Crise global da atenção primária à saúde / Global crisis in primary health care / Crisis global de la atención primaria

Enquanto no Norte Global se discute uma crise na Atenção Primária à Saúde, a maioria dos países nunca chegou a constituir sistemas de saúde baseados propriamente numa atenção primária robusta. Nesse cenário, o Brasil apresenta uma tendência mais favorável, com conquistas importantes para a atenção primária e a medicina de família e comunidade nos últimos dez anos. Restam desafios a serem superados para que o Sistema Único de Saúde alcance níveis satisfatórios de acesso a seus serviços, com profissionais adequadamente formados e valorizados pela população.

While the Global North is discussing a crisis in primary health care, the majority of countries have never managed to establish health systems based on robust primary care. Brazil presents a more favorable trend, with important achievements for primary care and family practice over the last ten years. There are still challenges to be overcome so that the Unified Health System achieves satisfactory levels of access to its services, with professionals who are properly trained and valued by the public.

Mientras que en el Norte Global se habla de una crisis de la atención primaria, la mayoría de los países nunca han creado realmente sistemas sanitarios basados en una atención primaria robusta. Brasil, muestra una tendencia más favorable, con importantes logros para la atención primaria y la medicina familiar y comunitaria en los últimos diez años. Aún quedan retos por superar para que el Sistema Único de Salud alcance niveles satisfactorios de acceso a sus servicios, con profesionales debidamente formados y valorados por la población.

Práticas Avançadas de Enfermagem ­ PAE / Advanced Nursing Practices ­ ANP

Trata de nota técnica sobre Práticas Avançadas de Enfermagem (PAE) no Brasil, elaborada por comissão e submetida à aprovação do plenário do Conselho Federal de Enfermagem (Cofen). O documento aborda conceitos, ações, implementação e regulação das práticas avançadas de Enfermagem, expandindo os limites do escopo da atuação do enfermeiro e reforçando a sua prática clínica. (AU)

This is a technical note on Advanced Nursing Practices (ANP) in Brazil, prepared by a committee and submitted for approval by the plenary of the Federal Nursing Council (Cofen). The document addresses concepts, actions, implementation and regulation of advanced nursing practices, expanding the limits of the scope of nurses' work and reinforcing their clinical practice. (AU)

Esta es una nota técnica sobre las Prácticas Avanzadas de Enfermería (PAE) en Brasil, elaborada por un comité y sometida a la aprobación del plenario del Consejo Federal de Enfermería (Cofen). El documento aborda los conceptos, acciones, implementación y reglamentación de las prácticas avanzadas de enfermería, ampliando los límites del ámbito de actuación de las enfermeras y reforzando su práctica clínica. (AU)

Expanding Global Surgery Education in Brazil: Perspectives after the 35th Brazilian Surgical Congress / Expandindo o Ensino de Cirurgia Global no Brasil: Perspectivas após o 35º Congresso Brasileiro de Cirurgia

ABSTRACT The 35th Brazilian Congress of Surgery marked a turning point for surgical education in the country. For the first time, the Brazilian College of Surgeons included Global Surgery on the main congressional agenda, providing a unique opportunity to rethink how surgical skills are taught from a public health perspective. This discussion prompts us to consider why and how Global Surgery education should be expanded in Brazil. Although Brazilian researchers and institutions have contributed to the fields expansion since 2015, Global Surgery education initiatives are still incipient in our country. Relying on successful strategies can be a starting point to promote the area among national surgical practitioners. In this editorial, we discuss potential strategies to expand Global Surgery education opportunities and propose a series of recommendations at the national level.

RESUMO O 35º Congresso Brasileiro de Cirurgia foi marcado por discussões inovadoras para a educação cirúrgica no país. Pela primeira vez, o Colégio Brasileiro de Cirurgiões incluiu a Cirurgia Global na pauta principal do congresso, proporcionando uma oportunidade única de repensar como as habilidades cirúrgicas são ensinadas a partir de uma perspectiva de saúde pública. Essa discussão nos leva a considerar por que e como o ensino da Cirurgia Global deve ser expandido no Brasil. Embora pesquisadores e instituições brasileiras tenham contribuído para a expansão do campo desde 2015, as iniciativas de educação em Cirurgia Global ainda são incipientes em nosso país. Basear-se em estratégias bem-sucedidas pode ser um ponto de partida para promover a área entre os profissionais de cirurgia nacionais. Neste editorial, discutimos potenciais estratégias para expandir as oportunidades de educação em Cirurgia Global e propomos uma série de recomendações a nível nacional.

Vacina contra zika: desenvolvimento, agenciamentos e controvérsias sociotécnicas / Zika vaccine: development, assemblages, and sociotechnical controversies

Resumo O ensaio teórico discute as controvérsias sobre o desenvolvimento da vacina contra a zika, evidenciando as negociações que envolvem as escolhas técnico-científicas e os efeitos da definição do "perfil do produto alvo da vacina" (TPP) para uso somente no cenário emergencial. São propostas três perspectivas de análise em diálogo com os Estudos Sociais da Ciência: os fluxos de estabelecimento de normativas pela Organização Mundial da Saúde (OMS), as narrativas publicadas em revistas especializadas e de um grupo de entrevistados. Concluímos que os termos de definição do TPP ajudaram a constituir a política ontológica da OMS, implicando: exposição, responsabilização e culpabilização de mulheres pela prevenção da síndrome congênita da zika; instituição de certas estratégias de vacinação; invisibilização de outros cenários possíveis; maior espaço de aceitação de determinadas plataformas; ampliação das desigualdades globais. Tal política ontológica engendrou uma potente racionalidade emergencial que distinguiu a vacina da necessidade social da vacinação, empurrando a última para a invisibilidade.

Abstract The theoretical essay discusses the controversies about the zika vaccine development, highlighting negotiations which involve technical-scientific choices and the effects of defining the Vaccine Target Product Profile (TPP) for use only in the emergency scenario. Three perspectives of analysis are presented aligned with the Social Studies of Science: the flows of normative establishment provided by the World Health Organization (WHO), the narratives published in specialized journals and the discuss of a group of interviewees. We conclude that the definition terms of TPP supported the establishment of the WHO ontological policy, implying in exposure, accountability and culpability of women for the prevention of Congenital Zika Syndrome; definition of certain vaccination strategies; making other possible scenarios invisible; greater acceptance of certain platforms; widening global inequalities. Such an ontological policy engendered a potent emergency rationality that distinguished the vaccine from the social need for vaccination, pushing the second one towards invisibility.

Health profile and training habits of 42k marathoners, temuco chile / Perfil de salud y hábitos de entrenamiento de maratonistas 42k, temuco chile / Perfil de saúde e hábitos de treinamento de maratonistas de 42k, temuco chile

ABSTRACT Context: participation of runners in marathons increases each year, making them an attractive population to investigate. In Chile, the characteristics of marathoners in decentralized and emerging races, such as the Temuco Araucanía International Marathon (MITA), are not yet known. Objective: to describe health profile, sociodemographic characteristics, and training habits of the 42K runners enrolled in MITA during the years 2017, 2018 and 2019. Methods: Non-probabilistic convenience sample composed of people over 18 years of age, who signed informed consent. The data were obtained through a survey prepared by the authors, and were analyzed with the statistical program Stata 16.0 to describe the group based on the variables of health profile, sociodemographic characteristics and training habits. Results: 135 adult marathoners were included (n=42-2017, n=45-2018, n=48-2019). The mean age was 39.5±9.1 years and 86.6% were men. Fifteen percent self-reported comorbidities, 96.7% were non-smokers, 80% were normal weight, 65% had a high educational level and 87% were workers. Regarding training habits, it is noteworthy that the frequency was 4.9±1 days per week, with a mean duration of 89±1 minutes per session. Finally, 71.9% of the sample reported doing high intensity training. Conclusions: the MITA 42K runners are generally healthy subjects, nonsmokers and without comorbidities; mostly men, normal weight, middle age, with a high educational level and workers. They present a high frequency of weekly training, with an average duration of 90 minutes per session, this being carried out at high intensity by almost 2/3 of the sample. Knowledge of the health profile and training habits of runners is a first step to responsibly generate guidelines that contribute to strengthening the safe practice of this sport. Level of Evidence IV; Descriptive and Cross-Sectional Study.

RESUMEN Introducción: la participación de corredores en maratones aumenta cada año, convirtiéndolos en una población atractiva de investigar. En Chile, aún no se conocen las características de maratonistas de carreras descentralizadas y emergentes, como la Maratón Internacional Temuco Araucanía (MITA). Objetivo: describir el perfil de salud, las características sociodemográficas y los hábitos de entrenamiento de los corredores de 42K, inscriptos en MITA durante los años 2017, 2018 y 2019. Métodos: Muestra no probabilística por conveniencia mayores de 18 años, que firmaron el término de consentimiento informado. Los datos fueron obtenidos a través de la aplicación de una encuesta de elaboración original, analizados con programa estadístico Stata 16.0 para describir al grupo en función de las variables perfil de salud, sociodemográficas y hábitos de entrenamiento. Resultados: Se incluyeron 135 adultos maratonistas (n=42-2017, n=45-2018, n= 48-2019) La edad promedio fue de 39,5±9,1 años y 86,6% fueron hombres. El 15% auto reportó comorbilidades, 96,7% eran no fumadores; 80% eran normopeso, con un 65% de participantes con nivel educacional alto y 87% trabajadores. En cuanto a los hábitos de entrenamiento, se destaca que la frecuencia es de 4,9±1 días por semana, con una duración media de 89±1 minutos por sesión y finalmente, el 71,9% de la muestra reporta realizar entrenamiento de alta intensidad. Conclusiones: los corredores 42K del MITA son en general sujetos sanos, no fumadores y sin comorbilidades; en su mayoría hombres, normopeso, de edad media, con un nivel educacional alto y trabajadores. Presentan una alta frecuencia de entrenamiento semanal, con una duración promedio de 1:30 minutos por sesión, siendo realizada a alta intensidad casi 2/3 de la muestra. El conocimiento del perfil de salud y hábitos de entrenamiento de los corredores, constituye un primer paso para generar, de forma responsable, lineamientos que contribuyan a fortalecer la práctica segura de este deporte. Nivel de Evidencia IV; Estudio Descriptivo y Transversal.

RESUMO Introdução: a participação de corredores em maratonas aumenta a cada ano, tornando-os uma população atrativa para investigação. No Chile, ainda não são conhecidas as características dos maratonistas em corridas descentralizadas e emergentes, como a Maratona Internacional Temuco Araucanía (MITA). Objetivo: descrever o perfil de saúde, características sociodemográficas e hábitos de treinamento dos corredores de 42K inscritos no MITA durante os anos de 2017, 2018 e 2019. Métodos: Amostra não probabilística de conveniência composta por pessoas maiores de 18 anos, que assinaram o termo de consentimento livre e esclarecido. Os dados foram obtidos por meio de um questionário elaborado pelos autores e foram analisados com o programa estatístico Stata 16.0 para descrever o grupo com base nas variáveis de perfil de saúde, características sociodemográficas e hábitos de treinamento. Resultados: foram incluídos 135 maratonistas adultos (n=42-2017, n=45-2018, n=48-2019). A média de idade foi de 39,5±9,1 anos e 86,6% eram homens. Comorbidades autorreferidas 15%, 96,7% não fumantes, 80% eutróficos, 65% com alta escolaridade e 87% trabalhadores. Em relação aos hábitos de treino, destaca-se que a frequência foi de 4,9±1 dias por semana, com duração média de 89±1 minutos por sessão. Por fim, 71,9% da amostra relatou fazer treinamento de alta intensidade. Conclusões: os corredores do MITA 42K são indivíduos geralmente saudáveis, não fumantes e sem comorbidades; em sua maioria homens, eutróficos, de meia idade, com alto nível educacional e trabalhadores. Apresentam uma elevada frequência de treino semanal, com duração média de 90 minutos por sessão, sendo este realizado em alta intensidade por quase 2/3 da amostra. O conhecimento do perfil de saúde e hábitos de treino dos corredores é um primeiro passo para gerar com responsabilidade orientações que contribuam para o fortalecimento da prática segura deste esporte. Nível de Evidência IV; Estudo Descritivo e Transversal.

Interconexão entre saúde planetária e resposta ao HIV/aids: uma reflexão sob a ótica do pensamento complexo / Interconnection between planetary health and HIV/AIDS response: a reflection from the perspective of complex thinking

OBJETIVO: Refletir sobre os pontos de interconexão entre saúde planetária e a resposta do mundo ao HIV/aids sob a ótica do pensamento complexo. MÉTODO: Trata-se de ensaio teórico do tipo reflexivo, ancorado no pensamento complexo proposto por Morin e na literatura atual e pertinente sobre saúde planetária e HIV/aids. RESULTADOS: Considerando que os Objetivos do Desenvolvimento Sustentável se interconectam com as atuais discussões sobre a saúde planetária, a reflexão foi tecida a partir dos cinco Ps (isto é, pessoas, planeta, prosperidade, paz e parcerias), os quais tem refletido na resposta do HIV/aids entre as diferentes nações. CONCLUSÃO: As reflexões incitam alguns pontos importantes que envolvem a saúde planetária e o acesso e a adesão ao tratamento, com a finalidade de controlar e erradicar o HIV/aids até 2030. O cuidar da saúde planetária representará o cuidado com todos os seres humanos, em especial aqueles com maior vulnerabilidade, como pessoas vivendo com HIV/aids.

OBJECTIVE: To reflect on the connections between planetary health and the world's response to HIV/AIDS from the perspective of complex thinking. METHOD: This is a theoretical reflective essay anchored in the complex thinking proposed by Morin and in the current and relevant literature on planetary health and HIV/AIDS. RESULTS: Recognizing that the Sustainable Development Goals are linked to current discussions on planetary health, the reflection was woven around the five Ps (i.e., people, planet, prosperity, peace, and partnerships) that are reflected in the response of different nations to HIV/AIDS. CONCLUSION: The reflections raise some important points related to planetary health and access to and treatment adherence, intending to control and eliminate HIV/AIDS by 2030. Caring for planetary health will mean caring for all people, especially those with greater vulnerability, such as people living with HIV/AIDS.

De la bioética de protección a la medicina basada en la evidencia desde una perspectiva transdisciplinar

En el contexto de la bioética se debate con frecuencia el hecho de que, con el desarrollo de la ciencia y la técnica, de las tecnologías de la información y las comunicaciones, y los cambios relacionados con el ecosistema, se hace necesario garantizar el respeto de la vulnerabilidad humana y la integridad personal al aplicar y fomentar el conocimiento científico, la práctica médica y las tecnologías vinculadas (artículo 8 de la Declaración Universal sobre Bioética y Derechos Humanos). Esta vulnerabilidad se protege a través del respeto con equidad y justicia, de los derechos básicos de cada ser humano y al garantizar la integridad personal; esta es la esencia de la bioética de protección y constituye, también, la base principal de la medicina basada en la evidencia, caracterizada por el uso consciente, explícito y juicioso de la evidencia clínica en la práctica diaria para el cuidado del paciente, en aras de ofrecer la mejor atención. Existe una necesidad inmediata de proporcionar beneficios sostenibles a las personas vulnerables en situaciones de enfermedad, por ello es vital mantener un enfoque en la salud pública cubana desde la perspectiva de la bioética de protección y la transdisciplinariedad, sustentada en una medicina basada en la evidencia, en las 3 esferas, en el proceso asistencial, en el proceso pedagógico y en el investigativo; como máximo exponente de la salud global, que tiene como esencia una visión transdisciplinaria, ya que aborda la salud desde la perspectiva del derecho universal a esta y al bienestar social.

In the context of bioethics, the fact that with the development of science and technology, of information and communication technologies, and the changes related to the ecosystem, it is necessary to guarantee respect for vulnerability and personal integrity when applying and promoting scientific knowledge, medical practice and related technologies (article 8 of the Universal Declaration on Bioethics and Human Rights). This vulnerability is protected through respect, with equity and justice, for the basic rights of every human being and by guaranteeing personal integrity; this is the essence of protection bioethics and also constitutes the main basis of evidence-based medicine, characterized by the conscious, explicit and judicious use of clinical evidence in daily practice for patient care, for the sake of to offer the best care. There is an immediate need to provide sustainable benefits to vulnerable people in disease situations, for this reason it is vital to maintain a focus on Cuban public health from the perspective of protective bioethics and transdisciplinarity, supported by evident-based medicine, in the 3 spheres, in the care process, in the pedagogical process and in the investigative process; as the greatest exponent of Global Health, whose essence is a transdisciplinary vision, since it addresses health from the perspective of the universal right to it and to social well-being.

Cursos en línea abiertos y masivos: oportunidad de aprendizaje sobre salud global en Latinoamérica / Massive open online courses: learning opportunities about global health for Latin American countries

Introducción. Los cursos en línea, masivos y abiertos, brindan la oportunidad de formar profesionales e investigadores en Latinoamérica sobre salud global. Objetivos. Determinar la oferta global de los cursos en línea, masivos y abiertos, sobre salud global y conocer las características de su contenido. Materiales y métodos. Se examinaron las plataformas especializadas en cursos en línea, masivos y abiertos, para recopilar aquellos sobre salud global. La búsqueda no tuvo restricción de tiempo y se realizó por última vez en noviembre de 2021. La estrategia de búsqueda solo incluyó el descriptor "global health". Posteriormente, se obtuvieron las características del curso, su contenido y el dominio abordado de salud global. Estos datos fueron analizados descriptivamente, y se reportaron frecuencias absolutas y relativas. Resultados. La estrategia de búsqueda identificó 4.724 cursos en línea, masivos y abiertos. De ellos, solo 92 estaban relacionados con salud global. La mayoría de estos cursos (n=44; 47,8 %) se ofrecieron mediante la plataforma Coursera. Más de la mitad de los cursos (n=50; 54,4 %) fueron realizados por instituciones de Estados Unidos y en idioma inglés (n=90; 97,8 %). La mayor parte de los cursos se centró en la "globalización de la salud y la asistencia sanitaria" (n=24; 26,1 %), seguido de los dominios "fortalecimiento de capacidades" (n=16; 17,4 %), "carga global de enfermedad" y "determinantes sociales y ambientales de la salud" (n=15; 16,3 %). Conclusiones. Se encontró una importante oferta de cursos en línea, masivos y abiertos, sobre salud global. Estos cursos abordaron las competencias de la salud global que se requieren para los profesionales sanitarios.

Introduction. Massive open online courses provide the opportunity to train health professionals and researchers from Latin America in global health. Objective. To determine the global offer of massive open online courses in global health and the characteristics of their content. Material and methods. We examined massive open online course platforms to compile the global health offerings. The search had no time restriction and was last conducted in November, 2021. The search strategy only included the descriptor "global health". We obtained the characteristics of the courses, their content, and the global health domain covered. These data were analyzed using descriptive statistics, reporting absolute and relative frequencies. Results. Our search strategy identified 4,724 massive open online courses. Of these, only 92 were related to global health. Most of these courses (n=44; 47.8%) were offered through Coursera. More than half (n=50; 54.4%) of the MOOCs were conducted by U.S.A. institutions and in English language (n=90; 97.8%). Most courses focused on "globalization of health and healthcare" (n=24; 26.1%), followed by the domains "capacity building" (n=16; 17.4%), "global burden of disease" and "social and environmental determinants of health" (n=15; 16.3%). Conclusions. We found a high offer of massive open online courses on global health. These courses covered the global health competencies required for health professionals.

The “Dravidian model”: egalitarianism and healthcare reform

Throughout the post-independence period, the state of Tamil Nadu has consistently performed better than most other states in several major healthcare indicators, including infant mortality rate and total fertility rate. At the same time, it has received praise for the deep penetration and robust functioning of its public health system. Tamil Nadu’s achievements in healthcare have been analysed in a number of scholarly studies in the past, and a recent book by Kalaiyarasan A and Vijayabaskar M, titled “The Dravidian Model: Interpreting the Political Economy of Tamil Nadu,” is the latest addition to this literature. The authors argue that the state’s uniqueness in human and social development primarily originates in the egalitarian politics and radical social movements of the early twentieth century which constituted a “Dravidian common-sense” that has since “shaped the development trajectory of the state.” Their arguments on the significance of egalitarian politics in improvements in health and wellbeing receive ample support from existing social sciences literature on health, equity, and justice.

Role of Nurse Leadership to Evaluate the Current Status of Nurses with a View to Invest in Nursing to Secure Global Health An Exploratory Approach

There is an opportunity for nurses to better explain what we do, to break the myths around nursing and to advocate for investment in the profession. This study endeavoured to explore the role of nurse leadership to invest in nursing to secure global health and to identify role of nurse leaders according to their demographic variables. An exploratory sequential mixed method re- search design was selected in this study. Through purposeful sampling, the researcher selected 60 nurse administrators. Data was collected from the nurse administrators in the form of an electronic survey and virtual face-to- face semi structured interview method after obtaining a formal permission. The data collected from them was utilised only for the purpose of the study and was kept confidential. The final analysis summarised the findings that emerged from both quantitative and qualitative data. In the present study there were 50 (83.3%) females and 10 males (16.7 %) and them had nurse administrators 52(86.6%) of experience. The results covered the issues like current status of nurses, ways and benefits to invest in nursing for global health and the role of nurse leaders in investing in nursing for global Health. Nurses are the head honchos and lifeline of health-care organisations but still lack recognition. Concern on this has been expressed by many, but till date no strong visible implementation of laws and policies are seen. Nurses need to take initiation and leadership at higher levels to bring change in the existing scenario and implement the recommendations regarding basic pay and maximum working hours per week..

Restricted participation: Drivers, experiences and implications of disability stigma in Ethiopia

Background: Community-based inclusive development (CBID) acknowledges society's critical role in supporting the active participation of persons with disabilities. However, research on how this approach relates to the context-sensitive socially situated barriers of disability stigma is underexplored. Objectives: This study aimed to understand the drivers and experiences of disability stigma in Ethiopia, from the perspective of persons with disabilities engaged in CBID programmes, and to establish how disability stigma acts as a barrier to participation. Methods: An inductive methodological approach guided the research design. Mixed methods were used including a narrative review of disabilities studies literature, 16 semi-structured interviews with persons with disabilities, and a quantitative survey of 970 persons with disabilities across three communities in Ethiopia. Results: Informed by theories of epistemic justice, this study identified specific indicators of meaningful participation and examined how these relate to experiences of disability stigma. The study found that the participation of adults with disabilities in society is restricted across different areas of life. Misconceptions about the causes of disability and social perceptions regarding the capacities of persons with disabilities are found to exacerbate stigma and act as a barrier to participation. Conclusion: Targeted efforts to challenge internalised norms and harmful beliefs within CBID approaches are required to address disadvantages arising from embedded disability stigma. Contribution: This study makes conceptual, empirical and practical contributions that advance insights into the relationship between disability stigma and participation in Ethiopia and the dimensions of epistemic justice relevant to understanding the nature and drivers of disability stigma.

Design and application of the global health talent competency index system / 中华医院管理杂志

Objective:To establish a global health talent competency index system in China as a scientific basis for improving the global health talent team construction.Methods:Such keywords as global health, competence, global competence and public health talent competence, were used to search for literature published from 2012 to 2022 in the China National Knowledge Infrastructure database. Through literature research and job responsibility analysis and the competency iceberg theory model, the authors established the initial Index set. In October 2022, the expert consultation method was used to identify indexes, with their weight evaluated. Based on the results of expert consultation, a survey questionnaire was developed to evaluate the importance of global health talent competency indexes. A questionnaire survey was conducted in November 2022 through random convenient sampling to select relevant personnel from domestic medical institutions, universities, and pharmaceutical enterprises, and exploratory factor analysis and regression analysis on questionnaire data were made to explore the internal structure, weights and quantitative relationships between indexes of the index system.Results:The global health talent competency index system consisted of 8 level-1 indexes and 28 level-2 indexes. The 8 level-1 indexes were professional accumulation, foreign language communication, international exchange, self-management and growth, influence, achievement drive, globalization literacy, and professionalism. The weights of the level-1 indexes were 0.110, 0.104, 0.153, 0.121, 0.106, 0.171, 0.139, and 0.096, respectively. Knowledge and skill related competencies included professional accumulation and foreign language communication; Behavioral competencies included international communication, self-management and growth, and influence; Personality traits and competencies included internal drive by achievements, global literacy, and professionalism. The regression analysis results showed that all the level-2 indexes, except for creativity, team collaboration, and independent thinking, had a significant predictive effect on their level-1 indexes ( P<0.01). Conclusions:The global health talent competency index system established in this study proves scientific, and practical for the selection, training, and evaluation of global health talents.

The role of the Global Fund to Fight AIDS, Tuberculosis and Malaria in the development of global health and its collaboration with China / 中国血吸虫病防治杂志

The Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund) has become an increasingly active and influential organization in global health during the past two decades. It is now playing an increasingly important role in the prevention and control of major infectious diseases, international financing for health, public procurement market development across the world. The article outlines the basic architecture of the Global Fund, including its overall information, financing mechanism, operational models and key experiences accumulated. Based on previous cooperation, the article analyzes the importance of the long-term partnership between China and the Global Fund, and proposes policy suggestions to achieve more win-win outcomes in the near future.

Research on Issues Preventing Japanese Global Health Personnel from Working at International Organizations / 国際保健医療

Objective  There is a growing need to develop human resources with diverse experience, expertise, and a global perspective who can contribute to global rule-making in health. One of the government’s goals is to increase the number of Japanese personnel working for international organizations, but it has not reached the desired level. This study identified the barriers that medical and non-medical professionals have when applying for or working at international organizations, as well as the support measures they expect from the government, to highlight issues and examine employment support measures.Methods  A qualitative and descriptive research was conducted based on semi-structured interviews with 20 physicians, nursing professionals, graduates of public health graduate schools, non-medical professionals, students, etc., who were (1) seeking employment with international organizations, (2) currently employed, and (3) previously employed but left.Results  The following seven themes were highlighted as barriers to applying for or working at an international organization: 〈issues specific to Japanese society and people〉, 〈concerns about a career in global health〉, 〈discrepancy between a career as a healthcare professional and a career in global health〉, 〈need to strengthen skills〉, 〈preparation for competitive examinations〉, 〈importance of WLB〉, 〈issues inherent in international organizations〉. Conclusion  Possible support measures include individual career counseling, seminars on how to survive in international organizations, and seminars for female applicants of child-rearing age, based on the knowledge and experience of current/former employees of international organizations. As for the issues that hinder the dispatch of medical personnel overseas, the first step would be to compare and verify the positive effects that strengthening the overseas dispatch would have on their skills, the workplace environment, and the acceptance of foreign patients. The development and introduction of systems, such as sabbatical and long-term leave, and reinstatement of employment is especially required of global companies and international hospitals.

On the brink: The climate and nature crisis and risks of nuclear war

@#The Russian military invasion of Ukraine on February 24, 2022, and Hamas’ terror attack on Israel on October 7, 2023, signaled the beginning of two of the most recent wars to make international headlines. To date, over 110 armed conflicts are taking place: over 45 in the Middle East and North Africa (Cyprus, Egypt, Iraq, Israel, Libya, Morocco, Palestine, Syria, Turkey, Yemen, Western Sahara); over 35 in Africa (Burkina Faso, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Ethiopia, Mali, Mozambique, Nigeria, Senegal, Somalia, South Sudan, Sudan); 21 in Asia (Afghanistan, India, Myanmar, Pakistan, the Philippines); seven in Europe (Russia, Ukraine, Moldova, Georgia, Armenia, Azerbaijan); and six in Latin America (three each in Mexico and Colombia); with two more international armed conflicts (between India and Pakistan, and between India and China) in Asia.1 This list does not even include such problematic situations as those involving China and the South East Asia region. As though these situations of armed violence were not enough, mankind has already passed or is on the verge of passing several climate tipping points – a recent review lists nine Global core tipping elements (and their tipping points) - the Greenland Ice Sheet (collapse); West Antarctic Ice Sheet (collapse); Labrador-Irminger Seas / SPG Convection (collapse); East Antarctic Subglacial Basins (collapse); Amazon Rainforest (dieback); Boreal Permafrost (collapse); Atlantic M.O. Circulation (collapse); Arctic Winter Sea Ice (collapse); and East Antarctic Ice Sheet (collapse); and seven Regional impact tipping elements (and their tipping points) – Low-latitude Coral Reefs (die-off); Boreal Permafrost (abrupt thaw); Barents Sea Ice (abrupt loss); Mountain Glaciers (loss); Sahel and W. African Monsoon (greening); Boreal Forest (southern dieback); and Boreal Forest (northern expansion).2 Closer to home, how can we forget the disaster and devastation wrought by Super Typhoon Haiyan (Yolanda) 10 years ago to date? Whether international or non-international, armed conflicts raise the risk of nuclear war. Russia has already “rehearsed its ability to deliver a ‘massive’ nuclear strike,” conducting “practical launches of ballistic and cruise missiles,” and stationed a first batch of tactical nuclear weapons in Belarus,3 and the possibility of nuclear escalation in Ukraine cannot be overestimated.4 Meanwhile, in a rare public announcement, the U.S. Central Command revealed that an Ohio- class submarine (560 feet long, 18,750 tons submerged and carrying as many as 154 Tomahawk cruise missiles) had arrived in the Middle East on November 5, 2023.5 Indeed, “the danger is great and growing,” as “any use of nuclear weapons would be catastrophic for humanity.”

Report of Online Conference on Measures against Coronavirus in Japan Organized by President of Subcommittee on Novel Coronavirus Disease Control and Medical Students / 国際保健医療

  An online lifestyle has become typical with the COVID-19 pandemic. Although the number of infected patients in Japan has decreased significantly from its peak, concern remains about the seasonality of the infection and the possibility of variant strains. In this context, 10 medical students and Dr. Shigeru Omi, Chairman of the Subcommittee on Countermeasures against Novel Coronavirus Infections, held an online panel discussion on November 6, 2021.  First, the frailty of Japan’s testing system compared to other countries was highlighted. Although weekly testing for all citizens would be ideal, implementing efficient countermeasures with limited resources was emphasized.  Second, concern exists about other diseases because people are refraining from receiving necessary medical examinations for fear of being infected with COVID-19. Strengthening mass approaches using the media and personal approaches by health care professionals is essential.  Third, much false information exists on social networking sites and is being spread. The importance of suitable individual risk communication was suggested.  Finally, medical students mentioned the loss of experience due to restrictions on school attendance and club activities. Although medical students are treated differently in each country, increasing opportunities to discuss the purpose of medical education and whether online alternatives are possible were highlighted.  This was the first opportunity for a direct discussion between medical students, who have been greatly affected by COVID-19, and Dr. Omi, a policymaker. We hope that more such discussions will be possible, and that people’s opinions will be considered toward a better environment.

A proposal on Kuroko leadership: An element of Japan’s global health competency extracted from the experiences of international health cooperation / 国際保健医療

  In the increasingly globalized world, developing global health competency (GHC) education by determining the required core elements for undergraduates is on the rise. A growing number of people from different backgrounds have migrated to Japan. To accommodate their various healthcare needs, potential GHC elements that facilitate Japanese GHC education should be identified. This paper aims to extract some of the key GHC elements required for students in medical and healthcare fields based on the abundant experience of Japan’s international health cooperation and to make recommendations for GHC education in Japan and worldwide.  To date, Japan’s international health cooperation has cultivated a variety of competencies to realize its mission of reducing global health disparities. Japanese GHC elements are the bases of core concepts in healthcare and share commonalities with GHC elements in global communities: Cultural competency, “Go to the People”, respect for diversity, transdisciplinary collaboration, capacity building, independence, people/patient-centered healthcare, and empowerment.   Comprehensive preparation of these elements is found among kabuki kurokos (black robes), people dressed in all black who assist kabuki actors onstage during performances. The black worn by the kurokos means “nothingness”; they should be invisible on stage, so as not to interfere with the performance. Kurokos understand the culture (values, behaviors, etc.) of the lead actors, manage and coordinate stage proceedings to meet the actors’ needs, and help them achieve the best performance by collaborating with other backstage workers.   Kurokos’s empowering leadership competency is akin to the Western concept of servant-leadership, which emphasizes being a servant first and devoting oneself to enabling greater health and independence/autonomy among vulnerable people. Japanese educators can exemplify kuroko values by providing their students with GHC education. Japanese GHC elements can be integrated into worldwide GHC education. Spiritual care is also essential for inclusion in GHC education to develop students’ holistic care competency.

Health risks of overweight and obesity among children / Монголын Анагаах Ухаан

@#Childhood obesity is, according to the WHO, one of the most serious challenges of the 21st century. More than 100 million children have obesity today. Globally, the prevalence of obesity and overweight tripled in the child and youth populations from the mid-1970s (about 4%) to 2016 (greater than 18%). In 2016, more than 330 million children and adolescents were affected by overweight or obesity globally. It is estimated that by 2030 nearly 30% of all children will be affected by overweight or obesity. For this reason, childhood obesity is a major public health problem worldwide. </br>This study summarizes and reviewed research findings related to childhood obesity and health risks. Overweight and obesity are defined as an abnormal or excessive accumulation of fat that can harm health. Obesity has a multifactorial origin that involves both genetic and environmental factors. Several studies showed that excess body fat increased the risk of multiple comorbidities, such as high blood pressure, coronary heart disease, type 2 diabetes, insulin resistance, and cancer. According to the results of the research, the mother's nutritional status and obesogenic environments have a great influence on childhood obesity. A summary of the results of many studies concluded that childhood obesity is more likely to develop non-communicable diseases in adulthood. The global prevalence of overweight in children aged 5 years or under has increased modestly, but with heterogeneous trends in low and middle-income regions, while the prevalence of obesity in children aged 2–4 years has increased moderately. Overweight or obesity during childhood has important short-term and long-term consequences.@*Conclusion@#In recent decades, the prevalence of obesity in children has increased dramatically. For the successful implementation of activities to prevent overweight and obesity in children, it is necessary to create a supportive environment and to promote health.

Acesso equitativo a vacinas: lições aprendidas e perspectivas futuras / Equal access to vaccines: lessons learned and future perspectives

Resumo A vacinação é um componente essencial da atenção primária à saúde e do enfrentamento de emergências em saúde. No entanto, apesar do progresso ocorrido nas últimas décadas, persistem importantes barreiras que resultam na queda de coberturas e disparidades entre os países no acesso a novas vacinas. Neste cenário, a Organização Mundial da Saúde (OMS) lançou, em 2020, a Agenda de Imunização para o decênio 2021-2030 (AI2030). Este artigo tem o objetivo de debater os principais fatores que afetam o acesso às vacinas e as estratégias para promoção da equidade no acesso a elas a nível global e nacional. Tais fatores são multisetoriais e precisam ser considerados em ambos os níveis, destacando-se as barreiras financeiras e geográficas, os desafios de infraestrutura, fatores socioeconômicos e culturais, políticas públicas e governança. O texto aponta a necessidade de remodelação da arquitetura global das cadeias produtivas e dos centros de pesquisa e inovação, criando e/ou fortalecendo as existentes em países de baixa e média renda. Além disso, é necessário estabelecer novos mecanismos e modelos de produção e comercialização de vacinas. As estratégias adotadas para acesso a vacinas e outras tecnologias em saúde estão no centro do debate da agenda de saúde global.

Abstract Vaccination is an essential component of primary health care and coping with health emergencies. However, despite the progress from the last decades, important barriers persist resulting in lower access and disparities between the countries in the access to new vaccines. In this scenario, the World Health Organization (WHO) launched, in 2020, the Immunization Agenda for the 2021-2030 decade (AI2030). This article aims to discuss the main factors that affect access to vaccines and strategies to promote equity in access to them at global and national levels. These factors are multi-sectoral and need to be considered in both levels, with emphasis on financial and geographic barriers, infrastructure challenges, socioeconomic and cultural factors, public policies, and governance. The text points the need to remodel the global architecture of production chains and research and innovation centers, creating and/or strengthening existing ones in low- and middle-income countries. In addition, establishing new mechanisms and models for the production and commercialization of vaccines is necessary. The strategies adopted for accessing vaccines and other health technologies are at the center of the global health agenda debate.