Health Imperatives Research Articles

Going through changes: A longitudinal study of meat reduction over time in the UK

There are increasing moral, environmental and public health imperatives to curb meat consumption. While research on meat reduction has proliferated in recent years, the majority of empirical work has taken cross-sectional and/or experimental approaches. Therefore, this study sought to understand the process of dietary change through an observational longitudinal survey of 1,529 UK residents over the course of one year. An online questionnaire was used to take measures of diet, exposure to animal advocacy, exposure to animals and animal-lovers, the transtheoretical model of change, the COM-B model (capability, opportunity, motivation → behaviour), and demographics at 0, 6, and 12 months. While no support was found for predictions made on the COM-B model, some support was found for hypotheses made on the transtheoretical model - in particular, there was some evidence that those at later stages who still ate meat were more likely to give it up, and those at earlier stages who had given up meat were more likely to start eating it again. There were also generally stronger measures of decisional balance (i.e. conviction in the decision to give up meat) and self-efficacy for those at more advanced stages. Analyses also indicate that increases in consumption of animal product alternatives were significantly correlated with decreases in animal products in the same category. Ordinal regression models yielded low predictive ability, meaning that information on the interventions which may influence animal product consumption was limited. Findings are discussed in the context of previous literature and recommendations for future research.

Health Equity in the Implementation of Genomics and Precision Medicine: A Public Health Imperative

ABSTRACT A long-term primary goal of public health is health equity (everyone having the opportunity to be as healthy as possible). There is intensified interest in public health to address health outcome disparities, which can affect length and quality of life, rates of disease, severity of disease, and access to treatments. In genomic medicine, health equity is defined as “the global applicability of genomic knowledge, fair and even access to genomic services such as testing and counseling, and unbiased implementation of genomic medicine.” The overall goal is to improve our understanding of interactions between social, biological, and environmental factors involved in disease occurrence. Health equity agendas beyond basic clinical research are necessary for ensuring improved health outcomes in every population segment. This includes implementation of so called “tier 1” genomic applications (Clin Pharmacol Ther 2014;95(4):394–402), that is, those supported by a strong evidence base, for reducing morbidity and mortality of various diseases, as well as for the improvement of health outcomes. Tier 1 genomic applications can potentially reduce morbidity and mortality for millions of people and include applications such as newborn screening and testing for Lynch syndrome, hereditary hemochromatosis, hereditary breast and ovarian cancer, familial hypercholesterolemia (FH), and hypertrophic cardiomyopathy. Implementation disparities have been reported for 3 genetic disorders in particular that are included in tier 1 guidelines—FH, Lynch syndrome, and hereditary breast and ovarian cancer. Although implementation is relatively low across the entire population, groups particularly affected by suboptimal implementation include racial and ethnic minority groups, rural communities, women, the underinsured or uninsured, and patients with lower income and education. One of the groups most prominently affected by suboptimal implementation includes Black women, who are less likely to discuss genetic testing with health care providers than their non-Hispanic White peers. A lack of testing may affect preventive care, meaning both individuals and families may not access such care. Implementation of precision medicine applications and evidence-based genomics is highly dependent on access to health care. To overcome such shortcomings and discrepancies in the health care system within the United States, inequities must be addressed and acknowledged. The failure to optimally integrate genomics into the assessment of current public health practice hinders the ability for improvement in this area. Many benefits are available from the integration of genomics into health care, such as population-based cancer registries that can assist in the identification of risk factors, survival patterns, treatment responses, and recurrences. Heterogeneous subgroups with similar risk factors can potentially be more accurately classified based on molecular markers, such as gene expression profiles. Ultimately, as an emerging field, genomics and precision medicine have the opportunity to fully integrate principles of health equity early on before disparities become deeply entrenched, as has already occurred in other, more established fields. As the pandemic demonstrated differential effects on various population subgroups, the achievement of health equity when considering implementation of genomics and precision medicine is likewise increasingly important as the potential benefits of this approach continue to grow.

Poisoning Regulation, Research, Health, and the Environment: The Glyphosate-Based Herbicides Case in Canada.

Despite discourse advocating pesticide reduction, there has been an exponential increase in pesticide use worldwide in the agricultural sector over the last 30 years. Glyphosate-Based Herbicides (GBHs) are the most widely used pesticides on the planet as well as in Canada, where a total of almost 470 million kilograms of declared "active" ingredient glyphosate was sold between 2007 and 2018. GBHs accounted for 58% of pesticides used in the agriculture sector in Canada in 2017. While the independent scientific literature on the harmful health and environmental impacts of pesticides such as GBHs is overwhelming, Canada has only banned 32 "active" pesticide ingredients out of 531 banned in 168 countries, and reapproved GBHs in 2017 until 2032. This article, based on interdisciplinary and intersectoral research, will analyze how as a result of the scientific and regulatory captures of relevant Canadian agencies by the pesticide industry, the Canadian regulation and scientific assessment of pesticides are deficient and lagging behind other countries, using the GBH case as a basis for analysis. It will show how, by embracing industry narratives and biased evidence, by being receptive to industry demands, and by opaque decision making and lack of transparency, Health Canada's Pest Management Regulatory Agency (PMRA) promotes commercial interests over the imperatives of public health and environmental protection.

Air pollution – the silent killer. Public Participation Solutions for Emissions and Health

In the context of a world grappling with the compounding challenges of the climate crises, fuel scarcity, and geopolitical tensions, the discourse around a general speed limit for the German Autobahn has gained unprecedented momentum. Despite Germany's unique absence of a speed limit, the imperatives of climate action and public health are driving the urgency of re-evaluating this tradition. This article engages with the complex intersection of public health, environmental impact, and democratic decision-making to address the compelling case for a speed limit on German highways. Amidst the global call for sustainable solutions, the interdisciplinary nature of this research is paramount. By exploring the intricate relationships between the automotive industry, public health, and environmental degradation, we shed light on the critical role that transportation policies play in shaping our collective future. Our investigation delves into diverse models of public participation, spotlighting the Citizens Assembly as a promising platform for democratic engagement. Beyond mere tokenism, we emphasize the necessity for actionable outcomes that genuinely empower citizens to influence policy directions. A key aspect are the evidence-based recommendations as a way forward in the German speed limit debate. Evidence reveals that public opinion in Germany favours a speed limit. Beyond the ecological gains, we underscore the underappreciated health co-benefits intrinsic to speed reduction—a dimension pivotal in shaping the discourse on comprehensive societal well-being. Progressive action, guided by informed democratic participation, is the cornerstone of sustainable change. We urge Germany to overcome inertia and propose concrete legislative measures that are in line with the aspirations of its citizens and the imperatives of global sustainability. Given the magnitude of the climate emergency, the adoption of pragmatic interventions, including a speed limit, assumes the character of a paramount step forward in Germany's commitment to a greener and healthier future.

Expanding Paid Sick Leave Laws: The Public Health Imperative

A key public health measure has received far too little attention over the course of the Covid-19 pandemic: paid sick leave policies that encourage people at risk of spreading disease to stay home rather than come to work. The United States is one of the only developed countries that fails to guarantee paid sick leave at the federal level, leaving a patchwork of state and private policies that undersupply time off when people are contagious and protect top wage earners at wildly disproportionate rates compared with what workers with lower incomes experience. Other countries have shown that sick leave mandates are neither unjustified burdens on employers nor gratuitous giveaways to employees. In fact, sick leave saves on health care costs by making employees less likely to infect coworkers, to be absent for longer themselves, or to need treatment in expensive hospital emergency departments. Nationally guaranteed sick leave is urgently needed to promote public health.

To Vax or Not? A Human Rights Review of the Implications of Mandatory Vaccination as a Response to COVID-19

The COVID-19 pandemic precipitated the largest public health emergency so far experienced in the twenty-first century. As the world frantically pursues a sustainable solution, several vaccines have been tested and approved by the World Health Organization (WHO) under the Emergency Use Listing procedure. On the heels of this development have been moves by some States to adopt mandatory vaccination policies. Several private firms have also required their employees to be vaccinated as a pre-condition for resuming work. This fast-evolving situation brings into sharp focus the tensions between the rights to health, privacy, bodily autonomy and the right to consent to medical treatment on the one hand, and the public health and safety imperatives of protecting global populations against a ravaging pandemic on the other hand. This article argues that aggressive mandatory vaccination policies being propagated globally violate human rights by strengthening prejudices, and stereotypes, and furthering discrimination against those who may be unwilling to take the vaccines for one reason or another. Ultimately, therefore, there will be a need for States to adopt their own tailor-made vaccination frameworks that ensure the respect of individual rights on the one hand, but also ensures that it does not prejudice public safety in the wake of a ravenous pandemic.

Implementing mandatory COVID-19 vaccination for Australian aged care workers.

Implementing mandatory COVID-19 vaccination for Australian aged care workers.

Families enacting ‘alternative’ schooling choices and the State: A power relationship

In recent years, French parents have increasingly chosen to homeschool their children or to send them to ‘alternative’ independent schools. French President Emmanuel Macron, in reaction to this trend, announced on October 2, 2020, his desire to restrict homeschooling to instances when ‘health imperatives’ necessitate this option and, further, to reinforce state control of independent schools. A bill to this effect passed on July 23, 2021, survived a challenge before the Constitutional Court, and became the law of the land one month later on August 24,.2021. The research for this paper was completed before the law took effect. Its aim was to understand the relationship between the State and those families who have made alternate schooling choices; that is, to explore the potential effects of implementing the new school policy. I relied on governmental data and, to capture how school policies were perceived by families, data collected in France that included interviews with parents, answers to an online survey, and one interview with a civil servant at the Ministry of National Education. The results of the research reveal that the dynamics that operate between ‘independent schooling’ families and the State have the markings of a power relationship that pits State authority against parents who tend to have low confidence in public schools and may identify with a counterculture. Finally, this recent legislation suggests that the French education system is moving from an educational model of ‘inclusion through control’ for children learning outside of public schools (Farges et al., 2018) to a model of exclusion through coercion.

16.4 The Allcove Youth Mental Health Imperative: Developing Early Intervention Mental Health Programs by and With Young People

Youth in the United States are in the midst of a devastating public mental health crisis. The headspace model from Australia was the first stand-alone, integrated care program for young people to access early mental health, physical health, and school/education support. The headspace model, and other international models that followed, were proven effective to improve young people’s mental, social, and emotional well-being. This presentation will explain the US development of allcove, an innovative integrated health system for young people aged 12 to 25 years, based on headspace, currently established in several locations in California.

Twenty-First Century Global ADR Management: A Need for Clarification, Redesign, and Coordinated Action.

Adverse drug reactions (ADRs) are estimated to be between the fourth and sixth most common cause of death worldwide, taking their place among other prevalent causes of mortality such as heart disease, cancer, and stroke. ADRs impact a broad range of populations across a wide variety of global geography and demographics, with significant mortality and morbidity burden in vulnerable groups such as older people, pediatric populations, and individuals in low-income settings. Too large a share of medicines risk management remains limited to signal detection in big ADR databases (USFDA, EMA, WHO, etc.) This resource allocation is antiquated and applied statistical signal detection methodologies have reached their limits of usefulness. In addition, existing databases are designed for short-term reactions, closely related to medication use and, thus, can only partially assess important broader consequences across geography, time, and clinical relevance. There is an urgent need change the dynamic. We need to identify (earlier and more regularly) many of the important but often overlooked or missed ADRs. Rather than assigning blame, we need to identify the root causes of the problem so they can be clearly addressed and fixed. The public health implications are profound—particularly as we recognize the importance of predicting and mitigating the next pandemic. Consequently, medicines risk management must be integrated within a broader global public health vision. To accomplish this, we need to develop the new tools and methodologies critical to assessing these public health imperatives.

Epistemic Exuberance at the Dinner Table

Epistemic Exuberance at the Dinner Table

Public-Private Partnerships to Lower the Risk of Diabetes Among Black Women Using Cooperative Agreements: The National Diabetes Prevention Program and the Black Women's Health Imperative.

The National Diabetes Prevention Program (National DPP) is a partnership of public and private organizations working to build a nationwide delivery system for a lifestyle change program (LCP), which is proved to prevent or delay onset of type 2 diabetes in adults with prediabetes. Through this program, the Centers for Disease Control and Prevention (CDC) establishes partnerships with organizations to prevent or delay the onset of type 2 diabetes by using the evidence-based and audience-tailored LCP. The DP17-1705 cooperative agreement aims to expand the reach of the program in underserved areas and to populations currently underrepresented in the program relative to their risk. This article highlights a successful adaptation of the National DPP PreventT2 curriculum to address the needs of women who are Black funded by this cooperative agreement. The Change your Lifestyle, Change your Life (CYL2) program resulted from a partnership between CDC and the Black Women's Health Imperative. Successes and challenges associated with this program are highlighted. Lessons learned from these efforts can be used by practitioners to inform future type 2 diabetes prevention initiatives.

Hotels as Noncongregate Emergency Shelters: An Analysis of Investments in Hotels as Emergency Shelter in King County, Washington During the COVID-19 Pandemic

This study analyzes the COVID-19 homelessness response in King County, Washington, in which people were moved out of high-density emergency shelters into hotel rooms. This intervention was part of a regional effort to de-intensify the shelter system and limit the transmission of the virus to protect vulnerable individuals experiencing homelessness. This study used quantitative and qualitative methods to describe the experiences of and outcomes on individuals who were moved from shelters to noncongregate hotel settings. The study highlights a new approach to shelter delivery that not only responded to the public health imperatives of COVID-19, but also indicated positive health and social outcomes compared to traditional congregate settings. The findings establish an evidence base to help inform future strategic responses to homelessness as well as to contribute to the broader policy conversations on our nation’s response to homelessness.

Imperatives of health or happiness: Narrative constructions of long-term smoking after undergoing lung screening.

Tobacco control policies reinforce a health imperative that positions citizens as duty-bound to manage their health by abstaining from or quitting smoking. Limited attention is paid to the repercussions - especially for lung screening - of anti-smoking rhetoric emphasising individual responsibility. Drawing on interviews with 27 long-term smokers involved in an international lung screening trial, this study analysed Australian smokers' narratives of smoking. By attending to stigma and the use of public health rhetoric within personal narratives, we show how narratives underscoring individual responsibility for quitting were layered with conflicting explanations of biological responsibility and normative expectations. Ironically, narratives of individual responsibility potentially undermine smoking cessation. In positioning smokers as responsible for their own healthy choices, such rhetoric also positions smokers as responsible for managing their emotional health, which some did through smoking. Thus, anti-smoking campaigns pit the neoliberal imperative of health against the happiness imperative. These findings have implications for the design and delivery of lung screening campaigns. They also support calls to move beyond health messaging emphasising individual choice, towards acknowledging the moral power of structures and public health campaigns to discipline citizens in unintended ways.

Global perceptions of South Korea's COVID-19 policy responses: Topic modeling with tweets

This article focuses on South Korea as a case, analyzes a collection of 87,487 tweets referencing both COVID-19 and South Korea during the period of the pandemic, and examines global users’ understandings and/or assessments of South Korean responses to the health crisis. This article uses Pseudo-document-based Topic Model (PTM) as an advanced machine learning technique for classifying short texts into viable topics or themes. In the PTM results, human rights-related topics received much less attention than other topics on government responses, health measures, vaccines, and economic issues. Furthermore, discussions on surveillance, restrictions on assembly, and stigmatization of religious groups tended to emerge rather briefly and soon subsided. Rights protection in the South Korean context appeared at odds with the larger target of protecting public health and the safety of society. The analyses demonstrate a tradeoff between implementing public health imperatives and respecting human rights in South Korea.

Unpaid Dementia Caregiving: A Policy and Public Health Imperative

Unpaid Dementia Caregiving: A Policy and Public Health Imperative

Diversity in clinical research: public health and social justice imperatives

It is well established that demographic representation in clinical research is important for understanding the safety and effectiveness of novel therapeutics and vaccines in diverse patient populations. In recent years,...

War prevention and mitigation are public health imperatives of our time

War has devastating immediate, long-term, and intergenerational-term impacts on health. Civilians, especially those who are internally displaced, disabled, living in poverty, children, and refugees bear the resulting disproportionate harm. The report ‘health in conflict settings’1 documents that 60% of chronically food-insecure and malnourished people globally, including 75% of all children with stunted growth, live in conflict-affected countries. Sub-Saharan Africa2,3 and the Middle East3 bear most of this burden, though other regions are not exempt.

Assembling Chinese health engagement in Africa: structures, strategies and emerging patterns

Employing the assemblage perspective, the paper examines the relations of exteriority, heterogeneity and fluidity in the development of global health cooperation ‘with Chinese characteristics’. Through the case of Chinese health engagement in Africa, the paper (1) reviews the shifting imperatives of China’s involvement in global health; (2) identifies the major approaches, institutions and actors in the design and implementation of overseas health projects; and (3) evaluates the linkages among diplomacy, politics and economics in shaping Chinese health cooperation. The findings demonstrate how public health emergencies such as Ebola and COVID-19 have served as catalysts to push forward new developments in the assemblage of China–Africa health cooperation. In particular, the last decade has witnessed a rescaling of the Chinese state to lead international health initiatives on the one hand and to incentivise diverse sub-state and non-state actors to engage in various health-related trade and investment activities on the other. The COVID-19 pandemic has accelerated the move from a state-guided process of health cooperation to a collective project pursued by multiple official and enterprise actors. The pandemic offers an opportunity to strengthen the links between health and non-health imperatives, hence further deepening China–Africa interdependence.

The COVID-19 sensorium and its vectors, victims, and violators

ABSTRACT The COVID-19 pandemic shifted relationships between hegemonic sensory perceptions and disease epistemologies. The affective pedagogies of the COVID-19 sensorium signal vectors and victims of disease through racialized, classed, and gendered assemblages of sensory presence and absence. Present sounds of weaponized coughing suture white consumerist entitlement to violate public health imperatives. The coughs in the film Corona critique the rise of anti-Asian violence and demonstrate how sound is intelligible through available stereotypes and circulating xenophobic rhetoric. Amid asymptomatic spread, appeals to “Typhoid Mary” Mallon—the first named asymptomatic typhoid carrier–re-emerged as another xenophobic sensory pedagogy to signify threatening absent symptoms.