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Orr Z, Fleming MD. Medical neutrality and structural competency in conflict zones: Israeli healthcare professionals’ reaction to political violence. Glob Public Health 2023. [DOI: 10.1080/17441692.2023.2171087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- Zvika Orr
- Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
| | - Mark D. Fleming
- School of Public Health, University of California, Berkeley, CA, USA
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Hyder AA, Ambrosio NS, García-Ponce O, Barberia L. Peace and health: exploring the nexus in the Americas. BMJ Glob Health 2022; 7:bmjgh-2022-009402. [PMID: 36210066 PMCID: PMC9535176 DOI: 10.1136/bmjgh-2022-009402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/01/2022] [Indexed: 11/03/2022] Open
Abstract
The relationship between peace and health is complex, multifactorial and fraught with challenges of definitions, measurements and outcomes. This exploratory commentary on this nexus within a focus on the Americas posits this challenge clearly and calls for more scholarship and empirical work on this issue from an interdisciplinary perspective. The overall goal of this paper is to try and explore the elements that impact the relationship between peace and health with a focus on the Americas (defined as countries spanning from Canada to Argentina) in the post-Cold war period. Focusing on the 1990s and onwards, we seek to underscore why violence continues to permeate these societies despite a third and lasting wave of democratisation in the hemisphere. We hope this will allow a more robust dialogue on peace and health in the regional and global health literature.
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Affiliation(s)
- Adnan A Hyder
- Department of Global Health, George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA
| | - Natalia S Ambrosio
- The George Washington University Elliott School of International Affairs, Washington, District of Columbia, USA
| | - Omar García-Ponce
- Department of Political Science, The George Washington University Columbian College of Arts and Sciences, Washington, District of Columbia, USA
| | - Lorena Barberia
- Department of Political Science, Sao Paulo University—Chacara Santo Antonio I Campus, Sao Paulo, Brazil
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AlGhatrif M, Darwish M, Alzoubi Z, Shawar YR. Power dynamics and health initiative design as determinants of peacebuilding: a case study of the Syrian conflict. BMJ Glob Health 2022; 7:bmjgh-2021-007745. [PMID: 36210065 PMCID: PMC9534776 DOI: 10.1136/bmjgh-2021-007745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 02/08/2022] [Indexed: 11/04/2022] Open
Abstract
Peace-through-health has emerged as a promising concept but with variable evidence of success. Cooptation of health initiatives in conflict is believed to be a major challenge undermining peacebuilding potential. We examine the role that existing power structures and health initiative characteristics play at various levels of a conflict in peacebuilding outcomes. Using the Syrian conflict as a case study, we assess healthcare initiatives’ characteristics and their peacebuilding tendencies accounting for power dynamics at the (1) state citizen, (2) interbelligerents and (3) intercommunity conflict levels, drawing on the WHO’s framework for health and peace initiatives. Healthcare interventions at state citizen and interbelligerent levels generally addressed combat-related and material-dependent health needs, relied on large-scale international funding and centralised governance structures, and bestowed credit to specific agencies with political implications. These characteristics made such initiatives prone to cooptation in conflict with limited peacebuilding capacity. Healthcare initiatives at the community level addressed more basic, service-dependent needs, had smaller budgets, relied on local organisations and distributed credit across stakeholders, making them less amenable to cooptation in the conflict with more propeace potential. A pilot peacebuilding health initiative designed to leverage these propeace attributes navigated the political environment, minimised cooptation and fostered community collaboration, resulting in peacebuilding potential. In summary, peacebuilding health initiatives are more likely to materialise at the community as compared with higher political levels. Further studies, accounting for conflict power structures, are needed to examine the effectiveness of such initiatives and identify methods that maximise their peacebuilding outcomes.
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Affiliation(s)
- Majd AlGhatrif
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA,Syria Peace Program, Foreign Policy Institute, Johns Hopkins School of Advanced International Studies, Baltimore, Maryland, USA
| | - Mohammad Darwish
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Zedoun Alzoubi
- Research for Health System Strengthening in northern Syria (R4HSSS) Project, London, UK
| | - Yusra Ribhi Shawar
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA,Johns Hopkins University School of Advanced International Studies, Washington, DC, USA
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Orr Z, Jackson L, Alpert EA, Fleming MD. Neutrality, conflict, and structural determinants of health in a Jerusalem emergency department. Int J Equity Health 2022; 21:89. [PMID: 35751059 PMCID: PMC9233380 DOI: 10.1186/s12939-022-01681-w] [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: 01/19/2022] [Accepted: 05/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medical neutrality is a normative arrangement that differentiates a zone of medical treatment disconnected from the field of politics. While medical neutrality aims to ensure impartial healthcare for all and to shield the healthcare personnel from political demands, it can also divert attention away from conflicts and their effects on health inequity. This article analyzes how healthcare professionals understand and negotiate the depoliticized space of the emergency department (ED) through their views on neutrality. It also examines how medical staff use depoliticized concepts of culture to account for differences in the health status of patients from disadvantaged groups. These questions are examined in the context of the Israeli-Palestinian conflict. METHODS Twenty-four in-depth, semi-structured interviews were conducted with healthcare personnel in a Jerusalem hospital's ED. All but one of the participants were Jewish. The interviews were analyzed using qualitative content analysis and Grounded Theory. RESULTS The ED staff endorsed the perspective of medical neutrality as a nondiscriminatory approach to care. At the same time, some medical staff recognized the limits of medical neutrality in the context of the Israeli-Palestinian conflict and negotiated and challenged this concept. While participants identified unique health risks for Arab patients, they usually did not associate these risks with the effects of conflict and instead explained them in depoliticized terms of cultural and behavioral differences. Culture served as a non-controversial way of acknowledging and managing problems that have their roots in politics. CONCLUSIONS The normative demand for neutrality works to exclude discussion of the conflict from clinical spaces. The normative exclusion of politics is a vital but under-appreciated aspect of how political conflict operates as a structural determinant of health. Healthcare personnel, especially in the ED, should be trained in structural competency. This training may challenge the neglect of issues that need to be solved at the political level and enhance health equity, social justice, and solidarity.
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Affiliation(s)
- Zvika Orr
- Department of Nursing, Jerusalem College of Technology, 11 Beit Hadfus Street, Jerusalem, Israel.
| | - Levi Jackson
- Department of Nursing, Jerusalem College of Technology, 11 Beit Hadfus Street, Jerusalem, Israel
| | - Evan Avraham Alpert
- Department of Emergency Medicine, Shaare Zedek Medical Center; Faculty of Medicine, The Hebrew University of Jerusalem, 12 Shmuel Bait Street, Jerusalem, Israel
| | - Mark D Fleming
- School of Public Health, University of California Berkeley, 2121 Berkeley Way, Berkeley, CA, USA
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van Druten VP, Bartels EA, van de Mheen D, de Vries E, Kerckhoffs APM, Nahar-van Venrooij LMW. Concepts of health in different contexts: a scoping review. BMC Health Serv Res 2022; 22:389. [PMID: 35331223 PMCID: PMC8953139 DOI: 10.1186/s12913-022-07702-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/23/2022] [Indexed: 01/07/2023] Open
Abstract
The rationale of our study was that the World Health Organization's (WHO) definition of health from 1947 which includes "… complete physical, mental and social wellbeing…" does not fit the current societal viewpoints anymore. The WHO's definition of health implies that many people with chronic illnesses or disabilities would be considered unhealthy and complete wellbeing would be utopian and unfeasible for them. This is no longer uniformly accepted. Many alternative concepts of health have been discussed in the last decades such as 'positive health', which focusses on someone's capability rather than incapability,. However, the question remains whether a general health concept can guide all healthcare practices. More likely, health concepts need to be specified for professions or settings. The objective of our study was to create a structured overview of published concepts of health from different perspectives by conducting a scoping review using the PRISMA-ScR guideline. A literature search was conducted in Pubmed and Cinahl. Articles eligible for inclusion focussed on the discussion or the conceptualisation of health or health-related concepts in different contexts (such as the perspective of care workers' or patients') published since 2009 (the Dutch Health Council raised the discussion about moving towards a more dynamic perspective on health in that year). Seventy-five articles could be included for thematic analyses. The results showed that most articles described a concept of health consisting of multiple subthemes; no consensus was found on one overall concept of health. This implies that healthcare consumers act based on different health concepts when seeking care than care workers when providing care. Having different understandings of the concepts of health can lead to misunderstandings in practice. In conclusion, from every perspective, and even for every individual, health may mean something different. This finding stresses the importance that care workers' and healthcare consumers' meaning of 'health' has to be clear to all actors involved. Our review supports a more uniform tuning of healthcare between healthcare providers (the organisations), care workers (the professionals) and healthcare consumers (the patients), by creating more awareness of the differences among these actors, which can be a guide in their communication.
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Affiliation(s)
- V P van Druten
- Jeroen Bosch Academy Research, Jeroen Bosch Hospital Jeroen Bosch Ziekenhuis, PO Box 90153, Henri Dunantstraat 1, 's Hertogenbosch, 5223 GZ, the Netherlands. .,Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, Professor Cobbenhagenlaan 125, Tilburg, 5000 LE, the Netherlands.
| | - E A Bartels
- Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, Professor Cobbenhagenlaan 125, Tilburg, 5000 LE, the Netherlands.,TiSEM Department of Management, Tilburg University, Tilburg, the Netherlands
| | - D van de Mheen
- Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, Professor Cobbenhagenlaan 125, Tilburg, 5000 LE, the Netherlands
| | - E de Vries
- Jeroen Bosch Academy Research, Jeroen Bosch Hospital Jeroen Bosch Ziekenhuis, PO Box 90153, Henri Dunantstraat 1, 's Hertogenbosch, 5223 GZ, the Netherlands.,Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, Professor Cobbenhagenlaan 125, Tilburg, 5000 LE, the Netherlands
| | - A P M Kerckhoffs
- Department of Nephrology, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands.,Department of Geriatric Medicine, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands
| | - L M W Nahar-van Venrooij
- Jeroen Bosch Academy Research, Jeroen Bosch Hospital Jeroen Bosch Ziekenhuis, PO Box 90153, Henri Dunantstraat 1, 's Hertogenbosch, 5223 GZ, the Netherlands
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Al Mandhari A, Ghaffar A, Etienne CF. Harnessing the peace dividends of health. BMJ Glob Health 2021; 6:bmjgh-2021-006287. [PMID: 34108148 PMCID: PMC8191600 DOI: 10.1136/bmjgh-2021-006287] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/15/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ahmed Al Mandhari
- World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
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