Global Health Inequalities Research Articles

Global burden of pediatric urolithiasis: A trend and health inequalities analysis from 1990 to 2021

This research seeks to evaluate the worldwide burden, health inequities, and projected trends of pediatric urolithiasis from 1990 through 2021. We calculated age-standardized incidence rates, prevalence rates, and disability-adjusted life years rates from the 2021 Global Burden of Disease database. Joinpoint regression was applied for time-trend analysis. Health disparities were measured by using Spearman correlation analysis, Relative Concentration Index, and Slope Index of Inequality. Bayesian Age-Period-Cohort models predicted future global age-standardized incidence rates trends. Global age-standardized incidence rates declined from 79 (95% confidence interval [CI], 38–132) cases per 100,000 population in 1990 to 75 (95% CI, 37–124) cases per 100,000 in 2021, although the total number of cases rose. Age-standardized incidence rates decrease sharper in high Socio-Demographic Index regions. Geographical differences reveal significant health disparities, with age-standardized disability-adjusted life years rates higher in countries with a low Socio-Demographic Index. Bayesian Age-Period-Cohort models forecast a slight rise in global age-standardized incidence rates.Conclusions: While global age-standardized incidence rates for pediatric urolithiasis have shown a downward trend, the increasing number of cases and persistent age-standardized disability-adjusted life years rates burden in low-SDI regions underscore pressing concerns. Efforts focused on prevention, early detection, and equitable access to healthcare are critical to bridging these gaps and improving global outcomes.What is Known:• Pediatric urolithiasis imposes a significant global burden, with higher recurrence rates and long-term impacts on kidney function.• The incidence of urolithiasis in children varies greatly in different countries or regions around the world.What is New:• This study provides the comprehensive analysis of global trends and health inequalities in pediatric urolithiasis from 1990 to 2021 using GBD 2021 data.• Persistent inequalities remain, with disadvantaged regions bearing heavier burdens despite global improvements.

The impact of climate change on child nutrition in Indonesia: a conceptual framework and scoping review of the available evidence

BackgroundClimate change is expected to significantly impact child nutrition, worsening global health inequities. Indonesia, a country highly vulnerable to climate change, also faces substantial child malnutrition challenges. However, comprehensive knowledge...

Global, regional, and national burden of self-harm among adolescents aged 10-24 years from 1990 to 2021, temporal trends, health inequities and projection to 2041.

Self-harm ranks as the third leading cause of disability-adjusted life years (DALYs) among adolescents globally, imposing substantial disease and economic burdens. Comprehensive analyses of global temporal trends, health inequities, and future projections are crucial for developing effective public health policies and interventions. This study analyzed the global, regional, and national age-standardized incidence, mortality, and DALYs for self-harm among adolescents using data from the Global Burden of Disease (GBD) 2021 database. Significant disease burdens and temporal trends were assessed. Projections and evaluations employed a combination of health inequities analysis, age-period-cohort (APC) analysis, socio-demographic index (SDI) analysis, Joinpoint regression analysis, and Bayesian APC modeling. The global burden of self-harm among adolescents demonstrated an overall downward trend. However, in 2021, the burden increased with age and is projected to decline further by 2041. Joinpoint regression analysis revealed a generally decreasing temporal trend, although some regions exhibited stable or slightly increasing trends. Significant regional and national heterogeneities were identified. The High SDI region showed a slight upward trend in incidence, Southern Latin America experienced the largest increase, and the Middle SDI region showed the largest decrease. Conversely, East Asia demonstrated the most significant reductions in both incidence and mortality. Age effects were most pronounced in Low-middle SDI regions, while period and cohort effects exhibited greater fluctuations in High SDI regions. Notably, SDI analysis revealed a positive, fluctuating nonlinear relationship with age-standardized DALYs (r = 0.324, P < 0.001). Gender and regional disparities were also significant. Male adolescents in Middle and High SDI regions bore a higher burden of mortality, whereas female adolescents in Low SDI regions experienced a disproportionately high incidence. Adolescents aged 15-24 carried the greatest burden, with females exhibiting a higher incidence and males experiencing higher mortality rates. Despite an overall decline, significant gender and regional disparities persist. Male adolescents in higher SDI regions and females in lower SDI regions are particularly vulnerable. These findings underscore the need for targeted interventions addressing gender and regional inequalities, optimizing healthcare resource allocation, improving health education, and reducing the socioeconomic costs associated with self-harm in adolescents.

The Pedagogical Potential of Affective Oral Histories: A Case Study of Student Interviewer Testimonies in the Health and Human Rights Oral History Project

ABSTRACT The Health and Human Rights Oral History Project (HHROHP) is a growing collection of video testimonies from diverse figures in the health and human rights movement, organized and overseen by the Institute of Inequalities in Global Health at the University of Southern California (USC IIGH). This article is part of an ongoing collaboration between USC IIGH and the University of the Witwatersrand, Johannesburg, to review the methodology of the pilot phase and consider its expansion as a new resource for teaching and research. In foregrounding the testimonies of the three student interviewers who had been involved in the pilot phase of the HHROHP, this article argues that cataloging student interviewers’ perceptions and reflections has embedded an additional primary source within the HHROHP archives, which can—and should—be used to engage with the subjectivity of the interviewer and the process of creating and curating archival collections. In engaging with the students’ reflections, it is clear that their personal perspectives and professional trajectories had been meaningfully affected by their involvement. The resulting sense of personal responsibility felt among the HHROHP’s student interviewers toward the promotion of health equity and justice work more broadly offers interesting implications for the employment of oral history in furthering the aims of the contemporary health and human rights movement, which this article aims to investigate.

Migration and Women's Health Research (2000-2023): A bibliometric analysis of trends and gaps.

This bibliometric study examines the scholarly landscape of migration and women's health, analyzing 1314 Scopus-indexed articles from 462 journals published between 2000 and 2023. Findings indicate a consistent increase in research output, reflecting growing global interest in this interdisciplinary field. Geographically, high-income countries (HICs), including the United States, Canada, the United Kingdom, and Australia, dominate contributions, while low- and middle-income countries (LMICs) remain underrepresented despite hosting significant migrant populations. International collaborations play a crucial role, with key institutions such as the University of California and the London School of Hygiene and Tropical Medicine shaping research efforts. The keyword co-occurrence analysis highlights migration, gender dynamics, mental health, and reproductive health as dominant themes. Persistent gaps in mental and reproductive healthcare access for migrant women emphasize the need for trauma-informed care (TIC), mobile bilingual healthcare services, and inclusive health policies. Disparities in research funding further exacerbate global health inequities, underscoring the necessity of equitable redistribution of resources, including redirecting at least 10% of HIC research grants to LMIC-led studies. The COVID-19 pandemic magnified pre-existing vulnerabilities, stressing the importance of multilateral collaborations and sustainable policy interventions to enhance migrant healthcare access. This study provides valuable insights into research trends, collaboration networks, and thematic focus areas, offering a foundation for future interdisciplinary research and evidence-based policymaking aimed at promoting health equity for migrant women globally.

Challenges associated with dapsone for leprosy treatment in Indonesia - urgent need for access to alternative antimicrobial drugs.

Challenges associated with dapsone for leprosy treatment in Indonesia - urgent need for access to alternative antimicrobial drugs.

Strategies used to access CFTR modulators in countries without reimbursement agreements.

CFTR modulators represent the international standard of care for the treatment of cystic fibrosis (CF). Yet due to prices of over $250,000 per year they are functionally inaccessible for people with CF (pwCF) unless reimbursed by healthcare systems. Current prices are unaffordable for payors in almost all low- and middle-income countries (LMICs) worldwide, and resulting disparities in access are widening existing global health inequities. In comparable situations in other therapeutic areas, patients have successfully developed strategies to bypass national reimbursement systems and gain access to treatment. We therefore undertook an international survey of CF clinicians in 15 countries where CFTR modulators are not reimbursed, to characterise alternative means of accessing modulator therapy. Successful methods were identified in 11 countries, and could broadly be categorised into legal challenges to access originator modulators, use of generic formulations, and access via donations. Aside from domestically produced generics used in Argentina and an originator-led donation program in Ukraine, these methods were only able to provide treatment to limited proportions of the local CF population due to significant associated financial costs. Accordingly, they are generally not sustainable or widely applicable, and fail to address the underlying structural issues driving international disparities in access. Twelve years after the initial marketing of CFTR modulators, pwCF in LMICs are being forced to take extraordinary measures to access disease-modifying treatment. Corrective measures are urgently required to overcome barriers posed by restrictive patents and prohibitively high prices, and to promote global health equity for pwCF.

The Global Polycrisis and Health Inequalities.

In the current era of multiple, overlapping global crises, it is essential to consider the political economy of health within the broader framework of global interconnectedness. In this article, we employ the polycrisis concept to understand the impacts of the multifaceted, concurrent, and synergistic contemporary global crises on global health and health inequalities. A polycrisis occurs when crises in multiple diverse global systems become causally entangled, compounding their effects. Despite its potential relevance and analytical insights, the polycrisis concept has rarely been applied in public health research. This article fills that gap, and through reviewing the impacts of past economic, environmental, health, and political crises, we argue that the polycrisis is creating a complex web of challenges that are likely to amplify existing and future health inequalities. We conclude by discussing strategies to mitigate these impacts and suggest pathways for research to ensure that the future is not inevitably unequal.

Global spatiotemporal trends in prostate cancer burden and its socioeconomic disparities: An observational study from 1990 to 2021.

325 Background: Prostate cancer is the second most common cancer in men globally, posing significant health challenges. Conflicting findings on its global burden and trends necessitate updated analyses. This study provides recent estimates of prostate cancer's global, regional, and national burden from 1990 to 2021, analyzes temporal trends, and offers epidemiological insights for clinicians, researchers, and policymakers. Methods: We analyzed data from the Global Burden of Disease Study 2021 on prostate cancer cases, deaths, and disability-adjusted life years (DALYs) from 1990 to 2021, including age-standardized rates (ASRs) for incidence, mortality, and DALYs. Trend analyses utilized average annual percent change (AAPC) calculations and joinpoint regression models. Age-period-cohort analysis assessed the effects of age, period, and cohort on incidence and mortality trends. Pearson correlation evaluated associations between ASRs and the Socio-demographic Index (SDI) to explore socioeconomic impacts. Results: From 1990 to 2021, global prostate cancer cases, deaths, and DALYs increased, reflecting aging populations. The age-standardized incidence rate (ASIR) showed a slight global increase (AAPC = 0.15, 95% CI: 0.05–0.25), while the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) decreased (ASMR AAPC = -0.83, 95% CI: -0.92 to -0.74; ASDR AAPC = -0.75, 95% CI: -0.82 to -0.68), indicating improved survival. High-SDI regions had decreasing ASMR and ASDR despite high ASIRs due to better detection and treatment. Low-SDI regions saw increases in ASIR, ASMR, and ASDR, with the highest mortality and DALY rates, indicating rising burden and potential healthcare access issues. Joinpoint regression showed initial increases then decreases in ASIR, ASMR, and ASDR, with regional differences in timing. Age-period-cohort analysis revealed age effects with rising incidence and mortality risks, declining incidence risk in the oldest age groups. Period effects showed incidence risk increasing until 2011–2017, then declining; mortality risk decreased over time. Cohort effects showed stable then increasing incidence risk in younger cohorts, while mortality risk decreased across cohorts, reflecting healthcare improvements. Conclusions: The global absolute burden of prostate cancer has increased, but age-standardized mortality and DALY rates have decreased, especially in high-SDI regions due to advancements in detection and treatment. Low-SDI regions face rising incidence and mortality, highlighting growing disparities. Targeted interventions and resource allocation in low-SDI regions are needed to address the increasing burden and reduce global health inequalities.

The 'us and them divide': A qualitative study of student experiences of global health education through the lens of 'inclusivity'.

The 'us and them divide': A qualitative study of student experiences of global health education through the lens of 'inclusivity'.

Primary health care strengthening through the lens of healthcare system thinking.

Despite the strides made in healthcare, many countries still struggle to meet citizen healthcare needs, leading to global and regional health inequalities. The complex interactions between healthcare systems and disciplines present challenges for primary care providers and family physicians. Primary care providers must be equipped with tools and resources to effectively fulfil their duties, such as clinical governance, leadership and capacity building. This article focusses on various thinking approaches that primary care providers can employ, namely systems thinking, complexity science thinking and learning health systems thinking. We appreciate that individual styles and preferences, organisational culture and systemic realities influence multiple modes of thinking and decision-making. A range of modes of thinking and mental models will assist with tackling challenges and opportunities in the primary healthcare system. We hope this brief overview encourages readers to experiment with different ways of thinking to help facilitate innovative solutions.

P1041 Efficacy and Safety of Adalimumab Biosimilar Dose Escalation Treatment in biologic naïve Patients With fistulas Crohn’s Disease: A Prospective, Single-Arm Clinical Practice

Abstract Background The introduction of tumor necrosis factor (TNF) inhibitors, including adalimumab, has dramatically changed the treatment landscape for moderate-to-severe Crohn’s disease (CD). The availability of biosimilars has minimized the economic burden on patients and reduced global health inequalities while ensuring efficacy. However, the efficacy of adalimumab biosimilars for fistula CD is unclear. Methods Sixty patients with fistulas CD from July 2021 to July 2023 were included, and all of them were treated with adalimumab biosimilar treatment for 12 weeks (subcutaneous injection of 160 mg in the 0th week, 80 mg in the 2nd week, and 40 mg from the 4th to the 12th week), and the decision of whether to receive adalimumab conventional therapy (40 mg q2w) or incremental therapy (80 mg q2w) was made based on the patients’ traumatic response at the end of the 12-week period. The decision to follow up with regular (40 mg q2w) or incremental (80 mg q2w) treatment of adalimumab was made based on wound response after 12 weeks, and the dosage was again adjusted according to efficacy after 24 weeks, and the patients were followed up to 52 weeks. The primary outcome of this study was the fistula healing rate at 52 week. Secondary outcomes were fistula response rate, endoscopic response rate and endoscopic remission rate. Results A total of 60 patients with active fistula-type Crohn’s disease were enrolled in the study. Most of the enrolled patients were in the middle-aged and young age group, with a mean age of (26.8±9.5) years, 75.5% males, CDAI score (180.9±97.62), SES-CD score (15.69±7.79), and PDAI score (4.58±2.12). In the conventional treatment group, the fistula response rate was 57.89%, 65.22% and 73.91% at 12, 24 and 52 weeks, respectively; the fistula healing rate was 55.26%, 69.57% and 65.22%, respectively; the endoscopic response rate was 60.53%, 82.61% and 100%, respectively; and the endoscopic relief rate was 36.84%, 73.91% and 86.96%, respectively. In the incremental treatment group, the fistula response rate was 12.5%, 66.67% and 66.67% at 12, 24 and 52 weeks, respectively; the fistula healing rate was 12.5%, 66.67% and 0, respectively; the endoscopic response rate was 50%, 66.67% and 66.67%, respectively; and the endoscopic remission rate was 0, 0 and 16.67%, respectively. All patients had no adverse drug reactions or serious infections during treatment. Conclusion In the real world, adalimumab biosimilar dose escalation treatment may somewhat improve fistula response rates and endoscopic response rates in fistulous CD patients initially treated with biologics, but has a limited effect on fistula healing rates and endoscopic remission rates.

Payment in arrears: a global health inequity that must be corrected.

Payment in arrears: a global health inequity that must be corrected.

Ethical considerations in the UK-Nepal nurse recruitment: Nepali nurses' perspectives.

The global migration of nurses from resource-constrained to affluent nations raises complex ethical concerns, often rooted in historical power imbalances and neocolonial legacies. The Nepal-UK Memorandum of Understanding (MoU) on nurse recruitment, while presented as a solution to workforce shortages, exemplifies this complex dynamic, prompting critical questions about its implications for individual nurses and the healthcare systems involved. This qualitative study explored the ethical complexities and dilemmas associated with the Nepal-UK nurse recruitment Memorandum of Understanding (MoU). This bilateral agreement has sparked debate about its potential impact on both individual nurses and the healthcare systems of Nepal and the UK. A qualitative exploratory design utilizing semi-structured interviews was employed. Data were analyzed using reflexive thematic analysis. Twelve Nepali nurses from two private hospitals in Kathmandu, Nepal, participated in the study. The study was approved by the Nepal Health Research Council. All participants provided informed consent and were assured of confidentiality and anonymity. Four themes emerged from the data: (1) The lingering legacy of colonialism casts a shadow on the Nepal-UK relationship, raising concerns about potential exploitation and unequal power dynamics. (2) Nepali nurses grapple with the ethical dilemmas of pursuing personal dreams while acknowledging their responsibilities towards their communities and Nepal's healthcare system. (3) The MoU's claims of ethical recruitment are scrutinized, with nurses questioning its fairness and sustainability. (4) The agreement is challenged as a potential band-aid solution that may perpetuate global health inequities rather than fostering a genuine partnership. The Nepal-UK MoU, while offering opportunities for individual nurses, also raises alarms about brain drain, exploitation, and the perpetuation of global health disparities. The study underscores the urgent need for a paradigm shift in international nurse recruitment practices, prioritizing genuine partnership, equitable distribution of benefits, and sustainable solutions that address the root causes of healthcare workforce challenges in both source and destination countries.

SYNTHESIZING THE SDG 3: INTERNATIONAL COOPERATION ON THE ETHICS OF GLOBAL HEALTH TOWARD 5.0 SOCIETY

Global health ethics tackles the complex ethical dilemmas associated with healthcare policies and practices at a global scale, focusing on key principles such as equity, solidarity, and beneficence. These principles are essential for fostering health and well-being, particularly in low- and middle-income countries where healthcare access remains limited. The aim of this study is to examine the ethical dimensions of global health, highlighting the interconnectedness of health outcomes and the collective responsibility of nations and communities in addressing global health inequities. The study employs a qualitative field research approach, utilizing in-depth interviews and secondary data analysis to assess the application of these ethical principles in practical settings. Data were gathered from key figures in the global health sector, including policymakers, healthcare professionals, and representatives from international organizations. The results underscore the importance of incorporating social determinants of health, such as poverty, education, and housing, into global health strategies. The research further emphasizes the crucial role of robust health systems, human rights, and social justice in achieving equitable health outcomes. Additionally, it illustrates the increasing significance of global health ethics in a 5.0 society, where sustainability, justice, and equity are central goals. The study advocates for collaborative efforts among global health stakeholders and stresses the need for a comprehensive approach to reduce health disparities and enhance the well-being of all populations.

Negotiation of new international health law on intellectual property, technology transfer, open science and pathogen access and benefit sharing: a textual and contextual analysis

IntroductionThis original research article reframes new international law and policy developments at the intersections of open science, technology transfer, intellectual property and access and sharing the benefits of biomedical innovation...

Experiential Learning in Global Health: Engaging with Multilateral Institutions in an Age of Rights Regression.

Experiential learning opportunities are recognized to help students put classroom discussions into practice, build new peer networks, and challenge their own preconceptions about the roles of global structures and systems to advance health and wellbeing. After a pandemic-related hiatus, the University of Southern California Institute on Inequalities in Global Health returned to Geneva, Switzerland with students for two weeks at the time of the 2024 World Health Assembly to learn and engage with how global health governance plays out on an international stage. We brought eleven passionate and engaged USC Master's in Public Health (MPH) students whose interests covered a range of issues, including child and maternal nutrition, sexual and reproductive health and rights in conflict settings, mental health, and noncommunicable diseases, among many other topics. We spent two weeks meeting with inter-governmental organizations, international advocacy organizations, United Nations agencies, and joint funded programs, and our students built their own event schedule during the World Health Assembly to cover the health topics they were most interested in pursuing. Our aim was to have students engage with the complex interplay of health, law, and rights, and to see in real time how research and education inform policy, on local, national and global levels. As instructors and coordinators, we are convinced that the role of experiential learning has never been more important or influential. Multilateralism is under attack, and rights regressions are rampant. We found that fostering honest, content driven conversations with our organizational partners, and then having intense follow-up with our students, resulted in new perspectives- personally and professionally - which is likely to serve the work of the students in global health for the years to come. When the distance between classroom readings and the actual people steering global health can be bridged, university courses that center experiential learning offer the opportunity for emerging health leaders to truly understand the structures and systems in place, and better imagine their own roles in the fight for the right to health.

Estimating the burden of temperature-related low birthweight attributable to anthropogenic climate change in low-income and middle-income countries: a retrospective, multicentre, epidemiological study.

Estimating the burden of temperature-related low birthweight attributable to anthropogenic climate change in low-income and middle-income countries: a retrospective, multicentre, epidemiological study.

Global, regional, and national pancreatitis burden and health inequality of pancreatitis from 1990 to 2019 with a prediction from 2020 to 2034

BackgroundPancreatitis is a digestive system disease that imposes a significant burden on society. However, there is a lack of comprehensive research on the incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) of pancreatitis, as well as on health inequalities and future trends.MethodsPancreatitis burden data, including the number and age-standardized rates (ASR) of incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs), were collected from the Global Burden of Diseases 2019 (GBD 2019). SDI and HDI were used to analyze the influence of societal development on the burden of pancreatitis in the population. Additionally, the Gini coefficient and the Concentration index were used to assess health inequalities in the burden of pancreatitis. Global population data from 1990 to 2034 was obtained from WHO. Based on the population data and pancreatitis burden data, a prediction model of the burden was constructed to calculate the number and ASR of incidence, prevalence, deaths, YLLs, YLDs, and DALYs from 2019 to 2034 using the BAPC package and the Nordpred package.ResultsFrom 1990 to 2019, there has been a decreasing trend in the ASR of incidence, prevalence, deaths, YLLs, YLDs, and DALYs in pancreatitis. However, despite this decline, the number of cases has been on the rise. Furthermore, pancreatitis imposes a higher burden on males in comparison to females, and there exists a negative correlation between pancreatitis burden and both the Social Development Index (SDI) and the Human Development Index (HDI). Additionally, health inequalities have progressively worsened globally between 1990 and 2019, particularly concerning the burden of pancreatitis in countries with low Social Development Index (SDI). Looking to the future, it is projected that the number of deaths and new cases will continue to increase from 2020 to 2034.ConclusionsPancreatitis remains a mounting worldwide burden. In order to alleviate this challenge, preventive strategies should focus on males and middle-aged or older individuals, specifically in countries with a low SDI. Pancreatitis is expected to predominantly impact Eastern Europe, characterized by a high ASR of incidence, and Asia, boasting a substantial population.

A Political-Economic Model of Community and Societal Health Resources: A 92-Country Global Analysis.

The quality and access to healthcare systems depend on community health resources, infrastructure, and funding; however, a significant disparity in these resources persists globally. The effectiveness of national health systems depends on a balanced approach to health spending, access to facilities and a skilled local health workforce. What accounts for country-level differences in those critical community and societal health resources? We proposed and tested a model that leverages political and socioeconomic factors to predict various health resources and services in countries. Data, including community health training, research, and support, universal health coverage, healthcare infrastructure, and per capita health expenditure, were collected and analysed by statistical methods, like bivariate correlations and hierarchical multiple linear regressions from 105 countries. Countries with more grassroots activism, fiscal decentralisation, freedom, and globalisation and less perceived corruption and inequality had more community and societal health resources. In multivariate analyses, stronger community health training and research is associated with the globalisation index, freedom score, government fiscal decentralisation, and income inequality. The strongest predictor of health insurance coverage and hospital beds was the country's population education index, and of nurses and midwives-per-capita and health expenditures-per-capita was GDP-per-capita. These insights could guide policymaking to reduce global health inequalities.