Global public health
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Global health's goal to address health issues across great sociocultural and socioeconomic gradients worldwide requires a sophisticated approach to the social root causes of disease and the social context of interventions. This is especially true today as the focus of global health work is actively broadened from acute to chronic and from infectious to non-communicable diseases. ⋯ Global health can learn much from social medicine to help practitioners understand the social behaviour, social structure, social networks, cultural difference and social context of ethical action central to the success or failure of global health's important agendas. This understanding - of global health as global social medicine - can coalesce global health's unclear identity into a coherent framework effective for addressing the world's most pressing health issues.
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Global public health · Jan 2014
Beyond Cairo: sexual and reproductive rights of young people in the new development agenda.
At the 1994 United Nations International Conference on Population and Development (ICPD), women's rights advocates fundamentally shifted the way the global development community views poverty, gender equality and reproductive rights. While the ICPD's call to action led to a marked improvement in reproductive health, more remains to be done to secure the sexual and reproductive rights and health of all, particularly for young people. As we approach the 20-year anniversary of Cairo, several global processes are happening concurrently that have implications for the future of the sexual and reproductive health and rights agenda, including the 20-year review of progress towards achieving the Cairo Programme of Action, the review of the Millennium Development Goals, and the open group discussions about the sustainable development goals and the new development agenda post-2015. There are five key areas of action where significant investment is needed moving forward to ensure young people's access and safeguard their rights: repeal outdated laws and create new policies that safeguard young people's health and rights; provide youth-friendly sexual and reproductive health services; guarantee young people's access to information and education; end gender discrimination and ensure government accountability.
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Global public health · Jan 2014
Designing the Expanded Programme on Immunisation (EPI) as a service: Prioritising patients over administrative logic.
Expanded Programme on Immunisation (EPI) vaccination rates remain well below herd immunity in regions of many countries despite huge international resources devoted to both financing and access. We draw upon service marketing theory, organisational sociology, development anthropology and cultural consumer research to conduct an ethnographic study of vaccination delivery in Jimma Zone, Ethiopia - one such region. We find that Western public health sector policies are dominated by an administrative logic. ⋯ While mothers value vaccination, it is a 'low involvement' good compared to the acute daily needs of a subsistence life. The costs imposed by poor service - such as uncaring staff with class hostilities, unpredictable and missed schedules and long waits - are too much and so they forego the service. Our service design framework illuminates specific service problems from the mother's perspective and points towards simple service innovations that could improve vaccination rates in regions that have poor uptake.
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Both the theory and practice of foreign policy and diplomacy, including systems of hard and soft power, are undergoing paradigm shifts, with an increasing number of innovative actors and strategies contributing to international relations outcomes in the 'New World Order'. Concurrently, global health programmes continue to ascend the political spectrum in scale, scope and influence. This concatenation of circumstances has demanded a re-examination of the existing and potential effectiveness of global health programmes in the 'smart power' context, based on adherence to a range of design, implementation and assessment criteria, which may simultaneously optimise their humanitarian, foreign policy and diplomatic effectiveness. ⋯ The desirability of making diplomatic and foreign policy criteria explicit, rather than implicit, in the context of global health programme design, delivery and evaluation are reflected in the identified implications for (1) international security, (2) programme evaluation, (3) funding and resource allocation decisions, (4) approval systems and (5) training. On this basis, global health programmes are shown to provide a valuable, yet underutilised, tool for diplomacy and foreign policy purposes, including their role in the pursuit of benign international influence. A corresponding alignment of resources between 'hard' and 'smart' power options is encouraged.