Latinos are the fastest-growing population in the United States and comprise nearly 20% of the population with approximately 63 million residing in the United States in 2021. The Latino population in the United States is a diverse community with approximately one-third of Latinos living in the United States being foreign born and representing every country in Latin America. Given the high proportion of recent immigrants to the United States within the group, the Latino community has unique social and policy needs that impact health and access to medical care. Latino immigrant country of origin, political trajectories, and nativity status are particularly relevant in regard to disease prevalence, treatment, and prevention. Although being foreign-born is a protective factor for some forms of cancers and cardiovascular disease among Latinos, for example, recent immigrant Latinos are susceptible to acute mental health distress and lack of access to medical care. Despite the observation that Latinos as a whole persistently exhibit longer life expectancies relative to non-Latino whites at the face of high comorbidity rates, the recent COVID-19 pandemic has impacted this health advantage for several age groups within the community. As one of the fastest-growing populations in the United States, Latino youth health is important to address, especially with prevention measures for metabolic disease, and the impact of poverty on family access to healthcare. Understanding the nuanced and varying social and political determinants of health for Latinos, as well as differences within subgroups, sheds light on the effects of environment, behavior, and the impact of access to health on morbidity and mortality.
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Article
Latino Health
Ana Abraído-Lanza, Lillian Amanda Ruiz, and Sonia Mendoza-Grey
Article
Legal, Regulatory, and Institutional Framework of Water and Sanitation Services in the Eastern and Southern Africa Region
Yvonne Magawa
Deteriorating quality of service provision and disease outbreaks (such as cholera) led to the institution of water supply and sanitation (WSS) sector reforms in Eastern and Southern Africa region in the 1990s. The realization of the urgent need to improve the performance of the sector, especially as related to health impacts, resulted in the formulation of new policy and legal and institutional frameworks to reorganize the sector and establish regulators who could address networked and nonnetworked WSS systems.
Regulators as policy implementers have the delicate role of balancing the interests of government, service providers, and consumers. Decision- makers continue to design, implement, and evaluate the outcomes associated with new frameworks. Regional regulatory cooperation can accelerate improvements in service provision to meet the United Nations Sustainable Development Goals through development of common frameworks and approaches for WSS that can be adapted to unique country situations.
Article
Male Reproductive Function and Fecundity
Michael T. Mbizvo and Tendai M. Chiware
Male reproductive function entails complex processes, involving coordinated interactions between molecular structures within the gonadal and hormonal pathways, tightly regulated by the hypothalamic–pituitary gonadal axis. Studies in men and animal models continue to unravel these processes from embryonic urogenital development to gonadal and urogenital ducts function.
The hypothalamic decapeptide gonadotropin-releasing hormone is released into the hypophyseal portal circulation in a pulsatile fashion. It acts on the gonadotropes to produce the gonadotropins, the main trophic hormones acting on the testis to regulate sperm production. This endocrine control is complemented by paracrine and autocrine regulation arising from the testis, where germ cells originate, modulated by growth factors and local regulators arising within the testis. The process of spermatogenesis, originating in seminiferous tubules, is characterized by stem cell proliferation and differentiation, meiotic divisions, expression of transcriptional regulators, through to morphological changes which include cytoplasm reorganization and flagellum development. Metabolic processes and signal transduction pathways facilitate the functional motion and transport of sperm to the site of fertilization. The normal sperm structure or morphology acquired during spermatogenesis, epididymal maturation, sperm capacitation including motility, and subsequent acrosome reaction are all critical events in the acquisition of sperm fertilizing ability. Generation of the male gamete is assured through adequate gonadal function, involving complex differentiation processes and regulation, during spermiogenesis and spermatogenesis. Sperm functional changes are acquired during epididymal transit, and functional motion is maintained in the female reproductive tract, involving activation of signaling processes and transduction pathways. Infertility can arise in the male, from spermatogenic failure, sperm functional quality, obstruction and other factors, but causes remain unknown in a large proportion of affected men. Semen analysis, complemented by the clinical picture, remains the mainstay of male infertility investigation. Assisted reproductive technology has proved useful in instances where the cause is not treatable. Complications from sexually transmitted infections could lead to male infertility, by impairing sperm quality, production, or transport through the reproductive tract.
Male fecundity denotes the biological capacity of men to reproduce, based on ability to ejaculate normal sperm. Lifestyle, environmental, and endocrine disruptors have been implicated in reduced male fecundity.
Interactions between vascular, neurological, hormonal, and psychological factors confer normal sexual function in men. Nocturnal erections begin in early puberty, occurring with REM sleep. Sexual health is an integral part of sexual and reproductive health, while sexual dysfunction, in various forms, is also experienced by some men.
Methods of contraception available to men are few, and underused. They include condoms and vasectomy.
Enhanced knowledge of male reproductive function and underlying physiological mechanisms, including sperm transit to fertilization, can be catalytic in improvements in assisted reproductive technologies, male infertility diagnosis and treatment, and development of contraceptives for men.
The article reviews the processes associated with male reproductive function, dysfunction, physiological processes and infertility, fecundity, approaches to male contraception, and sexual health. It further alludes to knowledge gaps, with a view to spur further research impetus towards advancing sexual and reproductive health in the human male.
Article
Malnutrition
Roger Shrimpton
Malnutrition is caused by consuming a diet with either too little and/or too much of one or more nutrients, such that the body malfunctions. These nutrients can be the macronutrients, including proteins, carbohydrates, and fats that provide the body with its building blocks and energy, or the micronutrients including vitamins and minerals, that help the body to function. Infectious diseases, such as diarrhea, can also cause malnutrition through decreased nutrient absorption, decreased intake of food, increased metabolic requirements, and direct nutrient loss. A double burden of malnutrition (both overnutrition and undernutrition) often occurs across the life course of individuals and can also coexist in the same communities and even the same households. While about a quarter of the world’s children are stunted, due to both maternal and young child undernutrition, overweight and obesity affects about one in three adults and one in ten children. Anemia, most commonly due to iron deficiency, is also affecting about a third of women of reproductive age and almost half of preschool children. Around 90% of nations have a serious burden of either two or three of these different forms of malnutrition.
Malnutrition is one of the principal and growing causes of global disease and mortality, affecting at least half of the world’s inhabitants. Programs for tackling maternal and child undernutrition have gained impetus in the last decade with a consensus developing around a package of effective interventions. The nutrition-specific interventions, mostly delivered through the health sector, are directed at immediate levels of causality, while nutrition-sensitive interventions, directed at the underlying and basic levels of causality are delivered through other sectors such as agriculture, education, social welfare, as well as water and sanitation.
Less consensus exists around the interventions needed to reduce overnutrition and the associated non-communicable diseases (NCDs), including diabetes, high blood pressure, and coronary heart disease. Prevention is certainly better than cure, however, and creating enabling environments for healthy food choices seems to be the most promising approach. Achieving “healthy diets for all,” by reducing consumption of meat and ultra-processed foods, as well as increasing consumption of fruit and vegetables, would help control rising rates of obesity and reduce NCD mortality. Adopting such healthy diets would also greatly contribute to reducing greenhouse gas emissions: the agriculture sector is responsible for producing a third of emissions, and a reduction on livestock farming would contribute to reducing global warming. Public health nutrition capacity to manage such nutrition programs is still widely lacking, however, and much still needs to be done to improve these programs and their governance.
Article
Managing Pain Within Vulnerable Populations of Seniors With Chronic Care Issues
Patricia Schofield
The Western world is facing a crisis. The population is aging dramatically, and soon there will be twice as many older adults as younger counterparts. Clearly, there is a high incidence of pain in the older population, and with this comes a significant burden, including falls, frailty, depression, anxiety, sleep disturbance, reduced mobility, and impaired cognitive function. Unfortunately, chronic pain in the older population is often neglected and poorly managed for many reasons, including the expectation that pain is part of the aging process and therefore to be expected; poor assessment practices, hampered by communication problems; limited time for a comprehensive assessment to be carried out; fear of prescribing and administering drugs; and beliefs held by the older person themselves that they should expect to be in pain and therefore do not report it. All of these issues can be addressed with appropriate education and training to enable staff to appropriately apply evidence-based guidelines and effectively manage pain.
Article
Managing the Paradox of Conflictual Policy and Strategy Regarding Health of Irregular Migrants: Perspective From Europe and Africa
Ursula Trummer, Michela Martini, and Sabelo Mbokazi
Irregular migrants belong to the most vulnerable migrant groups. Health threats associated with an irregular status are high, and access to health services is severely restricted globally. Concerning migration aspects, a common public narrative for Europe and Africa is that Africa is sending thousands of migrants to embark on an irregular life-threatening journey of migration to Europe every year. Although this is a well documented reality, it is by far not the most important migration pattern in terms of numbers and health threats when looking at Africa. It can be argued that, on the contrary, Africa is mainly characterized by south-to-south migration both for economic and humanitarian reasons, with African nation-states like Uganda being among the top three nations worldwide hosting refugees. In addition, main migration routes from Africa do not target Europe but rather other regions like the Gulf countries.
Existing dialogue between Europe and Africa has great potential to fast track and develop joint policies and strategies for meaningful, affordable legal migration patterns and access to the human right to health for irregular migrants. First, a change of the rhetoric around irregular migration from Africa mainly directed toward Europe is needed. Second, existing policies and strategies regarding the health of irregular migrants need to be examined and evaluated. Within all the huge differences concerning public health systems and capacities in Europe and Africa, a common strategy to discourage irregular migration seems to be restricting the access of irregular migrants to their human right to health through national regulations. This has paradoxically created a simultaneous inclusion on grounds of human rights regulations and exclusion on grounds of national restrictions, with “functional ignorance” (health care organizations and personnel ignore the lack of residence permits and its legal implications) and “structural compensation” (facilities run by nongovernmental organizations take over public health responsibilities and health care provision) as key features. Such strategies put a lot of strain on health care providers and irregular migrants and should not be considered as a sustainable solution.
Instead, action should be taken to overcome the paradox of contradictory migration and health policies by means of firewalls and structural mechanisms. An important step in this direction can be to rethink cooperation between Europe and Africa in this domain, starting with the development of a joint evidence base relevant for Europe and Africa in an interdisciplinary approach and with European and African scholars that can support proactive policy and strategy development to safeguard the human right to health for irregular migrants together with good migration governance.
Article
Mass Shootings as a Global Phenomenon
Jason R. Silva
There has been extensive media coverage, public concern, and calls for action surrounding mass shootings in the United States at the turn of the 21st century. To address this concern, there is a growing body of research aimed at understanding and remedying this problem in America. However, recent attacks around the world—like the Kerch Polytechnic College shooting in Ukraine, the Christchurch Mosque shooting in New Zealand, and the Suzano School shooting in Brazil—illustrate that mass shootings are a global phenomenon. To this end, it is critical for research to shed light on this troubling and complex issue and contribute to a more informed public and scholarly discourse on mass shootings and their impact around the world. To understand the global problem, it is necessary to evaluate the prevalence of incidents across countries, mass shooter backgrounds and profiles, and common locations targeted during these attacks. To address this phenomenon, it is important to consider strategies for prevention and harm mitigation, including instituting responsible gun legislation, addressing warning signs and leakage, implementing situational crime prevention measures, and advancing law enforcement responses.
Article
Maternal Health and Well-Being
Samuel Akombeng Ojong, Bridgette Wamakima, Cheryl A. Moyer, and Marleen Temmerman
Maternal health and well-being refers to the physical, psychological, and emotional well-being of women during pregnancy, childbirth, and the postnatal period, as well as the absence of any morbidities or death either due to pregnancy or its management.
Despite making a comparatively late appearance on the international global policy agenda, maternal health and well-being has progressively become a global health policy priority following Deborah Maine’s revolutionary article on maternal mortality. Consequently, key international policy events from Alma Ata to the International Conference on Population and Development events, through the Millennium Development Goals to the Sustainable Development Goals (SDGs) in the last decade have consecrated women’s inalienable right to safe and respectful health services. Also, the growing focus on rights-based care against the backdrop of the need to ensure equity in all communities worldwide has led to an evolution in policy focus, calling on health systems to not only protect women and girls from preventable deaths but to also empower them to thrive, all while recognizing their unique role is ensuring the positive transformation of the communities in which they live.
This increasing policy attention has contributed to a disproportionate yet marked reduction in global maternal mortality and morbidity statistics over the last 30 years. However, if the world is to achieve its 2030 SDGs women’s health and gender equality agendas, it is important to recognize that the broad concept of women’s health cannot be limited to the rather narrow window of pregnancy, childbirth, and the postpartum period. While there are huge gaps in all resource-type settings in promoting and protecting women’s agency and autonomy, the fact remains that in addition to ensuring the availability of and access to high-quality maternal health services, women’s health outcomes are inextricably linked to their decision-making power on key issues such as when to become sexually active, the use of contraception, whether or not they want to achieve pregnancy and childbirth, and access to safe abortion care services. Additionally, the growing burden of noncommunicable diseases and the increasing occurrence of worldwide pandemics are providing novel challenges to the health and well-being of the world’s most vulnerable women and girls, thus creating the need to ensure resilient health systems that are considerate of the rights and wishes of the world’s women and girls.
Article
Measuring Mortality Crises: A Tool for Studying Global Health
Stefano Mazzuco
Measuring the impact of a public health crisis in terms of mortality might seem a straightforward method to quantify its effect on the population because deaths are much more easily registered compared to other health outcomes. However, despite the intuitive appeal of this path, it is far from obvious how to best operationalize it, and all the most used methods have drawbacks that should be kept in mind. Especially during the COVID-19 pandemic, the major routes that have been considered are cause-specific death counts (and related measures such as case fatality rates), excess deaths estimates, and life expectancy decline. All the considered approaches have limitations: Cause-specific deaths are often subject to undercount or overcount issues with significant differences both between and within countries, excess deaths estimates may strongly depend on the baseline (there are several methods to estimate it), and life expectancy drop estimates (or estimates of years of life lost) also depend on the reference level used, which can vary substantially across countries. More generally, the issues of available data quality and standardization of age structure should be taken into proper account. Thus, the choice of which approach is worth using depends on the characteristics of the crisis that need to be evaluated and the type and quality of data available. Interestingly, the three approaches can also be combined so that some of their limitations can be mitigated.
Article
Membrane Filtration
Maryna Peter
Membrane systems provide a physical barrier to various contaminants in water and therefore are attractive for different applications. Depending on the type of the membrane and its pore size, membranes might remove microbial contaminants, organic chemicals, or salts. The membrane-based systems for drinking water purification exist at different scales. The costs have decreased considerably since the 1990s, increasing the attractiveness for various needs and affordability levels. Household tabletop filters and filters installed under a sink can be used when public water supply quality is unreliable or in emergencies with locally available buckets or jerry cans. Gravity or solar-driven systems exist for off-grid applications in schools, health care facilities, or small communities. Skid-mounted and container-based desalination units are deployed in emergencies when brackish or saline water sources are the only option. Large-scale membrane-based drinking water treatment plants operate worldwide for municipal drinking water treatment. The modular design and flexibility around the capacity, target contaminants, and available energy sources offer opportunities for membrane-based drinking water treatment in various contexts. Further research and development should focus on mitigating membrane fouling, and reducing energy consumption, costs, and the overall technical complexity of the systems.
Article
Menopause
Funmilola M. OlaOlorun and Wen Shen
Menopause is the natural senescence of ovarian hormonal production, and it eventually occurs in every woman. The age at which menopause occurs varies between cultures and ethnicities. Menopause can also be the result of medical or surgical interventions, in which case it can occur at a much younger age. Primary symptoms, as well as attitudes toward menopause, also vary between cultures. Presently, the gold standard for treatment of menopause symptoms is hormone therapy; however, many other options have also been shown to be efficacious, and active research is ongoing to develop better and safer treatments.
In a high-resource setting, the sequelae/physiologic changes associated with menopause can impact a woman’s physical and mental health for the rest of her life. In addition to “hot flashes,” other less well-known conditions include heart disease, osteoporosis, metabolic syndrome, depression, and cognitive decline. In the United States, cardiac disease is the leading cause of mortality in women over the age of 65. The growing understanding of the physiology of menopause is beginning to inform strategies either to prevent or to attenuate these common health conditions. As the baby boomers age, the distribution of age cohorts will increase the burden of disease toward post-reproductive women. In addition to providing appropriate medical care, public health efforts must focus on this population due to the financial impact of this age cohort of women.
Article
Menstrual Health
Erin C. Hunter, Adesola O. Olumide, and Marni Sommer
Menstruation refers to the periodic flow of blood from the uterus exiting the body through the vagina. Menarche (the first menstruation) signals the onset of reproductive maturity in females and is a result of the shedding of the wall of the uterus that occurs when there is no implantation of a fertilized ovum. The menstrual cycle commences on the first day of menstrual blood flow until the day before the next menstrual blood flow, and the cycle lasts an average of 28 days.
Menstrual health refers to the state of complete physical, mental, and social well-being related to the menstrual cycle and is integral to both human rights to dignity and reproductive health as well as achieving multiple Sustainable Development Goals. The concept of menstrual health as a holistic framework encompasses the factors that contribute to the menstrual experiences of girls, women, and all people who menstruate—as well as the broader impacts of those menstrual experiences on well-being.
The menstrual cycle has historically been neglected in global health discussions. The inaccessibility and inadequacy of information, support, and resources necessary for experiencing optimal menstrual health can have consequences for the physical health, well-being, social participation, education, and economic opportunities of individuals who menstruate. Timely provision of accurate, age-appropriate information about the menstrual cycle and the practical aspects of experiencing menstrual periods is important for girls who will soon reach menarche—and also for the wider population to foster appropriate social support and inclusive environments that accommodate the needs of those who menstruate. Such needs include access to effective and affordable menstrual materials and appropriate sanitation facilities with waste disposal mechanisms, timely diagnosis and treatment for menstrual discomforts and disorders, and freedom from menstrual stigma. Promoting menstrual health thus requires comprehensive efforts to promote menstrual health education, address pervasive menstrual stigma, challenge social norms that perpetuate discrimination based on menstruation, and improve access to necessary resources for addressing menstrual needs.
Article
Mental Health of Migrant Children
Saida M. Abdi
The psychosocial well-being of migrant children has become an urgent issue facing many Western countries as the number of migrant children in the population increases rapidly and health-care systems struggle to support them. Often, these children arrive with extensive exposure to trauma and loss before facing additional stressors in the host country. Yet, these children do not access mental health support even when available due to multiple barriers. These barriers include cultural and linguistic barriers, the primacy of resettlement needs, and the stigma attached to mental health illness. In order to improve mental health services for migrant children, there is a need to move away from focusing on trauma and mental health symptoms and to look instead at migrant children’s well-being across multiple domains, including activities that can promote or diminish psychological well-being. Trauma Systems Therapy for Refugees (TST-R) is an example of an approach that has succeeded in overcoming these barriers by adopting a culturally relevant and comprehensive approach to mental health care.
Article
Mental Health of Refugees
Jutta Lindert
People who are forcibly displaced are forced to flee by serious threats to fundamental human rights, caused by factors such as persecution, armed conflict, and indiscriminate violence. Contemporary drivers of forced displacement are increasingly complex and interrelated. They include population growth, food insecurity, and water scarcity, at times compounded and multiplied by the effects of climate change. A refugee is someone who fled his or her home and country owing to “a well-founded fear of persecution because of his/her race, religion, nationality, membership in a particular social group, or political opinion,” according to the United Nations 1951 Refugee Convention. Internally displaced persons (IDPs) are people who have not crossed an international border but were forced to move to a different region than the one they call home within their own country. People who cannot return home without serious risk to their human rights have specific needs.
Forced displacement, both within a country and to other countries, is a major life event that abruptly changes environmental living conditions, such as social networks, language, and cultural environment of the displaced populations. The changes in environmental living conditions and disruptions in life challenge both the individual and the families of the displaced persons. Both types of forced displacement challenge adaptational mechanisms of individuals and families. Accordingly, the challenges can contribute to changes in mental health and mental disorders. However, estimates of mental health, mental disorders, and mental health determinants vary across and between forcibly displaced persons. This heterogeneity in estimates is associated with differences between refugee groups and with methodological difficulties in assessing refugees’ mental health. Instruments to assess mental health need to be culture-grounded and gender-sensitive to capture the scope and extent of refugees’ mental health and mental disorders. Based on reliable and valid instrument needs for assessing mental health and mental disorders, determinants can be identified and intervention can be developed and evaluated.
Article
Migrant Health in Refugee Camps: A Neglected Public Health Issue
Manuela Valenti
There are 1 billion migrants in the world today, which means that one in seven of the world’s population are migrants. Of these, 272 million are international migrants and 763 million are internal migrants. It is estimated that around 70 million of the world’s migrants, both internal and international, have been forcibly displaced.
Many things force people to leave their homes in search of a better future: war, poverty, persecution, climate change, desertification, urbanization, globalization, inequality, and lack of job prospects. Migrants remain among the most vulnerable members of society even when their living conditions improve after migration.
Migrant women and children are a particularly vulnerable group and have a great need for basic and preventive health care.
Many refugees and migrants are young and in good health, but hard living conditions and difficulty accessing basic health care can affect their state of health. Many of them face inhuman journeys during migration and live in refugee camps with very low standards of hygiene; when they find a job, they are often exploited. All these things can also affect their mental health.
Migrants struggle with similar challenges as other marginalized groups when it comes to access to health care, but they face the additional barriers of mobility, language barriers, cultural differences, lack of familiarity with local health care services, and limited eligibility for publicly and privately funded health care.
Governments should provide affordable preventive and basic health care to refugees and migrants not only because it is a human right but also because in the long term it can lower the costs of the whole health care system.
Article
Migration and Obesity
Solveig A. Cunningham and Hadewijch Vandenheede
There are over 230 million international migrants worldwide, and this number continues to grow. Migrants tend to have limited access to and knowledge about resources and preventative care in their communities of reception, but nonetheless they are often in better health by many measures compared with native-born people in their communities of reception and with the people they left behind at their place of origin. With time since arrival, however, immigrants’ health advantages often dissipate and they experience increases in health problems, especially obesity and diabetes, which are chronic diseases that are increasingly prevalent in the overall population as well and are associated with multiple co-morbidities and limitations. It may be that immigrants have specific health endowments leading to these health patterns, or that the processes involved in migration, including exposure to new environments, behavioral change, and stress of migration may also affect risks of obesity and other chronic conditions. Understanding the health patterns of migrants can be useful in identifying their specific health needs, as well as contributing to our understanding of how specific environments, changes in environments, and individual health endowments interplay to shape the long-term health of populations.
Article
Migration, Migrants, and Health in Latin America and the Caribbean
Deisy Ventura, Jameson Martins da Silva, Leticia Calderón, and Itzel Eguiluz
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.
Article
Monitoring and Evaluation of Sexual and Reproductive Health Programs
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
Monitoring Migrants’ Health Risk Factors for Noncommunicable Diseases
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
Newborn Mortality
Li Liu, Lucia Hug, Diana Yeung, and Danzhen You
As under-5 mortality declines globally, newborn or neonatal mortality is becoming increasingly important. Depending on measurement and empirical data sources, calculation of the magnitude and trend of all-cause and cause-specific neonatal mortality ranges from direct methods to model-based estimates. From 1990 to 2019, the global neonatal mortality rate decreased by 52%, though wide regional variations persist, with sub-Saharan Africa (SSA) consistently experiencing the highest neonatal mortality rates, followed by Southern Asia, accounting for 79% of the 2.4 million total newborn deaths in 2019. Globally, most deaths in 2019 are due to preterm birth complications (36%), intrapartum-related events (24%), congenital abnormalities (10%), pneumonia (8%), and sepsis (7%). Since 2000, in low- and middle-income regions like Central Asia and South Asia and SSA, most deaths were avoided through declines in intrapartum-related events (3.4% and 1.9% AARR [average annual rate of reduction from 2000 to 2019], respectively) and preterm birth complications (2.9% and 1.9% AARR, respectively); whereas high-income regions like Europe, Northern America, Eastern Asia and South-Eastern Asia were more rapidly able to reduce deaths due to congenital abnormalities (2.8% and 3.2% AARR, respectively). More investment is urgently required to improve data collection and data quality, as well as to leverage supporting empirical data with statistical modeling to improve the validity of neonatal mortality and cause-of-death estimates.
