Public Health Leaders Research Articles

Multi-disciplinary Leadership to Mitigate COVID-19 in an Austere West African Military Environment.

The COVID-19 pandemic created challenges for forward-deployed military units to Western Africa. Austere military environments afford multiple avenues to transmit COVID-19 amongst service members. A COVID-19 outbreak on a military base in Western Africa spanning over 100 days is statistically analyzed using a Pearson's correlation coefficient. Furthermore, a COVID-19 reproductive number (R0) is evaluated to examine the relationship between specific command-directed policies to mitigate COVID-19 transmission. The multidisciplinary partnership of military command, medical, and public health leadership implemented evidence-based and epidemiologically informed COVID-19 preventive base-wide policies, including appropriate isolation/quarantine policies. The R0 for the outbreak was 0.03 and remained <1 for the outbreak duration. This base remained COVID-19 free for multiple weeks after policy implementation. The implementation of practical mitigating base-wide policies through seamless communication between military command/medical/public health leadership resolved the COVID-19 outbreak while maintaining mission readiness. Weekly COVID-19 testing epidemiological data may be utilized by commanders to direct further decision-making on tightening/loosening base-wide policy restrictions for continued mission-essential operations, e.g., security, food service, or airfield operations.

Vaccination Attitudes and Experiences of Medical Doctors in Croatia amid the COVID-19 Pandemic: A Social Roles Conflict?

The study aimed to investigate the range of experiences and attitudes of Croatian medical doctors (MDs) related to vaccination and vaccine hesitancy. In January 2021 three asynchronous online focus groups were held using MRQual, a web-based platform, which included 46 MDs from all three levels of the healthcare system in Croatia. NVivo, a qualitative data analysis software package, was used for the thematic analysis of collected data. The participants expressed a high level of support for the Croatian immunization program and vaccines in general. However, some skepticism was expressed regarding new vaccines and the regulatory processes of their approval. A significant number of participants raised concerns over the approval of COVID-19 vaccines, especially given their rapid development. The results also revealed that the process of communication with patients is often based on the very elaborate categorizations of patients based on previous experience, which leads to prioritizing and a communication breakup when dealing with “problematic patients”. MDs find themselves in a delicate situation where a fine balance between time-consuming communication with patients and the demands for maintaining satisfying vaccination uptake is needed. The situation arises from a social roles conflict that is embedded in wider social values and expectations, since communication problems do not arise in the doctor’s office, and therefore cannot be solved without addressing the social forces that cause trust deficiencies. To achieve better immunization results public health leaders need to better understand the social contexts and constraints of MDs vaccine-related behaviors.

The Challenges of Public Health Leadership

The Challenges of Public Health Leadership

COVID in Context: The Lived Experience of Richmond's Low-Income Older Adults.

Taking a phenomenological approach, this qualitative study describes the lived experiences of low-income older adults during the COVID-19 pandemic. A socio-ecological model was used to organize the five identified themes describing the lived experience: socio-economic context, Black Lives Matter and the politics of race, COVID and polarized views of COVID, interpersonal context (social connections), and individual context (feelings, beliefs, and behaviors). Study findings illustrate the intersectionality of contextual influences on the experience of low-income older adults. Study participants demonstrated remarkable resilience and coping strategies developed in response to the challenges they experienced throughout their lifetime which benefited them when faced with the pandemic, social unrest, and political events that took place in 2020. This study highlights the importance of understanding the larger context of COVID-19 which has significant implications for policy makers and public health leaders.

Engaging Native American High School Students in Public Health Career Preparation Through the Indigenous Summer Enhancement Program.

Native American1 populations are systematically marginalized in the healthcare and public health workforce. One effective approach to reduce health disparities and improve health care delivery among Indigenous populations is to train more Native American health professionals who integrate academic and cultural knowledge to understand and influence health behaviors and perspectives. Diné College partnered with Northern Arizona University to develop the Navajo Native American Research Center for Health (NARCH) Partnership, funded by the National Institutes of Health. The high school component of the Navajo NARCH Partnership created the Indigenous Summer Enhancement Program (ISEP), a 1-week summer training program providing exposure to health careers and mentorship in pursuing public health careers for Native American high school students. ISEP utilizes the Diné Educational Philosophy (DEP), a Navajo conceptual framework to serve as the foundation of the program. In 2020–2021, due to COVID-19 restrictions, the DEP model had to be incorporated in the Navajo NARCH high school virtual program activities. ISEP used 2018 and 2019 past program evaluation data to inform the virtual programming. Students' perception of the program was collected using an online Qualtrics evaluation questionnaire. Students stated appreciation for program staff, fellow students, peer mentors and culturally relevant learning experiences in both virtual and in-person environments. Recommendations included: expanding the length of ISEP and continuing the hands-on activities and Public Health Leadership series.

A One Health evaluation of water, sanitation, and hygiene (WASH) services in Butaro Sector, Rwanda

Abstract In 2018, rural residents of northern Rwanda raised water, sanitation, and hygiene (WASH) access and availability as a community concern; however, no baseline information was available to prioritize communities for intervention. This study aimed to assess WASH for people and animals in four cells in Butaro Sector and to identify the cell with the lowest WASH access. This cross-sectional, quantitative study utilized telephone surveys to collect data. Households were randomly selected, and 539 male and female heads-of-household agreed to participate. Overall, 56.8% of households reported access to safe drinking water, but this differed significantly by cell (p &amp;lt; 0.001). Approximately half (54.2%) of respondents walked 30 min or longer to fetch water, travelling one or more times per day. Nearly all (98.5%) households reported the presence of sanitation infrastructure, most often a pit latrine. Across cells, animals experienced poorer access to clean water and sanitation than people. One cell, Gatsibo, reported the poorest overall access to WASH services. Multi-sector collaboration among public health, water authorities, and local leaders is needed to reduce travel times for fetching water and to ensure that all residents can access sufficient safe water to meet the health and hygiene needs of people and animals.

Maternal and Infant Mortality in Physicians' Families in 1922.

Maternal and Infant Mortality in Physicians' Families in 1922.

Global public health leadership: The vital element in managing global health crises.

Global public health leadership: The vital element in managing global health crises.

Doctor of Public Health-Crisis Management and COVID-19 Prevention and Control: A Case Study in China.

In the fields of public health policy and public health care, advanced educational programs are an important strategy in dealing with public health crises. The COVID-19 pandemic has exposed the global need for skilled public health leaders and managers to address complex public health challenges, which requires the strengthening of public health education at the highest levels. This paper is a qualitative case study of a special educational program for doctors of public health in China. The program's educational objectives are in line with epidemic prevention and control. With the goal of developing the world's leading national public health management system, the Chinese government established an advanced academic program for public health crisis management. The program offers doctoral students a multidisciplinary degree based upon the theoretical knowledge of crisis management, supported by advanced training in the foundational concepts, theories, and practices of public health, and the study of basic medicine which provides the theoretical support for developing essential clinical skills. Program graduates develop the theoretical, practical, and leadership-related capabilities required for the management of national emergencies. The program introduced in this paper meets current epidemic prevention and control needs and should be considered by public health policy makers, leaders, and scholars in the discussion of advanced public health policy and health care education in China, including the development of an internationally recognized Doctor of Public Health program.

Leading from the Middle: Practical Innovation in Public Mental Health.

Leaders in public mental health are responsible for ensuring the care environment is conducive to provider wellbeing, and ultimately patient care. Given the effects of stress and burnout, healthcare organizations must explore interventions to support their employees. The Leadership + Innovation Lab is a pilot project focused on enhancing leadership skills, innovation capacity, and peer connections among clinical managers. Participants executed individual or group projects to improve the care environment and co-created a peer consultation program. They reported increased connection with peers, innovation and leadership skills, and capacity to facilitate a better experience for their provider staff as a result of the program. This model can be used in other settings to help achieve the goals of the Quadruple Aim and improve communication.

Contested leadership and the governance of COVID-19 in Brazil: The role of local government and community activism

ABSTRACT Strong public health governance and leadership driven by scientific evidence, community participation, and attention to social and structural determinants of health are key to effective covid-19 containment. Given the failure of the federal government in Brazil to adopt effective public health measures, state and municipal governments, as well as community activists, have stepped in to fill the void. This essay examines the synergistic role that local governments, public universities, public health institutions and mutual aid initiatives have played in Brazil to advance pandemic control and mitigate the damaging effects of central government policies and neglect. Drawing on literature, media reports, and insights from journalists and activists based in Rio’s favelas, we show how grass roots groups take actions that bear complex and vital relationships with local governments, NGOs, universities, and public health institutions. Effective local public health governance goes beyond technical public health responses and involves strategies for countering chronic marginalisation and disempowerment of local communities which open new pathways for creative intermunicipal collaboration, social change, power redistribution. It remains to be seen if actions and emerging networks at the local level can exert pressure on national government while not further exacerbating the polarising politicisation of the pandemic.

Exploratory Evaluation of Inclusion Wheel Model for Public Health Practice to Include People With Disabilities: Implications for Leadership and Training to Serve the Whole Community.

This study evaluated the presence of the Inclusion Wheel Model's factors and conditions across programs on a variety of public health topics, in which people with disabilities were intentionally included. We used an action research approach to facilitate three learning groups and two communities of practice, including participants from the national disability community, nonprofit, university, and government public health partners. We conducted a qualitative analysis using virtual meetings, meeting notes, and the series of feedback surveys as data sources. A primary coder and secondary coder reviewed, coded, and analyzed each data source according to preset coding schemes, using a previously developed codebook based on the Model. All supports and factors of the Inclusion Wheel were identified, including adaptive leadership supports, readiness for the change of including people with disabilities in public health efforts, capacity building activities, and capacity efforts across settings and topics. This examination has critical implications for public health trainers, leaders, and program designers on the inclusion of people with disabilities and other underserved populations in health promotion efforts. Public health practitioners must serve the whole community, including underserved and marginalized demographic groups, like the one in four Americans living with a disability. The Inclusion Wheel may be used as a model to guide disability inclusion training among public health partners and leaders in nonprofit, corporate, and government sectors, as well as to prioritize involvement of marginalized and underserved population groups in planning health promotion efforts.

Pharmacist leaders in public and global health: Nurturing practitioners at the forefront of an ever-connected world

Pharmacists’ role and accessibility poise them as ideal public and global health practitioners. The Bristol Myers Squibb Foundation and Rutgers University PharmD-Public Health Residency trains graduates to address health care challenges through two 6-month assignments in sub-Saharan Africa and the United States. While in sub-Saharan Africa, residents work with grant partners to provide technical assistance in research, quality improvement, capacity building, and outreach work through a model that embraces mutual exchange and joint development of sustainable solutions.

Communicating the Risks of Air Pollution to the Public: A Perspective from Jordan and Lebanon.

Background:Communicating air pollution to the public is essential in reducing exposure to air pollutants through increasing awareness and promoting precautionary actions. However, one way to approach the public is through healthcare professionals who are considered public health leaders and could influence the public’s opinion. The current study aimed to investigate the perception of health experts about communicating air pollution to the public.Methods:Personal interviews of 32 health professionals were conducted to report their opinions about communication of air pollution through an open-ended questionnaire. Interview questions were focused on 5 themes: common air pollutants and health risks, goals and barriers of communication, types of information to disseminate, target groups, and vehicles of communication.Results:Interviewees agreed that air pollution should be communicated to the public. Major barriers to achieving effective communication were people’s poor comprehension and lack of interest of policymakers. The levels of pollution, associated health risks, and ways to protect one’s self were the most frequently reported types of information to distribute. Most interviewees focused on patients with pre-existing conditions and children as the main target groups. Further, social media and text messages were preferred as vehicles of communication.Conclusion:Although not all interviewees had a clear idea of how to develop and implement a communication system, most of them agreed on its importance in protecting the public. More emphasis on this topic and further investigations are expected to increase the interest of health care professionals in communicating the risks of air pollution and advocating for public health policies regarding air pollution.

Using a Participatory Approach to Develop Research Priorities for Future Leaders in Cancer-Related Precision Public Health

Using a Participatory Approach to Develop Research Priorities for Future Leaders in Cancer-Related Precision Public Health

An Inter-professional Antiracist Curriculum Is Paramount to Addressing Racial Health Inequities.

Legal, medical, and public health professionals have been complicit in creating and maintaining systems that drive health inequities. To ameliorate this, current and future leaders in law, medicine, and public health must learn about racism and its impact along the life course trajectory and how to engage in antiracist practice and health equity work.

Evidenced-Based Approaches States and Territories Can Implement to Advance Adult Immunization Uptake During the COVID-19 Pandemic and Beyond.

Evidenced-Based Approaches States and Territories Can Implement to Advance Adult Immunization Uptake During the COVID-19 Pandemic and Beyond.

Factors influencing compliance with public health directives and support for government's actions against COVID-19: A Nigerian case study

Because COVID-19 is a novel viral pandemic, there is a dearth of research in the body of evidence that explore factors that can influence compliance with public health recommendations and Nigerian government's actions to prevent the spread of COVID-19. Hence, this study's aim is to address this gap to help inform policymakers and the actions of public health leaders in Nigeria. The study included a sample of 336 adult Nigerians who responded to an online Qualtrics survey. Descriptive and linear regression analyses were conducted to determine the predictors of compliance with COVID-19 public health directives and support for government's action against COVID-19 spread. Perceived risk of stigmatization, perceived threat of COVID-19, town/city, gender, and confidence in government's ability to curb the spread and impact of COVID-19 were found to be significantly associated with compliance with COVID-19 public-health directives, and support for governments action against COVID-19. Given Nigeria's weak health system and high level of poverty, there is need to ensure the public health responses to the pandemic are effective and contextually relevant. Nigerians and other concerned global health stakeholders will benefit from research that provides more information on issues of non-compliance with COVID-19 public health directives and government actions.

Estimating Public Health Workforce Efforts Toward Foundational Public Health Services.

The Foundational Public Health Services (FPHS) include a core set of activities that every health department should be able to provide in order to ensure that each resident has access to foundational services that protect and preserve health. Estimates of the public health workforce necessary to provide the FPHS are needed. This study assessed the potential use of an FPHS calculator to assess health department workforce needs. Qualitative interviews were conducted via Zoom in December 2020-January 2021. Seventeen state and local public health leaders. Qualitative insights into the potential use of an FPHS calculator. Almost all participants expressed that a reliable estimate would help them justify requests for new staff and that a calculator based on the FPHS would help organizations to critically assess whether they are meeting the needs of their communities and the core expectations of public health. Although participants expected that a tool to calculate full-time equivalent needs by the FPHS would be helpful, some participants expressed concerns in regard to using the tool, given ongoing workforce issues such as recruitment challenges, hiring freezes, and funding restrictions. An anticipated positive consequence of using this tool was that it may lead to cross-training the workforce and result in more diverse expertise and skills among existing workers. The other unintended consequences were that an FPHS calculator would require a substantial amount of time assessing the current FPHS efforts of existing staff and the results of the FPHS gap estimate could become the bar rather than the minimum needed. The current public and political focus on public health infrastructure as a result of the COVID-19 pandemic has created a window of opportunity to create change. An FPHS-based staffing tool may help transform public health and initiate a new era.

Examining the Economic Perspective of Treatable Mortality: The Role of Health Care Financing and the Importance for Economic Prosperity.

Health is an essential element of economic life and is therefore considered a source of comparative economic development of countries. The aim of the study was to examine the associations between health care financing, specific treatable mortality of males and females of working age, and economic prosperity, taking into account to the classification of health systems applied in the countries of the Organization for Economic Co-operation and Development (OECD). An insurance-based health system and a tax-based health system were identified in these countries, and data were collected for the period 1994–2016. Descriptive analysis, panel regression analysis and cluster analysis were used to achieve the aim. The analytical process included economic indicators [health expenditure, gross domestic product (GDP)] and health indicators (treatable mortality from circulatory system diseases and endocrine, nutritional and metabolic diseases). The results revealed significant negative associations of health care financing with treatable mortality from circulatory system diseases and endocrine, nutritional, and metabolic diseases in both health systems and both gender categories. There were also negative associations between treatable mortality in both diagnosis groups and economic prosperity. These results have shown that health care financing is linked to economic prosperity also through health variability in the working age population. In terms of assessing economic and health outcomes, less positive and more positive countries were identified using cluster analysis. Countries such as Latvia with a tax-based health system and Hungary, Lithuania, Estonia with an insurance-based health system were characterized by great potential for improvements. Although reducing treatable mortality is a great motivation for public health leaders to increase health care financing, the importance for economic prosperity may be a more compelling argument. Effective interventions should be considered in the light of their regional, social and economic contexts.