Accountability in global health systems: insights from a network analysis of Purdue Pharmaceuticals.

IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Andrea Bowra, Amaya Perez-Brumer, Lisa Forman, Jillian Clare Kohler
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Abstract

Beginning in 1996, Purdue Pharmaceuticals (Purdue) knowingly mislabeled and mass marketed OxyContin (oxycodone), an opioid painkiller, catalyzing the opioid crisis which has been responsible for more than 600 000 deaths in and beyond North America. This case is an extreme example of how transnational pharmaceutical companies prioritize shareholder profits over public wellbeing. As such, the field of global health faces the critical challenge of better understanding how transnational pharmaceutical companies, like Purdue, can be held to account for the harms they cause. Within the framework of Actor-Network Theory, a sociomaterial approach to analyzing complex networks, this case study uses key informant interviews (n = 18) to examine how accountability is taken up in and by global health systems in response to the harms caused by Purdue. Findings highlight the multiple co-existing versions of accountability enacted within global health systems organized as three separate but interrelated networks: social accountability, political accountability, and legal accountability. Though often interconnected, these diverse networks mobilized distinct tools, resources, and strategies, such as news articles, scholarly literature, and policy guidelines, to construct and stabilize enactments of accountability. Through this in-depth examination of the complex interactions involved in global health and pharmaceutical systems, this study offers a nuanced understanding of the diverse actors mobilized and the unique strengths leveraged within and by accountability networks. Further, in examining these networks' differences, interconnectedness, and peculiarities, we broaden the scope of how accountability is defined, conceptualized, and operationalized in global health systems.

全球卫生系统的责任:来自普渡制药公司网络分析的见解。
从1996年开始,普渡制药公司(Purdue Pharmaceuticals)故意贴错标签并大规模销售奥施康定(oxycodone),这是一种阿片类止痛药,催化了阿片类药物危机,该危机已导致北美及其他地区60多万人死亡。这个案例是跨国制药公司将股东利益置于公众福祉之上的一个极端例子。因此,全球卫生领域面临着一个关键的挑战,那就是更好地理解如何让像普渡这样的跨国制药公司为它们造成的危害负责。在行动者网络理论(一种分析复杂网络的社会材料方法)的框架内,本案例研究使用关键信息提供者访谈(n = 18)来检查全球卫生系统如何承担责任,以应对普渡大学造成的危害。调查结果强调了在全球卫生系统内制定的多重并存的问责制,这些问责制组织为三个独立但相互关联的网络:社会问责制、政治问责制和法律问责制。尽管经常相互联系,这些不同的网络调动了不同的工具、资源和策略,如新闻文章、学术文献和政策指导方针,以构建和稳定问责制的制定。通过对全球卫生和制药系统所涉及的复杂相互作用的深入研究,本研究提供了对动员的各种行动者以及问责网络内部和通过问责网络利用的独特优势的细致理解。此外,在检查这些网络的差异、相互联系和特点时,我们扩大了在全球卫生系统中如何定义、概念化和实施问责制的范围。
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来源期刊
Globalization and Health
Globalization and Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
18.40
自引率
1.90%
发文量
93
期刊介绍: "Globalization and Health" is a pioneering transdisciplinary journal dedicated to situating public health and well-being within the dynamic forces of global development. The journal is committed to publishing high-quality, original research that explores the impact of globalization processes on global public health. This includes examining how globalization influences health systems and the social, economic, commercial, and political determinants of health. The journal welcomes contributions from various disciplines, including policy, health systems, political economy, international relations, and community perspectives. While single-country studies are accepted, they must emphasize global/globalization mechanisms and their relevance to global-level policy discourse and decision-making.
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