Dataset Information

Punt Politics as Failure of Health System Stewardship: Evidence from the COVID-19 Pandemic Response in Brazil and Mexico.

ABSTRACT: We present a new concept, Punt Politics, and apply it to the COVID-19 non-pharmaceutical interventions (NPI) in two epicenters of the pandemic: Mexico and Brazil. Punt Politics refers to national leaders in federal systems deferring or deflecting responsibility for health systems decision-making to sub-national entities without evidence or coordination. The fragmentation of authority and overlapping functions in federal, decentralized political systems make them more susceptible to coordination problems than centralized, unitary systems. We apply the concept to pandemics, which require national health system stewardship, using sub-national NPI data that we developed and curated through the Observatory for the Containment of COVID-19 in the Americas to illustrate Punt Politics in Mexico and Brazil. Both countries suffer from protracted, high levels of COVID-19 mortality and inadequate pandemic responses, including little testing and disregard for scientific evidence. We illustrate how populist leadership drove Punt Politics and how partisan politics contributed to disabling an evidence-based response in Mexico and Brazil. These cases illustrate the combination of decentralization and populist leadership that is most conducive to punting responsibility. We discuss how Punt Politics reduces health system functionality, providing lessons for other countries and future pandemic responses, including vaccine rollout.

SUBMITTER: Knaul FM

PROVIDER: S-EPMC8514423 | biostudies-literature | 2021 Dec

REPOSITORIES: biostudies-literature

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Punt Politics as Failure of Health System Stewardship: Evidence from the COVID-19 Pandemic Response in Brazil and Mexico.

Knaul Felicia Marie FM Touchton Michael M Arreola-Ornelas Héctor H Atun Rifat R Anyosa Renzo Jc Calderon RJC Frenk Julio J Martínez-Valle Adolfo A McDonald Tim T Porteny Thalia T Sánchez-Talanquer Mariano M Victora Cesar C

Lancet regional health. Americas 20210927

We present a new concept, <i>Punt Politics</i>, and apply it to the COVID-19 non-pharmaceutical interventions (NPI) in two epicenters of the pandemic: Mexico and Brazil. Punt Politics refers to national leaders in federal systems deferring or deflecting responsibility for health systems decision-making to sub-national entities without evidence or coordination. The fragmentation of authority and overlapping functions in federal, decentralized political systems make them more susceptible to coordi ...[more]

PMID: 34664040

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Project description:With a focus on responses to coronavirus disease 2019 (COVID-19) in Ethiopia and on political developments that have occurred in the country during the pandemic, this article contributes to the existing scholarship that explores the relationship between health and politics. Drawing on qualitative data from the project 'COVID-19 Impact Tracing in Ethiopia: Social, Economic, Political, and Security Ramifications', carried out in the Tigray, Amhara and Oromia Regional States (RS) from June to September 2020, we offer new empirical and theoretical perspectives that shed light on the political status of health and health policies in Ethiopia and beyond. In all the three regions, COVID-19 and the government's pandemic response was subject to politicization and securitization. The degree of securitization and politicization differed between the regions and fluctuated over time; in areas with strong opposition to political authorities, the COVID-19 mitigating efforts were-during the first phase of the pandemic-more politicized and securitized than in areas with less opposition. Yet, as the political opposition and instability increased, threatening national security and Prime Minister Abiy Ahmed's political project, the authorities and the public paid increasingly less attention to the pandemic and the mitigating policies. In our analysis of these dynamics, we draw on a classic distinction that scholars of global public health have borrowed from political science: that of 'low' and 'high' politics. We argue that a contextually situated use of the high/low distinction allows us to recognize the fleeting and context-dependent nature of health's political status, providing valuable insights that help us understand the ways that health emerges and disappears as high politics. The temporal and inter-regional shifts that appeared in, and as a response to, Ethiopia's pandemic policies illustrate the importance of a continuous analysis of the relationships between health and politics at national as well as at sub-national levels.

Project description:This study aimed to evaluate changes in dietary and lifestyle habits during the period of confinement due to the first wave of the COVID-19 pandemic in Ibero-American countries. A cross-sectional investigation was conducted with 6,325 participants of both genders (68% women), over 18 years of age and from five countries: Brazil (N = 2,171), Argentina (N = 1,111), Peru (N = 1,174), Mexico (N = 686), and Spain (N = 1,183). Data were collected during the year 2020, between April 01 and June 30 in Spain and between July 13 and September 26, in the other countries studied using a self-administered online survey designed for the assessment of sociodemographic, employment, physical activity, health status, and dietary habits changes. Most participants (61.6%), mainly those from Spain, remained constant, without improving or worsening their pattern of food consumption. Among those who changed, a pattern of better eating choices prevailed (22.7%) in comparison with those who changed toward less healthy choices (15.7%). Argentina and Brazil showed the highest proportion of changes toward a healthier pattern of food consumption. Peruvians and Mexicans were less likely to make healthy changes in food consumption (OR: 0.51; 95% CI: 0.4-0.6 and OR: 0.69; 95% CI: 0.4-0.8, respectively), when compared to Argentinians. Most respondents did not change their pattern of meal consumption, but those who did reduced their consumption of main meals and increased intake of small meals and snacks. Although most participants affirmed to be doing physical activity at home, about one-half reported perception of weight gain. Individuals with alterations in sleep pattern (either by increasing or decreasing sleep time) were more likely to change their diets to a healthier pattern. In contrast, individuals with confirmed diagnosis of COVID-19 and those who reported feeling anxious were more likely to perform changes to a less healthy eating pattern (OR: 1.72; 95% CI: 1.2-2.3 and OR: 1.21; 95% CI: 1.1-1.4, respectively). In conclusion, although most participants remained constant in their eating habits, lifestyle changes and anxiety feelings were reported. Among those who changed patterns of food consumption, healthier choices prevailed, with differences between countries. However, there were alterations in the distribution of meals, with higher consumption of snacks and small meals. These results can be used to guide policies to prevent deleterious consequences that may affect the incidence of chronic diseases.

Dataset Information

Punt Politics as Failure of Health System Stewardship: Evidence from the COVID-19 Pandemic Response in Brazil and Mexico.

Publications

Punt Politics as Failure of Health System Stewardship: Evidence from the COVID-19 Pandemic Response in Brazil and Mexico.

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