Contemporary Public Health Research Articles

“First, Do No Harm”?

Screening for asymptomatic disease is a routine aspect of contemporary public health practice. However, it is also controversial, because it leads to overdiagnosis and overtreatment, with many arguing that programmes are “ineffective,” i.e., the “costs” outweigh the “benefits.” This paper explores a more fundamental objection to screening programmes: that, even if they are effective, they are ethically impermissible because they breach the principle of non-maleficence. In so doing, it suggests a new approach to the ethics of risk, justifying a concern with how policies affect individuals’ absolute ex-ante prospects. Part 1 sets up the tension between screening and non-maleficence. Part 2 introduces and motivates a novel interpretation of the non-maleficence principle, “ex-ante Do No Harm,” which resolves this tension. Part 3 defends and clarifies this principle by discussing its relationship to the ex-ante Pareto principle. Part 4 discusses the worry that risk estimates are too “subjective.”

A resiliência das grandes cidades brasileiras e a pandemia da Covid-19

ABSTRACT This paper aimed to describe the resilience of the Federal Government’s fund of Public Health Actions and Services (ASPS) in Brazil during the 2020 COVID-19 pandemic. It shows that the development of the contemporary public health sector was based on cooperative federalism. In this context, municipal participation in financing was consolidated around the constitutional agreement of budget binding between the levels of the Brazilian federation (Central Government, states, and municipalities). The Budget Binding Index (BBI) and the resilience of the sample of 87 municipalities with a high budget are described from the Public Health Budget Information System (SIOPS) indicators, available at DataSUS/Ministry of Health. The paper shows that the central government withdrew its support for increased ASPS expenditure in the last decade, stabilizing the allocation of its resources through the veto on budget binding. The change in federal orientation shifted the burden of expanding financing to municipal and state governments. The paper concludes that the increase in municipal expenditures offset the stabilization of federal expenditures. Budget binding was crucial to the resilience of ASPS funding in most municipalities in the sample during the first cycle of the COVID-19 pandemic.

Perceived determinants of implementation success of the neglected tropical diseases programme in Ghana: a qualitative study among programme officers

BackgroundThe importance of health policy implementation cannot be overemphasized in contemporary public health. Neglected Tropical Diseases (NTDs) have negatively impacted society, affect quality of life and make the poor societies poorer. Several policies and strategies have been put in place across the world including the neglected tropical diseases programme in Ghana. Though chalked many successes, the programme continues to lag behind in the full attainment of various objectives. Several factors exist that determine how effective a programme is implemented. Identification of these factors on every programme is essential to determine where more programme resources need to be channelled. This study assessed the determinants of successful implementation of the neglected tropical diseases programme in Ghana.MethodsA qualitative approach with the case study design was employed. Purposive and snowball sampling techniques were used to identify key programme officers at the national, regional and district levels of programme implementation. Eighteen (18) Key informant interviews were conducted at all the three levels of the Ghana Health Service NTDs programme. Data were thematically analysed and presented.ResultsFindings from the study revealed that determinants that influenced the successful implementation of the NTDs programme include donor support, education and training, partnerships, reliability of the health structure, integrative nature of the programme and management commitment. These determining factors cut across the inner settings of the implementing agency and the external environment.ConclusionNeglected tropical diseases continuously affect Ghanaians, especially the poor. It is important for both policy makers and implementers to identify the factors that ensure the success of the programme in the Ghanaian context. Though the factors are independently sufficient, they synergistically lead to improved programme implementation. Empowering all units involved (local to national level) and maximizing the enabling factors identified to would improve upon implementation and ensure sustainability.

МАГИСТРЫ ПУБЛИЧНОГО УПРАВЛЕНИЯ И АДМИНИСТРИРОВАНИЯ НМАПО ИМЕНИ П. Л. ШУПИКА - НОВАЯ МОДЕЛЬ СПЕЦИАЛИСТОВ НАЦИОНАЛЬНОЙ СФЕРЫ ЗДРАВООХРАНЕНИЯ

Цель исследования: определение составляющих модели руководителя национальной сферы здравоохранения начала XXI века - слушателя магистерской программы «Публичное управление и администрирование» Национальной медицинской академии последипломного образования имени П. Л. Шупика. Материалы и методы. Проанализированы научные источники по теме (11 ед.) с использованием методов системного подхода и системного анализа. Результаты. Реформирование здравоохранения Украины требует решения очень важной и неотложной задачи - подготовки магистров публичного управления и администрирования в сфере здравоохранения. Этот процесс в НМАПО имени П. Л. Шупика будет осуществляться в условиях созданной в 2020 году магистратуры. Выводы. Основными компонентами профессиональной модели современного руководителя здравоохранения являются: наличие системы профессиональных знаний, умений и навыков; обучение в течение всей жизни; приобретение общечеловеческих качеств через изучение гуманитарных дисциплин; психологическая готовность к выполнению управленческой деятельности. Отдельно выделим такие составляющие профессиональной модели современного руководителя как профессионализм, культура и управленческая ответственность. Главными преимуществами обучения в магистратуре НМАПО имени П. Л. Шупика по специальности «Публичное управление и администрирование в сфере здравоохранения» станут такие: индивидуальный подход к учебе, специальное консультативное сопровождение во время учебы, использование современных форм и методик проведения занятий, практико-ориентированный подход в обучении, практическая работа в лечебно-профилактических учреждениях и органах государственной власти, привлечение к проведению гостевых лекций практиков здравоохранения, возможность поступления в аспирантуру. Магистр публичного управления и администрирования может работать в органах государственной власти, местного самоуправления и общественных организациях.

Insecticide resistance by a host-symbiont reciprocal detoxification

Insecticide resistance is one of the most serious problems in contemporary agriculture and public health. Although recent studies revealed that insect gut symbionts contribute to resistance, the symbiont-mediated detoxification process remains unclear. Here we report the in vivo detoxification process of an organophosphorus insecticide, fenitrothion, in the bean bug Riptortus pedestris. Using transcriptomics and reverse genetics, we reveal that gut symbiotic bacteria degrade this insecticide through a horizontally acquired insecticide-degrading enzyme into the non-insecticidal but bactericidal compound 3-methyl-4-nitrophenol, which is subsequently excreted by the host insect. This integrated “host-symbiont reciprocal detoxification relay” enables the simultaneous maintenance of symbiosis and efficient insecticide degradation. We also find that the symbiont-mediated detoxification process is analogous to the insect genome-encoded fenitrothion detoxification system present in other insects. Our findings highlight the capacity of symbiosis, combined with horizontal gene transfer in the environment, as a powerful strategy for an insect to instantly eliminate a toxic chemical compound, which could play a critical role in the human-pest arms race.

Flexibility during the COVID-19 Pandemic Response: Healthcare Facility Assessment Tools for Resilient Evaluation.

Healthcare facilities are facing huge challenges due to the outbreak of COVID-19. Around the world, national healthcare contingency plans have struggled to cope with the population health impact of COVID-19, with healthcare facilities and critical care systems buckling under the extraordinary pressures. COVID-19 has starkly highlighted the lack of reliable operational tools for assessing the level sof flexibility of a hospital building to support strategic and agile decision making. The aim of this study was to modify, improve and test an existing assessment tool for evaluating hospital facilities flexibility and resilience. We followed a five-step process for collecting data by (i) doing a literature review about flexibility principles and strategies, (ii) reviewing healthcare design guidelines, (iii) examining international healthcare facilities case studies, (iv) conducting a critical review and optimization of the existing tool, and (v) assessing the usability of the evaluation tool. The new version of the OFAT framework (Optimized Flexibility Assessment Tool) is composed of nine evaluation parameters and subdivided into measurable variables with scores ranging from 0 to 10. The pilot testing of case studies enabled the assessment and verification the OFAT validity and reliability in support of decision makers in addressing flexibility of hospital design and/or operations. Healthcare buildings need to be designed and built based on principles of flexibility to accommodate current healthcare operations, adapting to time-sensitive physical transformations and responding to contemporary and future public health emergencies.

Intergenerational Commensality: A Critical Discussion on Non-Familial Age Groups Eating Together.

Connecting intergenerational relationships and commensality has been a neglected area in research and conceptual development within both food and life-course studies. This has been especially true of relations beyond the family. Here, public and private settings are explored in order to examine the relationship between eating together and generationally intelligent empathy. This is to help the discovery of spaces where different generations can interact positively around food and mealtimes. Contemporary social and public health challenges include: to adapt to increased longevity and to build solidarity between generations; to repair the relations between generations arising from institutional segregation; and to increase experiences of generational connection and social inclusion. As age-based cohorts are led to see themselves as separate from each other, we must find ways of building and negotiating new complementary roles for different parts of the life-course. Commensality, eating together at the same table provides an important cultural location and opportunity around which complementary understandings between generations may be built. A new framework is proposed to help identify and critically examine the variables underpinning non-familial intergenerational commensal spaces.

Weight and waist-to-hip ratio change pattern during the first five years of survival: data from a longitudinal observational Chinese breast cancer cohort

BackgroundBody weight management was an important component in breast cancer survivorship care. The present study described the change patterns of body weight and waist-to-hip ratio (WHR) during the first 5 years of survival, and investigated potential factors associated with very substantial changes.Patients and methodsBased on a longitudinal cohort with 1462 Chinese women with breast cancer, anthropometric measurements including body weight, height, waist and hip circumferences were measured by trained interviewers following standard protocol at four time-points: baseline at study entry, 18-, 36- and 60-months follow up assessments (termed as T0, T1, T2 and T3, respectively). Body height was measured at baseline and body weight at cancer diagnosis were retrieved from medical record.ResultsCompared to weight at breast cancer diagnosis, the median weight change was − 0.5 kg, 0 kg, + 0.5 kg, and + 1 kg at T0, T1, T2 and T3, respectively. During the first 5 years of survival, the proportion of women who were obese have slightly increased. At 60-months after diagnosis, only 14.3% of women had weight gain by > 5 kg; and the percentage of women who had weight gain by > 10% was 10.7%. Nearly half of patients had abdominal obesity at study entry, and this proportion were gradually increased to nearly 70% at 60-months follow-up. Multivariate analysis indicated that older age, and frequent sports participation during the first 5 years of survival were related to lower risk of very substantial weight gain (> 10%) at 60-month follow-up; patients aged 40–49 years, having ≥2 comorbidities and ER negative were associated with less likelihood of very substantial WHR substantial increase (> 10%) at 60-month follow-up.ConclusionWeight gain was modest in Chinese breast cancer survivors during the first 5 years of survival, while central adiposity has become a contemporary public health issue. The incorporation of healthy weight and abdominal circumference patient education and management has a potential to improve cancer survivorship.

Nephrotoxicity of Albendazole and Albendazole Loaded Solid Lipid Nanoparticles in Mice with Experimental Hydatidosis.

Purpose: Cystic echinococcosis (CE) is a serious contemporary public health problem. Different CE treatment methods are of considerable importance, with albendazole (ABZ) being one of the most preferred drugs for CE treatment and prophylaxis. In this study, we evaluated the nephrotoxicity caused by ABZ and ABZ-loaded solid lipid nanoparticles (SLNs) in mice with experimental hydatid cyst. Methods: ABZ-loaded SLNs were produced by micro-emulsification and a high shear homogenization technique. Thereafter, we evaluated the physicochemical characterization of the product. Live protoscolices were injected into mice to induce experimental hydatidosis. Mice were then treated with ABZ and ABZ-loaded SLNs. The nephrotoxicity effects were evaluated by biochemical and histopathological surveys. Results: Significantly different blood urea nitrogen (BUN) levels were observed between the two infected groups (ABZ treatment and ABZ-loaded SLN treatment) and the control group. The kidney malondialdehyde (MDA) and glutathione (GSH) levels of the infected groups were not significantly different from those of the control group. The histopathological study revealed nephropathic and pathologic changes in the ABZ and ABZ-loaded SLN groups. Conclusion: ABZ formulated for ABZ-loaded SLNs had a more prominent chemoprophylactic efficacy on CE and fewer side effects than ABZ alone. Neither ABZ nor ABZ-loaded SLNs caused significant biochemical and histopathological defects on the kidney, and all functional biochemical markers stayed within the normal range. Therefore, ABZ-loaded SLNs could be a potential new product for CE treatment.

Situating social connectedness in healthy cities: a conceptual primer for research and policy

ABSTRACT In response to growing levels of social isolation and loneliness in cities, the promotion of social connectedness has come to the forefront of urban health, sustainability, and resiliency agendas. Despite policy attention locally and internationally, social connectedness is not consistently defined, conceptualized, or measured in population health and urban planning research. The term has also been used interchangeably with various other concepts in research on social environments and health, particularly social cohesion, social capital, and social inclusion. These discrepancies create confusion for planners and policymakers looking for evidence-informed guidance on the implementation and evaluation of urban interventions designed to promote social connectedness. Further, it presents a challenge for intervention researchers interested in investigating possible causal pathways between urban change, social connectedness, and health. Drawing from contemporary public health and urban planning literature, this paper aims to delineate the concept of social connectedness, including its meaning, measurement, and relationship to neighbourhoods and health. Clarifying social connectedness for urban health research and policy is crucial to interpreting and advancing evidence on its role – both its determinants and impacts – in the development of healthy, sustainable, and resilient cities.

Feeling Valued and Adding Value: A Participatory Action Research Project on Co-creating Practices of Social Inclusion in Kindergartens and Communities.

Background: Contemporary public health problems connect to the social determinants of health, with a growing recognition of social inclusion as imperative to sustainable development. In this quest for social inclusion, early childhood and families are of particular interest. Although co-creation is suggested as viable path to support well-being, less is known how social inclusion might be co-created in practice. The aim of this study was to explore how Participatory Action Research (PAR) can be a tool for transformative practices in a local community, pointing to kindergartens as meeting places for recognizing social inclusion as a common value in early childhood.Methods: A qualitative PAR study was embedded in a Norwegian municipality as an integrated part of their local public health work. The study involved a wide range of participants and stakeholders in three kindergartens and the wider community. Together, we explored potentials for co-creating social inclusion to achieve well-being through cycles of transformative actions and reflections. Reflexive thematic analysis was applied to generate patterns and themes in the data.Results: The participants formulated and took on ownership to an inclusive agenda through the PAR-process. Acts of inclusion was framed by an intersection between political aims of achieving health and well-being for all and public value co-creation unfolding at the level of the place, in the context of the Norwegian welfare regime. To feel valued and adding value was seen as important aspects for social inclusion. Four themes were generated from analysis; (1) Co-creating a shared vision of inclusive communities, (2) Becoming aware and empowered through caring, sharing and collaboration, (3) Places and spaces of inclusiveness in kindergartens and beyond, and (4) Valuing and practicing inclusion, and signs of transformative change.Conclusions: Through the PAR process, parents, kindergartens employees, community members and policy makers appear to have opened a creative toolbox for inclusive and transformational change through formulating and co-creating inclusion and well-being as public values. The results suggest that local actors might support adaptive social systems to taking on relational responsibility for inclusive processes and outcomes in the pursuit of well-being for all.

DOES PANDEMIC PAVES WAY FOR INNOVATIONS IN HEALTHCARE?: A REVIEW

The world has witnessed innumerable epidemic and pandemic episodes for centuries from Small Pox to Influenza to Cholera and the most recent wave of COVID-19 still ruling global health.The contemporary healthcare and public health system witnessing every pandemic has been influenced by two trends over the past years, namely the development of scientific information about the etiology and means of disease control and the development of public recognition of disease control as both a probability and a public obligation. Also, every pandemic has urged the healthcare professionals and system to come up with innovative strategies to control and handle the disease. Like the Vaccination system after smallpox and Facemask after Influenza, every disease pandemic has thus left a new control strategy designed for them.The concept of Telemedicine is considered to be the latest innovation of the 21st century and handful in-need during COVID-19 pandemic as it binds digital technology and healthcare.We, in this paper, have reviewed in detail,the innovative medical discoveries that have been essential in times of need.

The Potential Role of Exosomes in Child and Adolescent Obesity.

Child and adolescent obesity constitute one of the greatest contemporary public health menaces. The enduring disproportion between calorie intake and energy consumption, determined by a complex interaction of genetic, epigenetic, and environmental factors, finally leads to the development of overweight and obesity. Child and adolescent overweight/obesity promotes smoldering systemic inflammation (“para-inflammation”) and increases the likelihood of later metabolic and cardiovascular complications, including metabolic syndrome and its components, which progressively deteriorate during adulthood. Exosomes are endosome-derived extracellular vesicles that are secreted by a variety of cells, are naturally taken-up by target cells, and may be involved in many physiological and pathological processes. Over the last decade, intensive research has been conducted regarding the special role of exosomes and the non-coding (nc) RNAs they contain (primarily micro (mi) RNAs, long (l) non-coding RNAs, messenger (m) RNAs and other molecules) in inter-cellular communications. Through their action as communication mediators, exosomes may contribute to the pathogenesis of obesity and associated disorders. There is increasing evidence that exosomal miRNAs and lncRNAs are involved in pivotal processes of adipocyte biology and that, possibly, play important roles in gene regulation linked to human obesity. This review aims to improve our understanding of the roles of exosomes and their cargo in the development of obesity and related metabolic and inflammatory disorders. We examined their potential roles in adipose tissue physiology and reviewed the scarce data regarding the altered patterns of circulating miRNAs and lncRNAs observed in obese children and adolescents, compared them to the equivalent, more abundant existing findings of adult studies, and speculated on their proposed mechanisms of action. Exosomal miRNAs and lncRNAs could be applied as cardiometabolic risk biomarkers, useful in the early diagnosis and prevention of obesity. Furthermore, the targeting of crucial circulating exosomal cargo to tissues involved in the pathogenesis and maintenance of obesity could provide a novel therapeutic approach to this devastating and management-resistant pandemic.

The interface of multisectoral and multilateral dimensions of public health policy: what's new in the 21st century?

The article examines key developments unfolding in the 21st century in the intersection of multisectoral and multilateral dimensions of public health policy. Several processes and mechanisms, relatively new or rapidly evolving, are fuelling this dynamic interface. They include, in particular, expansion of the spectrum of sectors involved in the health domain, the upsurge of trans-border and commercial determinants of health, growing presence of health issues in multilateral instruments and processes that are outside of the health sector, and strengthening the legal base of intersectoral relations and responsibilities for health. They also encompass and reflect important transformations in health diplomacy and governance for health, some of the fundamentals of contemporary public and global health. The article argues that overall, multisectoral and multilateral dimensions tend to interact, inform and reinforce each other, and that such interaction would be one of important drivers of 21st century intersectoral policy-and international cooperation-for health.

Continuous Evolution: Perspective on the Epidemiology of Carbapenemase Resistance Among Enterobacterales and Other Gram-Negative Bacteria.

The global emergence of carbapenemase-producing bacteria capable of hydrolyzing the once effective carbapenem antibiotics is considered a contemporary public health concern. Carbapenemase enzymes, once constrained to isolates of Klebsiella pneumoniae, are now routinely reported in different bacteria within the Enterobacterales order of bacteria, creating the acronym CRE which now defines Carbapenem-Resistant Enterobacterales. CRE harboring different types of enzymes, including the most prevalent types KPC, VIM, IMP, NDM, and OXA-48, are now routinely reported and more importantly, are now frequently present in many infections world-wide. Defining and updating the contemporary epidemiology of both the US and global burden of carbapenem-resistant infections is now more important than ever. This review describes the global distribution and continued evolution of carbapenemases which continue to spread at alarming rates. Informed understanding of the current epidemiology of CRE, coupled with advances in antibiotic options, and the use rapid diagnostics offers the potential for rapid identification and management of carbapenem-resistant infections.

The association between medication or alcohol use and the incidence of frailty: a retrospective cohort study

BackgroundUnderstanding potentially modifiable factors that influence the risk of frailty is a key concern for the management of this urgent contemporary public health challenge. This study evaluates the association between the use of various medications or alcohol and the incidence of frailty among older adults.MethodsThis study was a retrospective cohort study on older adults (≥ 65 years) using data from the longitudinal Survey of Health, Ageing and Retirement in Europe (SHARE survey, 28 countries). Medication use was measured as taking several different groups of medications. Alcohol use was assessed with SHARE questions corresponding to AUDIT-C. The outcome measure was the incidence of frailty after two years, defined by frailty index (FI) and frailty phenotype (FP). A multiple logistic regression model was used to evaluate the association with adjustment for several potential confounding factors.ResultsOf the 14,665 FI-population participants, 1800 (12.3%) developed frailty within two years. Of the 8133 FP-population participants, 2798 (34.4%) developed pre-frailty and 247 (3.0%) developed frailty within two years of baseline. After adjustment for potential confounding variables, non-hazardous alcohol use (adjusted OR; 95% CI for the FI-population: 0.68; 0.60–0.77) and hazardous alcohol use (0.80; 0.68–0.93) are associated with lower incidence of frailty compared to no alcohol use. The odds of frailty are increased when taking medications; the largest effect size was observed in older adults taking medication for chronic bronchitis (adjusted OR; 95% CI for the FI-population: 2.45; 1.87–3.22), joint pain and other pain medication (2.26; 2.00–2.54), medication for coronary and other heart disease (1.72; 1.52–1.96), medication for diabetes (1.69; 1.46–1.96), and medication for anxiety, depression and sleep problems (1.56; 1.33–1.84). Additionally, the risk of frailty was increased with stroke, Parkinson’s disease and dementia.ConclusionsTaking certain groups of medication was associated with increased incidence of frailty and pre-frailty, which might be due to either medication use or the underlying disease. Alcohol use was associated with a lower risk of pre-frailty and frailty compared to no alcohol use, which might be due to reverse causality or residual confounding. There was no significant interaction effect between medication groups and alcohol use on frailty incidence.

Biotech, Biodefense and COVID-19 Vaccines in Russia’s National Security State

Russian authorities’ decision to grant the Sputnik V vaccine emergency approval in August 2020 sent shock waves across the scientific and policy-making communities. How did Russia acquire the capacity to develop and produce a vaccine against SARS-Cov-2 so quickly? Based on a case study of the institutions and firms involved in the development and production of Sputnik V, I argue that this capacity results from efforts by Russia’s national security state to turn a Cold War advantage in the development of biological weapons into a contemporary public health advantage in vaccine and drug development. Since at least the late 2000s, the Russian state has pursued a form of security motivated statecraft aimed at supporting both the growth of handpicked domestically-owned biotechnological firms – with their growth being deemed essential to ensuring the pharmaceutical security of Russia’s population and Armed Forces – and the upgrading of state research institutes involved in Russian biodefense – i.e. in defending civilians and military troops against naturally occurring dangerous pathogens or pathogens potentially used in biological weapons. Yet contemporary Russia has also supported those specific firms and research institutes largely because these have had a pre-existing competitive advantage in the science of genetic engineering that they inherited from their involvement in the Soviet Union’s enhanced – effectively, the world’s most advanced – biological weapons program from the mid-1970s until the early 1990s in direct violation of the 1972 Biological Weapons Convention.

Liberty and Protection of Society During a Pandemic: Revisiting John Stuart Mill

John Stuart Mill's classic text, On Liberty, maps the scope and limits on individual freedom. His "harm principle"-that liberty can be legitimately restricted by government or society only to prevent harm to others-has had a great influence on contemporary public health ethics. This essay examines Mill's philosophy of liberty as it pertains to public health interventions in response to the coronavirus pandemic. Particular applications include examination of face masks, lockdowns, and mandatory vaccination.

Blessing unintended pregnancy

Within public health and medical anthropology research, the study of women’s agency in reproductive decision making often neglects the role of religion and women’s spirituality. This article is based on ethnographic research conducted at a shelter for homeless (mostly African American) mothers in the southeastern United States. We explore the inadequacy of rational choice models that emphasize intentionality and planning, which our research shows are in tension with the vernacular religious and moral ethos of pregnancy as a ‘blessing’ or unplanned gift. Our findings confirm that young and disadvantaged women may view pregnancy and motherhood as opportunities to improve their lives in ways that mediate against their acceptance of family planning models. For these women, the notion of ‘blessing’ also reflects an acceptance of contingency and indeterminacy as central to the reproductive experience. We also question the increasingly popular distinction between ‘religion’ and ‘spirituality’ in contemporary public health.

Uncertain space: Data illusions and the landscape of illness in the 21st century

Disease mapping offers certainty in the face of disease outbreaks. Spatially locating illness lets the average person assess their proximity to risk and appears to tie it to specific environmental conditions. During the cholera and yellow fever epidemics of the mid- to late 1800’s, disease mapping was a major factor in decision-making that shaped our environment. In the early 1900’s when hay fever and pulmonary illness continued to wrack urban environments, narrative medical geographies provided written depictions of healthy rural regions to contrast against congested urban cities with experimental maps linking climate, topography and airflow with emerging medical knowledge of respiratory systems and circulation. However, as germ theory and vaccines decoupled environment and illness, the relationship between the physical qualities of the immediate landscape and outbreaks became less important than its simple locus. In this exploratory essay, I discuss how this decoupling has allowed for the wholesale stigmatization of both places and marginalized populations, particularly in the cases of urban blight and the AIDS epidemic. Although we are currently in an era of abundant personal and spatial data, it has proven difficult to tie contemporary public health issues back to the environment, even in cases like obesity where there are tangible connections to the physical and social characteristics of neighborhoods, due to the way this data is collected and structured. Nuanced shifts in the built environment, social determinants of health, and invisible histories of policy and environmental change have on-the-ground impacts as well, and to better understand the nature of today’s landscape of disease, we must find a way to represent them spatially.