Conflict and its global health consequences: a decolonial call to action

Female Genital Mutilation/Cutting: A Systematic Review of Global Patterns, Sociocultural Drivers, and Health Consequences.

The aim: to develop a modern certification program "Global Health" for the continuous professional development of public health professionals. Materials and methods. The study employed bibliosemantic, informational-analytical, medical-statistical, sociological methods, and content analysis method. The research program included an analysis of the main competencies of public health professionals, as defined by the Association of Schools of Public Health in the European Region (ASPHER) and the higher education standard for specialty 229 "Public Health" for the second (master's) level of higher education; analysis of existing certification programs on global health; conducting sociological surveys of public health professionals regarding priority topics and preferred learning methods. The research was based on normative documents, electronic resources, and the results of sociological research. Statistical processing and mathematical analysis of materials were conducted using statistical analysis methods. Results. It was established that global health issues are significant in shaping the professional competencies of public health professionals, considering the requirements of the higher education standard for specialty 229 "Public Health" for the second (master's) level of higher education and those, defined by the European List of Core Competencies for Public Health Professionals ASPHER. The study of these issues was identified as important for continuous professional development based on sociological surveys of disease control and prevention center employees (38.4 out of 100 respondents). Among various forms of education, webinars (62.2±3.8 out of 100 respondents) and online learning (60.4±3.8) are most in demand. Analysis of the obtained data led to the justification of the "Global Health" certification program. In the developed "Global Health" certification program, 26.7% of the workload corresponds to lectures, 33.3% to practical classes, and 40% to preparatory work. Structurally, it covers 2 modules and 8 topics on current issues of the impact of globalization on health and analysis of global health indicators. Conclusions. The "Global Health" certification program meets the requirements of normative documents, considers contemporary challenges and consequences of globalization on health, highlights global health trends, and its topics are in demand among disease control and prevention center professionals.

This article examines why the 2014–15 outbreak of Ebola in West Africa, which subsequently spread more widely, was understood as a crisis. It begins from the basis that there was nothing ‘natural’ about it being considered a crisis; rather it was socially constructed as such. Specifically it suggests that the outbreak could be understood as a crisis because of the way in which it resonated with the global health narrative. The article examines how the elements which constitute this narrative – the effects of globalisation, the emergence of new risks and the requirement for new political responses – are fundamental to how Ebola was understood as a crisis.

Academic medicine and global health responsibilities

Says who? Northern ventriloquism, or epistemic disobedience in global health scholarship

The impact of COVID-19 on globalization

During the 2019-2020 academic year, 37 (17%) of 223 Council on Education for Public Health (CEPH) accredited or applicant schools and programs of public health offered Master of Public Health (MPH) degrees with concentrations in general global health. Concentration-specific competencies build on the foundational competencies required for all MPH students enrolled in CEPH-accredited programs. The most popular global health competencies focus on agencies and organizations, ethics and human rights, program management, social and environmental determinants of health, the global burden of disease, collaboration and partnerships, and cultural competency. There is significant overlap between the current concentration competencies and the ones recommended by the Association of Schools and Programs of Public Health in 2018. The online program descriptions for MPH concentrations in global health feature four key themes: globalization, low-income countries, social justice and equity, and culture and diversity. (1) Most programs emphasize transnational health issues and the effects of globalization on health in countries of all income levels. (2) Some programs have a special focus on preparation for serving low-income countries and other disadvantaged populations, such as refugees. (3) Most programs emphasize the social justice and equity issues underlying local and global health disparities. (4) Most programs promote development of the cultural knowledge, awareness, and skills required for serving diverse populations effectively as rising leaders in the international, national, or local public health workforce. Global health MPH programs prepare students for public health practice in resource-limited settings in their home communities as well as internationally.

BackgroundGlobal Health Education (GHE) focuses on training proactive global citizens to tackle health challenges in an increasingly interconnected and interdependent world. Studies show that health professionals in training have reported that GHE has improved their teamwork, responsiveness to contextual factors that impact health, and understanding of health systems; however, there is little research on the impact of GHE courses in undergraduate settings, especially in low and middle-income countries (LMICs).MethodsOur study analyzes a multidisciplinary online global health course at Tecnologico de Monterrey, México. We conducted a cross-sectional study with pre- and post-design. Students who took the multidisciplinary course of Global Health for Leaders in the Fall of 2019 (n = 153) and Spring of 2020 (n = 348) were selected for this study. Using a five-point Likert scale (strongly agree to strongly disagree), the survey assessed seven competencies as well as questions about course expectations, takeaways, and recommendations to improve the course. We performed descriptive statistical analyses comparing the combined pre-tests (from Fall and Spring cohorts) to the combined post-tests. Fisher’s exact test was used to compare the samples.ResultsOf the 501 pre-course surveys administered, 456 responses were completed in the pre-course and 435 in the post-course (91% overall response rate). Only 8.7% of the respondents in the pre-course survey strongly agreed that they could describe fundamental aspects of global health such as the Millennium Development Goals or Sustainable Development Goals, in contrast to a 56% of the students who strongly agreed in the post-course survey (p < 0.001). Similar differences were captured in understanding the global burden of disease, social determinants of health, the effects of globalization in health, health systems’ goals and functions, and human rights. 38% felt that the course helped them develop a more empathetic perception of the suffering of others experiencing global health-related issues.ConclusionIn this study, we have presented our experience in teaching an online global health course for multidisciplinary undergraduates in a LMIC. The competencies reported by our students indicate that the course prepared them to confront complex global health issues.

This essay provides an overview of the linkages between globalization and health. It examines many of the global health issues associated with the globalization of economic, political, social, and cultural forces in the world today. The conceptualization and analysis of these linkages between globalization and health and the effects of globalization on population health are discussed from the vantage point of various perspectives. Particular attention is given to the global spread of disease, the diseases of globalization, the health inequities associated with globalization, the effects of globalization on environmental health, and the globalization of health-related technologies.

Every silver lining has a cloud. The shift with development from food scarcity to food surplus is accompanied by rising obesity and all its associated health consequences. The steady reduction in mortality rates (until HIV/AIDS came along) has allowed people to live long enough to develop unpleasant chronic and degenerative diseases. And so with globalization, a process that has unquestionably brought benefits to many countries, is also accompanied by risks and negative consequences. In the last two years there has been increasingly lively discussion, particularly about the negative consequences of globalization, actual or potential. The argument needs to be balanced though, and that means including three important considerations. The first is that substantive economic evidence exists for the benefits of globalization (see for example the article by Dollar in this issue, pp. 827–833). Of particular note here are the established links between openness to trade, economic growth, incomes of the poor and the health of the poor. Second, due recognition must be given to the political and social benefits of openness. Egregious human rights abuses, whether acute (as in genocide) or chronic (as in the treatment of women) are more able to persist in closed societies that are sheltered from international scrutiny and intervention. ‘Open’ countries (such asMalaysia) have clearly benefited, in contrast to ‘‘closed’’ ones (such as Myanmar). Thirdly, where the dangers or ill-effects of globalization are emphasized, some kind of counterfactual or alternative pathway has to be put forward if the objections are to carry weight. If not globalization, then what? The critical task now is to promote a debate on globalization that is calm, rational and evidence-based. We hope that this issue of the Bulletin makes a contribution towards meeting this need. Openness to trade, technology and inward investment will (when accompanied by appropriate domestic economic policies) bring economic benefits including a reduction in poverty. This increasing income will in turn generate health benefits because of the strong link between wealth and health. However, openness also brings health risks and adverse consequences, many of which are set out in the papers of this issue. Such risks are not new: perhaps the most devastating impact of globalization was the spread of deadly epidemics that accompanied European expansion and colonization between roughly 1500 and 1800. These epidemics decimated immunologically naive populations, especially in the Americas and Oceania. Global spread of infection continues today, although (with the notable exception of AIDS) we now have better knowledge and tools with which to ameliorate the consequences. With research on the nature and extent of both positive and negative health consequences of globalization, must come new thinking about enhanced international mechanisms to optimize the net outcome. New global initiatives in infection control and control of smoking-related illness are examples of the way we need to go. Public–private partnerships (see last month’s issue of the Bulletin) and Kofi Annan’s call for a new global fund for the control of AIDS, malaria and tuberculosis are others. Lastly, globalization provides new opportunities for investing in global public goods that enhance health (see Kaul & Faust pp. 869–874). Up till now, most transfers of resources from rich countries to poor ones have focused on country-specific projects. The track record of this form of aid has been disappointing, as the new aid effectiveness literature shows. By contrast, some multi-country and multi-regional initiatives in health have been spectacularly successful. Examples include massively effective offensives against smallpox and poliomyelitis worldwide, and against river blindness in West Africa. Research on diseases of the poor, and international efforts to generate standardized data on disease burden and health system performance, are other noteworthy examples of global public goods for health. A globalized world with rapid transit of ideas, people, and money provides a setting for a new generation of successful investments in health that benefit people of all nations. n

&amp;lt;p&amp;gt;Many people in low-income countries and fragile states struggle to access the foundations of family and community health which we see as a three-way nexus of; access to safe water and sanitation, a sufficient and balanced diet and effective health services. These factors interact with each other to affect personal and community health in different ways mediated by environmental and social factors specific to local and national contexts. Our paper conceptually explores the hydrological foundations of safe water, food and health interactions that underpin individual, community and global health. In doing so we recognise the recursive dynamics of water and sanitation and health (WASH), food and diet systems, climate change, emergent diseases, conflict and freshwater ecosystems degradation, loss of biodiversity and migration.&amp;amp;#160; Outbreaks of Ebola and the COVID-19 pandemic have demonstrated that localised community health problems, and the local freshwater needed to combat them, can emerge and quickly escalate to have global health, economic, social, and political consequences. Therefore, a focus on improving the foundations of health (improved water access, food and nutrition security and health services) in low-income communities (LIC) and fragile or conflict affected states (FCS) not only targets populations in greatest need and most likely to benefit but creates opportunities to strengthen and protect global health.&amp;lt;/p&amp;gt;

Health globally faces a variety of challenges and barriers that need to be tackled. Global Health is a new discipline which considers (i) health of people in all nations worldwide as a consequence of globalisation (horizontal issues) and (ii) the complex influences of social determinants of health as comparable for all people (vertical issues). Academic global health approach recognises that interdependencies are increasingly relevant, while territorial boundaries become increasingly irrelevant, and that to understand both health challenges and needed solutions, the complexity of globalisation influences that transcend, or are oblivious to, territorial boundaries are beyond the capacity of individual nation states’ domestic institutions to address[...]

Obesity has increased over the last 20 years, from a condition affecting only a small portion of populations in developed countries, into a global pandemic.1 The impact of obesity can be appreciated in the context of the populations at risk, and it is estimated that >1 billion adults worldwide are overweight (BMI >25 kg/m2), 300 million of whom are clinically obese (BMI >30 kg/m2).2 In the United States, 65% of adults are overweight, and 32.2% of them are obese, a prevalence that has doubled over 20 years.3 In industrialized countries, obesity rates have tripled, coinciding with adoption of a Western lifestyle.4 Further, the growing worldwide rates of childhood obesity have reached epidemic values in developed countries.5 This global obesity pandemic reflects genetic susceptibility, availability of high-energy foods, and decreased physical activity. Accelerating rates of obesity have profound health and economic consequences. Obesity is associated with a myriad of co-morbidities, including type II diabetes, coronary artery disease, obstructive sleep apnea, stroke, cancer, hypertension, osteoarthritis, and liver and biliary disease which collectively increase mortality.6 Indeed, the health care impact of chronic obesity exceeds that of smoking or alcohol abuse.7 National health care costs of obesity are $70–100 billion, and if this trend continues, in 15 years 20% of health care costs in the United States will be attributed to the chronic diseases associated with obesity.8 Collectively, these considerations underscore the health and economic imperative to develop novel therapeutic approaches to combat obesity and its co-morbidities. In that context, overweight and obese individuals who receive assistance from their health care providers to lose weight are three times more likely to attempt weight loss.9 The most common approach to medical weight management is counseling and lifestyle modification. However, while patients enrolled in these programs initially lose weight, they usually regain 30–35% of their lost weight within one year following treatment, and >50% of patients return to their baseline weight by five years.10, 11 At present, only two drugs, orlistat and sibutramine, are approved for the long-term treatment of obesity. However, due to their inherent cardiovascular and gastrointestinal adverse effects, respectively, these drugs are often only utilized as rescue therapy for patients who fail diet and exercise. The scope of the obesity problem and the absence of available long-term solutions highlights the unmet clinical need for safe and effective pharmacotherapeutics to induce and maintain weight loss.

For 99% of our time on Earth, humans have been hunter-gatherers, intricately connected to and reliant upon our local lands and waters for food, materials, medicines and shelter. In this time we have evolved a unique and in-depth knowledge base, termed local ecological knowledge or ecoliteracy, which has been essential to sustaining human and ecosystem health over thousands of years. However with livelihood diversification towards non-resource dependent strategies, the emergence of local markets as a consequence of globalisation, and global patterns of economic development, our collective local knowledge is now being lost. With the loss of local livelihoods and knowledge comes a departure from traditional food systems as hunters, fishers, and gatherers and cultivators lose the skills needed to locate, collect, preserve, prepare, consume and manage indigenous foods. Traditional food systems have provided nutritional health and food security for indigenous and marginalised communities for generations, and play a critical role in cultural continuity, social systems and ecosystem biodiversity. The current phenomenon of local knowledge erosion with economic development, and its effect 66on local food systems, is discussed. There has been a global shift from traditional and local foods to industrialised marketed foods, most notable in indigenous and marginalised communities. This shift has consequences for human health (in terms of nutrition and physical health), cultural health (in terms of community identity, ceremonies and social networks) and ecosystem health (in terms of resource management and biodiversity) in both industrialised and developing countries across the world.

This paper considers the public health impacts of the income-generating activities of organised crime. These range from the traditional vice activities of running prostitution and supplying narcotics, to the newer growth areas of human trafficking in its various forms, from international supply of young people and children as sex workers through deceit, coercion or purchase from family, through to smuggling of migrants, forced labour and the theft of human tissues for transplant, and the sale of fake medications, foodstuffs and beverages, cigarettes and other counterfeit manufactures. It looks at the effect of globalisation on integrating supply chains from poorly-regulated and impoverished source regions through to their distant markets, often via disparate groups of organised criminals who have linked across their traditional territories for mutual benefit and enhanced profit, with both traditional and newly-created linkages between production, distribution and retail functions of cooperating criminal networks from different cultures. It discusses the interactions between criminals and the structures of the state which enable illegal and socially undesirable activities to proceed on a massive scale through corruption and subversion of regulatory mechanisms. It argues that conventional approaches to tackling organised crime often have deleterious consequences for public health, and calls for an evidence-based approach with a focus on outcomes rather than ideology.