Globalization and Health最新文献

Background: Migration is a growing global phenomenon and a recognized social determinant of health, contributing to significant health inequities between migrant and host populations. Iran, hosting an estimated 4.5 million migrants-including undocumented individuals-faces persistent challenges in ensuring equitable access to healthcare. This study identifies strategies to inform context-specific interventions within Iran's health system to improve migrant health.

Methods: We conducted a realist review, searching PubMed, Science Direct, Scopus, Web of Science, Google Scholar, and grey literature from 2010 to 2024. Using the Intervention-Context-Mechanism-Outcome (ICMO) framework, we analyzed 67 studies to identify effective strategies for enhancing migrant health in Iran. Ritchie and Spencer's five-stage framework method was applied to analyse the data.

Results: Twenty-seven strategies were identified. Mechanisms underpinning successful interventions included trust-building through intersectoral governance, reduction of financial barriers via inclusive insurance schemes, increased accessibility through cultural competency training, and improved service reach using digital health and community-based outreach. Iran-specific implications included the potential for piloting migrant-inclusive insurance for vulnerable groups and expanding culturally tailored services through community health workers.

Conclusion: Contextual adaptation of global strategies can address systemic barriers and improve health equity for migrants in Iran. The findings offer evidence-based, actionable insights for policymakers seeking to localize global best practices within Iran's healthcare infrastructure.

Background: This study examines the impact of Artificial Intelligence (AI) on maternal mortality in alignment with Sustainable Development Goal (SDG) 3.1, which aims to reduce maternal mortality to below 70 per 100,000 live births by 2030. Despite advancements, maternal mortality remains disproportionately high in developing countries due to weaker healthcare infrastructure.

Methods: Using panel data from 70 countries (1990-2022), sourced from WHO's Global Burden of Disease (GBD), World Bank's World Development Indicators (WDI), UNCTAD, and the World Robotics database, we apply the Difference-in-Differences (DiD) approach to assess AI's impact over time and the Auto-Regressive Distributed Lag (ARDL) model to examine short- and long-term effects.

Results: AI adoption significantly reduces maternal mortality, particularly in developing countries, where post-2000 advancements have led to notable declines. ARDL results show that 27% of deviations from long-term maternal mortality trends are corrected annually, highlighting AI's sustained impact. The DiD analysis indicates AI's greatest benefits in resource-limited settings, including improving early diagnostics, personalized care, and remote monitoring. In developed countries, AI's effects are marginal due to existing advanced healthcare systems.

Conclusion: AI presents a transformative solution for reducing maternal mortality, particularly in low-resource settings. Policymakers should prioritize AI-driven healthcare, expand digital infrastructure, and ensure equitable access to maximize its benefits. AI integration is crucial for addressing maternal health disparities and accelerating progress toward SDG 3.1.

Background: Imported malaria cases from endemic regions pose significant challenges for malaria-free countries, leading to diagnostic delays, high treatment costs, and the potential for secondary local transmissions. There is a lack of understanding regarding the cognitive decision-making processes that influence travelers' intentions to engage in protective behaviors against malaria. This study aims to fill this gap by examining the factors that impact the willingness of travelers from China to adopt protective measures against malaria.

Methods: In a cross-sectional study conducted between March and October 2023, we utilized an online survey based on the malaria knowledge and Protection Motivation Theory (PMT) scales in Nanjing and Suzhou of Jiangsu Province, China. The survey was distributed by staff from the Centers for Disease Control and Prevention to Chinese international travelers after their returning from abroad. We analyzed the intentions to engage in malaria protective behaviors by multiple linear regression and structural equation modeling.

Results: In total, 252 international travelers from Jiangsu Province provided valid responses. Approximately 127 (50.4%) reported that their destination was a malaria-endemic area when they had traveled abroad. All seven PMT subconstructs were significantly affected by the malaria knowledge (all P < 0.05). Of all seven PMT subconstructs, two (severity and vulnerability) were strongly associated with intentions to engage in protective behavior. Notably, the level of malaria knowledge was insufficient for motivating protective behavior intention.

Conclusions: The intention to engage in antimalarial behaviors is closely linked to travelers' evaluation of malaria-related risks and their perceived ability to manage these threats. It is essential to enhance general knowledge on the risk of malaria and to provide robust pre- and post-travel healthcare for international travelers heading to malaria-endemic regions. This approach will empower travelers to adopt protective measures and reduce the incidence of imported malaria cases.

Background: Despite increased scholarly attention to sexual violence, victimization among migrant men and boys remains under researched. This study aims to explore 1) migrant men's views on and understandings of sexual victimization, 2) their own experiences with surviving and witnessing sexual violence during their past and ongoing migration journeys and 3) the consequences of such victimization and their coping behaviors.

Results: Participant observation in Brussels (Belgium) and Calais (France) preceded in-depth interviews with 39 migrant men between 16 and 47. Participants varied in age, nationality, educational level and aspired migration projects yet all of them were undocumented. They held varying, yet consistently gendered understandings of sexual violence, depicting women as victims and men as perpetrators. Although they did not explicitly label their own experiences as sexual violence, both direct and indirect forms of it were part of their past and ongoing migration trajectories. Sexual violence had a profound impact on men, inducing shame and challenging their masculine identity. Coping and prevention strategies ranged from normalizing or minimizing the violence and avoidantly forgetting, to protecting one another against future threats.

Conclusions: The results advocate for safe legal migration routes, increased awareness of migrant men's vulnerabilities to sexual violence, and enhanced training and screening of professionals and volunteers working in the field.

Background: Contemporary conditions require detailed study of internationalisation. This article offers a novel perspective on processes of internationalisation in healthcare, adapting an approach from higher education studies and enhancing it with insights from sociological scholarship on moral economies. The article asks how institutions and individuals respond to the globalising healthcare environment, and what this reveals about normative questions that govern healthcare provisioning in national contexts. This is pursued using qualitative data from a study on international commercial services in the English National Health Service (NHS).

Results: The findings of the research demonstrate how the UK government has sought to build political consensus around specific (commodified) forms of internationalisation in a context of fiscal austerity and xenophobia surrounding the provision of public services. The English NHS has been politically re-imagined as world-leading and of interest as an export industry. Study findings show this stance is premised normatively on processes of subsidy between two apparently distinct spheres - from international (private) to national (public) - but that in practice the distinction is hazy and subsidy at times indirect, routed to individual staff members or to commercial teams. The ascendancy of this as a prevailing, politically legitimate form of internationalisation for the English NHS contrasts sharply with non-commodified alternatives decried as 'health tourism'.

Conclusions: The internationalisation framework presented in this article offers a platform for future research that can shed light on the contexts, visions, policies and contestations the emerge as healthcare institutions respond to processes of globalisation. It will be important to avoid uncritical approaches to research and policy by examining not just what forms of internationalisation find favour, and their basis in geographical and racialised hierarchies, but also how approaches to healthcare internationalisation impact inequalities within and between nations.

Background: Artificial intelligence (AI) will have a lasting and drastic impact on medical research and healthcare. In addition to the benefits, the associated risks are also the subject of controversial debate and there are fears of serious consequences. There is an urgent need for action, which must be underpinned by scientific information.

Methods: By analyzing temporal and geographic patterns, including national readiness for access to AI, we therefore identified incentives and barriers to global research under socioeconomic conditions.

Results: The explosive increase in annual publications started in 2017. The main players in AI_med research were the USA, China, the UK, Germany, and South Korea. There was a significant correlation between the publication output on AI in medicine (AI_med) and the metrics for economy and innovation. Additionally, citation patterns show the disadvantage of the Global South compared to the North American and European countries. In several weaker economies: Jordan, Pakistan, Egypt, Bangladesh, and Ethiopia, a more positive position was found in relation to the number of articles suggesting a better ranking in AI_med research in the future.

Conclusion: The results show the need for advanced global networking to ensure all relevant aspects for equitable development and the beneficial use of AI_med without promoting racial or regional inequities and to enforce this not only in the AI systems of economically strong countries but also for the participation of economically weaker countries.

Background: Building on the success of tobacco health warning labels, EU Member States and institutions are increasingly considering similar requirements for alcohol products. While industry responses to pricing and availability policies have been widely studied, their framing of Alcohol Health Warning Labels (AHWLs) as a policy solution remains comparatively underexplored. This paper examines how alcohol industry stakeholders responded to the EU notification process for Ireland's proposed alcohol labelling regulations, introduced under Ireland's Public Health (Alcohol) Act 2018.

Methods: This paper analyses 16 submissions from alcohol industry actors to the European Commission regarding Ireland's proposed alcohol warning label regulations. Qualitative methods, specifically thematic analysis, were used to examine industry arguments. The research team first reviewed five submissions to inductively develop a codebook, which was then applied to the remaining submissions, with new codes added as necessary. Two team members independently coded each submission, and thematic content was refined through team discussion.

Results: Alcohol industry arguments against AHWLs fall into four main themes: lack of evidence supporting the content of health warning labels and their broader use, negative trade and economic impacts of AHWLs, potential risks to EU governance posed by Ireland's labels, and the industry's self-positioning as responsible actors committed to public health. In addition, we identify novel industry strategies related to the intricacies of AHWLs, including a heightened focus on wording and language, coordination of activities across multiple governance levels, and tailored framing to suit the institutional context.

Conclusions: Alcohol industry actors employ arguments similar to those seen in other policy debates, which continue to pose a significant barrier to evidence-based alcohol policymaking. The analysis suggests that industry actors can strategically adapt their arguments to varying institutional settings and policy instruments, demonstrating their political dexterity and reinforcing the barriers to policy progress. These findings highlight the need for further research into the alcohol industry's influence and provide insights for jurisdictions considering labelling legislation.

Digital activism around Long Covid has reverberated around the globe, as patients, researchers, and clinicians worked together to understand the chronic condition. However, Long Covid networks, much like other social networks, have hierarchies and barriers that can impede equitable access. In this article, we examine how the global digital center and periphery shape how people with Long Covid connect to networks to learn about their illness symptoms, diagnoses, treatments, and experiences. We introduce case narratives of two Kenyan women-one elite Nairobian who was connected to the digital center and another middle class woman who connected with her through a peripheral digital community-to describe how elite patients were engaged at the digital center, and non-elite patients were engaged in the periphery with digital and non-digital connections through which they cultivated other social networks to communicate, share, and experience their illness experiences. The Kenyan case study introduces a context where people have sophisticated digital lives and are engaged in global information networks. Yet, we argue that some Long Covid patients' experiences are impossible to divorce from the digital activism that has drawn together a remarkable global patient community, causing a ripple effect on how people define and experience the self and illness throughout the world. We conclude that many Kenyans may be engaging with digital networks differently and from different places of geographic, cultural, linguistic, and technological power, possibly cultivating divergent idioms, interpretations, and experiences of the post-viral condition. This demonstrates not only how social networks function at the digital periphery but also the complexities situated within the periphery itself, which is at important social nodes, connected to the digital center.