Governing Ebola: between global health and medical humanitarianism

Medical humanitarianism and global health are two distinct but co-dependent spheres of global health security. Their actors differ in their units of analysis, understanding of neutrality, and organizational capacities. While health underpins the normative principles of humanitarian action, humanitarian ideas, and notably medical humanitarian organizations, are absent from global health security planning. This article develops the work of Lakoff [‘Two regimes of global health’, Humanity, 1(1), 59–79 (2010)], distinguishing between these two governance spheres and how this had stark consequences in the 2014/15 Ebola outbreak in Liberia and Sierra Leone, framed as a problem of global health but which rapidly became a humanitarian crisis. Such a frame excluded medical humanitarian organizations from the initial global strategy and resulted in the creation of a new organization (UMMEER – United Nations Mission for Ebola Emergency Response) and the involvement of militaries to bridge the health-humanitarian divide. Reconciling the distinct but co-dependent relationship between medical humanitarianism and global health is fundamental to effective delivery of global health security.     

Deafness and hearing loss - a global health problem

Throughout history deafness and hearing loss have been widely misunderstood. Issues concerning the education of deaf children, appropriate means of communication and remediation of deafness have consistently been a source of heated debate between the professionals working with the deaf and the deaf people themselves. The purpose of this paper is an attempt to illustrate these issues and to impart to the reader the realization that a diagnosis of "deaf" means so much more than the inability to hear and understand speech and other sounds. It is a way of life that cannot be ignored (Jacobs, A Deaf Adult Speaks Out, Harvard University Press, Washington, DC, 1994).     

College health 2050.

On May 31, 2040, Kunta Kinte Sanchez O'Shaunessey-Chan, MOND, president of the North American College Health Association (NACHA), gave the keynote address at the opening session of the annual meeting held in the Marriott Conference Center, Saskatoon, Saskatchewan. He recounted important events of the past 50 years that have shaped the college health field of today, and he predicted important trends for the next decade. Although his speech was given in Spanish, it was simultaneously translated into English, French, and 15 other languages requested by attendees. The English version follows.     

The road to a world health organization global strategy for reducing the harmful use of alcohol

Harmful alcohol use and the related health effects are a global problem and therefore need to be addressed not only by individual nations but also on an international level. For example, the World Health Organization (WHO) noted that harmful alcohol use is the third leading risk factor for premature deaths and disabilities in the world, accounting for approximately 2.5 million deaths worldwide (corresponding to 3.8 percent of all deaths) in 2004 (WHO 2010). Moreover, harmful alcohol use was considered responsible for 4.5 percent of the global burden of disease as measured in disability-adjusted life-years lost in the same year. Given this scope of the impact, the WHO initiated a series of efforts that culminated in the development of a global strategy for reducing the harmful use of alcohol. This article reviews the alcohol-related activities of the WHO over the years and summarizes the central issues addressed by the global strategy.     

Prescribing the Families Own Dysfunctional Rules as a Therapeutic Strategy*

The use of paradox-strategy in therapy is motivated by the fact that many families request help but at the same time seem to reject all offers of help. The therapist may be drawn into a game in which every effort on his part to act as an agent of change is nullified by the family group. In systemic terms these contradictory attitudes derive from the dynamic equilibrium existing between the tendency toward change, which is implicit in the request for help at one level, and the tendency toward homeostasis which at another level imposes the repetition of the family's habitual rules of interaction. The coexistence of these forces can entangle the therapist in the family's paradoxical logic of “help me to change, but without changing anything.” By accepting the contradiction facing him and by “uniting” himself with this within the family, the therapist puts himself into a position opposite to that which the family expects. His response to the family's paradoxical request is a paradox, or counterparadox, because it creates the contradictory communication typical of rigid family systems. By prescribing its own dysfunctional rules to the family, the therapist can stimulate the tendencies toward change present in the family system.     

Network range and health.

The inclusion of network concepts in the stress-distress model of health represents a major theoretical advance. Most researchers use the dyadic approach of social network analysis to construct network measures of social support. Working from the argument that network structure and social support are conceptually and empirically distinct, we extend the stress-distress model to include measures of network structure (network range) as predictors of exposure to stress, access to social support, and distress. We find that the density, diversity, and size dimensions of network range affect exposure to stress, access to social support, and distress differentially and that, in each case, their effects are gender-specific.     

Men's reproductive and sexual health.

A broad definition of men's reproductive and sexual health (MRSH) includes medical (pathophysiological) matters such as sexually transmitted infections (STIs), developmental anomalies, malignancy, trauma, and infertility. It also includes psychosocial concerns: sexuality, contraception, disease prophylaxis, developmental and lifecycle issues, tobacco and drug use, sexual identity and orientation, and partnership issues. College men, of whom a large majority are sexually active, have a range of MRSH needs, including some that are particular to their age and social environment. To reach men effectively requires approaches that are somewhat different from those used with women. Clinicians in college health services are in an excellent position to help young men recognize the importance of reproductive health and sexual responsibility. College health services therefore should offer men screening; clinical diagnosis and treatment for MRSH conditions; and information, education, and counseling services, in a manner designed to meet their unique needs.     

Promoting mental health. Lesbian nurse support groups.

1. Although an underground network of lesbian nurses has existed for years and they are powerful in their leadership in various specialty organizations, many lesbian nurses make themselves "known" only to a few close people. 2. The Lesbian Nurse Interest Group was formed to support lesbian nurses through difficult periods and to discuss unique areas of concern. 3. The group helps to combine all aspects of a lesbian nurse's life and to empower the members to address personal and professional issues.     

The long-run and short-run impacts of global competition on U.S. union wages

Union opposition to trade liberalizing agreements suggests that international trade harms organized labor. Using union contract data, we assess both long- and short-run impacts of international trade on U.S. collective bargaining outcomes. Results indicate that, in the short run, increases in either imports or exports reduce union wages. This is attributed to risk aversion on the part of both unions and management. In the long run, however, trade has little net impact on average union wage settlements. In forming their opposition to more open U.S. trade policies, unions appear more concerned with short-run impacts of trade and are willing to trade-off immediate wage gains in lieu of future employment possibilities. We thank Dan Rickman, Bill Levernier, and the anonymous referee for their useful comments.