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Since 1999, the CORE Group Polio Project (CGPP) has developed, refined, and deployed effective strategies to mobilize communities to improve vaccine uptake for polio (and other vaccine-preventable diseases such as measles) and conduct surveillance for infectious disease threats in high-risk, border, and hard-to-reach locations. CORE Group Polio Project teams have been called upon to address the COVID-19 pandemic, and, like with polio, the pandemic response is impacted by stigma in all areas of response, from health education, testing, contact tracing, and even treatment for infected individuals. The CGPP has reached back into its polio experience and is redeploying successful community engagement activities to address stigma as part of the COVID-19 response. Across country programs, community health volunteers communicate risk and behavior change at the household level by integrating health education and promotion activities with a focus on practical measures of COVID-19 prevention. Moreover, leveraging established and trusted partnerships with community networks and community leaders are providing lessons that can be adopted by the global community. The CGPP offers three overarching recommendations to curb stigma: 1) facilitating inclusive community engagement, 2) leveraging existing community networks and 3) cocreating with community leaders.

Zoonotic pathogens cause an estimated 70% of emerging and re-emerging infectious diseases in humans. In sub-Saharan Africa, bushmeat hunting and butchering is considered the primary risk factor for human-wildlife contact and zoonotic disease transmission, particularly for the transmission of simian retroviruses. However, hunting is only one of many activities in sub-Saharan Africa that bring people and wildlife into contact. Here, we examine human-animal interaction in western Uganda, identifying patterns of injuries from animals and contact with nonhuman primates. Additionally, we identify individual-level risk factors associated with contact. Nearly 20% (246/1,240) of participants reported either being injured by an animal or having contact with a primate over their lifetimes. The majority (51.7%) of injuries were dog bites that healed with no long-term medical consequences. The majority (76.8%) of 125 total primate contacts involved touching a carcass; however, butchering (20%), hunting (10%), and touching a live primate (10%) were also reported. Red colobus (Piliocolobus rufomitratus tephrosceles) accounted for most primate contact events. Multivariate logistic regression indicated that men who live adjacent to forest fragments are at elevated risk of animal contact and specifically primate contact. Our results provide a useful comparison to West and Central Africa where "bushmeat hunting" is the predominant paradigm for human-wildlife contact and zoonotic disease transmission.

In western Uganda, the landscape surrounding Kibale National Park (KNP) contains households, trading centers, roads, fields, and forest fragments. The mosaic arrangement of these landscape features is thought to enhance human-primate interaction, leading to primate population declines and increased bi-directional disease transmission. Using a social-ecological systems research framework that captures the complexity of interaction among people, wildlife, and environment, we studied five forest fragments near KNP and conducted intensive on-the-ground mapping to identify locations of human-primate spatial overlap. Primate locations and human activities were distributed within, on the edges, and far beyond fragment borders. Analysis of shared spaces indicated that 5.5% of human space overlapped with primate spaces, while 69.5% of primate spaces overlapped with human spaces. Nearest neighbor analysis indicated that human activities were significantly spatially clustered within and around individual fragments, as were primate locations. Getis-Ord statistics revealed statistically significant "hotspots" of human activity and primate activity, but only one location where spatial overlap between humans and primates was statistically significant. Human activities associated with collecting fuelwood and other forest products were the primary drivers of human-primate overlap; however, primates also spent time outside of forest fragments in agricultural spaces. These results demonstrate that fragmented landscapes are not uniform with respect to human-primate overlap, and that the implications of human-primate interaction, such as primate population declines and possible cross-species disease transmission, are spatially aggregated.

Conducting research in much of the Global South often involves engagement with communities, groups and even field staff living and working in constrained material conditions. As researchers from the USA with field experience in East Africa, we consider in this paper various aspects of reciprocity, mutual benefit and ethical engagement between researcher, respondents, host communities, and staff. With a focus on three stakeholder groups, we explore the challenges and rewards of implementing an ethical exchange of information, gifts and mentorship as well as the nuances of negotiating and articulating responsibilities and expectations. We offer general guidance informed by personal experiences to elucidate these lessons, their impacts on the outcomes of the research, and the implicit ethics behind mindful reciprocity as academics.

Keywords: Social determinants of health, logic models, equity, Pacific NorthwestIntroductionHealth begins where we live, work, learn and play - long before any clinical intervention is required to treat disease or injury.- Northwest Health FoundationThe concept of the social determinants of health (SDOH) has been widely embraced within the public health community. Research over the past two decades repeatedly demonstrates the relationship between poor health outcomes and socioeconomic factors such as poor housing, unsafe work environments, poor education, social exclusion, poverty, racism, and structural inequity (Krieger, 1994; Marmot & Wilkinson, 1999; Williams, Costa, Odunlami, & Mohammed, 2008; Commission on the Social Determinants of Health, 2008; Centers for Disease Control and Prevention, 2011). Despite this evidence, few community-based health foundations have taken the opportunity to invest in the social determinants of health.Addressing the social determinants of health is a challenge for two reasons. One is that societal conditions have evolved over generations; as a result, problems such as poverty, racism, and social exclusion cannot be mitigated, much less solved, through short-term investments. The second challenge is the long lag time between changes in social determinants and corresponding health outcomes. This delay means that scalable best practices are still largely theoretical (Bramba et al., 2010).BackgroundIn late 2004, Kaiser Permanente Northwest established the Kaiser Permanente Community Fund within the Northwest Health Foundation (NWHF) with a $28 million gift. In 2006, the fund advisors took the bold and strategic step of investing in improvements to the social determinants of health. In order to improve the impact of the fund, key leaders at the NWHF and Kaiser Permanente Northwest made a commitment to continuous learning based on their own experiences and those of community partners. As part of this commitment, NWHF commissioned the Center for Community Health and Evaluation (CCHE), part of Group Health Research Institute in Seattle, Wash., to retrospectively evaluate the first five years of the fund's grantmaking (2005-2009).In this article we present an overview of the Kaiser Permanente Community Fund's SDOH initiative and its theory of change. We then introduce the frameworks and methods we used to conduct our evaluation. In the findings section we summarize the accomplishments of the initiative and grantee success factors. We conclude the article by imparting the lessons learned during and from the evaluation. We believe these lessons will be helpful to other foundations and funders interested in interventions and initiatives focused on social determinants of health.Development of the InitiativeThe fund is based at the Northwest Health Foundation in Portland, Ore. In 2005, the fund invited and funded proposals to advance health equity and promote cultural competency in health care. Although some of the fund's 2005 grantees were already addressing social determinants, the following year, the fund's advisory board and NWHF staffmade a commitment to focus grantmaking on social determinants of health. They believed this refined strategy offered the greatest opportunity to improve community health. A survey of the local philanthropic landscape revealed a significant gap in upstream community health initiatives. The fund focused on determinants as diverse as economic opportunity, public safety, civic engagement, and early education as avenues for long-term health improvements.The fund is governed by an advisory board comprised of six representatives of different constituencies within the Kaiser Permanente system and five representatives from the broader community. Community representatives have worked in a variety of areas, including housing, economic development, public health, and advocacy for social equity. Advisors and NWHF staffjointly develop requests for proposals, outreach strategies, and criteria for selecting proposals that are most likely to achieve sustained community impact. …

Shoes are effective for blocking soil-transmitted helminths (STHs) that penetrate the skin. Unfortunately, shoe-wearing is uncommon in many areas where STHs are prevalent, in part because local populations are unaware of the health benefits of wearing shoes. This is especially true in low-literacy populations, where information dissemination through written messages is not possible. We launched a public health intervention that combines a public health image with sandals. The image is a "lenticular image" that combines two alternating pictures to depict the efficacy of shoes for preventing STH infection. This image is adhered to the shoe, such that the message is linked directly to the primary means of prevention. To create a culturally appropriate image, we conducted five focus group discussions, each with a different gender and age combination. Results of focus group discussions reinforced the importance of refining public health messages well in advance of distribution so that cultural acceptability is strong. After the image was finalized, we deployed shoes with the image in communities in western Uganda where hookworm is prevalent. We found that the frequency of shoe-wearing was 25% higher in communities receiving the shoes than in control communities. Microscopic analyses of fecal samples for parasites showed a sustained reduction in infection intensity for parasites transmitted directly through the feet when people received shoes with a public health image. Our results show that combining culturally appropriate images with public health interventions can be effective in low-literacy populations.

Emerging infectious diseases from animals pose significant and increasing threats to human health; places of risk are simultaneously viewed as conservation and emerging disease 'hotspots'. The One World/One Health paradigm is an 'assemblage' discipline. Extensive research from the natural and social sciences, as well as public health have contributed to designing surveillance and response policy within the One World/One Health framework. However, little research has been undertaken that considers the lives of those who experience risk in hotspots on a daily basis. As a result, policymakers and practitioners are unable to fully comprehend the social and ecological processes that catalyze cross-species pathogen exchange. This study examined local populations' comprehension of zoonotic disease. From October 2008-May 2009 we collected data from people living on the periphery of Kibale National Park, in western Uganda. We administered a survey to 72 individuals and conducted semi-structured, in-depth interviews with 14 individuals. Results from the survey showed respondents had statistically significant awareness that transmission of diseases from animals was possible compared to those who did not think such transmission was possible (x(2) = 30.68, df = 1, p 0.05). However, individual characteristics such as gender, occupation, location, and age were not significantly predictive of awareness. Both quantitative and qualitative data show local people are aware of zoonoses and provided biomedically accurate examples of possible infections and corresponding animal sources (e.g., worm infection from pigs and Ebola from primates). Qualitative data also revealed expectations about the role of the State in managing the prevention of zoonoses from wildlife. As a result of this research, we recommend meaningful discourse with people living at the frontlines of animal contact in emerging disease and conservation hotspots in order to develop informed and relevant zoonoses prevention practices that take into account local knowledge and perceptions.

There is little dispute that the global health agenda is increasingly being shaped by foundations and partnerships, as the introduction to and rationale for this book make plain. In the wake of structural adjustment in the Global South, and in the context of the worldwide dominance of neo-liberalism, new actors are addressing global health crises such as HIV/AIDS, malnutrition, and water-borne diseases (Farmer, 2005b; WHO, 2008d). This book examines the impact of these new global health actors on the wider system of global health governance. In this chapter, we argue that the mainstream global health agenda is being driven by powerful, wealthy, and generally market-oriented (and often corporate-funded) foundations as well as by new global health partnerships (GHPs). Given the resources and political support these actors enjoy, they have become de facto agenda-setters and increasingly shape the trajectory of global health governance. Whilst such actors are investing resources on an unprecedented scale – especially in combating specific diseases such as HIV, tuberculosis, and malaria – we argue here that they also have a tendency to bolster the same corporate, capitalist, neo-liberal agenda that has been so deleterious to health outcomes across the globe (Harvey, 2003; Kim et al., 2000). Certainly they are not alone in this – much publicly funded global and national health policy and spending are similarly underpinned by neo-liberal ideology (Saith, 2006). Nevertheless, there is a need to explore further the implications of this ‘private turn’ in global health governance, as these new actors remake the health agenda in specific ways.