Globalization and Health最新文献

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.

The Marrakesh Agreement, which established the World Trade Organization (WTO), permits WTO member countries to jointly decide to temporarily suspend certain obligations under the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement). The TRIPS Decision adopted at the 12th WTO Ministerial Conference in June 2022, following 20 months of extended negotiations during the COVID-19 pandemic, approved only a limited portion of the waiver proposal originally submitted by India and South Africa. Since the Decision was adopted, WTO members have faced a deadlock over whether to extend its scope to include COVID-19 diagnostics and therapeutics, despite being required by the Decision to reach a conclusion on this issue within six months. This paper re-examines the discussions surrounding the potential expansion of the Decision and argues that including COVID-19 diagnostics and therapeutics within its scope was both appropriate and necessary. In addition, the paper proposes ways to make effective use of TRIPS flexibilities during a pandemic, so that developing countries are not left dependent on unpredictable waiver negotiations. The paper also outlines possible approaches for reforming the waiver decision-making process, aiming to ensure that such decisions are made promptly and efficiently, without prolonged negotiations during times of emergency.Clinical trial number Not applicable.

The International Health Regulations (IHR) form the basis of the World Health Organization's governing framework for global health security and have a key role in preventing the international spread of disease. The COVID-19 pandemic rightfully brought the 'fitness for purpose' of the IHR (2005) into question, spurring WHO Member States to embark on a process of amending and improving the Regulations. This process concluded in mid-2024, with a package of substantive amendments adopted through Member State consensus. Global commentary during the COVID-19 pandemic spotlighted issues with both the letter and spirit of the Regulations, but one unifying theme was that of non-compliance. As such, much of the debate in the lead up to the amendment negotiations focused on the need for stronger enforcement and accountability mechanisms. However, the distinction between true IHR breaches and legitimate deviations was often ignored. Instead, these were frequently lumped together under the banner of 'non-compliance,' and with a predominantly negative slant; often as prelude to justification that stronger rules (and perhaps even punitive measures) were needed. The subtext was that the same rules must apply to all. There is little doubt that a legally binding instrument must have robust accountability mechanisms to underpin global collaboration and prevent pandemics. However, New Zealand's COVID-19 pandemic response - considered among the best in the world - illustrates why the balance between uniform compliance and State Party flexibility had to remain an essential consideration during the IHR amendment negotiations.

Background: Ultra-processed food companies in Thailand have rapidly expanded, and they play an important role in the domestic economy and public policy. These companies influence policy-making by building networks with political authorities and using various strategies to pursue their interests. Increased consumption of ultra-processed foods has been shown to be strongly associated with obesity and other non-communicable diseases (NCDs), which are a growing public health concern in Thailand. This study investigated the commercial determinants of health (CDOH) strategies of the major ultra-processed food companies in Thailand.

Methods: This study employed document review to classify CDOH's strategies of ultra-processed food companies in Thailand. The authors searched publicly available information by 15 ultra-processed food companies, including both national and transnational companies, between January 2019 and December 2024. In addition, 30 semi-structured interviews were conducted with field experts to provide additional insights to support the findings from the document review. Thematic analysis was used to interpret the data.

Results: National ultra-processed food companies in Thailand employ all seven strategies of CDOH, namely: (1) Political, (2) Scientific, (3) Marketing, (4) Supply chain and waste management, (5) Labour and employment, (6) Financial, and (7) Reputation management strategies. Transnational companies employed all but one of the seven strategies (labour and employment).

Conclusions: The wide array of CDOH strategies used to shape public policy and opinion may hinder efforts to protect the health of Thais from obesity and diet-related NCDs. To counter this, the authors recommend systematic monitoring of CDOH strategies, stronger accountability for the ultra-processed food companies, mandatory lobbyist registration, stricter management of conflict of interest between government officials and food companies, and strict enforcement of relevant legislation.

Background: Environmental and public health impacts are critical in the food processing industry. To demonstrate responsiveness to stakeholder expectations, firms foreground sustainability reporting through frameworks such as Environmental, Social, and Governance (ESG) and Corporate Social Responsibility (CSR). Yet the sustainability rhetoric usually centers on visible, marketable, and peripheral dimensions, including packaging, energy use, and philanthropy. In contrast, domains within their core operations, including product composition, nutritional quality, and marketing ethics, receive limited attention. Subsequently, concerns over the commercial determinants of health rise, particularly for vulnerable populations.

Methods: The study follows an embedded mixed-methods design to examine whether sustainability disclosures align with firms' innovation strategies. Using 2023 data from 90 multinational or export-oriented food processing firms, hierarchical and multiple regression models assess the effects of ESG sub-dimensions and CSR scores on R&D expenditure, controlling for market capitalization (MC). To complement the quantitative analysis, the study includes a qualitative examination of selected firms, illustrating how sustainability-innovation gaps manifest in practice.

Results: Findings reveal no systematic alignment between sustainability and innovation strategies. The environmental dimension shows a marginally positive yet statistically insignificant relationship with R&D, while social, governance, and CSR metrics exhibit no meaningful association. MC remains the strongest predictor of R&D, highlighting that financial and organizational capacity drives innovation rather than sustainability commitment. Notably, CSR aligns more closely with environmental than social performance, indicating a selective legitimacy orientation. Firm-level evidence also reflects the patterns of symbolic compliance, illustrating how strong ESG scores can coexist with weak sustainability integration.

Conclusion: The weak coupling between sustainability communication and innovation behavior exposes a structural gap between corporate legitimacy efforts and tangible outcomes for sustainable development. Firms that prioritize reputational visibility over substantive innovation reinforce health inequities and constrain systemic reform. To enhance environmental and public health outcomes, both corporate and regulatory strategies should move beyond symbolic compliance toward outcome-based accountability. Such a shift can better incentivize innovation that enhances nutritional quality, strengthens social equity, and protects environmental integrity.

Background: Supporting service delivery through the private sector is a policy priority for improving maternal and child health service delivery for UHC. Despite the increased attention, it is not clear how pay-for-performance interventions within the private sector perform post-donor transition. This study aimed to examine the impact of donor transition on private service providers' ability to deliver maternal and newborn health in Uganda.

Methods: An exploratory qualitative study was conducted in Uganda's Rwenzori and Lango sub-regions, which benefited from a USAID project to reduce maternal and newborn deaths from 2012 to 2016 in Rwenzori and 2015-2020 in the Lango sub-region. A purposive sample of 52 respondents (Rwenzori = 26, Lango = 16, National = 10) took part in the study. A thematic analysis technique was followed, guided by the components of the health systems dynamics framework, with data management supported by Atlas. ti a qualitative data management software.

Results: Overall, results reflect a mix of progress and setbacks following the cessation of donor funding to the participating private health service providers. The subnational governance to provide oversight to the private sector was strengthened, which extended into the post-transition period. Despite setbacks in the provision of a comprehensive MNCH package, such as a drastic reduction in patient volumes, reduced scope of services offered and inconsistent supply of emergency medicines, the popularisation of MNCH services among the private sector players created awareness of the same post-transition. The information systems built with donor support contributed to improved data reporting from the private sector, which was sustained post-transition. Human resources for health among private sector players were greatly affected post-transition, although the same benefited the public sector with an experienced pool of health workers from which they recruited into public service. Despite the continued use of equipment procured during donor support, the medicines and supplies were greatly affected by funding cessation. Equally affected was the financing following donor cessation to the private sector players post-transition.

Conclusion: Despite the mixed results following donor cessation of funding to the private sector, these results have important implications for supporting private sector players to improve MNCH services in low-resource settings. The governance, health information systems, and service delivery experiences are critical aspects worth emulating for better engagement of the private sector in strengthening MNCH service delivery.

Clinical trial number: Not applicable.

Background: The pharmaceutical industry is a key global health actor given its crucial role in the development and testing of medicines. Within Latin America, Chile currently has the highest number of multinational commercial clinical trials per inhabitant, predominantly for oncological therapies. Insufficient attention has been paid to context-specific conditions that enable clinical trials' successful implementation in the Global South. In examining what makes Chile an attractive hub for commercial trials and why patients enroll in them, this study seeks to elucidate the interplay among the pharmaceutical industry, health systems, and societies. We analyze how trial providers, cancer practitioners, and patient participants draw from their own lived experience to make sense of local healthcare, health policies and global pharmaceutical market trends, amid global health crises.

Methods: Using a critical political economy of global health framework, we conducted a critical ethnography in 2022-23 at a tertiary cancer center that is the lead recruiter of patients into oncology commercial trials in Santiago, Chile. In-depth interviews, participant observation, and document gathering were conducted, with materials analyzed through thematic content analysis using Nvivo12.

Results: Forty-seven subjects -fourteen patients, four caregivers, and twenty-nine providers- were interviewed and/or shadowed. The main theme, "A failed (health) system" reveals a perception that the growing presence of commercial clinical trials for advanced cancer works synergistically with a deficient health system. Subthemes of political economy levels of (mal)functioning, were grouped as follows: (i) the COVID-19 pandemic and the global organization of commercial trials; (ii) national factors (health services and post-trial access policies); and (iii) community/relational factors (palliative care and unaffordability of high-cost drugs). Clinical trials were experienced as an exit strategy from a broken healthcare system, even as participants regarded the pricing strategies of anticancer therapies acritically.

Conclusions: The conditions that make Chile an attractive hub for cancer commercial clinical trials are determined by an interplay of global, national, and community-level structural arrangements between public and private actors. Chile serves as an important global health case study on the role of the pharmaceutical industry in capitalizing on systemic healthcare failures to advance clinical research on metastatic cancer.