Global Public Health最新文献

The Canadian public healthcare system faces significant challenges in performance. While the formal healthcare system addresses funding, access and policy, there is a critical need to prioritise the informal system of community-oriented networks. This integration aligns with the World Health Organization's primary health care approach, emphasising a whole-of-society strategy for health equity. Canada's healthcare, harmonised through the Canada Health Act of 1984, focuses on need over ability to pay. Despite successes, the system struggles with social determinants of health and widening health inequities, especially among Indigenous peoples. Historical policies of forced assimilation have led to poor health outcomes and lower life expectancies for Indigenous populations. The Truth and Reconciliation Commission's Calls to Action stress removing barriers at multiple levels to improve Indigenous health. Indigenous perspectives on health, emphasising holistic wellness, contrast with Western healthcare's acute-illness focus. The emergence of parallel systems, informal networks within healthcare, reflects dissatisfaction with traditional approaches. Recognising the parallel system within Indigenous health, as proposed, can transform healthcare to better meet population needs. Systems mapping of Indigenous PHC in Alberta revealed numerous entities providing healthcare access, highlighting the importance of adequately funding and integrating these parallel systems to advance health equity.

More than 500 centres in China hold over 300,000 individuals in what has been described by the United Nations as unethical and ineffective compulsory treatment and rehabilitation centres. Individuals in these centres face widespread human rights abuses, including lack of due process, forced labour, physical and sexual violence, and denial of healthcare. Because of the vulnerability of individuals in detention settings to abuse in research trials, ethical guidelines have required research to pose no more than minimal risk, to address the process of incarceration, and the health or well-being of detained individuals. To understand the scope and ethical protections of research conducted in Chinese drug detention centres, we conducted a literature review by searching the China Academic Journals Database for Chinese language research articles published between 2012-2021. We identified 68 articles of drug detention detainees that examined physical and psychosocial health; infectious disease prevalence; past drug use; and other topics. The majority of studies (56%) did not provide any information on the consent of research participants. Only ten (15%) studies reported receiving ethics approval. No studies examined the process or conditions of detention. Journal editors, in China and globally, should increase scrutiny of research conducted in compulsory drug detention settings.

Governments worldwide have implemented mandates, restrictions, and other coercive measures to secure adequate vaccine coverage, with the COVID-19 pandemic providing numerous examples. While the ethics and public reception of such measures are matters of heated discussion, their effectiveness in motivating individuals to get vaccinated remains incompletely understood. This study addresses that gap by analyzing data from a 2022 nationwide online survey conducted in China. Respondents recruited through proportional quota sampling to reflect key demographic characteristics of the population were asked to specify their COVID-19 vaccination status and the reason behind their decision. Results reveal that while most respondents reported getting vaccinated voluntarily, 14.6% attributed their vaccination to the government's coercive mobilisation efforts. Moreover, members of the ruling Chinese Communist Party, as well as individuals favouring Western vaccines unavailable in China, were more likely to cite coercive mobilisation as the reason for their vaccination. These findings suggest that coercive measures can motivate a substantial proportion of the population to get vaccinated, especially those closely connected to the political system and those with unmet vaccination preferences. Given the controversy surrounding such measures, this enhanced understanding of their effectiveness could help with formulating targeted policies to combat infectious diseases and safeguard public health.

Most data governance frameworks are designed to protect the individuals from whom data originates. However, the impacts of digital practices extend to a broader population and are embedded in significant power asymmetries within and across nations. Further, inequities in digital societies impact everyone, not just those directly involved. Addressing these challenges requires an approach which moves beyond individual data control and is grounded in the values of equity and a just contribution of benefits and risks from data use. Solidarity-based data governance (in short: data solidarity), suggests prioritising data uses over data type and proposes that data uses that generate public value should be actively facilitated, those that generate significant risks and harms should be prohibited or strictly regulated, and those that generate private benefits with little or no public value should be 'taxed' so that profits generated by corporate data users are reinvested in the public domain. In the context of global health data governance, the public value generated by data use is crucial. This contribution clarifies the meaning, importance, and potential of public value within data solidarity and outlines methods for its operationalisation through the PLUTO tool, specifically designed to assess the public value of data uses.

Racial discrimination is a pervasive global problem. Bystanders who observe racism can intervene to support the targets of racism, but they often fail to do so due to several context-specific barriers. There is currently little research on bystander behaviour in racism outside of English-speaking countries. We used mixed methods to explore bystander responses to everyday racism in Colombia. In an online survey, participants (N = 1,157) were presented with a scenario where they observed racist behaviour as a bystander. Subsequently, they were asked to respond to a series of open and closed questions. Quantitative findings suggested that knowledge on how to act was predicted by confidence and responsibility; responsibility was predicted by ethnicity (being non-mestizo), confidence, noticing the event, and feeling more uncomfortable; and confidence was predicted by noticing the event, feeling less uncomfortable and more responsible. In the analysis of the qualitative data, we identified six themes. These were (i) Bystander characteristics and circumstances; (ii) Bystander morality and attitudes towards racism; (iii) Clarity of the situation; (iv) Perceived need and deservedness; (v) Presence of authorities and other people, and (vi) Consequences of action: Safety to the bystander. We discuss these findings in relation to racism in the Colombian context.

This paper draws from qualitative research undertaken with the mothers and primary caregivers of children aged under 5 years old and in recovery from severe acute malnutrition (SAM), as well as other community members, across three study sites in Kenya, Zambia, and Zimbabwe. The paper highlights how nutrition-related stigma is constructed and enacted in complex ways, by multiple actors and across diverse settings. Adopting an intersectional approach, the paper identifies how stigma emerges at the intersections of social identity, especially age, gender, and associated beliefs about women's, and especially young women's, assumed (in)capacity to care. The paper highlights how such stigmatising practices have the potential to place the children of mothers and primary caregivers affected by stigma at heightened vulnerability to SAM as well as to impair their recovery because of its impact upon health-seeking behaviours. In conclusion, we argue that intersectional approaches to stigma are crucial to better understand the social construction of stigma pertaining to SAM, the differential experiences, and responses, of caregivers, as well as how these shape pathways to differing forms of care.

Health lifestyles in China reflect complex interplays of various structural forces, yielding intricate and evolving patterns. Leveraging data from the 2004-2015 China Health and Nutrition Survey (N = 9,986), this study discerns latent health lifestyles, tracks transitional dynamics, and probes socioeconomic disparities in these shifts. Three distinct lifestyle categories emerge: 'high risk', 'overall healthy but inactive', and 'modernized and active'. Notably, the prevalent trend favours the 'overall healthy but inactive' lifestyle, steadily expanding over time, followed by the 'high-risk' group. Conversely, the 'modernized and active' lifestyle, while being the least common, exhibits a modest decline. Individuals engaged in primary industries are more likely to sustain an overall healthy but inactive lifestyle. Socioeconomic advantages, particularly in education and income, were linked to maintaining or transitioning into a modernised and active lifestyle, while lower income and unemployment were more prone to maintaining high-risk behaviours. These findings illuminate the intricate dynamics of health lifestyles in China's rapidly evolving landscape, highlighting socioeconomic influences on lifestyle transitions.

The requirements for actionability and accountability in data infrastructures are often viewed as incompatible, creating a trade-off where enhancing one diminishes the other. Through a comparative analysis of two data infrastructures used to share genomic data about the SARS-CoV-2 virus, we argue that making data actionable for knowledge development involves a commitment to ensuring that the data in question are representative of the phenomena being studied and accountable to data subjects and users. This in turn presupposes that: (1) enough data are contributed by a wide and diverse set of relevant sources; (2) mechanisms of feedback and inclusion are set up to ensure that data contributors can participate in data governance and interpretation, thereby helping to adequately contextualise data; and (3) accountability extends to the ways in which data infrastructures are run, financed and positioned vis-à-vis the communities they are meant to serve. Such a model of data sharing can only work on the understanding that data do not need to be easily accessible to be actionable; rather, actionability depends on the responsiveness and accountability of data infrastructures, and the efforts invested in ensuring open communication among contributors.

Mistreatment during institutional childbirth is multifactorial and can have a detrimental effect on women's health and future care-seeking behaviour. Understanding its determinants is essential for improving respectful maternity care. This study aimed to explore women's experiences of mistreatment during childbirth in Nepal. Sixteen in-depth interviews were conducted with women who had recently given birth in a tertiary health facility (between 5 and 16 weeks postpartum). Participants were selected using purposive sampling to ensure a heterogenous sample. Data were analysed using Nvivo12, following Braun and Clarke's thematic analysis approach. Four themes were identified: (1) mistreatment and undignified care, (2) health system constraints, (3) adverse hospital culture, (4) power and territorial display. Mistreatment and undignified care included abuse, threats, neglect, inadequate communication, painful medical procedures and lack of autonomy. Health system constraints included inadequate resources and overcrowding. Adverse hospital culture was characterised by work stress among health professionals, a rigid hierarchical structure and the normalisation of mistreatment practices. Power and territoriality were evident in an atmosphere of fear for women with restricted companionship during birth. Favorable institutional strategies and tailored interventions are needed to eliminate solitary births and to provide women-centered respectful care by motivated and competent health professionals.

African, Caribbean, and Black (ACB) women are overrepresented among new HIV diagnoses due to social and structural factors. This study seeks to create, implement, and evaluate a community-based peer-led intervention to improve access to HIV prevention and care for ACB women in Canada. This multisite, five-year project, using community-based participatory research, implementation science and evaluation frameworks, will be implemented in five non-iterative phases. Phase 1: Community and partner engagement; Phase 2: Critical health and racial literacy training curriculum and HIV resource development; Phase 3: Implementation research with first cohort of trained HIV Peer Equity Navigators [PENs] in three sites; Phase 4: Training of second cohort of HIV PENs and program implementation of HIV PEN intervention across Ontario; and Phase 5: Evaluation, knowledge sharing and plans for national scale up. We will use a mixed methods approach, including quantitative and qualitative data, such as surveys and qualitative interviews, to analyze and identify implementation scenarios, changes in improving access, and ensuring equity to HIV prevention and care for ACB women in Ontario, Canada. Evidence on the effectiveness of this innovative, peer-led intervention will be used to inform policies and practice related to HIV prevention and care for ACB women in Canada.