This report was commissioned by the Norwegian Institute of Public Health and focused on the political feasibility of an international agreement on antimicrobial resistance. The major finding was that a comprehensive response to AMR would commit all countries to act simultaneously on access, conservation and innovation. However, such an agreement is not immediately politically feasible without additional incentives and supports; instead a core groups of specialized countries could act to create the basis of an agreement before inviting other countries to join.
Background: In recent years, there have been numerous calls for global institutions to develop and enforce new international laws. International laws are, however, often blunt instruments with many uncertain benefits, costs, risks of harm, and trade-offs. Thus, they are probably not always appropriate solutions to global health challenges. Given these uncertainties and international law’s potential importance for improving global health, the paucity of synthesized evidence addressing whether international laws achieve their intended effects or whether they are superior in comparison to other approaches is problematic.
Methods: Ten electronic bibliographic databases were searched using predefined search strategies, including MEDLINE, Global Health, CINAHL, Applied Social Sciences Index and Abstracts, Dissertations and Theses, International Bibliography of Social Sciences, International Political Science Abstracts, Social Sciences Abstracts, Social Sciences Citation Index, PAIS International, and Worldwide Political Science Abstracts. Two reviewers will independently screen titles and abstracts using predefined inclusion criteria. Pairs of reviewers will then independently screen the full-text of articles for inclusion using predefined inclusion criteria and then independently extract data and assess risk of bias for included studies. Where feasible, results will be pooled through subgroup analyses, meta-analyses, and meta-regression techniques.
Discussion: The findings of this review will contribute to a better understanding of the expected benefits and possible harms of using international law to address different kinds of problems, thereby providing important evidence-informed guidance on when and how it can be effectively introduced and implemented by countries and global institutions.
This report provides options for navigating five key issues faced by humanitarian organizations when responding to an epidemic: training, communication of risk, insurance, medical evacuation and reintegration. Options focus on practices that a humanitarian organization ought to adopt when interacting with its employees, since employees are owed a legal duty of care that, when ignored, makes an organization vulnerable to legal action. The options were identified by studying the successes and shortcomings of the Ebola response, and are meant to equip humanitarian organizations with the tools necessary to respond to future epidemics in a way that is efficient and that mitigates their liability.
This report explores a number of drug development and delivery models for the Canadian government to consider implementing as it looks to improve access to essential medicines both domestically and internationally.The Office ofInternational Affairs for the Health Portfolio (OIA-HP) commissioned the research of four market-level case studies, which focus on innovative financing and collaborative initiatives, and one patient-level case study, which considers international legislation as a model to improve Canada’s purchasing power. The Innovative Medicines Initiative (IMI), the International Finance Facility for Immunization (IFFIm), Open Source Drug Discovery (OSDD), Drugs for Neglected Diseases Initiative (DNDi), and Australia’s Pharmaceutical Benefits Scheme (PBS) were specifically selected based on their relevance to Canada’s strong pharmaceutical industry, commitment to R&D and global aid, and domestic health needs.
Mental health issues pose critical challenges for Canada's systems of justice and health care. Problems with mental health are common, but often neglected due to stigma and the vulnerability of those living with these conditions. This is evident within our legal system. Every day in our courts we see played out the struggle to protect the human rights and dignity of individual Canadians with mental health challenges, to access adequate mental health care and social support, and to provide genuinely helpful responses to criminal behaviour associated with mental health problems. Law and Mind: Mental Health Law and Policy in Canada provides a comprehensive analysis of the most important cases and key debates at the intersection of mental health law and policy.
Written by a group of Canada's leading experts on mental health law, this volume provides practitioners, researchers and policy-makers with valuable insight into this challenging and important area of the law.
Features and benefits Law and Mind: Mental Health Law and Policy in Canada is an important resource for understanding the complexities of mental health law and related policy issues in Canada.
Law students, practising lawyers and policy-makers alike will benefit from the broad range of topics covered in this comprehensive text. Topics addressed include the law surrounding the funding and administration of mental health care in Canada, the principles of mental health law related to hospitalization and consent to treatment, the components of the criminal law of mental disorder, and mental health issues in the policing and correctional contexts. In addition, the authors offer focused treatment of mental health law issues facing specific populations, including children, the elderly, refugees and ethnic minorities.
This text is written by leading mental health law experts who bring years of practice, research and expertise to provide readers with a comprehensive resource which:
Presents the legal issues related to mental health in a comprehensive manner
Enables students and lawyers to learn this challenging subject matter quickly and effectively
Analyzes recent changes and developments in the law
Provides current information so lawyers can properly advise their clients
Discusses pressing and emerging mental health issues that are relevant to practitioners and their clients
Essential reading This new release will be particularly useful for:
Health lawyers advising clients and in-house lawyers at health service providers as it is an up-to-date resource on mental health law and policy
Students looking for a comprehensive resource on mental health law written by leading academics
Government health workers and policymakers who need to consult a reliable reference volume
Law libraries that want to stock essential guides for lawyers and students
Antimicrobial resistance (AMR) is a global health concern that poses a serious threat to the control of infectious disease. A continuous increase in rates of AMR poses a challenge to the global community and impedes progress previously made in improving health outcomes. This report examines how AMR can be addressed using international instruments, and the appropriate role of the World Health Organization (WHO) in this task. It is recommended that global collective action on AMR be achieved by implementing a Treaty under Article 19 and a Regulation under Article 21 of the WHO’s Constitution. This suite of international instruments can be used to address the greatest proportion of issues that currently impede AMR’s resolution and can mobilize the most effective action. This report further establishes that the WHO has legal authority under its Constitution to create these international instruments to address AMR.
Securing access to effective antimicrobials is one of the greatest challenges today. Until now, efforts to address this issue have been isolated and uncoordinated, with little focus on sustainable and international solutions. Global collective action is necessary to improve access to life-saving antimicrobials, conserving them, and ensuring continued innovation. Access, conservation, and innovation are beneficial when achieved independently, but much more effective and sustainable if implemented in concert within and across countries. WHO alone will not be able to drive these actions. It will require a multisector response (including the health, agriculture, and veterinary sectors), global coordination, and financing mechanisms with sufficient mandates, authority, resources, and power. Fortunately, securing access to effective antimicrobials has finally gained a place on the global political agenda, and we call on policy makers to develop, endorse, and finance new global institutional arrangements that can ensure robust implementation and bold collective action.
Background: Two themes consistently emerge from the broad range of academics, policymakers and opinion leaders who have proposed changes to the World Health Organization (WHO): that reform efforts are too slow, and that they do too little to strengthen WHO’s capacity to facilitate cross-sectoral collaboration. This study seeks to identify possible explanations for the challenges WHO faces in addressing the broader determinants of health, and the potential opportunities for working across sectors.
Methods: This qualitative study used a mixed methods approach of semi-structured interviews and document review. Five interviewees were selected by stratified purposive sampling within a sampling frame of approximately 45 potential interviewees, and a targeted document review was conducted. All interviewees were senior WHO staff at the department director level or above. Thematic analysis was used to analyze data from interview transcripts, field notes, and the document review, and data coded during the analysis was analyzed against three central research questions. First, how does WHO conceptualize its mandate in global health? Second, what are the barriers and enablers to enhancing cross-sectoral collaboration between WHO and other intergovernmental organizations? Third, how do the dominant conceptual frames and the identified barriers and enablers to cross-sectoral collaboration interact?
Results: Analysis of the interviews and documents revealed three main themes: 1) WHO’s role must evolve to meet the global challenges and societal changes of the 21st century; 2) WHO’s cross-sectoral engagement is hampered internally by a dominant biomedical view of health, and the prevailing institutions and incentives that entrench this view; and 3) WHO’s cross-sectoral engagement is hampered externally by siloed areas of focus for each intergovernmental organization, and the lack of adequate conceptual frameworks and institutional mechanisms to facilitate engagement across siloes.
Conclusion: There are a number of external and internal pressures on WHO which have created an organizational culture and operational structure that focuses on a narrow, technical approach to global health, prioritizing disease-based, siloed interventions over more complex approaches that span sectors. The broader approach to promoting human health and wellbeing, which is conceptualized in WHO’s constitution, requires cultural and institutional changes for it to be fully implemented.
Keywords: World Health Organization, United Nations, Global governance, Global health governance, Global governance for health, Social determinants of health, Health in all policies, WHO reform, Cross-sectoral collaboration
Background: Government interventions are critical to addressing the global tobacco epidemic, a major public health problem that continues to deepen. We systematically synthesize research evidence on the effectiveness of government tobacco control policies promoted by the Framework Convention on Tobacco Control (FCTC), supporting the implementation of this international treaty on the tenth anniversary of it entering into force.
Methods: An overview of systematic reviews was prepared through systematic searches of five electronic databases, published up to March 2014. Additional reviews were retrieved from monthly updates until August 2014, consultations with tobacco control experts and a targeted search for reviews on mass media interventions. Reviews were assessed according to predefined inclusion criteria, and ratings of methodological quality were either extracted from source databases or independently scored.
Results: Of 612 reviews retrieved, 45 reviews met the inclusion criteria and 14 more were identified from monthly updates, expert consultations and a targeted search, resulting in 59 included reviews summarizing over 1150 primary studies. The 38 strong and moderate quality reviews published since 2000 were prioritized in the qualitative synthesis. Protecting people from tobacco smoke was the most strongly supported government intervention, with smoke-free policies associated with decreased smoking behaviour, secondhand smoke exposure and adverse health outcomes. Raising taxes on tobacco products also consistently demonstrated reductions in smoking behaviour. Tobacco product packaging interventions and anti-tobacco mass media campaigns may decrease smoking behaviour, with the latter likely an important part of larger multicomponent programs. Financial interventions for smoking cessation are most effective when targeted at smokers to reduce the cost of cessation products, but incentivizing quitting may be effective as well. Although the findings for bans on tobacco advertising were inconclusive, other evidence suggests they remain an important intervention.
Conclusion: When designing and implementing tobacco control programs, governments should prioritize smoking bans and price increases of tobacco products followed by other interventions. Additional studies are needed on the various factors that can influence a policy’s effectiveness and feasibility such as cost, local context, political barriers and implementation strategies.
Global governance and market failures mean that it is not possible to ensure access to antimicrobial medicines of sustainable effectiveness. Many people work to overcome these failures, but their institutions and initiatives are insufficiently coordinated, led and financed. Options for promoting global collective action on antimicrobial access and effectiveness include building institutions, crafting incentives and mobilizing interests. No single option is sufficient to tackle all the challenges associated with antimicrobial resistance. Promising institutional options include monitored milestones and an interagency task force. A global pooled fund could be used to craft incentives and a special representative nominated as an interest mobilizer. There are three policy components to the problem of antimicrobials – ensuring access, conservation and innovation. To address all three components, the right mix of options needs to be matched with an effective forum and may need to be supported by an international legal framework.
Objectives: This case study evaluates a global health education experience aimed at training the next generation of global health advocates. Demand and interest in global health among Canadian students is well documented, despite the difficulty in integrating meaningful experiences into curricula.
Methods: Global health advocacy was taught to 19 undergraduate students at McMaster University through an experiential education course, during which they developed a national advocacy campaign on global access to medicines. A quantitative survey and an analysis of social network dynamics were conducted, along with a qualitative analysis of written work and course evaluations. Data were interpreted through a thematic synthesis approach.
Results: Themes were identified related to students’ learning outcomes, experience and class dynamics. The experiential education format helped students gain authentic, real-world experience in global health advocacy and leadership. The tangible implications for their course work was a key motivating factor. While experiential education is an effective tool for some learning outcomes, it is not suitable for all. As well, group dynamics and evaluation methods affect the learning environment.
Conclusion: Real-world global health issues, public health practice and advocacy approaches can be effectively taught through experiential education, alongside skills like communication and professionalism. Students developed a nuanced understanding of many strategies, challenges and barriers that exist in advocating for public health ideas. These experiences are potentially empowering and confidence-building despite the heavy time commitment they require. Attention should be given to how such experiences are designed, as course dynamics and grading structure significantly influence students’ experience.
Key words: Experiential learning; education; global health; health policy.