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Correction: UN peacekeeper health and risk factors --- a systematic scoping review

The original article was published in Global Health Research and Policy 2024 9 :13

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UN peacekeeper health and risk factors --- a systematic scoping review

Conflicts, natural disasters, and complex emergencies present substantial health challenges to United Nations (UN) peacekeepers deployed in mission areas. This scoping review aims at summarizing previous resea...

The Correction to this article has been published in Global Health Research and Policy 2024 9 :14

Access to essential medicines for diabetes care: availability, price, and affordability in central Ethiopia

Diabetes is a major global public health burden. Effective diabetes management is highly dependent on the availability of affordable and quality-assured essential medicines (EMs) which is a challenge especiall...

Development of the China’s list of ambulatory care sensitive conditions (ACSCs): a study protocol

The hospitalization rate of ambulatory care sensitive conditions (ACSCs) has been recognized as an essential indicator reflective of the overall performance of healthcare system. At present, ACSCs has been wid...

Government responses to the COVID-19 pandemic of the Gulf Cooperation Council countries: good practices and lessons for future preparedness

The COVID-19 pandemic has dramatically threatened the Gulf Cooperation Council (GCC) countries which have a large proportion of foreign workers. The governments of GCC countries have proactively implemented a ...

Association of pre-migration socioeconomic status and post-migration mental health in Syrian refugees in Lebanon: a descriptive sex-stratified cross-sectional analysis

Refugee populations present with high levels of psychological distress, which may vary among sociodemographic characteristics. Understanding the distribution across these characteristics is crucial to subseque...

Access, interest and equity considerations for virtual global health activities during the COVID-19 pandemic: a cross-sectional study

Global health activities (GHAs) reduce health disparities by promoting medical education, professional development, and resource sharing between high- and low- to middle-income countries (HICs and LMICs). Virt...

Development assistance, donor–recipient dynamic, and domestic policy: a case study of two health interventions supported by World Bank–UK and Global Fund in China

This study views sustainability after the exit of development assistance for health (DAH) as a shared responsibility between donors and recipients and sees transitioning DAH-supported interventions into domest...

The effects of social networks on HIV risk behaviors among Vietnamese female sex workers: a qualitative study

Female sex workers (FSWs) experience heightened vulnerability to HIV and other health harms, and cross-border FSWs face additional challenges due to language issues, higher mobility, and weaker negotiation ski...

Assessing the impact of comorbid type 2 diabetes mellitus on the disease burden of chronic hepatitis B virus infection and its complications in China from 2006 to 2030: a modeling study

China bears a high burden of both hepatitis B virus (HBV) infection and type 2 diabetes mellitus (T2DM). T2DM accelerates the progression of liver disease among individuals infected with HBV. This study aims t...

Mapping of health technology assessment in China: a comparative study between 2016 and 2021

Health Technology Assessment (HTA) in China has recently expanded from purely academic research to include policy or decision-oriented practice, especially after HTA evidence was used to update the National Re...

Reimagining gendered community interventions: the case of family planning programs in rural Bangladesh

Family planning programs in Bangladesh have been successfully operating for over half a century, achieving phenomenal reductions in fertility rates. Acknowledging restrictions on women’s freedoms, much of the ...

Building a resilient health system for universal health coverage and health security: a systematic review

Resilient health system (RHS) is crucial to achieving universal health coverage (UHC) and health security. However, little is known about strategies towards RHS to improve UHC and health security. This systema...

Integrated health reporting within the UN architecture: learning from maternal, newborn and child health

Despite a proliferation of the United Nations General Assembly high-level meetings on a range of health issues and developmental challenges, global funding continues to flow disproportionately to HIV and mater...

Correction: Strengthening the primary health care for non-communicable disease prevention and control in the post-pandemic period: a perspective from China

The original article was published in Global Health Research and Policy 2023 8 :49

Building quality primary health care development in the new era towards universal health coverage: a Beijing initiative

Primary health care (PHC) is the most effective way to improve people's health and well-being, and primary care services should act as the cornerstone of a resilient health system and the foundation of univers...

Human trafficking risk factors, health impacts, and opportunities for intervention in Uganda: a qualitative analysis

Human trafficking is a global public health issue that is associated with serious short- and long-term morbidity. To address and prevent human trafficking, vulnerabilities to human trafficking and forces susta...

Economic costs of alcohol consumption in Thailand, 2021

Alcohol is one of the leading risk factors contributing to avoidable economic loss worldwide. Estimates from the economic cost of alcohol consumption studies play an important role in prioritizing healthcare r...

Childhood immunization uptake determinants in Kinshasa, Democratic Republic of the Congo: ordered regressions to assess timely infant vaccines administered at birth and 6-weeks

Despite global efforts to reduce preventable childhood illness by distributing infant vaccines, immunization coverage in sub-Saharan African settings remains low. Further, timely administration of vaccines at ...

Strengthening the primary health care for non-communicable disease prevention and control in the post-pandemic period: a perspective from China

Non-communicable diseases (NCDs) have become the leading cause of deaths in China and many other countries worldwide. To call for actions in strengthening primary health care (PHC) and accelerate NCD preventio...

The Correction to this article has been published in Global Health Research and Policy 2023 8 :54

Global health collaborative research: beyond mandatory collaboration to mandatory authorship

Collaborative research between the global north and global south is common and growing in number. Due to inability of local governments to fund research, global north actors provide the bulk of research fundin...

Awareness of and participation in mass drug administration programs used for onchocerciasis control in the Atwima Nwabiagya North District, Ghana

Studies on Mass drug administration (MDA) in Ghana targeting various diseases, have mostly focused on factors that affect coverage and compliance to MDA with limited focus on evidence regarding awareness and c...

Adaptation of the CUGH global health competency framework in the Chinese context: a mixed-methods study

In 2014, the Consortium of Universities for Global Health (CUGH) developed a global health competency framework and called for its validation. Given China's increasing engagement in global health over the past...

Factors associated with the utilization of diagnostic tools among countries with different income levels during the COVID-19 pandemic

Disparities in the utilization of essential medical products are a key factor contributing to inequality in health outcomes. We aimed to analyze the trends and influencing factors in using Coronavirus disease ...

Belt and road initiative and healthy silk road: an alternative path for Pacific island countries to participate in global public health governance

Pacific island countries (PICs) located in a region with relatively insufficient capacity to respond to public health emergencies, establishing reliable public health cooperation is conducive to maintaining se...

Depression and health-related quality of life of patients with type 2 diabetes attending tertiary level hospitals in Dhaka, Bangladesh

Type 2 diabetes mellitus (T2DM) and depression are closely linked. People with T2DM are at increased risk of developing depression and vice versa. T2DM and depression comorbid conditions adversely affect Healt...

The development and application of a two-step surveillance process for Healthy China Initiative based on wide coverage interagency data

Healthy China is a nationwide health strategy aiming at improving health from diverse dimensions, and strengthening high-quality assessment is essential for its stimulation. However, there is limited evidence in ...

Household satisfaction and associated factors with community-based health insurance scheme in Ethiopia: systematic review and meta-analysis

Community-based health insurance (CBHI) schemes are crucial for households to avoid financial hardship, improve healthcare quality, and engage in health policies. Household satisfaction is a key indicator for ...

Malaria rapid diagnostic tests in community pharmacies in Rwanda: availability, knowledge of community pharmacists, advantages, and disadvantages of licensing their use

Presumptive treatment of malaria is often practiced in community pharmacies across sub-Saharan Africa (SSA).To address this issue, the World Health Organization (WHO) recommends that malaria Rapid Diagnostic T...

A mixed method analysis of the Botswana schistosomiasis control policy and plans using the policy triangle framework

The present goal of the World Health Organization (WHO) 2021–2030 roadmap for Neglected Tropical Diseases is to eliminate schistosomiasis as a public health problem, and reduce its prevalence of heavy infectio...

Infectious disease control: from health security strengthening to health systems improvement at global level

Since the twenty first century, the outbreaks of global infectious diseases have caused several public health emergencies of international concern, imposing an enormous impact on population health, the economy...

Geriatric assessment for older people with cancer: policy recommendations

Most cancers occur in older people and the burden in this age group is increasing. Over the past two decades the evidence on how best to treat this population has increased rapidly. However, implementation of ...

The priority areas and possible pathways for health cooperation in BRICS countries

As one of the largest alliances of middle-income countries, the BRICS, known as an acronym for five countries including “Brazil, Russia, India, China, and South Africa”, represents half of the global populatio...

Mental health around retirement: evidence of Ashenfelter’s dip

Mental health issues among retirees have become increasingly concerning because the aging population presents a significant challenge globally, particularly in Western countries. Previous studies on this issue...

Correction: Cost of diabetes and its complications: results from a STEPS survey in Punjab, India

The original article was published in Global Health Research and Policy 2023 8 :11

Effect of workplace violence on health workers injuries and workplace absenteeism in Bangladesh

Workplace violence (WPV) is an emerging problem for health workers (HWs) and a global concern in health systems. Scientific literatures infer that WPV against HWs is often attributed to workplace injuries and ...

A life course health development model of HIV vulnerabilities and resiliencies in young transgender women in Peru

Globally transgender women (TW) are at heightened vulnerability for HIV infection. In Lima Peru, sharp increases in HIV prevalence are seen among TW ages 25 years and older highlighting the need for early HIV ...

High performing primary health care organizations from patient perspective: a qualitative study in China

There is a global call to build people-centred primary health care (PHC) systems. Previous evidence suggests that without organization-level reform efforts, the full potential of policy reforms may be limited....

Addressing neglected tropical diseases in Africa: a health equity perspective

Africa accounts for over one-third of the global burden of neglected tropical diseases (NTDs). Although continental efforts have been made to combat these diseases, there still exists a significant gap in the ...

Optimized segmented regression models for the transition period of intervention effects

The interrupted time series (ITS) design is a widely used approach to examine the effects of interventions. However, the classic segmented regression (CSR) method, the most popular statistical technique for an...

Oral health of adolescents in West Africa: prioritizing its social determinants

Oral health is a major public health issue in West Africa, yet it has gotten little attention. Individual and group disparities in health status are influenced by social determinants of health (SDH), which als...

Population health and sociodemographic variables as predictors of access to cardiac medicine and surgery in Haiti

In Haiti, cardiovascular disease is a leading cause of morbidity and mortality, with congenital and rheumatic heart disease comprising a large portion of disease burden. However, domestic disparities in cardia...

Evolving market-shaping strategies to boost access to essential medical products in developing countries with HIV self-testing as a case study

The COVID-19 pandemic has exacerbated health inequities among countries in the Global South with limited access to essential medical products, leading to a higher infection and mortality rate, especially among...

Prevalence and trends of polypharmacy in U.S. adults, 1999–2018

Polypharmacy is one of the most important health issues for its potential impacts on disease burden and healthcare costs. The aim of this study was to update a comprehensive picture of prevalence and trends in...

Patient views of the good doctor in primary care: a qualitative study in six provinces in China

China has been striving to train primary care doctors capable of delivering high-quality service through general practitioner training programs and family doctor team reforms, but these initiatives have not ad...

Down the brain drain: a rapid review exploring physician emigration from West Africa

The emigration of physicians from low- and middle-income countries (LMICs) to high-income countries (HICs), colloquially referred to as the “brain drain”, has been a topic of discussion in global health sphere...

Incidence and mortality trends of neglected tropical diseases and malaria in China and ASEAN countries from 1990 to 2019 and its association with the socio-demographic index

People in China and the countries in the Association of Southeast Asian Nations (ASEAN) are affected by neglected tropical diseases and malaria (NTDM). In this study, we aimed to assess the current status and ...

Transnational public and global health education in China

Transnational public and global health programs in China have rapidly expanded over the past 20 years, and have potential to make important contributions to China’s global health workforce. However, there has ...

Finding the fragments: community-based epidemic surveillance in Sudan

Sudan faces inter-sectional health risks posed by escalating violent conflict, natural hazards and epidemics. Epidemics are frequent and overlapping, particularly resurgent seasonal outbreaks of diseases such ...

Impact of federalization for health financing and workforce in Nepal

The adoption of its 2015 constitution has converted Nepal to a federal government while simultaneously resulted in significant reforms of the health system in Nepal in terms of both structure and commitment. I...

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Global Health Research and Policy

ISSN: 2397-0642

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Page 1 of 498

Covid-19 hotlines, helplines and call centers: a systematic review of characteristics, challenges and lessons learned

During the Covid-19 pandemic, a number of hotlines/helplines/call centers was implemented to provide remote services and support public health. The objective of this study was to investigate the characteristic...

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Supportive and non-supportive social experiences following suicide loss: a qualitative study

Suicide bereavement entails profound social stressors, including stigma and communication barriers, which can impair social support for suicide loss survivors (SLS). Despite recognized benefits of empathetic i...

Vitamin A supplementation coverage and associated factors for children aged 6 to 59 months in integrated and campaign-based delivery systems in four sub-Saharan African countries

Vitamin A deficiency (VAD) is a leading contributor to the poor health and nutrition of young children in sub-Saharan Africa. Funding constraints are compelling many countries to shift from longstanding campai...

Mortality burden of cardiovascular disease attributable to ambient PM 2.5 exposure in Portugal, 2011 to 2021

Exposure to high levels of environmental air pollution causes several health outcomes and has been associated with increased mortality, premature mortality, and morbidity. Ambient exposure to PM 2.5 is currently c...

Thriving from work questionnaire: Spanish translation and validation

Thriving from Work is a construct that has been highlighted as an important integrative positive worker well-being indicator that can be used in both research and practice. Recent public discourse emphasizes t...

Relative and absolute inequalities in cerebrovascular disease mortality rates: exploring the influence of socioeconomic status and urbanization levels in Taiwan

Limited evidence exists regarding the socioeconomic inequalities in cerebrovascular disease (CBD) mortality at different urbanization levels. Therefore, this study was conducted to assess the socioeconomic ine...

Trends in HIV prevalence and risk factors among men who have sex with men in Mozambique: implications for targeted interventions and public health strategies

Men who have sex with Men (MSM) are known to contribute to increased HIV prevalence as an integral part of key populations with high vulnerability to HIV/AIDS due to their sexual behaviours. Mozambique conduct...

The effect of retirement on physical and mental health in China: a nonparametric fuzzy regression discontinuity study

With the rapid aging of the domestic population, China has a strong incentive to increase the statutory retirement age. How retirement affects the health of the elderly is crucial to this policymaking. The hea...

Randomised pilot and feasibility trial of a group intervention for men who perpetrate intimate partner violence against women

There is a need for robust evidence on the effectiveness and cost-effectiveness of domestic abuse perpetrator programmes in reducing abusive behaviour and improving wellbeing for victim/survivors. While any ra...

Does health literacy mediate the relationship between socioeconomic status and health related outcomes in the Belgian adult population?

Health literacy (HL) has been put forward as a potential mediator through which socioeconomic status (SES) affects health. This study explores whether HL mediates the relation between SES and a selection of he...

Risk factors for low back pain in the Chinese population: a systematic review and meta-analysis

In China, the world’s largest developing country, low back pain (LBP) is a common public health issue affecting workability. This meta-analysis aimed to systematically assess the risk factors of LBP in the Chi...

The risk of contact between visitors and Borrelia burgdorferi -infected ticks is associated with fine-scale landscape features in a southeastern Canadian nature park

Infectious diseases are emerging across temperate regions of the world, and, for some, links have been made between landscapes and emergence dynamics. For tick-borne diseases, public parks may be important exp...

The prevalence of preterm and low birth weight infants among migrant women in the Pearl River Delta region, China: a population-based birth cohort study

The existing literature evaluating the association between neonatal morbidity and migrant status presents contradictory results. The purpose of this study was to compare the risk of preterm birth (PTB) and low...

Health and health behaviours in adolescence as predictors of education and socioeconomic status in adulthood – a longitudinal study

The positive association of health with education level and socioeconomic status (SES) is well-established. Two theoretical frameworks have been delineated to understand main mechanisms leading to socioeconomi...

Asbestos ban policies and mesothelioma mortality in Greece

Malignant mesothelioma is a rare form of cancer that mostly affects the pleura and has a strong link to asbestos exposure. Greece banned the use of asbestos in 2005, however, the public was already aware of th...

Examining the association between perceived stigma, its correlates, and restrictions in participation among persons with disabilities in Nepal: a cross-sectional study

Disability stigma in low- and middle-income countries is one of the most persistent and complex barriers limiting persons with disabilities (PwDs) from enjoying their rights and opportunities. Perceived stigma...

A new neonatal BCG vaccination pathway in England: a mixed methods evaluation of its implementation

The introduction of a national evaluation of newborn screening for Severe Combined Immunodeficiency (SCID) in England triggered a change to the selective Bacillus Calmette-Guerin (BCG) vaccination programme de...

Using propensity score matching analysis to compare between cardiometabolic risk factors and physical activity type in Korean adults: findings from a nationwide population-based survey

We aimed to assess the effects of different exercise modalities on cardiometabolic risk factors within a comprehensive, representative sample of the Korean population.

Changes in adolescents’ daily-life solitary experiences during the COVID-19 pandemic: an experience sampling study

Adolescent solitude was drastically impacted by the COVID-19 pandemic. As solitude is crucial for adolescent development through its association with both positive and negative developmental outcomes, it is cr...

The impact of quality-adjusted life years on evaluating COVID-19 mitigation strategies: lessons from age-specific vaccination roll-out and variants of concern in Belgium (2020-2022)

When formulating and evaluating COVID-19 vaccination strategies, an emphasis has been placed on preventing severe disease that overburdens healthcare systems and leads to mortality. However, more conventional ...

Association between movement behavior patterns and cardiovascular risk among Chinese adults aged 40–75: a sex-specific latent class analysis

Cardiovascular disease (CVD) is a major global health threat, particularly in China, contributing to over 40% of deaths. While sleep behaviors, sedentary behaviors, and physical activities are recognized as in...

Impact of home quarantine on physical fitness of school-aged children in Xi’an during COVID-19 lockdown: a cross-sectional study

The emergence of the COVID-19 pandemic has sparked unprecedented global challenges. This study intends to investigate changes in the physical fitness of students aged 6–22 during the COVID-19 pandemic and to a...

Uncovering the extent of dementia prevalence in Iran: a comprehensive systematic review and meta-analysis

Dementia is one of the major causes of disability and dependency among older people worldwide. The formation of an aging population in Iran can be associated with societal problems, including age-related disor...

The good, the bad and the ugly – a Swedish qualitative interview study about the landscape of meaning-imbued, exercise-related physical pain, as experienced by ‘normal’ gym-users

The gym is a well-known place for health promoting or rehabilitating exercise whose availability to all is regarded significant for people’s personal health work and the public’s health. In this context, physi...

Prevalence of and factors associated with suboptimal glycemic control among patients with type 2 diabetes mellitus attending public hospitals in the Greater Male’ Region, Maldives: a hospital-based cross-sectional study

Suboptimal glycemic control of type 2 diabetes mellitus (T2DM) which is defined as having HbA1c greater than 7% is a major public health problem in several countries, including the Maldives. The study aimed to...

Risk factors for smoking in adolescence: evidence from a cross-sectional survey in Switzerland

Cigarette smoking during adolescence is a major public health concern with far-reaching health implications. Adolescents who smoke are at an increased risk of developing long-term health problems and are more ...

Financial scarcity, psychological well-being and perceptions: an evaluation of the Nigerian currency redesign policy outcomes

The relationship between insufficient financial resources and psychological health has been extensively studied and established in various contexts. However, there remains uncertainty regarding the potential i...

The relationship between COVID-19 stress and test anxiety in art students: the chain mediating roles of intolerance of uncertainty and sleep quality

The global spread of COVID-19 has brought immense physiological and psychological distress to students, such as test anxiety and poor sleep quality. This study aims to explore the relationship between COVID-19...

The dynamic risk factors of cardiovascular disease among people living with HIV: a real-world data study

This study aims to investigate the incidence and dynamic risk factors for cardiovascular diseases (CVD) among people living with HIV (PLWH).

A machine learning screening model for identifying the risk of high-frequency hearing impairment in a general population

Hearing impairment (HI) has become a major public health issue in China. Currently, due to the limitations of primary health care, the gold standard for HI diagnosis (pure-tone hearing test) is not suitable fo...

Involuntary displacement and self-reported health in a cross-sectional survey of people experiencing homelessness in Denver, Colorado, 2018–2019

The number of people experiencing unsheltered homelessness in the U.S. is increasing. Municipalities have responded with punitive responses such as involuntary displacement (i.e., encampment sweeps, move along...

The association between waist circumference and adult asthma attack using nationally representative samples

This study aims to explore the relationship between waist circumference and asthma attack in adults.

Socio-economic inequities in mental health problems and wellbeing among women working in the apparel and floriculture sectors: testing the mediating role of psychological capital, social support and tangible assets

It is still unknown whether the mechanisms proposed by the Reserve Capacity Model (RCM) explaining socio-economic health and wellbeing inequities in high income countries can be applied to low-income countries...

A scoping review of academic and grey literature on migrant health research conducted in Scotland

Migration to Scotland has increased since 2002 with an increase in European residents and participation in the Asylum dispersal scheme. Scotland has become more ethnically diverse, and 10% of the current popul...

Food diversity: its relation to children’s health and consequent economic burden

This study investigates the impact of low food diversity on the health status of children using the Dietary Diversity Score (DDS) and Dietary Serving Score (DSS) in a sub-district with the highest percentage o...

Is economic growth enough to propel rehabilitation expenditures? An empirical analysis of country panel data and policy implications

Rehabilitation is a set of services designed to increase functioning and improve wellbeing across the life course. Despite being a core part of Universal Health Coverage, rehabilitation services often receive ...

Social determinants of health and emergency department visits among older adults with multimorbidity: insight from 2010 to 2018 National Health Interview Survey

Multimorbidity is prevalent among older adults and is associated with adverse health outcomes, including high emergency department (ED) utilization. Social determinants of health (SDoH) are associated with man...

Development and validation of Malaysian one stop crisis center service quality instrument (OSCC-Qual) for domestic violence management

One Stop Crisis Center (OSCC) is a multi-sectorial center aimed to provide medical, social, legal, police and shelter services to survivors of domestic violence, rape, sexual assault, sodomy and child abuse. A...

Comparing PrEP initiation rates by service delivery models among high risk adolescent boys and young men in KwaZulu-Natal, South Africa: findings from a population-based prospective study

Pre-exposure prophylaxis (PrEP) is an HIV prevention strategy that can reduce the risk of HIV acquisition by more than 90% if taken consistently. Although South Africa has been implementing PrEP since 2016, in...

Assessment of the integrated disease surveillance and response system implementation in health zones at risk for viral hemorrhagic fever outbreaks in North Kivu, Democratic Republic of the Congo, following a major Ebola outbreak, 2021

The Democratic Republic of the Congo (DRC) experienced its largest Ebola Virus Disease Outbreak in 2018–2020. As a result of the outbreak, significant funding and international support were provided to Eastern...

Anthropometric failures and its predictors among under five children in Ethiopia: multilevel logistic regression model using 2019 Ethiopian demographic and health survey data

Composite Index of Anthropometric Failure (CIAF) combines all three forms of anthropometric failures to assess undernutrition status of children. There is no study on CIAF to identify the real and severe form ...

1 plus 1 is more than 2: mental health problems, financial difficulties, and social exclusion in a cross-sectional study of 28,047 general-population adults

Mental health problems and financial difficulties each increase the risk of social exclusion. However, few large studies representing a broad age range have investigated the combined social effect of having bo...

Access to family planning services and associated factors among young people in Lira city northern Uganda

Access to family planning services among young people is crucial for reproductive health. This study explores the access and associated factors among young people in Lira City, Northern Uganda.

Exploring the practice of Iranian adolescent females during menstruation and related beliefs: a qualitative study

Menstruation is a natural occurrence that women experience during their reproductive years and may encounter many years throughout their lifespan. Many adolescent females lack accurate knowledge about menstrua...

Bayesian modeling of quantiles of body mass index among under-five children in Ethiopia

Body Mass Index (BMI) is a measurement of nutritional status, which is a vital pre-condition for good health. The prevalence of childhood malnutrition and the potential long-term health risks associated with o...

Acceptability of Tele-mental Health Services Among Users: A Systematic Review and Meta-analysis

Mental disorders are currently a global public health concern, particularly after the coronavirus disease 2019 (COVID-19) pandemic. Mental health services gradually transitioned to teleservices, employing vari...

A large, multi-center survey assessing health, social support, literacy, and self-management resources in patients with heart failure

Most patients with heart failure (HF) have multimorbidity which may cause difficulties with self-management. Understanding the resources patients draw upon to effectively manage their health is fundamental to ...

Exploring information needs among family caregivers of children with intellectual disability in a rural area of South Africa: a qualitative study

Globally, families experience challenges caring for and raising children with intellectual disability (ID). Family caregivers in rural states are mostly known for lacking support resources, including informati...

Housing and health for people from refugee and asylum-seeking backgrounds: findings from an Australian qualitative longitudinal study

For people from asylum-seeking and refugee backgrounds, housing and the re-establishment of home are key social determinants of health. Research highlights the inequities faced by asylum seekers and refugees i...

Living with type 1 diabetes and schooling among young people in Ghana: a truism of health selection, inadequate support, or artefactual explanation of educational inequalities?

Type 1 diabetes mellitus (T1DM) is mostly diagnosed among young people. Despite the evidence that T1DM is disruptive, and affects individuals’ health and cognitive ability, there is dearth of knowledge on the ...

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Factors associated with help-seeking by women facing intimate partner violence in India: findings from National Family Health Survey-5 (2019–2021)

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• 1 Center for Health Decision Science and Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA 02115, USA. Electronic address: [email protected].
• 2 Center for Health Decision Science and Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA 02115, USA; Global Health and Education Learning Incubator, Harvard University, Cambridge, MA, USA.
• PMID: 38642567
• DOI: 10.1016/S0140-6736(24)00812-2

Digital Health Research Methods and Global Public Health

• Living reference work entry
• First Online: 07 February 2023
• Cite this living reference work entry

• Rayner K. J. Tan 2 , 3 ,
• Pearlyn H. M. Neo 3 ,
• Jane M. Lim 4 &
• Suan Ee Ong 3 , 5  

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The advent of technology has brought about new opportunities and interfaces to generate insights into individuals’ and societies’ social worlds and lived experiences. This chapter highlights broad trends in technological innovations and the concomitant rise of digital research methods. First, it explores the mediating role of technology in both accessing the social lives of individuals and understanding realities where novel interactions are easily generated. Second, it highlights how the advent of different technologies, including the internet and social media, personal handheld devices and wearables, as well as big data sources have led to a broadening and deepening of digital research methods. Third, it discusses the benefits of these approaches in the context of global public health. Finally, the chapter discusses several issues relating to the digital divide that must be addressed to realize the potential of digital research methods in furthering efforts to improve global public health.

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Rayner K. J. Tan

Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore

Rayner K. J. Tan, Pearlyn H. M. Neo & Suan Ee Ong

Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, Singapore, Singapore

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Research for Impact, Singapore, Singapore

Suan Ee Ong

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Tan, R.K.J., Neo, P.H.M., Lim, J.M., Ong, S.E. (2023). Digital Health Research Methods and Global Public Health. In: Liamputtong, P. (eds) Handbook of Social Sciences and Global Public Health. Springer, Cham. https://doi.org/10.1007/978-3-030-96778-9_54-1

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Research ethics and artificial intelligence for global health: perspectives from the global forum on bioethics in research

• James Shaw 1 , 13 ,
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• Caesar A. Atuire 4 , 5 ,
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BMC Medical Ethics volume  25 , Article number:  46 ( 2024 ) Cite this article

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The ethical governance of Artificial Intelligence (AI) in health care and public health continues to be an urgent issue for attention in policy, research, and practice. In this paper we report on central themes related to challenges and strategies for promoting ethics in research involving AI in global health, arising from the Global Forum on Bioethics in Research (GFBR), held in Cape Town, South Africa in November 2022.

The GFBR is an annual meeting organized by the World Health Organization and supported by the Wellcome Trust, the US National Institutes of Health, the UK Medical Research Council (MRC) and the South African MRC. The forum aims to bring together ethicists, researchers, policymakers, research ethics committee members and other actors to engage with challenges and opportunities specifically related to research ethics. In 2022 the focus of the GFBR was “Ethics of AI in Global Health Research”. The forum consisted of 6 case study presentations, 16 governance presentations, and a series of small group and large group discussions. A total of 87 participants attended the forum from 31 countries around the world, representing disciplines of bioethics, AI, health policy, health professional practice, research funding, and bioinformatics. In this paper, we highlight central insights arising from GFBR 2022.

We describe the significance of four thematic insights arising from the forum: (1) Appropriateness of building AI, (2) Transferability of AI systems, (3) Accountability for AI decision-making and outcomes, and (4) Individual consent. We then describe eight recommendations for governance leaders to enhance the ethical governance of AI in global health research, addressing issues such as AI impact assessments, environmental values, and fair partnerships.

Conclusions

The 2022 Global Forum on Bioethics in Research illustrated several innovations in ethical governance of AI for global health research, as well as several areas in need of urgent attention internationally. This summary is intended to inform international and domestic efforts to strengthen research ethics and support the evolution of governance leadership to meet the demands of AI in global health research.

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Introduction

The ethical governance of Artificial Intelligence (AI) in health care and public health continues to be an urgent issue for attention in policy, research, and practice [ 1 , 2 , 3 ]. Beyond the growing number of AI applications being implemented in health care, capabilities of AI models such as Large Language Models (LLMs) expand the potential reach and significance of AI technologies across health-related fields [ 4 , 5 ]. Discussion about effective, ethical governance of AI technologies has spanned a range of governance approaches, including government regulation, organizational decision-making, professional self-regulation, and research ethics review [ 6 , 7 , 8 ]. In this paper, we report on central themes related to challenges and strategies for promoting ethics in research involving AI in global health research, arising from the Global Forum on Bioethics in Research (GFBR), held in Cape Town, South Africa in November 2022. Although applications of AI for research, health care, and public health are diverse and advancing rapidly, the insights generated at the forum remain highly relevant from a global health perspective. After summarizing important context for work in this domain, we highlight categories of ethical issues emphasized at the forum for attention from a research ethics perspective internationally. We then outline strategies proposed for research, innovation, and governance to support more ethical AI for global health.

In this paper, we adopt the definition of AI systems provided by the Organization for Economic Cooperation and Development (OECD) as our starting point. Their definition states that an AI system is “a machine-based system that can, for a given set of human-defined objectives, make predictions, recommendations, or decisions influencing real or virtual environments. AI systems are designed to operate with varying levels of autonomy” [ 9 ]. The conceptualization of an algorithm as helping to constitute an AI system, along with hardware, other elements of software, and a particular context of use, illustrates the wide variety of ways in which AI can be applied. We have found it useful to differentiate applications of AI in research as those classified as “AI systems for discovery” and “AI systems for intervention”. An AI system for discovery is one that is intended to generate new knowledge, for example in drug discovery or public health research in which researchers are seeking potential targets for intervention, innovation, or further research. An AI system for intervention is one that directly contributes to enacting an intervention in a particular context, for example informing decision-making at the point of care or assisting with accuracy in a surgical procedure.

The mandate of the GFBR is to take a broad view of what constitutes research and its regulation in global health, with special attention to bioethics in Low- and Middle- Income Countries. AI as a group of technologies demands such a broad view. AI development for health occurs in a variety of environments, including universities and academic health sciences centers where research ethics review remains an important element of the governance of science and innovation internationally [ 10 , 11 ]. In these settings, research ethics committees (RECs; also known by different names such as Institutional Review Boards or IRBs) make decisions about the ethical appropriateness of projects proposed by researchers and other institutional members, ultimately determining whether a given project is allowed to proceed on ethical grounds [ 12 ].

However, research involving AI for health also takes place in large corporations and smaller scale start-ups, which in some jurisdictions fall outside the scope of research ethics regulation. In the domain of AI, the question of what constitutes research also becomes blurred. For example, is the development of an algorithm itself considered a part of the research process? Or only when that algorithm is tested under the formal constraints of a systematic research methodology? In this paper we take an inclusive view, in which AI development is included in the definition of research activity and within scope for our inquiry, regardless of the setting in which it takes place. This broad perspective characterizes the approach to “research ethics” we take in this paper, extending beyond the work of RECs to include the ethical analysis of the wide range of activities that constitute research as the generation of new knowledge and intervention in the world.

Ethical governance of AI in global health

The ethical governance of AI for global health has been widely discussed in recent years. The World Health Organization (WHO) released its guidelines on ethics and governance of AI for health in 2021, endorsing a set of six ethical principles and exploring the relevance of those principles through a variety of use cases. The WHO guidelines also provided an overview of AI governance, defining governance as covering “a range of steering and rule-making functions of governments and other decision-makers, including international health agencies, for the achievement of national health policy objectives conducive to universal health coverage.” (p. 81) The report usefully provided a series of recommendations related to governance of seven domains pertaining to AI for health: data, benefit sharing, the private sector, the public sector, regulation, policy observatories/model legislation, and global governance. The report acknowledges that much work is yet to be done to advance international cooperation on AI governance, especially related to prioritizing voices from Low- and Middle-Income Countries (LMICs) in global dialogue.

One important point emphasized in the WHO report that reinforces the broader literature on global governance of AI is the distribution of responsibility across a wide range of actors in the AI ecosystem. This is especially important to highlight when focused on research for global health, which is specifically about work that transcends national borders. Alami et al. (2020) discussed the unique risks raised by AI research in global health, ranging from the unavailability of data in many LMICs required to train locally relevant AI models to the capacity of health systems to absorb new AI technologies that demand the use of resources from elsewhere in the system. These observations illustrate the need to identify the unique issues posed by AI research for global health specifically, and the strategies that can be employed by all those implicated in AI governance to promote ethically responsible use of AI in global health research.

RECs and the regulation of research involving AI

RECs represent an important element of the governance of AI for global health research, and thus warrant further commentary as background to our paper. Despite the importance of RECs, foundational questions have been raised about their capabilities to accurately understand and address ethical issues raised by studies involving AI. Rahimzadeh et al. (2023) outlined how RECs in the United States are under-prepared to align with recent federal policy requiring that RECs review data sharing and management plans with attention to the unique ethical issues raised in AI research for health [ 13 ]. Similar research in South Africa identified variability in understanding of existing regulations and ethical issues associated with health-related big data sharing and management among research ethics committee members [ 14 , 15 ]. The effort to address harms accruing to groups or communities as opposed to individuals whose data are included in AI research has also been identified as a unique challenge for RECs [ 16 , 17 ]. Doerr and Meeder (2022) suggested that current regulatory frameworks for research ethics might actually prevent RECs from adequately addressing such issues, as they are deemed out of scope of REC review [ 16 ]. Furthermore, research in the United Kingdom and Canada has suggested that researchers using AI methods for health tend to distinguish between ethical issues and social impact of their research, adopting an overly narrow view of what constitutes ethical issues in their work [ 18 ].

The challenges for RECs in adequately addressing ethical issues in AI research for health care and public health exceed a straightforward survey of ethical considerations. As Ferretti et al. (2021) contend, some capabilities of RECs adequately cover certain issues in AI-based health research, such as the common occurrence of conflicts of interest where researchers who accept funds from commercial technology providers are implicitly incentivized to produce results that align with commercial interests [ 12 ]. However, some features of REC review require reform to adequately meet ethical needs. Ferretti et al. outlined weaknesses of RECs that are longstanding and those that are novel to AI-related projects, proposing a series of directions for development that are regulatory, procedural, and complementary to REC functionality. The work required on a global scale to update the REC function in response to the demands of research involving AI is substantial.

These issues take greater urgency in the context of global health [ 19 ]. Teixeira da Silva (2022) described the global practice of “ethics dumping”, where researchers from high income countries bring ethically contentious practices to RECs in low-income countries as a strategy to gain approval and move projects forward [ 20 ]. Although not yet systematically documented in AI research for health, risk of ethics dumping in AI research is high. Evidence is already emerging of practices of “health data colonialism”, in which AI researchers and developers from large organizations in high-income countries acquire data to build algorithms in LMICs to avoid stricter regulations [ 21 ]. This specific practice is part of a larger collection of practices that characterize health data colonialism, involving the broader exploitation of data and the populations they represent primarily for commercial gain [ 21 , 22 ]. As an additional complication, AI algorithms trained on data from high-income contexts are unlikely to apply in straightforward ways to LMIC settings [ 21 , 23 ]. In the context of global health, there is widespread acknowledgement about the need to not only enhance the knowledge base of REC members about AI-based methods internationally, but to acknowledge the broader shifts required to encourage their capabilities to more fully address these and other ethical issues associated with AI research for health [ 8 ].

Although RECs are an important part of the story of the ethical governance of AI for global health research, they are not the only part. The responsibilities of supra-national entities such as the World Health Organization, national governments, organizational leaders, commercial AI technology providers, health care professionals, and other groups continue to be worked out internationally. In this context of ongoing work, examining issues that demand attention and strategies to address them remains an urgent and valuable task.

The GFBR is an annual meeting organized by the World Health Organization and supported by the Wellcome Trust, the US National Institutes of Health, the UK Medical Research Council (MRC) and the South African MRC. The forum aims to bring together ethicists, researchers, policymakers, REC members and other actors to engage with challenges and opportunities specifically related to research ethics. Each year the GFBR meeting includes a series of case studies and keynotes presented in plenary format to an audience of approximately 100 people who have applied and been competitively selected to attend, along with small-group breakout discussions to advance thinking on related issues. The specific topic of the forum changes each year, with past topics including ethical issues in research with people living with mental health conditions (2021), genome editing (2019), and biobanking/data sharing (2018). The forum is intended to remain grounded in the practical challenges of engaging in research ethics, with special interest in low resource settings from a global health perspective. A post-meeting fellowship scheme is open to all LMIC participants, providing a unique opportunity to apply for funding to further explore and address the ethical challenges that are identified during the meeting.

In 2022, the focus of the GFBR was “Ethics of AI in Global Health Research”. The forum consisted of 6 case study presentations (both short and long form) reporting on specific initiatives related to research ethics and AI for health, and 16 governance presentations (both short and long form) reporting on actual approaches to governing AI in different country settings. A keynote presentation from Professor Effy Vayena addressed the topic of the broader context for AI ethics in a rapidly evolving field. A total of 87 participants attended the forum from 31 countries around the world, representing disciplines of bioethics, AI, health policy, health professional practice, research funding, and bioinformatics. The 2-day forum addressed a wide range of themes. The conference report provides a detailed overview of each of the specific topics addressed while a policy paper outlines the cross-cutting themes (both documents are available at the GFBR website: https://www.gfbr.global/past-meetings/16th-forum-cape-town-south-africa-29-30-november-2022/ ). As opposed to providing a detailed summary in this paper, we aim to briefly highlight central issues raised, solutions proposed, and the challenges facing the research ethics community in the years to come.

In this way, our primary aim in this paper is to present a synthesis of the challenges and opportunities raised at the GFBR meeting and in the planning process, followed by our reflections as a group of authors on their significance for governance leaders in the coming years. We acknowledge that the views represented at the meeting and in our results are a partial representation of the universe of views on this topic; however, the GFBR leadership invested a great deal of resources in convening a deeply diverse and thoughtful group of researchers and practitioners working on themes of bioethics related to AI for global health including those based in LMICs. We contend that it remains rare to convene such a strong group for an extended time and believe that many of the challenges and opportunities raised demand attention for more ethical futures of AI for health. Nonetheless, our results are primarily descriptive and are thus not explicitly grounded in a normative argument. We make effort in the Discussion section to contextualize our results by describing their significance and connecting them to broader efforts to reform global health research and practice.

Uniquely important ethical issues for AI in global health research

Presentations and group dialogue over the course of the forum raised several issues for consideration, and here we describe four overarching themes for the ethical governance of AI in global health research. Brief descriptions of each issue can be found in Table  1 . Reports referred to throughout the paper are available at the GFBR website provided above.

The first overarching thematic issue relates to the appropriateness of building AI technologies in response to health-related challenges in the first place. Case study presentations referred to initiatives where AI technologies were highly appropriate, such as in ear shape biometric identification to more accurately link electronic health care records to individual patients in Zambia (Alinani Simukanga). Although important ethical issues were raised with respect to privacy, trust, and community engagement in this initiative, the AI-based solution was appropriately matched to the challenge of accurately linking electronic records to specific patient identities. In contrast, forum participants raised questions about the appropriateness of an initiative using AI to improve the quality of handwashing practices in an acute care hospital in India (Niyoshi Shah), which led to gaming the algorithm. Overall, participants acknowledged the dangers of techno-solutionism, in which AI researchers and developers treat AI technologies as the most obvious solutions to problems that in actuality demand much more complex strategies to address [ 24 ]. However, forum participants agreed that RECs in different contexts have differing degrees of power to raise issues of the appropriateness of an AI-based intervention.

The second overarching thematic issue related to whether and how AI-based systems transfer from one national health context to another. One central issue raised by a number of case study presentations related to the challenges of validating an algorithm with data collected in a local environment. For example, one case study presentation described a project that would involve the collection of personally identifiable data for sensitive group identities, such as tribe, clan, or religion, in the jurisdictions involved (South Africa, Nigeria, Tanzania, Uganda and the US; Gakii Masunga). Doing so would enable the team to ensure that those groups were adequately represented in the dataset to ensure the resulting algorithm was not biased against specific community groups when deployed in that context. However, some members of these communities might desire to be represented in the dataset, whereas others might not, illustrating the need to balance autonomy and inclusivity. It was also widely recognized that collecting these data is an immense challenge, particularly when historically oppressive practices have led to a low-trust environment for international organizations and the technologies they produce. It is important to note that in some countries such as South Africa and Rwanda, it is illegal to collect information such as race and tribal identities, re-emphasizing the importance for cultural awareness and avoiding “one size fits all” solutions.

The third overarching thematic issue is related to understanding accountabilities for both the impacts of AI technologies and governance decision-making regarding their use. Where global health research involving AI leads to longer-term harms that might fall outside the usual scope of issues considered by a REC, who is to be held accountable, and how? This question was raised as one that requires much further attention, with law being mixed internationally regarding the mechanisms available to hold researchers, innovators, and their institutions accountable over the longer term. However, it was recognized in breakout group discussion that many jurisdictions are developing strong data protection regimes related specifically to international collaboration for research involving health data. For example, Kenya’s Data Protection Act requires that any internationally funded projects have a local principal investigator who will hold accountability for how data are shared and used [ 25 ]. The issue of research partnerships with commercial entities was raised by many participants in the context of accountability, pointing toward the urgent need for clear principles related to strategies for engagement with commercial technology companies in global health research.

The fourth and final overarching thematic issue raised here is that of consent. The issue of consent was framed by the widely shared recognition that models of individual, explicit consent might not produce a supportive environment for AI innovation that relies on the secondary uses of health-related datasets to build AI algorithms. Given this recognition, approaches such as community oversight of health data uses were suggested as a potential solution. However, the details of implementing such community oversight mechanisms require much further attention, particularly given the unique perspectives on health data in different country settings in global health research. Furthermore, some uses of health data do continue to require consent. One case study of South Africa, Nigeria, Kenya, Ethiopia and Uganda suggested that when health data are shared across borders, individual consent remains necessary when data is transferred from certain countries (Nezerith Cengiz). Broader clarity is necessary to support the ethical governance of health data uses for AI in global health research.

Recommendations for ethical governance of AI in global health research

Dialogue at the forum led to a range of suggestions for promoting ethical conduct of AI research for global health, related to the various roles of actors involved in the governance of AI research broadly defined. The strategies are written for actors we refer to as “governance leaders”, those people distributed throughout the AI for global health research ecosystem who are responsible for ensuring the ethical and socially responsible conduct of global health research involving AI (including researchers themselves). These include RECs, government regulators, health care leaders, health professionals, corporate social accountability officers, and others. Enacting these strategies would bolster the ethical governance of AI for global health more generally, enabling multiple actors to fulfill their roles related to governing research and development activities carried out across multiple organizations, including universities, academic health sciences centers, start-ups, and technology corporations. Specific suggestions are summarized in Table  2 .

First, forum participants suggested that governance leaders including RECs, should remain up to date on recent advances in the regulation of AI for health. Regulation of AI for health advances rapidly and takes on different forms in jurisdictions around the world. RECs play an important role in governance, but only a partial role; it was deemed important for RECs to acknowledge how they fit within a broader governance ecosystem in order to more effectively address the issues within their scope. Not only RECs but organizational leaders responsible for procurement, researchers, and commercial actors should all commit to efforts to remain up to date about the relevant approaches to regulating AI for health care and public health in jurisdictions internationally. In this way, governance can more adequately remain up to date with advances in regulation.

Second, forum participants suggested that governance leaders should focus on ethical governance of health data as a basis for ethical global health AI research. Health data are considered the foundation of AI development, being used to train AI algorithms for various uses [ 26 ]. By focusing on ethical governance of health data generation, sharing, and use, multiple actors will help to build an ethical foundation for AI development among global health researchers.

Third, forum participants believed that governance processes should incorporate AI impact assessments where appropriate. An AI impact assessment is the process of evaluating the potential effects, both positive and negative, of implementing an AI algorithm on individuals, society, and various stakeholders, generally over time frames specified in advance of implementation [ 27 ]. Although not all types of AI research in global health would warrant an AI impact assessment, this is especially relevant for those studies aiming to implement an AI system for intervention into health care or public health. Organizations such as RECs can use AI impact assessments to boost understanding of potential harms at the outset of a research project, encouraging researchers to more deeply consider potential harms in the development of their study.

Fourth, forum participants suggested that governance decisions should incorporate the use of environmental impact assessments, or at least the incorporation of environment values when assessing the potential impact of an AI system. An environmental impact assessment involves evaluating and anticipating the potential environmental effects of a proposed project to inform ethical decision-making that supports sustainability [ 28 ]. Although a relatively new consideration in research ethics conversations [ 29 ], the environmental impact of building technologies is a crucial consideration for the public health commitment to environmental sustainability. Governance leaders can use environmental impact assessments to boost understanding of potential environmental harms linked to AI research projects in global health over both the shorter and longer terms.

Fifth, forum participants suggested that governance leaders should require stronger transparency in the development of AI algorithms in global health research. Transparency was considered essential in the design and development of AI algorithms for global health to ensure ethical and accountable decision-making throughout the process. Furthermore, whether and how researchers have considered the unique contexts into which such algorithms may be deployed can be surfaced through stronger transparency, for example in describing what primary considerations were made at the outset of the project and which stakeholders were consulted along the way. Sharing information about data provenance and methods used in AI development will also enhance the trustworthiness of the AI-based research process.

Sixth, forum participants suggested that governance leaders can encourage or require community engagement at various points throughout an AI project. It was considered that engaging patients and communities is crucial in AI algorithm development to ensure that the technology aligns with community needs and values. However, participants acknowledged that this is not a straightforward process. Effective community engagement requires lengthy commitments to meeting with and hearing from diverse communities in a given setting, and demands a particular set of skills in communication and dialogue that are not possessed by all researchers. Encouraging AI researchers to begin this process early and build long-term partnerships with community members is a promising strategy to deepen community engagement in AI research for global health. One notable recommendation was that research funders have an opportunity to incentivize and enable community engagement with funds dedicated to these activities in AI research in global health.

Seventh, forum participants suggested that governance leaders can encourage researchers to build strong, fair partnerships between institutions and individuals across country settings. In a context of longstanding imbalances in geopolitical and economic power, fair partnerships in global health demand a priori commitments to share benefits related to advances in medical technologies, knowledge, and financial gains. Although enforcement of this point might be beyond the remit of RECs, commentary will encourage researchers to consider stronger, fairer partnerships in global health in the longer term.

Eighth, it became evident that it is necessary to explore new forms of regulatory experimentation given the complexity of regulating a technology of this nature. In addition, the health sector has a series of particularities that make it especially complicated to generate rules that have not been previously tested. Several participants highlighted the desire to promote spaces for experimentation such as regulatory sandboxes or innovation hubs in health. These spaces can have several benefits for addressing issues surrounding the regulation of AI in the health sector, such as: (i) increasing the capacities and knowledge of health authorities about this technology; (ii) identifying the major problems surrounding AI regulation in the health sector; (iii) establishing possibilities for exchange and learning with other authorities; (iv) promoting innovation and entrepreneurship in AI in health; and (vi) identifying the need to regulate AI in this sector and update other existing regulations.

Ninth and finally, forum participants believed that the capabilities of governance leaders need to evolve to better incorporate expertise related to AI in ways that make sense within a given jurisdiction. With respect to RECs, for example, it might not make sense for every REC to recruit a member with expertise in AI methods. Rather, it will make more sense in some jurisdictions to consult with members of the scientific community with expertise in AI when research protocols are submitted that demand such expertise. Furthermore, RECs and other approaches to research governance in jurisdictions around the world will need to evolve in order to adopt the suggestions outlined above, developing processes that apply specifically to the ethical governance of research using AI methods in global health.

Research involving the development and implementation of AI technologies continues to grow in global health, posing important challenges for ethical governance of AI in global health research around the world. In this paper we have summarized insights from the 2022 GFBR, focused specifically on issues in research ethics related to AI for global health research. We summarized four thematic challenges for governance related to AI in global health research and nine suggestions arising from presentations and dialogue at the forum. In this brief discussion section, we present an overarching observation about power imbalances that frames efforts to evolve the role of governance in global health research, and then outline two important opportunity areas as the field develops to meet the challenges of AI in global health research.

Dialogue about power is not unfamiliar in global health, especially given recent contributions exploring what it would mean to de-colonize global health research, funding, and practice [ 30 , 31 ]. Discussions of research ethics applied to AI research in global health contexts are deeply infused with power imbalances. The existing context of global health is one in which high-income countries primarily located in the “Global North” charitably invest in projects taking place primarily in the “Global South” while recouping knowledge, financial, and reputational benefits [ 32 ]. With respect to AI development in particular, recent examples of digital colonialism frame dialogue about global partnerships, raising attention to the role of large commercial entities and global financial capitalism in global health research [ 21 , 22 ]. Furthermore, the power of governance organizations such as RECs to intervene in the process of AI research in global health varies widely around the world, depending on the authorities assigned to them by domestic research governance policies. These observations frame the challenges outlined in our paper, highlighting the difficulties associated with making meaningful change in this field.

Despite these overarching challenges of the global health research context, there are clear strategies for progress in this domain. Firstly, AI innovation is rapidly evolving, which means approaches to the governance of AI for health are rapidly evolving too. Such rapid evolution presents an important opportunity for governance leaders to clarify their vision and influence over AI innovation in global health research, boosting the expertise, structure, and functionality required to meet the demands of research involving AI. Secondly, the research ethics community has strong international ties, linked to a global scholarly community that is committed to sharing insights and best practices around the world. This global community can be leveraged to coordinate efforts to produce advances in the capabilities and authorities of governance leaders to meaningfully govern AI research for global health given the challenges summarized in our paper.

Limitations

Our paper includes two specific limitations that we address explicitly here. First, it is still early in the lifetime of the development of applications of AI for use in global health, and as such, the global community has had limited opportunity to learn from experience. For example, there were many fewer case studies, which detail experiences with the actual implementation of an AI technology, submitted to GFBR 2022 for consideration than was expected. In contrast, there were many more governance reports submitted, which detail the processes and outputs of governance processes that anticipate the development and dissemination of AI technologies. This observation represents both a success and a challenge. It is a success that so many groups are engaging in anticipatory governance of AI technologies, exploring evidence of their likely impacts and governing technologies in novel and well-designed ways. It is a challenge that there is little experience to build upon of the successful implementation of AI technologies in ways that have limited harms while promoting innovation. Further experience with AI technologies in global health will contribute to revising and enhancing the challenges and recommendations we have outlined in our paper.

Second, global trends in the politics and economics of AI technologies are evolving rapidly. Although some nations are advancing detailed policy approaches to regulating AI more generally, including for uses in health care and public health, the impacts of corporate investments in AI and political responses related to governance remain to be seen. The excitement around large language models (LLMs) and large multimodal models (LMMs) has drawn deeper attention to the challenges of regulating AI in any general sense, opening dialogue about health sector-specific regulations. The direction of this global dialogue, strongly linked to high-profile corporate actors and multi-national governance institutions, will strongly influence the development of boundaries around what is possible for the ethical governance of AI for global health. We have written this paper at a point when these developments are proceeding rapidly, and as such, we acknowledge that our recommendations will need updating as the broader field evolves.

Ultimately, coordination and collaboration between many stakeholders in the research ethics ecosystem will be necessary to strengthen the ethical governance of AI in global health research. The 2022 GFBR illustrated several innovations in ethical governance of AI for global health research, as well as several areas in need of urgent attention internationally. This summary is intended to inform international and domestic efforts to strengthen research ethics and support the evolution of governance leadership to meet the demands of AI in global health research.

Data availability

All data and materials analyzed to produce this paper are available on the GFBR website: https://www.gfbr.global/past-meetings/16th-forum-cape-town-south-africa-29-30-november-2022/ .

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Acknowledgements

We would like to acknowledge the outstanding contributions of the attendees of GFBR 2022 in Cape Town, South Africa. This paper is authored by members of the GFBR 2022 Planning Committee. We would like to acknowledge additional members Tamra Lysaght, National University of Singapore, and Niresh Bhagwandin, South African Medical Research Council, for their input during the planning stages and as reviewers of the applications to attend the Forum.

This work was supported by Wellcome [222525/Z/21/Z], the US National Institutes of Health, the UK Medical Research Council (part of UK Research and Innovation), and the South African Medical Research Council through funding to the Global Forum on Bioethics in Research.

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Shaw, J., Ali, J., Atuire, C.A. et al. Research ethics and artificial intelligence for global health: perspectives from the global forum on bioethics in research. BMC Med Ethics 25 , 46 (2024). https://doi.org/10.1186/s12910-024-01044-w

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Why public health matters today and tomorrow: the role of applied public health research

Lindsay mclaren.

1 University of Calgary, Calgary, Canada

Paula Braitstein

2 University of Toronto, Toronto, Canada

David Buckeridge

3 McGill University, Montreal, Canada

Damien Contandriopoulos

4 University of Victoria, Victoria, Canada

Maria I. Creatore

5 CIHR Institute of Population & Public Health and University of Toronto, Toronto, Canada

Guy Faulkner

6 University of British Columbia, Vancouver, Canada

David Hammond

7 University of Waterloo, Waterloo, Canada

Steven J. Hoffman

8 CIHR Institute of Population & Public Health and York University, Toronto, Canada

Yan Kestens

9 Université de Montréal, Montreal, Canada

Scott Leatherdale

Jonathan mcgavock.

10 University of Manitoba and the Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada

Wendy V. Norman

11 University of British Columbia, Vancouver, Canada

Candace Nykiforuk

12 University of Alberta, Edmonton, Canada

Valéry Ridde

13 IRD (French Institute For Research on Sustainable Development), CEPED (IRD-Université Paris Descartes), ERL INSERM SAGESUD, Université Paris Sorbonne Cités, Paris, France

14 University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada

Janet Smylie

Public health is critical to a healthy, fair, and sustainable society. Realizing this vision requires imagining a public health community that can maintain its foundational core while adapting and responding to contemporary imperatives such as entrenched inequities and ecological degradation. In this commentary, we reflect on what tomorrow’s public health might look like, from the point of view of our collective experiences as researchers in Canada who are part of an Applied Public Health Chairs program designed to support “innovative population health research that improves health equity for citizens in Canada and around the world.” We view applied public health research as sitting at the intersection of core principles for population and public health: namely sustainability, equity, and effectiveness. We further identify three attributes of a robust applied public health research community that we argue are necessary to permit contribution to those principles: researcher autonomy, sustained intersectoral research capacity, and a critical perspective on the research-practice-policy interface. Our intention is to catalyze further discussion and debate about why and how public health matters today and tomorrow, and the role of applied public health research therein.

Résumé

La santé publique est essentielle à une société saine, juste et durable. Pour donner forme à cette vision, il faut imaginer une communauté de la santé publique capable de préserver ses valeurs fondamentales tout en s’adaptant et en réagissant aux impératifs du moment, comme les inégalités persistantes et la dégradation de l’environnement. Dans notre commentaire, nous esquissons un portrait possible de la santé publique de demain en partant de notre expérience collective de chercheurs d’un programme canadien de chaires en santé publique appliquée qui visent à appuyer « la recherche innovatrice sur la santé de la population en vue d’améliorer l’équité en santé au Canada et ailleurs ». Nous considérons la recherche appliquée en santé publique comme se trouvant à la croisée des principes fondamentaux de la santé publique et des populations, à savoir : la durabilité, l’équité et l’efficacité. Nous définissons aussi les trois attributs d’une solide communauté de recherche appliquée en santé publique nécessaires selon nous au respect de ces principes : l’autonomie des chercheurs, une capacité de recherche intersectorielle soutenue et une perspective critique de l’interface entre la recherche, la pratique et les politiques. Nous voulons susciter des discussions et des débats approfondis sur l’importance de la santé publique pour aujourd’hui et pour demain et sur le rôle de la recherche appliquée en santé publique.

Introduction

Public health is critical to a healthy, fair, and sustainable society. Public health’s role in this vision stems from its foundational values of social justice and collectivity (Rutty and Sullivan 2010 ) and—we argue—from its position at the interface of research, practice, and policy.

Realizing this vision requires imagining a public health community that can maintain that foundational core, embrace opportunities of our changing world, and predict and adapt to emerging challenges in a timely manner. Unprecedented ecosystem disruption creates far-reaching health implications for which the public health community is unprepared (CPHA 2015 ; Whitmee et al. 2015 ). Human displacement is at its highest levels on record; those forced from home include “stateless people,” who are denied access to basic rights such as education, health care, employment, and freedom of movement ( http://www.unhcr.org/figures-at-a-glance.html ). Significant growth in urban populations creates an urgent need to improve urban environments, including policies to reduce air pollution and prevent sprawl (CPHA 2015 ; Frumkin et al. 2004 ), to reduce the substantial burden of morbidity and mortality attributable to behaviours such as physical inactivity, which negatively impact quality and quantity of life (Manuel et al. 2016 ). Significant and entrenched forms of economic, social, political, and historical marginalization and exclusion (TRC 2015 ), coupled with inequitable and unsustainable patterns of resource consumption and technological development (CPHA 2015 ; Whitmee et al. 2015 ), cause and perpetuate health inequities. These inequities underlie the now longstanding recognition that the unequal distributions of health-damaging experiences are the main determinants of health (CSDH 2008 ; Ridde 2004 ).

These imperatives demand a broadly characterized public health community. A now classic definition of public health is the science and art of preventing disease, prolonging life, and promoting health through the organized efforts of society (Last 2001 ). Public health, conceptualized in this manner, engages multiple sectors, embraces inclusion and empowerment (Ridde 2007 ), and demands navigating diverse political and economic agendas. Across Canada, a large and growing proportion of provincial spending is devoted to health care, while the proportion devoted to social spending (i.e., the social determinants of health) is small, flat-lining, and in some places declining (Dutton et al. 2018 ). Recent discourse has highlighted a weakening of formal public health infrastructure (Guyon et al. 2017 ) and points of fracture within the field (Lucyk and McLaren 2017 ). Efforts to strengthen public health, in its broadest sense, and to work towards unity of purpose (Talbot 2018 ) are needed now more than ever. What might such efforts look like?

We reflect on this question from our perspectives as researchers who are part of an Applied Public Health Chairs (APHC) program designed to support “innovative population health research that improves health equity for citizens in Canada and around the world.” 1 The applied dimension 2 is facilitated through the program’s focus on “interdisciplinary collaborations and mentorship of researchers and decision makers in health and other sectors” ( http://www.cihr-irsc.gc.ca/e/48898.html ). The APHC program (Box 1) is part of a broader set of efforts to address gaps in public health capacity, including research. Cross-cutting themes for the 2014 cohort (Box 2) include the following: healthy public policy, supportive environments (e.g., cities), diverse methodological approaches, global health, and health equity; many of which 3 align with a Public Health Services and Systems Research perspective in that they “identif[y] the implementation strategies that work, building evidence to support decision-making across the public health sphere” ( http://www.publichealthsystems.org/ ). Applied public health research is broad and could span CIHR Pillars 4 (social, cultural, environmental, and population health research) and 3 (health services research); the 2014 APHC cohort is predominantly aligned with Pillar 4.

The APHC program represents a significant Canadian investment in public health, and thus provides an important vantage point from which to reflect on why public health matters today, and tomorrow.

Box 1 The Applied Public Health Chairs program

Box 2 2014 cohort of Applied Public Health Chairs

More details available at: http://www.cihr-irsc.gc.ca/e/48898.html

Our proposal

We propose that applied public health research is a critical component of a robust population and public health community. As illustrated in Fig.  1 , we view applied public health research as sitting at the nexus of three core principles: (1) sustainability, (2) equity, and (3) effectiveness, which align with a vision of public health as critical to a healthy, fair, and sustainable society. By sustainability , we mean an approach or way of thinking, about public health in particular (e.g., Schell et al. 2013 ) and population well-being more broadly ( https://sustainabledevelopment.un.org/sdgs ) that emphasizes “meet[ing] the needs of the present generation without compromising the ability of future generations to meet their own needs” (Brundtland et al. 1987 ). Sustainability has social, economic, environmental, and political dimensions. We define equity as a worldview concerned with the embedded or systemic—and often invisible—drivers of unfair distributions of health-damaging experiences. In Canada and elsewhere, inequity is entrenched in legacies of colonial, structural racism designed to sustain inequitable patterns of power and wealth. Equity transcends diverse axes and perspectives, and an equity lens is action-oriented (Ridde 2007 ). Finally, effectiveness refers to impact or benefits for population well-being, as demonstrated by rigorous research. Explicit core values (e.g., equity), while important, are insufficient without translation to demonstrable outcomes (Potvin and Jones 2011 ). These core principles—sustainability, equity, and effectiveness—overlap and are mutually reinforcing; for example, the inequitable concentration of power, wealth, and exploitation of resources precludes sustainability.

Visual depiction of the role and attributes of applied public health research, vis-à-vis core population and public health principles of equity, sustainability, and effectiveness

Although these principles are applicable to the public health community broadly (i.e., including but not limited to researchers), applied public health researchers are uniquely situated to embrace sustainability, equity, and effectiveness when asking questions and generating policy- and practice-relevant knowledge, as illustrated below. Drawing on our collective experiences, we describe three necessary attributes of applied public health research that support our model in Fig.  1 : researcher autonomy, sustained intersectoral research capacity; and a critical perspective on the research-practice-policy interface. We assert that applied public health research is best positioned to contribute meaningfully to the principles of sustainability, effectiveness, and equity if the attributes described below are in place.

Researcher autonomy

Researcher autonomy is a precondition for innovation and independent thinking, and for building and sustaining the conditions for collective efforts. Our working definition of researcher autonomy is the capacity to devote time and energy to activities that, at the researcher’s discretion, facilitate research that embraces principles of sustainability, effectiveness, and equity. Autonomy, beyond the scope of general academic independence, provides the freedom to build and nurture partnerships, and to navigate among universities, health care systems, governments, communities, and across sectors. Effective and respectful partnerships are critical to rigorous intersectoral work and can provide an important platform to discuss systemic forms of inequity (e.g., Olivier et al. 2016 ; Morton Ninomiya et al. 2017 ). Recognizing a potential tension around the role of the researcher in an applied public health context, we deliberately selected the word “autonomy,” which we view as conducive to meaningful collaboration (although that may be experienced differently by different researchers), rather than “independence” which can be seen as contrary to such collaboration. Yet despite their importance, the time and resources to form and sustain those relationships are often not accommodated within funding and academic structures.

Autonomy, when coupled with resources and recognition, permits applied public health researchers to balance foundations of public health with current policy relevance. Although many of us have research programs with particular thematic foci (e.g., physical activity, dental health, HIV), autonomy provides space and credibility to connect those focal issues to enduring and evolving problems in public health (e.g., determinants of population well-being and equity), and to inform the contemporary policy context. Examples include research on health implications of neighbourhood gentrification in urban settings (Steinmetz-Wood et al. 2017 ); using community water fluoridation as a window into public and political understanding and acceptance of public health interventions that are universal in nature (McLaren and Petit 2018 ); and using innovative sampling methods to identify how census methods can perpetuate exclusion (Rotondi et al. 2017 ). That latter work, which estimated that the national census undercounts urban Indigenous populations in Toronto by a factor of approximately 2–4, provides impetus to work towards an inclusive system that respects individual and collective data sovereignty, and that is accountable to the communities from whom data are collected.

These implications of autonomy are consistent with calls for greater reflexivity in public health research (Tremblay and Parent 2014 ).

Insight : To strengthen applied public health research in Canada, researcher autonomy – whereby researchers have the credibility and protected time to set their own agendas in partnerships with the communities they serve – must be privileged.

Sustained intersectoral research capacity

Applied public health research requires funding for resources and infrastructure that are essential to sustain an intersectoral research program, but for which operating funds are otherwise not readily available. Examples include ongoing cohort studies (e.g., Leatherdale et al. 2014 ), research software platforms (e.g., Shaban-Nejad et al. 2017 ), meaningful public sector engagement in developing public health priorities, and knowledge translation activities.

Partnerships, also considered under researcher autonomy above, are one form of intersectoral research capacity. In applied public health research, having strong partnerships in place permits timely response to research opportunities that arise quickly in real-world settings. Examples in our cohort include instances where researchers were able to mobilize for rapid response funding competitions in areas of environment and health, communicable disease in the global South, and Indigenous training networks, because collaborative teams and potential for knowledge co-creation and transfer were already in place.

Insight : A robust applied public health research community requires sustained funding to support foundations of a credible and internationally-competitive research program (e.g., cohort studies, research software platforms, meaningful public sector engagement) that are difficult to resource via usual operating grant channels.

A critical perspective on the research-practice-policy interface

One barrier to evidence-based policy in applied public health is an assumption that evidence is the most important factor in making policy decisions, versus a more holistic view of the policymaking process where evidence is one of many factors, as discussed in recent work (Fafard and Hoffman 2018 ; O’Neill et al. 2019 ; Ridde and Yaméogo 2018 ).

Applied public health research is ideally positioned to embrace a critical perspective on the research-practice-policy interface. Several recent trends are promising in that regard. These include the following: substantive efforts to bridge public health and social science scholarship ( http://www.cihr-irsc.gc.ca/e/50604.html ), growing success by Pillar 4 researchers (including applied public health) in CIHR’s open funding competitions ( http://www.cihr-irsc.gc.ca/e/50488.html ), and the CIHR Health System Impact Fellowship initiative ( http://www.cihr-irsc.gc.ca/e/50612.html ), which could facilitate the placement of doctoral and post-doctoral academic researchers within the public health system and related (e.g., public, NGO) organizations.

Insight : Applied public health researchers are ideally positioned to embrace and model a sophisticated and interdisciplinary perspective on the research-practice-policy interface. To do so, opportunities for researchers (including trainees) to gain skills and experience to navigate the policy context are needed.

Against the backdrop of discourse about a weakening of public health infrastructure and fracture within the field (Guyon et al. 2017 ; Lucyk and McLaren 2017 ), we believe that there is value in working towards a unity of purpose (Talbot 2018 ). This commentary was prompted by a shared belief that through our experience with the Applied Public Health Chair Program, we have seen a glimpse of what is needed to achieve a population and public health community that is positioned to tackle societal imperatives, which includes an important role for applied public health research, spanning CIHR Pillars 3 and 4. Anchored in principles of sustainability, equity, and effectiveness, we assert a strong need for applied research infrastructure that privileges and supports: researcher autonomy, sustained funding to support foundations of a credible and internationally competitive research program, and opportunities for researchers (including trainees) to gain skills and experience to navigate the policy context. We welcome and invite further discussion and debate.

1 Under CIHR-IPPH’s mandate, population health research refers to “research into the complex biological, social, cultural, and environmental interactions that determine the health of individuals, communities, and global populations.”

2 Applied may be defined as follows: “put to practical use,” as opposed to being theoretical ( https://www.merriam-webster.com/dictionary/applied ).

3 For example: https://uwaterloo.ca/compass-system/ (Leatherdale); http://cart-grac.ubc.ca/ (Norman); http://www.healthsystemsglobal.org/ (Ridde).

The original version of this article was revised due to a retrospective Open Access order.

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PENN GLOBAL RESEARCH & ENGAGEMENT GRANT PROGRAM 2024 Grant Program Awardees

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In 2024, Penn Global will support 24 new faculty-led research and engagement projects at a total funding level of $1.5 million.

The Penn Global Research and Engagement Grant Program prioritizes projects that bring together leading scholars and practitioners across the University community and beyond to develop new insight on significant global issues in key countries and regions around the world, a core pillar of Penn’s global strategic framework. 

PROJECTS SUPPORTED BY THE HOLMAN AFRICA RESEARCH AND ENGAGEMENT FUND

• Global Medical Physics Training & Development Program  Stephen Avery, Perelman School of Medicine
• Developing a Dakar Greenbelt with Blue-Green Wedges Proposal  Eugenie Birch, Weitzman School of Design
• Emergent Judaism in Sub-Saharan Africa  Peter Decherney, School of Arts and Sciences / Sara Byala, School of Arts and Sciences
• Determinants of Cognitive Aging among Older Individuals in Ghana  Irma Elo, School of Arts and Sciences
• Disrupted Aid, Displaced Lives Guy Grossman, School of Arts and Sciences
• A History of Regenerative Agriculture Practices from the Global South: Case Studies from Ethiopia, Kenya, and Zimbabwe Thabo Lenneiye, Kleinman Energy Center / Weitzman School of Design
• Penn Computerized Neurocognitive Battery Use in Botswana Public Schools Elizabeth Lowenthal, Perelman School of Medicine
• Podcasting South African Jazz Past and Present Carol Muller, School of Arts and Sciences
• Lake Victoria Megaregion Study: Joint Lakefront Initiative Frederick Steiner, Weitzman School of Design
• Leveraging an Open Source Software to Prevent and Contain AMR Jonathan Strysko, Perelman School of Medicine
• Poverty reduction and children's neurocognitive growth in Cote d'Ivoire Sharon Wolf, Graduate School of Education
• The Impacts of School Connectivity Efforts on Education Outcomes in Rwanda  Christopher Yoo, Carey Law School

PROJECTS SUPPORTED BY THE INDIA RESEARCH AND ENGAGEMENT FUND

• Routes Beyond Conflict: A New Approach to Cultural Encounters in South Asia  Daud Ali, School of Arts and Sciences
• Prioritizing Air Pollution in India’s Cities Tariq Thachil, Center for the Advanced Study of India / School of Arts and Sciences
• Intelligent Voicebots to Help Indian Students Learn English Lyle Ungar, School of Engineering and Applied Sciences

PROJECTS SUPPORTED BT THE CHINA RESEARCH AND ENGAGEMENT FUND

• Planning Driverless Cities in China Zhongjie Lin, Weitzman School of Design

PROJECTS SUPPORTED BY THE GLOBAL ENGAGEMENT FUND 

• Education and Economic Development in Nepal Amrit Thapa, Graduate School of Education
• Explaining Climate Change Regulation in Cities: Evidence from Urban Brazil Alice Xu, School of Arts and Sciences
• Nurse Staffing Legislation for Scotland: Lessons for the U.S. and the U.K.  Eileen Lake, School of Nursing
• Pathways to Education Development & Their Consequences: Finland, Korea, US Hyunjoon Park, School of Arts and Sciences
• Engaged Scholarship in Latin America: Bridging Knowledge and Action Tulia Falleti, School of Arts and Sciences
• Organizing Migrant Communities to Realize Rights in Palermo, Sicily  Domenic Vitiello, Weitzman School of Design
• Exploiting Cultural Heritage in 21st Century Conflict   Fiona Cunningham, School of Arts and Sciences
• Center for Integrative Global Oral Health   Alonso Carrasco-Labra, School of Dental Medicine

This first-of-its-kind Global Medical Physics Training and Development Program (GMPTDP) seeks to serve as an opportunity for PSOM and SEAS graduate students to enhance their clinical requirement with a global experience, introduce them to global career opportunities and working effectively in different contexts, and strengthens partnerships for education and research between US and Africa. This would also be an exceptional opportunity for pre-med/pre-health students and students interested in health tech to have a hands-on global experience with some of the leading professionals in the field. The project will include instruction in automated radiation planning through artificial intelligence (AI); this will increase access to quality cancer care by standardizing radiation planning to reduce inter-user variability and error, decreasing workload on the limited radiation workforce, and shortening time to treatment for patients. GMPTDP will offer a summer clinical practicum to Penn students during which time they will also collaborate with UGhana to implement and evaluate AI tools in the clinical workflow.

The proposal will address today’s pressing crises of climate change, land degradation, biodiversity loss, and growing economic disparities with a holistic approach that combines regional and small-scale actions necessary to achieve sustainability. It will also tackle a key issue found across sub-Saharan Africa, many emerging economies, and economically developed countries that struggle to control rapid unplanned urbanization that vastly outpaces the carrying capacity of the surrounding environment.

The regional portion of the project will create a framework for a greenbelt that halts the expansion of the metropolitan footprint. It will also protect the Niayes, an arable strip of land that produces over 80% of the country’s vegetables, from degradation. This partnership will also form a south-south collaboration to provide insights into best practices from a city experiencing similar pressures.

The small-scale portion of the project will bolster and create synergy with ongoing governmental and grassroots initiatives aimed at restoring green spaces currently being infilled or degraded in the capital. This will help to identify overlapping goals between endeavors, leading to collaboration and mobilizing greater funding possibilities instead of competing over the same limited resources. With these partners, we will identify and design Nature-based Solutions for future implementation.

Conduct research through fieldwork to examine questions surrounding Jewish identity in Africa. Research will be presented in e.g. articles, photographic images, and films, as well as in a capstone book. In repeat site-visits to Uganda, South Africa, Ghana, and Zimbabwe, we will conduct interviews with and take photographs of stakeholders from key communities in order to document their everyday lives and religious practices.

The overall aim of this project is the development of a nationally representative study on aging in Ghana. This goal requires expanding our network of Ghanian collaborators and actively engage them in research on aging. The PIs will build on existing institutional contacts in Ghana that include:

1). Current collaboration with the Navrongo Health Research Center (NCHR) on a pilot data collection on cognitive aging in Ghana (funded by a NIA supplement and which provides the matching funds for this Global Engagement fund grant application);

2) Active collaboration with the Regional Institute for Population Studies (RIPS), University of Ghana. Elo has had a long-term collaboration with Dr. Ayaga Bawah who is the current director of RIPS.

In collaboration with UNHCR, we propose studying the effects of a dramatic drop in the level of support for refugees, using a regression discontinuity design to survey 2,500 refugee households just above and 2,500 households just below the vulnerability score cutoff that determines eligibility for full rations. This study will identify the effects of aid cuts on the welfare of an important marginalized population, and on their livelihood adaptation strategies. As UNHCR faces budgetary cuts in multiple refugee-hosting contexts, our study will inform policymakers on the effects of funding withdrawal as well as contribute to the literature on cash transfers.

The proposed project, titled "A History of Regenerative Agriculture Practices from the Global South: Case Studies from Ethiopia, Kenya, and Zimbabwe," aims to delve into the historical and contemporary practices of regenerative agriculture in sub-Saharan Africa. Anticipated Outputs and Outcomes:

1. Research Paper: The primary output of this project will be a comprehensive research paper. This paper will draw from a rich pool of historical and contemporary data to explore the history of regenerative agriculture practices in Ethiopia, Kenya, and Zimbabwe. It will document the indigenous knowledge and practices that have sustained these regions for generations.

2. Policy Digest: In addition to academic research, the project will produce a policy digest. This digest will distill the research findings into actionable insights for policymakers, both at the national and international levels. It will highlight the benefits of regenerative agriculture and provide recommendations for policy frameworks that encourage its adoption.

3. Long-term Partnerships: The project intends to establish long-term partnerships with local and regional universities, such as Great Lakes University Kisumu, Kenya. These partnerships will facilitate knowledge exchange, collaborative research, and capacity building in regenerative agriculture practices. Such collaborations align with Penn Global's goal of strengthening institutional relationships with African partners.

The Penn Computerized Neurocognitive Battery (PCNB) was developed at the University of Pennsylvania by Dr. Ruben C. Gur and colleagues to be administered as part of a comprehensive neuropsychiatric assessment. Consisting of a series of cognitive tasks that help identify individuals’ cognitive strengths and weaknesses, it has recently been culturally adapted and validated by our team for assessment of school-aged children in Botswana . The project involves partnership with the Botswana Ministry of Education and Skills Development (MoESD) to support the rollout of the PCNB for assessment of public primary and secondary school students in Botswana. The multidisciplinary Penn-based team will work with partners in Botswana to guide the PCNB rollout, evaluate fidelity to the testing standards, and track student progress after assessment and intervention. The proposed project will strengthen a well-established partnership between Drs. Elizabeth Lowenthal and J. Cobb Scott from the PSOM and in-country partners. Dr. Sharon Wolf, from Penn’s Graduate School of Education, is an expert in child development who has done extensive work with the Ministry of Education in Ghana to support improvements in early childhood education programs. She is joining the team to provide the necessary interdisciplinary perspective to help guide interventions and evaluations accompanying this new use of the PCNB to support this key program in Africa.

This project will build on exploratory research completed by December 24, 2023 in which the PI interviewed about 35 South Africans involved in jazz/improvised music mostly in Cape Town: venue owners, curators, creators, improvisers.

• Podcast series with 75-100 South African musicians interviewed with their music interspersed in the program.
• 59 minute radio program with extended excerpts of music inserted into the interview itself.
• Create a center of knowledge about South African jazz—its sound and its stories—building knowledge globally about this significant diasporic jazz community
• Expand understanding of “jazz” into a more diffuse area of improvised music making that includes a wide range of contemporary indigenous music and art making
• Partner w Lincoln Center Jazz (and South African Tourism) to host South Africans at Penn

This study focuses on the potential of a Megaregional approach for fostering sustainable development, economic growth, and social inclusion within the East African Community (EAC), with a specific focus on supporting the development of A Vision for An Inclusive Joint Lakefront across the 5 riparian counties in Kenya.

By leveraging the principles of Megaregion development, this project aims to create a unified socio-economic, planning, urbanism, cultural, and preservation strategy that transcends county boundaries and promotes collaboration further afield, among the EAC member countries surrounding the Lake Victoria Basin.

Anticipated Outputs and Outcomes:

1. Megaregion Conceptual Framework: The project will develop a comprehensive Megaregion Conceptual Framework for the Joint Lakefront region in East Africa. This framework, which different regions around the world have applied as a way of bridging local boundaries toward a unified regional vision will give the Kisumu Lake region a path toward cooperative, multi-jurisdictional planning. The Conceptual Framework will be both broad and specific, including actionable strategies, projects, and initiatives aimed at sustainable development, economic growth, social inclusion, and environmental stewardship.

2. Urbanism Projects: Specific urbanism projects will be proposed for key urban centers within the Kenyan riparian counties. These projects will serve as tangible examples of potential improvements and catalysts for broader development efforts.

3. Research Publication: The findings of the study will be captured in a research publication, contributing to academic discourse and increasing Penn's visibility in the field of African urbanism and sustainable development

Antimicrobial resistance (AMR) has emerged as a global crisis, causing more deaths than HIV/AIDS and malaria worldwide. By engaging in a collaborative effort with the Botswana Ministry of Health’s data scientists and experts in microbiology, human and veterinary medicine, and bioinformatics, we will aim to design new electronic medical record system modules that will:

Aim 1: Support the capturing, reporting, and submission of microbiology data from sentinel surveillance laboratories as well as pharmacies across the country

Aim 2: Develop data analytic dashboards for visualizing and characterizing regional AMR and AMC patterns

Aim 3: Submit AMR and AMC data to regional and global surveillance programs

Aim 4: Establish thresholds for alert notifications when disease activity exceeds expected incidence to serve as an early warning system for outbreak detection.

  Using a novel interdisciplinary approach that bridges development economics, psychology, and neuroscience, the overall goal of this project is to improve children's development using a poverty-reduction intervention in Cote d'Ivoire (CIV). The project will directly measure the impacts of cash transfers (CTs) on neurocognitive development, providing a greater understanding of how economic interventions can support the eradication of poverty and ensure that all children flourish and realize their full potential. The project will examine causal mechanisms by which CTs support children’s healthy neurocognitive development and learning outcomes through the novel use of an advanced neuroimaging tool, functional Near Infrared Spectroscopy (fNIRS), direct child assessments, and parent interviews.

The proposed research, the GIGA initiative for Improving Education in Rwanda (GIER), will produce empirical evidence on the impact of connecting schools on education outcomes to enable Rwanda to better understand how to accelerate the efforts to bring connectivity to schools, how to improve instruction and learning among both teachers and students, and whether schools can become internet hubs capable of providing access e-commerce and e-government services to surrounding communities. In addition to evaluating the impact of connecting schools on educational outcomes, the research would also help determine which aspects of the program are critical to success before it is rolled out nationwide.

Through historical epigraphic research, the project will test the hypothesis that historical processes and outcomes in the 14th century were precipitated by a series of related global and local factors and that, moreover, an interdisciplinary and synergistic analysis of these factors embracing climatology, hydrology, epidemiology linguistics and migration will explain the transformation of the cultural, religious and social landscapes of the time more effectively than the ‘clash of civilizations’ paradigm dominant in the field. Outputs include a public online interface for the epigraphic archive; a major international conference at Penn with colleagues from partner universities (Ghent, Pisa, Edinburgh and Penn) as well as the wider South Asia community; development of a graduate course around the research project, on multi-disciplinary approaches to the problem of Hindu-Muslim interaction in medieval India; and a public facing presentation of our findings and methods to demonstrate the path forward for Indian history. Several Penn students, including a postdoc, will be actively engaged.  

India’s competitive electoral arena has failed to generate democratic accountability pressures to reduce toxic air. This project seeks to broadly understand barriers to such pressures from developing, and how to overcome them. In doing so, the project will provide the first systematic study of attitudes and behaviors of citizens and elected officials regarding air pollution in India. The project will 1) conduct in-depth interviews with elected local officials in Delhi, and a large-scale survey of elected officials in seven Indian states affected by air pollution, and 2) partner with relevant civil society organizations, international bodies like the United Nations Environment Program (UNEP), domain experts at research centers like the Public Health Foundation of India (PHFI), and local civic organizations (Janagraaha) to evaluate a range of potential strategies to address pollution apathy, including public information campaigns with highly affected citizens (PHFI), and local pollution reports for policymakers (Janagraaha).

The biggest benefit from generative AI such as GPT, will be the widespread availability of tutoring systems to support education. The project will use this technology to build a conversational voicebot to support Indian students in learning English. The project will engage end users (Indian tutors and their students) in the project from the beginning. The initial prototype voice-driven conversational system will be field-tested in Indian schools and adapted. The project includes 3 stages of development:

1) Develop our conversational agent. Specify the exact initial use case and Conduct preliminary user testing.

2) Fully localize to India, addressing issues identified in Phase 1 user testing.

3) Do comprehensive user testing with detailed observation of 8-12 students using the agent for multiple months; conduct additional assessments of other stakeholders.

The project partners with Ashoka University and Pratham over all three stages, including writing scholarly papers.

Through empirical policy analysis and data-based scenario planning, this project actively contributes to this global effort by investigating planning and policy responses to autonomous transportation in the US and China. In addition to publishing several research papers on this subject, the PI plans to develop a new course and organize a forum at PWCC in 2025. These initiatives are aligned with an overarching endeavor that the PI leads at the Weitzman School of Design, which aims to establish a Future Cities Lab dedicated to research and collaboration in the pursuit of sustainable cities.

This study aims to fill this gap through a more humanistic approach to measuring the impact of education on national development. Leveraging a mixed methods research design consisting of analysis of quantitative data for trends over time, observations of schools and classrooms, and qualitative inquiry via talking to people and hearing their stories, we hope to build a comprehensive picture of educational trends in Nepal and their association with intra-country development. Through this project we strive to better inform the efforts of state authorities and international organizations working to enhance sustainable development within Nepal, while concurrently creating space and guidance for further impact analyses. Among various methods of dissemination of the study’s findings, one key goal is to feed this information into writing a book on this topic.

Developing cities across the world have taken the lead in adopting local environmental regulation. Yet standard models of environmental governance begin with the assumption that local actors should have no incentives for protecting “the commons.” Given the benefits of climate change regulation are diffuse, individual local actors face a collective action problem. This project explores why some local governments bear the costs of environmental regulation while most choose to free-ride. The anticipated outputs of the project include qualitative data that illuminate case studies and the coding of quantitative spatial data sets for studying urban land-use. These different forms of data collection will allow me to develop and test a theoretical framework for understanding when and why city governments adopt environmental policy.

The proposed project will develop new insights on the issue of legislative solutions to the nurse staffing crisis, which will pertain to many U.S. states and U.K. countries. The PI will supervise the nurse survey data collection and to meet with government and nursing association stakeholders to plan the optimal preparation of reports and dissemination of results. The anticipated outputs of the project are a description of variation throughout Scotland in hospital nursing features, including nurse staffing, nurse work environments, extent of adherence to the Law’s required principles, duties, and method, and nurse intent to leave. The outcomes will be the development of capacity for sophisticated quantitative research by Scottish investigators, where such skills are greatly needed but lacking.  

The proposed project will engage multi-cohort, cross-national comparisons of educational-attainment and labor-market experiences of young adults in three countries that dramatically diverge in how they have developed college education over the last three decades: Finland, South Korea and the US. It will produce comparative knowledge regarding consequences of different pathways to higher education, which has significant policy implications for educational and economic inequality in Finland, Korea, the US, and beyond. The project also will lay the foundation for ongoing collaboration among the three country teams to seek external funding for sustained collaboration on educational analyses.

With matching funds from PLAC and CLALS, we will jointly fund four scholars from diverse LAC countries to participate in workshops to engage our community regarding successful practices of community-academic partnerships.

These four scholars and practitioners from Latin America, who are experts on community-engaged scholarship, will visit the Penn campus during the early fall of 2024. As part of their various engagements on campus, these scholars will participate after the workshops as key guest speakers in the 7th edition of the Penn in Latin America and the Caribbean (PLAC) Conference, held on October 11, 2024, at the Perry World House. The conference will focus on "Public and Community Engaged Scholarship in Latin America, the Caribbean, and their Diasporas."

Palermo, Sicily, has been a leading center of migrant rights advocacy and migrant civic participation in the twenty-first century. This project will engage an existing network of diverse migrant community associations and anti-mafia organizations in Palermo to take stock of migrant rights and support systems in the city. Our partner organizations, research assistants, and cultural mediators from different communities will design and conduct a survey and interviews documenting experiences, issues and opportunities related to various rights – to asylum, housing, work, health care, food, education, and more. Our web-based report will include recommendations for city and regional authorities and other actors in civil society. The last phase of our project will involve community outreach and organizing to advance these objectives. The web site we create will be designed as the network’s information center, with a directory of civil society and services, updating an inventory not current since 2014, which our partner Diaspore per la Pace will continue to update.

This interdisciplinary project has four objectives: 1) to investigate why some governments and non-state actors elevated cultural heritage exploitation (CHX) to the strategic level of warfare alongside nuclear weapons, cyberattacks, political influence operations and other “game changers”; 2) which state or non-state actors (e.g. weak actors) use heritage for leverage in conflict and why; and 3) to identify the mechanisms through which CHX coerces an adversary (e.g. catalyzing international involvement); and 4) to identify the best policy responses for non-state actors and states to address the challenge of CHX posed by their adversaries, based on the findings produced by the first three objectives.

Identify the capacity of dental schools, organizations training oral health professionals and conducting oral health research to contribute to oral health policies in the WHO Eastern Mediterranean region, identify the barriers and facilitators to engage in OHPs, and subsequently define research priority areas for the region in collaboration with the WHO, oral health academia, researchers, and other regional stakeholders.

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