مجله فرهنگ و ارتقای سلامت (فرهنگستان علوم پزشکی جمهوری اسلامی ایران)
سال چهارم شماره 2 (پیاپی 10، تابستان 1399)

One of the most important principles and values is observance of health equity in health care policy and services. Health equity means the propensity to provide a favorable state of health for the population. In this policy summary, strategies for achieving and monitoring health equity with regard to social determinants of health and general health policies, are presented in three sections as follows:1- Policies and strategies for prevention, care, treatment, education and research funding of health sciences 2- Policies and strategies for empowering and involving the community in the health-management process, 3- Policies and strategies for strengthening, coordinating and inter-sectional cooperation.

Expansion of the health care network has begun and it guarantees basic health care of the community, with priority to rural and deprived areas of the country. Considering the networkchr('39')s role in recent outbreaks of the coronavirus, and the high probability of recurrence or similar event, there is a need for an accountable and transparent system to be developed and regularly updated. The following principles should be considered: moral and political commitment of officials of the health care network, monitoring the health system, promotion of health in schools, sustainability of the job of health workers, equipping the health care network, strengthening the health volunteers program, monitoring all levels of the health care network performance, establishing a resilient economic health system, improving the health education system, integrating health research into the health care network, and provision of financial and administrative independency.

Social problems have been in all human societies. However, there is little evidence to illustrate the impact of the health systems in causing social problems. This study aimed to conduct an exploration of social problems in the health system.

We conducted a narrative review  from 2000 to 2019, using the related keywords in both Persian and English. Using the inclusion criteria a total of 58 articles were finally selected to be included in the research.

There is still no clear and uniform definition of social problems in the health system. Some studies have shown the impact of social problems on health. Researchers listed examples of conflict of interest, lack of transparency, induced demand, corruption and hazards as social problem of the health system.

As a social subsystem, the health system itself can create social dilemmas, which can lead to a compromise in health equity. By recognizing social problems in social subsystems and planning to address them appropriately, the society can enhance social health and prosperity, which can result in greater social capital and social welfare and health equity.

Effect of social determinants on health is the base of inequity in health of society. These factors have a main role in the spread of infectious and non-communicable diseases in community. Biological and genetic factors affect only 15%, health system about 25% and social determinants in 50% and in a number of studies, 75% affect peoplechr('39')s health. In this article, the impact of social determinants on health is discussed.

This research is a review study using national and international references and also the views and experiences of the author.

Social determinants include economic, cultural, environmental, social and political factors. Peoplechr('39')s health is more related to social factors than to medical care. Social determinants have various effects on the health of different communities and as a result, health indicators vary between countries and even within country. Several strategies are proposed to control the factors affecting health: controlling lethal diseases and improving the health system, reducing poverty, improving conditions of people live and work, prioritizing expenditure on health rather than medical technology, necessity for planning and supervising on private section .

It is necessary to perform two activity to ensure equity in health. Development of the health network of the country, and assessing the social determinants of health as much as possible which have a share of at least fifty percent in promoting the health of community and individuals. Implementing these two very valuable actions that lead to the establishment of equity in health requires national decision, peoplechr('39')s participation and trans-sectoral cooperation.

Achieving universal health is not possible without achieving equity. Equity in health means reducing or eliminating those factors that are the cause of health inequalities. Inequalities that can be avoided, and are actually unfairly distributed among different sections of society. In this article, the most important factors related to equity in health and its related indicators are presented.

This article describes 69 indicators developed in collaboration with related institutions and approved by the honorable office of the President of the Islamic Republic.

Thirty eight of these indicators are related to health, 12 are related to physical environment and infrastructure, 10 are related to social and human development, 4 are related to economic development and 5 are related to proper governance. The most important of these indicators are: poverty, discrimination, lack of jobs, inadequate income, low literacy, illiteracy, inadequate housing and employment, lack of clean and safe environment, lack of efficient affordable services, low professional ethics in the health system, lack of security and food safety, lack of social support and inadequate to proper transportation.

. In assessing equity in health and, more importantly, developing and execution of strategies to reduce or eliminate inequities, it is necessary to define indicators specifically for monitoring and measuring various aspects of health equity in the areas of social, cultural, economic and political determinants in addition to the common measures in the field of health and safety. Such “health equity indicators” must be measured and expressed with regard to common demographic variables (such as gender, place of residence, economic and social groups, etc”) to be an effective tool to reduce or eliminate inequalities. It requires effective participation and close collaboration of people, governmental institutions, and non-governmental organizations.
It is expected that by using these indicators and evaluating their effectiveness, one can begin to reduce  inequalities

The discourse regarding social determinants of health at the international level seeks to see if the health system can improve community health indicators equitably by providing medical services and advising people to follow a healthy lifestyle. In our country, there are different views on the application of this approach. Opponents see this approach as ineffective whilst proponents are implementing components of this approach. This study sought to assess the criteria for implementing the approach using social determinants of health.

This qualitative study was done via reviewing resources, interviews and group discussions. The results are summarized in two main sections and deployment patterns included five components of a sustainable system (purpose and plan, structure, procedure and standard, management style, and resources).

The social determinants of health approach, assuming the weight of the five components to be equal, was found to be 68%. The highest implementation score  related to the three components of structure, procedure and standard, and resources. The lowest score related to management style.

It is suggested that a comprehensive health roadmap of the country be at hand by 2025; the tasks and expectations of the executive organizations, the private sector and non-governmental organizations are specified to improve the social determinants of health in the Seventh socio-economic and cultural development plan of Iran. Additionally, auditing and ranking the performance of provinces as well as districts with regard to implementation of this approach can promote healthy competition between provincial and district governorates, as well as participation of the public in the institutions to be created. In this regard, the Ministry of Health and Medical Education, with the aim of social accountability and role modeling, must first determine and implement its share and role in cooperation to improve these determinants.

Cultural determinants of Health related concepts result from complicated socio-cultural processes. In addition to health and disease determinants, one’s culture can help assess the views of patients and health-care providers with regard to health .One’s health relates to various cultural beliefs, social, psycological and spiritual fundamentals.. The purpose of this article was to study the effects of culture on health. Islamic culture based on religious teachings is the prominent culture in our country , because the majority of the population are Muslims and the government is Islamic. In this article, health and spiritual health, which have a special value in Islamic culture are discussed.

This was a descriptive-analytical study which was performed using the indirect method for collecting archived documents, private documents, and books.

Islam has produced a culture based on beliefs, convictions, as well as verbal, behavioral and ethical rules; it has introduced an efficient and comprehensive lifestyle for its followers all over the world.Attention to the divine view provides physical, psychological and spiritual health for people, which shows the creation of a divine culture to ensure bliss and excellence for mankind.

This study explained that culture ensures bliss for mankind in this world and the next; the divine Islamic culture provides for health of the society in all aspects including spiritual health to prevent and treat diseases.

Sustainable food safety, which ensures the safety of individuals, family members and the community, is one of the main tasks of the government, however it is achieved by public participation. In crises, food safety is affected from the time of production distribution to consumption. The following are suggested short-term solutions to guarantee food safety during the Covid-19 outbreak. Immediate formation of a food safety work group at the national headquarters to combat corona, implementation of interventional food safety, packaging, supply and distribution of food packages, storage of essential food products, broadcasting educational programs, empowerment of rural and suburban households for agriculture, livestock and birds, strengthening and creating markets for direct supply of agricultural products, monitoring and control of food prices, encourage the support of non-governmental organizations (such as private, charity) to implement food production , storage and distribution programs.

Physical and economic access to adequate, healthy and nutritious food for all people at all times is the universal definition of food security, and the food available provides the dietary needs that are consistent with their preferences for an active and healthy life. In this regard, having a healthy dietary pattern in the family can help in promoting this situation.Health is one of the most valuable categories in Islamic culture. One of the approaches of the Qurchr('39')an is its nutritional recommendations in several verses. The purpose of this study is to introduce nutritional health and the role of Qurchr('39')anic teachings and hadiths in relation to human health.

The present study is based on descriptive and conceptual methods. First, by referring to the interpretive sources of Quran and Hadith, as well as searching in databases, the necessary information was collected and then the mentioned materials were summarized according to the objectives of the research.

The lessons of nutrition and health in Islam, by introducing a healthy and appropriate model for achieving body health based on food diversity, safety, cleanliness and food solubility, pursues spirituality in health, peace of mind and good mood. Sustainable food security is based on the possibility of access and fair distribution of food in the Islamic society, especially for low-income and vulnerable families. Other lessons of the Qurchr('39')an and Hadith.

According to the emphasis of Quranic teachings and hadiths, the model of healthy eating should include physical, psychological, social and spiritual indicators. Therefore, the rulers and policy makers of Islamic societies should be serious in creating and promoting health and nutritional safety according to the mentioned indicators and recommended principles.

Access to affordable and nutritious food in low-income areas, attention to food choices for reducing malnutrition and preventing various types of metabolic diseases, are important issues ensuring public health. The purpose of this article was to enjoin cooperation of organizations responsible for agriculture, trade, etc. to form emergency networks   to formulate executive strategies for organizing sustainable food safety which unfortunately, has yet to be implemented. The efforts of nutrition experts has resulted in gaining support of legislators to pass the essential laws to solve food and nutrition problems of existing laws, Item 197 of the Third Development Plan Law, and  item 84 of the Fourth Development Plan Law in Iran and the general policies are in line with  a resilient economy, and all of them emphasize health, welfare and food safety.  Cooperation through merging councils and formation of the High Council for Health, Food and Nutrition. has taken 5 years of work in the field of food safety, nutrition and food health from farm to fork, to prevent diseases caused by nutritional deficiencies and treat metabolic diseases.. There is still the need for cooperation among organizations to implement and control food safety.

The needs of society in the field of public health are rapidly changing. Schools of public health should prepare their students for the ever-changing world. However, the main value and responsibility of the schools is the commitment to public health. This article reviews the challenges and tasks of the schools of public health, and discusses the necessary areas for teaching in schools.

In this study, we reviewed a variety of literature on the issue.

Some important points to be considered in reviewing public health curriculums include: changing traditional methods of teaching, developing education skills and competencies, creating opportunities for interdisciplinary research projects, and continuity of education. Necessary topics for education in the schools of public health are as follows: Problem solving, health system functions, leadership, management and teamwork skills, global health policy, development, data analysis methods, technology and information processing, health economics, communication, community-based participatory research, and ethics. Looking at the future prospects, advances and changes in education at the school of public health can provide students with a unique opportunity to address health challenges in the general population over the next few decades.

School of public health needs to move in an evolutionary direction to meet the new and upcoming sciences and the different needs and opportunities for growth. In order to improve health situations in the society, it is necessary to train quality specialists in the field of public health through up-to-date theoretical and practical training and conducting research.

Today, the pharmaceutical industry is one of the key industries and strategies in the world. Due to its effect on human health and human societies, medicine has always been one of the most important pillars of healthcare. Accordingly, it is always a special priority of governments to provide and supply the medicine needed by the society, even in the most critical conditions of the country. So the question is, can the right to health be an effective factor in promoting the drug legal system and access to appropriate pricing and quality drugs? The purpose of this paper was to investigate the Iranian pharmaceutical legal system from the perspective of the right to public health, including access to drugs and the impact on health, price and distribution in society.

This study was performed by reviewing credible national documents.

The research hypothesis is that the right to health can play an effective role in the pharmaceutical legal system. Medicine its trade and health are interrelated, as the drug improves health and wellness leads to development. The right to health is one of the most important rights recognized in international documents and treaties and domestic documents of Iran, especially the Constitution and the five-year economic, social and cultural development plan and the 20-year vision document of the system recognized and approved by legislators and politicians. The right to health is part of the fundamental rights of citizens in any society. Every citizen, as a member of society, regardless of racial, religious, political or cultural considerations, has the right to benefit from it .

‘The right to health’ can be one of the important factors in promoting and improving the quality of life and also be effective in the legal pharmaceutical system. The importance and attention of government officials and legislators of the pharmaceutical system can play an important role in improving the health of society, so they can properly plan ways to protect society and people’s health from harmful drugs.

Due to the lack of approved treatment or vaccine against coronavirus, discovering and utilization of natural potentials of the human immunity system is essential in order to combat this virus.

Library studies and international databases including PubMed, Scopus, Google scholar were searched.

The innate immune system, mainly neutrophils and macrophages play a positive role in the initial defense against virus attack, but sustained responses and over expression of inflammatory cytokines and chemokines could lead to the destruction of involved tissues and their loss of function. Acquired immune systems, including T and B lymphocytes by eradicating infected cells, secreting response-boosting cytokines, and producing neutralizing antibodies try to eradicate the infection;however, in many patients this results in exaggeratedTh1 responses, uncontrollable inflammation and tissue damage. Anti-inflammatory, anti-viral, convalescent serum and supportive therapies are currently used for treating the critical patients but none of them show satisfying effects. Molecular and serological diagnostic techniques are rapidly evolving, and several ideas for designing anti-corona vaccines are under preclinical and clinical trials.

Preciseunderstanding of the quality and quantity of immune responses against corona virus and manipulating them in the right direction may be a good solution for COVID-19 problem. Immunology is involved in prevention (vaccine), treatment (anti-inflammatory drugs and enhanced defense) and diagnosis (molecular and serological methods) of COVID-19.

The Covid-19, virus reported in Wuhan, China in late December 2019, rapidly spreadaround the world. There is currently no vaccine against the disease, or reliable, evidence-based treatment for it. The best strategies to prevent the disease are: “personal hygiene”, “physical distancing” and wearing a mask”; herein we presentour experience, in the health system of the IR of Iran.

We reviewnational and international literatureand documents, and summarizing the lessons learned from the Islamic Republic of Iran regarding this epidemic.

The Islamic Republic of Iran operated in14 sectors namely: " leadership", "centralized command", "general education", "inter-sectoral cooperation", "public participation", "health network", "outpatient services", " center for disease control", "laboratories", "clinical and hospital personnel", "resistance approach", "cooperation between army and the community", "use of national, intra-sectional and inter-sectional capacities" and "public mobilization".

Positive aspects of Iran’s performance of the health system has been mentioned in result section of this article, which can guarantee health of the people if adhered to and executed properly.

Due to the fact that the Covid-19 pandemic has yet to be contained, there remains the need to render healthcare, educational and research activities safely alongside this pandemic. Herein, strategies are proposed in order to improve and continue these services and activities whilst providing maximum safety and addressing community concerns of contracting the disease when referring to healthcare centers and receiving services, and contracting the disease. Providing maximum safety for continuation of staff activities, continuous monitoring, and adherence to safety protocols to prevent spread of the disease are among the basic strategies to observe.