The authors are to be commended on an important article which makes a compelling point.
Out of interest, where authors are appropriately credited as joint first and joint last, should their names then be listed alphabetically? In the example of this paper, this would place authors based in more resource-poor countries as the first and last listed authors, and would also seem the more rational ordering if authorship is jointly shared. There is some evidence that the ordering of 'joint first' authors does involve some implicit biasing in terms of gender balance - might this not also be an issue in work published as part of an global partnership? Attributing authorship can be genuinely difficult, but where equivalence is recognised it then seems concerning that the chosen (but not explained) order still places the high-income authors in the traditional positions of distinction.
Recently, in BMJ Global Health, Nasir Jafar and colleagues made another attempt to redefine 'global health'. They aim for 'greater clarity and precision' in a pragmatic and more inclusive sense, with the noble objective '‘to offload colonial vestiges present within the field and terminology of ‘global health’.‘ While this goal is undoubtedly right, important and overdue, the argument is alarmingly unconvincing and narrow. In their attempt to redefine, or rather reinterpret, global health, the authors make two important restrictions. Their proposal is based on an understanding of global health that is limited not only to a single country, but also to the field of humanitarian aid. Health emergencies and relief are only part of global health, so reducing the latter to humanitarian aid is absolutely unacceptable. It blatantly neglects both the meaning of "global" as "universal" and the complexity of global health as an explicitly political concept.
The second, unacceptable limitation is the authors' narrowing of global health to healthcare and healthcare systems. It may be that a clinical-biomedical understanding dominates the theory and practice of global health, but the call for an a posteriori recognition of pragmatic development should not distract from the fact that global health is much more complex, encompassing the social, environmental, political and commercial determination of health, as well as inequalities...
Recently, in BMJ Global Health, Nasir Jafar and colleagues made another attempt to redefine 'global health'. They aim for 'greater clarity and precision' in a pragmatic and more inclusive sense, with the noble objective '‘to offload colonial vestiges present within the field and terminology of ‘global health’.‘ While this goal is undoubtedly right, important and overdue, the argument is alarmingly unconvincing and narrow. In their attempt to redefine, or rather reinterpret, global health, the authors make two important restrictions. Their proposal is based on an understanding of global health that is limited not only to a single country, but also to the field of humanitarian aid. Health emergencies and relief are only part of global health, so reducing the latter to humanitarian aid is absolutely unacceptable. It blatantly neglects both the meaning of "global" as "universal" and the complexity of global health as an explicitly political concept.
The second, unacceptable limitation is the authors' narrowing of global health to healthcare and healthcare systems. It may be that a clinical-biomedical understanding dominates the theory and practice of global health, but the call for an a posteriori recognition of pragmatic development should not distract from the fact that global health is much more complex, encompassing the social, environmental, political and commercial determination of health, as well as inequalities and power imbalances between and within countries. Against this backdrop, the attempt by Nasir Jafar et al. to redefine global health proves to be inadequate and misleading. Due to the fundamental reductionism reflected in their commentary, the approach is unlikely to make a relevant contribution to decolonising global health, as it diverts the attention from the far more relevant upstream determinants of global health and health inequalities.
A recently published article addresses the worrysome connections existing between the progressively increasing Arctic Sea ice melting and the chronic starvation experienced by polar bears (Ursus maritimus) (1). Indeed, the progressively declining Arctic Sea ice thickness represents a leading cause of the profound ecological, behavioural, feeding and dietary pattern modifications reported with an increased frequency in this highly threatened apex predator (1).
Within such an alarming context, the animals' chronic stress deriving from prolonged starvation is an additional matter of concern. Indeed, besides being a powerful and efficient machinery allowing us and all the other living organisms to cope with a huge number of environmental stressors, chronic stress responses are invariably characterized by immunosuppression, originating from enhanced cortisol production (2). Therefore, while increased cortisol levels should be reasonably expected to occur in the blood of polar bears experiencing chronic starvation (1), it should be emphasized they may also become, at the same time, much more susceptible to microbial pathogens impacting their health and conservation status.
This could be especially true for Toxoplasma gondii, a cosmopolitan and zoonotic protozoan parasite infecting humans and a large number of terrestrial and aquatic mammal species, including polar bears. In this respect, anti-T. gondii antibodies were previously reported in almost half of the p...
A recently published article addresses the worrysome connections existing between the progressively increasing Arctic Sea ice melting and the chronic starvation experienced by polar bears (Ursus maritimus) (1). Indeed, the progressively declining Arctic Sea ice thickness represents a leading cause of the profound ecological, behavioural, feeding and dietary pattern modifications reported with an increased frequency in this highly threatened apex predator (1).
Within such an alarming context, the animals' chronic stress deriving from prolonged starvation is an additional matter of concern. Indeed, besides being a powerful and efficient machinery allowing us and all the other living organisms to cope with a huge number of environmental stressors, chronic stress responses are invariably characterized by immunosuppression, originating from enhanced cortisol production (2). Therefore, while increased cortisol levels should be reasonably expected to occur in the blood of polar bears experiencing chronic starvation (1), it should be emphasized they may also become, at the same time, much more susceptible to microbial pathogens impacting their health and conservation status.
This could be especially true for Toxoplasma gondii, a cosmopolitan and zoonotic protozoan parasite infecting humans and a large number of terrestrial and aquatic mammal species, including polar bears. In this respect, anti-T. gondii antibodies were previously reported in almost half of the polar bears from Svalbard, Norway, with males showing higher seroprevalence values than females and with the infection's frequency turning out to have doubled in comparison to an earlier investigation carried out in the same area (3).
Furthermore, the well-known top predator position occupied by polar bears within the marine food chain makes these animals prone to bioaccumulate and biomagnify a huge number of persistent environmental pollutants within their body tissues, including immunotoxic heavy metals like methyl mercury (methyl Hg) (4).
Summarizing, the immunosuppression synergistically induced by the chronic stress response deriving from prolonged starvation as well as by the high tissue concentrations of immunotoxic environmental xenobiotics, may render polar bears much more susceptible toward the acquirement and subsequent development of various infectious disease processes, of both viral and non-viral nature, impacting their already threatened health and conservation status, including SARS-CoV-2 infection, which has shown a progressively expanding wild and domestic animal host range (5).
Once again, a multidisciplinary, One Health-based approach would be strongly recommended in order to get proper insight into, and adequately counteracT, the alarming risk of getting another "piece of biodiversity" irreversibly lost!
References
1) Pagano, A.M., Rode, K.D., Lunn, N.J., et al. Polar bear energetic and behavioral strategies on land with implications for surviving the ice-free period. Nat Commun 15, 947 (2024). https://doi.org/10.1038/s41467-023-44682-1.
2) O'Leary, A. Stress, emotion, and human immune function. Psychol. Bull.108, 363-382 (1990). doi: 10.1037/0033-2909.108.3.363.
3) Jensen, S.K., Aars, J., Lydersen, C., et al. The prevalence of Toxoplasma gondii in polar bears and their marine mammal prey: evidence for a marine transmission pathway?. Polar. Biol 33, 599–606 (2010). https://doi.org/10.1007/s00300-009-0735-x
4) St Louis, V.L., Derocher, A.E., Stirling, I., et al. Differences in mercury bioaccumulation between polar bears (Ursus maritimus) from the Canadian high- and sub-Arctic. Environ. Sci. Technol. 45, 922-928 (2011). doi: 10.1021/es2000672.
5) Di Guardo, G. The SARS-CoV-2 pandemic at the wildlife-domestic animal-human interface. Pathogens 12(2), 222 (2023). doi: 10.3390/pathogens12020222.
I am Jewish. My father escaped Nazi Germany in Spring 1939, age 17. He left his mother behind, and she was later gassed in Meinz. This was my unspoken and unspeakable heritage.
I commend the brave article by Layth Hanbali, Edwin Kwong, Amy Neilson, James Smith, Sali Hafez, and Rasha Khoury, who tell the truth as it is. With them, and with billions around the world, I call on the Israeli government to end the genocide they are committing in Palestine and to bring about an immediate ceasefire. I call on Israel’s allies to act as true allies and let go of vested interest, stop trading arms, and instead engage with Israel to forge a true and just peace.
We humans have, individually and collectively, suffered severe traumas at each other’s hands. Not only the traumas caused by genocide or war, but also trauma caused by the hunger, displacement, exploitation that go hand in hand with colonisation, extreme inequity, ecological destruction, and with excessive pollution, including carbon pollution. Many humans who are in positions of power may suffer their own legacy of trauma. For example, there is a tradition in the UK to send children as young as eight to boarding school, which is known to leave children scarred and adults with reduced empathy who struggle to engage in and maintain loving relationships.
Many humans have suffered traumas directly. Others, like myself, have grown up with inherited traumas. We are all interconnected and we are all affected. Our...
I am Jewish. My father escaped Nazi Germany in Spring 1939, age 17. He left his mother behind, and she was later gassed in Meinz. This was my unspoken and unspeakable heritage.
I commend the brave article by Layth Hanbali, Edwin Kwong, Amy Neilson, James Smith, Sali Hafez, and Rasha Khoury, who tell the truth as it is. With them, and with billions around the world, I call on the Israeli government to end the genocide they are committing in Palestine and to bring about an immediate ceasefire. I call on Israel’s allies to act as true allies and let go of vested interest, stop trading arms, and instead engage with Israel to forge a true and just peace.
We humans have, individually and collectively, suffered severe traumas at each other’s hands. Not only the traumas caused by genocide or war, but also trauma caused by the hunger, displacement, exploitation that go hand in hand with colonisation, extreme inequity, ecological destruction, and with excessive pollution, including carbon pollution. Many humans who are in positions of power may suffer their own legacy of trauma. For example, there is a tradition in the UK to send children as young as eight to boarding school, which is known to leave children scarred and adults with reduced empathy who struggle to engage in and maintain loving relationships.
Many humans have suffered traumas directly. Others, like myself, have grown up with inherited traumas. We are all interconnected and we are all affected. Our joint survival depends upon acknowledging and investigating our traumas both collectively and individually, to allow true healing.
It is not only the Palestinians of Gaza who urgently need the world to acknowledge their suffering and their right to life, but also ourselves.
Additional notes:
Moving towards alternative technological systems, such as those analysed by Project Drawdown, https://drawdown.org/, and alternative ways of living in communities, are not only possible but imperative for our children and grandchildren’s sake and for our own health and survival.
This hour-long talk by Mr Ashish Kothari, starting twenty minutes into the YouTube video, gives a worthwhile overview of some diverse and successful community initiatives from a Buddhist perspective: https://www.youtube.com/watch?v=0EEYSAwtBXc
Dr Diana Warner
Dr Warner is a retired GP living in Bristol, UK, and present environmental protector
Both this commentary and the previous one by Smith et al are both misleading and political attacks on the right for Israel to exist as a free and democratic nation. The Palestinian people of Gaza have been victims of Hamas since they took over in 2005/2006. To dismiss the horrendous terrorist attack of Oct 7 where children and women mutilated and raped, which was actually documented by the terrorists themselves is abhorrent and totally irresponsible of BMJ Global health. In fact prior to Oct 7, thousands of Palestinian Gazans were getting health care in Israel, including family members of Gaza leadership. Thousands of Gazans were crossing the border daily to work in Israeli Farms/Kibbutzim who paid them, fed them and at times housed them, only for them to map out each farm and houses to provide to the terrorists so they know how to attack them. In addition, many of those who worked in those farms/kibbutzim participated in the attacks. Finally, Gaza built an underground network/city under the hospitals and schools to plana and stage their attack on Israel, knowing using the Palestinian/Gazan residents as human shields to they can get sympathy from the world. In addition the communities that were attacked in the Negev, that were formed in the 1920s, were predominantly Jewish, with very few Muslims or "Palestinians" living there. Israel has every right to defend itself against this barbaric attack, as would any country. Health justice and publication of thi...
Both this commentary and the previous one by Smith et al are both misleading and political attacks on the right for Israel to exist as a free and democratic nation. The Palestinian people of Gaza have been victims of Hamas since they took over in 2005/2006. To dismiss the horrendous terrorist attack of Oct 7 where children and women mutilated and raped, which was actually documented by the terrorists themselves is abhorrent and totally irresponsible of BMJ Global health. In fact prior to Oct 7, thousands of Palestinian Gazans were getting health care in Israel, including family members of Gaza leadership. Thousands of Gazans were crossing the border daily to work in Israeli Farms/Kibbutzim who paid them, fed them and at times housed them, only for them to map out each farm and houses to provide to the terrorists so they know how to attack them. In addition, many of those who worked in those farms/kibbutzim participated in the attacks. Finally, Gaza built an underground network/city under the hospitals and schools to plana and stage their attack on Israel, knowing using the Palestinian/Gazan residents as human shields to they can get sympathy from the world. In addition the communities that were attacked in the Negev, that were formed in the 1920s, were predominantly Jewish, with very few Muslims or "Palestinians" living there. Israel has every right to defend itself against this barbaric attack, as would any country. Health justice and publication of this information is not something that should be published in Medical Journals, it is political and with much misinformation.
An excellent comprehensive, thoughtful review. Until such time as Israel-- a Jewish homeland and liberal democracy-- is accepted as a reality there can be no peace. To paraphrase Golda Meir, ",,,,,,, if the Arab world put down their weapons, there would be peace.,,,,,,, if Israel put down their weapons there would be no Israel".
I would like to register my strong support for this viewpoint. I am part of a large group of >200 physicians, researchers, and academics who endorsed and contributed to this article. Unfortunately, as part of a highly disappointing series of editorial decisions, BMJ Global did not allow the authors to publish our names and information as a supplement to this article (which was the original plan). I therefore would like to register a rapid response documenting that I was one of the extremely large group of academics who endorsed this article.
BMJ Global Health has served as a platform for highlighting the global forces that underpin inequities in health and wellbeing everywhere in the world. The journal has published similar articles in relation to wars and conflicts, and in doing so have consistently privileged the voices, needs, experiences, and perspectives those who are marginalised in those wars and conflicts. As with many other manuscripts submitted for consideration as editorials, this article, although unsolicited, was published with only internal peer review. As we have consistently done with papers published in the journal, we welcome rebuttals, contestations, and alternative interpretations. Some of these are being included as online 'rapid response' comments. In time, others will be published in the journal and on our blog.
Those of us who do global health have a responsibility to respect the dignity of people and communities who are marginalised as knowers, and to represent their interpretations of their own reality. The article is in fulfillment of that responsibility. To be socially/politically marginalised is to be interpretively (or hermeneutically) marginalised; or to have interpretations from one's standpoint under-represented in the collective pool of legitimised knowledge. For every complex reality, there may be multiple and even competing interpretations. Our responsibility as a field must include allowing space in our heads and on knowledge platforms for that multip...
BMJ Global Health has served as a platform for highlighting the global forces that underpin inequities in health and wellbeing everywhere in the world. The journal has published similar articles in relation to wars and conflicts, and in doing so have consistently privileged the voices, needs, experiences, and perspectives those who are marginalised in those wars and conflicts. As with many other manuscripts submitted for consideration as editorials, this article, although unsolicited, was published with only internal peer review. As we have consistently done with papers published in the journal, we welcome rebuttals, contestations, and alternative interpretations. Some of these are being included as online 'rapid response' comments. In time, others will be published in the journal and on our blog.
Those of us who do global health have a responsibility to respect the dignity of people and communities who are marginalised as knowers, and to represent their interpretations of their own reality. The article is in fulfillment of that responsibility. To be socially/politically marginalised is to be interpretively (or hermeneutically) marginalised; or to have interpretations from one's standpoint under-represented in the collective pool of legitimised knowledge. For every complex reality, there may be multiple and even competing interpretations. Our responsibility as a field must include allowing space in our heads and on knowledge platforms for that multiplicity, while also striving to privilege interpretations that are marginalised; including how marginalised people and communities see the world and their place in it.
Publication of this editorial is consistent with the nature, mission and rationale of global health and its commitment to equity and justice. This includes hearing voices and perspectives that are otherwise unheard, especially of marginalised people and communities. The content is also consistent with the field’s commitment to the upstream determination of health and wellbeing, including focussing analysis and action on 'root causes' – such as the impacts of colonisation, globalisation, hyper-capitalism, the climate/environment and social/political discrimination on inequities in health and wellbeing.
The International Network for Epidemiology and Policy (NEP) represents 24 epidemiology societies across the globe and works to address policies at the global level that have public health impacts. This includes wars and conflict which cause suffering to large populations and constitute major public health crises (1,2).
As public health experts, the International Network for Epidemiology leadership share the concerns expressed in the editorial by Smith et al (3). The lives of all people should be protected. There is never an ethically defensible justification for murdering civilians or taking them hostage, bombing families, hospitals, schools, universities, Non-Government Organizations, or any residential building. Nor is there justification for depriving people of water, food, electricity, medicine, and shelter.
Calling for a ceasefire based on humanitarian reasons is what every public health expert would do. This is what the authors of the above-mentioned editorial were calling for. We denounce any accusations and threats to authors and editors for expressing such views on the need for preservation of human life, and for ethical standards of conducting wars (2). Such accusations, threats, and lobbying for one political view or another, should not have any place in academic discussions on public health. These activities undermine freedom of speech, the global mission of public health, and the very basic tenets of human rights and dignity to live (2).
The International Network for Epidemiology and Policy (NEP) represents 24 epidemiology societies across the globe and works to address policies at the global level that have public health impacts. This includes wars and conflict which cause suffering to large populations and constitute major public health crises (1,2).
As public health experts, the International Network for Epidemiology leadership share the concerns expressed in the editorial by Smith et al (3). The lives of all people should be protected. There is never an ethically defensible justification for murdering civilians or taking them hostage, bombing families, hospitals, schools, universities, Non-Government Organizations, or any residential building. Nor is there justification for depriving people of water, food, electricity, medicine, and shelter.
Calling for a ceasefire based on humanitarian reasons is what every public health expert would do. This is what the authors of the above-mentioned editorial were calling for. We denounce any accusations and threats to authors and editors for expressing such views on the need for preservation of human life, and for ethical standards of conducting wars (2). Such accusations, threats, and lobbying for one political view or another, should not have any place in academic discussions on public health. These activities undermine freedom of speech, the global mission of public health, and the very basic tenets of human rights and dignity to live (2).
We recognize all loss of life in the current conflict and denounce the harmful actions of all actors. As public health experts focusing on the health and lives of all people, we can - and must - call out actions resulting in suffering to many, regardless of our political affiliation.
Yours sincerely,
International Network for Epidemiology in Policy (INEP) Executive Committee
Katy Bell (Chair)
Wael Al-Delaimy (Past Chair)
Camille Raynes-Greenow (Past Chair)
Robin Taylor Wilson (Chair Elect)
Jennifer Payne (Secretary)
Abbey Diaz (Communications Officer)
Steve Deppen (Treasurer)
Kathryn Gwiazdon (Expert Advisor)
1. International Network of Epidemiology in Policy. INEP Declaration on human rights and health in war, armed conflict, forced displacement, occupation, and violence: statement of solidarity with the peoples of Ukraine and around the globe, 2022 [Available from: https://www.epidemiologyinpolicy.org/ukraine]
2. International Network of Epidemiology in Policy. A Call for Courage: declaration on international law, health, and freedom of speech – statement of solidarity with the civilians of Israel and Palestine 2023 [Available from: https://www.epidemiologyinpolicy.org/palestine]
3. James S, Edwin Jit Leung K, Layth H, et al. Violence in Palestine demands immediate resolution of its settler colonial root causes. BMJ Global Health 2023;8(10):e014269. doi: 10.1136/bmjgh-2023-014269
We were absolutely horrified to read the blatantly political editorial entitled "Violence in Palestine demands immediate resolution of its settler colonial root causes" in the BMJ Global Health, which according to its website is an "online journal from BMJ dedicated to publishing high-quality peer-reviewed content". The article lacks any scientific value.
The editorial completely ignores the events of October 7, when Hamas terrorists raped, burnt, mutilated, tortured and killed entire families and took women, children and the elderly hostage. In addition, it is full of distortions and obfuscations.
The article refers to alleged "implementation of eliminatory settler colonial strategies by the Israeli occupation that aims to increase morbidity and mortality ". Besides the fact that Gaza has not been occupied by Israel since 2007, and putting aside for a moment the thousands of patients from Gaza (including Hamas terrorists!) that have been treated in Israeli hospitals, and Gazan physicians trained in Israeli hospitals, on the most objective level, the population in Gaza City has grown from 117423 in 1967 to 778187 in 2023. If Israel is trying to increase morbidity and mortality, she is doing a very poor job of it.
Despite this, no one would deny the intolerable living conditions of Gaza residents. Indeed, since Hamas's takeover of the Gaza Strip, they have done everyt...
We were absolutely horrified to read the blatantly political editorial entitled "Violence in Palestine demands immediate resolution of its settler colonial root causes" in the BMJ Global Health, which according to its website is an "online journal from BMJ dedicated to publishing high-quality peer-reviewed content". The article lacks any scientific value.
The editorial completely ignores the events of October 7, when Hamas terrorists raped, burnt, mutilated, tortured and killed entire families and took women, children and the elderly hostage. In addition, it is full of distortions and obfuscations.
The article refers to alleged "implementation of eliminatory settler colonial strategies by the Israeli occupation that aims to increase morbidity and mortality ". Besides the fact that Gaza has not been occupied by Israel since 2007, and putting aside for a moment the thousands of patients from Gaza (including Hamas terrorists!) that have been treated in Israeli hospitals, and Gazan physicians trained in Israeli hospitals, on the most objective level, the population in Gaza City has grown from 117423 in 1967 to 778187 in 2023. If Israel is trying to increase morbidity and mortality, she is doing a very poor job of it.
Despite this, no one would deny the intolerable living conditions of Gaza residents. Indeed, since Hamas's takeover of the Gaza Strip, they have done everything possible, including diverting humanitarian aid for terrorist purposes, to ensure these conditions persist. Recently the terrorists even stole 24,000 litres of fuel meant for Gazan hospitals and schools (https://unwatch.org/unrwa-reports-hamas-stole-humanitarian-aid-hillel-ne...). Israel provides the Gaza Strip water, food, and electricity from its own supplies during times of peace and allows the transport of basic humanitarian aid even during times of war and even now, when its own children, women, frail and sick elderly people are being held hostage there. These shipments are ongoing as I pen this response. The process can be observed in real time on international TV.
We do agree with the authors' call to identify root causes. But the root cause is not the lack of opportunity for Palestinian national determination. It is rather the total and nefarious intolerance of Jewish presence, let alone sovereignty, on even the most minimal swath of land in any part of land that was partitioned by the UN for Palestinian and Jewish national self-determination. This part of land now constitutes sovereign Israel, West Bank and Gaza, with Jews and Arabs in different population proportions in each subregion. The evidence for this is overwhelming in at least five historic missed opportunities all coupled with deadly violent consequences, initially by surrounding Arab nations and subsequently by Palestinian national movements and their supporting terrorist non-Palestinian allies (Hezbollah, Iran, others) in various guises.
It is sad when health professionals weaponize data to try make an invidious political (not health-related) point. And worse when their claims are so untrue.
Zion Hagay MD, President, Israeli Medical Association, Dean of the Faculty of Health Professions, Peres Academic Center
A. Mark Clarfield MD FRCPC
Emeritus Professor of Geriatrics
Chair, National Council on Ageing, Ministry of Health
Rivka Carmi MD, Former president, Ben Gurion University, President of the Israeli National Academy of Science in Medicine
Karl Skorecki MD FRCP(C) FASN
Professor Emeritus and former Dean, Azrieli Faculty of Medicine, Bar-Ilan University, Consultant in Nephrology and Population Genetics, Clinical Research Institute at Rambam Health Care Campus
Malke Borow JD, Director of the Division of Law and Policy, Israeli Medical Association
The authors are to be commended on an important article which makes a compelling point.
Out of interest, where authors are appropriately credited as joint first and joint last, should their names then be listed alphabetically? In the example of this paper, this would place authors based in more resource-poor countries as the first and last listed authors, and would also seem the more rational ordering if authorship is jointly shared. There is some evidence that the ordering of 'joint first' authors does involve some implicit biasing in terms of gender balance - might this not also be an issue in work published as part of an global partnership? Attributing authorship can be genuinely difficult, but where equivalence is recognised it then seems concerning that the chosen (but not explained) order still places the high-income authors in the traditional positions of distinction.
Recently, in BMJ Global Health, Nasir Jafar and colleagues made another attempt to redefine 'global health'. They aim for 'greater clarity and precision' in a pragmatic and more inclusive sense, with the noble objective '‘to offload colonial vestiges present within the field and terminology of ‘global health’.‘ While this goal is undoubtedly right, important and overdue, the argument is alarmingly unconvincing and narrow. In their attempt to redefine, or rather reinterpret, global health, the authors make two important restrictions. Their proposal is based on an understanding of global health that is limited not only to a single country, but also to the field of humanitarian aid. Health emergencies and relief are only part of global health, so reducing the latter to humanitarian aid is absolutely unacceptable. It blatantly neglects both the meaning of "global" as "universal" and the complexity of global health as an explicitly political concept.
The second, unacceptable limitation is the authors' narrowing of global health to healthcare and healthcare systems. It may be that a clinical-biomedical understanding dominates the theory and practice of global health, but the call for an a posteriori recognition of pragmatic development should not distract from the fact that global health is much more complex, encompassing the social, environmental, political and commercial determination of health, as well as inequalities...
Show MoreA recently published article addresses the worrysome connections existing between the progressively increasing Arctic Sea ice melting and the chronic starvation experienced by polar bears (Ursus maritimus) (1). Indeed, the progressively declining Arctic Sea ice thickness represents a leading cause of the profound ecological, behavioural, feeding and dietary pattern modifications reported with an increased frequency in this highly threatened apex predator (1).
Show MoreWithin such an alarming context, the animals' chronic stress deriving from prolonged starvation is an additional matter of concern. Indeed, besides being a powerful and efficient machinery allowing us and all the other living organisms to cope with a huge number of environmental stressors, chronic stress responses are invariably characterized by immunosuppression, originating from enhanced cortisol production (2). Therefore, while increased cortisol levels should be reasonably expected to occur in the blood of polar bears experiencing chronic starvation (1), it should be emphasized they may also become, at the same time, much more susceptible to microbial pathogens impacting their health and conservation status.
This could be especially true for Toxoplasma gondii, a cosmopolitan and zoonotic protozoan parasite infecting humans and a large number of terrestrial and aquatic mammal species, including polar bears. In this respect, anti-T. gondii antibodies were previously reported in almost half of the p...
I am Jewish. My father escaped Nazi Germany in Spring 1939, age 17. He left his mother behind, and she was later gassed in Meinz. This was my unspoken and unspeakable heritage.
I commend the brave article by Layth Hanbali, Edwin Kwong, Amy Neilson, James Smith, Sali Hafez, and Rasha Khoury, who tell the truth as it is. With them, and with billions around the world, I call on the Israeli government to end the genocide they are committing in Palestine and to bring about an immediate ceasefire. I call on Israel’s allies to act as true allies and let go of vested interest, stop trading arms, and instead engage with Israel to forge a true and just peace.
We humans have, individually and collectively, suffered severe traumas at each other’s hands. Not only the traumas caused by genocide or war, but also trauma caused by the hunger, displacement, exploitation that go hand in hand with colonisation, extreme inequity, ecological destruction, and with excessive pollution, including carbon pollution. Many humans who are in positions of power may suffer their own legacy of trauma. For example, there is a tradition in the UK to send children as young as eight to boarding school, which is known to leave children scarred and adults with reduced empathy who struggle to engage in and maintain loving relationships.
Many humans have suffered traumas directly. Others, like myself, have grown up with inherited traumas. We are all interconnected and we are all affected. Our...
Show MoreBoth this commentary and the previous one by Smith et al are both misleading and political attacks on the right for Israel to exist as a free and democratic nation. The Palestinian people of Gaza have been victims of Hamas since they took over in 2005/2006. To dismiss the horrendous terrorist attack of Oct 7 where children and women mutilated and raped, which was actually documented by the terrorists themselves is abhorrent and totally irresponsible of BMJ Global health. In fact prior to Oct 7, thousands of Palestinian Gazans were getting health care in Israel, including family members of Gaza leadership. Thousands of Gazans were crossing the border daily to work in Israeli Farms/Kibbutzim who paid them, fed them and at times housed them, only for them to map out each farm and houses to provide to the terrorists so they know how to attack them. In addition, many of those who worked in those farms/kibbutzim participated in the attacks. Finally, Gaza built an underground network/city under the hospitals and schools to plana and stage their attack on Israel, knowing using the Palestinian/Gazan residents as human shields to they can get sympathy from the world. In addition the communities that were attacked in the Negev, that were formed in the 1920s, were predominantly Jewish, with very few Muslims or "Palestinians" living there. Israel has every right to defend itself against this barbaric attack, as would any country. Health justice and publication of thi...
Show MoreAn excellent comprehensive, thoughtful review. Until such time as Israel-- a Jewish homeland and liberal democracy-- is accepted as a reality there can be no peace. To paraphrase Golda Meir, ",,,,,,, if the Arab world put down their weapons, there would be peace.,,,,,,, if Israel put down their weapons there would be no Israel".
I would like to register my strong support for this viewpoint. I am part of a large group of >200 physicians, researchers, and academics who endorsed and contributed to this article. Unfortunately, as part of a highly disappointing series of editorial decisions, BMJ Global did not allow the authors to publish our names and information as a supplement to this article (which was the original plan). I therefore would like to register a rapid response documenting that I was one of the extremely large group of academics who endorsed this article.
BMJ Global Health has served as a platform for highlighting the global forces that underpin inequities in health and wellbeing everywhere in the world. The journal has published similar articles in relation to wars and conflicts, and in doing so have consistently privileged the voices, needs, experiences, and perspectives those who are marginalised in those wars and conflicts. As with many other manuscripts submitted for consideration as editorials, this article, although unsolicited, was published with only internal peer review. As we have consistently done with papers published in the journal, we welcome rebuttals, contestations, and alternative interpretations. Some of these are being included as online 'rapid response' comments. In time, others will be published in the journal and on our blog.
Those of us who do global health have a responsibility to respect the dignity of people and communities who are marginalised as knowers, and to represent their interpretations of their own reality. The article is in fulfillment of that responsibility. To be socially/politically marginalised is to be interpretively (or hermeneutically) marginalised; or to have interpretations from one's standpoint under-represented in the collective pool of legitimised knowledge. For every complex reality, there may be multiple and even competing interpretations. Our responsibility as a field must include allowing space in our heads and on knowledge platforms for that multip...
Show MoreThe International Network for Epidemiology and Policy (NEP) represents 24 epidemiology societies across the globe and works to address policies at the global level that have public health impacts. This includes wars and conflict which cause suffering to large populations and constitute major public health crises (1,2).
As public health experts, the International Network for Epidemiology leadership share the concerns expressed in the editorial by Smith et al (3). The lives of all people should be protected. There is never an ethically defensible justification for murdering civilians or taking them hostage, bombing families, hospitals, schools, universities, Non-Government Organizations, or any residential building. Nor is there justification for depriving people of water, food, electricity, medicine, and shelter.
Calling for a ceasefire based on humanitarian reasons is what every public health expert would do. This is what the authors of the above-mentioned editorial were calling for. We denounce any accusations and threats to authors and editors for expressing such views on the need for preservation of human life, and for ethical standards of conducting wars (2). Such accusations, threats, and lobbying for one political view or another, should not have any place in academic discussions on public health. These activities undermine freedom of speech, the global mission of public health, and the very basic tenets of human rights and dignity to live (2).
...Show MoreOctober 24, 2023
To the Editor:
We were absolutely horrified to read the blatantly political editorial entitled "Violence in Palestine demands immediate resolution of its settler colonial root causes" in the BMJ Global Health, which according to its website is an "online journal from BMJ dedicated to publishing high-quality peer-reviewed content". The article lacks any scientific value.
The editorial completely ignores the events of October 7, when Hamas terrorists raped, burnt, mutilated, tortured and killed entire families and took women, children and the elderly hostage. In addition, it is full of distortions and obfuscations.
The article refers to alleged "implementation of eliminatory settler colonial strategies by the Israeli occupation that aims to increase morbidity and mortality ". Besides the fact that Gaza has not been occupied by Israel since 2007, and putting aside for a moment the thousands of patients from Gaza (including Hamas terrorists!) that have been treated in Israeli hospitals, and Gazan physicians trained in Israeli hospitals, on the most objective level, the population in Gaza City has grown from 117423 in 1967 to 778187 in 2023. If Israel is trying to increase morbidity and mortality, she is doing a very poor job of it.
Despite this, no one would deny the intolerable living conditions of Gaza residents. Indeed, since Hamas's takeover of the Gaza Strip, they have done everyt...
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