Broader Public Health Community Research Articles

Benchmarking for accountability on obesity prevention: evaluation of the Healthy Food Environment Policy Index (Food-EPI) in Australia (2016-2020).

Despite broad agreement on the need for comprehensive policy action to improve the healthiness of food environments, implementation of recommended policies has been slow and fragmented. Benchmarking is increasingly being used to strengthen accountability for action. However, there have been few evaluations of benchmarking and accountability initiatives to understand their contribution to policy change. This study aimed to evaluate the impact of the Healthy Food Environment Policy Index (Food-EPI) Australia initiative (2016-2020) that assessed Australian governments on their progress in implementing recommended policies for improving food environments. A convergent mixed methods approach was employed incorporating data from online surveys (conducted in 2017 and 2020) and in-depth semi-structured interviews (conducted in 2020). Data were analysed against a pre-defined logic model. Australia. Interviews: twenty stakeholders (sixteen government, four non-government). Online surveys: fifty-three non-government stakeholders (52 % response rate) in 2017; thirty-four non-government stakeholders (36 % response rate) in 2020. The Food-EPI process involved extensive engagement with government officials and the broader public health community across Australia. Food-EPI Australia was found to support policy processes, including as a tool to increase knowledge of good practice, as a process for collaboration and as an authoritative reference to support policy decisions and advocacy strategies. Key stakeholders involved in the Food-EPI Australia process viewed it as a valuable initiative that should be repeated to maximise its value as an accountability mechanism. The highly collaborative nature of the initiative was seen as a key strength that could inform design of other benchmarking processes.

The Use of Twitter as an Interactive Learning Tool Within a Postgraduate Public Health Course: A Pilot Study

Twitter has gained attention in recent years as a tool to use in higher education to enhance students’ learning, engagement, and reflective writing. This study explored public health students’ perceptions on the usefulness of Twitter as a learning tool, engagement with their peers, staff, and the broader public health community. Participants were Master of Public Health students from a public university based in Sydney, Australia. A mixed methods approach was used combining content analysis of tweets, an online survey and two focus groups. Students were asked to engage with Twitter by reflecting on each week’s teaching content and by liking and replying to their peers’ tweets. Participation and engagement in this task were high initially and declined toward the end of semester. Most student tweets aligned with topics taught during the semester. Survey and focus group data indicated most students had positive views on using Twitter and reported finding engagement with Twitter beneficial in obtaining current information on health promotion news and trends, increasing their professional networks and allowing them to connect with their peers and teaching staff. Results indicate Twitter is a promising interactive approach to enhance public health students’ engagement and overall learning experience, as well as being useful for professional networking. Larger scale empirical studies are needed to investigate the impact of the use of social media platforms such as Twitter to various learning outcomes longitudinally and beyond this course.

A US metropolitan county health department's response to a measles outbreak in a childcare facility - challenges faced and lessons learned.

In June 2018, the Multnomah County Health Department located in Portland, Oregon, US, responded to a measles exposure in a local childcare facility. This analysis describes lessons learned and challenges encountered during this measles response that may inform public health policy and help other local public health authorities prepare for measles outbreaks. These lessons will become increasingly important as measles cases continue to increase in both the US and abroad. A semi-structured videoconference interview was conducted with nine health department staff who were directly involved in the health department's response to the measles outbreak. Interview notes were iteratively discussed between all authors to identify those outbreak response challenges and lessons learned that were generalizable to the broader public health community. Some of the key challenges and lessons learned included the need for increased provider recognition and reporting of measles cases, difficulty in determining which staff and children to exclude from attending daycare during the 21-day postexposure monitoring period, determining who would be prioritized to receive immunoglobulin, and the need for childcare staff vaccine status requirements. Lessons from this response highlight important considerations for public health practitioners and policy makers. Given the relative severity of measles and the potential for spread in facilities that serve infants and young children, the public health community must continue to address key gaps through planning and policy.

Challenges and Opportunities for the Prevention and Treatment of Cardiovascular Disease Among Young Adults: Report From a National Heart, Lung, and Blood Institute Working Group.

Improvements in cardiovascular disease (CVD) rates among young adults in the past 2 decades have been offset by increasing racial/ethnic and gender disparities, persistence of unhealthy lifestyle habits, overweight and obesity, and other CVD risk factors. To enhance the promotion of cardiovascular health among young adults 18 to 39 years old, the medical and broader public health community must understand the biological, interpersonal, and behavioral features of this life stage. Therefore, the National Heart, Lung, and Blood Institute, with support from the Office of Behavioral and Social Science Research, convened a 2‐day workshop in Bethesda, Maryland, in September 2017 to identify research challenges and opportunities related to the cardiovascular health of young adults. The current generation of young adults live in an environment undergoing substantial economic, social, and technological transformations, differentiating them from prior research cohorts of young adults. Although the accumulation of clinical and behavioral risk factors for CVD begins early in life, and research suggests early risk is an important determinant of future events, few trials have studied prevention and treatment of CVD in participants <40 years old. Building an evidence base for CVD prevention in this population will require the engagement of young adults, who are often disconnected from the healthcare system and may not prioritize long‐term health. These changes demand a repositioning of existing evidence‐based treatments to accommodate new sociotechnical contexts. In this article, the authors review the recent literature and current research opportunities to advance the cardiovascular health of today's young adults.

Conducting operational research during outbreaks to improve preparedness and response

ObjectiveThe Outbreak Observatory (OO) aims to:●Strengthen outbreak/epidemic preparedness and response activities through real-time, one-the-ground observations and analyses●Identify best practices based on operational experience that are broadly applicable across outbreak response agencies●Serve as an independent voice to advocate for policies that support preparedness and response activities based on expert assessment of the resources required to build and maintain necessary outbreak response capabilities●Support local practitioners’ efforts to publish their experiencesSharing the firsthand experience of responders is critical for building outbreak preparedness and response capacity, and OO will serve as a dedicated mechanism to collect, analyze and disseminate this informationIntroductionEach significant outbreak and epidemic raises questions that must be answered in order to better inform future preparedness and response efforts, such as:●What are the systems and resources needed to characterize an outbreak?●What systems and resources are needed to bring an outbreak to a close?While we can anticipate these types of questions, the absence of dedicated mechanisms to record operational experiences and challenges can result in valuable, ephemeral data that are crucial for improving outbreak response not being consistently collected or analyzed.Participation in outbreaks by external experts can be instrumental in ensuring that this important operational information is documented, analyzed and shared with the broader public health community. There is a particular need for observers external to the response who can capture and analyze applied data about the operational response to outbreaks—eg, the systems and strategies involved in responding to the such events—in order to improve our understanding of best practices for detecting and responding to these events. These can then be shared so that the entire public health community can access and incorporate lessons learned into their own preparedness and response plans. External observers can also help describe the important work performed by local responders during outbreaks and advocate for necessary preparedness and response program resources.The Outbreak Observatory is currently in a pilot phase and is looking for international and US partners who may be interested in collaborating with members of our team during their next outbreak response. MethodsWhen an outbreak occurs, OO will reach out to our partners to assess their interest in having project team member(s) travel to their location to observe the ongoing outbreak for the purpose of collaborating on a joint analysis of the response. The team member(s) would engage with local officials to identify operational challenges and best practices to better understand their perspectives and experiences.Prior to the OO team’s arrival, they will provide local responders a list of sample questions that the team is interested in exploring for the purpose of potential future written analysis, with the goal of focusing on those questions that are most relevant to both the local and broader public health communities. Once a preliminary list of study questions is developed, team members will engage with local responders to discuss their experiences.Once on location, the OO team member(s) will regularly report their findings back to the Project Director. The OO team will work with the Project Director and local partners to compose and submit the findings to a peer-reviewed journal, ensuring that local practitioners receive appropriate authorship credit.ResultsOO aims to fill gaps in existing health security literature by sharing the experiences of practitioners involved in outbreak responses and co-authoring peer-reviewed publications with those responders. We envision that these publications will be available more quickly than existing outbreak reports. We will disseminate our findings to pertinent policymakers, members of the broader biosecurity and public health communities and the public to ensure that important lessons reach all appropriate audiences, especially those responsible for planning and resource allocation decisions for outbreak and epidemic response. In support of this, we have created a communication platform (www.outbreakobservatory.org) to publish interim observations via rapid communication channels (eg, communications with policymakers, social media, blog posts, video logs). All publications will be developed in partnership with local practitioners.ConclusionsThe lessons learned from previous epidemic and outbreak responses are critical to informing future response efforts. However, this data is often lost in the midst of an outbreak, when responders are too busy with the situation at hand to collect and analyze operational data. Outbreak Observatory endeavors to bridge this research gap, helping to capture and analyze this data and making it available to the broader public health community.

The Specialist Public Health and Preventive Medicine Physician: System Roles and Training Challenges

n their commentary, Lawrence Loh and Bart Harvey have described the evolution of the medical specialty in Canada currently named public health and preventive medicine. However, the role of this specialty within the larger public health system is still not clear in Canada. There remains lack of consensus about the role and necessary qualifications of the public health physician within the public health system. This lack of consensus is both within government and in the broader public health community. There is not even consensus among physicians currently in public health practice, who understandably regard their own path into the discipline as well as their particular level of training as adequate. The future of the specialty and its ongoing role within public health in Canada will depend on developing a common response to the following inter-related issues: The requirement for specialty certification to exercise regulatory authority under public health legislation Specialty certification, i.e., FRCPC, is not the minimum qualification for being a medical officer of health (MOH) or provincial chief MOH in most provinces in Canada. Most jurisdictions require a medical licence and a 1-year Masters of Public Health (MPH) or equivalent. The fact that this policy is changing slowly, if at all, is due to a number of factors, including difficulty in recruiting specialists – particularly in rural areas – and a belief among many politicians and even many practitioners that most public health decisions are mostly common sense and that the necessary expertise can be acquired on the job with a minimum of formal training. The argument that the job now requires a stronger scientific and technical base has not yet won the day. Many larger urban units with greater ease of recruiting do require specialty certification for their positions.

Connecting Care Through the Clinic and Community for a Healthier America

Yet, to date, our society has not yet optimally aligned the individual and community forces that can best foster health for all. For too long, fragmentation has ruled the day. In particular, the nation’s healthcare systems have focused predominantly on sick care, plagued by episodic and uncoordinated delivery, multiple paper-based clinical records, rising costs without related quality improvement, and reimbursement systems that reward volume and not value. Moreover, a suboptimal focus on prevention, without engagement of and integration with the broader public health community, has added to the fragmentation. As a result, patients and populations alike have not consistently reached their full health potential. Fortunately, a new day has dawned. The Affordable CareAct (ACA), the health reform lawof 2010, offers the romise of greater insurance coverage formillions. It also nits together the themes of care coordination and health romotion for both the clinic and the community.Many provisions offer opportunities for healthcare providers to partner with public health agencies and community organizations for the benefit of their patients. Hence, the various components of the ACA provide an unprecedented opportunity to overcome fragmentation and integrate primary care and public health. Doing so recognizes that health arises not simply from a visit to a doctor’s office, but also, more broadly, from where people live, labor, learn, play, and pray. Indeed, the overarching oals of Healthy People 2020 emphasize a life span aproach to health promotion and a society in which the ealthy choice represents the easier choice.

Ending the drought: New strategies for improving the flow of affordable, effective antivenoms in Asia and Africa

The development of snake antivenoms more than a century ago should have heralded effective treatment of the scourge of snakebite envenoming in impoverished, mostly rural populations around the world. That snakebite still exists today, as a widely untreated illness that maims, kills and terrifies men, women and children in vulnerable communities, is a cruel anachronism. Antivenom can be an effective, safe and affordable treatment for snakebites, but apathy, inaction and the politicisation of public health have marginalised both the problem (making snakebite arguably the most neglected of all neglected tropical diseases) and its solution. For lack of any coordinated approach, provision of antivenoms has been pushed off the public health agenda, leading to an incongruous decline in demand for these crucial antidotes, excused and fed by new priorities, an absence of epidemiological data, and a poor regulatory framework. These factors facilitated the infiltration of poor quality products that degrade user confidence and undermine legitimate producers. The result is that tens of thousands are denied an essential life-saving medicine, allowing a toll of human suffering that is a summation of many individual catastrophes. No strategy has been developed to address this problem and to overcome the intransigence and inaction responsible for the global tragedy of snakebite. Attempts to engage with the broader public health community through the World Health Organisation (WHO), GAVI, and other agencies have failed. Consequently, the toxinology community has taken on a leadership role in a new approach, the Global Snakebite Initiative, which seeks to mobilise the resources, skills and experience of scientists and clinicians for whom venoms, toxins, antivenoms, snakes and snakebites are already fields of interest. Proteomics is one such discipline, which has embraced the potential of using venoms in bio-discovery and systems biology. The fields of venomics and antivenomics have recently evolved from this discipline, offering fresh hope for the victims of snakebites by providing an exciting insight into the complexities, nature, fundamental properties and significance of venom constituents. Such a rational approach brings with it the potential to design new immunising mixtures from which to raise potent antivenoms with wider therapeutic ranges. This addresses a major practical limitation in antivenom use recognised since the beginning of the 20th century: the restriction of therapeutic effectiveness to the specific venom immunogen used in production. Antivenomic techniques enable the interactions between venoms and antivenoms to be examined in detail, and if combined with functional assays of specific activity and followed up by clinical trials of effectiveness and safety, can be powerful tools with which to evaluate the suitability of current and new antivenoms for meeting urgent regional needs. We propose two mechanisms through which the Global Snakebite Initiative might seek to end the antivenom drought in Africa and Asia: first by establishing a multidisciplinary, multicentre, international collaboration to evaluate currently available antivenoms against the venoms of medically important snakes from specific nations in Africa and Asia using a combination of proteomic, antivenomic and WHO-endorsed preclinical assessment protocols, to provide a validated evidence base for either recommending or rejecting individual products; and secondly by bringing the power of proteomics to bear on the design of new immunising mixtures to raise Pan-African and Pan-Asian polyvalent antivenoms of improved potency and quality. These products will be subject to rigorous clinical assessment. We propose radically to change the basis upon which antivenoms are produced and supplied for the developing world. Donor funding and strategic public health alliances will be sought to make it possible not only to sustain the financial viability of antivenom production partnerships, but also to ensure that patients are relieved of the costs of antivenom so that poverty is no longer a barrier to the treatment of this important, but grossly neglected public health emergency.

EUPHA section on injury prevention and safety promotion

The European Public Health Association or EUPHA in short, is an umbrella organisation for public health associations in Europe. EUPHA is an international, multidisciplinary, scientific organisation, bringing together around 12...