Global Knowledge Gaps in Equitable Delivery of Chronic Edema Care: A Political Economy Case Study Analysis.

Background: Most existing research in chronic edema (CO) care takes place in high-income countries and is both clinically and medically focused, although often accorded low prestige and status. A myriad of challenges define the problems and important gaps in understanding and translating what we know into sustainable practice. Less considered, however, are the consequences and socioeconomic significance of this "knowledge gap" in an increasingly globalized world. This article seeks to address this lacuna by suggesting a political economy approach across three different income settings, the United Kingdom (high), Kerala in India (middle), and Uganda (low), to learn from international practice and understand the contribution of local (community-specific) health traditions. Methods and Result: We used a comparative case study approach. In the three case studies we demonstrate how particular thinking, sets of power relationships, and resource distributions influence and structure the provision of CO management more generally. We demonstrate how these intertwined and often invisible processes reflect a market-led biomedical hierarchization that focuses on high-interventionist, high-cost approaches that are then imposed on lower income settings. At the same time, low-cost but evidence-based local knowledge innovation in wound and CO care from low- or middle-income countries is neither recognized nor valued. Conclusion: We conclude that unpacking these dynamics is a necessary route to providing a more equitable health delivery accessible for the many rather than the few.

The social determinants of health and the patient safety paradigm.

This article extends the thesis presented in the paper by Tingle, Gibson and Ferrante (2011) that the patient safety agenda needs to operate within a new paradigm. We will introduce the social determinants of health (SDH) as an emerging discourse in global public health. The SDH advocate social and health equity among nations and individuals, and within countries and communities. It has become a key driver for policy makers, health researchers and public health professionals (Raphael, 2011). This article will demonstrate that the paradigmatic lens of SDH offers the opportunity to develop a more upstream analysis of the patient safety agenda based on health systems.