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Yang G, Bekele A, Krishnaswami S, Ameh E, Sifri Z, Aisuodionoe-Shadrach O, Swaroop M, Orloff S, Abdullah F, Nwomeh B, Chen M, Charles A, Ezeme C, Juillard C, Menezes C, Chitalu M, Nwariaku F, Jawa RS. Cultural competency and ethical behavior for collaboration in limited-resource settings: Guidelines from the Society of University Surgeons Academic Global Surgery Committee and the Association for Academic Global Surgery. Surgery 2024; 176:108-114. [PMID: 38609784 DOI: 10.1016/j.surg.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/02/2024] [Accepted: 02/26/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND There are an increasing number of global surgery activities worldwide. With such tremendous growth, there is a potential risk for untoward interactions between high-income country members and low-middle income country members, leading to programmatic failure, poor results, and/or low impact. METHODS Key concepts for cultural competency and ethical behavior were generated by the Academic Global Surgery Committee of the Society for University Surgeons in collaboration with the Association for Academic Global Surgery. Both societies ensured active participation from high-income countries and low-middle income countries. RESULTS The guidelines provide a framework for cultural competency and ethical behavior for high-income country members when collaborating with low-middle income country partners by offering recommendations for: (1) preparation for work with low-middle income countries; (2) process standardization; (3) working with the local community; (4) limits of practice; (5) patient autonomy and consent; (6) trainees; (7) potential pitfalls; and (8) gray areas. CONCLUSION The article provides an actionable framework to address potential cultural competency and ethical behavior issues in high-income country - low-middle income country global surgery collaborations.
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Affiliation(s)
- George Yang
- Department of Surgery, University of Alabama, Birmingham, AL
| | - Abebe Bekele
- University of Global Health Equity, Kigali, Rwanda
| | | | - Emmanuel Ameh
- Department of Surgery, National Hospital, Abuja, Nigeria
| | - Ziad Sifri
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | | | - Mamta Swaroop
- Department of Surgery, Kern Medical Center, Bakersfield, CA
| | - Susan Orloff
- Department of Surgery, Oregon Health & Sciences University, Portland, OR
| | - Fizan Abdullah
- Department of Surgery, Northwestern University and Lurie Children's Hospital of Chicago, Chicago, IL
| | - Benedict Nwomeh
- Department of Surgery, Ohio State University and Nationwide Childrens Hospital, Columbus, OH
| | - Mike Chen
- Department of Surgery, University of Alabama, Birmingham, AL
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Catherine Juillard
- Department of Surgery, University of California Los Angeles, Los Angeles, CA
| | | | | | - Fiemu Nwariaku
- Department of Surgery, University of Utah, Salt Lake City, UT
| | - Randeep S Jawa
- Department of Surgery, Stony Brook Medicine, Stony Brook, NY.
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Karuga R, Steege R, Chowdhury S, Squire B, Theobald S, Otiso L. A multi-step analysis and co-produced principles to support equitable partnership with Liverpool School of Tropical Medicine, 125 years on. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002091. [PMID: 38820344 PMCID: PMC11142479 DOI: 10.1371/journal.pgph.0002091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 04/10/2024] [Indexed: 06/02/2024]
Abstract
Transboundary health partnerships are shaped by global inequities. Perspectives from the "global South" are critical to understand and redress power asymmetries in research partnerships yet are not often included in current guidelines. We undertook research with partners working with the Liverpool School of Tropical Medicine (LSTM) to inform LSTM's equitable partnership strategy and co-develop principles for equitable partnerships as an entry point towards broader transformative action on research partnerships. We applied mixed-methods and participatory approaches. An online survey (n = 21) was conducted with LSTM's transboundary partners on fairness of opportunity, fair process, and fair sharing of benefits, triangulated with key informant interviews (n = 12). Qualitative narratives were analysed using the thematic framework approach. Findings were presented in a participatory workshop (n = 11) with partners to co-develop principles, which were refined and checked with stakeholders. Early inclusion emerged as fundamental to equitable partnerships, reflected in principle one: all partners to input into research design, agenda-setting and outputs to reflect priorities. Transparency is highlighted in principle two to guide all stages including agenda-setting, budgeting, data ownership and authorship. Principle three underscores the importance of contextually embedded knowledge for relevant and impactful research. Multi-directional capacity strengthening across all cadres is highlighted in principle four. Principle five includes LSTM leveraging their position for strategic and deliberate promotion of transboundary partners in international forums. A multi-centric model of partnership with no centralised power is promoted in principle six. Finally, principle seven emphasises commitment to the principles and Global Code of Conduct values: Fairness, Respect, Care, Honesty. The co-developed principles are part of ongoing reflections and dialogue to improve and undo harmful power structures that perpetuate coloniality within global health. While this process was conducted with LSTM-Liverpool's existing partners, the principles to strengthen equity are applicable to other institutions engaged in transboundary research partnerships and relevant for funders.
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Affiliation(s)
- Robinson Karuga
- Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya
| | - Rosie Steege
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Shahreen Chowdhury
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Bertie Squire
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Lilian Otiso
- Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya
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Naidu T. Epistemic disobedience-Undoing coloniality in global health research. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003033. [PMID: 38648248 PMCID: PMC11034650 DOI: 10.1371/journal.pgph.0003033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- Thirusha Naidu
- Department of Behavioural Medicine, Nelson R. Mandela School of Medicine University of KwaZulu-Natal, Durban, South Africa
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
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4
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Beardmore-Gray A, Simwinga M, Vwalika B, Chinkoyo S, Chappell L, Sandall J, Shennan A. Understanding the language barriers to translating informed consent documents for maternal health trials in Zambia: a qualitative study. BMJ Open 2024; 14:e076744. [PMID: 38580359 PMCID: PMC11002372 DOI: 10.1136/bmjopen-2023-076744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 02/26/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVE Providing comprehensible information is essential to the process of valid informed consent. Recruitment materials designed by sponsoring institutions in English-speaking, high-income countries are commonly translated for use in global health studies in other countries; however, key concepts are often missed, misunderstood or 'lost in translation'. The aim of this study was to explore the language barriers to informed consent, focusing on the challenges of translating recruitment materials for maternal health studies into Zambian languages. DESIGN We used a qualitative approach, which incorporated a multistakeholder workshop (11 participants), in-depth interviews with researchers and translators (8 participants) and two community-based focus groups with volunteers from community advisory boards (20 participants). Content analysis was used to identify terms commonly occurring in recruitment materials prior to the workshop. The framework analysis approach was used to analyse interview data, and a simple inductive thematic analysis approach was used to analyse focus group data. SETTING The study was based in Lusaka, Zambia. RESULTS The workshop highlighted difficulties in translating research terms and pregnancy-specific terms, as well as widespread concern that current templates are too long, use overly formal language and are designed with little input from local teams. Framework analysis of in-depth interviews identified barriers to participant understanding relating to design and development of recruitment materials, language, local context and communication styles. Focus group participants confirmed these findings and suggested potential solutions to ensure the language and content of recruitment materials can be better understood. CONCLUSION Our findings demonstrate that the way in which recruitment materials are currently designed, translated and disseminated may not enable potential trial participants to fully understand the information provided. Instead of using overly complex institutional templates, recruitment materials should be created through an iterative and interactive process that provides truly comprehensible information in a format appropriate for its intended participants.
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Affiliation(s)
- Alice Beardmore-Gray
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | | | | | - Sebastian Chinkoyo
- Department of Obstetrics and Gynaecology, Ndola Teaching Hospital, Ndola, Zambia
| | - Lucy Chappell
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Jane Sandall
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Andrew Shennan
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
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Lebu S, Musoka L, Graham JP. Reflective questioning to guide socially just global health reform: a narrative review and expert elicitation. Int J Equity Health 2024; 23:3. [PMID: 38183120 PMCID: PMC10770991 DOI: 10.1186/s12939-023-02083-2] [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: 07/22/2023] [Accepted: 12/15/2023] [Indexed: 01/07/2024] Open
Abstract
Recent research has highlighted the impacts of colonialism and racism in global health, yet few studies have presented concrete steps toward addressing the problems. We conducted a narrative review to identify published evidence that documented guiding frameworks for enhancing equity and inclusion in global health research and practice (GHRP). Based on this narrative review, we developed a questionnaire with a series of reflection questions related on commonly reported challenges related to diversity, inclusion, equity, and power imbalances. To reach consensus on a set of priority questions relevant to each theme, the questionnaire was sent to a sample of 18 global health experts virtually and two rounds of iterations were conducted. Results identified eight thematic areas and 19 reflective questions that can assist global health researchers and practitioners striving to implement socially just global health reforms. Key elements identified for improving GHRP include: (1) aiming to understand the historical context and power dynamics within the areas touched by the program; (2) promoting and mobilizing local stakeholders and leadership and ensuring measures for their participation in decision-making; (3) ensuring that knowledge products are co-produced and more equitably accessible; (4) establishing a more holistic feedback and accountability system to understand needed reforms based on local perspectives; and (5) applying systems thinking to addressing challenges and encouraging approaches that can be sustained long-term. GHRP professionals should reflect more deeply on how their goals align with those of their in-country collaborators. The consistent application of reflective processes has the potential to shift GHRP towards increased equity.
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Affiliation(s)
- Sarah Lebu
- School of Public Health, University of California Berkeley, 2121, Berkeley Way, Berkeley, CA, 94704, USA.
- University of North Carolina, Gillings School of Public Health, Chapel Hill, NC, USA.
| | - Lena Musoka
- School of Public Health, University of California Berkeley, 2121, Berkeley Way, Berkeley, CA, 94704, USA
- Georgetown University, McDonough School of Business, Washington, DC, USA
| | - Jay P Graham
- School of Public Health, University of California Berkeley, 2121, Berkeley Way, Berkeley, CA, 94704, USA
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6
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Fogarty AS, Ahmed MJ, Linder AG, Zangana A, Muftin K, Standley CJ, Sorrell EM. Lost in translation: the importance of addressing language inequities in global health security. BMJ Glob Health 2023; 8:e014419. [PMID: 38154812 PMCID: PMC10759103 DOI: 10.1136/bmjgh-2023-014419] [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: 11/03/2023] [Accepted: 12/10/2023] [Indexed: 12/30/2023] Open
Abstract
Language inequities in global health stem from colonial legacies, and global health security is no exception. The International Health Regulations (IHRs), a legally binding framework published by the WHO, lay the foundation for global health security and state the roles and responsibilities States Parties are compelled to follow to improve their capabilities to prevent, detect and respond to potential public health emergencies of international concern. It includes the submission of a mandatory status report that assesses a nation's implementation of IHRs. Known as the States Party Self-Assessment Annual Report (SPAR) tool, WHO has made its guidance document available in all six WHO official languages (Arabic, Chinese, English, French, Russian and Spanish). The Republic of Iraq (Iraq) experienced significant challenges during the completion and submission of the 2022 SPAR. This experience demonstrated that translation of English materials to other languages, such as Arabic, is not prioritised and further underscored how scoring of a country's global health security capacities can be significantly impacted by users' ability to read and comprehend the materials in English. Not only can this lead to inaccurate SPAR scoring, but it can also lead to the improper allocation of resources and prioritisation of policy developments and/or amendments. By drawing attention to this issue, we aim to inform and advocate for global health security decision-makers to consider opportunities for increasing inclusion and accessibility, especially for requirements under legally binding international instruments.
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Affiliation(s)
- Alanna S Fogarty
- Center for Global Health Science and Security, Georgetown University, Washington, DC, USA
| | - Mohammed J Ahmed
- Directorate of Public Health, Republic of Iraq Ministry of Health, Baghdad, Iraq
| | - Alexander G Linder
- Center for Global Health Science and Security, Georgetown University, Washington, DC, USA
| | - Aso Zangana
- Directorate of Preventative Health and Food Safety, Kurdistan, Republic of Iraq Ministry of Health, Erbil, Iraq
| | | | - Claire J Standley
- Center for Global Health Science and Security, Georgetown University, Washington, DC, USA
- Institute of Global Health, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Erin M Sorrell
- Center for Health Security, Department of Environmental Health and Engineering, Johns Hopkins, Bloomberg School of Public Health, Baltimore, MD, USA
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Pelicioni PHS, Michell A, Santos PCRD, Schulz JS. Facilitating Access to Current, Evidence-Based Health Information for Non-English Speakers. Healthcare (Basel) 2023; 11:1932. [PMID: 37444766 DOI: 10.3390/healthcare11131932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Scientific communication is crucial for the development of societies and the advancement of knowledge. However, many countries, and, consequently, their researchers, clinicians and community members, lack access to this information due to the information being disseminated in English rather than their native language. In this viewpoint, we aim to discuss the impacts of this problem and also outline recommendations for facilitating non-English speakers' access to current, evidence-based health information, thus extending the impact of science beyond academia. First, the authors discuss the barriers to accessing scientific health information for non-English speakers and highlight the negative impact of imposing English as a predominant language in academia. Next, the authors discuss the impacts of reduced access to clinical information for non-English speakers and how this reduced access impacts clinicians, clients, and health systems. Finally, the authors provide recommendations for enhancing access to scientific communication worldwide.
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Affiliation(s)
- Paulo Henrique Silva Pelicioni
- School of Health Sciences, University of New South Wales, Randwick 2031, Australia
- Neuroscience Research Australia, University of New South Wales, Randwick 2031, Australia
| | - Antonio Michell
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Newtown 2042, Australia
| | | | - Jennifer Sarah Schulz
- The Faculty of Law and Justice, University of New South Wales, Randwick 2031, Australia
- School of Population Health, University of New South Wales, Randwick 2031, Australia
- Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland 0627, New Zealand
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8
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Tang Y, Zhang F, Xu DR. The implications of decolonization on China's academic global health: a dialogue with Stephen Gloyd at the Luhu Global Health Salon. Glob Health Res Policy 2023; 8:14. [PMID: 37198704 PMCID: PMC10190061 DOI: 10.1186/s41256-023-00299-x] [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: 02/27/2023] [Accepted: 04/21/2023] [Indexed: 05/19/2023] Open
Abstract
The call for decolonization in global health is growing alongside China's increasing involvement in the field. This perspective paper presents and extends with a further literature review of a dialogue with Stephen Gloyd, a global health professor from the University of Washington, conducted in July 2022 at the Luhu Global Health Salon. Drawing from Gloyd's four decades of experiences in low- and middle-income countries, as well as his role in creating the University of Washington's global health department, the doctoral program in implementation science, and the non-governmental organization, Health Alliance International, this paper delves into the concept of decolonization in global health and explores how Chinese universities can expand their participation in global health while striving for equity and justice. Focusing on China's academic global health research, education, and practice, the paper proposes specific recommendations for building an equity-focused global health curriculum, addressing power imbalances and inequalities in university-affiliated organizations, and strengthening South-South cooperation in practice. The paper offers implications for Chinese universities on expanding future global health cooperation, promoting global health governance, and avoiding recolonization.
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Affiliation(s)
- Yu Tang
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Feifei Zhang
- Southern Medical University Institute for Global Health (SIGHT), Dermatology Hospital of Southern Medical University (SMU), Guangzhou, China
| | - Dong Roman Xu
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China.
- Center for World Health Organization Studies and Department of Health Management, School of Health Management of Southern Medical University, Guangzhou, China.
- Southern Medical University Institute for Global Health (SIGHT), Dermatology Hospital of Southern Medical University (SMU), Guangzhou, China.
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9
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Sewankambo NK, Wallengren E, De Angeles KJC, Tomson G, Weerasuriya K. Envisioning the futures of global health: three positive disruptions. Lancet 2023; 401:1247-1249. [PMID: 36934734 DOI: 10.1016/s0140-6736(23)00513-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/18/2023]
Affiliation(s)
| | - Emma Wallengren
- Department of Global Public Health, Karolinska Institutet, SE-17177 Stockholm, Sweden.
| | | | - Göran Tomson
- Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, SE-17177 Stockholm, Sweden; President's Office, Karolinska Institutet, SE-17177 Stockholm, Sweden
| | - Krisantha Weerasuriya
- Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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10
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Hodson DZ, Etoundi YM, Parikh S, Boum Y. Striving towards true equity in global health: A checklist for bilateral research partnerships. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001418. [PMID: 36963065 PMCID: PMC10021183 DOI: 10.1371/journal.pgph.0001418] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Interest in "global health" among schools of medicine, public health, and other health disciplines in high-income countries (HIC) continues to rise. Persistent power imbalances, racism, and maintenance of colonialism/neocolonialism plague global health efforts, including global health scholarship. Scholarly projects conducted in low- and middle-income countries (LMIC) by trainees at these schools in HIC often exacerbate these problems. Drawing on published literature and shared experiences, we review key inequalities within each phase of research, from design through implementation and analysis/dissemination, and make concrete and practical recommendations to improve equity at each stage. Key problems facing global health scholarship include HIC-centric nature of global health organizations, paucity of funding directly available for LMIC investigators and trainees, misplaced emphasis on HIC selected issues rather than local solutions to local problems, the dominance of English language in the scientific literature, and exploitation of LMIC team members. Four key principles lie at the foundation of all our recommendations: 1) seek locally derived and relevant solutions to global health issues, 2) create paired collaborations between HIC and LMIC institutions at all levels of training, 3) provide funding for both HIC and LMIC team members, 4) assign clear roles and responsibilities to value, leverage, and share the strengths of all team members. When funding for global health research is predicated upon more ethical and equitable collaborations, the nature of global health collaborations will evolve to be more ethical and equitable. Therefore, we propose the Douala Equity Checklist as a 20-item tool HIC and LMIC institutions can use throughout the conduct of global health projects to ensure more equitable collaborations.
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Affiliation(s)
- Daniel Z Hodson
- Yale School of Medicine, New Haven, CT, United States of America
| | - Yannick Mbarga Etoundi
- Douala Military Hospital, Douala, Cameroon
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Sunil Parikh
- Yale School of Medicine, New Haven, CT, United States of America
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States of America
| | - Yap Boum
- Epicentre, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Science, University of Yaoundé I, Yaoundé, Cameroon
- Institut Pasteur of Bangui, Bangui, Central African Republic
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11
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Radhuber IM, Fiske A, Galasso I, Gessl N, Hill MD, Morales ER, Olarte-Sánchez LE, Pelfini A, Saxinger G, Spahl W. Toward global citizenship? People (de)bordering their lives during COVID-19 in Latin America and Europe. Glob Public Health 2023; 18:2285880. [PMID: 38010427 DOI: 10.1080/17441692.2023.2285880] [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: 07/06/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023]
Abstract
The COVID-19 pandemic highlighted global interdependencies, accompanied by widespread calls for worldwide cooperation against a virus that knows no borders, but responses were led largely separately by national governments. In this tension between aspiration and reality, people began to grapple with how their own lives were affected by the global nature of the pandemic. In this article, based on 493 qualitative interviews conducted between 2020 and 2021, we explore how people in Argentina, Austria, Bolivia, Ecuador, Ireland, Italy and Mexico experienced, coped with and navigated the global nature of the pandemic. In dialogue with debates about the parameters of the 'global' in global health, we focus on what we call people's everyday (de)bordering practices to examine how they negotiated (dis)connections between 'us' and 'them' during the pandemic. Our interviewees' reactions moved from national containment to an increasing focus on people's unequal socio-spatial situatedness. Eventually, they began to (de)border their lives beyond national lines of division and to describe a new normal: a growing awareness of global connectedness and a desire for global citizenship. This newfound sense of global interrelatedness could signal support for and encourage transnational political action in times of crises.
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Affiliation(s)
| | - Amelia Fiske
- Department of Clinical Medicine, TUM School of Medicine and Health, Institute of History and Ethics in Medicine, Technical University of Munich, Munchen, Germany
| | - Ilaria Galasso
- Department of Clinical Medicine, TUM School of Medicine and Health, Institute of History and Ethics in Medicine, Technical University of Munich, Munchen, Germany
- University College Dublin, Dublin, Ireland
| | - Nicolai Gessl
- Department of Political Science, University of Vienna, Wien, Austria
| | - Michael D Hill
- Department of Anthropology, Universidad San Francisco de Quito USFQ, Quito, Ecuador
| | - Emma R Morales
- Department of Habitat and Urban Development, ITESO, Universidad Jesuita de Guadalajara, Tlaquepaque, Mexico
| | | | - Alejandro Pelfini
- Faculty of Social Sciences, Universidad del Salvador, Buenos Aires, Argentina
- Global Studies Programme, Facultad Latinoamericana de Ciencias Sociales FLACSO-Argentina, Buenos Aires, Argentina
| | - Gertrude Saxinger
- Department of Political Science, University of Vienna, Wien, Austria
| | - Wanda Spahl
- Department of Political Science, University of Vienna, Wien, Austria
- Division Biomedical and Public Health Ethics, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
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12
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Stein F, Storeng KT, de Bengy Puyvallée A. Global health nonsense. BMJ 2022; 379:o2932. [PMID: 36535671 PMCID: PMC9832539 DOI: 10.1136/bmj.o2932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Global health discourse that either underinforms or misinforms its audience is “global health nonsense.” Such nonsense is widespread, and jeopardises improvement in global health governance, argue Stein, Storeng, and de Bengy Puyvallée
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Affiliation(s)
- Felix Stein
- Centre for Development and the Environment, University of Oslo
- Department of Social Anthropology, University of Cambridge
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13
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Kaplan L, Kuhnt J, Picot LE, Grasham CF. Safeguarding research staff “in the field”: a blind spot in ethics guidelines. RESEARCH ETHICS 2022. [DOI: 10.1177/17470161221131494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Across disciplines there is a large and increasing number of research projects that rely on data collection activities in low- and middle-income countries (LMICs). However, these are accompanied by an extensive range of ethical challenges. While the safeguarding of study participants is the primary aim of existing ethics guidelines, this paper argues that this “do no harm” principle should be extended to include research staff. This study is a comprehensive review of more than 80 existing ethics guidelines and protocols that reveals a lack of safeguarding research staff regarding the ethical challenges faced during data collection activities in LMICs. This is particularly the case when it comes to issues such as power imbalances, political risk, staff’s emotional wellbeing or dealing with feelings of guilt. Lead organizations are called upon to develop guiding principles that encompass the safeguarding of research staff, which are then to be adapted and translated into specific protocols and tools by institutions.
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Affiliation(s)
| | - Jana Kuhnt
- German Institute of Development and Sustainability, Germany
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14
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Malqvist M, Powell N. Health, sustainability and transformation: a new narrative for global health. BMJ Glob Health 2022; 7:bmjgh-2022-010969. [DOI: 10.1136/bmjgh-2022-010969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022] Open
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15
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Jaeger L, Devi T, Barbazza E, Neufeld M, Franz C, Marten R, Tello JE. Describing and mapping scientific articles on alcohol globally for the period 2010-2021: a bibliometric analysis. BMJ Open 2022; 12:e063365. [PMID: 36127108 PMCID: PMC9490636 DOI: 10.1136/bmjopen-2022-063365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To describe and map scientific literature related to alcohol consumption, its determinants, governance, harm and control policies by publication output, author affiliations, funding, countries of study and research themes. DESIGN Bibliometric analysis using performance analysis and science mapping techniques. DATA SOURCES Scientific articles. ELIGIBILITY CRITERIA Indexed scientific articles published between 1 January 2010 and 31 December 2021 with an English abstract focused on alcohol consumption, its determinants, harms, governance and control policies. DATA EXTRACTION AND SYNTHESIS Searches were run in Web of Science and PubMed. Performance metrics were analysed using descriptive statistics. Keywords were used for science mapping in a deductive approach to cluster articles by five main research themes. The 'policy response' theme was further analysed by six subthemes. RESULTS 4553 articles were included in the analysis. Three out of four articles (3479/4553, 76.4%) were authored solely by authors affiliated with HIC institutions. One in five articles (906/4553, 19.9%) had at least one author affiliated to an institution from an upper-middle-income, middle-income or low-income country context. Governments, followed by research institutions, were the predominant funding source. Half (53.1%) studied a single country and, of these, 77.0% were high-income countries (HICs). Australia, USA and UK were the most studied countries, together accounting for 44.9% (975/2172) of country-specific articles. Thematically, 'consumption' was most studied, and 'alcohol determinants', least. 'Policy response' articles were predominately conducted in HIC contexts. CONCLUSIONS Although the attributable harm of alcohol is known to affect more significantly lower-income and middle-income countries, scientific publications primarily report on HIC contexts by authors from HICs. Research themes reflect known cost-effective policy actions, though skewed towards HICs and a focus on consumption. The implementation of context-specific alcohol control policies requires addressing the determinants of the uneven geographical and thematic distribution of research.
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Affiliation(s)
| | - Tanmay Devi
- Data Analysis, CPC Analytics, Berlin, Germany
| | - Erica Barbazza
- Department of Public and Occupational Health, University of Amsterdam, Amsterdam, Netherlands
| | - Maria Neufeld
- WHO European Office for Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
| | | | - Robert Marten
- Alliance for Health Policy and Systems Research, World Health Organization, Geneve, Switzerland
| | - Juan E Tello
- Department of Health Promotion, World Health Organization, Geneve, Switzerland
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What is Global Health Equity? A Proposed Definition. Ann Glob Health 2022; 88:50. [PMID: 35860038 PMCID: PMC9266830 DOI: 10.5334/aogh.3754] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/12/2022] [Indexed: 11/29/2022] Open
Abstract
The term “global health equity” has become more visible in recent years, yet we were unable to find a formal definition of the term. Our Viewpoint addresses this gap by offering a discussion of this need and proposing a definition. We define global health equity as mutually beneficial and power-balanced partnerships and processes leading to equitable human and environmental health outcomes (which we refer to as “products”) on a global scale. Equitable partnerships actively work against racism and supremacy. Such partnerships foster processes with these same dynamics; for example, sharing lead authorship responsibilities with meaningful roles for host country researchers to frame relevant questions and to provide context and interpretation for the research findings. Equitable products, such as access to technology and tailored delivery of interventions effective in the specific context, are the fruits of these partnerships and processes.
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17
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Sayegh H, Harden C, Khan H, Pai M, Eichbaum QG, Ibingira C, Goba G. Global health education in high-income countries: confronting coloniality and power asymmetry. BMJ Glob Health 2022; 7:bmjgh-2022-008501. [PMID: 35589151 PMCID: PMC9121410 DOI: 10.1136/bmjgh-2022-008501] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/19/2022] [Indexed: 11/26/2022] Open
Abstract
Contemporary global health education is overwhelmingly skewed towards high-income countries (HICs). HIC-based global health curricula largely ignore colonial origins of global health to the detriment of all stakeholders, including trainees and affected community members of low- and middle-income countries. Using the Consortium of Universities for Global Health’s Global Health Education Competencies Tool-Kit, we analyse the current structure and content of global health curricula in HICs. We identify two major areas in global health education that demand attention: (1) the use of a competency-based education framework and (2) the shortcomings of curricular content. We propose actionable changes that challenge current power asymmetries in global health education.
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Affiliation(s)
- Hoda Sayegh
- School of Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Christina Harden
- Center for Infectious Disease Dynamics, Penn State, University Park, Pennsylvania, USA
| | - Hijab Khan
- School of Medicine & Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Madhukar Pai
- Epidemiology and Biostats, McGill University, Montreal, Québec, Canada
| | | | | | - Gelila Goba
- School of Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
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18
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Voller S, Schellenberg J, Chi P, Thorogood N. What Makes Working Together Work? A Scoping Review of the Guidance on North-South Research Partnerships. Health Policy Plan 2022; 37:523-534. [PMID: 35089994 PMCID: PMC9006068 DOI: 10.1093/heapol/czac008] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/29/2021] [Accepted: 01/28/2022] [Indexed: 11/14/2022] Open
Abstract
At their best, research partnerships provide a mechanism to optimize each partner’s strengths, make scientific discoveries and achieve development goals. Each partner stands to gain from the relationship and perceives it to be fair. However, partnerships between institutions in the global North and the global South have been beleaguered by structural inequalities and power imbalances, and Northern stakeholders have been criticized for perpetuating paternalistic or neo-colonial behaviours. As part of efforts to redress imbalances and achieve equity and mutual benefit, various principles, guidelines, frameworks and models for partnership have been developed. This scoping review maps the literature and summarizes key features of the guidelines for North–South research partnerships. The review was conducted between October 2020 and January 2021. Three academic journal databases and Google were searched, and additional resources were identified through a hand search of reference lists and expert recommendation. Twenty-two guidelines were identified published between 1994 and 2021 and originating predominantly in the fields of international development and global health. The themes addressed within the guidelines were aggregated using NVivo qualitative analysis software to code the content of each guideline. Topics featuring most prominently in the guidelines were: partner roles, responsibilities and ways of working; capacity strengthening; motivation and goals; resource contributions; agenda setting and study design; governance structures and institutional agreements; dissemination; respect for affected populations; data handling and ownership; funding and long-term commitments. The current study reinforces many of the themes from two recent scoping reviews specific to the field of global health, but gaps remain, which need to be addressed: Southern stakeholders continue to be under-represented in guideline development, and there is limited evidence of how guidelines are used in practice. Further exploration is needed of Southern stakeholder priorities and whether and how guidelines are operationalized.
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Affiliation(s)
- Shirine Voller
- *Corresponding author. Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK. E-mail:
| | - Joanna Schellenberg
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Primus Chi
- Health Systems and Research Ethics Department, KEMRI Wellcome Trust Research Programme, CGMRC, PO Box 230-80108 Kilifi, Kenya
| | - Nicki Thorogood
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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19
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Kwete X, Tang K, Chen L, Ren R, Chen Q, Wu Z, Cai Y, Li H. Decolonizing global health: what should be the target of this movement and where does it lead us? Glob Health Res Policy 2022; 7:3. [PMID: 35067229 PMCID: PMC8784247 DOI: 10.1186/s41256-022-00237-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/13/2022] [Indexed: 12/02/2022] Open
Abstract
The current decolonizing global health movement is calling us to take a post-colonial perspective at the research and practice of global health, an area that has been re-defined by contemporary scholars and advocates with the purpose of promoting equity and justice. In this article, we summarize the main points of discussion from the Symposium organized by the editorial board of Global Health Research and Policy, convened in July 2021 in Wuhan, China. Experts participating in the symposium discussed what decolonizing global health means, how to decolonize it, and what criteria to apply in measuring its completion. Through the meeting, a consensus was reached that the current status quo of global health is still replete with various forms of colonial vestiges-ideologies and practices-, and to fully decolonize global health, systemic reforms must be taken that target the fundamental assumptions of global health: does investment in global health bring socioeconomic development, or is it the other way around? Three levels of colonial vestiges in global health were raised and one guiding principle was proposed when thinking of solutions for them. More theoretical discussion needs to be explored to guide practices to decolonize global health.
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Affiliation(s)
- Xiaoxiao Kwete
- Global Health Research and Consulting, Yaozhi, Yangzhou, China.
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Lucy Chen
- National School of Development, Peking University, Beijing, China
| | - Ran Ren
- Global Health Research Center, Dalian Medical University, Dalian, China
| | - Qi Chen
- Institute for Advanced Studies in Humanities and Social Sciences, Beihang University, Beijing, China
| | - Zhenru Wu
- Institute for the World Economy, Shanghai Academy of Social Sciences, Shanghai, China
| | - Yi Cai
- Global Health Institute, Wuhan University, Wuhan, China
| | - Hao Li
- Global Health Institute, Wuhan University, Wuhan, China
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20
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Sbaiti M, Streule MJ, Alhaffar M, Pilkington V, Leis M, Budhathoki SS, Mkhallalati H, Omar M, Liu L, Golestaneh AK, Abbara A. Whose voices should shape global health education? Curriculum codesign and codelivery by people with direct expertise and lived experience. BMJ Glob Health 2021; 6:bmjgh-2021-006262. [PMID: 34475023 PMCID: PMC8413871 DOI: 10.1136/bmjgh-2021-006262] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/05/2021] [Indexed: 11/05/2022] Open
Abstract
There are contrasting opinions of what global health (GH) curricula should contain and limited discussion on whose voices should shape it. In GH education, those with first-hand expertise of living and working in the contexts discussed in GH classrooms are often absent when designing curricula. To address this, we developed a new model of curriculum codesign called Virtual Roundtable for Collaborative Education Design (ViRCoED). This paper describes the rationale and outputs of the ViRCoED approach in designing a new section of the Global Health Bachelor of Science (BSc) curriculum at Imperial College London, with a focus on healthcare in the Syrian conflict. The team, importantly, involved partners with lived and/or professional experience of the conflict as well as alumni of the course and educators in all stages of design and delivery through to marking and project evaluation. The project experimented with disrupting power dynamics and extending ownership of the curriculum beyond traditional faculty by codesigning and codelivering module contents together with colleagues with direct expertise and experience of the Syrian context. An authentic approach was applied to assessment design using real-time syndromic healthcare data from the Aleppo and Idlib Governorates. We discuss the challenges involved in our collaborative partnership and describe how it may have enhanced the validity of our curriculum with students engaging in a richer representation of key health issues in the conflict. We observed an enhanced self-reflexivity in the students’ approach to quantitative data and its complex interpretation. The dialogic nature of this collaborative design was also a formative process for partners and an opportunity for GH educators to reflect on their own positionality. The project aims to challenge current standards and structures in GH curriculum development and gesture towards a GH education sector eventually led by those with lived experience and expertise to significantly enhance the validity of GH education.
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Affiliation(s)
- Mariam Sbaiti
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Mike J Streule
- Centre for Higher Education Research and Scholarship, Imperial College London, London, UK
| | - Mervat Alhaffar
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Syria Research Group, London School of Hygiene and Tropical Medicine, London and National University of Singapore Saw Swee Hock School of Public Health, UK/ Singapore.,Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Victoria Pilkington
- Nuffield Department of Population Health, University of Oxford, Oxford, UK.,School of Medicine, Imperial College London, London, UK
| | - Melanie Leis
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Shyam Sundar Budhathoki
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Hala Mkhallalati
- Syria Research Group, London School of Hygiene and Tropical Medicine, London and National University of Singapore Saw Swee Hock School of Public Health, UK/ Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Maryam Omar
- Department of Respiratory Medicine, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Lillian Liu
- School of Medicine, Imperial College London, London, UK
| | | | - Aula Abbara
- Department of Infectious Disease, Imperial College London, London, UK
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