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This White Paper has been formally accepted for support by the International Federation for Emergency Medicine (IFEM) and by the World Federation of Intensive and Critical Care (WFICC), put forth by a multi-specialty group of intensivists and emergency medicine providers from low- and low-middle-income countries (LMICs) and high-income countries (HiCs) with the aim of 1) defining the current state of caring for the critically ill in low-resource settings (LRS) within LMICs and 2) highlighting policy options and recommendations for improving the system-level delivery of early critical care services in LRS. LMICs have a high burden of critical illness and worse patient outcomes than HICs, hence, the focus of this White Paper is on the care of critically ill patients in the early stages of presentation in LMIC settings. In such settings, the provision of early critical care is challenged by a fragmented health system, costs, a health care workforce with limited training, and competing healthcare priorities. Early critical care services are defined as the early interventions that support vital organ function during the initial care provided to the critically ill patient—these interventions can be performed at any point of patient contact and can be delivered across diverse settings in the healthcare system and do not necessitate specialty personnel. Currently, a single “best” care delivery model likely does not exist in LMICs given the heterogeneity in local context; therefore, objective comparisons of quality, efficiency, and cost-effectiveness between varying models are difficult to establish. While limited, there is data to suggest that caring for the critically ill may be cost effective in LMICs, contrary to a widely held belief. Drawing from locally available resources and context, strengthening early critical care services in LRS will require a multi-faceted approach, including three core pillars: education, research, and policy. Education initiatives for physicians, nurses, and allied health staff that focus on protocolized emergency response training can bridge the workforce gap in the short-term; however, each country’s current human resources must be evaluated to decide on the duration of training, who should be trained, and using what curriculum. Understanding the burden of critical Illness, best practices for resuscitation, and appropriate quality metrics for different early critical care services implementation models in LMICs are reliant upon strengthening the regional research capacity, therefore, standard documentation systems should be implemented to allow for registry use and quality improvement. Policy efforts at a local, national and international level to strengthen early critical care services should focus on funding the building blocks of early critical care services systems and promoting the right to access early critical care regardless of the patient’s geographic or financial barriers. Additionally, national and local policies describing ethical dilemmas involving the withdrawal of life-sustaining care should be developed with broad stakeholder representation based on local cultural beliefs as well as the optimization of limited resources.

Environmental health refers to the health effects associated with environmental factors, such as air pollution, water contamination, and climate change. Environmental hazards are associated with poor outcomes in common diseases, including diabetes and heart disease. In this position paper, the American College of Physicians (ACP) seeks to inform physicians about environmental health and offers policymakers recommendations to reduce the adverse health consequences of climate change, improve air and water quality, reduce exposure to toxic substances, and address environmental injustice. ACP affirms that all communities, including people of color, people with low income, and marginalized populations, deserve to live in a healthy environment.

Social cohesion is beneficial to economic restructuring, social change, and political action. At its core, it involves building shared values and communities of interpretation, reducing disparities in wealth and income, and generally enabling people to have a sense of belonging, inclusion, participation, recognition, and legitimacy. A family, as a major social institution, is central to the functioning of any society and is therefore potentially the bedrock of creating and maintaining social cohesion. This article draws inextricable links between the role of the family and the creation of social cohesion by evaluating South Africa’s White Paper on Families. First, it defines and unpacks social cohesion and contextualises the family environment. This is done through an evaluation of the available literature on social cohesion in the family. Second, an evaluation of legislation and the White Paper on family is presented. Third, the aid of Bronfenbrenner’s ecological systems theory is used to examine the various environments concerning social cohesion in the family. The White Paper on family recognises the family in aspects other than the concept of the family cycle, a key component of the developing individual who should be nurtured from infancy to adulthood. In addition, gaps in the policy are highlighted by looking at implementation challenges of the constitutional provisions and examining the way in which these gaps lead to social and economic exclusion and attendant poverty as the cardinal result.

Objectives (1) To describe facilitators and barriers to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food shopping via electronic benefits transfer (eWIC) compared with paper vouchers. (2) To explore suggestions that WIC participants had for modifying the program to enhance their overall WIC experience. Design Qualitative, semistructured, in-depth interviews. Setting WIC participants in East Tennessee. Participants Twenty-four primary food shoppers of WIC-participating households aged at least 18 years were recruited using a purposive sampling strategy. Phenomenon of Interest Perceived facilitators and barriers to use of eWIC as compared with paper vouchers. Analysis Interview transcripts were analyzed using a grounded theory approach to identify emergent themes. Results Participants identified several ways eWIC has improved their food shopping experience, including ad hoc redemption of WIC benefits and a quicker, more discrete checkout. Participants’ chief complaint about eWIC was transaction errors at checkout. Participants identified other barriers to shopping for WIC foods that cannot be addressed by the card alone, such as difficulty identifying WIC items in-store. Participants reported changes to their benefit tracking behaviors and provided suggestions to improve WIC further. Conclusions and Implications The transition to eWIC was viewed favorably among WIC participants, although participants identified a need for additional support in addressing transaction errors. This finding presents an opportunity to modify messages delivered to WIC participants by WIC nutrition educators and enhance collaboration between WIC agencies, retailers, and e-commerce technology providers.

The first cases of the novel coronavirus disease (COVID-19), previously known as 2019-nCoV, were reported in late December 2019 in Wuhan, China (Wu, Zhao, Yu B, et al 2020). The virus then spread to Malaysia and Thailand and eventually to the Americas, Europe, Australia and Africa. On the 11thof March 2020 the World Health Organisation (WHO) declared the COVID-19 a global pandemic. This concept paper explores the potential impact of COVID-19 on poverty stricken and conflict-ridden communities in Sub-Sahara Africa. In doing so, the paper also explored the implications for public health professionals working with these communities, including recommendation for future policy development.

Food insecurity functions as a social driver of health, directly negatively impacting health status and outcomes, which can further negatively impact employment and income and increase medical expenditures-all of which exacerbates food insecurity. Progress in meaningfully reducing the food-insecurity rate has stalled in recent years. Although rates have decreased since their peak during the Great Recession, these gains have been reversed by the economic implications of the COVID-19 pandemic. As the federal government is the largest provider of food assistance, there is much potential in better leveraging nutrition assistance programs like the Supplemental Nutrition Assistance Program (SNAP) and the Child Nutrition Programs to increase access to healthful foods and improve public health. However, these programs face many funding challenges and internal shortcomings that create uncertainties and prevent maximal effect. Physicians and other medical professionals also have a role in improving nutritional health by screening for food insecurity and serving as connectors between patients, community organizations, and government services. Governments and payers must support these efforts by providing sufficient resources to practices to fulfill this role. In this position paper, the American College of Physicians (ACP) offers several policy recommendations to strengthen the federal food-insecurity response and empower physicians and other medical professionals to better address those social drivers of health occurring beyond the office doors.

Summary Letter writing was used as a qualitative research strategy to access the narratives of individuals living in rural poverty. Undergraduate social work students in a freshman seminar course were paired with participants of a local agency to engage in a letter writing exchange about life experiences. Community members who volunteered to participate in the letter-writing exchange were identified via their participation in services offered by a local, community-based agency that is situated in a rural community. In the fall of 2018, a sample of 20 community members and 28 students participated in two rounds of letter exchange. Findings The letter-writing exchange was an effective way to collect data. The content of the letters enhanced students’ understanding of the daily experiences of individuals living in rural poverty. Data collected demonstrated that social isolation remains a central concern among poor, rural residents. Letter writing supported a sense of personal connection between students and community members; these social connections may have attenuated the pain of social isolation that many community members experience. Applications Narrative inquiry and the use of letter writing as a research methodology allowed us access to greater understanding about the lived experience of rural poverty. People living in rural poverty experience a layered isolation that keeps them separate from resources and each other. Letter writing provided connection and rich data that enhanced our understanding of this community.

Question Most adolescents live in low- and middle-income countries (LMIC), and about 10% of them face mental problems. The mental health provision gap in low- and middle-income countries could be addressed by evidence-based practices, however costs are implementational barriers. Digitalization can improve the accessibility of these tools and constitutes a chance for LMIC to use them more easily at a low cost. We reviewed free and brief evidence-based mental health assessment tools available for digital use to assess psychopathology across different domains in youth. Methods For the current study, instruments from a recent review on paper-based instruments were re-used. Additionally, a systematic search was conducted to add instruments for the personality disorder domain. We searched and classified the copyright and license terms available from the internet in terms of free usage and deliverability in a digital format. In the case that this information was insufficient, we contacted the authors. Results In total, we evaluated 109 instruments. Of these instruments, 53 were free and digitally usable covering 11 mental health domains. However, retrieving information on copyright and license terms was very difficult. Conclusions Free and digitally adaptable instruments are available, supporting the strategy of using instruments digitally to increase access. The instrument’s authors support this initiative, however, the lack of copyright information and the difficulties in contacting the authors and licence holders are barriers to using this strategy in LMIC. A comprehensive, online instrument repository for clinical practice would be an appropriate next step to make the instruments more accessible and reduce implementation barriers.

Using ethnographic fieldwork from four distinct settings across the globe, Mendenhall finds that diabetes is produced by dynamics that are more complicated than can be understood by merely locating individuals in a context A common trope for understanding the global diabetes "epidemic" is that diabetes is produced by processed food diets and sedentary lifestyles that have accompanied "modernization " [Extracted from the article] Copyright of Journal of Anthropological Research is the property of The University of New Mexico and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

The paper adopts Actor-Network Theory (ANT) endorsed by sociologists Callon, Mitchell and Latour to reveal how the Chicago School of economics has utilized big data and policies based on abstract quantitative analysis of big data to ‘measure’ the livelihood of urban poor who remain outside the regulation of modern state authority in post-colonial nations. Specifically, by studying contemporary Morocco and the policies targeting eradication of informal human settlements to eradicate poverty in urban cities, the paper utilizes Callon and Mitchell’s theory of Economization to understand how big data plays a transforming role in framing and the politics of metrology- which have become critical for the re-alignment of state and market power. International organizations and Hayekian economic experts have relied on abstract big data analysis to import results from one country to another, thereby producing ‘policy experts’ on poverty and development with little recognition of the contingent socioeconomic realities of countries in the global south. Consequently, the paper dwells on three of the given topics for the workshop covering socioeconomic implications of big data, the consequent urban planning focused on urban poor’s living settlements and the role of academic economics and the free market in re-instating state power.

Poverty Reduction Strategy Papers (PRSPs) represent the World Bank and the International Monetary Fund’s (IMF) most recent initiative for reducing the plight of the poor. This paper examines whether the PRSPs for Liberia, Afghanistan and Haiti follow World Bank guidance on health. The health data, analysis and strategy content of the three PRSPs are assessed with respect to the ‘Health, Nutrition and Population’ chapter of the World Bank’s PRSP Sourcebook. This guidance states that PRSPs should include: health data on the poor and a clear analysis showing the determinants of ill health and pro-poor health strategies. Unfortunately, none of the PRSPs analysed comply with the guidance and, consequently, do not adequately portray the health situation within their countries. Thus health is not given a high priority in the PRSP process and is seemingly low on the agenda of both poor country governments and the International Financial Institutions (IFIs). If the situation for the world’s poorest people is to improve, health and the right to health need to be promoted within PRSPs.

Background: Early childhood caries (ECC) is a common disorder characterized by the presence of one or more decayed (non-cavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces of primary teeth in children 71 months old or younger. South Africa has a diverse population in terms of culture, education, income, and occupation. This diversity is due to the consequences of historical racial discrimination, poverty, unemployment, lack of accessibility to health services, and quality of education. These factors make South Africa unique, and the disease and risk profiles for this country differ from those of other countries at similar stages of development. For these reasons, it is important to identify the unique maternal and infant risk factors for ECC in the South African context. Objective: The purpose of this study is to determine the risk factors associated with the incidence and prevalence of ECC in South Africa in children under the age of 6 years. Methods: All cross-sectional and cohort studies documenting risk factors associated with the prevalence and incidence of dental disease and severity (decayed, missing, and filled scores) will be included. We will search 7 databases for eligible studies, and those included will be based on prespecified inclusion criteria. Only studies conducted with South African children who are aged 6 years and younger in which dental caries risk factors are documented will be included. There is no restriction on the time or language of publication. Included articles will be scrutinized for quality by using a risk of bias tool developed by the Joanna Briggs Institute. The results will be presented narratively, and if possible, a meta-analysis will be performed. Results: The literature search was conducted in November 2020. Conclusions: The results of this study will provide a framework to inform medical and dental personnel to highlight mothers and infants at risk of developing ECC. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020216455; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=216455

The relationship between regulation and economic outcomes is a longstanding question in economic analysis. Considering the underlying foundations of good regulatory systems — such as their effectiveness at enforcing contracts or permitting business creation — is critical for spurring improvements in economic opportunity. A March 2019 Policy Research Working Paper for the World Bank Group examines how “business-friendly” regulations and their enforcement affect poverty at the country level. This review analyzes the paper’s main claims, examines its methodology, and recommends ways to make improvements. While the paper contributes to the literature on how country-level regulatory characteristics affect poverty, it makes strong claims that are not fully supported by the results or methodology. Modifying the analysis could enhance the findings and expand the paper’s contribution to the literature on country-level determinants of poverty. Rather than offering a clear path forward to addressing poverty, the World Bank working paper is better seen as a starting point for further research.

Child marriage is still a massive problem in many developing countries. The issue is more concentrated in countries of Sub Saharan Africa and South Asia. This paper, through literature review attempts to assess the situation, the consequences, various programmes and recommendations on the reduction of child marriage. In this article it is reinforced that, consequences of child marriage put the girls at risk of early pregnancies with life-threatening conditions. This paper suggests that each country should set up its own mid-term and long-term goals to bring about significant reduction in child marriages.

This analysis refocuses attention to the relationship between neoliberal government practice and co-conditioning rhetorical consequence through examination of Electronic Benefits Transfer (EBT). Operating by a plastic card similar to consumer debit cards, EBT opens new possibilities of consumption for those receiving Food Stamps. Rather than simply signaling a disciplining governmentality, electronic food assistance functions as a technology of neoliberalization, proffering the potentiality of social equity while (re)instantiating class boundaries. I appropriate the finance term securitization to specify the disposal of liberalist logics that transform the poor from economic risk to state asset while also leaving the conditions of poverty and food insecurity unchallenged.

IntroductionChronic stress has adverse effects on health. Adults and children from low-income families are subject to multiple sources of stress. Existing literature about economic hardship mostly focuses on either adults or children but not both. Moreover, there is limited knowledge on the relationship between parental generalised stress and child health problems. This study aims to explore the bidirectional relationship between parental stress and child health in Chinese low-income families and to identify other modifiable factors influencing this relationship.Methods and analysisThis prospective cohort study will sample 254 low-income parent–child pairs and follow them up for 24 months with assessments at three time points (baseline, 12 and 24 months) on parental stress, health-related quality of life (HRQOL) and child health and behaviour using both subjective measures and objective physiological parameters. This study will collect data using standardised measures on HRQOL and behaviours of children as well as on HRQOL, mental health and stress levels of parents along with physiological tests of allostatic load and telomere length. The mediating or moderating effect of family harmony, parenting style and neighbourhood conditions will also be assessed. Data will be analysed using latent growth modelling and cross-lagged path analysis modelling to examine the bidirectional effect of parental stress and child health over time. Mediation and moderation analysis will also be conducted to examine the mechanism by which the variables relate.Ethics and disseminationThis study was approved by the institutional review board of the University of Hong Kong—the Hospital Authority Hong Kong West Cluster, reference no: UW 16-415. The study findings will be disseminated through peer-reviewed publications and international conferences.Trial registration numberNCT03185273; Pre-results.

Should Poverty Reduction Strategy Papers (PRSPs) be the tool for implementing the new Sustainable Development Goals, as they were for the Millennium Development Goals? Surprisingly, despite the controversies around them, there has never been a quantitative evaluation of PRSPs. This paper estimates the impact of having a PRSP on various targets of the Millennium Development Goals. Results suggest that countries under PRSP treatment achieve much greater reductions than control countries, in head count poverty and infant mortality, while also achieving greater improvements in primary school enrolments and gender parity.

To assess family medicine's role in developing strong, coordinated, community-based, integrated health care systems in low-resource settings globally.A subgroup of the Besrour Centre of the College of Family Physicians of Canada developed connections with selected international colleagues with expertise in international family medicine practice, health systems and capacity building, and teaching to map family medicine globally and give a bird's eye view of family medicine internationally.Following a background literature review, the authors collectively reflected on their substantial international experience to attempt to describe best practices for various contexts.With the failure of vertical, disease-oriented models to provide sustained improvements in health outcomes, the need to develop integrated primary care involving the most appropriate health professionals for differing contexts is becoming apparent worldwide. Health system planning is required to develop policies on health professional training to achieve this. Advocating and offering appropriate incentives for, and coordination of, local opportunities within the health system also becomes paramount. The adaptability and generalist nature of family medicine allows it to respond to the unique needs of a given population. Family physicians with adequate financial and physical resources can function most effectively as members of interdisciplinary teams, thus providing valuable, comprehensive health services in any area of the world.

A big cat overthrows the Indian state and establishes a reign of terror over the residents of a Himalayan town. A welfare legislation aimed at providing employment and commanding a huge budget becomes 'unimplementable' in a region bedeviled by high levels of poverty and unemployment. Paper Tiger provides a lively ethnographic account of how such seemingly bizarre scenarios come to be in contemporary India. Based on eighteen months of intensive fieldwork, this book presents a unique explanation for why and how progressive laws can do what they do and not, ever-so-often, what they are supposed to do. It reveals the double-edged effects of the reforms that have been ushered in by the post-liberalization Indian state, particularly the effort to render itself more transparent and accountable. Through a meticulous detailing of everyday bureaucratic life on the Himalayan borderland, Paper Tiger makes an argument for shifting the very frames of thought through which we apprehend the workings of the developmental Indian state.