Syndemic health crises-The growing role of National Public Health Institutes in shaping a coordinated response.

Countries across the world are experiencing syndemic health crises where infectious pathogens including COVID-19 interact with epidemics of communicable and non-communicable diseases. Combined with war, environmental instability and the effects of soaring inflation, a public health crisis has emerged requiring an integrated response. Increasingly, national public health institutes (NPHIs) are at the forefront of leading this, as demonstrated at the 2022 Annual Meeting of the International Association of National Public Health Institutes (IANPHI). These effects are particularly evident where conflict is exacerbating health crises in Ukraine and Somalia. In Ukraine, medical and public health workers have been killed and infrastructure destroyed, which require major efforts to rebuild to international standards. In Somalia, these crises are magnified by the effects of climate change, leading to greater food insecurity, heat-related deaths and famine. National public health institutes are crucial in these contexts and many others to support integrated political responses where health challenges span local, national and international levels and involve multiple stakeholders. This can be seen in strengthening of Integrated Disease Surveillance and work towards the Sustainable Development Goals. National public health institutes also provide integration through the international system, working jointly to build national capacities to deliver essential public health functions. In this context, the 2022 IANPHI Annual meeting agreed the Stockholm Statement, highlighting the role that NPHIs play in tackling the causes and effects of interconnected global and local challenges to public health. This represents an important step in addressing complex health crises and syndemics which require whole-of-society responses, with NPHIs uniquely placed to work across sectors and provide system leadership in response.

Experience of homelessness during the COVID-19 pandemic in Tower Hamlets, London: a health needs assessment.

BACKGROUND: The COVID-19 pandemic has affected people experiencing homelessness in multiple ways. The Everyone In initiative during 2020 was initially transformative in providing short-term accommodation for this group but was accompanied by major disruptions to treatment and support services. Understanding how these changes have affected health needs of people experiencing homelessness in the inner-city London Borough of Tower Hamlets can inform future service commissioning. METHODS: We conducted a focussed health needs assessment of people experiencing homelessness in Tower Hamlets. Quantitative data were gathered from the Combined Homelessness and Information Network (CHAIN), local authority housing services, primary care datasets, and substance dependency services. These data were combined with qualitative data from stakeholder meetings, facility visits, and lived experience insight from service users through interviews and focus groups. Analysis was targeted towards identifying gaps in existing commissioning. FINDINGS: We gathered data from 80 service users experiencing homelessness in Tower Hamlets between Sept 1 to Dec 31, 2021. Participants reported the largest impact of the pandemic being on their mental health. For people registered with specific homeless primary care services, 26·3% were experiencing depression and 12·8% other severe mental health issues. Service users with lived experience of homelessness described feeling let down by mental health support systems, describing that, despite positive experiences of individual staff, they felt the system as a whole was not well integrated. Specific issues were identified in hostel-based accommodation, where poor psychological and physical safety during lockdowns contributed to declines in mental health. INTERPRETATION: Using a health needs assessment, a necessity was identified to support the mental health of people experiencing homelessness in Tower Hamlets emerging from pandemic restrictions. People with lived experience of homelessness attributed deteriorations in mental health to extended time in inadequate accommodation, and reported that environments that take account of emotional and psychological needs were required. Provision of psychologically-informed accommodation environments and improved support service integration must be priorities for future local authority commissioning. FUNDING: None.