It is with great interest that I read the original research by Lobkowicz et al, ascertaining that coinfections do not strongly influence clinical manifestations of uncomplicated ZIKV infections [1]. With this interesting finding in mind, it is important to remember that Neglected Tropical Diseases (NTDs) exist and persist for social and economic reasons that enable the vectors and pathogens to take advantage of changes in the behavioural and physical environment [2]. More than 70% of countries and territories affected by NTDs are low-income and low and middle income countries [2]. Thus, there are extreme inequalities with regards to disease distribution. People are affected by NTDs because of an array of social determinants. It is plausible that these social determinants may allow for coinfections of Zika (ZIKV), dengue virus (DENV) and chikungunya (CHIKV).
Social Determinants of Health (SDH) are the conditions in which individuals are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life [3]. SDH encompass socioeconomic factors, environmental factors and biological factors. These factors play a fundamental role in the proliferation of vector-borne diseases such as ZIKV, DENV and CHIKV. The relationship between the vector and SDH is complex, yet it is extremely important to recognise in order to evaluate the impact of socioeconomic factors on infectious diseases.
It is with great interest that I read the original research by Lobkowicz et al, ascertaining that coinfections do not strongly influence clinical manifestations of uncomplicated ZIKV infections [1]. With this interesting finding in mind, it is important to remember that Neglected Tropical Diseases (NTDs) exist and persist for social and economic reasons that enable the vectors and pathogens to take advantage of changes in the behavioural and physical environment [2]. More than 70% of countries and territories affected by NTDs are low-income and low and middle income countries [2]. Thus, there are extreme inequalities with regards to disease distribution. People are affected by NTDs because of an array of social determinants. It is plausible that these social determinants may allow for coinfections of Zika (ZIKV), dengue virus (DENV) and chikungunya (CHIKV).
Social Determinants of Health (SDH) are the conditions in which individuals are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life [3]. SDH encompass socioeconomic factors, environmental factors and biological factors. These factors play a fundamental role in the proliferation of vector-borne diseases such as ZIKV, DENV and CHIKV. The relationship between the vector and SDH is complex, yet it is extremely important to recognise in order to evaluate the impact of socioeconomic factors on infectious diseases.
There are major inequalities with regards to disease distribution. The relationship between Gross Domestic Product (GDP) and health is a starting point for examination of inequalities in the global health context. High income countries tend to have greater GDPs, which often means nations have better health systems and social services.
The distribution of ZIKV infection is unevenly spread across the globe [2]. The weight of Zika Virus Disease falls on the poor for different reasons. In tropical urban areas, those from a low socioeconomic income group are not able to manage the cost of air-conditioning, window screens, or insect repellent [4]. With no piped water and poor sanitation, they are compelled to store water in containers, giving perfect conditions to the expansion of mosquitoes [5].
The combination of ZIKV, DENV and CHIKV coinfections obfuscates the public health problem in various populations where complications due to poverty, poor basic sanitation and poor vector control persist. Further work is needed to elucidate the importance of the interactions between socio-environmental factors and transmission of ZIKV, DENV and CHIKV. The importance of SDH when understanding the risk factors that potentiate NTDs spread, is crucial for public health academics, health ministers and governments, as any interventions must consider ecological, biological and social factors.
References
1. Lobkowicz L, Ramond A, Sanchez Clemente N, et al. The frequency and clinical presentation of Zika virus coinfections: a systematic review. BMJ Global Health 2020;5:e002350.
2. Manderson L, Aagaard-Hansen J, Allotey P, Gyapong M, Sommerfeld J. Social Research on Neglected Diseases of Poverty: Continuing and Emerging Themes. PLoS Neglected Tropical Diseases. 2009;3(2):e332.
4. Lundgren K, Kjellstrom T. Sustainability Challenges from Climate Change and Air Conditioning Use in Urban Areas. Sustainability. 2013;5(7):3116-3128.
5. Dhimal M, Gautam I, Joshi H, O’Hara R, Ahrens B, Kuch U. Risk Factors for the Presence of Chikungunya and Dengue Vectors (Aedes aegypti and Aedes albopictus), Their Altitudinal Distribution and Climatic Determinants of Their Abundance in Central Nepal. PLOS Neglected Tropical Diseases. 2015;9(3):e0003545.
Responding to https://gh.bmj.com/content/5/4/e002094
‘The Commonwealth Pharmacists Association (CPA) https://commonwealthpharmacy.org/welcomes the publication of this systematic review which confirms the views held by the CPA that usable, point of prescribing decision information in low and middle income countries, is often not readily available where it is most needed. This of particular concern when we consider the prescribing and appropriate use of antimicrobials.
The UK DHSC Fleming Fund (https://www.flemingfund.org/) Commonwealth Partnership for Antimicrobial Stewardship (CwPAMS) Project has for the last 6 months been piloting an App for use in Ghana, Tanzania, Uganda and Zambia. This is part of the wider CwPAMS programme which is a collaboration between CPA and The Tropical Health and Education Trust (THET) https://www.thet.org/our-work/grants/cwpams/
The App guides prescribers as per national guidelines, and contains links to WHO resources and other training materials. It is explained clearly in this short u-tube video https://www.youtube.com/watch?v=MJ7fa_aLgCI It is free, to download to a smart phone or device anywhere in the world where there is access to the internet and then...
Responding to https://gh.bmj.com/content/5/4/e002094
‘The Commonwealth Pharmacists Association (CPA) https://commonwealthpharmacy.org/welcomes the publication of this systematic review which confirms the views held by the CPA that usable, point of prescribing decision information in low and middle income countries, is often not readily available where it is most needed. This of particular concern when we consider the prescribing and appropriate use of antimicrobials.
The UK DHSC Fleming Fund (https://www.flemingfund.org/) Commonwealth Partnership for Antimicrobial Stewardship (CwPAMS) Project has for the last 6 months been piloting an App for use in Ghana, Tanzania, Uganda and Zambia. This is part of the wider CwPAMS programme which is a collaboration between CPA and The Tropical Health and Education Trust (THET) https://www.thet.org/our-work/grants/cwpams/
The App guides prescribers as per national guidelines, and contains links to WHO resources and other training materials. It is explained clearly in this short u-tube video https://www.youtube.com/watch?v=MJ7fa_aLgCI It is free, to download to a smart phone or device anywhere in the world where there is access to the internet and then may be used off line. Whilst the analysis of the CwPAMS programme is ongoing, positive impacts are emerging. We believe that the CwPAMS App may have significant and far reaching benefits beyond this initial four country pilot https://viewer.microguide.global/CPA/CWPAMS’
Sarah Cavanagh CPA International Partnerships Lead and Victoria Rutter Executive Director CPA on behalf of the CPA App development team Chloe Tuck, Diane Ashiru-Oredope, Omotayo Olaoye, WeiPing Khor, Roisin McMenamin
Implementation research is crucial to determining effectiveness and appropriateness of interventions that are urgently needed in many contexts, constituting "global health". There is, however, an ongoing surprising relative lack of discussion on the need for appropriate understand of the ethical implications of Implementation research. Ethics committees and researchers are often not well versed in the ethics implications, and how these differ form traditional clinical research. the potential for unintended harm is great in the vulnerable circumstances wheer implementation research is often conducted. It is vital that if implementation research is conducted, ethical implications are considered throughout the process (i.e. continuing throughout the implementation itself and post-research). These issues have been laid out in an online teaching tool (by TDR/Global health Ethics Unit at WHO) and in the following publications: https://www.who.int/tdr/publications/year/2019/ethics-in-ir-course/en/ https://implementationscience.biomedcentral.com/articles/10.1186/s13012-... https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30310-9/fulltext
Paul et al [1] argue for a systemic approach to global health policy. This shift is long overdue, and as they pointed out systems thinking has long been suppressed by the all-powerful reductionist research industry.
Part of the problem is understanding of health and disease as distinctly dichotomous. However, the experience of health and dis-ease are dynamic as much in the presence as absence of identifiable disease [2]. In addition, health, illness dis-ease and disease occur on a continuum in the same person over time. It entails a continuous change in the physiological dynamics within the person that ultimately leads to changes that we recognise as one or the other disease. The process can lead to multiple expressions of disease, nevertheless, they are nothing more than the result of the overall physiological dysfunction within the same person [3].
As is well known health and disease disparities follow the socioeconomic gradient [4]. The question arises – how? There is increasing evidence from psychoneuroimmunology research that shows the longterm effects of psychosocial stress on the physiological stress response pathways resulting in chronic inflammatory dysregulation and its link to disease burden [5, 6].
Taken together, these findings provide a complex adaptive system explanation of the nature of health and disease arising through the network interaction between our environmental, socio-cultural and economic-political contexts and our biological...
Paul et al [1] argue for a systemic approach to global health policy. This shift is long overdue, and as they pointed out systems thinking has long been suppressed by the all-powerful reductionist research industry.
Part of the problem is understanding of health and disease as distinctly dichotomous. However, the experience of health and dis-ease are dynamic as much in the presence as absence of identifiable disease [2]. In addition, health, illness dis-ease and disease occur on a continuum in the same person over time. It entails a continuous change in the physiological dynamics within the person that ultimately leads to changes that we recognise as one or the other disease. The process can lead to multiple expressions of disease, nevertheless, they are nothing more than the result of the overall physiological dysfunction within the same person [3].
As is well known health and disease disparities follow the socioeconomic gradient [4]. The question arises – how? There is increasing evidence from psychoneuroimmunology research that shows the longterm effects of psychosocial stress on the physiological stress response pathways resulting in chronic inflammatory dysregulation and its link to disease burden [5, 6].
Taken together, these findings provide a complex adaptive system explanation of the nature of health and disease arising through the network interaction between our environmental, socio-cultural and economic-political contexts and our biological blueprint [3], and should be the basis for the redesign of effective, efficient and equitable health systems [7].
It is encouraging to see that systems thinking is slowly emerging in a wide range of health-related disciplines. Those involved ought to more closely collaborate to gain influence and impact [8].
References
1. Paul E, Brown GW, Ridde V. COVID-19: time for paradigm shift in the nexus between local, national and global health. BMJ Global Health. 2020;5(4):e002622. doi: https://dx.doi.org/10.1136/bmjgh-2020-002622
2. Sturmberg JP. The personal nature of health. J Eval Clin Pract 2009;15(4):766-69.doi: https://dx.doi.org/10.1111/j.1365-2753.2009.01225.x
3. Sturmberg JP, Picard M, Aron DC, Bennett JM, Bircher J, deHaven MJ, et al. Health and Disease—Emergent States Resulting From Adaptive Social and Biological Network Interactions. Frontiers in Medicine. 2019;6:59. doi: https://dx.doi.org/10.3389/fmed.2019.00059
4. Marmot M. The Influence Of Income On Health: Views Of An Epidemiologist. Health Aff. 2002;21(2):31-46. doi: https://dx.doi.org/10.1377/hlthaff.21.2.31
5. Slavich GM, Cole SW. The Emerging Field of Human Social Genomics. Clinical Psychological Science. 2013;1(3):331-48. doi: https://dx.doi.org/10.1177/2167702613478594
6. Seeman M, Stein Merkin S, Karlamangla A, Koretz B, Seeman T. Social status and biological dysregulation: the "status syndrome" and allostatic load. Social science & medicine (1982). 2014;118:143-51. doi: https://dx.doi.org/10.1016/j.socscimed.2014.08.002
7. Sturmberg JP. Health System Redesign. How to Make Health Care Person-Centered, Equitable, and Sustainable. Cham, Switzerland: Springer; 2018.
8. International Society for Systems and Complexity Sciences for Health. [Internet] www.isscsh.org
Richardson (1) argues three substantive points:
1. Models are merely fables dressed in formal language.
2. Fables are unscientific.
3. Models serve as epistemic confines to our understanding.
We argue that 2., a premise he makes implicitly, is wrong. Formal language in fables cannot produce an ‘illusion’ of scientific-ness, because there is no division between ‘fables’ and ‘science’. We suggest that scientific models are stories (2) in some real sense, and therefore it does not make sense to say that models are unscientific because they are fables. Science is composed of a complex web of interacting models (stories) whose aims are to explain and understand the world. This would be consistent with Sugden’s (3) view of economic models as credible worlds.
Richardson cites Rubinstein (4) to buttress his argument that models are merely fictions. This misuses Rubinstein, who argues ‘The models presented… are nothing but fables. Neither of them describes reality, but both of them still describe something from reality… studying both of them together helps to some extent in understanding economic mechanisms.’ (p.182). It does not seem fair to brand models as ‘merely’ fables on this reading, and nor does this give us licence to dismiss fables as unscientific.
Epidemiologists often make significant assumptions in order to model disease progression. Many parameters are unknown, and there are often practical constraints to modelling significant hete...
Richardson (1) argues three substantive points:
1. Models are merely fables dressed in formal language.
2. Fables are unscientific.
3. Models serve as epistemic confines to our understanding.
We argue that 2., a premise he makes implicitly, is wrong. Formal language in fables cannot produce an ‘illusion’ of scientific-ness, because there is no division between ‘fables’ and ‘science’. We suggest that scientific models are stories (2) in some real sense, and therefore it does not make sense to say that models are unscientific because they are fables. Science is composed of a complex web of interacting models (stories) whose aims are to explain and understand the world. This would be consistent with Sugden’s (3) view of economic models as credible worlds.
Richardson cites Rubinstein (4) to buttress his argument that models are merely fictions. This misuses Rubinstein, who argues ‘The models presented… are nothing but fables. Neither of them describes reality, but both of them still describe something from reality… studying both of them together helps to some extent in understanding economic mechanisms.’ (p.182). It does not seem fair to brand models as ‘merely’ fables on this reading, and nor does this give us licence to dismiss fables as unscientific.
Epidemiologists often make significant assumptions in order to model disease progression. Many parameters are unknown, and there are often practical constraints to modelling significant heterogeneity in the population, for example computing power. When an epidemiologist assumes ‘symptomatic individuals are 50% more infectious than asymptomatic individuals,’ [https://www.imperial.ac.uk/media/imperial-college/medicine/mrc-gida/2020... they are explaining how the world might be under this assumption. This is just one example, but we are not the first to suggest that models in science describe the world as it might be rather than necessarily as it is (5–7).
Therefore, science is composed of a network of interconnected stories (models), and it does not make sense to think that because models are stories, they are unscientific.
Richardson’s description of models appears to grant them agency (8). This means it is the models themselves that warp our understanding of the spread of SARS-CoV-2. He thinks this happens in a similar fashion to philanthropists obscuring economic exploitation. We argue, however, that this is an unhelpful inflation of models’ agency: if models restrict COVID-19 discourse and impose epistemic confines, it is humans, political actors, who make them do so. Thus, just as billionaire philanthropists (humans) marginalise discussions over more equitable taxation regimes, it is human political actors who instrumentalise models to suppress contemplation of potential worlds. Concern over one or another model’s agency seems to lead only to more discussion over models - if the model has too much or too little agency, this is a problem for the model, and the question of how humans use models is vanished.
Even if we accept that models are indeed agentic, we argue his remedy of ‘liberation by model’ is misplaced. More modelling with ‘radical wealth redistribution as its moral’ feels unlikely to move discussion away from the modelling and towards the other causes of poor health. Instead, we suggest looking to other materials to aid our understanding of COVID-19. Models must sit alongside (e.g.) history and politics as tools to usefully describe what is happening (and what could) - but models cannot tell us what ought to.
References
1. Richardson ET. Pandemicity, COVID-19 and the limits of public health ‘science.’ BMJ Glob Heal [Internet]. 2020 Apr 1;5(4):e002571. Available from: http://gh.bmj.com/content/5/4/e002571.abstract
2. Frigg R. Models and Fiction. Synthese [Internet]. 2010 Apr 18;172(2):251–68. Available from: http://www.jstor.org/stable/40496038
3. Sugden R. Credible worlds: the status of theoretical models in economics. J Econ Methodol [Internet]. 2000 Jan 1;7(1):1–31. Available from: https://doi.org/10.1080/135017800362220
4. Rubinstein A. Economic fables. Open book publishers; 2012.
5. Frigg R, Nguyen J. The turn of the valve: representing with material models. Eur J Philos Sci [Internet]. 2018;8(2):205–24. Available from: https://doi.org/10.1007/s13194-017-0182-4
6. Frigg R, Hartmann S. Models in Science. In: The Stanford Encyclopedia of Philosophy [Internet]. Spring 202. Metaphysics Research Lab, Stanford University; 2020. Available from: https://plato.stanford.edu/archives/spr2020/entries/models-science/
7. Rhodes T, Lancaster K, Rosengarten M. A model society: maths, models and expertise in viral outbreaks. Crit Public Health [Internet]. 2020 Mar 31;1–4. Available from: https://doi.org/10.1080/09581596.2020.1748310
8. Latour B. On actor-network theory: A few clarifications. Soz Welt [Internet]. 1996 Apr 18;47(4):369–81. Available from: http://www.jstor.org/stable/40878163
As highlighted by Bowe and colleagues, air pollution is closely linked to burden of Chronic Kidney Disease (CKD). (1) A recent article on cardio-pulmonary mortality also highlighted similar issue, with a focus on provision of ventilation. (2)
India faces similar issues due to air pollution attributable to wide spread traditional habit of cooking with biomass. The contribution of CKD to Disability Adjusted Life Years (DALY) in the country has increased from 0.8% in 1990 to 1.6% in 2016 and it is the 9th common cause of mortality. (3)
With focus on prevention, CKD has been included under National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke, the flagship program for Non-Communicable Diseases (NCD). Through NCD Clinics, diabetes and hypertension, two common risk factors for CKD, are being addressed. Population based screening is also underway for prevention, awareness and early diagnosis of these two morbidities. (4) Pradhan Mantri National Dialysis Program has been put in place to meet the need of dialysis services by the poor people at free of cost. (5) Ujjwala scheme has recently been introduced, under which more than 80 million families have been provided clean fuel. The scheme specifically targets rural areas where biomass is considered as one of the major mean for cooking. (6)
With so many initiatives, researches are warranted from India to estimate their effects in mitigating CKD burden and to tailor hea...
As highlighted by Bowe and colleagues, air pollution is closely linked to burden of Chronic Kidney Disease (CKD). (1) A recent article on cardio-pulmonary mortality also highlighted similar issue, with a focus on provision of ventilation. (2)
India faces similar issues due to air pollution attributable to wide spread traditional habit of cooking with biomass. The contribution of CKD to Disability Adjusted Life Years (DALY) in the country has increased from 0.8% in 1990 to 1.6% in 2016 and it is the 9th common cause of mortality. (3)
With focus on prevention, CKD has been included under National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke, the flagship program for Non-Communicable Diseases (NCD). Through NCD Clinics, diabetes and hypertension, two common risk factors for CKD, are being addressed. Population based screening is also underway for prevention, awareness and early diagnosis of these two morbidities. (4) Pradhan Mantri National Dialysis Program has been put in place to meet the need of dialysis services by the poor people at free of cost. (5) Ujjwala scheme has recently been introduced, under which more than 80 million families have been provided clean fuel. The scheme specifically targets rural areas where biomass is considered as one of the major mean for cooking. (6)
With so many initiatives, researches are warranted from India to estimate their effects in mitigating CKD burden and to tailor health policies according to the need.
References
1. Bowe B, Xie Y, Li T, Yan Y, Xian H, Al-Aly Z. The global and national burden of chronic kidney disease attributable to ambient fine particulate matter air pollution: a modelling study. BMJ Glob Health 2020;5:e002063.
2. Yu K, Lv J, Qiu G, et al. Cooking fuels and risk of all-cause and cardiopulmonary mortality in urban China: a prospective cohort study. Lancet Glob Health 2020; 8(3):e430-e439.
3. Indian Council of Medical Research, Public Health Foundation of India, and Institute for Health Metrics and Evaluation. India: Health of the Nation's States - The India State-level Disease Burden Initiative. New Delhi, India: ICMR, PHFI, and IHME. 2017.
4. Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India. National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke. (Available at http://dghs.gov.in/content/1363_3_ NationalProgrammePreventionControl.aspx, last accessed on 1st April, 2020).
5. Ministry of Health and Family Welfare. Pradhan Mantri National Dialysis Program. (Available at https://mohfw.gov.in/basicpage/pradhan-mantri-national-dialysis-programm..., last accessed on 1st April, 2020).
6. Pradhan Mantri Ujjwala Yojana. (available from www.pmuy.gov.in, last accessed on 1st April, 2020)
We read with great interest the original research by Coll CVN, Ewerling F, García-Moreno C, et al which found that domestic violence in low- and middle-income countries was more prevalent amongst certain groups of women.
The ongoing COVID-19 pandemic has already ravaged countries within Asia, Europe and the United States, defined as high-income by the World Bank Group. [1] Actions taken to prevent the spread of the virus has meant a large proportion of the population in these countries is currently under some degree of confinement, and consequently, an alarming increase in domestic violence has been reported by the news. [2]
Coll CVN, Ewerling F, García-Moreno C, et al recognises Africa and SouthEast Asia to have a higher prevalence of domestic violence. At the time of writing (29/03/2020), the WHO has already reported 3005 cases and 51 deaths in Africa and 3709 cases and 139 deaths in SouthEast Asia, with no doubt that these numbers will continue to grow. [3]
Resources to fight the COVID-19 epidemics in these regions are limited and thus, efforts aiming to curb the transmission will soon undoubtedly follow other countries’ mitigation plans; police enforcing a lockdown, healthcare workers treating COVID-19 patients and government officials attempting to gather the necessary equipment for the care of its citizens. This means an extensive proportion of the workforce needed to help women undergoing domestic violence will already be si...
We read with great interest the original research by Coll CVN, Ewerling F, García-Moreno C, et al which found that domestic violence in low- and middle-income countries was more prevalent amongst certain groups of women.
The ongoing COVID-19 pandemic has already ravaged countries within Asia, Europe and the United States, defined as high-income by the World Bank Group. [1] Actions taken to prevent the spread of the virus has meant a large proportion of the population in these countries is currently under some degree of confinement, and consequently, an alarming increase in domestic violence has been reported by the news. [2]
Coll CVN, Ewerling F, García-Moreno C, et al recognises Africa and SouthEast Asia to have a higher prevalence of domestic violence. At the time of writing (29/03/2020), the WHO has already reported 3005 cases and 51 deaths in Africa and 3709 cases and 139 deaths in SouthEast Asia, with no doubt that these numbers will continue to grow. [3]
Resources to fight the COVID-19 epidemics in these regions are limited and thus, efforts aiming to curb the transmission will soon undoubtedly follow other countries’ mitigation plans; police enforcing a lockdown, healthcare workers treating COVID-19 patients and government officials attempting to gather the necessary equipment for the care of its citizens. This means an extensive proportion of the workforce needed to help women undergoing domestic violence will already be significantly stretched.
We propose that countries of low- and middle income must quickly recognise and prevent this likely occurrence by raising awareness of the matter and putting in place a special human resource, whose sole focus would be to identify and help women who find themselves in these difficult circumstances, whilst at the same time considering the implications of the country's epidemic on such interventions. More specifically, we call for particular attention to be given to the groups of women identified by Coll CVN, Ewerling F, García-Moreno C et al. as being at an increased risk of domestic violence.
We are in complete agreement with Coll CVN, Ewerling F, García-Moreno C et al.’s policy of leaving no one behind and through our rapid response, hope to have highlighted the need for preventing rather than mitigating domestic violence in low- and middle income countries, especially amongst more vulnerable groups of women, during these uncertain and unsettling times.
While liking the idea, I find two main problems with the suggested definition of global health as "public health somewhere else": 1) it is too narrow and 2) it sounds dismissive. In "global health", the word "global" is inclusive and suggests a health agenda embracing all the communities of the rest of the world. This is lost in the definition. Then there is the dismissive sound of "somewhere else" ("You can join our club or go somewhere else", "This could be Paradise or it could be somewhere else", etc.). I may be thin-skinned, but disdaining to specify a location sounds to me like a slur. For these reasons, and for all the other good reasons offered in the original Commentary, I suggest amending the definition to "public health everywhere else". This follows the original in asserting "elseness", while being inclusive and positive.
Why the first sentence of this article with its exaggerated claim about the health outcomes of Aboriginal and Torres Strait Islander Australians? The reference cited, 1 does not support the comparison with other populations globally, and the article itself seeks to move beyond negative images of Aboriginal and Torres Strait Islander people. Beginning with this negative statement – regardless of its veracity - continues the long history of deficit discourse used in discussing Aboriginal and Torres Strait Islander people. Rather than contribute to improved outcomes deficit discourse can actually reinforce and perpetuate approaches and behaviours such as those the article seeks to address. 2
Overall the article presents important new research moving beyond negative stereotypes of Aboriginal and Torres Strait Islander people, highlighting their perspectives and insights, and encouraging a more culturally driven approach. This makes the opening even more inappropriate and unnecessary.
References
1. Gracey M, King M. Indigenous health part 1: determinants and disease patterns. Lancet. 2009;374:65-74.
2. Fogarty W, Bulloch H, McDonnell S et al. Deficit Discourse and Indigenous Health: How narrative framings of Aboriginal and Torres Strait Islander people are reproduced in policy. Melbourne: The Lowitja Institute; 2018 [cited 20 Jan 2020]. Available from:...
Why the first sentence of this article with its exaggerated claim about the health outcomes of Aboriginal and Torres Strait Islander Australians? The reference cited, 1 does not support the comparison with other populations globally, and the article itself seeks to move beyond negative images of Aboriginal and Torres Strait Islander people. Beginning with this negative statement – regardless of its veracity - continues the long history of deficit discourse used in discussing Aboriginal and Torres Strait Islander people. Rather than contribute to improved outcomes deficit discourse can actually reinforce and perpetuate approaches and behaviours such as those the article seeks to address. 2
Overall the article presents important new research moving beyond negative stereotypes of Aboriginal and Torres Strait Islander people, highlighting their perspectives and insights, and encouraging a more culturally driven approach. This makes the opening even more inappropriate and unnecessary.
References
1. Gracey M, King M. Indigenous health part 1: determinants and disease patterns. Lancet. 2009;374:65-74.
2. Fogarty W, Bulloch H, McDonnell S et al. Deficit Discourse and Indigenous Health: How narrative framings of Aboriginal and Torres Strait Islander people are reproduced in policy. Melbourne: The Lowitja Institute; 2018 [cited 20 Jan 2020]. Available from: https://www.lowitja.org.au/page/services/resources/Cultural-and-social-d....
United States withdrawal from the Iran nuclear deal in May 2018 has led to increasing pressure on all members of society (1). Economic sanctions against Iran have not formally targeted health care or access to drugs and ordinary people, but they have indirectly serious impact on health services and consequently on research programs. Economic sanctions resulted in decline in the value of Iran's currency and government faced big budget deficit. Therefore, the cost of research programs and initial equipments for conducting any projects will increase too much. In this case they are unaffordable by institutions (1-3). Based the on Kokabisaghi et al. paper published in BMJ Global Health in 2019, the economic sanctions imposed more problems on Iran’s research and publishing. Also they claimed that academic boycotts violate researchers’ freedom and curtail progress (2). Free exchange of ideas irrespective of creed is needed to optimize global scientific progress (2). But it seems that another factor can indirectly effects on research programs in Iran. Economic sanctions and scientific boycotts are among the most important problems for researchers on Iran. In the meantime importance of domestic political crisis due to economic sanctions has been ignored. This is not mentioned in this study. With decreased national budget and GDP (gross domestic product) per capita, the government was forced to raise prices of energy and oil carriers; as a result, it created a major political c...
United States withdrawal from the Iran nuclear deal in May 2018 has led to increasing pressure on all members of society (1). Economic sanctions against Iran have not formally targeted health care or access to drugs and ordinary people, but they have indirectly serious impact on health services and consequently on research programs. Economic sanctions resulted in decline in the value of Iran's currency and government faced big budget deficit. Therefore, the cost of research programs and initial equipments for conducting any projects will increase too much. In this case they are unaffordable by institutions (1-3). Based the on Kokabisaghi et al. paper published in BMJ Global Health in 2019, the economic sanctions imposed more problems on Iran’s research and publishing. Also they claimed that academic boycotts violate researchers’ freedom and curtail progress (2). Free exchange of ideas irrespective of creed is needed to optimize global scientific progress (2). But it seems that another factor can indirectly effects on research programs in Iran. Economic sanctions and scientific boycotts are among the most important problems for researchers on Iran. In the meantime importance of domestic political crisis due to economic sanctions has been ignored. This is not mentioned in this study. With decreased national budget and GDP (gross domestic product) per capita, the government was forced to raise prices of energy and oil carriers; as a result, it created a major political crisis. Therefore, that global internet access was disrupted (4). Based on Netblocks.org, worldwide internet access has been less than 20% for almost a week, then continued with severe censorship and restrictions (4). In such a situation it is very difficult to have research activities and publish scientific papers. Higher educational institutions and researchers faced with great challenges and difficulties and communication with the world was limited. Similarly in China, internet restrictions, known as the ‘great firewall of China’, have often been an issue for Chinese academics who find their access to overseas research restricted (5). Unfortunately, researchers in Iran encounter with similar restrictions which are not mentioned in this article or other articles presented by Iranian scholars. For example, access to YouTube and many internet resources is restricted. However, the impact of sanctions is far greater.
1. Hassani M. Impact of Sanctions on Cancer Care in Iran. Arch Bone Jt Surg. 2018 Jul;6(4):248-249.
2. Kokabisaghi F, Miller AC, Bashar FR, Salesi M, Zarchi AAK, Keramatfar A, Pourhoseingholi MA, Amini H, Vahedian-Azimi A. Impact of United States political sanctions on international collaborations and research in Iran. BMJ Glob Health. 2019 3;4(5):e001692.
3. Arab-zozani M. Health sector evolution in Iran; a short review. Evid Based Health Policy Manag Econ. 2017; 1(3):193-7.
4. Internet disrupted in Iran amid fuel protests in multiple cities.(2019). https://netblocks.org/reports/internet-disrupted-in-iran-amid-fuel-prote...
5. Research could suffer as internet controls tightened. (2017). https://www.universityworldnews.com › post › story=20170713140950894
Dear Editor,
It is with great interest that I read the original research by Lobkowicz et al, ascertaining that coinfections do not strongly influence clinical manifestations of uncomplicated ZIKV infections [1]. With this interesting finding in mind, it is important to remember that Neglected Tropical Diseases (NTDs) exist and persist for social and economic reasons that enable the vectors and pathogens to take advantage of changes in the behavioural and physical environment [2]. More than 70% of countries and territories affected by NTDs are low-income and low and middle income countries [2]. Thus, there are extreme inequalities with regards to disease distribution. People are affected by NTDs because of an array of social determinants. It is plausible that these social determinants may allow for coinfections of Zika (ZIKV), dengue virus (DENV) and chikungunya (CHIKV).
Social Determinants of Health (SDH) are the conditions in which individuals are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life [3]. SDH encompass socioeconomic factors, environmental factors and biological factors. These factors play a fundamental role in the proliferation of vector-borne diseases such as ZIKV, DENV and CHIKV. The relationship between the vector and SDH is complex, yet it is extremely important to recognise in order to evaluate the impact of socioeconomic factors on infectious diseases.
There are major ineq...
Show MoreResponding to https://gh.bmj.com/content/5/4/e002094
Show More‘The Commonwealth Pharmacists Association (CPA) https://commonwealthpharmacy.org/welcomes the publication of this systematic review which confirms the views held by the CPA that usable, point of prescribing decision information in low and middle income countries, is often not readily available where it is most needed. This of particular concern when we consider the prescribing and appropriate use of antimicrobials.
The UK DHSC Fleming Fund (https://www.flemingfund.org/) Commonwealth Partnership for Antimicrobial Stewardship (CwPAMS) Project has for the last 6 months been piloting an App for use in Ghana, Tanzania, Uganda and Zambia. This is part of the wider CwPAMS programme which is a collaboration between CPA and The Tropical Health and Education Trust (THET) https://www.thet.org/our-work/grants/cwpams/
The App guides prescribers as per national guidelines, and contains links to WHO resources and other training materials. It is explained clearly in this short u-tube video https://www.youtube.com/watch?v=MJ7fa_aLgCI It is free, to download to a smart phone or device anywhere in the world where there is access to the internet and then...
Implementation research is crucial to determining effectiveness and appropriateness of interventions that are urgently needed in many contexts, constituting "global health". There is, however, an ongoing surprising relative lack of discussion on the need for appropriate understand of the ethical implications of Implementation research. Ethics committees and researchers are often not well versed in the ethics implications, and how these differ form traditional clinical research. the potential for unintended harm is great in the vulnerable circumstances wheer implementation research is often conducted. It is vital that if implementation research is conducted, ethical implications are considered throughout the process (i.e. continuing throughout the implementation itself and post-research). These issues have been laid out in an online teaching tool (by TDR/Global health Ethics Unit at WHO) and in the following publications:
https://www.who.int/tdr/publications/year/2019/ethics-in-ir-course/en/
https://implementationscience.biomedcentral.com/articles/10.1186/s13012-...
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30310-9/fulltext
Paul et al [1] argue for a systemic approach to global health policy. This shift is long overdue, and as they pointed out systems thinking has long been suppressed by the all-powerful reductionist research industry.
Part of the problem is understanding of health and disease as distinctly dichotomous. However, the experience of health and dis-ease are dynamic as much in the presence as absence of identifiable disease [2]. In addition, health, illness dis-ease and disease occur on a continuum in the same person over time. It entails a continuous change in the physiological dynamics within the person that ultimately leads to changes that we recognise as one or the other disease. The process can lead to multiple expressions of disease, nevertheless, they are nothing more than the result of the overall physiological dysfunction within the same person [3].
As is well known health and disease disparities follow the socioeconomic gradient [4]. The question arises – how? There is increasing evidence from psychoneuroimmunology research that shows the longterm effects of psychosocial stress on the physiological stress response pathways resulting in chronic inflammatory dysregulation and its link to disease burden [5, 6].
Taken together, these findings provide a complex adaptive system explanation of the nature of health and disease arising through the network interaction between our environmental, socio-cultural and economic-political contexts and our biological...
Show MoreRichardson (1) argues three substantive points:
1. Models are merely fables dressed in formal language.
2. Fables are unscientific.
3. Models serve as epistemic confines to our understanding.
We argue that 2., a premise he makes implicitly, is wrong. Formal language in fables cannot produce an ‘illusion’ of scientific-ness, because there is no division between ‘fables’ and ‘science’. We suggest that scientific models are stories (2) in some real sense, and therefore it does not make sense to say that models are unscientific because they are fables. Science is composed of a complex web of interacting models (stories) whose aims are to explain and understand the world. This would be consistent with Sugden’s (3) view of economic models as credible worlds.
Show MoreRichardson cites Rubinstein (4) to buttress his argument that models are merely fictions. This misuses Rubinstein, who argues ‘The models presented… are nothing but fables. Neither of them describes reality, but both of them still describe something from reality… studying both of them together helps to some extent in understanding economic mechanisms.’ (p.182). It does not seem fair to brand models as ‘merely’ fables on this reading, and nor does this give us licence to dismiss fables as unscientific.
Epidemiologists often make significant assumptions in order to model disease progression. Many parameters are unknown, and there are often practical constraints to modelling significant hete...
As highlighted by Bowe and colleagues, air pollution is closely linked to burden of Chronic Kidney Disease (CKD). (1) A recent article on cardio-pulmonary mortality also highlighted similar issue, with a focus on provision of ventilation. (2)
Show MoreIndia faces similar issues due to air pollution attributable to wide spread traditional habit of cooking with biomass. The contribution of CKD to Disability Adjusted Life Years (DALY) in the country has increased from 0.8% in 1990 to 1.6% in 2016 and it is the 9th common cause of mortality. (3)
With focus on prevention, CKD has been included under National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke, the flagship program for Non-Communicable Diseases (NCD). Through NCD Clinics, diabetes and hypertension, two common risk factors for CKD, are being addressed. Population based screening is also underway for prevention, awareness and early diagnosis of these two morbidities. (4) Pradhan Mantri National Dialysis Program has been put in place to meet the need of dialysis services by the poor people at free of cost. (5) Ujjwala scheme has recently been introduced, under which more than 80 million families have been provided clean fuel. The scheme specifically targets rural areas where biomass is considered as one of the major mean for cooking. (6)
With so many initiatives, researches are warranted from India to estimate their effects in mitigating CKD burden and to tailor hea...
Dear Editor,
We read with great interest the original research by Coll CVN, Ewerling F, García-Moreno C, et al which found that domestic violence in low- and middle-income countries was more prevalent amongst certain groups of women.
The ongoing COVID-19 pandemic has already ravaged countries within Asia, Europe and the United States, defined as high-income by the World Bank Group. [1] Actions taken to prevent the spread of the virus has meant a large proportion of the population in these countries is currently under some degree of confinement, and consequently, an alarming increase in domestic violence has been reported by the news. [2]
Coll CVN, Ewerling F, García-Moreno C, et al recognises Africa and SouthEast Asia to have a higher prevalence of domestic violence. At the time of writing (29/03/2020), the WHO has already reported 3005 cases and 51 deaths in Africa and 3709 cases and 139 deaths in SouthEast Asia, with no doubt that these numbers will continue to grow. [3]
Resources to fight the COVID-19 epidemics in these regions are limited and thus, efforts aiming to curb the transmission will soon undoubtedly follow other countries’ mitigation plans; police enforcing a lockdown, healthcare workers treating COVID-19 patients and government officials attempting to gather the necessary equipment for the care of its citizens. This means an extensive proportion of the workforce needed to help women undergoing domestic violence will already be si...
Show MoreWhile liking the idea, I find two main problems with the suggested definition of global health as "public health somewhere else": 1) it is too narrow and 2) it sounds dismissive. In "global health", the word "global" is inclusive and suggests a health agenda embracing all the communities of the rest of the world. This is lost in the definition. Then there is the dismissive sound of "somewhere else" ("You can join our club or go somewhere else", "This could be Paradise or it could be somewhere else", etc.). I may be thin-skinned, but disdaining to specify a location sounds to me like a slur. For these reasons, and for all the other good reasons offered in the original Commentary, I suggest amending the definition to "public health everywhere else". This follows the original in asserting "elseness", while being inclusive and positive.
Why the first sentence of this article with its exaggerated claim about the health outcomes of Aboriginal and Torres Strait Islander Australians? The reference cited, 1 does not support the comparison with other populations globally, and the article itself seeks to move beyond negative images of Aboriginal and Torres Strait Islander people. Beginning with this negative statement – regardless of its veracity - continues the long history of deficit discourse used in discussing Aboriginal and Torres Strait Islander people. Rather than contribute to improved outcomes deficit discourse can actually reinforce and perpetuate approaches and behaviours such as those the article seeks to address. 2
Overall the article presents important new research moving beyond negative stereotypes of Aboriginal and Torres Strait Islander people, highlighting their perspectives and insights, and encouraging a more culturally driven approach. This makes the opening even more inappropriate and unnecessary.
References
1. Gracey M, King M. Indigenous health part 1: determinants and disease patterns. Lancet. 2009;374:65-74.
Show More2. Fogarty W, Bulloch H, McDonnell S et al. Deficit Discourse and Indigenous Health: How narrative framings of Aboriginal and Torres Strait Islander people are reproduced in policy. Melbourne: The Lowitja Institute; 2018 [cited 20 Jan 2020]. Available from:...
United States withdrawal from the Iran nuclear deal in May 2018 has led to increasing pressure on all members of society (1). Economic sanctions against Iran have not formally targeted health care or access to drugs and ordinary people, but they have indirectly serious impact on health services and consequently on research programs. Economic sanctions resulted in decline in the value of Iran's currency and government faced big budget deficit. Therefore, the cost of research programs and initial equipments for conducting any projects will increase too much. In this case they are unaffordable by institutions (1-3). Based the on Kokabisaghi et al. paper published in BMJ Global Health in 2019, the economic sanctions imposed more problems on Iran’s research and publishing. Also they claimed that academic boycotts violate researchers’ freedom and curtail progress (2). Free exchange of ideas irrespective of creed is needed to optimize global scientific progress (2). But it seems that another factor can indirectly effects on research programs in Iran. Economic sanctions and scientific boycotts are among the most important problems for researchers on Iran. In the meantime importance of domestic political crisis due to economic sanctions has been ignored. This is not mentioned in this study. With decreased national budget and GDP (gross domestic product) per capita, the government was forced to raise prices of energy and oil carriers; as a result, it created a major political c...
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