Analysing Leadership in Global Health Governance

Rhetoric around the need for more and better leadership is everywhere in contemporary global health governance, yet there has been little articulation of what type of leadership is required, who might play leadership roles, and in what fora leadership might be exercised. Global health governance has widely been seen as a policy space characterised by a multiplicity of (often competing) actors with no overall authority. Yet despite this things do ‘get done’, and in some cases there are impressive levels of collective action to address particular health problems. We argue that leadership provides an important lens for understanding how things do (or do not) get done in global health governance. Drawing on the existing literatures on global health governance and leadership and agency in international relations, we set out in this paper a framework for analysing leadership in global health governance. Crucially, we argue, such a framework must be specific enough to be operationalisable in terms of a program of research and at the same time broad enough to capture a wide variety of different sources, sites and forms of leadership – including the roles played by ‘hidden leaders’ who are seldom acknowledged in mainstream analyses of global health politics

Anti-microbial Use in Animals: How to Assess the Trade-offs

Antimicrobials are widely used in preventive and curative medicine in animals. Benefits from curative use are clear – it allows sick animals to be healthy with a gain in human welfare. The case for preventive use of antimicrobials is less clear cut with debates on the value of antimicrobials as growth promoters in the intensive livestock industries. The possible benefits from the use of antimicrobials need to be balanced against their cost and the increased risk of emergence of resistance due to their use in animals. The study examines the importance of animals in society and how the role and management of animals is changing including the use of antimicrobials. It proposes an economic framework to assess the trade-offs of anti-microbial use and examines the current level of data collection and analysis of these trade-offs. An exploratory review identifies a number of weaknesses. Rarely are we consistent in the frameworks applied to the economic assessment anti-microbial use in animals, which may well be due to gaps in data or the prejudices of the analysts. There is a need for more careful data collection that would allow information on (i) which species and production systems antimicrobials are used in, (ii) what active substance of antimicrobials and the application method and (iii) what dosage rates. The species need to include companion animals as well as the farmed animals as it is still not known how important direct versus indirect spread of resistance to humans is. In addition, research is needed on pricing antimicrobials used in animals to ensure that prices reflect production and marketing costs, the fixed costs of anti-microbial development and the externalities of resistance emergence. Overall, much work is needed to provide greater guidance to policy, and such work should be informed by rigorous data collection and analysis systems

The politics of researching global health politics. A comment on Jeremy Shiffman’s ‘Knowledge, moral claims and the exercise of power in global health'

In this comment, I build on Shiffman’s call for the global health community to more deeply investigate structural and productive power. I highlight two challenges we must grapple with as social scientists carrying out the types of investigation that Shiffman proposes: the politics of challenging the powerful; and the need to investigate types of expertise that have traditionally been thought of as ‘outside’ global health. In doing so, I argue that moving forward with the agenda Shiffman sets out requires social scientists interested in the global politics of health to be reflexive about our own exercise of structural and productive power and the fact that researching global health politics is itself a political undertaking

Estimating the burden of occupational cancer: assessing bias and uncertainty.

BACKGROUND AND OBJECTIVES: We aimed to estimate credibility intervals for the British occupational cancer burden to account for bias uncertainty, using a method adapted from Greenland's Monte Carlo sensitivity analysis. METHODS: The attributable fraction (AF) methodology used for our cancer burden estimates requires risk estimates and population proportions exposed for each agent/cancer pair. Sources of bias operating on AF estimator components include non-portability of risk estimates, inadequate models, inaccurate data including unknown cancer latency and employment turnover and compromises in using the available estimators. Each source of bias operates on a component of the AF estimator. Independent prior distributions were estimated for each bias, or graphical sensitivity analysis was used to identify plausible distribution ranges for the component variables, with AF recalculated following Monte Carlo repeated sampling from these distributions. The methods are illustrated using the example of lung cancer due to occupational exposure to respirable crystalline silica in men. RESULTS: Results are presented graphically for a hierarchy of biases contributing to an overall credibility interval for lung cancer and respirable crystalline silica exposure. An overall credibility interval of 2.0% to 16.2% was estimated for an AF of 3.9% in men. Choice of relative risk and employment turnover were shown to contribute most to overall estimate uncertainty. Bias from using an incorrect estimator makes a much lower contribution. CONCLUSIONS: The method illustrates the use of credibility intervals to indicate relative contributions of important sources of uncertainty and identifies important data gaps; results depend greatly on the priors chosen

Hanging In, Stepping up and Stepping Out: Livelihood Aspirations and Strategies of the Poor Development in Practice

In recent years understanding of poverty and of ways in which people escape from or fall into poverty has become more holistic. This should improve the capabilities of policy analysts and others working to reduce poverty, but it also makes analysis more complex. This paper describes a simple schema which integrates multidimensional, multilevel and dynamic understandings of poverty, of poor people’s livelihoods, and of changing roles of agricultural systems. The paper suggests three broad types of strategy pursued by poor people: ‘hanging in’; ‘stepping up’; and ‘stepping out’. This simple schema explicitly recognises the dynamic aspirations of poor people; diversity among them; and livelihood diversification. It also brings together aspirations of poor people with wider sectoral, inter-sectoral and macro-economic questions about policies necessary for realisation of those aspirations

The transmission of nosocomial pathogens in an intensive care unit: a space–time clustering and structural equation modelling approach

We investigated the incidence of cases of nosocomial pathogens and risk factors in an intensive treatment unit ward to determine if the number of cases is dependent on location of patients and the colonization/infection history of the ward. A clustering approach method was developed to investigate the patterns of spread of cases through time for five microorganisms [methicillin-resistant Staphylococcus aureus (MRSA), Acinetobacter spp., Klebsiella spp., Candida spp., and Pseudomonas aeruginosa] using hospital microbiological monitoring data and ward records of patient-bed use. Cases of colonization/infection by MRSA, Candida and Pseudomonas were clustered in beds and through time while cases of Klebsiella and Acinetobacter were not. We used structural equation modelling to analyse interacting risk factors and the potential pathways of transmission in the ward. Prior nurse contact with colonized/infected patients, mediated by the number of patient-bed movements, were important predictors for all cases, except for those of Pseudomonas. General health and invasive surgery were significant predictors of cases of Candida and Klebsiella. We suggest that isolation and bed movement as a strategy to manage MRSA infections is likely to impact upon the incidence of cases of other opportunist pathogen