Global Health Research and Policy最新文献

The United Nations announced a historic milestone in global child mortality in March 2024, with deaths among children less than 5 years falling below 5 million in 2022. While this news is welcome, the headline news is too definitive and masks uncertainties in the results. The UN's projections rely heavily on modeled estimates based on historical data, with only 5% of the 2022 estimate derived from countries with actual data for that year. The model also fails to account for the potential temporal discontinuity caused by the COVID-19 pandemic and is inconsistent with related data on declining vaccination rates. This critique calls for greater humility in communicating the uncertainties inherent in such projections and emphasizes the need for more robust, empirically grounded estimates to inform global health policy. The UN's role as a science communicator should be to provide clear, evidence-based insights while acknowledging the limitations of its methodology.

Background: Improving maternal and child health (MCH) outcomes is a critical agenda item in global development. Health financing factors play a crucial role in affecting MCH outcomes, which vary substantially in the Middle East and North Africa (MENA) region. This study aims to examine the trends in maternal mortality rate (MMR), infant mortality rate (IMR), and under-5 mortality rate (U5MR) in the MENA region and the potential impact of health financing factors on them.

Methods: We compiled data on MCH mortalities and potential determinants, including health financing factors, for all countries in the MENA region from 2000 to 2020. We calculated the growth rate of mortalities and explored the association between mortality rates and potential determinants using fixed-effects models.

Results: The average MMR, IMR, and U5MR showed an overall descending trend in the region. Middle-income countries experienced the highest reduction rates (3.46-3.73%), followed by high-income countries (2.97-3.02%) and then low-income countries (0.33-0.92%). Gross domestic product (GDP) per capita, current health expenditure (CHE) per capita, urbanization, and fragility were consistently associated with all three mortality rates (p < 0.05). GDP elasticity of MMR, IMR, and U5MR was estimated at - 0.121, - 0.076, and - 0.138, respectively, while corresponding CHE elasticity was - 0.319, - 0.275, and - 0.225, with a larger magnitude. Fragility was positively associated with higher MMR, IMR, and U5MR. Additionally, government health spending, air pollution, and immigration were associated with MMR, but not with IMR and U5MR.

Conclusions: Low-income countries in the MENA region, with the highest mortality rates, face greater challenges in reducing MCH mortality rates, necessitating tailored interventions to expand evidence-based MCH services and/or reinforce their effectiveness. Total investment in health plays a critical role in reducing mortality rates. Efforts to build a sustainable health financing system are key to improving MCH outcomes. Besides, endeavors to address broader socioeconomic factors and political stability should be prioritized in countries with major concerns of poverty and conflict.

Background: The rapid aging in the Philippines presents significant challenges, including high rates of activities of daily living (ADL) disability among older adults. While research has identified various social determinants of ADL disability, there is a gap in understanding how their joint impact on disability among older Filipinos. We adopted the polysocial score approach to assess these joint associations of multiple social factors with disability among older adults in the Philippines.

Methods: Individuals included in the analysis were from the Longitudinal Study of Ageing and Health in the Philippines. Twenty-nine social factors from five domains were included. The Light Gradient Boosting Machine (LightGBM) model was employed to identify and rank key social determinants, which were then incorporated into a logistic regression model to derive the polysocial score, both continuously and in categories and assessed its association with ADL disability. Model performances were assessed by discrimination, calibration, and reclassification (compared to a reference model). All analyses were separated for men and women.

Results: We included 5,000 participants (37.0% men) with an average age of 68.3 years. The polysocial score included 19 social factors for men and 18 for women. Among men, the most significant predictors were the frequency of engaging in social activities and the number of friends they had contact with. Attending religious services outside the home and the frequency of attending social activities were the most important factors for women. Eleven social factors overlapped between men and women. Individuals with moderate or high polysocial scores exhibited reduced likelihood of experiencing ADL disability relative to those with low scores. We observed satisfactory model performance among men and women.

Conclusions: We identified important social factors for men and women and their joint association with ADL disability. The polysocial score could be used to design person-centered social interventions that promote health and support independence.

The most cited definition of global health, published in The Lancet in 2009, defines global health as "an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide". In this article, we propose an updated definition that expresses the motivations of diverse global health actors and makes One Health and sustainability more visible: "Global health is a field of academic study, research, policy, and applied practice that advances the equitable protection and improvement of population and planetary health". Our "5 Ps model" illustrates global health as a grid that places health for all at the center of two axes representing four domains: (1) People, (2) Planet, (3) Priorities, and (4) Policies and Practices. The people-planet axis spans from social, economic, political, and other systems that affect human health to complex worldwide challenges such as those related to globalization, migration, pandemics, and climate change. The priorities-policies/practices axis positions global health as an action-oriented field in which factors such as human rights, international law, the global burden of disease, and evidence of economic impact inform the financing, implementation, and evaluation of multisectoral partnerships and interventions. We propose using this updated definition and the 5 Ps framework to modernize discussions of the scope and purpose of global health.

Introduction: Although there has been attention paid to decolonizing global health, there is no consensus around the concept. To act in the face of various crises, including neocolonialism, there is a need to understand the key components of this concept within mainstream global health, how it can be acted on, and who is contributing to these discussions.

Methods: A scoping review was undertaken to assess the academic literature for discussions on decolonizing global health. The PRISMA guidelines for Scoping Reviews (PRISMA-ScR) were used to guide reporting. OVID Medline, OVID Embase, EBSCO CINAHL Plus, Web of Science Core Collection, PAIS Index, Worldwide Political Science Abstracts, and the International Bibliography of the Social Sciences databases were searched from inception to August 8, 2023. The inclusion criterion was that texts had to: (i) use the exact phrasing of "decoloni* global health" or "anticolonial global health," (ii) include substantive discussion of what decolonizi* global health or anticolonial global health means (i.e., single mentions that do not include an explanation, elaboration, or context were excluded), and (iii) be published in English.

Results: When analyzing how scholars understand "decolonizing global health", its meaning is rooted in three key components: (i) power asymmetries between the global north and south; (ii) a legacy of colonialism in global health or neocolonialism; and (iii) epistemic injustice. The second part of the analysis looked to understand if decolonizing global health can be acted on, and if so, how? The analysis demonstrated that decolonization of global health involves: (i) overhauling existing power structures; (ii) establishing agency and self-determination of the global south; (iii) epistemic reformation and epistemic and ontological pluralism; (iv) education; and (v) inclusivity, solidarity, and allyship. Lastly, in assessing which scholars' work was retrieved in this systematic search of the literature, most first authors were situated in the Americas Region (n = 45/99; 46%), followed by the European Region (n = 29/99; 29%). When combining these two regions, this accounted for almost 75% of all included articles. Notably, only 22% of first authors of retrieved articles had an affiliation in a low- and/or middle-income country.

Conclusions: The findings from this scoping review are anticipated to bring much needed clarity to discussions around decolonizing global health, in terms of key components, gaps, and possible actions. For instance, this review presents ongoing challenges faced in coming to a comprehensive and agreed upon definition of decolonizing global health in mainstream global health.

Background: Access to primary healthcare (PHC) services is a critical determinant of population health outcomes and a key indicator of health system performance. However, comprehensive methods for batch assessment of PHC accessibility and the associated economic burden are relatively scarce. This gap is particularly evident in developing countries, where accessibility challenges are often more pronounced.

Methods: We developed an integrated assessment methodology for the large-scale calculation of travel costs to access PHC services. This methodology combines high-resolution friction surface mapping, the construction of a comprehensive PHC facility spatial dataset, and the application of least-cost path algorithms. The batch processing capability of the methodology ensures efficient computation while maintaining high spatial resolution, enabling a detailed evaluation of PHC accessibility and its economic burden across diverse geographical contexts.

Results: Our analysis revealed that 88.70% of Chinese mainland's population could access PHC facilities within an hour, indicating relatively good overall accessibility to primary healthcare services. However, significant regional disparities in accessibility and associated economic burdens were observed. While urban areas, particularly in eastern and coastal regions, generally exhibit high levels of accessibility, rural and remote areas, especially in the western and northwestern regions, face substantial challenges in reaching PHC facilities. The total economic burden associated with travel to PHC facilities in Chinese mainland is estimated at approximately 38.29 billion CNY annually. The southern, northern, and northwestern regions accounted for 62.91%, 21.72%, and 14.94% of the total burden respectively, with northwestern provinces facing a disproportionately high economic burden relative to their GDP.

Conclusions: Our methodology supports future large-scale, high-resolution accessibility analyses that can guide interventions aimed at addressing healthcare disparities and improving equity. The empirical application of this methodology in Chinese mainland revealed significant disparities in PHC access across the country and quantified the substantial economic costs associated with these disparities.

Background: Despite advancements in global healthcare, Asia lacks a systematic framework for postoperative pain-related symptoms, particularly in addressing pain identification/prevention and reporting sex differences. This study used network analysis to unravel the complex interplay of pain-related symptoms, analgesic opioid dosages, and psychosocial factors, with a particular focus on sex differences in the Asian population.

Methods: Utilizing anonymized data from 5,093 adult patients across seven Asian regions between 2018 and 2021 from the PAIN OUT registry, this study applied network analysis: 1) to map the relationships between analgesic opioid dosages and multidimensional pain-related symptoms and 2) to explore sex differences. This network analysis was performed based on information from the International Pain Outcomes Questionnaire (IPO-Q), which included pain severity, adverse events, perceptions of pain care perception, and pain treatment satisfaction within 24h of an operation. The model utilized Least Absolute Shrinkage and Selection Operator (LASSO) for regularization and edge estimation, a penalized estimation method allowing for the identification of the most relevant connections while effectively controlling for overfitting.

Results: Network structures demonstrated high stability, revealing distinct sex-based patterns. Chronicity of pain (#CP) emerged as the most central node in the overall network structure (EI = 1.50) and among male patients (EI = 1.80), reflecting the profound effect of persistent pain on their functional activities and sensory-focused symptoms, such as dizziness (#AE4). In contrast, helplessness (#MH2) was a significant symptom in female patients (EI = 1.70), highlighting the emotional and psychological dimensions of their pain experience. Comparative analysis uncovered significant structural differences between males and females (M = 0.154, p = 0.023), emphasizing the unique interplay of psychological, emotional, societal, and pathophysiological symptoms in shaping postoperative pain experiences.

Conclusions: This study was the first comprehensive network analysis of pain-related symptoms with sex differences. The results highlighted a significant difference in associations between analgesic opioid dosages and multidimensional pain-related symptoms among males and females, implying the necessity for region-specific, multimodal interventions to optimize postoperative care in Asian populations.

Background: Liver cancer is among the top five causes of cancer death in 90 countries, with China accounting for a substantial proportion of the global burden. This study aimed to analyse the national liver cancer policies and programs in China.

Methods: This study applied a documentary research method using the systematic READ approach. Six national official websites and one public policy database were searched. The document analysis was based on the WHO Health System's Six Building Blocks and the WHO's four modules of cancer control (prevention, early detection, diagnosis and treatment, and palliative care).

Results: A total of 74 liver cancer-related policies and 8 programs published from 1 January 1984 to 31 March 2025 were included in this study. The analysis revealed that liver cancer management in China mainly focused on Medical products and Technologies (n = 46, 62.16%), and Service Delivery (n = 34, 45.95%) within the WHO health system building blocks. When it came to WHO cancer control four modules, most policies (n = 39, 52.70%) targeted Diagnosis and Treatment of liver cancer, followed by Prevention of liver cancer (n = 33, 44.59%). Additionally, 8 national programs were implemented to improve the prevention, diagnosis, and treatment of liver cancer. Before 2019, the emphasis of liver cancer prevention was primarily on hepatitis prevention and control. However, since 2020, the national-level programs aimed at preventing and controlling liver cancer emphasizing patient education and treatment for high-risk groups.

Conclusions: China's liver cancer control mainly focused heavily on prevention, diagnosis and treatment modules with special focus on medical products and technology, as well as service delivery. Currently, less attention has been given to the detection and palliative care of survivors. The control of liver cancer in China still requires further strengthening of the health system for implementation. Considering the continual increase in the burden of liver cancer, it is imperative for future efforts to develop a comprehensive national liver cancer strategy.

Background: Monkeypox (mpox) has emerged as a global public health concern, particularly among men who have sex with men (MSM). Stigma limits access to care, and the role of social support in shaping care-seeking through psychosocial mechanisms remains unclear. This study examined whether social support influences care-seeking intentions via stigma and perceived healthcare benefits among MSM in China.

Methods: A cross-sectional study was conducted from October 2023 to March 2024 across 6 provinces in China. Descriptive statistics, chi-square tests, Spearman correlations, and logistic regression were performed to explore associations between HBM-related constructs and healthcare-seeking intentions. Structural equation modeling was used to examine the direct and indirect effects of social support via stigma and perceived healthcare benefits.

Results: Among participants, 83.4% expressed an intention to seek healthcare for mpox. Directly, social support was positively associated with healthcare-seeking intention (β = 0.274, p < 0.001). Indirectly, social support affected healthcare-seeking intention through two pathways: (1) by reducing stigma (β = -0.108, p < 0.001), which in turn enhanced perceived healthcare benefits (β = -0.663, p < 0.001), ultimately increasing healthcare-seeking intention (chain effect β = 0.033, p = 0.005); and (2) directly enhancing perceived healthcare benefits (β = 0.091, p < 0.001), thereby increasing healthcare-seeking intention (β = 0.231, p < 0.001; indirect effect β = 0.042, p = 0.005). The total indirect effect accounted for 22.6% of the total effect.

Conclusions: Social support enhances mpox care-seeking intention among MSM in China by reducing stigma and improving perceptions of privacy, affordability, and treatment efficacy. Integrated interventions-combining peer support, stigma reduction, and privacy protection-are needed to foster early health engagement.