Public Health Advocates Research Articles

Fireside Chat on the Asian American, Native Hawaiian, and Pacific Islander Special Edition of the Health Equity Journal Featuring Authors.

Fireside Chat on the Asian American, Native Hawaiian, and Pacific Islander Special Edition of the Health Equity Journal Featuring Authors.

Firearm-Related Injuries and Deaths in Children and Youth: Injury Prevention and Harm Reduction.

Firearms are the leading cause of death in children and youth 0 to 24 years of age in the United States. They are also an important cause of injury with long-term physical and mental health consequences. A multipronged approach with layers of protection focused on harm reduction, which has been successful in decreasing motor vehicle-related injuries, is essential to decrease firearm injuries and deaths in children and youth. Interventions should be focused on the individual, household, community, and policy level. Strategies for harm reduction for pediatric firearm injuries include providing anticipatory guidance regarding the increased risk of firearm injuries and deaths with firearms in the home as well as the principles of safer firearm storage. In addition, lethal means counseling for patients and families with individuals at risk for self-harm and suicide is important. Community-level interventions include hospital and community-based violence intervention programs. The implementation of safety regulations for firearms as well as enacting legislation are also essential for firearm injury prevention. Increased funding for data infrastructure and research is also crucial to better understand risks and protective factors for firearm violence, which can then inform effective prevention interventions. To reverse this trend of increasing firearm violence, it is imperative for the wider community of clinicians, public health advocates, community stakeholders, researchers, funders, and policy makers to collaboratively address the growing public health crisis of firearm injuries in US youth.

Firearm-Related Injuries and Deaths in Children and Youth.

Firearms are the leading cause of death in children and youth 0 to 24 years of age in the United States. In 2020, firearms resulted in 10,197 deaths (fatality rate 9.91/100,000 youth 0-24 years old). Firearms are the leading mechanism of death in pediatric suicides and homicides. Increased access to firearms is associated with increased rates of firearm deaths. Substantial disparities in firearm injuries and deaths exist by age, gender, race, ethnicity, and sexual orientation and gender identity and for deaths related to legal intervention. Barriers to firearm access can decrease the risk to youth for firearm suicide, homicide, or unintentional shooting injury and death. Given the high lethality of firearms and the impulsivity associated with suicidal ideation, removing firearms from the home or securely storing them-referred to as lethal means restriction of firearms-is critical, especially for youth at risk for suicide. Primary care-, emergency department-, mental health-, hospital-, and community-based intervention programs can effectively screen and intervene for individuals at risk for harming themselves or others. The delivery of anticipatory guidance coupled with safety equipment provision improves firearm safer storage. Strong state-level firearm legislation is associated with decreased rates of firearm injuries and death. This includes legislation focused on comprehensive firearm licensing strategies and extreme risk protection order laws. A firm commitment to confront this public health crisis with a multipronged approach engaging all stakeholders, including individuals, families, clinicians, health systems, communities, public health advocates, firearm owners and nonowners, and policy makers, is essential to address the worsening firearm crisis facing US youth today.

Mathematical model of COVID-19 transmission dynamics incorporating booster vaccine program and environmental contamination

COVID-19 is one of the greatest human global health challenges that causes economic meltdown of many nations. In this study, we develop an SIR-type model which captures both human-to-human and environment-to-human-to-environment transmissions that allows the recruitment of corona viruses in the environment in the midst of booster vaccine program. Theoretically, we prove some basic properties of the full model as well as investigate the existence of SARS-CoV-2-free and endemic equilibria. The SARS-CoV-2-free equilibrium for the special case, where the constant inflow of corona virus into the environment by any other means, Ω is suspended (Ω=0) is globally asymptotically stable when the effective reproduction number R0c<1 and unstable if otherwise. Whereas in the presence of free-living Corona viruses in the environment (Ω>0), the endemic equilibrium using the centre manifold theory is shown to be stable globally whenever R0c>1. The model is extended into optimal control system and analyzed analytically using Pontryagin's Maximum Principle. Results from the optimal control simulations show that strategy E for implementing the public health advocacy, booster vaccine program, treatment of isolated people and disinfecting or fumigating of surfaces and dead bodies before burial is the most effective control intervention for mitigating the spread of Corona virus. Importantly, based on the available data used, the study also revealed that if at least 70% of the constituents followed the aforementioned public health policies, then herd immunity could be achieved for COVID-19 pandemic in the community.

Decolonising global health in Africa: research agendas in public health, law, and human rights

Abstract Background In recent years the Groningen Centre for Health Law (‘GCHL’ - formerly the Global Health Law Groningen Research Centre), Netherlands, has held annual summer schools on global health, law, and human rights. Responding to calls to decolonise global health (Fofana, 2021), in February 2022 GCHL convened an online academic colloquium to explore the issues in Africa. Panellists and discussants comprised leading African academics and advocates for public health, law, and human rights. Objectives 1. Identify priority current and emerging issues in global health, law, and human rights in the African region with, where possible, reference to the climate crisis. 2. Explore opportunities for identifying academic institutions, networks, and researchers working these issues across Africa. 3. Identify opportunities to support collaboration between institutions, networks and researchers and other actors to address the issues identified across the region Results Top public health issues identified for further research included: public health law frameworks in Africa; One Health and climate change; inequality in the distribution of the determinants of health and disease; international trade and public health; the right to benefit from scientific progress (e.g. in accessing vaccines for COVID-19); gender-based violence; public health and agri-food systems; noncommunicable diseases; healthy diets; poverty; mental health; social protection; and plastic pollution. The first meeting of the network on health, law and human rights in Africa was held in May 2022. The second academic colloquium was held in July 2022, co-hosted with Moi University and the University of Nairobi, Kenya. Conclusions Public health and legal academics in Africa are ready to engage systematically with European partners to address key health-related law and human rights issues of global interest. Research agendas should reflect African priorities, and collaboration should be led by African institutions. Key messages • Capacity must be built to understand the links between public health, law and human rights in Africa. • Collaboration with European institutions to build capacity in public health, law and human rights is welcome, however priorities should be identified by - and responses led by - African academics.

3.P. Round table: The Commercial Determinants of Health: Industry tactics shaping science, policy and our environment

Abstract Prevailing narratives on health and illness emphasise individual choice and product ‘misuse’ for the disease and environmental burdens associated with harmful industries, deflecting from the wider environment in which these choices are made. Public Health frameworks such as the Dahlgren and Whitehead model enable us to consider the broader socio-economic, cultural and environmental conditions that influence these choices (or lack thereof). Until recently, the influence of multinational corporations on these broader conditions has often been ignored, despite the global impact these corporations have in shaping science, policy and our environment. Increasingly Public Health academics and advocates are calling for an enhanced focus on these ‘commercial determinants of health’ (CDoH) to understand the ways through which corporate interests affect health, sustainability, and health inequities. The concept of CDoH considers (among other things) the harmful or damaging nature of certain products and the tactics employed by industries to protect their commercial interests. The harmful tactics employed by the tobacco industry are well documented, but there is growing evidence that similar tactics are employed by other harmful industries more generally, from alcohol, gambling and food, to agrichemical and fossil fuel industries. In addition to driving consumption (with resulting population and planetary ill health), these tactics have a cross-industry, complementary, cumulative effect; spreading misinformation, shaping ‘personal responsibility’ and ‘nanny state’ narratives, weakening regulation and undermining science and policymaking. The impact of these harms accumulates across the life-course, with differential exposure to both harmful products and tactics driving health inequities. We argue there is a need to make visible, or ‘resurface’ these tactics; at present, Public Health often fails to challenge corporate strategies and, more concerningly, can be complicit in reinforcing industry framings of issues. This session will outline how a life-course, complex systems approach can support this endeavour, exploring a range of industry strategies through a series of case studies and discussing actions needed to safeguard public understanding and policy from commercial interests. This workshop will include 3 short presentations to illuminate some of the more insidious and less overt tactics, with opportunities for questions and panel discussion. The CDoH is an emerging field in Public Health and this session will give audience members an introduction to industry strategies and influences within a life-course framework, focusing on less overt channels of influence and some of the lesser-known industries. Key messages • The commercial determinants of health present a significant threat to public and planetary health but are conspicuously absent in the majority of public health conceptual frameworks. • Framing these hidden harms and exposures within the life-course model can support awareness of CDoH and facilitate public health professionals to counter corporate influences. Speakers/Panellists Claire Mulrenan LSHTM, London, UK May Van Schalkwyk LSHTM, London, UK Nason Maani LSHTM, London, UK

Food marketing

Abstract The Commission has established a joint action with Member States through the Best ReMaP joint action (2020-2023) to facilitate the effective implementation of the Audiovisual Media Services Directive which, in its revised version, calls on Member States to ensure that codes of conduct protect children from exposure to unhealthy food marketing. This provision itself highlights the tension between, on the one hand, the desire to limit the exposure of children to harmful food marketing and, on the other, the likelihood of achieving this objective through the implementation of codes of conduct. Speakers/Panellists Nikolai Pushkarev Healthy Environments &amp; EPHA Policy, European Public Health Alliance, Brussels, Belgium Contact: nikolai.pushkarev@epha.org EPHA will present the perspective of the public health advocacy community, and discuss some of the initiatives civil society are engaged in to help the EU move from rhetoric to practice.

Alcohol industry’s arguments against French pregnancy warning labels: a press coverage analysis

Abstract Background Alcohol drinking during pregnancy has harmful consequences. Warnings displayed on alcohol bottles are an effective measure to inform people about these risks and have been put in place in France. However, the alcohol industry (AI) resisted this measure when it was introduced in 2007 and during an expansion project in 2018. This study aims to identify arguments used by the AI against warnings targeting pregnant women. Methods A documentary method was used to analyse these arguments disseminated by the AI and its partners (elected representatives of wine-producing regions, etc.) in the French mainstream press (the national, regional and specialised press) from 2000 to 2020 through the Europresse documentary database. A quantitative analysis (number and evolution of press articles, mapping of the actors of AI who expressed themselves) and an inductive thematic content analysis (analytical framework of the arguments identified) using NVivo Software were carried out. Results Among the 85 articles included in this study, a majority of the arguments used by the AI are against this measure. It argues that this measure (1) is a questionable measure because ineffective in changing behaviours, (2) will have counterproductive effects (on women and on the economy); and (3) there are other preferred alternatives than warnings (targeted prevention programs, etc.). A minority is nevertheless in favour of this measure. Among the actors who expressed themselves, a large majority comes from the winegrowing sector. Conclusions The analysis of these arguments will add new insights about AI lobbying against warnings, by analyzing the arguments over a 20 years period covering a failure and a success of industry lobbying. It will also be useful for public health advocacy to better counter this lobbying influence and these arguments, which are not necessarily evidence based. Key messages • Warnings displayed on alcohol bottles are an effective measure which is challenged by the alcohol industry. • Analysing the arguments disseminated by the alcohol industry is useful for public health advocacy in order to counter them.

Rhea Boyd: paediatrician advocating for health equity

Rhea Boyd describes herself as a paediatrician, a public health advocate, and a scholar who works at a paediatric clinic, as the Director of Equity and Justice for The California Children's Trust, and as a co-developer of The Conversation: Between Us About Us, a campaign that provides credible information about COVID-19 vaccines to Black and Latinx communities across the USA.

National Blood Foundation 2021 Research and Development summit: Discovery, innovation, and challenges in advancing blood and biotherapies.

National Blood Foundation 2021 Research and Development summit: Discovery, innovation, and challenges in advancing blood and biotherapies.

Public Health Liberation – An Emerging Transdiscipline to Elucidate and Transform the Public Health Economy

Public Health Liberation (PHL) is an innovative general theory of public health aimed at accelerating health equity. This paper provides a rich synthesis of philosophical traditions, novel theories, and approaches to establish the basis for a new public health transdiscipline. The authors argue that the "public health economy" as a single analytic lens elucidates the contradictions and tensions that reproduce vast health inequity. Authored by a majority of Black women, community experiences and perspectives are a major strength of this paper because they draw upon leadership experiences with contemporary issues. The authors begin by describing their background in public health advocacy and by demonstrating the need for PHL using lead-contaminated water crises from Flint, Michigan and Washington, DC. They discuss the benefits of horizontal and vertical integration that broaden public health discourse to include affected populations and that seek opportunities throughout the public health economy. Their philosophical and theoretical reasoning reinterprets and adopts disciplinary concepts in political theory, sociology, women's studies, African American emancipatory writing, anti-racism, and community psychology to form a culturally relevant worldview and cogent thesis. Several new constructs emerge that do not appear elsewhere in the literature - Gaze of the Enslaved, Morality Principle, liberation, illiberation, liberation safe spaces, public health realism, and hegemony. The authors use their ethical and theoretical assumptions to guide practice and community self-help. Public Health Liberation presents a major challenge to assumptions about public health effectiveness in addressing vast health inequity.

Framings of risk and responsibility in newsprint media coverage of alcohol licensing regulations during the COVID-19 pandemic in England.

IntroductionLicensing is recognised as a World Health Organization (WHO) ‘best buy’ for reducing alcohol harms. In response to the 2020 COVID‐19 outbreak, many countries‐imposed restrictions on outlets selling alcohol to reduce virus transmission. In England, while shops selling alcohol were deemed ‘essential’, multiple restrictions were imposed on licenced outlets such as pubs and bars. Media reporting of licensing restrictions during the pandemic might have shaped public discourses of alcohol risks and responsibilities.MethodsThis study aimed to understand how alcohol licensing changes in England were framed in newsprint media. Two hundred and fifty‐three relevant articles from UK newsprint publications were identified through the Nexis database, published within six time points between March and December 2020 reflecting key changes to licencing in England. Thematic analysis, drawing on framing theory, was conducted to identify ‘problems’ framed in the reporting of these changes.ResultsFour dominant framings were identified: (i) licensed premises as ‘risky’ spaces; (ii) problematic drinking practices; (iii) problematic policy responses; and (iv) ‘victimisation’ of licensed premises. The presence of these framings shifted across the reporting period, but consistently, social disorder was constructed as a key risk relating to licensing changes over health harms from alcohol consumption.Discussion and ConclusionsThe analysis shows newsprint media reproduced narratives of ‘inevitable’ drinking culture and social disorder, but also emphasised expectations for evidence‐based policy‐making, in the context of licensing during the pandemic. Discourses of dissatisfaction with licensing decisions suggests potential for public health advocacy to push for licensing change to reduce alcohol health harms, in England and internationally.

Covid-19 and Worker Issues: Lessons From a University-based Ad-Hoc Network.

The Covid-19 pandemic has made clear the central role of the workplace in public health. Workers and working families have been particularly impacted by a public health and economic crisis that has revealed both structural shortcomings and opportunities for future preparedness. In response to the pandemic, a group of scholars, labor and anti-poverty advocates, activists, union representatives, frontline workers, and public health professionals gathered to share observations and create a forum for information sharing and collaboration. Conversations evolved with the pandemic to include policy solutions aimed at addressing the pandemic's health and economic impacts. In this paper, we summarize key lessons from the “Covid-19 and Workers” calls and suggest that ongoing collaboration among labor activists and academic and public health advocates may help to prepare for new public health crises and protect the safety and health of workers and communities.

Two countries, similar practices: the political practices of the food industry influencing the adoption of key public health nutrition policies in Guatemala and Panama.

To identify the corporate political activity (CPA) strategies used by food industry actors during the development of two public health nutrition policies in Central America: Law #570 (taxation of sugar-sweetened beverages) in Panama and Bill #5504 (labelling and food marketing regulations) in Guatemala. We triangulated data from publicly available information from 2018 to 2020, (e.g. industry and government materials; social media material) with semi-structured interviews with key stakeholders. Guatemala and Panama. Government, academia and international organisations workers in health and nutrition. CPA strategies were categorised according to an existing internationally used taxonomy into action-based, instrumental strategies (coalition management, information management, direct involvement and influence in policy, legal action) and discursive strategies. Instrumental strategies included the establishment of relationships with policymakers and direct lobbying against the proposed public policies. Discursive strategies were mainly criticising on the unfounded ground that they lacked evidence of effectiveness and will imply negative impacts on the economy. The industry pointed at individuals for making their own food choices, in order to shift the focus away from the role of its products in contributing to ill health. We provide evidence of the political practices used by the food industry to interfere with the development and implementation of public health nutrition policies to improve diets in Central America. Policymakers, public health advocates and the public should be informed about those practices and develop counterstrategies and arguments to protect the public and policies from the vested interests of the food industry.

Helmet Use in Preventing Head Injuries in Bicycling, Snow Sports, and Other Recreational Activities and Sports.

Recreational activities and sports are a common and popular way for youth to enjoy physical activity; however, there are risks related to physical injury. Injuries can potentially result in death and long-term disability, especially from traumatic brain injury. Helmet use can significantly decrease the risk of fatal and nonfatal head injury, including severe traumatic brain injury and facial injuries when participating in recreational sports. The most robust evidence of helmet effectiveness has been demonstrated with bicycling and snow sports (eg, skiing, snowboarding). Despite this evidence, helmets are not worn consistently with all recreational sports. A multipronged approach is necessary to increase helmet use by children and youth participating in recreational sports. This approach includes legislation and enforcement, public educational campaigns, child education programs, and anticipatory guidance from clinicians. This policy statement guides clinicians, public health advocates, and policymakers on best practices for increasing helmet use in recreational sports, including bicycling and snow sports.

Are Australian junior doctors failing to act as health advocates? A qualitative analysis

ObjectiveTo explore junior doctors’ attitudes towards and experiences of health advocacy practice and teaching in Australia. MethodsSemi‐structured interviews were conducted with 15 junior doctors across Australia. Data were thematically analysed. ResultsThree themes were identified: i) participants inconsistently understood and practised health advocacy, with many failing to conduct any advocacy work; ii) distinct factors motivated and enabled participants to undertake health advocacy; however, these were largely unrelated to any formal medical education; iii) the current medical workplace and education system is non‐conducive to health advocacy practice given the numerous barriers faced by junior doctors when engaging with health advocacy. ConclusionsHealth advocacy is generally poorly taught, weakly understood, and rarely performed despite being one of the four core graduate competencies of the Australian Medical Council (AMC). The AMC must clearly define health advocacy and its scope in their outcome statements, and this must be translated into medical education curricula and advocacy opportunities in the workplace. Implications for public healthDoctors are well‐placed to act as public health advocates, yet they are denied the encouragement and training to do so. With the growing burden of complex and sensitive public health issues, junior doctors should be trained and encouraged in health advocacy.

The 1964 US Surgeon General's report on smoking and health.

The 1964 report of the US Surgeon General on smoking and health made an authoritative case that tobacco smoking was a cause of premature deaths from lung cancer and chronic bronchitis. It justified the practice of drawing causal inferences from epidemiological studies, specified influential criteria for doing so, and made use of an early form of meta-analysis.

Prevalence and characteristics of advocacy curricula in Australian public health degrees.

Public health advocacy is a fundamental part of health promotion practice. Advocacy efforts can lead to healthier public policies and positive impacts on society. Public health educators are responsible for equipping graduates with cross-cutting advocacy competencies to address current and future public health challenges. Knowledge of the extent to which students are taught public health advocacy is limited. To determine whether advocacy teaching within public health degrees matches industry needs, knowledge of pedagogical approaches to advocacy curricula is required. This study sought to understand the extent to which advocacy is taught and assessed within Australian public health degrees. Australian public health Bachelor's and Master's degrees were identified using the CRICOS database. Open-source online unit guides were reviewed to determine where and how advocacy was included within core and elective units (in title, unit description or learning outcomes). Degree directors and convenors of identified units were surveyed to further garner information about advocacy in the curriculum. Of 65 identified degrees, 17 of 26 (65%) undergraduate degrees and 24 of 39 (62%) postgraduate degrees included advocacy within the core curriculum, while 6 of 26 (23%) undergraduate and 8 of 39 (21%) postgraduate offered no advocacy curriculum. Australian and international public health competency frameworks indicate advocacy curriculum should be included in all degrees. This research suggests advocacy competencies are not ubiquitous within Australian public health curricula. The findings support the need to advance public health advocacy teaching efforts further.

An Evaluation of Roles and Integration of Female Soldiers in Peace Building in Central African Republic: A Case of Zambian Regiment Lusaka, Zambia.

Purpose: The rationale of this study was to evaluate the roles and integration of female soldiers in peace building in the Central African Republic, a case of a Zambian Regiment in Lusaka, Zambia. The motivation to undertake this study was premised on the fact that despite Zambian female soldiers being actively involved in the United Nations peacekeeping efforts, their special roles and responsibilities in the mission are scantly recorded. The study further sought to examine the gender dynamics and challenges encountered by female soldiers in peacekeeping operations.&#x0D; Methodology: The study adopted a qualitative approach where ninety (90) research participants were homogeneously selected and data was collected through interviews, questionnaires and focus group discussions. The gathered bulk data was then transcribed and coded into categories and was thematically analysed by examining the patterns of meaning within the collected data sets and drawing inferences both explicitly and implicitly.&#x0D; Findings: The major findings revealed that Zambian female soldiers were actively engaged in community activities; force protection; public health and human rights advocacy; the de-escalation of gender associated cases and acting as role models to community members of Birao and Bria. Challenges encountered include male chauvinism; sexual harassment; insufficient numbers of female soldiers and suspicion of infidelity.&#x0D; Contribution to Theory, Practice and Policy: This paper calls on Zambia Army to realign its training curriculum to incorporate gender studies and human rights issues; Acceleration of skills development of female soldiers to build capacity in advocacy on human rights and counselling strategies; Policy on quota system to be adopted to increase the strength of female soldiers during recruitment; Regional bodies under African Union should lobby for resources from the United Nations to have sufficient numbers of female soldiers on the continent to contribute in the de-escalation of conflicts on the continent.

Public health advocacy: How to effectively communicate research findings to policy makers and the press

Public health advocacy: How to effectively communicate research findings to policy makers and the press