Global Public Health最新文献

In humanitarian settings with high levels of sexual violence (SV), care is often offered through fragmented silos, exacerbating the burden on the health workforce and survivors. We aimed to identify contextual and health systems barriers and enablers to providing integrated medical and mental health & psychosocial support (MHPSS) in the care for SV survivors in humanitarian settings. Using Valentijn's framework, a qualitative, real-time Delphi study (RTD) approach was conducted with 17 experts representing seven geographical subregions. Challenges and enablers identified across the participants' contexts were consistent. Contextual challenges included volatile contexts, collapsed health systems, and insufficient basic infrastructure. Professional-related challenges included lacking expertise among healthcare professionals (HCPs), high staff attrition rates, and compassion fatigue. Health systems-related challenges included poor referral and coordination mechanisms, lack of funding and resources, misaligned donor priorities and low prioritisation of SV comprehensive care. Effective networking, community engagement, capacity building, co-locating services, participatory management, promoting employees' sense of ownership, establishing a digital information system, and a unified joint patient file were key identified enablers. Further research should be conducted to assess HCPs' and SV survivors' perceptions and experiences of how best to integrate MHPSS services, and understand the challenges and opportunities in delivering integrated services.

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.

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.

Pakistan has 40 Super High Risk Union Councils (SHRUCs) where polio has been persistently endemic, and community relationships have been a persistent challenge due to campaign fatigue and violent, organised resistance. This study aimed to gather perspectives from frontline workers in these areas to improve community engagement. We conducted participant observation, over 100 interviews, and held Human-centred Design inspired sessions with 171 teams of frontline polio staff from 2020 to 2022 in the SHRUCs of a major city in Pakistan. The results show that frontline polio workers repeatedly visited households broadly neglected by government services in SHRUCs, but some households refused the vaccine due to fatigue from multiple visits and fear of government surveillance. Others refused the vaccine to draw attention to their more pressing needs. Frontline polio workers suggested that decreasing touchpoints and providing additional services, such as food, medicines, primary health care, and sanitation services, would improve vaccine uptake. We discuss several implications for vaccine communications, including the importance of quality engagement, the legitimacy of rumours surrounding vaccination, the limited applicability of 'vaccine hesitancy', and the critical role of service provision in improving vaccine acceptability.

Despite being widely implemented, little information exists on the effect of Value Clarification and Attitude Transformation (VCAT) workshops on health care provider knowledge and attitudes and abortion provision. Between 2019 and 2021, we conducted a cluster-randomised controlled trial among 101 private abortion-providing healthcare facilities in Ethiopia. We surveyed 217 providers prior to a VCAT workshop and again at 2 weeks, 6 months, and one year following VCAT workshop participation to understand abortion knowledge and attitudes, examined service statistics to assess abortion client volumes, and conducted in-depth interviews with 30 providers. We found that a VCAT workshop for providers increased abortion service provision. In the year following the workshop, intervention facilities served 13% more abortion clients than expected based on the control group trend (95% CI: 6%-21%, p = .01). VCAT workshops moderately improved knowledge and supportive attitudes about abortion in the short-term. The VCAT workshop worked to change providers' attitudes by highlighting the importance of abortion in protecting clients from potential death and harm, but providers were less comfortable providing care to patients in situations deemed to be less socially justified (e.g. for married clients). Results support implementing ongoing VCAT refreshers with additional emphasis on client autonomy, cultural norms, and person-centred care.Trial registration: ClinicalTrials.gov identifier: NCT04181021.

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.

Despite almost a century's research capacity strengthening in Africa, HIV/AIDS research has been dominated by high-income countries (HICs), illustrating broader inequalities in the global knowledge economy. The perpetuation of weak social science capacity in east Africa is analysed as part of a complex system with multiple causes at different socio-ecological levels. Furthermore, although primarily driven by HIC/ neo-colonialist interests, causes also stem from low-income countries (LICs), and individual actions reproduce macro-level structures. Most factors link to global economic inequalities, and the extraction of data and intellectual capacity from east Africa operates akin to Dependency Theory, but this is exacerbated by African governments. At the meso-level, HIC institutions prioritise revenue and publications over strengthening LIC research capacity, whatever their rhetoric, while serious impediments exist in east African institutions. At the micro-level, HIC researchers perpetuate inequalities through, e.g., prioritising output, maintaining dependency, and choosing HIC rather than LIC conferences and journals. Multiple responses are needed, particularly at the macro-level, especially long-term, tailored funding. Meso-level responses include meritocratic career structures and institutional research consultancies. Individual HIC researchers should, ideally, prioritise training and mentoring, but this risks career advancement. Above all, honesty is required about motives and conflicting interests, at institutional and individual levels.

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.