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Foley S, Falconer Hall T, Bates D, Attridge K. Global health context for the military in Defence Engagement (Health). BMJ Mil Health 2024; 170:e59-e64. [PMID: 37536934 DOI: 10.1136/military-2023-002374] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/09/2023] [Indexed: 08/05/2023]
Abstract
Global health practice is becoming a key enabler within UK Defence and foreign policy. The definition of global health remains debated, though some important themes have been identified including: the multidisciplinary nature of global health, its ethical foundation and the political nature of global health. This paper contributes to the ongoing rational discourse that this important discipline deserves and recommends a framework and principles to apply to military health and care system strengthening in the Defence Engagement (Health) (DE(H)) practitioner role. DE(H) involves complex multiorganisational relationships and processes, and while practitioners should be mindful of the political nature of their role, the broad aims of preventing conflict and building stability mean DE(H) should contribute positively to global health.This paper forms part of a special issue of BMJ Military Health dedicated to Defence Engagement.
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Affiliation(s)
- Sue Foley
- Medical Operational Support Unit (MOSU), British Army, York, UK
| | | | - D Bates
- Institute of Health, University of Cumbria, Carlisle, UK
| | - K Attridge
- Public Health, Royal Air Force Medical Service, Naphill, UK
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Lin CY, Meagher K, Bricknell M, Patel P, El Achi N, Kutluk T, Harding R, Kienzler H, Giacaman R, Mukherji D, Shamieh O, Sullivan R. The challenges of international collaboration in conflict and health research: experience from the Research for Health in Conflict-Middle East and North Africa (R4HC-MENA) partnership. Confl Health 2023; 17:29. [PMID: 37316903 DOI: 10.1186/s13031-023-00527-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/26/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Healthcare is a basic human right extending across all humanitarian contexts, including conflict. Globally, two billion people are living under conditions of insecurity and violent armed conflict with a consequent impact on public health. Health research in conflict-affected regions has been recognised as important to gain more understanding of the actual needs of such populations, to optimise healthcare delivery, as well as to inform advocacy and policy change. International collaborative research maximises the resources and skills available for dealing with global health issues, builds capacity and endeavours to ensure the research reflects real needs of the populations. Under the UK's Global Challenge Research Fund in 2017 a number of such international programs were created including the Research for Health in Conflict-Middle East and North Africa (R4HC-MENA) partnership to build capacity in conflict and health research as well as study specific areas, namely noncommunicable diseases in conflict (cancer & mental health) and the political economy of health in conflict. METHODS A qualitative study using semi-structured online interviews was conducted to explore researchers' and stakeholders' perspectives on the R4HC-MENA programme over its lifetime from 2017 to 2021. It aimed to understand the factors that influenced and accelerated international collaboration within the R4HC-MENA programme on conflict and health research, and to provide deeper insights into the implementation of the programme. Data collection was conducted from March 2022 to June 2022. Purposive and snowball sampling techniques were used for participant recruitment. Thematic analysis was applied for data analysis. RESULTS Twelve researchers/stakeholders participated in this study: four men and eight women. Four main themes were generated: Theme 1: Network building (personal and institutional levels); Theme 2: Hierarchies and power dynamics (power imbalance between different academic status, genders and institutions); Theme 3: Communication challenges; Theme 4: Career development (management, leadership, research, and teaching skills). CONCLUSIONS This study provided preliminary insights into perspectives on international collaboration in a major international programme of research on conflict and health. Several key challenges and outputs were generated by the researchers in this study. The findings are important for further developing effective strategies to tackle the challenge of power imbalance and ineffective communication in international research collaborations.
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Affiliation(s)
- Chiu-Yi Lin
- Centre for Conflict and Health Research, King's College London, London, UK.
| | - Kristen Meagher
- Centre for Conflict and Health Research, King's College London, London, UK
| | - Martin Bricknell
- Centre for Conflict and Health Research, King's College London, London, UK
| | - Preeti Patel
- Centre for Conflict and Health Research, King's College London, London, UK
| | - Nassim El Achi
- Centre for Conflict and Health Research, King's College London, London, UK
| | - Tezer Kutluk
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, Ankara, Turkey
| | - Richard Harding
- Florence Nightingale Faculty of Nursing Midwifery & Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Hanna Kienzler
- Department of Global Health & Social Medicine, School of Global Affairs, King's College London, London, UK
| | - Rita Giacaman
- Institute of Community and Public Health, Birzeit University, West Bank, Birzeit, Occupied Palestinian Territory
| | - Deborah Mukherji
- Department of Internal Medicine, Division of Hematology-Oncology, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Omar Shamieh
- Center for Palliative & Cancer Care in Conflict, King Hussein Cancer Center, Amman, Jordan
| | - Richard Sullivan
- Centre for Conflict and Health Research, King's College London, London, UK
- King's Institute Cancer Policy, King's College London, London, UK
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Wiggins D, Downie A, Engel R, Brown BT. Factors that influence scope of practice of the chiropractic profession in Australia: a scoping review. Chiropr Man Therap 2022; 30:19. [PMID: 35421996 PMCID: PMC9011944 DOI: 10.1186/s12998-022-00428-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/01/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The World Health Organization describes chiropractic as a health profession that treats the musculoskeletal system and the effects of that system on the function of the nervous system and general health. Notwithstanding such descriptions, scope of practice remains a contentious issue in Australia chiropractic with various authors defining it differently. To date, the peak governing body, the Chiropractic Board of Australia, has focused on title protection rather than defining a scope of practice for the profession. A well-defined scope of practice is important, as it helps to identify what is acceptable in the profession and the role chiropractic has in the broader healthcare system. OBJECTIVE The objective of this scoping review was to explore the literature on the factors that influence scope of practice of chiropractic in Australia. METHODS This study employed scoping review methodology to document the current state of the literature on factors that influence scope of practice of the chiropractic profession in Australia. RESULTS A total of 1270 articles were identified from the literature search. Six studies fulfilled the inclusion criteria and were included in the final analysis. Four factors that influence scope of practice were identified: education, professional identity, patient safety, and organisational structure. CONCLUSION The results of this study will inform future discussions around establishing a framework for a more comprehensive scope of practice for the chiropractic profession in Australia. Such a framework has the potential to benefit patient safety, professional identity, public perception, education, and regulation of the profession.
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Affiliation(s)
- Desmond Wiggins
- Department of Chiropractic, Macquarie University, Sydney, Australia.
| | - Aron Downie
- Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Roger Engel
- Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Benjamin T Brown
- Department of Chiropractic, Macquarie University, Sydney, Australia
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Gad M, Kazibwe J, Quirk E, Gheorghe A, Homan Z, Bricknell M. Civil-military cooperation in the early response to the COVID-19 pandemic in six European countries. BMJ Mil Health 2021; 167:234-243. [PMID: 33785587 PMCID: PMC8011427 DOI: 10.1136/bmjmilitary-2020-001721] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/02/2021] [Accepted: 02/09/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The COVID-19 pandemic has presented many countries with significant health system and economic challenges. The role of civil-military cooperation in a health crisis of the magnitude presented by COVID-19 remains virtually unexplored. This review aims to detect and identify typologies, if any, of associations between security or military systems and the national response measures during the COVID-19, as adopted by six European countries during the early phase of the outbreak (January to March 2020). METHODS We designed a structured qualitative literature review (qualitative evidence synthesis), primarily targeting open-source grey literature using a customised Google web search. Our target countries were UK, France, Spain, Italy, Belgium and Sweden. We employed a 'best fit' framework synthesis approach in qualitative analysis of the result records. RESULTS A total of 277 result records were included in our qualitative synthesis, with an overall search relevance yield of 46%. We identified 19 distinct descriptive categories of civil-military cooperation extending across seven analytical themes. Most prominent themes included how military support was incorporated in the national COVID-19 response, including support to national health systems, military repatriation and evacuation, and support to wider public systems. CONCLUSION Findings of this review show the significance of military systems in supporting an expansive response during the COVID-19 pandemic, and our proposed methodological approach for capturing military health data in a reproducible manner and providing a comparative view on common types of interventions provided by civil-military cooperation to inform lessons from the use of military capacities during current COVID-19 outbreak.
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Affiliation(s)
- Mohamed Gad
- Global Health and Development (GHD) Group, Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK
| | - J Kazibwe
- Global Health and Development (GHD) Group, Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK
| | - E Quirk
- Faculty of Medicine, Imperial College London, London, UK
| | - A Gheorghe
- Global Health and Development (GHD) Group, Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK
| | - Z Homan
- Centre for Science & Security Studies, Department of War Studies, King's College London, London, UK
| | - M Bricknell
- Conflict and Health Research Group, King's College London-Strand Campus, London, UK
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Leone R, Whitaker J, Homan Z, Bandekow L, Bricknell M. Framework for the evaluation of military health systems. BMJ Mil Health 2021; 169:280-284. [PMID: 33619229 DOI: 10.1136/bmjmilitary-2020-001699] [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] [Received: 10/22/2020] [Revised: 01/02/2021] [Accepted: 01/09/2021] [Indexed: 11/03/2022]
Abstract
The organisation of a military health system (MHS) differs from the civilian system due to the role of the armed forces, the unique nature of the supported population and their occupational health requirements. A previously published review of the Military Medical Corps Worldwide Almanac demonstrated the value of a standardised framework for evaluation and comparison of MHSs. This paper proposes such a framework which highlights the unique features of MHSs not covered by health services research of national health systems. These include: national context and summary; organisational structure; firm base facilities, healthcare beneficiaries and medical research; operational capabilities, overseas deployments, collaborations and alliances; personnel including recruitment, training and education; and history and culture. This common framework can help facilitate international collaboration between military medical services including capability development, training exercises and mutual support during military operations. It can also inform national contributions to future editions of the Almanac.
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Affiliation(s)
- Ryan Leone
- Conflict and Health Research Group, King's College London-Strand Campus, London, UK
| | - J Whitaker
- Department of Vascular Surgery, Royal Free Hospital NHS Trust, London, UK
| | - Z Homan
- War Studies, King's College London-Strand Campus, London, UK
| | - L Bandekow
- Worldwide Military-Medicine Almanac, Bonn, Germany
| | - M Bricknell
- Conflict and Health Research Group, King's College London-Strand Campus, London, UK
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Bricknell M, Horne S. Personal view: security sector health systems and global health. BMJ Mil Health 2020; 169:e64-e67. [PMID: 32999086 PMCID: PMC10176418 DOI: 10.1136/bmjmilitary-2020-001607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/23/2020] [Accepted: 08/26/2020] [Indexed: 11/03/2022]
Abstract
In many countries the security sector is a major contributor to the healthcare system. The role and transformation of a state’s security health system within the universal health coverage is important, in that it sits at the interface of the United Nations Sustainable Development Goals 3 (ensure healthy lives and promote well-being) and 16 (promote just, peaceful and inclusive societies). The paper describes the breadth of the security sector and outlines the potential beneficiaries, clinical services and macro-organisation of a security sector health system from the perspective of its contribution to wider government health services and crisis response. It examines the characteristics of the security sector compared with other providers of health services, including those generic to the sector and unique to a given service. Understanding civil–security relationships is a critical facet of effective Defence Healthcare Engagement (DHE), which includes the use of defence medical assets in support of capacity-building overseas. The analytical process described may form the basis of DHE planning. It may have even greater importance in the near future as countries review national resilience and global health diplomacy after the COVID-19 crisis.
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Affiliation(s)
- Martin Bricknell
- Conflict and Health Research Group, King's College London, London, UK
| | - S Horne
- Conflict and Health Research Group, King's College London, London, UK
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
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