Global Health Ethics Research Articles

Integrating environmental sustainability into the teaching of global health ethics from a students’ perspective: new guiding questions

ABSTRACT Environmental sustainability stands out as a crucial topic in global health. Although this concept has been part of ethical discussions for over two decades, progress toward its adoption within global health ethics education remains slow and hesitant, hindering its integration into global health practice and decision-making processes. As recent global health graduates, we believe that global health relies on the interconnectedness of human and environmental health. Therefore, we sought to address a gap in our ethics formation by proposing the inclusion of an environmental sustainability perspective in global health ethics teaching through a revised question checklist and classroom activity. This question checklist expands on the seven teaching principles for public health ethics by Schröder-Bäck et al. applying an environmental ethics lens to global health ethics. The group activity offers a structured method for students to explore practical applications of environmental sustainability in global health processes. We aim to foster more critical reflections and discussions on this topic among future global health professionals and students, paving the way for a more environmentally sustainable future in global health.

Solidarity and its decoloniality in global health ethics

Solidarity is one of the emerging values in global health ethics, and a few pieces of bioethics literature link it to decoloniality. However, conceptions of solidarity in global health ethics are influenced primarily by Western perspectives, thus suggesting the decolonial needs to include non-Western perspectives. This article explores a decolonial interpretation of solidarity to enrich our understanding of solidarity. It employs a palaver approach, typical of African (Yorùbá) relational culture, in developing a conception of solidarity grounded in a beehive metaphor. Through a decolonial methodological approach, this article posits that a beehive metaphor allegorically symbolises solidarity. In this decolonial interpretive account, solidarity embeds relational virtues and duties that foster harmony. Solidarity is a positively oriented affective disposition with people with whom one shares similar circumstances for harmonious well-being through concerted efforts. This article addresses five potential objections to this account of solidarity in global health ethics and consequently explores what an African account of solidarity means for global health research funding. This article concludes that the palaver decolonial approach from the Global South has implications for expanding conceptual perspectives on solidarity in global health ethics.

全球健康倫理：公共健康倫理發展的一種合作路徑

LANGUAGE NOTE | Document text in Chinese; abstract also in English. Some issues in national public health are increasingly intersecting with global health issues, leading to greater overlap between public health ethics and global health ethics. In this context, scholars from both fields should collaborate with each other to address shared challenges. For instance, when constructing a framework for public health ethics, differences in core values between the East and the West can be addressed through the lens of universal moral responsibility that is emphasised in global health ethics, facilitating the development of principles that respect cultural diversity. Additionally, professionals trained in global health ethics can be selected to work on public health ethics, helping to alleviate the shortage of expertise in this field.

Centering Africa as context and driver for Global Health Ethics: incompleteness, conviviality and the limits of Ubuntu

Silences exist in global health ethics scholarship because of the particular caricatures of Africa that abound in the world, and these silences profoundly impact scholarship in this field. In this paper, I outline three such silences. The first concerns the consequences of representations of Africa as a place of theoretical scarcity, where the only theory seemingly worth mentioning is relational ontology. The second issue I highlight is the impact of dehumanization on global health and ethics. The third concerns the expectation that African science should serve the goal of development, which limits not only the scientific imagination but also the range of ethical questions that are engaged with. Finally, I turn to Francis Nyamnjoh’s theory of incompleteness and conviviality to propose a shift in bioethics scholarship towards increased focus on the interconnections, encounters and mutual dependency of people and places elsewhere. Incompleteness requires epistemic humility and a curiosity about the views and experiences of others; conviviality is the predisposition required to allow for meaningful exchanges and mutual learning in global health ethics. As a theoretical framework, incompleteness and conviviality are part of a rich African intellectual tradition to help articulate opportunities for a transformative research agenda that helps us understand our world, and its crises, better.

Ethics in Mental Health Research with Haitian Migrants: Lessons from a Community-Based Study in Santiago, Chile.

Migration research poses several unique challenges and opportunities. Conducting ethical global health practice, especially when studying migrant mental health, is of particular concern. This article explores seven challenges and lessons learned in our mixed-methods study conducted to assess the impact of the migration experience on Haitian migrants' mental health in Santiago, Chile. The primary challenges were recruiting in a highly mobile population, building trust and community participation, overcoming language barriers, safety considerations during the Covid-19 pandemic, mitigating potential negative impacts of research on the community, providing psychological support, and finding meaningful ways to benefit the community. We propose moving toward a better and more ethical migrant research practice by ensuring language accessibility, hiring community members for the study team, working with local institutions and nongovernmental organizations, and maintaining sustainable connections.

Looking ahead: ethical and social challenges of somatic gene therapy for sickle cell disease in Africa.

Somatic gene therapy will be one of the most exciting practices of genetic medicine in Africa and is primed to offer a "new life" for persons living with sickle cell disease (SCD). Recently, successful gene therapy trials for SCD in the USA have sparked a ray of hope within the SCD community in Africa. However, the high cost, estimated to exceed 1.5 million USD, continues to be a major concern for many stakeholders. While affordability is a key global health equity consideration, it is equally important to reflect on other ethical, legal and social issues (ELSIs) that may impact the responsible implementation of gene therapy for SCD in Africa. These include informed consent comprehension, risk of therapeutic misestimation and optimistic bias; priorities for SCD therapy trials; dearth of ethical and regulatory oversight for gene therapy in many African countries; identifying a favourable risk-benefit ratio; criteria for the selection of trial participants; decisional conflict in consent; standards of care; bounded justice; and genetic tourism. Given these ELSIs, we suggest that researchers, pharma, funders, global health agencies, ethics committees, science councils and SCD patient support/advocacy groups shouldwork together to co-develop: (1) patient-centric governance for gene therapy in Africa, (2) public engagement and education materials, and (3) decision making toolkits for trial participants. It is also critical to establish harmonised ethicaland regulatory frameworks for gene therapy in Africa, and for global health agencies to accelerate access to basic care for SCD in Africa, while simultaneously strengthening capacity for gene therapy.

Decolonization Projects

Decolonization Projects

Diversity, Equity, and Inclusion on Editorial Boards of Global Health Journals.

The online version contains supplementary material available at 10.1007/s41649-023-00243-8.

Where is knowledge from the global South? An account of epistemic justice for a global bioethics

The silencing of the epistemologies, theories, principles, values, concepts and experiences of the global South constitutes a particularly egregious epistemic injustice in bioethics. Our shared responsibility to rectify that injustice...

Vaccine equity in COVID-19: a meta-narrative review

The topic of inequitable vaccine distribution has been widely discussed by academics, journalists and policy-makers in the context of the COVID-19 pandemic. However, research into perceptions of vaccine equity has...

An Online Ethics Curriculum for Short-Term Global Health Experiences: Evaluating a Decade of Use

Background:Medical students and early career healthcare professionals commonly participate in short-term experiences in global health (STEGH).Objective:The authors evaluate the use of a free-to-access, case-based online curriculum addressing ethical issues trainees should consider prior to engaging in STEGH.Methods:Demographic data and feedback on specific cases were collected from 5,226 respondents accessing the online curriculum between November 1, 2011 and October 31, 2021. Feedback on the curriculum included 5-point Likert scale and open-ended responses. Quantitative data were analyzed using standard descriptive statistics. Qualitative data were independently dual coded and analyzed thematically in NVivo.Findings:The curriculum reached respondents from 106 countries. Undergraduate (36%) and graduate (38%) respondents included those from several different professional specialties. Less than a quarter of all of respondents, less than half with previous global health experience, and one-third with planned future global health experiences had received prior global health ethics training. Overall, the curriculum was highly rated; respondents felt it provided necessary tools to improve their thought processes, confidence, and behavior when encountering ethical issues during STEGH. Areas for curriculum improvement include balancing case specificity with generalizability.Conclusion:This curriculum has met a need for accessible introductory global health ethics education and demonstrates successful use of an online platform in case-based ethics learning.

Scientific Consensus, Doctrinal Paradox and Discursive Dilemma

Global ignorance about Africa continues to sustain inappropriate global interventions to resolve public health crises, often with disastrous consequences. To explain why this continues to happen, I marshal two theorems that predict basic statistical properties, called ‘the doctrinal paradox’ and ‘the discursive dilemma’, which underlie scientific consensus formation and evidence-based decision making on a global scale. These mathematical results illuminate the epistemic and material injustices committed by the protocols of medical research conducted at the highest level of global knowledge production in the service of international humanitarian aid for Africans. These social choice theorems reveal that a global scientific consensus projecting claims and proposing policies about Africa’s disease burden is likely to yield a low degree of reliability, in that the probability of its accuracy is less than chance. The solution to this anomaly is to remove from the global scientific agenda the statistically unrealisable demand of satisfying too many multinational corporate and foreign governments’ priorities as equally entitled to benefit from the knowledge produced to improve Africa’s public health sector. Instead, foreign funding targeted to support medical science and policy in Africa should be directed by those specialists in situ who are most familiar with their own national health challenges and potential solutions, rather than relying upon foreign decision makers to interpret Africa’s emergency public health care needs.
 
 Keywords
 Doctrinal paradox, discursive dilemma, scientific consensus, epistemic trust, global health ethics, group agency

A learner-centered global oral health education approach

Objectives: The present research indicates an increased interest in global health among dental students. We focused on developing our future dental practitioners with the skills and capacity to treat underserved populations as international experiences. Materials and Methods: This pilot explored the perspective of dental learners regarding global oral health knowledge who had experienced mission trips. Participants were assessed with a validated global oral health survey to understand their existing knowledge. Gaps in training were noted and a global oral health interactive module was created to address international community service learning approaches. Later, all students who intended to participate in a global oral health education or mission trip were administered the same validated pre-test. Finally, on the completion of mission trips or global oral health experiences, the same post-global oral health questionnaire survey was administered to assess knowledge gained. Results: Thirty-two dental students (Female = 18 and Male = 14) and learners who had completed mission trips to Jamaica and the Dominican Republic were invited to complete the pre-survey. Twenty-seven students completed the pre-survey in its entirety. About 41% (11/27) were not aware of developed and developing countries’ oral healthcare systems. Participant dental learners (56%) expressed limited cultural competency. They also expressed the lack of global health ethics (52%) awareness (knowledge). Conclusion: Results indicated that students benefited from a structured global oral health module, where their perspectives shifted positively. The results suggested that a shift from “mission trip” perspectives to a global oral health readiness is feasible as a student empowerment approach.

Crossing the Innovation Chasm: Identifying Facilitators and Barriers to Early Adoption of the Global Health Starter Kit Curriculum.

Purpose:The Global Health Starter Kit (GHSK) is an interdisciplinary, competency-based, open access global health curriculum covering global disease and demographic trends, Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs), the connection between oral health and overall health, social determinants of health, and concepts of sustainable and ethical global health programs. In this study, we evaluate and describe barriers to and facilitators for using and implementing the GHSK curriculum across a variety of new users.Methods:This two-phase study uses the Roger’s Adoption Curve concept to standardize this evaluation and inform a strategic plan for continuing to move the curriculum across the chasm from early adopters to an early majority of global oral health educators and learners. We utilized a theoretical adoption framework to identify facilitators and barriers under the domains of innovation and curricular, educator and learner, and institutional and structural factors. Under qualitative Phase 1, five early adopter institutions were interviewed to elicit understanding of factors that contribute to adoption of the GHSK curriculum. Common themes identified were next used to create a Phase 2 quantitative survey for early majority subscribers of the GHSK (N = 27).Results:These qualitative and quantitative results showed an overall high satisfaction with the quality of the GHSK materials, but also effectively identified barriers to its adoption, including inexperience of faculty in teaching global oral health, a lack of awareness and marketing, and absence of global health accrediting requirements.Conclusions:By identifying the barriers and facilitators of GHSK curriculum integration, this study provides concrete and specific opportunities to improve its format, relevance, content, and delivery. This study outlines next steps to creating a standardized approach to successfully adopting competency-based global oral health teaching and learning.

Smoking, Comorbidities, and Severity of Disease in Hospitalized COVID-19 Patients in Japan

Background: The aim of this study was to identify associations between smoking status and the severity of COVID-19 using a large-scale data registry of hospitalized COVID-19 patients in Japan (COVIREGI-JP) and to explore the reasons for the inconsistent results previously reported on this subject. Methods: The analysis included 17,702 COVID-19 inpatients aged 20-89 years (10,279 men and 7,423 women). We graded the severity of COVID-19 (grade 0 to 5) according to the most intensive treatment required during hospitalization. Associations of smoking status with severe grade 3/4/5 (invasive mechanical ventilation/extracorporeal membrane oxygenation/death) and separately with grade 5 (death) were analyzed using multiple logistic regression with grade 0 (no oxygen) as the control group. Results were expressed as odds ratios (OR) and 95% confidence intervals (CI) adjusted for age and other factors considering the potential intermediate effects of comorbidities.Findings: Among men, former smoking significantly increased the risk of grade 3/4/5 and grade 5, with age-adjusted ORs (95% CI) of 1·50 (1·18-1·90) and 1·65 (1·23-2·21), respectively. An additional adjustment for comorbidities weakened these ORs to 1·29 (1·00-1·66) and 1.41 (1·01-1·95), respectively. Similar results were seen for women. Current smoking did not significantly increase the risk of grade 3/4/5 and grade 5 in either sex.Interpretation: Smoking cessation should be recommended even if the observed relationship between current smoking and the severity of COVID-19 is null because current smoking increases the risks of future comorbidities due to different diseases that increase the risk of severe COVID-19.Funding Information: This research was funded by the Health and Labour Sciences Research grant (19HA1003, 20CA2031) and the National Center for Global Health and Medicine (20A-3002).Declaration of Interests: All authors report no conflict of interest.Ethics Approval Statement: This study was approved by the National Center for Global Health and Medicine (NCGM) ethics review (NCGM-G-003494-0).

BIOBANKS. ASSOCIATED RISKS AND BENEFITS

Biobanks are repositories of human organic material, that have an important role in the clinic. The World Health Organization (WHO) and the Global Health Ethics Unit have a great contribution considering the ideology of a well-functioning biobank. At the European Union, the functioning of biobanks is strictly regulated and research is being sustained by programs financed at a community level. The administration of biobanks brings both advantages and risks socially. To prevent these, international standards have been implemented for biobanks. In the research domain but also in the public health domain, an analysis in accordance with the legal framework must be considered in order to preserve the well-functioning of biobanks.

Developing Ethical and Sustainable Global Health Educational Exchanges for Clinical Trainees: Implementation and Lessons Learned from the 30-Year Academic Model Providing Access to Healthcare (AMPATH) Partnership.

Background:There is strong interest among healthcare trainees and academic institutions in global health rotations. There are a number of guidelines detailing the ethical principles for equitable and ethical global health rotations and bilateral exchanges, but it is often challenging to know to implement those principles and develop longstanding partnerships.Objectives:The Academic Model Providing Access to Healthcare (AMPATH) is a 30-year continuous partnership between a consortium of 12 universities in North America and Moi University in Kenya. The AMPATH bilateral educational exchange has had 1,871 North American and over 400 Kenyan clinical trainees participate to date. The article describes the bilateral exchange of trainees including curriculum, housing, and costs and discusses how each is an application of the principles of ethical global engagement.Findings:The article takes the experiences of the AMPATH partnership and offers practical strategies for implementing similar partnerships based on previously published ethical principles.Conclusions:AMPATH provides a model for developing an institutional partnership for a bilateral educational exchange grounded in cultural humility, bidirectional relationships, and longitudinal, sustainable engagement.

62,406 and Counting

AbstractWhat will we remember, as scholars, practitioners, policy‐makers, educators, and citizens, about this acute phase of the catastrophe in the United States? The shocking federal failure concerning testing? That the first shortage was not of ventilators but protective gear? How infection rates and deaths in communities of color, immigrant neighborhoods, and nursing homes mercilessly exposed the relationship between social inequalities and health inequities? I hope we will remember that the field of bioethics did good work under pressure, learned that public health ethics and global health ethics are about securing the conditions for decent lives and decent work as well as saving lives, and committed ourselves to progress on the problem of inequality.

Using Photovoice to Encourage Reflection in Health Professions Students Completing a Short-term Experience in Global Health

Objective. To engage health professions students in a photo and caption sharing methodology to stimulate reflection and inculcate principles related to global health at a formative time in training. Methods. Undergraduate and graduate students from multiple colleges enrolled in a course that would prepare them for an in-country global health experience. As part of the course, participants took photos to illustrate one of three topics: global health ethics, interprofessional practice, or social determinants of health. The iterative and participatory photovoice process was used for students to analyze, discuss, and reflect on their work in country and upon return. Final photos with captions were displayed online. Researchers analyzed photos and captions using content analysis to identify unifying themes. All students were required to complete the photovoice assignment, but only those who gave informed consent were included in the qualitative analysis. Results. Twenty-six students were included in the analysis. Two overarching themes emerged: revelation and adaptation. Revelation encompassed novel elements that surprised the students, including differences and similarities between the United States and Ecuador. Coded segments related to adaptation discussed participants' resourcefulness while challenging work environments, and how they would apply this new perspective to their future practice in the United States. Conclusion. This global health photovoice project provided a unique medium for reflection for health care trainees. This project enhanced our understanding of the learners' perspectives and this new means of expression offered the learners a greater opportunity for deeper reflection. The assignment also revealed gaps in learning related to social determinants of health and areas of concern related to solidarity and privilege.

An International Partnership of 12 Anatomy Departments - Improving Global Health through Internationalization of Medical Education.

Background:At a time of global interconnectedness, the internationalization of medical education has become important. Anatomy as an academic discipline, with its close connections to the basic sciences and to medical education, can easily be connected with global health and internationalization of medical education. Here the authors present an international program based on a partnership between twelve anatomy departments in ten countries, on four continents. Details of a proposed plan for the future direction of the program are also discussed.Objective:The aim is to improve global healthcare by preparing future global healthcare leaders via early international networking, international collaboration and exchange, intercultural experience, and connecting two seemingly distant academic disciplines – anatomy and global health – via internationalization of medical education.Methods:Based in the anatomy course, the program involved early international collaboration between preclinical medical and dental students. The program provided a stepwise progression for learning about healthcare and intercultural topics beyond pure anatomy education – starting with virtual small groups of international students, who subsequently presented their work to a larger international audience during group videoconferences. The above progressed to in-person visits for research internships in the basic sciences within industrialized countries.Findings:Students appreciated the international and intercultural interaction, learned about areas outside the scope of anatomy (e.g., differences in healthcare education and delivery systems, Public and Global Health challenges, health ethics, and cultural enrichment), and valued the exchange travel for basic sciences research internships and cultural experience.Conclusions:This unique collaboration of international anatomy departments can represent a new role for the medical anatomy course beyond pure anatomy teaching – involving areas of global health and internationalization of medical education – and could mark a new era of international collaboration among anatomists.