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Young health advocates have the legitimate aspiration to be masters of their future and are increasingly contributing to public health research and practice worldwide, yet their potential to contribute to the documentation and communication of outputs from public health conferences has not been fully realised. This short communication highlights the Youth Committee of the 2023 European Conference on Tobacco or Health as an example of youth involvement in a major public health conference focused on tobacco control. The authors explore the benefits, practicalities and challenges of incorporating young professionals into conference workflow, including creativity, networking and engagement with broader public health challenges within their communities. This article emphasises the active participation of Youth Committees in public health fora as a model for future conferences and underscores a commitment to achieving a tobacco-free generation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Marketing has a significant impact on the normalisation of gambling for youth across the globe. This has included shaping positive attitudes towards gambling, as well as increasing the social and cultural acceptance of gambling - particularly aligned with valued activities such as sport. Because of this, public health experts argue that gambling marketing poses a significant risk to the health and wellbeing of youth. While young people are increasingly exposed to, and impacted by marketing for gambling products, they are rarely consulted about policy issues and options. This study aimed to explore young Australians' perceptions of current policy responses to gambling advertising, whether they thought young people should be involved in discussions and decisions about gambling marketing regulations, and their perceptions of the duty of governments to protect young people from gambling industry marketing strategies., Methods: Qualitative focus groups (n = 22) were held with n = 64, 12-17 year olds in the Australian states of Victoria and New South Wales. Participants were asked to reflect on current gambling policies, particularly relating to marketing, what they thought should be done about gambling marketing, and if and how young people should be included in public health responses to gambling. An interpretivist 'Big Q' approach to reflexive thematic analysis was used., Results: Young people highlighted the need for more effective regulations around the content and frequency of gambling marketing. They also wanted to see more realistic representations of the negative impacts of gambling to counter persistent positive commercial marketing messages. Most thought that young people should be given an opportunity to have a say about responses to gambling due to their unique experiences. Participants identified mechanisms to increase young people's engagement in decision making, such as direct lines of communication to different levels of government, involvement in research, and diversifying ways of engagement. Specific recommendations included more regulatory action such as bans on gambling advertising., Conclusions: Creating formal structures that facilitate the inclusion of young people's perspectives in decisions made about gambling can result in more innovative and effective strategies to prevent the harms from gambling industry products, promotions, and practices., (© 2024. The Author(s).)

To show how sugar-sweetened beverage (SSB) taxes were framed in posts on Twitter (now known as X) through text and images, we conducted a content analysis on a sample of Tweets from California users posted between January 1, 2015 and December 31, 2018 about SSB taxes in Berkeley, San Francisco, Oakland, and/or Albany, California. We evaluated posts for information sources, arguments for or against SSB tax policies, and images used. We found that posts presented a mix of messages through text and images. The majority of posts (64%) included arguments supporting SSB taxes, 28% presented a neutral position (e.g., factual information) or a mix of both pro-and anti-tax arguments, and 8% opposed. One-third of posts included an image, almost half of which appeared to be stock photos from SSB advertisements: many of these were shared by medical and public health users. Some tax supporters also reposted messages and images from opposition campaigns and added their own criticisms. By reposting opponents' anti-tax messages and images of SSBs, tax supporters may have inadvertently promoted SSBs, reinforced opposition to SSB taxes, and normalized SSBs. While advocates effectively shared pro-tax arguments, they should also ensure that accompanying images reflect the solutions they seek, not just the problem they are trying to combat., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Garcia, Mejia, Perez-Sanz, Dorfman, Madsen and Schillinger.)

Aims: The middle-out perspective (MOP) provides a lens to examine how actors positioned between government (top) and individuals (bottom) act to promote broader societal changes from the middle-out (rather than the top-down or bottom-up). The MOP has been used in recent years in the fields of energy, climate change, and development studies. We argue that public health practitioners involved with advocacy activities and creating alliances to amplify health promotion actions will be familiar with the general MOP concept if not the formal name. The article aims to demonstrate this argument., Methods: This article introduces the MOP conceptual framework and customises it for a public health audience by positioning it among existing concepts and theories for actions within public health. Using two UK case studies (increasing signalised crossing times for pedestrians and the campaign for smoke-free legislation), we illustrate who middle actors are and what they can do to result in better public health outcomes., Results: These case studies show that involving a wider range of middle actors, including those not traditionally involved in improving the public's health, can broaden the range and reach of organisations and individuals involving in advocating for public health measures. They also demonstrate that middle actors are not neutral. They can be recruited to improve public health outcomes, but they may also be exploited by commercial interests to block healthy policies or even promote a health-diminishing agenda., Conclusion: Using the MOP as a formal approach can help public health organisations and practitioners consider potential 'allies' from outside traditional health-related bodies or professions. Formal mapping can expand the range of who are considered potential middle actors for a particular public health issue. By applying the MOP, public health organisations and staff can enlist the additional leverage that is brought to bear by involving additional middle actors in improving the public's health., Competing Interests: Conflict of InterestThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The National Public Health Law Conference: People. Policy. Progress., held October 2023, brought together more than 400 stakeholders in public health to explore how law and policy can be leveraged to advance health equity, improve data sharing for community health, protect access to reproductive health and facilitate system change.

Given the complexities of youth violence prevention and longstanding violence inequities, advocacy by pediatric clinicians provides a critical voice to represent youth at multiple levels to address the myriad contributors and effects of youth violence. Institutional, community, state, and federal programs, policies, and legislation are required to support a public health approach to the amelioration of youth violence. This article focuses on the role of pediatric clinicians in advocating for youth and families, promoting change within clinical and hospital systems, partnering with communities to advance evidence-informed prevention and intervention, and legislative advocacy to advance violence prevention policy, research, and practice., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Effecting policy change is a key strategy in tackling wider determinants of health. In England, public health sits within Local Authorities (LAs) and responsibility for ensuring health is considered across directorates increasingly falls to public health practitioners. While international professional standards expect competence in understanding policy processes, the advocacy role has been under-explored. This paper explores the professional skills, role characteristics and learning needs of practitioners advocating for the restriction of advertising high-fat, salt and sugar products in a region of England. A series of three interviews were conducted at three time points over 10 months with policy advocates leading this policy change from four LAs. Three focus groups were also held with 12 public health advocates from 10 LAs at the end of the 10-month period of data collection. Data were transcribed and analysed retroductively. Data showed that practitioners felt inexperienced as policy advocates and saw this work as different from other public health approaches. Successful advocates required interpersonal skills, knowledge of policy-making and local governance, determination, resilience, confidence, belief in their work's value and leadership. These skills were difficult to acquire through formal education, but advocacy training, mentorship and role modelling were seen as important for professional development. To successfully implement a Health in all Policies approach and address wider determinants of health, public health practitioners need to be equipped and supported as policy advocates. The advocacy role and the complex skills required need to be more fully understood by the public health profession and prioritized within workforce development at both local and national levels., (© The Author(s) 2023. Published by Oxford University Press.)

Oral conditions are a public health problem globally and stark oral health inequalities exist between and within countries. Yet, oral diseases are rarely considered as a health priority and evidence-informed policy generation is challenging. Science communication and health advocacy are critical in that respect. However, due to time limitations, research workload and other factors, academics are usually hindered from participating in such lengthy endeavours. Here, we make the case that 'science communication and health advocacy task forces' should be a priority at academic institutions. The two main duties of these task forces are knowledge transfer about the burden of oral conditions and patterns of inequalities, and their underlying social and commercial determinants, and advocacy and mediation between the stakeholders involved directly or indirectly in policy making. These interdisciplinary task forces, including both academics and non-academics, should collectively have skills that include (1) knowledge about oral health, dental public health and epidemiology, (2) ability to communicate clearly and coherently and make the case in both lay and scientific language terms, (3) familiarity with digital and social media platforms and ability to create visual aids, videos and documentaries, (4) good negotiation skills and (5) maintaining scientific transparency and avoiding getting involved in confrontation with political parties. In the current context, the role of the academic institutions should not only be the production of knowledge, but also the active transferability and application of this knowledge towards public benefit., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: Food systems are a major contributor to climate change, producing one-third of global greenhouse gas emissions. However, public knowledge of food systems' contributions to climate change is low. One reason for low public awareness may be limited media coverage of the issue. To investigate this, we conducted a media analysis examining coverage of food systems and their contribution to climate change in Australian newspapers., Design: We analysed climate change articles from twelve Australian newspapers between 2011 and 2021, sourced from Factiva. We explored the volume and frequency of climate change articles that mentioned food systems and their contributions to climate change, as well as the level of focus on food systems., Setting: Australia., Participants: N/A., Results: Of the 2892 articles included, only 5 % mentioned the contributions of food systems to climate change, with the majority highlighting food production as the main contributor, followed by food consumption. Conversely, 8 % mentioned the impact of climate change on food systems., Conclusions: Though newspaper coverage of food systems' effects on climate change is increasing, coverage of the issue remains limited. As newspapers play a key role in increasing public and political awareness of matters, the findings provide valuable insights for advocates wishing to increase engagement on the issue. Increased media coverage may raise public awareness and encourage action by policymakers. Collaboration between public health and environmental stakeholders to increase public knowledge of the relationship between food systems and climate change is recommended.

The upstream framework presented in public health and medicine considers health problems from a preventive perspective, seeking to understand and address the root causes of poor health. Medical-legal partnerships (MLPs) have demonstrated the value of this upstream framework in the practice of law and engage in upstream lawyering by utilizing systemic advocacy to address root causes of injustices and health inequities. This article explores upstreaming and its use by MLPs in reframing legal practice.

This year we celebrate 50 years of the UK Faculty of Public Health (FPH). This commentary serves as a reflection on the history of the FPH, considering the origins of public health in the UK and the role of the FPH in shaping public health practice and policy. The genesis and evolution of the FPH are discussed, drawing upon reflections from past presidents and the wider literature. Historical shifts in the identity and roles of public health practitioners are also explored in the context of an increasingly complex and dynamic health and social care system. Key changes in public health practice are described, including the development of a multidisciplinary public health workforce and an increased focus on health inequalities over recent decades. Building upon this is a discussion of the current purpose of the FPH and perspectives on the future of the FPH amidst a changing public health landscape., (© The Author(s) 2022. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Public health advocacy is a fundamental part of health promotion practice. Advocacy efforts can lead to healthier public policies and positive impacts on society. Public health educators are responsible for equipping graduates with cross-cutting advocacy competencies to address current and future public health challenges., Problem: Knowledge of the extent to which students are taught public health advocacy is limited. To determine whether advocacy teaching within public health degrees matches industry needs, knowledge of pedagogical approaches to advocacy curricula is required. This study sought to understand the extent to which advocacy is taught and assessed within Australian public health degrees., Methodology: Australian public health Bachelor's and Master's degrees were identified using the CRICOS database. Open-source online unit guides were reviewed to determine where and how advocacy was included within core and elective units (in title, unit description or learning outcomes). Degree directors and convenors of identified units were surveyed to further garner information about advocacy in the curriculum., Results: Of 65 identified degrees, 17 of 26 (65%) undergraduate degrees and 24 of 39 (62%) postgraduate degrees included advocacy within the core curriculum, while 6 of 26 (23%) undergraduate and 8 of 39 (21%) postgraduate offered no advocacy curriculum., Implications: Australian and international public health competency frameworks indicate advocacy curriculum should be included in all degrees. This research suggests advocacy competencies are not ubiquitous within Australian public health curricula. The findings support the need to advance public health advocacy teaching efforts further., (© 2022 The Authors. Health Promotion Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of Australian Health Promotion Association.)

The circumstances leading to one million American deaths from COVID-19 are familiar to health educators: The pandemic was politicized from the outset; public health professionals were pushed aside and sometimes attacked; in many areas, compliance with public health recommendations was low, and vaccine uptake was much less than required to meet the threat; the public health community tied itself in knots trying to figure out how to cut through the plethora of misinformation; people in marginalized populations died in vastly disproportionate numbers in spite of years of preparation to prevent just that outcome. Cumulative mortality is equivalent to some of the "worst case" scenarios put forth by U.S. public health experts at the beginning of the pandemic even though we've worked so hard to prepare for this type of global pandemic, so what went wrong? Profound changes in American politics have led to a relationship between public health and swaths of society that is quite unlike what previously was assumed in the dominant models of public health; it was believed that public health experts would be treated as and listened to as the experts they are in the field. As the politicization of the pandemic and subsequent deaths show, these assumptions are no longer valid and we cannot assure the health of the public as we are required to do. The assumptions that we have operated under for so long in public health now must be deconstructed and revisited in order to move forward and prevent unnecessary future deaths. To do this, we must better understand the influence of American politics and we must more effectively engage in politics at all levels.

Since its introduction, photovoice has been implemented in numerous fields with a wide array of outcomes of interest, but has the method been implemented in a way that is consistent with its initial aims in mind? From Caroline Wang and Mary Ann Burris's initial 1994 project, photovoice has demonstrated power to harness visual imagery and stories within a participatory empowerment process and established a new tool for the profession for understanding community members' lived experience and needs, raising the critical consciousness of communities, and advocating for actions leading to social change. Based in Freirean philosophy, feminist theory, and documentary photography, photovoice engages community members to identify, represent, and change their community by means of photography, dialogue, and action. Public health can benefit when researchers and practitioners more carefully conceptualize the intended aims of each photovoice effort. The purpose of this article is to consider the varied applications of photovoice and propose a classification system that encapsulates its wide-ranging aims. Close examination of foundational literature and previous applications of photovoice suggest the following categories for framing the application of the method; specifically, photovoice for (a) photovention, (b) community assessment, (c) community capacity building, and (d) advocacy for change. Full implementations of photovoice have the capacity to illuminate complex real-world issues leading to advocacy for policy, systems, and environmental change. It is our hope that the proposed framing clarifies the language used to discuss photovoice and its outcomes, distinguishes its various uses and stated aims, and maximizes its impact in future applications.

Photovoice is a participatory action research method that was founded on mobilizing communities toward action. However, there is limited research detailing the action stages of photovoice that are meant to follow the initial research. In this article, we describe the action stage of a youth photovoice project conducted at the planning phase of a Community Health Needs Assessment of the Latino community in North Philadelphia. In collaboration with local leaders, we utilized photovoice to prioritize the health needs identified in the assessment. We announced a request for proposals and launched twelve, 1-year, community catalyst grants in the amount of US$50,000 each. While grants were funded and implemented, the participants continued to exhibit their findings in Philadelphia City Hall and engage with city policymakers. We developed a health policy workshop where Philadelphia youth beyond the original photovoice participants could learn advocacy skills and policy research to develop a proposal addressing a priority health need identified through photovoice. This workshop was expanded into a year-round program where participants can be matched with a career mentor, engage in professional development sessions, and continue to refine and advocate for their policy proposal. We found that successful action planning stemmed from setting goals several steps ahead of the current stage of action while enhancing the ability to center community voice in guiding action forward. Photovoice influenced decision-making throughout each of the steps taken toward action. Future research should recognize and describe action planning as a central tenet of photovoice methodologies.

When conducting interviews or focus groups, researchers often end with a simple question; "Is there anything else you would like to add?" This article takes responses to this question provided by participants in a study of "West Africans' Perceptions of Ebola research" as its point of departure. A number of participants in that study accepted the invitation to add on to their interview at its end with details of suffering from the sequelae of Ebola in their communities, and criticisms of state social abandonment. Some explicitly asked the researcher to ensure the suffering of Ebola survivors would be recognized at the international level. These closing words exceeded the objectives of the study within which they emerged. This was a study focused on lived experiences and decision-making to participate in Ebola research during or after the 2013-16 West Africa Ebola outbreak. The study aimed to inform the ethical conduct of research in future public health emergencies. What to do, then, in the face of these participants' entreaties to the interviewer for action to address Ebola survivors' suffering and social abandonment? Can and should the public health emergency or qualitative researcher better anticipate such requests? Where participants' expressed concerns and hopes for the impact of a study exceed its intended scope and the researchers' original intentions, what is at stake ethically in how we respond to those entreaties as researchers? This paper offers reflections on these questions. In doing so, our intention is to open up a space for further consideration and debate on the ethics of how researchers respond to unanticipated requests made to them in the course of research projects, to leverage their power and privilege to advance local priorities., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Nouvet, Hunt and Schwartz.)

Background and Objectives: This translational research had 2 aims: first, to analyze and translate data from multiple original data sources to provide accurate, unbiased local community and statewide information about healthy aging; second, to work with stakeholders to use the tools to identify disparities in healthy aging and to support their efforts to advance healthy aging., Research Design and Methods: Data sources from the Centers for Medicare and Medicaid Services, Behavioral Risk Factor Surveillance System, U.S. Census American Community Survey, and other sources were analyzed using small area estimation techniques to determine age/gender-adjusted local community rates in Connecticut (CT), Massachusetts (MA), New Hampshire (NH), and Rhode Island (RI)., Results: State-level analyses revealed gender and racial/ethnic disparities in healthy aging. A factor analysis identified 4 dimensions of community population healthy aging/morbidity: serious complex chronic disease, indolent conditions, physical disability, and psychological disability., Discussion and Implications: Healthy Aging Data Reports now exist for MA (2014, 2015, and 2018), NH (2019), RI (2016 and 2020), and CT (2021) and demonstrate differences in health by place. Each report includes community profiles for every city, town, and some urban neighborhoods with more than 170-197 indicators. The reports include maps of the statewide distribution of rates, an infographic, highlights report with state-specific multivariate analyses, and 18 interactive web maps, 18 regional interactive web maps, and technical documentation about data sources and methods. Overall, the research has identified variations in healthy aging and provided tools to track change over time to support age-friendly efforts in the region., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Ultra-processed food (UPF) and Ultra-processed beverage (UPB) consumption is associated with higher risks of numerous non-communicable diseases (NCDs). Yet global consumption of these products is rising due to profound changes in production, processing, manufacturing, marketing, retail, and consumption practices, alongside the growth of the resources and political influence of Big Food. Whilst the sales of UPFs and UPBs in high-income countries (HICs) are stagnating, sales are rapidly expanding in more populous middle-income countries (MICs). In this paper, we adopt a political economy of food systems approach to understand how growth of Big Food in MICs drives the NCD pandemic., Methods: We conducted a mixed methods synthesis review. This involved quantitative data collection and development of descriptive statistics; a search for academic, market and grey literature on the expansion of UPF in MICs; and the development of themes, three illustrative case examples (South Africa, Colombia, and Indonesia), and synthesis of the enablers of successful campaigns in MICs into recommendations for public health campaigns., Results: We project that the combined sales volume of UPFs in MICs will reach equivalency with HICs by 2024, and the total sales volume of UPBs in MICs is already significantly higher than in HICs. Similarly, annual growth in UPF sales is higher in MICs compared to HICs. We also show how Big Food has entrenched its presence within MICs through establishing global production and hyper-local distribution networks, scaling up its marketing, challenging government policies and scientific expertise, and co-opting civil society. We argue that public health can counter the influence of Big Food by developing an expanded global network of driven and passionate people with diverse skillsets, and advocating for increased government leadership., Conclusion: The projected increase in sales of UPFs and UPBs in MICs raises major concerns about the global capacity to prevent and treat NCDs., (© 2021 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

People affected by overdose deaths are advocating for prevention and increased access to treatment. Activist coalitions challenged the deadly impact of stigma, discrimination, and inadequate access to life-saving substance use disorder (SUD) and mental health care. Advocacy by coalitions resulted in federal and state funding and legislation, improving access to care. New York State is a model for these reforms. Occupational safety and health activists have largely been absent from this critical policy work even though 70% of people who are struggling with substance use are working. Antiquated workplace policies discipline workers who have substance use problems, silencing those who need support. Pain related to hazardous and stressful work are drivers of the crisis. Prevention and recovery-friendly workplace programs are part of the solution. Partnerships among employers, unions and safety and health activists with the recovery movement can prevent SUD and help affected workers build and sustain their recovery.

Newborn screening (NBS) is more than 50 years old and has proven to be a powerful and successful public health system. NBS must be regarded as a system and not simply as a test. We need to work as a community to improve the culture of safety for the NBS system and thereby to reduce the risk of babies being missed by the NBS system. Adding new technologies will not prevent system failures; that will require adherence to the culture of safety. Some have argued that every newborn should have their genome sequenced at birth and this sequencing could be part of NBS. However, NBS has depended on biomarker phenotypes throughout its history and our understanding of the relationships between genotype and phenotype is imperfect. Therefore, we should avoid being seduced by genomic sequencing technology and continue to focus on phenotypic biomarkers in NBS., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: To achieve zero hunger targets set within the United Nations' Agenda 2030, high-income countries such as Australia must reconsider current efforts to improve food security. This study aimed to; explore perspectives from public health nutrition experts on the usefulness of drawing on the international human right to food, and associated mechanisms, to address food insecurity; identify potential roles of key stakeholders in Australia to implement a rights-based approach; and examine barriers and enablers to achieving the right to food in Australia., Methods: Qualitative in-depth interviews were conducted with key informants (> 10 years professional experience). Braun and Clarke's (2006) six-phase approach to thematic analysis was employed to analyse data, using Kingdon's multiple streams framework (1984) to examine interactive variables which affect policy-making processes., Results: Thirty interviews took place, with most participants representing academia (n = 16), majority had 10-14 years of experience (n = 12) and almost one quarter (n = 7) were in senior leadership roles. Participants believed that framing food insecurity as a human rights issue could be effective when communicating with some audiences, however alternative rhetoric is more popular and potentially more effective. Citizens, government, food industry, non-profit sector, research/tertiary and legal institutions were described as playing critical roles. Barriers to progress were identified as lack of awareness and acknowledgement of the problem, prioritisation of the private sector, lack of political will and domestic laws, and an inefficient/ineffective charitable food sector. Participants identified various enablers and opportunities for implementing a rights-based approach such as grass-roots advocacy efforts to raise awareness of the issue, integrating human rights into government frameworks and community projects and the political will to support action aligned with sustainable development., Conclusions: Human rights language and mechanisms have the potential to trigger genuine commitment to addressing food insecurity however should be used with caution. Australia's public health workforce requires increased capacity to implement a human-rights approach and framing such efforts to align with sustainable development may achieve greater political action., Trial Registration: Ethics approval was received from the Deakin University Human Research Ethics committee (project ID HEAG 168_2018).

Oral disease in children is an urgent public health issue worldwide. Early childhood caries (ECC) affects 600 million children globally, yet it is entirely preventable. Dental health professionals around the world need to act to improve use of measures to prevent ECC and of quality dental health care to improve oral health worldwide. The University of California/Los Angeles (UCLA) Center for Children's Oral Health hosted an interprofessional innovation forum to discuss and recommend options. We present the policy, educational, and public health-related suggestions for improving outcomes and professional collaboration and five key areas for action: (1) increase advocacy efforts, (2) support interprofessional education and practice, (3) promote oral health education and increase health literacy, (4) increase collaboration with community and school-based oral health care workers, and (5) use of technology to increase access to dental care and health information.

Women's health activists laid the groundwork for passage of the law that created the U.S. Food and Drug Administration in 1906. The pharmaceutical and food industries fought regulatory reforms then and continue to do so now. We examine public health activism in the Progressive Era, the postwar era and the present day. The women's health movement began in the 1960s, and criticized both the pharmaceutical industry and the medical establishment. In the 1990s, patient advocacy groups began accepting industry funds; thousands of commercially-funded groups now dominate the advocacy landscape. As pharma funding became normalized, concerns arose regarding a) the lack of transparency and public accountability regarding funding, b) the distortion of groups' agendas, and c) the ability of pharma-funded groups to dominate the discourse and override less well-resourced patient and health advocacy groups. Although industry-funded groups argue that funding allows them to provide useful services, the trade-off in health risks, exorbitant prices and distorted information is far too high. Sincerity is beside the point; patients and the industry have differing interests when it comes to drug safety and efficacy, drug information and drug prices. A growing resistance movement is asserting the values of its activist predecessors and opposing the prevailing culture of pharma-funded advocacy.

Evidence-based communications and policy outreach are critical elements in building awareness about a disease, build public momentum and decision making and resource mobilization. In India, communications and advocacy played an important role in managing diseases like HIV/AIDS, pneumonia, tuberculosis, etc. and addressing barriers to adoption of new health interventions. These learnings from the past, can help India manage cholera more effectively through a strong advocacy and communications strategy involving multiple stakeholders and partners, with a focus on engaging decision makers. The article discusses strategic communications and advocacy programs for cholera that can be instrumental in paving the way for cholera vaccine use to combat this public health problem and its social and economic impact., Competing Interests: Declaration of Competing Interest The authors declared that there is no conflict of interest., (Copyright © 2019. Published by Elsevier Ltd.)

CKD is a growing public health problem. The Global Kidney Health Atlas (GKHA) is an important initiative of the International Society of Nephrology. The GKHA aims to improve the understanding of inter- and intranational variability across the globe, focusing on capacity for kidney care delivery. The GKHA survey was launched in 2017 and then again in 2019, using the same core data, supplemented by information about dialysis access and conservative care. Based on a WHO framework of the 6 building blocks essential for health care, the GKHA assesses capacity in 6 domains: information systems, services delivery, workforce, financing, access to essential medicines, and leadership/governance. In addition, the GKHA assesses the capacity for research in all regions of the world, across all domains (basic, translational, clinical, and health system research). The results of the GKHA have informed policy and been used to enhance advocacy strategies in different regions. In addition, through documentation of the disparities within and between countries and regions, initiatives have been launched to foster change. Since the first survey, there has been an increase in the number of countries which have registries to document the burden of CKD or dialysis. For many, information about the burden of disease is the first step toward addressing care delivery issues, including prevention, delay of progression, and access to services. Worldwide collaboration in the documentation of kidney health and disease is an important step toward the goal of ensuring equitable access to kidney health worldwide., (© 2021 The Author(s) Published by S. Karger AG, Basel.)

Concerns have been raised that the divisions emerging within public health in response to electronic cigarettes are weakening tobacco control. This paper employed thematic and network analysis to assess 90 policy consultation submissions and 18 interviews with political actors to examine the extent of, and basis for, divisions between health-focused actors with regard to the harms and benefits of e-cigarettes and appropriate approaches to regulation in Scotland. The results demonstrated considerable engagement in e-cigarette policy development by health-focused actors and a widely held perception of strong disagreement. They show that actors agreed on substantive policy issues, such as age-of-sale restrictions and, in part, the regulation of advertising. Points of contestation were related to the harms and benefits of e-cigarettes and the regulation of vaping in public places. The topicality, limitations of the evidence base and underlying values may help explain the heightened sense of division. While suggesting that some opportunities for joint advocacy might have been missed, this analysis shows that debates on e-cigarette regulation cast a light upon differences in thinking about appropriate approaches to health policy development within the public health community. Constructive debates on these divisive issues among health-focused actors will be a crucial step toward advancing public health.

Objectives: To draw advocacy lessons from actions undertaken by public health groups to assist the development of Australia and New Zealand's Health Star Rating (HSR) front-of-pack nutrition labelling system., Methods: The advocacy approaches undertaken by the Public Health Association of Australia leading up to the time of the adoption of the HSR is examined using a 10 step advocacy framework. Key roles in advocacy planning and implementation are described, along with coordinating efforts by health and consumer groups during the HSR development processes., Results: HSR aims to support consumers to make informed choices to protect from diet-related diseases, including obesity. The HSR launched despite a number of major obstacles, owing to a strategic, coordinated advocacy effort undertaken by a guiding coalition., Conclusions: Actions to improve nutrition are often highly contested, particularly if the desired outcome competes with commercial interests. However, by deploying a structured approach to public health advocacy it is possible to influence government despite opposition from commercial interests. Implications for public health: A shared vision and a coordinated effort by public health professionals enabled advocates to overcome undue commercial influence., (© 2019 The Authors.)

There has been renewed concern about the state of public health in Canada, with several recent articles in this journal suggesting that the discipline of public health is under threat and that there has been a significant erosion of its core infrastructure. We strongly agree with the need for a well-resourced formal public health system and preservation of capacity to carry out core public health functions, while also positing a complementary narrative that emphasizes the possibility for a broad notion of public health to persevere and thrive in the face of these challenges. We consider what public health is, who public health is, and why public health exists, and suggest that the answers to these questions point to opportunities to strengthen the necessary interdisciplinary approaches that can best address current and future public health concerns.

As public health professionals, our duty as advocates extends beyond public policy development into advocating for why public health matters. This duty is an imperative given the documented challenges currently faced by our public health system. Storytelling is a deliberate means by which we can exercise our professional agency and present the diverse contributions that public and population health professionals are making to the health of communities and families. Storytelling may serve a critical role in professional reflection to enable transformative change within this challenging public health landscape. We highlight the value of storytelling by presenting the lived experience of a frontline service provider reflecting on her work with Tara-a resilient, young woman facing multiple challenges throughout her life that impacted her health and that of her family. Tara's story represents but one of countless examples from across the country that public health professionals can use to advance work on addressing health inequities. Professionals should be encouraged to build their competency in reflective practice and storytelling and to continue to use stories like Tara's in the unification of their practice and in their advocacy efforts for why public health matters to Canadians.

We reflect on why public health matters today from the perspective of Canada's provincial, territorial, and national public health associations. As independent, non-profit organizations that transcend professional roles and sectors, public health associations are positioned to play an essential role in strengthening public health, broadly speaking, across Canada. We outline three reasons why public health associations matter today. First, public health associations are uniquely positioned to champion a public health perspective. Second, they represent and connect a diverse range of roles, professions, and stakeholders involved in public health. Finally, they are positioned for advocacy, providing a platform for participation to those who may not otherwise be able to engage but who understand the importance of a collective voice. These reasons why public health associations are important are not new, but arguably carry renewed importance in the context of a contemporary public health landscape characterized by, among other things, weakened formal public health infrastructure, neoliberal agendas and individualism, and public health imperatives such as growing economic and social inequity and ecological determinants of health that require intersectoral responses.

Background: Faculty in nursing and history at Creighton University directed two service-learning courses on the history and public health implications of lead (Pb) exposure in Omaha, NE. As part of their service requirements, students conducted or observed blood lead screenings in area schools and reflected on these shared experiences in discipline-specific coursework. Strong student response encouraged the faculty to enrich transdisciplinary teaching and learning between these two courses. Although studies supply numerous best practices to develop collaborative experiences and service-oriented pedagogies, little work focuses on enriching collaborations between preexisting courses. Purpose: This study examines the outcomes of a partnership between nursing and history and presents a practical model that instructors can use to foster and deepen transdisciplinary service-learning. Methodology: Employing a hybrid grounded theory/topic modeling analysis of student reflection papers, we identify course outcomes of closest convergence. Findings/Conclusions: We argue that instructors can deepen transdisciplinary partnerships between service-learning courses by focusing on a common exemplar, encouraging collaborative experiences in the classroom and at service sites, and employing civic health as a shared concept in curricula. Implications: Beyond nursing and history, our model may be employed by faculty in preexisting service-learning courses to bring their courses into transdisciplinary convergence.

Objectives: This study assessed the outcomes of a tobacco control advocacy behavioural capacity (ABC)-building programme among public health faculty and students in China., Study Design: This is a cluster intervention study with subjects matching in the different stages of the intervention and observation., Methods: Public health students (n = 1046) and faculty (n = 199) were recruited in the intervention group. The intervention included a series of tobacco control advocacy curriculum and activities that were developed and implemented at schools or departments of public health in 22 universities across China. The control group participants (n = 540) were public health undergraduate students from another 11 universities selected from the different geographic regions. A comprehensive assessment tool was used to measure the tobacco control ABC and perceived stress level to compare changes at baseline, midterm and 12-month follow-up. Repeated measures analysis of variance, paired t tests and chi-squared tests, general linear model and generalized estimating equation were used to determine the time effect for targeted students and faculty. Multivariate analysis of variance and logistic regression model were conducted to evaluate the treatment effects for students between intervention and control sites., Results: Nine hundred and thirty-seven students and 170 faculty members in the intervention group and 469 students in the control group were valid for the final evaluation. Findings from treatment effect analyses show that the capacity-building programme significantly improved public health students' ABC, including awareness of tobacco control messages (F = 107.65, P < 0.01), general and public heath tobacco control attitudes (F = 7.52, P < 0.01; F = 8.53, P < 0.01), advocacy interest and motivation (F = 10.11, P < 0.01) and public advocacy behaviour for both family members and relatives or friends. The perceived stress in the intervention group students was also reduced significantly in comparison with the control group students (F = 4.99, P < 0.01). For faculty members, their ABC except advocacy for family members was all increased by time effect analyses. The training programme did not impact faculty and students' smoking behaviour., Conclusions: This study provided evidence to support the implementation of tobacco control advocacy capacity training among public health professionals and students to curb the tobacco epidemic in China., (Copyright © 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

The rise of right-wing populism, embodied in the figure of Donald Trump, has been characterized by conspiracy theories, "fake news," and other forms of mis- and disinformation in what has been described as a "post-truth" era. The COVID-19 pandemic exacerbated this problem, and national conflicts around appropriate content, methods, and modes of schooling often involved disinformation circulated in school board meetings and other local contexts during the 2021-2022 school year. In this study, we adopt a critical literacy lens and take up the tools of discourse analysis to examine the rhetoric of post-truth, conspiracy-oriented groups opposed to public health mandates, critical race theory (CRT), and social emotional learning (SEL) in public schools. Our discourse analysis of Purple for Parents Indiana (P4PI), a local advocacy group, suggests that P4PI and similar groups are engaging in "cosmetic criticality," a project superficially resembling critical literacy that poses a unique challenge to public education--a challenge literacy scholars and teacher educators must confront.

The purpose of this article is to provide public health organizations and practitioners a guide for organizing an advocacy summit to develop and practice advocacy skills. Further development of advocacy skills in current and prospective public health practitioners is vital in improving health outcomes among communities creating sustainable change. Though many approaches are available to help students and professionals acquire advocacy skills, an engaging real-life event such as the advocacy summit described within this commentary can be highly beneficial for both novice and seasoned advocates. The feedback obtained from summit participants showed that participants are interested in similar opportunities and believe that such events help further hone their advocacy skills. The essential steps to plan a successful advocacy summit are provided in the article, as well as a sample planning timeline, making it easier for public health advocates in other states to successfully plan similar events.

Influencing public policy change can be difficult and complex, particularly for those with limited power and resources. For any one issue there may be several groups, including the commercial sector and public health advocates advocating from different policy perspectives. However, much of the public health advocacy literature and tools available for those wanting to improve their practice is based on research from one specific perspective of an issue. This approach deprives advocates of potential insight into the most effective levers for this complex and difficult process. To provide a more comprehensive insight into effective levers for influencing public health policy change, a conceptual model for poorly-resourced advocates was developed. The model was developed through the integration and synthesis of policy process and network theories with the results from three studies conducted previously by the authors: a systematic literature review; a social network analysis of influential actors in Australian nutrition policy; plus in-depth interviews with a sample of these actors who had diverse perspectives on influencing nutrition policy. Through understanding the key steps in this model advocates will be better equipped to increase political and public will, and affect positive policy change.

Background: Chronic Kidney Disease (CKD) is a major public health problem and is increasingly being recognized as an important driver of costs in all health care systems. The diversity of outcomes for people living with CKD is in part due to variability in biology, access to care, environmental factors, and health care system differences. The International Society of Nephrology (ISN), working in collaboration with its partners, has evolved into a philanthropic organization, from a traditional medical society, committed to a vision that sees "a future where all people have access to sustainable kidney health". A set of activities, including a Global Kidney Health Summit, the Global Kidney Health Atlas, and a Global Kidney Health Policy Forum, which has formed the basis of a multi-stakeholder engagement process, building on a solid base of ISN programs and educational activities, is described. Through building awareness and increasing capacity to conduct research, the international community will build a more solid foundation on which to advocate for sustainable, ethical solutions to the problem of kidney disease throughout the world., Summary: The ISN aims to improve kidney health worldwide through a variety of diverse activities addressing education, advocacy, and research. Collaboration with partners within and outside the medical community is key in achieving this goal. Key Messages: Kidney disease is an important public health problem and is driven by genetic, environmental, and socioeconomic factors. Through active collaboration with diverse partners, the international community is striving for sustainable kidney health and aims to achieve this through coordinated work in a variety of spheres., (© 2018 The Author(s) Published by S. Karger AG, Basel.)

Purpose: From 2018, the Schools Up North (SUN) programme worked with three remote Australian schools to enhance their capability and resilience to support the wellbeing and mental health of Aboriginal and Torres Strait Islander students and staff. This paper explores the implementation of SUN during the first two years of COVID-19 (2020-2021). Method: Using grounded theory methods, school staff, other service providers and SUN facilitators were interviewed, with transcripts and programme documents coded and interrelationships between codes identified. An implementation model was developed. Results: The SUN approach was place-based, locally informed and relational, fostering school resilience through staff reflection on and response to emerging contextual challenges. Challenges were the: community lockdowns and school closures; (un)availability of other services; community uncertainty and anxiety; school staff capability and wellbeing; and risk of educational slippage. SUN strategies were: enhancing teachers' capabilities and resources, facilitating public health discussions, and advocating at regional level. Outcomes were: enhanced capability of school staff; greater school-community engagement; student belonging and engagement; a voice for advocacy; and continuity of SUN's momentum. Conclusions: The resilience approach (rather than specific strategies) was critical for building schools' capabilities for promoting students and staff wellbeing and provides an exemplar for remote schools globally.

Climate change's health effects are most strongly felt in Environmental Justice (EJ) communities which are predominantly people of color. This results in a disproportionate burden of climate change health effects on EJ communities. Climate change is a public health crisis, and more importantly to pediatricians -- it is a pediatric public health crisis. We are five pediatricians who are part of the American Academy of Pediatrics (AAP) Climate Advocate Program representing four diverse regions; Colorado, California, Puerto Rico, and North Carolina. We are applied research practitioners, as we live in the world between academic research and clinical practice. We are natural advocates to ensure that the future world is rebuilt with children's health, especially children of EJ communities, at the center. Each of us has seen the direct effects of climate change adversely impact EJ Communities. In this article, we will briefly review the literature on the dangers that children face in the air they breathe, the lack of natural green spaces, and the increasingly hostile built environments, especially to children in EJ communities. We will review opportunities in our local areas to change the built environment that will work toward reducing carbon emissions and increase overall pediatric health. We will illustrate the commonalities that helped us succeed as Climate Advocates including collaboration, working locally, and purposefully choosing to identify ourselves as climate advocates and child-advocates. The intersection between public health, policy, and medicine will now become increasingly important as we head into this new decade and approach the point of no return on climate change.

This study investigated the implementation of a place-based socioscientific issue curricular unit designed to improve rising middle school students' abilities to think critically about the pros and cons of hydraulic fracturing and engage in evidence-based reasoning on whether the practice should be banned in Massachusetts. Forty-three rising middle school students from a summer enrichment program for science, mathematics, reading and writing operated by a non-profit organization in the northeastern United States participated in this study. The instructional unit exposed the students to information and activities on hydraulic fracturing for five consecutive days (50 minutes each day). The findings from this study showed that through productive socioscientific issues pedagogy, the students used the evidence collected from their investigation to engage in evidence-based reasoning about the cost and benefits of hydraulic fracturing on the public health, economy, and the environment. The students used their understanding of the science and engineering practices to construct valid arguments on whether or not hydraulic fracturing should be allowed in their state. The results further indicate that the use of socioscientific issues as a critical pedagogical strategy can equip students with the skills necessary for them to become better advocates for themselves and their communities.

In this commentary, we review the growth of populist politics, associated with exploitation of what has been termed fake news. We explore how certain words have been used in similar contexts historically, in particular the term "enemy of the people," especially with regard to public health. We then set out 6 principles for public health professionals faced with these situations. First, using their epidemiological skills, they can provide insights into the reasons underlying the growth of populist politics. Second using their expertise in modelling and health impact assessment, they can anticipate and warn about the consequences of populist policies. Third, they can support the institutions that are necessary for effective public health. Fourth they can reclaim the narrative, rejecting hatred and division, to promote social solidarity. Fifth, they can support fact checking and the use of evidence. Finally, they should always remember the lessons of history, and in particular, the way that public health has, on occasions, collaborated with totalitarian and genocidal regimes., (© 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Background and Purpose: An electronic cigarette (e-cigarette) is a device used to mimic the experience of smoking tobacco cigarettes. Considering their growing popularity amongst adolescents, it is imperative that education surrounding e-cigarettes be provided. The purpose of this project is to describe the development and delivery of a pilot interactive presentation and survey tool by doctor of pharmacy (PharmD) candidates to gauge the use and understanding of e-cigarettes amongst teens., Educational Activity and Setting: An interactive presentation providing information on e-cigarettes was created by a PharmD candidate, and presented to 357 high school students in Massachusetts and New Hampshire. An anonymous survey tool was administered after the presentation to evaluate students' perception, use, and knowledge of e-cigarettes., Findings: When asked which is safer, an e-cigarette or a tobacco cigarette, most students (84%) responded "neither," and most stated that they learned something new from the presentation. Of the 96% of students that indicated they had heard of e-cigarettes, 27% of them had tried one. PharmD candidates reported increased confidence in public speaking and preparation of patient-suitable material., Discussion: This pilot project provided both education to adolescents and insight into their experience and understanding of the potential harms of e-cigarettes. Having a PharmD candidate deliver the presentation may have increased the students' level of comfort., Summary: An interactive, PharmD candidate-delivered presentation about e-cigarettes is an innovative method to both provide education about e-cigarettes, and ascertain information about knowledge and use in adolescents. Facilitating presentations like this could be successful in other settings or topics., (Copyright © 2017 Elsevier Inc. All rights reserved.)

There is a critical need to build the capacity of our current and future public health workforce and the communities we serve to engage in public health advocacy. Advocacy should be an integral piece of our intervention strategies and public health discourse. Incorporating public health advocacy into public health training, practice, and research serves as a long-term investment for the public's health. Advocacy can achieve systemic change by addressing the social determinants of health. We developed an advocacy training program that embeds students in community-based organizations (CBOs) for 9 months, providing students with experiential education through the application of advocacy skills and CBOs with opportunities to expand and broaden their advocacy efforts. We have three priority populations: graduate students, CBOs serving Los Angeles County, and the broader Los Angeles County community, focusing on vulnerable populations. Our multifaceted approach addresses the necessity of public health advocacy among the health professions. Through changing how we train students and how communities and universities collaborate, we can strengthen the public health workforce and build healthier communities.

The role of 'advocacy' within public health attracts considerable debate but is rarely the subject of empirical research. This paper reviews the available literature and presents data from qualitative research (interviews and focus groups conducted in the UK in 2011-2013) involving 147 professionals (working in academia, the public sector, the third sector and policy settings) concerned with public health in the UK. It seeks to address the following questions: (i) What is public health advocacy and how does it relate to research?; (ii) What role (if any) do professionals concerned with public health feel researchers ought to play in advocacy?; and (iii) For those researchers who do engage in advocacy, what are the risks and challenges and to what extent can these be managed/mitigated? In answering these questions, we argue that two deeply contrasting conceptualisations of 'advocacy' exist within public health, the most dominant of which ('representational') centres on strategies for 'selling' public health goals to decision-makers and the wider public. This contrasts with an alternative (less widely employed) conceptualisation of advocacy as 'facilitational'. This approach focuses on working with communities whose voices are often unheard/ignored in policy to enable their views to contribute to debates. We argue that these divergent ways of thinking about advocacy speak to a more fundamental challenge regarding the role of the public in research, policy and practice and the activities that connect these various strands of public health research., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Big data can be used to assess perceptions about public health issues. This study assessed social media data from Twitter to inform communication campaigns to promote HIV testing and reduce discrimination related to HIV/AIDS or towards key populations to the HIV epidemic, and its potential utility to evaluate such campaigns through HIV testing uptake. Tweets from Brazil were collected from January 2014 to March 2015 and filtered by four categories of keywords including discrimination, HIV prevention, HIV testing, and HIV campaigns. In total over 100,000 geo-located tweets were extracted and analyzed. A dynamic online dashboard updated daily allowed mapping trends, anomalies and influencers, and enabled its use for feedback to campaigns, including correcting misconceptions. These results encourage the use of social networking data for improved messaging in campaigns. Clinical HIV test data was collected monthly from the city of Curitiba and compared to the number of tweets mapped to the city showing a moderate positive correlation (r = 0.39). Results are limited due to the availability of the HIV testing data. The potential of social media as a proxy for HIV testing uptake needs further validation, which can only be done with higher frequency and higher spatial granularity of service delivery data, enabling comparisons with the social media data. Such timely information could empower early response immediate media messaging to support programmatic efforts, such as HIV prevention, testing, and treatment scale up.

The public health (PH) sector is ideally situated to take a lead advocacy role in catalysing and guiding multi-sectoral action to address social determinants of health inequities, but evidence suggests that PH's advocacy role has not been fully realised. The purpose of this review was to determine the extent to which the PH advocacy literature addresses the goal of reducing health and social inequities, and to increase understanding of contextual factors shaping the discourse and practice of PH advocacy. We employed scoping review methods to systematically examine and chart peer-reviewed and grey literature on PH advocacy published from January 1, 2000 to June 30, 2015. Databases and search engines used included: PubMed, CINAHL, PsycINFO, Social Sciences Citation Index, Google Scholar, Google, Google Books, ProQuest Dissertations and Theses, Grey Literature Report. A total of 183 documents were charted, and included in the final analysis. Thematic analysis was both inductive and deductive according to the objectives. Although PH advocacy to address root causes of health inequities is supported theoretically and through professional practice standards, the empirical literature does not reflect that this is occurring widely in PH practice. Tensions within the discourse were noted and multiple barriers to engaging in PH advocacy for health equity were identified, including a preoccupation with individual responsibilities for healthy lifestyles and behaviours, consistent with the emergence of neoliberal governance. If the PH sector is to fulfil its advocacy role in catalysing action to reduce health inequities, it will be necessary to address advocacy barriers at multiple levels, promote multi-sectoral efforts that implicate the state and corporations in the production of health inequities, and rally state involvement to redress these injustices., (© 2016 John Wiley & Sons Ltd.)