Nutrition labelling: a review of research on consumer and industry response in the global South

Background

To identify peer-reviewed research on consumers’ usage and attitudes towards the nutrition label and the food industry's response to labelling regulations outside Europe, North America, and Australia and to determine knowledge gaps for future research.

Design

Narrative review.

Results

This review identified nutrition labelling research from 20 countries in Asia, Africa, the Middle East, and Latin America. Consumers prefer that pre-packaged food include nutrition information, although there is a disparity between rates of use and comprehension. Consumer preference is for front-of-pack labelling and for information that shows per serving or portion as a reference unit, and label formats with graphics or symbols. Research on the food and beverage industry's response is more limited but shows that industry plays an active role in influencing legislation and regulation.

Conclusions

Consumers around the world share preferences with consumers in higher income countries with respect to labelling. However, this may reflect the research study populations, who are often better educated than the general population. Investigation is required into how nutrition labels are received in emerging economies especially among the urban and rural poor, in order to assess the effectiveness of labelling policies. Further research into the outlook of the food and beverage industry, and also on expanded labelling regulations is a priority. Sharing context-specific research regarding labelling between countries in the global South could be mutually beneficial in evaluating obesity prevention policies and strategies.

A review of ancestrality and admixture in Latin America and the caribbean focusing on native American and African descendant populations

Genomics can reveal essential features about the demographic evolution of a population that may not be apparent from historical elements. In recent years, there has been a significant increase in the number of studies applying genomic epidemiological approaches to understand the genetic structure and diversity of human populations in the context of demographic history and for implementing precision medicine. These efforts have traditionally been applied predominantly to populations of European origin. More recently, initiatives in the United States and Africa are including more diverse populations, establishing new horizons for research in human populations with African and/or Native ancestries. Still, even in the most recent projects, the under-representation of genomic data from Latin America and the Caribbean (LAC) is remarkable. In addition, because the region presents the most recent global miscegenation, genomics data from LAC may add relevant information to understand population admixture better. Admixture in LAC started during the colonial period, in the 15th century, with intense miscegenation between European settlers, mainly from Portugal and Spain, with local indigenous and sub-Saharan Africans brought through the slave trade. Since, there are descendants of formerly enslaved and Native American populations in the LAC territory; they are considered vulnerable populations because of their history and current living conditions. In this context, studying LAC Native American and African descendant populations is important for several reasons. First, studying human populations from different origins makes it possible to understand the diversity of the human genome better. Second, it also has an immediate application to these populations, such as empowering communities with the knowledge of their ancestral origins. Furthermore, because knowledge of the population genomic structure is an essential requirement for implementing genomic medicine and precision health practices, population genomics studies may ensure that these communities have access to genomic information for risk assessment, prevention, and the delivery of optimized treatment; thus, helping to reduce inequalities in the Western Hemisphere. Hoping to set the stage for future studies, we review different aspects related to genetic and genomic research in vulnerable populations from LAC countries.

Championing Equity, Empowerment, and Transformational Leadership in (Mental Health) Research Partnerships: Aligning Collaborative Work With the Global Development Agenda

Through a narrative synthesis of existing literature on research partnerships, the paper underscores four core values championed in public policy and practice: equity, empowerment, transformational leadership, and treating mental health research as a cooperative inquiry. Building on these values, the author maps the challenges before mental health researchers in forging resilient, egalitarian, and committed Global North-South partnerships within the context of current global development agenda. Reports appraising the UN Millennium Development Goals lament how the goal of developing global partnerships to combat health, gender, and economic inequities has remained under-realized. Emphasis has been placed on the great need to augment Sustainable Development Goals (SDG) in ways where partnership processes would drive development and human rights agenda for the most afflicted, under-resourced, and marginalized in the world. Global North-South partnerships result in fewer lasting benefits to Global South-a regressive trend that is critically analyzed. The need for Global North to adopt ethical and responsible stances while creating/curating new knowledge is discussed. Being responsible is not only imperative for Global North researchers; it is imperative for both North and South researchers to adopt a dialogical approach in clarifying and sharing roles, responsibilities, access, and leadership in developing scholarship and praxis in mental health. The importance of de-centering hierarchies, valuing reciprocity in one another, improving communication, demonstrating empathy, and sharing resources and benefits are found to be key components in the narrative synthesis towards achieving greater empowerment and equity. The paper reflects on the potential problems in engagement and development of de-centered and transformational leadership in partnerships and implications for research ethics in the context of lower-and-middle-income countries. Lastly, the author in a bid to encourage global partnerships suggests that engaging in transparent and bi-directional conversations regarding these issues and realigning research priorities along the four core values will contribute to greater success in research collaborations (across cultural contexts) and more so in the global mental health field.

When Wife-Beating Is Not Necessarily Abuse: A Feminist and Cross-Cultural Analysis of the Concept of Abuse as Expressed by Tibetan Survivors of Domestic Violence

This article describes the views of Tibetan women who have experienced physical violence from male intimate partners. How they conceptualise abuse, their views on acceptable versus unacceptable hitting, and the acts besides hitting which they felt to be unacceptable or abusive, are explored. Views of survivors' relatives/friends and men who have hit their wives are also included. Western-based domestic violence theory is shown to be incommensurate with abuse in particular socio-cultural settings. As feminist scholars emphasize listening deeply to voices of women in the global South, this article demonstrates how such listening might be undertaken when the views expressed by women diverge from feminism.

Ethical principles for promoting health research data sharing with sub-Saharan Africa

A powerful feature of global health research is data-sharing with regions which bear the heaviest burden of disease. It offers novel opportunities for aggregating data to address critical global health challenges in ways higher than relying on individual studies. Yet there exist important stratifiers of the capacity to share data, particularly across the Global North-South divide. Systemic challenges that characterize sub-Saharan Africa and disadvantage the region's scientific productivity threaten the burgeoning data-sharing culture too. Like all endeavors requiring equal commitments under unequal circumstances, a strong ethical impetus is needed to help reduce inequities and imbalances to encourage adherence. This article discusses mandatory data-sharing in relation to peculiar challenges faced by sub-Saharan African scientists to suggest ethical principles for rethinking and reframing solutions. We propose six principles which mirror guidelines from the Institute of Medicine and encapsulate principles from the Emanuel Framework, Nairobi Data Sharing Principles, and the COHRED guidelines.

Understanding Health Research Ethics in Nepal

Unlike other countries in South Asia, in Nepal research in the health sector has a relatively recent history. Most health research activities in the country are sponsored by international collaborative assemblages of aid agencies and universities. Data from Nepal Health Research Council shows that, officially, 1,212 health research activities have been carried out between 1991 and 2014. These range from addressing immediate health problems at the country level through operational research, to evaluations and programmatic interventions that are aimed at generating evidence, to more systematic research activities that inform global scientific and policy debates. Established in 1991, the Ethical Review Board of the Nepal Health Research Council (NHRC) is the central body that has the formal regulating authority of all the health research activities in country, granted through an act of parliament. Based on research conducted between 2010 and 2013, and a workshop on research ethics that the authors conducted in July 2012 in Nepal as a part of the on‐going research, this article highlights the emerging regulatory and ethical fields in this low‐income country that has witnessed these increased health research activities. Issues arising reflect this particular political economy of research (what constitutes health research, where resources come from, who defines the research agenda, culture of contract research, costs of review, developing Nepal's research capacity, through to the politics of publication of data/findings) and includes questions to emerging regulatory and ethical frameworks.

Re-making the global economy of knowledge: do new fields of research change the structure of North-South relations?

How is global-North predominance in the making of organized knowledge affected by the rise of new domains of research? This question is examined empirically in three interdisciplinary areas - climate change, HIV-AIDS, and gender studies - through interviews with 70 researchers in Southern-tier countries Brazil, South Africa and Australia. The study found that the centrality of the North was reinstituted as these domains came into existence, through resource inequalities, workforce mechanisms, and intellectual framing. Yet there are tensions in the global economy of knowledge, around workforce formation, hierarchies of disciplines, neoliberal management strategies, and mismatches with social need. Intellectual workers in the Southern tier have built significant research centres, workforces and some distinctive knowledge projects. These create wider possibilities of change in the global structure of organized knowledge production.

Local Faith Actors and the Global Compact on Refugees

Power dynamics of global decision-making have meant that local faith actors have not been frequently heard in the context of refugee response. The development of new global refugee and humanitarian frameworks gives hope that there will be greater inclusion of Southern-led, faith-based responses. A closer look, however, demonstrates discrepancies between the frameworks used in global policy processes and the realities of local faith actors in providing refugee assistance. We present primary research from distinct case studies in Mexico and Honduras, which counters much of what is assumed about local faith actors in refugee services and aid. Interventions that are considered to be examples of good practice in the global South are not always congruent with those conceptualized as good practices by the international community. Failure to recognize and integrate approaches and practices from the global South, including those led by actors inspired by faith, will ultimately continue to replicate dominant global power structures.

The feasibility of using photovoice as a loneliness intervention with older Myanmar migrants

Loneliness has detrimental physical and mental health outcomes. To date, there are few studies on loneliness interventions in lower-resource settings. Based on participatory action research methods that are theoretically informed by the social relationship expectations framework, we developed a loneliness intervention called amanane using the photovoice method with older Myanmar migrants in northern Thailand. The aim of our study was to test the feasibility and preliminary effectiveness of photovoice as an intervention for lonely older adults. Over 6 weeks, we coproduced 5 weekly workshops, individual interviews, and a photo exhibition with an older Myanmar migrant cofacilitator and nine participants (57-82 years old). The workshops focused on older people's care provisions. The qualitative evaluation entailed group discussions, interviews, and videos. Results indicated a perfect completion rate and high acceptability. Participants reported a reduction in loneliness due to opening up to each other through photography, feeling united despite cultural differences, and feeling valued by visitors attending the photo exhibition. Overall, photovoice may be a promising intervention for lonely older adults and has the potential to be tested in larger trials across diverse settings.

The informal economy as a provider of assistive technology: lessons from Indonesia and Sierra Leone

Promoting the use of assistive technology (AT) is crucial for the health and well-being of users, but there is a huge global problem of unmet need for AT. In this context informal (unregulated) providers of AT play a significant role of meeting AT user need, particularly in less-resourced settings. This study draws on research into formal and informal AT provision in low-income urban communities in Indonesia and Sierra Leone to explore the potential of informal providers in addressing unmet need. Specifically, it looks at the different performance of formal and informal providers regarding the availability and the adequacy of AT that they provide. The study concludes by proposing further research into the scope for coproduction of AT between formal and informal providers.

Street vending, vulnerability and exclusion during the COVID-19 pandemic: the case of Cali, Colombia

The COVID-19 pandemic has had a profound effect on livelihoods everywhere, but especially in the informal economy where crucial forms of protection and security are often absent. A detailed understanding of the impacts for informal workers, the public policy approaches that could most effectively respond to their needs, and the barriers to such policy, is urgently needed. This paper discusses the results of a 2021 street vendor survey in Cali, Colombia, focusing on (1) vendors' socioeconomic circumstances and (2) their political engagement and attitudes on key policy and governance issues. It argues that while the pandemic and the government responses to it negatively impacted street vendors, there are steps that government could have taken, and can still take, to address vendors' needs and priorities. To ensure a just, equitable, sustainable recovery, and to protect economically marginalized groups from future crises, informal workers must be more meaningfully included in decision-making processes.

Social determinants of pacemaker reuse among patients and family members in Pakistan

OBJECTIVES

This survey aimed to quantify the opinions of CIED reuse among patients and family members in Pakistan and to identify the social determinants which may predict these views.

METHODS

A questionnaire formulating attitudes toward PPM reuse was administered to patients and family members at cardiology institutes in Pakistan from 1 July 2022 to 30 September 2022. The eligibility criteria (age > 18 years; inline for PPM placement) were taken into account and incomplete responses were excluded from the final analysis.

RESULTS

A total of 9,246 participants recorded their responses, of which 7,152 (78.16%) accepted pre-used PPMs. The lower social class had more PPM reuse acceptance rate than the middle and upper class (92.72% vs. 60.52% vs. 35.38%), respectively. Age ≥ 65 (OR(95%CI): 0.68 (0.41-0.99); P-value = 0.023), male gender (OR(95%CI): 0.55 (0.35-0.72), P-value = 0.016), unemployment (OR(95%CI): 0.47 (0.25-0.64); P-value = 0.007), poor health status (OR(95%CI): 0.72 (0.53-0.92); P-value = 0.041), and lower social class (OR(95%CI): 0.36 (0.28-0.53); P-value = 0.003) were social determinants of PPM reuse acceptance.

CONCLUSION

Patients and their family members endorse the concept of PPM reuse in Pakistan who cannot afford new devices.

What in the world is global health? A conceptual analysis

This article suggests that the concept of global health - and to an extent the field that it designates - is problematic in various ways. Within public health, the concept of the 'public' has been widely investigated. However, "global health" has been introduced in academic, policy, and public discussion with comparably lower level of conceptual, philosophical scrutiny. Thus, while public health ethics addresses the ethical and political issues that the different meanings of 'public' allow to identify, global health ethics tends to leave ethical and political issues raised by the concept of 'global health' implicit and insufficiently analysed. I will briefly present the debate around the 'public' in public health, describing some of the ethical and political questions that might arise, depending on what 'public' is taken to mean. I will then use this discussion as a conceptual map for an analogous analysis of the concept of 'global' in global health. I will discuss what dimensions 'global' adds to the concept of 'public'. In the second part of the article, I will briefly introduce the philosophical debate on the concept of health, before suggesting that its cultural sensitivity makes it ill-suited to be qualified as 'global'. All in all, this article wants to bring to light the ethical implications that the terminology of 'global health' introduces in academic research and public policy that goes under that heading, as a first step towards better defining the ethical contours of this discipline.

Minimally good life and the human right to health

In Global Health Impact: Extending Access to Essential Medicines, Nicole Hassoun argues that the concept of a minimally good life grounds the human right to health, which in turn implies the human right to access essential medicines in developing countries. This article argues that Hassoun's argument must be revised. If the temporal unit of a minimally good life is identified, her argument faces a substantive problem, which undermines an important part of her argument. This article then proposes a solution to this problem. If this proposed solution is accepted, Hassoun's project turns out to be more radical than her argument is supposed to be.

A sustainable blue economy may not be possible in Tanzania without cutting emissions

Balancing blue growth with the conservation of wild species and habitats is a key challenge for global ocean management. This is exacerbated in Global South nations, such as Tanzania, where climate-driven ocean change requires delicate marine spatial planning (MSP) trade-offs to ensure climate resilience of marine resources relied upon by coastal communities. Here, we identified challenges and opportunities that climate change presents to the near-term spatial management of Tanzania's artisanal fishing sector, marine protected areas and seaweed farming. Specifically, spatial meta-analysis of climate modelling for the region was carried out to estimate the natural distribution of climate resilience in the marine resources that support these socially important sectors. We estimated changes within the next 20 and 40 years, using modelling projections forced under global emissions trajectories, as well as a wealth of GIS and habitat suitability data derived from globally distributed programmes. Multi-decadal analyses indicated that long-term climate change trends and extreme weather present important challenges to the activity of these sectors, locally and regionally. Only in few instances did we identify areas exhibiting climate resilience and opportunities for sectoral expansion. Including these climate change refugia and bright spots in effective ocean management strategies may serve as nature-based solutions: promoting adaptive capacity in some of Tanzania's most vulnerable economic sectors; creating wage-gaining opportunities that promote gender parity; and delivering some economic benefits of a thriving ocean where possible. Without curbs in global emissions, however, a bleak future may emerge for globally valuable biodiversity hosted in Tanzania, and for its coastal communities, despite the expansion of protected areas or curbs in other pressures. Growing a sustainable ocean economy in this part of the Global South remains a substantial challenge without global decarbonization.

The underrepresentation of women in sport leadership in South Africa

Introduction

The lack of representation of women in sport leadership, despite global movements and policies that have found some traction, is a persistent, unremitting challenge globally, and especially in South Africa. This study aimed to explore the intersections of gender and sports ideology and its impact on gender (in) equity in the South African context. The study draws on African feminist theories and perspectives as a conceptual framework.

Methods

Twenty-eight interviews with prominent administrators, gender activists in sport, and practitioners from the sport-for-development sector and thematic document analysis provided qualitative data for the generation of three main themes relating to: (i) norms and values; (ii) male resistance; and (iii) agency.

Results

The results of the study show minimal traction on changing patriarchally informed cultural beliefs towards women with men as gatekeepers and masculinity framed for leadership attributes in most sports.

Discussion

Within an African feminist viewpoint, gender justice is multilayered and the inclusion of women within a holistic environment of shared decision-making and equitable resource mobilisation and distribution cannot be achieved through advocacy alone but necessitate the mainstreaming of a gender agenda to meaningfully address transformative change of sport systems and practices.

D, Mandal S, Menon JS, Roy A, Dixit S, Gupta R, Swaminathan S, Thankachan P, Bhavnani S, Divan G, Prabhakaran P, van Schayck OCP, Babu GR, Srinivas PN, Mukherjee D. Protocol of the Nutritional, Psychosocial, and Environmental Determinants of Neurodevelopment and Child Mental Health (COINCIDE) study

Background

Over 250 million children are developing sub-optimally due to their exposure to early life adversities. While previous studies have examined the independent effects of nutritional status, psychosocial adversities, and environmental pollutants on children's outcomes, little is known about their interaction and cumulative effects.

Objectives

This study aims to investigate the independent, interaction, and cumulative effects of nutritional, psychosocial, and environmental factors on children's cognitive development and mental health in urban and rural India. It also seeks to explain pathways leading to inequities in child outcomes at the individual, household, and neighbourhood levels.

Methods

A mixed-methods prospective cohort study will be conducted on 1600 caregiver-child dyads (child age 3-10 years) in urban and rural India. Nutritional status, psychosocial adversities, environmental pollutants, and child mental health outcomes will be assessed using parent-report questionnaires. Performance-based measures will be used to assess cognitive outcomes. Venous blood and urine samples will be used to measure nutritional and pesticide biomarkers in 500 children. Indoor air pollution will be monitored in 200 households twice, during two seasons. Multilevel regression, weighted quantile sum regression, and Bayesian kernel machine regression will assess the individual and combined effects of exposures on child outcomes. Thematic analysis of in-depth interviews and focus group discussions will explore pathways to middle-and late childhood development inequities.

Discussion

The data will be used to formulate a Theory of Change (ToC) to explain the biological, psychosocial, and environmental origins of children's cognitive and mental health outcomes across the first decade of life in diverse Indian settings, which can inform interventions targets for promoting children's outcomes beyond the first 1000 days, potentially generalizable to similar under-resourced global settings. The COINCIDE research infrastructure will comprise a valuable global health resource, including prospective cohort data, validated study tools, and stored biological and environmental samples for future studies.

Record linkage for routinely collected health data in an African health information exchange

Introduction

The Patient Master Index (PMI) plays an important role in management of patient information and epidemiological research, and the availability of unique patient identifiers improves the accuracy when linking patient records across disparate datasets. In our environment, however, a unique identifier is seldom present in all datasets containing patient information. Quasi identifiers are used to attempt to link patient records but sometimes present higher risk of over-linking. Data quality and completeness thus affect the ability to make correct linkages.

Aim

This paper describes the record linkage system that is currently implemented at the Provincial Health Data Centre (PHDC) in the Western Cape, South Africa, and assesses its output to date.

Methods

We apply a stepwise deterministic record linkage approach to link patient data that are routinely collected from health information systems in the Western Cape province of South Africa. Variables used in the linkage process include South African National Identity number (RSA ID), date of birth, year of birth, month of birth, day of birth, residential address and contact information. Descriptive analyses are used to estimate the level and extent of duplication in the provincial PMI.

Results

The percentage of duplicates in the provincial PMI lies between 10% and 20%. Duplicates mainly arise from spelling errors, and surname and first names carry most of the errors, with the first names and surname being different for the same individual in approximately 22% of duplicates. The RSA ID is the variable mostly affected by poor completeness with less than 30% of the records having an RSA ID.The current linkage algorithm requires refinement as it makes use of algorithms that have been developed and validated on anglicised names which might not work well for local names. Linkage is also affected by data quality-related issues that are associated with the routine nature of the data which often make it difficult to validate and enforce integrity at the point of data capture.