource allocation, human rights, health care reform, Colombia.

Toward primary health care adapted to elderly people

This Spanish-language piece summarizes a World Health Organization report entitled Towards Age-friendly Primary Health Care. The piece presents principles for primary health care centers that are adapted for older adults. These principles focus on three major areas: (1) information, education, communication, and training, including staff training in clinical geriatrics and patient education; (2) health care management systems, including adapting administrative procedures, such as patient registration, to the special needs of older adults, and supporting the continuity of medical care by having updated medical records ready and available at every patient visit; and (3) the physical environment, with clean and comfortable centers that adhere, as much possible, to universal design principles, thus making them usable by as many people as possible regardless of age or ability.

Keywords: primary health care, aging.

Neoliberal health sector reforms in Latin America: unprepared managers and unhappy workers

This work analyzes the neoliberal health sector reforms that have taken place in Latin America, the preparation of health care workers for the reforms, the reforms' impacts on the workers, and the consequences that the reforms have had on efficiency and quality in the health sector. The piece also looks at the process of formulating and implementing the reforms. The piece utilizes secondary sources and in-depth interviews with health sector managers in Bolivia, Colombia, Costa Rica, the Dominican Republic, Ecuador, El Salvador, and Mexico. Neoliberal reforms have not solved the human resources problems that health sector evaluations and academic studies had identified as the leading causes of health system inefficiency and low-quality services that existed before the reforms. The reforms worsened the situation by putting new pressures on health personnel, in terms of both the lack of necessary training to face the challenges that came with the reforms and efforts to take away from workers the rights and benefits that they had gained during years of struggles by unions, and to replace them with temporary contracts, reduced job security, and lower benefits. The secrecy with which the reforms were developed and applied made workers even more unified. In response, unions opposed the reforms, and in some countries they were able to delay the reforms. The neoliberal reforms have not improved the efficiency or quality of health systems in Latin America despite the resources that have been invested. Nor have the neoliberal reforms supported specific changes that have been applied in the public sector and that have demonstrated their ability to solve important health problems. These specific changes have produced better results than the neoliberal reforms, and at a lower cost.

Key words: health sector reform, health personnel, Latin America.

Neoliberal reforms in health services in Latin America: a critical view from two case studies

Neoliberal reforms have promoted privatization and decentralization as strategies to improve equity, efficiency, and the quality of health services. In this piece the impact of these reforms in Latin America is critically analyzed, and the impacts of privatization in Colombia and of decentralization in Mexico are detailed. These two cases show that after 10 years of privatization in Colombia and 20 years of decentralization in Mexico the reforms have had the opposite of the desired effect: They have not improved equity, have increased health expenditures, have not increased efficiency, and have not shown a positive impact on quality. Public health programs in Colombia have deteriorated, while decentralization in Mexico has had a very high cost, without achieving the proposed objectives. It is officially accepted that decentralization in Mexico has increased inequity, and that new reforms implemented in 2003 promote vertical programs. Health systems based on regulated competition are not the most suitable ones for Latin America. Latin American countries should improve their health systems in line with the principles stated in the Declaration of Alma Ata and according to their own national experiences.

Key words: health sector reform, decentralization, privatization, Latin America, Colombia, Mexico.

Atraumatic restorative treatment to control dental caries: history, characteristics, and contributions of the technique

This paper presents relevant scientific information on the history, characteristics, and contributions of atraumatic restorative treatment (ART) for use in preventing and controlling dental caries.
Within the area of oral public health, ART has been for years an economical, effective method for preventing and controlling caries in vulnerable populations. Among other things, ART reduces the stress and anxiety in patients that conventional restoration methods produce. This technique promises major benefits for Latin America. However, given its limitations with dental cavities on two or more surfaces, it is recommended that more research on this approach be encouraged, with the aim of improving the technique’s effectiveness based on its characteristics, indications, and technical merits.

Keywords: Public health dentistry; community dentistry; preventive dentistry; dental caries; glass ionomer cements; dental restoration, temporary.

Este trabajo presenta información de relevancia científica sobre la historia, características y aportes de la técnica de restauración atraumática en la prevención y el control de la caries dental.
Dentro del ámbito de la salud pública bucodental, la técnica de restauración atraumática ha sido desde hace muchos años una medida económica y eficaz para la prevención y el control de la caries en poblaciones vulnerables. Permite, entre otras cosas, reducir el estrés y la ansiedad que generan los métodos convencionales de restauración. Vistas las limitaciones de su aplicación en cavidades dentales de dos o más superficies, se recomienda promover más la investigación sobre esta técnica, que promete grandes beneficios en los países latinoamericanos, con el propósito de mejorar su eficacia a partir de sus propias características, indicaciones y fundamentos técnicos.

The SAPUVET and SPVet networks: an integration model in veterinary public health between Europe and Latin America

This paper underscores the need for animal health professionals to play a more significant role in the sphere of public health, particularly during natural disasters and other emergency situations which can reduce the availability of safe foods from animal sources. In order to help readers understand the importance of the emerging field of veterinary public health (VPH), the authors review the importance and current status of VPH in different countries and assess the role that veterinarians can play in overcoming situations that threaten human health. The last section discusses the need for training veterinarians in VPH and the important role that veterinarians can play within international public health organizations and multidisciplinary groups, such as SAPUVET and SPVet networks.

Key words: public health, veterinary medicine, zoonoses, emergencies, animal welfare.

Objective. To estimate the prevalence of tobacco use, exposure to secondhand smoke, and smoking restrictions in the home and workplace among residents of Tijuana, one of Mexico’s largest cities.

Methods. This cross-sectional household survey was conducted in Tijuana, Baja California, Mexico, during 2003 and 2004. A population-based sample of 400 Tijuana adult residents responded to a tobacco survey, and 397 of the surveys were analyzed.

Results. About 22.9% (95% confidence interval (CI): 18.7%–27.1%) of Tijuana adults reported current smoking, and 53.9% (95% CI: 48.8%–58.9%) reported chronic exposure to secondhand smoke. Approximately 44.4% (95% CI: 37.9%–50.9%) of Tijuana adults had a nonsmoking policy in their workplace, while 65.8% (95% CI: 61.0%–70.6%) of Tijuana households were smoke-free.

Conclusions. The results underline the need for increased tobacco control efforts, particularly stricter enforcement of existing passive smoking regulations, in order to expand protection from secondhand smoke from private settings to public ones and to curb the tobacco epidemic in Tijuana and elsewhere in Mexico.

Objetivo. Calcular la prevalencia del consumo de tabaco, de la exposición a humo ajeno o ambiental y de la existencia de medidas restrictivas contra el tabaquismo en el hogar y en el lugar de trabajo entre residentes de Tijuana, una de las ciudades más grandes de México.

Métodos. Esta encuesta domiciliaria transversal se llevó a cabo en Tijuana, Baja California, México, durante 2003 y 2004. Una muestra poblacional de 400 adultos residentes de Tijuana respondió a una encuesta sobre el tabaquismo y 397 de las encuestas se sometieron a análisis.

Resultados. Cerca de 22,9% (intervalo de confianza de 95% [IC95%]: 18,7% a 27,1%) de los adultos residentes de Tijuana declararon que fumaban en el momento de la encuesta y 53,9% (IC95%: 48,8% a 58,9%) declararon estar expuestos crónicamente a humo ajeno o ambiental. Alrededor de 44,4% (IC95%: 37,9% a 50,9%) de los adultos en Tijuana dijeron que había reglamentos contra el tabaquismo en su lugar de trabajo, mientras que en 65,8% (IC95%: 61,0% a 70,6%) de los hogares de Tijuana no se fumaba dentro del hogar.

Conclusiones. Los resultados subrayan la necesidad de incrementar las medidas para el control del tabaquismo, especialmente las orientadas a hacer cumplir los reglamentos existentes contra la contaminación ambiental por humo de tabaco, todo a fin de extender la protección contra dicha contaminación más allá de los entornos privados a los públicos y frenar la epidemia de tabaquismo en Tijuana y en otras partes de México.