Multisectoral Strategies Research Articles

Global nurse/midwife workforce and reproductive health through social ecology lens.

To explore how community social ecology factors may be associated with country registered nurse/registered midwife (RN/RM) workforce supply and reproductive health globally. A cross-sectional design using a social ecology framework was employed. Data were retrieved from publicly available websites for 107 countries. Dependent variables included RN/RM density, maternal mortality ratios (MMR), and adolescent birth rates (ABR). Independent variables included gender inequality, region, country income classification, education, gross domestic product per capita, government expenditure of spending on education and health, life expectancy, percent of female seats in legislature, and labor force participation factors. The best fit multivariable model of RN/RM density showed that after adjustment for region, country income and the GII, the percent of females with some secondary education explained most of variation in RN/RM density. The best fit models of MMR and ABR showed that gender inequality explained most of the variation. Other factors in the models were the percent of female seats in legislatures, region, country income class, and mean years of schooling. Employing a social ecology model can useful in RN/RM workforce planning and development as countries seek multisectoral strategies for increasing the RN/RM supply and improving reproductive health outcomes.

Priority Issues from a Health Implementation Plan: A Qualitative Study of Local Foundation and Nonprofit Leaders’ Perceptions

The purpose of this article is to examine how local leaders of health foundations and nonprofit organizations perceive key health issues (such as violence, housing, and chronic disease) included in a municipal health department’s implementation plan. Specifically, we examine how these leaders prioritize health issues and what their ideas are regarding how to address them. To do this, we used a semistructured interviewing strategy to gather feedback from 10 senior leaders of health foundations and 13 senior leaders of nonprofit agencies in the City of Chicago. We conducted a content analysis of these interviews and found that participants emphasized the importance of addressing broad conditions related to violence, economic development, and education across the lifespan using multisector collaboration strategies. These findings suggest that these foundation and nonprofit representatives consider social determinants of health to be key in promoting population health.

Social determinants of under-5 child health: A qualitative study in Wolkayit Woreda, Tigray Region, Ethiopia.

Despite the significant reductions seen in under-5 child mortality in Ethiopia over the last two decades, more than 10,000 children still die each year in Tigray Region alone, of whom 75% die from preventable diseases. Using an equity lens, this study aimed to investigate the social determinants of child health in one particularly vulnerable district as a means of informing the health policy decision-making process. An exploratory qualitative study design was adopted, combining focus group discussions and qualitative interviews. Seven Focus Group Discussions with mothers of young children, and 21 qualitative interviews with health workers were conducted in Wolkayit district in May-June 2015. Data were subjected to thematic analysis. Mothers’ knowledge regarding the major causes of child mortality appeared to be good, and they also knew about and trusted the available child health interventions. However, utilization and practice of these interventions was limited by a range of issues, including cultural factors, financial shortages, limited female autonomy on financial resources, seasonal mobility, and inaccessible or unaffordable health services. Our findings pointed to the importance of a multi-sectoral strategy to improve child health equity and reduce under-5 mortality in Wolkayit. Recommendations include further decentralizing child health services to local-level Health Posts, and increasing the number of Health Facilities based on local topography and living conditions.

Drug Overdose Deaths Involving Cocaine and Psychostimulants with Abuse Potential - United States, 2003-2017.

In 2016, a total of 63,632 persons died from drug overdoses in the United States (1). Drug overdose deaths involving cocaine, psychostimulants with abuse potential (psychostimulants), or both substances combined increased 42.4% from 12,122 in 2015 to 17,258 in 2016.* Psychostimulants with abuse potential include drugs such as methamphetamine, 3,4-methylenedioxy-methamphetamine (MDMA), dextroamphetamine, levoamphetamine, methylphenidate (Ritalin), and caffeine. From 2015 to 2016, cocaine-involved and psychostimulant-involved death rates increased 52.4% and 33.3%, respectively (1). A total of 70,237 persons died from drug overdoses in the United States in 2017; approximately two thirds of these deaths involved an opioid (2). CDC analyzed 2016-2017 changes in age-adjusted death rates involving cocaine and psychostimulants by demographic characteristics, urbanization levels, U.S. Census region, 34 states, and the District of Columbia (DC). CDC also examined trends in age-adjusted cocaine-involved and psychostimulant-involved death rates from 2003 to 2017 overall, as well as with and without co-involvement of opioids. Among all 2017 drug overdose deaths, 13,942 (19.8%) involved cocaine, and 10,333 (14.7%) involved psychostimulants. Death rates increased from 2016 to 2017 for both drug categories across demographic characteristics, urbanization levels, Census regions, and states. In 2017, opioids were involved in 72.7% and 50.4% of cocaine-involved and psychostimulant-involved overdoses, respectively, and the data suggest that increases in cocaine-involved overdose deaths from 2012 to 2017 were driven primarily by synthetic opioids. Conversely, increases in psychostimulant-involved deaths from 2010 to 2017 occurred largely independent of opioids, with increased co-involvement of synthetic opioids in recent years. Provisional data from 2018 indicate that deaths involving cocaine and psychostimulants are continuing to increase.† Increases in stimulant-involved deaths are part of a growing polysubstance landscape. Increased surveillance and evidence-based multisectoral prevention and response strategies are needed to address deaths involving cocaine and psychostimulants and opioids. Enhancing linkage to care, building state and local capacity, and public health/public safety collaborations are critical components of prevention efforts.

F-105 Surveillance of viral zoonoses in Africa

In recent years, the increased rates in the mergence and re-emergence of highly infectious diseases of humans and animals, with high health and socio-economic impacts and serious biosafety and biosecurity challenges have been observed, worldwide. In Africa, highly dangerous pathogens even unpredictably re-emerge or emerge in new geographic areas or are newly discovered. Most recent examples include discovery of highly pathogenic Old World arenavirus (Lujo virus) following air transport of a fatally ill patient from Zambia to South Africa and the spread of Zaire ebolavirus associated with severe and widespread outbreaks of Ebola viral haemorrhagic fever in West Africa in 2014. To strengthen the research and surveillance capacity for viral zoonosis in Zambia, a 5 year (2013–2018) project entitled “Surveillance of viral zoonoses in Africa” was implemented through collaborative research between Zambia and Japanese Research Institutions. This is supported through a Technical Cooperation Project by the Japan International Cooperation Agency (JICA) and the Agency for Medical Research and Development (AMED)/Japan Science and Technology Agency (JST) under the framework of the Science and Technology Research Partnership for Sustainable Development (SATREPS). The University of Zambia (UNZA) with financing from the World Bank has established the Africa Centre of Excellence for Infectious Diseases of Humans and Animals (ACEIDHA) to address some of the public health challenges. ACEIDHA endeavours to achieve the regional goal of understanding the natural history of some infectious diseases, through new evidence-based, cost effective, multi-disciplinary, multi-sectoral, and collaborative strategies to be implemented by well-trained and skilled scientists. It will, subsequently, increase the sub-region's human resource capacity to deal with these problems by training a pool of scientists at MSc and PhD levels. Recently, ACEIDHA has been accepted as a GVN Affiliate Centre of Excellence. This status will enable ACEIDHA to better train virologists at MSc, PhD and post-doctoral levels. It will, further, help to facilitate interactions of other GVN members with a number of partners in Africa, which is critical to GVN's mission in preparing the world for future outbreaks of viral diseases. Considering that zoonoses cannot be eradicated, it is imperative to take pre-emptive action to determine the circulation of the related pathogens in the environment. In this regard, biological samples from potential hosts (wild animals, livestock and human) are collected and examined for the status of the known and unknowns pathogens. We, also, embark on establishment an/or improvement of detection methods for known viral zoonoses. In this regard, inter alia, a simple, reliable, low cost immunochromatographic assay, named QuickNaviTMEbola, for rapid diagnosis of Ebola virus disease (EVD) has been developed. Furthermore, working together in a multidisciplinary One Health platform, activities are conducted to identify natural reservoirs for the elucidation of transmission pathways of zoonotic viruses and risk factors as well as drivers for emergence of known and/or unknown viruses in communities and our work has potential for discovery of novel viruses originating from animals. Incidentally, since the outbreak of 2014 EVD in West Africa, all samples from cases of suspected EVD in Zambia are tested under our project working with the Ministry responsible for Health in Zambia. This work contributes to building the capacity for Africa to be better prepared for any eventual outbreak of highly infectious diseases of humans and animals.

Integrating Typhoid Fever Within the Sustainable Development Goals: Pragmatism or Utopia?

Several decades following the first estimates of the global burden of typhoidal salmonellosis (infections caused by Salmonella Typhi and Salmonella Paratyphi), this disorder remains a major cause of morbidity worldwide with an estimated 17 million cases annually. The risk factors for typhoid include poverty, poor living conditions with unsafe water and lack of adequate sanitation, and unsafe foods—all reasons for the disease burden being highest among such populations including urban slums. A recent review of typhoid trends globally and in specific countries suggests that the relative contributions of these risk factors to disease burden reduction as well as persistence have varied. There is also the risk of periodic outbreaks related to introduction of relatively virulent drug-resistant strains or movements of vulnerable populations, including those in conflict zones. Most countries of the world are now aligning their health and multisectoral strategies to address the Sustainable Development Goals (SDGs) and targets, which were agreed upon by all countries of the world in September 2015. Though neglected so far, there are huge opportunities for mainstreaming typhoid prevention and control strategies within the SDGs. This article reviews some of the approaches that may help elevate typhoid to a higher level of awareness in public health programs and policy and to ensure that investments in major public health preventive measures are made part of the universal health coverage agenda.

Burden and profile of spinal pathology at a major tertiary hospital in the Western Cape, South Africa

Background: Spinal pathology in the Western Cape is managed at three tertiary level hospitals, including Tygerberg Hospital. The Tygerberg Hospital Orthopaedic Spinal Unit is responsible for the management of spinal pathology for the 3.4 million people in the hospital’s catchment area. However, the unit’s overall burden of disease and associated resource use is currently unclear. Aim: The first aim was to investigate the overall burden and clinical profile of spinal pathology presenting to the Tygerberg Hospital Spinal Unit over a one-year period. The second aim was to determine resource use associated with spine pathology admissions. Methods: Overall burden was investigated by performing a retrospective review of all patients admitted to the Spine Unit between 1 October 2016 and 30 September 2017. Demographic and clinical data was collected, and patients were assigned to one of five spinal pathology sub-groups. Resource use was determined by length of hospital stay, waiting times, advanced imaging and theatre usage. Results: Overall burden comprised 349 individual patients and 376 admissions, including readmissions. Trauma (51%) and infection (24%) accounted for the majority of admitted pathology with degenerative (10%), deformity (7%) and malignancy (7%) representing fewer admissions. Motor vehicle accidents were the primary mechanism of injury, accounting for 48% of spine trauma. Tuberculosis was the causative organism in 87% of spinal infections with 44% HIV co-infection. Hospital resource use was considerable with 92% of spine patients requiring advanced imaging, a median operating time of 3 h 36 min and a median hospital stay of 19 days. Infection and malignancy sub-groups had the longest waiting times for advanced imaging and theatre with a median wait of 14–16 days, accounting for approximately 62% of the typical total hospital stay. Conclusions: The Spine Unit experienced a substantial patient burden requiring significant hospital resources. Reduced in-patient waiting times and upskilling of orthopaedic services at secondary hospitals represent key areas for health system strengthening. However, multi-sectoral strategies would be required to effectively address our high burden of largely preventable spinal pathology. Level of evidence: Level 4

Prevalence of Trachoma in 47 Administrative Districts of Zambia: Results of 32 Population-Based Prevalence Surveys

ABSTRACTPurpose: A number of previous administrative-district-level baseline trachoma prevalence estimates in Zambia required verification. We used methodologies and systems for trachoma surveys considered to represent international best practice in order to generate reliable estimates of the prevalence of trachoma.Methods: Between March 2016 and July 2017, we undertook 32 population-based prevalence surveys covering 47 administrative districts. In each of the 32 evaluation units (EUs), we selected 31 households in each of 24 clusters. In selected households, trained, certified graders examined all residents aged 1 year and above for evidence of trachomatous inflammation—follicular (TF) and trichiasis. In eyes that had trichiasis, the presence or absence of trachomatous scarring (TS) was recorded, and the subject was asked about previous trichiasis management recommendations from health workers.Results: Five EUs (encompassing seven administrative districts) had prevalence estimates of trichiasis+TS unknown to the health system in ≥15-year-olds of ≥0.2%, and require public-health-level implementation of trichiasis surgery services. Eleven EUs (encompassing 16 administrative districts) had TF prevalence estimates in 1–9-year-olds of ≥5%. Intervention with the A, F and E components of the SAFE strategy for trachoma elimination is required for nearly 1.5 million people.Conclusion: Trachoma is a public health problem in some parts of Zambia. The Ministry of Health will continue to partner with other stakeholders to implement the multi-sectoral SAFE strategy. Consideration should be given to re-surveying other suspected-endemic administrative districts in which surveys using older methodologies returned TF prevalence estimates ≥5%.

Seattle’s Yesler Terrace Redevelopment: Assessing the Impact of Multisector Strategies on Redevelopment Plans and Community Health

ABSTRACTThere is growing evidence supporting comprehensive community development efforts that focus on multiple determinants of well-being. Yet evaluation has been limited by a lack of longitudinal studies, difficulty tracking displaced residents, and limited data on diverse cultural communities. The Yesler Terrace Redevelopment Project analyzes longitudinal and repeated cross-sectional data to evaluate the impact of redevelopment on a low-income, ethnically diverse cohort of residents in Yesler Terrace. Yesler Terrace is a 30-acre publicly subsidized housing community in downtown Seattle, Washington, owned and operated by the Seattle Housing Authority. To evaluate the redevelopment strategies and related programs on resident well-being, we are examining multiple sources of data, linking housing and healthcare data, and collecting contextual data about residents’ experiences. Here we describe the participating agencies and residents, study objectives and methods, and preliminary results. Early study results include shifts in resident demographics, health outcomes, and community social cohesion and perception of safety measures.

Opportunity Youth: Insights and Opportunities for a Public Health Approach to Reengage Disconnected Teenagers and Young Adults.

Approximately 1 in 9 teenagers and young adults aged 16-24 in the United States is currently disconnected from school and employment. These disconnected young people (ie, opportunity youth) are not only at high risk for long-term emotional, behavioral, and health problems, but they also represent a loss of human capital, with high social and economic costs. In this article, we offer a public health perspective on opportunity youth by describing their distribution in the population and consequences of their disconnection; proposing a conceptual model of the issue based on epidemiological principles, life course development concepts, and ecological theory; and recommending multisector strategies for preventing disconnection of young people and reengaging opportunity youth. A public health approach to the problem of opportunity youth would involve developing and investing in youth monitoring data systems that can be coordinated across multiple sectors, consolidating both the delivery and funding of services for opportunity youth, developing policies and programs that encourage engagement of young people, and fostering systematic approaches to the testing and scaling up of preventive and reengagement interventions.

Strategic communication for climate change awareness and behavioural change in Ota Local Government of Ogun State

Background: The use of mutli-sectoral communication on human’s handling processes of environment is not popular in the literature as crucial factor in winning the war against climate change and its attendant problems of greenhouse pollution, global warming and destruction of lives and properties. Objective: The study investigates the practices surrounding climate change and its awareness in Ado Odo/Ota local government of Ogun State. Methods: The survey data obtained from randomly selected 970 residents in Ado-Odo/Ota local government was complimented with six key indepth interview with opinion leaders. Results: The findings show that the current behaviours surrounding climate change in the study location includes burning of waste and bush (41.1%), indiscriminate disposal of waste (18.1%), the use of kerosene (45.4%), fire wood (6.4%) and coal for domestic purposes (3.3%). Conclusion: The study recommends multi-sectoral communication strategy (MCS) and the use of television for effective climate change awareness campaign for behaviour modification

Ethiopian Orthodox Fasting and Lactating Mothers: Longitudinal Study on Dietary Pattern and Nutritional Status in Rural Tigray, Ethiopia.

About half of Ethiopians belong to the Orthodox Tewahedo religion. Annually, more than 200 days are dedicated to religious fasting, which includes abstaining from all types of food, animal source foods, and water. However, the association of fasting with undernutrition remains unknown in Ethiopia. Therefore, dietary pattern and nutritional status of lactating women during lent fasting and non-fasting periods were studied, and predictor variables for maternal underweight were identified. To achieve this, lactating mothers in lent fasting (N = 572) and non-fasting (N = 522) periods participated from rural Tigray, Northern Ethiopia. Average minimum diet diversity (MDD-W) was computed from two 24-h recalls, and nutritional status was assessed using body mass index (BMI). Binary logistic regression was used to identify potential predictors of maternal underweight. Wilcoxon signed-rank (WSRT) and McNemar’s tests were used for comparison of the two periods. The prevalence of underweight in fasting mothers was 50.6%. In the multivariate logistic regression model, younger age, sickness in the last four weeks preceding the survey, fasting during pregnancy, lactation periods, grandfathers’ as household decision makers, previous aid experience, non-improved water source, and not owning chicken were positively associated with maternal underweight. In WSRT, there was no significant (p > 0.05) difference on maternal body weight and BMI between periods. The average number of meals, diet diversity, and animal source foods (ASFs), consumption scores were significantly increased in non-fasting compared to fasting periods in both fasting and non-fasting mothers (p < 0.001, p < 0.05, and p < 0.001, respectively). Consumption of dark green leafy vegetables was higher in the fasting period (11%) than non-fasting (3.6%), in the study population. As a conclusion, Ethiopian Orthodox fasting negatively affected maternal nutritional status and dietary pattern in rural Tigray, Northern Ethiopia. To reduce maternal malnutrition in Ethiopia, existing multi-sectoral nutrition intervention strategies, should include religious institutions in a sustainable manner.

The virtual special section of active transport papers from the 2017 active living research conference

Since 2004, the Active Living Research (ALR) Conference has focused on advancing knowledge and practice related to the creation of communities that increase opportunities for physical activity. Communities designed for active living are better for health, economic vitality, and environmental sustainability. The Annual ALR Conference serves as a premier venue for cross-disciplinary learning, as over 30 disciplines are represented among participants. This commentary serves as an introduction to a virtual Special Section of Journal of Transport and Health that includes several of the best transport-related studies that were presented at ALR 2017. The theme of the 2017 ALR Conference, Active Living across the Life Span, placed emphasis on the importance of promoting physical activity from childhood through mature adulthood and offered solutions for achieving this goal. The theme challenged attendees to consider the myriad needs across age cohorts and the ways that community design, policies, and programs affect opportunities for active living. The conference highlighted the importance of policy-relevant research and facilitated cross-sector exchange among scientists, practitioners, and policymakers to create and sustain active living environments where residents can grow, live, and thrive at any age. Jana Lyncott from the AARP Public Policy Institute delivered the Keynote Address on creating environments for active and engaged living for all ages. The presentation provided examples from communities across the United States that are promoting livability and fostering healthy, active, and engaged lifestyles. The presentation highlighted AARP's Livability Index, which scores neighborhoods and communities for the services and amenities that have a significant impact on residents. The featured panel included Drs. Adrian Bauman, NiCole Keith, and David Bann and focused on the challenges of integrating equity perspectives in research on active living across the lifespan. Dr. Bauman, from Australia, shared lessons from his research on middle-age-to-older adults and his international collaborations. Dr. Keith, from the United States, described the effort to ensure disadvantaged populations were given high priority in developing the multi-sector strategies of the US National Physical Activity Plan. Dr. Bann, from the UK, presented findings on active living across the lifespan from a large, long-term birth cohort study. The second panel featured Deputy Commissioner Adetokunbo 'Toks' Omishakin, (Tennessee Department of Transportation), Councillor Kristyn Wong-Tam (City of Toronto, Canada), and Otis Johnson (Former Mayor of Savannah, Georgia) and provided local and state examples of active transportation and lessons learned. A clear takeaway from the keynote and panelists was the need to integrate and apply life-course research and practice/policy lessons learned to most effectively create activity-supportive cities. The concept of active living includes physical activity for all purposes, including transport, recreation, occupation, and household. Active transport continues to be a dominant theme at ALR Conferences, and the link between transport and health outcomes is rising on research and policy agendas internationally, as shown by extensive coverage in Journal of Transport and Health and the 2016 Lancet Series on Urban Design, Transport, and Health. In the Lancet Series, Giles-Corti and colleagues (2016) reviewed a wide range of physical, mental, and social health problems linked with motorized transport. Stevenson and colleagues (2016) reported models that revealed a shift of just 10% of motorized trips to active modes could produce important reductions in mortality in cities as diverse as Copenhagen and Delhi. Thus, as co-chairs of the ALR 2017 Conference we want to thank Dr. Jennifer Mindell, Editor-in-Chief of Journal of Transport and Health, for facilitating this virtual special section of papers that will further advance evidence on active transport and health.

Multi-sector mitigation strategies at the neighbourhood scale

Abstract Climate change mitigation in urban areas requires a portfolio of policies and practices that are implemented across a range of scales and sectors. The local scale allows the development and implementation of site specific strategies to address climate change in urban areas that have been proven to be more efficient, especially within buildings. But these must be within the wider context of transport and other energy consumption. A unique integrated assessment methodology for the analysis of energy at the neighbourhood scale that considers the key sectors of buildings, transport and outdoor lighting has been developed. The influence of key drivers of energy consumption: land use, technology, infrastructure design, are considered to assess how neighbourhood choices impact upon wider energy usage, such as transport emissions. Applied to a neighbourhood in Italy, results show that building retrofit has the greatest benefit, of up to 60%. However, by transitioning to a mixed land use neighbourhood, growing local employment and improving the transit network, reductions of 80% can be achieved in line with the requirements of the Paris Agreement. The method highlights the importance of taking a multi-sector and multi-scale approach to considering neighbourhood mitigation.

Changing Trend of Infectious Diseases in Nepal.

Many infectious/ communicable diseases (IDs) are endemic in Nepal. Until a decade and half ago, IDs were the major cause of both morbidity and mortality accounting 70% for both. However, as a result of various preventive measures implemented by both the state and non-state actors, the overall IDs have shown a changing (declining) trend. The most impressive decline has been seen in the intestinal helminth infection. Though the overall burden of IDs is decreasing, several newer infectious diseases (emerging infections) namely, dengue fever, scrub typhus, influenza (H5N1 and H1N1), and others are posing a great public health problem. On the other hand, though sporadic, outbreaks of endemic diseases together with HIV-TB coinfection and infection with drug resistance microbes during recent years have constituted a serious public health as well as medical problem. On the contrary, with the decline of IDs, noninfectious diseases (noncommunicable disease, NCD) namely, diabetes, cancer (and cancer therapy), and others are on the rise particularly in urban areas. Hence, currently Nepal is trapped in “double burden” of diseases. Risk of opportunistic infection has increased in immunocompromised person with NCD. To address the present situation, the multi-sectoral plan and strategies developed must be implemented effectively.

Explaining German Economic Modernization: The French Revolution, Prussian Reforms, and the Inevitable Continuity of Change

The centuries-long path to German industrialization must be understood as a gradual institutional evolution in response to new circumstances, new opportunities, and new scarcities. Efforts to identify a single deus ex machina—whether Napoleon, Prussian reformers, or some other exogenous driver—do not lead to convincing results. Gradualism offers a plausible account of how a market economy and capitalism took root in German society. Only those German regions that had successfully launched gradual institutional reforms in the eighteenth century were well situated, by the early years of the nineteenth century, to move quickly to an identifiable market economy. Against this background we discuss the role of Prussia and Napoleon in modernizing the institutional framework of the German economy. The Prussian model of agrarian reforms and economic freedom represents a profound event in the history of economic development. A comparable strategic approach was absent in all French-controlled territories before or after 1815. Prussian reformers were the first in history to embrace a multi-sectoral strategy of rural development, enabling them to successfully combine growth with equity.

Identifying health conditions, priorities, and relevant multilevel health promotion intervention strategies in African American churches: A faith community health needs assessment

Identifying health conditions, priorities, and relevant multilevel health promotion intervention strategies in African American churches: A faith community health needs assessment

Scenario analysis of urban GHG peak and mitigation co-benefits: A case study of Xiamen City, China

Because cities are key to Chinese GHG management, a LEAP-based model integrating energy-related and non-energy related sectors was developed to study urban CO2 and GHG peak volume and time. Using Xiamen City as a case study, the future GHG emissions trends from 2015 to 2050 was simulated under three scenarios, namely a business-as-usual scenario (BAU), an emission-controlled scenario (EC), and a reinforced mitigation scenario (RM). Results show that Xiamen City will peak its total GHG emissions in 2039 under EC scenario and 2034 under RM scenario, while there might not be an obvious GHG peak under BAU scenario before 2050. Total CO2 emissions will peak at the same year as the GHG emissions peak year under EC and RM scenarios. Our research also indicates that population and economic growth has a significant impact on the city's CO2 and GHG peak, and Xiamen might reach the CO2 peak later than the national goal due to clean energy supply limitations and continued rapid growth. Lack of favorable conditions for large-scale renewable energy development and relatively high price of natural gas are the main obstacles for CO2 and GHG reduction in Xiamen City. In the future, greater attention on multi-sector reduction strategies is needed, including transforming industrial structure, expanding public transport while limiting private car growth, controlling per capita residential living area, improving public building energy efficiency, and reducing and reusing waste.

From Delivery to Adoption of Physical Activity Guidelines: Realist Synthesis

Background: Evidence-based guidelines published by health authorities for the promotion of health-enhancing physical activity (PA), continue to be implemented unsuccessfully and demonstrate a gap between evidence and policies. This review synthesizes evidence on factors influencing delivery, adoption and implementation of PA promotion guidelines within different policy sectors (e.g., health, transport, urban planning, sport, education). Methods: Published literature was initially searched using PubMed, EBSCO, Google Scholar and continued through an iterative snowball technique. The literature review spanned the period 2002–2017. The realist synthesis approach was adopted to review the content of 39 included studies. An initial programme theory with a four-step chain from evidence emersion to implementation of guidelines was tested. Results: The synthesis furthers our understanding of the link between PA guidelines delivery and the actions of professionals responsible for implementation within health services, school departments and municipalities. The main mechanisms identified for guidance implementation were scientific legitimation, enforcement, feasibility, familiarity with concepts and PA habits. Threats emerged to the successful implementation of PA guidelines at national/local jurisdictional levels. Conclusions: The way PA guidelines are developed may influence their adoption by policy-makers and professionals. Useful lessons emerged that may inform synergies between policymaking and professional practices, promoting win-win multisectoral strategies.

A process for developing multisectoral strategies for zoonoses: the case of leptospirosis in Fiji

BackgroundZoonotic diseases such as leptospirosis occur as a result of the often complex interactions that exist at the human-animal-environment interface. The most obvious consequence of this complexity is the need for the health sector to partner with institutions in other sectors of society such as agriculture, labour and local government. This multisectoral engagement is complicated by the different agendas and cultures of the various institutions and their ability to “see” their role and ant benefits in a collaborative response.MethodsThe research used a realist review methodology combined with systems thinking frameworks to determine the optimal strategy and governance for the prevention and control of leptospirosis in Fiji. The process included facilitated workshops with multiple stakeholders to determine the needs, issues and potential interventions that was guided by a synthesis of locally available data and information on the impact of leptospirosis. This process was informed by interviews with bureaucrats from different government ministries.ResultsStakeholders concurred that leptospirosis generally only received wide-spread attention in outbreaks, when there is media coverage of deaths or a large number of hospitalisations. In general, all ministries expressed support for a multisectoral strategy but saw the Ministry of Health and Medical Services as the lead agency with overall responsibility. The final consultation workshop yielded a clearly articulated goal to reduce the case fatality rate attributable to leptospirosis by 50% by 2020 and 4 overarching strategies: 1) improved clinical management of leptospirosis, 2) improved surveillance for leptospirosis, 3) enhanced communication to minimise risk and improve health seeking behaviours, and 4) strengthening coordination and governance structures.ConclusionHuman mortality and morbidity remained the primary drive for government action, defining leptospirosis as a human health problem. The process of deliberative consultation, and the engagement of multidisciplinary partners has provided a platform for collaborative policy development, and a consensus for a National Action Plan from which further negotiated collaboration will be possible.