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The Emulation and Adaptation of a Global Model of Clinical Practice Guidelines on Chronic Heart Failure in BRICS
Tao Liu1,2,3,4, Benjamin Quasinowski2,3,4, André Soares2,3
1School of Public Affairs, Zhejiang University, Hangzhou 310058, China.
Insights
Clinical practice guidelines for heart failure in BRICS nations largely mirror global models but show some adaptation. They rarely address country-specific healthcare costs or access issues.
Area of Science:
- Global Health
- Health Policy
- Sociology of Health
Background:
- Access to healthcare is uneven globally, particularly for non-communicable diseases in low- and middle-income countries (LMIC).
- BRICS (Brazil, Russia, India, China, South Africa) nations are increasingly influential in global health, advocating for equitable healthcare access.
- Non-communicable diseases disproportionately affect LMIC, with 80% of global deaths occurring in these regions.
Purpose of the Study:
- To investigate the influence of global health scripts on heart failure guidelines in BRICS countries.
- To analyze the convergence and divergence of these guidelines within the BRICS inter-state context.
- To explore the adaptation of international cardiology models within BRICS healthcare systems.
Main Methods:
- Content analysis of heart failure clinical practice guidelines published by BRICS countries.
- Comparative analysis of guideline recommendations against established European and American cardiology standards.
- Sociological interpretation using neoinstitutionalism and globalization theories.
Main Results:
- BRICS heart failure guidelines predominantly adopt frameworks from European and American cardiology organizations.
- Guidelines show some divergence, particularly concerning specific epidemiological conditions relevant to BRICS.
- Most BRICS guidelines, except India's, minimally address cost, access, and affordability of care within their specific contexts.
Conclusions:
- Clinical practice guidelines for heart failure in BRICS countries exhibit isomorphic diffusion, largely conforming to global standards.
- Localized adaptation occurs, incorporating some local medical traditions and addressing specific epidemiological variations.
- A significant gap remains in integrating country-specific economic and access-related factors into these guidelines.
Abstract:
Whilst knowledge about diseases is universal, access to health care is not equally distributed. During the last decade, the countries of BRICS (Brazil, Russia, India, China, South Africa) have become important actors on the global health scene, pushing for universal, affordable, and more equal access to health care. Although non-communicable diseases place a significant burden on all populations and health systems, low- and middle-income countries (LMIC), such as BRICS, have been affected particularly hard. Approximately 80 percent of worldwide deaths from non-communicable diseases occur in LMIC. We examined if guidelines concerning chronic heart failure from BRICS countries are influenced by global scripts and if these guidelines have converged or diverged in an inter-state context. Our analysis shows that guidelines on heart failure published in BRICS predominantly rely on models initially formulated by European or American cardiological organisations. Guidelines from BRICS deviate from these models to some extent, in particular with regard to specific epidemiological conditions. Except for the Indian guideline, they do not, however, extensively engage with BRICS-specific aspects of costs, access to and affordability of health care services. We interpret these results through the lens of sociological theories on globalisation. Consistent with neoinstitutionalism, recommendations for clinical practice guidelines have spread in BRICS countries in a rather isomorphic fashion. Notwithstanding, some local medical traditions have also been included into these guidelines through localised adaptation and variation.
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