It was October 2014, and Ebola was raging out of control in Guinea, Liberia, and Sierra Leone. Margaret Chan, the World Health Organization's director‐general, defended the organization against charges that its response was late and ineffective: “We are a technical agency, with governments having first priority to take care of their people.” In January 2015, the WHO executive board undertook a systematic reform of the agency's performance, and Chan again offered a defense: I followed protocol, leaving (...) it to the Africa office (AFRO) to respond. Yet the three nations could not possibly have stemmed the outbreak alone, and AFRO was known to be dysfunctional.Ebola represents an inflection point requiring fundamental reform for the WHO. A failure of leadership will impact its status and legitimacy for a generation. Here, I offer five reforms that would transform it and ensure that it fulfills its constitutional mission as “the directing and coordinating authority on international health work.”. (shrink)

ArgumentScientific uncertainty is fundamental to the management of contemporary global risks. In 2009, the World Health Organization declared the start of the H1N1 Influenza Pandemic. This declaration signified the risk posed by the spread of the H1N1 virus, and in turn precipitated a range of actions by global public health actors. This article analyzes the WHO's public representation of risk and examines the centrality of scientific uncertainty in the case of H1N1. It argues that the WHO's (...) risk narrative reflected the context of scientific uncertainty in which it was working. The WHO argued that it was attempting to remain faithful to the scientific evidence, and the uncertain nature of the threat. However, as a result, the WHO's public risk narrative was neither consistent nor socially robust, leading to the eventual contestation of the WHO's position by other global public health actors, most notably the Council of Europe. This illustrates both the significance of scientific uncertainty in the investigation of risk, and the difficulty for risk managing institutions in effectively acting in the face of this uncertainty. (shrink)

“I want my leadership to be judged by the impact of our work on the health of two populations: women and the people of Africa.” This is how Dr. Margaret Chan, the current Director-General of the World Health Organization , described her leadership mission. The reason behind this mission is evident. Women and girls constitute 70% of the world’s poor and 80% of the world’s refugees. Gender violence against women aged 15–44 is responsible for (...) more deaths and disability than cancer, malaria, traffic accidents, and war. An estimated 350,000 to 500,000 women still die in childbirth every year. The negative health implications of absolute poverty are worst in Sub-Saharan Africa and South Asia. Hence, Chan aims to have the biggest impact on the world’s poorest people. (shrink)

In the development of a rights-based approach to global health governance, international organizations have looked to human rights under international law as a basis for public health. Operationalizing human rights law through global health policy, the World Health Organization has faced obstacles in efforts to mainstream human rights across the WHO Secretariat. Without centralized human rights leadership in an increasingly fragmented global health policy landscape, regional health offices have sought to advance human (...) rights in health governance and support states in realizing a rights-based approach to health. Examining the efforts of the Pan American Health Organization, this article explores the evolution of human rights in PAHO policy, assesses the mainstreaming of human rights in the Pan American Sanitary Bureau, and analyzes the future of the rights-based approach through regional health governance. (shrink)

The World Health Organisation declared COVID-19 a global pandemic on 11th March 2020, recognising that the underlying SARS-CoV-2 has caused the greatest global crisis since World War II. In this chapter, we present a framework to evaluate whether and to what extent the use of digital systems that track and/or trace potentially infected individuals is not only legal but also ethical.

In 2009, health authorities from Taiwan formally attended the 62nd World Health Assembly of the World Health Organization as observers, marking the country’s participation for the first time since 1972. The long process of negotiating this breakthrough has been cited as an example of successful global health diplomacy. This paper analyses this negotiation process, drawing on government documents, formal representations from both sides of the Taiwan Strait, and key informant interviews. The actors and (...) their motivations, along with the forums, practices and outcomes of the negotiation process, are detailed. While it is argued that non-traditional diplomatic action was important in establishing the case for Taiwan’s inclusion at the WHA, traditional concerns regarding Taiwanese sovereignty and diplomatic representation ultimately played a decisive role. The persistent influence of these traditional diplomatic questions illustrates the limits of global health diplomacy. (shrink)

In January 2010 the Director General of the World Health Organization called for an “informal consultation on the future of financing for WHO” and in her opening remarks expressed the need to make the WHO fit for purpose given the unique health challenges of the 21st century.Margaret Chan referred to the constitutional role that WHO has to “act as the directing and co-ordinating authority on international health work” and stated clearly that global health leadership (...) today and for the future must be earned through strategic and selective engagement. She said, “WHO can no longer aim to direct and coordinate all of the activities and policies in multiple sectors that influence public health today.” This is a clear challenge that she has put to the global health community in recognition that WHO’s role must be clarified in the face of major change. (shrink)

Since its recognition in the early 1980s, the global HIV/AIDS pandemic has continued to grow relentlessly. Early efforts in HIV prevention sought to influence behavior by providing information about the dangers of AIDS along with recommendations for safe behavior. This approach helped to alert people about AIDS, but was insufficient to promote or sustain behavioral change.The second approach attempted to promote individual behavioral change by designing AIDS programs that would deliver a mix of information, materials, and services. This program-based approach (...) emerged within communities, was gradually adopted by some countries, and was subsequently articulated by the World Health Organization as the first Global AIDS Strategy. The emphasis during this period was to ensure that each community and country developed its own comprehensive program by adapting a global model to local and national circumstances. (shrink)

The field of global health has reached a critical juncture, where both its visibility and the complexity of its challenges are unprecedented. The World Health Organization, as the only global health actor possessing both democratic and formal legal legitimacy, is best positioned to capitalize on this new, precarious situation in public health and respond with the governance innovation that is needed to bring the increasingly chaotic network of activities and entities affecting health outcomes (...) under the fold of a centralized, standard-setting agency. One such proposed innovation to guide normative and strategic coordination in global health is the creation of a Committee C of the World Health Assembly that would promote consensus building and multi-stakeholder decision-making within the unique convening power of the World Health Organization. (shrink)

The World Health Organisation's programme for the eradication of poliomyelitis as currently practised in India raises many ethical issues. In this paper we concentrate on just two. The first is the balance to be struck between the risks and benefits generated by the eradication programme itself. The issue of risks and benefits arises in relation to the choice between two different vaccine types available for polio programmes: oral polio vaccine (OPV) and inactivated polio vaccine (IPV). OPV is the (...) vaccine currently used in the eradication campaign in India. We argue that given the current risks/benefits profile of this vaccine, there is an urgent need to review the programme and take remedial action to address existing problems (at least in India). The second issue we discuss is the fact that there is little effort to gain the informed consent of the parents of vaccinated children, as they are not currently told about the potential limitations of OPV or the possibility of vaccine-induced harm. We suggest that such a policy might be justifiable, given the importance of polio eradication, but only if there is a system of compensation for vaccine-induced harm as part of the eradication programme itself. There is a real danger that if these issues are not addressed then public trust in the eradication programme and vaccination programmes as a whole will be lost. (shrink)

The World Health Organisation encourages that blood donation becomes voluntary and unremunerated, a system already operated in the UK. Drawing on public documents and videos, this paper argues that blood donation is regarded and presented as altruistic and supererogatory. In advertisements, donation is presented as something undertaken for the benefit of others, a matter attracting considerable gratitude from recipients and the collecting organisation. It is argued that regarding blood donation as an act of supererogation is wrongheaded, and an (...) alternative account of blood donation as moral obligation is presented. Two arguments are offered in support of this position. First, the principle of beneficence, understood in a broad consequentialist framework obliges donation where the benefit to the recipient is large and the cost to the donor relatively small. This argument can be applied, with differing levels of normativity, to various acts of donation. Second, the wrongness of free riding requires individuals to contribute to collective systems from which they benefit. Alone and in combination these arguments present moral reasons for donation, recognised in communication strategies elsewhere. Research is required to evaluate the potential effects on donation of a campaign which presents blood donation as moral obligation, but of wider importance is the recognition that other-regarding considerations in relation to our own as well as others’ health result in a range not only of choices but also of obligations. (shrink)

The World Health Organisation recently listed air pollution as the most significant threat to human health. Air pollution comprises particulate matter (PM), metals, black carbon and gases such as ozone (O3), nitrogen dioxide (NO2) and carbon monoxide (CO). In addition to respiratory and cardiovascular disease, PM exposure is linked with increased risk of neurodegeneration as well as neurodevelopmental impairments. Critically, studies suggest that PM crosses the placenta, making direct in utero exposure a reality. Rodent models reveal that (...) neuroinflammation, neurotransmitter imbalance and oxidative stress are triggered following gestational/early life exposure to PM, and may be exacerbated by concomitant mitochondrial dysfunction. Gestational PM exposure (potentiated by mitochondrial impairment in the metabolically active neonatal brain) not only impacts neurodevelopment but may sensitise the brain to subsequent cognitive impairment. Having reviewed this field, we conclude that strategies are urgently required to reduce exposure to PM during this sensitive developmental period. (shrink)

The World Health Organisation (WHO) is leading a global effort to deliver improved diagnostic testing to people living in low‐resource settings. A reliance on the healthcare technologies marketplace and industry, shapes many aspects of the WHO project, and in this situation normative guidance comes by way of the ASSURED criteria — Affordable, Sensitive, Specific, User‐friendly, Rapid and robust, Equipment‐free, and Delivered. While generally improving access to diagnostics, I argue that the ASSURED approach to distributive justice — efficiency — (...) and assessment of worth — productivity — may constrain efforts to deliver timely and accurate diagnosis in the developing world equitably by holding back new and innovative diagnostics and indirectly encouraging program and device design that may unfairly discriminate against certain groups. Even as we try to overcome the problem of global healthcare injustice, we may be entrenching disadvantage. I present my critique of ASSURED by 1) referencing Boltanski and Thévenot's theory of orders of worth to highlight the industrial and market foundations of the ASSURED guidelines; 2) comparing ASSURED with other normative guides that elevate the importance of civic responsibility in evaluations of distributive justice; 3) presenting a case study of the failed promise of microfluidic diagnostic devices. I conclude that a new approach to normative guidance is required to assess the value of developing world diagnostics, preferably, one that does not force global public goods into the marketplace. (shrink)

The United Nations (UN) General Assembly High-Level Meeting (HLM) on pandemic prevention, preparedness and response (PPPR) was a missed opportunity to bring high-level commitment and momentum to the global governance of health emergencies. Intended to bring much-needed attention to a policy issue that is rapidly slipping down the international agenda, the fraught diplomacy among member states, lack of consensus on key issues, and weak UN Political Declaration in New York foreshadow a difficult road ahead for upcoming negotiations under the (...) World Health Organization (WHO) in Geneva. This column chronicles the evolving engagement of the UN in global health governance, examines the diplomatic process leading to the UN HLM on PPPR, and assesses the contributions and missed opportunities of its resulting Political Declaration. (shrink)

Health inequalities are of concern both becausestudying them may help one learn how to improvehealth and because health inequalities may beunjust. This paper argues that attending tothese reasons why health inequalities may beimportant undercuts the claims of researchersat the World Health Organization in favor offocusing on individual health variation ratherthan on social group health differences. Inequalities in individual health are of littleinterest unless one goes on to study how theyare related to (...) other factors. (shrink)

The ethical guidelines for prenatal diagnosis proposed by the World Health Organisation , as well as by national regulations, only refer to paternity and gender of the fetus as unacceptable, disease-unrelated criteria for prenatal selection, as no other such parameters are at hand so far. This perspective is too narrow because research on complex genetic systems such as cognition and ageing is about to provide clinically applicable tests for genetic constituents of potentially desirable properties such as intelligence or (...) longevity which could be misused as parameters for prenatal diagnosis. Moreover, there is an increasing number of prenatally testable genetic traits, such as heritable deafness, which are generally regarded as pathological but desired by some prospective parents and taken into account as parameters for pro-disability selection. To protect prenatal diagnosis from ethically unacceptable genetic consumerism, guidelines must be clarified as soon as possible and updated towards a worldwide restriction of prenatal genetic testing to immediately disease-determining traits. (shrink)

The 1948 constitution of the World Health Organization (WHO) defines health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’. It was a bold and revolutionary health idea to gain international consensus in a period characterized by fervent anti-communism. This article explores the genealogy of the health definition and demonstrates how it was possible to expand the scope of health, redefine it as ‘well-being’, (...) and overcome ideological resistance to progressive and international health approaches. The first part of the article demonstrates how the health definition was composed through a trajectory of draft ideas from scholars in the history of medicine, as well as political actors working to promote national health insurance. The definition was authored by League of Nations veteran Raymond Gautier, but secretly drew heavily on medical historian Henry E. Sigerist’s controversial book Socialized Medicine in the Soviet Union (1937). The second part analyses how it was possible to resist the ideological pushback against the WHO and secure US ratification. The WHO’s progressive constitution was not simply a deviation from dominant health ideas, but a direct outcome of the entrenched health conflict. The genealogy is based on original archival material from international organizations and US government archives. The article contributes to understandings of the political controversies surrounding the WHO and to scholarship on understandings of health. It also illustrates how influential health ideas cross the boundaries between politics and health sciences, as well as the boundaries between domestic health policy and global health. (shrink)

Increased awareness of the importance of mental health for global health has led to a number of new initiatives, including influential policy instruments issued by the World Health Organization (WHO) and the United Nations (UN). This policy brief describes two WHO instruments, the Mental Health Action Plan for 2013–2020 (World Health Organization, 2013) and the Mental Health Atlas (World Health Organization, 2015), and presents a comparative analysis with (...) the Sustainable Development Goals (SDGs) of the UN’s 2030 Agenda for Sustainable Development (United Nations, 2015). The WHO’s Action Plan calls for several specific objectives and targets, with a focus on improving global mental health governance and service coverage. In contrast, the UN’s SDGs include only one goal specific to mental health, with a single indicator tracking suicide mortality rates. The discrepancy between the WHO and UN frameworks suggests a need for increased policy coherence. Improved global health governance can provide the basis for ensuring and accelerating progress in global mental health. (shrink)

The history of the documentation of health inequality is long. The way in which health inequality has customarily been documented is by comparing differences in the average health across groups, for example, by sex or gender, income, education, occupation, or geographic region. In the controversial World Health Report 2000, researchers at the World Health Organization criticized this traditional practice and proposed to measure health inequality across individuals irrespective of individuals’ group affiliation. (...) They defended its proposal on the moral grounds without clear explanation. In this paper I ask: is health inequality across individuals of moral concern, and, if so, why? Clarification of these questions is crucial for meaningful interpretation of health inequality measured across individuals. Only if there was something morally problematic in health inequality across individuals, its reduction would be good news. Specifically, in this paper I provide three arguments for the moral significance of health inequality across individuals: (a) health is special, (b) health equity plays an important and unique role in the general pursuit of justice, and (c) health inequality is an indicator of general injustice in society. I then discuss three key questions to examine the validity of these arguments: (i) how special is health?, (ii) how good is health as an indicator?, and (iii) what do we mean by injustice? I conclude that health inequality across individuals is of moral interest with the arguments (b) and (c). (shrink)

The World Health Organization has declared a world pandemic due to COVID-19. In response, most affected countries have enacted measures involving compulsory confinement and restrictions on free movement, which likely influence citizens' lifestyles. This study investigates changes in health risk behaviors with duration of confinement. An online cross-sectional survey served to collect data about the Spanish adult population regarding health behaviors during the first 3 weeks of confinement. A large sample of participants from all (...) Spanish regions completed the survey. Binomial logistic regressions adjusted for socioeconomic characteristics, body mass index, previous HRBs, and confinement context were conducted to investigate associations between the number of weeks confined and a set of six HRBs. When adjusted, we observed significantly lower odds of experiencing a higher number of HRBs than before confinement overall in a time-dependent fashion: OR 0.63; 95% CI: 0.49–0.81 for the second and OR 0.47; 95% CI: 0.36–0.61 for the third week of confinement. These results were equally consistent in all age and gender subgroup analyses. The present study indicates that changes toward a higher number of HRBs than before confinement, as well as the prevalence of each HRB except screen exposure, decreased during the first 3 weeks of COVID-19 confinement, and thus the Spanish adult population may have adapted to the new situational context by gradually improving their health behaviors. (shrink)

According to the World Health Organisation, three to five million individuals are infected by influenza, and around 250,000 to 500,000 people die of this infectious disease worldwide. Influenza epidemics pose a serious public health threat. Moreover, graver dangers are encountered with influenza subtypes against which there is little or no preexisting human immunity. Such subtypes of influenza have the potential to cause devastating epidemics. Thus, enhancing surveillance systems for the purpose of detecting influenza epidemics in an early (...) stage can quicken response times and save millions of lives. This paper presents three adapting intelligence models: support vector machine regression, artificial neural network using particle swarm optimisation, and our intelligent time series to predict influenza epidemics. The novelty of the current study is that it proposes a new intelligent model to predict influenza outbreaks. The INTS model combines clustering with a time series model to enhance the prediction of influenza outbreaks. The innovation of our proposed model integrates the results obtained from the existing weighted exponential smoothing model with centroids obtained from clustering. We developed a surveillance system for influenza epidemics using Google search queries. The current research is based on a weighted version of the Center for Disease Control and Prevention influenza-like illness activity level obtained from the Center for Disease Control and Prevention data, as well as query data obtained from the Goggle search engine in the USA. The influenza-like illness data was collected from January 4, 2009, to December 27, 2015, stretching across a total time span of 312 weeks. Google Correlate was used to select search queries related to influenza epidemics. In total, 100 search queries were obtained from Google Correlate, 10 of which were better and more relevant search queries selected in this study. The model was evaluated using online Google search queries collected from Google Correlate. Standard measure performance MSE, RMSE, and MAE were employed to estimate the results of the proposed model. The empirical results of the INTS model showed MSE = 0.003, RMSE = 0.036, and MAE = 0.0185, indicating that the errors of the proposed model are very limited. A comparative model of predicting results between the INTS model, alternative Google Flu Trend, and autoregression with Google search data is also presented. The proposed model outperformed the existing models. (shrink)

We reply to critics of the World Health Organisation's Report "Making Fair Choices on the Path to Universal Health Coverage". We clarify and defend the report's key moral commitments. We also explain its role in guiding policy in the face of both financial and political constraints on making fair choices.

The definitions and conceptualizations of health, and the management of healthcare have been challenged by the current global scenarios (e.g., new diseases, new geographical distribution of diseases, effects of climate change on health, etc.) and by the ongoing scholarship in humanities and science. In this paper we question the mainstream definition of health adopted by the WHO—‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ (WHO in Preamble to (...) the constitution of the World Health Organization as adopted by the international health conference, The World Health Organization, 1948)—and its role in providing tools to understand what health is in the contemporary context. More specifically, we argue that this context requires to take into account the role of the environment both in medical theory and in the healthcare practice. To do so, we analyse WHO documents dated 1984 and 1986 which define health as ‘coping with the environment’. We develop the idea of ‘coping with the environment’, by focusing on two cardinal concepts: adaptation in public health and adaptivity in philosophy of biology. We argue that the notions of adaptation and adaptivity can be of major benefit for the characterization of health, and have practical implications. We explore some of these implications by discussing two recent case studies of adaptivity in public health, which can be valuable to further develop adaptive strategies in the current pandemic scenario: community-centred care and microbiologically healthier buildings. (shrink)

Since the World Health Organization first declared the novel coronavirus a pandemic, diverse strategies have emerged to address it. This paper focuses on two leading strategies, elimination and mitigation, and examines their ethical basis. Elimination or ‘Zero-COVID’ dominates policies in Pacific Rim societies. It sets as a goal zero deaths and seeks to contain transmission using stringent short-term lockdowns, followed by strict find, test, trace and isolate methods. Mitigation, which dominates in the US and most European nations, (...) sets targets for community transmission and lifts restrictions once targets are met. This approach takes calculated risks and regards a certain amount of disease and death as ethically justified. Section I examines different societal responses to risk that underlie these different policy approaches. Section II focuses on ethical arguments favouring Zero-COVID and raises health equity objections. Section III proposes a long-term strategy that balances the twin goals of promoting population health and health equity. There are no data available for this work. (shrink)

The response to COVID-19 demonstrates an inclusive and dispersed form of global health security that is less reliant on the UN Security Council or the World Health Organization (WHO). While WHO remains central to fighting the pandemic, the dispersed global health security addressing the crisis is inclusive of the wider UN system, civil society, and epistemic communities in global health. As part of the special issue on “The United Nations at Seventy-Five: Looking Back to (...) Look Forward,” this essay argues that instead of facing crisis or criticism like WHO, this inclusive and dispersed form of global health security provides mechanisms of resilience and support to the UN at the height of global political tensions surrounding COVID-19. (shrink)

Ensuring that countries have adequate research capacities is essential for an effective and efficient response to infectious disease outbreaks. The need for ethical principles and values embodied in international research ethics guidelines to be upheld during public health emergencies is widely recognized. Public health officials, researchers and other concerned stakeholders also have to carefully balance time and resources allocated to immediate treatment and control activities, with an approach that integrates research as part of the outbreak response. Under such (...) circumstances, research “ethics preparedness” constitutes an important foundation for an effective response to infectious disease outbreaks and other health emergencies. A two-day workshop was convened in March 2018 by the World Health Organisation Global Health Ethics Team and the African coaLition for Epidemic Research, Response and Training, with representatives of National Ethics Committees, to identify practical processes and procedures related to ethics review preparedness. The workshop considered five areas where work might be undertaken to facilitate rapid and sound ethics review: preparing national ethics committees for outbreak response; pre-review of protocols; multi-country review; coordination between national ethics committees and other key stakeholders; data and benefit sharing; and export of samples to third countries. In this paper, we present the recommendations that resulted from the workshop. In particular, the participants recommended that Ethics Committees would develop a formal national standard operating procedure for emergency response ethical review; that there is a need to clarify the terminology and expectations of pre-review of generic protocols and agree upon specific terminology; that there is a need to explore mechanisms for multi-country emergency ethical consultation, and to establish procedures for communication between national ethics committees and other oversight bodies and public health authorities. In addition, it was suggested that ethics committees should request from researchers, at a minimum, a preliminary data sharing and sample sharing plan that outlines the benefit to the population from which data and samples are to be drawn. This should be followed in due time by a full plan. It is hoped that the national ethics committees, supported by the WHO, relevant collaborative research consortia and external funding agencies, will work towards bringing these recommendations into practice, for supporting the conduct of effective research during outbreaks. (shrink)

ObjectiveTo examine how physical and psychological childbirth experiences affect maternal perceptions and experiences of early infant behavioural style.BackgroundUnnecessary interventions may disturb the normal progression of physiological childbirth and instinctive neonatal behaviours that facilitate mother–infant bonding and breastfeeding. While little is known about how a medicalised birth may influence developing infant temperament, high impact interventions which affect neonatal crying and cortisol levels could have longer term consequences for infant behaviour and functioning.MethodsA retrospective Internet survey was designed to fully explore maternal experiences (...) of childbirth and her postnatal perceptions of infant behaviour. Data collected from 999 mother–infant dyads were analysed using Pearson’s correlations and multiple analyses of covariance, employing the Bonferroni method of correction to establish initially significant variables. Multiple linear regressions were conducted to determine major perinatal contributors to perceived early infant temperament.ResultsMultiple regression analyses on each of the eight Mother and Baby Scales outcome variables indicated that early infant behavioural style was largely predicted by subjective maternal states during and post-childbirth, postnatal depression scores, maternal personality traits and infant age. For example, infant age was the most significant predictor of Alert-Responsive infant behaviour, followed by maternal Postnatal Positive experience. In contrast, depression scores were the most significant predictor of Unsettled-Irregular infant behaviour, followed by Anxious-Afraid Birth Emotions and infant age. Mothers also perceived their infants as more Alert-Responsive and Easier overall after a Supported birth experience.ConclusionMaternal and infant outcomes were influenced by multiple physical and psychological perinatal variables. The mother’s subjective experience appeared to be of equal significance to more objective factors. Social support enhanced the mother’s childbirth experience, benefitting her perceptions of her baby’s early temperament. These findings provide further support for current World Health Organisation intrapartum guidelines on the importance of making childbirth a ‘positive experience’ for women. (shrink)

The World Health Organization (WHO) has identified mental health as a priority for global health promotion and international development to be targeted through promulgation of evidence-based medical practices, health systems reform, and respect for human rights. Yet these overlapping strategies are marked by tensions as the historical primacy of expert-led initiatives is increasingly subject to challenge by new social movements — in particular, disabled persons' organizations (DPOs). These tensions come into focus upon situating the (...) WHO's mental health policy initiatives in light of certain controversies arising under the Convention on the Rights of Persons with Disabilities (CRPD), particularly as it applies to persons with mental (psychosocial) disabilities. I examine two such controversies — concerning, respectively, the legitimacy of involuntary psychiatric interventions and the legitimacy of regimes of substitute decision-making. These controversies illustrate the radical challenges to global and domestic mental health policy that have gained new momentum through the participation of DPOs in the CRPD process. At the same time, they illustrate the need for ongoing, inclusive forums for deliberation at the nexus of mental health policy and human rights, aimed at enabling human flourishing within a framework of respect for diversity. (shrink)

Highlights: -/- • Breastfeeding and breastfeeding support can contribute to mitigating climate change. • Achieving global nutrition targets will save more emissions than fuel-switching. • Breastfeeding support programmes support a just transition. • This work can support the expansion of mitigation options in energy system models. -/- Abstract: -/- Renewable gas has been proposed as a solution to decarbonise industrial processes, specifically heat demand. As part of this effort, the breast-milk substitutes industry is proposing to use renewable gas as a (...) substitute for fossil natural gas. However, decarbonising the industrial processing of breast-milk substitutes can increase social license for these products, potentially undermining breastfeeding. World Health Organisation nutrition targets aim to increase exclusive breastfeeding to at least 50% globally by 2025 to improve maternal, infant, and young child health and nutrition. This target will have implications for the energy transition. A weakness of existing energy models is that demands for end-use products such as breast-milk substitutes are typically not considered explicitly. This paper develops an analytical framework for explicitly representing infant feeding methods in energy systems models. We compare the emissions saved in Ireland from decarbonising the industrial processing of breast-milk substitutes with renewable gas with the emissions saved by an increase in exclusive breastfeeding to 50% in both Ireland and a key export market, China. We demonstrate that the emissions saved from achieving the minimum global breastfeeding target are greater than when renewable gas is used to displace natural gas in the production of breast-milk substitutes in Ireland. We discuss the decarbonisation of breast-milk substitutes in relation to the principle of justice as non-maleficence, a principle based on the commitment to avoid harm, a novel application of a principle of justice. We conclude that breastfeeding support can be considered a demand-side measure for mitigating climate change by reducing the demand for energy services to produce breast-milk substitutes. A key recommendation is to position breastfeeding support as both a public health and a climate justice issue that is relevant for a just transition. The framework developed for this paper could be applied to support the inclusion of a wider range of mitigation options with social justice outcomes in energy system models. [Open access]. (shrink)

This paper presents the foundation upon which the contemporary knowledge of body integrity dysphoria (BID) is built. According to the World Health Organisation’s International Classification of Diseases, 11th edition (ICD-11), the main feature of BID is an intense and persistent desire to become physically disabled in a significant way. Three putative aetiologies that are considered to explain the insurgence of the condition are discussed: neurological, psychological and postmodern theories. The concept of bodily representation within the medical context is (...) highlighted, with the concept of dysphoria, which was brought to the fore with the introduction of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), and the ICD-11. Contemporary issues of “justice” are addressed to identify ethically relevant distinctions between BID and sex reassignment surgery. It is argued that there is no ethically relevant difference between the BID actor’s desire for invasive surgical intervention and the wish of gender dysphoric individuals to undergo sex reassignment surgery procedures. Some BID actors self-mutilate, and this presents medical professionals with difficult choices regarding whether or not to intervene in order to satisfy the BID patient’s desire. Both abstention and intervention may lead to severe ethical complications for doctors and patients despite the positive outcomes in terms of quality of life for BID individuals who manage to undergo such procedures. (shrink)

The World Health Organization has been subjected to serious criticism for its handling of the COVID-19 virus, specifically that it failed to act decisively to stop the global outbreak and tha...

The World Health Organization has in the last decade identified mental health as a priority for global health promotion and international development, to be targeted through promulgation of evidence-based medical practices, health systems reform, and respect for human rights. Yet these overlapping strategies are marked by tensions as the historical primacy of expert-led initiatives is increasingly subject to challenge by new social movements — in particular, disabled persons’ organizations. These tensions come into focus upon (...) situating the WHO’s contributions to the analysis of global mental health in light of the negotiation and early stages of implementation of the Convention on the Rights of Persons with Disabilities, particularly as it applies to persons with mental disabilities. (shrink)