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Smith J. Manufactured scarcity and the allocation of scarce resources. Lancet 2024; 403:530-531. [PMID: 38341250 DOI: 10.1016/s0140-6736(23)02886-6] [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: 05/16/2023] [Accepted: 12/21/2023] [Indexed: 02/12/2024]
Affiliation(s)
- James Smith
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK.
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2
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Fanning Z. "Socialization for Scarcity" in Emergency Management: Rethinking Assumptions of Resource Scarcity in Humanitarian Crises. Ann Glob Health 2023; 89:24. [PMID: 36969098 PMCID: PMC10038112 DOI: 10.5334/aogh.3960] [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: 09/09/2022] [Accepted: 01/26/2023] [Indexed: 03/26/2023] Open
Abstract
Background Physician-anthropologist Paul Farmer theorizes a process of "socialization for scarcity" (SfS), which assumes permanent and unchangeable resource scarcity for the world's poor. International health and poverty decisions that are based off of this premise are therefore used to justify inadequate care for vulnerable populations. Objectives The theory of SfS has predominantly been applied to the context of global health and development. This paper aims to apply SfS to the field of emergency management, asking, "How does SfS function in the context of humanitarian crises, and what implications does this have for emergency management?" Methods This paper reviewed Farmer's own descriptions of SfS as well as articles by colleagues and other scholars who elaborated on his theory, analyzing their contributions to issues relevant in emergency management. Findings This review finds that SfS is both applicable to and amplified within emergency management because of the uncertain, competitive, and urgent nature of humanitarian crises. The paper then describes potential approaches to combating SfS in emergency contexts. Conclusions SfS is the result of deficient effort toward discovering approaches to managing emergencies that do not presume scarcity. The assumption of permanent resource scarcity, especially in low- and middle-income countries (LMICs), is a matter of inequity and injustice and stands opposed to imperative systemic change. Emergency managers must work to eradicate dangerous presumptions that leave already suffering individuals even further from the dignified, appropriate and adequate care they require and deserve.
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Affiliation(s)
- Zoe Fanning
- London School of Economics and Political Science, London, UK
- Mayo Clinic Alix School of Medicine, Rochester, MN, US
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3
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Harvey M, Neff J, Knight KR, Mukherjee JS, Shamasunder S, Le PV, Tittle R, Jain Y, Carrasco H, Bernal-Serrano D, Goronga T, Holmes SM. Structural competency and global health education. Glob Public Health 2020; 17:341-362. [PMID: 33351721 DOI: 10.1080/17441692.2020.1864751] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Structural competency is a new curricular framework for training health professionals to recognise and respond to disease and its unequal distribution as the outcome of social structures, such as economic and legal systems, healthcare and taxation policies, and international institutions. While extensive global health research has linked social structures to the disproportionate burden of disease in the Global South, formal attempts to incorporate the structural competency framework into US-based global health education have not been described in the literature. This paper fills this gap by articulating five sub-competencies for structurally competent global health instruction. Authors drew on their experiences developing global health and structural competency curricula-and consulted relevant structural competency, global health, social science, social theory, and social determinants of health literatures. The five sub-competencies include: (1) Describe the role of social structures in producing and maintaining health inequities globally, (2) Identify the ways that structural inequalities are naturalised within the field of global health, (3) Discuss the impact of structures on the practice of global health, (4) Recognise structural interventions for addressing global health inequities, and (5) Apply the concept of structural humility in the context of global health.
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Affiliation(s)
- Michael Harvey
- College of Public Health, Temple University, Philadelphia, PA, USA
| | - Joshua Neff
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Kelly R Knight
- School of Medicine, University of California, San Francisco, CA, USA
| | - Joia S Mukherjee
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Sriram Shamasunder
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Phuoc V Le
- School of Medicine, University of California, San Francisco, CA, USA.,School of Public Health, University of California, Berkeley, CA, USA
| | - Robin Tittle
- Division of Hospital and Specialty Medicine, Portland VA Medical Center, Oregon Health and Sciences University, Portland, OR, USA
| | | | - Héctor Carrasco
- School of Medicine and Health Sciences, Tecnológico de Monterrey, Mexico City Campus, Mexico
| | - Daniel Bernal-Serrano
- School of Medicine and Health Sciences, Tecnológico de Monterrey, Mexico City Campus, Mexico
| | | | - Seth M Holmes
- Division of Society and Environment, Department of Environmental Science, Policy, and Management, University of California, Berkeley, CA, USA
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4
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Sayeed S, Taylor L. Institutionalising global health: a call for ethical reflection. BMJ Glob Health 2020; 5:bmjgh-2020-003353. [PMID: 32943431 PMCID: PMC7500186 DOI: 10.1136/bmjgh-2020-003353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 11/17/2022] Open
Abstract
We describe a global health course and pedagogy that highlights the moral ambiguity and many ethical compromises that have emerged as the discipline has increasingly become institutionalised. We encourage students to reflect on how the oft-declared aspiration for global health equity still remains seriously contested as a normative and political matter, especially in settings like the USA. We further encourage students to reflect on how authentic concern for social justice, health equity and human rights are consistently undermined by unconscious and/or intentional fealty to standard operating procedures within hierarchical structures and systems. Lastly, we encourage students to openly question and critique the dominant socioeconomic and institutional paradigms that influence practitioner ways of thinking about global health. Our aim is to provide a learning space for students to at least imagine, if not demand, more daring modes of engagement. We also encourage our colleagues in the global health education community to be forthright that the process of institutionalising global health reliably favours our own interests more than those we claim to be most concerned about. If the ideal of global health is to build a bridge to human solidarity, we see substantial risk that current popularised approaches might never yield a structural tipping point.
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Affiliation(s)
- Sadath Sayeed
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren Taylor
- Population Health, NYU Grossman School of Medicine, New York, New York, USA
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5
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Sabitova A, Sajun SZ, Nicholson S, Mosler F, Priebe S. Job morale of physicians in low-income and middle-income countries: a systematic literature review of qualitative studies. BMJ Open 2019; 9:e028657. [PMID: 31796473 PMCID: PMC6924858 DOI: 10.1136/bmjopen-2018-028657] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 11/14/2019] [Accepted: 11/14/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To systematically review the available literature on physicians' and dentists' experiences influencing job motivation, job satisfaction, burnout, well-being and symptoms of depression as indicators of job morale in low-income and middle-income countries. DESIGN The review was reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for studies evaluating outcomes of interest using qualitative methods. The framework method was used to analyse and integrate review findings. DATA SOURCES A primary search of electronic databases was performed by using a combination of search terms related to the following areas of interest: 'morale', 'physicians and dentists' and 'low-income and middle-income countries'. A secondary search of the grey literature was conducted in addition to checking the reference list of included studies and review papers. RESULTS Ten papers representing 10 different studies and involving 581 participants across seven low-income and middle-income countries met the inclusion criteria for the review. However, none of the studies focused on dentists' experiences was included. An analytical framework including four main categories was developed: work environment (physical and social), rewards (financial, non-financial and social respect), work content (workload, nature of work, job security/stability and safety), managerial context (staffing levels, protocols and guidelines consistency and political interference). The job morale of physicians working in low-income and middle-income countries was mainly influenced by negative experiences. Increasing salaries, offering opportunities for career and professional development, improving the physical and social working environment, implementing clear professional guidelines and protocols and tackling healthcare staff shortage may influence physicians' job morale positively. CONCLUSIONS There were a limited number of studies and a great degree of heterogeneity of evidence. Further research is recommended to assist in scrutinising context-specific issues and ways of addressing them to maximise their utility. PROSPERO REGISTRATION NUMBER CRD42017082579.
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Affiliation(s)
- Alina Sabitova
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Sana Zehra Sajun
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Sandra Nicholson
- Institute of Health Sciences Education, Queen Mary University of London, London, UK
| | - Franziska Mosler
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
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6
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Ivers LC. Advancing Control of Cholera in the Interest of the Most Vulnerable in our Global Society. J Infect Dis 2018; 218:S135-S136. [PMID: 30184099 PMCID: PMC6188543 DOI: 10.1093/infdis/jiy458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Louise C Ivers
- Center for Global Health, Massachusetts General Hospital, and Department of Global Health and Social Medicine, Harvard Medical School, Boston
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7
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Schrecker T. Priority Setting: Right Answer to a Far Too Narrow Question? Comment on "Global Developments in Priority Setting in Health". Int J Health Policy Manag 2018; 7:86-88. [PMID: 29325408 PMCID: PMC5745873 DOI: 10.15171/ijhpm.2017.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 05/23/2017] [Indexed: 12/18/2022] Open
Abstract
In their recent editorial, Baltussen and colleagues provide a concise summary of the prevailing discourse on priority-setting in health policy. Their perspective is entirely consistent with current practice, yet they unintentionally demonstrate the narrowness and moral precariousness of that discourse and practice. I respond with demonstrations of the importance of 'interrogating scarcity' in a variety of contexts.
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Affiliation(s)
- Ted Schrecker
- School of Medicine, Pharmacy and Health, Durham University, University Boulevard, Stockton-on-Tees, UK
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8
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Barradas CDS, Nunes JA. Facing austerity: the decline in health access and quality of care for patients with cancer in Portugal. HISTORIA, CIENCIAS, SAUDE--MANGUINHOS 2017; 24:933-951. [PMID: 29412273 DOI: 10.1590/s0104-59702017000500005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 03/01/2016] [Indexed: 06/08/2023]
Abstract
In April 2011, Portugal called on the European Union for a financial bailout due to its debt crisis, and counterbalanced this rescue with various austerity measures. Within the Portuguese public health system (Serviço Nacional de Saúde, SNS) these measures were swiftly applied on a large scale, and in turn led to increasing difficulties among the health professionals within the SNS with regard to the use of diagnostics, treatments, and medications for patients, as well as growing obstacles to regular clinical consultations. Through media analysis of Portuguese health policy related to cancer and statements from professionals in the SNS, this article expresses the concerns of these health providers and explores how this situation is negatively impacting the lives of those who deal with this disease every day.
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Affiliation(s)
- Carlos da Silva Barradas
- Doutorando, Programa de Doutoramento em Governação, Conhecimento e Inovação/Centro de Estudos Sociais/Universidade de Coimbra
| | - João Arriscado Nunes
- Investigador, Centro de Estudos Sociais/Faculdade de Economia/Universidade de Coimbra
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9
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Hall W. Don't Discount Societal Value in Cost-Effectiveness Comment on "Priority Setting for Universal Health Coverage: We Need Evidence-Informed Deliberative Processes, Not Just More Evidence on Cost-Effectiveness". Int J Health Policy Manag 2017; 6:543-545. [PMID: 28949468 PMCID: PMC5582442 DOI: 10.15171/ijhpm.2017.03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/08/2017] [Indexed: 11/09/2022] Open
Abstract
As healthcare resources become increasingly scarce due to growing demand and stagnating budgets, the need for effective priority setting and resource allocation will become ever more critical to providing sustainable care to patients. While societal values should certainly play a part in guiding these processes, the methodology used to capture these values need not necessarily be limited to multi-criterion decision analysis (MCDA)-based processes including 'evidence-informed deliberative processes.' However, if decision-makers intend to not only incorporates the values of the public they serve into decisions but have the decisions enacted as well, consideration should be given to more direct involvement of stakeholders. Based on the examples provided by Baltussen et al, MCDA-based processes like 'evidence-informed deliberative processes' could be one way of achieving this laudable goal.
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Affiliation(s)
- William Hall
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
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10
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van de Pas R. Global Health in the Anthropocene: Moving Beyond Resilience and Capitalism Comment on "Health Promotion in an Age of Normative Equity and Rampant Inequality". Int J Health Policy Manag 2017; 6:481-486. [PMID: 28812849 PMCID: PMC5553218 DOI: 10.15171/ijhpm.2016.151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 12/07/2016] [Indexed: 12/22/2022] Open
Abstract
There has been much reflection on the need for a new understanding of global health and the urgency of a paradigm shift to address global health issues. A crucial question is whether this is still possible in current modes of global governance based on capitalist values. Four reflections are provided. (1) Ecological –centered values must become central in any future global health framework. (2) The objectives of ‘sustainability’ and ‘economic growth’ present a profound contradiction. (3) The resilience discourse maintains a gridlock in the functioning of the global health system. (4) The legitimacy of multi-stakeholder governance arrangements in global health requires urgent attention. A dual track approach is suggested. It must be aimed to transform capitalism into something better for global health while in parallel there is an urgent need to imagine a future and pathways to a different world order rooted in the principles of social justice, protecting the commons and a central role for the preservation of ecology.
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Affiliation(s)
- Remco van de Pas
- Department of Public Health, Unit of Health Policy, Institute of Tropical Medicine, Antwerp, Belgium
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11
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Kiragu AW, Dunlop SJ, Wachira BW, Saruni SI, Mwachiro M, Slusher T. Pediatric Trauma Care in Low- and Middle-Income Countries: A Brief Review of the Current State and Recommendations for Management and a Way Forward. J Pediatr Intensive Care 2016; 6:52-59. [PMID: 31073425 DOI: 10.1055/s-0036-1584676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 02/15/2016] [Indexed: 10/21/2022] Open
Abstract
Traumatic injuries are a significant cause of death and disability worldwide. The vast majority of these injuries occur in low- and middle-income countries (LMICs). Attention to protocolized care and adaptations to treatments based on availability of resources, regionalization of care, and the development of centers of excellence within each LMIC are crucial to improving outcomes and lowering trauma-related morbidity and mortality worldwide. Given limitations in the availability of the resources necessary to provide the levels of care found in high-income countries, strategies to prevent trauma and make the best use of available resources when prevention fails, and thus achieve the best possible outcomes for injured and critically ill children, are vital. Overall, a commitment on the part of governments in LMICs to the provision of adequate health care services to their populations will improve the outcomes of injured children. This review details the evaluation and management of traumatic injuries in pediatric patients and gives some recommendations for improvements to trauma care in LMICs.
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Affiliation(s)
- Andrew W Kiragu
- Department of Pediatrics, Hennepin County Medical Center, Minneapolis, Minnesota, United States
| | - Stephen J Dunlop
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, United States.,Division of Global Medicine, University of Minnesota, Minneapolis, Minnesota, United States
| | - Benjamin W Wachira
- Accident and Emergency Department, Aga Khan University Hospital, Nairobi, Kenya
| | - Seno I Saruni
- Department of Surgery, Tenwek Hospital, Bomet, Kenya
| | | | - Tina Slusher
- Department of Pediatrics, Hennepin County Medical Center, Minneapolis, Minnesota, United States.,Division of Global Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States
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12
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Schrecker T. Globalization, austerity and health equity politics: taming the inequality machine, and why it matters. CRITICAL PUBLIC HEALTH 2014. [DOI: 10.1080/09581596.2014.973019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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Forman L, Ooms G, Chapman A, Friedman E, Waris A, Lamprea E, Mulumba M. What could a strengthened right to health bring to the post-2015 health development agenda?: interrogating the role of the minimum core concept in advancing essential global health needs. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2013; 13:48. [PMID: 24289096 PMCID: PMC4220671 DOI: 10.1186/1472-698x-13-48] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 11/19/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Global health institutions increasingly recognize that the right to health should guide the formulation of replacement goals for the Millennium Development Goals, which expire in 2015. However, the right to health's contribution is undercut by the principle of progressive realization, which links provision of health services to available resources, permitting states to deny even basic levels of health coverage domestically and allowing international assistance for health to remain entirely discretionary. DISCUSSION To prevent progressive realization from undermining both domestic and international responsibilities towards health, international human rights law institutions developed the idea of non-derogable "minimum core" obligations to provide essential health services. While minimum core obligations have enjoyed some uptake in human rights practice and scholarship, their definition in international law fails to specify which health services should fall within their scope, or to specify wealthy country obligations to assist poorer countries. These definitional gaps undercut the capacity of minimum core obligations to protect essential health needs against inaction, austerity and illegitimate trade-offs in both domestic and global action. If the right to health is to effectively advance essential global health needs in these contexts, weaknesses within the minimum core concept must be resolved through innovative research on social, political and legal conceptualizations of essential health needs. SUMMARY We believe that if the minimum core concept is strengthened in these ways, it will produce a more feasible and grounded conception of legally prioritized health needs that could assist in advancing health equity, including by providing a framework rooted in legal obligations to guide the formulation of new health development goals, providing a baseline of essential health services to be protected as a matter of right against governmental claims of scarcity and inadequate international assistance, and empowering civil society to claim fulfillment of their essential health needs from domestic and global decision-makers.
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Affiliation(s)
- Lisa Forman
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada
| | - Gorik Ooms
- Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Audrey Chapman
- University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, Connecticut 06030, USA
| | - Eric Friedman
- Georgetown University Law Center, 600 New Jersey Avenue NW, Washington DC 20001, USA
| | - Attiya Waris
- University of Nairobi, P. O. Box 30197 – 00100 Parklands Campus, Nairobi, Kenya
| | | | - Moses Mulumba
- Centre for Health, Human Rights and Development, Plot 614 Tufnell Drive, Kamwokya, PO Box 16617, Wandegeya, Kampala, Uganda
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