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Perkins J, Chandler C, Kelly A, Street A. The social lives of point-of-care tests in low- and middle-income countries: a meta-ethnography. Health Policy Plan 2024; 39:782-798. [PMID: 38907518 PMCID: PMC11308614 DOI: 10.1093/heapol/czae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 05/28/2024] [Accepted: 06/21/2024] [Indexed: 06/24/2024] Open
Abstract
Point-of-care tests (POCTs) have become technological solutions for many global health challenges. This meta-ethnography examines what has been learned about the 'social lives' of POCTs from in-depth qualitative research, highlighting key social considerations for policymakers, funders, developers and users in the design, development and deployment of POCTs. We screened qualitative research examining POCTs in low- and middle-income countries and selected 13 papers for synthesis. The findings illuminate five value-based logics-technological autonomy, care, scalability, rapidity and certainty-shaping global health innovation ecosystems and their entanglement with health systems. Our meta-ethnography suggests that POCTs never achieve the technological autonomy often anticipated during design and development processes. Instead, they are both embedded in and constitutive of the dynamic relationships that make up health systems in practice. POCTs are often imagined as caring commodities; however, in use, notions of care inscribed in these devices are constantly negotiated and transformed in relation to multiple understandings of care. POCTs promise to standardize care across scale, yet our analysis indicates nonstandard processes, diagnoses and treatment pathways as essential to 'fluid technologies' rather than dangerous aberrations. The rapidity of POCTs is constructed and negotiated within multiple distinct temporal registers, and POCTs operate as temporal objects that can either speed up or slow down experiences of diagnosis and innovation. Finally, while often valued as epistemic tools that can dispel diagnostic uncertainty, these papers demonstrate that POCTs contribute to new forms of uncertainty. Together, these papers point to knowledge practices as multiple, and POCTs as contributing to, rather than reducing, this multiplicity. The values embedded in POCTs are fluid and contested, with important implications for the kind of care these tools can deliver. These findings can contribute to more reflexive approaches to global health innovation, which take into account limitations of established global health logics, and recognize the socio-technical complexity of health systems.
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Affiliation(s)
- Janet Perkins
- Department of Social Anthropology, School of Social and Political Science, University of Edinburgh, Chrystal Macmillan Building, 15a George Square, Edinburgh EH8 9LD, United Kingdom
| | - Clare Chandler
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
| | - Ann Kelly
- Department of Global Health and Social Medicine, King’s College London, Bush House North East Wing, 30 Aldwych, London WC2B 4BG, United Kingdom
| | - Alice Street
- Department of Social Anthropology, School of Social and Political Science, University of Edinburgh, Chrystal Macmillan Building, 15a George Square, Edinburgh EH8 9LD, United Kingdom
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Petrovici N, Belbe SȘ, Mare CC, Cotoi CC. Hybrid health regimes: Access to primary care physicians and COVID-19 vaccine uptake across municipalities in Romania. Soc Sci Med 2023; 337:116305. [PMID: 37857237 DOI: 10.1016/j.socscimed.2023.116305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 09/01/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023]
Abstract
This study analyses COVID-19 vaccine uptake at the municipal level in Romania using the global health regimes and vaccine hesitancy perspectives. Our spatial regression (SARAR-het Durbin) shows that the number of primary care physicians is a significant predictor of vaccine uptake, and municipalities with higher access to the labour market have higher vaccination rates. We provide a historical perspective to demonstrate that the current health regime in Romania is a hybrid of internationalist and global health regimes, with socialist investments affecting labour participation, education, poverty, and vaccination rates. Our findings highlight the impact of regional disparities and partial privatization of the health system.
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Affiliation(s)
- Norbert Petrovici
- Dep. of Sociology, Faculty of Sociology and Social Work, Babes-Bolyai University, 1, Anghel Saligny, 400394, Cluj-Napoca, Romania; Interdisciplinary Centre for Data Science, Babes-Bolyai University, 68, Avram Iancu Str., 400083, 4th Floor, Cluj-Napoca, Romania.
| | - Stefana Ștefana Belbe
- Dep. of Statistics, Forecasts, Mathematics, Faculty of Economics and Business Administration, Babes-Bolyai University, 58-60, Teodor Mihali Str., 400591, Cluj-Napoca, Romania; Interdisciplinary Centre for Data Science, Babes-Bolyai University, 68, Avram Iancu Str., 400083, 4th Floor, Cluj-Napoca, Romania.
| | - Codruta Codruța Mare
- Dep. of Statistics, Forecasts, Mathematics, Faculty of Economics and Business Administration, Babes-Bolyai University, 58-60, Teodor Mihali Str., 400591, Cluj-Napoca, Romania; Interdisciplinary Centre for Data Science, Babes-Bolyai University, 68, Avram Iancu Str., 400083, 4th Floor, Cluj-Napoca, Romania.
| | - Calin Călin Cotoi
- Dep. of Sociology, Faculty of Sociology and Social Work, University of Bucharest, 9, Schitu Magureanu Blv., Sector 1, Bucharest, Romania.
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Prevalence, and associated factors of tobacco smoking among adults in the United Arab Emirates; results from national health survey. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-021-01571-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Mlinarić M, Kohler E, Kunst AE, Lorant V, Rimpelä A, Hoffmann L, Anastasi D, Richter M. The association between migration and smoke-free families: how do migrants from different world regions compare? Eur J Public Health 2021; 31:333-340. [PMID: 33403397 DOI: 10.1093/eurpub/ckaa241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Studies on adolescent secondhand smoke exposure within the family often dichotomously operationalize migration background without paying attention to social and cultural diversity within migrant populations. As a result, little is known about variation within migrant groups in smoke-free family environments (SFFEs). This study analyses the association between SFFEs and parental migration from different world regions. METHODS Data from 14- to 16-year-old adolescents (N = 17 144) on SFFEs and parental migration were obtained from cross-sectional repeated SILNE-R surveys. A multivariable multinomial regression was applied, presenting relative risks (RRs) with 95% confidence intervals (CIs) for maternal or paternal tobacco smoking and home smoking bans. Variation in migration background was measured according to parental sex and place of birth. RESULTS Approximately 18% of adolescents are exposed to maternal smoking, and 25% are exposed to paternal smoking. Almost half of the respondents do not live in SFFEs but are subject to permissive (5%) or partial (39%) smoking bans at home. We found that adolescents of Eastern European descent are at a higher risk of being exposed to both paternal and maternal smoking. A sex difference in parental smoking was found among Arabic/Islamic migrants, where mothers are less likely to be smokers. Maternal and paternal African origins are associated with prohibitive smoking bans at home. Eastern European mothers show higher odds of permissiveness and freely allowing smoking at home. CONCLUSION Notable within-differences according to parental sex and place of birth were found for SFFEs and should be taken into account when implementing equity-sensitive tobacco prevention programs.
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Affiliation(s)
- Martin Mlinarić
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Emma Kohler
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Anton E Kunst
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Vincent Lorant
- Institute of Health and Society, UC Louvain, Brussels, Belgium
| | - Arja Rimpelä
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland.,Department of Adolescent Psychiatry, Tampere University Hospital, Nokia, Finland
| | - Laura Hoffmann
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Daniela Anastasi
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Italy
| | - Matthias Richter
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Reubi D. Epidemiological Imaginaries of the Social: Epidemiologists and Pathologies of Modernization in Postcolonial Africa. Med Anthropol Q 2020; 34:438-455. [PMID: 32812289 DOI: 10.1111/maq.12609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 07/04/2020] [Accepted: 07/10/2020] [Indexed: 01/21/2023]
Abstract
There is a growing anthropological literature analyzing the place that epidemiological surveillance occupies in contemporary global health. In this article, I build on this literature and take it into new directions by exploring what I call the epidemiological imaginaries of the social. Drawing on science and technology studies, I suggest that epidemiologists help make up the world, articulating complex and normatively loaded visions of social life that both enable and constrain action. More specifically, I argue that epidemiologists tell stories about the type of societies and people that compose the world and that these stories often shape global health policies and programs in powerful ways. To substantiate this argument, I examine epidemiologists' efforts to map smoking in postcolonial Africa, documenting how they have imagined smokers and smoking through the lense of modernization theory and showing how these imaginaries have shaped tobacco control policies in the region up to this day.
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Affiliation(s)
- David Reubi
- Department of Global Health & Social Medicine, King's College London
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Moon G, Barnett R, Pearce J, Thompson L, Twigg L. The tobacco endgame: The neglected role of place and environment. Health Place 2018; 53:271-278. [PMID: 30238907 DOI: 10.1016/j.healthplace.2018.06.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 06/27/2018] [Accepted: 06/29/2018] [Indexed: 01/10/2023]
Abstract
An increasing number of countries across the world are planning for the eradication of the tobacco epidemic. The actions necessary to realise this ambition have been termed the tobacco endgame. The focus of this paper is on the intersection between the tobacco endgame with place, a neglected theme in recent academic and policy debates. We begin with an overview of the key themes in the literature on endgame strategies before detailing the international landscape of engame initiatives, paying particular attention to the opportunities and challenges of endgame strategies in low and middle income countries. Finally, we critically assess the current endgame debates and suggest a novel agenda for integrating geographical perspectives into research on the endgame that provides enhanced understanding of the challenges associated with this important global health vision.
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Affiliation(s)
- Graham Moon
- School of Geography and Environmental Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, England, United Kingdom.
| | - Ross Barnett
- Department of Geography, University of Canterbury, Private Bag 4800, Christchurch 8020, New Zealand.
| | - Jamie Pearce
- School of GeoSciences, Drummond Street, University of Edinburgh, Edinburgh EH8 9XP, Scotland, United Kingdom.
| | - Lee Thompson
- Department of Population Health, University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand.
| | - Liz Twigg
- Department of Geography, University of Portsmouth, Buckingham Building, Lion Terrace, PO1 3HE England, United Kingdom.
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Reubi D. Epidemiological accountability: philanthropists, global health and the audit of saving lives. ECONOMY AND SOCIETY 2018; 47:83-110. [PMID: 29805316 PMCID: PMC5950534 DOI: 10.1080/03085147.2018.1433359] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
There have been concerns about the recent private turn and re-emergence of philanthropies in world health, with many worrying about philanthropies' perceived lack of transparency and accountability. In contrast, I argue that while the private turn might have led to a decline in democratic or public accountability, it did not bring an end to all forms of accountability. Specifically, I suggest that philanthropists' involvement in global health has led to the spread of another, new form of accountability: epidemiological accountability. The latter is a combination of two regimes of expertise and practices hitherto kept separate: audit and epidemiology. To substantiate this argument, I draw on my research on the Bloomberg Initiative - a global effort to reduce tobacco use spearheaded by the Bloomberg and Gates foundations.
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Affiliation(s)
- David Reubi
- Department of Global Health & Social Medicine, King’s College London, Room 2.4, East Wing Building, Strand, London WC2R 2LS, United Kingdom
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Abstract
Metrics have become all pervasive in global health today. Instead of highlighting their advantages or shortcomings, this article builds on Hacking's notion of historical ontology and explores their political, conceptual and material conditions of possibility. Drawing on research on the Bloomberg Initiative to Reduce Tobacco Use in Developing Countries, one of the largest international efforts to address the non-communicable disease epidemic in the global South, the article starts by introducing the notion of epidemiological reason - a thought style associated with modern epidemiology that undergirds the metrics permeating the global health field and which is made of a multiplicity of elements, from the ethical imperative to save lives to the social-scientific technique of the survey and the concept of global population. The article then goes on to explore the genealogy of this thought style, arguing that three epistemological ruptures have been critical to its development: the reconfiguration of power articulated around a biopolitics of population in the eighteenth and nineteenth centuries; the twentieth-century shift in medical thought marked by the emergence of surveillance medicine and the idea of lifestyle; and the re-organisation of world health informed by globalisation theories at the start of the twenty-first century.
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Affiliation(s)
- David Reubi
- Department of Social Science, Health & Medicine, King's College London, East Wing Building, Strand, London W2R 2LS, UK
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Global health from the outside: The promise of place-based research. Health Place 2017; 45:55-63. [DOI: 10.1016/j.healthplace.2017.03.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 02/28/2017] [Accepted: 03/05/2017] [Indexed: 11/19/2022]
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Abstract
This article explores the internationalisation of tobacco control as a case study in the history of international health regulation. Contrary to the existing literature on the topic, it argues that the history of international anti-smoking efforts is longer and richer than the making of the World Health Organisation's Framework Convention on Tobacco Control in the early twenty-first century. It thereby echoes the point made by other scholars about the importance of history when making sense of contemporary global health. Specifically, the article shows how the internationalisation of tobacco control started in the 1950s through informal contacts between scientists working on cancer research and how these initial interactions were followed by a growing number of more formal initiatives, from the World Conferences on Tobacco or Health to the Bloomberg Initiative to Reduce Tobacco Use. Rather than arranging these efforts in a linear narrative of progress culminating with the Framework Convention on Tobacco Control, we take anthropological claims about global health's uneven terrain seriously and portray a history of international tobacco control marked by ruptures and discontinuities. Specifically, we identify three successive periods, with each of them characterised by specific understandings of international action, tobacco control expertise, advocacy networks and funding strategies.
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Affiliation(s)
- David Reubi
- Department of Global Health & Social Medicine, King’s
College London, Strand,London WC2R 2LS,
UK
| | - Virginia Berridge
- Centre for History in Public Health, London School of
Hygiene and Tropical Medicine, 15–17 Tavistock Place,
London WC1H 9SH, UK
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Reubi D, Herrick C, Brown T. The politics of non-communicable diseases in the global South. Health Place 2016; 39:179-87. [PMID: 26365886 PMCID: PMC4889786 DOI: 10.1016/j.healthplace.2015.09.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 08/28/2015] [Accepted: 09/01/2015] [Indexed: 11/26/2022]
Abstract
In this paper, we explore the emergence of non-communicable diseases (NCDs) as an object of political concern in and for countries of the global South. While epidemiologists and public health practitioners and scholars have long expressed concern with the changing global distribution of the burden of NCDs, it is only in more recent years that the aetiology, politics and consequences of these shifts have become an object of critical social scientific enquiry. These shifts mark the starting point for this special issue on 'The Politics of NCDs in the Global South' and act as the basis for new, critical interventions in how we understand NCDs. In this paper, we aim not only to introduce and contextualise the six contributions that form this special issue, but also to identify and explore three themes - problematisation, care and culture - that index the main areas of analytical and empirical concern that have motivated analyses of NCDs in the global South and are central to critical engagement with their political contours.
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Affiliation(s)
- David Reubi
- Social Science, Health and Medicine, King's College London, United Kingdom.
| | | | - Tim Brown
- Geography, Queen Mary University of London, United Kingdom.
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