Motivation of Nurses in Humanitarian and National Initiatives

The COVID-19 pandemic is over, but its impact on global health equity remains a significant concern. The pandemic highlighted and, in some cases, exacerbated longstanding inequities in global health systems, especially in low-resource settings. Power dynamics played a critical role in shaping global health equity and cooperation, influencing the allocation of resources, decision-making processes, and access to life-saving interventions. While existing studies have examined the relationship between global health diplomacy and health equity, the specific impact of power dynamics on health equity and diplomacy during the pandemic remains underexplored. This review explores how power dynamics influenced global health cooperation and health equity during the COVID-19 pandemic. A narrative review, guided by Lukes' three-dimensional model of power, was conducted. The review spans publications from 2000 to 2025 and includes 89 eligible articles, encompassing research studies, policy documents, and global health reports. Data extraction focused on three key domains: Development Assistance for Health (DAH), equity in the pandemic response, and political power dynamics. The review revealed that donor countries increased Development Assistance for Health (DAH) support in response to COVID-19. However, vaccine nationalism, geopolitical tensions, sanctions, and intellectual property regimes perpetuated inequities between the Global North and South. Despite multilateral initiatives like COVAX, inequitable access to vaccines and diagnostics persisted, largely due to the concentration of decision-making power among high-income countries and powerful institutions. The review concludes that achieving sustainable global health equity requires confronting entrenched power asymmetries that hinder meaningful cooperation, promoting inclusive governance, and depoliticizing health diplomacy. Transparent, equity-focused policies, strengthened regional health systems, and expanded South-South collaboration are essential for building resilience to future global health crises. Further research is recommended to evaluate the post-pandemic impact of power dynamics on global health equity and cooperation.

Information access: an online resource for health and social care professionals providing information to people affected by neurological conditions

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

Many global health challenges are characterized by the inequitable patterning of their health and economic consequences, which are etched along the lines of pre-existing inequalities in resources, power, and opportunity. These links require us to reconsider how we define global health equity, and what we consider as most consequential in its pursuit. In this article, we discuss the extent to which improving underlying global equity is an essential prerequisite to global health equity. We conclude that if we are to improve global health equity, there is a need to focus more on foundational—rather than proximal—causes of ill health and propose ways in which this can be achieved.

Introduction Self-immolation (SIM) is an uncommon method of attempted suicide involving flammable substances, with suicidal intent. By contrast self-inflicted (SIF) burn injuries utilize a chemical or heated object to cause injury, without suicidal intent. Caring for either patient population can have emotional and ethical challenges. The purpose of this study was to better understand the perspectives and experiences of the healthcare clinician when caring for these patients and identify the need for enhanced support. Methods An 11-item survey was distributed to burn center professionals via SurveyMonkey. Questions were developed to seek healthcare professionals’ attitudes, emotional and ethical challenges in treating these patient populations. Respondents were stratified into two groups, those that responded yes to having found it emotionally challenging to care for this patient population (Y) and those that responded no (N). Results A total of 65 individuals responded to the survey, and 58 surveys were fully completed. The majority, 65%, of respondents were between ages 22-39, (n=41). Most were burn nurses, 46.7% (n = 29), followed by rehabilitation professionals (rehab), 12.9% (n = 8), advanced practice practitioners (APP), 9.6% (n=6) and physicians 8% (n=5). When stratified, 53% (n=31) responded yes (Y) when asked if they found it emotionally challenging to care for this patient population and 48% (n=28) responded no (N). There were no significant differences between groups for age, gender, years in profession or years in burn care. When examined by profession, 75% of rehab, 67% of psychosocial, 50% of nurses, 40% of physicians and 33% of APP respondents answered yes that care of this population was emotionally challenging. The majority of both groups responded that they received support from team members. When asked if care of these patients created an ethical or moral dilemma 42% of Y and 25% of N responded yes. Y were more likely to have experienced a change in their own mental health 52% vs 7% N. When asked if same day support would be helpful 74% (n=23) of Y and 42% (n=12) responded yes. The preferred format for help was 1:1 or group. Conclusions The majority of staff reported emotional and/or ethical challenges when caring for this population created. Of those who responded that care of these patients was not emotionally challenging, interestingly, 25% experienced ethical or moral dilemmas and 43% felt that having same day support would be beneficial. Identification of the need for enhanced support for staff in the hospital setting is critical to avoid burnout, secondary traumatic stress and compassion fatigue for healthcare professionals. Applicability of Research to Practice This study highlights the need for a specialized in-house enhanced support program for burn professionals to address their emotional and mental well-being.

Context and setting Although steady and dramatic medical advances have characterised our generation, a very significant proportion of the world's population continues to suffer and die from preventable and treatable diseases. Doctors wishing to impact these inequities often undertake direct medical service provision in resource-poor settings or health services research as a means to this goal. Why the idea was necessary Most doctors become interested in international health while completing their graduate medical education. However, they lack specific training that would empower them to impact on global health, including skills in public health, health advocacy, programme development, economics, ethics and service-based research. The Howard Hiatt Residency in Global Health Equity and Internal Medicine was established in 2004 at Brigham and Women's Hospital (BWH), a Harvard Medical School-affiliated, academic medical centre with a long history of community service and innovative health programming. What was done A 4-year training programme for medical residents in global health equity was developed. Specific new core competencies were defined as guideposts of successful training that will supplement the existing competencies defined by ACGME (Accreditation Council for Graduate Medical Education). It is expected that residents who complete the programme will be well poised to become leaders in the field of global health equity and to participate in meaningful clinical fieldwork and research on health equity issues. Early in training, residents are matched with a primary clinical and research mentor who is senior in the field of health disparities. Year 1 of the programme consists of a standard internal medicine internship, with ambulatory electives focused on resource-poor communities. In Year 2, residents alternate between clinical rotations and blocks focused on health equity topics. Year 2 also includes 1 month spent visiting international project sites in low-income and middle-income countries to gain a better understanding of operations at each site. At the beginning of Year 3, residents receive formal instruction in quantitative and qualitative research methodology and select a primary field site for further clinical training and research. The residents then spend an additional 3 months during Year 3 and 6 months during Year 4 at the selected project site carrying out the planned work. Joint didactics inclusive of trainees in Years 2, 3 and 4 include monthly grand rounds, research and clinical seminars. Evaluation of results and impact Both process and outcome evaluations will be used to assess the programme's success. Successful completion of a health disparities project by the residents will also be required. In the longterm, continued work on the part of residents in the field of health disparities will be tracked as a marker of programme success. To date, 6 residents have been enrolled in the programme and are in Years 2 and 3. The Howard Hiatt Residency in Global Health Equity and Internal Medicine at BWH offers a unique training track for medical residents interested in addressing the most pressing health problems facing the world today. The programme aims to provide a solid foundation on which trainees can build as they enter careers in global health equity.

Equity in Global Health Research.

Health equity remains a major challenge to policymakers despite the resurgence of interest to promote it. In developing countries, especially, the sheer inadequacy of financial and human resources for health and the progressive undermining of state capacity in many under-resourced settings have made it extremely difficult to promote and achieve significant improvements in equity in health and access to healthcare. In the last decade, public-private partnerships have been explored as a mechanism to mobilise additional resources and support for health activities, notably in resource-poor countries. While public-private partnerships are conceptually appealing, many concerns have been raised regarding their impact on global health equity. This paper examines the viability of public-private partnerships for improving global health equity and highlights some key prospects and challenges. The focus is on global health partnerships and excludes domestic public-private mechanisms such as the state contracting out publicly-financed health delivery or management responsibilities to private partners. The paper is intended to stimulate further debate on the implications of public-private partnerships for global health equity.

BackgroundLittle is known about how health care professionals deal with ethical challenges in mental health care, especially when not making use of a formal ethics support service. Understanding this is important in order to be able to support the professionals, to improve the quality of care, and to know in which way future ethics support services might be helpful.MethodsWithin a project on ethics, coercion and psychiatry, we executed a focus group interview study at seven departments with 65 health care professionals and managers. We performed a systematic and open qualitative analysis focusing on the question: ‘How do health care professionals deal with ethical challenges?’ We deliberately did not present a fixed definition or theory of ethical challenge.ResultsWe categorized relevant topics into three subthemes: 1) Identification and presence of ethical challenges; 2) What do the participants actually do when dealing with an ethical challenge?; and 3) The significance of facing ethical challenges.Results varied from dealing with ethical challenges every day and appreciating it as a positive part of working in mental health care, to experiencing ethical challenges as paralyzing burdens that cause a lot of stress and hinder constructive team cooperation. Some participants reported that they do not have the time and that they lack a specific methodology. Quite often, informal and retrospective ad-hoc meetings in small teams were organized. Participants struggled with what makes a challenge an ethical challenge and whether it differs from a professional challenge. When dealing with ethical challenges, a number of participants experienced difficulties handling disagreement in a constructive way. Furthermore, some participants plead for more attention for underlying intentions and justifications of treatment decisions.ConclusionsThe interviewed health care professionals dealt with ethical challenges in many different ways, often in an informal, implicit and reactive manner. This study revealed nine different categories of what health care professionals implicitly or explicitly conceive as ‘ethical challenges’. Future research should focus on how ethics support services, such as ethics reflection groups or moral case deliberation, can be of help with respect to dealing with ethical challenges and value disagreements in a constructive way.

A Global Call for Action to Prioritize Healthcare Worker Suicide Prevention During the COVID-19 Pandemic and Beyond.

BackgroundDespite common recognition of joint responsibility for global health by all countries particularly to ensure justice in global health, current discussions of countries’ obligations for global health largely ignore obligations of developing countries. This is especially the case with regards to obligations relating to health financing. Bearing in mind that it is not possible to achieve justice in global health without achieving equity in health financing at both domestic and global levels, our aim is to show how fulfilling the obligation we propose will make it easy to achieve equity in health financing at both domestic and international levels.DiscussionAchieving equity in global health financing is a crucial step towards achieving justice in global health. Our general view is that current discussions on global health equity largely ignore obligations of Low Income Country (LIC) governments and we recommend that these obligations should be mainstreamed in current discussions. While we recognise that various obligations need to be fulfilled in order to ultimately achieve justice in global health, for lack of space we prioritise obligations for health financing. Basing on the evidence that in most LICs health is not given priority in annual budget allocations, we propose that LIC governments should bear an obligation to allocate a certain minimum percent of their annual domestic budget resources to health, while they await external resources to supplement domestic ones. We recommend and demonstrate a mechanism for coordinating this obligation so that if the resulting obligations are fulfilled by both LIC and HIC governments it will be easy to achieve equity in global health financing.SummaryAlthough achieving justice in global health will depend on fulfilment of different categories of obligations, ensuring inter- and intra-country equity in health financing is pivotal. This can be achieved by requiring all LIC governments to allocate a certain optimal per cent of their domestic budget resources to health while they await external resources to top up in order to cover the whole cost of the minimum health opportunities for LIC citizens.

BackgroundIn recent years, the attention on the use of coercion in mental health care has increased. The use of coercion is common and controversial, and involves many complex ethical challenges. The research question in this study was: What kind of ethical challenges related to the use of coercion do health care practitioners face in their daily clinical work?MethodsWe conducted seven focus group interviews in three mental health care institutions involving 65 multidisciplinary participants from different clinical fields. The interviews were recorded and transcribed verbatim. We analysed the material applying a ‘bricolage’ approach. Basic ethical principles for research ethics were followed. We received permission from the hospitals’ administrations and all health care professionals who participated in the focus group interviews.ResultsHealth care practitioners describe ethical dilemmas they face concerning formal, informal and perceived coercion. They provide a complex picture. They have to handle various ethical challenges, not seldom concerning questions of life and death. In every situation, the dignity of the patient is at stake when coercion is considered as morally right, as well as when coercion is not the preferred intervention. The work of the mental health professional is a complicated “moral enterprise”.The ethical challenges deserve to be identified and handled in a systematic way. This is important for developing the quality of health care, and it is relevant to the current focus on reducing the use of coercion and increasing patient participation. Precise knowledge about ethical challenges is necessary for those who want to develop ethics support in mental health care. Better communication skills among health care professionals and improved therapeutic relationships seem to be vital.ConclusionsA systematic focus on ethical challenges when dealing with coercion is an important step forward in order to improve health care in the mental health field.

International grant making by U.S. foundations.

Dementia care: Research and clinical innovation.

Human resources for health in the Americas