Schools Of Public Health Research Articles

MEASURING QUALITY IN LONG-TERM SERVICES AND SUPPORTS THROUGH PERSON-REPORTED OUTCOMES: VALUE OF NCI DATA

Abstract Long-Term Services and Supports (LTSS) include medical, social, and personal care services that people may need to perform activities of daily living due to physical or cognitive impairments. Measuring the quality of LTSS is essential for improving the care and outcomes of people with disabilities and older adults and ensuring that services meet consumer needs. Several frameworks have been developed to measure LTSS quality, including the National Quality Forum’s LTSS Framework. Yet, few data sources are available to measure person-reported quality in HCBS. This symposium will provide an overview of National Core Indicators (NCI) as a unique data source to address this gap. It also includes presentations from researchers from organizations in two states who utilize NCI data – Minnesota and Massachusetts – who will share their perspectives about the value of the data, results from empirical analyses, and how they use and plan to use the data to inform policy. Researchers from the Lurie Institute for Disability Policy will present findings on the association between person-centered planning and key person-reported outcomes in Medicaid HCBS. Researchers from the University of Minnesota School of Public Health and Brown University will share findings from national NCI data on unmet needs among older adults by dementia status and race/ethnicity. They will also share results of analyses in MN, linking person-reported HCBS plan quality and healthcare utilization, using claims data. Collectively, this symposium will address the gap in measurement of HCBS quality nationally and identify key directions for policy and future research.

Education for public health 2030: transformation to meet health needs in a changing world.

Education for public health is at a critical inflection point, and either transforms for success or fails to remain relevant. In 2020, the Association for Schools and Programs of Public Health launched an initiative, Framing the Future 2030: Education for Public Health (FTF 2030) to develop a resilient educational system for public health that promotes scientific inquiry, connects research, education, and practice, eliminates inequities, incorporates anti-racism principles, creates and sustains diverse and inclusive teaching and learning communities, and optimizes systems and resources to prepare graduates who are clearly recognizable for their population health perspectives, knowledge, skills, attitudes, and practices. Three expert panels: (1) Inclusive excellence through an anti-racism lens; (2) Transformative approaches to teaching and learning; and (3) Expanding the reach, visibility, and impact of the field of academic public health are engaged in ongoing deliberations to generate recommendations to implement the necessary change. The article describes the panels' work completed thus far, a "Creating an Inclusive Workspace" guide, and work planned, including questions for self-evaluation, deliberation, and reflection toward actions that support academe in developing a resilient education system for public health, whether beginning or advancing through a process of change. The FTF 2030 steering committee asserts its strong commitment to structural and substantial change that strengthens academic public health as an essential component of a complex socio-political system. Lastly, all are called to join the effort as collaboration is essential to co-develop an educational system for public health that ensures health equity for all people, everywhere.

The impact of routines on emotional and behavioural difficulties in children and on parental anxiety during COVID-19

BackgroundThe Covid-19 pandemic and related public health measures, including lockdowns and school closures, have impacted on mental health of children.Aims and hypothesisWe hypothesised that there would be an association between maintaining a routine during lockdown and both lower emotional and behavioural difficulties in children and lower parental anxiety. Routine was taken as keeping to the same basic activities such as mealtimes and bedtimes. We also hypothesised that children of ‘keyworker’ parents would have fewer emotional and behavioural symptoms due to having maintained more normal routines. The key reason was that children of keyworkers still attended school or nursery and parents would have been getting up and coming home at the same times as pre-Covid. Keyworker status was defined as those whose work was essential to Covid-19 response, including work in health and social care and other key sectors.MethodsWe used data from the Avon Longitudinal Study of Parents and Children (ALSPAC) to explore associations between maintaining a routine, and emotional and behavioural difficulties in children, using linear regression models. All eligible ALSPAC-G2 participants were sent the survey and the responders are representative of the eligible G2 population. We included measures of parental anxiety. We separately explored associations with having a keyworker parent. We used the Carey Infant Temperament Questionnaire and the Revised Rutter Parent Scale for Preschool Children to establish levels of emotional and behavioural difficulties. The measures were chosen to match previous waves in multi-generations in ALSPAC where they had been shown to be predictive of later mental health in children. The scales measure emotional and behavioural problems.ResultsTwo hundred eighty-nine parents completed questionnaires about their 411 children. Keeping a routine was associated with emotional and behavioural difficulty scores 5.0 points lower (95% CI −10.0 to −0.1), p = 0.045 than not keeping a routine. Parents who reported keeping a routine had anxiety scores 4.3 points lower (95% CI −7.5 to −1.1), p = 0.009 than those who did not. Children of keyworkers tended to have lower emotional and behavioural difficulty scores [−3.1 (95%CI −6.26 to 0.08), p = 0.056] than children of non-keyworkers. All models were adjusted for relevant potential confounders.ConclusionMaintaining a routine may be beneficial for both child emotional wellbeing and parental anxiety, although it is also possible that lower parental anxiety levels made maintaining a routine easier. Being the child of a keyworker parent during lockdown may have been protective for child emotional wellbeing.

PAARI: Police helping, not arresting, drug users and their families

Last week's annual summit of PAARI (Police Assisted Addiction & Recovery Initiative) featured police chiefs, judges and others talking about how the organization, now eight years old and with more than 651 police department members in 40 states, is helping drug users. Co‐founder and CEO John Rosenthal opened that meeting, hosted by the Boston University School of Public Health, by noting that PAARI departments have now placed more than 30,000 people into treatment “through non‐arrest pathways.” Many drug users do find treatment through the coercive pathway of “go to treatment or [go to] jail,” which is not effective. Furthermore, it just deters people from asking for help. “You can't arrest yourself out of a public health crisis,” said Rosenthal.

Bringing structure and success to internal communications: Why and how the Johns Hopkins Bloomberg School of Public Health turned multiple listserv e-mails a day into the bi-weekly ‘SPHeed Read’

As the largest school of public health in the world, the Johns Hopkins Bloomberg School of Public Health struggled to find a way to effectively share internal communications with its community — especially during the COVID-19 pandemic. To address this challenge, the school's communications and marketing team conceptualised, piloted and successfully launched ‘The SPHeed Read’. The twice-per-week, one-stop-shop newsletter has dramatically changed how the school's internal communications are sent and received and earned praise from the school's community.

European Glaucoma Society – A guide on surgical innovation for glaucoma

PROLOGUE: Glaucoma surgery has been, for many decades now, dominated by the universal gold standard which is trabeculectomy augmented with antimetabolites. Tubes also came into the scene to complement what...

The Thich Nhat Hanh Center for Mindfulness in Public Health at the Harvard T.H. Chan School of Public Health, Boston, MA

The Thich Nhat Hanh Center for Mindfulness in Public Health at the Harvard T.H. Chan School of Public Health, Boston, MA

Teaching Community Engagement Through an Anti-Racism Lens: Lessons Learned From a Pilot Micro Course in Public Health and Health Care

Growing appreciation of the necessity of, and evidence-based strategies for, working collaboratively with communities in health promotion and related fields have been well documented. Yet community engagement, the umbrella term for many of these efforts, is rarely taught as a standalone course, nor is a critical component of community engagement –antiracism practice—typically included. Following a review of the literature, we discuss the contexts, pedagogical grounding and strategies, learning objectives and piloting of a “micro course” on community engagement using an antiracism lens at UC Berkeley’s School of Public Health. Designed for graduate students interested in community-based participatory research and practice but unable to take a full academic course in this area, the 30 hour pilot course drew a diverse mix of 16 students. Focused attention on racism, systematic racism, and antiracism practice was provided through lectures, in-class exercises, homework reflections, and the course final. Case-based examples of the critical role of antiracism practice in community engagement, particularly in and with BIPOC communities, were shared, and a range of strategies explored for building and maintaining cross-cultural partnerships and transforming our own institutions to better reflect antiracism practice. Challenges faced are highlighted, and lessons learned shared, including the imperative of creating, in both course planning and teaching, sharing our positionality and creating safe spaces for discussing any tensions that may arise.

Utilization of accessible resources in the fabrication of an affordable, portable, high-resolution, 3D printed, digital microscope for Philippine diagnostic applications.

Philippine clinical laboratory licensing requirements mandate that diagnostic microscopy for Tuberculosis (TB) sputum microscopy, urinalysis, pap smears, wet smears, an option for complete blood count, stool exams, and malaria thick and thin smears should be accessible and available in health facilities including primary care centers. However, access to these essential diagnostics is hampered by the lack of trained personnel, relatively high costs for supplies and equipment especially in rural and underserved areas. This served as motivation for our team to utilize accessible resources in the form of affordable 3D printers, available CAD software, and components to build our low-cost Openflexure microscope (OFM) prototype. We successfully fabricated our prototype for a total of 310$ with a weight of 525g. We used pathology teaching slides from the Ateneo School of Medicine and Public Health and examined the OFM prototype imaging capabilities. The calculated image resolution was 13% higher compared to an LED light microscope sample captured by a mobile phone at 40x and 15% for 100x. The sampled slide images had adequate clarity with some identifiable cellular features for Rheumatic Heart Disease (RHD), Tuberculosis in soft tissue, and Ascariasis. We were able to correct the color aberrations of the OFM we built and was able to scan images up to 1000x magnification without using oil. Given the features and cost, the OFM prototype can be an attractive and affordable option as an alternative or augmentation to diagnostic microscopy in Philippine primary care. Moreover, it may enable telepathology to support diagnostic microscopy in frontline care.

Compliance with U.S. Government Nutrition Advice and Concurrent Obesity Trends Using Nurses' Health Study Data, 1980–2011

BackgroundBeginning in 1977, the U.S. Government began formally issuing dietary advice, a main objective of which was to reduce and prevent the prevalence of obesity in the American population. Concurrently, the Harvard School of Public Health began conducting dietary intake surveys and collecting body mass index (BMI) (kg/m2) data on female nurses in the Nurses’ Health Study I (NHSI) and II (NHSII). ObjectivesWe aimed to assess whether compliance with the nutrition guidance from the U.S. Government to restrict dietary intake regarding total fat, saturated fat, and cholesterol was meaningfully associated with the prevalence of obesity. MethodsWe analyzed nutrition survey data from 1980 to 2011, grouping the sample into “compliers,” those who complied with guidance on the intake of total fat, saturated fat, and cholesterol, and “noncompliers,” those who did not. We then compared the means, medians, and distributions of BMI for compliers and noncompliers over the period for both the full survey population and an age-controlled sample. Finally, we plotted raw NHS data to examine respondents’ Fat Proportion intake of energy and concurrent BMI. ResultsThe mean and median BMI for both compliers and noncompliers increased throughout the sample period, and the BMI distributions shifted toward obese and severely obese overall and for an age-controlled subset compared with the 1980 NHSI and 1990 NHSII baselines. Compliers had slightly lower mean BMI increases than noncompliers but saw a relatively higher increase in the growth of the prevalence of those with BMI >30. We also found no linear relationship between Fat Proportion of energy intake and concurrent BMI. ConclusionsGuidance from the U.S. Government to limit fat, saturated fat, and cholesterol consumption was widely adopted by American female nurses during the study period. Our results show that compliance with this guidance had little if any effect in mitigating population-wide BMI increases during our study period.

Mpox Viral Lineage Analysis and Technique Development Using Next-generation Sequencing Approach.

In response to Mpox endemic and public health emergency, DCHHS aimed to develop NGS based techniques to streamline Mpox viral clade and lineage analysis. The Mpox sequencing workflow started with DNA extraction and adapted Illumina's COVIDSeq assay using hMpox primer pools from Yale School of Public Health. Sequencing steps included cDNA amplification, tagmentation, PCR indexing, pooling libraries, sequencing on MiSeq, data analysis, and report generation. The bioinformatic analysis comprised read assembly and consensus sequence mapping to reference genomes and variant identification, and utilized pipelines including Illumina BaseSpace, NextClade, CLC Workbench, Terra.bio for data quality control (QC) and validation. In total, 171 mpox samples were sequenced using modified COVIDSeq workflow and QC metrics were assessed for read quality, depth, and coverage. Multiple analysis pipelines identified the West African clade IIb as the only clade during peak Mpox infection from July through October 2022. Analyses also indicated lineage B.1.2 as the dominant variant comprising the majority of Mpox viral genomes (77.7%), implying its geographical distribution in the United States. Viral sequences were uploaded to GISAID EpiPox. We developed NGS workflows to precisely detect and analyze mpox viral clade and lineages aiding in public health genomic surveillance.

Prevalence and changes of intimate partner violence against women aged 15 to 49 years in 53 low-income and middle-income countries from 2000 to 2021: a secondary analysis of population-based surveys

In low-income and middle-income countries (LMICs), intimate partner violence poses a substantial barrier to accomplishing target 5.2 of the Sustainable Development Goals: to eliminate all forms of violence against women and girls. Our study aimed to assess the prevalence and changes of intimate partner violence against women in LMICs. We also explored the association between women's empowerment and intimate partner violence. In this secondary analysis of population-based surveys, we obtained data from the nationally representative Demographic and Health Surveys conducted in LMICs between 2000 and 2021. We selected countries with available data on the domestic violence module, and women aged 15 to 49 years who currently or formerly had a husband or partner, and who had provided information about intimate partner violence, were included in the analysis. We first estimated the weighted prevalence of intimate partner violence in LMICs with available data, and then we assessed the average annual rate of change using Poisson regression with robust error variance in a subset of countries with at least two surveys. We used multilevel analysis to investigate the association between intimate partner violence and women's empowerment measured at both the country and individual levels. Country-level empowerment was measured by gender inequality index, while individual-level empowerment considered social independence, decision making, and attitude to violence. A total of 359 479 women aged 15 to 49 years were included from 53 LMICs. 336 811 women from 21 countries with two surveys provided data for assessing the trends of intimate partner violence. The weighted prevalence of any type of intimate partner violence was 37·2% (95% CI 36·6 to 37·8). A significant overall decline in the prevalence of any type of intimate partner violence was observed with an average annual rate of change of -0·2% (95% CI -0·4 to -0·03); however six countries showed significant increasing trends, with average annual rates of change ranging from 1·2% (95% CI 0·7 to 1·7) in Nigeria to 6·6% (5·3 to 7·8) in Sierra Leone. Notably, the prevalence of psychological intimate partner violence has risen (average annual rate of change, 2·3% [95% CI 2·1 to 2·6]), reflected in increased rates across eight countries. Higher levels of country-level women's empowerment were associated with a lower risk of intimate partner violence: women from countries with the highest tertile of gender inequality index had an increased odds of any type of intimate partner violence (odds ratio 1·58 [95% CI 1·12 to 2·23]). Similarly, better individual-level women's empowerment also showed significant associations with a lower risk of intimate partner violence. The prevalence of intimate partner violence remains high, and some countries have shown an increasing trend. The strong relationship between both country-level and individual-level women's empowerment and the prevalence of intimate partner violence suggests that accelerating women's empowerment could be one strategy to further reduce intimate partner violence against women. National Natural Science Foundation; Vanke School of Public Health, Tsinghua University; and Sanming Project of Medicine in Shenzhen.

Declaration on high-quality development of public health education

On July 15, 2023, National Joint meeting of Deans/Directors of Schools of Public Health was held in Taiyuan, Shanxi Province, China. Focusing on the theme of"accelerating the construction of high-quality public health education system,"the conference had a warm discussion on the construction of high-level schools of public health, as well as the synergistic development of universities and the Centers for Disease Control and Prevention (CDCs). All meeting members reached a consensus and released the"high-quality development of public health education,"which is the first declaration issued by Chinese public health experts and of milestone significance in the new era of China's public health system construction and public health talent cultivation, as well as the critical year of the construction of high-level schools of public health.

Indiana University study highlights billions in annual losses from untreated MI in the state

Untreated mental illness in the Hoosier state comes at a cost of more than $4 billion a year, according to a new Indiana University study, the Daily Journal reported Nov. 1. The research published by the IU Richard M. Fairbanks School of Public Health found that one in five Indiana residents with mental illness do not receive the treatment they need. Hoosiers who do not receive such treatment are also more likely to experience other chronic health conditions, such as diabetes and cardiovascular disease, researchers said. The economic burden of untreated mental illness in Indiana is estimated to be $4.2 billion annually, including $3.3 billion in indirect costs — like unemployment and caregiving — $708.5 million in direct health care costs, and $185.4 million in non‐health care costs. The largest cost attributable to untreated mental illness was premature mortality, at over $1.4 billion. Productivity losses were estimated to cost $885 million each year. “The findings were published Oct. 13 in the Journal of the American Medical Association. Researchers worked with the Indiana Behavioral Health Commission to perform their analysis. Through the researchers' work, they developed a framework that allows Indiana to prioritize key areas in mental health services and treatment. The framework also provides Indiana with a baseline for tracking progress toward improvement efforts. The research was used in support of Senate Enrolled Act 1, which passed during the 2023 legislative session. The sweeping legislation will create a new mental health care system in Indiana, fortifying the relatively new 988 crisis response center and hotline with funding for mental health emergencies. The IU study population consisted of more than 6.1 million individuals of whom an estimated 429,000 had untreated mental illness in 2019, according to the research paper. “One of the most significant impacts of this research is that other states can use this framework to understand the financial burden in their state,” said Justin Blackburn, Ph.D., associate professor at the Fairbanks School. “There is a scarcity of data on the costs incurred by each state — especially by individuals, families and communities — from untreated mental illnesses in the United States. Policymakers, clinicians and employers need this sort of data to determine how we should allocate our societal resources.”

Role of Ibea Gene in Hbmecs Invasion and Biofilm Formation Induced By Neonatal Meningitis Escherichia coli

Background: Bacterial meningitis is a severe infectious disease that affects the central nervous system and can result in high mortality rates and neurological complications. In neonates, meningitis is mainly caused by neonatal meningitis Escherichia coli (NMEC), which invades the intestine, leading to hematogenous spreadand potential bacterial meningitis through blood-brain barrier. Previous studies indicated that the ability of NMEC to adhere and invade is associated with biofilm formation and a deficiency in ibeA may result in decreased virulence and biofilm-forming ability of avian pathogenic Escherichia coli (APEC). Furthermore, the ibeA gene is positioned downstream of ibeR. Our previous studies have shown that ibeR and ibeA genes can both regulate the virulence and relevant phenotypes in E. coli K1. However, the effects of ibeR and ibeA on the biofilm formation and invasion of K1 strain remain to be further studied. Recent studies suggest that indole may act as a signaling molecule to regulate the expression of adhesion and biofilm-promoting factors in E. coli. However, the mechanism by which indole affects biofilms is still unclear. This study aimed to investigate the mechanism of ibeA inhibition of indole-induced NMEC invasion and biofilm formation. Methods: The viability and growth of the wild strain E44 and ibeA-deletion mutant strain ZD1 were assessed by MTT cell proliferation assay kit (Coolaber). The absorbance values were measured at 490 nm and 540 nm by ELISA. The invasion activities and the biofilm formation ability of E44 and ZD1 were detected in vitro studies. We conducted a cell invasion test using the Human Brain Microvascular Endothelial Cells (HBMEC) model. The ability to form a biofilm was measured at 600 nm using a specific biofilm formation index. Biofilm phenotypic was observed by an confocal laser-scanning microscope(Olympus FV-1000, Japan). Then, we used indole as a regulatory agency to compare its biofilm inhibitory efficacy between E44 and ibeR-deletion mutant strain BR2. The experimental data were analyzed using the SPSS 19.0 statistical package. A statistically significant difference was indicated by P<0.05. Results: No difference was found in bacterial growth between the E. coli strains E44 and ZD1. The biofilm formation and HBMECs invasion of ZD1 was significantly lower than that of E44. After treatment with 0.5mM indole, the biofilm formation ability and the ibeA protein expressions of E44 were significantly inhibited. However, indole at different concentrations had no obvious inhibition on BR2 biofilm formation and the ibeA protein expressions. Conclusion: In summary, the study found that ibeA had a significant regulatory effect on HBMECs invasion and biofilm formation of NMEC, which may inhibit by indole via regulating ibeA through ibeR. ( Acknowledgements: Grant from School of Public Health of Southern Medical University, Guangzhou, China, No. GW202329; J.Z., Q.L. and L.W. contributed equally to this work; Corresponding author: Hong Cao, gzhcao@smu.edu.cn)

Supplementation with fortified balanced energy–protein during pregnancy and lactation and its effects on birth outcomes and infant growth in southern Nepal: protocol of a 2×2 factorial randomised trial

IntroductionMany women in low and middle-income countries enter pregnancy with low nutritional reserves with increased risk of fetal growth restriction and poor birth outcomes, including small-for-gestational-age (SGA) and preterm birth....

The role of the multiple Index of deprivation in predicting mental health outcomes after the COVID-19 pandemic in adolescents: a cross-sectional study

BackgroundThe number of children and young people (CYP) diagnosed with mental health problems has increased over the past decade. The COVID-19 pandemic also has accelerated this increase, raising significant concerns about adolescent emotional wellbeing. Research suggests that adolescents who live in more deprived areas are more likely to experience poor emotional wellbeing. Children in the northwest of England are among those with the poorest outcomes in the UK. We aimed to investigate the association between deprivation and mental health outcomes from 2019 to 2022. The aim was to support local authorities with targeted provision of public health services as well as predicting service need for 2022 onwards. MethodsIn this cross-sectional study, we analysed routinely collected Schools Health Needs Assessment (SHNA) data. The School Health Needs Assessment dataset contained 32 676 responses from Year 6 (ages 10–11 years) and Year 9 (ages 13–14 years) who completed the annual survey in 2019–22. The questionnaire was offered to all mainstream schools, delivered by the public health school nursing service. Index of multiple deprivation (IMD) data were provided for household postcodes. Data were analysed using IBM SPSS. Factor analysis created a composite emotional wellbeing scale (EWS) and estimates generated by school year (Years 6 and 9) and three academic years (2019–22). We calculated correlations between IMD and EWS overall and within school and academic year samples. FindingsThe final total sample across the three consecutive survey years and the two school years was 32 659. The sample consisted of 15 932 (49%) female students and 5066 (16%) students who registered at school as from an ethnic minority. Of the total sample, 9209 (28%) lived in a postcode in the most deprived IMD quintile in England. There was an overall decrease in EWS from Year 6 to Year 9 and from 2019 to 2022. The Year 6 students in 2022 reported mean levels of EWS equivalent to Year 9 students in 2019 indicating a shift toward poorer mental health in younger children. The correlational analyses showed no significant associations between IMD and EWS scores within the school or academic year cohorts. A follow-up analysis of children in receipt or not in receipt of free school meals also showed no significant association with EWS scores. InterpretationFindings showed that the emotional wellbeing of children and young people in the northwest of England has deteriorated since 2019, with greatest changes observed in the younger cohort of children in Year 6. This was not explained by postcode-based indices of multiple deprivation. Although it is recognised that deprivation is both a cause and a result of poor mental health, policy decisions on service provision for children and young people should not be based solely on IMD or receipt of free school meals. A rapid response is required to address the decline in emotional wellbeing currently observed in younger children of the northwest of England. FundingNone.

What do experts mean by “misinformation” in the COVID-19 era? A critical scoping review protocol

In April 2020, the World Health Organization released the report Managing the COVID-19 infodemic: A call to action, declaring that “the 2020 pandemic of Coronavirus disease (COVID-19) [had] been accompanied by a massive ‘infodemic.’” Soon afterwards UN Secretary General Antonio Guterres tweeted - also alluding to COVID-19 - that “a tsunami of misinformation, scapegoating and scaremongering [had] been unleashed” also in relation to COVID-19. The tweet was followed by a March 2021 report from the Centre for Health Security at the Johns Hopkins Bloomberg School of Public Health, warning that “health-related misinformation and disinformation” were undermining the public response to COVID-19, and by a February 2022 US Department of Homeland Security infographic, Disinformation Stops With You”, alerting about the dangers of “misinformation”, “disinformation”, and “malinformation” – dubbed MDM - distinguishing these terms based on the presumed intentionality of the agents producing or spreading them. However, there has been scant interrogation of expert meanings of MDM in the COVID-19 context and of the implications of the premises underlying these meanings for public policy, equity, and civil, social, and political rights. Drawing from the traditions of critical policy, discourse, and document analysis, we will apply Arksey O’Malley’s framework, enhanced by Levac et al.’s team-based approach, to conduct a critical scoping review of the medical and social scientific peer-reviewed literature, identifying, summarizing, and appraising expert meanings of MDM. We will also assess the implications of our findings for the health and well-being of populations affected by policies informed by dominant concepts of MDM.

Exploring the spiritual foundations of public health leadership

The Covid-19 pandemic has laid bare the challenges of public health leadership. Faced with criticism, threats, and even violence, many public health leaders have left the field. A healthier future for the nation may well rest on training aspiring public health leaders to build deeper capacity for perseverance, healing, and resilience. Reflecting the growing experience of a team of public health educators at the Harvard T.H. Chan School of Public Health (Harvard Chan), this article offers recommendations for public health schools to recognize, and incorporate into leadership education, themes of spirituality—ie, the way people seek ultimate meaning and purpose and deep connectedness to something larger than themselves. Doing so can serve as a foundation for the lifelong journey of leadership. Over the past decade, Harvard Chan has incorporated meaning, purpose, and connectedness themes to complement more traditional coursework addressing research and translation. While many established leadership frameworks address the “what” and “how” of career development, the spirituality framework can support aspiring leaders to more fully understand their “why” and its alignment with challenging work. Such a deeply personal topic, traditionally kept private, has been shared and nurtured in Harvard Chan classrooms through a range of pedagogical strategies including personal reflection, one-on- one coaching, experiential learning, case discussions, and candid conversations with public health leaders. By encouraging a values-based foundation for decision-making in crises and difficult leadership moments, such grounding can help aspiring leaders navigate the challenges of public health leadership that inevitably lie ahead.

1.H. Round table: How can we strengthen planning for health and universal health coverage in the 21st century?

Abstract Universal health coverage (UHC) is one of the most important goals to improve health and health service delivery for entire populations. It is thus high on the agenda in most high- as well as middle and low-income countries globally. However, for UHC to be successful in actually improving the health of the entire population, it is not enough to enshrine legal coverage dimensions on population, service, and cost coverage. While these are necessary steps to improve access, actual accessibility also necessitates geographically available services at numbers which are adequate to cover the needs and which are of sufficient quality - these steps should be at the core of any conscious and systematic health planning. The progress made in terms of legal coverage entitlements, accessibility, and quality over the past decades in health services is overshadowed by reports of costly and ineffective health services, long waiting times, inadequate attention to people's needs, unequal use of services and lack of human manpower. In addition, many in the health workforce feel alienated and diminished to number-crunching administrators at the cost of time with patients and clients. Never have the possibilities to treat so many, so well been better. Still, we seem to lose out on the ability to deliver many of these services adequately in high-income as well as in low-income countries. The aim of this workshop is to discuss how strengthened planning of health services may contribute to more rational, timely and effective health services to reach universal health coverage and ultimately improved health. A panel consisting of Reinhard Busse (Professor, Berlin Technical University), Peter Berman (Adjunct Professor, Harvard T.H.Chan School of Public Health) and Birger Forsberg (Associate Professor, Department of Global Public Health, The Karolinska Institute) will define health planning and based on their long experience and expertise in the area, provide examples of successful and failed health planning efforts in The United States, Germany and Sweden. Also, global health perspectives on health planning will be discussed. Barriers and facilitators for improved health planning will be described and an ensuing discussion will engage the audience to address how health planning based on careful analysis of needs, demand and supply of services can be strengthened. Jointly with the audience the panelists will seek the answers to questions, such as 1. What signifies health planning today in insurance-based and tax-based systems, respectively? 2. How can more consistent and well-developed health planning processes contribute to improved health services, universal health coverage and reduced inequities? 3. What next steps needs to be taken to strengthen health planning; globally and nationally? This workshop will create interest around a revival of health planning as a way to tie it with UHC dimensions and to improve health and reduce inequities in access to and use of health services. Key messages • Conscious and systematic health planning is a necessary next step following UHC entitlements but has been neglected and needs to be revived. • Health planning based on analysis of needs, demand and supply can make positive contributions to achieving universal health coverage and reduce inequities. Speakers/Panelists Birger Forsberg Karolinska Institutet, Stockholm, Sweden Peter Berman Global Health and Population, Harvard University, West Braintree, USA Reinhard Busse Berlin University of Technology, Berlin, Germany