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Hanson-DeFusco J, Shi M, Du Z, Zounon O, Hounnouvi FM, DeFusco A. Systems analysis of the effects of the 2014-16 Ebola crisis on WHO-reporting nations' policy adaptations and 2020-21 COVID-19 response: a systematized review. Global Health 2023; 19:96. [PMID: 38053050 PMCID: PMC10696695 DOI: 10.1186/s12992-023-00997-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/25/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Recent case studies indicate that the 2014-2016 Ebola outbreak, one of the worst pre-2020 global biological catastrophes in modern history, helped some nations to better prepared their responses for the COVID-19 pandemic. While such national case studies explore how specific nations applied EVD-related policies in their domestic battle against the COVID-19 pandemic, there is no known study that assesses how many WHO nations learned from the West African crisis and to what scale. OBJECTIVE Applying the policy legacies analytical framework and a systematized literature review, this research examines how prior policy experiences with the 2014-16 EVD crisis as a large-scale emergent outbreak helped to inform and to condition WHO nations to proactively prepare their national policies and health systems for future threats, including ultimately COVID-19. METHODS A systematized literature review of 803 evaluated sources assesses to what extent Ebola-affected and non-affected nations directly modified governmental health systems in relation to this warning. The study further evaluates how nations with documented Ebola-related changes fared during COVID-19 compared to nations that did not. We present a categorical theoretical framework that allows for classifying different types of national response activities (termed conditioned learning). RESULTS Ten (90.9%) of 11 nations that were affected by 2014-16 Ebola crisis have documented evidence of repurposing their EVD-related policies to fight COVID-19. 164 (70.0%) of 234 non-EVD-affected nations had documented evidence of specifically adapting national systems to incorporate policy recommendations developed from the 2014-16 crisis, which informed their COVID-19 responses in 2020. CONCLUSIONS The shock of 2014-16 EVD outbreak affected most nations around the world, whether they experienced Ebola cases. We further develop a categorical framework that helps characterised nations previous experiences with this biological catastrophe, providing a means to analyse to what extent that individual nations learned and how these EVD-related changes helped inform their COVID-19 response. Nations that demonstrated EVD-related conditioned learning nations tended to have more stringent COVID-19 responses before April 2020 and utilized documented response mechanisms developed out of the West African crisis.
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Affiliation(s)
- Jessi Hanson-DeFusco
- University of Texas at Dallas, Cecil H. Green Hall 3.526, 800 West Campbell Road, Richardson, TX, 75080-3021, USA.
| | - Min Shi
- University of Texas at Dallas, Richardson, TX, USA
| | - Zoe Du
- University of Texas at Dallas, Richardson, TX, USA
| | | | | | - Albert DeFusco
- Anaconda, Inc, University of Pittsburgh, Pittsburgh, USA
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2
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Sifat RI. ChatGPT and the Future of Health Policy Analysis: Potential and Pitfalls of Using ChatGPT in Policymaking. Ann Biomed Eng 2023:10.1007/s10439-023-03204-2. [PMID: 37061595 DOI: 10.1007/s10439-023-03204-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 04/17/2023]
Abstract
Scholars increasingly rely on new artificial intelligence models for convenience and simple access to necessities due to the rapid evolution of scientific literature and technology. The invention of ChatGPT by OpenAI stands out as a key example of how significant advances in large language model technology have recently changed the field of artificial intelligence (AI). Since ChatGPT's development, it has been tested by multiple sectors on various topics to see how well it functions in a natural and conversational mode. The crucial question is how much ChatGPT can influence global health policy analysis. In this article, the researcher briefly explains ChatGPT's potential and the difficulties that users, such as researchers or policymakers, may continue to face.
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Affiliation(s)
- Ridwan Islam Sifat
- School of Public Policy, University of Maryland, Baltimore County, Baltimore, MD, 21250, USA.
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3
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Rogers Van Katwyk S, Giubilini A, Kirchhelle C, Weldon I, Harrison M, McLean A, Savulescu J, Hoffman SJ. Exploring Models for an International Legal Agreement on the Global Antimicrobial Commons: Lessons from Climate Agreements. Health Care Anal 2023; 31:25-46. [PMID: 31965398 PMCID: PMC10042908 DOI: 10.1007/s10728-019-00389-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
An international legal agreement governing the global antimicrobial commons would represent the strongest commitment mechanism for achieving collective action on antimicrobial resistance (AMR). Since AMR has important similarities to climate change-both are common pool resource challenges that require massive, long-term political commitments-the first article in this special issue draws lessons from various climate agreements that could be applicable for developing a grand bargain on AMR. We consider the similarities and differences between the Paris Climate Agreement and current governance structures for AMR, and identify the merits and challenges associated with different international forums for developing a long-term international agreement on AMR. To be effective, fair, and feasible, an enduring legal agreement on AMR will require a combination of universal, differentiated, and individualized requirements, nationally determined contributions that are regularly reviewed and ratcheted up in level of ambition, a regular independent scientific stocktake to support evidence informed policymaking, and a concrete global goal to rally support.
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Affiliation(s)
- Susan Rogers Van Katwyk
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, ON, M3J 1P3, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Alberto Giubilini
- Oxford Martin School, University of Oxford, Oxford, UK
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Claas Kirchhelle
- Oxford Martin School, University of Oxford, Oxford, UK
- Wellcome Unit for the History of Medicine, University of Oxford, Oxford, UK
| | - Isaac Weldon
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, ON, M3J 1P3, Canada
- Department of Politics, York University, Toronto, Canada
| | - Mark Harrison
- Oxford Martin School, University of Oxford, Oxford, UK
- Wellcome Unit for the History of Medicine, University of Oxford, Oxford, UK
| | - Angela McLean
- Oxford Martin School, University of Oxford, Oxford, UK
- Department of Zoology, University of Oxford, Oxford, UK
| | - Julian Savulescu
- Oxford Martin School, University of Oxford, Oxford, UK
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Steven J Hoffman
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, ON, M3J 1P3, Canada.
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
- Oxford Martin School, University of Oxford, Oxford, UK.
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA.
- Department of Health Research Methods, Evidence, and Impact and McMaster Health Forum, McMaster University, Hamilton, Canada.
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4
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Muinde JVS, Prince RJ. A new universalism? Universal health coverage and debates about rights, solidarity and inequality in Kenya. Soc Sci Med 2023; 319:115258. [PMID: 36307339 DOI: 10.1016/j.socscimed.2022.115258] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 05/23/2022] [Accepted: 08/01/2022] [Indexed: 10/15/2022]
Abstract
The rise of universal health coverage (UHC) as a global policy endorsed in the Sustainable Development Goals (SGDs) appears to signal new directions in global health as it introduces a progressive language of inclusion, solidarity and social justice and advocates the right of 'everyone' to access the healthcare they need 'without financial hardship'. Since 2018 the Kenyan government has attempted to widen access to healthcare by experimenting with free health care services and expanding health insurance coverage. Such progressive moves are, however, layered onto histories of healthcare, citizenship and state responsibility that in Kenya have been dominated by forms of exclusion, differentiation, a politics of patronage, and class inequality, all of which work against universal access. In this paper, we follow recent attempts to increase access to healthcare, paying particular attention to how a language of rights and inclusion circulated among "ordinary citizens" as well as among the health workers and government officials tasked with implementing reforms. Despite being clothed in a language of universalism, solidarity and inclusion, Kenya's UHC reforms feed into an already fragmented and struggling healthcare system, reinforcing differentiated, limited and uneven access to healthcare services and reproducing inequity and exclusions. In this context, reforms for universal health coverage that promise a form of substantial citizenship are in tension with Kenyans' experiences of accessing healthcare. We explore how, amid vocal concerns about healthcare costs and state neglect, the promises and expectations surrounding universal health coverage reforms shaped the claims people made to accessing care. While our informants were cynical about these promises, they were also hopeful. The language of universality and inclusion drew people's attention to entrenched forms of inequality and difference, the limits of solidarity and the gaps between promises and realities, but it also generated expectations and a sense of new possibilities.
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Affiliation(s)
- Jacinta Victoria S Muinde
- University of Oslo, Department of Social Anthropology, Norway; University of Oslo, Institute of Health and Society, Norway.
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5
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Borre ED, Ayer A, Der C, Ibekwe T, Emmett SD, Dixit S, Shahid M, Olusanya B, Garg S, Johri M, Saunders JE, Tucci DL, Wilson BS, Ogbuoji O, Sanders Schmidler GD. Validation of the Decision model of the Burden of Hearing loss Across the Lifespan (DeciBHAL) in Chile, India, and Nigeria. EClinicalMedicine 2022; 50:101502. [PMID: 35770254 PMCID: PMC9234074 DOI: 10.1016/j.eclinm.2022.101502] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 11/29/2022] Open
Abstract
Background There is no published decision model for informing hearing health care resource allocation across the lifespan in low- and middle-income countries. We sought to validate the Decision model of the Burden of Hearing loss Across the Lifespan International (DeciBHAL-I) in Chile, India, and Nigeria. Methods DeciBHAL-I simulates bilateral sensorineural hearing loss (SNHL) and conductive hearing loss (CHL) acquisition, SNHL progression, and hearing loss treatment. To inform model inputs, we identified setting-specific estimates including SNHL prevalence from the Global Burden of Disease (GBD) studies, acute otitis media (AOM) incidence and prevalence of otitis-media related CHL from a systematic review, and setting-specific pediatric and adult hearing aid use prevalence. We considered a coefficient of variance root mean square error (CV-RMSE) of ≤15% to indicate good model fit. Findings The model-estimated prevalence of bilateral SNHL closely matched GBD estimates, (CV-RMSEs: 3.2-7.4%). Age-specific AOM incidences from DeciBHAL-I also achieved good fit (CV-RMSEs=5.0-7.5%). Model-projected chronic suppurative otitis media prevalence (1.5% in Chile, 4.9% in India, and 3.4% in Nigeria) was consistent with setting-specific estimates, and the incidence of otitis media-related CHL was calibrated to attain adequate model fit. DeciBHAL-projected adult hearing aid use in Chile (3.2-19.7% ages 65-85 years) was within the 95% confidence intervals of published estimates. Adult hearing aid prevalence from the model in India was 1.4-2.3%, and 1.1-1.3% in Nigeria, consistent with literature-based and expert estimates. Interpretation DeciBHAL-I reasonably simulates hearing loss natural history, detection, and treatment in Chile, India, and Nigeria. Future cost-effectiveness analyses might use DeciBHAL-I to inform global hearing health policy. Funding National Institutes of Health (3UL1-TR002553-03S3 and F30 DC019846).
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Affiliation(s)
- Ethan D. Borre
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Duke University, Durham NC, USA
| | - Austin Ayer
- Duke University School of Medicine, Durham, NC, USA
| | - Carolina Der
- Facultad de Medicina Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile
| | - Titus Ibekwe
- Department of Ear, Nose and Throat, Head & Neck, University of Abuja Teaching Hospital, Gwagwalada Abuja, Nigeria
| | - Susan D. Emmett
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Siddharth Dixit
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Center for Policy Impact in Global Health, Duke Global Health Institute, Durham NC, USA
| | - Minahil Shahid
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Center for Policy Impact in Global Health, Duke Global Health Institute, Durham NC, USA
| | | | - Suneela Garg
- Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Mohini Johri
- Duke-Margolis Center for Health Policy, Duke University, Durham NC, USA
| | - James E. Saunders
- Department of Surgery, Geisel School of Medicine, Dartmouth University, Lebanon, NH, USA
| | - Debara L. Tucci
- National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD, USA
| | - Blake S. Wilson
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
- Department of Electrical & Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Osondu Ogbuoji
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Duke University, Durham NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Center for Policy Impact in Global Health, Duke Global Health Institute, Durham NC, USA
| | - Gillian D. Sanders Schmidler
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Duke University, Durham NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham NC, USA
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6
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Smithers D, Waitzkin H. Universal health coverage as hegemonic health policy in low- and middle-income countries: A mixed-methods analysis. Soc Sci Med 2022; 302:114961. [PMID: 35527089 DOI: 10.1016/j.socscimed.2022.114961] [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] [Received: 08/01/2021] [Revised: 02/19/2022] [Accepted: 04/02/2022] [Indexed: 11/24/2022]
Abstract
Universal health coverage (UHC) has become an influential global health policy. This study asked whether and to what extent UHC became a "hegemonic" health policy. The article consists of three parts: a historical timeline of UHC's rise, a bibliometric analysis of UHC in the literature, and a qualitative thematic analysis of how UHC is defined and the thematic content of those definitions. The roots of UHC can be traced to policies enacted by international financial institutions (IFIs) such as the World Bank and International Monetary Fund (IMF) during the latter half of the twentieth century. These policies caused the debt of low- and middle-income countries (LMICs) to rise precipitously and led the same IFIs and other institutions like the World Health Organization to become involved in the development and restructuring of health systems. UHC was presented as the leading method for financing development of health systems. As the bibliometric analysis shows, UHC has come to predominate in the literature around health system reforms. The thematic analysis based on a random selection of papers obtained in the bibliometric component of the study shows that often the term is not defined or only poorly defined. There is wide variation in the definitions, with many papers mentioning concepts such as quality, access, and equity without further clarification. Usually, papers define UHC to include tiering of benefits, with discussions of financing that focus on preventing "catastrophic [individual] expenditures" rather than discussing universal budgeting of a national health care system or national health insurance. We conclude that UHC has become hegemonic within global health policy, to the exclusion of discussions about other approaches to the transformation of health systems that are not predominately based on insurance coverage such as Health Care for All system, a system which provides equal services for the entire population.
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Affiliation(s)
- Daniel Smithers
- Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA.
| | - Howard Waitzkin
- University of New Mexico, Department of Sociology and Health Sciences Center, 801 Encino Place NE, Albuquerque, NM 87102, USA.
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7
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Abstract
The COVID‐19 pandemic has taught us some very painful lessons about underinvestment in healthcare and the lack of adequate preparation for a pandemic. In this article, ICN Chief Executive Officer Howard Catton examines the World Health Organization's review of global preparedness and looks to the future and how nursing can contribute to better planning and health outcomes for all.
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Affiliation(s)
- Howard Catton
- International Council of Nurses, Genève, Switzerland
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8
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Frati P, La Russa R, Santurro A, Fineschi B, Di Paolo M, Scopetti M, Turillazzi E, Fineschi V. Bioethical issues and legal frameworks of surrogacy: A global perspective about the right to health and dignity. Eur J Obstet Gynecol Reprod Biol 2021; 258:1-8. [PMID: 33387981 DOI: 10.1016/j.ejogrb.2020.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 08/14/2020] [Accepted: 12/07/2020] [Indexed: 12/11/2022]
Abstract
Modern advances in assisted reproduction technology (ART) have disrupted the traditional concept of parenthood. Every year, thousands of people travel abroad from their home countries in order to circumvent restrictive legislation or to benefit from lower fees. In a similar context, surrogacy raises many bioethical and legal issues. The present paper will address the main questions arising from the debate prompted by surrogacy, focusing on international legislation, and looking critically at the different legislative models. As a result of worldwide heterogeneity in policies, legal approaches, and access to ART throughout the world, a growing number of would-be parents are seeking treatment abroad. The lack of regulation on cross-border surrogacy in low income countries can undermine the dignity and rights of women as even modest economic compensation determines a significant purchasing power. The international effort should be aimed at creating an international regulatory framework from which guidelines useful to national governments derive. An international agreement would provide a solid legal basis for the protection of surrogate women. In order to limit the economic interests linked to procreative tourism, so as to truly protect global health and women's rights, legislative uniformity is therefore necessary between the various states.
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9
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Weldon I, Hoffman SJ. Bridging the commitment-compliance gap in global health politics: Lessons from international relations for the global action plan on antimicrobial resistance. Glob Public Health 2020; 16:60-74. [PMID: 32623966 DOI: 10.1080/17441692.2020.1788623] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In 2015, 196 countries boldly committed to address global antimicrobial resistance (AMR). Now, five years later, progress reports suggest the implementation of AMR activities is vastly below what was initially promised. The challenge of overcoming the 'commitment-compliance gap' is not unique to AMR and is common in other areas of international politics. Global health policymakers can therefore learn from theories of international relations and experience in other sectors. We reviewed international relations scholarship to generate five hypotheses for why states might comply or not comply with their global commitments. We then conducted a public policy analysis of three past international agreements on biological diversity, climate change, and nuclear weapons to test these hypotheses and identify lessons for encouraging country compliance with global health agreements, with specific application to global AMR policies. To bridge the commitment-compliance gap, international leaders should: (1) frame incentives to maximise interests for action; (2) pursue enforcement mechanisms to induce state behaviour; (3) emphasise building a culture of trust by providing mutual assurance for action; (4) include mechanisms for managing poor performers; and (5) find opportunities for continual social learning. Agreements should be designed with flexibility, data sharing, and dispute settlement mechanisms and provide financial and technical assistance to states with less capacity to deliver.
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Affiliation(s)
- Isaac Weldon
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, Canada.,Department of Politics, Faculty of Liberal Arts and Professional Studies, York University, Toronto, Canada
| | - Steven J Hoffman
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, Canada.,Department of Politics, Faculty of Liberal Arts and Professional Studies, York University, Toronto, Canada.,Department of Health Research Methods, Evidence & Impact and McMaster Health Forum, McMaster University, Hamilton, Canada.,Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
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10
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Reddy CL, Patterson RH, Wasserman I, Meara JG, Afshar S. Oral and Maxillofacial Surgery: An Opportunity to Improve Surgical Care and Advance Sustainable Development Globally. Oral Maxillofac Surg Clin North Am 2020; 32:339-54. [PMID: 32482559 DOI: 10.1016/j.coms.2020.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Global health has evolved to focus on reducing health inequity and obtaining the highest attainable standard of health for all people. To do this, a range of actors now pursue interventions and policy with an eye toward global targets that place strong emphasis on improving health systems. Within global health, global surgery has sought to delineate the burden of surgical disease and propose policy to improve access to surgery. Oral and maxillofacial surgery has been underrepresented in global health but has a vital role in reducing the global health inequity attributable to the impact of oral and craniofacial conditions.
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Hoffman SJ, Savulescu J, Giubilini A, Kirchhelle C, Rogers Van Katwyk S, Weldon I, Campus B, Harrison M, Maslen H, McLean A. Governing the Global Antimicrobial Commons: Introduction to Special Issue. Health Care Anal 2020; 31:1-8. [PMID: 32236832 PMCID: PMC10042753 DOI: 10.1007/s10728-019-00388-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Antimicrobial resistance is one of the greatest public health crises of our time. The natural biological process that causes microbes to become resistant to antimicrobial drugs presents a complex social challenge requiring more effective and sustainable management of the global antimicrobial commons-the common pool of effective antimicrobials. This special issue of Health Care Analysis explores the potential of two legal approaches-one long-term and one short-term-for managing the antimicrobial commons. The first article explores the lessons for antimicrobial resistance that can be learned from recent climate change agreements, and the second article explores how existing international laws can be adapted to better support global action in the short-term.
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Affiliation(s)
- Steven J Hoffman
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, ON, M3J 1P3, Canada.
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA.
- Department of Health Research Methods, Evidence, and Impact and McMaster Health Forum, McMaster University, Hamilton, Canada.
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
- Oxford Martin School, University of Oxford, Oxford, UK.
| | - Julian Savulescu
- Oxford Martin School, University of Oxford, Oxford, UK
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Alberto Giubilini
- Oxford Martin School, University of Oxford, Oxford, UK
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Claas Kirchhelle
- Oxford Martin School, University of Oxford, Oxford, UK
- Wellcome Unit for the History of Medicine, University of Oxford, Oxford, UK
| | - Susan Rogers Van Katwyk
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, ON, M3J 1P3, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Isaac Weldon
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, ON, M3J 1P3, Canada
- Department of Politics, York University, Toronto, Canada
| | - Brooke Campus
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, ON, M3J 1P3, Canada
| | - Mark Harrison
- Oxford Martin School, University of Oxford, Oxford, UK
- Wellcome Unit for the History of Medicine, University of Oxford, Oxford, UK
| | - Hannah Maslen
- Oxford Martin School, University of Oxford, Oxford, UK
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Angela McLean
- Oxford Martin School, University of Oxford, Oxford, UK
- Department of Zoology, University of Oxford, Oxford, UK
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12
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Rogers Van Katwyk S, Weldon I, Giubilini A, Kirchhelle C, Harrison M, McLean A, Savulescu J, Hoffman SJ. Making Use of Existing International Legal Mechanisms to Manage the Global Antimicrobial Commons: Identifying Legal Hooks and Institutional Mandates. Health Care Anal 2020; 31:9-24. [PMID: 32236833 PMCID: PMC10042894 DOI: 10.1007/s10728-020-00393-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 02/08/2023]
Abstract
Antimicrobial resistance (AMR) is an urgent threat to global public health and development. Mitigating this threat requires substantial short-term action on key AMR priorities. While international legal agreements are the strongest mechanism for ensuring collaboration among countries, negotiating new international agreements can be a slow process. In the second article in this special issue, we consider whether harnessing existing international legal agreements offers an opportunity to increase collective action on AMR goals in the short-term. We highlight ten AMR priorities and several strategies for achieving these goals using existing "legal hooks" that draw on elements of international environmental, trade and health laws governing related matters that could be used as they exist or revised to include AMR. We also consider the institutional mandates of international authorities to highlight areas where additional steps could be taken on AMR without constitutional changes. Overall, we identify 37 possible mechanisms to strengthen AMR governance using the International Health Regulations, the Agreement on the Application of Sanitary and Phytosanitary Measures, the Agreement on Trade-Related Aspects of Intellectual Property Rights, the Agreement on Technical Barriers to Trade, the International Convention on the Harmonized Commodity Description and Coding System, and the Basel, Rotterdam, and Stockholm conventions. Although we identify many shorter-term opportunities for addressing AMR using existing legal hooks, none of these options are capable of comprehensively addressing all global governance challenges related to AMR, such that they should be pursued simultaneously with longer-term approaches including a dedicated international legal agreement on AMR.
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Affiliation(s)
- Susan Rogers Van Katwyk
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, ON, M3J 1P3, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Isaac Weldon
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, ON, M3J 1P3, Canada.,Department of Politics, York University, Toronto, Canada
| | - Alberto Giubilini
- Oxford Martin School, University of Oxford, Oxford, UK.,Wellcome Centre for Ethics and Humanities, Oxford, UK
| | - Claas Kirchhelle
- Oxford Martin School, University of Oxford, Oxford, UK.,Wellcome Unit for the History of Medicine, University of Oxford, Oxford, UK
| | - Mark Harrison
- Oxford Martin School, University of Oxford, Oxford, UK.,Wellcome Unit for the History of Medicine, University of Oxford, Oxford, UK
| | - Angela McLean
- Oxford Martin School, University of Oxford, Oxford, UK.,Department of Zoology, University of Oxford, Oxford, UK
| | - Julian Savulescu
- Oxford Martin School, University of Oxford, Oxford, UK.,Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Steven J Hoffman
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, ON, M3J 1P3, Canada. .,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada. .,Oxford Martin School, University of Oxford, Oxford, UK. .,Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA. .,Department of Health Research Methods, Evidence, and Impact and McMaster Health Forum, McMaster University, Hamilton, Canada.
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13
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Wang X, Liu P, Xu T, Chen Y, Yu Y, Chen X, Chen J, Zhang Z. China-UK partnership for global health: practices and implications of the Global Health Support Programme 2012-2019. Glob Health Res Policy 2020; 5:13. [PMID: 32206728 PMCID: PMC7083009 DOI: 10.1186/s41256-020-00134-7] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 02/13/2020] [Indexed: 01/05/2023] Open
Abstract
Background Over the past few decades, a series of major challenges to global health have successively emerged, which call for China’s deeper engagement in global health governance. In this context, the China-UK Global Health Support Programme (GHSP) was launched in 2012 with about 12 million pounds funded by the United Kingdom. Objectives The GHSP was expected to explore a new type of China-UK partnership to strengthen the cooperation in global health, and enhance China’s capacity to engage in global health governance and provide effective development assistance in health (DAH), in order to jointly improve global health outcomes. Programme design and implementation The GHSP was programmed to support capacity building activities in Chinese experience distillation, DAH, global health governance and pilot partnership at national and institutional levels between October 2012 and March 2019. These activities were assigned to different project implementing agencies (PIAs) and their project cooperative agencies (PCAs) or pilot areas, and were then implemented under the guidance and management by the strategic oversight committee and the project management office of GHSP respectively. Main achievements At the national level, the GHSP held five rounds of China-UK high-level dialogues, conducted studies on China Global Health Strategies to provide robust evidence for developing and issuing relevant national policies, and supported the establishment of the China Global Health Network. At the institutional level, the GHSP funded a series of activities in research, training, international exchange and pilots etc., produced a large number of high-quality research outputs and policy briefings, cultivated a group of PIAs and individual researchers, facilitated the partnership building between the PIAs and PCAs, enhanced the practical ability of Chinese institutions to conduct overseas DAH, and improved the health service delivery and outcomes in pilot areas of three Asian and African countries. Policy implications In the GHSP, China and UK have established a good model for North-South Cooperation and the programme facilitated the 2030 Agenda for Sustainable Development by building a new type of bilateral partnership and carrying out triangular cooperation practices. This model has demonstrated huge potential for cooperation through partnership and can also be referred to by other countries to develop bilateral partnerships.
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Affiliation(s)
- Xiaohua Wang
- Center for Project Supervision and Management, National Health Commission of the People's Republic of China, Beijing, 100044 China
| | - Peilong Liu
- 2School of Public Health, Peking University, Beijing, 100191 China
| | - Tongwu Xu
- 3Graduate School of the Chinese Academy of Social Sciences, Beijing, 102488 China
| | - Yan Chen
- 4School of Health Sciences/Global Health Institute, Wuhan University, Wuhan, 430071 China
| | - Yang Yu
- Center for Project Supervision and Management, National Health Commission of the People's Republic of China, Beijing, 100044 China
| | - Xun Chen
- Center for Project Supervision and Management, National Health Commission of the People's Republic of China, Beijing, 100044 China
| | - Jingyi Chen
- Center for Project Supervision and Management, National Health Commission of the People's Republic of China, Beijing, 100044 China
| | - Zhaoyang Zhang
- Center for Project Supervision and Management, National Health Commission of the People's Republic of China, Beijing, 100044 China
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14
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Lencucha R, Pal NE, Appau A, Thow AM, Drope J. Government policy and agricultural production: a scoping review to inform research and policy on healthy agricultural commodities. Global Health 2020; 16:11. [PMID: 31959213 PMCID: PMC6971899 DOI: 10.1186/s12992-020-0542-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 08/13/2019] [Accepted: 01/13/2020] [Indexed: 12/20/2022] Open
Abstract
Unhealthy foods and tobacco remain the leading causes of non-communicable disease (NCDs). These are key agricultural commodities for many countries, and NCD prevention policy needs to consider how to influence production towards healthier options. There has been little scholarship to bridge the agriculture with the public health literature that seeks to address the supply of healthy commodities. This scoping review synthesizes the literature on government agricultural policy and production in order to 1) present a typology of policies used to influence agricultural production, 2) to provide a preliminary overview of the ways that impact is assessed in this literature, and 3) to bring this literature into conversation with the literature on food and tobacco supply.This review analyzes the literature on government agricultural policy and production. Articles written in English and published between January 1997 and April 2018 (20-year range) were included. Only quantitative evaluations were included. Studies that collected qualitative data to supplement the quantitative analysis were also included. One hundred and three articles were included for data extraction. The following information was extracted: article details (e.g., author, title, journal), policy details (e.g., policy tools, goals, context), methods used to evaluate the policy (e.g., outcomes evaluated, sample size, limitations), and study findings. Fifty four studies examined the impact of policy on agricultural production. The remaining articles assessed land allocation (n = 25) (e.g., crop diversification, acreage expansion), efficiency (n = 23), rates of employment including on- and off-farm employment (n = 18), and farm income (n = 17) among others. Input supports, output supports and technical support had an impact on production, income and other outcomes. Although there were important exceptions, largely attributed to farm level allocation of labour or resources. Financial supports were most commonly evaluated including cash subsidies, credit, and tax benefits. This type of support resulted in an equal number of studies reporting increased production as those with no effects.This review provides initial extrapolative insights from the general literature on the impact of government policies on agricultural production. This review can inform dialogue between the health and agricultural sector and evaluative research on policy for alternatives to tobacco production and unhealthy food supply.
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Affiliation(s)
- Raphael Lencucha
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir William Osler, Montreal, QC, H3G 1Y5, Canada.
| | - Nicole E Pal
- Faculty of Sciences, Vrije Universiteit, Amsterdam, Netherlands
| | - Adriana Appau
- Research and Evaluation, PolicyWise for Children and Families, Edmonton, Alberta, Canada
| | - Anne-Marie Thow
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, Australia
| | - Jeffrey Drope
- Economic and Health Policy Research, American Cancer Society, Atlanta, USA
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15
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Ruggeri K, Ivanović N, Razum J, Kácha O, Menezes IG, Zafari Z, Garcia-Garzon E. An evidence-based policy for improving choice in global health access through medical travel. Health Policy 2018; 122:1372-1376. [PMID: 30337161 DOI: 10.1016/j.healthpol.2018.09.017] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/01/2018] [Accepted: 09/25/2018] [Indexed: 11/16/2022]
Abstract
Global medical travel has had an increasing trend without a comprehensive, evidence-driven policy to ensure safe and effective practice. To identify key factors that influence medical travel, we conducted a series of studies culminating with a preference and decision-making component of over 500 prospective medical travelers from a number of countries. Results indicated that quality of care was the most critical factor in the decision, followed by lower costs of procedure and shorter waiting times. Lower costs were less of a factor if the procedure was more invasive, which also increased the importance of waiting time in the decision. The most desired destinations for care were in Europe (United Kingdom, Germany) and North America (United States). Building on these insights and previous literature, we present a model that implements applications from these factors and additional insights generated across the series of studies toward an effective policy framework.
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Affiliation(s)
- Kai Ruggeri
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, USA; Policy Research Group, University of Cambridge, UK.
| | - Nevena Ivanović
- Faculty of Economics and Business, University of Groningen, the Netherlands
| | - Josip Razum
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Croatia
| | - Ondřej Kácha
- Faculty of Arts, Masaryk University, Czech Republic
| | - Igor G Menezes
- Predictive Psychometrics Laboratory, University of Lincoln, UK
| | - Zafar Zafari
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, USA
| | - Eduardo Garcia-Garzon
- Department of Social Psychology and Methodology Department, Psychology Faculty, Universidad Autónoma de Madrid, Spain
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16
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Sherwood J, Sharp A, Honermann B, Horrigan C, Chatterjee M, Jones A, Cooney C, Millett G. Mapping the impact of the expanded Mexico City Policy for HIV/ family planning service integration in PEPFAR-supported countries: a risk index. BMC Public Health 2018; 18:1116. [PMID: 30208876 PMCID: PMC6134602 DOI: 10.1186/s12889-018-6008-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 01/04/2018] [Accepted: 08/31/2018] [Indexed: 12/01/2022] Open
Abstract
Background The previously-named Mexico City Policy (MCP) — which prohibited non U.S.-based non-governmental organizations (NGOs) from receiving U.S. family planning (FP) funding if they advocated, provided, counseled, or referred clients for abortions, even with non-U.S. funds — was reinstated and expanded in 2017. For the first time, the expanded MCP (EMCP) applies to HIV funding through the President’s Emergency Plan for AIDS Relief (PEPFAR) in addition to FP funding. Previous, and more limited, iterations of the policy forced clinic closures and decreased contraceptive access, prompting the need to examine where and how the EMCP may impact FP/HIV service integration. Methods The likelihood of FP/HIV service de-integration under the EMCP was quantified using a composite risk index for 31 PEPFAR-funded countries. The index combines six standardized indicators from publically available sources organized into three sub-indexes: 1) The importance of PEPFAR for in-country service delivery of HIV and FP services; 2) The susceptibility of implementing partners to the EMCP; and 3) The integration of FP/HIV funds and programming through PEPFAR and USAID. Results Countries with the highest overall risk scores included Zambia (3.3) Cambodia (3.2), Uganda (3.1), South Africa (2.9), Haiti (2.8), Lesotho (2.8), Swaziland (2.1), and Burundi (1.5). Zambia’s risk score is driven by sub-index 1, having a high proportion of country HIV expenditures provided by PEPFAR (86.3%). Cambodia and Uganda’s scores are driven sub-index 3, with both countries reporting 100% of PEPFAR supported HIV delivery sites were providing integrated FP services in 2017. South Africa’s risk score is driven by sub-index 2, where roughly 60% of PEPFAR funding is to non U.S.-based NGOs. Of the countries with the highest risk scores, Swaziland, Lesotho, and South Africa, are also in the top quartile of PEPFAR countries for HIV prevalence and unintended pregnancies among young women. Conclusion This analysis highlights where and why the EMCP may have the greatest impact on FP/HIV service integration. The possible disruption of service integration in countries with generalized HIV epidemics highlights significant risks. Researchers, national governments, and non-U.S. funders can consider these risk factors to help target their responses to the EMCP and mitigate potential harms of the policy.
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Affiliation(s)
| | - Alana Sharp
- amfAR The Foundation for AIDS Research, New York City, USA
| | | | | | | | - Austin Jones
- amfAR The Foundation for AIDS Research, New York City, USA
| | - Chloe Cooney
- Planned Parenthood Federation of America, New York City, USA
| | - Greg Millett
- amfAR The Foundation for AIDS Research, New York City, USA
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17
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Abstract
Globally 2.9 million babies die each year before reaching 28 days of life. Over the past quarter century, neonatal mortality has declined at a slower pace than post-neonatal under-five mortality: in consequence newborns now comprise 44% of all deaths to children under five years. Despite high numbers of newborn deaths, global organizations and national governments paid little attention to the issue until 2000, and resources, while growing since then, remain inadequate. This study examines the factors behind these patterns of policy attention: the delayed emergence of attention, its sudden appearance in 2000, its growth thereafter, but the dearth of resources to date. Drawing on a framework on global health networks grounded in collective action theory, the study finds that a newborn survival network helped to shift perceptions about the problem's severity and tractability, contributing to the rise of global attention. Its efforts were facilitated by pressure on governments to achieve the child survival Millennium Development Goal and by growing awareness that the neonatal period constituted a growing percentage of under-five mortality, a fact the network publicized. The network's relatively recent emergence, its predominantly technical rather than political composition and strategies, and its inability to date to find a framing of the issue that has convinced national political leaders of the issue's urgency, in part explain the insufficiency of resources. However, since 2010 a number of non-health oriented inter-governmental organizations have begun to pay attention to the issue, and several countries with high neonatal mortality have created national plans, developments which augur well for the future. The study points to two broader implications concerning how neglected global health issues come to attract attention: priority emerges from a confluence of factors, rather than any single cause; and growth in priority may depend on the creation of a broader political coalition that extends beyond the largely technically oriented actors who may first press for attention to a problem.
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Affiliation(s)
- Jeremy Shiffman
- Department of Public Administration and Policy, School of Public Affairs, American University, 4400 Massachusetts Ave., NW, Washington, DC 20016-8070, USA
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18
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Abstract
Indonesia is recognized as a nurse exporting country, with policies that encourage nursing professionals to emigrate abroad. This includes the country's adoption of international principles attempting to protect Indonesian nurses that emigrate as well as the country's own participation in a bilateral trade and investment agreement, known as the Indonesia-Japan Economic Partnership Agreement that facilitates Indonesian nurse migration to Japan. Despite the potential trade and employment benefits from sending nurses abroad under the Indonesia-Japan Economic Partnership Agreement, Indonesia itself is suffering from a crisis in nursing capacity and ensuring adequate healthcare access for its own populations. This represents a distinct challenge for Indonesia in appropriately balancing domestic health workforce needs, employment, and training opportunities for Indonesian nurses, and the need to acknowledge the rights of nurses to freely migrate abroad. Hence, this article reviews the complex operational and ethical issues associated with Indonesian health worker migration under the Indonesia-Japan Economic Partnership Agreement. It also introduces a policy proposal to improve performance of the Indonesia-Japan Economic Partnership Agreement and better align it with international principles focused on equitable health worker migration.
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Affiliation(s)
- Ferry Efendi
- National Cheng Kung University, Taiwan, ROC; Airlangga University, Indonesia
| | - Timothy Ken Mackey
- Global Health Policy Institute, USA; University of California, San Diego, USA
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19
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Quissell K, Walt G. The challenge of sustaining effectiveness over time: the case of the global network to stop tuberculosis. Health Policy Plan 2015; 31 Suppl 1:i17-32. [PMID: 26282859 DOI: 10.1093/heapol/czv035] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2015] [Indexed: 11/13/2022] Open
Abstract
Where once global health decisions were largely the domain of national governments and the World Health Organization, today networks of international organizations, governments, private philanthropies and other entities are actively shaping public policy. However, there is still limited understanding of how global networks form, how they create institutions, how they promote and sustain collective action, and how they adapt to changes in the policy environment. Understanding these processes is crucial to understanding their effectiveness: whether and how global networks influence policy and public health outcomes. This study seeks to address these gaps through the examination of the global network to stop tuberculosis (TB) and the factors influencing its effectiveness over time. Drawing from ∼ 200 document sources and 16 interviews with key informants, we trace the development of the Global Partnership to Stop TB and its work over the past decade. We find that having a centralized core group and a strategic brand helped the network to coalesce around a primary intervention strategy, directly observed treatment short course. This strategy was created before the network was formalized, and helped bring in donors, ministries of health and other organizations committed to fighting TB-growing the network. Adaptations to this strategy, the creation of a consensus-based Global Plan, and the creation of a variety of participatory venues for discussion, helped to expand and sustain the network. Presently, however, tensions have become more apparent within the network as it struggles with changing internal political dynamics and the evolution of the disease. While centralization and stability helped to launch and grow the network, the institutionalization of governance and strategy may have constrained adaptation. Institutionalization and centralization may, therefore, facilitate short-term success for networks, but may end up complicating longer-term effectiveness.
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Affiliation(s)
- Kathryn Quissell
- American University, School of Public Affairs, Department of Public Administration and Policy, Washington, DC 20016, USA and
| | - Gill Walt
- London School of Hygiene and Tropical Medicine, Global Health and Development Department, London, UK WC1H 9SH, London, UK
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20
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Kadetz P. Manufacturing risk: reframing the discourse of safety of commodified potent substances. J Ethnopharmacol 2015; 167:115-122. [PMID: 25557033 DOI: 10.1016/j.jep.2014.12.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 08/19/2014] [Revised: 12/16/2014] [Accepted: 12/16/2014] [Indexed: 06/04/2023]
Abstract
ETHNOPHARMALOGICAL RELEVANCE The rapid commodification of plant-based medicines has led to the development of regulatory guidelines and standards by the World Health Organization to ensure the safety of these products. However, these standards have been identified to be selectively implemented, if implemented at all, in many contexts. A primary concern for proving the safety of intrinsic factors of plant-based medicines, may result in less attention paid to the often more problematic extrinsic factors of mass production. This article critically examines the normative global discourse of safety concerning plant-based medicines and problematises many of the assumptions identified in this discourse. MATERIALS AND METHODS This qualitative research was conducted in the Traditional Medicine Unit of the Western Pacific Regional Office of the World Health Organization (WHO) and in field work in the rural Philippines. Data was collected through archival research, analysis of WHO data sets, semi-structured and structured interviews and surveys, participant observation concerning local plant-based medicine use in the Philippines and participant observation in WHO meetings regarding future strategies for traditional Asian medicines. RESULTS Although informants reported concerns of safety for every aspect of the production, marketing and sales of plant-based medicines, this research has identified that the implementation (WHO guidelines) has been uneven and inconsistent over the past ten years in the Western Pacific Region of the WHO. Differences in local contexts that are not consistent with global guidelines and standards were reported by informants. Issues have also been identified in the inconsistent regulation of plant-based medicines as pharmaceuticals within only certain, rather than all, processes of production. CONCLUSIONS It is imperative to understand plant-based medicines as the potent substances they are, whose rapid global commodification may affect both their potency and safety. The WHO discourse of the need for safety in the use of plant-based medicines has justified the need for biomedical oversight through processes of commodification. Yet, it is often through these very processes of commodification and mass production that safety may be compromised. This research suggests that the discourse concerning the safety of the plant-based medicines needs to be reframed from a primary focus on the intrinsic factors of plant-based medicines to a greater focus on the extrinsic factors of global commodification.
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Affiliation(s)
- Paul Kadetz
- Xi׳an Jiaotong-Liverpool University, 111 Ren׳ai Road, Public Building Room 516A, Dushu Lake Higher Education Town, Suzhou Industrial Park Suzhou, Jiangsu, 215123 People׳s Republic of China.
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21
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van der Rijt T, Pang Pangestu T. Governance within the World Health Assembly: a 13-year analysis of WHO Member States' contribution to global health governance. Health Policy 2014; 119:395-404. [PMID: 25596958 DOI: 10.1016/j.healthpol.2014.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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] [Received: 11/04/2013] [Revised: 12/02/2014] [Accepted: 12/06/2014] [Indexed: 11/16/2022]
Abstract
There is a widespread perception that developed countries in the Western world dictate the shaping and governance of global health. While there are many bodies that engage in global health governance, the World Health Organisation (WHO) is the only entity whereby 194 countries are invited to congregate together and engage in global health governance on an equal playing field. This paper examines the diversity of governance within the World Health Assembly (WHA), the supreme decision-making body of the WHO. It explores the degree and balance of policy influence between high, middle and low-income countries and the relevance of the WHO as a platform to exercise global governance. It finds that governance within the WHA is indeed diverse: relative to the number of Member States within the regions, all regions are well represented. While developed countries still dominate WHA governance, Western world countries do not overshadow decision-making, but rather there is evidence of strong engagement from the emerging economies. It is apparent that the WHO is still a relevant platform whereby all Member States can and do participate in the shaping of global health governance.
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Affiliation(s)
- Tess van der Rijt
- Lee Kuan Yew School of Public Policy, National University of Singapore, 469C Bukit Timah Road, Singapore 259772, Singapore.
| | - Tikki Pang Pangestu
- Lee Kuan Yew School of Public Policy, National University of Singapore, 469C Bukit Timah Road, Singapore 259772, Singapore
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