Ronald Labonté

University of Ottawa · School of Epidemiology and Public Health

A challenging budget environment during the Harper years has meant that crucial investments in the social determinants of health (SDHs) have increasingly been neglected. The tabling of what is widely considered a more progressive budget with expansionary fiscal elements under the new Prime Minister, Justin Trudeau, raises the question as to what ex...

One Health is a transdisciplinary approach used to address complex concerns related to human, animal, plant, and ecosystem health. One Health frameworks and operational tools are available to support countries and communities, particularly for the prevention and control of zoonotic diseases and antimicrobial resistance and the protection of food sa...

Background Maternal mortality continues to decrease in the world but remain the most important health problems in low-income countries. Although evidence indicates that social support is an important factor influencing health facility delivery, it has not been extensively studied in Ethiopia. Therefore, this study aimed to assess the effect of mate...

Background Childbirth at health institutions is critical to preventing major maternal and newborn deaths. In low and middle-income countries, many women still give childbirth without skilled assistance. Religious leaders may play a crucial role to promote childbirth at health institutions. So, this study aims to explore religious leaders’ experienc...

With COVID-19 receding, many countries are pondering what a post-pandemic economy should look like. Some advocate a more inclusive stakeholder model of capitalism. Others caution that this would be insufficient to deal with our pre-pandemic crises of income inequality and climate change. Many countries emphasize a 'green recovery' with improved fun...

Covid-19 has impeded achievement of the sustainable development goals and a radical rethink of the global economy is required to meet them argue Fran Baum and colleagues

The tobacco epidemic remains the most preventable health threat of our time, with nearly eight million people dying annually from tobacco use (World Health Organization [WHO], 2019a). While governments continue to pursue tobacco control measures around the world, such efforts face strong opposition from tobacco interests (Bump & Reich, 2013). This...

Background Accelerating progress to implement effective alcohol policies is necessary to achieve multiple targets within the WHO global strategy to reduce the harmful use of alcohol and the Sustainable Development Goals. However, the alcohol industry's role in shaping alcohol policy through international avenues, such as trade fora, is poorly under...

A return to a business as usual economy would be a fatal mistake argues Ronald Labonté

Background: Global health diplomacy (GHD) focuses on the actions taken by diverse stakeholders from different nations –governments, multilateral agents, and civil society– to phenomena that can affect population health and its determinants beyond national borders. Although the literature on conceptual advancements of GHD exists, empirical studies a...

Background A special session of the World Health Assembly (WHA) will be convened in late 2021 to consider developing a WHO convention, agreement or other international instrument on pandemic preparedness and response – a so-called ‘Pandemic Treaty’. Consideration is given to this treaty as well as to reform of the International Health Regulations (...

The COVID-19 pandemic is unprecedented. The pandemic not only induced a public health crisis, but has led to severe economic, social, and educational crises. Across economies and societies, the distributional consequences of the pandemic have been uneven. Among groups living in vulnerable conditions, the pandemic substantially magnified the inequal...

HOW TO INCORPORATE HEALTH EQUITY IN PANDEMIC PREPAREDNESS, PLANNING, RESPONSE, AND RECOVERY

This Policy Brief introduces the Health Equity Resource Tool Kit for the Governance of Infectious Diseases, developed by Global 1HN. The purpose of the Toolkit is to inform health practitioners, researchers, and decision-makers about the unique perspectives and challenges that must be considered when working with equity-seeking groups.

Institutional arrangements are key for problem-solving; therefore, pandemics require a strong governance response. While a plethora of ideas about prevention actions for pandemics have been advanced, there has been relatively limited consideration for how those can be operationalized through governance macro structures, particularly within the cont...

Today’s food systems are contributing to multiple intersecting health and ecological crises. Many are now calling for transformative, or even radical, food systems change. Our starting assumption in this Special Issue is the broad claim that the transformative changes being called for in a global food system in crisis cannot – and ultimately will n...

Poverty has long been a concern in public health with people living in poor circumstances generally suffering higher burdens of disease. Understanding the persistence of poverty, and of its impacts on health, unavoidably intersects with analyses of how inequalities arise in the distribution of income and wealth, and of the material and psychosocial...

Background: Maternal mortality continues to decrease in the world but remains the most important health problems in low-income countries. Although evidence indicates that social support is important factor influencing health facility delivery, it has not been extensively studied in Ethiopia. Therefore, this study aimed to assess social support in i...

Since the end of the Cold War, health has gone from a peripheral concern in foreign policy negotiations to a prominent place on the global political agenda. While the rise of health onto the foreign policy agenda is by now old news, the driving forces behind its expansion into new political spheres remain understudied and undertheorized. This artic...

Background The 2005 International Health Regulations (IHR (2005)) require States Parties to establish National Focal Points (NFPs) responsible for notifying the World Health Organization (WHO) of potential events that might constitute public health emergencies of international concern (PHEICs), such as outbreaks of novel infectious diseases. Given...

Addressing global health is one of the largest challenges facing humanity in the 21st century, however, this task is becoming even more formidable with the accelerated destruction of the planet. Building on the success of the previous edition, the book outlines how progress towards improving global health relies on understanding its core social, ec...

Background: The 2005 International Health Regulations (IHR (2005)) require States Parties to establish National Focal Points (NFPs) responsible for notifying the World Health Organization (WHO) of potential events that might constitute public health emergencies of international concern (PHEICs), such as outbreaks of novel infectious diseases. Given...

Findings of an analysis of Canadian policy responses to COVID-19 in terms of impacts on the social determinants of health equity

Part 1 of this glossary provided a brief background on the rise of regional/bilateral free trade agreements (FTAs) and described the health implications of new trade obligations that figure prominently in current and recent trade negotiations, focusing on those provisions that build on previous agreements of the World Trade Organization (WTO). This...

The global trading system has undergone a shift away from multilateral trade negotiations to a ‘spaghetti-bowl’ of regional and bilateral free trade agreements (FTAs). In this two-part glossary, we discuss why this shift has occurred, focusing on how it poses new challenges for public health. Specifically, we introduce key terms that shape this new...

Background: The pursuit of health equity is a priority in Ethiopia, especially with regards to maternal, newborn, and child health (MNCH). To date, there has been little characterization of the ‘problem’ of health inequity, and the normative assumptions implicit in the representation of the problem. Yet, such insights have implications for shaping...

Background: Advancing gender equality and health equity are concurrent priorities of the Ethiopian health sector. While gender is regarded as an important determinant of health, there is a paucity of literature that considers the interface between how these two priorities are pursued. Objective: This article explores how government stakeholders und...

In 2015, the United Nations' (UN) Member States adopted a bold and holistic agenda of the Sustainable Development Goals (SDGs), integrating a vision of peace and prosperity for people and planet. Extensive work within, between, across sectors is required for this bold and holistic agenda to be implemented. It is in this context that this special ar...

The USMCA (NAFTA 2.0), although signed over a year ago, went through several months of renegotiation of certain of its new rules that the Democrat-controlled US Congress wanted altered or strengthened. In December a ‘Protocol of Amendment’ was agreed upon and signed by the three Parties (the USA, Mexico, and Canada). A number of tough, new measures...

Antimicrobial resistance (AMR), a central health challenge of the twenty first century, poses substantial population health risks, with deaths currently estimated to be around 700,000 per year globally. The international community has signaled its commitment to exploring and implementing effective policy responses to AMR, with a Global Action Plan...

Objective While there is urgent need for policymaking that prioritises health equity, successful strategies for advancing such an agenda across multiple policy sectors are not well known. This study aims to address this gap by identifying successful strategies to advance a health equity agenda across multiple policy domains. Design We conducted in...

Background Maternity waiting homes (MWHs), residential spaces for pregnant women close to obstetric care facilities, are being used to tackle physical barriers to access. However, their effectiveness has not been rigorously assessed. The objective of this cluster randomized trial was to evaluate the effectiveness of functional MWHs combined with co...

This commentary discusses the contributions that One Health (OH) principles can make in improving the global response to the COVID-19 pandemic. We highlight four areas where the application of OH has the potential to significantly improve the governance of infectious diseases in general, and of COVID-19 in particular. First, more integrated surveil...

With public health attention on the commercial determinants of health showing little sign of abatement, how to manage conflicts of interest (COI) in regulatory policy discussions with corporate actors responsible for these determinants is gaining critical traction. The contribution by Ralston et al explores how COI management has itself become a te...

Background: Analysis of disaggregated national data suggest uneven access to essential maternal healthcare services within countries. This is of concern as it hinders equitable progress in health outcomes. Mounting an effective response requires identification of subnational areas that may be lagging behind. This paper aims to explore spatial vari...

Our paper responds to a narrative review on the influence of populist radical right parties (PRRPs) on welfare policy and its implications for population health in Europe. Five aspects of their review are striking: (i) welfare chauvinism is higher in tax-funded healthcare systems; (ii) PRRPs in coalition with liberal or social democratic parties ar...

Background: The People's Health Movement (PHM) was formed in 2000 and drew inspiration from the Alma Ata Declaration on Primary Health Care's 'Health for All' (1978). Since then PHM has been an active part of a global counter-hegemonic social movement. This study aimed to gain insights on social movement building, drawing on the successes and fail...

The COVID-19 pandemic has ushered in a new climate of uncertainty which is fuelling protectionism and playing into nationalist narratives. Globalisation is under significant threat as governments scramble to reduce their vulnerability to the virus by limiting global trade and flows of people. With the imposition of border closures and strict migrat...

Changing global markets have generated a dramatic shift in tobacco consumption from high-income countries (HICs) to low-and middle-income countries (LMICs); by 2030, more than 80% of the disease burden from tobacco use will fall on LMICs. Propelling this shift, opponents of tobacco control have successfully asserted that tobacco is essential to the...

Background: Despite greater attention to the nexus between trade and investment agreements and their potential impacts on public health, less is known regarding the political and governance conditions that enable or constrain attention to health issues on government trade agendas. Drawing on interviews with key stakeholders in the Australian trade...

COVID-19 has further exposed the strong association between race, ethnicity, culture, socioeconomic status and health outcomes and illuminated monumental ethnoracialised differences reflecting the ‘colour of disease’. Racism, segregation and inequality have been invisibly and pervasively embedded in dominant cultures and social institutions for de...

Tobacco is the primary export commodity in Malawi and an important contributor to foreign earnings. The entrenchment of tobacco interests within government has partly explained why Malawi has lagged in its efforts to address the health consequences of tobacco and has been a vocal opponent of global tobacco control. Despite the extensive historical...

Background The People’s Health Movement (PHM) formed in 2000 and drew inspiration from the Alma Ata Declaration on Primary Health Care’s ‘Health for All’ (1978). Since then PHM has been an active part of a global counter-hegemonic social movement. From locations across the world including eleven countries, health activists shared their insights on...

Events have progressed with dizzying rapidity since the World Health Organization (WHO) was first alerted to cases of severe pneumonia in the Wuhan City of China on December 31st 2019. The novel SARS-CoV-2 coronavirus disease (COVID-19) was declared a pandemic on March 11th 2020. As of April 7th, a total of 1.38 million cases of COVID-19 had been d...

Tobacco is a key cash crop for many farmers in Kenya, although there is a variety of challenges associated with tobacco production. This study seeks to understand alternatives to tobacco production from the perspective of government officials, extension officers, and farmers at the sub-national level (Migori, Busia, and Meru) in Kenya. The study an...

Issue addressed: Group work, such as peer support and health promotion is an important strategy available to comprehensive primary health care. However, group work and how it contributes to the goals of comprehensive primary health care has been under-researched and under-theorised. Methods: In this five year study we partnered with seven Austra...

This chapter reviews key research methods used to interrogate trade and health relationships organised under seven categories: ‘Big Trade’ studies that rely on large data sets; country case studies which dig deeper into specific trade-related pathways; natural experiments which compare health outcomes between matched countries following new liberal...

This chapter explores the implications of trade agreements for the provision of health services and access to medicines and other health technologies. It first examines the potential effects of the General Agreement on Trade in Services and subsequent bilateral and regional trade agreements on the provision of universal health care and the ‘brain d...

Trade is as old as human societies, but treaties governing trade between nations are relatively new. Negotiations for international trade rules began after World War II, culminating in the creation of the World Trade Organization (WTO) in 1995. The WTO established principles to govern trade, schedules for tariff reductions, rules for dispute settle...

New trade agreements often include measures promising protection of labour rights and the environment. The section on labour describes how labour rights are said to be protected in such agreements and how (or if) the inclusion of these rights within trade treaties improves labour market outcomes. A key weakness in such provisions is that they becom...

The Conclusion draws together all of the arguments of this book. It briefly recaps the emergence of the multilateral rules-based trading system and the shift towards bilateral and regional trade agreements, explores the main areas of policy incoherence between trade and health and discusses flaws in the trade policy-making process that frustrate ef...

This chapter presents an analysis of the actors, ideas, institutions and processes that shape trade policy and the negotiation of trade agreements. The roles played by nation states, industry, civil society and academics are explored. The trade policy-making process is described, and the ways in which influence is exerted. The role of intergovernme...

This chapter discusses the implications of trade agreements for tobacco, alcohol and ultra-processed foods. For each of these unhealthy commodities, the impact of reducing tariffs and other non-tariff barriers is explored, along with the ways in which trade agreements can reduce the policy space available to governments to address rising rates of n...

Abstract To respond to the global noncommunicable disease (NCD) crisis, the Codex Alimentarius Commission (Codex), a multilateral United Nations body responsible for work on food standards, is developing global guidance for front of pack (FoP) nutrition labelling. Guidance from Codex regarding FoP nutrition labelling at the global level will almost...

The need for policy coherence between trade and health has never been greater, yet few public health workers are equipped to navigate this complex field. This book aims to fill this gap, providing a focused and readable introduction to the topic. It introduces the principles underpinning trade treaties and examines the implications of trade rules f...

Background: Community health workers (CHW) are an established workforce in many low- and middle-income countries (LMICs). Some countries with national CHW programs are Brazil, India, Nepal, Ethiopia, Pakistan, Bangladesh, Iran, and Afghanistan. These large-scale CHW programs are often evaluated using data from individual CHWs rather than the progra...

This article describes how states which have committed to the right to health in international human rights law are obligated to take measures to respect and fulfill this right for their citizens, including measures to protect against the harm to health caused by tobacco. It also reaffirms the duality of both international trade and investment law,...

Many qualitative research studies acknowledge the possibility of social desirability bias (a tendency to present reality to align with what is perceived to be socially acceptable) as a limitation that creates complexities in interpreting findings. Drawing on experiences conducting interviews and focus groups in rural Ethiopia, this article provides...

Background and aims: Trade liberalisation is hypothesised to increase the availability of imported alcoholic beverages in importing countries. This study provides the first longitudinal analysis of the impact of preferential trade agreements (PTAs) on alcohol imports. Design: Panel data comprising alcohol-product (N=15) by importing country (N=1...

Background: Ethiopia is one of the ten countries in the world that together account for almost 60% of all maternal deaths. Recent reductions in maternal mortality have been seen, yet just 26% of women who gave birth in Ethiopia in 2016 reported doing so at a health facility. Maternity waiting homes (MWHs) have been introduced to overcome geographi...

Trade has long been an axiomatic characteristic of globalization, although international rules governing trade are of more recent vintage. Notably in the post-World War II period, an ever increasing number of countries began negotiating treaties to reduce, first, tariff barriers and, later, non-tariff barriers (government measures of any sort) that...

Background Access to trusted health information has contribution to improve maternal and child health outcomes. However, limited research to date has explored the perceptions of communities regarding credible messenger and messaging in rural Ethiopia. Therefore, this study aimed to explore sources of trusted maternal health information and preferen...

Background Health equity is a cross-cutting theme in the United Nations 2030 Agenda for Sustainable Development, and a priority in health sector planning in countries including Ethiopia. Subnational health managers in Ethiopia are uniquely positioned to advance health equity, given the coordination, planning, budgetary, and administration tasks tha...

Background: Trade and investment agreements negotiated after the World Trade Organization's Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) have included increasingly elevated protection of intellectual property rights along with an expanding array of rules impacting many aspects of pharmaceutical policy. Despite the lar...

Neoliberal logic and institutional lethargy may well explain part of the reason why governments pay little attention to how their economic and development policies negatively affect health outcomes associated with the global diffusion of unhealthy commodities. In calling attention to this the authors encourage health advocates to consider strategie...

Background: In Ethiopia, malaria infections and other complications during pregnancy contribute to the high burden of maternal morbidity and mortality. Preventive measures are available, however little is known about the factors influencing the uptake of maternal health services and interventions by pregnant women in Ethiopia. Methods: We analyz...

Background: Maternal and child morbidity and mortality remains one of the most important public health challenges in developing countries. In rural settings, the promotion of household and community health practices through health extension workers in collaboration with other community members is among the key strategies to improve maternal and ch...

Background: Despite improvements in recent years, Ethiopia faces a high burden of maternal morbidity and mortality. Antenatal care (ANC) may reduce maternal morbidity and mortality through the detection of pregnancy-related complications, and increased health facility-based deliveries. Midwives and community-based Health Extension Workers (HEWs) c...

Introduction: telemedicine is seen as a potential solution to improve access to specialist services in underserved areas, but using telemedicine depends on physicians' beliefs regarding its use. Applying the theory of planned behaviour, there are three kinds of beliefs of relevance: behavioural, normative and control beliefs. This study aimed to de...

Introduction: Tobacco production continues to increase in low- and middle-income countries creating complications for tobacco control efforts. There is the need to understand and address the global tobacco leaf supply as a means of decreasing tobacco consumption and improving farmers livelihoods in line with Article 17 of the WHO Framework Convent...

Zambia, a tobacco-growing country, provides manufacturing incentives to attract foreign and domestic investment. In an earlier study, we cautioned that these incentives could lead to local tobacco manufacturing, undermining its domestic tobacco control efforts. In 2018, as part of our continuing research program, we conducted key informant intervie...

The paper “Consequences of policy incoherence: how Zambia’s post-FCTC investment policy stimulated tobacco production” was published without including the acknowledgements:

Primary health care (PHC), codified at the historic 1978 Alma Ata Conference, was advocated as the means to achieve health for all by the year 2000. 1 The principles of PHC included universal access and equitable coverage; comprehensive care emphasising disease prevention and health promotion; community and individual participation in health policy...

Civil society engagement around health care and population health improvement is an important driver towards Health for All. Research can improve the effectiveness of health activism by examining the resources, structures and strategies of civil society engagement. However, research to support such engagement faces epistemological and methodologica...