During a health crisis should you invest in gold or oil?

Despite abundant scientific evidence supporting immunization benefits, vaccine hesitancy remains a significant global health concern, particularly during public health crises. Exploring public attitudes towards vaccination is crucial. This study aimed to develop and validate a tailored Public Vaccination Attitudes Scale specifically under the unique circumstances of a public health crisis. A psychometric evaluation was conducted using a cross-sectional study during the peak of a major public health crisis. The scale was developed and its psychometric properties validated using three approaches: (1) generating the item pool through literature research and focus group discussions; (2) assessing the items through expert consultation; and (3) evaluating construct validity, content validity, and internal consistency reliability through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Data from a total of 3921 respondents were randomly divided into two subsets, one for EFA (n = 1935) and the other for CFA (n = 1986). A 22-item draft scale with five factors was created after literature research and focus group discussion. The content validity of this scale ranged between 0.88 and 1.00. EFA showed a 17-item scale with four factors (Cronbach’s α > 0.7) accounting for 68.044% of the total variance. CFA showed that the values of the fit indices, including convergent validity and discriminant validity, were excellent or acceptable. The overall Cronbach’s α was 0.874, and each factor ranged from 0.726 to 0.885. This study introduces a valuable tool for assessing vaccination attitudes during public health crises, aiding researchers, policymakers, and nurses in combating vaccine hesitancy. Emphasizing the importance of fostering vaccine acceptance, it enhances disease control during emergencies, contributing to the knowledge needed for more effective public health strategies and crisis responses

This opening article for the volume dedicated to the diversity of paediatric healthcare systems in Europe, discusses the topic of children facing natural, economic, and public health crises in Europe. The natural and economic adversities and public health crises, which have repeatedly stormed the globe during the past twenty years, have often unveiled a low degree of self-sufficiency and a high degree of unpreparedness by European countries. It is always the case that the most vulnerable take the brunt, and these adverse events have shown their effects and a negative direct impact particularly on the population aged 0–18 years, with important implications for families and communities. The article discusses a rational approach to properly confront future public health emergencies and crises in general. The authors stress the concept that such approaches should be built on past negative experiences, in order to explore, identify, and make clear which are the priorities governing the disaster management activities at all levels in this population group. The authors conclude that safeguarding the health of children could be effectively accomplished by developing adequate, shared emergency management strategies. Improving pediatric preparedness approaches with the use of emergency measures and ongoing collaboration will facilitate a better and more efficient response, able to effectively care for the needs of children in actual crises.

Return and volatility spillovers among global assets: Comparing health crisis with geopolitical crisis

Public health crises have their most devastating effects on people who are marginalized due to structural vulnerability mechanisms. As a reflection of this phenomenon, the Novel Coronavirus Disease (COVID-19) pandemic as a public health crises has increased the vulnerability of groups such as refugees, asylum-seekers and LGBTQ+ individuals facing discrimination, stigmatisation, displacement, economic instability, risk environments, precarious living and working conditions among others, and health inequities have been further deepened. A critical post-pandemic task is to develop comprehensive crisis response plans that prioritize inclusivity and address diverse needs. Integral to these plans are Risk Communication (RC), Community Engagement (CE), and Infodemic Management (IM) strategies. While international organizations have provided guidelines for RCCE-IM, there is an urgent need to translate these principles into tailored, context-specific strategies that account for the unique circumstances and requirements of diverse groups. The aim of this workshop is to reflect the lessons learned from the COVID-19 pandemic to strengthen the RCCE-IM strategies, using the cases of migrants and LGBTQ+ people, two groups who are intensively influenced by structural vulnerability mechanisms. The first 20 minutes of this workshop will feature four short presentations. First, the concepts of RCCE-IM will be defined, followed by an explanation of why related strategies should differ for vulnerable groups. The second presentation will focus on the issues that LGBTQ+ people faced during the COVID-19 pandemic, as well as their specific RCCE-IM needs. The third and fourth presentations are based on a collective project taking an expert perspective on the RCCE experience with migrants during the COVID-19 pandemic. Firstly, the extent to which the RCCE actions in Munich, Germany, has been able to include asylum-seekers and areas for improvement will be presented. This will be followed by a presentation on recommendations to enhance RCCE of the experts who were working with undocumented migrants, unaccompanied minors, and newly arrived refugees in Malmö, Sweden. In the final part of the workshop, participants will be invited to provide brief recommendations on the operationalization of international RCCE-IM principles across four key thematic areas: 1) Rapid adaptation of RC materials to culture and context, 2) Trust-building in crisis, 3) Navigating sociocultural and linguistic diversity, 4) Addressing LGBTQ+ migrants in RCCE activities. Key messages • Addressing vulnerable groups in (public) health and humanitarian crises using RCCE-IM strategies are needed to leave no one behind. • To conduct inclusive RCCE-IM activities, cities need to address structural vulnerabilities, identify different needs and context-based strategies, and integrate various sectors and perspectives.

EditorialsSeptember 2023Preparing the United States for the Next PandemicFREEAshish K. Jha, MD, MPHAshish K. Jha, MD, MPHBrown University School of Public Health, Providence, Rhode IslandAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M23-1894 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Although SARS-CoV-2 infections continue to occur, the United States has exited the emergency phase of the pandemic. COVID-19 is manageable without major disruptions to the health care system and society. Effective COVID-19 vaccines and treatments are accessible to nearly all Americans (1–3). The current moment of recovery is an important time to reflect on what went right and what went wrong in this historic pandemic to learn how to do better next time. In this issue, the American College of Physicians (ACP) presents thoughtful recommendations of how we might do so (4).When we first became aware of SARS-CoV-2 in early 2020, our nation was clearly not adequately prepared for what was to come. This lack of preparedness has been decades in the making: The challenges ranged from poor funding of public health and inadequate crisis coordinating mechanisms to inadequate attention paid to critical supply chains and an information ecosystem that would require a novel approach to communicating with the public (5, 6).The ACP recommendations begin to meaningfully address those gaps, including the need for investments in public health, data infrastructure, effective communication strategies, and personnel. The Biden administration has begun this investment with substantial funds flowing to public health agencies, including the Centers for Disease Control and Prevention and local public health departments, to begin to fortify personnel and modernize data. Translating these resources into effective action will be critical.The strengthening of supply chains is another area of substantial progress. When President Biden came into office, the key parts of the supply chain for vaccines, personal protective equipment, and other essential equipment were weak. Through both investments and sustained focus, those have been largely repaired. However, clear challenges remain in establishing a robust supply chain for all essential medical and health-related products that can withstand shocks like a global pandemic. The shortages of essential medicines that plague the United States and other nations of the world are evidence of these persisting challenges.Although it is essential to recognize how our nation was ill prepared, it is also essential to recognize that which went very right. The position paper does this—identifying vaccine development and telehealth as areas of success. I want to note 3 areas where we saw some success and need to redouble our efforts: building on real innovations of the pandemic, addressing the information crisis, and strengthening integration of health care and public health.Sustaining and Scaling Pandemic InnovationsAs the ACP notes, the pandemic brought groundbreaking innovations. While telehealth is widely touted, and rightly so, a closely related innovation that received less attention is the "test-to-treat" programs that improved access to care in a range of communities and addressed issues of equity (7). For example, in New York City, mobile vans traveled to communities to provide people who had COVID-19 symptoms with rapid testing and treatment on the spot (8). Delivery innovations need to be scaled up beyond the context of COVID-19 as a model of care delivery for acute diseases where a trip to the physician's office or emergency department is neither needed nor feasible.Another notable pandemic innovation was Operation Warp Speed. Partnership and collaboration between the federal government, private sector, and academia were the key ingredients of this program which delivered highly effective, safe vaccines in record time. We should model this program to develop other vaccines and treatments where progress is too slow. The Biden Administration recently launched Project Next Gen to accelerate development of the next generation of vaccines and treatments for COVID-19 with the hope of creating a sustainable model for the development of vaccines and treatments against future pandemics (9).The Role of Physicians in the Response to the Health Information CrisisUnfortunately, we practice medicine and public health in a polluted information environment. The pandemic has shown that an overabundance of bad information contributes to negative health outcomes (10). A top-down, central communications approach is ineffective in today's networked information ecosystem. The time for one trusted voice to speak to 330 million Americans is over. Physicians and other health care professionals are trusted sources of information for millions of Americans. They must know how to evaluate evidence and engage diverse people in well-informed conversations about health. It will be critical for organizations like ACP to take a leadership role in training physicians to more effectively share good information. This does not require physicians to go on television or social media; Those who prefer offline engagement can share good information at town halls, school board meetings, and elsewhere in the communities they serve.Strengthening the Integration of Public Health and Health CareEven the best-funded public health system cannot respond to a major health crisis on its own. The U.S. health care delivery system had to step up to meet needs during this pandemic that public health could not adequately address; however, moving forward, we need to invest in building the partnership between public health and health care. What might this look like? It starts with greater data integration—health care data and public health data rarely communicate with each other. Breaking down these silos will be critical, as will breaking down the cultural divides that separate the health care and public health communities. The ACP identifies health care workers as a reserve force for public health crises. Beginning to use that health care workforce to address the public health crises that exist today—such as the mental health crisis and the opioid crisis—can begin to build the partnerships that will be essential the next time a pandemic hits.As we come out of the emergency phase of the COVID-19 pandemic, it is essential that we use the lessons learned to be well prepared for the next pandemic or other public health crises. If we do not, we risk sliding back to where things were in 2019. The choice is both stark and consequential. The ACP position paper offers thoughtful steps we must take to build on innovations and address our gaps in healthcare delivery and equity. We have made real progress on pandemic preparedness over the past 2 years. Now is the time to not just continue that work but accelerate it—to ensure that when the next health crisis hits, we are ready.

Averting A ‘Group Grope’ Response To Public Health Catastrophes

Objective: to determine if the economic crises of 1994 and 2008 and the health crises of 2009 and 2020 affected the relationship between the main price and the production of agricultural products in the states that have the highest production in the regions of the agricultural sector of Mexico. Design/methodology/approach: sixty structural stability tests were carried out with dummy variables, to analyze the effect of these crises on the price-quantity relationship of the main producer States of the five regions of the agricultural, sector of the main products produced in Mexico that they are grain corn, grain sorghum and beans. Results: the economic crises of 1994 and 2008, as well as the health crises of 2009 and 2020, in general (with some exceptions), did not impact the relationship between price and production in the main producing States of the five regions of the sector agriculture of Mexico of the main products produced in Mexico. Limitations on study/implications: not all products and all states of Mexico are examined. Findings/conclusions: economic and health crises, in general, do not disappear from the relationship between the price and production of the States and producers analyzed, that the price-production relationship of these is resilient in the face of economic and health crises, that is, producers do not significantly alter their production, given the price variations caused by the economic and health crises.

How to Manage a Public Health Crisis and Bioterrorism in Korea

Background: Scant attention has been paid to how risk perceptions of public health crises may affect people’s mental health. Aims: The aims of this study are to (1) construct a conceptual framework for risk perception and depression of people in public health crises, (2) examine how the mental health of people in the crisis of Coronavirus Disease 2019 (COVID-19) is affected by risk perception and its associated factors, including distance perception of the crisis and support of prevention and control policies, and (3) propose policy recommendations on how to deal with psychological problems in the current COVID-19 crisis. Methods: Online questionnaire survey was implemented. A total of 6373 people visited the questionnaire online, 1115 people completed the questionnaire, and the number of valid questionnaires was 1081. Structural equation modeling was employed for data analysis. Results: Risk perception and its associated factors significantly affect the mental health of people in public health crises. Specifically, (1) distance perception of public health crises is negatively associated with depression among people, (2) affective risk perception is positively associated with depression of people in public health crises, (3) cognitive risk perception is negatively associated with depression of people in public health crises, and (4) support of prevention and control policies is negatively associated with depression of people in public health crises. Conclusion: The findings of this study suggest that risk perception plays an important role in affecting the mental health of people in a public health crisis. Therefore, health policies aiming to improve the psychological wellbeing of the people in a public health crisis should take risk perception into consideration.

Public health crises are the “touchstone” to test the ability of national public health crisis governance. The public health crisis in the new era presents new characteristics: systematic, cross-border and uncertainty. The governance dilemma of a public health crisis generally emphasizes the joint participation and communication of different subjects, which is suspected of overlapping and redundancy, and lacks the auxiliary support of major public health crisis events. It dispels the significance of government-level cooperation. The essence of the public health crisis governance system is the chain law of stimulus–response. In combination with COVID-19 development in China, we track down the main reasons for the temporary disruption and the government’s response to this major public health crisis. We mainly examine the tension between the centralization of power in China’s governance structure and the effectiveness of local governance, and the control of local governments in information disclosure. The response to a public health crisis and the optimization of a decision-making mechanism should build tension between the centralization of power and effectiveness of local governance. It is suggested that government should disclose and share information to the public timely and pay more attention to the core value of order in crisis management.

Recognized as a specialty by the American Board of Medical Specialties over 40 years ago, emergency medicine is unique since its inception-providing care to all patients in all times of unscheduled, time-sensitive need. Members of our specialty-whether working in an academic or private practice setting-provide this care without regard to a patient's sex, sexual orientation, gender, creed, physical ability, ability to pay, or race/ethnicity. The last human determinant of health bears emphasis in our current climate of a race-based inequity crisis.

Dismantling the structural ageism of ‘ageing in place’ to ensure ‘ageing in the right place’

AREA: A Mobile Application for Rapid Epidemiology Assessment

Rapid adjustment to free-market systems, which often takes place during economic crises, poses serious problems for public health outcomes. At a time of economic crisis, it is particularly important to understand the relationship between economic circumstances and public health outcomes. As more countries are forced to adopt free-market models of economic austerity, a number of threats to public health prospects emerge. Therefore we suggest that we are not only in an economic crisis, but also in a health crisis—a “healthconomic crisis.” Further exploration of these issues is needed if we are to recommend more sustainable global public health solutions during the coming years.

To develop a common structure for reports on health crises and critical health events guidelines have recently been published (Kulling et al 2010). They try to capture the experiences gained and for promoting a standardized methodology for sharing results and lessons. If future reporting follows common standards, then the documented findings would be comparable and could be used to learn and apply lessons within an individual field of activity and to apply those lessons learned also to other related preparedness activities. It could also facilitate the implementation of joint activities and joint reports involving different sectors. The development of this proposed method for common reporting on health crises and critical health events has been derived mainly from the following processes: (i) Health Disaster Management: Guidelines for Evaluation and Research in the Utstein Style; (ii) the Swedish Disaster Medicine Study Organization (KAMEDO); (iii) the Swedish Emergency Management Agency network of observers; (iv) the WHO Regional Office for Europe project (supported by the EU Health Programme) ‘Support Health Security, Preparedness Planning and Crisis Management in the EU, EU accession and neighboring (ENP) countries’ including expert consultations. The guidelines include the following headlines: Title, Preface, Authors, Executive Summary, Introduction/Material/Methodology, Pre-Event Status (Background, Preparedness, Hazard(s)involved, Risks, Vulnerability, Resilience), Health Crises and Critical Health Events (Damage, Consequences of Damage (Changes in Functions/Disturbances), Responses (Relief Responses, Recovery Responses), Development, Discussion, Lessons Identified and Actions Recommended, Conclusions, References, Appendices, Keywords, Index, Abbreviations. Pilot testing is suggested followed by an extensive review process. The guidelines should be supplemented further with determinants and indicators when the guidelines are used for in depth reporting to evaluate crisis response operations. Reference Kulling P, Birnbaum M, Murray V, Rockenschaub G. Guidelines for Reports on Health Crises and Critical Health Events.