Local Public Health Research Articles

Needs and opportunities for developing health and well-being profiles in Estonian local governments

Abstract The creation and implementation of health and wellbeing profile, an evidence-based framework for planning health promotion as holistic process, is the responsibility of public health practitioners, who tend work part-time and sometimes lack professional competences. The current study maps the level of awareness, attitudes, needs and possibilities of local government leaders and public health practitioners to develop and implement profiles effectively in Estonian local governments. Semi-structured interviews with leaders in local governments (10) and practitioners (9) were conducted in 2022-2023. Data was analysed using qualitative content analysis. Sample included representatives from all Estonian local governments (79 in total) and were categorized into subgroups based on local governments size, status of the profile, public health specialist employment, and educational background. Preliminary results indicate that leaders find as a supportive factors for enabling and encouraging profile compilation process for example: mandatory requirement; motivated implementors; well organized and effective workplan. Specialists find supportive factors to be cooperation on the national level, good communication practices and joint responsibility. Barriers for health promoters are the lack of time, motivation, financial resources, stakeholders understanding and meaningful action. The first qualitative study on these topics in Estonia highlight that creating a profile is supported by previous positive experience and have per contra an opposite negative effect to start the process. In general, the profile was considered necessary for helping identify problems and support decision-making processes for managing resources, however, assessment whether the profile should be obligatory is needed. In addition, there is a need for further support for the evidence-based decision-making process on the local level in health promotion by offering education and guidance from the national level. Key messages • Knowledge about the importance of public health, barriers and decision-making principles of local government leaders and specialists helps to develop interventions based on actual needs. • Continuously updated health and well-being profile ensures sustainability of health promotion action and is useful knowledge to policymakers, local government leaders and public health practitioners.

The Norwegian Counties Public Health Survey (NCPHS)

Abstract Effective public health initiatives should be based upon a thorough understanding of important health-related factors. The purpose of The Norwegian Counties Public Health Survey (NCPHS) is to gain insights from the adult population on topics relevant for planning of public health policy, interventions, and action at the county and municipality levels. The survey includes a core questionnaire on public health-related topics such as health behaviour, subjective quality of life, distress, subjective health, social support, social capital, community contexts, and demographics, including indicators of socio-economy, with additional optional questions and scales varying across data collections. Samples are drawn from the Norwegian National Population Register. NCPHS was piloted in three counties in 2015 and in one county in 2018. After some revision of instruments and sampling procedures, surveys have been carried out in most Norwegian counties since 2019. The total number of participants has now passed 400 000. Expedient data analysis and reporting has enabled the Norwegian Institute of Public Health to present comprehensive reports within six weeks after completed data collections. In these, outcome variables are analysed against district (within counties), gender, age, educational attainment, and assessment of household economy. Tables are also made available at the municipality level. The NCPHS represent a valuable addition to existing health registries and regional health surveys, providing critical information for planning purposes for local and regional public health authorities, for assessing trends over time, comparisons across counties and regions, and for evaluation of policies and interventions. The value of such a system during times of crises was demonstrated during the COVID-19 pandemic. At the Lisbon 2024 European Public Health conference, a few selected examples of use of data from the NCPHS system will be presented. Key messages • Large-scale community surveys provide important insights for planning of public health policies and action. • Strong involvement and collaboration with regional and local public health personnell as well as with media and local people is a prerequisite for succeeding.

How characteristics of place affect multimorbidity: a systematic scoping review

Abstract Background Multimorbidity has become a global public health challenge. Increasing work has identified different individual- and household-level determinants of multimorbidity; however, our understanding of how characteristics of place affect multimorbidity remains limited. This scoping review aims to identify the place-based risk factors of multimorbidity and to synthesis evidence (longitudinal in particular) on how place-based risk factors affect multimorbidity. Methods Following PRISMA-ScR guidelines, a predefined search strategy (https://osf.io/bf84m) was run across 7 major databases in 2023, with a double screening and data extraction process. English-language peer-reviewed studies exploring the relationship between place-based characteristics (from neighbourhood to region) and multimorbidity among the general population aged over 18 years old were included from 2010 to 2023. Results Out of 7761 records, 129 underwent full-text review, resulting in 76 included studies (15 longitudinal). We identified 12 types of place-based risk factors of multimorbidity, with area-level deprivation/SES, pollution, and urban/rurality most frequently examined. Fairly consistent findings suggested that people in more deprived, polluted, or urbanised areas were more likely to be multimorbid, which may further vary by multimorbidity definitions/measurements. Other place-based risk factors, such as social cohesion and greenspace availability, were linked to different single health conditions, but their associations with multimorbidity were underexplored. Finally, we proposed a potential theoretical framework that links place and multimorbidity through multiple pathways based on the synthesised evidence. Conclusions There remains only a partial understanding of how ‘place’ affects multimorbidity. Future studies should employ more precise measures for both place-based risk factors and multimorbidity and use longitudinal designs and analytical approaches for more causal insights. Key messages • This is the first scoping review that proposed a theoretical framework that demonstrates the links between place and multimorbidity. • This study will greatly benefit local policymaking and public health intervention initiation.

Innovation in border regions: from inequality to equity! Starting with acknowledgment in policy

Abstract Living in a border area can create health inequalities due to limited access to healthcare compared to people in central regions. In centrally located areas, citizens can choose healthcare providers 360 degrees around them, benefiting from full prevention and health promotion coverage. In contrast, border residents have only 180 degrees of access, leading to partial inclusion in health services. National systems typically prioritize health equality but not necessarily equity, especially for those living in border regions. To address this gap, innovative policies that account for cross-border interactions are needed, benefiting over 35% of the EU population living in border areas. A key question is how to ensure health equity in border regions. To explore this, cross-border case studies, like air pollution, food purchases, antibiotic availability and q fever were looked at to identify the situation, the public health challenges it entails and existing solutions. The Essential Public Health Functions (EPHF) framework, developed by the World Health Organization and the International Association of National Public Health Institutes, was used to evaluate public health functions with a focus on achieving greater equity and inclusiveness. Currently in cross-border health key EPHF functions such as health promotion and disease prevention are emphasized, while others like public health governance and community participation need improvement. To better implement health equity in border regions, for use of the EPHF framework an additional and short guideline was developed on how border regions should be considered in national, regional, and local public health policies. This approach offers a pathway to addressing health inequalities in these unique environments: a crucial step towards creating health equity. Key messages • The EPHF framework as an innovative tool to strengthen public health in border regions. • Take the geographical living space of citizens in a border region into account to achieve health equity.

Ensuring sustainable impact of the national report on climate change and health in Germany 2023

Abstract Issue/problem The Robert Koch Institute recently coordinated a status report on climate change and health for Germany, detailing the current and future impact of climate change on health through 14 chapters. Description of the problem A central aim was to ensure the report’s long-term impact and public health value. Essential areas of focus have therefore been stakeholder-specific communication and establishing a network of experts for continued scientific exchange. Results The publication of the report as peer-reviewed articles has served to reach the scientific community. Another target group are public health practitioners and decision makers at subnational levels, who can contribute towards climate change mitigation and adaptation measures relevant to health, as recommended in the report. This latter group was reached through various methods and formats of science communication, including conferences aimed at the public health sector, through target-group oriented podcasts, social media engagement and digital town hall discussions. Following publication, the experts involved in writing, reviewing and using the report were invited to establish a network in order to support long-term scientific exchange and collaborations and in turn ensure the report’s sustainable impact and value. Lessons Through follow-up evaluations, the reception of the report and the further communication needs of this target group were analysed. A major lesson was to include the insights of public health practitioners more systematically and at an earlier stage in any future reports. As for the establishment of a network, a survey amongst the authors and other experts showed what this group considers the goals of this network: creating synergies and connections with existing initiatives and providing a platform for further exchange, especially amongst researchers addressing similar questions, such as the efficacy of mitigation and adaptation measures, from different angles. Key messages • Local public health practitioners are important stakeholders for climate change and health for ensuring public health impact. • The expertise in the network will support continued scientific exchange on climate change and health and thus ensure the national report’s sustainability.

Measles cluster in Northern Portugal: enhancing surveillance strengths

Abstract Although measles was declared eliminated in Portugal in 2015, outbreaks persist, despite high vaccination coverage. The last outbreak in the northern region was in 2017. Portugal has a Surveillance System implemented for mandatory communicable diseases (SINAVE) integrating clinical, epidemiological and laboratory data. In 2021, WHO expressed concern about the low sensitivity of measles surveillance and urged Portugal to strengthen its surveillance practices. Our study aims to describe a measles cluster in northern Portugal during the first trimester of 2024. Data from measles cases from the first trimester of 2024 were collected from SINAVE. Contact tracing and Public Health (PH) intervention data was sent by Local Public Health Authorities through a survey designed for that purpose. A total of 70 suspected cases were reported and investigated: 6 cases were laboratory confirmed and 64 were discarded. The confirmed cases had a mean age of 28 years (all adults), with 50% female. The mean notification time was 0,3 days. The index case was imported (Mauritania) and unvaccinated, leading to 2 secondary cases. Five cases had 2 doses of a measles vaccine, with 1 case being a health professional. Additionally, 1 case was imported from France. For 2 cases the source of infection could not be unequivocally identified and no travel history during incubation period. A total of 851 contacts of confirmed cases were identified. Although sustainable transmission is not evident in our region, measles is being introduced through migration and tourism. Despite clinical awareness, strengthening early case detection is essential to enforce effective control measures. PH teams have been working tirelessly to trace clusters origins, gathering large number of contacts and adapting strategies for sustained control. In a globalized world, ensuring surveillance sensitivity is paramount. Integrating other data sources in surveillance routine is crucial for upholding Measles-Free Status compliance. Key messages • Measles must take centre stage on our agenda. • Reinforcing surveillance, integrating additional data sources, is crucial for heightened sensitivity and prompt response.

Measles outbreak under the Leaning Tower of Pisa in Italy

Abstract Background Measles cases in Italy (58,9 mln population) were 8 in 2021, 15 in 2022 and 43 in 2023. Between January and April 2024 there were 213 cases in Italy, with higher incidence in children. Pisa Local Public Health Department (201073 population) experienced a measles outbreak in the same period. Methods Cases were classified according to Decision (EU) 2018/945. A bidirectional tracing (backward and forward) was conducted to identify transmission chain and contacts of cases. Immunization status was checked on Regional Vaccination Registry. Results 33 suspected measles cases were notified in Pisa between 21st January and 17th April 2024: 16 by General Practitioners and 17 by Hospital Emergency Room. Additionally, 1 undiagnosed case was found during the epidemiological investigation. 2 notifications were withdrawn by General Practitioner because of lack of the diagnostic criteria. Laboratory analysis confirmed 24 cases. Last confirmed case occurred on 23rd February, while not confirmed cases occurred mostly in the last part of the period (6 in a row from 3rd March to 17th April), suggesting an infodemic effect. Women were more affected than men (17 vs. 7). Except for 2 babies (9 months and 1 year old age), the outbreak affected young adults with a mean age of 40 yo. Hospitalization rate was 37,5%. The first 5 unrelated cases occurred between 19th and 21st January. A second wave involved 13 people, 12 of them were related to a single case. Transmission occurred in Emergency Room (7), in a mall (1) and in the neighborhood (4). A third wave involved 4 cases (family contacts). 2 cases were imported from Sicily and Spain. All cases were unvaccinated, 2 were migrants. Around 950 contacts were traced. Conclusions In Pisa, high vaccination coverage of children < 2years of age (≥95%) protected school population and cases to spread, but there are pockets of unvaccinated adults which could allow measles circulation. Key messages • An effective public health response is required to contrast increasing measles cases in EU/EE countries. • As recommended by ECDC, public health services need to close immunity gaps, addressing catch-up actions towards adults and vulnerable groups as migrants.

Investigation of a Norovirus GII outbreak in a primary school in Portugal,2023

Abstract Background The onset of acute gastroenteritis cases among students in a primary school class on September 19, 2023, prompted an immediate response from the local Public Health unit. A collaborative effort was initiated to investigate and contain the outbreak. Methods Epidemiological questionnaires were distributed to 166 students and 8 staff members, defining cases as individuals exhibiting symptoms including diarrhoea, vomiting, or nausea between September 19th and September 24th, 2023. Additionally, stool samples were collected from three individuals. Results Out of 166 students and 8 staff members, 39 individuals met the case definition, resulting in attack rates of 22% (37/166) and 25% (2/8) among students and staff, respectively. Laboratory analysis confirmed two cases of Norovirus GII among the tested specimens, with five students requiring medical attention. Conclusions Our investigation underscores the significance of continuous epidemiological surveillance and swift implementation of infection control measures in school settings. The detection of Norovirus transmission emphasizes the necessity for rigorous adherence to infection control best practices. Our findings advocate for sustained technical support from public health authorities to prevent and manage similar outbreaks effectively. Key messages • Study on Norovirus outbreak in a primary school highlights the imperative of infection control measures, emphasizing the importance of ongoing support from public health authorities. • The Norovirus outbreak investigation underscores the vital role of surveillance and swift response in containing infectious diseases within educational settings safeguarding all.

Adapting, expanding and embedding community and culture into health ecosystems

Abstract Background Community anchor organisations (CAOs) work with communities who experience health inequalities and disadvantage, providing a range of activities and services to meet individuals’ needs in an integrated way. This study explored how CAOs use art, cultural and nature-based activities as part of their work to respond to the needs of people facing inequalities and considered how activities can be scaled in this health setting. Methods This study used community-based participatory research within a case study approach to work with four purposively sampled CAOs. Participants were community members, volunteers, staff, trustees, partner organisations and commissioners. Data collection methods included: document analysis, interviews (n = 45), workshops (n = 5) and focus groups (n = 11). This study was also supported by data collected by trained community researchers (n = 18). Framework analysis was conducted for within- and cross-case analysis. Results In the context of CAOs, the delivery of art, cultural and nature-based activities were found to be an important mechanism for developing trusted relationships with marginalised groups, who may lack trust in statutory services and health focused activities. Other facilitators to community engagement were the CAOs’ longevity, localness and co-location of services within a trusted and familiar place that connect people to personalised support. Barriers to scaling up included funding models as well as insufficient dialogue and understanding between CAOs and the local public health ecosystem. Conclusions CAOs have long term trusted relationships with disadvantaged communities and are influential in connecting individuals with projects and services. Findings suggest that the effectiveness of action to address inequality through art, cultural and nature-based activities could be improved if the role of CAOs was recognised more coherently in place-based public health plans. Key messages • Creative activities enable meaningful engagement with disadvantaged groups within place-based settings. • CAOs must be recognised more coherently in place-based strategies to reduce health inequalities.

Investigation of a Norovirus GII.4Sydney[P16] outbreak in a care facility in Portugal, 2022

Abstract Background On the 29th of April 2022 the local Public Health unit was notified of 12 cases of acute gastroenteritis in residents of a long-term care facility (LTCF). A joint epidemiological investigation team was established and initiated an outbreak investigation to characterize the outbreak and implement infection control measures. Methods Epidemiological questionnaires were administered to staff (n = 44) and residents (n = 60). Case definition was LTCF residents or staff members with at least one of the following symptoms: diarrhoea, vomiting, nausea, between April 25th and May 14th, 2022. Stool or vomit samples were collected for 11 individuals. To assess environmental contamination fifteen food samples from previous meals and six surface samples from toilet faucets, wash tubs, and cutting boards were collected. Spatial distribution of cases within the LTCF was performed to guide infection control implementation. Results A total of 43 people met the case definition. Attack rates in residents and staff were 37% (23/63) and 42% (20/48), respectively. Of the total tested specimens, six (6/8) from residents and two (2/3) from staff were positive for the Norovirus (NoV) GII.4 Sydney [P16] variant by genotyping. Two (2/6) samples from surface swabs from the toilet faucet in the resident’s living room were also positive for NoV GII. Food samples were negative for major bacterial agents implicated in gastrointestinal outbreaks. Cases were distributed throughout the LTCF wards with no clear clustering. Four residents required hospital admission. Conclusions Results suggest person-to-person as well as environmental transmission of NoV. Identification of behavioural and spatial patterns of residents and staff and subsequent enactment of infection control strategies mitigated the outbreak. These findings reinforce the need for public health to maintain continuous technical support to LTCF on the implementation of infection control best practices. Key messages • Outbreak investigation in LTCF confirms Norovirus transmission, emphasizing the importance of infection control measures in long-term care facilities. • Study reveals Norovirus outbreak in LTCF, underscores the role of person-to-person and environmental transmission, highlighting the need for robust infection control protocols.

An After-Action Review at Municipal Level in the Public Health Service - Lessons Learned at the Corona Unit of the Duesseldorf Public Health Authority after the end of the Covid-19 Pandemic, March 2023

After-Action Reviews (AARs) represent structured, qualitative evaluations of crisis interventions. Here, we describe the implementation of an AAR to assess the Corona Unit of the Duesseldorf Health Department. We employed an after-action review (AAR) using the working group format supplemented by structured interviews with key personnel. Our approach was guided by the guidelines for AARs provided by the World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC). Participants identified nine relevant challenges with potential for improvement in three categories: (I) challenges in recruiting requested personnel, (II) overarching coordination issues, and (III) frequent relocations. Participants proposed solutions for these challenges: (I) 1. Routine cross-agency inquiries for voluntarily available personnel, 2. consideration of resources from municipal subsidiaries and involvement of personnel with leadership experience from other departments, 3. Better coordination of deployment and onboarding, 4. proposal for early communication regarding different compensation regulations, (II) 5. establishment of an overarching coordination authority for the crisis unit, 6. clearer delineation of responsibilities within the crisis unit with explicit job profiles, 7. establishment of a shared working platform, and 8. creation of a central dashboard for generating all situation reports. Additionally, they identified (III) 9. a facility for housing a crisis unit in case of an emergency. This study represents one of the first applications of an AAR for evaluating crisis structures at the level of a local Public Health Authority (LPHA) in the context of the COVID-19 pandemic. While some of the identified challenges are specific to Duesseldorf, many municipalities faced personnel recruitment and coordination challenges during the COVID-19 pandemic. Municipal crisis plans can be reviewed and adjusted concerning the identified challenges. Sharing evaluation results among LPHA stakeholders can contribute to strengthening crisis structures in the long term.

Equity-centered adaptive sampling in sub-sewershed wastewater surveillance using census data.

Sub-city, or sub-sewershed, wastewater monitoring for infectious diseases offers a data-driven strategy to inform local public health response and complements city-wide data from centralized wastewater treatment plants. Developing strategies for equitable representation of diverse populations in sub-city wastewater sampling frameworks is complicated by misalignment between demographic data and sampling zones. We address this challenge by: (1) developing a geospatial analysis tool that probabilistically assigns demographic data for subgroups aggregated by race and age from census blocks to sub-city sampling zones; (2) evaluating representativeness of subgroup populations for COVID-19 wastewater-based disease surveillance in Davis, California; and (3) demonstrating scenario planning that prioritizes vulnerable populations. We monitored SARS-CoV-2 in wastewater as a proxy for COVID-19 incidence in Davis (November 2021-September 2022). Daily city-wide sampling and thrice-weekly sub-city sampling from 16 maintenance holes covered nearly the entire city population. Sub-city wastewater data, aggregated as a population-weighted mean, correlated strongly with centralized treatment plant data (Spearman's correlation 0.909). Probabilistic assignment of demographic data can inform decisions when adapting sampling locations to prioritize vulnerable groups. We considered four scenarios that reduced the number of sampling zones from baseline by 25% and 50%, chosen randomly or to prioritize coverage of >65-year-old populations. Prioritizing representation increased coverage of >65-year-olds from 51.1% to 67.2% when removing half the zones, while increasing coverage of Black or African American populations from 67.5% to 76.7%. Downscaling had little effect on correlations between sub-city and centralized data (Spearman's correlations ranged from 0.875 to 0.917), with strongest correlations observed when prioritizing coverage of >65-year-old populations.

The Norwegian Counties Public Health Survey (NCPHS): a design study.

Effective public health initiatives should be founded on a comprehensive and robust understanding of health-related factors including societal and community contexts. The Norwegian Counties Public Health Survey (NCPHS) aims for insights into the adult population on topics relevant for planning public health practices at county and municipality levels. The NCPHS includes a core questionnaire on public health-related topics and demographics, including indicators of socio-economy, with additional optional questions and scales varying across data collections. Samples are drawn from the Norwegian National Population Register and 'washed' against the Common Contact Register to retrieve digital contact information and exclude those who cannot be contacted electronically. NCPHS was piloted in 2015 and 2018 (four counties). After some revision of instruments and sampling procedures, surveys have been carried out in most Norwegian counties since 2019. The total number of participants has now passed 400,000. Expedient data analysis has enabled the Norwegian Institute of Public Health to present comprehensive reports within 6 weeks of completed data collections. In these, outcome variables are analysed against district (within counties), gender, age, educational attainment and self-reported sufficiency of household income. Tables are also made available at the municipality level. The NCPHS represents a valuable addition to existing data sources, providing critical information for planning purposes for local and regional public health authorities, for assessing trends over time, comparisons across counties and regions and for evaluation of policies and interventions. The value of such a system during times of crisis was demonstrated during the COVID-19 pandemic.

The adoption and implementation of local government planning policy to manage hot food takeaways near schools in England: A qualitative process evaluation

IntroductionAccess to hot food takeaways, particularly near schools, is of growing concern for policymakers seeking to reduce childhood obesity globally. In England, United Kingdom (UK), local government jurisdictions are implementing planning policies to reduce access by restricting or denying planning permission for new takeaway outlets near schools. We used a qualitative approach to explore local government officers’ perspectives on the barriers to and facilitators of the adoption, implementation, and perceived effectiveness of these policies. MethodsIn 2021–2022, we conducted semi-structured interviews with 29 local planning (‘planners’) and public health government officers from 15 different local authorities across England who adopted a policy to restrict new takeaways. Data were analysed thematically. ResultsParticipants explained that they mostly thought the policies facilitated the refusal of applications for new takeaways near schools. However, participants speculated that businesses identified alternative opportunities to operate including functioning as ‘restaurants’ or within other locations. Effective working relationships between planners and public health officers were important for adoption and implementation, although planning and public health agendas did not always align and there were tensions between economic development and health improvement goals. The policy was adapted to suit local needs and priorities; in some cases, the policy was not used in areas where economic growth was prioritised. Clarity in policy wording and establishing a formal process for implementing policies including a designated individual responsible for checking and reviewing takeaway applications helped ensure consistency and confidence in policy implementation. ConclusionAlthough sometimes challenging, the policies were commonly described as feasible to implement. However, they may not completely prevent new takeaways opening, particularly where takeaways are relied upon to enhance local economies or where takeaway businesses find alternative ways to operate. Nevertheless, the policies can serve to shift the balance of power that currently favours commercial interests over public health priorities.

Prevalence of HIV, Syphilis, and Hepatitis B and C Among Blood Donors in a Tertiary Care Hospital in Mexico

The prevalence of transfusion-transmissible infections (TTIs) among blood donors is critical for ensuring blood safety. Aim: To provide an updated assessment of TTIs at a tertiary care hospital in Mexico over a ten-year period. We conducted a retrospective cross-sectional study. Blood samples were analyzed from potential donors at tertiary care hospital between 2012 and 2022. Donors completed a questionnaire and were screened for HIV, syphilis, hepatitis B, and hepatitis C using nucleic acid testing and serological tests. Prevalence and trends were estimated. Among the 117,756 donors analyzed, 0.48% were positive for syphilis, with a significant annual decrease of −5.9% (p < 0.001), although notable fluctuations occurred, including a peak in 2021. HIV showed a significant annual increase of 9.8% (p = 0.029), with a peak in approximately 2019–2020. Hepatitis C maintained a stable trend, with a slight annual decrease of −5.6% (p = 0.170). Hepatitis B consistently decreased, with an annual decrease of −11.3% (p = 0.06). This study highlights the importance of continuous monitoring and screening of blood donors to ensure blood safety. These findings underscore the need for localized public health interventions, particularly to address the increasing incidence of HIV. Further research should focus on enhancing donor screening practices and public health strategies to reduce the prevalence of TTIs.

The Use of the CDC Preventive Health and Health Services Block Grant to Address Social Determinants of Health to Advance Health Equity.

State public health departments use federal funding to examine and address social determinants of health (SDOH) within their communities to improve health and advance health equity. Yet, most federal funding is categorical (ie, funding used for a specific program or narrow purpose), which can create barriers to addressing social and structural drivers of inequity. The Preventive Health and Health Services Block Grant (PHHS Block Grant) is a flexible funding mechanism that provides health departments the latitude to identify and fund initiatives that address local public health needs. It is unclear, however, to what extent health departments use this flexible resource to incorporate SDOH into their programs. Cross-sectional, descriptive analysis of state health department PHHS Block Grant program administrative data. This study examined PHHS Block Grant budgets and workplans for the federal Fiscal Year 2021 to assess whether state health departments aligned their grant-funded program with the national objectives associated with the Healthy People 2030 SDOH Framework. Forty-seven states and the District of Columbia were included in this study. Percent of states that used PHHS Block Grant funds to address SDOH; proportion of funding allocated to address SDOH; percentage of programs that addressed SDOH. Three-fourths (75%) of states allocated funds to 97 programs aligning with at least 1 Healthy People 2030 SDOH-related objective. Fifty of the programs were fully or primarily funded by the PHHS Block Grant. Results also show that as the states' PHHS Block Grant funding level increased so did the percent of states that allocated funding toward SDOH programs. This study shows that state health departments are using the PHHS Block Grant to address SDOH, and that the grant plays an important funding role for these programs. States are incorporating the grant into their funding strategies to address SDOH.

Insights From Community Organizations Collaborating With Government and Academia to Foster Health Literacy.

The COVID-19 pandemic disproportionately impacted ethnic minority and other underserved communities, prompting the federal government to fund community-led health literacy initiatives. This evaluation shares challenges and lessons learned, and identifies best practices from community-based organizations (CBOs) partnering with academia and local government to support health literacy programming. In 2023, 20 representatives from 12 CBOs in Southern California responded to an interviewer-administered survey, including open-ended questions about lessons learned. We analyze text data to identify key themes. CBOs expressed a need for additional financial resources and technical assistance, including grantsmanship training, access to in-language resources, support to build and use in-house evaluation systems, and greater university oversight for student collaborators. Respondents highlighted the importance of community engagement efforts to build trust and enhance the uptake of programming. They also stressed the need for specialized training of community health workers engaged in health programs and the utilization of population sub-group data to inform policy and funding development to better serve communities' needs. CBOs are eager to partner with government and academia and acknowledge the need for targeted support and resources that can be facilitated through multisectoral partnerships. We offer recommendations and actionable strategies for funders and academia to create and improve equitable partnerships with CBOs. Partnerships that address the needs and systemic barriers experienced by ethnic minority communities will support local public health goals while fostering resilience and health equity.

Adherence to COVID-19 measures and the associated factors: evidence from a two-wave longitudinal study in Singapore

BackgroundAt the onset of the Coronavirus disease (COVID-19) pandemic when pharmaceutical interventions were not readily available, governments relied on public health mandates and social distancing measures to counter rising infection rates. In order to address the dearth of longitudinal studies, this study sought to identify factors associated with continued adherence to COVID-19 preventive behaviours in Singapore.MethodsData were from a two-wave longitudinal cohort study; baseline study was conducted from May 2020 to June 2021 and follow-up study from October 2021 to September 2022. Participants (n = 858) were Singapore residents, aged 18 and above, and able to speak English, Chinese or Malay. Weighted multivariable logistic regressions were conducted to identify factors associated with adherence to the COVID-19 measures.ResultsAdherence rates of ‘avoid dining out’, ‘crowded places’, ‘people with flu symptoms’ and ‘small group gatherings’ at baseline were 39.41%, 60.82%, 79.82%, and 44.82% respectively. All measures had a decrease in adherence rates across the two-waves. Older age groups were associated with greater adherence to ‘avoid dining out’ and ‘avoid crowded places’. Having high trust in local public health experts was associated with greater adherence to ‘avoid crowded places’ and ‘avoid people with flu symptoms’. Fear of family and friends getting infected with COVID-19 was associated with ‘avoid dining out’ and ‘avoid crowded places’.ConclusionsSoft interventions like nudges can be implemented at crowded places to remind the public of the ease of transmitting the virus to their loved ones. Increasing media presence of public health experts can be a viable alternative to improve adherence.

Achieving deep transport energy demand reductions in the United Kingdom

The transport sector is a crucial yet challenging area to decarbonize, given its heavy reliance on fossil fuel usage, carbon-intensive infrastructure and car-centric lifestyles. It remains the largest contributor to local air pollution in cities yet has the potential to improve people's physical and mental health. This research investigated the potential contribution of transport energy demand reduction to climate change mitigation and improving public health. Using a comprehensive bottom-up modelling framework, the Transport Energy and Air pollution Model (TEAM), this study provides an integrated assessment of the impacts of deep mobility-related energy demand reductions, including lifecycle carbon emissions, local air pollution and health impacts. Using a sociotechnical scenario approach and the UK as a case study, this research reveals that energy demand reductions of up to 61 % by 2050 compared to baseline levels are achievable and can enhance citizens' quality of life. Business as usual approaches which rely on a technical transition miss the legislated carbon budgets and result in higher energy demand in 2050. More comprehensive scenarios deliver a reduction of up to 72 % in total lifecycle carbon emissions by 2050, with approximately half of the reduction achieved through mode shifting and avoiding travel, while the other half comes from vehicle energy efficiency, electrification, and downsizing of the vehicle fleets. The research shows that it can lead to significant co-benefits such as improved local air pollution and public health. The feasibility and practicality of policy measures and integrated strategies identified for achieving deep transport-energy demand reductions are discussed.

Respiratory Isolation for Tuberculosis: A Historical Perspective.

Although tuberculosis is an ancient disease, recognition of its airborne route of transmission, with implications for respiratory isolation, is only relatively recent. Since the time of Hippocrates, the dogma among health practitioners was that the disease was hereditary or that it could be contracted by inhaling "miasma", or corrupted air. Consequently, isolation of patients was not routine practice, and, in fact, patients with scrofula (morbus regius, or "king's evil) sought to be cured by the "royal touch" throughout the middle ages. The sanatorium, which emerged in the mid-19th century, initially served as a place of healing, where patients could receive the appropriate diet, rest therapy, graduated exercise, and abundant fresh air. Major scientific breakthroughs, including Robert Koch's 1882 discovery of the tubercle bacillus as the disease's etiological agent and early 20th century experimental evidence that the organism could be transmitted via expectorated droplet nuclei, helped to reinforce the important public health role of sanatoria and tuberculosis hospitals in preventing disease transmission through isolation. The advent of highly efficacious and oral antitubercular regimens in the mid-20th century and the concurrent declining incidence of the disease contributed to the closure of tuberculosis sanatoria and hospitals in the US and western Europe. Over the past several decades, tuberculosis treatment in the US has been conducted in the outpatient setting under the supervision of local public health departments. Patients receiving treatment are required to remain in respiratory isolation in the home until they are deemed noninfectious based on multiple sputum samples. This historical review demonstrates that despite changing medical knowledge, drug therapies, and social conditions over time, the role of isolation remains an important topic of debate in the treatment of patients with pulmonary tuberculosis.