Globalization and Health最新文献

Background: What constitutes state`s global power to shape access to medicines? How was it distributed between states and how did this change from 2000 to 2019? In this comparative case study, we explored the powers of China, India and the United States, and discuss whether our findings from the pre-pandemic era were reflected in the global COVID-19 response related to pharmaceuticals. We used an analytical framework from the international relations literature on structural power, and assessed the following power structures after adapting them to the context of access to medicines: finance, production, financial protection, knowledge, trade and official development assistance.

Results: We found that from 2000 to 2019 there had been a power-shift towards China and India in terms of finance and production of pharmaceuticals, and that in particular China had increased its powers regarding knowledge and financial protection and reimbursement. The United States remained powerful in terms of finance and knowledge. The data on trade and official development assistance indicate an increasingly powerful China also within these structures. During the COVID-19 pandemic, we found that the patterns from previous decades were continued in terms of cutting-edge innovation coming out of the United States. Trade restrictions from the United States and India contrasted our findings as well as the limited effective aid from the United States. Building on our findings on structural powers, we argue that both structural power and political decisions shaped access to medical technologies during the COVID-19 pandemic. We also examined the roles and positions of the three states regarding developments in global health governance on the COVAX mechanism, the TRIPS Agreement waiver and the pandemic accord in this context.

Conclusion: From 2000-2019, China and India increased their structural powers to shape global access to medical technologies. The recent COVID-19 pandemic demonstrated that both structural power and political decisions shaped global access to COVID-19 technologies.

Background: Adequate knowledge and awareness regarding diseases are essential for appropriate, high-quality healthcare. Female Genital Schistosomiasis (FGS) is a non-sexually transmitted gynaecological disease that is caused by the presence of Schistosoma haematobium eggs in the female genital tract and the resulting immune response that causes tissue damage. It is estimated to affect 56 million women, mostly in sub-Saharan Africa (SSA), where healthcare workers (HCWs) have limited awareness and knowledge of FGS. Most migrants in Europe are female, often from SSA and therefore at risk of FGS. This study investigated awareness and knowledge of FGS among European HCWs with the aim of informing strategies to improve the management of migrant health.

Methods: We conducted a cross-sectional survey using a self-administered, closed, multilingual, anonymous online questionnaire between 1st June 2023 to 31st January 2024. Medical doctors (MDs) (n = 581) and nurses or midwives (NMs) (n = 341) working in infectiology, gynaecology, urology and general, travel, internal or occupational medicine in European countries were enrolled in the survey. A Poisson regression was used to identify factors associated with MDs' knowledge and awareness of FGS and adjusted prevalence ratios (aPR) were estimated. Practices related to FGS were described using counts and proportions for a subsample of MDs aware of FGS.

Results: Among the 922 eligible participants, FGS awareness was 43.7% (CI95%: 39.6; 47.9) for MDs and 12.0% (CI95%: 8.8; 16.0) for NMs. FGS awareness among MDs was higher among men (50.0%; CI95%: 43.7; 56.3), working in clinics for migrants (72.0%, CI95%: 63.2; 79.7) and among infectiologists/travel medicine specialists (68.9%, CI95%: 62.2; 75.0). No knowledge was reported by 67.6% (95% CI 63.7-71.4) of MDs, while 25.3% (CI95%: 21.8; 29.0) had low and 7.1% (CI95%: 5.1; 9.5) medium knowledge. Working in healthcare for migrants was positively associated with medium knowledge (aPR = 3.49; CI95% 1.67;7.28), which was lower for general practitioners (aPR = 0.23, CI95%:0.07;0.81).

Conclusions: Our study highlights that HCWs in Europe might not be adequately prepared to manage FGS patients, resulting in a high risk of neglect. We believe that the promotion of existing medical networks could improve knowledge about FGS and thus the health of migrant women.

Background: The Covid pandemic and its aftermath have triggered new alarm and social unrest across the Global South over the deepening international debt crisis that now threatens to derail Universal Health Coverage (UHC), other Sustainable Development Goals (SDGs), future pandemic preparedness, and global warming mitigation. The recent Globalization and Health article by Alex Kentikelenis and Thomas Stubbs (May 2024), "Social protection and the International Monetary Fund: promise versus performance", offers a meticulously quantified rendering of the social costs imposed by the crisis and takes aim at IMF solutions. They advocate for a rejection of IMF austerity programs and offer a valuable prescription for change through the International Labor Organization's "Universal Social Protection" concept.

Main body: Similar to the Jubilee movement at the turn of the century, global civil society, humanitarian aid, and health organizations are mobilizing in a variety of global networks to call for debt cancellation and restructuring as well as an end to austerity. These include new debt law campaigns in London and New York to rein in private creditors, calls for new IMF issuance of "Special Drawing Rights", demands for "Global Public Investment", and promotion of Universal Social Protection.

Conclusion: The Universal Social Protection approach described by Kentikelenis and Stubbs provides a focal point for these demands to confront this latest and worst episode of sovereign debt crisis already undermining global health progress.

Background: Caribbean populations face complex health issues related to diet and food security as they undergo a rapid nutrition transition, resulting in some of the world's highest number of premature deaths from noncommunicable diseases (NCDs). Despite policy efforts to promote local and regional food consumption, reliance on food imports remains high with many Caribbean countries importing more than 80% of their food from larger economies. Previous regional research revealed the importance of food sharing practices in the Caribbean, with implications for the consumption of local foods, food security, and community resilience against climate change. However, there is limited understanding of these practices and how they have evolved.

Methods: Using a transition lens, we explored the generational, life course, and sociocultural factors influencing food sharing practices in the Caribbean. We conducted semistructured online interviews with 10 intergenerational dyads involved in food sharing recruited from the virtual campus of the University of West Indies. Our study sample included 20 participants, ranging from 18 to 83 years old, from five English-speaking Caribbean countries (6 different islands).

Results: Food sharing practices had a central role within the social fabric of all participants, contributing to their mental health and well-being. They represented a fundamental aspect of participants' culture and traditions, driving a sense of belonging and connection among Caribbean communities. However, contemporary food sharing practices indicated a move towards more convenience-oriented and processed foods, with reduced time spent cooking and a decline in the use of food sources such as backyard gardens, fishing, and marketplaces, with a preference for supermarkets. These trends, particularly observed among younger generations, aligned with the ongoing nutrition transition in the Caribbean and were influenced by various sociopolitical and environmental factors such as climate events, economic fluctuations, urbanisation, and changing family structures.

Conclusions: The evolving landscape of food sharing practices in the Caribbean has linkages with various domains of nutrition, health, society, culture, environment and globalisation. While a transition towards less healthy diets will increase the risk of many NCDs, the intrinsic cultural, social, and emotional benefits of food sharing could also positively impact health outcomes in the Caribbean region.

Eliminating gender inequality and promoting population health are stand-alone goals in the Sustainable Development Goals (SDGs). It is crucial to understand goal setting and policy making processes aimed at promoting gender and health equality given the entrenched and structural natures of these inequalities. Our research examines the process of problem and solution representation, priority setting, and factors that shape the policymaking process concerning women and girls within the UN system in relation to the SDGs. Data for this study were collected from semi-structured one-on-one interviews with participants who have work experience within the United Nations (UN) (n = 9). The analysis was informed by a qualitative descriptive methodology. Our findings identify the role of political forces in influencing policy, the challenges of limited and tied financial resources, the role of scientific evidence and data, and the purpose of different mandates across agencies. Political forces were found to shape the work of UN agencies, often hindering advancement of the SDG agenda. At the same time participants noted how they navigated opposition or what they considered regressive approaches to women and girls' health in order to pursue a more progressive agenda. Finite financial resources were also noted to play an important role in shaping SDG implementation pertaining to women and girls' health. Identification of the types of knowledge, evidence, and data that drive and are given preference in policy creation and development can highlight shortcomings and strengths of current modes of policy development and implementation. Key stakeholders and future research in health and development policy spheres can draw from our findings to gain insight into problem representation and prioritization. This will help identify underlying assumptions that inform work on women's and girls' health and how they shape policy agendas.

Background: Marketing of commercial milk formula (CMF) is well resourced and has influenced societal beliefs and practices that have undermined breastfeeding. This has occurred despite legislation in many countries largely reflecting the provisions of the International Code of Marketing of Breast-milk Substitutes.

Methods: A cross-sectional survey was conducted in seven countries: Bangladesh, Mexico, Morocco, Nigeria, South Africa, United Kingdom and Viet Nam to explore the scope and nature of CMF marketing among pregnant women and mothers. A marketing-research methodology was adopted using convenience sampling of women stratified according to infant feeding practices and the infant's age. Participants were identified in hospitals and clinics, as well as in the street, markets and shopping malls. In each country the sample size comprised 300 pregnant women, 150 mothers of children aged > 18 months who were breastfeeding without giving CMF and 600 women feeding their children with CMF. Data were collected using a questionnaire administered on tablets by trained field workers.

Results: Interviews were conducted with 8528 women between October 2019 and March 2021. Overall, 3095/7480 (41.3%) of women reported exposure to CMF marketing ranging from 3% in Morocco to 92% in Viet Nam. The commonest marketing site in all countries was television, but advertising in-store and in magazines and newspapers was also common. In most countries, CMF advertising on social media, websites and YouTube was less compared to traditional media. Reports of receiving free CMF samples varied from 3.1% in Nigeria to 34.6% in Viet Nam. Health professionals were the most common source of advice to mothers about starting CMF and which CMF brand to use.

Conclusions: The study provides quantitative data about CMF marketing and insights on how marketing companies develop effective messages, helping to explain how individual vulnerabilities or aspirations are integrated into marketing strategies. The findings reaffirm the need for action across political and health domains to counter actions of CMF companies. This will require effective national legislation fully reflecting the Code and action by professional bodies to protect health professionals from targeting by CMF marketing. Marketing-research methods could be employed to develop messaging in support of breastfeeding and breastfeeding-friendly policies.

Background: The World Health Organization certified China malaria-free in 2021. Consequently, preventing the risk of malaria re-introduction caused by imported malaria has now become a major challenge. This study aims to characterize the dynamics and predict the risk of malaria importation in Jiangsu Province, where the number of imported malaria cases ranks among the highest in China.

Methods: The annual number of cases with imported malaria in Jiangsu Province, the annual number of travelers from sub-Saharan Africa (SSA) to Jiangsu Province (both Chinese and international travelers), and the annual number of Chinese migrant workers from Jiangsu Province who stayed abroad between 2013 and 2020 were assessed. The spatio-temporal dynamics of malaria importation was characterized with ArcGIS 10.8. A negative binomial model was applied to model malaria importation to Jiangsu Province, China.

Results: A total of 2,221 of imported malaria cases were reported from January 1, 2013, until December 31, 2020. Imported malaria cases into China were mainly from SSA (98%) and P. falciparum (78%), the most common species. A seasonal pattern was observed, with the most cases occurring from December to February. The negative binomial model, which incorporates the number of Chinese migrant workers from Jiangsu Province who stayed abroad as an independent variable, demonstrated better performance (AIC: 96.495, BIC: 94.230) compared to the model based solely on travelers from SSA to Jiangsu Province. The model indicated an estimated 139% increase in imported cases for a 10% increase in Chinese migrant workers from Jiangsu Province who stayed abroad.

Conclusion: In conclusion, our study underscores the importance of incorporating data on Chinese migrant workers who have stayed abroad when predicting malaria importation risks. By integrating both international travel patterns and migrant worker data, our findings offer a more robust framework for assessing and managing malaria risk in Jiangsu Province. This approach provides valuable insights for public health officials, enabling more effective resource allocation and targeted interventions to prevent the re-introduction of malaria and improve overall disease management.

Background: The global movement of people in the context of strict immigration laws and policies places significant numbers of people in insecure migration status worldwide. Insecure status leaves people without recourse to legal, governmental or social protection from violence and abuse. This review synthesized qualitative studies that reported how migrants associated physical and physically enforced sexual violence they experienced with their insecure migration status.

Methods: We conducted a qualitative evidence synthesis of 31 studies published between 1 January 2000 and 31 May 2023, with data from Europe, North America, East Asia, South Asia, the Middle East and Africa. Our thematic synthesis produced 14 inductive descriptive codes, four descriptive themes and three analytical themes.

Results: We generated robust qualitative evidence showing that women experienced sexual violence while in transit or without status in a host state, and that they associated that violence with their insecure migration status. This was the case across the various geographic routes and destination countries. We found evidence that women associated intimate partner violence with lacking (legal) access to support because of their insecure migration status. We found evidence that women connected their unwillingness to leave violent circumstances, and therefore their prolonged or repeated exposure to violence, with a fear of immigration removal produced by their insecure migration status.

Conclusion: To protect people in insecure migration status from experiencing violence that they associated with their migration status, it's necessary to ensure that the reporting of violence does not lead to immigration enforcement consequences for the victim.

Background: The Coronavirus disease (COVID-19) pandemic caused significant morbidity and mortality in Africa, in addition to other socio-economic consequences. Across the continent, Schools of Public Health (SPHs) played several roles in supporting national, regional, and global response to the pandemic. Following a published and grey literature search, this paper reviews and analyses the contribution of SPHs in Africa during the COVID-19 pandemic.

Contribution of the schools of public health: SPH faculty in most countries contributed their expertise through COVID-19 task forces and advisory committees where they guided and supported decision-making. Faculty also supported the identification, review, and synthesis of rapidly evolving global and local evidence, adapting it to the local context to guide policy decisions. Through research, SPHs contributed to a better understanding of the disease epidemiology, response interventions, as well as prevention and control measures. SPHs engaged in training field epidemiologists, frontline health workers, and district response teams. SPH staff, students and field epidemiology trainees also supported field activities including surveillance, contact tracing, as well as managing quarantine facilities and points of entry. SPHs engaged in public education and awareness-raising initiatives to share information and dispel misinformation. In partnership with other stakeholders, SPHs also developed important innovations and technologies.

Conclusion: SPHs are a critical pillar for pandemic prevention, preparedness, and response, that support health systems with important functions. To further enhance their capacity, efforts to improve coordination of SPHs, strengthen collaboration among schools, harmonize training and curricula, and enhance capacity for advanced research are needed. There is also a need to bridge the inequities in capacity and resources that exist among SPHs across regions and countries.