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Segev R, Videl H, Spitz A. Nurses under fire: Insights from testimonies of community nurses and midwives in nonhospital settings in the southern Israel conflict zone. Res Nurs Health 2024; 47:513-521. [PMID: 38837799 DOI: 10.1002/nur.22402] [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: 02/18/2024] [Revised: 05/02/2024] [Accepted: 05/23/2024] [Indexed: 06/07/2024]
Abstract
Nurses-with or without prehospital care training-may find themselves delivering immediate care to injured individuals outside a healthcare facility, sometimes even in situations where their own life is at risk. This study explores the experiences of community nurses and midwives who provided immediate care during the Hamas militant movement's attack in southern Israel. The researchers collected and analyzed eight nurse and midwife survivors' testimonies published in digital media to gain a deeper understanding of their perspectives. Through qualitative content analysis, common themes, patterns, and insights were identified. The study aimed to contribute valuable knowledge in this field and followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist for methodological rigor. Two themes emerged from the testimonies, focusing on the nurses' swift realization of necessary action under fire and resilience and ingenuity in practice. Despite lacking training and resources, the nurses professionally assessed the situation and improvised creative solutions to care for the wounded. Although they had no prehospital emergency care background, community nurses and midwives were able to respond effectively, providing lifesaving care. The findings highlight the nurses' resilience, adaptability, and dedication in unprecedented situations. However, the study also emphasizes the importance of providing all nurses with baseline prehospital care training and structured planning of this care to empower them to deliver optimal patient care in uncertain and dangerous conditions, especially in and around conflict and disaster zones.
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Affiliation(s)
- Ronen Segev
- Department of Nursing, Steyer School of Health Professions, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Hila Videl
- Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
- Department of Infection Control and Quality Division, Herzliya Medical Center, Herzliya, Israel
| | - Ahuva Spitz
- Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
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2
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Whitaker J, Rickard R, Leather A, Davies J. Exploring the global health and defence engagement interface. BMJ Mil Health 2024; 170:e65-e69. [PMID: 38053261 DOI: 10.1136/military-2023-002497] [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: 07/13/2023] [Accepted: 11/10/2023] [Indexed: 12/07/2023]
Abstract
Militaries have an important and inevitable role in global health and will interface with existing health systems on deployments. While the primary concern of militaries is not global health, there are clear, and increasingly frequent, circumstances when global health activities align with the interests of defence. Recognising this link between global health and security warrants thoughtful consideration and action where concerns affecting both intersect. In addition to providing medical support to military personnel on operations, advantageous effects can be achieved directly from military medical activities as part of Defence Engagement. While there are limitations and ethical boundaries to the role of militaries in global health, further training, research and conceptual development are warranted to optimise military medical activity at the intersection of security and global health to deliver advantageous effects. This paper forms part of a special issue of BMJ Military Health dedicated to Defence Engagement.
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Affiliation(s)
- John Whitaker
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - R Rickard
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - A Leather
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - J Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Surgery, Stellenbosch University, Stellenbosch, South Africa
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3
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Foley S, Falconer Hall T, Bates D, Attridge K. Global health context for the military in Defence Engagement (Health). BMJ Mil Health 2024; 170:e59-e64. [PMID: 37536934 DOI: 10.1136/military-2023-002374] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/09/2023] [Indexed: 08/05/2023]
Abstract
Global health practice is becoming a key enabler within UK Defence and foreign policy. The definition of global health remains debated, though some important themes have been identified including: the multidisciplinary nature of global health, its ethical foundation and the political nature of global health. This paper contributes to the ongoing rational discourse that this important discipline deserves and recommends a framework and principles to apply to military health and care system strengthening in the Defence Engagement (Health) (DE(H)) practitioner role. DE(H) involves complex multiorganisational relationships and processes, and while practitioners should be mindful of the political nature of their role, the broad aims of preventing conflict and building stability mean DE(H) should contribute positively to global health.This paper forms part of a special issue of BMJ Military Health dedicated to Defence Engagement.
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Affiliation(s)
- Sue Foley
- Medical Operational Support Unit (MOSU), British Army, York, UK
| | | | - D Bates
- Institute of Health, University of Cumbria, Carlisle, UK
| | - K Attridge
- Public Health, Royal Air Force Medical Service, Naphill, UK
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4
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Falconer Hall T, Williams LG, Williams L, Horne ST. Defence context for the UK's Defence Engagement (Health). BMJ Mil Health 2024; 170:e55-e58. [PMID: 37192763 DOI: 10.1136/military-2023-002369] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/02/2023] [Indexed: 05/18/2023]
Abstract
Defence Engagement (DE) has been a core UK Defence task since 2015. DE (Health) is the use of military medical capabilities to achieve DE effects within the health sector to achieve security and defence objectives. DE (Health) practitioners must understand the underlying defence context that shapes these objectives. The strategic context is becoming more uncertain with the return of great power competition layered on enduring threats from non-state actors and transnational challenges. The UK response has been to develop the Integrated Review, outlining four national security and international policy objectives. UK Defence has responded by developing the integrated operating concept, differentiating military activity between operating and warfighting. Engage is one of the three functions of operate activity, which is complementary to the other operate functions of protect and constrain. DE (Health) can play a unique role in engagement, given its ability to develop new partnerships through health-related activity. DE (Health) may be an enabler for other engagements or to enable the protect and constrain functions. This will be dependent on delivering improvement in health outcomes. Therefore, the DE (Health) practitioner must be conversant with both the contemporary defence and global health contexts to deliver effective DE (Health) activities. This is an article commissioned for the DE special issue of BMJ Military Health.
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Affiliation(s)
- Thomas Falconer Hall
- AMS Support Unit, Army Medical Services, Camberley, UK
- DMS Centre for Defence Engagement, Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
| | - L G Williams
- AMS Support Unit, Army Medical Services, Camberley, UK
| | - L Williams
- 2 Armoured Medical Regiment, British Army, Tidworth, UK
| | - S T Horne
- DMS Centre for Defence Engagement, Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
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5
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Licina D, Bricknell M, Erickson E, Varnau E, Payne L, Ediger M. Expanding Global Health Engagement through Multilateral Security Organizations. Mil Med 2024; 189:e1710-e1718. [PMID: 38079458 DOI: 10.1093/milmed/usad458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/26/2023] [Accepted: 11/15/2023] [Indexed: 07/05/2024] Open
Abstract
INTRODUCTION Many countries around the world employ defense capabilities in support of global health engagement (GHE) through bilateral and multilateral organizations. Despite this, there does not appear to be a strategic approach and implementation plan for U.S. DoD GHE in support of and through multilateral organizations. The purpose of this research is to identify which security multilateral organizations are engaged in GHE, as well as how and why. These findings could inform an interoperable approach for doing so going forward. METHODS A systematic review was conducted to develop a list of multilateral security organizations and agreements which engage in GHE, or could potentially play a role in GHE. RESULTS Of the 3,488 agreements and organizations identified, 15 met the inclusion criteria. Among them, 87% (13/15) of the multilateral organizations are regional and 13% (2/15) are international, all established between 1948 and 2020. The 15 organizations cover all DoD Geographical Combatant Commands. Among them, 20% (3/15) are a legally binding alliance, 73% (11/15) have a treaty, and 7% (1/15) have a diplomatic partnership. Twenty percent (3/15) have an explicit intent to improve health in either their mission statement or as part of their goals, priorities, and/or objectives. Eighty percent (12/15) engage in at least two GHE domains outlined in DoD Policy, 67% in three (10/15), and 47% in all four (7/15). The most common domain is humanitarian assistance and foreign disaster response at 100% (15/15) and least common is Nuclear, Chemical, and Biological Defense Programs at 53% (8/15). CONCLUSIONS Although there is high demand for GHE, resourcing to enable implementation has not been prioritized. Therefore, multilateral organizations continue to support what is funded (e.g., disaster response) versus prioritizing capacity building or modifying authorities and appropriations to match demand. It is also worth noting most organizations included in this review support the European theater aligning to historical defense priorities, versus emerging threats in the Indo-Pacific region. Identifying a forum within these multilateral institutions to convene GHE policy makers and practitioners is a logical next step. The forums could guide and direct priorities, devise solutions, and implement best practices. Near term efforts could include GHE financing, governance, assurance, and technical assistance within and across multilateral institutions. Recent efforts highlight growth in both interest and action to support the variety of GHE activities regionally and internationally. As the United States seeks to reinforce multilateral institutions and uphold the international and rules-based order, employing GHE through multilateral cooperation could buttress efforts. Now is a perfect time given the sustained interest in global health, amplified value of allies and partners, and renewed emphasis placed on multilateral cooperation for the DoD to design a multilateral GHE strategy and seek Congressional support to resource it accordingly.
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Affiliation(s)
- Derek Licina
- Deloitte Consulting LLP, Arlington, VA 22209, USA
| | - Martin Bricknell
- Conflict and Health Research Group, Department of War Studies, School of Security Studies, Faculty of Social Science & Public Policy, King's College London WC2R 2LS, UK
| | | | - Erika Varnau
- Deloitte Consulting LLP, Arlington, VA 22209, USA
| | - Lee Payne
- Deloitte Consulting LLP, Arlington, VA 22209, USA
| | - Mark Ediger
- Deloitte Consulting LLP, Arlington, VA 22209, USA
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6
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Baird MD, Madha ES, Arnaouti M, Cahill GL, Hewa Kodikarage SN, Harris RE, Murphy TP, Bartel MC, Rich EL, Pathirana YG, Kim E, Bain PA, Alswaiti GT, Ratnayake AS, Worlton TJ, Joseph MN. Global assessment of military and civilian trauma systems integration: a scoping review. Int J Surg 2024; 110:3617-3632. [PMID: 38935828 PMCID: PMC11175771 DOI: 10.1097/js9.0000000000001265] [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: 06/07/2023] [Accepted: 02/21/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND The global burden of trauma disproportionately affects low-income countries and middle-income countries (LMIC), with variability in trauma systems between countries. Military and civilian healthcare systems have a shared interest in building trauma capacity for use during peace and war. However, in LMICs it is largely unknown if and how these entities work together. Understanding the successful integration of these systems can inform partnerships that can strengthen trauma care. This scoping review aims to identify examples of military-civilian trauma systems integration and describe the methods, domains, and indicators associated with integration including barriers and facilitators. METHODS A scoping review of all appropriate databases was performed to identify papers with evidence of military and civilian trauma systems integration. After manuscripts were selected for inclusion, relevant data was extracted and coded into methods of integration, domains of integration, and collected information regarding indicators of integration, which were further categorized into facilitators or barriers. RESULTS Seventy-four studies were included with authors from 18 countries describing experiences in 23 countries. There was a predominance of authorship and experiences from High-Income Countries (91.9 and 75.7%, respectively). Five key domains of integration were identified; Academic Integration was the most common (45.9%). Among indicators, the most common facilitator was administrative support and the lack of this was the most common barrier. The most common method of integration was Collaboration (50%). CONCLUSION Current evidence demonstrates the existence of military and civilian trauma systems integration in several countries. High-income country data dominates the literature, and thus a more robust understanding of trauma systems integration, inclusive of all geographic locations and income statuses, is necessary prior to development of a framework to guide integration. Nonetheless, the facilitators identified in this study describe the factors and environment in which integration is feasible and highlight optimal indicators of entry.
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Affiliation(s)
- Michael D. Baird
- Program in Global Surgery and Social Change
- Department of Global Health and Social Medicine
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center
| | - Emad S. Madha
- Program in Global Surgery and Social Change
- Department of Global Health and Social Medicine
- Department of General Surgery, Walter Reed National Military Medical Center
| | - Matthew Arnaouti
- Program in Global Surgery and Social Change
- Department of Global Health and Social Medicine
- Royal National Orthopaedic Hospital, Stanmore, Middlesex
| | - Gabrielle L. Cahill
- Program in Global Surgery and Social Change
- Department of Global Health and Social Medicine
- Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Sadeesh N. Hewa Kodikarage
- Department of Surgery, Army Hospital Colombo
- Postgraduate Institute of Medicine, University of Colombo, Colombo Sri Lanka
| | | | - Timothy P. Murphy
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center
| | - Megan C. Bartel
- Department of General Surgery, Walter Reed National Military Medical Center
| | - Elizabeth L. Rich
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center
| | - Yasar G. Pathirana
- Department of Surgery, Army Hospital Colombo
- Postgraduate Institute of Medicine, University of Colombo, Colombo Sri Lanka
| | - Eungjae Kim
- School of Medicine, Uniformed Services University
| | - Paul A. Bain
- Countway Library, Harvard Medical School, Boston
| | | | | | - Tamara J. Worlton
- Department of General Surgery, Walter Reed National Military Medical Center
- Department of Surgery, Uniformed Services University, Bethesda
| | - Michelle N. Joseph
- Program in Global Surgery and Social Change
- Department of Global Health and Social Medicine
- Department of Surgery, Uniformed Services University, Bethesda
- Clinical Trials Unit, University of Warwick, Warwickshire, UK
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7
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Goniewicz K, Khorram-Manesh A, Burkle FM. Empowering Communities in Geopolitical Crises: A Role for Disaster Medicine and Public Health Preparedness. Disaster Med Public Health Prep 2024; 18:e90. [PMID: 38639109 DOI: 10.1017/dmp.2024.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Affiliation(s)
| | - Amir Khorram-Manesh
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sweden
- Disaster Medicine Center, Gothenburg University, Sweden
- Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska Academy, Gothenburg University, Sweden
| | - Frederick M Burkle
- Global Fellow, Woodrow Wilson International Center for Scholars, Washington, DC, USA
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8
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Asfaw ZK, Greisman JD, Comuniello B, Shlobin NA, Etienne M, Zuckerman SL, Laeke T, Al-Sharshahi ZF, Barthélemy EJ. Global Neurosurgery Advances From Trenches to Bedside: Lessons From Neurosurgical Care in War, Humanitarian Assistance, and Disaster Response. Mil Med 2024; 189:e532-e540. [PMID: 37261884 DOI: 10.1093/milmed/usad170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/20/2023] [Accepted: 05/03/2023] [Indexed: 06/02/2023] Open
Abstract
INTRODUCTION War has influenced the evolution of global neurosurgery throughout the past century. Armed conflict and mass casualty disasters (MCDs), including Humanitarian Assistance Disaster Relief missions, require military surgeons to innovate to meet extreme demands. However, the military medical apparatus is seldom integrated into the civilian health care sector. Neurosurgeons serving in the military have provided a pragmatic template for global neurosurgeons to emulate in humanitarian disaster responses. In this paper, we explore how wars and MCD have influenced innovations of growing interest in the resource-limited settings of global neurosurgery. METHODS We performed a narrative review of the literature examining the influence of wars and MCD on contemporary global neurosurgery practices. RESULTS Wartime innovations that influenced global neurosurgery include the development of triage systems and modernization with airlifts, the implementation of ambulance corps, early operation on cranial injuries in hospital camps near the battlefield, the use of combat body armor, and the rise of damage control neurosurgery. In addition to promoting task-shifting and task-sharing, workforce shortages during wars and disasters contributed to the establishment of the physician assistant/physician associate profession in the USA. Low- and middle-income countries (LMICs) face similar challenges in developing trauma systems and obtaining advanced technology, including neurosurgical equipment like battery-powered computed tomography scanners. These challenges-ubiquitous in low-resource settings-have underpinned innovations in triage and wound care, rapid evacuation to tertiary care centers, and minimizing infection risk. CONCLUSION War and MCDs have catalyzed significant advancements in neurosurgical care both in the pre-hospital and inpatient settings. Most of these innovations originated in the military and subsequently spread to the civilian sector as military neurosurgeons and reservist civilian neurosurgeons returned from the battlefront or other low-resource locations. Military neurosurgeons have utilized their experience in low-resource settings to make volunteer global neurosurgery efforts in LMICs successful. LMICs have, by necessity, responded to challenges arising from resource shortages by developing innovative, context-specific care paradigms and technologies.
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Affiliation(s)
- Zerubabbel K Asfaw
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jacob D Greisman
- Department of Neurology, New York Medical College, Valhalla, NY 10595, USA
| | - Briana Comuniello
- Department of Neurology, New York Medical College, Valhalla, NY 10595, USA
| | - Nathan A Shlobin
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Mill Etienne
- Department of Neurology, New York Medical College, Valhalla, NY 10595, USA
| | - Scott L Zuckerman
- Department of Neurosurgery, Vanderbilt School of Medicine, Nashville, TN 37232, USA
| | - Tsegazeab Laeke
- Neurosurgery Division, Department of Surgery, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
| | - Zahraa F Al-Sharshahi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ernest J Barthélemy
- Division of Neurosurgery, SUNY Downstate College of Medicine, Brooklyn, NY 11203, USA
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Li Y, Zhang J, Ullah S. Unleashing the power of emergency response: controlling natural disasters by addressing environmental risk. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:114901-114911. [PMID: 37875757 DOI: 10.1007/s11356-023-30332-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/04/2023] [Indexed: 10/26/2023]
Abstract
The primary focus of the analysis is to investigate the impact of emergency response management and environmental risk on natural disasters by controlling the variables of national income and financial development. To investigate the model empirically, we have employed the quantile autoregressive distributed lag model that estimates the short- and long-run estimates across various quantiles. The long-run estimates of emergency response management are negative and significant only at higher quantiles, i.e., from 60 to 95th quantiles. In the short run, emergency response management's estimated coefficients are negative and significant from 70 to 95th quantiles. Environmental risk shows a significant positive correlation with natural disasters across quantiles, while national income and financial development decrease natural disasters in the long run. Furthermore, we observed the asymmetric impact of emergency response management on natural disasters in both the short and long run.
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Affiliation(s)
- Yue Li
- China University of Geosciences, Wuhan, China
| | | | - Sana Ullah
- Lebanese American University, Beirut, Lebanon
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10
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McCoy D, Roberts S, Daoudi S, Kennedy J. Global health security and the health-security nexus: principles, politics and praxis. BMJ Glob Health 2023; 8:e013067. [PMID: 37748796 PMCID: PMC10537961 DOI: 10.1136/bmjgh-2023-013067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/20/2023] [Indexed: 09/27/2023] Open
Abstract
The past four decades have seen a steady rise of references to 'security' by health academics, policy-makers and practitioners, particularly in relation to threats posed by infectious disease pandemics. Yet, despite an increasingly dominant health security discourse, the many different ways in which health and security issues and actors intersect have remained largely unassessed and unpacked in current critical global health scholarship. This paper discusses the emerging and growing health-security nexus in the wake of COVID-19 and the international focus on global health security. In recognising the contested and fluid concept of health security, this paper presents two contrasting approaches to health security: neocolonial health security and universal health security. Building from this analysis, we present a novel heuristic that delineates the multiple intersections and entanglements between health and security actors and agendas to broaden our conceptualisation of global health security configurations and practices and to highlight the potential for harmful unintended consequences, the erosion of global health norms and values, and the risk of health actors being co-opted by the security sector.
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Affiliation(s)
- David McCoy
- International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia
| | - Stephen Roberts
- Institute for Global Health, University College London, London, UK
| | - Salma Daoudi
- Department of Politics and International Relations, University of Oxford, Oxford, UK
| | - Jonathan Kennedy
- Wolfson Institute for Population Health, Queen Mary University London, London, UK
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11
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Lowe G, Zhong Y, Plummer V, Tori K. The extent, range and nature of the evidence on advanced practice among military nurses during war and terrorism: A scoping review. Int Emerg Nurs 2023; 69:101295. [PMID: 37285644 DOI: 10.1016/j.ienj.2023.101295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 03/22/2023] [Accepted: 04/04/2023] [Indexed: 06/09/2023]
Affiliation(s)
- Grainne Lowe
- Institute of Health and Wellbeing, Federation University, 100 Clyde Road, Berwick, Australia.
| | - Yaping Zhong
- Institute of Health and Wellbeing, Federation University, 100 Clyde Road, Berwick, Australia.
| | - Virginia Plummer
- Institute of Health and Wellbeing, Federation University, 100 Clyde Road, Berwick, Australia.
| | - Kathleen Tori
- Torrens University, 196 Flinders St, Melbourne, Australia.
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12
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Erickson P, Kljajić M, Shelef N. Domestic Military Deployments in Response to COVID-19. ARMED FORCES AND SOCIETY 2023; 49:350-371. [PMID: 38603159 PMCID: PMC8958307 DOI: 10.1177/0095327x211072890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Militaries are commonly deployed in response to domestic disasters. However, our understanding of this phenomenon remains incomplete, partly because the particulars of disasters make it hard to generalize about deployments used in response. This article leverages the COVID-19 pandemic's global reach to systematically evaluate common hypotheses about when and how militaries are used to respond to domestic disasters. It presents original global data about domestic military deployments in pandemic response and uses it to assess common theoretical expectations about what shapes whether and how militaries are used in such contexts. The results suggest that decisions about whether to deploy militaries stem from the securitization of domestic disaster relief rather than being responses to specific disaster-related features, state capacity shortcomings, or other social or political factors, even as some of these elements shaped how militaries were used. The article concludes by outlining some hypotheses for future research about the impact of this securitization on civil-military relations.
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Affiliation(s)
- Peter Erickson
- Political Science Department, University of
Wisconsin-Madison, Madison WI, USA
| | - Marko Kljajić
- Political Science Department, University of
Wisconsin-Madison, Madison WI, USA
| | - Nadav Shelef
- Political Science Department, University of
Wisconsin-Madison, Madison WI, USA
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13
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Snowden BS, Licina D, Crowley K, Migliaccio G, Ramsey S. Enhancing Partner Nation Security: A Mixed-Methods Evaluation of A Peacekeeping Public Health Capacity Building Initiative. Mil Med 2023; 188:e359-e367. [PMID: 34296259 DOI: 10.1093/milmed/usab306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/08/2021] [Accepted: 07/13/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION One way the U.S. Department of Defense (DoD) works to achieve national security is through security cooperation, by way of building and enhancing partner nation capacity. This study evaluated a health-related security cooperation training initiative delivered by the DoD to military peacekeepers. The study specifically examined outcomes of change, including the beginning phase of sustainability. MATERIALS AND METHODS The U.S. DoD employed a train-the-trainer model in Ghana, Rwanda, Senegal, and Uganda to support the African Peacekeeping Rapid Response Partnership program. U.S. instructors trained 192 peacekeepers through 11 training iterations between December 2016 and March 2020. A mixed-method explanatory sequential design was used to explore training outcomes. Quantitatively, three hypotheses were tested using nonparametric statistical analysis. Qualitative analysis of documents was used to inform and contextually understand the quantitative results. This study was submitted to the George Washington University Institutional Review Board and was fully approved (NCR202918). RESULTS Quantitative and qualitative results indicated improved short-term public health knowledge and upskill among partner nation participants. There was the beginning of a cascade effect of the partner nations' ability to autonomously teach tasks and skills to their military to sustain the initiative. Differences in achieving and maintaining change outcomes were related to student characteristics, the training course, and the partner nation. CONCLUSIONS This research serves as the first published study to empirically examine health-related security cooperation train-the-trainer initiative change outcomes. This research is an essential building block to empirically evaluate and capture change outcomes from security cooperation capacity building training initiatives. The findings and recommendations inform security cooperation policy and associated investments.
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Affiliation(s)
- Bobbi S Snowden
- Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA
| | | | - Kathleen Crowley
- Graduate School of Education and Development, The George Washington University, Washington, DC 20052, USA
| | - Gene Migliaccio
- Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA
| | - Sueann Ramsey
- Center for Global Health Engagement, Uniformed Services University of the Health Sciences, Bethesda, MD 20817, USA
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14
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Epidemics and the Military: Responding to COVID-19 in Uganda. Soc Sci Med 2022; 314:115482. [PMID: 36370659 PMCID: PMC9617651 DOI: 10.1016/j.socscimed.2022.115482] [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: 07/01/2022] [Revised: 10/03/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022]
Abstract
The UN Security Council's response to Ebola in 2014 legitimised militarised responses. It also influenced responses to COVID-19 in some African countries. Yet, little is known about the day-to-day impacts for ordinary citizens of mobilising armies for epidemic control. Drawing on 18 months ethnographic research, this article analyses militarised responses to COVID-19 during, and following, two lockdowns at contrasting sites in Uganda: a small town in Pakwach district and a village in Kasese district. Both field sites lie close to the border of the Democratic Republic of Congo. Although the practice of health security varied between sites, the militarised response had more impact than the disease in these two places. The armed forces scaled back movement from urban conurbations to rural and peri-urban areas; while simultaneously enabling locally based official public authorities to use the proclaimed priorities of President Museveni's government to enhance their position and power. This led to a situation whereby inhabitants created new modes of mutuality to resist or subvert the regulations being enforced, including the establishment of new forms of cross-border movement. These findings problematise the widely held view that Uganda's response to COVID-19 was successful. Overall, it is argued that the on-going securitisation of global health has helped to create the political space to militarise the response. While this has had unknown effects on the prevalence of COVID-19, it has entrenched unaccountable modes of public authority and created a heightened sense of insecurity on the ground. The tendency to condone the violent practice of militarised public health programmes by international and national actors reflects a broader shift in the acceptance of more authoritarian forms of governance.
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Valladares-Garrido MJ, Huamani-Colquichagua Y, Anchay-Zuloeta C, Picón-Reátegui CK, Valladares-Garrido D. Time in Service and Resilience in Active Military Personnel during the COVID-19 Pandemic: A Cross-Sectional Study in Northern Peru. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11052. [PMID: 36078763 PMCID: PMC9518471 DOI: 10.3390/ijerph191711052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 06/15/2023]
Abstract
Greater occupational exposure may have a positive effect on the development of resilience. We aimed to determine the association between working time and resilience in Peruvian military personnel during the COVID-19 pandemic. A secondary data analysis was performed including 586 records of military personnel who supported the health emergency during the second epidemic wave in Lambayeque, Peru. Resilience was measured with the short form of the Connor-Davidson Resilience Scale (CD-RISC). Working time and other relevant covariates were collected by self-report. Generalized linear models were used. The mean resilience score was 22.18 and 43.2% scored high for resilience. Participants reported that they are strong individuals when facing difficulties (42.3%), are able to handle unpleasant feelings (40.3%), and achieve their goals despite obstacles (40.4%). Working more than 18 months was associated with a 35% higher prevalence of high resilience (PR: 1.35; 95% CI: 1.05-1.75). In conclusion, a notable number of military personnel experienced high levels of resilience during the pandemic. Working time may have played an important role in the development of this ability. Our findings could help guide the deployment and organization of the military in health emergency support missions.
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Affiliation(s)
- Mario J. Valladares-Garrido
- South American Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima 15046, Peru
- Oficina de Epidemiología, Hospital Regional Lambayeque, Chiclayo 14012, Peru
| | | | - Claudia Anchay-Zuloeta
- Facultad de Medicina, Universidad de San Martín de Porres, Chiclayo 14012, Peru
- Sociedad Científica de Estudiantes de Medicina Veritas (SCIEMVE), Chiclayo 14012, Peru
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Biselli R, Nisini R, Lista F, Autore A, Lastilla M, De Lorenzo G, Peragallo MS, Stroffolini T, D’Amelio R. A Historical Review of Military Medical Strategies for Fighting Infectious Diseases: From Battlefields to Global Health. Biomedicines 2022; 10:2050. [PMID: 36009598 PMCID: PMC9405556 DOI: 10.3390/biomedicines10082050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/12/2022] [Accepted: 08/13/2022] [Indexed: 11/17/2022] Open
Abstract
The environmental conditions generated by war and characterized by poverty, undernutrition, stress, difficult access to safe water and food as well as lack of environmental and personal hygiene favor the spread of many infectious diseases. Epidemic typhus, plague, malaria, cholera, typhoid fever, hepatitis, tetanus, and smallpox have nearly constantly accompanied wars, frequently deeply conditioning the outcome of battles/wars more than weapons and military strategy. At the end of the nineteenth century, with the birth of bacteriology, military medical researchers in Germany, the United Kingdom, and France were active in discovering the etiological agents of some diseases and in developing preventive vaccines. Emil von Behring, Ronald Ross and Charles Laveran, who were or served as military physicians, won the first, the second, and the seventh Nobel Prize for Physiology or Medicine for discovering passive anti-diphtheria/tetanus immunotherapy and for identifying mosquito Anopheline as a malaria vector and plasmodium as its etiological agent, respectively. Meanwhile, Major Walter Reed in the United States of America discovered the mosquito vector of yellow fever, thus paving the way for its prevention by vector control. In this work, the military relevance of some vaccine-preventable and non-vaccine-preventable infectious diseases, as well as of biological weapons, and the military contributions to their control will be described. Currently, the civil-military medical collaboration is getting closer and becoming interdependent, from research and development for the prevention of infectious diseases to disasters and emergencies management, as recently demonstrated in Ebola and Zika outbreaks and the COVID-19 pandemic, even with the high biocontainment aeromedical evacuation, in a sort of global health diplomacy.
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Affiliation(s)
- Roberto Biselli
- Ispettorato Generale della Sanità Militare, Stato Maggiore della Difesa, Via S. Stefano Rotondo 4, 00184 Roma, Italy
| | - Roberto Nisini
- Dipartimento di Malattie Infettive, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Roma, Italy
| | - Florigio Lista
- Dipartimento Scientifico, Policlinico Militare, Comando Logistico dell’Esercito, Via S. Stefano Rotondo 4, 00184 Roma, Italy
| | - Alberto Autore
- Osservatorio Epidemiologico della Difesa, Ispettorato Generale della Sanità Militare, Stato Maggiore della Difesa, Via S. Stefano Rotondo 4, 00184 Roma, Italy
| | - Marco Lastilla
- Istituto di Medicina Aerospaziale, Comando Logistico dell’Aeronautica Militare, Viale Piero Gobetti 2, 00185 Roma, Italy
| | - Giuseppe De Lorenzo
- Comando Generale dell’Arma dei Carabinieri, Dipartimento per l’Organizzazione Sanitaria e Veterinaria, Viale Romania 45, 00197 Roma, Italy
| | - Mario Stefano Peragallo
- Centro Studi e Ricerche di Sanità e Veterinaria, Comando Logistico dell’Esercito, Via S. Stefano Rotondo 4, 00184 Roma, Italy
| | - Tommaso Stroffolini
- Dipartimento di Malattie Infettive e Tropicali, Policlinico Umberto I, 00161 Roma, Italy
| | - Raffaele D’Amelio
- Dipartimento di Medicina Clinica e Molecolare, Sapienza Università di Roma, Via di Grottarossa 1035-1039, 00189 Roma, Italy
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Stone AB, Weg AL, Petzing SR, Rollings A, Perdue CL. Lack of Alignment Between WHO Joint External Evaluation and State Party Self-Assessment Scores Undermines Utility as Evaluation Tools for the Department of Defense. Health Secur 2022; 20:321-330. [PMID: 35881868 DOI: 10.1089/hs.2021.0209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The International Health Regulations 2005 (IHR) set standards for countries to detect and respond to public health threats such as COVID-19. The US Department of Defense engages with partner nations to build IHR-related health security capacities. In this article, we compare 2 elements of the IHR Monitoring and Evaluation Framework to determine if they align in a useful way. The version of the State Party Annual Reporting tool (SPAR) used for this study is a self-assessment of 13 capacities, while the Joint External Evaluation (JEE) requires collaboration with international subject matter experts to evaluate 19 capacities. The SPAR indicators are scored separately from 0% to 100%, whereas the JEE uses a rank-ordered scale from 1 to 5 for variable numbers of indicators in each capacity. Using 2018-2019 data from the World Health Organization, we quantitatively and qualitatively evaluated the alignment of the SPAR and JEE scoring systems, using paired t tests for related capacities and 3 approaches to matching the scales. Whether using a simple, evenly divided scale for the SPAR or downscaling the SPAR scores to match with lower JEE scores, the paired t tests indicate that the JEE and SPAR scoring systems are not aligned. Many of the capacities in the JEE and SPAR are defined differently, pointing to one of the reasons for the discordance. We discuss implications for revision of the JEE and SPAR assessment tools along with ways in which the scores might be used for planning global health engagement capacity-building activities.
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Affiliation(s)
- Alexandra B Stone
- Alexandra B. Stone, PhD, MSc, is Senior Advisor for Assessment, Monitoring, and Evaluation, The Henry M. Jackson Foundation for the Advancement of Military Medicine and the Center for Global Health Engagement, at the Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Alden L Weg
- Alden L. Weg, MD, MPH, is Director, Combatant Command Support, Center for Global Health Engagement, at the Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Stephanie R Petzing
- Stephanie R. Petzing, PhD, is Senior Global Health Security Advisor, The Henry M. Jackson Foundation for the Advancement of Military Medicine and the Center for Global Health Engagement, at the Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Amber Rollings
- Amber Rollings, PhD, is an Assessment, Monitoring, and Evaluation Data Analyst, The Henry M. Jackson Foundation for the Advancement of Military Medicine and the Center for Global Health Engagement, at the Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Christopher L Perdue
- Christopher L. Perdue, MD, MPH, is a Senior Policy Analyst, Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services, Washington, DC
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Janse J, Kalkman JP, Burchell GL, Hopperus Buma APCC, Zuiderent-Jerak T, Bollen MTIB, Timen A. Civil-military cooperation in the management of infectious disease outbreaks: a scoping review. BMJ Glob Health 2022; 7:bmjgh-2022-009228. [PMID: 35705227 PMCID: PMC9204439 DOI: 10.1136/bmjgh-2022-009228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/21/2022] [Indexed: 11/04/2022] Open
Abstract
Introduction Civil–military cooperation (CMC) in infectious disease outbreak responses has become more common, and has its own cooperation dynamics. These collaborations fit WHO’s call for multisectoral cooperation in managing health emergencies according to the emergency management cycle (EMC). However, the literature on CMC on this topic is fragmented. The core aim of this review is to understand the breadth and dynamics of this cooperation by using the EMC as a framework and by identifying challenges and opportunities in the management of outbreaks. Methods A scoping review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guideline was conducted. A systematic search for peer-reviewed journals was performed in PubMed, Embase, Web of Science and Scopus. Eligible papers addressed substantive contributions to the understanding of CMC. Papers were categorised by EMC phase and relevant information on study characteristics and areas of cooperation were extracted from the data. Recurring themes on challenges and opportunities in cooperation were identified by means of qualitative interpretation analysis. Results The search resulted in 8360 papers; 54 were included for analysis. Most papers provided a review of activities or expert opinions. CMC was described in all EMC phases, with the fewest references in the recovery phase (n=1). In total, eight areas of CMC were explored. Regarding the better understanding of cooperative dynamics, the qualitative analysis of the papers yielded five recurring themes covering challenges and opportunities in CMC: managing relations, framework conditions, integrating collective activities, governance and civil–military differences. Conclusion Guided by these five themes, successful CMC requires sustainable relations, binding agreements, transparency, a clear operational perspective and acknowledgement of organisational cultural differences. Early and continuous engagement proves crucial to avoid distrust and tension among stakeholders, frequently caused by differences in strategical goals. Original research on this topic is limited.
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Affiliation(s)
- Jacobine Janse
- Military Management Studies, Netherlands Defense Academy, Breda, Netherlands .,Athena Institute, VU University Amsterdam, Amsterdam, Netherlands
| | - Jori Pascal Kalkman
- Military Management Studies, Netherlands Defense Academy, Breda, Netherlands
| | | | | | | | | | - Aura Timen
- Athena Institute, VU University Amsterdam, Amsterdam, Netherlands.,Primary and Community Care, Radboud University Medical Centre, Nijmegen, Netherlands
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19
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Chaufan C, Dutescu IA, Fekre H, Marzabadi S, Noh KJ. The military as a neglected pathogen transmitter, from the nineteenth century to COVID-19: a systematic review. Glob Health Res Policy 2021; 6:48. [PMID: 34893071 PMCID: PMC8661370 DOI: 10.1186/s41256-021-00232-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/17/2021] [Indexed: 12/02/2022] Open
Abstract
Background The risk of outbreaks escalating into pandemics has soared with globalization. Therefore, understanding transmission mechanisms of infectious diseases has become critical to formulating global public health policy. This systematic review assessed evidence in the medical and public health literature for the military as a disease vector. Methods We searched 3 electronic databases without temporal restrictions. Two researchers independently extracted study data using a standardized form. Through team discussions, studies were grouped according to their type of transmission mechanism and direct quotes were extracted to generate themes and sub-themes. A content analysis was later performed and frequency distributions for each theme were generated. Results Of 6477 studies, 210 met our inclusion criteria and provided evidence, spanning over two centuries (1810–2020), for the military as a pathogen transmitter, within itself or between it and civilians. Biological mechanisms driving transmission included person-to-person transmission, contaminated food and water, vector-borne, and airborne routes. Contaminated food and/or water were the most common biological transmission route. Social mechanisms facilitating transmission included crowded living spaces, unhygienic conditions, strenuous working, training conditions, absent or inadequate vaccination programs, pressure from military leadership, poor compliance with public health advice, contractor mismanagement, high-risk behaviours, and occupation-specific freedom of movement. Living conditions were the most common social transmission mechanism, with young, low ranking military personnel repeatedly reported as the most affected group. Selected social mechanisms, such as employment-related freedom of movement, were unique to the military as a social institution. While few studies explicitly studied civilian populations, considerably more contained information that implied that civilians were likely impacted by outbreaks described in the military. Conclusions This study identified features of the military that pose a significant threat to global health, especially to civilian health in countries with substantial military presence or underdeveloped health systems. While biological transmission mechanisms are shared by other social groups, selected social transmission mechanisms are unique to the military. As an increasingly interconnected world faces the challenges of COVID-19 and future infectious diseases, the identified features of the military may exacerbate current and similar challenges and impair attempts to implement successful and equitable global public health policies. Supplementary Information The online version contains supplementary material available at 10.1186/s41256-021-00232-0.
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Affiliation(s)
| | | | - Hanah Fekre
- Faculty of Health, York University, Toronto, Canada.
| | | | - K J Noh
- Independent Scholar, Oakland, USA
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Leone RM, Homan Z, Lelong A, Bandekow L, Bricknell M. An Analysis of International Military Health Systems Using the Military Medical Corps Worldwide Almanac. Mil Med 2021; 186:e1017-e1023. [PMID: 33241312 DOI: 10.1093/milmed/usaa376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/04/2020] [Accepted: 11/13/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION A number of organizations publish comparisons of civilian health systems between countries. However, the authors were unable to find a global, systematic, and contemporary analysis of military healthcare systems. Although many databases exist for comparing national healthcare systems, the only such compilation of information for military medical systems is the Military Medical Almanac. A thorough review of the Almanac was conducted to understand the quality of information provided in each country's profile and to develop a framework for comparing between countries. This information is valuable because it can facilitate collaboration and lesson sharing between nations while providing a structured source of information about a nation's military medical capabilities for internal use. MATERIALS AND METHODS Each of the 142 profiles (submitted by 132 countries) published in the Almanac were reviewed. The information provided was extracted and aggregated into a spreadsheet that covered the broader categories of country background, force demographics, beneficiary populations, administration and oversight, physical structures and capabilities, research capabilities, and culture and artifacts. An initial sample of 20 countries was evaluated to test these categories and their subsections before the rest of the submissions were reviewed. Clear definitions were revised and established for each of the 69 subcategories. Qualitative and quantitative data were compiled in the spreadsheet to enable comparisons between entries. RESULTS Significant variation was found in how information was presented in country profiles and to what extent this was comparable between submissions. The most consistently provided information was in the country background, where the categories ranged from 90.15% to 100% completion across submissions. There was inconsistency in reporting of the numbers and types of healthcare workers employed within military medical services. Nearly 25% of nations reported providing medical care to family members of service members, but retirees, veterans, reservists, and law enforcement personnel were also mentioned. Some countries described organizational structures, military medical education institutions, and humanitarian operations. A few reported military medical research capabilities, though each research domain was present in 25% or less of all submissions. Interestingly, cultural identities such as emblems were present in nearly 90% of profiles, with many countries also having badges, symbols, and mottos. CONCLUSIONS The Military Medical Almanac is potentially a highly valuable collection of publicly available baseline information on military medical services across the world. However, the quality of this collection is highly dependent on the submission provided by each country. It is recommended that the template for collecting information on each health system be refined, alongside an effort to increase awareness of the value of the Almanac as an opportunity to raise the international profile of each country's military medical system. This will ensure that the Almanac can better serve the international military medical community.
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Affiliation(s)
- Ryan M Leone
- Conflict and Health Research Group, School of Security Studies, King's College London, London, WC2R 2LS, UK
| | - Zenobia Homan
- Centre for Science & Security Studies, Department of War Studies, King's College London, London, WC2R 2LS, UK
| | - Antonin Lelong
- School of Population Health & Environmental Sciences, King's College London, London WC2R 2LS, UK
| | - Lutz Bandekow
- Worldwide Military-Medicine Almanac, Bonn, 53125, Germany
| | - Martin Bricknell
- Centre for Science & Security Studies, Department of War Studies, King's College London, London, WC2R 2LS, UK
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21
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Jabbar R, Makki M. Managing health disasters and Civil-Military Cooperation: A case of COVID-19 in Pakistan. JAMBA (POTCHEFSTROOM, SOUTH AFRICA) 2021; 13:1113. [PMID: 34522287 PMCID: PMC8424743 DOI: 10.4102/jamba.v13i1.1113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/11/2021] [Indexed: 06/13/2023]
Abstract
As an institution, the Pakistan Army has been playing a significant role in dealing with emergencies and disasters facing the nation. The novel coronavirus disease, Severe Acute Respiratory Syndrome (SARS) COVID-19, was wreaking havoc around the world. The pandemic is a threat to health and has caused severe damage across most aspects of the society. The situation forced the formation of a unique series of civil-military inter-agency relationships to be formed, in order to curb the spread of the pandemic. The Pakistan Army that was neither trained nor equipped to undertake any such health disaster management operation played a significant role in preventing disease and overcoming the disaster. Civil-military cooperation (CIMIC) was the key to the successful response of Pakistan towards COVID-19. The research was based on qualitative interviews that analysed the phenomenon of COVID-19 pandemic, that is, 'health disaster', to elucidate the disaster management practices performed through the framework of CIMIC in Pakistan. With regard to this, the article argued that formulating a comprehensive guideline or framework was necessary to maintain an effective and cooperative relationship between civil and military components. It further demonstrated the need to recognise the constitutive factors that influenced the functionalisation and institutionalisation of CIMIC to manage the highly complex health-related emergencies.
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Affiliation(s)
- Rabeea Jabbar
- Centre of International Peace and Stability, Faculty of Social Sciences, National University of Sciences and Technology, Islamabad, Pakistan
| | - Muhammad Makki
- Centre of International Peace and Stability, Faculty of Social Sciences, National University of Sciences and Technology, Islamabad, Pakistan
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22
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Exploring competencies of military nurses in general hospitals in China: a qualitative content analysis. BMC Nurs 2021; 20:152. [PMID: 34425795 PMCID: PMC8381514 DOI: 10.1186/s12912-021-00673-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 08/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Military nurses should possess the competency to provide quality care in both clinical and military nursing contexts. This study aimed to identify the competencies of military nurses in general hospitals. METHODS A qualitative study was carried out using a qualitative content analysis. We purposefully sampled and interviewed 21 nurses in general hospitals in China. RESULTS The data analysis revealed 40 competencies, which were categorised into four main categories according to the Onion Model. These categories were motive (mission commitment), traits (perseverance, flexibility, etc.), self-identity of dual roles (obedience, empathy, etc.), as well as knowledge, skills and abilities (clinical and military nursing knowledge and skills, basic nursing ability, professional development ability, leadership and management ability). CONCLUSIONS Existing knowledge of competencies of military nurses in general hospitals is limited. A detailed exploration of this topic can provide guidance for recruitment, competency assessment, and competency building.
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Koch L, Lopes AA, Maiguy A, Guillier S, Guillier L, Tournier JN, Biot F. Natural outbreaks and bioterrorism: How to deal with the two sides of the same coin? J Glob Health 2021; 10:020317. [PMID: 33110519 PMCID: PMC7535343 DOI: 10.7189/jogh.10.020317] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Lionel Koch
- Bacteriology Unit, French Armed Forces Biomedical Research Institute (IRBA), Bretigny sur Orge, France
| | - Anne-Aurelie Lopes
- Pediatric Emergency Department, AP-HP, Robert Debre Hospital, Paris, Sorbonne University, France
| | | | - Sophie Guillier
- Bacteriology Unit, French Armed Forces Biomedical Research Institute (IRBA), Bretigny sur Orge, France
| | - Laurent Guillier
- Risk Assessment Department, University of Paris-Est, French Agency for Food, Environmental and Occupational Health & Safety (ANSES), Maisons-Alfort, France
| | - Jean-Nicolas Tournier
- Department of Microbiology and Infectious Diseases, French Armed Forces Biomedical Research Institute (IRBA), Bretigny sur Orge, France
| | - Fabrice Biot
- Bacteriology Unit, French Armed Forces Biomedical Research Institute (IRBA), Bretigny sur Orge, France
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Gad M, Kazibwe J, Quirk E, Gheorghe A, Homan Z, Bricknell M. Civil-military cooperation in the early response to the COVID-19 pandemic in six European countries. BMJ Mil Health 2021; 167:234-243. [PMID: 33785587 PMCID: PMC8011427 DOI: 10.1136/bmjmilitary-2020-001721] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/02/2021] [Accepted: 02/09/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The COVID-19 pandemic has presented many countries with significant health system and economic challenges. The role of civil-military cooperation in a health crisis of the magnitude presented by COVID-19 remains virtually unexplored. This review aims to detect and identify typologies, if any, of associations between security or military systems and the national response measures during the COVID-19, as adopted by six European countries during the early phase of the outbreak (January to March 2020). METHODS We designed a structured qualitative literature review (qualitative evidence synthesis), primarily targeting open-source grey literature using a customised Google web search. Our target countries were UK, France, Spain, Italy, Belgium and Sweden. We employed a 'best fit' framework synthesis approach in qualitative analysis of the result records. RESULTS A total of 277 result records were included in our qualitative synthesis, with an overall search relevance yield of 46%. We identified 19 distinct descriptive categories of civil-military cooperation extending across seven analytical themes. Most prominent themes included how military support was incorporated in the national COVID-19 response, including support to national health systems, military repatriation and evacuation, and support to wider public systems. CONCLUSION Findings of this review show the significance of military systems in supporting an expansive response during the COVID-19 pandemic, and our proposed methodological approach for capturing military health data in a reproducible manner and providing a comparative view on common types of interventions provided by civil-military cooperation to inform lessons from the use of military capacities during current COVID-19 outbreak.
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Affiliation(s)
- Mohamed Gad
- Global Health and Development (GHD) Group, Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK
| | - J Kazibwe
- Global Health and Development (GHD) Group, Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK
| | - E Quirk
- Faculty of Medicine, Imperial College London, London, UK
| | - A Gheorghe
- Global Health and Development (GHD) Group, Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK
| | - Z Homan
- Centre for Science & Security Studies, Department of War Studies, King's College London, London, UK
| | - M Bricknell
- Conflict and Health Research Group, King's College London-Strand Campus, London, UK
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25
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Younger A, Worlton TJ, Wallace S, Steigleman WA, Ortiz-Pomales Y. Ethical Considerations for Surgical Planners from the Lessons Learned on USNS COMFORT (T-AH 20) Deployment 2019. Mil Med 2021; 186:117-120. [PMID: 33350446 DOI: 10.1093/milmed/usaa407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/20/2020] [Accepted: 09/23/2020] [Indexed: 11/15/2022] Open
Abstract
Ethical issues can arise when planning for direct patient care surgical missions. Based on the lessons learned from the USNS COMFORT Deployment 2019, the authors present concise considerations and recommendations for future hospital ship surgical mission planning.
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Affiliation(s)
- Austin Younger
- Department of Urology Naval Hospital Pensacola, Pensacola, FL, 32512, USA
| | - Tamara J Worlton
- Department of Surgery Walter Reed National Military Medical Center, Bethesda, MD, 20814, USA.,Department of Anesthesia Uniformed Service University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Scott Wallace
- Department of Ophthalmology Naval Medical Center San Diego, San Diego, CA, 92134, USA
| | - W Allan Steigleman
- Department of Surgery Naval Medical Center Portsmouth, Portsmouth, VA, 23708, USA
| | - Yan Ortiz-Pomales
- Department of Ophthalmology Naval Medical Center San Diego, San Diego, CA, 92134, USA
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26
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Gibson-Fall F. Military responses to COVID-19, emerging trends in global civil-military engagements. REVIEW OF INTERNATIONAL STUDIES 2021; 47:155-170. [PMCID: PMC7870912 DOI: 10.1017/s0260210521000048] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/16/2020] [Accepted: 01/11/2021] [Indexed: 06/14/2023]
Abstract
The COVID-19 pandemic is giving way to increases in military engagements in health-related activities at the domestic level. This article situates these engagements amid issues of continuity, change, and resistance in contemporary redefinitions of military health roles. It positions the COVID-19 pandemic as a pivotal moment in global health military practice. I identify three emerging trends within national military responses to COVID-19: (1) Minimal technical military support; (2) Blended civil-military responses; and (3) Military-led responses. The dynamics that underpin each type of military involvement follow context-specific military political legacies. These levels of involvement also relate to national public health approaches and the degree of capacity within health care systems. Each identified trend points towards specific trajectories for the future co-constitution of global and local civil-military engagements.
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Affiliation(s)
- Fawzia Gibson-Fall
- School of Politics and International Relations, Queen Mary University of London, United Kingdom
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Licina D, DeHaai B, Slattery A. Enhancing Military Field Hospitals: World Health Organization Emergency Medical Team Verification. Mil Med 2021; 186:230-231. [PMID: 33742648 DOI: 10.1093/milmed/usab111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/23/2021] [Accepted: 03/09/2021] [Indexed: 11/14/2022] Open
Abstract
Despite the significant investment in the U.S. and partner nation military field hospital capability, the DoD has not pursued WHO Emergency Medical Team verification. Doing so would reinforce the DoD as an international leader, uphold the DoD as a partner of choice for response when requested, and enable the DoD to assist other nations in achieving the same.
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Affiliation(s)
| | - Brian DeHaai
- Sanford World Clinic, Sioux Falls, SD 57105, USA
| | - Andrea Slattery
- Joint Commission International, Joint Commission Resources, Oak Brook, IL 60523, USA
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Forshey BM, Woodward A, Sanchez JL, Petzing SR. Military Participation in Health Security: Analysis of Joint External Evaluation Reports and National Action Plans for Health Security. Health Secur 2021; 19:173-182. [PMID: 33719585 DOI: 10.1089/hs.2020.0030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Militaries around the world play an important but at times poorly defined and underappreciated role in global health security. They are often called upon to support civilian authorities in humanitarian crises and to provide routine healthcare for civilians. Military personnel are a unique population in a health security context, as they are highly mobile and often deploy to austere settings domestically and internationally, which may increase exposure to endemic and emerging infectious diseases. Despite the role of militaries, few studies have systematically evaluated their involvement in global health security activities including the Global Health Security Agenda. We analyzed Joint External Evaluation (JEE) mission reports (n = 94) and National Action Plan for Health Security plans (n = 12), published as of July 2020, to determine the extent to which military organizations were involved in the evaluation process, military involvement in health security activities were described, and specific recommendations were provided for the country's military. For JEE reports, descriptions of military involvement were highest in 3 of the 4 core areas: Respond (76%), Prevent (39%), and Detect (32%). Similarly, National Action Plan for Health Security plans mentioned military involvement in the same 3 core areas: Respond (58%), Prevent (33%), and Detect (33%). Only 28% of JEE reports provided recommendations for the military in any of the core areas. Our results indicate that military roles and contributions are incorporated into some aspects of country-level health security activities, but that more extensive involvement may be warranted to improve national capabilities to prevent, detect, and respond to infectious disease threats.
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Affiliation(s)
- Brett M Forshey
- Brett M. Forshey, PhD, is a US Public Health Service Officer and an Epidemiologist and Alexandra Woodward, MPH, is a Senior Biosurveillance Specialist, Global Emerging Infections Surveillance; and Jose L. Sanchez, MD, is Deputy Chief; all with the Armed Forces Health Surveillance Division, Silver Spring, MD. Alexandra Woodward is also a Senior Biosurveillance Specialist, Cherokee Nation Strategic Programs, Tulsa, OK; and a DrPH Health Security Student, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Stephanie R. Petzing, PhD, is Senior Global Health Security Advisor, Henry M. Jackson Foundation, Center for Global Health Engagement, Bethesda, MD. The views expressed in this article are those of the authors and do not reflect the official policy or position of the US Department of Defense or of the US government
| | - Alexandra Woodward
- Brett M. Forshey, PhD, is a US Public Health Service Officer and an Epidemiologist and Alexandra Woodward, MPH, is a Senior Biosurveillance Specialist, Global Emerging Infections Surveillance; and Jose L. Sanchez, MD, is Deputy Chief; all with the Armed Forces Health Surveillance Division, Silver Spring, MD. Alexandra Woodward is also a Senior Biosurveillance Specialist, Cherokee Nation Strategic Programs, Tulsa, OK; and a DrPH Health Security Student, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Stephanie R. Petzing, PhD, is Senior Global Health Security Advisor, Henry M. Jackson Foundation, Center for Global Health Engagement, Bethesda, MD. The views expressed in this article are those of the authors and do not reflect the official policy or position of the US Department of Defense or of the US government
| | - Jose L Sanchez
- Brett M. Forshey, PhD, is a US Public Health Service Officer and an Epidemiologist and Alexandra Woodward, MPH, is a Senior Biosurveillance Specialist, Global Emerging Infections Surveillance; and Jose L. Sanchez, MD, is Deputy Chief; all with the Armed Forces Health Surveillance Division, Silver Spring, MD. Alexandra Woodward is also a Senior Biosurveillance Specialist, Cherokee Nation Strategic Programs, Tulsa, OK; and a DrPH Health Security Student, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Stephanie R. Petzing, PhD, is Senior Global Health Security Advisor, Henry M. Jackson Foundation, Center for Global Health Engagement, Bethesda, MD. The views expressed in this article are those of the authors and do not reflect the official policy or position of the US Department of Defense or of the US government
| | - Stephanie R Petzing
- Brett M. Forshey, PhD, is a US Public Health Service Officer and an Epidemiologist and Alexandra Woodward, MPH, is a Senior Biosurveillance Specialist, Global Emerging Infections Surveillance; and Jose L. Sanchez, MD, is Deputy Chief; all with the Armed Forces Health Surveillance Division, Silver Spring, MD. Alexandra Woodward is also a Senior Biosurveillance Specialist, Cherokee Nation Strategic Programs, Tulsa, OK; and a DrPH Health Security Student, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Stephanie R. Petzing, PhD, is Senior Global Health Security Advisor, Henry M. Jackson Foundation, Center for Global Health Engagement, Bethesda, MD. The views expressed in this article are those of the authors and do not reflect the official policy or position of the US Department of Defense or of the US government
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Leone R, Whitaker J, Homan Z, Bandekow L, Bricknell M. Framework for the evaluation of military health systems. BMJ Mil Health 2021; 169:280-284. [PMID: 33619229 DOI: 10.1136/bmjmilitary-2020-001699] [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] [Received: 10/22/2020] [Revised: 01/02/2021] [Accepted: 01/09/2021] [Indexed: 11/03/2022]
Abstract
The organisation of a military health system (MHS) differs from the civilian system due to the role of the armed forces, the unique nature of the supported population and their occupational health requirements. A previously published review of the Military Medical Corps Worldwide Almanac demonstrated the value of a standardised framework for evaluation and comparison of MHSs. This paper proposes such a framework which highlights the unique features of MHSs not covered by health services research of national health systems. These include: national context and summary; organisational structure; firm base facilities, healthcare beneficiaries and medical research; operational capabilities, overseas deployments, collaborations and alliances; personnel including recruitment, training and education; and history and culture. This common framework can help facilitate international collaboration between military medical services including capability development, training exercises and mutual support during military operations. It can also inform national contributions to future editions of the Almanac.
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Affiliation(s)
- Ryan Leone
- Conflict and Health Research Group, King's College London-Strand Campus, London, UK
| | - J Whitaker
- Department of Vascular Surgery, Royal Free Hospital NHS Trust, London, UK
| | - Z Homan
- War Studies, King's College London-Strand Campus, London, UK
| | - L Bandekow
- Worldwide Military-Medicine Almanac, Bonn, Germany
| | - M Bricknell
- Conflict and Health Research Group, King's College London-Strand Campus, London, UK
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Khorram-Manesh A, Burkle FM, Phattharapornjaroen P, Ahmadi Marzaleh M, Sultan MA, Mäntysaari M, Carlström E, Goniewicz K, Santamaria E, Comandante JD, Dobson R, Hreckovski B, Torgersen GE, Mortelmans LJ, de Jong M, Robinson Y. The Development of Swedish Military Healthcare System: Part II-Re-evaluating the Military and Civilian Healthcare Systems in Crises Through a Dialogue and Study Among Practitioners. Mil Med 2021; 186:e442-e450. [PMID: 33135765 PMCID: PMC7665683 DOI: 10.1093/milmed/usaa364] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/28/2020] [Accepted: 09/07/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Historical changes have transformed Sweden from being an offensive to a defensive and collaborative nation with national and international engagement, allowing it to finally achieve the ground for the civilian-military collaboration and the concept of a total defense healthcare. At the same time, with the decreasing number of international and interstate conflicts, and the military's involvement in national emergencies and humanitarian disaster relief, both the need and the role of the military healthcare system within the civilian society have been challenged. The recent impact of the COVID-19 in the USA and the necessity of military involvement have led health practitioners to anticipate and re-evaluate conditions that might exceed the civilian capacity of their own countries and the need to have collaboration with the military healthcare. This study investigated both these challenges and views from practitioners regarding the benefits of such collaboration and the manner in which it would be initiated. MATERIAL AND METHOD A primary study was conducted among responsive countries using a questionnaire created using the Nominal Group Technique. Relevant search subjects and keywords were extracted for a systematic review of the literature, according to the PRISMA model. RESULTS The 14 countries responding to the questionnaire had either a well-developed military healthcare system or units created in collaboration with the civilian healthcare. The results from the questionnaire and the literature review indicated a need for transfer of military medical knowledge and resources in emergencies to the civilian health components, which in return, facilitated training opportunities for the military staff to maintain their skills and competencies. CONCLUSIONS As the world witnesses a rapid change in the etiology of disasters and various crises, neither the military nor the civilian healthcare systems can address or manage the outcomes independently. There is an opportunity for both systems to develop future healthcare in collaboration. Rethinking education and training in war and conflict is indisputable. Collaborative educational initiatives in disaster medicine, public health and complex humanitarian emergencies, international humanitarian law, and the Geneva Convention, along with advanced training in competency-based skill sets, should be included in the undergraduate education of health professionals for the benefit of humanity.
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Affiliation(s)
- Amir Khorram-Manesh
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, Gothenburg University, 405 30, Gothenburg, Sweden
- Department of Research and Development, Swedish Armed Forces Center for Defense Medicine, 426 76 Västra Frolunda, Gothenburg, Sweden
| | - Frederick M Burkle
- Harvard Humanitarian Initiative, T.H. Chan School of Public Health, Harvard University, Cambridge, MA 02138, USA
| | - Phatthranit Phattharapornjaroen
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, 10400, Thailand
| | - Milad Ahmadi Marzaleh
- Department of Health in Disasters and Emergencies, Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, 14336-71348, Iran
| | - Mohammed Al Sultan
- Department of Emergency Medicine, King Khalid Hospital, Najran, 66262, Saudi Arabia
| | - Matti Mäntysaari
- Aeromedical Centre, Centre for Military Medicine, PO BOX 5, 11311 Riihimäki, Helsinki, Finland
| | - Eric Carlström
- Health and Crisis Management and Policy, Sahlgrenska Academy, Gothenburg University, Gothenburg, 40530, Sweden
- Department of Business, History, and Social Sciences, University of South-Eastern Norway, 3679 Notodden, Kongsberg, Norway
| | | | - Emelia Santamaria
- Health Emergencies and Disasters (HEAD) Study Group, National Institute of Health, University of the Philippines-Manila, 623 Pedro Gil Street, Ermita 1000 Manila, the Philippines
| | - John David Comandante
- Department of Emergency Medicine, Prehospital Disaster and Ambulatory Care Medicine, Ospital ng Makati, Makati City, 1218 Metro Manila, the Philippines
| | - Robert Dobson
- London Ambulance Service UK, 220 Waterloo Road, SE1 8SD, London, UK
| | - Boris Hreckovski
- Department of Surgery, General Hospital, Slavonski Brod 35000, Croatia
| | - Glenn-Egil Torgersen
- Harvard Humanitarian Initiative, T.H. Chan School of Public Health, Harvard University, Cambridge, MA 02138, USA
| | - Luc J Mortelmans
- Center for Research and Education in Emergency Care, University of Leuven, Oude Markt 13, 3000, Leuven, Belgium
| | - Mirjam de Jong
- Major Incident Hospital, University Medical Center (UMC) Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, Netherland
| | - Yohan Robinson
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, Gothenburg University, 405 30, Gothenburg, Sweden
- Department of Research and Development, Swedish Armed Forces Center for Defense Medicine, 426 76 Västra Frolunda, Gothenburg, Sweden
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Tallowin S, Naumann DN, Bowley DM. Defence Healthcare Engagement: A UK Military Perspective to Improve Healthcare Leadership and Quality of Care Overseas. J Healthc Leadersh 2021; 13:27-34. [PMID: 33542672 PMCID: PMC7854361 DOI: 10.2147/jhl.s224906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 10/06/2020] [Indexed: 11/23/2022] Open
Abstract
Defence Healthcare Engagement (DHE) describes the use of military medical capabilities to achieve health effects overseas through enduring partnerships. It forms a key part of a wider strategy of Defence Engagement that utilises defence assets and activities, short of combat operations, to achieve influence. UK Defence Medical Services have significant recent DHE experience from conflict and stabilisation operations (e.g. Iraq and Afghanistan), health crises (e.g. Ebola epidemic in Sierra Leone), and as part of a long-term partnership with the Pakistan Armed Forces. Taking a historical perspective, this article describes the evolution of DHE from ad hoc rural health camps in the 1950s, to a modern integrated, multi-sector approach based on partnerships with local actors and close civil-military cooperation. It explores the evidence from recent UK experiences, highlighting the decisive contributions that military forces can make to healthcare leadership and quality of care overseas, particularly when conflict and health crisis outstrips the capacity of local healthcare providers to respond. Lessons identified include the need for long-term engagement with partners and the requirement for DHE activities to be closely coordinated with humanitarian agencies and local providers to prevent adverse effects on the local health economy and ensure a sustainable transition to civilian oversight.
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Affiliation(s)
- Simon Tallowin
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, UK
| | - David N Naumann
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, UK
| | - Douglas M Bowley
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, UK
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Analysing the intersection between health emergencies and abortion during Zika in Brazil, El Salvador and Colombia. Soc Sci Med 2021; 270:113671. [PMID: 33486425 PMCID: PMC7895814 DOI: 10.1016/j.socscimed.2021.113671] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 01/19/2023]
Abstract
The Zika outbreak of 2015-7 is a lens to analyse the positioning of abortion within in global health security. The sequelae of the virus almost exclusively affected newborn children, manifested through Congenital Zika Syndrome (CZS), and a focus on women at risk of, planning or being pregnant. At the global level, debate considered whether Zika would provide impetus for regulatory change for reproductive rights in Latin America, a region with some of the most restrictive abortion regulation in the world. However, regulatory change for abortion did not occur. We analyse why the Zika health emergency did not lead to any changes in abortion regulation through multi-method analysis of the intersection between Zika, health emergencies and abortion in Brazil, Colombia and El Salvador. These case study countries were purposefully selected; each had Zika infected women (albeit with differing incidence) yet represent diverse regulatory environments for abortion. Our comparative research is multi-method: framework analysis of key informant interviews (n = 49); content analysis of women's enquiries to a medical abortion telemedicine provider; and, policy analysis of (inter)national-level Zika response and abortion policies. We consider this within literature on global health security, and the prioritisation of a particular approach to epidemic control. Within this securitized landscape, despite increased public debate about abortion regulatory change, no meaningful change occurred, due to a dominant epidemiological approach to the Zika health emergency in all three countries and prominent conservative forces in government and within anti-abortion rights movements. Simultaneously, we demonstrate that regulation did not deter all women from seeking such service clandestinely. Zika affected reproductive decision making, but did not impact abortion regulation. Epidemiological framing ignored reproductive dimensions of emergency responses. Conservative forces instrumentalized disability concerns to oppose abortion rights. Women sought abortions clandestinely, citing Zika as a justification. Abortion provision must form part of health emergency planning and response.
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Ma H, Huang J, Deng Y, Zhang Y, Lu F, Yang Y, Luo Y. Deployment experiences of military nurses: A systematic review and qualitative meta-synthesis. J Nurs Manag 2020; 29:869-877. [PMID: 33128266 PMCID: PMC8359314 DOI: 10.1111/jonm.13201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 11/28/2022]
Abstract
Aims The purpose of this systematic review is to explore military nurses’ preparation, deployment and reintegration experiences in order to provide recommendations for effective management of the nursing team. Background Nurses provide health care in different settings including community, hospital and the disaster site. Military nurses have a long history of deploying for global health. Method A systematic review and qualitative meta‐synthesis of studies focusing on the preparation, deployment and reintegration experiences of military nurses was carried out. Results Five synthesized findings were concluded: (a) preparing and sharing experience are the key coping strategies; (b) transition from the civilian care to emergency situations; (c) teamwork contributing to team bonding and the growing role of nursing in the medical team; (d) devoting to nursing duty achieves growth; (e) reintegration is not easy and external support matters. Conclusion Transition from civilian care to deployment and from structured deployment environment to reintegration poses challenges to nurses, and better preparation, sufficient support enables them to gain growth. Implications for Nursing Management Nurse managers should consider how to sustain a competent and ready nursing team by proposing training protocols to nurses for the potential challenges during the deployment cycle when responding to disasters and public emergencies.
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Affiliation(s)
- Huijuan Ma
- School of Nursing, Third Military Medical University, Army Medical University, Chongqing, China
| | | | - Yajie Deng
- School of Nursing, Third Military Medical University, Army Medical University, Chongqing, China
| | - Yue Zhang
- Department of Military Nursing, NCO School, Army Medical University, Shijiazhuang, China
| | - Fang Lu
- School of Nursing, Third Military Medical University, Army Medical University, Chongqing, China
| | - Yuhui Yang
- School of Nursing, Third Military Medical University, Army Medical University, Chongqing, China
| | - Yu Luo
- School of Nursing, Third Military Medical University, Army Medical University, Chongqing, China
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Bricknell M, Horne S. Personal view: security sector health systems and global health. BMJ Mil Health 2020; 169:e64-e67. [PMID: 32999086 PMCID: PMC10176418 DOI: 10.1136/bmjmilitary-2020-001607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/23/2020] [Accepted: 08/26/2020] [Indexed: 11/03/2022]
Abstract
In many countries the security sector is a major contributor to the healthcare system. The role and transformation of a state’s security health system within the universal health coverage is important, in that it sits at the interface of the United Nations Sustainable Development Goals 3 (ensure healthy lives and promote well-being) and 16 (promote just, peaceful and inclusive societies). The paper describes the breadth of the security sector and outlines the potential beneficiaries, clinical services and macro-organisation of a security sector health system from the perspective of its contribution to wider government health services and crisis response. It examines the characteristics of the security sector compared with other providers of health services, including those generic to the sector and unique to a given service. Understanding civil–security relationships is a critical facet of effective Defence Healthcare Engagement (DHE), which includes the use of defence medical assets in support of capacity-building overseas. The analytical process described may form the basis of DHE planning. It may have even greater importance in the near future as countries review national resilience and global health diplomacy after the COVID-19 crisis.
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Affiliation(s)
- Martin Bricknell
- Conflict and Health Research Group, King's College London, London, UK
| | - S Horne
- Conflict and Health Research Group, King's College London, London, UK
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
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35
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Modgil S, Singh RK, Foropon C. Quality management in humanitarian operations and disaster relief management: a review and future research directions. ANNALS OF OPERATIONS RESEARCH 2020; 319:1045-1098. [PMID: 32836617 PMCID: PMC7322719 DOI: 10.1007/s10479-020-03695-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Quality management has been widely discussed in the literature, and recent special issues on humanitarian supply chains and relief operations have emphasized the increasing importance of quality management in this key emerging area. In this paper, we provide an extensive literature review in the field of quality management in humanitarian operations and disaster relief management. Our comprehensive review, comprising 61 articles published from 2009 to 2018, leads to the identification of enablers (e.g., transparency, policy framework), challenges (e.g., financial services, identity protection), and theory development approaches, as well as numerous research gaps that must be addressed.
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Affiliation(s)
- Sachin Modgil
- International Management Institute (IMI), Kolkata, 2/4 C, Judges Ct Rd, Alipore, Kolkata, West Bengal 700027 India
| | - Rohit Kumar Singh
- International Management Institute (IMI), Kolkata, 2/4 C, Judges Ct Rd, Alipore, Kolkata, West Bengal 700027 India
| | - Cyril Foropon
- Montpellier Business School (MBS), France, 2300 Avenue des Moulins, 34185 Montpellier, France
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36
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Bricknell M, Hinrichs-Krapels S, Ismail S, Sullivan R. Understanding the structure of a country’s health service providers for defence health engagement. BMJ Mil Health 2020; 167:454-456. [PMID: 32503861 PMCID: PMC8639950 DOI: 10.1136/bmjmilitary-2020-001502] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 12/02/2022]
Abstract
There are a variety of structural and systems frameworks for describing the building blocks of country’s public health and health systems. In this paper, we propose a conceptual framework for a holistic view of a country’s health service providers in order to inform the plan for Defence Health Engagement activities with partner countries. This includes all potential government ministries involved in healthcare provision, the independent, private sector and the non-government organisation/charity sector. The framework provides a visualisation to support the analysis of a country’s health services providers. We propose that recognising and analysing the different contributions of all these national health providers is essential for understanding the wider political economy of a nation’s health systems. This can inform a plan of Defence Health Engagement for capacity building in crisis response, development and health systems strengthening.
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Affiliation(s)
- Martin Bricknell
- Conflict and Health Research Group, King's College London-Strand Campus, London, UK
| | | | - S Ismail
- Department of Primary Care and Public Health, Imperial College London Faculty of Medicine, London, UK
| | - R Sullivan
- Conflict and Health Research Group, King's College London, London, UK
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37
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Zemke JN, Sanchez JL, Pang J, Gray GC. The Double-Edged Sword of Military Response to Societal Disruptions: A Systematic Review of the Evidence for Military Personnel as Pathogen Transmitters. J Infect Dis 2020; 220:1873-1884. [PMID: 31519020 DOI: 10.1093/infdis/jiz400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/02/2019] [Indexed: 11/12/2022] Open
Abstract
Given their lack of immunity and increased exposure, military personnel have the potential to serve as carriers or reservoirs for infectious diseases into or out of the deployment areas, but, to our knowledge, the historical evidence for such transmission events has not previously been reviewed. Using PubMed, we performed a systematic review of published literature between 1955 and 2018, which documented evidence for military personnel transporting infectious pathogens into or out of deployment areas. Of the 439 articles screened, 67 were included for final qualitative and quantitative review. The data extracted from these articles described numerous instances in which thousands of military service members demonstrated potential or actual transmission and transportation of multiple diverse pathogens. These data underscore the immense importance preventive medical professionals play in mitigating such risk, how their public health efforts must be supported, and the importance of surveillance in protecting both military and civilian populations.
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Affiliation(s)
- Juliana N Zemke
- Duke Global Health Institute, Duke University, Durham, North Carolina.,Division of Infectious Diseases, Duke University, Durham, North Carolina
| | - Jose L Sanchez
- Department of Defense, Defense Health Agency, Public Health Division, Armed Forces Health Surveillance Branch, Silver Spring, Maryland
| | - Junxiong Pang
- Duke Global Health Institute, Duke University, Durham, North Carolina.,Centre for Infectious Disease Epidemiology & Research, Saw Swee Hock School of Public Health, National University of Singapore
| | - Gregory C Gray
- Duke Global Health Institute, Duke University, Durham, North Carolina.,Division of Infectious Diseases, Duke University, Durham, North Carolina.,Emerging Infectious Disease Program, Duke-National University of Singapore Medical School, Singapore.,Global Health Research Center, Duke-Kunshan University, Kunshan, China
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38
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Khan T, Quintana L, Aguilera S, Garcia R, Shoman H, Caddell L, Latifi R, Park KB, Garcia P, Dempsey R, Rosenfeld JV, Scurlock C, Crisp N, Samad L, Smith M, Lippa L, Jooma R, Andrews RJ. Global health, global surgery and mass casualties. I. Rationale for integrated mass casualty centres. BMJ Glob Health 2019; 4:e001943. [PMID: 31908871 PMCID: PMC6936385 DOI: 10.1136/bmjgh-2019-001943] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/28/2019] [Accepted: 11/30/2019] [Indexed: 01/27/2023] Open
Abstract
It has been well-documented recently that 5 billion people globally lack surgical care. Also well-documented is the need to improve mass casualty disaster response. Many of the United Nations (UN) Sustainable Development Goals (SDGs) for 2030-healthcare and economic milestones-require significant improvement in global surgical care, particularly in low-income and middle-income countries. Trauma/stroke centres evolved in high-income countries with evidence that 24/7/365 surgical and critical care markedly improved morbidity and mortality for trauma and stroke and for cardiovascular events, difficult childbirth, acute abdomen. Duplication of emergency services, especially civilian and military, often results in suboptimal, expensive care. By combining all healthcare resources within the ongoing healthcare system, more efficient care for both individual emergencies and mass casualty situations can be achieved. We describe progress in establishing mass casualty centres in Chile and Pakistan. In both locations, planning among the stakeholders (primarily civilian and military) indicates the feasibility of such integrated surgical and emergency care. We also review other programmes and initiatives to provide integrated mass casualty disaster response. Integrated mass casualty centres are a feasible means to improve both day-to-day surgical care and mass casualty disaster response. The humanitarian aspect of mass casualty disasters facilitates integration among stakeholders-from local healthcare systems to military resources to international healthcare organisations. The benefits of mass casualty centres-both healthcare and economic-can facilitate achieving the 2030 UN SDGs.
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Affiliation(s)
- Tariq Khan
- Chair, Neurotrauma Committee, World Federation of Neurosurgical Societies, Nyon, Switzerland
- Dean and Chair of Neurosurgery, Northwest General Hospital and Research Centre, Peshawar, Pakistan
| | - Leonidas Quintana
- Neurosurgery, Valparaiso University School of Medicine, Valparaiso, Chile
- World Federation of Neurosurgical Societies, Nyon, Switzerland
| | - Sergio Aguilera
- Neurosurgery, Almirante Nef Naval Hospital & Valparaiso University Hospital, Viña del Mar & Valparaiso, Chile
| | - Roxanna Garcia
- Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Haitham Shoman
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Luke Caddell
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Rifat Latifi
- Chair, Department of Surgery, New York Medical College, Valhalla, New York, USA
- Founder & President, International Virtual eHospital Foundation, Hope, Idaho, USA
| | - Kee B Park
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Patricia Garcia
- Professor, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
- Former Minister of Health, Peru
| | - Robert Dempsey
- Professor & Chair, Neurosurgery, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA
- Chair, Foundation for International Education in Neurological Surgery, Madison, Wisconsin, USA
| | - Jeffrey V Rosenfeld
- Senior Neurosurgeon, Alfred Hospital, Melbourne, Victoria, Australia
- Major General, Royal Australian Army Medical Corps, Melbourne, Victoria, Australia
| | - Corey Scurlock
- Professor Anesthesiology/Internal Medicine & Director e-Health, Westchester Medical Center, Valhalla, New York, USA
| | - Nigel Crisp
- Co-Chair, House of Lords Parliamentary Group on Global Health, London, UK
- Co-Chair, Nursing Now, London, UK
| | - Lubna Samad
- Director, Center for Essential Surgical Network, Indus Health Network, Karachi, Sindh, Pakistan
- Center for Global Health Delivery Harvard Medical School, Dubai, United Arab Emirates
| | - Montray Smith
- Assistant Professor and Health & Social Justice Scholar, University of Louisville School of Nursing, Louisville, Kentucky, USA
| | - Laura Lippa
- Neurosurgery, Azienda Ospedaliera Universitaria Senese, Siena, Toscana, Italy
| | - Rashid Jooma
- Neurosurgery, Aga Khan University, Karachi, Sindh, Pakistan
- Former Director General of Health Services, Government of Pakistan, Islamabad, Pakistan
| | - Russell J Andrews
- World Federation of Neurosurgical Societies, Nyon, Switzerland
- Nanotechnology & Smart Systems, NASA Ames Research Center, Moffett Field, California, USA
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39
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Kennedy J, McCoy D, Abouzeid M, Jabbour S. Militaries and global health. Lancet 2019; 394:916-917. [PMID: 31526732 DOI: 10.1016/s0140-6736(19)31341-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 05/30/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Jonathan Kennedy
- Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK.
| | - David McCoy
- Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK
| | - Marian Abouzeid
- Centre for Humanitarian Leadership, Deakin University Melbourne, Burwood, VIC, Australia; Faculty of Health Sciences, American University Beirut, Beirut, Lebanon; The Lancet-American University Beirut Commission on Syria
| | - Samer Jabbour
- Faculty of Health Sciences, American University Beirut, Beirut, Lebanon; The Lancet-American University Beirut Commission on Syria
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40
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Michaud J, Moss K, Lillywhite L. Militaries and global health - Authors' reply. Lancet 2019; 394:917-918. [PMID: 31526734 DOI: 10.1016/s0140-6736(19)31339-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Joshua Michaud
- Henry J Kaiser Family Foundation, Washington, DC 20005, USA; Johns Hopkins University School of Advanced International Studies, Washington, DC, USA.
| | - Kellie Moss
- Henry J Kaiser Family Foundation, Washington, DC 20005, USA
| | - Louis Lillywhite
- Chatham House Royal Institute of International Affairs, London, UK
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41
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Barker K, Hagopian A, Pfeiffer J. Militaries and global health. Lancet 2019; 394:917. [PMID: 31526733 DOI: 10.1016/s0140-6736(19)31342-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Kathy Barker
- School of Public Health, University of Washington, Seattle, WA 98195, USA
| | - Amy Hagopian
- School of Public Health, University of Washington, Seattle, WA 98195, USA.
| | - James Pfeiffer
- School of Public Health, University of Washington, Seattle, WA 98195, USA
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42
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Thomson N, Littlejohn M, Strathdee SA, Southby RF, Coghlan B, Rosenfeld JV, Galvani AP. Harnessing synergies at the interface of public health and the security sector. Lancet 2019; 393:207-209. [PMID: 30663581 DOI: 10.1016/s0140-6736(18)32999-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 11/16/2018] [Indexed: 01/13/2023]
Affiliation(s)
- Nicholas Thomson
- Security and Health Executive Leadership Institute and the Law Enforcement and Public Health Program, Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Mason Littlejohn
- Security and Health Executive Leadership Institute and the Law Enforcement and Public Health Program, Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Steffanie A Strathdee
- Department of Medicine, University of California School of Medicine, La Jolla, CA, USA
| | - Richard F Southby
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA; Security and Health Executive Leadership Institute and the Law Enforcement and Public Health Program, Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Benjamin Coghlan
- Health-Security Program, Burnet Institute, Melbourne, VIC, Australia
| | - Jeffrey V Rosenfeld
- The Alfred Hospital, Melbourne, VIC, Australia; Monash University, Clayton, VIC, Australia; F Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, MD, USA
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA
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