Master of Public Health Concentrations in Global Health in 2020: Preparing Culturally Competent Professionals to Address Health Disparities in the Context of Globalization.

During the 2019-2020 academic year, 37 (17%) of 223 Council on Education for Public Health (CEPH) accredited or applicant schools and programs of public health offered Master of Public Health (MPH) degrees with concentrations in general global health. Concentration-specific competencies build on the foundational competencies required for all MPH students enrolled in CEPH-accredited programs. The most popular global health competencies focus on agencies and organizations, ethics and human rights, program management, social and environmental determinants of health, the global burden of disease, collaboration and partnerships, and cultural competency. There is significant overlap between the current concentration competencies and the ones recommended by the Association of Schools and Programs of Public Health in 2018. The online program descriptions for MPH concentrations in global health feature four key themes: globalization, low-income countries, social justice and equity, and culture and diversity. (1) Most programs emphasize transnational health issues and the effects of globalization on health in countries of all income levels. (2) Some programs have a special focus on preparation for serving low-income countries and other disadvantaged populations, such as refugees. (3) Most programs emphasize the social justice and equity issues underlying local and global health disparities. (4) Most programs promote development of the cultural knowledge, awareness, and skills required for serving diverse populations effectively as rising leaders in the international, national, or local public health workforce. Global health MPH programs prepare students for public health practice in resource-limited settings in their home communities as well as internationally.

Climate Change as an Involuntary Exposure: A Comparative Risk Perception Study from Six Countries across the Global Development Gradient.

Climate change has been referred to as an involuntary exposure, meaning people do not voluntarily put themselves at risk for climate-related ill health or reduced standard of living. The purpose of this study is to examine people's risk perceptions and related beliefs regarding (1) the likelihood of different risks occurring at different times and places and (2) collective (government) responsibility and personal efficacy in dealing with climate change, as well as (3) explore the ways in which climate risk may be amplified when posed against individual health and well-being. Previous research on this topic has largely focused on one community or one nation state, and so a unique characteristic of this study is the comparison between six different city (country) sites by their development and national wealth. Here, we collected 401 surveys from Phoenix (USA), Brisbane (Australia), Wellington (New Zealand), Shanghai (China), Viti Levu (Fiji), and Mexico City (Mexico). Results suggest that the hyperopia effect characterized the sample from each study site but was more pronounced in developed sites, suggesting that the more developed sites employ a broader perspective when approaching ways to mitigate their risk against climate-related health and well-being impacts.

Global convergence in ethnotheories of water and disease.

Using interviews conducted with 468 adults in nine different global locations, we tested for commonalities in how people culturally understand water-disease connections. On the basis of consensus analysis, we find evidence of shared cultural ideas about the causes and solutions to waterborne disease both within and across all locations. Causes of water-related illness with the highest salience in the different countries were comparable across sites, and mapped reasonably onto public health understandings. Comparison of specific items (statements) between public health and lay knowledge about the causes and solutions to waterborne disease showed a high level of agreement. We suggest that a straightforward, cohesive approach to water-health messaging in public health campaigns could often be the most effective point of departure, and that sophisticated cultural tailoring may be less important in regard to global waterborne disease prevention efforts than might be expected.

Food deserts and nutritional risk in Paraguay.

OBJECTIVES: The purpose of this case study in San Lorenzo, Paraguay is to identify a food desert in a developing context and to test if food deserts shape residential obesity risk. This article reviews some of the debate surrounding whether food deserts really exist; and, if so, what are the dietary implications of living in a food desert. METHODS: The research is an exploratory/explanatory design. The author mapped the downtown food retail district and the neighborhood food environment to identify what stores/markets. The author assessed each type of food store using an adapted version of the Nutrition Environment Measure Survey for Stores (NEMS-S) for Paraguay. Body mass index and household characteristics were collected with 68 households in a small neighborhood; and, the author matched the NEMS-S scores to the store reported by households as their primary grocery store for regression tests. RESULTS: The results suggest that a tradeoff exists in the local food environment between food stores which negatively impact obesity risk for local residents. Exposure to this tradeoff appears to worsen as people live longer in the food desert. Thus, the results support the location of a food desert finding in Paraguay. CONCLUSIONS: The underlying factors of a food desert extend beyond food access to focus on the issues of justice. A way to improve upon future research to build scholarship on the relationship between deprivation and obesity requires that sample sizes are either large or representative of the population and that the research should be based on multiple neighborhood and city sites.

Nonprescription antibiotic therapy: cultural models on both sides of the counter and both sides of the border.

Antibiotic resistance is a global public health threat exacerbated by medically unwarranted or improper antibiotic use. Pharmacy counters at the U.S.-Mexico border provide an example of where lay decisions to use antibiotics in ways considered "risky" may be initiated and negotiated. We test how cultural and public health knowledge of antibiotics is distributed among pharmacy staff, local Mexican clients, and U.S. medical tourists in the bordertown of Nogales using a cultural consensus tool. We find that shared cultural models across these groups include public health statements; however, other shared statements are likely to reinforce antibiotic sales at pharmacy counters by those on both sides of the purchase as economic, rather than therapeutic, encounters. From a public health perspective, border pharmacy counters are not a location where increased "safe" knowledge about antibiotic use is being transmitted. However, we do find a positive relationship between "safe" knowledge and reductions in risky behavior.

Biocultural construction of obesogenic ecologies of childhood: parent-feeding versus child-eating strategies.

Human biologists recognize the centrality of parental feeding beliefs and related practices in structuring children's under-nutrition risk in food-insecure settings. By contrast, how they might similarly structure children's nutrition-related health risks in calorically rich ecologies has barely been considered. Using the case of 3- to 6-year-old children in a rural Southeastern U.S. community with very high obesity rates, we use cognitive methods such as consensus analysis to determine how parental cultural models of child eating and feeding are linked to high calorie, obesogenic child diets. We find that parental models are very consistent with biomedical understandings (reduce fat, reduce sugar, portion control, etc.). Regardless, children's diets are extremely high in calories overall as well as in high sugar and fat food items. We suggest three likely and mutually reinforcing contributing factors to persistent and increasing early childhood overweight and obesity: parents' ambivalence about modeling healthy eating, children's active resistance, and the balance of parents' social against nutritive goals at meal times. The active role of children as social architects of their own biology has been little explored in human biological studies, and should provide novel and important understandings of the biocultural construction of childhood over-nutrition.