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In 2013, Illinois enacted a new law (SB 957) to allow undocumented motorists to acquire Temporary Visitor Driver's Licenses (TVDLs). We explored the impact of this legislation on organ donor registration in the state. Using Freedom of Information Act requests, we obtained the Illinois TVDL and general adult driver's license applicant organ donation statistics for the last 3 years from the Illinois Secretary of State. We found that between 2017 and 2019, TVDLs directly resulted in 91,720 newly registered organ donors. This group registered as organ donors at rates significantly higher (p < 0.0001) than the general population. In the 3 years studied, only 7.3% of general driver's license registrants became new organ donor registrants, while TVDL drivers signed up at an average rate of 44.9%. TVDLs resulted in a significant increase in registered organ donors. Similar policies implemented nationwide could increase donor registrations substantially. In addition, this finding among a population largely of Latin American origin may suggest strategies for future organ donor registration efforts globally.

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.

Given recent legal developments in the United States, now is a critical time to draw attention to how 'conscientious objection' is sometimes used by health care providers to discriminate against the LGBTQ community. We review legal developments from 2019 and present several cases where health care providers used conscientious objection in ways that discriminate against the LGBTQ community, resulting in damaged trust by this underserved population. We then discuss two important conceptual points in this debate. The first involves the interpretation of discrimination (provider versus patient-centered views), and we argue for a patient-centered view; the second involves the use of the people versus procedure distinction to reach a compromise between LGBTQ individuals and the clinicians who do not want to treat them. We argue the distinction is problematic when applied to treatment of the LGBTQ population.

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.

The Trump administration has severely curtailed the work of the United States Environmental Protection Agency (EPA). The EPA has rolled back environmental protections, lost ground on addressing climate change and environmental justice, and shed large numbers of experienced staff. All of this has accelerated a longer-term decline in EPA resources, expertise, and authority. Here, we present perspectives of EPA employees and retirees on reconfiguring and strengthening the agency to address current and future environmental health problems, based on qualitative data obtained through 100 semi-structured interviews with 76 current and former EPA employees. Interviewees emphasized a number of internal and external issues, including a hyper-partisan context in which the agency operates, lack of public understanding of the extent of domestic and global environmental problems, budget shortfalls, staffing and leadership challenges, reduced scientific capacity and use of science in decision-making, insufficient attention to environmental justice, and lagging technology. We argue that reforms cannot only be expert-driven but must also come from the public, incorporating community driven solutions and focusing on remedying environmental injustice.

Vaccine hesitancy, defined as delay in acceptance or refusal of vaccines despite availability of vaccinations services, constrains control of vaccine-preventable diseases. This study determined the prevalence and correlates of vaccine hesitancy among pregnant women attending a university teaching hospital in Enugu metropolis, South-east Nigeria using cross-sectional survey and parent attitudes about childhood vaccines (PACV) questionnaire. We dichotomised the 256 expectant mother participants into hesitant and non-hesitant categories using median PACV and sub-scale scores. Overall, 31.6% of participants were hesitant. About 17.6%, 14.8%, and 30.9% of mothers were hesitant due to their vaccination behaviour, beliefs about vaccine safety and efficacy, and general attitudes and trust of service providers, respectively. Mothers aged less than 30 years were three times more likely to be vaccine hesitant than older ones. Public health practitioners should target young, expectant mothers by developing and conducting vaccine hesitancy screening, focused health education, and information campaigns. The prevalence of childhood vaccine hesitancy among expectant mothers is high. Younger expectant mothers are more likely to be vaccine hesitant than older ones. Involvement of maternal health service workers to provide vaccine literacy and to support expectant mothers to make informed decision about childhood vaccination might be helpful in reducing vaccine hesitancy.

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.

Maternal mortality remains a large concern in the United States (US), although other Western countries are making progress. In this scoping review, we identify four problems that may contribute to the maternal mortality burden in the US: inadequately investing in women's health, poor quality of care, increasing disparities, and poor data collection and monitoring of maternal health issues. Because maternal mortality is decreasing in California, we identify strategies implemented there that could improve maternal health outcomes nationwide: funding programs to address social determinants of maternal health; supporting health care strategies to improve maternal health (including national standards and goals for health care systems); and investing in maternal health monitoring and surveillance (including use of technology). We encourage researchers, practitioners, and policymakers to work together to develop evidence-based policies and practices to improve maternal health and reduce maternal. We conclude with recommendations for the United States and globally.

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.

This article explores how the Russian state exercises power over international migrants by continuing a 1995 ban on residence for HIV-positive foreigners. International migrants look for work in Russia, the largest host country for migration in the region of East Europe and Central Asia. I conducted qualitative interviews with service providers and health experts and analyzed cases in the database of a Moscow-based non-governmental organization (NGO) where HIV-positive international migrants seek HIV care. To secure permits to work and reside in Russia, they must prove HIV-negative status. I explored how Russia created legal uncertainty for those who are HIV-positive due to lack of legal employment and irregular residence status. I also explain how difficult it is to obtain antiretroviral treatment or other health services for HIV-positive migrants, and discuss epidemiologic, economic, and social implications of the Russian HIV residence ban in the light of the Russian migration policy.

This study investigates the effect of social identity (caste, religion, gender, and asset) on adult chronic energy deficiency (CED) using the Indian Human Development Survey (IHDS) data from 2005 and 2011. From 2005 to 2011, out of 63,323 adult individuals, four-fifths (85.7%) of men and two-fifths (44.7%) of women improved their health status from CED to non-CED. The lowest improvement was observed among Dalit (Scheduled Casts, Scheduled Tribes) women: 41.9% moved from CED to non-CED status. We also find significant differences in prevalence of CED between Dalit and non-Dalit individuals and households. To achieve a significant improvement in CED, programs targeting malnourishment must be prioritized the Dalit households.

How do refugee youth use social media and Information and Communication Technologies (ICTs)? Is ICT use relevant to refugee health and well-being? We conducted a systematic scoping review to identify current social media use behaviors. We examined impacts of social media and information sharing applications on health, well-being, inclusion, and integration of refugees into host countries. Review findings reveal that refugee youth commonly use ICTs for social networking, presentation of self, health information consumption, and political rights. Studies suggest that uptake of social media through personal mobile devices, such as smartphones, positively enhanced interactions of newly arrived refugees. Our review identifies policy opportunities to enable social media to facilitate delivery of resettlement and health information, to foster integration for refugees, and to improve their health.

This study documents all tobacco control proposals (bills) introduced in the United States into all 50 state legislatures from the start of 2010 through 2015 and assesses associations between tobacco-related strategies and tobacco product types with enactment of the bills into law. In total, members of state legislatures introduced 2801 tobacco control bills, and state legislatures enacted 17.4%. Bills most introduced addressed clean air (n = 696) and tax or price bills (n = 582), yet both had lower likelihood of enactment (each OR, 0.51; 95% CI 0.38–0.69) compared to bills on any other tobacco control strategy. Legislators introduced only 147 product manufacturing bills, but these had the highest odds of enactment (OR, 3.70, 95% CI 2.52–5.44) compared to any other intended strategy, followed by tax evasion (OR, 3.08; 95% CI 2.33–4.08) and retailer licensing or location (OR, 1.73; 95 CI 1.24–2.41). Compared to other products, bills regulating e-cigarettes had the highest enactment rate (21.2%). Despite introduction of many bills promoting traditional, evidence-based tobacco control strategies, these had less likelihood of enactment than others.

A policy proposal to ban public housing smoking indoors has received support, but it is unclear how certain affected groups, specifically smokers in housing units, perceive such a policy. To review the literature on attitudes and perceptions of housing unit tenants towards an indoor smoke-free housing policy, using various databases, we searched articles for attitudes towards smoking ban enforcement in housing units. We identified fourteen articles. Non-smokers heavily favored indoor policies and current smokers heavily opposed them. Current smokers represented a substantial minority in the reviewed articles, resulting in overall outcomes of the surveys driven by non-smokers. Studies investigating attitudes about housing smoking bans largely represent the views of non-smokers and lack data about barriers and concerns of tenants who do not support a smoke-free policy. Future studies should investigate if such a discrepancy impacts the efficacy of smoke-free housing policies.

In 2016 the Philippine Department of Health (DOH) introduced a novel dengue vaccine in a mass immunization program to reduce the substantial economic and social burden of the disease on households and the government. The vaccine manufacturer's announcement regarding new findings on the small but increased risk of severe dengue for vaccinated seronegative patients caused turmoil as various people claimed that the vaccine caused deaths and that health authorities are corrupt. While health department staff split-some having to preserve its reputation and others to monitor over 800,000 children administered the vaccine-communication between the frontline health workers and parents suffered. As a result, public confidence in vaccines dramatically dropped and the repercussions challenge the public health system. We examine factors that contributed to the crisis and argue for strengthening risk communication strategies and increasing transparency on decision making to counter misinformation and protect public health.

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.

Participants in religious festivals have practiced animal sacrifice as a core part of Hinduism for hundreds of years-at a small scale by individuals and at large scale at major festivals. Butchers frequently perform sacrificial slaughter openly, in sight and sound of other animals with little or no guidance from or adherence to hygienic standards, which are poor or non-existent. One Health principles could guide development of interventions to protect human and animal health and welfare from these practices, but this concept is poorly understood in Nepal. Animal welfare organizations and international outcry have prompted some action through the Supreme Court, but the result fell short of a ban and little has been done in the face of religious considerations. Public health agencies and policymakers must act to implement effective regulations and enforce laws to prevent the human, animal, and environmental health risks surrounding these inhumane and unhygienic practices in order to ensure the protection of animal welfare and public health.

This study analyzes caloric intake in Iran as a proxy for food security to determine factors associated with caloric intake that could be impacted by policies. We modeled regional heterogeneity by analyzing a complete countrywide dataset disaggregated for rural intra-provincial areas using unique data from the Iranian Statistical Centre for 2007–2016. We applied logistic regression modeling and likelihood ratio tests to assess the association between socio-economic determinants and caloric intake among rural areas of all provinces. National policies (nation-wide food subsidies and a cash equivalent for food for each adult regardless of residence or income) had significant negative associations with caloric intake among all provinces. The detected spatial diversity suggests policies specific to each area could be more effective than a centralized national policy for food security. Rather than implementing one-size-fits-all policies, such as across-the-board cash food subsidies, the government should take a differential spatially targeted approach to directly support low-income households.

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.

Peanut allergy that affects 1.4–4.5% of North American children, has increased in prevalence in the past 20 years, is often diagnosed early in life, and outgrown in fewer than 20–32% of children by age 6. Recent self-reported data suggest that over 50% of peanut allergic individuals have had a severe reaction. Because food (and peanut in particular) is a ubiquitous part of school attendance, this raises the potential for reactions to accidental peanut ingestion at school. Accordingly, there is increasing interest in creating policy to protect peanut allergic children in the school environment—sometimes as a ban on peanut-containing items either in the classroom, the lunchroom, or even in the entire facility. We review the evidence for, and against, peanut bans in schools.

Strong public health system capacity is essential to protection against climate change health threats. Taken as a whole, the United States (U.S.) public health system lacks the requisite capacity. Unlike some other countries, the U.S. federal government and most state and local governments give low priority to strengthening public health capacity even though states and localities have begun investing billions of dollars in strategies to protect physical infrastructure from climate change-related severe weather events. I recommend enactment of new legislative authority specifically to develop public health capacity more rapidly and completely. Doing so can give new impetus to construction of, ultimately, a national public health system able to protect all those who reside in the U.S. from climate change health threats and to serve as a model for building such system capacity globally.

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.

Intimate partner violence (IPV) is a major threat to women's safety and well-being worldwide. Firearms heighten this threat by increasing the morbidity and mortality of IPV. This paper focuses on the United States, a nation with high rates of IPV alongside high rates of gun ownership. The United States has implemented several policy approaches to reduce the harmful role that firearms play in IPV by limiting access to firearms for IPV offenders. One such law prohibits persons under Domestic Violence Restraining Orders (DVROs) from purchasing or possessing firearms or ammunition. Although DVRO firearm prohibitions can reduce the risk of firearm-related injury and homicide associated with IPV, implementation and enforcement of these laws at regional and local levels is challenging and variable. We discuss implications for DVRO research, policy, and practice as part of a comprehensive approach to prevent and reduce firearm-related IPV.

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.

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.

National and international policies, mechanisms, and tools are being used by health authorities to promote effective risk management of climate change, including through addressing health inequalities and effective governance.