{'fraction_non_alphanumeric': 0.026946688206785138, 'fraction_numerical': 0.022164781906300484, 'mean_word_length': 5.4215767634854775, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 2, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 1, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
How can engagement with political science and international relations for health be improved?

The need to engage political science and international relations in analyses of domestic and international policy making for public health is undisputable, because political processes and decisions influence and shape health policy. The urgency of this need is underlined by the complex context of the COVID-19 pandemic, which exposed the political nature of health policy, and the war in Ukraine—the latest in a series of 21st-century conflicts that are stark reminders of the profound impacts of conflict on the provision of health care to affected populations. The papers in a new Lancet Series on political science and health provide a detailed exploration of the interface between health and political science and international relations’ concepts, frameworks, and institutions. This Series outlines important questions for future research and analytical investigation. What becomes clear from the Series papers is that, although there is a long history of engaging political science in the analysis of public health policy making, there is much left to explore and understand. Fundamental epistemological, ontological, and methodological differences between the disciplines of public health, political science, and international relations present obstacles to in-depth engagement. Intradisciplinary fault lines create challenges and opportunities for cross-disciplinary dialogue. The question remains about how best to draw on insights from international relations and political science to advance our understanding of global and national health policy. Global health political analyses generally engage with a select, narrow spectrum of international relations perspectives and advocate for reform within existing international structures and practices. Such analyses are typically Euro-centric and US-centric (North Atlantic-centric) and exclude other experiences and perspectives. Such analyses largely validate and naturalise existing political structures—ie, the dominant system of multinational governance based on the principles of state sovereignty and state cooperation through intergovernmental organisations—as key to solving transborder problems. Although there has been some recognition of alternative approaches, these have not been engaged effectively and in sufficient depth by analysts in health to date. North-Atlantic scholarship in international relations has largely privileged a state-centric view of international 2 Ho CJ, Khalid H, Skead K, Wong J. The politics of universal health coverage. Lancet 2022; published online May 17. https://doi.org/10.1016/S01406736(22)00585-2. 3 Kickbusch I, Liu A. Global health diplomacy—reconstructing power and governance. Lancet 2022; published online May 17. https://doi.org/10.1016/ S0140-6736(22)00583-9. 4 Lasswell H. Politics: who gets what, when, how? New York, NY: P Smith Publications, 1950. 5 Dahl RA. The concept of power. Behavioral Sci 1957; 2: 202–03. 6 Barnett M, Duvall R. Power in international politics. Int Organ 2005; 59: 39–75. 7 Shearer J, Abelson J, Kouyaté B, et al. Why do policies change? Institutions, interests, ideas and networks in three cases of policy reform. Health Policy Plan 2016; 31: 1200–11. 8 Hall P. The role of interests, institutions, and ideas in the comparative political economy of the industrialized nations. In Lichbach MI, Zuckerman AS, eds. Comparative politics: rationality, culture, and structure. Cambridge: Cambridge University Press, 1997: 174–207. 9 Walt G. Health policy: an introduction to process and power. Johannesburg: Witwatersrand University Press, 1994. 10 Wong J. Healthy democracies: welfare politics in Taiwan and South Korea. Ithaca, NY: Cornell University Press, 2006. 11 North D. Institutions. J Econ Perspect 1991; 5: 97–112. 12 Immergut EM. Institutions, veto points, and policy results: a comparative analysis of health care. J Public Policy 1990; 10: 391–416. 13 Béland D. Ideas and social policy: an institutionalist perspective. Soc Policy Administr 2005; 39: 1–18. 14 Finnemore M, Sikkink K. International norm dynamics and political change. Int Organ 1998; 52: 887–917. 15 Barberia LG, Gómez EJ. Political and institutional perils of Brazil’s COVID-19 crisis. Lancet 2020; 396: 367–68. 16 Singh P. How solidarity works for welfare: subnationalism and social development in India. Cambridge: Cambridge University Press, 2015. 17 Lieberman E. Boundaries of contagion. Princeton, NJ: Princeton University Press, 2009. 18 Gómez EJ. Coca-Cola’s political and policy influence in Mexico: understanding the role of institutions, interests, and divided society. Health Policy Plan 2021; 34: 520–28. 19 Mahoney J. Path dependency in historical sociology. Theory Soc 2000; 29: 507–48. 20 Hacker J. The historical logic of national insurance: structure and sequence in the development of British, Canadian, and U.S medical policy. Stud Am Political Develop 1998; 52: 57–130. 21 Bali AS, He AJ, Ramesh M. Health policy and COVID-19: path dependency and trajectory. Policy Soc 2022; 41: 83–95. 22 Chua AQ, Tan MMJ, Verma M, et al. Health systems resilience in managing the COVID-19 pandemic: lessons from Singapore. BMJ Global Health 2020; 5: e003317. 23 You J. Lessons from South Korea’s COVID-19 policy response. Am Rev Public Administr 2020; 50: 801–08.


How can engagement with political science and international relations for health be improved?
The need to engage political science and international relations in analyses of domestic and international policy making for public health is undisputable, because political processes and decisions influence and shape health policy. The urgency of this need is underlined by the complex context of the COVID-19 pandemic, which exposed the political nature of health policy, and the war in Ukraine-the latest in a series of 21st-century conflicts that are stark reminders of the profound impacts of conflict on the provision of health care to affected populations. The papers in a new Lancet Series on political science and health 1-3 provide a detailed exploration of the interface between health and political science and international relations' concepts, frameworks, and institutions. This Series outlines important questions for future research and analytical investigation. What becomes clear from the Series papers is that, although there is a long history of engaging political science in the analysis of public health policy making, there is much left to explore and understand. Fundamental epistemological, ontological, and methodological differences between the disciplines of public health, political science, and international relations present obstacles to in-depth engagement. 4 Intradisciplinary fault lines create challenges and opportunities for cross-disciplinary dialogue.
The question remains about how best to draw on insights from international relations and political science to advance our understanding of global and national health policy. Global health political analyses generally engage with a select, narrow spectrum of international relations perspectives and advocate for reform within existing international structures and practices. Such analyses are typically Euro-centric and US-centric (North Atlantic-centric) and exclude other experiences and perspectives. Such analyses largely validate and naturalise existing political structures-ie, the dominant system of multinational governance based on the principles of state sovereignty and state cooperation through intergovernmental organisations-as key to solving transborder problems. Although there has been some recognition of alternative approaches, these have not been engaged effectively and in sufficient depth by analysts in health to date.
North-Atlantic scholarship in international relations has largely privileged a state-centric view of international politics, within which state foreign policy is guided primarily by considerations of power and the pursuit of security in a system of politics dominated by the socalled great powers. 5 This perspective thus obscures the political experiences of the majority of states in the international system and misses out on opportunities to draw insights from these experiences. North Atlanticcentric scholarship also generalises and universalises local experiences, which consciously or unconsciously results in the marginalisation or dismissal of nonwestern experiences and views. 6 The limitations of this approach have policy implications; Achille Mbembe, an analyst of postcoloniality and African politics, observes "as a practice that flows from abstraction to action theory becomes a guideline or a template that operates on different scales and registers". 7 Engagement with only a narrow spectrum of dominant theories and approaches to understanding politics excludes or silences other possibilities and reifies, validates, and naturalises a particular western neoliberal political order, with specific values and goals-ie, the values espoused by and prioritised by the G7 and expressed through what is known as the Washington consensus. 8 Such projection of North Atlantic-centric values into global principles curtails the ability of stakeholders to imagine ways to reform and improve existing structures and to identify innovative solutions beyond the status quo.
Global health political analyses often take for granted ingrained assumptions in international relationseg, that global cooperation is the best way to deliver improved health outcomes globally; that the existing global health architecture is the main vehicle for the promotion of interstate cooperation; or that the participation and role of the private sector may contribute to improved efficiency and be beneficial. Such assumptions obscure some of the inherent problems of global cooperation, such as the lack of immediacy of decision making, difficulties in achieving coordination and agreement on a common course of action, and unequal resources available to states to implement global agreements. As anthropologist Mark Goodale reflects in Reinventing Human Rights, the "global COVID-19 pandemic simply laid bare all of the weaknesses and contradictions in the postwar international system". 9 Goodale suggests there is a need for a deeper understanding of everyday practice and lived experiences at different levels where politics take place-eg, in communities, societies, states, regions-and that this approach could reveal more pragmatic and inclusive solutions to collective action problems.
Public health policy has implications for human health and by extension life and centres on the promotion of health and wellbeing and protection from disease. This complex intersection between existential threats, strategic interests, and duties of care for the individual and populations is where actors in health can draw on insights from political analyses across the fields of security studies and geopolitical strategy, human rights, and environmental politics. Relevant approaches from these fields include frameworks such as positive and cooperative security, which emphasise the possibilities of non-oppositional and multi-actor negotiations of issues of existential importance to communities; 10 the examination and reinvention of human rights from a practice perspective using an anthropological approach; 9 and exploring decoloniality as a tool for imagining and building global futures where human beings and natural resources are not exploited for wealth accumulation. 11,12 Such political analyses promote views from everyday practice at the grass-roots level in translocal contexts that highlight how practices have meaning and implications beyond their location. Such approaches are therefore not defined or restrained by state-centric analytical biases. Drawing on broader insights from political science, as suggested in this Lancet Series, can catalyse innovative thinking and policies to address health challenges. I declare no competing interests. I am responsible for the views expressed in this Comment and they do not necessarily represent the views of the institution with which I am affiliated.

Responding to the Ukraine refugee health crisis in the EU
The worsening military invasion of Ukraine by Russia since Feb 24, 2022 has massive geopolitical consequences. Up to May 4, 2022, more than 5·7 million refugees have fled into surrounding host countries in Europe. 1 In late April, 2022, I returned from 6·5 weeks as the Emergency Coordinator for the WHO refugee health response at the Refugee Health Extension, a small hub created to support strategies, guidance, systems, and interagency and intercountry coordination for the Ukrainian refugee health response based in Poland. This humanitarian response is different from my previous humanitarian experiences.
The response by the refugee hosting countries in the EU is unprecedented and will be instructive for future refugee responses globally. These EU countries have provided temporary protection since March 3, 2022 to all Ukrainian refugees that includes the ability to work, receive education, and access health care in the same way as nationals. 2 The difference in the EU's response to the complex needs of people fleeing Ukraine compared with its response to the previous migration and refugee crisis beginning in 2015 is stark and hypocritical. 3 The EU needs to implement credible migration and refugee policies that respect international human rights and refugee law and are applicable to all people. Other humanitarian crises, such as in Afghanistan, Ethiopia, Syria, and Yemen must not be neglected from a humanitarian imperative. 4 Surprisingly, in the EU there is only limited availability of reported health data about refugees from Ukraine to inform evidence-based decisions. There are functioning precrisis disease surveillance systems in place; however, the immense and rapid movement of the refugees within and through many of the countries surrounding Ukraine (eg, Hungary, Poland, Romania, and Slovakia) makes tracking refugees extremely difficult. Furthermore, the Schengen Agreement, which allows free travel among Schengen countries, makes it challenging to track all the refugees to their temporary destinations. As more refugees register for temporary protection in these host countries, these data from the governments will be important for decision making. There is currently insufficient data to know if people are adequately accessing health services, including continuity of care for infectious and non-communicable diseases and essential maternal and child health services, 5 such as vaccines and pregnancy-related care. 6 Although access to health services for Ukrainian refugees is the same as for EU nationals, the rules vary by country, including those for co-payments, dental coverage, and mental health treatment. Furthermore, in many host countries there are an insufficient number of general practitioners, who are the gatekeepers to the health-care system. 7 Unique workarounds, such as Ukrainian Medical Points, have been instituted in some countries to allow Ukrainian refugees to see nationally licensed Ukrainian health-care providers, but an examination of how health systems and financing need to adapt due to the refugee influx is needed.
The ministries of health in host countries are leading the refugee health response, and their requests to the