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Orievulu K, Hinga A, Nkosi B, Ngwenya N, Seeley J, Akanlu A, Tindana P, Molyneux S, Kinyanjui S, Kamuya D. A scoping review of ethics review processes during public health emergencies in Africa. BMC Med Ethics 2024; 25:63. [PMID: 38778293 PMCID: PMC11110293 DOI: 10.1186/s12910-024-01054-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic forced governments, multilateral public health organisations and research institutions to undertake research quickly to inform their responses to the pandemic. Most COVID-19-related studies required swift approval, creating ethical and practical challenges for regulatory authorities and researchers. In this paper, we examine the landscape of ethics review processes in Africa during public health emergencies (PHEs). METHODS We searched four electronic databases (Web of Science, PUBMED, MEDLINE Complete, and CINAHL) to identify articles describing ethics review processes during public health emergencies and/or pandemics. We selected and reviewed those articles that were focused on Africa. We charted the data from the retrieved articles including the authors and year of publication, title, country and disease(s) reference, broad areas of (ethical) consideration, paper type, and approach. RESULTS Of an initial 4536 records retrieved, we screened the titles and abstracts of 1491 articles, and identified 72 articles for full review. Nine articles were selected for inclusion. Of these nine articles, five referenced West African countries including Liberia, Guinea and Sierra Leone, and experiences linked to the Ebola virus disease. Two articles focused on South Africa and Kenya, while the other two articles discussed more general experiences and pitfalls of ethics review during PHEs in Africa more broadly. We found no articles published on ethics review processes in Africa before the 2014 Ebola outbreak, and only a few before the COVID-19 outbreak. Although guidelines on protocol review and approval processes for PHEs were more frequently discussed after the 2014 Ebola outbreak, these did not focus on Africa specifically. CONCLUSIONS There is a gap in the literature about ethics review processes and preparedness within Africa during PHEs. This paper underscores the importance of these processes to inform practices that facilitate timely, context-relevant research that adequately recognises and reinforces human dignity within the quest to advance scientific knowledge about diseases. This is important to improve fast responses to PHEs, reduce mortality and morbidity, and enhance the quality of care before, during, and after pandemics.
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Affiliation(s)
- Kingsley Orievulu
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa.
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
- Centre for Africa China Studies, University of Johannesburg, Johannesburg, South Africa.
| | - Alex Hinga
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
| | - Busisiwe Nkosi
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
- University of Toledo, Ohio, Toledo, USA
| | - Nothando Ngwenya
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Global Health and Development Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Anthony Akanlu
- West Africa Centre for Cell Biology and Infectious Pathogens, University of Ghana, Accra, Ghana
| | - Paulina Tindana
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Sassy Molyneux
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Samson Kinyanjui
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Dorcas Kamuya
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Lebu S, Musoka L, Graham JP. Reflective questioning to guide socially just global health reform: a narrative review and expert elicitation. Int J Equity Health 2024; 23:3. [PMID: 38183120 PMCID: PMC10770991 DOI: 10.1186/s12939-023-02083-2] [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: 07/22/2023] [Accepted: 12/15/2023] [Indexed: 01/07/2024] Open
Abstract
Recent research has highlighted the impacts of colonialism and racism in global health, yet few studies have presented concrete steps toward addressing the problems. We conducted a narrative review to identify published evidence that documented guiding frameworks for enhancing equity and inclusion in global health research and practice (GHRP). Based on this narrative review, we developed a questionnaire with a series of reflection questions related on commonly reported challenges related to diversity, inclusion, equity, and power imbalances. To reach consensus on a set of priority questions relevant to each theme, the questionnaire was sent to a sample of 18 global health experts virtually and two rounds of iterations were conducted. Results identified eight thematic areas and 19 reflective questions that can assist global health researchers and practitioners striving to implement socially just global health reforms. Key elements identified for improving GHRP include: (1) aiming to understand the historical context and power dynamics within the areas touched by the program; (2) promoting and mobilizing local stakeholders and leadership and ensuring measures for their participation in decision-making; (3) ensuring that knowledge products are co-produced and more equitably accessible; (4) establishing a more holistic feedback and accountability system to understand needed reforms based on local perspectives; and (5) applying systems thinking to addressing challenges and encouraging approaches that can be sustained long-term. GHRP professionals should reflect more deeply on how their goals align with those of their in-country collaborators. The consistent application of reflective processes has the potential to shift GHRP towards increased equity.
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Affiliation(s)
- Sarah Lebu
- School of Public Health, University of California Berkeley, 2121, Berkeley Way, Berkeley, CA, 94704, USA.
- University of North Carolina, Gillings School of Public Health, Chapel Hill, NC, USA.
| | - Lena Musoka
- School of Public Health, University of California Berkeley, 2121, Berkeley Way, Berkeley, CA, 94704, USA
- Georgetown University, McDonough School of Business, Washington, DC, USA
| | - Jay P Graham
- School of Public Health, University of California Berkeley, 2121, Berkeley Way, Berkeley, CA, 94704, USA
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Martin R, Maleche A, Gay J, Fatima H. Lessons learnt from COVID-19 to reduce mortality and morbidity in the Global South: addressing global vaccine equity for future pandemics. BMJ Glob Health 2024; 9:e013680. [PMID: 38167259 PMCID: PMC10773420 DOI: 10.1136/bmjgh-2023-013680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/06/2023] [Indexed: 01/05/2024] Open
Abstract
COVID-19, which killed more than 6 million people, will not be the last pandemic. Vaccines are key to preventing and ending pandemics. Therefore, it is critical to move now, before the next pandemic, towards global vaccine equity with shared goals, intermediate steps and long-term advocacy goals. Scientific integrity, ethical development, transparency, accountability and communication are critical. Countries can draw on lessons learnt from their response to the HIV pandemics, which has been at the vanguard of ensuring equitable access to rights-based services, to create shared goals and engage communities to increase access to and delivery of safe, quality vaccines. Access can be increased by: fostering the spread of mRNA intellectual property (IP) rights, with mRNA vaccine manufacturing on more continents; creating price transparency for vaccines; creating easily understandable, accessible and transparent data on vaccines; creating demand for a new international legal framework that allows IP rights to be waived quickly once a global pandemic is identified; and drawing on scientific expertise from around the world. Delivery can be improved by: creating strong public health systems that can deliver vaccines through the lifespan; creating or strengthening national regulatory agencies and independent national scientific advisory committees for vaccines; disseminating information from reliable, transparent national and subnational surveillance systems; improving global understanding that as more scientific data become available, this may result in changes to public health guidance; prioritising access to vaccines based on scientific criteria during an epidemic; and developing strategies to vaccinate those at highest risk with available vaccines.
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Affiliation(s)
- Rebecca Martin
- Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Allan Maleche
- Kenya Legal & Ethical Issues Network on HIV and AIDS (KELIN), Nairobi, Kenya
| | - Jill Gay
- Global Health Institute, Emory University, Atlanta, Georgia, USA
- J Gay Associates, Takoma Park, Maryland, USA
| | - Haram Fatima
- Global Health Institute, Emory University, Atlanta, Georgia, USA
- Georgia State University, Atlanta, Georgia, USA
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Gleeson D, Townsend B, Tenni BF, Phillips T. Global inequities in access to COVID-19 health products and technologies: A political economy analysis. Health Place 2023; 83:103051. [PMID: 37379732 PMCID: PMC10247888 DOI: 10.1016/j.healthplace.2023.103051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/30/2023]
Abstract
This paper presents a political economy analysis of global inequities in access to COVID-19 vaccines, treatments, and diagnostic tests. We adapt a conceptual model used for analysing the political economy of global extraction and health to examine the politico-economic factors affecting access to COVID-19 health products and technologies in four interconnected layers: the social, political, and historical context; politics, institutions, and policies; pathways to ill-health; and health consequences. Our analysis finds that battles over access to COVID-19 products occur in a profoundly unequal playing field, and that efforts to improve access that do not shift the fundamental power imbalances are bound to fail. Inequitable access has both direct effects on health (preventable illness and death) and indirect effects through exacerbation of poverty and inequality. We highlight how the case of COVID-19 products reflects broader patterns of structural violence, in which the political economy is structured to improve and lengthen the lives of those in the Global North while neglecting and shortening the lives of those in the Global South. We conclude that achieving equitable access to pandemic response products requires shifting longstanding power imbalances and the institutions and processes that entrench and enable them.
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Affiliation(s)
- Deborah Gleeson
- School of Psychology and Public Health, La Trobe University, VIC, 3086, Australia.
| | - Belinda Townsend
- Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, 8 Fellows Road Acton, Canberra, ACT, 2000, Australia
| | - Brigitte F Tenni
- School of Psychology and Public Health, La Trobe University, VIC, 3086, Australia; Nossal Institute for Global Health, University of Melbourne, 5th Floor, 333 Exhibition Street, Melbourne, Victoria, 3189, Australia
| | - Tarryn Phillips
- Department of Social Inquiry, La Trobe University, VIC, 3086, Australia
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Rasweswe MM, Peu MD, Mulaudzi FM. The importance of local language in healthcare: naming and defining dysmenorrhea. JOURNAL OF COMMUNICATION IN HEALTHCARE 2023; 16:205-214. [PMID: 37401880 DOI: 10.1080/17538068.2022.2094690] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
INTRODUCTION Using local language improves the quality of healthcare and patient safety but little has been done to understand and use local language in naming and defining conditions such as dysmenorrhea. Many indigenous African women value their language especially when communicating about women's health. METHOD In this exploratory study, we wanted to understand the local language used to construct and conceptualize dysmenorrhea and highlight the importance of local language when healthcare practitioners engage with women experiencing dysmenorrhea guided by Africana Womanism Theory. Data were collected from 15 Black indigenous women using a Lekgotla discussion group and in-depth interviews. Data were thematically analyzed. RESULTS Participants described how local language is important in naming and seeking healthcare. Drawing from their descriptions three themes emerged: (1) Self-naming and self-defining dysmenorrhea using a local language; (2) Types of local words, phrases, and terms used to name and define dysmenorrhea; (3) The importance of self-naming and self-defining dysmenorrhea in a local language. CONCLUSIONS Communication between healthcare seekers and healthcare providers is at the heart of effective healthcare provision. Poor communication due to language barriers contributes to misunderstanding, misdiagnoses, poor or incomplete patient assessment, and delayed treatment. Therefore, communicating healthcare issues in a local language would promote culturally sensitive care.
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Affiliation(s)
- Melitah Molatelo Rasweswe
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Arcadia, South Africa
| | - Mmapheko Doriccah Peu
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Arcadia, South Africa
| | - Fhumulani Mavis Mulaudzi
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Arcadia, South Africa
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Krugman DW. Global health and the elite capture of decolonization: On reformism and the possibilities of alternate paths. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002103. [PMID: 37384634 DOI: 10.1371/journal.pgph.0002103] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Global Health is experiencing a moment of reckoning over the field's legacy and current structuring in a world facing multiple, intersecting challenges to health. While "decolonization" has emerged as the dominant frame to imagine change in the field, what the concept refers to and entails has become increasingly unclear. Despite warnings, the concept is now being used by elite Global North institutions and organization to imagine their reformation. In this article, I attempt to provide clarity to the issue of conceptualizing change in Global Health. By first outlining a brief history of decolonial thought and then exploring the current state of the decolonizing global health literature, I show a profound disjuncture between popularized calls for decolonization in Global Health and other theorizations of the term. I then argue that the diluting of "decolonization" into a depoliticized vision of reforming the inherently colonial and capitalistic institutions and organizations of Global Health is an example of "elite capture"-the coopting and reconfiguration of radical, liberatory theories and concepts then used by elites for their own gain. Showing how this elite capture has facilitated harm within the field and beyond, I conclude by calling for resistance to elite capture in all its forms.
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Affiliation(s)
- Daniel W Krugman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Amisi JA, Cuba-Fuentes MS, Johnston EM, Makwero M, Prasad S, Ras T, Szkwarko D, von Pressentin K. A pragmatic approach to equitable global health partnerships in academic health sciences. BMJ Glob Health 2023; 8:bmjgh-2022-011522. [PMID: 37230545 DOI: 10.1136/bmjgh-2022-011522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
Global partnerships offer opportunities for academic departments in the health sciences to achieve mutual benefits. However, they are often challenged by inequities in power, privilege and finances between partners that have plagued the discipline of global health since its founding. In this article, a group of global health practitioners in academic medicine offer a pragmatic framework and practical examples for designing more ethical, equitable and effective collaborative global relationships between academic health science departments, building on the principles laid out by the coalition Advocacy for Global Health Partnerships in the Brocher declaration.
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Affiliation(s)
- James A Amisi
- AMPATH Kenya, Eldoret, Kenya
- Department of Family Medicine, Community Health and Medical Education, Moi University College of Health Sciences, Eldoret, Kenya
| | - María Sofía Cuba-Fuentes
- Center for Research in Primary Health Care, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Esther M Johnston
- The Wright Center National Family Medicine Residency Program at HealthPoint, Auburn, Washington, USA
| | - Martha Makwero
- Department of Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Shailendra Prasad
- Center for Global Health and Social Responsibility, University of Minnesota, Minneapolis, Minnesota, USA
| | - Tasleem Ras
- Department of Family, Community and Emergency Care, University of Cape Town, Rondebosch, South Africa
| | - Daria Szkwarko
- AMPATH Kenya, Eldoret, Kenya
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Klaus von Pressentin
- Department of Family, Community and Emergency Care, University of Cape Town, Rondebosch, South Africa
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Ramos AA. Considerations in designing trauma-focused interventions for displaced Afghan women. Front Glob Womens Health 2023; 3:893957. [PMID: 36909736 PMCID: PMC9996057 DOI: 10.3389/fgwh.2022.893957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 12/21/2022] [Indexed: 02/25/2023] Open
Abstract
In light of the 2021 United States military withdrawal from Afghanistan, as well as the humanitarian crises of mass displacement and subsequent health system strain that have ensued, practitioners worldwide will need to develop a more nuanced understanding of the adverse life experiences that women from Afghanistan frequently endorse. As they bear a disproportionate impact of constraints within Afghan society, and as patriarchal systems affect most of their life domains, women from Afghanistan may present with high levels of baseline trauma upon resettlement, and health systems may seek to attenuate this distress; However, the nature of these traumatogenic events may shape women's receptivity to psychosocial interventions, particularly those which are at least partially rooted in Western modalities. In the absence of sufficient literature on evidence-based interventions for this population, a diversity of ethnographic and clinical literature is synthesized, including literature on interventions alleged to be compatible with Afghan norms. As it will be essential to support Afghan women's mental health following social reorganization on a massive scale, considerations arising from the interdisciplinary literature are offered so that they may inform the development of structured, trauma-focused interventions and so that the health systems with which they interface may be better prepared to serve them.
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Hodson DZ, Etoundi YM, Parikh S, Boum Y. Striving towards true equity in global health: A checklist for bilateral research partnerships. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001418. [PMID: 36963065 PMCID: PMC10021183 DOI: 10.1371/journal.pgph.0001418] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Interest in "global health" among schools of medicine, public health, and other health disciplines in high-income countries (HIC) continues to rise. Persistent power imbalances, racism, and maintenance of colonialism/neocolonialism plague global health efforts, including global health scholarship. Scholarly projects conducted in low- and middle-income countries (LMIC) by trainees at these schools in HIC often exacerbate these problems. Drawing on published literature and shared experiences, we review key inequalities within each phase of research, from design through implementation and analysis/dissemination, and make concrete and practical recommendations to improve equity at each stage. Key problems facing global health scholarship include HIC-centric nature of global health organizations, paucity of funding directly available for LMIC investigators and trainees, misplaced emphasis on HIC selected issues rather than local solutions to local problems, the dominance of English language in the scientific literature, and exploitation of LMIC team members. Four key principles lie at the foundation of all our recommendations: 1) seek locally derived and relevant solutions to global health issues, 2) create paired collaborations between HIC and LMIC institutions at all levels of training, 3) provide funding for both HIC and LMIC team members, 4) assign clear roles and responsibilities to value, leverage, and share the strengths of all team members. When funding for global health research is predicated upon more ethical and equitable collaborations, the nature of global health collaborations will evolve to be more ethical and equitable. Therefore, we propose the Douala Equity Checklist as a 20-item tool HIC and LMIC institutions can use throughout the conduct of global health projects to ensure more equitable collaborations.
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Affiliation(s)
- Daniel Z. Hodson
- Yale School of Medicine, New Haven, CT, United States of America
| | - Yannick Mbarga Etoundi
- Douala Military Hospital, Douala, Cameroon
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Sunil Parikh
- Yale School of Medicine, New Haven, CT, United States of America
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States of America
| | - Yap Boum
- Epicentre, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Science, University of Yaoundé I, Yaoundé, Cameroon
- Institut Pasteur of Bangui, Bangui, Central African Republic
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Radhuber IM, Fiske A, Galasso I, Gessl N, Hill MD, Morales ER, Olarte-Sánchez LE, Pelfini A, Saxinger G, Spahl W. Toward global citizenship? People (de)bordering their lives during COVID-19 in Latin America and Europe. Glob Public Health 2023; 18:2285880. [PMID: 38010427 DOI: 10.1080/17441692.2023.2285880] [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: 07/06/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023]
Abstract
The COVID-19 pandemic highlighted global interdependencies, accompanied by widespread calls for worldwide cooperation against a virus that knows no borders, but responses were led largely separately by national governments. In this tension between aspiration and reality, people began to grapple with how their own lives were affected by the global nature of the pandemic. In this article, based on 493 qualitative interviews conducted between 2020 and 2021, we explore how people in Argentina, Austria, Bolivia, Ecuador, Ireland, Italy and Mexico experienced, coped with and navigated the global nature of the pandemic. In dialogue with debates about the parameters of the 'global' in global health, we focus on what we call people's everyday (de)bordering practices to examine how they negotiated (dis)connections between 'us' and 'them' during the pandemic. Our interviewees' reactions moved from national containment to an increasing focus on people's unequal socio-spatial situatedness. Eventually, they began to (de)border their lives beyond national lines of division and to describe a new normal: a growing awareness of global connectedness and a desire for global citizenship. This newfound sense of global interrelatedness could signal support for and encourage transnational political action in times of crises.
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Affiliation(s)
| | - Amelia Fiske
- Department of Clinical Medicine, TUM School of Medicine and Health, Institute of History and Ethics in Medicine, Technical University of Munich, Munchen, Germany
| | - Ilaria Galasso
- Department of Clinical Medicine, TUM School of Medicine and Health, Institute of History and Ethics in Medicine, Technical University of Munich, Munchen, Germany
- University College Dublin, Dublin, Ireland
| | - Nicolai Gessl
- Department of Political Science, University of Vienna, Wien, Austria
| | - Michael D Hill
- Department of Anthropology, Universidad San Francisco de Quito USFQ, Quito, Ecuador
| | - Emma R Morales
- Department of Habitat and Urban Development, ITESO, Universidad Jesuita de Guadalajara, Tlaquepaque, Mexico
| | | | - Alejandro Pelfini
- Faculty of Social Sciences, Universidad del Salvador, Buenos Aires, Argentina
- Global Studies Programme, Facultad Latinoamericana de Ciencias Sociales FLACSO-Argentina, Buenos Aires, Argentina
| | - Gertrude Saxinger
- Department of Political Science, University of Vienna, Wien, Austria
| | - Wanda Spahl
- Department of Political Science, University of Vienna, Wien, Austria
- Division Biomedical and Public Health Ethics, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
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Chabrol F, David PM. How resilience affected public health research during COVID-19 and why we should abandon it. Glob Public Health 2023; 18:2212750. [PMID: 37196668 DOI: 10.1080/17441692.2023.2212750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/07/2023] [Indexed: 05/19/2023]
Abstract
Resilience has accompanied the COVID-19 pandemic as a rallying motto, with calls by governments for a resilient society, resilient families and schools, and, of course, resilient healthcare systems in the face of this unprecedented pandemic shock. Resilience had already gained traction as an analytical concept in public health research for approximately a decade. It became a key concept despite the recognition of its lack of conceptual consistency. The COVID-19 pandemic presented itself as a perfect test-case and encouraged a multiplicity of studies on resilience and health care systems. In this commentary, we add to the existing critiques of resilience in the social sciences by reflecting on the effects of resilience when used to frame empirical inquiries and to draw lessons from the crisis. Resilience as a concept is unable to address crucial structural issues that health systems already faced throughout the world, and it remains a non-neutral political notion. We argue that we need to resist a generalised view of resilience and work with alternative imaginaries.
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Affiliation(s)
- Fanny Chabrol
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
- Institute for Humanities in Africa (HUMA), University of Cape Town, Cape Town, South Africa
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12
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Parker R, Murray L. Introduction: Human rights and global health special issue. Glob Public Health 2022; 17:3090-3097. [PMID: 36342208 DOI: 10.1080/17441692.2022.2135752] [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: 11/09/2022]
Abstract
The emergence of the field of health and human rights during the closing decades of the twentieth century offered the promise of an important shift of perspective within global health. It has been increasingly questioned, however, to what extent the health and human rights framework has indeed succeeded in ushering in a new era of global health governance and justice, as the topic has remained marginalised, marked by regional inequalities, and often dominated by legalist visions and global North perspectives. The articles and commentaries in this special issue seek to create a space where a number of other perspectives and voices can be part of the discussion. They add new perspectives and offer roadmaps for how to rewire the ways in which knowledge is constructed and relationships are formed in the field of health and human rights. In doing so, they present important possibilities for how to build a more just and egalitarian field.
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Affiliation(s)
- Richard Parker
- Department of Sociomedical Sciences, Columbia University, New York, NY, USA.,ABIA - Associação Brasileira Interdisciplinar de AIDS, Rio de Janeiro, Brazil.,LIDHS - Laboratório Interdisciplinar de Direitos Humanos e Saúde, Instituto de Estudos em Saúde Coletiva (IESC), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Laura Murray
- Núcleo de Políticas Públicas em Direitos Humanos (NEPP-DH), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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Meagher K. Crisis Narratives and the African Paradox: African Informal Economies, COVID-19 and the Decolonization of Social Policy. DEVELOPMENT AND CHANGE 2022; 53:1200-1229. [PMID: 36718282 PMCID: PMC9877792 DOI: 10.1111/dech.12737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This article challenges the role of COVID-19 crisis narratives in shaping social policy choices in Africa. The COVID-19 pandemic has focused attention on Africa's vast informal economies, both as a symbol of the continent's intense vulnerability to the ravages of the pandemic, and as a puzzle in the face of the uneven and limited effects of COVID-19 across the continent. Indeed, an examination of statistical and documentary evidence reveals an inverse relationship between COVID-19 fatalities and the size of African informal economies, and a perverse relationship between best-practice COVID social protection responses and levels of COVID-19 mortality. Scrutinizing the evidence behind African COVID-19 crisis narratives raises questions about the ability of donor-led digitized social protection paradigms to address social needs in highly informalized, low-resource environments. This article highlights the role of crisis narratives as an exercise of power geared to remastering, homogenizing and reimagining African informal economies in ways that facilitate particular types of development intervention, sidelining alternative, more socially grounded policy perspectives. Through a closer examination of historical and contemporary realities in Africa's vast and varied informal economies, the article highlights the need to decolonize social policy by privileging local needs and policy perspectives over global policy agendas in the interest of transformative rather than palliative policy responses.
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Boro E, Stoll B. Barriers to COVID-19 Health Products in Low-and Middle-Income Countries During the COVID-19 Pandemic: A Rapid Systematic Review and Evidence Synthesis. Front Public Health 2022; 10:928065. [PMID: 35937225 PMCID: PMC9354133 DOI: 10.3389/fpubh.2022.928065] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/13/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction The coronavirus disease 2019 (COVID-19) pandemic has intensified the urgency in addressing pressing global health access challenges and has also laid bare the pervasive structural and systemic inequities that make certain segments of society more vulnerable to the tragic consequences of the disease. This rapid systematic review analyses the barriers to COVID-19 health products in low-and middle-income countries (LMICs). It does so from the canon of global health equity and access to medicines by proposing an access to health products in low-and middle-income countries framework and typology adapted to underscore the complex interactive and multiplicative nature and effects of barriers to health products and their root cause as they coexist across different levels of society in LMICs. Methods Modified versions of the Joanna Briggs Institute (JBI) reviewers' manual for evidence synthesis of systematic reviews and the PRISMA-ScR framework were used to guide the search strategy, identification, and screening of biomedical, social science, and gray literature published in English between 1 January 2020 and 30 April 2021. Results The initial search resulted in 5,956 articles, with 72 articles included in this review after screening protocol and inclusion criteria were applied. Thirty one percent of the articles focused on Africa. The review revealed that barriers to COVID-19 health products were commonly caused by market forces (64%), the unavailability (53%), inaccessibility (42%), and unaffordability (35%), of the products, incongruent donors' agenda and funding (33%) and unreliable health and supply systems (28%). They commonly existed at the international and regional (79%), health sectoral (46%), and national cross-sectoral [public policy] (19%) levels. The historical heritage of colonialism in LMICs was a commonly attributed root cause of the barriers to COVID-19 health products in developing countries. Conclusion This review has outlined and elaborated on the various barriers to health products that must be comprehensively addressed to mount a successful global, regional, national and subnational response to present and future epidemics and pandemics in LMICs.
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Affiliation(s)
- Ezekiel Boro
- Faculty of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland
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15
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Eze MO, Ejike CECC, Ifeonu P, Mignone J, Udenigwe CC, Uzoegwu PN. Mutual Pan-African support paradigm to produce scientific evidence of traditional medical practices for use against COVID-19 and emerging pandemics. SCIENTIFIC AFRICAN 2021; 14:e01046. [PMID: 34805649 PMCID: PMC8594059 DOI: 10.1016/j.sciaf.2021.e01046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 10/21/2021] [Accepted: 11/10/2021] [Indexed: 01/11/2023] Open
Abstract
Africa is endowed with a profoundly rich and diverse system of plants and other bio-resources out of which, by traditional medicine practice, the people have satisfied their healthcare needs right from antiquity. In contemporary times, it has become necessary to modernize this traditional medical care system via scientific studies. Validation of the efficacy of health-enhancement products and drugs from plants and other bio-resources is predicated on diligent and intensive research accompanied by rigorous and conclusive clinical trials. Africa has eminently qualified human resources but due to the finance-intensive nature of medical research, individual African states on their own cannot fund the level of research desired for dealing with such serious issues as the COVID-19 pandemic. A collaboration among African states guided by a Mutual Pan-African support paradigm (MPASP) is a unique strategy for achieving success in any such a high-impact global project as the use of traditional medicine against COVID-19 and emerging pandemics; and this is hereby advocated.
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Key Words
- CAM, conventional and alternative medicine
- CDC, centers for disease control and prevention
- COVID-19
- COVID-19, SARS-CoV-2 diseases 2019 [severe acute respiratory syndrome-coronavirus-2 disease 2019]
- COVID-organics
- CWM, conventional western medicine
- MERS, Middle East respiratory syndrome
- MPASP, mutual Pan-African support paradigm
- Paradigm
- Research
- SARS-CoV-2, severe acute respiratory syndrome-coronavirus-2
- SCD, sickle cell disease
- SSHA, South-South humanitarian assistance
- TCM, traditional Chinese medicine
- TM, traditional medicine
- Traditional medicine
- WHO, world health organization
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Affiliation(s)
- Michael O Eze
- Department of Chemistry, Health Enhancement and Public Health Biochemistry Lab, University of Winnipeg, 515 Portage Avenue, Winnipeg, Manitoba R3B 2E9, Canada
- Department of Medical Biochemistry, Faculty of Basic Medical Sciences, College of Medical Sciences, Alex Ekwueme Federal University, Ndufu-Alike, Abakaliki, Ebonyi PMB 1010, Nigeria
| | - Chukwunonso E C C Ejike
- Department of Medical Biochemistry, Faculty of Basic Medical Sciences, College of Medical Sciences, Alex Ekwueme Federal University, Ndufu-Alike, Abakaliki, Ebonyi PMB 1010, Nigeria
| | - Patrick Ifeonu
- National Association of Nigerian Traditional Medicine Practitioners, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
| | - Javier Mignone
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, The University of Manitoba, 307 Human Ecology Building, 35 Chancellor's Circle, Winnipeg, Manitoba R3T 2N2, Canada
| | - Chibuike C Udenigwe
- Department of Medical Biochemistry, Faculty of Basic Medical Sciences, College of Medical Sciences, Alex Ekwueme Federal University, Ndufu-Alike, Abakaliki, Ebonyi PMB 1010, Nigeria
- Faculty of Health Sciences, School of Nutrition Sciences, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada
| | - Peter N Uzoegwu
- Department of Biochemistry, The University of Nigeria, Nsukka, Enugu, Nigeria
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Kulesa J, Brantuo NA. Barriers to decolonising educational partnerships in global health. BMJ Glob Health 2021; 6:e006964. [PMID: 34789513 PMCID: PMC8601064 DOI: 10.1136/bmjgh-2021-006964] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/01/2021] [Indexed: 12/22/2022] Open
Abstract
Global health partnerships between high-income countries and low/middle-income countries can mirror colonial relationships. The growing call to advance global health equity therefore involves decolonising global health partnerships and outreach. Through decolonisation, local and international global health partners recognise non-western forms of knowledge and authority, acknowledge discrimination and disrupt colonial structures and legacies that influence access to healthcare.Despite these well-described aims, the ideal implementation process for decolonising global health remains ill-defined. This ambiguity exists, in part, because partners face barriers to adopting a decolonised perspective. Such barriers include overemphasis on intercountry relationships, implicit hierarchies perpetuated by educational interventions and ethical dilemmas in global health work.In this article, we explore the historical entanglement of education, health and colonialism. We then use this history as context to identify barriers that arise when decolonising contemporary educational global health partnerships. Finally, we offer global health partners strategies to address these challenges.
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Affiliation(s)
- John Kulesa
- Graduate School of Education and Human Development, George Washington University, Washington, DC, USA
- Department of Hospital Medicine, Children's National Hospital, Washington, DC, USA
| | - Nana Afua Brantuo
- Graduate School of Education and Human Development, George Washington University, Washington, DC, USA
- Department of Education, University of Maryland at College Park, College Park, Maryland, USA
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17
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Aprilio K, Wilar G. Emergence of Ethnomedical COVID-19 Treatment: A Literature Review. Infect Drug Resist 2021; 14:4277-4289. [PMID: 34703254 PMCID: PMC8541748 DOI: 10.2147/idr.s327986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/06/2021] [Indexed: 12/24/2022] Open
Abstract
The emergence of COVID-19 as a new pandemic in the modern era has led the public to a new perspective of health. In the earlier days of the COVID-19 pandemic, many factors made people go on their own ways in finding its supposed "cure". With conventional medicines' limited availability and access, traditional medicines become more appealing due to its widespread availability and increased perception of safety. Several herbal medicines are then believed to be able to alleviate or cure COVID-19 and its symptoms. Similarities and patterns in herbal medicines being used show local wisdom of the respective communities regarding their knowledge of diseases and its treatment, known as ethnomedicine. Despite not being approved yet by regulatory bodies as a definitive guideline in COVID-19 management, the application of ethnomedicine results in several herbal medicine candidates that show a promising result regarding its efficacy in managing COVID-19. This literature review aims to study how a society and its knowledge of medicine responds to a new and currently developing disease, and whether if that knowledge merits further study in search of a cure for the pandemic. Furthermore, the narrative aspect in this review also explores socio-politics and public health aspects and considerations of non-conventional COVID-19 treatment.
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Affiliation(s)
- Kevin Aprilio
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, West Java, 45363, Indonesia
| | - Gofarana Wilar
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, West Java, 45363, Indonesia
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18
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Syntia Munung N, Ujewe SJ, Afolabi MO. Priorities for global access to life-saving interventions during public health emergencies: Crisis nationalism, solidarity or charity? Glob Public Health 2021; 17:1785-1794. [PMID: 34555300 DOI: 10.1080/17441692.2021.1977973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Access to COVID-19-vaccines by the global poor has unveiled the impact of global health and scientific inequities on access to life saving interventions during public health emergencies (PHE). Despite calls for global solidarity to ensure equitable global access to COVID-19 vaccines, wealthy countries both in the north and southern hemisphere may find a charity-based approach more appealing and are using the opportunity to forge neo-colonial cooperation ties with some African countries. Solidarity is undoubtedly an ideal equity-based principle of public health emergency of international concern (PHEIC). However, its application may be wanting especially as crisis nationalism is more likely to inform the public health policy of any country during a PHEIC, even when they are strong advocates of global solidarity. African countries, on the other hand, must re-appraise their heavy reliance on international aids during PHE and recognise the importance of boosting their epidemic preparedness including research and translation of its findings to practice.
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Affiliation(s)
- Nchangwi Syntia Munung
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Samuel J Ujewe
- The Global Emerging Pathogen Treatment (GET) Consortium, Lagos, Nigeria.,Canadian Institutes of Health Research, Ottawa, Canada
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Abstract
This Special Issue of Global Public Health on Politics & Pandemics brings together 26 articles and commentaries that address diverse aspects of the politics of COVID-19 and related issues. These papers are grouped together in six topical areas: theories and politics of global health, health systems and policies, country responses, social inequalities, social responses, and the politics of science and technology. The goal of the Special Issue is to give readers a sense of the range of topics that have been a focus for research in relation to the COVID-19 pandemic and to provide diverse examples of how research and analysis on the political dimensions of the pandemic can contribute to confronting the COVID-19 crisis.
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Affiliation(s)
- Richard Parker
- Instituto de Estudos de Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,ABIA - Associação Brasileira Interdisciplinar de AIDS, Rio de Janeiro, Brazil.,Sociomedical Sciences and Anthropology, Columbia University, New York City, NY, USA
| | - Dulce Ferraz
- Escola FIOCRUZ de Governo, Diretoria Regional de Brasília, Fundação Oswaldo Cruz, Brasília, Brazil.,Groupe de Recherche en Psychologie Sociale, Université Lumière Lyon 2, Bron, France
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20
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Liwanag HJ, Rhule E. Dialogical reflexivity towards collective action to transform global health. BMJ Glob Health 2021; 6:e006825. [PMID: 34417275 PMCID: PMC8381326 DOI: 10.1136/bmjgh-2021-006825] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Harvy Joy Liwanag
- United Nations University International Institute for Global Health, Cheras, Federal Territory of Kuala Lumpur, Malaysia
| | - Emma Rhule
- United Nations University International Institute for Global Health, Cheras, Federal Territory of Kuala Lumpur, Malaysia
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