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Friel S, Collin J, Daube M, Depoux A, Freudenberg N, Gilmore AB, Johns P, Laar A, Marten R, McKee M, Mialon M. Commercial determinants of health: future directions. Lancet 2023; 401:1229-1240. [PMID: 36966784 DOI: 10.1016/s0140-6736(23)00011-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 09/06/2022] [Accepted: 12/23/2022] [Indexed: 04/07/2023]
Abstract
This paper is about the future role of the commercial sector in global health and health equity. The discussion is not about the overthrow of capitalism nor a full-throated embrace of corporate partnerships. No single solution can eradicate the harms from the commercial determinants of health-the business models, practices, and products of market actors that damage health equity and human and planetary health and wellbeing. But evidence shows that progressive economic models, international frameworks, government regulation, compliance mechanisms for commercial entities, regenerative business types and models that incorporate health, social, and environmental goals, and strategic civil society mobilisation together offer possibilities of systemic, transformative change, reduce those harms arising from commercial forces, and foster human and planetary wellbeing. In our view, the most basic public health question is not whether the world has the resources or will to take such actions, but whether humanity can survive if society fails to make this effort.
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Affiliation(s)
- Sharon Friel
- Menzies Centre for Health Governance, School of Regulation and Global Governance, The Australian National University, Acton, ACT, Australia.
| | - Jeff Collin
- School of Political and Social Science, University of Edinburgh, Edinburgh, UK
| | - Mike Daube
- Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Anneliese Depoux
- Virchow-Villermé Public Health Centre, University of Paris, Paris, France
| | - Nicholas Freudenberg
- School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Anna B Gilmore
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
| | - Paula Johns
- ACT Health Promotion, Rio de Janeiro, Brazil
| | - Amos Laar
- School of Public Health, University of Ghana, Legon, Ghana
| | - Robert Marten
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Martin McKee
- London School of Hygiene & Tropical Medicine, London, UK
| | - Melissa Mialon
- Trinity Business School, Trinity College Dublin, Dublin, Ireland
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Electricity and generator availability in LMIC hospitals: improving access to safe surgery. J Surg Res 2017; 223:136-141. [PMID: 29433865 DOI: 10.1016/j.jss.2017.10.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 09/19/2017] [Accepted: 10/12/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Access to reliable energy has been identified as a global priority and codified within United Nations Sustainable Goal 7 and the Electrify Africa Act of 2015. Reliable hospital access to electricity is necessary to provide safe surgical care. The current state of electrical availability in hospitals in low- and middle-income countries (LMICs) throughout the world is not well known. This study aimed to review the surgical capacity literature and document the availability of electricity and generators. METHODS Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search for surgical capacity assessments in LMICs in MEDLINE, PubMed, and World Health Organization Global Health Library was performed. Data regarding electricity and generator availability were extracted. Estimated percentages for individual countries were calculated. RESULTS Of 76 articles identified, 21 reported electricity availability, totaling 528 hospitals. Continuous electricity availability at hospitals providing surgical care was 312/528 (59.1%). Generator availability was 309/427 (72.4%). Estimated continuous electricity availability ranged from 0% (Sierra Leone and Malawi) to 100% (Iran); estimated generator availability was 14% (Somalia) to 97.6% (Iran). CONCLUSIONS Less than two-thirds of hospitals providing surgical care in 21 LMICs have a continuous electricity source or have an available generator. Efforts are needed to improve electricity infrastructure at hospitals to assure safe surgical care. Future research should look at the effect of energy availability on surgical care and patient outcomes and novel methods of powering surgical equipment.
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Cloninger CR, Salvador-Carulla L, Kirmayer LJ, Schwartz MA, Appleyard J, Goodwin N, Groves J, Hermans MHM, Mezzich JE, van Staden CW, Rawaf S. A Time for Action on Health Inequities: Foundations of the 2014 Geneva Declaration on Person- and People-centered Integrated Health Care for All. INTERNATIONAL JOURNAL OF PERSON CENTERED MEDICINE 2014; 4:69-89. [PMID: 26140190 PMCID: PMC4485425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Global inequalities contribute to marked disparities in health and wellness of human populations. Many opportunities now exist to provide health care to all people in a person- and people-centered way that is effective, equitable, and sustainable. We review these opportunities and the scientific, historical, and philosophical considerations that form the basis for the International College of Person-centered Medicine's 2014 Geneva Declaration on Person- and People-centered Integrated Health Care for All. Using consistent time-series data, we critically examine examples of universal healthcare systems in Chile, Spain, and Cuba. In a person-centered approach to public health, people are recognized to have intrinsic dignity and are treated with respect to encourage their developing health and happiness. A person-centered approach supports the freedom and the responsibility to develop one's life in ways that are personally meaningful and that are respectful of others and the environment in which we live together. Evidence suggests that health care organizations function well when they operate in a person-and people-centered way because that stimulates better coordination, cooperation, and social trust. Health care coverage must be integrated at several interconnected levels in order to be effective, efficient, and fair. To reduce the burden of disease, integration is needed between the people seeking and delivering care, within the social network of each person, across the trajectory of each person's life, among primary caregivers and specialists, and across multiple sectors of society. For integration to succeed across all these levels, it must foster common values and a shared vision of the future.
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Affiliation(s)
- C. Robert Cloninger
- Center for Well-Being, Departments of Psychiatry, Genetics, & Psychology, Washington University, St. Louis, Missouri, USA 63110
| | - Luis Salvador-Carulla
- Mental Health Policy Unit at BMRI and Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Australia
| | - Laurence J. Kirmayer
- Division of Social & Transcultural Psychiatry, Department of Psychiatry, McGill University, 1033 Pine Ave West, Montreal, Quebec H3A 1A1, Canada
| | - Michael A. Schwartz
- Department of Psychiatry and Behavioral Sciences, Texas A&M Health Science Center College of Medicine, Round Rock, Texas, USA
| | - James Appleyard
- International College of Person-centered Medicine, Canterbury, United Kingdom
| | - Nick Goodwin
- International Foundation for Integrated Care, 7200 The Quorum, Oxford Business Park North, Garsington Road, Oxford, OX4 212, United Kingdom
| | - JoAnna Groves
- International Alliance of Patients’ Organizations, CAN Mezzanine, 49-51 East Road, London, N1 6AH, United Kingdom
| | - Marc H. M. Hermans
- Het Park, Center for Child and Adolescent Psychiatry, Psychology and Psychotherapy, Sint-Niklaas, Belgium
| | - Juan E. Mezzich
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
| | - C. W. van Staden
- Division of Philosophy & Ethics of Mental Health, Department of Psychiatry, University of Pretoria, South Africa
| | - Salman Rawaf
- WHO Collaborating Center for Public Health Education & Training, School of Public Health, Faculty of Medicine, Imperial College, London, United Kingdom
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Dalglish SL, Poulsen MN, Winch PJ. Localization of health systems in low- and middle-income countries in response to long-term increases in energy prices. Global Health 2013; 9:56. [PMID: 24199690 PMCID: PMC3826843 DOI: 10.1186/1744-8603-9-56] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 10/17/2013] [Indexed: 11/17/2022] Open
Abstract
External challenges to health systems, such as those caused by global economic, social and environmental changes, have received little attention in recent debates on health systems’ performance in low-and middle-income countries (LMICs). One such challenge in coming years will be increasing prices for petroleum-based products as production from conventional petroleum reserves peaks and demand steadily increases in rapidly-growing LMICs. Health systems are significant consumers of fossil fuels in the form of petroleum-based medical supplies; transportation of goods, personnel and patients; and fuel for lighting, heating, cooling and medical equipment. Long-term increases in petroleum prices in the global market will have potentially devastating effects on health sectors in LMICs who already struggle to deliver services to remote parts of their catchment areas. We propose the concept of “localization,” originating in the environmental sustainability literature, as one element of response to these challenges. Localization assigns people at the local level a greater role in the production of goods and services, thereby decreasing reliance on fossil fuels and other external inputs. Effective localization will require changes to governance structures within the health sector in LMICs, empowering local communities to participate in their own health in ways that have remained elusive since this goal was first put forth in the Alma-Ata Declaration on Primary Health Care in 1978. Experiences with decentralization policies in the decades following Alma-Ata offer lessons on defining roles and responsibilities, building capacity at the local level, and designing appropriate policies to target inequities, all of which can guide health systems to adapt to a changing environmental and energy landscape.
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Affiliation(s)
- Sarah L Dalglish
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of International Health, 615 N, Wolfe St,, Baltimore, MD 21205, USA.
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Brown LH, Chaiechi T, Buettner PG, Canyon DV, Crawford JM, Judd J. Higher energy prices are associated with diminished resources, performance and safety in Australian ambulance systems. Aust N Z J Public Health 2013; 37:83-9. [PMID: 23379811 DOI: 10.1111/1753-6405.12015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the impact of changing energy prices on Australian ambulance systems. METHODS Generalised estimating equations were used to analyse contemporaneous and lagged relationships between changes in energy prices and ambulance system performance measures in all Australian State/Territory ambulance systems for the years 2000-2010. Measures included: expenditures per response; labour-to-total expenditure ratio; full-time equivalent employees (FTE) per 10,000 responses; average salary; median and 90th percentile response time; and injury compensation claims. Energy price data included State average diesel price, State average electricity price, and world crude oil price. RESULTS Changes in diesel prices were inversely associated with changes in salaries, and positively associated with changes in ambulance response times; changes in oil prices were also inversely associated with changes in salaries, as well with staffing levels and expenditures per ambulance response. Changes in electricity prices were positively associated with changes in expenditures per response and changes in salaries; they were also positively associated with changes in injury compensation claims per 100 FTE. CONCLUSION Changes in energy prices are associated with changes in Australian ambulance systems' resource, performance and safety characteristics in ways that could affect both patients and personnel. Further research is needed to explore the mechanisms of, and strategies for mitigating, these impacts. The impacts of energy prices on other aspects of the health system should also be investigated.
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Affiliation(s)
- Lawrence H Brown
- School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Queensland.
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Schwartz BS, Parker CL, Hess J, Frumkin H. Public health and medicine in an age of energy scarcity: the case of petroleum. Am J Public Health 2011; 101:1560-7. [PMID: 21778506 DOI: 10.2105/ajph.2010.205187] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Petroleum supplies have heretofore been abundant and inexpensive, but the world petroleum production peak is imminent, and we are entering an unprecedented era of petroleum scarcity. This fact has had little impact on policies related to climate, energy, the built environment, transportation, food, health care, public health, and global health. Rising prices are likely to spur research and drive efficiency improvements, but such innovations may be unable to address an increasing gap between supply and demand. The resulting implications for health and the environment are explored in the articles we have selected as additional contributions in this special issue. Uncertainty about the timing of the peak, the shape of the production curve, and decline rates should not delay action. The time for quick, decisive, comprehensive action is now.
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Affiliation(s)
- Brian S Schwartz
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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