Journal: BMJ Global Health

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BMJ

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2059-7908

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2017 - 201912020 - 20253
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Publications 1 - 4 of 4
  • Building a multisystemic understanding of societal resilience to the COVID-19 pandemic
    Item type: Review Article
    Wernli, Didier; Clausin, Mia; Antulov-Fantulin, Nino; et al. (2021)
    BMJ Global Health
    The current global systemic crisis reveals how globalised societies are unprepared to face a pandemic. Beyond the dramatic loss of human life, the COVID-19 pandemic has triggered widespread disturbances in health, social, economic, environmental and governance systems in many countries across the world. Resilience describes the capacities of natural and human systems to prevent, react to and recover from shocks. Societal resilience to the current COVID-19 pandemic relates to the ability of societies in maintaining their core functions while minimising the impact of the pandemic and other societal effects. Drawing on the emerging evidence about resilience in health, social, economic, environmental and governance systems, this paper delineates a multisystemic understanding of societal resilience to COVID-19. Such an understanding provides the foundation for an integrated approach to build societal resilience to current and future pandemics.
  • Health policy and systems research: towards a better understanding and review of ethical issues
    Item type: Journal Article
    Luyckx, Valerie Ann; Biller-Andorno, Nikola; Saxena, Abha; et al. (2017)
    BMJ Global Health
    Given the focus on health systems in the post-millennium development goal era and moving towards the sustainable development goals, there is a compelling need for a common framework for health policy and systems research ethics to guide researchers and facilitate review by research ethics committees. A consultation of global health policy and systems research and ethics experts was convened to identify ethical considerations relevant to health policy and systems research based on existing knowledge and to identify knowledge gaps through a scoping review and further expert deliberation. Health policy and systems research is highly complex and, in the absence of guidance documents, there is significant variability in ethics review. Although fundamental ethical principles pertain to both traditional clinical research and health policy and systems research, the application of these principles requires a comprehensive understanding of the nature of health policy and systems research with its distinct challenges. Such awareness must be raised among researchers and research ethics committees. Current research ethics committees lack familiarity with health policy and systems research and because health policy and systems research is conducted in real-world contexts, committees often have difficulties in determining whether a project is indeed research and/or requires ethical review. Given the strong current focus on health policy and systems research to rapidly improve health and health systems functioning globally, greater engagement and dialogue around the ethical concerns is required to optimise research review and research conduct in this rapidly evolving field.
  • Empowering the crowd: feasible strategies for epidemic management in high-density informal settlements. The case of COVID-19 in Northwest Syria
    Item type: Journal Article
    Pascual-García, Alberto; Klein, Jordan D.; Villers, Jennifer; et al. (2021)
    BMJ Global Health
    More than 1 billion people live in informal settlements worldwide, where precarious living conditions pose unique challenges to managing a COVID-19 outbreak. Taking Northwest Syria as a case study, we simulated an outbreak in high-density informal Internally Displaced Persons (IDP) camps using a stochastic Susceptible-Exposed-Infectious-Recovered model. Expanding on previous studies, taking social conditions and population health/structure into account, we modelled several interventions feasible in these settings: moderate self-distancing, self-isolation of symptomatic cases and protection of the most vulnerable in 'safety zones'. We considered complementary measures to these interventions that can be implemented autonomously by these communities, such as buffer zones, health checks and carers for isolated individuals, quantifying their impact on the micro-dynamics of disease transmission. All interventions significantly reduce outbreak probability and some of them reduce mortality when an outbreak does occur. Self-distancing reduces mortality by up to 35% if contacts are reduced by 50%. A reduction in mortality by up to 18% can be achieved by providing one self-isolation tent per eight people. Protecting the most vulnerable in a safety zone reduces the outbreak probability in the vulnerable population and has synergistic effects with the other interventions. Our model predicts that a combination of all simulated interventions may reduce mortality by more than 90% and delay an outbreak's peak by almost 2 months. Our results highlight the potential for non-medical interventions to mitigate the effects of the pandemic. Similar measures may be applicable to controlling COVID-19 in other informal settlements, particularly IDP camps in conflict regions, around the world.
  • 'Knowing how the machine works': a novel framework for engaging with the political determinants of health
    Item type: Journal Article
    Brugger, Fritz; Proksik, Joschka J.; Cambaço, Olga; et al. (2025)
    BMJ Global Health
    It is well established that social determinants influence people's health and well-being. Yet, limited attention is given to the fact that social determinants are, in turn, the result of political determinants. The political struggle between different ideas, interests and power over public policies, that is, how societies shall function, results in formal and informal structures that work as a 'sorting machine': they determine how societies (re)distribute material resources and opportunities among their members, creating societal classes that face disparate health outcomes. Their visible and measurable characteristics are then labelled 'social determinants'. Improving public health, therefore, needs engaging with the political determinants. We contribute to this broader vision with a process-oriented, interdisciplinary framework. It first operationalises the analysis of political determinants of health to understand how, in a specific public health concern, politics shapes policy processes and causes differential health outcomes. Building on these insights, the framework then supports strategic engagement with the politics of policy processes, using agile methods to identify and promote more equitable and politically feasible policy options. We illustrate our approach by reporting on an interdisciplinary 6-year research project in Burkina Faso, Ghana, Mozambique and Tanzania, examining how structural determinants contribute to unequal public health outcomes in industrial mining areas. Trade-offs between attracting mining firms and safeguarding public health have led to a patchwork of national legislation, global governance regimes and voluntary commitments, inviting an eclectic consideration of public health industrial mining. For instance, among over 560 mining projects across Africa, more than 90% of impact assessments were inaccessible. In the few that were, public health is only marginally considered, disproportionately harming vulnerable populations. To strengthen the 'structural competence' and policy relevance of the public health discipline, our results suggest an institutionalised cooperation with political science in curricula, training and applied research.
Publications 1 - 4 of 4