Globalization and Health最新文献

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.

Background: AMR is an important global public health challenge, but there is a lack of good data on response progress. This study addresses country governance of antimicrobial resistance (AMR) surveillance, considering changes in responses to the Tracking Antimicrobial Resistance Country Self-Assessment Survey (TrACSS) between 2019 and 2024. Its first objective is to describe progress under the global action agenda on AMR. Its second objective is to assess the effectiveness of a major development aid intervention to encourage action against AMR, the United Kingdom (UK)-funded Fleming Fund (FF). The study applies a pragmatic approach to analysis, involving descriptive exploration and difference-in-differences methodology.

Results: Governance of AMR surveillance in low- and middle-income countries generally strengthened over the five years to 2024, converging with high-income countries (HIC). South-East Asian countries reported relatively strong gains, a striking exception to limited global progress. Globally, over fifteen indicators, clear progress was only reported in four: two on strengthening underlying AMR surveillance systems, in both human health (HH) and animal health (AH); and two on regulatory frameworks in AH. FF-supported countries reported strengthening HH surveillance systems more than comparable countries, even accounting for income-group differences. The standardised change score for the 'national surveillance system for AMR in humans' was 0.11 higher in FF-supported than in other Official Development Assistance (ODA)-eligible countries (95% confidence level, p = 0.046). FF-supported countries also reported greater progress on other topics, such as use of surveillance data for decision-making in AH. FF-supported countries were approximately a quarter (25%) more likely to respond 'yes' on this topic. Additional reflections on the strengths and weaknesses of TrACSS data are discussed in detail.

Conclusion: Our study adds empirical observations about country governance systems as they relate to AMR surveillance efforts. The idea of progressive global momentum, with South-East Asia playing a key role, disrupts established perceptions of European leadership and obstacles to change. From an aid effectiveness perspective, this study indicates that FF strengthened country HH and AH surveillance systems. It also points to institutional changes in how data are used in administrative decision-making processes and, potentially, in the translation of evidence into policy, programmes and regulation.

Clinical trial number: Not applicable.

Background: Transformative change in the global food governance (GFG) system is essential to address the interlinked crises of non-communicable diseases, social inequities, and environmental degradation that collectively undermine global health and sustainable development. However, this transformation agenda raises important questions regarding how powerful actors and interests, entrenched institutions and institutional legacies, and dominant ideologies and belief systems may resist or enable such change.

Methods: In this paper, we adopt a narrative review and synthesis method, drawing on multidisciplinary and grey literature, to explore these questions. We investigate the evolution of the GFG system through historical trajectories and institutional legacies and examine its current challenges through the lens of food systems transformation.

Results: Four interlinked key findings emerged. First, GFG has evolved from a predominantly multilateral system led by intergovernmental organisations and their member nation-states to a more decentralised multistakeholder system involving a diverse array of non-state actors and interests. Second, food systems and GFG have been constrained ideologically by neoliberal policy positions, exemplified by the narratives pushed by intergovernmental organisations such as the World Bank, International Monetary Fund, and World Trade Organization. They have also been constrained financially by rich country governments and philanthropic donors, compelling key institutions to seek external funding and partnership opportunities merely to fulfill their basic mandates. Third, by privileging multistakeholder governance and public-private partnerships, the world's largest corporations and business interest groups have reshaped power relations in global policy agendas, including those established at multilateral 'world food summits,' in ways that sideline public health imperatives. Fourth, recurrent global food crises reflect deep structural and power asymmetry issues that have historically privileged certain nation-states and, increasingly, private sector actors, thereby perpetuating inequities that exacerbate global health vulnerabilities.

Conclusion: The interconnected and complex challenges identified in this review - rooted in power asymmetry and institutional favouritism in GFG - pose significant barriers to transforming food systems in ways that safeguard public health, environmental sustainability, and social justice. Overcoming these obstacles is pivotal not only for achieving global climate and sustainable development goals, but also for rebalancing power in GFG so that policies better align with the needs of all people and the planet.

Background: Many low- and middle-income countries face a double burden of malnutrition, i.e., a co-occurrence of undernutrition with overweight, obesity, or other diet-related noncommunicable diseases. In an increasingly connected global food system, multinational and domestic food industry actors - through their commercial practices and corporate political activity - both contribute to the double burden of malnutrition and hold potential to address it. Systematic monitoring of relevant industry commitments and practices may help to hold industry accountable and foster constructive engagement. The Business Impact Assessment - Obesity and population-level nutrition (BIA-Obesity) tool has been developed to assess and benchmark food companies' commitments and practices related to obesity and support for healthy diets at a national level.

Methods: To enable the application of BIA-Obesity for countries facing a double burden of malnutrition, this study aimed to identify and select relevant best practice indicators for assessing food company commitments and practices regarding the double burden of malnutrition, with a focus on indicators not currently captured by the BIA-Obesity tool. A three-round Delphi study was conducted between April and October 2024, involving an international panel of experts.

Results: From 52 invited experts, 30 contributed to our expert panel (response rate 58%). Based on a systematic review, 16 best practice indicators addressing the double burden of malnutrition were proposed. Consensus (i.e., group agreement of 75% or higher) for inclusion was reached for 8 indicators covering the production, distribution and marketing of (i) breastmilk substitutes and (ii) complementary foods, (iii) breastfeeding support and (iv) parental leave for employees, (v) food fortification, (vi) use of traditional foods, (vii) use of discounts and donations, and (viii) healthy diets at work. One additional indicator on corporate strategy was included as an overarching indicator.

Conclusions: Food industry action may complement other efforts to address the double burden of malnutrition, such as public policies and investments. Tools like the extended BIA-Obesity framework can be used for a systematic monitoring of relevant industry commitments and practices and may help to disseminate and establish favourable industry practices as part of broader efforts to address the double burden of malnutrition in low- and middle-income countries.

Clinical trial number: Not applicable.

Academic publishing is one of several forces that shape what is recognized as global health knowledge. The peer review process is meant to ensure rigor and quality, yet it can reproduce political and structural inequalities, especially when research challenges dominant narratives. For researchers from marginalized and colonized communities, these dynamics determine whether their language, identity, and lived realities are permitted in scholarly spaces. When political, historical, and socio-legal context is minimized or replaced with state-sanctioned labels, the result is not neutrality but the silencing of essential truths that directly shape health and mental health. This Comment examines how editorial and peer review practices operate as gatekeeping mechanisms that privilege dominant geopolitical narratives and marginalize Indigenous and decolonial perspectives. Drawing on a recent case where a peer-reviewed article, recommended for publication, faced subsequent editorial demands to replace politically accurate terminology referring to Palestinians, we show how language policing functions as epistemic control. These are not isolated incidents: global publishing norms pressure scholars toward state-sanctioned labels and "neutral" frames, sidelining colonial and political determinants of health. In global health, that pressure produces an evidence base that overlooks the sociopolitical conditions; occupation, systemic violence, legal segregation, displacement, that shape exposure, access, care pathways, and outcomes, including mental health. It produces an appearance of neutrality that is methodologically incomplete and ethically fragile, with downstream consequences for research agendas, funding priorities, program design, and accountability. Confronting the politics of knowledge production in global health requires structural change, not just diversity statements. Safeguarding researchers' right to represent their communities in their own terms and embedding sociopolitical realities into analysis are essential. Without these changes, global health will continue to reproduce the inequalities it seeks to reduce, failing to generate knowledge that is genuinely global, representative, and just.