Search

In this manuscript, we point out that the federal government headed by President Bolsonaro has pursued a political agenda that contributed to the spread of COVID-19, transforming the country into a major repository for SARS-CoV-2 and its variants, thus representing a risk for worldwide containment efforts. Furthermore his actions are also weakening democratic institutions, which could counter his political agenda, effectively facilitating the spread of COVID-19. Thus, the perpetuation of the COVID-19 pandemic in Brazil is due to human behaviour factors, especially high-level public decision makers.

The severe acute respiratory syndrome coronavirus 2 pandemic has had disproportionate effects on economically and socially marginalized people. We explore the effects on low-wage migrant workers (migrant workers) in three countries: Singapore, South Korea and Brazil, through the lens of the social determinants of health. Our analysis shows that governments missed key opportunities to mitigate pandemic risks for migrant workers. Government measures demonstrate potential for effective and sustainable policy reform, including universal and equitable access to healthcare, social safety nets and labour rights for migrant workers—key concerns of the Global Compact for Migration. A whole-of-society and a whole-of-government approach with Health in All Policies, and migrant worker frameworks developed by the World Health Organization could be instrumental. The current situation indicates a need to frame public health crisis responses and policies in ways that recognize social determinants as fundamental to health.

Safe surgical care, including anesthesia, obstetrics, and trauma, is an essential component of a functional health system, yet five billion people lack access to high-quality, timely and affordable surgical care. As health decision makers are grappling with how to make appropriate investments for crisis readiness and resilience, investments in surgical care should be considered for their compounding benefits to meet a country’s diverse health goals. National Surgical, Obstetric, and Anesthesia Plans (NSOAPs) are developed through global partnerships and multi-stakeholder consensus and provide a dynamic framework for surgical scale-up that also improves the resilience of the larger health system. Our paper applies principles from the literature on health system resilience to surgical systems and examines the unique capabilities of the surgical workforce and infrastructure to be redeployed during times of crisis, using examples from the current pandemic.

In order to effectively control spread of coronavirus 2019 (COVID-19), it is essential that jurisdictions have the capacity to rapidly trace close contacts of each and every case. Best practice guidance on how to implement such programs is urgently needed. We describe the early experience in the City and County of San Francisco (CCSF), where the City’s Department of Health expanded contact tracing capability in anticipation of changes in San Francisco’s ‘shelter in place’ order between April and June 2020. Important prerequisites to successful scale-up included a rapid expansion of the COVID-19 response workforce, expansion of testing capability, and other containment resources. San Francisco’s scale-up offers a model for how other jurisdictions can rapidly mobilize a workforce. We underscore the importance of an efficient digital case management system, effective training, and expansion of supportive service programs for those in quarantine or isolation, and metrics to ensure continuous performance improvement.

During the COVID-19 pandemic, a countrywide lockdown of nearly twelve weeks in India reduced access to regular healthcare services. As a policy response, the Ministry of Health & Family Welfare which exercises jurisdiction over telemedicine in India, rapidly issued India’s first guidelines for use of telemedicine. The authors argue that: guidelines must be expanded to address ethical concerns about the use of privacy, patient data and its storage; limited access to the internet and weaknesses in the telecom infrastructure challenge widespread adoption of telemedicine; only by simultaneously improving both will use of telemedicine become equitable; Indian medical education curricula should include telemedicine and India should rapidly extend training to practitioner. They determine that for low- and middle-income countries (LMIC), including India, positive externalities of investing in telemedicine are ample, thus use of this option can render healthcare more accessible and equitable in future.

The WHO, FAO, and OIE (the Tripartite) promote One Health (OH) as the guiding frame for national responses to antimicrobial resistance (AMR). Little is known, however, about how much national action plans (NAPs) on AMR actually rely on the OH measures outlined by the Tripartite. The paper investigates attention to OH through a systematic content analysis of 77 AMR NAPs to discern regional and income patterns in the integration of these OH measures. Our findings suggest that (1) AMR NAPs almost universally address the three key sectors of OH, namely, human, animal, and environmental health; (2) AMR NAPs primarily apply OH measures in policies related to human health care, food production, hygiene, and agriculture, whereas the level of attention to OH measures in sanitation, aquaculture, waste management, and water governance is generally low and mainly present in NAPs from low-income countries; (3) AMR NAPs of low-income and lower-middle-income countries' display greater congruence with OH measures than NAPs from upper-middle-income and high-income countries; and (4) the level of OH attention on paper appears to matter little for the extent of multisectoral collaboration in practice.

No study has examined Prescription Drug Monitoring Program (PDMP) data for West Virginia or among specialty practices, such as veterinary medicine. The objectives of this study were to conduct time series modeling to describe the PDMP policy reform impact on prescribing rates for human and veterinary providers. We obtained data from the WV PDMP for 2008 through 2020 for the number of opioid prescriptions filled and providers. We estimated prescribing rates for human and veterinary providers separately based upon the top five opioids prescribed by veterinarians. We estimated temporal effects using a Bayesian log-normal time series model for humans and veterinarians separately. Throughout the study period prescribing rates increased significantly for veterinarians, and decreased for human providers, particularly during 2018 after implementation of the Opioid Reduction Act. Findings provide novel insight into the differential impact of policy on specialty practices and highlight decreasing human opioid prescribing observed elsewhere.

Abstract Recent policy focus is on the ‘non-obvious’ role of community-based organisations in tackling causes of poor health, such as social exclusion. Men’s Sheds are a type of community-based organisation offering health and wellbeing benefits to men, despite this not being the explicit reason they exist. A qualitative study was conducted in Scotland to identify sustainability challenges that impact on the ability of Sheds to become a formal healthcare service. Findings showed that a reliance on ageing and retired volunteers to undertake operational tasks and generate income to fund activities affected the ability of Sheds to sustain and develop. Further, members preferred their Sheds to remain informal and flexible to fit their specific needs. Although Sheds are recognised for their health and wellbeing benefits to men, policymakers must recognise that formalising their activities might detract from the Shed’s primary aims. This paper summarises specific policy implications and recommendations, taking into consideration tensions between the expectations placed on Sheds to expand into formal healthcare delivery, and the needs of Shed users. Highlights: Men’s Shed are known for their ability to contribute to men’s health and wellbeing. The potential of Shed to take on a formal healthcare role is questionable because of a reliance on ageing and retired volunteers and a preference to remain informal. Policymakers must recognise that although Sheds might be well placed to offer formal health care this may detract from their primary aims.

The ongoing COVID-19 pandemic constitutes not only a danger for public health, but may also threaten civil liberties. Looking at the examples of recent events in Poland and Hungary, the authors argue that governments may misuse pandemic for their political advantage, thus endangering public health. Political decisions taken to stem the spread of pandemics should be limited and strictly proportionate to the situation., publishedVersion

Health officials and scientists have warned that we face the threat of a potentially devastating influenza pandemic. Instead, we are now in the midst of a global coronavirus (COVID-19) pandemic. National and international pandemic preparedness plans have focused on developing vaccines and antiviral treatments. Another way to confront the COVID-19 pandemic (and future pandemics) might be to treat patients with inexpensive and widely available generic drugs that target the host response to infection, not the virus itself. The feasibility of this idea was tested during the Ebola outbreak in West Africa in 2014. This experience should inform our approach to treating COVID-19 patients. It could also save lives during outbreaks of other emerging infectious diseases and episodes of everyday acute critical illness. If this “bottom up” syndromic approach to treating acute critical illness were shown to be effective, it could have a dramatic impact on health, equity and security throughout the world. Highlights: Uncertainty about the outcome of COVID-19 is driving the social, economic and political distress associated with the pandemic.Treating the host response to COVID-19 with inexpensive and widely available generic drugs might save lives and mitigate this distress.Undertaking research on this idea will require political leadership.

During the early months of the 2020 COVID-19 crisis, critical services in India for tuberculosis (TB) have been disrupted. India has one of the highest burdens of TB and requires continuity of critical TB care. Here, we highlight important points and approaches that can be used to guide navigation of the combined COVID-19 and TB crisis in India.

In the United States, California’s highly-regarded Tobacco Control Program (CTCP) has defined its goal as “ending the tobacco epidemic for all population groups” by 2035. To understand local advocates’ perceptions of endgame-oriented policies, we interviewed 28 advocates from California communities that had recently adopted tobacco control policies. There was no consensus among participants on which specific policies would constitute the tobacco endgame in California. There was agreement, however, that policymakers should promote policies that would impact communities with the highest tobacco use prevalence and that policies should be “clean,” avoiding exemptions. Participants were cognizant of California’s history of tobacco control policy innovations beginning locally and eventually being adopted at the state level. Many commented that recent policy innovations in the state had begun a conversation that made more “radical” ideas seem possible. California tobacco control advocates are engaged in local endgame policy discussions and prepared to advance California’s endgame goal.

Studies have assessed early population-level impact of human papillomavirus (HPV) vaccination programs for preventing cervical cancer. Through a case study in Hong Kong we examined stakeholder engagement and interactions to promote a universal HPV vaccination program using the Health Policy Triangle framework for structured health policy analysis. Using data from a document review and semi-structured in-depth interviews, we used thematic and stakeholder analyses to describe the process of policy formation. Given Hong Kong’s political and health system, and a mix of Chinese and Western values, stakeholders judged legitimacy of the process differently. We discuss their varied ethical stances and the role of research evidence for informing policy-making. For effective HPV vaccination policy and promotion of universal free HPV vaccination among adolescent girls, new strategies are needed to broaden acceptance of the process, to frame policies in terms of facts and values, and to connect research to policy-making and improve coalition-building.

On Friday, 20 September 2019, over 4 million people worldwide participated in the youth-led Global Climate Strike. Emphasizing the dire impacts of the climate crisis on people’s health, planetary health, and health equity, participants called for politicians and those with power to listen to the scientists and to the evidence. But who are these politicians and what is the evidence regarding to whom they listen? In the United States (US), critical research documents how the public’s will is being subverted—and people and planetary health are being harmed—via changes to the ‘rules of the game’ that affect democratic governance. Health professionals, organizations, and institutions should encourage civic engagement—for themselves, their staff, members, and study participants—regarding: voter registration; being counted in the 2020 Census; countering partisan gerrymandering; and helping to build strong coalitions addressing profound links between climate change, health equity, and democratic governance.

Effectively responding to global health emergencies requires substantial financial commitment from many stakeholders, including governments, multilateral agencies, and nongovernmental organizations. A major current policy challenge needs attention: how to better coordinate investment among actors aiming to address a common problem, disease outbreaks. For donors who commit colossal sums of money to outbreak response, the current model is neither efficient nor transparent. Innovative approaches to coordinate financing have recently been tested as part of a broader development agenda for humanitarian response. Adopting a system that enables donors to invest in disease outbreaks rather than actors represents an opportunity to deliver a more cost-effective, transparent, and unified global response to infectious disease outbreaks. Achieving this will be challenging, but the World Health Organization (WHO) must play a vital role. New thinking is required to improve emergency response in an increasingly crowded and financially convoluted global health arena.

Public health policymakers face increasingly complex questions and decisions and need to deal with an increasing quantity of data and information. For policy advisors to make use of scientific evidence and to assess available intervention options effectively and therefore indirectly for those deciding on and implementing public health policies, mathematical modeling has proven to be a useful tool. In some areas, the use of mathematical modeling for public health policy support has become standard practice at various levels of decision-making. To make use of this tool effectively within public health organizations, it is necessary to provide good infrastructure and ensure close collaboration between modelers and policymakers. Based on experience from a national public health institute, we discuss the strategic requirements for good modeling practice for public health. For modeling to be of maximal value for a public health institute, the organization and budgeting of mathematical modeling should be transparent, and a long-term strategy for how to position and develop mathematical modeling should be in place.

A widespread global outbreak of Hepatitis A virus (HAV) has prompted regulations in a few cities in the United States (US) mandating HAV vaccination of food service workers. This Viewpoint considers the global impact of HAV, analyzes ethical issues pertinent to recent mandatory vaccination regulations and the core values of public health. It explores the health and rights of stakeholders and ethical criteria for mandatory vaccination that could be applied globally with the ethical codes of the World Health Organization and the American Public Health Association. The goal is to help create ethical guidance for determining under what conditions, and for what populations, should regulations be created requiring vaccination for a communicable disease.

Campaigns against risk factors for non-communicable diseases (NCDs) caused by smoking and obesity have become increasingly common on multiple levels of government, from the local to the international. Non-governmental actors have cooperated with government bodies to make policies. By analysing the policies of the World Trade Organization, the World Health Organization, the European Union, and the United Kingdom and United States governments, we identify how the struggles between public health advocates and commercial interests reached the global level, and how the relatively successful fight to 'denormalize' tobacco consumption has become a model for anti-obesity advocates. It highlights three factors important in policy change: framing the policy problem, the policymaking environment and 'windows of opportunity'-to analyse the struggle between 'harm regulation' and 'neoprohibition' approaches to an international obesity prevention regime.

The severe acute respiratory syndrome coronavirus 2 pandemic has had disproportionate effects on economically and socially marginalized people. We explore the effects on low-wage migrant workers (migrant workers) in three countries: Singapore, South Korea and Brazil, through the lens of the social determinants of health. Our analysis shows that governments missed key opportunities to mitigate pandemic risks for migrant workers. Government measures demonstrate potential for effective and sustainable policy reform, including universal and equitable access to healthcare, social safety nets and labour rights for migrant workers-key concerns of the Global Compact for Migration. A whole-of-society and a whole-of-government approach with Health in All Policies, and migrant worker frameworks developed by the World Health Organization could be instrumental. The current situation indicates a need to frame public health crisis responses and policies in ways that recognize social determinants as fundamental to health.

Lead exposure is a major health hazard affecting children and their growth and is a concern in many urban areas around the world. One such city in the United States (US), South Bend Indiana, gained attention for its high levels of lead in blood and relatively low testing rates for children. We assessed current lead screening practices in South Bend and the surrounding St. Joseph County (SJC). The 2005-2015 lead screening data included 18,526 unique children. Lead screening rates ranged from 4.7 to 16.7%. More than 75% of children had 'elevated blood lead levels' (EBLL) ≥ 1 micrograms per deciliter (µg/Dl) and 9.7% had an EBLL ≥ 5 μg/dL. Over 65% of the census tracts in SJC had mean EBLL ≥ 5 μg/dL, suggesting widespread risk. Inconsistent lead screening rates, coupled with environmental and societal risk factors, put children in SJC at greater risk for harmful lead exposure than children living in states with provisions for universal screening. Indiana and other states should adhere to the US Centers for Disease Control's guideline and use universal lead testing to protect vulnerable populations.

This article examines how Argentina, Brazil, Chile, Colombia, Mexico, and Peru addressed the COVID-19 pandemic and the effectiveness of these policy responses from the date each country declared a sanitary emergency, between middle and late March 2020 to the most recent available measurement on 23 September 2020. To analyze how governments responded to the COVID-19 pandemic in these six Latin American countries, we use an index of government response, created by the University of Oxford. To explore the effects of these governmental mitigation policies on reducing social mobility, we use Google mobility reports. We also analyze how these policies may have influenced COVID-19 mortality rates. Overall, the results showed that both timelier and more stringent implementation of the public policies analyzed to address the COVID-19 pandemic seem to be associated with higher mobility reductions and lower mortality rates. We draw five policy lessons from the way each country implemented these mitigation policies. Key message Timelier and more stringent implementation of these public policies may contribute to a higher mobility reduction in several public spaces and to lower mortality rates.The effectiveness of the closure and containment policies in each Latin American country seem to depend on the degree of compliance of their respective populations and to their socioeconomic living conditions.Economic and social policies of income support and debt relief provided by governments allowed people to comply with closure and containment policies.Health systems should maintain high levels of policy stringency together with effective surveillance through testing policy and contact tracing. Supplementary information The online version of this article (10.1057/s41271-020-00269-4) contains supplementary material, which is available to authorized users.

We undertook this study knowing that for people throughout the Midwest who live in low-income urban neighborhoods, finding and affording healthy foods continues to be a problem. People with less money are not only forced to spend it on food, but have so limited options for avoiding purchase of foods with high levels of fat, salt, and sugar. A review of the literature shows that very little is known about how mobile food trucks can increase availability and affordability of healthy foods in low-income neighborhoods in the United States. We compared municipal codes regulating mobile food truck operators and evaluated the impact on cities in the Midwest for encouraging a 'culture of health.' We analyzed six Midwest metropolitan areas with the highest proportion of minorities who lived below the poverty level and had mobile food trucks selling provisions in their neighborhoods. We found that developing more incentives for mobile food truck operators to sell healthier food options can contribute to improving health outcomes in low-income neighborhoods.

During a public health emergency, a government must balance public welfare, equity, individual rights, and democratic processes and norms. These goods may conflict. Although science has a role in informing wise policy, no empirical evidence or algorithm can determine how to balance competing goods under conditions of uncertainty. Especially in a crisis, it is crucial to have a broad and free conversation about public policy. Many countries are moving in the opposite direction. Sixty-one percent of governments have imposed at least some problematic restrictions on individual rights or democratic processes during the COVID-19 pandemic, and 17 have made substantial negative changes. The policies of Poland and Hungary reflect these global trends and continue these countries' recent histories of democratic erosion. The expertise of public health should be deployed in defense of civil liberties.

The unprecedented COVID-19 pandemic of 2019–2020 generated an equally unprecedented response from government institutions to control contagion. These legal responses included shelter in place orders, closure of non-essential businesses, limiting public gatherings, and mandatory mask wearing, among others. The State of Delaware in the United States experienced an outbreak later than most states but a particularly intense one that required a rapid and effective public health response. We describe the ways that Delaware responded through the interplay of public health, law, and government action, contrasting the state to others. We discuss how evolution of this state’s public heath legal response to the pandemic can inform future disease outbreak policies.

Thailand lacks occupational injury and illness (OII) surveillance for its agricultural sector, a sector that comprises 34% of the total Thai workforce but is not covered by the workers compensation system. This study used data from Thailand’s Universal Health Care System to estimate the medical costs of OIIs from agricultural work in Thailand. In 2017, OII medical costs totaled $47 million (USD), about ~ 0.2% of the gross domestic product produced by the Thai agricultural sector. We recommend that some of the national funds currently used for medical treatment of OIIs be used instead to develop and implement prevention programs in agriculture. This would improve not only worker health and safety, but also productivity. Availability of data on working conditions, injuries and illnesses, and especially lost time, lost income and productivity, and OII-related costs for the workers and their dependents might enable better public health policy formulation.

The COVID-19 pandemic has caused a complementary infodemic, whereby various outlets and digital media portals shared false information and unsourced recommendations on health. In addition, journals and authors published a mass of academic articles at a speed that suggests a non-existent or a non-rigorous peer review process. Such lapses can promote false information and adoption of health policies based on misleading data. Reliable information is vital for designing and implementing preventive measures and promoting health awareness in the fight against COVID-19. In the age of social media, information travels wide and fast, emphasizing a need for accurate data to be corroborated swiftly and for preventing misleading information from wide dissemination. Here, we discuss the implications of the COVID-19 infodemic and explore practical ways to leverage health communication strategies to overcome it. We propose the “Infodemic Response Checklist” as a comprehensive tool to overcome the challenges posed by the current and any future infodemics. Electronic supplementary material The online version of this article (10.1057/s41271-020-00247-w) contains supplementary material, which is available to authorized users.

This paper assesses the possibility of using debt relief funds to sustain HIV treatment in sub-Saharan Africa, suppress transmission, and reach global goals to quell the epidemic by 2030. The cost of providing antiretroviral treatment is a huge burden on African countries. Concerns for Africa’s capacity to keep pace with global advances are well founded. By analysing levels of ‘debt distress’, health expenditure per capita, and HIV antiretroviral therapy requirements in sub-Saharan African countries, the need for innovative finance with international cooperation emerges clearly. In addition to the HIV epidemic, African countries may become more vulnerable to disasters and other public health diseases such as malaria, tuberculosis, Ebola and COVID-19, especially without alternatives to current means of financing. Relief from debt service payments could release funds for sub-Saharan African countries to support universal HIV antiretroviral treatment with sustainable results. Electronic supplementary material The online version of this article (10.1057/s41271-020-00238-x) contains supplementary material, which is available to authorized users.

The unprecedented scale of the CovID-19 disaster will define public health failure for generations to come. Its causes include inadequate funding, hostility towards science in general and public health science in particular, a government culture steeped in deception and misinformation, and a disdain for collaboration for the greater good among the community of nations. The consequences have been devastating, but it is essential that the public health community uses its moment in the spotlight to promote the agenda of science-based policy, honesty and transparency in communication, and international cooperation to advance the common good of humanity.

Global concern about arsenic in drinking water and its link to numerous diseases make translation of evidence-based research into national policy a priority. Delays in establishing a maximum contaminant level (MCL) to preserve health have increased the burden of disease and caused substantial and avoidable loss of life. The current Mexican MCL for arsenic in drinking water is 25 μg/l (2.5 times higher than the World Health Organization (WHO) recommendation from 1993). Mexico's struggles to set its arsenic MCL offer a compelling example of shortcomings in environmental health policy. We explore factors that might facilitate policy change in Mexico: scientific evidence, risk communication and public access to information, economic and technological resources, and politics. To raise awareness of the health, societal, and economic implications of arsenic contamination of drinking water in Mexico, we suggest action steps for attaining environmental policy change and better protect population health.

© 2017 Macmillan Publishers Ltd. Multiple factors, including marijuana decriminalization/legalization, tobacco endgame discourse, and alcohol industry pressures, suggest that the retail regulatory environment for psychoactive or addictive substances is a dynamic one in which new options may be considered. In most countries, the regulation of tobacco, marijuana, and alcohol is neither coherent, nor integrated, nor proportional to the potential harms caused by these substances. We review the possible consequences of restricting tobacco sales to outlets run by government-operated alcohol retail monopolies, as well as the likely obstacles to such a policy. Such a move would allow governments more options for regulating tobacco sales, and increase coherence, integration, and proportionality of substance regulation. It might also serve as an incremental step toward an endgame goal of eliminating sales of commercial combustible tobacco.