The role of ethics and ideology in our contribution to global health The topic of this article has vividly interested the author for many years. It is fascinating to him that the issues at stake have not changed for the last 30 years or so. As proof of this – and on purpose – references quoted are both those published before 1985 and after 1995 (Table 1). Considerable material on this topic was already available from the mid 1970s on. The end result has been the (re)construction of a scenario that has been stubborn to change and that looks into most of the, still highly relevant, burning questions of then and now on the issues pertaining to the title of this contribution for debate. It will be of interest to the reader to see how we often need to be reminded of the things our peers had evidence of and wrote about long before us – as the examples of Dr. Virchov and of the Alma Ata Declaration, for instance, show.

What drives public health professionals in their daily work? Presumably it is the appeal of working, either locally or globally, to alleviate the suffering caused by (preventable) ill-health. This article explores the political awareness of health professionals, the political implications of their daily activities and suggests an enhanced role for them in the battle against preventable ill-health worldwide. The starting point for this article is the motivating principles behind these professionals as individuals. It challenges established paradigms in health, medicine, development and academia with a focus on health professionals' political, ethical and ideological motivations and awareness plus the implications of their actions in the realm of global health in the future. It further has implications for the everyday practice of health care providers, public health practitioners, epidemiologists and social scientists in academia

Looking into the future, what do we see?

This series of short communications introduces and celebrates the occasion of World Nutrition Rio2012, and looks ahead. There will be another series published next month in our May issue, which will be on-line early, at 0001 GMT on Thursday 26 April, the day before Rio2012 begins. The questions and answers: Our contributors, this month and next month, have been asked to write within a standard framework, based on their knowledge and experience, in a style comparable with those of the news and comment sections of journals concerned with public health. Their contributions are judgements, as any policy statements are and must be. The first question is about Rio2012 itself. The second question is addressed to young colleagues. All the questions are designed to look forward and to advise, warn and encourage. What do I hope Rio2012 will achieve? My advice to a young public health nutritionist When I am optimistic, what is my vision? When I am pessimistic, what do I foresee? My most highly recommended writer One choice of my own publication

Considerations for preparing a randomized population health intervention trial: lessons from a South African–Canadian partnership to improve the health of health workers

Background: Community-based cluster-randomized controlled trials (RCTs) are increasingly being conducted to address pressing global health concerns. Preparations for clinical trials are well-described, as are the steps for multi-component health service trials. However, guidance is lacking for addressing the ethical and logistic challenges in (cluster) RCTs of population health interventions in low- and middle-income countries. Objective: We aimed to identify the factors that population health researchers must explicitly consider when planning RCTs within North–South partnerships. Design: We reviewed our experiences and identified key ethical and logistic issues encountered during the pre-trial phase of a recently implemented RCT. This trial aimed to improve tuberculosis (TB) and Human Immunodeficiency Virus (HIV) prevention and care for health workers by enhancing workplace assessment capability, addressing concerns about confidentiality and stigma, and providing onsite counseling, testing, and treatment. An iterative framework was used to synthesize this analysis with lessons taken from other studies. Results: The checklist of critical factors was grouped into eight categories: 1) Building trust and shared ownership; 2) Conducting feasibility studies throughout the process; 3) Building capacity; 4) Creating an appropriate information system; 5) Conducting pilot studies; 6) Securing stakeholder support, with a view to scale-up; 7) Continuously refining methodological rigor; and 8) Explicitly addressing all ethical issues both at the start and continuously as they arise. Conclusion: Researchers should allow for the significant investment of time and resources required for successful implementation of population health RCTs within North–South collaborations, recognize the iterative nature of the process, and be prepared to revise protocols as challenges emerge

Health equity issues at the local level: Socio-geography, access, and health outcomes in the service area of the Hôpital Albert Schweitzer-Haiti

<p>Abstract</p> <p>Background</p> <p>Although health equity issues at regional, national and international levels are receiving increasing attention, health equity issues at the local level have been virtually overlooked. Here, we describe here a comprehensive equity assessment carried out by the Hôpital Albert Schweitzer-Haiti (HAS) in 2003. HAS has been operating health and development programs in the Artibonite Valley of Haiti for 50 years.</p> <p>Methods</p> <p>We reviewed all available information arising from a comprehensive evaluation of the programs of HAS carried out in 1999 and 2000. As part of this evaluation, two demographic and health surveys were carried out. We carried out exit interviews with clients receiving primary health care, observations within health facilities, interviews with households related to quality of care, and focus group discussions with community-based health workers. A special study was carried out in 2003 to assess factors determining the use of prenatal care services. Finally, selected findings were obtained from the HAS information system.</p> <p>Results</p> <p>We found markedly reduced access to health services in the peripheral mountainous areas compared to the central plains. The quality of services was more deficient and the coverage of key services was lower in the mountains. Finally, health status, as measured by under-five mortality rates and levels of childhood malnutrition, was also worse in the mountains.</p> <p>Conclusion</p> <p>These findings indicate that local health programs need to give attention to monitoring the health status as well as the quality and coverage of basic services among marginalized groups within the program service area. Health inequities will not be overcome until such monitoring occurs and leaders of health programs ensure that inequities identified are addressed in the local programming of activities. It is quite likely that, within relatively small geographic areas in resource-poor settings around the world, similar, if not even greater, levels of health inequities exist. These inequities need to be measured and addressed in order for health programs to achieve equity and maximum improvement in health status within the population.</p

Improving Newborn Survival in Low-Income Countries: Community-Based Approaches and Lessons from South Asia

David Osrin and colleagues discuss the critical importance of reducing global neonatal mortality in developing countries and how community-based approaches can help

A human right to health approach for non-communicable diseases [letter]

De Vos, Pol - ORCID 0000-0002-1672-6469 https://orcid.org/0000-0002-1672-6469Item not available in this repository.https://doi.org/10.1016/S0140-6736(13)60274-3381pubpub986