In an interesting interview for Global Health Now (GHN), Carel IJsselmuiden and James Lavery share their view on "how the RFI speaks to the need for organizations to reflect and take stock of any shortcomings". The RFI isn’t a report card that brands institutions as good or bad. It’s intended, instead, to provide a pathway to self-improvement—which is the essence of decolonization.
Background: Community engagement (CE) is increasingly accepted as a critical aspect of health research, because of its potential to make research more ethical, relevant and well implemented. While CE activities linked to health research have proliferated in Low and Middle Income Countries (LMICs), and are increasingly described in published literature, there is a lack of conceptual clarity around how engagement is understood to ‘work’, and the aims and purposes of engagement are varied and often not made explicit. Ultimately, the evidence base for engagement remains underdeveloped.
Methods: To develop explanations for how and why CE with health research contributes to the pattern of outcomes observed in published literature, we conducted a realist review of CE with malaria research – a theory driven approach to evidence synthesis.
Results: We found that community engagement relies on the development of provisional ‘working relationships’ across differences, primarily of wealth, power and culture. These relationships are rooted in interactions that are experienced as relatively responsive and respectful, and that bring tangible research related benefits. Contextual factors affecting development of working relationships include the facilitating influence of research organisation commitment to and resources for engagement, and constraining factors linked to the prevailing ‘dominant health research paradigm context’, such as: differences of wealth and power between research centres and local populations and health systems; histories of colonialism and vertical health interventions; and external funding and control of health research.
"This pandemic is not over until it is over everywhere."
A commentary by COHRED's Executive Director, Board members, associates and partners published in Think Global Health highlights a complete change is needed in the approach to and funding of global preparedness.
Regardless of an increasing provision of vaccines, there are many of the poorest countries, health and research and development (R&D) systems are absolutely lacking to serve the needs of their populations. Although some are privileged to live in countries with effective health research and development systems that can ramp up their responses to such emergencies, many are not. This R&D inequity lies at the core of current and future lost lives.
The COVID-19 pandemic underlines the vaccine inequity is ethically wrong. Its continuation for more than two years into the pandemic shows the limits of global solidarity as an effective global public health strategy. For several decades, most LMICs have invested low in their own R&D ecosystems and remain depended on the scientific, and financing efforts of high-income countries to address their R&D requirements which does not solve the long-term problem of inequitable participation in effective R&D and resulting interventions.
The two biggest current threats to global health security—pandemics and climate change—require equitable access to R&D and implementation.
"Vaccine inequity" should not become "vaccination inequity."
R&D equity should become an explicit objective in national and international development and collaboration policy, especially between high- and low- and middle-income countries.
The coronavirus disease 2019 (COVID-19) pandemic has subjected the mental health and well-being of Filipino children under drastic conditions. While children are more vulnerable to these detriments, there remains the absence of unified and comprehensive strategies in mitigating the deterioration of the mental health of Filipino children. Existing interventions focus on more general solutions that fail to acknowledge the circumstances that a Filipino child is subjected under. Moreover, these strategies also fail to address the multilayered issues faced by a lower-middle-income country, such as the Philippines. As the mental well-being of Filipino children continues to be neglected, a subsequent and enduring mental health epidemic can only be expected for years to come.
Keywords: Mental Health, Philippines, COVID-19, Psychology, Child, Child care, Health services, Social problems
Objective Generations of colonialism, abuse, racism, and systemic trauma have contributed to Indigenous women in Canada bearing the greatest burden of substance use in pregnancy. Stigma associated with substance use in pregnancy translates into multiple barriers to women engaging in care. Care providers have key interactions that can act as a bridge or a barrier to care.
Methods Patient journey maps were created for women living with substance use (n = 3) and semi-structured interviews (n = 20) were performed to understand perceptions of maternity-care providers around women with substance use in pregnancy at a regional hospital in northern British Columbia.
Results Patient journey maps showed overall emotions of hurt, loss, judgment, and anger at their interface with health care during pregnancy. Providers described gaps in knowledge of substance use in pregnancy and harm reduction. Although care providers overall perceived themselves to be providing compassionate care without bias, the patient journey maps suggested profound judgment on behalf of providers.
Conclusion Ongoing cultural humility and trauma-informed care training along the continuum of care is critical to impacting discrepancies between perceived lack of bias and harm in patient interactions. Acknowledgment of systemic racism's impact on provision of maternity care is critical for health system change.