Global Health Research and Policy最新文献

In November 2022, a draft of the next EU Global Health Strategy was published. The European Global Health Research Institutes Network (EGHRIN) of 22 leading European Universities has analysed the Strategy. In this commentary, EGHRIN notes the Strategy's positive commitments to life-course wellbeing, strengthening health systems and combating health threats in an equitable and collaborative manner. We find the strategy is compatible with the sustainable development goals and addresses social, political and environmental determinants of health. However, our analyses also highlight a lack of critical assessment of the private sector's role within health systems, insufficient attention to syndemics, and little emphasis on transdisciplinary education and the ethical training of a global health workforce. We conclude that, while its commitments are commendable, the greatest challenge for the next EU Strategy will be in its implementation. The trategy currently lacks a fully-resourced and clearly hypothecated funding mechanism and there is little evidence to date of the stated commitment that Global Health will be considered in all EU policy areas. In the present geopolitical climate, a speedy acceptance of both the policy and an implementation plan is needed more than ever.

Background: China has implemented the priority review (PR) program and flexible registration requirements for new drugs with significant clinical value since 2016 to accelerate drug access. We aim to explore the impact of the reform efforts on the drug access gap between China and the US.

Methods: We collected data on the imported new drug approvals that were licensed in China between 2007 and 2023, and measured their launch delays as compared to the US. Difference-in-difference models were used to compare the launch delays of PR approvals and non-PR approvals before and after the implementation of the PR. Propensity score matching was used to construct the imputed PR and non-PR approvals in the pre-PR period.

Results: A total of 410 imported approvals were licensed in China in 2007-2023. Most approvals (316[77.1%]) were licensed after the PR was implemented, of which 189[59.8%] received the PR designation. The difference-in-difference models found that the PR program reduced drug launch delay by 1157.0 days (robust standard error, 571.0; P<0.05) and reduced drug submission delay by 1037.3 days (robust standard error, 520.8; P<0.05). The PR identified drugs with high clinical value and informed flexible registration requirements for them, which accelerated drug submission and market entry.

Conclusions: Our findings proved the importance of value-based prioritization of new drugs and flexibility in the statutory evidentiary standard in the drug approval process. Further efforts from the drug agency are needed to leverage the regulatory flexibility to provide fast market entry of new drugs without compromising their quality.

Background: The COVID-19 pandemic exposed significant limitations in health systems worldwide and emphasized the need for updated National Health Policies, Strategies, and Plans (NHPSPs). This study aimed to evaluate the NHPSPs of Organization for Economic Cooperation and Development (OECD) and BRICS (Brazil, Russia, India, China, and South Africa) countries before and after the COVID-19 pandemic. Specifically, it explored each country's commitment to strengthening health systems to address health threats and analyzed the specific changes made.

Methods: NHPSP documents from the WHO document repository and official governmental websites were systematically searched. Data were extracted using a standardized template. A coding framework was inductively developed to sort qualitative texts into categories, with frequencies calculated and weighting evaluated, followed by organizing underlying content into subthemes.

Results: Out of 154 documents initially identified, 36 met the screening criteria, covering 14 OECD and 3 BRICS countries. The most predominant theme was prevention (88.9% pre-pandemic, 99.4% post-pandemic), which was addressed as a primary theme in 26 included NHPSPs. After the COVID-19 pandemic, 6 out of 14 analyzed themes saw higher occurrences, among which infection prevention and control (22.2-50.0%) and resilience to health crisis (22.2-44.4%) increased most significantly. Themes mainstreamed in post-pandemic NHPSPs included prevention (94.4%), health research and technology (61.1%), and One Health (66.7%). Primary healthcare emerged as the most concerned subtheme under prevention. Notably, OECD countries displayed more increased occurrences of themes (13 out of 14) or increased emphasis on themes with similar occurrences before and after COVID-19, while BRICS countries only differed in infection control. Additionally, OECD and BRICS countries varied in their subthemes and specific actions under similar primary themes.

Conclusions: COVID-19 exposed vulnerabilities in many countries' health systems, highlighting the need to build resilient health infrastructures through the optimization of NHPSPs. However, only about half of the OECD and BRICS countries have implemented new NHPSPs since the pandemic. Our findings highlight the critical need for global health system reforms and offer actionable recommendations for other countries in formulating their NHPSPs.

Background: Although the implementation of a hierarchical medical system (HMS) has been shown to improve the allocation of medical resources and patient health-seeking behaviour, its role in patient's perceived quality of primary care remains unexplored. This study aimed to assess the impact of HMS implementation on rural and urban residents' perceived quality of primary care.

Methods: Data were obtained from the China Family Panel Study for 2012, 2014, 2016, and 2018. A total of 40,011 rural and 22,482 urban residents were included in the research participants for analysis. This study adopted a quasi-natural experimental design, and the multiple-period difference-in-differences method was used to capture changes in patient's perceived quality of primary care before and after the introduction of HMS.

Results: We found that HMS implementation declined the perceived quality of primary care by an average of 18% among rural residents (OR: 0.82, 95% CI 0.68-0.99), while there was no significant change among urban residents (OR: 1.13, 95% CI 0.87-1.46). There was a 24% reduction in the perceived quality of primary care (OR: 0.76, 95% CI 0.61-0.96) one year after HMS among rural residents, and there was no statistically significant difference two years after HMS. After HMS implementation, the level of perceived quality of primary care by rural patients with chronic diseases decreased by 72% (OR: 0.28, 95% CI 0.11-0.78).

Conclusions: HMS has a limited effect on improving residents' perceived quality of primary care, especially for those living in rural areas. Policymakers are suggested to establish a quality monitoring system that incorporates patient experience as an essential standard to systematically evaluate the impacts of the HMS, with more efforts being put into helping vulnerable groups such as residents under 60 years old and patients with chronic diseases.

There has been a rising call to decolonize global health so that it more fully includes the concerns, knowledge, and research from people all over the world. This endeavor can only succeed, we argue, if we also recognize that much of established global health doctrine is rooted in Euro-American beliefs, values, and practice rather than being culturally neutral. This paper examines the cultural biases of child feeding recommendations as a case in point. We argue that the global promotion of Responsive Feeding-a set of allegedly best practices for child feeding promulgated by the WHO and others-is based on a tacit conviction that certain Western middle-class feeding practices are universally best, along with a promise that future evidence will demonstrate their superiority. These recommendations denounce feeding practices that diverge from this style as Non-Responsive Feeding, thereby pathologizing the many valued ways of feeding children in communities all over the world without sound scientific evidence. Drawing on ethnographic research, we show that there is a wide variety in feeding practices around the world and these are closely interlinked with the understandings and priorities of caregivers, as well as with favored forms of relationships and ways of maintaining them. For global health nutrition interventions to be justified and effective, they would need to be based on more pertinent, culturally responsive research than they currently are. We suggest the use of ethnographic research as an important tool in building empirically grounded, epistemically inclusive, and locally meaningful approaches to improving nutritional support for children in communities around the world and to global health efforts more broadly.

Background: As population aging intensifies, it becomes increasingly important to elucidate the casual relationship between aging and changes in population health. Therefore, our study proposed to develop a systematic attribution framework to comprehensively evaluate the health impacts of population aging.

Methods: We used health-adjusted life expectancy (HALE) to measure quality of life and disability-adjusted life years (DALY) to quantify the burden of disease for the population of Guangzhou. The HALE and DALY projections were generated using both the Bayesian age-period-cohort models and the population prediction models. Changes in HALE and DALY between 2010-2020 and 2020-2030 were decomposed to isolate the effects of population aging. Three scenarios were analyzed  to examine the relative relationship between disease burden and population aging. In Scenarios 1 and 2, the disease burden rates in 2030 were assumed to  either remain at 2020 levels or follow historical trends. In Scenario 3, it was assumed that the absolute numbers of years of life lost (YLL) and years lived with disability (YLD) in 2030 would remain unchanged from the 2020 levels.

Results: Between 2010 and 2020, 56.24% [69.73%] of the increase in male [female, values in brackets] HALE was attributable to the mortality effects in the population aged 60 and over, while - 3.74% [- 9.29%] was attributable to the disability effects. The increase in DALY caused by changes in age structure accounted for 72.01% [46.68%] of the total increase in DALY. From 2020 to 2030, 61.43% [69.05%] of the increase in HALE is projected to result from the mortality effects in the population aged 60 and over, while - 3.88% [4.73%] will be attributable to the disability effects. The increase in DALY due to changes in age structure is expected to account for 102.93% [100.99%] of the total increase in DALY. In Scenario 1, YLL are projected to increase by 45.0% [54.7%], and YLD by 31.8% [33.8%], compared to 2020. In Scenario 2, YLL in 2030 is expected to decrease by - 2.9% [- 1.3%], while YLD will increase by 12.7% [14.7%] compared to 2020. In Scenario 3, the expected YLL rates and YLD rates in 2030 would need to be reduced by 15.3% [15.4%] and 15.4% [15.6%], respectively, compared to 2020.

Conclusions: The disability effects among the elderly population hinder improvements in quality of life, while changes in age structure are the primary driver of disease burden accumulation. To mitigate the excess disease burden caused by population aging, it is essential to achieve a reduction of more than 15% in the disease burden by 2030 compared to 2020. Our proposed attribution framework evaluates the health impacts of population aging across two dimensions: quality of life and disease burden. This framework enables comparisons of these effects over time and across different regions.

Utilizing innovative methods to advance the research and development (R&D) of health products and enhance their accessibility has become crucial to achieving universal health coverage, addressing public health emergencies, and promoting population health and wellbeing. However, structural contradictions do exist in the supply and demand of health products in the Association of Southeast Asian Nations (ASEAN). With the joint support of the Ministry of Science and Technology of China, the Ministry of Education, and the China-ASEAN Center, Peking University established the China-ASEAN Science and Technology Cooperation Center for Public Health in April 2023. The Center held the Second Annual Forum on China-ASEAN Cooperation in Public Health on June 26-28, 2024, and the participants reached consensus on launching the China-ASEAN Beijing Declaration on Cooperation in Innovation of Health Products and Technologies, which calls on China and ASEAN countries to carry out the following actions: (1) Establish a more effective, open, and inclusive cooperation mechanism for health product innovation towards a China-ASEAN innovation ecosystem; (2) Enhance R&D capabilities by targeting new technologies, methods and appropriate and affordable health products for key populations and addressing diseases prevalent in China and ASEAN; (3) Establish a China-ASEAN Collaboration Center for Health Product Innovation, coordinate regional development plans, and enhance equitable access to pharmaceutical products at the regional level; (4) Accelerate regulatory harmonization in the region by optimizing and improving regulatory modalities of China and ASEAN Countries; and (5) Strengthen cross-sectoral cooperation to build resilient health system and achieve sustainable development of innovation cooperation. The Declaration will play an active role in regional public health governance and development cooperation, in order to promote the R&D and accessibility of health products in the region and to help achieve faster and more equitable access to health products for a broader population.

There is a growing tendency in global discourse to describe a health issue as a security issue. But why is this health security language and framing necessary during times of crisis? Why is the term "health security" used when perhaps simply saying "public health" would do? As reference to 'health security' grows in contemporary discourse, research, advocacy, and policymaking, its prominence is perhaps most consequential in public health. Existing power dynamics in global health are produced and maintained through political processes. Securitisation of health, which facilitates urgent and exceptional measures in response to an event, is a politically charged process with the tendency to further marginalise already marginalised individuals, groups, and nations. By exploring the ethical and practical consequences of a powerful actor's move to securitise health, the essay highlights the importance of considering the perspectives and well-being of marginalised individuals, groups and nations who may be impacted by the move. The essay challenges the assumption that securitising health or framing health as a security issue necessarily leads to good outcomes. It highlights the historical roots and explores the contemporary implications of "health security", and invites critically informed discourse on its use within global health.

Malaria vector surveillance is required to determine disease transmission dynamics, vector insecticide susceptibility status, suitable control strategies and impact of control interventions. However, capacity and resources for vector surveillance and insecticide resistance monitoring is often inadequate in most countries at risk of vector-borne diseases. Collaborations and linkages between malaria control policy makers and existing research institutions generating vector surveillance research data are often weak, thereby hindering the availability of data for decision-making. A national vector surveillance programme, mobilizing all stakeholders towards quality data generation and policy making, is required for effective data-driven country-wide vector control. This paper provides an analysis and suggested future directions for such synergized national malaria vector surveillance and insecticide resistance monitoring system currently being implemented by all research and policy stakeholders in Nigeria. The harmonized national vector surveillance system described here can be used as a model for the development or improvement of such structures in other countries with high malaria transmission risks.