• Chauncey Strauss posted an update 5 days, 3 hours ago

    Consider international terrorism; a growing threat to which conventional “hard power” responses have had limited success in addressing. What could, or should, global health do about it? Dissociate (as advocated by the Deans of the US medical schools), isolate, establish boundaries, and “stove-pipe”? Or accept the possibility that such disciplinary overlaps, and associated consideration of both health and non-health considerations in programme design, delivery, and location, are both benign and inevitable under “smart”, multifarious, and interrelated approaches? To focus efforts only on health outcomes risks, as one report puts it, creating “tense and confusing dualities” when measured against political, diplomatic, or other foreign policy metrics and benchmarks. It could therefore be both appropriate and timely for global health leaders to take the initiative in establishing mutually acceptable parameters for such interdisciplinary engagements before it moclobemide is too late, and the chance for such inputs has passed.Two recent pieces—one developing an instrument for the establishment and evaluation of diplomatic and foreign policy principles and standards within global health programmes, the other proposing a set of codes or soft laws by which global health governance can control and calibrate its inputs to international security and the broader, non-health interests of the global community—might help to provide the basis for such an approach. For so long reliant on resource allocation instruments such as cost-effectiveness, making narrow metrics the only consideration in assessing programmatic worth or value, policy makers now have the option of expanded, holistic assessments of the effects of global health programmes across both health and non-health outcomes.The current geopolitical landscape has resulted in unprecedented numbers of refugee populations. For the first time since World War 2, the total number of people forced to flee their homes as refugees, asylum seekers, and internally displaced persons has exceeded 50 million. In the first 8 months of 2015 alone, more than 540 000 asylum applications were filed across European Union member states. In addition to increased physical health risks, asylum seekers and refugees are at a higher risk than average for the development of a range of comorbid psychiatric diagnoses including mood, anxiety-related, psychotic, and substance-use disorders. Suicidality is particularly high in refugees diagnosed with post-traumatic stress disorder; some studies report rates as high as 64% for suicidal ideation and plans. Additionally, asylum seekers and refugees are at risk of further traumatisation through rape and sexual exploitation, loss of family members, physical abuse, community violence, and the loss of social structures, cultural practices, and familial systems that might lessen the impact of traumatic events.Despite the frequency of traumatic exposure, as demonstrated by results of epidemiological research, human beings seem to be very resilient, with estimates of trauma-related disorders in the general population being quite low. The European Study of the Epidemiology of Mental Disorders reported an average lifetime prevalence rate of post-traumatic stress disorder of 1·9% (based on a sample of 21 425 adults across six countries in western Europe). In North America, rates hover around 8% in adults. By comparison, rates of trauma-related disorders are far higher in people displaced by conflict, with the estimated prevalence of post-traumatic stress disorder ranging between 13% and 25%. As the population of migrants in Europe rises, the prevalence of trauma-related disorders is also likely to rise, increasing the need to deepen understanding of these disorders in diverse populations.I arrived at the Johns Hopkins University campus with a sense of déjà vu; it was my first visit to my alma mater in years. I had travelled to Baltimore for a meeting about the licensing of sutezolid, a much-awaited drug candidate for treatment of . The research faculty, technology transfer officers, university administration, and advocates at the meeting felt the weight of the responsibility. We knew that licensing a tuberculosis drug candidate could be a historic event.

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