Global Public Health Community Research Articles

4.Q. Workshop: Inclusive and non-discriminatory language and health communication: state, needs, perspectives

Abstract Language has the potential to cause harm when used unreflectively, e.g. the inaccurate and derogatory/stigmatising term ‘illegal migrant’, the terms ‘second (or third) generation migrant’ emphasising recency or lack of belonging, crude and imprecise descriptive labels such as ‘Blacks’ or ‘Asians’, historic terms such as ‘Oriental’ or ‘Easterner’, and other similar terms impliying second-class or outsider status, such as ‘alien’ or ‘foreigner’ (or indeed, ‘native’ when used to indicate a ‘first nation’ or autochthonous group lacking in status). This applies to everyday life, health care and research. In public health (e.g. in publications and study materials) and in policy and medical guidelines, there is a particular need for risk awareness of the potential for discrimination and stigmatisation through the language and terminology used. The issue has been discussed since the late 1980s and was identified as a clear challenge during the recent COVID-19 pandemic in light of the social and ethnic disparities of risks, incidence and vaccination uptake that were communicated in research, policies and interventions. However, there are only few guidelines or materials to support the responsible use of language. Moreover, reflection on language is often not considered as important as other aspects of public health research and practice. Yet it seems to be a basic requirement for ensuring responsible communication of policies and research results and within the research process itself. After all, classification and accuracy of decriptive terms and analysis categories are quality standards in public health research. In the workshop we will take stock of what has been achieved so far in the field of anti-discriminatory communication and language and what challenges were faced in terms of communicating evidence and policies in relation to the COVID-19 pandemic. This will be followed by a presentation of a specific example from the National Public Health Institute in Germany, which has developed a guideline on anti-discriminatory language. The important perspective of community/NGOs will be also included as a presentation. Building on the work of the last decades, the EUPHA conference offers a great opportunity to bring together perspectives and experiences from different researchers, institutions and countries. The workshop takes up the theme at a time when public health research on migrants and refugees is on the rise due to global crises including climate change and war, migratory movements, and the need for awareness and discourse on anti-discrimination and anti-racism within the modern globalised world. As a global public health community, we have a responsibility to shape the public discourse. It is in our hands to continue the discussion and to raise awareness for continuous (self-) reflection, responsible communication and appropriate terminology within the public health community. Key messages • The workshop aims to contribute to increased awareness for responsible and discrimination-sensitive language and terminology within the public health community. • The global public health community has a responsibility to represent the population in its diversity. Reflective, accurate and responsible discrimination-sensitive communication are essential.

How the Orthodox Features of Orthopoxviruses Led to an Unorthodox Mpox Outbreak: What We've Learned, and What We Still Need to Understand.

Orthopoxviruses have repeatedly confounded expectations in terms of the clinical illness they cause and their patterns of spread. Monkeypox virus (MPXV), originally characterized in the late 1950s during outbreaks among captive primates, has been recognized since the 1970s to cause human disease (mpox) in West and Central Africa, where interhuman transmission has largely been associated with nonsexual, close physical contact. In May 2022, a focus of MPXV transmission was detected, spreading among international networks of gay, bisexual, and other men who have sex with men. The outbreak grew in both size and geographic scope, testing the strength of preparedness tools and public health science alike. In this article we consider what was known about mpox before the 2022 outbreak, what we learned about mpox during the outbreak, and what continued research is needed to ensure that the global public health community can detect, and halt further spread of this disease threat.

Advances in the Diagnosis and Treatment of Non-Alcoholic Fatty Liver Disease.

Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease that affects approximately one-quarter of the global adult population, posing a significant threat to human health with wide-ranging social and economic implications. The main characteristic of NAFLD is considered that the excessive fat is accumulated and deposited in hepatocytes without excess alcohol intake or some other pathological causes. NAFLD is a progressive disease, ranging from steatosis to non-alcoholic steatohepatitis (NASH), cirrhosis, hepatocellular carcinoma, liver transplantation, and death. Therefore, NAFLD will probably emerge as the leading cause of end-stage liver disease in the coming decades. Unlike other highly prevalent diseases, NAFLD has received little attention from the global public health community. Liver biopsy is currently considered the gold standard for the diagnosis and staging of NAFLD because of the absence of noninvasive and specific biomarkers. Due to the complex pathophysiological mechanisms of NAFLD and the heterogeneity of the disease phenotype, no specific pharmacological therapies have been approved for NAFLD at present, although several drugs are in advanced stages of development. This review summarizes the current evidence on the pathogenesis, diagnosis and treatment of NAFLD.

Early Response to COVID-19

Early Response to COVID-19

Introduction to Evidence for Global Health Care Interventions for Preterm or Low Birth Weight Infants.

In 2010, many research gaps in the care of preterm and low birth weight (LBW) infants were identified.1 Important questions about the efficacy and effectiveness of interventions for preterm and LBW infants have been answered over the last 10 years,2 yet gaps in the global evidence base remain. A framework of care needed for preterm and LBW infants was developed at a World Health Organization (WHO) guideline development group expert meeting in December 2020.3 Thirty-eight interventions were identified (Tables 1 and 2). Thirty interventions had already been included in other WHO guidelines. Eight interventions with 24 research questions had not been addressed by other WHO guidelines (Table 3).An overview of the systematic reviews process was conducted (as outlined in paper 1 of this supplement),4 to understand which systematic reviews, if any, had addressed the 24 research questions in the last 3 years. Eight had already been addressed by published systematic reviews (donor human milk, multicomponent fortifier, formula milk, probiotics, emollients, use of continuous positive airways pressure [CPAP] in infants with respiratory distress syndrome, early initiation of CPAP, and prophylactic CPAP). Sixteen required new systematic reviews (kangaroo mother care, mother’s own milk, early initiation, responsive feeding, advancement of feeding, duration of exclusive breastfeeding, iron, zinc, vitamin A, vitamin D, calcium and phosphorous, multiple micronutrients, methylxanthines, family involvement, and family support).The sixteen systematic reviews were subsequently completed. Four have been published elsewhere (kangaroo mother care, CPAP pressure source, methylxanthines, family support).5–8 Twelve are presented in this supplement. These reviews fill a much-needed gap in the evidence base. They can be used by the global public health community to (1) understand the impact, research priorities, and implementation considerations and (2) assist in the development of policies and programs to improve the care of these most vulnerable preterm and LBW infants.

BioCaster in 2021: automatic disease outbreaks detection from global news media.

SummaryBioCaster was launched in 2008 to provide an ontology-based text mining system for early disease detection from open news sources. Following a 6-year break, we have re-launched the system in 2021. Our goal is to systematically upgrade the methodology using state-of-the-art neural network language models, whilst retaining the original benefits that the system provided in terms of logical reasoning and automated early detection of infectious disease outbreaks. Here, we present recent extensions such as neural machine translation in 10 languages, neural classification of disease outbreak reports and a new cloud-based visualization dashboard. Furthermore, we discuss our vision for further improvements, including combining risk assessment with event semantics and assessing the risk of outbreaks with multi-granularity. We hope that these efforts will benefit the global public health community.Availability and implementationBioCaster web-portal is freely accessible at http://biocaster.org.

Leverage the power of ritual to improve community health worker efficacy and public health outcomes: Lessons from Bihar, India

Biomedical health interventions now have global reach and interact in complex and often poorly understood ways with traditional medical rituals that precede biomedicine. People often experience biomedical practices and treatments as rituals because they are very similar from an experiential perspective. 1 Yet the global public health community often views ritual practices of communities as obstacles to adopting new health-promoting behaviors. The lack of engagement with the biomedical and traditional medical rituals of local populations has obscured understanding the critical functions of these behaviors, limited the potential to leverage ritualization to increase behavioral uptake, and stymied social and behavioral change efforts. Our large-scale, mixed methods research with Community Health Workers (CHW) in Bihar, India, has shown that understanding the rituals of a community provides critical insight into their identities, norms, values, and goals. We propose that health interventions should be informed by, and build upon, knowledge of health rituals. A deep understanding of existing beliefs and behaviors will allow local health "influencers" such as CHW to encourage new and modified rituals that integrate the best of biomedical and traditional health practices in ways that preserve their meaning and shared purpose. Grants INV-008582 and INV-016014 to C.L. from The Bill & Melinda Gates Foundation funded this manuscript.

Digital Visual Communication for Public Health: Design Proposal for a Vaccinated Emoji.

In the 21st century, the internet and particularly social media have become essential platforms for the spread of health information (including misinformation and disinformation). One of the distinguishing features of communication on these platforms is the widespread use of emojis. Though seemingly trivial emojis are now used by many if not most public health figures and organizations alongside important health updates. Much of that information has had to do with vaccination. Vaccines are a critical public health tool but one surrounded by falsehoods, phobias, and misinformation fueling vaccine hesitancy. Part of that has to do with their lack of positive representation on social media (eg, the syringe emoji is a plain needle, which for many people is an uncomfortable image). We thus argue that vaccination deserves an entirely new emoji to communicate vaccine confidence and discuss a design proposal for a vaccinated emoji that has gained traction in the global public health community.

Global Observatory of COVID-19 Vaccine Incentives

The availability of the COVID-19 Vaccines was a turning point in the global pandemic which was declared a Public Health Emergency of International Concern. While making vaccines available was a major challenge that the global public health community has to deal with, the COVID-19 vaccine hesitancy also has been a significant challenge faced in some parts of the world. Incentives have been used as tools to promote vaccine acceptance in some parts of the world. Do vaccine incentives work? Yes? No? The Global Observatory of COVID-19 Vaccine Incentives (GOCOVI), as a global virtual platform to track COVID-19 Vaccine Incentives, will curate and compile evidence in relation to the use of Vaccine Incentives for the promotion of vaccine acceptance.

Risk factors of stunting and wasting in Somali pre-school age children: results from the 2019 Somalia micronutrient survey

BackgroundStunting and wasting in children less than 5 years of age are two key indicators of child malnutrition. Reducing their prevalence is a priority of the global public health community and for Somalia, a country suffering complex humanitarian emergencies such as drought, flooding, conflict and large-scale displacements.MethodsData from the nationally representative cross-sectional Somalia Micronutrient Survey (SMS 2019) on 1947 children were analyzed to assess the prevalence and potential risk factors of stunting and wasting. Bivariate and multivariable analyses were conducted separately for children 0–5 months and 6–59 months, and population attributable fractions were calculated using adjusted risk ratios produced by Poisson regression models.ResultsAmong the 1947 children, the prevalence of stunting and wasting were 17.2% (95% CI: 15.0, 19.6) and 11.0% (95% CI: 9.3, 12.9), respectively. Among children 6–59 months of age, those residing in severely food insecure households had a higher risk of stunting (adjusted risk ratio [aRR] 1.47; CI: 1.12, 1.93) compared to those in food secure households. This risk of stunting was also higher in children with inflammation (aRR 1.75; CI: 1.35, 2.25) and iron deficiency (ID) (aRR 2.09; CI: 1.58, 2.80). For wasting, a dose-response relationship was found with household wealth, with the risk of wasting increasing significantly as the household wealth quintile decreased. On the other hand, the risk of wasting was lower in iron-deficient children (aRR 0.69; CI: 0.49, 0.98) than in iron-replete children. Among children 0–5 months of age no variables remained statistically significantly associated with stunting in the multivariable analysis. Wasting, however, was more common in children with recent diarrhea (aRR 3.51; CI: 1.68, 7.36).ConclusionsNutritional status of children in Somalia may be improved by prevention of diarrhea and other infections and improvements in household food security.

What are the effects of ethnicity, sexuality, disability and obesity on the odds of experiencing discrimination among Australian males? A nationwide cross-sectional survey

ObjectivesThe global public health community has been slow to acknowledge the important role of discrimination in health inequality. Existing evidence on discrimination is largely based on studies of specific subpopulations...

Advancing the global public health agenda for NAFLD: a consensus statement.

Non-alcoholic fatty liver disease (NAFLD) is a potentially serious liver disease that affects approximately one-quarter of the global adult population, causing a substantial burden of ill health with wide-ranging social and economic implications. It is a multisystem disease and is considered the hepatic component of metabolic syndrome. Unlike other highly prevalent conditions, NAFLD has received little attention from the global public health community. Health system and public health responses to NAFLD have been weak and fragmented, and, despite its pervasiveness, NAFLD is largely unknown outside hepatology and gastroenterology. There is only a nascent global public health movement addressing NAFLD, and the disease is absent from nearly all national and international strategies and policies for non-communicable diseases, including obesity. In this global Delphi study, a multidisciplinary group of experts developed consensus statements and recommendations, which a larger group of collaborators reviewed over three rounds until consensus was achieved. The resulting consensus statements and recommendations address a broad range of topics - from epidemiology, awareness, care and treatment to public health policies and leadership - that have general relevance for policy-makers, health-care practitioners, civil society groups, research institutions and affected populations. These recommendations should provide a strong foundation for a comprehensive public health response to NAFLD.

Trust, influence, and community: Why pharmacists and pharmacies are central for addressing vaccine hesitancy

In 2019, the World Health Organization listed vaccine hesitancy, defined as the reluctance or refusal to vaccinate against preventable infectious diseases, as one of the top ten threats to global health. To address hesitancy, we must focus our attention on building vaccine confidence, trust in the vaccine itself, in providers who administer vaccines, and in the process that leads to vaccine licensure and the recommended vaccination schedule. Building vaccine confidence, particularly in communities that have higher levels of distrust of vaccines and low vaccination coverage rates, is a critical public health priority, particularly in the current climate as the United States and the global public health community grapple with the coronavirus disease 2019 pandemic. In this commentary, we focus on the central role that pharmacists play in promoting the health and wellness of the local communities in which they are embedded, how they are one of the most trusted sources for their communities when it comes to health information and care, and their unique position in making a profound contribution to building vaccine confidence. We propose to arm all health professionals with a tool, the ASPIRE framework, which serves as a series of actionable steps to facilitate conversations with communities. This framework is intended to assist pharmacists in communicating with community members who may have concerns about vaccines by sharing trustworthy health information about vaccines to increase vaccine adoption. We conclude that it is insufficient to merely relay accurate health information about vaccines to the public and expect dramatic increases to vaccination rates. Accurate health information needs to be conveyed by trusted sources. Open engagement and dialogue layered on top of fundamental facts and messages are central to building confidence. Pharmacists and other providers can use tools such as ASPIRE to guide their conversations with community members to increase vaccine adoption.

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

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

Build Back Better: Leadership for US–Cuba Health Cooperation

As members of the global public health community, we thought the outgoing Trump administration in Washington could not do much else to shock us. But when President Biden revealed that his predecessor had left him not with a bad plan to tackle the COVID-19 pandemic—but with no plan at all—we were appalled, contemplating the nearly […]

Devi Sridhar: illuminating global health governance

Devi Sridhar has travelled far in her fairly short career. She was the youngest Rhodes Scholar, aged just 18 years, and became Professor of Global Public Health at the University of Edinburgh, UK, when she was 30. But milestones are of little interest to her, especially as her role as a leader in global health governance has been accelerated by the impacts of the COVID-19 pandemic. “This is the time for the global public health community to step up”, she comments. “We have never before been required to work so intensively and as rapidly as in today's environment, where effective public health responses and global health governance are having an impact on the entire world's population.

1.D. Workshop: Food and water insecurities in a warming climate: What role for Public Health?

Abstract Food and water are fundamental environmental health determinants. They are necessities of life, such that shortfalls in ready access in sufficient quality and quantity precipitate poor health, failure to thrive, susceptibility to disease, and if not rectified, ultimately lead to death. Archeological and historical records testify that large scale interruptions to food and water supplies trigger widespread social upheaval and when driven by systematic inequities in distribution, can overthrow governments. The desperation to secure survival is deep-seated. Competition for scarce resources, mass migration and conflict further generate environmental damage, disruptions to social cohesion, and can also herald novel challenges to health and wellbeing. Climate change is accelerating and with it, increasing intensity of extreme events such as heatwaves, droughts, fires, storms and floods. These interrupt food and water supplies and income generation. Unless transformative and rapid reductions in global greenhouse gas emissions can be achieved, and achieved promptly, the global population will be forced to confront escalation in shortfalls. Will wealthy nations accommodate the needs of the global disadvantaged? Exposure of agricultural sectors to climate extremes is already reversing gains made towards ending malnutrition and achieving SDG1: Reducing global hunger and malnutrition. Global water insecurity is also intensifying. A perfect storm is looming with accelerated global warming against a backdrop of rapid population growth and existing challenges in ensuring water and food security for all. The combination of lethal heat extremes and intensifying insecurities in these basic human needs threatens to make many homelands uninhabitable. Humanity is creating a Climate Change Emergency, which translates to a Global Public Health Emergency. It is thus incumbent upon the world's public health community to move beyond engagement in this climate change crisis. We must step up and take leadership to protect the health of all. Is the PPRR risk management model: Prevent, Prepare, Respond and Recover, the way forward? Workshop participants will have the opportunity to hear from a panel of three public health experts from the World Federation of Public Health Association to gain a deep understanding of the relationship pathways between climate change and these accelerating health threats. Recent global disasters events will illustrate the diversity and extent of this unfolding crisis. Examples of promising Public Health Response solutions will highlight what can be achieved by applying a coordinated public health lens. This interactive session elicits audience involvement through facilitated Question and Answer discussion. Following the panel presentations, the Q&A session will enable workshop participants to explore how better engagement of the public health sector can serve to help ameliorate the risks, and build resilience through Climate Change PPRR. Key messages Interruptions to food and water security generate disease, famine, conflict and in severe circumstances mass migration, disproportionately harming the global disadvantaged, and ultimately everyone. Climate change risks food & water security and thus threatens human wellbeing. Observed effects will dramatically escalate. The global public health community must engage to protect health.

Plenary programme

Abstract The global public health community will be meeting at a critical time for our planet. Global temperatures lie far beyond historical records and there are real fears that we are reaching a tipping point. Threats to food and water supply, poverty and inequalities are leading to mass migration and conflict. Political structures, at national, regional, and global level, are struggling to respond. International agreements, on climate change, nuclear weapons, and much else, are being torn up. The Enlightenment view, that policy should be shaped by evidence, is being rejected by some leading politicians. At a time when global solidarity is required, populist politicians are exploiting divisions. The theme of the Congress, Public health for the future of humanity: analysis, advocacy, and action, reflects our firm commitment that we, in the global public health community, have an obligation to respond to these new circumstances. We must make visible the threats to health, some of which are already emerging. We must challenge and hold to account those with the power to make a difference. And we must act, making real our commitment to health in all policies. We, as public health community, have much to contribute and much to learn. As always, we will have many opportunities to share ideas among ourselves, but this year we can enrich our experiences even further, bringing a global perspective to our thinking.

Barriers and enablers for Indigenous public health practitioners

Abstract Indigenous Maori Public Health Practitioners who work in mainstream public health systems experience significant barriers to workplace success and the barriers to positive public health impact in our communities. This is a Kaupapa Maori qualitative study that highlights the barriers and enablers to Maori Senior Public Health practitioners within Mainstream New Zealand Public Health Units. Given there are nearly 400 million Indigenous people worldwide, this is an opportunity to share recommendations from this research study with the global public health community about how to re-orient public health organisations and approaches to effectively address workforce development as well as improve engagement and impact in Indigenous communities. Key messages Indigenous knowledge is undervalued in Mainstream Public Health Systems. Indigenous inequities cannot be truly addressed unless providers re-orient themselves by authentically understanding Indigenous ways of working.

Moving out of the silos

Abstract We know that we need truly interdisciplinary approaches to analyse the threats to health and to evaluate the effectiveness of responses. Yet we often find difficulty in putting them into practice. Who creates the silos? And for which purpose? What actions do we need to take in the global public health community to promote and sustain interdisciplinary working? And what changes in the wider society do we need to advocate for to make this happen?