The World Health Organization has recognized health as a right of migrants and refugees, who are entitled to responsive healthcare policies, due to their particular social determinants of health. Migrants’ and refugees’ health is not only related to transmissible diseases but also to mental health, sexual and reproductive health, and non-communicable diseases, such as diabetes. Historically, however, migration has been linked to the spread of diseases and has often artificially served as a scapegoat to local shortcomings, feeding on the xenophobic rhetoric of extremist groups and political leaders. This approach fosters the criminalization of migrants, which has led to unacceptable violations of human rights, as demonstrated by the massive incarceration and deportation policies in developed countries, for example, the United States under the Trump administration.
In Latin America and the Caribbean, in particular, there have been legal developments, such as pioneering national legislation in Argentina in 2004 and Brazil in 2017, which suggest some progress in the direction of human rights, although in practice drawbacks abound in the form of countless barriers for migrants to access and benefit from healthcare services in the context of political turmoil and severe socioeconomic inequality. The COVID-19 pandemic has exposed and enhanced the effects of such inequality in the already frail health conditions of the most disenfranchised, including low-income migrants and refugees; it has both caused governments in Latin America to handle the crisis in a fragmented and unilateral fashion, ignoring opportunities to cooperate and shield the livelihoods of the most vulnerable, and served as a pretext to sharpen the restrictions to cross-border movement and, ultimately, undermine the obligation to protect the dignity of migrants, as the cases of Venezuela and the U.S.-Mexico border illustrate. Still, it could represent an opportunity to integrate the health of migrants to the public health agenda as well as restore cooperation mechanisms building on previous experiences and the existing framework of human rights organizations.
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Article
Deisy Ventura, Jameson Martins da Silva, Leticia Calderón, and Itzel Eguiluz
Article
Janine Barden-O'Fallon and Erin McCallum
Monitoring and evaluation (M&E) can be defined as the systematic collection, analysis, and use of data to answer questions about program performance and achievements. An M&E system encompasses all the activities related to setting up, collecting, reporting, and using program information. A robust, well-functioning M&E system can provide program stakeholders with the information necessary to carry out a responsive and successful program intervention and is therefore a critical tool for program management. There are many tools and techniques needed for successful M&E of sexual and reproductive health (SRH) programs. These include frameworks to visually depict the organization of the program, its context and goals, and the logic of its M&E system. Essential practices of M&E also include continuous stakeholder engagement, the development of indicators to measure program activities and outcomes, the collection and use of data to calculate the indicators, and the design and implementation of evaluation research to assess the benefits of the program.
Over time, language around “M&E” has evolved, and multiple variations of the phrase are in use, including “MEL” (monitoring, evaluation, and learning), “MER” (monitoring, evaluation, and reporting), and “MERL” (monitoring, evaluation, research, and learning), to name but a few. These terms bring to the forefront a particular emphasis of the M&E system, with an apparent trend toward the use of “MEL” to emphasize the importance of organizational learning. Despite this trend, “M&E” continues to be the most widely known and understood phrase and implicitly includes activities such as learning, research, and reporting within a robust system.
Article
Stefano Campostrini
Noncommunicable diseases (NCDs) have become the first cause of morbidity and mortality around the world. These have been targeted by most governments because they are associated with well-known risk factors and modifiable behaviors. Migrants present, as any population subgroup, peculiarities with regard to NCDs and, more relevantly, need specific information on associated risk factors to appropriately target policies and interventions. The country of origin, assimilation process, and many other migrant health aspects well studied in the literature can be related to migrants’ health risk factors. In most countries, existing sources of information are not sufficient or should be revised, and new sources of data should be found. Existing survey systems can meet organizational difficulties in changing their questionnaires; moreover, the number of changes in the adopted questionnaire should be limited for the sake of brevity to avoid excessive burden on respondents. Nevertheless, a limited number of additional variables can offer a lot of information on migrant health. Migrant status, country of origin, time of arrival should be included in any survey concerned about migrant health. These, along with information on other Social Determinants of Health and access to health services, can offer fundamental information to better understand migrants’ health and its evolution as they live in their host countries. Migrants are often characterized by a better health status, in comparison with the native population, which typically is lost over the years. Public health and health promotion could have a relevant role in modifying, for the better, this evolution, but this action must be supported by timely and reliable information.
Article
A. Mushtaque R. Chowdhury and Henry B. Perry
Non-governmental organizations (NGOs) working in developing countries are chiefly a post-World War II phenomenon. Though they have made important contributions to health and development among impoverished people throughout the world, the documentation of these contributions has been limited. Even though BRAC and the Jamkhed Comprehensive Rural Health Project (CRHP) are but two of 9.7 million NGOs registered around the world, they are unique. Established in 1972 in Bangladesh, BRAC is now the largest NGO in the world in terms of population served—now reaching 130 million people in 11 different countries. Its programs are multi-sectoral but focus on empowering women and improving the health of mothers and children. Through its unique scheme of generating income through its own social enterprises, BRAC is able to cover 85% of its $1 billion budget from self-generated funds. This innovative approach to funding has enabled BRAC to grow and to sustain that growth as its social enterprises have also prospered. The Jamkhed CRHP, founded in 1970 and located in the Indian state of Maharashtra, is notable for its remarkable national and global influence. It is one of the world’s early examples of empowering communities to address their health problems and the social determinants of those problems, in part by training illiterate women to serve as community health workers. The Jamkhed CRHP served as a major influence on the vision of primary health care that emerged at the 1978 International Conference on Primary Health Care at Alma-Ata, Kazakhstan. Its Institute for Training and Research in Community Health and Population has provided on-site training in community health for 45,000 people from 100 different countries. The book written by the founders entitled Jamkhed: A Comprehensive Rural Health Project, describing its pioneering approach, has been translated into five languages beyond English and is one of the most widely read books on global health. These two exemplary NGOs provide a glimpse of the breadth and depth of NGO contributions to improving the health and well-being of impoverished people throughout the world.
Article
Catarina Roseta-Palma, Miguel Carvalho, and Ricardo Correia
Many utilities, including water, electricity, and gas, use nonlinear pricing schedules which replace a single uniform unit price, with multiple elements such as access charges and consumption blocks with different prices. Whereas consumers are typically assumed to be utility maximizers with nonlinear budget constraints, it is more likely that consumer behavior shows limited-rationality features such as reference dependence. Recent studies of water demand have explored consumer reactions to social comparison nudges, which can moderate consumption and might be a useful tool given low demand-price elasticities. Other authors have noted the difficulties of correct price perception when tariff schedules are complex, and attributed those low elasticities to a lack of information. Nonetheless, it is also possible that consumers form reference prices, relative to which the actual price paid is compared, in a way that affects consumption choices. Faced with a nonlinear price schedule, such as increasing block tariffs, consumers could evaluate their actual marginal price as a loss or a gain relative to a particular reference price that is derived from the schedule. Introducing gain/loss terms into the utility function, in the discrete/continuous model of consumer choice that has been widely used for water demand analysis, leads to consumption decisions that vary when a higher-than-reference price is seen as a loss and a lower-than-reference price as a gain. Utilities might wish to explore these reference-price effects according to their strategic goals. For example, if there are capacity constraints or water scarcity problems, potential water savings can be achieved from highlighting the first-block price as a reference and framing higher-block prices as losses, inducing conservation even without raising overall prices. Furthermore, if higher-block prices are subsequently raised the demand response could be stronger.
Article
Chi Chiung Grace Chen and René Génadry
Obstetric fistula (OF) is a condition that remains prevalent in non-industrialized nations, mainly in sub-Saharan Africa and Southeast Asia where proper and timely obstetrical care is inaccessible, unavailable, or inadequate. The reasons for the delay vary from country to country where poverty remains a common thread, and understanding the many factors leading to the development of OF is critical in preventing this scourge that has been all but eliminated in industrialized nations. Preventive measures can be effective when developed in conjunction with local resources and expertise and should include patient education and empowerment in addition to educating and equipping healthcare providers. In the absence of such measures, patients develop an « obstructed labor injury complex » involving the genital, urinary, and gastrointestinal tracts. Many troublesome health consequences arise from this complex, including skin lesions from the caustic effects of urine, endocrine abnormalities such as amenorrhea and infertility, neuropsychological consequences such as depression and suicide, and musculoskeletal impairments such as foot drop and contractures.
Globally, evidence-based interventions are needed to address the debilitating and persistent medical, psychological, and social effects of this condition on its sufferers. While surgery offers the amelioration of symptoms, many patients may not have access to such care due to lack of funds, knowledge of surgical options, or availability of surgical facility. Even after successful repair of the fistula, patients may still suffer from persistent incontinence, stigma, and socio-economic hardship requiring special programs for support, rehabilitation, and reintegration. Additionally, the patients who are deemed inoperable require special counseling and care. Consensus is needed on standardizing care and outcome measures to improve the quality of care and to evaluate programs directed toward prevention that will render this condition obsolete.
Article
Emily Q. Ahonen
Occupational health and safety concerns classically encompass conditions and hazards in workplaces which, with sufficient exposure, can lead to injury, distress, illness, or death. The ways in which work is organized and the arrangements under which people are employed have also been linked to worker health. Migrants are people who cross borders away from their usual place of residence, and about one in seven people worldwide is a migrant. Terms like “immigrant” and “emigrant” refer to the direction of that movement relative to the stance of the speaker. Any person who might be classified as a migrant and who works or seeks to work is an immigrant worker and may face challenges to safety, health, and well-being related to the work he or she does. The economic, legal, and social circumstances of migrant workers can place them into employment and working conditions that endanger their safety, health, or well-being. While action in support of migrant worker health must be based on systematic understanding of these individuals’ needs, full understanding the possible dangers to migrant worker health is limited by conceptual and practical challenges to public health surveillance and research about migrant workers. Furthermore, intervention in support of migrant worker health must balance tensions between high-risk and population-based approaches and need to address the broader, structural circumstances that pattern the health-related experiences of migrant workers. Considering the relationships between work and health that include but go beyond workplace hazards and occupational injury, and engaging with the ways in which structural influences act on health through work, are complex endeavors. Without more critically engaging with these issues, however, there is a risk of undermining the effectiveness of efforts to improve the lot of migrant workers by “othering” the workers or by failing to focus on what is causing the occupational safety and health concern in the first place—the characteristics of the work people do. Action in support of migrant workers should therefore aim to ameliorate structural factors that place migrants into disadvantageous conditions while working to improve conditions for all workers.
Article
Maria Cristina Schneider, Claudia Munoz-Zanzi, Kyung-duk Min, and Sylvain Aldighieri
The vision that everything is connected in this world is not new. However, to respond to the current challenges that the world is facing, the integrated vision that humans, animals, and the environment are linked is more important than ever. Collaboration among multiple disciplines is crucial, and this approach is fundamental to understanding the One Health concept.
A transdisciplinary definition of One Health views animals, humans, and their shared settings or environment as linked and affected by the socioeconomic interest of humans and external pressures. A One Health concept calls for various disciplines to work together to provide new methods and tools for research and implementation of effective services to support the formulation of norms, regulations, and policies to the benefit of humanity, animals, and the environment for current and future generations. This will improve the understanding of health and disease processes as well as prediction, detection, prevention, and control of infectious hazards and other issues affecting health and well-being in the human-animal-ecosystem interface, contributing to sustainable development goals, and to improving equity in the world.
Article
The International Conference on Population and Development (ICPD), which has guided programming on sexual reproductive health and rights (SRHR) for 25 years, reinforced that governments have a role to play in addressing population issues but in ways that respect human rights and address social and gender inequities. The shift at ICPD was partly in response to excesses that had occurred in some family planning programs, resulting in human rights abuses. The 2012 London Summit on Family Planning refocused attention on family planning as a crucial component of SRHR and, in part due to significant pushback on the announcement of a goal of reaching an additional 120 million women and girls with contraception by 2020 in the world’s poorest countries, ignited work to ensure that programming to achieve this ambitious goal would be grounded in respecting, protecting, and fulfilling human rights. This attention to human rights has been maintained in Family Planning 2030 (FP2030), the follow on to Family Planning 2020 (FP2020). While challenges remain, particularly in light of pushback on reproductive rights, widespread work over the past decade to identify human rights principles and standards related to family planning, integrate them into programming, strengthen accountability, and incorporate rights into monitoring and evaluation has improved family planning programs.
Article
J. Jill Suitor, Yifei Hou, Catherine Stepniak, Robert T. Frase, and Destiny Ogle
Parents and children continue to impact each other’s lives across the life course. Intergenerational relationships affect older adults’ physical and psychological well-being in a multitude of complex processes. Contact and interaction with adult offspring, as well as both giving and receiving support and caregiving, can have either positive or negative effects on parents’ well-being, depending upon whether these experiences are perceived by the older adults as enriching, harmonious, and desired. Furthermore, the impact of parent–adult child relations on older adults’ health is shaped by social structural characteristics of families and individual family members, such as race, ethnicity, and gender, as well as by cultural contexts within and across nations. Generally, close intergenerational relationships characterized by high levels of contact and reciprocal exchanges of support positively affect older parents’ well-being, whereas tense intergenerational relationships characterized by adult children’s problems or disregard for older adults’ values and autonomy negatively affect older parents’ well-being.
Article
Daniel E. Dawes, Christian M. Amador, and Nelson J. Dunlap
The political determinants of health create the structural conditions and the social drivers—including poor environmental conditions, inadequate transportation, unsafe neighborhoods, poor and unstable housing, and lack of healthy food options—that affect all dynamics involved in health. Globally, recurring examples of the role that these political determinants—through government action or inaction, and policy—are playing in health outcomes and life expectancy, particularly in under-resourced communities, can be observed currently as well as historically. Most notably, the political determinants of health are more than merely separate and distinct from social determinants of health: they serve as the instigators of the social determinants of health with which many people are already well acquainted. They involve the systematic process of structuring relationships, distributing resources, and administering power, operating simultaneously in ways that mutually reinforce or influence one another to shape opportunities that either advance health equity or exacerbate health inequities. Focusing on the political determinants of health homes in on the fundamental causes that give rise to, sustain, and exacerbate the social determinants of health that create and worsen the persistent and devastating health inequities that are observed, experienced, researched, and reported. By employing both a theoretical and practical lens to the amelioration of health inequities that continue to pervade communities across the globe, the article contextualizes many of the historic harms that have occurred throughout history, providing a unique perspective on the current state of affairs, and offering a tangible path forward toward a more equitable future. Furthermore, consideration of this new framework at all levels of government as it relates to improving health outcomes for any nation is imperative in order to eliminate existential threats for any and all populations.
Article
Suzanne Vallance and Ashley Rudkevitch
Disaster scholarship has resurrected interest in social capital, and it has become well established that strong social ties—bonding capital—can also help individuals and communities to survive in times of crisis, as well as provide substantial and wide-ranging benefits on the long road to recovery. The theoretical tripartite of bonding capital generated in “close ties,” bridging capital developed through “associations,” and linking capital from possibly cool but nonetheless “civil” encounters is also reasonably well established. So too are the currencies of trust and reciprocity. Social capital is noted to be a potent resource capable of facilitating many benefits in terms of health and well-being, and it is considered fundamental to post-disaster attempts to Build Back Better in the Sendai Framework for Disaster Risk Reduction. Indeed, the idea of social capital has become almost synonymous with resilience.
Nonetheless, it is also acknowledged that there may be disadvantages associated with social capital, such as tribalism, neoptism, and marginalization. Scholarship therefore paints a rather complex picture, and there is still considerable debate about what social capital is: what it does, where it comes from and where it goes, and for what purpose. Without denying the value of a celebratory approach that focuses on the benefits, it is concluded that there is a need for more attention to be given to the broader ideological contexts that may shape the generative and distributional effects of social capital, particularly as these underscore health and well-being outcomes post-disaster.
Article
Ana Luiza Vilela Borges, Christiane Borges do Nascimento Chofakian, and Ana Paula Sayuri Sato
The focus on non-sexually transmitted infections during pregnancy is relevant, as they are one of the main causes of fetal and neonatal morbidity and mortality in many regions of the world, especially in low- and middle-income countries, respecting no national boundaries. While their possible vertical transmission may lead to adverse pregnancy outcomes, congenital rubella syndrome, measles, mumps, varicella, influenza, Zika virus, dengue, malaria, and toxoplasmosis are all preventable by measures such as vector control or improvement in sanitation, education, and socioeconomic status. Some are likewise preventable by specific vaccines already available, which can be administered in the first years of childhood. A package for intervention also includes adequate preconception care, routine antenatal screening, diagnosis, and treatment during pregnancy. Non-sexually transmitted diseases during pregnancy have different worldwide distributions and occasionally display as emerging or re-emerging diseases. Their epidemiological and clinical aspects, as well as evidence-based prevention and control measures, are relevant to settings with ongoing transmission or those about to be in vulnerable situations. Non-sexually transmitted infections are major public and global health concerns as potential causes of epidemics or pandemics, with numerous social, economic, and societal impacts..
Article
Danuta Wasserman
Around 700,000 people take their lives each year worldwide. Suicide accounts for approximately 1.3% of all deaths and therefore represents a major public health problem. The global age-standardized suicide rate is 9 per 100,000 population, yet there are large variations among genders, ages, countries, and world regions. The stress–vulnerability model of suicidal behaviors has been proposed to explain how a diathesis, developed through the influence of genetic and neurodevelopmental factors in relation to perinatal, postnatal, and life experiences, interacts with different risk and protective factors that either decrease or enhance the individual’s level of resilience to stress and suicidal risk. Public health suicide prevention strategies include suicide means restriction, reducing harmful substance use, promoting responsible media reporting, public-awareness campaigns, gatekeeper trainings, school-based interventions, crisis helplines, and postvention. Mental health strategies comprise identification, treatment, and rehabilitation of persons in distress and at risk for suicide. Multicomponent strategies that use a combination of evidence-based methods from public and mental health sectors are recommended. Future work should aim at enhancing the quality of epidemiological data, improving the research on protective and ideation-to-action factors, expanding the quantity and quality of data coming from low- and middle-income countries, and evaluating the cost-effectiveness of different suicide prevention strategies.
Article
Nancy Morrow-Howell and Peter Sun
Population aging has largely been approached as a problem. Demographic shifts toward aging societies have been viewed from a deficit perspective. Certainly, the remarkable extension of human life has created challenges to individuals, families, healthcare and social care systems, and income security policies. Yet, the “age-drain” approach fails to recognize the vast heterogeneity of the older population and the growing human capital among older adults. The productive-aging perspective is an alternative to the age-drain perspective that can shape social approaches to population aging. The concept of productive aging was introduced by Dr. Robert Butler in 1985, and he called for the redirection of attention from the dependencies associated with later life to the actual and potential contribution of older adults. Further, he suggested that society could not afford to dismiss the growing capacity of the older population. From the productive-aging perspective, the capacity of older adults to contribute to families and communities through working, volunteering, and caregiving is highlighted. It is likely that societies will need more people in these roles longer into the life course, and it is possible to facilitate engagement in these roles to maximize positive outcomes for older adults and society.
Productive engagement is defined as engaging in activities that produce goods and services, whether paid for or not, including working, volunteering (formal and informal), and caregiving. In all these cases, monetary values have been assigned to the contributions made by people over a certain age, depending on the age selected by the researcher. Outcomes of productive engagement have been conceptualized at multiple levels, including well-being for older people, experienced person-power for organizations, relief to retirement income programs, and stronger civic society. Attaining these outcomes requires social policies and programs that increase opportunities for all segments of the older population. Since the conceptual beginnings, scholars have proposed that productive engagement be viewed as an outcome of extra-individual factors, distinguishing this perspective from the successful aging paradigm that focused more on individual determinants. To date, outdated programs and policies have constrained the engagement of older adults as workers, volunteers, and caregivers. Many innovations have been proposed, and promising interventions are being demonstrated. The aim is to transform work environments and employment policies to enable people to work longer, to increase opportunities to engage older adults in volunteer roles while helping organizations more fully utilize this talent pool, and to improve support for caregiving and other forms of care work in later life. The goal is to create opportunities and to facilitate engagement in productive roles—not to exploit or coerce older people or to exclude lower-resourced individuals who have been marginalized across their life course. Fundamentally, progress depends on changing attitudes about aging and dispelling current assumptions about older adults and aging populations.
Article
Claire E. Brolan
The COVID-19 crisis—the most catastrophic international public health emergency since the Spanish influenza 100 years ago—provides impetus to review the significance of public and global health in the context of Sustainable Development Goal (SDG) achievement. When countries unanimously adopted the 17 SDGs in September 2015, stakeholders had mixed views on global health goal SDG 3 (Good Health and Well-Being). Concern arose over the feasibility of achieving SDG 3 by 2030 when countries pursued its nine targets and four means of implementation with sixteen other ambitious global goals. Nonetheless, health surely cuts across the SDG framework: for instance, the underlying health determinants are expressed in many goals as is urban and planetary health. Although health (and its different constructions) is central to overall SDG achievement, SDG success depends on a paradigm shift toward whole-of-government policy and planning. Indeed, the 2030 Agenda echoes calls for a Health in All Policies (HiAP) approach to public health programming. This depends on another paradigm shift in public health tertiary education, practitioner training, and policy skills development within and beyond ministries of health. Added to this are the underlying problematics around SDG health financing, human resources for health, health target and indicator localization for equitable country responses that leave no one behind, strengthening civil registration and vital statistics systems for inclusive and accountable health implementation, and the sidelining of human rights from SDG metrics. While COVID-19 has derailed SDG efforts, it could also be the ultimate game changer for intergenerational human and environmental health transformation. Yet strong global health governance and rights-based approaches remain key.
Article
Colin Binns and Mi Kyung Lee
Breastfeeding is one of the best public health “buys” available for countries at all levels of development. In the first year of life, appropriate infant nutrition (exclusive breastfeeding to around 6 months) reduces infant mortality and hospital admissions by 50% or more. Early life nutrition has important influences, including on childhood illnesses, obesity, cognitive development, hospitalizations, and later chronic disease. Breastfeeding is consistent with the historical cultural practices of all societies, and its benefits of breastfeeding last a lifetime. While the development of infant formula has been of benefit to some infants, its inappropriate promotion has resulted in a decline of breastfeeding, and, as a result, health gains in many countries have not been as great as they could have been. The health benefits of breastfeeding will provide some protection against the effects of climate change, which will cause a decline in potable water supplies and increases in the incidence of some infections. Infant formula production has very high environmental costs, while breastfeeding as well as being the best infant feeding intervention also has very low environmental impact. An important part of the sustainable development agenda must be to promote breastfeeding and its benefits and to reverse the inappropriate promotion and use of infant formula.
Article
Peter McIntyre and Tony Walls
From the first vaccine (cowpox, developed by Edward Jenner in 1796), more than 100 years elapsed before additional vaccines for broad population use (diphtheria toxoid, tetanus toxoid, and whole cell pertussis) became available between 1920 and 1940. Then followed inactivated polio vaccine in the 1950s, and live attenuated vaccines for measles, mumps, rubella, and polio in the 1960s. In 1979, global elimination of smallpox was formally certified, with the last human case occurring in Somalia, almost 200 years after Jenner administered cowpox vaccine to James Phipps.
In 2019, global elimination is tantalizingly close for maternal and neonatal tetanus and polio. Despite recent outbreaks, elimination has also been achieved at country and regional levels for measles and rubella and, if achieved globally, will offer, as it has for smallpox, large reductions in child mortality and morbidity and in health system costs. Short of elimination, it is important to define the public health impact of vaccines broadly and at the population level. These broader impacts include benefits to families flowing from prevention of long-term sequelae of infection in children, and to populations and health systems from reduced transmission of infection. Importantly, well-delivered vaccination programs will have a substantial impact by improving equality in health outcomes across populations. Broader impacts include reductions in syndromic disease beyond laboratory-proven infection (e.g., diarrhea and pneumonia), indirect reductions in disease in those not immunized (within and beyond age cohorts targeted by vaccine programs), and improvements in other health services driven by the infrastructure for vaccine delivery. Measurement of these broader impacts can be challenging and must also acknowledge the potential for trade-offs, such as replacement disease due to non-vaccine strains, as documented for pneumococcal infection.
The realization of the benefits of vaccines globally for all children began with the Expanded Program on Immunization (EPI) initiated by the World Health Organization (WHO) in 1974. The EPI focused on improving coverage of six already available but grossly underutilized vaccines—diphtheria–tetanus–pertussis (DTP), polio, measles, and Bacille Calmette–Guerin (BCG). Through the EPI, estimated global coverage for 3 doses of DTP increased from around 20% to over 85%. Subsequent to the EPI, the Global Alliance for Vaccines and Immunization (GAVI), the Global Immunization Vision and Strategy (GIVS), and, most recently, the Global Vaccine Action Plan (GVAP) have aimed to improve access to additional vaccines in the poorest countries. These include Haemophilus influenzae type b (Hib), hepatitis B, pneumococcal conjugate, rotavirus, and human papillomavirus (HPV) vaccines, all introduced in high-income countries from the 1990s. In this chapter, the scope and methodological issues in measuring public health impact are reviewed, and estimates of the global public health impact of individual vaccines in children summarized, concluding with potential future benefits to global child health from expanded maternal vaccination and vaccines under development.
Article
Water is one the most indispensable human needs. Although pumped wells, bottled water, or public faucets are used in many parts of the world as means to obtain this crucial good, piped water services are considered the gold standard to ensure wide, regular, and secure access. At first glance, piped water services have all the characteristics of a natural monopoly in which the government is better positioned for provision than the private sector: high sunk costs and economies of scale are present, and the quality of the service is costly to supervise. However, in that first intuition, there is one missing block: government behavior. In countries with low state capacity and accountability, weak checks and balances, and institutional dysfunction, public companies are frequently used to fulfill political goals instead of their stated objectives. In those cases, privatization coupled with the creation of an independent regulatory agency can limit the predatory capacity of the government, displace the service to the sphere of private incentives, and provide the opportunity to extend coverage and improve quality.
There is, nonetheless, a fragile side to this solution. If the same institutional vulnerabilities that create poor public companies’ management persist, incentives for predatory government behavior remain latent and can emerge when circumstances facilitate it. This whole parable was observed with the privatization of Obras Sanitarias de la Nación in Argentina. First, a paralyzed and overstaffed public company was replaced by a dynamic private company. During this period, more than 2 million people gained access to the water service and 1.2 million people gained access to the sewage networks, which substantially improved health outcomes for the newly incorporated groups. Then a big economic crisis hit the contractual relationship between the government and the company, and renationalization took place. This change was paired with a return of previously observed predatory practices such as unsustainable pricing policy and non-meritocratic appointments.
Article
Yin Paradies
There are an estimated 300 million indigenous peoples worldwide. Although there is ample evidence of worse health and social outcomes for the majority of indigenous peoples, compared to their non-indigenous counterparts, there has yet to be a review of racism as a determinant of indigenous health using global literature. Racism constitutes unfair and avoidable disparities in power, resources, capacities, or opportunities centered on ethnic, racial, religious, or cultural differences that can occur at three levels: internalized, interpersonal, or systemic. For indigenous peoples this is closely related to ongoing processes of colonization. Available research suggests that at least a third of indigenous adults experience racism at least once during their lives and that about a fifth of indigenous children experience racism. For indigenous peoples, racism has been associated with a considerable range of health outcomes, including psychological distress, anxiety, depression, suicide, posttraumatic stress disorder, asthma, physical illness, obesity, cardiovascular disease, increased blood pressure, excess body fat, poor sleep, reduced general physical and mental health, and poor oral health, as well as increased alcohol, tobacco, and marijuana use and underutilization of medical and mental healthcare services. Disparities in medical care experienced by indigenous patients compared to non-indigenous patients have also been found. Existing studies indicate that avoidant and passive coping tends to exacerbate the detrimental health impacts of racism for indigenous peoples, whereas active coping ameliorates the ill-health effects of racism. Reducing individual and interpersonal racism can be achieved by (a) providing accurate information and improving awareness of the nature of racism and racial bias; (b) activating values of fairness, reconciling incompatible beliefs, and developing antiracist motivation; (c) fostering empathy and perspective-taking and confidence in regulating emotional responses; (d) improving comfort with other groups and reducing anxiety; and (e) reinforcing antiracist social norms and highlighting personal accountability. There are five key areas for combating systemic racism in organizations and institutions: (a) institutional accountability; (b) diversity in human resources; (c) community partnership; (d) antiracism and cultural competence training; and (e) research and evaluation.
