Global Public Health最新文献

Evidence is emerging that long COVID is at least as prevalent in the Global South as the Global North, but literature on long COVID healthcare in the Global South is in its infancy. Brazil is seeing significant levels of debility due to long COVID but a limited national evidence-base. long COVID shares symptomatology and appropriate care with a wider category of infection-associated chronic conditions (IACCs). This article reviews literature published between 2000 and 2023 addressing healthcare for long COVID and IACCs in Brazil, in the interest of exploring challenges and opportunities for the SUS (Brazil's universal health system) to offer appropriate long COVID healthcare. We find that long COVID and IACCs collectively are subject to erasure from Brazilian healthcare knowledge, through lack of expertise, a resource-limited health system prioritising urgent care, and the concentration of poor health in marginalised populations with limited decision-making power. A nascent intellectual will to address long COVID, and a tradition of social participation in healthcare governance present potential opportunities. We call for ignition of a global step-change in tackling healthcare for long COVID and IACCs. Global equity in long COVID healthcare requires the development and sharing of expertise regarding its universal and context-specific features.

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.

Recent infectious disease crises (e.g. COVID-19, Ebola, mpox) show that the mainstream market-driven innovation model cannot ensure both rapid innovation and equitable global access to vaccines, drugs, and diagnostics critical for pandemic preparedness and response. Alternative models that may better address global access needs exist, but analysis of their merits is limited. We analysed the pharmaceutical innovation 'niche' for pandemic products and 35 alternative initiatives within it, to inductively derive a typology of three archetypal alternative models: The National Biosecurity model is well-established, proliferating since COVID-19, driven and funded primarily by the public sector, and delivering innovation for national needs. The Cosmopolitan Public Private Partnership model combines global access with innovation, but relies on voluntary participation, and must navigate tensions between public and private interests. The Open Science Collaborative Network model accelerates innovation through scientific cooperation and builds global access into early R&D stages, but remains small-scale, nascent, and requires effective coordination. Cosmopolitan and Open Science models offer significant advantages for achieving innovation with global access, but require sustained political, financial and technical support. Alternative innovation models should be institutionalised during inter-pandemic periods, when markets for pandemic products are economically unattractive, and political resistance to systemic change is easier to overcome.

Community health workers are crucial bridges between health systems and local populations, uniquely positioned at the intersection of personal experiences and professional duties. Yet, limited research examines how these workers' personal health decisions influence their clients' behaviours. This study addresses this gap by investigating associations between the maternal experiences of Accredited Social Health Activists (ASHAs) and perinatal health practices among their clients (recent mothers) in Bihar, India. Using a large-scale cross-sectional survey involving 400 ASHAs and 1166 clients, we conducted mixed-effects logistic regression analyses to examine these relationships. Our findings reveal a strong association between ASHAs' personal practices and their clients' behaviours during pregnancy. ASHAs who adhered to evidence-based health practices recommended by formal healthcare systems, such as early pregnancy registrations and antenatal check-ups, and those who engaged in traditional practices, such as concealing pregnancy or calling traditional midwives during labour, predicted similar practices among their clients. These results highlight the critical position of community health workers at the intersection of personal and professional spheres, where their lived experiences meaningfully influence their work. Public health systems should leverage community health workers' shared sociocultural and personal experiences through targeted training, supporting their role in fostering sustainable maternal and child health improvement.

Young people have a high burden of sexually transmitted infections (STIs) but low uptake of and high attrition from services. We adopted a positive deviance approach to explore uptake of STI screening, treatment, and partner notification within a sexual and reproductive health service. We conducted in-depth interviews with young people (aged 16-24 years) who accepted screening, treatment, and partner notification slips (n = 15), and healthcare providers who delivered the service (n = 13). We used thematic analysis to understand decisions at each stage of the STI care cascade. Young people who accepted STI screening and returned to receive their results were influenced by the friendliness and informativeness of providers, which helped overcome their anxiety. Experiencing symptoms and health being a priority were also motivators to seek treatment and overcame the inconvenience of returning to the service and the fear of the test result. While all participants accepted partner notification slips, only those in secure relationships felt able to tell their partners. This study identified both supply (positive provider attitudes, information provision, and same-day treatment provision) and demand side factors (prioritise one's health, experiencing symptoms, and knowledge about asymptomatic infections) that STI interventions can build on to support young people's engagement with STI services.

Fathers' alcohol use impacts family well-being, including increased risk for violence, poor child outcomes, and low engagement in care. Yet few studies examine the drivers of alcohol use among fathers or the role of gendered expectations and sociocultural norms on use, especially in low-resource settings like Kenya. Understanding why fathers drink, the consequences of use, and barriers to care is key to designing scalable, responsive interventions. In Eldoret, Kenya, community members, leaders, providers, and fathers experiencing problematic alcohol use participated in interviews and focus groups. Participants discussed reasons for drinking, its impacts, and barriers to care. Using the framework method, transcripts were coded and summarised using the socioecological model. Reasons and consequences of alcohol use emerged across individual, interpersonal, and sociocultural levels. Individually, fathers used alcohol to escape distress with consequences on physical and mental health. At the family level, alcohol was used to avoid conflict, contributing to risk for violence and poor child outcomes. Socioculturally, drinking was shaped by gender norms, with consequences like stigma and loss of social status, which reinforced shame and isolation. Barriers to care included lack of awareness, poor service access, and stigma. Intervention and implementation strategies must address avoidant coping, masculinity norms, and local resource constraints.

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.

Globally there has been increased focus on the prevalence of sexual violence in workplaces, including the mining industry. In Western Australia, where this study is situated, this industry is a significant employer, predominantly male-dominated, and the prevalent use of fly-in-fly-out schedules can blur work and social life. Consequently, efforts to prevent and manage workplace sexual violence have become a priority, leading to the development and implementation of various strategies and resources. Qualitative interviews were conducted with 34 participants, including sexual violence prevention professionals (n = 16) and mining industry workers (n = 18). Reflexive thematic analysis identified systemic and behavioural considerations that may be transferrable to other male-dominated workplaces. Participants emphasised the importance of primary prevention training programmes that included engaging activities, realistic scenarios, careful use of language, humour and inspirational facilitators. Genuine consultation with workers is critical to ensure key messages are appropriately received. Prevention interventions also need to be supported by appropriate reporting mechanisms and support processes for victim/survivors. This research aims to provide an understanding of current sexual violence prevention initiatives within the Australian mining sector, offering recommendations for future approaches tailored to industries and contexts with similar dynamics.

Adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA) face difficulties accessing sexual and reproductive health (SRH) services. Youth-friendly service delivery models may prove an alternative to increase SRH service uptake. This analysis utilises evidence from the Girl Power-Malawi study, a study designed to compare the impact of different models of service delivery on SRH service uptake for AGYW. Three intervention clinics trained providers in youth-friendly health services (YFHS), engaged young peer educators in patient outreach, expanded hours and integrated various services into youth-dedicated spaces. A standard of care (SOC) clinic was included as a comparator. This paper draws on qualitative data from in-depth interviews with 60 participants (15 per clinic) and 8 focus group discussions (2 per clinic). Thematic analysis identified three key themes regarding SRH service acceptability: having peer educators made AGYW feel more comfortable seeking services; AGYW perceived services at intervention clinics to be more private; and clinic modifications such as free services, longer operating hours and integration of different SRH services made services easier to access. Adolescents expressed that these factors contributed to higher service uptake in intervention clinics. Youth-friendly service provisions are needed to ensure AGYW find care-seeking acceptable.

The UNFPA-UNICEF Global Programme to End Child Marriage and the Joint Programme on the Elimination of Female Genital Mutilation aim to contribute to SDG target 5.3 on the elimination of harmful practices against women and girls through gender-transformative approaches (GTAs). In collaboration with Collective Impact, the Global Programme developed and implemented the Gender-Transformative Accelerator tool, a workshop-based rapid gender assessment and planning process for country offices and implementing partners to advance operationalisation of GTAs. The Accelerator was rolled out in 15 countries in Sub-Saharan Africa, South Asia, and the Middle East from 2021 to 2023. Looking across country contexts, this case study describes the Accelerator approach, implementation, key successes, challenges, and early outcomes. Workshop values clarification activities enabled staff to reflect critically on their social contexts and gender- and age-related biases, and deepened the resonance and relevance of GTAs. This, in turn, facilitated productive critical assessment of programmes and development of action plans to advance GTAs at multiple socio-ecological levels. The case study concludes with lessons learned and the path forward for implementing the Accelerator and operationalising GTAs to promote the rights, health, and wellbeing of adolescent girls and boys in all their diversity.