Unlocking data elements potential for enhanced urban public health emergency governance: Configuration analysis based on 23 mega-cities in China.

BackgroundOwing to the complexity of and changes associated with modern public health emergencies, cross-departmental collaborative governance is an inevitable choice for ensuring effective emergency management. In the context of emergency management research, the way in which taking full advantage of synergy can be used to enhance the effectiveness of emergency prevention and control approaches is an important issue that must be addressed urgently.MethodsCombined with China's responses to the management of public health emergencies, in this study, we construct a theoretical analysis framework involving three dimensions: information, organization, and environment. Our proposed framework relies on the fuzzy-set qualitative comparative analysis (fsQCA) method to analyze the mechanisms behind the prevention and control of coronavirus disease 2019 (COVID-19) cases across 15 cities located in typical provinces throughout China and explore the roles of cross-departmental collaboration in the processing of various elements as well as the effects of their combination on the action mechanisms for ensuring the effectiveness of emergency management approaches.FindingsThe results show a significant conditional correlation between the effectiveness of emergency management and the factors affecting cross-departmental coordination. Based on the characteristics of multiple concurrent paths, the driving paths can be classified into four categories: organizational, environmental, environment-balanced, and organization environment-based dual-core categories.ConclusionsThe effectiveness of public health emergency management is the result of multiple factors. Local governments should strengthen the coordination and integration of information, organization, and environment, improve the coordinated system associated with emergency management, promote the “two-wheel drive” of high-quality development as well as accurate prevention and control, explore and perfect the adaptive combinatorial optimization path, and effectively transform the advantages of linking multi-dimensional factors with governance efficiency.

Public health emergencies (PHEs) pose significant challenges to global urban governance systems, necessitating the establishment of more efficient and dynamically adaptive response mechanisms. Numerous cases indicate that current urban governance still faces the risk of systemic failure under PHE shocks, leading to severe socio-economic consequences. Existing studies, based on theories such as resilience, emergency management, and risk management, primarily employ traditional statistical modeling or single-discipline approaches to explore improvement pathways. However, they fall short in cross-system and multi-agent coordination mechanisms, as well as data-driven intelligent optimization. Therefore, this project draws inspiration from the principles of the human immune system, introduces the concept of urban immunity to characterize the level of urban governance under PHEs, and follows the approach of “feature decoding → mechanism analysis → spatiotemporal measurement → trend prediction → model optimization → decision output.” It refines the theoretical framework of urban immunity, analyzes urban immune response mechanisms, develops an immunity indicator system, assesses the spatiotemporal patterns of urban immunity, and builds a decision-making model using intelligent optimization methods to generate optimized solutions for different scenarios. Ultimately, the project aims to establish a data-driven, evidence-based decision-making approach. This project seeks to provide a more systematic and operational theoretical framework for urban public health governance while promoting the digital and intelligent transformation of public health management, thereby enhancing PHE prevention and control capabilities.

Background: Currently, the family doctor team still faces many obstacles in managing public health emergencies as the gatekeeper. However, there is little research on the difficulties of family doctor teams in the prevention and management of public health emergencies. Objective: To explore the difficulties of family doctor teams in the prevention and management of public health emergencies, providing a theoretical basis and recommendations on ensuring the highly efficient performance of family doctor teams in preventing and managing the emergencies. Methods: Convenience sampling was used to select frontline healthcare workers from 25 primary healthcare institutions of Guangzhou to complete an online survey using a self-administered questionnaire conducted in June 2020 for investigating the implementation of essential public health services, essential medical services and prevention and management of public health emergencies in their hospitals between February and June 2020. Interviews were conducted with some of the healthcare workers who volunteered to be interviewed. Results: According to the questionnaire survey, during February to June 2020, of the 25 institutions, 19 had halted the delivery of some or all essential public health services, 6 had no capacities and channels to transfer suspected or confirmed COVID-19 cases to designated COVID-19 hospitals, 24 had implemented the emergency response plan for the COVID-19 pandemic, 10 had offered COVID-19-related health education, 9 had not set up the infectious diseases and public health emergencies reporting and managing system, 10 had not established the fever clinic, and 11 had operated all the clinics as usual. Value chain analysis of the interviews indicated that difficulties faced by the family doctor team in preventing and managing public health emergencies were: insufficient in-hospital support, unsuccessful communication and collaboration between hospitals or between the hospital and other institutions, poor monitoring and early warning effect of the COVID-19 pandemic, insufficient COVID-19-related health education, residents' unmet needs of essential medical services, inadequate emergency response infrastructure, lack of public health professionals, discrepancy between the construction of various information systems, inappropriate emergency procurement system. Conclusion: To make the community a solid fortress for the prevention and management of public health emergencies to ensure residents' health and safety, the authors suggest that efforts shall be made to address the barriers to the implementation of essential medical services first, then to solve issues existing in the implementation of auxiliary services. Copyright © 2021 by the Chinese General Practice.

The aim of this study was to review the role of public health emergency operations centers in recent public health emergencies and to identify the barriers and enablers influencing the effective use of a public health emergency operations center (PHEOC) in public health emergency management. A systematic search was conducted in 5 databases and selected grey literature websites. Forty-two articles, consisting of 28 peer-reviewed studies and 14 grey literature sources matched the inclusion criteria. Results suggest that PHEOCs are used to prepare and respond to a range of public health emergencies, including coronavirus disease (COVID-19). Factors found to influence the use of a PHEOC include the adoption of an incident management system, internal and external communications, data management, workforce capacity, and physical infrastructure. PHEOCs play an important role in public health emergency management. This review identified several barriers and enablers to using a PHEOC in public health emergency management. Future research should focus on addressing the barriers to using a PHEOC and looking at ways to evaluate the impact of using a PHEOC on public health emergency outcomes.

Background: Uncertainty is inherent in public health emergency management (PHEM) due to the unpredictable nature of emergencies and interplay of public health threats and their drivers. PHEM practitioners must continually develop and adapt methods to manage this uncertainty. General morphological analysis (GMA) is a computer-aided scenario modelling method that effectively addresses issues where uncertainty exists. GMA examines possible components of a complex problem and allows practitioners to consider potential connections and outcomes. Through iterative steps, GMA can generate new knowledge and insights in the development of scenarios to aid in decision-making and planning within PHEM. Method: An environmental scan was designed to identify articles that utilized GMA as one of the primary methodologies across different natural hazards within the context of PHEM. Academic databases included PubMed and Research Gate. A broad search strategy was applied to scan grey literature which included Google Scholar. Results: This environmental scan identified ten examples of GMA employed in PHEM across multiple countries and organizations. Examples in the literature targeted either a specific natural hazard or broadly targeted all known natural hazards. The findings can be divided into three interconnected categories: (a) scenario modelling for managing natural disasters, (b) strategy development and prioritization tools, and (c) decision-making support tools for emergency management teams. Conclusions: GMA is a decision-making and planning tool in PHEM that can be extended beyond scenario modelling to address uncertainties. This modelling method leverages subject matter experts to uncover innovative connections and outcomes when navigating complex problems like those observed within PHEM. Future research can involve applying GMA to PHEM in a Canadian context. Currently, the Public Health Agency of Canada is applying GMA to cyclical events (e.g., wildfires, floods, extreme heat events, and extreme weather events) to create scenarios using a PHEM lens. Future practice should involve integrating GMA with other PHEM methodologies to enhance strategies to prevent, prepare, respond and recover from future public health emergencies.

Public health emergency decisions are explored to ensure the emergency response measures in an environment where various emergencies occur frequently. An emergency decision is essentially a multi-criteria risk decision-making problem. The feasibility of applying prospect theory to emergency decisions is analyzed, and how psychological behaviors of decision-makers impact decision-making results are quantified. On this basis, the cognitive process of public health emergencies is investigated based on the rough set theory. A Decision Rule Extraction Algorithm (denoted as A-DRE) that considers attribute costs is proposed, which is then applied for attribute reduction and rule extraction on emergency datasets. In this way, decision-makers can obtain reduced decision table attributes quickly. Considering that emergency decisions require the participation of multiple departments, a framework is constructed to solve multi-department emergency decisions. The technical characteristics of the blockchain are in line with the requirements of decentralization and multi-party participation in emergency management. The core framework of the public health emergency management system-plan, legal system, mechanism, and system can play an important role. When delta { = }0.10, the classification accuracy under the K-Nearest Neighbor (KNN) classifier reaches 73.5%. When delta { = }0.15, the classification accuracy under the Support Vector Machines (SVM) classifier reaches 86.4%. It can effectively improve China’s public health emergency management system and improve the efficiency of emergency management. By taking Coronavirus Disease 2019 (COVID-19) as an example, the weight and prospect value functions of different decision-maker attributes are constructed based on prospect theory. The optimal rescue plan is finally determined. A-DRE can consider the cost of each attribute in the decision table and the ability to classify it correctly; moreover, it can reduce the attributes and extract the rules on the COVID-19 dataset, suitable for decision-makers' situation face once an emergency occurs. The emergency decision approach based on rough set attribute reduction and prospect theory can acquire practical decision-making rules while considering the different risk preferences of decision-makers facing different decision-making results, which is significant for the rapid development of public health emergency assistance and disaster relief.

The construction of medical infrastructure is a significant part of urban modernization. The accessibility of medical resources reflects the ability to respond and decentralize control in emergency management of public health emergencies. An improved gravity model is used to evaluate the accessibility of urban medical services based on the hospital and population distribution in a typical metropolis, and conducts a spatial analysis of control areas of urban public health emergency management, so as to identify risk points and propose improvements.

Harnessing urbanisation for human wellbeing and planetary health

With the time frame 1912–1949, and according to the recording in the government gazettes and Chinese press, this essay systematically discusses the powerful and effective measures and achievements in cholera prevention, epidemic prevention, and infectious disease control of the Macao-Portuguese government. Meanwhile, it analyzes and investigates the cooperation and interaction in cholera prevention between the Macao and Hong Kong governments and emphasizes the critical significance of regional developments of Macao’s cholera prevention and control, that is, with the internal control to lower incidence and external control to minimize importation and diffusion, the aim to control cholera was achieved thus allayed the public panic among Macao and perimeter zone, creating advantages to stabilize economic development, social order and peaceful living environment in Macao as well as other Cantonese regions. As one of the seaport cities that adopted the European medical system and model and implemented free cholera vaccination for all, the fighting process and measures of Macao-Portuguese government adopted to control the cholera epidemic show that cholera, a dreadful infectious disease, can be effectively managed as long as scientific and appropriate methods are taken. Sorting out the types and characteristics of infectious diseases in Macao during this period and the mechanism of combining medical and preventive treatment at that time, and analyzing the effectiveness of the administration of disease prevention and control by the Macao-Portuguese government and the limitations of governance under the conflict between Chinese and Portuguese will have important academic significance for understanding the efficiency and deficiency of Macao-Portuguese governance towards disease control, the construction, development and change of the urban public health emergency management system and the urban governance. The more important significance will bring to the urban public health emergency management system and the urban governance in modern China.

Chapter 4 - Applying evidence-based strategies for public health preparedness and emergency management

Public health emergency management has been one of the main challenges of social sustainable development since the beginning of the 21st century. Research on public health emergency management is becoming a common focus of scholars. In recent years, the literature associated with public health emergency management has grown rapidly, but few studies have used a bibliometric analysis and visualization approach to conduct deep mining and explore the characteristics of the public health emergency management research field. To better understand the present status and development of public health emergency management research, and to explore the knowledge base and research hotspots, the bibliometric method and science mapping technology were adopted to visually evaluate the knowledge structure and research trends in the field of public health emergency management studies. From 2000 to 2020, a total of 3723 papers related to public health emergency management research were collected from the Web of Science Core Collection as research data. The five main research directions formed are child prevention, mortality from public health events, public health emergency preparedness, public health emergency management, and coronavirus disease 2019 (COVID-19). The current research hotspots and frontiers are climate change, COVID-19 and related coronaviruses. Further research is needed to focus on the COVID-19 and related coronaviruses. This study intends to contribute inclusive support to related academia and industry in the aspects of public health emergency management and public safety research, as well as research hotspots and future research directions.

Introduction:As public health emergency management (PHEM) is a growing field, so is the development of its workforce. Ensuring workforce readiness from graduate-level education and courses can be challenging given the limitations of the traditional classroom environment. This presentation highlights a novel curriculum created and taught by first responders consisting of simulation and application of practical skills developed within a public health graduate certificate program.Method:The semester-long course reviews foundations of PHEM and students progress through a sequence of increasingly complex discussions and operation-based exercises for both domestic and international disaster preparedness and response. Students progress through case studies, tabletops, functional exercises, and full-scale exercises with practical skills interspersed. This includes creation of SMART objectives and incident action planning, crisis communication and public messaging drills, use of radios, personal protective donning and doffing, and Geiger counter use.During the COVID-19 pandemic, the curriculum was adapted for asynchronous and live virtual sessions with further offerings including various online trainings that are required for most employments in the field and guest speakers with national recognition for their experiences in public health and healthcare emergency management and subject matter expertise in various fields related to preparedness and response.Results:Since commencing in 2016, approximately 100 students have completed the course and feedback has been overwhelmingly positive even with limitations of in-person activities during the COVID-19 Pandemic. Student feedback has noted that the majority of students feel that the knowledge and skills from the coursework is applicable to future employment and that their ability to think critically about the subject matter increased as a result of taking the course.Conclusion:Implementation of this innovative graduate level course can serve as a model to enrich students’ education through practical activities and hands-on simulations.

Some jurisdictions have reduced workforce and reallocated responsibilities for public health preparedness and emergency management to more efficiently use resources and improve planning and response. Key informant interviews were conducted in six counties in North Carolina (USA) to discuss perceptions of the challenges and opportunities provided by the new shared positions. Respondents feel that planning and response have improved, but that requirements related to activities or equipment that are eligible for funding (particularly on the public health side) can present an impediment to consolidating public health preparedness and emergency management roles. As the financial resources available for public health preparedness and emergency management continue to be reduced, the merging of the roles and responsibilities of public health preparedness and emergency management may present jurisdictions with an effective alternative to reducing staff, and potentially, readiness.

Uganda is highly vulnerable to public health emergencies (PHEs) due to its geographic location next to the Congo Basin epidemic hot spot, placement within multiple epidemic belts, high population growth rates, and refugee influx. In view of this, Uganda’s Ministry of Health established the Public Health Emergency Operations Center (PHEOC) in September 2013, as a central coordination unit for all PHEs in the country. Uganda followed the World Health Organization’s framework to establish the PHEOC, including establishing a steering committee, acquiring legal authority, developing emergency response plans, and developing a concept of operations. The same framework governs the PHEOC’s daily activities. Between January 2014 and December 2021, Uganda’s PHEOC coordinated response to 271 PHEs, hosted 207 emergency coordination meetings, trained all core staff in public health emergency management principles, participated in 21 simulation exercises, coordinated Uganda’s Global Health Security Agenda activities, established 6 subnational PHEOCs, and strengthened the capacity of 7 countries in public health emergency management. In this article, we discuss the following lessons learned: PHEOCs are key in PHE coordination and thus mitigate the associated adverse impacts; although the functions of a PHEOC may be legalized by the existence of a National Institute of Public Health, their establishment may precede formally securing the legal framework; staff may learn public health emergency management principles on the job; involvement of leaders and health partners is crucial to the success of a public health emergency management program; subnational PHEOCs are resourceful in mounting regional responses to PHEs; and service on the PHE Strategic Committee may be voluntary.

The city is a crucial space carrier for the country to carry out low-carbon construction and solve sustainable–development problems. However, existing research lacks an in-depth discussion of the complex mechanisms and governance paths of urban low-carbon transformation. Therefore, this study explores multiple paths of urban low-carbon governance (ULCG). This study constructs a theoretical model of ULCG based on the technology–organisation–environment (TOE) framework. It uses fuzzy-set qualitative comparative analysis (fsQCA) to analyse the overall and sub-regional paths of 35 key cities in China to explore various ULCG approaches. The following three conclusions are drawn. First, a single antecedent condition is not a necessary condition for ULCG. Second, five differentiated paths have been formed under the joint action of the TOE conditions to improve ULCG. It can be divided into three types: the ULCG model dominated by ‘big data + market’, ‘big data’, and ‘market’. Third, apparent differences exist in the ULCG paths in China’s eastern, central and western regions. The study deepens the rational understanding of multiple factors interacting in the complex mechanism behind urban low-carbon transformation and provides differentiated ULCG paths, enabling cities in eastern, central, and western China to choose low-carbon governance paths tailored to their local conditions based on both a comprehensive perspective and a regional perspective.