RESUMO
The use of sanctions as a policy tool to affect change in the political behavior of target states has increased over the past 30 years, along with a concern about their impact on civilian health. Some researchers have proposed that targeting sanctions can avoid their moral costs, yet others have challenged this claim. This systematic mixed-studies review explored the debate about targeted sanctions by appraising their health effects as reported in the medical and public health literature, with a global focus and through the COVID-19 era.We searched three electronic databases without temporal or geographical restrictions and identified 50 studies spanning three decades (1992-2021) meeting our inclusion criteria. Using a piloted form, we extracted quotations addressing our research questions and identified themes that we grouped according to the effects of sanctions on health or its determinants, generating frequency distributions to assess the strength of support for each theme. While no study posited a causal relationship between sanctions and health, or engaged the morality of sanctions, most implied that when sanctions were present, health was inevitably impacted, even for sanctions ostensibly targeted to minimize civilian harm. Our findings suggest that given the integrated nature of the global economy, it is all but impossible to design sanctions that will achieve their stated goals without inflicting significant harm on civilians. We conclude that the use of sanctions as a policy tool threatens global health and human rights, especially in times of crises.
RESUMO
Foetal Alcohol Spectrum Disorder (FASD) has emerged as a significant public health issue, in Canada and elsewhere. Health experts increasingly acknowledge that the disproportionate impact of FASD on indigenous people is driven by social and historical contexts, especially in settler colonial states like Canada. However, they generally frame FASD as preventable through abstinence and the effects of FASD as manageable through provision of appropriate medical and legal protection to affected offspring. Drawing from Marxist, anticolonial and anti-imperial theories and applying a Critical Discourse Analysis approach, we identify the (re) production of colonial and capitalist dominance in the expert literature. We show that dominant narratives depoliticize FASD by conceptualizing settler colonialism as a past event, ignoring ongoing, contemporary forms of settler colonial dispossession and resituating FASD within an expert language that locates solutions to FASD within affected individuals and communities. In so doing, these narratives legitimize, and contribute to perpetuating, existing disease inequities, prevent the formulation of policies that address the very real and as yet unmet needs of FASD affected individuals, families and communities and erase from the public discourse discussions about changes that could truly address FASD inequities at their root. We conclude by elaborating on the implication of these narratives for policy, practice and equity, in Canada and other settler colonial states.
