Addressing Infectious Diseases in Vulnerable Populations Under the Auspices of One Health: A Call for Action in Europe

Coming Together for Climate and Health: Proceedings of the Second Annual Clinical Climate Change Meeting, January 24, 2020.

Transportation has been identified as a major barrier to healthcare access, particularly, within vulnerable population groups. The level of healthcare access that most population segments have in traditional transit systems may be increased with new initiatives that involve complex and large investments in transit oriented developments (TOD) projects. However, the increasing attractiveness of neighborhoods affected by TOD initiatives may result in the gentrification of vulnerable population segments. These vulnerable segments are likely to be relocated into less attractive neighborhoods characterized by inadequate transit systems. This relocation increases the probabilities of reducing healthcare access for these underserved groups leading to an increase in health disparities. The present discussion calls for research to explore relevant factors that affects these dynamics. A framework that enables the identification of individual factors that affect gentrification processes under TOD initiatives as well as quantifying the effects from these processes is suggested in this paper. A system dynamics framework that allows the understanding of the dynamics associated with this system is suggested in this paper. Critical areas for empirical research are highlighted. These are prerequisites for the effective deployment of initiatives that ensure the mitigation of possible negative impacts on vulnerable populations.

On 11 March 2020, the World Health Organization announced that COVID-19 was characterised as a pandemic—a global first for coronavirus.1 Coronaviruses are a large family of viruses that cause illness such as the common cold to more severe diseases such as Severe Acute Respiratory Syndrome.2 A novel coronavirus is typically a new strain of the infectious disease that has not been previously identified in humans.2 COVID-19 is the most recent version of a novel coronavirus.2 COVID-19 has received significant public and government attention over the past weeks after it was first detected in the Wuhan province of China in December 2019, with subsequent epidemics in China, Italy, Republic of Korea and Iran.1 As of 12 March 2020, 125 000 cases were reported from 118 countries and territories globally, with predictions this will continue to rise rapidly.3 This has led to an array of public health measures being advocated by the WHO, including four critical areas for action—(a) prepare and be ready; (b) detect, protect and treat; (c) reduce transmission; and (d) innovate and learn.3 This has been complemented, to varying degrees, through concurrent action by local, state and national governments worldwide. There can be a tendency in the health promotion profession to think of infectious diseases from a biomedical viewpoint. As such, the prevention and treatment of infectious diseases is sometimes perceived to be the responsibility of the clinical realm. Yet, the reality is that both nonclinical and clinical public health responses are required—and sometimes we need to relax professional boundaries to work collaboratively for the health and wellbeing of our communities. We need to work in partnership with health surveillance teams, epidemiologists, environmental health scientists, public health physicians, infectious disease physicians, general practitioners, nurses, allied health professions, health policy-makers, health planners, health geographers and many others, to reduce the risks associated with pandemics. We also need to work across sectors to achieve the best possible outcomes. The health promotion profession plays a vital role in pandemics, and this has been abundantly evident in the responses to COVID-19. Messaging about health and hygiene, particularly hand-washing, is one example of the role that health promotion has played—ultimately drawing on our expertise in delivering health education, and implementing health-related mass media and social marketing campaigns. Over the last two decades, information technology and social media have transformed the way we can reach people during pandemics. Indeed, social media has catapulted the ability to reach large populations, while also simultaneously targeting vulnerable and at-risk populations, to deliver health messages, such as those associated with hand-washing. Over the past few weeks, there has been a steady flow of memes urging people to wash their hands, often with thoughtful use of graphics alongside a successful use of humour. JS's personal favourite, was an online post from Round Rock Texas that read: 'Texas Coronavirus Protection—wash your hands like you just got done slicing jalapenos for a batch of nachos and you need to take your contacts out (that's like 20 seconds scrubbing, y'all)'. It delivers an essential public health message in a factual, yet contextually relevant and humorous way. However, social media can also have its pitfalls. Misinformation and fake news are rampant. This has the potential to stifle health promotion efforts in times of need, such as during the current COVID-19 pandemic. Therefore, it is important to know who is saying what, why, and with what level of authority. As mentioned above, we also need to be mindful of cross-sectoral communication efforts during pandemics. As an example, JS received 12 emails from his children's schools and 14 from his current workplaces about COVID-19—a total of 26 emails from educational institutions in both Australia and the United States. Email topics ranged from: hygiene issues such as hand washing and sanitiser use; social distancing, self-isolation and self-quarantining strategies such as cancellation of school activities and fundraisers; proposed adoption of online learning options, and flexibility about attendance at school/work, including possible closures; travel restrictions imposed by schools and universities associated with concerts, plays, public events/seminars and conferences; guidance to limit travel on public transport; and advice about when to seek help and access local health services if myself or my family members experience symptoms associated with COVID-19. This bombardment of communication, albeit extremely useful, emphasises the importance of coordination in key messaging between health, education and various other sectors, when planning and implementing effective pandemic responses. In health promotion, we need new strategies to communicate important health messages in a concise and meaningful way that makes it easy and accessible for citizens to understand, navigate and take action. We also need to be careful how we convey content through electronic communication channels and consider an appropriate level of frequency of such communication to achieve optimal impact. Without doing so, there is potential to reinforce community ambivalence at one end of the spectrum and create panic at the other. The recent toilet paper saga in Australia, whereby stocks of toilet paper were rapidly depleted from grocery stores in response to the perceived likelihood of home quarantining measures, is one such example (albeit somewhat humorous and embarrassing). Panic buying like this reinforces the powerful ramifications of communication gone wrong. Health literacy research that embraces new and emerging technologies will be particularly important to guide online health promotion efforts of this nature in the future. To emphasise the importance of getting health communication right, the Australian Medical Association were particularly critical of the mixed-messaging of public health directives between the Australian, State and Territory Governments concerning COVID-19.4 There was concern about how this mixed-messaging was being interpreted by the Australian public, but also how it was likely to impact health professionals and the use of Australia's hospitals and health care system more broadly. The Australian Government has since committed a $2.4 billion health package to protect all Australians from COVID-19, including vulnerable groups such as the elderly, those with chronic conditions and Indigenous communities.5 The US Government pledged $50 billion on the same day. Importantly, the Australian health package includes $30 million for implementing an information campaign to provide people with practical advice on how they can play their part in containing the virus and staying healthy.5 We trust health promotion professionals with expertise in health literacy, health communication, and social marketing will be consulted throughout its development. We also trust that health promoters will be involved in the multi-million dollar primary care and research responses outlined by the Australian Prime Minister. At this juncture, it is worth reflecting on who is most vulnerable in pandemics. While COVID-19 has the potential to impact everyone in society, these impacts will be felt differentially. That is, the way we prepare, protect, treat, reduce transmission and innovate, needs to be viewed from a health equity lens. It is essential to recognise that pandemics—and the respective Government and corporate decisions that emanate—both influence and are influenced by social, economic and political determinants of health. As the WHO Director-General has recently stated—'all countries must strike a fine balance between protecting health, preventing economic and social disruption, and respecting human rights'.3 However, knowing what this 'fine balance' constitutes can be difficult. As such, it helps to reflect on what we know. While we do not know much about COVID-19, we do now how pandemics can impact vulnerable populations. We know that many developing countries do not have the surveillance systems, health resources and health infrastructure to respond in a manner that can slow the harms of COVID-19 in the way we would like.6-8 We know that there are vulnerable populations, such as: the elderly, those with disabilities, people in prison, Aboriginal and Torres Strait Islander communities, people with chronic conditions, and people from Culturally and Linguistically Diverse (CALD) backgrounds, that will be impacted disproportinately by COVID-19, particularly if assertive health promotion action is absent.9-13 We know that people from low socio-economic backgrounds, those who work in casual employment, and many racial and ethnic minorities, are unlikely to have the necessary financial resources to make self-distancing and self-isolation a viable option within the context of their daily livelihoods.12-14 We know that access to health services in some countries, including basic primary health care, is contingent upon insurance and user-pays systems that already make them inaccessible to the people most at-risk.15, 16 We know that the elderly and people with disabilities rely on public transport to access essential services, including food shopping and health services that are required during pandemics.17, 18 We know that vulnerable populations may not have the necessary language and literacy skills to understand and appropriately respond to pandemic messaging.19 We know that mental health concerns among the most vulnerable within our communities will be exacerbated by expectations to self-isolate if not approached sensitively.20, 21 We know that governments have trouble implementing strategies focused on reducing health inequities through action on social determinants of health.22 We know all these things, but what do we do about them? Most of the evidence-based discussion presented above demonstrates the power of privilege in a pandemic. It indicates that those most vulnerable will be the hardest hit. The health promotion community must ensure that considerations of health equity and social justice principles remain at the forefront of pandemic responses.12, 14 This will not be easy at a time when neoliberal forces pitch population health against national economic stability. While hand-washing is a significant health promotion intervention, it can also act as a useful façade for advancing actions that enhance equitable social and economic outcomes for those most vulnerable during pandemics. The WHO has encouraged us to think innovatively.1, 3 The health promotion profession can lead this charge and advocate for a national public health social media campaign and other pragmatic measures that reach people most in need. This will help support them to get accurate and timely information to prepare and reduce the risk to themselves, their families, friends and their community.

Cancer Risk Factors Among Adults with Serious Mental Illness

Background One of the COVID-19 pandemic’s greatest silver linings has been the success of mRNA-based vaccines. While successful, the public has had many questions and even concerns about these vaccines as the pandemic is the first time they were clinically used. Both clinically and socially vulnerable populations have borne a hugely disproportionate burden of the pandemic. It is a public health imperative to ensure vaccine uptake in these groups are as high as possible. This project aimed to understand vulnerable populations perspectives on mRNA vaccines and immunizations to inform the development and dissemination of educational materials. Methods We conducted semi-structured qualitative descriptive interviews with clinically vulnerable (e.g., 50+, those living in LTC and congregate settings, having immunocompromising conditions/treatments) and socially vulnerable (e.g., racialized, newcomer and indigenous) populations across Canada. We thematically analyzed the data to identify patterns of meaning across the interviews. Results Fourteen people participated in interviews. Themes include: 1) clinically vulnerable populations view mRNA vaccines as safe and important for protecting themselves against COVID-19 and wish for the general public to get vaccinated to protect those who are most vulnerable; 2) socially vulnerable populations felt that there was a lack of accessible and concise information about who is high risk for COVID-19, timing of vaccination and how natural immunity to COVID-19 impacts the need for vaccination; and 3) vulnerable populations felt that the general public no longer views getting vaccinated as important since they do not view themselves as at-risk of hospitalization or severe adverse events. Conclusion These findings suggest that vulnerable populations view the vaccine as safe but perceive that getting vaccinated is not a priority for the general public. Our team is developing educational resources for vulnerable populations and the public to promote vaccine uptake. With more mRNA vaccines being developed for other infectious diseases, these findings can help inform vaccine promotion efforts and increase confidence in mRNA vaccines. Disclosures All Authors: No reported disclosures

General Medical Problems of Incarcerated Persons With Severe and Persistent Mental Illness: A Population-Based Study

How Do Data Bolster Pandemic Preparedness and Response? How Do We Improve Data and Systems to Be Better Prepared?

US advisory panel revisits prison research rules

A RARELY REPORTED PNEUMONIA PATHOGEN: ROTHIA MUCILAGINOSA

Mitigating lockdown challenges in response to COVID-19 in Sub-Saharan Africa

The research presented is within the context of urban health, and its objectives include: (1) To highlight the efforts made in Geneva in improving access to health care for vulnerable and disadvantaged populations, such as undocumented migrants and detainees; (2) To describe the sociodemographic and epidemiologic profile concerning the main morbidities of these populations; and (3) To outline future developments related to the research, generally concerning access to health care for these vulnerable populations in urban centers. Urban health includes two main aspects. One is the description of the health status of urban populations, and two, an understanding of urban health determinants with the aim to implement those interventions that promote good health. Since 2007 the majority of individuals live in cities, which has a major influence on all spheres of life, especially health. In Europe, the rural/urban transition occurred prior to 1950.1 Urban areas have higher proportions of migrants and other vulnerable populations and concentrate social inequalities. Access to health care for all residents is a fundamental human right. Its realization for vulnerable populations helps to increase social justice thereby serving not only the vulnerable but the entire community. Switzerland's cities have a substantial number of undocumented migrants, i.e., migrants without a legal residency permit. In the beginning of the 1990's they had no structured access to health care. In 1996 the creation of the “Unite Mobile de Soins Communautaires (UMSCO)”, a mobile health care unit attached to the Division of Primary Care of the Geneva University Hospitals (HUG), markedly improved access to health care for undocumented migrants in Geneva. Additionally, this unit improved our epidemiologic knowledge concerning this hard-to-reach and easy-to-miss population. Compared to the urban population with a residency permit, this undocumented population was found to have high rates of unintended pregnancy (odds ratio (OR) 8.0), delayed prenatal care (>12 weeks of amenorrhea) (OR 10.8), increased episodes of violence during pregnancy (OR 8.6), and elevated prevalence of chlamydia (5.8%) or chagas disease (Trypanosoma cruzi prevalence 12.8%). Undocumented Latin American migrants had a greater than fivefold risk (OR 5.5) of TB-related fibrotic signs on chest X-ray. From the perspective of infectious disease control it is particularly important for the urban community to have structures which are in contact with hard-to-reach populations.

PurposeProviding health care to the poor is evolving in the new US marketplace. The Affordable Care Act has set goals enhancing access to health care, lowering costs and improving patient outcomes. A key segment in this evolution is the most vulnerable health-care population of all: Medicaid. This paper aims to provide a general review of how providing health care to Medicaid patients is changing including how socio-economic aspects of this vulnerable population affects the quality of the health care provided.Design/methodology/approachThe paper is entirely secondary research; no primary research has been conducted.FindingsManaged care Medicaid provides a risk-based model to treating a vulnerable health-care market segment. The jury is still out on whether managed care Medicaid (MCM) is improving health-care quality and saving cost, but the provision of health care to the Medicaid segment is definitely shifting from a fee-for-service model to value based payment. Very recent developments of new health-care delivery approaches present a positive outlook for improving quality and containing costs going forward.Research limitations/implicationsAt this stage, whether or not MCM saves money or provides better health-care quality to this vulnerable population is a work in progress. Health-care marketing can impact socio-economic aspects of health care for the poor. There is a need to follow up on the positive results being documented in demonstration health-care delivery models.Practical implicationsAt this point, there has been no long-term study of whether managed care Medicaid offers better quality of health care and cost savings. The research to date suggest that the quality of health-care delivery to the poor is improving at a lower cost to payers.Social implicationsMedicaid patients are an underserved market segment. Managed care Medicaid offers a new model that has the potential to provide quality care at acceptable cost. Critical to this vulnerable market segment is the need to integrate socio-economic aspects of the population with the delivery of health care.Originality/valueThere has been very little discussion of Medicaid overall in the marketing literature, much less any discussion of managed care Medicaid.

Assessing access to obstetrical care via telehealth in the era of COVID-19

The emergence of coronavirus back in 2019 posed an epidemic threat to global public health security even after the execution of precautionary and control measures. The infectious disease was first identified in Wuhan, China and spread rapidly to multiple countries. Gradually, it caused casualties of people with a large number of coronavirus cases. Different countries implemented several interventions to mitigate the human-to-human transmission of this disease including travel restrictions, setting up isolation centers, lockdowns, and social quarantine. A systematic search was implemented through five electronic databases (PubMed, WHO, NIH, Scopus and Google Scholar). Research studies that were published until 30th May 2021 were included in this study, and eligibility criteria were selected for this review. The study shed light on the critical aspects of the implications of social quarantine preventive intervention to avoid the spread of COVID-19. The lessons learned from the pandemic can help the future preparedness and response plan to combat the progression of this disease. Yet limited studies have been conducted about the socio-economic impact of these social-distancing measures for most vulnerable populations. In this study, various research studies that have reported the positive and negative impact of physical distancing on the population were evaluated. In this situation, the Pakistani government must combat the coronavirus disease and take steps to improve the economic condition of the country. Special attention must be paid to the most disadvantaged and vulnerable populations such as the disabled, older population, homeless and poor populations to lessen the risks of coronavirus disease. Policymakers must ensure transparency in communication and provide evidence-based interventions to tackle the worse situation. The countries must coordinate their efforts to develop antivirals and vaccines for the treatment of infectious fatal diseases. Government must support the community through access to the use of technology, and home care to older residents, deliver health counseling services, and deliver home-based learning. All countries must use print, electronic and social media wisely and they must be coordinated, and provide education and social awareness among the citizenry regarding how to avoid being infected.

TIME SERIES ANALYSIS OF INFECTIOUS DISEASE MORTALITY IN UKRAINE (1965-2015)