Yip, Cheng-Har; Cazap, Eduardo; Anderson, Benjamin O; Bright, Kristin L; Caleffi, Maira; Cardoso, Fatima; Elzawawy, Ahmed M; Harford, Joe B; Krygier, Gabriel D; Masood, Shahla; Murillo, Raul; Muse, Ignacio M; Otero, Isabel V; Passman, Leigh J; Santini, Luiz A; da Silva, Ronaldo Corrêa Ferreira; Thomas, David B; Torres, Soledad; Zheng, Ying; Khaled, Hussein M
In middle resource countries (MRCs), cancer control programs are becoming a priority as the pattern of disease shifts from infectious diseases to non-communicable diseases such as breast cancer, the most common cancer among women in MRCs. The Middle Resource Scenarios Working Group of the BHGI 2010 Global Summit met to identify common issues and obstacles to breast cancer detection, diagnosis and treatment in MRCs. They concluded that breast cancer early detection programs continue to be important, should include clinical breast examination (CBE) with or without mammography, and should be coupled with active awareness programs. Mammographic screening is usually opportunistic and early detection programs are often hampered by logistical and financial problems, as well as socio-cultural barriers, despite improved public educational efforts. Although multidisciplinary services for treatment are available, geographical and economic limitations to these services can lead to an inequity in health care access. Without adequate health insurance coverage, limited personal finances can be a significant barrier to care for many patients. Despite the improved availability of services (surgery, pathology, radiology and radiotherapy), quality assurance programs remain a challenge. Better access to anticancer drugs is needed to improve outcomes, as are rehabilitation programs for survivors. Focused and sustained government health care financing in MRCs is needed to improve early detection and treatment of breast cancer. Copyright © 2011 Elsevier Ltd. All rights reserved.
Nodora, Jesse N; Carvajal, Scott C; Robles-Garcia, Rebeca; Agraz, Francisco Páez; Daneri-Navarro, Adrian; Meza-Montenegro, Maria Mercedes; Gutierrez-Millan, Luis Enrique; Martinez, Maria Elena
Lacking in the literature are data addressing the extent to which changes in reproductive and lifestyle factors predispose women in developing nations to higher breast cancer rates, and the degree to which these are due to globalization influences. This article describes the development and psychometric assessment of an instrument intended to measure global, predominantly U.S., influences on breast cancer risk profile among women residing in Mexico. Using investigator consensus and a focus group methodology, the Measure of Globalization Influence on Health Risk (MGIHR) was developed and completed by 341 women. Psychometric analysis support the use of an 11-item Consumerism and Modernity scale and 7-item Reproductive Control and Gender Role scale. The MGIHR is a valid and reliable instrument for understanding changing lifestyle and reproductive factors for breast cancer risk and may provide a more complete understanding of breast cancer development and needed interventions.
Benjamin O. Anderson
Full Text Available The Breast Health Global Initiative (BHGI applied an evidence-based consensus review process to develop guidelines for breast cancer early detection, diagnosis, and treatment in low- and middle-income countries (LMCs including those in Latin America. Breast cancer outcomes correlate with the degree to which 1 cancers are detected early, 2 cancers can be diagnosed correctly, and 3 proper multimodality treatment can be provided in a timely fashion. Cancer prevention through health behavior modification may influence breast cancer incidence in LMCs. Diagnosing breast cancer at earlier stages will reduce breast cancer mortality. Programs to promote breast self-awareness and clinical breast examination and resource-adapted mammographic screening are important early detection steps. Screening mammography has been shown to reduce breast cancer mortality, but is cost prohibitive in some settings. Breast imaging, initially with ultrasound and, at higher resource levels with diagnostic mammography, improves preoperative diagnostic assessment and permits image-guided needle sampling. Multimodality therapy includes surgery, radiation, and systemic therapies.La Iniciativa Global para la Salud de la Mama (BGHI ha aplicado un proceso de revisión de consenso, basado en la evidencia, a fin de desarrollar guías para la detección precoz del cáncer de mama, diagnóstico y tratamiento, en países de bajos y medianos ingresos (PBMI incluyendo aquellos en América latina. La evolución del cáncer de mama se correlaciona con el grado al cual 1 los cánceres son detectados tempranamente 2los cánceres pueden ser diagnosticados correctamente, y 3el adecuado tratamiento multimodal suministrado a tiempo. La prevención del cáncer a través de modificaciones de las conductas de salud puede modificar la incidencia del cáncer de mama en PBMI. El diagnóstico del cáncer de mama en estadios iniciales reduce la mortalidad por cáncer de mama. Los programas que promueven
Benatar, S. R; Brock, Gillian
...? What are our responsibilities and how can we improve global health? Global Health and Global Health Ethics addresses these questions from the perspective of a range of disciplines, including medicine, philosophy and the social sciences...
Adams, Vincanne; Novotny, Thomas E; Leslie, Hannah
A variety of shifts emergent with globalization, which are reflected in part by nascent programs in "Global Public Health," "Global Health Sciences," and "Global Health," are redefining international public health. We explore three of these shifts as a critical discourse and intervention in global health diplomacy: the expansion in non-governmental organization participation in international health programs, the globalization of science and pharmaceutical research, and the use of militarized languages of biosecurity to recast public health programs. Using contemporary anthropological and international health literature, we offer a critical yet hopeful exploration of the implications of these shifts for critical inquiry, health, and the health professions.
Optimisation of the continuum of supportive and palliative care for patients with breast cancer in low-income and middle-income countries: executive summary of the Breast Health Global Initiative, 2014.
Distelhorst, Sandra R; Cleary, James F; Ganz, Patricia A; Bese, Nuran; Camacho-Rodriguez, Rolando; Cardoso, Fatima; Ddungu, Henry; Gralow, Julie R; Yip, Cheng-Har; Anderson, Benjamin O
Supportive care and palliative care are now recognised as critical components of global cancer control programmes. Many aspects of supportive and palliative care services are already available in some low-income and middle-income countries. Full integration of supportive and palliative care into breast cancer programmes requires a systematic, resource-stratified approach. The Breast Health Global Initiative convened three expert panels to develop resource allocation recommendations for supportive and palliative care programmes in low-income and middle-income countries. Each panel focused on a specific phase of breast cancer care: during treatment, after treatment with curative intent (survivorship), and after diagnosis with metastatic disease. The panel consensus statements were published in October, 2013. This Executive Summary combines the three panels' recommendations into a single comprehensive document covering breast cancer care from diagnosis through curative treatment into survivorship, and metastatic disease and end-of-life care. The recommendations cover physical symptom management, pain management, monitoring and documentation, psychosocial and spiritual aspects of care, health professional education, and patient, family, and caregiver education. Copyright © 2015 Elsevier Ltd. All rights reserved.
Dr. Jordan Tappero, a CDC senior advisor on global health, discusses the state of global health security. Created: 9/21/2017 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Center for Global Health (CGH). Date Released: 9/21/2017.
Brown, Tim; Moon, Graham
In the wake of the report of the World Health Organisation's Commission on the Social Determinants of Health, Closing the gap in a generation (Marmot 2008), this invited commentary considers the scope for geographical research on global health. We reflect on current work and note future possibilities, particularly those that take a critical perspective on the interplay of globalisation, security and health.
Full Text Available Objective: to unravel some theoretical and factual elements required to implement more effective health promotion strategies and practices in the field of health services whilst following the great challenges that globalization has imposed on the health systems, which are inevitably expressed in the local context (glocalization. Methodology: a narrative review taking into account the concepts of globalization and health promotion in relation to health determinants. The authors approach some courses of action and strategies for health promotion based on the social principles and universal values that guide health promotion, health service reorientation and primary healthcare, empowerment, social participation, and inter-sectoral and social mobilization. Discussion: the discussion focuses on the redirection of health promotion services in relation to the wave of health reforms that has spread throughout the world under the neoliberal rule. The author also discusses health promotion, its ineffectiveness, and the quest for renewal. Likewise, the author sets priorities for health promotion in relation to social determinants. Conclusion: the current global order, in terms of international relations, is not consistent with the ethical principles of health promotion. In this paper, the author advocates for the implementation of actions to change the social and physical life conditions of people based on changes in the use of power in society and the appropriate practice of politics in the context of globalization in order to achieve the effectiveness of the actions of health promotion.
Van Hollen, Cecilia
This article describes how local responses to global health initiatives on infant feeding for HIV-positive mothers reflect and transform sociocultural values in Tamil Nadu, India. Drawing from ethnographic research conducted from 2002 to 2008, the article compares guidelines for counseling HIV-positive mothers established by UNICEF and WHO with decision-making processes and perceptions of HIV-positive mothers. In addition to the financial considerations, three factors are identified as impinging on this decision: (1) a strong sociocultural value in favor of breastfeeding linked to historical traditions and contemporary state and international development discourses, (2) constructions of class identity, (3) the influence of a rights-based discourse in HIV/AIDS advocacy. This wide range of factors points to the difficulty of implementing the international protocols. This is the first study of its kind to closely examine the complex determinants in HIV-positive women's decisions and evaluations of infant feeding methods in India.
Rowland, Michael L.
With the advent of twenty-four-hour news media, local, state, and national agencies' warnings and with the explosive role of the Internet, people are more aware of global health concerns that may have significant consequences for the world's population. As international travel continues to increase, health care professionals around the world are…
Pagliusi, Sonia; Ting, Ching-Chia; Lobos, Fernando
The Developing Countries Vaccine Manufacturers' Network (DCVMN) gathered leaders in immunization programs, vaccine manufacturing, representatives of the Argentinean Health Authorities and Pan American Health Organization, among other global health stakeholders, for its 17th Annual General Meeting in Buenos Aires, to reflect on how vaccines are shaping global health. Polio eradication and elimination of measles and rubella from the Americas is a result of successful collaboration, made possible by timely supply of affordable vaccines. After decades of intense competition for high-value markets, collaboration with developing countries has become critical, and involvement of multiple manufacturers as well as public- and private-sector investments are essential, for developing new vaccines against emerging infectious diseases. The recent Zika virus outbreak and the accelerated Ebola vaccine development exemplify the need for international partnerships to combat infectious diseases. A new player, Coalition for Epidemic Preparedness Innovations (CEPI) has made its entrance in the global health community, aiming to stimulate research preparedness against emerging infections. Face-to-face panel discussions facilitated the dialogue around challenges, such as risks of viability to vaccine development and regulatory convergence, to improve access to sustainable vaccine supply. It was discussed that joint efforts to optimizing regulatory pathways in developing countries, reducing registration time by up to 50%, are required. Outbreaks of emerging infections and the global Polio eradication and containment challenges are reminders of the importance of vaccines' access, and of the importance of new public-private partnerships. Copyright © 2017.
Dr. Mike Miller reads an abridged version of the Emerging Infectious Diseasesâ Perspective, The New Global Health. Created: 8/13/2013 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID). Date Released: 8/14/2013.
Greenwood, Brian; Salisbury, David; Hill, Adrian V. S.
Vaccines have made a major contribution to global health in recent decades but they could do much more. In November 2011, a Royal Society discussion meeting, ‘New vaccines for global health’, was held in London to discuss the past contribution of vaccines to global health and to consider what more could be expected in the future. Papers presented at the meeting reviewed recent successes in the deployment of vaccines against major infections of childhood and the challenges faced in developing vaccines against some of the world's remaining major infectious diseases such as human immunodeficiency virus (HIV), malaria and tuberculosis. The important contribution that development of more effective veterinary vaccines could make to global health was also addressed. Some of the social and financial challenges to the development and deployment of new vaccines were reviewed. The latter issues were also discussed at a subsequent satellite meeting, ‘Accelerating vaccine development’, held at the Kavli Royal Society International Centre. Delegates at this meeting considered challenges to the more rapid development and deployment of both human and veterinary vaccines and how these might be addressed. Papers based on presentations at the discussion meeting and a summary of the main conclusions of the satellite meeting are included in this issue of Philosophical Transactions of the Royal Society B. PMID:21893534
Gill, Stephen; Bakker, Isabella
Although the resources and knowledge for achieving improved global health exist, a new, critical paradigm on health as an aspect of human development, human security, and human rights is needed. Such a shift is required to sufficiently modify and credibly reduce the present dominance of perverse market forces on global health. New scientific discoveries can make wide-ranging contributions to improved health; however, improved global health depends on achieving greater social justice, economic redistribution, and enhanced democratization of production, caring social institutions for essential health care, education, and other public goods. As with the quest for an HIV vaccine, the challenge of improved global health requires an ambitious multidisciplinary research program. PMID:21330597
The term 'globalization' describes the integration of economic systems through improved communication, but it also represents increased insecurity for those with few resources--particularly refugees. This article examines why people migrate, their numbers, constraints on their movement and their particular health care needs. Immigrants have much to contribute to their recipient countries, but at some loss to their homelands. Both economically and morally, more liberal immigration policies would be beneficial. Policies towards asylum seekers should not be more restrictive in the aftermath of 11 September 2001 and detention should be the exception rather than the rule. Globalization should be managed so as to improve people's lives throughout the world.
Bygbjerg, Ib Christian; Meyrowitsch, Dan W
"Tempora mutantur et nos in illis" King Lothar I remarked by year 900 AD. What exactly changed in us over time, i.e. how patterns of the epidemiological transition in populations locally and globally might appear, was described by Omran in 1971 . The effect of transition on health and diseases...... in populations was demonstrated by Frenkl et al in 1991 . And which major public health problems following each other, and why, was underscored by LaPorte in 1995 . In 2000, leaders of the world society decided to identify a range of common goals, the Millennium Development Goals (MDG), to be reached...... by year 2015. Many of the MDG are directly or indirectly related with the major health problems, particularly those hitting the poorest: lack of clean drinking water, unhealthy environment, high maternal mortality due to lack of care for the pregnant, and lack of control of major communicable, often fatal...
Feldbaum, Harley; Lee, Kelley; Michaud, Joshua
Health has long been intertwined with the foreign policies of states. In recent years, however, global health issues have risen to the highest levels of international politics and have become accepted as legitimate issues in foreign policy. This elevated political priority is in many ways a welcome development for proponents of global health, and it has resulted in increased funding for and attention to select global health issues. However, there has been less examination of the tensions that characterize the relationship between global health and foreign policy and of the potential effects of linking global health efforts with the foreign-policy interests of states. In this paper, the authors review the relationship between global health and foreign policy by examining the roles of health across 4 major components of foreign policy: aid, trade, diplomacy, and national security. For each of these aspects of foreign policy, the authors review current and historical issues and discuss how foreign-policy interests have aided or impeded global health efforts. The increasing relevance of global health to foreign policy holds both opportunities and dangers for global efforts to improve health. PMID:20423936
Ioannou, Andriani; Mechili, Aggelos; Kolokathi, Aikaterini; Diomidous, Marianna
Globalization is the process of international integration arising from the interchange of world views, products, ideas, and other aspects of culture. Globalization describes the interplay of macro-social forces across cultures. The purpose of this study is a systematic review of the bibliography on the impacts of globalization in health. The consequences of globalization on health present a twofold dimension, on the one hand affects the health of the population and on the other hand organization and functioning of health systems. As a result of globalization, there has been an undeniable economic development and technological progress to support the level of health around the world, improving the health status of certain populations with a beneficial increase in life expectancy. In many aspects globalization is good but there are many problems too.
Eckenwiler, Lisa; Straehle, Christine; Chung, Ryoa
The grounds for global solidarity have been theorized and conceptualized in recent years, and many have argued that we need a global concept of solidarity. But the question remains: what can motivate efforts of the international community and nation-states? Our focus is the grounding of solidarity with respect to global inequities in health. We explore what considerations could motivate acts of global solidarity in the specific context of health migration, and sketch briefly what form this kind of solidarity could take. First, we argue that the only plausible conceptualization of persons highlights their interdependence. We draw upon a conception of persons as 'ecological subjects' and from there illustrate what such a conception implies with the example of nurses migrating from low and middle-income countries to more affluent ones. Next, we address potential critics who might counter any such understanding of current international politics with a reference to real-politik and the insights of realist international political theory. We argue that national governments--while not always or even often motivated by moral reasons alone--may nevertheless be motivated to acts of global solidarity by prudential arguments. Solidarity then need not be, as many argue, a function of charitable inclination, or emergent from an acknowledgment of injustice suffered, but may in fact serve national and transnational interests. We conclude on a positive note: global solidarity may be conceptualized to helpfully address global health inequity, to the extent that personal and transnational interdependence are enough to motivate national governments into action. © 2012 Blackwell Publishing Ltd.
Michaud, Josh; Kates, Jennifer
Attention to global health diplomacy has been rising but the future holds challenges, including a difficult budgetary environment. Going forward, both global health and foreign policy practitioners would benefit from working more closely together to achieve greater mutual understanding and to advance respective mutual goals.
Rosso, A; Civitelli, G; Marceca, M
The international scientific community has recently seen a growing debate on global health, and what similarities exist between this, public health and international health. Going through the definitions of global health found in the literature, we will highlight points of contact and differences, and discuss the definition of global health provided by the Italian Network Global Health Education. Finally, we will stress the need to incorporate the global health approach in the training of future medical doctors,in particular public health specialists, with the aim of providing current and future health professionals with the skills to deal with the challenges posed by globalization at the local level.
Rodin, Danielle; Yap, Mei Ling; Grover, Surbhi
programs. However, formalized training and career promotion tracks in global health within radiation oncology have been slow to emerge, thereby limiting the sustained involvement of students and faculty, and restricting opportunities for leadership in this space. We examine here potential structures...... and benefits of formalized global health training in radiation oncology. We explore how defining specific competencies in this area can help trainees and practitioners integrate their activities in global health within their existing roles as clinicians, educators, or scientists. This would also help create...... and funding models might be used to further develop and expand radiation oncology services globally....
... International Health Regulations (2005) Monitoring Framework 2.2 Child malnutrition Stunting, wasting and overweight in children 6.1 ... Reports Map gallery Country health data systems Country statistics Regional Health Observatories Africa Americas South-East Asia ...
Full Text Available It is not yet clear whether white blood cell DNA global methylation is associated with breast cancer risk. In this review we examine the relationships between multiple breast cancer risk factors and three markers of global DNA methylation: LINE-1, 5-mdC, and Alu. A literature search was conducted using Pubmed up to April 1, 2016, using combinations of relevant outcomes such as “WBC methylation,” “blood methylation,” “blood LINE-1 methylation,” and a comprehensive list of known and suspected breast cancer risk factors. Overall, the vast majority of reports in the literature have focused on LINE-1. There was reasonably consistent evidence across the studies examined that males have higher levels of LINE-1 methylation in WBC DNA than females. None of the other demographic, lifestyle, dietary, or health condition risk factors were consistently associated with LINE-1 DNA methylation across studies. With the possible exception of sex, there was also little evidence that the wide range of breast cancer risk factors we examined were associated with either of the other two global DNA methylation markers: 5-mdC and Alu. One possible implication of the observed lack of association between global WBC DNA methylation and known breast cancer risk factors is that the association between global WBC DNA methylation and breast cancer, if it exists, is due to a disease effect.
Aabenhus, Mette Morre; Schriver, Michael; Kallestrup, Per
Global health interventions often focus on specific diseases, thus forming vertical programmes. Studies show that vertical programmes perform poorly, which underlines the need for a horizontal basis: universal community-based primary health care, which improves health equity and outcomes. The diagonal approach supports an integrated patient-centered health-care system. The ''15% by 2015''-initiative suggests that vertical programmes invest 15% of their budgets in strengthening integrated primary health care. Strategies depend on local context.
.... This study diverges from that paper, however, in that it expands the field of inquiry to fully encompass all aspects of global health, including maternal mortality, malnutrition, chronic diseases...
Bhoo Pathy, N.
The burden of breast cancer had been increasing in Asia. However, little is known regarding the presentation, management and outcome of breast cancer among multi-ethnic Asian women. Asian ethnicities, lifestyles, health beliefs, and even life expectancies are substantially different from those of
The overall survival of breast cancer patients has increased quite remarkably in the past decades in the developed countries due to substantial improvements in diagnosis and treatment. As a consequence, the proportion of women alive after a breast cancer diagnosis is currently increasing. It is therefore becoming of outmost importance to also focus on medium- and long-term health outcomes of women with breast cancer. Swedish population registers were used to study time-dependent surviva...
Hardon, A.; Pool, R.
Can global health experiments be part of more flexible systems of knowledge generation, where different bodies of knowledge come together to provide understanding not only of the outcomes of new interventions but also of the mechanisms through which they affect people’s well-being and health?
Full Text Available Income related health inequalities have been estimated for various groups of individuals at local, state, or national levels. Almost all of theses estimates are based on individual data from sample surveys. Lack of consistent individual data worldwide has prevented estimates of international income related health inequalities. This paper uses the (population weighted aggregate data available from many countries around the world to estimate worldwide income related health inequalities. Since the intra-country inequalities are subdued by the aggregate nature of the data, the estimates would be those of the inter-country or international health inequalities. As well, the study estimates the contribution of major socioeconomic variables to the overall health inequalities. The findings of the study strongly support the existence of worldwide income related health inequalities that favor the higher income countries. Decompositions of health inequalities identify inequalities in both the level and distribution of income as the main source of health inequality along with inequalities in education and degree of urbanization as other contributing determinants. Since income related health inequalities are preventable, policies to reduce the income gaps between the poor and rich nations could greatly improve the health of hundreds of millions of people and promote global justice. Keywords: global, income, health inequality, socioeconomic determinants of health
Lam, Tai Hing; Chim, David
Alcohol's adverse public health impact includes disease, injury, violence, disability, social problems, psychiatric illness, drunk driving, drug use, unsafe sex, and premature death. Furthermore, alcohol is a confirmed human carcinogen. The International Agency for Research on Cancer concluded that alcohol causes cancer of the oral cavity, pharynx, larynx, esophagus, liver, colon-rectum, and breast. World Cancer Research Fund/American Institute for Cancer Research concluded that the evidence justifies recommending avoidance of consuming any alcohol, even in small quantities. Despite being responsible for 3.8% of global deaths (2,255,000 deaths) and 4.6% of global disability-adjusted life years in 2004, alcohol consumption is increasing rapidly in China and Asia. Contrary to the World Health Assembly's call for global control action, Hong Kong has reduced wine and beer taxes to zero since 2008. An International Framework Convention on Alcohol Control is urgently needed. Increasing alcohol taxation and banning alcohol advertisement and promotion are among the most effective policies.
Mackey, Tim K; Kohler, Jillian; Lewis, Maureen; Vian, Taryn
Corruption is a critical challenge to global health efforts, and combating it requires international action, advocacy, and research. Copyright © 2017 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.
Petersen, Poul E; Baehni, Pierre C
Chronic diseases are a growing burden to people, to health-care systems and to societies across the world. The rapid increase in the burden of chronic diseases is particularly prevalent in the developing countries. Periodontal disease is one of the two most important oral diseases contributing to the global burden of chronic disease. In addition to social determinants, periodontal health status is related to several proximal factors. Modifiable risk factors, such as tobacco use, excessive alcohol consumption, poor diet and nutrition, obesity, psychological stress and insufficient personal/oral hygiene, are important and these principal risk factors for periodontal disease are shared by other chronic diseases. The present monograph is devoted to the existing evidence on the practice of public health related to periodontal health. Public health is defined as the process of mobilizing and engaging local, national and international resources to assure that people can be healthy. Social determinants of health, environmental hazards and unhealthy lifestyles are prioritized in modern public health-care. Disease prevention and health promotion are cornerstones in actions for public health. This volume of Periodontology 2000 is entitled ‘Periodontal health and global public health’; the 12 articles of this volume discuss different aspects of this statement. It covers a range of subjects from public health issues to patient care. This monograph intends to stimulate community action research in the field of periodontology in order to help the development of appropriate public health intervention and relevant surveillance programs. It also expects to stimulate health authorities and professional organizations to initiate and support actions to promote periodontal health in their respective countries.
Barreto, Mauricio Lima
The objective of this article is to present health inequalities as a global problem which afflicts the populations of the poorest countries, but also those of the richest countries, and whose persistence represents one of the most serious and challenging health problems worldwide. Two components of global inequalities are highlighted: inequalities between groups within the same society, and inequalities between nations. The understanding that many of these inequalities are unjust, and therefore inequities, is largely derived from the inequalities that are identified between the various social groups of a given society. Inequalities between different societies and nations, while relevant and often of greater magnitude, are not always considered to be unjust. There have been several proposed solutions, which vary according to different theoretical interpretations and explanations. At the global level, the most plausible thesis has focused on improving global governance mechanisms. While that latter are attractive and have some arguments in their favor, they are insufficient because they do not incorporate an understanding of how the historical process of the constitution of the nations occurred and the importance of the position of each country in the global productive system.
In health care today, scientific and technological frontiers are expanding at unprecedented rates, even as economic and financial pressures shrink profit margins, intensify competition, and constrain the funds available for investment. Therefore, the world today has more economic, and social opportunities for people than 10 or 100 years since globalization has created a new ground somewhat characterized by rapid economic transformation, deregulation of national markets by new trade regimes, amazing transport, electronic communication possibilities and high turnover of foreign investment and capital flow as well as skilled labor. These trends can easily mask great inequalities in developing countries such as importation and spreading of infectious and non-communicable diseases; miniaturization of movement of medical technology; health sector trades management driven by economics without consideration to the social and health aspects and its effects, increasing health inequalities and their economic and social burden creation; multinational companies' cheap labor employment promotion in widening income differentials; and others. As a matter of fact, all these factors are major determinants of ill health. Health authorities of developing countries have to strengthen their regulatory framework in order to ensure that national health systems derive maximum benefit in terms of equity, quality and efficiency, while reducing potential social cost to a minimum generated risky side of globalization.
... ÐºÐ¸Ð¹ EspaÃ±ol Global Strategy on Diet, Physical Activity and Health Menu Diet, Physical Activity & Health Global ... obesity Documents & publications Related links Global recommendations on physical activity for health WHO developed the "Global Recommendations on ...
Inoue, Megumi; Pickard, Joseph G.; Welch-Saleeby, Patricia; Johnson, Sharon
This study utilizes a stress and coping framework which includes cognitive appraisal, personal and environmental resources, coping and stress to examine factors related to African-American caregivers’ breast cancer screenings, including mammograms, clinical examinations and self-examinations. Using data from the Black Rural and Urban Caregivers Mental Health and Functioning Study, we performed separate logistic regressions for each type of breast cancer screening. Results reveal that having a...
Globalization is the key challenge for public health care and primary health protection, given the links between globalization and health care, which are very complex today, the emphasis increasingly being on developing countries, in which group is also Croatia. Although there are numerous papers available on this subject, it is necessary to provide an institutional framework for the assessment of direct and indirect health impacts of various aspects of globalization. Therefore, this paper pr...
Petersen, Poul E; Baehni, Pierre C
Chronic diseases are a growing burden to people, to health-care systems and to societies across the world. The rapid increase in the burden of chronic diseases is particularly prevalent in the developing countries. Periodontal disease is one of the two most important oral diseases contributing...... to the global burden of chronic disease. In addition to social determinants, periodontal health status is related to several proximal factors. Modifiable risk factors, such as tobacco use, excessive alcohol consumption, poor diet and nutrition, obesity, psychological stress and insufficient personal....../oral hygiene, are important and these principal risk factors for periodontal disease are shared by other chronic diseases. The present monograph is devoted to the existing evidence on the practice of public health related to periodontal health. Public health is defined as the process of mobilizing and engaging...
Goldman, Mindy; O'Hair, Kim
Breast cancer is very common and seen in both premenopausal and postmenopausal women. Research into prevention, better screening, and more effective treatments is occurring continually, and changes are translated into clinical practice relatively quickly. It is important for women's health care providers to have an understanding of breast cancer treatments and the gynecologic side effects. For premenopausal women interested in fertility, options should be discussed prior to chemotherapy. Issues pertaining to pregnancy after breast cancer should be discussed in a multidisciplinary fashion, involving the obstetrician/gynecologist, breast surgeon, and oncologist. Ovarian suppression is often used as part of breast cancer treatment in premenopausal women with hormone positive disease, and menopausal symptoms may be severe. Hormonal therapies including tamoxifen and the aromatase inhibitors are used in the treatment of hormone positive breast cancers. Each of these drugs has a variety of gynecologic implications. Understanding the options for treatment for menopausal complaints in breast cancer patients is important for women's health providers. Although most breast cancers are sporadic, a small percentage will be due to mutations in the BRCA genes. It is important for women's health providers to take an appropriate family history and refer to genetic counselors for possible testing when hereditary cancer is suspected. This review focuses on the various women's health issues pertaining to breast cancer and treatment.
Full Text Available Chronic technology and business process disparities between High Income, Low Middle Income and Low Income (HIC, LMIC, LIC research collaborators directly prevent the growth of sustainable Global Health innova‐ tion for infectious and rare diseases. There is a need for an Open Source-Open Science Architecture Framework to bridge this divide. We are proposing such a framework for consideration by the Global Health community, by utiliz‐ ing a hybrid approach of integrating agnostic Open Source technology and healthcare interoperability standards and Total Quality Management principles. We will validate this architecture framework through our programme called Project Orchid. Project Orchid is a conceptual Clinical Intelligence Exchange and Virtual Innovation platform utilizing this approach to support clinical innovation efforts for multi-national collaboration that can be locally sustainable for LIC and LMIC research cohorts. The goal is to enable LIC and LMIC research organizations to acceler‐ ate their clinical trial process maturity in the field of drug discovery, population health innovation initiatives and public domain knowledge networks. When sponsored, this concept will be tested by 12 confirmed clinical research and public health organizations in six countries. The potential impact of this platform is reduced drug discovery and public health innovation lag time and improved clinical trial interventions, due to reliable clinical intelligence and bio-surveillance across all phases of the clinical innovation process.
Full Text Available Chronic technology and business process disparities between High Income, Low Middle Income and Low Income (HIC, LMIC, LIC research collaborators directly prevent the growth of sustainable Global Health innovation for infectious and rare diseases. There is a need for an Open Source-Open Science Architecture Framework to bridge this divide. We are proposing such a framework for consideration by the Global Health community, by utilizing a hybrid approach of integrating agnostic Open Source technology and healthcare interoperability standards and Total Quality Management principles. We will validate this architecture framework through our programme called Project Orchid. Project Orchid is a conceptual Clinical Intelligence Exchange and Virtual Innovation platform utilizing this approach to support clinical innovation efforts for multi-national collaboration that can be locally sustainable for LIC and LMIC research cohorts. The goal is to enable LIC and LMIC research organizations to accelerate their clinical trial process maturity in the field of drug discovery, population health innovation initiatives and public domain knowledge networks. When sponsored, this concept will be tested by 12 confirmed clinical research and public health organizations in six countries. The potential impact of this platform is reduced drug discovery and public health innovation lag time and improved clinical trial interventions, due to reliable clinical intelligence and bio-surveillance across all phases of the clinical innovation process.
In this article I argue for the development of a macro perspective within psychology, akin to that found in macroeconomics. Macropsychology is the application of psychology to factors that influence the settings and conditions of our lives. As policy concerns the strategic allocation of resources—who gets what and why?—it should be an area of particular interest for macropsychology. I review ways in which psychology may make a contribution to policy within the field of global health. Global health emphasizes human rights, equity, social inclusion, and empowerment; psychology has much to contribute to these areas, both at the level of policy and practice. I review the sorts of evidence and other factors that influence policymakers, along with the content, process, and context of policymaking, with a particular focus on the rights of people with disabilities in the low- and middle-income countries of Africa and Asia. These insights are drawn from collaborations with a broad range of practitioners, governments, United Nations agencies, civil society organizations, the private sector and researchers. Humanitarian work psychology is highlighted as an example of a new area of psychology that embraces some of the concerns of macropsychology. The advent of "big data" presents psychology with an opportunity to ask new types of questions, and these should include "understanding up," or how psychological factors can contribute to human well-being, nationally and globally. PsycINFO Database Record (c) 2014 APA, all rights reserved.
Current definitions of 'global health' lack specificity about the term 'global'. This debate presents and discusses existing definitions of 'global health' and a common problem inherent therein. It aims to provide a way forward towards an understanding of 'global health' while avoiding redundancy. The attention is concentrated on the dialectics of different concepts of 'global' in their application to malnutrition; HIV, tuberculosis & malaria; and maternal mortality. Further attention is payed to normative objectives attached to 'global health' definitions and to paradoxes involved in attempts to define the field. The manuscript identifies denotations of 'global' as 'worldwide', as 'transcending national boundaries' and as 'holistic'. A fourth concept of 'global' as 'supraterritorial' is presented and defined as 'links between the social determinants of health anywhere in the world'. The rhetorical power of the denotations impacts considerably on the object of 'global health', exemplified in the context of malnutrition; HIV, tuberculosis & malaria; and maternal mortality. The 'global' as 'worldwide', as 'transcending national boundaries' and as 'holistic' house contradictions which can be overcome by the fourth concept of 'global' as 'supraterritorial'. The 'global-local-relationship' inherent in the proposed concept coheres with influential anthropological and sociological views despite the use of different terminology. At the same time, it may be assembled with other views on 'global' or amend apparently conflicting ones. The author argues for detaching normative objectives from 'global health' definitions to avoid so called 'entanglement-problems'. Instead, it is argued that the proposed concept constitutes an un-euphemistical approach to describe the inherently politicised field of 'global health'. While global-as-worldwide and global-as-transcending-national-boundaries are misleading and produce redundancy with public and international health, global
Full Text Available Abstract Background Current definitions of 'global health' lack specificity about the term 'global'. This debate presents and discusses existing definitions of 'global health' and a common problem inherent therein. It aims to provide a way forward towards an understanding of 'global health' while avoiding redundancy. The attention is concentrated on the dialectics of different concepts of 'global' in their application to malnutrition; HIV, tuberculosis & malaria; and maternal mortality. Further attention is payed to normative objectives attached to 'global health' definitions and to paradoxes involved in attempts to define the field. Discussion The manuscript identifies denotations of 'global' as 'worldwide', as 'transcending national boundaries' and as 'holistic'. A fourth concept of 'global' as 'supraterritorial' is presented and defined as 'links between the social determinants of health anywhere in the world'. The rhetorical power of the denotations impacts considerably on the object of 'global health', exemplified in the context of malnutrition; HIV, tuberculosis & malaria; and maternal mortality. The 'global' as 'worldwide', as 'transcending national boundaries' and as 'holistic' house contradictions which can be overcome by the fourth concept of 'global' as 'supraterritorial'. The 'global-local-relationship' inherent in the proposed concept coheres with influential anthropological and sociological views despite the use of different terminology. At the same time, it may be assembled with other views on 'global' or amend apparently conflicting ones. The author argues for detaching normative objectives from 'global health' definitions to avoid so called 'entanglement-problems'. Instead, it is argued that the proposed concept constitutes an un-euphemistical approach to describe the inherently politicised field of 'global health'. Summary While global-as-worldwide and global-as-transcending-national-boundaries are misleading and produce
Full Text Available In the 21st Century, distinctions and boundaries between global health, international politics, and the broader interests of the global community are harder to define and enforce than ever before. As a result, global health workers, leaders, and institutions face pressing questions around the nature and extent of their involvement with non-health endeavors, including international conflict resolution, counter-terrorism, and peace-keeping, under the global health diplomacy (GHD paradigm.
In the 21st Century, distinctions and boundaries between global health, international politics, and the broader interests of the global community are harder to define and enforce than ever before. As a result, global health workers, leaders, and institutions face pressing questions around the nature and extent of their involvement with non-health endeavors, including international conflict resolution, counter-terrorism, and peace-keeping, under the global health diplomacy (GHD) paradigm. © 2015 by Kerman University of Medical Sciences.
Knaul, Felicia; Bustreo, Flavia; Ha, Eugene; Langer, Ana
Breast cancer has not been sufficiently integrated into broader efforts either on maternal and child, or reproductive health and this presents an opportunity to strengthen early detection. The analysis is based on global breast cancer statistics and a bibliographic review of key global programs and strategies to promote women s health in the developing world. Breast cancer is a leading cause of cancer deaths in all regions of the developing world and is striking many women during the reproductive phase. There is an opportunity to increase awareness among women and undertake clinical examination to detect breast cancer by linking to existing health interventions related to reproductive and maternal and child health in developing countries. These synergies should be tested and evaluated in developing countries to identify the potential impact on early detection and on reducing the proportion of cases that are found in more advanced stages.
Nour, Nawal M
The burden of disease and public health issues affecting girls and women throughout their lives is significantly greater in resource-poor settings. These women and girls suffer from high rates of maternal mortality, obstetric fistulas, female genital cutting, HIV/AIDS, malaria in pregnancy, and cervical cancer. Although the Millennium Development Goals (MDGs) are being met in some nations, the majority of the goals will not be reached by 2015. In addition, insufficient attention is given to non-communicable and chronic diseases such as diabetes, hypertension, hypercholesterolemia, cardiovascular diseases, stroke, obesity, and chronic respiratory diseases. A life-course approach that includes improvements in earlier-life factors such as diet and exercise is necessary to improve women's long-term health outcomes. Innovative diagnostic tools and treatment strategies along with cost-effective health service delivery systems are needed to make a significant impact on women's and girls' health worldwide.
CERN. Geneva; Schwede, Torsten; Moore, Celia; Smith, Thomas E; Williams, Brian; Grey, François
Distributed computing harnesses the power of thousands of computers within organisations or over the Internet. In order to tackle global health problems, several groups of researchers have begun to use this approach to exceed by far the computing power of a single lab. This event illustrates how companies, research institutes and the general public are contributing their computing power to these efforts, and what impact this may have on a range of world health issues. Grids for neglected diseases Vincent Breton, CNRS/EGEE This talk introduces the topic of distributed computing, explaining the similarities and differences between Grid computing, volunteer computing and supercomputing, and outlines the potential of Grid computing for tackling neglected diseases where there is little economic incentive for private R&D efforts. Recent results on malaria drug design using the Grid infrastructure of the EU-funded EGEE project, which is coordinated by CERN and involves 70 partners in Europe, the US and Russi...
Olayinka, Olaniyi; Kekeh, Michele; Sheth-Chandra, Manasi; Akpinar-Elci, Muge
The ability to synthesize and analyze massive amounts of data is critical to the success of organizations, including those that involve global health. As countries become highly interconnected, increasing the risk for pandemics and outbreaks, the demand for big data is likely to increase. This requires a global health workforce that is trained in the effective use of big data. To assess implementation of big data training in global health, we conducted a pilot survey of members of the Consortium of Universities of Global Health. More than half the respondents did not have a big data training program at their institution. Additionally, the majority agreed that big data training programs will improve global health deliverables, among other favorable outcomes. Given the observed gap and benefits, global health educators may consider investing in big data training for students seeking a career in global health. Copyright © 2017 Icahn School of Medicine at Mount Sinai. Published by Elsevier Inc. All rights reserved.
Ehn, S; Agardh, A; Holmer, H; Krantz, G; Hagander, L
Global health education is increasingly acknowledged as an opportunity for medical schools to prepare future practitioners for the broad health challenges of our time. The purpose of this study was to describe the evolution of global health education in Swedish medical schools and to assess students' perceived needs for such education. Data on global health education were collected from all medical faculties in Sweden for the years 2000-2013. In addition, 76% (439/577) of all Swedish medical students in their final semester answered a structured questionnaire. Global health education is offered at four of Sweden's seven medical schools, and most medical students have had no global health education. Medical students in their final semester consider themselves to lack knowledge and skills in areas such as the global burden of disease (51%), social determinants of health (52%), culture and health (60%), climate and health (62%), health promotion and disease prevention (66%), strategies for equal access to health care (69%) and global health care systems (72%). A significant association was found between self-assessed competence and the amount of global health education received (pmedical students (83%) wished to have more global health education added to the curriculum. Most Swedish medical students have had no global health education as part of their medical school curriculum. Expanded education in global health is sought after by medical students and could strengthen the professional development of future medical doctors in a wide range of topics important for practitioners in the global world of the twenty-first century. © 2015 the Nordic Societies of Public Health.
Swende, T Z; Sokpo, J; Tamen, F I
Health has long been recognized as a central feature of development. Globalization tends to be understood as a process of economic integration, but it implies more. It entails openness to trade, ideas, investment, people and culture all of which impact health. Review of relevant literature on globalization and health obtained from texts and Pubmed search. Globalization affects health positively and negatively simultaneously, depending on such factors as geographical location, sex, age, ethnic origin, educational level and socioeconomic status. The challenge remains how to make globalization work for health and to use health to foster better forms of globalization. The health community must brace up to the challenge of engaging in the globalization debate with a view to promoting better health for us all.
Downs, Jennifer A; Reif, Lindsey K; Hokororo, Adolfine; Fitzgerald, Daniel W
Globally, women experience a disproportionate burden of disease and death due to inequities in access to basic health care, nutrition, and education. In the face of this disparity, it is striking that leadership in the field of global health is highly skewed towards men and that global health organizations neglect the issue of gender equality in their own leadership. Randomized trials demonstrate that women in leadership positions in governmental organizations implement different policies than men and that these policies are more supportive of women and children. Other studies show that proactive interventions to increase the proportion of women in leadership positions within businesses or government can be successful. Therefore, the authors assert that increasing female leadership in global health is both feasible and a fundamental step towards addressing the problem of women's health. In this Perspective, the authors contrast the high proportion of young female trainees who are interested in academic global health early in their careers with the low numbers of women successfully rising to global health leadership roles. The authors subsequently explore reasons for female attrition from the field of global health and offer practical strategies for closing the gender gap in global health leadership. The authors propose solutions aimed to promote female leaders from both resource-wealthy and resource-poor countries, including leadership training grants, mentorship from female leaders in global professions, strengthening health education in resource-poor countries, research-enabling grants, and altering institutional policies to support women choosing a global health career path.
Downs, Jennifer A.; Reif, Lindsey K.; Hokororo, Adolfine; Fitzgerald, Daniel W.
Globally, women experience a disproportionate burden of disease and death due to inequities in access to basic health care, nutrition, and education. In the face of this disparity, it is striking that leadership in the field of global health is highly skewed towards men and that global health organizations neglect the issue of gender equality in their own leadership. Randomized trials demonstrate that women in leadership positions in governmental organizations implement different policies than men and that these policies are more supportive of women and children. Other studies show that proactive interventions to increase the proportion of women in leadership positions within businesses or government can be successful. Therefore, the authors assert that increasing female leadership in global health is both feasible and a fundamental step towards addressing the problem of women’s health. In this article, the authors contrast the high proportion of young female trainees who are interested in academic global health early in their careers with the low numbers of women successfully rising to global health leadership roles. The authors subsequently explore reasons for female attrition from the field of global health and offer practical strategies for closing the gender gap in global health leadership. The authors propose solutions aimed to promote female leaders from both resource-wealthy and resource-poor countries, including leadership training grants, mentorship from female leaders in global professions, strengthening health education in resource-poor countries, research-enabling grants, and altering institutional policies to support women choosing a global health career path. PMID:24918761
Full Text Available Forest ecosystems are the arsenal that supplies food and medicines for those who are the poorest members of the global community. These are referred to as “forest dwellers”. However the extent of those who depend on the products of the forest go well beyond these humble forest dwellers. In the modern context the forest ecosystems contribute to the diets and the medicines of even urban populations. This being so the widespread destruction of tropical rainforest ecosystems and the consequent extinction of plant and animal species that is ongoing, brings forth consequences that are of mind-boggling proportions. Though tropical moist rainforets are estimated to cover just only 6% of the surface of the earth, they contain an estimated 50% of all species of plants and animal life. The abundant botanical resources of the rainforests have provided mankind, and even neanderthal man, with food and medicines over several millennia. Yet it is just only 1% of this vast resource that has been scientifically evaluated for medicinal potential. At the same time an estimated 2% of the global rain forest resources are irreparably damaged each year, a rate which seems likely to witness the destruction of a possible 20- 25% of the present species of flora and fauna, in a decade from now..The rain forest resources are the basis on which the traditional medical systems have thrived. Medical systems such as the old Arabian-Greek systems from which modern western medicine is derived, the Traditional Chinese Medicine (TCM, the Ayurvedic, Siddi, and Unani systems, all depend substantially on plants for their therapeutic armoury. Therefore the safeguarding of the resource which is so vital to global health becomes a major reponsibility of mankind.Download Paper (pdf
This article presents a Latin American vision of global health from a counterhegemonic perspective, applicable to various countries of the world in similar circumstances. It begins by reviewing several concepts and trends in global health and outlining the differences between conventional public health, international health, and global health, but without seeing them as antagonistic, instead situating them in a model that is based on global health and also includes the other two disciplines. It is understood that global factors influenced earlier theories, schemes, and models of classic international health. The article emphasizes the importance of several aspects of world-geopolitics and economic globalization that impose constraints on world health; it also underscores the theory of social and environmental determinants of the health-disease spectrum, which have impacts beyond those of epidemiologic risk factors. The suggested approach is based on cosmopolitanism and holism: global philosophical and political currents that allow for a better interpretation of world phenomena and are more relevant because they give rise to lines of action. Structurally, the theoretical foundations of global health are presented in three analytical areas: global justice and equity, governance and the supranational protection of rights, and holism and a new global consciousness. The article concludes by underscoring the need to construct an approach to the existence and praxis of global public health that is based on the Latin American perspective, an approach that highlights grassroots social movements as an alternative way to secure a new order and global awareness of rights and to redefine the architecture of global health governance.
Tarrant, R C
Breast-feeding is the superior infant feeding method from birth, with research consistently demonstrating its numerous short- and long-term health benefits for both mother and infant. As a global recommendation the WHO advises that mothers should exclusively breast-feed for the first 6-months of life, thus delaying the introduction of solids during this time. Historically, Irish breast-feeding initiation rates have remained strikingly low in comparison with international data and there has been little improvement in breast-feeding duration rates. There is wide geographical variation in terms of breast-feeding initiation both internationally and in Ireland. Some of these differences in breast-feeding rates may be associated with differing socio-economic characteristics. A recent cross-sectional prospective study of 561 pregnant women attending a Dublin hospital and followed from the antenatal period to 6 months post partum has found that 47% of the Irish-national mothers initiated breast-feeding, while only 24% were still offering \\'any\\' breast milk to their infants at 6 weeks. Mothers\\' positive antenatal feeding intention to breast-feed is indicated as one of the most important independent determinants of initiation and \\'any\\' breast-feeding at 6 weeks, suggesting that the antenatal period should be targeted as an effective time to influence and affect mothers\\' attitudes and beliefs pertaining to breast-feeding. These results suggest that the \\'cultural\\' barrier towards breast-feeding appears to still prevail in Ireland and consequently an environment that enables women to breast-feed is far from being achieved. Undoubtedly, a shift towards a more positive and accepting breast-feeding culture is required if national breast-feeding rates are to improve.
Fourth Global Health Systems Research Symposium features innovative research on improving maternal and child health in Africa. January 13, 2017. Image. Sue Szabo and Karina Gould at HSR2016 Conference. IDRC / Louise Guenette. Sue Szabo and Karina Gould at the Fourth Global Symposium on Health Systems ...
Aulakh, Alex; Tweed, Sam; Moore, Jolene; Graham, Wendy
Globalisation has implications for the next generation of doctors, and thus for medical education. Increasingly, global health is being taught in medical schools, although its incorporation into an already full curriculum presents challenges. Global health was introduced into the MBChB curriculum at the University of Aberdeen through a student-selected component (SSC) as part of an existing medical humanities block. The Global Health and Humanities (GHH) module was first delivered in the autumn of 2013 and will shortly enter its third year. This student-led study used quantitative and qualitative methods to assess the module's appropriateness and effectiveness for strengthening learning on global health, consisting of online surveys for course participants and semi-structured interviews with faculty members. Integrating global health into the undergraduate medical curriculum by way of an SSC was regarded by teaching staff as an effective and realistic approach. A recognised strength of delivering global health as part of the medical humanities block was the opportunity to expose students to the social determinants of health through interdisciplinary teaching. Participating students all agreed that the learning approach strengthened both their knowledge of global health and a range of generic skills. SSCs are, by definition, self-selecting, and will have a tendency to attract students already with an interest in a topic - here global health. A wide range of learning opportunities is needed to integrate global health throughout medical curricula, and to reach all students. © 2016 John Wiley & Sons Ltd.
Downs, Jennifer A; Reif, Lindsey K.; Hokororo, Adolfine; Fitzgerald, Daniel W.
Globally, women experience a disproportionate burden of disease and death due to inequities in access to basic health care, nutrition, and education. In the face of this disparity, it is striking that leadership in the field of global health is highly skewed towards men and that global health organizations neglect the issue of gender equality in their own leadership. Randomized trials demonstrate that women in leadership positions in governmental organizations implement different policies tha...
Christiana M. Russ MD, DTMH
Full Text Available Background and Objectives: To identify the effects of global health electives over a decade in a pediatric residency program. Methods: This was an anonymous email survey of the Boston Combined Residency alumni funded for global health electives from 2002 to 2011. A test for trend in binomial proportions and logistic regression were used to document associations between elective and participant characteristics and the effects of the electives. Qualitative data were also analyzed. Results: Of the 104 alumni with available email addresses, 69 (66% responded, describing 94 electives. Elective products included 27 curricula developed, 11 conference presentations, and 7 academic publications. Thirty-two (46% alumni continued global health work. Previous experience, previous travel to the site, number of global electives, and cumulative global elective time were associated with postresidency work in global health or with the underserved. Conclusions: Resident global electives resulted in significant scholarship and teaching and contributed to long-term career trajectories.
Full Text Available Background: Global public health today faces new challenges and is impacted by a range of actors from within and outside state boundaries. The diversity of the actors involved has created challenges and a complex environment that requires a new context-tailored global approach. The World Federation of Public Health Associations has embarked on a collaborative consultation with the World Health Organization to encourage a debate on how to adapt public health to its future role in global health. Design: A qualitative study was undertaken. High-level stakeholders from leading universities, multilateral organizations, and other institutions worldwide participated in the study. Inductive content analyses were performed. Results: Stakeholders underscored that global public health today should tackle the political, commercial, economic, social, and environmental determinants of health and social inequalities. A multisectoral and holistic approach should be guaranteed, engaging public health in broad dialogues and a concerted decision-making process. The connection between neoliberal ideology and public health reforms should be taken into account. The WHO must show leadership and play a supervising and technical role. More and better data are required across many programmatic areas of public health. Resources should be allocated in a sustainable and accountable way. Public health professionals need new skills that should be provided by a collaborative global education system. A common framework context-tailored to influence governments has been evaluated as useful. Conclusions: The study highlighted some of the main public health challenges currently under debate in the global arena, providing interesting ideas. A more inclusive integrated vision of global health in its complexity, shared and advocated for by all stakeholders involved in decision-making processes, is crucial. This vision represents the first step in innovating public health at the
Hu, Kaimin; Lou, Lixia; Tian, Wei; Pan, Tao; Ye, Juan; Zhang, Suzhan
Breast cancer is a worldwide threat to female health with patient outcomes varying widely. The exact correlation between global outcomes of breast cancer and the national socioeconomic status is still undetermined. Mortality-to-incidence ratio (MIR) of breast cancer was calculated with the contemporary age standardized incidence and mortality rates for countries with data available at GLOBOCAN 2012 database. The MIR matched national human development indexes (HDIs) and health system attainments were respectively obtained from Human Development Report and World Health Report. Correlation analysis, regression analysis, and Tukey-Kramer post hoc test were used to explore the effects of HDI and health system attainment on breast cancer MIR. Our results demonstrated that breast cancer MIR was inversely correlated with national HDI (r = -.950; P < .001) and health system attainment (r = -.898; P < .001). Countries with very high HDI had significantly lower MIRs than those with high, medium and low HDI (P < .001). Liner regression model by ordinary least squares also indicated negative effects of both HDI (adjusted R2 = .903, standardize β = -.699, P < .001) and health system attainment (adjusted R2 =. 805, standardized β = -.009; P < .001), with greater effects in developing countries identified by quantile regression analysis. It is noteworthy that significant health care disparities exist among countries in accordance with the discrepancy of HDI. Policies should be made in less developed countries, which are more likely to obtain worse outcomes in female breast cancer, that in order to improve their comprehensive economic strength and optimize their health system performance.
Blouin Genest, Gabriel
Health issues now evolve in a global context. Real-time global surveillance, global disease mapping and global risk management characterize what have been termed 'global public health'. It has generated many programmes and policies, notably through the work of the World Health Organization. This globalized form of public health raises, however, some important issues left unchallenged, including its effectiveness, objectivity and legitimacy. The general objective of this article is to underline the impacts of WHO disease surveillance on the practice and theorization of global public health. By using the surveillance structure established by the World Health Organization and reinforced by the 2005 International Health Regulations as a case study, we argue that the policing of 'circulating risks' emerged as a dramatic paradox for global public health policy. This situation severely affects the rationale of health interventions as well as the lives of millions around the world, while travestying the meaning of health, disease and risks. To do so, we use health surveillance data collected by the WHO Disease Outbreak News System in order to map the impacts of global health surveillance on health policy rationale and theory. © The Author(s) 2014.
Full Text Available Seon-Ha Kim,1 Min-Woo Jo,2 Minsu Ock,2 Hyeon-Jeong Lee,2 Jong-Won Lee3,4 1Department of Nursing, College of Nursing, Dankook University, Cheonan, 2Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, 3Department of Breast and Endocrine Surgery, Asan Medical Center, Seoul, 4Department of Surgery, University of Ulsan College of Medicine, Seoul, South Korea Purpose: The aim of this study is to determine the utility of breast cancer health states using the standard gamble (SG and visual analog scale (VAS methods in the Korean general population.Materials and methods: Eight hypothetical breast cancer health states were developed based on patient education material and previous publications. Data from 509 individuals from the Korean general population were used to evaluate breast cancer health states using the VAS and the SG methods, which were obtained via computer-assisted personal interviews. Mean utility values were calculated for each human papillomavirus (HPV-related health state.Results: The rank of health states was identical between two valuation methods. SG values were higher than VAS values in all health states. The utility values derived from SG were 0.801 (noninvasive breast cancer with mastectomy and followed by reconstruction, 0.790 (noninvasive breast cancer with mastectomy only, 0.779 (noninvasive breast cancer with breast-conserving surgery and radiation therapy, 0.731 (invasive breast cancer with surgery, radiation therapy, and/or chemotherapy, 0.610 (locally advanced breast cancer with radical mastectomy with radiation therapy, 0.587 (inoperable locally advanced breast cancer, 0.496 (loco-regional recurrent breast cancer, and 0.352 (metastatic breast cancer.Conclusion: Our findings might be useful for economic evaluation of breast cancer screening and interventions in general populations. Keywords: breast neoplasm, Korea, quality-adjusted life years, quality of life
We are challenged to develop a public health approach that responds to the globalized world. The present global health crisis is not primarily one of disease, but of governance: its key characteristic is a weakening of public policy and interstate mechanisms as a consequence of global restructuring. The response needs to focus on the political determinants of health, in particular on mechanisms that help ensure the global public goods that are required for a more equitable and secure development. A first step in this direction would be to take up the proposal from the recent 6th Global Conference on Health Promotion to explore the possibility of a new type of global health treaty which would help to establish the new parameters of global health governance. National public health associations should take the lead to establish health as a global public good and organize "National Global Health Summits" to discuss the possible mechanisms for the necessary political process. This means putting global health governance issues onto the agenda of other sectors such as foreign policy, as health is critical not only for poverty reduction but for human security as a whole.
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Wilson, Lynda; Callender, Brian; Hall, Thomas L; Jogerst, Kristen; Torres, Herica; Velji, Anvar
As universities increase their focus on global health-related professional education, the need for specific competencies and outcomes to guide curriculum development is urgent. To address this need, the chair of the Education Committee of the Consortium of Universities for Global Health (CUGH) appointed a Subcommittee to determine if there is a need for broad global health core competencies applicable across disciplines, and if so, what those competencies should be. Based on that work, this paper (a) discusses the benefits of developing interprofessional and discipline-specific global health competencies; (b) highlights themes that emerged from a preliminary review of existing related literature; and (c) reviews the process used to identify two levels of interprofessional global health competencies. © 2014 American Society of Law, Medicine & Ethics, Inc.
The first part of this paper reviews the work of the World Health Organization's Regional Office for Europe undertaken to clarify the relevance of health promotion for all member states and regions. This work led to a definition of "health" as the ability to realize aspirations and satisfy needs and to change or cope with the environment. Health promotion was considered to 1) involve the population as a whole in the context of everyday lives, 2) be directed towards action on the determinants of health, 3) combine diverse but complementary methods or approaches, 4) aim for effective and concrete public participation, and 5) involve health professionals. Areas covered by health promotion activities include 1) access to health, 2) development of an environment conductive to health, 3) strengthening of social networks and social supports, 4) promoting positive health behavior and appropriate coping strategies, and 5) increasing knowledge and disseminating information. The next section of the paper traces the development of the concept of health promotion from its roots in health education, and the third section presents a brief history of public health to contextualize this development. The differences between the old and new approaches to public health are presented (the new role of the health sector is to ensure access to health, create advocacy for health, and move beyond health care through intersectoral action and public participation), and the new "forcefield" of public health that emerges from a conceptualization of health promotion is described. This forcefield, illustrated as a triangle linking healthy public policy, health promotion, and community action, works at all levels and is the framework for the development of appropriate strategies. It is concluded that in many cases public health will have to be reorganized as will the health care system as a whole. Health must be viewed as a social project linked to political responsibilities not as a medical
In the light of recent very prominent studies, especially that of Mukherjee and Krieckhaus (), one should be initially tempted to assume that nowadays globalization is a driver of a good public health performance in the entire world system. Most of these studies use time series analyses based on the KOF Index of Globalization. We attempt to re-analyze the entire question, using a variety of methodological approaches and data. Our re-analysis shows that neoliberal globalization has resulted in very important implosions of public health development in various regions of the world and in increasing inequality in the countries of the world system, which in turn negatively affect health performance. We use standard ibm/spss ordinary least squares (OLS) regressions, time series and cross-correlation analyses based on aggregate, freely available data. Different components of the KOF Index, most notably actual capital inflows, affect public health negatively. The "decomposition" of the available data suggests that for most of the time period of the last four decades, globalization inflows even implied an aggregate deterioration of public health, quite in line with globalization critical studies. We introduce the effects of inequality on public health, widely debated in global public health research. Our annual time series for 99 countries show that globalization indeed leads to increased inequality, and this, in turn, leads to a deteriorating public health performance. In only 19 of the surveyed 99 nations with complete data (i.e., 19.1%), globalization actually preceded an improvement in the public health performance. Far from falsifying globalization critical research, our analyses show the basic weaknesses of the new "pro-globalization" literature in the public health profession. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.
Laaser, Ulrich; Brand, Helmut
Since the end of the 1990s, globalization has become a common term, facilitated by the social media of today and the growing public awareness of life-threatening problems common to all people, such as global warming, global security and global divides. For the main parameters of health like the burden of disease, life expectancy and healthy life expectancy, extreme discrepancies are observed across the world. Infant mortality, malnutrition and high fertility go hand in hand. Civil society, as an indispensable activator of public health development, mainly represented by non-governmental organisations (NGOs), is characterised by a high degree of fragmentation and lack of public accountability. The World Federation of Public Health Associations is used as an example of an NGO with a global mission and fostering regional cooperation as an indispensable intermediate level.The lack of a globally valid terminology of basic public health functions is prohibitive for coordinated global and regional efforts. Attempts to harmonise essential public health functions, services and operations are under way to facilitate communication and mutual understanding. 1) Given the limited effects of the Millennium Development Goal agenda, the Post-2015 Development Goals should focus on integrated regional development. 2) A code of conduct for NGOs should be urgently developed for the health sector, and NGOs should be registered and accredited. 3) The harmonisation of the basic terminology for global public health essentials should be enhanced.
Laaser, Ulrich; Brand, Helmut
Introduction Since the end of the 1990s, globalization has become a common term, facilitated by the social media of today and the growing public awareness of life-threatening problems common to all people, such as global warming, global security and global divides. Review For the main parameters of health like the burden of disease, life expectancy and healthy life expectancy, extreme discrepancies are observed across the world. Infant mortality, malnutrition and high fertility go hand in hand. Civil society, as an indispensable activator of public health development, mainly represented by non-governmental organisations (NGOs), is characterised by a high degree of fragmentation and lack of public accountability. The World Federation of Public Health Associations is used as an example of an NGO with a global mission and fostering regional cooperation as an indispensable intermediate level. The lack of a globally valid terminology of basic public health functions is prohibitive for coordinated global and regional efforts. Attempts to harmonise essential public health functions, services and operations are under way to facilitate communication and mutual understanding. Recommendations 1) Given the limited effects of the Millennium Development Goal agenda, the Post-2015 Development Goals should focus on integrated regional development. 2) A code of conduct for NGOs should be urgently developed for the health sector, and NGOs should be registered and accredited. 3) The harmonisation of the basic terminology for global public health essentials should be enhanced.
Shea, Katherine M
There is a broad scientific consensus that the global climate is warming, the process is accelerating, and that human activities are very likely (>90% probability) the main cause. This warming will have effects on ecosystems and human health, many of them adverse. Children will experience both the direct and indirect effects of climate change. Actions taken by individuals, communities, businesses, and governments will affect the magnitude and rate of global climate change and resultant health impacts. This technical report reviews the nature of the global problem and anticipated health effects on children and supports the recommendations in the accompanying policy statement on climate change and children's health.
Ruger, J P
A world divided by health inequalities poses ethical challenges for global health. International and national responses to health disparities must be rooted in ethical values about health and its distribution; this is because ethical claims have the power to motivate, delineate principles, duties and responsibilities, and hold global and national actors morally responsible for achieving common goals. Theories of justice are necessary to define duties and obligations of institutions and actors in reducing inequalities. The problem is the lack of a moral framework for solving problems of global health justice. To study why global health inequalities are morally troubling, why efforts to reduce them are morally justified, how they should be measured and evaluated; how much priority disadvantaged groups should receive; and to delineate roles and responsibilities of national and international actors and institutions. Duties and obligations of international and state actors in reducing global health inequalities are outlined. The ethical principles endorsed include the intrinsic value of health to well-being and equal respect for all human life, the importance of health for individual and collective agency, the concept of a shortfall from the health status of a reference group, and the need for a disproportionate effort to help disadvantaged groups. This approach does not seek to find ways in which global and national actors address global health inequalities by virtue of their self-interest, national interest, collective security or humanitarian assistance. It endorses the more robust concept of "human flourishing" and the desire to live in a world where all people have the capability to be healthy. Unlike cosmopolitan theory, this approach places the role of the nation-state in the forefront with primary, though not sole, moral responsibility. Rather shared health governance is essential for delivering health equity on a global scale.
Gostin, Lawrence O; Mok, Emily A
This review identifies an agenda for global health by highlighting the current 'grand challenges' related to governance. Literature from the disciplines of health policy and medicine, conference presentations and documents, and materials from international agencies (such as the World Health Organization). The present approach to global health governance has proven to be inadequate and major changes are necessary. The source of problems behind the current global health governance challenges have not always been agreed upon, but this paper attempts to highlight the recurrent themes and topics of consensus that have emerged in recent years. A solution to the 'grand challenges' in global health governance is urgently needed and serves as an area for developing research.
Once an orphan field, 'global mental health' now has wide acknowledgement and prominence on the global health agenda. Increased recognition draws needed attention to individual suffering and the population impacts, but medicalizing global mental health produces a narrow view of the problems and solutions. Early framing by advocates of the global mental health problem emphasised biological disease, linked psychiatry with neurology, and reinforced categories of mental health disorders. Universality of biomedical concepts across culture is assumed in the globalisation of mental health but is strongly disputed by transcultural psychiatrists and anthropologists. Global mental health movement priorities take an individualised view, emphasising treatment and scale-up and neglecting social and structural determinants of health. To meet international targets and address the problem's broad social and cultural dimensions, the global mental health movement and advocates must develop more comprehensive strategies and include more diverse perspectives.
Global health partnerships have been hailed as a means of addressing the global health worker shortage, bringing forth health systems strengthening and, therefore, the universal health coverage aspirations of the Sustainable Development Goals. In contrast to other critical engagements with partnerships which have tended to focus on experiences and effects of these partnerships in situ; this paper draws on the example of the UK to explore how partnership working and development agendas have become entwined. Moreover, this entwinement has ensured that GHPs are far from the "global" endeavour that might be expected of global health and instead exhibit geographies that are far more representative of the geopolitics of overseas development assistance than biomedical need. Copyright © 2017 Elsevier Ltd. All rights reserved.
Bradbury-Jones, Caroline; Clark, Maria
'Globalisation' is the term used to describe the increasing economic and social interdependence between countries. Shifting patterns of health and disease are associated with globalisation. Global health refers to a health issue that is not contained geographically and that single countries cannot address alone. In response to globalisation and global health issues, nurses practise in new and emerging transnational contexts. Therefore, it is important that nurses respond proactively to these changes and understand the effects of globalisation on health worldwide. This article aims to increase nurses' knowledge of, and confidence in, this important area of nursing practice.
Full Text Available Abstract Antimicrobial resistance is a growing threat to public health the world over. Global health governance strategies need to address the erosion of antimicrobial effectiveness on three levels. Firstly, mechanisms to provide incentives for the pharmaceutical industry to develop antimicrobials for diseases threatening the developing world need to be sought out. Secondly, responsible use of antimicrobials by both clinicians and the animal food growing industry needs to be encouraged and managed globally. And lastly, in-country and international monitoring of changes in antimicrobial effectiveness needs to be stepped up in the context of a global health governance strategy.
Schirnding, Yasmin von; Onzivu, William; Adede, Andronico O
The environment continues to be a source of ill-health for many people, particularly in developing countries. International environmental law offers a viable strategy for enhancing public health through the promotion of increased awareness of the linkages between health and environment, mobilization of technical and financial resources, strengthening of research and monitoring, enforcement of health-related standards, and promotion of global cooperation. An enhanced capacity to utilize international environmental law could lead to significant worldwide gains in public health.
More than 2,000 people convened for the ninth annual Global Health and Innovation Conference at Yale University on April 21-22, 2012. Participants discussed the latest innovations, ideas in development, lessons learned, opportunities and challenges in global health activities. Several themes emerged, including the important role of frontline workers, strengthening health systems, leveraging social media, and sustainable and impact-driven philanthropy. Overall, the major outcome of the conference was the increased awareness of the potential of mobile technologies and social enterprises in transforming global health. Experts warned that donations and technological advances alone will not transform global health unless there are strong functioning health infrastructures and improved workforce. It was noted that there is a critical need for an integrated systems approach to global health problems and a need for scaling up promising pilot projects. Lack of funding, accountability, and sustainability were identified as major challenges in global health.
Full Text Available Once an orphan field, ‘global mental health’ now has wide acknowledgement and prominence on the global health agenda. Increased recognition draws needed attention to individual suffering and the population impacts, but medicalizing global mental health produces a narrow view of the problems and solutions. Early framing by advocates of the global mental health problem emphasised biological disease, linked psychiatry with neurology, and reinforced categories of mental health disorders. Universality of biomedical concepts across culture is assumed in the globalisation of mental health but is strongly disputed by transcultural psychiatrists and anthropologists. Global mental health movement priorities take an individualised view, emphasising treatment and scale-up and neglecting social and structural determinants of health. To meet international targets and address the problem's broad social and cultural dimensions, the global mental health movement and advocates must develop more comprehensive strategies and include more diverse perspectives.
Full Text Available Cancer represents a major public health and economical burden in developed countries and has emerged as a major public health problem in developing countries, matching its effect in industrialized nations. Although there have been recent declines in breast cancer mortality rates in some European Union countries, breast cancer remains of key importance to public health in Europe. Now days there is increasing recognition of the causative role of lifestyle factors, as smoking, diet, alcohol consumption, or lake of physical activity. The present study aimed to appreciate the presence and magnitude of modifiable risk factors for breast cancer in a sample of patients diagnosed with the disease, and to outline a risk profile liable to be changed in the intention of reducing the global risk. Risk factors have been investigated in 65 patients diagnosed with breast cancer using a questionnaire for breast cancer risk factors evaluation. The high risk profile was identified as taking shape for urban environment, modulated by the impact of overweight-obesity, smoking, reproductive factors and environmental exposure to different chemical substances. From the public health perspective, the control of overweight and obesity comes out in the foreground of preventive activities. Public health approaches emphasize on inexpensive, practical methods and in this perspective the approach of obesity should focus on the alteration of environmental context, promoting healthy eating and increased physical activity which could have a positive, independent impact on breast cancer risk
Lora, A.; Sharan, P.
Background. Information is needed for development of mental health (MH) services; and particularly in low- and middle-income countries (LAMICs), where the MH systems are relatively weak. World Health Organization (WHO) has worked intensively during the last 15 years for developing a strategy in the field of MH information. Methods. The paper analyzes WHO instruments developed in this area [MH Atlas series and WHO Assessment Instrument for Mental Health Systems (WHO-AIMS)]. Results. Data from ...
Kickbusch, Ilona; Franz, Christian; Holzscheiter, Anna; Hunger, Iris; Jahn, Albrecht; Köhler, Carsten; Razum, Oliver; Schmidt, Jean-Olivier
Germany has become a visible actor in global health in the past 10 years. In this Series paper, we describe how this development complements a broad change in perspective in German foreign policy. Catalysts for this shift have been strong governmental leadership, opportunities through G7 and G20 presidencies, and Germany's involvement in managing the Ebola virus disease outbreak. German global health engagement has four main characteristics that are congruent with the health agenda of the Sustainable Development Goals; it is rooted in human rights, multilateralism, the Bismarck model of social protection, and a link between development and investment on the basis of its own development trajectory after World War 2. The combination of momentum and specific characteristics makes Germany well equipped to become a leader in global health, yet the country needs to accept additional financial responsibility for global health, expand its domestic global health competencies, reduce fragmentation of global health policy making, and solve major incoherencies in its policies both nationally and internationally. Copyright © 2017 Elsevier Ltd. All rights reserved.
Huster, Karin; Petrillo, Carl; O'Malley, Gabrielle; Glassman, Debra; Rush, Jessica; Wasserheit, Judith
A growing number of organizations have launched social entrepreneurship competitions to help students develop the knowledge and skills to create sustainable solutions to the intertwined challenges of health and development. We conducted a program evaluation of the first 9 years of the Global Social Entrepreneurship Competition (GSEC) at the…
In this comment, I build on Shiffman’s call for the global health community to more deeply investigate structural and productive power. I highlight two challenges we must grapple with as social scientists carrying out the types of investigation that Shiffman proposes: the politics of challenging the powerful; and the need to investigate types of expertise that have traditionally been thought of as ‘outside’ global health. In doing so, I argue that moving forward with the agenda Shiffman sets out requires social scientists interested in the global politics of health to be reflexive about our own exercise of structural and productive power and the fact that researching global health politics is itself a political undertaking. PMID:25905482
Viens, A M
The connection between health and human rights continues to play a prominent role within global health law. In particular, a number of theorists rely on the claim that there is a relation of interdependence between health and human rights. The nature and extent of this relation, however, is rarely defined, developed or defended in a conceptually robust way. This paper seeks to explore the source, scope and strength of this putative relation and what role it might play in developing a global health law framework.
Universal health coverage (UHC) has emerged as the leading and recommended overarching health goal on the post-2015 development agenda, and is promoted with fervour. UHC has the backing of major medical and health institutions, and is designed to provide patients with universal access to needed health services without financial hardship, but is also projected to have 'a transformative effect on poverty, hunger, and disease'. Multiple reports and resolutions support UHC and few offer critical analyses; but among these are concerns with imprecise definitions and the ability to implement UHC at the country level. A medicalization lens enriches these early critiques and identifies concerns that the UHC campaign contributes to the medicalization of global health. UHC conflates health with health care, thus assigning undue importance to (biomedical) health services and downgrading the social and structural determinants of health. There is poor evidence that UHC or health care alone improves population health outcomes, and in fact health care may worsen inequities. UHC is reductionistic because it focuses on preventative and curative actions delivered at the individual level, and ignores the social and political determinants of health and right to health that have been supported by decades of international work and commitments. UHC risks commodifying health care, which threatens the underlying principles of UHC of equity in access and of health care as a collective good.
Chatwood, Susan; Bjerregaard, Peter; Young, T Kue
Global health should encompass circumpolar health if it is to transcend the traditional approach of the "rich North" assisting the "poor South." Although the eight Arctic states are among the world's most highly developed countries, considerable health disparities exist among regions across...... the Arctic, as well as between northern and southern regions and between indigenous and nonindigenous populations within some of these states. While sharing commonalities such as a sparse population, geographical remoteness, harsh physical environment, and underdeveloped human resources, circumpolar regions...... in the northern hemisphere have developed different health systems, strategies, and practices, some of which are relevant to middle and lower income countries. As the Arctic gains prominence as a sentinel of global issues such as climate change, the health of circumpolar populations should be part of the global...
Benzian, Habib; Greenspan, John S; Barrow, Jane; Hutter, Jeffrey W; Loomer, Peter M; Stauf, Nicole; Perry, Dorothy A
The Lancet Commission on Education of Health Professionals for the 21(st) Century calls for enhancing health education for the needs and challenges of the 21st century to improve health status globally. To complement the Lancet report, this article makes recommendations for including core global health competencies in the education of health care professionals and specific groups of the public who are relevant to oral health in a global context in order to tackle the burden of oral diseases. Experts from various professional backgrounds developed global oral health competencies for four target groups: Group 1 was defined as dental students, residents/trainee specialists (or equivalent), and dentists; Group 2 was community health workers, dental hygienists, and dental therapists (or the equivalent); Group 3 was health professionals such as physicians, physician assistants, nurses, nurse practitioners, and pharmacists; and Group 4 was non-health professionals in the public arena such as parents, teachers, decision makers, key opinion leaders, and health and consumer advocates. Key competencies for members of each of the four target groups are presented in a matrix. The suggested competency matrix shows that many other health professions and groups in society have potentially crucial roles in the prevention, control, and management of oral diseases globally. Workforce models including a wider range of professionals working together as a team will be needed to tackle the burden of oral diseases in an integrated way in the broader context of non-communicable diseases. Further discussion and research should be conducted to validate or improve the competencies proposed here with regard to their relevance, appropriateness, and completeness.
McMichael, A J; Beaglehole, R
Future health prospects depend increasingly on globalisation processes and on the impact of global environmental change. Economic globalisation--entailng deregulated trade and investment--is a mixed blessing for health. Economic growth and the dissemination of technologies have widely enhanced life expectancy. However, aspects of globalisation are jeopardising health by eroding social and environmental conditions, exacerbating the rich-poor gap, and disseminating consumerism. Global environmental changes reflect the growth of populations and the intensity of economic activity. These changes include altered composition of the atmosphere, land degradation, depletion of terrestrial aquifers and ocean fisheries, and loss of biodiversity. This weakening of life-supporting systems poses health risks. Contemporary public health must therefore encompass the interrelated tasks of reducing social and health inequalities and achieving health-sustaining environments.
Global health financing has increased dramatically in recent years, indicative of a rise in health as a foreign policy issue. Several governments have issued specific foreign policy statements on global health and a new term, global health diplomacy, has been coined to describe the processes by which state and non-state actors engage to position health issues more prominently in foreign policy decision-making. Their ability to do so is important to advancing international cooperation in health. In this paper we review the arguments for health in foreign policy that inform global health diplomacy. These are organized into six policy frames: security, development, global public goods, trade, human rights and ethical/moral reasoning. Each of these frames has implications for how global health as a foreign policy issue is conceptualized. Differing arguments within and between these policy frames, while overlapping, can also be contradictory. This raises an important question about which arguments prevail in actual state decision-making. This question is addressed through an analysis of policy or policy-related documents and academic literature pertinent to each policy framing with some assessment of policy practice. The reference point for this analysis is the explicit goal of improving global health equity. This goal has increasing national traction within national public health discourse and decision-making and, through the Millennium Development Goals and other multilateral reports and declarations, is entering global health policy discussion. Initial findings support conventional international relations theory that most states, even when committed to health as a foreign policy goal, still make decisions primarily on the basis of the 'high politics' of national security and economic material interests. Development, human rights and ethical/moral arguments for global health assistance, the traditional 'low politics' of foreign policy, are present in discourse but do
Labonté, Ronald; Gagnon, Michelle L
Global health financing has increased dramatically in recent years, indicative of a rise in health as a foreign policy issue. Several governments have issued specific foreign policy statements on global health and a new term, global health diplomacy, has been coined to describe the processes by which state and non-state actors engage to position health issues more prominently in foreign policy decision-making. Their ability to do so is important to advancing international cooperation in health. In this paper we review the arguments for health in foreign policy that inform global health diplomacy. These are organized into six policy frames: security, development, global public goods, trade, human rights and ethical/moral reasoning. Each of these frames has implications for how global health as a foreign policy issue is conceptualized. Differing arguments within and between these policy frames, while overlapping, can also be contradictory. This raises an important question about which arguments prevail in actual state decision-making. This question is addressed through an analysis of policy or policy-related documents and academic literature pertinent to each policy framing with some assessment of policy practice. The reference point for this analysis is the explicit goal of improving global health equity. This goal has increasing national traction within national public health discourse and decision-making and, through the Millennium Development Goals and other multilateral reports and declarations, is entering global health policy discussion. Initial findings support conventional international relations theory that most states, even when committed to health as a foreign policy goal, still make decisions primarily on the basis of the 'high politics' of national security and economic material interests. Development, human rights and ethical/moral arguments for global health assistance, the traditional 'low politics' of foreign policy, are present in discourse but do
Full Text Available Abstract Global health financing has increased dramatically in recent years, indicative of a rise in health as a foreign policy issue. Several governments have issued specific foreign policy statements on global health and a new term, global health diplomacy, has been coined to describe the processes by which state and non-state actors engage to position health issues more prominently in foreign policy decision-making. Their ability to do so is important to advancing international cooperation in health. In this paper we review the arguments for health in foreign policy that inform global health diplomacy. These are organized into six policy frames: security, development, global public goods, trade, human rights and ethical/moral reasoning. Each of these frames has implications for how global health as a foreign policy issue is conceptualized. Differing arguments within and between these policy frames, while overlapping, can also be contradictory. This raises an important question about which arguments prevail in actual state decision-making. This question is addressed through an analysis of policy or policy-related documents and academic literature pertinent to each policy framing with some assessment of policy practice. The reference point for this analysis is the explicit goal of improving global health equity. This goal has increasing national traction within national public health discourse and decision-making and, through the Millennium Development Goals and other multilateral reports and declarations, is entering global health policy discussion. Initial findings support conventional international relations theory that most states, even when committed to health as a foreign policy goal, still make decisions primarily on the basis of the 'high politics' of national security and economic material interests. Development, human rights and ethical/moral arguments for global health assistance, the traditional 'low politics' of foreign policy, are
Global Health. Information for change. 4th report of the Italian Observatory on Global Health. InformAzione (InformAction) is the title of the last OISG report (Italian observatory on Global Health), dedicated to information and education, the essential bases for a conscious action aimed at decreasing inequalities. Increasing the investments in information, education and interventions oriented to global health may broaden the number of aware and informed citizens, able to start a dialogue, to make pressures to increase the interventions in favor of those in need.
Parker, Richard G; Sommer, Marni
... processes such as the growth of inequalities between the rich and the poor in countries around the world, the globalisation of trade and commerce, new patterns of travel and migration, as well as a reduction in resources for the development and sustainability of public health infrastructures. The Routledge Handbook of Global Public Health explores ...
Stein, Dan J; He, Yanling; Phillips, Anthony; Sahakian, Barbara J; Williams, John; Patel, Vikram
Global mental health has emerged as an important specialty. It has drawn attention to the burden of mental illness and to the relative gap in mental health research and services around the world. Global mental health has raised the question of whether this gap is a developmental issue, a health issue, a human rights issue, or a combination of these issues-and it has raised awareness of the need to develop new approaches for building capacity, mobilising resources, and closing the research and treatment gap. Translational neuroscience has also advanced. It comprises an important conceptual approach to understanding the neurocircuitry and molecular basis of mental disorders, to rethinking how best to undertake research on the aetiology, assessment, and treatment of these disorders, with the ultimate aim to develop entirely new approaches to prevention and intervention. Some apparent contrasts exist between these fields; global mental health emphasises knowledge translation, moving away from the bedside to a focus on health systems, whereas translational neuroscience emphasises molecular neuroscience, focusing on transitions between the bench and bedside. Meanwhile, important opportunities exist for synergy between the two paradigms, to ensure that present opportunities in mental health research and services are maximised. Here, we review the approaches of global mental health and clinical neuroscience to diagnosis, pathogenesis, and intervention, and make recommendations for facilitating an integration of these two perspectives. Copyright © 2015 Elsevier Ltd. All rights reserved.
The Global Health Beyond 2015 was organized in Stockholm in April 2013, which was announced as public engagement and where the dialogue focused on three main themes: social determinants of health, climate change and the non-communicable diseases. This event provided opportunity for both students and health professionals to interact and brainstorm ideas to be formalized into Stockholm Declaration on Global Health. Amongst the active participation of various health professionals, one that was found significantly missing was that of oral health. Keeping this as background in this debate, a case for inclusion of oral health professions is presented by organizing the argument in four areas: education, evidence base, political will and context and what each one offers at a time when Scandinavia is repositioning itself in global health.
Marano, Cinzia; Freedman, David O
Monitoring disease trends among travelers can inform both pretravel advice and posttravel management. Data from sentinel travelers upon their return to medically sophisticated environments can also benefit local populations in resource-limited countries. Provider-based surveillance of travelers is increasingly sophisticated. Recently, networks such as GeoSentinel have provided cumulative trends in travel-related illness to assess pretravel risk for a mass gathering event--the Beijing Olympic Games. Data provided by the GeoSentinel also helped in determining the seasonality of dengue by region of travel and risk of acquiring schistosomiasis after a single short exposure. For chikungunya fever, detailed study of returned travelers exposed new clinical aspects of a disease previously studied in the tropics only. Clusters of hepatitis A, a vaccine-preventable disease, among European travelers, illustrated continued gaps in the preparation of the traveling public. Plasmodium knowlesi has emerged as the fifth human malaria parasite and is now a consideration in the diagnosis of febrile travelers from Asia. Automated global news scanning software is increasingly being able to detect and prioritize disease events. Every year millions of travelers visit countries where they are exposed to pathogens that are usually rare in their home countries. Global surveillance of travel-related disease represents a powerful tool for the detection of infectious diseases. These data should encourage clinicians to take a detailed travel history during every patient encounter.
Franco-Paredes, Carlos; Zeuli, Julia; Hernández-Ramos, Isabel; Santos-Preciado, Jose I
If the field of global health is to evolve in the second decade of the new millennium, we need to revive the idealistic spirit and by using the lens of health equity work toward improved health status around the world. Morality and empathy are considered by-products of our evolutionary history as a human species. Idealism may be a trait that we may choose to preserve in our modern evolutionary history.
The Department of Surgery of Abia State University Teaching Hospital Aba, before implementing an extensive Breast Cancer Awareness Programe) in Abia State, did a preliminary survey using a questionnaire on breast self – examination among three hundred and fifty (350) non-health professionals, to ascertain whether ...
The research will look at three examples of global health diplomacy important to sub-Saharan Africa: 1) the implementation of the World Health Organization's Code on International Recruitment of Health Personnel; 2) new collaboration on access to essential drugs through South-South relationships involving Africa, China, ...
Full Text Available Global health has attracted growing attention from academic institutions. Its emergence corresponds to the increasing interdependence that characterizes our time and provides a new worldview to address health challenges globally. There is still a large potential to better delineate the limits of the field, drawing on a wide perspective across sciences and geographical areas. As an implementation and integration science, academic global health aims primarily to respond to societal needs through research, education, and practice. From five academic institutions closely engaged with international Geneva, we propose here a definition of global health based on six core principles: 1 cross–border/multilevel approach, 2 inter–/trans–disciplinarity, 3 systems thinking, 4 innovation, 5 sustainability, and 6 human rights/equity. This definition aims to reduce the century–old divide between medicine and public health while extending our perspective to other highly relevant fields. Overall, this article provides an intellectual framework to improve health for all in our contemporary world with implications for academic institutions and science policy.
Cohen, Emma R M; Masum, Hassan; Berndtson, Kathryn; Saunders, Vicki; Hadfield, Tom; Panjwani, Dilzayn; Persad, Deepa L; Minhas, Gunjeet S; Daar, Abdallah S; Singh, Jerome A; Singer, Peter A
Experience with public engagement activities regarding the risks and benefits of science and technology (S&T) is growing, especially in the industrialized world. However, public engagement in the developing world regarding S&T risks and benefits to explore health issues has not been widely explored. This paper gives an overview about public engagement and related concepts, with a particular focus on challenges and benefits in the developing world. We then describe an Internet-based platform, which seeks to both inform and engage youth and the broader public on global water issues and their health impacts. Finally, we outline a possible course for future action to scale up this and similar online public engagement platforms. The benefits of public engagement include creating an informed citizenry, generating new ideas from the public, increasing the chances of research being adopted, increasing public trust, and answering ethical research questions. Public engagement also fosters global communication, enables shared experiences and methodology, standardizes strategy, and generates global viewpoints. This is especially pertinent to the developing world, as it encourages previously marginalized populations to participate on a global stage. One of the core issues at stake in public engagement is global governance of science and technology. Also, beyond benefiting society at large, public engagement in science offers benefits to the scientific enterprise itself. Successful public engagement with developing world stakeholders will be a critical part of implementing new services and technologies. Interactive engagement platforms, such as the Internet, have the potential to unite people globally around relevant health issues.
Kickbusch, I; Reddy, K S
The recent Ebola crisis has re-opened the debate on global health governance and the role of the World Health Organization. In order to analyze what is at stake, we apply two conceptual approaches from the social sciences - the work on gridlock and the concept of cosmopolitan moments - to assess the ability of the multilateral governance system to reform. We find that gridlock can be broken open by a health crisis which in turn generates a political drive for change. We show that a set of cosmopolitan moments have led to the introduction of the imperative of health in a range of policy arenas and moved health into 'high politics' - this has been called a political revolution. We contend that this revolution has entered a second phase with increasing interest of heads of state in global health issues. Here lies the window of opportunity to reform global health governance. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
LaPorte, R E
Applications of networking to health care have focused on the potential of networking to transmit data and to reduce the cost of health care. In the early 198Os networks began forming among academic institutions; one of them was Bitnet. During the 1980s Internet evolved, which joined diverse networks, including those of governments and industry. The first step is to connect public health organizations such as ministries of health, the World Health Organization, the Pan-American Health Organization, and the United Nations. Computer-based telecommunication will vastly increase effective transmission of information. Networking public health workers in local health departments, academia, governments, industry, and private agencies, will bring great benefits. One is global disease telemonitoring: with new epidemiological techniques such as capture-recapture, accurate estimates of incidences of important communicable and non-communicable diseases can now be obtained. Currently all countries in the Americas except Haiti are connected through Internet. No systematic integration of telecommunication and public health systems across countries has occurred yet. On-line vital statistics could be usable almost instantaneously to facilitate monitoring and forecasting of population growth and the health needs of mothers and children. Linking global disease telemonitoring (morbidity data for non-communicable diseases) with environmental data systems would considerably improve understanding of the environmental determinants of disease. Internet is already linked to the National Library of Medicine through Bitnis. Computer based distance education is rapidly improving through E-mail searches. Reading materials, video, pictures, and sound could be transmitted across huge distances for low costs. Hundreds of schools are already networked together. On-line electronic journals and books have the potential for instantaneous dissemination of free information through gopher servers. Global
Mohamed-Ahmed, Rayan; Daniels, Alex; Goodall, Jack; O'Kelly, Emily; Fisher, James
As society diversifies and globalisation quickens, the importance of teaching global health to medical undergraduates increases. For undergraduates, the majority of exposure to 'hands-on' teaching on global health occurs during optional elective periods. This article describes an innovative student-led initiative, 'Disaster Day', which used simulation to teach global health to undergraduates. The teaching day began with an introduction outlining the work of Médecins Sans Frontières and the basic principles of resuscitation. Students then undertook four interactive simulation scenarios: Infectious Diseases in a Refugee Camp, Natural Disaster and Crush Injury, Obstetric Emergency in a Low-Income Country, and Warzone Gunshot Wound. Sessions were facilitated by experienced doctors and fourth-year students who had been trained in the delivery of the scenarios. Students completed pre- and post-session evaluation forms that included the self-rating of confidence in eight learning domains (using a five-point Likert scale). Twenty-seven students voluntarily attended the session, and all provided written feedback. Analysis of the pre- and post-session evaluations demonstrated statistically significant improvements in confidence across all but one domains (Wilcoxon signed rank test). Free-text feedback was overwhelmingly positive, with students appreciating the practical aspect of the scenarios. For undergraduates, the majority of exposure to 'hands-on' teaching on global health occurs during optional elective periods Simulation-based teaching can provide students with 'hands-on' exposure to global health in a controlled, reproducible fashion and appears to help develop their confidence in a variety of learning domains. The more widespread use of such teaching methods is encouraged: helping tomorrow's doctors develop insight into global health challenges may produce more rounded clinicians capable of caring for more culturally diverse populations. © 2015 John Wiley & Sons
Adams, Lisa V; Wagner, Claire M; Nutt, Cameron T; Binagwaho, Agnes
Among academic institutions in the United States, interest in global health has grown substantially: by the number of students seeking global health opportunities at all stages of training, and by the increase in institutional partnerships and newly established centers, institutes, and initiatives to house global health programs at undergraduate, public health and medical schools. Witnessing this remarkable growth should compel health educators to question whether the training and guidance that we provide to students today is appropriate, and whether it will be applicable in the next decade and beyond. Given that "global health" did not exist as an academic discipline in the United States 20 years ago, what can we expect it will look like 20 years from now and how can we prepare for that future? Most clinicians and trainees today recognize the importance of true partnership and capacity building in both directions for successful international collaborations. The challenge is in the execution of these practices. There are projects around the world where this is occurring and equitable partnerships have been established. Based on our experience and observations of the current landscape of academic global health, we share a perspective on principles of engagement, highlighting instances where partnerships have thrived, and examples of where we, as a global community, have fallen short. As the world moves beyond the charity model of global health (and its colonial roots), it is evident that the issue underlying ethical global health practice is partnership and the pursuit of health equity. Thus, achieving equity in global health education and practice ought to be central to our mission as educators and advisors when preparing trainees for careers in this field. Seeking to eliminate health inequities wherever they are ingrained will reveal the injustices around the globe and in our own cities and towns.
Benditte-Klepetko, Heike; Leisser, Valerie; Paternostro-Sluga, Tatjana; Rakos, Monika; Trattnig, Siegfried; Helbich, Thomas; Schemper, Michael; Deutinger, Maria
Despite the complex health burden for women with breast hypertrophy, medical directors of health insurance companies are not convinced that this procedure is of medical benefit for patients. Therefore, coverage of cost by the health insurance companies is no longer guaranteed. The purpose of this study is to evaluate the influence of breast weight on the physical and psychological morbidity of women and to prove the medical necessity of reduction mammaplasty. We performed a cohort study of 50 women with various breast sizes, a mean age of 28 years (range 20-40 years), and a body mass index (BMI) <25. Breast weight was measured, the spine was investigated by magnetic resonance imaging (MRI), and a spine score of clinical symptoms was assessed. The Beck Depression Inventory (BDI) was used to evaluate psychological impairment. Pathological findings have been correlated with breast weight, and the risk of developing a morphological or psychological disorder independence of the breast weight was calculated. The incidence of degenerative spine disorders and the extent of depressive symptoms are correlated with increasing breast weight. The data show that high breast weight has a negative influence on the physical and psychological morbidity of women. This objective evidence in support of the medical necessity of reduction mammaplasty should guide managed care organizations' methods for determining coverage for reduction mammaplasty.
subtype of infiltrating ductal carcinoma (7) and the MYB -NFIB fusion in adenoid cystic carcinomas, another rare form of breast cancer (8). Recently...Andren Y, Mark J, Horlings HM, Persson F, Stenman G. Recurrent fusion of MYB and NFIB transcription factor genes in carcinomas of the breast and
Full Text Available Breast cancer is a worldwide threat to female health with patient outcomes varying widely. The exact correlation between global outcomes of breast cancer and the national socioeconomic status is still undetermined. Mortality-to-incidence ratio (MIR of breast cancer was calculated with the contemporary age standardized incidence and mortality rates for countries with data available at GLOBOCAN 2012 database. The MIR matched national human development indexes (HDIs and health system attainments were respectively obtained from Human Development Report and World Health Report. Correlation analysis, regression analysis, and Tukey-Kramer post hoc test were used to explore the effects of HDI and health system attainment on breast cancer MIR. Our results demonstrated that breast cancer MIR was inversely correlated with national HDI (r = -.950; P < .001 and health system attainment (r = -.898; P < .001. Countries with very high HDI had significantly lower MIRs than those with high, medium and low HDI (P < .001. Liner regression model by ordinary least squares also indicated negative effects of both HDI (adjusted R2 = .903, standardize β = -.699, P < .001 and health system attainment (adjusted R2 =. 805, standardized β = -.009; P < .001, with greater effects in developing countries identified by quantile regression analysis. It is noteworthy that significant health care disparities exist among countries in accordance with the discrepancy of HDI. Policies should be made in less developed countries, which are more likely to obtain worse outcomes in female breast cancer, that in order to improve their comprehensive economic strength and optimize their health system performance.
Ruger, Jennifer Prah; Yach, Derek
The 21st century global health landscape requires effective global action in the face of globalization of trade, travel, information, human rights, ideas, and disease. The new global health era is more plural, comprising a number of key actors, and requiring more coordination of effort, priorities and investments. The World Health Organization (WHO) plays an essential role in the global governance of health and disease; due to its core global functions of establishing, monitoring and enforcin...
Selgelid, Michael J
This paper examines cumulative ethical and self-interested reasons why wealthy developed nations should be motivated to do more to improve health care in developing countries. Egalitarian and human rights reasons why wealthy nations should do more to improve global health are that doing so would (1) promote equality of opportunity (2) improve the situation of the worst-off, (3) promote respect of the human right to have one's most basic needs met, and (4) reduce undeserved inequalities in well-being. Utilitarian reasons for improving global health are that this would (5) promote the greater good of humankind, and (6) achieve enormous benefits while requiring only small sacrifices. Libertarian reasons are that this would (7) amend historical injustices and (8) meet the obligation to amend injustices that developed world countries have contributed to. Self-interested reasons why wealthy nations should do more to improve global health are that doing so would (9) reduce the threat of infectious diseases to developed countries, (10) promote developed countries' economic interests, and (11) promote global security. All of these reasons count, and together they add up to make an overwhelmingly powerful case for change. Those opposed to wealthy government funding of developing world health improvement would most likely appeal, implicitly or explicitly to the idea that coercive taxation for redistributive purposes would violate the right of an individual to keep his hard-earned income. The idea that this reason not to improve global health should outweigh the combination of rights and values embodied in the eleven reasons enumerated above, however is implausibly extreme, morally repugnant and perhaps imprudent.
This is the first in a series of four papers critically examining the medicalization of global health. Please find the other papers here.Medicalization analyses have roots in sociology and have critical usefulness for understanding contemporary health issues including the ‘post-2015 global health agenda’. Medicalization is more complex than just ‘disease mongering’ – it is a process and not only an outcome; has both positive and negative elements; can be partial rather than complete; and is o...
Flahault, Antoine; Geissbuhler, Antoine; Guessous, Idris; Guérin, Philippe; Bolon, Isabelle; Salathé, Marcel; Escher, Gérard
Precision global health is an approach similar to precision medicine, which facilitates, through innovation and technology, better targeting of public health interventions on a global scale, for the purpose of maximising their effectiveness and relevance. Illustrative examples include: the use of remote sensing data to fight vector-borne diseases; large databases of genomic sequences of foodborne pathogens helping to identify origins of outbreaks; social networks and internet search engines for tracking communicable diseases; cell phone data in humanitarian actions; drones to deliver healthcare services in remote and secluded areas. Open science and data sharing platforms are proposed for fostering international research programmes under fair, ethical and respectful conditions. Innovative education, such as massive open online courses or serious games, can promote wider access to training in public health and improving health literacy. The world is moving towards learning healthcare systems. Professionals are equipped with data collection and decision support devices. They share information, which are complemented by external sources, and analysed in real time using machine learning techniques. They allow for the early detection of anomalies, and eventually guide appropriate public health interventions. This article shows how information-driven approaches, enabled by digital technologies, can help improving global health with greater equity.
Kruk, Margaret E
Globalisation is a defining economic and social trend of the past several decades. Globalisation affects health directly and indirectly and creates economic and health disparities within and across countries. The political response to address these disparities, exemplified by the Millennium Development Goals, has put pressure on the global community to redress massive inequities in health and other determinants of human capability across countries. This, in turn, has accelerated a transformation in the architecture of global health governance. The entrance of new actors, such as private foundations and multi-stakeholder initiatives, contributed to a doubling of funds for global health between 2000 and 2010. Today the governance of public health is in flux, with diminished leadership from multilateral institutions, such as the WHO, and poor coherence in policy and programming that undermines the potential for sustainable health gains. These trends pose new challenges and opportunities for global public health, which is centrally concerned with identifying and addressing threats to the health of vulnerable populations worldwide.
Falkenberry, S S; Chung, M; Legare, R; Strenger, R; Wallace, D; Phillips, G; Morry, S; Marchant, D J; Cady, B
The Breast Health Center, a component of the program in Women's Oncology at Women & Infants Hospital, is a multidisciplinary center devoted to the treatment and study of benign and malignant breast diseases. The philosophy, structure, and function of The Breast Health Center are described along with its specific components. The Breast Health Center's three fundamental missions of patient care, education, and research are discussed.
ECOHEALTH CHAIRS in HEALTH and GLOBAL ENVIRONMENTAL CHANGE in SUB-SAHARAN AFRICA. Frequently asked questions. 1. Can Applicants from the listed eligible countries in Africa partner with institutions not based in Africa? Applicants from Sub-Saharan Africa can partner with institutions based outside ...
Mycotoxins are fungal metabolites produced my micro-fungi (molds and mildews) that have significant impacts on global economics and health. Some of these metabolites are beneficial, but most are harmful and have been associated with well-known epidemics dating back to medieval times. The terms ‘myco...
Introduction. Leptospirosis has been recognized as an important emerging global public health problem because of its epidemic proportions and increasing incidence in both developing and developed countries (Meites et .... and E jaundice, non-malarial febrile illnesses and non-dengue haemorrhagic fever in South East ...
Full Text Available Delgermaa Demchig, Claudia Mello-Thoms, Patrick C Brennan Medical Image Optimization and Perception Group (MIOPeG, Faculty of Health Science, The University of Sydney, Sydney, NSW, Australia Abstract: Breast cancer is a leading cause of cancer-related death for women in both developed and developing countries. The incidence and mortality of breast cancer in Mongolia, while low compared with other counties, has been increasing on an annual basis. In addition, in Mongolia, approximately 90% of the patients are diagnosed at a late stage, resulting in high mortality, with the majority of individuals diagnosed with breast cancer dying within 5 years of diagnosis. Breast cancer screening plays an important role in reducing mortality in Western countries and has been adopted by a number of Asian countries; however, no such approach exists in Mongolia. In a country of limited resources, implementation of expensive health strategies such as screening requires effective allocations of resources and the identification of the most effective imaging methods. This requirement relies on recent accurate data; however, at this time, there is a paucity of information around breast cancer in Mongolia. Until data around features of the disease are available, effective strategies to diagnose breast cancer that recognize the economic climate in Mongolia cannot be implemented and the impact of breast cancer is likely to increase. Keywords: incidence, mortality, breast screening, Mongolia
Su, Xiaoyou; Liang, Xiaohui; Mao, Zongfu; Sun, Jikuan; Jiang, Yu; Liu, Yuanli; Ren, Minghui
Under the background of globalization, public health issues are becoming more and more complicated. In the international arena, global health has gradually replaced international health and "global public health" as one of the dominant terms in the field of public health. However, until now, there is no unified understanding and definition for the concept of global health domestically and internationally. In this article, various foreign experts 'views and domestic experts' opinions about the concept of global health are collected and solicited, in order to generalize appropriate Chinese definition of global health of China.
Full Text Available Health promotion is very relevant today. There is a global acceptance that health and social wellbeing are determined by many factors outside the health system which include socioeconomic conditions, patterns of consumption associated with food and communication, demographic patterns, learning environments, family patterns, the cultural and social fabric of societies; sociopolitical and economic changes, including commercialization and trade and global environmental change. In such a situation, health issues can be effectively addressed by adopting a holistic approach by empowering individuals and communities to take action for their health, fostering leadership for public health, promoting intersectoral action to build healthy public policies in all sectors and creating sustainable health systems. Although, not a new concept, health promotion received an impetus following Alma Ata declaration. Recently it has evolved through a series of international conferences, with the first conference in Canada producing the famous Ottawa charter. Efforts at promoting health encompassing actions at individual and community levels, health system strengthening and multi sectoral partnership can be directed at specific health conditions. It should also include settings-based approach to promote health in specific settings such as schools, hospitals, workplaces, residential areas etc. Health promotion needs to be built into all the policies and if utilized efficiently will lead to positive health outcomes.
Medicalization analyses have roots in sociology and have critical usefulness for understanding contemporary health issues including the 'post-2015 global health agenda'. Medicalization is more complex than just 'disease mongering'--it is a process and not only an outcome; has both positive and negative elements; can be partial rather than complete; and is often sought or challenged by patients or others in the health field. It is understood to be expanding rather than contracting, plays out at the level of interaction or of definitions and agenda-setting, and is said to be largely harmful and costly to individuals and societies. Medicalization of global health issues would overemphasise the role of health care to health; define and frame issues in relation to disease, treatment strategies, and individual behaviour; promote the role of medical professionals and models of care; find support in industry or other advocates of technologies and pharmaceuticals; and discount social contexts, causes, and solutions. In subsequent articles, three case studies are explored, which critically examine predominant issues on the global health agenda: global mental health, non-communicable disease, and universal health coverage. A medicalization lens helps uncover areas where the global health agenda and its framing of problems are shifted toward medical and technical solutions, neglecting necessary social, community, or political action.
Paulo M. Buss
Full Text Available More than 2,300 public health professionals from around the world attended the 12th World Public Health Congress, in Istanbul, between April 27th and May 1st, 2009. Participants from 120 countries from all corners of the globe advocated for different disciplines and composed an eclectic and propitious audience for a profound discussion on the part each individual – as well as national associations, at the country level, and the Federation, at the global level – plays in facing the challenges currently posed to the field of Public Health.
Cesario, Sandra K; Moran, Barbara
The health and productivity of a global society is dependent upon the elimination of gender inequities that prevent girls from achieving their full potential. Although some progress has been made in reducing social, economic, and health disparities between men and women, gender equality continues to be an elusive goal. The Millennium Development Goals (2000-2015) and the Sustainable Development Goals (2015-2030) include intergovernmental aspirations to empower women and stress that change must begin with the girl child. Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.
Full Text Available Global health networks, webs of individuals and organizations with a shared concern for a particular condition, have proliferated over the past quarter century. They differ in their effectiveness, a factor that may help explain why resource allocations vary across health conditions and do not correspond closely with disease burden. Drawing on findings from recently concluded studies of eight global health networks—addressing alcohol harm, early childhood development (ECD, maternal mortality, neonatal mortality, pneumonia, surgically-treatable conditions, tobacco use, and tuberculosis—I identify four challenges that networks face in generating attention and resources for the conditions that concern them. The first is problem definition: generating consensus on what the problem is and how it should be addressed. The second is positioning: portraying the issue in ways that inspire external audiences to act. The third is coalition-building: forging alliances with these external actors, particularly ones outside the health sector. The fourth is governance: establishing institutions to facilitate collective action. Research indicates that global health networks that effectively tackle these challenges are more likely to garner support to address the conditions that concern them. In addition to the effectiveness of networks, I also consider their legitimacy, identifying reasons both to affirm and to question their right to exert power.
Shang, Chenyu; Beaver, Kinta; Campbell, Malcolm
Incidence rates for breast cancer have increased significantly among Chinese women, accompanied by low utilization of breast screening and delay in symptom presentation. The aims of this study were to explore (1) views on breast cancer and breast health among Chinese women in the United Kingdom and (2) the potential influence of social and cultural context on views and screening behavior. Qualitative interviews were carried out with 22 Chinese women. Pertinent aspects of Grounded Theory methods, including simultaneous data collection and analysis, constant comparison, and memo writing, were used. Four themes emerged: cultural views on breast cancer, information sources and knowledge, breast screening practice, and views on healthcare services. The theme views on breast cancer had 3 subthemes: a fearful disease, taboo, and fatalism. Aspects of traditional Chinese culture had important influences on Chinese women's views on breast cancer. Self-care formed the most significant strategy to promote health and prevent illness. Although the study found high utilization of breast screening when offered, only 6 women reported breast awareness practices. This study found that traditional beliefs were not the sole determinant of breast health behavior. The way in which breast screening services are offered in the United Kingdom may reduce the significance of cultural views and shape individuals' health behavior. Findings indicate that information on breast awareness should be delivered to this group of women in Chinese by health professionals through Chinese mass media.
Brown, Garrett Wallace
This article agrees with recent arguments suggesting that normative and epistemic power is rife within global health policy and provides further examples of such. However, in doing so, it is argued that it is equally important to recognize that global health is, and always will be, deeply political and that some form of power is not only necessary for the system to advance, but also to try and control the ways in which power within that system operates. In this regard, a better focus on health politics can both expose illegitimate sources of power, but also provide better recommendations to facilitate deliberations that can, although imperfectly, help legitimate sources of influence and power. PMID:25674575
Muran, Peter J; Muran, Sandra Y; Beseler, Cheryl L; Cavalieri, Ercole L; Rogan, Eleanor G; Zahid, Muhammad
A functional medicine approach to reduce breast cancer risk is preferable to early detection and treatment in maintaining breast health. Estrogens are implicated in breast cancer initiation through conversion to metabolites that react with DNA to form specific adducts associated with the development of breast cancer. The purpose of this study was to determine the ability of a defined clinical intervention, the AVERTi-Healthy Breast Program (AHBP), to reduce breast cancer risk conditions likely to develop into breast disease. To obtain evidence that risk conditions in breast tissue can be reduced with a defined, multifaceted approach, this small clinical trial of 21 women measured indicators of breast health. A detailed clinical evaluation was conducted with all participants, including identification of physical symptoms, such as areas of tenderness upon palpation. Two laboratory assessments were conducted to determine the efficacy of the AHBP. First, 31 estrogen metabolites, estrogen conjugates, and depurinating estrogen-DNA adducts in urine samples taken before intervention were analyzed. The ratio of DNA adducts to metabolites and conjugates was calculated for each sample. Second, oxidative stress was analyzed by measuring the redox potential of glutathione and cysteine in blood plasma. All assessments were conducted before and after participation. The estrogen adduct ratio and redox potential were improved after 90 days on the AHBP. A significant mean reduction of 3.31 (p=0.03) was observed in the adduct ratio, along with a significant improvement in the redox potential of 3.80 (p=0.05). The significant change in the adduct ratio occurred in women whose oxidative stress profile also improved. These significant within-individual decreases suggest that the AHBP can reduce the risk for breast cancer in a relatively short time.
Drawing on an in-depth analysis of eight global health networks, a recent essay in this journal argued that global health networks face four challenges to their effectiveness: problem definition, positioning, coalition-building, and governance. While sharing the argument of the essay concerned, in this commentary, we argue that these analytical concepts can be used to explicate a concept that has implicitly been used in global health governance scholarship for quite a few years. While already prominent in the discussion of climate change governance, for instance, global health governance scholarship could make progress by looking at global health governance as being polycentric. Concisely, polycentric forms of governance mix scales, mechanisms, and actors. Drawing on the essay, we propose a polycentric approach to the study of global health governance that incorporates coalitionbuilding tactics, internal governance and global political priority as explanatory factors. © 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Minhas Gunjeet S
Full Text Available Abstract Background Experience with public engagement activities regarding the risks and benefits of science and technology (S&T is growing, especially in the industrialized world. However, public engagement in the developing world regarding S&T risks and benefits to explore health issues has not been widely explored. Methods This paper gives an overview about public engagement and related concepts, with a particular focus on challenges and benefits in the developing world. We then describe an Internet-based platform, which seeks to both inform and engage youth and the broader public on global water issues and their health impacts. Finally, we outline a possible course for future action to scale up this and similar online public engagement platforms. Results The benefits of public engagement include creating an informed citizenry, generating new ideas from the public, increasing the chances of research being adopted, increasing public trust, and answering ethical research questions. Public engagement also fosters global communication, enables shared experiences and methodology, standardizes strategy, and generates global viewpoints. This is especially pertinent to the developing world, as it encourages previously marginalized populations to participate on a global stage. One of the core issues at stake in public engagement is global governance of science and technology. Also, beyond benefiting society at large, public engagement in science offers benefits to the scientific enterprise itself. Conclusion Successful public engagement with developing world stakeholders will be a critical part of implementing new services and technologies. Interactive engagement platforms, such as the Internet, have the potential to unite people globally around relevant health issues.
Delpech, Paula Alexander; Haynes-Smith, Glenenna
Breast cancer incidence and mortality are rising in Grenada, and there is a lack of knowledge about women's beliefs about breast self-examination (BSE). The objective of this study was to quantify and identify patterns of beliefs about health and BSE in Grenadian women to help plan targeted community interventions. In this descriptive cross-sectional study of 110 women in a community parish in Grenada, sociodemographic data and health beliefs were collected using a self-administered questionnaire. The Champion revised Health Belief Model Scale was used to measure general health motivation (5 items), perceived susceptibility to breast cancer (4 items), seriousness of breast cancer (7 items), confidence in performing BSE (7 items), benefits of BSE (2 items), and barriers to BSE (6 items). Younger women were motivated to perform BSE (P = .018), and divorced/separated/widowed women felt more susceptible to breast cancer (P = .014) but perceived fewer benefits in performing BSE (P = .032). Women who did not attend church were more motivated (P = .015) and saw greater benefit (P = .033) in BSE. Frequent church attendees perceived that they were more susceptible (P = .01), were less confident (P women in Grenada with belief patterns and sociodemographic characteristics that may benefit from targeted community intervention, perhaps in partnership with other stakeholders such as the church. Beliefs about health and BSE affect BSE uptake and are culture dependent. These data help identify the at-risk population to guide the development of targeted community-based and culturally appropriate breast screening programs.
Kim, Yoonseo; Han, Kihye; Yoo, Hae Young
As the need for greater global health competency increases for health care professionals in South Korea, educational efforts for nursing students have begun. This study examined the effectiveness of two educational courses for freshmen and sophomores that were designed to improve students' global health competencies. A trend study was conducted for all undergraduate nursing students enrolled in a 4-year undergraduate nursing program in 2013 and 2014. We assessed students' global health competencies (1-knowledge and interests in global health and health equity, 2-global health skills, and 3-learning needs) in 2013 and 2014 and analyzed variance between mean scores by year and by course exposure, using 95% confidence intervals. Students who took both global health courses (sophomores in both years) reported higher global health-related knowledge and interests than did freshmen (p students' global health competencies. Reinforcement of knowledge in later courses may be needed to build on the global competencies. © 2017 Wiley Periodicals, Inc.
Full Text Available This book review examines Mollura and Lungren’s (eds. Radiology in Global Health: Strategies, Implementation, and Applications (2014. The contributors have attempted to investigate root causes for radiological service-related disparity that exists between prosperous economies and low- and middle-income countries. The book is clearly geared towards manufacturing consent among stakeholders through research-based evidence to amplify the role of radiology in global healthcare through initiation, implementation, amelioration, and developing sustainable solutions for rollout of essential diagnostic/therapeutic radiology services at population levels. This includes reducing access gaps for radiology/imaging services within industrialized countries as well.
Chang, Chia-Lin; McAleer, Michael
textabstractThe paper presents an overview of recent topical research on global, energy, health & medical, and tourism economics, and global software. We have interpreted “global” in the title of the Journal of Reviews on Global Economics to cover contributions that have a global impact on economics, thereby making it “global economics”. In this sense, the paper is concerned with papers on global, energy, health & medical, and tourism economics, as well as global software algorithms that have...
This article takes a historical perspective on the changing position of WHO in the global health architecture over the past two decades. From the early 1990s a number of weaknesses within the structure and governance of the World Health Organization were becoming apparent, as a rapidly changing post Cold War world placed more complex demands on the international organizations generally, but significantly so in the field of global health. Towards the end of that decade and during the first half of the next, WHO revitalized and played a crucial role in setting global health priorities. However, over the past decade, the organization has to some extent been bypassed for funding, and it lost some of its authority and its ability to set a global health agenda. The reasons for this decline are complex and multifaceted. Some of the main factors include WHO's inability to reform its core structure, the growing influence of non-governmental actors, a lack of coherence in the positions, priorities and funding decisions between the health ministries and the ministries overseeing development assistance in several donor member states, and the lack of strong leadership of the organization. Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Watts, Tessa; Merrell, Joy; Murphy, Fiona; Williams, Angela
For women from minority ethnic groups to make informed decisions about their health, and particularly about whether to participate in breast cancer screening programmes, access to a range of appropriately designed high quality, culturally-specific and sensitive health information is needed. Through a critical review of the literature, this paper aims to determine the breast health and breast cancer screening information needs of women from minority ethnic groups and to discuss the implications of cultural difference for nurses in relation to the development and dissemination of health information. A critical review of the research literature published in English between 1996 and 2002 was conducted. Electronic and the relevant Cochrane Collaboration databases were searched using a range of search terms to retrieve literature specifically relevant to the aims of the review. The use of personal contacts and posting a request for information on the mailing list at firstname.lastname@example.org facilitated the retrieval of grey literature. All references retrieved were entered on a bibliographic database. The title and abstract of each was examined to assess it for inclusion in the review. There was little published information about specific breast cancer screening information needs from the perspective of women from minority ethnic groups. In comparison with the indigenous population, the information needs of people from minority ethnic groups differ in relation to their cultural beliefs and values and the effects of these on health care practices. Inadequate knowledge about breast health and breast cancer screening may be a consequence of the provision of insufficient or culturally inappropriate information. There is a dearth of research highlighting breast health and breast cancer screening information needs of women from minority ethnic groups. In providing information, their needs appear to have been an 'add on'. Health care professionals' lack of
Ahdoot, Samantha; Pacheco, Susan E
Rising global temperature is causing major physical, chemical, and ecological changes across the planet. There is wide consensus among scientific organizations and climatologists that these broad effects, known as climate change, are the result of contemporary human activity. Climate change poses threats to human health, safety, and security. Children are uniquely vulnerable to these threats. The effects of climate change on child health include physical and psychological sequelae of weather disasters, increased heat stress, decreased air quality, altered disease patterns of some climate-sensitive infections, and food, water, and nutrient insecurity in vulnerable regions. Prompt implementation of mitigation and adaptation strategies will protect children against worsening of the problem and its associated health effects. This technical report reviews the nature of climate change and its associated child health effects and supports the recommendations in the accompanying policy statement on climate change and children's health. Copyright © 2015 by the American Academy of Pediatrics.
Ali, S Harris
The prejudicial linking of infection with ethnic minority status has a long-established history, but in some ways this association may have intensified under the contemporary circumstances of the "new public health" and globalization. This study analyzes this conflation of ethnicity and disease victimization by considering the stigmatization process that occurred during the 2003 outbreak of Severe Acute Respiratory Syndrome (SARS) in Toronto. The attribution of stigma during the SARS outbreak occurred in multiple and overlapping ways informed by: (i) the depiction of images of individuals donning respiratory masks; (ii) employment status in the health sector; and (iii) Asian-Canadian and Chinese-Canadian ethnicity. In turn, stigmatization during the SARS crisis facilitated a moral panic of sorts in which racism at a cultural level was expressed and rationalized on the basis of a rhetoric of the new public health and anti-globalization sentiments. With the former, an emphasis on individualized self-protection, in the health sense, justified the generalized avoidance of those stigmatized. In relation to the latter, in the post-9/11 era, avoidance of the stigmatized other was legitimized on the basis of perceiving the SARS threat as a consequence of the mixing of different people predicated by economic and cultural globalization.
Tang, Kun; Li, Zhihui; Li, Wenkai; Chen, Lincoln
In 2013, China proposed its Belt and Road Initiative to promote trade, infrastructure, and commercial associations with 65 countries in Asia, Africa, and Europe. This initiative contains important health components. Simultaneously, China launched an unprecedented overseas intervention against Ebola virus in west Africa, dispatching 1200 workers, including Chinese military personnel. The overseas development assistance provided by China has been increasing by 25% annually, reaching US$7 billion in 2013. Development assistance for health from China has particularly been used to develop infrastructure and provide medical supplies to Africa and Asia. China's contributions to multilateral organisations are increasing but are unlikely to bridge substantial gaps, if any, vacated by other donors; China is creating its own multilateral funds and banks and challenging the existing global architecture. These new investment vehicles are more aligned with the geography and type of support of the Belt and Road Initiative. Our analysis concludes that China's Belt and Road Initiative, Ebola response, development assistance for health, and new investment funds are complementary and reinforcing, with China shaping a unique global engagement impacting powerfully on the contours of global health. Copyright © 2017 Elsevier Ltd. All rights reserved.
Rising global temperatures are causing major physical, chemical, and ecological changes in the planet. There is wide consensus among scientific organizations and climatologists that these broad effects, known as "climate change," are the result of contemporary human activity. Climate change poses threats to human health, safety, and security, and children are uniquely vulnerable to these threats. The effects of climate change on child health include: physical and psychological sequelae of weather disasters; increased heat stress; decreased air quality; altered disease patterns of some climate-sensitive infections; and food, water, and nutrient insecurity in vulnerable regions. The social foundations of children's mental and physical health are threatened by the specter of far-reaching effects of unchecked climate change, including community and global instability, mass migrations, and increased conflict. Given this knowledge, failure to take prompt, substantive action would be an act of injustice to all children. A paradigm shift in production and consumption of energy is both a necessity and an opportunity for major innovation, job creation, and significant, immediate associated health benefits. Pediatricians have a uniquely valuable role to play in the societal response to this global challenge. Copyright © 2015 by the American Academy of Pediatrics.
Ooms, Gorik; Hammonds, Rachel
Global constitutionalism is a way of looking at the world, at global rules and how they are made, as if there was a global constitution, empowering global institutions to act as a global government, setting rules which bind all states and people. This essay employs global constitutionalism to examine how and why global health governance, as currently structured, has struggled to advance the right to health, a fundamental human rights obligation enshrined in the International Covenant on Economic, Social and Cultural Rights. It first examines the core structure of the global health governance architecture, and its evolution since the Second World War. Second, it identifies the main constitutionalist principles that are relevant for a global constitutionalism assessment of the core structure of the global health governance architecture. Finally, it applies these constitutionalist principles to assess the core structure of the global health governance architecture. Leading global health institutions are structurally skewed to preserve high incomes countries' disproportionate influence on transnational rule-making authority, and tend to prioritise infectious disease control over the comprehensive realisation of the right to health. A Framework Convention on Global Health could create a classic division of powers in global health governance, with WHO as the law-making power in global health governance, a global fund for health as the executive power, and the International Court of Justice as the judiciary power.
Gable, Lance; Meier, Benjamin Mason
The Framework Convention on Global Health (FCGH) represents an important idea for addressing the expanding array of governance challenges in global health. Proponents of the FCGH suggest that it could further the right to health through its incorporation of rights into national laws and policies, using litigation and community empowerment to advance rights claims and prominently establish the right to health as central to global health governance. Building on efforts to expand development and influence of the right to health through the implementation of the FCGH, in this article we find that human rights correspondingly holds promise in justifying the FCGH. By employing human rights as a means to develop and implement the FCGH, the existing and evolving frameworks of human rights can complement efforts to reform global health governance, with the FCGH and human rights serving as mutually reinforcing bases of norms and accountability in global health. Copyright © 2013 Gable and Meier. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.
Full Text Available En este artículo se exploran diversos aspectos de la relación entre salud y globalización. Se consideran diferentes dimensiones de la globalización (económica, tecnológica, cultural y política y se discuten sus consecuencias sobre la salud en términos epidemiológicos, éticos, sanitarios, ambientales y en relación con la distribución del poder y la equidad. Se analizan datos que evidencian la globalización de los riesgos y las enfermedades, atribuibles al actual modelo de relaciones internacionales y a la movilidad entre países. En el artículo se defiende la propuesta de globalizar la salud, integrando conceptos renovados y adelantos en las ciencias afines a la salud pública con nuevas estrategias políticas, sociales y organizativas de la práctica sanitaria. Finalmente, se reconocen las oportunidades que nos brinda la globalización, desde mediados del siglo pasado, para redefinir la gobernabilidad mundial y desarrollar movimientos locales, basados en la solidaridad y en una nueva concepción política que favorezcan la universalización de la salud.In this article diverse aspects of the relationship between health and globalization are explored. Different dimensions of globalization (economic, technological, cultural and political are considered. Aspects of its effects on health (epidemiological, ethical and environmental, as well as its relationship with public health, power distribution and equity are discussed. Data that demonstrate the globalization of risks and of diseases, due to the current model of international relations and geographical mobility, are analyzed. The article defends the globalization of health and integrates renewed concepts and scientific advances in public health with politics, social strategies and new organizational forms of the practice of public health. Finally, we discuss the opportunities that have been provided by globalization since the middle of the last century for redefining world government
Pratt, Bridget; Hyder, Adnan A
Global health research partnerships are increasingly taking the form of consortia of institutions from high-income countries and low- and middle-income countries that undertake programs of research. These partnerships differ from collaborations that carry out single projects in the multiplicity of their goals, scope of their activities, and nature of their management. Although such consortia typically aim to reduce health disparities between and within countries, what is required for them to do so has not been clearly defined. This article takes a conceptual approach to explore how the governance of transnational global health research consortia should be structured to advance health equity. To do so, it applies an account called shared health governance to derive procedural and substantive guidance. A checklist based on this guidance is proposed to assist research consortia determine where their governance practices strongly promote equity and where they may fall short.
Vermund, Sten H; Sahasrabuddhe, Vikrant V; Khedkar, Sheetal; Jia, Yujiang; Etherington, Carol; Vergara, Alfredo
The Institute for Global Health at Vanderbilt enables the expansion and coordination of global health research, service, and training, reflecting the university's commitment to improve health services and outcomes in resource-limited settings. Global health encompasses both prevention via public health and treatment via medical care, all nested within a broader community-development context. This has fostered university-wide collaborations to address education, business/economics, engineering, nursing, and language training, among others. The institute is a natural facilitator for team building and has been especially helpful in organizing institutional responses to global health solicitations from the National Institutes of Health (NIH), Centers for Disease Control (CDC), and other funding agencies. This center-without-walls philosophy nurtures noncompetitive partnerships among and within departments and schools. With extramural support from the NIH and from endowment and developmental investments from the school of medicine, the institute funds new pilot projects to nurture global educational and research exchanges related to health and development. Vanderbilt's newest programs are a CDC-supported HIV/AIDS service initiative in Africa and an overseas research training program for health science graduate students and clinical fellows. New opportunities are available for Vanderbilt students, staff, and faculty to work abroad in partnership with international health projects through a number of Tennessee institutions now networked with the institute. A center-without-walls may be a model for institutions contemplating strategic investments to better organize service and teaching opportunities abroad, and to achieve greater successes in leveraging extramural support for overseas and domestic work focused on tropical medicine and global health.
Kollar, Eszter; Laukötter, Sebastian; Buyx, Alena
One of the most ambitious and sophisticated recent approaches to provide a theory of global health justice is Sridhar Venkatapuram's recent work. In this commentary, we first outline the core idea of Venkatapuram's approach to global health justice. We then argue that one of the most important elements of the account, Venkatapuram's basis of global health duties, is either too weak or assumed implicitly without a robust justification. The more explicit grounding of the duty to protect and promote health capabilities is based on Martha Nussbaum's version of the capability approach. We argue that this foundation gives rise to humanitarian duties rather than duties of justice proper. Venkatapuram's second argument from the social determinants of health thesis is instead a stronger candidate for grounding duties of justice. However, as a justificatory argument, it is only alluded to and has not yet been spelled out sufficiently. We offer plausible justificatory steps to fill this gap and draw some implications for global health action. We believe this both strengthens Venkatapuram's approach and serves to broaden the basis for future action in the area of global health. © 2016 John Wiley & Sons Ltd.
Full Text Available Abstract The tremendous benefits which have been conferred to almost 5 billion people through improved technologies and knowledge highlights the concomitant challenge of bringing these changes to the 1 billion people living mostly in sub-Saharan Africa and South Asia who are yet to benefit. There is a growing awareness of the need to reduce human suffering and of the necessary participation of governments, non-government organizations and industry within this process. This awareness has recently translated into new funding mechanisms to address HIV/Aids and vaccines, a global push for debt relief and better trade opportunities for the poorest countries, and recognition of how global norms that address food safety, infectious diseases and tobacco benefit all. 'Globalization and Health' will encourage an exchange of views on how the global architecture for health governance needs to changes in the light of global threats and opportunities.
The Constitution of the World Health Organization (1946) states that the "enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social position." The international legal framework for this right was laid by the Universal Declaration of Human Rights (1948) and reaffirmed in the International Covenant on Economic, Social, and Cultural Rights (1966) and the Declaration of Alma-Ata (1978). In recent years, the framework has been developed on 10 key elements: national and international human rights, laws, norms, and standards; resource constraints and progressive realization; obligations of immediate effect; freedoms and entitlements; available, accessible, acceptable, and good quality; respect, protect, and fulfill; non-discrimination, equality, and vulnerability; active and informed participation; international assistance and cooperation; and monitoring and accountability. Whereas public health law plays an essential role in the protection and promotion of the right to health, the emergence of SARS (2003) highlighted the urgent need to reform national public health laws and international obligations relating to public health in order to meet the new realities of a globalized world, leading to the WHO Framework Convention on Tobacco Control (2003) and the revision of the WHO International Health Regulations (2005). The Asian Institute for Bioethics and Health Law, in conjunction with the Republic of Korea's Ministry of Health and Welfare and the WHO International Digest of Health Legislation, conducted a comparative legal analysis of national public health laws in various countries through a project entitled Domestic Profiles of Public/Population Health Legislation (2006), which underscored the importance of recognizing the political and social contexts of distinct legal cultures, including Western, Asian, Islamic, and African.
Full Text Available Abstract The impact of increased national wealth, as measured by Gross Domestic Product (GDP, on public health is widely understood, however an equally important but less well-acclaimed relationship exists between improvements in health and the growth of an economy. Communicable diseases such as HIV, TB, Malaria and the Neglected Tropical Diseases (NTDs are impacting many of the world's poorest and most vulnerable populations, and depressing economic development. Sickness and disease has decreased the size and capabilities of the workforce through impeding access to education and suppressing foreign direct investment (FDI. There is clear evidence that by investing in health improvements a significant increase in GDP per capita can be attained in four ways: Firstly, healthier populations are more economically productive; secondly, proactive healthcare leads to decrease in many of the additive healthcare costs associated with lack of care (treating opportunistic infections in the case of HIV for example; thirdly, improved health represents a real economic and developmental outcome in-and-of itself and finally, healthcare spending capitalises on the Keynesian 'economic multiplier' effect. Continued under-investment in health and health systems represent an important threat to our future global prosperity. This editorial calls for a recognition of health as a major engine of economic growth and for commensurate investment in public health, particularly in poor countries.
Lencucha, Raphael; Mohindra, Katia
Global health education is becoming increasingly prominent in North America. It is widely agreed upon that global health is an important aspect of an education in the health sciences and increasingly in other disciplines such as law, economics and political science. There is currently a paucity of studies examining the content of global health courses at the post-secondary level. The purpose of our research is to identify the content areas being covered in global health curricula in North American universities, as a first step in mapping global health curricula across North America. We collected 67 course syllabi from 31 universities and analyzed the topics covered in the course. This snapshot of global health education will aid students searching for global health content, as well as educators and university administrators who are developing or expanding global health programs in Canada and the United States.
Keim-Malpass, Jessica; Doede, Aubrey; Kennedy, Christine; Showalter, Shayna L
Health literacy is recognized as an integral component of high-quality health care. However, health literacy has been understudied in the context of cancer care delivery and surgical decision making. The goal of this article is to outline a process for implementation of a health literacy screening assessment within the routine practices of an academic breast surgical oncology clinic. The self-reported health literacy assessment is feasible, particularly with integration of the health literacy screen in the electronic health record. The authors' estimated clinic prevalence of low health literacy was 22%, which has numerous implications for communication and shared decision-making processes. .
Martin, Paul; Duffy, Tim; Johnston, Brian; Banks, Pauline; Harkess-Murphy, Eileen; Martin, Colin R
The European Family Health Nursing Project is a revitalized World Health Organization initiative led by the University of the West of Scotland. Partner countries include Armenia, Austria, Germany, Italy, Poland, Portugal, Romania, Slovenia, and Spain. European Union Lifelong Learning funding was received in 2011 to facilitate a consistency of approach in the development of a definition of family health nursing, required core competencies and capabilities, and consequent education and training requirements. Global health challenges have informed the development of the project: increasingly aging populations, the increasing incidence in noncommunicable diseases that are currently the main cause of death, and the significant progress made in the way health systems have developed to meet the demands in relation to access and equality of health services. Governments and policy makers should develop a health workforce based on the principles of teamwork and interdisciplinarity while recognizing the core contribution of the "specialist generalist" role in the primary care setting.
Van Puymbroeck, Marieke; Burk, Brooke N; Shinew, Kimberly J; Cronan Kuhlenschmidt, Megan; Schmid, Arlene A
The purpose of this paper is to describe the health benefits reported by breast cancer survivors following an 8-week yoga intervention. This phenomenological study employed three focus groups with six breast cancer survivors each (n = 18) following the yoga intervention. The focus groups and yoga classes were conducted in a large hospital in a midsized town in the Midwest. Eighteen female breast cancer survivors who were at least 9 months posttreatment participated in the focus groups following the 8-week yoga intervention. An 8-week yoga intervention designed specifically for this population was led by a yoga therapist. A semistructured interview guide was utilized to guide each focus group. Interpretative phenomenological analysis methods were employed to explore breast cancer survivors' experiences after participating in an 8-week yoga intervention. The findings revealed that the women in the study found health promoting benefits in the areas of physical health and healing, mental health and healing, and social health and healing. Yoga may be an important tool in the healing process for breast cancer survivors.
Labonté, Ronald; Schrecker, Ted
This article is the third in a three-part review of research on globalization and the social determinants of health (SDH). In the first article of the series, we identified and defended an economically oriented definition of globalization and addressed a number of important conceptual and metholodogical issues. In the second article, we identified and described seven key clusters of pathways relevant to globalization's influence on SDH. This discussion provided the basis for the premise from which we begin this article: interventions to reduce health inequities by way of SDH are inextricably linked with social protection, economic management and development strategy. Reflecting this insight, and against the background of the Millennium Development Goals (MDGs), we focus on the asymmetrical distribution of gains, losses and power that is characteristic of globalization in its current form and identify a number of areas for innovation on the part of the international community: making more resources available for health systems, as part of the more general task of expanding and improving development assistance; expanding debt relief and taking poverty reduction more seriously; reforming the international trade regime; considering the implications of health as a human right; and protecting the policy space available to national governments to address social determinants of health, notably with respect to the hypermobility of financial capital. We conclude by suggesting that responses to globalization's effects on social determinants of health can be classified with reference to two contrasting visions of the future, reflecting quite distinct values.
Arora, Gitanjli; Russ, Christiana; Batra, Maneesh; Butteris, Sabrina M; Watts, Jennifer; Pitt, Michael B
Although there has been rapid growth in global health educational experiences over the last two decades, the flow of learners remains overwhelmingly one directional; providers from high-resourced settings travel to limited-resourced environments to participate in clinical care, education, and/or research. Increasingly, there has been a call to promote parity in partnerships, including the development of bidirectional exchanges, where trainees from each institution travel to the partner's setting to learn from and teach each other. As global health educators and steering committee members of the Association of Pediatric Program Directors Global Health Pediatric Education Group, we endorse the belief that we must move away from merely sending learners to international partner sites and instead become true global health partners offering equitable educational experiences. In this article, we summarize the benefits, review common challenges, and highlight solutions to hosting and providing meaningful global health experiences for learners from limited-resourced partner institutions to academic health centers in the United States.
Evans, Retta R.; Horton, Jacqueline A.; Ahmad, Wajih A.; Davies, Susan L.; Snyder, Scott W.; Macrina, David M.
Purpose: A breast health educational program was administered in two public high school settings in north Alabama to subjects enrolled in health related courses. The purpose of this quasi-experimental study was to determine if teaching breast health with or without interactive learning would affect the breast health knowledge and beliefs of…
Full Text Available With the achievements, failures and passing of the Millennium Development Goals (MDG, the world has turned its eyes to the Sustainable Development Goals (SDG, designed to foster sustainable social, economic and environmental development over the next 15 years.(1 Community-led initiatives are increasingly being recognised as playing a key role in realising sustainable community development and in the aspirations of universal healthcare.(2 In many parts of the world, faith-based organisations are some of the main players in community-led development and health care.(3 Community Health Global Network (CHGN creates links between organisations, with the purpose being to encourage communities to recognise their assets and abilities, identify shared concerns and discover solutions together, in order to define and lead their futures in sustainable ways.(4 CHGN has facilitated the development of collaborative groups of health and development initiatives called ‘Clusters’ in several countries including India, Bangladesh, Kenya, Tanzania, Zambia and Myanmar. In March 2016 these Clusters met together in an International Forum, to share learnings, experiences, challenges, achievements and to encourage one another. Discussions held throughout the forum suggest that the CHGN model is helping to promote effective, sustainable development and health care provision on both a local and a global scale.
Demchig, Delgermaa; Mello-Thoms, Claudia; Brennan, Patrick C
Breast cancer is a leading cause of cancer-related death for women in both developed and developing countries. The incidence and mortality of breast cancer in Mongolia, while low compared with other counties, has been increasing on an annual basis. In addition, in Mongolia, approximately 90% of the patients are diagnosed at a late stage, resulting in high mortality, with the majority of individuals diagnosed with breast cancer dying within 5 years of diagnosis. Breast cancer screening plays an important role in reducing mortality in Western countries and has been adopted by a number of Asian countries; however, no such approach exists in Mongolia. In a country of limited resources, implementation of expensive health strategies such as screening requires effective allocations of resources and the identification of the most effective imaging methods. This requirement relies on recent accurate data; however, at this time, there is a paucity of information around breast cancer in Mongolia. Until data around features of the disease are available, effective strategies to diagnose breast cancer that recognize the economic climate in Mongolia cannot be implemented and the impact of breast cancer is likely to increase.
Building on the successful eradication of smallpox, the World. Health Organisation, together with other agencies, is now moving quickly to the eradication of poliomyelitis, originally aimed for the year 2000. Plans for the subsequent global eradication of measles are in an advanced stage. Eradication of both polio and ...
Building on the successful eraclication of smallpox, the World Health Organisation, together with other agencies, is now moving quickly to the eradication of poliomyelitis, originally aimed for the year 2000. Plans for the subsequent global eradication of measles are in an advanced stage. Eradication of both polio and ...
Magnusson Roger S
Full Text Available Abstract This paper assesses progress in the development of a global framework for responding to non-communicable diseases, as reflected in the policies and initiatives of the World Health Organization (WHO, World Bank and the UN: the institutions most capable of shaping a coherent global policy. Responding to the global burden of chronic disease requires a strategic assessment of the global processes that are likely to be most effective in generating commitment to policy change at country level, and in influencing industry behaviour. WHO has adopted a legal process with tobacco (the WHO Framework Convention on Tobacco Control, but a non-legal, advocacy-based approach with diet and physical activity (the Global Strategy on Diet, Physical Activity and Health. The paper assesses the merits of the Millennium Development Goals (MDGs and the FCTC as distinct global processes for advancing health development, before considering what lessons might be learned for enhancing the implementation of the Global Strategy on Diet. While global partnerships, economic incentives, and international legal instruments could each contribute to a more effective global response to chronic diseases, the paper makes a special case for the development of international legal standards in select areas of diet and nutrition, as a strategy for ensuring that the health of future generations does not become dependent on corporate charity and voluntary commitments. A broader frame of reference for lifestyle-related chronic diseases is needed: one that draws together WHO's work in tobacco, nutrition and physical activity, and that envisages selective use of international legal obligations, non-binding recommendations, advocacy and policy advice as tools of choice for promoting different elements of the strategy.
2008. Key activities will include mobilizing Canadian investment in global health research, building global health research capacity in Canada and LMICs, translating research into action, nurturing partnerships between researchers in Canada ...
Rayess, Fadya El; Filip, Anna; Doubeni, Anna; Wilson, Calvin; Haq, Cynthia; Debay, Marc; Anandarajah, Gowri; Heffron, Warren; Jayasekera, Neil; Larson, Paul; Dahlman, Bruce; Valdman, Olga; Hunt, Vince
Many US medical schools and family medicine departments have responded to a growing interest in global health by developing global health fellowships. However, there are no guidelines or consensus statements outlining competencies for global health fellows. Our objective was to develop a mission and core competencies for Family Medicine Global Health Fellowships. A modified Delphi technique was used to develop consensus on fellowship competencies. A panel, comprised of 13 members with dual expertise in global health and medical education, undertook an iterative consensus process, followed by peer review, from April to December 2014. The panel developed a mission statement and identified six domains for family medicine global health fellowships: patient care, medical knowledge, professionalism, communication and leadership, teaching, and scholarship. Each domain includes a set of core and program-specific competencies. The family medicine global health competencies are intended to serve as an educational framework for the design, implementation, and evaluation of individual family medicine global health fellowship programs.
Yefremov, D V; Jyliyaeva, E P
The article demonstrates the impact of globalization on development of public health legislation at the international level and in particular countries. The legislation is considered as a tool to decrease the globalization health risks for population
Clark, William C.; Szlezak, Nicole Alexandra; Moon, Suerie; Bloom, Barry R.; Gerald T Keusch; Catherine M Michaud; Jamison, Dean T.; Frenk, Julio; Kilama, Wen L
The global health system is in a period of rapid transition, with an upsurge of funds and greater political recognition, a broader range of health challenges, many new actors, and the rules, norms and expectations that govern them in flux. The traditional actors on the global health stage—most notably national health ministries, the World Health Organization (WHO) and a relatively small group of national medical research agencies and foundations funding global health research—are now being jo...
Moon, Suerie; Røttingen, John-Arne; Frenk, Julio
Since at least the 1990s, there has been growing recognition that societies need global public goods (GPGs) in order to protect and promote public health. While the term GPG is sometimes used loosely to denote that which is 'good' for the global public, we restrict our use of the term to its technical definition (goods that are non-excludable and non-rival in consumption) for its useful analytical clarity. Examples of important GPGs for health include standards and guidelines, research on the causes and treatment of disease, and comparative evidence and analysis. While institutions for providing public goods are relatively well developed at the national level - being clearly recognized as a responsibility of sovereign states - institutional arrangements to do so remain fragmented and thin at the global level. For example, the World Health Organization, mandated to provide many GPGs, is not appropriately financed to do so. Three steps are needed to better govern the financing and provision of GPGs for health: first, improved data to develop a clearer picture of how much money is currently going to providing which types of GPGs; second, a legitimate global political process to decide upon priority missing GPGs, followed by estimates of total amounts needed; and third, financing streams for GPGs from governments and private sources, to be channeled through new or existing institutions. Financing should go toward fully financing some GPGs, complementing or supplementing existing national or international financing for others, or deploying funds to make potential GPGs less 'excludable' by putting them into the public domain. As globalization deepens the degree of interdependence between countries and as formerly low-income economies advance, there may be less relative need for development assistance to meet basic health care needs, and greater relative need to finance GPGs. Strengthening global arrangements for GPGs today is a worthy investment for improved global
Lelièvre, Sophie A; Weaver, Connie M
The gene-environment interaction is paramount in light of the worldwide rise in incidence of chronic diseases, with cancers in the pole position. Diet is an environmental factor with potential to influence cancer onset by shaping the epigenome (i.e., the genome organization that controls the differential expression of genes). Yet, there is no consensus regarding how diet might help prevent breast cancer, the second most frequent malignancy globally. The complexity of breast cancers requires working on a global and multidisciplinary scale to further understand the relationship between breast cancer type, diet, and the epigenome. This article describes the International Breast Cancer & Nutrition collaboration as one such approach. A global endeavor brings the diversity necessary to pinpoint important diet-gene relationships. Being developed are models, detection and assessment tools, and funding and public policy frameworks necessary to advance primary prevention research for the benefit of all populations affected by breast cancer. This paradigm can be adapted to understanding diet-gene relationships for other chronic diseases. © 2013 International Life Sciences Institute.
Gondek, Matthew; Shogan, May; Saad-Harfouche, Frances G; Rodriguez, Elisa M; Erwin, Deborah O; Griswold, Kim; Mahoney, Martin C
This project assessed the impact of a community-based educational program on breast cancer knowledge and screening among Buffalo (NY) immigrant and refugee females. Program participants completed language-matched pre- and post-test assessments during a single session educational program; breast cancer screening information was obtained from the mobile mammography unit to which participants were referred. Pre- and post-test knowledge scores were compared to assess changes in responses to each of the six individual knowledge items, as well as overall. Mammogram records were reviewed to identify Breast Imaging Reporting and Data System (BI-RADS) scores. The proportion of correct responses to each of the six knowledge items increased significantly on the post-program assessments; 33 % of women >40 years old completed mammograms. The findings suggest that a health education program for immigrant and refugee women, delivered in community-based settings and involving interpreters, can enhance breast cancer knowledge and lead to improvements in mammography completion.
Woodward, D.; Drager, N.; Beaglehole, R; Lipson, D.
Globalization is a key challenge to public health, especially in developing countries, but the linkages between globalization and health are complex. Although a growing amount of literature has appeared on the subject, it is piecemeal, and suffers from a lack of an agreed framework for assessing the direct and indirect health effects of different aspects of globalization. This paper presents a conceptual framework for the linkages between economic globalization and health, with the intention ...
Mackey, Tim K; Liang, Bryan A
Corruption is a serious threat to global health outcomes, leading to financial waste and adverse health consequences. Yet, forms of corruption impacting global health are endemic worldwide in public and private sectors, and in developed and resource-poor settings alike. Allegations of misuse of funds and fraud in global health initiatives also threaten future investment. Current domestic and sectorial-level responses are fragmented and have been criticized as ineffective. In order to address this issue, we propose a global health governance framework calling for international recognition of "global health corruption" and development of a treaty protocol to combat this crucial issue.
The Canadian Coalition for Global Health Research (CCGHR) is a not-for-profit organization dedicated to supporting research for global health equity. The CCGHR provides a networking and action platform for the Canadian global health research community and partners in low- and middle-income countries. This grant will ...
Maruthappu, Mahiben; Watkins, Johnathan A; Waqar, Mueez; Williams, Callum; Ali, Raghib; Atun, Rifat; Faiz, Omar; Zeltner, Thomas
The global economic crisis has been associated with increased unemployment, reduced health-care spending and adverse health outcomes. Insights into the impact of economic variations on cancer mortality, however, remain limited. We used multivariate regression analysis to assess how changes in unemployment and public-sector expenditure on health care (PSEH) varied with female breast cancer mortality in the 27 European Union member states from 1990 to 2009. We then determined how the association with unemployment was modified by PSEH. Country-specific differences in infrastructure and demographic structure were controlled for, and 1-, 3-, 5- and 10-year lag analyses were conducted. Several robustness checks were also implemented. Unemployment was associated with an increase in breast cancer mortality [P unemployment rises (P unemployment and breast cancer mortality remained in all robustness checks. Rises in unemployment are associated with significant short- and long-term increases in breast cancer mortality, while increases in PSEH are associated with reductions in breast cancer mortality. Initiatives that bolster employment and maintain total health-care expenditure may help minimize increases in breast cancer mortality during economic crises. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
Kim, Jim Yong; Farmer, Paul; Porter, Michael E
Initiatives to address the unmet needs of those facing both poverty and serious illness have expanded significantly over the past decade. But many of them are designed in an ad-hoc manner to address one health problem among many; they are too rarely assessed; best practices spread slowly. When assessments of delivery do occur, they are often narrow studies of the cost-effectiveness of a single intervention rather than the complex set of them required to deliver value to patients and their families. We propose a framework for global health-care delivery and evaluation by considering efforts to introduce HIV/AIDS care to resource-poor settings. The framework introduces the notion of care delivery value chains that apply a systems-level analysis to the complex processes and interventions that must occur, across a health-care system and over time, to deliver high-value care for patients with HIV/AIDS and cooccurring conditions, from tuberculosis to malnutrition. To deliver value, vertical or stand-alone projects must be integrated into shared delivery infrastructure so that personnel and facilities are used wisely and economies of scale reaped. Two other integrative processes are necessary for delivering and assessing value in global health: one is the alignment of delivery with local context by incorporating knowledge of both barriers to good outcomes (from poor nutrition to a lack of water and sanitation) and broader social and economic determinants of health and wellbeing (jobs, housing, physical infrastructure). The second is the use of effective investments in care delivery to promote equitable economic development, especially for those struggling against poverty and high burdens of disease. We close by reporting our own shared experience of seeking to move towards a science of delivery by harnessing research and training to understand and improve care delivery. Copyright © 2013 Elsevier Ltd. All rights reserved.
Physical activity is recommended after breast cancer surgery. Fencing is a sport that is well suited to combatting fatigue, pain and reduced arm mobility. A healthcare executive, herself a fencer, puts the benefits of this sport into perspective, both physically and psychologically. Copyright © 2017. Publié par Elsevier Masson SAS.
Bjegovic-Mikanovic, Vesna; Jovic-Vranes, Aleksandra; Czabanowska, Katarzyna; Otok, Robert
At the present time, higher education institutions dealing with education for public health in Europe and beyond are faced with a complex and comprehensive task of responding to global health challenges. Literature reviews in public health and global health and exploration of internet presentations of regional and global organisations dealing with education for public health were the main methods employed in the work presented in this paper. Higher academic institutions are searching for appropriate strategies in competences-based education, which will increase the global attractiveness of their academic programmes and courses for continuous professional development. Academic professionals are taking advantage of blended learning and new web technologies. In Europe and beyond they are opening up debates about the scope of public health and global health. Nevertheless, global health is bringing revitalisation of public health education, which is recognised as one of the core components by many other academic institutions involved in global health work. More than ever, higher academic institutions for public health are recognising the importance of institutional partnerships with various organisations and efficient modes of cooperation in regional and global networks. Networking in a global setting is bringing new opportunities, but also opening debates about global harmonisation of competence-based education to achieve functional knowledge, increase mobility of public health professionals, better employability and affordable performance. As public health opportunities and threats are increasingly global, higher education institutions in Europe and in other regions have to look beyond national boundaries and participate in networks for education, research and practice.
Bjegovic-Mikanovic, Vesna; Jovic-Vranes, Aleksandra; Czabanowska, Katarzyna; Otok, Robert
Introduction At the present time, higher education institutions dealing with education for public health in Europe and beyond are faced with a complex and comprehensive task of responding to global health challenges. Review Literature reviews in public health and global health and exploration of internet presentations of regional and global organisations dealing with education for public health were the main methods employed in the work presented in this paper. Higher academic institutions are searching for appropriate strategies in competences-based education, which will increase the global attractiveness of their academic programmes and courses for continuous professional development. Academic professionals are taking advantage of blended learning and new web technologies. In Europe and beyond they are opening up debates about the scope of public health and global health. Nevertheless, global health is bringing revitalisation of public health education, which is recognised as one of the core components by many other academic institutions involved in global health work. More than ever, higher academic institutions for public health are recognising the importance of institutional partnerships with various organisations and efficient modes of cooperation in regional and global networks. Networking in a global setting is bringing new opportunities, but also opening debates about global harmonisation of competence-based education to achieve functional knowledge, increase mobility of public health professionals, better employability and affordable performance. Conclusions As public health opportunities and threats are increasingly global, higher education institutions in Europe and in other regions have to look beyond national boundaries and participate in networks for education, research and practice.
Sarkar, Norma; Dallwig, Amber; Abbott, Patricia
Community Health Nursing (N456) is a required senior clinical course in the undergraduate nursing curriculum at the University of Michigan in which students learn to assess and address the health of populations and communities. In 2012, we began our efforts to internationalize the curriculum using a globally engaged nursing education framework. Our goal is for all students to have an intercultural learning experience understanding that all students are unable to travel internationally. Therefore, this intercultural learning was implemented through a range of experiences including actual immersion, virtual activities (videoconferencing) and interventions with local vulnerable populations. Grants were obtained to provide immersion experiences in Quito, Ecuador and New Delhi, India. Several technologies were initiated with partner nursing schools in Leogane, Haiti and New Delhi, India. Weekly videoconferencing utilizing BlueJeans software and exchange of knowledge through the Knowledge Gateway facilitated intercultural exchange of knowledge and culture. Local clinical groups work with a variety of vulnerable populations. A private blog was developed for all sections to share community assessment data from local and international communities. Qualitative evaluation data was collected for local and international students to begin to assess cultural competence and student learning. Analysis of data documented increased awareness of culture and identified the many positive benefits of interaction with a global partner.
Beca, Francisco; Kensler, Kevin; Glass, Benjamin; Schnitt, Stuart J; Tamimi, Rulla M; Beck, Andrew H
Enhancer of zeste homolog 2 (EZH2) is a polycomb-group protein that is involved in stem cell renewal and carcinogenesis. In breast cancer, increased EZH2 expression is associated with aggressiveness and has been suggested to identify normal breast epithelium at increased risk of breast cancer development. However, the association between EZH2 expression in benign breast tissue and breast cancer risk has not previously been evaluated in a large prospective cohort. We examined the association between EZH2 protein expression and subsequent breast cancer risk using logistic regression in a nested case-control study of benign breast disease (BBD) and breast cancer within the Nurses' Health Studies. EZH2 immunohistochemical expression in normal breast epithelium and stroma was evaluated by computational image analysis and its association with breast cancer risk was analyzed after adjusting for matching factors between cases and controls, the concomitant BBD diagnosis, and the Ki67 proliferation index. Women with a breast biopsy in which more than 20% of normal epithelial cells expressed EZH2 had a significantly increased risk of developing breast cancer (odds ratio (OR) 2.95, 95% confidence interval (CI) 1.11-7.84) compared to women with less than 10% EZH2 epithelial expression. The risk of developing breast cancer increased for each 5% increase in EZH2 expression (OR 1.22, 95% CI 1.02-1.46, p value 0.026). Additionally, women with high EZH2 expression and low estrogen receptor (ER) expression had a 4-fold higher risk of breast cancer compared to women with low EZH2 and low ER expression (OR 4.02, 95% CI 1.29-12.59). These results provide further evidence that EZH2 expression in the normal breast epithelium is independently associated with breast cancer risk and might be used to assist in risk stratification for women with benign breast biopsies.
Walpole, Sarah C; Shortall, Clare; van Schalkwyk, May Ci; Merriel, Abi; Ellis, Jayne; Obolensky, Lucy; Casanova Dias, Marisa; Watson, Jessica; Brown, Colin S; Hall, Jennifer; Pettigrew, Luisa M; Allen, Steve
Globalisation is having profound impacts on health and healthcare. We solicited the views of a wide range of stakeholders in order to develop core global health competencies for postgraduate doctors. Published literature and existing curricula informed writing of seven global health competencies for consultation. A modified policy Delphi involved an online survey and face-to-face and telephone interviews over three rounds. Over 250 stakeholders participated, including doctors, other health professionals, policymakers and members of the public from all continents of the world. Participants indicated that global health competence is essential for postgraduate doctors and other health professionals. Concerns were expressed about overburdening curricula and identifying what is 'essential' for whom. Conflicting perspectives emerged about the importance and relevance of different global health topics. Five core competencies were developed: (1) diversity, human rights and ethics; (2) environmental, social and economic determinants of health; (3) global epidemiology; (4) global health governance; and (5) health systems and health professionals. Global health can bring important perspectives to postgraduate curricula, enhancing the ability of doctors to provide quality care. These global health competencies require tailoring to meet different trainees' needs and facilitate their incorporation into curricula. Healthcare and global health are ever-changing; therefore, the competencies will need to be regularly reviewed and updated. © The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.
Mehta, Ambar; Xu, Tim; Murray, Matthew; Casey, Kathleen M
Robust global health demands access to safe, affordable, timely surgical care for all. The long-term success of global surgery requires medical students to understand and engage with this emerging field. The authors characterized medical students' perceptions of surgical care relative to other fields within global health. An optional, anonymous survey was given to all Johns Hopkins medical students from February to March 2016 to assess perceptions of surgical care and its role in global health. Of 480 students, 365 (76%) completed the survey, with 150 (41%) reporting global health interests. One-third (34%) of responding students felt that surgical care is one of two fields with the greatest potential global health impact in the future, second to infectious disease (49%). A minority (28%) correctly identified that trauma results in more deaths worldwide than obstetric complications or HIV/AIDS, tuberculosis, and malaria combined. Relative to other examined fields, students perceived surgical care as the least preventive and cost-effective, and few students (3%) considered adequate surgical care the best indicator of a robust health care system. Students believed that practicing in a surgical field was least amenable to pursuing a global health career, citing several barriers. Medical students have several perceptions of global surgery that contradict current evidence and literature, which may have implications for their career choices. Opportunities to improve students' global health knowledge and awareness of global surgery career paths include updating curricula, fostering meaningful international academic opportunities, and creating centers of global surgery and global health consortia.
Warren, Ashley E; Wyss, Kaspar; Shakarishvili, George; Atun, Rifat; de Savigny, Don
Millions of dollars are invested annually under the umbrella of national health systems strengthening. Global health initiatives provide funding for low- and middle-income countries through disease-oriented programmes while maintaining that the interventions simultaneously strengthen systems. However, it is as yet unclear which, and to what extent, system-level interventions are being funded by these initiatives, nor is it clear how much funding they allocate to disease-specific activities - through conventional 'vertical-programming' approach. Such funding can be channelled to one or more of the health system building blocks while targeting disease(s) or explicitly to system-wide activities. We operationalized the World Health Organization health system framework of the six building blocks to conduct a detailed assessment of Global Fund health system investments. Our application of this framework framework provides a comprehensive quantification of system-level interventions. We applied this systematically to a random subset of 52 of the 139 grants funded in Round 8 of the Global Fund to Fight AIDS, Tuberculosis and Malaria (totalling approximately US$1 billion). According to the analysis, 37% (US$ 362 million) of the Global Fund Round 8 funding was allocated to health systems strengthening. Of that, 38% (US$ 139 million) was for generic system-level interventions, rather than disease-specific system support. Around 82% of health systems strengthening funding (US$ 296 million) was allocated to service delivery, human resources, and medicines & technology, and within each of these to two to three interventions. Governance, financing, and information building blocks received relatively low funding. This study shows that a substantial portion of Global Fund's Round 8 funds was devoted to health systems strengthening. Dramatic skewing among the health system building blocks suggests opportunities for more balanced investments with regard to governance, financing, and
The author here distills his long-time personal experience with the deleterious effects of globalization on health and on the health sector reforms embarked on in many of the more than 50 countries where he has worked in the last 25 years. He highlights the role that the "human right to health" framework can and should play in countering globalization's negative effects on health and in shaping future health policy. This is a testimonial article.
Pati, Sanghamitra; Sinha, Rajeshwari; Panda, Meely; Pati, Sandipana; Sharma, Anjali; Zodpey, Sanjay
Today, health has transcended national boundaries and become more multifaceted. Global health has evolved as a new paradigm and is recently being identified as a thrust area now in India. Despite an existing need for a standardized global health curriculum, there is little information available on its education and curriculum in medical and health education space. In the Indian context, we are yet to have a fuller picture of the current status, including, content, structure, selection, teaching methods of global health, and how students are evaluated in India. The objective of this study was to map courses relating to studies on global health in India and analyze its mode of delivery. A detailed Internet search was carried out to identify global health courses and analyzed for: (i) whether global health is a part of the teaching curriculum, (ii) mode of teaching, (iii) broad contents, (iv) instructional formats, (v) assessment, and (vi) selection process. It was found that delivery of global health education in India was fragmented with limited focus at the undergraduate and postgraduate levels. Global health teaching was largely based on certificate courses or online courses, with hardly any institutions imparting a distinct global health education program. There is also no definite specification as to which institutes can impart teaching on global health education and what the specific eligibility requirements are. Our analysis suggests that efforts should be directed toward integrating global health education into broader public health curriculum. At the same time, the need for generation of global health leaders, creation of a common forum for addressing merits and demerits of global health issues, as well as creation of more opportunities for placements are recognized.
Full Text Available Objective: This paper examines the scope of practice of global health, drawing on the practical experience of a global health initiative of the Government of Canada – the Teasdale-Corti Global Health Research Partnership Program. A number of challenges in the practical application of theoretical definitions and understandings of global health are addressed. These challenges are grouped under five areas that form essential characteristics of global health: equity and egalitarian North–South partnerships, interdisciplinary scope, focus on upstream determinants of health, global conceptualization, and global health as an area of both research and practice. Design: Information in this paper is based on the results of an external evaluation of the program, which involved analysis of project proposals and technical reports, surveys with grantees and interviews with grantees and program designers, as well as case studies of three projects and a review of relevant literature. Results: The philosophy and recent definitions of global health represent a significant and important departure from the international health paradigm. However, the practical applicability of this maturing area of research and practice still faces significant systemic and structural impediments that, if not acknowledged and addressed, will continue to undermine the development of global health as an effective means to addressing health inequities globally and to better understanding, and acting upon, upstream determinants of health toward health for all. Conclusions: While it strives to redress global inequities, global health continues to be a construct that is promoted, studied, and dictated mostly by Northern institutions and scholars. Until practical mechanisms are put in place for truly egalitarian partnerships between North and South for both the study and practice of global health, the emerging philosophy of global health cannot be effectively put into practice.
Daibes, Ibrahim; Sridharan, Sanjeev
Objective This paper examines the scope of practice of global health, drawing on the practical experience of a global health initiative of the Government of Canada - the Teasdale-Corti Global Health Research Partnership Program. A number of challenges in the practical application of theoretical definitions and understandings of global health are addressed. These challenges are grouped under five areas that form essential characteristics of global health: equity and egalitarian North-South partnerships, interdisciplinary scope, focus on upstream determinants of health, global conceptualization, and global health as an area of both research and practice. Design Information in this paper is based on the results of an external evaluation of the program, which involved analysis of project proposals and technical reports, surveys with grantees and interviews with grantees and program designers, as well as case studies of three projects and a review of relevant literature. Results The philosophy and recent definitions of global health represent a significant and important departure from the international health paradigm. However, the practical applicability of this maturing area of research and practice still faces significant systemic and structural impediments that, if not acknowledged and addressed, will continue to undermine the development of global health as an effective means to addressing health inequities globally and to better understanding, and acting upon, upstream determinants of health toward health for all. Conclusions While it strives to redress global inequities, global health continues to be a construct that is promoted, studied, and dictated mostly by Northern institutions and scholars. Until practical mechanisms are put in place for truly egalitarian partnerships between North and South for both the study and practice of global health, the emerging philosophy of global health cannot be effectively put into practice.
Daibes, Ibrahim; Sridharan, Sanjeev
This paper examines the scope of practice of global health, drawing on the practical experience of a global health initiative of the Government of Canada--the Teasdale-Corti Global Health Research Partnership Program. A number of challenges in the practical application of theoretical definitions and understandings of global health are addressed. These challenges are grouped under five areas that form essential characteristics of global health: equity and egalitarian North-South partnerships, interdisciplinary scope, focus on upstream determinants of health, global conceptualization, and global health as an area of both research and practice. Information in this paper is based on the results of an external evaluation of the program, which involved analysis of project proposals and technical reports, surveys with grantees and interviews with grantees and program designers, as well as case studies of three projects and a review of relevant literature. The philosophy and recent definitions of global health represent a significant and important departure from the international health paradigm. However, the practical applicability of this maturing area of research and practice still faces significant systemic and structural impediments that, if not acknowledged and addressed, will continue to undermine the development of global health as an effective means to addressing health inequities globally and to better understanding, and acting upon, upstream determinants of health toward health for all. While it strives to redress global inequities, global health continues to be a construct that is promoted, studied, and dictated mostly by Northern institutions and scholars. Until practical mechanisms are put in place for truly egalitarian partnerships between North and South for both the study and practice of global health, the emerging philosophy of global health cannot be effectively put into practice.
St Louis, Michael E; Hess, Jeremy J
The most severe consequences of climate change will accrue to the poorest people in the poorest countries, despite their own negligible contribution to greenhouse gas emissions. In recent years, global health efforts in those same countries have grown dramatically. However, the emerging scientific consensus about climate change has not yet had much influence on the routine practice and strategies of global health. We review here the anticipated types and global distribution of health impacts of climate change, discuss relevant aspects of current global interventions for health in low-income countries, and consider potential elements of a framework for appropriately and efficiently mainstreaming global climate change-mitigation and -adaptation strategies into the ongoing enterprise of global health. We propose a collaborative learning initiative involving four areas: (1) increased awareness among current global health practitioners of climate change and its potential impacts for the most disadvantaged, (2) strengthening of the evidence base, (3) incorporation now of climate change-mitigation and -adaptation concerns into design of ongoing global health programs, and (4) alignment of current global health program targets and methods with larger frameworks for climate change and sustainable development. The great vulnerability to climate change of populations reached by current global health efforts should prompt all concerned with global health to take a leading role in advocating for climate change mitigation in their own countries.
Siddharthan, Trishul; North, Crystal M; Attia, Engi F; Christiani, David C; Checkley, William; West, T Eoin
A growing number of pulmonary and critical care medicine fellowship programs in the United States offer global health training opportunities. Formal, integrated global health programs within pulmonary and critical care fellowships are relatively new but are built on principles and ideals of global health that focus on the mutually beneficial exchange of knowledge and social justice. Although core competencies consistent with these overarching themes in global health education have not been formalized for pulmonary and critical care trainees, relevant competency areas include clinical knowledge, international research training, cultural competency, and clinical and research capacity building. Existing global health education in U.S. pulmonary and critical care medicine training programs can generally be classified as one of three different models: integrated global health tracks, global health electives, and additional research years. Successful global health education programs foster partnerships and collaborations with international sites that emphasize bidirectional exchange. This bidirectional exchange includes ongoing, equitable commitments to mutual opportunities for training and professional development, including a focus on the particular knowledge and skill sets critical for addressing the unique priorities of individual countries. However, barriers related to the availability of mentorship, funding, and dedicated time exist to expanding global health education in pulmonary and critical care medicine. The implementation of global health training within pulmonary and critical care medicine programs requires continued optimization, but this training is essential to prepare the next generation of physicians to address the global aspects of respiratory disease and critical illness.
C-L. Chang (Chia-Lin); M.J. McAleer (Michael)
textabstractThe paper presents an overview of recent topical research on global, energy, health & medical, and tourism economics, and global software. We have interpreted “global” in the title of the Journal of Reviews on Global Economics to cover contributions that have a global impact on
Wang, Xingwei; Lederman, Dror; Tan, Jun; Wang, Xiao Hui; Zheng, Bin
We have developed and preliminarily tested a new breast cancer risk prediction model based on computerized bilateral mammographic tissue asymmetry. In this study, we investigated and compared the performance difference of our risk prediction model when the bilateral mammographic tissue asymmetrical features were extracted in two different methods namely (1) the entire breast area and (2) the mirror-matched local strips between the left and right breast. A testing dataset including bilateral craniocaudal (CC) view images of 100 negative and 100 positive cases for developing breast abnormalities or cancer was selected from a large and diverse full-field digital mammography (FFDM) image database. To detect bilateral mammographic tissue asymmetry, a set of 20 initial "global" features were extracted from the entire breast areas of two bilateral mammograms in CC view and their differences were computed. Meanwhile, a pool of 16 local histogram-based statistic features was computed from eight mirror-matched strips between the left and right breast. Using a genetic algorithm (GA) to select optimal features, two artificial neural networks (ANN) were built to predict the risk of a test case developing cancer. Using the leave-one-case-out training and testing method, two GAoptimized ANNs yielded the areas under receiver operating characteristic (ROC) curves of 0.754+/-0.024 (using feature differences extracted from the entire breast area) and 0.726+/-0.026 (using the feature differences extracted from 8 pairs of local strips), respectively. The risk prediction model using either ANN is able to detect 58.3% (35/60) of cancer cases 6 to 18 months earlier at 80% specificity level. This study compared two methods to compute bilateral mammographic tissue asymmetry and demonstrated that bilateral mammographic tissue asymmetry was a useful breast cancer risk indicator with high discriminatory power.
Watson, Robert T.; Patz, Jonathan; Gubler, Duane J.; Parson, Edward A.; Vincent, James H.
This paper reviews the background that has led to the now almost-universally held opinion in the scientific community that global climate change is occurring and is inescapably linked with anthropogenic activity. The potential implications to human health are considerable and very diverse. These include, for example, the increased direct impacts of heat and of rises in sea level, exacerbated air and water-borne harmful agents, and - associated with all the preceding - the emergence of environmental refugees. Vector-borne diseases, in particular those associated with blood-sucking arthropods such as mosquitoes, may be significantly impacted, including redistribution of some of those diseases to areas not previously affected. Responses to possible impending environmental and public health crises must involve political and socio-economic considerations, adding even greater complexity to what is already a difficult challenge. In some areas, adjustments to national and international public health practices and policies may be effective, at least in the short and medium terms. But in others, more drastic measures will be required. Environmental monitoring, in its widest sense, will play a significant role in the future management of the problem. (Author)
Many countries in Asia, Africa, Latin America, and the Caribbean offer substantial tax breaks to foreign corporations that set up shops in free-trade zones and waive environmental regulations and repress trade unions to further induce this practice. Workers in these shops--mainly women--perform repetitive machine-based motions, are exposed to toxic chemicals and unsafe equipment, and face dangerously high production quotas. Health problems caused by these working conditions include headache and dizziness, fatigue, anemia, forgetfulness, stomach pains, respiratory problems, hypertension, heart disease, and allergies. Water and air pollution and dumping of hazardous waste affect the health of entire communities. Since free-trade zones are a permanent feature of the global economy, organizing to protect workers and communities assumes critical importance. Groups such as the Border Committee of Women Workers in Mexico are providing workers with skills and support to make demands such as better treatment of pregnant workers. International labor, environmental, and public health advocates can support such efforts by providing assistance to worker-controlled organizations and pressuring governments to enforce laws intended to protect workers and their communities.
Gauthier, S; Bernier, P; Kuuluvainen, T; Shvidenko, A Z; Schepaschenko, D G
The boreal forest, one of the largest biomes on Earth, provides ecosystem services that benefit society at levels ranging from local to global. Currently, about two-thirds of the area covered by this biome is under some form of management, mostly for wood production. Services such as climate regulation are also provided by both the unmanaged and managed boreal forests. Although most of the boreal forests have retained the resilience to cope with current disturbances, projected environmental changes of unprecedented speed and amplitude pose a substantial threat to their health. Management options to reduce these threats are available and could be implemented, but economic incentives and a greater focus on the boreal biome in international fora are needed to support further adaptation and mitigation actions. Copyright © 2015, American Association for the Advancement of Science.
Labonté, Ronald; Mohindra, Katia; Schrecker, Ted
In recent decades, public health policy and practice have been increasingly challenged by globalization, even as global financing for health has increased dramatically. This article discusses globalization and its health challenges from a vantage of political science, emphasizing increased global flows (of pathogens, information, trade, finance, and people) as driving, and driven by, global market integration. This integration requires a shift in public health thinking from a singular focus on international health (the higher disease burden in poor countries) to a more nuanced analysis of global health (in which health risks in both poor and rich countries are seen as having inherently global causes and consequences). Several globalization-related pathways to health exist, two key ones of which are described: globalized diseases and economic vulnerabilities. The article concludes with a call for national governments, especially those of wealthier nations, to take greater account of global health and its social determinants in all their foreign policies.
Ooms, Gorik; Hammonds, Rachel
In "Just Health", Norman Daniels makes a strong argument for obligations of mutual assistance to fulfill the right to health at the national level and challenges readers to develop arguments supporting obligations of mutual assistance at the global level. In this paper, we argue that there is global responsibility for global health and that there are obligations of justice (beyond charity) to help fulfill (not merely respect or even protect) the right to health in other countries; these we call obligations of global health justice. We show how international human rights law affirms obligations of global health justice - beyond national obligations and beyond obligations of charity - and assert that the human rights approach provides guidance on delineating the relationship between national and global responsibility for fulfilling the core obligations that arise from socioeconomic human rights and addressing global health inequities. We further argue that new ways of providing international assistance, originating from the global HIV/AIDS response, demonstrate the feasibility of improving health outcomes through exogenous efforts and that obligations of global health justice thus carry much weight: the weight of lives not saved. The global response to the HIV/AIDS pandemic has led to the emergence of a new international health assistance paradigm, and the Global Fund to fight AIDS, Tuberculosis and Malaria is, we suggest, an embryonic form of this new paradigm. We conclude that agreements on several common parameters delineating global and national responsibility for global health can advance the movement towards a global institution for the distribution of health-related goods.
Stagg, Amy R; Blanchard, May Hsieh; Carson, Sandra A; Peterson, Herbert B; Flynn, Erica B; Ogburn, Tony
To evaluate obstetrics and gynecology resident interest and participation in global health experiences and elucidate factors associated with resident expectation for involvement. A voluntary, anonymous survey was administered to U.S. obstetrics and gynecology residents before the 2015 Council on Resident Education in Obstetrics and Gynecology in-training examination. The 23-item survey gathered demographic data and queried resident interest and participation in global health. Factors associated with resident expectation for participation in global health were analyzed by Pearson χ tests. Of the 5,005 eligible examinees administered the survey, 4,929 completed at least a portion of the survey for a response rate of 98.5%. Global health was rated as "somewhat important" or "very important" by 96.3% (3,761/3,904) of residents. "Educational opportunity" (69.2%) and "humanitarian effort" (17.7%) were cited as the two most important aspects of a global health experience. Residents with prior global health experience rated the importance of global health more highly and had an increased expectation for future participation. Global health electives were arranged by residency programs for 18.0% (747/4,155) of respondents, by residents themselves as an elective for 44.0% (1,828/4,155), and as a noncredit experience during vacation time for 36.4% (1,514/4,155) of respondents. Female gender, nonpartnered status, no children, prior global health experience, and intention to incorporate global health in future practice were associated with expectations for a global health experience. Most obstetrics and gynecology residents rate a global health experience as somewhat or very important, and participation before or during residency increases the perceived importance of global health and the likelihood of expectation for future participation. A majority of residents report arranging their own elective or using vacation time to participate, suggesting that residency programs have
VanDyke, Santana D; Shell, Madelynn D
This study explored the role of the Health Belief Model in predicting breast cancer screening among women in rural Appalachia. Health beliefs (perceived susceptibility to breast cancer, severity of breast cancer, and benefits and barriers to screening) were used to predict health behavior (mammogram frequency). A total of 170 women aged 18-78 were recruited at a free health clinic in central Appalachia. Women completed surveys that assessed demographic characteristics, mammogram frequency, and perceived susceptibility, severity, and benefits and barriers to mammography. Consistent with expectations, women with objectively elevated risks for breast cancer (history of abnormal mammograms or family history of breast cancer) perceived themselves to be at higher risk for breast cancer, and those with a history of abnormal mammograms were more likely to receive mammograms regularly. In addition, older women expected their prognosis to be marginally poorer following a diagnosis, perceived greater benefits and fewer barriers to mammography, and were significantly more likely to receive mammograms regularly. Consistent with the Health Belief Model, fewer perceived barriers to mammography predicted greater mammogram frequency. However, the model was not fully supported because perceived susceptibility, severity, and benefits to mammography did not predict mammogram frequency. Results highlight the importance of reducing real and perceived barriers to screening in order to improve mammography rates among rural populations. © 2016 National Rural Health Association.
no such associations. The reasons for these important differences are currently unknown. In conclusion, this study consisted of methodological and clinical investigations of HRQL in primary breast cancer patients. The initial questionnaire development resulted in a combination of questionnaires that was more......The treatment of primary breast cancer usually consists of surgery often followed by adjuvant therapy (radiotherapy, chemotherapy, hormonal treatment, etc.) to reduce the risk of recurrence. The cancer diagnosis and the treatments may have significant impact on the patients' quality of life....... This thesis deals with scientific aspects and clinical results of a study aimed at assessing the impact of breast cancer (and its treatment) on the patients' quality of life. Studies such as this assessing the problems and symptoms experienced by the patients are often referred to as health-related quality...
Desai, Manish Anil
In this dissertation, I motivate, develop, and demonstrate three such approaches for investigating multiscale drivers of global environmental health: (1) a metric for analyzing contributions and responses to climate change from global to sectoral scales, (2) a framework for unraveling the influence of environmental change on infectious diseases at regional to local scales, and (3) a model for informing the design and evaluation of clean cooking interventions at community to household scales. The full utility of climate debt as an analytical perspective will remain untapped without tools that can be manipulated by a wide range of analysts, including global environmental health researchers. Chapter 2 explains how international natural debt (IND) apportions global radiative forcing from fossil fuel carbon dioxide and methane, the two most significant climate altering pollutants, to individual entities -- primarily countries but also subnational states and economic sectors, with even finer scales possible -- as a function of unique trajectories of historical emissions, taking into account the quite different radiative efficiencies and atmospheric lifetimes of each pollutant. Owing to its straightforward and transparent derivation, IND can readily operationalize climate debt to consider issues of equity and efficiency and drive scenario exercises that explore the response to climate change at multiple scales. Collectively, the analyses presented in this chapter demonstrate how IND can inform a range of key question on climate change mitigation at multiple scales, compelling environmental health towards an appraisal of the causes and not just the consequences of climate change. The environmental change and infectious disease (EnvID) conceptual framework of Chapter 3 builds on a rich history of prior efforts in epidemiologic theory, environmental science, and mathematical modeling by: (1) articulating a flexible and logical system specification; (2) incorporating
Anagnostopoulos, Fotios; Slater, Julie; Fitzsimmons, Deborah; Kolokotroni, Philippa
The aim of this study was to examine the factor structure and the psychometric properties of the Life Attitude Profile-Revised (LAP-R) among a sample of Greek breast cancer patients, and to test the fit of a structural equation model with one latent factor underlying the measured LAP-R dimensions. A total of 153 patients with breast cancer completed the LAP-R. Convergent validity was assessed by examining the correlations between the LAP-R subscales and measures of perceived stress, intrusiveness, mental health, and coping styles. Known-groups validity was also assessed. Principal axis factor analysis with promax rotation yielded four factors: purpose-coherence-vacuum, choice, death acceptance, and goal seeking. Internal consistency reliability of the subscales and convergent validity of LAP-R were satisfactory. LAP-R was able to detect differences in meaning between different age groups. Confirmatory factor analysis provided support for a single-factor model including a latent meaning-variable indicated by the observed subscales. The LAP-R is a reliable and valid measure of global meaning in life, when administered to breast cancer patients. The use of LAP-R in evaluating meaning-centered psychotherapy interventions for patients with cancer is emphasized. Copyright © 2010 John Wiley & Sons, Ltd.
Courtney, Brooke; Bond, Katherine C; Maher, Carmen
In February 2014, health officials from around the world announced the Global Health Security Agenda, a critical effort to strengthen national and global systems to prevent, detect, and respond to infectious disease threats and to foster stronger collaboration across borders. With its increasing global roles and broad range of regulatory responsibilities in ensuring the availability, safety, and security of medical and food products, the US Food and Drug Administration (FDA) is engaged in a range of efforts in support of global health security. This article provides an overview of FDA's global health security roles, focusing on its responsibilities related to the development and use of medical countermeasures (MCMs) for preventing, detecting, and responding to global infectious disease and other public health emergency threats. The article also discusses several areas-antimicrobial resistance, food safety, and supply chain integrity-in which FDA's global health security roles continue to evolve and extend beyond MCMs and, in some cases, beyond traditional infectious disease threats.
Petersen, Poul Erik
The World Health Organization (WHO) Global Oral Health Programme has worked hard over the past five years to increase the awareness of oral health worldwide as an important component of general health and quality of life. Meanwhile, oral disease is still a major public health problem in high income...... countries and the burden of oral disease is growing in many low- and middle income countries. In the World Oral Health Report 2003, the WHO Global Oral Health Programme formulated the policies and the necessary actions for the improvement of oral health. The strategy is that oral disease prevention...... and the promotion of oral health needs to be integrated with chronic disease prevention and general health promotion as the risks to health are linked. The World Health Assembly (WHA) and the Executive Board (EB) are supreme governance bodies of WHO and for the first time in 25 years oral health was subject...
The article deals with the issues of impact of globalization on population health and public health. The positive and negative aspects of this process are analyzed. The role of international organizations (UN, WHO, UNESCO, ILO, UNISEF) is demonstrated in the area of management of globalization impact on public health of different countries, Russia included.
Hatfield, Jennifer M.; Hecker, Kent G.; Jensen, Ashley E.
Faculty from the University of Calgary's bachelor of health sciences (BHSc) Global Health Program argue for the development of "global health research competencies" to prepare students for international placements in low- and middle-income countries. These competencies include the ability to define and describe (a) how to use the concept…
Boehmer, Ulrike; Ozonoff, Al; Potter, Jennifer
Sexual minority women (e.g., lesbians, bisexual women, and women who prefer a female partner) are a known risk population for overweight, obesity, and mental health problems. Our objective is to compare sexual minority women with breast cancer to a control sample of sexual minority women without cancer to identify differences in healthful lifestyle practices, weight, well-being and mental health. This is a cross-sectional study of 85 sexual minority women with a breast cancer history (cases) matched by age and partner status to 85 sexual minority controls without cancer. We compared self-reported physical activity, fruit and vegetable intake, weight, quality of life, anxiety, and depression. Cases and controls had similar health behaviors, BMI, quality of life, anxiety, and depression. Of the weight-related behaviors, meeting the recommended guidelines of physical activity was significantly associated with lower likelihood of being overweight or obese, less depression, and better mental quality of life. Sexual minority women with breast cancer are similar to sexual minority women without cancer with respect to healthful behaviors, body weight, anxiety, depression, and quality of life. Lifestyle interventions to reduce the risk of poor outcomes after cancer should be implemented in this population as well as in sexual minority women without cancer.
Katz, Rebecca; Kornblet, Sarah; Arnold, Grace; Lief, Eric; Fischer, Julie E
Context: Accelerated globalization has produced obvious changes in diplomatic purposes and practices. Health issues have become increasingly preeminent in the evolving global diplomacy agenda. More leaders in academia and policy are thinking about how to structure and utilize diplomacy in pursuit of global health goals. Methods: In this article, we describe the context, practice, and components of global health diplomacy, as applied operationally. We examine the foundations of various approaches to global health diplomacy, along with their implications for the policies shaping the international public health and foreign policy environments. Based on these observations, we propose a taxonomy for the subdiscipline. Findings: Expanding demands on global health diplomacy require a delicate combination of technical expertise, legal knowledge, and diplomatic skills that have not been systematically cultivated among either foreign service or global health professionals. Nonetheless, high expectations that global health initiatives will achieve development and diplomatic goals beyond the immediate technical objectives may be thwarted by this gap. Conclusions: The deepening links between health and foreign policy require both the diplomatic and global health communities to reexamine the skills, comprehension, and resources necessary to achieve their mutual objectives. PMID:21933277
Katz, Rebecca; Kornblet, Sarah; Arnold, Grace; Lief, Eric; Fischer, Julie E
Accelerated globalization has produced obvious changes in diplomatic purposes and practices. Health issues have become increasingly preeminent in the evolving global diplomacy agenda. More leaders in academia and policy are thinking about how to structure and utilize diplomacy in pursuit of global health goals. In this article, we describe the context, practice, and components of global health diplomacy, as applied operationally. We examine the foundations of various approaches to global health diplomacy, along with their implications for the policies shaping the international public health and foreign policy environments. Based on these observations, we propose a taxonomy for the subdiscipline. Expanding demands on global health diplomacy require a delicate combination of technical expertise, legal knowledge, and diplomatic skills that have not been systematically cultivated among either foreign service or global health professionals. Nonetheless, high expectations that global health initiatives will achieve development and diplomatic goals beyond the immediate technical objectives may be thwarted by this gap. The deepening links between health and foreign policy require both the diplomatic and global health communities to reexamine the skills, comprehension, and resources necessary to achieve their mutual objectives. © 2011 Milbank Memorial Fund. Published by Wiley Periodicals Inc.
Geoffrey A. Cordell
Full Text Available Each day, Earth's finite resources are being depleted for energy, for material goods, for transportation, for housing, and for drugs. As we evolve scientifically and technologically, and as the population of the world rapidly approaches 7 billion and beyond, among the many issues with which we are faced is the continued availability of drugs for future global health care. Medicinal agents are primarily derived from two sources, synthetic and natural, or in some cases, as semi-synthetic compounds, a mixture of the two. For the developed world, efforts have been initiated to make drug production "greener", with milder reagents, shorter reaction times, and more efficient processing, thereby using less energy, and reactions which are more atom efficient, and generate fewer by-products. However, most of the world's population uses plants, in either crude or extract form, for their primary health care. There is relatively little discussion as yet, about the long term effects of the current, non-sustainable harvesting methods for medicinal plants from the wild, which are depleting these critical resources without concurrent initiatives to commercialize their cultivation. To meet future public health care needs, a paradigm shift is required in order to adopt new approaches using contemporary technology which will result in drugs being regarded as a sustainable commodity, irrespective of their source. In this presentation, several approaches to enhancing and sustaining the availability of drugs, both synthetic and natural, will be discussed, including the use of vegetables as chemical reagents, and the deployment of integrated strategies involving information systems, biotechnology, nanotechnology, and detection techniques for the development of medicinal plants with enhanced levels of bioactive agents.
Opollo, Jackline G; Bond, Mary Lou; Gray, Jennifer; Lail-Davis, Vivian J
Strengthened efforts to achieve the United Nations Millennium Development Goals by 2015 are urgently needed. A fundamental step toward achieving these goals is strengthening global partnerships for development. This article describes critical challenges and opportunities in global health and the social responsibility of the nursing profession in this area. Examples and suggestions for nursing action are provided for consideration by those interested in influencing global health. Engaging in global health activities such as study abroad programs, interprofessional exchanges, continuing education workshops, and seminars with a global health focus can have significant implications for nursing education, research, policy, and practice. Equipping nurses with the leadership skills, knowledge, and attitudes needed to advance global health is integral in the delivery of effective, culturally relevant health care. Copyright 2012, SLACK Incorporated.
García Casanova, M C; García Casanova, S; Pi Juan, M; Ruiz Mariscal, E; Parellada Esquius, N
Mother's milk is the ideal meal for the baby during the first six months of life. A good health education (before and after birth) helps to prolong breastfeeding (BF). To know the prevalence of BF among a group of women and to study the relationship with health education. Observational and analytic study. Dr. Pujol i Capsada Primary Health Center (El Prat de Llobregat); Casagemes CAD's afterbirth group in Badalona, and Alba Lactancia Women's group. SUBJECTS OF THE STUDY: 135 women with babies born between the 1st of March 2002 and the 28th of February 2003. Mother's motivation for breast-feeding and the type of information she has got were evaluated. Breast-feeding period was measured from the second month of baby's life by means of a survey passed by nursing staff. The average BF period was of 160 days, 22% breastfed their babies for less than a week, and 14% between a week and a month. The main variables in relation with the increase of BF are: to want to breast-feed (P=.05); mother sleeping with the baby (P=.03); to receive assistance from nursing staff while in hospital (P=.01); not to receive additional meals in hospital (P=.02); no problems during the first month of life (P<.0001); to receive information from health center (P=.009). If the first contact mother-baby (bringing the baby close to the breast) lasts more than 30 minutes 51% give up BF before the first month; but if the first contact is before of 30 minutes only give up 20.8% (P=.002). The prevalence of BF increases among the women that got health education and support from the health professionals.
Li, Zhixin; Peng, Zhiqiang; Gu, Siyu; Zheng, Junfang; Feng, Duiping; Qin, Qiong; He, Junqi
MicroRNAs (miRNAs) have been linked to a number of cancer types including breast cancer. The rate of brain metastases is 10-30% in patients with advanced breast cancer which is associated with poor prognosis. The potential application of miRNAs in the diagnostics and therapeutics of breast cancer with brain metastasis is an area of intense interest. In an initial effort to systematically address the differential expression of miRNAs and mRNAs in primary breast cancer which may provide clues for early detection of brain metastasis, we analyzed the consequent changes in global patterns of gene expression in Gene Expression Omnibus (GEO) data set obtained by microarray from patients with in situ carcinoma and patients with brain metastasis. The miRNA-pathway regulatory network and miRNA-mRNA regulatory network were investigated in breast cancer specimens from patients with brain metastasis to screen for significantly dysregulated miRNAs followed by prediction of their target genes and pathways by Gene Ontology (GO) analysis. Functional coordination of the changes of gene expression can be modulated by individual miRNAs. Two miRNAs, hsa-miR-17-5p and hsa-miR-16-5p, were identified as having the highest associations with targeted mRNAs [such as B-cell lymphoma 2 (BCL2), small body size/mothers against decapentaplegic 3 (SMAD3) and suppressor of cytokine signaling 1 (SOCS1)] and pathways associated with epithelial-mesenchymal transitions and other processes linked with cancer metastasis (including cell cycle, adherence junctions and extracellular matrix-receptor interaction). mRNAs for two genes [HECT, UBA and WWE domain containing 1 (HUWE1) and BCL2] were found to have the highest associations with miRNAs, which were down-regulated in brain metastasis specimens of breast cancer. The change of 11 selected miRNAs was verified in The Cancer Genome Atlas (TCGA) breast cancer dataset. Up-regulation of hsa-miR-17-5p was detected in triple-negative breast cancer tissues in
Aluttis, Christoph; Bishaw, Tewabech; Frank, Martina W
The 'crisis in human resources' in the health sector has been described as one of the most pressing global health issues of our time. The World Health Organization (WHO) estimates that the world faces a global shortage of almost 4.3 million doctors, midwives, nurses, and other healthcare professionals. A global undersupply of these threatens the quality and sustainability of health systems worldwide. This undersupply is concurrent with globalization and the resulting liberalization of markets, which allow health workers to offer their services in countries other than those of their origin. The opportunities of health workers to seek employment abroad has led to a complex migration pattern, characterized by a flow of health professionals from low- to high-income countries. This global migration pattern has sparked a broad international debate about the consequences for health systems worldwide, including questions about sustainability, justice, and global social accountabilities. This article provides a review of this phenomenon and gives an overview of the current scope of health workforce migration patterns. It further focuses on the scientific discourse regarding health workforce migration and its effects on both high- and low-income countries in an interdependent world. The article also reviews the internal and external factors that fuel health worker migration and illustrates how health workforce migration is a classic global health issue of our time. Accordingly, it elaborates on the international community's approach to solving the workforce crisis, focusing in particular on the WHO Code of Practice, established in 2010.
DeCamp, Matthew; Rodriguez, Joce; Hecht, Shelby; Barry, Michele; Sugarman, Jeremy
Background Interest in short-term global health training and service programs continues to grow, yet they can be associated with a variety of ethical issues for which trainees or others with limited global health experience may not be prepared to address. Therefore, there is a clear need for educational interventions concerning these ethical issues. Methods We developed and evaluated an introductory curriculum, ?Ethical Challenges in Short-term Global Health Training.? The curriculum was deve...
Full Text Available Abstract Background Breast cancer is the leading cause of cancer mortality among Jordanian women. Breast malignancies are detected at late stages as a result of deferred breast health-seeking behaviour. The aim of this study was to explore Jordanian women’s views and perceptions about breast cancer and breast health. Methods We performed an explorative qualitative study with purposive sampling. Ten focus groups were conducted consisting of 64 women (aged 20 to 65 years with no previous history and no symptoms of breast cancer from four governorates in Jordan. The transcribed data was analysed using latent content analysis. Results Three themes were constructed from the group discussions: a Ambivalence in prioritizing own health; b Feeling fear of breast cancer; and c Feeling safe from breast cancer. The first theme was seen in women’s prioritizing children and family needs and in their experiencing family and social support towards seeking breast health care. The second theme was building on women’s perception of breast cancer as an incurable disease associated with suffering and death, their fear of the risk of diminished femininity, husband’s rejection and social stigmatization, adding to their apprehensions about breast health examinations. The third theme emerged from the women’s perceiving themselves as not being in the risk zone for breast cancer and in their accepting breast cancer as a test from God. In contrast, women also experienced comfort in acquiring breast health knowledge that soothed their fears and motivated them to seek early detection examinations. Conclusions Women’s ambivalence in prioritizing their own health and feelings of fear and safety could be better addressed by designing breast health interventions that emphasize the good prognosis for breast cancer when detected early, involve breast cancer survivors in breast health awareness campaigns and catalyse family support to encourage women to seek breast
Bjegovic-Mikanovic, Vesna; Jovic-Vranes, Aleksandra; Czabanowska, Katarzyna; Otok, Robert
Introduction At the present time, higher education institutions dealing with education for public health in Europe and beyond are faced with a complex and comprehensive task of responding to global health challenges. Review Literature reviews in public health and global health and exploration of internet presentations of regional and global organisations dealing with education for public health were the main methods employed in the work presented in this paper. Higher academic institutions are searching for appropriate strategies in competences-based education, which will increase the global attractiveness of their academic programmes and courses for continuous professional development. Academic professionals are taking advantage of blended learning and new web technologies. In Europe and beyond they are opening up debates about the scope of public health and global health. Nevertheless, global health is bringing revitalisation of public health education, which is recognised as one of the core components by many other academic institutions involved in global health work. More than ever, higher academic institutions for public health are recognising the importance of institutional partnerships with various organisations and efficient modes of cooperation in regional and global networks. Networking in a global setting is bringing new opportunities, but also opening debates about global harmonisation of competence-based education to achieve functional knowledge, increase mobility of public health professionals, better employability and affordable performance. Conclusions As public health opportunities and threats are increasingly global, higher education institutions in Europe and in other regions have to look beyond national boundaries and participate in networks for education, research and practice. PMID:24560263
Bennett, Belinda; Cohen, I Glenn; Davies, Sara E; Gostin, Lawrence O; Hill, Peter S; Mankad, Aditi; Phelan, Alexandra L
The year 2015 was a significant anniversary for global health: 15 years since the adoption of the Millennium Development Goals and the creation of the Global Alliance for Vaccines and Immunization, followed two years later by the Global Fund to Fight AIDS, TB and Malaria. 2015 was also the 10-year anniversary of the adoption of the International Health Regulations (May 2005) and the formal entering into force of the Framework Convention on the Tobacco Control (February 2005). The anniversary of these frameworks and institutions illustrates the growth and contribution of 'global' health diplomacy. Each initiative has also revealed on-going issues with compliance, sustainable funding and equitable attention in global health governance. In this paper, we present four thematic challenges that will continue to challenge prioritisation within global health governance into the future unless addressed: framing and prioritising within global health governance; identifying stakeholders of the global health community; understanding the relationship between health and behaviour; and the role of governance and regulation in supporting global health.
Holland, J Brian; Malvey, Donna; Fottler, Myron D
As health care organizations expand and move into global markets, they face many leadership challenges, including the difficulty of leading individuals who are geographically dispersed. This article provides global managers with guidelines for leading and motivating individuals or teams from a distance while overcoming the typical challenges that "virtual leaders" and "virtual teams" face: employee isolation, confusion, language barriers, cultural differences, and technological breakdowns. Fortunately, technological advances in communications have provided various methods to accommodate geographically dispersed or "global virtual teams." Health care leaders now have the ability to lead global teams from afar by becoming "virtual leaders" with a responsibility to lead a "virtual team." Three models of globalization presented and discussed are outsourcing of health care services, medical tourism, and telerobotics. These models require global managers to lead virtually, and a positive relationship between the virtual leader and the virtual team member is vital in the success of global health care organizations.
Goss, C; Leverment, I M G; de Bono, A M
Cancer survivors are at a higher risk of leaving the labour market prematurely than healthy individuals or those with other chronic conditions. They continue to report difficulty in re-entering the workplace after diagnosis and treatment. To investigate return to work in health care staff with a diagnosis of breast cancer and the adjustments required to assist them. We identified health care workers with a diagnosis of breast cancer, seen by occupational physicians in a National Health Service occupational health (OH) service, between 2000 and 2012. Review of OH records was conducted and information relating to return to work and sick leave was recorded. One hundred and seventeen staff members were identified, and 111 (95%) returned to work. Almost all (109) required workplace adjustments to do so: 97 had temporary adjustments and 12 permanent changes. The majority of those who returned to work (98) did so within 1 year. This study showed a higher return to work rate in the first year, following treatment for breast cancer, than described previously. Workplace adjustments, recommended by an occupational physician, were provided for the majority. © The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: email@example.com.
Taymoori, Parvaneh; Berry, Tanya
Breast cancer is a global issue that continues to be the most diagnosed cancer in women. The incidence of breast cancer is increasing, and the incidence age for Iranian women is at least 10 years earlier than in western countries. Beliefs related to breast cancer have been found to be a factor in a woman's decision about breast screening behavior, and a valid and reliable questionnaire is necessary to the development of education interventions in this area. The aim of the current study was to translate the Champion Health Belief Model Scale to Farsi and to examine the psychometric properties of the Farsi version. A random sample of 606 employed women (20-69 years old) from Sanandaj, Iran, participated in the study. Construct validity of the Farsi version was supported through factor analysis. Nine factors emerged for breast self-examination (2 barriers factors, 2 benefits factors, 2 confidence factors, and 1 factor each related to seriousness, motivation, and susceptibly) and 6 factors related to mammography (barriers, seriousness, susceptibly, benefits, and 2 motivation factors). All items loaded on their respective factors except 1 item. It was concluded that the Farsi version of the Champion Health Belief Model Scale has the potential to measure beliefs related to breast self-examination and mammography with Iranian women. Further evaluation of the measure with different populations is warranted.
Gostin, Lawrence O; Friedman, Eric A
A growing tide of populism in Europe and the United States, combined with other factors, threatens the solidarity upon which the global health movement is based. The highest-profile example of the turn toward populism is US president-elect Donald Trump, whose proposals would redefine US engagement in global health, development, and environmental efforts. In this challenging landscape, three influential global institutions-the United Nations, the World Health Organization, and the World Bank-are undergoing leadership transitions. This new global health leadership should prioritize global health security, including antimicrobial resistance, health system strengthening, and action on mass migration and climate change. They will need to work as a team, leveraging the World Health Organization's technical competence and mandate to set health norms and standards, the United Nations' political clout, and the World Bank's economic strength. Human rights, including principles of equality, participation, and accountability, should be their foremost guide, such as holding a United Nations special session on health inequities and advancing the Framework Convention on Global Health. The need for predictable and innovative financing and high ethical standards to prevent conflicts of interest can further guide global health leaders. Project HOPE—The People-to-People Health Foundation, Inc.
Taichman, L Susan; Griggs, Jennifer J; Inglehart, Marita R
This population-based analysis examined the prevalence of periodontal diseases along with the self-perceived oral health and patterns of dental care utilization of breast cancer survivors in the United States. Data from the 1999-2004 National Health and Nutrition Surveys were utilized, examining information from 3,354 women between 50 and 85 years of age. Primary outcomes were gingivitis and periodontitis, self-perceived oral health, and dental care utilization. Logistic regression analyses were used to estimate relationships of breast cancer diagnosis and primary outcomes while controlling for confounding factors. Breast cancer survivors were more likely to be older than 55 years, white, nonsmokers, have higher levels of education and income, and a higher prevalence of osteoporosis. Breast cancer survivors were significantly less likely to have dental insurance (P = 0.04). Utilization of dental services and reason for last dental visit did not significantly differ between groups. A history of a breast cancer diagnosis did not increase the odds of gingivitis [odds ratio (OR): 1.32; 95 percent confidence interval (CI): 0.53-3.63], periodontitis (OR: 1.82; 95 percent CI: 0.89-4.01), or poor self-perceived oral health (OR: 0.89; 95 percent CI: 0.61-1.33) after adjusting for age, race, education, dental care utilization, and smoking status. In this sample, a history of breast cancer does not significantly impact periodontal health, self-perceived oral health, and dental care utilization. However, efforts should be made to assure that breast cancer survivors have dental insurance. © 2015 American Association of Public Health Dentistry.
The current phase of globalization represents a "double-edged sword" challenge facing public health practitioners and health policy makers. The first "edge" throws light on two constructs in the field of public health: global health (formerly international health) and globalized public health. The second "edge" is that of global governance, and raises the question, "how can we construct public health regulations that adequately respond to both global and local complexities related to the two constructs mentioned earlier (global health and globalized public health)?" The two constructs call for the development of norms that will assure sustained population-wide health improvement and these two constructs have their own conceptual tools and theoretical models that permit a better understanding of them. In this paper, we introduce the "globalized public health" construct and we present an interactive comprehensive framework for critically analyzing contemporary globalization's influences on the field of public health. "Globalized public health", simultaneously a theoretical model and a conceptual framework, concerns the transformation of the field of public health in the sociohistorical context of globalization. The model is the fruit of an original theoretical research study conducted from 2005 to 2008 ("contextualized research," Gibbons' Mode II of knowledge production), founded on a QUAL-quant sequential mixed-method design. This research also reflects our political and ideological position, fuelled with aspirations of social democracy and cosmopolitical values. It is profoundly anchored in the pragmatic approach to globalization, looking to "reconcile" the market and equity. The model offers several features to users: (1) it is transdisciplinary; (2) it is interactive (CD-ROM); (3) it is nonlinear (nonlinear interrelations between the contextual globalization and the field of public health); (4) it is synchronic/diachronic (a double-crossed perspective permits
When first described in 1958, Burkitt lymphoma was considered by many to be an African curiosity. However, over the next few decades, over 10,000 publications on Burkitt lymphoma would influence many facets of oncology research including immunology, molecular genetics, chemotherapy, and viral oncology. At the time of discovery, its distribution in equatorial Africa was unique; it was where a child was born and lived, and not what race they were, that conveyed the greatest incidence risk. Its association with Epstein-Barr virus brought attention to the possibility that oncogenesis may be influenced by viruses. The influence that Burkitt lymphoma had on furthering oncology is far-reaching, and it is fitting that the physician credited with bringing attention to this disease was himself broad in his influence. Denis Burkitt was a humanitarian surgeon whose work was not limited to Burkitt lymphoma: he instigated a plan to rid an entire Ugandan district of yaws, he designed and created affordable orthopaedic equipment that could be locally produced in Kampala, and he was an early advocate of a high fiber diet. The following article will examine the biography of Denis Burkitt, with a focus on how he was able to further oncology and global health. © The Author(s) 2016.
Dana M Brantley-Sieders
Full Text Available Despite available demographic data on the factors that contribute to breast cancer mortality in large population datasets, local patterns are often overlooked. Such local information could provide a valuable metric by which regional community health resources can be allocated to reduce breast cancer mortality. We used national and statewide datasets to assess geographical distribution of breast cancer mortality rates and known risk factors influencing breast cancer mortality in middle Tennessee. Each county in middle Tennessee, and each ZIP code within metropolitan Davidson County, was scored for risk factor prevalence and assigned quartile scores that were used as a metric to identify geographic areas of need. While breast cancer mortality often correlated with age and incidence, geographic areas were identified in which breast cancer mortality rates did not correlate with age and incidence, but correlated with additional risk factors, such as mammography screening and socioeconomic status. Geographical variability in specific risk factors was evident, demonstrating the utility of this approach to identify local areas of risk. This method revealed local patterns in breast cancer mortality that might otherwise be overlooked in a more broadly based analysis. Our data suggest that understanding the geographic distribution of breast cancer mortality, and the distribution of risk factors that contribute to breast cancer mortality, will not only identify communities with the greatest need of support, but will identify the types of resources that would provide the most benefit to reduce breast cancer mortality in the community.
Zimmerman, Cathy; Kiss, Ligia
In this collection review, Cathy Zimmerman and colleague introduce the PLOS Medicine Collection on Human Trafficking, Exploitation and Health, laying out the magnitude of the global trafficking problem and offering a public health policy framework to guide responses to trafficking.
Full Text Available Since the mid-19th century, human activities have increased greenhouse gases such as carbon dioxide, methane, and nitrous oxide in the Earth's atmosphere that resulted in increased average temperature. The effects of rising temperature include soil degradation, loss of productivity of agricultural land, desertification, loss of biodiversity, degradation of ecosystems, reduced fresh-water resources, acidification of the oceans, and the disruption and depletion of stratospheric ozone. All these have an impact on human health, causing non-communicable diseases such as injuries during natural disasters, malnutrition during famine, and increased mortality during heat waves due to complications in chronically ill patients. Direct exposure to natural disasters has also an impact on mental health and, although too complex to be quantified, a link has even been established between climate and civil violence. Over time, climate change can reduce agricultural resources through reduced availability of water, alterations and shrinking arable land, increased pollution, accumulation of toxic substances in the food chain, and creation of habitats suitable to the transmission of human and animal pathogens. People living in low-income countries are particularly vulnerable. Climate change scenarios include a change in distribution of infectious diseases with warming and changes in outbreaks associated with weather extreme events. After floods, increased cases of leptospirosis, campylobacter infections and cryptosporidiosis are reported. Global warming affects water heating, rising the transmission of water-borne pathogens. Pathogens transmitted by vectors are particularly sensitive to climate change because they spend a good part of their life cycle in a cold-blooded host invertebrate whose temperature is similar to the environment. A warmer climate presents more favorable conditions for the survival and the completion of the life cycle of the vector, going as far
Since the mid-19th century, human activities have increased greenhouse gases such as carbon dioxide, methane, and nitrous oxide in the Earth's atmosphere that resulted in increased average temperature. The effects of rising temperature include soil degradation, loss of productivity of agricultural land, desertification, loss of biodiversity, degradation of ecosystems, reduced fresh-water resources, acidification of the oceans, and the disruption and depletion of stratospheric ozone. All these have an impact on human health, causing non-communicable diseases such as injuries during natural disasters, malnutrition during famine, and increased mortality during heat waves due to complications in chronically ill patients. Direct exposure to natural disasters has also an impact on mental health and, although too complex to be quantified, a link has even been established between climate and civil violence. Over time, climate change can reduce agricultural resources through reduced availability of water, alterations and shrinking arable land, increased pollution, accumulation of toxic substances in the food chain, and creation of habitats suitable to the transmission of human and animal pathogens. People living in low-income countries are particularly vulnerable. Climate change scenarios include a change in distribution of infectious diseases with warming and changes in outbreaks associated with weather extreme events. After floods, increased cases of leptospirosis, campylobacter infections and cryptosporidiosis are reported. Global warming affects water heating, rising the transmission of water-borne pathogens. Pathogens transmitted by vectors are particularly sensitive to climate change because they spend a good part of their life cycle in a cold-blooded host invertebrate whose temperature is similar to the environment. A warmer climate presents more favorable conditions for the survival and the completion of the life cycle of the vector, going as far as to speed it up
Güler, Sertaç Ata; Güllüoğlu, Bahadır M
Breast health is a subject of increasing importance. The statistical increase in the frequency of breast cancer and the consequent increase in death rate increase the importance of quality of services to be provided for breast health. For these reasons, the minimum standards and optimum quality metrics of breast care provided to the community are determined. The quality parameters for breast care service include the results, the structure and the operation of services. Within this group, the results of breast health services are determined according to clinical results, patient satisfaction and financial condition. The structure of quality services should include interdisciplinary meetings, written standards for specific procedures and the existence of standardized reporting systems. Establishing breast centers that adopt integrated multidisciplinary working principles and their cost-effective maintenance are important in terms of operation of breast health services. The importance of using a "reviewing/auditing" procedure that checks if all of these functions existing in the health system are carried out at the desired level and an "accreditation" system indicating that the working breast units/centers provide minimum quality adequacy in all aspects, is undeniable. Currently, the accreditation system for breast centers is being used in the European Union and the United States for the last 5-10 years. This system is thought to provide standardization in breast care services, and is accepted as one of the important factors that resulted in reduction in mortality associated with breast cancer.
This paper considers how operational research and management science can improve the design of health systems and the delivery of health care, particularly in low-resource settings. It identifies some gaps in the way operational research is typically used in global health and proposes steps to bridge them. It then outlines some analytical tools of operational research and management science and illustrates how their use can inform some typical design and delivery challenges in global health. The paper concludes by considering factors that will increase and improve the contribution of operational research and management science to global health.
Dilger, Hansjörg; Mattes, Dominik
The interdisciplinary, politically contested field of Global Health has often been described as a consequence of, and response to, an intensification of the mobilities of, and connectivities between, people, pathogens, ideas, and infrastructure across national borders and large distances. However, such global mobilities and connectivities are not as omnidirectional and unpatterned as the rhetoric of many Global Health actors suggests. Instead, we argue that they are suffused by a plethora of institutional, national, and global political agendas, and substantially shaped by transnational and postcolonial power relations. Furthermore, the configurations that are typically subsumed under the category of Global Health represent only a minor part of the range of im/mobilities and dis/connectivities that are essential for understanding transformations of epidemiological patterns, health care infrastructures, and the responses to health-related challenges in a globalising world. In order to broaden such a limiting analytical perspective, we propose to expand the analytical focus in studying Global Health phenomena by paying close attention to the myriad ways in which particular im/mobilities and dis/connectivities constitute medicine and well-being in global and transnational settings. Pursuing a conceptual shift from studies of 'Global Health' to studying 'medical globalization' may carve out new analytical ground for such an endeavour.
This paper considers how operational research and management science can improve the design of health systems and the delivery of health care, particularly in low-resource settings. It identifies some gaps in the way operational research is typically used in global health and proposes steps to bridge them. It then outlines some analytical tools of operational research and management science and illustrates how their use can inform some typical design and delivery challenges in global health. ...
.... Also emphasizing a wide variety of issues of global interest, the thoroughly revised second edition contains updated information on such timely topics as toxicology, exposure assessment, climate...
Jiménez-Puente, Alberto; Maañón-di Leo, José Claudio; Lara-Blanquer, Antonio
Breast reconstruction (BR) after mastectomy is widely recommended but there are significant variations in its application. The objective was to know the rate of BR in the Andalusian Public Health System (APHS), timing (immediate or delayed), surgical procedure, frequency of postoperative complications and their characteristics. We used the Minimum Basic Data Set of the APHS with personal data and identification of hospitals encrypted. We selected discharges for breast cancer and mastectomy in 2010-2013 and related readmissions of the same patients in 2010-2014. BR rates were calculated according to patient age and type of mastectomy. Timing of BR (immediate or delayed) and surgical techniques used were described. Postoperative complications were analyzed in the initial episode and in readmissions occurring within a minimum period of 2 years. BR failures were specifically studied. We analyzed the information of 6,026 women, of which 4,412 met the inclusion criteria (basically, two years follow-up). The BR rate was 29% (22% immediate and 7% delayed) and reached 58% in women younger than 46 years. BR was performed by 27 of the 36 hospitals that practice mastectomies. Global percentage of postoperative complications was 18.6% for immediate BR, 12.1% for delayed BR and 7.9% for patients without BR. Failure occurred in 12.7% of immediate BR and 7.2% of delayed BR. In the Andalusian Public Health System the Breast reconstruction rate, is at a similar level to that reported nationally and in other countries.
Sarah Carbone; Jannah Wigle; Nadia Akseer; Raluca Barac; Melanie Barwick; Stanley Zlotkin
...’ participation in global child health-related work. Benefits were measured in the form of skills, knowledge and attitude strengthening as estimated by an adapted Global Health Competency Model...
Leffers, Jeanne; Mitchell, Emma
Although nursing has a long history of service to the global community, the profession lacks a theoretical and empirical base for nurses to frame their global practice. A study using grounded theory methodology to investigate partnership and sustainability for global health led to the development of a conceptual model. Interviews were conducted with 13 global health nurse experts. Themes from the interviews were: components for engagement, mutual goal setting, cultural bridging, collaboration, capacity building, leadership, partnership, ownership, and sustainability. Next, the identified themes were reviewed in the literature in order to evaluate their conceptual relationships. Finally, careful comparison of the interview transcripts and the supporting literature led to the Conceptual Framework for Partnership and Sustainability in Global Health Nursing. The model posits that engagement and partnership must precede any planning and intervention in order to create sustainable interventions. This conceptual framework will offer nurses important guidance for global health nursing practice. © 2010 Wiley Periodicals, Inc.
A very welcome and important contribution to understanding the rapidly changing policy environment surrounding global health.... A highly recommended read. — Kelley Lee (Chair, WHO Scientific Resource Group on Globalization, Trade and Health). The G8 (the United States, England, France, Germany, Japan, Italy, ...
Chin, Ming-Kai, Ed.; Edginton, Christopher R.
"Physical Education and Health: Global Perspectives and Best Practice" draws together global scholars, researchers, and practitioners to provide a review and analysis of new directions in physical education and health worldwide. The book provides descriptive information from 40 countries regarding contemporary practices, models, and…
he recent Ebola crisis has caused approximately 20.000 deaths so far. Compared to other global health crises, including the deaths caused by armed conflicts and chronic diseases, this is still a small amount. Yet, from a global and domestic health law and governance perspective, this crisis raises a
Bender, Amy; Walker, Pamela
An outcome of globalization and internationalization in higher education in the health professions has been increasing global health placements. There is, however, a lack of literature on debriefing and support following these placements. The authors undertook a participatory project to develop peer support and debriefing in a global health nursing elective, during which this gap in literature was addressed. The purpose of the project was to develop a peer support component of the course and revise the debriefing component based on results of a previous course evaluation. The methods were guided by a participatory approach involving course alumni and included a scoping review and focus groups. The project resulted in development of: (1) a peer support statement and (2) a debriefing framework. Key lessons about the obligation of appropriate debriefing for students returning from global health placements include importance of affective learning, a pedagogy of discomfort, and global health ethics.
Woodward, D; Drager, N; Beaglehole, R; Lipson, D
Globalization is a key challenge to public health, especially in developing countries, but the linkages between globalization and health are complex. Although a growing amount of literature has appeared on the subject, it is piecemeal, and suffers from a lack of an agreed framework for assessing the direct and indirect health effects of different aspects of globalization. This paper presents a conceptual framework for the linkages between economic globalization and health, with the intention that it will serve as a basis for synthesizing existing relevant literature, identifying gaps in knowledge, and ultimately developing national and international policies more favourable to health. The framework encompasses both the indirect effects on health, operating through the national economy, household economies and health-related sectors such as water, sanitation and education, as well as more direct effects on population-level and individual risk factors for health and on the health care system. Proposed also is a set of broad objectives for a programme of action to optimize the health effects of economic globalization. The paper concludes by identifying priorities for research corresponding with the five linkages identified as critical to the effects of globalization on health.
Woodward, D.; Drager, N.; Beaglehole, R.; Lipson, D.
Globalization is a key challenge to public health, especially in developing countries, but the linkages between globalization and health are complex. Although a growing amount of literature has appeared on the subject, it is piecemeal, and suffers from a lack of an agreed framework for assessing the direct and indirect health effects of different aspects of globalization. This paper presents a conceptual framework for the linkages between economic globalization and health, with the intention that it will serve as a basis for synthesizing existing relevant literature, identifying gaps in knowledge, and ultimately developing national and international policies more favourable to health. The framework encompasses both the indirect effects on health, operating through the national economy, household economies and health-related sectors such as water, sanitation and education, as well as more direct effects on population-level and individual risk factors for health and on the health care system. Proposed also is a set of broad objectives for a programme of action to optimize the health effects of economic globalization. The paper concludes by identifying priorities for research corresponding with the five linkages identified as critical to the effects of globalization on health. PMID:11584737
Anthropology and global health have long been a focus of research for both biological and medical anthropologists. Research has looked at physiological adaptations to high altitudes, community responses to water-borne diseases, the integration of traditional and biomedical approaches to health, global responses to HIV/AIDS, and more recently, to the application of cultural approaches to the control of the Ebola epidemic. Academic anthropology has employed theory and methods to extend knowledge, but less often to apply that knowledge. However, anthropologists outside of the academy have tackled global health issues such as family planning and breast-feeding by bringing together applied medical anthropology and social marketing. In 2014, that potent and provocative combination resulted in the University of South Florida in Tampa, Florida being made the home of an innovative center designed to combine academic and applied anthropology with social marketing in order to facilitate social change. This article discusses how inter- and intra-disciplinary research/application has led to the development of Florida's first World Health Organization Collaborating Center (WHO CC), and the first such center to focus on social marketing, social change and non-communicable diseases. This article explains the genesis of the Center and presents readers with a brief overview, basic principles and applications of social marketing by reviewing a case study of a water conservation project. The article concludes with thoughts on the ecology of collaboration among global health, medical anthropology and social marketing practitioners.
Boyages, Costa S
Rio+20's proposed Sustainable Development Goals have the potential to redefine the course of international action on climate change. They recognise that environmental health is inextricably linked with human health, and that environmental sustainability is of paramount importance in safeguarding global health. Competition entrants were asked to discuss ways of making global health a central component of international sustainable development initiatives and environmental policy, using one or two concrete examples
Ouyang, Yan-Qiong; Hu, Xiaoyan
Studies indicate that women in China are not frequently carrying out breast cancer prevention practices. This is assumed to be due to lack of knowledge and/or lack of personalized instruction. This study was to explore the effect of breast cancer health education on women's knowledge and attitudes on breast cancer and breast self-examination, behavior related to breast self-examination among women living in the catchment area of a community health center. A pretest and posttest assessment of a 1-h health education session was conducted with 38 participants. A telephone reminder and questionnaires were administered at 1 and 3 months after the education. Three instruments were administered at each contact to assess the knowledge and attitudes on breast cancer and behavior related to breast self-examination and accuracy of breast self-examination before education, 1- and 3-month follow-ups after education. The findings showed the incidence of self-examination, and scores on the accuracy of breast self-examination practice were significantly increased immediately following the intervention and at 1- and 3-month follow-ups. Furthermore, the scores of the health belief regarding perceived benefits, perceived competency, and perceived seriousness significantly improved. The current findings imply community-based intervention could be used to teach women about the general knowledge of breast cancer and how to perform breast self-examination correctly, especially for women who are lack of such information.
Full Text Available Abstract Purpose and background: despite outstanding breakthroughs in medical sciences, breast cancer is still considered one of the most important disease and the most prevalent women cancer and the second reason of death among them. The present study was conducted aiming to compare public health and marital satisfaction among breast cancer patients with breast evacuation, breast keeping and normal women in Tehran. Material and methods: the method of the present study, due to the lack of interference to alter the research variables, was causal comparative. The statistical population included all women with breast cancer and normal women in the city of Tehran. From these people in each group (breast cancer patients with breast evacuation, breast keeping and normal people 80 individuals were selected through available sampling from clients of medical centers and special hospitals in Tehran during October 2012 to December 2013. The applied instruments were the questionnaires of public health, body image, and marital satisfaction. The achieved data were analyzed via one-way ANOVA and Tukey test by SPSS software. Findings: the results of the analysis showed that there is a significant difference between the mean scores of marital satisfaction, body image and public health in three groups (women with cancer who evacuated their breast, those who didn't and normal ones(p<0.01. Conclusion: according to the findings of the present study the women with breast cancer are in more different state in variables of marital satisfaction, mental health and body image comparing to normal group. So it seems necessary for cancer treatment centers to consider psychological treatment courses for these people.
Welander, Anna; Lyttkens, Carl Hampus; Nilsson, Therese
Good health is crucial for human and economic development. In particular poor health in childhood is of utmost concern since it causes irreversible damage and has implications later in life. Recent research suggests globalization is a strong force affecting adult and child health outcomes. Yet, there is much unexplained variation with respect to the globalization effect on child health, in particular in low- and middle-income countries. One factor that could explain such variation across countries is the quality of democracy. Using panel data for 70 developing countries between 1970 and 2009 this paper disentangles the relationship between globalization, democracy, and child health. Specifically the paper examines how globalization and a country's democratic status and historical experience with democracy, respectively, affect infant mortality. In line with previous research, results suggest that globalization reduces infant mortality and that the level of democracy in a country generally improves child health outcomes. Additionally, democracy matters for the size of the globalization effect on child health. If for example Côte d'Ivoire had been a democracy in the 2000-2009 period, this effect would translate into 1200 fewer infant deaths in an average year compared to the situation without democracy. We also find that nutrition is the most important mediator in the relationship. To conclude, globalization and democracy together associate with better child health in developing countries. Copyright © 2015 Elsevier Ltd. All rights reserved.
Cox, Raymond L
The United States spends more than the rest of the world on healthcare. In 2000, the U.S. health bill was 1.3 trillion dollars, 14.5% of its gross domestic product. Yet, according to the WHO World Health Report 2000, the United States ranked 37th of 191 member nations in overall health system performance. Racial/ethnic disparities in health outcomes are the most obvious examples of an unbalanced healthcare system. This presentation will examine health disparities in the United States and reveal how health disparities among and within countries affect the health and well-being of the African Diaspora.
San Francisco has a distinguished history as a cosmopolitan, progressive, and international city, including extensive associations with global health. These circumstances have contributed to new, interdisciplinary scholarship in the field of global health diplomacy (GHD). In the present review, we describe the evolution and history of GHD at the practical and theoretical levels within the San Francisco medical community, trace related associations between the local and the global, and propose a range of potential opportunities for further development of this dynamic field. We provide a historical overview of the development of the "San Francisco Model" of collaborative, community-owned HIV/AIDS treatment and care programs as pioneered under the "Ward 86" paradigm of the 1980s. We traced the expansion and evolution of this model to the national level under the Ryan White Care Act, and internationally via the President's Emergency Plan for AIDS Relief. In parallel, we describe the evolution of global health diplomacy practices, from the local to the global, including the integration of GHD principles into intervention design to ensure social, political, and cultural acceptability and sensitivity. Global health programs, as informed by lessons learned from the San Francisco Model, are increasingly aligned with diplomatic principles and practices. This awareness has aided implementation, allowed policymakers to pursue related and progressive social and humanitarian issues in conjunction with medical responses, and elevated global health to the realm of "high politics." In the 21st century, the integration between diplomatic, medical, and global health practices will continue under "smart global health" and GHD paradigms. These approaches will enhance intervention cost-effectiveness by addressing and optimizing, in tandem with each other, a wide range of (health and non-health) foreign policy, diplomatic, security, and economic priorities in a synergistic manner
Jaggar, Alison M
Contemporary processes of globalization have been accompanied by a serious deterioration in the health of many women across the world. Particularly disturbing is the drastic decline in the health status of many women in the global South, as well as some women in the global North. This paper argues that the health vulnerability of women in the global South is inseparable from their political and economic vulnerability. More specifically, it links the deteriorating health of many Southern women with the neo-liberal economic policies that characterize contemporary economic globalization and argues that this structure is sustained by the heavy burden of debt repayments imposed on many Southern countries. In conclusion, it argues that many Southern debt obligations are not morally binding because they are not democratically legitimate.
Ruth M. Campbell
Full Text Available In late 2011, the Expert Panel on Canada’s Strategic Role in Global Health (herein: the panel selected a global health definition for Canada. This decision is significant as the chosen definition forms the foundation of the panels forthcoming recommended role for Canada in global health. In turn, the global health community can draw lessons from Canada’s decision to inform their own understanding of the term and demystify priority setting. In this paper we examine the five definitions considered by the panel and analyze the core characteristics of each in order to understand the rationale for the final choice as well as the implications of the chosen definition. To understand the basis upon which Canada will build its strategic direction for global health it is useful to frame this analysis in light of the other short-listed definitions.
Tediosi, Fabrizio; Finch, Aureliano; Procacci, Christina; Marten, Robert; Missoni, Eduardo
This article explores BRICS' engagement in the global movement for Universal Health Coverage (UHC) and the implications for global health governance. It is based on primary data collected from 43 key informant interviews, complemented by a review of BRICS' global commitments supporting UHC. Interviews were conducted using a semi-structured questionnaire that included both closed- and open-ended questions. Question development was informed by insights from the literature on UHC, Cox's framework for action, and Kingdon's multiple-stream theory of policy formation. The closed questions were analysed with simple descriptive statistics and the open-ended questions using grounded theory approach. The analysis demonstrates that most BRICS countries implicitly supported the global movement for UHC, and that they share an active engagement in promoting UHC. However, only Brazil, China and to some extent South Africa, were recognized as proactively pushing UHC in the global agenda. In addition, despite some concerted actions, BRICS countries seem to act more as individual countries rather that as an allied group. These findings suggest that BRICS are unlikely to be a unified political block that will transform global health governance. Yet the documented involvement of BRICS in the global movement supporting UHC, and their focus on domestic challenges, shows that BRICS individually are increasingly influential players in global health. So if BRICS countries should probably not be portrayed as the centre of future political community that will transform global health governance, their individual involvement in global health, and their documented concerted actions, may give greater voice to low- and middle-income countries supporting the emergence of multiple centres of powers in global health. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please email: firstname.lastname@example.org.
Seymour, Brittany; Shick, Elizabeth; Chaffee, Benjamin W; Benzian, Habib
The Global Oral Health Interest Group of the Consortium of Universities for Global Health (GOHIG-CUGH) published recommended competencies to support development of competency-based global health education in dental schools. However, there has been no comprehensive, systematically derived, or broadly accepted framework for creating and delivering competency-based global health education to dental students. This article describes the results of a collaborative workshop held at the 2016 American Dental Education Association (ADEA) Annual Session & Exhibition designed to build on the GOHIG-CUGH competencies and start to develop systematic approaches for their practical application. Workshop organizers developed a preliminary theoretical framework for guiding the development of global health in dental education, grounded in published research. Collectively, workshop participants developed detailed outcomes for the theoretical framework with a focus on three educational practices: didactic, experiential, and research learning and how each can meet the competencies. Participants discussed learning objectives, keys to implementation, ethical considerations, challenges, and examples of success. Outcomes demonstrated that no educational practice on its own meets all 33 recommended competencies for dental students; however, the three educational practices combined may potentially cover all 33. Participants emphasized the significance of sustainable approaches to student learning for both students and communities, with identified partners in the communities to collaborate on the development, implementation, evaluation, and long-term maintenance of any student global health activity. These findings may represent early steps toward professional consensus and best practices for global health in dental education in the United States.
The year 2016 could turn out to be a turning point for global health, new political realities and global insecurities will test governance and financing mechanisms in relation to both people and planet. But most importantly political factors such as the global power shift and "the rise of the rest" will define the future of global health. A new mix of health inequity and security challenges has emerged and the 2015 humanitarian and health crises have shown the limits of existing systems. The global health as well as the humanitarian system will have to prove their capacity to respond and reform. The challenge ahead is deeply political, especially for the rising political actors. They are confronted with the consequences of a model of development that has neglected sustainability and equity, and was built on their exploitation. Some direction has been given by the path breaking international conferences in 2015. Especially the agreement on the Sustainable Development Goals (SDGs) and the Paris agreement on climate change will shape action. Conceptually, we will need a different understanding of global health and its ultimate goals - the health of people can no longer be seen separate from the health of the planet and wealth measured by parameters of growth will no longer ensure health. © 2016 by Kerman University of Medical Sciences.
Full Text Available The year 2016 could turn out to be a turning point for global health, new political realities and global insecurities will test governance and financing mechanisms in relation to both people and planet. But most importantly political factors such as the global power shift and “the rise of the rest” will define the future of global health. A new mix of health inequity and security challenges has emerged and the 2015 humanitarian and health crises have shown the limits of existing systems. The global health as well as the humanitarian system will have to prove their capacity to respond and reform. The challenge ahead is deeply political, especially for the rising political actors. They are confronted with the consequences of a model of development that has neglected sustainability and equity, and was built on their exploitation. Some direction has been given by the path breaking international conferences in 2015. Especially the agreement on the Sustainable Development Goals (SDGs and the Paris agreement on climate change will shape action. Conceptually, we will need a different understanding of global health and its ultimate goals - the health of people can no longer be seen separate from the health of the planet and wealth measured by parameters of growth will no longer ensure health.
McNeill, D; Ottersen, O P
In this article, we address a central theme that was discussed at the Durham Health Summit: how can politics be brought back into global health governance and figure much more prominently in discussions around policy? We begin by briefly summarizing the report of the Lancet - University of Oslo Commission on Global Governance for Health: 'The Political Origins of Health Inequity' Ottersen et al. In order to provide compelling evidence of the central argument, the Commission selected seven case studies relating to, inter alia, economic and fiscal policy, food security, and foreign trade and investment agreements. Based on an analysis of these studies, the report concludes that the problems identified are often due to political choices: an unwillingness to change the global system of governance. This raises the question: what is the most effective way that a report of this kind can be used to motivate policy-makers, and the public at large, to demand change? What kind of moral or rational argument is most likely to lead to action? In this paper we assess the merits of various alternative perspectives: health as an investment; health as a global public good; health and human security; health and human development; health as a human right; health and global justice. We conclude that what is required in order to motivate change is a more explicitly political and moral perspective - favouring the later rather than the earlier alternatives just listed. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Blouin, Chantal; Dubé, Laurette
To date the global health diplomacy agenda has focused primarily on infectious diseases. Policymakers have not dedicated the same level of attention to chronic diseases, despite their rising contribution to the global burden of disease. Negotiation of the Framework convention on tobacco control provides an apt example from global health diplomacy to tackle diet-related chronic diseases. What lessons can be learned from this experience for preventing obesity? This article looks at why a global policy response is necessary, at the actors and interests involved in the negotiations, and at the forum for diplomacy.
Full Text Available Abstract Background Since the early 1990s there has been a burgeoning interest in global health teaching in undergraduate medical curricula. In this article we trace the evolution of this teaching and present recommendations for how the discipline might develop in future years. Discussion Undergraduate global health teaching has seen a marked growth over the past ten years, partly as a response to student demand and partly due to increasing globalization, cross-border movement of pathogens and international migration of health care workers. This teaching has many different strands and types in terms of topic focus, disciplinary background, the point in medical studies in which it is taught and whether it is compulsory or optional. We carried out a survey of medical schools across the world in an effort to analyse their teaching of global health. Results indicate that this teaching is rising in prominence, particularly through global health elective/exchange programmes and increasing teaching of subjects such as globalization and health and international comparison of health systems. Our findings indicate that global health teaching is moving away from its previous focus on tropical medicine towards issues of more global relevance. We suggest that there are three types of doctor who may wish to work in global health – the ‘globalised doctor’, ‘humanitarian doctor’ and ‘policy doctor’ – and that each of these three types will require different teaching in order to meet the required competencies. This teaching needs to be inserted into medical curricula in different ways, notably into core curricula, a special overseas doctor track, optional student selected components, elective programmes, optional intercalated degrees and postgraduate study. Summary We argue that teaching of global health in undergraduate medical curricula must respond to changing understandings of the term global health. In particular it must be taught from the
Martens, Pim; Akin, Su-Mia; Maud, Huynen; Mohsin, Raza
It is clear that globalization is something more than a purely economic phenomenon manifesting itself on a global scale. Among the visible manifestations of globalization are the greater international movement of goods and services, financial capital, information and people. In addition, there are technological developments, more transboundary cultural exchanges, facilitated by the freer trade of more differentiated products as well as by tourism and immigration, changes in the political landscape and ecological consequences. In this paper, we link the Maastricht Globalization Index with health indicators to analyse if more globalized countries are doing better in terms of infant mortality rate, under-five mortality rate, and adult mortality rate. The results indicate a positive association between a high level of globalization and low mortality rates. In view of the arguments that globalization provides winners and losers, and might be seen as a disequalizing process, we should perhaps be careful in interpreting the observed positive association as simple evidence that globalization is mostly good for our health. It is our hope that a further analysis of health impacts of globalization may help in adjusting and optimising the process of globalization on every level in the direction of a sustainable and healthy development for all.
It is clear that globalization is something more than a purely economic phenomenon manifesting itself on a global scale. Among the visible manifestations of globalization are the greater international movement of goods and services, financial capital, information and people. In addition, there are technological developments, more transboundary cultural exchanges, facilitated by the freer trade of more differentiated products as well as by tourism and immigration, changes in the political landscape and ecological consequences. In this paper, we link the Maastricht Globalization Index with health indicators to analyse if more globalized countries are doing better in terms of infant mortality rate, under-five mortality rate, and adult mortality rate. The results indicate a positive association between a high level of globalization and low mortality rates. In view of the arguments that globalization provides winners and losers, and might be seen as a disequalizing process, we should perhaps be careful in interpreting the observed positive association as simple evidence that globalization is mostly good for our health. It is our hope that a further analysis of health impacts of globalization may help in adjusting and optimising the process of globalization on every level in the direction of a sustainable and healthy development for all. PMID:20849605
Full Text Available Abstract It is clear that globalization is something more than a purely economic phenomenon manifesting itself on a global scale. Among the visible manifestations of globalization are the greater international movement of goods and services, financial capital, information and people. In addition, there are technological developments, more transboundary cultural exchanges, facilitated by the freer trade of more differentiated products as well as by tourism and immigration, changes in the political landscape and ecological consequences. In this paper, we link the Maastricht Globalization Index with health indicators to analyse if more globalized countries are doing better in terms of infant mortality rate, under-five mortality rate, and adult mortality rate. The results indicate a positive association between a high level of globalization and low mortality rates. In view of the arguments that globalization provides winners and losers, and might be seen as a disequalizing process, we should perhaps be careful in interpreting the observed positive association as simple evidence that globalization is mostly good for our health. It is our hope that a further analysis of health impacts of globalization may help in adjusting and optimising the process of globalization on every level in the direction of a sustainable and healthy development for all.
Both the theory and practice of foreign policy and diplomacy, including systems of hard and soft power, are undergoing paradigm shifts, with an increasing number of innovative actors and strategies contributing to international relations outcomes in the 'New World Order'. Concurrently, global health programmes continue to ascend the political spectrum in scale, scope and influence. This concatenation of circumstances has demanded a re-examination of the existing and potential effectiveness of global health programmes in the 'smart power' context, based on adherence to a range of design, implementation and assessment criteria, which may simultaneously optimise their humanitarian, foreign policy and diplomatic effectiveness. A synthesis of contemporary characteristics of 'global health diplomacy' and 'global health as foreign policy', grouped by common themes and generated in the context of related field experiences, are presented in the form of 'Top Ten' criteria lists for optimising both diplomatic and foreign policy effectiveness of global health programmes, and criteria are presented in concert with an examination of implications for programme design and delivery. Key criteria for global health programmes that are sensitised to both diplomatic and foreign policy goals include visibility, sustainability, geostrategic considerations, accountability, effectiveness and alignment with broader policy objectives. Though diplomacy is a component of foreign policy, criteria for 'diplomatically-sensitised' versus 'foreign policy-sensitised' global health programmes were not always consistent, and were occasionally in conflict, with each other. The desirability of making diplomatic and foreign policy criteria explicit, rather than implicit, in the context of global health programme design, delivery and evaluation are reflected in the identified implications for (1) international security, (2) programme evaluation, (3) funding and resource allocation decisions, (4) approval
Kluge, Hans; Martín-Moreno, Jose Maria; Emiroglu, Nedret; Rodier, Guenael; Kelley, Edward; Vujnovic, Melitta; Permanand, Govin
The International Health Regulations (IHR) 2005, as the overarching instrument for global health security, are designed to prevent and cope with major international public health threats. But poor implementation in countries hampers their effectiveness. In the wake of a number of major international health crises, such as the 2014 Ebola and 2016 Zika outbreaks, and the findings of a number of high-level assessments of the global response to these crises, it has become clear that there is a need for more joined-up thinking between health system strengthening activities and health security efforts for prevention, alert and response. WHO is working directly with its Member States to promote this approach, more specifically around how to better embed the IHR (2005) core capacities into the main health system functions. This paper looks at how and where the intersections between the IHR and the health system can be best leveraged towards developing greater health system resilience. This merging of approaches is a key component in pursuit of Universal Health Coverage and strengthened global health security as two mutually reinforcing agendas.
How is radical change in global health policy possible? Material factors such as economics or human resources are important, but ideational factors such as ideas and discourse play an important role as well. In this paper, I apply a theoretical framework to show how discourse made it possible for public and private actors to fundamentally change their way of working together--to shift from international public and private interactions to global health partnerships (GHPs)--and in the process create a new institutional mechanism for governing global health. Drawing on insights from constructivist analysis, I demonstrate how discourse justified, legitimised, communicated and coordinated ideas about the practice of GHPs through a concentrated network of partnership pioneers. As attention from health policy analysts turns increasingly to ideational explanations for answers to global health problems, this paper contributes to the debate by showing how, precisely, discourse makes change possible.
Politics play a central part in determining health and development outcomes as Gorik Ooms highlights in his recent commentary. As health becomes more global and more politicized the need grows to better understand the inherently political processes at all levels of governance, such as ideological positions, ideas, value judgments, and power. I agree that global health research should strengthen its contribution to generating such knowledge by drawing more on political science, such research is gaining ground. Even more important is – as Ooms indicates – that global health scholars better understand their own role in the political process. It is time to acknowledge that expert-based technocratic approaches are no less political. We will need to reflect and analyse the role of experts in global health governance to a greater extent and in that context explore the links between politics, expertise and democracy. PMID:26927593
Beasley, J.W.; Starfield, B.; Weel, C. van; Rosser, W.W.; Haq, C.L.
A strong primary health care system is essential to provide effective and efficient health care in both resource-rich and resource-poor countries. Although a direct link has not been proven, we can reasonably expect better economic status when the health of the population is improved. Research in
Andrew Liebhold; Michael. Wingfield
Consideration of forest health is central to the sustainable management of forests. While many definitions of forest health have been proposed, the most widely adopted concept refers to the sustained functioning of desired forest ecosystem processes (Kolb et al., 1994). Legitimate complaints have been raised about the human-centric usage of the term "Forest Health...
Van de Pas, Remco; Hill, Peter S; Hammonds, Rachel; Ooms, Gorik; Forman, Lisa; Waris, Attiya; Brolan, Claire E; McKee, Martin; Sridhar, Devi
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.
McKimm, Judy; McLean, Michelle
Although many health issues transcend national boundaries and require international co-operation, global health is rarely an integral part of the medical curriculum. While medical schools have a social responsibility to train healthcare professionals to serve local communities, the internationalisation of medical education (e.g. international medical students, export of medical curricula or medical schools) makes it increasingly difficult to define it as 'local'. It is therefore necessary to produce practitioners who can practice medicine in an ever-changing and unpredictable world. These practitioners must be clinically and culturally competent as well as able to use their global knowledge and experience to improve health and well-being, irrespective of where they eventually practice medicine. Global health practitioners are tomorrow's leaders, change agents and members of effective multiprofessional teams and so need to be aware of the environmental, cultural, social and political factors that impact on health, serving as advocates of people's rights to access resources, education and healthcare. This article addresses some of the difficulties of developing global health practitioners, offering suggestions for a global health curriculum. It also acknowledges that creating a global health practitioner requires international collaboration and shared resources and practices and places the onus of social accountability on academic leaders.
For many years the World Health Organization (WHO) has provided the global direction and leadership that has helped to shape the way we view health promotion today. The future role of the WHO is now uncertain and the lack of global leadership for health promotion and identification of who will provide the future direction are issues that need to be addressed. The crucial question posed in this commentary is: Where are the individuals and organisations that will provide the global leadership and vision for health promotion in the future? We need named champions for the future leadership of health promotion practice - people and organisations who offer a leadership style that will maintain its global profile, be representative across sectors and have the ability to maintain its political efficacy. The two key health promotion approaches, top-down and bottom-up, do not always share the same goals, and they demand different styles of leadership. This is an important consideration in our goal to find champions who can work with both approaches and understand how to accommodate them as a part of the future direction of health promotion. This commentary raises key questions to stimulate discussion and action towards addressing the lack of global leadership in health promotion. It discusses some of the key players, leadership characteristics and the contradictions in style that are inherent in achieving a goal of charismatic global champions.
Rassiwala, Jasmine; Vaduganathan, Muthiah; Kupershtok, Mania; Castillo, Frank M; Evert, Jessica
Global health learning experiences for medical students sit at the intersection of capacity building, ethics, and education. As interest in global health programs during medical school continues to rise, Northwestern University Alliance for International Development, a student-led and -run organization at Northwestern University Feinberg School of Medicine, has provided students with the opportunity to engage in two contrasting models of global health educational engagement.Eleven students, accompanied by two Northwestern physicians, participated in a one-week trip to Matagalpa, Nicaragua, in December 2010. This model allowed learning within a familiar Western framework, facilitated high-volume care, and focused on hands-on experiences. This approach aimed to provide basic medical services to the local population.In July 2011, 10 other Feinberg students participated in a four-week program in Puerto Escondido, Mexico, which was coordinated by Child Family Health International, a nonprofit organization that partners with native health care providers. A longer duration, homestays, and daily language classes hallmarked this experience. An intermediary, third-party organization served to bridge the cultural and ethical gap between visiting medical students and the local population. This program focused on providing a holistic cultural experience for rotating students.Establishing comprehensive global health curricula requires finding a balance between providing medical students with a fulfilling educational experience and honoring the integrity of populations that are medically underserved. This article provides a rich comparison between two global health educational models and aims to inform future efforts to standardize global health education curricula.
Labonté, Ronald; Schrecker, Ted
Globalization is a key context for the study of social determinants of health (SDH): broadly stated, SDH are the conditions in which people live and work, and that affect their opportunities to lead healthy lives. In the first article in this three part series, we described the origins of the series in work conducted for the Globalization Knowledge Network of the World Health Organization's Commission on Social Determinants of Health and in the Commission's specific concern with health equity. We identified and defended a definition of globalization that gives primacy to the drivers and effects of transnational economic integration, and addressed a number of important conceptual and methodological issues in studying globalization's effects on SDH and their distribution, emphasizing the need for transdisciplinary approaches that reflect the complexity of the topic. In this second article, we identify and describe several, often interacting clusters of pathways leading from globalization to changes in SDH that are relevant to health equity. These involve: trade liberalization; the global reorganization of production and labour markets; debt crises and economic restructuring; financial liberalization; urban settings; influences that operate by way of the physical environment; and health systems changed by the global marketplace.
Full Text Available Abstract Globalization is a key context for the study of social determinants of health (SDH: broadly stated, SDH are the conditions in which people live and work, and that affect their opportunities to lead healthy lives. In the first article in this three part series, we described the origins of the series in work conducted for the Globalization Knowledge Network of the World Health Organization's Commission on Social Determinants of Health and in the Commission's specific concern with health equity. We identified and defended a definition of globalization that gives primacy to the drivers and effects of transnational economic integration, and addressed a number of important conceptual and methodological issues in studying globalization's effects on SDH and their distribution, emphasizing the need for transdisciplinary approaches that reflect the complexity of the topic. In this second article, we identify and describe several, often interacting clusters of pathways leading from globalization to changes in SDH that are relevant to health equity. These involve: trade liberalization; the global reorganization of production and labour markets; debt crises and economic restructuring; financial liberalization; urban settings; influences that operate by way of the physical environment; and health systems changed by the global marketplace.
Ford, Marvella E; Alford, Sharon Hensley; Britton, Diandra; McClary, Beth; Gordon, Howard S
The study assessed perceptions of breast cancer genetic counseling. Focus groups were conducted with twenty women (ages cancer and referred for breast cancer genetic counseling following mammography. All participants associated the words "breast cancer" with fear. African American women who received breast cancer genetic counseling may have channeled their fear into increased vigilance related to breast health. African American women who did not receive breast cancer genetic counseling were most knowledgeable about it. In contrast, Caucasian women who did not receive it reported uncertainty about the role of genetic counseling and testing in assessing breast cancer risk, mistrust in medical professionals, and lack of trust in the accuracy of genetic tests. The results could be used to help develop interventions to improve informed decision-making regarding breast cancer genetic counseling.
Greater equity in health status of populations between and within countries can be regarded as key measurement of the world's progress towards global health development. With only two years remaining to meet the MDG targets, closing the health equity gap between and within countries has gained the attention of all ...
van de Pas, Remco
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. PMID:28812849
A moral right to health or health care is a special instance of a right to fair equality of opportunity. Nation-states generally have the capabilities to specify the entitlements of such a right and to raise the resources needed to satisfy those entitlements. Can these functions be replicated globally, as a global right to health or health care requires? The suggestion that "better global governance" is needed if such a global right is to be claimed requires that these two central capabilities be present. It is unlikely that nation-states would concede these two functions to a form of global governance, for doing so would seriously compromise the authority that is generally included in sovereignty. This claim is a specification of what is often recognized as the "sovereignty problem." The argument of this paper is not an "impossibility" claim, but a best guess about whether the necessary conditions for better global governance that supports a global right to health or health care can be achieved.
Farajzadegan, Ziba; Fathollahi-Dehkordi, Fariba; Hematti, Simin; Sirous, Reza; Tavakoli, Neda; Rouzbahani, Reza
Participation of Iranian women with a family history of breast cancer in breast cancer screening programs is low. This study evaluates the compliance of women having a family history of breast cancer with clinical breast exam (CBE) according to the stage of transtheoretical model (TTM) and health belief model (HBM). In this cross-sectional study, we used Persian version of champion's HBM scale to collect factors associated with TTM stages applied to screening from women over 20 years and older. The obtained data were analyzed by SPSS, using descriptive statistics, Chi-square test, independent t-test, and analysis of covariance. Final sample size was 162 women. Thirty-three percent were in action/maintenance stage. Older women, family history of breast cancer in first-degree relatives, personal history of breast disease, insurance coverage, and a history of breast self-examination were associated with action/maintenance stage. Furthermore, women in action/maintenance stages had significantly fewer perceived barriers in terms of CBE in comparison to women in other stages (P 0.05). The finding indicates that the rate of women in action/maintenance stage of CBE is low. Moreover, results show a strong association between perceived barriers and having a regular CBE. These clarify the necessity of promoting national target programs for breast cancer screening, which should be considered as the first preference for reducing CBE barriers.
Magnusson, R S
Chronic diseases, including cardiovascular disease, diabetes and cancer, are the leading cause of death and disability in both the developed and developing world (excluding sub-Saharan Africa). At present, the global framework for action on chronic disease is strongly 'World Health Organization (WHO)-centric', defined by two WHO initiatives: the WHO Framework Convention on Tobacco Control, and the Global Strategy on Diet, Physical Activity and Health. This paper explores the difficulties of developing a collective response to global health challenges, and draws out some implications for chronic disease. It highlights how political partnerships and improved governance structures, economic processes, and international laws and standards function as three, concurrent pathways for encouraging policy implementation at country level and for building collective commitment to address the transnational determinants of chronic disease. The paper evaluates WHO's initiatives on chronic disease in terms of these pathways, and makes the case for a global compact on chronic disease as a possible structure for advancing WHO's free-standing goal of reducing mortality from chronic diseases by an additional 2% between 2005 and 2015. Beneath this overarching structure, the paper argues that global agencies, donor governments and other global health stakeholders could achieve greater impact by coordinating their efforts within a series of semi-autonomous 'policy channels' or 'workstreams'. These workstreams - including trade and agriculture, consumer health issues and workplace health promotion - could act as focal points for international cooperation, drawing in a wider range of health stakeholders within their areas of comparative advantage.
Full Text Available This opinion piece focuses on global health action by hands-on bottom-up practice: Initiation of an organizational framework and securing financial efficiency are – however - essential, both clearly a domain of well trained public health professionals. Examples of action are cited in the four main areas of global threats: planetary climate change, global divides and inequity, global insecurity and violent conflicts, global instability and financial crises. In conclusion a stable health systems policy framework would greatly enhance success. However, such organisational framework dries out if not linked to public debates channelling fresh thoughts and controversial proposals: the structural stabilisation is essential but has to serve not to dominate bottom-up activities. In other words a horizontal management is required, a balanced equilibrium between bottom-up initiative and top-down support. Last not least rewarding voluntary and charity work by public acknowledgement is essential.
Deadline: August 7, 2013. Please note that all applicafions must be sent electronically. IDRC is one of the world's leaders in generang new knowledge to meet global challenges. We offer a number of research awards providing a unique opportunity to enhance research skills and gain a fresh perspecve on crucial.
Dawe, Russell; Pike, Andrea; Kidd, Monica; Janakiram, Praseedha; Nicolle, Eileen; Allison, Jill
Global health addresses health inequities in the care of underserved populations, both domestic and international. Given that health systems with a strong primary care foundation are the most equitable, effective and efficient, family medicine is uniquely positioned to engage in global health. However, there are no nationally recognized standards in Canada for postgraduate family medicine training in global health. To generate consensus on the essential components of a Global Health/Health Equity Enhanced Skills Program in family medicine. A panel comprised of 34 experts in global health education and practice completed three rounds of a Delphi small group process. Consensus (defined as ≥ 75% agreement) was achieved on program length (12 months), inclusion of both domestic and international components, importance of mentorship, methods of learner assessment (in-training evaluation report, portfolio), four program objectives (advocacy, sustainability, social justice, and an inclusive view of global health), importance of core content, and six specific core topics (social determinants of health, principles and ethics of health equity/global health, cultural humility and competency, pre and post-departure training, health systems, policy, and advocacy for change, and community engagement). Panellists agreed on a number of program components forming the initial foundation for an evidence-informed, competency-based Global Health/Health Equity Enhanced Skills Program in family medicine.
Mackey, Tim K
As the 2014 Ebola virus disease outbreak (EVD) transitions to its post-endemic phase, its impact on the future of global public health, particularly the World Health Organization (WHO), is the subject of continued debate. Criticism of WHO's performance grew louder in the outbreak's wake, placing this international health UN-specialized agency in the difficult position of navigating a complex series of reform recommendations put forth by different stakeholders. Decisions on WHO governance reform and the broader role of the United Nations could very well shape the future landscape of 21st century global health and how the international community responds to health emergencies. In order to better understand the implications of the EVD outbreak on global health and infectious disease governance, this debate article critically examines a series of reports issued by four high-level commissions/panels convened to specifically assess WHO's performance post-Ebola. Collectively, these recommendations add increasing complexity to the urgent need for WHO reform, a process that the agency must carry out in order to maintain its legitimacy. Proposals that garnered strong support included the formation of an independent WHO Centre for Emergency Preparedness and Response, the urgent need to increase WHO infectious disease funding and capacity, and establishing better operational and policy coordination between WHO, UN agencies, and other global health partners. The recommendations also raise more fundamental questions about restructuring the global health architecture, and whether the UN should play a more active role in global health governance. Despite the need for a fully modernized WHO, reform proposals recently announced by WHO fail to achieve the "evolution" in global health governance needed in order to ensure that global society is adequately protected against the multifaceted and increasingly complex nature of modern public health emergencies. Instead, the lasting
McMichael, A J; Butler, C D
Populations today face increasing health risks from human-induced regional and global environmental changes and resultant ecological nonsustainability. Localized environmental degradation that has long accompanied population growth, industrialization, and rising consumerism has now acquired a global and often systemic dimension (e.g., climate change, disrupted nitrogen cycling, biodiversity loss). Thus, the economic intensification and technological advances that previously contributed to health gains have now expanded such that humanity's environmental (and ecological) footprint jeopardizes global population health. International data show, in general, a positive correlation of a population's health with level of affluence and size of per-person footprint. Yet, beyond a modest threshold, larger footprints afford negligible health gain and may impair health (e.g., via the rise of obesity). Furthermore, some lower-income countries have attained high levels of health. Many changes now needed to promote ecological (and social) sustainability will benefit local health. Continued improvement of global health could thus coexist with an equitably shared global environmental footprint.
DeCamp, Matthew; Rodriguez, Joce; Hecht, Shelby; Barry, Michele; Sugarman, Jeremy
Interest in short-term global health training and service programs continues to grow, yet they can be associated with a variety of ethical issues for which trainees or others with limited global health experience may not be prepared to address. Therefore, there is a clear need for educational interventions concerning these ethical issues. We developed and evaluated an introductory curriculum, "Ethical Challenges in Short-term Global Health Training." The curriculum was developed through solicitation of actual ethical issues experienced by trainees and program leaders; content drafting; and external content review. It was then evaluated from November 1, 2011, through July 1, 2012, by analyzing web usage data and by conducting user surveys. The survey included basic demographic data; prior experience in global health and global health ethics; and assessment of cases within the curriculum. The ten case curriculum is freely available at http://ethicsandglobalhealth.org. An average of 238 unique visitors accessed the site each month (standard deviation, 19). Of users who had been abroad before for global health training or service, only 31% reported prior ethics training related to short-term work. Most users (62%) reported accessing the site via personal referral or their training program; however, a significant number (28%) reported finding the site via web search, and 8% discovered it via web links. Users represented different fields: medicine (46%), public health (15%), and nursing (11%) were most common. All cases in the curriculum were evaluated favorably. The curriculum is meeting a critical need for an introduction to the ethical issues in short-term global health training. Future work will integrate this curriculum within more comprehensive curricula for global health and evaluate specific knowledge and behavioral effects, including at training sites abroad.
Bemme, Doerte; D'souza, Nicole A
Global Mental Health's (GMH) proposition to "scale up" evidence-based mental health care worldwide has sparked a heated debate among transcultural psychiatrists, anthropologists, and GMH proponents; a debate characterized by the polarization of "global" and "local" approaches to the treatment of mental health problems. This article highlights the institutional infrastructures and underlying conceptual assumptions that are invested in the production of the "global" and the "local" as distinct, and seemingly incommensurable, scales. It traces how the conception of mental health as a "global" problem became possible through the emergence of Global Health, the population health metric DALY, and the rise of evidence-based medicine. GMH also advanced a moral argument to act globally emphasizing the notion of humanity grounded in a shared biology and the universality of human rights. However, despite the frequent criticism of GMH promoting the "bio"-medical model, we argue that novel logics have emerged which may be more important for establishing global applicability than arguments made in the name of "nature": the procedural standardization of evidence and the simplification of psychiatric expertise. Critical scholars, on the other hand, argue against GMH in the name of the "local"; a trope that underlines specificity, alterity, and resistance against global claims. These critics draw on the notions of "culture," "colonialism," the "social," and "community" to argue that mental health knowledge is locally contingent. Yet, paying attention to the divergent ways in which both sides conceptualize the "social" and "community" may point to productive spaces for an analysis of GMH beyond the "global/local" divide. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
The aims of this thesis were to: (1) examine enduring distress and its predictors in women with breast cancer; (2) determine the extent to which distress-related problems are portrayed in a graphic novel about breast cancer; (3) examine health care use and additional needs (with regard to medical, paramedical, psychosocial, supplementary, CAM, and dental care services), and predictors of health care use in women with breast cancer; and (4) examine predictors of unmet care needs of women with ...
De Lima, Liliana; Radbruch, Lukas
At the May 2014 meeting of the World Health Assembly, the assembly passed a resolution intended to reduce barriers to palliative care. T4eh resolution calls for integrating palliative care into national health services. It contains recommendation on improved availability and access to such care and calls for it to be included in national health policies and budgets. The full resolution with commentary is presented.
Meier, Benjamin Mason
The right to health was codified in Article 12 of the International Covenant on Economic, Social and Cultural Rights as an individual right, focusing on individual health services at the expense of public health systems. This article assesses the ways in which the individual human right to health has evolved to meet collective threats to the public's health. Despite its repeated expansions, the individual right to health remains normatively incapable of addressing the injurious societal ramifcations of economic globalization, advancing individual rights to alleviate collective inequalities in underlying determinants of health. By examining modern changes to underlying determinants of health, this article concludes that responding to globalized health threats necessitates a collective right to public health.
Patel, Ronak B
Microfinance has recently come under criticism for not meeting its potential for poverty reduction and its exploitation by for-profit entities. Access to finance still remains limited for many of the world’s poor. This re-examination of microfinance should not impede its proliferation and development into a tool to improve health for the underserved. There are significant returns on microfinance investments in health at the household level. Microfinance that allows the consumption of goods and services that can improve health can also lead to increased savings and productivity making it a financially viable and powerful tool for both health improvement and development.
Stoner, Lee; Perry, Lane; Wadsworth, Daniel; Stoner, Krystina R; Tarrant, Michael A
Despite growing public awareness, health systems are struggling under the escalating burden of non-communicable diseases. While personal responsibility is crucial, alone it is insufficient. We argue that one must place themselves within the broader/global context to begin to truly understand the health implications of personal choices. Global citizenship competency has become an integral part of the higher education discourse; this discourse can and should be extended to include global health. A global citizen is someone who is (1) aware of global issues, (2) socially responsible, and (3) civically engaged. From this perspective, personal health is not solely an individual, self-serving act; rather, the consequences of our lifestyle choices and behaviors have far-reaching implications. This paper will argue that, through consciously identifying global health within the constructs of global citizenship, institutions of higher education can play an instrumental role in fostering civically engaged students capable of driving social change. Copyright © 2014 Elsevier Inc. All rights reserved.
The concept of "global health" that led to the establishment of the World Health Organization in the 1940s is still promoting a global health movement 70 years later. Today's global health acts first as a guiding principle for our effort to improve people's health across the globe. Furthermore, global health has become a branch of science, "global health science," supporting institutionalized education. Lastly, as a discipline, global health should focus on medical and health issues that: 1) are determined primarily by factors with a cross-cultural, cross-national, cross-regional, or global scope; 2) are local but have global significance if not appropriately managed; and 3) can only be efficiently managed through international or global efforts. Therefore, effective global health education must train students 1) to understand global health status; 2) to investigate both global and local health issues with a global perspective; and 3) to devise interventions to deal with these issues.
. Predicting the cost-‐ effectiveness of developing prevention, screening and treatment strategies continue to be the focus strategies to optimize cancer care. KEY WORDS: Cancer; Global health perspectives; Palliative care; Stem cell cancer; ...
NCI's Center for Global Health announced grants that will support the development and validation of low-cost, portable technologies. These technologies have the potential to improve early detection, diagnosis, and non-invasive or minimally invasive treatm
Martin, Greg; MacLachlan, Malcolm; Labonté, Ronald; Larkan, Fiona; Vallières, Frédérique; Bergin, Niamh
Founded in 2005, Globalization and Health was the first open access global health journal. The journal has since expanded the field, and its influence, with the number of downloaded papers rising 17-fold, to over 4 million. Its ground-breaking papers, leading authors -including a Nobel Prize winner- and an impact factor of 2.25 place it among the top global health journals in the world. To mark the ten years since the journal's founding, we, members of the current editorial board, undertook a review of the journal's progress over the last decade. Through the application of an inductive thematic analysis, we systematically identified themes of research published in the journal from 2005 to 2014. We identify key areas the journal has promoted and consider these in the context of an existing framework, identify current gaps in global health research and highlight areas we, as a journal, would like to see strengthened.
... Home Current Issue Past Issues Special Section NIH Abroad: Inspiring the Next Generation of Global Health Researchers ... interaction has always been important to me, but working with these patients in Zambia lit a fire ...
Interest in global health (GH) among medical students worldwide is measurably increasing. There is a concomitant emphasis on emphasizing globally-relevant health professions education. Through a structured literature review, expert consensus recommendations, and contact with relevant professional organizations, we review the existing state of GH education in US medical schools for which data were available. Several recommendations from professional societies have been developed, along with a renewed emphasis on competencies in global health. The implementation of these recommendations was not observed as being uniform across medical schools, with variation noted in the presence of global health curricula. Recommendations for including GH in medical education are suggested, as well as ways to formalize GH curricula, while providing flexibility for innovation and adaptation PMID:23331630
Mykhalovskiy, Eric; Weir, Lorna
The recent SARS epidemic has renewed widespread concerns about the global transmission of infectious diseases. In this commentary, we explore novel approaches to global infectious disease surveillance through a focus on an important Canadian contribution to the area--the Global Public Health Intelligence Network (GPHIN). GPHIN is a cutting-edge initiative that draws on the capacity of the Internet and newly available 24/7 global news coverage of health events to create a unique form of early warning outbreak detection. This commentary outlines the operation and development of GPHIN and compares it to ProMED-mail, another Internet-based approach to global health surveillance. We argue that GPHIN has created an important shift in the relationship of public health and news information. By exiting the pyramid of official reporting, GPHIN has created a new monitoring technique that has disrupted national boundaries of outbreak notification, while creating new possibilities for global outbreak response. By incorporating news within the emerging apparatus of global infectious disease surveillance, GPHIN has effectively responded to the global media's challenge to official country reporting of outbreak and enhanced the effectiveness and credibility of international public health.
Striking disparities in access to healthcare and in health outcomes are major characteristics of health across the globe. This inequitable state of global health and how it could be improved has become a highly popularized field of academic study. In a series of articles in this journal the roles of power and politics in global health have been addressed in considerable detail. Three points are added here to this debate. The first is consideration of how the use of definitions and common terms, for example 'poverty eradication,' can mask full exposure of the extent of rectification required, with consequent failure to understand what poverty eradication should mean, how this could be achieved and that a new definition is called for. Secondly, a criticism is offered of how the term 'global health' is used in a restricted manner to describe activities that focus on an anthropocentric and biomedical conception of health across the world. It is proposed that the discourse on 'global health' should be extended beyond conventional boundaries towards an ecocentric conception of global/planetary health in an increasingly interdependent planet characterised by a multitude of interlinked crises. Finally, it is noted that the paucity of workable strategies towards achieving greater equity in sustainable global health is not so much due to lack of understanding of, or insight into, the invisible dimensions of power, but is rather the outcome of seeking solutions from within belief systems and cognitive biases that cannot offer solutions. Hence the need for a new framing perspective for global health that could reshape our thinking and actions. © 2016 by Kerman University of Medical Sciences.
Risk factors for breast cancer are female sex and advancing age, inherited risk, breast density, obesity, alcohol consumption, and exposure to ionizing radiation. Interventions to prevent breast cancer include chemoprevention (e.g. SERMs, AIs), risk-reducing surgery (e.g. mastectomy, oophorectomy). Review the evidence on risk factors and interventions to prevent breast cancer in this expert-reviewed summary.
Elson, Sarah L; Hiatt, Robert A; Anton-Culver, Hoda; Howell, Lydia P; Naeim, Arash; Parker, Barbara A; Van't Veer, Laura J; Hogarth, Michael; Pierce, John P; Duwors, Robert J; Hajopoulos, Kathy; Esserman, Laura J
The term breast cancer covers many different conditions, whose clinical course ranges from indolent to aggressive. However, current practice in breast cancer prevention and care, and in breast cancer epidemiology, does not take into account the heterogeneity of the disease. A comprehensive understanding of the etiology and progression of different breast cancer subtypes would enable a more patient-centered approach to breast health care: assessing an individual's risk of getting specific subtypes of the disease, providing risk-based screening and prevention recommendations, and, for those diagnosed with the disease, tailored treatment options based on risk and timing of progression and mortality. The Athena Breast Health Network is an initiative of the five University of California medical and cancer centers to prototype this approach and to enable the development of a rapid learning system-connecting risk and outcome information from a heterogeneous patient population in real time and using new knowledge from research to continuously improve the quality of care. The Network is based on integrating clinical and research processes to create a comprehensive approach to accelerating patient-centered breast health care. Since its inception in 2009, the Network has developed a multi-site, transdisciplinary collaboration that enables the learning system. The five-campus collaboration has implemented a shared informatics platform, standardized electronic patient intake questionnaires, and common biospecimen protocols, as well as new clinical programs and multi-center research projects. The Athena Breast Health Network can serve as a model of a rapid learning system that integrates epidemiologic, behavioral, and clinical research with clinical care improvements.
Small, William; Bacon, Monica A; Bajaj, Amishi; Chuang, Linus T; Fisher, Brandon J; Harkenrider, Matthew M; Jhingran, Anuja; Kitchener, Henry C; Mileshkin, Linda R; Viswanathan, Akila N; Gaffney, David K
Cervical cancer is the fourth most common malignancy diagnosed in women worldwide. Nearly all cases of cervical cancer result from infection with the human papillomavirus, and the prevention of cervical cancer includes screening and vaccination. Primary treatment options for patients with cervical cancer may include surgery or a concurrent chemoradiotherapy regimen consisting of cisplatin-based chemotherapy with external beam radiotherapy and brachytherapy. Cervical cancer causes more than one quarter of a million deaths per year as a result of grossly deficient treatments in many developing countries. This warrants a concerted global effort to counter the shocking loss of life and suffering that largely goes unreported. This article provides a review of the biology, prevention, and treatment of cervical cancer, and discusses the global cervical cancer crisis and efforts to improve the prevention and treatment of the disease in underdeveloped countries. Cancer 2017;123:2404-12. © 2017 American Cancer Society. © 2017 American Cancer Society.
Pesec, Madeline; Sherertz, Tracy
Cancer is now recognized as one of the four leading causes of morbidity and mortality worldwide, and incidence is expected to rise significantly in the next two decades. Unfortunately, low- and middle-income countries (LMIC) suffer disproportionately from the world's cancer cases. The growing burden of cancer and maldistribution of cancer care resources in LMIC warrant a massive re-evaluation of the structural inequalities that produce global oncological disparities and a worldwide commitment to improve both prevention and treatment strategies. Efforts to improve cancer care capacity should focus on horizontal strengthening of healthcare systems that provide safe, affordable, effective and sustainable care. In response to current deficiencies, many international organizations have started to partner with LMIC to create solutions. Telemedicine and international collaboration are also promising ways to effect change and improve global oncological care.
Ana L. Gervassi; Collins, Laura J.; Britschgi, Theresa B.
Despite a flourishing biomedical and global health industry  too few of Washington state's precollege students are aware of this growing sector and emerging ideas on bacteria, fungi, parasites and viruses. Against the backdrop of numerous reports regarding declining precollege student interest in science , a precollege program was envisioned at Seattle Biomedical Research Institute (as of 2010, Seattle BioMed) to increase youth engagement in biomedical research and global health, increa...
V. A. Alekseev; K. N. Borisov
The social aspect of globalization is characteristic that in health care the increasing distribution is received by market mechanisms, turning medical care into the goods in «the market trading in services». In the conditions of inevitability of globalization experts of WHO recommend to observe a uniform world trend in health care availability, justice, quality of medical care. It often not productively as the same experts of WHO ascertain. In most cases, unfortunately, the effect appears neg...
de la Fuente, Juan Ramón
Psychosis, dementias, anxiety, depression, suicide and suicide attempts, as well as psychiatric disorders associated to violence and poverty have increased the global burden of disease. Other related problems associated to special diets, body image, compulsive use of computers and mobile phones, and those frequently observed in migrants subjected to intense distress are reviewed as well. Information and communication technologies may have undesirable side effects affecting some individuals in their conduct and social interactions.
Chapman, Audrey R
Globalization, a process characterized by the growing interdependence of the world's people, impacts health systems and the social determinants of health in ways that are detrimental to health equity. In a world in which there are few countervailing normative and policy approaches to the dominant neoliberal regime underpinning globalization, the human rights paradigm constitutes a widely shared foundation for challenging globalization's effects. The substantive rights enumerated in human rights instruments include the right to the highest attainable level of physical and mental health and others that are relevant to the determinants of health. The rights stipulated in these documents impose extensive legal obligations on states that have ratified these documents and confer health entitlements on their residents. Human rights norms have also inspired civil society efforts to improve access to essential medicines and medical services, particularly for HIV/AIDS. Nevertheless, many factors reduce the potential counterweight human rights might exert, including and specifically the nature of the human rights approach, weak political commitments to promoting and protecting health rights on the part of some states and their lack of institutional and economic resources to do so. Global economic markets and the relative power of global economic institutions are also shrinking national policy space. This article reviews the potential contributions and limitations of human rights to achieving greater equity in shaping the social determinants of health.
McNabb Scott JN
Full Text Available Abstract At a crossroads, global public health surveillance exists in a fragmented state. Slow to detect, register, confirm, and analyze cases of public health significance, provide feedback, and communicate timely and useful information to stakeholders, global surveillance is neither maximally effective nor optimally efficient. Stakeholders lack a globa surveillance consensus policy and strategy; officials face inadequate training and scarce resources. Three movements now set the stage for transformation of surveillance: 1 adoption by Member States of the World Health Organization (WHO of the revised International Health Regulations (IHR; 2 maturation of information sciences and the penetration of information technologies to distal parts of the globe; and 3 consensus that the security and public health communities have overlapping interests and a mutual benefit in supporting public health functions. For these to enhance surveillance competencies, eight prerequisites should be in place: politics, policies, priorities, perspectives, procedures, practices, preparation, and payers. To achieve comprehensive, global surveillance, disparities in technical, logistic, governance, and financial capacities must be addressed. Challenges to closing these gaps include the lack of trust and transparency; perceived benefit at various levels; global governance to address data power and control; and specified financial support from globa partners. We propose an end-state perspective for comprehensive, effective and efficient global, multiple-hazard public health surveillance and describe a way forward to achieve it. This end-state is universal, global access to interoperable public health information when it’s needed, where it’s needed. This vision mitigates the tension between two fundamental human rights: first, the right to privacy, confidentiality, and security of personal health information combined with the right of sovereign, national entities
Private business and philanthropic organizations have played a prominent role in the response to the Ebola outbreak in West Africa and the support of global health governance more broadly. While this involvement may appear to be novel or unprecedented, this article argues that this active role for private actors and philanthropies actually mirrors the historical experience of cross-border health governance in the first half of the twentieth century. By examining the experiences, roles and criticisms of the Rockefeller Foundation's International Health Division and the Bill and Melinda Gates Foundation, it is possible to identify potential opportunities for better cooperation between public and private actors in global health governance.
Full Text Available Global health's goal of reducing low-and-middle-income country versus high-income country health disparities faces complex challenges. Although there have been discussions of barriers, there has not been a broad-based, quantitative survey of such barriers.432 global health professionals were invited via email to participate in an online survey, with 268 (62% participating. The survey assessed participants' (A demographic and global health background, (B perceptions regarding 66 barriers' seriousness, (C detailed ratings of barriers designated most serious, (D potential solutions.Thirty-four (of 66 barriers were seen as moderately or more serious, highlighting the widespread, significant challenges global health development faces. Perceived barrier seriousness differed significantly across domains: Resource Limitations mean = 2.47 (0-4 Likert scale, Priority Selection mean = 2.20, Corruption, Lack of Competence mean = 1.87, Social and Cultural Barriers mean = 1.68. Some system-level predictors showed significant but relatively limited relations. For instance, for Global Health Domain, HIV and Mental Health had higher levels of perceived Social and Cultural Barriers than other GH Domains. Individual-level global health experience predictors had small but significant effects, with seriousness of (a Corruption, Lack of Competence, and (b Priority Selection barriers positively correlated with respondents' level of LMIC-oriented (e.g., weeks/year spent in LMIC but Academic Global Health Achievement (e.g., number of global health publications negatively correlated with overall barrier seriousness.That comparatively few system-level predictors (e.g., Organization Type were significant suggests these barriers may be relatively fundamental at the system-level. Individual-level and system-level effects do have policy implications; e.g., Priority Selection barriers were among the most serious, yet effects on seriousness of how LMIC-oriented a professional
Bettcher, D. W.; Yach, D.; Guindon, G. E.
Globalization of trade, marketing and investment has important implications for public health, both negative and positive. This article considers the implications of the single package of World Trade Organization (WTO) agreements for public health research and policy, focusing on three themes: commodities, intellectual property rights, and health services. The main aims of the analysis are as follows: to identify how trade issues are associated with the transnationalization of health risks and possible benefits; to identify key areas of research; and to suggest policy-relevant advice and interventions on trade and health issues. The next wave of international trade law will need to take more account of global public health issues. However, to become more engaged in global trade debates, the public health community must gain an understanding of the health effects of global trade agreements. It must also ensure that its own facts are correct, so that public health is not blindly used for political ends, such as justifying unwarranted economic protectionism. "Healthy trade" policies, based on firm empirical evidence and designed to improve health status, are an important step towards reaching a more sustainable form of trade liberalization. PMID:10885181
Beadling, Charles; Maza, John; Nakano, Gregg; Mahmood, Maysaa; Jawad, Shakir; Al-Ameri, Ali; Zuerlein, Scott; Anderson, Warner
This article presents findings from a survey conducted to examine the availability of foreign language and culture training to Civil Affairs health personnel and the relevance of that training to the tasks they perform. Civil Affairs forces recognize the value of cross-cultural communication competence because their missions involve a significant level of interaction with foreign governments? officials, military, and civilians. Members of the 95th Civil Affairs Brigade (Airborne) who had a health-related military occupational specialty code were invited to participate in the survey. More than 45% of those surveyed were foreign language qualified. Many also received predeployment language and culture training specific to the area of deployment. Significantly more respondents reported receiving cultural training and training on how to work effectively with interpreters than having received foreign language training. Respondents perceived interpreters as important assets and were generally satisfied with their performance. Findings from the survey highlight a need to identify standard requirements for predeployment language training that focuses on medical and health terminology and to determine the best delivery platform(s). Civil Affairs health personnel would benefit from additional cultural training that focuses on health and healthcare in the country or region of deployment. Investing in the development of distance learning capabilities as a platform for delivering health-specific language and culture training may help ease the time and resources constraints that limit the ability of Civil Affairs health personnel to access the training they need. 2012.
Moore, Melinda; Gould, Philip; Keary, Barbara S
Nearly half the world's population now lives in urban settlements. Cities offer the lure of better employment, education, health care, and culture; and they contribute disproportionately to national economies. However, rapid and often unplanned urban growth is often associated with poverty, environmental degradation and population demands that outstrip service capacity. These conditions place human health at risk. Reliable urban health statistics are largely unavailable throughout the world. Disaggregated intra-urban health data, i.e., for different areas within a city, are even more rare. Data that are available indicate a range of urban health hazards and associated health risks: substandard housing, crowding, air pollution, insufficient or contaminated drinking water, inadequate sanitation and solid waste disposal services, vector-borne diseases, industrial waste, increased motor vehicle traffic, stress associated with poverty and unemployment, among others. Local and national governments and multilateral organizations are all grappling with the challenges of urbanization. Urban health risks and concerns involve many different sectors, including health, environment, housing, energy, transportation, urban planning, and others. Two main policy implications are highlighted: the need for systematic and useful urban health statistics on a disaggregated, i.e., intra-urban, basis, and the need for more effective partnering across sectors. The humanitarian and economic imperative to create livable and sustainable cities must drive us to seek and successfully overcome challenges and capitalize on opportunities. Good urban planning and governance, exchange of best practice models and the determination and leadership of stakeholders across disciplines, sectors, communities and countries will be critical elements of success.
Full Text Available Breast cancer is a major public health problem in Latin America (LA and the most common form of cancer among women. An important variability according to ethnicity/race with respect to incidence/mortality, clinical characteristics, and prognosis is observed throughout LA. In addition, women are more likely to develop breast cancer (BC at younger age and to be diagnosed at an advanced stage compared to western women. While little is known about specific risk factors, changes in reproductive pattern (parity, breastfeeding and lifestyle factors including sedentary behaviours, unhealthy diet, and alcohol intake may contribute to the increase of BC incidence. In this paper we give an overview of the burden and patterns of BC, review the leading causes of BC and discuss the possible ways to improve BC prevention and control in LA.
Shahla Foozonkhah; Leila R. Kalankesh
Background: Variety of mobile health initiatives in different levels have been undertaken across many countries. Trends of these initiatives can be reflected in the research published in m-health domain. Aim: This paper aims to depict global trends in the published works on m-health topic. Materials and Methods: The Web of Science database was used to identify all relevant published papers on mobile health domain worldwide. The search was conducted on documents published from January 18...
Lee, Kelley; Eckhardt, Jappe; Holden, Chris
Shifting patterns of tobacco production and consumption, and the resultant disease burden worldwide since the late twentieth century, prompted efforts to strengthen global health governance through adoption of the Framework Convention on Tobacco Control. While the treaty is rightfully considered an important achievement, to address a neglected public health issue through collective action, evidence suggests that tobacco industry globalization continues apace. In this article, we provide a systematic review of the public health literature and reveal definitional and measurement imprecision, ahistorical timeframes, transnational tobacco companies and the state as the primary units and levels of analysis, and a strong emphasis on agency as opposed to structural power. Drawing on the study of globalization in international political economy and business studies, we identify opportunities to expand analysis along each of these dimensions. We conclude that this expanded and interdisciplinary research agenda provides the potential for fuller understanding of the dual and dynamic relationship between the tobacco industry and globalization. Deeper analysis of how the industry has adapted to globalization over time, as well as how the industry has influenced the nature and trajectory of globalization, is essential for building effective global governance responses. This article is published as part of a thematic collection dedicated to global governance. PMID:28458910
Lee, Kelley; Eckhardt, Jappe; Holden, Chris
Shifting patterns of tobacco production and consumption, and the resultant disease burden worldwide since the late twentieth century, prompted efforts to strengthen global health governance through adoption of the Framework Convention on Tobacco Control. While the treaty is rightfully considered an important achievement, to address a neglected public health issue through collective action, evidence suggests that tobacco industry globalization continues apace. In this article, we provide a systematic review of the public health literature and reveal definitional and measurement imprecision, ahistorical timeframes, transnational tobacco companies and the state as the primary units and levels of analysis, and a strong emphasis on agency as opposed to structural power. Drawing on the study of globalization in international political economy and business studies, we identify opportunities to expand analysis along each of these dimensions. We conclude that this expanded and interdisciplinary research agenda provides the potential for fuller understanding of the dual and dynamic relationship between the tobacco industry and globalization. Deeper analysis of how the industry has adapted to globalization over time, as well as how the industry has influenced the nature and trajectory of globalization, is essential for building effective global governance responses. This article is published as part of a thematic collection dedicated to global governance.
... change, population pressure, developing nations and urbanization, energy production, building and community design, solid and hazardous waste, and disaster preparedness. In addition, each chapter of Environmental Health includes learning objectives, key points, and discussion questions.
divert their limited resources for a global goal of eradication that may have ... global initiative? (iii) How does an individual poor country benefit from NIDs? (iv) What are the negative effects of NIDs on sustainability of PHC? (v) Can these effects be minimised? .... did the sensitivity of the reporting of cases of suspected polio.
V. A. Alekseev
Full Text Available The social aspect of globalization is characteristic that in health care the increasing distribution is received by market mechanisms, turning medical care into the goods in «the market trading in services». In the conditions of inevitability of globalization experts of WHO recommend to observe a uniform world trend in health care availability, justice, quality of medical care. It often not productively as the same experts of WHO ascertain. In most cases, unfortunately, the effect appears negative. The general in health care reforming in the modern world of globalization is the state way of financing and health care regulation, including obligatory medical insurance (compulsory health insurance and the state guarantees of free medical care with emphasis on prevention.
Yang, Qian; Li, Lihua; Zhang, Juan; Shao, Guoliang; Zheng, Bin
To develop a new computer-aided detection scheme to compute a global kinetic image feature from the dynamic contrast enhanced breast magnetic resonance imaging (DCE-MRI) and test the feasibility of using the computerized results for assisting classification between the DCE-MRI examinations associated with malignant and benign tumors. The scheme registers sequential images acquired from each DCE-MRI examination, segments breast areas on all images, searches for a fraction of voxels that have higher contrast enhancement values and computes an average contrast enhancement value of selected voxels. Combination of the maximum contrast enhancement values computed from two post-contrast series in one of two breasts is applied to predict the likelihood of the examination being positive for breast cancer. The scheme performance was evaluated when applying to a retrospectively collected database including 80 malignant and 50 benign cases. In each of 91% of malignant cases and 66% of benign cases, the average contrast enhancement value computed from the top 0.43% of voxels is higher in the breast depicted suspicious lesions as compared to another negative (lesion-free) breast. In classifying between malignant and benign cases, using the computed image feature achieved an area under a receiver operating characteristic curve of 0.839 with 95% confidence interval of [0.762, 0.898]. We demonstrated that the global contrast enhancement feature of DCE-MRI can be relatively easily and robustly computed without accurate breast tumor detection and segmentation. This global feature provides supplementary information and a higher discriminatory power in assisting diagnosis of breast cancer. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Yang, Qian [College of Life Information Science and Instrument Engineering, Hangzhou Dianzi University, Hangzhou, 310018 (China); Li, Lihua, E-mail: email@example.com [College of Life Information Science and Instrument Engineering, Hangzhou Dianzi University, Hangzhou, 310018 (China); Zhang, Juan; Shao, Guoliang [Zhejiang Cancer Hospital, Hangzhou, 310010 (China); Zheng, Bin [College of Life Information Science and Instrument Engineering, Hangzhou Dianzi University, Hangzhou, 310018 (China); School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK 73019 (United States)
Objectives: To develop a new computer-aided detection scheme to compute a global kinetic image feature from the dynamic contrast enhanced breast magnetic resonance imaging (DCE-MRI) and test the feasibility of using the computerized results for assisting classification between the DCE-MRI examinations associated with malignant and benign tumors. Materials and Methods: The scheme registers sequential images acquired from each DCE-MRI examination, segments breast areas on all images, searches for a fraction of voxels that have higher contrast enhancement values and computes an average contrast enhancement value of selected voxels. Combination of the maximum contrast enhancement values computed from two post-contrast series in one of two breasts is applied to predict the likelihood of the examination being positive for breast cancer. The scheme performance was evaluated when applying to a retrospectively collected database including 80 malignant and 50 benign cases. Results: In each of 91% of malignant cases and 66% of benign cases, the average contrast enhancement value computed from the top 0.43% of voxels is higher in the breast depicted suspicious lesions as compared to another negative (lesion-free) breast. In classifying between malignant and benign cases, using the computed image feature achieved an area under a receiver operating characteristic curve of 0.839 with 95% confidence interval of [0.762, 0.898]. Conclusions: We demonstrated that the global contrast enhancement feature of DCE-MRI can be relatively easily and robustly computed without accurate breast tumor detection and segmentation. This global feature provides supplementary information and a higher discriminatory power in assisting diagnosis of breast cancer.
Chan, L H; Lee, P K; Chan, G
Using HIV/AIDS, Severe Acute Respiratory Syndrome (SARS), and avian influenza as case studies, this paper discusses the processes and dilemmas of China's participation in health governance, both at the domestic level and the global level. Globalization has eroded the boundary between public and private health and between domestic and global health governance. In addition, the SARS outbreak of 2002-2003 focused global attention on China's public health. As a rising power with the largest population on earth, China is expected by the international community to play a better and more active role in health management. Since the turn of this century, China has increasingly embraced multilateralism in health governance. This paper argues that China's multilateral cooperation is driven by both necessity and conscious design. International concerns about good governance and its aspiration to become a 'responsible' state have exerted a normative effect on China to change tack. Its interactions with United Nations agencies have triggered a learning process for China to securitize the spread of infectious diseases as a security threat. Conversely, China has utilized multilateralism to gain access to international resources and technical assistance. It is still a matter of debate whether China's cooperative engagement with global health governance can endure, because of the persistent problems of withholding information on disease outbreaks and because of its insistence on the Westphalian notion of sovereignty.
The pace of globalization has brought the world to the brink of a new era in international relations. While the world has outgrown traditional mechanisms for addressing global issues, it has not yet developed new forms of effective governance. This temporary void poses threats and enormous opportunities. The public health sector will play a crucial "formal" role--that is, carried out by existing bodies such as WHO and the UN. But WHO does not necessarily represent the full spectrum of views and its members necessarily work, to some degree, for separate national interests. The formal dimension must be supplemented. Globalization is not synonymous with lack of regulation. Many responsible businesses would welcome a transparent and universally applied regulatory regime to prevent a race to the lowest standards. The economic benefits of globalization may hit a glass ceiling if societies outside the global economy become progressively poorer and less healthy. The business community is recognizing that good health is essential for economic growth and social stability. Globalization may cause millions to migrate for economic opportunity. The private sector's forward-thinkers recognize the health threats of migration and are beginning to view global health promotion as a means to ensure optimal market access.
Mackey, Timothy Ken; Liang, Bryan Albert
Global public health is threatened by an imbalance in health worker migration from resource-poor countries to developed countries. This "brain drain" results in health workforce shortages, health system weakening, and economic loss and waste, threatening the well-being of vulnerable populations and effectiveness of global health interventions. Current structural imbalances in resource allocation and global incentive structures have resulted in 57 countries identified by WHO as having a "critical shortage" of health workers. Yet current efforts to strengthen domestic health systems have fallen short in addressing this issue. Instead, global solutions should focus on sustainable forms of equitable resource sharing. This can be accomplished by adoption of mandatory global resource and staff-sharing programs in conjunction with implementation of state-based health services corps. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Katz, Rebecca; Blazes, David; Bae, Jennifer; Puntambekar, Nisha; Perdue, Christopher L; Fischer, Julie
Given the unprecedented growth of global health initiatives in the past decade, informal diplomacy between technical partners plays an increasingly important role in shaping opportunities and outcomes. This article describes a course developed and executed specifically to equip U.S. military health professionals with core skills in practical diplomacy critical to help them successfully plan and implement public health surveillance, research, and capacity building programs with partner nation governments and organizations. We identified core competencies in practical diplomacy for laboratory and public health researchers, catalogued and evaluated existing training programs, and then developed a pilot course in global health diplomacy for military medical researchers. The pilot course was held in June 2012, and focused on analyzing contemporary issues related to global health diplomacy through the framework of actors, drivers, and policies that affect public health research and capacity-building, beginning at the level of global health governance and cooperation and moving progressively to regional (supranational), national, and institutional perspective. This course represents an approach geared toward meeting the needs specific to U.S. military public health personnel and researchers working in international settings. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.
a priori hypotheses for all these potential comparisons. Therefore, a staff survey involving experienced doctors and nurses was conducted in order to generate hypotheses that could be tested in the data from patients. We contacted 46 health care professionals and 36 (78%) responded. Overall, the staff...... chemotherapy, ovarian ablation, and endocrine therapy. After a literature study and interviews with breast cancer patients, a questionnaire was composed that included two widely used standard questionnaires (EORTC QLQ-C30 and Hospital Anxiety and Depression (HAD) Scale) and a DBCG 89 Questionnaire developed...... survey did not prove very useful for the intended purpose. The main reason for this was probably that the health care professionals had limited insight into the patients' HRQL. A different approach to the problem of multiple hypothesis testing proved more useful. Hypotheses generated from the initial...
Full Text Available Background: Delay in presenting breast cancer for health care is dangerous because it can increase the mortality rate amongst affected women. Delaying health care and treatment makes it difficult to manage advanced breast cancer successfully. Understanding the factors that contribute to delays in presentation for health care can save lives.Objectives: The purpose of the study was to describe the factors which contribute to the latepresentation of Ghanaian women with breast cancer for health care at a tertiary hospital in Kumasi, Ghana.Method: A descriptive qualitative research design was utilised to answer the research question: ‘What factors contribute to presenting with late breast cancer for health care amongst Ghanaian women who were treated for breast cancer at a tertiary hospital in Kumasi, Ghana?’ A sample of 30 women diagnosed with breast cancer and presented with Stage II and Stage III participated in the study. Semi-structured interviews and field notes were conducted for data collection. Content data analysis was used in line with the research question.Findings: Five themes were discovered as findings. These were: lack of knowledge about breast cancer; fear of cancer treatment and its outcomes; poverty; traditional and spiritual beliefs and treatments and caring for others.Conclusions: We recommend the development of breast cancer awareness programmes and health education at primary health care level.
Watt, Nicola F; Gomez, Eduardo J; McKee, Martin
Amidst the growing literature on global health, much has been written recently about the Brazil, Russia, India, China, South Africa (BRICS) countries and their involvement and potential impact in global health, particularly in relation to development assistance. Rather less has been said about countries' motivations for involvement in global health negotiations, and there is a notable absence of evidence when their motivations are speculated on. This article uses an existing framework linking engagement in global health to foreign policy to explore differing levels of engagement by BRICS countries in the global health arena, with a particular focus on access to medicines. It concludes that countries' differing and complex motivations reinforce the need for realistic, pragmatic approaches to global health debates and their analysis. It also underlines that these analyses should be informed by analysis from other areas of foreign policy. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.
Nossal, G J V
The contributions of immunology to world health must be seen in the context of the severe disadvantage prevailing in many countries. Low life expectancy, high infant and maternal mortality rates, and continued prevalence of infections as causes of preventable deaths highlight what vaccines can do to improve the situation. This paper will briefly review some major new international health programs, including the GAVI Alliance; the Global Polio Eradication Initiative; the Global Fund to Fight AIDS, Tuberculosis and Malaria; the President's Emergency Plan for AIDS Relief; and the Global Malaria Action Plan. It will also outline the state of research progress for vaccines that are not yet licensed but that, in many cases, appear within reach. Of course, vaccines are not the be-all and the end-all of global health, so brief reference will be made to nutrition, vector biology and control, and the emergence of noncommunicable diseases as threats. © 2013 New York Academy of Sciences.
Erbil, Nülüfer; Bölükbaş, Nurgül
Breast cancer (BC) is one of the most common cancer affecting women worldwide. Although a great deal of progress has been made in the health sciences, early diagnosis, and increasing community awareness, breast cancer remains a life-threatening illness. In order to reduce this threat, breast cancer screening needs to be implemented in all communities where possible. The purpose of this study was to examine health beliefs, attitudes and behaviors about breast cancer and breast self-examination of Turkish women. Data were collected from a sample of 656 women, using an adapted Turkish version of Champion's Health Belief Model Scale (CHBMS), between January and May 2011, in Ordu province of Turkey. The results showed that 67.7% of women had knowledge about and 55.8% performed BSE, however 60.6% of those who indicated they practiced BSE reported they did so at irregular intervals. CHBMS subscales scores of women according to women's age, education level, occupation, family income and education level of the women's mothers, family history of breast cancer, friend and an acquaintance with breast cancer, knowledge about breast cancer, BSE and mammography were significantly different. Knowledge of women about the risks and benefits of early detection of breast cancer positively affect their health beliefs, attitudes, and behaviors. Health care professionals can develop effective breast health programs and can help women to gain good health behavior and to maintain health.
Watterson, Rita; Matthews, David; Bach, Paxton; Kherani, Irfan; Halpine, Mary; Meili, Ryan
This study set out to explore the current state of global health concentrations in Canadian medical schools and to solicit feedback on the barriers and challenges to implementing rigorous global health concentration programs. A set of consensus guidelines for global health concentrations was drafted through consultation with student and faculty leaders across Canada between May 2011 and May 2012. Drawing on these guidelines, a formal survey was sent to prominent faculty at each of the 14 English-speaking Canadian medical schools. A thematic analysis of the results was then conducted. Overall, the guidelines were strongly endorsed. A majority of Canadian medical schools have programs in place to offer global health course work, extracurricular learning opportunities, local community service-learning, low-resource-setting clinical electives, predeparture training, and postreturn debriefing. Although student evaluation, global health mentorship, and knowledge translation projects were endorsed as important components, few schools had been successful in implementing them. Language training for global health remains contested. Other common critiques included a lack of time and resources, and difficulties in setting standards for student evaluation. The results suggest that these guidelines are appropriate and, at least for the major criteria, achievable. Although many Canadian schools offer individual components, the majority of schools have yet to develop formally structured concentration programs. By better articulating guidelines, a standardized framework can aid in the establishment and refinement of future programs.
In the space of a decade, the Lake Geneva region has become the Health Valley, a world-class laboratory for discovering and developing healthcare of the future. Through visionary individuals and thanks to exceptional infrastructure this region has become one of the most dynamic in the field of innovation, including leading scientific research and exceptional actors for the commercialization of academic innovation to industrial applications that will improve the lives of patients and their families. Here follows the chronicle of a spectacular expansion into the Health Valley.
McNeil, Candice J; Shetty, Avinash K
In February 2016, the World Health Organization declared Zika virus (ZIKV) infection a public health emergency of international concern, given the precipitous spread of the virus across the Americas. Unlike arboviruses such as Chikungunya and Dengue, which have also recently emerged in the western hemisphere, ZIKV was identified in communities where concurrent neurologic conditions such as microcephaly and Guillain-Barre (GB) syndrome were occurring at alarming rates. Thus, investigations to systematically evaluate the link between ZIKV, congenital malformations (including microcephaly) and GB syndrome remain a top priority. © The Author . Published by Oxford University Press. All rights reserved. For Permissions, please email: firstname.lastname@example.org.
Sashidharan, S.P.; White, Ross; Mezzina, Roberto; Jansen, Stefan; Gishoma, Darius
Over the past decade there have been significant efforts to scale-up mental health services in resource-poor countries. A number of cost-effective innovations have emerged as a result. At the same time, there is increasing concern in resource-rich countries about efficacy, efficiency and acceptability of mental health services. We consider two specific innovations used widely in low- and middle-income countries, task-sharing and a development model of mental healthcare, that we believe have t...
Buss Paulo Marchiori
Full Text Available In this paper, originally presented at an event held by the National Institutes of Health (NIH in the United States, the author analyzes the repercussions of globalization on various health aspects: the spread of infectious and parasitic diseases, bioterrorism, and new behavioral patterns in health, among others. He goes on to examine the positive and negative effects of international agreements on health, particularly in the trade area, including the TRIPS Agreement on medicines in the area of public health. The paper concludes that the resumption of cooperation among nations is the best way to achieve world progress in public health.
Kirmayer, Laurence J; Pedersen, Duncan
Current efforts in global mental health (GMH) aim to address the inequities in mental health between low-income and high-income countries, as well as vulnerable populations within wealthy nations (e.g., indigenous peoples, refugees, urban poor). The main strategies promoted by the World Health Organization (WHO) and other allies have been focused on developing, implementing, and evaluating evidence-based practices that can be scaled up through task-shifting and other methods to improve access to services or interventions and reduce the global treatment gap for mental disorders. Recent debates on global mental health have raised questions about the goals and consequences of current approaches. Some of these critiques emphasize the difficulties and potential dangers of applying Western categories, concepts, and interventions given the ways that culture shapes illness experience. The concern is that in the urgency to address disparities in global health, interventions that are not locally relevant and culturally consonant will be exported with negative effects including inappropriate diagnoses and interventions, increased stigma, and poor health outcomes. More fundamentally, exclusive attention to mental disorders identified by psychiatric nosologies may shift attention from social structural determinants of health that are among the root causes of global health disparities. This paper addresses these critiques and suggests how the GMH movement can respond through appropriate modes of community-based practice and ongoing research, while continuing to work for greater equity and social justice in access to effective, socially relevant, culturally safe and appropriate mental health care on a global scale. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
IDRC has supported over the years. The record shows that even modest invest- ments can go a long way toward achieving better health outcomes and policies. David M. Malone ... Maternal mortality stemming from obstetric emergen- cies is often attributed to “three delays” – the time taken to realize medical help is needed, ...
Full Text Available Abstract Background Breast cancer is the most common cancer and the second principal cause of cancer deaths in women worldwide as well as in Malaysia. Breast self-examination (BSE has a role in raising breast cancer awareness among women and educational programs play an important role in breast cancer preventive behavior. The aim of this study is to develop, implement and evaluate the effectiveness of Breast Health Awareness program based on health belief model on knowledge of breast cancer and breast-selfexamination and BSE practice among female students in Malaysia. Methods A single-blind randomized controlled trial was carried out among 370 female undergraduate students from January 2011 to April 2012 in two selected public universities in Malaysia. Participants were randomized to either the intervention group or the control group. The educational program was delivered to the intervention group. The outcome measures were assessed at baseline, 6, and 12 months after implementing the health educational program. Chi-square, independent samples t-test and two-way repeated measures ANOVA (GLM were conducted in the course of the data analyses. Results Mean scores of knowledge on breast cancer (p<0.003, knowledge on breast self examination (p<0.001, benefits of BSE (p<0.00, barrier of BSE (0.01 and confidence of BSE practice (p<0.00 in the intervention group had significant differences in comparison with those of the control group 6 and 12 months after the intervention. Also, among those who never practiced BSE at baseline, frequency of BSE practice increased 6 and 12 months after the intervention (p<0.05. Conclusion The Breast Health Awareness program based on health the belief model had a positive effect on knowledge of breast cancer and breast self-examination and practice of BSE among females in Malaysia. Trial registration The ANZCTR clinical trial registry ( ACTRN12616000831482 , retrospectively registered on Jun 23, 2016 in ANZCTR.org.au.
Background: Health has long been recognized as a central feature of development. Globalization tends to be understood as a process of economic integration, but it implies more. It entails openness to trade, ideas, investment, people and culture all of which impact health. Method: Review of relevant literature on ...
Full Text Available In this collection review, Cathy Zimmerman and colleague introduce the PLOS Medicine Collection on Human Trafficking, Exploitation and Health, laying out the magnitude of the global trafficking problem and offering a public health policy framework to guide responses to trafficking.
Lackey, Mellanye; Swogger, Susan; McGraw, Kathleen A
This paper describes how a large, academic health sciences library built capacity for supporting global health at its university and discusses related outcomes. Lean budgets require prioritization and organizational strategy. A committee, with leadership responsibilities assigned to one librarian, guided strategic planning and the pursuit of collaborative, global health outreach activities. A website features case studies and videos of user stories to promote how library partnerships successfully contributed to global health projects. Collaborative partnerships were formed through outreach activities and from follow-up to reference questions. The committee and a librarian's dedicated time established the library's commitment to help the university carry out its ambitious global agenda.
Lackey, Mellanye; Swogger, Susan; McGraw, Kathleen A.
This paper describes how a large, academic health sciences library built capacity for supporting global health at its university and discusses related outcomes. Lean budgets require prioritization and organizational strategy. A committee, with leadership responsibilities assigned to one librarian, guided strategic planning and the pursuit of collaborative, global health outreach activities. A website features case studies and videos of user stories to promote how library partnerships successfully contributed to global health projects. Collaborative partnerships were formed through outreach activities and from follow-up to reference questions. The committee and a librarian's dedicated time established the library's commitment to help the university carry out its ambitious global agenda. PMID:24860264
West, Daniel J; Ramirez, Bernardo; Filerman, Gary
The impact of globalization on graduate health care management education is evident, yet challenging to quantify. The Commission on Healthcare Management Education (CAHME) recently authorized two research studies to gather specific information and answer important questions about accredited graduate programs in the USA and Canada. Two surveys provided the most comprehensive data impacting international health management education efforts by 70 programs. An inventory was made of 22 countries; information was compiled on 21 accrediting or quality improvement organizations. Observations on leadership and the demand for qualified health care professionals is discussed in terms of accreditation, certification, competency models, outcome assessment, improving quality, and the impact of globalization on higher education.
Gill, Stephen; Benatar, Solomon R
Ilona Kickbusch's thought provoking editorial is criticized in this commentary, partly because she fails to refer to previous critical work on the global conditions and policies that sustain inequality, poverty, poor health and damage to the biosphere and, as a result, she misreads global power and elides consideration of the fundamental historical structures of political and material power that shape agency in global health governance. We also doubt that global health can be improved through structures and processes of multilateralism that are premised on the continued reproduction of the ecologically myopic and socially unsustainable market civilization model of capitalist development that currently prevails in the world economy. This model drives net financial flows from poor to rich countries and from the poor to the affluent and super wealthy individuals. By contrast, we suggest that significant progress in global health requires a profound and socially just restructuring of global power, greater global solidarity and the "development of sustainability." © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Aboud, Frances E; Yousafzai, Aisha K
Health and nutritional risks co-occur in the lives of children under the age of 2 years who live in developing countries. We review evidence showing how these risks, in addition to inadequate psychosocial stimulation, prevent children from developing expected cognitive and language abilities. A systematic review and meta-analysis of 21 interventions aimed at enhancing stimulation and 18 interventions that provided better nutrition--all conducted since 2000--revealed that stimulation had a medium effect size of 0.42 and 0.47 on cognitive and language development, respectively, whereas nutrition by itself had a small effect size of 0.09. The implementation processes of these interventions are described and compared. A number of unresolved issues are outlined and discussed, including ways to maximize parental health behavior change, assess mediators that account for intervention effects, and expand the assessment of young children's brain functions that underlie language and cognition and are affected by nutrition and stimulation.
特別講演「高齢化社会における世代間正義と健康」 = Special Lecture “Intergenerational Justice and Health in an Aging Society”. 2010年11月7日（日） . 北海道大学人文・社会科学総合研究棟W409号室, 札幌市.
Karnik, Sameera; Kanekar, Amar
Childhood obesity is a major public health crisis nationally and internationally. The prevalence of childhood obesity has increased over few years. It is caused by imbalance between calorie intake and calories utilized. One or more factors (genetic, behavioral, and environmental) cause obesity in children. Physical, psychological, and social health problems are caused due to childhood obesity. Hence, effective intervention strategies are being used to prevent and control obesity in children. The purpose of this manuscript is to address various factors influencing childhood obesity, a variety of interventions and governmental actions addressing obesity and the challenges ahead for managing this epidemic. In order to collect materials for this review a detailed search of CINAHL, MEDLINE, ERIC, Academic Search Premier databases was carried out for the time period 1999-2011. Some of the interventions used were family based, school based, community based, play based, and hospital based. The effective school-based interventions were seen targeting physical activity along with healthy diet education. The major challenges faced by these intervention programs are financial, along with stigmatization of obese children. Governments along with other health care organizations are taking effective actions like policy changing and environmentally safe interventions for children to improve physical activity. In conclusion, childhood obesity can be tackled at the population level by education, prevention and sustainable interventions related to healthy nutrition practices and physical activity promotion.
Thornicroft, Graham; Cooper, Sara; Van Bortel, Tine; Kakuma, Ritsuko; Lund, Crick
Research-generated information about mental disorders is crucial in order to establish the health needs in a given setting, to propose culturally apt and cost-effective individual and collective interventions, to investigate their implementation, and to explore the obstacles that prevent recommended strategies from being implemented. Yet the capacity to undertake such research in low- and middle-income countries is extremely limited. This article describes two methods that have proved successful in strengthening, or that have the potential to strengthen, mental health research capacity in low-resource settings. We identify the central challenges to be faced, review current programs offering training and mentorship, and summarize the key lessons learned. A structured approach is proposed for the career development of research staff at every career stage, to be accompanied by performance monitoring and support. A case example from the Mental Health and Poverty Project in sub-Saharan Africa illustrates how this approach can be put into practice—in particular, by focusing upon training in core transferrable research skills. (harv rev psychiatry 2012;20:13–24.) PMID:22335179
Tulchinsky Theodore H
Full Text Available Micronutrient deficiency conditions are widespread among 2 billion people in developing and in developed countries. These are silent epidemics of vitamin and mineral deficiencies affecting people of all genders and ages, as well as certain risk groups. They not only cause specific diseases, but they act as exacerbating factors in infectious and chronic diseases, greatly impacting morbidity, mortality, and quality of life. Deficiencies in some groups of people at special risk require supplementation, but the most effective way to meet community health needs safely is by population based approaches involving food fortification. These complementary methods, along with food security, education, and monitoring, are challenges for public health and for clinical medicine. Micronutrient deficiency conditions relate to many chronic diseases, such as osteoporosis osteomalacia, thyroid deficiency colorectal cancer and cardiovascular diseases. Fortification has a nearly century long record of success and safety, proven effective for prevention of specific diseases, including birth defects. They increase the severity of infectious diseases, such as measles, HIV/AIDS and tuberculosis. Understanding the pathophysiology and epidemiology of micronutrient deficiencies, and implementing successful methods of prevention, both play a key part in the New Public Health as discussed in this section, citing the examples of folic acid, vitamin B12, and vitamin D.
Preker, A S
Changes in the role of the state and private sector are seen as central to success of many health care reforms. The article argues for a more focused "stewardship" function of governments in securing equity, efficiency, and quality objectives through more effective policy making (steering), regulating, contracting, and ensuring that adequate financing arrangements are available for the whole population. At the same time, the author argues a strong case for greater private participation in providing health services (rowing). The article reviews related reform trends in health care financing, generation of inputs and service providers. It concludes that reforms often fail, not because of a flawed technical design, but because of other factors. These include a lack of political commitment to change, resistance from vested stakeholders who fear loosing some of their existing benefits, and a failure by policymakers to translate successful aspects of the reforms into something visible that ordinary people and the public can see with their own eyes when next they use the reformed services.
Petersen, P E; Kandelman, D; Arpin, S
The aim of this report is (1) to provide a global overview of oral health conditions in older people, use of oral health services, and self care practices; (2) to explore what types of oral health services are available to older people, and (3) to identify some major barriers to and opportunities...... for the establishment of oral health services and health promotion programmes....
Full Text Available Global Public Health is increasingly being seen as a speciality field within the university education of Public Health. However, the exact meaning of Global Public Health is still unclear resulting in varied curricula and teaching units among universities. The contextual differences between high and low and middle income countries, and the process of globalisation need to be taken into account while developing any global public health course.Global Public Health and Public Health are not separable and Global Public Health often appears as an extension of Public Health in the era of globalisation and interdependence. Though Global Public Health is readily understood as health of global population, it is mainly practised as health problems and their solutions set within low and middle income countries. Additional specialist competencies relevant to the context of low and middle income countries are needed to work in this field. Although there can be a long list of competencies relevant to this broad topic, available literature suggests that knowledge and skills related with ethics and vulnerable groups/issues; globalisation and its impact on health; disease burden; culture, society and politics; and management are important.
Asgary, Ramin; Smith, Clyde Lanford; Sckell, Blanca; Paccione, Gerald
Half a million immigrants enter the United States annually. Clinical providers generally lack training in immigrant health. We developed a curriculum with didactic, clinical, and analytic components to advance residents' skills in immigrant and travel health. The curriculum focused on patients and their countries of origin and encompassed (a) societal, cultural, economical, and human rights profiles; (b) health system/ policies/resources/statistics, and environmental health; and (c) clinical manifestations, tropical and travel health. Residents evaluated sociocultural health beliefs and human rights abuses; performed history and physical examinations while precepted by faculty; developed specific care plans; and discussed patients in a dedicated immigrant health morning report. We assessed resident satisfaction using questionnaires and focus groups. Residents (n=20) found clinical, sociocultural, and epidemiological components the most helpful. Morning reports reinforced peer education. The immigrant health curriculum was useful for residents. Multiple teaching modules, collaboration with grassroot organizations, and an ongoing clinical component were key features.
Nossal, G J V
Increased international support for both research into new vaccines and their deployment in developing countries has been evident over the past decade. In particular, the GAVI Alliance has had a major impact in increasing uptake of the six common infant vaccines as well as those against hepatitis B and yellow fever. It further aims to introduce pneumococcal and rotavirus vaccines in the near future and several others, including those against human papillomavirus, meningococcal disease, rubella and typhoid not long after that. In addition, there is advanced research into vaccines against malaria, HIV/AIDS and tuberculosis. By 2030, we may have about 20 vaccines that need to be used in the developing world. Finding the requisite funds to achieve this will pose a major problem. A second and urgent question is how to complete the job of global polio eradication. The new strategic plan calls for completion by 2013, but both pre-eradication and post-eradication challenges remain. Vaccines will eventually become available beyond the field of infectious diseases. Much interesting work is being done in both autoimmunity and cancer. Cutting across disease groupings, there are issues in methods of delivery and new adjuvant formulations.
Aghaei, Faranak; Tan, Maxine; Hollingsworth, Alan B.; Zheng, Bin; Cheng, Samuel
Dynamic contrast-enhanced breast magnetic resonance imaging (DCE-MRI) has been used increasingly in breast cancer diagnosis and assessment of cancer treatment efficacy. In this study, we applied a computer-aided detection (CAD) scheme to automatically segment breast regions depicting on MR images and used the kinetic image features computed from the global breast MR images acquired before neoadjuvant chemotherapy to build a new quantitative model to predict response of the breast cancer patients to the chemotherapy. To assess performance and robustness of this new prediction model, an image dataset involving breast MR images acquired from 151 cancer patients before undergoing neoadjuvant chemotherapy was retrospectively assembled and used. Among them, 63 patients had "complete response" (CR) to chemotherapy in which the enhanced contrast levels inside the tumor volume (pre-treatment) was reduced to the level as the normal enhanced background parenchymal tissues (post-treatment), while 88 patients had "partially response" (PR) in which the high contrast enhancement remain in the tumor regions after treatment. We performed the studies to analyze the correlation among the 22 global kinetic image features and then select a set of 4 optimal features. Applying an artificial neural network trained with the fusion of these 4 kinetic image features, the prediction model yielded an area under ROC curve (AUC) of 0.83+/-0.04. This study demonstrated that by avoiding tumor segmentation, which is often difficult and unreliable, fusion of kinetic image features computed from global breast MR images without tumor segmentation can also generate a useful clinical marker in predicting efficacy of chemotherapy.
... of Breast & Gynecologic Cancers Breast Cancer Screening Research Breast Cancer Treatment (PDQ®)–Patient Version General Information About Breast Cancer Go to Health Professional Version Key Points Breast ...
... of Breast & Gynecologic Cancers Breast Cancer Screening Research Breast Cancer Treatment (PDQ®)–Patient Version General Information About Breast Cancer Go to Health Professional Version Key Points Breast ...
Crone, Robert K
Trailing nearly every other industry, health care is finally globalizing. Highly trained and experienced expatriate health care professionals are returning to their home countries from training in the West or are staying home to work in newly developed corporate health care delivery systems that can compete quite favorably with less-than-perfect providers in Europe and North America. In turn, these health care systems are attracting patients from around the world who are interested in exploring high-quality, lower-cost health care alternatives. Much of this activity is occurring in the emerging economies of the Middle East, South and Southeast Asia, and beyond. Three Harvard Medical International collaborations--in Dubai, Turkey, and India--highlight these trends and demonstrate the potential for new models of global health care, as well as potential ramifications for patients and providers in the established economies of the West, including the United States. Although globalization is not a cure-all solution to achieving universal access to health care, it is not only a significant first step for patients in these emerging economies, but may also present alternative solutions for those patients in wealthier nations who nonetheless lack adequate health care coverage. The increase in health care quality and competitiveness around the globe is important, but these improvements will need to be matched by the development of comprehensive payer solutions, to benefit as many people as possible.
Armin, Julie; Torres, Cristina Huebner; Vivian, James; Vergara, Cunegundo; Shaw, Susan J.
Objective: This study aimed to quantitatively and qualitatively examine breast cancer screening practices, including breast self-examination (BSE), and health literacy among patients with chronic disease. Design: A prospective, multi-method study conducted with a targeted purposive sample of 297 patients with diabetes and/or hypertension from four…
Fazeli Dehkordy, Soudabeh; Carlos, Ruth C; Hall, Kelli S; Dalton, Vanessa K
Millions of people use online search engines everyday to find health-related information and voluntarily share their personal health status and behaviors in various Web sites. Thus, data from tracking of online information seeker's behavior offer potential opportunities for use in public health surveillance and research. Google Trends is a feature of Google which allows Internet users to graph the frequency of searches for a single term or phrase over time or by geographic region. We used Google Trends to describe patterns of information-seeking behavior in the subject of dense breasts and to examine their correlation with the passage or introduction of dense breast notification legislation. To capture the temporal variations of information seeking about dense breasts, the Web search query "dense breast" was entered in the Google Trends tool. We then mapped the dates of legislative actions regarding dense breasts that received widespread coverage in the lay media to information-seeking trends about dense breasts over time. Newsworthy events and legislative actions appear to correlate well with peaks in search volume of "dense breast". Geographic regions with the highest search volumes have passed, denied, or are currently considering the dense breast legislation. Our study demonstrated that any legislative action and respective news coverage correlate with increase in information seeking for "dense breast" on Google, suggesting that Google Trends has the potential to serve as a data source for policy-relevant research. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.
Objective: Todetermine theefficacy of massscreening in the control of primary breast cancer among a selected group of women from Mpigi district, Uganda. Design: Qualitative study by comparing the level of knowledge of risk factors, attitude and practice to breast cancer and the ability to carry out self breast examination ...
... old injury, or inflammation and are usually benign . Microcalcifications , which look like white specks on a mammogram. If found in an area of rapidly dividing cells or grouped together in a certain way, they may be a sign of DCIS or breast cancer . Dense breast tissue : A dense breast has relatively ...
Leggat, Sandra G; Tse, Nancy
Globalization is impacting on Hong Kong and Australia in different ways, but the experience of the public healthcare systems in both jurisdictions suggests a need for teaching and research hospitals to refocus from the management of international patients to better meet the needs for global health. Traditional globalization suggests a stockpiling of capital--a focus on improving global health suggests dismantling the stockpiles and sharing access to the necessary data, information, knowledge and discoveries to further develop local health expertise. Consistent with its position as a leading healthcare provider, the University Health Network (UHN) has been reflecting on the impact of increasing globalization on hospitals. The goals of the UHN paper on globalization are threefold--to suggest how the external and internal environments of hospitals will change as a result of globalization; to suggest a role for hospitals in a globalized world; and to stimulate discussion and debate. Given our perspective, from the other side of the world, we are pleased to contribute to the discussion and debate but will limit our comments to the future role of teaching and research hospitals based on some of the experiences of Australia and Hong Kong. The citizens of Hong Kong have been acutely aware of the issue of globalization--the excellent deep-water harbour has ensured the position of Hong Kong as a major trading hub. Hong Kong has also had a continually evolving role as a financial centre and gateway to China, and with China's accession to the World Trade Organization the impact of globalization will be even greater. On the other hand, the citizens of Australia have lived with geographic isolation, relatively limited natural resources and a small population, all of which have limited their role in global trade and financial markets. However, both Hong Kong and Australia have seen recent benefits from the increasing speed of communication and information transfer and exchange
Taylor, Allyn; Alfvén, Tobias; Hougendobler, Daniel; Buse, Kent
Recent debate over World Health Organization reform has included unprecedented attention to international lawmaking as a future priority function of the Organization. However, the debate is largely focused on the codification of new binding legal instruments. Drawing upon lessons from the success of the Global AIDS Reporting Mechanism, established pursuant to the United Nations' Declaration of Commitment on HIV/AIDS, we argue that effective global health governance requires consideration of a broad range of instruments, both binding and nonbinding. A detailed examination of the Global AIDS Reporting Mechanism reveals that the choice of the nonbinding format makes an important contribution to its effectiveness. For instance, the flexibility and adaptability of the nonbinding format have allowed the global community to: (1) undertake commitments in a timely manner; (2) adapt and experiment in the face of a dynamic pandemic; and (3) grant civil society an unparalleled role in monitoring and reporting on state implementation of global commitments. UNAIDS' institutional support has also played a vital role in ensuring the continuing effectiveness of the Global AIDS Reporting Mechanism. Overall, the experience of the Global AIDS Reporting Mechanism evidences that, at times, nimbler nonbinding instruments can offer benefits over slower, more rigid binding legal approaches to governance, but depend critically, like all instruments, on the perceived legitimacy thereof. © 2014 American Society of Law, Medicine & Ethics, Inc.
Plummer, Leigh C; Chalmers, Kerry A
Physical activity after a diagnosis of breast cancer is associated with many health benefits. Health literacy has been shown to relate to physical activity, but there is limited research on this relationship. The aim of this study was to explore the relationship between health literacy and physical activity in women diagnosed with breast cancer. Specifically, we examined which of Nutbeam's 3 levels of health literacy (functional, interactive, and critical health literacy) predicted physical activity in women who have completed treatment for breast cancer. Participants were women (N = 36) who had attended a local cancer care centre for breast cancer treatment. During a telephone interview conducted 6 to 18 months after completion of treatment, women completed a measure of health literacy and reported on their engagement in physical activity. Results showed that health literacy predicted physical activity after breast cancer treatment. Of the 3 levels of health literacy proposed by Nutbeam, functional health literacy was shown to be the most important predictor of physical activity. These findings highlight the role of health literacy in physical activity in women diagnosed with breast cancer and have implications for targeted supportive physical activity interventions. Copyright © 2016 John Wiley & Sons, Ltd.
Bahadar, Haji [International Campus, Tehran University of Medical Sciences (Iran, Islamic Republic of); Pharmaceutical Sciences Research Center and Faculty of Pharmacy, Tehran University of Medical Sciences (Iran, Islamic Republic of); Mostafalou, Sara [Pharmaceutical Sciences Research Center and Faculty of Pharmacy, Tehran University of Medical Sciences (Iran, Islamic Republic of); Abdollahi, Mohammad, E-mail: Mohammad.Abdollahi@UToronto.Ca [Pharmaceutical Sciences Research Center and Faculty of Pharmacy, Tehran University of Medical Sciences (Iran, Islamic Republic of)
Objective: Benzene, as a volatile organic compound, is known as one of the main air pollutants in the environment. The aim of this review is to summarize all available evidences on non-cancerous health effects of benzene providing an overview of possible association of exposure to benzene with human chronic diseases, specially, in those regions of the world where benzene concentration is being poorly monitored. Methodology: A bibliographic search of scientific databases including PubMed, Google Scholar, and Scirus was conducted with key words of “benzene toxic health effects”, “environmental volatile organic compounds”, “diabetes mellitus and environmental pollutants”, “breast cancer and environmental pollution”, “prevalence of lung cancer”, and “diabetes prevalence”. More than 300 peer reviewed papers were examined. Experimental and epidemiologic studies reporting health effects of benzene and volatile organic compounds were included in the study. Results: Epidemiologic and experimental studies suggest that benzene exposure can lead to numerous non-cancerous health effects associated with functional aberration of vital systems in the body like reproductive, immune, nervous, endocrine, cardiovascular, and respiratory. Conclusion: Chronic diseases have become a health burden of global dimension with special emphasis in regions with poor monitoring over contents of benzene in petrochemicals. Benzene is a well known carcinogen of blood and its components, but the concern of benzene exposure is more than carcinogenicity of blood components and should be evaluated in both epidemiologic and experimental studies. Aspect of interactions and mechanism of toxicity in relation to human general health problems especially endocrine disturbances with particular reference to diabetes, breast and lung cancers should be followed up. - Highlights: • Benzene is a volatile organic compound and established blood carcinogen. • Exposure to benzene needs to be
Bamisaiye, A; Oyediran, M A
The importance of breast-feeding to the health of infant and mother is discussed. However the working conditions of employed women in developing countries prevent exclusive breast-feeding once the mother has returned to work after delivery and also present obstacles to partial breast-feeding. The breast-feeding practices of women employed at a major health institution in Lagos, Nigeria are examined. Duration of breast-feeding was in inverse relation to salary level. Women on the lowest salaries had a mean duration of breast-feeding their last child of 8 months, whereas women in senior professional positions had a mean breast-feeding duration of 3.3 months. Conflicts with work responsibilities were the most commonly cited reason for terminating breast-feeding earlier than the mother desired. If a creche was available at place of work, half the women surveyed said they would breast-feed for longer. Anticipated durations, if a creche was available, would lengthen breast-feeding to 12 months for lowest paid women and to nearly 9 months for women at the higher salary levels. Present options available to the employed women who wishes to breast-feed as long as possible, namely the use of wet-nurses and expression of breast-milk, are discussed. It is concluded that the most satisfactory means of promoting breast-feeding among employed women is the provision of paid leave post delivery for at least three months and the provision of a creche at place of work. The costs should be borne by the employer, assisted by government in the form of grants and tax-relief.(ABSTRACT TRUNCATED AT 250 WORDS)
Haghighi, Soheila Tontab; Lamyian, Minoor; Granpaye, Loabat
Health literacy is one of the main determinants of health promotion. Regarding the influential role of the women in a society, enhancing their critical health literacy would be a prerequisite for the promotion of public health. The aims of this study were to determine the level of health literacy among fertile Iranian women with breast cancer and to determine the relationship between the health literacy level and socio demographic factors, such as age, educational level, occupation, age of marriage, duration of marriage, and several clinical factors, including taking psychiatric medication and the type of breast surgery among breast cancer patients. This cross-sectional study was conducted on 260 fertile patients with breast cancer from screening and monitoring centers and breast cancer clinics in Tehran from August 2014 to August 2015. Data were collected using socio demographic and clinical questionnaires developed by the researchers and the questionnaire for health literacy for Iranian adults (HELIA).The results were analyzed using SPSS-IBM version 20 and the Pearson product-moment correlation coefficient, along with Kido's correlation test. The mean age of the participants was 43.32. Most of the participants (68.5%) had high school diplomas or lower school degrees (based on educational system in Iran). The mean score of health literacy was 75.73. The levels of health literacy among the different groups of participants were as follows: insufficient health literacy (6.9% of patients), barely enough health literacy (18.8% of patients), enough health literacy (38.8% of patients) and excellent health literacy (35.1% of patients). Also, significant relationships were found between the level of health literacy and the participants' age of marriage, duration of marriage, educational level, and occupation (p literacy was high among women with breast cancer. This indicates that their high level of health literacy might be used as a contributor to the promotion of the
Matthew P. Lungren
Full Text Available In high- and medium-income countries, the use of radiology has grown substantially in the last several decades. But in the developing world, access to medical imaging remains a critical problem. Unlike more structured efforts in the field of global health, interventions in global radiology have been largely unplanned, fragmented and sometimes irrelevant to the needs of the recipient society, and have not resulted in any significant progress. Access to medical imaging around the world remains dismal. There is a therefore a clear and urgent need for the radiology community to develop a vision for global radiology, beginning with defining the scope of the subject and establishing measurable goals. Agreement must be reached to declare global radiology as a bona fide subspecialty of radiology. This should soon be followed by the establishment of divisions of Global Radiology in academic radiology departments. Resident and medical students should be taught how physicians in low -income countries practice medicine without access to adequate radiology. As part of training and electives, residents and medical students should accompany global health teams to countries where the need for radiology services is great. Global scholar exchange and sabbatical opportunities should be offered to staff radiologists. Successful implementation of a unified vision of global radiology has the potential to improve access to medical imaging on a large scale. Radiology journals dedicated to the promotion of global radiology can play an important role in providing forums of discussion, analyses and sharing of field experiences. In this discussion we have attempted to make a case for assigning global radiology a subspecialty status.
Fidler, David P
Indonesia's decision to withhold samples of avian influenza virus A (H5N1) from the World Health Organization for much of 2007 caused a crisis in global health. The World Health Assembly produced a resolution to try to address the crisis at its May 2007 meeting. I examine how the parties to this controversy used international law in framing and negotiating the dispute. Specifically, I analyze Indonesia's use of the international legal principle of sovereignty and its appeal to rules on the protection of biological and genetic resources found in the Convention on Biological Diversity. In addition, I consider how the International Health Regulations 2005 applied to the controversy. The incident involving Indonesia's actions with virus samples illustrates both the importance and the limitations of international law in global health diplomacy.
Villa-Caballero, Leonel; Caballero-Solano, Víctor Manuel; Andrade-Barreto, Olga Alicia
The international process of trading goods and services with significant reduction in barriers known as globalization is clearly observed at the San Diego-Tijuana region. This essay addresses issues arising at this unique geographical area associated with the globalization process and its public health consequences. Social, cultural and political aspects have very important implications on the health status of the U.S-Mexican population and in the health care systems on both sides of the border. One of the most powerful world economies borders a developing country resulting in a dramatic comparison that has negative outcomes such as health disparities, high prevalence of chronic diseases and new epidemiological risks. Poverty and migration are a few of the contributing factors triggering this asymmetrical relationship. Challenges in border health require a comprehensive binational participation and the solutions are yet to be determined.
Paxton, Anne; Frost, Laura J
Systems Thinking provides a useful set of concepts and tools that can be used to train students to be effective and innovative global health leaders in an ever-changing and often chaotic world. This paper describes an experiential, multi-disciplinary curriculum that uses Systems Thinking to frame and analyse global health policies and practices. The curriculum uses case studies and hands-on activities to deepen students' understanding of the following concepts: complex adaptive systems, dynamic complexity, inter-relationships, feedback loops, policy resistance, mental models, boundary critique, leverage points, and multi-disciplinary, multi-sectoral, and multi-stakeholder thinking and action. A sample of Systems Thinking tools for analysing global health policies and practices are also introduced.
Shiraiwa, Manabu; Ueda, Kayo; Pozzer, Andrea; Lammel, Gerhard; Kampf, Christopher J; Fushimi, Akihiro; Enami, Shinichi; Arangio, Andrea M; Fröhlich-Nowoisky, Janine; Fujitani, Yuji; Furuyama, Akiko; Lakey, Pascale S J; Lelieveld, Jos; Lucas, Kurt; Morino, Yu; Pöschl, Ulrich; Takahama, Satoshi; Takami, Akinori; Tong, Haijie; Weber, Bettina; Yoshino, Ayako; Sato, Kei
Poor air quality is globally the largest environmental health risk. Epidemiological studies have uncovered clear relationships of gaseous pollutants and particulate matter (PM) with adverse health outcomes, including mortality by cardiovascular and respiratory diseases. Studies of health impacts by aerosols are highly multidisciplinary with a broad range of scales in space and time. We assess recent advances and future challenges regarding aerosol effects on health from molecular to global scales through epidemiological studies, field measurements, health-related properties of PM, and multiphase interactions of oxidants and PM upon respiratory deposition. Global modeling combined with epidemiological exposure-response functions indicates that ambient air pollution causes more than four million premature deaths per year. Epidemiological studies usually refer to PM mass concentrations, but some health effects may relate to specific constituents such as bioaerosols, polycyclic aromatic compounds, and transition metals. Various analytical techniques and cellular and molecular assays are applied to assess the redox activity of PM and the formation of reactive oxygen species. Multiphase chemical interactions of lung antioxidants with atmospheric pollutants are crucial to the mechanistic and molecular understanding of oxidative stress upon respiratory deposition. The role of distinct PM components in health impacts and mortality needs to be clarified by integrated research on various spatiotemporal scales for better evaluation and mitigation of aerosol effects on public health in the Anthropocene.
Sevinc Tastan, RN, PhD
Conclusion: It is important to be aware of the health beliefs of nurses regarding BSE so that their own health can be protected and improved. Beneficial attitudes and behaviors of nurses regarding BSE will enable them to provide more effective services to women regarding breast cancer. Understanding the nurses’ health beliefs, attitude and behavior that are influential to make BSE will guide nursing practices towards early diagnosis of breast cancer at the societal level.
McPeak, Katie E; Sandrock, Deborah; Spector, Nancy D; Pattishall, Amy E
The present article addresses recent research related to three important determinants of newborn health: postpartum depression, teenage parents and their offspring, and breast-feeding. Postpartum depression can impact the entire family unit, and fathers may be affected more than previously recognized. Teenage mothers and their infants are at risk of a number of poor physical and mental health outcomes. New research continues to support the benefits of breast-feeding infants, and hospitals have adopted policies to improve breast-feeding rates. Recognizing both maternal and paternal depression during outpatient visits is key to family well-being, as well as to infant development and attachment. Pediatric providers should address the unique emotional, socioeconomic, educational, and health needs of teen mothers. Hospital implementation of evidence-based policies may increase the number of mothers who are successful in establishing breast-feeding, and pediatric healthcare providers should be prepared to support mothers of breast-feeding infants.
Franco-Giraldo, Alvaro; Alvarez-Dardet, Carlos
This article comes from the intense international pressure that follows a near-catastrophy, such as the human influenza A H1N1 epidemic, and the limited resources for confronting such events. The analysis covers prevailing 20th century trends in the international public health arena and the change-induced challenges brought on by globalization, the transition set in motion by what has been deemed the "new" international public health and an ever-increasing focus on global health, in the context of an international scenario of shifting risks and opportunities and a growing number of multinational players. Global public health is defined as a public right, based on a new appreciation of the public, a new paradigm centered on human rights, and altruistic philosophy, politics, and ethics that undergird the changes in international public health on at least three fronts: redefining its theoretical foundation, improving world health, and renewing the international public health system, all of which is the byproduct of a new form of governance. A new world health system, directed by new global public institutions, would aim to make public health a global public right and face a variety of staggering challenges, such as working on public policy management on a global scale, renewing and democratizing the current global governing structure, and conquering the limits and weaknesses witnessed by international health.
Bell, Ruth; Taylor, Sebastian; Marmot, Michael
In May 2009 the World Health Assembly passed a resolution on reducing health inequities through action on the social determinants of health, based on the work of the global Commission on Social Determinants of Health, 2005-2008. The Commission's genesis and findings raise some important questions for global health governance. We draw out some of the essential elements, themes, and mechanisms that shaped the Commission. We start by examining the evolving nature of global health and the Commission's foundational inspiration--the universal pattern of health inequity and the imperative, driven by a sense of social justice, to make better and more equal health a global goal. We look at how the Commission was established, how it was structured internally, and how it developed external relationships--with the World Health Organization, with global networks of academics and practitioners, with country governments eager to spearhead action on health equity, and with civil society. We outline the Commission's recommendations as they relate to the architecture of global health governance. Finally, we look at how the Commission is catalyzing a movement to bring social determinants of health to the forefront of international and national policy discourse. © 2010 American Society of Law, Medicine & Ethics, Inc.
Full Text Available Maura MacPhee,1 Lilu Chang,2 Diana Lee,3 Wilza Spiri4 1University of British Columbia School of Nursing, Vancouver, British Columbia, Canada; 2Center for Advancement of Nursing Education, Koo Foundation, Sun Yat-Sen Cancer Center, Taipei, Taiwan; 3Nethersole School of Nursing, Chinese University of Hong Kong, Hong Kong, 4São Paulo State University, Botucatu, São Paulo, Brazil Abstract: This paper provides an overview of trends associated with global health care leadership development. Accompanying these trends are propositions based on current available evidence. These testable propositions should be considered when designing, implementing, and evaluating global health care leadership development models and programs. One particular leadership development model, a multilevel identity model, is presented as a potential model to use for leadership development. Other, complementary approaches, such as positive psychology and empowerment strategies, are discussed in relation to leadership identity formation. Specific issues related to global leadership are reviewed, including cultural intelligence and global mindset. An example is given of a nurse leadership development model that has been empirically tested in Canada. Through formal practice–academic–community collaborations, this model has been locally adapted and is being used for nurse leader training in Hong Kong, Taiwan, and Brazil. Collaborative work is under way to adapt the model for interprofessional health care leadership development. Keywords: health care leadership, development models, global trends, collective
Bello, Aminu K; Levin, Adeera; Tonelli, Marcello; Okpechi, Ikechi G; Feehally, John; Harris, David; Jindal, Kailash; Salako, Babatunde L; Rateb, Ahmed; Osman, Mohamed A; Qarni, Bilal; Saad, Syed; Lunney, Meaghan; Wiebe, Natasha; Ye, Feng; Johnson, David W
Kidney disease is a substantial worldwide clinical and public health problem, but information about available care is limited. To collect information on the current state of readiness, capacity, and competence for the delivery of kidney care across countries and regions of the world. Questionnaire survey administered from May to September 2016 by the International Society of Nephrology (ISN) to 130 ISN-affiliated countries with sampling of key stakeholders (national nephrology society leadership, policy makers, and patient organization representatives) identified by the country and regional nephrology leadership through the ISN. Core areas of country capacity and response for kidney care. Responses were received from 125 of 130 countries (96%), including 289 of 337 individuals (85.8%, with a median of 2 respondents [interquartile range, 1-3]), representing an estimated 93% (6.8 billion) of the world's population of 7.3 billion. There was wide variation in country readiness, capacity, and response in terms of service delivery, financing, workforce, information systems, and leadership and governance. Overall, 119 (95%), 95 (76%), and 94 (75%) countries had facilities for hemodialysis, peritoneal dialysis, and kidney transplantation, respectively. In contrast, 33 (94%), 16 (45%), and 12 (34%) countries in Africa had facilities for hemodialysis, peritoneal dialysis, and kidney transplantation, respectively. For chronic kidney disease (CKD) monitoring in primary care, serum creatinine with estimated glomerular filtration rate and proteinuria measurements were reported as always available in only 21 (18%) and 9 (8%) countries, respectively. Hemodialysis, peritoneal dialysis, and transplantation services were funded publicly and free at the point of care delivery in 50 (42%), 48 (51%), and 46 (49%) countries, respectively. The number of nephrologists was variable and was low (<10 per million population) in Africa, the Middle East, South Asia, and Oceania and South East
There has been substantial discussion of globalization in the scholarly and popular press yet limited attention so far among public health professionals. This is so despite the many potential impacts of globalization on public health. Defining public health broadly, as focused on the collective health of populations requiring a range of intersectoral activities, globalization can be seen to have particular relevance. Globalization, in turn, can be defined as a process that is changing the nature of human interaction across a wide range of spheres and along at least three dimensions. Understanding public health and globalization in these ways suggests the urgent need for research to better understand the linkages between the two, and effective policy responses by a range of public health institutions, including the UK Faculty of Public Health Medicine. The paper is based on a review of secondary literature on globalization that led to the development of a conceptual framework for understanding potential impacts on the determinants of health and public health. The paper then discusses major areas of public health in relation to these potential impacts. It concludes with recommendations on how the UK Faculty of Public Health Medicine might contribute to addressing these impacts through its various activities. Although there is growing attention to the importance of globalization to public health, there has been limited research and policy development in the United Kingdom. The UK Faculty of Public Health Medicine needs to play an active role in bringing relevant issues to the attention of policy makers, and encourage its members to take up research, teaching and policy initiatives. The potential impacts of globalization support a broader understanding and practice of public health that embraces a wide range of health determinants.
Meier, Benjamin Mason; Fox, Ashley M
This article analyzes the growing chasm between international power and state responsibility in health rights, proposing an international legal framework for collective rights - rights that can reform international institutions and empower developing states to realize the determinants of health structured by global forces. With longstanding recognition that many developing state governments cannot realize the health of their peoples without international cooperation, scholars have increasingly sought to codify international obligations under the purview of an evolving human right to health, applying this rights-based approach as a foundational framework for reducing global health inequalities through foreign assistance. Yet the inherent limitations of the individual human rights framework stymie the right to health in impacting the global institutions that are most crucial for realizing underlying determinants of health through the strengthening of primary health care systems. Whereas the right to health has been advanced as an individual right to be realized by a state duty-bearer, the authors find that this limited, atomized right has proven insufficient to create accountability for international obligations in global health policy, enabling the deterioration of primary health care systems that lack the ability to address an expanding set of public health claims. For rights scholars to advance disease protection and health promotion through national primary health care systems - creating the international legal obligations necessary to spur development supportive of the public's health - the authors conclude that scholars must look beyond the individual right to health to create collective international legal obligations commensurate with a public health-centered approach to primary health care. Through the development and implementation of these collective health rights, states can address interconnected determinants of health within and across countries
Full Text Available Background: Participation of Iranian women with a family history of breast cancer in breast cancer screening programs is low. This study evaluates the compliance of women having a family history of breast cancer with clinical breast exam (CBE according to the stage of transtheoretical model (TTM and health belief model (HBM. Materials and Methods: In this cross-sectional study, we used Persian version of champion's HBM scale to collect factors associated with TTM stages applied to screening from women over 20 years and older. The obtained data were analyzed by SPSS, using descriptive statistics, Chi-square test, independent t-test, and analysis of covariance. Results: Final sample size was 162 women. Thirty-three percent were in action/maintenance stage. Older women, family history of breast cancer in first-degree relatives, personal history of breast disease, insurance coverage, and a history of breast self-examination were associated with action/maintenance stage. Furthermore, women in action/maintenance stages had significantly fewer perceived barriers in terms of CBE in comparison to women in other stages (P < 0.05. There was no significant difference in other HBM subscales scores between various stages of CBE screening behavior (P < 0.05. Conclusion: The finding indicates that the rate of women in action/maintenance stage of CBE is low. Moreover, results show a strong association between perceived barriers and having a regular CBE. These clarify the necessity of promoting national target programs for breast cancer screening, which should be considered as the first preference for reducing CBE barriers.
Mittal, Rahul; Nguyen, Desiree; Debs, Luca H.; Patel, Amit P.; Liu, George; Jhaveri, Vasanti M.; S. Kay, Sae-In; Mittal, Jeenu; Bandstra, Emmalee S.; Younis, Ramzi T.; Chapagain, Prem; Jayaweera, Dushyantha T.; Liu, Xue Zhong
Zika virus (ZIKV) is an emerging healthcare threat. The presence of the mosquito Aedes species across South and Central America in combination with complementary climates have incited an epidemic of locally transmitted cases of ZIKV infection in Brazil. As one of the most significant current public health concerns in the Americas, ZIKV epidemic has been a cause of alarm due to its known and unknown complications. At this point, there has been a clear association between ZIKV infection and severe clinical manifestations in both adults and neonates, including but not limited to neurological deficits such as Guillain-Barré syndrome (GBS) and microcephaly, respectively. The gravity of the fetal anomalies linked to ZIKV vertical transmission from the mother has prompted a discussion on whether to include ZIKV as a formal member of the TORCH [Toxoplasma gondii, other, rubella virus, cytomegalovirus (CMV), and herpes] family of pathogens known to breach placental barriers and cause congenital disease in the fetus. The mechanisms of these complex phenotypes have yet to be fully described. As such, diagnostic tools are limited and no effective modalities are available to treat ZIKV. This article will review the recent advancements in understanding the pathogenesis of ZIKV infection as well as diagnostic tests available to detect the infection. Due to the increase in incidence of ZIKV infections, there is an immediate need to develop new diagnostic tools and novel preventive as well as therapeutic modalities based on understanding the molecular mechanisms underlying the disease. PMID:29276699
Philip Kam Tao Li
Full Text Available Acute kidney injury (AKI is increasingly prevalent in developing and developed countries and is associated with severe morbidity and mortality. Most etiologies of AKI can be prevented by interventions at the individual, community, regional and in-hospital levels. Effective measures must include community-wide efforts to increase an awareness of the devastating effects of AKI and provide guidance on preventive strategies, as well as early recognition and management. Efforts should be focused on minimizing causes of AKI, increasing awareness of the importance of serial measurements of serum creatinine in high risk patients, and documenting urine volume in acutely ill people to achieve early diagnosis; there is as yet no definitive role for alternative biomarkers. Protocols need to be developed to systematically manage prerenal conditions and specific infections. More accurate data about the true incidence and clinical impact of AKI will help to raise the importance of the disease in the community, increase awareness of AKI by governments, the public, general and family physicians and other health care professionals to help prevent the disease. Prevention is the key to avoid the heavy burden of mortality and morbidity associated with AKI.
The aims of this thesis were to: (1) examine enduring distress and its predictors in women with breast cancer; (2) determine the extent to which distress-related problems are portrayed in a graphic novel about breast cancer; (3) examine health care use and additional needs (with regard to medical,
Tosam, Mbih J; Chi, Primus Che; Munung, Nchangwi Syntia; Oukem-Boyer, Odile Ouwe Missi; Tangwa, Godfrey B
Although the world has experienced remarkable progress in health care since the last half of the 20th century, global health inequalities still persist. In some poor countries life expectancy is between 37-40 years lower than in rich countries; furthermore, maternal and infant mortality is high and there is lack of access to basic preventive and life-saving medicines, as well a high prevalence of neglected diseases, HIV/AIDS, tuberculosis, and malaria. Moreover, globalization has made the world more connected than before such that health challenges today are no longer limited within national or regional boundaries, making all persons equally vulnerable. Because of this, diseases in the most affluent countries are closely connected with diseases in the poorest countries. In this paper, we argue that, because of global health inequalities, in a situation of equal vulnerability, there is need for global solidarity not only as a means of reducing health inequalities, but also as a way of putting up a united force against global health challenges. We argue for an African approach to solidarity in which the humanity of a person is not determined by his/her being human or rational capacity, but by his/her capacity to live a virtuous life. According to this view of solidarity, because no one is self-sufficient, no individual can survive alone. If we are to collectively flourish in a world where no individual, nation or region has all the health resources or protection needed for survival, we must engage in solidarity where we remain compassionate and available to one another at all times. © 2017 John Wiley & Sons Ltd.
Rick, Tara J; Ballweg, Ruth
The physician assistant and other types of medical providers with accelerated and focused training were developed to serve the specific health-care needs of individual countries. They have an important role in providing care globally in response to physician shortages. Working in over 50 nations, these clinicians increase access to team-based health care. This perspective explores the successes and challenges of these professionals as an international community. Steps are proposed to increase global awareness and acceptance of these professionals including platforms to increase discussion, scholarly activity, and collaboration.
The WHO Framework Convention on Tobacco Control (FCTC) demonstrates the international political will invested in combating the tobacco pandemic and a newfound prominence for tobacco control within the global health agenda. However, major difficulties exist in managing conflicts with foreign and trade policy priorities, and significant obstacles confront efforts to create synergies with development policy and avoid tensions with other health priorities. This paper uses the concept of policy coherence to explore congruence and inconsistencies in objectives, policy, and practice between tobacco control and trade, development and global health priorities. Following the inability of the FCTC negotiations to satisfactorily address the relationship between trade and health, several disputes highlight the challenges posed to tobacco control policies by multilateral and bilateral agreements. While the work of the World Bank has demonstrated the potential contribution of tobacco control to development, the absence of non-communicable diseases from the Millennium Development Goals has limited scope to offer developing countries support for FCTC implementation. Even within international health, tobacco control priorities may be hard to reconcile with other agendas. The paper concludes by discussing the extent to which tobacco control has been pursued via a model of governance very deliberately different from those used in other health issues, in what can be termed 'tobacco exceptionalism'. The analysis developed here suggests that non-communicable disease (NCD) policies, global health, development and tobacco control would have much to gain from re-examining this presumption of difference.
Al-Sakkaf, Khaled Abdulla; Basaleem, Huda Omer
The incidence of breast cancer is rapidly increasing in Yemen with recent indications of constituting one-third of female cancers. The main problem in Yemen remains very late presentation of breast cancer, most of which should have been easily recognisable. Since stage of disease at diagnosis is the most important prognostic variable, early diagnosis is an important option to be considered for control of breast cancer in low resourced settings like Yemen. In the present study, we aimed at describing breast cancer knowledge, perceptions and breast self-examination (BSE) practices among a sample of Yemeni women. This cross-sectional study covered 400 women attending four reproductive health centres in Aden, Yemen through face-to-face interview using a structured questionnaire during April - July 2014. We collected data on sociodemographic characteristics, knowledge about breast cancer, and screening practices as well as respondents' perceptions based on the five sub scales of the Health Belief Model (HBM): perceived susceptibility; perceived severity; perceived barriers; perceived benefits; and self-efficacy. The response format was a fivepoint Likert scale. Statistical Package for Social Sciences (SPSS 20) was used for statistical analysis. Statistical significance was set at pwomen was 26.5 (S.D=5.6) years. The majority (89.0%) had never ever performed any screening. Two-thirds of respondents had poor knowledge. Perceived BSE benefits and self-efficacy and lower BSE barriers perception were significant independent predictors of BSE practice. Poor knowledge and inadequate BSE practices are prevailing in Yemen. The need for implementing culturally sensitive targeted education measures is mandatory in the effort to improve early detection and reduce the burden of breast cancer.
Sawleshwarkar, Shailendra; Negin, Joel
During the last decade, the literature about global health has grown exponentially. Academic institutions are also exploring the scope of their public health educational programs to meet the demand for a global health professional. This has become more relevant in the context of the sustainable development goals. There have been attempts to describe global health competencies for specific professional groups. The focus of these competencies has been variable with a variety of different themes being described ranging from globalization and health care, analysis and program management, as well as equity and capacity strengthening. This review aims to describe global health competencies and attempts to distill common competency domains to assist in curriculum development and integration in postgraduate public health education programs. A literature search was conducted using relevant keywords with a focus on public health education. This resulted in identification of 13 articles that described global health competencies. All these articles were published between 2005 and 2015 with six from the USA, two each from Canada and Australia, and one each from UK, Europe, and Americas. A range of methods used to describe competency domains included literature review, interviews with experts and employers, surveys of staff and students, and description or review of an academic program. Eleven competency domains were distilled from the selected articles. These competency domains primarily referred to three main aspects, one that focuses on burden of disease and the determinants of health. A second set focuses on core public health skills including policy development, analysis, and program management. Another set of competency domains could be classified as "soft skills" and includes collaboration, partnering, communication, professionalism, capacity building, and political awareness. This review presents the landscape of defined global health competencies for postgraduate public
Hansoti, Bhakti; Aluisio, Adam R; Barry, Meagan A; Davey, Kevin; Lentz, Brian A; Modi, Payal; Newberry, Jennifer A; Patel, Melissa H; Smith, Tricia A; Vinograd, Alexandra M; Levine, Adam C
Despite recent strides in the development of global emergency medicine (EM), the field continues to lag in applying a scientific approach to identifying critical knowledge gaps and advancing evidence-based solutions to clinical and public health problems seen in emergency departments (EDs) worldwide. Here, progress on the global EM research agenda created at the 2013 Academic Emergency Medicine Global Health and Emergency Care Consensus Conference is evaluated and critical areas for future development in emergency care research internationally are identified. A retrospective review of all studies compiled in the Global Emergency Medicine Literature Review (GEMLR) database from 2013 through 2015 was conducted. Articles were categorized and analyzed using descriptive quantitative measures and structured data matrices. The Global Emergency Medicine Think Tank Clinical Research Working Group at the Society for Academic Emergency Medicine 2016 Annual Meeting then further conceptualized and defined global EM research priorities utilizing consensus-based decision making. Research trends in global EM research published between 2013 and 2015 show a predominance of observational studies relative to interventional or descriptive studies, with the majority of research conducted in the inpatient setting in comparison to the ED or prehospital setting. Studies on communicable diseases and injury were the most prevalent, with a relative dearth of research on chronic noncommunicable diseases. The Global Emergency Medicine Think Tank Clinical Research Working Group identified conceptual frameworks to define high-impact research priorities, including the traditional approach of using global burden of disease to define priorities and the impact of EM on individual clinical care and public health opportunities. EM research is also described through a population lens approach, including gender, pediatrics, and migrant and refugee health. Despite recent strides in global EM research and
Wolicki, Sara Beth; Nuzzo, Jennifer B; Blazes, David L; Pitts, Dana L; Iskander, John K; Tappero, Jordan W
Global health security involves developing the infrastructure and capacity to protect the health of people and societies worldwide. The acceleration of global travel and trade poses greater opportunities for infectious diseases to emerge and spread. The International Health Regulations (IHR) were adopted in 2005 with the intent of proactively developing public health systems that could react to the spread of infectious disease and provide better containment. Various challenges delayed adherence to the IHR. The Global Health Security Agenda came about as an international collaborative effort, working multilaterally among governments and across sectors, seeking to implement the IHR and develop the capacities to prevent, detect, and respond to public health emergencies of international concern. When examining the recent West African Ebola epidemic as a case study for global health security, both strengths and weaknesses in the public health response are evident. The central role of public health surveillance is a lesson reiterated by Ebola. Through further implementation of the Global Health Security Agenda, identified gaps in surveillance can be filled and global health security strengthened.
Hayes Constant, Tara K; Winkler, Jennifer L; Bishop, Amie; Taboada Palomino, Leyla G
Breast cancer rates in Peru, as in other low- and middle-income countries, continue to rise, and survival rates are poor, in part because many women are diagnosed with late-stage disease. As part of a pilot project to improve breast cancer screening and diagnostic services in remote regions of Peru, the Program for Appropriate Technology in Health (PATH) partnered with Peruvian organizations to train community health workers in breast health promotion and providers in clinical breast exam (CBE). To inform these strategies, we undertook a qualitative study to determine factors that influence Peruvian women's decisions to seek CBE. Anthropological approaches incorporating the PRECEDE/PROCEED public health model guided our conversations with providers and women living in the region of the pilot intervention. Grounded theory analysis helped us uncover a central theme of uncertainty, a state of doubt and insecurity that created a sense of impotent worry and impeded clinical health-seeking behaviors. © The Author(s) 2014.
Globalization is a key challenge facing health policy-makers. A significant dimension of this is trade in health services. Traditionally, the flow of health services exports went from North to South, with patients travelling in the opposite direction. This situation is changing and a number of papers have discussed the growth of health services exports from Southern countries in its different dimensions. Less attention has been paid to assess the real scope of this trade at the global level and its potential impact at the local level. Given the rapid development of this area, there are little empirical data. This paper therefore first built an estimate of the global size and of the growth trend of international trade in health services since 1997, which is compared with several country-based studies. The second purpose of the paper is to demonstrate the significant economic impact of this trade at the local level for the exporting country. We consider the case of health providers in the South-Mediterranean region for which the demand potential, the economic effects and the consequence for the health system are presented. These issues lead to the overall conclusion that different policy options would be appropriate, in relation to the nature of the demand. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Drawing on research conducted in British Columbia, Ontario, and Quebec it is argued that tension exists between mental health reforms born out of concern for the well-being and care of people and those that are being driven by cost-containment and efficiency. Contributing to this tension are competing discourses about mental health and mental illness. It is argued that progressive change requires the meaningful engagement of mental health care recipients in policy decision-making processes and ongoing analysis about the interconnections between economic globalization, social welfare state restructuring and mental health reform.
Friedman, Eric A; Gostin, Lawrence O; Buse, Kent
Organizations, partnerships, and alliances form the building blocks of global governance. Global health organizations thus have the potential to play a formative role in determining the extent to which people are able to realize their right to health. This article examines how major global health organizations, such as WHO, the Global Fund to Fight AIDS, TB and Malaria, UNAIDS, and GAVI approach human rights concerns, including equality, accountability, and inclusive participation. We argue that organizational support for the right to health must transition from ad hoc and partial to permanent and comprehensive. Drawing on the literature and our knowledge of global health organizations, we offer good practices that point to ways in which such agencies can advance the right to health, covering nine areas: 1) participation and representation in governance processes; 2) leadership and organizational ethos; 3) internal policies; 4) norm-setting and promotion; 5) organizational leadership through advocacy and communication; 6) monitoring and accountability; 7) capacity building; 8) funding policies; and 9) partnerships and engagement. In each of these areas, we offer elements of a proposed Framework Convention on Global Health (FCGH), which would commit state parties to support these standards through their board membership and other interactions with these agencies. We also explain how the FCGH could incorporate these organizations into its overall financing framework, initiate a new forum where they collaborate with each other, as well as organizations in other regimes, to advance the right to health, and ensure sufficient funding for right to health capacity building. We urge major global health organizations to follow the leadership of the UN Secretary-General and UNAIDS to champion the FCGH. It is only through a rights-based approach, enshrined in a new Convention, that we can expect to achieve health for all in our lifetimes. Copyright © 2013 Friedman, Gostin
Soot, Laurel; Weerasinghe, Roshanthi; Wang, Lian; Nelson, Heidi D
High rates of surgical breast biopsies in community hospitals have been reported but may misrepresent actual practice. Patient-level data from 5,757 women who underwent breast biopsies in a large integrated health system were evaluated to determine biopsy types, rates, indications, and diagnoses. Between 2008 and 2010, 6,047 breast biopsies were performed on 5,757 women. Surgical biopsy was the initial diagnostic procedure in 16% (n = 942) of women overall and in 6% (72 of 1,236) of women with newly diagnosed invasive breast cancer. Invasive breast cancer was diagnosed in 72 women (8%) undergoing surgical biopsy compared with 1,164 (24%) undergoing core needle biopsy (P biopsies included symptomatic abnormalities, technical challenges, and patient choice. Surgical biopsy was the initial diagnostic procedure in 16% of women with breast abnormalities, comparable with rates at academic centers. Rates could be improved by more careful consideration of indications. Copyright © 2014 Elsevier Inc. All rights reserved.
In the context of reemerging universalistic approaches to health care, the objective of this article was to contribute to the discussion by highlighting the potential influence of global trade liberalization on the balance between health demand and the capacity of health systems pursuing universal health coverage (UHC) to supply adequate health care. Being identified as a defining feature of globalization affecting health, trade liberalization is analyzed as a complex and multidimensional influence on the implementation of UHC. The analysis adopts a systems-thinking approach and refers to the six building blocks of World Health Organization's current "framework for action," emphasizing their interconnectedness. While offering new opportunities to increase access to health information and care, in the absence of global governance mechanisms ensuring adequate health protection and promotion, global trade tends to have negative effects on health systems' capacity to ensure UHC, both by causing higher demand and by interfering with the interconnected functioning of health systems' building blocks. The prevention of such an impact and the effective implementation of UHC would highly benefit from a more consistent commitment and stronger leadership by the World Health Organization in protecting health in global policymaking fora in all sectors. Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
In today's globalized world, nations cannot be totally isolated from or indifferent to their neighbors, especially in regards to medicine and health. While globalization has brought prosperity to millions, disparities among nations and nationals are growing raising once again the question of justice. Similarly, while medicine has developed dramatically over the past few decades, health disparities at the global level are staggering. Seemingly, what our humanity could achieve in matters of scientific development is not justly distributed to benefit everyone. In this paper, it will be argued that a global theoretical agreement on principles of justice may prove unattainable; however, a grass-roots change is warranted to change the current situation. The UNESCO Declaration on Bioethics and Human Rights will be considered as a starting point to achieve this change through extracting the main values embedded in its principles. These values, namely, respecting human dignity and tending to human vulnerability with a hospitable attitude, should then be revived in medical practice. Medical education will be one possible venue to achieve that, especially through role models. Future physicians will then become the fervent advocates for a global and just distribution of health care.
Jaime C. Sapag
Full Text Available Background: Mental health is increasingly recognised as integral to good public health, but this area continues to lack sufficient planning, resources, and global strategy. It is a pressing concern in Latin America, where social determinants of health aggravate existing inequities in access to health services. Nicaragua faces serious mental health needs and challenges. One key strategy for addressing gaps in mental health services is building capacity at the primary healthcare and system levels. Objective: Using the framework of best practice literature, this article analyses the four-year collaborative process between the National Autonomous University of Nicaragua in León (UNAN-León and the Centre for Addiction and Mental Health (CAMH in Canada, which is aimed at improving mental healthcare in Nicaragua. Design: Based on a critical analysis of evaluation reports, key documents, and discussion among partners, the central steps of the collaboration are analysed and main successes and challenges identified. Results: A participatory needs assessment identified local strengths and weaknesses, expected outcomes regarding competencies, and possible methodologies and recommendations for the development of a comprehensive capacity-building programme. The partners delivered two international workshops on mental health and addiction with an emphasis on primary healthcare. More recently, an innovative Diploma and Master programme was launched to foster interprofessional leadership and effective action to address mental health and addiction needs. Collaborative activities have taken place in Nicaragua and Canada. Discussion: To date, international collaboration between Nicaragua and CAMH has been successful in achieving the jointly defined goals. The process has led to mutual knowledge sharing, strong networking, and extensive educational opportunities. Evidence of effective and respectful global health capacity building is provided. Lessons learned and
Kevany, Sebastian; Sahak, Omar; Workneh, Nibretie Gobezie; Saeedzai, Sayed Ataullah
Global health programmes require extensive adaptation for implementation in conflict and post-conflict settings. Without such adaptations, both implementation success and diplomatic, international relations and other indirect outcomes may be threatened. Conversely, diplomatic successes may be made through flexible and responsive programmes. We examine adaptations and associated outcomes for malaria treatment and prevention programmes in Afghanistan. In conjunction with the completion of monitoring and evaluation activities for the Global Fund to Fight AIDS, Tuberculosis and Malaria, we reviewed adaptations to the structure, design, selection, content and delivery of malaria-related interventions in Afghanistan. Interviews were conducted with programme implementers, service delivery providers, government representatives and local stakeholders, and site visits to service delivery points were completed. Programmes for malaria treatment and prevention require a range of adaptations for successful implementation in Afghanistan. These include (1) amendment of educational materials for rural populations, (2) religious awareness in gender groupings for health educational interventions, (3) recruitment of local staff, educated in languages and customs, for both quality assurance and service delivery, (4) alignment with diplomatic principles and, thereby, avoidance of confusion with broader strategic and military initiatives and (5) amendments to programme 'branding' procedures. The absence of provision for these adaptations made service delivery excessively challenging and increased the risk of tension between narrow programmatic and broader diplomatic goals. Conversely, adapted global health programmes displayed a unique capacity to access potentially extremist populations and groups in remote regions otherwise isolated from international activities. A range of diplomatic considerations when delivering global health programmes in conflict and post-conflict settings are
Bolton, Paul A.
In this paper, the author contrasts the substantial impact of mental health problems on global disability with the limited attention and resources these problems receive. The author discusses possible reasons for the disparity: Compared to physical disorders, mental health problems are considered less important, perhaps due to lower priority of disorders that primarily cause dysfunction rather than mortality, and skepticism that mental disorders are treatable in low-resource countries. He argues that achieving improved global health and development requires addressing problems causing disability, particularly mental health problems among populations in which the common mental disorders are frequent due to deprivation, war, and disasters. The author contends that services addressing the common mental disorders could be made widely and relatively cheaply accessible if provided by non-professional workers at the community level. PMID:25191140
Ooms, G; Marten, R; Waris, A; Hammonds, R; Mulumba, M; Friedman, E A
Establishing a reform agenda for the World Health Organization (WHO) requires understanding its role within the wider global health system and the purposes of that wider global health system. In this paper, the focus is on one particular purpose: achieving universal health coverage (UHC). The intention is to describe why achieving UHC requires something like a Framework Convention on Global Health (FCGH) that have been proposed elsewhere,(1) why WHO is in a unique position to usher in an FCGH, and what specific reforms would help enable WHO to assume this role. Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Macintosh, Janelle L B; Eden, Lacey M; Luthy, Karlen E; Schouten, Aimee E
Immunizations are one of the most important health interventions of the 20th century, yet people in many areas of the world do not receive adequate immunizations. Approximately 3 million people worldwide die every year from vaccine-preventable diseases; about half of these deaths are young children and infants. Global travel is more common; diseases that were once localized now can be found in communities around the world. Multiple barriers to immunizations have been identified. Healthcare access, cost, and perceptions of safety and trust in healthcare are factors that have depressed global immunization rates. Several global organizations have focused on addressing these barriers as part of their efforts to increase immunization rates. The Bill and Melinda Gates Foundation, The World Health Organization, and the United Nations Children's Emergency Fund each have a part of their organization that is concentrated on immunizations. Maternal child nurses worldwide can assist in increasing immunization rates. Nurses can participate in outreach programs to ease the burden of patients and families in accessing immunizations. Nurses can work with local and global organizations to make immunizations more affordable. Nurses can improve trust and knowledge about immunizations in their local communities. Nurses are a powerful influence in the struggle to increase immunization rates, which is a vital aspect of global health promotion and disease prevention.
One major conclusion of the Global Burden of Disease Study (GBDS) is that the global burden of disease will not change significantly from 1990 to 2020, in developed regions, developing regions or as a whole. Using the disability-adjusted life year (DALY), the Study estimates the burden as a result of 107 diseases, accidents and their disabling sequelae, disaggregated with respect to cause, sex, age and geographical region. The basic data used to construct estimates are sparse, and the DALY as a tool has received many criticisms. It obscures the distribution of disease and its impact in terms of handicap, and includes several social and economic value judgements. This weakens its power as a guide for the rational allocation of health resources at any point in time. Does it have use in guiding future planning and preventive action? At a global level, exceeding ecological capacity primarily through relative overpopulation is likely to be the greatest threat to overall health, yet overpopulation is not considered as a risk factor in itself. This reflects the understanding of health as an issue of the individual rather than the community. Together with the productivity-orientated weighting of DALYs, the Study appears to be more concerned with cost-effectiveness of health interventions rather than their equity. This underlies the reservations of the World Health Organization regarding the Study's use as a rational tool in health policy.
Bolton, Paul A.
In this paper, the author contrasts the substantial impact of mental health problems on global disability with the limited attention and resources these problems receive. The author discusses possible reasons for the disparity: Compared to physical disorders, mental health problems are considered less important, perhaps due to lower priority of disorders that primarily cause dysfunction rather than mortality, and skepticism that mental disorders are treatable in low-resource countries. He arg...
Koehn Peter H
Abstract Unprecedented migration, a core dimension of contemporary globalization, challenges population health. In a world of increasing human mobility, many health outcomes are shaped by transnational interactions among care providers and care recipients who meet in settings where nationality/ethnic match is not an option. This review article explores the value of transnational competence (TC) education as preparation for ethnically and socially discordant clinical encounters. The relevance ...
Özeren, Gül Sultan; CABAR, Huriye Demet
Today, all humanity is moving with increasing speed towards being a global information society by following and experiencing social, cultural, economical, scientific and technological advancements. Implementation of health informatics provides disposal of manpower, short hospitalization durations, time saving by its effect on work process, reduction in failures and abolition of unnecessary processes. It is accepted that health is a fundamental human right and humans possess equal rights to re...
Patel, Meghal; Miller, Margaret Ann
Regulatory science plays a vital role in protecting and promoting global public health by providing the scientific basis for ensuring that food and medical products are safe, properly labeled, and effective. Regulatory science research was first developed for the determination of product safety in the early part of the 20th Century, and continues to support innovation of the processes needed for regulatory policy decisions. Historically, public health laws and regulations were enacted followi...
... under the Copyright, Designs and Patents Act, 1988, to be identiﬁed as the author of this work. British Library Cataloguing in Publication Data Communicating health risks to the public : a global perspective 1. Health risk communication I. Hillier, Dawn, 1950- 614.4'4 ISBN-13: 978-0-566-08672-4 ISBN-10: 0 566 08672 7 Library of Congress Cataloging-in-Publ...
Gervassi, Ana L; Collins, Laura J; Britschgi, Theresa B
Despite a flourishing biomedical and global health industry too few of Washington state's precollege students are aware of this growing sector and emerging ideas on bacteria, fungi, parasites and viruses. Against the backdrop of numerous reports regarding declining precollege student interest in science, a precollege program was envisioned at Seattle Biomedical Research Institute (as of 2010, Seattle BioMed) to increase youth engagement in biomedical research and global health, increase community interest in infectious diseases and mobilize a future biomedical workforce. Since 2005, 169 rising high school juniors have participated in the BioQuest Academy precollege immersion program at Seattle BioMed. Assembling in groups of 12, students conduct laboratory experiments (e.g., anopheline mosquito dissection, gene expression informed tuberculosis drug design and optimizing HIV immunization strategies) related to global health alongside practicing scientific mentors, all within the footprint the institute. Laudable short-term impacts of the program include positive influences on student interest in global health (as seen in the students' subsequent school projects and their participation in Seattle BioMed community events), biomedical careers and graduate school (e.g., 16.9% of teens departing 2008-2009 Academy report revised goals of attaining a doctorate rather than a baccalaureate diploma). Long-term, 97% of alumni (2005-2008) are attending postsecondary schools throughout North America; eight graduates have already published scientific articles in peer-reviewed journals and/or presented their scientific data at national and international meetings, and 26 have been retained by Seattle BioMed researchers as compensated technicians and interns. Providing precollege students with structured access to practicing scientists and authentic research environments within the context of advancing global health has been a robust means of both building a future pool of talented
Ana L Gervassi
Full Text Available Despite a flourishing biomedical and global health industry too few of Washington state's precollege students are aware of this growing sector and emerging ideas on bacteria, fungi, parasites and viruses. Against the backdrop of numerous reports regarding declining precollege student interest in science, a precollege program was envisioned at Seattle Biomedical Research Institute (as of 2010, Seattle BioMed to increase youth engagement in biomedical research and global health, increase community interest in infectious diseases and mobilize a future biomedical workforce. Since 2005, 169 rising high school juniors have participated in the BioQuest Academy precollege immersion program at Seattle BioMed. Assembling in groups of 12, students conduct laboratory experiments (e.g., anopheline mosquito dissection, gene expression informed tuberculosis drug design and optimizing HIV immunization strategies related to global health alongside practicing scientific mentors, all within the footprint the institute. Laudable short-term impacts of the program include positive influences on student interest in global health (as seen in the students' subsequent school projects and their participation in Seattle BioMed community events, biomedical careers and graduate school (e.g., 16.9% of teens departing 2008-2009 Academy report revised goals of attaining a doctorate rather than a baccalaureate diploma. Long-term, 97% of alumni (2005-2008 are attending postsecondary schools throughout North America; eight graduates have already published scientific articles in peer-reviewed journals and/or presented their scientific data at national and international meetings, and 26 have been retained by Seattle BioMed researchers as compensated technicians and interns. Providing precollege students with structured access to practicing scientists and authentic research environments within the context of advancing global health has been a robust means of both building a future
Hart, Tae L; Blacker, Susan; Panjwani, Aliza; Torbit, Lindsey; Evans, Michael
To create informational tools for breast cancer patients with low levels of health literacy. Tools were developed through a three-stage process. (1) Focus groups were conducted with breast cancer survivors and interviews were held with health educators to determine content, source of information, format and medium of the tools. (2) Based on this feedback, a suite of tools was developed. (3) Focus groups were reconvened and health educators re-interviewed to obtain feedback and determine satisfaction. We developed a suite of five informational tools using low health literacy principles, which focused on learning about breast cancer resources and learning about the members of one's healthcare team, understanding the "journey" or trajectory of care beginning at diagnosis, hearing from other breast cancer patients about their own journey, and becoming informed about what to expect pre-and post-surgery for breast cancer. The final products were rated highly by breast cancer survivors. The developed materials, designed for patients who read below an 8th grade level, reflect the informational needs reported by breast cancer patients. Healthcare providers must consider utilizing design principles and theories of adult learning appropriate for those with low health literacy. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Blum, Nicole; Bourn, Douglas
The discourses around globalisation and internationalisation within higher education to date have tended to focus on institutional change. While recognising the importance of these debates, this paper suggests that issues around curriculum change and teaching and learning through global professions such as health and engineering have so far been…
Hefferon, Kathleen L
Agricultural biotechnology offers a robust series of tools by which to address global concerns such as food security, crop protection, and fuel/energy requirements. A number of advances made recently in plant molecular biology also have resulted in applications which largely focus on improving global human health. This review describes some of the recent innovations in plant biotechnology that have come to the forefront over the past year. Included are novel techniques by which plants can be improved as platforms for biopharmaceutical protein production, a growing field also referred to as 'molecular pharming'. The metabolic engineering of plants to produce compounds which have additional nutritional benefits is also outlined. The review concludes with a discussion of the future impact that these innovations may have both on global health and on the development of our future intellectual property landscape.
Abu-Saad Huijer, Huda; Abboud, Sarah
High incidence rates of breast cancer (BC) emphasize the need to address health-related quality of life (QoL) in this population. The aim of this study was to evaluate the QoL, symptom prevalence and management, functional ability, and quality of care in Lebanese women with BC at a tertiary health care facility. Cross-sectional descriptive survey targeting Lebanese adults with cancer and using a combination of four instruments: European Organization for Research and treatment of Cancer-Quality of Life Questionnaire, Memorial Symptom Assessment Scale; Barthel Index; Needs at End of life Screening Tool, and a demographic/clinical characteristics section. 89 breast cancer patients participated in the study; data was collected from 2009 to 2010. Descriptive analysis in addition to independent sample t-test, ANOVA, and Pearson r correlation were used for data analysis. The most prevalent symptoms were feeling nervous, feeling sad, lack of energy, and pain; symptom management was inadequate; high scores were reported on functional ability, medical care, spirituality, and relationships. Younger, single, and better educated participants who were diagnosed for less than 30 months, had no metastasis, and paid less than $450 dollars per month on medical expenses showed better global health status/QoL. Payments per month for medical expenses, presence of metastasis, time since diagnosis, and type of treatment received were significantly associated with QoL, the different functioning dimensions, and symptoms. Strategies addressing symptom management in particular psychological symptoms need to be developed and implemented in addition to a holistic multidisciplinary palliative care approach. Copyright © 2011 Elsevier Ltd. All rights reserved.
Anderson, Emily E.; Hoskins, Kent
Research suggests that individual breast cancer risk assessment may improve adherence to recommended screening and prevention guidelines, thereby decreasing morbidity and mortality. Further research on the use of risk assessment models in underserved minority populations is critical to informing national public health efforts to eliminate breast cancer disparities. However, implementing individual breast cancer risk assessment in underserved patient populations raises particular ethical issues that require further examination. After reviewing these issues, we will discuss how empirical bioethics research can be integrated with health disparities research to inform the translation of research findings. Our in-progress National Cancer Institute (NCI) funded study, How Do Underserved Minority Women Think About Breast Cancer?, conducted in the context of a larger study on individual breast cancer risk assessment, is presented as a model. PMID:23124498
Bruselius-Jensen, Maria; Renwick, Kerry; Aagaard-Hansen, Jens
, understanding and agency towards global inequality in health. Methods: MEL facilitates cultural meetings, primarily Skype-based, between students from Kenya and Denmark, with the aim to promote reflections on differences and similarities in the everyday living conditions across cultures and nations...
Balmer, Dorene F; Marton, Stephanie; Gillespie, Susan L; Schutze, Gordon E; Gill, Anne
Although nonphysician reentry transitions have been characterized in literature, little is known about the reentry physicians in general, or residents in particular. We conducted a qualitative study to explore pediatric residents' reentry, using reverse culture shock as a conceptual framework. Eighteen pediatric residents who completed global health experiences in Africa (9 categorical residents with 1-month elective, 9 global child health residents with 12-month training) participated in interviews that included a card-sort to solicit emotional responses consistent with the conceptual framework. Data in the form of interview transcripts were coded and analyzed according to principles of grounded theory. All pediatric residents, despite variable time abroad, reported a range of emotional responses on reentry to residency. Global child health residents felt disconnection and frustration more intensely than categorical residents, whereas categorical residents felt invigoration more intensely than global child health residents. Although residents met with program leadership after their return, no resident described these meetings as a formal debriefing, and few described a deliberate strategy for processing emotions on reentry. Consistent with reverse culture shock, pediatric residents felt a range of emotions as they move toward a steady state of acculturating back into their residency program. Residency programs might consider creating safety nets to help cultivate support for residents when they reenter training. Copyright © 2015 by the American Academy of Pediatrics.
This paper examines the extent that scholars are analysing gender and reproductive health issues in a global era. The examination is necessitated by existing data which indicate that African researchers are investigating these phenomena as static and monolithic. Their approach fails to view the concepts as embedded in ...
This thesis presents a sequence of papers to illustrate selected aspects of the neglect of global oral health, highlights new approaches to describing the extent and impact of dental caries, explains the difficulties related to quality assurance of fluoride toothpastes; and, finally, describes a
Hardon, A.; Dilger, H.
In this introduction to the special issue, we follow the journey of global AIDS medicines into diverse health facilities in East Africa, which for decades have been subjected to neoliberal reform processes and increasing fragmentation. The introduction explores the multifaceted and multidirectional
A new set of 11 global health studies calls attention to the burden of tobacco-related inequalities in low- and middle-income countries and finds that socioeconomic inequalities are associated with increased tobacco use, second-hand smoke exposure and tob
Dell, Evelyn M; Varpio, Lara; Petrosoniak, Andrew; Gajaria, Amy; McMcarthy, Anne E
To explore and characterize the ethical and safety challenges of global health experiences as they affect medical students in order to better prepare trainees to face them. Semi-structured interviews were conducted with 23 Canadian medical trainees who had participated in global health experiences during medical school. Convenience and snowball sampling were utilized. Using Moustakas's transcendental phenomenological approach, participant descriptions of ethical dilemmas and patient/trainee safety problems were analyzed. This generated an aggregate that illustrates the essential meanings of global health experience ethical and safety issues faced. We interviewed 23 participants who had completed 38 electives (71%, n=27, during pre-clinical years) spending a mean 6.9 weeks abroad, and having visited 23 countries. Sixty percent (n=23) had pre-departure training while 36% (n=14) had post-experience debriefing. Three macro-level themes were identified: resource disparities and provision of care; navigating clinical ethical dilemmas; and threats to trainee safety. Medical schools have a responsibility to ensure ethical and safe global health experiences. However, our findings suggest that medical students are often poorly prepared for the ethical and safety dilemmas they encounter during these electives. Medical students require intensive pre-departure training that will prepare them emotionally to deal with these dilemmas. Such training should include discussions of how to comply with clinical limitations.
Zika virus infection has emerged as the world’s newest health threat, linked to microcephaly in infants and Guillain–Barré syndrome in adults. We address the rapid global spread of this disease, and the prospects for successful prevention and treatment.
Till, Brian M; Peters, Alexander W; Afshar, Salim; Meara, John G
Blockchain technology and cryptocurrencies could remake global health financing and usher in an era global health equity and universal health coverage. We outline and provide examples for at least four important ways in which this potential disruption of traditional global health funding mechanisms could occur: universal access to financing through direct transactions without third parties; novel new multilateral financing mechanisms; increased security and reduced fraud and corruption; and the opportunity for open markets for healthcare data that drive discovery and innovation. We see these issues as a paramount to the delivery of healthcare worldwide and relevant for payers and providers of healthcare at state, national and global levels; for government and non-governmental organisations; and for global aid organisations, including the WHO, International Monetary Fund and World Bank Group. PMID:29177101
Till, Brian M; Peters, Alexander W; Afshar, Salim; Meara, John
Blockchain technology and cryptocurrencies could remake global health financing and usher in an era global health equity and universal health coverage. We outline and provide examples for at least four important ways in which this potential disruption of traditional global health funding mechanisms could occur: universal access to financing through direct transactions without third parties; novel new multilateral financing mechanisms; increased security and reduced fraud and corruption; and the opportunity for open markets for healthcare data that drive discovery and innovation. We see these issues as a paramount to the delivery of healthcare worldwide and relevant for payers and providers of healthcare at state, national and global levels; for government and non-governmental organisations; and for global aid organisations, including the WHO, International Monetary Fund and World Bank Group.
Kjoller, Kim; Friis, Soren; Lipworth, Loren; McLaughlin, Joseph K.; Olsen, Jorgen H.
Background: To assess whether maternal cosmetic breast implants are associated with adverse health outcomes among offspring, the authors examined published findings of epidemiologic studies that addressed this hypothesis. Methods: Four epidemiologic studies, ail from Scandinavia, were identified.
Chattu, Vijay Kumar
Global health diplomacy (GHD) is relatively a very new field that has yet to be clearly defined and developed though there are various definitions given by different experts from foreign policy, global health, diplomacy, international relations, governance, and law. With the intensification of globalization and increasing gaps between countries, new and reemerging health threats such as HIV/AIDS, tuberculosis, influenza, severe acute respiratory syndrome, Ebola, and Zika and a gradual rethinking on security concepts framed a new political context. The health problems addressed diplomatically have also become diverse ranging from neglected tropical diseases, infectious diseases, sale of unsafe, counterfeit drugs to brain drain crisis. We see that global health has become more diverse as the actors widened and also the interests appealing not only to the traditional humanitarian ideals associated with health but also to the principles grounded in national and global security. Recently, we are witnessing the increased priority given to the GHD because the issue of health is discussed by various actors outside the WHO to shape the global policy for health determinants. In fact, the area of health has become the part of UN Summit Diplomacy involving the G8, G20, BRICS, and the EU. The recent WHO Pandemic Influenza Framework, UN High Level Framework on Prevention and Control of Noncommunicable Diseases, and the WHO Framework Convention on Tobacco Control are some of the examples of long-term negotiation processes for agreements that took place.
McCall, Daniel; Iltis, Ana S
The popularity and availability of global health experiences has increased, with organizations helping groups plan service trips and companies specializing in "voluntourism," health care professionals volunteering their services through different organizations, and medical students participating in global health electives. Much has been written about global health experiences in resource poor settings, but the literature focuses primarily on the work of health care professionals and medical students. This paper focuses on undergraduate student involvement in short term medical volunteer work in resource poor countries, a practice that has become popular among pre-health professions students. We argue that the participation of undergraduate students in global health experiences raises many of the ethical concerns associated with voluntourism and global health experiences for medical students. Some of these may be exacerbated by or emerge in unique ways when undergraduates volunteer. Guidelines and curricula for medical student engagement in global health experiences have been developed. Guidelines specific to undergraduate involvement in such trips and pre-departure curricula to prepare students should be developed and such training should be required of volunteers. We propose a framework for such guidelines and curricula, argue that universities should be the primary point of delivery even when universities are not organizing the trips, and recommend that curricula should be developed in light of additional data.
Andrew J Pellatt
Full Text Available Selenoproteins are a class of proteins containing a selenocysteine residue, many of which have been shown to have redox functions, acting as antioxidants to decrease oxidative stress. Selenoproteins have previously been associated with risk of various cancers and redox-related diseases. In this study we evaluated possible associations between breast cancer risk and survival and single nucleotide polymorphisms (SNPs in the selenoprotein genes GPX1, GPX2, GPX3, GPX4, SELS, SEP15, SEPN1, SEPP1, SEPW1, TXNRD1, and TXNRD2 among Hispanic/Native American (2111 cases, 2597 controls and non-Hispanic white (NHW (1481 cases, 1586 controls women in the Breast Cancer Health Disparities Study. Adaptive Rank Truncated Product (ARTP analysis was used to determine both gene and pathway significance with these genes. The overall selenoprotein pathway PARTP was not significantly associated with breast cancer risk (PARTP = 0.69, and only one gene, GPX3, was of borderline significance for the overall population (PARTP =0.09 and marginally significant among women with 0-28% Native American (NA ancestry (PARTP=0.06. The SEPP1 gene was statistically significantly associated with breast cancer risk among women with higher NA ancestry (PARTP=0.002 and contributed to a significant pathway among those women (PARTP=0.04. GPX1, GPX3, and SELS were associated with Estrogen Receptor-/Progesterone Receptor+ status (PARTP = 0.002, 0.05, and 0.01, respectively. Four SNPs (GPX3 rs2070593, rsGPX4 rs2074451, SELS rs9874, and TXNRD1 rs17202060 significantly interacted with dietary oxidative balance score after adjustment for multiple comparisons to alter breast cancer risk. GPX4 was significantly associated with breast cancer survival among those with the highest NA ancestry (PARTP = 0.05 only. Our data suggest that SEPP1 alters breast cancer risk among women with higher levels of NA ancestry.
Pellatt, Andrew J; Wolff, Roger K; John, Esther M; Torres-Mejia, Gabriela; Hines, Lisa M; Baumgartner, Kathy B; Giuliano, Anna R; Lundgreen, Abbie; Slattery, Martha L
Selenoproteins are a class of proteins containing a selenocysteine residue, many of which have been shown to have redox functions, acting as antioxidants to decrease oxidative stress. Selenoproteins have previously been associated with risk of various cancers and redox-related diseases. In this study we evaluated possible associations between breast cancer risk and survival and single nucleotide polymorphisms (SNPs) in the selenoprotein genes GPX1, GPX2, GPX3, GPX4, SELS, SEP15, SEPN1, SEPP1, SEPW1, TXNRD1, and TXNRD2 among Hispanic/Native American (2111 cases, 2597 controls) and non-Hispanic white (NHW) (1481 cases, 1586 controls) women in the Breast Cancer Health Disparities Study. Adaptive Rank Truncated Product (ARTP) analysis was used to determine both gene and pathway significance with these genes. The overall selenoprotein pathway PARTP was not significantly associated with breast cancer risk (PARTP = 0.69), and only one gene, GPX3, was of borderline significance for the overall population (PARTP =0.09) and marginally significant among women with 0-28% Native American (NA) ancestry (PARTP=0.06). The SEPP1 gene was statistically significantly associated with breast cancer risk among women with higher NA ancestry (PARTP=0.002) and contributed to a significant pathway among those women (PARTP=0.04). GPX1, GPX3, and SELS were associated with Estrogen Receptor-/Progesterone Receptor+ status (PARTP = 0.002, 0.05, and 0.01, respectively). Four SNPs (GPX3 rs2070593, rsGPX4 rs2074451, SELS rs9874, and TXNRD1 rs17202060) significantly interacted with dietary oxidative balance score after adjustment for multiple comparisons to alter breast cancer risk. GPX4 was significantly associated with breast cancer survival among those with the highest NA ancestry (PARTP = 0.05) only. Our data suggest that SEPP1 alters breast cancer risk among women with higher levels of NA ancestry.
Cesario, Sandra K
Women and children compose the largest segment of the more than 1 billion people worldwide who are unable to access needed health care services. To address this and other global health issues, the United Nations brought together world leaders to address growing health inequities, first by establishing the Millennium Development Goals in 2000 and more recently establishing Sustainable Development Goals, which are an intergovernmental set of 17 goals consisting of 169 targets with 304 indicators to measure compliance; they were designed to be applicable to all countries. Goal number 3, "Good Health and Well-Being: Ensure Heathy Lives and Promote Well-Being for All at All Ages," includes targets to improve the health of women and newborns. © 2016 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses.
Chambers, Kyle J; Creighton, Francis; Abdul-Aziz, Dunia; Cheney, Mack; Randolph, Gregory W
Determine trends in global health-related publication in otolaryngology. A review of research databases. A search of publications available on PubMed and nine additional databases was undertaken reviewing two time periods 10 years apart for the timeframes 1998 to 2002 (early time period) and 2008 to 2012 (recent time period) using specific search terms to identify global health-related publications in otolaryngology. Publications were examined for region of origin, subspecialty, type of publication, and evidence of international collaboration. χ and t test analyses were used to identify trends. In the 1998 to 2002 time period, a total of 26 publications met inclusion criteria for the study, with a mean of 5.2 ± 2.8 publications per year. In the 2008 to 2012 time period, a total of 61 publications met inclusion criteria, with a mean of 12.3 ± 5.6 publications per year. The 235% increase in global health-related publications identified between the two study periods was statistically significant (P = .02). The absolute number of publications in which collaboration occurred between countries increased from three in the early time period to nine the recent time period. There has been a significant increase in the volume of global health-related publications in English language otolaryngology journals over the past decade, providing strong evidence of the increasing trend of global health as an academic pursuit within the field of otolaryngology. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.
Levine, Adam C; Barry, Meagan A; Agrawal, Pooja; Duber, Herbert C; Chang, Mary P; Mackey, Joy M; Hansoti, Bhakti
There are many barriers impeding the conduct of high-quality emergency care research, particularly in low- and middle-income countries. Several of these barriers were originally outlined in 2013 as part of the Academic Emergency Medicine Global Health and Emergency Care Consensus Conference. This paper seeks to establish a broader consensus on the barriers to emergency care research globally and proposes a comprehensive array of new recommendations to overcome these barriers. An electronic survey was conducted of a purposive sample of global emergency medicine research experts from around the world to describe the major challenges and solutions to conducting emergency care research in low-resource settings and rank them by importance. The Global Emergency Medicine Think Tank Clinical Research Working Group at the Society for Academic Emergency Medicine 2016 Annual Meeting utilized a modified Delphi technique for consensus-based decision making to categorize and expand upon these barriers and develop a comprehensive array of proposed solutions. The working group identified four broad categories of barriers to conducting emergency care research globally, including 1) the limited availability of research personnel, particularly those with prior research training; 2) logistic barriers and lack of standardization of data collection; 3) ethical barriers to conducting research in resource-limited settings, particularly when no local institutional review board is available; and 4) the relative dearth of funding for global emergency care research. Proposed solutions included building a diverse and interdisciplinary research team structured to promote mentorship of junior researchers, utilizing local research assistants or technologic tools such as telemedicine for language translation, making use of new tools such as mobile health (mHealth) to standardize and streamline data collection, identifying alternatives to local institutional review board approval and the use of
Blum, J D
Significant efforts have been directed toward addressing the financial needs of the developing world for assistance with public health and related development problems. Both public and private organizations have made considerable economic contributions to assist with immediate and long term health challenges, and there is growing international support for programs of national debit relief. Still, there is a need for additional resources to combat international health problems, which go beyond largesse. This paper calls for the creation of a legally rooted, global tax as a mechanism for consistent long term funding. Specifically, the paper proposes engagement of the World Trade Organization as a vehicle to sponsor a global tax on multinational corporations who have benefited most from the international trading scheme.
Eradication of both polio and measles incorporate as a fundamental strategy high routine coverage, surveillance and special national immunisation days (NIDs), which are supplementary to routine vaccination services. There has been a lively debate on whether poor countries, with many health problems that could be ...
Full Text Available Grace X Ma,1 Wanzhen Gao,1 Sunmin Lee,2 MinQi Wang,3 Yin Tan,1 Steven E Shive,1,41Department of Public Health, Center for Asian Health, College of Health Professions, Temple University, Philadelphia, PA, USA; 2Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA; 3Department of Public and Community Health, University of Maryland, College Park, Maryland, MD, USA; 4East Stroudsburg University, East Stroudsburg, PA, USAObjective: The purpose of this community-based study was to apply a Sociocultural Health Behavior Model to determine the association of factors proposed in the model with breast cancer screening behaviors among Asian American women.Methods: A cross-sectional design included a sample of 682 Chinese, Korean, and Vietnamese women aged 40 years and older. The frequency distribution analysis and Chi-square analysis were used for the initial screening of the following variables: sociodemographic, cultural, enabling, environmental, and social support. Univariate and multivariate analyses were conducted on factors for breast cancer screening using multinomial logistic regression analysis.Results: Correlates to positive breast cancer screening included demographics (ethnicity, cultural factors (living in the United States for 15 years or more, speaking English well, enabling factors (having a regular physician to visit, health insurance covering the screening, and family/social support factors (those who had a family/friend receiving a mammogram.Conclusions: The results of this study suggest that breast cancer screening programs will be more effective if they include the cultural and health beliefs, enabling, and social support factors associated with breast cancer screening. The use of community organizations may play a role in helping to increase breast cancer screening rates among Asian American women.Keywords: breast cancer screening, Vietnamese, Korean, Chinese, breast
Raeburn, John; Akerman, Marco; Chuengsatiansup, Komatra; Mejia, Fanny; Oladepo, Oladimeji
In this paper, community capacity building (CCB) is seen as part of a long-standing health promotion tradition involving community action in health promotion. The conceptual context of the term CCB is presented, and compared with other community approaches. The usage of the term is variable. It is submitted that its common features are (i) the concepts of capacity and empowerment (versus disease and deficiency), (ii) bottom-up, community-determined agendas and actions and (iii) processes for developing competence. A brief literature review looks at some of the main contributions from the 1990 s on, which reveal an emphasis on building competencies, the measurement of community capacity and the attempt to break CCB down into operational components. Academic research on the impact of CCB on health is lacking, but multiple case studies documented in the 'grey literature' suggest CCB is highly effective, as does research in related areas, such as community empowerment. Five contemporary case studies submitted by the contributing authors show both the range and efficacy of CCB applications. The concluding synthesis and recommendations say that what is needed for health promotion in a globalized world is a balance between global macro (policy, regulatory, etc.) actions and those of the human and local scale represented by CCB. It is concluded that action centred on empowered and capable communities, in synergistic collaboration with other key players, may be the most powerful instrument available for the future of health promotion in a globalized world.
Full Text Available We have two goals in this paper: first, to provide a diagnosis of global health and underline some of its blockages; second, to offer an alternative interpretation of what the demands for those in global health may be. The assumption that health is a "good" that requires no further explanation, and that per se it can serve as an actual modus operandi, lays the foundations of the problem. Related blockages ensue and are described using HIV prevention with a focus on vaginal microbicides as a case study. Taking health as a self-evident, and self-explanatory "good" limits other possible goods; and prevents further inquiry into the actual practices of creating good practices and good measures. We propose that to create conditions under which global health could be reconstructed, "problematization" be taken up as a practice, around a series of questions asked in conjunction with those ever-urgent ones of how to ameliorate the condition of living beings.
Rebello, Tahilia J; Marques, Andrea; Gureje, Oye; Pike, Kathleen M
In the field of global mental health, an enormous gap between what we know and what we do exists in the delivery of clinical care. Creative and effective strategies that surmount the barriers to provision of mental healthcare are essential to improve the lives of millions affected by mental illness. This article provides a review of three classes of innovative strategies currently being developed and implemented to diminish the mental health treatment gap globally. This review provides recent evidence related to the feasibility of implementation and efficacy for the following three classes of innovation that show promise for building clinical capacity and expanding mental health coverage: integration of mental health services into primary care; expansion of human capacity through task sharing and training of nonspecialists; and innovative use of technological platforms to enhance access, cut costs, and reduce stigma. The strategies outlined in this review hold great potential for enhancing mental health treatment services, and address some of the major barriers globally to accessing mental healthcare, such as scarcity of resources (infrastructure, capacity, and funding) and stigma. Despite much evidence supporting the efficacy of these models, thorough studies that test their feasibility, acceptability, utility, and effectiveness in various contexts, including low-income and middle-income countries, are required. Moreover, these innovations require social support and political will in order to be successfully implemented and scaled-up such that they have a meaningful impact on the burden of disease associated with mental illness worldwide.
Schrecker, Ted; Labonté, Ronald; De Vogli, Roberto
The reduction of health inequities is an ethical imperative, according to the WHO Commission on Social Determinants of Health (CSDH). Drawing on detailed multidisciplinary evidence assembled by the Globalization Knowledge Network that supported the CSDH, we define globalisation in mainly economic terms. We consider and reject the presumption that globalisation will yield health benefits as a result of its contribution to rapid economic growth and associated reductions in poverty. Expanding on this point, we describe four disequalising dynamics by which contemporary globalisation causes divergence: the global reorganisation of production and emergence of a global labour-market; the increasing importance of binding trade agreements and processes to resolve disputes; the rapidly increasing mobility of financial capital; and the persistence of debt crises in developing countries. Generic policies designed to reduce health inequities are described with reference to the three Rs of redistribution, regulation, and rights. We conclude with an examination of the interconnected intellectual and institutional challenges to reduction of health inequities that are created by contemporary globalisation.
Ertem, Gül; Dönmez, Yelda Candan; Dolgun, Eda
This study has been carried out with the purpose of determining the belief and attitude of women regarding breast cancer and breast self-exam and the factors which affect the performance frequency of breast self-exam and it is a descriptive kind of study. Data has been collected through questionnaire forms created by the researchers based on literature information and Champion Health Belief Model Scale. Data collection was collected via face-to-face interviews with the patients. Questionnaire forms were applied to 350 women who accepted to participate in the study. Data was analyzed frequency, percentage, t-test and x2 test with SPSS for Windows 12.0. Average age of women who were included in the study was found to be 33.25±10.27. Average point for the sensitivity sub-dimension of the women within the scope of study was 7.79±2.38, average score for the seriousness sub-dimension 23.30±5.82, average score for the benefit sub-dimension 15.48±4.03, average score for the obstacle sub-dimension was 26.34±7.64, average score of health motivation sub-dimension was 32.77±9.11 and average score for the self-confidence sub-dimension was 25.20±5.02. The beliefs of women regarding the subject should be developed by providing in-service training regarding breast cancer and breast self-exam. It can be suggested that studies be carried out analyzing the effect of the attempts for increasing the performance frequency of breast self-exam of women on the beliefs and attitudes.
Hahn, Erin E; Ganz, Patricia A; Melisko, Michelle E; Pierce, John P; von Friederichs-Fitzwater, Marlene; Lane, Karen T; Hiatt, Robert A
The Athena Breast Health Network collaboration is a University of California system-wide project initiated with the intent to drive innovation in breast cancer prevention, screening, and treatment. This qualitative research examines provider perceptions and expectations of posttreatment breast cancer care across five network sites with the goal of better understanding provider behavior during the posttreatment phase of the cancer care trajectory. Investigators at each site conducted semi-structured interviews with oncology specialists and primary care providers (PCPs). Interviews used case study examples and open- and closed-ended questions on the delivery of posttreatment breast cancer care. Informant responses were manually recorded by the interviewer, compiled in a database, then coded and analyzed using NVivo 9 software. There were 39 key informants across the sites: 14 medical oncologists, 7 radiation oncologists, 11 surgeons, 3 oncology nurses, and 4 PCPs. Care coordination was a major unprompted theme identified in the interviews. There was a perceived need for greater care coordination across institutions in order to improve delivery of posttreatment health care services and a need for greater care coordination within oncology, particularly to help avoid duplication of follow-up care and services. Participants expect frequent follow-up visits and to use biomarker tests and advanced imaging services as part of routine surveillance care. Implementing survivorship care programs was perceived as a way to improve care delivery. These results identify a need for increased focus on care coordination during the posttreatment phase of breast cancer care within the University of California system and the potential for system and provider-level interventions that could help increase coordination of posttreatment care. Breast cancer survivors do not always receive evidence-based care. This research helps to better understand what motivates provider behavior during the
Hahn, Erin E.; Ganz, Patricia A.; Melisko, Michelle; Pierce, John; von Friederichs-Fitzwater, Marlene; Lane, Karen; Hiatt, Robert
Purpose The Athena Breast Health Network collaboration is a University of California system-wide project initiated with the intent to drive innovation in breast cancer prevention, screening and treatment. This qualitative research examines provider perceptions and expectations of post-treatment breast cancer care across five Network sites with the goal of better understanding provider behavior during the post-treatment phase of the cancer care trajectory. Methods Investigators at each site conducted semi-structured interviews with oncology specialists and primary care providers (PCPs). Interviews used case study examples and open- and closed-ended questions on the delivery of post-treatment breast cancer care. Informant responses were manually recorded by the interviewer, compiled in a database, then coded and analyzed using NVivo 9 software. Results There were 39 key informants across the sites: 14 medical oncologists, 7 radiation oncologists, 11 surgeons, 3 oncology nurses, and 4 PCPs. Care coordination was a major unprompted theme identified in the interviews. There was a perceived need for greater care coordination across institutions in order to improve delivery of post-treatment health care services and a need for greater care coordination within oncology, particularly to help avoid duplication of follow-up care and services. Participants expect frequent follow-up visits and to use biomarker tests and advanced imaging services as part of routine surveillance care. Implementing survivorship care programs was perceived as a way to improve care delivery. Conclusions These results identify a need for increased focus on care coordination during the post-treatment phase of breast cancer care within the UC system, and the potential for system and provider level interventions that could help increase coordination of post-treatment care. Implications for Cancer Survivors Breast cancer survivors do not always receive evidence-based care. This research helps to better
Litzelman, Debra K; Gardner, Adrian; Einterz, Robert M; Owiti, Philip; Wambui, Charity; Huskins, Jordan C; Schmitt-Wendholt, Kathleen M; Stone, Geren S; Ayuo, Paul O; Inui, Thomas S; Umoren, Rachel A
Globalization has increased the demand for international experiences in medical education. International experiences improve medical knowledge, clinical skills, and self-development; influence career objectives; and provide insights on ethical and societal issues. However, global health rotations can end up being no more than tourism if not structured to foster personal transformation and global citizenship. We conducted a qualitative assessment of trainee-reported critical incidents to more deeply understand the impact of our global health experience on trainees. A cross-sectional survey was administered to trainees who had participated in a 2-month elective in Kenya from January 1989 to May 2013. We report the results of a qualitative assessment of the critical incident reflections participants (n = 137) entered in response to the prompt, "Write about one of your most memorable experiences and explain why you chose to describe this particular one." Qualitative analyses were conducted using thematic analysis and crystallization immersion analytic methods based on the principles of grounded theory, employing a constructivists' research paradigm. Four major themes emerged. These themes were Opening Oneself to a Broader World View; Impact of Suffering and Death; Life-Changing Experiences; and Commitment to Care for the Medically Underserved. Circumstances that learners encounter in the resource-scarce environment in Kenya are eye-opening and life-changing. When exposed to these frame-shifting circumstances, students elaborate on or transform existing points of view. These emotionally disruptive experiences in an international health setting allowed students to enter a transformational learning process with a global mind. Students can see the world as an interdependent society and develop the capacity to advance both their enlightened self-interest and the interest of people elsewhere in the world as they mature as global citizens. Medical schools are encouraged to
Fried, Linda P; Piot, Peter; Frenk, Julio J; Flahault, Antoine; Parker, Richard
We are at an unprecedented moment in history in terms of the health of populations around the world. New and old problems all require both short- and long-term solutions, at the individual, community, national and global levels. Unique solutions for each challenge may not be feasible or adequately effective or cost-effective. We are confronted by health systems that are not well matched to current and future needs, both for sustained prevention and chronic care. Moving forward effectively as a field will benefit from a focus on the changing needs of global health, and on how changing conditions, globally, should define the next generation of public health leadership so as to best accomplish global health goals.
Helen H Cui
Full Text Available Genome science and technologies are transforming life sciences globally in many ways, and becoming a highly desirable area for international collaboration to strengthen global health. The Genome Science Program at the Los Alamos National Laboratory is leveraging a long history of expertise in genomics research to assist multiple partner nations in advancing their genomics and bioinformatics capabilities. The capability development objectives focus on providing a molecular genomics-based scientific approach for pathogen detection, characterization, and biosurveillance applications. The general approaches include introduction of basic principles in genomics technologies, training on laboratory methodologies and bioinformatic analysis of resulting data, procurement and installation of next generation sequencing instruments, establishing bioinformatics software capabilities, and exploring collaborative applications of the genomics capabilities in public health. Genome centers have been established with public health and research institutions in the Republic of Georgia, Kingdom of Jordan, Uganda, and Gabon; broader collaborations in genomics applications have also been developed with research institutions in many other countries.
Regens, J.L.; Hodges, D.G. [Tulane Univ. Medical Center, New Orleans, LA (United States)
Modeling projections of future climatic conditions suggest changes in temperature and precipitation patterns that might induce direct adverse effects on human health by altering the extent and severity of infectious and vector-borne diseases. The incidence of mosquito-borne diseases, for example, could increase substantially in areas where temperature and relative humidity rise. The application of Geographic Information Systems (GIS) offers new methodologies to evaluate the impact of global warming on changes in the incidence of infectious and vector-borne diseases. This research illustrates the potential analytical and communication uses of GIS for monitoring historical patterns of climate and human health variables and for projecting changes in these health variables with global warming.
The treatment of primary breast cancer usually consists of surgery often followed by adjuvant therapy (radiotherapy, chemotherapy, hormonal treatment, etc.) to reduce the risk of recurrence. The cancer diagnosis and the treatments may have significant impact on the patients' quality of life. This thesis deals with scientific aspects and clinical results of a study aimed at assessing the impact of breast cancer (and its treatment) on the patients' quality of life. Studies such as this assessing the problems and symptoms experienced by the patients are often referred to as health-related quality of life (HRQL) research. HRQL research deals with subjective experiences and raises challenging, scientific questions. Therefore, much attention was directed towards methodological issues in this clinically motivated project. The study was a prospective, longitudinal, questionnaire-based investigation of women with newly diagnosed breast cancer registered in the Danish Breast Cancer Co-operative Group's DBCG 89 Program. The patients were sub-divided into low-risk and high-risk patients. High-risk patients were offered randomisation in one of three randomised adjuvant therapy trials involving chemotherapy, ovarian ablation, and endocrine therapy. After a literature study and interviews with breast cancer patients, a questionnaire was composed that included two widely used standard questionnaires (EORTC QLQ-C30 and Hospital Anxiety and Depression (HAD) Scale) and a DBCG 89 Questionnaire developed for this study. A total of 1,898 eligible patients were invited by post to participate in the study involving six assessments over a 2-year period, and 1,713 patients (90%) completed the first questionnaire. Furthermore, a questionnaire was sent to 872 women selected at random from the general population; 608 (70%) responded. The multi-item scales of the two standard questionnaires were analysed for so-called differential item functioning (DIF) in order to investigate whether the
O'Donnell, K; O'Donnell, M Lewis
Global mental health (GMH) is a growing domain with an increasing capacity to positively impact the world community's efforts for sustainable development and wellbeing. Sharing and synthesizing GMH and multi-sectoral knowledge, the focus of this paper, is an important way to support these global efforts. This paper consolidates some of the most recent and relevant 'context resources' [global multi-sector (GMS) materials, emphasizing world reports on major issues] and 'core resources' (GMH materials, including newsletters, texts, conferences, training, etc.). In addition to offering a guided index of materials, it presents an orientation framework (global integration) to help make important information as accessible and useful as possible. Mental health colleagues are encouraged to stay current in GMH and global issues, to engage in the emerging agendas for sustainable development and wellbeing, and to intentionally connect and contribute across sectors. Colleagues in all sectors are encouraged to do likewise, and to take advantage of the wealth of shared and synthesized knowledge in the GMH domain, such as the materials featured in this paper.
Full Text Available This paper developed an effective model for improving global health nursing competence among undergraduate students. A descriptive case study was conducted by implementing four programs. All programs were conducted with students majoring nursing and healthcare, where the researcher was a program director, professor, or facilitator. These programs were analyzed in terms of students’ needs assessment, program design, and implementation and evaluation factors. The concept and composition of global nursing competence, identified within previous studies, were deemed appropriate in all of our programs. Program composition varied from curricular to extracurricular domains. During the implementation phase, most of the programs included non-Korean students to improve cultural diversity and overcome language barriers. Qualitative and quantitative surveys were conducted to assess program efficacy. Data triangulation from students’ reflective journals was examined. Additionally, students’ awareness regarding changes within global health nursing, improved critical thinking, cultural understanding, and global leadership skills were investigated pre and post-program implementation. We discuss how identifying students’ needs regarding global nursing competence when developing appropriate curricula.
Full Text Available The Global Health 2035 report notes that the "grand convergence"--closure of the infectious, maternal, and child mortality gap between rich and poor countries--is dependent on research and development (R&D of new drugs, vaccines, diagnostics, and other health tools. However, this convergence (and the R&D underpinning it will first require an even more fundamental convergence of the different worlds of public health and innovation, where a largely historical gap between global health experts and innovation experts is hindering achievement of the grand convergence in health.
Schmidt, Anna; Ernstmann, Nicole; Wesselmann, Simone; Pfaff, Holger; Wirtz, Markus; Kowalski, Christoph
After a short hospital stay of just some days follows long-term outpatient care for breast cancer patients. The aim of the study is to describe the information needs of breast cancer outpatients and to get in touch with aspects of health literacy, as well as contact various health care workers. In a multicenter study, patients were asked about their information needs 10 weeks after surgery. The analysis on hand includes data about 1248 female patients. In addition to descriptive analyses identifying the most prevalent information needs, logistic regression analyses were calculated to identify factors associated with these. The results show that information needs of breast cancer outpatients are mainly in "follow-up after acute treatment", "coping with long-term side effects", and "heredity of breast cancer". In addition to sociodemographic patient characteristics, perceived helpful contacts with various health care workers as well as a satisfactory patient's level of health literacy reduced the probability of unmet information needs. Breast cancer outpatients have numerous information needs. In addition to provide information at the right time regarding a specific disease phase, it is important that health professionals' support affected breast cancer patients in coping with the new situation.
Krettek, Alexandra; Karlsson, Leena Eklund; Toan, Tran Khanh; Chuc, Nguyen Thi Kim
This article describes the legacy of the Nordic School of Public Health NHV (NHV) in global health. We delineate how this field developed at NHV and describe selected research and research training endeavours with examples from Vietnam and Nepal as well as long-term teaching collaborations such as BRIMHEALTH (Baltic RIM Partnership for Public HEALTH) in the Baltic countries and Arkhangelsk International School of Public Health in Russia. © 2015 the Nordic Societies of Public Health.
Avci, Ilknur Aydin; Kumcagiz, Hatice; Altinel, Busra; Caloglu, Ayse
This study aimed to analyse female academician health beliefs for breast cancer screening and levels of self-esteem. This cross-sectional study was conducted between October 2010 and March 2011, covering female academicians working in all faculties and vocational schools at Ondokuz Mayis University, except for the ones in the field of health (n=141). Data was collected using a questionnaire developed by researchers in the light of the related literature, the Champion's Health Belief Model Scale for Breast Cancer, and the Coopersmith Self-Esteem Inventory. Descriptive statistics, the t-test, Mann-Whitney U and correlation analysis were used to analyze the data with the SPSS 13.0 statistical package. 53.8% of the participants were single, 58.6% did not have children, 80.7% had regular menstrual cycles, 28.3% was taking birth control pills, 17.9% were undergoing hormone therapy, 11% suffered breast problems, 8.3% had relatives with breast cancer, 78,6% knew about breast self-examination (BSE), 68.3% was performing BSE, 16.2% were performing BSE monthly, 17.9% had had mammograms, and 30.3% had undergone breast examinations conductedby physicians. The women who had breast physical examinations done by physicians had higher susceptibility, self-efficacy and health motivation, and fewer barriers to mammography than those who did not have breast physical examinations. There was a relationship between the female academician self-esteem and their perceived seriousness of breast cancer, perceived barriers to BSE and health motivation. Our Turksih female academicians had medium levels of self-esteem.
Gantz, Nancy Rollins; Sherman, Rose; Jasper, Melanie; Choo, Chua Gek; Herrin-Griffith, Donna; Harris, Kathy
As part of the 2011 annual American Organization of Nurse Executives conference held in San Diego, California, a session was presented that focused on nursing workforce and health systems challenges from a global perspective. This article includes content addressed during the session representing nurse leader perspectives from the UK, Singapore and the USA. Recent events in global economic markets have highlighted the interdependence of countries. There is now a global focus on health-care costs and quality as government leaders struggle to reduce budgets and remain solvent. Finding solutions to these complex problems requires that nurse leaders adopt more of a world view and network with one another as they look for best practices and creative strategies. Nursing leadership challenges such as staffing, competency development, ageing populations, reduced health-care funding and maintaining quality are now common global problems. There is a need for innovation in nursing practice to accommodate the enormous challenges facing nursing's future. Opportunities on an international scale for nurse leaders to have dialogue and network, such as the conference presentation discussed in this article, will become increasingly more important to facilitate the development of innovative leadership strategies. © 2012 Blackwell Publishing Ltd.
Fernando Simón Soria
Full Text Available From the plague epidemics of the Middle Ages to the Ebola epidemic in Western Africa in 2014-15, health emergencies have played a significant role in the history of mankind. However, from the second half of the 20th century onwards, the frequency with which events and situations posing a risk for the health of the population at a global level seems to have increased. During that same period a global change has been taking place in different spheres, including climate, which given the speed with which it is occurring can put humanity’s ability to adapt to the test. In this paper we try to evaluate the links between said global change and the observed change in the pattern of alerts and emergencies of international interest and consider the potential impact of this change of pattern. Although this impact could be controllable in the short term, the complexities of the interrelationships among the different aspects of global change, their potential synergies, and their impact on human health make it difficult to make predictions in the medium and long terms.
Liaw, Siaw-Teng; Ashraf, Mahfuz; Ray, Pradeep
The UNSW WHO Collaborating Centre (WHOCC) in eHealth was established in 2013. Its designated activities are: mHealth and evidence-based evaluation, including use case analyses. The UNSW Yunus Social Business Health Hub (YSBHH), established in 2015 to build on the Yunus Centre/Grameen Bank eHealth initiatives, added social business and community participation dimensions to the UNSW global eHealth program. The Grameen Bank is a social business built around microcredit, which are small loans to poor people to enable them to "produce something, sell something, earn something to develop self-reliance and a life of dignity". The vision revolves around global partnerships for development, Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs). The scope includes mHealth implementation and evaluation in the context of the Internet of Things (IoT), with a growing focus on social business and citizen engagement approaches. This paper summarises a critical case study of the UNSW WHOCC (eHealth) designated activities in collaboration with Bangladesh institutions (International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDRB) and Yunus Centre). Issues and challenges are highlighted.
Full Text Available Regulatory science plays a vital role in protecting and promoting global public health by providing the scientific basis for ensuring that food and medical products are safe, properly labeled, and effective. Regulatory science research was first developed for the determination of product safety in the early part of the 20th Century, and continues to support innovation of the processes needed for regulatory policy decisions. Historically, public health laws and regulations were enacted following public health tragedies, and often the research tools and techniques required to execute these laws lagged behind the public health needs. Throughout history, similar public health problems relating to food and pharmaceutical products have occurred in countries around the world, and have usually led to the development of equivalent solutions. For example, most countries require a demonstration of pharmaceutical safety and efficacy prior to marketing these products using approaches that are similar to those initiated in the United States. The globalization of food and medical products has created a shift in regulatory compliance such that gaps in food and medical product safety can generate international problems. Improvements in regulatory research can advance the regulatory paradigm toward a more preventative, proactive framework. These improvements will advance at a greater pace with international collaboration by providing additional resources and new perspectives for approaching and anticipating public health problems. The following is a review of how past public health disasters have shaped the current regulatory landscape, and where innovation can facilitate the shift from reactive policies to proactive policies.
Full Text Available Abstract Background The significant mortality associated with breast cancer (BCa suggests a need to improve current research strategies to identify new genes that predispose women to breast cancer. Differential allele-specific expression (DASE has been shown to contribute to phenotypic variables in humans and recently to the pathogenesis of cancer. We previously reported that nonsense-mediated mRNA decay (NMD could lead to DASE of BRCA1/2, which is associated with elevated susceptibility to breast cancer. In addition to truncation mutations, multiple genetic and epigenetic factors can contribute to DASE, and we propose that DASE is a functional index for cis-acting regulatory variants and pathogenic mutations, and that global analysis of DASE in breast cancer precursor tissues can be used to identify novel causative alleles for breast cancer susceptibility. Results To test our hypothesis, we employed the Illumina® Omni1-Quad BeadChip in paired genomic DNA (gDNA and double-stranded cDNA (ds-cDNA samples prepared from eight BCa patient-derived normal mammary epithelial lines (HMEC. We filtered original array data according to heterozygous genotype calls and calculated DASE values using the Log ratio of cDNA allele intensity, which was normalized to the corresponding gDNA. We developed two statistical methods, SNP- and gene-based approaches, which allowed us to identify a list of 60 candidate DASE loci (DASE ≥ 2.00, P ≤ 0.01, FDR ≤ 0.05 by both methods. Ingenuity Pathway Analysis of DASE loci revealed one major breast cancer-relevant interaction network, which includes two known cancer causative genes, ZNF331 (DASE = 2.31, P = 0.0018, FDR = 0.040 and USP6 (DASE = 4.80, P = 0.0013, FDR = 0.013, and a breast cancer causative gene, DMBT1 (DASE=2.03, P = 0.0017, FDR = 0.014. Sequence analysis of a 5′ RACE product of DMBT1 demonstrated that rs2981745, a putative breast cancer risk locus, appears to be one of the causal variants leading to DASE
Villagran, Melinda; Weathers, Melinda; Keefe, Brian; Sparks, Lisa
Climate change is a threat to wildlife and the environment, but it also one of the most pervasive threats to human health. The goal of this study was to examine the relationships among dimensions of health literacy, patient education about global warming and climate change (GWCC), and health behaviors. Results reveal that patients who have higher…
Full Text Available Background: Variety of mobile health initiatives in different levels have been undertaken across many countries. Trends of these initiatives can be reflected in the research published in m-health domain. Aim: This paper aims to depict global trends in the published works on m-health topic. Materials and Methods: The Web of Science database was used to identify all relevant published papers on mobile health domain worldwide. The search was conducted on documents published from January 1898 to December 2014. The criteria for searching were set to be “mHealth” or “Mobile health” or “m health” or “m_health” or “m-health” in topics. Results: Findings revealed an increasing trend of citations and publications on m-health research since 2012. English was the first most predominant language of the publication. The US had the highest number of publication with 649 papers; however, the Netherlands ranked first after considering publication number in terms of countries population. “Studies in Health Technology and Informatics” was the source title with highest number of publications on mobile health topics. Conclusion: Trend of research observed in this study indicates the continuing growth is happening in mobile health domain. This may imply that the new model of health-care delivery is emerging. Further research is needed to specify directions of mobile health research. It is necessary to identify and prioritize the research gaps in this domain.
Farthmann, Juliane; Hanjalic-Beck, A; Veit, J; Rautenberg, B; Stickeler, E; Erbes, T; Földi, M; Hasenburg, A
In this prospective trial, we evaluated the influence of chemotherapy for breast cancer on women's health-related quality of life (HR-QoL), sexual function, and mental status. The patients completed validated questionnaires on HR-QoL, sexual function, and depression before, during, and at the end and finally 6 months after chemotherapy. Special attention was paid to possible differences between pre- and postmenopausal patients. Between 2008 and 2012, 79 patients were enrolled in the trial (mean age 47.46 years). Premenopausal participants were 63.3 %. Sexual activity dropped from 71.9 % before chemotherapy to a minimum of 47 % at the end of chemotherapy. A similar effect was seen for pleasure and discomfort. Depression values were the highest at the beginning of chemotherapy, with spontaneous improvement in many patients during the course of time. HR-QoL and global health status both increased 6 months after therapy. For almost all parameters, changes were more obvious in pre- than in postmenopausal patients. In a close monitoring, we observed significant changes in HR-QoL, depression, and sexual function in breast cancer patients. Special attention needs to be paid to premenopausal patients. The knowledge of effective recovery and spontaneous improvement of HR-QoL in spite of still impaired sexuality are important information in counseling both pre- and postmenopausal patients with diagnosis of breast cancer prior to upcoming therapy.
Ruger, Jennifer Prah
The World Bank began operations on June 25, 1946. Although it was established to finance European reconstruction after World War II, the bank today is a considerable force in the health, nutrition, and population (HNP) sector in developing countries. Indeed, it has evolved from having virtually no presence in global health to being the world's largest financial contributor to health-related projects, now committing more than $1 billion annually for new HNP projects. It is also one of the world's largest supporters in the fight against HIV/AIDS, with commitments of more than $1.6 billion over the past several years. I have mapped this transformation in the World Bank's role in global health, illustrating shifts in the bank's mission and financial orientation, as well as the broader changes in development theory and practice. Through a deepened understanding of the complexities of development, the World Bank now regards investments in HNP programs as fundamental to its role in the global economy.
Larkan, Fiona; Uduma, Ogenna; Lawal, Saheed Akinmayọwa; van Bavel, Bianca
The Centre for Global Health, Trinity College Dublin has as one of its goals, strengthening health systems in developing countries. In realising this goal we work across more than 40 countries with third-level, civil society, government, private sector and UN partners. Each of these requires that different relationships be established. Good principles must guide all global health research partnerships. An exploratory research project was undertaken with research partners of, and staff within, the Centre for Global Health. The aim was to build an evidence-based framework. An inductive exploratory research process was undertaken using a grounded theory approach in three consecutive phases: Phase I: An open-ended questionnaire was sent via email to all identified partners. Phase II: A series of consultative meetings were held with the staff of the Centre for Global Health. Phase III: Data sets from Phases I and II were applied to the development of a unifying framework. Data was analysed using grounded theory three stage thematic analysis - open, axial and selective coding. Relational and operational aspects of partnership were highlighted as being relevant across every partnership. Seven equally important core concepts emerged (focus, values, equity, benefit, leadership, communication and resolution), and are described and discussed here. Of these, two (leadership and resolution) are less often considered in existing literature on partnerships. Large complex partnerships can work well if all parties are agreed in advance to a common minimum programme, have been involved from the design stage, and have adequate resources specifically allocated. Based on this research, a framework for partnerships has been developed and is shared.
Cratsley, Kelso; Mackey, Tim K
Increased awareness of the importance of mental health for global health has led to a number of new initiatives, including influential policy instruments issued by the World Health Organization (WHO) and the United Nations (UN). This policy brief describes two WHO instruments, the Mental Health Action Plan for 2013-2020 (World Health Organization, 2013) and the Mental Health Atlas (World Health Organization, 2015), and presents a comparative analysis with the Sustainable Development Goals (SDGs) of the UN's 2030 Agenda for Sustainable Development (United Nations, 2015). The WHO's Action Plan calls for several specific objectives and targets, with a focus on improving global mental health governance and service coverage. In contrast, the UN's Sustainable Development Goals include only one goal specific to mental health, with a single indicator tracking suicide mortality rates. The discrepancy between the WHO and UN frameworks suggests a need for increased policy coherence. Improved global health governance can provide the basis for ensuring and accelerating progress in global mental health. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Full Text Available Background: To emphasise the value of on-going commitment in Global Health Partnerships. Materials and Methods: A hospital link, by invitation, was set up between United Kingdom and Tanzania since 2002. The project involved annual visits with activities ranging from exchange of skill to training health professionals. Furthermore, the programme attracted teaching and research activities. For continuity, there was electronic communication between visits. Results: Six paediatric surgeons are now fully trained with three further in training in Africa. Paediatric surgery services are now separate from adult services. Seven trainee exchanges have taken place with four awarded fellowships/scholarships. Twenty-three clinical projects have been presented internationally resulting in eight international publications. The programme has attracted other health professionals, especially nursing and engineering. The Tropical Health and Education Trust prize was recently achieved for nursing and radiography. National Health Service has benefited from volunteering staff bringing new cost-effective ideas. A fully funded medical student elective programme has been achieved since 2008. Conclusion: Global Health Partnerships are an excellent initiative in establishing specialist services in countries with limited resources. In the future, this will translate into improved patient care as long as it is sustained and valued by long term commitment.
De Lima, Liliana
The Global Atlas of Palliative Care at the End of Life, published by the Worldwide Palliative Care Alliance (WPCA) jointly with the World Health Organization (WHO) estimated that every year >20 million patients need palliative care (PC) at the end of life. Six percent of these are children. According to the Atlas, in 2011, approximately 3 million patients received PC and only 1 in 10 people in need is currently receiving it. Although most PC is provided in high-income countri