Globalization and Health最新文献

Background: Following three years of complex negotiations, the Intergovernmental Negotiating Body announced consensus among Member States on 16 April 2025, leading to the adoption of the Pandemic Accord at the Seventy-Eighth World Health Assembly on 19 May 2025. The accord aims to address the systemic inequities and failures exposed by the COVID-19 pandemic by enhancing early detection and rapid response capacities, promoting equitable access to pandemic-related health products, and ensuring sustainable financing for pandemic activities. This commentary highlights why the accord is of critical importance to Africa and describes the strategic options for its effective implementation on the continent.

Main text: Africa, with its unique pandemic vulnerabilities and weaknesses in global health security capacities, stands to gain the most from the Pandemic Accord. The continent faces challenges such as high-threat pathogens, weak health systems, political instability, and limited domestic financing. Additionally, Africa's low capacity to influence global negotiations and fragmented public health governance complicates the implementation of global health agreements. To overcome these challenges, eleven priority recommendations are proposed, including joint analysis and domestication of the accord's provisions, strong political commitment, better alignment of regional and global health security initiatives and public health organizations, leveraging digital technologies, prioritizing local manufacturing, and community engagement.

Conclusion: We urge African stakeholders to collaborate in ensuring the transformation of the accord from a global commitment into meaningful pandemic prevention and control action for the continent.

Background: The right to health for all individuals, including refugees, is recognized as one of the most fundamental human rights. However, refugees continue to face numerous barriers in accessing healthcare services. Iran has not yet achieved full coverage despite implementing a health insurance scheme for refugees. Therefore, this study aims to identify the contextual factors influencing the basic universal health insurance program for Afghan refugees in Iran using the PESTEL framework.

Methods: This qualitative study was conducted between October 2024 and March 2025. Data were collected through semi-structured interviews with 22 key individuals, including managers and experts from the Health Insurance Organization, the Bureau for Aliens and Foreign Immigrants Affairs (BAFIA), the United Nations High Commissioner for Refugees (UNHCR), refugee researchers, educated Afghan refugees, and healthcare service providers. Participants were selected through purposive sampling. Data analysis was conducted using framework analysis based on the PESTEL framework. MAXQDA 20 software was used to assist with data management and analysis.

Results: The contextual determinants of the universal public health insurance policy for Afghan refugees in Iran were 61 factors that were categorized into six main themes and 17 sub-themes. The main themes identified in this study included political (four factors), economic (five factors), legal and regulatory (two factors), sociocultural (four factors), technological (one factor), and environmental factors (one factor).

Conclusion: Findings from this study, based on the PESTEL framework, revealed that the refugee health insurance policy in Iran is influenced by a range of political, economic, social, technological, legal, and environmental factors. To improve insurance coverage among refugees, policymakers-particularly senior health system managers-can create an enabling environment for equitable and sustainable access to healthcare services by strengthening information infrastructures, reforming financial and legal mechanisms, and enhancing intersectoral and international collaboration.

Clinical trial number: Not applicable.

Beginning in 1996, Purdue Pharmaceuticals (Purdue) knowingly mislabeled and mass marketed OxyContin (oxycodone), an opioid painkiller, catalyzing the opioid crisis which has been responsible for more than 600 000 deaths in and beyond North America. This case is an extreme example of how transnational pharmaceutical companies prioritize shareholder profits over public wellbeing. As such, the field of global health faces the critical challenge of better understanding how transnational pharmaceutical companies, like Purdue, can be held to account for the harms they cause. Within the framework of Actor-Network Theory, a sociomaterial approach to analyzing complex networks, this case study uses key informant interviews (n = 18) to examine how accountability is taken up in and by global health systems in response to the harms caused by Purdue. Findings highlight the multiple co-existing versions of accountability enacted within global health systems organized as three separate but interrelated networks: social accountability, political accountability, and legal accountability. Though often interconnected, these diverse networks mobilized distinct tools, resources, and strategies, such as news articles, scholarly literature, and policy guidelines, to construct and stabilize enactments of accountability. Through this in-depth examination of the complex interactions involved in global health and pharmaceutical systems, this study offers a nuanced understanding of the diverse actors mobilized and the unique strengths leveraged within and by accountability networks. Further, in examining these networks' differences, interconnectedness, and peculiarities, we broaden the scope of how accountability is defined, conceptualized, and operationalized in global health systems.

On January 20, 2025, the United States initiated its withdrawal from the World Health Organization (WHO) through an executive order, citing concerns over the organization's handling of global health crises, political influences, and financial inequities. This commentary explores the historical context of the U.S.-WHO relationship, provides an analysis of the justifications for withdrawal, and examines the global and domestic consequences of this decision. Historically, the U.S. has been a significant player in the WHO, contributing substantial funding and advancing global health initiatives. However, tensions have arisen, particularly following the COVID-19 pandemic, where accusations of inefficiency, political bias, and financial disparities became more pronounced. The withdrawal highlights a call for WHO reform, particularly in enhancing transparency, accountability, and efficiency. On a global scale, the U.S. departure threatens to destabilize WHO's funding, weaken leadership, and hinder future pandemic preparedness. Domestically, the U.S. plans to redirect resources to alternative organizations and enhance national health capacities. Critics argue that this move could weaken international collaboration, erode trust, and damage U.S. influence in global health governance. This commentary ultimately underscores the complexities and potential risks associated with disengagement from multilateral health initiatives and the broader implications for global health security.

Background: During the coronavirus disease 2019 pandemic, the South Korean government initiated the Global Vaccine Hub Project (GVHP) purportedly to address global vaccine inequality. This study analyzes the strategies and underlying epistemology of GVHP through the perspective of global governmentality. Critical Discourse Study (CDS) approaches were used to identify governmental technologies and explain how their embedded knowledge is related to power relations.

Results: The findings reveal that GVHP merely pursues national interests by implementing governmental technologies, such as calculative practice, support to private companies, patent protection and circumvention, and pursuing vaccine diplomacy. The South Korean government considered the pandemic an economic and diplomatic opportunity to become an advanced country. The governmental strategies resulted in the depoliticization of vaccines and facilitated the government's opposition to other alternatives, such as an intellectual property waiver at the World Trade Organization level.

Conclusion: This study argues that the failure of global pandemic governance does not imply the failure of global governmentality; rather, the success of neoliberal global governmentality made global solidarity challenging.

Background: In 2006, the Fiji Government introduced a 0.05FJ$ (0.03USD) per litre excise tax on domestically produced sugar-sweetened beverages (SSBs). Since then, the tax has been abandoned, reintroduced, or adjusted at least ten times, while tariffs on imported SSBs have also undergone reform. These rapid iterations of Fiji's SSB tax raise questions about which interests and motivations underpin the tax, what instigated the multiple adjustments, and implications for its impact on health versus economic and political considerations.

Methods: Using case study methodology, this study maps the history of SSB tax adjustments in Fiji and examines the political economy forces that have shaped, and continually re-shaped, this policy landscape. We used policy analysis and theories of power to analyse the intersection of ideas, interests and institutions, drawing on policy documents (n = 304), key informant interviews (n = 32) and direct observations of socio-political events (n = 7) as data sources.

Results: Findings from this study indicate that the introduction of the SSB tax and subsequent adjustments were motivated more by economic, than health, imperatives. The relationship of mutual dependence between the Fiji Government and domestic SSB industry actors led policymakers to make multiple adjustments, seesawing in an attempt to balance the immediate need for revenue and long-term economic development through strengthened local industries. Early SSB tax lobbying from health actors alone had minimal impact. However, a subsequent alliance between government health actors and politically savvy and well-positioned civil society actors proved persuasive in both increasing the tax rate and ensuring a health and rights focus, arguably achieving a health and economic 'win-win'.

Conclusion: Global adoption of SSB taxes is increasing. Examining the protracted history of Fiji's SSB tax reveals the political ebbs and flows that alter how prospective population health 'wins' are weighed up against other policy imperatives. For health-interested actors, these insights point to important strategic in-roads around the explicit use of political economy analysis to complement technical policy insights. Building and maintaining coalitions that extend beyond government and into civil society also proved pivotal. Health system leadership that champions political thinking and cross-sectoral partnerships holds great promise for enhancing health actors' engagement with SSB tax-specific policy making and other multisectoral reform in Fiji and elsewhere.

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.