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1.
Am J Epidemiol ; 2022 Mar 17.
Article in English | MEDLINE | ID: covidwho-1852932

ABSTRACT

The United States has been in the grip of an epidemic of drug overdose mortality for the past few decades; deaths from drug overdose increased dramatically during the COVID-19 pandemic. Townsend et al. (Am J Epidemiol. XXXX;XXX(XX):XXXX-XXXX) add to the growing literature highlighting the steep rise of drug overdose mortality among racial and ethnic minorities in the country. Using data from National Center for Health Statistics death certificates and employing principles of small area estimation and a Bayesian hierarchical model to stabilize the estimates of smaller racial/ethnic groups and states, the authors found that combinations of opioid/stimulant drug overdose deaths saw a steep increase among racial and ethnic minorities, particularly Black Americans between 2007 and 2019. The results from their analysis highlight the need to change the narrative around opioid deaths, to invest in targeted policies that address the growing burden of drug overdose faced by racial/ethnic minorities, and the importance of using innovative methods to address limitations to data disaggregation. The paper also demonstrates the importance of a holistic view of the challenges to the health of the American public.

2.
SSRN; 2022.
Preprint in English | SSRN | ID: ppcovidwho-336309

ABSTRACT

In response to the COVID-19 pandemic, a suite of international initiatives has been developed to strengthen and reform the global architecture for pandemic preparedness and response (PPR), including proposals for a pandemic treaty, financial intermediary fund, and mechanisms for equitable access to medical countermeasures, among others. These proposed initiatives seek to draw upon critical lessons gleaned from the ongoing crisis by addressing gaps in health security and traditional public health functions. However, to date, there is insufficient consideration of the vital role of universal health coverage and robust primary health care in sustainably, equitably, and efficiently safeguarding health systems from future public health threats. The international community must not repeat the mistakes of past health security efforts that ultimately fueled the COVID-19 catastrophe – in particular, by overlooking the importance of coherent, multisectoral health systems. This paper outlines major (though often neglected) gaps in PPR, and identifies opportunities to reconceptualize health security by scaling up universal health coverage. We then propose a comprehensive set of recommendations to help inform the development of key PPR mechanisms across three themes – legal governance, financing mechanisms, and supporting initiatives. By synthesizing approaches that simultaneously strengthen global health architecture for both health security and universal health coverage, we aim to provide tangible solutions that equitably meet the needs of all communities while ensuring resilience to future pandemic threats.

3.
Sci Adv ; 8(9): eabm9737, 2022 Mar 04.
Article in English | MEDLINE | ID: covidwho-1723457

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has been accompanied by an increase in depression in U.S. adults. Previous literature suggests that having assets may protect against depression. Using a nationally representative longitudinal panel survey of U.S. adults studied in March and April 2020 and in March and April 2021, we found that (i) 20.3% of U.S. adults reported symptoms of persistent depression in Spring 2020 and Spring 2021, (ii) having more assets was associated with lower symptoms of persistent depression, with financial assets-household income and savings-most strongly associated, and (iii) while having assets appeared to protect persons-in particular those without stressors-from symptoms of persistent depression over the COVID-19 pandemic, having assets did not appear to reduce the effects of job loss, financial difficulties, or relationship stress on symptoms of persistent depression. Efforts to reduce population depression should consider the role played by assets in shaping risk of symptoms of persistent depression.

4.
Lancet ; 398(10316): 2109-2124, 2021 12 04.
Article in English | MEDLINE | ID: covidwho-1598178

ABSTRACT

Understanding the spread of SARS-CoV-2, how and when evidence emerged, and the timing of local, national, regional, and global responses is essential to establish how an outbreak became a pandemic and to prepare for future health threats. With that aim, the Independent Panel for Pandemic Preparedness and Response has developed a chronology of events, actions, and recommendations, from December, 2019, when the first cases of COVID-19 were identified in China, to the end of March, 2020, by which time the outbreak had spread extensively worldwide and had been characterised as a pandemic. Datapoints are based on two literature reviews, WHO documents and correspondence, submissions to the Panel, and an expert verification process. The retrospective analysis of the chronology shows a dedicated initial response by WHO and some national governments, but also aspects of the response that could have been quicker, including outbreak notifications under the International Health Regulations (IHR), presumption and confirmation of human-to-human transmission of SARS-CoV-2, declaration of a Public Health Emergency of International Concern, and, most importantly, the public health response of many national governments. The chronology also shows that some countries, largely those with previous experience with similar outbreaks, reacted quickly, even ahead of WHO alerts, and were more successful in initially containing the virus. Mapping actions against IHR obligations, the chronology shows where efficiency and accountability could be improved at local, national, and international levels to more quickly alert and contain health threats in the future. In particular, these improvements include necessary reforms to international law and governance for pandemic preparedness and response, including the IHR and a potential framework convention on pandemic preparedness and response.


Subject(s)
COVID-19/epidemiology , Pandemics , Animals , COVID-19/transmission , China/epidemiology , Disease Outbreaks , Global Health/legislation & jurisprudence , Humans , Information Dissemination , International Cooperation , International Health Regulations , Risk Assessment , SARS-CoV-2/isolation & purification , Time Factors , World Health Organization , Zoonoses/virology
12.
J Urban Health ; 98(Suppl 1): 51-59, 2021 08.
Article in English | MEDLINE | ID: covidwho-1491333

ABSTRACT

The inclusion of social determinants of health offers a more comprehensive lens to fully appreciate and effectively address health. However, decision-makers across sectors still struggle to appropriately recognise and act upon these determinants, as illustrated by the ongoing COVID-19 pandemic. Consequently, improving the health of populations remains challenging. This paper seeks to draw insights from the literature to better understand decision-making processes affecting health and the potential to integrate data on social determinants. We summarised commonly cited conceptual approaches across all stages of the policy process, from agenda-setting to evaluation. Nine conceptual approaches were identified, including two frameworks, two models and five theories. From across the selected literature, it became clear that the context, the actors and the type of the health issue are critical variables in decision-making for health, a process that by nature is a dynamic and adaptable one. The majority of these conceptual approaches implicitly suggest a possible role for data on social determinants of health in decision-making. We suggest two main avenues to make the link more explicit: the use of data in giving health problems the appropriate visibility and credibility they require and the use of social determinants of health as a broader framing to more effectively attract the attention of a diverse group of decision-makers with the power to allocate resources. Social determinants of health present opportunities for decision-making, which can target modifiable factors influencing health-i.e. interventions to improve or reduce risks to population health. Future work is needed to build on this review and propose an improved, people-centred and evidence-informed decision-making tool that strongly and explicitly integrates data on social determinants of health.


Subject(s)
COVID-19 , Social Determinants of Health , Health Policy , Humans , Pandemics , SARS-CoV-2
13.
Lancet Reg Health Am ; 5: 100091, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1446925

ABSTRACT

BACKGROUND: The COVID-19 pandemic and its consequences have been associated with an increase in poor population mental health. We assessed how depressive symptoms changed among U.S. adults over the course of the COVID-19 pandemic and identified the key risk factors for these symptoms. METHODS: Longitudinal panel study of a nationally representative group of U.S. adults ages 18 years and older surveyed in March-April 2020 (Time 1; N=1441) and March-April 2021 (Time 2; N=1161) in the COVID-19 and Life Stressors Impact on Mental Health and Well-being study (CLIMB). The Patient Health Questionnaire-9 (PHQ-9) was used to define elevated depressive symptoms (cut-off ≥10) and depressive symptoms score (0-27). FINDINGS: The prevalence of elevated depressive symptoms persisted from 27.8% in 2020 (95% CI: 24.9, 30.9) to 32.8% in 2021 (95% CI: 29.1, 36.8). Over time, the central drivers of depressive symptoms were low household income, not being married, and experiencing multiple stressors during the COVID-19 pandemic. The odds ratio of elevated depressive symptoms for low income relative to high income persons increased from 2.3 (95% CI: 1.2, 4.2) in 2020 to 7.0 (95% CI: 3.7, 13.3) in 2021. Fewer people reported experiencing 4 or more COVID-19 stressors in 2021 than in 2020 (47.5% in 2020 vs 37.1% in 2021), but the odds ratio of elevated depressive symptoms associated with 4 or more stressors relative to 1 stressor or less increased from 1.9 (95% CI: 1.2, 3.1) in 2020 to 5.4 (95% CI: 3.2, 9.2) in 2021. INTERPRETATION: The burden of depressive symptoms in the U.S. adult population increased over the course of the COVID-19 pandemic. Mental health gaps grew between populations with different assets and stressor experiences during the COVID-19 pandemic. FUNDING: CLIMB Time 1 was sponsored by the Rockefeller Foundation-Boston University 3-D Commission. CLIMB Time 2 was sponsored by the de Beaumont Foundation.

14.
J Urban Health ; 98(Suppl 1): 15-30, 2021 08.
Article in English | MEDLINE | ID: covidwho-1397043

ABSTRACT

Housing is a paradigmatic example of a social determinant of health, as it influences and is influenced by structural determinants, such as social, macroeconomic, and public policies, politics, education, income, and ethnicity/race, all intersecting to shaping the health and well-being of populations. It can therefore be argued that housing policy is critically linked to health policy. However, the extent to which this linkage is understood and addressed in public policies is limited and highly diverse across and within countries. This analysis seeks to describe the linkages between housing policies and health and well-being using examples from three countries at different levels of the wealth spectrum: Singapore, the UK, and Kenya.We conducted a comparative policy analysis across three country contexts (Singapore, the UK, and Kenya) to document the extent to which housing policies address health and well-being, highlighting commonalities and differences among them. To guide our analysis, we used the United Nations (UN) definition of adequate housing as it offers a broad framework to analyze the impact of housing on health and well-being.The anatomy of housing policies has a strong correlation to the provision of adequate housing across Singapore, the UK, and Kenya, especially for vulnerable groups. The paper demonstrates that contextual factors including population composition (i.e., aging versus youthful), political ideologies, legal frameworks (i.e., welfare versus market-based provision of housing), and presence (or absence) of adequate, quality, timely, reliable, robust data systems for decision-making, which are taken up by stakeholders/state, have strong implications of the type of housing policies developed and implemented, in turn directly and indirectly impacting the overall health and well-being of populations.This analysis demonstrates the value of viewing housing policies as public health policies that could significantly impact the health and well-being of populations, especially vulnerable groups. Moreover, the findings highlight the importance of the Health in All Policies approach to facilitate integrated policy responses to address social determinants of health such as housing. This is more critical than ever, given the context of the global pandemic that has led to worsening overall health and well-being.


Subject(s)
Housing , Social Determinants of Health , Humans , Kenya , Public Policy , Singapore , United Kingdom
15.
BMJ Open ; 11(8): e044125, 2021 08 09.
Article in English | MEDLINE | ID: covidwho-1350021

ABSTRACT

OBJECTIVE: To document the prevalence of anxiety disorders in the USA during the COVID-19 pandemic. DESIGN: A cross-sectional analysis. SETTING: A nationally representative sample in the USA between 31 March and 13 April 2020. PARTICIPANTS: 1450 English-speaking adult participants in the AmeriSpeak Panel. AmeriSpeak is a probability-based panel designed to be representative of households in the USA. MAIN OUTCOME MEASURES: Prevalence of probable generalised anxiety disorder (GAD) using the GAD-7 and post-traumatic stress symptoms (PTSS) using the four-item PTSD (post-traumatic stress disorder) checklist. Both outcomes were stratified by demographics and COVID-19-related stressors. RESULTS: The majority of participants were female (51.8%), non-Hispanic white (62.9%) and reported a household saving of $5000 or more. Those between 18 and 29 years old were the largest age group (38.1%) compared with 40-59 years (32.0%) and 60 years or more (29.9%). The prevalence of probable GAD was 10.9% (95% CI 9.1% to 13.2%) and the prevalence of PTSS was 21.7% (95% CI 19.1% to 24.6%). Among participants reporting five or more COVID-19-related stressors, the prevalence of probable GAD was 20.5% (95% CI 16.1% to 25.8%) and the prevalence of PTSS was 35.7% (95% CI 30.2% to 41.6%). Experiencing five or more COVID-19-related stressors was a predictor of both probable GAD (OR=4.5, 95% CI 2.3 to 8.8) and PTSS (OR=3.3, 95% CI 2.1 to 5.1). CONCLUSIONS: The prevalence of probable anxiety disorders in the USA, as the COVID-19 pandemic and policies implemented to tackle it unfolded, is higher than estimates reported prior to the pandemic and estimates reported following other mass traumatic events. Exposure to COVID-19-related stressors is associated with higher prevalence of both probable GAD and PTSS, highlighting the role these stressors play in increasing the risk of developing anxiety disorders in the USA. Mitigation and recovery policies should take into account the mental health toll the pandemic had on the USA population.


Subject(s)
COVID-19 , Pandemics , Adolescent , Adult , Anxiety , Anxiety Disorders/epidemiology , Cross-Sectional Studies , Depression , Female , Humans , Male , Mental Health , Middle Aged , SARS-CoV-2 , United States/epidemiology , Young Adult
16.
Nat Med ; 27(6): 964-980, 2021 06.
Article in English | MEDLINE | ID: covidwho-1232071

ABSTRACT

Health systems resilience is key to learning lessons from country responses to crises such as coronavirus disease 2019 (COVID-19). In this perspective, we review COVID-19 responses in 28 countries using a new health systems resilience framework. Through a combination of literature review, national government submissions and interviews with experts, we conducted a comparative analysis of national responses. We report on domains addressing governance and financing, health workforce, medical products and technologies, public health functions, health service delivery and community engagement to prevent and mitigate the spread of COVID-19. We then synthesize four salient elements that underlie highly effective national responses and offer recommendations toward strengthening health systems resilience globally.


Subject(s)
COVID-19/epidemiology , Global Health , Pandemics , Public Health , COVID-19/prevention & control , COVID-19/virology , Delivery of Health Care , Government , Government Programs , Humans , SARS-CoV-2/pathogenicity
19.
J Health Polit Policy Law ; 46(4): 577-584, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1045580

ABSTRACT

The COVID-19 pandemic transformed the American political landscape, influencing the course of the 2020 election and creating an urgent policy priority for the new administration. The Biden-Harris plan for beating COVID-19 represents a practicable, technically competent plan to contain the pandemic, one that will serve the country well in the months ahead. The authors suggest that the United States would also benefit from an even bolder set of aspirations-reframing the national conversation on COVID-19, embedding equity in all health decision making, strengthening the social safety net, and changing how we talk about health-as part of the national response to COVID-19. This would represent a genuine step forward in the US approach to health, informed by the systemic flaws COVID-19 exposed, and would realize benefits from the pandemic moment that in turn would propel national health forward for the rest of the century.


Subject(s)
COVID-19/prevention & control , Health Equity , Health Policy , Public Health , Humans , SARS-CoV-2 , Social Determinants of Health , United States
20.
Development (Rome) ; 63(2-4): 200-204, 2020.
Article in English | MEDLINE | ID: covidwho-1035905

ABSTRACT

The global response to COVID-19 has been uneven and disappointing in the vast majority of countries. The United States has borne the largest absolute burden of disease globally, as COVID-19 exploited pre-existing poor population health among Americans to spread rapidly, with devastating consequences. Why does the country that spends the most on healthcare in the world have one of the worst responses to COVID-19? We argue that this is because the United States conception of health is predominantly focused on healthcare, an overwhelming investment in developing drugs and treatments, and an underinvestment in the foundational conditions that keep people healthy. COVID-19 has exposed the limits of this approach to health. In order to prevent COVID-19 and future such pandemics, we must create the conditions that can keep population-level health threats at bay. This means addressing the conditions that shape health, including economics, employment, community networks, racial disparities, how we treat older adults, and the physical layout of our communities. To do so means acknowledging health as a public good, as a transnational project with countries working together to build a healthier world. It also means acknowledging that everyone has a right to health. These aspirations should become core to the global community's health aspirations in the post-COVID-19 era.

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