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Faddoul A, Shannon G, Asghar K, Boukari Y, Smith J, Neilson A. The health dimensions of violence in Palestine: a call to prevent genocide. Lancet 2024; 403:25-26. [PMID: 38128558 DOI: 10.1016/s0140-6736(23)02751-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Alix Faddoul
- Heidelberg Institute for Global Health, Heidelberg 69120, Germany.
| | | | - Khudejha Asghar
- University of Edinburgh School of Social and Political Science, Edinburgh, United Kingdom
| | | | - James Smith
- University College London, London, United Kingdom
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2
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Shannon G, Basu P, Peters LER, Clark-Ginsberg A, Herrera Delgado TM, Gope R, Guanilo M, Kelman I, Noelli L, Meriläinen E, Riley K, Wood C, Prost A. Think global, act local: using a translocal approach to understand community-based organisations' responses to planetary health crises during COVID-19. Lancet Planet Health 2023; 7:e850-e858. [PMID: 37821163 DOI: 10.1016/s2542-5196(23)00193-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 03/28/2023] [Accepted: 08/17/2023] [Indexed: 10/13/2023]
Abstract
Little is known on how community-based responses to planetary health crises, such as the COVID-19 pandemic, can integrate concerns about livelihoods, equity, health, wellbeing, and the environment. We used a translocal learning approach to co-develop insights on community-based responses to complex health and environmental and economic crises with leaders from five organisations working with communities at the front line of intersecting planetary health challenges in Finland, India, Kenya, Peru, and the USA. Translocal learning supports collective knowledge production across different localities in ways that value local perspectives but transcend national boundaries. There were three main findings from the translocal learning process. First, thanks to their proximity to the communities they served, community-based organisations (CBOs) can quickly identify the ways in which COVID-19 might worsen existing social and health inequities. Second, localised CBO actions are key to supporting communities with unique challenges in the face of systemic planetary health crises. Third, CBOs can develop rights-based, ecologically-minded actions responding to local priorities and mobilising available resources. Our findings show how solutions to planetary health might come from small-scale community initiatives that are well connected within and across contexts. Locally-focused globally-aware actions should be harnessed through greater recognition, funding, and networking opportunities. Globally, planetary health initiatives should be supported by applying the principles of subsidiarity and translocalism.
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Affiliation(s)
- Geordan Shannon
- Institute for Global Health. University College London, London, UK; Stema, London, UK.
| | | | - Laura E R Peters
- Institute for Global Health. University College London, London, UK; College of Earth, Ocean, and Atmospheric Sciences, Oregon State University, OR, USA
| | | | | | | | | | - Ilan Kelman
- Institute for Global Health. University College London, London, UK; Institute for Global Development and Social Planning, University of Agder, Kristiansand, Norway
| | | | - Eija Meriläinen
- Institute for Global Health. University College London, London, UK; School of Humanities, Education and Social Sciences, Örebro University, Örebro, Sweden; Centre for Corporate Responsibility, Hanken School of Economics, Helsinki, Finland
| | | | | | - Audrey Prost
- Institute for Global Health. University College London, London, UK
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3
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Shannon G, Morgan R, Zeinali Z, Brady L, Couto MT, Devakumar D, Eder B, Karadag O, Mukherjee M, Peres MFT, Ryngelblum M, Sabharwal N, Schonfield A, Silwane P, Singh D, Van Ryneveld M, Vilakati S, Watego C, Whyle E, Muraya K. Intersectional insights into racism and health: not just a question of identity. Lancet 2022; 400:2125-2136. [PMID: 36502850 DOI: 10.1016/s0140-6736(22)02304-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 11/01/2022] [Accepted: 11/04/2022] [Indexed: 12/13/2022]
Abstract
Intersectionality is a useful tool to address health inequalities, by helping us understand and respond to the individual and group effects of converging systems of power. Intersectionality rejects the notion of inequalities being the result of single, distinct factors, and instead focuses on the relationships between overlapping processes that create inequities. In this Series paper, we use an intersectional approach to highlight the intersections of racism, xenophobia, and discrimination with other systems of oppression, how this affects health, and what can be done about it. We present five case studies from different global locations that outline different dimensions of discrimination based on caste, ethnicity and migration status, Indigeneity, religion, and skin colour. Although experiences are diverse, the case studies show commonalities in how discrimination operates to affect health and wellbeing: how historical factors and coloniality shape contemporary experiences of race and racism; how racism leads to separation and hierarchies across shifting lines of identity and privilege; how racism and discrimination are institutionalised at a systems level and are embedded in laws, regulations, practices, and health systems; how discrimination, minoritisation, and exclusion are racialised processes, influenced by visible factors and tacit knowledge; and how racism is a form of structural violence. These insights allow us to begin to articulate starting points for justice-based action that addresses root causes, engages beyond the health sector, and encourages transnational solidarity.
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Affiliation(s)
- Geordan Shannon
- Institute for Global Health, University College London, London, UK.
| | - Rosemary Morgan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Leanne Brady
- Emergency Medical Services, Western Cape Department of Health, Cape Town, South Africa
| | - Marcia Thereza Couto
- Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Delan Devakumar
- Institute for Global Health, University College London, London, UK
| | - Ben Eder
- Institute of Development Studies, University of Sussex, Brighton, UK
| | - Ozge Karadag
- Center for Sustainable Development, Earth Institute, Columbia University, New York, NY, USA
| | | | | | - Marcelo Ryngelblum
- Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Nidhi Sabharwal
- Centre for Policy Research in Higher Education, National Institute of Educational Planning and Administration, New Delhi, India
| | - Amos Schonfield
- Oxford Department of International Development, University of Oxford, Oxford, UK
| | - Pamela Silwane
- Gugulethu Community Action Network, Cape Town Together Community Action Network, Cape Town, South Africa
| | - David Singh
- School of Public Health & Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Manya Van Ryneveld
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Siyasanga Vilakati
- Phillipi Community Action Network, Cape Town Together Community Action Network, Cape Town, South Africa
| | - Chelsea Watego
- School of Public Health & Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Eleanor Whyle
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Kui Muraya
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
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Devakumar D, Selvarajah S, Abubakar I, Kim SS, McKee M, Sabharwal NS, Saini A, Shannon G, White AIR, Achiume ET. Racism, xenophobia, discrimination, and the determination of health. Lancet 2022; 400:2097-2108. [PMID: 36502848 DOI: 10.1016/s0140-6736(22)01972-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 12/13/2022]
Abstract
This Series shows how racism, xenophobia, discrimination, and the structures that support them are detrimental to health. In this first Series paper, we describe the conceptual model used throughout the Series and the underlying principles and definitions. We explore concepts of epistemic injustice, biological experimentation, and misconceptions about race using a historical lens. We focus on the core structural factors of separation and hierarchical power that permeate society and result in the negative health consequences we see. We are at a crucial moment in history, as populist leaders pushing the politics of hate have become more powerful in several countries. These leaders exploit racism, xenophobia, and other forms of discrimination to divide and control populations, with immediate and long-term consequences for both individual and population health. The COVID-19 pandemic and transnational racial justice movements have brought renewed attention to persisting structural racial injustice.
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Affiliation(s)
- Delan Devakumar
- Institute for Global Health, University College London, London, UK.
| | | | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - Seung-Sup Kim
- Department of Environmental Health Sciences, Seoul National University, Seoul, South Korea
| | - Martin McKee
- London School of Hygiene & Tropical Medicine, London, UK
| | - Nidhi S Sabharwal
- Centre for Policy Research in Higher Education, National Institute of Educational Planning and Administration, New Delhi, India
| | | | - Geordan Shannon
- Institute for Global Health, University College London, London, UK
| | - Alexandre I R White
- Johns Hopkins University and Johns Hopkins School of Medicine, Baltimore, MD, USA
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Affiliation(s)
- Delan Devakumar
- Institute for Global Health, University College London, London, UK.
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - E Tendayi Achiume
- Department of Law, UCLA School of Law, University of California, Los Angeles, CA, USA
| | - Kui Muraya
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Yin Paradies
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Melbourne, VIC, Australia
| | | | | | - Geordan Shannon
- Institute for Global Health, University College London, London, UK
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Abubakar I, Gram L, Lasoye S, Achiume ET, Becares L, Bola GK, Dhairyawan R, Lasco G, McKee M, Paradies Y, Sabharwal NS, Selvarajah S, Shannon G, Devakumar D. Confronting the consequences of racism, xenophobia, and discrimination on health and health-care systems. Lancet 2022; 400:2137-2146. [PMID: 36502851 DOI: 10.1016/s0140-6736(22)01989-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 12/13/2022]
Abstract
Racism, xenophobia, and discrimination are key determinants of health and equity and must be addressed for improved health outcomes. We conclude that far broader, deeper, transformative action is needed compared with current measures to tackle adverse effects of racism on health. To challenge the structural drivers of racism and xenophobia, anti-racist action and other wider measures that target determinants should implement an intersectional approach to effectively address the causes and consequences of racism within a population. Structurally, legal instruments and human rights law provide a robust framework to challenge the pervasive drivers of disadvantage linked to caste, ethnicity, Indigeneity, migratory status, race, religion, and skin colour. Actions need to consider the historical, economic, and political contexts in which the effects of racism, xenophobia, and discrimination affect health. We propose several specific actions: a commission that explores how we action the approaches laid out in this paper; building a conversation and a series of events with international multilateral agency stakeholders to raise the issue and profile of racism, xenophobia, and discrimination within health; and using our multiple platforms to build coalitions, expand knowledge, highlight inequities, and advocate for change across the world.
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Affiliation(s)
- Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK.
| | - Lu Gram
- Institute for Global Health, University College London, London, UK
| | - Sarah Lasoye
- Institute for Global Health, University College London, London, UK
| | | | - Laia Becares
- Department of Social Work and Social Care, University of Sussex, Brighton, UK
| | | | | | - Gideon Lasco
- Department of Anthropology, University of the Philippines Diliman, Quezon City, Philippines
| | - Martin McKee
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Yin Paradies
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Melbourne, VIC, Australia
| | - Nidhi S Sabharwal
- Centre for Policy Research in Higher Education, National Institute of Educational Planning and Administration, New Delhi, India
| | | | - Geordan Shannon
- Institute for Global Health, University College London, London, UK
| | - Delan Devakumar
- Institute for Global Health, University College London, London, UK
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Shannon G, Issa R, Wood C, Kelman I. Regenerative economics for planetary health: A scoping review. Int Health Trends & Persp 2022. [DOI: 10.32920/ihtp.v2i3.1704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction: The relationship between humans and our planet is conditioned by an economic system that undermines rather than supports health. There has been an emerging focus on the relationship between economic structures and planetary health, but alternative economic approaches to support health for people and the planet require further development. Regenerative economics offers a compelling approach to transform humankind’s relationships with each other and their environment. Regenerative economics fosters grounded, pragmatic solutions to wider human and ecological crises that moves beyond a sustainability discourse towards one of regeneration. While there are, notionally, large areas of overlap between regenerative economics and planetary health, to date these have not been systematically articulated. Methods: A scoping review was performed to examine the background, principles, and applications of regenerative economics, and their implications for planetary health. Five databases (SCOPUS, Ovid Medline, Web of Science, Geobase, IEEE Xplore) were searched for peer-reviewed literature using key terms relating to regenerative economics and planetary health. Findings were reported using thematic synthesis. Results: The review identified a total of 121 articles and included 30 papers in the final review, from economics, industrial design, business, tourism, education, urban design and architecture, energy, technology, and food and agriculture. The principles of regenerative economics focused on people, place, planet, position, peace, plurality, and progress. Putting these principles into action requires identifying and valuing different forms of capital, taking a dynamic systems approach, applying regenerative design, developing a true circular economy, good governance, and transdisciplinary education and advocacy. Conclusions: While the principles of regenerative economics and planetary health are well aligned, the tools and actions of each field differ substantially. Planetary health can learn from regenerative economics’ grounding in natural design principles, systems-based approaches, actions at the right scale and cadence, respect for diversity, community and place, and mindset that moves beyond sustainability towards a regenerative future.
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Maldonado N, Llorente B, Reynales-Shigematsu LM, Saenz-de-Miera B, Jha P, Shannon G. Tobacco Taxes as the Unsung Hero: Impact of a Tax Increase on Advancing Sustainable Development in Colombia. Int J Public Health 2022; 67:1604353. [PMID: 35431761 PMCID: PMC9006985 DOI: 10.3389/ijph.2022.1604353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 02/16/2022] [Indexed: 11/25/2022] Open
Abstract
Objective: Tobacco taxes are a well-established cost-effective policy to prevent Noncommunicable Diseases. This paper evaluates the expected effects of a tobacco tax increase on the Sustainable Development Goals in Colombia. Methods: We use microsimulation to build an artificial society that mimics the observed characteristics of Colombia's population, and from there we simulate the behavioral response to a tax increase of COP$4,750 (an increase that has been discussed by policy makers and legislators) and the subsequent effects in all SDGs. Results: The tobacco tax hike reduces the number of smokers (from 4.51 to 3.45 MM smokers) and smoking intensity, resulting in a drop in the number of cigarettes smoked in Colombia (from 332.3 to 215.5 MM of 20-stick packs). Such reduction is expected to decrease premature mortality, healthcare costs, poverty and people facing catastrophic expenditure on healthcare, to increase health, income and gender equity, and to strengthen domestic resource mobilization even in the presence of illicit cigarettes. Conclusion: Tobacco taxes are an effective intervention for public health and a powerful instrument to advance on the 2030 Sustainable Development Agenda. Relevance: A comprehensive analysis of the impact of tobacco taxes on all areas of Sustainable Development is missing in the empirical literature. Such perspective is needed to break the barriers for further tobacco tax increases by gathering wider societal support, especially from stakeholders and key decision makers from development areas other than health. SDG Nr: SDG3 (health), SDG 1 (no poverty), SDG 4 (education), SDG 5 (gender equality), SDG6 (water), SDG10 (inequality), SDG12 (responsible production and consumption), SDG17 (partnerships).
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Affiliation(s)
- Norman Maldonado
- Research Center on Health Economics and Social Protection (PROESA), Universidad ICESI, Cali, Colombia
- Global Tobacco Economics Consortium (GTEC), Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Blanca Llorente
- Global Tobacco Economics Consortium (GTEC), Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- Fundación Anáas, Bogotá, Colombia
| | - Luz Myriam Reynales-Shigematsu
- Global Tobacco Economics Consortium (GTEC), Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Belen Saenz-de-Miera
- Global Tobacco Economics Consortium (GTEC), Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- Universidad Autónoma de Baja California Sur, La Paz, México
| | - Prabhat Jha
- Global Tobacco Economics Consortium (GTEC), Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- Centre for Global Health Research, University of Toronto, Toronto, ON, Canada
| | - Geordan Shannon
- Global Tobacco Economics Consortium (GTEC), Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- Institute for Global Health, University College London, London, United Kingdom
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Mannell J, Lowe H, Brown L, Mukerji R, Devakumar D, Gram L, Jansen HAFM, Minckas N, Osrin D, Prost A, Shannon G, Vyas S. Risk factors for violence against women in high-prevalence settings: a mixed-methods systematic review and meta-synthesis. BMJ Glob Health 2022; 7:bmjgh-2021-007704. [PMID: 35296455 PMCID: PMC8928330 DOI: 10.1136/bmjgh-2021-007704] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/08/2022] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Violence against women (VAW) affects one in three women globally. In some countries, women are at much higher risk. We examined risk factors for VAW in countries with the highest 12-month prevalence estimates of intimate partner violence (IPV) to develop understanding of this increased risk. METHODS For this systematic review, we searched PUBMED, CINAHL, PROQUEST (Middle East and North Africa; Latin America and Iberia; East and South Asia), Web of Science, EMBASE and PsycINFO (Ovid) for records published between 1 January 2000 and 1 January 2021 in English, French and Spanish. Included records used quantitative, qualitative, or mixed-methods, reported original data, had VAW as the main outcome, and focused on at least one of 23 countries in the highest quintile of prevalence figures for women's self-reported experiences of physical and/or sexual violence in the past 12 months. We used critical interpretive synthesis to develop a conceptual model for associations between identified risk factors and VAW. RESULTS Our search identified 12 044 records, of which 241 were included for analysis (2 80 360 women, 40 276 men, 274 key informants). Most studies were from Bangladesh (74), Uganda (72) and Tanzania (43). Several quantitative studies explored community-level/region-level socioeconomic status and education as risk factors, but associations with VAW were mixed. Although fewer in number and representing just one country, studies reported more consistent effects for community-level childhood exposure to violence and urban residence. Theoretical explanations for a country's high prevalence point to the importance of exposure to other forms of violence (armed conflict, witnessing parental violence, child abuse) and patriarchal social norms. CONCLUSION Available evidence suggests that heightened prevalence of VAW is not attributable to a single risk factor. Multilayered and area-level risk analyses are needed to ensure funding is appropriately targeted for countries where VAW is most pervasive. PROSPERO REGISTRATION NUMBER The review is registered with PROSPERO (CRD42020190147).
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Affiliation(s)
| | - Hattie Lowe
- Institute for Global Health, UCL, London, UK
| | - Laura Brown
- Institute for Global Health, UCL, London, UK
| | | | | | - Lu Gram
- Institute for Global Health, UCL, London, UK
| | | | | | - David Osrin
- Institute for Global Health, UCL, London, UK
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10
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Palmer T, Jennings HM, Shannon G, Salustri F, Grewal G, Chelagat W, Sarker M, Pelletier N, Haghparast-Bidgoli H, Skordis J. Improving access to diabetes care for children: An evaluation of the changing diabetes in children project in Kenya and Bangladesh. Pediatr Diabetes 2022; 23:19-32. [PMID: 34713540 DOI: 10.1111/pedi.13277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/23/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The changing diabetes in children (CDiC) project is a public-private partnership implemented by Novo Nordisk, to improve access to diabetes care for children with type 1 diabetes. This paper outlines the findings from an evaluation of CDiC in Bangladesh and Kenya, assessing whether CDiC has achieved its objectives in each of six core program components. RESEARCH DESIGN AND METHODS The Rapid Assessment Protocol for Insulin Access (RAPIA) framework was used to analyze the path of insulin provision and the healthcare infrastructure in place for diagnosis and treatment of diabetes. The RAPIA facilitates a mixed-methods approach to multiple levels of data collection and systems analysis. Information is collected through questionnaires, in-depth interviews and focus group discussions, site visits, and document reviews, engaging a wide range of stakeholders (N = 127). All transcripts were analyzed thematically. RESULTS The CDiC scheme provides a stable supply of free insulin to children in implementing facilities in Kenya and Bangladesh, and offers a comprehensive package of pediatric diabetes care. However, some elements of the CDiC program were not functioning as originally intended. Transitions away from donor funding and toward government ownership are a particular concern, as patients may incur additional treatment costs, while services offered may be reduced. Additionally, despite subsidized treatment costs, indirect costs remain a substantial barrier to care. CONCLUSION Public-private partnerships such as the CDiC program can improve access to life-saving medicines. However, our analysis found several limitations, including concerns over the sustainability of the project in both countries. Any program reliant on external funding and delivered in a high-turnover staffing environment will be vulnerable to sustainability concerns.
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Affiliation(s)
- Tom Palmer
- Institute for Global Health, University College London, London, UK
| | | | - Geordan Shannon
- Institute for Global Health, University College London, London, UK
| | | | | | | | - Mithun Sarker
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Nicole Pelletier
- Institute for Global Health, University College London, London, UK
| | | | - Jolene Skordis
- Institute for Global Health, University College London, London, UK
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Palmer T, Waliaula C, Shannon G, Salustri F, Grewal G, Chelagat W, Jennings HM, Skordis J. Understanding the Lived Experience of Children With Type 1 Diabetes in Kenya: Daily Routines and Adaptation Over Time. Qual Health Res 2022; 32:145-158. [PMID: 34841984 PMCID: PMC8721679 DOI: 10.1177/10497323211049775] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Focusing only on biomedical targets neglects the important role that psychosocial factors play in effective diabetes self-management. This study aims to understand the lived experiences of children with Type 1 Diabetes (T1DM) in Kenya. Children (n = 15) participated in focus group discussions and photo diary data collection. Focus group discussions and semi-structured interviews were also conducted with caregivers (n = 14). We describe an adaptation to diabetes over time, identifying four overarching themes: knowledge and awareness, economic exclusion, the importance of social support, and striving for normality. Photo diaries are then categorized to explore daily realities of diabetes management. Children with T1DM in Kenya face varied barriers to care but can lead a "normal" and fulfilling life, provided adequate support is in place. To improve the lives of children with diabetes in this context and others like it, stakeholders must take note of children's experiences and recognize their multidimensional needs.
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Affiliation(s)
- Tom Palmer
- Institute for Global Health, 4919University College London, London, UK
| | - Cynthia Waliaula
- Institute for Global Health, 4919University College London, London, UK
| | - Geordan Shannon
- Institute for Global Health, 4919University College London, London, UK
| | | | | | | | | | - Jolene Skordis
- Institute for Global Health, 4919University College London, London, UK
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12
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Stern E, Batista M, Shannon G, Heise L, Mannell J. A case study comparison of engaging community activists to prevent gender-based violence in Peru and Rwanda. Glob Public Health 2021; 17:2300-2315. [PMID: 34932917 DOI: 10.1080/17441692.2021.2018010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Community mobilisation is recognised as an important strategy to shift inequitable gender norms and ensure an enabling environment to prevent gender-based violence (GBV). Yet there is a need to better understand the factors that facilitate effective community activism in particular contexts. Although fundamental to the success of mobilisation programmes, there is also limited appreciation of the experiences and agency of engaged community activists. This paper draws on qualitative evaluations from two community mobilisation GBV prevention programmes: the Gender Violence in the Amazon of Peru (GAP) Project and the Indashyikirwa programme in Rwanda. In Peru, participatory data was collected, in addition to baseline and endline interviews with 8 activists. In Rwanda, baseline and endline interviews and observations were conducted with 12 activists, and interviews were conducted with 8 staff members. The data was thematically analysed, and a comparative case study approach was applied to both data sets. The comparative study identified similar programmatic aspects that could hinder or enable activist's engagement and development, and how these are embedded within contextual social and structural factors. We discuss these insights in reference to the current emphasis in public health on individualistic programming, with insufficient attention to how wider environments influence violence prevention programming.
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Affiliation(s)
- Erin Stern
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins School of Nursing, Baltimore, MD, USA.,London School of Hygiene and Tropical Medicine, London, UK
| | - Murylo Batista
- London School of Hygiene and Tropical Medicine, London, UK
| | - Geordan Shannon
- Institute for Global Health, University of College London, London, UK
| | - Lori Heise
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Jenevieve Mannell
- Institute for Global Health, University of College London, London, UK
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Abstract
Communities are powerful and necessary agents for defining and pursuing their health, but outside organizations often adopt community health promotion approaches that are patronizing and top-down. Conversely, bottom-up approaches that build on and mobilize community health assets are often critiqued for tasking the most vulnerable and marginalized communities to use their own limited resources without real opportunities for change. Taking into consideration these community health promotion shortcomings, this article asks how communities may be most effectively and appropriately supported in pursuing their health. This article reviews how community health is understood, moving from negative to positive conceptualizations; how it is determined, moving from a risk-factor orientation to social determination; and how it is promoted, moving from top-down to bottom-up approaches. Building on these understandings, we offer the concept of 'resourcefulness' as an approach to strengthen positive health for communities, and we discuss how it engages with three interrelated tensions in community health promotion: resources and sustainability, interdependence and autonomy, and community diversity and inclusion. We make practical suggestions for outside organizations to apply resourcefulness as a process-based, place-based, and relational approach to community health promotion, arguing that resourcefulness can forge new pathways to sustainable and self-sustaining community positive health.
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Affiliation(s)
- Laura E R Peters
- Institute for Risk and Disaster Reduction, University College London, London, UK.,Institute for Global Health, University College London, London, UK.,College of Earth, Ocean, and Atmospheric Sciences, Oregon State University, Corvallis, OR, USA.,Stema Health Systems, London, UK
| | - Geordan Shannon
- Institute for Global Health, University College London, London, UK
| | - Ilan Kelman
- Institute for Risk and Disaster Reduction, University College London, London, UK.,Institute for Global Health, University College London, London, UK.,University of Agder, Kristiansand, Norway
| | - Eija Meriläinen
- Institute for Risk and Disaster Reduction, University College London, London, UK.,Institute for Global Health, University College London, London, UK
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14
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Peters L, Shannon G, Kelman I, Meriläinen E, Scobie M, Clark-Ginsberg A, Myhre S. Toward resourcefulness: Pathways for community positive health. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Communities play a central role in strengthening their health, but conventional community health promotion often adopts paternalistic and top-down approaches. Conversely, agentic approaches are critiqued for tasking marginalized communities to create change without opportunities. Taking into consideration these shortcomings, we ask how communities may be most effectively and appropriately supported in their pursuit of health. We review community health literature to articulate how community health is understood, moving from negative to positive conceptions; determined, moving from a risk-factor orientation to social determination; and promoted, moving from conventional to agentic approaches. We develop the concept of resourcefulness as a pathway to strengthen positive health, and explore how this approach may be applied in diverse communities through fieldwork in Kenya, Peru, Trinidad and Tobago, and the US. Through resourcefulness-based approaches to community health, communities cultivate agency to 1) conceptualize what constitutes their health and assets and 2) pursue and sustain health agendas driven by local priorities, needs, and learning, while they also work to 3) change power imbalances that drive inequitable patterns of resource distribution and 4) nurture ecologically sound relationships with their local environment. We discuss how resourcefulness addresses tensions between resource use and sustainability, and how communities leverage partnerships for change. We make practical suggestions to apply resourcefulness as a process-based, place-based, and relational strategy, while recognizing that contexts and scale matter and limit the viability of community-based solutions.
Key messages
Resourcefulness-based strategies can forge new pathways to sustainable and self-sustaining community positive health. Resourcefulness builds on agentic approaches, but it also challenges inequitable power relations and environmental practices that degrade local capacities for health.
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Affiliation(s)
- L Peters
- Institute for Global Health, University College London, London, UK
- Institute for Risk and Disaster Reduction, University College London, London, UK
- College of Earth, Ocean, and Atmospheric Sciences, Oregon State University, Corvallis, USA
| | - G Shannon
- Institute for Global Health, University College London, London, UK
| | - I Kelman
- Institute for Global Health, University College London, London, UK
- Institute for Risk and Disaster Reduction, University College London, London, UK
- University of Agder, Kristiansand, Norway
| | - E Meriläinen
- Institute for Global Health, University College London, London, UK
- Institute for Risk and Disaster Reduction, University College London, London, UK
| | - M Scobie
- Institute of International Relations, The University of the West Indies - St. Augustine, St. Augustine, Trinidad and Tobago
| | | | - S Myhre
- Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
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15
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Wu DC, Shannon G, Reynales-Shigematsu LM, Saenz de Miera B, Llorente B, Jha P. Implications of household tobacco and alcohol use on child health and women's welfare in six low and middle-income countries: An analysis from a gender perspective. Soc Sci Med 2021; 281:114102. [PMID: 34118685 DOI: 10.1016/j.socscimed.2021.114102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/18/2021] [Accepted: 06/01/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To study the implications of household tobacco and alcohol use on child health and women's welfare using a gender lens in Ethiopia, India, Indonesia, Jordan, Kenya, and Nigeria with varied geographical and cultural characteristics in the pattern of tobacco and alcohol use. METHODS We identified child health and women's welfare outcomes that may be impacted by tobacco and alcohol use, with a focus on the crowding-out effects on household resource allocation. For child health indicators, we focussed on engagement in preventative care, nutrition, and responses to acute illness. For women, we focused on access to resources for health-seeking and intimate partner violence (IPV). We used logistic regression to determine the association between household gender tobacco and/or alcohol use on child health and women's welfare, using data from six nationally-representative Demographic and Health Surveys, with each having a sample size of 5000-30,000 households and conducted after 2010. RESULTS Children in households where men and women use tobacco are significantly less likely to receive the full schedule of Diphtheria-Pertussis-Tetanus (DPT) vaccine in India, Indonesia, and Jordan (Odds ratio or OR; ORIndia = 0.67, p < 0.001; ORIndonesia = 0.55, p = 0.028; ORJordan = 0.45, p = 0.048), and all basic vaccinations as well as receive appropriate treatment for fever/diarrhoea in India and Indonesia (all basic vaccinations: ORIndia = 0.78, p < 0.001, ORIndonesia = 0.43, p = 0.009; treatment for fever/diarrhoea: ORIndia = 0.65, p < 0.001; ORIndonesia = 0.50, p = 0.038). In most countries, women are significantly more likely to experience IPV when their husband/partner uses tobacco and/or alcohol. CONCLUSIONS Across a diverse set of countries with varied cultural characteristics which affect the uptake and use of tobacco and alcohol, tobacco and alcohol use are associated with crowding-out of acute and preventative health-related behaviours and crowding-in of harmful behaviours. This has significant implications for tobacco and alcohol control programmes, and positions tobacco and alcohol control as central to human capital initiatives and in achieving health for all.
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Affiliation(s)
- Daphne C Wu
- Centre for Global Health Research, Unity Health Toronto, University of Toronto, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada
| | - Geordan Shannon
- Institute for Global Health, University College London, Gower Street, London, WC1E 6BT, United Kingdom
| | - Luz Myriam Reynales-Shigematsu
- Instituto Nacional de Salud Publica, Avenida Universidad 655, Santa María Ahuacatitlan, 62100, Cuernavaca, Morelos, Mexico
| | - Belen Saenz de Miera
- Universidad Autonoma de Baja California Sur, KM 5.5., 23080, La Paz, Baja California Sur, Mexico
| | - Blanca Llorente
- Fundación Anáas, Carrera 11A # 90 - 16, Oficina 509, Bogotá, Colombia
| | - Prabhat Jha
- Centre for Global Health Research, Unity Health Toronto, University of Toronto, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada.
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16
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Mannell J, Amaama SA, Boodoosingh R, Brown L, Calderon M, Cowley-Malcolm E, Lowe H, Motta A, Shannon G, Tanielu H, Vergara CC. Decolonising violence against women research: a study design for co-developing violence prevention interventions with communities in low and middle income countries (LMICs). BMC Public Health 2021; 21:1147. [PMID: 34130681 PMCID: PMC8205204 DOI: 10.1186/s12889-021-11172-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 05/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There has been substantial progress in research on preventing violence against women and girls (VAWG) in the last 20 years. While the evidence suggests the potential of well-designed curriculum-based interventions that target known risk factors of violence at the community level, this has certain limitations for working in partnership with communities in low- and middle-income (LMIC) countries, particularly when it comes to addressing the power dynamics embedded within north-south research relationships. METHODS As an alternative approach, we outline the study design for the EVE Project: a formative research project implemented in partnership with community-based researchers in Samoa and Amantaní (Peru) using a participatory co-design approach to VAWG prevention research. We detail the methods we will use to overcome the power dynamics that have been historically embedded in Western research practices, including: collaboratively defining and agreeing research guidelines before the start of the project, co-creating theories of change with community stakeholders, identifying local understandings of violence to inform the selection and measurement of potential outcomes, and co-designing VAWG prevention interventions with communities. DISCUSSION Indigenous knowledge and ways of thinking have often been undermined historically by Western research practices, contributing to repeated calls for better recognition of Southern epistemologies. The EVE Project design outlines our collective thinking on how to address this gap and to further VAWG prevention through the meaningful participation of communities affected by violence in the research and design of their own interventions. We also discuss the significant impact of the COVID-19 pandemic on the project in ways that have both disrupted and expanded the potential for a better transfer of power to the communities involved. This article offers specific strategies for integrating Southern epistemologies into VAWG research practices in four domains: ethics, theories of change, measurement, and intervention design. Our aim is to create new spaces for engagement between indigenous ways of thinking and the evidence that has been established from the past two decades of VAWG prevention research and practice.
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Affiliation(s)
| | | | | | - Laura Brown
- Institute for Global Health, University College London, London, UK
| | | | | | - Hattie Lowe
- Institute for Global Health, University College London, London, UK
| | - Angélica Motta
- Department of Anthropology, San Marcos University, San Marcos, Peru
| | - Geordan Shannon
- Institute for Global Health, University College London, London, UK
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17
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Peters LER, Kelman I, Shannon G, Tan D. Synthesising the shifting terminology of community health: A critiquing review of agent-based approaches. Glob Public Health 2021; 17:1492-1506. [PMID: 34097587 DOI: 10.1080/17441692.2021.1938169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The field of community health promotion encompasses a wide range of approaches, including bottom-up approaches that recognise and build on the agency and strengths of communities to define and pursue their health goals. Momentum towards agent-based approaches to community health promotion has grown in recent years, and several related but distinct conceptual and methodological bodies of work have developed largely in isolation from each other. The lack of a cohesive collection of research, practice, and policy has made it difficult to learn from the innovations, best practices, and shortcomings of these approaches, which is exacerbated by the imprecise and inconsistent use of related terms. This article provides a review of three agent-based approaches to promoting community health: asset-based approaches, capacity building, and capabilities approaches, noting the theoretical origins and fundamental concepts, applications and methodologies, and limitations and critiques of each. This article discusses their commonalities and differences in terms of how they conceptualise and approach the promotion of community health, including a critical consideration of their limitations and where they may prove to be counterproductive. This article argues that agent-based approaches to community health must be met with meaningful opportunities to disengage from the structures that constrain their health.
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Affiliation(s)
- Laura E R Peters
- Institute for Risk and Disaster Reduction, University College London, London, UK.,Institute for Global Health, University College London, London, UK.,College of Earth, Ocean, and Atmospheric Sciences, Oregon State University, Corvallis, OR, USA.,Stema Health Systems, London, UK
| | - Ilan Kelman
- Institute for Risk and Disaster Reduction, University College London, London, UK.,Institute for Global Health, University College London, London, UK.,University of Agder, Kristiansand, Norway
| | - Geordan Shannon
- Institute for Global Health, University College London, London, UK.,Stema Health Systems, London, UK
| | - Des Tan
- Stema Health Systems, London, UK
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18
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Minckas N, Shannon G, Mannell J. The role of participation and community mobilisation in preventing violence against women and girls: a programme review and critique. Glob Health Action 2021; 13:1775061. [PMID: 32588783 PMCID: PMC7480621 DOI: 10.1080/16549716.2020.1775061] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Violence against women and girls (VAWG) is a public health problem and one of the most prevalent human rights violations in the world. Recently practitioners and researchers have taken an interest in community participation as a strategy for preventing VAWG. Despite the recent enthusiasm however, there has been little articulation of how participation in VAWG prevention programmes mobilises communities to challenge social norms and prevent VAWG. Objectives In an attempt to help address this gap, this article seeks to answer two research questions: (1) How does participation theoretically mobilise communities to prevent VAWG, and (2) how do nominally participatory programmes make use of these theoretical concepts in their (explicit or implicit) theories of change? Methods To answer the first question, we draw on two well-recognised theories of participation and community mobilisation – Rifkin and Pridmore’s continuum of participation and Freire’s steps towards achieving critical consciousness – to clarify theoretical assumptions about how participation can mobilise community to reduce VAWG. To answer our second research question, we present the results from a review of primary prevention programmes that seek to reduce VAWG through community participation. Our analysis examines the explicit and implicit theories of change for these prevention programmes against the assumptions outlined from the theoretical literature. Results Our results help to better articulate realistic goals for community mobilisation and outline a theoretical basis for how participation as part of programming can effectively mobilise communities to reduce violence. Conclusion We argue that, in order to be both effective and sustainable, the role of external agents in introducing programmes needs to be secondary to the ownership and empowerment of communities in designing and delivering their own strategies for VAWG prevention.
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Affiliation(s)
- Nicole Minckas
- Institute for Global Health, University College London , London, UK
| | - Geordan Shannon
- Institute for Global Health, University College London , London, UK
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19
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Oseni Z, Shannon G. The relationship between Indigenous and allopathic health practitioners in Africa and its implications for collaboration: a qualitative synthesis. Glob Health Action 2020; 13:1838241. [PMID: 33150856 PMCID: PMC7646596 DOI: 10.1080/16549716.2020.1838241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 10/14/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND There have been increasing calls for collaboration between Indigenous health practitioners (IHPs) and allopathic health practitioners (AHPs) in Africa. Despite this, very few successful systems exist to facilitate formal collaboration. Direct relationships between providers, and at a health systems level are crucial to successful collaboration, but the nature and extent of these relationships have yet to be adequately explored. OBJECTIVE To explore the relationship between IHPs and AHPs in Africa, and to discuss the implications of this for future collaboration. METHODS An interpretive qualitative synthesis approach, combining elements of thematic analysis, meta-ethnography, and grounded theory, was used to systematically bring together findings of qualitative studies addressing the topic of collaboration between Indigenous and allopathic health practitioners in Africa. RESULTS A total of 1,765 papers were initially identified, 1,748 were excluded after abstract, full text and duplicate screening. Five additional studies were identified through references. Thus, 22 papers were included in the final analysis. We found that the relationship between Indigenous and allopathic health practitioners is defined by a power struggle which gives rise to lack of mutual understanding, rivalry, distrust, and disrespect. CONCLUSION The power struggle which defines the relationship between IHPs and AHPs in Africa is a hindrance to their collaboration and as such could partly account for the limited success of efforts to foster collaboration to date. Future efforts to foster collaboration between IHPs and AHPs in Africa must aim to balance the power disparity between them if collaboration is to be successful. Since this would be a novel approach, decision-makers and organisations who trial this power balancing approach to facilitate collaboration should evaluate resultant policies and interventions to ascertain their feasibility and efficacy in fostering collaboration, and the lessons learnt should be shared.
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Affiliation(s)
- Zainab Oseni
- Institute of Global Health, University College London, London, UK
| | - Geordan Shannon
- Institute of Global Health, University College London, London, UK
- Stema Health Systems Innovation, London, UK
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20
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Devakumar D, Selvarajah S, Shannon G, Muraya K, Lasoye S, Corona S, Paradies Y, Abubakar I, Achiume ET. Racism, the public health crisis we can no longer ignore. Lancet 2020; 395:e112-e113. [PMID: 32534630 PMCID: PMC7289562 DOI: 10.1016/s0140-6736(20)31371-4] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Delan Devakumar
- Institute for Global Health, University College London, London WC1N 1EH, UK.
| | | | - Geordan Shannon
- Institute for Global Health, University College London, London WC1N 1EH, UK
| | - Kui Muraya
- Health Systems & Research Ethics Department, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Sarah Lasoye
- Institute for Global Health, University College London, London WC1N 1EH, UK
| | - Susanna Corona
- Institute for Global Health, University College London, London WC1N 1EH, UK
| | | | - Ibrahim Abubakar
- Institute for Global Health, University College London, London WC1N 1EH, UK
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21
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McBlain M, Jones KA, Shannon G. Sleeping Eurasian oystercatchers adjust their vigilance in response to the behaviour of neighbours, human disturbance and environmental conditions. J Zool (1987) 2020. [DOI: 10.1111/jzo.12812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M. McBlain
- School of Natural Sciences Bangor University Bangor UK
| | - K. A. Jones
- School of Natural Sciences Bangor University Bangor UK
| | - G. Shannon
- School of Natural Sciences Bangor University Bangor UK
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22
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Affiliation(s)
| | - Sunil S Bhopal
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4BN, UK
- Northumbria Healthcare NHS Foundation Trust, Tyne and Wear NE29 8NH, UK
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23
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Affiliation(s)
| | | | - Sunil S Bhopal
- Newcastle University, Newcastle, UK; Northumbria Healthcare NHS Foundation Trust, London, UK
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24
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Affiliation(s)
| | | | - Sunil S Bhopal
- Newcastle University, Newcastle, UK; Northumbria Healthcare NHS Foundation Trust, London, UK
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25
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Shannon G, Minckas N, Tan D, Haghparast-Bidgoli H, Batura N, Mannell J. Correction to: Feminisation of the health workforce and wage conditions of health professions: an exploratory analysis. Hum Resour Health 2019; 17:84. [PMID: 31727098 PMCID: PMC6857298 DOI: 10.1186/s12960-019-0425-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The original article [1] contained an error in the presentation of all figures and tables; each figure and table is now set out and designated appropriately in the original article.
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Affiliation(s)
- Geordan Shannon
- Centre for Gender and Global Health, Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
- STEMA, Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
- Centre for Global Health Economics, Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Nicole Minckas
- Centre for Gender and Global Health, Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- STEMA, Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Des Tan
- STEMA, Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Centre for Global Health Economics, Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Hassan Haghparast-Bidgoli
- Centre for Global Health Economics, Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Neha Batura
- Centre for Global Health Economics, Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Jenevieve Mannell
- Centre for Gender and Global Health, Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
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26
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Shannon G, Minckas N, Tan D, Haghparast-Bidgoli H, Batura N, Mannell J. Feminisation of the health workforce and wage conditions of health professions: an exploratory analysis. Hum Resour Health 2019; 17:72. [PMID: 31623619 PMCID: PMC6796343 DOI: 10.1186/s12960-019-0406-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 08/12/2019] [Indexed: 05/31/2023]
Abstract
BACKGROUND The feminisation of the global health workforce presents a unique challenge for human resource policy and health sector reform which requires an explicit gender focus. Relatively little is known about changes in the gender composition of the health workforce and its impact on drivers of global health workforce dynamics such as wage conditions. In this article, we use a gender analysis to explore if the feminisation of the global health workforce leads to a deterioration of wage conditions in health. METHODS We performed an exploratory, time series analysis of gender disaggregated WageIndicator data. We explored global gender trends, wage gaps and wage conditions over time in selected health occupations. We analysed a sample of 25 countries over 9 years between 2006 and 2014, containing data from 970,894 individuals, with 79,633 participants working in health occupations (48,282 of which reported wage data). We reported by year, country income level and health occupation grouping. RESULTS The health workforce is feminising, particularly in lower- and upper-middle-income countries. This was associated with a wage gap for women of 26 to 36% less than men, which increased over time. In lower- and upper-middle-income countries, an increasing proportion of women in the health workforce was associated with an increasing gender wage gap and decreasing wage conditions. The gender wage gap was pronounced in both clinical and allied health professions and over lower-middle-, upper-middle- and high-income countries, although the largest gender wage gaps were seen in allied healthcare occupations in lower-middle-income countries. CONCLUSION These results, if a true reflection of the global health workforce, have significant implications for health policy and planning and highlight tensions between current, purely economic, framing of health workforce dynamics and the need for more extensive gender analysis. They also highlight the value of a more nuanced approach to health workforce planning that is gender sensitive, specific to countries' levels of development, and considers specific health occupations.
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Affiliation(s)
- Geordan Shannon
- Centre for Gender and Global Health, Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
- STEMA, Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
- Centre for Global Health Economics, Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
| | - Nicole Minckas
- Centre for Gender and Global Health, Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
- STEMA, Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
| | - Des Tan
- STEMA, Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
- Centre for Global Health Economics, Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
| | - Hassan Haghparast-Bidgoli
- Centre for Global Health Economics, Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
| | - Neha Batura
- Centre for Global Health Economics, Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
| | - Jenevieve Mannell
- Centre for Gender and Global Health, Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
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27
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Stephenson J, Vogel C, Hall J, Hutchinson J, Mann S, Duncan H, Woods-Townsend K, de Lusignan S, Poston L, Cade J, Godfrey K, Hanson M, Barrett G, Barker M, Conti G, Shannon G, Colbourn T. Preconception health in England: a proposal for annual reporting with core metrics. Lancet 2019; 393:2262-2271. [PMID: 31162084 DOI: 10.1016/s0140-6736(19)30954-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/20/2019] [Accepted: 04/10/2019] [Indexed: 12/12/2022]
Abstract
There is growing interest in preconception health as a crucial period for influencing not only pregnancy outcomes, but also future maternal and child health, and prevention of long-term medical conditions. Successive national and international policy documents emphasise the need to improve preconception health, but resources and action have not followed through with these goals. We argue for a dual intervention strategy at both the public health level (eg, by improving the food environment) and at the individual level (eg, by better identification of those planning a pregnancy who would benefit from support to optimise health before conception) in order to raise awareness of preconception health and to normalise the notion of planning and preparing for pregnancy. Existing strategies that target common risks factors, such as obesity and smoking, should recognise the preconception period as one that offers special opportunity for intervention, based on evidence from life-course epidemiology, developmental (embryo) programming around the time of conception, and maternal motivation. To describe and monitor preconception health in England, we propose an annual report card using metrics from multiple routine data sources. Such a report card should serve to hold governments and other relevant agencies to account for delivering interventions to improve preconception health.
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Affiliation(s)
- Judith Stephenson
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.
| | - Christina Vogel
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Jennifer Hall
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Jayne Hutchinson
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Sue Mann
- Public Health England, London, UK
| | | | - Kathryn Woods-Townsend
- Southampton Education School, University of Southampton and NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK; Royal College of General Practitioners, London, UK
| | - Lucilla Poston
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, St Thomas Hospital, London, UK
| | - Janet Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Keith Godfrey
- NIHR Southampton Biomedical Research Centre, MRC Lifecourse Epidemiology Unit (University of Southampton), University Hospital Southampton, Southampton, UK
| | - Mark Hanson
- Institute of Developmental Sciences, University of Southampton, Southampton, UK
| | - Geraldine Barrett
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Mary Barker
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Gabriella Conti
- Department of Economics and Department of Social Science, University College London, London, UK
| | - Geordan Shannon
- Global Health Epidemiology and Evaluation, UCL Institute for Global Health, University College London, London, UK
| | - Tim Colbourn
- Global Health Epidemiology and Evaluation, UCL Institute for Global Health, University College London, London, UK
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Ochieng CA, Haghparast-Bidgoli H, Batura N, Odhiambo A, Shannon G, Copas A, Palmer T, Dickin S, Noel S, Fielding M, Onyango S, Odera S, Eleveld A, Mwaki A, Vanhuyse F, Skordis J. Conditional cash transfers to retain rural Kenyan women in the continuum of care during pregnancy, birth and the postnatal period: protocol for a cluster randomized controlled trial. Trials 2019; 20:152. [PMID: 30823886 PMCID: PMC6397480 DOI: 10.1186/s13063-019-3224-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 01/28/2019] [Indexed: 11/25/2022] Open
Abstract
Background Antenatal care (ANC), facility delivery and postnatal care (PNC) are proven to reduce maternal and child mortality and morbidity in high-burden settings. However, few pregnant rural women use these services sufficiently. This study aims to assess the impact, cost-effectiveness and scalability of conditional cash transfers to promote increased contact between pregnant women or women who have recently given birth and the formal healthcare system in Kenya. Methods The intervention tested is a conditional cash transfer to women for ANC health visits, a facility birth and PNC visits until their newborn baby reaches 1 year of age. The study is a cluster randomized controlled trial in Siaya County, Kenya. The trial clusters are 48 randomly selected public primary health facilities, 24 of which are in the intervention arm of the study and 24 in the control arm. The unit of randomization is the health facility. A target sample of 7200 study participants comprises pregnant women identified and recruited at their first ANC visit over a 12-month recruitment period and their subsequent newborns. All pregnant women attending one of the selected trial facilities for their first ANC visit during the recruitment period are eligible for the trial and invited to participate. Enrolled mothers are followed up at all health visits during their pregnancy, at facility delivery and for a number of visits after delivery. They are also contacted at three additional time points after enrolling in the study: 5–10days after enrolment, 6 months after the expected delivery date and 12 27 months after birth. If they have not delivered in a facility, there is an additional follow-up 2 wees after the expected due date. The impact of the conditional cash transfers on maternal healthcare services and utilization will be measured by the trial’s primary outcomes: the proportion of all eligible ANC visits made during pregnancy, delivery at a health facility, the proportion of all eligible PNC visits attended, the proportion of referrals attended during the pregnancy and the postnatal period, and the proportion of eligible child immunization appointments attended. Secondary outcomes include; health screening and infection control, live birth, maternal and child survival 48 h after delivery, exclusive breastfeeding, post-partum contraceptive use and maternal and newborn morbidity. Data sources for the measurement of outcomes include routine health records, an electronic card-reader system and telephone surveys and focus group discussions. A full economic evaluation will be conducted to assess the cost of delivery and cost effectiveness of the intervention and the benefit incidence and equity impact of trial activities and outcomes. Discussion This trial will contribute to evidence on the effectiveness and cost-effectiveness of conditional cash transfers in facilitating health visits and promoting maternal and child health in rural Kenya and in other comparable contexts. Trial registration ClinicalTrials.gov, NCT03021070. Registered on 13 January 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3224-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Caroline A Ochieng
- Stockholm Environment Institute, Linnegatan 87D, Box 24218, 10451, Stockholm, Sweden
| | - Hassan Haghparast-Bidgoli
- UCL Institute for Global Health, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Neha Batura
- UCL Institute for Global Health, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Aloyce Odhiambo
- Safe Water and AIDS Project (SWAP), P.O. Box 3323, Kisumu, 40100, Kenya
| | - Geordan Shannon
- UCL Institute for Global Health, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Andrew Copas
- UCL Institute for Global Health, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Tom Palmer
- UCL Institute for Global Health, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Sarah Dickin
- Stockholm Environment Institute, Linnegatan 87D, Box 24218, 10451, Stockholm, Sweden
| | - Stacey Noel
- Stockholm Environment Institute, Linnegatan 87D, Box 24218, 10451, Stockholm, Sweden
| | - Matthew Fielding
- Stockholm Environment Institute, Linnegatan 87D, Box 24218, 10451, Stockholm, Sweden
| | - Sangoro Onyango
- Stockholm Environment Institute, Linnegatan 87D, Box 24218, 10451, Stockholm, Sweden
| | - Sarah Odera
- Stockholm Environment Institute, Linnegatan 87D, Box 24218, 10451, Stockholm, Sweden
| | - Alie Eleveld
- Safe Water and AIDS Project (SWAP), P.O. Box 3323, Kisumu, 40100, Kenya
| | - Alex Mwaki
- Safe Water and AIDS Project (SWAP), P.O. Box 3323, Kisumu, 40100, Kenya
| | - Fedra Vanhuyse
- Stockholm Environment Institute, Linnegatan 87D, Box 24218, 10451, Stockholm, Sweden.
| | - Jolene Skordis
- UCL Institute for Global Health, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
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Shannon G, Jansen M, Williams K, Cáceres C, Motta A, Odhiambo A, Eleveld A, Mannell J. Gender equality in science, medicine, and global health: where are we at and why does it matter? Lancet 2019; 393:560-569. [PMID: 30739691 DOI: 10.1016/s0140-6736(18)33135-0] [Citation(s) in RCA: 217] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/26/2018] [Accepted: 12/03/2018] [Indexed: 11/25/2022]
Abstract
The purpose of this Review is to provide evidence for why gender equality in science, medicine, and global health matters for health and health-related outcomes. We present a high-level synthesis of global gender data, summarise progress towards gender equality in science, medicine, and global health, review the evidence for why gender equality in these fields matters in terms of health and social outcomes, and reflect on strategies to promote change. Notwithstanding the evolving landscape of global gender data, the overall pattern of gender equality for women in science, medicine, and global health is one of mixed gains and persistent challenges. Gender equality in science, medicine, and global health has the potential to lead to substantial health, social, and economic gains. Positioned within an evolving landscape of gender activism and evidence, our Review highlights missed and future opportunities, as well as the need to draw upon contemporary social movements to advance the field.
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Affiliation(s)
- Geordan Shannon
- Centre for Gender and Global Health, Institute for Global Health, University College London, London, UK.
| | - Melanie Jansen
- Paediatric Intensive Care Unit and Centre for Children's Health Ethics and Law, Children's Health Queensland, Brisbane, QLD, Australia
| | | | - Carlos Cáceres
- Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Angelica Motta
- Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | - Jenevieve Mannell
- Centre for Gender and Global Health, Institute for Global Health, University College London, London, UK
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Collins JH, Bowie D, Shannon G. A descriptive analysis of health practices, barriers to healthcare and the unmet need for cervical cancer screening in the Lower Napo River region of the Peruvian Amazon. Womens Health (Lond) 2019; 15:1745506519890969. [PMID: 31840562 PMCID: PMC6918491 DOI: 10.1177/1745506519890969] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 08/05/2019] [Accepted: 10/31/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To undertake an descriptive analysis of the health needs, healthcare practices and barriers to accessing healthcare faced by women in Lower Napo River Region, Peru, and to understand health literacy regarding cervical cancer and the need for more effective cervical cancer screening services. METHODS We performed a community-based needs assessment adapting Demographic and Health survey methodology with additional questions determining female health literacy on cervical cancer and assessing the availability and need for cervical cancer screening services. We surveyed women (N = 121) across all households in six communities along the Lower Napo River, Loreto, Peru, in May 2015. Data were collected as part of the larger Amazon Community Based Participation Cervical Cancer Screen-and-Treat Programme. Survey data were compared to national results from ENDES 2014. RESULTS Comparison between our findings and the ENDES 2014 survey highlighted considerable inequality between indigenous or mixed indigenous, rural populations in Loreto, Peru, and national population data averages over level of formal education, literacy, barriers to accessing healthcare and maternal and sexual health. Even though only 5.9% (N = 7/117) of women had no formal health insurance coverage, money was reported as the leading barrier accessing healthcare (N = 88/117, 75.2%). Health literacy regarding cervical and breast cancer was poor. A high proportion of women highlighted fear of screening processes (70.8%, N = 80/113) and lack of available services (53.6%, N = 60/112) as barriers to cervical cancer screening. CONCLUSION Although progress has been made in improving healthcare access in Peru, such gains have not been experienced equitably and women living in remote communities face persistent marginalization regarding their health. There is a significant need for education related to and screening for cervical cancer in this region that is tailored to the reality of women's lives in remote communities in Loreto.
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Affiliation(s)
- Joseph H Collins
- Institute for Global Health, University College London, London, UK
| | | | - Geordan Shannon
- Institute for Global Health, University College London, London, UK
- DB Peru, Miraflores, Lima, Peru
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Hagedorn A, Shannon G. EXPLORING PERSONALITY CHARACTERISTICS THROUGH NARRATIVE ANALYSIS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Hagedorn
- USC Leonard Davis School of Gerontology, Los Angeles, California, United States
| | - G Shannon
- University of Southern California, Leonard Davis School of Gerontology, Los Angeles, CA, USA
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McKenna MF, Shannon G, Fristrup K. Characterizing anthropogenic noise to improve understanding and management of impacts to wildlife. ENDANGER SPECIES RES 2016. [DOI: 10.3354/esr00760] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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33
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Quilty S, Shannon G, Yao A, Sargent W, McVeigh MF. Factors contributing to frequent attendance to the emergency department of a remote Northern Territory hospital. Med J Aust 2016; 204:111.e1-7. [DOI: 10.5694/mja15.00648] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 10/29/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Simon Quilty
- Katherine Hospital, Katherine, NT
- Menzies School of Health Research, Darwin, NT
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Shannon G, Sekar R, Kimble RMN. Septic shock following cervical cerclage for advanced cervical dilatation. Aust N Z J Obstet Gynaecol 2011; 51:469-70. [PMID: 21883136 DOI: 10.1111/j.1479-828x.2011.01351.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Roxanas M, Shannon G. Drug-induced hyponatraemia. Aust Prescr 2011. [DOI: 10.18773/austprescr.2011.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Mian MAR, Boerma HR, Phillips DV, Kenty MM, Shannon G, Shipe ER, Blount ARS, Weaver DB. Performance of Frogeye Leaf Spot-Resistant and -Susceptible Near-Isolines of Soybean. Plant Dis 1998; 82:1017-1021. [PMID: 30856828 DOI: 10.1094/pdis.1998.82.9.1017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Frogeye leaf spot (FLS) caused by Cercospora sojina Hara is a disease of soybean (Glycine max (L.) Merr.) that causes significant seed yield losses in warm, humid environments of southeastern United States. The Rcs3 gene in soybean has been reported to condition resistance to all known races of C. sojina. The objectives of this study were to determine the effectiveness of Rcs3 in limiting seed yield loss due to FLS and to compare the seed yield of the resistant and susceptible near-isolines (NILs) in the absence of significant FLS disease. Four pairs of NILs-Colquitt/Colquitt-Rcs3, Gordon/Gordon-Rcs3, Thomas/Thomas-Rcs3, and Wright/Wright-Rcs 3-were evaluated in 23 field experiments in Alabama, Florida, Georgia, Louisiana, Mississippi, and South Carolina during 1992 to 1994. The amount of damage to susceptible soybean caused by FLS was dependent on the specific environment. All four of the Rcs3 NILs were resistant to the prevalent races of FLS in all environments. In the absence of significant FLS disease, each of the Rcs3 NILs was at least equal to the respective susceptible line in its seed yield. In the presence of FLS infestation, the susceptible lines suffered significant seed yield loss (up to 31%) compared to their Rcs3 NILs. The effect of FLS on seed yield was dependent on cumulative disease severity over the growing season. Thus, the area under disease progress curve was more useful than percent of leaf area infected at the end of the growing season (R7 stage of development) in explaining the seed yield loss due to FLS.
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Affiliation(s)
- M A R Mian
- Department of Crop and Soil Sciences, University of Georgia, Athens 30602-7272
| | - H R Boerma
- Department of Crop and Soil Sciences, University of Georgia, Athens 30602-7272
| | - D V Phillips
- Department of Plant Pathology, Georgia Experiment Station, Griffin 30223
| | - M M Kenty
- American Cyanamid Co., Collierville, TN 38017
| | - G Shannon
- Delta and Pine Land Co., Scott, MS 38772
| | - E R Shipe
- Department of Crop and Soil Science, Clemson University, Clemson, SC 29634-0359
| | | | - D B Weaver
- Department of Agronomy, Auburn University, Auburn, AL 36849
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Johnson DW, McMahon M, Campbell S, Wilkinson J, Kime N, Shannon G, Fleming SJ. Non-invasive, optical measurement of absolute blood volume in hemodialysis patients. Kidney Int 1996; 49:255-60. [PMID: 8770977 DOI: 10.1038/ki.1996.36] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- D W Johnson
- Department of Renal Medicine, Royal Brisbane Hospital, Queensland, Australia
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38
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Stillman R, Darveniza M, Shannon G. Risk, Hazard and Negligence in an Electricity Distribution System. International Journal of Quality & Reliability Management 1991. [DOI: 10.1108/eum0000000001643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article is concerned with the application of human statistical techniques to risk engineering in the electricity distribution system in Australia. It examines legal negligence in terms of the cause of action, care and duty, and economic criteria. A mathematical hazard model of risk analysis is presented.
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Affiliation(s)
- P G Middleton
- Department of Endocrinology, Royal North Shore Hospital, St. Leonards, Sydney, NSW, Australia
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40
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Prough DS, Roy R, Bumgarner J, Shannon G. Acute pulmonary edema in healthy teenagers following conservative doses of intravenous naloxone. Anesthesiology 1984; 60:485-6. [PMID: 6711858 DOI: 10.1097/00000542-198405000-00018] [Citation(s) in RCA: 77] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Abstract
Data and findings are presented pertaining to the expressed travel limits for general medical care of a rural population and the degree to which their observed travel behavior reflects these limits. Considerable variation in expressed reasonable and maximum travel distances and times was observed among respondents in a countywide cross-section sample of the resident population in western Maine. A substantial proportion of the respondents' visits for general medical care exceeds their reasonable travel limits and some visits exceed the travel limits they considered maximal. Additionally, a comparison of expectations from this study with those of a similar population in another section of the county reveals significant differences. The findings suggest that health planning could be considerably enhanced by a better understanding of patient preferences for medical care travel behavior, the origins of these preferences, and their relationship to the use of available medical care opportunities. This is particularly true if stated goals of incorporating patient preferences into the health planning process are to be realized.
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Rodrigues M, Shannon G. Orbital meningoencephalocele in a healthy adult. Can J Ophthalmol 1977; 12:63-5. [PMID: 849542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A 28-year-old white female had a two month history of a slightly painful right eye without proptosis. A radiolucent area was noted in the roof of the right orbit. Orbital exploration demonstrated brown friable tissue without any communication to the cranium. Microscopic examination revealed brain tissue, glial cells and fibrous tissue compatible with dura.
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Rodrigues MM, Cullen G, Shannon G. Primary localized conjunctival amyloidosis following strabismus surgery. Can J Ophthalmol 1976; 11:177-9. [PMID: 1078336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A 13-year-old white boy developed bilateral polypoid conjunctival masses overlying the lateral rectus muscles six months after surgery for divergent strabismus. Histologic examination confirmed the presence of amyloid in these lesions.
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Affiliation(s)
- M M Rodrigues
- Pathology Department, Wills Eye Hospital, Philadelphia, Pa. 19130
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