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[GO4HEALTH] Formulating new Goals for global health, and proposing new Governance for global health that will allow the achievement of these goals (305240)
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  • Open Access English
    Authors: 
    Vannarath Te; Nadia Floden; Sameera Hussain; Claire E. Brolan; Peter S. Hill;
    Publisher: BioMed Central
    Project: NHMRC | Formulating New Goals for... (1055138), EC | GO4HEALTH (305240)

    Background: In 2012, the European Commission funded Go4Health—Goals and Governance for Global Health, a consortium of 13 academic research and human rights institutions from both Global North and South—to track the evolution of the Sustainable Development Goals (SDGs), and provide ongoing policy advice. This paper reviews the research outputs published between 2012 and 2016, analyzing the thematic content of the publications, and the influence on global health and development discourse through citation metrics.Findings and discussion: Analysis of the 54 published papers showed 6 dominant themes related to the SDGs: the formulation process for the SDG health goal; the right to health; Universal Health Coverage; voices of marginalized peoples; global health governance; and the integration of health across the other SDGs. The papers combined advocacy---particularly for the right to health and its potential embodiment in Universal Health Coverage—with qualitative research and analysis of policy and stakeholders. Go4Health's publications on the right to health, global health governance and the voices of marginalized peoples in relation to the SDGs represented a substantial proportion of papers published for these topics. Go4Health analysis of the right to health clarified its elements and their application to Universal Health Coverage, global health governance, financing the SDGs and access to medicines. Qualitative research identified correspondence between perceptions of marginalized peoples and right to health principles, and reluctance among multilateral organizations to explicitly represent the right to health in the goals, despite their acknowledgement of their importance. Citation metrics analysis confirmed an average of 5.5 citations per paper, with a field-weighted citation impact of 2.24 for the 43 peer reviewed publications. Citations in the academic literature and UN policy documents confirmed the impact of Go4Health on the global discourse around the SDGs, but within the Go4Health consortium there was also evidence of two epistemological frames of analysis—normative legal analysis and empirical research—that created productive synergies in unpacking the health SDG and the right to health.Conclusion: The analysis offers clear evidence for the contribution of funded programmatic research—such as the Go4Health project—to the global health discourse.

  • Open Access English
    Authors: 
    Claire E. Brolan; Vannarath Te; Nadia Floden; Peter S. Hill; Lisa Forman;
    Publisher: BMJ Publishing Group
    Project: EC | GO4HEALTH (305240)

    Since the new global health and development goal, Sustainable Development Goal (SDG) 3, and its nine targets and four means of implementation were introduced to the world through a United Nations (UN) General Assembly resolution in September 2015, right to health practitioners have queried whether this goal mirrors the content of the human right to health in international law. This study examines the text of the UN SDG resolution, Transforming our world: the 2030 Agenda for Sustainable Development, from a right to health minimalist and right to health maximalist analytic perspective. When reviewing the UN SDG resolution's text, a right to health minimalist questions whether the content of the right to health is at least implicitly included in this document, specifically focusing on SDG 3 and its metrics framework. A right to health maximalist, on the other hand, queries whether the content of the right to health is explicitly included. This study finds that whether the right to health is contained in the UN SDG resolution, and the SDG metrics therein, ultimately depends on the individual analyst's subjective persuasion in relation to right to health minimalism or maximalism. We conclude that the UN General Assembly's lack of cogency on the right to health's position in the UN SDG resolution will continue to blur if not divest human rights' (and specifically the right to health's) integral relationship to high-level development planning, implementation and SDG monitoring and evaluation efforts.

  • Open Access English
    Authors: 
    Claire E. Brolan; Lisa Forman; Stéphanie Dagron; Rachel Hammonds; Attiya Waris; Lyla Latif; Ana Lorena Ruano;
    Countries: Switzerland, Norway, Belgium
    Project: CIHR , EC | GO4HEALTH (305240)

    Introduction: Under the Millennium Development Goals (MDGs), United Nations (UN) Member States reported progress on the targets toward their general citizenry. This focus repeatedly excluded marginalized ethnic and linguistic minorities, including people of refugee backgrounds and other vulnerable non-nationals that resided within a States’ borders. The Sustainable Development Goals (SDGs) aim to be truly transformative by being made operational in all countries, and applied to all, nationals and non-nationals alike. Global migration and its diffuse impact has intensified due to escalating conflicts and the growing violence in war-torn Syria, as well as in many countries in Africa and in Central America. This massive migration and the thousands of refugees crossing borders in search for safety led to the creation of two-tiered, ad hoc, refugee health care systems that have added to the sidelining of non-nationals in MDG-reporting frameworks. Conclusion: We have identified four ways to promote the protection of vulnerable non-nationals’ health and well being in States’ application of the post-2015 SDG framework: In setting their own post-2015 indicators the UN Member States should explicitly identify vulnerable migrants, refugees, displaced persons and other marginalized groups in the content of such indicators. Our second recommendation is that statisticians from different agencies, including the World Health Organization’s Gender, Equity and Human Rights programme should be actively involved in the formulation of SDG indicators at both the global and country level. In addition, communities, civil society and health justice advocates should also vigorously engage in country’s formulation of post-2015 indicators. Finally, we advocate that the inclusion of non-nationals be anchored in the international human right to health, which in turn requires appropriate financing allocations as well as robust monitoring and evaluation processes that can hold technocratic decision-makers accountable for progress. publishedVersion

  • Open Access
    Authors: 
    Alejandro Cerón; Ana Lorena Ruano; Silvia Sánchez; Aiken S. Chew; Diego Díaz; Alison Hernández; Walter Flores;
    Publisher: Springer Science and Business Media LLC
    Project: EC | GO4HEALTH (305240), CIHR

    Background: Health inequalities disproportionally affect indigenous people in Guatemala. Previous studies have noted that the disadvantageous situation of indigenous people is the result of complex and structural elements such as social exclusion, racism and discrimination. These elements need to be addressed in order to tackle the social determinants of health. This research was part of a larger participatory collaboration between Centro de Estudios para la Equidad y Gobernanza en los Servicios de Salud (CEGSS) and community based organizations aiming to implement social accountability in rural indigenous municipalities of Guatemala. Discrimination while seeking health care services in public facilities was ranked among the top three problems by communities and that should be addressed in the social accountability intervention. This study aimed to understand and categorize the episodes of discrimination as reported by indigenous communities.Methods: A participatory approach was used, involving CEGSS’s researchers and field staff and community leaders. One focus group in one rural village of 13 different municipalities was implemented. Focus groups were aimed at identifying instances of mistreatment in health care services and documenting the account of those who were affected or who witnessed them. All of the 132 obtained episodes were transcribed and scrutinized using a thematic analysis.Results: Episodes described by participants ranged from indifference to violence (psychological, symbolic, and physical), including coercion, mockery, deception and racism. Different expressions of discrimination and mistreatment associated to poverty, language barriers, gender, ethnicity and social class were narrated by participants.Conclusions: Addressing mistreatment in public health settings will involve tackling the prevalent forms of discrimination, including racism. This will likely require profound, complex and sustained interventions at the programmatic and policy levels beyond the strict realm of public health services. Future studies should assess the magnitude of the occurrence of episodes of maltreatment and racism within indigenous areas and also explore the providers’ perceptions about the problem.

  • Open Access English
    Authors: 
    Claire Brolan; IJHPM IJHPM; Lisa Forman; Gorik Ooms;
    Publisher: Kerman University of Medical Sciences
    Country: United Kingdom
    Project: EC | GO4HEALTH (305240)

    While the right to health is increasingly referenced in Sustainable Development Goal (SDG) discussions, its contribution to global health and development remains subject to considerable debate. This hypothesis explores the potential influence of the right to health on the formulation of health goals in 4 major SDG reports. We analyse these reports through a social constructivist lens which views the use of rights rhetoric as an important indicator of the extent to which a norm is being adopted and/or internalized. Our analysis seeks to assess the influence of this language on goals chosen, and to consider accordingly the potential for rights discourse to promote more equitable global health policy in the future.

  • Open Access English
    Authors: 
    Gorik Ooms; Lisa Forman; Owain David Williams; Peter S. Hill;
    Publisher: BioMed Central
    Countries: Belgium, Belgium, United Kingdom
    Project: CIHR , EC | GO4HEALTH (305240)

    Abstract: Background: The heads of the Global Fund and the GAVI Alliance have recently promoted the idea of an international tiered pricing framework for medicines, despite objections from civil society groups who fear that this would reduce the leeway for compulsory licenses and generic competition. This paper explores the extent to which an international tiered pricing framework and the present leeway for compulsory licensing can be reconciled, using the perspective of the right to health as defined in international human rights law. Discussion: We explore the practical feasibility of an international tiered pricing and compulsory licensing framework governed by the World Health Organization. We use two simple benchmarks to compare the relative affordability of medicines for governments ? average income and burden of disease ? to illustrate how voluntary tiered pricing practice fails to make medicines affordable enough for low and middle income countries (if compared with the financial burden of the same medicines for high income countries), and when and where international compulsory licenses should be issued in order to allow governments to comply with their obligations to realize the right to health. Summary: An international tiered pricing and compulsory licensing framework based on average income and burden of disease could ease the tension between governments? human rights obligation to provide medicines and governments? trade obligation to comply with the Agreement on Trade-Related Aspects of Intellectual Property Rights.

  • Open Access English
    Authors: 
    Gorik Ooms;
    Countries: Belgium, United Kingdom, Belgium
    Project: EC | GO4HEALTH (305240), CIHR

    Abstract: Background: Public health recommendations are usually based on a mixture of empirical evidence and normative arguments: to argue that authorities ought to implement an intervention that has proven effective in improving people's health requires a normative position confirming that the authorities are responsible for improving people's health. While public health (at the national level) is based on a widely accepted normative starting point - namely, that it is the responsibility of the state to improve people's health - there is no widely accepted normative starting point for international health or global health. As global health recommendations may vary depending on the normative starting point one uses, global health research requires a better dialogue between researchers who are trained in empirical disciplines and researchers who are trained in normative disciplines. Discussion: Global health researchers with a background in empirical disciplines seem reluctant to clarify the normative starting point they use, perhaps because normative statements cannot be derived directly from empirical evidence, or because there is a wide gap between present policies and the normative starting point they personally support. Global health researchers with a background in normative disciplines usually do not present their work in ways that help their colleagues with a background in empirical disciplines to distinguish between what is merely personal opinion and professional opinion based on rigorous normative research. If global health researchers with a background in empirical disciplines clarified their normative starting point, their recommendations would become more useful for their colleagues with a background in normative disciplines. If global health researchers who focus on normative issues used adapted qualitative research guidelines to present their results, their findings would be more useful for their colleagues with a background in empirical disciplines. Summary: Although a single common paradigm for all scientific disciplines that contribute to global health research may not be possible or desirable, global health researchers with a background in empirical disciplines and global health researchers with a background in normative disciplines could present their 'truths' in ways that would improve dialogue. This paper calls for an exchange of views between global health researchers and editors of medical journals.

  • Open Access English
    Authors: 
    Ana Lorena Ruano; Silvia Sánchez; Fernando José Jerez; Walter Flores;
    Publisher: BioMed Central
    Country: Norway
    Project: CIHR , EC | GO4HEALTH (305240)

    Introduction: The United Nations presented a set of Millennium Development Goals that aimed to improve social and economic development and eradicate poverty by 2015. Most low and middle-income countries will not meet these goals and today there is a need to set new development agenda, especially when it comes to health. The paper presents the findings from a community consultation process carried out within the Goals and Governance for Global Health (GO4Health) research consortium in Guatemala, which aims to identify community needs and expectations around public policies and health services. Methods: Through a participative and open consultation process with experts, civil society organizations and members of the research team, the municipalities of Tectitan and Santa Maria Nebaj were selected. A community consultation process was undertaken with community members and community leaders. Group discussions and in-depth interviews were conducted and later analyzed using thematic analysis, a qualitative method that can be used to analyze data in a way that allows for the identification of recurrent patterns that can be grouped into categories and themes, was used. Findings: Following the Go4Health framework’s domains for understanding health-related needs, the five themes identified were health, social determinants of health, essential health needs and their provision, roles and responsibilities of relevant stakeholders and community participation in decision-making. Participants reported high levels of discrimination related to ethnicity, to being poor and to living in rural areas. Ethnicity played a major role in how community members feel they are cared for in the health system. Conclusion: Achieving health goals in a context of deep-rooted inequality and marginalization requires going beyond the simple expansion of health services and working with developing trusting relationships between health service providers and community members. Involving community members in decision-making processes that shape policies will contribute to a larger process of community empowerment and democratization. Still, findings from the region show that tackling these issues may prove complicated and require going beyond the health system, as this lack of trust and discrimination has permeated to all public policies that deal with indigenous and rural populations. publishedVersion

  • Open Access
    Authors: 
    Gorik Ooms; Laila Abdul Latif; Attiya Waris; Claire E. Brolan; Rachel Hammonds; Eric A. Friedman; Moses Mulumba; Lisa Forman;
    Publisher: Springer Science and Business Media LLC
    Countries: Belgium, United Kingdom, Belgium
    Project: CIHR , EC | GO4HEALTH (305240)

    The present Millennium Development Goals are set to expire in 2015 and their next iteration is now being discussed within the international community. With regards to health, the World Health Organization proposes universal health coverage as a 'single overarching health goal' for the next iteration of the Millennium Development Goals. The present Millennium Development Goals have been criticised for being 'duplicative' or even 'competing alternatives' to international human rights law. The question then arises, if universal health coverage would indeed become the single overarching health goal, replacing the present health-related Millennium Development Goals, would that be more consistent with the right to health? The World Health Organization seems to have anticipated the question, as it labels universal health coverage as "by definition, a practical expression of the concern for health equity and the right to health". Rather than waiting for the negotiations to unfold, we thought it would be useful to verify this contention, using a comparative normative analysis. We found that - to be a practical expression of the right to health - at least one element is missing in present authoritative definitions of universal health coverage: a straightforward confirmation that international assistance is essential, not optional. But universal health coverage is a 'work in progress'. A recent proposal by the United Nations Sustainable Development Solutions Network proposed universal health coverage with a set of targets, including a target for international assistance, which would turn universal health coverage into a practical expression of the right to health care.

  • Publication . Article . Other literature type . 2013
    Open Access French
    Authors: 
    Claire E. Brolan; Stéphanie Dagron; Lisa Forman; Rachel Hammonds; Laila Abdul Latif; Attiya Waris;
    Country: Switzerland
    Project: EC | GO4HEALTH (305240)

    With the approach of the September 2013 meeting of the United Nations General Assembly on the post-2015 Development Agenda, the health and intersectoral development goals have become the subject of considerable debate. Little of this debate has to do, however, with how the “right to the highest attainable standard of health” applies to non-nationals – i.e. people who live in a country without being its citizens and hence without access to health system benefits. The right to health obligates governments to facilitate access to health care to non-nationals and nationals alike. This is not simply a matter of human rights: it is a global development imperative. Today there are 214 million international migrants – far more than ever recorded – and millions more are experiencing forced migration and displacement.1,2 This massive movement of people across borders is linked to factors such as globalization, climate change, poverty, poor governance, conflict, education, economics, labour trends, transportation and technology.3,4 Further intensification of this trend is forecast: By 2050, the number of migrants could reach 405 million – with 25 million to 1 billion of them projected to be “environmental migrants”.5 These figures are offset by the predicted increase in the world’s population to at least 8.92 billion by 2050.6 Unprecedented numbers of non-nationals – with varying legal status – pose challenges to low- and high-resource states’ responsibilities, resources, distributive justice mechanisms and long-standing Westphalian systems and structures. The large demographic influence that cross-border movement will have in shaping tomorrow’s world is noted in key post-2015 reports.7,8 Awareness of this influence is reflected in the High-Level Panel of Eminent Person’s post-2015 transformative agenda of “leaving no one behind” and in the United Nations Secretary-General’s call for “a life of dignity for all”.7,9 Ensuring that governments apply new development goals and targets to all, including non-nationals, who are often the most vulnerable and marginalized social group, is an overriding challenge. Most countries regularly exclude non-nationals from the protection afforded by right-to-health laws, yet under international law, countries are required to protect the right to health of all people within their borders and to fulfil minimum core obligations vis-a-vis basic primary health care, essential medicines, and non-discriminatory access to health facilities, goods and services. However, the de facto reality is very different, as exemplified by Australia’s limiting of tuberculosis treatment for Papuans along its Queensland border;10 Spain’s exclusion of undocumented migrants from testing and treatment for human immunodeficiency virus infection;11 and Kenya’s High Court decision that the right-to-health “law” in the nation’s Constitution is a matter of policy for its nationals only.12 The denial of preventive and curative care is frequently tied to policies regulating cross-border movement.11 Underlying statist traditions – health as security and foreign policy “metaphors”13 and anti-immigrant policies – abound, mixed with global financial crisis shockwaves. Escalating unemployment and nations’ fiscal tightening, including downsizing of the health workforce, are pressing concerns rendering the extension of health-care entitlements to non-nationals of little interest to governments keen on securing the popular vote. This is especially so when electorates question the “universal” nature of their state’s “universal” health-care coverage – or want to see it implemented more effectively. There are other aspects to be considered: what type of services would be available to non-nationals; who would be eligible; how would service implementation be measured; and, most importantly, who would pay. On a positive note, several countries in varying stages of development are extending social protection, including health-care benefits, to non-nationals. Thailand is a notable example.14 Partnering with health economists to show that such a measure can be beneficial in terms of equitable national development might be a way forward. High-level rhetoric around population dynamics in the post-2015 agenda is welcome, for the global community cannot continue to ignore the in-country inequities related to present and future large-scale human movement. As right-to-health lawyers, we submit that the discourse surrounding the post-2015 development agenda must progress to expressly include non-nationals. Realizing global goals for all rather than some will arguably be a truly transformative, paradigm shift. However, key issues pertaining to citizenship, population dynamics and interrelated health and human rights are likely to remain the elephant in the room in this iteration of global policy-making.

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[GO4HEALTH] Formulating new Goals for global health, and proposing new Governance for global health that will allow the achievement of these goals (305240)
Include:
The following results are related to Canada. Are you interested to view more results? Visit OpenAIRE - Explore.
10 Research products, page 1 of 1
  • Open Access English
    Authors: 
    Vannarath Te; Nadia Floden; Sameera Hussain; Claire E. Brolan; Peter S. Hill;
    Publisher: BioMed Central
    Project: NHMRC | Formulating New Goals for... (1055138), EC | GO4HEALTH (305240)

    Background: In 2012, the European Commission funded Go4Health—Goals and Governance for Global Health, a consortium of 13 academic research and human rights institutions from both Global North and South—to track the evolution of the Sustainable Development Goals (SDGs), and provide ongoing policy advice. This paper reviews the research outputs published between 2012 and 2016, analyzing the thematic content of the publications, and the influence on global health and development discourse through citation metrics.Findings and discussion: Analysis of the 54 published papers showed 6 dominant themes related to the SDGs: the formulation process for the SDG health goal; the right to health; Universal Health Coverage; voices of marginalized peoples; global health governance; and the integration of health across the other SDGs. The papers combined advocacy---particularly for the right to health and its potential embodiment in Universal Health Coverage—with qualitative research and analysis of policy and stakeholders. Go4Health's publications on the right to health, global health governance and the voices of marginalized peoples in relation to the SDGs represented a substantial proportion of papers published for these topics. Go4Health analysis of the right to health clarified its elements and their application to Universal Health Coverage, global health governance, financing the SDGs and access to medicines. Qualitative research identified correspondence between perceptions of marginalized peoples and right to health principles, and reluctance among multilateral organizations to explicitly represent the right to health in the goals, despite their acknowledgement of their importance. Citation metrics analysis confirmed an average of 5.5 citations per paper, with a field-weighted citation impact of 2.24 for the 43 peer reviewed publications. Citations in the academic literature and UN policy documents confirmed the impact of Go4Health on the global discourse around the SDGs, but within the Go4Health consortium there was also evidence of two epistemological frames of analysis—normative legal analysis and empirical research—that created productive synergies in unpacking the health SDG and the right to health.Conclusion: The analysis offers clear evidence for the contribution of funded programmatic research—such as the Go4Health project—to the global health discourse.

  • Open Access English
    Authors: 
    Claire E. Brolan; Vannarath Te; Nadia Floden; Peter S. Hill; Lisa Forman;
    Publisher: BMJ Publishing Group
    Project: EC | GO4HEALTH (305240)

    Since the new global health and development goal, Sustainable Development Goal (SDG) 3, and its nine targets and four means of implementation were introduced to the world through a United Nations (UN) General Assembly resolution in September 2015, right to health practitioners have queried whether this goal mirrors the content of the human right to health in international law. This study examines the text of the UN SDG resolution, Transforming our world: the 2030 Agenda for Sustainable Development, from a right to health minimalist and right to health maximalist analytic perspective. When reviewing the UN SDG resolution's text, a right to health minimalist questions whether the content of the right to health is at least implicitly included in this document, specifically focusing on SDG 3 and its metrics framework. A right to health maximalist, on the other hand, queries whether the content of the right to health is explicitly included. This study finds that whether the right to health is contained in the UN SDG resolution, and the SDG metrics therein, ultimately depends on the individual analyst's subjective persuasion in relation to right to health minimalism or maximalism. We conclude that the UN General Assembly's lack of cogency on the right to health's position in the UN SDG resolution will continue to blur if not divest human rights' (and specifically the right to health's) integral relationship to high-level development planning, implementation and SDG monitoring and evaluation efforts.

  • Open Access English
    Authors: 
    Claire E. Brolan; Lisa Forman; Stéphanie Dagron; Rachel Hammonds; Attiya Waris; Lyla Latif; Ana Lorena Ruano;
    Countries: Switzerland, Norway, Belgium
    Project: CIHR , EC | GO4HEALTH (305240)

    Introduction: Under the Millennium Development Goals (MDGs), United Nations (UN) Member States reported progress on the targets toward their general citizenry. This focus repeatedly excluded marginalized ethnic and linguistic minorities, including people of refugee backgrounds and other vulnerable non-nationals that resided within a States’ borders. The Sustainable Development Goals (SDGs) aim to be truly transformative by being made operational in all countries, and applied to all, nationals and non-nationals alike. Global migration and its diffuse impact has intensified due to escalating conflicts and the growing violence in war-torn Syria, as well as in many countries in Africa and in Central America. This massive migration and the thousands of refugees crossing borders in search for safety led to the creation of two-tiered, ad hoc, refugee health care systems that have added to the sidelining of non-nationals in MDG-reporting frameworks. Conclusion: We have identified four ways to promote the protection of vulnerable non-nationals’ health and well being in States’ application of the post-2015 SDG framework: In setting their own post-2015 indicators the UN Member States should explicitly identify vulnerable migrants, refugees, displaced persons and other marginalized groups in the content of such indicators. Our second recommendation is that statisticians from different agencies, including the World Health Organization’s Gender, Equity and Human Rights programme should be actively involved in the formulation of SDG indicators at both the global and country level. In addition, communities, civil society and health justice advocates should also vigorously engage in country’s formulation of post-2015 indicators. Finally, we advocate that the inclusion of non-nationals be anchored in the international human right to health, which in turn requires appropriate financing allocations as well as robust monitoring and evaluation processes that can hold technocratic decision-makers accountable for progress. publishedVersion

  • Open Access
    Authors: 
    Alejandro Cerón; Ana Lorena Ruano; Silvia Sánchez; Aiken S. Chew; Diego Díaz; Alison Hernández; Walter Flores;
    Publisher: Springer Science and Business Media LLC
    Project: EC | GO4HEALTH (305240), CIHR

    Background: Health inequalities disproportionally affect indigenous people in Guatemala. Previous studies have noted that the disadvantageous situation of indigenous people is the result of complex and structural elements such as social exclusion, racism and discrimination. These elements need to be addressed in order to tackle the social determinants of health. This research was part of a larger participatory collaboration between Centro de Estudios para la Equidad y Gobernanza en los Servicios de Salud (CEGSS) and community based organizations aiming to implement social accountability in rural indigenous municipalities of Guatemala. Discrimination while seeking health care services in public facilities was ranked among the top three problems by communities and that should be addressed in the social accountability intervention. This study aimed to understand and categorize the episodes of discrimination as reported by indigenous communities.Methods: A participatory approach was used, involving CEGSS’s researchers and field staff and community leaders. One focus group in one rural village of 13 different municipalities was implemented. Focus groups were aimed at identifying instances of mistreatment in health care services and documenting the account of those who were affected or who witnessed them. All of the 132 obtained episodes were transcribed and scrutinized using a thematic analysis.Results: Episodes described by participants ranged from indifference to violence (psychological, symbolic, and physical), including coercion, mockery, deception and racism. Different expressions of discrimination and mistreatment associated to poverty, language barriers, gender, ethnicity and social class were narrated by participants.Conclusions: Addressing mistreatment in public health settings will involve tackling the prevalent forms of discrimination, including racism. This will likely require profound, complex and sustained interventions at the programmatic and policy levels beyond the strict realm of public health services. Future studies should assess the magnitude of the occurrence of episodes of maltreatment and racism within indigenous areas and also explore the providers’ perceptions about the problem.

  • Open Access English
    Authors: 
    Claire Brolan; IJHPM IJHPM; Lisa Forman; Gorik Ooms;
    Publisher: Kerman University of Medical Sciences
    Country: United Kingdom
    Project: EC | GO4HEALTH (305240)

    While the right to health is increasingly referenced in Sustainable Development Goal (SDG) discussions, its contribution to global health and development remains subject to considerable debate. This hypothesis explores the potential influence of the right to health on the formulation of health goals in 4 major SDG reports. We analyse these reports through a social constructivist lens which views the use of rights rhetoric as an important indicator of the extent to which a norm is being adopted and/or internalized. Our analysis seeks to assess the influence of this language on goals chosen, and to consider accordingly the potential for rights discourse to promote more equitable global health policy in the future.

  • Open Access English
    Authors: 
    Gorik Ooms; Lisa Forman; Owain David Williams; Peter S. Hill;
    Publisher: BioMed Central
    Countries: Belgium, Belgium, United Kingdom
    Project: CIHR , EC | GO4HEALTH (305240)

    Abstract: Background: The heads of the Global Fund and the GAVI Alliance have recently promoted the idea of an international tiered pricing framework for medicines, despite objections from civil society groups who fear that this would reduce the leeway for compulsory licenses and generic competition. This paper explores the extent to which an international tiered pricing framework and the present leeway for compulsory licensing can be reconciled, using the perspective of the right to health as defined in international human rights law. Discussion: We explore the practical feasibility of an international tiered pricing and compulsory licensing framework governed by the World Health Organization. We use two simple benchmarks to compare the relative affordability of medicines for governments ? average income and burden of disease ? to illustrate how voluntary tiered pricing practice fails to make medicines affordable enough for low and middle income countries (if compared with the financial burden of the same medicines for high income countries), and when and where international compulsory licenses should be issued in order to allow governments to comply with their obligations to realize the right to health. Summary: An international tiered pricing and compulsory licensing framework based on average income and burden of disease could ease the tension between governments? human rights obligation to provide medicines and governments? trade obligation to comply with the Agreement on Trade-Related Aspects of Intellectual Property Rights.

  • Open Access English
    Authors: 
    Gorik Ooms;
    Countries: Belgium, United Kingdom, Belgium
    Project: EC | GO4HEALTH (305240), CIHR

    Abstract: Background: Public health recommendations are usually based on a mixture of empirical evidence and normative arguments: to argue that authorities ought to implement an intervention that has proven effective in improving people's health requires a normative position confirming that the authorities are responsible for improving people's health. While public health (at the national level) is based on a widely accepted normative starting point - namely, that it is the responsibility of the state to improve people's health - there is no widely accepted normative starting point for international health or global health. As global health recommendations may vary depending on the normative starting point one uses, global health research requires a better dialogue between researchers who are trained in empirical disciplines and researchers who are trained in normative disciplines. Discussion: Global health researchers with a background in empirical disciplines seem reluctant to clarify the normative starting point they use, perhaps because normative statements cannot be derived directly from empirical evidence, or because there is a wide gap between present policies and the normative starting point they personally support. Global health researchers with a background in normative disciplines usually do not present their work in ways that help their colleagues with a background in empirical disciplines to distinguish between what is merely personal opinion and professional opinion based on rigorous normative research. If global health researchers with a background in empirical disciplines clarified their normative starting point, their recommendations would become more useful for their colleagues with a background in normative disciplines. If global health researchers who focus on normative issues used adapted qualitative research guidelines to present their results, their findings would be more useful for their colleagues with a background in empirical disciplines. Summary: Although a single common paradigm for all scientific disciplines that contribute to global health research may not be possible or desirable, global health researchers with a background in empirical disciplines and global health researchers with a background in normative disciplines could present their 'truths' in ways that would improve dialogue. This paper calls for an exchange of views between global health researchers and editors of medical journals.

  • Open Access English
    Authors: 
    Ana Lorena Ruano; Silvia Sánchez; Fernando José Jerez; Walter Flores;
    Publisher: BioMed Central
    Country: Norway
    Project: CIHR , EC | GO4HEALTH (305240)

    Introduction: The United Nations presented a set of Millennium Development Goals that aimed to improve social and economic development and eradicate poverty by 2015. Most low and middle-income countries will not meet these goals and today there is a need to set new development agenda, especially when it comes to health. The paper presents the findings from a community consultation process carried out within the Goals and Governance for Global Health (GO4Health) research consortium in Guatemala, which aims to identify community needs and expectations around public policies and health services. Methods: Through a participative and open consultation process with experts, civil society organizations and members of the research team, the municipalities of Tectitan and Santa Maria Nebaj were selected. A community consultation process was undertaken with community members and community leaders. Group discussions and in-depth interviews were conducted and later analyzed using thematic analysis, a qualitative method that can be used to analyze data in a way that allows for the identification of recurrent patterns that can be grouped into categories and themes, was used. Findings: Following the Go4Health framework’s domains for understanding health-related needs, the five themes identified were health, social determinants of health, essential health needs and their provision, roles and responsibilities of relevant stakeholders and community participation in decision-making. Participants reported high levels of discrimination related to ethnicity, to being poor and to living in rural areas. Ethnicity played a major role in how community members feel they are cared for in the health system. Conclusion: Achieving health goals in a context of deep-rooted inequality and marginalization requires going beyond the simple expansion of health services and working with developing trusting relationships between health service providers and community members. Involving community members in decision-making processes that shape policies will contribute to a larger process of community empowerment and democratization. Still, findings from the region show that tackling these issues may prove complicated and require going beyond the health system, as this lack of trust and discrimination has permeated to all public policies that deal with indigenous and rural populations. publishedVersion

  • Open Access
    Authors: 
    Gorik Ooms; Laila Abdul Latif; Attiya Waris; Claire E. Brolan; Rachel Hammonds; Eric A. Friedman; Moses Mulumba; Lisa Forman;
    Publisher: Springer Science and Business Media LLC
    Countries: Belgium, United Kingdom, Belgium
    Project: CIHR , EC | GO4HEALTH (305240)

    The present Millennium Development Goals are set to expire in 2015 and their next iteration is now being discussed within the international community. With regards to health, the World Health Organization proposes universal health coverage as a 'single overarching health goal' for the next iteration of the Millennium Development Goals. The present Millennium Development Goals have been criticised for being 'duplicative' or even 'competing alternatives' to international human rights law. The question then arises, if universal health coverage would indeed become the single overarching health goal, replacing the present health-related Millennium Development Goals, would that be more consistent with the right to health? The World Health Organization seems to have anticipated the question, as it labels universal health coverage as "by definition, a practical expression of the concern for health equity and the right to health". Rather than waiting for the negotiations to unfold, we thought it would be useful to verify this contention, using a comparative normative analysis. We found that - to be a practical expression of the right to health - at least one element is missing in present authoritative definitions of universal health coverage: a straightforward confirmation that international assistance is essential, not optional. But universal health coverage is a 'work in progress'. A recent proposal by the United Nations Sustainable Development Solutions Network proposed universal health coverage with a set of targets, including a target for international assistance, which would turn universal health coverage into a practical expression of the right to health care.

  • Publication . Article . Other literature type . 2013
    Open Access French
    Authors: 
    Claire E. Brolan; Stéphanie Dagron; Lisa Forman; Rachel Hammonds; Laila Abdul Latif; Attiya Waris;
    Country: Switzerland
    Project: EC | GO4HEALTH (305240)

    With the approach of the September 2013 meeting of the United Nations General Assembly on the post-2015 Development Agenda, the health and intersectoral development goals have become the subject of considerable debate. Little of this debate has to do, however, with how the “right to the highest attainable standard of health” applies to non-nationals – i.e. people who live in a country without being its citizens and hence without access to health system benefits. The right to health obligates governments to facilitate access to health care to non-nationals and nationals alike. This is not simply a matter of human rights: it is a global development imperative. Today there are 214 million international migrants – far more than ever recorded – and millions more are experiencing forced migration and displacement.1,2 This massive movement of people across borders is linked to factors such as globalization, climate change, poverty, poor governance, conflict, education, economics, labour trends, transportation and technology.3,4 Further intensification of this trend is forecast: By 2050, the number of migrants could reach 405 million – with 25 million to 1 billion of them projected to be “environmental migrants”.5 These figures are offset by the predicted increase in the world’s population to at least 8.92 billion by 2050.6 Unprecedented numbers of non-nationals – with varying legal status – pose challenges to low- and high-resource states’ responsibilities, resources, distributive justice mechanisms and long-standing Westphalian systems and structures. The large demographic influence that cross-border movement will have in shaping tomorrow’s world is noted in key post-2015 reports.7,8 Awareness of this influence is reflected in the High-Level Panel of Eminent Person’s post-2015 transformative agenda of “leaving no one behind” and in the United Nations Secretary-General’s call for “a life of dignity for all”.7,9 Ensuring that governments apply new development goals and targets to all, including non-nationals, who are often the most vulnerable and marginalized social group, is an overriding challenge. Most countries regularly exclude non-nationals from the protection afforded by right-to-health laws, yet under international law, countries are required to protect the right to health of all people within their borders and to fulfil minimum core obligations vis-a-vis basic primary health care, essential medicines, and non-discriminatory access to health facilities, goods and services. However, the de facto reality is very different, as exemplified by Australia’s limiting of tuberculosis treatment for Papuans along its Queensland border;10 Spain’s exclusion of undocumented migrants from testing and treatment for human immunodeficiency virus infection;11 and Kenya’s High Court decision that the right-to-health “law” in the nation’s Constitution is a matter of policy for its nationals only.12 The denial of preventive and curative care is frequently tied to policies regulating cross-border movement.11 Underlying statist traditions – health as security and foreign policy “metaphors”13 and anti-immigrant policies – abound, mixed with global financial crisis shockwaves. Escalating unemployment and nations’ fiscal tightening, including downsizing of the health workforce, are pressing concerns rendering the extension of health-care entitlements to non-nationals of little interest to governments keen on securing the popular vote. This is especially so when electorates question the “universal” nature of their state’s “universal” health-care coverage – or want to see it implemented more effectively. There are other aspects to be considered: what type of services would be available to non-nationals; who would be eligible; how would service implementation be measured; and, most importantly, who would pay. On a positive note, several countries in varying stages of development are extending social protection, including health-care benefits, to non-nationals. Thailand is a notable example.14 Partnering with health economists to show that such a measure can be beneficial in terms of equitable national development might be a way forward. High-level rhetoric around population dynamics in the post-2015 agenda is welcome, for the global community cannot continue to ignore the in-country inequities related to present and future large-scale human movement. As right-to-health lawyers, we submit that the discourse surrounding the post-2015 development agenda must progress to expressly include non-nationals. Realizing global goals for all rather than some will arguably be a truly transformative, paradigm shift. However, key issues pertaining to citizenship, population dynamics and interrelated health and human rights are likely to remain the elephant in the room in this iteration of global policy-making.