1
|
Dako F, Omofoye TS, Scheel J. Radiologists' Role in Decolonizing Global Health. J Am Coll Radiol 2024:S1546-1440(24)00272-2. [PMID: 38461914 DOI: 10.1016/j.jacr.2023.10.027] [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: 05/18/2023] [Revised: 08/29/2023] [Accepted: 10/16/2023] [Indexed: 03/12/2024]
Abstract
The colonial origins and power imbalances between Western high-income countries and low- and middle-income countries (LMICs) are barriers to self-reliance and sustained structural improvements to health care systems. Radiologists working in global health (global radiologists) are tasked with improving the state of imaging in LMICs while mitigating the effects of colonial structures and processes. To accomplish this, we need to be aware of factors such as colonialism, neocolonialism, parachute research, and brain drain that contribute to global health inequities. Potential solutions to decolonizing global radiology include commitment to understanding local context; strengthening local capacity for technology advancement, research, and development; and policies and educational programs to combat medical brain drain from LMICs. In this article, we describe how the legacies of colonialism can interfere with improving health in LMICS, despite the best intentions, and provide a call to action for decolonizing our field with intentional approaches and equitable partnerships that emphasize investments in sustainable infrastructure, robust training of personnel, and policies that support self-reliance to match true health system strengthening with our passion for addressing health equity.
Collapse
Affiliation(s)
- Farouk Dako
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Director of the Center for Global and Population Health Research in Radiology.
| | - Toma S Omofoye
- Strategic Director of Education, Department of Breast Imaging, Department of Clinical Radiology and Radiological Sciences, Vanderbilt University Medical Center. Nashville, Tennessee. https://twitter.com/TomaOmofoyeMD
| | - John Scheel
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center. Houston, Texas; Vice Chair of Global and Planetary Health. https://twitter.com/JohnRScheel
| |
Collapse
|
2
|
Townsend B, Johnson TD, Ralston R, Cullerton K, Martin J, Collin J, Baum F, Arnanz L, Holmes R, Friel S. A framework of NGO inside and outside strategies in the commercial determinants of health: findings from a narrative review. Global Health 2023; 19:74. [PMID: 37817196 PMCID: PMC10565967 DOI: 10.1186/s12992-023-00978-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/02/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Public health scholarship has uncovered a wide range of strategies used by industry actors to promote their products and influence government regulation. Less is known about the strategies used by non-government organisations to attempt to influence commercial practices. This narrative review applies a political science typology to identify a suite of 'inside' and 'outside' strategies used by NGOs to attempt to influence the commercial determinants of health. METHODS We conducted a systematic search in Web of Science, ProQuest and Scopus. Articles were eligible for inclusion if they comprised an empirical study, explicitly sought to examine 'NGOs', were in English, and identified at least one NGO strategy aimed at commercial and/or government policy and practice. RESULTS One hundred forty-four studies met the inclusion criteria. Eight industry sectors were identified: extractive, tobacco, food, alcohol, pharmaceuticals, weapons, textiles and asbestos, and a small number of general studies. We identified 18 types of NGO strategies, categorised according to the target (i.e. commercial actor or government actor) and type of interaction with the target (i.e. inside or outside). Of these, five NGO 'inside' strategies targeted commercial actors directly: 1) participation in partnerships and multistakeholder initiatives; 2) private meetings and roundtables; 3) engaging with company AGMs and shareholders; 4) collaborations other than partnerships; and 5) litigation. 'Outside' strategies targeting commercial actors through the mobilisation of public opinion included 1) monitoring and reporting; 2) protests at industry sites; 3) boycotts; 4) directly engaging the public; and 5) creative use of alternative spaces. Four NGO 'inside' strategies directly targeting government actors included: 1) lobbying; 2) drafting legislation, policies and standards; 3) providing technical support and training; and 4) litigation. NGO 'outside' strategies targeting government included 1) protests and public campaigns; 2) monitoring and reporting; 3) forum shifting; and 4) proposing and initiating alternative solutions. We identified three types of NGO impact: substantive, procedural, and normative. CONCLUSION The analysis presents a matrix of NGO strategies used to target commercial and government actors across a range of industry sectors. This framework can be used to guide examination of which NGO strategies are effective and appropriate, and which conditions enable NGO influence.
Collapse
Affiliation(s)
- Belinda Townsend
- Australian Research Centre for Health Equity, School of Regulation and Global Governance, Australian National University, Canberra, Australia.
| | - Timothy D Johnson
- Australian Research Centre for Health Equity, School of Regulation and Global Governance, Australian National University, Canberra, Australia
| | - Rob Ralston
- Global Health Policy Unit, Social Policy, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | | | - Jane Martin
- Obesity Policy Coalition, Melbourne, Australia
| | - Jeff Collin
- Global Health Policy Unit, Social Policy, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Fran Baum
- Stretton Health Equity & School of Social Science, University of Adelaide, Adelaide, Australia
| | | | - Rodney Holmes
- Foundation for Alcohol Research and Education, Canberra, Australia
| | - Sharon Friel
- Australian Research Centre for Health Equity, School of Regulation and Global Governance, Australian National University, Canberra, Australia
| |
Collapse
|
3
|
Kickbusch I, Liu A. Global health diplomacy-reconstructing power and governance. Lancet 2022; 399:2156-2166. [PMID: 35594877 PMCID: PMC9113726 DOI: 10.1016/s0140-6736(22)00583-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 03/14/2022] [Accepted: 03/23/2022] [Indexed: 01/13/2023]
Abstract
Over the past two decades, global health diplomacy, foreign policy for health, and global health policy have changed substantially. Diplomacy is a constitutive part of the system of global health governance. COVID-19 hit the world when multilateral cooperation was subject to major challenges, and global health has since become integral to geopolitics. The importance of global health diplomacy, especially at WHO, in keeping countries jointly committed to improving health for everyone, has once again been shown. Through a systematic review, this Series paper explores how international relations concepts and theories have been applied to better understand the role of power in shaping positions, negotiations, and outcomes in global health diplomacy. We apply an international relations perspective to reflect on the effect that those concepts and theories have had on global health diplomacy over the past two decades. This Series paper argues that a more central role of international relations concepts and theories in analysing global health diplomacy would help develop a more nuanced understanding of global health policy making. However, the world has changed to an extent that was not envisioned in academic discourse. This shift calls for new international relations concepts and theories to inform global health diplomacy.
Collapse
Affiliation(s)
- Ilona Kickbusch
- Global Health Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland.
| | | |
Collapse
|
4
|
Asadi-Lari M, Ahmadi Teymourlouy A, Maleki M, Afshari M. Opportunities and challenges of global health diplomacy for prevention and control of noncommunicable diseases: a systematic review. BMC Health Serv Res 2021; 21:1193. [PMID: 34736461 PMCID: PMC8567539 DOI: 10.1186/s12913-021-07240-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 10/29/2021] [Indexed: 11/11/2022] Open
Abstract
Background and aim The growing globalization has changed the goals and methods of diplomacy. Due to the challenges and complexities of dealing with noncommunicable diseases (NCDs) at the national and international levels, policy makers require global health diplomacy (GHD) to achieve the goals of prevention and control of NCDs. The purpose of this systematic review was to identify the challenges and opportunities in GHD for NCDs. Methods A systematic review of articles was conducted by searching MEDLINE via PubMed, Web of Science, Scopus, and Embase and by using Google and Google Scholar search engines. Additional articles were identified by reviewing reference lists and a number of special journals. The inclusion criteria include literature published in English from 2007 to 2020, and the exclusion criteria are literature published in any language other than English, absence of full text, dissertations, and duplicates. Overall, 32 articles met the requirements for inclusion in this review and were analyzed using content analysis in MAXQDA 10. Findings There are 32 published articles on GHD for NCDs. Identified challenges were classified into three levels: global (global health governance), national (Governance at the state level, health sector, and civil society), and industry. The progress on global health issues has created opportunities for the development of GHD for the prevention and control of NCDs. These opportunities were divided into three levels: international, national, and individual level. Conclusion Various challenges at the global level, national level, and industry led to less engagement of policymakers in GHD for prevention and control of NCDs and, as a consequence, a less coordinated approach to address prevention and control of NCDs worldwide. So, there is a need for more efforts of collective action and negotiation for tackling NCDs. Policymakers and managers of the health system should increase the advocacy, building a coalition with civil society, use negotiation and diplomacy to engage with other sectors and organizations, manage industry conflicts, and leverage foreign policy to promote health and welfare. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07240-3.
Collapse
Affiliation(s)
- Mohsen Asadi-Lari
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Ahmadi Teymourlouy
- Department of Health Service Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Maleki
- Department of Health Service Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Afshari
- Department of Health Service Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
5
|
Agustina HS, Widiasih R, Rusyidi B, Maryam NNA. Preventing and Controlling Pneumonia among Under-Five Children: A Qualitative Study of Civil Society Organizations’ Roles in West Java and East Nusa Tenggara. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Pneumonia is the leading cause of under-five children mortality in the world, including in Indonesia. Various programs were developed both nationally and internationally to overcome this disease. One of the programs is cross-sectorial collaboration and community involvement as part of pneumonia prevention and control programs, including the involvement of civil society organizations (CSO). However, the limited research has explored through the role of CSO in this program.
AIM: This study aimed to explore the roles of CSO in preventing and controlling the childhood pneumonia.
METHODS: This qualitative descriptive study interviewed 15 participants who were representatives of CSO in West Java and East Nusa Tenggara. These CSO have focused on health activities programs. In-depth interviews were conducted using semi-structured interview guides. Data were analyzed using the comparative analysis technique for qualitative descriptive research.
RESULTS: Three main themes have been found from the data analysis, including community empowerment and integrated actions to prevent childhood pneumonia, providing pneumonia services and advocacies to overcome childhood pneumonia, and the expectation versus challenges of CSO. The three themes showed that CSO have significant roles in various aspects of the prevention and control programs of under-five pneumonia.
CONCLUSION: Various roles have been done by CSO. However, several functions were not performed optimally. Further research that was analyzing factors the influence CSO’s roles is needed as fundamental information to develop strategies in improving the functions of civil society organizations in childhood pneumonia.
Collapse
|
6
|
Sircar NR, Yadav A, Bialous SA. Assessing sector representation of non-state actors within the World Health Organisation Framework Convention on Tobacco Control. Glob Public Health 2021; 16:1111-1121. [PMID: 32960751 PMCID: PMC7982346 DOI: 10.1080/17441692.2020.1823451] [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: 05/22/2020] [Accepted: 09/10/2020] [Indexed: 10/23/2022]
Abstract
The WHO Framework Convention on Tobacco Control (WHO FCTC) has accomplished much in advancing tobacco control. Non-governmental organisations (NGOs) were critical to the development of the Convention, who aided in mobilising stakeholders and advocated for core provisions of the treaty. NGOs and intergovernmental organisation are well recognised within the Convention and deemed essential to its continued implementation and evolution. Further, the treaty has been understood to be multidisciplinary in its aspiration to improve public health, and the role of both health sector and non-health sector stakeholders is an important component for describing the reach and potential for the Convention. In 15 years, however, non-state actors' participation in the WHO FCTC Conference of the Parties (COP) - where Parties to the treaty engage in discussions that shape the treaty's implementation and evolution - has been underrepresented in terms of sectoral diversity. We reviewed COP documents and assessed non-state actors' participation in the COPs since the Convention's entry into force. We conclude that greater inclusion in COPs from health and non-health sector NGOs, intergovernmental organisations and UN Special Agencies would strengthen the global reach and full implementation of the WHO FCTC.
Collapse
Affiliation(s)
- Neiloy R. Sircar
- Center for Tobacco Control Research and Education, University of California San Francisco
| | - Amit Yadav
- Center for Tobacco Control Research and Education, University of California San Francisco
| | - Stella Aguinaga Bialous
- Center for Tobacco Control Research and Education, University of California San Francisco
- Department of Social and Behavioral Sciences, School of Nursing, University of California San Francisco
| |
Collapse
|
7
|
Alizadeh M, Abbasi M, Bashirivand N, Mojtahed A, Karimi SE. Nongovernmental organizations and social aspects of COVID-19 pandemic: A successful experience in health policy. Med J Islam Repub Iran 2020; 34:170. [PMID: 33816369 PMCID: PMC8004583 DOI: 10.47176/mjiri.34.170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background: This study aimed to provide information on activities and experiences of Nongovernmental organizations in Tabriz regarding COVID-19 to develop a framework for effective measures and actions for other communities based on relevant achievements and experiences. Method: The Social determinants of health research center of Tabriz University of Medical Sciences coordinated the NGOs to deal with the consequences of COVID-19 disease by announcing, inviting, developing networks and preparing aims and objectives and action plans in participation with the NGOs. Results: This cooperation and synergy among NGOs led to following results: providing public health education, fund raising to provide health service and food items for vulnerable families, advocacy by writing letters to the governor and the City Council and emphasizing the needs for controlling the epidemics. Conclusion: NGOs can increase public awareness, change social policies, and provide services and facilities to the vulnerable groups of people to deal with these problems.
Collapse
Affiliation(s)
- Mahasti Alizadeh
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Madineh Abbasi
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Narges Bashirivand
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Atefe Mojtahed
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Salah Eddin Karimi
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
8
|
Afshari M, Ahmadi Teymourlouy A, Asadi-Lari M, Maleki M. Global Health diplomacy for noncommunicable diseases prevention and control: a systematic review. Global Health 2020; 16:41. [PMID: 32375804 PMCID: PMC7201808 DOI: 10.1186/s12992-020-00572-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/22/2020] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The prevention and control of noncommunicable diseases (NCDs) are one of the main challenges of healthcare systems around the world. In addition to the technical level, it requires political negotiations and solutions, such as global health diplomacy (GHD), which involves the participation of a wide range of actors and stakeholders and innovative international health partnerships. This review aimed to draw lessons for strengthening linkages with a wide range of actors and stakeholders from the GHD literature for NCDs, and how policymakers and political leaders can effectively use international health partnerships to beat NCDs. METHODS This research was a systematic review of the literature on GHD for NCDs. All relevant articles published in English were identified by searching PubMed, Web of Science, Scopus, and Embase databases, Google and Google Scholar search engines, and the reference lists of identified articles as well as a number of special journals. 30 articles that met the inclusion criteria were analyzed using content analysis in MAXQDA 10. The Global Health Diplomacy Pyramid and Blouin and Dubé's (2010) analytical framework for examining negotiations were used to classify the data. FINDINGS 30 articles have been published on GHD for NCDs. Five key themes, i.e. the specific problem requiring global collective action, key actors, their interests in the problem, potential negotiation process, and potential scenarios for collective action and 46 sub-themes were identified. Moreover, given the importance of collaboration on NCDs in the international arena, actors were categorized into three groups based on the GHD Pyramid: (1) core diplomacy, (2) multi-stakeholder diplomacy, and (3) informal diplomacy. CONCLUSION Development and adoption of a global policy to tackle the rise in NCDs in developed and developing countries require policymakers and political leaders that participate in GHD. Successful developments in global health policy depend on the performance of and respectful relationships among the stakeholders, and global health diplomats need to understand the complexities of the institutional structures and functional relationships of the international institutions involved in health.
Collapse
Affiliation(s)
- Mahnaz Afshari
- Department of Health Service Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Ahmadi Teymourlouy
- Department of Health Service Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Mohsen Asadi-Lari
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Maleki
- Department of Health Service Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
9
|
Smith SL. Factoring civil society actors into health policy processes in low- and middle-income countries: a review of research articles, 2007-16. Health Policy Plan 2019; 34:67-77. [PMID: 30668676 DOI: 10.1093/heapol/czy109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2018] [Indexed: 01/12/2023] Open
Abstract
Civil society actors have substantially increased their participation in global and national health policymaking processes since the 1970s. Civil society roles in shaping such significant global health milestones as the Doha Declaration on Intellectual Property Rights, the Framework Convention on Tobacco Control and the recently adopted United Nations Sustainable Development Goals are well documented, but knowledge of civil society actor influence on health policy processes in low- and middle-income countries remains fragmented. This study analyses 24 peer-reviewed research articles published between 2007 and 2016 to identify factors affecting civil society influence in the pre-implementation stages of the policy process. The articles reviewed span 13 health issues and more than 50 countries in four regions of the world. This body of work focuses on civil society as represented by formal groups, primarily domestic and to some extent international non-governmental organizations, but also social movements, professional associations and faith-based organizations, among others. The studies document several actor-centred and contextual factors that affect civil society actor power, commonly across stages of the policy process. Crucially, civil society actors were challenged to impact the process in countries that lacked participative norms and governing structures. When repressive conditions existed, regime changes and donors sometimes helped to open doors to participation. The power of civil society actors was enhanced when they joined strong epistemic networks and broader coalitions of stakeholders, were resourced, and framed issues in ways that resonated with national policies and political priorities. The synthesis offers guidance to practitioners on factors to consider in strategy development and points to several issues for further investigation by health policy analysis scholars, including the implications of issue (non)adoption by civil society actors and contestation dynamics among those with differing perspectives.
Collapse
Affiliation(s)
- Stephanie L Smith
- School of Public Administration, The University of New Mexico, Social Sciences Building, Room 3008, MSC05-3100, 1 University of New Mexico, Albuquerque, NM, USA
| |
Collapse
|
10
|
Chattu VK, Kevany S. The need for health diplomacy in health security operations. Health Promot Perspect 2019; 9:161-163. [PMID: 31508335 PMCID: PMC6717919 DOI: 10.15171/hpp.2019.23] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 04/24/2019] [Indexed: 11/09/2022] Open
Abstract
The concept of health security involves the intersection of several fields and disciplines and is an inherently political and sensitive area. It is also a relatively a new field of study and practice which lacks a precise definition - though numerous disciplines and areas like foreign policy, national interests, trade interests, health security, disaster relief, and human rights contribute to the concept. The purpose of this paper is to highlight the need for, health diplomacy in improving health security. For example, it is not unusual for developing country societies to build their health security measures by restricting travel and movement of those emanating from affected areas. When extreme health security measures threaten cordial and cooperative relations between nations, the issue of protection of one country's population may lead to the risk of international conflict. As the World Health Organization (WHO) stated in 2007 that'functioning health systems are the bedrock of health security,' it is crucial that partners with sound financial and technical capacities benefit developing countries through their assistance and sharing information. This paper explores how health diplomacy holds great promise to address the needs of global health security through binding or nonbinding instruments, enforced by global governance mechanisms.
Collapse
Affiliation(s)
- Vijay Kumar Chattu
- Department of Psychiatry, Faculty of Medicine, University of Toronto, ON, Canada.,Institute of International Relations, The University of the West Indies; St. Augustine, Trinidad and Tobago.,Department of Public Health Research, Global Institute of Public Health, Thiruvananthapuram 695024, India
| | - Sebastian Kevany
- Department of HIV/AIDS, University of California, San Francisco, CA, USA
| |
Collapse
|
11
|
Lencucha R, Ruckert A, Labonte R, Drope J. Opening windows and closing gaps: a case analysis of Canada's 2009 tobacco additives ban and its policy lessons. BMC Public Health 2018; 18:1321. [PMID: 30486817 PMCID: PMC6260734 DOI: 10.1186/s12889-018-6157-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2009, Canada adopted legislation (Bill C-32) restricting the sale of flavoured tobacco products, one of the first in the world. This study examines the agenda-setting process leading to the adoption of Bill C-32. METHODS This research was conducted using a case study design informed by Kingdon's Multiple Streams framework and Heclo's policy learning approach. In-depth interviews were conducted with key informants from government, health-based non-governmental organizations (NGOs), trade associations and the cigar manufacturing sector (n = 11). Public documents produced by media (n = 19), government (n = 11), NGOs (n = 15), as well as technical reports (n = 8) and formal stakeholder submissions (n = 137) were included for analysis. Data were coded with the objective of understanding key events or moments in the lead up to the adoption of Bill C-32 and the actors and arguments in support of and opposition to Bill C-32. RESULTS The findings point to the importance of a small but active group of NGOs who worked to publicize the issue and eventually take advantage of an open policy window. Our analysis also illustrates that even though consensus was developed about the policy problem and civil society was able to garner political support to address the problem, disagreement and dissent pertaining to the technical dimensions of the policy solution created loopholes for the tobacco industry to exploit. CONCLUSIONS NGOs remain a critical factor in efforts to strengthen tobacco control policy. These organizations were able to mobilize support for the tobacco flavouring ban adopted at the Federal level in Canada, and although the initial Bill had major limitations to achieving the health objectives, the persistence of these NGOs resulted in amendments to close these loopholes.
Collapse
Affiliation(s)
- Raphael Lencucha
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, 3630 Promenade Sir William Osler, Montreal, QC H3G 1Y5 Canada
| | - Arne Ruckert
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
| | - Ronald Labonte
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
| | - Jeffrey Drope
- Economic and Health Policy Research, American Cancer Society, Atlanta, GA USA
| |
Collapse
|
12
|
Jones CM, Clavier C, Potvin L. Adapting public policy theory for public health research: A framework to understand the development of national policies on global health. Soc Sci Med 2017; 177:69-77. [DOI: 10.1016/j.socscimed.2017.01.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 02/04/2016] [Accepted: 01/22/2017] [Indexed: 10/20/2022]
|
13
|
Ruckert A, Labonté R, Lencucha R, Runnels V, Gagnon M. Global health diplomacy: A critical review of the literature. Soc Sci Med 2016; 155:61-72. [DOI: 10.1016/j.socscimed.2016.03.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 11/17/2015] [Accepted: 03/06/2016] [Indexed: 10/22/2022]
|
14
|
Russell A, Wainwright M, Tilson M. Means and ENDS - e-cigarettes, the Framework Convention on Tobacco Control, and global health diplomacy in action. Glob Public Health 2016; 13:83-98. [PMID: 26948492 DOI: 10.1080/17441692.2016.1152284] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
E-cigarettes are a new and disruptive element in global health diplomacy (GHD) and policy-making. This is an ethnographic account of how e-cigarettes and other Electronic Nicotine Delivery Systems (ENDS) were tackled at the 6th Conference of the Parties to the World Health Organization's Framework Convention on Tobacco Control. It demonstrates how uncertainty about ENDS and differences of opinion are currently so great that 'agreeing to disagree' as a consensus position and 'strategic use of time' were the principles that ensured effective GHD in this case. Observers representing accredited non-governmental organisations were active in briefing and lobbying country delegates not to spend too much time debating an issue for which insufficient evidence exists, and for which countries were unlikely to reach a consensus on a specific regulatory approach or universally applicable regulatory measures. Equally, the work of Costa Rica in preparing and re-negotiating the draft decision, and the work of the relevant Committee Chair in managing the discussion, contributed to effectively reining in lengthy statements from Parties and focusing on points of consensus. As well as summarising the debate itself and analysing the issues surrounding it, this account offers an example of GHD working effectively in a situation of epistemic uncertainty.
Collapse
Affiliation(s)
- Andrew Russell
- a Department of Anthropology , Durham University , Durham , UK
| | - Megan Wainwright
- b Division of Social and Behavioural Sciences, School of Public Health and Family Medicine , University of Cape Town , Cape Town , South Africa
| | - Melodie Tilson
- c Non-Smokers' Rights Association , Ottawa , ON , Canada
| |
Collapse
|
15
|
Runnels V, Labonté R, Ruckert A. Global health diplomacy: Barriers to inserting health into Canadian foreign policy. Glob Public Health 2014; 9:1080-92. [DOI: 10.1080/17441692.2014.928740] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
16
|
Lee K, Kamradt-Scott A. The multiple meanings of global health governance: a call for conceptual clarity. Global Health 2014; 10:28. [PMID: 24775919 PMCID: PMC4036464 DOI: 10.1186/1744-8603-10-28] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 02/20/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The term global health governance (GHG) is now widely used, with over one thousand works published in the scholarly literature, almost all since 2002. Amid this rapid growth there is considerable variation in how the term is defined and applied, generating confusion as to the boundaries of the subject, the perceived problems in practice, and the goals to be achieved through institutional reform. METHODOLOGY This paper is based on the results of a separate scoping study of peer reviewed GHG research from 1990 onwards which undertook keyword searches of public health and social science databases. Additional works, notably books, book chapters and scholarly articles, not currently indexed, were identified through Web of Science citation searches. After removing duplicates, book reviews, commentaries and editorials, we reviewed the remaining 250 scholarly works in terms of how the concept of GHG is applied. More specifically, we identify what is claimed as constituting GHG, how it is problematised, the institutional features of GHG, and what forms and functions are deemed ideal. RESULTS After examining the broader notion of global governance and increasingly ubiquitous term "global health", the paper identifies three ontological variations in GHG scholarship - the scope of institutional arrangements, strengths and weaknesses of existing institutions, and the ideal form and function of GHG. This has produced three common, yet distinct, meanings of GHG that have emerged - globalisation and health governance, global governance and health, and governance for global health. CONCLUSIONS There is a need to clarify ontological and definitional distinctions in GHG scholarship and practice, and be critically reflexive of their normative underpinnings. This will enable greater precision in describing existing institutional arrangements, as well as serve as a prerequisite for a fuller debate about the desired nature of GHG.
Collapse
Affiliation(s)
- Kelley Lee
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC V5S 1S6, Canada
| | - Adam Kamradt-Scott
- Centre for International Security Studies, Department of Government and International Relations, University of Sydney, Room 384, H04 Merewether Building, Sydney, NSW 2006, Australia
| |
Collapse
|
17
|
Ottersen OP, Dasgupta J, Blouin C, Buss P, Chongsuvivatwong V, Frenk J, Fukuda-Parr S, Gawanas BP, Giacaman R, Gyapong J, Leaning J, Marmot M, McNeill D, Mongella GI, Moyo N, Møgedal S, Ntsaluba A, Ooms G, Bjertness E, Lie AL, Moon S, Roalkvam S, Sandberg KI, Scheel IB. The political origins of health inequity: prospects for change. Lancet 2014; 383:630-67. [PMID: 24524782 DOI: 10.1016/s0140-6736(13)62407-1] [Citation(s) in RCA: 299] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Chantal Blouin
- Institut National de Santé Publique du Québec, QC, Canada
| | - Paulo Buss
- Centre for Global Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Julio Frenk
- Harvard School of Public Health, Harvard University, Boston, MA, USA
| | - Sakiko Fukuda-Parr
- Graduate Program in International Affairs, The New School, New York, NY, USA
| | | | - Rita Giacaman
- Institute of Community and Public Health, Birzeit University, West Bank, occupied Palestinian territory
| | | | - Jennifer Leaning
- FXB Center for Health and Human Rights, Harvard University, Boston, MA, USA
| | - Michael Marmot
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Desmond McNeill
- Centre for Development and the Environment, University of Oslo, Oslo Norway
| | | | - Nkosana Moyo
- Mandela Institute for Development Studies, Johannesburg, South Africa
| | - Sigrun Møgedal
- Global Health Unit, Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | | | - Gorik Ooms
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Espen Bjertness
- Institute of Health and Society, University of Oslo, Oslo Norway
| | - Ann Louise Lie
- Institute of Health and Society, University of Oslo, Oslo Norway
| | - Suerie Moon
- Harvard Global Health Institute, Harvard University, Cambridge, MA, USA
| | - Sidsel Roalkvam
- Centre for Development and the Environment, University of Oslo, Oslo Norway
| | - Kristin I Sandberg
- Centre for Development and the Environment, University of Oslo, Oslo Norway
| | - Inger B Scheel
- Institute of Health and Society, University of Oslo, Oslo Norway
| |
Collapse
|
18
|
van de Pas R, van Schaik LG. Democratizing the world health organization. Public Health 2014; 128:195-201. [PMID: 24417900 DOI: 10.1016/j.puhe.2013.08.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 08/21/2013] [Accepted: 08/29/2013] [Indexed: 11/17/2022]
Abstract
A progressive erosion of the democratic space appears as one of the emerging challenges in global health today. Such delimitation of the political interplay has a particularly evident impact on the unique public interest function of the World Health Organization (WHO). This paper aims to identify some obstacles for a truly democratic functioning of the UN specialized agency for health. The development of civil society's engagement with the WHO, including in the current reform proposals, is described. The paper also analyses how today's financing of the WHO--primarily through multi-bi financing mechanisms--risks to choke the agency's role in global health. Democratizing the public debate on global health, and therefore the role of the WHO, requires a debate on its future role and engagement at the country level. This desirable process can only be linked to national debates on public health, and the re-definition of health as a primary political and societal concern.
Collapse
Affiliation(s)
| | - L G van Schaik
- Netherlands Institute of International Relations 'Clingendael', The Hague
| |
Collapse
|
19
|
Labonté R, Runnels V, Gagnon M. Past Fame, Present Frames and Future Flagship? An Exploration of How Health is Positioned in Canadian Foreign Policy. ADMINISTRATIVE SCIENCES 2012; 2:162-185. [PMID: 24977037 PMCID: PMC4072654 DOI: 10.3390/admsci2020162] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Canada has been regarded as a model global citizen with firm commitments to multilateralism. It has also played important roles in several international health treaties and conventions in recent years. There are now concerns that its interests in health as a foreign policy goal may be diminishing. This article reports on a thematic analysis of key Canadian foreign policy statements issued over the past decade, and interviews with key informants knowledgeable of, or experienced in the interstices of Canadian health and foreign policy. It finds that health is primarily and increasingly framed in relation to national security and economic interests. Little attention has been given to human rights obligations relevant to health as a foreign policy issue, and global health is not seen as a priority of the present government. Global health is nonetheless regarded as something with which Canadian foreign policy must engage, if only because of Canada’s membership in many United Nations and other multilateral fora. Development of a single global health strategy or framework is seen as important to improve intersectoral cooperation on health issues, and foreign policy coherence. There remains a cautious optimism that health could become the base from which Canada reasserts its internationalist status.
Collapse
Affiliation(s)
- Ronald Labonté
- Globalization and Health Equity, Institute of Population Health, University of Ottawa, 1 Stewart Street, Ottawa, ON K1N 6N5, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, 1 Stewart Street, Ottawa, ON K1N 6N5, Canada
- Author to whom correspondence should be addressed; ; Tel.: +1-613-562-5800 (ext.2288); Fax: +1-613-562-5659
| | - Vivien Runnels
- Globalization and Health Equity, Institute of Population Health, University of Ottawa, 1 Stewart Street, Ottawa, ON K1N 6N5, Canada
| | - Michelle Gagnon
- Institute of Population Health, University of Ottawa, 1 Stewart Street, Ottawa, ON K1N 6N5, Canada
| |
Collapse
|