非政府组织与全球健康:国际经验与借鉴

非政府组织(Non-governmental organization,NGO)在全球健康领域发挥着重要作用。本专题集中研究NGO在全球健康领域的作用、治理工具、在政府全球健康战略中的地位、项目管理经验、中国NGO的发展状况等五个方面。研究认为,全球健康已初步形成大国、国际政府间组织和大型NGO主导的治理格局,中国仅靠政府力量并不能满足日益增长的全球健康需求。建议中国应将NGO纳入全球健康战略,建立NGO管理和合作机制,使其成为实施全球健康项目的重要补充力量;对中国非政府组织采取"重点扶持、整体改善"策略。     

全球卫生法:全球卫生治理的新趋势

全球化对全球人口的健康产生了深刻影响.疾病全球化呼吁公共卫生治理的全球化.全球卫生治理与传统的国际卫生治理在治理主体、治理方式、治理结构及价值取向等方面存在区别.全球卫生治理的目标是让全世界人民获得可能的最高水平的健康标准.人人享有健康的美好理想只有通过全球卫生"善治"才能实现.而实现全球卫生"善治"的主要机制是国际卫...     

HIV/AIDS: global trends,global funds and delivery bottlenecks

Globalisation affects all facets of human life, including health and well being. The HIV/AIDS epidemic has highlighted the global nature of human health and welfare and globalisation has given rise to a trend toward finding common solutions to global health challenges. Numerous international funds have been set up in recent times to address global health challenges such as HIV.     

全球卫生与医学卫生国际合作

全球卫生是国际上迅速发展的新兴学科和研究领域,其定义显示出其跨学科和多学科的特点;该学科研究范畴包括健康决定因素与卫生公平、全球卫生治理格局、卫生合作模式等热点问题。了解全球卫生研究的热点问题对我国医学与卫生界,特别是教育和研究机构应对全球卫生变化所带来的机遇与挑战,探讨新的合作模式,积极参与全球医学与卫生合作,具有指导意义     

全球健康领域的国际合作者分析——以在中国开展卫生合作的机构为例

在全球化背景下,健康影响因素与公共卫生治理已超越国界,而促进全球健康目标的实现需要多方协调和努力。在全球健康这一相对新兴的领域内,有越来越多的国际参与者,包括国家政府、联合国、其他国际组织、双边机构以及非国际组织、基金会等。本文主要通过查阅我国卫生合作项目的相关资料,对在中国开展合作的主要国际卫生机构及合作项目、重点合作领域进行总结,并对其特点进行比较分析,认为应完善以世界卫生组织为主导,其他国际组织、双边机构、非国际组织等为行动主体的多重治理,并提出加强顶层协调、促进非卫生领域参与卫生治理,以及建设多方沟通机制等建议,以促进国际合作者进一步参与中国全球健康领域国际合作。     

传染病问题的全球治理机制及其完善

为了应对新发传染病带来的全球卫生危机,国际社会发展和完善了现代国际卫生合作机制,初步形成了传染病的全球治理机制。由于受到全球经济发展不平衡、国际民主失衡与冲突频发、多个并存的国际组织公共卫生职能重叠、非政府组织参与全球卫生治理的有效性有待提高等因素的影响,初具雏形的传染病全球治理机制还比较粗糙,有待在传染病治理的实践中接受检验并不断完善。建议加强世界卫生组织的领导地位、增加全球卫生投入、改善全球经济治理机构、推动国际政治民主化、协调伙伴关系、明确非政府组织的法律地位、重视健康的决定因素。     

日本全球卫生策略及特点

日本是亚洲第一个出台全球卫生策略的国家,先后制定了四个全球卫生相关策略。本文从社会经济、卫生发展和卫生外交三方面分别介绍了日本全球卫生策略出台的背景,描述和比较日本在不同阶段全球卫生策略的目标、重点关注领域、援助措施和组织结构等,总结出日本全球卫生策略发展的基本特点:战略目标和优先领域随着国际国内形势发生变化;全球卫生策略是一个连续动态的过程;发挥高层国际会议在策略提出中的重要作用;强调多方伙伴关系;全球卫生人力资源是全球卫生策略实施的基础。本文还讨论了其对我国全球卫生策略的制定和实施的借鉴意义。     

Reducing global health inequalities. Part 1

This paper summarizes four UK reviews of socially stratified health inequalities that were undertaken during the past five decades. It describes the background of misplaced optimism and false hopes which characterized the UK's own record of health inequalities; the broken promises on debt cancellations which was the experience of developing countries. It describes why the UK's past leadership record in international health provides grounds for optimism for the future and for benefits for both developed and developing countries through the adoption of more collaborative approaches to global health than have characterized international relationships in the past. It recalls the enthusiasm generated in the UK, and internationally, by the establishment of the Global Commission on the Social Determinants of Health. It promotes the perception of health both as a global public good and as a developmental issue and why a focus on poverty is essential to the address of global health issues. It sees the designing of appropriate strategies and partnerships towards the achievement of the Millennium Development Goals as an important first step for achieving successful address to global public health issues.     

Australia's contribution to global immunisation

Objective : To review Australian contributions to global immunisation. Approach : We summarise Australian scientific and program contributions to vaccines and global immunisation, describe key developments and strengths in Australia's national immunisation program, and outline how both of these can link with Australia's increasing international development budget to build Australia's future contribution to global immunisation. Conclusions : Australian contributions to vaccines and immunisation have been substantial, and Australia offers a range of good practices in its domestic and development approaches. There are major opportunities to build on this strong track record. These include committing to help roll out important new life‐saving vaccines against pneumococcal disease, rotavirus and human papilloma virus (HPV) to the children who need them most, but whose communities can least afford them. Implications : Australia is one of a few countries expanding their aid budgets towards 0.7% development assistance and other development commitments. Given the importance of immunisation to health gains, Australia is well placed to expand its investment in immunisation within its development portfolio. The GAVI Alliance is the best‐established global mechanism to do this. Additionally, however, Australia could harness other national and regional mechanisms to support low and middle‐income countries, thereby complementing GAVI's focus and global needs.     

全球健康学科中的几个基本问题

全球健康日益受到关注,但关于学科的概念、特征、任务和历史还未完全明朗,结合中国学者的认识,本文将围绕上述问题进行阐述。简单地说,＂全球健康＂就是指全世界人口的共同健康,即一切以全球人口的共同健康为优先关注的事项。＂全球健康＂由国际卫生演变而来,但两者存在重大差别。＂全球健康＂的宗旨与最高目标是＂实现全人类最大可能的健康＂和＂促进人类和谐发展＂。其主要研究任务是为全球健康治理提供证据支持与理论指导,包括全球性疾病或健康的社会决定因素、国家卫生系统、全球健康治理和卫生人力资源等诸多方面。     

Ethics and governance of global health inequalities

BACKGROUND: A world divided by health inequalities poses ethical challenges for global health. International and national responses to health disparities must be rooted in ethical values about health and its distribution; this is because ethical claims have the power to motivate, delineate principles, duties and responsibilities, and hold global and national actors morally responsible for achieving common goals. Theories of justice are necessary to define duties and obligations of institutions and actors in reducing inequalities. The problem is the lack of a moral framework for solving problems of global health justice. AIM: To study why global health inequalities are morally troubling, why efforts to reduce them are morally justified, how they should be measured and evaluated; how much priority disadvantaged groups should receive; and to delineate roles and responsibilities of national and international actors and institutions. DISCUSSION AND CONCLUSIONS: Duties and obligations of international and state actors in reducing global health inequalities are outlined. The ethical principles endorsed include the intrinsic value of health to well-being and equal respect for all human life, the importance of health for individual and collective agency, the concept of a shortfall from the health status of a reference group, and the need for a disproportionate effort to help disadvantaged groups. This approach does not seek to find ways in which global and national actors address global health inequalities by virtue of their self-interest, national interest, collective security or humanitarian assistance. It endorses the more robust concept of "human flourishing" and the desire to live in a world where all people have the capability to be healthy. Unlike cosmopolitan theory, this approach places the role of the nation-state in the forefront with primary, though not sole, moral responsibility. Rather shared health governance is essential for delivering health equity on a global scale.     

The World Health Organization and the transition from "international" to "global" public health

The term "global health" is rapidly replacing the older terminology of "international health." We describe the role of the World Health Organization (WHO) in both international and global health and in the transition from one to the other. We suggest that the term "global health" emerged as part of larger political and historical processes, in which WHO found its dominant role challenged and began to reposition itself within a shifting set of power alliances.Between 1948 and 1998, WHO moved from being the unquestioned leader of international health to being an organization in crisis, facing budget shortfalls and diminished status, especially given the growing influence of new and powerful players. We argue that WHO began to refashion itself as the coordinator, strategic planner, and leader of global health initiatives as a strategy of survival in response to this transformed international political context.     

Developing collaborative approaches to international research: Perspectives of new global health researchers

Within a global context of growing health inequities, the fostering of partnerships and collaborative research have been promoted as playing a critical role in tackling health inequities and health system problems worldwide. Since 2004, the Canadian Coalition for Global Health Research (CCGHR) has facilitated annual Summer Institutes for new global health researchers aimed at strengthening global health research competencies and partnerships among participants. We sought to explore CCGHR Summer Institute alumni perspectives on the Summer Institute experience, particularly on the individual research pairings of Canadian and low- and middle-income countries researchers that have characterised the program. The results reveal that the Summer Institute offered an enriching learning opportunity for participants and worked to further their collaborative projects through providing dedicated one-on-one time with their international research partner, feedback from colleagues from around the world and mentorship by more senior researchers. Positive individual relationships among researchers, as well as the existence of institutional collaborations, employer and funding support, and agendas of local and national politicians were factors that have influenced the ongoing collaboration of partners. There is a need to more fully examine the interplay between individual and institutional-level collaborations, as well as their social and political contexts.     

Combating healthcare corruption and fraud with improved global health governance

Corruption is a serious threat to global health outcomes, leading to financial waste and adverse health consequences. Yet, forms of corruption impacting global health are endemic worldwide in public and private sectors, and in developed and resource-poor settings alike. Allegations of misuse of funds and fraud in global health initiatives also threaten future investment. Current domestic and sectorial-level responses are fragmented and have been criticized as ineffective. In order to address this issue, we propose a global health governance framework calling for international recognition of “global health corruption” and development of a treaty protocol to combat this crucial issue.     

公共卫生人才全球化视野的内涵与培养

随着中国在国际舞台上的重要性不断提高,培养具有全球化视野的公共卫生人才成为关键问题。全球化视野包括对全球政治、经济、社会发展的深入理解,对全球卫生问题的历史、现状与发展趋势的掌握,对公共卫生全球治理与公共卫生专业本身关系的理解和感悟,在多元文化环境中对多元价值的理解、适应和自我发展,以及通过外交谈判手段获得问题解决方案的能力和向全球卫生治理提供中国案例的能力。培养这些能力,既需要打造理论与实践相结合的师资队伍,选择适宜人才进行后备队伍培养和教育,也需要提供多种多样的实践与培训,如到国外留学、到国际组织或者跨国机构任职、参与中国政府对外援助项目等。     

Engagement or dismissiveness? Intersecting international theory and global health

ABSTRACT

International relations theorists and global health politics scholars largely fail to communicate with one another. We argue that drawing on insights from classic and contemporary international theory more explicitly will positively augment the study of global health politics. This paper highlights four major theoretical orientations in the international relations literature (realism, neoliberal institutionalism, constructivism, and feminism) and discusses how an understanding of these perspectives can strengthen our understanding of global health policy.     

七个经合组织国家全球卫生战略比较研究

全球化对健康产生了广泛而深刻的影响,挑战了原有的国际卫生体系,推动了全球卫生概念的提出,开拓了全球卫生治理的新局面。经济合作与发展组织中的七个国家已经发布并实施了国家全球卫生战略。本文比较研究了这些国家出台全球卫生战略的背景、目标利益,指导价值理念、重点领域及战略的制定过程等,并对七国战略的共同点及不同特色进行了总结提炼,发现尊重和维护健康权、积极承担国际责任并发展合作伙伴的能力是共同的价值理念;维护和改善本国人民的健康并为改善全球健康做出贡献、促进国家利益的实现是共同的目标;基于本国比较优势满足发展中国家卫生合作的需求是确定重点领域的关键;加强全球卫生治理、影响健康的全球治理,以及影响全球的卫生治理的思想贯穿战略的始终;多部门和全社会参与战略制订的过程。在借鉴上述国家全球卫生战略核心思想和经验的基础上,提出对中国制订国家全球卫生战略的建议。     

Financing global health: mission unaccomplished

Poor countries account for 56 percent of the global disease burden but less than 2 percent of global health spending. With the global commitment to the Millennium Development Goals in 2000, poverty and the deplorable health conditions of the world's poor have finally reached center stage in the international policy arena, and aid for health has greatly increased. This paper evaluates health financing in developing countries from global- and country-level perspectives and briefly describes the types of reforms needed in the global aid architecture to make effective use of this historic opportunity to improve the plight of the world's poor.     

Global health and the global economic crisis

Although the resources and knowledge for achieving improved global health exist, a new, critical paradigm on health as an aspect of human development, human security, and human rights is needed. Such a shift is required to sufficiently modify and credibly reduce the present dominance of perverse market forces on global health. New scientific discoveries can make wide-ranging contributions to improved health; however, improved global health depends on achieving greater social justice, economic redistribution, and enhanced democratization of production, caring social institutions for essential health care, education, and other public goods. As with the quest for an HIV vaccine, the challenge of improved global health requires an ambitious multidisciplinary research program.     

Exploring the international arena of global public health surveillance

Threats posed by new, emerging or re-emerging communicable diseases are taking a global dimension, to which the World Health Organization (WHO) Secretariat has been responding with determination since 1995. Key to the global strategy for tackling epidemics across borders is the concept of global public health surveillance, which has been expanded and formalized by WHO and its technical partners through a number of recently developed instruments and initiatives. The adoption by the 58th World Health Assembly of the revised (2005) International Health Regulations provides the legal framework for mandating countries to link and coordinate their action through a universal network of surveillance networks. While novel environmental threats and outbreak-prone diseases have been increasingly identified during the past three decades, new processes of influence have appeared more recently, driven by the real or perceived threats of bio-terrorism and disruption of the global economy. Accordingly, the global surveillance agenda is being endorsed, and to some extent seized upon by new actors representing security and economic interests. This paper explores external factors influencing political commitment to comply with international health regulations and it illustrates adverse effects generated by: perceived threats to sovereignty, blurred international health agendas, lack of internationally recognized codes of conduct for outbreak investigations, and erosion of the impartiality and independence of international agencies. A companion paper (published in this issue) addresses the intrinsic difficulties that health systems of low-income countries are facing when submitted to the ever-increasing pressure to upgrade their public health surveillance capacity.