BackgroundGlobal health institutions increasingly recognize that the right to health should guide the formulation of replacement goals for the Millennium Development Goals, which expire in 2015. However, the right to health’s contribution is undercut by the principle of progressive realization, which links provision of health services to available resources, permitting states to deny even basic levels of health coverage domestically and allowing international assistance for health to remain entirely discretionary.DiscussionTo prevent progressive realization from undermining both domestic and international responsibilities towards health, international human rights law institutions developed the idea of non-derogable “minimum core” obligations to provide essential health services. While minimum core obligations have enjoyed some uptake in human rights practice and scholarship, their definition in international law fails to specify which health services should fall within their scope, or to specify wealthy country obligations to assist poorer countries. These definitional gaps undercut the capacity of minimum core obligations to protect essential health needs against inaction, austerity and illegitimate trade-offs in both domestic and global action. If the right to health is to effectively advance essential global health needs in these contexts, weaknesses within the minimum core concept must be resolved through innovative research on social, political and legal conceptualizations of essential health needs.SummaryWe believe that if the minimum core concept is strengthened in these ways, it will produce a more feasible and grounded conception of legally prioritized health needs that could assist in advancing health equity, including by providing a framework rooted in legal obligations to guide the formulation of new health development goals, providing a baseline of essential health services to be protected as a matter of right against governmental claims of scarcity and inadequate international assistance, and empowering civil society to claim fulfillment of their essential health needs from domestic and global decision-makers.

Background The term “judicialization of health care” describes the use of rights-based litigation to demand access to pharmaceuticals and medical treatments. The judicialization of health care in Latin America has two defining features. Firstly, it has been conducted in an individualized fashion. Secondly, it is highly pharmaceuticalized , since most public expenditure related to health rights litigation is invested in paying for costly medications. Recent studies also suggest that the judicialization of health care is bad for equity since it skews limited health resources away from the poorest citizens and in favor of the more affluent. Methods We used a scoping methodology to analyze the study-design and the quality of the data employed by the literature that explicitly assesses the impact of the judicialization of health care on equity in Latin American countries. Articles were selected on the basis of their use of an empirical strategy to determine the effect of the judicialization on equity. We searched Google Scholar, PubMed, Scopus, and Scielo databases. We also went through the studies’ bibliographic references, and hand-searched key journals and authors. Results Half of the studies analyzed find that judicialization has a negative impact on equity, but the other half finds that evidence is inconclusive or that the judicialization of healthcare has a positive effect on equity. The majority of the studies that collect their own data rely on limited samples that are sometimes not representative and mostly not generalizable. Only few studies conduct systematic comparative analysis of different cross-country or within-country cases. None of the studies reviewed aim to establish causation between judicialization and health outcomes. Conclusions We conclude that in order to prove or disprove that the judicialization of health care is at odds with equity we first need to overcome the methodological and research-design problems that have beleaguered the available empirical studies. We also conclude that pharmaceuticals’ price regulation, state capacity, the behavior of litigants, prescribers and judges, and the economic interests of big-pharma, are variables that have to be incorporated into a rigorous empirical literature capable of assessing the regressive effect of health rights’ litigation. Electronic supplementary material The online version of this article (10.1186/s12939-019-0961-y) contains supplementary material, which is available to authorized users.

This article charts the trajectory of the judicialization of health care from the perspective of Global South countries. It shows how the emergence of health rights litigation in the 1990s and early 2000s was bolstered by the global expansion of the HIV/AIDS epidemic and by major constitutional reforms that triggered a period of rights revolutions in South Africa and several Latin American countries. This article also tracks the litigation epidemic in countries like Colombia and Brazil, where the escalation of health rights lawsuits is threatening the financial stability of health systems and the fair allocation of scarce health resources. It concludes by discussing a fundamental challenge confronting the field, namely, how to look upstream for new approaches to the right to health to reinstate litigation and adjudication as mechanisms to promote more equitable health systems.

<p>Este artículo presenta los resultados de un estudio empírico que sistematizó las acciones populares falladas por el Consejo de Estado colombiano durante un<br />período de 17 años (1998-2015). Los autores utilizaron metodologías de análisis cuantitativo y cualitativo para sistematizar más de 250 fallos de acciones populares decididas por el Consejo de Estado. Los resultados presentados en este artículo muestran las tendencias más importantes del litigio de acciones populares ambientales en Colombia: tipos de demandantes y demandados; tipo de recursos medioambientales protegidos; tasas de éxito de los demandantes; regiones y ciudades más litigiosas; efectos generales del incentivo económico en el tipo de litigio, entre otras variables. Los resultados de este estudio también muestran que el incentivo económico para las acciones populares no estaba favoreciendo los intereses de litigantes temerarios, como lo sostuvo el gobierno nacional cuando propuso al Congreso una reforma a las acciones populares, que se concretó en la Ley 1425 de 2010. Finalmente, se sugiere que la eliminación del incentivo económico de las acciones populares puede tener un efecto negativo sobre el litigio de interés público.</p>

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