BMJ Global Health最新文献

The frequent criticism of a programme of reparations for Black Americans is that, however justified, no feasible blueprint exists for its implementation. We provide a detailed outline of a viable plan for reparations for Black American descendants of persons enslaved in the USA. Central to the plan are monetary payments calculated to eliminate the racial wealth gap, the foremost economic indicator of the cumulative, intergenerational effects of White supremacy. Closing the racial wealth gap can, in turn, contribute significantly to reducing racial disparities in health, including overall life expectancy. By providing a comprehensive and actionable plan, it becomes clear that the primary obstacle to adoption of reparations by the US Congress is political resistance. The article concludes with a discussion of the current political climate regarding reparations in the USA and an assessment of whether there are grounds for optimism for progress in the reparations movement.

Beginning in the 1980s and 1990s, the International Monetary Fund (IMF) and the World Bank implemented neoliberal structural adjustment programmes (SAPs) across most countries in Asia, Africa and Latin America. SAPs imposed austerity, privatisation and economic deregulation and have been associated with severe negative impacts on human welfare, including (a) declining real wages and working-class consumption, (b) increased rates of poverty and basic-needs deprivation, (c) increased neonatal and maternal mortality and (d) reduced health system access. Structural adjustment also created conditions for increased financial outflows and drain from the global South through unequal exchange. This paper reviews evidence of these damages and proposes possible options for reparations and distributive justice. We argue that the IMF and the World Bank should be democratised and restructured-or otherwise replaced by alternative institutions-to prevent further harm.

The reparations movement has emerged as a critical global force addressing the historical injustices of slavery, colonialism and underdevelopment. Grounded in the 2001 World Conference Against Racism, Discrimination, Xenophobia and Related Intolerance, the movement has gained momentum through regional bodies like the Caribbean Community Reparations Commission (CRC). This article examines the intersection of colonialism, enslavement and contemporary challenges related to health and the environment-highlighting the Caribbean as a focal point for reparatory and environmental justice. It underscores how legacies of depredation, including structural underdevelopment and path-dependent health inequities, exacerbate the region's vulnerability to climate change and its impacts, such as severe hurricanes and rising sea levels. The CRC's Ten-Point Action Plan offers a comprehensive reparations strategy, encompassing formal apologies, debt cancellation, cultural preservation and public health investment. We advocate for reparative and decolonial approaches to rectify historical wrongs while addressing present and future ecological crises.

Background: Injury burden is high in low-income and middle-income countries (LMICs). Delays in accessing definitive care after injury beyond the 'golden' hour or 2 hours worsen outcomes. We examined delays in accessing definitive healthcare after injury and whether their magnitude and associations differ across four diverse LMICs: Ghana, Pakistan, Rwanda and South Africa.

Methods: Across 19 hospitals providing definitive care for injuries in urban or rural settings, we enrolled patients with moderate to severe injuries who were hospitalised for at least 12 hours. The time between injury and admission for definitive care and perceived reasons for delays in seeking and reaching care were captured. The association between more than 1-hour delay to reaching definitive care and age, sex, education, wealth, injury mechanism or severity, prior healthcare encounters, ambulance transport, the hospital type and catchment area was evaluated in a multivariable model. Patients' perceived reasons for delay in seeking and reaching care were described. Findings were compared between countries.

Result: Data on delays were available for 8331 patients, of whom 57.3% experienced delays exceeding 1 hour. Prior healthcare encounter before definitive care showed the strongest association with delay (OR: 8.44, 95% CI 7.41 to 9.60). Delays were associated with older age, less education and wealth, greater injury severity, urban (vs rural) catchment area, ambulance transport, injury mechanism due to falls or fire (vs road traffic collision) and tertiary (vs secondary) hospital admission in the adjusted model. Ghana and Rwanda showed the lowest and highest odds of delays compared with South Africa, respectively. Only 18.8% of patients perceived being delayed, most citing unawareness of urgency and ambulance unavailability as reasons.

Conclusions: Most injured patients do not arrive at definitive care within the critical golden hour, with delays inequitably affecting the population. Improvements in pathways to care are needed to reduce delays across healthcare systems.

Climate change is already leading to loss of health for some people and this is expected to intensify as climate change increases. Moreover, ill health from climate change is experienced unevenly: overall, those who have been least responsible for causing the problem are often those most vulnerable to these losses due to the intersection of climate-related health threats with structural inequality. In this context, there have been multiple arguments made for reparations intended to address disproportionate climate impacts. While the United Nations Framework Convention on Climate Change has been a focus for these efforts, due to political challenges, a more distributed, multifaceted approach to reparations may be needed. This analysis provides a summary of reparative arguments and identifies multiple potential pathways towards reparative efforts intended to address losses in health due to climate change.

Introduction: The guideline development process for the WHO guideline on prevention and management of wasting and nutritional oedema highlighted extensive evidence gaps. We, the WHO Steering Committee and methodologists for the 2023 WHO guideline, therefore aimed to develop a comprehensive global research priority agenda for wasting and nutritional oedema in infants and children. It has a timeframe up to 2030 aligning with the Sustainable Development Goals and Global Nutrition Targets related to wasting and nutritional oedema.

Methods: We used a Child Health and Nutrition Research Initiative (CHNRI) exercise to develop this research priority agenda for four populations and topics of interest: (1) infants less than 6 months of age at risk of poor growth and development; (2) infants and children 6-59 months of age with severe wasting and/or nutritional oedema; (3) infants and children 6-59 months of age with moderate wasting and (4) prevention of wasting and nutritional oedema. For this CHNRI process, we conducted two anonymous surveys, the first to ensure the list of research questions was comprehensive and clear, and the second to score research questions based on their answerability, effectiveness, deliverability and effects on equity.

Results: 63 people from 28 countries completed survey 1 and 50 people from 23 countries completed survey 2. We identified 10 priority research questions for each of the four populations and topics of interest, which had median research priority scores of 89.9 (IQR 2.8) and average expert agreement scores with a median of 83.4 (IQR 4.5) indicating high agreement. The research questions are largely focused on delivery and effectiveness of interventions for prevention and management of wasting and nutritional oedema rather than discovery or development.

Conclusions: This research priority agenda will guide researchers and research institutions, funders and others to address pressing research questions on wasting and nutritional oedema.

Conflict-related sexual violence (CRSV) generates devastating harms that affect the individual victim (female, male, Lesbian, Gay, Bisexual, Transgender, Intersex, Queer and inclusive of other orientations (LGBTIQ+), disabled, young and elderly), families, communities and the whole fabric of society. CRSV is a public health concern as it can lead to health consequences including physical, psychosocial and stigma-related harms that are exacerbated by a lack of healthcare infrastructure. There has been some progress on understanding the harm, but data gaps prevail due to practical reasons, definitional problems and stigma.When violations of human rights or humanitarian law take place, diverse harms can occur, and victims have a right to reparation as enshrined in international law. Reparation aims to address, as far as possible, the multiple harms victims suffer and to positively transform their lives. The right to reparation is fulfilled through a victim-centred process and delivered via appropriate forms of reparation: restitution, compensation, rehabilitation, satisfaction measures and guarantees of non-repetition. When implemented in a timely, participatory and inclusive manner, reparations can have a transformative impact on victims of CRSV. The process should be prompt and combined with individual monetary and rehabilitation measures alongside clear institutional and societal reforms to ensure the non-repetition of such violations. Domestic reparation programmes, fully supported by government and other stakeholders such as health professionals, offer the most sustainable framework for achieving these goals.

In 2005, the governments of Bangladesh, India and Nepal, in partnership with the WHO, started the Kala-azar Elimination Programme (KEP) to reduce the incidence of visceral leishmaniasis to below 1 new case in 10 000 population. The target was achieved by Bangladesh in 2017 and validated in 2023. The KEP has demonstrated that, through a concerted approach and public-private partnership, it is possible to eliminate visceral leishmaniasis from the world's highest endemic region, Southeast Asia. The experience learnt can be used elsewhere for visceral leishmaniasis as well as for other diseases targeted for elimination.

Community engagement and approaches that aim to change unequal power relations are essential for inclusive, relevant and sustainable health interventions. A people-centred approach to research and programme implementation can amplify the voices of disadvantaged and often forgotten people and move towards genuine partnership with the communities, ensuring that research and action meaningfully reflect the priorities and realities of those most affected.