http://www.globalizationandhealth.com The latest research articles published by Globalization and Health 2009-02-26T00:00:00Z This is an RSS newsfeed from BioMed Central It is intended to be used with an RSS reader. For more information about RSS newsfeeds from BioMed Central, visit http://www.biomedcentral.com/info/about/rss/ Background: Each year medical providers from wealthy countries participate in short-term medical volunteer work in resource-poor countries. Various authors have raised concern that such work has the potential to be harmful to recipient communities; however, the social science and medical literature contains little research into the perceptions of short-term medical volunteer work from the perspective of members of recipient communities. This exploratory study examines the perception of short-term medical volunteer work in Guatemala among groups of actors affected by or participating in these programs. Methods: The researchers conducted in-depth, semi-structured interviews with 72 individuals, including Guatemalan healthcare providers and health authorities, foreign medical providers, non-medical personnel working on health projects, and Guatemalan parents of children treated by a short-term volunteer group. Detailed notes and summaries of these interviews were uploaded, coded and annotated using Atlas.ti (Scientific Software Development GmbH, Berlin) to identify recurrent themes from the interviews. Results: Informants commonly identified a need for increased access to medical services in Guatemala, and many believed that short-term medical volunteers are in a position to offer improved access to medical care in the communities where they serve. Informants most frequently cited appropriate patient selection and attention to payment systems as the best means to avoid creating dependence on foreign aid. The most frequent suggestion to improve short-term medical volunteer work was coordination with and respect for local Guatemalan healthcare providers and their communities, as insufficient understanding of the country's existing healthcare resources and needs may result in perceived harm to the recipient community. Conclusion: The perceived impact of short-term medical volunteer projects in Guatemala is highly variable and dependent upon the individual project. In this exploratory study, project characteristics were identified that are consistently perceived to be either positive or negative. These findings have direct implications for anyone involved in the planning and execution of short-term medical volunteer projects, including local and foreign medical team members, project planners and coordinators, and health authorities. Most importantly, this preliminary study suggests avenues for future study and evaluation of the impact of short-term medical volunteer programs on local health care services. http://www.globalizationandhealth.com/content/5/1/4 Tyler Green Heidi Green Jean Scandlyn Andrew Kestler Globalization and Health 2009, 5:4 2009-02-26T00:00:00Z doi:10.1186/1744-8603-5-4 Globalization and Health 1744-8603 5 4 2009-02-26T00:00:00Z XML In December 2008, the US Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism, released a report, World At Risk. The Report points to the fact that, not only is the use of a weapon of mass destruction in a terrorist attack before the end of 2013, more likely than not, but also to the fact that terrorists are more likely to be able to obtain and use biological weapons than nuclear. This paper examines the recommendations of the report in the context of the historic and geopolitical changes, in particular globalization. The authors highlight the "dual-use" dilemma, as described in the report, as the paradoxical use of technology developed for the benefit of mankind being used for sinister purposes. The mitigation of such a threat lies in broad stakeholder involvement and cooperation, including non-state actors, governments and the bio-tech industry itself. The importance of vigilance measures within the life science community is emphasized and, the authors propose, could include a web-based didactic course in bioterrorism and weapons of mass destruction identification. The site could outline safety protocols, have detailed disaster management tutorials, and could be specifically tailored for different subsets of industry and health professionals. The paper concludes with an endorsement of a multi-pronged approach including strong international guidelines and intelligence cooperation and preparatory measures such as the wide-spread use of detection systems as well as diagnostic decision support systems for bioterrorism detection at the local level. http://www.globalizationandhealth.com/content/5/1/3 Mark D'Agostino Greg Martin Globalization and Health 2009, 5:3 2009-02-16T00:00:00Z doi:10.1186/1744-8603-5-3 Globalization and Health 1744-8603 5 3 2009-02-16T00:00:00Z XML Background: In 1988 South Korea opened its cigarette market to foreign companies under the threat of US trade sanctions. Despite strong social stigma against female smoking in South Korea, and restrictions on tobacco marketing to women and children, smoking rates among young Korean females increased from 1.6% in 1988 to 13% in 1998. Previous analyses describe how Asian countries have been targeted by transnational tobacco companies for new markets, with Asian females offering substantial future growth potential. An understanding of the strategies used by TTCs to increase smoking among Korean females is critical to public health efforts to adopt a stronger gender perspective in implementing the Framework Convention on Tobacco Control. Methods: Internal documents of transnational tobacco corporations were systematically searched using keywords focused on the targeting of the female market since market liberalisation in 1988. Industry documents were analysed alongside primary and secondary data on the tobacco industry in South Korea. Results: TTCs have targeted Korean females since the late 1980s, conducting market research to understand consumer preferences, cultural characteristics and social changes affecting women and girls. Brands designed to appeal to females have focused on "slim" and "superslim" cigarettes, "light" and "mild" claims, and marketing which appeals to the growing numbers of young women entering the labour force. Strategies for overcoming legal restrictions on marketing to women and children have included the use of company rather than brand names, retail distribution at venues frequented by females, trademark diversification and sponsorship. Conclusion: Given the high male smoking rates in South Korea, tobacco control efforts have given limited attention to girls and women. The limited data available on female smoking behaviour suggests that, despite legal restrictions and social stigma, smoking among females has increased since market opening, notably within younger age groups. In addition to more detailed trend data, there is an urgent need for the development and implementation of gender-sensitive tobacco control measures. Part of South Korea's accession to the FCTC should include emphasis on measures to address the strategic targeting of Korean females by TTCs. http://www.globalizationandhealth.com/content/5/1/2 Kelley Lee Carrie Carpenter Chaitanya Challa Sungkyu Lee Gregory Connolly Howard Koh Globalization and Health 2009, 5:2 2009-01-30T00:00:00Z doi:10.1186/1744-8603-5-2 Globalization and Health 1744-8603 5 2 2009-01-30T00:00:00Z XML Background: Economic changes and policy reforms, consistent with economic globalization, in New Zealand in the mid-1980s, combined with the recent global demand for dairy products, particularly from countries undergoing a 'nutrition transition', have created an environment where a proportion of the New Zealand population is now experiencing financial difficulty purchasing milk. This situation has the potential to adversely affect health.DiscussionSimilar to other developed nations, widening income disparities and health inequalities have resulted from economic globalization in New Zealand; with regard to nutrition, a proportion of the population now faces food poverty. Further, rates of overweight/obesity and chronic diseases have increased in recent decades, primarily affecting indigenous people and lower socio-economic groups. Economic globalization in New Zealand has changed the domestic milk supply with regard to the consumer and may shed light on the link between globalization, nutrition and health outcomes. This paper describes the economic changes in New Zealand, specifically in the dairy market and discusses how these changes have the potential to create inequalities and adverse health outcomes. The implications for the success of current policy addressing chronic health outcomes is discussed, alternative policy options such as subsidies, price controls or alteration of taxation of recommended foods relative to 'unhealthy' foods are presented and the need for further research is considered.SummaryChanges in economic ideology in New Zealand have altered the focus of policy development, from social to commercial. To achieve equity in health and improve access to social determinants of health, such as healthy nutrition, policy-makers must give consideration to health outcomes when developing and implementing economic policy, both national and global. http://www.globalizationandhealth.com/content/5/1/1 Moira Smith Louise Signal Globalization and Health 2009, 5:1 2009-01-19T00:00:00Z doi:10.1186/1744-8603-5-1 Globalization and Health 1744-8603 5 1 2009-01-19T00:00:00Z XML Before the onset of the current food crisis, the evidence of a severely neglected nutrition crisis was starting to receive attention. Increased food prices are having severe impacts on the nutritional status of populations. Our current food system has evolved over decades in a largely unplanned manner and without consideration for the complexity and implications of linkages between health, nutrition, agricultural, economic, trade and security issues. The underlying causes for the nutrition crisis include the above, as well as decades of neglect with regard to nutrition, and agricultural science (especially in emerging markets); a failure of governance with respect to the major players involved in nutrition, a weak response by government donors and Foundations to invest in basic nutrition (in contrast to growing support for humanitarian aspects of food aid), and a reluctance to develop private-public partnerships. The emergence of new business models that tackle social problems while remaining profitable offers promise that the long term nutrition needs of people can be met. Businesses can have greater impact acting collectively than individually. Food, retail, food service, chemical and pharmaceutical companies have expertise, distribution systems and customers insights, if well harnessed, could leapfrog progress in addressing the food and nutrition crises. While business can do lots more, its combined impact will be minimal if a range of essential government actions and policies are not addressed. Governments need to create innovative and complementary opportunities that include incentives for businesses including: setting clear nutritional guidelines for fortification and for ready-to eat products; offering agreements to endorse approved products and support their distribution to clinics and schools; eliminating duties on imported vitamins and other micronutrients; and providing tax and other incentives for industry to invest with donors in essential nutrition and agricultural research. Currently governments in developed countries provide a wide range of incentives to the pharmaceutical industry to develop medicated solutions to nutritional problems. We need equivalent effort to be given to the development of more sustainable agricultural and food based solutions. We now face a truly global set of interlinked crises related to food that affect all people. The same degree of urgency and high level leadership and partnership seen during the Second World War is required on a global basis. This time it will need to simultaneously address agricultural, environmental and health considerations with the aim being the attainment of optimal nutrition for all within a framework of sustainable development. http://www.globalizationandhealth.com/content/4/1/12 Derek Yach Globalization and Health 2008, 4:12 2008-12-05T00:00:00Z doi:10.1186/1744-8603-4-12 Globalization and Health 1744-8603 4 12 2008-12-05T00:00:00Z XML In a recent issue of Globalization and Health, Yu et al. examine the impact of HIV/AIDS programs on health care systems. This editorial considers their position and confirms that the former actually supports the latter aim; the two approaches are not at odds with one another, but could be viewed as complementary. A key requirement towards meeting both objectives is to ensure sustained international aid. http://www.globalizationandhealth.com/content/4/1/11 Gorik Ooms Globalization and Health 2008, 4:11 2008-11-18T00:00:00Z doi:10.1186/1744-8603-4-11 Globalization and Health 1744-8603 4 11 2008-11-18T00:00:00Z XML Background: In a restricted sense, the resource curse is a theory that explains the inverse relationship classically seen between dependence on natural resources and economic growth. It defines a peculiar economic and political environment, epitomised by oil extraction in sub-Saharan Africa. Methods: Based on secondary research and illustrations from four oil-rich geographical areas (the Niger Delta region of Nigeria, Angola, southern Chad, Southern Sudan), I propose a framework for analysing the effects of the resource curse on the structure of health systems at sub-national levels. Qualitative attributes are emphasised. The role of the corporate sector, the influence of conflicts, and the value of classical mitigation measures (such as health impact assessments) are further examined. Results: Health systems in a resource curse environment are classically fractured into tripartite components, including governmental health agencies, non-profit non-governmental organisations, and the corporate extractive sector. The three components entertain a range of contractual relationships generally based on operational considerations which are withdrawn from social or community values. Characterisation of agencies in this system should also include: values, operating principles, legitimacy and operational spaces. From this approach, it appears that community health is at the same time marginalised and instrumentalised toward economic and corporate interests in resource curse settings. Conclusion: From a public health point of view, the resource curse represents a fundamental failure of dominant development theories, rather than a delay in creating the proper economy and governance environment for social progress. The scope of research on the resource curse should be broadened to include more accurate or comprehensive indicators of destitution (including health components) and more open perspectives on causal mechanisms. http://www.globalizationandhealth.com/content/4/1/10 Philippe Calain Globalization and Health 2008, 4:10 2008-10-21T00:00:00Z doi:10.1186/1744-8603-4-10 Globalization and Health 1744-8603 4 10 2008-10-21T00:00:00Z XML Background: Climate change has begun to negatively affect human health, with larger burdens projected in the future as weather patterns continue to change. The climate change-related health consequences of diarrhoeal diseases, malnutrition, and malaria are projected to pose the largest risks to future populations. Limited work has been done to estimate the costs of adapting to these additional health burdens. Methods: The costs of treating diarrhoeal diseases, malnutrition (stunting and wasting only), and malaria in 2030 were estimated under three climate scenarios using (1) the current numbers of cases; (2) the projected relative risks of these diseases in 2030; and (3) current treatment costs. The analysis assumed that the number of annual cases and costs of treatment would remain constant. There was limited consideration of socioeconomic development. Results: Under a scenario assuming emissions reductions resulting in stabilization at 750 ppm CO2 equivalent in 2210, the costs of treating diarrhoeal diseases, malnutrition, and malaria in 2030 were estimated to be $4 to 12 billion. This is almost as much as current total annual overseas development assistance for health. Conclusion: The investment needs in the health sector to address climate-sensitive health outcomes are large. Additional human and financial resources will be needed to prevent and control the projected increased burden of health outcomes due to climate change. http://www.globalizationandhealth.com/content/4/1/9 Kristie Ebi Globalization and Health 2008, 4:9 2008-09-19T00:00:00Z doi:10.1186/1744-8603-4-9 Globalization and Health 1744-8603 4 9 2008-09-19T00:00:00Z XML Background: There is increasing debate about whether the scaled-up investment in HIV/AIDS programs is strengthening or weakening the fragile health systems of many developing countries. This article examines and assesses the evidence and proposes ways forward.DiscussionConsiderably increased resources have been brought into countries for HIV/AIDS programs by major Global Health Initiatives. Among the positive impacts are the increased awareness of and priority given to public health by governments. In addition, services to people living with HIV/AIDS have rapidly expanded. In many countries infrastructure and laboratories have been strengthened, and in some, primary health care services have been improved. The effect of AIDS on the health work force has been lessened by the provision of antiretroviral treatment to HIV-infected health care workers, by training, and, to an extent, by task-shifting. However, there are reports of concerns, too – among them, a temporal association between increasing AIDS funding and stagnant reproductive health funding, and accusations that scarce personnel are siphoned off from other health care services by offers of better-paying jobs in HIV/AIDS programs. Unfortunately, there is limited hard evidence of these health system impacts.Because service delivery for AIDS has not yet reached a level that could conceivably be considered "as close to Universal Access as possible," countries and development partners must maintain the momentum of investment in HIV/AIDS programs. At the same time, it should be recognized that global action for health is even more underfunded than is the response to the HIV epidemic. The real issue is therefore not whether to fund AIDS or health systems, but how to increase funding for both.SummaryThe evidence is mixed – mostly positive but some negative – as to the impact on health systems of the scaled-up responses to HIV/AIDS driven primarily by global health partnerships. Current scaled-up responses to HIV/AIDS must be maintained and strengthened. Instead of endless debate about the comparative advantages of vertical and horizontal approaches, partners should focus on the best ways for investments in response to HIV to also broadly strengthen the primary health care systems. http://www.globalizationandhealth.com/content/4/1/8 Dongbao Yu Yves Souteyrand Mazuwa Banda Joan Kaufman Joseph Perriens Globalization and Health 2008, 4:8 2008-09-16T00:00:00Z doi:10.1186/1744-8603-4-8 Globalization and Health 1744-8603 4 8 2008-09-16T00:00:00Z XML ObjectiveDental caries remains the most common disease worldwide and the use of fluoride toothpaste is a most effective preventive public health measure to prevent it. Changes in diets following globalization contribute to the development of dental caries in emerging economies. The aim of this paper is to compare the cost and relative affordability of fluoride toothpaste in high-, middle- and low-income countries. The hypothesis is that fluoride toothpaste is not equally affordable in high-, middle- and low-income countries. Methods: Data on consumer prices of fluoride toothpastes were obtained from a self-completion questionnaire from 48 countries. The cost of fluoride toothpaste in high-, middle- and low-income countries was compared and related to annual household expenditure as well as to days of work needed to purchase the average annual usage of toothpaste per head. Results: The general trend seems to be that the proportion of household expenditure required to purchase the annual dosage of toothpaste increases as the country's per capita household expenditure decreases. While in the UK for the poorest 30% of the population only 0.037 days of household expenditure is needed to purchase the annual average dosage (182.5 g) of the lowest cost toothpaste, 10.75 days are needed in Kenya. The proportion of annual household expenditure ranged from 0.02% in the UK to 4% in Zambia to buy the annual average amount of lowest cost toothpaste per head. Conclusion: Significant inequalities in the affordability of this essential preventive care product indicate the necessity for action to make it more affordable. Various measures to improve affordability based on experiences from essential pharmaceuticals are proposed. http://www.globalizationandhealth.com/content/4/1/7 Ann Goldman Robert Yee Christopher Holmgren Habib Benzian Globalization and Health 2008, 4:7 2008-06-13T00:00:00Z doi:10.1186/1744-8603-4-7 Globalization and Health 1744-8603 4 7 2008-06-13T00:00:00Z XML