Politics, Power, Poverty and Global Health: Systems and Frames

Autonomy and freedom of choice: A mixed methods analysis of the endorsement of SRHR and its core principles by global agencies

Based on an adapted version of the conceptual framework used by the Guttmacher-Lancet Commission on Sexual and Reproductive Health and Rights (SRHR), this study sought to analyse to what extent seven global agencies, five of which belong to the UN family and the other two closely linked, incorporate women's autonomy and freedom of choice in accessing services into their SRHR policies, and how they operationalize these in their global SRHR programmes that target women and adolescent girls. Twenty-nine SRHR-related policy documents published in 2013-2020 and 17 independent evaluations of global SRHR programmes in the same period were analysed. They were found to fall short of considering women's individual autonomy and choice as the two core principles of SRHR. By ignoring autonomy and choice, global SRHR programmes missed the opportunity to incorporate activities that could enhance the emancipatory empowerment of women and girls to improve their sexual and reproductive wellbeing. The study identified concrete aspects on which global agencies, in view of their respective mandates, could have pronounced themselves more explicitly and might have been more effective in implementing SRHR programmes. In light of the international gender equality and women's empowerment discourse this suggests that donor countries could hold global agencies more accountable, bilaterally or jointly, for their SRHR performance, in particular their active endorsement and application of SRHR core principles.

Research ethics and artificial intelligence for global health: perspectives from the global forum on bioethics in research

BACKGROUND

The ethical governance of Artificial Intelligence (AI) in health care and public health continues to be an urgent issue for attention in policy, research, and practice. In this paper we report on central themes related to challenges and strategies for promoting ethics in research involving AI in global health, arising from the Global Forum on Bioethics in Research (GFBR), held in Cape Town, South Africa in November 2022.

METHODS

The GFBR is an annual meeting organized by the World Health Organization and supported by the Wellcome Trust, the US National Institutes of Health, the UK Medical Research Council (MRC) and the South African MRC. The forum aims to bring together ethicists, researchers, policymakers, research ethics committee members and other actors to engage with challenges and opportunities specifically related to research ethics. In 2022 the focus of the GFBR was "Ethics of AI in Global Health Research". The forum consisted of 6 case study presentations, 16 governance presentations, and a series of small group and large group discussions. A total of 87 participants attended the forum from 31 countries around the world, representing disciplines of bioethics, AI, health policy, health professional practice, research funding, and bioinformatics. In this paper, we highlight central insights arising from GFBR 2022.

RESULTS

We describe the significance of four thematic insights arising from the forum: (1) Appropriateness of building AI, (2) Transferability of AI systems, (3) Accountability for AI decision-making and outcomes, and (4) Individual consent. We then describe eight recommendations for governance leaders to enhance the ethical governance of AI in global health research, addressing issues such as AI impact assessments, environmental values, and fair partnerships.

CONCLUSIONS

The 2022 Global Forum on Bioethics in Research illustrated several innovations in ethical governance of AI for global health research, as well as several areas in need of urgent attention internationally. This summary is intended to inform international and domestic efforts to strengthen research ethics and support the evolution of governance leadership to meet the demands of AI in global health research.

(Almost) 50 shades of an ethical situation - international physiotherapists' experiences of everyday ethics: a qualitative analysis

INTRODUCTION

Different cultures and societal structures influence the ethical experiences of physiotherapists.

OBJECTIVE

The study aimed to discover and describe contextual shades of ethical situations experienced by physiotherapists in their global practice.

METHODS

This paper reports the qualitative analysis of responses to an optional open question in an internationally distributed online survey (ESPI study) with 1,212 participants from 94 countries. All responses were coded to five categories describing the data's relationship to the survey list of ethical situations. Data that described new ethical situations were analyzed thematically.

RESULTS

Three hundred and fifty four individual responses to the optional survey question reported 400 ethical issues. Three hundred and seventy-eight of these issues were associated with the original survey questions. Twenty-two responses raised four new themes of ethical issues: lack of regulatory and/or accreditation policy and infrastructure, lack of recognition of the role and position of physiotherapists in healthcare, economic factors driving the conduct of practice, and political threats.

DISCUSSION

Local contexts and pressures of workplaces and societies in which physiotherapists practice make it almost impossible for some practitioners to comply with codes of ethics. Physiotherapists need support and preparation to respond to local affordances and the complexity, ambiguity, and sometimes messiness of ethical situations encountered in their practice.

CONCLUSION

The findings highlight the relevance of cross-cultural research in the field of physiotherapy, and the necessity of investigating and bridging the gap between professional ethics theory and practice in diverse settings.

Beyond global health: Redefining the ‘public’ in public health

The world has seen unprecedented changes over the last 50 years, with enormous gains in human health and living standards. Global public health has been a part of this transition to an interconnected and interdependent world, evolving from a medically based international health perspective to a global health discipline focusing on the social determinants of health and systems thinking. As we now face global challenges such as climate change, the loss of biodiversity and antimicrobial resistance, global public health needs to be transformed yet again. Public health needs to redefine its focus. To expand the scope beyond the anthropocentric – and to include nature and our planet as subjects and not merely resources for human well-being – is of the essence.

Healthcare Management: A Bibliometric Analysis Based on the Citations of Research Articles Published between 1967 and 2020

The purpose of this study is to analyse the trends manifested in research literature from the field of healthcare management, with emphasis on bibliometric features and different influencing factors. For this, a search was conducted of nine academic databases between January and May 2021. Article features were registered in our database after first applying the validation criteria used for their inclusion. Then, data regarding the publication of the included articles were collected. The analysis focused on trends over time, topic, and journals in which they were published. Moreover, the effect of some factors on the citation of articles was analysed. Our results showed that the 250 analysed articles were published in 139 journals, and many of were by researchers affiliated with universities in the United States. Over time, the publication of analysed articles and their number of citations registered a continuous increase. The most common topics of focus were healthcare management systems and their challenges. In our study, we identified factors that significantly affect citation number, such as number of years since publication, the number of words in the title, and the number of authors of an article. In addition, major gaps were identified, as were new unresolved challenges that can trigger new research ideas.

You can't report your feelings: The hidden labor of managing threats to safety by women in global public health fieldwork

Increasing job market demand for and availability of Canadian and U.S. global academic health programs in post-secondary education increases student demand to participate in internationally based fieldwork, while supportive resources remain weakly developed. Previous studies indicate provisions to protect the health, safety, and well-being of women students remain inadequately addressed during training, while more research to identify needs, expectations, gaps, and best practices would inform policy and practice to improve conditions for women working off-campus on global public health studies. One approach, reported here, is to document and better understand the lived experience of U.S. or Canadian women graduate students participating in global public health fieldwork. Participant in-depth phenomenological interviews and guided writing exercises aimed to capture lived experience descriptions for 25 women. A phenomenology of practice was applied throughout the research process, following Max van Manen's qualitative methodology approach. Loss of environmental familiarity, combined with graduate students' lack of power, created considerable hidden labor described by women in working to keep themselves safe from sexual and gender-based violence (SGBV) while participating in global public health fieldwork. Women shared specific experiences exemplifying how this can be both alleviated and/or intensified through a range of negotiated strategies, coping styles, and management techniques. Additionally, women recalled laboring as students to avoid or reduce instances of SGBV, that then, precluded them from having any material "of substance" to report once returned home. These findings offer new meaning structures, language for a foreign experience, or ways to describe, conceive of, and respond to global public health fieldwork that hold the potential to positively affect individuals' experiences, institutional understanding, and thus practice, of future women students in global public health.

'You just prefer to die early!': how socioecological context impedes treatment for people living with HIV in Iran

INTRODUCTION

Despite the low prevalence of HIV and broad provision of antiretroviral therapy, the Middle East and North Africa (MENA) remains the only region where new HIV infections and AIDS-related deaths are not declining. There is a dearth of evidence from MENA on antiretroviral therapy engagement. In this qualitative study, we sought to identify the ways in which successful treatment is hindered in Iran, which is home to 24% of HIV infections in MENA.

METHODS

From August 2018 to January 2019, we used purposive sampling and conducted 12 individual interviews and 8 focus group discussions with 27 female and 31 male patients, in addition to 5 individual interviews with HIV care providers and 1 focus group discussion with 8 care providers. Social constructivism augmented with realist-informed thematic analysis was used to understand how the socioecological context triggers cognitive and affective mechanisms that disrupt antiretroviral therapy.

RESULTS

The use of Thematic Network Analysis resulted in the identification of three key cognitive and affective mechanisms that appear to shape treatment experience and are triggered via HIV's socioecological context and changing economic conditions in Iran: denial in response to societal negative perceptions of HIV; fear in response to societal lack of awareness regarding HIV and misinformation; and despair in response to HIV-related stigma and enacted discrimination, economic insecurity and social support.

CONCLUSIONS

To our knowledge, this is the first study within MENA to identify pathways through which successful treatment is hindered. It appears that lack of societal awareness regarding HIV is specific to low prevalence settings, such as MENA countries, where negative perceptions, stigma, discrimination and misinformation regarding HIV and its treatment produce denial, fear and despair, acting as mechanisms that disrupt antiretroviral therapy. The experience of despair, in response to changing economic conditions and social support, further impacts treatment experience.

Intersectoral Action for Addressing NCDs through the Food Environment: An Analysis of NCD Framing in Global Policies and Its Relevance for the African Context

Noncommunicable diseases contribute the greatest to global mortality. Unhealthy diet-a prominent risk factor-is intricately linked to urban built and food environments and requires intersectoral efforts to address. Framings of the noncommunicable disease problem and proposed solutions within global and African regional diet-related policy documents can reveal how amenable the policy landscape is for supporting intersectoral action for health in low-income to middle-income countries. This study applied a document analysis approach to undertake policy analysis on global and African regional policies related to noncommunicable disease and diet. A total of 62 global and 29 African regional policy documents were analysed. Three problem frames relating to noncommunicable disease and diet were identified at the global and regional level, namely evidence-based, development, and socioeconomic frames. Health promotion, intersectoral and multisectoral action, and evidence-based monitoring and assessment underpinned proposed interventions to improve education and awareness, support structural changes, and improve disease surveillance and monitoring. African policies insufficiently considered associations between food security and noncommunicable disease. In order to effectively address the noncommunicable disease burden, a paradigm shift from 'health for development' to 'development for health' is required across non-health sectors. Noncommunicable disease considerations should be included within African food security agendas, using malnutrition as a possible intermediary concept to motivate intersectoral action to improve access to nutritious food in African low-income to middle-income countries.

Defining global health: findings from a systematic review and thematic analysis of the literature

INTRODUCTION

Debate around a common definition of global health has seen extensive scholarly interest within the last two decades; however, consensus around a precise definition remains elusive. The objective of this study was to systematically review definitions of global health in the literature and offer grounded theoretical insights into what might be seen as relevant for establishing a common definition of global health.

METHOD

A systematic review was conducted with qualitative synthesis of findings using peer-reviewed literature from key databases. Publications were identified by the keywords of 'global health' and 'define' or 'definition' or 'defining'. Coding methods were used for qualitative analysis to identify recurring themes in definitions of global health published between 2009 and 2019.

RESULTS

The search resulted in 1363 publications, of which 78 were included. Qualitative analysis of the data generated four theoretical categories and associated subthemes delineating key aspects of global health. These included: (1) global health is a multiplex approach to worldwide health improvement taught and pursued at research institutions; (2) global health is an ethically oriented initiative that is guided by justice principles; (3) global health is a mode of governance that yields influence through problem identification, political decision-making, as well as the allocation and exchange of resources across borders and (4) global health is a vague yet versatile concept with multiple meanings, historical antecedents and an emergent future.

CONCLUSION

Extant definitions of global health can be categorised thematically to designate areas of importance for stakeholders and to organise future debates on its definition. Future contributions to this debate may consider shifting from questioning the abstract 'what' of global health towards more pragmatic and reflexive questions about 'who' defines global health and towards what ends.

What is considered as global health scholarship? A meta-knowledge analysis of global health journals and definitions

Despite the rapid growth of the global health field over the past few decades, consensus on what qualifies as global health scholarship or practice remains elusive. We conducted a meta-knowledge analysis of the titles and abstracts of articles published in 25 journals labelled as global health journals between 2001 and 2019. We identified the major topics in these journals by creating clusters based on terms co-occurrence over time. We also conducted a review of global health definitions during the same period.

The analysis included 16 413 articles. The number of journals, labelled as global health, and articles published in these journals, increased dramatically during the study period. The majority of global health publications focused on topics prevalent in low-resource settings. Governance, infectious diseases, and maternal and child health were major topics throughout the analysis period. Surveillance and disease outcomes appeared during the 2006–2010 epoch and continued, with increasing complexity, until the 2016–2019 epoch. Malaria, sexual and reproductive health, and research methodology appeared for only one epoch as major topics. We included 11 relevant definitions in this analysis. Definitions of global health were not aligned with the major topics identified in the analysis of articles published in global health journals.

These results highlight a lack of alignment between what is published as global health scholarship and global health definitions, which often advocate taking a global perspective to population health. Our analysis suggests that global health has not truly moved beyond its predecessor, international health. There is a need to define the parameters of the discipline and investigate the disconnect between what is published in global health versus how the field is defined.

Our Postpandemic World: What Will It Take to Build a Better Future for People and Planet?

Policy Points Despite the pandemic's ongoing devastating impacts, it also offers the opportunity and lessons for building a better, fairer, and sustainable world. Transformational change will require new ways of working, challenging powerful individuals and industries who worsened the crisis, will act to exploit it for personal gain, and will work to ensure that the future aligns with their interests. A flourishing world needs strong and equitable structures and systems, including strengthened democratic, research, and educational institutions, supported by ideas and discourses that are free of opaque and conflicted influence and that challenge the status quo and inequitable distribution of power.

Identifying Decisive Socio-Political Sustainability Barriers in the Supply Chain of Banking Sector in India: Causality Analysis Using ISM and MICMAC

The banking sector often plays a crucial role in the improvement of infrastructure and economy of any country. In many emerging economies, it is apparent that a wide variety of social and political issues are related to the associated supply chain sustainability of financial service firms. Although such sustainability and its implementation issues have largely been addressed in existing research literature and in practice for many years, the attention towards socio-political sustainability aspects has been quite limited. Thus, this study attempted to explore the determinants for improving socio-political sustainability in financial service firms. Through adopting the fuzzy Delphi method (FDM), performing an exhaustive literature review, and conducting semi-structured interviews with the decision-makers of the service firms, nine key barriers for socio-political sustainability were first identified in this study. Then, the influence relationships of the key barriers were assessed by 15 experts. During the assessment process, the interrelationships and their dependence powers among key barriers were analyzed using the interpretive structural modelling (ISM) approach and cross-impact matrix multiplication applied to classification (MICMAC) methods. The assessment results show that among the studied barriers, “antisocial considerations”, “unstable political climate”, and “lack of political coherence” are the decisive barriers that affect the socio-political sustainability in the supply chain of financial service firms. The knowledge in understanding and reducing these decisive barriers can provide service sector practitioners, especially those with limited resources, the enhanced capability to conduct better planning and designing of effective and continuous improvement programs, so as to win over new consumers and retain existing clients by offering sustainable services.

Unequal discourses: Problems of the current model of world health development

The COVID-19 pandemic has exposed institutional deficiencies in world health development. This viewpoint paper examines the allegations about the partiality and political bias of the World Health Organization's (WHO) response to world health emergencies. We draw on quantitative and qualitative analysis of the WHO's Director-General's speeches pertaining to the COVID-19 and EVD outbreaks. We find that the WHO's discourse on COVID-19 praised the Chinese government's role in the containment. By contrast, the WHO's discourse on the African countries fighting to contain Ebola centered on the unpreparedness of these countries. We argue that the WHO's unbalanced emphasis on different practices and "traits" of member states paints a partial picture of global health emergencies, thus it fails to uphold its founding principles of egalitarianism and impartiality. Finally, we put forward suggestions about a more equal and fairer model of world health development.

Bibliometric analysis of scientific publications on "sustainable development goals" with emphasis on "good health and well-being" goal (2015-2019)

BACKGROUND

Global progress in the United Nations' Sustainable Development Goals (SDGs) requires significant national and international research efforts and collaboration. The current study aimed to provide policymakers, academics, and researchers with a snapshot of global SDGs-related research activity.

METHOD

This was a cross-sectional descriptive bibliometric study. SciVerse Scopus was used to retrieve SDGs-related research publications for the period from 2015 to 2019.

RESULTS

In total, 18,696 documents were found. The Sustainability journal ranked first (n = 1008; 5.4%) in the number of SDGs-related publications. The World Health Organization was the most active institution in publishing SDGs-related documents (n = 581; 1.3%). Most of the retrieved documents belonged to SDG 17 (partnership) followed by SDG 13 (climate action), and SDG 12 (responsible consumption and production), while SDG 7 (affordable and clean energy) had the least number of publications. The European region (n = 9756; 52.2%) had the highest research contribution while the Eastern Mediterranean region (n = 1052; 5.6%) had the least contribution. After exclusion of SDG 17, the SDG 3 (good health and well-being) was the top researched SDG for the African region, the Eastern Mediterranean regions, and the South-Eastern Asian region. For the region of the Americas, European region, and the Western Pacific region, the SDG 13 (climate action) was the most researched. The SDG 7 (affordable and clean energy) was the least researched in the African region, the region of the Americas, the European region, and the South-East Asian region. In the Eastern Mediterranean region, SDG 10 (reduced inequality) was the least researched while in the Western Pacific region, SDG 5 (gender inequality) was the least researched. The most researched targets of SDG 3 were targets 7 (sexual and reproductive health services) and 8 (universal health coverage) while the least researched targets were 5 (substance use disorders) and 9 (death from hazardous materials). International research collaboration within SDG 3 between high- and low-income countries was inadequate.

CONCLUSION

The analysis presented in the current study are useful for researchers, institutes, governments, funding agencies, and policy-makers. Countries in Africa, the Middle East, and South-East Asia need to increase their funding and research collaboration in the field of SDGs.

Investigating global mental health: Contributions from political science

This article outlines an agenda for political science engagement with global mental health. Other social sciences have tackled the topic, investigating such questions as the link between poverty and mental health disorders. Political science is noticeably absent from these explorations. This is striking because mental health disorders affect one billion people globally, governments spend only about 2% of their health budgets on these disorders, and most people lack access to treatment. With its focus on power, political science could deepen knowledge on vulnerabilities to mental illness and explain weak policy responses. By illustrating how various forms of power pertaining to governance, knowledge, and moral authority work through the concepts of issue framing, collective action, and institutions, the article shows that political science can deepen knowledge on this global health issue. Political science can analyse how incomplete knowledge leads to contentious framing, thus hobbling advocacy. It can explain why states shirk their obligations in mental health, and it can question how incentives drive mental health mobilisation. The discipline can uncover how power undergirds institutional responses to global mental health at the international, national, and community levels. Political science should collaborate with other social sciences in research networks to improve policy outcomes.

The political construction of public health nutrition problems: a framing analysis of parliamentary debates on junk-food marketing to children in Australia

OBJECTIVE

Junk-food marketing contributes significantly to childhood obesity, which in turn imposes major health and economic burdens. Despite this, political priority for addressing junk-food marketing has been weak in many countries. Competing interests, worldviews and beliefs of stakeholders involved with the issue contribute to this political inertia. An integral group of actors for driving policy change are parliamentarians, who champion policy and enact legislation. However, how parliamentarians interpret and portray (i.e. frame) the causes and solutions of public health nutrition problems is poorly understood. The present study aimed to understand how Australian parliamentarians from different political parties frame the problem of junk-food marketing.

DESIGN

Framing analysis of transcripts from the Australian Government's Parliamentary Hansard, involving development of a theoretical framework, data collection, coding transcripts and thematic synthesis of results.

SETTINGS

Australia.

PARTICIPANTS

None.

RESULTS

Parliamentarian framing generally reflected political party ideology. Liberal parliamentarians called for minimal government regulation and greater personal responsibility, reflecting the party's core values of liberalism and neoliberalism. Greens parliamentarians framed the issue as systemic, highlighting the need for government intervention and reflecting the core party value of social justice. Labor parliamentarians used both frames at varying times.

CONCLUSIONS

Parliamentarians' framing was generally consistent with their party ideology, though subject to changes over time. This project provides insights into the role of framing and ideology in shaping public health policy responses and may inform communication strategies for nutrition advocates. Advocates might consider using frames that resonate with the ideologies of different political parties and adapting these over time.

Connecting knowledge with action for health equity: a critical interpretive synthesis of promising practices

Connecting knowledge with action (KWA) for health equity involves interventions that can redistribute power and resources at local, national, and global levels. Although there is ample and compelling evidence on the nature, distribution, and impact of health inequities, advancing health equity is inhibited by policy arenas shaped by colonial legacies and neoliberal ideology. Effective progress toward health equity requires attention to evidence that can promote the kind of socio-political restructuring needed to address root causes of health inequities. In this critical interpretive synthesis, results of a recent scoping review were broadened to identify evidence-informed promising practices for KWA for health equity. Following screening procedures, 10 literature reviews and 22 research studies were included in the synthesis. Analysis involved repeated readings of these 32 articles to extract descriptive data, assess clarity and quality, and identify promising practices. Four distinct kinds of promising practices for connecting KWA for health equity were identified and included: ways of structuring systems, ways of working together, and ways of doing research and ways of doing knowledge translation. Our synthesis reveals that advancing health equity requires greater awareness, dialogue, and action that aligns with the what is known about the causes of health inequities. By critically reflecting on dominant discourses and assumptions, and mobilizing political will from a more informed and transparent democratic exercise, knowledge to action for health equity can be achieved.

Innovating Governance for Planetary Health with Three Critically Informed Frames

In May 2019, the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services warned that "around one million animal and plant species are now threatened with extinction." In September 2019, Naomi Klein, an astute writer on environmental change, described the interconnected social and ecological breakdowns on the planet in a new book. Ecological crises noted by these and other scholars speak well to the rise of planetary health as a new scholarship. Loss of biodiversity has manifold negative impacts on health, for example, rise of zoonotic infections and changes in healthy microbiome. But reducing our ecological footprints is not enough. We ought to change mindsets, the narrow science, and technology governance regimes that value nature and other life forms instrumentally by their usefulness to us. I describe three new, broader and critically informed, frames on governance for planetary health. First, I explain why we ought to acknowledge animal sentience, for example, as recognized in Article 13 of the Lisbon Treaty in 2009. I describe how political determinants of health, power, and agency operate at multiple sociological and planetary loci, not only among human beings but also at human and nonhuman animal interfaces. Second, planetary health calls for a shift toward ecological and political determinants beyond a narrow anthropocentric view, while resisting the entrenched dogma of exponential growth with finite planetary natural resources. Third, for critically informed governance of emerging technologies in planetary health (e.g., glycomics, artificial intelligence, health care robots), I refer to a question highlighted recently (Frodeman, 2019): "When Plato (more exactly, Juvenal) asked who guards the guardians, he was questioning whether any group can be trusted to look past its own interests for the common good." Hence, it is time we broaden the question "Who will guard the guardians?" beyond the scientific community, to actors in science policy as well. Policy questions cannot be limited to "which social issues emerge from a new technology?" but ought to include, "who should be framing science and technology policy, and why?" Youth leaders of the global climate movement such as Greta Thunberg and others are now rightly asking these epistemological questions that might contribute toward a new social contract on health for all sentient beings on planet Earth. While ecological changes accelerate and a new space industry is emerging, governance for planetary health will continue to be at the epicenter of systems thinking, responsible innovation and science policy in the 21st century.

Relieving the tension between national health equity strategies and global health equity

Globally, numerous national strategies have taken aim at reducing health inequities. An ever-present tension characterizing these strategies, however, is their lack of attention to the global political economy. This commentary argues that national policies which target only domestic factors (without engaging with the global political economy) will be limited, both, in their ability to address national levels of health equity and the larger global health inequity problem. Meaningful proposals to reduce health inequities have been made that take into account a global political economy perspective. National health equity strategies could provide the lacking momentum to advance such proposals, but will require united and sustained advocacy by global health and health equity scholars. Ultimately, relieving the tension between national health equity commitments and global health equity concerns could be one of the new approaches needed to improve health equity worldwide.

The CCGHR Principles for Global Health Research: Centering equity in research, knowledge translation, and practice

Medical geography and global health share a fundamental concern for health equity. Both fields operate within similar multiple intersecting funding, academic, health systems, and development landscapes to produce scholarship. Both reflect complex interactions and partnerships between people, communities and institutions of unequal power. The Canadian Coalition of Global Health Research Principles for Global Health Research evolved from deep concern about the absence of standards for how Canadians engage in this field. They can serve as a broadly relevant framework to guide how to integrate equity considerations into everyday research, knowledge translation, and practice activities. Comprised of six principles (authentic partnering, inclusion, shared benefits, commitment to the future, responsiveness to causes of inequities, and humility), they are an aspirational and reflective frame that can elevate equity as a central procedural goal and outcome. In this commentary, we describe each of the six principles and offer examples of how they are being applied to guide research practices, inform knowledge translation science and build capacity. We invite collective reflection about moving our field toward more meaningful health equity research and action, using the CCGHR Principles for Global Health Research to spark dialogue about how to align our practices with desire for a more equitable world.

Correlation between human rights promotion and health protection: a cross country analysis

Purpose

The purpose of this paper is to explore the correlation among health outcomes, and civil and political rights (CPR) and also economic, social and cultural rights.

Design/methodology/approach

The study uses cross-sectional data from 161 countries. The authors use health outcomes and human rights variables in the model. In order to combine dimensions of human rights, this paper uses factor analysis and obtains proxy variables that measure economic, social and cultural rights and CPR. The two proxy variables are used as independent variables to explain variations in health in a regression model. The paper then classifies countries by cluster analysis and explores the patterns of different components of human rights and health outcomes across country clusters.

Findings

The regression model demonstrates that the economic, social and cultural rights variables explain variations in all health outcomes. The relationship between CPR and health is weaker than that of the economic, social and cultural rights. Cluster analysis further reveals that despite the country’s commitment to CPR, those that highly respect economic, social and cultural rights lead to superior health outcomes. The more respect a country has for economic, social and cultural rights, the better the health outcomes for the citizens of that country.

Practical implications

National policies should consider equal emphasis on all dimensions of human rights for further improvements in health.

Originality/value

The sole promotion of CPR such as democracy and empowerment, absence of adequate support of economic, social and cultural rights such as rights to housing, education, food and work can only contribute partially to health.

10 best resources on power in health policy and systems in low- and middle-income countries

Power is a critical concept to understand and transform health policy and systems. Power manifests implicitly or explicitly at multiple levels-local, national and global-and is present at each actor interface, therefore shaping all actions, processes and outcomes. Analysing and engaging with power has important potential for improving our understanding of the underlying causes of inequity, and our ability to promote transparency, accountability and fairness. However, the study and analysis of the role of power in health policy and systems, particularly in the context of low- and middle-income countries, has been lacking. In order to facilitate greater engagement with the concept of power among researchers and practitioners in the health systems and policy realm, we share a broad overview of the concept of power, and list 10 excellent resources on power in health policy and systems in low- and middle-income countries, covering exemplary frameworks, commentaries and empirical work. We undertook a two-stage process to identify these resources. First, we conducted a collaborative exercise involving crowdsourcing and participatory validation, resulting in 24 proposed articles. Second, we conducted a structured literature review in four phases, resulting in 38 articles reviewed. We present the 10 selected resources in the following categories to bring out key facets of the literature on power and health policy and systems-(1) Resources that provide an overarching conceptual exploration into how power shapes health policy and systems, and how to investigate it; and (2) examples of strong empirical work on power and health policy and systems research representing various levels of analyses, geographic regions and conceptual understandings of power. We conclude with a brief discussion of key gaps in the literature, and suggestions for additional methodological approaches to study power.

Chronic pain as a human rights issue: setting an agenda for preventative action

Background: Historically, chronic pain has been viewed primarily as a medical issue, and research has been focused on the individual and predominantly on pain sufferers in high-income countries.

Objectives: This article argues the need for a broader understanding of the context of chronic pain and its complex aetiologies and maintenance. It is suggested that the interaction between chronic pain and social context has been inadequately explored.

Methods: A single case study is used of a man living in a violent urban environment in South Africa accessing a pain clinic at a tertiary hospital. Following the case-study approach, as used in the chronic traumatic stress field by Kaminer et al., the case material is utilised to develop an argument for a new research agenda.

Results: Analysis of the case material demonstrates the complex interplay between bodily and psychological experiences, with chronic pain being contextually maintained and exacerbated by very difficult life circumstances, ongoing violence, and marginalisation.

Conclusions: It is suggested that a research agenda be developed which explores the links between chronic pain and ongoing chronic traumatisation in contexts of continuous violence, oppression, and disempowerment – common features of much of the contemporary majority world.

The Sustainable Development Goals: Contextualizing Africa's Economic and Health Landscape

The sustainable development goals (SDGs) encompass 17 goals with targets and indicators, collectively striving to improve national, regional, continental, and global development. SDG 8 strives for improved and sustainable economic growth. Africa's population is estimated to increase markedly and rapidly over the next few decades. The African demographic dividend presents opportunities to be harnessed, but several socioeconomic challenges exist that may constrain progress for achieving the SDGs. Poverty and inequality are pervasive in Africa and constrain economic and health gains. SDG 3 aims for good health and well-being for all ages and has 13 targets linked to 26 indicators. Collectively, SDG 3 targets aim to improve health outcomes by reducing mortality, ending epidemics, and preventing diseases to ensure affordable and quality healthcare access for all. The dynamic African health landscape and scarcity of healthcare human capital also present challenges for advancing SDG 3. The implementation of the SDGs presents major and complex challenges but ultimately yields rewards. Advancement across all SDG 3 targets is necessary for the benefit of healthier global citizens.

Framing Political Change: Can a Left Populism Disrupt the Rise of the Reactionary Right? Comment on "Politics, Power, Poverty and Global Health: Systems and Frames"

Solomon Benatar offers an important critique of the limited frame that sets the boundaries of much of what is referred to as 'global health.' In placing his comments within a criticism of increasing poverty (or certainly income and wealth inequalities) and the decline in our environmental commons, he locates our health inequities within the pathology of our present global economy. In that respect it is a companion piece to an editorial I published around the same time. Both Benatar's and my paralleling arguments take on a new urgency in the wake of the US presidential election. Although not a uniquely American event (the xenophobic right has been making inroads in many parts of the world), the degree of vitriol expressed by the President-elect of the world's (still) most powerful and militarized country is being used to further legitimate the policies of right-extremist parties in Europe while providing additional justification for the increasingly autocratic politics of leaders (elected or otherwise) in many other of the world's nations. To challenge right-populism's rejection of the predatory inequalities that 4 years of (neo)-liberal globalization have created demands strong and sustained left populism built, in part, on the ecocentric frame advocated by Benatar.

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"

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.

Critical Global Health: Responding to Poverty, Inequality and Climate Change Comment on "Politics, Power, Poverty and Global Health: Systems and Frames"

A recent article by Sol Benatar calls on the global health community to reassess its approach to twin crises of global poverty and climate change. I build on his article by challenging mainstream narratives that claim satisfactory progress in efforts to reduce poverty and improve health for all, and arguing that any eradication of poverty that is consistent with environmental sustainability will require a more explicit emphasis on the redistribution of power and wealth. I suggest that the global health community has been largely socialised into accepting that progress and future solutions can be attained through more neoliberal development, technological advancement and philanthropic endeavour and that a more critical global health is required. I propose three steps that the global health community should take: first, create more space for the social, political and political sciences within global health; second, be more prepared to act politically and challenge power; and third, do more to bridge the global-local divide in recognition of the fact that progressive change requires mobilisation from the bottom-up in conjunction with top-down policy and legislative change.

Thinking Out of the Box: A Green and Social Climate Fund Comment on "Politics, Power, Poverty and Global Health: Systems and Frames"

Solomon Benatar's paper "Politics, Power, Poverty and Global Health: Systems and Frames" examines the inequitable state of global health challenging readers to extend the discourse on global health beyond conventional boundaries by addressing the interconnectedness of planetary life. Our response explores existing models of international cooperation, assessing how modifying them may achieve the twin goals of ensuring healthy people and planet. First, we address why the inequality reducing post World War II European welfare model, if implemented state-by-state, is unfit for reducing global inequality and respecting environmental boundaries. Second, we argue that to advance beyond the 'Westphalian,' human centric thinking integral to global inequality and climate change requires challenging the logic of global economic integration and exploring the politically infeasible. In conclusion, we propose social policy focused changes to the World Trade Organisation (WTO) and a Green and Social Climate Fund, financed by new global greenhouse gas charges, both of which could advance human and planetary health. Recent global political developments may offer a small window of opportunity for out of the box proposals that could be advanced by concerted and united advocacy by global health activists, environmental activists, human rights activists, and trade unions.

Global Health in the Anthropocene: Moving Beyond Resilience and Capitalism Comment on "Health Promotion in an Age of Normative Equity and Rampant Inequality"

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.

The elusive ideal of inclusiveness: lessons from a worldwide survey of neurologists on the ethical issues raised by whole-genome sequencing

The anticipation of ethical issues that may arise with the clinical use of genomic technologies is crucial to envision their future implementation in a manner sensitive to local contexts. Yet, populations in low- and middle-income countries are underrepresented in studies that aim to explore stakeholders’ perspectives on the use of such technologies. Within the framework of a research project entitled “Personalized medicine in the treatment of epilepsy”, we sought to increase inclusiveness by widening the reach of our survey, inviting neurologists from around the world to share their views and practices regarding the use of whole-genome sequencing in clinical neurology and its associated ethics. We discuss herein the compelling scientific and ethical reasons that led us to attempt to recruit neurologists worldwide, despite the lack, in many low- or middle-income countries, of access to genomic technologies. Recruitment procedures and their results are presented and discussed, as well as the barriers we faced. We conclude that inclusive recruitment remains a challenging, albeit necessary and legitimate, endeavour.

Global health governance in the sustainable development goals: Is it grounded in the right to health?

This paper explores the extent to which global health governance - in the context of the early implementation of the Sustainable Development Goals is grounded in the right to health. The essential components of the right to health in relation to global health are unpacked. Four essential functions of the global health system are assessed from a normative, rights-based, analysis on how each of these governance functions should operate. These essential functions are: the production of global public goods, the management of externalities across countries, the mobilization of global solidarity, and stewardship. The paper maps the current reality of global health governance now that the post-2015 Sustainable Development Goals are beginning to be implemented. In theory, the existing human rights legislation would enable the principles and basis for the global governance of health beyond the premise of the state. In practice, there is a governance gap between the human rights framework and practices in global health and development policies. This gap can be explained by the political determinants of health that shape the governance of these global policies. Current representations of the right to health in the Sustainable Development Goals are insufficient and superficial, because they do not explicitly link commitments or right to health discourse to binding treaty obligations for duty-bearing nation states or entitlements by people. If global health policy is to meaningfully contribute to the realization of the right to health and to rights based global health governance then future iterations of global health policy must bridge this gap. This includes scholarship and policy debate on the structure, politics, and agency to overcome existing global health injustices.