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Strengthening Latin America's presence in global health

The BMJ’s regional advisory board will give this important region a louder voice

In recent decades, Latin America has made important contributions to global health. Although substantial economic and social inequalities and political instability continue to adversely affect population health, the region is developing knowledge, health policies, and experience that deserve wider recognition. Contributions include Latin America’s efforts in social medicine, especially in social security and nutrition1; national public policies that have become a world reference, such as the compulsory licensing of an AIDS drug in Brazil in 20072; and the health cooperation agenda intended to create a platform for solidarity focusing on infrastructure, health, security, and natural resources within the framework of the now dissolved Union of South American Nations.3

Building on these contributions, and to help boost the region’s profile and leadership in global health, The BMJ has established its first regional advisory board for Latin America, as part of its wider regional advisory board programme.4 We began work in late 2023 with a focus on identifying common themes and issues in countries within the region to advance collective efforts for health. The board will also advise and support the journal’s editorial strategies to publish leading research and commentary from Latin America.

The 20 countries in Latin America, with a total population …

United-states , Sydney , New-south-wales , Australia , Buenos-aires , Distrito-federal , Argentina , Brazil , Montevideo , Uruguay , Spain , Peru

The predictable crisis of covid-19 in Canada's long term care homes

Sharon Straus and colleagues argue that residents, families, and staff in long term care homes in Canada were failed by governments during the pandemic and need coordinated efforts across federal, provincial, and territorial governments to safeguard these populations

### Key messages

People living and working in long term care homes (LTCHs) (box 1) in Canada—mostly older adults—were disproportionately affected by covid-19.1 LTCH residents accounted for 3% of covid cases in Canada and 43% of related deaths by December 2021, among the highest proportion of LTCH covid-19 deaths worldwide.12 LTCH residents were prioritised for the covid-19 vaccine rollout and by 15 March 2021 95% had received their first dose.1 Outbreaks and deaths declined but continued; more LTCH outbreaks occurred in 2022 than in 2020 and 2021 combined as vaccination booster uptake varied.3 In 2022 covid-19 was the leading cause of hospital admissions of older adults in Canada.4 Compared with before the pandemic, LTCH residents received less medical care, experienced increased antipsychotic use, and had less visitor contact, resulting in social isolation.56

Box 1
### Long term care homes in CanadaRETURN TO TEXT

Canada , Australia , United-kingdom , Denmark , Finland , Norway , Quebec , Canadian , British , Scotland , Sharon-straus , Vivian-ewa

Race, racism, and covid-19 in the US: lessons not learnt

Keisha Bentley-Edwards and colleagues argue that systemic racism and economic inequality are at the root of disparity in covid-19 outcomes and suggest how to distribute resources more equitably.

The story of covid-19 in the United States is one of many systemic failures to protect its residents from preventable illness and death. Racist stereotypes about disease susceptibility1 were subsequently discredited by the data.2 Covid-19 brought the US to a sobering standoff with race, a social construct that through systemic racism materializes as disparate outcomes (box 1).3 Once testing became available researchers disaggregated and analyzed data along racial lines, providing a more accurate understanding that was unsurprising to anyone who has examined health equity4: covid-19 is a preventable disease that disproportionately affects racial minorities. Although the effects were felt in all racialized communities, they were magnified most powerfully for black, Latino, and indigenous people in the US.

Box 1
### Race is not a risk factor for disparate health outcomes—racism and capitalism are

Race has been largely debunked as a plausible reason for susceptibility to disease, despite lagging realization and action in the medical community.67

If we can understand race as a social construct, then we can point to social contexts as causes for health inequalities rather than biology. The following definitions can be used to understand race in the US:RETURN TO TEXT

United-states , Hawaii , Philadelphia , Pennsylvania , American , Hawaiians , America , Americans , Kl-bentley-edwards-keisha , Whitneyr-robinson , Elizabeths-mcclure , Olanrewaju-adisa

Covid-19 in US jails and prisons: implications for the next public health crisis

Katherine LeMasters and Lauren Brinkley-Rubinstein raise concerns about the lack of sustained change in prison health transparency after covid-19 and implications for future public health crises

People in the jails and prisons across the United States are often housed in abysmal and unlawful conditions that have dire consequences for health.1 From poorly designed built environments (eg, lack of air conditioning, overcrowded dorms) to stressful and unpredictable living quarters, to a lack of quality and timely healthcare, time spent in incarceration worsens peoples’ health.23 In fact, the American Public Health Association considers the current state of incarceration in the US to be a public health crisis.4 Rates of incarceration are high. Although the US contains less than 5% of the global population, it accounts for 20% of the global incarcerated population.5 Furthermore, incarceration disproportionately affects Black, Native American, and Latino people, contributing to racial health inequities.6

Despite the problems of mass incarceration, it is not monitored like other public health crises in the US.7 For instance, there is no real time or comprehensive health data reporting from the country’s 53 disaggregated prison systems (50 state prison systems, the Federal Bureau of Prisons, Puerto Rico, and the national Immigrations and Customs Enforcement). These data are critical for understanding prison population dynamics (eg, when and how many people are dying in custody), quantifying health inequities (eg, rates of infectious disease spread in prisons versus the general population), and documenting how incarceration is affecting chronic health conditions. Only with these real time, comprehensive data can we work toward improving the health and wellbeing of individuals and communities affected by mass incarceration. In this article, part of a BMJ series examining US covid-19 lessons (http://bmj.com/collections/uscovid- series), we examine how despite the problems of mass incarceration, it is not monitored …

United-states , North-carolina , Texas , Alabama , Vermont , Rhode-island , Louisiana , Mississippi , Puerto-rico , Massachusetts , Tennessee , Washington

Building harm reduction into global health security and pandemic prevention

Building harm reduction into global health security and pandemic prevention
bmj.com - get the latest breaking news, showbiz & celebrity photos, sport news & rumours, viral videos and top stories from bmj.com Daily Mail and Mail on Sunday newspapers.

United-states , New-york , Diez-roux , Gavin-yamey , Jessica-malatyrivera , Saskia-popescu , Jocalyn-clark , Global-health-security-agenda , Harm-reduction-international , World-health-organization-preparedness , Reduction-international , Rapid-epidemiologic-study

Legal infrastructure for pandemic response: lessons not learnt in the US

Michelle Mello and colleagues argue that state legal reforms have generally exacerbated rather than improved weaknesses in US emergency powers revealed by covid-19, jeopardizing future responses

Covid-19 related mortality in the US was higher than in every western European country.1 Compared with its closest neighbour, Canada, also a federated country with a decentralised health system, the US fared far worse.2 With over 1.1 million dead at the end of 2023,3 leaders and academics have begun a painful postmortem. What went wrong, and what can be done to make authorities in the US better equipped for the next pandemic?

In this article, part of a BMJ series examining US covid-19 lessons (http://bmj.com/collections/us-covid-series), we focus on the role of legal infrastructure, including both the law itself and the capacity to wield it effectively.45 A web of federal, state, and local laws determines what officials can do to respond to emergencies. These laws are helpful only to the extent that officials are willing and able to use them effectively. From almost the beginning of the pandemic, criticism was levelled at the White House and some state governors for failing to implement or maintain essential interventions to combat covid-19. Even where legal powers were wielded, trouble arose.

Governmental powers proved too fragmented and limited in some respects, making it difficult to erect a nationwide net of community mitigation measures such as stay-at-home orders; school and business closures; mask, vaccination, and testing requirements; and restrictions on gatherings. Many Americans, however, saw the powers as too expansive in other respects, objecting to protracted health orders that impinged on religious freedom and other personal liberties.6 Both problems need fixing, but this lesson is only half learnt. Political forces have pushed reform efforts strongly in one direction—weakening public health legal powers—with potentially …

Canada , Montana , United-states , South-carolina , District-of-columbia , White-house , Florida , Idaho , Utah , Americans , Diez-roux , Raevyn-walker

Is the US prepared for the next pandemic? No, but it could be

Chelsea Cipriano , Kushal Kadakia , and Dave Chokshi argue that the US must end its collective amnesia about public health disasters and act collaboratively to strengthen services

Throughout American history, leaders have stood up in the aftermath of disasters and committed to honoring the past by investing for the future. For example, the Space Shuttle Columbia disaster in 2003 led NASA to overhaul its safety culture and attracted new partnerships that are paving the way to America’s return to the Moon.1 Likewise, after a multistate blackout that same year, the North American Electric Reliability Corporation was charged with ensuring nationwide reliability of the power grid through an innovative multistate model of standardized sharing of data, staffing, and resources among power companies.2

Yet when it comes to public health disasters, the US has consistently chosen to forget instead of futureproof. Consider the repeated cuts to core public health agencies and programs, including the Public Health Emergency Preparedness Program, after the H1N1, Ebola, and Zika outbreaks in the decade before covid-19.3 More recently, growing misinformation about childhood immunizations has reversed progress on …

United-states , Dallas , Texas , New-york , America , American , Americans , Dave-chokshi , Kushalt-kadakia , Chelsea-cipriano , Chelseab-cipriano , Jocalyn-clark

US public health after covid-19: learning from the failures of the hollow state and racial capitalism

Justin Feldman and Mary Bassett describe how diminished political will to use government powers for service provision hampered the US response to the covid-19 pandemic and what needs to change

The US response to the covid-19 pandemic failed in its central task of protecting life. When the government’s public health emergency declaration ended on 11 May 2023, more than 1.1 million people in the US had died, the covid-19 death rate was higher than in comparable wealthy nations,1 and gaping racial and ethnic inequalities in mortality remained.2 In public health circles, chronic underfunding of public health agencies is often used to explain the shortcomings of the US covid-19 pandemic response.3 If only health departments had larger budgets, these arguments go, government could have expanded efforts to prevent SARS-CoV-2 transmission, promote vaccination, and deliver early treatment to medically vulnerable people.

The budgetary concerns are warranted. Only 1% of the country’s total health spending is devoted to public health activities.4 State public health spending was flat in the decade following the 2008-09 recession5 despite growing needs, including rising maternal mortality6 and stagnant or declining life expectancy.7 However, the challenges facing government public health go beyond budgetary constraints. Although starving health department budgets is harmful, it is a symptom of the more fundamental problem of political divestment from state capacity and state directed projects of social transformation.

The pandemic has revealed that US federal politics can support high levels of spending in response to a major crisis. The CARES Act, a $2.2tn pandemic response bill passed by US Congress in March of 2020, was the largest spending bill in the country’s history, and the American Rescue Plan Act (ARPA), passed by Congress in March 2021, provided $350bn in fiscal support to state, local, and tribal governments. …

United-states , Texas , Boston , Massachusetts , Rwanda , Vietnam , Republic-of , Kerala , India , White-house , District-of-columbia , New-york

After covid-19: the case for optimism for US leadership in global health

As the United States enters an election year with huge international stakes, it is easy to be pessimistic that the value of continued US leadership in global health, including pandemic preparedness, will be the subject of prominent debate in the 2024 elections. Geopolitical crises in Ukraine, Israel-Palestine, and China-Taiwan dominate attention and policy. Climate, debt overhang, food insecurity, and humanitarian crises compete for attention. The flagship President’s Emergency Plan for AIDS Relief (PEPFAR) has lost prominence. President Biden has said little on the campaign trail about the value of global health to US national interests. If Donald Trump is the Republican candidate, he will certainly say little positive about global health. And, as the BMJ series on lessons from the US covid response lays out (http://bmj.com/collections/us-covid-series), covid-19 exposed and aggravated pre-existing systemic and structural weaknesses in healthcare and public health.

There is little doubt that US performance during covid-19, along with that of most other powerful, high income countries, was dominated by sovereign self-interest, alienated the global south, and raised doubts about the sustainability and reliability of the global north during crises.

Pessimism and awareness of the damage to the US’s standing, though realistic and accurate, miss a vital opportunity. There is considerable reason to be hopeful. The US contributed more than $19bn (£15bn; €17bn) to the global covid-19 response, far more than any other high income country.1 US global health funding remains steady at more than $12bn a year.2 Moreover, much progress in global health is unfolding, grounded in enduring political support across partisan party lines. Global health remains …

United-states , Taiwan , China , Israel , Ukraine , American , America , Americans , Gavin-yamey , Paul-friedrichs , Helened-gayle , J-stephen-morrison

Pandemic lessons for the 2024 US presidential election

Pandemic lessons for the 2024 US presidential election
bmj.com - get the latest breaking news, showbiz & celebrity photos, sport news & rumours, viral videos and top stories from bmj.com Daily Mail and Mail on Sunday newspapers.

United-states , Canada , North-carolina , New-york , United-kingdom , Americans , Kamran-abbasi , Gavin-yamey , V-diez-roux , Diez-roux , Jocalyn-clark , National-academy-of-science