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In the wake of the COVID-19 pandemic, it is clear that the struggle for global health justice must be our highest priority. To understand the challenges that such a priority faces, we must recognise that this struggle has a long history, and to analyse current challenges within this historical perspective. This commentary explores the gradual construction of the global health justice movement during different historical periods (tropical/colonial medicine, international health, and global health) in the history of approaches to health worldwide. It examines the changing relationship between the political economy of capitalism, colonialism, and racism. It analyses attempts to confront injustice through both human rights and social justice movements in seeking to address stigma and discrimination as well as poverty and social exclusion. It highlights emerging battlegrounds such as access to medical treatments and healthcare services as well as the ways in which private interests continue to undercut such efforts. But it also points to windows of opportunity for defending principles such as solidarity and social inclusion, for building advocacy/analysis alliances and toolkits to inform social movements, and possibilities to reconstruct global health 'governance' mechanisms and institutions in accord with the most basic principles of health justice. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic highlighted global interdependencies, accompanied by widespread calls for worldwide cooperation against a virus that knows no borders, but responses were led largely separately by national governments. In this tension between aspiration and reality, people began to grapple with how their own lives were affected by the global nature of the pandemic. In this article, based on 493 qualitative interviews conducted between 2020 and 2021, we explore how people in Argentina, Austria, Bolivia, Ecuador, Ireland, Italy and Mexico experienced, coped with and navigated the global nature of the pandemic. In dialogue with debates about the parameters of the 'global' in global health, we focus on what we call people's everyday (de)bordering practices to examine how they negotiated (dis)connections between 'us' and 'them' during the pandemic. Our interviewees' reactions moved from national containment to an increasing focus on people's unequal socio-spatial situatedness. Eventually, they began to (de)border their lives beyond national lines of division and to describe a new normal: a growing awareness of global connectedness and a desire for global citizenship. This newfound sense of global interrelatedness could signal support for and encourage transnational political action in times of crises. [ABSTRACT FROM AUTHOR]

The high risk of maternal death in Africa has cast a shadow over representations and experiences of pregnancy and childbirth. In the 1980s, amid new awareness of disparities in maternal mortality rates between high and low-income countries, tragic anecdotes of women dying during childbirth emerged as a tool to garner political and economic support for global health interventions aimed at women. While successfully raising public concern and billions of dollars in aid, given that these stories are some of the few stories of African women so widely circulated, it is important to ask: what else does the genre of maternal death narrative do? How might discursive practices around childbirth structure the care offered to African women? What power relations are revealed in this form of knowledge production and promotion? This article examines how maternal death narratives function, circulate, and structure potential solutions to the problem of maternal mortality. In focusing on the pathways to death, women's bodies are foregrounded as sites of knowledge production over their experiences. I use fieldwork with pregnant and birthing women in southwest Nigeria to explore the ways that women piece together different sources of care in an effort to ensure successful deliveries amidst considerable uncertainty. [ABSTRACT FROM AUTHOR]

While global health leaders call disparities in access to COVID-19 vaccines an 'apartheid,' this gap is not the first such disparity. The recurrence of these gaps in low and middle-income countries and especially in Africa, raises questions about their determinants and about the persistent failures of global health institutions to remediate them. We interrogate these determinants and questions by examining: (1) the distribution of COVID-19 vaccines; (2) primary determinants of vaccine access including availability and affordability; (3) factors affecting availability (hoarding, COVAX, and manufacturing capacity); and (4) factors affecting affordability (pricing, intellectual property rights (IPR), the TRIPS waiver and a potential pandemic treaty). We conclude that IPR constrained the affordability and availability of COVID-19 vaccines in ways inadequately addressed by COVAX and a waiver compromise thwarted by political, corporate, and philanthropic interests. While stronger limits to IPR in a pandemic treaty and a reformed International Health Regulations will not resolve structural inequities, they could meaningfully expand LMIC autonomy to protect public health. We urge equity-seeking Global South and North actors to fight for such IPR reforms as small and meaningful steps towards a more equitable global health order. Otherwise, criminally racist 'apartheids' will continue to be the norm when it comes to the distribution of essential health goods during global health emergencies. [ABSTRACT FROM AUTHOR]

How can governing digital health for infectious disease outbreaks be enhanced? In many ways, the COVID-19 pandemic has simultaneously represented both the potential and marked limitations of digital health practices for infectious disease outbreaks. During the pandemic's initial stages, states along with Big Data and Big Tech actors unleashed a scope of both established and experimental digital technologies for tracking infections, hospitalisations, and deaths from COVID-19 – and sometimes exposure to the virus SARS-CoV-2. Despite the proliferation of these technologies at the global level, transnational and cross-border integration, and cooperation within digital health responses to COVID-19 often faltered, while digital health regulations were fragmented, contested, and uncoordinated. This article presents a critiquing reflection of approaches to conceptualising, understanding, and implementing digital health for infectious disease outbreaks, observed from COVID-19 and previous examples. In assessing the strengths and limitations of existing practices of governing digital health for infectious disease outbreaks, this article particularly examines 'informal' digital health to build upon and consider how digitised responses to addressing and governing infectious disease outbreaks may be reconceptualised, revisited, or revised. [ABSTRACT FROM AUTHOR]

This paper evaluates global health responses to the COVID-19 pandemic through the 'two regimes of global health' framework. This framework juxtaposes global health security, which contains the threat of emerging diseases to wealthy states, with humanitarian biomedicine, which emphasises neglected diseases and equitable access to treatments. To what extent did the security/access divide characterise the response to COVID-19? Did global health frames evolve during the pandemic? Analysis focused on public statements from the World Health Organization (WHO), the humanitarian nonprofit Médecins Sans Frontières (MSF), and the American Centers for Disease Control and Prevention (CDC). Following a content analysis of 486 documents released in the first two years of the pandemic, the research yielded three findings. First, the CDC and MSF affirmed the framework; they exemplified the security/access divide, with the CDC containing threats to Americans and MSF addressing the plight of vulnerable populations. Second, surprisingly, despite its reputation as a central actor in global health security, the WHO articulated both regime priorities and, third, after the initial outbreak, it began to favour humanitarianism. For the WHO, security remained, but was reconfigured: instead of traditional security, global human health security was emphasised – collective wellbeing was rooted in access and equity. [ABSTRACT FROM AUTHOR]

This article compares the discursive construction of news values in English news reporting of China Daily and CNN about the COVID-19 vaccine, to reveal how the two media packaged the vaccine and improved the acceptance of the international community towards the vaccines made in the respective countries. Adopting corpus linguistic methods and Discursive news values analysis (DNVA) framework, this study examines news values through keywords, nomination strategies, and photographs. The results show that the two media outlets constructed the news value of Eliteness dominantly through a systematic combination of words and images, albeit in different ways. China Daily prominently consists of references to China's international communications in the production and application of the COVID-19 vaccine, at the same time packaging the COVID-19 vaccine as foreign aid to enhance diplomatic relations as well as protect and promote the order of the international community. In contrast, CNN chiefly demonstrates references to domestic medical experts and the well-known manufacturers of the COVID-19 vaccine, packaging the COVID-19 vaccine as the US' medical/commercial product. The respective ways in which they portray the COVID-19 vaccine have helped to bolster the acceptance of each country's vaccine by the international community. [ABSTRACT FROM AUTHOR]

Colonial history has deeply influenced the structures that govern global health. Though many curricula promote equity, few focus on developing competency in understanding and dismantling colonialism, and the structural barriers to global health equity. To dismantle colonial structures and create equitable collaborations, learners must be able to recognise how colonialism permeates global health practice. We propose a praxis cycle in education that asks learners to actively engage with these concepts. The praxis cycle includes: Theory: Learners explore the principles of decoloniality to understand how attitudes and practices are shaped by biased social structures influenced by colonialism. Reflection: Learners reflect on their work in LMIC settings through a lens of decoloniality and positionality. Action: Learners work in LMIC settings where they apply and actively engage with these concepts and insights. During implementation of this curriculum, we encountered several challenges including the cognitive dissonance of the learner to changing mental models of global health practice, existing systemic barriers to changing one's practice and the development of accountability mechanisms for learners in this type of curriculum. Intentionally incorporating a praxis cycle helps learners recognise their role in disrupting the structural forces that promote inequities, and actively dismantle the forces upholding systemic oppression. [ABSTRACT FROM AUTHOR]

This article explores stakeholders' perceptions of the challenges for developing a One Health agenda to tackle antimicrobial resistance (AMR) in Brazil, including the development and implementation of the Brazilian National Action Plan (BR-NAP). The data originate from 27 interviews conducted with human, environmental, and animal health stakeholders, including academics, managers, and policymakers involved in developing the BR-NAP. Through thematic analysis, we identified three interconnected themes: governance, the health system, and technical and scientific challenges. The findings draw particular attention to failures in the agenda-setting process, revealed by interviewees strongly emphasising that AMR is not considered a policy priority in Brazil. The lack of political will and awareness of the clinical, social, and economic impacts of AMR are considered the main impediments to the agenda's progress. The joint work across disciplines and ministries must be reinforced through policymaker engagement and better environmental sector integration. The agenda must include sustainable governance structures less affected by political winds. Policies should be designed jointly with state and local governments to create strategies to engage communities and improve their translation into effective implementation. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

China has been contributing to new approaches to global governance. The Health Silk Road (HSR), a significant component of the Belt and Road Initiative (BRI), was proposed by China in 2016. This paper claims that HSR is a new institution introduced alongside the existing WHO-led multilateral health system, and its relationship with the existing system can be described as layering. Having explored the new development of HSR during COVID-19, this paper further argues that while HSR has its unique strength in making contributions to global health governance and economic recovery, it faces a prominent issue of securitisation in the context of China-U.S. strategic competition, suspicion of the quality of medical products and sectoral fragmentation. [ABSTRACT FROM AUTHOR]

Global health researchers often discount mutual learning and benefit to address shared health challenges across high and low- and middle-income settings. Drawing from a 30-year partnership called AMPATH that started between Indiana University in the US and Moi University in Kenya, we describe an innovative approach and program for mutual learning and benefit coined 'reciprocal innovation.' Reciprocal innovation harnesses a bidirectional, co-constituted, and iterative exchange of ideas, resources, and innovations to address shared health challenges across diverse global settings. The success of AMPATH in Kenya, particularly in HIV/AIDS and community health, resulted in several innovations being 'brought back' to the US. To promote the bidirectional flow of learning and innovations, the Indiana CTSI reciprocal innovation program hosts annual meetings of multinational researchers and practitioners to identify shared health challenges, supports pilot grants for projects with reciprocal exchange and benefit, and produces educational and training materials for investigators. The transformative power of global health to address systemic health inequities embraces equitable and reciprocal partnerships with mutual benefit across countries and communities of academics, practitioners, and policymakers. Leveraging a long-standing partnership, the Indiana CTSI has built a reciprocal innovation program with promise to redefine global health for shared wellbeing at a global scale. [ABSTRACT FROM AUTHOR]

This article unites different disciplinary debates on 'southern innovation', 'theory from the South', and 'decolonisation of knowledge' in order to discuss existing understandings around the role of Africa in the production of health-related knowledge, public health policy, and medical innovation. Arguing that high-income countries have much to learn from the global South when it comes to health-related knowledge and practices, we propose an interdisciplinary research approach to uncovering and examining African contributions to global health, drawing on an ongoing collaborative project funded by the Swiss National Science Foundation. We present four empirical case studies concerning drug development, healthcare systems, and urban planning to critically enquire into both historical and contemporary transcontinental knowledge circulation and learning potentials, as much as cases of forgetting and silencing. On this basis, we argue that 'learning from the South' must mean more than transplanting quick and cheap technological fixes to serve societies in the global North, but rather recognising the vast contributions that Africans have made to global epistemologies, without losing sight of the asymmetries inherent in South–North knowledge exchanges. Lessons learned might apply to fields other than those discussed here and go far beyond 'reverse innovation'. [ABSTRACT FROM AUTHOR]

Empowering women is presented as a key strategy to achieve several goals of the sustainable development (SDG) agenda, including child health. However, the literature on the subject shows mixed results and is limited regarding political empowerment. Responding to this gap, we explore whether women's political empowerment is associated with positive health outcomes for children under 5 years of age. We use the V-Dem project's 'Women's Political Empowerment Index' (WPEI) in combination with selected SDG indicators of child health from the Institute for Health Metrics and Evaluation's 2017 Global Burden of Disease, for 161 countries, between 1990 and 2016. We estimate fixed-effects regressions for the WPEI against child mortality, stunting and immunisation coverage, controlling for structural and socio-economic indicators from the SDGs and potential lagged effects. The WPEI is associated with improved nutrition and immunisation but its substantive effect is small. High-, low-income and least developed countries benefit more from the effect of women's political empowerment on child mortality. The effect of women's political empowerment on stunting is stronger in middle-income countries while its effect on immunisation is more relevant to low-income and least developed countries. Our study demonstrates the complexity of the relations between women's political empowerment and child health. [ABSTRACT FROM AUTHOR]

In the wake of global racial justice and Indigenous sovereignty movements, there have been calls to decolonise global health as an academic discipline and set of policies, programmes, and practices. Identifying these calls for decolonisation of global health as both promising but limited, we argue that global health needs to engage in deeper critical reassessment of its ontological foundations in Western thought and that Indigenous ontologies have an important role to play in deconstructing and reimagining global health. We identify four Western ontological assumptions that are particularly relevant to global health and demonstrate how Indigenous ontologies assist in thinking outside of and beyond these assumptions, offering a path toward a reconstructed Indigenized imagining of global health. [ABSTRACT FROM AUTHOR]

When health systems are overwhelmed during a public health crisis regular care is often delayed and deaths result from lapses in routine care. Indigenous primary healthcare (PHC) can include a range of programmes that incorporate treatment and management, prevention and health promotion, as well as addressing the social determinants of health (SDoH) and a focus on redressing health inequities. We examined how Indigenous PHC mobilises and innovates during a public health crisis to address patient needs and the broader SDoH. A rapid review methodology conducted from January 2021 – March 2021 was purposefully chosen given the urgency with COVID-19, to understand the role of Indigenous PHC during a public health crisis. Our review identified five main themes that highlight the role of Indigenous PHC during a public health crisis: (1) development of culturally appropriate communication and education materials about vaccinations, infection prevention, and safety; (2) Indigenous-led approaches for the prevention of infection and promotion of health; (3) strengthening intergovernmental and interagency collaboration; (4) maintaining care continuity; and (5) addressing the SDoH. The findings highlight important considerations for mobilising Indigenous PHC services to meet the needs of Indigenous patients during a public health crisis such as the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Exposure to tobacco marketing is positively associated with smoking initiation and behaviours. There is limited literature examining disparities among reported exposure in low- and middle-income countries. This study sought to fill this gap with a survey among 1427 adolescents and 889 adult smokers in Mexico City in 2020. Data were analysed using chi-square and hierarchical regression models. Two-thirds of adolescents noticed cigarette pack displays in stores. Participants from low- and mid-socioeconomic status (SES) neighbourhoods were more exposed to tobacco marketing than their counterparts through several channels. After addressing the shared variance among participants from the same household nested in neighbourhood SES level and controlling for gender, adolescent non-smokers and adult smokers who noticed pack displays were more likely to be susceptible to smoking (OR = 1.8, 95% CI 1.4–2.4) and to smoke more (OR = 1.7, 95% CI 1.21–2.47); adult smokers who noticed tobacco marketing at more places were less likely to be certain about smoking risks (OR = 0.9, 95% CI 0.8–0.9). The results suggest that the tobacco industry targets youth and individuals from low-SES neighbourhoods through several channels. Greater exposure to tobacco marketing was associated with increased susceptibility to smoking and decreased risk perception. These findings support a comprehensive ban on tobacco marketing in Mexico. [ABSTRACT FROM AUTHOR]

COVAX, the vaccines pillar of the Access to Covid-19 Tools Accelerator (ACT-A), has been promoted as 'the only global solution' to vaccine equity and ending the Covid-19 pandemic. ACT-A and COVAX build on the public-private partnership (PPP) model that dominates global health governance, but take it to a new level, constituting an experimental form that we call the 'super-PPP'. Based on an analysis of COVAX's governance structure and its difficulties in achieving its aims, we identify several features of the super-PPP model. First, it aims to coordinate the fragmented global health field by bringing together existing PPPs in an extraordinarily complex Russian Matryoshka doll-like structure. Second, it attempts to scale up a governance model designed for donor-dependent countries to tackle a health crisis affecting the entire world, pitting it against the self-interest of its wealthiest government partners. Third, the super-PPP's structural complexity obscures the vast differences between constituent partners, giving pharmaceutical corporations substantial power and making public representation, transparency, and accountability elusive. As a super-PPP, COVAX reproduces and amplifies challenges associated with the established PPPs it incorporates. COVAX's limited success has sparked a crisis of legitimacy for the voluntary, charity-based partnership model in global health, raising questions about its future. [ABSTRACT FROM AUTHOR]

This Special Issue of Global Public Health draws on the concept of 'body work' among those employed to support operationalising, researching, and implementing global health while in direct contact with the bodies of others. This collection brings into sharp focus the specific forms of labour of those occupying positions as frontline workers - those who make global health work. Making Global Health Work includes authors from diverse backgrounds, disciplines, and geographies. Through compelling ethnographies, qualitative interviews, and focus group discussions, they explore 'body work' globally, including: Afghanistan, Bangladesh, Ethiopia, India, Indonesia, Kenya, Malawi, Myanmar, Nigeria, Nepal, Pakistan, Sierra Leone, South Sudan, Tanzania, Thailand, The Democratic Republic of the Congo (DRC), The Gambia, Vietnam, and Zimbabwe. These papers demonstrate that proximity to, and work on, the bodies of others engenders specific forms of (physical, emotional, mental, social, ethical, and political) labour, which occur not only in emergencies and pandemics, but also throughout the quotidian practice of global health. Making Global Health Work provides insights into the provision of maternal healthcare, treatment of multidrug resistant tuberculosis, rapid HIV testing programmes, sleeping sickness and polio eradication campaigns, mass drug administration clinical trials, epidemic preparedness and response, and the management and care of dead bodies. These papers argue for greater attention by global health actors on frontline workers in management of the complexities involved in making global health work. [ABSTRACT FROM AUTHOR]

In this article we offer an introduction to a special issue of Global Public Health on the theme of 'African Voices in Global Health: Knowledge, Creativity, Accountability'. This special issue explores Africans' self-understood roles – and voices – in global health (as both researchers and interlocutors in relation to various global health institutions/policies). We argue that the special issue's focus on African voices in global health is critical in view of the legacies of colonial medicine and public health for contemporary narratives, discourses, and practices. It is important to acknowledge that Africans continue to address the structural injustices facing them in relation to global health policies and practices on the continent. In the face of this they have demanded that donors, NGOs, governments, and intergovernmental organisations be politically, fiscally, and ethically accountable to the people they serve on the continent. As the special issue highlights, critical scholars of global health based in Africa are increasingly offering challenges to the frequent positioning of African patients and study-participants as either invisible, or disempowered, in understanding and shaping their own lived experiences of health in a transnational context. [ABSTRACT FROM AUTHOR]

Drawing on the reflections and discussions from a special session at the 2021 Global Health Bioethics Network summer school, this paper has summarised the key challenges faced by Frontline Workers (FWs) across research sites in Africa and Asia in performing the everyday 'body work' entailed in operationalising global health research. Using a 'body work' lens, we specifically explore and map key challenges that FWs face in Africa and Asia and the physical, social, ethical, emotional, and political labour involved in operationalising global health in these settings. The research encounter links with wider social and economic structures, and spatial dimensions and impacts on the FWs' performance and well-being. Yet, FWs' 'body-work' and the embedded emotions during the research encounter remain hidden and undervalued. [ABSTRACT FROM AUTHOR]

Drawing on long-term ethnographic fieldwork in maternity settings in Tanzania and Pakistan, we argue that 'bodywork' condenses all politically and practically at stake for maternal healthcare providers. Our research confronts how global health programmes expect paramedical providers working on the frontlines of obstetrics to implement interventions without also attending to violent everyday realities of providing care amidst structural constraint and precarity. We demonstrate this approach's dire aftermaths. Healthcare workers' bodies evidence risks and injuries not only attendant on care in lower-resource settings, but which unfold specifically from their efforts to meet the onerous demands of global health systems. Toxic hospital environments represent a paradox of care – medicine exposes patients and providers to greater risks than if medicine were not involved – but this inherent riskiness barely registers. Elisions of healthcare providers' experiences of harm are telling; they reveal global health's neglect of occupational risk and a racialised under-attention and under-valuing of the risks carried by bodies of colour, and women especially. We trace and corroborate providers' experiences of threats to their wellbeing while enacting global health agendas. We conclude with a provocation that social scientists' bedside witnessing must result in actionable evidence if a more sustainable global health is to prevail. [ABSTRACT FROM AUTHOR]

Frontline workers (FLWs) in the Global Polio Eradication Initiative go door-to-door delivering polio vaccine to children. They have played a pivotal role in eliminating wild polio from most countries on earth; at the same time, they face significant bodily risk. STRIPE, an international consortium, conducted a mixed-methods study exploring the knowledge and experiences of polio staff in seven countries (Afghanistan, Bangladesh, Democratic Republic of Congo, Ethiopia, India, Indonesia and Nigeria). We surveyed 826 polio FLWs and conducted semi-structured interviews with 22 of them. We used a body work framework to guide analysis. Polio workers perform a different kind of body work than many other FLWs. Delivering a few drops of oral vaccine takes a light touch, but gendered spaces can make the work physically dangerous. Polio's FLWs must bend or break gendered space norms as they move from house-to-house. Navigating male spaces carries risk for women, including lethal risk, particularly in conflict settings. Workers manoeuvre between skeptical community members and the demands of supervisors which generates emotional labour. Providing FLWs with more power to make operational decisions and providing them with robust teams and remuneration would improve the likelihood that they could act to improve their working conditions. [ABSTRACT FROM AUTHOR]

This scoping review assesses the use of conditional cash transfer (CCT) interventions – direct distribution of money to individuals conditional on their compliance to certain requirements – in randomised controlled trials, quasi-experimental studies and large community-based randomised trials with health-focused outcomes. Five databases were searched to identify 68 records published 2004–2021 from 25 countries (8 low- (32%), 5 lower middle- (20%), 6 upper middle- (24%) and 6 high-income (24%), according to the World Bank Categorisation (2017). Forty-six studies were unique (after excluding multiple publications on a single study). The most common outcomes assessed were infectious diseases (30%); maternal health (24%); vaccination rates (17%); and childhood developmental measures (17%). The number of participants receiving CCT in each study ranged from 47 to 5,788, with a median of 487 individuals. The number of total participants ranged from 72 to 14,000, with a median of 1,289 individuals. Fifteen percent of studies involved mobile CCT disbursement. More than a quarter of payments were greater than 50 USD (29%), and most payments were 20 USD or less (58%). Seventy-eight percent of unique full-length studies reported statistically significant CCT effects. Although CCTs remain controversial, a growing evidence base is emerging for their potential impact in specific health conditions. [ABSTRACT FROM AUTHOR]

This paper utilises empirical data to explore the value of 'body work' performed by last responders charged with the duty of dead body management, with a focus on the Global South. While frontline staff work to save lives, little is known about the experiences and roles of those who care for the dead in global health in times of crises and even during normal times. This paper discusses ethical and socio-cultural challenges pathologists face in 'working on the bodies of others' while conducting any form of post-mortem procedures – necessary for ascertaining and recording the causes of death. Identifying and reporting the cause of death have significant public health benefits and provide closure for bereaved families. Despite the foregoing, the pathology field does not attract funding from governments or donors, and it is overlooked compared to other disciplines. Autopsy procedure bears social stigma – as it is associated with body mutilation and therefore disrespecting the dead; certain cultural beliefs or taboos about impurity and death persist, further raising some social and ethical tensions. As a result, the dearth of autopsy procedures contributes to the cause of death uncertainty in global health. [ABSTRACT FROM AUTHOR]

Community engagement is gaining prominence in global health research. But communities rarely have a say in the agendas or conduct of the very health research projects that aim to help them. This paper provides new evidence on how to share power in priority-setting in ways that seek to overcome structural constraints created by the funding environment. The five strategies were identified through case study research on the Participation for Local Action project in Karnataka, India. That project was carried out by researchers in partnership with the Zilla Budakattu Girijana Abhivrudhhi Sangha, an indigenous community development organisation representing the Solega people. The paper describes each identified strategy for sharing power in priority-setting, followed by a report of the pitfalls and challenges that arose when implementing it. Thus, the study also demonstrates that even where actions and strategies are used to address power imbalances, pitfalls will arise that need to be navigated. Given those challenges, considerations to reflect upon before employing the identified strategies are suggested. Ultimately, the paper aims to communicate strategies for sharing power during and after priority-setting and lessons on how to implement them effectively that can be used by global health researchers in the current funding environment. [ABSTRACT FROM AUTHOR]

Development Assistance for health (DAH) has increased dramatically these last two decades. While according to the official rhetoric, it aims at 'health improvement' and 'poverty reduction', such apolitical purposes have been questioned by scholars who identified other major objectives. However, few studies have sought to uncover the motivations behind EU's health assistance. To fill such academic gap, this article explores the main drivers that have guided the EU's DAH in Vietnam where the EU celebrated in 2020 its 25 years of health cooperation. Opting for a 'multiple sources of foreign aid model' that considers that no single factor can explain foreign aid decision, and adopting a 'holistic approach' that focuses on the modalities, the narratives, the allocation, and the terms of health assistance, as well as the international and domestic contexts in which it has taken place, this study identifies four major purposes: (a) the confirmation of EU's identities within the global health community. (b) the defense of the relevance of its approach of health assistance to influence international norms framing international health aid, (c) its support to the leading role of the WHO in global health, and (d) the facilitation of trade and investment opportunities for European companies. [ABSTRACT FROM AUTHOR]

Mental health is a key issue for populations affected by conflict. The evidence base on the mental health of internally displaced Colombians is undefined, as well as protective strategies utilised by this group. This systematic literature review aims to identify and assess the evidence base on the mental health of Colombian internally displaced persons (IDPs). Specific objectives are to examine (1) prevalence and incidence rates of common mental disorders (CMDs) amongst adult Colombian IDPs, (2) risk factors associated with CMDs amongst this group, and (3) coping strategies used by these displaced persons. A database search was conducted in May 2021. Included studies reported quantitative and/or qualitative mental health outcomes of CMDs, and/or coping strategies, among Colombian IDPs. The search yielded 34 articles. Study quality ranged from adequate to poor, with several containing serious shortcomings. PTSD prevalence ranged from 1.2%-97.3%, anxiety from 0.0%-60.0%, depression from 5.1%-100%, and problematic alcohol use from 8.0%-33.5%. Factors significantly associated with CMDs were inconsistent. Seeking social support and problem-solving strategies were the two most-commonly reported coping strategies. Associations between mental health and coping were largely unreported. As the evidence base is weak, there is a clear need for better quality research in this area. [ABSTRACT FROM AUTHOR]

Global health has become fashionable and an important topic on the international policy agenda. Even before the COVID-19 pandemic, cross-border infectious diseases had provoked a great deal of media and public interest, academic research and foreign-policy agendas. This paper analyses the relevance of health security in global health. It stresses global health as an explicitly political concept taking into consideration existing inequalities and power asymmetries. Global health represents the necessary evolution of public health in the face of ubiquitous global challenges and the growing number of international players. Some of them tend to divert global health towards technification, marketisation and privatisation, promoting biomedical reductionism and predominantly technological solutions. Overall, the current global health concept fails to adequately consider the global burden of disease, which is largely determined by non-communicable conditions. Global health goes beyond preventing infectious diseases and health security and must first and foremost focus on the social, economic, ecologic and political determination of health, which interacts with non-communicable and communicable diseases, turning them into syndemics. Health-in-all policies in a global perspective are required for sustainably reducing health inequalities within and between countries, instead of primarily focusing on security and safeguarding the status quo in a changing world. [ABSTRACT FROM AUTHOR]

As global health researchers, we have long embraced the conviction that the answers to complex problems of poverty and disease will reveal themselves if only we apply enough scientific rigor. Yet, at the community level, our group of American and Kenyan investigators has begun to question whether our veneration of rigor is itself contributing to the intractability of certain types of global health problems. Here, we illustrate examples from our experience among the remote island communities of Lake Victoria, Kenya, and join a chorus of emerging voices, to examine how our culture of control as global health scientists may marginalise truth-seekers and change-makers within communities we seek to serve. More broadly, we seek to acknowledge the limitations of control over truth that rigorous academic research affords. We suggest that by relinquishing this pervasive illusion of control, we can more fully appreciate complementary modes of answering important questions that rely upon the intrinsic resourcefulness and creativity of community-based enterprises taking place across sub-Saharan Africa. While such inquiries may never solve all problems facing the diverse populations of the continent, we advocate for a deeper appreciation of the inherent capacity of adaptive, locally contextualised investigations to identify meaningful and enduring solutions. [ABSTRACT FROM AUTHOR]

The emergence of the field of health and human rights during the closing decades of the twentieth century offered the promise of an important shift of perspective within global health. It has been increasingly questioned, however, to what extent the health and human rights framework has indeed succeeded in ushering in a new era of global health governance and justice, as the topic has remained marginalised, marked by regional inequalities, and often dominated by legalist visions and global North perspectives. The articles and commentaries in this special issue seek to create a space where a number of other perspectives and voices can be part of the discussion. They add new perspectives and offer roadmaps for how to rewire the ways in which knowledge is constructed and relationships are formed in the field of health and human rights. In doing so, they present important possibilities for how to build a more just and egalitarian field. [ABSTRACT FROM AUTHOR]

The relationship between health and human rights has gained growing importance, whether in activist agendas or in governments strategies to face the challenging scenarios of global public health. However, there are important gaps to be filled so that the articulation between these two fields develops its full potential, and the question of knowledge plays a key role in this regard. This study aims at examining the possibilities and challenges of integrating a human rights perspective into the construction and validation of health knowledge, based on the contribution of authors from various theoretical traditions that have discussed the so-called 'hermeneutic turn' in contemporary philosophy and science. The thesis developed is that recognizing the place of hermeneutics in human rationality and its consequences for understanding various forms of knowledge and their respective practical meanings is a fundamental step towards an effective articulation between the fields of health and human rights. I argue that the hermeneutic rescue of the value of practical reason can enhance emancipatory reconstructions in the exercise of cognitive-instrumental rationality in the field of health. [ABSTRACT FROM AUTHOR]

In February 2021, the Peruvian 'vaccinegate' scandal broke when the media reported that nearly 500 experimental doses of an ongoing COVID-19 trial were given to key individuals not enrolled in the trial. Indeed, vaccine doses were administered to leading politicians, such as the former President and his wife, and other high-level health officials and academic leaders at the universities overseeing ethical compliance and administration of the trial. The 'vaccinegate' scandal in Peru is but one example of how the lack of a coordinated global response to COVID-19 has allowed countries to act in the best interest of some, ultimately, failing to secure a democratic approach to the right to health for all during a global pandemic. While Peruvian vaccinegate is an example of the egregious use of power to further cronyism amid fear and mounting COVID-19 related death, unfortunately, it is not an anomaly. We argue that the sensationalisation of the event has distracted from the existing precarious health system in Peru and the ways in which long-existing abuses of power evident prior to the pandemic limit a just response to it. [ABSTRACT FROM AUTHOR]

Mama Amaan Project (MAP) delivered perinatal education and doula services to underserved refugee and immigrant communities in Seattle, Washington. MAP presented at a 'global to local (glocal)' workshop for US-based global health agencies redirecting their experience and resources to address domestic health crises. Glocal models reference Global South anti-colonial social transformations through Primary Health Care (PHC) – 'health for all as a right' and investment in strong public sectors. As Black women working in our communities, we resisted labelling MAP glocal. Western donors and NGOs appropriate PHC's community participation narratives, meanwhile implementing World Bank/IMF economic structural adjustment health system cuts – thereby shifting austerity-related resource shortfalls to communities. In US contexts of neoliberal shrinking social safety nets and workers' rights, similar strategies to address austerity-related health disparities are promoted as 'global to local'. Projects like MAP cannot substitute quality public services. They expose gaps and build community empowerment to demand quality healthcare. Drawing on MAP and 'global health' experience in Mozambique, we call for re-embracing PHC's activist values – agitating for health as a universal human right for all, rather than putting the burden and blame on underserved communities. We propose decolonising the 'glocal' paradigm by embracing 'transnationality', 'relationality' and 'mutuality'. [ABSTRACT FROM AUTHOR]

The purpose of this article is to understand the 'Rio Negro, We Care' campaign in its cosmopolitical implications for discussions of global health and human rights. This article is part of a collaborative process centred on the city of São Gabriel da Cachoeira and the Alto Rio Negro region of Brazil. This campaign was developed by the Department of Women of the Federation of Indigenous Organizations of Rio Negro (DMIRN/FOIRN) at the beginning of the COVID-19 pandemic. It had significant effects on the pandemic experience in the region during 2020. The Brazilian responses to the COVID-19 pandemic highlight complex, intersectional and neocolonial processes, associated with what has been understood as the necropolitics led by the Brazilian federal government. At the same time, such responses shed light on the limitations of the biopolitical orientation of public and global health for the management of the pandemic. We seek to narrate a cosmopolitical intervention located 'in culture' as a counterpoint to this process. Our analysis highlights questions in the field of global and planetary health milestones, such as the conditions of legitimacy for cosmological knowledge and care technologies, or the ontological implications of the persistent biopolitical bias of mainstream public health interventions. [ABSTRACT FROM AUTHOR]

The pandemic as a portal has deeply changed life as we know it, including our homes. While countries continue to strengthen their health systems and policies, marginalized groups in local communities are absorbed, reassembled, and transformed in everyday 'portals' which generate mutually entangled and composite forces of unification and healing as well as forces of division and wounding. In this commentary, I argue that these forces can be taken as embodying a geopolitics of love already subsumed by intimate, proximal, and mediated relations, therefore leaving out aspects of love that are populated by voids, hollows, and liminalities. Here, I reflect upon Massey's spatial politics vis-a-vis Harrison's notion of non-relationality in order to puncture the representational limits of the geopolitical as a way to transform 'bad' love (i.e. love that eclipses pains, sufferings, and otherness) while simultaneously not succumbing to a desire for sameness underpinning 'good' love (i.e. love that promotes unification and healing). Specifically, I suggest that the nonrelationality of place making and its geographies of nowhereness may lead us back home to love as always already there. [ABSTRACT FROM AUTHOR]

In this article, we set out how menstrual activism is emerging as a novel strand in global feminist health demands that challenge the norms and practices which condone and institutionalise gender inequalities. Menstruation has moved from being understood principally as a biological function, invisible in the public sphere, to a vibrant form of global body politics with a flourishing set of diverse practices. We examine how menstruation has been brought to global attention in two ways: one through a global development discourse that promotes menstrual health by improving hygiene and the sanitary infrastructure in the Global South; and two through the upswell of feminist groups involved in menstrual activism around the world. The article is a contribution to moving closer towards productive alliances between these two strands as together they contribute to important changes in menstrual health and sexual rights. [ABSTRACT FROM AUTHOR]

Access to COVID-19-vaccines by the global poor has unveiled the impact of global health and scientific inequities on access to life saving interventions during public health emergencies (PHE). Despite calls for global solidarity to ensure equitable global access to COVID-19 vaccines, wealthy countries both in the north and southern hemisphere may find a charity-based approach more appealing and are using the opportunity to forge neo-colonial cooperation ties with some African countries. Solidarity is undoubtedly an ideal equity-based principle of public health emergency of international concern (PHEIC). However, its application may be wanting especially as crisis nationalism is more likely to inform the public health policy of any country during a PHEIC, even when they are strong advocates of global solidarity. African countries, on the other hand, must re-appraise their heavy reliance on international aids during PHE and recognise the importance of boosting their epidemic preparedness including research and translation of its findings to practice. [ABSTRACT FROM AUTHOR]

Partnerships between Higher Education Institutions in the global South and North have potential for building capacity in public health research in low-resource countries. We present experiences of partners involved in a North–South–South partnership between universities in Norway, the Democratic Republic of Congo (DRC) and South Africa. The partnership aimed to establish a postgraduate programme in nutritional epidemiology at the University of Kinshasa, DRC, and develop a cadre of researchers and academic leaders to provide locally generated health research to inform policy. In-depth interviews were conducted with 31 purposively selected stakeholders, facilitators, and students from partner institutions. All participants expressed positive experiences, indicating that the partnership provided excellent opportunities to network, enriched participants' learning and enhanced academic growth, with benefits at individual, institutional, and country levels. Participants suggested that maintaining a common vision was important for success, facilitated by joint planning of project activities, focussing strongly on building research and academic capacity at Kinshasa School of Public Health and addressing local nutrition problems. Important challenges highlighted for future partnerships included failures of co-facilitation and co-supervision, poor research dissemination and policy impact, and concerns about sustainability. Notwithstanding, North–South–South partnerships can address skills shortages in public health research with significant benefits to all partner institutions. [ABSTRACT FROM AUTHOR]

Few studies have investigated corporate political activity by unhealthy commodity industries in low- and middle-income countries, and the significance of social and political context has been largely neglected. This study aimed to explore the stalled development of marketing restriction policies in Brazil with an analysis of strategies used to undermine the Legal Framework for Early Childhood. Using a constructivist approach based on a typology of corporate political strategies, decision-making processes were assessed to understand interference by food companies in the Legal Framework, and how this was perceived by policy actors. Semi-structured interviews were conducted with public health advocates, academics and legislature officials. Three broad strategies that contributed to the stalling of marketing restrictions in the Legal Framework were identified: relational approaches to policy influence; collective participation in formal decision-making; and specific strategy choices (information and financial incentives). Key opportunities for policy influence through informal social networks in the 'backstage' of policy making are found to privilege commercial sector actors. Informal policy making may have a critical function in obstructing the development of health-focused regulation in Brazil. This highlights the need for a better understanding of non-codified and hidden corporate efforts to shape the policy environment. [ABSTRACT FROM AUTHOR]

With millions of cases and thousands of deaths every year in Asia and Latin America, dengue fever continues to be of global public health significance. This article uses the concept of 'medical populism' to analyse the political construction of the 2019 dengue epidemics in Bangladesh, the Philippines, and Honduras. Through this framework, we examine the narratives of these outbreaks by reconstructing how political actors simplified the discourse, spectacularised the crises, offered multiple knowledge claims, and forged divisions between the people and 'dangerous others'. Taken together, our case studies, obtained through government, journalistic, and scholarly sources, illuminate the role of medical populists (who are almost always politicians) in defining and responding to public health emergencies, underscoring the performative dimension of disease outbreaks. By detracting attention from less spectacular but more substantive policies and programs, these 'performances' of health crises perpetuate health inequities, especially in fragile democracies like the aforementioned Global South countries. We conclude by reflecting on the implications of medical populism to public health, health communications, and the inevitable recurrence of epidemics. [ABSTRACT FROM AUTHOR]

The movement to decolonise global health is gathering pace. In its concern with the fundamental, distal causes of inequality and its call for social justice, the decolonisation movement forces us to question how global health works, for whom, where it is located, its funding practices, power asymmetries, cultures of collaboration and publication. This paper uses a new book by Harvard-based physician-anthropologist Eugene T. Richardson, Epidemic Illusions, as a point of departure for a broader analysis of the nature of global health knowledge, science, authorship, research and practice. Written in a 'carnivalesque' style, the book proceeds through a series of 'ironic (re)descriptions' to argue that global public health is an 'apparatus of coloniality'. In so doing, the book is generative of four ironic turns that we explore through the themes of guilt, humility, privilege and ambiguity. In locating these ironic turns within the broader landscape of global health, we reflect on whether the means of such a book achieve the ends of decolonisation. [ABSTRACT FROM AUTHOR]

While the United Nations has long implemented strategies to tackle deep-rooted gender-based inequalities and discrimination in its programmes and policies, there is limited evidence on successful strategies to foster institutional structures and practices that promote gender equality or institutional gender mainstreaming. This paper explores and analyses the experience of institutional gender mainstreaming within UN Agencies working on global health, highlighting potential areas for learning. Overall, progress on institutional gender mainstreaming has been modest, with slow increases (if any) in investments in financial and human resources. The findings highlight the importance of well-established strategies, such as enforcing accountability, a robust gender architecture, and a cohesive capacity-building policy. Drawing on the experiences of gender experts, the paper shows that equally or more critical to the success of institutional gender mainstreaming were approaches such as leveraging strategic internal and external support and identifying strategic entry points for gender mainstreaming. There is considerable scope for strengthening gender mainstreaming within UN Agencies by reviewing and learning from UN system successes. In addition to learning from practice, the way forward lies in making visible and developing strategies to challenge embedded patriarchal organisational norms and systems. [ABSTRACT FROM AUTHOR]

Language – the words we use – can play a key role in enabling or limiting transformation of inequalities in the field of global health. At the same time, given the interdisciplinary, intersectoral, and international nature of much global health work, intended meanings, commitments, and underlying values for words used cannot be taken for granted. This commentary sets out to clarify, and in this manner render available for further discussion and debate, the phrase 'critical and ethical global engagement' (CEGE). It derives from discussions between scholars and partners in research, education, and healthcare practice based at one Canadian and two Rwanda institutions. Initially, our aim was to conceptualise the term 'critical and ethical global engagement' in order to guide our own practices. As the complexity of the values, commitments, and considerations underlying our use of this phrase emerged, however, we realised these discussions merited being captured and shared, to facilitate further exploration and exchange on this phrase. [ABSTRACT FROM AUTHOR]

Short-term medical missions (STMMs) have the potential to increase local health care capacity in low resource settings. Few studies have examined capacity building within STMMs from the perspective of both donor and host providers. A qualitative study using a transcendental method for research with human subjects examined the experiences of 21 North American 'donor' and Dominican 'host' health care providers who participated in STMMs in the Dominican Republic. Perry and Ojemeni's levels of capacity building for human good provided the theoretical framework, proposing a three-level approach: (1) augmenting local health care delivery capacity (2) assisting local communities to develop their own capacities and (3) transforming barriers to capacity. Findings are grouped into five themes and their subthemes: (1) making a difference (2) education and knowledge transfer, (3) acknowledging barriers, (4) host empowerment and (5) personal and interpersonal development. An overarching paradigm of 'Mete Tèt Nou Ansanm', or 'putting our heads together', emerged from the data, reflecting a dynamic process in which donor and host participants evolved their collaborative partnerships. STMMs have the potential for addressing global health capacity at all three levels. Mission compatibility with the local health system, host empowerment and repeated interactions over time are noteworthy determinants for STMMs sustainability. [ABSTRACT FROM AUTHOR]

Funding and defunding decisions in global health are often not subject to ethical scrutiny although they carry the potential for iatrogenic violence. The funding and defunding of a maternal health project in Kabul, Afghanistan during the 2000s reveals the post 9/11 science-politics dynamics that resulted in the emergence of maternal mortality in Afghanistan as a humanitarian object. Despite concerns raised by the Afghan Ministry of Public Health, U.S. Department of Health and Human Services subcontractors renovated one of four public maternity hospitals in Kabul, doubling the number of births per year and increasing the rate of caesarean sections. Project defunding in 2011 was due to a confluence of primarily political factors. Project actors – Afghan and internationals – expressed ethical concerns about the abrupt defunding and the particular risks to women undergoing emergency caesarean sections at the hospital. The analysis presented here has wider relevance for the global surgery movement and concerns about fluctuations in donor funding in global health. There is a need for an ethics of global health funding and defunding decisions that encompasses policies, relationships, stronger local public health systems and civic participation. Global health (de)funding must be made more of an object of ethical deliberation and negotiation. [ABSTRACT FROM AUTHOR]

The complex phenomenon of vaccine hesitancy has been causing increasing global concern. This systematic review aims at analysing the state of art of scientific literature concerning vaccine hesitancy in Latin America and Africa, observing if: (i) they use the same research trends as the global North; and (ii) the parameters recommended by the World Health Organization (WHO) and taken from the experience of the global North are adequate to the Global South's context. This review analyses empirical, qualitative, quantitative, or mixed-study publications, from 2015 to 2020, available at five different databases. The studies produced in the Global South bring up important context-specific issues, such as issues of access (that are not included in the WHO's definition of vaccine hesitancy), cultural and religious issues, reactions to governments, reactions to recent episodes of vaccine tests on populations, and reactions to past of colonial violence. Initiatives to understand the phenomenon based on methodological and conceptual frameworks from the global North alone can cause wrongful conclusions. [ABSTRACT FROM AUTHOR]

Since the end of the Cold War, health has gone from a peripheral concern in foreign policy negotiations to a prominent place on the global political agenda. While the rise of health onto the foreign policy agenda is by now old news, the driving forces behind its expansion into new political spheres remain understudied and undertheorized. This article builds on empirical findings from a four-country study of the integration of health into foreign policy, and proposes a conceptual approach to GHD to improve understanding of the conditions under which health is successfully positioned on the foreign policy agenda. Our approach consists of three dimensions: features of institutions and the interest various actors represent in GHD; the ideational environment in which GHD operates; and issue characteristics of the specific health concern entering foreign policy. Within each dimension, we identify specific variables that, in combination, make up the explanatory power of the proposed approach. The proposed approach does not relate to, or build upon, a single social sciences, public health, or international relations (IR) theory, but can be seen as a heuristic device to identify dimensions and variables that may shape why certain health issues rise onto the foreign policy agenda. [ABSTRACT FROM AUTHOR]

This paper examines the decline of the AIDS Programme in Brazil, the Latin American country most affected by the epidemic, with emphasis in the second decade of the twenty-first century. For many years, Brazil served as a model in Global Health due to a comprehensive preventive policy, a partnership between the government and health activists and the support of life-saving drugs as public goods rather than commodities. The regression of AIDS policies in Brazil interacted with developments in the United States as well as with multilateral agencies like UNAIDS that emphasised biomedicalisation in the response to the disease where broad human-rights programmes and alliance with activists were not priorities. International programmes like the 'Ending AIDS' campaign indirectly undermined the exceptional status AIDS enjoyed since the late 1980s. The backlash in Brazilian policies to fight AIDS was a result of the fragmentation of the left and the empowerment of radical conservative authoritarian and religious forces. The result was the breakdown of the long-held belief that successful anti-AIDS disease programmes could simultaneously help control the disease and build better healthcare systems and ultimately prompted the end of the special place AIDS' policy had in Brazil. [ABSTRACT FROM AUTHOR]

The content of comprehensive sexuality education (CSE) programmes is contested in many parts of the world, yet we know less about what primary beneficiaries (learners) consider as (in) appropriate school curriculum. I examined this phenomenon in Ghana. Data generated from focus group discussions suggests that, overall, participants used positive phrases to describe the need for sexuality education. The prevalent and recurrent needs of adolescents centred around personal reproductive health hygiene, pregnancy prevention, healthy relationships, reproductive infections and control, reproductive physiology and maturation, gender differences and sexual orientations, and sexual pleasure and pain. However, these needs varied in some ways between males and females and between early adolescents and older adolescents. The study shows that what adolescents seek to learn fall within international norms/standards on CSE. However, some of these concepts were not covered in the guidelines proposed for Ghana. The prevalent view among many opponents that CSE is not driven by local need may not be consistent with adolescents' own aspirations and realities. The voices of children and adolescents should constitute part of the discussions on the form and content of sexuality education. [ABSTRACT FROM AUTHOR]