Monday, 15 December 2014

Amazing PhD funding for philosophy, science & policy at Durham Univ, UK

PhD Positions in Philosophy at Durham University (Deadline: January 12, 2015)

The Department of Philosophy at Durham University and Centre for Humanities Engaging Science and
Society (CHESS) are inviting applications for full-time, three-year PhD studentships in philosophy of
the natural, social and policy sciences, starting in October, 2015. Suitable candidates should have a
Masters degree (with merit or distinction) or equivalent, an interest in ʻscience and policyʼ and are
expected to work in one of the six areas below. We are especially interested in work on these topics that
interfaces with climate science, medicine, economics and other social sciences, and social policy.

1. Evidence, conviction, endeavour
The nature of scientific evidence; evidence-based medicine; evidence-based social policy;
hierarchies of evidence; non-randomised and randomised experiments; theory and practice of

2. Expertise
The nature of scientific expertise; problems of legitimacy and extension; experts in democracy;
experts versus mechanical objectivity; the nature of tacit knowledge.

3. Moral and social order
Visions of well-ordered and disordered, decent and indecent societies; strategies of creating and
maintaining order in society; the nature and role of institutions; justifying economic systems;
studies of specific cases

4. Narratives, modelling and representation
Models and representation in science; representation in art versus representation in the sciences;
literary methods and thought experiments in the sciences and humanities; narratives as
evidence; understanding and narratives.

5. Modality and power
Causality and causal powers; theories of causation; causal inference; counterfactuals.

6. Values in science and policy
What role values play and why; whose values and who decides; well-ordered science; areas of
special concern, e.g. genetic engineering, human subject research, politically sensitive issues
where scientific results matter.

Primary supervisors of PhD dissertations will be CHESS directors Professors Nancy Cartwright, Julian
Reiss, associate director Dr Wendy Parker or Professor Alison Wylie. Successful candidates are
expected to contribute to the research environment at the Centre. Complete applications have to be
received by January 12, 2015. These Durham Doctoral Studentships are awarded by the Faculty of
Arts & Humanities after candidates have been nominated by the Philosophy Department and CHESS.

Ahead of applying for a post through the university online system (available at: candidates should discuss their research proposal with a member of CHESS.

Please send a CV, grade average and two-page research proposal to

Thursday, 20 November 2014

Request for bioethics books for library at American University in Beirut

The Salim El-Hoss Bioethics and Professionalism Program at the American University of Beirut Faculty of a medicine and Medical Center  is currently building a Bioethics Library to be made accessible to colleagues and students in the Region where there is a dearth of such books and references.

At SHBPP have no funds to buy books for the library and we are thus seeking generous book donations on bioethics, research ethics, public health ethics, clinical ethics, humane medicine, medical professionalism, etc.

It would be great if you can be part of this endeavor and donate books/bioethics reports, etc. for this purpose.
All books will be indexed and references published online with acknowledgements.
If you have colleagues/institutions who would be interested in being part of this, I would really appreciate your help in disseminating this message.
We would appreciate sending hard copies to the snail mail address below.
Many thanks in advance,

Thalia Arawi, PhD
Founding Director,
Salim El-Hoss Bioethics & Professionalism Program (SHBPP)
Clinical Bioethicist
Vice Chair, Medical Center Ethics Committee
American University of Beirut & Medical Center
Faculty of Medicine
P.O.BOX 11-0236
Riad El-Solh 1107 2020

Monday, 10 November 2014

30 tenure track positions at Univ. of Groningen for women.

find out more here  and here.

30 Rosalind Franklin Fellowships at the University of Groningen (214286-313 RFF)


Since its inception in 1614, the University of Groningen has enjoyed an international reputation as a dynamic and innovative centre of higher education providing high-quality teaching and research. Balanced study and career paths in a wide variety of disciplines encourage the 30,000 students and researchers to develop their own individual talents. As one of the best universities in Europe, and by joining forces with prestigious partner universities and networks, the University of Groningen is truly an international place of knowledge.
The University of Groningen focusses on three main societal themes – Energy, Healthy Ageing and Sustainable Society. With these themes the University is looking to bridge the gap between science and society. The University encourages researchers to participate in these themes by means of their research.

Job description

The University of Groningen initiated the prestigious Rosalind Franklin Fellowship programme to promote the advancement of talented international researchers at the highest levels of the institution. The ambitious programme has been running since 2007 and has financed over seventy Fellows.
The Rosalind Franklin Fellowship programme is aimed at women in industry, academia or research institutes who have a PhD and would like a career as full professor in a European top research university. The Fellowship is only awarded to outstanding researchers.
Successful candidates will be expected to establish an independent, largely externally funded research programme in collaboration with colleagues at our University and elsewhere. They will also be expected to participate in and contribute to the development of the teaching programme of their discipline.
Under European jurisdiction it is lawful to specifically recruit underrepresented groups
The University of Groningen has 30 tenure track positions available in this programme, currently co-funded by the European Union. We invite ambitious female academics to apply for these positions.
Positions are available in the following areas (
Behavioural and Social Sciences
Economics and Business
Mathematics and Natural Sciences
Spatial Sciences
Theology and Religious Studies
Medical and Life Sciences


• PhD degree for at least 3 years on reference date 11/30/2014
• exemplary research record demonstrated by publications in international top journals and/or in peer-reviewed books
• proof of independence and international recognition
• experience in various working environments in different countries
• successful in acquiring external funding for research projects
• teaching experience or proven inclination for teaching demonstrated by tutoring/mentoring of individuals or small groups
• demonstrable organizational qualities and communication skills
• a well-founded and motivated application with an innovative research plan for the first five years and a challenging outlook for the future which takes into account the international research landscape in their field of specialization
• must not have resided or carried out their main activity (work, studies, etc.) in the Netherlands for more than 12 months in the 3 years immediately prior to the reference date of 30/11/2014. Please check whether you are eligible to apply by doing the eligibility check: eligibility check:
Please note:
• There may be additional requirements formulated by the faculty of your preference. Please check the faculty job description.

Conditions of employment

The University of Groningen offers a starting salary for the Rosalind Franklin Fellow/assistant professor, dependent on qualifications and relevant work experience, of a minimum of € 3,259 gross per month (salary scale 11 Dutch Universities) up to a maximum of € 5,070 gross per month (salary scale 12 Dutch Universities) for a full-time position.
The salaries include an 8% holiday allowance, an 8.3% end-of-year bonus and participation in an employee pension scheme. The conditions of employment comply with the Collective Labour Agreement for the University of Groningen.
The appointment of a Rosalind Franklin Fellow/assistant professor will be on a temporary basis for a maximum of 6 years. After 4-5 years of employment, there will be an assessment of performance based on established criteria including research and teaching qualifications. If the outcome of the assessment is positive, the assistant professor will be promoted to the rank of associate professor with tenure. At the end of a further 4-7 year period, there will be another assessment aimed at promotion to full professor.
Please visit our webpage for more information about conditions of employment:
Applicants should submit:
1. a full curriculum vitae including a complete list of publications (file 1.)
2. a letter of motivation (file 2.)
3. a 3-5 page statement of research accomplishments and future research goals (file 3.)
4. a list of five selected ‘best papers’ (preferably including copies) (file 4.)
5. the names and contact information (including e-mail address) of 3 referees (file 5.).
The application files should be sent electronically in PDF format.
Applications with missing credentials will not be taken into consideration.
You may apply for this position before 1 December 2014 Dutch local time by means of the application form. Please visit our website:, for more information about these Fellowships, the requirements and the application procedure.
Unsolicited marketing is not appreciated.


For information you can contact:
(please do not use for applications)

Thursday, 11 September 2014

TTIP and global health. Panel event at Royal Society of Medicine #globalhealth

Original posting can be found here.

global health alert: the trans-atlantic trade and investment negotiations - what's the fuss about?

Tuesday 23 September 2014
VenueRoyal Society of Medicine
1 Wimpole Street
W1G 0AE  
Organised by
CPD - Applied for
Event Image

about this event

This lecture is organised by RSM Global Health, Medact and the Faculty of Public Health.
The United States and the European Union are currently engaged in negotiations to
establish a new trade and investment agreement with each other. This is set to
become one of the biggest such agreements – encompassing the world’s two
largest economic unions. 
The scope of the negotiations is extremely broad; and covers issues such as
environmental, food and occupational safety; public procurement policy; and the
application of commercial law to public services such as the NHS. Just about
everything covered in the negotiations will have an impact (direct and
indirect) on human and environmental health and on the NHS.
The RSM, Medact and the Faculty of Public Health have teamed up to bring together a range of trade, public health and investment experts to inform doctors and
other health professionals about this vitally important issue.
This evening meeting  will describe the broad scope of the negotiations;
highlight the key concerns (with a focus on health) and examine the argument
that the negotiations will lead to economic growth and development in Europe
that will benefit everyone.
Hear from the experts, debate the issues and engage in discussion about how the
health community can ensure that the negotiations promote and protect health.
If you are concerned or involved in any of these areas then please join us on 23
September 2014.
    • food, chemical, occupational and consumer safety
    • intellectual property rights, including those that affect the price of medicines
    • banking governance and the flow of finance capital
    • public procurement
    • the duties and powers of the state to shape and regulate their health systems
    • cross-border flow of peoples

The panel of speakers include:
John Hilary, Director, War on Want
Dr Gabriel Siles-Brugge, Lecturer in politics, University of Manchester 
Nick Dearden, Director, World Development Movement
Sue Davies, Chief Policy Adviser on Food, Which? 
The evening discussion will be chaired by Dr Sridhar Venkatapuram, Lecturer in Global Health, Kings College London and Medact Trustee
If you have any difficulties in registering, please contact, 0207 290 3904

Wednesday, 10 September 2014

Political Science in Global Health - Call for Papers #globalhealth

Original post found here

Special Issue, “Political Science in Global Health”- Call for Papers

“Political Science in Global Health”
Special Issue of Global Health Governance
Guest Editor:
Eduardo J. Gómez, PhD
King’s College London
The application of political science theory and method to the study of global health is a
relatively new area of scholarly research. While political scientists have a long track record
of studying the health policy-making process in the United States and other advanced
industrialized nations, political scientists have only recently investigated the international
and domestic politics of health policy change in developing nations and multilateral
organizations (e.g., the United Nations and the World Bank). In recent years, other political
scientists have explored the domestic and international security aspects of global health.
This recent interest is mainly reflective of the fact that in the field of Comparative Politics
and International Relations, health politics and policy have not been at the forefront of
scholarly research; rather, and understandably so, the study of comparative
democratization, electoral systems, ethnic and social conflict in the field of Comparative
Politics, as well as international security, inter-state negotiations and conflict in
International Relations has been of greater concern. And yet, recent seminal contributions
to the field of comparative and international health politics and policy have kindled political
scientists’ interests in the topic.
The goal of this special issue of Global Health Governance is to analyze the progress that the
political science community has made in the area of global health governance, to explain
why political scientists should be interested in this field, and to consider new areas of
scholarly research.
This series also strives to underscore the importance of undertaking multidisciplinary
research in global health. Of particular importance is addressing the sustained divide
between the political science and public health communities. Some political scientists for
example are concerned about lack of interest in political science approaches to global health
in mainstream public health journals. On the other hand, we wish to address why political
scientists have failed to engage the public health scholarly community and other broader
global health forums.
With this in mind, this special series seeks submissions of research articles addressing the
following two themes and questions:
I. Where are we? And why does global health matter?
For this section of the special series, scholars will address the progress that the
political science community has made in better explaining and understanding international and domestic health politics and policy. For example, articles may
address the following research questions:
a) What new insights have been achieved through the application of
political science theory to global health research?
b) What new empirical challenges and needs have been raised through this
approach to global health?
c) What may be the limitations of the political science approach and how
can other theoretical/methodological approaches be combined with political
science to better understand and explain global health politics/policy?
II. Exploring New Areas of Scholarly Research
In this section, scholars will submit articles addressing new areas of research in
the fields of political science and global health. For example, some may wish to
explore the processes of government response to neglected diseases, such as
cancer, diabetes, malnutrition, obesity, as well as areas of controversial scientific
inquiry, such as stem cell research. Alternatively, some may be interested in
proposing new comparative methodologies and/or theories for better analyzing
the international and domestic politics of global health. Authors may consider
one or more health issues as well as one or more country case studies.
Those interested in contributing must submit abstracts to the guest editor Eduardo J.
Gómez ( and cc ( by October 1, 2014.
The guest editor will review the abstracts and make decisions by October 15. Authors
whose abstracts are accepted will be invited to submit full manuscripts, which are due by
February 15, 2015. The manuscripts must be uploaded on the Global Health Governance
submission website, which can be found at the following website:
When submitting your abstracts, please make sure to indicate that you are submitting it to a
special GHG journal series, by including in the subject line “Political Science and Global
Health Special GHG Journal Series.”
Please limit the word count of your submission to 3,000-5,000 words. After the February 15
deadline, all manuscripts will be internally reviewed. Those articles selected will then be
sent out for peer review. Authors will be notified of a decision by April 1, 2015. Revisions to
manuscripts will need to be sent back by May 1, with the goal of publishing the articles in
June, 2015.
If you have any further questions, please contact the Guest Editor for this special series at
Very best wishes and we look forward to receiving your submission.

Friday, 29 August 2014

Phd funding in ethics of animal to human diseases

The chair group Philosophy at Wageningen University, The Netherlands, is seeking applications for a PhD position (fully employed) for a study on ETHICAL ISSUES IN RELATION TO PREVENTION OF ZOONOSES 

Zoonoses - infectious diseases that may spread from animals to humans - are one of the great challenges to global public health. Some important zoonoses such as avian influenza, Q-fever, MRSA, and BSE find their origin in livestock, and protection against these diseases will also affect food production. Certain infections however also spread from companion animals or wild animals to humans (toxoplasmosis, Lyme, etc.). A variety of measures can be taken to reduce the risk of zoonoses: extra hygienic measures in farms and food production, vaccination of animals, administration of antibiotics to infected animals, prophylactic use of antibiotics, isolation of farms, and the culling or hunting of animals that are sick, exposed, or otherwise risk spreading infection. 

Societal debates about these issues often focus on the easily polarized conflict between safeguarding public health versus serving the interests of agriculture and livestock farming. Although this conflict cannot be ignored, such a conceptualization easily obscures other dimensions of the risk of zoonoses. Other values and actors are at stake as well. Values like animal welfare and integrity, biodiversity, and environmental values, and actors like citizens (who consume meat and dairy products, and often appreciate living close to nature), food producers, and government. Moreover, a highly polarized debate may create obstacles to finding policies that are reasonable and fair to all stakeholders.

In this project we analyze a number of ethical issues in relation to the prevention and control of zoonoses. The general research question is how we as a society can responsibly deal with the risks of zoonoses. The emphasis is on dealing with infection risks from animal husbandry. The project includes an inventory of dilemmas in different contexts (health care, infectious disease control, livestock farming and nature conservation), an analysis of responsibilities of stakeholders, and a series of practical ethical case discussions. The project will be designed in such a way that it can take emerging cases of zoonoses into account. A more general theme will be how far we should go in eliminating risks. How should we weigh protection against risk reduction against other values, such as privacy, animal welfare and integrity, and a viable and sustainable farming?

Dilemmas concerning the prevention of zoonoses also raise a number of more theoretical questions in ethics, for example concerning the relationship between collective societal responsibility and responsibilities of individual parties (companies, consumers, farmers, hunters); the question how to deal with ethical dilemmas in non-ideal conditions (e.g. the - rapidly increasing - global demand for meat and animal production); and questions concerning the desirability and feasibility of overcoming conflicting interests through ethical reflection and deliberation. The project specifically aims at interaction with such fundamental questions.

- Master's degree in philosophy or applied ethics, with special interest in human and animal bioethics.
- Very good study results.
- Affinity with interdisciplinary research, particularly combining philosophical and empirical approaches
- Good writing and presentation skills in English; knowledge of the Dutch language is an advantage.
- An interest in assisting in teaching activities.

We offer you fulltime employment (38 hours a week) for 18 months with a possible extension of 30 months after positive evaluation. The gross salary is € 2.083,- per month in the first year and increases to € 2.664,- per month in the fourth year. (based on fulltime employment). In addition, we offer a holiday bonus of 8% and an end-of-the-year bonus of 8.3% of your annual salary.

For more information please contact Professor Marcel Verweij (>).

You can apply till 15 September 2014 (extended deadline). Candidates should upload the following information on the website
- Letter of motivation
- CV, including GPA (average grades) in your last study
- Two reference letters
- A (maximum 600 words) text in which you explain your vision on this topic and reflect on philosophical questions that you consider to be important in the study.

The Chair Group Philosophy at Wageningen University works on ethical and other philosophical issues in relation to the Wageningen domains of healthy food and living environments. In these domains we have research projects in animal and environmental ethics, public health ethics, and responsible innovation. Projects often involve cooperation with societal actors like governments, public health authorities, and research institutes like the RIVM (National Institute for Public Health and the Environment).

The Chair Group is embedded within the section Communication, Philosophy and Technology: Centre for Integrative Development in the Department of Social Sciences, Wageningen University.

PhD funding in philosophy and human sciences

CFA: Doctoral School in Philosophy and Human Sciences - University of Milan, Italy
Call for Applications

6 PhD positions (6 scholarships) in Philosophy and Human Sciences
Duration: 3 years
Language: English
Application deadline:30 September, 2014 (1 pm).

The intersection between Philosophy and Human Sciences is one of the most exciting and fast-moving contemporary scenarios. The Doctoral School in Philosophy and Human Sciences provides students with both theoretical and empirical tools for carrying out top-quality research in Philosophy and related disciplines like Anthropology, Sociology, Geography, Linguistics, the Cognitive Sciences, and Art Critics. The Doctoral School in Philosophy and Human Sciences aims at becoming a leading research centre in these fields, in Italy and abroad. There will be many opportunities for joint PhD degrees with foreign institutions, and the School will promote the mobility of faculty members and students affiliated with the partner universities.

Program Objectives
The Doctoral School in Philosophy and Human Sciences is a three-year PhD program and promotes innovative approaches to theoretical and empirical research. The program is articulated in the following activities: classes, workshops and conferences, research seminars and reading groups. During the second and third year, the Doctoral School encourages PhD students to take visiting periods abroad.

How to apply:

Thursday, 14 August 2014

Full fee bursary for PG Certificate in global health for humanitarian workers and volunteers

Special HCRI bursary - postgraduate certificate in Global Health (PG Cert)

HCRI is pleased to offer a special full-fee bursary for the PG Cert in Global Health. This bursary is open tonew applications from those who work or volunteer for the IFRC/ICRC/RCRC who apply within the period of1-28 August 2014.
Applicants must complete all sections of the PG Cert application process for this bursary. The deadline for applications is 28 August 2014, Midnight (UK-GMT).
Please note that we are still accepting applications to study the PG Cert during this period, however applicants must work or volunteer for the IFRC/ICRC/RCRC to eligible for consideration of the bursary.
Amount: £2,100 (1-year, full fee)
Eligibility criteria:
  • This bursary is tenable for one year only (commencing September 2014)
  • Applicants must be new and who work or volunteer for the IFRC/ICRC/RCRC
  • Applicants may be of any nationality
  • Candidates must have submitted an application for a place on the PG Cert programme by the bursary application deadline, 28 August 2014, Midnight (UK-GMT)
  • All elements of the application process must be received before the deadline closes. This includes the supporting statement and tailored online reference
  • The supporting statement should detail the impact the bursary award would have on the applicants and their work in the Movement.
  • Students who have already accepted full scholarships or bursaries for September 2014 entry or are already in receipt of a full scholarship or bursary are ineligible

Wednesday, 13 August 2014

Ebola experimental drugs really a sideshow.

As always, the focus on health issues becomes the vaccine or drug treatment rather than figuring out how to prevent the infections and vulnerability of individuals due to physical and social environments. The WHO ethical consultation on experimental drugs has irresponsibly moved the focus of attention to drugs still in the early phases of research. Who and when will we discuss why we are in this current situation where there are no available medical interventions as well as the fact that it is controllable through non-medical interventions.

The ethical consultation also had no representatives from the countries most affected by the Ebola outbreaks.

This piece by the BBC I think does a good job covering some of the issues. Let's be clear that Ebola infections are preventable through non-medical interventions. They require social and behavioural changes.  Governments, health  institutions, and global health organizations need to focus on helping make those changes.  A continued focus on medical interventions, or lack thereof, just shows how narrow the current thinking in global health continues to be.

We also learned how incredibly counter-productive it is to implement the old 'contain and control' approach in the early days of the HIV/AIDS epidemic.  It seems we are following the same old plan.   People who are ill or think they are ill will not want to be identified as they will worry about being quarantined or socially shunned.

Sunday, 6 July 2014

How “Global” is “Global Health”? The Diversity of Global Health 'Thinkers'

From the journal Global Health Governance.  Original page here.

How “Global” is “Global Health”? Examining the Geographical Diversity of Global Health Thinkers

globalhealth Tess van der Rijt and Tikki Pang
Many health issues are transnational in nature and cannot be contained within national borders. Global health is therefore an area of study and  research that should involve the collective opinions and ideas of diverse global health thinkers. This paper poses the question: how “global” is ”global  health”? Through an analysis of four different contributors shaping global health, including academics, journals, health institutions and presenters at  global health conferences, this paper aims to determine if the development of global health is truly global. The paper concludes that global health is not  being shaped by those who are most affected by it; the majority of people influencing and defining global health priorities represent institutions based in the developed world. A number of trends and opportunities are identified and recommendations are made to ameliorate the observed imbalance.

Friday, 20 June 2014

Have your say on the treatment gap in global mental health

Posted: 19 Jun 2014 04:50 AM PDT
by Victoria de Menil and Valentina Iemmi
Lord Crisp chairing the APPG on global mental health (c) Victoria De Menil
Lord Crisp chairing the APPG on global mental health
(c) Victoria de Menil

An historic first took place in Portcullis House on 10 June. The UK All Party Parliamentary Groups (APPGs) on global health and mental health convened a joint hearing to discuss global mental health. The event, chaired by Lord Nigel Crisp together with James Morris MP, was the first of two oral evidence sessions to address the question of whether the UK government should be “doing more or doing differently” to address the treatment gap in global mental health. Three additional Parliamentarians, Meg Hillier MP, Vicount Eccles and Peter Bottomley MP, were also in attendance.

The session opened with evidence from three speakers: Professor Vikram Patel of the London School of Hygiene and Tropical Medicine, Professor Graham Thornicroft of the Institute of Psychiatry, and Dr Gary Belkin, director of New York University’s Global Mental Health Programme. Their task was to answer two questions: how significant a problem is mental illness in low- and middle-income countries; and what evidence is there for cost-effective ways to address mental health needs in low- and middle-income countries?

Startling statistics
Vikram Patel highlighted a few startling statistics. Suicide kills more young women globally than maternal causes. Furthermore, the life expectancy of people with schizophrenia is 15-20 years shorter than the general population. Finally, mental disorders are the cause of one-quarter of years lived with disability globally, which places it above cardiac disease and cancer in terms of disability. Equally noteworthy, however, was a positive scenario: if maternal depression were eliminated, then 25% of childhood stunting and malnourishment would disappear in South Asia.

Professor Patel also emphasised the timeliness of this hearing and cited four changes that make today an opportune time to invest in mental health:
1.       The WHO has issued a new Comprehensive Mental Health Action Plan that establishes an international consensus on priorities and solutions in addressing the gap;
2.       Middle-income countries such as Brazil, India and China have increased public investments in mental health care and need technical support to make best use of those funds;
3.       In spring 2015, the World Bank will devote a session to mental health within its annual finance meeting;
4.       Evidence has emerged that appropriately trained and supervised non-specialist health workers can deliver mental health treatments successfully, which Vikram Patel deemed one of the most exciting innovations for mental health care in years.
Fear of contagion
Graham Thornicroft’s specialty is stigma, and he recounted how an Ethiopian nurse did not want to touch the case notes of a patient with mental illness for fear of contamination. Many individuals say that stigma and social exclusion are more painful than the primary symptoms of their condition. Reporting findings from the INDIGO study, Professor Thornicroft explained that some individuals internalize stigma and stop trying to make friends or find jobs. However, the evidence suggests the best antidote to stigma is personal contact.

What gap?
Professor Patel corrected a common myth that there is no mental health treatment in low- and middle-income countries: “We shouldn’t assume that people aren’t getting treatment. They are getting treatment, but they are getting the wrong treatment.” Most people with a common mental disorder in India are prescribed sleeping medicines (benzodiazepines) and vitamins. Professor Thornicroft is also likely to have shocked more than one person in the public with an image of the shackled feet of a mentally ill person who had been “treated” with hyenas by a traditional healer in Somalia. The gap for mental health care is not for any treatment, but for evidence-based treatment.

Professor Thornicroft quantified the gap, pointing out that low- and middle-income countries are not the only ones with this problem. Whereas in the UK treatment is available for one-third of people with mental disorders (varying by illness type), only 10% of people access evidence-based treatmentsin low- and middle-income countries.
Diagram for root-cause analysis presented by Dr Belkin (c) Victoria de Menil
Diagram for root-cause analysis presented by Dr Belkin
(c) Victoria de Menil

Gary Belkin spoke in absolute terms about the gap, estimating it to be “one billion minds and lives” – the name of a project he is working on with the Institute for Healthcare Improvement. He believes that to tackle a problem of that scale requires standardized quality improvement tools. The Billion Minds and Lives project is expected to test a set of quality improvement tools in large-scale projects in Ghana, Kenya, Ethiopia, Zambia and Rwanda. In a show-and-tell moment, Dr Belkin projected a large image of what is cryptically known as a “fishbone diagram for root-cause analysis,” a group problem-solving technique that maps proximate and underlying causes of a problem. The outcome – a meaningful mess of squares and arrows (see photo) – was observed by several audience members to capture the true complexity of factors at play in addressing mental health problems.

Dr Belkin closed with a rousing invocation to the British government to take action: “The only people that can make this change happen are governments.” He advised a two-way approach to scaling up mental healthcare: “Take mental health with you when you go out; and bring others in.” In other words, mental health policy makers need to branch out to non-mental health arenas, such as the G8, and also to bring non-specialist actors, such as schools and primary care providers, into the discussion about mental health.

Voices of dissent
The hearing was not without controversy. When it opened up for questions, a service user said he had heard that outcomes for schizophrenia were better in low- and middle-income countries and asked whether that was related to their taking less antipsychotics or to being less isolated. Professor Patel responded that the claim that outcomes are better in developing countries is based on a single study conducted by the WHO 25 years ago. All studies conducted locally since then have demonstrated the contrary. He stated firmly, “The life expectancy of someone with schizophrenia in India is half that in England – I see that as a bad outcome.”

Derek Summerfield, a psychiatrist of South African origin affiliated with the Institute of Psychiatry, challenged the speakers, particularly Professor Thornicroft, declaring that it was “slick and facile” to say that stigma is the reason people in low-income countries don’t seek services. He argued that they don’t seek services because they live in absolute poverty and are struggling to survive. They don’t have depression, they have poverty. He called the desire to spread mental healthcare globally a “new imperialism.”

In response to Dr Summerfield, Professor Patel stated,“What Dr. Summerfield is pointing out is failures in our Western medical system, and I wish him and his colleagues the best of luck in sorting that out. What we are concerned with is the mental health systems in the rest of the world.” Professor Thornicroft agreed with Dr Summerfield that poverty is central to mental health problems in low-income countries and that the two problems should ideally be addressed in tandem. He cited the work of BasicNeeds as exemplary of this two-pronged approach to tackling health and poverty. Lord Crisp closed the debate by inviting Dr Summerfield to “tell us what you think we should do as parliamentarians – and not just to avoid mental health.”

The second parliamentary hearing will be held on 7 July 2014. Lord Crisp is asking for all relevant evidence addressing the question of what parliamentarians should do to address the mental health treatment gap ahead of the second session. So now is your chance to have your say in the UK government’s response to global mental health.

To contribute evidence or register to attend the second session, email Jonty Roland.
For more on the proceedings of global mental health hearings on Twitter, follow @APPGGlobHealth, @ThornicroftG, @abillionminds

About the authors
Victoria de Menil is a PhD Student within the Personal Social Services Research Unit at the London School of Economics and Political Science.
Valentina Iemmi is Research Officer within the Personal Social Services Research Unit at the London School of Economics and Political Science.