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Yassaie R, Brooks L. Reassessing 'good' medical practice and the climate crisis. JOURNAL OF MEDICAL ETHICS 2024:jme-2023-109713. [PMID: 38871401 DOI: 10.1136/jme-2023-109713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 06/05/2024] [Indexed: 06/15/2024]
Abstract
In August 2023, the General Medical Council released the latest update of Good Medical Practice, which sets out the standards of patient care and professional behaviour to be expected of UK doctors. These updated guidelines offer some environmental considerations that previous standards did not include. This paper explores these latest additions to Good Medical Practice through the healthcare ethics lens of non-maleficence, beneficence, justice and autonomy, alongside trust and physician well-being, to make the case that the latest updates to Good Medical Practice do not go far enough in specifying the duties for doctors in responding to climate and ecological emergencies to be seen as ethically justifiable.The paper argues that given the health implications of the climate crisis and the harms associated with high-emission healthcare, as well as the co-benefits of climate action on health, there must be a stronger commitment from the medical regulator to ensure the groundwork is set for doctors to learn, understand and advocate for the importance and urgency of practicing sustainable healthcare. The case for this is strengthened by also examining the importance of maintaining public trust in the medical profession as advocates for public health, along with the notable societal and generational injustices that continue to deepen as the climate emergency escalates.The paper concludes by arguing that doctors can and should be a part of writing a new chapter for health in the climate era, but our standards for practice need to offer a strengthened starting point of consensus for what is expected of the medical profession for that to come to fruition and raise questions as to what doctors can and should do when they have questions over their own regulators' commitment to maintaining public health in relation to the climate and ecological crisis.
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Affiliation(s)
- Rammina Yassaie
- Sheffield Hallam University College of Health Wellbeing and Life Sciences, Sheffield, UK
| | - Lucy Brooks
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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2
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Baliga MS, Marakala V, Madathil LP, George T, D'souza RF, Palatty PL. Ethical and moral principles for oncology healthcare workers: A brief report from a Bioethics consortium emphasizing on need for education. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:145. [PMID: 38784285 PMCID: PMC11114567 DOI: 10.4103/jehp.jehp_1048_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/02/2023] [Indexed: 05/25/2024]
Abstract
The medical sub-specialty of Oncology presents diverse ethical dilemmas, often challenging cancer healthcare workers with difficult-to-handle clinical scenarios that are tough from a personal and professional perspective. Making decisions on patient care in various circumstances is a defining obligation of an oncologist and those duty-based judgments entail more than just selecting the best treatment or solution. Ethics is an essential and inseparable aspect of clinical medicine and the oncologists as well as the allied health care workers are ethically committed to helping the patient, avoiding or minimizing harm, and respecting the patient's values and choices. This review provides an overview of ethics and clinical ethics and the four main ethical principles of autonomy, beneficence, non-maleficence, and justice are stated and explained. At times there are frequently contradictions between ethical principles in patient care scenarios, especially between beneficence and autonomy. In addition, truth-telling, professionalism, empathy, and cultural competence; which are recently considered important in cancer care, are also addressed from an Indian perspective.
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Affiliation(s)
- Manjeshwar S. Baliga
- Department of Education, International Program, International Chair in Bioethics, World Medical Association Cooperating Centre (Formerly UNESCO Chair in Bioethics University of Haifa), Melbourne, Australia
- The Bioethics SAARC Nodal Centre, International Network Bioethics, Amrita Institute of Medical Sciences, Kochi, Ernakulam, Kerala, India
- Bioethics Education and Research Unit, Mangalore Institute of Oncology, Pumpwell, Mangalore, Karnataka, India
| | - Vijaya Marakala
- Department of Biochemistry, College of Medicine and Health Sciences, National University of Science and Technology, Sohar, Oman
| | - Lal P. Madathil
- Department of Education, International Program, International Chair in Bioethics, World Medical Association Cooperating Centre (Formerly UNESCO Chair in Bioethics University of Haifa), Melbourne, Australia
- The Bioethics SAARC Nodal Centre, International Network Bioethics, Amrita Institute of Medical Sciences, Kochi, Ernakulam, Kerala, India
| | - Thomas George
- Internal Medicine, Coney Island Hospital, 2601 Ocean Pkwy, Brooklyn, New York, USA
| | - Russell F. D'souza
- Department of Education, International Program, International Chair in Bioethics, World Medical Association Cooperating Centre (Formerly UNESCO Chair in Bioethics University of Haifa), Melbourne, Australia
| | - Princy L. Palatty
- The Bioethics SAARC Nodal Centre, International Network Bioethics, Amrita Institute of Medical Sciences, Kochi, Ernakulam, Kerala, India
- Department of Pharmacology, Amrita School of Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ernakulam, Kerala, India
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3
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Herington J, Connelly K, Illes J. Ethical Imperatives for Working With Diverse Populations in Digital Research. J Med Internet Res 2023; 25:e47884. [PMID: 37721792 PMCID: PMC10546274 DOI: 10.2196/47884] [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: 04/06/2023] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 09/19/2023] Open
Abstract
Digital research methodologies are driving a revolution in health technology but do not yet fully engage diverse and historically underrepresented populations. In this paper, we explore the ethical imperative for such engagement alongside accompanying challenges related to recruitment, appreciation of risk, and confidentiality, among others. We critically analyze existing research ethics frameworks and find that their reliance on individualistic and autonomy-focused models of research ethics does not offer adequate protection in the context of the diversity imperative. To meet the requirements of justice and inclusivity in digital research, methods will benefit from a reorientation toward more participatory practices.
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Affiliation(s)
- Jonathan Herington
- Department of Health Humanities and Bioethics, University of Rochester, Rochester, NY, United States
| | - Kay Connelly
- Department of Informatics, Indiana University, Bloomington, IN, United States
- College of Engineering, Michigan State University, Lansing, MI, United States
| | - Judy Illes
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Jessani NS, Williamson RT, Choonara S, Gautier L, Hoe C, Jafar SK, Khalid AF, Rodríguez Salas I, Turcotte-Tremblay AM, Rodríguez DC. Evidence attack in public health: Diverse actors' experiences with translating controversial or misrepresented evidence in health policy and systems research. Glob Public Health 2022; 17:3043-3059. [PMID: 34996335 DOI: 10.1080/17441692.2021.2020319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Bringing evidence into policy and practice discussions is political; more so when evidence from health studies or programme data are deemed controversial or unexpected, or when results are manipulated and misrepresented. Furthermore, opinion and misinformation in recent years has challenged our notions about how to achieve evidence-informed decision-making (EIDM). Health policy and systems (HPS) researchers and practitioners are battling misrepresentation that only serves to detract from important health issues or, worse, benefit powerful interests. This paper describes cases of politically and socially controversial evidence presented by researchers, practitioners and journalists during the Health Systems Research Symposium 2020. These cases cut across global contexts and range from public debates on vaccination, comprehensive sexual education, and tobacco to more inward debates around performance-based financing and EIDM in refugee policy. The consequences of engaging in controversial research include threats to commercial profit, perceived assaults on moral beliefs, censorship, fear of reprisal, and infodemics. Consequences for public health include research(er) hesitancy, contribution to corruption and leakage, researcher reflexivity, and ethical concerns within the HPS research and EIDM fields. Recommendations for supporting researchers, practitioners and advocates include better training and support structures for responding to controversy, safe spaces for sharing experiences, and modifying incentive structures.
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Affiliation(s)
- Nasreen S Jessani
- Centre for Evidence-Based Health CareStellenbosch University, Cape Town, South Africa.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Shakira Choonara
- Shakira Choonara Development Consulting, Johannesburg, South Africa
| | - Lara Gautier
- Département de Gestion, d'Évaluation et de Politique de Santé, École de Santé Publique de l'Université de Montréal, Montreal, Canada
| | - Connie Hoe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Sakeena K Jafar
- Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | | | - Irene Rodríguez Salas
- Canadian Institutes of Health Research, Health System Impact Fellowship, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Anne-Marie Turcotte-Tremblay
- Health & Science Section, La Nación Newspaper, San José, Costa Rica.,Department of Global Health and Population, Harvard T.H. Chan School of Public health, Cambridge, MA, USA
| | - Daniela C Rodríguez
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Troughton L, Obasi A. An exploration of practices affecting research integrity in global health partnerships. BMJ Glob Health 2022; 7:bmjgh-2022-009092. [PMID: 36028285 PMCID: PMC9422887 DOI: 10.1136/bmjgh-2022-009092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/12/2022] [Indexed: 12/02/2022] Open
Abstract
Background Research integrity is central to good research practice yet it is under-researched in global health. Aim To identify and explore factors which promote or constrain adherence to research integrity principles in global health research partnerships, specifically at a UK higher education institution (HEI) and its low-to-middle-income country (LMIC) partners. Methods Qualitative study using key informant interviews among researchers at a HEI and a number of its LMIC partners exploring their understanding of the principles of research integrity and experience of its implementation in relation to research. Results Thirteen interviews, five from HEI and eight from partner organisations, were conducted. Analysis found that understanding of research integrity focused on issues relating to rigour and did not include ‘care and respect’. Barriers to research integrity included, supra institutional factors such as funding flows, inequitable power relations, the competitive culture of the global health ecosystem and institutional psychosocial safety. Most respondents had direct or indirect knowledge of incidences of research misconduct. Conclusion Improved recognition of the importance of care and respect is key to improving the integrity of research conduct within global health partnerships.
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Affiliation(s)
- Lindsay Troughton
- Department of Research Governance and Ethics, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Angela Obasi
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Bendowska A, Malak R, Zok A, Baum E. The Ethics of Translational Audiology. Audiol Res 2022; 12:273-280. [PMID: 35645198 PMCID: PMC9149949 DOI: 10.3390/audiolres12030028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/16/2022] Open
Abstract
Translational research moves promising primary research results from the laboratory to practical application. The transition from basic science to clinical research and from clinical research to routine healthcare applications presents many challenges, including ethical. This paper addresses issues in the ethics of translational audiology and discusses the ethical principles that should guide research involving people with hearing loss. Four major ethical principles are defined and explained, which are as follows: beneficence, nonmaleficence, autonomy, and justice. In addition, the authors discuss issues of discrimination and equal access to medical services among people with hearing loss. Despite audiology’s broad field of interest, which includes evaluation and treatment of auditory disorders (e.g., deafness, tinnitus, misophonia, or hyperacusis) and balance disorders, this study focuses primarily on deafness and its therapies.
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Affiliation(s)
- Aleksandra Bendowska
- Department of Social Sciences and the Humanities, Poznan University of Medical Sciences, 60-806 Poznan, Poland;
- Correspondence:
| | - Roksana Malak
- Department and Clinic of Rheumatology, Rehabilitation and Internal Diseases, Poznan University of Medical Sciences, 61-545 Poznan, Poland;
| | - Agnieszka Zok
- Division of Philosophy of Medicine and Bioethics, Poznan University of Medical Sciences, 60-806 Poznan, Poland;
| | - Ewa Baum
- Department of Social Sciences and the Humanities, Poznan University of Medical Sciences, 60-806 Poznan, Poland;
- Division of Philosophy of Medicine and Bioethics, Poznan University of Medical Sciences, 60-806 Poznan, Poland;
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Vincent R, Adhikari B, Duddy C, Richardson E, Wong G, Lavery J, Molyneux S. 'Working relationships' across difference - a realist review of community engagement with malaria research. Wellcome Open Res 2022; 7:13. [PMID: 37621950 PMCID: PMC10444998 DOI: 10.12688/wellcomeopenres.17192.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 08/26/2023] Open
Abstract
Background: Community engagement (CE) is increasingly accepted as a critical aspect of health research, because of its potential to make research more ethical, relevant and well implemented. While CE activities linked to health research have proliferated in Low and Middle Income Countries (LMICs), and are increasingly described in published literature, there is a lack of conceptual clarity around how engagement is understood to 'work', and the aims and purposes of engagement are varied and often not made explicit. Ultimately, the evidence base for engagement remains underdeveloped. Methods: To develop explanations for how and why CE with health research contributes to the pattern of outcomes observed in published literature , we conducted a realist review of CE with malaria research - a theory driven approach to evidence synthesis. Results: We found that community engagement relies on the development of provisional 'working relationships' across differences, primarily of wealth, power and culture. These relationships are rooted in interactions that are experienced as relatively responsive and respectful, and that bring tangible research related benefits. Contextual factors affecting development of working relationships include the facilitating influence of research organisation commitment to and resources for engagement, and constraining factors linked to the prevailing 'dominant health research paradigm context', such as: differences of wealth and power between research centres and local populations and health systems; histories of colonialism and vertical health interventions; and external funding and control of health research. Conclusions: The development of working relationships contributes to greater acceptance and participation in research by local stakeholders, who are particularly interested in research related access to health care and other benefits. At the same time, such relationships may involve an accommodation of some ethically problematic characteristics of the dominant health research paradigm, and thereby reproduce this paradigm rather than challenge it with a different logic of collaborative partnership.
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Affiliation(s)
- Robin Vincent
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Robin Vincent Learning and Evaluation Ltd, Sheffield, S89FH, UK
| | - Bipin Adhikari
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Claire Duddy
- Nuffield Department of Primary Health Care Services, University of Oxford, Oxford, OX2 6GG, UK
| | - Emma Richardson
- Health Research, Evidence and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Geoff Wong
- Nuffield Department of Primary Health Care Services, University of Oxford, Oxford, OX2 6GG, UK
| | - James Lavery
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, 30322, USA
- Center for Ethics, Emory University, Atlanta, Georgia, 30322, USA
| | - Sassy Molyneux
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, University of Oxford, Kilifi, 80108, Kenya
| | - The REAL team: Mary Chambers, Phaik Yeong Cheah, Al Davies, Kate Gooding, Dorcas Kamuya, Vicki Marsh, Noni Mumba, Deborah Nyirenda, and Paulina Tindana.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Robin Vincent Learning and Evaluation Ltd, Sheffield, S89FH, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Primary Health Care Services, University of Oxford, Oxford, OX2 6GG, UK
- Health Research, Evidence and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, 30322, USA
- Center for Ethics, Emory University, Atlanta, Georgia, 30322, USA
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, University of Oxford, Kilifi, 80108, Kenya
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Manguele A, Sidat M, IJsselmuiden C, Ferrinho P. Addressing conflicts of interest of ethical reviewers of health planning, management, policy and systems research proposals. Int J Health Plann Manage 2021; 36:2044-2047. [PMID: 34382265 DOI: 10.1002/hpm.3295] [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: 02/11/2021] [Revised: 07/09/2021] [Accepted: 07/27/2021] [Indexed: 11/05/2022] Open
Abstract
Steering health systems towards universal health coverage requires research on themes that are of particular interest to health planning, management, policy and systems researchers. Some issues, such as strikes regarded as illegal and health sector corruption, because of their social and political sensitivity have, for too long, remained outside adequate research inquiry. Their emergence in the research agenda raises some challenges for Human Research Ethics Committees, particularly related to their conflicts of interests as reviewers, that need clarification.
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Affiliation(s)
| | - Mohsin Sidat
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique.,Research Centre on Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Carel IJsselmuiden
- Council on Health Research for Development, Geneva, Switzerland.,School of Applied Human Sciences, Univ of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Paulo Ferrinho
- Research Centre on Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
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Marten R, Yangchen S, Campbell-Lendrum D, Prats EV, Neira MP, Ghaffar A. Climate change: an urgent priority for health policy and systems research. Health Policy Plan 2021; 36:218-220. [PMID: 33347561 PMCID: PMC7996636 DOI: 10.1093/heapol/czaa165] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Robert Marten
- Alliance for Health Policy and Systems Research, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Sonam Yangchen
- Alliance for Health Policy and Systems Research, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Diarmid Campbell-Lendrum
- Environment, Climate Change and Health Department, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Elena Villalobos Prats
- Environment, Climate Change and Health Department, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Maria Purificacion Neira
- Environment, Climate Change and Health Department, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
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Faure MC, Munung NS, Ntusi NAB, Pratt B, de Vries J. Mapping experiences and perspectives of equity in international health collaborations: a scoping review. Int J Equity Health 2021; 20:28. [PMID: 33422065 PMCID: PMC7796532 DOI: 10.1186/s12939-020-01350-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/09/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Whilst global health research often involves international collaborations, achieving or promoting equity within collaborations remains a key challenge, despite established conceptual approaches and the development of frameworks and guidelines to promote equity. There have also been several empirical studies documenting researchers' experiences of inequity and views on what is required to advance equity in global health collaborations. While these empirical studies provide critical insights, there has been no attempt to systematically synthetize what constitutes equity and how it can be achieved. To address this gap, we conducted a scoping review of qualitative studies, opinion and editorial pieces about what equity is and how it can be promoted in international collaborations. METHODS We conducted a scoping review to explore domains of equity in international health collaborations. This review included qualitative studies and opinion pieces or editorial pieces on equity in international health collaborations. We mapped the data and identified common themes using a thematic analysis approach. RESULTS This initial search retrieved a total of 7611 papers after removing duplicates. A total of 11 papers were included in this review, 10 empirical studies and 1 editorial piece. We conducted our search between October - November 2019. We identified 10 key domains which are important for promoting equity in international collaborations: funding; capacity building; authorship; sample ownership and export; trust; research agreement; acknowledging inequality; recognition and communication. DISCUSSION Our findings suggest that for international collaborations to be considered more equitable, it must at least consider the 10 domains we highlighted. The 10 domains map onto five key aspects of social justice theory, namely avoiding unequal power relations like subordination, group recognition and affirmation, promoting the well-being of all, inclusion in decision-making and ensuring self-development.
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Affiliation(s)
- Marlyn C. Faure
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Nchangwi S. Munung
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Ntobeko A. B. Ntusi
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Bridget Pratt
- Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Jantina de Vries
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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