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Moser F, Bump JB. Assessing the World Health Organization: What does the academic debate reveal and is it democratic? Soc Sci Med 2022; 314:115456. [PMID: 36274457 DOI: 10.1016/j.socscimed.2022.115456] [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: 12/03/2021] [Revised: 09/17/2022] [Accepted: 10/09/2022] [Indexed: 11/05/2022]
Abstract
The World Health Organization (WHO), the leading global authority in public health, routinely attracts loud calls for reform. Although Member States negotiate reform internally, academic debate is more public, and can generate ideas and provide independent accountability. We investigate why authors advocate for WHO reform so commonly. We wondered if this literature had potentially useful themes for WHO, what methods and evidence were used, and we wanted to analyze the geography of participation. We conducted a systematic review using four databases to identify 139 articles assessing WHO or advocating for reform. We discuss these using categories we derived from the management literature on organizational performance. We also analyzed evidence, country of origin, and topic. The literature we reviewed contained 998 claims about WHO's performance or reform, although there were no standard methods for assessing WHO. We developed a framework to analyze WHO's performance and structure a synthesis of the claims, which find WHO imperiled. Its legitimacy and governance are weakened by disagreements about purpose, unequal Member State influence, and inadequate accountability. Contestation of goals and strategies constrain planning. Structure and workforce deficiencies limit coordination, agility, and competence. WHO has technical and normative authority, but insufficient independence and legal power to influence uncooperative states. WHO's identity claims transparency, independence, and courage, but these aspirations are betrayed in times of need. Most articles (88%) were commentaries without specified methods. More than three-quarters (76%) originated from the US, the UK, or Switzerland. A quarter of papers (25%) focused on international infectious disease outbreaks, and another 25% advocated for WHO reform generally. Many criticisms cite wide-ranging performance problems, some of which may relate to obstructive behavior by Member States. This literature is incomplete in the geographic representation of authors, evidence, methods, and topics. We offer ideas for developing more rigorous and inclusive academic debate on WHO.
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Affiliation(s)
- Fabian Moser
- Institute of Public Health, Charité - Universitätsmedizin Berlin, 10117, Berlin, Germany.
| | - Jesse B Bump
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA; Bergen Center for Ethics and Priority Setting, University of Bergen, Norway; Initiative on the Future of Health and Economic Resilience in Africa, Boston MA 02115, USA.
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Buse K, Aftab W, Akhter S, Phuong LB, Chamli H, Dahal M, Hawkes S, Pradhan NA. Time to clarify State obligations and accountability on NCDs with human rights instruments. BMJ Glob Health 2019; 4:e002155. [PMID: 31908879 PMCID: PMC6936371 DOI: 10.1136/bmjgh-2019-002155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 12/05/2022] Open
Affiliation(s)
- Kent Buse
- Political Affairs and Strategy, UNAIDS, Geneva, Switzerland
| | - Wafa Aftab
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | | | - Linh Bui Phuong
- Center for Population Health Sciences, Hanoi University of Public Health, Hanoi, Vietnam
| | | | - Minakshi Dahal
- Center for Research on Environment Health and Population Studies, Kathmandu, Nepal
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Kraak VI, Rincón-Gallardo Patiño S, Sacks G. An accountability evaluation for the International Food & Beverage Alliance's Global Policy on Marketing Communications to Children to reduce obesity: A narrative review to inform policy. Obes Rev 2019; 20 Suppl 2:90-106. [PMID: 31034139 DOI: 10.1111/obr.12859] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/08/2019] [Accepted: 03/11/2019] [Indexed: 11/30/2022]
Abstract
United Nations (UN) organizations have urged governments to restrict the marketing of unhealthy food and nonalcoholic beverage products to children. This study conducted an accountability evaluation for the International Food & Beverage Alliance's (IFBA's) Global Policy on Marketing Communications to Children (Global Policy) compared with UN and other best-practice recommendations. We used the National Academy of Medicine's LEAD (ie, locate, evaluate, assemble evidence to inform decisions) framework to identify evidence (January 2004 to October 2018). We assigned a progress score (ie, none, limited, some, extensive) for five accountability steps. No progress was made to appoint an empowered body to evaluate IFBA's Global Policy. IFBA and the Access to Nutrition Foundation made some progress to take and share the account. Diverse actors made no progress to hold IFBA to account for nonadherence or to strengthen accountability structures for future compliance. IFBA could strengthen its Global Policy to align with best practices. UN organizations and other stakeholders should encourage IFBA firms to restrict the marketing of unhealthy foods and beverages to reduce children's obesity risk. This evaluation is relevant to all firms and industry associations that market products to children that undermine their diet and health.
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Affiliation(s)
- Vivica I Kraak
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia, USA
| | | | - Gary Sacks
- Global Obesity Centre (GLOBE), Deakin University, Geelong, Victoria, Australia
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Patterson D, Buse K, Magnusson R, Toebes B. Identifying a human rights-based approach to obesity for States and civil society. Obes Rev 2019; 20 Suppl 2:45-56. [PMID: 31297936 DOI: 10.1111/obr.12873] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/28/2019] [Accepted: 03/29/2019] [Indexed: 11/27/2022]
Abstract
Obesity and its comorbidities pose daunting challenges to global health and development in the 21st century. This paper reviews some commonalities between obesity and another global health challenge, the pandemic of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). International human rights law was an important catalyst for civil society movements that helped to overcome inertia and generate political will for State action in response to HIV and AIDS. Drawing on the HIV experience, the authors propose a conceptual model for a human rights-based response to obesity founded on the twin pillars of State obligations and civil society engagement. Framing States' obligations to address the global obesity pandemic as a matter of international law, informed by the examples of the United Nations "International Guidelines on HIV/AIDS and Human Rights" and the General Comments of the United Nations human rights treaty bodies on HIV and AIDS, provides a normative framework to guide State actions and opportunities to engage the extensive accountability mechanisms of the United Nations international human rights system. In addition, it provides civil society organizations with the language and tools to demand State action on obesity. The authors call for similar authoritative guidance for States on the application of international human rights law to obesity.
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Affiliation(s)
- David Patterson
- Global Health Law Groningen Research Centre, Faculty of Law, University of Groningen, Netherlands
| | | | - Roger Magnusson
- Sydney Law School, University of Sydney, Camperdown, NSW, Australia
| | - Brigit Toebes
- Faculty of Law, University of Groningen, Groningen, Netherlands
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Yuan Q. The construction mechanism and algorithm of cross border E-commerce export logistics mode from the perspective of value chain. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2019. [DOI: 10.3233/jifs-179142] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Qingwen Yuan
- Department of Finance and Economics, Shandong University of Science and Technology, Jinan, China
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Li S, Xu J, Cele S. Application of graph theory in transportation linkage in logistics management and its computer aided model design. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2019. [DOI: 10.3233/jifs-179134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Shuangdong Li
- School of Mathematical Sciences, Anhui University, Hefei, Anhui, China
- Jianghuai College, Anhui University, Hefei, Anhui, China
| | - Jing Xu
- School of Mathematical Sciences, Anhui University, Hefei, Anhui, China
| | - Ste Cele
- Tarrant County College, Texas, USA
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Padiyara P, Inoue H, Sprenger M. Global Governance Mechanisms to Address Antimicrobial Resistance. Infect Dis (Lond) 2018; 11:1178633718767887. [PMID: 29686487 PMCID: PMC5900814 DOI: 10.1177/1178633718767887] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/09/2018] [Indexed: 11/17/2022] Open
Abstract
Since their discovery, antibiotics, and more broadly, antimicrobials, have been a cornerstone of modern medicine. But the overuse and misuse of these drugs have led to rising rates of antimicrobial resistance, which occurs when bacteria adapt in ways that render antibiotics ineffective. A world without effective antibiotics can have drastic impacts on population health, global development, and the global economy. As a global common good, antibiotic effectiveness is vulnerable to the tragedy of the commons, where a shared limited resource is overused by a community when each individual exploits the finite resource for their own benefit. A borderless threat like antimicrobial resistance requires global governance mechanisms to mitigate its emergence and spread, and it is the responsibility of all countries and relevant multilateral organizations. These mechanisms can be in the form of legally binding global governance mechanisms such as treaties and regulatory standards or nonbinding mechanisms such as political declarations, resolutions, or guidelines. In this article, we argue that while both are effective methods, the strong, swift, and coordinated action needed to address rising rates of antimicrobial resistance will be better served through legally binding governance mechanisms.
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Affiliation(s)
- Ponnu Padiyara
- Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Hajime Inoue
- UHC and Health Systems, World Health Organization, Geneva, Switzerland
| | - Marc Sprenger
- AMR Secretariat, World Health Organization, Geneva, Switzerland
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Horvath KJ, Meyer C, Rosser BRS. Monitoring HIV-Related Laws and Policies: Lessons for AIDS and Global Health in Agenda 2030. AIDS Behav 2017; 21:51-61. [PMID: 26780329 PMCID: PMC4947446 DOI: 10.1007/s10461-016-1621-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The National Commitments and Policy Instrument (NCPI) has been used to monitor AIDS-related laws and policies for over 10 years. What can be learnt from this process? Analyses draw on NCPI questionnaires, NCPI responses, the UNAIDS Law Database, survey data and responses to a 2014 survey on the NCPI. The NCPI provides the first and only systematic data on country self-reported national HIV laws and policies. High NCPI reporting rates and survey responses suggest the majority of countries consider the process relevant. Combined civil society and government engagement and reporting is integral to the NCPI. NCPI experience demonstrates its importance in describing the political and legal environment for the HIV response, for programmatic reviews and to stimulate dialogue among stakeholders, but there is a need for updating and in some instances to complement results with more objective quantitative data. We identify five areas that need to be updated in the next iteration of the NCPI and argue that the NCPI approach is relevant to participatory monitoring of targets in the health and other goals of the UN 2030 Agenda for Sustainable Development.
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Affiliation(s)
- Keith J Horvath
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S. 2nd Street, Suite 300, Minneapolis, MN, 55454, USA.
| | - Craig Meyer
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S. 2nd Street, Suite 300, Minneapolis, MN, 55454, USA
| | - B R Simon Rosser
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S. 2nd Street, Suite 300, Minneapolis, MN, 55454, USA
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Horvath KJ, Meyer C, Rosser BRS. Men Who have Sex with Men Who Believe that Their State has a HIV Criminal Law Report Higher Condomless Anal Sex than Those Who are Unsure of the Law in Their State. AIDS Behav 2017; 21:51-58. [PMID: 26780329 DOI: 10.1007/s10461-016-1286-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We assessed the effects of beliefs about state HIV criminal law on condomless anal sex (CAS < 3 months) among men who have sex with men (MSM) residing in 16 US states (n = 2013; M = 36 years old; 75 % White; 82 % HIV-negative) completing an online survey in 2010 and stratified by residency in a state with any or sex-specific HIV criminal law(s) or where a HIV-related arrest, prosecution, or sentence enhancement (APSE) had occurred. Three-quarters of MSM reported that they were unsure of the law in their state. Men who believed there was a HIV law in their state but lived in states without any or a sex-specific HIV criminal law(s) had higher probabilities of CAS compared to those who were unsure of their state's law; men who believed there was a HIV law in their state and lived in a state where an APSE had occurred had higher probabilities of CAS compared to those who were unsure of their state's law. Correct knowledge of state law was not associated with CAS. Findings suggest that HIV criminal laws have little or counter-productive effects on MSM's risk behavior.
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Affiliation(s)
- Keith J Horvath
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S. 2nd Street, Suite 300, Minneapolis, MN, 55454, USA.
| | - Craig Meyer
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S. 2nd Street, Suite 300, Minneapolis, MN, 55454, USA
| | - B R Simon Rosser
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S. 2nd Street, Suite 300, Minneapolis, MN, 55454, USA
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Abstract
The field of global health law and the contribution of international organizations to its development are described. The growth and elaboration of the field of global health law in the last two decades is one of the most notable developments in global health policy. In this new era of global health governance, international law has an important, albeit limited, role to play in promoting and coordinating international cooperation and national action to protect and promote global health. Particular attention is paid to the global impact of binding international agreements and other international legal instruments developed under the auspices of the World Health Organization and the World Trade Organization.
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Jay J, Buse K, Hart M, Wilson D, Marten R, Kellerman S, Odetoyinbo M, Quick JD, Evans T, Piot P, Dybul M, Binagwaho A. Building from the HIV Response toward Universal Health Coverage. PLoS Med 2016; 13:e1002083. [PMID: 27529809 PMCID: PMC4987004 DOI: 10.1371/journal.pmed.1002083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Jonathan Jay and colleagues draw lessons from the the global HIV response that could help guide the universal health coverage movement.
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Affiliation(s)
- Jonathan Jay
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Marielle Hart
- International HIV/AIDS Alliance/STOP AIDS NOW!, Washington, D.C., United States of America
| | - David Wilson
- World Bank Group, Washington, D.C., United States of America
| | - Robert Marten
- Rockefeller Foundation, New York, New York, United States of America
| | - Scott Kellerman
- Management Sciences for Health, Medford, Massachusetts, United States of America
| | | | - Jonathan D. Quick
- Management Sciences for Health, Medford, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Timothy Evans
- World Bank Group, Washington, D.C., United States of America
| | - Peter Piot
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mark Dybul
- Global Fund to Fight AIDS, TB and Malaria, Geneva, Switzerland
| | - Agnes Binagwaho
- Harvard Medical School, Boston, Massachusetts, United States of America
- Geisel School of Medicine, Hanover, New Hampshire, United States of America
- University of Global Health Equity, Kigali, Rwanda
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Wu D, Hawkes S, Buse K. Prevention of mother-to-child transmission of syphilis and HIV in China: What drives political prioritization and what can this tell us about promoting dual elimination? Int J Gynaecol Obstet 2015; 130 Suppl 1:S32-6. [PMID: 25968490 PMCID: PMC4510314 DOI: 10.1016/j.ijgo.2015.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective The present study aims to identify reasons behind the lower political priority of mother-to-child transmission (MTCT) of syphilis compared with HIV, despite the former presenting a much larger and growing burden than the latter, in China, over the 20 years prior to 2010. Methods We undertook a comparative policy analysis, based on informant interviews and documentation review of control of MTCT of syphilis and HIV, as well as nonparticipant observation of relevant meetings/trainings to investigate agenda-setting prior to 2010. Results We identified several factors contributing to the lower priority accorded to MTCT of syphilis: relative neglect at a global level, dearth of international financial and technical support, poorly unified national policy community with weak accountability mechanisms, insufficient understanding of the epidemic and policy options, and a prevailing negative framing of syphilis that resulted in significant stigmatization. Conclusion A dual elimination goal will only be reached when prioritization of MTCT of syphilis is enhanced in both the international and national agendas.
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Affiliation(s)
- Dadong Wu
- Institute for Global Health, University College London, London, UK
| | - Sarah Hawkes
- Institute for Global Health, University College London, London, UK.
| | - Kent Buse
- The Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
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