This commentary discusses how professionalisation and expertise is both a positive, constructive project as well as an exclusionary one. The discussion suggests that global health, rather than being a new sub-field of science catalysed by new discoveries, is better understood as being part of the economic and scientific expansionism of the few richest G7 countries. It is argued that global health expertise, aside from scientific expertise, also involves expertise in being a driver of the expansionism. It also points to ethical expansionism and signs of epistemic domination of global health ethics by scholars from 2-3 countries. The collection of contributions in this first Black and Brown in Bioethics topic collection is described as being an effort to resist the exclusionary and expansionist aspects of global health expertise, while also exhorting to do better at saving lives with better ethics.

Children’s growth extends beyond gains in height and weight: it includes non-physical achievements. This paper reviews the research conducted by the International Union for Nutritional Sciences Task Force ‘Towards a Multidimensional Approach to Child Growth’, which developed a Multidimensional Index of Child Growth (MICG) framed within a capability- and human-rights- based conceptualisation of child growth across interconnected dimensions, including physical health, love and care, mental wellbeing, participation, autonomy, mobility, and safety. Qualitative research in Bangladesh and southeastern Tanzania informed the operationalisation of the MICG, showing that caregivers understand child growth as a multidimensional capability set distributed across children, caregivers, and households. Quantitatively, we prototyped the MICG using Young Lives Survey data from Ethiopia, India, Peru, and Vietnam. The MICG reveals patterns of deprivation not captured by anthropometric indicators alone, such as compounded shortfalls in education, mobility, and mental wellbeing among rural girls in Peru, despite similar physical growth profiles. Regression and quantile analyses indicate that community participation in the design of WASH programmes is associated with higher multidimensional achievements, particularly among the most deprived children. To bridge observed achievements and unrealised potential, we extend the MICG using a Bayesian stochastic-frontier approach to estimate context-specific capability distributions and identify children at risk of being left behind. Finally, we propose a spiderweb growth chart for monitoring multidimensional child growth, complementing WHO anthropometric charts. Overall, the MICG offers an equity-sensitive tool for evaluating nutrition interventions, strengthening child growth surveillance, and advancing the Sustainable Development Goal commitment to leave no child behind.

This commentary responds to the article by Qureishi et al (Am J Epidemol. 2024;193(10):1313-1317) that criticizes a new proposal for "positive epidemiology." They argue that positive epidemiology, as it is being proposed and conducted, ignores supraindividual social contextual factors that constrain the well-being of some individuals more than others, and it could exacerbate inequalities if applied at a population level, among other harms. They offer an alternative approach to defining causal factors that are helpful for well-being and seek to ground their view in human rights and economic justice frameworks. This commentary considers their criticisms of positive epidemiology and suggests that their alternative, as well as all research into positive health and well-being, would benefit from drawing on the ongoing debates and literature in health equity and justice philosophy. A coherent conception of health and well-being, the link between health/well-being and theories of justice, and the capabilities approach are discussed. The efforts at conducting epidemiology for the causes and distribution of good health and well-being grounded in justice are welcomed. This article is part of a Special Collection on Mental Health.

In a thoughtful reflection on the emergence and purpose of occupational science, Venkatapuram poses issues for occupational therapists in relation to what it means to be a science. Citing debates within epidemiology, characterized as being a biological or social science, Venkatapuram argues that in the post-pandemic context occupational scientists must think hard about the values underpinning their enterprise, and the implications for people's quality of life and well-being. Ultimately, he raises questions about what science is for, whether science can convince people about what to do, and how we should be striving for something better than what is now. Pointing to the overlap between the capabilities approach and what occupational science is trying to achieve, Venkatapuram concludes with the challenge: "How are you going to bridge knowledge production with transforming the world?"

The negotiations for the WHO Pandemic Agreement have brought attention to issues of racism and colonialism in global health. Although the agreement aims to promote global solidarity, it fails to address these deeply embedded problems. This Viewpoint argues that not including the principle of subsidiarity into Article 4 of the agreement as a pragmatic strategy was a missed opportunity to decolonise global health governance and promote global solidarity. Subsidiarity, as a structural principle, empowers local units to make decisions and address issues at their level, fostering collaboration, coordination, and cooperation. By integrating subsidiarity, the agreement could have ensured contextually appropriate responses, empowered local communities, and achieved justice in global health. This paper discusses the elements of subsidiarity—namely, agency and non-abandonment—and highlights the need to strike a balance between them. It also maps the principle of subsidiarity within the Pandemic Agreement, emphasising the importance of creating a practical framework for its implementation. By integrating subsidiarity into the agreement, a just and decolonialised approach to pandemic prevention and response could have been closer to being realised, promoting global solidarity and addressing health inequities.

Abstract Context Heart failure has high, growing global prevalence, morbidity and mortality, and is a leading cause of death with serious health-related suffering in low- and middle-income countries. Person-centred care (PCC) is a critical component of high-quality healthcare and is particularly vital in the context of a serious illness such as heart failure. However, there are limited data exploring PCC in this population in low- and middle-income settings. Aim The aim of this study was to explore how clinical services could respond to the PCC needs of individuals living with heart failure in Thailand, with potential for adaptation in other settings. The specific objectives were (i) to understand the experiences and needs of persons living with heart failure, their caregivers and HCPs; (ii) to explore specific practical actions that can help deliver PCC for heart failure patients in this setting. Methods Cross-sectional qualitative study. In depth, semi-structured interviews were conducted in Thailand with heart failure patients (n = 14), their caregivers (n = 10) and healthcare professionals (n = 12). Framework analysis was conducted with deductive coding to populate an a priori coding frame based on Santana et al’s PCC model (2018) and Giusti et al’s systematic review (2020), with further inductive coding of novel findings to expand the frame. The study is reported in accordance with the consolidated criteria for reporting qualitative research guidelines (COREQ). Results The findings reveal specific practice actions that deliver PCC for persons living with heart failure in Thailand, such as (i) compassionate communication by healthcare professionals; (ii) effective teamwork amongst multidisciplinary healthcare professionals; (iii) proactive responses to physical, psychosocial, relational and information needs of patients and caregivers; (iv) engaging patients and families in symptom management; (v) providing opportunities for patients to be cared for in the community; and (vi) responding to the social determinants of health, illness and healthcare access. Conclusion Person-centred healthcare systems must aim to address the social determinants of illness and place focus on community- and home-based care. Heart failure patients and caregivers must be supported to self-manage, including how to recognise symptoms and take appropriate action. Delivering PCC in such a way has the potential to improve outcomes for patients, enhance patients’ sense of agency and experiences of care, improve health equity, and reduce hospital admissions, relieving pressure on the hospital system and reducing overall costs of care.

As we mark the anniversary of the publication of the 2030 Agenda mid-term report, the world's nations stand at a crossroads. While off-track in achieving most Sustainable Development Goals (SDGs), multiple crises have further exposed deep inequalities and vulnerabilities in the current dominant approach centred on economic growth and resource allocations. In this editorial paper, scholars of the human development and capability association and editors of the Journal of Human Development and Capabilities, express our deep concern at the lack of progress towards the SDGs. We argue for prioritising human development rather than economic growth and for putting human agency at the centre of development policy. This agency-centric approach includes the implementation of feedback systems for assessing human development progress through broader grassroots participation and relies critically on strengthening state capacities, safeguarding human rights, and promoting democracy.

Researchers seeking to assess the impact of a program on the capability of its target audience face numerous methodological challenges. The purpose of our review was to see to what extent such challenges are recognised and what choices researchers made in order to address them, and why. We identified 3354 studies by searching five databases in addition to cross-checking references from selected studies. A total of 71 studies met our pre-defined selection criteria: empirical studies reporting data on how interventions impacted the beneficiaries' capability, providing sufficient detail on how impact was measured, in English language. Four independent raters assessed those studies on four domains: descriptive information, consideration of causal attribution, operationalisation of capability, and interpretation of findings. Challenges related to capability impact assessment were not widely explicitly acknowledged, and available measures to address these challenges were not being used routinely. Major weaknesses included little attention to causal attribution, infrequent justification of the specific content of capability, and failure to research the constitutive elements of capability and their interactions. Research into a program's impact on the capability of its recipients is challenging for several reasons, but options are available to further improve the quality of this type of research.

This chapter presents a rough sketch of my nascent thinking regarding a theory or approach to global health justice. It has three parts. The first is an introduction and background to the topic of global justice, and a brief overview of the state of the global health justice literature. In the second part, I present some criteria for what we want from a theory of global health justice or, perhaps, a theory of global justice that appropriately centres on health. Then, in the third part, I conclude with a discussion for what a human capabilities-centred theory of global health justice would or could look like. The discussion is purposefully tentative and rough in light of the still ongoing impact of the Covid-19 pandemic, and the enormous stress on global health institutions and the world order. The greater awareness of epistemic oppression and injustices in global health and beyond also motivate greater care and humility in positing conceptions of justice that are meant to apply globally.

In the following discussion, we present a quick conceptual history of healthy equity and health justice, some plausible outcomes from the Covid-19 pandemic for the public's understanding of these concepts, and some recent and relevant learnings for realizing equity and justice that could be useful for dental public health and beyond.

In the rapidly evolving landscape of global health issues and policy, surgery has historically been sidelined due to concerns about high cost, complexity and other concerns including quantitatively less surgical disease burden in comparison to infectious disease or other health conditions. Now, in the context of pandemics, climate change, shrinking health budgets and other global health security concerns, the hard-won progress in raising the profile of surgical care is at risk, and a reconceptualisation is needed to maintain its position in global healthcare agendas. We challenge the long-standing ethical frameworks that underlie healthcare priority setting, namely cost-effectiveness analysis and human rights, that have contributed to surgery being sidelined for decades. They incompletely account for improvements to life quality and well-being that are possible through surgical healthcare systems. We argue for the Capabilities Approach as an alternative normative framework because it emphasises the moral importance of supporting every person’s abilities to be and to do the things they value. Through this framework, we can produce a more comprehensive conception of healthcare that goes beyond biomedical health, and surgical healthcare would ultimately gain a higher priority in valuation of healthcare and non-healthcare interventions.

Olusoji Adeyi starts his book on global health with an epigraph quoting Nestor, a character in Homer's Odyssey. In the ancient Greek epic poem, Nestor has returned home from fighting in the Trojan war and he promises to tell all of what he knows happened. From such an epigraph, it is plausible to expect that the book will recount a comparable tale of an epic war. Adeyi recently retired from a long career at senior levels of global health institutions, the last of which was at the World Bank as Director of Health, Nutrition, and Population Global Practice. Adeyi's choice of war as a metaphor for his career in global health challenges the pervasive rhetoric of global health as an enterprise of benevolence, altruism, and equity. It is also important to note that Adeyi is claiming the role of the primary narrator of an epic tale. In the board rooms, government offices, and power tables of global health policy making, a Black African doctor is likely to have encountered and perceived things that others may not have.

This commentary discusses the WHO definition of health ageing in terms of functional abilities, and the problem definition and evidence-based public health response framework outlined in the 2015 WHO Report on Ageing and Health. After identifying the neglect of older people in health policy at national and global levels, some data are presented on the majority of COVID-19 deaths being older people. The discussion then focuses on the underlying ethical and analytical framework of functional abilities provided by the Capability Approach. The approach is presented as distinguishing between achievement and capability, the ethical significance of recognising both, and its inclusion of surrounding social conditions from local to global in assessing wellbeing of older people's functional abilities. Measurement of functional abilities, informed by the Capabilities Approach, is stated to be an enormous and crucial task in establishing a global baseline, and making progress in improving the health and wellbeing of older people.

The global response to the COVID-19 pandemic has been marred by a widespread failure to embed ethics in policymaking. The consequences have included vaccine hoarding by rich countries and the deaths of millions of people around the world. Governments have followed a simplistic narrative of science and finance teaming up against a virus and delivering a silver bullet in the form of a new vaccine, rather than recognizing that a health emergency reflects patterns of inequality within and across countries and other social factors that need to be addressed. Given the interconnection and interdependency of globalization, ethics must be incorporated in global health policy as a primary consideration, not an afterthought.