Globalization and Health最新文献

Background: The World Health Organization recommends initiating breastfeeding in the first hour of life, exclusive breastfeeding for six months, and continued breastfeeding for at least two years. Aggressive marketing of breast milk substitutes (BMS) undermines breastfeeding and is linked to adverse child and maternal health outcomes. This is particularly problematic in the Global South, where socioeconomic conditions often amplify the risks associated with BMS. The adoption of national BMS legislation in line with the 1981 International Code of Marketing of Breast-milk Substitutes is therefore crucial but difficult due to strong opposition from the transnational formula milk industry. Breastfeeding advocates in Kenya were able to overcome this powerful opposition when the country adopted a strict BMS Act in 2012, which has since facilitated and protected remarkable improvements in breastfeeding rates. We conduct a qualitative case study to identify the political enablers of the successful adoption of this important law.

Results: BMS legislation was first politically debated in Kenya in the 1980s following mobilization of women-led civil society organizations, namely the Breastfeeding Information Group and the Maendeleo ya Wanawake Organization. The issue re-emerged on the political agenda in the 2000s but faced opposition from the transnational formula milk industry. Kenya's BMS Act was ultimately adopted during a policy window opened by a constitutional reform. Support for the adoption of this landmark law was led by effective female political leaders, including public health minister Beth Mugo, the ministry's nutrition division head Terrie Wefwafwa, and members of the Kenya Women's Parliamentary Association. In the formulation and adoption of the law, these female leaders received important support from international organizations, such as the United Nations Children's Fund, as well as from powerful male allies, including president Mwai Kibaki.

Conclusions: The Kenyan case illustrates how women's political leadership can counteract the power of the transnational formula milk industry and help achieve strict BMS legislation. Effective female leadership for BMS legislation can occur in various political offices and positions, including those of ministers, legislators and bureaucrats. Female leaders can leverage their own influence by strategically exploiting policy windows and recruiting male allies.

Background: Telemedicine is mentioned as a technological solution in various fields of medicine and nowadays using telemedicine in the field of mental health in the refugee population, has attracted special attention in the world. This research was conducted with the aim of investigating the usage of telemedicine in the refugee populations mental health.

Methods: This study, conducted in 2024, involved a comprehensive search of databases including Web of Science, Cochrane, ProQuest, Ovid, EBSCO, PubMed, and Scopus, up until April 2023. Based on predefined inclusion and exclusion criteria, 12 relevant articles were identified. The quality and methodology of the selected articles were evaluated using the Mixed Methods Appraisal Tool (MMAT) checklist.

Results: A total of 12 articles were included in the review. Feasibility and investigation of telemedicine challenges (5 articles) and its evaluation and effectiveness investigation (7 articles) were used. Most of the studies were quantitative (8 cases) and mostly dealt with socio-economic-cultural application issues (5 cases) and screening (2 cases). Most of the studies were purely focused on refugees (5 cases).

Conclusions: Results have shown that paying attention to the challenges, disadvantages, and telemedicine required Infrastructure in the field of mental health, will lead to effectiveness, screening, and treatment. This causes positive social, economic, and cultural effects on refugees. However, the need for future studies with more attention to technical and governmental challenges and their issues (security and reimbursement), the refugee population with various ethnicities, and different health fields (prevention, treatment, follow-up, rehabilitation, etc.) seems to be necessary.

Background: Alcohol use disorder (AUD) imposes a significant burden on individuals and society. With globalization, transnational alcohol corporations influence policy enforcement and consumer behavior, hindering cost-effective and evidence-based interventions such as reducing alcohol availability and restricting alcohol advertising, as recommended in the World Health Organization (WHO) Best Buys for the prevention and control of noncommunicable diseases (NCDs).This study utilizes the Global Burden of Disease Study 2021 dataset to examine global and regional disparities, offering key insights into the global trends of AUD and addressing critical research gaps.

Results: The global age-standardised prevalence of alcohol use disorders among individuals aged 15 years and older decreased from 1,698 per 100,000 in 1990 to 1,335 per 100,000 in 2021, with an average annual percent change of -0.78%. Similarly, the average annual percent change for mortality and disability-adjusted life years were - 0.82% and - 0.83%, respectively. Importantly, the age-standardised decline in alcohol use disorders was more pronounced in females compared to males (prevalence: -0.82% versus - 0.75%; mortality: -1.22% versus - 0.73%; disability-adjusted life years: -0.95% versus - 0.79%). The age-standardised prevalence of alcohol use disorders may remain higher among males until the year 2040. For the older adult groups aged 55 to 74, there was no statistically significant decline in alcohol use disorders mortality rates (Ps ≥ 0.17). Furthermore, countries characterized by a high sociodemographic index did not exhibit a significant reduction in mortality (average annual percent change: 0.02%). Between 1990 and 2021, high levels of alcohol consumption and experiences of childhood sexual abuse were identified as major risk factors for alcohol use disorders.

Conclusion: Understanding the trends of AUD in the context of globalization is crucial. Given that certain populations continue to experience persistent alcohol-related issues, protecting these groups from the influence of transnational alcohol corporations through effective policy measures such as strengthening regulations on alcohol advertising targeting older adults, and establishing independent regulatory agencies may be a key strategy for reducing the global health burden of AUD.

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.