Global Learning for Health Equity: A Literature Review

BACKGROUND: In high income countries struggling with escalating health care costs and persistent lack of equity, there is growing interest in searching for innovative solutions developed outside national borders, particularly in low- and middle-income countries (LMICs). Engaging with global ideas to apply them to local health equity challenges is becoming increasingly recognized as an approach to shift the health equity landscape in the United States (US) in a significant way. No single name or set of practices yet defines the process of identifying LMIC interventions for adaptation; implementing interventions in high-income countries (HIC) settings; or evaluating the implementation of such projects. OBJECTIVES: This paper presents a review of the literature describing the practice of adapting global ideas for use in the US, particularly in the area of health equity. Specifically, the authors sought to examine; (i) the literature that advocates for, or describes, adaption of health-related innovations from LMICs to HICs, both generally and for health equity specifically, and (ii) implementation practices, strategies, and evidence-based outcomes in this field, generally and in the area of health equity specifically. The authors also propose terminology and a definition to describe the practice. METHODS: The literature search included two main concepts: global learning and health equity (using these and related terms). The search consisted of text-words and database-specific terminology (e.g., MeSH, Emtree) using PubMed, Embase (Elsevier), CINAHL (Ebsco), and Scopus in March 2021. The authors also contacted relevant experts to identify grey literature. Identified sources were categorized according to theme to facilitate analysis. In addition, five key interviews with experts engaged with global ideas to promote health equity in the United States were conducted to develop additional data. RESULTS: The literature review yielded over ninety (n = 92) sources relating to the adaptation of global ideas from low resource to higher resource settings to promote health equity (and related concepts). Identified sources range from those providing general commentaries about the value of seeking health-related innovations outside the US border to sources describing global projects implemented in the US, most without implementation or outcome measures. Other identified sources provide frameworks or guidance to help identify and/or implement global ideas in the US, and some describe the role of the World Health Organization and other international consortia in promoting a global approach to solving domestic health equity and related challenges. CONCLUSIONS: The literature review demonstrates that there are resources and commentary describing potential benefits of identifying and adapting novel global ideas to address health equity in the US, but there is a dearth of implementation and evaluation data. Terminology is required to define and frame the field. Additional research, particularly in the area of implementation science and evidence-based frameworks to support the practice of what we define as \u27global learning\u27 for health equity, is necessary to advance the practice

Community Health Workers as Innovators: Methods and Results from a Tele-Education Pilot for Community Health Workers in Detroit, Michigan

Community health workers (CHWs) have played an important role in improving the health of underserved populations in resource-limited settings. CHWs are trusted in communities that they serve, and are often able to see solutions to community problems that outside persons cannot. Solutions need to be low cost and easily accessible, and address the knowledge gaps among CHWs through appropriate training. Utilizing information technology solutions can be key to increasing access to knowledge for these community agents. This paper outlines the methods and results from a pilot study of the Community Health Innovator Program performed in Detroit, Michigan with a group of community health workers in basic grant-writing training, utilizing an information technology platform. The results will be discussed as a larger response to growing issues in global health and how such platforms can be used and adapted in response to ever-evolving global health challenges

On the typology and the worship status of sacred trees with a special reference to the Middle East

This article contains the reasons for the establishment of sacred trees in Israel based on a field study. It includes 97 interviews with Muslim and Druze informants. While Muslims (Arabs and Bedouins) consider sacred trees especially as an abode of righteous figures' (Wellis') souls or as having a connection to their graves, the Druze relate sacred trees especially to the events or deeds in the lives of prophets and religious leaders. A literary review shows the existence of 24 known reasons for the establishment of sacred trees worldwide, 11 of which are known in Israel one of these is reported here for the first time. We found different trends in monotheistic and polytheistic religions concerning their current worship of sacred trees

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Official development assistance and women\u27s rights: How aid donor characteristics affect women\u27s rights improvement in recipient countries

How does official development assistance (ODA) affect women\u27s rights in aid-receiving countries? We argue that ODA allows those donor countries who have more respect for women\u27s rights and who have the intention of spreading the norm of gender equality to successfully influence recipient countries, and thus improve women\u27s rights in aid-recipient countries. We argue that this is possible because aid is equipped with technical assistance, donor conditionality, and donor-recipient collaborative projects that can be tailored to address a specific policy objective and that are ripe with opportunities for transfers of technical know-how and synergistic exchanges of local and global norms. We further contend that the effect of foreign aid on the improvement of women\u27s rights is conditional on donors\u27 respect for women\u27s rights at home: foreign aid from countries with more equal women\u27s rights has a stronger positive effect than that from countries with less equal women\u27s rights. We illustrate the plausibility of our theoretical argument in the context of a case of aid projects in Bangladesh and use statistical analysis to test our argument more systematically. We show that aid in general, and aid from France and the Nordic countries - those with better provision of women\u27s rights at home among major aid donors - in particular exert positive effects on improving women\u27s rights in recipient countries from 1981 to 2011, after controlling for political, socio-economic, and regional factors. [ABSTRACT FROM AUTHOR

Intersecting Health, Housing, and Urban Inclusion in the Time of COVID-19

“Housing is a key site through which COVID-19 is experienced” (Rogers and Power, 2020: 177). This paper explores how COVID-19 has illuminated the intersection between health and housing, in the context of equity and inclusive cities. This paper reviews the theoretical pathways that link housing as an important determinant of health, and applies them to the COVID-19 situation. For example, stay-at-home orders are impossible for homeless individuals; social distancing is difficult in overcrowded housing; lockdowns in poor quality homes can result in health challenges; and pandemic-induced unemployment increases risk of eviction and poor health outcomes. Importantly, the pandemic has sharpened the visibility of existing inequitable structures that shape the social and built environment and place vulnerable populations at heightened risk. Anecdotal evidence from Detroit, Michigan, USA and Durban, South Africa allows for preliminary exploration of these intersections. The paper concludes with recommendations for cities to improve equity and inclusivity. &nbsp

A cross-sectional survey on medical education needs of general practitioners and family medicine: Delhi, Himachal Pradesh and Tamil Nadu, India.

Background: In India, most physicians pursue a specialist\u27s degree resulting in a dearth of general practitioners (GPs). To provide primary care across populations and support universal healthcare coverage (UHC), there is a need to develop a core educational foundation for generalists and family medicine in undergraduate and post-graduate training. Methodology: A cross-sectional survey was conducted as a part of a medical educational needs assessment (ENA) with a focus on family medicine. Respondents included practicing physicians, residents and medical students in Himachal Pradesh, Delhi and Tamil Nadu. Descriptive and bi-variate data analysis (Pearson\u27s Chi square, independent t-tests and analysis of variance [ANOVA]) was performed to summarise data and determine significant differences between demographic groups of respondents. Results: Three hundred and sixty-one surveys were completed. From which, 80.7% (284) of respondents felt that family medicine would be beneficial/very beneficial to the Indian health system. Respondents were split over whether family medicine programmes should be integrated within the existing bachelor of medicine and bachelor of surgery (MBBS) programmes (149/42.5%) or created as a separate post-graduate level specialty (131/37.3%). Overall, 84.2% (292) and 85.4% (294) agreed/strongly agreed that family medicine would benefit specialists and decrease the health disparities. Challenges include lack of information about family medicine and patients\u27 use of specialists for primary healthcare needs. Conclusions: There was a positive response to expanding education for generalists and development of family medicine as a specialty in India. Mechanisms to support policies and programmes need to be further explored to ensure successful implementation across the country. Interest in skills-based courses can be an opportunity to provide GP and family medicine training while broader system-level changes are considered

Global learning: A post-COVID-19 approach to advance health equity

ABSTRACTThe COVID-19 pandemic has accelerated acceptance of learning from other countries, especially for high-income countries to learn from low- and middle-income countries, a practice known as global learning. COVID-19’s rapid disease transmission underscored how connected the globe is as well as revealed stark health inequities which facilitated looking outside of one’s borders for solutions. The Global Learning for Health Equity (GL4HE) Network, supported by Robert Wood Johnson Foundation, held a 3-part webinar series in December 2021 to understand the current state of global learning and explore how global learning can advance health equity in the post-COVID-19 era. This paper reflects on these cutting-edge discussions about the current state of global learning, drawing upon the highlights, perspectives, and conclusions that emerged from these webinars. The paper also comments on best practices for global learning, including adapting for context, addressing biases, funding considerations, ensuring bidirectional partnerships, community engagement, and adopting a multidisciplinary approach