Description
Part 1 Define the following five terms and discuss briefly (in 5 sentences or less for each) each term’s relevance to global health. One Health “Health in all policies” approach to governance Explain the difference between Multilaterals and Bilaterals as Health Development Partners Explain the difference between Foundations and Civil Society Organizations as Health Development Partners Demographic and epidemiological transition (define both)Part 2: Short essay (maximum 2 pages): Review the Climate Financing agreements that have been made related to climate and health during COP28. https://www.bcg.com/publications/2023/this-is-what-has-been-agreed-at-cop28-so-far. Provide an example of how one Low- or Middle-Income country could specifically use the additional funding to develop a policy to address two of these three issues: For urban health: improve food security to reduce the incidence of malnutrition amongst children of migrants.For pandemic preparedness: work with a civil society organization (CSO) or community-based organization (CBO) to put in place a community-based system to combat public health misinformation.For climate change: reduce exposure to air pollution for Urban slum dwellers to reduce incidence of upper respiratory diseases. Part 3: Short essay (maximum 2 pages): The COVID-19 pandemic’s impact could have been considerably less if governments and multilateral organizations had acted more effectively. The paper below highlights lessons we have learned and proposes innovations that together could make the world safer and better prepared for the next pandemic. Provide your thoughts and opinions on the lessons and proposed innovations. Read and use: Frenk, J., Godal, T., Gómez-Dantés, O., & Store, J. G. (2022). A reinvigorated multilateralism in health: lessons and innovations from the COVID-19 pandemic. The Lancet, 400(10363), 1565-1568.
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Foundations of Global Health, All Sections
FINAL ASSIGNMENT FALL 2023
INSTRUCTIONS:
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This is a take-home, open-book assignment that you have 1 week to complete. You should
complete this assignment ON YOUR OWN – you may not work with your classmates or get
assistance from anyone outside of the class. The assignment counts for 25% of your final
grade.
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Roman), and 1-inch margins in a Word document (no PDFs allowed). You may type your
answers directly into this template.
•
You may use references when necessary. You may use any citation style as long as it is
consistent. You should draw from class lectures, team presentations, readings, press stories
and other reliable references to inform your answers.
•
The assignment has five parts, and you must answer ALL of them. Your completed assignment
must be submitted on Brightspace no later than Friday, December 22nd at 11:55pm.
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Assignments submitted after this time will incur a severe grade penalty. No extensions are
allowed. Points will be deducted if you exceed the below-mentioned word limits.
—————————————————————————————————————————-Part I (5 POINTS):
Define the following five terms and discuss briefly (in 5 sentences or less for each) each term’s
relevance to global health (1 POINT each).
1. One Health
2. “Health in all policies” approach to governance
Page 1 of 4
Foundations of Global Health, All Sections
FINAL ASSIGNMENT FALL 2023
3. Explain the difference between Multilaterals and Bilaterals as Health Development
Partners
4. Explain the difference between Foundations and Civil Society Organizations as Health
Development Partners
5. Demographic and epidemiological transition (define both)
Part II (5 POINTS): Short essay (maximum 2 pages):
Identify TWO approaches in which conflict and migration impact the health of Syrian children and
adolescents.
1. Propose ONE approach public health officials in Syria can utilize to mitigate the risks of
conflict on the mental health of children under 10 years of age in Syria.
2. Propose ONE approach to reduce the risk of gender-based violence amongst Syrian girl
adolescent refugees in Lebanon.
Read and use: Alhaffar, M. B. A., & Janos, S. (2021). Public health consequences after ten years of
the Syrian crisis: a literature review. Globalization and health, 17, 1-11.
Part III (5 POINTS): Short essay (maximum 2 pages):
1. Describe the main objectives of the Global Fund to end the global epidemic of HIV/AIDs.
2. Select one Low- or Middle-Income country.
3. Using the article below, briefly describe two ways that GFATM support to the selected
country for HIV/AIDs (i.e., the conditions on their grants) is neocolonial. That is, identify
and describe two examples of inequitable power relationships between GFATM and that
country.
Page 2 of 4
Foundations of Global Health, All Sections
FINAL ASSIGNMENT FALL 2023
4. Then, provide two specific, measurable, feasible, and realistic recommendations that
address these power imbalances by engaging Indigenous groups as active participants in
decolonizing and redesigning the support the country receives from the Global Fund.
Read and use: Ordóñez, C. E., Marconi, V. C., & Manderson, L. (2023). Addressing coloniality of
power to improve HIV care in South Africa and other LMIC. Frontiers in Reproductive Health, 5,
1116813.
Part IV (5 POINTS): Short essay (maximum 2 pages):
Review the Climate Financing agreements that have been made related to climate and health
during COP28. https://www.bcg.com/publications/2023/this-is-what-has-been-agreed-at-cop28so-far. Provide an example of how one Low- or Middle-Income country could specifically use the
additional funding to develop a policy to address two of these three issues:
1. For urban health: improve food security to reduce the incidence of malnutrition amongst
children of migrants.
2. For pandemic preparedness: work with a civil society organization (CSO) or communitybased organization (CBO) to put in place a community-based system to combat public
health misinformation.
3. For climate change: reduce exposure to air pollution for Urban slum dwellers to reduce
incidence of upper respiratory diseases.
Part V (5 POINTS): Short essay (maximum 2 pages):
The COVID-19 pandemic’s impact could have been considerably less if governments and
multilateral organizations had acted more effectively. The paper below highlights lessons we have
learned and proposes innovations that together could make the world safer and better prepared
Page 3 of 4
Foundations of Global Health, All Sections
FINAL ASSIGNMENT FALL 2023
for the next pandemic. Provide your thoughts and opinions on the lessons and proposed
innovations.
Read and use: Frenk, J., Godal, T., Gómez-Dantés, O., & Store, J. G. (2022). A reinvigorated
multilateralism in health: lessons and innovations from the COVID-19 pandemic. The
Lancet, 400(10363), 1565-1568.
Page 4 of 4
Since January 2020 Elsevier has created a COVID-19 resource centre with
free information in English and Mandarin on the novel coronavirus COVID19. The COVID-19 resource centre is hosted on Elsevier Connect, the
company’s public news and information website.
Elsevier hereby grants permission to make all its COVID-19-related
research that is available on the COVID-19 resource centre – including this
research content – immediately available in PubMed Central and other
publicly funded repositories, such as the WHO COVID database with rights
for unrestricted research re-use and analyses in any form or by any means
with acknowledgement of the original source. These permissions are
granted for free by Elsevier for as long as the COVID-19 resource centre
remains active.
Comment
CZ receives consulting fees from the UK Health Alliance on Climate Change.
PY receives honoraria from Novartis, bioMérieux, and Pfizer and receives advisory
board fees from Pfizer and fees for serving on a DSMB from the US National
Heart, Lung, and Blood Institute all unrelated to the topic of this Comment. JM is
an unpaid Board member of the International Working Group for Health systems
strengthening unrelated to the topic of this Comment. DO-A receives advisory
board fees from Inovio Pharmaceuticals and is a member of the Board of Directors
of GLICO Healthcare all unrelated to the topic of this Comment. The other authors
declare no competing interests.
Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access
article under the CC BY 4.0 license.
Lukoye Atwoli, Editor-in-Chief, East African Medical
Journal; Gregory E Erhabor, Editor-in-Chief, West African
Journal of Medicine; Aiah A Gbakima, Editor-in-Chief,
Sierra Leone Journal of Biomedical Research;
Abraham Haileamlak, Editor-in-Chief, Ethiopian Journal of
Health Sciences; Jean-Marie Kayembe Ntumba, Chief Editor,
Annales Africaines de Medecine; James Kigera,
Editor-in-Chief, Annals of African Surgery;
Laurie Laybourn-Langton, University of Exeter, UK;
Robert Mash, Editor-in-Chief, African Journal of Primary
Health Care & Family Medicine; Joy Muhia, London School
of Medicine & Tropical Hygiene, UK;
Fhumulani Mavis Mulaudzi, Editor-in-Chief, Curationis;
David Ofori-Adjei, Editor-in-Chief, Ghana Medical Journal;
Friday Okonofua, Editor-in-Chief, African Journal of
Reproductive Health; Arash Rashidian, Director of Science,
Information and Dissemination, and Maha El-Adawy,
Director of Health Promotion, WHO, Eastern Mediterranean
Health Journal; Siaka Sidibé, Director of Publication, Mali
Médical; Abdelmadjid Snouber, Managing Editor, Journal de
la Faculté de Médecine d’Oran; James Tumwine, Editor-inChief, African Health Sciences; Mohammad Sahar Yassien,
Editor-in-Chief, Evidence-Based Nursing Research;
Paul Yonga, Managing Editor, East African Medical Journal;
Lilia Zakhama, Editor-in-Chief, La Tunisie Médicale;
Chris Zielinski, University of Winchester, UK
[email protected]
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This Comment is being published simultaneously in multiple journals (appendix).
The full list of journals and supporting journals can be found on the BMJ website.
1
Intergovernmental Panel on Climate Change. Climate change 2022: impacts,
adaptation and vulnerability. Working Group II Contribution to the IPCC Sixth
Assessment Report. 2022. https://www.ipcc.ch/report/ar6/wg2/ (accessed
Oct 4, 2022).
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Atwoli L, Baqui AH, Benfield T, et al. Call for emergency action to limit global
temperature increases, restore biodiversity, and protect health. Lancet 2021;
398: 939–41.
UN. The Paris Agreement. 2015. https://www.un.org/en/climatechange/
paris-agreement (accessed Sept 12, 2022).
Climate Investment Funds. Climate change and health in sub-Saharan Africa:
the case of Uganda. 2020. https://www.climateinvestmentfunds.org/sites/
cif_enc/files/knowledge-documents/final_chasa_report_19may2020.pdf
(accessed Sept 26, 2022).
WHO. Strengthening health resilience to climate change. Geneva:
World Health Organization, 2016.
Trisos CH, Adelekan IO, Totin E, et al. Africa. In: Intergovernmental Panel on
Climate Change. Climate change 2022: impacts, adaptation, and
vulnerability. 2022. https://www.ipcc.ch/report/ar6/wg2/ (accessed
Sept 26, 2022).
World Bank. Climate change adaptation and economic transformation in
sub-Saharan Africa. Washington, DC: World Bank, 2021.
Opoku SK, Leal Filho W, Hubert F, Adejumo O. Climate change and health
preparedness in Africa: analysing trends in six African countries.
Int J Environ Res Public Health 2021; 18: 4672.
Evans M, Munslow B. Climate change, health, and conflict in Africa’s arc of
instability. Perspect Public Health 2021; 141: 338–41.
Stawicki SP, Papadimos TJ, Galwankar SC, Miller AC, Firstenberg MS.
Reflections on climate change and public health in Africa in an era of global
pandemic. Contemporary developments and perspectives in international
health security, vol 2. London: IntechOpen, 2021.
African Climate Policy Centre. Climate change and health in Africa: issues and
options. 2013. https://archive.uneca.org/sites/default/files/PublicationFiles/
policy_brief_12_climate_change_and_health_in_africa_issues_and_options.
pdf (accessed Sept 12, 2022).
UN. Climate change is an increasing threat to Africa. UN Climate Change
News. 2020. https://unfccc.int/news/climate-change-is-an-increasingthreat-to-africa (accessed Sept 12, 2022).
Atwoli L, Muhia J, Merali Z. Mental health and climate change in Africa.
BJPsych International 2022; published online June 17. https://doi.org/10.1192/
bji.2022.14.
Vulnerable Twenty Group. Climate vulnerable economies loss report.
Switzerland: Vulnerable Twenty Group, 2020.
Ritchie H. Who has contributed most to global CO2 emissions? Our World in
Data. 2019. https://ourworldindata.org/contributed-most-global-co2
(accessed Sept 12, 2022).
Bilotta N, Botti F. Paving the way for greener central banks: current trends
and future developments around the globe. Rome: Edizioni Nuova Cultura
for Istituto Affari Internazionali, 2022.
WHO. COP26 special report on climate change and health: the health
argument for climate action. Geneva: World Health Organization, 2021.
Al-Mandhari A, Al-Yousfi A, Malkawi M, El-Adawy M. “Our planet, our
health”: saving lives, promoting health and attaining well-being by
protecting the planet—the Eastern Mediterranean perspectives.
East Mediterr Health J 2022; 28: 247−48.
Evans S, Gabbatiss J, McSweeney R, et al. COP26: key outcomes agreed at the
UN climate talks in Glasgow. Carbon Brief. 2021. https://www.carbonbrief.
org/cop26-key-outcomes-agreed-at-the-un-climate-talks-in-glasgow/
(accessed Sept 12, 2022).
A reinvigorated multilateralism in health: lessons and
innovations from the COVID-19 pandemic
The COVID-19 pandemic has brought into sharp focus the
shared frailty of societies in the face of common threats.
If the world is to respond successfully to future pandemics
and other emerging challenges, it will be essential to
develop new public health instruments and a framework
that redefines the rules of global governance. In many
www.thelancet.com Vol 400 November 5, 2022
ways, a quantum lift in global health is needed similar to
that achieved at the turn of the 21st century. That was a
time when new multilateral initiatives with innovative
governance and financial arrangements were established
(eg, Gavi, the Vaccine Alliance in 2000, The Global Fund
to Fight AIDS, Tuberculosis and Malaria in 2002, and
Published Online
October 7, 2022
https://doi.org/10.1016/
S0140-6736(22)01943-2
1565
Comment
Panel: Six lessons from the COVID-19 pandemic
Pandemics are becoming more common as a result of
unsustainable practices, so all countries should strengthen
their commitment to sustainable development
Increased frequency of pandemics is as anthropogenic as climate
change.8 The way humans abuse the planet (eg, the destruction of
habitats, unsanitary and inhumane mass production of poultry
and livestock, and the sale of live wild animals in so-called wet
markets) allows pathogens to cross the species barrier. COVID-19
should be a wake-up call about the need to protect our planet.
1566
mechanism for distributed production of vaccines and
protective equipment that will ensure equitable access to these
and other life-saving resources.
National leadership is crucial in the response to a global
public health threat
The huge variation in the effectiveness of national responses to
the COVID-19 pandemic demonstrates that trust in rational,
science-based leadership, which provides clear guidance and
brings people together, is crucial for effective collective action
during moments of uncertainty.12
When dealing with a pandemic, it is necessary to supersede
the false dilemma between public health and economic
goals, both of which must be pursued in a synergistic way
There is consensus that to resume economic life after a lockdown
it is necessary to have the pandemic under local control. A rushed
reopening strategy can produce not only new cases and deaths,
but also major economic losses.9 The pandemic has provided a
dramatic demonstration that health is not only a consequence of
but also a condition for economic growth and prosperity.
Regional collaboration promotes health security
Pandemics frequently prompt governments to block the export
of goods that are essential for the protection of their respective
populations.13 This constraint is compounded by geopolitical
tensions. Since very few countries are self-sufficient, regional
collaboration can help overcome this constraint and strengthen
health security, as exemplified by the European Union and the
African Union.
The COVID-19 pandemic has revealed and magnified social
inequities, which make it necessary to build specific
mitigation interventions into preparedness plans
The COVID-19 pandemic has disproportionately affected
marginalised groups.10,11 In future pandemics, programmes to
deal with the structural determinants of infection rates and
public policies to improve access to health care will have to be
implemented. Inequities among countries must also be
addressed. Because all governments are expected and required
to prioritise their own people, it is crucial to develop a
No local response to a pandemic can be effective without
global solutions
The brightest point of the pandemic has been the unprecedented
level of international collaboration to develop the global public
goods—tests, treatments, and vaccines—that are enabling the
world to solve the current crisis. Global efforts, however, require
more than like-minded individuals and institutions to work
together. They require agile global governance supported by
national governments committed to international collective
action as the only means to face common threats.
adoption of the WHO Framework Convention on Tobacco
Control in 2003), and development assistance for health
expanded at an unprecedented rate.1 However, the
circumstances in 2022 are different and therefore call
for original solutions. We outline the lessons that must
be learned and the innovations that must be adopted to
realise that purpose.
Global health faces a sovereignty paradox.2 We live in a
world of sovereign nation states where health is mostly
a national responsibility. However, the determinants
of health and the means to fulfil that responsibility are
increasingly global.3 No single country can control on
its own the health risks associated with globalisation or
generate by itself an effective response to most global
challenges. The way to solve this paradox is not for nation
states to sacrifice but rather to share their sovereignty
by mobilising global collective action through vigorous
multilateral institutions.
Unfortunately, the global alarm systems did not
perform as expected during the COVID-19 pandemic,
and there is consensus about the main sources of this
failure. The early and consistent calls to strengthen the
surveillance and response system designed to confront
global threats were ignored.4 It is a sad irony that a
miniscule proportion of the costs to the global economy
of COVID-19 could have financed a robust global alarm
and response system.5
This failure cannot happen again. All countries
should introduce structural adjustments in the global
health system to protect everyone in an increasingly
interdependent world. Such improvements should be
agreed on while the COVID-19 pandemic continues and
not later when attention will wane. The global health
community owes it to the millions of people who have
lost their lives and their livelihoods in this pandemic
to apply the lessons we have learned at huge cost. The
recommendations from the Independent Panel for
Pandemic Preparedness and Response in 20216 and
the 2022 report of the Lancet Commission on lessons for
the future from the COVID-19 pandemic7 offer thorough
www.thelancet.com Vol 400 November 5, 2022
Comment
analyses in this respect. Here we focus on six key lessons
from the COVID-19 pandemic (panel). Several innovations
have been proposed to put these lessons into practice. We
highlight three innovations that together could make the
world safer and better prepared for the next pandemic.
The first innovation is the establishment of an
international sentinel network of health-care facilities
that can rapidly collect and share data about any
emerging disease and thus avoid potential national
cover-up of outbreaks.14 A complementary mechanism
to promote epidemiological transparency consists of
an insurance scheme that would protect countries from
harm to their economies as a result of reporting disease
outbreaks in a timely way—something that would benefit
the rest of the world.
A second innovation is to harness adaptable
technological platforms so that the scientific community
can move swiftly in identifying the nature of new
pathogens and developing the tools to combat future
outbreaks of infectious diseases, including diagnostic
procedures and devices, treatments, and vaccines. Such
coordinated action has advanced rapidly during the
COVID-19 pandemic, but with better preparedness
planning further progress can be made.
A third innovation is the creation of a multinational
rapid deployment force with the standing capacity to
use innovative tools. This approach would control future
disease outbreaks before they could spread globally—
something akin to the proposal by Bill Gates to establish
a GERM (Global Epidemic Response and Mobilization)
team, which should be led by WHO.15
As a foundation for these innovations, all countries
should immediately commit to the strengthening of
their national preparedness plans under the supervision
of WHO and its regional offices. These plans should meet
clear goals in terms of inputs, human resources, and
protocols.
To take advantage of these and other innovations, it is
necessary to develop frameworks that will enable national
actors and the international community to solve the
sovereignty paradox. What is required is a bold metainnovation of multilateralism that will make all other
innovations possible.
There has been much discussion about the imperative
of reforming the institutional architecture of global
governance. To date most calls for reform have focused
on the secretariats of multilateral organisations—and
www.thelancet.com Vol 400 November 5, 2022
there are indeed huge opportunities to improve their
performance. However, it is equally important to review
the behaviour of member states, which often weaken
multilateral institutions deliberately (eg, by resisting their
coordinating authority) or passively (eg, by failing to pay
assessed contributions on time).
The lessons from the COVID-19 pandemic point to the
crucial need to strengthen the effective enforcement
of improved International Health Regulations through
incentives that promote participation and respect for
rules, as well as sanctions that curtail non-compliance. A
global public health convention or treaty that redefines
the rules and norms of global governance for health
security is needed for sovereign states to accept such
enforcement authority.16 The World Health Assembly
has initiated the process to develop an agreement of
this type,17 which the Intergovernmental Negotiating
Body considers should be legally binding.18 A new global
health instrument must establish clear mechanisms
to guarantee the autonomy and authority of WHO to
effectively coordinate the prevention, preparedness
measures, and response to pandemics and other global
health challenges.
An effective global health convention also requires a
solid financing system that protects its governing body
from political influences and fluctuations. Global health
security demands robust, sustainable, and sovereign
funding. Such funding needs to mostly come from regular
mandatory contributions by member states and not
from voluntary, unpredictable, and earmarked donations.
In a positive reversal of previous reluctance, WHO
member states are planning for a substantial increase of
mandatory contributions by 2030.19 Additionally, a robust
financial framework would make it possible to support a
sustainable prevention, preparedness, and response fund
at the World Bank in close coordination with WHO (and
potentially also with The Global Fund), which should
operate under transparent rules allowing for an agile
mobilisation of resources.20
These efforts must also consider the rapidly evolving
financial constraints that face national, regional, and
global institutions due to the COVID-19 pandemic,
the climate crises, the war in Europe, and the ensuing
global economic instability, including rising energy
and food prices. Since these headwinds could lead to
further resource constraints for health, it is imperative
that national, regional, and global investments
1567
Comment
yield the largest returns in terms of improved health
outcomes.
At the same time, meta-innovation of multilateralism
cannot depend solely on regional and global institutions.
These efforts need to be reinforced by networks of
devoted scientists and other groups. This approach is
exemplified by philanthropic groups engaging in global
surveillance innovations, as well as the Coalition for
Epidemic Preparedness Innovation (CEPI) and some
vaccine companies stimulating a distributed multilateral
and speedy production of vaccines.21
Driven by the frailty that the COVID-19 pandemic has
uncovered, the guiding force of the new global agenda
should be a renewed commitment to global solidarity and
sustainable development. In these perilous times, such a
commitment has become vital.
JF is President of the University of Miami. TG is Special Adviser to the Norwegian
Ministry of Health and Care Services. OG-D is Senior Researcher at Mexico’s
National Institute of Public Health. JGS is the Prime Minister of Norway. JGS, TG,
and JF were directly involved in several of the global health developments from
the early part of the 21st century mentioned in this Comment. TG reports
consulting fees from WHO. JF, OG-D, and JGS declare no competing interests.
This Comment was prepared as background material for the Oslo Symposium,
A World in Transitions: Implications for Priorities and Efficiencies in Global Health, on
Oct 14, 2022, organised by the Norwegian Ministry of Health and Care Services
and the Centre for Global Health at the University of Oslo, Oslo, Norway.
*Julio Frenk, Tore Godal, Octavio Gómez-Dantés,
Jonas Gahr Store
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[email protected]
Office of the President, University of Miami, Coral Gables, FL 33146, USA (JF);
Norwegian Ministry of Health and Care Services, Oslo, Norway (TG); National
Institute of Public Health, Cuernavaca, Mexico (OG-D); Office of the Prime Minister,
Government of Norway, Oslo, Norway (JGS)
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August 10, 2022
https://doi.org/10.1016/
S0140-6736(22)01486-6
1568
July 20, 2022 marked the eagerly awaited full
publication of the women’s health strategy for England,
UK.1 The strategy brings a welcome focus on women’s
health after crises such as the Ockenden Review,2 which
exposed the failures in care of women and babies
at Shrewsbury and Telford Hospital NHS Trust, and
the Paterson Inquiry report,3 which documented the
many ways in which women were harmed by a rogue
www.thelancet.com Vol 400 November 5, 2022
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