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The World Health Organization (WHO) is tasked with the ‘attainment by all peoples of the highest possible level of health’, yet, it is widely struggling to meet this mandate, and COVID-19 has revealed significant limitations of the organisation. Despite clear guidance provided by the institution as to how best to respond to the pathogen, many governments departed from WHO's guidance in their response efforts. Is this a new crisis for WHO? Does WHO need to restore its legitimacy in the eyes of the global community? As renewed calls for changes to WHO emerge, in this perspective we lay out the obstacles WHO face to become the WHO ‘we’ need. The assumption is that UN member states need an empowered and well-funded organisation. Yet, many years of discussion of reform of WHO have failed to lead to meaningful change, and glaring challenges remain in its financing, governance and politics, which are considered in turn. The reality may be that we have the WHO that UN member states need – one that can provide guidance and advice, but also take criticism for health governance failures when states want to avoid blame or responsibility. We discuss this, by analysing three key areas of WHO'S challenges: mandate and scope; structure, governance and money and domestic vs international.
Worldwide type 2 diabetes (T2D) prevalence is increasing dramatically. The present study aimed to evaluate the association between dietary habits and T2D in an Iranian adult population using a cross-sectional analysis of the Shahedieh cohort study. Participants were adults aged 35–70 years (n 9261) from Zarch and Shahedieh, Yazd, Iran, who attended the baseline phase of the Shahedieh cohort study. Dietary habits including meal frequency, fried-food consumption, adding salt to prepared meals and grilled-food consumption were assessed by a standard questionnaire. T2D was defined as fasting plasma glucose (FPG) ≥126 mg/dl according to the American Diabetes Association. Multiple logistic regression assessed the association between dietary habits and T2D. Individuals who consumed a meal more than six times per day compared to three times per day had greater odds for T2D (OR 2⋅503, 95 % CI 1⋅651, 3⋅793). These associations remained significant in a fully adjusted model. There was a significant association between greater intakes of fried foods and prevalence of T2D (OR 1⋅294, 95 % CI 1⋅004, 1⋅668) in the adjusted model. No significant associations were observed between other dietary habits (adding salt to prepared meals and grilled-food consumption) and odds of T2D in all crude and adjusted models. In conclusion, we have highlighted the association between meal and fried-food consumption frequencies with risk of T2D. Large longitudinal studies in different ethnicities are needed to confirm these associations.
The Women, Peace and Security (WPS) agenda and women's participation in peace processes are strongly supported by states. Yet financing to support the implementation of WPS has lagged behind overt international commitments to the agenda. WPS scholars and practitioners have highlighted the funding shortfalls for enabling WPS implementation and continued under-investment in gender-inclusive peace. In this article, we ask how much are donor states financially backing the implementation of gender-inclusive peace agreements which they promote? We use a high ambiguity-conflict model of policy implementation to explore the mechanisms of bilateral and multilateral financing for gender-inclusive peace. We trace to what extent international investments are supporting specific gender provisions in two progressive gender-inclusive peace processes, the 2016 Colombian Peace Agreement and 2015 Comprehensive Peace Agreement in the Philippines. In both case studies, we reveal a drastic gap between the international donor rhetoric and the funding. Patterns of financial investment do not follow nor support the life cycle of inclusive peace processes. We suggest key strategies for further research to address this policy and recommend that all gender provisions of peace agreements be monitored in-country and all gender-responsive investments be tracked and evaluated.
In response to annual outbreaks of human cercarial dermatitis (HCD) in Lake Wanaka, New Zealand, ducks and snails were collected and screened for avian schistosomes. During the survey from 2009 to 2017, four species of Trichobilharzia were recovered. Specimens were examined both morphologically and genetically. Trichobilharzia querquedulae, a species known from four continents, was found in the visceral veins of the duck Spatula rhynchotis but the snail host remains unknown. Cercaria longicauda [i.e. Trichobilharzia longicauda (Macfarlane, 1944) Davis, 2006], considered the major aetiological agent of HCD in Lake Wanaka, was discovered, and redescribed from adults in the visceral veins of the duck Aythya novaeseelandiae and cercariae from the snail Austropeplea tomentosa. Recovered from the nasal mucosa of Ay. novaeseelandiae is a new species of Trichobilharzia that was also found to cycle naturally through Au. tomentosa. Cercariae of a fourth species of Trichobilharzia were found in Au. tomentosa but the species remains unidentified.
Artificial intelligence (AI) is reaching into every aspect of global health. In this essay, I examine one example of AI's potential contributions and limitations in global health: the prediction, treatment, and containment of a global influenza outbreak. The potential advantages are clear. AI can aid global influenza surveillance platforms by improving the capacity of organizations to look for novel influenza outbreak strains in the right places, to identify populations most likely to spread influenza, and to produce real-time information about the disease's spread by monitoring social media communications to track outbreak events. There are also very real limitations to what AI can do, and it is crucial that AI not be used as an excuse not to invest in strengthening health systems and other traditional components of global healthcare. AI may also be able to improve our understanding of who should receive a vaccine and what is most effective for large-scale vaccine delivery, but there will always be blind spots that the data cannot fill. Investment in healthcare, with attention to the danger of minimal access to care for minority groups that are at risk and in fragile situations, remains the best chance to prepare communities for outbreak detection, surveillance, and containment.
The United States presidential election of Donald Trump in 2016 was observed by global health commentators as posing dire consequences for the progress made in global health outcomes, governance, and financing. This article shares these concerns, however, we present a more nuanced picture of the global health governance progress narrative pre-Trump. We argue that Trump’s presidency is a displacement activity to which global health’s pre-existing inequalities and problems of global health security, financing, and reproductive health can be attributed. Unfettered access to sexual and reproductive rights, sustained financing of health system strengthening initiatives, affordable medicines and vaccines, and a human security-centred definition of global health security were already problematic shortfalls for global health governance. Trump no doubt exacerbates these concerns, however, to blame his presidency for failings in these areas ignores the issues that have been endemic to global health governance prior to his presidency. Instead of using Trump as a displacement activity, his presidency could be an opportunity to confront dependency on US financing model, the lack of a human-security centred definition of global health security, and the norm of restricting reproductive health. It is such engagement and confrontation with these issues that could see Trump’s presidency as being a catalyst for change rather than displacement as a means of preserving the uncomfortable status quo in global health. We make this argument by focusing on three specific areas of US-led global health governance: reproductive health and the ‘global gag rule’, health financing and the President’s Emergency Plan for AIDS Relief (PEPFAR), and pandemic preparedness and global health security.
The first section of this chapter looks at how the two terms ‘migrant’ and ‘refugee’ came to be defined as distinct from each other in the context of the modern state. As the reification of borders intensified in the nineteenth and twentieth centuries, citizenship became an essential part of ‘belonging’ to a state as well as indicating the strength of the state itself. Hence, the categorisation of those ‘outside’ the state developed as a way of ascertaining who belonged and who did not. The second section examines how states define and categorise refugees through laws that seek to contain and limit their flow. The third section is concerned with the consequences of limiting the definition of a refugee, which has led to an unequal burden between developed and developing states. The final section canvasses the various options presented to reduce the present imbalance, where the vast majority of the world's refugees eke out an existence in refugee camps in developing countries. Ultimately, this chapter seeks to demonstrate that the choices made by states in border protection become the key determinants of how refugees will be accepted. Adherence to international refugee law will not necessarily address all the problems associated with refugees, but nor will seeing refugees as unwanted intruders in contrast to ‘desirable’ migrants.
States, refugees and immigrants
Former Australian Prime Minister John Howard campaigned in the 2001 federal election under the slogan ‘We will decide who comes to this country and under what circumstances’ (Marr and Wilkinson 2003: 277). As this demonstrates, there is arguably no greater control than determining who is a ‘legitimate’ citizen of the state – that is, determining who can and cannot live within your borders. Being able to secure borders and identify when they are being breached is essential to state sovereignty. Consider how Hungarian Prime Minister Viktor Orban recently called Syrian refugees attempting to enter his country ‘a poison’ that his country ‘won't swallow’. Orban went on to describe refugees as migrants that the country did not want or need, because ‘every single migrant poses a public security and terror risk’ (The Guardian 2016). The determination of whether an individual's crossing of a border is illegal, whether they are crossing as a migrant or a refugee, is part of how a state constructs its identity and territoriality.
Over the past decade, there have been increased attempts to understand the contributing factors to the relationship between healthy populations (that is, populations that have long life expectancy from birth), the prevention of conflict, and governance regimes that enable ‘healthy nations’ to survive and thrive. These studies have been largely informed by longitudinal studies on the positive relationship between regime type, provision of health care, and conflict prevention. This article examines what insights a comparison of postconflict countries in a regional setting may provide to challenge or indeed extend the findings advanced so far in the literature on the relationship between regime type and health insecurity. The Southeast Asian experience confirms the obvious – that the cessation of armed conflict is related to improved health outcomes. However, it challenges presumptions that democratisation plays a significant role in shaping this relationship.
Two studies examined the nature and processes underlying the joint role of interparental aggression and maternal antisocial personality as predictors of children's disruptive behavior problems. Participants for both studies included a high-risk sample of 201 mothers and their 2-year-old children in a longitudinal, multimethod design. Addressing the form of the interplay between interparental aggression and maternal antisocial personality as risk factors for concurrent and prospective levels of child disruptive problems, the Study 1 findings indicated that maternal antisocial personality was a predictor of the initial levels of preschooler's disruptive problems independent of the effects of interparental violence, comorbid forms of maternal psychopathology, and socioeconomic factors. In attesting to the salience of interparental aggression in the lives of young children, latent difference score analyses further revealed that interparental aggression mediated the link between maternal antisocial personality and subsequent changes in child disruptive problems over a 1-year period. To identify the family mechanisms that account for the two forms of intergenerational transmission of disruptive problems identified in Study 1, Study 2 explored the role of children's difficult temperament, emotional reactivity to interparental conflict, adrenocortical reactivity in a challenging parent–child task, and experiences with maternal parenting as mediating processes. Analyses identified child emotional reactivity to conflict and maternal unresponsiveness as mediators in pathways between interparental aggression and preschooler's disruptive problems. The findings further supported the role of blunted adrenocortical reactivity as an allostatic mediator of the associations between parental unresponsiveness and child disruptive problems.
This chapter proceeds in four sections. The first looks at how the two terms, ‘migrant’ and ‘refugee’, came to be defined as distinct from each other in the context of the modern state. As the reification of borders intensified in the nineteenth and twentieth centuries, citizenship became an essential part of ‘belonging’ to a state as well as indicating the strength of the state itself. Hence, the categorisation of those ‘outside’ the state developed as a way of ascertaining who belonged and who did not. The second examines how states define and categorise refugees through laws that seek to contain and limit their flow. The third is concerned with the consequences of limiting the definition of a refugee, which has led to an unequal burden between developed and developing states. The final section will canvass the various options presented to reduce the present imbalance where the vast majority of the world’s ‘people of concern’ eke out an existence in refugee camps in developing countries. Ultimately, this chapter seeks to demonstrate that the choices made by states in border protection become the key determinants of how refugees will be accepted. Adherence to international refugee law will not necessarily address all the problems associated with refugees, but nor will seeing refugees as unwanted intruders in contrast to ‘desirable’ migrants.
States, refugees and immigrants
The former Prime Minister of Australia, John Howard, campaigned in the 2001 federal election under the banner ‘we will decide who comes to this country and under what circumstances’ (Marr and Wilkinson 2003: 277). As this slogan demonstrates, there is arguably no greater control than determining who is a ‘legitimate’ citizen of the state – that is, determining who can and cannot live within your borders. Being able to secure borders and identify when they are being breached is essential to state sovereignty. Entry into a state without permission is seen as an ‘illegal’ breach of sovereignty, or even a threat to sovereignty. Consider Canadian Prime Minister Stephen Harper’s comments in relation to the arrival of Sri Lankan asylum seekers who stowed away on a cargo ship: ‘It’s a fundamental exercise of sovereignty and we’re responsible for the security of our borders and the ability to welcome people or not welcome people when they come’ (Sydney Morning Herald 2010). The determination of whether an individual’s crossing of a border is deemed as illegal, threatening or permissible is part of how a state constructs its identity and territoriality. Therefore, this chapter will first look at how states define an individual’s entry, through tracing the development of the term ‘refugee’, contrasting it to the term ‘migrant’ and exploring how this delineation affects the lives of people seeking entry into states.
This chapter will proceed in five sections. The first section looks at how the two terms, migrant and refugee, came to be defined as distinct from each other in the context of the modern state. As the reification of borders intensified in the nineteenth and twentieth centuries, citizenship became an essential part of ‘belonging’ to a state as well as indicating the strength of the state itself. Hence, the categorisation of those ‘outside’ the state developed as a way of ascertaining who belonged and who did not. The second part of this chapter then examines how states define and categorise refugees through laws that seek to contain and limit their flow. The third section is concerned with the consequences of limiting the definition of a refugee, which has led to an unequal burden between developed and developing states. In the fourth section, we look at the specific case of Australia and the development of its relationship with refugees. The final section examines the case of the MV Tampa and traces how the Australian government's response to this boatload of rescued asylum seekers marked a new chapter in its migration laws. Ultimately, this chapter seeks to demonstrate that the choices made by states in border protection become the key determinants of how refugees will be accepted. Adherence to international refugee law will not necessarily address all the problems associated with refugees, but nor will seeing refugees as unwanted intruders in contrast to ‘desirable’ migrants.
Over the past decade, the number of clinical trials registered with the Food and Drug Administration (FDA) has increased dramatically. The business of clinical research has become more diverse, involving academic institutions, clinician-researchers in community settings, pharmaceutical companies, and contract research organizations. This growth has been accompanied by increasing concerns about the ethical conduct of research. Much of this concern has been directed to procedural issues including institutional review board (IRB) review, data monitoring, and informed consent forms. However, the protection of human subjects cannot be achieved by relying solely on procedural safeguards. There are more nuanced issues related to recruitment and retention of subjects, and to the process of informed consent, that are generated during the interaction between study staff and subjects. It is only through an examination of these relationships that one can more fully define and understand the challenges of protecting subjects in research.
Previous studies show that among Black Caribbeans there is a higher prevalence of schizophrenia and higher levels of both voluntary and compulsory admissions. These suggest that Black Caribbean patients may find psychiatric services less appropriate to their needs. The aim of this study was to establish the satisfaction with mental health services of representative psychosis patients in South London, especially in relation to ethnic group.
A random sample of all cases of psychotic disorder identified in the two sectors was interviewed using the Verona Service Satisfaction Schedule. Questionnaires from 50 Black Caribbean patients and 134 White patients were analysed.
Black Caribbean patients, particularly those of second generation born in the UK, were significantly less satisfied with almost every aspect of the services that they received than either older Black Caribbean patients born in the Caribbean or White patients. Using multiple regression analysis it was found that among the younger Black Caribbean patients, unlike the other patients, the number of previous admissions was a significant predictor of dissatisfaction.
Patients' ratings of satisfaction with mental health services are significantly worse for UK-born Black Caribbean than other patients with psychotic disorder in South London.
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