Globalization and Health最新文献

{"title":"Corruption risks in COVID-19 vaccine deployment: lessons learned for future pandemic preparedness.","authors":"Gul Saeed, Jillian Clare Kohler","doi":"10.1186/s12992-025-01096-6","DOIUrl":"10.1186/s12992-025-01096-6","url":null,"abstract":"<p><strong>Background: </strong>During the COVID-19 pandemic corruption risks were amplified in health systems globally, increasing health inequities within and between countries. During the pandemic, the deployment of COVID-19 vaccines, particularly concerning their procurement and distribution, had corruption risks given the large amounts of public and private funding allocated to them, the need for speed, the involvement of a high number of stakeholders, and often insufficient oversight. To explore this issue further, we conducted a descriptive, qualitative study of corruption risks in the COVID-19 vaccine deployment process.</p><p><strong>Methods: </strong>We conducted a descriptive, qualitative study triangulating two data sources between May and August 2022: (1) published academic and grey literature and (2) key informant interviews with representatives from organizations involved with the COVAX Facility, representatives from COVAX donor and recipient countries, and individuals with expert knowledge of the COVID-19 vaccine deployment process (e.g., consultants for international organizations involved in COVID-19 vaccine deployment, members of non-governmental organizations, etc.).</p><p><strong>Results: </strong>We identified 44 academic articles and policy documents and triangulated. Documentary data with 16 key informant interviews. A review of the literature identified several corruption risks in the international COVID-19 vaccine procurement and distribution process such as a lack of transparency in the vaccine procurement process; a lack of transparency in the operation of the COVAX Facility; a risk of bribery; and a risk of vaccine theft or the introduction of substandard and falsified vaccines at the point of distribution. Key informants further articulated concerns about a lack of transparency in vaccine pricing and contracts and the exclusion of civil society organizations from the vaccine deployment process. Reported anti-corruption, transparency, and accountability (ACTA) mechanisms implemented across the many levels of the vaccine procurement and distribution deployment included institutional oversight processes, blockchain-based supply-chain solutions, and civil society engagements.</p><p><strong>Conclusion: </strong>Public health emergencies require nimble and quick actions on the part of governments, international organizations and other actors Our study on the COVID-19 vaccine deployment process highlights the pressing need for more robust ACTA mechanisms to reduce corruption risks and ensure fair and equitable access to lifesaving vaccines for populations.</p>","PeriodicalId":12747,"journal":{"name":"Globalization and Health","volume":"21 1","pages":"8"},"PeriodicalIF":5.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11887148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stakeholder perceptions on the impact of trade and investment agreements on nutrition policy space in small island developing states.","authors":"Noah Bunkley, Judith McCool, Kelly Garton","doi":"10.1186/s12992-024-01091-3","DOIUrl":"10.1186/s12992-024-01091-3","url":null,"abstract":"<p><strong>Background: </strong>Trade liberalisation has contributed to obesogenic food environments globally. Small Island Developing States (SIDS) have some of the world's highest rates of obesity and nutrition-related noncommunicable diseases. Nutrition regulations have been recognised as necessary population health measures for combating malnutrition, however, legally-binding trade and investment agreements (TIAs) can constrain the policy options available to governments. Geographical, economic, historical, and cultural contexts of SIDS may place them at greater risk of TIA constraints resulting in barriers to the uptake of public health nutrition policies. This article explores the perceptions and experiences of key SIDS nutrition and trade policy stakeholders regarding SIDS' ability to formulate and implement healthy nutrition policies in the context of TIAs.</p><p><strong>Methods: </strong>Twelve semi-structured interviews were conducted with key Pacific and Caribbean stakeholders. Analysis was performed via a critical realist grounded theory approach. TIA constraints to policy space, challenges faced by SIDS, and solutions for improving nutrition policy space were identified.</p><p><strong>Findings: </strong>Participants identified that TIAs did not substantively constrain nutrition policy so long as the policy targeted a legitimate public health objective, was evidenced-based, non-discriminatory, non-arbitrary, necessary, and the least trade-restrictive measure available. However, TIAs were perceived to pose structural and procedural constraints in the form of regulatory chill, increased burden of ensuring trade-compliant nutrition policies, unfair TIA negotiation processes, inconsistent perceptions of 'unhealthy' foods, trade liberalisation ideology, and industry interference. These constraints were noted to be particularly acute for SIDS due to their financial and capacity constraints, industry influence and limited international power.</p><p><strong>Conclusion: </strong>TIA obligations were deemed unlikely to substantively prevent meaningful public health nutrition policies from being developed and implemented in SIDS if nutrition policy met specific trade principles. However, concerns were noted that some of these principles may impose procedural and structural constraints that risked preventing, postponing or diluting potential nutrition policies. These constraints may be particularly problematic for SIDS due to their contextual challenges. Despite this, local, regional and international actors can increase SIDS' policy space through capacity building, fostering multisectoral collaboration, developing conflict of interest policies, improving TIA negotiation processes, and championing the prioritisation of public health nutrition in trade governance.</p>","PeriodicalId":12747,"journal":{"name":"Globalization and Health","volume":"21 1","pages":"7"},"PeriodicalIF":5.9,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Equity of National Essential Public Health Services (NEPHS) in Mainland China, 2019: a cross-sectional study based on the NEPHS database.","authors":"Lu Liu, Jinhong Zhao, Yuxing Wang, Xinyue Chen, Siqi Zhang, Mengyu Li, Lili You, Yuanli Liu","doi":"10.1186/s12992-025-01101-y","DOIUrl":"10.1186/s12992-025-01101-y","url":null,"abstract":"<p><strong>Background: </strong>China's National Essential Public Health Service (NEPHS) Program was launched in 2009 to deliver population-based public health and individual health management services to all residents at 800,000 primary health-care centers nationwide. This study assessed NEPHS utilization data and evaluated usage inequities using comprehensive nationwide data.</p><p><strong>Methods: </strong>A cross-sectional study was conducted, selecting 16 indicators (out of 18) from 12 service packages to evaluate inequity. These included 4 indicators for services provided to all residents and 12 for pregnant women, new mothers, children aged 0-6 years, and patients with hypertension, diabetes, severe mental disorders, or tuberculosis. Data on service utilization and target populations for these indicators across the 31 provinces and 453 cities in mainland China were obtained from the NEPHS database and management platform for the period January 1 to December 31, 2019. Service utilization rates and bias-corrected bootstrap confidence intervals (CIs) were calculated to determine utilization. Inequities were assessed using the Gini coefficient and Sitthiyot-Holasut composite inequality index at the national and provincial levels, and the Theil index was employed to decompose overall inequity into within-region and between-region subgroups.</p><p><strong>Results: </strong>The NEPHS collected health records for 88.25% of China's permanent residents (95% CI: 79.23%-98.82%). The nationwide vaccination coverage rate was 97.44% (95% CI: 91.33%-99.91%). Newborn visit and child health management rates for children aged 0-6 years were 92.08% (95% CI: 74.85%-98.34%) and 90.87% (95% CI: 82.49%-98.47%), respectively. At the national level, NEPHS service utilization in 2019 was generally equitable, with Gini coefficients below 0.4 for the 15 indicators. Potential large equity gaps were observed in the provision of health education services in Shanghai [Gini coefficient = 0.358 (95% CI: 0.219, 0.444)], Inner Mongolia [Gini coefficient = 0.370 (95% CI: 0.073, 0.440)] and Xinjiang [Gini coefficient = 0.457 (95% CI: 0.217, 0.502)]. Additionally, the utilization of family planning education and sanitation inspection services also indicated potential large and severe equity gap in 13 provinces. The Theil indices revealed that inequities primarily existed within rather than between regions. Province-level results indicated perfect equity in health record management and vaccination coverage, while several provinces showed potential equity gaps in health education and family planning services. Potential equity gaps were also observed in health management services for patients with hypertension and diabetes, particularly in Beijing, Hunan and Xinjiang.</p><p><strong>Conclusions: </strong>This study provides evidence for health planning in China's primary health sector and guidance for analyzing equity in national health programs similar to the NEPHS Program.</p>","PeriodicalId":12747,"journal":{"name":"Globalization and Health","volume":"21 1","pages":"6"},"PeriodicalIF":5.9,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Normative convergence between global health security and universal health coverage: a qualitative analysis of international health negotiations in the wake of COVID-19.","authors":"Arush Lal, Clare Wenham, Justin Parkhurst","doi":"10.1186/s12992-025-01099-3","DOIUrl":"10.1186/s12992-025-01099-3","url":null,"abstract":"<p><strong>Background: </strong>The UN Sustainable Development Goals (SDGs) and WHO Thirteenth General Programme of Work underscored the importance of mitigating health emergencies while ensuring accessible and affordable health services. Central to these efforts are global health security (GHS) and universal health coverage (UHC), which act both as standalone goals and as cross-cutting approaches to health policy and practice. While GHS and UHC each operate as distinct norms, global health stakeholders increasingly advocate for advancing them synergistically to address interconnected health challenges amid limited resources. However, the current extent of alignment between GHS and UHC remains unclear, especially post-COVID-19. This qualitative study assesses normative convergence between GHS and UHC by tracing their development through iterative draft texts across two major international health negotiations - specifically examining how UHC norms are expressed in the WHO Pandemic Agreement, and how GHS norms are expressed in the 2023 UNGA Political Declaration on Universal Health Coverage.</p><p><strong>Results: </strong>UHC was promoted in the WHO Pandemic Agreement through three closely-associated discourse themes (rights-based narratives, equity frames, focus on social determinants of health) and three closely-associated core functions (accessible and affordable health commodities, prioritizing vulnerable populations, primary health care approach). Meanwhile, GHS was reciprocally promoted in the 2023 UHC Political Declaration through three related discourse themes (existential threat narratives, resilience frames, focus on infectious diseases) and three related core functions (outbreak preparedness, health emergency response, One Health approach).</p><p><strong>Conclusions: </strong>The findings indicate that the COVID-19 pandemic created a policy window uniquely-positioned to accelerate normative convergence between GHS and UHC. Both international agreements advanced convergence by demonstrating increased complementarity and interdependency between the two norms through the co-promotion of their underlying features. However, negotiators agreed to political and operational trade-offs which made it difficult to sustain progress. This study provides a nuanced account of how global health norms evolve through integration in complex policy environments - finding that normative convergence may not always be explicit, but rather implicit through incremental linkages in their underlying discourse and core functions. This research contributes to pragmatic efforts by global health actors seeking consensus amidst an era of polycrisis, and highlights the importance of navigating geopolitics and overcoming path dependencies. It also deepens scholarly understanding on how 'hybrid norms' develop through the dynamic process of normative convergence via diplomacy.</p>","PeriodicalId":12747,"journal":{"name":"Globalization and Health","volume":"21 1","pages":"5"},"PeriodicalIF":5.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11853778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A political economy analysis of the legislative response to unhealthy food and beverage marketing in Chile, Canada and the UK.","authors":"Fiona Sing, Sally Mackay, Boyd Swinburn, Kelly Garton","doi":"10.1186/s12992-024-01093-1","DOIUrl":"10.1186/s12992-024-01093-1","url":null,"abstract":"<p><p>United Nations bodies call for legal responses to restrict children's exposure to unhealthy food marketing; however, few governments have introduced legislative controls. This research studies the underlying political economy influences that impacted the introduction of legal responses. We used a multiple case study methodology to examine the political economy influences on the policy process in three contexts (Chile, Canada and the UK). Data from documentary evidence and 21 semi-structured key informant interviews were analysed using a political economy framework studying the institutions, interests, ideas and the associated power dynamics that shaped the policy process. The prevailing neoliberal ideologies and overarching institutional paradigm, in which all actors were operating, meant any form of government intervention had to be justified, evidence-based and no more intrusive on commercial enterprise and public life than necessary. The neoliberal paradigm permeated each of the political economy elements (institutions, ideas and interests). In addition, its influence was observed in all stages of the policy process, from introduction through to adoption of the resulting law or regulation, and experienced in both the executive and legislative branches of government. A paradigm shift away from the protection and primacy of commercial enterprise and limited government interference would reduce the barriers governments face when introducing legislative responses to unhealthy food marketing. These dynamics may be tempered if institutional, actor and discursive power is harnessed in support of the legitimate public health measure, which would involve a strong mandate for the ministry responsible and a dedicated and influential policy entrepreneur. - Provides an insight into how three different governments legislated unhealthy food marketing. - Provides lessons for other governments about what challenges those countries faced and how they overcame them. - Considers the political reality behind policy making that impacts on how evidence-based policy making occurs.</p>","PeriodicalId":12747,"journal":{"name":"Globalization and Health","volume":"21 1","pages":"4"},"PeriodicalIF":5.9,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"States, global power and access to medicines: a comparative case study of China, India and the United States, 2000-2019.","authors":"Berit S H Hembre, Maulik Chokshi, Steven J Hoffman, Fatima Suleman, Steinar Andresen, Kristin Sandberg, John-Arne Røttingen","doi":"10.1186/s12992-024-01092-2","DOIUrl":"10.1186/s12992-024-01092-2","url":null,"abstract":"<p><strong>Background: </strong>What constitutes state`s global power to shape access to medicines? How was it distributed between states and how did this change from 2000 to 2019? In this comparative case study, we explored the powers of China, India and the United States, and discuss whether our findings from the pre-pandemic era were reflected in the global COVID-19 response related to pharmaceuticals. We used an analytical framework from the international relations literature on structural power, and assessed the following power structures after adapting them to the context of access to medicines: finance, production, financial protection, knowledge, trade and official development assistance.</p><p><strong>Results: </strong>We found that from 2000 to 2019 there had been a power-shift towards China and India in terms of finance and production of pharmaceuticals, and that in particular China had increased its powers regarding knowledge and financial protection and reimbursement. The United States remained powerful in terms of finance and knowledge. The data on trade and official development assistance indicate an increasingly powerful China also within these structures. During the COVID-19 pandemic, we found that the patterns from previous decades were continued in terms of cutting-edge innovation coming out of the United States. Trade restrictions from the United States and India contrasted our findings as well as the limited effective aid from the United States. Building on our findings on structural powers, we argue that both structural power and political decisions shaped access to medical technologies during the COVID-19 pandemic. We also examined the roles and positions of the three states regarding developments in global health governance on the COVAX mechanism, the TRIPS Agreement waiver and the pandemic accord in this context.</p><p><strong>Conclusion: </strong>From 2000-2019, China and India increased their structural powers to shape global access to medical technologies. The recent COVID-19 pandemic demonstrated that both structural power and political decisions shaped global access to COVID-19 technologies.</p>","PeriodicalId":12747,"journal":{"name":"Globalization and Health","volume":"21 1","pages":"3"},"PeriodicalIF":5.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Awareness and knowledge regarding female genital schistosomiasis among European healthcare workers: a cross-sectional online survey.","authors":"Valentina Marchese, Aaron Remkes, Irina Kislaya, Pia Rausche, André Brito, Jana Christina Hey, Tahinamandranto Rasamoelina, Rivo Andry Rakotoarivelo, Jürgen May, Daniela Fusco","doi":"10.1186/s12992-024-01095-z","DOIUrl":"10.1186/s12992-024-01095-z","url":null,"abstract":"<p><strong>Background: </strong>Adequate knowledge and awareness regarding diseases are essential for appropriate, high-quality healthcare. Female Genital Schistosomiasis (FGS) is a non-sexually transmitted gynaecological disease that is caused by the presence of Schistosoma haematobium eggs in the female genital tract and the resulting immune response that causes tissue damage. It is estimated to affect 56 million women, mostly in sub-Saharan Africa (SSA), where healthcare workers (HCWs) have limited awareness and knowledge of FGS. Most migrants in Europe are female, often from SSA and therefore at risk of FGS. This study investigated awareness and knowledge of FGS among European HCWs with the aim of informing strategies to improve the management of migrant health.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey using a self-administered, closed, multilingual, anonymous online questionnaire between 1st June 2023 to 31st January 2024. Medical doctors (MDs) (n = 581) and nurses or midwives (NMs) (n = 341) working in infectiology, gynaecology, urology and general, travel, internal or occupational medicine in European countries were enrolled in the survey. A Poisson regression was used to identify factors associated with MDs' knowledge and awareness of FGS and adjusted prevalence ratios (aPR) were estimated. Practices related to FGS were described using counts and proportions for a subsample of MDs aware of FGS.</p><p><strong>Results: </strong>Among the 922 eligible participants, FGS awareness was 43.7% (CI95%: 39.6; 47.9) for MDs and 12.0% (CI95%: 8.8; 16.0) for NMs. FGS awareness among MDs was higher among men (50.0%; CI95%: 43.7; 56.3), working in clinics for migrants (72.0%, CI95%: 63.2; 79.7) and among infectiologists/travel medicine specialists (68.9%, CI95%: 62.2; 75.0). No knowledge was reported by 67.6% (95% CI 63.7-71.4) of MDs, while 25.3% (CI95%: 21.8; 29.0) had low and 7.1% (CI95%: 5.1; 9.5) medium knowledge. Working in healthcare for migrants was positively associated with medium knowledge (aPR = 3.49; CI95% 1.67;7.28), which was lower for general practitioners (aPR = 0.23, CI95%:0.07;0.81).</p><p><strong>Conclusions: </strong>Our study highlights that HCWs in Europe might not be adequately prepared to manage FGS patients, resulting in a high risk of neglect. We believe that the promotion of existing medical networks could improve knowledge about FGS and thus the health of migrant women.</p>","PeriodicalId":12747,"journal":{"name":"Globalization and Health","volume":"21 1","pages":"2"},"PeriodicalIF":5.9,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11715917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on \"Social protection and the International Monetary Fund: promise versus performance\" by Alexander Kentikelenis and Thomas Stubbs.","authors":"James Pfeiffer","doi":"10.1186/s12992-024-01081-5","DOIUrl":"https://doi.org/10.1186/s12992-024-01081-5","url":null,"abstract":"<p><strong>Background: </strong>The Covid pandemic and its aftermath have triggered new alarm and social unrest across the Global South over the deepening international debt crisis that now threatens to derail Universal Health Coverage (UHC), other Sustainable Development Goals (SDGs), future pandemic preparedness, and global warming mitigation. The recent Globalization and Health article by Alex Kentikelenis and Thomas Stubbs (May 2024), \"Social protection and the International Monetary Fund: promise versus performance\", offers a meticulously quantified rendering of the social costs imposed by the crisis and takes aim at IMF solutions. They advocate for a rejection of IMF austerity programs and offer a valuable prescription for change through the International Labor Organization's \"Universal Social Protection\" concept.</p><p><strong>Main body: </strong>Similar to the Jubilee movement at the turn of the century, global civil society, humanitarian aid, and health organizations are mobilizing in a variety of global networks to call for debt cancellation and restructuring as well as an end to austerity. These include new debt law campaigns in London and New York to rein in private creditors, calls for new IMF issuance of \"Special Drawing Rights\", demands for \"Global Public Investment\", and promotion of Universal Social Protection.</p><p><strong>Conclusion: </strong>The Universal Social Protection approach described by Kentikelenis and Stubbs provides a focal point for these demands to confront this latest and worst episode of sovereign debt crisis already undermining global health progress.</p>","PeriodicalId":12747,"journal":{"name":"Globalization and Health","volume":"21 1","pages":"1"},"PeriodicalIF":5.9,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11705845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An exploratory case study of food sharing practices in Caribbean countries through a transition lens using intergenerational dyad interviews.","authors":"Anna Brugulat-Panés, Louise Foley, Madhuvanti M Murphy, Nigel Unwin, Cornelia Guell","doi":"10.1186/s12992-024-01094-0","DOIUrl":"10.1186/s12992-024-01094-0","url":null,"abstract":"<p><strong>Background: </strong>Caribbean populations face complex health issues related to diet and food security as they undergo a rapid nutrition transition, resulting in some of the world's highest number of premature deaths from noncommunicable diseases (NCDs). Despite policy efforts to promote local and regional food consumption, reliance on food imports remains high with many Caribbean countries importing more than 80% of their food from larger economies. Previous regional research revealed the importance of food sharing practices in the Caribbean, with implications for the consumption of local foods, food security, and community resilience against climate change. However, there is limited understanding of these practices and how they have evolved.</p><p><strong>Methods: </strong>Using a transition lens, we explored the generational, life course, and sociocultural factors influencing food sharing practices in the Caribbean. We conducted semistructured online interviews with 10 intergenerational dyads involved in food sharing recruited from the virtual campus of the University of West Indies. Our study sample included 20 participants, ranging from 18 to 83 years old, from five English-speaking Caribbean countries (6 different islands).</p><p><strong>Results: </strong>Food sharing practices had a central role within the social fabric of all participants, contributing to their mental health and well-being. They represented a fundamental aspect of participants' culture and traditions, driving a sense of belonging and connection among Caribbean communities. However, contemporary food sharing practices indicated a move towards more convenience-oriented and processed foods, with reduced time spent cooking and a decline in the use of food sources such as backyard gardens, fishing, and marketplaces, with a preference for supermarkets. These trends, particularly observed among younger generations, aligned with the ongoing nutrition transition in the Caribbean and were influenced by various sociopolitical and environmental factors such as climate events, economic fluctuations, urbanisation, and changing family structures.</p><p><strong>Conclusions: </strong>The evolving landscape of food sharing practices in the Caribbean has linkages with various domains of nutrition, health, society, culture, environment and globalisation. While a transition towards less healthy diets will increase the risk of many NCDs, the intrinsic cultural, social, and emotional benefits of food sharing could also positively impact health outcomes in the Caribbean region.</p>","PeriodicalId":12747,"journal":{"name":"Globalization and Health","volume":"20 1","pages":"88"},"PeriodicalIF":5.9,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11669230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"China's position and competitiveness in the global antibiotic value chain: implications for global health.","authors":"Yang Yang, Lewis Husain, Yangmu Huang","doi":"10.1186/s12992-024-01089-x","DOIUrl":"10.1186/s12992-024-01089-x","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Antibiotics are a key commodity for global health, and inadequate access is a major contributor to global mortality. COVID-19 has refocused attention on global pharmaceutical value chains and the need for sustainable and secure production and supply of key products, including antibiotics. Production of antibiotics and their active pharmaceutical ingredients is capital- and technology-intensive, however, and value chains are dominated by a limited number of countries. China is known to be one of the largest producers, but its position in global value chains has not previously been analyzed. This is important for discussions about equitable and resilient global supplies, including through global instruments such as the pandemic treaty.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study utilizes data from the International Trade Center database to analyze global and Chinese export trade patterns in the antibiotic industry from 2002 to 2021, along with trends in comparative advantage. The antibiotic trade data included in this study covers different antibiotic products, including some tuberculosis drugs, while other types of antimicrobial drugs (such as antivirals, antiparasitics) are excluded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The export share of antibiotic ingredients from China increased from 9.0% in 2002 to 44.5% in 2021. China is the largest exporter of antibiotic ingredients (with a strong comparative advantage). Additionally, the export share of antibiotic medicines increased from 0.5% in 2002 to 6.5% in 2021, making it the 7th largest exporter of antibiotic medicines (though with a comparative disadvantage). The proportion of antibiotic medicines in China's exports is gradually increasing, though the country's antibiotic industry is expected to remain in the upstream-to-midstream segments of the global supply chain in the short term. China's export market for antibiotic medicines is fragmented, focusing on developing countries, though European (17.9% in 2021) and North American markets (13.1% in 2021) are increasing in importance. China's weight in global antibiotic exports, particularly of antibiotic ingredients, creates dependencies for countries reliant on China, and for Chinese companies reliant on certain overseas markets.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;China is central to global antibiotic manufacturing. Policies promoting the reshaping of global supply chains and reshoring of critical medicines will likely create challenges for Chinese exporters, though are unlikely to alter the global supply structure in the short term. This has implications for Chinese policymakers, including strengthening innovation, quality, international competitiveness, and diversifying markets. Equally, China's huge manufacturing capability, cost advantages, and rapid scientific and technological progress, make the country an inevitable and important part of future arrangements to ensure equitable global antibiotic access. As the Chine","PeriodicalId":12747,"journal":{"name":"Globalization and Health","volume":"20 1","pages":"87"},"PeriodicalIF":5.9,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11656612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}