The corporatization of global health: The impact of neoliberalism

Concomitant with the emergence of a neoliberal precept for global health is the decline in support for publicly funded programs working to alleviate health disparities in poor countries. An unequivocal faith in the privatization and marketization of public health services is evident in current day national policy reforms.  Commodification of health services is perceived as a cure-all. Privatization of global health initiatives contrasts with the past institutional paradigm. Corporate and philanthropic power trumps intergovernmental governance. The epistemological precept is clear: Global health is best served with mandated private initiatives. Powerful foundations cause critical shifts in the balance of power among stakeholders and become preeminent players in global health policy agenda formation. The ethics of consequentialism have attained current day prominence. This contrasts with the merits and relevancy of de-ontological ethics in which rules and moral duty are central. In this paper, authors make a case for contesting the ethos of effective altruism or venture philanthropy, suggesting that this approach keeps nations and people from recognizing the oppressive nature of neoliberalism as a governing precept for global health

Global health in transition: The coming of neoliberalism

Global health as a transnational, intergovernmental, value-based initiative led by the World Health Organization (WHO), working toward improving health and achieving equity in health for all people worldwide, has for years yielded to a growing reliance on corporate-led solutions. Private organizations, non-governmental organizations (NGO), religious and other philanthropic and charitable organizations, increasingly serve a dominant role in setting the global health agenda. Short-term success in combating epidemics and in the provision of funding for project-based initiatives appeals to supporters of marketization of health services. For 30 years, a neoliberal paradigm has dominated the international political economy and hence the governance of global health. A utilitarian logic or the ethics of consequentialism have attained prominence under such banners as effective altruism or venture philanthropy.  This contrasts with the merits and relevance of deontological ethics in which rules and moral duty are central. This paper seeks to explain how neo-liberalism became a governing precept and paradigm for global health governance. A priority is to unmask terms and precepts serving as ethos or moral character for corporate actions that benefit vested stakeholders.   &nbsp

Positive postpartum depression screening practices and subsequent mental health treatment for low-income women in Western countries: a systematic literature review

Problem statement and significance Left undiagnosed and/or untreated, the short-and long-term sequelae of postpartum depression may negatively impact both mother and child. In Western countries, access to mental health care is influenced by socioeconomic factors. The objective of this systematic literature review is to compile factors that hinder and improve access to postpartum depression treatment in low-income women after a positive screen for postpartum depression. The key question of focus is: what are the characteristics associated with access to mental health treatment for low-income women with a positive postpartum depression screen in Western countries? Methods A PRISMA-based systematic literature review was conducted of studies published in English before February 2016 that looked at treatment for postpartum depression in low-income women who had been identified with the condition. PubMed and EBSCO databases were searched using MESH and key terms and found 100 articles that met the selection criteria. After review by two independent researchers, 18 studies with 17 unique populations were included in the literature review. Results Two independent abstractors searched the included articles for themes surrounding impediments and advantages for low-income women identified with postpartum depression in obtaining mental health treatment. Characteristics of successful mental health treatment included studies that employed the use of a home visitor and those that separated outcomes for women with previous mental health treatment. Themes that emerged as treatment obstacles included cultural barriers, physical barriers, systemic health care barriers, and social barriers. Implications for practice This review will help to better inform screening and treatment priorities for those in the medical field who may encounter women experiencing postpartum depression and are not aware of the various barriers to care specific to low-income women. This review will also help policymakers identify specific obstacles that are not addressed in postpartum screening mandate policies which can affect the implementation of these policies

Facilitators and barriers to the use of economic evaluations in nutrition and public health

Aims: Interventions targeting diets have the potential to reduce a consistent fraction of the chronic disease burden. Economic evaluations of such interventions can be an important tool in guiding public health practitioners and decision makers at various levels, yet there are still not many economic evaluations in this area. This qualitative study explored facilitators and barriers in conducting and using economic analyses to inform decision makers in the field of public health nutrition. Methods: Data were collected through written, open-ended questionnaires administered to twenty-three participants (13 from academia and 10 from government) using purposive sampling and analysed through a conventional content analysis. Results: The analysis revealed two broad categories of barriers, which included: i) “Methodological challenges”, and; ii) “Barriers related to application of economic evaluations.” Two main categories of facilitators were also identified: i) “Facilitators to improving the methodology of economic evaluations”, with subcategories further detailing frameworks and methods to be applied, and; ii) “Facilitators to broaden the use of economic evaluations”, with most subcategories addressing science-into-policy translations. These barriers and facilitators to the use of economic evaluations in public health are perceived differently by researchers and policymakers, the former more focused on implementation aspects, the latter more concerned by methodological gaps. Conclusion: Public health nutrition policies seldom take into account data from formal economic evaluations. Economic evaluation methodologies can be improved to ensure their broader application to decision making.   Conflicts of interest: None declared.   Acknowledgements: The work of AL is partially supported by a Jean Monnet Erasmus+ grant (574376-EPP-1-2016-1-IT-EPPJMO-MODULE)

Facilitators and barriers to the use of economic evaluations in nutrition and public health

Aims: Interventions targeting diets have the potential to reduce a consistent fraction of the chronic disease burden. Economic evaluations of such interventions can be an important tool in guiding public health practitioners and decision makers at various levels, yet there are still not many economic evaluations in this area. This qualitative study explored facilitators and barriers in conducting and using economic analyses to inform decision makers in the field of public health nutrition. Methods: Data were collected through written, open-ended questionnaires administered to twenty-three participants (13 from academia and 10 from government) using purposive sampling and analysed through a conventional content analysis. Results: The analysis revealed two broad categories of barriers, which included: i) “Methodological challenges”, and; ii) “Barriers related to application of economic evaluations.” Two main categories of facilitators were also identified: i) “Facilitators to improving the methodology of economic evaluations”, with subcategories further detailing frameworks and methods to be applied, and; ii) “Facilitators to broaden the use of economic evaluations”, with most subcategories addressing science-into-policy translations. These barriers and facilitators to the use of economic evaluations in public health are perceived differently by researchers and policymakers, the former more focused on implementation aspects, the latter more concerned by methodological gaps. Conclusion: Public health nutrition policies seldom take into account data from formal economic evaluations. Economic evaluation methodologies can be improved to ensure their broader application to decision making. &nbsp

Global health in transition: The coming of neoliberalism

 Global health as a transnational, intergovernmental, value-based initiative led by the World Health Organization (WHO), working toward improving health and achieving equity in health for all people worldwide, has for years yielded to a growing reliance on corporate-led solutions. Private organizations, non-governmental organizations (NGO), religious and other philanthropic and charitable organizations, increasingly serve a dominant role in setting the global health agenda. Short-term success in combating epidemics and in the provision of funding for project-based initiatives appeals to supporters of marketization of health services. For 30 years, a neoliberal paradigm has dominated the international political economy and hence the governance of global health. A utilitarian logic or the ethics of consequentialism have attained prominence under such banners as effective altruism or venture philanthropy.  This contrasts with the merits and relevance of deontological ethics in which rules and moral duty are central. This paper seeks to explain how neo-liberalism became a governing precept and paradigm for global health governance. A priority is to unmask terms and precepts serving as ethos or moral character for corporate actions that benefit vested stakeholders.  

Global health leadership : recall the past to better understand the present

Pandemia COVID-19 skłania do refleksji nad nauką płynącą z historii. Autorki podejmują próbę omówienia związków przeszłości z radzeniem sobie w obliczu obecnego kryzysu zdrowotnego. Skala oraz nieprzewidywalność koronawirusa w znaczący sposób wstrząsnęły współczesnymi systemami opieki zdrowotnej i dostępem do nich. Bez względu na płeć, rasę, pochodzenie etniczne, religię czy wiek – liderzy służby zdrowia na każdym poziomie systemu opieki zdrowotnej, a także pracownicy pierwszej linii kontaktu, tacy jak pielęgniarki, lekarze i ratownicy medyczni, stają w obliczu bezprecedensowych sytuacji wymagających etycznego podejścia opartego na wartościach. Tym samym raz na sto lat pandemia stwarza liderom opieki zdrowotnej możliwość ponownego przemyślenia i odświeżenia wartości i priorytetów, jakimi się kierują, odnawiając zobowiązanie do poszukiwań bardziej ludzkiego podejścia do pandemii, solidarności, równości i demokracji oraz - co oczywiste - do dzielenia się wiedzą naukową. Historia pozwala nam wierzyć, że ludzkość będzie świętować zwycięstwo nad obecnymi i przyszłymi pandemiami.The COVID-19 pandemic makes us reflect on the lessons learnt from history, which witnessed the loss of lives, opportunities and leadership. The authors attempt to discuss the implications of the past on dealing with the contemporary health crisis. The scale and unpredictability of the coronavirus have shaken our systems and access to them in a significant way. Regardless of gender, race, ethnicity, religion, or age, health care leaders at every level of health system including frontline health care professionals such as nurses, physicians and medical rescuers are confronted with the unprecedented situations that require values-driven, ethical approaches. A once-in-a-hundred-years pandemic offers an opportunity for health leaders to reconsider and refresh the values and priorities they espouse, renew a commitment to strive for a more humanized approach to the pandemic, solidarity, equality and democracy and, of course, shared, scientific knowledge. As we learn from history, humanity will celebrate a victory against current and future pandemics

Increasing fruit and vegetable consumption in Ireland

Context: Following recommended dietary guidelines, Ireland has since 2010 implemented a  0% Value Added Tax (VAT) on fruits and vegetables to increase consumption. Eleven years after policy implementation, the Irish still do not meet recommended intake for fruit and vegetable consumption, consuming 3.9 portions a day compared to 7 daily portions recommended. Policy Options: Four alternatives for improvement were assessed and compared:            1) retain the status quo of reduced VAT for healthy foods, 2) VAT only for locally produced fruits and vegetables, 3) increased VAT for salty and sweet foods with a subsidy for fruits and vegetables, and 4) an education-based policy. Four evaluation criteria were applied for the comparison: economic feasibility, effectiveness, political feasibility, and equity. Recommendations: The status quo remains the best option for Ireland. However, further assessment of this 0% VAT policy on fruits and vegetables is warranted, pending the availability of additional data to enable an in-depth understanding of policy implementation. &nbsp

Sustainable Reform of European Union (EU): Common Fisheries Policy

Context:Oceans are encountering great loss of biodiversity. Global overfishing and overconsumption of aquatic foods prompted the European Union to create the Common Fishery Policy (CFP) with the intention of supporting sustainability of the environment, economy, and society, and to protect the long-term supply of aquatic foods. The Mediterranean Sea is a vulnerable European region due to fishing at unsustainable levels. Factors exacerbating the situation in this region include socio-economic conditions, weakregulatory power of the EU, poor communication and low levels of consensus among stakeholders.Policy Options:Three policy options are highlighted: 1) Fish-restricted areas (FRA) in eight Mediterranean regions to maintain or reverse fish collapse, as a means to recover fish stocks in regions with higher exploitation rates: 2) Supporting and improving small-scale fisheries (SSF) to reduce the impact on marine wildlife and increase selectivity, including standard gear and size restrictions,as well asstrict seasonal closures; 3) Integration of Participatory Action Research (PAR) to improve stakeholder compliance with the landing obligation.Recommendations:Policy options were assessed by four evaluation criteria (economic feasibility, effectiveness, political feasibility, and equity). Integrating the PAR into the CFP was deemed to be the best option of those examined. A positive impact on the economy, political feasibility, and equity for stakeholders would be expected outcomes of implementation of this alternative. Regular evaluation and continuous improvement would increase the likelihood of policy success