Health Policy Research Articles

TRANSFORMATION THROUGH COMMUNICATION: COMMUNITY EMPOWERMENT IN FAMILY PLANNING PROGRAMS IN SOUTH SUMATERA

Transformation through communication is critical in empowering communities in South Sumatera to adopt family planning practices. The purpose of this research is to analyze the role of communication in community empowerment, with a specific focus on family planning programs. This study examines how effective communication can enhance community participation in family planning programs and how appropriate communication strategies can empower individuals and communities to make better decisions regarding reproductive health and family planning. The research results indicate that effective communication, involving local media, training for healthcare workers, and engagement with community leaders, can increase understanding and awareness among communities about the importance of family planning. Additionally, interpersonal communication between healthcare workers and the community has proven crucial in building trust and motivating behavioral change. Also, that community empowerment through participatory and inclusive communication not only enhances the acceptance and practice of family planning but also strengthens the capacity of communities to manage their reproductive health independently. The implications of this research suggest that successful family planning programs should integrate holistic and sustainable communication strategies to achieve comprehensive community empowerment. These findings provide valuable contributions to developing policies and intervention programs in the reproductive health and family planning field in Indonesia.

Mathematical modeling of cholera dynamics in the presence of antimicrobial utilization strategy

Antimicrobial resistance poses a significant threat to public health, particularly in cholera treatment. The emergence of antibiotic resistance, coupled with the sharp decline in pharmaceutical companies developing new cholera antibiotics, is a cause for concern. We formulate a multidrug-resistant (MDR) cholera epidemic model that incorporates a stage-switching strategy between two antibiotics to reduce the magnitude of resistance. The model is analyzed mathematically, and sensitivity analysis of the reproduction number is performed using sub-reproduction numbers. Stability analysis of the cholera-sensitive-only and cholera-resistant-only equilibria is investigated using Centre Manifold Theory. The model is calibrated through Markov Chain Monte Carlo simulations in Stan, showing stability at equilibrium points, which is further verified through numerical simulations. The simulations demonstrate an inverse relationship between the number of MDR cholera cases and the number of individuals receiving second-line treatment for cholera. This study suggests that the correct use of antibiotics can effectively manage the emergence of antimicrobial resistance. From a public health policy perspective, these findings emphasize the importance of antibiotic stewardship programs and the need for policies that promote the responsible use of existing antibiotics while encouraging the development of new treatment options. Such measures could help mitigate the global burden of MDR cholera and prevent further escalation of resistance.

Status of inpatients with pediatric epilepsy in children's hospitals in China (2016-2021).

Pediatric epilepsy is the most common disease of pediatric neurological diseases in China. Current demographic characteristics and economic burdens are needed to guide public health policy. In this study, we provide the demographic characteristics and economic burden of pediatric epilepsy patients in China from 2016 to 2021, and describe the change trend and correlation of demographic characteristics and economic burden by province. Using data from the Futang Research Center of Pediatric Development, we conducted a demographic-based cross-sectional study of pediatric epilepsy patients in 29 children's hospitals in China to assess changes in the distribution and economic burden over 6 years and related factors. We obtained per capita disposable income information from the Economic Statistical Bulletin of the National Bureau of Statistics of China and the statistical bureaus of provincial administrative regions. Demographic, diagnostic classification proportion and distribution trends, and economic burden from 2016 to 2021 were verified for pediatric patients with epilepsy. From 2016 to 2021, there were 149,375 patients diagnosed with epilepsy. The proportion of patients younger than 3 years decreased significantly from 51.13% to 29.43% (P=0.00853, R2=0.9803). The root-mean-square-error between the Inter-Provincial Visits Indexes decreased from 1.70 to 0.90, decreasing significantly (R2=0.8306). The disease burden decreased from 17.26% to 12.11% with a significant upward trend (P=0.02417, R2=0.8817). A negative correlation between disease burden and the Inter-Provincial Visits Index (P=0.0383) was observed, along with a positive correlation with the proportion of patients younger than 3 years old (P<0.0001). From 2016 to 2021, the proportion of young patients, population mobility and economic burden on patients decreased, and healthcare level of pediatric epilepsy improved. In addition, based on the current observations, the healthcare level of pediatric epilepsy in Western and Central China is lower than in other regions, and the economic burden on patients is higher than in other regions. In the future, these areas require higher priority concerning policy and financial support.

Hedges: 'Laws will get bogged down in quicksand'

Although the 'alliance of the willing' that Daniela Teichert, CEO of AOK Nordost, has often called for is rarely formed, there is little chance that Robert Habeck's 'alliance of the sensible' will carry the outstanding legislative proposals of the collapsed traffic light coalition, especially those in the healthcare sector, over the 'ramp'. The latter was one of the statements made by Tino Sorge, health policy spokesperson for the CDU-CSU parliamentary group and CDU MP, during a panel discussion at the Federal General Assembly of the Virchowbund. He strictly denied that - quote - 'the CDU/CSU would have to take one or two of the project proposals of the Trümmer-Ampel' over the ramp out of national political responsibility. Sorge: 'I can say quite clearly that we will not do that.'

Childcare as a social determinant of access to healthcare: a scoping review

IntroductionAs health systems strive to screen for and address social determinants of health (SDOH), the role of access to childcare and barriers to healthcare posed by childcare needs remains underexplored. A gap exists in synthesizing existing evidence on the role of access to childcare as a SDOH.MethodsThis scoping review aimed to examine and analyze existing literature on the role of childcare needs as a social determinant of access to healthcare. We conducted a structured literature search across PubMed, Scopus, health policy fora, and professional healthcare societies to inclusively aggregate studies across interdisciplinary sources published between January 2000 and June 2023. Two independent reviewers reviewed results to determine inclusions and exclusions. Studies were coded into salient themes utilizing an iterative inductive approach.ResultsAmong 535 search results, 526 met criteria for eligibility screening. Among 526 eligible studies, 91 studies met inclusion criteria for analysis. Five key themes were identified through data analysis: (1) barriers posed by childcare needs to healthcare appointments, (2) the opportunity for alternative care delivery models to overcome childcare barriers, (3) the effect of childcare needs on participation in medical research, (4) the impact of the COVID-19 pandemic on childcare needs, and (5) the disproportionate burden of childcare experienced by vulnerable populations.DiscussionChildcare needs remain underexplored in existing research. Current evidence demonstrates the relevance of childcare needs as a barrier to healthcare access, however dedicated studies are lacking. Future research is needed to understand mechanisms of childcare barriers in access to healthcare and explore potential interventions.

Resilient health reforms in times of permacrisis: the Greek citizens’ perspective

This study investigates Greek citizens’ attitudes toward the current healthcare system and their perspectives on healthcare reforms. Additionally, it explores the role of both endogenous and exogenous crises in accelerating the implementation of long-overdue structural reforms that might otherwise be challenging to achieve. To this end, the research examines the level of trust in institutions and the implementation of healthcare reforms following the fiscal crisis and during the COVID-19 pandemic. The findings reveal that while most Greek citizens recognize the necessity of structural reforms within the healthcare system, approximately half of the population views these changes negatively. The primary obstacles to successful reform are identified as a lack of political will and resistance from specific interest groups. The contradiction within Greek society concerning healthcare reform is largely driven by low levels of institutional trust and social capital. Although there is a clear need for radical reforms, public perception tends to be negative when these changes are framed within political discourse. However, when reforms align with the actual needs of society, citizens’ trust in institutions increases, thereby improving the likelihood of successful policy implementation. This underscores the critical role of institutional trust in facilitating significant healthcare policy transformations.

Historical Traces Of Health Law: Tracing The Dynamics Of Health Regulation Development Through Literature

This article discusses the historical development of health law, focusing on the evolution and dynamics of health regulation. The study in this research uses the literautr research method. The purpose of this study is to provide insight into the current legal challenges and future directions of Health regulation. The results found that the historical development of health law was influenced by various socio-political factors and significant medical advances. Key milestones such as 19th century sanitary regulation and public health policy in the 1918 influenza pandemic show how health law has evolved. Important figures such as health activists and legal academics were instrumental in shaping influential legal frameworks, such as the Public Health Act and bioethics. The impact of these legal reforms on public health varies depending on the responsiveness and adaptivity of the regulations to current global health challenges, such as health data privacy and access to medicines. By understanding the historical evolution of health law, it can be concluded that an adaptive legal framework is necessary to achieve optimal public health outcomes in the future.

Young men's everyday life experiences with contraception and unintended pregnancy in Papua New Guinea.

Unintended adolescent pregnancy is a public health priority in Papua New Guinea (PNG), where national policies specify need for easier access to reliable modern contraceptives. To reduce young people's experiences of unintended pregnancy in PNG, improved understandings of use of modern and other forms of contraception within young people's relationships is required to support the development of new sexual and reproductive health (SRH) programs and policies. The aim of this paper is to understand young men's use of modern and other contraceptives. This qualitative study involved semi-structured interviews with 35 sexually active young men aged 15-24 years, who were sampled purposively from the general population within community-based settings. Data were analysed using inductive thematic analysis techniques. Our analysis of young men's everyday experiences of using condoms and other contraceptives highlights clear drivers of unintended adolescent pregnancies. Across three settings, these included non-use of any modern method at first sex or during early sexual experiences; inconsistent use of condoms, often only after first pregnancy experiences; difficulties accessing condoms from health service providers, pharmacies and stores; a lack of understanding of other modern contraceptive strategies; inconsistent use of the withdrawal method; and inconsistent and incorrect use of calendar approaches due to misunderstandings about women's fertile period. Ten young men had never used any form of contraception. These occurred largely because young men's sexual agency is constrained within sexual and peer relationships, and community, school and health service settings, in ways that inhibit pregnancy prevention. It is important to engage meaningfully with young men to build sexual and reproductive health policies and programs that pay honest, respectful attention to young people's everyday sexual and social lives. Young men's everyday stories provide a unique lens through which we can identify mechanisms of change required to address the health and social inequities associated with unintended pregnancy among young men and young women in PNG and beyond.

Hemolytic disease of the fetus and newborn: pregnant person's and fetal immune systems interaction.

There exists a need to research new diagnostic and therapeutic approaches that consider hemolytic disease of fetus and newborn (HDFN)'s physiopathology and focus not only on the pregnant person's immune system but also on the fetal immune system. This implies, in the final sense, to view the fetus as our patient. In spite of having found a safe and efficient method of prevention of HDFN more than 50 years ago, HDFN continues to be a relevant cause of perinatal morbidity and mortality, due to lack of access to immunoprophylaxis. In light of the above, we should strive to prevent sensitization and HDFN by ensuring certain health policies across the globe, especially in countries and regions of high morbidity and mortality.

Predicting particulate matter ( ) levels in Morocco: a 5-day forecast using the analog ensemble method.

The accurate prediction of particulate matter ( ) levels, an indicator of natural pollutants such as those resulting from dust storms, is crucial for public health and environmental planning. This study aims to provide accurate forecasts of over Morocco for 5days. The analog ensemble (AnEn) and the bias correction (AnEnBc) techniques were employed to post-process forecasts produced by the Copernicus Atmosphere Monitoring Service (CAMS) global atmospheric composition forecasts, using CAMS reanalysis data as a reference. The results show substantial prediction improvements: the root mean squared error (RMSE) decreased from 63.83 in the original forecasts to 44.73 with AnEn and AnEnBc, while the mean absolute error (MAE) reduced from 36.70 to 24.30 . Additionally, the coefficient of determination ( ) increased more than twofold from 29.11 to 65.18%, and the Pearson correlation coefficient increased from 0.61 to 0.82. The integrating reanalysis data and the utilization of the AnEn substantially improved the accuracy of 5-day forecasting in Morocco. This is the first application of this approach in Morocco and the Middle East and North Africa (MENA) and has the potential for translation into early and more accurate warnings of pollution events. The application of such approaches in environmental policies and public health decision-making can minimize the health impacts of air pollution.

Mercury and Cardiovascular Health: Exploring the Correlation between Atherosclerosis and Hypertension

Aims: To explore the association between mercury exposure and cardiovascular health, focusing on its impact on hypertension and atherosclerosis in individuals exposed to inorganic and organic mercury forms. This study aims to review the evidence on how mercury contributes to endothelial dysfunction, oxidative stress, and inflammation, which are critical mechanisms in cardiovascular disease development. Study Design: This is a literature review based on observational and epidemiological studies conducted between 2000 and 2023, which investigated the effects of mercury exposure on cardiovascular diseases. Place and Duration of Study: Studies included were sourced from PUBMED, BVS, SCIELO, LILACS, and MEDLINE databases, published between 2000 and 2023. Methodology: This integrative review included studies on the association between mercury exposure and cardiovascular health, focusing on hypertension and atherosclerosis. The search was conducted in the PUBMED, BVS, SCIELO, LILACS, and MEDLINE databases, covering publications from 2000 to 2023 and using specific terms with Boolean operators. Observational and experimental studies in humans were included, excluding those with significant biases, unavailable in full text, or involving only in vitro or animal models. Screening was performed in three stages, with two independent reviewers and a PRISMA flow diagram to document the process. Results: The studies consistently indicated a significant association between mercury exposure and increased risk of hypertension and atherosclerosis. Individuals with higher mercury levels showed greater arterial stiffness, calcification, and an elevated risk of myocardial infarction and strokes. Observational studies in populations exposed to mercury, either occupationally or through diet, demonstrated a dose-dependent relationship between mercury exposure and cardiovascular events. Conclusion: Mercury exposure, particularly in vulnerable populations like industrial workers and communities with high fish consumption, is a significant risk factor for cardiovascular diseases. The review underscores the importance of stringent public health policies and regular monitoring of mercury levels in at-risk populations to prevent long-term cardiovascular damage.

Risk messaging style and its effect on public preparedness for earthquakes: longitudinal intervention-based study

AbstractThis study examines the effect of risk communication styles (fear-based versus empowerment-based) on households’ earthquake preparedness. An online longitudinal study with intervention and control groups was conducted using a representative sample of the adult population in Israel. The change in the reported level of preparedness was assessed through Repeated Measures ANOVA with interaction effects for both the risk communication style and gender. The Analysis revealed a significant difference in reported levels of earthquake preparedness over time (F(1.697,303.70) = 102.58, p &lt; 0.001; partial η2 = 0.36). However, no statistically significant interaction was found with the risk communication style (p = 0.55). Borderline significance (p = 0.04) was observed in the three-way interaction (time-intervention-gender). Gender (β = 0.19), age (β = 0.21), perceived earthquake likelihood (β = 0.14), and sense of preparedness (β = 0.28) were significant predictors in multivariate regression analysis. While consistently showing that participants exposed to empowering information reported higher earthquake preparedness, the research hypothesis was not substantiated. Recommendations for public health policy are discussed.

Updated Insights on Childhood Diabetes Epidemiology 2019-2021 and Projections to 2045

This cross-sectional study examines global childhood diabetes trends to guide health care policies, resource allocation, and targeted interventions.

Mathematical modelling to estimate the impact of maternal and perinatal healthcare services and interventions on health in sub-Saharan Africa: A scoping review.

Mathematical modelling is a commonly utilised tool to predict the impact of policy on health outcomes globally. Given the persistently high levels of maternal and perinatal morbidity and mortality in sub-Saharan Africa, mathematical modelling is a potentially valuable tool to guide strategic planning for health and improve outcomes. The aim of this scoping review was to explore the characteristics of mathematical models and modelling studies evaluating the impact of maternal and/or perinatal healthcare interventions or services on health-related outcomes in the region. A search across three databases was conducted on 2nd November 2023 which returned 8660 potentially relevant studies, from which 60 were included in the final review. Characteristics of these studies, the interventions which were evaluated, the models utilised, and the analyses conducted were extracted and summarised. Findings suggest that the popularity of modelling within this field is increasing over time with most studies published after 2015 and that population-based, deterministic, linear models were most frequently utilised, with the Lives Saved Tool being applied in over half of the reviewed studies (n = 34, 57%). Much less frequently (n = 6) models utilising system-thinking approaches, such as individual-based modelling or systems dynamics modelling, were developed and applied. Models were most applied to estimate the impact of interventions or services on maternal mortality (n = 34, 57%) or neonatal mortality outcomes (n = 39, 65%) with maternal morbidity (n = 4, 7%) and neonatal morbidity (n = 6, 10%) outcomes and stillbirth reported on much less often (n = 14, 23%). Going forward, given that healthcare delivery systems have long been identified as complex adaptive systems, modellers may consider the advantages of applying systems-thinking approaches to evaluate the impact of maternal and perinatal health policy. Such approaches allow for a more realistic and explicit representation of the systems- and individual- level factors which impact the effectiveness of interventions delivered within health systems.

Spatial analysis of malaria cases and Anopheles species in East Java region, Indonesia

Malaria remains a significant public health challenge worldwide, including in Indonesia, particularly in the East Java region. This study aimed to analyse the spatial distribution of malaria cases and Anopheles species that act as vectors in the area. Using an observational design with a cross-sectional approach, data on malaria cases were collected from tiers from the Community Health Centre, District Health Office and Province, all of which were documented on the Ministry of Health's malaria information system for the period 2021–2023. Malaria Vector Distribution Data from the East Java Health Office and the research team directly. Sampling of mosquitoes and larvae was carried out by researchers using a purposive sampling method, which prioritised locations with districts that have a high risk factor for the presence of breeding Anopheles sp., namely, Treggalek District, Malang District and Pacitan District with diverse topography, such as coastal (lagoon), rice fields and hills. The results of the analysis show that the distribution of imported malaria cases in East Java is uneven, with hotspots identified in several areas that have working population mobility from outside the East Java region. The presence of Anopheles species, particularly An. sundaicus and An. maculatus, contributes to their potential as vectors of malaria transmission, with An.sundaicus being more common in coastal areas and An. maculatus in valley and paddy fields. Environmental factors, such as topography of the region, temperature, humidity, and rainfall, influence the variation of Anopheles species. This study emphasises the importance of an ecosystem-based approach to malaria control, as well as the need to improve access to health services and community education. The findings provide important insights for the development of more effective and sustainable health policies in an effort to maintain malaria elimination areas in East Java.

Deep learning-based mortality surveillance: implications for healthcare policy and practice

Deep learning-based mortality surveillance: implications for healthcare policy and practice

A good start for all children: integrating early-life course medical and social care through Solid Start, the Netherlands’ nationwide action programme

The foundations of human wellbeing are laid in early life during the preconception stage and the 1,000-days of life from conception to the child's second birthday. This period is therefore receiving scrutiny as a concept for guiding pregnancy-care innovation and public health policy. The Dutch government took responsibility to invest in this. In September 2018, the Dutch Ministry of Health, Welfare, and Sport launched the Solid Start action programme. Coordinated nationally, the programme is implemented locally through coalitions in all 342 Dutch municipalities involving collaboration between medical and social-care professionals, policymakers, parents and organisations. The programme has generated a nationwide movement in which medical and social-care professionals now develop forms of structural collaboration that support (future) parents by offering evidence-based interventions that simultaneously enhance early healthy human development and prevent unwanted pregnancies. Although monitoring of the programme does not currently make it possible to address the causal effects of the programme itself, lessons can be distilled which have contributed to the successful implementation of this nationwide programme. These lessons include 1) having and maintaining an unambiguous narrative, 2) creating a lasting sense of urgency among stakeholders, and 3) ensuring that the programme is multi-sectoral.

Mortality burden and economic loss attributable to cold and heat in Central and South America.

We quantify the mortality burden and economic loss attributable to nonoptimal temperatures for cold and heat in the Central and South American countries in the Multi-City Multi-Country (MCC) Collaborative Research Network. We collected data for 66 locations from 13 countries in Central and South America to estimate location-specific temperature-mortality associations using time-series regression with distributed lag nonlinear models. We calculated the attributable deaths for cold and heat as the 2.5th and 97.5th temperature percentiles, above and below the minimum mortality temperature, and used the value of a life year to estimate the economic loss of delayed deaths. The mortality impact of cold varied widely by country, from 9.64% in Uruguay to 0.22% in Costa Rica. The heat-attributable fraction for mortality ranged from 1.41% in Paraguay to 0.01% in Ecuador. Locations in arid and temperate climatic zones showed higher cold-related mortality (5.10% and 5.29%, respectively) than those in tropical climates (1.71%). Arid and temperate climatic zones saw lower heat-attributable fractions (0.69% and 0.58%) than arid climatic zones (0.92%). Exposure to cold led to an annual economic loss of $0.6 million in Costa Rica to $472.2 million in Argentina. In comparison, heat resulted in economic losses of $0.05 million in Ecuador to $90.6 million in Brazil. Most of the mortality burden for Central and South American countries is caused by cold compared to heat, generating annual economic losses of $2.1 billion and $290.7 million, respectively. Public health policies and adaptation measures in the region should account for the health effects associated with nonoptimal temperatures.

Industry influence on public health policy formulation in the UK: a complex systems approach.

Unhealthy commodity industries (UCIs) such as tobacco, alcohol, gambling, ultra-processed food and beverage producers are known to influence policy-making to advance their interests, often to the detriment of public health goals. This study mapped the complex system underpinning UCI's influence on public health policy formulation in the UK and identified potential interventions to shift the system towards being able to better attain public health goals. We conducted a participatory systems mapping workshop with ten experts to build a causal loop diagram (CLD) and identify potential interventions to address UCI's influence on public health policy development. The resulting CLD depicts a highly interconnected and reinforcing system driving UCI's involvement in public health policy formulation across five thematic areas. Among the most connected elements were the 'dominance of market mechanisms', 'perception of partnership as good governance principle', 'industry involvement lending perceived legitimacy to the policy formulation process', 'industry is seen as part of the solution' and 'industry ties to policy-makers'. Participants identified a total of 22 interventions within this system. Analysis of the CLD and interventions identified the potential for two key paradigmatic changes in this complex system: de-normalizing the perception of unhealthy commodity industry actors as legitimate stakeholders in policy formulation; and prioritizing public health and wellbeing objectives over profit and economic gain. In order to shift the system towards better attaining public health goals, interventions should reinforce each other and be supportive of these two key paradigmatic shifts.

“There is a crack in everything, That's how the light gets in”. Maintaining hygiene and striving for purity: An interdisciplinary study

ContextThe concept of hygiene plays a significant role in human life, dividing spaces into opposing categories (clean vs. dirty, pure vs. taboo, familiar and uncanny, etc.) in the pursuit of a long and meaningful life. Across multiple disciplines, hygiene encompasses both physical-material and also mental-spiritual-abstract dimensions, and is studied through various lenses—medicine, religious and cultural studies, psychiatry and psychoanalysis, philosophy and more. ObjectivesThe article aims to describe and critically analyze the pattern that defines hygiene maintenance mechanisms in multiple spheres of human activity. The analysis include physical and cultural hygiene in external aspects of our lives, as well as mental-spiritual hygiene in the internal spheres. The investigation explores how the mechanism of pursuing the hygiene works to preserve the “clean” or the “pure” by preventing the intrusion of the “dirty” and “polluting” and examines the implications of strict hygiene practices on life and vitality. MethodThis is a theoretical study drawing on interdisciplinary approaches, including medical research on the formation of the concept of hygiene, leading to the presentation of the “hygiene hypothesis”, religious and cultural analysis of concepts of purity and pollution, as explored by Mary Douglas, and Freud's psychoanalytic theory with focus on the concept of the uncanny (unheimlich) as a sphere of life that seems to “pollute” our inner world. The implications of Freud's ideas are further examined in the works of Winnicott and others. ResultsThe study reveals that the strict enforcement of hygiene mechanisms, while aiming to eliminate the polluting element entirely, can paradoxically threaten the very vitality it seeks to protect. This paradox appears in different ways but follows a common pattern: the excessive pursuit of cleanliness may inadvertently harm the source of life that hygiene is intended to safeguard. InterpretationsThe article interprets the findings within a broader theoretical framework, and poses questions regarding the balance between the aspiration for purity and the preservation of life's essential vitality. Theoretical implications suggest a need for caution in how hygiene is approached in health policy, and also in contexts like psychology or psychoanalysis. Future research should explore how this balance can be maintained across other fields, such as ethics, media policy in consumer-driven society or education.