Sustainable Public Health Research Articles

Community Health-Education Intervention Trial against Human Taenia solium Taeniasis/Cysticercosis in Central and Southern Zones of Tanzania.

Poor knowledge of human T. solium taeniasis/cysticercosis and insufficient sanitary and hygienic practices have been associated with the persistence of human T. solium infections in endemic areas. Community health education intervention measures were implemented in 42 villages of Kongwa and Songwe Districts to increase knowledge, improve good practices against infection and reduce incidences of human cysticercosis transmission using a health education package. The health education package comprised of leaflet, poster and a booklet The 42 villages were allocated into intervention group and control group, and each group consisted of 21 villages. Baseline and post-intervention information on social demography, knowledge, safe practices and incidences of human cysticercosis was collected from both village groups. The impact of the intervention was evaluated by comparing changes in knowledge, preventive practices related to human T. solium infections and the cumulative incidence of human cysticercosis between intervention and control villages. There was no significant difference in mean knowledge scores and preventive practice mean scores between the control and intervention groups at baseline. However, there were significantly higher knowledge mean scores in the intervention group compared to the control group at one year post-intervention (2.06 ± 1.45 vs. 0.94 ± 1.18, p < 0.001). There was no significant difference in the mean practice scores between the intervention and the control group at one year post-intervention (2.49 ± 1.13 vs. 2.40 ± 1.13, p = 0.31). Furthermore, there was no significant difference in the prevalence of human T. solium cysticercosis between the intervention and the control group at the baseline (1.4% vs. 1.4%, p = 0.97) by Ag-Elisa, and at one year post-intervention the cumulative incidence of human cysticercosis was 1.9 and 1.2 per cent in the control and intervention group, respectively. There was no significant difference in the cumulative incidence of human cysticercosis between the intervention and the control group at one year post-intervention (p > 0.05). Community health-education intervention is effective at improving the knowledge of human T. solium infections. The improvement in preventive practices and reduction in incidences of human cysticercosis are a gradual process, they may require sanitary and hygienic improvement and more time after the intervention to see improved changes. The study recommends a sustainable public health education on T. solium infections using the health education package through one health approach.

Impact of administrative state capacity determinants on sustainable healthcare

Public administration implements government policies through prudent administrative practices and state capacity. Based on Asia's political and administrative proficiency and paradox, this study explores the administrative state capacity determinants—bureaucratic quality (BQ) and military in politics (MP)—and their interaction with sustainable public health quality (PHQ) in Asia from 2006 to 2020. With its focus on the scenario and Asian state administrative issues, Goal 04: Health and Well-being of Sustainable Development Goals has been the core aspect of state capacity and sustainable development. Applying the generalized method of moments (GMM) econometric estimation, the study finds that the high risk of poor BQ due to political pressures and policy inconsistency has significantly and negatively impacted PHQ in Asia. In contrast, by overtaking the administration, a high degree of MP and military dominancy has been a progressive force for PHQ in Asia. The interaction of BQ and MP negatively affects the state's social development due to conflict of interest and shredding policy outcomes. This is the first study that deals with the nexus between sustainable development and administrative state capacity determinants of Asia's public sector. The paper finds that an effective and prudent administrative collaboration and expertise-sharing between the bureaucracy and the military accelerates sustainable healthcare in Asia. Furthermore, the study believes that a healthy institutional collaboration will help overcome the development loopholes in Asia, promote PHQ, and accelerate regional development.

Pattern and Socio-demographic characteristics of Drug Users at the National Drug Law Enforcement Agency (NDLEA) Rehabilitation Facility, Port Harcourt

Background: Substance abuse particularly among young people has become a large phenomenon globally affecting all segments of society. The abuse of alcohol, tobacco, cannabis and other psychoactive drugs among young people has become an issue of public health concern with untold negative consequences on human existence. Aim: This study sought to examine the sociodemographic profiles and patterns of drug use among drug users at the NDLEA Rehabilitation Facility, Port Harcourt. Materials and Methods: This was a descriptive cross-sectional study conducted among inmates of the National Drug Law Enforcement Agency (NDLEA), Port Harcourt. A structured questionnaire covering socio-demographic characteristics and other factors were self-administered to inmates of the facility, who have been brought by their relative for addiction care over a period of 3 years (2017 to 2020). Ethical approval was obtained from the ethical committee of the University of Port Harcourt Teaching Hospital and approval was obtained from the NDLEA Authority. All other ethical provisions were followed. Descriptive statistics was used to analyzed the data. Data were analyzed with number count, percentage, and then Chi-square of independence. Results: Majority of the drug users were male (98,8%), single (72.5%), unemployed (27.5%) and apprentice (40.0%), between the ages of 15 and 35 (67.5%) and with tertiary education. Cannabis was the most consumed drug (75.7%), followed by nicotine (30.8%) alcohol (28.3%), cocaine (27.4%) and heroine (25.8%). Majority of the users were introduced to drug by friends and family members and referred to the feeling they got on the first day of use as high and happy. Majority had 15 to 25 years as age of onset of drug use and there were no family history of psychoactive substance use or mental illness. Conclusion: Substance use is common among young people between the ages of 26 and 30, single, with higher level of education and low-income earners. Majority use illicit drugs, which they started at early age of 15 to 25 and introduced to by friends and family members. Improvement in socio-economic status of adolescents and sustained public health enlightenment will help to reduce the rising prevalence of drug use.

ReporTree: a surveillance-oriented tool to strengthen the linkage between pathogen genetic clusters and epidemiological data

BackgroundGenomics-informed pathogen surveillance strengthens public health decision-making, playing an important role in infectious diseases’ prevention and control. A pivotal outcome of genomics surveillance is the identification of pathogen genetic clusters and their characterization in terms of geotemporal spread or linkage to clinical and demographic data. This task often consists of the visual exploration of (large) phylogenetic trees and associated metadata, being time-consuming and difficult to reproduce.ResultsWe developed ReporTree, a flexible bioinformatics pipeline that allows diving into the complexity of pathogen diversity to rapidly identify genetic clusters at any (or all) distance threshold(s) or cluster stability regions and to generate surveillance-oriented reports based on the available metadata, such as timespan, geography, or vaccination/clinical status. ReporTree is able to maintain cluster nomenclature in subsequent analyses and to generate a nomenclature code combining cluster information at different hierarchical levels, thus facilitating the active surveillance of clusters of interest. By handling several input formats and clustering methods, ReporTree is applicable to multiple pathogens, constituting a flexible resource that can be smoothly deployed in routine surveillance bioinformatics workflows with negligible computational and time costs. This is demonstrated through a comprehensive benchmarking of (i) the cg/wgMLST workflow with large datasets of four foodborne bacterial pathogens and (ii) the alignment-based SNP workflow with a large dataset of Mycobacterium tuberculosis. To further validate this tool, we reproduced a previous large-scale study on Neisseria gonorrhoeae, demonstrating how ReporTree is able to rapidly identify the main species genogroups and characterize them with key surveillance metadata, such as antibiotic resistance data. By providing examples for SARS-CoV-2 and the foodborne bacterial pathogen Listeria monocytogenes, we show how this tool is currently a useful asset in genomics-informed routine surveillance and outbreak detection of a wide variety of species.ConclusionsIn summary, ReporTree is a pan-pathogen tool for automated and reproducible identification and characterization of genetic clusters that contributes to a sustainable and efficient public health genomics-informed pathogen surveillance. ReporTree is implemented in python 3.8 and is freely available at https://github.com/insapathogenomics/ReporTree.

Conceptualizing socio-emotional disablism: a duoethnography of Crohn’s disease and OCD during COVID-19

We utilize duoethnography to help readers better understand the constitutive nature of disability in the contexts of chronic illness and mental health. By doing so, we articulate the concept of socio-emotional disablism, which expands structural and psycho-emotional theories of disablism to account for the ways socio-material interactions trigger emotion-work—the communicative labor and fatigue that accompanies negotiating our own emotions as well as the emotions of others in disabling contexts—thus limiting relational and ideological engagement with disability. We conclude by discussing what the concept of socio-emotional disablism teaches us about how to build more inclusive social futures through deeper interpersonal engagement and more sustainable public health practices.

Accreditation of Agri-Food and Medical Laboratories in the UEMOA Region: An Opportunity for the Promotion of Sustainable Public Health

In an increasingly changing and demanding world, Quality Infrastructure is an instrument that is both important and essential in a context marked by health, environmental, economic, and social issues. Among the pillars of Quality Infrastructure, accreditation plays an important role, ensuring the technical competence and integrity of bodies offering conformity assessment services, such as testing, medical testing, calibration, certification, inspection, and validation/verification based on recognized international standards. The objective of this article is to highlight the importance and role of the Système Ouest Africain d’Accréditation/West African Accreditation System (SOAC-WAAS) in preserving and promoting the health of populations and the competitiveness of West African economies. Given the importance of accreditation, the West African Economic and Monetary Union (UEMOA) that gathers eight countries (Benin, Burkina Faso, Côte d'Ivoire, Guinea Bissau, Mali, Niger, Senegal, and Togo) created, in 2005, SOAC-WAAS, a multi-economy accreditation body. The latter is the only authorized accreditation body for the eight UEMOA member states. Its mission is to deliver and promote accreditation in the community area, particularly through the issuance of accreditation certificates to conformity assessment bodies (CABs). To date, SOAC-WAAS has accredited forty-six (46) conformity assessment bodies, including four (4) calibration laboratories, three (3) certification bodies, and thirty-nine (39) testing laboratories. Among the SOAC accredited testing laboratories, one (1) is in the field of forensics and ten (10) are medical laboratories. Fourteen (14) testing laboratories and the three (3) accredited certification bodies are operating in the agri-food sector. This result, which is certainly insufficient for the entire UEMOA region, is still encouraging and contributes to the preservation of health and protection of the population, particularly with regard to accredited agri-food and medical testing laboratories.

The Reemergence of Syphilis Among Females of Reproductive Age and Congenital Syphilis in Victoria, Australia, 2010 to 2020: A Public Health Priority.

Syphilis notifications in Victoria, Australia, have been increasing over the past decade, with an increase in infectious syphilis (syphilis of less than 2 years in duration) cases in females of reproductive age and an associated reemergence of congenital syphilis (CS). Before 2017, there had been 2 CS cases in the preceding 26 years. This study describes the epidemiology of infectious syphilis among females of reproductive age and CS in Victoria. Routine surveillance data provided by mandatory Victorian syphilis case notifications were extracted and grouped into a descriptive analysis of infectious syphilis and CS incidence data from 2010 to 2020. In 2020, infectious syphilis notifications in Victoria were approximately 5 times more than 2010 (n = 289 in 2010 to n = 1440 in 2020), with a more than 7-fold rise among females (n = 25 in 2010 to n = 186 in 2020). Females made up 29% (n = 60 of 209) of Aboriginal and Torres Strait Islander notifications occurring between 2010 and 2020. Between 2017 and 2020, 67% of notifications in females (n = 456 of 678) were diagnosed in low-caseload clinics, at least 13% (n = 87 of 678) of all female notifications were known to be pregnant at diagnosis, and there were 9 CS notifications. Cases of infectious syphilis in females of reproductive age and CS are on the rise in Victoria, necessitating sustained public health action. Increasing awareness among individuals and clinicians, and health system strengthening, particularly targeting primary care where most females are diagnosed before pregnancy, are required. Treating infections before or promptly during pregnancy and undertaking partner notification and treatment to reduce risk of reinfection are critical to reducing CS cases.

The impact of strict lockdowns on the mental health and well-being of people living in Australia during the first year of the COVID-19 pandemic.

There are limited longitudinal studies on the effects of the COVID-19 pandemic on mental health and well-being, including the effects of imposed restrictions and lockdowns. This study investigates how living in a pandemic, and related lockdowns and restrictions, affected the mental health of people living in Australia during the first year of the COVID-19 pandemic. A total of 875 people living in Australia participated in a longitudinal survey from 27 May to 14 December 2020. This time period includes dates that span pre-, during and post-wave 2 lockdowns in Australia, with strict and sustained public health measures. Linear mixed models were fitted to investigate the effect of lockdown on depression and anxiety symptoms. Symptoms of depression and anxiety improved over time, during and after lockdowns. More adverse mental health symptoms were observed for people with a history of medical or mental health problems, caring responsibilities, more neurotic personality traits or less conscientiousness, and for people who were younger. People who reported being more conscientious reported better mental health. Despite notoriously strict lockdowns, participants did not experience a deterioration of mental health over time. Results suggest a lack of significant adverse effects of lockdown restrictions on mental health and well-being. Findings highlight cohorts that could benefit from targeted mental health support and interventions, so that public policy can be better equipped to support them, particularly if future strict public health measures such as lockdowns are being considered or implemented for the COVID-19 pandemic and other disasters.

Better health through better housing - Current impact and future prospects of randomized trials.

Safe and stable housing in integrated neighborhoods with access to basic amenities and social elements is indispensable for good health. Recent randomized controlled trials have demonstrated that improvements in the built environment have positive impacts on malaria, fall injuries, and gun violence outcomes. There are several challenges associated with performing studies that assess house improvement as an intervention for advancing human health and well-being, including ethical issues, lack of blinding, spillover effects, and differential behavior. Future research is warranted to evaluate the clinical benefits and cost-effectiveness of prototype houses or energyefficient prefabricated modular homes by employing more holistic strategies, such as integration of data analytics, peer support, and whole health coaching, addition of social contextual perspectives on mobile technology-supported community-based interventions, and combination of digital technology-informed community-engaged citizen science and participatory action programs with multi-sector partnerships. Gleaning stronger evidence from clinical trials and model-based economic analyses that ascertain the effects of multiple intersecting factors on individuals and communities would illuminate effective policymaking options in healthy housing and guide successful implementation of sustainable public health policies. Straightforward and cost-effective pathways should therefore be created based on highest-quality scientific data to lead the scaling up of novel housing interventions and capacity building for health-in-all-policies to support population health equity, thereby ensuring that everyone has access to housing and the chance to live a healthy and productive life.

Health System Financing: A Comparative Analysis of India and Saudi Arabia

The objective of this study is to provide a comparative analysis of the health financing systems in India and the Kingdom of Saudi Arabia (KSA) across three major domains: resource mobilisation, pooling of resources and purchase of health services. This is an observational study using secondary data collected from international organisations, ministries of health and other government and non-government agencies in India and KSA. The study revealed that India has a very low expenditure on healthcare and markedly lower health outcomes compared to KSA. Although India’s health financing system has undergone notable changes in the last two decades, it is lagging behind in many health financing system parameters. However, the share of government expenditure on current health expenditure has been increasing steadily with higher allocations to primary and secondary care. By expanding health insurance coverage and sustainable public health funding, it is likely that India will make significant progress towards achieving UHC.

Incremental Net Benefit and Incremental Cost-Effectiveness Ratio of COVID-19 Vaccination Campaigns: Systematic Review of Cost-Effectiveness Evidence.

SARS-CoV-2 vaccination has been the most effective tool to prevent COVID-19, significantly reducing deaths and hospitalizations worldwide. Vaccination has played a huge role in bringing the COVID-19 pandemic under control, even as the inequitable distribution of vaccines still leaves several countries vulnerable. Therefore, organizing a mass vaccination campaign on a global scale is a priority to contain the virus spread. The aim of this systematic review was to assess whether COVID-19 vaccination campaigns are cost-effective with respect to no vaccination. A systematic literature search was conducted in the WHO COVID-19 Global literature database, PubMed, Web of Science, Embase, and Scopus from 2020 to 2022. Studies assessing the COVID-19 vaccination campaign cost-effectiveness over no vaccination were deemed eligible. The "Drummond's checklist" was adopted for quality assessment. A synthesis of the studies was performed through the "dominance ranking matrix tool". Overall, 10 studies were considered. COVID-19 vaccination was deemed cost-effective in each of them, and vaccination campaigns were found to be sustainable public health approaches to fight the health emergency. Providing economic evaluation data for mass vaccination is needed to support decision makers to make value-based and evidence-based decisions to ensure equitable access to vaccination and reduce the COVID-19 burden worldwide.

Diverse and inclusive leadership teams in public health schools: the change agents for sustainable and inclusive public health education

Context: An inclusive and diverse public health workforce maximizes health outcomes. However, little is known about the current diversity and inclusiveness profile of professionals, leaders and students of public health. To obtain a diverse and inclusive (D&amp;I) public health workforce in the future, D&amp;I leadership in Public Health Schools is necessary to encourage a D&amp;I student body. Policy Options: A variety of policy responses can be utilized to diversify schools of public health (SPH). Response types include (i) exploratory policies that instigate D&amp;I research with the aim to increase knowledge and build hypotheses, (ii) regulatory (and financial) policies that change the environment by placing rules, restrictions, or expectations on the institution to increase and promote D&amp;I and (iii) soft options, which are non-binding actions that aim to change the institutional culture surrounding D&amp;I. However, policies are often not specifically tailored to their school and are therefore unsuccessful. Recommendations: To understand the composition and identify gaps within the current diversity and inclusion (D&amp;I) profile of leadership in European Schools of Public Health (SPH) an exploratory needs assessment is advised. A baseline assessment will be the much needed first step of this paper’s proposed project: The Diverse and Inclusive Public Health Schools (DIPHS) Project. A needs assessment should be seen as a baseline evaluation of the current D&amp;I profile among leaders in European Schools of Public Health (SPH). This information should then build the basis to encourage institution-tailored policy interventions for SPH to actively promote a diverse and inclusive public health workforce.

How organizations can use carbon emissions data to achieve carbon neutrality

To help China achieve the "dual carbon" goal at an early date and mitigate global climate change brought about by the greenhouse effect, people are increasingly interested in topics such as carbon neutrality, sustainability, and energy, which has led to apparent changes in many cross-disciplinary disciplines. While upgrading the organization industry, people often neglect to implement measures from the energy side. The study is based on 492 articles retrieved from the Web of Science (WoS) database between 1900 and 2023, and conducted comprehensive data and visual analysis of keywords such as "carbon neutrality", "carbon emissions", and "carbon footprint". Bibliometrics show that publications have proliferated since 2008 and also involve multiple disciplines, such as management, sustainable development studies, public health, energy, and other related major fields. At the same time, research institutions in China, the United Kingdom, and Singapore have excelled in such disciplines. The authors use big data analysis technology and visualization software to comprehensively analyze the research results in the form of charts from the aspects of literature publication and citation trends, top research institutions, and keyword clustering, which provides research ideas for research organizations to use carbon emission data to achieve carbon neutrality.

Economically and thermodynamically efficient pressure-swing distillation with heat integration and heat pump techniques

• Pressure-swing distillation is intensified with heat integration and heat pump. • Designs are evaluated from economic, thermodynamic, and environmental perspectives. • Heat pump-assisted pressure-swing distillation gives the best performance. • Reliability of compression process in heat pump working process is analysed. The recovery of isopropanol from wastewater is of significance in the industry in light of sustainable development and public health. In this study, the separation has been investigated in the pressure-swing distillation process to avoid contamination by the additional solvent. To address the problem of tremendous energy consumption in conventional pressure-swing distillation, three energy-efficient pressure-swing distillation processes were proposed based on heat integration and heat pump techniques. For each scheme, the sequential iterative optimisation was performed targeting the minimum total annual cost. The temperature-enthalpy diagrams were employed to analyse the energy consumption of the proposed configurations. The reliability of the compression process in the compressor was ensured by means of the temperature-entropy diagrams. All pressure-swing distillation designs were compared from the economic, thermodynamic, and environmental perspectives. In comparison with the proposed conventional pressure-swing distillation, the heat integration and heat pump can save 31.44% and 51.30% total annual cost with a capital payback period of 3 years, respectively. Special attention was paid to evaluating a combined utilization of heat integration and heat pump techniques which can reduce 38.30% of the total annual cost. The savings in the total annual cost of all intensified designs were expected enhanced for a longer payback period. Besides, all alternative designs were found with good performance in decreasing CO 2 emissions and enhancing thermodynamic efficiency. The present study can serve as a reference for designing other azeotrope separations to achieve sustainable development.

Herd Immunity: History, Concepts, and Ethical Rationale.

Public health emergencies are fraught by epistemic uncertainty, which raises policy issues of how to handle that uncertainty and devise sustainable public health responses. Among such responses, a herd immunity policy might be an option. Particularly before the development of vaccines, the current COVID-19 pandemic has highlighted the polarized nature of the political debate concerning the ethical feasibility of herd immunity strategies. This article provides a conceptual framework tailored to uncover the ethical rationale behind such strategies. Clarity on this issue is important in order to facilitate the terms of the political debate when tackling future health emergencies.

Socially relevant and inclusive operations management

Many parts of the world are experiencing extreme weather events, energy poverty, food insecurity, and lack of access to basic healthcare. Moreover, concerns over socioeconomic, gender, and racial inequalities are growing. These socially relevant issues are ripe for analysis and improvement using an operations management lens. In this paper, we review some of the relevant research advancements made in the last decade, and identify future research directions on these important topics. In particular, we focus on papers related to sustainable planet (renewable energy, environmentally and socially responsible operations, regulation‐driven operations), agriculture, and public health. For future research directions, we discuss the role of innovative business models and disruptive technologies, such as artificial intelligence (AI) and blockchain, in addressing these pressing issues.

Using machine learning models to predict the effects of seasonal fluxes on Plesiomonas shigelloides population density

Seasonal variations (SVs) affect the population density (PD), fate, and fitness of pathogens in environmental water resources and the public health impacts. Therefore, this study is aimed at applying machine learning intelligence (MLI) to predict the impacts of SVs on P. shigelloides population density (PDP) in the aquatic milieu. Physicochemical events (PEs) and PDP from three rivers acquired via standard microbiological and instrumental techniques across seasons were fitted to MLI algorithms (linear regression (LR), multiple linear regression (MR), random forest (RF), gradient boosted machine (GBM), neural network (NN), K-nearest neighbour (KNN), boosted regression tree (BRT), extreme gradient boosting (XGB) regression, support vector regression (SVR), decision tree regression (DTR), M5 pruned regression (M5P), artificial neural network (ANN) regression (with one 10-node hidden layer (ANN10), two 6- and 4-node hidden layers (ANN64), and two 5- and 5-node hidden layers (ANN55)), and elastic net regression (ENR)) to assess the implications of the SVs of PEs on aquatic PDP. The results showed that SVs significantly influenced PDP and PEs in the water (p < 0.0001), exhibiting a site-specific pattern. While MLI algorithms predicted PDP with differing absolute flux magnitudes for the contributing variables, DTR predicted the highest PDP value of 1.707 log unit, followed by XGB (1.637 log unit), but XGB (mean-squared-error (MSE) = 0.0025; root-mean-squared-error (RMSE) = 0.0501; R2 =0.998; medium absolute deviation (MAD) = 0.0275) outperformed other models in terms of regression metrics. Temperature and total suspended solids (TSS) ranked first and second as significant factors in predicting PDP in 53.3% (8/15) and 40% (6/15), respectively, of the models, based on the RMSE loss after permutations. Additionally, season ranked third among the 7 models, and turbidity (TBS) ranked fourth at 26.7% (4/15), as the primary significant factor for predicting PDP in the aquatic milieu. The results of this investigation demonstrated that MLI predictive modelling techniques can promisingly be exploited to complement the repetitive laboratory-based monitoring of PDP and other pathogens, especially in low-resource settings, in response to seasonal fluxes and can provide insights into the potential public health risks of emerging pathogens and TSS pollution (e.g., nanoparticles and micro- and nanoplastics) in the aquatic milieu. The model outputs provide low-cost and effective early warning information to assist watershed managers and fish farmers in making appropriate decisions about water resource protection, aquaculture management, and sustainable public health protection.

Beyond bans: A political economy of used vehicle dependency in Africa

African countries serve as used vehicle dumping sites for advanced capitalist countries, undermining global and local goals to move toward safe and low-emissions transport. Africa’s used vehicle dependency is commonly explained in terms of push-pull factors linked to demand for new cars and stringent environmental policies in wealthier countries that make available used vehicles for export, the limited purchasing power for less-polluting new safer vehicles, and weak regulation of vehicle emissions in Africa, all of which sustain used vehicle import on the continent. Drawing on the Ghanaian case, we present an enhanced explanation that brings in the role of historical underinvestment in public transport and larger processes that channel public resources toward car-oriented transport and land use, marginalizing other modes of transport used by the majority. Using historically informed political economy analyses and drawing on interviews and grey literature including media and institutional sources, this paper makes two contributions. First, it advances used vehicle research by moving beyond the push-pull approach to incorporate the historical institutional drivers of used vehicle and automobile consumption generally in Africa. Second, it provides insight into why used vehicle import bans on their own are unlikely to lead to sustained environmental and public health benefits and instead recommends more holistic policies for shifting toward cleaner, safer and affordable public transport in Africa. Transport and land-use planning reforms and investment prioritizing public transit including minibus recapitalization programs, as well as mixed land use and transit-oriented development can help reduce used vehicle dependency and the harms it brings.

High level review of configuration and reform of Public Health systems in selected countries

Abstract Background The impact of the COVID-19 pandemic has prompted governments internationally to consider reform and strengthening of their Public Health systems. To support this work in Ireland, we undertook a review Public Health systems internationally (research question [RQ] 1), and identified lessons learned from the COVID-19 pandemic (RQ2). Methods Data relating to Public Health systems (RQ1), and lessons learned (RQ2) for a select group of 12 countries were identified from organisations’ websites, an electronic database and grey literature search and representatives from key national-level organisations. Data for RQ1 were extracted, mapped to the 12 Essential Public Health functions (EPHFs) at national, regional and local levels, and verified by participating representatives. For RQ2, thematic analysis of semi-structured interviews with participating representatives was undertaken and. Results Typically, across all included countries, there is national strategic oversight of all EPHFs and, for certain functions, there is regional and local level implementation. Lessons learned from the COVID-19 pandemic broadly related to the themes of legislation and decision making; data collection, surveillance, evidence synthesis and collaboration; public health interventions; public participation, public messaging and communication; continuation of healthcare services; and workforce capacity and resilience. Conclusions When structuring Public Health systems, there is a need to identify which functions, and or which elements of a function, should be delivered at a national, regional or local level to ensure a sustainable and comprehensive Public Health system. Appropriate IT infrastructure, strong communication and an established evidence synthesis function are key to timely and informed decision making. Ideally, these functions should be established during periods of relative stability to permit a faster response during a pandemic or emergency situation.

COVID-19, public health messaging, and sanitation and hygiene practices in rural India

Abstract Despite the importance of safe sanitation and hygiene for sustainable development and public health, approximately half of India's rural population lacks access to safely managed sanitation. Policies prioritizing improved sanitation access have accelerated coverage, yet barriers to universal access and use remain. In this paper, we investigate how personal experience with a public health shock impacts recall of public health messages and households' sanitation and hygiene practices. Using a panel survey conducted before and after the first wave of the COVID-19 pandemic, and the resulting lockdown, in Bihar, India, we compare public health messaging recall and hygiene and sanitation behaviors among households that experienced severe economic disruptions due to the COVID-19 lockdown and those that did not. We find that households that experienced economic disruptions had a higher recall of public health messaging around safe sanitation and hygiene. In addition, households that experienced these disruptions reported more social distancing, increased handwashing behavior, and reduced open defecation. A major public health shock, the COVID-19 pandemic, increased messaging around the importance of safe hygiene and sanitation for public health in India. We find that personal experience increased the salience of public health messaging, with positive returns to sanitation and hygiene practices.