With the onset of the coronavirus disease 2019 (COVID-19) pandemic, public health measures such as physical distancing were recommended to reduce transmission of the virus causing the disease. However, the same approach in all areas, regardless of context, may lead to measures being of limited effectiveness and having unforeseen negative consequences, such as loss of livelihoods and food insecurity. Focusing on sub-Saharan Africa, the authors outline and discuss challenges that are faced by residents of urban informal settlements in the ongoing COVID-19 pandemic. The authors describe how new geospatial data sets can be integrated to provide more detailed information about local constraints on physical distancing and can inform planning of alternative ways to reduce transmission of COVID-19 between people. A case study of Nairobi County, Kenya, is included with mapped outputs which illustrate the intra-urban variation in the feasibility of physical distancing and the expected difficulty for residents of many informal settlement areas. These examples demonstrate the potential of new geospatial data sets to provide insights and support to policy-making for public health measures, including COVID-19.
Monitoring equity and research policy
In August 2022, a group of female scholars wrote ‘Why four scientists spent a year saying no’: an article about what they had gained by saying no to 100 work-related requests over the course of year. That led the authors, four female professors, to form the No Club. Over the past decade, the authors have researched work that doesn’t help to advance careers — an attempt to understand why they, along with many others, were doing so much of it. They gave this work a name: non-promotable tasks (NPTs). Studies show that women, regardless of occupation, take on the bulk of NPTs. So, what can organizations do? The authors argue that women are more likely than men to volunteer for an NPT, so asking for volunteers exacerbates the inequity in allocation. Everyone in organizations should be enabled to understand which tasks will move their careers forward (the promotable work) and which ones won’t, and tasks defined as promotable or non-promotable. Knowing where to focus time is argued to help both employees and the organization. If tasks are assigned strategically to take advantage of specialized skill sets, given that an NPT for one position might be promotable for someone at a lower level, the authors propose that tasks be allocated to create equitable portfolios of work and rewards provided for some NPTs.
In this statement the Director of Wellcome Jeremy Farrar reports that two years ago, Wellcome made a commitment to developing anti-racist principles and an anti-racist programme, and to an external evaluation of progress at the institution. An evaluation has now been reported. While it found some progress, such as improvements in the racial diversity of the workforce and some positive behavioural and practice shifts, it reached a clear conclusion that Wellcome continues to fall short of the commitment to anti-racism, both as a funder and as an employer. Farrar accepted and apologised for this and announced two measures to addressing inequity in Wellcome research funding in 2023, including a set of positive action principles applied to funding decision-making processes and the establishment of a dedicated stream of funding available exclusively to researchers who are Black and people of colour, targeted at the career stages where this will have the greatest benefits for diversity.
This consortium did work to understand the benefits and challenges of using a theory of change (ToC) -based approach for monitoring and evaluating the scale-up of health system strengthening interventions. The consortium held annual ToC reflections that entailed multiple participatory methods, including individual scoring exercises, country and consortium-wide group discussions and visualizations, capturing the reflections around an initiative for strengthening district health management teams, to improve health workforce performance and service delivery at scale. The annual ToC reflections proved valuable in gaining a nuanced understanding of how change did happen and strategizing on actions to further steer the scale-up the intervention. It also led to adaptations of the ToC over time. Based on the experience the authors suggest that ToC-based approaches are useful, should include a variety of stakeholders and require their continued commitment to reflection and learning on intervention implementation and scale-up. ToC-based approaches can help in adapting interventions as well as scale-up processes to be in tune with contextual changes and stakeholders involved, to potentially increase chances for successful scale-up.
The Teaching Health Economics Special Interest Group (THE SIG) has organized a series of virtual workshops during 2022. This workshop provides an overview of curriculum development and writing powerful learning outcomes for health economics courses and the importance of identifying topics and readings that are most relevant to the local context. The workshop considers how to ensure courses are inclusive and contain diverse perspectives, and information shared on how academics in low- and middle-income countries can directly access a wide range of publications to use in their teaching programs at no (or low) cost.
The authors conducted a realist review to understand how and why community engagement with health research contributes to the pattern of outcomes observed, with a focus on malaria research. Community engagement was found to rely on the development of provisional ‘working relationships’ across differences, primarily of wealth, power and culture that bring tangible research related benefits. Contextual factors that affect these working relationships were reported to include the research organisation commitment to and resources for engagement, while a prevailing ‘dominant health research paradigm context’ was reported to undermine working relationships, as did differences of wealth and power between research centres and local populations and health systems; histories of colonialism and vertical health interventions; and external funding and control of health research. Accommodation of such ethically problematic characteristics in the dominant health research paradigm can undermine community engagement and reproduce this paradigm rather than challenge it with a different logic of collaborative partnership.
“Health equity tourism” is described as the process of previously unengaged investigators pivoting into health equity research without developing the necessary expertise for high-quality work. In this essay, the authors define the phenomenon and provide an explanation of the antecedent conditions that facilitated its development. They outline its consequences as recapitulating systems of inequity within the academy and diluting a landscape carefully curated by scholars who have demonstrated sustained commitments to equity research as a primary scientific discipline and praxis. The authors provide a set of principles to guide equity researchers.
Female adolescents living with Human Immunodeficiency Virus (HIV) face lifelong challenges in reproductive and sexual health ranging from relational, social and legal-ethical considerations. A visual method and storybook research innovation was used with young female adolescents in Malawi that initiate sex as early as 15 years, mostly with adult partners, given their reluctance to discuss sexual matters through more direct questions during interviews. The researchers thus used invoke youth-friendly research approaches to address these issues and enable these vulnerable individuals to articulate their experience and advocate their preferred changes.
This 'cartographic' and political economy analysis of Frantz Fanon’s ‘geographies’ points to a series of narrative maps that draw attention to the differential geographies of racism and colonialism, using geography, landscape, cartography, architecture, space, place, and borders, to make sense of blackness and oppression and liberation. Fanon’s envisions anti-colonial geographies as always in flux, nested in, yet cannot be fully defined by, the colonial imperative. Stasis – even the street or the walls of the clinic – is impossible. Colonial geographies are thus identified as unsustainable because, even in their heaviness, they are impermanent, in flux, and alterable.
Algorithms act according to what they are trained for, and human beings are the ones training them. Therefore, when algorithms are clearly reinforcing existing inequalities, it is crucial to question who writes these algorithms, and in whose interests they are writing them. More importantly, these people should be held accountable for the socio-spatial effects of their products. As local governments have failed to build a good spatial data infrastructure for informal settlements, other stakeholders are stepping in and the authors raise the threat posed by algorithms moderated by big tech corporations deciding the boundaries ad features of neighbourhoods.