ABSTRACT
Objectives
Coronavirus stigmatization may be disproportionately impacting ethnoracial mi... more ABSTRACT Objectives Coronavirus stigmatization may be disproportionately impacting ethnoracial minority groups in the US. We test three hypotheses: [H1] Asians in the US are more likely to report experiencing coronavirus stigmatization than non-Hispanic Whites; [H2] Coronavirus stigmatization is associated with psychological distress; [H3] Magnitude of association between coronavirus stigmatization and psychological distress is more pronounced among US-born Asians, compared to non-Hispanic Whites.
Design We analyzed cross-sectional survey data from the 10–31 March 2020 wave of the Understanding America Survey, a nationally representative survey of adults in the US. Psychological distress was assessed with the PHQ-4. Measures of association were estimated using multiple logistic regression and survey sampling weights. Predicted probabilities were calculated using marginal standardization ( n = 6707).
Results [H1] The adjusted predicted probability of experiencing any coronavirus stigma among foreign-born Asians (11.2%, 95% CI: 5.5–17.0%; E-value = 4.52), US-born Asians (10.9%, 95% CI: 5.8–16.0%; E-value = 4.23), Blacks (8.0%, 95% CI: 5.3–10.7%; E-value = 2.92), and Hispanic Whites (7.3%, 95% CI: 4.6–9.9%; E-value = 2.58) was significantly greater than non-Hispanic Whites (4.5%, 95% CI: 3.7–5.4%). [H2] Individuals reporting any coronavirus stigma experience were significantly more likely to exhibit psychological distress (19.9%, 95% CI: 14.6–25.2% vs 10.6%, 9.6–11.6%; E-value = 3.16). [H3] The overall magnitude of association between experience of any coronavirus stigma and psychological distress was not significantly between US-born Asians and non-Hispanic Whites, though we found gender to mask this effect. US-born Asian females who experienced coronavirus stigmatization were more likely to exhibit psychological distress than non-Hispanic white females who experienced coronavirus stigmatization (relative risk (RR): 10.21, 95% CI: 2.69–38.74 vs 1.24, 95% CI: 0.76–2.01; p < 0.01).
Conclusion Comprehensive measures around care seeking, public awareness, and disaggregated data collection are needed to address ethnoracial coronavirus stigmatization and its impact on psychological health and well-being.
Many countries face cycles of repeated violence. Attacks on health workers and facilities exact a... more Many countries face cycles of repeated violence. Attacks on health workers and facilities exact a toll on civilian access to care and, in aggregate, population health status. A variety of humanitarian organizations provide essential services to augment limited state capacity. Yet, humanitarian organizations often work in parallel even in the same conflict-affected contexts. We use a high reliability organization lens to examine violent attacks on the health care programs that humanitarian organizations operate in fragile states. More specifically, we examine Perrow’s (1984) construct of coupling through qualitative evidence of collaborative relationships and creative problem solving under stressful conditions, respectively. We found three salient features from qualitative data: Trade-off between security and field access; transfer of risk to local actors; and marketization of aid. We find that these three features drive humanitarian organizations to act nimbly within countries in order to prioritize their organizational reliability across countries. While stabilizing the individual organization, these features create disincentives to interorganizational coordination at the Cluster level and are agnostic to output (i.e., healthcare provision) reliability. Our study hopes to sensitize readers to several issues facing high reliability healthcare in times of war.
This article examines the policy change process that resulted in the current sugar-sweetened beve... more This article examines the policy change process that resulted in the current sugar-sweetened beverages taxes in Mexico and Chile, using the Kaleidoscope Model for Policy Change, a framework developed for nutrition and food policy change analysis. We used a qualitative study design, including 24 key informant (KI) interviews (16 researchers, 5 civil society representatives and 3 food/beverage industry representatives), encompassing global and in-country perspectives. The analysis shows concurrence with the Kaleidoscope Model, highlighting commonalities in the policy change process. These included the importance of focusing events and coalitions for agenda-setting. Both top-down executive leadership and bottom-up pressure from civil society coalitions were important for the policy adoption as were flexible framing of the tax, and taking advantage of windows of opportunity. In both countries, the tax resulted from national, revenue-seeking fiscal reforms and in sub-optimal tax rates, as a result of the industry influence. KIs also discussed emerging evaluation results, highlighting differences in interpretation concerning the magnitude of change from the tax, and shared potential modifications to the current policies. This analysis contributes to a greater understanding of the policy change process focused on obesity prevention, using an innovative theoretical framework developed specifically for food and nutrition policy.
Abstract
Background Knowledge use is an integral theme of public policy studies. National obesity... more Abstract Background Knowledge use is an integral theme of public policy studies. National obesity policy merits attention given its technical and social complexity. Scientific evidence about the obesity epidemic has been contested and obesity prevention is political in nature because it raises tensions between population health promotion and the principle of non-interference in citizens’ lives. Countries that are early adopters of obesity policy are enmeshed in this two-fold complexity. In this study, we examine the knowledge that was used in the development of sugar-sweetened beverage (SSB) tax policy in Mexico and Chile. Methods We conducted semi-structured interviews with key informants from the epistemic community, civil society, and food and beverage industry. We also collected documents about SSB tax policy in Mexico, Chile, and elsewhere in Latin America. Interviews were professionally transcribed and translated verbatim. We analysed the transcripts and published material using the same coding scheme. We also conducted a bibliometric analysis of the documents collected. Findings Between February and August, 2018, we interviewed 24 key informants: 16 researchers, five civil society representatives, and three food and beverage industry representatives; nine from Mexico, seven from Chile, and eight international respondents. We included 215 total documents dated from Jan 17, 2002, to Feb 11, 2020, including 175 journal articles, 25 newspaper articles, eight books, five conference papers, one report, and one master’s thesis. Three themes emerged from our dataset. First, interviewees focused on the evidence that showed an immediate relation between tax and reduced consumption of SSB rather than SSB’s long-term impact on population health. Second, interviewees endorsed the concept of “policy-based evidence making”, defined as an increase in the production of scientific evidence after SSB tax policy was enacted in the two countries. Lastly, the document analysis showed that each type of respondent cited literature published by their peers. Interpretation The study of public policy should include the evaluation of evidence in the national response to population health problems. Our findings on causality, knowledge gaps, and citation homophily have implications for the adoption of controversial health policy.
Cancer is one of the major non-communicable diseases posing a threat to world health. Unfortunate... more Cancer is one of the major non-communicable diseases posing a threat to world health. Unfortunately, improvements in socioeconomic conditions are usually associated with increased cancer incidence. In this Commission, we focus on China, India, and Russia, which share rapidly rising cancer incidence and have cancer mortality rates that are nearly twice as high as in the UK or the USA, vast geographies, growing economies, ageing populations, increasingly westernised lifestyles, relatively disenfranchised subpopulations, serious contamination of the environment, and uncontrolled cancer-causing communicable infections. We describe the overall state of health and cancer control in each country and additional specific issues for consideration: for China, access to care, contamination of the environment, and cancer fatalism and traditional medicine; for India, affordability of care, provision of adequate health personnel, and sociocultural barriers to cancer control; and for Russia, monitoring of the burden of cancer, societal attitudes towards cancer prevention, effects of inequitable treatment and access to medicine, and a need for improved international engagement.
Intravenous tissue plasminogen activator is the most effective treatment for acute ischemic strok... more Intravenous tissue plasminogen activator is the most effective treatment for acute ischemic stroke, and its use may therefore serve as an indicator of the available level of acute stroke care. The greatest burden of stroke is in low- and middle-income countries, but the extent to which intravenous tissue plasminogen activator is used in these countries is unreported. A systematic review was performed searching each country name AND &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;stroke&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; OR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;tissue plasminogen activator&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; OR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;thrombolysis&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; using PubMed, Embase, Global Health, African Index Medicus, and abstracts published in the International Journal of Stroke (Jan. 1, 1996-Oct. 1, 2012). The reported use of intravenous tissue plasminogen activator was then analyzed according to country-level income status, total expenditure on health per capita, and mortality and disability-adjusted life years due to stroke. There were 118,780 citations reviewed. Of 214 countries and independent territories, 64 (30%) reported use of intravenous tissue plasminogen activator for acute ischemic stroke in the medical literature: 3% (1/36) low-income, 19% (10/54) lower-middle-income, 33% (18/54) upper-middle-income, and 50% (35/70) high-income-countries (test for trend, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). When considering country-level determinants of reported intravenous tissue plasminogen activator use for acute ischemic stroke, total healthcare expenditure per capita (odds ratio 3.3 per 1000 international dollar increase, 95% confidence interval 1.4-9.9, P = 0.02) and reported mortality rate from cerebrovascular disease (odds ratio 1.02, 95% confidence interval 0.99-1.06, P = 0.02) were significant, but reported disability-adjusted life years from cerebrovascular diseases and gross national income per capita were not (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). Of the 10 countries with the highest disability-adjusted life years due to stroke, only one reported intravenous tissue plasminogen activator use. By reported use, intravenous tissue plasminogen activator for acute ischemic stroke is available to some…
Objective To estimate the shortage of mental health professionals in low- and middle-income count... more Objective To estimate the shortage of mental health professionals in low- and middle-income countries (LMICs).
Methods We used data from the World Health Organization’s Assessment Instrument for Mental Health Systems (WHO-AIMS) from 58 LMICs, country-specific information on the burden of various mental disorders and a hypothetical core service delivery package to estimate how many psychiatrists, nurses and psychosocial care providers would be needed to provide mental health care to the total population of the countries studied. We focused on the following eight problems, to which WHO has attached priority: depression, schizophrenia, psychoses other than schizophrenia, suicide, epilepsy, dementia, disorders related to the use of alcohol and illicit drugs, and paediatric mental disorders.
Findings All low-income countries and 59% of the middle-income countries in our sample were found to have far fewer professionals than they need to deliver a core set of mental health interventions. The 58 LMICs sampled would need to increase their total mental health workforce by 239 000 full-time equivalent professionals to address the current shortage.
Conclusion Country-specific policies are needed to overcome the large shortage of mental health-care staff and services throughout LMICs.
—Global consensus and national policies have emphasized deinstitutionalization, or a shift in pro... more —Global consensus and national policies have emphasized deinstitutionalization, or a shift in providing mental health care from institutional to community settings. Yet, psychiatric hospitals and asylums receive the majority of mental health funding in many countries, at odds with research evidence that suggests that services should be delivered in the community. Our aim is to investigate the norms, actors, and strategies that influence the uptake of deinstitutionalization internationally. Our study is informed by prior literature on management and implementation science. The success and failure of mental health care operations depend on identifying and overcoming challenges related to implementing innovations within national contexts. We surveyed 78 experts spanning 42 countries on their knowledge and experiences in expanding community-based mental health care and/or downsizing institution-based care. We also asked them about the contexts in which said methods were implemented in a country. We found that mental health care, whether it is provided in institutions or in the community, does not seem to be standardized across countries. Our analysis also showed that moving deinstitutionalization forward requires meaningful engagement of three types of actors: government officials, health care professionals, and local experts. Progress toward deinstitutionalization depends on the partnerships formed among these actors and with diverse stakeholders, which have the potential to garner resources and to scale-up pilot projects. In conclusion, different countries have adapted deinstitutionalization in ways to meet idiosyncratic situations and population needs. More attention should be given to the management and implementation strategies that are used to augment treatment and preventive services.
International Journal of Health Policy and Management, 2014
Background: Policies generate accountability in that they offer a standard against which governme... more Background: Policies generate accountability in that they offer a standard against which government performance can be assessed. A central question of this study is whether ideological imprint left by policy is realized in the time following its adoption. National mental health policy expressly promotes the notion of deinstitutionalization, which mandates that individuals be cared for in the community rather than in institutional environments. Methods: We investigate whether mental health policy adoption induced a transformation in the structure of mental health systems, namely psychiatric beds, using panel data on 193 countries between 2001 and 2011. Results: Our striking regression results demonstrate that late-adopters of mental health policy are more likely to reduce psychiatric beds in mental hospitals and other biomedical settings than innovators, whereas they are less likely than non-adopters to reduce psychiatric beds in general hospitals. Conclusions: It can be inferred late adopters are motivated to implement deinstitutionalization for technical efficiency rather than social legitimacy reasons.
International Journal of Health Policy and Management, 2014
Background: Following the tenets of world polity and innovation diffusion theories, I focus on th... more Background: Following the tenets of world polity and innovation diffusion theories, I focus on the coercive and mimetic forces that influence the diffusion of mental health policy across nations. International organizations' mandates influence government behavior. Dependency on external resources, namely foreign aid, also affects governments' formulation of national policy. And finally, mounting adoption in a region alters the risk, benefits, and information associated with a given policy. Methods: I use postwar , discrete time data spanning 1950 to 2011 and describing 193 nations' mental health systems to test these diffusion mechanisms. Results: I find that the adoption of mental health policy is highly clustered temporally and spatially. Results provide support that membership in the World Health Organization (WHO), interdependence with neighbors and peers in regional blocs, national income status, and migrant sub-population are responsible for isomorphism. Aid, however, is an insufficient determinant of mental health policy adoption. Conclusion: This study examines the extent to which mental, neurological, and substance use disorder are addressed in national and international contexts through the lens of policy diffusion theory. It also adds to policy dialogues about non-communicable diseases as nascent items on the global health agenda. Implications for policy makers • Mental health policy is a powerful declaration governments make to address mental, neurological, and substance use disorders prevalent in their population. • Membership in the World Health Organization (WHO) or the United Nations (UN) alone does not predict the adoption of national mental health policy, but their regional offices do have a statistically significant effect on policy adoption. • Bilateral and multilateral aid are insufficient determinants of mental health policy adoption. • Prosperous countries are more likely to adopt a mental health policy. • Countries with a high proportion of migrant to native population are less likely to adopt a mental health policy adoption. Implications for public The current study uses quantitative data to describe the rate and pattern of national mental health policy adoption across 193 nations. Overall, I find that the adoption of mental health policy is highly clustered temporally and spatially. The first interpretation is that the World Health Organization (WHO) exerts an influence on governments, particularly through their regional offices. It can thus be inferred that mounting adoption in a given region alters the risk, benefits, and information associated with mental health policy. The second finding is that aid is an insufficient determinant of mental health policy adoption. Non-communicable diseases are nascent items on the global health agenda, and a mandate to address them is not a condition for exchanging foreign aid. And finally, direct advocacy for mental health has more prominent results in developed countries and countries with a sizable migrant population.
Background: Performance-based financing (PBF) has been implemented in a number of countries with ... more Background: Performance-based financing (PBF) has been implemented in a number of countries with the aim of transforming health systems and improving maternal and child health. This paper examines the effect of PBF on health workers' job satisfaction, motivation, and attrition in Zambia. It uses a randomized intervention/control design to evaluate before–after changes for three groups: intervention (PBF) group, control 1 (C1; enhanced financing) group, and control 2 (C2; pure control) group. Methods: Mixed methods are employed. The quantitative portion comprises of a baseline and an endline survey. The survey and sampling scheme were designed to allow for a rigorous impact evaluation of PBF or C1 on several key performance indicators. The qualitative portion seeks to explain the pathways underlying the observed differences through interviews conducted at the beginning and at the three-year mark of the PBF program.
There is a prevailing view of China as a unitary actor in its relationships with African countrie... more There is a prevailing view of China as a unitary actor in its relationships with African countries. This view is incomplete: on the contrary, China is a collection of provinces, autonomous regions and municipalities with myriad strategic ties to African countries, with decentralization shaping the current form of Chinese government and its level of efficiency. In this paper, factors have been explored for why Chinese provinces have played a role in foreign cooperation in health of African countries, in addition to trade and foreign direct investment. Incentives and disincentives for Chinese provinces to engage internationally in foreign cooperation and health assistance have been identified. The concept of paradiplomacy for health has been presented and this typology has been applied to the example of Chinese medical teams. Finally, we draw linkages between China and other members of Brazil,
BackgroundThere is a growing recognition of China?s role as a global health donor, in particular ... more BackgroundThere is a growing recognition of China?s role as a global health donor, in particular in Africa, but there have been few systematic studies of the level, destination, trends, or composition of these development finance flows or a comparison of China?s engagement as a donor with that of more traditional global health donors.MethodsUsing newly released data from AidData on China?s development finance activities in Africa, developed to track under reported resource flows, we identified 255 health, population, water, and sanitation (HPWS) projects from 2000?2012, which we descriptively analyze by activity sector, recipient country, project type, and planned activity. We compare China?s activities to projects from traditional donors using data from the OECD?s Development Assistance Committee (DAC) Creditor Reporting System.ResultsSince 2000, China increased the number of HPWS projects it supported in Africa and health has increased as a development priority for China. China?s contributions are large, ranking it among the top 10 bilateral global health donors to Africa. Over 50% of the HPWS projects target infrastructure, 40% target human resource development, and the provision of equipment and drugs is also common. Malaria is an important disease priority but HIV is not. We find little evidence that China targets health aid preferentially to natural resource rich countries.ConclusionsChina is an important global health donor to Africa but contrasts with traditional DAC donors through China?s focus on health system inputs and on malaria. Although better data are needed, particularly through more transparent aid data reporting across ministries and agencies, China?s approach to South-South cooperation represents an important and distinct source of financial assistance for health in Africa.
ABSTRACT
Objectives
Coronavirus stigmatization may be disproportionately impacting ethnoracial mi... more ABSTRACT Objectives Coronavirus stigmatization may be disproportionately impacting ethnoracial minority groups in the US. We test three hypotheses: [H1] Asians in the US are more likely to report experiencing coronavirus stigmatization than non-Hispanic Whites; [H2] Coronavirus stigmatization is associated with psychological distress; [H3] Magnitude of association between coronavirus stigmatization and psychological distress is more pronounced among US-born Asians, compared to non-Hispanic Whites.
Design We analyzed cross-sectional survey data from the 10–31 March 2020 wave of the Understanding America Survey, a nationally representative survey of adults in the US. Psychological distress was assessed with the PHQ-4. Measures of association were estimated using multiple logistic regression and survey sampling weights. Predicted probabilities were calculated using marginal standardization ( n = 6707).
Results [H1] The adjusted predicted probability of experiencing any coronavirus stigma among foreign-born Asians (11.2%, 95% CI: 5.5–17.0%; E-value = 4.52), US-born Asians (10.9%, 95% CI: 5.8–16.0%; E-value = 4.23), Blacks (8.0%, 95% CI: 5.3–10.7%; E-value = 2.92), and Hispanic Whites (7.3%, 95% CI: 4.6–9.9%; E-value = 2.58) was significantly greater than non-Hispanic Whites (4.5%, 95% CI: 3.7–5.4%). [H2] Individuals reporting any coronavirus stigma experience were significantly more likely to exhibit psychological distress (19.9%, 95% CI: 14.6–25.2% vs 10.6%, 9.6–11.6%; E-value = 3.16). [H3] The overall magnitude of association between experience of any coronavirus stigma and psychological distress was not significantly between US-born Asians and non-Hispanic Whites, though we found gender to mask this effect. US-born Asian females who experienced coronavirus stigmatization were more likely to exhibit psychological distress than non-Hispanic white females who experienced coronavirus stigmatization (relative risk (RR): 10.21, 95% CI: 2.69–38.74 vs 1.24, 95% CI: 0.76–2.01; p < 0.01).
Conclusion Comprehensive measures around care seeking, public awareness, and disaggregated data collection are needed to address ethnoracial coronavirus stigmatization and its impact on psychological health and well-being.
Many countries face cycles of repeated violence. Attacks on health workers and facilities exact a... more Many countries face cycles of repeated violence. Attacks on health workers and facilities exact a toll on civilian access to care and, in aggregate, population health status. A variety of humanitarian organizations provide essential services to augment limited state capacity. Yet, humanitarian organizations often work in parallel even in the same conflict-affected contexts. We use a high reliability organization lens to examine violent attacks on the health care programs that humanitarian organizations operate in fragile states. More specifically, we examine Perrow’s (1984) construct of coupling through qualitative evidence of collaborative relationships and creative problem solving under stressful conditions, respectively. We found three salient features from qualitative data: Trade-off between security and field access; transfer of risk to local actors; and marketization of aid. We find that these three features drive humanitarian organizations to act nimbly within countries in order to prioritize their organizational reliability across countries. While stabilizing the individual organization, these features create disincentives to interorganizational coordination at the Cluster level and are agnostic to output (i.e., healthcare provision) reliability. Our study hopes to sensitize readers to several issues facing high reliability healthcare in times of war.
This article examines the policy change process that resulted in the current sugar-sweetened beve... more This article examines the policy change process that resulted in the current sugar-sweetened beverages taxes in Mexico and Chile, using the Kaleidoscope Model for Policy Change, a framework developed for nutrition and food policy change analysis. We used a qualitative study design, including 24 key informant (KI) interviews (16 researchers, 5 civil society representatives and 3 food/beverage industry representatives), encompassing global and in-country perspectives. The analysis shows concurrence with the Kaleidoscope Model, highlighting commonalities in the policy change process. These included the importance of focusing events and coalitions for agenda-setting. Both top-down executive leadership and bottom-up pressure from civil society coalitions were important for the policy adoption as were flexible framing of the tax, and taking advantage of windows of opportunity. In both countries, the tax resulted from national, revenue-seeking fiscal reforms and in sub-optimal tax rates, as a result of the industry influence. KIs also discussed emerging evaluation results, highlighting differences in interpretation concerning the magnitude of change from the tax, and shared potential modifications to the current policies. This analysis contributes to a greater understanding of the policy change process focused on obesity prevention, using an innovative theoretical framework developed specifically for food and nutrition policy.
Abstract
Background Knowledge use is an integral theme of public policy studies. National obesity... more Abstract Background Knowledge use is an integral theme of public policy studies. National obesity policy merits attention given its technical and social complexity. Scientific evidence about the obesity epidemic has been contested and obesity prevention is political in nature because it raises tensions between population health promotion and the principle of non-interference in citizens’ lives. Countries that are early adopters of obesity policy are enmeshed in this two-fold complexity. In this study, we examine the knowledge that was used in the development of sugar-sweetened beverage (SSB) tax policy in Mexico and Chile. Methods We conducted semi-structured interviews with key informants from the epistemic community, civil society, and food and beverage industry. We also collected documents about SSB tax policy in Mexico, Chile, and elsewhere in Latin America. Interviews were professionally transcribed and translated verbatim. We analysed the transcripts and published material using the same coding scheme. We also conducted a bibliometric analysis of the documents collected. Findings Between February and August, 2018, we interviewed 24 key informants: 16 researchers, five civil society representatives, and three food and beverage industry representatives; nine from Mexico, seven from Chile, and eight international respondents. We included 215 total documents dated from Jan 17, 2002, to Feb 11, 2020, including 175 journal articles, 25 newspaper articles, eight books, five conference papers, one report, and one master’s thesis. Three themes emerged from our dataset. First, interviewees focused on the evidence that showed an immediate relation between tax and reduced consumption of SSB rather than SSB’s long-term impact on population health. Second, interviewees endorsed the concept of “policy-based evidence making”, defined as an increase in the production of scientific evidence after SSB tax policy was enacted in the two countries. Lastly, the document analysis showed that each type of respondent cited literature published by their peers. Interpretation The study of public policy should include the evaluation of evidence in the national response to population health problems. Our findings on causality, knowledge gaps, and citation homophily have implications for the adoption of controversial health policy.
Cancer is one of the major non-communicable diseases posing a threat to world health. Unfortunate... more Cancer is one of the major non-communicable diseases posing a threat to world health. Unfortunately, improvements in socioeconomic conditions are usually associated with increased cancer incidence. In this Commission, we focus on China, India, and Russia, which share rapidly rising cancer incidence and have cancer mortality rates that are nearly twice as high as in the UK or the USA, vast geographies, growing economies, ageing populations, increasingly westernised lifestyles, relatively disenfranchised subpopulations, serious contamination of the environment, and uncontrolled cancer-causing communicable infections. We describe the overall state of health and cancer control in each country and additional specific issues for consideration: for China, access to care, contamination of the environment, and cancer fatalism and traditional medicine; for India, affordability of care, provision of adequate health personnel, and sociocultural barriers to cancer control; and for Russia, monitoring of the burden of cancer, societal attitudes towards cancer prevention, effects of inequitable treatment and access to medicine, and a need for improved international engagement.
Intravenous tissue plasminogen activator is the most effective treatment for acute ischemic strok... more Intravenous tissue plasminogen activator is the most effective treatment for acute ischemic stroke, and its use may therefore serve as an indicator of the available level of acute stroke care. The greatest burden of stroke is in low- and middle-income countries, but the extent to which intravenous tissue plasminogen activator is used in these countries is unreported. A systematic review was performed searching each country name AND &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;stroke&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; OR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;tissue plasminogen activator&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; OR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;thrombolysis&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; using PubMed, Embase, Global Health, African Index Medicus, and abstracts published in the International Journal of Stroke (Jan. 1, 1996-Oct. 1, 2012). The reported use of intravenous tissue plasminogen activator was then analyzed according to country-level income status, total expenditure on health per capita, and mortality and disability-adjusted life years due to stroke. There were 118,780 citations reviewed. Of 214 countries and independent territories, 64 (30%) reported use of intravenous tissue plasminogen activator for acute ischemic stroke in the medical literature: 3% (1/36) low-income, 19% (10/54) lower-middle-income, 33% (18/54) upper-middle-income, and 50% (35/70) high-income-countries (test for trend, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). When considering country-level determinants of reported intravenous tissue plasminogen activator use for acute ischemic stroke, total healthcare expenditure per capita (odds ratio 3.3 per 1000 international dollar increase, 95% confidence interval 1.4-9.9, P = 0.02) and reported mortality rate from cerebrovascular disease (odds ratio 1.02, 95% confidence interval 0.99-1.06, P = 0.02) were significant, but reported disability-adjusted life years from cerebrovascular diseases and gross national income per capita were not (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). Of the 10 countries with the highest disability-adjusted life years due to stroke, only one reported intravenous tissue plasminogen activator use. By reported use, intravenous tissue plasminogen activator for acute ischemic stroke is available to some…
Objective To estimate the shortage of mental health professionals in low- and middle-income count... more Objective To estimate the shortage of mental health professionals in low- and middle-income countries (LMICs).
Methods We used data from the World Health Organization’s Assessment Instrument for Mental Health Systems (WHO-AIMS) from 58 LMICs, country-specific information on the burden of various mental disorders and a hypothetical core service delivery package to estimate how many psychiatrists, nurses and psychosocial care providers would be needed to provide mental health care to the total population of the countries studied. We focused on the following eight problems, to which WHO has attached priority: depression, schizophrenia, psychoses other than schizophrenia, suicide, epilepsy, dementia, disorders related to the use of alcohol and illicit drugs, and paediatric mental disorders.
Findings All low-income countries and 59% of the middle-income countries in our sample were found to have far fewer professionals than they need to deliver a core set of mental health interventions. The 58 LMICs sampled would need to increase their total mental health workforce by 239 000 full-time equivalent professionals to address the current shortage.
Conclusion Country-specific policies are needed to overcome the large shortage of mental health-care staff and services throughout LMICs.
—Global consensus and national policies have emphasized deinstitutionalization, or a shift in pro... more —Global consensus and national policies have emphasized deinstitutionalization, or a shift in providing mental health care from institutional to community settings. Yet, psychiatric hospitals and asylums receive the majority of mental health funding in many countries, at odds with research evidence that suggests that services should be delivered in the community. Our aim is to investigate the norms, actors, and strategies that influence the uptake of deinstitutionalization internationally. Our study is informed by prior literature on management and implementation science. The success and failure of mental health care operations depend on identifying and overcoming challenges related to implementing innovations within national contexts. We surveyed 78 experts spanning 42 countries on their knowledge and experiences in expanding community-based mental health care and/or downsizing institution-based care. We also asked them about the contexts in which said methods were implemented in a country. We found that mental health care, whether it is provided in institutions or in the community, does not seem to be standardized across countries. Our analysis also showed that moving deinstitutionalization forward requires meaningful engagement of three types of actors: government officials, health care professionals, and local experts. Progress toward deinstitutionalization depends on the partnerships formed among these actors and with diverse stakeholders, which have the potential to garner resources and to scale-up pilot projects. In conclusion, different countries have adapted deinstitutionalization in ways to meet idiosyncratic situations and population needs. More attention should be given to the management and implementation strategies that are used to augment treatment and preventive services.
International Journal of Health Policy and Management, 2014
Background: Policies generate accountability in that they offer a standard against which governme... more Background: Policies generate accountability in that they offer a standard against which government performance can be assessed. A central question of this study is whether ideological imprint left by policy is realized in the time following its adoption. National mental health policy expressly promotes the notion of deinstitutionalization, which mandates that individuals be cared for in the community rather than in institutional environments. Methods: We investigate whether mental health policy adoption induced a transformation in the structure of mental health systems, namely psychiatric beds, using panel data on 193 countries between 2001 and 2011. Results: Our striking regression results demonstrate that late-adopters of mental health policy are more likely to reduce psychiatric beds in mental hospitals and other biomedical settings than innovators, whereas they are less likely than non-adopters to reduce psychiatric beds in general hospitals. Conclusions: It can be inferred late adopters are motivated to implement deinstitutionalization for technical efficiency rather than social legitimacy reasons.
International Journal of Health Policy and Management, 2014
Background: Following the tenets of world polity and innovation diffusion theories, I focus on th... more Background: Following the tenets of world polity and innovation diffusion theories, I focus on the coercive and mimetic forces that influence the diffusion of mental health policy across nations. International organizations' mandates influence government behavior. Dependency on external resources, namely foreign aid, also affects governments' formulation of national policy. And finally, mounting adoption in a region alters the risk, benefits, and information associated with a given policy. Methods: I use postwar , discrete time data spanning 1950 to 2011 and describing 193 nations' mental health systems to test these diffusion mechanisms. Results: I find that the adoption of mental health policy is highly clustered temporally and spatially. Results provide support that membership in the World Health Organization (WHO), interdependence with neighbors and peers in regional blocs, national income status, and migrant sub-population are responsible for isomorphism. Aid, however, is an insufficient determinant of mental health policy adoption. Conclusion: This study examines the extent to which mental, neurological, and substance use disorder are addressed in national and international contexts through the lens of policy diffusion theory. It also adds to policy dialogues about non-communicable diseases as nascent items on the global health agenda. Implications for policy makers • Mental health policy is a powerful declaration governments make to address mental, neurological, and substance use disorders prevalent in their population. • Membership in the World Health Organization (WHO) or the United Nations (UN) alone does not predict the adoption of national mental health policy, but their regional offices do have a statistically significant effect on policy adoption. • Bilateral and multilateral aid are insufficient determinants of mental health policy adoption. • Prosperous countries are more likely to adopt a mental health policy. • Countries with a high proportion of migrant to native population are less likely to adopt a mental health policy adoption. Implications for public The current study uses quantitative data to describe the rate and pattern of national mental health policy adoption across 193 nations. Overall, I find that the adoption of mental health policy is highly clustered temporally and spatially. The first interpretation is that the World Health Organization (WHO) exerts an influence on governments, particularly through their regional offices. It can thus be inferred that mounting adoption in a given region alters the risk, benefits, and information associated with mental health policy. The second finding is that aid is an insufficient determinant of mental health policy adoption. Non-communicable diseases are nascent items on the global health agenda, and a mandate to address them is not a condition for exchanging foreign aid. And finally, direct advocacy for mental health has more prominent results in developed countries and countries with a sizable migrant population.
Background: Performance-based financing (PBF) has been implemented in a number of countries with ... more Background: Performance-based financing (PBF) has been implemented in a number of countries with the aim of transforming health systems and improving maternal and child health. This paper examines the effect of PBF on health workers' job satisfaction, motivation, and attrition in Zambia. It uses a randomized intervention/control design to evaluate before–after changes for three groups: intervention (PBF) group, control 1 (C1; enhanced financing) group, and control 2 (C2; pure control) group. Methods: Mixed methods are employed. The quantitative portion comprises of a baseline and an endline survey. The survey and sampling scheme were designed to allow for a rigorous impact evaluation of PBF or C1 on several key performance indicators. The qualitative portion seeks to explain the pathways underlying the observed differences through interviews conducted at the beginning and at the three-year mark of the PBF program.
There is a prevailing view of China as a unitary actor in its relationships with African countrie... more There is a prevailing view of China as a unitary actor in its relationships with African countries. This view is incomplete: on the contrary, China is a collection of provinces, autonomous regions and municipalities with myriad strategic ties to African countries, with decentralization shaping the current form of Chinese government and its level of efficiency. In this paper, factors have been explored for why Chinese provinces have played a role in foreign cooperation in health of African countries, in addition to trade and foreign direct investment. Incentives and disincentives for Chinese provinces to engage internationally in foreign cooperation and health assistance have been identified. The concept of paradiplomacy for health has been presented and this typology has been applied to the example of Chinese medical teams. Finally, we draw linkages between China and other members of Brazil,
BackgroundThere is a growing recognition of China?s role as a global health donor, in particular ... more BackgroundThere is a growing recognition of China?s role as a global health donor, in particular in Africa, but there have been few systematic studies of the level, destination, trends, or composition of these development finance flows or a comparison of China?s engagement as a donor with that of more traditional global health donors.MethodsUsing newly released data from AidData on China?s development finance activities in Africa, developed to track under reported resource flows, we identified 255 health, population, water, and sanitation (HPWS) projects from 2000?2012, which we descriptively analyze by activity sector, recipient country, project type, and planned activity. We compare China?s activities to projects from traditional donors using data from the OECD?s Development Assistance Committee (DAC) Creditor Reporting System.ResultsSince 2000, China increased the number of HPWS projects it supported in Africa and health has increased as a development priority for China. China?s contributions are large, ranking it among the top 10 bilateral global health donors to Africa. Over 50% of the HPWS projects target infrastructure, 40% target human resource development, and the provision of equipment and drugs is also common. Malaria is an important disease priority but HIV is not. We find little evidence that China targets health aid preferentially to natural resource rich countries.ConclusionsChina is an important global health donor to Africa but contrasts with traditional DAC donors through China?s focus on health system inputs and on malaria. Although better data are needed, particularly through more transparent aid data reporting across ministries and agencies, China?s approach to South-South cooperation represents an important and distinct source of financial assistance for health in Africa.
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Objectives
Coronavirus stigmatization may be disproportionately impacting ethnoracial minority groups in the US. We test three hypotheses: [H1] Asians in the US are more likely to report experiencing coronavirus stigmatization than non-Hispanic Whites; [H2] Coronavirus stigmatization is associated with psychological distress; [H3] Magnitude of association between coronavirus stigmatization and psychological distress is more pronounced among US-born Asians, compared to non-Hispanic Whites.
Design
We analyzed cross-sectional survey data from the 10–31 March 2020 wave of the Understanding America Survey, a nationally representative survey of adults in the US. Psychological distress was assessed with the PHQ-4. Measures of association were estimated using multiple logistic regression and survey sampling weights. Predicted probabilities were calculated using marginal standardization ( n = 6707).
Results
[H1] The adjusted predicted probability of experiencing any coronavirus stigma among foreign-born Asians (11.2%, 95% CI: 5.5–17.0%; E-value = 4.52), US-born Asians (10.9%, 95% CI: 5.8–16.0%; E-value = 4.23), Blacks (8.0%, 95% CI: 5.3–10.7%; E-value = 2.92), and Hispanic Whites (7.3%, 95% CI: 4.6–9.9%; E-value = 2.58) was significantly greater than non-Hispanic Whites (4.5%, 95% CI: 3.7–5.4%). [H2] Individuals reporting any coronavirus stigma experience were significantly more likely to exhibit psychological distress (19.9%, 95% CI: 14.6–25.2% vs 10.6%, 9.6–11.6%; E-value = 3.16). [H3] The overall magnitude of association between experience of any coronavirus stigma and psychological distress was not significantly between US-born Asians and non-Hispanic Whites, though we found gender to mask this effect. US-born Asian females who experienced coronavirus stigmatization were more likely to exhibit psychological distress than non-Hispanic white females who experienced coronavirus stigmatization (relative risk (RR): 10.21, 95% CI: 2.69–38.74 vs 1.24, 95% CI: 0.76–2.01; p < 0.01).
Conclusion
Comprehensive measures around care seeking, public awareness, and disaggregated data collection are needed to address ethnoracial coronavirus stigmatization and its impact on psychological health and well-being.
Background Knowledge use is an integral theme of public policy studies. National obesity policy merits attention
given its technical and social complexity. Scientific evidence about the obesity epidemic has been contested and
obesity prevention is political in nature because it raises tensions between population health promotion and the
principle of non-interference in citizens’ lives. Countries that are early adopters of obesity policy are enmeshed in this
two-fold complexity. In this study, we examine the knowledge that was used in the development of sugar-sweetened
beverage (SSB) tax policy in Mexico and Chile.
Methods We conducted semi-structured interviews with key informants from the epistemic community, civil society,
and food and beverage industry. We also collected documents about SSB tax policy in Mexico,
Chile, and elsewhere in Latin America. Interviews were professionally transcribed and translated verbatim. We
analysed the transcripts and published material using the same coding scheme. We also conducted a bibliometric
analysis of the documents collected.
Findings Between February and August, 2018, we interviewed 24 key informants: 16 researchers, five civil society
representatives, and three food and beverage industry representatives; nine from Mexico, seven from Chile, and eight
international respondents. We included 215 total documents dated from Jan 17, 2002, to Feb 11, 2020, including
175 journal articles, 25 newspaper articles, eight books, five conference papers, one report, and one master’s thesis.
Three themes emerged from our dataset. First, interviewees focused on the evidence that showed an immediate relation
between tax and reduced consumption of SSB rather than SSB’s long-term impact on population health. Second,
interviewees endorsed the concept of “policy-based evidence making”, defined as an increase in the production of
scientific evidence after SSB tax policy was enacted in the two countries. Lastly, the document analysis showed that each
type of respondent cited literature published by their peers.
Interpretation The study of public policy should include the evaluation of evidence in the national response
to population health problems. Our findings on causality, knowledge gaps, and citation homophily have implications
for the adoption of controversial health policy.
Methods We used data from the World Health Organization’s Assessment Instrument for Mental Health Systems (WHO-AIMS) from 58 LMICs, country-specific information on the burden of various mental disorders and a hypothetical core service delivery package to estimate how many psychiatrists, nurses and psychosocial care providers would be needed to provide mental health care to the total population of the countries studied. We focused on the following eight problems, to which WHO has attached priority: depression, schizophrenia, psychoses other than schizophrenia, suicide, epilepsy, dementia, disorders related to the use of alcohol and illicit drugs, and paediatric mental disorders.
Findings All low-income countries and 59% of the middle-income countries in our sample were found to have far fewer professionals than they need to deliver a core set of mental health interventions. The 58 LMICs sampled would need to increase their total mental health workforce by 239 000 full-time equivalent professionals to address the current shortage.
Conclusion Country-specific policies are needed to overcome the large shortage of mental health-care staff and services throughout LMICs.
Objectives
Coronavirus stigmatization may be disproportionately impacting ethnoracial minority groups in the US. We test three hypotheses: [H1] Asians in the US are more likely to report experiencing coronavirus stigmatization than non-Hispanic Whites; [H2] Coronavirus stigmatization is associated with psychological distress; [H3] Magnitude of association between coronavirus stigmatization and psychological distress is more pronounced among US-born Asians, compared to non-Hispanic Whites.
Design
We analyzed cross-sectional survey data from the 10–31 March 2020 wave of the Understanding America Survey, a nationally representative survey of adults in the US. Psychological distress was assessed with the PHQ-4. Measures of association were estimated using multiple logistic regression and survey sampling weights. Predicted probabilities were calculated using marginal standardization ( n = 6707).
Results
[H1] The adjusted predicted probability of experiencing any coronavirus stigma among foreign-born Asians (11.2%, 95% CI: 5.5–17.0%; E-value = 4.52), US-born Asians (10.9%, 95% CI: 5.8–16.0%; E-value = 4.23), Blacks (8.0%, 95% CI: 5.3–10.7%; E-value = 2.92), and Hispanic Whites (7.3%, 95% CI: 4.6–9.9%; E-value = 2.58) was significantly greater than non-Hispanic Whites (4.5%, 95% CI: 3.7–5.4%). [H2] Individuals reporting any coronavirus stigma experience were significantly more likely to exhibit psychological distress (19.9%, 95% CI: 14.6–25.2% vs 10.6%, 9.6–11.6%; E-value = 3.16). [H3] The overall magnitude of association between experience of any coronavirus stigma and psychological distress was not significantly between US-born Asians and non-Hispanic Whites, though we found gender to mask this effect. US-born Asian females who experienced coronavirus stigmatization were more likely to exhibit psychological distress than non-Hispanic white females who experienced coronavirus stigmatization (relative risk (RR): 10.21, 95% CI: 2.69–38.74 vs 1.24, 95% CI: 0.76–2.01; p < 0.01).
Conclusion
Comprehensive measures around care seeking, public awareness, and disaggregated data collection are needed to address ethnoracial coronavirus stigmatization and its impact on psychological health and well-being.
Background Knowledge use is an integral theme of public policy studies. National obesity policy merits attention
given its technical and social complexity. Scientific evidence about the obesity epidemic has been contested and
obesity prevention is political in nature because it raises tensions between population health promotion and the
principle of non-interference in citizens’ lives. Countries that are early adopters of obesity policy are enmeshed in this
two-fold complexity. In this study, we examine the knowledge that was used in the development of sugar-sweetened
beverage (SSB) tax policy in Mexico and Chile.
Methods We conducted semi-structured interviews with key informants from the epistemic community, civil society,
and food and beverage industry. We also collected documents about SSB tax policy in Mexico,
Chile, and elsewhere in Latin America. Interviews were professionally transcribed and translated verbatim. We
analysed the transcripts and published material using the same coding scheme. We also conducted a bibliometric
analysis of the documents collected.
Findings Between February and August, 2018, we interviewed 24 key informants: 16 researchers, five civil society
representatives, and three food and beverage industry representatives; nine from Mexico, seven from Chile, and eight
international respondents. We included 215 total documents dated from Jan 17, 2002, to Feb 11, 2020, including
175 journal articles, 25 newspaper articles, eight books, five conference papers, one report, and one master’s thesis.
Three themes emerged from our dataset. First, interviewees focused on the evidence that showed an immediate relation
between tax and reduced consumption of SSB rather than SSB’s long-term impact on population health. Second,
interviewees endorsed the concept of “policy-based evidence making”, defined as an increase in the production of
scientific evidence after SSB tax policy was enacted in the two countries. Lastly, the document analysis showed that each
type of respondent cited literature published by their peers.
Interpretation The study of public policy should include the evaluation of evidence in the national response
to population health problems. Our findings on causality, knowledge gaps, and citation homophily have implications
for the adoption of controversial health policy.
Methods We used data from the World Health Organization’s Assessment Instrument for Mental Health Systems (WHO-AIMS) from 58 LMICs, country-specific information on the burden of various mental disorders and a hypothetical core service delivery package to estimate how many psychiatrists, nurses and psychosocial care providers would be needed to provide mental health care to the total population of the countries studied. We focused on the following eight problems, to which WHO has attached priority: depression, schizophrenia, psychoses other than schizophrenia, suicide, epilepsy, dementia, disorders related to the use of alcohol and illicit drugs, and paediatric mental disorders.
Findings All low-income countries and 59% of the middle-income countries in our sample were found to have far fewer professionals than they need to deliver a core set of mental health interventions. The 58 LMICs sampled would need to increase their total mental health workforce by 239 000 full-time equivalent professionals to address the current shortage.
Conclusion Country-specific policies are needed to overcome the large shortage of mental health-care staff and services throughout LMICs.