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拉丁美洲结核病患者的社会保护策略:(重新)思考政策与实践 拉丁美洲结核病患者的社会保护策略:(重新)思考政策与实践

[Social protection strategies for people with tuberculosis in Latin America: (re)thinking policies and practicesEstrategias de protección social para las personas con tuberculosis en América Latina: (re)pensar las políticas y las prácticas].

作者信息

Pavinati Gabriel, de Lima Lucas Vinícius, Alves Kleydson Bonfim Andrade, López Miguel Angel Aragón, Magnabosco Gabriela Tavares

机构信息

Universidade Estadual de Maringá Departamento de Enfermagem MaringáPR Brasil Universidade Estadual de Maringá, Departamento de Enfermagem, Maringá, PR, Brasil.

Secretaria Municipal de Saúde Gerência de Planejamento MaringáPR Brasil Secretaria Municipal de Saúde, Gerência de Planejamento, Maringá, PR, Brasil.

出版信息

Rev Panam Salud Publica. 2025 Jul 21;49:e78. doi: 10.26633/RPSP.2025.78. eCollection 2025.

Abstract

This study critically analyzes the effects of social protection policies on tuberculosis treatment and discusses perspectives for the implementation of comprehensive, sustainable care in Latin America. Based on the theory of social determinants of health, this article offers theory and reflection on the effects of social inequalities on adherence to treatment, showing that financial support, food security, and access to transportation are fundamental elements in reducing the impact of the disease on individuals and communities. In addition, the worsening of tuberculosis control indicators due to the COVID-19 pandemic is contextualized, highlighting the interruption of essential services, increased underreporting, and compromised treatment coverage. Latin American countries show progress in the implementation of social protection programs, but structural challenges such as poor intersectoral integration, unstable funding for public policies, and bureaucratic barriers to implementation limit their effectiveness in controlling tuberculosis. Furthermore, dependence on external government resources sometimes reveals the fragility of policies in contexts of political and economic instability. It follows that social protection must be a key pillar in the response to tuberculosis in Latin America, through permanent, intersectoral, sustainable actions. This proposal could help to support the goals of the End TB Strategy and those of the 2030 Agenda for Sustainable Development. The elimination of tuberculosis in the region depends on strengthening primary care, political and social commitment, and the adoption of strategies aligned with global targets for equity and sustainable development.

摘要

本研究批判性地分析了社会保护政策对结核病治疗的影响,并探讨了在拉丁美洲实施全面、可持续护理的前景。基于健康的社会决定因素理论,本文对社会不平等对治疗依从性的影响提供了理论和思考,表明财政支持、粮食安全和交通便利是减少该疾病对个人和社区影响的基本要素。此外,还结合背景情况分析了由于新冠疫情导致结核病控制指标恶化的问题,强调了基本服务的中断、报告不足的增加以及治疗覆盖范围受到的影响。拉丁美洲国家在实施社会保护计划方面取得了进展,但部门间整合不佳、公共政策资金不稳定以及实施过程中的官僚障碍等结构性挑战限制了这些计划在控制结核病方面的有效性。此外,在政治和经济不稳定的背景下,对外部政府资源的依赖有时会揭示政策的脆弱性。因此,社会保护必须通过长期、跨部门、可持续的行动,成为拉丁美洲应对结核病的关键支柱。这一提议有助于支持《终止结核病战略》以及《2030年可持续发展议程》的目标。该地区结核病的消除取决于加强初级保健、政治和社会承诺,以及采取与全球公平和可持续发展目标相一致的战略。

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