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Colonialism, which involves the systemic domination of lands, markets, peoples, assets, cultures or political institutions to exploit, misappropriate and extract wealth and resources, affects health in many ways. In recent years, interest has grown in the decolonization of global health with a focus on correcting power imbalances between high-income and low-income countries and on challenging ideas and values of some wealthy countries that shape the practice of global health. We argue that decolonization of global health must also address the relationship between global health actors and contemporary forms of colonialism, in particular the current forms of corporate and financialized colonialism that operate through globalized systems of wealth extraction and profiteering. We present a three-part agenda for action that can be taken to decolonize global health. The first part relates to the power asymmetries that exist between global health actors from high-income and historically privileged countries and their counterparts in low-income and marginalized settings. The second part concerns the colonization of the structures and systems of global health governance itself. The third part addresses how colonialism occurs through the global health system. Addressing all forms of colonialism calls for a political and economic anticolonialism as well as social decolonization aimed at ensuring greater national, racial, cultural and knowledge diversity within the structures of global health. Le colonialisme, qui implique la domination systemique de terres, de marches, de peuples, de ressources, de cultures ou d'institutions politiques dans le but d'exploiter, de detourner et d'extraire des richesses et des ressources, affecte la sante de nombreuses manieres. Ces dernieres annees, la decolonisation de la sante mondiale a suscite un interet croissant, l'accent etant mis sur la correction des desequilibres de pouvoir entre les pays a revenu eleve et les pays a faible revenu, ainsi que sur la remise en question des idees et des valeurs de certains pays riches qui faponnent la pratique de la sante mondiale. Nous soutenons que la decolonisation de la sante mondiale doit egalement aborder la relation entre les acteurs de la sante mondiale et les formes contemporaines de colonialisme, en particulier les formes actuelles de colonialisme d'entreprise et de colonialisme financiarise qui operent par des systemes mondialises detraction de richesses et de profits. Nous presentons un programme d'action en trois parties destine a decoloniser la sante mondiale. La premiere partie porte sur les asymetries de pouvoir existant entre les acteurs de la sante mondiale des pays a hauts revenus et historiquement privilegies et leurs homologues des pays a faibles revenus et marginalises. La deuxieme partie concerne la colonisation des structures et des systemes de la gouvernance mondiale de la sante elle-meme. La troisieme partie traite de la maniere dont le colonialisme se manifeste a travers le systeme de sante mondial. La lutte contre toutes les formes de colonialisme necessite un anticolonialisme politique et economique ainsi qu'une decolonisation sociale visant a garantir une plus grande diversite nationale, raciale, culturelle et des connaissances au sein des structures de la sante mondiale. El colonialismo, que implica la dominacion sistemica de tierras, mercados, pueblos, bienes, culturas o instituciones politicas para explotar, apropiarse indebidamente y extraer riqueza y recursos, afecta a la salud de muchas maneras. En los ultimos anos ha crecido el interes por descolonizar la salud mundial, en particular para corregir los desequilibrios de poder entre los paises de ingresos altos y los de ingresos bajos, y para cuestionar las ideas y los valores de algunos paises ricos que influyen en la practica de la salud mundial. Sostenemos que la descolonizacion de la salud mundial tambien debe abordar la relacion entre los actores de la salud mundial y las formas contemporaneas de colonialismo, en especial las formas actuales de colonialismo corporativo y financiarizado que operan a traves de sistemas globalizados de extraccion de riqueza y especulacion. Presentamos un programa de accion dividido en tres partes para descolonizar la salud mundial. La primera parte se refiere a las asimetrias de poder que existen entre los actores de la salud mundial procedentes de paises de ingresos altos e historicamente privilegiados y sus homologos de entornos de ingresos bajos y marginados. La segunda parte se refiere a la colonizacion de las estructuras y sistemas de la propia gobernanza de la salud mundial. La tercera parte aborda como se produce el colonialismo a traves del sistema sanitario mundial. Abordar todas las formas de colonialismo exige un anticolonialismo politico y economico, asi como una descolonizacion social destinada a garantizar una mayor diversidad nacional, racial, cultural y de conocimientos dentro de las estructuras de la salud mundial. [phrase omitted], Introduction Medicine and public health have always been shaped by social and political values, (1) as evident in efforts to redress social inequities in health, struggles to realize health as [...]

Abstract Background Healthcare workers (HCWs) in the United Kingdom (UK) have faced many challenges during the COVID-19 pandemic, some of these arising out of their social positions. Existing literature explicating these challenges (e.g., lack of appropriate PPE, redeployment, understaffing) have highlighted inequities in how these have been experienced by HCWs based on ethnicity, gender or, job role. In this paper, we move a step ahead and examine how the intersection of these social positions have impacted HCWs’ experiences of challenges during the pandemic. Methods We collected qualitative data, using interviews and focus groups, from 164 HCWs from different ethnicities, gender, job roles, migration statuses, and regions in the United Kingdom (UK) between December 2020 and July 2021. Interviews and focus groups were conducted online or by telephone, and recorded with participants’ permission. Recordings were transcribed and a hybrid thematic analytical approach integrating inductive data-driven codes with deductive ones informed by an intersectional framework was adopted to analyse the transcripts. Results Thematic analysis of transcripts identified disempowerment, disadvantage and, discrimination as the three main themes around which HCWs’ experiences of challenges were centred, based on their intersecting identities (e.g., ethnicity gender, and/or migration status). Our analysis also acknowledges that disadvantages faced by HCWs were linked to systemic and structural factors at the micro, meso and macro ecosystemic levels. This merging of analysis which is grounded in intersectionality and considers the ecosystemic levels has been termed as ‘intrasectionalism’. Discussion Our research demonstrates how an intrasectional lens can help better understand how different forms of mutually reinforcing inequities exist at all levels within the healthcare workforce and how these impact HCWs from certain backgrounds who face greater disadvantage, discrimination and disempowerment, particularly during times of crisis like the COVID-19 pandemic.

Background Migration and health are key priorities in global health and essential for protecting and promoting the health of migrants. To better understand the existing evidence on migration health, it is critical to map the research publication activity and evidence on the health of migrants and mobile populations. This paper presents a search strategy protocol for a bibliometric analysis of scientific articles on global migration health (GMH), leveraging the expertise of a global network of researchers and academics. The protocol aims to facilitate the mapping of research and evidence on the health of international migrants and their families, including studies on human mobility across international borders.Methods A systematic search strategy using Scopus will be developed to map scientific articles on GMH. The search strategy will build upon a previous bibliometric study and will have two main search components: (1) ‘international migrant population’, covering specific movements across international borders, and (2) ‘health’. The final search strategy will be implemented to determine the final set of articles to be screened for the bibliometric analysis. Title and abstract screening will exclude irrelevant articles and classify the relevant articles according to predefined themes and subthemes. A combination of the following approaches will be used in screening: applying full automation (ie, DistillerSR’s machine learning tool) and/or semiautomation (ie, EndNote, MS Excel) tools, and manual screening. The relevant articles will be analysed using MS Excel, Biblioshiny and VOSviewer, which creates a visual mapping of the research publication activity around GMH. This protocol is developed in collaboration with academic researchers and policymakers from the Global South, and a network of migration health and research experts, with guidance from a bibliometrics expert.Ethics and dissemination The protocol will use publicly available data and will not directly involve human participants; an ethics review will not be required. The findings from the bibliometric analysis (and other research that can potentially arise from the protocol) will be disseminated through academic publications, conferences and collaboration with relevant stakeholders to inform policies and interventions aimed at improving the health of international migrants and their families.

Lassa and colleagues’ study is a strong commentary on the biomedical hegemony and professional monopoly of medical doctors in the policy landscape of the Global Fund in Nigeria. Situating this critical dimension of professional power within wider scholarship of power and governance of global health initiatives (such as the Global Fund), in this comment, I put forth two core arguments. I call for a relational perspective of power in a dynamic policy space that the Fund characterises. I argue that a systems-view analysis of power requires a thorough examination of subsystems, how they interact, and the diverse forms of power — individual agentic, ideational, and structural — and the mechanisms through which power is wielded. The lens of governmentality allows linking individual (expertise and practices) with institutional regimes and social practices these enable; and in examining the interface of local/sub-national, national, and global within which policy formulation and implementation occurs.

Planning for investment in human resources for health (HRH) is critical to achieve Universal Health Coverage (UHC) and establish a sustainable health system. Informed planning warrants a better understanding of the health labour market (HLM) to tackle a variety of health and care workforce challenges: from addressing critical supply shortage, to ensuring optimal skills mix and distribution, and addressing motivation and performance challenges. Scant evidence around the overall role of socioeconomic and cultural factors like gender, race, marital status, citizenship (migrant) status, workplace hierarchy etc. in determining workforce composition, deployment, distribution, retention, un- and underemployment, sub-optimal work environments and other factors in the 'HRH crisis' warrants further exploration. This scoping review protocol aims to map and present the available evidence on inequalities experienced by health and care workforce, the socio-economic, cultural and other bases of these inequalities, and their outcomes/ consequences. PubMed, Web of Science, CINAHL and SCOPUS will be used to identify relevant literature. All types of published study designs in English language will be included if they discuss any inequality experienced by any category of health and care workers. Elaborate keyword categories for health and care workers and inequalities context have been developed, tested and reduced to the near-final search string. Eligible articles will be charted using the Joanna Briggs Institute checklist. The sample data extraction chart in JBI manual will be used as a basic skeleton with fields added to it to serve the needs of the scoping review. Descriptive analysis will be performed, depicting basic frequencies. While no further analysis has been advised in the JBI and PRISMA protocol, thematic analysis will be undertaken; following the Braun and Clarke's method with some modification and open coding as suggested by Maquire and Delahunt.

In the past few years, the numbers of refugees and migrants have increased worldwide, with a reported 79.5 million people forcibly displaced in 2019, the highest number ever recorded. Migrants [...]

Planning for investment in human resources for health (HRH) is critical to achieve Universal Health Coverage (UHC) and establish a sustainable health system. Informed planning warrants a better understanding of the health labour market (HLM) to tackle a variety of health and care workforce challenges: from addressing critical supply shortage, to ensuring optimal skills mix and distribution, and addressing motivation and performance challenges. Scant evidence around the overall role of socioeconomic and cultural factors like gender, race, marital status, citizenship (migrant) status, workplace hierarchy etc. in determining workforce composition, deployment, distribution, retention, un- and underemployment, sub-optimal work environments and other factors in the 'HRH crisis' warrants further exploration. This scoping review protocol aims to map and present the available evidence on inequalities experienced by health and care workforce, the socio-economic, cultural and other bases of these inequalities, and their outcomes/ consequences. PubMed, Web of Science, CINAHL and SCOPUS will be used to identify relevant literature. All types of published study designs in English language will be included if they discuss any inequality experienced by any category of health and care workers. Elaborate keyword categories for health and care workers and inequalities context have been developed, tested and reduced to the near-final search string. Eligible articles will be charted using the Joanna Briggs Institute checklist. The sample data extraction chart in JBI manual will be used as a basic skeleton with fields added to it to serve the needs of the scoping review. Descriptive analysis will be performed, depicting basic frequencies. While no further analysis has been advised in the JBI and PRISMA protocol, thematic analysis will be undertaken; following the Braun and Clarke's method with some modification and open coding as suggested by Maquire and Delahunt. [ABSTRACT FROM AUTHOR]

Abstract Background Multiple structural, contextual and individual factors determine social disadvantage and affect health experience. There is limited understanding, however, of how this complex system works to shape access to health enabling resources (HER), especially for most marginalised or hard-to-reach populations. As a result, planning continues to be bereft of voices and lived realities of those in the margins. This paper reports on key findings and experience of a participatory action research (PAR) that aimed to deepen understanding of how multiple disadvantages (and structures of oppression) interact to produce difference in access to resources affecting well-being in disadvantaged communities in Edinburgh. Methods An innovative approach combining intersectionality and PAR was adopted and operationalised in three overlapping phases. A preparatory phase helped establish relationships with participant groups and policy stakeholders, and challenge assumptions underlying the study design. Field-work and analysis was conducted iteratively in two phases: with a range of participants working in policy and community roles (or ‘bridge’ populations), followed by residents of one Edinburgh locality with relatively high levels of deprivation (As measured by the Scottish Index of Multiple Deprivation, a geographically-based indicator. See http://www.gov.scot/Topics/Statistics/SIMD/DataAnalysis/SPconstituencyprofile/EdinburghNorthern-Leith). Traditional qualitative methods (interviews, focus groups) alongside participatory methods (health resource mapping, spider-grams, photovoice) were employed to facilitate action-oriented knowledge production among multiply disadvantaged groups. Results There was considerable agreement across groups and communities as to what healthful living (in general) means. This entailed a combination of material, environmental, socio-cultural and affective resources including: a sense of belonging and of purpose, feeling valued, self-esteem, safe/secure housing, reliable income, and access to responsive and sensitive health care when needed. Differences emerge in the value placed by people at different social locations on these resources. The conditions/aspects of their living environment that affected their access to and ability to translate these resources into improved health also appeared to vary with social location. Conclusion Integrating intersectionality with PAR enables the generation of a fuller understanding of disparities in the distribution of, and access to, HER, notably from the standpoint of those excluded from mainstream policy and planning processes. Employing an intersectionality lens helped illuminate links between individual subjectivities and wider social structures and power relations. PAR on the other hand offered the potential to engage multiply disadvantaged groups in a process to collectively build local knowledge for action to develop healthier communities and towards positive community-led social change.

Abstract Background The Global Public Private Partnerships for Health (GPPPH) constitute an increasingly central part of the global health architecture and carry both financial and normative power. Gender is an important determinant of health status, influencing differences in exposure to health determinants, health behaviours, and the response of the health system. We identified 18 GPPPH - defined as global institutions with a formal governance mechanism which includes both public and private for-profit sector actors – and conducted a gender analysis of each. Results Gender was poorly mainstreamed through the institutional functioning of the partnerships. Half of these partnerships had no mention of gender in their overall institutional strategy and only three partnerships had a specific gender strategy. Fifteen governing bodies had more men than women – up to a ratio of 5:1. Very few partnerships reported sex-disaggregated data in their annual reports or coverage/impact results. The majority of partnerships focused their work on maternal and child health and infectious and communicable diseases – none addressed non-communicable diseases (NCDs) directly, despite the strong role that gender plays in determining risk for the major NCD burdens. Conclusions We propose two areas of action in response to these findings. First, GPPPH need to become serious in how they “do” gender; it needs to be mainstreamed through the regular activities, deliverables and systems of accountability. Second, the entire global health community needs to pay greater attention to tackling the major burden of NCDs, including addressing the gendered nature of risk. Given the inherent conflicts of interest in tackling the determinants of many NCDs, it is debatable whether the emergent GPPPH model will be an appropriate one for addressing NCDs.

Transgender people face numerous obstacles to accessing adequate, affordable, and appropriate sexual and reproductive health (SRH) services as outlined by the UN's Sustainable Development Goal 3.7 target of achieving universal access to SRH services by 2030. However, transgender SRH sits as a poorly researched area within public health that makes it difficult to understand the current dilemmas facing transgender SRH. This article reports the findings of a study aimed at taking stock of global research in transgender SRH. A bibliometric analysis, used to gain insights from the retrieved literature's metadata, alongside a content analysis were utilized to examine the growth, impact, and content of retrieved articles. Nine hundred fourteen journal articles were retrieved, predominately in English (884; 96.7%). These involved 3653 authors from 46 affiliated countries. Most frequent keywords included HIV, PrEP, and gender identity; corresponding to the SRH issues studied, namely HIV/AIDs and gender reassignment. Top cited and overall articles originated heavily from US affiliated authors. Content analysis outlined the articles' inclusion of the transgender community to largely have a mixed focus with cisgender people in research, these articles largely disease-focused and conducted within cities in the United States. Growth in transgender SRH research was minimal until the early-2010s, after which a steep rise can be observed. Research retrieved has a disproportionate clinical and biomedical focus around HIV and related STI issues suggesting a failure to engage with reproductive justice and more comprehensive rights-based understanding of SRH. The sustained use of derogative language suggests a need for greater inclusion and awareness of trans identities within research and publishing. The dominance of the United States in authorship and as a site of research establishes the need for more geographically diverse research, trans, and LMIC-led research enquiry and creating greater opportunities for cross-cultural, comparative, and collaborative scholarly work. [ABSTRACT FROM AUTHOR]

Background and Aims: Epidemiological transition in the form of noncommunicable diseases (NCDs) now becoming the main cause of mortality and morbidity is very much evident even in developing countries like India. Alcohol is an important risk factor for NCD. The use of alcohol is increasing especially in young people and women. This increased use can be attributed to aggressive and innovative marketing by alcohol, in spite of and due to restrictions on its marketing. Social media, in recent times, has been misused by alcohol companies for marketing their products legally, due to legal loophole. The present study examined the reach of alcohol companies on social media and the marketing strategies used by them. Design, Settings, Participants: Facebook, Twitter and YouTube were explored for accounts and content by alcohol companies for marketing their product. Policies of social media sites pertaining to alcohol marketing were also studied. Measurements: Alcohol marketing was measured in terms of content posted by alcohol companies, use of direct or surrogate advertisement and engagement with users. Findings: Alcohol companies have been conveniently using social media to target young urban population with direct and surrogate advertisements of their products. Current social media policies and laws are ineffective in controlling it. Conclusions: Amendment of laws pertaining to alcohol marketing to include social media also in its ambit is necessary. Social media sites should revise their policies to prevent alcohol marketing and promotion especially to underaged users.

We report a systematic study of the thickness dependency of room temperature ferromagnetism in pristine MgO (~100–500 nm) and ZnO (~100–1000 nm) thin films deposited by reactive magnetron sputtering technique under the respective identical controlled optimum oxygen ambience. As far as we know this is the first such report on ferromagnetic pure MgO thin films, a result which should be of significance in understanding the functional aspects of magnetic tunnelling characteristics in devices using MgO dielectrics. From the magnetic characterization we observe a distinct variation in the saturation magnetization (MS) with increasing film thickness. In the case of MgO thin films MS values vary in the range 0.04–1.58 emu/g (i.e. 0.0012–0.046 μB/unit cell) with increasing film thickness showing the highest MS value for the 170 nm thick film. Above this thickness MS is found to decrease and eventually above 420 nm the films show a paramagnetic behaviour followed by the well known diamagnetic property for the bulk (>500 nm). It is obvious that since initially the MS values increase with thickness, there has to be a maximum before the films become diamagnetic at some finite thickness. We also note that the MS values observed for MgO are the highest (more than twice the value observed for ZnO) to be reported for such a defect induced ferromagnetism in a pristine oxide. The origin of ferromagnetic order in both the oxides appears to arise from the respective cat-ion vacancies. The discovery of film thickness dependent ferromagnetic order should be very useful in developing multifunctional devices based on the technologically important materials MgO and ZnO.

Background Migration and health are increasingly recognised as a global public health priority, but concerns have been raised on the skewed nature of current research and the potential disconnect between health needs and policy and governance responses. The Migration Health South Asia (MiHSA) network led the first systematic research priority-setting exercise for India, aligned with the global call to develop a clearly defined migration health research agenda that will inform research investments and guide migrant-responsive policies by the year 2030. Methods We adapted the Child Health and Nutrition Research Initiative (CHNRI) method for this priority setting exercise for migration health. Guided by advisory groups established at international and country levels, we sought research topics from 51 experts from diverse disciplines and sectors across India. We consolidated 223 responses into 59 research topics across five themes and scored them against five predefined criteria: answerability, effectiveness, feasibility, impact, and effect on equity. We then calculated research priority scores (RPS) and average expert agreement (AEA) each research topic and theme. Results A third of the 59 research topics were on migrants' health and health care access, 12 on social determinants of migrants' health, 10 on policies, law and migration health governance, eight on health systems' responsiveness, and five on migration health discourse. Three of the top five priority topics pertained to migrants' health care access. The policies, law, and governance theme had the highest overall RPS score. Conclusions There is a noticeable gap between research priorities identified by experts at the country-level and the current research focus and priorities set globally. This disconnect between the global and local perspectives in migration health scholarship hinders the development of context-specific and suitable policy agendas for improving migrants' health. Our co-developed agenda emphasises the need to prioritise research on the capacity of existing systems and policies so as to make them more migration-aware and responsive to migrants' health needs. [ABSTRACT FROM AUTHOR]

Background Community and stakeholder involvement in decision-making to determine publicly-funded health services and interventions is advocated to fulfil citizens' rights and improve health outcomes. The inclusion of public actors, particularly disadvantaged populations, in priority setting for universal health coverage (UHC) is also enshrined in guidance from the World Health Organization (WHO). However, challenges remain in operationalising this policy aim and ensuring that these approaches are effective and equitable. This study aimed to synthesise published evidence on the role of community and stakeholder participation in determining health service coverage. Methods A systematic review was conducted, searching the Web of Science, Ovid Global Health, and PubMed Central databases from 2000 onwards, including all study types. A framework synthesis approach was used for charting and synthesising data on mechanisms, effectiveness (equity, depth, and stage), and barriers and facilitators for engagement. Results Twenty-seven relevant studies were identified that involve community actors and other stakeholders in priority setting and decision-making processes for defining health benefit packages and UHC, health technology assessment, and pharmaceutical coverage. Mechanisms of engagement include a wide variety of consultation approaches; participation in decision-making committees, advisory councils, and local planning meetings; and appeals mechanisms. Participation occurs primarily at Data and Dialogue stages of decision-making processes, and we found limited depth of engagement among identified cases. Limited consideration of equity was observed in planning and reporting on community involvement in priority setting. A number of challenges are identified in the literature, which we typologise as institutional, procedural, technical, and structural / normative barriers to meaningful participation. Conclusions This systematic review identifies key gaps and opportunities in the literature and practice related to effective and equitable community and stakeholder participation in determining health service coverage. It offers essential considerations for planning and executing inclusive approaches to priority setting for publicly-funded health services and interventions and defining health benefit packages for UHC. [ABSTRACT FROM AUTHOR]

This paper examines determinants of ethnic disparities in workplace risks of COVID-19 among health and social care workers (HCWs) in the UK. This was undertaken to inform public health policy in the management of COVID-19 relating to health and social care provision. A cross-sectional survey was administered in July–August 2020 (n = 456) to elicit HCWs' experiences of COVID-19 management in the workplace and their perceptions of exposure, personal protection against infection, involvement in local clinical management, and other workplace hazards. Findings suggest minority ethnic HCWs were twice as likely as White HCWs to be in a patient-facing role (OR = 2.14, 95% CI:1.21; 3.78, P < 0.01) and twice as likely (63% vs 39%) to be caring for COVID-19 positive patients (OR = 2.68, 95% CI: 1.77; 4.06, P < 0.01). Those in nursing, were three times as likely to be redeployed to a COVID-19 care setting (OR = 3.33, 95%CI: 1.23; 9.02, P= 0.02). Minority ethnic HCWs within lower- and mid-level roles carried a higher burden of frontline clinical management of COVID-19 positive patients than their White counterparts. This study found evidence of ethnic disparities across several workplace hazards, with increased exposure to and less protection against infection, more responsibility for the clinical management of infection, and evidence of systemic racial bias in the disproportionate redeployment of minority ethnic nursing staff to COVID-19 areas. An NHS-wide review is required to assess procedural fairness, ensure safe practices now, and to avert future crises. [ABSTRACT FROM AUTHOR]

The identification of lattice multiphases in TiO2 nanocrystals is studied by high resolution transmission electron microscope and electron diffraction patterns. Based on the spectroscopic analysis using soft x-ray absorption and resonant inelastic soft x-ray scattering, it is believed that the oxygen vacancies at the interface exhibit structural distortion of the TiO 6 8 − cluster around the defect site as for the multiphase lattice. We elucidate that the extra 3d electrons nearby induce the inelastic scattering features with the excitation energy dependence owing to different energy relaxation processes, a characteristic of the electron-phonon coupling or the nature of the electron-hole pair at the intermediate state. The manifold dd excitations driven by the strong interaction between Ti-3d and O-2p electrons are noticeably rich, coexisting on both Ti and O sites. This sophisticated experiment can advance the perspective of nanocomposite TiO2 for various interactions of surface Ti3+ in applications of future devices. [ABSTRACT FROM AUTHOR]