Globalization and Health最新文献

Background: Latin America is distinguished by diverse regulatory frameworks and evolving dietary patterns, including the weakening of traditional diets and the increasing consumption of ultra-processed foods (UPFs). Predominantly produced by transnational corporations, UPFs rely heavily on food additives to achieve desirable sensory properties (e.g., flavor, color), ensure food safety, and extend shelf life. ​Over the past decade, research has increasingly shown that higher consumption of UPFs is associated with poor health outcomes, and food additives have emerged as a potential mechanism underlying this association. However, few studies have systematically analyzed the presence of food additives in the food supply. This study aimed to assess the distribution and patterns of food additives in packaged foods from five Latin American countries.

Methods: Data were obtained from packaged foods and beverages sold in supermarkets in Brazil (2017; n = 9,673), Mexico (2017; n = 15,846), Chile (2018; n = 13,913), Colombia (2018; n = 8,282), and Ecuador (2019; n = 2,083). We used the list of ingredients to search for food additives described in the Codex Alimentarius. We assessed the prevalence of specific food additives, categorized their functional classes, and applied exploratory factor analysis to identify patterns of food additive use, overall and in each country.

Results: Food additives were present in over 75% of the studied products, ranging from 76.1% in Colombia to 84.0% in Ecuador. Food categories with the highest prevalence of additives (> 90%) included confectionery, dairy products, bakery items, and meat products. Most products contained two or more additives (64.3%); nearly 10% contained ten or more. We observed consistent results on the most used additives (i.e., flavorings, citric acid, phosphates, and lecithin) and patterns of food additives used across countries, although differences were observed in the use of specific additives, particularly low-calorie sweeteners and colorings.

Conclusion: Food additives are widely used in the packaged food supply of Latin American countries, and variations in the use of specific food additives likely reflect differences in regulatory frameworks, industry practices, and consumer preferences across countries. Given the increasing concern about the potential health effects of food additives, there is an urgent need to strengthen monitoring efforts and further investigate population-level exposures and associated health outcomes.

Background: The fast-food industry has transformed substantially in recent decades - from diverse, locally rooted providers into a globalised, and increasingly corporate-led industry. Corporate fast-food retailers (FFRs) represent a key retail channel through which both ultra-processed foods and intensively produced animal source foods are consumed and normalised within corporate-industrial food systems. These dietary patterns are strongly associated with increased risks of diet-related diseases and contribute significantly to environmental degradation, including greenhouse gas emissions, land use change, and biodiversity loss. Despite the growing significance of FFRs, there has been limited analysis of their financial strategies and implications for global food system transformation.

Results: We conducted a global analysis of market data from 54 countries and financial data of publicly listed FFRs, examining trends in FFR sales (2009-2023), market dominance, and the financial performance of leading publicly listed firms (1980-2023). We found that while sales in high-income countries were stagnating, leading firms maintained stable net profit margins and delivered relatively high shareholder returns, facilitated by financial strategies such as franchising and private equity ownership. U.S.-based corporations dominated the global market, with substantial expansion into countries outside the global North. These trends reflect the consolidation of power within the corporate food regime.

Conclusions: The global expansion of corporate FFRs underscore their growing influence over diets and food systems, with critical implications for public health, ecological sustainability, and social justice. Policies targeting structural leverage points, for example, democratising corporate governance, reducing the influence of private equity, and re-orienting agri-food subsidies, are essential to countering the entrenchment of this model and supporting more democratic and sustainable food systems.

Clinical trial number: Not applicable.

Background: Corporate Social Responsibility (CSR) initiatives are part of a suite of marketing and promotional strategies used by industries whose products and/or practices may be harmful to health and equity. These include the tobacco, alcohol, gambling, fossil fuel and pharmaceutical industries. CSR initiatives have included support for gender equity and empowerment initiatives, such as associations with women's organisations and charities, educational activities, and sports. Limited research has qualitatively investigated women's perceptions of these types of gendered CSR initiatives, including their opinions about appropriate public health and policy responses.

Methods: This study sought the opinions of n=506 Australian women, aged 18 years and over. Data was collected through an online qualitative survey. Participants were asked about the CSR strategies of a range of harmful industries, including gendered marketing, sponsorship of women's sport, and support for women's causes. Data were interpreted using a reflexive approach to thematic analysis.

Results: Three themes were constructed from the data. First, while participants acknowledged that CSR was a profit-making tactic used to enhance the image of harmful industries and mitigate reputational risk, they also thought there could be benefits associated with some CSR strategies - particularly related to women's sport. Second, while many women perceived that CSR strategies could positively influence women's views about harmful industries, others felt women needed to take responsibility for engaging with messages from these industries. Finally, while participants supported increased government regulation of harmful industry promotional tactics, they also recommended educational initiatives to expose industry tactics, and increased responsibility from organisations partnering or taking funding from these industries.

Conclusions: The insights from this study contribute to the growing evidence about the influence of the corporate tactics of industries who are harmful to women's health and equity. While mapping and monitoring of marketing tactics are essential in public health arguments for regulatory reform of these practices, this study shows the important role that community opinions play in understanding the impact of these tactics, and public expectations of policy and public health actions to prevent harms. There is broad support for increased government regulation, and independent education initiatives focused on exposing industry tactics.

Clinical trial number: Not applicable.

Background: Chronic underfunding of pandemic preparedness remains a critical weakness in global health security. Without sustained, strategic investment, the world risks repeating the reactive approaches of past crises. This study examines the modes of COVID-19 aid delivered by the Chinese government across African countries and regions, offering a nuanced understanding of China's operational role in pandemic response. In doing so, it contributes to the global health assistance literature by providing a more comprehensive view of China's involvement in the prevention, treatment, and control of COVID-19.

Results: Analysis of 727 Chinese health-related project commitments to African countries indicates that the majority targeted the provision of personal protective equipment (43.33%), followed by diagnostic and medical equipment (26%), and vaccination initiatives (17.88%). Regionally, Southern Africa received the highest average number of projects per country, while Northern Africa received the lowest. At the national level, South Africa (5.09%), Zimbabwe (4.00%), and Cameroon (3.85%) accounted for the largest shares of total projects, whereas Eritrea (0.001%), Cabo Verde (0.004%), and Somalia (0.004%) received the smallest proportions.

Conclusions: This research reveals the growing significance of Chinese aid in the global health agenda through its active role in combating COVID-19 across the African continent. It also highlights emerging trends and suggests potential adjustments needed in pandemic financing strategies for more effective future efforts.

Background: Brazil faces challenges in ensuring equitable access to prescription drugs for its population. Socioeconomic disparities contribute to health inequalities, impacting access to health care services, including medicines. Brazil's Unified Health System aims to provide universal health care coverage, but only 30·5% of people obtain all of their prescribed medications through public channels free of charge. The objective is to characterize the Brazilian pharmaceutical market to better understand the underlying factors affecting medicine accessibility.

Methods: We conducted a literature review to assess the current state of the pharmaceutical market and prescription drug access in Brazil.

Findings: The Brazilian pharmaceutical market is extensive but highly concentrated, characterized by low investment in original research and development (R&D) and a heavy reliance on imported active pharmaceutical ingredients. Challenges include vulnerability to economic and external factors. Additionally, high medicine prices, prioritization of production of expensive new medicines over those for prevalent diseases, and shortages contribute to inequalities in access. Regulatory issues, underfunding of health care, and legal discrepancies exacerbate these challenges but also present opportunities for reform.

Interpretation: The policymakers should prioritize enhancing R&D investment, reducing dependency on international markets, strengthening regulatory frameworks, and improving health care system efficiency to ensure reliable access to essential medicines.

Background: Despite strong evidence supporting breastfeeding's benefits for maternal and child health, breastfeeding rates (e.g. any breastfeeding, exclusive breastfeeding for the first six months etc.) in China are still suboptimal. The pervasive marketing of breast-milk substitutes (BMS) plays a significant role. Yet research on BMS marketing-especially in China-is scarce, and a clear characterization of the channels and underlying themes through which pregnant women and new mothers encounter such advertising is critical for informing effective regulation of BMS promotions, advancing breastfeeding practices and ultimately improving maternal and child health.

Methods: A marketing diary approach was employed in a one-week pilot study involving 20 participants in Beijing and Jinan, China. Each participant was required to document all BMS marketing-related messages encountered-capturing screenshots or photos and annotating channel and thematic content. Quantitative exposure proportions by channel were calculated, and qualitative data underwent thematic content analysis by two independent coders. This study aimed to preliminarily map the online marketing ecology of BMS and to compare these findings against existing regulatory frameworks, thereby informing actionable recommendations to strengthen monitoring of compliance of BMS marketing.

Results: A total of 234 BMS marketing records were documented, 90.2% of which occurred via digital platforms. Among online channels, social media (45.3%), e-commerce websites (15.4%), video streaming platforms (15.0%) and general web browsing (14.5%) predominated; offline channels accounted for the remaining 9.8%. Four principal promotional strategies were identified-competitive promotions, nutritional claims, corporate identity building and word-of-mouth endorsements. Eight thematic categories emerged, led by nutrition claims, sales promotions and infant health benefits. Several participants critically appraised ambiguous or scientifically unsubstantiated assertions.

Conclusions: Chinese pregnant women and mothers of infants aged 0-18 months encounter frequent, multifaceted BMS marketing (activities, or strategies, or tactics) predominantly through digital channels. China's current regulatory framework governs food labelling but affords limited monitoring of BMS advertising across all channels-particularly digital platforms-underscoring the need for comprehensive regulation that explicitly includes online marketing tactics. A multisectoral strategy-combining policy reform, targeted health education and rigorous enforcement of the International Code of Marketing of Breast-milk Substitutes (the International Code)-is required to protect and promote breastfeeding.

In sub-Saharan Africa, public hospitals should play a key role in providing quality, affordable health care and contribute to robust health systems, particularly in war-torn contexts. In Mali, a multidimensional crisis has had a severe impact on the health of the people and on the overall health infrastructure and its capacity to respond to the crisis. Public hospitals suffer from multiple long-standing constraints that are rendered even more acute in the context of war. This paper presents governmental, development, and humanitarian efforts and interventions aimed at strengthening hospital infrastructure in Mopti, central Mali. Three key dimensions of hospital infrastructure are fundamental to ongoing operations: human resources, governance, and equipment/maintenance. The results revealed two approaches to strengthening hospital infrastructure: a developmental approach, aimed at constructing new buildings and implementing hospital autonomy-oriented reforms, and a pragmatic approach that focuses more on concrete solutions to the most urgent needs. The insights presented here argue for stronger linkages between these two approaches to reinforce the everyday functionality of health care infrastructures in destabilized contexts.

Professional health associations increasingly serve as vital transnational actors in responding to global public health emergencies and shaping health system resilience. Their cross-border collaboration becomes especially critical in conflict-affected settings, where local infrastructure is overwhelmed, and international expertise, advocacy, and solidarity can bridge urgent gaps. In Ukraine, the intersection of war, health system disruption, and infectious disease threats has underscored the role of organizations such as the All-Ukrainian Association of Public Health Specialists (UPHA), the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), the American Society for Microbiology (ASM), and the American Public Health Association (APHA). These associations contribute technical assistance, policy guidance, and emergency response and cultivate a shared professional culture and knowledge base that transcends national borders. While the role of professional health associations in routine healthcare delivery and advocacy has been previously explored in the literature, few publications have addressed their mobilization during acute crises-particularly in lower-resource or conflict settings. This comment responds to that gap by examining how professional associations act as platforms for coordinated response, capacity building, and health diplomacy during complex emergencies, with a specific focus on addressing infectious diseases in Ukraine. It draws on desk reviews, organizational reports, and authors' insights to inform how these associations support infection prevention, biosafety, antimicrobial resistance surveillance, and the development of a resilient public health workforce-issues of global relevance that demand collaborative solutions.

Background: TB, HIV, and AMR are closely related global health challenges. In the context of limited global health funds and insufficient resources, an integrated tuberculosis, HIV and antimicrobial resistance prevention and control method will play an important role in the optimization of resources and cost-effectiveness.

Objective: This study aims to analyze the degree of policy integration for issues of tuberculosis, HIV and antimicrobial resistance in global health strategies and make recommendations for improving global health governance on related issues.

Methods: We conducted a thorough analysis of global health policy documents from January 2015 to February 2024, using both quantitative and qualitative approaches. Our focus was on assessing the integration effectiveness of current global health governance mechanisms in addressing tuberculosis, HIV, and antimicrobial resistance from the global governance view based on the content analysis through word frequency analysis and thematic framework analysis. Besides, we conduct a thematic framework analysis of the action plans and policy recommendations outlined in the most recent reports from UNAIDS, Stop TB, and UNEP on HIV, TB and AMR.

Results: The analysis revealed that most documents address TB, HIV, and AMR in isolation, with limited integration and intersectionality. TB and HIV are more frequently linked, while AMR is less associated with the other two. The proposed action lacks specific provisions for joint implementation or monitoring of the evaluation. Additionally, no documented comprehensive overview includes the overall framework of three health priorities.

Conclusions: The study found that the current global health governance mechanism is significantly inadequate in dealing with integration solutions among tuberculosis, HIV and antimicrobial resistance. So we propose establishing integrated governance and coordination mechanisms for the same population at both horizontal and vertical levels, including individual, interpersonal, community, institutional, and societal levels, and developing an integrated policy framework to facilitate better resolution to address the association between TB, HIV infection and antimicrobial resistance in a resource-limited context.

Clinical trial number: Not applicable.