Wolf in Sheep’s Clothing? Alcohol Industry’s Involvement in Road Safety

By Connie Hoe (Johns Hopkins Bloomberg School of Public Health)

Background

Road traffic injuries are a major public health problem and the leading killer of children and young adults around the world. One of the key risk factors is drinking and driving. This is because alcohol impairment leads to poor judgement, increased reaction time, lowered vigilance and weakened eye muscle coordination; all abilities necessary for an individual to safely operate a vehicle.

In 2012, the world’s leading beer, wine and spirit producers collectively vowed to continue their efforts to combat harmful drinking, including the goal of reducing drinking and driving. Acknowledging the serious effects that the harmful use of alcohol can have, these producers committed themselves to supporting the World Health Organization’s Global Strategy to Reduce the Harmful Use of Alcohol as well as Target 3.6 of the United Nation’s Sustainable Development Goals to halve the number of global deaths and injuries from road-traffic crashes.

Good corporate citizenship? Or a wolf in sheep’s clothing?   

Our study showed that while the alcohol industry acknowledges that drinking and driving is an issue of concern, it usually promotes solutions that are not aligned with public health evidence-based recommendations and would limit impact on sales, while allowing the industry to maintain its reputation as a good corporate citizen. It is important to note that the majority of the most effective and cost-effective interventions for reducing alcohol-related road traffic injuries are directed at reducing the availability and sale of alcohol, either overall or to particular vulnerable groups. Public health key informants from the study explained that drinking and driving is an issue that the alcohol industry cannot outright deny and as a result it has become a public health area where the industry has been investing in, particularly in terms of its corporate social responsibility activities, to make itself look like a good corporate citizen and divert attention away from the fact that alcohol serves as a major risk factor for over 200 different health conditions. This is similar to the message “drink – but don’t drive.”

The alcohol industry accomplishes this by developing arguments to frame the issue of drink-driving. One example is that alcohol misuse is an issue of personal responsibility – a rhetoric that has also been employed by other health harming industries such as the tobacco industry. Other arguments include: the majority of drinkers are moderate and responsible, and that the alcohol industry is a legitimate stakeholder. These messages are then conveyed through the following mechanisms described below to achieve the industry’s preferred outcome:

  1. Coalition management

The alcohol industry presents itself as a legitimate stakeholder by partnering with public health and road safety stakeholders and participating in road safety coalitions. The industry also uses third parties such as Social Aspect Public Relations Organizations and other “astroturf” organizations (e.g. American Beverage Institute) to represent the industry during policy debates and in public and social discourse. Our study showed that partnership between the alcohol industry and public health/road safety stakeholders appeared to the enabler for all other types of involvement listed below.

  1. Information production and management

The alcohol industry recruits scientists to carry out research, funds research directly or through a third party, and conducts research itself. It also manages its reputation as a good corporate citizen through engaging in corporate social responsibility activities: donating breathalyzers to police departments, putting money into the road safety sector, providing training and technical assistance to government, sponsoring campaigns, and promoting activities that have high public relations visibility.

  1. Direct involvement in policymaking

The alcohol industry is also directly involved in the road safety policymaking process at both the global and national levels. At the global level, there is evidence to suggest that the alcohol industry is very active in its engagement with the United Nations. At the national level, industry representatives, lobbyists and other affiliates cultivate positive relationships with decision makers, setting up events to increase interactions and providing incentives, including donations to political campaigns.

  1. Implementation of interventions

The alcohol industry supports and carries out drink-driving interventions, which often advocates for “responsible” drinking. A study conducted in 2016 found that of the 266 alcohol industry sponsored global initiatives to reduce drink-driving, only 2 (0.08%) were consistent with evidence-based public health recommendations.

Questions for the Future

Given this scenario, we would expect an outcry from the road safety and public health communities. Unfortunately, the responses thus far have been fragmented particularly with regards to the topics of receiving funding from and partnering with the alcohol industry. Groups affiliated with the industry argued that one of the key advantages of partnering with the alcohol industry is funding since there are few funders in the area of road safety. Several of them also highlighted that they were able to maintain independence from the industry, while retaining funding. On the other hand, non-industry-affiliated public health groups asserted that there is an inherent conflict of interest between public health and the alcohol industry and funding from the industry will necessarily make recipients more susceptible to industry influence, whether they are aware of such influence. Some groups within the road safety community also separate the issue of drink driving from other alcohol problems, arguing that it goes beyond the organization’s mandate.

This raises several important questions:

  • Should corporations that are promoting health harming products engage in corporate social responsibility activities, particularly when these activities help promote their products?
  • Should guidelines be developed to help road safety organizations gauge when it is ethical to partner with and/or receive funding from the alcohol industry?
    • In the field of tobacco control, Cohen et al identified 8 criteria that could be used by tobacco control organizations to evaluate tobacco industry funding: 1) transparency and independence, 2) competitive funding process, 3) ownership of data and freedom to publish, 4) independent research agenda, 5) governance, 6) protection against conflict of interest, 7) industry public relations gains that counteract public health and 8) feasibility
  • How do we convince road safety organizations that by separating the issue of drink driving from other alcohol problems we are actually doing public health a disservice?
  • And what about a Framework Convention for Alcohol Control?

Conclusion

The alcohol industry is involved in road safety despite the fact that drink driving is a key risk factor for road traffic injuries. Yet, responses from the public health and road safety communities remain fragmented. Political scientists have long argued that cohesiveness among the networks of actors concerned with a particular social issue is a key ingredient for meaningful macro-level change. Given this, there is an urgent need to raise awareness about the involvement of the alcohol industry in road safety and for the public health and road safety communities to generate consensus, rally in one voice, and build a cohesive transnational alcohol control advocacy alliance to curb injuries and deaths unnecessarily lost to drink driving.

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Ensuring access to essential sexual and reproductive health products during COVID-19: Challenges and future directions

By Hamsadvani Anand Kuganantham, MBBS, MSc, HPPF; Independent consultant, Sexual and Reproductive Health

In this blogpost, we focus on maintaining access to key Sexual and Reproductive Health (SRH) products included in the Minimum Initial Service Package, essential maternal care medicines such as Tranexamic acid for prevention of postpartum hemorrhage and Prevention of Mother-to-Child HIV Transmission (PMTCT) kits. COVID-19 has affected health systems in an unimaginable way – but how does this affect the sexual and reproductive health (SRH) of women and their partners, and what are the implications for the future. This blogpost aims to explain the long-lasting effect COVID-19 will have on the supply chain of key SRH products and thereby, the health of women and their partners.
This blog is part of our Voices from the Front Line during COVID-19 blog series. These posts seek to facilitate timely cross- learning by sharing opinions, insights and lessons on the challenges and actions taken by those on the COVID-19 front line.

Many health systems across the world have been adversely affected by COVID-19. The global health security index shows that most countries were not prepared for new disease outbreaks. The procurement and supply chain systems for medicines, diagnostics and medical devices have also been significantly disrupted due to obstructions in usual routes of supply. Products are being stalled at the import country site due to delayed customs clearances. The manufacturers face barriers in procuring raw material. Many skilled workers from these sites are forced to find new employment causing a huge challenge. This has led to an unforeseen deficit of contraceptive medicines and devices and has put a huge strain on women and their partners from accessing essential SRH services including family planning. The effects of such disruptions are felt acutely in weak health systems, and places where there are ongoing humanitarian crises.  It also exacerbates the existing gender and socio-economic inequalities in several lower- and middle-income countries that negatively affect the access to SRH services.

It requires prioritizing the most marginalized and vulnerable populations such as refugees, immigrants, informal workers, undocumented domestic workers etc.

According to estimates, a 10% proportional decline in contraceptive use would result in an additional 49 million women with an unmet need and an additional 15 million unintended pregnancies in LMICs. If 10% of women who would opt for safe abortion in normal circumstances, undergo unsafe abortions instead (because medical abortion is considered a non-essential service during the pandemic), it would result in additional three million unsafe abortions in a year – which translates to an additional 1000 maternal deaths[1].

Responses needed in the short term

Strengthening data management systems: Many countries do not have a comprehensive data architecture to monitor their medicines and related supplies. There are issues around data quality and fear of being held accountable for poor performance. There is a need for investment in health information systems in many LMICs. Countries may need to consider aligning their communications at the National and subnational level on data sharing to understand inventory needs. This should involve setting up data systems to monitor the stock levels of key SRH commodities including those required for the delivery of the Minimum Initial Service Package for Sexual and Reproductive Health and for the provision of essential maternal care medicines such as Tranexamic acid for PPH prevention and Prevention of Mother-to-Child HIV Transmission (PMTCT) kits.  One way of strengthening data systems is by strengthening electronic health records and making it mandatory for private health care givers to share their prescription data – this is especially relevant for countries where private health spending is considerably high.

Collaboration and Partnerships: Engaging within ministerial departments, intersectoral collaboration within government (e.g. Transport ministry, social welfare, etc.), public private partnerships and even with nongovernmental organizations (NGOs) can improve access to key SRH commodities[2].

For instance, most young women in India use only one or two types of contraceptives. NGOs can use their community presence to increase awareness about different methods of contraception other than condom use, the morning after pill and tubal ligation. Nutrition and grassroots health workers (example, Anganwadi workers in India), who bridge social welfare and health care departments can help reduce the gap in access which has widened because of the pandemic.

Lastly, women who approach the health facility seeking care should be received with respect and empathy. Many times, judgmental attitude and stigma shown by health care workers present huge barriers in access to essential health care services in many settings.

Responses needed in the long term

Strengthen logistics channels at the National level – establish a robust global network

  1. One suggestion to mitigate the challenges of lockdowns is to focus on regional procurement of bulk generics (especially for chronic diseases like diabetes and hypertension) and streamlining distribution channels at the national level.
  2. Many international organizations have adapted to the new ‘normal’ and realigned their distribution hubs. Governments may consider tapping into these resources to fulfill their population needs. For example,
    • United Nations Population Fund (UNFPA) is donating reproductive health supplies, including contraceptives through their country offices.
    • The International Planned Parenthood Federation (IPPF) has established a microsite where the commodity needs are indicated to the supply team in London to take appropriate action through their local agencies.
    • The Pandemic Supply Chain Network (PSCN) is engaging with national authorities and UN partners to support the procurement, storage and distribution of critical supplies.

Conclusion

COVID-19 continues to teach us the importance of global cooperation on pooling resources, data and technology, to ensure that countries are better prepared for pandemics and other emergency situations. Better systems need to be set up to ensure a resilient procurement and supply chain structure. It is critical to understand the importance of good data systems to understand the impact of the pandemic on access to all services, especially essential SRH services and commodities, so that it would support policy and programme decisions and ensure that SRH will not be left behind.


[1] Even though it is hypothetically assumed that there is a 10% decline, messages from many frontline workers and local member organizations estimate an 80% decline in use of services

[2] However, this also requires safe-guarding the public and consumers from potential harm where necessary through amending existing regulatory laws.

Photo by Reproductive Health Supplies Coalition on Unsplash

Health Systems of Oppression? How health systems operate within and perpetuate systems of oppression

By Ruth Young (Johns Hopkins Bloomberg School of Public Health), Richard Mangwi (Makerere University), Maylene Shung-King (University of Cape Town) and Rosemary Morgan (Johns Hopkins Bloomberg School of Public Health).

Health system functioning, operation, design and governance can reflect and perpetuate broader power structures in multiple ways. This dynamic of advantage/disadvantage may contribute to health disparities that reflect broader power structures. The aim of this blog post and associated commentary is to start a conversation around how and why we can use an intersectional lens to understand the power dynamics within health systems and the resulting health inequities in our communities.

Drawing on our previous work, we highlight the following ways health systems operate within and perpetuate systems of oppression:

  • Health systems are based within existing societal systems
  • Health service delivery excludes marginalized groups
  • Health information systems reflect and perpetuate existing systems of oppression

Health systems are based within existing societal systems

Health systems and the ways we govern, finance and deliver health are rooted in historical and contemporary systems of oppression and power. For example, South Africa’s history of oppression of Black people during the apartheid era, coupled with a patriarchal society, restricted access to education and work opportunities especially for Black women. During apartheid, the career advancement and training for Black men, and even more so for Black women, were limited, contributing to poor representation in management positions, especially in senior positions. We see the repercussions of this history today, where the confluence of gender, race, and professional hierarchy still influence the nature of leadership and management in today’s health system. Historical barriers to advancement, coupled with gender norms, result in fewer Black women holding health management (and even fewer senior) positions. Understanding the intersectional drivers of leadership and representation in health systems can show how health systems reflect and perpetuate existing systems of oppression and power.

Health service delivery excludes marginalized groups

Different groups experience different barriers to accessing and utilizing health services. For example, in Masindi, Uganda, one of the authors of the commentary found that immigrant women perceived or experienced additional barriers to accessing maternal and newborn care compared to non-immigrant women. Immigrant women were likely to delay maternal care during delivery due to potential discrimination by health workers, cultural norms that perceive women as ‘strong’ if they did not complain during labor pains, and belief that delivery is a woman-only issue. Given the unique needs of immigrant women seeking maternal and newborn health care, services could be redesigned to be more user-friendly and as a result, make health delivery more equitable.

Health information systems reflect and perpetuate existing systems of oppression

What is measured reflects what is valued in a health system. In Uganda, for example, the sexual and reproductive health needs of women with physical disabilities were left unaddressed. Women with physical disabilities were perceived as not having the same reproductive and sexual needs as women without walking disabilities as they were often perceived to be asexual and/or unable to look after offspring. Without data describing the sexual and reproductive health needs of women with physical disabilities, preconceptions of their health needs prevail and services are not designed to meet their needs.

Applying an intersectional lens to help understand and dismantle systems of oppression within health systems

Applying an intersectional lens is a fundamental step to dismantling systems of oppression both in the health sector and beyond. Intersectionality shows how overlaying social stratifiers (gender, ableness, sexual orientation and identity etc.) can intersect making some groups at an advantage and others at a disadvantage. Intersectionality was first coined by Kimberlé Crenshaw to describe how the experience of Black women is not wholly captured by being Black or a woman alone. Rather, the intersection of being both Black and a woman interact in ways that result in a unique experience unable to be explained by either single identity.

Applying an intersectional lens to health systems helps us comprehensively examine health inequities. If we don’t, we run the risk of a superficial analysis of inequity in health outcomes, focused on the outcomes rather than the entrenched and root causes of the inequity. Policymakers, researchers and planners can take appropriate steps to help reduce the impact of entrenched inequity by examining power structures, describing health inequities, recognizing that health systems are set within historical and contemporary legacies of oppression. Applying an intersectional lens is key dismantling systems of oppression both in the health sector and beyond.

This blog and commentary is designed to start a discussion on ways to understand how health systems can perpetuate and challenge systems of oppression – can you think of other ways from your own work or experience that highlight how health systems operate within and perpetuate systems of oppression and/or how an intersectional lens can be used to dismantle systems of oppression both in the health sector and beyond?


Related Resources

60 seconds with Ariella Rosita King

Dr Ariella (Ariel) Rosita King (PhD Public Health and Policy, 2002) is the Founder and President of The Ariel Foundation International. We asked her about her role, projects she is working on and some quick-fire questions.

What is your role and what does it involve?

I started the Ariel Foundation International (AFI) in 2000; however, it was registered as a non-profit organisation in 2002. The basis for creating this foundation was the difficulties that children and youth suffered daily. We are legally based in Switzerland, France, and the USA, yet we work all over the world.

The aim is to open channels and opportunities for the youth to prosper and take control of the future. It aims to involve the children and youth in decision making, leadership, entrepreneurship, and improving the lives of young people and their families at local, national and international levels.

All my efforts are focused on the foundation and the work that we do.

What is a typical day for you?

A typical day is quite long because we are in communication with young Changemakers from all over the world, there is no separation of hours or days. I work every day from morning until late evening depending on the activities that need to be accomplished.

Tell us about a project you are currently working on?

We are currently working on our AFI Changemakers being a part of UN meetings online, and also developing a Children’s World Humanitarian Forum with our young people for January 2021. We have also just completed several publications on COVID-19 on African, Youth and Older Persons Day, and also AFI Changemakers at the World Humanitarian Forum. All our publications, 42 thus far are written by children and young people. Their publications are reflective of the UN, EU and international issues important to and for children and young people.

What three words would you use to describe your role?

My role is to inspire, dream and to be a “positive change architect.”

What is your favourite thing about working there?

Working with children and the youth in building the world they want to see and be an important part of.

What challenges have you had to overcome?

The challenges I have faced are mainly related to executing the ideas of the organisation. While having a vision is great, it is hard to implement these ideas, as it requires a lot of teamwork, commitment, and patience. The drive is to see young people participating at all levels of our society be given the same importance as gender equity at all levels of society. I believe that I am preparing the youth to have a seat at any table and contribute positively to the group’s success.

Another challenge was the model of the foundation as it was solely dependent on volunteers. Now the model is more focused on funding so that we can continue to provide opportunities to young people, enabling them to take leadership positions within the organisation and represent the organisation. The youth are also incorporated into the board of directors so that they can have a say in the running of the Ariel Foundation.

What is your proudest career achievement?

Some key moments of my career and the accomplishments of the foundation have been when I received a Special Economic and Social Counsel (ECOSOC) status with the United Nation (New York, Geneva, Rome, Vienna and Nairobi), we were the first in history to accredit children and young people as delegates to represent themselves and the foundation at official UN meetings, and we developed the International Community Children’s Camps to address trauma in Botswana, Liberia, and Morocco.

What lessons could young people learn from your journey?

Find a way to adapt to those in power so you can have a say, figure out how to be at the table of power and don’t wait for an invitation, preparation is key to success, be part of the change you want to see around you, never give up and always be yourself!

Where are you from?

I was born in New York, USA and have lived in Europe for most of my adult life (over 35 years).

Who is your biggest inspiration?

My biggest influence in my life is my recently late mother, Dr Margo G. King.  I am her only child in a long line of Matriarchs in our family. During my entire life my mother was the most prominent figure in my life and this is where I draw my inspiration and strength from daily.

My mother had me at an early age. However, that didn’t deter her from pursuing an education with a doctorate in psychology. I always saw my grandmother (Dr Margo King) with books and this is where my love for learning started.

She set the tone for me to start my foundation and continue the journey of helping people all over the world.

When I’m not working….

I am spending time with my children and family, travelling, learning (humanitarian law and golf) and I have been a Rotarian for over 30 years.

What did you want to be when you were growing up?

As a child, I wanted to develop and own an alternative school for bright children.

What three words would you use to describe yourself?

In motion, dedicated, and tenacious.

What is your favourite book?

Dr Maya Angelou, “I Know Why The Caged Birds Sing”.

What is your most treasured possession?

A personalised signed photo from the late President Nelson Mandela and a photo of my daughter, Ariana jumping on Archbishop Desmond Tutu.

What is your favourite place?

I have travelled to over 70 countries and have lived in 12 countries. There is something wonderful about all the countries. Their diversity of culture, history, food and daily life gives them all positive memories.

What would it surprise people to know about you?

Both Dr Peter Piot (when he was at UNAIDS) and I were Committee Members for the Expert Group on HIV/AIDS as a part of the Gates Foundation and Health Service Research Agency (in South Africa) in the 90s.

MeSH update for 2021: new subject headings of interest to LSHTM users

Every year the National Library of Medicine updates its MeSH index for Medline and PubMed. This adds new terms to catch up with changes in the research. Details of the update are published on the NLM website and will be incorporated into papers added to Medline/PubMed from 2021. Be aware that the new MeSH terms are not retrospectively added to papers, so any papers already included in the database will not be re-indexed.

New MeSH terms associated with the COVID-19 pandemic

Unsurprisingly, a number of new MeSH terms have been added to index papers associated with SARS-CoV-2 and COVID-19.

  • COVID-19
  • SARS-CoV-2
  • Coronavirus 3C proteases
  • Coronavirus Papain-like proteases
  • Coronavirus RNA-dependent RNA polymerase
  • Coronavirus envelope proteins
  • Coronavirus M proteins
  • Coronavirus nucleocapsid proteins
  • Receptors, coronavirus
  • COVID-19 vaccines
  • Coronavirus protease inhibitors
  • COVID-19 nucleic acid testing
  • COVID-19 serological testing
  • COVID-19 testing
  • N95 respirators
  • Physical distancing

Other new MeSH terms of interest to LSHTM researchers

I have picked out some other terms which may be of interest to LSHTM researchers.

  • Service animals
  • Therapy animals
  • Working dogs
  • Human-animal interaction
  • Bacterial Zoonoses
  • Viral Zoonoses
  • Blood-Borne Infections
  • Latent infection
  • Chain of infection
  • Disease hotspot
  • Reinfection
  • Opiate overdose
  • Recreational drug use
  • HIV testing
  • Self testing
  • Quick diagnosis units
  • Diagnostic reference levels
  • Sanitary surveys, water supply
  • User-centered design
  • Caregiver burden
  • Compulsive exercise
  • Team sports
  • Financial stress
  • Economic factors
  • Gender equity
  • Gender role
  • Internet addiction disorder
  • Psychosocial functioning
  • Social comparison
  • Social cognition
  • Social defeat
  • Social evolution
  • Social factors
  • Social inclusion
  • Social interaction
  • Social network analysis
  • Digital technology
  • Internet use
  • Teleworking
  • Deportation
  • Freedom of movement
  • Freedom of religion
  • Pseudoscience
  • Emotional abuse
  • Test anxiety
  • Soil erosion
  • Water insecurity
  • Food deserts
  • Food insecurity
  • Food security
  • Supermarkets
  • Sustenance
  • Interprofessional education
  • Return to school

Contact us in the Library if you would like to discuss how to update your searches or incorporate these new terms into your searches.

100th anniversary of opening of Endsleigh Gardens building

Today, 11th November 2020, marks the 100th anniversary of the official opening of the London School of Tropical Medicine and Hospital for Tropical Diseases in Endsleigh Gardens by HRH The Duke of York.

At the end of 1918, Sir Havelock Charles, Dean of the London School of Tropical Medicine (as the School was then called), made the decision that the School would move from the Albert Dock Hospital in the East End into Central London. The School had largely outgrown its premises and there was concern that as a result of the end of the First World War there would be an increase in patients returning to Britain suffering from tropical diseases. There was also a general desire to be closer to, and enhance the School’s standing with, the University of London.

Charles Havelock. Photograph. Credit: Wellcome Library, London. Wellcome Images images@wellcome.ac.uk http://images.wellcome.ac.uk Charles Havelock. Photograph. Published: – Copyrighted work available under Creative Commons by-nc 2.0 UK, see http://images.wellcome.ac.uk/indexplus/page/Prices.html

The building was a former hotel, the Endsleigh Palace Hotel, which had been used as an army hospital for officers during the First World War and was suitably equipped to house both the Hospital for Tropical Diseases and the School. It also had the added benefit of being located close to the proposed new site of the University of London and the Wellcome Institute.

The move was made possible by a donation from the Royal Red Cross Society who at the end of the war found itself with a substantial credit balance from funds collected during the war years. It was decided to devote some of this for the benefit of ex-servicemen who had suffered from tropical diseases, so that a grant of £100,000 was made to the Seamen’s Hospital Society.  Lord Milner at the Colonial Office raised another £80,000 and by Feb 1920 the former Endsleigh Garden Hotel had been refurbished. Staff and students moved in early 1920 but it wasn’t officially opened until November.

The nine storey building was suitable to house both School and hospital, the lower four were devoted to the School and the upper to the Hospital for Tropical Diseases. The ground floor housed a lecture room, library (shown on the left), board room, refectory and offices, on the first floor were the museum and departments of tropical pathology and entomology, on the second floor helminthology and protozoology and on the third floor the Tropical Diseases Bureau.

It was estimated that the hospital should accommodate sixty beds. There were two public wards of fair size, and numerous smaller ones for 2-4 beds and there was one floor mainly of single rooms for private cases. The surgical block was at the top of the building and the X-ray department was in the basement.

The Hospital for Tropical Diseases was at first fully occupied by pensioners of the First World War. They flocked there with malaria, amoebic and bacillary dysentery, liver abscess, kala azar, trypanosomiasis and other tropical diseases. There was an abundance of tropical cases for the students to study. The first case admitted to hospital in Feb 1920 was one of bilharziasis in an ex-serviceman from Egypt which was regarded as a good omen for the future.

An account from a former staff member said that the building was dark, awkward, and inconvenient, with multitudes of doors and narrow passages. The lecture was dingy, dusty, dirty and noisy where it impinged upon Gordon Street and with the bustle of the traffic outside it was difficult to be heard. There are stories about students falling asleep in the lecture theatre as it was so dark. The staff and students must have been very happy with the new facilities of the Keppel Street building when then moved there in 1929.

The Endsleigh Gardens building is still standing in Gordon Street and is now the student union for University College London, there is a blue plaque on the wall to commemorate its history.

Blue plaque on UCL Student Union building

For further information, please contact the LSHTM Archives Service at archives@lshtm.ac.uk

SUPPLEMENT LAUNCH! Health policy and systems research mentoring: Supporting early career women in LMICs

By Sameera Hussain (Office of Strategic Policy and Planning, Public Health Agency of Canada) and Dena Javadi (Researcher/PhD student, Harvard TH Chan School of Public Health)

This supplement, a collaboration between Health Systems Global (HSG) and the Alliance for Health Policy and Systems Research (AHPSR), is the product of a six-month publication mentorship programme aimed at supporting early-career women conducting Health Policy and Systems Research (HPSR) in Low- and Middle- Income Countries (LMICs). The mentorship programme guided mentees – selected based on a motivation letter and draft abstract – in preparing a high-quality manuscript for a peer-reviewed journal. Topics for submission were restricted to themes identified for the Sixth Global Symposium on Health Systems Research on “Re-imagining health systems for better health and social justice.” A call for expressions of interest drew 252 applicants, with 20 papers submitted, and finally 9 selected for publication. The mentorship model worked well, with 22 mentors and mentees matched by their area of expertise.

It is well-documented that gender, race, ethnicity, socioeconomic status, and other combinations of social identities impede women’s progress in the health workforce and restrict access to corridors of power. Women’s progress in academic medicine and public health is often impeded by structural barriers and gendered institutions. Some of the key barriers include gendered stereotypes and bias, imbalanced family and care-taking roles, lack of mentorship, and poor organizational support. Institutions today have commenced practices for redress, implementing training in unconscious bias, career development support, childcare services, availability of culturally responsive mentorship, networking opportunities, and diversity practices in recruitment across their organizations. In academia, high-impact publications remain a benchmark of productivity, expertise, and success—hence the gender disparities we see in the publication output of early and mid-career women researchers, and particularly among women of  underrepresented minorities, have a negative impact on equitable academic placement and promotions.  An intersectional lens – accounting for interactions across gender, race, ethnicity, disability, and other social identities – is required to improve measures designed to empower those facing structural barriers.

HPSR is a dynamic field focused on addressing systemic barriers, enhancing social justice, and leaving no one behind. Therefore, all measures that diversify the field and amplify under-represented voices, can help to enrich its scholarship with new perspectives, approaches, and methods.

The papers that form this supplement span a wide range of equity-oriented topics affecting health system performance and outcomes. Topics include health workforce support, intimate partner violence, health sector corruption, implementation factors in service delivery, universal health coverage, and more.  Countries represented include Kenya, Vietnam, Uganda, Ghana, Uganda, Ethiopia, Bangladesh, Nigeria, Brazil.

We invite you to engage with the findings across these papers:

  1. Editorial: Enhancing diversity in public health scholarship: the role of publication mentorship
  2. Supporting early-career mentorship for women in Health Policy and Systems Research: a vital input to building the field
  3. The magnitude of intimate partner violence during pregnancy in Eldoret, Kenya: exigency for policy action
  4. Intimate partner violence is associated with poorer maternal mental health and breastfeeding practices in Bangladesh
  5. Factors associated with the utilization of inactivated polio vaccine among children aged 12 to 23 months in Kalungu District, Uganda
  6. Perspectives and practices of healthcare providers and caregivers on healthcare-associated infections in the neonatal intensive care units of two hospitals in Ghana
  7. Predictors of nursing leadership in Uganda: a cross-sectional study
  8. Effectiveness of a nutrition education and counselling training package on antenatal care: a cluster randomized controlled trial in Addis Ababa
  9. Do social accountability approaches work? A review of the literature from selected low- and middle-income countries in the WHO South-East Asia region
  10. How ready is the system to deliver primary healthcare? Results of a primary health facility assessment in Enugu State, Nigeria
  11. Health reform and Indigenous health policy in Brazil: contexts, actors and discourses

Check out the podcast with two authors from this journal supplement here.

Welcome

Ian Timaeus

This is a work-related web site and therefore rather boring unless you are (perhaps even if you are) a demographer. It provides access to those of my publications that can be downloaded from the web (including several that are no longer readily available elsewhere). I have also linked up my CV to make it more meaningful. Other content may appear in due course.

Official London School of Hygiene & Tropical Medicine profile page

SUPPLEMENT LAUNCH! Innovations in Implementation Research in LMICs

By James Hargreaves (London School of Hygiene & Tropical Medicine), Sandra Mounier-Jack (London School of Hygiene & Tropical Medicine), Mishal Khan ((London School of Hygiene & Tropical Medicine) and Kabir Sheikh (Alliance for Health Policy and Systems Research)

The mainstreaming of implementation research within public health programmes around the world – properly resourced and capacitated – will be a necessary component of the Sustainable Development Goals (SDGs) vision to achieve a better future for all. The new supplement in Health Policy and Planning on “Innovations in Implementation Research in Low- and Middle-Income Countries” is a timely reminder of the growing importance of this diverse field of enquiry in realising global health gains.

This supplement showcases methodological innovations in 12 papers conducting implementation research across a range of critical public health domains in low- and middle-income countries. The papers cover diverse public health challenges, from expanding the electrification of rural primary health care facilities in Ghana and Uganda, to improving the quality of team-based primary health care in India, and identifying effective implementation strategies to improve newborn care in a systematic review.

A common thread runs through the papers in the series. Across a range of settings, we see authors tackling real-life problems by deploying critical, rigorous research methods and invoking contemporary theoretical frameworks. For example, in identifying what is needed to support the large-scale implementation of school-based mental health programmes in the Eastern Mediterranean region, policymakers, programmers and researchers co-developed a Theory of Change to identify critical pathways of change. Meanwhile, the techniques of Human Centred Design were used to develop a longitudinal process evaluation and illuminate what is needed to sustainably engage community health volunteers in Kenya. Full-country evaluation studies conducted by the Global Alliance for Vaccine and Immunisation (GAVI) in Bangladesh, Mozambique, Uganda and Zambia studied the processes, inputs, outputs, and outcomes of immunization programs.

Understanding contextual influences on the effective implementation of health policies and programmes is a critical component of implementation research. For example, one paper uses a policy analysis lens to highlight how gender issues and bias have influenced the implementation of universal health care policies in Kenya. Meanwhile, power dynamics and everyday politics strongly influenced the implementation of a flagship maternal health policy in India.

Perhaps the strongest theme of all relates to the growing experience with, and importance of, embedding implementation research as part of a learning agenda for programmes. Participatory action research approaches helped integrate communities into learning processes, thereby strengthening neglected tropical disease control in Nigeria and Liberia. An embedded approach helped support research uptake in projects in Latin America and the Caribbean. In Nigeria, researchers and programme implementers worked on research co-production to enable the adoption of findings from implementation research within adolescent sexual and reproductive health programmes.

For far too long there has been an artificial and unhelpful divide between “research on” and “implementation of” public health programmes. The implementation research agenda that is now taking shape seeks, where appropriate, to erode this distinction. Growing support for this agenda, reflected in the Commentaries that accompany this series, is encouraging. Implementation research must continue to be institutionalised with sustained funding, clear professional pathways and a commitment to research coupled “with” implementation from the outset.

Access the supplement papers in full below:


Check out the podcast with three authors from this journal supplement here.

COVID-19 Alumni Stories: Abraar Karan

Abraar Karan (Diploma in Tropical Medicine & Hygiene, 2019) works as an Internal Medicine and Global Health Physician within Brigham and Women’s Hospital and Harvard Medical School. Here, he discusses how life has changed since the COVID-19 pandemic and what his thoughts for the future are.

At the start of the COVID-19 outbreak, I worked as a medical fellow to the Massachusetts State Commissioner of Public Health. In this role, I was able to assist with a number of initiatives, including crisis standards of care, ventilator allocation, and remdesivir allocation, as well as writing health policy. I have continued working clinically seeing patients, a number of them with COVID-19.

“Currently, my days are mainly spent in the hospital seeing patients and reading COVID-19 literature, as well as helping to author a few different op-eds. Hopefully, I’ll soon be back to work at the public health department!

“The response in the US has been fragmented; unfortunately, many states have been left to respond without the level of national leadership I would have hoped for. Clinically, we were overwhelmed earlier in April and May during the peak in our city and state. But, things have certainly slowed down since then. I am concerned that we will see the same again this winter.

“The Diploma in Tropical Medicine & Hygiene at LSHTM covered outbreak response, with a focus on Ebola in the Democratic Republic of Congo, which at the time was the major global outbreak people were focused on. From this, I learned important skills in epidemiology, biostatistics, and ecology which has helped me during this pandemic.

I am optimistic that we will eventually drive COVID-19 transmission down and keep it there through a multitude of strategies — but we have a long way to go.”

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story, please click here to find out more.

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LSHTM’s COVID-19 Response work is available here.