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Brisbois B, Plamondon K, Walugembe D, Pereira RC, Edet C, Dixon J, Habibi R, Karamouzian M, Labonté R, Murthy S, Ravitsky V. Pandemics, intellectual property and 'our economy': A worldview analysis of Canada's role in compromising global access to COVID-19 vaccines. Glob Public Health 2024; 19:2335360. [PMID: 38626321 DOI: 10.1080/17441692.2024.2335360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 03/21/2024] [Indexed: 04/18/2024]
Abstract
Despite self-congratulatory rhetoric, Canada compromised COVID-19 vaccine equity with policies impeding a proposed global waiver of vaccine intellectual property (IP) rules. To learn from Canada's vaccine nationalism we explore the worldview - a coherent textual picture of the world - in a sample of Government of Canada communications regarding global COVID-19 vaccine sharing. Analysed documents portray risks and disparities as unrelated to the dynamics and power relations of the Canadian and international economies. Against this depoliticised backdrop, economic growth fueled by strict IP rules and free trade is advanced as the solution to inequities. Global vaccine access and distribution are pursued via a charity-focused public-private-partnership approach, with proposals to relax international IP rules dismissed as unhelpful. Rather than a puzzling lapse by a good faith 'middle power', Canada's obstruction of global COVID-19 vaccine equity is a logical and deliberate extension of dominant neoliberal economic policy models. Health sector challenges to such models must prioritise equity in global pandemic governance via politically assertive and less conciliatory stances towards national governments and multilateral organisations. Mobilisation for health equity should transform the overall health-damaging macroeconomic model, complementing efforts based on specific individual health determinants or medical technologies.
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Affiliation(s)
- Ben Brisbois
- School of Health Sciences, University of Northern British Columbia, Prince George, Canada
| | - Katrina Plamondon
- School of Nursing, University of British Columbia - Okanagan, Kelowna, Canada
| | - David Walugembe
- School of Nursing, University of British Columbia - Okanagan, Kelowna, Canada
| | - Rodrigo Curty Pereira
- Department of Geography and Environmental Management, University of Waterloo, Waterloo, Canada
| | - Christine Edet
- School of Nursing, University of British Columbia - Okanagan, Kelowna, Canada
| | - Jenna Dixon
- School of Nursing, University of British Columbia - Okanagan, Kelowna, Canada
| | - Roojin Habibi
- Faculty of Law, University of Ottawa, Ottawa, Canada
| | - Mohammad Karamouzian
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Ronald Labonté
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Srinivas Murthy
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, Vancouver, Canada
| | - Vardit Ravitsky
- School of Public Health, Université de Montréal, Montréal, Canada
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Plamondon KM, Dixon J, Brisbois B, Pereira RC, Bisung E, Elliott SJ, Graham ID, Ndumbe-Eyoh S, Nixon S, Shahram S. Turning the tide on inequity through systematic equity action-analysis. BMC Public Health 2023; 23:890. [PMID: 37189082 DOI: 10.1186/s12889-023-15709-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/19/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Collective agreement about the importance of centering equity in health research, practice, and policy is growing. Yet, responsibility for advancing equity is often situated as belonging to a vague group of 'others', or delegated to the leadership of 'equity-seeking' or 'equity-deserving' groups who are tasked to lead systems transformation while simultaneously navigating the violence and harms of oppression within those same systems. Equity efforts also often overlook the breadth of equity scholarship. Harnessing the potential of current interests in advancing equity requires systematic, evidence-guided, theoretically rigorous ways for people to embrace their own agency and influence over the systems in which they are situated. ln this article, we introduce and describe the Systematic Equity Action-Analysis (SEA) Framework as a tool that translates equity scholarship and evidence into a structured process that leaders, teams, and communities can use to advance equity in their own settings. METHODS This framework was derived through a dialogic, critically reflective and scholarly process of integrating methodological insights garnered over years of equity-centred research and practice. Each author, in a variety of ways, brought engaged equity perspectives to the dialogue, bringing practical and lived experience to conversation and writing. Our scholarly dialogue was grounded in critical and relational lenses, and involved synthesis of theory and practice from a broad range of applications and cases. RESULTS The SEA Framework balances practices of agency, humility, critically reflective dialogue, and systems thinking. The framework guides users through four elements of analysis (worldview, coherence, potential, and accountability) to systematically interrogate how and where equity is integrated in a setting or object of action-analysis. Because equity issues are present in virtually all aspects of society, the kinds of 'things' the framework could be applied to is only limited by the imagination of its users. It can inform retrospective or prospective work, by groups external to a policy or practice setting (e.g., using public documents to assess a research funding policy landscape); or internal to a system, policy, or practice setting (e.g., faculty engaging in a critically reflective examination of equity in the undergraduate program they deliver). CONCLUSIONS While not a panacea, this unique contribution to the science of health equity equips people to explicitly recognize and interrupt their own entanglements in the intersecting systems of oppression and injustice that produce and uphold inequities.
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Affiliation(s)
- Katrina M Plamondon
- Science of Health Equity Learning Lab & Assistant Professor, School of Nursing, University of British Columbia ART360, 1147 Research Road, Kelowna, BC, Canada.
| | - Jenna Dixon
- Science of Health Equity Learning Lab School of Nursing, University of British Columbia, Kelowna, BC, Canada
| | - Ben Brisbois
- Science of Health Equity Learning Lab at the School of Nursing, School of Health Sciences, University of British Columbia, University of Northern British Columbia, Kelowna, Prince George, BC, BC, Canada
| | | | - Elijah Bisung
- School of Kinesiology & Health Studies, Queens University, Kingston, Canada
| | - Susan J Elliott
- Geography and Environmental Management, University of Waterloo, Ontario, Canada
| | - Ian D Graham
- Centre for Practice-Changing Research, School of Epidemiology & Public Health, Faculty of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Sume Ndumbe-Eyoh
- Dalla Lana School of Public Health, Black Health Education Collaborative &, University of Toronto, Toronto, Canada
| | - Stephanie Nixon
- Health Sciences & Director, School of Rehabilitation Therapy, Queens University, Kingston, Canada
| | - Sana Shahram
- Science of Health Equity Learning Lab & Assistant Professor, School of Nursing, University of British Columbia, Columbia, Canada
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Pratt B, de Vries J. Where is knowledge from the global South? An account of epistemic justice for a global bioethics. JOURNAL OF MEDICAL ETHICS 2023; 49:325-334. [PMID: 36657964 PMCID: PMC10176400 DOI: 10.1136/jme-2022-108291] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 11/30/2022] [Indexed: 05/14/2023]
Abstract
The silencing of the epistemologies, theories, principles, values, concepts and experiences of the global South constitutes a particularly egregious epistemic injustice in bioethics. Our shared responsibility to rectify that injustice should be at the top of the ethics agenda. That it is not, or only is in part, is deeply problematic and endangers the credibility of the entire field. As a first step towards reorienting the field, this paper offers a comprehensive account of epistemic justice for global health ethics. We first introduce several different conceptions of justice and decolonisation in relation to knowledge, purposefully drawing on work emanating from the global South as well as the global North. We then apply those conceptions to the global health ethics context to generate a tripartite account of the layers of epistemic justice in the field: who is producing ethics knowledge; what theories and concepts are being applied to produce ethics knowledge; and whose voices are sought, recorded and used to generate ethics knowledge. These layers reflect that the field spans conceptual and empirical research. We conclude by proposing that, going forward, three avenues are key to achieve greater epistemic justice at each layer and to help decolonise global health ethics: namely, understanding the problem, dialogue and structural change.
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Affiliation(s)
- Bridget Pratt
- Queensland Bioethics Centre, Australian Catholic University - Brisbane Campus, Banyo, Queensland, Australia
| | - Jantina de Vries
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- The Ethics Lab, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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Harper A, Pratt B. Combatting neo-Colonialism in Health Research: What can Aboriginal Health Research Ethics and Global Health Research Ethics Teach Each Other? J Empir Res Hum Res Ethics 2022; 17:431-454. [PMID: 34931853 DOI: 10.1177/15562646211058253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The ethics of research involving Aboriginal populations and low and middle-income country populations each developed out of a long history of exploitative research projects and partnerships. Commonalities and differences between the two fields have not yet been examined. This study undertook two independent literature searches for Aboriginal health research ethics and global health research ethics. Content analysis identified shared and differently emphasised ethical principles and concepts between the two fields. Shared ethical concepts like "benefit" and "capacity development" have been developed to guide collaborations in both Aboriginal health research and global health research. However, Aboriginal health research ethics gives much greater prominence to ethical principles that assist in decolonising research practice such as "self-determination", "community-control", and "community ownership". The paper argues that global health research ethics would benefit from giving greater emphasis to these principles to guide research practice, while justice as approached in global health research ethics may inform Aboriginal health research practice. With increasing attention being drawn to the need to decolonise global health research, the lessons Aboriginal health research ethics can offer may be especially timely.
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Affiliation(s)
- Adrian Harper
- School of Population and Global Health, University of Melbourne, Australia
| | - Bridget Pratt
- School of Population and Global Health, University of Melbourne, Australia
- Queensland Bioethics Centre, 1513Australian Catholic University, Australia
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Agudelo Motta ML, Osorio Ortega DF, Rubio Roa AC, Beltrán Casas OI. Privacidad y confidencialidad de los datos genéticos y genómicos de uso diagnóstico en Colombia. REVISTA LATINOAMERICANA DE BIOÉTICA 2022. [DOI: 10.18359/rlbi.5196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
La información genética y genómica requiere regulaciones estrictas para su manejo adecuado con el fin de evitar la divulgación inapropiada y la discriminación secundaria, pues tiene una relación directa con los derechos fundamentales y los principios bioéticos. De ahí la necesidad de evaluar la regulación colombiana existente, por lo que se realizó una revisión sistemática de la literatura en bases de datos del 2000 al 2020, sitios web del Congreso de la República de Colombia, la Comisión de Reforma de la Ley Australiana y la Corte Constitucional de Colombia, para identificar las falencias y los aciertos en la jurisprudencia actual del manejo, el control y la accesibilidad de la población colombiana a las pruebas e información genética. Se toma como referente Australia para comprender y plantear mejoras. Se encontró que en Colombia la información genética se cataloga como sensible (Sentencia C-334-10) con regulaciones inespecíficas sin norma legislativa. En contraste, Australia dispone de directrices bioéticas específicas, penalización y protocolos que abarcan las implicaciones individuales y colectivas descritas en el Privacy Legislation Amendment Act del 2006. Es necesario que en Colombia se cree una regulación jurídica específica para la información genética y genómica con énfasis en pautas de uso sobre la privacidad, la divulgación y la no discriminación.
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Plamondon K, Neufeld V. Are we there yet? Principles in advancing equity though global public health research. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 113:178-183. [PMID: 35290654 PMCID: PMC8975980 DOI: 10.17269/s41997-022-00624-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Canadian engagement in global and public health includes a long history of centering issues of equity in practice, policy, and research. In 2015, through a series of deliberative dialogues about what ethical standards should guide how people engage in global health research, the Canadian Coalition for Global Health Research (CCGHR) released a set of six equity-centred principles and critically reflective questions. These principles offered a platform for identifying equity implications and choices about theories, methods, approaches, partnerships, or practices in global and public health. In 2022, as questions of how to unsettle systems of power and move beyond rhetorical efforts to advance equity action continue to grow, Canada's global public health research community is turning a critically reflexive gaze at our own practices and ways of working, recognizing excellence as necessarily integrating equity in research pursuits, processes, and outcomes. In this commentary, we reflect on the contexts that led to the evolution of the CCGHR Principles for Global Health Research and highlight their current reach and impact, including their integration in the Canadian Institutes Framework for Action on Global Health Research. We invite others to embrace a lifelong commitment to equity work as an act of solidarity and investment in our collective futures.
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Affiliation(s)
- Katrina Plamondon
- School of Nursing, University of British Columbia, Kelowna, BC, Canada.
| | - Vic Neufeld
- Centre for Global Studies, University of Victoria, Victoria, BC, Canada
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Meghani Z. Regulation of genetically engineered (GE) mosquitoes as a public health tool: a public health ethics analysis. Global Health 2022; 18:21. [PMID: 35189901 PMCID: PMC8862287 DOI: 10.1186/s12992-021-00760-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/27/2021] [Indexed: 11/10/2022] Open
Abstract
Background In recent years, genetically engineered (GE) mosquitoes have been proposed as a public health measure against the high incidence of mosquito-borne diseases among the poor in regions of the global South. While uncertainties as well as risks for humans and ecosystems are entailed by the open-release of GE mosquitoes, a powerful global health governance non-state organization is funding the development of and advocating the use of those bio-technologies as public health tools. In August 2016, the US Food and Drug Agency (FDA) approved the uncaged field trial of a GE Aedes aegypti mosquito in Key Haven, Florida. The FDA’s decision was based on its assessment of the risks of the proposed experimental public health research project. The FDA is considered a global regulatory standard setter. So, its approval of the uncaged field trial could be used by proponents of GE mosquitoes to urge countries in the global South to permit the use of those bio-technologies. Method From a public health ethics perspective, this paper evaluates the FDA’s 2016 risk assessment of the proposed uncaged field trial of the GE mosquito to determine whether it qualified as a realistic risk evaluation. Results The FDA’s risk assessment of the proposed uncaged field trial did not proximate the conditions under which the GE mosquitoes would be used in regions of the global South where there is a high prevalence of mosquito-borne diseases. Conclusion Given that health and disease have political-economic determinants, whether a risk assessment of a product is realistic or not particularly matters with respect to interventions meant for public health problems that disproportionately impact socio-economically marginalized populations. If ineffective public health interventions are adopted based on risk evaluations that do not closely mirror the conditions under which those products would actually be used, there could be public health and ethical costs for those populations.
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Affiliation(s)
- Zahra Meghani
- Philosophy Department, University of Rhode Island, Kingston, RI, 02881, USA.
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Samuel G, Lucivero F. Framing ethical issues associated with the UK COVID-19 contact tracing app: exceptionalising and narrowing the public ethics debate. ETHICS AND INFORMATION TECHNOLOGY 2022; 24:5. [PMID: 35110970 PMCID: PMC8802538 DOI: 10.1007/s10676-022-09628-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 06/14/2023]
Abstract
This paper explores ethical debates associated with the UK COVID-19 contact tracing app that occurred in the public news media and broader public policy, and in doing so, takes ethics debate as an object for sociological study. The research question was: how did UK national newspaper news articles and grey literature frame the ethical issues about the app, and how did stakeholders associated with the development and/or governance of the app reflect on this? We examined the predominance of different ethical issues in news articles and grey literature, and triangulated this using stakeholder interview data. Findings illustrate how news articles exceptionalised ethical debate around the app compared to the way they portrayed ethical issues relating to 'manual' contact tracing. They also narrowed the debate around specific privacy concerns. This was reflected in the grey literature, and interviewees perceived this to have emerged from a 'privacy lobby'. We discuss the findings, and argue that this limited public ethics narrative masked broader ethical issues.
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Affiliation(s)
- G Samuel
- Department of Global Health and Social Medicine, King's College London, Bush House, Strand, London, UK
| | - F Lucivero
- Ethox Centre and Wellcome Centre for Ethics and Humanities, Oxford University, Oxford, UK
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Bump JB, Aniebo I. Colonialism, malaria, and the decolonization of global health. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000936. [PMID: 36962810 PMCID: PMC10021769 DOI: 10.1371/journal.pgph.0000936] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 07/31/2022] [Indexed: 11/19/2022]
Abstract
This paper explores the decolonization of global health through a focus on malaria and European colonialism in Africa. We employ an historical perspective to better articulate what "colonial" means and to specify in greater detail how colonial ideas, patterns, and practices remain an obstacle to progress in global health now. This paper presents a history of malaria, a defining aspect of the colonial project. Through detailed analysis of the past, we recount how malaria became a colonial problem, how malaria control rose to prominence as a colonial activity, and how interest in malaria was harnessed to create the first schools of tropical medicine and the academic specialization now known as global health. We discuss how these historical experiences shape malaria policy around the world today. The objective of this paper is to advance discussion about how malaria and other aspects of global health could be decolonized, and to suggest directions for future analysis that can lead to concrete steps for action.
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Affiliation(s)
- Jesse B Bump
- Department of Global Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Initiative on the Future of Health and Economic Resiliency in Africa, Boston, Massachusetts, United States of America
- Bergen Center for Ethics and Priority Setting, University of Bergen, Bergen, Norway
| | - Ifeyinwa Aniebo
- Initiative on the Future of Health and Economic Resiliency in Africa, Boston, Massachusetts, United States of America
- Health Strategy and Delivery Foundation, Lagos, Nigeria
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Mac-Seing M, Ringuette L, Zinszer K, Godard B, Zarowsky C. How to navigate the application of ethics norms in global health research: reflections based on qualitative research conducted with people with disabilities in Uganda. BMC Med Ethics 2021; 22:140. [PMID: 34663292 PMCID: PMC8521956 DOI: 10.1186/s12910-021-00710-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As Canadian global health researchers who conducted a qualitative study with adults with and without disabilities in Uganda, we obtained ethics approval from four institutional research ethics boards (two in Canada and two in Uganda). In Canada, research ethics boards and researchers follow the research ethics norms of the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS2), and the National Guidelines for Research Involving Humans as Research Participants of Uganda (NGRU) in Uganda. The preparation and implementation of this qualitative research raised specific ethical issues related to research participant privacy and the importance of availability and management of financial resources. MAIN BODY Our field experience highlights three main issues for reflection. First, we demonstrate that, in a global health research context, methodological and logistic adjustments were necessary throughout the research implementation process to ensure the protection of study participants' privacy, especially that of people with disabilities, despite having followed the prescribed Canadian and Ugandan ethics norms. Data collection and management plans were adapted iteratively based on local realities. Second, securing financial support as a key aspect of financial management was critical to ensure privacy through disability-sensitive data collection strategies. Without adequate funding, the recruitment of research participants based on disability type, sex, and region or the hiring of local sign language interpreters would not have been possible. Third, although the TCPS2 and NGRU underscore the significance of participants' privacy, none of these normative documents clearly express this issue in the context of global health research and disability, nor broadly discuss the ethical issue related to financial availability and management. CONCLUSIONS Conducting research in resource limited settings and with study participants with different needs calls for a nuanced and respectful implementation of research ethics in a global health context. We recommend a greater integration in both the TCPS2 and NGRU of global health research, disability, and responsible conduct of research. This integration should also be accompanied by adequate training which can further guide researchers, be they senior, junior, or students, and funding agencies.
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Affiliation(s)
- Muriel Mac-Seing
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada.
- Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada.
| | - Louise Ringuette
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada
- Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
- Laboratoire Transformation Numérique en Santé, Montreal, Canada
| | - Kate Zinszer
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada
- Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
| | - Béatrice Godard
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada
| | - Christina Zarowsky
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada
- Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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Andrews GJ. Re-imagining world: From human health in the world to 'all-world health'. Health Place 2021; 71:102620. [PMID: 34330008 DOI: 10.1016/j.healthplace.2021.102620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
This article explores the concept of 'world' as it frequently appears across health studies; specifically largely humanistic and phenomenological variations in use of 'the world' and 'lifeworld' are considered as they have helped cast knowledge on health and care. Looking forward, it is argued that world might be reimagined post-humanistically and post-phenomenologically as a vital emergent material entity and property. This is a reimagination that pays dividends by drawing attention to all-world processes and productions, hence to 'all-world health'. On one level, all-world health involves consideration of the healths of all the world's material and biological entities (all parts of the world). On another level, all-world health involves understanding what an entity gains from its total surround as it moves through life (all parts of its world). Together these levels provide a more processual, relational and holistic understanding of health than that provided by traditional notions of human health states, determinants or meanings, and even by some environmental (ist) ideas on health. All-world health arguably provides a vision of interrelatedness on which greater unity, cooperation and care might be built.
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Affiliation(s)
- Gavin J Andrews
- Department of Health, Aging and Society KTH, McMaster University, Hamilton, Ontario, L8S 4M4, Canada.
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12
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Logie CH. Sexual rights and sexual pleasure: Sustainable Development Goals and the omitted dimensions of the leave no one behind sexual health agenda. Glob Public Health 2021; 18:1953559. [PMID: 34278957 DOI: 10.1080/17441692.2021.1953559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This commentary explores the missing discourse of sexual rights and sexual pleasure in the Sustainable Development Goals (SDG) that purport to leave no one behind. The SDG propose a welcome focus on sexual health and human rights for all, expanding beyond the Millennium Development Goals. While promising in many ways for advancing global sexual and reproductive health, and reproductive rights, the omission of sexual rights is troubling. So too is the erasure of lesbian, gay, bisexual, transgender and queer (LGBTQ) persons, and sex workers, from the SDG discussions of social inequities. Illustrative examples are provided to demonstrate how a sexual rights focus could advance SDG 3 focused on healthy lives and well-being for all. First, sexual rights are presented as integral to realizing Target 3.3's focus on ending the HIV pandemic among LGBTQ persons and sex workers (and LGBTQ sex workers). Second, sexual pleasure is introduced as an integral component of sexual health and sexual rights that could facilitate the realization of Target 3.7's aim to provide universal access to sexual and reproductive health information and education. To truly leave no one behind and realize sexual health for all, the SDG need to begin from a foundation of sexual rights.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada.,Centre for Gender & Sexual Health Equity, Vancouver, Canada
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Plamondon KM, Brisbois B, Dubent L, Larson CP. Assessing how global health partnerships function: an equity-informed critical interpretive synthesis. Global Health 2021; 17:73. [PMID: 34215301 PMCID: PMC8254362 DOI: 10.1186/s12992-021-00726-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background Global health partnerships (GHPs) are situated in complex political and economic relationships and involve partners with different needs and interests (e.g., government agencies, non-governmental organizations, corporations, universities, professional associations, philanthropic organizations and communities). As part of a mixed methods study designed to develop an equity-sensitive tool to support more equity-centred North-South GHPs, this critical interpretive synthesis examined reported assessments of GHPs. Results We examined 30 peer-reviewed articles for power dynamics, equity and inequities, and contradictions or challenges encountered in North-South partnerships. Among articles reviewed, authors most often situated GHPs around a topical focus on research, capacity-building, clinical, or health services issues, with the ‘work’ of the partnership aiming to foster skills or respond to community needs. The specific features of GHPs that were assessed varied widely, with consistently-reported elements including the early phases of partnering; governance issues; the day-to-day work of partnerships; the performance, impacts and benefits of GHPs; and issues of inclusion. Articles shared a general interest in partnering processes and often touched briefly on issues of equity; but they rarely accounted for the complexity of sociopolitical and historical contexts shaping issues of equity in GHPs. Further, assessments of GHPs were often reported without inclusion of voices from all partners or named beneficiaries. GHPs were frequently portrayed as inherently beneficial for Southern partners, without attention to power dynamics and inequities (North-South, South-South). Though historical and political dynamics of the Global North and South were inconsistently examined as influential forces in GHPs, such dynamics were frequently portrayed as complex and characterized by asymmetries in power and resources. Generally, assessments of GHPs paid little attention to the macroeconomic forces in the power and resource dynamics of GHPs highlights the importance of considering the broader political. Our findings suggest that GHPs can serve to entrench both inequitable relationships and unfair distributions of power, resources, and wealth within and between countries (and partners) if inequitable power relationships are left unmitigated. Conclusions We argue that specific practices could enhance GHPs’ contributions to equity, both in their processes and outcomes. Enhancing partnering practices to focus on inclusion, responsiveness to North-South and South-South inequities, and recognition of GHPs as situated in a broader (and inequitable) political economy. A relational and equity-centred approach to assessing GHPs would place social justice, humility and mutual benefits as central practices—that is, regular, routine things that partners involved in partnering do intentionally to make GHPs function well. Practicing equity in GHPs requires continuous efforts to explicitly acknowledge and examine the equity implications of all aspects of partnering. Supplementary Information The online version contains supplementary material available at 10.1186/s12992-021-00726-z.
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Affiliation(s)
- Katrina M Plamondon
- Michael Smith Foundation for Health Research Scholar, School of Nursing, Faculty of Health & Social Development, University of British Columbia, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada.
| | - Ben Brisbois
- School of Health Sciences, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Leslie Dubent
- Canadian Coalition for Global Health Research, 46 Cremona Crescent, Nepean, ON, K2G 1A1, Canada
| | - Charles P Larson
- Faculty of Medicine and Health Sciences, School of Population and Global Health, McGill University, 772 Sherbrooke Street West, Montreal, QC, H3A 1G1, Canada
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14
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Plamondon KM, Caxaj CS, Graham ID, Bottorff JL. Connecting knowledge with action for health equity: a critical interpretive synthesis of promising practices. Int J Equity Health 2019; 18:202. [PMID: 31878940 PMCID: PMC6933619 DOI: 10.1186/s12939-019-1108-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/10/2019] [Indexed: 11/12/2022] Open
Abstract
Connecting knowledge with action (KWA) for health equity involves interventions that can redistribute power and resources at local, national, and global levels. Although there is ample and compelling evidence on the nature, distribution, and impact of health inequities, advancing health equity is inhibited by policy arenas shaped by colonial legacies and neoliberal ideology. Effective progress toward health equity requires attention to evidence that can promote the kind of socio-political restructuring needed to address root causes of health inequities. In this critical interpretive synthesis, results of a recent scoping review were broadened to identify evidence-informed promising practices for KWA for health equity. Following screening procedures, 10 literature reviews and 22 research studies were included in the synthesis. Analysis involved repeated readings of these 32 articles to extract descriptive data, assess clarity and quality, and identify promising practices. Four distinct kinds of promising practices for connecting KWA for health equity were identified and included: ways of structuring systems, ways of working together, and ways of doing research and ways of doing knowledge translation. Our synthesis reveals that advancing health equity requires greater awareness, dialogue, and action that aligns with the what is known about the causes of health inequities. By critically reflecting on dominant discourses and assumptions, and mobilizing political will from a more informed and transparent democratic exercise, knowledge to action for health equity can be achieved.
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Affiliation(s)
- Katrina M Plamondon
- School of Nursing, The University of British Columbia, 1147 Research Rd., ART 360, Kelowna, BC, V1V 1V7, Canada.
| | | | - Ian D Graham
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Canada
| | - Joan L Bottorff
- School of Nursing, The University of British Columbia, 1147 Research Rd., ART 360, Kelowna, BC, V1V 1V7, Canada
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15
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Plamondon KM, Bottorff JL, Caxaj CS, Graham ID. The integration of evidence from the Commission on Social Determinants of Health in the field of health equity: a scoping review. CRITICAL PUBLIC HEALTH 2018. [DOI: 10.1080/09581596.2018.1551613] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Katrina M. Plamondon
- Interdisciplinary Graduate Studies, University of British Columbia, Kelowna, Canada
- School of Nursing, University of British Columbia, Kelowna, Canada
| | - Joan L. Bottorff
- School of Nursing, University of British Columbia, Kelowna, Canada
| | - C. Susana Caxaj
- School of Nursing, University of British Columbia, Kelowna, Canada
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Canada
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16
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Spini L. Ethics-based global health research for all, including women, children, indigenous people, LGBTQI, people with disabilities, refugees and other relevant stakeholders, especially in least developing countries and small island developing states in the Global South. Soc Sci Med 2018; 214:167-170. [DOI: 10.1016/j.socscimed.2017.11.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 11/21/2017] [Indexed: 11/15/2022]
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17
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McDermott-Levy R, Leffers J, Mayaka J. Ethical Principles and Guidelines of Global Health Nursing Practice. Nurs Outlook 2018; 66:473-481. [DOI: 10.1016/j.outlook.2018.06.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 06/14/2018] [Accepted: 06/16/2018] [Indexed: 11/27/2022]
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