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Towards mission-driven investment in new antimicrobials? What role for Chinese strategic industrial financing vehicles in responding to the challenge of antimicrobial resistance? 新型抗菌药物投资的使命驱动?中国战略性产业融资工具在应对抗菌药耐药性挑战中发挥什么作用?
IF 10.8 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-03-26 DOI: 10.1186/s12992-024-01030-2
Lewis Husain, Yajing Hu, Yangmu Huang

Background: Antimicrobial resistance (AMR) causes high levels of global mortality. There is a global need to develop new antimicrobials to replace those whose efficacy is being eroded, but limited incentive for companies to engage in R&D, and a limited pipeline of new drugs. There is a recognised need for policies in the form of 'push' and 'pull' incentives to support this R&D. This article discusses China, a country with a rapidly emerging pharmaceuticals and biotech (P&B) sector, and a history of using coordinated innovation and industrial policy for strategic and developmental ends. We investigate the extent to which 'government guidance funds' (GGFs), strategic industrial financing vehicles (a 'push' mechanism), support the development of antimicrobials as part of China's 'mission-driven' approach to innovation and industrial policy. GGFs are potentially globally significant, having raised approximately US$ 872 billion to 2020.

Results: GGFs have a substantial role in P&B, but almost no role in developing new antimicrobials, despite this being a priority in the country's AMR National Action Plan. There are multiple constraints on GGFs' ability to function as part of a mission-driven approach to innovation at present, linked to their business model and the absence of standard markets for antimicrobials (or other effective 'pull' mechanisms), their unclear 'social' mandate, and limited technical capacity. However, GGFs are highly responsive to changing policy demands and can be used strategically by government in response to changing needs.

Conclusions: Despite the very limited role of GGFs in developing new antimicrobials, their responsiveness to policy means they are likely to play a larger role as P&B becomes an increasingly important component of China's innovation and industrial strategy. However, for GGFs to effectively play that role, there is a need for reforms to their governance model, an increase in technical and managerial capacity, and supporting ('pull') incentives, particularly for pharmaceuticals such as antimicrobials for which there is strong social need, but a limited market. Given GGFs' scale and strategic importance, they deserve further research as China's P&B sector becomes increasingly globally important, and as the Chinese government commits to a larger role in global health.

背景:抗菌药耐药性(AMR)导致全球死亡率居高不下。全球都需要开发新的抗菌药物,以取代那些疗效被削弱的抗菌药物,但企业参与研发的积极性有限,新药研发渠道有限。人们认识到,需要以 "推 "和 "拉 "激励的形式制定政策,支持研发工作。本文讨论的中国是一个制药和生物技术(P&B)行业迅速崛起的国家,也是一个利用协调创新和产业政策实现战略和发展目标的国家。我们研究了 "政府引导基金"(GGFs)这一战略性产业融资工具(一种 "推动 "机制)在多大程度上支持了抗菌药物的开发,这是中国 "使命驱动 "的创新和产业政策的一部分。到 2020 年,全球绿色基金已筹集了约 8,720 亿美元:结果:全球公益基金在预防和治疗方面发挥了重要作用,但在开发新抗菌药物方面几乎没有发挥任何作用,尽管这在中国的《AMR 国家行动计划》中是一个优先事项。目前,GGFs 作为任务驱动型创新方法的一部分发挥作用的能力受到多重限制,这与其商业模式、缺乏抗菌药物标准市场(或其他有效的 "拉动 "机制)、其 "社会 "任务不明确以及技术能力有限有关。然而,全球治理基金对不断变化的政策需求反应灵敏,政府可根据不断变化的需求战略性地加以利用:尽管全球基因工程基金在开发新型抗菌药物方面发挥的作用非常有限,但它们对政策的响应能力意味着,随着宝盈娱乐生物技术成为中国创新和产业战略中日益重要的组成部分,它们有可能发挥更大的作用。然而,要使全球绿色基金有效地发挥这一作用,需要对其治理模式进行改革,提高技术和管理能力,并采取支持性("拉动")激励措施,特别是对于抗菌药物等社会需求强烈但市场有限的药品。鉴于全球公益基金的规模和战略重要性,随着中国的宝盈娱乐部门在全球的重要性日益增加,以及中国政府致力于在全球卫生领域发挥更大作用,它们值得进一步研究。
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引用次数: 0
Where should "Humans" be in "One Health"? Lessons from COVID-19 for One Health. 人类 "在 "一体健康 "中应处于什么位置?COVID-19 为 "一个健康 "带来的启示。
IF 5.9 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-03-25 DOI: 10.1186/s12992-024-01026-y
Zhaohui Su, Dean McDonnell, Ali Cheshmehzangi, Barry L Bentley, Sabina Šegalo, Claudimar Pereira da Veiga, Yu-Tao Xiang

The culling of animals that are infected, or suspected to be infected, with COVID-19 has fuelled outcry. What might have contributed to the ongoing debates and discussions about animal rights protection amid global health crises is the lack of a unified understanding and internationally agreed-upon definition of "One Health". The term One Health is often utilised to describe the imperative to protect the health of humans, animals, and plants, along with the overarching ecosystem in an increasingly connected and globalized world. However, to date, there is a dearth of research on how to balance public health decisions that could impact all key stakeholders under the umbrella of One Health, particularly in contexts where human suffering has been immense. To shed light on the issue, this paper discusses whether One Health means "human-centred connected health" in a largely human-dominated planet, particularly amid crises like COVID-19. The insights of this study could help policymakers make more informed decisions that could effectively and efficiently protect human health while balancing the health and well-being of the rest of the inhabitants of our shared planet Earth.

扑杀感染或疑似感染 COVID-19 的动物引发了强烈不满。在全球卫生危机中,关于动物权利保护的争论和讨论之所以持续不断,可能是因为对 "一体健康 "缺乏统一的理解和国际商定的定义。统一健康 "一词经常被用来描述在一个联系日益紧密的全球化世界中,保护人类、动物和植物的健康以及整个生态系统的必要性。然而,迄今为止,关于如何平衡 "一体健康 "保护伞下可能影响所有主要利益相关者的公共卫生决策的研究还很匮乏,尤其是在人类遭受巨大痛苦的情况下。为了阐明这一问题,本文讨论了 "一个健康 "是否意味着 "以人为本的互联健康",在这个主要由人类主导的星球上,尤其是在像 COVID-19 这样的危机中。本研究的见解可帮助决策者做出更明智的决策,从而有效、高效地保护人类健康,同时平衡我们共同居住的地球上其他居民的健康和福祉。
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引用次数: 0
How can the Sendai framework be implemented for disaster risk reduction and sustainable development? A qualitative study in Iran. 如何实施仙台框架以减少灾害风险和促进可持续发展?伊朗的定性研究。
IF 10.8 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-03-21 DOI: 10.1186/s12992-024-01028-w
Mahmood Nekoei-Moghadam, Seyed Mobin Moradi, Asghar Tavan

Background: The Sendai Framework is the United Nations' most significant approach to reducing the risk of disasters from 2015 to 2030. This framework designed for all communities. However, communities should create operational and remedial strategies based on their unique circumstances. Considering the gaps in the implementation of Sendai framework strategies in Iran, as a developing country, the present study was designed.

Method: This study was conducted by using a qualitative direct content analysis method to find out the expert's opinions on the implementation of the Sendai framework in Iran from 2021 to 2023. 35 experts in the focus group discussion and 9 experts in the interview were the participants of the study.

Results: Study findings were merged and reported as one main theme entitled Executive actions for implementing the Sendai Framework, four categories, and 37 codes. Eleven codes for the strategy of understanding disaster risk, 11 codes for the strategy of strengthening disaster risk governance to manage disaster risk, eight codes for the strategy of Investing in disaster risk reduction for resilience, and finally, seven codes for the strategy of enhancing disaster preparedness for effective response and to "Build Back Better" in recovery, rehabilitation, and reconstruction were identified as implementation solutions.

Conclusion: The Sendai Framework has not provided any detailed implementation solutions because the countries' economic, social, level of development, etc., are different. The study's findings can be used as a guide for other developing countries.

背景:仙台框架是联合国在 2015 年至 2030 年期间减少灾害风险的最重要方法。该框架面向所有社区。然而,各社区应根据其独特情况制定业务和补救战略。考虑到伊朗作为发展中国家在实施仙台框架战略方面存在的差距,我们设计了本研究:本研究采用定性直接内容分析法,以了解专家对 2021 年至 2023 年在伊朗实施仙台框架的看法。35 名专家参加了焦点小组讨论,9 名专家参加了访谈:研究结果合并为一个题为 "实施仙台框架的执行行动 "的主题、四个类别和 37 个代码。了解灾害风险的战略有 11 个代码,加强灾害风险治理以管理灾害风险的战略有 11 个代码,投资于减少灾害风险以提高抗灾能力的战略有 8 个代码,最后,加强备灾以有效应对灾害和在恢复、复原和重建中 "重建得更好 "的战略有 7 个代码被确定为实施方案:结论:由于各国的经济、社会和发展水平不同,仙台框架并没有提供详细的实施方案。研究结果可作为其他发展中国家的指南。
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引用次数: 0
Drivers of consumer food choices of multinational corporations' products over local foods in Ghana: a maximum difference scaling study. 加纳消费者选择跨国公司产品而非本地食品的驱动因素:最大差异比例研究。
IF 10.8 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-03-19 DOI: 10.1186/s12992-024-01027-x
Eric Nyarko, Tina Bartelmeß

Introduction: The fundamental transformation of food systems and retail environments in low-income countries is influencing consumers' food choices and dietary habits in unfavourable directions through the consumption of highly processed, energy-dense foods, predominantly manufactured by multinational food corporations. This study aims to identify the principal factors driving consumers' preference for multinational foods over local foods in the urban Accra region of Ghana.

Method: This cross-sectional survey involving a random sample of 200 consumers conducted in March/April 2023 using interviewer-administered questionnaires employed a maximum difference scaling approach to investigate the drivers of urban Ghanaian consumer food choices for multinational food corporations' products over local foods. The maximum difference scaling modelling analysis utilized in this study identifies the primary drivers of multinational food corporations' product preferences and the associated trade-offs.

Result: The study discovered that food quality and safe packaging, perceived healthiness, taste and flavour, and nutritional value were the most significant factors driving consumer preference for multinational food corporations' products over local foods in Ghana. The criterion food quality and safe packaging had the significantly highest utility than all other attributes in terms of consumer preference for products/meals from multinational food corporations over local foods.

Conclusion: The results of this study provide significant contributions to the existing body of research, as previous studies have not identified these factors as primary drivers of multinational food products. Public health authorities and nutritionists can use the study's findings to implement targeted quality assurance measures in local markets and to address the drivers in health education campaigns.

导言:低收入国家食品体系和零售环境的根本性转变正通过消费主要由跨国食品公司生产的高加工、高能量食品,对消费者的食品选择和饮食习惯产生不利影响。本研究旨在确定加纳阿克拉城市地区消费者偏好跨国食品而非本地食品的主要因素:这项横断面调查于 2023 年 3 月/4 月进行,随机抽样 200 名消费者,采用访谈员发放问卷的方式,采用最大差分比例法调查加纳城市消费者选择跨国食品公司产品而非本地食品的驱动因素。本研究采用的最大差异比例模型分析确定了跨国食品公司产品偏好的主要驱动因素和相关权衡:研究发现,在加纳,食品质量和安全包装、健康感知、口感和风味以及营养价值是消费者偏好跨国食品公司产品而非本地食品的最重要因素。在消费者偏好跨国食品公司的产品/餐食而非本地食品方面,食品质量和安全包装标准的效用明显高于所有其他属性:本研究的结果为现有研究做出了重大贡献,因为之前的研究并未将这些因素确定为跨国食品的主要驱动因素。公共卫生当局和营养学家可以利用研究结果在本地市场实施有针对性的质量保证措施,并在健康教育活动中解决这些驱动因素。
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引用次数: 0
Food insecurity, environment, institutional quality, and health outcomes: evidence from South Asia. 粮食不安全、环境、机构质量和健康结果:来自南亚的证据。
IF 10.8 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-03-08 DOI: 10.1186/s12992-024-01022-2
Mohammad Naim Azimi, Mohammad Mafizur Rahman

Background: Food insecurity and environmental degradation pose significant threats to health outcomes in South Asia, necessitating effective policy interventions. Therefore, this study aims to examine the impact of food insecurity and environmental degradation on health outcome indicators amidst global inflationary shocks and institutional quality arrangements. Additionally, it aims to explore the intricate moderating role of institutional quality on the relationship between food insecurity, endogenous variables, and external shocks.

Method: In alignment with the study's objectives, a set of panel data spanning from 2000 to 2021 is compiled for South Asia. The study introduces a novel variable representing inflationary shock, crafted through the integration of inflation datapoints and the application of the generalized autoregressive conditional heteroskedasticity model. Additionally, a distinctive aggregate institutional quality index is formulated, drawing from six key measures of the Worldwide Governance indicators. To scrutinize the effects of food insecurity, environmental degradation, and other explanatory variables, the study employs the two-step system generalized method of moment technique, offering a robust analytical approach to uncover complex relationships and dynamics in the region.

Results: The results indicate that the prevalence of undernourishment, inequality in per capita calorie intake, and CO2 emissions significantly reduce life expectancy and increase mortality rates. Additionally, it shows that per capita kilocalorie supply, per capita GDP, per capita health expenditures, and urbanization are statistically significant for increasing life expectancy and decreasing mortality rates. The findings reveal that inflationary shocks severely affect food insecurity and environmental factors, exerting further pressure on contemporary life expectancy and mortality rates. In rebuttal, the institutional quality index is found to have significant effects on increasing and decreasing life expectancy and mortality rates, respectively. Furthermore, the institutional quality index is effective in moderating the nexus between food insecurity, environmental degradation, and health outcomes while also neutralizing the negative impact of inflationary shocks on the subject.

Conclusion: The results verify triple health constraints such as food insecurity, environmental factors, and economic vulnerability to global shocks, which impose severe effects on life expectancy and mortality rates. Furthermore, poor institutional quality is identified as a hindrance to health outcomes in South Asia. The findings suggest specific policy implications that are explicitly discussed.

背景:粮食不安全和环境退化对南亚地区的健康结果构成了重大威胁,需要采取有效的政策干预措施。因此,本研究旨在探讨在全球通胀冲击和制度质量安排下,粮食不安全和环境退化对健康结果指标的影响。此外,本研究还旨在探讨制度质量对粮食不安全、内生变量和外部冲击之间关系的复杂调节作用:为与研究目标保持一致,本研究汇编了一组 2000 年至 2021 年的南亚面板数据。研究引入了一个代表通胀冲击的新变量,该变量是通过整合通胀数据点和应用广义自回归条件异方差模型制作而成的。此外,根据全球治理指标的六个关键衡量指标,制定了独特的综合制度质量指数。为了仔细研究粮食不安全、环境退化和其他解释变量的影响,本研究采用了两步系统广义矩法技术,为揭示该地区的复杂关系和动态提供了一种稳健的分析方法:结果:研究结果表明,营养不良的普遍程度、人均卡路里摄入量的不平等以及二氧化碳排放量都会显著缩短预期寿命并增加死亡率。此外,研究还表明,人均热量供应、人均国内生产总值、人均医疗支出和城市化对延长预期寿命和降低死亡率具有显著的统计学意义。研究结果表明,通货膨胀冲击严重影响了粮食不安全和环境因素,对当代预期寿命和死亡率造成了进一步的压力。作为反驳,研究发现制度质量指数分别对预期寿命和死亡率的提高和降低有显著影响。此外,制度质量指数还能有效缓和粮食不安全、环境退化和健康结果之间的关系,同时还能中和通货膨胀冲击对这一主题的负面影响:研究结果证实,粮食不安全、环境因素和经济易受全球冲击影响等三重健康制约因素对预期寿命和死亡率造成了严重影响。此外,机构质量低下也被认为是南亚卫生成果的一个障碍。研究结果提出了明确讨论的具体政策影响。
{"title":"Food insecurity, environment, institutional quality, and health outcomes: evidence from South Asia.","authors":"Mohammad Naim Azimi, Mohammad Mafizur Rahman","doi":"10.1186/s12992-024-01022-2","DOIUrl":"10.1186/s12992-024-01022-2","url":null,"abstract":"<p><strong>Background: </strong>Food insecurity and environmental degradation pose significant threats to health outcomes in South Asia, necessitating effective policy interventions. Therefore, this study aims to examine the impact of food insecurity and environmental degradation on health outcome indicators amidst global inflationary shocks and institutional quality arrangements. Additionally, it aims to explore the intricate moderating role of institutional quality on the relationship between food insecurity, endogenous variables, and external shocks.</p><p><strong>Method: </strong>In alignment with the study's objectives, a set of panel data spanning from 2000 to 2021 is compiled for South Asia. The study introduces a novel variable representing inflationary shock, crafted through the integration of inflation datapoints and the application of the generalized autoregressive conditional heteroskedasticity model. Additionally, a distinctive aggregate institutional quality index is formulated, drawing from six key measures of the Worldwide Governance indicators. To scrutinize the effects of food insecurity, environmental degradation, and other explanatory variables, the study employs the two-step system generalized method of moment technique, offering a robust analytical approach to uncover complex relationships and dynamics in the region.</p><p><strong>Results: </strong>The results indicate that the prevalence of undernourishment, inequality in per capita calorie intake, and CO<sub>2</sub> emissions significantly reduce life expectancy and increase mortality rates. Additionally, it shows that per capita kilocalorie supply, per capita GDP, per capita health expenditures, and urbanization are statistically significant for increasing life expectancy and decreasing mortality rates. The findings reveal that inflationary shocks severely affect food insecurity and environmental factors, exerting further pressure on contemporary life expectancy and mortality rates. In rebuttal, the institutional quality index is found to have significant effects on increasing and decreasing life expectancy and mortality rates, respectively. Furthermore, the institutional quality index is effective in moderating the nexus between food insecurity, environmental degradation, and health outcomes while also neutralizing the negative impact of inflationary shocks on the subject.</p><p><strong>Conclusion: </strong>The results verify triple health constraints such as food insecurity, environmental factors, and economic vulnerability to global shocks, which impose severe effects on life expectancy and mortality rates. Furthermore, poor institutional quality is identified as a hindrance to health outcomes in South Asia. The findings suggest specific policy implications that are explicitly discussed.</p>","PeriodicalId":12747,"journal":{"name":"Globalization and Health","volume":"20 1","pages":"21"},"PeriodicalIF":10.8,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10924333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140065129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Does unequal economic development contribute to the inequitable distribution of healthcare resources? Evidence from China spanning 2001–2020 不平等的经济发展是否会导致医疗资源的不公平分配?来自中国 2001-2020 年的证据
IF 10.8 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-03-05 DOI: 10.1186/s12992-024-01025-z
Afei Qin, Wenzhe Qin, Fangfang Hu, Meiqi Wang, Haifeng Yang, Lei Li, Chiqi Chen, Binghong Bao, Tianjiao Xin, Lingzhong Xu
There is a dearth of research combining geographical big data on medical resource allocation and growth with various statistical data. Given the recent achievements of China in economic development and healthcare, this study takes China as an example to investigate the dynamic geographical distribution patterns of medical resources, utilizing data on healthcare resources from 290 cities in China, as well as economic and population-related data. The study aims to examine the correlation between economic growth and spatial distribution of medical resources, with the ultimate goal of providing evidence for promoting global health equity. The data used in this study was sourced from the China City Statistical Yearbook from 2001 to 2020. Two indicators were employed to measure medical resources: the number of doctors per million population and the number of hospital and clinic beds per million population. We employed dynamic convergence model and fixed-effects model to examine the correlation between economic growth and the spatial distribution of medical resources. Ordinary least squares (OLS) were used to estimate the β values of the samples. The average GDP for all city samples across all years was 36,019.31 ± 32,029.36, with an average of 2016.31 ± 1104.16 doctors per million people, and an average of 5986.2 ± 6801.67 hospital beds per million people. In the eastern cities, the average GDP for all city samples was 47,672.71 ± 37,850.77, with an average of 2264.58 ± 1288.89 doctors per million people, and an average of 3998.92 ± 1896.49 hospital beds per million people. Cities with initially low medical resources experienced faster growth (all β < 0, P < 0.001). The long-term convergence rate of the geographic distribution of medical resources in China was higher than the short-term convergence rate (|βi + 1| > |βi|, i = 1, 2, 3, …, 9, all β < 0, P < 0.001), and the convergence speed of doctor density exceeded that of bed density (bed: |βi| >doc: |βi|, i = 3, 4, 5, …, 10, P < 0.001). Economic growth significantly affected the convergence speed of medical resources, and this effect was nonlinear (doc: βi < 0, i = 1, 2, 3, …, 9, P < 0.05; bed: βi < 0, i = 1, 2, 3, …, 10, P < 0.01). The heterogeneity between provinces had a notable impact on the convergence of medical resources. The experiences of China have provided significant insights for nations worldwide. Governments and institutions in all countries worldwide, should actively undertake measures to actively reduce health inequalities. This includes enhancing healthcare standards in impoverished regions, addressing issues of unequal distribution, and emphasizing the examination of social determinants of health within the domain of public health research.
将医疗资源配置与增长的地理大数据与各种统计数据相结合的研究尚不多见。鉴于中国近年来在经济发展和医疗卫生方面取得的成就,本研究以中国为例,利用中国 290 个城市的医疗卫生资源数据以及经济和人口相关数据,研究医疗资源的动态地理分布模式。研究旨在探讨经济增长与医疗资源空间分布之间的相关性,最终目的是为促进全球卫生公平提供证据。本研究使用的数据来自 2001 年至 2020 年的《中国城市统计年鉴》。我们采用了两个指标来衡量医疗资源:每百万人口医生数和每百万人口医院和诊所床位数。我们采用动态收敛模型和固定效应模型来研究经济增长与医疗资源空间分布之间的相关性。我们使用普通最小二乘法(OLS)来估计样本的 β 值。所有城市样本的历年平均 GDP 为 36019.31 ± 32029.36,平均每百万人拥有 2016.31 ± 1104.16 名医生,平均每百万人拥有 5986.2 ± 6801.67 张病床。在东部城市,所有城市样本的平均 GDP 为 47672.71 ± 37850.77,平均每百万人拥有 2264.58 ± 1288.89 名医生,平均每百万人拥有 3998.92 ± 1896.49 张病床。最初医疗资源较少的城市增长较快(所有 β |βi|, i = 1, 2, 3, ..., 9, 所有 β doc:|βi|, i = 3, 4, 5, ..., 10, P < 0.001)。经济增长明显影响医疗资源的汇聚速度,且这种影响是非线性的(doc:βi < 0,i = 1,2,3,...,9,P <0.05;bed:βi < 0,i = 1,2,3,...,10,P <0.01)。省际间的异质性对医疗资源的汇聚产生了显著影响。中国的经验为世界各国提供了重要启示。世界各国的政府和机构都应积极采取措施,积极减少医疗不平等现象。这包括提高贫困地区的医疗水平,解决分配不均的问题,以及在公共卫生研究领域重视对健康的社会决定因素的研究。
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引用次数: 0
The COVID-19 quandemic COVID-19 的窘境
IF 10.8 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-03-02 DOI: 10.1186/s12992-024-01024-0
Olivier Rubin, Carina King, Johan von Schreeb, Claudia Morsut, Gyöngyi Kovács, Emmanuel Raju
The terms syndemic and infodemic have both been applied to the COVID-19 pandemic, and emphasize concurrent socio-cultural dynamics that are distinct from the epidemiological outbreak itself. We argue that the COVID-19 pandemic has exposed yet another important socio-political dynamic that can best be captured by the concept of a quandemic – a portmanteau of “quantification” and “pandemic”. The use of quantifiable metrics in policymaking and evaluation has increased throughout the last decades, and is driven by a synergetic relationship between increases in supply and advances in demand for data. In most regards this is a welcome development. However, a quandemic, refers to a situation where a small subset of quantifiable metrics dominate policymaking and the public debate, at the expense of more nuanced and multi-disciplinary discourse. We therefore pose that a quandemic reduces a complex pandemic to a few metrics that present an overly simplified picture. During COVID-19, these metrics were different iterations of case numbers, deaths, hospitalizations, diagnostic tests, bed occupancy rates, the R-number and vaccination coverage. These limited metrics came to constitute the internationally recognized benchmarks for effective pandemic management. Based on experience from the Nordic region, we propose four distinct dynamics that characterize a quandemic: 1) A limited number of metrics tend to dominate both political, expert, and public spheres and exhibit a great deal of rigidity over time. 2) These few metrics crowd-out other forms of evidence relevant to pandemic response. 3) The metrics tend to favour certain outcomes of pandemic management, such as reducing hospitalization rates, while not capturing potential adverse effects such as social isolation and loneliness. 4) Finally, the metrics are easily standardized across countries, and give rise to competitive dynamics based on international comparisons and benchmarking. A quandemic is not inevitable. While metrics are an indispensable part of evidence-informed policymaking, being attentive to quandemic dynamics also means identifying relevant evidence that might not be captured by these few but dominant metrics. Pandemic responses need to account for and consider multilayered vulnerabilities and risks, including socioeconomic inequities and comorbidities.
Syndemic 和 infodemic 这两个术语都被用于 COVID-19 大流行病,它们强调的是与流行病爆发本身不同的社会文化动态。我们认为,COVID-19 大流行暴露了另一种重要的社会政治动态,而 "quandemic"("量化 "和 "大流行 "的谐音)这一概念最能体现这一动态。过去几十年来,在决策和评估中使用量化指标的情况越来越多,其驱动力是数据供应的增加和需求的增长之间的协同关系。在大多数方面,这是一个可喜的发展。然而,"窘境 "指的是一小部分量化指标主导决策和公共辩论,而忽略了更细致入微的多学科讨论。因此,我们认为,"流行病 "将复杂的流行病简化为少数几个指标,呈现出过于简化的图景。在 COVID-19 期间,这些指标是病例数、死亡人数、住院人数、诊断检测、病床占用率、R 编号和疫苗接种覆盖率的不同迭代。这些有限的指标逐渐成为国际公认的大流行病有效管理基准。根据北欧地区的经验,我们提出了疫情的四种不同动态特征:1)数量有限的指标往往在政治、专家和公共领域占据主导地位,并随着时间的推移表现出很大的僵化性。2) 这些为数不多的指标挤掉了与大流行病应对相关的其他形式的证据。3) 这些衡量标准往往偏向于大流行病管理的某些结果,如降低住院率,而没有反映潜在的不利影响,如社会隔离和孤独。4) 最后,这些指标很容易在各国之间实现标准化,并在国际比较和基准的基础上产生竞争态势。窘境并非不可避免。虽然衡量标准是循证决策不可或缺的一部分,但关注疫情动态也意味着要识别这些为数不多但占主导地位的衡量标准可能无法捕捉到的相关证据。大流行病应对措施需要考虑多层次的脆弱性和风险,包括社会经济不平等和并发症。
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引用次数: 0
Globalization, platform work, and wellbeing-a comparative study of Uber drivers in three cities: London, Helsinki, and St Petersburg. 全球化、平台工作与福祉--三座城市 Uber 司机的比较研究:伦敦、赫尔辛基和圣彼得堡。
IF 10.8 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-03-01 DOI: 10.1186/s12992-024-01021-3
Meri Koivusalo, Arseniy Svynarenko, Benta Mbare, Mikko Perkiö

Background: Globalization of platform work has become a challenge for wider social and employment relations and wellbeing of workers, yet on-location work remains governed also by local regulatory context. Understanding common challenges across countries and potential for regulatory measures is essential to enhance health and wellbeing of those who work in platform economy. Our comparative study on platform work analyzed concerns of Uber drivers in three cities with a different regulatory and policy context.

Methods: Drawing from current understanding on employment and precarity as social determinants of health we gathered comparative documentary and contextual data on regulatory environment complemented with key informant views of regulators, trade unions, and platform corporations (N = 26) to provide insight on the wider regulatory and policy environment. We used thematic semi-structured interviews to examine concerns of Uber drivers in Helsinki, St Petersburg, and London (N = 60). We then analysed the driver interviews to identify common and divergent concerns across countries.

Results: Our results indicate that worsening of working conditions is not inevitable and for drivers the terms of employment is a social determinant of health. Drivers compensated declining pay with longer working hours. Algorithmic surveillance as such was of less concern to drivers than power differences in relation to terms of work.

Conclusions: Our results show scope for regulation of platform work especially for on-location work concerning pay, working hours, social security obligations, and practices of dismissal.

背景:平台工作的全球化已成为对更广泛的社会和就业关系以及工人福利的挑战,但就地工作仍受当地监管环境的制约。了解各国面临的共同挑战以及监管措施的潜力,对于提高平台经济从业者的健康和福利至关重要。我们关于平台工作的比较研究分析了监管和政策背景不同的三个城市的 Uber 司机所关注的问题:根据当前对就业和不稳定性作为健康的社会决定因素的理解,我们收集了有关监管环境的比较文件和背景数据,以及监管机构、工会和平台公司(N = 26)的关键信息提供者的观点,以提供对更广泛的监管和政策环境的见解。我们采用专题半结构化访谈的方式,对赫尔辛基、圣彼得堡和伦敦的 Uber 司机(60 人)所关心的问题进行了研究。然后,我们对司机访谈进行了分析,以确定各国共同和不同的关注点:结果:我们的研究结果表明,工作条件的恶化并非不可避免,对司机而言,就业条件是健康的社会决定因素。司机们用更长的工作时间来弥补薪酬的下降。与工作条件方面的权力差异相比,算法监控对司机的影响较小:我们的研究结果表明,平台工作,尤其是本地工作,在薪酬、工作时间、社会保障义务和解雇惯例等方面都存在监管空间。
{"title":"Globalization, platform work, and wellbeing-a comparative study of Uber drivers in three cities: London, Helsinki, and St Petersburg.","authors":"Meri Koivusalo, Arseniy Svynarenko, Benta Mbare, Mikko Perkiö","doi":"10.1186/s12992-024-01021-3","DOIUrl":"10.1186/s12992-024-01021-3","url":null,"abstract":"<p><strong>Background: </strong>Globalization of platform work has become a challenge for wider social and employment relations and wellbeing of workers, yet on-location work remains governed also by local regulatory context. Understanding common challenges across countries and potential for regulatory measures is essential to enhance health and wellbeing of those who work in platform economy. Our comparative study on platform work analyzed concerns of Uber drivers in three cities with a different regulatory and policy context.</p><p><strong>Methods: </strong>Drawing from current understanding on employment and precarity as social determinants of health we gathered comparative documentary and contextual data on regulatory environment complemented with key informant views of regulators, trade unions, and platform corporations (N = 26) to provide insight on the wider regulatory and policy environment. We used thematic semi-structured interviews to examine concerns of Uber drivers in Helsinki, St Petersburg, and London (N = 60). We then analysed the driver interviews to identify common and divergent concerns across countries.</p><p><strong>Results: </strong>Our results indicate that worsening of working conditions is not inevitable and for drivers the terms of employment is a social determinant of health. Drivers compensated declining pay with longer working hours. Algorithmic surveillance as such was of less concern to drivers than power differences in relation to terms of work.</p><p><strong>Conclusions: </strong>Our results show scope for regulation of platform work especially for on-location work concerning pay, working hours, social security obligations, and practices of dismissal.</p>","PeriodicalId":12747,"journal":{"name":"Globalization and Health","volume":"20 1","pages":"18"},"PeriodicalIF":10.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10908096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140012463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Health policy competencies in regional organizations: a retrospective analysis for 76 regional organizations from 1945 to 2015 区域组织的卫生政策能力:对1945年至2015年76个区域组织的回顾性分析
IF 10.8 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-02-26 DOI: 10.1186/s12992-024-01023-1
Zongbin Wang, Zhisheng Liang, Xuejie Dong, Liqun Gao, Shuduo Zhou, Hui Yin, Yinzi Jin, Zhi-Jie Zheng
Health policy competencies of regional organizations include mandates to create regional health laws and policies, as well as authorities that allow member states to undertake collective actions in the health field. The examination of the health policy competencies of regional organizations is essential, as it constitutes an important prerequisite for regional organizations to govern regional health. This study aims to map the development trajectory of health policy competencies in regional organizations worldwide and investigate their potential correlates. This will contribute to the enhanced promotion of both existing and new regional health cooperation. This retrospective analysis utilized the health policy competencies of the 76 regional organizations worldwide from 1945 to 2015, as investigated in the Regional Organizations Competencies Database. By aggregating member state data from various sources such as the IHME Global Burden of Disease 2019, the World Bank, and the World Trade Organization, we extracted the mean values and coefficients of variation for the covariates in regional organization characteristics, socioeconomic and demographic factors, health status and health-system capacity. The correlation between changes in the health policy scope of regional organizations and independent variables was analyzed using Poisson pseudo-likelihood regression with multiple levels of fixed effects. From 1945 to 2015, the number of regional organizations with health policy competencies experienced a slow growth stage before 1991 and an explosive growth stage post-1991. By 2015, 48 out of the 71 existing regional organizations had developed their health policy competencies, yet 26 (54.2%) of these organizations possessed only 1–2 health policy competencies. An enhancement in the health policy scope of a regional organization correlated with its founding year, a greater number of policy fields, higher under-five mortality, and larger disparities in trade and healthcare access and quality indexes among member states. In contrast, larger disparities in population, under-five mortality and health worker density among member states, along with more hospital beds per capita, were negatively correlated with the expansion of a regional organization’s health policy scope. Since 1991, there has been a surge of interest in health among regional organizations, although health remains a secondary priority for them. The health policy competencies of regional organizations are pivotal for promoting social equity within regional communities. Its establishment is also closely linked to the level and disparities among member states in aspects such as trade, population, child mortality rates, and health system capacity.
区域组织的卫生政策权限包括制定区域卫生法律和政策的任务,以及允许成员国在卫生领域采取集体行动的权力。审查区域组织的卫生政策能力至关重要,因为这是区域组织管理区域卫生的重要前提。本研究旨在描绘全球区域组织卫生政策能力的发展轨迹,并调查其潜在的相关因素。这将有助于加强促进现有的和新的区域卫生合作。这项回顾性分析利用了区域组织能力数据库(Regional Organizations Competencies Database)中调查的1945年至2015年全球76个区域组织的卫生政策能力。通过汇总IHME《2019年全球疾病负担》、世界银行和世界贸易组织等不同来源的成员国数据,我们提取了区域组织特征、社会经济和人口因素、健康状况和卫生系统能力等协变量的均值和变异系数。利用多级固定效应的泊松伪似然回归分析了区域组织卫生政策范围的变化与自变量之间的相关性。从1945年到2015年,具有卫生政策能力的区域组织数量在1991年之前经历了缓慢增长阶段,在1991年之后经历了爆发式增长阶段。到 2015 年,在现有的 71 个区域组织中,有 48 个组织发展了卫生政策能力,但其中 26 个组织(54.2%)仅拥有 1-2 项卫生政策能力。区域组织卫生政策范围的扩大与其成立年份、政策领域数量、五岁以下儿童死亡率以及成员国之间贸易和医疗保健获取和质量指数的差距增大相关。相反,成员国之间在人口、五岁以下儿童死亡率和卫生工作者密度方面的更大差距,以及更多的人均病床与区域组织卫生政策范围的扩大呈负相关。自1991年以来,区域组织对卫生的兴趣大增,尽管卫生仍是它们的次要优先事项。区域组织的卫生政策能力对于促进区域社区内的社会公平至关重要。它的建立也与成员国在贸易、人口、儿童死亡率和卫生系统能力等方面的水平和差距密切相关。
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引用次数: 0
Corporate interest groups and their implications for global food governance: mapping and analysing the global corporate influence network of the transnational ultra-processed food industry 企业利益集团及其对全球食品治理的影响:绘制和分析跨国超加工食品工业的全球企业影响网络图
IF 10.8 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-02-22 DOI: 10.1186/s12992-024-01020-4
Scott Slater, Mark Lawrence, Benjamin Wood, Paulo Serodio, Phillip Baker
A major challenge to transforming food systems to promote human health and sustainable development is the global rise in the manufacture and consumption of ultra-processed foods (UPFs). A key driver of this dietary transition is the globalization of UPF corporations, and their organized corporate political activity (CPA) intended to counter opposition and block government regulation. UPF industry CPA and the corporate interest groups who lobby on their behalf have been well described at the national level, however, at the global level, this network has not been systematically characterized. This study aims to map, analyse, and describe this network, and discuss the implications for global food policy action on UPFs, global food governance (GFG), and food systems transformation. We conducted a network analysis of the declared interest group memberships of the world’s leading UPF corporations, extracted from web sources, company reports, and relevant academic and grey literature. Data on the characteristics of these interest groups were further extracted for analysis, including year founded, level, type, and headquarter location. We identified 268 interest groups affiliated with the UPF industry. The UPF manufacturers Nestlé (n = 171), The Coca-Cola Company (n = 147), Unilever (n = 142), PepsiCo (n = 138), and Danone (n = 113) had the greatest number of memberships, indicating strong centrality in coordinating the network. We found that this network operates at all levels, yet key actors now predominantly coordinate globally through multistakeholder channels in GFG. The most common interest group types were sustainability/corporate social responsibility/multistakeholder initiatives, followed by branding and advertising, and food manufacturing and retail. Most corporate interest groups are headquartered where they can access powerful government and GFG decision-makers, nearly one-third in Washington DC and Brussels, and the rest in capital cities of major national markets for UPFs. The UPF industry, and especially its leading corporations, coordinate a global network of interest groups spanning multiple levels, jurisdictions, and governance spaces. This represents a major structural feature of global food and health governance systems, which arguably poses major challenges for actions to attenuate the harms of UPFs, and to realising of healthy and sustainable food systems.
转变食品体系以促进人类健康和可持续发展所面临的一个重大挑战是全球超加工食品(UPFs)生产和消费的增长。这种膳食转型的一个主要驱动因素是超加工食品企业的全球化,以及它们为抵制反对意见和阻挠政府监管而开展的有组织的企业政治活动(CPA)。UPF 行业的 CPA 以及代表其进行游说的企业利益集团已在国家层面上得到充分描述,但在全球层面上,这一网络尚未得到系统描述。本研究旨在绘制、分析和描述这一网络,并讨论全球粮食政策行动对 UPF、全球粮食治理(GFG)和粮食系统转型的影响。我们从网络资源、公司报告以及相关学术和灰色文献中提取数据,对世界领先的 UPF 公司所申报的利益集团成员资格进行了网络分析。我们还进一步提取了这些利益集团的特征数据进行分析,包括成立年份、级别、类型和总部所在地。我们确定了 268 个隶属于 UPF 行业的利益集团。UPF制造商雀巢公司(n = 171)、可口可乐公司(n = 147)、联合利华(n = 142)、百事可乐公司(n = 138)和达能公司(n = 113)的成员数量最多,表明它们在协调该网络方面具有很强的中心地位。我们发现,该网络在各个层面都有运作,但主要参与者目前主要通过全球治理论坛的多方利益相关者渠道进行全球协调。最常见的利益集团类型是可持续发展/企业社会责任/多方利益相关者倡议,其次是品牌和广告,以及食品制造和零售。大多数企业利益集团的总部都设在能够接触到有权势的政府和全球食品添加剂集团决策者的地方,近三分之一的企业利益集团总部设在华盛顿特区和布鲁塞尔,其余的则设在全球食品添加剂主要国家市场的首都。万国邮联行业,特别是其龙头企业,协调着一个跨越多层次、多管辖区和多治理空间的全球利益集团网络。这代表了全球食品和健康治理体系的一个主要结构特征,可以说对减轻 UPFs 危害的行动以及实现健康和可持续的食品体系构成了重大挑战。
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