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Linking international clinical research with stateless populations to justice in global health.

ABSTRACT: In response to calls to expand the scope of research ethics to address justice in global health, recent scholarship has sought to clarify how external research actors from high-income countries might discharge their obligation to reduce health disparities between and within countries. An ethical framework-'research for health justice'-was derived from a theory of justice (the health capability paradigm) and specifies how international clinical research might contribute to improved health and research capacity in host communities. This paper examines whether and how external funders, sponsors, and researchers can fulfill their obligations under the framework.Case study research was undertaken on the Shoklo Malaria Research Unit's (SMRU) vivax malaria treatment trial, which was performed on the Thai-Myanmar border with Karen and Myanmar refugees and migrants. We conducted nineteen in-depth interviews with trial stakeholders, including investigators, trial participants, community advisory board members, and funder representatives; directly observed at trial sites over a five-week period; and collected trial-related documents for analysis.The vivax malaria treatment trial drew attention to contextual features that, when present, rendered the 'research for health justice' framework's guidance partially incomplete. These insights allowed us to extend the framework to consider external research actors' obligations to stateless populations. Data analysis then showed that framework requirements are largely fulfilled in relation to the vivax malaria treatment trial by Wellcome Trust (funder), Oxford University (sponsor), and investigators. At the same time, this study demonstrates that it may be difficult for long-term collaborations to shift the focus of their research agendas in accordance with the changing burden of illness in their host communities and to build the independent research capacity of host populations when working with refugees and migrants. Obstructive factors included the research funding environment and staff turnover due to resettlement or migration.Our findings show that obligations for selecting research targets, research capacity strengthening, and post-trial benefits that link clinical trials to justice in global health can be upheld by external research actors from high-income countries when working with stateless populations in LMICs. However, meeting certain framework requirements for long-term collaborations may not be entirely feasible.

SUBMITTER: Pratt B

PROVIDER: S-EPMC4085396 | biostudies-literature | 2014 Jun

REPOSITORIES: biostudies-literature

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Linking international clinical research with stateless populations to justice in global health.

Pratt Bridget B Zion Deborah D Lwin Khin Maung KM Cheah Phaik Yeong PY Nosten Francois F Loff Bebe B

BMC medical ethics 20140626

<h4>Background</h4>In response to calls to expand the scope of research ethics to address justice in global health, recent scholarship has sought to clarify how external research actors from high-income countries might discharge their obligation to reduce health disparities between and within countries. An ethical framework-'research for health justice'-was derived from a theory of justice (the health capability paradigm) and specifies how international clinical research might contribute to impr ...[more]

PMID: 24969638

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Project description:Background"Decolonizing global health" (DGH) may help global health trainees understand and remediate the effects of historical colonialism on global health, but little is known regarding how trainees perceive DGH. Understanding their perspectives is critical for designing educational interventions tailored to their needs.ObjectivesTo understand how trainees perceive DGH research and to determine if perspectives differ between trainees from high- (HICs) versus low- and middle-income countries (LMICs).MethodsAn online survey of all 2017-2022 pre-doctoral and post-doctoral trainees (n = 111) and mentors (n = 91) within a multi-university program that supports US and international investigators in one-year mentored global health research. The survey evaluated individuals' self-reported knowledge and attitudes toward DGH and their perceptions of historical colonialism's impact on eight aspects of global health.FindingsThe response rate to trainee surveys was 56%. Trainees from LMICs were less aware of the concept of DGH; 5/25 (20%) had never heard of DGH and 16/25 (64%) reported that they "know a little," whereas all HIC trainees had heard of DGH and 29/36 (81%) reported that they "know a little" (p = 0.019). For three aspects of global health (i.e., which research questions get asked; development of collaborative relationships; and data/statistical analyses), trainees from LMICs were more likely to report positive effects of colonialism. However, in open-ended responses, no thematic differences existed between how LMIC and HIC trainees defined DGH (i.e., actively eliminating power imbalances; prioritizing local needs; promoting local leadership; providing equitable opportunities; and ensuring programs are culturally appropriate).ConclusionsDifferent perspectives surrounding what DGH means suggest a shared understanding may be needed and is arguably prerequisite to designing educational interventions to help global health trainees recognize, understand, and act in global health. Future research is needed to understand perspectives on decolonization across diverse contexts with attention to constructs such as race, ethnicity, and gender.

Project description:BackgroundIn the past few decades Arab countries had witnessed several intra-regional conflicts and civil wars that led to the creation of millions of refugees and migrants. Assessment of research activity is an indicator of national and international efforts to improve the health of those millions of war victims. Therefore, the aim of this study was to analyze published literature in international Arab migrants.MethodsLiterature in international Arab migrants published during the past three decades (1988-2017) was retrieved using Scopus database. A bibliometric analysis methodology was implemented on the retrieved data. Author keywords were mapped using VOSviewer program.ResultsIn total, 1186 documents were retrieved. More than half (658; 55.5%) were published in the last five years (2013-2017). Retrieved documents received an average of 8.6 citations per document and an h-index of 45. The most frequently encountered author keywords were refugees and mental health-related terms. Three countries in the Middle East; Jordan, Lebanon, and Turkey, were among the most active countries. In total, 765 (63.7%) documents were about refugees, 421 (35.5%) were about migrant workers, 30 (2.5%) were about asylum seekers, and 7 (0.6%) were about trafficked and smuggled people. When data were analyzed for the nationality of migrants being investigated, 288 (24.3%) documents were about Syrians, 214 (18.0%) were about Somali, 222 (18.7%) were about Arab or Middle Eastern in general, and 147 (12.4%) were about Palestinians. The American University of Beirut ranked first with 45 (2.4%) publications. The most active journal in publishing research in this field was Journal of Immigrant and Minority Health (35; 3.0%) followed by Journal of Refugee Studies (23, 1.9%), The Lancet (19, 1.6%) and BMC Public Health (16, 1.3%). Publications from Jordan and Lebanon had the highest percentage of international research collaboration.ConclusionResearch in international Arab migrants showed a dramatic increase in the last few years mostly due to the Syrian war. Both mental health and Syrian refugees dominated the literature of international Arab migrants. Research in infectious diseases was relatively low. Research on non-refugee migrants such as workers, trafficked victims, and asylum seekers was also relatively low.

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Project description:ObjectiveTo study cross-national inequalities in mortality of adults and of children aged <5 years using a novel approach, with clustering techniques to stratify countries into mortality groups (better-off, worse-off, mid-level) and to examine risk factors associated with inequality.Design, setting and participantsAnalysis of data from the World Development Indicators 2003 database, compiled by the World Bank.Main outcome measuresAdult and child mortality among countries placed into distinct mortality categories by cluster analysis.Results29 countries had a high adult mortality (mean 584/1000; range 460/1000 to 725/1000) and 23 had a high child mortality (mean 207/1000, range 160/1000 to 316/1000). All these countries were in western and sub-Saharan Africa and Afghanistan. Bivariate analyses showed that relative to countries with low child mortality, those with high child mortality had significantly higher rates of extreme poverty (p<0.001), populations living in rural areas (p<0.001) and female illiteracy (p<0.001), significantly lower per capita expenditure on healthcare (p<0.001), outpatient visits, hospital beds and doctors, and lower rates of access to improved water (p<0.001), sanitation (p<0.001) and immunisations. In multivariate analyses, countries with high adult mortality had a higher prevalence of HIV infection (odds ratio per 1% increase 18.6; 95% CI 0.3 to 1135.5). Between 1960 and 2000, adult male mortality in countries with high mortality increased at >4 times the rate in countries with low mortality. For child mortality, the worse-off group made slower progress in reducing <5 mortality than the better-off group.ConclusionsInequalities in child and adult mortality are large, are growing, and are related to several economic, social and health sector variables. Global efforts to deal with this problem require attention to the worse-off countries, geographic concentrations, and adopt a multidimensional approach [corrected] to development.

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Linking international clinical research with stateless populations to justice in global health.

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Linking international clinical research with stateless populations to justice in global health.

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