Developing an agenda for the decolonization of global health.

Colonialism, which involves the systemic domination of lands, markets, peoples, assets, cultures or political institutions to exploit, misappropriate and extract wealth and resources, affects health in many ways. In recent years, interest has grown in the decolonization of global health with a focus on correcting power imbalances between high-income and low-income countries and on challenging ideas and values of some wealthy countries that shape the practice of global health. We argue that decolonization of global health must also address the relationship between global health actors and contemporary forms of colonialism, in particular the current forms of corporate and financialized colonialism that operate through globalized systems of wealth extraction and profiteering. We present a three-part agenda for action that can be taken to decolonize global health. The first part relates to the power asymmetries that exist between global health actors from high-income and historically privileged countries and their counterparts in low-income and marginalized settings. The second part concerns the colonization of the structures and systems of global health governance itself. The third part addresses how colonialism occurs through the global health system. Addressing all forms of colonialism calls for a political and economic anticolonialism as well as social decolonization aimed at ensuring greater national, racial, cultural and knowledge diversity within the structures of global health.

Le colonialisme, qui implique la domination systémique de terres, de marchés, de peuples, de ressources, de cultures ou d'institutions politiques dans le but d'exploiter, de détourner et d'extraire des richesses et des ressources, affecte la santé de nombreuses manières. Ces dernières années, la décolonisation de la santé mondiale a suscité un intérêt croissant, l'accent étant mis sur la correction des déséquilibres de pouvoir entre les pays à revenu élevé et les pays à faible revenu, ainsi que sur la remise en question des idées et des valeurs de certains pays riches qui façonnent la pratique de la santé mondiale. Nous soutenons que la décolonisation de la santé mondiale doit également aborder la relation entre les acteurs de la santé mondiale et les formes contemporaines de colonialisme, en particulier les formes actuelles de colonialisme d'entreprise et de colonialisme financiarisé qui opèrent par des systèmes mondialisés d'extraction de richesses et de profits. Nous présentons un programme d'action en trois parties destiné à décoloniser la santé mondiale. La première partie porte sur les asymétries de pouvoir existant entre les acteurs de la santé mondiale des pays à hauts revenus et historiquement privilégiés et leurs homologues des pays à faibles revenus et marginalisés. La deuxième partie concerne la colonisation des structures et des systèmes de la gouvernance mondiale de la santé elle-même. La troisième partie traite de la manière dont le colonialisme se manifeste à travers le système de santé mondial. La lutte contre toutes les formes de colonialisme nécessite un anticolonialisme politique et économique ainsi qu'une décolonisation sociale visant à garantir une plus grande diversité nationale, raciale, culturelle et des connaissances au sein des structures de la santé mondiale.

El colonialismo, que implica la dominación sistémica de tierras, mercados, pueblos, bienes, culturas o instituciones políticas para explotar, apropiarse indebidamente y extraer riqueza y recursos, afecta a la salud de muchas maneras. En los últimos años ha crecido el interés por descolonizar la salud mundial, en particular para corregir los desequilibrios de poder entre los países de ingresos altos y los de ingresos bajos, y para cuestionar las ideas y los valores de algunos países ricos que influyen en la práctica de la salud mundial. Sostenemos que la descolonización de la salud mundial también debe abordar la relación entre los actores de la salud mundial y las formas contemporáneas de colonialismo, en especial las formas actuales de colonialismo corporativo y financiarizado que operan a través de sistemas globalizados de extracción de riqueza y especulación. Presentamos un programa de acción dividido en tres partes para descolonizar la salud mundial. La primera parte se refiere a las asimetrías de poder que existen entre los actores de la salud mundial procedentes de países de ingresos altos e históricamente privilegiados y sus homólogos de entornos de ingresos bajos y marginados. La segunda parte se refiere a la colonización de las estructuras y sistemas de la propia gobernanza de la salud mundial. La tercera parte aborda cómo se produce el colonialismo a través del sistema sanitario mundial. Abordar todas las formas de colonialismo exige un anticolonialismo político y económico, así como una descolonización social destinada a garantizar una mayor diversidad nacional, racial, cultural y de conocimientos dentro de las estructuras de la salud mundial.

Discrimination, disadvantage and disempowerment during COVID-19: a qualitative intrasectional analysis of the lived experiences of an ethnically diverse healthcare workforce in the United Kingdom.

BACKGROUND: Healthcare workers (HCWs) in the United Kingdom (UK) have faced many challenges during the COVID-19 pandemic, some of these arising out of their social positions. Existing literature explicating these challenges (e.g., lack of appropriate PPE, redeployment, understaffing) have highlighted inequities in how these have been experienced by HCWs based on ethnicity, gender or, job role. In this paper, we move a step ahead and examine how the intersection of these social positions have impacted HCWs' experiences of challenges during the pandemic. METHODS: We collected qualitative data, using interviews and focus groups, from 164 HCWs from different ethnicities, gender, job roles, migration statuses, and regions in the United Kingdom (UK) between December 2020 and July 2021. Interviews and focus groups were conducted online or by telephone, and recorded with participants' permission. Recordings were transcribed and a hybrid thematic analytical approach integrating inductive data-driven codes with deductive ones informed by an intersectional framework was adopted to analyse the transcripts. RESULTS: Thematic analysis of transcripts identified disempowerment, disadvantage and, discrimination as the three main themes around which HCWs' experiences of challenges were centred, based on their intersecting identities (e.g., ethnicity gender, and/or migration status). Our analysis also acknowledges that disadvantages faced by HCWs were linked to systemic and structural factors at the micro, meso and macro ecosystemic levels. This merging of analysis which is grounded in intersectionality and considers the ecosystemic levels has been termed as 'intrasectionalism'. DISCUSSION: Our research demonstrates how an intrasectional lens can help better understand how different forms of mutually reinforcing inequities exist at all levels within the healthcare workforce and how these impact HCWs from certain backgrounds who face greater disadvantage, discrimination and disempowerment, particularly during times of crisis like the COVID-19 pandemic.

Pandemic preparedness with 20/20 vision: Applying an intersectional equity lens to health workforce planning.

Human resource for health (HRH) is considered critical for achieving Universal Health Coverage, and the crisis surrounding HRH is now established as a global emergency. Their vital role has been central in the pandemic response. Yet, the discussions and deliberations on the recent pandemic treaty circumscribe HRH discussions to their capacities and protection, and address discrimination mainly in relation to gender. While this paper endorses the case for prioritisation of HRH in global pandemic preparedness planning, it re-frames the HRH crisis in relation to the institutional and structural factors driving HRH shortage, maldistribution and skills-needs misalignment. We critique the supply-and-demand framing of HRH crisis as one that obliviates the systematic inequalities within health systems that underpin health workforce motivations, distribution, satisfaction and performance. We propose an intersectional equity lens to redefine the HRH challenges, understand their underlying drivers and accordingly integrate in the global pandemic preparedness plans.

Mental health and COVID-19: is the virus racist?

COVID-19 has changed our lives and it appears to be especially harmful for some groups more than others. Black and Asian ethnic minorities are at particular risk and have reported greater mortality and intensive care needs. Mental illnesses are more common among Black and ethnic minorities, as are crisis care pathways including compulsory admission. This editorial sets out what might underlie these two phenomena, explaining how societal structures and disadvantage generate and can escalate inequalities in crises.

Examining intersectional inequalities in access to health (enabling) resources in disadvantaged communities in Scotland: advancing the participatory paradigm.

BACKGROUND: Multiple structural, contextual and individual factors determine social disadvantage and affect health experience. There is limited understanding, however, of how this complex system works to shape access to health enabling resources (HER), especially for most marginalised or hard-to-reach populations. As a result, planning continues to be bereft of voices and lived realities of those in the margins. This paper reports on key findings and experience of a participatory action research (PAR) that aimed to deepen understanding of how multiple disadvantages (and structures of oppression) interact to produce difference in access to resources affecting well-being in disadvantaged communities in Edinburgh. METHODS: An innovative approach combining intersectionality and PAR was adopted and operationalised in three overlapping phases. A preparatory phase helped establish relationships with participant groups and policy stakeholders, and challenge assumptions underlying the study design. Field-work and analysis was conducted iteratively in two phases: with a range of participants working in policy and community roles (or 'bridge' populations), followed by residents of one Edinburgh locality with relatively high levels of deprivation (As measured by the Scottish Index of Multiple Deprivation, a geographically-based indicator. See http://www.gov.scot/Topics/Statistics/SIMD/DataAnalysis/SPconstituencyprofile/EdinburghNorthern-Leith ). Traditional qualitative methods (interviews, focus groups) alongside participatory methods (health resource mapping, spider-grams, photovoice) were employed to facilitate action-oriented knowledge production among multiply disadvantaged groups. RESULTS: There was considerable agreement across groups and communities as to what healthful living (in general) means. This entailed a combination of material, environmental, socio-cultural and affective resources including: a sense of belonging and of purpose, feeling valued, self-esteem, safe/secure housing, reliable income, and access to responsive and sensitive health care when needed. Differences emerge in the value placed by people at different social locations on these resources. The conditions/aspects of their living environment that affected their access to and ability to translate these resources into improved health also appeared to vary with social location. CONCLUSION: Integrating intersectionality with PAR enables the generation of a fuller understanding of disparities in the distribution of, and access to, HER, notably from the standpoint of those excluded from mainstream policy and planning processes. Employing an intersectionality lens helped illuminate links between individual subjectivities and wider social structures and power relations. PAR on the other hand offered the potential to engage multiply disadvantaged groups in a process to collectively build local knowledge for action to develop healthier communities and towards positive community-led social change.

Expertise in action: Insights into the dynamic nature of expertise in community-based nursing.

AIMS AND OBJECTIVES: To gain insight into community nurses' experiences and how they make sense of the expertise they offer in their role. BACKGROUND: Globally, the spotlight is currently on community nursing expertise because of the movement of hospital-based to community-based care. Caring for people at home is no longer solely concerned with prevention, but delivering complex care to patients who are acutely unwell or at the end of their life. Little is known about the distinct expertise of community nurses, or their contribution to patient outcomes. There is a need to examine expertise in this group in order to inform current and future care provision within community settings. DESIGN: A hermeneutic, phenomenological study. METHOD: Semistructured interviews were conducted with eight community nurses in Scotland, UK, who hold an additional postregistration, professional qualification. Participants also kept audio-journals. Data were analysed using interpretive phenomenological analysis. FINDINGS: Participants described their expertise in three themes: negotiating a "way in" to care, managing complexity and "thinking on your feet." They did not refer to themselves as specialist practitioners, nor did they perceive that they were viewed as specialist by colleagues or management. They appeared to dismiss their range of expertise which included forming trusting relationships, anticipating care needs and problem-solving, enabling them to undertake complex care management. CONCLUSIONS: Expertise of community nurses in this study is dynamic, contextualised and action-oriented enabling them to be creative problem-solvers. It reflects engagement with patients and families and all aspects of the setting where care is provided, rather than being solely an identifiable set of specialist skills. RELEVANCE TO CLINICAL PRACTICE: It is vital to recognise community-based expertise internationally, especially if current WHO aims for community-based health care are to be achieved. Highlighting this expertise contributes to current discourse and may be considered in education and practice reviews.

Gender blind? An analysis of global public-private partnerships for health.

BACKGROUND: The Global Public Private Partnerships for Health (GPPPH) constitute an increasingly central part of the global health architecture and carry both financial and normative power. Gender is an important determinant of health status, influencing differences in exposure to health determinants, health behaviours, and the response of the health system. We identified 18 GPPPH - defined as global institutions with a formal governance mechanism which includes both public and private for-profit sector actors - and conducted a gender analysis of each. RESULTS: Gender was poorly mainstreamed through the institutional functioning of the partnerships. Half of these partnerships had no mention of gender in their overall institutional strategy and only three partnerships had a specific gender strategy. Fifteen governing bodies had more men than women - up to a ratio of 5:1. Very few partnerships reported sex-disaggregated data in their annual reports or coverage/impact results. The majority of partnerships focused their work on maternal and child health and infectious and communicable diseases - none addressed non-communicable diseases (NCDs) directly, despite the strong role that gender plays in determining risk for the major NCD burdens. CONCLUSIONS: We propose two areas of action in response to these findings. First, GPPPH need to become serious in how they "do" gender; it needs to be mainstreamed through the regular activities, deliverables and systems of accountability. Second, the entire global health community needs to pay greater attention to tackling the major burden of NCDs, including addressing the gendered nature of risk. Given the inherent conflicts of interest in tackling the determinants of many NCDs, it is debatable whether the emergent GPPPH model will be an appropriate one for addressing NCDs.

Understanding women's experience of violence and the political economy of gender in conflict: the case of Syria.

Political conflicts create significant risks for women, as new forms and pathways of violence emerge, and existing patterns of violence may get amplified and intensified. The systematic use of sexual violence as a tactic of war is well-documented. Emergent narratives from the Middle East also highlight increasing risk and incidence of violence among displaced populations in refugee camps in countries bordering states affected by conflict. However, much less is known about the changing nature of violence and associated risks and lived experiences of women across a continuum of violence faced within the country and across national borders. Discussion on violence against women (VAW) in conflict settings is often stripped of an understanding of the changing political economy of the state and how it structures gender relations, before, during and after a conflict, creating particular risks of violence and shaping women's experiences. Drawing on a review of grey and published literature and authors' experiences, this paper examines this underexplored dimension of VAW in political conflicts, by identifying risk environments and lived realities of violence experienced by women in the Syrian conflict, a context that is itself poorly understood. We argue for multi-level analysis of women's experiences of violence, taking into account the impact of the political economy of the wider region as shaping the lived realities of violence and women's response, as well as their access to resources for resistance and recovery.

Social movements and public health advocacy in action: the UK people's health movement.

There are growing calls within public health for researchers and practitioners working to improve and protect the public's health to become more involved in politics and advocacy. Such a move takes practitioners and researchers beyond the traditional, evidence-based public health paradigm, raising potential dilemmas and risks for those who undertake such work. Drawing on the example of the People's Health Movement, this short paper argues that advocacy and social movements are an essential component of public health's efforts to achieve great health equity. It outlines how the Scottish branch of the People's Health Movement sought to overcome potential tensions between public health evidence and advocacy by developing a regional manifesto for health via transparent and democratic processes which combine empirical and experiential evidence. We suggest that this is an illustrative example of how potential tensions between public health research and advocacy can be overcome, through bottom-up movements of solidarity and action.

Exploring the inequalities experienced by health and care workforce and their bases - A scoping review protocol.

Planning for investment in human resources for health (HRH) is critical to achieve Universal Health Coverage (UHC) and establish a sustainable health system. Informed planning warrants a better understanding of the health labour market (HLM) to tackle a variety of health and care workforce challenges: from addressing critical supply shortage, to ensuring optimal skills mix and distribution, and addressing motivation and performance challenges. Scant evidence around the overall role of socioeconomic and cultural factors like gender, race, marital status, citizenship (migrant) status, workplace hierarchy etc. in determining workforce composition, deployment, distribution, retention, un- and underemployment, sub-optimal work environments and other factors in the 'HRH crisis' warrants further exploration. This scoping review protocol aims to map and present the available evidence on inequalities experienced by health and care workforce, the socio-economic, cultural and other bases of these inequalities, and their outcomes/ consequences. PubMed, Web of Science, CINAHL and SCOPUS will be used to identify relevant literature. All types of published study designs in English language will be included if they discuss any inequality experienced by any category of health and care workers. Elaborate keyword categories for health and care workers and inequalities context have been developed, tested and reduced to the near-final search string. Eligible articles will be charted using the Joanna Briggs Institute checklist. The sample data extraction chart in JBI manual will be used as a basic skeleton with fields added to it to serve the needs of the scoping review. Descriptive analysis will be performed, depicting basic frequencies. While no further analysis has been advised in the JBI and PRISMA protocol, thematic analysis will be undertaken; following the Braun and Clarke's method with some modification and open coding as suggested by Maquire and Delahunt.

Expert consensus on a protocol for conducting bibliometric analysis of scientific articles on global migration health (GMH).

BACKGROUND: Migration and health are key priorities in global health and essential for protecting and promoting the health of migrants. To better understand the existing evidence on migration health, it is critical to map the research publication activity and evidence on the health of migrants and mobile populations. This paper presents a search strategy protocol for a bibliometric analysis of scientific articles on global migration health (GMH), leveraging the expertise of a global network of researchers and academics. The protocol aims to facilitate the mapping of research and evidence on the health of international migrants and their families, including studies on human mobility across international borders. METHODS: A systematic search strategy using Scopus will be developed to map scientific articles on GMH. The search strategy will build upon a previous bibliometric study and will have two main search components: (1) 'international migrant population', covering specific movements across international borders, and (2) 'health'. The final search strategy will be implemented to determine the final set of articles to be screened for the bibliometric analysis. Title and abstract screening will exclude irrelevant articles and classify the relevant articles according to predefined themes and subthemes. A combination of the following approaches will be used in screening: applying full automation (ie, DistillerSR's machine learning tool) and/or semiautomation (ie, EndNote, MS Excel) tools, and manual screening. The relevant articles will be analysed using MS Excel, Biblioshiny and VOSviewer, which creates a visual mapping of the research publication activity around GMH. This protocol is developed in collaboration with academic researchers and policymakers from the Global South, and a network of migration health and research experts, with guidance from a bibliometrics expert. ETHICS AND DISSEMINATION: The protocol will use publicly available data and will not directly involve human participants; an ethics review will not be required. The findings from the bibliometric analysis (and other research that can potentially arise from the protocol) will be disseminated through academic publications, conferences and collaboration with relevant stakeholders to inform policies and interventions aimed at improving the health of international migrants and their families.

Situating Biomedical and Professional Monopoly at the Intersections of Structural, Ideational and Agentic Power Comment on "Power Dynamics Among Health Professionals in Nigeria: A Case Study of the Global Fund Policy Process".

Lassa and colleagues' study is a strong commentary on the biomedical hegemony and professional monopoly of medical doctors in the policy landscape of the Global Fund in Nigeria. Situating this critical dimension of professional power within wider scholarship of power and governance of global health initiatives (such as the Global Fund), in this comment, I put forth two core arguments. I call for a relational perspective of power in a dynamic policy space that the Fund characterises. I argue that a systems-view analysis of power requires a thorough examination of subsystems, how they interact, and the diverse forms of power-individual agentic, ideational, and structural-and the mechanisms through which power is wielded. The lens of governmentality allows linking individual (expertise and practices) with institutional regimes and social practices these enable; and in examining the interface of local/ sub-national, national, and global within which policy formulation and implementation occurs.

Community participation and stakeholder engagement in determining health service coverage: A systematic review and framework synthesis to assess effectiveness.

Background: Community and stakeholder involvement in decision-making to determine publicly-funded health services and interventions is advocated to fulfil citizens' rights and improve health outcomes. The inclusion of public actors, particularly disadvantaged populations, in priority setting for universal health coverage (UHC) is also enshrined in guidance from the World Health Organization (WHO). However, challenges remain in operationalising this policy aim and ensuring that these approaches are effective and equitable. This study aimed to synthesise published evidence on the role of community and stakeholder participation in determining health service coverage. Methods: A systematic review was conducted, searching the Web of Science, Ovid Global Health, and PubMed Central databases from 2000 onwards, including all study types. A framework synthesis approach was used for charting and synthesising data on mechanisms, effectiveness (equity, depth, and stage), and barriers and facilitators for engagement. Results: Twenty-seven relevant studies were identified that involve community actors and other stakeholders in priority setting and decision-making processes for defining health benefit packages and UHC, health technology assessment, and pharmaceutical coverage. Mechanisms of engagement include a wide variety of consultation approaches; participation in decision-making committees, advisory councils, and local planning meetings; and appeals mechanisms. Participation occurs primarily at Data and Dialogue stages of decision-making processes, and we found limited depth of engagement among identified cases. Limited consideration of equity was observed in planning and reporting on community involvement in priority setting. A number of challenges are identified in the literature, which we typologise as institutional, procedural, technical, and structural / normative barriers to meaningful participation. Conclusions: This systematic review identifies key gaps and opportunities in the literature and practice related to effective and equitable community and stakeholder participation in determining health service coverage. It offers essential considerations for planning and executing inclusive approaches to priority setting for publicly-funded health services and interventions and defining health benefit packages for UHC.

Pandemic, precarity and health of migrants in South Asia: Mapping multiple dimensions of precarity and pathways to states of health and well-being.

Mobility patterns in South Asia are complex, defined by temporary and circular migration of low waged labourers within and across national borders. They move, live and work in conditions that expose them to numerous hazards and health risks that result in chronic ailments and physical and mental health problems. Yet, public policies and discourses either ignore migrants' health needs or tend to pathologise them, framing them as carriers of diseases. Their structural neglect was exposed by the ongoing pandemic crisis. In this paper, we take stock of the evidence on the health of low-wage migrants in South Asia and examine how their health is linked to their social, political and work lives. The paper derives from a larger body of work on migration and health in South Asia and draws specifically on content analysis and scoping review of literature retrieved through Scopus from 2000 to 2021 on health of low-income migrants. Utilising the lens of precarity and building on previous applications, we identify four dimensions of precarity and examine how these influence health: i) Work-based, concerned with hazardous and disempowering work conditions, ii) Social position-based, pertaining to the social stratification and intersecting oppressions faced by migrants, iii) Status-based, derived from vulnerabilities arising from the mobile and transient nature of their lives and livelihoods, and iv) Governmentality-based, relating to the formal policies and informal procedures of governance that disenfranchise migrants. We illustrate how these collectively produce distinct yet interrelated and interlocking oppressive states of insecurity, disempowerment, dispossession, exclusion, and disposability that define health outcomes, health-seeking pathways, and lock migrants in a continuing cycle of precarity, impoverishment and ill-health.

Visualizing patterns and gaps in transgender sexual and reproductive health: A bibliometric and content analysis of literature (1990-2020).

Background: Transgender people face numerous obstacles to accessing adequate, affordable, and appropriate sexual and reproductive health (SRH) services as outlined by the UN's Sustainable Development Goal 3.7 target of achieving universal access to SRH services by 2030. However, transgender SRH sits as a poorly researched area within public health that makes it difficult to understand the current dilemmas facing transgender SRH. This article reports the findings of a study aimed at taking stock of global research in transgender SRH. Methods: A bibliometric analysis, used to gain insights from the retrieved literature's metadata, alongside a content analysis were utilized to examine the growth, impact, and content of retrieved articles. Results: Nine hundred fourteen journal articles were retrieved, predominately in English (884; 96.7%). These involved 3653 authors from 46 affiliated countries. Most frequent keywords included HIV, PrEP, and gender identity; corresponding to the SRH issues studied, namely HIV/AIDs and gender reassignment. Top cited and overall articles originated heavily from US affiliated authors. Content analysis outlined the articles' inclusion of the transgender community to largely have a mixed focus with cisgender people in research, these articles largely disease-focused and conducted within cities in the United States. Conclusions: Growth in transgender SRH research was minimal until the early-2010s, after which a steep rise can be observed. Research retrieved has a disproportionate clinical and biomedical focus around HIV and related STI issues suggesting a failure to engage with reproductive justice and more comprehensive rights-based understanding of SRH. The sustained use of derogative language suggests a need for greater inclusion and awareness of trans identities within research and publishing. The dominance of the United States in authorship and as a site of research establishes the need for more geographically diverse research, trans, and LMIC-led research enquiry and creating greater opportunities for cross-cultural, comparative, and collaborative scholarly work.

Bridging the gap: Using CHNRI to align migration health research priorities in India with local expertise and global perspectives.

Background: Migration and health are increasingly recognised as a global public health priority, but concerns have been raised on the skewed nature of current research and the potential disconnect between health needs and policy and governance responses. The Migration Health South Asia (MiHSA) network led the first systematic research priority-setting exercise for India, aligned with the global call to develop a clearly defined migration health research agenda that will inform research investments and guide migrant-responsive policies by the year 2030. Methods: We adapted the Child Health and Nutrition Research Initiative (CHNRI) method for this priority setting exercise for migration health. Guided by advisory groups established at international and country levels, we sought research topics from 51 experts from diverse disciplines and sectors across India. We consolidated 223 responses into 59 research topics across five themes and scored them against five predefined criteria: answerability, effectiveness, feasibility, impact, and effect on equity. We then calculated research priority scores (RPS) and average expert agreement (AEA) each research topic and theme. Results: A third of the 59 research topics were on migrants' health and health care access, 12 on social determinants of migrants' health, 10 on policies, law and migration health governance, eight on health systems' responsiveness, and five on migration health discourse. Three of the top five priority topics pertained to migrants' health care access. The policies, law, and governance theme had the highest overall RPS score. Conclusions: There is a noticeable gap between research priorities identified by experts at the country-level and the current research focus and priorities set globally. This disconnect between the global and local perspectives in migration health scholarship hinders the development of context-specific and suitable policy agendas for improving migrants' health. Our co-developed agenda emphasises the need to prioritise research on the capacity of existing systems and policies so as to make them more migration-aware and responsive to migrants' health needs.

Transformative or Functional Justice? Examining the Role of Health Care Institutions in Responding to Violence Against Women in India.

With the growing salience of ideas and reforms concerning women's human rights and gender equality, violence against women (VAW) has received heightened policy attention. Recent global calls for ending VAW identify health care systems as having a crucial role in a multisector response to tackle this social injustice. Scholars emphasize the transformative potential of such response in its ability to not only address the varied health consequences but also prevent future recurrence by enabling wider access to support and justice. This wider consensus on the role of health systems, however, demands stronger empirical basis. This article reports findings from an exploratory research developed around the core question: What are the perceived strengths and challenges confronting health systems in offering a comprehensive response to VAW in India? Drawing on site visits, observations, and interviews with front-line staff and program managers of an integrated intervention to tackle violence in Kerala and nongovernment organisation staff in Delhi and Mumbai, the article presents its historical context and key barriers to effective implementation. While promising in terms of outreach and incremental changes in attitudes, barriers include deficits in infrastructure and institutional practices that reinforce inequities in gender-power relations, hostile attitudes, and limited capacities of health workforce to tackle the complex and diverse needs of women experiencing abuse. Locating these experiences in relation to other models rooted in feminist approach, I argue how conventional intervention models of provisioning fail to challenge institutional contexts and structural inequalities that underpin violence and compound vulnerabilities experienced by women, thereby serving a functional response. Health systems are social institutions embedded in prevailing gender norms and power relations that must be tackled alongside addressing imminent needs of women victims of abuse. To this end, feminist approaches to counselling and relational perspectives to social justice can strengthen responsiveness (and transformative potential) of integrated sector-wide interventions.

Victims, villains and the rare hero: Analysis of migrant and refugee health portrayals in the Indian print media.

The Indian media's reportage of the Covid-19 pandemic has exposed the State's long-standing apathy towards low-income migrants and the structural neglect and violence faced by them in society. But how consistent were the country's print media in reporting on this population group before the crisis? This paper reports the findings of a study that examines the representation of migrants and refugees and their health in the Indian print media prior to the pandemic. A secondary objective was to examine any variations in their representation based on their social positions (for example, ethnicity, nationality, gender, religion). Using frame and content analyses, three English language newspapers were examined for the period January 1, 2017 to December 31, 2018. A total of 1,111 articles were retrieved. Analysis revealed that migrants were most frequently framed as "villains", posing a threat to the security, culture, health and economy in their destination states/cities, and less often as victims. On health coverage, the study found that the media frequently pathologised migrants and projected them as carriers of infection. Migrants' religion, ethnicity and class, and their proximity to the majoritarian population appeared most prominent in determining the frame imposed. The articles mostly relied on accounts of state officials and political leaders, whereas migrants' voices comprised less than a quarter of the sources of information. The media thus play a vital role in crystallising these disparities and, through acts of both omission and commission, end up vilifying migrants.