Global Health Inequalities Research Articles

Global health inequities: a call for papers

Global health inequities: a call for papers

Measuring Global Inequity in Radiation Therapy: Resource Deficits in Low- and Middle-Income Countries Without Radiation Therapy Facilities

Although radiation therapy (RT) is an effective and inexpensive pillar of multidisciplinary cancer care, access to RT facilities remains highly inequitable globally. Numerous studies have documented this resource gap, yet many countries continue facing their raging cancer epidemics ill-equipped. In this study, we present an estimation of resource deficits in low- and middle-income countries (LMICs) without any RT facilities at all. This study builds on publicly available data on country classification, population, cancer incidence, and RT requirements provided by the World Bank Group, the World Health Organization, and the International Atomic Energy Agency. Leveraging these data, we developed a capacity-planning model to estimate the current deficit of fundamental RT resources for LMICs with more than 1 million inhabitants and no active RT facilities. There were 23 LMICs with a population of more than 1 million inhabitants and without any active RT facilities, 78% of which were located in sub-Saharan Africa. The aggregate population of these countries was 197.3 million people. The largest countries without RT facilities were Afghanistan and Malawi, with a population of 38.0 million and 18.6 million inhabitants, respectively. Estimated cancer incidence for all countries under study totaled at 134,783 new cases per year, 84,239 (62.5%) of which would have required RT. There was an aggregate deficit of 188 megavoltage machines and 85 brachytherapy afterloaders, along with simulation equipment and human capital in the magnitude of approximately 3363 trained radiation oncology staff. Hundreds of thousands of patients with cancer in LMICs continue to live in countries without access to RT in their own country. This extreme form of global health inequity requires urgent and decisive action, the success of which depends on the integration of international and local efforts.

Ebola and the Ravages of History in Paul Farmer: A Catholic Theological Ethical Response to Global Health Inequity in Africa

In this chapter, I explore with Paul Farmer why Ebola has persisted in Africa and why it continues to kill so many Africans as we see in the current outbreak in Uganda (September 2022) with the Sudanese strain. Farmer’s appeal to social medicine and social context in understanding the remote causes of the cause of Ebola offers an important corrective to the disease control and treatment paradigm approach in global health amidst the devastating impact of health inequity. I conclude my chapter by using Farmer’s analysis of the causes of global health inequity in Africa to propose how theological ethics can serve the mission of churches and African communities in designing healthcare systems for health improvement and health protection in solidarity with the poor and the most vulnerable. I will propose some effective strategies for global health partnerships in Africa against the current preoccupation with disease control and prevention, medical mission, and crisis intervention from outside Africa.

Part 4: Global Health as a Theological Locus

This introduction to Part 4: Global Health as a Theological Locus provides an overview of the section and brief descriptions of the following chapters: Chapter Twelve, “Ebola and the Ravages of History in Paul Farmer: A Catholic Theological Ethical Response to Global Health Inequity in Africa,” by Stan Chu Ilo; Chapter Thirteen, “The Legacy of Paul Farmer for Theological Ethics,” by Andrea Vicini; and Chapter Fourteen, “From Compassion to Pragmatic Solidarity: Considering the Right to Health from the Margins,” by Maura Ryan.

Letter from the Editor

Dear Reader,
 Throughout the past year, the Journal of Global Health remains committed towards serving as an active platform for discussions in public and global health in the post-pandemic world. At the core of the journal’s mission, we aim to encourage the dissemination of research that explores a variety of global health challenges and inequities as well as the multifaceted approaches that can be taken to address them. We are grateful for the opportunity to work with writers, students, researchers and community members at our Columbia campus and beyond. We are excited to share our newest Fall 2022 issue with you.
 Beyond our biannual publication featuring research manuscripts, we are excited to share the new content published on our “What is Global Health?” podcast and blog produced by the Online Board, which includes interviews with Columbia public health faculty and op-ed reflections on current health issues. In light of the pandemic, science communication has become the spotlight of discussion over recent years. Our podcast and blog seeks to make public and global health research and associated discussions accessible to a broader audience. The “What is Global Health?” podcast can be accessed online at whatisglobalhealth.podcasts.library.columbia.edu or on multiple streaming platforms including Spotify, iTunes and Stitcher. The blog can be accessed on our journal’s website. Both our podcast and blog are hosted through our partnership with Columbia University Libraries.
 This Fall 2022 issue explores a broad range of global health topics from the U.S. to Africa. This issue delves into examining the 2021 SAMHSA Grant Allocation as a Federal Response to the Opioid Epidemic, corruption and healthcare in Africa and factors influencing family planning in the Buyende District of Uganda. We thank our authors and peer reviewers for their submissions and contributions without which our journal could not exist.
 We would like to express our gratitude towards our 55-person journal team, composed of our Managing Board, Editorial Board, Production & Design Board, Online Board, and Business & Communications Board. We also wish to thank our peer reviewers who volunteered their time to provide the authors with insightful feedback on their manuscripts. Thank you to our collaborators at the Columbia University Libraries and the Faculty Advisory Board composed of Scholarly Communication Technologies Librarian Esther Jackson and faculty advisor Columbia University Mailman School of Public Health Professor James Colgrove.
 Sincerely,Scarlet Au & Kairaluchi OraeduCo-Editors-in-Chief, The Columbia University Journal of Global Health

Understandings and practices: Towards socially responsive curricula for the health professions.

Global health inequities have created an urgency for health professions education to transition towards responsive and contextually relevant curricula. Such transformation and renewal processes hold significant implications for those educators responsible for implementing the curriculum. Currently little is known about how health professions educators across disciplines understand a responsive curriculum and how this understanding might influence their practice. We looked at curricula that aim to deliver future health care professionals who are not only clinically competent but also critically conscious of the contexts in which they serve and the health care systems within which they practice. We conducted a qualitative study across six institutions in South Africa, using focus group discussions and in-depth individual interviews to explore (i) how do health professions educators understand the principles that underpin their health professions education curriculum; and (ii) how do these understandings of health professions educators shape their teaching practices? The transcripts were analysed thematically following multiple iterations of critical engagement to identify patterns of meaning across the entire dataset. The results reflected a range of understandings related to knowing, doing, and being and becoming; and a range of teaching practices that are explicit, intentionally designed, take learning to the community, embrace a holistic approach, encourage safe dialogic encounters, and foster reflective practice through a complex manner of interacting. This study contributes to the literature on health professions education as a force for social justice. It highlights the implications of transformative curriculum renewal and offers insights on how health professions educators embrace notions of social responsiveness and health equity to engage with these underlying principles within their teaching.

Access to Drugs and Vaccines for Mpox in Africa: Lack of Indigenous Political Will or Global Health Inequity?

Access to Drugs and Vaccines for Mpox in Africa: Lack of Indigenous Political Will or Global Health Inequity?

Palliative care practices and policies in diverse socio-cultural contexts: aims and framework of the ERC globalizing palliative care comparative ethnographic study.

Palliative care as a specialist professional practice of care for people with advanced illness is becoming increasingly influential worldwide. This process is affected by global health inequalities as well as cultural dimensions of approaching death and practicing care in life-limiting illness. The European Research Council-funded Globalizing Palliative Care (ENDofLIFE) project aims to understand how palliative care policies, discourses and practices are translated, adapted and reconstituted in diverse socio-cultural settings and how cultural dimensions of approaching death and local practices of care shape palliative care implementation. Using a multi-scalar and multi-sited ethnographic approach, the project uses person-centered ethnography, participant observation, semi-structured interviewing, focus group discussions and policy and discourse analysis at transnational, national and local levels. Ethnographic case-studies are conducted in Brazil, India and Indonesia. The globalizing palliative care project develops a novel ethnographic methodology of studying end-of-life care trajectories through long-term participant observation with individual patients and families as they manage and practice formal and informal health care in advanced illness. By analyzing how patients and families experience and navigate care over time, complemented by stakeholder interviews, the study advances critical theoretical insight into the relation between (large-scale and dynamically traveling) palliative care models, policies and discourses on the one hand and the experience and practice of palliative care in the lives of patients and informal care givers in local health care practices on the other hand. Insights are expected to benefit culturally situated palliative care policies and practices.

Global Perspectives and Health Inequalities in Addressing the Psychosocial Impact of Visible Disfigurement: An Inclusive Approach

Global Perspectives and Health Inequalities in Addressing the Psychosocial Impact of Visible Disfigurement: An Inclusive Approach

IT WAS TERRIBLE, I DIDN'T SLEEP FOR TWO YEARS: A MIXED-METHODS EXPLORATION OF SLEEP AMONG HOSPICE FAMILY CAREGIVERS

Abstract Due to overnight caregiving demands and inadequate social support, over 1.2 million hospice family caregivers in the U.S. and millions more worldwide are at risk of poor sleep and resulting negative effects on health. Sleep problems are a modifiable source of global health inequities. The purpose of this study was to describe hospice family caregiver sleep experiences, efforts to improve sleep, and effects of sleep. Developed using the Symptom Management Model, this mixed methods study featured a concurrent nested design prioritizing qualitative reflexive thematic analysis. In 2021, 47 family caregivers of hospice care-recipients from two randomized clinical trials in the United States (NCT03712410, NCT02929108) were interviewed. Sleep-related questions from PHQ-9 and GAD-7, and self-rated health and energy were administered at baseline. Three themes emerged: quality of sleep, factors influencing sleep, and effects of sleep. Hospice family caregivers commonly experienced “interrupted” sleep with frequent night-waking due to “on-call” “vigilance” and anxiety overnight and, sometimes, in bereavement. Negative effects included exhaustion, mental and physical health decline, and reduced performance. 72.5% described sleep quality as “fair” or “poor.” At baseline, 35.5% of caregivers were bothered by trouble falling asleep, staying asleep, or sleeping too much at least “more than half the days” in a week. Caregivers were reluctant to take sleep medications. Over half quit jobs or reduced work hours to provide care; few reported adequate support. Hospice family caregivers commonly experience disordered sleep with negative effects. Clinicians must assess sleep, offer tailored sleep interventions, and provide more supports to hospice family caregivers.

Addressing diversity and inclusion challenges in global neuro-psychiatric and behavioral genomics research.

Advancements in neuro-psychiatric and behavioral genomics offer significant opportunities for better understanding the human brain, behavior and associated disorders. Such advancements may help us prevent, manage and/or cure complex conditions. The serious challenge confronted by these disciplines however is diversity. Both fields lack diversity in terms of genomic reference datasets needed for discovery research, engagement of diverse communities in translational research and in terms of diverse and multidisciplinary scientific teams. This is a challenge because diversity is needed on all levels in order to increase representation and inclusion of all populations across the globe as we move research activities forward. The lack of diversity can translate to an inability to use scientific innovations from these fields for the benefit of all people everywhere and signifies a missed opportunity to address pervasive global health inequities. In this commentary we identify three persistent barriers to reaching diversity targets while focusing on discovery and translational science. Additionally, we propose four suggestions on how to advance efforts and rapidly move towards achieving diversity and inclusion in neuro-psychiatric and behavioral genomics. Without systematically addressing the diversity gap within these fields, the benefits of the science may not be relevant and accessible to all people.

Utilization of remote monitoring among patients receiving cardiac resynchronization therapy and comparison between Asia and the Americas.

There is increasing momentum in application of digital solutions in medicine to improve patient outcomes and reduce global health inequities.1,2 Remote monitoring (RM) of patients with cardiac implantable electronic devices received a Class 1 recommendation in 2015 in the United States.3 However, adoption varies by device type (eg, pacemakers less frequently) and patient condition, possibly because sicker patients and/or those with more complex devices are perceived to have the most to gain. Cardiac resynchronization therapy (CRT) is the most complex cardiac implantable electronic device, and “nonresponders” (CRT-NR) have one of the poorest prognoses among heart failure patients.

Reducing global health inequalities for a rare disorder: evaluating the international Prader–Willi Syndrome Organisation’s Echo® programme

BackgroundPeople with rare disorders face significant global health inequalities; the challenge is how to raise awareness and develop a nucleus of experts in a country who are then able to provide guidance to others in that country. The International Prader–Willi Syndrome Organisation (IPWSO) established Project ECHO® with the aim of facilitating the sharing of knowledge and the building of international partnerships to reduce global health inequalities for a particular rare genetically-determined neurodevelopmental disorder, Prader–Willi Syndrome (PWS). Four different ECHO programmes were established for the following groups: (a) Individuals (usually parents) who had taken on a leadership role in their country; (b) health professionals interested in PWS; (c) professional care providers supporting children and adults with PWS; and (d) a Latin American ECHO in Spanish. The programme started in 2020 and an evaluation was undertaken after one year to determine: the extent to which IPWSO had been able to recruit and retain individuals globally; the nature and extent of any benefits gained from the sessions; and examples of how individual involvement in the programme had led to local benefits. The methods included analysing routinely kept process indicators and survey data from the attendees of one component of the programme (the Leadership ECHO), together with a qualitative analysis of survey data and recorded interviews of attendees from countries of differing socio-economic status.ResultsWe describe the IPWSO ECHO programme and report on the outcomes from the evaluation of one aspect of the programme, the Leadership ECHO. Attendance of the Leadership ECHO sessions was satisfactory, with a mean of 24.7 participants, with participants attending a mean of 5.67 sessions, i.e., 30% of sessions. There was also good global reach, with individuals attending from 34 countries, although there were notable geographic regions with very limited representation. Feedback and interviews demonstrated the positive impact of the programme with some early evidence of positive developments at national level.ConclusionsFamilies and professionals from countries with a range of expertise and services offered to people with PWS remained engaged throughout the ECHO programme, established networks of support and fostered the development of good practice.

JAHEE internal evaluation

Abstract The evaluation of the project for both the intermediate and the final report was based on an internal evaluation conducted by Work Package on Evaluation and on an external evaluation conducted by the Center for Global Health Inequality Research (CHAIN). The project evaluation as based on systematic and continuous monitoring of processes, outputs and outcomes indicators aimed to guarantee the achievement of the planned objectives and the identification of the lessons learned for future health inequalities programs. The main results will be presented.

The National and Global Impact of Systemic and Structural Violence on the Effective Prevention, Treatment, and Management of COVID-19 in African or Black Communities: Protocol for a Scoping Review.

BackgroundAs COVID-19 ravages the globe and cases increase rapidly, countries are presented with challenging policy choices to contain and mitigate its spread. In Canada and globally, the COVID-19 pandemic has added a new stratum to the debate concerning the root causes of global and racial health inequities and disparities. Individuals who exist as targets of systemic inequities are not only more susceptible to contracting COVID-19, but also more likely to bear the greatest social, economic, and physical burdens. Therefore, data collection that focuses on the impact of COVID-19 on the lives and health of African/Black communities worldwide is needed to develop intersectional, culturally relative, antiracist/antioppression, and empowerment-centered interventions and social policies for supporting affected communities.ObjectiveThe primary objective of this review is to investigate the impact and management of COVID-19 among African/Black individuals and communities, and understand how anti-Black racism and intersectional violence impact the health of African/Black communities during the pandemic. Moreover, the study aims to explore research pertaining to the impact of COVID-19 on Black communities in the global context. We seek to determine how Black communities are impacted with regard to structural violence, systematic racism, and health outcomes, and the ways in which attempts have been made to mitigate or manage the consequences of the pandemic and other injurious agents.MethodsA systematic search of quantitative and qualitative studies published on COVID-19 will be conducted in MEDLINE (Ovid), Embase (Ovid), Cumulative Index to Nursing and Allied Health Literature (EBSCO), Cochrane Library, PsychInfo (Ovid), CAB s (Ovid), Scopus (Elsevier), Web of Science (Clarivate), and Global Index Medicus. To be included in the review, studies should present data on COVID-19 in relation to African/Black individuals, populations, and communities in the global sphere. Studies must discuss racism, oppression, antioppression, or systemic and structural violence and be published in English, French, Spanish, or Portuguese. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, the findings will be synthesized quantitatively and qualitatively through thematic analysis. The risk of bias will not be assessed.ResultsTitle, abstract, and full-text screening concluded in June 2022. Data collection is in progress and is expected to be completed by December 2022. Data analysis and drafting of the manuscript will be done thereafter. Findings from the scoping review are expected to be provided for peer review in 2023.ConclusionsThis review will collect important data and evidence related to COVID-19 in African/Black communities. The findings could help identify existing gaps in COVID-19 management in African/Black communities and inform future research paradigms. Furthermore, the findings could be applied to decision-making for health policy and promotion, and could potentially influence services provided by health care facilities and community organizations around the globe.International Registered Report Identifier (IRRID)DERR1-10.2196/40381

Teach About Heat: Rising Temperature From Climate Change Is a Nursing Issue.

Deaths attributed to rising temperatures and heat waves represent a continuing public health concern. Climate change affects social determinants of health and local and global health inequities, especially those negatively impacted by high temperatures. Individuals with chronic health conditions have greater likelihood of mortality due to rising temperatures. Nurses witness the harmful effects of climate change but may not be aware that a patient's worsening symptoms can be due to heat. Nurses need to understand and then educate patients and communities about ways to reduce harm from heat, medication interactions with heat, and what safety measures to take in regions of high heat or during heat waves to best promote health equity and reduce mortality. [J Contin Educ Nurs. 2022;53(10):460-464.].

Can You Hear Us Now? Equity in Global Advocacy for Palliative Care.

Evidence-based advocacy underpins the sustainable delivery of quality, publicly guaranteed, and universally available palliative care. More than 60 million people in low- and middle-income countries (LMICs) have no or extremely limited access to either palliative care services or essential palliative care medicines (e.g., opioids) on the World Health Organization Model List. Indeed, only 12% of the global palliative care need is currently being met. Palliative care advocacy works to bring this global public health inequity to light. Despite their expertise, palliative care practitioners in LMICs are rarely invited to health policymaking tables - even in their own countries - and are underrepresented in the academic literature produced largely in the high-income world. In this paper, palliative care experts from Bangladesh, Colombia, Egypt, Sudan, Uganda, and Zambia affiliated with the International Association for Hospice & Palliative Care Advocacy Focal Point Program articulate the urgent need for evidence-based advocacy, focusing on significant barriers such as urban/rural divides, cancer-centeredness, service delivery gaps, opioid formulary limitations, public policy, and education deficits. Their advocacy is situated in the context of an emerging global health narrative that stipulates palliative care provision as an ethical obligation of all health systems. To support advocacy efforts, palliative care evaluation and indicator data should assess the extent to which LMIC practitioners lead and participate in global and regional advocacy. This goal entails investment in transnational advocacy initiatives, research investments in palliative care access and cost-effective models in LMICs, and capacity building for a global community of practice to capture the attention of policymakers at all levels of health system governance.

Bringing the lab bench to the field: Point-of-care testing for enhancing health research and stakeholder engagement in rural/remote, indigenous, and resource-limited contexts.

Point-of-care testing (POCT) allows researchers and health-care providers to bring the lab bench to the field, providing essential health information that can be leveraged to improve health care, accessibility, and understanding across clinical and research settings. Gaps in health service access are most pronounced in what we term RIR settings-rural/remote regions, involving Indigenous peoples, and/or within resource-limited settings. In these contexts, morbidity and mortality from infectious and non-communicable diseases are disproportionately higher due to numerous geographic, economic, political, and sociohistorical factors. Human biologists and global health scholars are well-positioned to contribute on-the-ground-level insights that can serve to minimize global health inequities and POCT has the potential to augment such approaches. While the clinical benefits of POCT include increasing health service access by bringing testing, rapid diagnosis, and treatment to underserved communities with limited pathways to centralized laboratory testing, POCT also provides added benefits to both health-focused researchers and their participants. Through portable, minimally invasive devices, researchers can provide actionable health data to participants by coupling POCT with population-specific health education, discussing results and their implications, creating space for participants to voice concerns, and facilitating linkages to treatment. POCT can also strengthen human biology research by shedding light on questions of evolutionary and biocultural importance. Here, we expand on the epidemiological and research value, as well as practical and ethical challenges of POCT across stakeholders (i.e., participant, community, health researcher, and trainee). Finally, we emphasize the immense opportunities of POCT for fostering collaborative research and enhancing access to health delivery and information and, by extension, helping to mitigate persistent global health inequities.

Cervical Imaging in the Low Resource Setting: A Review.

Cervical cancer is one of the most significant global health inequities of our time and is the fourth most common cancer in women worldwide, disproportionally affecting developing countries where the disease burden is 84%. Sometimes referred to as preventable cancer, it progresses slowly, providing a window of time for routine screening in which pre-cancerous lesions can be identified and treated. The high mortality rate can be attributed to many reasons, including the high cost of cytology-based screening, lack of human resources to conduct screening, and inadequate preventive medicine services and systems. Due to its slow progression, early intervention is feasible with appropriate screening. However, the standard screening procedures require access to lab-based tests and physician expertise. Several imaging devices have been introduced in the literature to aid cervical screening in low-resource settings. This review details the instrumentation and clinical testing of devices currently deployed in low-resource locations worldwide. The devices’ imaging, portability, illumination, and power requirements (among other metrics) are documented with specifics of human pilot studies conducted with these tools.

Anthropological Engagements with Global Health

Epidemic infectious diseases like HIV/AIDS, tuberculosis, Ebola, and more recently COVID-19, have persistent and devastating impacts in human populations across the globe. In this Review essay, we consider together the monographs Epidemic Illusions (Richardson 2021) and Fevers, Feuds, and Diamonds (Farmer 2020), as well as the documentary film Bending the Arc (Davidson and Kos 2017), Together, they demonstrate the history of transnational colonialism, the significance of structural violence as a contributor to global health inequity, and the increasing presence of co-occurring epidemics worldwide, topics which are often absent from discussions of global health systems. These three works discuss epidemics as pathologies of history and sociocultural patterns of colonial dispossession in global health systems; the inclusion of patient narratives in two of them, the film Bending the Arc and the book Fevers, Feuds, and Diamonds, is pivotal in describing the intricacies of HIV infection and other infectious diseases, as well as the complexity of gaining control of syndemic diseases. Further, these three materials point to the importance of health education in communities and of access to healthcare by community members, and to the roles that health education and access play in health policy implementation.