War and Peace: The Health and Health System Consequences of Conflict in Colombia

战争与和平：哥伦比亚冲突对卫生和卫生系统的影响

• 批准号: MR/R013667/1
• 负责人: Rodrigo Moreno-Serra
• 金额: $ 105.77万
• 依托单位: University of York
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2018
• 资助国家: 英国
• 起止时间: 2018 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FR013667%2F1
• 关键词: War; Peace; Health; System; Consequences

Internal armed conflicts have become more common and more physically destructive since the mid-20th century. Although these conflicts constitute a global problem, poorer countries have been disproportionately affected, with devastating consequences for health and development. Beyond the direct health effects of people being killed or maimed, population health is affected indirectly through destruction of economic assets, damage or lack of access to public health infrastructure and large population displacements.The overarching goal of our project is to investigate the consequences of long-term internal conflict for population health, the health system and post-conflict health policymaking through an in-depth study of the past and current experience of conflict and peace agreement in Colombia. Since 1958 an estimated 220,000 people have died in Colombia due to the civil conflict and more than six million (13% of the population) have been forcibly displaced. A peace accord between rebel forces and the Colombian government was agreed in December 2016 and has ended hostilities, creating a unique window of opportunity to conduct research of immediate policy relevance. Our project will provide much needed evidence on under-researched issues such as the consequences of conflict for health service organisation and delivery, and the impact on often overlooked populations including internally displaced families and the poorest groups.These questions will be answered through a mixed-methods research programme involving two linked work packages. The quantitative package will rely on survey data collected by the team and data already available, analysed using state-of-the-art techniques. The qualitative and historic analyses will employ focus groups with residents of selected municipalities, interviews with national and local government officials and civil society representatives, and examination of publicly available official documents and historic administrative datasets, generating a uniquely rich portrait of the consequences of civil conflicts for the health system. The conclusions drawn from all these analyses will provide the basis for specific, evidence-based health policy recommendations by the research team.The principal elements that will ensure this project has practical impact are its distinctive timeliness for health policymaking, constant stakeholder engagement and methodological rigour. Close engagement with Colombian and international policymakers, aligned with the breadth and depth of our analyses, will inform the extent of generalisation of health system policy implications to other developing countries, particularly where sustained conflicts with resulting population displacements are currently ongoing or have recently concluded. Potential beneficiaries of our research include populations affected by conflict violence, health policymakers and the broad academic community.

自 20 世纪中叶以来，国内武装冲突变得更加普遍，破坏性也更大。尽管这些冲突构成了全球性问题，但较贫穷国家受到的影响尤为严重，对健康和发展造成了毁灭性后果。除了人员被杀或致残造成的直接健康影响之外，人口健康还因经济资产遭到破坏、公共卫生基础设施遭到破坏或无法获得公共卫生服务以及大量人口流离失所而受到间接影响。我们项目的总体目标是通过深入研究哥伦比亚过去和现在的冲突与和平协议经验，调查长期内部冲突对人口健康、卫生系统和冲突后卫生政策制定的影响。自 1958 年以来，哥伦比亚估计有 22 万人因内战而死亡，超过 600 万人（占人口的 13%）被迫流离失所。叛军与哥伦比亚政府于 2016 年 12 月达成和平协议，并结束了敌对行动，为开展与直接政策相关的研究创造了独特的机会之窗。我们的项目将为研究不足的问题提供急需的证据，例如冲突对卫生服务组织和提供的后果，以及对经常被忽视的人群（包括国内流离失所家庭和最贫困群体）的影响。这些问题将通过涉及两个相互关联的工作包的混合方法研究计划得到解答。定量包将依赖于团队收集的调查数据和现有数据，并使用最先进的技术进行分析。定性和历史分析将利用选定城市居民的焦点小组，采访国家和地方政府官员以及民间社会代表，并对公开的官方文件和历史行政数据集进行审查，从而对国内冲突对卫生系统造成的后果进行独特而丰富的描述。所有这些分析得出的结论将为研究团队提出具体的、基于证据的卫生政策建议提供基础。确保该项目产生实际影响的主要因素是其卫生政策制定的独特及时性、利益相关者的持续参与和方法的严谨性。与哥伦比亚和国际政策制定者的密切接触，结合我们分析的广度和深度，将了解卫生系统政策对其他发展中国家影响的普遍程度，特别是在目前正在发生或最近结束了导致人口流离失所的持续冲突的国家。我们研究的潜在受益者包括受冲突暴力影响的人群、卫生政策制定者和广大学术界。

项目成果

Health perceptions among victims in post-accord Colombia: Focus groups in a province affected by the armed conflict.

• DOI: 10.1371/journal.pone.0264684
• 发表时间: 2022
• 期刊: PloS one
• 影响因子: 3.7
• 作者: González-Uribe C;Olmos-Pinzón A;León-Giraldo S;Bernal O;Moreno-Serra R
• 通讯作者: Moreno-Serra R

A light of hope? Inequalities in mental health before and after the peace agreement in Colombia: a decomposition analysis.

• DOI: 10.1186/s12939-021-01381-x
• 发表时间: 2021-01-19
• 期刊: International journal for equity in health
• 影响因子: 4.8
• 作者: León-Giraldo S;Casas G;Cuervo-Sánchez JS;González-Uribe C;Olmos A;Kreif N;Suhrcke M;Bernal O;Moreno-Serra R
• 通讯作者: Moreno-Serra R

The impact of civil conflict on child health: Evidence from Colombia

• DOI: 10.1016/j.ehb.2021.101074
• 发表时间: 2021-11-25
• 期刊: ECONOMICS & HUMAN BIOLOGY
• 影响因子: 2.5
• 作者: Kreif, Noemi;Mirelman, Andrew;Moreno-Serra, Rodrigo
• 通讯作者: Moreno-Serra, Rodrigo

Acceso y percepción sobre la calidad de la atención médica en el sistema de salud en el departamento del Meta: una mirada después de los acuerdos con las Farc [Access and perception of the quality of medical care in the health system in the department of Meta: a look after the agreements with the FARC]

Acceso y Percepción sobre la calidad de la atención médica en el sistema de salud en el Departmentamento del Meta: una mirada después de los acuerdos con las Farc [对卫生系统中医疗保健质量的获取和看法

• 发表时间: 2022
• 作者: León-Giraldo, S.

Inequalities in catastrophic health expenditures in conflict-affected areas and the Colombian peace agreement: an oaxaca-blinder change decomposition analysis.

• DOI: 10.1186/s12939-021-01555-7
• 发表时间: 2021-09-29
• 期刊: International journal for equity in health
• 影响因子: 4.8
• 作者: León-Giraldo S;Cuervo-Sánchez JS;Casas G;González-Uribe C;Kreif N;Bernal O;Moreno-Serra R
• 通讯作者: Moreno-Serra R