Contemporary Global Health Research Articles

The European Union's Global Health Actorness: A Research Agenda for a New Age of Pandemics

AbstractWhilst the European Union's (EU's) response to health emergencies has historically been subpar, some suggest that it emerged from COVID‐19 as a stronger global health actor. This prompts two interrelated questions: how have International Relations scholars conceptualised and assessed EU ‘actorness’ in the all‐too‐often neglected field of global health, and what adjustments are required in anticipation of a potential new age of pandemics? This article revisits the longstanding notion of ‘actorness’ and dissects the few studies that apply it systematically to analyse the EU's role in global health. After identifying some key shortcomings in the literature, the article formulates a research agenda suitable for the complex and high‐stakes nature of contemporary global health endeavours. By further adapting the concept of ‘actorness’ to a multifaceted EU external action as well as to an increasingly intricate global governance architecture, this research agenda contributes to the broader scholarship on the EU's international outreach.

Missing in action: a scoping review of gender as the overlooked component in decolonial discourses

IntroductionRace and gender were intimately intertwined aspects of the colonial project, used as key categories of hierarchisation within both colonial and modern societies. As such, true decolonisation is only possible...

One Health Paradigm: An Inclusive Approach to Tackling Global Health Complexities

The One Health paradigm, a holistic approach encompassing human, animal, and environmental health, has gained significant attention in addressing the complexities of contemporary global health challenges. This extensive review explores the foundational principles, historical evolution, and diverse applications of One Health. By promoting interdisciplinary collaboration and recognizing the interdependence of health domains, One Health emerges as a potent strategy to counter emerging diseases, combat antimicrobial resistance, and address multifaceted health threats.

Invisibility in global health: A case for disturbing bioethical frameworks.

In recent years, the global health community has increasingly reported the problem of 'invisibility': aspects of health and wellbeing, particularly amongst the world's most marginalized and impoverished people, that are systematically overlooked and ignored by people and institutions in relative positions of power. It is unclear how to realistically manage global health invisibility within bioethics and other social science disciplines and move forward. In this letter, we reflect on several case studies of invisibility experienced by people in Brazil, Malaysia, West Africa and other transnational contexts. Highlighting the complex nature of invisibility and its interconnectedness with social, political and economic issues and trends, we argue that while local and targeted interventions might provide relief and comfort locally, they will not be able to solve the underlying causes of invisibility. Building from the shared lessons of case study presentations at an Oxford-Johns Hopkins Global Infectious Disease Ethics Collaborative (GLIDE), we argue that in dealing with an intersectional issue such as invisibility, twenty-first century global health bioethics could pursue a more 'disturbing' framework, challenging the narrow comforting solutions which take as a given the sociomaterial inequalities of the status quo. We highlight that comforting and disturbing bioethical frameworks should not be considered as opposing sides, but as two approaches working in tandem in order to achieve the internationally set global health milestones of providing better health and wellbeing for everyone. Insights from sociology, anthropology, postcolonial studies, history, feminist studies and other styles of critical reasoning have long been disturbing to grand narratives of people and their conditions. To rediscover the ethos of the WHO Alma Ata Declaration-a vision of "health for all by the year 2000"-these thinking tools will be necessary aids in developing cooperation and support beyond the narrow market logic that dominates the landscape of contemporary global health.

Aligning global health policy and research with sustainable development: A strategic market approach

AbstractAttaining Sustainable Development Goal 3 (SDG 3: Health and Well‐Being) faces a dual challenge of diminishing returns of established intervention designs, and a threat to future gains from complex inter‐connected global health challenges like antimicrobial resistance and global biodiversity loss. The growing movement of context‐sensitive approaches could help realise yet untapped potential for intervention designs, but contemporary global health policy and research still remain dominated by a model of individual market style choices. This paper therefore aims to support the development of global health planning processes that are more grounded and integrative across the SDGs. Reiterating calls for disruptive policy change is unlikely to impact the modus operandi of global health policy and research. This paper therefore builds on a logic that already finds widespread and intuitive application in their underlying planning processes: ‘the market’. However, it challenges the dominant supply‐and‐demand approach to healthcare markets and redefines them from a strategic marketing perspective. Translated to the interface of populations and health systems, the strategic market is a site for solving problems that are defined by people with multidimensional health needs. This framework offers four guiding questions to define the strategic market and six premises as a simple intellectual starting point and checklist for more grounded and inter‐sectorial action across the SDGs. The analysis of data from one of the largest behavioural survey data sets, covering 6683 villagers across China, India, Lao PDR and Thailand, demonstrates the relevance of the premises empirically.

Unethical Issues in Twenty-First Century International Development and Global Health Policy

Abstract Billions in development aid is provided annually by international donors in the Majority World, much of which funds health equity. Yet, common neocolonial practices persist in development that compromise what is done in the name of well-intentioned policymaking and programming. Based on a qualitative analysis of fifteen case studies presented at a 2022 conference, this research examines trends involving unethical partnerships, policies, and practices in contemporary global health. The analysis identifies major modern-day issues of harmful policy and programming in international aid. Core issues include inequitable partnerships between and representation of international stakeholders and national actors, abuse of staff and unequal treatment, and new forms of microaggressive practices by Minority World entities on low-/middle-income nations (LMICs), made vulnerable by severe poverty and instability. When present, these issues often exacerbate institutionalized discrimination, hostile work environments, ethnocentrism, and poor sustainability in development. These unbalanced systems perpetuate a negative development culture and can place those willing to speak out at risk. At a time when the world faces increased threats including global warming and new health crises, development and global health policy and practice must evolve through inclusive dialogue and collaborative effort.

Invisibility in global health: A case for disturbing bioethical frameworks

In recent years, the global health community has been increasingly reporting the problem of ‘invisibility’ as aspects of health and wellbeing that are often overlooked and ignored, and predominantly affects the most marginalized and precarious people. However, it is unclear how to realistically manage global health invisibility and move forward. In this letter, we reflect on several case studies of invisibility experienced by people in Brazil, Malaysia, West Africa and other transnational contexts. Highlighting the complex nature of invisibility and its interconnectedness with social, political and economic issues and trends, we argue that while local and targeted interventions might provide relief and comfort locally, they will not be able to solve the underlying causes of invisibility. Moving forward, we argue that in dealing with an intersectional issue such as invisibility, twenty-first century global health bioethics could pursue a more ‘disturbing’ framework, challenging the narrow comforting solutions and sociomaterial inequalities of the sociopolitical status quo. We highlight that comforting and disturbing bioethical frameworks should not be considered as opposing sides, but as two approaches working in tandem in order to achieve the internationally set global health milestones of providing better health and wellbeing for everyone. In doing so, we call for taking seriously insights from sociology, anthropology, postcolonial studies, history, feminist studies and other styles of critical reasoning that have long been disturbing the grand assumptions about people and their conditions, and, practically, to rediscover the ethos of the WHO Alma Ata Declaration, calling for cooperation and support beyond the narrow market logic that dominates the landscape of contemporary global health.

Chakachua Pharmaceuticals and Fugitive Science.

Chakachua Pharmaceuticals and Fugitive Science.

Global antimicrobial-resistance drivers: an ecological country-level study at the human–animal interface

Antimicrobial resistance (AMR) is a pressing, holistic, and multisectoral challenge facing contemporary global health. In this study we assessed the associations between socioeconomic, anthropogenic, and environmental indicators and country-level rates of AMR in humans and food-producing animals. In this modelling study, we obtained data on Carbapenem-resistant Acinetobacter baumanii and Pseudomonas aeruginosa, third generation cephalosporins-resistant Escherichia coli and Klebsiella pneumoniae, oxacillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium AMR in humans and food-producing animals from publicly available sources, including WHO, World Bank, and Center for Disease Dynamics Economics and Policy. AMR in food-producing animals presented a combined prevalence of AMR exposure in cattle, pigs, and chickens. We used multivariable β regression models to determine the adjusted association between human and food-producing animal AMR rates and an array of ecological country-level indicators. Human AMR rates were classified according to the WHO priority pathogens list and antibiotic-bacterium pairs. Significant associations were identified between animal antimicrobial consumption and AMR in food-producing animals (OR 1·05 [95% CI 1·01-1·10]; p=0·013), and between human antimicrobial consumption and AMR specifically in WHO critical priority (1·06 [1·00-1·12]; p=0·035) and high priority (1·22 [1·09-1·37]; p<0·0001) pathogens. Bidirectional associations were also found: animal antibiotic consumption was positively linked with resistance in critical priority human pathogens (1·07 [1·01-1·13]; p=0·020) and human antibiotic consumption was positively linked with animal AMR (1·05 [1·01-1·09]; p=0·010). Carbapenem-resistant Acinetobacter baumanii, third generation cephalosporins-resistant Escherichia coli, and oxacillin-resistant Staphylococcus aureus all had significant associations with animal antibiotic consumption. Analyses also suggested significant roles of socioeconomics, including governance on AMR rates in humans and animals. Reduced rates of antibiotic consumption alone will not be sufficient to combat the rising worldwide prevalence of AMR. Control methods should focus on poverty reduction and aim to prevent AMR transmission across different One Health domains while accounting for domain-specific risk factors. The levelling up of livestock surveillance systems to better match those reporting on human AMR, and, strengthening all surveillance efforts, particularly in low-income and middle-income countries, are pressing priorities. None.

Decolonising Global Solidarity: The WHO’s Broken Alarm and Epidemiological Nationalism

The COVID-19 pandemic has traumatised world leaders, leading people to question the capability and accountability of global health governance. Against this background, we have heard multiple calls to strengthen ‘solidarity’ within and between states – which, weirdly, is practised by keeping a distance from ‘Others’ through, for instance, social distancing, lockdowns, and border control. In this paper, I first introduce the post-World War II international pandemic response regime, especially the International Health Regulations 2005, using the multiple positions of the Republic of China and/or Taiwan to illustrate the prioritisation of national sovereignty over health justice. In and beyond this context, I conceptualise epidemiological nationalism, which contains three dimensions (territorial, affective, and epistemic) to critically examine the responses to COVID-19 from the WHO and different states. This concept enables us to analyse the solidarity-through-distancing practices from a decolonial perspective to deconstruct the contemporary global health regime. The regime is underpinned by the coloniality of modern epidemiology, which creates the hierarchies between nations and races imposed on the making and working of geographical, population, and disease categories by racialising diseases and response measures. Such racialisation practices vary in different contexts and are often tied to states’ securitisation practices, which justify the exclusion of minority communities.

Between nation and empire: how the state matters in global health

Abstract The role of the state has been underplayed in scholarship on global health. Taking a historical view, this paper argues that state institutions, practices and ideologies have in fact been crucial to the realisation of contemporary global health governance and to its predecessor regimes. Drawing on state theory, work on governmentality, and Third World approaches to international law, it traces the origins of the ‘health state’ in late colonial developmentalism, which held out the prospect of conditional independence for the subjects of European empires. Progress in health was also a key goal for nationalist governments in the Global South, one which they sought to realise autonomously as part of a New International Economic Order. The defeat of that challenge to the dominance of the Global North in the 1980s led to the rise of ‘global governance’ in health. Far from rendering the state redundant, the latter was realised through the co-option and disciplining of institutions at national level. To that extent, the current order has an unmistakably imperial character, one which undercuts its declared cosmopolitan aspirations, as evidenced in the approach to vaccine distribution and travel bans during the Covid-19 pandemic.

Moving psychiatric deinstitutionalization forward: A scoping review of barriers and facilitators.

Psychiatric deinstitutionalization (PDI) processes aim to transform long-term psychiatric care by closing or reducing psychiatric hospitals, reallocating beds, and establishing comprehensive community-based services for individuals with severe and persistent mental health difficulties. This scoping review explores the extensive literature on PDI, spanning decades, regions, socio-political contexts, and disciplines, to identify barriers and facilitators of PDI implementation, providing researchers and policymakers with a categorization of these factors. To identify barriers and facilitators, three electronic databases (Medline, CINAHL, and Sociological Abstracts) were searched, yielding 2,250 references. After screening and reviewing, 52 studies were included in the final analysis. Thematic synthesis was utilized to categorize the identified factors, responding to the review question. The analysis revealed that barriers to PDI include inadequate planning, funding, and leadership, limited knowledge, competing interests, insufficient community-based alternatives, and resistance from the workforce, community, and family/caregivers. In contrast, facilitators encompass careful planning, financing and coordination, available research and evidence, strong and sustained advocacy, comprehensive community services, and a well-trained workforce engaged in the process. Exogenous factors, such as conflict and humanitarian disasters, can also play a role in PDI processes. Implementing PDI requires a multifaceted strategy, strong leadership, diverse stakeholder participation, and long-term political and financial support. Understanding local needs and forces is crucial, and studying PDI necessitates methodological flexibility and sensitivity to contextual variation. At the same time, based on the development of the review itself, we identify four limitations in the literature, concerning "time," "location," "focus," and "voice." We call for a renewed research and advocacy agenda around this neglected aspect of contemporary global mental health policy is needed.

Ignorance and the paradoxes of evidence-based global health: the case of mortality statistics in India’s million death study

ABSTRACT Quantitative evidence and metrics play a central role in contemporary global health. Mortality statistics, for example, are considered essential for improving health in the global South. Yet, many observers lament that reliable cause of death data is not available for many low- and middle-income countries. The Million Death Study (MDS) in India forms an effort to address this issue, seeking to reduce ignorance around mortality by generating representative statistics by combining an existing, representative demographic sample with an innovative diagnostic method called verbal autopsy. Yet, ignorance is more than the absence of reliable mortality statistics in this study. Social science perspectives on institutionalized ignorance can help unpack how certain paradoxes of evidence-based global health manifest through three different articulations of ignorance in the MDS. First, the study’s simultaneously national and global ambitions intersect in arguments that present ignorance as legitimation for the study. Second, ignorance is presented as instrumental in balancing the need for expertise with the risk of bias in diagnosing causes of death. Third, MDS researchers dismiss remaining ignorance or uncertainty about diagnoses, by claiming it is relative compared to the ‘actionability’ of study results for improving public health. In exploring these various manifestations of institutionalized ignorance, several paradoxes of the MDS as an evidence-based global health project become visible. By exploring these paradoxes, this analysis suggests that studies of institutionalized ignorance can provide novel perspectives on how deliberate articulations and mobilization of ignorance helps constitute evidence-based global health.

“We should be at the table together from the beginning”: perspectives on partnership from stakeholders at four research institutions in sub-Saharan Africa

BackgroundGlobal health research partnerships have been scrutinised for how they operate and criticised for perpetuating inequities. Guidance to inform fair partnership practice has proliferated and the movement to decolonise global health has added momentum for change. In light of this evolving context, we sought in this study to document contemporary experiences of partnership from the perspective of stakeholders in four sub-Saharan African research institutions.MethodsWe conducted qualitative interviews with 20 stakeholders at research institutions in four countries in anglophone eastern and southern Africa. Interview questions were informed by published guidance on equitable research partnerships. Data was analysed through an iterative process of inductive and deductive coding, supported by NVivo software.ResultsEarly-career, mid-career and senior researchers and research administrators from four sub-Saharan African research institutions described wide-ranging experiences of partnership with high-income country collaborators. Existing guidelines for partnership provided good coverage of issues that participants described as being the key determinants of a healthy partnership, including mutual respect, role clarity and early involvement of all partners. However, there was almost no mention of guidelines being used to inform partnership practice. Participants considered the key benefits of partnership to be capacity strengthening and access to research funding. Meanwhile, participants continued to experience a range of well-documented inequities, including exclusion from agenda setting, study design, data analysis and authorship; and relationships that were exploitative and dominated by high-income country partners’ interests. Participants also reported emerging issues where their institution had been the prime recipient of funds. These included high-income country partners being unwilling to accept a subordinate role and failing to comply with reporting requirements.ConclusionsInsights from stakeholders in four sub-Saharan African research institutions suggest that contemporary global health research partnerships generate considerable benefits but continue to exhibit longstanding inequities and reveal emerging tensions. Our findings suggest that long-term support targeted towards institutions and national research systems remains essential to fulfil the potential of research led from sub-Saharan Africa. High-income country stakeholders need to find new roles in partnerships and stakeholders from sub-Saharan Africa must continue to tackle challenges presented by the resource-constrained contexts in which they commonly operate.

Antibiotic stories: a mixed-methods, multi-country analysis of household antibiotic use in Malawi, Uganda and Zimbabwe

BackgroundAs concerns about the prevalence of infections that are resistant to available antibiotics increase, attention has turned toward the use of these medicines both within and outside of formal healthcare...

Outsourcing sovereignty: global health partnerships and the state in Zambia

ABSTRACT Global health organisations are increasingly involved in large-scale health interventions in countries in the Global South, partnering with states to implement programmes to strengthen national health systems and promote Universal Health Coverage (UHC). Drawing on an ethnography of a large-scale global health partnership between the Zambian state and the Clinton Foundation, this paper examines the novel configurations of sovereignty that are created by these large-scale global health partnerships. It shows how officials from the Clinton Foundation came to believe that senior Zambian government actors had granted them the authority to implement the programme outside of the formal channels of the government health system. I conceptualise this as an informal mode of ‘outsourcing sovereignty’ and show how it led Clinton Foundation employees to behave as de facto state actors in rural Zambia. This paper contributes to the broader critical task of describing and analysing new forms of governmental pluralism in contemporary global health and highlights some of the politically troubling consequences when sovereignty is informally outsourced in this way.

The interface of multisectoral and multilateral dimensions of public health policy: what's new in the 21st century?

The article examines key developments unfolding in the 21st century in the intersection of multisectoral and multilateral dimensions of public health policy. Several processes and mechanisms, relatively new or rapidly evolving, are fuelling this dynamic interface. They include, in particular, expansion of the spectrum of sectors involved in the health domain, the upsurge of trans-border and commercial determinants of health, growing presence of health issues in multilateral instruments and processes that are outside of the health sector, and strengthening the legal base of intersectoral relations and responsibilities for health. They also encompass and reflect important transformations in health diplomacy and governance for health, some of the fundamentals of contemporary public and global health. The article argues that overall, multisectoral and multilateral dimensions tend to interact, inform and reinforce each other, and that such interaction would be one of important drivers of 21st century intersectoral policy-and international cooperation-for health.

Epidemiological Imaginaries of the Social: Epidemiologists and Pathologies of Modernization in Postcolonial Africa.

There is a growing anthropological literature analyzing the place that epidemiological surveillance occupies in contemporary global health. In this article, I build on this literature and take it into new directions by exploring what I call the epidemiological imaginaries of the social. Drawing on science and technology studies, I suggest that epidemiologists help make up the world, articulating complex and normatively loaded visions of social life that both enable and constrain action. More specifically, I argue that epidemiologists tell stories about the type of societies and people that compose the world and that these stories often shape global health policies and programs in powerful ways. To substantiate this argument, I examine epidemiologists' efforts to map smoking in postcolonial Africa, documenting how they have imagined smokers and smoking through the lense of modernization theory and showing how these imaginaries have shaped tobacco control policies in the region up to this day.

From complexity to simplicity – how chasing success stories affects gendered NGO practices

ABSTRACT This article argues that the “production” of success has become crucial for NGOs to manage their individual brand and secure funding within the contemporary global health and development landscape. Based on an empirical study of a Save the Children project in Malawi aimed at reducing teenage pregnancies by retaining girls in school, it illustrates how gender has become de-politicised within global health. Furthermore, it also shows how their changing role and growing pressure on NGOs to achieve impact and success stories affect NGOs’ ability to represent and understand the lives of women and girls.

Reconnecting for our future: The Lancet One Health Commission

The evolution and sustenance of our planet hinges on a symbiotic relationship between humans, animals, and the environment that we share—we are interconnected. However, this past century has seen human dominance over the biosphere, manifest in technological innovations, accelerated mobility, and converted ecosystems that characterise industrialisation, globalisation, and urbanisation.1 These developmental trajectories have advanced human health in unprecedented ways. However, they also make humans increasingly vulnerable to contemporary global health challenges, such as emerging and re-emerging infectious diseases,2 as shown by the coronavirus disease 2019 (COVID-19) pandemic, antimicrobial resistance (AMR),3 and the increasing burden of non-communicable diseases.