Santiago, Chile - Crosswalk in long-exposure.

Chile’s New Constitution, the Right to Health, and Health System Reforms

By Marco Antonio Nuñez

During these months of the COVID-19 pandemic in Chile, the need to align the constitutional process with long-postponed structural reforms to the health system has become evident among public health experts.

Capitalizing on this moment might avoid the possibility of a constitutional right to health becoming a dead letter or being reduced only to the prosecution of particular cases, postponing again the aspirations of the majority of Chileans.

Although the Chilean Constitution promulgated under the dictatorship in 1980 and subsequently reformed in several of its chapters recognizes “The right to the protection of health,” it has been tainted by authoritarianism from its origin, and promotes a subsidiary role of the state in health.

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gavel and stethoscope on white background

The Right to Health in the Upcoming Constitutional Debate in Chile

By Veronica Vargas

At this unprecedented COVID moment, health has been revealed as one of our most precious possessions and protecting it has become imperative. The right to health was articulated by the WHO in the Declaration of Alma-Ata of 1978. The upcoming constitutional debate in Chile is an opportunity to re-examine this concept.

The Chilean constitution specifies the right to “free and egalitarian access” to health care. Simultaneously, the constitution guarantees that “each person has the right to choose the health system they wish to join, either public or private.”

These provisions have championed a prospering private health sector, with corporate clinics and a private insurance system that represents almost half of total health spending.

However, this private sector serves less than 20 percent of the population. Nearly 80 percent of the population utilizes public sector insurance. Although the public sector has been expanding its coverage of health services, and health indicators for those with public insurance have been improving, the public sector is chronically underfunded. Public sector health care spending represents only 4% of the GDP.

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New York City, New York / USA - June 13 2020 New York City healthcare workers during coronavirus outbreak in America.

COVID-19 and the ‘Essential’ Yet Underappreciated Front-Line Health Care Worker 

By Kimani Paul-Emile

When considering those on the front lines of the coronavirus pandemic response, most people likely envision doctors and nurses. However, there is an often forgotten, front-line workforce comprised of orderlies, nursing facility workers, and nursing assistants (“NAs”) that earns very little money, has few protections, and is largely Black and Brown and female. Many individuals in this group are also subject to a unique form of discrimination: rejection on the basis of their race or ethnicity by some of the very patients they are assigned to aid.

The millions of people who make up this group of essential workers constitute a substantial portion of the health care workforce and earn an average of $13.48 per hour despite the risks they take. Their work, which involves bathing, dressing, and feeding patients; brushing their teeth, and assisting with their use of the toilet, puts these workers at high risk of contracting COVID-19. Nevertheless, early in the pandemic, many of these workers lacked or had inadequate personal protective gear due to the tiered system used for distributing this equipment. Doctors and nurses were first in line for smocks, masks, and other essential gear; last were members of this underappreciated group of front-line health care workers.

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Close-up Of Doctor's Hand Measuring Blood Pressure Of Male Patient.

Understanding the Role of Race in Health: A New Digital Symposium

By Craig Konnoth

In the 1980s, a vanguard of critical race theorists debated their contemporaries as to whether law could or should play a role in achieving equity — in particular, racial equity. Scholars such as Kimberlé Crenshaw and Patricia Williams argued that while legal discourse historically had been used to oppress Black, Indigenous, and people of color (BIPOC), history had shown that in the law also lay the seeds of empowerment. Conceptualizing BIPOC as persons endowed with legal rights, and as a community subject to heightened legal solicitude because of the historical injustices they have faced, has helped undergird their selfhood, dignity, identity and activism. Law could thus be a discourse of despair — but also one of hope.

Whether or not the years have proved those claims correct as to the law, today, a similar debate unfolds in the context of race, medicine, and health care. Today, medicine and the health care system embody discourses of power that rival the law. Will these discourses inevitably serve to oppress BIPOC — and if not, how can we harness their power to achieve justice? Those are the questions that this symposium seeks to answer.

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Santiago, Chile.

Pragmatism and the Chilean Constitutional Moment

By Sebastián Soto

Chile is heading into a constitutional change.

After 40 years, the Chilean 1980 Constitution, enacted under Pinochet’s rule, but subsequently amended over fifty times, will probably be replaced. On October 25th, a referendum will decide whether or not to call a constitutional convention to change the Constitution.

If the referendum passes, in April 2021 the convention will be called and will have nine months (extendable for three more, if needed) to write a new constitution. If the convention reaches an agreement on a new constitution by 2/3 of its members, a new referendum to approve it will be called during the first semester of 2022.

Social rights are expected to be one of the most contested topics discussed during the process.

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Buenos Aires, Argentina.

Concerns Mount About Rule of Law in Argentina During COVID-19

By Roberto Gargarella

From the first time that I wrote about the COVID-19 situation in Argentina, June 8, until the date I am writing this, September 7, things have changed significantly.

First, the number of people who have died of COVID-19 in Argentina has risen to nearly 10,000; the 16th highest death toll in the world. The total number of cases is 500,000; which places Argentina among the top 10 countries for infections worldwide.

These alarming statistics are particularly worrying in Argentina, given a number of additional facts mentioned in my original blog.

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Protest against Brazil's President Jair Bolsonaro.

Between Gross Negligence and Genocide: Brazil’s Failed Response to COVID-19

By Octávio Luiz Motta Ferraz

When my first piece in this series was published on May 12th, Brazil counted 11,000 deaths caused by COVID-19. A new health secretary had just been appointed to replace Dr. Luiz Henrique Mandetta, who was sacked for disagreeing with President Jair Bolsonaro’s views that the pandemic (which he infamously called a “little flu”) was a conspiracy of the media and that public health measures should be immediately lifted to avoid damage to the economy.

Fast forward to September 10th and the situation, predictably, has gotten significantly worse. Brazil now counts 128,539 deaths, the second highest number in absolute terms (after the U.S., where the death toll is 190,872), and the sixth in per capita terms, with just over 60 deaths per 100,000 population. When Brazil reached the 100,000 deaths mark in early August, the president thought it more appropriate to use his Twitter account to celebrate his football team’s win at the local tournament than to make any statement on the health crisis.

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Downtown Santiago, Chile.

The Novel Coronavirus and Civil Rights: An Update from Chile

By Lidia Casas Becerra

As the COVID-19 pandemic continues apace in Chile, a test of the country’s commitment to democracy and the rule of law looms close – in just over a month, a historic referendum will be held on the possibility to change the Constitution.

The plebiscite was a key political demand during the social mobilization after October 19, 2019. But since March 18, 2020, Chile has been under the state of constitutional catastrophe or calamity due to the COVID-19 pandemic, which will continue at least through September 24, 2020.

Due to the pandemic, the date of the plebiscite was moved from April to October 25th after a political agreement between Congress and the executive. Chile does not have a system allowing for either electronic voting or voting by mail.

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Petrie-Flom Center student fellows 2020-2021.

Petrie-Flom Welcomes 2020-2021 Student Fellows

(Clockwise from top left: Jenna Becker, Sravya Chary, Vrushab Gowda, Abe Sutton, Sunnie Ning, Laura Karas)

We are so excited to welcome a new group of Student Fellows to the Petrie-Flom Center family. These six students are a fantastic cohort of health law policy, biotechnology, and bioethics scholars who join us from Harvard Law School and the HMS Center for Bioethics. While we cannot physically welcome our fellows this year, we are excited to provide them with a robust virtual fellowship.

They each will undertake a year-long research project with mentorship from Center faculty and affiliates, and also will blog here at Bill of Health regularly. Keep an eye out for their bylines!

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Senior citizen woman in wheelchair in a nursing home.

COVID-19 and Nursing Homes: The New York State Experience

By James W. Lytle 

While New York State has generally earned high marks for its response to the COVID-19 pandemic, nagging questions continue over whether more might have been done to protect patients in nursing homes and other congregate settings — and whether some of the state’s policies even may have made matters worse.

Lessons from the New York State experience may prove helpful to those regions that have displaced New York as the epicenter of the American pandemic, and may help ensure that adequate steps are taken to protect the most frail and vulnerable among us from any resurgence of COVID-19 or from some future disease.

Although New York was among the hardest hit states, with the highest number of deaths thus far (over 32,000, more than twice as many as California), the aggressive steps taken by Governor Andrew Cuomo and his administration have been widely credited with reducing the spread of the disease in the State.

But a key, sustained criticism of the Governor’s handling of the pandemic focuses on the state’s nursing homes.

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