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Few empirical studies have examined the relationships between differing regulatory approaches and patterns of gambling behaviors. This article reports on a correlational cross-cultural comparison of differences in the regulatory approaches and gambling behavior among general adult populations in France and Québec, Canada. We drew data from two large population surveys conducted in France and Québec (N=27 653 and N=11 888, respectively). We found diverging and converging aspects of government regulatory policies. Statistical analyses demonstrated significantly higher participation rates and prevalence of 'assiduous gamblers' in Québec. In France, among assiduous gamblers, the proportion of moderate-risk and probable pathological gamblers is significantly higher. Future research should examine environmental conditions and varying gambling offerings, as well as gambling regulation, to determine their potential influence on gambling behaviors.

Multidrug-resistant tuberculosis (MDR-TB) challenges TB control efforts because of delays in diagnosis plus its long-term treatment which has toxic effects. Of TB high-incidence countries, India carries the highest burden of MDR-TB cases. We describe policy issues in India concerning MDR-TB diagnosis and management in a careful review of the literature including a systematic review of studies on the prevalence of MDR-TB. Of 995 articles published during 2001-2016 and retrieved from the PubMed, only 20 provided data on the population prevalence of MDR-TB. We further reviewed and describe diagnostic criteria and treatment algorithms in use and endorsed by the Revised National TB Control Program of India. We discuss problems encountered in treating MDR-TB patients with standardized regimens. Finally, we provide realistic suggestions for policymakers and program planners to improve the management and control of MDR-TB in India.Journal of Public Health Policy advance online publication, 6 May 2016; doi:10.1057/jphp.2016.14.

Definitions and interpretations of 'health literacy' have important implications for the delivery of health care and for health policy-related initiatives. We conducted a systematic review and critical analysis to determine the extent to which definitions of health literacy differ in the academic literature, the similarities and differences across definitions, and possible interpretations for the most commonly used definitions. We identified 250 different definitions of health literacy and grouped them into three categories: (i) most commonly used definitions (n=6), (ii) modified versions of these most commonly used definitions (n=133), and (iii) 'other' definitions (n=111). We found the most commonly used definitions to be open to multiple interpretations and to reflect underlying assumptions that are not always justifiable. Attention is needed to the ways in which differing definitions and interpretations of health literacy may affect patient care and the delivery of health literacy-related policy initiatives.Journal of Public Health Policy advance online publication, 19 May 2016; doi:10.1057/jphp.2016.18.

We studied oral health knowledge and practices of 12 to 14-year-old Almajiri boys in northern Nigeria because we found few studies on their health, and none on their oral health. We present our study after explaining the desperate life circumstances and context of Nigeria's approximately 10 million Almajiri youth. Our results, when compared with those of previously studied populations (those most similar in terms of environment, age range, and oral health characteristics) show that the Almajiris fare poorly. Although the international community has paid some attention to the Nigerian Almajiri children's educational needs, there has been little support for health, and none for oral health. We argue that the World Health Organization could better assist Nigeria and these children by assuring that the Almajiris are not excluded from programs targeting children classified as 'street children', and make specific recommendations.

The use of Inactivated Polio Vaccine (IPV) in routine immunization to replace Oral Polio Vaccine (OPV) is crucial in eradicating polio. In June 2014, Nigeria launched an IPV campaign in the conflict-affected states of Borno and Yobe, the largest ever implemented in Africa. We present the initiatives and lessons learned. The 8-day event involved two parallel campaigns. OPV target age was 0-59 months, while IPV targeted all children aged 14 weeks to 59 months. The Borno state primary health care agency set up temporary health camps for the exercise and treated minor ailments for all. The target population for the OPV campaign was 685,674 children in Borno and 113,774 in Yobe. The IPV target population for Borno was 608,964 and for Yobe 111,570. OPV coverage was 105.1 per cent for Borno and 103.3 per cent for Yobe. IPV coverage was 102.9 per cent for Borno and 99.1 per cent for Yobe. (Where we describe coverage as greater than 100 per cent, this reflects original underestimates of the target populations.) A successful campaign and IPV immunization is viable in conflict areas.

Alcohol use is deeply engrained in the socio-cultural fabric of the Caribbean where heavy episodic drinking is an accepted and common drinking pattern. This article aims to create awareness of the tremendous negative impact on population health in the English-speaking Caribbean from culturally customary levels of alcohol consumption. It advocates for the urgent development and implementation of a regional alcohol policy in the English-speaking Caribbean, and emphasizes the importance of crafting and implementing the policy without cultural offence.

In 2010, the Mexican government implemented a multi-sector agreement to prevent obesity. In response, the Ministries of Health and Education launched a national school-based policy to increase physical activity, improve nutrition literacy, and regulate school food offerings through nutritional guidelines. We studied the Guidelines' negotiation and regulatory review process, including government collaboration and industry response. Within the government, conflicting positions were evident: the Ministries of Health and Education supported the Guidelines as an effective obesity-prevention strategy, while the Ministries of Economics and Agriculture viewed them as potentially damaging to the economy and job generation. The food and beverage industries opposed and delayed the process, arguing that regulation was costly, with negative impacts on jobs and revenues. The proposed Guidelines suffered revisions that lowered standards initially put forward. We documented the need to improve cross-agency cooperation to achieve effective policymaking. The 'siloed' government working style presented a barrier to efforts to resist industry's influence and strong lobbying. Our results are relevant to public health policymakers working in childhood obesity prevention.

This study aimed to assess HIV/AIDS point-prevalence among inmates and evaluate costs related to universal screening as currently practiced and appraise its necessity. All inmates newly incarcerated in Israel (2003-2010) underwent HIV tests and their medical files were cross-matched the with the national HIV/AIDS registry to who had been newly infected and detected on prison entry. They were classified by key risk-groups. Of 108,866 new inmates during the period, 215 (0.2 per cent) were diagnosed with HIV/AIDS, 44 of those (0.04 per cent) were not aware of their infection. A large majority (94.2 per cent) of the infected inmates were members of a key-risk group: drug-users, homosexuals, or originating from a high-HIV prevalence country. The direct cost of detecting a single HIV-infected inmate who was not previously recorded was [euro ]12,386. The HIV/AIDS-screening process can be improved by interviewing the new inmates and performing targeted HIV-testing for those who are members of a known risk-group. These data from Israel are pertinent to developed countries with low HIV prevalence, because they present a picture of all newly infected inmates over an 8-year period within the paradigm of a fully functional HIV surveillance system.

New interest in the 'pandemic' of falsified medicines has resulted in efforts to put in place a treaty on 'medicines crime'. If the goal is to protect the interests of people and public health, an international agreement to ensure that all proven effective and necessary medicines are affordable, available, and of assured quality will do far more to combat falsified and substandard medicines than an agreement that deals primarily with the criminal aspects of problematic medicines production and distribution.

Shisha smoking, with origins in India and the Arab world, is today spreading rapidly into other parts of the world. One such region is Southeast Asia, where shisha bars are commonly seen around educational institutions. The general public remains unaware of the harmful effects of shisha smoking and many assume that shisha smoking does not involve tobacco. Shisha smoking is not adequately addressed in the current anti-tobacco policies by most governments of Southeast Asia. Only a few countries have already taken concrete measures of including shisha smoking in anti-tobacco policies. We highlight the emerging trend of shisha smoking in Southeast Asian nations, associated health effects, and the loopholes in the governmental policies that are being exploited by the vendors of shisha. While most research, taxation policies, and health education on tobacco-related products have focused on cigarettes, additional methods of tobacco delivery become more common.

Nipah virus (NiV) encephalitis is endemic in Bangladesh, with yearly seasonal outbreaks occurring since 2003. NiV has a notable case fatality rate, 75–100 per cent depending on the strain. In Bangladesh, primary transmission to humans is believed to be because of consumption of bat-contaminated date palm sap (DPS). Both the disease and the virus have been investigated extensively, however efforts to implement preventive strategies have met social and cultural challenges. Here we present a variety of community approaches to control the spread of Nipah encephalitis, along with advantages and disadvantages of each. This information may be useful to health workers and policymakers in potential NiV outbreak areas in Southeast Asia.

Uganda introduced an HIV Early Infant Diagnosis (EID) program in 2006, and then worked to improve the laboratory, transportation, and clinical elements. Reported here are the activities involved in setting up a prospective analysis in which the Ministry of Health, with its NGO partners, determined it would be more effective and efficient to consolidate the initial eight-laboratory system for EID testing of HIV dried blood samples offered by two nongovernmental partners operating research facilities into a single well-equipped and staffed laboratory within the Ministry. A retrospective analysis confirmed that redesign reduced overhead cost per PCR test of HIV dried blood samples from US$22.20 to an average of $5. Along with the revamped system of sample collection, transportation, and result communication, Uganda has been able to vastly increase the HIV diagnosis of babies and engagement of them and their mothers in clinical care, including antiretroviral therapy. Uganda reduced turnaround times for results reporting to clinicians from more than a month in 2006 to just 2 weeks by 2014, even as samples tested increased dramatically. The next challenge is overcoming loss of babies and mothers to follow up.

New Zealand is implementing a policy of pre-announced 10 per cent annual increases in tobacco excise for 7 years (from 2010 to 2016). Internationally, little is known about smokers' receptiveness to persistent step-increases in tobacco excise. This article reports on data collected in 2013 (600 interviews in total). The New Zealand Smoking Monitor is a fortnightly survey of smokers and recent quitters; respondents are maintained on a panel and interviewed up to six times. We found that, one-quarter of respondents supported continuing with a 10 per cent annual increase. Eight in ten were aware that a pack of cigarettes will cost US$16.50 in 3 years, and six in ten believed knowing the future cost of cigarettes gave them a strong reason to stop smoking now. While most respondents did not want the annual excise increase to continue, how they perceived the impact of persistent excise increases suggests this policy has the potential to increase quit attempts.

To gather insight on how Health in All Policies (HiAP) is applied in practice, we carried out a case study on transport policies intended to stimulate a shift from car use to bicycling. We reviewed 3 years (2010, 2011, and 2012) of national budgets and policy documents in the Netherlands, followed by two focus group sessions and a second round of document analysis. We found to our surprise, given the country's history of bicycle promotion, that no HiAP approaches for bicycle promotion remain in place in national transport policies. The Netherlands may face serious challenges in the near future for facilitating bicycle use. Inclusion of health goals requires that the health sector work towards acquiring a better understanding of core values in other sector's policies.

This Viewpoint discusses the World Health Organization's Declaration on 1 February 2016 that the epidemic infection caused by the Zika virus is a public health emergency of international concern - the basis of the decision and controversy surrounding it.

As far back as the late 1700s, peoples in the United States were developing ways to control infectious disease without infringing on Constitutional rights. Despite acknowledgement that an infected person has certain civil liberties, the history of public health law shows that, in many instances, infectious disease isolation and quarantine proved to be scientifically questionable at best. I examine an historical example of such questionable relationship between public health and civil liberties: the locked ward at Firland Sanatorium in Seattle, Washington. Mandatory quarantine at Firland began in the late 1940s and lasted until the facility closed in the early 1970s. Can examining this history enhance understanding of the relationship between "the greater good" and an individual's civil liberties?

Conflicts of interest arise when corporations marketing harmful products establish financial relationships with research institutions, researchers, or public health organizations. As obesity becomes a worldwide epidemic, such relationships threaten to jeopardize the integrity of scientific research. Latin America, a region undergoing rapid development, is particularly vulnerable to such conflicts. Here, we provide examples of how food and beverage companies are funding nutrition-focused research and institutions in Latin America, putting their credibility at risk. Public health organizations and institutions should take measures to identify, manage, and limit (or eliminate) conflicts of interest caused by partnerships with food companies making and marketing unhealthful products.Journal of Public Health Policy advance online publication, 29 October 2015; doi:10.1057/jphp.2015.37.

Over the past decade, India’s economic growth has been remarkable – yet almost half of India’s children under 5 remain stunted. The National Food Security Bill is the country’s response to this critical situation. Studies reveal that Indian children are chronically undernourished, not only because of lack of food but also because of recurring gastrointestinal infections. The stunting problem revolves more around lack of sanitation than food insecurity. Despite acknowledging that malnutrition is ‘complex and multidimensional’, government action has consisted largely of nutritional interventions and subsidized food. Although improvements in sanitation would be the most effective way to reduce excessively high levels of chronic undernutrition and stunting, a review of policy formulation and implementation reveals deficits and disconnects with available scientific evidence. It is time to change these mistaken assumptions and focus on improving access and use of safe sanitation facilities to achieve India’s nutritional goals.

During the past decade, tobacco leaf production has shifted from high-income countries to developing countries, particularly those in Africa. Most African governments promote tobacco farming as a way to alleviate poverty. The economic benefit of tobacco farming has been used by the tobacco industry to block tobacco control policies. The tobacco industry is active in promoting the alleged positive aspects of tobacco farming and in 'protecting' farmers from what they portray as unfair tobacco control regulations that reduce demand. Tobacco farming has many negative consequences for the health and well-being of farmers, as well as for the environment and the long-term well-being of the countries concerned. We provide an overview of tobacco farming issues in Africa. Encompassing multi-dimensional issues of economic development, there is far more to it than tobacco control questions.

State anti-bullying laws have been enacted across the United States to address bullying both by and of youths. Although these statutes can provide critical protection to youth, there is debate about whether such laws should enumerate protected classes of youth. Weight-based bullying is an increasingly prevalent form of harassment and it has been overlooked in policy initiatives. Enumeration in existing laws might help protect overweight victims. As no research has examined this issue, we conducted a national survey of American adults (N=1155) to assess public opinion about enactment of anti-bullying laws that vary according to whether or not they enumerate distinguishing characteristics. Our results demonstrated substantial public agreement (ranging from 2/3 to 3/4 of participants) with enactment of state and federal anti-bullying laws that enumerate distinguishing characteristics, including physical appearance and weight, which are currently absent in most statutes. Our evidence can inform policy and legal approaches to protect youth effectively from bullying.

Suicide is a global public health problem and solutions to it can be found only through a global dialog. The suicide rate in Japan has been alarming, but Japan has made substantial efforts to reduce this rate, making prevention a high priority. This report reviews the developmental stages of a comprehensive policy of suicide prevention in Japan from 1998 to 2013. Our review suggests that suicide prevention activities were facilitated by the 2006 Basic Act for Suicide Prevention and the 2007 General Principles of Suicide Prevention Policy. Along with the establishment of a Special Fund program for local governments, the Basic Act and General Principles led to the development of a comprehensive and multi-sector approach to suicide prevention. Suicide rates in Japan, especially among middle-aged men, decreased consistently after 2009, suggesting that the initiatives were effective. Continuous monitoring is needed to evaluate Japan's suicide prevention policy.

Ancient China emphasized disease prevention. As a Chinese saying goes, 'it is more important to prevent the disease than to cure it'. Traditional Chinese medicine posits that diseases can be understood, thus, prevented. In today's China, the state of people's health seems worse than in the past. Thus the Chinese government undertook the creation of a new health system. Alas, we believe the results are not very satisfactory. The government seems to have overlooked rational allocation between resources for treatment and prevention. Public investment has been gradually limited to the domain of treatment. We respond to this trend, highlighting the importance of prevention and call for government and policymakers to adjust health policy and work out a solution suitable for improving the health of China's people.

I examine possibilities for strengthening essential public health functions in the context of India’s drive to implement universal health care. In a country where population health outcomes are rooted in social, political, economic, cultural, and ecological conditions, it is important to have a state mediated public health system that can modify the causes of the major public health problems. This calls for strengthening the social epidemiological approach in public health by demarcating public health functions distinct from medical care. This will be a prerequisite for the growth of the public health profession in the country, because it can offer avenues for newly trained professionals within the country to work in ‘core’ public health.

In 2010, the United States (US) enacted a restaurant menu labeling law. The law also applied to vending machine companies selling food. Research suggested that providing nutrition information on menus in restaurants might reduce the number of calories purchased. We tested the effect of providing nutrition information and 'healthy' designations to consumers where vending machines were located in college residence halls. We conducted our study at one university in Southeast US (October-November 2012). We randomly assigned 18 vending machines locations (residence halls) to an intervention or control group. For the intervention we posted nutrition information, interpretive signage, and sent a promotional email to residents of the hall. For the control group we did nothing. We tracked sales over 4 weeks before and 4 weeks after we introduced the intervention. Our intervention did not change what the residents bought. We recommend additional research about providing nutrition information where vending machines are located, including testing formats used to present information.

Health and dis-ease by their etymological origins refer to an evaluative, not objective, state. Health is an adaptive state, constantly reestablishing itself through interactions between the many biological, social, emotional, and cognitive factors in a person's life. Such adaptive processes define health as an emergent state. Outcomes of emergent phenomena are not precisely predictable and reside in a phase space that contains all possible states ranging from perfect to poor health states, the latter reflecting dis-ease. However, we have seen a migration of meaning from the subjective, dis-ease, to the objective, disease, referring to uniquely identifiable biomedical change. Clinical reality though teaches us that many experiences of dis-ease are not associated with any objective abnormality, an insight with important implications for clinical care and health policy.

The Meikirch Model of Bircher and Kuruvilla provides a new and very interesting definition of health and disease, based on a biopsychosocial framework and the idea of an interaction of an individual with social and environmental determinants of health. It is a modern systems approach, not only for acute, but particularly for chronic diseases. For this reason, I have adopted this analytic approach for conducting independent medical evaluations in the Swiss system of Social Security.

By investing in healthy human life we are investing in our social capital, the primary treasure of a modern technologically advanced society. In rethinking the definition of health from a new interdisciplinary viewpoint, I argue that health can be measured by satisfaction with life fulfillment and by abilities that permit an individual to perform tasks demanded by a society. While considering health as a property of a dynamic system governed by social and environmental determinants, a balance between societal and personal responsibility for health and wellbeing has to be maintained to protect those who have limited opportunities to "use their biologically given and personally acquired potentials" or to entertain their rights of healthy living standards. Instead of separating the biologically given and personally acquired potentials, I suggest capitalizing on emerging information, technologies, and materials aiming to enhance human potentials, both physical and intellectual.

The National Youth Service Action and Social Development Research Institute (NYSASDRI) has been implementing the Meikirch Model in 100 villages in the state of Odisha where rates of poverty, infant and maternal mortality are the highest in India. Although no formal evaluation yet exists, NYSASDRI staff have monitored 20 villages closely and associate great improvements in sanitation, malaria prevention, immunization, and nutrition with implementation of the Meikirch Model. NYSASDRI engaged in implementation with villagers and elders and with growing support of health practitioners, government officials, people’s representative, media, social activists, and functionaries of other non-governmental organizations.

We address the controversies surrounding a 2013 outbreak of methanol poisoning in Tripoli, Libya. We critically examine and systematically analyze the outbreak to highlight the lessons learned from this disaster and how to act properly to prevent similar outbreaks in future. Many health problems have been directly attributed to drinking alcohol; the type and quality of alcohol determines the detrimental effects. An unregulated and flourishing black market in alcohol is among the factors behind the Libyan tragedy, where approximately 90 deaths and about 1000 hospital admissions were reported. We reviewed gaps in local and regional alcohol policy, and highlighted the issue of illegally produced and home-made alcohol. Collaboration between countries in the region plus critical health and policy reforms in Libya, with emphasis on public health preparedness, can dramatically decrease morbidity and mortality associated with such outbreaks.

The scope of the International Health Regulations of 2005 (IHR (2005)) has been expanded. The IHR (2005) are no longer limited to a specific set of infectious diseases, instead they prescribe detection and assessment of any event of potential public health concern regardless of its source or origin. We examine events of non-infectious origin that might fulfill the criteria of a potential public health emergency of international concern under the IHR (2005). These comprise predominately events related to food safety, but also events related to drug safety or of chemical or industrial origin. We argue that to identify these events and assess health effects related to them, existing disease surveillance systems should be augmented with less specific indicator-based syndromic surveillance strategies that use available routine health-related service data for monitoring purposes.

China has achieved rapid economic development, but faces tremendous challenges in occupational safety and health (OSH). We describe China's laws, rights, and administrative structures in OSH and in workers' compensation. The article compares these with comparable laws, rights, and administrative structures in the United States. We hope this comparison may provide useful lessons for continued OSH development and improvement in China.

This excellent article may need some context for Western readers. My commentary attempts to provide a brief background about working conditions and the occupational safety and health situation in China during the past 40 years. This is all within the framework of the political changes and the development of the Chinese 'economic miracle' of which so many in the West are enamoured.

The United Nations adopted an historic international Arms Trade Treaty (ATT) in April 2013. A 1997 meeting of Nobel Peace Prize laureates who called for an International Code of Conduct to address the 'destructive effects of the unregulated arms trade' initiated discussions that led to the Treaty. Public health institutions, including the World Health Organization and the International Committee of the Red Cross, and nongovernmental health groups such as International Physicians for the Prevention of Nuclear War, made adoption of the ATT a public health imperative. The poorly regulated $70 billion annual trade in conventional arms fuels conflict, with devastating effects on global health. The ATT aims to 'reduce human suffering'. It prohibits arms' sales if there is knowledge that the arms would be used in the commission of genocide, attacks against civilians, or war crimes. The health community has much to contribute to ensuring ratification and implementation of the ATT.

This article empirically evaluates advocacy in low- and middle-income countries as a key tool for raising policy priority and securing high-level decision maker support in eye health. We used a unique data set based on a survey conducted by World Health Organization in 2011 on eye care and prevention of blindness in 82 low- and middle-income countries. The theoretical framework derives from the idea that a plethora of stakeholders at local and global level pressure national governments, acting in economic and the political spheres. Previously, eye care has not been investigated in such a framework. We found structural differences across countries with different income levels and proposed policy recommendations to secure high-level decision makers’ support for promoting eye health. Three case studies suggest that, in order to secure more support and resources for eye health, domestic and international stakeholders must strengthen their engagement with ministries of health at political and above all economic levels. We gratefully acknowledge financial support from the Spanish Ministry of Science and Innovation (ECO2011-23634) and from Universitat Jaume I (P1.1B2012-27).

More than a decade in the making, a new, legally binding treaty on mercury will be adopted by governments in the fall of 2013. The treaty's objective is to protect human health and the environment from anthropogenic mercury emissions through a range of provisions - including an article devoted to reducing exposure to mercury. Global emissions have increased since 2005, with the environmental health burden increasingly shifting to developing countries. Time is of the essence to reduce pollution because (i) exposure risk to mercury is much greater than previously thought and (ii) mercury already in the environment can be re-emitted via processes in the natural cycle, resulting in a longer lag time before pollution reduction can have a demonstrable effect on the food chain. Health professionals can assist in reducing exposure, choosing mercury-free products and urging governments to ratify the treaty as quickly as possible so that it can take effect.

Through their purchasing powers, government agencies can play a critical role in leveraging markets to create healthier foods. In the United States, state and local governments are implementing creative approaches to procuring healthier foods, moving beyond the traditional regulatory relationship between government and vendors. They are forging new partnerships between government, non-profits, and researchers to increase healthier purchasing. On the basis of case examples, this article proposes a pathway in which state and local government agencies can use the procurement cycle to improve healthy eating.

Many critical public health issues require non-traditional approaches. Although many novel strategies are used, one approach not widely applied involves improving the treatment of animals. Emerging infectious diseases are pressing public health challenges that could benefit from improving the treatment of animals. Other human health issues, that overlap with animal treatment issues, and that warrant further exploration, are medical research and domestic violence. The diverse nature of these health issues and their connection with animal treatment suggest that there may be other similar intersections. Public health would benefit by including the treatment of animals as a topic of study and policy development.