Globalization and Health最新文献

Background: Global Health Equity is increasingly threatened by interconnected global crises that expose systemic inequities in health systems, global health governance and evidence infrastructures. Global Collaborative Evidence Networks have emerged as mechanisms for mobilising knowledge, fostering interdisciplinary collaboration, and supporting decision-making across diverse contexts to address Global Health Equity. However, their potential is constrained by persistent challenges related to governance, inclusion, and power asymmetries. This review critically examines the conceptual, structural, and governance dimensions of Global Collaborative Evidence Networks to assess their potential and limitations in advancing Global Health Equity.

Methods: A narrative literature review was conducted in July 2024, searching PubMed, Scopus, Web of Science, Embase, CINAHL, and grey literature sources. A thematic analysis of 162 included studies was conducted using Braun and Clarke's reflexive approach to identify themes and sub-themes.

Results: The review found that while Global Health Equity has emerged as a key normative framework shaped by historical, political, and socio-economic structures, its operationalisation remains fragmented, particularly in global governance and research systems. Global Collaborative Evidence Networks, positioned as vehicles to advance Global Health Equity, demonstrate considerable potential yet often reproduce entrenched power asymmetries. Substantial gaps remain in how equity, diversity, and inclusion are conceptualised and operationalised within these networks. Although many promote shared purpose and trust-based collaboration, participation and influence often concentrated in high-income institutions, reinforcing systemic and resource asymmetries. Key tensions, such as between efficiency and inclusiveness, unity and diversity, and centralisation and decentralisation, shape governance dynamics and impact who benefits from network participation. Despite the proliferation of equity-focused frameworks in global health partnerships, none have been adapted for networks, and accountability mechanisms remain weak. Theoretical perspectives from network typologies and governance modes offer valuable perspectives but require integration with intersectional and decolonial approaches to address persistent power imbalances.

Conclusion: Global Collaborative Evidence Networks are a powerful mechanism for supporting and strengthening evidence-based decision-making to address global health inequities. However, they risk replicating existing inequities without deliberate, equity-centred governance. This review calls for the development of empirically grounded, context-sensitive frameworks to guide the equitable, diverse and inclusive design, evaluation, and governance of Global Collaborative Evidence Networks.

In the wake of COVID-19 pandemic, the African Union elevated the Africa Centres for Disease Control and Prevention (Africa CDC) to autonomous status, empowering it to declare Public Health Emergencies of Continental Concern (PHECs). This mechanism was first operationalized in 2024 in response to sustained mpox transmission across multiple African countries, despite the World Health Organization's (WHO) earlier lifting of the Public Health Emergency of International Concern (PHEIC). This article examines the PHECs as a decolonial intervention in global health governance. Applying the Critique, Reform, Withdrawal, and Transformation (CRWT) framework, I argue that the PHECs reflect both a strategic withdrawal from overreliance on the WHO PHEIC system and a transformative effort to embed African-led governance rooted in Pan-African solidarity. The article highlights mechanisms for sustaining Pandemic Prevention, Preparedness, and Response (PPPR), including tiered activation, cross-sectoral oversight, civil society engagement, and alignment with continental financial instruments. Invariably, the PHECs represent a critical reconfiguration of Africa's role in global health-from recipient of external interventions to architect of regional norms, practices, and accountability. Its promise lies not in rejecting multilateralism but in recalibrating it, embedding regional expertise, political leadership, and operational autonomy within broader global frameworks.

Background: Antibiotic resistance (ABR) poses a significant global health and development threat from increasing globalization of travel, trade, and animal and human migration. ABR impacts refugees and migrants in unique ways due to increased exposure to infections and inequitable access to healthcare. The objective of this review is to synthesize the evidence on access to and appropriate use of antibiotics by migrants and refugees, identify the barriers they may experience in accessing and using antibiotics, and reflect on global policy entry points to modify such barriers considering the persistent globalization-related impacts on ABR.

Methods: A global rapid scoping review was conducted to collect evidence on barriers to access and appropriate use of antibiotics among migrants and refugees. MEDLINE (Ovid), Scopus, Web of Science, CABI Global Health and the IGO Custom Search Engine were searched for academic and grey literature published in English, French, or Spanish from inception until September 22nd, 2025. A conceptual framework structured data extraction and thematic analysis of barriers to antibiotic use along the access pathway, including approachability, acceptability, availability, accommodation, affordability, and appropriateness.

Results: This review included 125 studies from an array of geographic locations. Migrants and refugees experience barriers along the continuum of care from both the patient and health-system side, impacting access to, and appropriate use of antibiotics. Limited access to resources, prevalence of certain social norms and values, health literacy and beliefs, and autonomy, can impact healthcare seeking and utilization. Health system barriers, such as location and affordability of services or language barriers, can also limit access and appropriate use of quality-assured antibiotics.

Conclusion: Migrants and refugees face structural, financial, and systemic barriers in accessing and using antibiotics. While globalization processes have shaped the barriers migrants and refugees experience when accessing health services, access pathways are heterogeneous and influenced by the health systems of the host countries, and other contextual, non-health policies and factors. Potential policy solutions to mitigate these barriers include initiatives to address country-of-origin norms and values and improving language accessibility. Improved global policy coordination can also address access challenges for migrants and refugees, as tackling ABR requires collective global action.

Clinical trial number: Not applicable.

Introduction: Understanding and evaluating health system governance is essential for resilient health systems. This study develops a framework to analyse health system governance in conflict-affected and high-risk areas, including fragmented systems.

Methods: The methodology adopts a qualitative multi-faceted approach, encompassing five methods: consultations with experts, thematic analysis of existing health system governance frameworks, focus group discussions, interviews with key informants, and reflections from primary authors during fieldwork. The discussion centred on examples primarily drawn from northwest Syria throughout the conflict (2011-2024).

Findings: Existing health system governance frameworks are less relevant in conflict-affected and high-risk areas. The authors developed a new institutional framework by adding more dimensions to well-known principle-based frameworks, such as Siddiqi et al., to address the complexities imposed by conflicts. The framework has a descriptive part that includes power dynamics (types and dimensions) and stakeholders' traditional and non-traditional roles and responsibilities. Additionally, it has an evaluative part that includes eleven principles: strategic vision; participation and consensus orientation; rule of law and ethics; intelligence and conflict-sensitive transparency; responsiveness; equity and inclusiveness; effectiveness and efficiency; complex accountability; complementarity; localisation; and legitimacy.

Conclusion: The proposed framework can deal with fragmented health systems characterised by multipolar health systems. It is typically applicable in conflict-affected and high-risk areas. It provides policymakers with a structured approach to describing and evaluating health system governance.