Globalization and Health最新文献

The food industry is a very influential actor in public health policies in Colombia. In particular, industry incentives, such as financial donations and other gifts to political parties, can help develop future alliances and initiate an exchange of favors. The objective of this study was to analyze the incentives granted by the food industry to policymakers in Colombia from 2018-2020 and to understand how these incentives could affect public health policy in the country. An analysis of interest groups was carried out via qualitative methods, which was carried out in six stages: i) a documentary review of information and a content analysis of digital social networks; ii) the identification and characterization of actors in the food industry and decision makers; iii) twenty semi-structured interviews with key actors identified in previous stage); iv) characterization of the types and mechanisms through which incentives are provided; v) a mapping of actors; and vi) the reporting of results. Food industry actors, mainly at the national level, were identified as incentive providers to Colombia's government officials in the executive and legislative branches. We identified six types of incentives: financing electoral campaigns, financial donations, in-kind support, gifts, entertainment, and travel. Our analysis shows that the incentives of the food industry in Colombia can help influence the processes of formulation and implementation of food and nutritional public policies.

Background: The proliferation of International Investment Agreements (IIAs), as the result of globalization, has been identified as one of the factors contributing to policy inertia or chill on meaningful public health policy action. Health safeguards, i.e., specific clauses to protect the State's right to regulate, have been increasingly included in IIAs to protect health policy. However, an in-depth understanding of the processes involved in the diffusion of health safeguards in IIAs globally and the factors acting as barriers and facilitators for their uptake is still lacking. In this context, the present study intends to fill this research gap by analysing the uptake of health safeguards in the context of Uruguay, a developing Latin American country. The objectives were to: (i) examine the evolution of the inclusion of health safeguards in the Bilateral Investment Treaties (BITs) signed by Uruguay until 2024, (ii) analyse how Uruguay has approached BITs after the Philip Morris ISDS case, (iii) explore Uruguayan stakeholders' perspectives on the inclusion of health safeguards in BITs, (iv) identify barriers and facilitators for the uptake of health safeguards in the BITs.

Results: Documentary analysis of the BITs signed by Uruguay showed an ascending trend in the inclusion of health safeguards, reaching 100% since 2010. Interviews with key stakeholders suggested that health safeguards diffused from abroad through transnational transfer networks. While Uruguay has not faced challenges in including health safeguards in recent BITs, the renegotiation of old generation BIT agreements with developed countries has proven to be difficult. A wide range of factors that act as facilitators and barriers for the inclusion for health safeguards in the BITs were identified, which were related to both the national and intergovernmental levels.

Conclusions: Results contribute to the understanding of the factors that influence the evolution of the interface between investment agreements and public health policy by analysing the adoption of health safeguards in BITs. Strong recommendations from international organizations to renegotiate old generation BITs may contribute to overcoming the existing power dynamics and support developing countries in the protection of their regulatory space.

Background: Injuries represent a major threat to child health globally. In the US, firearm injuries are the leading cause of death among children and adolescents. Despite limited evidence of their effectiveness industry-funded bodies promote the delivery of their youth education programs while lobbying against firearm control policies. This article analyzes how the National Rifle Association (NRA) frames issues of gun ownership, safety and the role of the Eddie Eagle GunSafe^® program as an effective firearm safety intervention and examines how the design, promotion and delivery of the program serves the corporate political interests of the firearm industry at the expense of public health.

Methods: We conducted an analysis of Eddie Eagle Gunsafe^® program-related materials and the NRA's practices to promote the program's legitimacy and effectiveness, by applying published taxonomies of corporate framing and action strategies. Data were collected from the program-specific websites and other NRA outlets to capture the breadth of strategies used by the NRA.

Results: The NRA's education-related practices support the firearm industry's political agenda. The NRA adopts framing and action strategies that present the presence of firearms in homes and communities as inevitable and normal, and the education of children through the delivery of their "lifesaving" program as the common-sense and effective way of keeping children safe from firearm injuries. They make misleading claims about the effectiveness of the Eddie Eagle Gunsafe^® program while undermining the credibility of those who advocate for child safety, including mothers and public health actors.

Conclusion: The delivery of the Eddie Eagle GunSafe^® program needs critical scrutiny as is increasingly applied to other industry-funded initiatives. Policies based on a recognition that children and adolescents are safest when their homes and communities are free of firearms are needed. Findings from this analysis are relevant beyond the US and can be used to inform the governance of child safety and injury prevention globally. Analysis of the firearm industry extends the literature on the commercial determinants of health to an important new sector with significant impacts on global health.

Background: Transition in care involves the transfer of responsibility for aspects of patient and public health care among providers, institutions, and health and social sectors. Indeed, health systems increasingly require individuals to interact with a number of providers, in a number of health settings, and across multiple points of time. Refugees, immigrants, and migrant (RIM) individuals face several precarious transitions, language and cultural barriers, and unfamiliarity with public health systems, which may result in health inequities. A greater understanding of the interventions that facilitate effective transitions in care for RIM populations is needed to improve health outcomes in this vulnerable group.

Methods: This health equity-oriented scoping review aimed to report the characteristics of Transition in Care (TiC) interventions for RIM populations and identify which equity-relevant characteristics of RIM populations were targeted by these interventions. We searched MEDLINE, Embase, and Scopus for eligible studies published in English from the year 2000 onward. Two independent reviewers screened search records and extracted relevant data from included studies. We used a public health and health equity lens to identify the social determinants of health that were addressed by TiC interventions.

Results: Our systematic search identified a total of 42 studies, evaluating the impact of 38 unique interventions or public health programs. The delivery of interventions involved various healthcare sectors and professionals. Additionally, some programs enlisted non-medical personnel to provide health-related education and support. The most promising programs for health outcomes involved health navigation or providing public health education for RIM populations. The most common equity-relevant characteristics considered in these studies were language, cultural background, and education level.

Conclusion: This novel scoping review reveals a diverse range of public health interventions that are being implemented to improve national and international transitions in care for RIM populations, with the most promising from healthcare navigation and health education. Future research should target transitions to digital health technologies, public health, hospital-to-home, and pediatric to adult care gaps to ensure smoother transitions in care for equity-deserving populations navigating new healthcare systems.

The global transition to renewable energy is increasing the demand for critical minerals mining in Africa. Without appropriate safeguards, expansion of mining operations on the continent increases the risk of mining-associated infectious disease outbreaks with epidemic and pandemic potential.

The Gates Foundation is the most influential private philanthropic foundation in global health and development. This article examines how the Foundation has developed an unparalleled capacity to rally other donors to its priorities, which include the development and distribution of technological tools to reduce the burden of infectious disease and child mortality in the world's most impoverished regions. Using publicly available data, the article analyses the Gates Foundation's strategic engagement in Europe, focusing on its bureaucratic presence, government relations, and grant-making in its three European focus countries: the United Kingdom (UK), Germany and France. It highlights that, since 2010, the Gates Foundation has built a bureaucratic infrastructure akin to a diplomatic service, establishing country offices in London and Berlin alongside representation in Paris, Brussels and Stockholm. Through regular engagement with elected officials and bureaucrats in these nations, the Foundation has forged many strategic partnerships, effectively leveraging European states' diplomatic power in wider political forums and alliances. Moreover, the Foundation has disbursed billions in grants to recipients in the UK, Germany, and France to advance research and innovation on its priority health issues, implement programs in poor countries, and develop policy and advocacy related to global health and development. Combined, these efforts have contributed to securing substantial and recurrent government co-investment in Gates-supported initiatives. The article proposes that the Foundation exercises a form of 'network diplomacy' that entails building and maintaining wide networks across European societies with the aim of aligning donor governments' overseas development assistance and policies with the Foundation's strategic objectives in global health and development. The concept of network diplomacy offers a new perspective on how the Gates Foundation has consolidated and expanded its transnational political presence through an approach that is strategic, bureaucratised and institutionalised, rather than simply a product of its financial might. The findings amplify existing concerns regarding the sway of private foundations over public policy, their impact on democratic accountability and governance in donor states, and the resultant implications for the Foundation's intended beneficiaries in low- and middle-income countries.

Background: Alcohol is a global health issue with a high level of controversy. After being absent from World Health Organization (WHO) global governing body discussions for about 20 years, alcohol re-entered the agenda in 2005. The expression 'harmful use of alcohol' became the compromise language after hard negotiations, an example of 'adopted language" that has remained for almost 20 years. This article analyses the background and use of the expression 'harmful use of alcohol' in the context of WHO governing bodies, current challenges and implications for public health.

Methods: The article is based on textual analysis of source documents from the time periods 2004-2010 and 2019-2022 and the authors' experience from involvement in the global alcohol policy scene for more than 20 years: WHO governing body records and other documents were analysed, as well as Member State and Non-State Actors' positions and contributions in consultations and statements in WHO governing body debates.

Results: The introduction of the concept 'harmful use of alcohol' in WHO documents from 2005 onwards was a political compromise between approaches focussed either on 'alcohol abuse' or a wider concept of harm from alcohol consumption. It has permeated into national alcohol policy documents, academic literature about alcohol harm and UN documents, and been embraced by the alcohol industry. However, it has not prevented and some would argue that it has enabled development of normative statements from WHO that include recommendations for population wide interventions. The relatively new evidence of harm from alcohol at low levels and questioning of evidence suggesting a beneficial effect of moderate use of alcohol together with industry appropriation of 'harmful use' have led to increasing critique of the framing implied by 'harmful use of alcohol'.

Conclusions: The language used in WHO documents holds political power in that it may influence the subsequent course of events. This is accentuated by the normative role of WHO in global health policy and the uptake of negotiated language beyond WHO documents. In the next five years it will be possible and valuable to examine in more detail the extent to which this power was made manifest and the need and possible ways to effect change.

Background: Inattention to young child growth and development in a transitioning global environment can undermine the foundation of human capital and future progress. Diets that provide adequate energy and nutrients are critical for children's physical and cognitive development from 6 to 23.9 months of age and beyond. Still, over 70% of young children do not receive foods with sufficient nutrition particularly in low-and-middle income countries. Program evaluations have documented the effectiveness of large-scale behavior change interventions to improve children's diets, but the budgetary implications of programs are not known. This paper provides the incremental financial costs of strengthening three large-scale programs based on expenditure records from Bangladesh, Ethiopia, and Vietnam.

Results: The programs reached between one and 2.5 million mothers and children annually per country at unit costs of between $0.9 to $1.6 per mother and child reached. An additional 0.7 to 1.6 million people who were influential in supporting mothers and achieving scale were also engaged. The largest cost component was counselling of mothers. Rigorous external impact evaluations showed that over 434,500 children benefited annually from consuming a minimum acceptable diet in all countries combined, at an annual cost per country of $6.3 to $34.7 per child benefited.

Conclusions: Large scale programs to improve young children's nutrition can be affordable for low- and middle-income countries. The study provides the incremental costs of selectively strengthening key program components in diverse settings with lessons for future budgeting. The costs of treating a malnourished child are several-fold higher than prevention through improved improving young children's dietary practices. Differences across countries in program models, coverage, costs, and outcomes suggest that countries need a minimum investment of resources for strengthening high-reach service delivery and communication channels and engaging relevant behavioral levers and community support for mothers to achieve impact at scale.

Background: How do Northern Global Health scholars navigate authoritarian political contexts in their research in other countries? This question motivated the research project on which this article is based. Over ten months, we conducted in-depth qualitative interviews with sixteen European and North American scholars who were engaged in health-related research in an authoritarian country we refer to as Patria.

Results: All our interviewees recognized health as a political matter and acknowledged the importance of considering politics in Global Health research. Yet, they were reluctant to explicitly integrate politically sensitive topics and discuss questions related to local political context in their research. To gain and maintain access, and to protect themselves and their local collaborators in a politically sensitive and authoritarian context, the researchers employed practices of 'framing'. Such strategies included avoiding terms, scholarly references, and questions that were politically loaded; strategically conforming to the assumed apolitical language and methodologies of health research, and negotiating with and leaning on their local counterparts in processes of research dissemination and writing.

Conclusion: Drawing on frame theory and literature on fieldwork and authoritarianism we discuss the implications our findings have, not only for Global Health research, but for healthcare sciences more broadly. While researchers who work in authoritarian regimes may be particularly prone to engage in practices of framing, the strategies our interviewees used are not limited to Global Health researchers working in such settings. As anthropologists with experience researching health in multiple countries, including in the United States, we recognize the strategies that our interlocutors used from our own research. By including a discussion of some of the ways political factors have shaped our research we make an argument for the value of political reflexivity in health research: the critical scrutiny of the taken-for-granted presuppositions and norms that guide our research, and of the political environments and power dynamics that shape and are shaped by our research. A turn to political reflexivity in health research can unravel some of the tacit assumptions, biases, norms and practices that are integral to the health care sciences and which students and researchers must critically think about.