Public Health Workers Research Articles

Perspectives and challenges in developing and implementing integrated dengue surveillance tools and technology in Thailand: a qualitative study.

Dengue remains a persistent public health concern, especially in tropical and sub-tropical countries like Thailand. The development and utilization of quantitative tools and information technology show significant promise for enhancing public health policy decisions in integrated dengue control. However, the effective implementation of these tools faces multifaceted challenges and barriers that are relatively underexplored. This qualitative study employed in-depth interviews to gain a better understanding of the experiences and challenges of quantitative tool development and implementation with key stakeholders involved in dengue control in Thailand, using a phenomenological framework. A diverse range of participants, including public health workers and dengue control experts, participated in these interviews. The collected interview data were systematically managed and investigated using thematic analysis to extract meaningful insights. The ability to collect dengue surveillance data and conduct ongoing analyses were contingent upon the availability of individuals possessing essential digital literacy and analytical skills, which were often in short supply. Furthermore, effective space-time early warning and precise data collection were hindered by the absence of user-friendly tools, efficient reporting systems, and complexities in data integration. Additionally, the study underscored the importance of the crucial role of community involvement and collaboration among organizations involved in integrated dengue surveillance, control and quantitative tool development. This study employed a qualitative approach to gain a deeper understanding of the contextual intricacies surrounding the development and implementation of quantitative tools, which, despite their potential for strengthening public health policy decisions in dengue control, remain relatively unexplored in the Thai context. The findings yield valuable insights and recommendations for the development and utilization of quantitative tools to support dengue control in Thailand. This information also has the potential to support use of such tools to exert impact beyond dengue to a broader spectrum of diseases.

Infrastructures of epidemic response: Mpox and everyday repair work in southwestern Nigeria

Mpox (formerly known as monkeypox) was declared a Public Health Emergency of International Concern (PHEIC) by the World Health Organization on 23rd July 2022, however cases of the disease have been detected in Nigeria since the 1970s and more recently since it began spreading in more urban areas of the country from 2017 onward. Nigeria has a strong track record of epidemic preparedness and response, spearheaded by the Nigeria Centre for Disease Control. Despite being somewhat separate architectures on paper, epidemic response (in particular, integrated disease surveillance and response) relies on a foundation of primary health care, which is inadequately funded not only in Nigeria, but globally. Situating mpox response within this wider landscape, we draw on ethnographic research from September 2022–March 2023 in southwestern Nigeria on lived experiences of mpox and mpox response, focusing on the perspectives of frontline health workers and community-based suspected or confirmed mpox cases. We aimed to understand how prioritization and resource constraints shape mpox response at a local level, including effects on the everyday work of frontline health workers in public health and clinical care who are left to “make do.” We analyze their experiences interfacing with two intersecting infrastructures, community-based surveillance and primary health care. Health workers’ improvisation and “repair work,” which we detail, enables the surveillance system to function in some capacity. However, health workers must regularly contend with competing priorities and routine care that may be sidelined during an outbreak or epidemic. We argue that this reveals the limitations of a global health security agenda as it materializes at a local level and the need for strengthening primary health care for longer-term sustainability.

Burnout among public health workers during the COVID-19 response: Results from a follow-up survey

The public health workforce began the response to the COVID-19 pandemic with a critical workforce deficit, losing 20% of staff between 2018 and 2019. This study assesses changes in burnout among a cohort of 80 public health workers in the U.S. who completed multiple assessments during the ongoing COVID-19 response via Qualtrics. Self-reported burnout was assessed using a 5-point, validated, non-proprietary single-item measure. A binary burnout variable (1,2 = No; 3,4,5 = Yes) was created based on responses. Burnout direction (e.g., decreased, same, increased) was derived from changes in five-level work-related burnout scores. Factors indicating work-related exhaustion was higher among individuals reporting burnout in the follow-up survey compared to those without burnout. Baseline burnout, hours worked per week, and sleep quality were significant predictors of burnout at follow-up. A higher proportion of respondents reported burnout at follow-up than at the baseline survey. The ubiquitous nature of burnout among public health workers is a threat to the wellbeing of individuals in the workforce and the population’s health at large. Investments in expanding and supporting the public health workforce are needed.

Caregiver perceptions of complementary feeding in rural and urban Indonesia: A qualitative comparative study

ObjectiveTo explore caregivers’ perspectives on complementary feeding in rural and urban areas of Central Java, Indonesia. DesignA qualitative comparative study using in-depth interviews. We applied thematic analysis to identify themes and subthemes and presented representative quotes. SettingRural and urban villages in Central Java Province, Indonesia. Participants46 mothers and grandmothers of 6- to 23-month-old children. FindingsWe identified five themes: 1) timing of food introduction, 2) types of complementary foods, 3) meal preparations, 4) complementary food benefits, and 5) expectations toward complementary foods. While caregivers in urban areas had more favourable perceptions of complementary feeding, some misperceptions existed regarding complementary feeding in both areas. These misconceptions included the age of complementary food introduction, the delay in introducing animal-source foods, and the emphasis on any food the child preferred as long as they ate rather than on healthy food choices. Key conclusionsThere were similarities and differences in complementary feeding perspectives between caregivers in rural and urban areas. Therefore, policymakers and public health workers should design interventions to enhance complementary feeding practices by addressing the contextual issues in specific settings.

Impact of COVID-19 on human immunodeficiency virus tests, new diagnoses, and healthcare visits in the Republic of Korea: a retrospective study from 2016 to 2021.

Public health workers have been at the forefront of treating patients with coronavirus disease 2019 (COVID-19) and managing the pandemic. The redeployment of this workforce has limited or interrupted other public health services, including testing for human immunodeficiency virus (HIV). This study aims to examine the impact of COVID-19 on HIV testing and diagnosis in the Republic of Korea from 2016 to 2021, comparing data before and after the onset of COVID-19. Annual HIV testing data were collected from each institution through direct communication or from open-source databases. The annual number of new HIV cases was obtained from the official report of the Korea Disease Control and Prevention Agency. Data on healthcare visits for HIV diagnosis or treatment were extracted from the open-source database of the National Insurance Health Service of Korea. Interrupted time series regression was conducted, stratified by institution type. In 2020, HIV tests, diagnoses, and visits decreased. Notably, public health centers experienced a substantial reduction in 2020-2021 compared to previous years. The annual percentage change in HIV tests was -53.0%, while for HIV diagnoses, it was -31.6%. The decrease in visits for HIV was also most pronounced for public facilities: -33.3% in 2020 and -45.6% in 2021 relative to 2019. The numbers of tests, diagnoses, and healthcare visits for HIV at public health centers in the Republic of Korea substantially decreased in 2020 and 2021. The impacts of these changes on the early diagnosis and treatment of HIV necessitate further monitoring.

Novel wellbeing and repair peptide use in the UK: Netnographic findings

Recently, there has been an explosion of interest in synthetic peptides hormones promoted for wellbeing enhancement purposes, including BPC-157, TB-500 and CJC-1295. With these drugs increasingly accessible through online platforms such as e-commerce sites, this research seeks to understand user experiences of taking these drugs, and the ways in which digital forum spaces facilitate the development of a shared folk pharmacology and further indigenous harm reduction.Data is drawn from a netnography of peptide-related forum posts, encompassing 493 unique threads totalling almost 15,000 posts. Thematic analysis was used to analyse the data.Findings are split into two major sections, encompassing motivations for peptide use, and online folk pharmacology. In the first of these sections, findings explored include: Peptide use for the purposes of injury rehabilitation, including post-surgery recovery; Everyday wellbeing use of peptides, including for anti-ageing, with a particular focus on older men wishing to return to gym training for aesthetic and general health purposes; And the relationship between seeking black market peptides following negative experiences with healthcare providers for wellbeing-related issues.In the second section, key themes relate to: Community knowledge exchange regarding use, including community distribution of harm reduction information; Community understandings of the limits to utility of peptides, and experiences of product not working as anticipated; And information sharing regarding product quality, and potential harms relating to ‘scam’ sellers and substituted or poor-quality product.Conclusions show that an emergent folk pharmacology relating to peptides has developed in forum spaces, which informs and encourages use. Many older men appear to be taking peptides for everyday wellbeing purposes, suggesting a need for specific focus on this population in public health work. Issues with healthcare providers appeared to lead users to accessing black market peptides, suggesting specific education for healthcare practitioners around peptides may be important to pursue.

Associations between digital health literacy and health system navigating abilities among Norwegian adolescents: validating the HLS19-DIGI scale using Rasch modeling

BackgroundDespite increasing global attention to health literacy and adolescents’ digital health information seeking, no unidimensional instruments measuring digital health literacy (DHL) in adolescents have reportedly been validated using Rasch modeling. Moreover, the evidence of adolescents’ abilities to navigate the health system (NAV-HL) in light of their DHL proficiency is still scarce. Therefore, our study aims to evaluate the psychometric properties of a DHL instrument (HLS19-DIGI scale) in order to investigate DHL in adolescents and young adults aged 16–25 and associations with abilities to navigate the health system.MethodsA population-based cross-sectional survey among 890 Norwegian adolescents was conducted during April–October 2020 using computer-assisted telephone interviewing. Rasch modeling, independent samples t-test, chi-square test, and binary regression models were used to analyze the data.ResultsThe HLS19-DIGI scale was sufficiently unidimensional, whereas no differential item functioning or disordered response categories were observed. However, relatively poor targeting was revealed indicating too many easy items for the target population. Yet, a high proportion (54%) of low DHL proficiency in adolescents was observed, as well as DHL was positively associated with the abilities to navigate the health system.ConclusionsThe HLS19-DIGI scale is considered a sufficiently unidimensional and valid instrument for measuring DHL in adolescents, which may be a useful tool for health authorities, public health workers, and health service providers. While DHL affects adolescents’ abilities to navigate the health system, future research should measure and examine their ability to utilize digital health services, separately.

Using digital technology as a platform to strengthen the continuum of care at community level for maternal, child and adolescent health in Tanzania: introducing the Afya-Tek program

Inadequate care within Tanzania’s primary health system contributes to thousands of preventable maternal and child deaths, and unwanted pregnancies each year. A key contributor is lack of coordination between three primary healthcare actors: public sector Community Health Workers (CHWs) and health facilities, and private sector Accredited Drug Dispensing Outlets (ADDOs). The Afya-Tek program aims to improve the continuity of care amongst these actors in Kibaha district, through a mobile-application based digital referral system that focuses on improving maternal, child and adolescent health. The digital system called Afya-Tek was co-created with users and beneficiaries, and utilises open-source technology in-line with existing government systems. The system guides healthcare actors with individualised decision support during client visits and recommends accurate next steps (education, treatment, or referral). From July 2020 to June 2023, a total of 241,000 individuals were enrolled in the Afya-Tek program covering 7,557 pregnant women, 6,582 postpartum women, 45,900 children, and 25,700 adolescents. CHWs have conducted a total of 626,000 home visits to provide health services, including screening clients for danger signs. This has resulted in 38,100 referrals to health facilities and 24,300 linkages to ADDOs. At the ADDO level, 48,552 clients self-presented; 33% of children with pneumonia symptoms received Amoxicillin; 34% of children with diarrhoea symptoms received ORS and zinc; and 4,203 referrals were made to nearest health facilities. Adolescents preferred services at ADDOs as a result of increased perceived privacy and confidentiality. In total, 89% of all referrals were attended by health facilities. As the first digital health program in Tanzania to demonstrate the linkage among public and private sector primary healthcare actors, Afya-Tek holds promise to improve maternal, child and adolescent health as well as for scale-up and sustainability, through incorporation of other disease conditions and integration with government’s Unified Community System (UCS).

Gaining influence: Developing a Healthy Public Policy Unit at Vancouver Coastal Health.

Regional Public Health Unit (Office of the Chief MHO, Vancouver Coastal Health Authority, BC, Canada). Recognizing the need to invest resources that strategically move public health work "upstream" where policies and investments can shape the determinants of health, the Office of the Chief MHO for Vancouver Coastal Health embarked on a process in 2019 to develop a population health team designed to engage in Healthy Public Policy (HPP) and Health in All Policies (HiAP) approaches to health promotion. The mission and design of this unit was informed by internal and external research and engagement which continued even through the COVID-19 pandemic. Inthe fall of 2022, this new unit, the first of its kind in British Columbia, was launched. In 2023, it embarked on strategic planning, engaged in key public policy processes, and implemented priority areas of work to help advance healthy public policy in the region, including the development of processes, tools, and practices to support a more systematic and rigorous approach to this emerging area of public health practice. The creation of this new Healthy Public Policy Unit invites discussion within Canada's public health community on the issue of resource allocation to support upstream interventions seeking to build the capacity and effectiveness of HPP and HiAP approaches.

Shame-Sensitive Public Health.

In this article, we argue that shaming interventions and messages during Covid-19 have drawn the relationship between public health and shame into a heightened state of contention, offering us a valuable opportunity to reconsider shame as a desired outcome of public health work, and to push back against the logics of individual responsibility and blame for illness and disease on which it sits. We begin by defining shame and demonstrating how it is conceptually and practically distinct from stigma. We then set out evidence on the consequences of shame for social and relational health outcomes and assess the past and present dimensions of shame in the context of the Covid-19 pandemic, primarily through a corpus of international news stories on the shaming of people perceived to have transgressed public health directions or advice. Following a brief note on shame (and policymaking) in a cultural context, we turn to the concept and practice of 'shame-sensitivity' in order to theorise a set of practical and adaptable principles that could be used to assist policymakers in short- and medium-term decision-making on urgent, tenacious, and emerging issues within public health. Finally, we consider the longer consequences of pandemic shame, making a wider case for the acknowledgement of the emotion as a key determinant of health.

Strategic Workforce Analysis: Identifying Skills and Gaps Among Frontline Public Health Workers Amidst Transformation.

Recent shifts in public health (PH) include consistent budget cuts, workforce attrition, and loss of vital skills and institutional knowledge followed by heightened pandemic-driven attention, new responsibilities, and renewed funding. This study investigates whether frontline employees working in different types of public health departments have different educational characteristics and whether these characteristics are associated with differentials in skill gaps toward informing targeted interventions to nurture a competitive workforce. Utilizing 2021 Public Health Workforce Interests and Needs Survey (PH WINS) data, we document variations in educational qualifications, skill gaps, and workforce characteristics among frontline workers in different sizes of health departments and examine attributes associated with skill gaps: level and field of education, years of experience, program areas, and job classifications using a negative binomial model. Skill gaps in resource management, systems and strategic thinking, and change management persist across all local health departments (LHDs), but the extent of these gaps is greater in small LHDs. Small LHDs also have few employees with graduate and public health degrees. Additionally, whereas public health degrees were not associated with fewer skill gaps, tenure in public health was, suggesting people learn on the job. The results highlight the role regional training centers can play in emphasizing the need for strategic skills and foundational public health concepts, as well as customizing training content by agency size and educational levels to improve accessibility, particularly for small LHDs with resource constraints.

Lessons From Leading During a Pandemic: An Exploratory Study of Public Health Leadership Insights on Training, Preparation, and Experiences From the Field During COVID-19.

The public health workforce encountered challenges during the COVID-19 pandemic that exposed areas for improvement in preparation for future public health threats. Key among these is well-trained public health leaders equipped with an array of crisis leadership skills. To examine the training background, assess the perceived preparedness, and garner recommendations for training of the future public health workforce from public health leaders who navigated the COVID-19 pandemic. This exploratory research gleaned information by utilizing an online questionnaire and interviews to provide lessons learned regarding improvements needed for public health leader preparedness. Three California public health departments representing urban, suburban, and rural populations. Thirty public health leaders who were directly involved in public health work for ≥3years in a leadership/management role and involved in COVID-19-related work for at least 6months participated. Questionnaire findings revealed gaps in crisis leadership, communication, and collaboration training. Interview results supported and expanded upon the quantitative findings, including the value of various competencies and recommendations to improve the preparedness of future public health leaders. The findings suggested that although many of the skills needed are competencies for accredited public health training programs, effective leadership during public health emergencies may require additional training beyond what is generally provided. Recommendations include integrating study findings into public health training programs to address competency gaps, leveraging results to enhance leadership skills, and promoting collaboration between public health departments and academic institutions to develop evidence-informed crisis leadership training. These findings inform strategies to ensure the preparedness of the public health workforce for future crises.

Enlightenment and Freemasonry in the Life and Work of the Physician Joannis Baptistae Lalangue

Data on the educational and Freemasonry activities of Doctor Joannis Baptistae Lalangue have been relatively modestly represented in the scientific literature until now. Based on recent research, we have come to the realizations that give us a new context for the life and work of Lalangue, especially from the aspect of his social activity. All of the above had very significant repercussions on his entire public health work and especially on his journalistic and publishing work. John the Baptist Lalangue was a successful physician. During his medical studies in Vienna, he was recognized by Baron van Swieten, the first name in medicine of the Habsburg Monarchy. Recent knowledge speaks of his very notable Enlightenment and Freemasonry work, which largely determined his life and work. Lalangue has created a truly impressive literary work, which is closely related to his active Enlightenment and public Masonry engagement. The mentioned progressive Enlightenment engagement is also responsible for the fact that thanks to Lalangue, we already had printed medical original professional literature in the Croatian language in the second half of the 18th century. This directly changed the conditions in society, primarily in the field of public health, for the better, not only in Croatia but also throughout the Habsburg Monarchy.

"Lusog-Linang": Utilizing Community-engaged Research towards Capacity Building in Health of an Underserved Community.

Nurses have a pivotal role in nurturing the capabilities of individuals, families, and population groups for better health. However, underserved communities in the Philippines, such as those with socioeconomic inadequacies, geographic isolation, and service access problems, have significant limitations in attaining the highest possible level of health. Hence, a community extension service (Project "Lusog-Linang"), employing community-engaged research, was launched with the residents of an underserved locality in Central Luzon. The current paper aimed to describe the engagement of the community residents in describing their current health situation and related priority problems, as well as explore appropriate initiatives to manage the identified problems. Community-engaged research was utilized to enable the residents of Barangay San Vicente, Bamban, Tarlac to participate in health capacity building. Particularly, records review and focus group discussions were conducted to assess the community's health needs and to identify the residents' perceived problems. The findings were presented in a community assembly, where residents further discussed their priority health concerns and potential interventions to address them. Quantitative data were summarized through descriptive statistics, while qualitative information was synthesized via content analysis. The priority community health problems included healthcare inaccessibility (trained staff, health equipment, and facility access), food insecurity, water supply limitations, and environmental sanitation. Moreover, there was inadequate knowledge and skills among the residents in health promotion, disease prevention, and illness management. While Barangay San Vicente had limited socioeconomic resources to optimize their health capacities, the sense of community among the residents is a vital resource towards empowering them to improve their health. The results could be utilized as a launching pad for developing appropriate health programs for the residents of Barangay San Vicente. Hence, the next steps in Project "Lusog-Linang" should include the identification and training of core group members toward community mobilization, and further exploring collaborative and sustainable partnerships across organizations to ensure that the community will have long-term solutions to their problems. Consequently, this project could guide public health workers in ensuring the active involvement and participation of the community members in managing their own health.

The Public Health Leader Who Brought Antisepsis to William Halsted.

William Halsted wrote to aging surgeon, Stephen Smith, in 1919, that he remembered the lessons Smith had taught him, "when I walked with you through the wards of Bellevue Hospital." Smith was an early advocate of Joseph Lister's antiseptic method, and because of his public health work, he was also an early advocate of environmental hygiene and microbial control based on the unproved germ theory. While Lister's work at the time emphasized germ-killing around the operative site with carbolic acid (antisepsis), Smith adopted and encouraged surgical practices at Bellevue that would be hallmarks of the germ-preventing (asepsis) surgical approach that fully developed after German bacteriologic discoveries in the mid-1880s, and with which Halsted is historically identified. Some physicians and historians have emphasized temporal and conceptual differences between Lister's antisepsis and German asepsis, but Smith and Halsted's experiences argue that surgical asepsis was the evolutionary outcome of germ theory-based surgical changes that began well before scientific proof arrived.

Pursuit of a Dual Degree During Residency Training

Background: The increasing complexity of the health care system is requiring physicians to become more expansive and comprehensive in their knowledge. Public health awareness, biostatistics, and fiscal understanding including medical reimbursements are only small facets of the expertise physicians are needing to understand. Residency programs across the country are starting to permit the incorporation of graduate education into residency curricula. Residents in academic training programs are starting to have the opportunity to pursue a dual degree study in addition to their residency training. Despite the recognized need for well-rounded physicians and growing opportunities for master’s degree education concurrent with residency training, there is a lack of research regarding residents’ interest in pursuing concurrent degrees. Additionally, the resources that institutions offer repertoires needed to support residents during such endeavors are lacking. Objective: The purpose of this study was to elucidate current interest, resource availability, as well as barriers that Obstetrics and Gynecology (OBGYN) residents may come across when considering a dual degree opportunity during their residency. Methods: A comprehensive questionnaire of 28 items was developed by the researchers using a focus group. The innovative survey was sent to the program directors of all ACGME-accredited OBGYN programs in the US in an electronic format. The survey offered anonymity and easy online accessibility while being available for a total of four weeks (during the month of August 2022). A reminder was sent one week prior to the conclusion of data collection. Results: A total of 298 ACGME-accredited OBGYN programs were contacted with 52 individual responses received. The majority of the respondents identified as white females, with all respondents being under the age of 35. A total of 72% of respondents came from combined academic programs or strictly academic programs with 25% of respondents having initiated or completed additional graduate-level degrees at the time of the survey. Most programs did not mention the opportunity of pursuing a dual degree at the time of residency interviews, and over 50% of programs did not permit their residents to pursue another graduate study during their training. Of those permitting such an endeavor, criteria for pursuing the graduate degree included successfully completing the first year of residency and having a ‘passing’ CREOG score, whereas 40% of respondents were unsure of stipulations by their health systems. Regarding the source of the degree, 90% of respondents stated their residency institution did not have the setup or offer a combined dual degree program option, and >75% of respondents reported a lack of tuition reimbursement for such growth opportunities. Whereas 38% of respondents would consider a dual degree option during residency training if available, 51% of those surveyed are interested in pursuing another degree only after residency, with time and cost being the biggest deterrent to pursuing a degree while in residency. Additionally, the platform utilized for the courses - online versus in-person – was another significant factor that plays a role. Regarding growth opportunities, the majority of respondents are interested in leadership roles and believe that supplementing their credentials, ideally with a Masters in Public Health. Conclusion: The increasing demand for physician knowledge outside of clinical medicine has slowly increased throughout the years. As a response, residency programs are beginning to integrate graduate classes and degrees into the training curriculum. Although a majority of residents appear to be interested in pursuing a graduate degree at some point in their career, their biggest concerns during residency include the time needed to devote to their studies and the cost of earning a graduate degree. It is also apparent through the survey that many programs have not been clear regarding the resources they offer for those who are interested in continuing graduate education during residency training. Recognizing the need for physicians to navigate studies outside of clinical medicine, residency programs need to establish more robust pathways for residents to pursue additional graduate education in fields including business, public health, and social work amongst others. Large-scale research will be needed to further investigate how programs can better support their residents’ interests as they diversify their knowledge base to support their clinical decision-making skills.

Upravljanje javnim zdravstvom u Gani: Fokus na Korle-Bu učiteljsku bolnicu (1923-2020)

Since the pre-colonial period to the post-colonial era, public health administration has been intertwined with several issues ranging from the inadequacy of public health facilities and health workers, improper settlement planning, insanitary conditions, inadequate laws, their implementation and enforcement of same. Using a qualitative approach of research, the study focused on the historical interpretation of the challenges and effects of public health administration on health workers and patients in Ghana. This empirical study focused on responses from workers in the Accident and Emergency Department of the Korle-Bu Teaching Hospital (KBTH), Ghana. The study teased out information from expert informants to make useful generalizations to shape public health administration in relation to similar facilities in Ghana and elsewhere in Africa. Among other things, it also studies how reported sicknesses and or medical cases such as COVID-19 and the management of same at the Korle-Bu Teaching Hospital in contemporary times. Again, based on the empirical responses, the study provided empirical prescriptions to help improve public health administration in health facilities in Ghana, which has wider ramifications for related facilities on the African continent. Attention and resources should not only be given to clinical care, to the neglect of public health. Efforts should cut across every sector of healthcare and fully equip the office of public health administration to do a more efficient work. There is also the need to make inferences from the various past challenges and effects of public health administration in the Korle-Bu Teaching Hospital and Ghana at large to know how to deal with similar challenges emanating from the day to day running of Ghana’s health institutions including the required preparednes to deal with epidemics and pandemics at the local and national levels.

Older adults’ perceptions about meat consumption: a qualitative study in Gasabo district, Kigali, Rwanda

BackgroundThe global population is increasingly aging, imposing a substantial burden on social and healthcare systems as aging is associated with gradual muscle wasting and functional decline. Consumption of protein-rich foods, such as livestock-based meat, providing high-quality proteins can prevent muscle wasting and related functional decline in older adults. However, there is a lack of data on the older adults’ perceptions about meat consumption, particularly in Sub-Saharan Africa.ObjectiveTo explore the perceptions about dietary meat consumption among older adults in Gasabo district, Kigali, Rwanda.MethodsWe conducted a descriptive qualitative study, using focus group discussions. A total of eight FGDs, lasting between 55 and 80 min, were conducted with gender-mixed groups, including 31 men and 33 women aged ≥ 55 years old. Eight older adults participated in each FGD session, and all discussions were conducted in the local language (Kinyarwanda) using a pre-designed interview guide. The discussions were audio-recorded and transcribed verbatim and translated into English. The transcript was inductively analyzed using thematic analytical process.ResultsThree themes were identified from the data, predominantly related to motives and barriers of meat consumption. The motives of meat consumption included improved quality and taste of the diet, improving own health, and having a social function. Barriers of meat consumption were perceived to be related to health risks, sustainability concerns (depletion of resources), and religious beliefs. Lastly, it was widely perceived that meat was unavailable and economically inaccessible, thus meat consumption was perceived to be associated with improved wealth.ConclusionThe findings revealed a low and declining meat consumption among older adults due to poverty. Improving financial capacity or strategic public health work to improve protein consumption in the elderly is necessary to meet nutritional needs and facilitate healthy aging.

The Community As A Full Partner: A New Model For Public Health.

The COVID-19 pandemic demonstrated a need to strengthen the US public health system by shifting toward much greater community engagement and leadership. In November and December 2023, we conducted separate online surveys of community-based organizations and large metropolitan health departments to identify barriers and opportunities for building a public health system with strong community partnerships. Identified barriers included mistrust, siloed health departments with structural challenges in funding community-based organizations, and insufficient shared decision making. The surveys helped inform our six policy recommendations: establish state and local community councils to formalize the roles of community-based organizations in public health decision making; dedicate funding to these organizations; offer funding that is not limited to a specific disease or condition; simplify procurement and reporting processes directed to community-based organizations; create a training and technical assistance program for these organizations; and increase public health worker diversity, including sustainable funding for community health workers.

The principles and guidelines on human rights and public health emergencies

Launched by the Global Health Law Consortium and the International Commission of Jurists in 2023, the Principles and Guidelines on Human Rights and Public Health Emergencies (the ‘Principles’) clarify and affirm international law and correlative standards on human rights and the rule of law in the context of public health emergency prevention, preparedness, response, and recovery. The Principles were developed through a three-year deliberative and consensus-building process between more than 150 individuals from around the world, including international legal scholars and practitioners, human rights defenders, civil society advocates, public health researchers, health workers, and others bearing relevant insights and expertise. Spanning 28 interrelated provisions, they aim to guide the decisions and actions of governments, civil society, and other stakeholders who are at the forefront of efforts to address public health emergencies.