Protect Population Health Research Articles

Seasonal and Spatial Variability of PM2.5 Concentration, and Associated Metal(loid) Content in the Toluca Valley, Mexico.

This study provides evidence of the seasonal and spatial variation of metal(lloid)s in particulate matter minor to 2.5 microns (PM2.5) in the Toluca Valley Metropolitan Area (TVMA), the fifth largest urban center in Mexico. Four sites were sampled between 2013 and 2014, which included urban and industrial areas, in the dry-cold (November-February) and dry-hot (March-May) seasons; PM2.5 was collected using high- and medium-volume samplers. Metal(lloid) concentrations in PM2.5 were analyzed using inductively coupled plasma‒mass spectrometry (ICP‒MS). The highest 24-hour PM2.5 concentration in the northern area was observed, and the PM2.5 concentrations were independent of the season. Five metal(lloid)s with a recovery percentage above 80% were considered to be reported (Co, Cr, Cu, Mn, and Sb). The maximum concentrations of metal(lloid)s were observed during the dry-cold season, and concentrations were up to one hundred or thousand fold with respect to the dry-hot season. The 24-hour PM2.5 and metal(lloid) concentrations exceeded national and international guidelines to protect population health.

Strengthening Health Systems for Climate Adaptation and Health Security: Key Considerations for Policy and Programming.

Strengthening Health Systems for Climate Adaptation and Health Security: Key Considerations for Policy and Programming.

A Social-Ecological Study of Perceptions and Determinants of Sexual Enhancement Drug Use among Men and Women in Ghana.

The use and sale of sexual enhancement drugs (particularly unapproved aphrodisiacs) have become a public health concern in Ghana and many other sub-Saharan African countries. While most studies have examined this phenomenon from the level of individual perspectives, this study investigates the multi-dimensional and multi-level factors (e.g., individual characteristics and behaviours, interpersonal factors, community norms and practices, institutional and public policy factors) that influence attitudes, perceptions, and use of aphrodisiacs among men and women in Ghana. Using a concurrent mixed-method design, we derived the data from a semi-structured interview and cross-sectional survey conducted across five administrative regions in Ghana. Interpretative phenomenological analysis and logistic regression techniques were used to analyse the qualitative and quantitative (survey) data, respectively. Approximately 12.6% of participants (17.6% among males and 7.2% among females) had used an aphrodisiac in the six months prior to the study. Approximately 23.4% of the participants had more than one partner during the same period. Among men, being religious (B = −0.238, p < 0.05) and having multiple sexual partners (B = 0.481, p < 0.01) were positively associated with the use of aphrodisiacs. For women, being employed (B = −1.539, p < 0.01), engaging in physical activities (exercising) (B = −0.658, p < 0.05), having good health (B = 0.869, p < 0.05), having multiple sexual partners (B = 1.191, p < 0.01), and taking alcohol (B = 1.041, p < 0.01) were associated with use of aphrodisiacs. Although many participants had used aphrodisiacs, women, in particular, held unfavourable views about the drugs due to perceived negative health implications for themselves and their partners. The findings also show that community-level factors (e.g., social norms and expectations), interpersonal factors (e.g., expectations of partners and friends), public policy (e.g., drug-related regulations), and organisational/institutional factors (e.g., health system arrangements about access and use of drugs) were critical to the sale and use of aphrodisiacs among both men and women in Ghana. A multi-level analysis of the use of sexual enhancement drugs among men and women is crucial to formulating social and public health policies that aim to improve public knowledge of these drugs, reduce uncontrolled production, and protect population health and well-being.

Supervised learning using routine surveillance data improves outbreak detection of Salmonella and Campylobacter infections in Germany.

The early detection of infectious disease outbreaks is a crucial task to protect population health. To this end, public health surveillance systems have been established to systematically collect and analyse infectious disease data. A variety of statistical tools are available, which detect potential outbreaks as abberations from an expected endemic level using these data. Here, we present supervised hidden Markov models for disease outbreak detection, which use reported outbreaks that are routinely collected in the German infectious disease surveillance system and have not been leveraged so far. This allows to directly integrate labeled outbreak data in a statistical time series model for outbreak detection. We evaluate our model using real Salmonella and Campylobacter data, as well as simulations. The proposed supervised learning approach performs substantially better than unsupervised learning and on par with or better than a state-of-the-art approach, which is applied in multiple European countries including Germany.

Sea Level Rise and City-Level Climate Action

Background: Climate change is the greatest threat to global health in the 21st century. Rising sea levels are one particularly concerning manifestation of this and many of the world’s largest cities are vulnerable to sea level rise (SLR). Thus, urban climate adaptation and mitigation policies are increasingly important to protect population health. Objectives: This study aimed to determine whether being at risk of SLR was associated with city-level climate action. It also aimed to assess the wider drivers of climate action in cities, in order to guide ongoing efforts to motivate climate action, assess public health preparedness and identify research gaps. Methods: This is an ecological cross-sectional study using secondary data from CDP, the Urban Climate Change Research Network (UCCRN), World Bank, United Nations Cities and EM-DAT (Emergency Events Database). The study population consisted of 517 cities who participated in CDP’s 2019 Cities Survey. Multivariable logistic regression was utilized to assess the relationship between risk of SLR and city-level climate action, and secondly, to assess the wider determinants of city-level climate action. Results: There was evidence of crude associations between risk of SLR and three outcome variables representing city-level climate action. However, after adjusting for confounding variables, these crude associations disappeared. World region, national income status and urban population were shown to be stronger predictors of city-level climate action. Conclusion: It is concerning for population health that there is no association demonstrated between risk of SLR and climate action. This could indicate a lack of awareness of the risks posed by SLR within urban governance. To fulfil their health protection responsibilities, it is essential that public health professionals take a leading role in advocating for climate action.

Urban climate-health governance: Charting the role of public health in large global city adaptation plans

Over the last decade many large world cities have scaled up efforts at climate adaptation, a primary focus of which is protecting population health. With extreme weather disasters increasing worldwide, public health agencies are among local institutions under greatest stress; the Covid-19 pandemic has only heightened pressure on these agencies. Yet the limited literature examining adaptation actions across world cities suggest few, mainly high-income cities report health-related adaptation, while city public health agency engagement in adaptation has received little research attention. In this comparative review, we aimed to characterize the public health role in the adaptation plans of 22 large cities pre-identified as highly health-adaptive, by examining five health-associated adaptation activities chosen as “promising practice” based on evidence synthesized from evaluation research and practical experience: (i) hazard and vulnerability mapping; (ii) extreme weather preparedness and response; (iii) extreme heat plans (including heat early warning); (iv) non-heat early warning (e.g., flooding, vector-borne disease); and (v) climate-health monitoring and outcome surveillance. We found most (90%) city adaptation plans reported actions in at least three of these five activity areas. However, only 73% of these health-focused plans reported involvement of a public health agency (though the share was higher for cities in low- and middle-income countries). We detected differences across the five activities, including an ascending pattern of public health engagement starting with heat plans and including activities such as preparedness and mapping as health agency involvement increased. We also identified substantial presence of other city agencies–notably urban planning, emergency management and public utilities–in implementing these health-associated activities. With every world region likely to experience more widespread and intensifying climate impacts, and growing pressure on local public health agencies in conjunction with the Covid-19 pandemic, we identify opportunities for enhancing public health engagement in climate adaptation in large cities with a view to scaling up their ability to contribute to climate adaptation goals.

A Well-Designed Implement for Promoting Population Health and Property via Insurance.

The frequency and intensity of catastrophes (including natural disasters and pandemics) rise and damage the population's health, life and property more seriously. In order to protect population health and wealth via full insurance indemnity, many countries set up a public catastrophe insurance scheme (PCIS) to maintain the function of catastrophe insurance markets. Little literature discusses the smart payment way of contributions charged by PCIS. This article design a model to describe the upward trend and cyclic frequency and intensity of catastrophic events. Such characteristics also promote the business cycle of the insurance industry. We analyze the changes in catastrophic insurer's capital structures under three cases of that the volume-based charges to the PCIS may come from equity holders or policyholders or both. PCIS may entail a shift of equity capital toward minimum solvency requirements, and then adverse incentives regarding insurer's security level arise. Various numerical experiments illustrate the changes in equity position, default probabilities, or expected policyholder deficits. The results show that the payment way of contributions should be designed carefully, not only with regard to PCIS's finance balance but also the resultant incentives and effects.

Local Health Departments' Characteristics and Their Performance Scores in PHAB Accreditation Standards.

Local health departments (LHDs) function to promote and protect population health by executing programs and activities through the 10 essential public health (PH) services in their operationalization of the core functions of PH systems-assessment, policy development, and assurance. PH accreditation supports LHDs by assessing their ability to promote community well-being through a set of standards and measures based on the 10 essential PH services. Prior studies show variation in LHD characteristics relative to their likelihood of participating in accreditation, but no studies have examined the variation in LHD accreditation scores to understand how LHD characteristics relate to performance improvement. This work examines variation in LHD accreditation scores relative to their organizational and jurisdiction characteristics. Cross-sectional data were obtained from 250 LHDs from 38 states that underwent Public Health Accreditation Board (PHAB) accreditation review. We used exploratory cluster analysis to identify and group LHDs with similar performance scores in PHAB accreditation standards. Descriptive analyses were undertaken to characterize each LHD cluster group's organizational structure, jurisdiction characteristics, and core PH function activity levels. We then employed multivariate regression analysis to confirm the cluster analysis results. The analysis showed 3 clusters of PHAB accreditation performance scores (cluster 1 = 0.95; cluster 2 = 0.87; and cluster 3 = 0.71). Subtle differences in organizational and jurisdiction characteristics across clusters, notably in population size of the jurisdictions served, were observed. LHDs in cluster 3 tended to have jurisdictions with less than 250000 population size and serve more than 1 county. Performance scores in PHAB accreditation can be a useful standardized metric for assessing LHD ability to promote community well-being. LHDs serving less than 20000 population size, which exhibit relatively lower performance than other LHDs, may require more targeted supports to close the gap in their performance score.

Satellite mapping of air temperature under polar night conditions

ABSTRACT A novel satellite technique for air temperature mapping with a spatial resolution of ~100 m was proposed for the town of Apatity, the Kola Peninsula (Russia), taken as a case study. The main idea behind this novel technique is to find the statistical relationships between the land surface temperatures in each point of the study area, observed by multiple infrared thermal satellite imagery, and the time series of air temperatures recorded by World Meteorological Organization (WMO) weather station. Fourteen scenes of infrared thermal spectral band of the Landsat satellites for the period 2014–2019 were used, as well as the long-term time series of air temperature from the weather station and the results of air temperature observations carried out by the network of loggers. For calm weather conditions, according to the ground truth, the error of air temperature mapping was σ = 1.5°C, and the precision was estimated as δ = 1.0°C. An analysis of the compiled air temperature map showed that, under polar night conditions, the air temperature on the hilltops was by 10–18°C higher than in the lowlands. It was concluded that, for economic reasons, as well as for the reasons of population health protection in the Arctic, it would be advisable to plan the placement of new cities on the hills. Each of these new areas should be designed in a “semi-isolated” manner in order to minimize the time needed by the local people for crossing the lowlands between the nearby districts. A characteristic feature of modern megalopolises is their internal structure formed by the growing primary settlements that can be considered as nuclei interlinked by transportation routes. Thus, the new Arctic cities can be called “Arctic megalopolises” because of their internal structure that is specific to megalopolises.

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In conditions of circular economy production and consumption procedures are implemented in a closed cycle, which enables to minimize the used resources and ensure zero waste industry. The introduced mechanisms are of high economic, social and environmental significance, since unlike the traditional linear economy, the wastes are turned into production resources in case of closed-loop economy. Thus, it is more efficient to apply the mechanisms of circular economy in the agricultural sector, as they promote the increase of food security level and protection of population health.

Recommendations of Controlling and Preventing Acute Health Risks of Fine Particulate Matter Pollution - China, 2021.

The task force has comprehensively reviewed efforts for air pollution prevention and control, the acute health effects of fine particles (PM2.5), and the health benefits of air pollution prevention and control in China. It has been found that the overall prevention and control of ambient PM2.5 pollution in China has made remarkable progress in recent years. However, it still remains at a relatively high level. Short-term exposure to ambient PM2.5 significantly increases the mortality and morbidity risk of Chinese residents, resulting in changes to levels of relevant biological markers. Prolonged PM2.5 heavily polluted weather greatly increases the risk of cardiovascular disease morbidity and mortality. Among chemical composition of PM2.5, carbon-containing components, some inorganic salts, and heavy metals are linked with the health impacts. The health risks of PM2.5 pollution are higher for children, the elderly, and patients with cardiovascular or respiratory diseases than for the general population because the former groups are vulnerable subpopulations. The implementation of air pollution prevention and control policies has significantly improved human health. The implementation of personal protective equipment can significantly reduce the health damage caused by short-term exposure to ambient PM2.5 pollution. Based on scientific evidence of PM2.5 pollution and acute health risks in China, the following three recommendations are proposed. 1) The policy recommendations for the prevention and control of ambient PM2.5 pollution include the following: to continuously strengthen the widespread use and efficient development of clean energy; to further promote industrial upgrading; to focus on the control of transportation pollution; to keep improving the modernization system of air pollution control; to formulate and refine relevant standards for air quality gradually; and to estimate the effects and health benefits after the implementation of clean air actions, and relevant policies. 2) Prevention of ambient PM2.5 pollution and protection of public health recommendations include the following: to strengthen the release of air pollution monitoring and relevant information; to strengthen awareness of air pollution hazards; to clarify the guidance and recommendations for protecting population health from air pollution; and to strengthen the health protection of population vulnerable to ambient air pollution. 3) Recommendations for research on health risks of air pollution include the following: to strengthen research on air pollutant monitoring technology and monitoring system based on the promotion of accurate exposure assessment; to systematically carry out full-spectrum identification and correlation studies of air pollutants and health effects; to conduct studies on key toxic components and early biomarker inventory of air pollution health effects; to discover the toxicity mechanisms of the key toxic components of air pollutants; to carry out research on population health risk assessment and early warning of combined exposure to air pollutants; and to execute comprehensive studies on the health and economic benefits of pollution and carbon reduction under the national strategies of carbon neutrality and beautiful China.

Administrative and precautional measures in the sphere of population health protection in the Russian Federation

Administrative and precautional measures in the sphere of population health protection in the Russian Federation

Environmental Taxes Impact for the Population Health Protection: Cross-Country Analysis

The current demographic situation in the world encourages the search and implementation of optimal tools for stabilizing the population’s life expectancy and ensuring their health. The study was designed to investigate the impact of environmental taxes, as environmental policy instruments, on the state and the health of the population. The analysis of scientific works, built based on the Publish or Perish software, made it possible to confirm the unfailing relevance of research on the topic of the impact of environmental taxes. Where environmental taxes are considered as a tool for influencing the level of pollution of the surrounding natural Environment and indicators of life and health of the population. The analysis of scientific works published in recent years under the keywords «environmental tax» and «healthy» based on the Scopus scientometric database also confirmed the study’s relevance, considering the level of citations of the presented works. Some authors pay considerable attention to additional taxation of producers of harmful products and subsidizing enterprises that grow or produce eco-products. Other scientists emphasize changing the existing environmental legislation (increasing environmental tax rates, targeted use, introducing additional critical emission limits, etc.). They believe this will have the effect of a hidden intervention in the prevention of disease through reducing climate change. The main part of the study was based on visual confirmation of the relationship between environmental taxes and the population’s level of health using the VOSviewer software product. This bibliometric analysis confirmed that limiting the environmental pollution level due to environmental taxes determines the possibility of improving the population’s health. At the same time, financial instruments for curbing habits harmful to human health also have a positive impact. Clustering made it possible to: confirm the impact of environmental taxes on the actual level of environmental pollution; reflect the dependence of personal habits and tendencies that affect the life and health of the population; to argue the fact that ecological culture and the culture of a healthy lifestyle are formed not only by objective but also by subjective reasons, as well as by the general psychological state of the population; to confirm the existence of the socio-regulatory orientation of the ecological tax, including the environmental exposure and the level of health of the people, etc. The graphical method (built based on Stata software) made it possible to confirm that environmental taxation can improve the state of the natural environment. The transmission nature of environmental taxation’s impact on the population’s life and health is also determined. The research results are a scientific basis for developing the latest environmental policy, which would fully enable the environmental tax to perform its compensatory function, as well as ensure the formation of green production and expand the access of individuals to quality food products.

Recommendations to improve insurance coverage for physiotherapy services in Iran: a multi criteria decision-making approach

BackgroundHigh toll of traffic-related injuries, climate change, natural disasters, population aging, as well as chronic diseases have all made considerable demands on receiving physiotherapy services in Iran. Nevertheless, there is an assortment of complications facing utilization of such services, particularly poor insurance coverage. Therefore, the present study investigated and identified gaps in insurance coverage in order to inform future policy reforms and the design of a more comprehensive and universal benefits package for physiotherapy services in Iran.MethodsThis project was carried out in Iran, using a mix-methods (viz. qualitative-quantitative) approach. Within the first phase, a qualitative study was completed to find policy recommendations. Such recommendations were then prioritized through the Analytical Hierarchy Process (AHP), in the second phase, based on effectiveness, acceptability, cost, fairness, feasibility, and time.ResultsWithin the first phase, a total number of 30 semi-structured interviews with health policy-makers, health insurers, faculty members, rehabilitation experts, and physiotherapists were completed. Several policy recommendations were also proposed by the study participants. Following the second phase, prioritized recommendations were provided to promote stewardship (e.g., informing policy-makers about physiotherapy services), collection of funds (e.g., placing value-added taxes on luxury goods and services), pooling of funds (e.g., moving allocated resources towards insurance (viz. third-party) mechanism), purchasing (e.g., using strategic purchasing), and benefit package (e.g., considering preventive interventions) as the main components of insurance coverage.ConclusionThe study findings provided a favorable ground to improve insurance coverage for physiotherapy services in Iran. As well, decision- and policy-makers can place these recommendations on the agenda in the health sector to protect population health status, especially that of groups with disabilities.

New implication of pesticide regulatory management in soils: Average vs ceiling legal limits

To help regulatory agencies better interpret pesticide soil standards (PSSs) and promote pesticide soil regulations, this study revealed new PSS implications by introducing the average (i.e., PSSAC) and ceiling (i.e., PSSCC) legal limits of pesticides. The PSSAC indicates the average legal limit of a pesticide in the soil over a duration (e.g., annual or monthly average), ensuring that no adverse human health effects can occur. The PSSCC indicates the ceiling legal limit that cannot be exceeded by pesticide concentrations in the soil, which was introduced to comply with pesticide application in real-world scenarios. We introduced the regulatory ceiling factor (RCF) to screen whether a pesticide in the surface soil could be regulated using the PSSAC and PSSCC values. The results indicated that except for some pesticides with high lipophilicity and low degradability (e.g., legacy pesticides), many pesticides were eligible to be regulated by both average and ceiling legal limits. In addition, we conducted a case study to evaluate chlorpyrifos soil standards via a four-step regulatory procedure; the results indicated that our new interpretation using the simulated PSSAC and PSSCC values of chlorpyrifos demonstrated that most current chlorpyrifos soil standards can protect population health, which is in contrast to the findings of current regulatory studies. Furthermore, based on the new implication of PSSs interpreted in this study, we recommend that regulatory agencies clarify PSSs to avoid confusion and promote cost-efficient remediations, and recommend improving the regulatory communication between environmental agencies and pesticide manufacturers to define a comprehensive policy integrating PSSs and application patterns.

Nowcasting towards sustainable SARS-CoV-2 endemicity

Nowcasting towards sustainable SARS-CoV-2 endemicity

HTA of novel biocontainment systems for ambulance transport: public health implications

BackgroundBiocontainment systems in healthcare settings are intended to ensure isolation of contagious or potentially contagious patients so as to protect healthcare providers and control infection spread. The need for safe and effective biocontainment systems has emerged during the COVID-19 outbreak. In particular, transport of potentially contagious patients poses technical, logistical and medical challenges that are to be addressed to protect population health and enable safe healthcare services delivery.MethodsAs novel biocontainment systems become available it is important to assess their operational effectiveness and safety and to define their organizational impact. We applied the Health Technology Assessment (HTA) framework to evaluate a novel rigid bio-containment system (Billy-Cab) integrated with the stretcher support, for ambulance transport of contagious patients.ResultsWe applied the EUnetHTA core model to conduct an HTA report of Billy-Cab. A multi-disciplinary working group was established. We assessed available biocontainment under the nine dimensions of the EUnetHTA core model. We derived and pooled: 1) original data derived from clinical practice, 2) secondary data derived from systematic reviews of the literature, conducted according to the PRISMA guidelines, 3) original data derived from validated questionnaires, 4) economic original data.ConclusionsPreliminary data allow to conclude selected biocontainment systems are effective in ensuring infection control during ambulance transport, with manageable organizational impact. In addition, the use biocontainment systems positively influence healthcare professionals' attitudes and performances. The HTA methodology offers substantial support to evaluate the introduction of innovative technologies during health emergencies and beyond.Key messages Selected biocontainment systems are effective in ensuring infection control during ambulance transport.HTA is to be applied to evaluate the introduction of innovative technologies during health emergencies and beyond.

Adherence to non-pharmaceutical interventions for COVID-19: a national survey

BackgroundThe global Covid-19 pandemic response depends heavily on non-pharmaceutical interventions to protect population health. This aim of this study was to provide insights into levels and determinants of adherence to travel restrictions and wearing of face coverings during the early phase of the pandemic response in Ireland.MethodsA series of four cross-sectional surveys were administered through random digit dialling of mobile and landline numbers during May-June 2020. Questions were asked about compliance with local travel restrictions and where relevant, the reasons for travel. A question on mask use was added to the final wave of data collection.ResultsOverall, across the four waves, 73.4% reported adhering to the travel restrictions and these levels were maintained over time (wave 1: 72.1%, wave 2: 73.7%, wave 3: 67.3%, wave 4: 79.7%) and were broadly similar across different socioeconomic groups. Higher proportions reported travelling for non-exempt reasons over time particularly in the final wave of data collection including exercise (from 3% in wave 1, 5% in wave 2 up to 8% in waves 3 and 4) and recreational or social activities (2% in waves 1 and 2, 4% in wave 3, up to 15% by wave 4). Overall, over two-thirds of respondents reported use of masks in the final wave, (72% of women, 65% of men) with shops or supermarkets the most common place of use. Among primary respondents, older age (Age 70+ vs. 18k-44, OR 3.2 [2.4-4.3]), attending higher education (attending vs. completed third level OR 2.2 [ 1.6-3.0]) and female gender (OR 1.2 [1.1-1.4]) were independently associated with compliance with travel restrictions.ConclusionsThe findings demonstrate high levels of adherence to travel restrictions during the early stages of the emerging COVID-19 pandemic, albeit with a modest trend towards reduced compliance over time. There was a high uptake of mask use in advance of relevant national guidance.

Vaccine Hesitancy in Parents: Role of Social Networks, Social Media, and Parental Autonomy

Introduction. Vaccine hesitancy in parents is a composite of multiple dimensions such as confidence, complacency, and convenience. A large proportion of parents can be deemed vaccine hesitant, meaning that their vaccine behaviors can range from delaying vaccines, skipping select vaccines, to refusal of all vaccinations. Furthermore, parental vaccine uptake rates and patterns can reflect their decisions based on the balance of parental autonomy versus protecting population health. The current manuscript uses Social Network Theory to explain some of the external influences on parental autonomy. Social networks, both private and public, play a role in vaccine decision making through providing information and support for parents in their choices. This influence, in turn, is mediated by parents’ health literacy and local vaccination policy. Discussion. Social media is an important type of public network that has an outsized influence on vaccine hesitancy. The rhetoric used on anti-vaccine websites often denigrates scientific evidence while at the same time endorsing poor-quality evidence that supports the anti-vaccine point of view. The websites continually propose new hypotheses of how vaccines can cause harm when studies refute their previous assertions, censor critics, and attack people with opposing viewpoints. The contentious nature of vaccine hesitancy based on beliefs, opinions, and attitudes needs a solution much deeper than simply providing factual knowledge or pointing people to reliable websites. Recommendations. Public health practitioners and researchers should try segmenting audiences, targeting private and public social networks, and then testing which persuasive strategies towards vaccinations appeal to different community groups.

A Playbook for Implementing Medicaid Expansion: Louisiana's Experience.

Policy Points Twelve states have yet to expand Medicaid under the Affordable Care Act (ACA). Louisiana offers a model of steps that states and counties can take to rapidly enroll eligible persons while balancing eligibility integrity and doing so within a limited administrative budget. In a post-COVID-19 health care landscape, Medicaid expansion can improve and protect population health and boost state economies, even amid budget shortfalls. Even though Louisiana compares well with other states in eligibility and enrollment efforts, future expansions may integrate other social support programs into their implementation strategies.