Globalization and Health最新文献

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.

Background: Second-generation mothers (SGMs), born in European countries to foreign-born parents, represent a growing population. While disparities in maternal and neonatal health outcomes among first-generation migrants and natives are well documented, less is known about these outcomes among SGMs. This systematic review and meta-analysis aimed to synthesize evidence on maternal and neonatal health outcomes among SGMs, comparing them to both native-born women and first-generation migrants.

Methods: We searched MEDLINE, Embase, and Scopus databases up to December 2024, for studies reporting on maternal and/or neonatal outcomes in SGMs in Europe. Eligible studies were critically appraised, and random-effects meta-analyses were conducted where possible to obtain pooled, unadjusted odds ratios.

Results: A total of 19 studies were included, mostly conducted in Germany and Nordic countries. SGMs had a lower risk of C-section compared to natives (pooled OR = 0.68, 95% CI: 0.60-0.78). They also seemed to have a higher risk of late access to antenatal care (ANC) and of gestational diabetes, although not significant for the latter. For other outcomes, such as near-miss, low birth weight and preterm birth, included studies reported conflicting results or the pooled estimates were not significant. The generalizability of findings is strongly affected by the limited number of studies, data heterogeneity and underrepresentation of key migrant groups and countries.

Conclusions: Structural factors, acculturation, and persistent inequalities may shape health trajectories across generations. Late access to ANC highlights that SGMs still face barriers in accessing care, despite being born and educated in host countries. Improved data collection, disaggregation by parental background, and attention to social determinants are essential to better understand and address the needs of this growing population.

Poor authorship practices in global health research may be a sign of unequal partnerships. Previous studies have shown that authors from low- and middle-income countries (LMICs) are frequently underrepresented in publications from global research collaborations between LMICs and high-income countries (HICs). To the best of our knowledge, the patterns of authorship from LMICs in international industry-sponsored clinical research on breast, lung and colon cancer have not yet been investigated. Therefore, as a spin-off to broader research on globalization of commercial clinical trials in oncology, we conducted an analysis of authorship in the publications from completed industry-sponsored therapeutic trials in breast, lung and colon cancer (from phase I to IV) that involved LMICs. Only articles published in a peer-reviewed journal in English by March 30, 2024 were included. A total of 302 publications from 173 trials were analysed. 63% (n = 191) of them have at least one author from a middle-income country (MIC); 14% (n = 42) articles have the first author from a MIC; and 13% (n = 39) articles have the last author from a MIC. Conversely, 37% (n = 111) of articles had no author from MIC, including two trials conducted only in MICs. In conclusion, our study found an imbalance in authorship, suggestive of significant inequalities, in collaborative research in industry-sponsored clinical trials for breast, lung and colon cancer. Industry sponsors need to work towards greater equity in authorship when collaborating with researchers in (L)MICs, and oncology researchers and opinion leaders in HICs should actively advocate for greater fairness to their colleagues in (L)MICs.

Background: Access to reliable, accurate, and up-to-date health information is a crucial component of global population health. Like other health-harming industries, the alcohol industry is known to provide misinformation to the public, including on alcohol, pregnancy, and infant health. It is unknown whether industry information changes following independent public health analysis.

Methods: We extracted data using the homepage, menu, and search tool functions (where available) from seven industry-funded charity and nonprofit company websites (Aware, South Africa; Drinkaware, Ireland; Drinkaware, United Kingdom; Éduc'alcool, Canada; DrinkWise, Australia; Foundation for Advancing Alcohol Responsibility, United States; and International Alliance for Responsible Drinking) that have previously been found to misrepresent the evidence on alcohol, pregnancy, and infant health. We conducted a qualitative, thematic analysis using a published framework of 'dark nudges and sludge' misinformation techniques.

Results: Omission of information, functionality problems, and the positioning and sequencing of information in ways that framed or obfuscated its meaning were the most common forms of misinformation identified. These types of misinformation were often mixed with (limited) relevant information and were most often found in combination. We found pregnancy and infant health information for the consumer on five of the seven websites studied (Drinkaware, Ireland; Drinkaware, United Kingdom; DrinkWise; Éduc'alcool; and Aware). Information on pregnancy and fetal alcohol spectrum disorder was found on these five sites, although they did not all provide information on miscarriage, breastfeeding, or fertility. We could not find any pregnancy and infant health information directed to the consumer on the remaining sites (Foundation for Advancing Alcohol Responsibility and International Alliance for Responsible Drinking). Six of the seven websites had a search tool function; these often produced irrelevant information.

Conclusions: Following independent public health analysis of their informational outputs, misinformation about pregnancy and infant health remains present on alcohol industry-funded websites. Warnings to the public to avoid alcohol industry-funded information sources should form an essential part of the global effort to tackle health misinformation.

Background: Multistakeholderism as a norm stating that global public issues should be addressed by all those who affect or are affected by this issue, has become increasingly institutionalised in global governance, including the United Nations (UN) system. Despite an increasing body of evidence showing the risks of corporate capture of multistakeholder governance (MSG) and its related inability to deliver effective public health outcomes, this approach is increasingly common. While research shows that industry actors have pushed for MSG, and others have questioned its legitimacy, how MSG is constructed, legitimised and contested by different actors has not been systematically studied. Analysing responses to World Health Organization (WHO) consultations related to non-communicable diseases (NCDs) and associated risk factors, this study examines how actors construct or contest the legitimacy of MSG to address these public health issues.

Results: Our analysis of 135 responses to 10 consultations revealed significant differences in how actors justified or contested MSG. Proponents of MSG, primarily industry-affiliated organisations, often cited industry expertise and resources as key justifications for a multistakeholder approach, in which they invariably included industry as a key stakeholder. Conversely, non-profit and academic respondents often argued against industry inclusion in MSG, referring to conflicts of interest, corporate capture of the policy process and the associated risks that MSG with industry actors poses to democratic and effective policymaking. While actors commonly invoked the same values (e.g., participation, effectiveness, fairness), they interpreted these differently, to argue for or against the inclusion of industry in MSG.

Conclusion: Our findings underscore the contested nature of MSG, with actors calling on similar values and terminology to support fundamentally opposing positions. The ambiguity of concepts like participation, accountability and conflicts of interest may risk creating an opportunity for private sector interests to promote MSG as an ambiguous governance concept to fit their agenda. Given the normative role of WHO and other UN agencies in shaping what is considered 'good governance', it is essential for the WHO and other UN agencies to critically examine the evidence on multistakeholder approaches before deciding on its appropriateness and use unambiguous terminology when discussing their interpretation of the approach.

Background: Public-private partnerships have the potential to advance solutions to complex dilemmas such as the prevention and control of noncommunicable diseases. Knowledge creation, trust, and social capital among partners - encapsulated in the term "connective tissue" - are key considerations for the cohesion and sustainability of multisectoral collaborative efforts in global health.

Methods: A survey was conducted with 23 stakeholders of projects in four countries supported by Access Accelerated, a collective of biopharmaceutical and life sciences companies. The survey elicited perspectives on the factors that strengthen collaboration and develop knowledge creation, trust, and social capital within the multisectoral partner network.

Results: Survey respondents related how connective tissue was cultivated through implementation of multiple projects with shared goals. Identified barriers to effective collaboration included resource constraints, while facilitators included shared objectives and overlapping activities. Qualitative responses provide deeper understanding of how multisectoral collaboration contributed to the sustainability of the Access Accelerated initiative.

Conclusion: Measurement of connective tissue enhances understanding of project performance by addressing dynamic and previously overlooked outcomes of multisectoral collaboration. Multisectoral health initiatives can incorporate implementation science methods into measurement approaches to strengthen connective tissue among partners and stakeholders.

Clinical trial number: Not applicable.

The Gaza Strip, characterized by its dense population and persistent geopolitical instability, has experienced decades of armed conflict, resulting in systematic healthcare infrastructure deterioration. The healthcare delivery system has been collapsed by Israeli military operations, creating cascading effects that extend beyond regional boundaries. The medical facilities have been targeted, combined with humanitarian aid restrictions, has created unprecedented challenges in providing essential healthcare services to the affected population. The environmental degradation resulting from infrastructure destruction poses additional threats to regional and global health systems. This analysis examines the multifaceted health crisis encompassing healthcare system dysfunction, pharmaceutical supply chain disruption, infectious disease proliferation, and the consequent implications for global health security.

Background: Public health crises are governed not only through policies but also through talk. Government press conferences are ritualized arenas where authorities construct meaning, claim competence, and manage domestic and international legitimacy. China's abrupt transition from "zero‑COVID" to a strategy of coexistence provides a critical case for examining how transnational pressures-from the World Health Organization, diplomatic partners, markets, and global media-shape official communication over time.

Main body: This study analyzes 154 central government press‑conference transcripts (February 2020-February 2023) using a mixed‑methods design that combines topic modeling with qualitative frame analysis and process tracing of international pressure events. We segment the period into four phases-International Scrutiny, Global Cooperation, International Isolation, and Global Alignment-and identify seven recurring frames spanning health‑system capacity, epidemiological standards, vaccine diplomacy, economic-health trade‑offs, supply‑chain interdependence, and policy adaptation. Event‑timing analysis shows a consistent lag of roughly 7-21 days between major international cues and subsequent adjustments in domestic frames, with the economic-health and policy‑adaptation frames most responsive. A micro‑level discourse analysis demonstrates "semantic governance": lexical substitutions ("optimization," "new phase") and contextual recoding that converted a substantive policy reversal into a narrative of adaptive improvement. We argue that authorities achieved discursive alignment with evolving global norms without immediate policy convergence, illustrating how sovereignty sensitivities are managed communicatively. The findings also reveal equity‑relevant mechanisms: semantic smoothing that stabilizes compliance can under‑specify risks for vulnerable groups during transition windows, and generic references to "key populations" can displace time‑bound commitments to protection and access. Building on these insights, we propose two practical tools for global health governance: (1) an equity checkpoint for each policy pivot (plain‑language risk summaries, service guarantees, and a short equity note), and (2) a discursive alignment dashboard that tracks lead-lag to international guidance, domain‑specific alignment, and semantic markers of convergence or divergence.

Conclusions: Pandemic communication in China followed a cyclical frame‑reinforcement pattern rather than a linear arc, and relied on semantic governance to manage rapid policy change under transnational pressure. Recognizing and monitoring these communicative mechanisms can strengthen global health governance and reduce equity risks during future protracted emergencies.

Background: The shortage of nurses poses a growing threat to global healthcare quality, particularly in low- and middle-income countries. Out-flow of nurses from these regions to developed countries exacerbates the global imbalance in nursing resources. However, some nurses decide to return home after gaining experience abroad. Understanding their motivations, challenges, and opportunities can offer valuable insights for China and other nations facing similar challenges.

Methods: Data were collected from October to November 2023, with a mixed-methods research design. Trends and the distribution of returning nurses were visualized. Cox proportional hazards regression and subgroup analyses were used to examine the relationship between associated factors and return rate. Qualitative data, gathered through semi-structure interview, were analyzed using inductive thematic analysis.

Results: 29.69% participants have returned to China, with the cumulative incidence of return was 47.01% (95% CI 37.96%-57.04%) after 13 years, varying by destination. In the multivariable Cox model, factors like age 30-39 (adjusted HR [aHR] = 0.48, 95%CI 0.31-0.74), advanced language proficiency (aHR = 0.30, 95%CI 0.14-0.64), and average annual income abroad of $50,000: $100,000 (aHR = 0.32, 95%CI 0.20-0.52) and over $100,000 (aHR = 0.52, 95%CI = 0.33-0.83) were independently associated with return rates. Interviews with returning nurses revealed three main themes: (1) challenges faced overseas, mainly language barriers; (2) reasons for return, particularly family considerations; and (3) challenges and opportunities after returning, with better chance in private hospitals as a notable subtheme.

Conclusions: This study provides the first comprehensive analysis of Chinese nurses returning from abroad, revealing that nearly 30% returned, mainly due to family considerations. More skilled nurses, with international licenses and higher incomes, tend to stay abroad. Most of these returning nurses secure employment in private hospitals, while reintegration into public hospitals proves challenging. The study indicates the potential to leverage returning nurses' global expertise to enhance China's healthcare system.