Impact of Early Life or Intrauterine Factors and Socio-Economic Interaction on Diabetes - An Evidence on Thrifty Hypothesis

Diabetes mellitus is one of the most concerning non-communicable diseases worldwide. The prevalence of diabetes increased rapidly by the influence of socioeconomic interactions. The thrifty hypothesis postulates that certain genes that are involved in positive selection promote efficient fat deposition and storage. This is beneficial for the survival of mankind in adverse conditions. However, in this modern society, these genes have become disadvantageous as people are significantly less likely to experience famines and nutrition shortages. The socioeconomic development that has occurred during the 20th century induced abundance of food supplies in almost all regions of the world. This has led to a rapid rise in the prevalence of obesity, and type 2 diabetes as a consequence. Boom of diabetic pandemic in newly developed countries compare with others those who developed gradually can be explain by thrifty hypothesis, as a result of the difference in the exposure to environmental factors and famine by the ancestors leads. The globalization, urbanization, lack of physical activity, intake of high calorie food and migration is major cause of pandemic emergence of diabetes in high as well as middle and low-income countries.

The international partner universities of East African health professional programmes: why do they do it and what do they value?

Background

Globalization and funding imperatives drive many universities to internationalize through global health programmes. University-based global health researchers, advocates and programmes often stress the importance of addressing health inequity through partnerships. However, empirical exploration of perspectives on why universities engage in these partnerships and the benefits of them is limited.

Objective

To analyse who in international partner universities initiated the partnerships with four East African universities, why the partnerships were initiated, and what the international partners value about the partnerships.

Methods

Fifty-nine key informants from 26 international universities partnering with four East African universities in medicine, nursing and/or public health participated in individual in-depth interviews. Transcripts were analysed thematically. We then applied Burton Clark’s framework of “entrepreneurial” universities characterized by an “academic heartland”, “expanded development periphery”, “managerial core” and “expanded funding base”, developed to examine how European universities respond to the forces of globalization, to interpret the data through a global health lens.

Results

Partnerships that were of interest to universities’ “academic heartland” - research and education - were of greatest interest to many international partners, especially research intensive universities. Some universities established and placed coordination of their global health activities within units consistent with an expanded development periphery. These units were sometimes useful for helping to establish and support global health partnerships. Success in developing and sustaining the global health partnerships required some degree of support from a strengthened steering or managerial core. Diversified funding in the form of third-stream funding, was found to be essential to sustain partnerships. Social responsibility was also identified as a key ethos required to unite the multiple elements in some universities and sustain global health partnerships.

Conclusion

Universities are complex entities. Various elements determine why a specific university entered a specific international partnership and what benefits it accrues. Ultimately, integration of the various elements is required to grow and sustain partnerships potentially through embracing social responsibility as a common value.

Urbanization-globalization-CO2 emissions nexus revisited: empirical evidence from South Africa

The environmental effects of urbanization and globalization are still subject to debate among scholars. South Africa is the most globalized, most urbanized and the most carbon-intensive economy in Sub Saharan Africa (SSA) region. Taking this into cognizance, this study examines the effects of urbanization and globalization on CO2 emissions for South Africa using time series annual data for the period 1980-2017. Zivot and Andrews single and Bai and Perron multiple structural break unit root tests are employed to assess if all the series are stationary. This procedure follows ARDL cointegration test to check the presence of a long-run association among variables. Having been confirmed about such a cointegrating relation, ARDL short-run and long run coefficients indicate that urbanization induces CO2 emissions while only long-run significant emissions effect of globalization was noted. Toda-Yamamoto non-causality test reports a bi-directional causal link between urbanization and CO2 emissions. No causal link is observed between globalization and CO2 emissions. Variance decomposition results do not rule out these effects in future. Policy implications are discussed.

Climate change and human health linkages in the context of globalization: An overview from global to southwestern coastal region of Bangladesh

This article attempts to analyze the main impacts of climate change on public health starting with global and going through local by analyzing coastal communities in the area of influence of Sundarbans, located in southwestern coastal region of Bangladesh. In dealing with paramount health problems caused by climate change, we discuss what are the major challenges faced by different actors. From the opinion of globalization and world system theory it will be argued that developing countries are facing major defiance in terms of mitigation and adaptation, including human health problems. Those living in developing world, as the case of Bangladesh, responsible for the lowest contributions to climate change, are already suffering the most. This paper is based on bibliographical and statistical review, and uses primary data collected from field and secondary from publications, books, scientific journals, international reports. In this paper we also focused that poor countries shall not be liable for the damages caused by carbon emissions already trapped into atmosphere, a historic problem caused by developed world, so we expect that multi-governance platforms should make mutual efforts to promote health in partnership with local institutions in order to solve the climatic crisis.

Does globalization increase the ecological footprint? Empirical evidence from Malaysia

This study focuses to investigate the relationship between globalization and the ecological footprint for Malaysia from 1971 to 2014. The results of the Bayer and Hanck cointegration test and the ARDL bound test show the existence of cointegration among variables. The findings disclose that globalization is not a significant determinant of the ecological footprint; however, it significantly increases the ecological carbon footprint. Energy consumption and economic growth stimulate the ecological footprint and carbon footprint in Malaysia. Population density reduces the ecological footprint and carbon footprint. Further, financial development mitigates the ecological footprint. The causality results disclose the feedback hypothesis between energy consumption and economic growth in the long run and short run.

Food security in 2044: How do we control the fungal threat?

Plant fungal pathogens place considerable strain on agricultural productivity and threaten global food security. In recent decades, advances in crop breeding, farming practice and the agrochemical industry have allowed crop yields to keep pace with food demand. In this opinion article, we speculate on which recent technological advances will allow us to maintain this situation into the future. We take inspiration that it is 25 y since the first plant disease resistance genes were cloned, and imagine if and how agricultural control of pathogens will be achieved by the year 2044. We examine which technologies are best poised to make the jump from lab bench to field application, and propose that future control measures will likely depend on effective integrated disease management.

Inequality in body mass indices across countries: Evidence from convergence tests

This study examines the long-term inequality in body mass index (BMI) based on convergence tests applied to a database of 172 countries recently published by the NCD Risk Factor Collaboration. First, we find that countries converge in clubs, which indicates that country disparities in BMIs will persist over time. Second, there are three and six convergence clubs in BMIs for female and male individuals, respectively. That is, we would not observe a single convergence pattern in body weights as the nutrition transition theory and the dietary convergence hypothesis seem to suggest. Females have only one healthy club (18.5 ≤ BMI < 25) and two overweight clubs (BMI ≥ 25). Males have three healthy clubs and three overweight clubs. Third, the analysis of club convergence indicates that BMI inequality has increased due to the BMI growth observed in club 1 (the one with the highest average BMI and led by the US) in each gender group. Finally, potential determinants of BMI such as globalization, human capital, income, and urbanization are relevant to understand differences across clubs. We interpret the club convergence as the result of a heterogeneous integration of countries into the global economy, which is probably related to strong domestic preferences, policies designed to manage the impacts of globalization, and shifts in productive structures.

The impact of globalization and financial development on environmental quality: evidence from selected countries in the Organization for Economic Co-operation and Development (OECD)

This study investigates the impacts of globalization and financial development on environmental quality by incorporating energy consumption in the framework of the Environmental Kuznets Curve (EKC) hypothesis for selected countries in the Organization for Economic Co-operation and Development (OECD) over the 1990-2014 time spans. The cross-sectional dependence is determined by using the cross-sectional dependence and Lagrange Multiplier (LM) methods. This study employs second-generation panel unit root tests to check the unit root properties and the Westerlund panel cointegration test to examine the long-run equilibrium relationship among the variables. The results confirm the presence of cointegration in the long run. The Continuously Updated Fully Modified Ordinary Least Square (CUP-FM) and Continuously Updated Bias-Corrected (CUP-BC) approaches are applied to investigate long-term output elasticities of the variables. The results show the stimulating role of energy consumption on Carbon dioxide (CO₂) emissions. This study finds support for the EKC hypothesis as it relates to selected OECD countries. Globalization and financial development increase environmental quality by reducing CO₂ emissions. The causal relationship reveals the presence of a bidirectional relationship between energy consumption and CO₂ emissions. The feedback causal effect runs between economic growth and CO₂ emissions and between globalization and economic growth, while unidirectional causality runs from CO₂ emissions to financial development, from economic growth to energy consumption, from energy consumption to financial development, from globalization to energy consumption, and from globalization to financial development. Policies that support green technology transfer among OECD countries, foreign direct investment in the renewable energy sector, financial development to support green infrastructure, and energy generation using renewable energy sources are recommended.

Testing the relationship between globalization and carbon dioxide emissions in Pakistan: does environmental Kuznets curve exist?

Over the last few decades, the atmospheric carbon dioxide emission has been amplified to a great extent in Pakistan. This amplification may cause global warming, climate change, and environmental degradation in Pakistan. Consequently, ecological condition and human life may suffer in the near future from these indicated threats. Therefore, an attempt was made to test the relationship between globalization and carbon dioxide emissions in case of Pakistan. The study covers the time series data over the period of 1975-2014. We employed modern econometric techniques such as Johansen co-integration, ARDL bound testing approach, and variance decomposition analysis. Results of the Johansen co-integration test show that there is a significant long-run relationship between carbon dioxide emissions and globalization. The long-run elasticities of the ARDL model show that a 1% increase in economic globalization, political globalization, and social globalization will increase carbon dioxide emissions by 0.38, 0.19, and 0.11%, respectively. Further, our findings reveal that the environmental Kuznets curve (EKC) hypothesis prevails an inverted U-shaped relationship between carbon dioxide emission and economic growth. Therefore, the EKC hypothesis is valid in the presence of globalization. The diagnostic test results show that the parameters of the ARDL model are credible, stable, and reliable in the current form. Finally, variance decomposition analysis displays that economic, political, and social globalization are contributing significantly to carbon dioxide emissions in Pakistan.

Natural resources, globalization, and economic growth: evidence from Pakistan

Globalization is increasingly a driving force behind vibrant economies around the world. This paper discusses the impact of globalization and natural resources on economic growth from 1970 to 2014 in Pakistan. Based on an auto-regressive distributive lag (ARDL) model, the paper infers that globalization promotes economic growth in Pakistan. Natural resources also contribute to economic growth, as the causality results suggest bi-directional causality between globalization and use of natural resources. Policy implications are that countries should emphasize security, increase exports, encourage technological strength, and increase its intellectual management capacity.

What is driving global obesity trends? Globalization or "modernization"?

BACKGROUND

Worldwide obesity has more than doubled since 1980. Researchers have attributed rising obesity rates to factors related to globalization processes, which are believed to contribute to obesity by flooding low-income country markets with inexpensive but obesogenic foods and diffusing Western-style fast food outlets (dependency/world systems theory). However, alternative explanations include domestic factors such as increases in unhealthy food consumption in response to rising income and higher women's labor force participation as countries develop economically ("modernization" theory). To what extent are processes of globalization driving rising global overweight/obesity rates versus domestic economic and social development processes? This study evaluates the influence of economic globalization versus economic development and associated processes on global weight gain.

RESULTS

Using two-way fixed-effects OLS regression with a panel dataset of mean body weight for 190-countries over a 30-year period (1980-2008), we find that domestic factors associated with "modernization" including increasing GDP per capita, urbanization and women's empowerment were associated with increases in mean BMI over time. There was also evidence of a curvilinear relationship between GDP per capita and BMI: among low income countries, economic growth predicted increases in BMI whereas among high-income countries, higher GDP predicted lower BMI. By contrast, economic globalization (dependency/world systems theory) did not significantly predict increases in mean BMI and cultural globalization had mixed effects. These results were robust to different model specifications, imputation approaches and variable transformations.

DISCUSSION

Global increases in overweight/obesity appear to be driven more by domestic processes including economic development, urbanization and women's empowerment, and are less clearly negatively impacted by external globalization processes suggesting that the harms to health from global trade regimes may be overstated.

Sugar-sweetened beverage affordability and the prevalence of overweight and obesity in a cross section of countries

Background

A key component of ‘obesogenic environments’ is the ready availability of convenient, calorie-dense foods, in the form of hyper-palatable and relatively inexpensive ultra-processed products. Compelling evidence indicates that the regular consumption of soft drinks, specifically carbonated and non-carbonated sugar-sweetened beverages (SSBs), has a significant impact on the prevalence of overweight and obesity. However, to implement country-level effective prevention programmes we need to supplement this evidence with quantitative knowledge of the relationships between overweight/obesity and the main determinants of SSB consumption, notably SSB prices and consumers’ disposable income.

Method

Affordability considers the simultaneous effects of both price and disposable income on the buying decision. The purpose of this study was to investigate the effect of SSB affordability on the consumers’ purchasing behaviour and weight-related health outcomes. Our study was divided into three parts. First, we computed SSB consumption and affordability for approximately 150 countries worldwide. Second, we estimated a demand function for SSBs to assess the impact of affordability on consumption at the country level. Third, we used a multivariate regression model and country data on the prevalence of overweight and obesity to test the role of SSB affordability in the current obesity epidemic.

Results

The analysis reveals that SSB affordability: 1) showed both a large variability across countries and a clear tendency to increase substantially with the level of economic development; 2) played a key role in determining cross-country differences in the amount of soft drink consumed per capita; and 3) was significantly associated with the prevalence rates of both overweight and obesity. Specifically, we show that a 10 % increase in SSB affordability was associated, on average, with approximately 0.4 more overweight/obese adults per 100 inhabitants.

Conclusions

By controlling for the main possible confounding factors, our results clearly indicate that affordability is a major driver of purchasing behaviours and is significantly associated with the prevalence rates of both overweight and obesity. We thus suggest a fiscal approach to curb SSB consumption based on the effectiveness of ‘soda taxes’ to affect the long-term dynamic of SSB affordability.

Electronic supplementary material

The online version of this article (10.1186/s12992-019-0474-x) contains supplementary material, which is available to authorized users.

The aftermath of resilience in the global world

Just as there is an aftermath of trauma, there is reason to think of an aftermath of resilience, different from the resilience capacities developed after a trauma. The aftermath of resilience reflects the ability to activate resilient memory in response to traumatic memory in order to rebuild oneself. This is a major challenge for the global mental health of our fragile societies. The challenge is significant for France, Europe and the world. Beyond the overuse of the word resilience in scientific literature and the media, it contributes to the methodology, epistemology and politics of resilience.

Examining the impact of globalization in the environmental Kuznets curve hypothesis: the case of tourist destination states

This paper examines the relationship between carbon emissions and international tourism growth through the channels of globalization, energy consumption, and real income via testing the environmental Kuznets curve over the periods of 1995 to 2014 for 15 selected tourism destination states that prioritized tourism as a means of maximizing economic growth. Using the panel data analysis, results confirm globalization-tourism-induced EKC hypothesis for tourist destination states. This implies international tourism growth and carbon emissions, through the channels of energy consumption, globalization, and real income, are in a long-term equilibrium relationship. International tourism and squared term of real income have an inverse significant effect on carbon emission level, while energy consumption, globalization, and real income without squared term exert positive and significant effects on carbon emission level in the long-run. Thus, globalization-tourism-induced EKC hypothesis is suggested with credible policy suggestions in the case of tourist destination states.

Idolization and ramification between globalization and ecological footprints: evidence from quantile-on-quantile approach

Globalization persists the tendency to alter numerous aspects of today's world including religion, transport, language, living styles, and international relations; however, its potential to influence quality of environment is the prime concern for trade and environmental policies guidelines (Audi and Ali 2018). In response to the growing interest for identifying the dynamic relationship between globalization and environmental performance, the present study seeks to investigate the critical link between globalization and ecological footprints in top 15 globalized countries between 1970 and 2016. Applying the novel methods of quantile-on-quantile regression (QQ) and Granger causality in quantiles, the findings examine the manners in which quantiles of globalization affect the quantiles of ecological footprints and vice versa. The empirical results suggest that globalization has a long-term positive effect on ecological footprint and vice versa in case of Belgium, the Netherlands, Sweden, Switzerland, Denmark, Norway, Canada, and Portugal. On the other hand, the estimated results indicate a negative effect between globalization and ecological footprint in the case of France, Germany, the UK, and Hungary. These results extend the recent findings on the globalization-environment nexus implying that the magnitude of relationship among both variables varies with countries demanding individual focus and cautions for postulating environmental and trade policies.

Globalization of pediatric research: pharmacological RCTs in Latin America

Globalization caused a shift in trial locations towards low-middle income countries, raising ethical concerns. These include the risk that conditions primarily affecting children in these countries will be neglected in favor of those affecting developed countries. We analyzed 253 published and 69 ongoing pharmacological RCTs performed in Latin America between 2000 and 2015 involving exclusively children. While over 50% of the previously highly investigated diseases were no longer priorities, other diseases acquired greater attention in recent years. Brazil and Mexico resulted as the most active countries. A large gap remains between the real needs of children in these countries and scientific research.

Does information and communication technologies improve environmental quality in the era of globalization? An empirical analysis

This study intends to examine the impact of ICTs (i.e., internet usage and mobile cellular subscriptions), globalization, electricity consumption, financial development, and economic growth on environmental quality by using 1994-2014 panel data of BRICS economies. This study employed a second-generation panel unit root test accounting for the presence of cross-sectional dependence and indicated that carbon dioxide emissions, electricity consumption, financial development, internet usage, mobile usage, globalization, and economic growth have integration of order one. The results from Westerlund panel co-integration test confirms that the variables are co-integrated and revealed that ICT-finance-globalization-electricity-GDP-CO₂ nexus has long-run equilibrium relationship. The results from dynamic seemingly unrelated regression (DSUR) indicate that internet usage and mobile cellular subscriptions (ICTs) have significant, adverse impact on carbon dioxide emissions. To put it simply, ICT positively contributes towards environmental quality. Similarly, economic growth also has an adverse effect on carbon dioxide emissions. On the other hand, electricity consumption, globalization, and financial development have a significant positive effect on carbon emissions. In addition, Granger causality test results show the presence of a bidirectional causal relationship between internet usage and environmental quality, financial development and electricity consumption, ICT and financial development, mobile cellular subscription and globalization, economic growth and environmental quality, and internet usage and economic growth. A unidirectional causal link is detected running from mobile cellular subscriptions towards environmental quality, ICT towards electricity consumption, financial development towards environmental quality, globalization towards environmental quality, and globalization towards economic growth. Moreover, time series analysis has also been done in this study to analyze the findings for each of BRICS countries which are directed towards important policy implications. For instance, ICT policy can play an integral part in improving environmental quality policy.

Economic globalization, nutrition and health: a review of quantitative evidence

Background

Unhealthy dietary patterns have in recent decades contributed to an endemic-level burden from non-communicable disease (NCDs) in high-income countries. In low- and middle-income countries rapid changes in diets are also increasingly linked to malnutrition in all its forms as persistent undernutrition and micronutrient deficiencies continue to coexist with a rising prevalence of obesity and associated NCDs. Economic globalization and trade liberalization have been identified as potentially important factors driving these trends, but the mechanisms, pathways and actual impact are subject to continued debate.

Methods

We use a ‘rigorous review’ to synthesize evidence from empirical quantitative studies analysing the links between economic globalization processes and nutritional outcomes, with a focus on impact as well as improving the understanding of the main underlying mechanisms and their interactions.

Findings

While the literature remains mixed regarding the impacts of overall globalization, trade liberalization or economic globalization on nutritional outcomes, it is possible to identify different patterns of association and impact across specific sub-components of globalization processes. Although results depend on the context and methods of analysis, foreign direct investment (FDI) appears to be more clearly associated with increases in overnutrition and NCD prevalence than to changes in undernutrition. Existing evidence does not clearly show associations between trade liberalization and NCD prevalence, but there is some evidence of a broad association with improved dietary quality and reductions in undernutrition. Socio-cultural aspects of globalization appear to play an important yet under-studied role, with potential associations with increased prevalence of overweight and obesity. The limited evidence available also suggests that the association between trade liberalization or globalization and nutritional outcomes might differ substantially across population sub-groups.

Overall, our findings suggest that policymakers do not necessarily face a trade-off when considering the implications of trade or economic liberalization for malnutrition in all its forms. On the contrary, a combination of nutrition-sensitive trade policy and adequate regulation of FDI could help reduce all forms of malnutrition. In the context of trade negotiations and agreements it is fundamental, therefore, to protect the policy space for governments to adopt nutrition-sensitive interventions.

Electronic supplementary material

The online version of this article (10.1186/s12992-019-0456-z) contains supplementary material, which is available to authorized users.

The health impacts of extractive industry transnational corporations: a study of Rio Tinto in Australia and Southern Africa

BACKGROUND

Operations of transnational corporations (TNCs) affect population health through production methods, shaping social determinants of health, or by influencing regulation of their activities. Research on community exposures to TNC practices and policies has been limited. Our research on extractive industries examined Rio Tinto in Australia and Southern Africa to test methods for assessing the health impacts of corporates in high and middle income jurisdictions with different regulatory frameworks.

METHODS

We adapted existing Health Impact Assessment methods. Data identifying potential impacts were sourced through media analysis, document analysis, company literature and semi-structured interviews. The data were mapped against a corporate health impact assessment framework (CHIA) which included Rio Tinto's political and business practices; productions; and workforce, social, environmental and economic conditions.

RESULTS

Both positive and detrimental aspects of Rio Tinto's operations were identified. Requirements imposed by Rio Tinto on its global supply chain are likely to have positive health impacts for workers. However, political lobbying and membership of representative organisations can influence government policy in ways that are unfavourable to health and equity. Positive impacts include provision of direct employment under decent working conditions, but countered by an increase in precariousness of employment. Commitments to upholding sustainable development principles are undermined by limited site remediation and other environmental impacts. Positive contributions are made to national and local economies but then undermined by business strategies that include tax minimisation.

CONCLUSION

Our study confirmed that it is possible to undertake a CHIA on an extractive industry TNC. The different methods provided sufficient information to understand the need to strengthen regulations that are conducive to health; the opportunity for Rio Tinto to extend corporate responsibility initiatives and support their social licence to operate; and for civil society actors to inform their advocacy towards improving health and equity outcomes from TNC operations.

The effects of urbanization and globalization on CO2 emissions: evidence from the Sub-Saharan Africa (SSA) countries

Ecological modernization theories suggest that it is hard to determine a priori the environmental effects of urbanization, while neoliberal doctrine advocates a positive role of globalization in developing economies especially in terms of reducing poverty and inequality. Yet, the environmental effect of globalization is not unanimous. This study employs second-generation panel regression techniques that account for heterogeneous slope coefficients and cross-sectional dependence to estimate the impacts that urbanization and globalization have on CO₂ emissions for a panel of 44 Sub-Saharan Africa (SSA) countries for the period 1984-2016. Also, a causality test that considers both these issues is performed. The estimated coefficient of urbanization is positive, statistically significant, and highly consistent across different estimation techniques. The magnitude of the coefficient and level of significance are different in different econometric estimations. In most specifications, the estimated coefficient on the globalization variable is statistically insignificant. Urbanization is found to cause emissions. The environmental implications of these results are discussed with a set of policy recommendations for an environmentally better SSA region.

The health of workers in the global gig economy

Background

The “gig” economy connects consumers with contractors (or workers) through online platform businesses to perform tasks (or “gigs”). This innovation in technology provides businesses and consumers access to low-cost, on-demand labour, but gig workers’ experiences are more complex. They have access to very flexible, potentially autonomous work, but also deal with challenges caused by the nature of the work, its precariousness, and their relationships with the platform businesses. Workers in the Global North and South may also experience these challenges very differently. Based on our report “Towards an Understanding of Canadian Workers in the Global Gig Economy”, we present a commentary on the implications of a globalized online platform labour market on the health of gig workers in Canada and globally.

Main body

Based on our scoping review of peer and grey literature, we categorized gig worker vulnerabilities in three ways: 1) occupational vulnerabilities, 2) precarity, and 3) platform-based vulnerabilities. Occupational vulnerabilities are connected to the work being performed (e.g. driving a car or computer work) and are not specific to platform labour. Precarity refers to the short-term, contingent nature of the work, characteristics that may be shared with other forms of work. Some examples of precariousness are lack of health insurance, collective bargaining, or career training and promotion. Finally, platform-based vulnerabilities are particular to the way platform labour is structured. These vulnerabilities include worker misclassification, information asymmetries, and the culture of surveillance. We suggest that, together, these vulnerabilities challenge gig workers’ right to health.

Conclusions

We propose that the experience of gig workers around the world must be understood in the context of neoliberalism, which has increased both the globalization and precaritization of work. While gig workers share some vulnerabilities, which have important negative consequences on their health, with other workers, the platform-specific vulnerabilities of workers require further inquiry. In particular, the specific health and overall experience of gig workers in different regions of the world – with different labour policies and sociopolitical contexts for work – must be disentangled as workers in the Global North and South experience this work very differently.

The importance of national levels of eudaimonic well-being to life satisfaction in old age: a global study

PURPOSE

The present study sought to test the hypotheses that the relationship between age and life satisfaction is moderated by five societal factors: (1) eudaimonic well-being (i.e., psycho-social functioning), (2) economic quality, (3) healthcare system efficiency, (4) globalization, and (5) national age.

METHODS

This study was a cross-sectional analysis based on data from the Gallup World Poll. The sample consisted of 264,123 individuals across 133 countries. Multi-level modeling was used to analyze the data.

RESULTS

The results showed that out of the five moderators, only national levels of eudaimonic well-being robustly moderated the relationship between age and life satisfaction. The relationship between age and life satisfaction was negative in countries with low and moderate levels of eudaimonic well-being, and non-significant in countries with high levels of eudaimonic well-being.

CONCLUSION

It seems that a non-financial way to maintain higher levels of life satisfaction in aging populations is to enhance eudaimonic well-being. This can be achieved through interventions and policies targeted at individuals, groups, and organizations.

Global supermarkets' corporate social responsibility commitments to public health: a content analysis

Background

Supermarkets have unprecedented political and economic power in the food system and an inherent responsibility to demonstrate good corporate citizenship via corporate social responsibility (CSR). The aim of this study was to investigate the world’s largest and most powerful supermarkets’ publically available CSR commitments to determine their potential impact on public health.

Methods

The world’s largest 100 retailers were identified using the Global Powers of Retailing report. Thirty-one supermarkets that published corporate reports referring to CSR or sustainability, in English, between 2013 and 2018, were included and thematically analysed.

Results

Although a large number of themes were identified (n = 79), and there were differences between each business, supermarket CSR commitments focused on five priorities: donating surplus food to charities for redistribution to feed the hungry; reducing and recovering food waste; sustainably sourcing specific ingredients including seafood, palm oil, soy and cocoa; governance of food safety; and growing the number of own brand foods available, that are made by suppliers to meet supermarkets’ requirements.

Conclusions

CSR commitments made by 31 of the world’s largest supermarkets showed they appeared willing to take steps to improve sustainable sourcing of specific ingredients, but there was little action being taken to support health and nutrition. Although some supermarket CSR initiatives showed promise, the world’s largest supermarkets could do more to use their power to support public health. It is recommended they should: (1) transparently report food waste encompassing the whole of the food system in their waste reduction efforts; (2) support healthful and sustainable diets by reducing production and consumption of discretionary foods, meat, and other ingredients with high social and environmental impacts; (3) remove unhealthful confectionery, snacks, and sweetened beverages from prominent in-store locations; (4) ensure a variety of minimally processed nutritious foods are widely available; and (5) introduce initiatives to make healthful foods more affordable, support consumers to select healthful and sustainable foods, and report healthful food sales as a proportion of total food sales, using transparent criteria for key terms.

Insights into globalization: comparison of patient characteristics and disease progression among geographic regions in a multinational Alzheimer's disease clinical program

BACKGROUND

Globalization of clinical trials has important consequences for trial planning and interpretation. This study investigated heterogeneity in patient characteristics and outcomes among world regions in the global idalopirdine Phase 3 clinical program.

METHODS

Data were pooled from three 24-week randomized controlled trials in patients aged ≥ 50 years with mild-to-moderate Alzheimer's disease (AD) (n = 2506). Patients received idalopirdine (10, 30, or 60 mg/day) or placebo, added to cholinesterase inhibitor treatment. Patients were categorized into the following regions: Eastern Europe/Turkey (n = 759), Western Europe/Israel (n = 709), USA/Canada (n = 444), South America/Mexico (n = 361), Asia (n = 134), and Australia/South Africa (n = 99). For each region, operational characteristics, baseline demographic and clinical characteristics, adverse events, and mean change from baseline to week 24 in clinical rating scale scores (placebo group only) were summarized using descriptive statistics.

RESULTS

Completion rates were 0.86-0.90 in all regions. Heterogeneity among global regions was evident. Protocol deviations were twice as common in South America/Mexico as in USA/Canada (2.64 vs 1.35 per patient screened). Educational level ranged from 9.2 years in South America/Mexico to 13.4 years in USA/Canada. APOE ε4 carriage was 80.6% in Australia/South Africa, 63.1% in Western Europe/Israel, and < 60% in other regions. Screening Mini-Mental State Examination scores were higher in Eastern Europe/Turkey (18.0) and USA/Canada (17.5) than in other regions (16.9-17.1). Baseline AD Assessment Scale-Cognitive subscale (ADAS-Cog) scores ranged from 24.3 in USA/Canada to 27.2 in South America/Mexico. Baseline AD Cooperative Study-Activities of Daily Living, 23-item version (ADCS-ADL23) scores ranged from 58.5 in USA/Canada to 53.5 in Eastern Europe/Turkey. In the placebo group, adverse events were 1.6-1.7 times more common in Western Europe/Israel, USA/Canada, and Australia/South Africa than in Eastern Europe/Turkey. On the ADAS-Cog, Australia/South Africa and Western Europe/Israel showed the most worsening among patients receiving placebo (1.56 and 1.40 points, respectively), whereas South America/Mexico showed an improvement (-0.71 points). All regions worsened on the ADCS-ADL23, from -3.21 points in Western Europe/Israel to -0.59 points in Eastern Europe/Turkey.

CONCLUSIONS

Regional heterogeneity-in terms of study conduct, patient characteristics, and outcomes-exists, and should be accounted for, when planning and conducting multinational AD clinical trials.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT01955161 . Registered on 27 September 2013. ClinicalTrials.gov, NCT02006641 . Registered on 5 December 2013. ClinicalTrials.gov, NCT02006654 . Registered on 5 December 2013.

A Quarter Century of Emerging Infectious Diseases - Where Have We Been and Where Are We Going?

A quarter century ago the landmark report from the U. S. National Academies of Sciences, Engineering, and Medicine entitled "Emerging Infections, Microbial Threats to Health in the United States" was released. This classic study captured the societal changes then underway in our rapidly growing world: The growth of the world's population and changing human behavior; the advances and globalization of technology and industry; the changes in economic development and land use; the dramatic increase in speed and frequency of international travel and commerce; the adaptation of microbes and the appearance of never before seen pathogens; and the breakdown of traditional public health measures. This societal evolution has only increased and the growing frequency of outbreaks foretold in the report has come to pass. Each new disaster has precipitated changes and adaptations in our global response to infectious diseases designed to reduce risks and avoid future outbreaks. We discuss these past events and how each led to change in an effort to mitigate future threats. We also look to the future to consider what challenges might lay ahead.

CONCLUSION

Major outbreaks over the past quarter century validated the concept of emerging infectious diseases and led to improvements in global policies and national public health programs; however, there will likely always be new diseases and the threat of reemergence of diseases once thought controlled leading to a constant need for vigilance in public health preparedness.

Financial development, globalization, and CO2 emission in the presence of EKC: evidence from BRICS countries

This study examines the impact of energy consumption, financial development, globalization, economic growth, and urbanization on carbon dioxide emissions in the presence of Environmental Kuznets Curve (EKC) model for BRICS economies, by using a family of econometric techniques robust to heterogeneity and cross-sectional dependence. Results from LM test, CIPS and CADF unit root test, Westerlund Cointegration test, the Dynamic seemingly unrelated regression (DSUR), and Dumitrescu-Hurlin Granger causality test show that (i) the data is cross sectionally dependent and heterogeneous; (ii) carbon dioxide emissions, energy consumption, financial development, globalization, economic growth, square of GDP and urbanization have integration of order one; (iii) the examined variables are co-integrated; (iv) energy consumption and financial development contribute to the carbon dioxide emissions whereas globalization and urbanization have negative but insignificant relationship with carbon dioxide emissions; (v) supports the EKC hypothesis in BRICS economies; (vi) bidirectional causality exists among energy consumption, financial development, economic growth and square of GDP with carbon dioxide emissions whereas globalization and urbanization have unidirectional relationship with carbon dioxide emissions. Since these panel techniques account for heterogeneity and cross-sectional dependence in their estimation procedure, the empirical results are robust and reliable for policy recommendations. Furthermore, this study also uses time series tests (ADF, P-P, and FMOLS) to find the empirical results for each of the country and finds mixed results. Empirical findings directed towards some important policy implications.

Nexus between financial development and CO2 emissions in Saudi Arabia: analyzing the role of globalization

This study examines the contribution of financial development to environmental degradation in Saudi Arabia in the period from 1971 to 2016, controlling the model for globalization and electricity consumption. The autoregressive distributive lag (ARDL) and vector error correction methods (VECM) are applied to the long-run and causal relationship, respectively. Empirical results indicate that financial development contributes to CO₂ emissions and degrades environmental quality. The results also show that the role of globalization in environmental degradation is insignificant and that electricity consumption is the main culprit behind the growing CO₂ emissions in Saudi Arabia. In addition, bidirectional causality exists between globalization and CO₂ emissions in the long run, and financial development and CO₂ emissions Granger-cause each other. Insights from the study help policymakers to understand the roles of financial development and globalization in environmental degradation and to comply with global mandate for the reduction of CO₂ emissions.

Geographically representative scholarship and internationalization in school and educational psychology: A bibliometric analysis of eight journals from 2002-2016

Although the discipline of school and educational psychology is arguably international (e.g., relevant research and practice is evident in more than 80 countries), there has been limited research examining the international scholarship published in school and educational psychology journals. Such an assessment is important because it provides one important metric for better understanding the field's level of internationalization. The purpose of this study was to evaluate every article (N = 4456) published from 2002 to 2016 across eight school and educational psychology journals that publish international scholarship. Each article's authorship and participant data were coded and reported in terms of respective country and geographical region. Research questions examined, for example, how the published scholarship aligns with international employment data for school psychologists and whether particular journals published a geographically wider breadth of articles. Overall findings indicated that although the field of school psychology is present in more than 80 countries, the overall scholarship in the reviewed journals predominantly features participants living in, and authors working in, North America or Western Europe. However, one journal (School Psychology International) published relatively more articles with participants from outside of these geographic regions. Also, journals affiliated with a national professional organization largely differed in their percentage of "within-nation" publications (e.g., articles with participants living in the same nation that sponsors the respective journal). Explanations of the data are discussed and several recommendations are made that, if followed, could improve the internationalization and geographical representation of scholarship in school and educational psychology.

An empirical analysis of financial development and energy demand: establishing the role of globalization

The rapid mode of globalization is experienced in the last few years. The acceleration in globalization expands economic activities through a share of knowledge and transfer of technology which influence energy demand. So, the objective of this empirical work is to explore the impact of financial development on energy demand incorporating globalization. The empirical finding is based on autoregressive distributed lag (ARDL) bound testing approach from 1980 to 2016 in case of China. Overall, we infer that financial development increases energy demand in China. Furthermore, the finding shows that globalization has a negative and significant impact on energy demand. The additional determinants, such as economic growth, and urbanization stimulate energy consumption. Besides, energy consumption granger cause financial development in the long-run path. Similarly, unidirectional causality is detected between globalization and energy consumption. The result gives direction to policymakers to preserve as well as to enhance efficient energy consumption and sustain economic growth in China with acceleration in globalization.

The nexus between energy consumption and financial development: estimating the role of globalization in Next-11 countries

In the modern era of globalization, the economic activities expand with the passage of time. This expansion may increase demand for energy both in developing and developed countries. Therefore, this study assesses the impact of financial development on energy consumption incorporating the role of globalization in Next-11 countries. A group of panel estimation techniques is used to analyze the panel data and time series data for the time 1990-2014. The empirical results of the study suggest that financial development stimulates energy consumption. Also, globalization increases demand for energy consumption, although the single country analysis suggests that the effect of globalization on energy demand is heterogeneous among N-11 countries. Furthermore, feedback hypothesis is confirmed between financial development and energy consumption. Also, bidirectional causality is found between economic growth and energy consumption. The findings urge for the attention of policymaker in emerging countries to develop a strategy to reduce the consequences of energy consumption by controlling resource transfer through globalization to the host country and by adopting energy conversation policies.

Astonishing diversity-the medicinal plant markets of Bogotá, Colombia

BACKGROUND

Despite the importance of local markets as a source of medicinal plants in Colombia, comparatively little comparative research reports on the pharmacopoeiae sold. This stands in contrast to wealth of available information for other components of plant use in Colombia and other countries. The present provides a detailed inventory of the medicinal plant markets in the Bogotá metropolitan area, hypothesizing that the species composition, and medicinal applications, would differ across markets of the city.

METHODS

From December 2014 to February 2016, semi-structured interviews were conducted with 38 plant vendors in 24 markets in Bogotá in order to elucidate more details on plant usage and provenance.

RESULTS

In this study, we encountered 409 plant species belonging to 319 genera and 122 families. These were used for a total of 19 disease categories with 318 different applications. Both species composition and uses of species did show considerable differences across the metropolitan area-much higher in fact than we expected.

CONCLUSIONS

The present study indicated a very large species and use diversity of medicinal plants in the markets of Bogotá, with profound differences even between markets in close proximity. This might be explained by the great differences in the origin of populations in Bogotá, the floristic diversity in their regions of origin, and their very distinct plant use knowledge and preferences that are transferred to the markets through customer demand. Our study clearly indicated that studies in single markets cannot give an in-depth overview on the plant supply and use in large metropolitan areas.

Reprising the globalization dimensions of international health

Globalization is a fairly recent addition to the panoply of concepts describing the internationalization of health concerns. What distinguishes it from ‘international health’ or its newer morphing into ‘global health’ is a specific analytical concern with how globalization processes, past or present, but particularly since the start of our neoliberal era post-1980, is affecting health outcomes. Globalization processes influence health through multiple social pathways: from health systems and financing reforms to migration flows and internal displacement; via trade and investment treaties, labour market ‘flexibilization’, and the spread of unhealthy commodities; or through deploying human rights and environment protection treaties, and strengthening health diplomacy efforts, to create more equitable and sustainable global health outcomes. Globalization and Health was a pioneer in its focus on these critical facets of our health, well-being, and, indeed, planetary survival. In this editorial, the journal announces a re-focusing on this primary aim, announcing a number of new topic Sections and an expanded editorial capacity to ensure that submissions are ‘on target’ and processed rapidly, and that the journal continues to be on the leading edge of some of the most contentious and difficult health challenges confronting us.

The effect of sugar and processed food imports on the prevalence of overweight and obesity in 172 countries

Background

Studies find that economic, political, and social globalization – as well as trade liberalization specifically – influence the prevalence of overweight and obesity in countries through increasing the availability and affordability of unhealthful food. However, what are the mechanisms that connect globalization, trade liberalization, and rising average body mass index (BMI)? We suggest that the various sub-components of globalization interact, leading individuals in countries that experience higher levels of globalization to prefer, import, and consume more imported sugar and processed food products than individuals in countries that experience lower levels of globalization.

Method

This study codes the amount of sugar and processed food imports in 172 countries from 1995 to 2010 using the United Nations Comtrade dataset. We employ country-specific fixed effects (FE) models, with robust standard errors, to examine the relationship between sugar and processed foods imports, globalization, and average BMI. To highlight further the relationship between the sugar and processed food import and average BMI, we employ a synthetic control method to calculate a counterfactual average BMI in Fiji.

Conclusion

We find that sugar and processed food imports are part of the explanation to increasing average BMI in countries; after controlling for globalization and general imports and exports, sugar and processed food imports have a statistically and substantively significant effect in increasing average BMI. In the case of Fiji, the increased prevalence of obesity is associated with trade agreements and increased imports of sugar and processed food. The counterfactual estimates suggest that sugar and processed food imports are associated with a 0.5 increase in average BMI in Fiji.

Electronic supplementary material

The online version of this article (10.1186/s12992-018-0344-y) contains supplementary material, which is available to authorized users.

Planning and preparing for public health threats at airports

The ever-increasing speed and scope of human mobility by international air travel has led to a global transport network for infectious diseases with the potential to introduce pathogens into non-endemic areas, and to facilitate rapid spread of novel or mutated zoonotic agents.

Robust national emergency preparedness is vital to mitigate the transmission of infectious diseases agents domestically and to prevent onward spread to other countries. Given the complex range of stakeholders who respond to an infectious disease threat being transmitted through air travel, it is important that protocols be tested and practised extensively in advance of a real emergency. Simulation exercises include the identification of possible scenarios based on the probability of hazards and the vulnerability of populations as a basis for planning, and provide a useful measure of preparedness efforts and capabilities.

In October 2016, a live simulation exercise was conducted at a major airport in Ireland incorporating a public health threat for the first time, with the notification of a possible case of MERS-CoV aboard an aircraft plus an undercarriage fire. Strengths of the response to the communicable disease threat included appropriate public health risk assessment, case management, passenger information gathering, notification to relevant parties, and communication to passengers and multiple agencies.

Lessons learned include:

o Exercise planning should not be overly ambitious. In testing too many facets of emergency response, the public health response could be deprioritised.

o The practical implementation of communication protocols in a real-time exercise of this scope proved challenging. These protocols should continue to be checked and tested by desk-top exercises to ensure that all staff concerned are familiar with them, especially in the context of staff turn-over.

o The roles and responsibilities of the various agencies must be clear to avoid role confusion.

o Equipment and infrastructure capacities must be considered and in place in advance of an actual incident or test, for example whether or not cell phone signals require boosting during a major event.

Importantly, exercises bring together individuals representing organisations with different roles and perspectives allowing identification of capabilities and limitations, and problem solving about how to address the gaps and overlaps in a low-threat collaborative setting.

Human dignity as a basis for providing post-trial access to healthcare for research participants: a South African perspective

This paper discusses the need to focus on the dignity of human participants as a legal and ethical basis for providing post-trial access to healthcare. Debate about post-trial benefits has mostly focused on access to products or interventions proven to be effective in clinical trials. However, such access may be modelled on a broad fair benefits framework that emphasises both collateral benefits and interventional products of research, instead of prescribed post-trial access alone (Legal and ethical regulation of biomedical research in developing countries p. 134, 2016). The wording of the current version of the Declaration of Helsinki could in fact be interpreted to broaden the scope to include other collateral benefits by applying such a broad fair benefits framework. We argue that this possibility should be utilised by low and middle income countries' (LMICs) health research ethics committees (RECs) in order to ensure that research participants who enrol in clinical trials so as to receive medical care continue to access care after the trial is concluded, as befits their dignity. Although each LMIC has unique concerns, nonetheless there are common challenges based especially on emerging issues, such as post-trial access to healthcare. Accordingly, the South African perspective is used to draw lessons that can benefit other LMICs.

Obesity stigma as a globalizing health challenge

Background

Based on studies conducted in the global north, it is well documented that those who feel stigmatized by overweight/obesity can suffer extreme emotional distress, be subject to (often legal and socially-acceptable) discrimination, and adjust diet and exercise behaviors. These lead to significant negative health impacts, including depression and further weight gain. To date, weight-related stigma has been conceptualized as a problem particular to the highest income, industrialized, historically thin-valorizing societies like the US, Australasia, and Western Europe.

Main body

There is limited but highly suggestive evidence that obesity stigma is an emergent phenomenon that affects populations across the global south. Emergent evidence includes: implicit and explicit measures showing very high levels of weight stigma in middle and low-income countries, complex ethnographic evidence of widespread anti-fat beliefs even where fat-positivity endures, the globalization of new forms of “fat talk,” and evidence of the emotional and material damage of weight-related rejection or mistreatment even where severe undernutrition is still a major challenge.

Conclusion

Recognizing weight stigma as a global health problem has significant implications for how public health conceives and implements appropriate responses to the growing “obesity epidemic” in middle and lower income settings.

Internationalization or globalization of higher education

INTRODUCTION

Studies about globalization and internationalization demonstrate different attitudes in explaining these concepts. Since there is no consensus among Iranian specialists about these concepts, the purpose of this study is to explain the concepts of internationalization and globalization in Iran.

MATERIALS AND METHODS

This study is a systematic review done in the first half of 2016. To explain the concept of globalization and internationalization, articles in Scientific Information D atabase, Magiran database, and Google Scholar were searched with the keywords such as globalization, scientific exchange, international cooperation, curriculum exchange, student exchange, faculty exchange, multinational cooperation, transnational cooperation, and collaborative research. Articles, used in this study, were in Persian and were devoted to internationalization and globalization between 2001 and 2016. The criterion of discarding the articles was duplicity.

RESULTS

As many as 180 Persian articles were found on this topic. After discarding repetitive articles, 64 remained. Among those, 39 articles mentioned the differences between globalization and internationalization. Definitions of globalization were categorized in four categories, including globalization, globalizing, globalization of higher education, and globalizing of higher education. Definitions about internationalization were categorized in five categories such as internationalization, internationalization of higher education, internationalization of the curriculum, internationalization of curriculum studies, and internationalization of curriculum profession.

CONCLUSION

The spectrum of the globalization of higher education moves from dissonance and multipolarization to unification and single polarization of the world. One end of the spectrum, which is unification and single polarization of the world, is interpreted as globalization. The other side of the spectrum, which is dissonance and multipolarization, is interpreted as globalizing. The definition of internalization is the same as that of globalizing. In other words, it is possible to say that internalization is similar to globalizing but different from globalization.

Responding to New Psychoactive Substances in the European Union: Early Warning, Risk Assessment, and Control Measures

New psychoactive substances (NPS) are drugs that are not controlled by the United Nations international drug control conventions of 1961 and 1971 but that may pose similar threats to public health. Many of them are traded as "legal" replacements to controlled drugs such as cannabis, heroin, benzodiazepines, cocaine, amphetamines, and 3,4-methylenedioxymethamphetamine (MDMA). Driven by globalization, there has been a large increase in the availability and, subsequently, harms caused by these substances over the last decade in Europe. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is monitoring more than 670 NPS that have appeared on Europe's drug market in the last 20 years, of which almost 90% have appeared in the last decade. While some recent policy responses have been successful in reducing availability and sales of these substances in some settings - such as "legal highs" and "research chemicals" sold openly in the high street and online - and there are signs that growth in the market is slowing, new challenges have emerged. This includes monitoring a growing number of highly potent substances - including 179 synthetic cannabinoid receptor agonists and 28 fentanils - that can pose a high risk of life-threatening poisoning to users and can cause explosive outbreaks. This chapter briefly traces the origins of NPS, provides an overview of the situation in Europe, and discusses the work of the EMCDDA as part of a legal framework of early warning, risk assessment, and control measures that allows the European Union to rapidly detect, assess, and respond to public health and social threats caused by these substances.

WHO FCTC as a Pioneering and Learning Instrument Comment on "The Legal Strength of International Health Instruments - What It Brings to Global Health Governance?"

The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) is a unique global health instrument, since it is in the health field the only instrument that is international law. After the 10 years of its existence an Independent Expert Group assessed the impact of the FCTC using all available data and visiting a number of countries interviewing different stakeholders. It is quite clear that the Treaty has acted as a strong catalyst and framework for national actions and that remarkable progress in global tobacco control can be seen. At the same time FCTC has moved tobacco control in countries from a pure health issue to a legal responsibility of the whole government, and on the international level created stronger interagency collaboration. The assessment also showed the many challenges. The spread of tobacco use, as well as of other risk lifestyles, is related to globalization. FCTC is a pioneering example of global action to counteract the negative social consequences of globalization. A convention is not an easy instrument, but the FCTC has undoubtedly sparked thinking and development of other stronger public health instruments and of needed governance structures.

Family Life and Social Medicine: Discourses and Discontents Surrounding Puebla's Psychiatric Care

Drawing on clinical data from 15 months of on-site participant observation in the only public psychiatric hospital in the state of Puebla, Mexico, this article advances our understanding of globalization in relation to psychiatry. I challenge the construction of psychiatry as only treating the individual patient and provide grounded doctor-patient-family member interaction in a Mexican psychiatric clinic in order to review what happens when doctors cannot interact with patients as atomized individuals even though in theory they are trained to think of patients that way. Challenged by severe structural constraints and bolstered by lessons from other nations' efforts at deinstitutionalization, psychiatrists in Puebla push to keep patients out of the inpatient wards and in their respective communities. To this end, psychiatrists call upon co-present kin who are identified both as the customer and part of the caretaking system outside the clinic. This modification to the visit structure changes the dynamic and content of clinical visits while doctors seamlessly respond to unspoken beliefs and values that are central to local life, ultimately showing that efforts to define a "global psychiatry" informed by global policy will fail because it cannot exist in a uniform way-interpersonal interaction and personal experience matters.

Global collaborative healthcare: assessing the resource requirements at a leading Academic Medical Center

INTRODUCTION

Academic Medical Centers ("AMCs") have served as a hub of the United States ("US") health system and represented the state-of-the art in American health care for well over a century. Currently, the global healthcare market is both massive and expanding and is being altered by the unprecedented impact of technological advances and globalization. This provides AMCs a platform to enter into trans-national collaborative partnerships with healthcare organizations around the world, thus providing a means to deliver on its promise globally while also expanding and diversifying its resources. A number of leading US AMCs have engaged in global collaborative healthcare, employing different models based on services offered, global distribution, and inclination to assume risk. Engaging in these collaborations requires significant effort from across the health system, and an understanding of the resources required is paramount for effective delivery and to avoid overextension and diversion from the primary mission of these organizations. The goal of this paper is to discuss the role of US AMCs in this current global healthcare landscape and to also investigate our institutional faculty and staff resource requirements to support the operating model.

METHODOLOGY

We extracted and retrospectively analyzed data from the JHI Global Services database for a 3-year period (Jan, 2013-Dec, 2015) to determine total utilization (hours and full time equivalent (FTE)), utilization by profession, and clinical and non-clinical areas of expertise.

RESULTS

JHI utilized on average 21,940 h annually, or 10.55 FTEs of faculty and staff subject matter experts. The majority of the hours are for work performed by physician faculty members from 23 departments within the School of Medicine, representing 77% percent or on average 16,894 h annually. Clinical and allied health departments had an average annual utilization of 17,642 h or 7.8 FTEs, while non-clinical departments, schools and institutes averaged 4298 h or 1.9 FTEs, representing 80.4% and 19.6% respectively.

CONCLUSION

We found that significant human resources are required within a broad range of AMC subject matter expertise across multiple disciplines, and that with adequate forecasting AMCs can successfully engage in these collaborations while continuing to fulfill their core mission.

Quality of institution and the FEG (forest, energy intensity, and globalization) -environment relationships in sub-Saharan Africa

The current share of sub-Saharan Africa in global carbon dioxide emissions is negligible compared to major contributors like Asia, Americas, and Europe. This trend is, however, likely to change given that both economic growth and rate of urbanization in the region are projected to be robust in the future. The current study contributes to the literature by examining both the direct and the indirect impacts of quality of institution on the environment. Specifically, we investigate whether the institutional setting in the region provides some sort of a complementary role in the environment-FEG relationships. We use the panel two-step system generalized method of moments (GMM) technique to deal with the simultaneity problem. Data consists of 43 sub-Saharan African countries. The result shows that energy inefficiency compromises environmental standards. However, the quality of the institutional setting helps moderate this negative consequences; countries with good institutions show greater prospects than countries with poor institutions. On the other hand, globalization of the region and increased forest size generate positive environmental outcomes in the region. Their impacts are, however, independent of the quality of institution. Afforestation programs, promotion of other clean energy types, and investment in energy efficiency, basic city infrastructure, and regulatory and institutional structures, are desirable policies to pursue to safeguard the environment.

Medical Tourism, Medical Migration, and Global Justice: Implications for Biosecurity in a Globalized World

We live in the age of globalization. In medicine, that globalization has brought many benefits such as the diffusion of technology and the spread of health care training, but it has also brought threats to biosecurity. This article examines how medical tourism and medical migration pose risks to biosecurity. It also argues that designing legal responses to these risks requires not only technical competence but also a theory of global justice to guide that design.

Social determinants of tobacco use: towards an equity lens approach

Tobacco is the only commercial product that eventually kills nearly half of all long-term users. The prevalence of tobacco use is disproportionately high in lower socioeconomic strata and vulnerable groups (such as adolescents) within and across countries. Given its highly addictive nature, tobacco use perpetuates poverty and loss of opportunities, thus undermining the UN Sustainable Development Goals. Moreover, by shaping the national and international context, globalization and governance impact on the tobacco epidemic and underlying disparities. Therefore, socio-economic gradients, which influence predisposition to tobacco uptake and cessation, must be confronted. Here I argue that tobacco prevention and control must be addressed through a lifelong, equity lens approach. This approach describes the essential need for every individual to have equal access to informative prevention and cessation services independent of income, occupational status, social stratum, or residence. I also contend that rather than being occupied with "research on research", the focus should shift to how to practically implement the existing accumulated, cogent body of scientific evidence in a societally equitable manner. Finally, in line with the core dilemma of "who really governs the policies that shape our health?" raised by the WHO's Director General, it is time for civil society either on its own or in partnership with local authorities to formulate policies that implement the "health for all" imperative rather than the currently dominant "wealth for some".

Business as Usual: A Lack of Institutional Innovation in Global Health Governance Comment on "Global Health Governance Challenges 2016 - Are We Ready?"

There were once again high expectations that a major global health event - the Ebola virus outbreak of 2014-2015 - would trigger meaningfully World Health Organization (WHO) reform and strengthen global health governance (GHG). Rather than a "turning point," however, the global community has gone back to business as usual. This has occurred against a backdrop of worldwide political turmoil, characterised by a growing rejection of existing political leaders and state-centric institutions. Debates about GHG so far have given insufficient attention to the need for institutional innovation. This entails rethinking the traditional bureaucratic model of postwar intergovernmental organizations which is disconnected from the transboundary, fast-paced nature of today’s globalizing world.

Assessing the health impact of transnational corporations: a case study on McDonald's Australia

Background

The practices of transnational corporations affect population health through production methods, shaping social determinants of health, or influencing the regulatory structures governing their activities. There has been limited research on community exposures to TNC policies and practices. Our pilot research used McDonald’s Australia to test methods for assessing the health impacts of one TNC within Australia.

Methods

We adapted existing Health Impact Assessment methods to assess McDonald’s activities. Data identifying potential impacts were sourced through document analysis, including McDonald’s corporate literature; media analysis and semi-structured interviews. We commissioned a spatial and socioeconomic analysis of McDonald’s restaurants in Australia through Geographic Information System technology. The data was mapped against a corporate health impact assessment framework which included McDonald’s Australia’s political and business practices; products and marketing; workforce, social, environmental and economic conditions; and consumers’ health related behaviours.

Results

We identified both positive and detrimental aspects of McDonald’s Australian operations across the scope of the CHIA framework. We found that McDonald’s outlets were slightly more likely to be located in areas of lower socioeconomic status. McDonald’s workplace conditions were found to be more favourable than those in many other countries which reflects compliance with Australian employment regulations. The breadth of findings revealed the need for governments to strengthen regulatory mechanisms that are conducive to health; the opportunity for McDonald’s to augment their corporate social responsibility initiatives and bolster reputational endorsement; and civil society actors to inform their advocacy towards health and equity outcomes from TNC operations.

Conclusion

Our study indicates that undertaking a corporate health impact assessment is possible, with the different methods revealing sufficient information to realise that strong regulatory frameworks are need to help to avoid or to mediate negative health impacts.

Economic growth, urbanization, globalization, and the risks of emerging infectious diseases in China: A review

Three interrelated world trends may be exacerbating emerging zoonotic risks: income growth, urbanization, and globalization. Income growth is associated with rising animal protein consumption in developing countries, which increases the conversion of wild lands to livestock production, and hence the probability of zoonotic emergence. Urbanization implies the greater concentration and connectedness of people, which increases the speed at which new infections are spread. Globalization-the closer integration of the world economy-has facilitated pathogen spread among countries through the growth of trade and travel. High-risk areas for the emergence and spread of infectious disease are where these three trends intersect with predisposing socioecological conditions including the presence of wild disease reservoirs, agricultural practices that increase contact between wildlife and livestock, and cultural practices that increase contact between humans, wildlife, and livestock. Such an intersection occurs in China, which has been a "cradle" of zoonoses from the Black Death to avian influenza and SARS. Disease management in China is thus critical to the mitigation of global zoonotic risks.

Applied epidemiology and public health: are we training the future generations appropriately?

To extend the reach and relevance of epidemiology for public health practice, the science needs be broadened beyond etiologic research, to link more strongly with emerging technologies and to acknowledge key societal transformations. This new focus for epidemiology and its implications for epidemiologic training can be considered in the context of macro trends affecting society, including a greater focus on upstream causes of disease, shifting demographics, the Affordable Care Act and health care system reform, globalization, changing health communication environment, growing centrality of team and transdisciplinary science, emergence of translational sciences, greater focus on accountability, big data, informatics, high-throughput technologies ("omics"), privacy changes, and the evolving funding environment. This commentary describes existing approaches to and competencies for training in epidemiology, maps macro trends with competencies, highlights an example of competency-based education in the Epidemic Intelligence Service of Centers for Disease Control and Prevention, and suggests expanded and more dynamic training approaches. A reexamination of current approaches to epidemiologic training is needed.

[Migration: A neglected dimension of inequalities in health?]

Over the past 70 years, several million people have immigrated into Germany-from different countries of origin and for different reasons. The categories used by society to label immigrants ("guest workers", "persons with a migration background") have changed over time. This change has occurred in parallel with changes in the societal attitude towards immigrants and in their legal position. There is unequivocal evidence that the forms that migration takes, in addition to the societal responses towards immigrants, have an effect on their health. The spectrum of migration to Germany is likely to remain fluent because of the continuing process of globalization; also, societal responses to migration will change over time. Thus, migration will continue to pose challenges to society and to health. Only through continuous attentiveness will it be possible to identify, and then avoid or reduce, health disadvantages faced by persons with a migration background.

Trade liberalization and social determinants of health: A state of the literature review

The health impacts of trade liberalization are often described in relation to access to medicines, changing dietary patterns, tobacco use and alcohol consumption. The impacts of trade liberalization on the social determinants of health (SDH), are by contrast, less well known. Missing is an account of how liberalizing processes identified across different research areas relate to each other and how the association between trade liberalization and health is conceptualized within each of them, especially with reference to SDH. This paper presents a systematic review which provides a more complete picture of the pathways between trade liberalization and health, with special attention to SDH pathways. This picture captures the interrelationships between different areas of investigation, along with current limitations of our understanding and recommendations for future research.