Our Research is Completed: is There an Ethical Way to Disseminate its Findings?

Full of suggestions, this article turns the spotlight on what should be strictly pursued to timely, clearly and transparently disseminate all findings of health and medical research to the people who can make use of them. To this aim, it maintains that all research stakeholders should integrate ethics and integrity principles in their institutional dissemination policies and personal belief systems 

By Raffaella Ravinetto

Institute of Tropical Medicine, Antwerp, Belgium (Twitter: @RRavinetto) 

Our Research is Completed: is There an Ethical Way to Disseminate its Findings?


All findings of health and medical research, whether positive, inconclusive or negative, should be timely, clearly and transparently disseminated to the people who can make use of them[1],[2]. This, in order to inform policies and practices, and to maximize the social value and benefit of the research without delay”[3]. In a paper recently published in the BMJ Evidence Based Medicines[4], Jerome A Singh and myself reflected on the ethics challenges faced not only by researchers, but also by other concerned stakeholders, when it comes to disseminating research findings. In particular, we looked at the challenges and opportunities of peer-review publications, abstracts, pre-prints, press-releases, and media and social media coverage. Dissemination of research findings to the research participants and communities is at least equally important, but it requires different modalities and contextualized approaches.

Herein, I present an overview of our reflection and call from the publication in the BMJ Evidence Based Medicine, which is available open access at Responsible dissemination of health and medical research: some guidance points | BMJ Evidence-Based Medicine.

The main modalities of dissemination

Publishing in peer-reviewed journals remains the benchmark dissemination modality. However, it is not exempt from shortcomings and weaknesses[5], particularly if there is lack of qualified reviewers, and/or if researchers are subject to a ‘publish or perish’ institutional culture. Furthermore, independent researchers or those in resource-constrained settings may be unable to publish their research due prohibitively high publication fees[6]. Before peer-review publication, scientific conferences provide adequate platforms for sharing research results with peers. However, the limited information contained in a conference abstract will not allow reviewers to identify all potential scientific and/or ethical shortcomings of the concerned work.  Preprints, i.e. preliminary reports of work not yet peer-reviewed, are more and more frequently uploaded in dedicated free-access servers, such as https://www.medrxiv.org/[7]. They allow for rapid, open-access dissemination, accompanied by informal peer-appraisal; but rushed readers may miss the cautioning  that they are not peer-reviewed, thus not suitable yet to inform policy or medical guidelines.

The scientific community, health system policy-makers, and regulators are the primary target of  peer-reviewed manuscripts, abstracts, and pre-prints. Conversely, corporate press-releases for early dissemination of (in particular) clinical trial findings, primarily aim at influencing the market. They are drafted by marketing experts, and are often preceded by stock repurchasing, i.e. companies buy back part of their own stock held by executives, thus increasing demand for the stock and enhancing earnings per share.[8]

Last, irrespective of the initial dissemination modality, upstream information is cascaded to mainstream and social media, helping to spread valuable knowledge, but also risking to catalyze misunderstanding or overemphasis on marginal, unsignificant or inaccurate findings.

A call for good dissemination practices

In our paper in the BMJ Evidence Based Medicine, we drafted some recommendations for good dissemination practices. They are aimed at researchers, research institutions, developers, medical journals editors, media, journalists, social media actors, medical opinion leaders, policy makers, regulators, and the scientific community. For instance, researchers, research institutions and developers (including pharmaceutical companies) should publish all results, including those that are negative or inconclusive, and they should do it in open access journals when possible. They should also ensure that conference abstracts, pre-prints and press-releases are (rapidly) followed by a peer review publication – and if this does not happen, be transparent on why this does not happen. Research institution should avoid fostering an explicit or implicit ‘publish or perish’ culture. Medical journals should adopt fair prices for open access publication; rigorously ensure compliance with the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals of the International Committee of Medical Journal Editors (ICMJE), beyond a formal “checklist approach”; and comply with the core practices of the Committee on Publication Ethics (COPE). As we advocated for elsewhere, the scientific community as a whole should agree on “good pre-print practices”, and on a less ambiguous terminology, e.g. not peer reviewed”[9]. There is also a key-responsibility of journalists and key-opinion leaders to critically appraise any dissemination modality (and press-releases in particular) for ethics, science and possible bias, and to communicate accordingly, whether in mainstream media or in personal social media feeds.

In summary, in order to ensure timely, comprehensive, accurate, unbiased, unambiguous, and transparent dissemination, all research stakeholders should integrate ethics and integrity principles in their institutional dissemination policies and personal belief systems.



[1] World Medical Association. Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013; 310: 2191–94.

[2] Council for International Organizations of Medical Sciences (CIOMS). International ethical guidelines for health-related research involving humans. 4th ed. Geneva: Council for International Organizations of Medical Sciences (CIOMS); 2016 Nov. Accessed on 21/04/2022 at: https://cioms.ch/shop/product/international-ethical-guidelines-for-health-related-research-involving-humans/

[3] National Institute for Health Care and Research. “How to disseminate your research”. Version 1.0, January 2019. Accessed on 21/4/2022 at https://www.nihr.ac.uk/documents/how-to-disseminate-your-research/19951

[4] Ravinetto R, Singh JA. Responsible dissemination of health and medical research: some guidance points. BMJ Evidence-Based Medicine Epub ahead of print 2.9.2022; doi:10.1136/bmjebm-2022-111967

[5] Smith MJ, Upshur REG, Emanuel EJ. Publication ethics during public health emergencies such as the COVID-19 pandemic. Am J Public Health. 2020; 110:947–8.

[6] Ellingson MK, Shi X, Skydel JJ, et al. Publishing at any cost: a cross-sectional study of the amount that medical researchers spend on open access publishing each year. BMJ Open 2021; 11: e047107. 7

[7] Massey DA, Opare MA, Wallach JD, Ross JS and Krumholz HM. Assessment of Preprint Policies of Top-Ranked Clinical Journals. JAMA Network Open. 2020;3(7): e2011127

[8] Sorkin AR, Karaian J, Gandel S, de la Merced MJ, Hirsch L, and Livni E. Biden Renews Pushback Against Stock Buybacks. 28 March 2022. https://www.nytimes.com/2022/03/28/business/dealbook/biden-stock-buybacks.html.

[9] Ravinetto, R., Caillet, C., Zaman, M.H. et al. Preprints in times of COVID19: the time is ripe for agreeing on terminology and good practices. BMC Med Ethics 2021;  22 (106).

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News Flash 497: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

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...the voice of funders with clear commitments on how they intend, and should ensure, that there is equity in global health research remains disturbingly absent. If any concrete progress is envisaged in ensuring equity in global health research, then the funders must walk the talk... 

...funders should come up with clear guidelines and indicators to ensure that equity is engrained throughout the research cycle with the research they fund...

 By Luchuo Engelbert Bain, MD, PhD1,2,3

  1. International Development Research Centre, IDRC, Ottawa, Canada.
  2. Department of Psychology, Faculty of Humanities, University of Johannesburg, South Africa
  3. Pan African Medical Journal, PAMJ.
Email: lengelbert-bain@idrc.ca




Healthy partnerships in the global health research agenda stand to greatly accelerate the decolonization of decolonizing global health. Indeed, the much-awaited Cape Town Statement of the just ended 7th World Conference on Research Integrity (29 May-1 June 2022, Cape Town, South Africa) will put extra momentum in ending “helicopter research”. Some major players in the global health publication space (The Lancet, Nature, The BMJ, Anesthesia) have taken a clear commitment to ensure equity when it comes to authorship. As we speak, the voice of funders with clear commitments on how they intend, and should ensure, that there is equity in global health research remains disturbingly absent. If any concrete progress is envisaged in ensuring equity in global health research, then the funders must walk the talk.

As a starting point in this reflection, funders should come up with clear guidelines and indicators to ensure that equity is engrained throughout the research cycle with the research they fund. Clear equity indicators in the terms of engagement, that should/must be respected by grantees, as well as reporting framework are highly needed. Conscious inclusion of capacity building plans of grantees is required. Only through an extra and conscious effort in building the capacities of researchers can ending helicopter research be envisaged. Empirical research to identify the needs of actors, as well as co- defined meaning of equity for stakeholders to have a common meaning of the concept at the outset.

Coming up with a clear transparency mechanism (e.g through guidance documents on the websites) is highly needed to ensure that funder is actually walking the talk in ensuring equity in global health research.




As a dominant model of economic growth, development and economic diversification, extractivism continues its enormous existence and influence on the ecosystems and conservation approaches of the environmentalists and health activists in Africa. With the overwhelming ambitions of boasting the Countries’ Gross Domestic Products (GDPs) and nations’ income per capita especially among the emerging global-south economies, a heavy parallel diversion has existed over the years between the environmentalists and political-economic approaches to extractivism in Uganda. The economic impact that comes along with the valuable economic rent gains of extraction ventures elevate and strengthen the State’s economic growth stages especially from the pre-conditions to take-off economic stage through the drive-to-maturity economic stage.

This paper further high-marks the unimaginable awful climate dynamic implications that come lengthwise with the mining activities that cause human-induced destructions.

Mining in Uganda is mainly done for exportation of the raw-form minerals by the multinational corporations through private sector investments to the foreign markets and highly industrialized global-north nations that have highly-advanced appropriate technology to convert mined minerals into finished valuable treasurable products. This paper postures a heavy juxtaposition question on the two extreme ends of extractivism gains, that is, positive and negative gains through critically studying and analyzing the adverse health costs of extractivism in developing countries like Uganda.   According to (Arquinego, 2014), climate change does not affect the global South and global North equally, and within those hemispheres not everyone is affected equally either. Climate impacts affect people according to their race, class and gender. Responses to climate change need to begin from this recognition.

This paper continues to explore the gaps and issues underlying management and exploration of natural resources through natural resource governance, and approaches to extractivism, and its dangers on the Uganda’s ecosystem with oil exploration as the major area of focus. Further we discuss the health effects of extractivism as one of the physical environment determinants of health in the vulnerable communities and low-resource settings around the oil and other mineral fields, the displacement of the local natives due to dominant civil corporate controls with amplified militarization of resource regions and transnational corporations’ influence in the conservation policies of the environment protection authorities

 By Michael Ssemakula

Monitoring and Evaluation Specialist, and Health Rights Advocate

Alliance of Women Advocating for Change, and PHM-Network






Background and Introduction

Extractivism is the mining or extraction of natural resources that are intended to be sold in the country’s export market.  This comprises the extraction of minerals and fossil fuels, deforestation for lumbering, agro-industry, and megadams. Down-the-factual lane, extractivism disastrous consequences are more eminent in Low-Income Countries (LICs) compared to the High-Income Countries (HICs), this is reflected in the LICs’ native communities and penniless disadvantaged women especially countries in sub-Saharan Africa like Uganda and Democratic Republic of Congo; and in contrary, this has benefited the rich and wealthy HICs at the expense of the poor and destitute countries henceforth environment conflicts and resource-wars.

As an emerging economy with the ambition of achieving the well-laid down Nation Development Plan or Vision 2040 (NPA), of   Transforming Ugandan Society from a Peasant to a Modern and Prosperous Country within 30 years, and following the United Nations’ Sustainable Development Goal #1 of end poverty in all its forms everywhere, there has been a praxis dynamic development in Uganda’s diversification vehicle through exploring and embracing all sorts of economic ventures that best suit the structure of Uganda’s economy with the major focus on main unindustrialized income generating ventures such as extractivism. The extraction industry in Uganda has several minerals including the colonial era minerals such as copper and gold which have been bracketed in several generations of national incomes and GDP computations, however, in the historic shift, the petroleum (oil and gas) exploration in the mineral sub-sector especially in the Albertine rift has shadowed the entire picture of the extractivism industry since its discovery in 2006. Oil and gas in the Uganda National development plan is referred to as oil industry. Through the health and conservational protection lenses, exploration activities are taking place in ecologically protected areas which makes the resource landscapes become the major concern and areas of extreme significance to the environmental and health advocates.

Uganda announced the discovery of commercially viable oil and gas deposits in and around the North-Western shores of Lake Albert, a region known as the Albertine Graben. (Holterman, 2013) In a report, (EPRC, Feb, 2015). Albertine Graben region, which stretches along the entire western border of the country, is host to endangered biodiversity. At least 5,793 different plant varieties have been recorded in the region, and 551 of these species are endemic to it. The Albertine Graben’s Lake Albert has 53 different fish species, and approximately 10 of these are unique to the lake and thus are found nowhere else in the world. The region’s residents depend on these critical natural resources for their livelihoods—in agriculture, fishing and tourism—all of which could be adversely affected by oil exploitation.

These new and fresh explorations in the western part of Uganda are magnified by further recent past discoveries in the northern parts of Uganda which traverse diverse ethnic, environmental and political lines with a storyline dissimilarity concerning the oil deposits’ location thereby bringing an immensely a parallel historic viewpoint.

The geopolitics is at the center-edge of mineral exploration in Uganda’s oil and mineral regions depicted through the vivid existence of major multinational corporations in the region such as Ireland’s Tullow oil Uganda Operations Pty Ltd, the French company Total and Chinese National Offshore Oil Company (CNOOC), making up the tripartite and other oil companies (Pulse, 2015). The Ministry of Energy and Minerals Development (MEMD) through the Petroleum Authority of Uganda (PAU) and the Uganda National Oil Company (NATOIL) with the investment advisory assistance of the Private sector, are planning to permit more firms through a request for proposal and modal production-sharing agreement documents (NPA), as a way of streamlining the oil and gas extractivism activities, and clearly drawing the guiding policy for the corporations’ activities. All the companies will thrive on the presence of the oil in the oil regions, new explorations, political and macroeconomic outlook of the economy. In the recent past, findings show oil exploration has marked a fruitful end through oil discoveries in the Albertine rift for Uganda. By 2014 (Patey, October 2015) the Ugandan government estimated that there were 6.5 billion barrels of oil in place, but recoverable oil is estimated to be between 1.8 and 2.2 billion barrels with an annual revenue forecast of 2billion US-Dollars. Oil production is expected to reach heights of between 200,000 and 250,000 barrels per day (bpd) based on current discoveries. This places Uganda in the position to be a mid-level African producer, comparable with present day levels in Equatorial Guinea and Gabon. The global oil price rise in the previous decade was influential in revealing Uganda’s oil resources thus beguiling intercontinental oil corporations to set their direct oil investments to the virgin Ugandan oil and gas sub-sector in the-face of the economic and political security challenges.

Underlying Social, Economic, Political, Health and Environmental Implications

The extractivism gains is a long time-anthem of economic growth that is being hummed by millions of Ugandans and the national economy planners due to the backward-forward economic linkages and the mining outward-looking industrial-strategy economic benefits associated with oil, and accompanied by the anticipated positive dynamic shift in the income elasticity of demand of Ugandans to reduce the deflationary-economic gap that is being experienced due to the low effective aggregate demand and income inelastic demand. Oil and gas top the scale of economic ventures that the country is expectantly waiting to improve its balance of payment position in the global economy and stabilize its ever deteriorating Terms Of Trade (T.O.T) due to the excessive reliance of the economy on agricultural sector that is ever faced by price fluctuations in agricultural products that results in low price exchange for imports thereby increasing currency depreciation.

Across the globe especially in the Organization of Petroleum Exporting Countries (OPEC) oil prices have experienced a positive wave trend through minimal volatilities with the barrel of oil expected to rise from the current $72 to $82 in October 2018 (Amadeo, 2018). The attractive price movements heighten the expectations of the citizenry from the extractivism sector with undoubtable immediate primary benefits such as employment creation by the oil companies and service providers, scaling-up foreign direct investments, supplies of goods and services by Ugandan companies, capacity development of Ugandans through training in the sector (to enhance their capacity fortunes to work in Uganda or abroad), infrastructural development, and growth of a petrochemical industry to reduce expenditure on global north product importation and rawmaterials thus increasing the overall national income, national income multipliers (Savings, investments, government expenditure and consumption multipliers), GDP growth rate, GDP per capita, improving the economy fiscal performance and closing the gap in the Uganda’s deficit budget to reduce the country’s reliance on public debt and foreign tied-aid, thereby giving the government an edge through political forces to defend for oil exploration at the expense of ecosystem conservation. The World Bank (BankWorld, 2016) through the Country Economic Memorandum (CEM) projected a GDP growth rate bracket of 7-10% when the oil production starts which will improve our investment multiplier effect. The Country Economic Memorandum also points out and highlights experience of other countries in the African continent and other parts of the world, which had large scale production of oil, gas and other mineral resources that created great economic opportunities. However, the Country Economic Memorandum presents foremost challenges as in the foregoing. A case in point is Angola where high oil production and high international prices boosted gross domestic product (GDP) growth during most of the 2000s but a massively expanded, incompetently managed, public investment program created congestion, inefficiencies and inflationary-gap in the country, instead of developing the long-term physical and human capital necessary to replace non-renewable resources.

The new century contemporary switch in the economic diversification drive through new extractivism discoveries, has forecasted enormous projected benefits to revitalize and fortify the national social economic and political building blocks for Uganda, to strengthen its influential footprint in the sub-Saharan Africa region and Africa in its entirety. The countless ugly gory tales have come along with oil explorations due to the untamable ambitions of the economy’s targets and development goals through indescribable ecologically unfriendly and harsh extraction undertakings which is intensifying the foul misconceptions of the environmentalists and health activists about extractivism activities vis-à-vis the great gain projections as discussed in this paper in the preceding discourses.

Internal displacements of people in the oil regions has been the foremost point of concern in the social adverse effects of extractivism. This has resulted in creation of group-temporary roofs commonly termed as Internally Displaced Persons (IDP) camps due to land grabbing and conflicts fueled by well-connected island of unscrupulous civil corporate controls. In (Nalubega, 2014) Buliisa the Member of Parliament, Stephen Mukitale (2011-2016) questioned the manner in which his constituents were being evicted. There’re over 120 land cases in Buliisa district and we all know that the grabber is working with some of the district leaders because he would not know where these oils would be set up, and there is an escalating number of land conflicts. In Nwoya District which started in 2006, around the time oil was found, farming activities are diminishing every passing day due to the restricted access to land in these areas yet people must find means of survival.

Therefore, they fight against these dominant structures for their only asset to secure their fundamental right to land as the only source of livelihood which is under attack. Land is a physical determinant of health through which one grows food to adequately meet his/her nutrition needs as one of the aims of the Sustainable Development Goal #2 and #3, and one of the significant components in Primary Health Care used to achieve Universal Health Coverage. During the dislodgments, the health of the vulnerable women and the children is the most affected in contrast to men. This is because land in most impoverished communities is the only source of food to feed households and generate income for them through farming. Therefore, land grabbing intercepts their subsistence and commercial farming activities which incapacitates and cripples their financial muscles thus making such societies deprived of access to fundamental basic necessities of life, adequate feeding and personal developments. This further exacerbates the gender disparity and income Gini-coefficient gap due to the gender structuralized economic violence against women through socio-economic system pathways that harm their welfare especially the penniless underprivileged and indigenous women.

The Resource Governance in Uganda which incorporates management and allocation of resources is being hovered by a micro- and personalized system of resource management through a tight terrifying resource militarization. This is evidently and heavily being felt by the natives in the resource regions, done to protect the interests of a group of black-to-black apartheid oppressive rulers, the Museveni-bush men and company. Since they are the country managers, they tend to owe unbreakable materialistic-allegiance to the transnational oil corporations, with the intent of expanding and strengthening their financial empires and grip on power. In return, due to the constrained and expensive regulatory and bureaucratic procedures, the transnational corporations in extractivism leverage on maximizing resource exploitation with limited inclusion of ecosystem protection into their management systems and programmes. Given their strong set-of-capacities and influence in the global oil and gas industry, transnational corporations tend to compromise the global climate change policy enshrined in the United Nations Framework Convention on Climate Change (UNFCCC). This undermines and violates the sovereignty of some states especially the LICs in the global-south because the transnational oil corporations tend to parade their economic interests above the environmental, health and social interests of people.

The oil industry is undertaking its activities within the communities and environs of the ecosystems. Destruction of the Lake Albert area’s ecological biodiversity is unescapable due to the poor and inefficient environmental governance which exposes the region’s rich wildlife ecologies to six-feet under degradation. Thus, creating a rift between the politicians, health activists and the environmentalists’ approach to extractivism. According to the report by (Patey, October 2015) Albertine Graben, along with eco-tourism in Murchison Falls National Park, where 40 per cent of Uganda’s discovered oil resources are located is under threat if the oil   industry does not follow the international environmental standards. By virtue of the fact that Uganda’s oil is waxy, groundwork infrastructure requirements are bigger, and they are at the verge of leaving a large black-mark on the natural resource environment, thus creating a need for extra power plants that will deal with heating, storage, and transport of oil, and the shallow depths of oil wells and weak natural flow pressures will require significant water injection for oil extraction.


Formulate and strengthen regulatory policies concerning extractivism

This provides space for checks and balances in the sector because oil companies are self-regulating due to the fact that Uganda’s system body that is National Environment Management Authority (NEMA) is inadequately supported in terms of funding from the government and has deficiencies in its administrative authority to sufficiently penalize the ecology destroyers. Therefore, such regulatory policy helps to guide the oil corporations to frequently conduct environmental impact assessment and treat their wastes like oil spills that may be a health hazard to humanity and in long-run cause a cancer nightmare to the populace in the region.

Proper mapping and formulating a well streamlined compensation policy

Uganda has a land Act but does not have a compensation policy. In many incidents this Act works in favor of the bourgeoisie class over the interests of peasants on the land. Section 6(5) (b) of the Land Act provides that, where a person awarded compensation under this Section refuses to accept payment, the High Court on the application of the Attorney General may order payment to be made into court on such conditions as it thinks appropriate. Most of the times the compensation awarded is inadequate and this becomes a financial and a heavy wealth loss to the victims. Further, the property valuers who can help are government employees and the law does not provide for private property valuers. Most government valuers are easily bribed and manipulated by the rich and experts from the corporations to authenticate the unscrupulous results.  The outcomes out land evictions are often disastrous especially in the wave-length of health. Most of the times, evictions involve resettlement of the victims in distant and remote free lands secured by the government which are far away from the health centres. This limit people’s access to health care especially the HIV/AIDs patients who consistently need to visit the health centres to get health advisory services in regards to their CD4 counts and access to medicines such as antiretrovirals.


Oil discovery in Uganda is the newest economic gear in the diversification vehicle that has been embraced by economists and politicians as a heavy-rewarding economic undertaking to revive the Uganda’s economy. This will close the budgetary gap in order to reduce the country’s reliance on domestic and foreign public borrowing in the national budgets to stimulate the drive to economic self-sustenance. Contrariwise, the oil exploration drive under the environmentalists’ and health advocates’ approach has been sieged on the grounds of overwhelming adversative effects it may have on the ecosystems and health. Crude oil leakages and spills my cause escape of substances used in the oil production processes which detrimentally affect the habitats of flora and fauna in the freshwater and in-land biodiversity systems thereby troubling several living organisms’ functions like feeding, respiration, and body temperature-regulation. Meanwhile, the ecosystem in its entireness changes with time because of the chemical substances and compound-elements of the dripped oil that are noxious to the environs. Therefore, the government should come up with a stringent activity regulatory policy framework that standardizes and controls the activities of the oil companies to protect the ecologies against destructions by the oil and gas industry.



Amadeo, K. (2018). Oil Price forcast 2018-2050.

Arquinego, S. (2014). Climate Impacts. Extractivism, 1.

BankWorld, G. (2016). Uganda Economic Memorandum: Black Gold: Oil and Mineral Extraction Can Diversify Uganda’s Economy. Kampala: World Bank.


Holterman, D. (2013). The Biopolitical War for Life: Extractivism and the Ugandan Oil State. Critical Managament Studies, University of Manchester (p. 9). Oxford: ScienceDirect.

Nalubega, B. O. (2014, September Friday). Oil fuels land grabs in the Albertine Region. Oilinuganda.org, p. 1.

NPA, N. P. (n.d.). NDPII.

Patey, L. (October 2015). Oil in Uganda: Hard bargaining and Complex politics in East Africa. Oxford: The Oxford Institute For Energy Studies.

Pulse, W. (2015). Uganda names 16 firms eligible for first licensing round. Building Towards the Future of Energy.



News Flash 496: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

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News Flash 496

Weekly Snapshot of Public Health Challenges


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Population Aging, a Challenge for Public Health in Latin America and the World

The information contained in this work and the recommendations proposed seek to expand the opportunities for older adults to maintain their health as they age. The current situation of aging in the world deserves immediate attention. Society can no longer afford to merely ensure the survival of its citizens to advanced ages; it must now promote the healthy and active aging of the population, which can be planned and supported. The scientific-technical advances achieved still do not satisfy the needs of an aging population. The investment that governments make in science and technology for social good must be aimed not only at prolonging years of life but also at achieving a satisfactory quality of life in a world population that is getting older every day

By Nicolas Castillo

Biochemical. Private Laboratory Santa Clara de Saguier Sanatorium, Santa Fe, Argentina. Graduated in Clinical Biochemistry. Master in Public Health. Master in Digital Health Management

Population Aging, a Challenge for Public Health in Latin America and the World




Old age and aging are problems that modern societies have been facing for a relatively short time. Aging is an integral and natural part of life, it is a biological process that is accompanied by a great vulnerability to disease, and in which individuals present a series of characteristic physical manifestations, not particularly associated with any disease. Aging is a process that lasts a lifetime. It is multidimensional and multidirectional, in the sense that there are differences in the rate and direction of change (gains and losses) of the different characteristics of each individual and between individuals. Every stage of life is important. Therefore, aging must be viewed from a perspective that encompasses the entire life course. Aging is a very complex and variable phenomenon. Not only do organisms of the same species age at different rates, but the rate of aging also varies within the organism of any species itself; This heterogeneity between individuals is a characteristic of ageing.

The most significant problem of aging is the loss of autonomy that leads to dependency. It is a state of a permanent nature, in which people find themselves who, for reasons derived from age, require the attention of another or other people or important help to carry out basic activities of daily life. Aging and dependency constitute a real challenge for families and the social policy of a country. That is why the societies of the different countries must face this challenge in an equitable and supportive manner so that all people can function autonomously and with quality of life in this period. The notion of healthy aging is a health goal, individual and for the population.

Health and functional capacity are of vital importance for the quality of people’s social life; The level of functional capacity determines the extent to which they can manage autonomously within the community, participate in different events, visit other people, use the services and facilities offered by organizations and, in general, enrich their own lives and those of others of the people closest to them.

The increase in older adults will undoubtedly demand the need for more services, related to educational, economic, social, health, environmental, recreational and generational aspects, among others. The present work was based on a documentary review of different works carried out at a global, regional and local level in order to give a different approach to the aging of the population.

The clinical history of elderly people must unquestionably contemplate an analysis, to a lesser or greater extent, of their functional capacities. This evaluation allows the knowledge of the present and past functional situation, and the realization of the functional diagnosis. The functional assessment of the elderly is essential for the design of individualized geriatric care plans. The most important functions to assess in the elderly are physical, mental, and social function. Therefore, functional capacity is usually assessed through the degree of autonomy one has to carry out a series of daily activities related to personal care (basic activities of daily living: moving around the house, eating, dressing, washing oneself, drinking a bath or shower, use the toilet,..).

It is currently accepted that functional capacity is one of the best indicators of the health status of the elderly, and it is very useful for predicting disability, mortality and consumption of healthcare resources, as well as for screening for alterations in the state of the elderly health with preventive objectives. Taking functional capacity into account, dependency will be understood as the fact of not being able to fend for oneself to some degree, that is, having difficulties or not being able to carry out certain activities that are common for the population as a whole. To approach the social burden that dependency represents in old age, some authors establish the need to evaluate those factors that have a greater risk of being in a situation of dependency in old age, factors that are known as determinants or predictors. Among the factors that show a greater risk of dependence in old age, illiteracy, widowhood, suffering from a situation of comorbidity with three or more diagnosed chronic diseases, feeling unwell or very unwell, having exceeded 75 years of age or being obese stand out. On the contrary, the characteristics that seem to determine more favorable situations when dealing with old age with a certain quality of life and autonomy are having educational resources (secondary or university), enjoying a medium or high social status, doing some physical exercise and not be in a situation of loneliness. In Spain, demographic and social changes are producing a progressive increase in the population in a situation of dependency.


Public policy refers to the philosophies and priorities followed by a government (in the form of legislation or programs) and represents the emphasis on government responsibility. The main influencing factors are the number of those affected or the organized pressure groups. Today we clearly observe in a large number of different national censuses, that there are fewer children and older people are increasing (change in the population pyramid). For this reason, the aging of nations is an important imperative of public policy in this century, having been exposed in the 1st World Assembly on Aging, in 1982 (Vienna), and reaffirmed in the second held in 2002 (Madrid). Health policy for older adults must consider the unique needs and problems that distinguish them from non-elderly people. A pioneer was the World Health Organization (1959) and, subsequently, numerous other international organizations agree that the most important thing is to maintain functionality in daily life (quantifiable with geriatric assessment). There is consensus that this is the most important factor in older adults to predict possible future dependence, the use of health resources, economic resources or death. As the percentage of the elderly (>80 years) increases, something that occurs in all countries, an increase in disability is projected. This would increase the emotional, social, economic and environmental handicaps. The dominant view of health planners and planners from the 1980s to the 1990s was that the elderly would be totally dependent and very expensive, but this has been denied. Currently, in the United States of America and other countries (including culturally close ones, such as Spain) it has been shown consistently over the last ten years that disability is decreasing despite the increase in the very elderly. In other words, by investing in efficient programs and with geriatric services focused on function, it is possible to reverse the projections. Something similar was done in the global fight against child malnutrition and is similar to what is currently being done against morbid obesity. Any human being with multiple chronic noncommunicable diseases that affect their functionality will have a decrease in “quality of life” that will affect the family and require prolonged care. We know that functional impairment is preventable.


The World Health Organization (WHO) promotes “active ageing” which is based on three pillars: social participation, economic security and health. Most countries advance first in social participation. The same thing happened in Argentina where municipalities, churches and other organizations have implemented it to achieve “participatory ageing”. Achieving economic security is complex and is being faced in various ways to achieve a decent and sustainable pension system over time. Health aspects are generally the most backward. Its great guidelines have already been studied in other countries, so we have the knowledge about the correct way to do it. Efficient health systems must respect the following three guidelines:

  • Acute and continuous and integrated services that are developed simultaneously: massive prevention and promotion to achieve “healthy ageing” in the majority of the population; ambulatory health care; hospital geriatric care for acute cases; implementation of functional geriatric recovery units (average stay) and the development of long-term care at home and in institutions.
  • Training of health teams, together with an adequate number of geriatricians. Academic education and training programs are required for all health and other professional careers.
  • Adequate financing, including ongoing, outpatient, and institutionalized care.


In societies, there is a common concern about the rising costs of health care for the elderly and the increase in the number of citizens who require continuous medical-social services.

Policies for the elderly should be formulated within the context of other age groups because:

  • The well-being of the older population is based on the living conditions of the young years. The ability of the elderly to move easily, retain their hearing, vision and mental faculties, and take care of themselves is, in part, a result of adequate health care at an early age. Continued efforts to reduce health inequalities for all will also benefit the elderly.
  • The health programs implemented for the elderly also serve young people, especially those who suffer from some kind of disability.

A reassessment of the method by which health care for them is conceived, organized and delivered is required. It has been amply proven that the classic model of medical care, useful in the young adult population, fails when it is applied automatically to the elderly.

A simile would be that of child health and especially in those who are born with low weight. It could therefore be considered “discriminatory” today to provide appropriate health care only for the fact of being “old” or in places not appropriate for them, especially if the staff is also not trained and there are no geriatric specialists to attend to cases more complex.

The main objective of a national health policy for the elderly should be to keep them physically and mentally independent for as long as possible. This will require an effective health care system and adequate financial means. The older population is different and requires its own services. They currently receive the same services as the younger ones. Today no one disputes that in order to obtain good quality care for populations of children or pregnant women, changes and investments had to be made. In addition, it was possible over time to reduce costs and improve quality of life. Today it is wrong not to have the trained health teams, nor the necessary geriatric services. This is a responsibility of all the governments that have signed the agreements of the 2nd World Assembly on Aging in 2002, in Madrid.


The elderly needs basic health services and economic-social assistance similar to the rest of the population, although adapted to their concrete, peculiar and specific needs.

If we are heading towards an older society, we must emphasize the development of geriatric medicine. The geriatric service (hospital and its community network) in Europe and other countries is the cornerstone of healthcare provision for elderly patients and has proven to be cost-effective. Hospitals in the United States of America have shied away from this role, in part due to an emphasis on high-tech curative medicine, but today they see the elderly as the majority group of hospitalized patients and have begun to emphasize ongoing geriatric care.

Hospitals often act as an important focal point for receiving medico-social services for the sick elderly population. Consequently, the development of a more human orientation with an emphasis on functional recovery, less technical towards its inpatients, with treatment by a multi-professional geriatric team is a welcome innovation. The Geriatric Service or Unit plays the central role both in the provision and in the cooordination of the continuous care requirements in a close relationship with the primary care teams. It is obvious that this will depend, to a large extent, on how doctors and health teams are trained (undergraduate and postgraduate) in the basics of geriatrics. This is the current line of development of the European Community and other countries.

Geriatrics’ focus on caring rather than healing can help rejuvenate medical practice in general. It achieves better doctor-patient communication and greater commitment of family members in treatment guidelines.

The implementation of a national policy for the elderly is essential, regarding its health dimension. Latin America currently faces not only the challenge of achieving these goals for a growing number of its population, but also with a more compressed term of years (about 25 years) than that of the most developed countries (100 years), to respond to these challenges. The “social” dimension of public policies for the elderly has presented achievements, from the point of view of the number of programs, social organizations developed and others. These programs have largely managed to change the perception of the elderly people. However, the “quality of life” of older people is directly related to physical-mental well-being and therefore to health indicators. In general, the biggest fears of the elderly are premature aging, losing health (especially being dependent on their care), poverty and loneliness. Regarding the measures implemented in the region, of the public programs for the elderly, we can say that, of the three priority areas, such as biological (medical), psychological and social defined as interacting and, therefore, in the actions and measures to be carried out, the biological one has had a slower pace of execution than the other two. Taking only the medical aspects into consideration, we can affirm that one of the most relegated has been the training of specialized human resources, that is, geriatricians and services, despite the fact that these are among its specific objectives. Surely, in the future we will be judged by how we treat our elderly people today. It is essential to invest in comprehensive community health, including primary care adapted to older adults, recognizing that it has long-term benefits with the appropriate budget allocation and training support for professionals and formal and informal caregivers. The adaptation of Health Centers is required, eliminating architectural and administrative barriers, as well as the inclusion of protocols for the elderly in Primary Health Care services.

The challenge also involves raising awareness in society as a whole to understand aging as part of the life cycle and not as a different stage from others. All efforts must be made to delay dependency and disability until the last moments of life. This implies promoting, preventing, assisting and rehabilitating; the classic functions of public health that have their specificity when talking about older adults.


The information contained in this work and the recommendations proposed seek to expand the opportunities for older adults to maintain their health as they age. The current situation of aging in the world deserves immediate attention. Society can no longer afford to merely ensure the survival of its citizens to advanced ages; it must now promote the healthy and active aging of the population, which can be planned and supported. Planning for a healthy and active old age implies launching promotion programs, prevention services and timely diagnosis in the field of primary health care with this orientation, long before old age begins. The real expectation of a healthy and active life for older people forces us to reformulate the concept of “aging” as a burden and as a deficiency that still prevails in Mexican society and, instead, to highlight the current participation of older people in social, economic, cultural and civic spheres, as well as in its continuous contribution within society, particularly in the transmission of values ​​through generations and during a longer period of life. The promotion and protection of the human rights of the elderly must be a concern for all, because aging is a universal process. Older people are especially vulnerable as a group, in part due to stereotypical and misconceptions that they are an ‘outdated’ segment of society; nevertheless, as life expectancy increases and health improves, people remain functional and active longer than ever before, both professionally and in the community. Encouraging and supporting older people to stay active for as long as possible will have benefits for society as a whole. From this perspective, it is clear that the development of new care models that are qualitatively different from the current ones, that are adapted to the new needs and promote the training of competent human resources, necessary both at the primary level and at the specialized levels, are a priority. These new models will have to be developed based on considerations of the national context of each particular region, recognizing the social, legal and institutional aspects, as well as the forms of social organization that prevail. Likewise, they must be based on the recognition of the obligation of the State, institutional responsibility and social co-responsibility. Models like this would focus on the community and the family, help rebuild the social fabric and reward intergenerational solidarity. In this way, greater distancing between medical care and social services will be avoided and it will help to make them more dynamic, taking into account regulations, institutional feasibility, human capital requirements and the necessary sustainability. Currently, government work is not only defined by institutions and public servants: but also various actors are recognized who participate actively and committed in the definition and execution of public policies under a principle of co-responsibility, participation and plurality. This way of doing government is defined as governance, and it is necessary in a scenario where aging is not just a matter of age or of a single population group, but involves everyone directly or indirectly and requires innovative and sustainable proposals. Undoubtedly, the role of organized civil society – which had been developing beforehand – becomes relevant, so its actions must be accompanied by an adequate legal framework that gives them strength and transparency. From this perspective,

  • Change the traditional conception that aging implies passivity, isolation and dependence; Emphasis must be placed on autonomy, the exercise of rights and co-responsible participation by the population through self-care and collaboration in health promotion actions.
  • Include the age perspective, as has happened with the gender perspective, in all public tasks, which will allow redirecting a greater amount of resources and outlining the implementation of complementary programs and actions in less time.
  • Review the institutional capacity to ensure that it is adequate in the performance of functions, resolution of problems and achievement of objectives of the public policies necessary for development in each stage of life.
  • Strengthen and stimulate the capacity of the family and the community to respond to the needs of the elderly, which promotes care at home and contributes to the creation of new jobs in this area.
  • The link between research in public health and other areas will allow the transfer of knowledge to health policies and strategic plans related to the elderly, their families and their environment to continue.


  • United Nations, 2002 (UN). Report of the Second World Assembly on Aging. New York. United Nations.
  • Rojas Pérez M, Silveira Hernández P, Martínez Rojas LM. Gerontology and Geriatrics, a count of little more than a century. Medical Record of the Center. 2014; 8(1). [Cited: February 8, 2015]. Available in: http://www.revactamedicacentro.sld.cu/index.php/amc/article/view/49/153
  • Bases of the Federal Health Plan 2004-2007. Ministry of Health of the Nation. Federal Health Council (2004). Presidency of the Nation. Buenos Aires, Argentina.
  • Mandatory Medical Program (PMO) (2001). Ministry of Health of the Nation. Superintendency of Health Services, Buenos Aires, Argentina.
  • Transfer of knowledge. [Cited 2013 Apr 20]. Available in: https://www.who.int/es/news-room/fact-sheets/detail/ageing-and-health
  • Madrid International Plan of Action on Aging Santiago de Chile, (2003). Regional Dialogue.
  • Primary Care Adapted to Older Adults. Regional Implementation Strategy for Latin America and the Caribbean. Towards a PHC adapted to the Elderly (2004). Irene Hoskins, Alexandre Kalache, and Susan Mende. PAHO/WHO Document
  • Pérez Rojo N, Laria MS, Pastor Castell-Florit S, Piñeiro Pérez J, Romero Barroso Z. Research on health systems and services in Cuba and Projections until 2015. Cuban Journal of Public Health. 2010; 36(3)209-214. [Cited February 8, 2015]. Available in: http://scielo.sld.cu/pdf/rcsp/v36n3/spu04310.pdf
  • La construcción de las bases de la buena salud en la vejez: situación en las Américas. Martha Peláez. Available in: https://iris.paho.org/bitstream/handle/10665.2/8094/26267.pdf?sequence=1&isAllowed=y
  • WHO Global Network of Age-Friendly Cities and Communities. [Cited April 20, 2013]. Available at: https://www.who.int/es/publications/m/item/decade-of-healthy-ageing-connection-series-no2
  • Report on the Elderly in Argentina (2000). Chap. 3 “Health in the elderly”, Carlos Vassallo, Matilde Sellanes. Secretariat for the Elderly and Social Action. Buenos Aires, Argentina.
  • Llanes Betancourt C. Demographic aging and the need to develop professional skills in geriatric nursing. Rev haban cienc méd. [magazine on the Internet]. 2015 Feb; 14(1): 89-96. [Cited Oct 19, 2015]. Available in: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1729-519X2015000100013&lng=es
  • Revue de littérature sur la promotion de la santé des personnes agées (1999). Good vivre avec son age. Sante publish. Collection Promotion de la Santé. Document available at www.msss.gouv.qc.ca. Ministère de la Santé et des Services Sociales, Québec, Canada. Orientations ministérielles sur les services offers aux personnes agées en perte d’autonomie. (2001). Ministry of Health and Social Services, Canada.
  • World Health Organization (2002) “Active ageing: a policy framework”.
  • Department of Prevention of Noncommunicable Diseases and Health Promotion, Aging and Life Cycle.
  • Aging, Communication and Politics (2004). Ministry of Communications and Gerontological Psychology Center (CEPSIGER), Bogotá, Colombia.
  • Gascon, S. and Redondo, N. (2005). “Programming of integrated long-term care services for elderly people with loss of autonomy in Argentina, Chile and Uruguay”. Final report of the International Technical Cooperation between the Pan American Health Organization, the Government of Quebec, Canada and the Ministries of Health of Argentina, Chile and Uruguay. Gascón, S., Redondo, N. and collaborators, 2003. ECLAC, preliminary document on social and community participation and the situation of older persons in Latin America and the Caribbean, Santiago de Chile. Gascon, Silvia and Tamargo, Maria (2004). Citizen Participation in Health in Mercosur, Fundación Salud.


News Flash 495: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

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