Global Advocacy Research Articles

The Power of Advocacy: Advancing Vision for Everyone to Meet the Sustainable Development Goals.

Advocacy is instrumental to achieving significant policy change for vision. Global advocacy efforts over the past decades enabled recognition of vision as a major public health, human rights, and development issue. The United Nations General Assembly adopted its first-ever Resolution on vision: “Vision for Everyone—Accelerating Action to Achieve the Sustainable Development Goals (SDGs)” on 23 July 2021. The Resolution sets the target and commits the international community to improve vision for the 1.1 billion people living with preventable vision impairment by 2030. To fulfill their commitments, governments and international institutions must act now. Advocacy remains instrumental to mobilize funding and empower governments and stakeholders to include eye health in their implementation agenda. In this paper, we discuss the pivotal role advocacy plays in advancing vision for everyone now and in the post-COVID-19 era. We explore the link between improved eye health and the advancement of SDGs and define the framework and key pillars of advocacy to scaling-up success by 2030.

Advancing Global Palliative Care Over Two Decades: Health System Integration, Access to Essential Medicines, and Pediatrics.

Between 2000 and 2020 Open Society Foundations was one of very few funders that supported global palliative care development and advocacy. To describe progress made in three priority areas-the integration of palliative care into public health systems, access to controlled medicines, and pediatric palliative care-during those 20 years. Activities and developments between 2000 and 2020 on global integration of palliative care into health systems, access to and availability of controlled medicines, and pediatric palliative care are described and analyzed. Major progress has been made in each area. Whereas in 2000, integration of palliative care into public healthcare systems was on the agenda in just a few pioneering countries, by 2020 a global consensus had emerged that palliative care should be integral to all health systems including in universal health coverage and countries were increasingly taking steps to integrate it into national health systems. While limited availability of these medicines was barely recognized as a public health or drug control issue in 2000, it had become an important priority in global drug policy debates by 2020 and numerous countries had taken steps to improve access to these medicines. Pediatric palliative care, available mostly in a small number of wealthy countries in the 1990s, has seen rapid growth, especially in low- and middle-income countries, and now has a solid foothold in all world regions. Despite this progress, significant challenges remain as funding for palliative care advocacy is limited, the overdose crisis in the US has recently had a chilling effect on efforts to improve availability of opioid analgesics, and economic crises related to the COVID-19 pandemic create uncertainty over the future of universal health coverage.

The trouble with ‘quiet advocacy’: local journalism and reporting climate change in rural and regional Australia

Climate activists and environmental communicators stress that addressing the climate crisis requires both global and local advocacy for transformational change-making. While journalists in small, rural communities are known to actively advocate on issues for the common good, there has been little investigation of local media advocacy on climate change in rural Australia: a region at the forefront of global heating. This paper analyses the accounts of local journalists of their media coverage of the School Strikes 4 Climate in rural and regional Australia, as an empirical entry point for a conceptual discussion of local media advocacy in reporting climate change. We find that normative ideas about journalism coupled with polarised community views on climate change hindered these journalists from taking an advocacy stance. We explore and critique the tacit ‘quiet advocacy’ practices used by these journalists reporting on climate in rural and regional Australia.

Insights into the advanced non-small cell lung cancer patient journey: Treatment decision-making, preferences, and quality of life considerations.

e21129 Background: Individuals with advanced non-small-cell lung cancer (aNSCLC) who have undergone multiple lines of prior therapy face a poor prognosis and limited treatment options, significantly impacting quality of life (QoL). This exercise explored European, North, and South American patient advocate perspectives on QoL and its relation to treatment decision-making and preferences in aNSCLC. Methods: A global aNSCLC patient advocacy advisory board was convened with organizations from Europe, US, Canada, and Brazil, asking participants about QoL and treatment side effects, and how these relate to subsequent care and treatment decision-making. The discussion was moderated by an oncologist, transcribed, and analyzed using thematic analysis. Results: Preserving one’s independence was highlighted as a key component of QoL, with advocates noting that tumor-related symptoms and treatment toxicities have a substantial negative impact on an individual’s ability to engage in daily activities. Fatigue – both physical and psychological – is especially burdensome, particularly for those who have undergone multiple lines of therapy. Participants also noted the need for more accessible care (e.g., telehealth appointments, oral therapies) that fits into the routines of individuals and caregivers. The importance of palliative care and its ability to improve QoL was noted, showing the need for health systems to better integrate palliative care into treatment regimens. Finally, participants noted that treatment priorities change as individuals undergo subsequent lines of therapy, with participants noting the importance of independence and QoL in later stages of therapy, and thus must be assessed regularly by the care team. Conclusions: Individuals with aNSCLC place importance on consideration of QoL when making treatment decisions, particularly those related to maintaining independence. While there remains a need for additional and more effective therapies, an integrated and accessible care approach, with patient-provider communication focusing on maintaining QoL and independence, should be a priority.

An Econometric Analysis of Clean Energy Supply and Industrial Development in Nigeria: Implications for Sustainable Development

The continuous demand and usage of energy in large quantum for industrial purposes has motivated the global advocacy for energy sustainability (SDG-7). Against this backdrop, this study employed various econometric techniques to study the nexus between clean energy supply in Nigeria and industrial development between 1990 and 2019. This study sets to establish the nature of the relationship in the long run, direction of causality and the stochastic dynamic interaction between clean energy supply and industrial development in Nigeria. Consequently, the following findings emerged from this study; clean energy supply and manufacturing value added had a significant negative relationship. This implies that the contribution of clean energy supply is negatively significant to the manufacturing value added in the Country. Therefore, the supply of electricity production from hydroelectric sources had not led to industrial development in Nigeria. Further evidence indicates that no feedback relationship exists between clean energy supply and industrial development. Also, the stochastic dynamic interaction between clean energy supply and industrial development shows a shock to manufacturing value added determines the behavior of clean energy supply to a larger extent in one hand, whereas, variance decomposition of clean energy supply shows the similar effect on the behavior of industrial development on the other hand. In the light of the findings from this study, the following recommendations are made for the policymakers in Nigeria; in achieving the Sustainable Development Goal (SDG 7), clean energy supply could be explored for future industrial development in Nigeria, thought it currently lacks the capacity to drive the manufacturing sector of the economy. And as such, the Nigerian policymakers and other stakeholders should work hard to achieve sustainable supply of adequate electricity production from hydroelectric sources in the country.

Emergence of universal antiretroviral therapy coverage in South Africa: applying the advocacy coalition framework to refine the narratives and inform epidemic responses

South Africa possesses the largest anti-retroviral therapy (ART) program in the world, but the path to this record was dramatic. There is scarce literature employing a comprehensive framework to explain this achievement and inform epidemic responses. This paper applies the Advocacy Coalition Framework (ACF) to analyse the interactions among diverse actors, institutions and networks that were associated with the AIDS policy change in South Africa. Post-apartheid, HIV/AIDS and AIDS-related mortality were serious public health problems. At the time, the discernible coalitions in the HIV/AIDS policy subsystem were the pro-science coalition and AIDS dissidents. In view of the availability of compelling scientific evidence on the pathogenesis of HIV/AIDS, the clinical usefulness of ART, the availability of funding for national ART roll-out, strong global advocacy to reduce the cost of ART, all of these in an era when access to adequate HIV treatment/care was increasingly considered a human right, the environment to establish an appropriate HIV/AIDS policy for the country was conducive. However, AIDS dissidents dominated the policy agenda via their control over key institutions, the use of various dimensions of power, biasing evidence to inform policy, and promoting the activities of strong interest groups that were not in support of ART. National ART roll-out finally emerged as a political priority because of external shocks (on the AIDS policy subsystem) which disfavoured the dominant coalition. As in this important experience in the history of HIV treatment, stakeholders involved in epidemic response tend to engage in intense ideological conflicts. An adequate appraisal of the outcomes of these conflicts in terms of population health gains and adopted public health and social measures to control epidemics would require the supplementation of complex system thinking with relevant public policy concepts, notably power dimensions, governance, emergence of global health networks and evidence use in policy.

Toward inclusive internationalisation of schools: educators’ perspectives on leading students in global experiences

ABSTRACT This article focuses on internationalisation of teaching and teacher education with a specific focus on educators’ experiences in leading global mobility programmes with students. It draws on a qualitative study of the District of Columbia Public Schools (DCPS) Study Abroad Program, a fully-funded education abroad programme aimed at making K12 study abroad more accessible to a greater number of underrepresented US students. Utilising interviews with a sub-set of DCPS classroom teachers and educational staff involved in the programme, findings elaborate on educators’ perspectives on guiding students through the programme, particularly how that experience has informed educators’ own professional identities and classroom practice; their relationships with students; and the new ways that they see themselves as global education advocates.

Christine Jenkins—global advocate for asthma and COPD

Speaking to The Lancet Respiratory Medicine on her first overseas trip since COVID-19 arrived, Christine Jenkins reflects that “one of the few good things that COVID has done is to focus people's attention on how important lung health is for our overall health”. As Chair of the Lung Foundation Australia over the past 6 years, she has been actively raising the profile of lung diseases. For four decades, she has been a clinician-researcher aiming to improve outcomes and care for people with asthma and COPD, and currently heads the Respiratory Group at the George Institute, based at the University of New South Wales (UNSW), Sydney, Australia.

Using Action Research to Mentor Nursing Students in Global Health Advocacy.

The current diverse health care environment makes it vital for nursing students to have multicultural respect and understanding. Collaborative action research can be used to engage students in the learning process. Action research addressing adolescent pregnancy in rural Paraguay involved nursing students in the research process and care delivery. Two groups of nursing students participated in two or more cycles of action research. The first cycle included identifying the problem, research development, data gathering, and interpreting results. Contributing factors to adolescent pregnancy and potential solutions were discovered. Teaching reproductive education informed the second cycle of the action research. Students created reproductive education modules and taught them to more than 700 adolescents in Paraguay. Action research provided a collaborative and engaging method to teach undergraduate nursing students about both global health advocacy and the research process. The cyclic nature of action research provides an excellent way to involve subsequent student groups. [J Nurs Educ. 2022;61(4):193-196.].

The evolution of the global movement to end child marriage

Although international and domestic laws prohibit child marriage, millions of girls are married every year worldwide, a trend only aggravated by the COVID-19 pandemic. Since the turn of the century, the global advocacy movement to end child marriage has gained momentum by standardizing its framing, using testimonies and symbols to generate empathy and mobilize solidarity, and engaging with policymakers to end the practice. In this article, I draw on newspaper articles, advocacy reports, and interviews with activists in the United States and Latin America to identify the reasons behind its success. I also discuss several challenges activists are grappling with as the movement evolves, including intra-network dynamics regarding the centrality of sexuality and the forms child marriage adopts around the world.

Global Justice Advocacy, Trade Unions, and the Supply Chain Law Initiative in Germany

Abstract This article focuses on the Supply Chain Law Initiative in Germany (SCLI)/Initiative Lieferkettengesetz as a case of global justice advocacy. The SCLI was a campaign by German civil society organizations that advocated for a law that would make it mandatory for corporations active in Germany to respect human, labor, and environmental rights along their supply chains. This research explores the strategies for advocacy used by the SCLI in the process of effective law-making. It also investigates the role of the SCLI in the context of global labor solidarity. The research results show that although this new law has some shortcomings in terms of international human rights standards, it has achieved partial progress as one of the most successful examples of alliance building between unions and civil society organizations in Germany. The SCLI has brought about a paradigm shift from voluntary towards mandatory due diligence. This experience can be carried one step further to accomplish a supply chain law at the European Union level. The authors argue that the SCLI experience opens up a new stage for rethinking the structural dilemma of unions in Germany in choosing between global solidarity and national corporatist social partnership.

Transforming Global Health Communications During the COVID-19 Pandemic: International Partner Perspectives.

Background:With the COVID-19 pandemic restricting travel, global health programs are faced with the challenge of bidirectionally supporting students, partners, and communities in new ways. Though other global health programs have—to the best of our knowledge—temporarily frozen, we at the Nuvance Health/University of Vermont Larner College of Medicine Global Health Program have carried forward by transforming our communications through launching a COVID-19 Resources Page with bi-weekly article summaries, redirecting our monthly eMagazine and weekly blog to pandemic themes, and staying in constant communication with our partners around the world.Objective:To investigate the extent to which our program’s published content shifted in sync with the COVID-19 pandemic, as well as our international partners’ perception of the COVID-19 resource center, eMagazine, and blog in terms of relevance, representation, and utility.Methods:A survey consisting of quantitative questions and open-ended response questions was allocated along the following themes: (1) eMagazine; (2) Global Health Diaries blog; (3) COVID-19 Resource Center including article summaries; and (4) communications. It was sent to 34 leaders in our partner sites across nine countries—Botswana, China, the Dominican Republic, India, Thailand, Russia, Uganda, Vietnam, and Zimbabwe—and filled out by 31.Findings:Survey results revealed overwhelmingly positive feedback from our global health partners who reported frequently using our COVID-19 resources, often as first-line information about the pandemic; feeling emotional support through our communications; enjoying content in our eMagazine and blog; and finding fair representation in our published content. Our global health program is more deeply connected than ever.Conclusions:Though global health programs seemingly have their hands tied, we are only beginning to imagine the breadth of new avenues for connectivity, learning, and sharing. We must all be creative about staying connected. There are avenues for global health advocacy yet to be discovered.

Commentary: Dear Federal Chief Nursing Officer: Why Canada Needs You.

Calls for national-level chief nursing officers are over a century old. However, global uptake of these roles and Canadian opportunities for nurses to lead in federal health policy environments have been limited. The absence of such a role in Canada limits connection to global activities, reduces Canadian capacity to participate as a member state in World Health Organization-led nursing activities and, within our borders, leaves the healthcare system without national leadership to coordinate and liaise with senior nurses across our provinces and territories for the benefit of our citizens and systems. In this article, a brief history of global advocacy for state or national level chief nursing officer roles and examples of federal chief nursing officers, in the Canadian context, offers a consideration of the unique contribution of nursing knowledge and leadership to health policy - extending arguments for nursing leadership in the policy arena beyond traditional arguments of strength in numbers or unique claims to caring. Findings from a Canadian national project by the Global Nursing Leadership Institute further illuminate the concrete steps we need to take toward enabling full-spectrum nursing leadership in policy, where policy science, political competency, identification of policy nurses and a revitalization of organizational structures across the country can extend the vision for nursing leadership in policy beyond a single seat at a single table.

Understanding factors impacting global priority of emergency care: a qualitative policy analysis

IntroductionThe high burden of emergency medical conditions has not been met with adequate financial and political prioritisation especially in low and middle-income countries. We examined the factors that have shaped...

Abstract 9584: Familial Hypercholesterolemia Patient Perspectives and their Alignment With the FH Global Call to Action

Introduction: Familial hypercholesterolemia (FH) is an inherited disorder that leads to premature morbidity and mortality due to atherosclerotic cardiovascular disease. The 2020 FH Global Call to Action, produced by international FH global advocacy organizations, individuals with FH, and scientific experts, provides nine recommendations to reduce premature death and the public health burden of FH. We explored alignment of patient and family member perspectives with these recommendations. Methods: Interviews and focus groups were conducted with individuals with FH and their family members from multiple U.S. health systems and members of the FH Foundation community to identify barriers to identification, cascade testing, and treatment. Patient-centered perspectives were sought to develop solutions that can be implemented. These perspectives were then examined and classified, according to their alignment to recommendations within the FH Global Call to Action. Results: Stories from 75 individuals with FH and family members, who participated in at least one of the qualitative assessments, were analyzed. The table lists the FH Global Call to Action recommendations with patient-centric perspectives abstracted from individuals’ stories. The most common stories and perspectives linked to the recommendations for awareness, screening, diagnosis, testing, and treatment, and family-based care. Conclusions: The Global Call to Action recommendations resonate highly with U.S. FH individuals and their family members. Patient-centric perspectives further address the need to prioritize FH as a global public health concern and support FH education and advocacy efforts.

Twitter reacts to absence of women on Wikipedia: a mixed-methods analysis of #VisibleWikiWomen campaign

Digital gender divide (DGD) is visible in access, participation, representation, and biases against women embedded in Wikipedia, the largest digital reservoir of co-created content. This article examined the content of #VisibleWikiWomen, a global digital advocacy campaign aimed at encouraging inclusion of women voices in the global technology conversation and improving digital sustainability of feminist data on Wikipedia. In a mixed-methods study, Sentiment Analysis followed by a Feminist Critical Discourse Analysis of the campaign tweets reveals how digital gender divide manifested in the public response. An overwhelming majority of tweets expressed positive sentiment towards the objective of the campaign. An inductive reading of the coded tweets (n = 1067) generated five themes: Feminist Activism, Invisibility & Marginalization of Women, Technology for Women Empowerment, Gendered Knowledge Inequity, and Power Dynamics in the Digital Sphere. Twitter discourse presented many agitated digital users calling out the epistemic injustice on Wikipedia that goes beyond the invisibility of women. Their tweets reveal that they want an equal social platform inclusive of women of color and varied identities currently absent in the Wikipedia universe. Extracting ideas, values, and themes from new media campaigns holds unparalleled potential in the diffusion of interventions and messages on a larger scale.

The impact of Covid-19 on symptomatic back pain – A new surging epidemic?

BackgroundThe Covid-19 pandemic led to global public health advocacy for a population behavioural and daily routine change. Remote work and social distancing were advocated to curb the community spread. A consequential effect on the physical health of the population is expected. The study aimed to explore whether since the onset of Covid-19 back pain complaints have increased while identifying potential reasons, among the Malta adult population.MethodsAn anonymous online survey was distributed on social media (6th to 20th April 2021). The survey enquired about changes in employment, daily routine, physical activity (PA) patterns and for the presence of back pain before (>6 months duration) and during Covid-19. Data on the socio-demographic status was noted. Descriptive, comparative and multivariant regression analyses were performed.ResultsA total of 388 responded with 30% (CI 95%: 25.55-34.64) reporting chronic back pain pre-Covid-19 while 49% (CI 95%:44.28-54.18) reported back pain since the onset of Covid-19. A significant change in daily routine and physical activity (p < 0.01 respectively) to a more sedentary pattern was observed. Out of those reporting back pain since Covid-19, 51.83% (CI 95%:44.78-58.81) reported a shift to remote working/learning. Indeed, continuously sitting down (OR: 15.53 p = <0.01), no PA (OR:4.22 p = <0.01), once a week PA (OR:5.74 p = <0.01), 2-3 times PA a week (OR:2.58 p = 0.05) and 4-5 PA a week (OR:3.46 p = 0.02) were associated with experiencing back pain since onset of Covid-19, when adjusted for sex, age, education and employment status.ConclusionsThe pandemic led to behavioural changes that have enhanced a sedentary lifestyle with a consequential negative impact on back pain. Those working/learning remotely may be experiencing non-optimal ergonomic conditions intensifying musculoskeletal strain with back pain complaints. Such occurrence is anticipated to increase the burden on the healthcare systems and the disability adjusted-life years.Key messages Covid-19 has impacted on behavioural attitudes and daily routines resulting in enhanced sedentary lifestyles with anticipated consequential effects including back pain.Covid-19 is anticipated to increase the burden on healthcare systems with enhanced chronic diseases occurrences including back pain.

Global leadership in paediatric and congenital cardiac care: "global health advocacy, lift as you rise - an interview with Liesl J. Zühlke, MBChB, MPH, PhD".

Professor Liesl Zühlke is the focus of our fifth in a series of interviews in Cardiology in the Young entitled, "Global Leadership in Paediatric and Congenital Cardiac Care". Professor Zühlke (nee Hendricks) was born in Cape Town, South Africa. She would attend medical school in her hometown at University of Cape Town, graduating in 1991. Professor Zühlke then went on to complete a Diploma in Child Health at College of Medicine in Cape Town followed by completion of her Paediatric and Paediatric Cardiology training in 1999 and 2007, respectively. She would subsequently complete her Masters of Public Health (Clinical Research Methods) at the University of Cape Town, completing her dissertation in 2011 on computer-assisted auscultation as a screening tool for cardiovascular disease, under the supervision of Professors Landon Myer and Bongani Mayosi.Professor Zühlke began her clinical position as a paediatric cardiologist in the Department of Paediatrics and Child Health at the Red Cross War Memorial Children's Hospital in Cape Town, South Africa in 2007. In this role, she has been instrumental in developing a transitional clinic at the paediatric hospital, is a team member of the combined cardio-obstetric and grown-up congenital heart disease clinics, each of which are rare in South Africa, with very few similar clinics in Africa. Professor Zühlke would continue her research training, completing her Doctorate at the University of Cape Town in 2015, with her dissertation on the outcomes of asymptomatic and symptomatic rheumatic heart disease under the supervision of Professor Bongani Mayosi and Associate Professor Mark Engel. In 2015, in affiliation with the University of Cape Town and the Department of Paediatrics and the Institute of Child Health, she established The Children's Heart Disease Research Unit, with the goals to conduct, promote and support paediatric cardiac research on the African continent, facilitate Implementation Science and provide postgraduate supervision and training in paediatric cardiac research. In 2018, she would subsequently complete her Master of Science at the London School of Economics in Health Economics, Outcomes and Management of cardiovascular sciences. Professor Zühlke currently serves as the acting Deputy-Dean of Research at the Faculty of Health Sciences, University of Cape Town.Professor Zühlke has achieved the highest leadership positions within cardiology in South Africa, including President of the Paediatric Cardiac Society of South Africa and President of the South African Heart Association. She is internationally regarded as a leader in research related to rheumatic heart disease. Professor Zühlke's work includes patient, family and health advocacy on a global scale, being involved in the development of policies that have been adopted by major global organisations such as the World Health Organization. In addition to her clinical and research efforts, she is highly regarded by students, colleagues and graduates as an effective teacher, mentor and advisor. This article presents our interview with Professor Zühlke, an interview that covers her experience as a thought leader in the field of Paediatric Cardiology, specifically in her work related to rheumatic heart disease, Global Health and paediatric and congenital cardiac care in resource-limited settings.

Clean Air, Smart Cities, Healthy Hearts: Action on Air Pollution for Cardiovascular Health.

More than twenty percent of all cardiovascular disease (CVD) deaths are caused by air pollution — more than three million deaths every year — and these numbers will continue to rise unless the global community takes action. Nine out of ten people worldwide breathe polluted air, which disproportionately affects those living in low-resource settings. The World Heart Federation (WHF) is committed to reducing the impact of air pollution on people’s health and has made this a priority area of its global advocacy efforts. In pursuit of this goal, WHF has formed an Air Pollution Expert Group to inform action on air pollution for CVD health and recommend changes to public health policy. This policy paper lays out the health impacts of air pollution, examines its position on the global policy agenda, demonstrates its relevance to the cardiovascular community, and proposes actionable policy measures to mitigate this deadly risk factor to health. The paper considers the important roles to be played by the Members of WHF, including scientific societies and the physicians that constitute them, heart health foundations, and patient advocacy groups. The paper concludes with a detailed table of recommendations for the various sub-target groups at the global, national, local, and patient level.

Barriers and facilitators to father involvement in early child health services: A qualitative study in rural Mozambique

Engaging men and increasing their involvement as partners and parents can improve child health and development. Despite the increasing global evidence and advocacy around father involvement and caregiving, there remain few father-inclusive interventions for promoting early child health, especially within primary health systems in low- and middle-income countries. In this study, we explored community perspectives regarding fathers' roles in early child health services during the first three years of life to identify the barriers and facilitators to father involvement in Monapo District in northern, rural Mozambique. A qualitative sub-study was embedded within a qualitative intervention implementation evaluation conducted in October–November 2020. In-depth interviews were conducted with 36 caregivers, 15 health facility providers, 12 community health providers, 4 government officials, and 7 non-governmental partner organizations. Data were analyzed using inductive thematic content analysis. Results revealed that fathers were generally uninvolved in early child healthcare services. Primary barriers to fathers' involvement included the absence of fathers in many households; opportunity costs associated with fathers' accompanying children to health facilities; long waiting times at facilities; negative health provider attitudes towards fathers; and patriarchal gender norms. Respondents also highlighted facilitators of father involvement, which included fathers' broader engagement with their child at home; fathers’ desires to support their partners; parental awareness about the importance of father involvement in child healthcare; and community outreach and sensitization campaigns targeting fathers directly. Our study highlights opportunities for enhancing the focus, design, and delivery of child health services so that they are more inclusive and responsive to fathers. Future research should assess the feasibility, acceptability, and effectiveness of father-focused child health interventions on caregiving and early child health and development outcomes. These strategies should holistically address not only individual and household factors, but also broader structural and sociocultural determinants at the health system and community levels.