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Instruments of Colonial Administration and White Saviorism: The Past and Present of Public Health
Humanitarian themes, such as rights and entitlements to universal well-being, feature prominently in narratives of global health, even as many recent authors have pointed to systematic imbalances of power, unfair governance structures, and unwanted influences as evidence of ongoing colonial interference in the health affairs of many low- and middle-income countries. This article employs an historical perspective to analyze major forces that have shaped the development of global health, and which remain as obstacles to its objectives. These include macroeconomics, geopolitics, and the activism and resources of the HIV/AIDS pandemic that led to global health in its current form. Through an examination of this history and its effects, I argue that the humanitarian goals of global health will not be realized without dramatic changes to the field. Particularly in the failure to engage economic relationships and trade policy, global health limits its attention to downstream consequences of resource inequalities, where its goal of a more egalitarian, more healthy world is difficult, if not impossible, to achieve.
Global health emerged as a distinct public health discipline within the last two decades. With over 95% of Masters of Global Health degree programmes located in high-income countries (HICs), the area of study has been primarily pursued by White, middle and upperclass, citizens of Europe and North America. In turn, the global health workforce and leadership reflect these same demographics. In this article, we present several key arguments against the current state of global health education: (1) admissions criteria favour HIC applicants; (2) the curriculum is developed with the HIC gaze; (3) student practicums can cause unintended harms in low- and middle-income country communities. We argue that global health education in its current form must be dismantled. We conclude with suggestions for how global health education may be reimagined to shift from a space of privilege and colonial practice to a space that recognises the strengths of experiences and knowledge above and beyond those from HICs.
Decolonising global health has gained momentum in recent years and has called for more reflexive individuals.
However, the call to be reflexive may run the risk of becoming lip service without clarity on what reflexivity requires.
We diverge from reflexivity’s usual place in qualitative research, bring it closer to individual positionalities and frame it as comprising of: (a) self-understanding; (b) dialogue with peers; and (c) insights-to-action.
We argue that reflexivity that is either in isolation or without action will not contribute to global health transformation.
We present insights and action points from our journeys in global health to demonstrate examples of what may emerge from dialogical reflexivity as we have framed it here.
We call on peers to build a culture of reflexivity by sparking dialogues in their institutions and translating their insights into collective action.
The caste system is social stratification system that has been used over the last 3 millennia. This review aims to investigate caste-based inequity in health care utilization in South Asia, particularly focusing those at the bottom of the caste hierarchy, commonly known as Dalit communities. A systematic methodology was followed; key databases (including CINAHL, Medline, SocINDEX, PubMed, Nepjol, JSTOR, and ASSIA) were searched for relevant articles published before October 2019, using comprehensive search strategy in accordance with the PRISMA guidelines. In total 15,109 papers were found, and from these, 9 selected papers were included in the review. The papers focused on studies in both India (n = 7) and Nepal (n = 2) and utilized a range of methods including qualitative (n = 2), quantitative (n = 3), and mixed methods (n = 4) approaches. The review identified 4 main themes: stigma, poverty, cultures and beliefs, and health care. Caste-based inequity impacts upon all aspects of an individual’s well-being including violence and everyday life risks. Caste also impacts upon individuals’ opportunities to access education, employment, and health care. Dalits appear to experience this more significantly due to both poverty and their caste status, which increases their vulnerability to health risks.
Despite decades of evidence showing that institutional racism serve as significant barriers to accessible healthcare for Aboriginal and Torres Strait Islander Peoples, attempts to address this systemic problem still fall short. The social determinants of health are particularly poignant given the socio-political-economic history of invasion, colonisation, and subsequent entrenchment of racialised practices in the Australian healthcare landscape. Embedded within Euro-centric, bio-medical discourses, Western dominated healthcare processes can erase significant cultural and historical contexts and unwittingly reproduce unsafe practices. Put simply, if Black lives matter in healthcare, why do Aboriginal and Torres Strait Islander Peoples die younger and experience ‘epidemic’ levels of chronic diseases as compared to white Australians? To answer this, we utilise critical race perspectives to theorise this gap and to de-center whiteness as the normalised position of ‘doing’ healthcare. We draw on our diverse knowledges through a decolonised approach to promote a theoretical discussion that we contend can inform alternative ways of knowing, being, and doing in healthcare practice in Australia.
The institutionalisation of racism in healthcare has had a detrimental effect on the treatment and health outcomes of Aboriginal and Torres Strait Islander populations. Institutional racism describes the ways that race has been encoded into medical education, funding regimes, health policy and clinical settings. Proposals seeking to address this situation tend to ignore the historical formation of racialised institutions and instead focus on the attitudes of individuals working in those institutions. Drawing on critical theory of race and whiteness studies, this article argues that colonial medicine and political liberalism co-produced a social ontology and epistemology that centres whiteness as the norm to the exclusion of racialised others. It contends that it is necessary to understand this history to adequately address its continuing effects in Australian healthcare system today. The article argues that bioethics, a field that ordinarily functions as a source of regulation and critique of medicine, has been unable to respond to institutional racism because it too is shaped by this history of whiteness. The article concludes by questioning whether a bioethics centred on racial justice and Indigenous sovereignty could provide a way forward.
Background:
Eliminating indigenous and ethnic health inequities requires addressing the determinants of health inequities which includes institutionalised racism, and ensuring a health care system that delivers appropriate and equitable care. There is growing recognition of the importance of cultural competency and cultural safety at both individual health practitioner and organisational levels to achieve equitable health care. Some jurisdictions have included cultural competency in health professional licensing legislation, health professional accreditation standards, and pre-service and in-service training programmes. However, there are mixed definitions and understandings of cultural competency and cultural safety, and how best to achieve them.
Methods:
A literature review of 59 international articles on the definitions of cultural competency and cultural safety was undertaken. Findings were contextualised to the cultural competency legislation, statements and initiatives present within Aotearoa New Zealand, a national Symposium on Cultural Competence and Māori Health, convened by the Medical Council of New Zealand and Te Ohu Rata o Aotearoa - Māori Medical Practitioners Association (Te ORA) and consultation with Māori medical practitioners via Te ORA.
Results:
Health practitioners, healthcare organisations and health systems need to be engaged in working towards cultural safety and critical consciousness. To do this, they must be prepared to critique the 'taken for granted' power structures and be prepared to challenge their own culture and cultural systems rather than prioritise becoming 'competent' in the cultures of others. The objective of cultural safety activities also needs to be clearly linked to achieving health equity. Healthcare organisations and authorities need to be held accountable for providing culturally safe care, as defined by patients and their communities, and as measured through progress towards achieving health equity.
Conclusions:
A move to cultural safety rather than cultural competency is recommended. We propose a definition for cultural safety that we believe to be more fit for purpose in achieving health equity, and clarify the essential principles and practical steps to operationalise this approach in healthcare organisations and workforce development. The unintended consequences of a narrow or limited understanding of cultural competency are discussed, along with recommendations for how a broader conceptualisation of these terms is important.
The rise of the Institute for Health Metrics and Evaluation (IHME) has augured profound changes in the landscape of global health metrics. Primarily funded by the Bill and Melinda Gates Foundation, the IHME has offered donors a platform for assessing many health‐related Sustainable Development Goal (SDG) indicators and a toolkit to measure the progress of different countries. The IHME's increasing influence reveals the relative sidelining of international agencies and especially the World Health Organization which has long been central to global health metrics production. This shift reflects a growing conflict between the expertise and norms of national and intergovernmental statistical production on the one hand, and the distinct epistemologies and logics of new non‐state data actors. These transitions – from an international world of statistics to a more plural, global realm of data – have acute implications for the politics and accountability of knowledge production related to the SDGs and development writ large. Even as the SDGs embrace the rubric of ‘no one left behind’, the emerging data politics might be eroding the ability of poorer states to know and act upon their development problems on their own terms.
In September 1978, the WHO convened a momentous International Conference on Primary Health Care in Alma-Ata, capital of the Soviet republic of Kazakhstan. This unprecedented gathering signalled a break with WHO’s long-standing technically oriented disease eradication campaigns. Instead, Alma-Ata emphasised a community-based, social justice-oriented approach to health. Existing historical accounts of the conference, largely based on WHO sources, have characterised it as a Soviet triumph. Such reasoning, embedded in Cold War logic, contradicts both the decision-making processes in Geneva and Moscow that led the conference to be held in the Union of Soviet Socialist Republics (USSR) and the reality that the highest Soviet authorities did not consider it a significant ideological or political opportunity. To redress the omissions and assumptions of prior accounts, this article examines the Alma-Ata conference in the context of Soviet political and health developments, drawing from Soviet archival and published sources as well as WHO materials and interviews with several key Soviet protagonists. We begin by outlining the USSR’s complicated relationship to WHO and the international health sphere. Next, we trace the genesis of the proposal for—and realisation and repercussions of—the primary healthcare (PHC) meeting, framed by Soviet, Kazakh, WHO and Cold War politics. Finally, we explore misjudgements and competing meanings of PHC from both Soviet and WHO perspectives, in particular focusing on the role of physicians, community participation and socialist approaches to PHC.
Background:
Suicide is the second leading cause of death among adolescents worldwide, and is a major driver of health inequity among Indigenous people in high-income countries. However, little is known about the burden of suicide among Indigenous populations in low- and middle-income nations, and no synthesis of the global data is currently available. Our objective was to examine the global incidence of suicide among Indigenous peoples and assess disparities through comparisons with non-Indigenous populations.
Methods:
We conducted a systematic review of suicide rates among Indigenous peoples worldwide and assessed disparities between Indigenous and non-Indigenous populations. We performed text word and Medical Subject Headings searches in PubMed, MEDLINE, Embase, Cumulative Index of Nursing and Allied Health (CINAHL), PsycINFO, Latin American and Caribbean Health Sciences Literature (LILACS), and Scientific Electronic Library Online (SciELO) for observational studies in any language, indexed from database inception until June 1, 2017. Eligible studies examined crude or standardized suicide rates in Indigenous populations at national, regional, or local levels, and examined rate ratios for comparisons to non-Indigenous populations.
Results:
The search identified 13,736 papers and we included 99. Eligible studies examined suicide rates among Indigenous peoples in 30 countries and territories, though the majority focused on populations in high-income nations. Results showed that suicide rates are elevated in many Indigenous populations worldwide, though rate variation is common, and suicide incidence ranges from 0 to 187.5 suicide deaths per 100,000 population. We found evidence of suicide rate parity between Indigenous and non-Indigenous populations in some contexts, while elsewhere rates were more than 20 times higher among Indigenous peoples.
Conclusions:
This review showed that suicide rates in Indigenous populations vary globally, and that suicide rate disparities between Indigenous and non-Indigenous populations are substantial in some settings but not universal. Including Indigenous identifiers and disaggregating national suicide mortality data by geography and ethnicity will improve the quality and relevance of evidence that informs community, clinical, and public health practice in Indigenous suicide prevention.
Background:
The global health system has faced significant expansion over the past few decades, including continued increase in both the number and diversity of actors operating within it. However, without a stronger understanding of what the global health system encompasses, coordination of actors and resources to address today's global health challenges will not be possible.
Methods:
This study presents a conceptually sound and operational definition of the global health system. Importantly, this definition can be applied in practice to facilitate analysis of the system. The study tested the analytical helpfulness of this definition through a network mapping exercise, whereby the interconnected nature of websites representing actors in the global health system was studied.
Results:
Using a systematic methodology and related search functions, 203 global health actors were identified, representing the largest and most transparent list of its kind to date. Identified global health actors were characterized and the structure of their social network revealed intriguing patterns in relationships among actors.
Conclusions:
These findings provide a foundation for future inquiries into the global health system's structure and dynamics that are critical if we are to better coordinate system activities and ensure successful response to our most pressing global health challenges.
In a globalised world social welfare professionals confront a diversity of clients, with needs which are demonstrably culturally determined. As such, professional understanding of the nexus between clients and their environmental control strategies is paramount. The medium through which families negotiate their surroundings, occupation, shelter, and safety are significant matters to Aboriginal people within Australia. The progression from former Aboriginal "assimilationist" policy to present approaches exposes problematic contemporary needs-based approaches to public policy intervention. The highly troublesome policy intervention history prompts a reconceptualisation of "needs"-based approaches to Aboriginal welfare. Theoretical perspectives on needs support culturally-safe methodologies for innovation in social service delivery. The role of social work is highlighted in promoting such a policy in respect of environmental control.
On August 29] Susan Daniels called me to enlist my help because her sister-in-law, a quadriplegic woman in New Orleans, had been unsuccessfully trying to evacuate to the Super-dome for two days…but, despite promises, no one came. The very same paratransit system that people can't rely on in good weather is what was being relied on in the evacuation. I was on the phone with Benilda when she told me, with panic in her voice 'the water is rushing in.' And then her phone went dead. We learned five days later that she had been found in her apartment dead, floating next to her wheelchair. Natural disasters and disasters that directly derive from human actions, both evolving and sudden, trace the structural fault lines of the societies that they affect. Disaster outcomes disproportionately impact those with the least access to social and material resources: women and children, and people who are elderly, disabled or impoverished. Using a disability conceptual framework, the essays in this volume focus on disasters within their social and environmental ecologies, with particular attention to the ways in which conventional disaster planning and responses ensure that existing social inequalities will be perpetuated as consequences of disasters. We argue that by foregrounding the needs of those with the fewest resources, an applied anthropology of disaster points to potential benefits to all when disaster preparedness, response, and recovery plans include the expertise of disabled people.
We are currently experiencing an era that is facing increasing global environmental and societal problems (e.g., climate change, habitat destruction and economic recession). Scientific research projects are often required to emphasize and counter the effects of inequity and globalisation, and prioritise cooperation supported by cooperative research. This paper investigates whether publication of research that is carried out in least developed countries is done in cooperation with research institutes from these countries. The study uses the Current Contents database of peer-reviewed publications from more than 7,000 journals in all sciences (Biology and environmental sciences; Physical, chemical and earth sciences; Engineering, computing and technology; Life sciences; Clinical medicine; Arts and humanities; Social and behavioral sciences) published between 1 January 1999 and 3 November 2000. From a total of 1,601,196 papers published, 2,798 articles of research activities carried out in the 48 least developed countries were selected using title information as an indicator. Collaborative relationships between research institutions involved was then analysed within and between countries and sciences. Our results show that publications of research, carried out in the least developed countries, do not have co-authorship of local research institutes in 70% of the cases, and that a majority of the papers is published by research institutes from the most industrialised countries in the world. We employed the use of questionnaires sent to authors from papers in the above-mentioned database to detect possible causes of this high percentage of lack of authorship in the essential academic currency that 'publications' are. 'Neo-colonial science' is identified as one of them. In addition, there exists a large discrepancy between what the surveyed scientists say they find important in international collaboration and joint publishing, and the way they act to it. However, the interpretation given to the fact that institutional co-authorship is underrepresented for local research institutions in the least developed countries is less important than the fact itself, and future research should concentrate on a scientific way to equilibrate this adverse trend.
This paper situates paradigm talk with its insistence on multiplicities and proliferations in tension with a resurgent positivism and governmental imposition of experimental design as the gold stan-dard in research methods. Using the concept of 'coloring epistemologies' as an index of such tensions, the essay argues for proliferation as an ontological and historical claim. What all of this might mean in the teaching of research in education is dealt with in a delineation of five aporias that are fruitful in helping students work against technical thought and method: aporias of objectivity, complicity, difference, interpretation, and legitimization. The essay concludes with a 'disjunctive affirmation' of multiple ways of going about educational research in terms of finding our way into a less comfortable social science full of stuck places and difficult philosophical issues of truth, interpretation and responsibility.
Socioeconomic disadvantage (SED) and its contribution to the pain experience is of growing interest and relevance. This review will provide a brief overview of definitional and measurement issues related to SED. Selected literature considering the relationships between SED and pain will then be summarized, and several possible mechanisms to explain the relationships will be considered. Last, future directions for research and practice will be discussed.
Despite being globally pervasive, racism, xenophobia, and discrimination are not universally recognised determinants of health. We challenge widespread beliefs related to the inevitability of increased mortality and morbidity associated with particular ethnicities and minoritised groups. In refuting that racial categories have a genetic basis and acknowledging that socioeconomic factors offer incomplete explanations in understanding these health disparities, we examine the pathways by which discrimination based on caste, ethnicity, Indigeneity, migratory status, race, religion, and skin colour affect health. Discrimination based on these categories, although having many unique historical and cultural contexts, operates in the same way, with overlapping pathways and health effects. We synthesise how such discrimination affects health systems, spatial determination, and communities, and how these processes manifest at the individual level, across the life course, and intergenerationally. We explore how individuals respond to and internalise these complex mechanisms psychologically, behaviourally, and physiologically. The evidence shows that racism, xenophobia, and discrimination affect a range of health outcomes across all ages around the world, and remain embedded within the universal challenges we face, from COVID-19 to the climate emergency.
For many years I have discussed with colleagues, and more recently with students, the definition of critical perspectives (plural, for there are many) on public health. Based on those discussions, and with a focus on health inequalities, this article identifies five elements of such perspectives. First, they involve some degree of commitment to health equity. Second, they situate health inequalities with regard to underlying social arrangements or institutions. Third, history matters. Fourth, the potentially pernicious impact of medicalisation and the dominance of medical frames of reference must be acknowledged. Fifth, production of scientific knowledge must be recognized as a social process whose material and institutional contexts matter. The elements of critical perspectives interact and intersect in practice, as shown with illustrations.
Public health in the Mandated Territory of New Guinea shared characteristics with regimes in other colonial territories. The protection of European health and ensuring a supply of efficient indigenous labour were the principle aims of the public health regime. Measures to control infectious disease focused on racial segregation of urban spaces, surveillance, and control of indigenous mobility. Yet, if the mandate did not systemically encourage projects in preventive health and social medicine, wider public engagement with the international discourse of indigenous welfare and uplift surrounding it at times shaped colonial administration indirectly. One Director of Public Health in New Guinea, Raphael Cilento, invoked the terms of the mandate during acrimonious debates over nutrition in the 1920s that led to significant changes to rations included in the Native Labour Ordinance.
Health promotion aspires to work in empowering, participatory ways, with the goal of supporting people to increase control over their health. However, buried in this goal is an ethical tension: while increasing people's autonomy, health promotion also imposes a particular, health promotion-sanctioned version of what is good. This tension positions practitioners precariously, where the ethos of empowerment risks increasing health promotion's paternalistic control over people, rather than people's control over their own health. Herein we argue that this ethical tension is amplified in Indigenous Australia, where colonial processes of control over Indigenous lands, lives and cultures are indistinguishable from contemporary health promotion 'interventions'. Moreover, the potential stigmatisation produced in any paternalistic acts 'done for their own good' cannot be assumed to have evaporated within the self-proclaimed 'empowering' narratives of health promotion. This issue's guest editor's call for health promotion to engage 'with politics and with philosophical ideas about the state and the citizen' is particularly relevant in an Indigenous Australian context. Indigenous Australians continue to experience health promotion as a moral project of control through intervention, which contradicts health promotion's central goal of empowerment. Therefore, Indigenous health promotion is an invaluable site for discussion and analysis of health promotion's broader ethical tensions. Given the persistent and alarming Indigenous health inequalities, this paper calls for systematic ethical reflection in order to redress health promotion's general failure to reduce health inequalities experienced by Indigenous Australians.
In our chapter in the first edition of this Handbook (see record
1994-98625-005), we presented two tables that summarized our positions, first, on the axiomatic nature of paradigms (the paradigms we considered at that time were positivism, postpositivism, critical theory, and constructivism, p. 109, Table 6.1); and second, on the issues we believed were most fundamental to differentiating the four paradigms (p. 112, Table 6.2). These tables are reproduced here as a way of reminding our readers of our previous statements. The axioms defined the ontological, epistemological, and methodological bases for both established and emergent paradigms. The issues most often in contention that we examined were inquiry aim, nature of knowledge, the way knowledge is accumulated, goodness (rigor and validity) or quality criteria, values, ethics, voice, training, accommodation, and hegemony. An examination of these two tables will reacquaint the reader with our original Handbook treatment. Since publication of that chapter, at least one set of authors, J. Heron and P. Reason, have elaborated on our tables to include the participatory/cooperative paradigm (Heron, 1996; Heron & Reason, 1997, pp. 289-290). Thus, in addition to the paradigms of positivism, postpositivism, critical theory, and constructivism, we add the participatory paradigm in the present chapter (this is an excellent example, we might add, of the hermeneutic elaboration so embedded in our own view, constructivism). Our aim here is to extend the analysis further by building on Heron and Reason's additions and by rearranging the issues to reflect current thought. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Missionaries have played a long-running part in the history of African healthcare but now they are more widespread and diverse than ever before. Samuel Loewenberg reports from Tanzania.
At the 2006 National Conference of the Australian Health Promotion, Māori academic and public health physician Dr Papaarangi Reid challenged us to critique our own practice and asked whether health promotion needs to be de-colonised. In this paper, one Indigenous and two non-Indigenous researchers working within the Aboriginal community controlled health sector reflect on ways in which research and health promotion interventions with Indigenous populations challenge or reinforce the very values that have led to the disadvantage, neglect and apathy experienced by Indigenous populations in the first place. While our practice is framed by the principles of Aboriginal self-determination and community control, we suggest that de-colonising is not so much about the need to invent new research methods nor to search for research methods in traditional Aboriginal culture; it is much more about values, processes and relationships. We recognise the need to challenge the deficit model in health promotion and research, and we do not want to inflict any more damage to the community, through reinforcing stereotypes, creating fear, or contributing to further bad press. We argue for adopting a methodology that shifts power and enables Indigenous people to frame research in ways they want it framed, and for taking a holistic approach and focusing on community strength and resilience.
The great increase in the number of deaths attributed to cancer of the lung in the last 25 years justifies the search for a cause in the environment. An investigation was therefore carried out into the possible association of carcinoma of the lung with smoking, exposure to car and fuel fumes, occupation, etc. The preliminary findings with regard to smoking are reported. The material for the investigation was obtained from twenty hospitals in the London region which notified patients with cancer of the lung, stomach, and large bowel. Almoners then visited and interviewed each patient. The patients with carcinoma of the stomach and large bowel served for comparison and, in addition, the almoners interviewed a non-cancer control group of general hospital patients, chosen so as to be of the same sex and age as the lung-carcinoma patients. Altogether 649 men and 60 women with carcinoma of the lung were interviewed. Of the men 0.3% and of the women 31.7% were non-smokers (as defined in the text). The corresponding figures for the non-cancer control groups were : men 4.2%, women 53.3%. Among the smokers a relatively high proportion of the patients with carcinoma of the lung fell in the heavier smoking categories. For example, 26.0% of the male and 14.6% of the female lung-carcinoma patients who smoked gave as their most recent smoking habits prior to their illness the equivalent of 25 or more cigarettes a day, while only 13.5% of the male and none of the female non-cancer control patients smoked as much. Similar differences were found when comparisons were made between the maximum amounts ever smoked and the estimated total amounts ever smoked. Cigarette smoking was more closely related to carcinoma of the lung than pipe smoking. No distinct association was found with inhaling. Taken as a whole, the lung-carcinoma patients had begun to smoke earlier and had continued for longer than the controls, but the differences were very small and not statistically significant. Rather fewer lung-carcinoma patients had given up smoking. Consideration has been given to the possibility that the results could have been produced by the selection of an unsuitable group of control patients, by patients with respiratory disease exaggerating their smoking habits, or by bias on the part of the interviewers. Reasons are given for excluding all these possibilities, and it is concluded that smoking is an important factor in the cause of carcinoma of the lung. From consideration of the smoking histories given by the patients without cancer of the lung a tentative estimate was made of the number of people who smoked different amounts of tobacco in Greater London, and hence the relative risks of developing the disease among different grades of smokers were calculated. The figures obtained are admittedly speculative, but suggest that, above the age of 45, the risk of developing the disease increases in simple proportion with the amount smoked, and that it may be approximately 50 times as great among those who smoke 25 or more cigarettes a day as among non-smokers. The observed sex ratio among non-smokers (based, it must be stressed, on very few cases) can be readily accounted for if the true incidence among non-smokers is equal in both sexes. It is not possible to deduce a simple time relationship between the increased consumption of tobacco and the increased number of deaths attributed to cancer of the lung. This may be because part of the increase is apparent - that is, due to improved diagnosis - but it may also be because the carcinogen in tobacco smoke is introduced into the tobacco during its cultivation or preparation. Greater changes may have taken place in the methods involved in these processes than in the actual amount of tobacco consumed.
Series of articles in response to the first English printing of Schairer and Scho:niger's study on lung cancer and smoking.
1. Sir Richard Doll. "Commentary: Lung cancer and tobacco consumption" pp30-31
2. Richard N. Proctor
3. Susanne Zimmerman, Matthias Egger and Uwe Hossfeld. "Commentary: Pioneering research into smoking and health in Nazi Germany -- The 'Wissenschaftliches Institut zur Erforschung der Tabakgefahren' in Jena" pp. 35-7
4. E Ernst. "Commentary: The Third Reich -- German physicians between resistance and participation" pp. 37-42
The gross inequalities in health that we see within and between countries present a challenge to the world. That there should be a spread of life expectancy of 48 years among countries and 20 years or more within countries is not inevitable. A burgeoning volume of research identifies social factors at the root of much of these inequalities in health. Social determinants are relevant to communicable and non-communicable disease alike. Health status, therefore, should be of concern to policy makers in every sector, not solely those involved in health policy. As a response to this global challenge, WHO is launching a Commission on Social Determinants of Health, which will review the evidence, raise societal debate, and recommend policies with the goal of improving health of the world's most vulnerable people. A major thrust of the Commission is turning public-health knowledge into political action.
Sage encyclopedia of qualitative research methods
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