Global Health Practice Research Articles

A review and analysis of accountability in global health funding, research collaborations and training: towards conceptual clarity and better practice

IntroductionAccountability is a complex idea to unpack and involves different processes in global health practice. Calls for accountability in global health would be better translated to action through a better...

Development, Evaluation, and impLemenTation for guideline adaptation: a quality improvement protocol for the DELTA study in global health practice.

Guideline adaptation is an emerging field to provide more appropriate recommendations for local clinical practice quality and to promote global health equity. However, its utilization status, adaptation procedures, and related materials remain to be studied. This study developed a quality improvement protocol for a study as the Development, Evaluation, and impLemenTation for guideline Adaptation (DELTA) study. Current adapted clinical practice guidelines (CPGs) will be systematically searched. Their characteristics, utilization status, and adaptation procedures will be extracted, compared, and analyzed. Whether these adapted CPGs rigorously followed the instruments and steps of adaptation frameworks will also be appraised. In addition, the advantages and limitations of current adaptation methods and their suitable application situations will be analyzed. In addition, future perspectives as DELTA series and DELTA system, aiming for comprehensively evaluating current needs for guideline adaptation and developing a unified framework and related materials were proposed to improve the acceptability, applicability, and implementation of guideline adaptation in clinical practice. The DELTA series are divided into four phases: phase I in analyzing status, characteristics, and procedures and completeness of adapted CPGs; phase II in analyzing differences, heterogeneity, and implementation between adapted and original CPGs; and phase III in collecting, analyzing, and comparing all available adaptation materials. With these research bases, an international working group will be established in phase IV and will develop unified guideline adaptation materials after Delphi consensus, including adaptation frameworks, appraisal tools and checklists, registries, and databases. Guideline adaptation has been advanced as an efficient way to guide local clinical practice. However, it still faces several major challenges. The proposed DELTA study, series, and system will further contribute to this emerging topic. This study has been registered by the PROSPERO international database. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=400170 .

Exploring the interest of medical students in global health in South Korea: Does taking a global health course matter?

BackgroundPrioritizing global health is important for positive health outcomes. Doctors play a pivotal role in addressing health issues that they need to recognize the importance of global health practice. However, medical education in global health is still in its early stages in many countries, including South Korea.MethodsThis study is a quantitative cross-sectional study. Medical students were recruited from all 40 Korean medical schools and data collection was conducted in 2021. Stratified proportional quota sampling was employed as the sampling method. The study examined medical students’ interest in global health as the dependent variable. Independent variables included whether individuals had taken global health courses as part of their medical curriculum, while covariates included student background and institutional factors. Logistic regression was used to determine if taking a global health class was associated with global health interests.ResultsThe study included 2450 participants and almost 32% of medical students (n = 781) were interested in global health. Taking global health classes in school was associated with a higher likelihood of developing an interest in global health (OR: 1.29, 95% CI: 1.00-1.67). The likelihood of being interested in global health decreased across the academic year (OR: 0.70, 95% CI: 0.53–0.94). Individuals in graduate entry programs were associated with an interest in global health (OR: 1.32, 95% CI: 1.01–1.72).ConclusionThis study provides the first comprehensive nationwide assessment of medical students’ perspectives on global health education in South Korea. The findings underscore the importance of early and sustained exposure to global health topics in medical education in fostering interest in global health. These results can serve as valuable evidence for medical educators seeking to integrate global health education into their curricula.

Decolonizing global health curriculum: from fad to foundation

IntroductionIncreasing calls have been made to decolonize global health education but there has been a lack of consensus and clarity on how this should be done. We conducted a qualitative study to understand current educational programs and curricula that aim to educate public health and allied health students to increase awareness of how colonialist structures of power influence current global health practice and provide students with tools to decolonize global health. Our goal is to inform related curriculum development and provide recommendations.MethodsWe conducted key-informant interviews with 14 study coordinators and faculty from institutions of higher learning with global health programs who are involved in developing educational approaches. All interviews were audio recorded, transcribed, and analyzed using an ‘up from the data’ approach.ResultsParticipants varied in their understanding of decolonizing global health and recognized that there is a lack of guidance in the field; this has an impact on how curriculum is developed and taught. Participants described a range of decolonizing global health educational activities in the classrooms and in applied learning activities. Most programming was situated in Diversity, Equity, and Inclusion Initiatives and participants did not always feel this was the best ‘home’ for such work; to some this reflected a lack of institutional support. Other institutional barriers included lack of protected time for faculty and limited budgets for speaker honoraria, co-creation, and related teaching expenses.DiscussionInstitutes of higher learning can play an important role, either positively or negatively, in decolonizing global health education. At a minimum such institutions should financially support faculty to incorporate decolonizing global health in their pedagogy and strengthen scholarship towards common understandings. More substantive institutional support is needed however to meaningfully transform institutional relationships that actively support equitable partnerships, co-creation, and responsiveness to local community priorities.

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

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

Cultivating critical consciousness through a Global Health Book Club

IntroductionCentral to public health practice is mindfulness and intentionality toward achieving social justice and health equity. However, there is limited literature published on how educators are integrating these concepts into their curricular, pedagogical and instructional efforts. The goal of this study was to leverage the pluralistic views, social identities, and demographics within the classroom to explore the effects of introducing a Global Health Book Club (GHBC) assignment focused on identity of culture, equity, and power. We also sought to explore the use of first-account narratives illustrating the human experience as an instructional strategy to cultivate an empathic understanding of global health threats, while fostering critical consciousness toward one’s positionality within macro-level contexts. Finally, students were encouraged to reflect on their lived cultural experiences and engage in open and authentic dialogue with their peers.MethodsWe implemented a four-week GHBC assignment within an undergraduate global public health course. At the conclusion of the GHBC, students engaged in a reflective Individual Analysis Paper, which captured students’ perspectives on their cultural values and traditions, how these views shaped their understanding of their book, and evaluate whether their global perspective had changed as a result of the assignment. Thirty-one students consented to have their Individual Analysis Paper downloaded and de-identified for analysis. Student responses were analyzed using inductive thematic analysis procedures.ResultsThrough our analysis, six themes, with several coinciding categories, were identified as salient. The themes include Demonstrated Empathy, Personal Reflection and Growth, Personally Inspired, Immersive Learning Experience, Broadened Perspective, and Provoked Emotion.DiscussionOur findings support that a GHBC assignment is a viable and effective mechanism for engaging students in critical reflection, critical motivation and critical action. In cultivating a learning environment that promotes student-centered learning and active participation, students exemplified agency in their own learning. This work can serve as an exemplary model for other public health educators to engage students in reflective-based assignments regarding their positionality and critical consciousness. By utilizing frameworks conceived out of antiracism, diversity, equity, and inclusion, our work presents an innovative activity in engaging students in decolonization efforts within global public health practice.

Towards anti-racist policies and strategies to reduce poor health outcomes in racialised communities: introducing the O'Neill–Lancet Commission on Racism, Structural Discrimination, and Global Health

Audre Lorde said, “There is no thing as a single-issue struggle because we do not live single-issue lives.” 1 Lorde A Sister outsider: essays and speeches. Crossing Press, Trumansburg, NY1984 Google Scholar The O'Neill–Lancet Commission on Racism, Structural Discrimination, and Global Health posits racism as one of the most consequential transnational phenomena to impact the health and lives of afflicted communities globally. This Commission aims to explore the axis of discrimination across structural determinants of health at intranational, international, and supranational levels and our objectives are shown in the panel. There is ample evidence of racism among health-care-provider behaviour in many contexts and as the cause of physical injury due to racial violence. 2 Batur P Heart of violence: global racism, war, and genocide. in: Vera H Feagin JR Handbook of the sociology of racial and ethnic relations. Springer, Boston, MA2007: 441-454 Crossref Scopus (3) Google Scholar , 3 Ben J Cormack D Harris R Paradies Y Racism and health service utilisation: a systematic review and meta-analysis. PLoS One. 2017; 12: e0189900 Crossref PubMed Scopus (160) Google Scholar , 4 Paradies Y Ben J Denson N et al. Racism as a determinant of health: a systematic review and meta-analysis. PLoS One. 2015; 10: e0138511 Crossref PubMed Scopus (1145) Google Scholar Further, the Lancet Series on racism, xenophobia, discrimination, and health 5 Devakumar D Selvarajah S Abubakar I et al. Racism, xenophobia, discrimination, and the determination of health. Lancet. 2022; 400: 2097-2108 Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar joined earlier scholarship to characterise pathways of discrimination in health systems and other structures. The Commission will deepen the existing scholarship and explore racism and discrimination within global public health practice, policies, governance, and legal systems that are determinants of racial and ethnic health disparities. PanelObjectives of the O'Neill–Lancet Commission on Racism, Structural Discrimination, and Global HealthAccurately diagnose the problem of racism in health This will be achieved by reviewing existing national and cross-national evidence on racism in health in a global context, and using a set of empirical analytical work, to further describe the effects of racial and ethnic discrimination and its intersections on health at a national and international level. Identify best practices and actionable anti-racist strategies The Commission will achieve this goal by, among other activities, holding consultations with populations with lived experiences of structural discrimination in health, to discover how racist structures in select countries were addressed to close health equity gaps. Compile a report of the Commission's findings, highlighting the strategies, tactics, and actionable lessons We expect the Commission's recommendations to be used to develop anti-racist approaches in the sphere of health policy and service delivery to ensure equitable and just health outcomes. Widely disseminate the Commission's findings Broad dissemination will ensure that the anti-racist strategies and actionable lessons can be used by governments and health advocates to lobby for improved health outcomes for marginalised sections of the population in their respective countries and contribute a body of global knowledge to augment efforts to decolonise global health. Accurately diagnose the problem of racism in health This will be achieved by reviewing existing national and cross-national evidence on racism in health in a global context, and using a set of empirical analytical work, to further describe the effects of racial and ethnic discrimination and its intersections on health at a national and international level. Identify best practices and actionable anti-racist strategies The Commission will achieve this goal by, among other activities, holding consultations with populations with lived experiences of structural discrimination in health, to discover how racist structures in select countries were addressed to close health equity gaps. Compile a report of the Commission's findings, highlighting the strategies, tactics, and actionable lessons We expect the Commission's recommendations to be used to develop anti-racist approaches in the sphere of health policy and service delivery to ensure equitable and just health outcomes. Widely disseminate the Commission's findings Broad dissemination will ensure that the anti-racist strategies and actionable lessons can be used by governments and health advocates to lobby for improved health outcomes for marginalised sections of the population in their respective countries and contribute a body of global knowledge to augment efforts to decolonise global health.

The implications of decolonization on China’s academic global health: a dialogue with Stephen Gloyd at the Luhu Global Health Salon

The call for decolonization in global health is growing alongside China’s increasing involvement in the field. This perspective paper presents and extends with a further literature review of a dialogue with Stephen Gloyd, a global health professor from the University of Washington, conducted in July 2022 at the Luhu Global Health Salon. Drawing from Gloyd’s four decades of experiences in low- and middle-income countries, as well as his role in creating the University of Washington’s global health department, the doctoral program in implementation science, and the non-governmental organization, Health Alliance International, this paper delves into the concept of decolonization in global health and explores how Chinese universities can expand their participation in global health while striving for equity and justice. Focusing on China’s academic global health research, education, and practice, the paper proposes specific recommendations for building an equity-focused global health curriculum, addressing power imbalances and inequalities in university-affiliated organizations, and strengthening South-South cooperation in practice. The paper offers implications for Chinese universities on expanding future global health cooperation, promoting global health governance, and avoiding recolonization.

Educational approaches to teach students to address colonialism in global health: a scoping review

IntroductionThe enduring legacy of colonisation on global health education, research and practice is receiving increased attention and has led to calls for the ‘decolonisation of global health’. There is little...

Mindfulness for Global Public Health: Critical Analysis and Agenda

Abstract Objective The modern mindfulness movement and the public health field are aligned in many approaches, including recognizing psychosocial stress impacts and physical-mental health linkages, valuing “upstream” preventive approaches, and seeking to integrate health promotion activities across multiple social sectors. Yet mindfulness is conspicuously absent from most global and public health literature and practice, suggesting unfulfilled potential. This paper analyzes the mindfulness field from a public health perspective, with the aim of identifying evidential and conceptual bases, methods, potential consequences, and initial research and action agendas for greater integration of mindfulness approaches into global, national, and local public health efforts. Methods This paper reviews scientific and scholarly literature on the currently existing and potential relationships between mindfulness and public health, with special attention to 14 dimensions of potential tension or alignment. Results Several alignments were noted above. However, the mindfulness field is substantially lagging on multi-level interventions (e.g., both individual and collective levels), cultural and religious adaptations, and epidemiologic underpinnings. Both mindfulness and public health initiatives are in need of efforts to promote intercultural, interreligious, and intercontemplative competencies, in developing interventions to address pathogenic factors in the collective attentional environments in society, and in attending to religious and spiritual factors. Conclusions Full public health uptake will benefit from several additional lines of research and innovation, especially greater attention to cultural and religious adaptation, with attention also much needed to multi-level interventions and epidemiologic foundations.

Applying Human-Centered Design in Global Mental Health to Improve Reach Among Underserved Populations in the United States and India.

Human-centered design (HCD) refers to a diverse suite of interactive processes that engage end users in the development of a desired outcome. We showcase how 2 global mental health research teams applied HCD to develop mobile health tools, each directed at reducing treatment gaps in underserved populations. CASE STUDY 1: Refugees face higher risks for mental health problems, yet these communities face structural and cultural barriers that reduce access to and use of services. To address these challenges, the Research Program on Children and Adversity at the Boston College School of Social Work, in partnership with resettled refugee communities in the northeastern United States, used codesign methodology to digitally adapt delivery of the Family Strengthening Intervention for Refugees-a program designed to improve mental health and family functioning among resettled families. We describe how codesign methods support the development of more feasible, acceptable, and sustainable interventions. CASE STUDY 2: Sangath, an NGO in India focused on mental health services research, in partnership with Harvard Medical School, designed and evaluated a digital training program for community health workers to deliver an evidence-based, brief psychological treatment for depression as part of primary care in Madhya Pradesh, India. We describe how HCD was applied to program development and discuss our approach to scaling up training and capacity-building to deliver evidence-based treatment for depression in primary care. HCD involves a variety of techniques that can be flexibly adapted to engage end users in the conceptualization, implementation, scale-up, and sustainment of global mental health interventions. Community solutions generated using HCD offer important benefits for key stakeholders. We encourage widespread adoption of HCD within global mental health policy, research, and practice, especially for addressing mental health disparities with underserved populations.

Why 'elevating country voice' is not decolonizing global health: A frame analysis of in-depth interviews.

Recent calls for global health decolonization suggest that addressing the problems of global health may require more than 'elevating country voice'. We employed a frame analysis of the diagnostic, prognostic, and motivational framings of both discourses and analyzed the implications of convergence or divergence of these frames for global health practice and scholarship. We used two major sources of data-a review of literature and in-depth interviews with actors in global health practice and shapers of discourse around elevating country voice and decolonizing global health. Using NVivo 12, a deductive analysis approach was applied to the literature and interview transcripts using diagnostic, prognostic and motivational framings as themes. We found that calls for elevating country voice consider suppressed low- and middle-income country (LMIC) voice in global health agenda-setting and lack of country ownership of health initiatives as major problems; advancing better LMIC representation in decision making positions, and local ownership of development initiatives as solutions. The rationale for action is greater aid impact. In contrast, calls for decolonizing global health characterize colonialityas the problem. Its prognostic framing, though still in a formative stage, includes greater acceptance of diversity in approaches to knowledge creation and health systems, and a structural transformation of global health governance. Its motivational framing is justice. Conceptually and in terms of possible outcomes, the frames underlying these discourses differ. Actors' origin and nature of involvement with global health work are markers of the frames they align with. In response to calls for country voice elevation, global health institutions working in LMICs may prioritize country representation in rooms near or where power resides, but this falls short of expectations of decolonizing global health advocates. Whether governments, organizations, and communities will sufficiently invest in public health to achieve decolonization remains unknown and will determine the future of the call for decolonization and global health practice at large.

Implications of Oral Health Policy Consequent Covid19

COVID 19 virus rearrange the priorities of the global society regarding oral health to systemic health. Oral Health Policy and Epidemiology (OHPE) is the connection of dentistry, medicine, and public health which increase the perspective and impact of global and community health practice and policy through education, research, and leadership. Dental faculties and students, with community stakeholders and oral health professionals, drive collaborative, interdisciplinary, and innovative approaches to achieve oral health equity and wellbeing for all. Global vision for oral health policy is fully integrated in general health and based on primary health care, with emphasis on promotion on oral health and prevention of oral disease. This policy is a framework contribute to a program strategy of public health to guarantee the access to fundamental rights.

Rethinking global health from south and north: A social medicine approach to global health education

ABSTRACT This study examines efforts to integrate social medicine into global health education and its potential to guide the new practice of structural competency. The methods employ participant observation and interviews with program coordinators and participants in a social medicine course. Areas of success included: pedagogical innovation, conscientizing course participants, decentralising global health practice, and promoting reflexivity. Accompanying these successes were points of friction, including: inequities in personal risk and mobility limitations among course participants, as well as complexities and nuances in unintentionally reproducing hierarchies of knowledge. Specifically, further recommendations from our research include: (1) incorporating innovative pedagogical approaches, which highlight social medicine practices outside the global north, prioritising opportunities for cross-collaboration among practitioners from the global south; (2) framing social theory as a bidirectional flow: global south traditions must be included in teaching social theory; (3) practising structural humility by highlighting the perspectives and expertise of communities experiencing social and structural marginalisation, while including strategies in organising and direct pathways to political engagement. These conclusions highlight how social medicine-based training can both build from and move beyond the competencies explicitly specified by the structural competency model to create a global health practice inclusive of diverse thought from around the world.

To ensure universal eye health coverage to accelerate progress towards the achievement of sustainable development goals

The United Nations signed "Vision for Everyone-Accelerating Action to Achieve the Sustainable Development Goals (A/RES/75/310)" at the 75th UN sessions, committing to great efforts to improve eye health globally and address the increasing impact of vision loss on sustainable development. It is the first agreement designed to tackle preventable sight loss to be adopted at the United Nations and to enshrine eye health as an integral part of universal health coverage. The resolution summarized the lessons learned from previous global eye health practices, set a target of eye care for all by 2030-with countries set to ensure full access to eye care services for their populations, and, to support global efforts, to make eye care part of their nation's journey to achieving the Sustainable Development Goals (SDG). This global initiative will also have a significant impact on eye health in China, and we should implement this United Nations General Assembly Resolution to promote the continued development of eye health in China.

Prioritizing gender equity and intersectionality in Canadian global health institutions and partnerships.

Despite governmental efforts to close the gender gap and global calls including Sustainable Development Goal 5 to promote gender equality, the sobering reality is that gender inequities continue to persist in Canadian global health institutions. Moreover, from health to the economy, security to social protection, COVID-19 has exposed and heightened pre-existing inequities, with women, especially marginalized women, being disproportionately impacted. Women, particularly women who face bias along multiple identity dimensions, continue to be at risk of being excluded or delegitimized as participants in the global health workforce and continue to face barriers in career advancement to leadership, management and governance positions in Canada. These inequities have downstream effects on the policies and programmes, including global health efforts intended to support equitable partnerships with colleagues in low- and middle- income countries. We review current institutional gender inequities in Canadian global health research, policy and practice and by extension, our global partnerships. Informed by this review, we offer four priority actions for institutional leaders and managers to gender-transform Canadian global health institutions to accompany both the immediate response and longer-term recovery efforts of COVID-19. In particular, we call for the need for tracking indicators of gender parity within and across our institutions and in global health research (e.g., representation and participation, pay, promotions, training opportunities, unpaid care work), accountability and progressive action.

Global Health 101.

Global health is an evolving field that has been broadly defined as the promotion of health for all through transnational collaboration and research. It centers on the concepts of equity and collaboration. The focus of global health has recently undergone a major shift toward emphasizing the importance of a systems-based approach to healthcare delivery, which considers not only the target disease but also the many contextual factors, influencing the ability to deliver care equitably to a population to reduce the burden of any particular disease. Thus, an important global health delivery framework has been established to outline this inter- and multi-disciplinary systems-based to address major global health issues and improve health for all globally. The practice of global health, whether in research or in active intervention, necessitates guiding principles to ensure ethical conduct in the transnational partnerships and efforts to advance the field. With the introduction of the United Nations' Sustainable Development Goals in 2015, there has been a major shift in response to epidemiologic transition to focus on reducing the burden of noncommunicable diseases, including cancer, which disproportionately impact low-to-middle income countries. This is true for colorectal cancer, with care challenged by significant gaps in screening, early detection, and referral systems.

Virtual global health in graduate medical education: a systematic review.

To synthesize recent virtual global health education activities for graduate medical trainees, document gaps in the literature, suggest future study, and inform best practice recommendations for global health educators. We systematically reviewed articles published on virtual global health education activities from 2012-2021 by searching MEDLINE, EMBASE, Cochrane Library, ERIC, Scopus, Web of Science, and ProQuest Dissertations & Theses A&I. We performed bibliography review and search of conference and organization websites. We included articles about primarily virtual activities targeting for health professional trainees. We collected and qualitatively analyzed descriptive data about activity type, evaluation, audience, and drivers or barriers. Heterogeneity of included articles did not lend to formal quality evaluation. Forty articles describing 69 virtual activities met inclusion criteria. 55% of countries hosting activities were high-income countries. Most activities targeted students (57%), with the majority (53%) targeting trainees in both low- to middle- and high-income settings. Common activity drivers were course content, organization, peer interactions, and online flexibility. Common challenges included student engagement, technology, the internet, time zones, and scheduling. Articles reported unanticipated benefits of activities, including wide reach; real-world impact; improved partnerships; and identification of global health practice gaps. This is the first review to synthesize virtual global health education activities for graduate medical trainees. Our review identified important drivers and challenges to these activities, the need for future study on activity preferences, and considerations for learners and educators in low- to middle-income countries. These findings may guide global health educators in their planning and implementation of virtual activities.

Deconstructing design thinking as a tool for the implementation of a population health initiative

BackgroundThe translation of evidence-based practices and rapid uptake of innovations into global health practice is challenging. Design thinking is a consultative process involving multiple stakeholders and has been identified as a promising solution to create and apply implementation strategies in complex environments like health systems.MethodsWe conducted a process evaluation of a real-world example, namely an initiative to innovate hypertension screening, diagnosis and care in São Paulo, Brazil. The parameters of the evaluation were informed by a specification rubric and categorization system, recommended for the investigation of implementation strategies, and the double-diamond conceptual framework to describe and examine the strategic architecture and nature of the design thinking approach, with particular emphasis on identifying potential areas of “value-add” particular to the approach. The retrospective evaluation was performed by an independent partner who had not been involved in the setting up and implementation of the design thinking process.ResultsThe evaluation unveiled a dense catalogue of strategically driven, mostly theoretically based, activities involving all identified health system stakeholders including patients. Narrative reconstruction illuminated the systematic and coherent nature of this approach, with different resulting actions progressively accounting for all relevant layers of the health system to engineer a broad selection of specific implementation solutions. The relevance of the identified features and the mechanics used to promote more successful implementation practices was manifested in several distinct ways: design thinking offered a clear direction on which innovations really mattered and when, as well as several new dimensions for consideration in the development of an innovation mindset amongst stakeholders. It thereby promoted relationship quality in terms of familiarity and trust, and commitment to evidence-based enquiry and action. Design thinking was also able to navigate the territory between the need for intervention “fidelity” versus “adaptation” and provide the operational know-how to face familiar implementation hurdles. Lastly, it brought a new kind of skill set to the public health stakeholders that incorporated diplomacy, multidisciplinary approaches and management sciences—skills that are considered necessary but not yet widely taught as part of public health training.ConclusionsDesign thinking is a sound and viable tool to use as part of an implementation strategy for engaging with health system stakeholders and successfully translating evidence-based practices and new innovations into routine practice, thereby addressing an important knowledge—practice gap and, more broadly, contributing to the strategic repertoire available to implementation science.

Sustainable global health practice: An ethical imperative?

We are in the midst of a crisis of climate change and environmental degradation that will only get worse, unless significant changes are rapidly made. Globally, the healthcare sector causes a large share of our total environmental footprint: 4.4% of greenhouse gases. Sustainable healthcare has emerged as a way for healthcare sectors in high-income countries to help mitigate climate change by reducing their emissions. Whether global health should be sustainable and what ethical grounds might exist to support such a claim are not questions that have been investigated. The paper argues that global health practice-the delivery of health services to underserved populations in resource-poor areas of the world-should be sustainable as a matter of climate justice and solidarity. Reducing climate change-related risks and harms for the vulnerable is integral to the mission of global health and thus it is necessary to consider the climate impact of its practice. The field has a duty to provide sustainable health services that are responsive to climate change-related changes in the local burden of disease and to build sustainable health system infrastructure. Specific responsibilities for global health funders, managers, and implementers to uphold the duty are proposed. To conclude, the paper considers what limits might be placed on the duty to deliver sustainable global healthcare.