Global Health Action Research Articles

A new era in global climate change and human health research funding and action – CDC

Background: In 2021, the Centers for Disease Control and Prevention (CDC) established an agency-wide Climate and Health Task Force in response to Executive Order 14008, Tackling the Climate Crisis at Home and Abroad. The Task Force’s objective is to reduce the health impacts of climate change by developing a comprehensive approach to integrate climate and health activities across CDC programs, coordinate with external partners, and increase capacity to prepare for and respond to the health impacts of climate change, particularly among those disproportionately affected. The new agency-wide climate and health strategy emphasizes health equity, surveillance, preparedness, research and communication. Methods: The agency created mission and vision statements that focus on the need to address climate-related health inequities at home and abroad. The Task Force subsequently identified five focus areas for the climate and health strategic framework: Health Equity and Environmental Justice; Surveillance, Analytics, Modeling, and Forecasting; Preparedness, Response, Prevention, and Adaptation; Research, Implementation Science, and Evaluation; and Education and Dissemination. Results: For each focus area, an overarching goal and several priority outcomes have been developed, along with key implementation actions for each outcome, evaluation metrics and implementation timelines. Several of the focus areas have important intersections with other agency priorities, including health equity, emergency preparedness and data modernization initiatives. Conclusion: Climate change is the biggest environmental public health threat of our time, and its direct and indirect impacts on human health and wellbeing are worsening. By implementing the new strategic approach, CDC aims to address this threat by detecting, investigating, forecasting, tracking, preventing, and responding to the public health threats of climate change, addressing health inequities, and strengthening community resilience. Keywords: Climate change; public health; health equity; climate resilience

Why Climate Action Is Global Health Action.

ABSTRACT.The impacts of climate change on global health and populations are far-reaching, yet they disproportionately affect vulnerable groups, thereby exacerbating disparities. As humanity reckons with the emergency of climate change, our global health community needs to contend with our own contributions to greenhouse gas emissions. We know that transformation is possible and that climate action is the antidote to the existential challenge. As a global health community, we have an immense opportunity, responsibility, and commitment to lead, support, inspire, and empower climate action, research, and innovation that align deeply with our mission and core values.

Health impacts of the Russian invasion in Ukraine: need for global health action

More than 1 month since Russia began its illegal invasion of Ukraine the tragic human suffering and loss of life are clear. Each day brings more death, injuries, and stories of people fighting for their lives. The implications of the war extend beyond the military and civilian casualties. There are geopolitical, financial, infrastructural, and health impacts. And the effects of this war, particularly on health and health care within and outside Ukraine, will continue long after violent conflict ends.

Human Monkeypox Outbreak in Non-Endemic Countries: The Need for Global Health Action

Monkeypox (MPX) is a re-emerging zoonotic disease caused by the MPX virus (MPXV), a member of the orthopoxvirus genus of the poxviridae family. Before 2022, local transmission of MPX was essentially limited to the rainforest regions of Central and West Africa where the disease is known to be endemic1. The MPXV is a large DNA virus that is very stable and more efficient than many RNA viruses at detecting and repairing mutations. This makes the virus less prone to higher transmissibility unlike RNA viruses such as SARS-CoV-22. Prior to the 2022 outbreak, two distinct clades of the MPXV were recognized: the Congo Basin (Central African) and the West African clades, otherwise known as Clades I and II in the newly proposed nomenclature. The Congo Basin clade is associated with a higher transmission rate and higher case fatality rate (CFR) of about 11% compared to the West African clade with an estimated CFR of 1%2. The first case of MPX in the ongoing 2022 epidemic among non-endemic countries was reported in the United Kingdom (UK) by the UK Health Security Agency (UKHSA) on 7 May 2022, in a returning traveler from Nigeria. Subsequent cases discovered one week later in London were unrelated to the index case and had no travel links to endemic regions in Africa3. Since then, the World Health Organization (WHO) has reported more than 64,300 cases outside Africa in over 90 countries across Europe, the Americas and the West Pacific Regions4. On 23 July 2022, the WHO declared MPX a Public Health Emergency of International Concern (PHEIC). A newly discovered Clade IIb among the circulating strains of MPXV in non-endemic countries has been reported to have similarities with the West African clade but with higher transmissibility1. The WHO projects detection of more cases as surveillance is enhanced to involve more non-endemic countries4. This is surprisingly occurring at a time several countries are lifting COVID-19 pandemic lockdowns with increased international travels.

Harmonising regulatory approval for antibiotics in children

Antimicrobial resistance represents a substantial threat to the Sustainable Development Goals (SDGs), with a large impact on the health of children worldwide. 1 Alfvén T Dahlstrand J Humphreys D et al. Placing children and adolescents at the centre of the Sustainable Development Goals will deliver for current and future generations. Glob Health Action. 2019; 121670015 Crossref PubMed Scopus (11) Google Scholar , 2 Laxminarayan R Bhutta ZA Antimicrobial resistance—a threat to neonate survival. Lancet Glob Health. 2016; 4: e676-e677 Summary Full Text Full Text PDF PubMed Scopus (29) Google Scholar However, very few paediatric trials for new antibiotics have been done to inform the optimal treatment of multidrug-resistant infections in children. The current drug regulatory framework has evolved from a system that rightly aimed to protect children, yet remains governed by interpretation of laws established in response to historical incidents involving agents that caused harm. 3 National Institute of Medicine (US)Forum on Drug Discovery, Development, and Translation. Addressing the Barriers to Pediatric Drug Development: Workshop Summary. Regulatory Framework, Washington, DC2008 Google Scholar This approach, particularly for medicines from well established classes with a long experience of safe use in children (such as β-lactam penicillins), now unnecessarily complicates the process of paediatric antibiotic development, and is one of the many barriers to children with multidrug-resistant infections being appropriately treated with licensed drugs. Regulatory approval for anti-infectives in childrenWe recognise the challenges in doing clinical trials for anti-infectives in children and thank Phoebe Williams and colleagues1 for highlighting some of these challenges. We have provided clarifications to address some points raised by the authors. Full-Text PDF

The Impact of Weather on Hospitalization due to Pneumonia Among Children in Nghe An from 2014 to 2019

This paper studies the impact of weather on the number of under 15-year-old children hospitalized for pneumonia at Nghe An Pediatric Hospital using time series analysis of the data collected from 2014 to 2019. The study was carried out on 45,466 children, most of whom were under 5 years old. The study results show that there was a statistically significant inverse correlation between mean daily temperature and children’s hospitalization for pneumonia while humidity was positively correlated. Specifically, when the average daily temperature increased by 1 degree Celsius, the risk of hospitalization for pneumonia on the same day decreased by 1% (95% CI: 0.3 - 1.7%); whereas when the humidity increased, the risk of hospitalization increased by 14.4% (95% CI: 0.2 - 30.7%) on the day of hospitalization; risk increased by 16.5% (95% CI: 9.5 - 23.9%) one day before hospitalization; and risk increased by 15.2% (95% CI: 8.2 - 22.7%) two days before hospitalization. The results suggest that children are highly sensitive to weather factors, including temperature and humidity; therefore, it is necessary to take measures to protect children against changing weather.
 Keywords
 Weather, pneumonia, children, effect.
 References
 [1] I. Rudan, et al., Epidemiology and etiology of childhood pneumonia. Bulletin of the World Health Organization 86(5) (2008) 408-416.[2] M. Harris, et al., British Thoracic Society guidelines for the management of community acquired pneumonia in children: update Thorax, 66 (2011) (Suppl 2): p. ii1.[3] Margolis, P. and A. Gadomski, The rational clinical examination. Does this infant have pneumonia? Jama 279(4) (1998) 308-13.[4] World Health Organization, Handbook : IMCI integrated management of childhood illness. 2005, World Health Organization: Geneva.[5] Sönke Kreft, David Eckstein, and Inga Melchior, Global Climate Risk Index 2017, Germanwatch Nord-Süd Initiative e.V.,.[6] Pham Khoi Nguyen, Vietnam's event about sea level rising and climate chang, 2009, Ministry of Natural resources and enviroment.[7] L.M.T. Luong, et al., Effects of temperature on hospitalisation among pre-school children in Hanoi, Vietnam, 26(3) (2019) 2603-2612.[8] D. Phung, et al., Temperature as a risk factor for hospitalisations among young children in the Mekong Delta area, Vietnam. Occupational and Environmental Medicine 72(7) (2015) 529.[9] J. Gao, et al., Impact of ambient humidity on child health: a systematic review. PloS one 9(12) (2014) p. e112508-e112508.[10] Y. Liu, et al., Temporal relationship between hospital admissions for pneumonia and weather conditions in Shanghai, China: a time-series analysis. BMJ Open, 4(7) (2014) p. e004961.[11] T. Egondi, et al., Time-series analysis of weather and mortality patterns in Nairobi's informal settlements. Global health action, 5 (2012) 23-32.[12] Leckebusch, G.C. and A.F. Abdussalam, Climate and socioeconomic influences on interannual variability of cholera in Nigeria. Health Place, 34 (2015) 107-17.
 
 
 

Somali-Swedish Research Cooperation for Health (SSRCH) - a joint initiative by Somali and Swedish Universities to guide the Somali health system recovery process

Abstract In the fragile Somali state, there is a research imperative to effectively guide health systems recovery, which is crucial in the national rebuilding process for societal stability and peace. Our collaboration has its roots in the early 1980's, was cut short by the civil war and revived in 2014 to meet the need for health research capacity in Somalia today. Somali universities, representing different regions (East Africa University, University of Hargeisa, Galkayo University, Benadir University, Puntland Health Science University, Amoud University, and recently Somali National University) formed a consortium with Swedish universities (Umeå, Lund, Uppsala, Karolinska Institutet and Dalarna) and Somali diaspora professionals. Most recently we joined forces with the Public Health Agency of Sweden, linking us to the National Institute of Health Somalia (NIHS). A joint action programme for capacity building in health research has been developed, as outlined in the article “Rebuilding research capacity in fragile states: the case of a Somali-Swedish global health initiative” (Glob Health Action, 2017;10:1;1348693). We have a model for working collaboratively across regions and cultural barriers, creating hope for real change. As a first step, priority was given to research capacity development of faculty staff at the Somali universities' health faculties and Ministries of Health. A 'training of trainers' course in health research methodology was carried out during 2016-2018, supported by WHO-based Alliance for Health Policy and Systems Research. This has fostered health research as an integral component of these universities' academic development process. Institutional and research capacity in public health has a key role in rebuilding national health services for better health and wellbeing and to reach the SDGs (goals 3, 5, 10, 16).

Transdisciplinary action for global health: the cases of vaccine hesitancy and Ebola epidemic

Abstract Background The storm of increasing global disease burden and health threats calls for the combined utilisation of all disciplines to promote global health. In practice, natural sciences and clinical perspectives still dominate global health discussions and proposed solutions, with little room for effective collaborations with social sciences and humanities. The aim is to examine the extent of multidisciplinary collaborations in global health, identify and analyse the types of actors and disciplinary approaches employed, and the modes or patterns of multidisciplinarity. Vaccine hesitancy and refusal, and the Ebola epidemic of 2014-16 serve our analysis as two case studies of recent global health threats, that brought various global health actors together in diverse projects: Methods A literature review was conducted using the PubMed database and Google Scholar over a period of five years (2014-2019). Results The findings suggest that different social science and humanities disciplines were involved in solving global health threats at different stages and in various ways. We identified two types of collaboration: 1) Reactive collaborations where a team of health experts in the natural sciences turn to social sciences only because of challenges in implementing the project. 2) Interactive collaborations, that aim to involve social sciences in the early stages of research, development, and implementation of programs to understand and work effectively within the cultural and social contexts of communities affected by health emergencies. This type of interaction pays more attention to affected populations and the health workers, who are responsible for implementing the SDGs and global health interventions. Conclusions Disciplinary hierarchies are huge barriers to solving global challenges. A transdisciplinary framework has most potential to respond effectively to global health threats and action is needed to implement this approach in global health education.

Strengthening Lao TPHI

Abstract With support from the European Union, the Lao Tropical and Public Health Institute developed policy advice in the area of reproductive health and rights and in the area of nutrition. The institute published its findings in a special edition of the journal Global Health Action in July 2020. The institute was able to communicate with decision-makers in government to improve policies in nutrition and reproductive health. The institute was also able to work together with youth groups to improve their understanding. The Lao TPHI organised meetings, conferences and produced policy briefs, which contributed to the exchange. Most important lesson learned: more emphasis on knowledge translation in the institute was an important step forward in improving the dialogue between researchers and policy makers and non-governmental stakeholders.

Building a global policy agenda to prioritize preterm birth: A qualitative analysis on factors shaping global health policymaking

Background: Preterm birth, defined as infants born before 37 weeks of gestation, is the largest contributor to child mortality. Despite new evidence highlighting the global burden of prematurity, policymakers have failed to adequately prioritize preterm birth despite the magnitude of its health impacts. Given current levels of political attention and investment, it is unlikely that the global community will be adequately mobilized to meet the 2012 Born Too Soon report goal of reducing the preterm birth rate by 50% by 2025. Methods: This study adapts the Shiffman and Smith framework for political priority to examine four components contributing to policy action in global health: actor power, ideas, political context, and issue characteristics. We conducted key informant interviews with 18 experts in prematurity and reproductive, maternal, newborn, and child health (RMNCH) and reviewed key literature on preterm birth. We aimed to identify the factors that shape the global political priority of preterm birth and to describe policy opportunities to increase its priority moving forward. Results: The global preterm birth community (academic researchers, multilateral organizations, government agencies, and civil society organizations) lacks evidence about the causes of and solutions to preterm birth; and country-level data quality is poor with gaps in the understanding required for implementing effective interventions. Limited funding compounds these challenges, creating divisions among experts on what policy actions to recommend. These factors contribute to the lack of priority and underrepresentation of preterm birth within the larger RMNCH agenda. Conclusion: Increasing the political priority of prematurity is essential to reduce preventable newborn and child mortality, a key target of the 2030 Sustainable Development Goal for health (target 3.2). This study identifies three policy recommendations for the preterm birth community: address data and evidence gaps, clarify and invest in viable solutions, and bring visibility to prematurity within the larger RMNCH agendas.

Clinical, Paraclinical Characteristics and Pathogens of Pneumonia in Children at the Pediatric Deparment, Bach Mai Hospital

This study describes the clinical, paraclinical characteristics and pathogens of pneumonia in 195 children with pneumonia at the Pediatric Department, Bach Mai Hospital from January to June 2019. According to the study results, most of the cases were aged under five (93.3%) with pneumonia clinical features of tachypnea, 99%; cough, 97.4%; crackling sound, 81.6%; respiratory failure, 80.5%; leukocytosis, 55.9%; and high CRP level in serum, 54.9%. There were 90 cases positive with incubated bacteria with the prevalence of three nasopharyngeal carriages: S.pneumoniae was 48.7%; H.influenzae, 27.8%; and M.catarrhalis, 18.3%. All the bacteria were susceptible to almost all the antibiotics used in treatment, such as Amoxicillin/acid clavunamic, cefotaxim and ceftriason. The study concludes that clinical and paraclinical characteristics in children with pneumonia were fairly various and bacterial pathogens of pediatric pneumonia were similar and susceptible to basic antibiotics.
 Keywords
 Pneumonia, Steptococcus pneumoniae, Haemophilus influenzae, antibiotic-resistant.
 References
 [1] T.K.P. Nguyen, T.H.Tran, C.L. Roberts et al, Child pneumonia – focus on the Western Pacific Region, Paediatr Respir Rev 21 (2017) 102-110.[2] P.M.M. Yan Jin, Jose Irineu, Rigotti et al, Cause-specific child mortality performance and contributions to all-cause child mortality, and number of child lives saved during the Millennium Development Goals era: a country-level analysis, Glob Health Action 11(1) (2018) 1-20.[3] L. Liu, S. Oza, D. Hogan et al, Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the Sustainable Development Goals, Lancet Child Adolesc Health 16 (2016) 31593-31598.[4] WHO, World Health Statistics, 2015.[5] Bonita F. Stanton and Richard E. Behrman (2016), Overview of Pediatrics, Robert M. Kliegman Nelson Text Book of Pediatrics, 20th Edition, (Elsevier), Philadelphia, 20-39.[6] L.N. Tra, Biologycal constant of Vietnamese in 90th decade, 20th century. Medical Publishing house, Hanoi ( 2004).[7] WHO, Anemia. Global Database on Anaemia, (2015) 4-9.[8] Thomas Bénet, Sánchez Picot, Mélina Messaoudi et al, Microorganisms Associated With Pneumonia in Children <5 Years of Age in Developing and Emerging Countries: The GABRIEL Pneumonia Multicenter, Prospective, Case-Control Study, Clin Infect Dis 65(4) (2018) 604–612.[9] S.E. Katz and D.J. Williams, Pediatric Community-Acquired Pneumonia in the United States Changing Epidemiology, Diagnostic and Therapeutic Challenges, and Areas for Future, Infect Dis Clin North Am 32(1) (2018) 47–63.[10] Yi-Yi Yu, Luo Ren, Yu Deng et al, Epidemiological characteristics of nasopharyngeal Streptococcus pneumoniae strains among children with pneumonia in Chongqing, China, Sci Rep (9) (2019) 1-8.[11] Mohamed M Rashad, Sahar M Fayed and Aly Mona K El-Hag, Iron-deficiency anemia as a risk factor for pneumonia in children, Benha Medical Journal 32(2) (2015) 96-100.[12] Sopio Chochua, Valérie D'Acremont, Christiane Hanke et al, Increased Nasopharyngeal Density and Concurrent Carriage of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis Are Associated with Pneumonia in Febrile Children, PLoS One 11(12) (2016) 1-12.[13] Le Thi Hong Hanh, Đao Minh Tuan, Nguyen Duy Bo et al, Pneumonia at the Respiratory Department and Allergy Immunology Department of National Children Hospital in 2015, Vietnam Medical Journal 447 (2016) 70-75.[14] Ministry of Health, Guinline diagnosis and treatment pneumonia in children, 2015.[15] A. Zafar, R. Hasan, S. Nizamuddin,, Antibiotic susceptibility in Streptococcus pneumoniae, Haemophilus influenzae and Streptococcus pyogenes in Pakistan: a review of results from the Survey of Antibiotic Resistance (SOAR) 2002–15, J Antimicrob Chemother 71(1) (2016) 103-109.

Building a global policy agenda to prioritize preterm birth: A qualitative analysis on factors shaping global health policymaking.

Background: Preterm birth, defined as infants born before 37 weeks of gestation, is the largest contributor to child mortality. Despite new evidence highlighting the global burden of prematurity, policymakers have failed to adequately prioritize preterm birth despite the magnitude of its health impacts. Given current levels of political attention and investment, it is unlikely that the global community will be adequately mobilized to meet the 2012 Born Too Soon report goal of reducing the preterm birth rate by 50% by 2025. Methods: This study adapts the Shiffman and Smith framework for political priority to examine four components contributing to policy action in global health: actor power, ideas, political context, and issue characteristics. We conducted key informant interviews with 18 experts in prematurity and reproductive, maternal, newborn, and child health (RMNCH) and reviewed key literature on preterm birth. We aimed to identify the factors that shape the global political priority of preterm birth and to describe policy opportunities to increase its priority moving forward. Results: The global preterm birth community (academic researchers, multilateral organizations, government agencies, and civil society organizations) lacks evidence about the causes of and solutions to preterm birth; and country-level data quality is poor with gaps in the understanding required for implementing effective interventions. Limited funding compounds these challenges, creating divisions among experts on what policy actions to recommend. These factors contribute to the lack of priority and underrepresentation of preterm birth within the larger RMNCH agenda. Conclusion: Increasing the political priority of prematurity is essential to reduce preventable newborn and child mortality, a key target of the 2030 Sustainable Development Goal for health (target 3.2). This study identifies three policy recommendations for the preterm birth community: address data and evidence gaps, clarify and invest in viable solutions, and bring visibility to prematurity within the larger RMNCH agendas.

Explaining the impact of environmental risk factors on cardiovascular health by the “exposome” concept

There is growing evidence that environmental risk factors (pollution and non‐chemical stressors) contribute to the global burden of cardiovascular, metabolic and mental disease. Clinical and epidemiological studies support that traffic‐associated environmental risk factors, air pollution and noise exposure, are associated with a higher risk for cardiovascular disease and significantly contribute to overall mortality. According to the results of the Lancet Commission on pollution and health, up to 9 Mio global annual deaths can be attributed to environmental pollution [Landrigan et al., Lancet 2018]. The numbers will rather increase in the future, because of increasing urbanization and continuous refinement of global exposure‐mortality models, which is supported by the recently reported global all‐cause mortality rate attributable to ambient air pollution by PM2.5 and O3 of 8.79 Mio [Lelieveld et al. and Münzel, Eur Heart J 2019]. Air pollution is obviously the leading health risk factor in the physical environment, followed by water and soil pollution with heavy metals, pesticides, other chemicals and occupational exposures. However, non‐chemical environmental health risk factors such as mental stress, light exposure, climatic changes and traffic noise are so far ignored by global health action plans. Especially for traffic noise‐related health effects there are numerous clinical and epidemiological studies reporting significant impact on cardiovascular disease. In this respect, the “exposome” concept represents a comprehensive description of lifelong exposure history and a rather novel scientific field that is now investigated more systematically. We here provide an in‐depth overview on the health effects of the external exposome, with emphasis on air pollution and traffic noise, and briefly present the actual studies on this topic. In addition, we summarize our previously published experimental research investigating effects of aircraft noise exposure in mice and men providing mechanistic insights on how noise contributes to non‐communicable disease.Support or Funding InformationThe present work was supported by the Boehringer Ingelheim Foundation “Novel and neglected risk factors” (to A.D. and T.M.).The exposome concept. The external exposome represents the sum of all environmental exposures including behavioral/ lifestyle factors. The external exposome (e.g. mental stress and environmental pollution) confer changes of the internal exposome (e.g. altered circadian clock by forward/backward shift, stress hormones, inflammation and oxidative stress) leading to health risks and disease conditions (e.g. atherosclerosis, vascular stenosis and myocardial infarction). BJP, submitted.Figure 1

Suicide and Suicide Prevention From a Global Perspective.

In this introductory chapter, we provide the background and rationale for the compilation of overviews of national suicide prevention strategies from all geographic regions globally. Currently, suicide is the second leading cause of death among young people aged 15-29 years at global level. Overall, suicide rates in low- and middle-income countries (LMIC) are lower than the rates in high-income countries (HIC) of 11.2 per 100,000 compared with 12.7 per 100,000 population, but the majority of suicide deaths worldwide occur in LMICs. However, there are ongoing challenges in relation to the accuracy of suicide figures in many countries. The rationale for the global approach to suicide prevention is linked to major strategic documents provided by the WHO, including the Global Mental Health Action Plan, 2013-2020, the WHO report Preventing Suicide: A Global Imperative, in 2014, and the United Nations Sustainable Development Goals (SDGs) for 2030, including a target of reducing premature mortality from noncommunicable diseases by one-third, with suicide mortality rate identified as an indicator for this target. In addition, a review is provided of the evidence base and best practice of suicide prevention programs.

Globalization, internet and psychiatric disorders: Call for research and action in global mental health

BackgroundStudies have largely analyzed the association between globalization and mental health. However, the main focus has been on the challenges of migration trauma and living together into multicultural societies. Yet, Internet-related mental disorders are poorly studied, while Internet, as the main tool of 21st century globalization, is reconceptualizing psychiatric illnesses. AimsThis current debate paper discusses the association between globalization, Internet and mental disorders. It aims to stimulate a current, important, urgent and necessary debate to integrate this important characteristic of globalization in the genesis, etiology, and treatment of mental disorders. ObservationsAlthough studies have been conducted on the relation between mental health and Internet (cyberbullying, online gambling addiction, cyberdependence, etc.), none has integrated globalization in their analysis. Similarly, Internet-related traumas are less explored, while traumatic images from the Internet are increasingly present in the children, adolescents and adults’ lives. Also, globalization is based primarily on the interconnectedness of institutions, populations and individuals and plays an increasingly key role in the individuals’ life. The resulted hyperconnectivity is bringing new mental disorders, reconceptualizing others and, above all, can obsolete mental disorder classification manuals if the various factors associated with it are not integrated. ConclusionsThis study shows that it is important to adapt our tools for assessing, classifying and describing mental disorders in the light of this new reality of globalization. With a perspective both as a researcher and a clinician, it shows research and action options needed before the train is too far away and difficult to catch.

Gender Based Violence and Health Effects

Gender Based Violence (GBV) violates the basic human right of a person’s physical, sexual and emotional integrity and health ([i]) such that globally, one out of every three women is subject to some form of violence, ranging from verbal and physical abuse to emotional blackmailing and  psychological torture eventually leading to futile despair and hopelessness. The ironical perception of gender equality in our society is the root cause of gender based violence, with women being more afflicted by such a form of gender discrimination than men [i].  Ali TS, Krantz G, Gul R, Asad N, Johansson E, Mogren I. Gender roles and their influence on life prospects for women in urban Karachi, Pak0istan: a qualitative study. Global health action. 2011;4(1):7448.

Promoting radical action for global oral health: integration or independence?

Promoting radical action for global oral health: integration or independence?

A new platform for theories and action in global health

A new platform for theories and action in global health

Clinical Research and Medical Journal

Clinical Research and Medical Journal

Applied global health diplomacy: profile of health diplomats accredited to the UNITED STATES and foreign governments

BackgroundGlobal health diplomacy (GHD) is a burgeoning field bridging the priorities of global health and foreign affairs. Given the increasing need to mobilize disparate global health stakeholders coupled with the need to design complex public health partnerships to tackle issues of international concern, effective and timely cooperation among state actors is critical. Health Attachés represent this coordination focal point and are key diplomatic professionals at the forefront of GHD. Despite their unique mandate, little is published about this profession and the perspectives of those who work in the field.MethodsThrough purposive sampling, we performed in-depth qualitative interviews with seven Health Attachés: three foreign Health Attachés accredited to the United States and four U.S. Health Attachés accredited to foreign governments. Our interviews explored four key topics: the role and mission of Health Attachés, skills needed to perform GHD, examples of successes and challenges in accomplishing their respective missions, and suggestions for the future development of the diplomatic profession.ResultsWe identified several lessons to apply to the growing field of GHD. First, GHD actors need to receive appropriate training to successfully negotiate the intersection of global health and foreign affairs. Participants suggested several areas of training that would benefit GHD actors: diplomacy and negotiation, applied science, and cross-cultural competency. Second, participants articulated the need for a career path for GHD practitioners, increased opportunities for on-the-job training and mentored experiences, and GHD competencies with defined levels of mastery that can be used in occupational evaluation and career development.ConclusionsOur findings indicate that skills in diplomacy and negotiation, applied science, and cross cultural competency are essential for the statecraft of Health Attachés. Additionally, establishing a clear career pathway for Health Attachés is critical for future maturation of the profession and for fostering effective global health action that aligns public health and foreign diplomacy outcomes. Achieving these goals would ensure that this special cadre of diplomats could effectively practice GHD and would also better position Health Attachés to take the lead in advancing shared global health goals among nation states in a new era of twenty-first century diplomacy.