The Right to Health and the Social Determinants of Health in the Face of COVID-19. Tthe Spanish Experience after Austerity Policies
DOI:
https://doi.org/10.17561/tahrj.v16.6326Keywords:
Right to Health, COVID-19, Social Determinants of Health, Austerity PoliciesAbstract
The COVID-19 pandemic has particularly affected Spain in 2020. Although the specific causes and Spain’s response—as well as the aspects to be improved—are yet to be evaluated, many experts agree that this crisis has magnified some of the problems of the Spanish health system, highlighting the problems derived from the cuts in the capacities of the health and public health systems. We assess the current situation from the perspective of the right to health in its twofold dimension: health care and social determinants. For this purpose, we look into the configuration of the right to health in Spain and how the economic crisis and austerity policies affected it. In particular, we consider the impact both on institutional health care systems and in terms of social determinants of health. Finally, we make several proposals for strengthening the right to health.
References
AI, Amnestiy International (2020) Abandonadas a su suerte. La desprotección y discriminación de las personas mayores en residencias durante la pandemia Covid-19 en España. Madrid: Amnistía Internacional.
Álvarez González EM (2007) El Sistema Nacional de Salud como sistema: realidad y carencias. Derecho y Salud, 15(1): 1-28.
Añón MJ (2016) ¿Hay límites a la regresividad de derechos sociales?. Derechos y Libertades, 34:57-90.
Arcà E, Principe F, Doorslaer E (2020) Death by Austerity? The Impact of Cost Containment on Avoidable Mortality in Italy. Health Economics, 29(12):1500- 516. https://doi.org/10.1002/hec.4147
Bambra C, et al. (2020) The COVID-19 pandemic and health inequalities. Journal of Epidemiology and Community Health, 74:964-968. https://doi.org/10.1136/jech-2020-214401
Bartley M (2004) Health inequality. An introduction to theories, concepts and methods. Cambridge: Polity Press.
Benach J, et al. (2012) La sanidad está en venta. Y también nuestra salud. Barcelona: Icaria.
Borra C, Pons-Pons J, Vilar-Rodriguez M (2020) Austerity, healthcare provision, and health outcomes in Spain. The European Journal of Health Economics, 21(7): 409-423. https://doi.org/10.1007/s10198-019-01141-3
Cabrera de León A, et al. Austerity Policies and Mortality in Spain After the Financial Crisis of 2008. Am J Public Health. 2018 Aug;108(8):1091-1098. https://doi.org/10.2105/AJPH.2018.304346
Calvo M (2013) Crisis económica y efectividad de los derechos sociales, en Bernuz, MJ y Calvo M (eds.), La eficacia de los derechos sociales. Valencia: Tirant Lo Blanch, 89-132.
Cervero-Liceras F, Mckee M, Legido-Quigley H (2014) The Effects of the Financial Crisis and Austerity Measures on the Spanish Health Care System: A Qualitative Analysis of Health Professionals' Perceptions in the Region of Valencia. Health Policy, 119(1):100-06. https://doi.org/10.1016/j.healthpol.2014.11.003
Commission on Social Determinants of Health (2008), Closing the gap in a generation. Health equity through the social determinants of health. Geneva: World Health Organization.
Ehni H-J, Wiesing U, Ranisch R (2020) Saving the most lives. A comparison of European triage guidelines in the context of the COVID-19 pandemic, Bioethics:00 1- 10. https://doi.org/10.1111/bioe.12836
Escobar Roca G (2008) Filosofía y dogmática en la configuración del derecho fundamental a la protección de la salud, en Estudios en homenaje al profesor Gregorio Peces- Barba, vol. 3. Madrid: Dykinson, 523-558.
Esping-Andersen G (1990) The Three Worlds of Welfare Capitalism. Princeton: Princeton University Press. https://doi.org/10.1177/095892879100100108
FOESSA (2014), VII Informe Sobre Exclusión y Desarrollo Social en España 2014. Madrid: Cáritas Española.
FOESSA (2019), VIII Informe Sobre Exclusión y Desarrollo Social en España 2019. Madrid: Cáritas Española.
García-Basteiro A (2020a) The Need for an Independent Evaluation of the COVID-19 Response in Spain. The Lancet, 396(10250):529-30. https://doi.org/10.1016/S0140-6736(20)31713-X
García-Basteiro A, et al. (2020b) Evaluation of the COVID-19 Response in Spain: Principles and Requirements. The Lancet. Public Health, 5(11):E575. https://doi.org/10.1016/S2468-2667(20)30208-5
Garrett L (2001) Betrayal of trust. The collapse of global public health. Oxford: Oxford University Press.
Gemmill MC, Thomson S, Mossialos E (2008) What impact do prescription drug charges have on efficiency and equity? Evidence from high-income countries. International Journal for Equity in Health, 7, 12 https://doi.org/10.1186/1475-9276-7-12
González Suárez G (2020) Análisis ético y jurídico sobre los criterios de priorización en las unidades de cuidados intensivos. Derecho y salud, 30(2):44-56.
Hassoun N (2020) The Human Right to Health: A Defense. Journal of Social Philosophy, 51(2):158-79. https://doi.org/10.1111/josp.12298
Hofrichter R (ed.) (2000) Health and Social Justice. Politics, ideology, an inequity in the distribution of disease. San Francisco: Jossey-Bass.
Horton R (2020) COVID-19 Is Not a Pandemic. The Lancet, 396(10255):874. https://doi.org/10.1016/S0140-6736(20)32000-6
House JS, Williams D (2000) Understanding and Reducing Socioeconomic and Racial/ Ethnic Disparities in Health, in R. Hofrichter (ed.), Health and Social Justice. Politics, ideology, an inequity in the distribution of disease. San Francisco: Jossey- Bass, pp. 89-131.
ISCIII, Instituto de Salud Carlos III (2020), Estudio ENE-COVID: Cuarta Ronda. Estudio Nacional de Sero-Epidemiología de la infección por SARS-CoV-2 en España. 15 de diciembre de 2020. Madrid, Instituto de Salud Carlos III. https://portalcne.isciii. es/enecovid19/informes/informe_cuarta_ronda.pdf
Jöbges S, et al. (2020) Recommendations on COVID-19 Triage: International Comparison and Ethical Analysis. Bioethics, 34(9):948-59. https://doi.org/10.1111/bioe.12805
Karanikolos M, et al. (2013) Financial Crisis, Austerity, and Health in Europe. The Lancet, 381(9874):1323-331. https://doi.org/10.1016/S0140-6736(13)60102-6
Legido-Quigley H, et al. (2013) Will Austerity Cuts Dismantle the Spanish Healthcare System?. British Medical Journal, 346(Jun13):F2363. https://doi.org/10.1136/bmj.f2363
León Alonso M (2009) La protección constitucional de la salud. Madrid: La Ley.
Lopez-Valcarcel B, Barber P (2017) Economic Crisis, Austerity Policies, Health and Fairness: Lessons Learned in Spain. Applied Health Economics and Health Policy, 15(1):13-21. https://doi.org/10.1007/s40258-016-0263-0
Mackenbach J, et al. (2019) Determinants of inequalities in life expectancy: an international comparative study of eight risk factors. The Lancet Public Health, 4/10:e529-e537, https://doi.org/10.1016/S2468-2667(19)30147-1. https://doi.org/10.1016/S2468-2667(19)30147-1
Marmot M, Wilkinson R (2006) Social Determinants of Health. New York: Oxford University Press. https://doi.org/10.1093/acprof:oso/9780198565895.001.0001
McKeown T (1976) The Modern Rise of Population. London: Edward Arnold.
Menéndez Rexach A (2003) El derecho a la asistencia sanitaria y el régimen de las prestaciones sanitarias públicas. Derecho y Salud, 11(1):15-36.
Ministerio de Sanidad (Ministry of Health) (2020), Informe del Ministerio de Sanidad sobrelos aspectos éticos ensituaciones de pandemia: El SARS-CoV-2 (3 de abril de 2020) https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov/documentos/AspectosEticos_en_situaciones_de_pandemia.pdf (consultado el 4/1/2020)
Monereo JL, Molina C (2007) La Asistencia sanitaria como derecho fundamental y el sistema nacional de salud como garantía institucional: Balance y desafíos para el siglo XXI de su modelo regulador. en Comentario Práctico a la legislación reguladora de la sanidad en España. Granada: Comares, 3-50.
OECD/European Union (2020), Health at a Glance: Europe 2020: State of Health in the EU Cycle. Paris: OECD Publishing.
Palasca S, Jaba E (2015) Economic Crisis' Repercussions on European Healthcare Systems. Procedia Economics and Finance, 23:525-33. https://doi.org/10.1016/S2212-5671(15)00568-7
Pemán Gavín J (1989) Derecho a la salud y administración sanitaria. Bolonia: Publicaciones del Real Colegio de España.
Pemán Gavín J (2008) Sobre el derecho constitucional a la protección de la salud. Derecho y Salud, 16:29-62
Pollán M, et al. (2020) Prevalence of SARS-CoV-2 in Spain (ENE-COVID): A Nationwide, Population-based Seroepidemiological Study. The Lancet, 396(10250): 535-44. https://doi.org/10.1016/S0140-6736(20)31483-5
Regidor E, Alberto Mateo, Gregorio Barrio, and Luis de la Fuente (2019) Mortality in Spain in the Context of the Economic Crisis and Austerity Policies. American Journal of Public Health, 109(7):1043-049. https://doi.org/10.2105/AJPH.2019.305075
Ruhm CJ (2000) Are Recessions Good For Your Health?. Quarterly Journal of Economics, 15(2):617-650. https://doi.org/10.1162/003355300554872
Santos B (1992) O Estado, a Sociedade e as políticas sociais: o caso das políticas de saúde. en O Estado e a sociedade em Portugal (1974-1988). Porto: Afrontamento.
Sassen, S (2014) Expulsions. Brutality and Complexity in the Global Economy, Cambridge-Massachusetts, London-England, The Belknap Press of Harvard University Press. https://doi.org/10.4159/9780674369818
Schmidt H (2020) Vaccine Rationing and the Urgency of Social Justice in the Covid-19 Response. The Hastings Center Report, 50(3):46-49. https://doi.org/10.1002/hast.1113
Singer M (2009) Introduction to Syndemics: A Systems Approach to Public and Community Health. San Francisco: Jossey-Bass.
Stuckler D, Basu S (2013) The Body Economic. Why Austerity Kills. London: Allen Lane. Stuckler D, et al. (2017) Austerity and health: the impact in the UK and Europe. European Journal of Public Health, 27(4):18-21. https://doi.org/10.1093/eurpub/ckx167
The Lancet (2020) COVID-19 in Spain: A Predictable Storm?. The Lancet. Public Health, 5(11):E568. https://doi.org/10.1016/S2468-2667(20)30239-5
Toebes B (2006) The Right to Health and the Privatization of National Health Systems: The Case Study of the Netherlands. Health and Human Rights, 9(1):103-127. https://doi.org/10.2307/4065392
United Nations - Economic and Social Council- Committee on Economic, Social and Cultural Rights UN-ESC (2018) "Concluding observations on the sixth periodic report of Spain", E/C.12/ESP/CO/6, 25 April 2018, http://docstore.ohchr.org/SelfServices/ FilesHandler.ashx?enc=4slQ6QSmlBEDzFEovLCuW1SKyxvprlxEitT 1iPv5tsG80ELH30lp%2bURW%2fv0pMkQcf61TicGbfUD%2bE8x0cF6 WYYM778UpzlrUblhJ9r0bs0EL2J7qf7UtzVrUrdKNocu0
United Nations Committee on Economic, Social and Cultural Rights (CESCR) (2000) General Comment No. 14: The Right to the Highest Attainable Standard of Health (Art. 12 of the Covenant), 11 August 2000, E/C.12/2000/4
Vallejo-Torres L, García-Lorenzo B, Serrano-Aguilar P (2018) Estimating a Cost-effectiveness Threshold for the Spanish NHS. Health Economics, 27(4):746-61. https://doi.org/10.1002/hec.3633
WORLD HEALTH ORGANIZATION (WHO) (2016), Social justice and human rights as a framework for addressing social determinants of health. Final report of the Task group on Equity, Equality and Human Rights. Review of social determinants of health and the health divide in the WHO European Region. Copenhagen: WHO.
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