In 2010, the Mexican government implemented a multi-sector agreement to prevent obesity. In response, the Ministries of Health and Education launched a national school-based policy to increase physical activity, improve nutrition literacy, and regulate school food offerings through nutritional guidelines. We studied the Guidelines' negotiation and regulatory review process, including government collaboration and industry response. Within the government, conflicting positions were evident: the Ministries of Health and Education supported the Guidelines as an effective obesity-prevention strategy, while the Ministries of Economics and Agriculture viewed them as potentially damaging to the economy and job generation. The food and beverage industries opposed and delayed the process, arguing that regulation was costly, with negative impacts on jobs and revenues. The proposed Guidelines suffered revisions that lowered standards initially put forward. We documented the need to improve cross-agency cooperation to achieve effective policymaking. The 'siloed' government working style presented a barrier to efforts to resist industry's influence and strong lobbying. Our results are relevant to public health policymakers working in childhood obesity prevention.
A moral right to health or health care, given reasonable resource constraints, implies a reasonable array of services, as determined by a fair deliberative process. Such a right can be embodied in a constitution where it becomes a legal right with similar entitlements. What is the role of the courts in deciding what these entitlements are? The threat of "judicialization" is that the courts may overreach their ability if they attempt to carry out this task; the promise of judicialization is that the courts can do better than health systems have done at determining such entitlements. We propose a middle ground that requires the health system to develop a fair, deliberative process for determining how to achieve the progressive realization of the same right to health or health care and that also requires the courts to develop the capacity to assess whether the deliberative process in the health system is fair.
salud pública de méxico / vol. 62, no. 2, marzo-abril de 2020 Vacunación en México, cifras imprecisas Artículo especiAl Hernández-Ávila M, Palacio-Mejía LS, Hernández-Ávila JE, Charvel S. Vacunación en México: coberturas imprecisas y deficiencia en el seguimiento de los niños que no completan el esquema. Salud Publica Mex. 2020;62:215-224. https://doi.org/10.21149/10682 Hernández-Ávila M, Palacio-Mejía LS, Hernández-Ávila JE, Charvel S. Vaccination in Mexico: imprecise coverages and deficiency in the follow-up of children with incomplete immunization. Salud Publica Mex. 2020;62:215-224.https: //doi.org/10.21149/10682 Vacunación en México: coberturas imprecisas y deficiencia en el seguimiento de los niños que no completan el esquema
Objetivo. Analizar la cobertura en salud de cáncer pulmonar en México y ofrecer recomendaciones al respecto. Material y métodos. Mediante la conformación de un grupo multidisciplinario se analizó la carga de la enfermedad relativa al cáncer de pulmón y el acceso al tratamiento médico que ofrecen los diferentes subsistemas de salud en México. Resultados. Se documentan desigualdades importantes en la atención del cáncer de pulmón entre los distintos subsistemas de salud que sugieren acceso y cobertura en salud variable, tanto a los tratamientos tradicionales como a las innovaciones terapéuticas existentes, y diferencias en la capacidad de los prestadores de servicios de salud para garantizar el derecho a la protección de la salud sin distinciones. Conclusión. Se hacen recomendaciones sobre la necesidad de mejorar las acciones para el control del tabaco, el diagnóstico temprano y la inclusión de terapias innovadoras y la homologación entre los diferentes prestadores públicos de servicios de salud a través del financiamiento con la recaudación de impuestos al tabaco
ENSAYOResumen La disminución de la tasa de lactancia materna en México es un problema de salud pública. En este artículo discutimos un enfoque regulatorio -Regulación Basada en Desempeño-y su aplicación para mejorar las tasas de lactancia materna. Este enfoque obliga a la industria a asumir su responsabilidad por la falta de lactancia materna y sus consecuencias. Se considera una estrategia factible de ser aplicada al caso, ya que el mercado de sucedáneos tiene una estructura oligopólica, donde es relativamente fácil fijar la contribución de cada participante del mercado en el problema; incide en un grupo poblacional definido; tiene un objetivo regulatorio que puede ser fácilmente evaluado, y se pueden definir las sanciones bajo criterios objetivos. Para su aplicación se recomienda: modificar la política pública, crear convenios de concertación con la industria, establecer sanciones disuasorias, fortalecer los mecanismos de supervisión y alinear lo anterior al Código Internacional de Comercialización de Sucedáneos. AbstractThe decreasing breastfeeding rate in México is of public health concern. In this paper we discus an innovative regulatory approach -Performance Based Regulation-and its application to improve breastfeeding rates. This approach, forces industry to take responsibility for the lack of breastfeeding and its consequences. Failure to comply with this targets results in financial penalties. Applying performance based regulation as a strategy to improve breastfeeding is feasible because: the breastmilk substitutes market is an oligopoly, hence it is easy to identify the contribution of each market participant; the regulation's target population is clearly defined; it has a clear regulatory standard which can be easily evaluated, and sanctions to infringement can be defined under objective parameters. Recommendations: modify public policy, celebrate concertation agreements with the industry, create persuasive sanctions, strengthen enforcement activities and coordinate every action with the International Code of Marketing of Breast-milk Substitutes.
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