Dissertation Ivette María Oritz Alcántara

Abstract

This thesis examines the normative and ethical issues that arise in the distribution of health resources within the public sector of the Mexican health system, which is committed to ensuring accessibility, quality, and availability of services. However, in a complex social context such as Mexico, the allocation and distribution of health resources is significantly influenced by non-medical factors that affect health outcomes, such as living and working conditions. These determinants are further strained by crises, including widespread violence and the COVID-19 pandemic, creating a network of ethical and regulatory dilemmas. This thesis aims to identify and map these dilemmas.

Consisting of four papers, this thesis examines the impact of crisis situations on the allocation of health resources within the Mexican public health system. The first chapter is based on a paper that addresses the impact of the shortage of medical personnel on the availability of services. This shortage is not only due to Mexico's below-average physician-population ratio compared to other Latin American countries, but is also exacerbated by the prevalence of violence, which has had a significant impact on health services. As a result, physicians have migrated from violent regions due to widespread insecurity, as documented by international organizations such as Médecins Sans Frontières.

The second chapter presents a qualitative interview study that explores the experiences of physicians working in regions of significant violence. It highlights the ethical conflicts arising from resource constraints and their intersection with the pandemic. The study highlights the importance of different ethical principles in health care and the balance between the well-being of physicians and the protection of public health, as well as the normative issues that arise in such contexts.

The third chapter examines the Mexican government's response to the COVID-19 pandemic, focusing on the principle of proportionality as applied by Mexican courts. It presents three key arguments that demonstrate the inadequacy of this application: the insufficient definition of proportionate measures, conflicts between fundamental rights, and epistemic uncertainty. In addition, the chapter highlights how unemployment, especially among informal workers, became a significant issue and how the scarcity of health resources during the pandemic exacerbated social inequalities.

The fourth paper proposes a model for implementing a "vaccine tax" to establish a fund to support the purchase of COVID-19 vaccines in low- and middle-income countries, such as Mexico. This initiative aims to promote equitable vaccine distribution during the global health crisis and underscores the importance of equitable health resource allocation.