Applying up: How ethnographers powered public health changes in the United States during the COVID‐19 pandemic

Early Pandemic Experiences and Lessons Learned Within A Multinational Corporation: A Testimonial of the COVID-19 Pandemic.

COVID-19 Highlights Critical Need for Public Health Data Modernization to Remain a Priority.

Strategies for Enhancing Governmental Public Health Workforce Well-being and Retention.

Reimagining Our Public Health Systems: The Robert Wood Johnson Foundation's National Commission to Transform Public Health Data Systems.

Background and Purpose of the Research The purpose of the research reported in this thesis was to explore the challenges of managing the 2009/A/H1N1 influenza pandemics in primary care in Australia, Israel and England. The influenza pandemic 2009/A/H1N1 was less devastating than originally anticipated; however, its burden on the health systems of many countries was substantial. It affected 214 countries and territories disproportionally afflicting young children and pregnant women. During this influenza pandemic, the main burden of the pandemic response fell on primary care services, and General Practitioners (GPs) were the ones who diagnosed and treated most of the patients. The prominent role of GPs in the 2009/A/H1N1 influenza pandemic presented an excellent opportunity to investigate the implications of pandemic policies for primary care and to tackle the potential problems that these policies may impose on the ability of GPs to participate effectively in the pandemic response. Method The research design consisted of three complementary studies: a systematic review of the literature, a document study, and qualitative semi-structured interviews with GPs. The systematic literature review (Study 1) was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and applied systematic approach to the literature search, study selection and data extraction. The objective of the systematic review was to examine evidence of challenges that primary care physicians encountered responding to past pandemics or large-scale epidemics. The document study (Study 2) involved analysis of the documents published by the health authorities in Australia, Israel and England during the 2009/A/H1N1 influenza pandemic. Information pertinent for the research question was separated from non-pertinent applying qualitative content analysis approach. Subsequent thematic analysis involved more focused reviewing of the retrieved data, which involved coding and category construction. The objective of the document study was to compare the approaches for management of the 2009/A/H1N1 influenza pandemic in primary care in these three countries. Qualitative semi-structured interviews with 65 GPs in Australia, Israel and England (Study 3) were conducted during June-September 2010. Thematic analysis of the qualitative data was applied. The objective was to explore the views of GPs on challenges they encountered managing the 2009/A/H1N1 influenza pandemic in these three countries. Findings The systematic review of the literature (Study 1) revealed that GPs from different countries experienced similar challenges during past epidemic or pandemic responses. These included: difficulties of communication with the health authorities; limited supply of Personal Protective Equipment (PPE) and difficulties with its use; challenges in performing public health responsibilities; limited support from the authorities; lack of appropriate training. However, the review did not allow a full-scale list of possible challenges of the pandemic response in primary care and yielded little systematic information concerning the nature of the identified challenges. The reasons for these were that only 10 studies met the inclusion criteria of the systematic review; the included studies had different objectives and designs; the studies provided little relevant information needed to consider the differences in patterns of the disease spread and GP involvement in the response in different countries. Study 2 and Study 3 of this thesis were designed to address the identified gap and to investigate the challenges of GP involvement in the 2009/A/H1N1 pandemic response in the selected examples of Australia, Israel and England. Study 2, document analysis, provided systematic evidence concerning the different approaches for involvement of GPs in the pandemic response in Australia, Israel and England. It showed that the involvement of GPs in the three countries differed in timing and allocated responsibilities. Study 3 of the thesis, qualitative interviews with GPs in Australia, Israel and England, elicited challenges in providing the pandemic response in primary care from the respective of GPs. The identified challenges were consistent with the findings of the systematic review of the literature. Systematic collection and analysis of the qualitative data from the three countries allowed identification of a full-scale list of challenges in three fields of the pandemic response: treatment of patients, performance of public health responsibilities and communication with the health authorities. Contribution of the Research to Knowledge This thesis adds to the existing knowledge concerning challenges of the pandemic response in primary care by differentiating between two types of challenges: (i) country specific challenges and (ii) cross country challenges intrinsic to the pandemic response in primary care in general. This was done by collating the data from the document study (Study 2) and qualitative interviews with GPs (Study 3). (i) Country specific challenges. These challenges were found to be influenced by the timing and severity of the disease spread, level of GP involvement in the response, support provided to GPs by the health authorities, and organization of primary care services in a country. (ii) Cross country challenges intrinsic to the pandemic response in primary care in general. These same difficulties were evident in each of the three countries and included difficulties in following pandemic guidelines (barriers affecting knowledge, attitudes and behaviour of GPs) and challenges related to the role delineation during the pandemic response that resulted in role ambiguity and role conflict. Conclusion and Recommendations for Future Pandemic Planning The experience of the 2009/A/H1N1 influenza pandemic management highlighted the centrality of primary care in the pandemic response. The findings of this thesis showed that GPs were intensively involved in the pandemic response in the three investigated countries, despite the differences in the responsibilities that were allocated to them. The connection of GPs to the populations they routinely serve and trust that these populations have in GPs, positioned them as the pivotal figures when people were concerned about their health or the possibility of getting sick. This situation is not likely to change in the future. In order to overcome challenges identified in this research, improvements in planning for involvement of GPs in the pandemic response should be introduced. Based on the thesis findings, the following recommendations were made: First, broader involvement of GPs in the process of planning should be targeted. This includes engagement of GPs and public health representatives in pre-pandemic drills, collaborative meetings and knowledge transfer; engagement of GP representatives and health authorities in pandemic policy evaluation; inclusion of GP representatives in decision making and planning committees. Second, improvement in clarity and strategy of the pandemic policies and guidelines communication to GPs should be introduced. This includes the establishment of one body that is responsible for communicating pandemic policy updates to GPs; making policy updates oriented to primary care by engaging GPs in pre-pandemic policy planning committees; engagement with GP professional bodies that develop and distribute guidelines for primary care; and establishment of mechanisms for GP feedback provision during the pandemic response. Third, planning the support to be provided to GPs during the pandemic response is imperative. This should include planning for rapid distribution of PPE and antiviral drugs in primary care; reimbursement for the pandemic vaccine administration; coordination during the mass vaccination campaign in primary care; and detailed guidelines to treat complicated pandemic cases.

Adherence to public health recommendations is critical for public safety and well-being. Effective and appropriate communication plays an important role in whether populations trust government and public health authorities, and the extent to which people follow public health recommendations. Poor trust in communication from public health authorities can pose significant challenges for mitigating public health emergencies and maintaining health security. This study aimed to explore the importance of trust in and understanding of communication from public health authorities in improving adherence to public health recommendations, and how that communication can be improved to develop and maintain public trust, particularly in the context of public health emergencies. To understand which factors are important for public trust in communication from public health authorities, we conducted in-depth interviews (n = 25) with a racially and demographically diverse group of individuals living in Baltimore. We found that communication source and communication transparency, such as timeliness, completeness, and clarity of information, were critical constructs of trust in communication from public health authorities. We also found that many participants misunderstood the flow of information from public health authorities to news media, and many were unaware that public health authorities provide the most reliable source of health information and recommendations during a public health emergency. To ensure adherence to public health recommendations, the public needs to trust that public health authorities are providing accurate, practical, and prudent recommendations. Drawing on these results, we provide several recommendations for developing and optimizing communication from various public health authorities.

Initial public health response and interim clinical guidance for the 2019 novel coronavirus outbreak - United States, December 31, 2019-February 4, 2020.

Pandemic Preparedness and Responses to the 2009 H1N1 Influenza: Crisis Management and Public Policy Insights

Background Articulation between Civil Protection and Public Health authorities is of paramount importance to control, reduce and prevent threats to the health of the population in situations of crisis or catastrophes. National Civil Protection Authority produces Emergency Plans which describe the role of every stakeholder in emergency situations. Role and importance of Public Health and Public Health Authorities is not always present or well described and known amongst stakeholders. Methods Data was collected from all Districtal Emergency Plans (n = 18). Each document was analysed considering time frame, refences to Public Health and Health Authorities, definition of roles, communication channels, coordination and inclusion of intersectoral communication flow. Quantitative analysis included absolute and relative frequencies and qualitative analysis to all parts related to the terms “Public Health” and “Health Authority”. Each document was reviewed by 2 independent researchers. Results From 18 Districtal Emergency Plans (DEP) analysed, 94,4% (n = 17) had references to Public Health, but none referred the role of Public Health Officers. Only 16,7% referred to Health Authorities, although 94,4% mentioned the law 135/2013, defining the role and attributes of Health Authority. In 72,2%, coordination of Public Health Measures was attributed to the National Medical Emergency Institute. Epidemiological surveillance and Public Health Emergencies were referred in 55,6%, and attributed to the Regional Administration of Health. Conclusions Public Health Authorities and Public Health Medical Officers role in articulation with National Civil Protection Authority in emergency situations lacks severely, with this role being replaced by other entities. This is of great concern regarding management and control of diseases, particularly communicable diseases. Key messages Public Health Authorities lack the necessary involvement in Emergency Plans and emergency situations. Public health measures are coordinated by other entities rather than Public Health Authorities.

Editorial: Coronavirus disease 2019 (COVID-19) - advances in epidemiology, diagnostics, treatments, host-directed therapies, pathogenesis, vaccines, and ongoing challenges.

Building a Strong Foundation for Public Health Transformation.

Advancing the Science of Delivery

Nurses' Ethical Obligations Toward Unvaccinated Individuals.

For decades, governmental public health in the united States has been relegated to operating at the margins of the country's massive healthcare system that drives nearly 20% of the uS economy.1 Further buffeted in recent years by a variety of external forces (including the 2008 economic recession, shifting demographics, a high and complex population burden of chronic disease, and a rapidly changing health care delivery system), public health leaders and policymakers increasingly recognize that the existing practice models are no longer adequate for the task of protecting and promoting the public's health.2 put simply, uS public health risks moving from being marginalized to becoming irrelevant if public health practice is not transformed.the challenges embedded in changing public health practice are multiple, and are made more complex by the decentralized structure of public health in the united States. public health here is a federated enterprise that includes national entities such as the Center for Disease Control and prevention, the Food and Drug Administration, and others; state and local governmental health departments; non-governmental organizations at the national, state, and community levels that are organized around single or multiple health-related issues; and public and private colleges and universities that provide education and training to the multiple disciplines making up the public health workforce. National study committees convened by the National Academy of Science's institute of Medicine over the past 30 years3-5 have consistently found the uS public health system to be in a state of disarray: misunderstood by elected policymakers and the general public; under-resourced in financial, technological, and workforce spheres; and highly variable in practice and services provided by over 2500 state and local governmental public health departments.For more than 20 years, the robert Wood Johnson Foundation (rWJF) has made significant investments in advancing public health in the united States. this includes multi-million dollar, flagship investments in public health accreditation and in public health systems and services research, with both efforts broadly directed toward improving the quality and impact of public health practice. it also includes more recent, and more narrowly concentrated, investments in engaging public health leaders in focused dialogues on critical operational issues as well as on more aspirational strategic thinking about how to catalyze and support transformational change in public health practice. three current examples of these strategic investments include:1. Building consensus around a set of core and foundational public health capabilities and services;2. developing an aspirational vision for uS public health in 2030; and3. identifying leadership and educational preparation needed to prepare the public health workforce of the future.Foundational Capabilitiesrecognition of the significant variability in the type, amount and financing of public health services led the institute of Medicine in 2012 to call for a '... minimum package of public health services, which includes the foundational capabilities and an array of basic programs no health department can be without...'.5 through funding a public Health Leadership Forum (pHLF), rWJF convened a diverse group of federal, state, and local public health leaders and stakeholders in April 2013 to review this recommendation and operationalize it. over the course of the next nine months, the group developed consensus around a foundational capabilities and services framework6 (see Figure 1) and operationalized them with enough specificity that a costing model is now being developed. the framework is being systematically vetted with the broader uS public health community by way of presentations at multiple conferences, webinars, and social media. once vetted, it is hoped that the foundational capabilities and services framework will be utilized by state, local, and federal policymakers and result in increased resources for public health while decreasing variability in practice and, ultimately, improve population health outcomes. …

COVID-19 vaccine prioritisation for people with disabilities