World Health Organization Code Research Articles

The World Health OrganisationGlobal Code of Practice and migration of health workers from Zimbabwe.

The migration of health workers remains one of the most pressing challenges facing many countries in the global South. This short communication seeks to reignite debate on the effectiveness of the World Health Organisation (WHO) Code as a tool for managing the migration of health workers from the South. While the WHO Code was somewhat effective in reducing the migration of health workers from countries such as Zimbabwe during the first five years of its implementation, demand for health workers in the UK after Brexit and the COVID-19 pandemic has accelerated the rate of migration of health workers from countries facing critical shortages. Clearly, new solutions are needed that strike a balance between the right of health workers in the South to migrate and the right of citizens in the region to a stable supply of health workers.

A Critical Review of the Drug Promotional Literature Published in Scientific Medical Journals and Available at Outpatient Departments: A Cross-Sectional Observational Study.

Background A vital method used by pharmaceutical companies to make physicians aware of new drugs and increase the prescription and sale of the same is through drug promotion literature (DPL) published in scientific journals and distributed in outpatient departments (OPDs). It is important that drug promotion is done ethically to avoid the spread of false information for which guidelines are available at the international level by the World Health Organization (WHO) and at the national level by the Organisation of Pharmaceutical Producers of India (OPPI). In this study, we aim to review the DPLs used for promotion by market authorization holders (pharmaceutical businessentities) in scientific healthcare journals and OPDs for their compliance with the "Ethical criteria for medicinal drug promotion" of the WHO and OPPI Code of Ethics Practice. In addition, we compare the ethical standard of the DPL available in scientific journals and OPDs with respect to existing norms and guidelines. Methodology A cross-sectional, observational study was conducted at a tertiary care teaching institute in Navi Mumbai, India. DPLs were collected from journals available at the institute library nearby published from January-June 2022 and from the outpatient departments of our hospital and other clinics nearby during the same time duration.Analysis was done according to the criteria given in WHO and OPPI guidelines. Each point in the criteria was scored as 1 or 0 based on whether the DPL was compliant or not respectively. DPLs were graded into 3 categories based on percentage compliance: Grade A (>70%), Grade B (35-70%), and Grade C (<35%). Results A total of 370 DPLs were collected, of which 191 (51.6%) were collected from scientific journals and 179 (48.4%) from OPDs. DPLs collected from journals showed that only 7.85% belonged to Grade A (WHO guidelines). According to the OPPI guidelines, 57.59% of the same DPLs belonged to Grade A. DPLs from OPDs showed similar results by both guidelines with >90% belonging to Grade B. Approximately less than 5% of the DPLs belonged to Grade C from both scientific journals and OPDs. Conclusions None of the DPLs were found to be entirely compliant with either of the guidelines. Most of the DPLs from both sources belong to Grade B, withinformation about adjuvants, adverse drug reactions, contraindications, drug interaction, and references to scientific literature missing from them. DPLs belonging to Grade C even had information about active ingredients missing from them which can lead to serious harm due to the wrong prescription of drugs.

Combating Pervasive and Misleading Formula Marketing Practices Is All of Our Responsibility.

Breastfeeding MedicineVol. 17, No. 6 President's CornerFree AccessCombating Pervasive and Misleading Formula Marketing Practices Is All of Our ResponsibilityAnn KellamsAnn Kellams—Ann Kellams, MD, IBCLC, FAAP, FABM, President, Academy of Breastfeeding Medicine Search for more papers by this authorPublished Online:8 Jun 2022https://doi.org/10.1089/bfm.2022.29210.alkAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail This month, I would like to call your attention to a ground-breaking report that was recently released by the World Health Organization (WHO) and UNICEF, entitled “How the Marketing of Formula Milk Influences Our Decisions on Infant Feeding.”1The report highlights the findings of an international research study performed by an independent research firm, M&C Saatchi World Services. Data was collected from eight countries, including China, Mexico, South Africa, and the United Kingdom of Great Britain, with >8,500 pregnant women, mothers, and 300 health care professionals surveyed. Additionally, over 100 focus groups and 80 in-depth interviews were conducted. Although marketing is a pervasive part of all of our lives, the report calls out the fact that the marketing of formula can impact feeding decisions that can have tremendous individual and public health consequences. Deciding how to feed an infant should be based on sound evidence and information, ideally obtained from health professionals, and not influenced by commercial interests.Here is a summary of several key findings with quotes directly from the report: 1.Marketing of formula is “pervasive, personalized, and powerful.”2.These companies use “manipulative marketing tactics that exploit parents' anxieties and aspirations.”3.Formula marketing “distort[s] science and medicine” making “false and incomplete scientific claims” to sell their product(s)4.These companies target health professionals5.Strategies used “undermine parents' confidence” in breastfeeding; messages are “slick and misleading”6.Immediate counter-measures at the level of governments, health professionals, and associations.For those of us in breastfeeding medicine, many of these findings may not come as a surprise. We are used to “swimming upstream,” and advocating for the rights and support of breastfeeding families.A number of action items are highlighted, including one that is specifically relevant to the mission of the Academy of Breastfeeding Medicine (ABM): “Protect the integrity of science and medicine.” The ABM lists “Knowledge and Research” as one or our key domains. We strive to promote, distill, and disseminate evidence-based research that improves clinical care and is globally accessible. As members of ABM, we have a responsibility to find ways to spread the word about the importance of breastfeeding, the best ways to support breastfeeding families, and how to appropriately manage breastfeeding concerns.We need to find ways to “actively counter” misleading and inaccurate commercially driven information. We need to normalize breastfeeding, not because it is “best” but because it is the physiological norm against which all other substances must be compared.As health care professionals, we also need to commit to divesting from formula companies in the name of public health. At ABM, we are very proud to not accept sponsorship from companies that are not WHO code compliant. Does this mean our membership and our conferences are more expensive? It does. We feel strongly that we all need to stop using our time and effort to provide these corporations with “cheap advertising.” When they sponsor our events, or we wear their lanyards, or recommend nonmedical use of their products, we both knowingly and unknowingly endorse their product.Health care professionals have a strong influence on families' practices and attitudes toward infant feeding. These companies profit when breastfeeding fails, and we must preserve the integrity of our role of trusted health experts, not tarnish it. We must use our influence to make sure all families have the most up-to-date accurate information about infant feeding so they can make the best decision for themselves, and then, we must do everything in our power to help remove obstacles and manage any concerns that arise so that as many infants as possible are able to breastfeed.Reference1. World Health Organization. How the marketing of formula milk influences our decisions on infant feeding. Available at https://www.who.int/publications/i/item/9789240044609 (accessed April 29, 2022). Google ScholarFiguresReferencesRelatedDetails Volume 17Issue 6Jun 2022 InformationCopyright 2022, Mary Ann Liebert, Inc., publishersTo cite this article:Ann Kellams.Combating Pervasive and Misleading Formula Marketing Practices Is All of Our Responsibility.Breastfeeding Medicine.Jun 2022.550-550.http://doi.org/10.1089/bfm.2022.29210.alkPublished in Volume: 17 Issue 6: June 8, 2022Online Ahead of Print:May 25, 2022PDF download

Global implications of the new WHO and UNICEF implementation guidance on the revised Baby-Friendly Hospital Initiative.

Although breastfeeding confers both short- and long-term benefits for children and their mothers, breastfeeding practice remains suboptimal, globally. In addition to barriers including misperceptions and inappropriate marketing of breast milk substitutes, inadequate support for breastfeeding remains a challenge in many settings. To improve access to appropriate health system support, the World Health Organization (WHO) has reviewed the Baby-Friendly Hospital Initiative (BFHI), which ensures provision of optimal clinical care and support to mothers and their infants. This review has resulted in revision of the Ten Steps to Successful Breastfeeding, which form the core standards of (BFHI). These now consist of critical management procedures to support breastfeeding (Steps 1 and 2) and key clinical practices to support breastfeeding (Steps 3-10). In Step 1, there is now specific emphasis on compliance with the WHO Code of Marketing of Breast-milk Substitutes and relevant World Health Assembly resolutions as well as on internal monitoring. There are also significant position shifts like the recommendation to "Counsel mothers on the use and risks of feeding bottles, teats, and pacifiers," which is a departure from the earlier position of avoiding reference to these technologies. These revisions require countries and states to revise activities and tools for their local situation but without compromising the standards.

Advocating to Protect Our Nurses: Addressing Unethical Recruitment of Foreign-Educated Nurses.

Advocacy in the nursing sector is often about advocating for patients. However, nurses have begun to put more effort into protecting their rights as workers. Advocacy on behalf of foreign-educated nurses has been a critical component of this advocacy. While foreign-educated nurses can make our nursing workforce stronger, this can only happen if they are well-treated and well-trained. Organizations across diverse missions and perspectives have come together to promote fair treatment of foreign-educated nurses, which ultimately ensures that all nurses are working as effectively as possible and that patients receive proper care. The Alliance for Ethical International Recruitment Practices' Health Care Code for Ethical Recruitment and Employment Practices represents a bottom-up agreement on which market practices constitute ethical recruitment. From a top-down level, the World Health Organization's Code of Global Practice establishes obligations and reporting requirements for member states that commit to ensuring ethical recruitment. This combination of efforts, bolstered by strong advocacy, is gaining traction as nursing migration grows at the global level. The collaboration across diverse stakeholder groups and the combination of legal, voluntary, and global efforts to promote the rights of foreign-educated nurses provides a model to apply for advocacy in different areas.

Empirically evaluating the WHO global code of practice on the international recruitment of health personnel's impact on four high-income countries four years after adoption.

BackgroundShortages of health workers in low-income countries are exacerbated by the international migration of health workers to more affluent countries. This problem is compounded by the active recruitment of health workers by destination countries, particularly Australia, Canada, UK and USA. The World Health Organization (WHO) adopted a voluntary Code of Practice in May 2010 to mitigate tensions between health workers’ right to migrate and the shortage of health workers in source countries. The first empirical impact evaluation of this Code was conducted 11-months after its adoption and demonstrated a lack of impact on health workforce recruitment policy and practice in the short-term. This second empirical impact evaluation was conducted 4-years post-adoption using the same methodology to determine whether there have been any changes in the perceived utility, applicability, and implementation of the Code in the medium-term.MethodsForty-four respondents representing government, civil society and the private sector from Australia, Canada, UK and USA completed an email-based survey evaluating their awareness of the Code, perceived impact, changes to policy or recruitment practices resulting from the Code, and the effectiveness of non-binding Codes generally. The same survey instrument from the original study was used to facilitate direct comparability of responses. Key lessons were identified through thematic analysis.ResultsThe main findings between the initial impact evaluation and the current one are unchanged. Both sets of key informants reported no significant policy or regulatory changes to health worker recruitment in their countries as a direct result of the Code due to its lack of incentives, institutional mechanisms and interest mobilizers. Participants emphasized the existence of previous bilateral and regional Codes, the WHO Code’s non-binding nature, and the primacy of competing domestic healthcare priorities in explaining this perceived lack of impact.ConclusionsThe Code has probably still not produced the tangible improvements in health worker flows it aspired to achieve. Several actions, including a focus on developing bilateral codes, linking the Code to topical global priorities, and reframing the Code’s purpose to emphasize health system sustainability, are proposed to improve the Code’s uptake and impact.

The WHO Code and US Nursing

In 2010, all member states of the World Health Assembly, including the United States, adopted the World Health Organization (WHO) Global Code of Practice on the International Recruitment of Health Personnel (the WHO Code). 1 The development and unanimous adoption of the Code by all WHO affiliate countries marked a watershed in policy focus on the issue of health worker migration.

Infant food marketing strategies undermine effective regulation of breast‐milk substitutes: trends in print advertising in Australia, 1950–2010

This study addresses the issue of whether voluntary industry regulation has altered companies' marketing of breast-milk substitutes in Australia since the adoption of the World Health Organization (WHO) International Code on the Marketing of Breast-milk Substitutes 1981. Print advertisements marketing breast-milk substitutes were systematically sampled from the Australian Women's Weekly (AWW) magazine and the Medical Journal of Australia (MJA) for the 61 years from 1950 to 2010. Breast-milk substitute advertising in both the MJA and the AWW peaked and began declining before the introduction of the WHO Code in 1981. Although there was almost no infant formula advertising in AWW after 1975-79, other breast-milk substitute advertising has been increasing since 1992, in particular for baby food, toddler formula and food and brand promotion. Companies have adopted strategies to minimise the effects of the Code on sales and profit in Australia, including increasing toddler formula and food advertisements, increasing brand promotion to the public, and complying with more limited voluntary regulatory arrangements. Comprehensive regulation is urgently required to address changed marketing practices if it is to protect breastfeeding in Australia.

Multinational Corporations and the Impact of Public Advocacy on Corporate Strategy: Nestle and the Infant Formula Controversy

Preface. Book I: The Setting. 1. The Infant Formula Controversy at the Center Stage. 2. The Societal Context of the Infant Formula Controversy. 3. The Institutional Context of the Formula Controversy. Book II: The Gathering Storm. 4. Sowing the Seeds of the Infant Formula Controvery -- the Early Years. 5. The Infant Formula Controversy comes to the United States. 6. The Activistis throw down the Gauntlet -- the Kennedy Hearings and their Aftermath. 7. The Drive toward Code Enactment -- the Post Kennedy Era. Book III: Issues and Institution. 8. Health, Medical and Scientific Aspects of the Infant Formula Controversy. 9. Worldwide Infant Formula Sales, Markets and Industry Structure. 10. Infant Formula Industry and Major Manufacturers involved in the Controversy. 11. Major Religious and Activist Groups involved in the Infant Formula Controversy. Book IV: Escalation of the Conflict. 12. Involvement of the World Health Organization (WHO) Hearings in Geneva. 13. Dynamics of the Passage of the WHO Code -- Interplay between Institutions and Players. 14. The U.S. casts the 'Sole' Negative Vote: the Impact of Ideology and Domestic Policies. Book V: Drive toward Resolution of the Conflict. 15. Nestle Coordination Center for Nutrition, Inc. (NCCN): Nestle's Change in Organizational Structure and Strategies to deal with the Boycott. 16. 'Winning the Methodists': the Last Major Battle-Ground to enlist the Religious Community's Support for the Boycott. 17. Nestle Infant Formula Audit Commission (NIFAC): a New Model for Gaining External Legitimacy for Corporate Actions. 18. Settlement ofthe Dispute and Termination of the Boycott: Discussions between INBC/INFACT and Nestle -- UNICEF in the Role of an Honest Broker. Book VI: Some Lessons Learned and Unlearned. 19. The Lessons of Accountability -- Third World Governments: Expectations and Performance -- WHO'S Non-Existent Monitoring. 20. Code Compliance by the Infant Formula Industry: the New Nestle -- the More Things Change, the More they Remain the Same. 21. Emerging Modes of Business--Society Conflict Resolution -- an Assessment. Index.

Production and reproduction: Women and breastfeeding: Some Nigerian examples

Breastfeeding is of crucial importance in the developing world, not only to the health of the mother and her infant, but to the community in general. The importance of breastfeeding of infants lies not only in its nutritional and hygienic properties, but also because of its immunological effects and its influence in the control of fertility. The literature review is combined with a discussion of aspects of research undertaken by the authors under the headings of length of breastfeeding, bottlefeeding and breastfeeding and fertility. Most of the examples come from Nigeria, but the problems discussed are common to much of the developing world. Under a discussion of social and policy implications, the need for governments in the developing countries to adopt the recent World Health Organisation's code of practice to curtail the sale of artificial infant milks, is stressed. It is suggested that health agencies in countries like Nigeria should go to the rural areas now, to instruct the women and men in the dangers of bottle feeding and the benefits of breastfeeding, before the ‘modernisation’ of infant feeding, so evident in the towns, spreads to the rural areas.