Publics and their health: Historical problems and perspectives

The nature of the relationship between publics and their health has long been a concern for those seeking to improve collective and individual health. Attempts to secure the health of the population of any given place are one of the oldest forms of governmental action. Whether it be providing clean water or preventing the spread of disease, such efforts require the involvement of the publics these measures are designed to protect. Despite its importance, surprisingly little attention has been paid to who or what the ‘public' of public health consisted of. This collection addresses this gap by considering ‘who' the public of public health was in an array of places and around a variety of public health problems. Ranging across Europe and North and South America, and from the interwar period to the near present, this book explores the construction of ‘problem publics' to deepen our understanding of the ‘who' of public health. This book offers detailed case studies of the making of ‘problem' publics and public health problems in different places and at different times. By placing examples of the construction of problem publics in contexts as diverse as the USA in the interwar period, East Germany in the 1980s and contemporary Argentina, this collection identifies what is general and what is specific to the processes that make certain kinds of publics appear problematic. In the wake of the COVID-19 pandemic, this volume offers fresh insights into the nature of public health problems, practices and publics. © Manchester University Press 2023.

Future challenges and their impact on respiratory health and lung cancer

Air pollution, climate and population health are closely related in terms of their impacts on respiratory health and lung cancer. Air pollutants contribute to the exacerbation of chronic respiratory problems such as COPD and asthma. Air pollutants are also toxic and carcinogenic, initiating and promoting lung cancer development. Climate change in relation to environmental pollution affects the geographical distribution of food supply and diseases such as pneumonia in adults and children. The threat of air pollution, and hence global warming and climate changes, and their effects on population and respiratory health, is an imminent threat to the world and deserves immediate and sustainable combating strategies and efforts. The goals are to increase public awareness and engagement in action, with alignment of international collaboration and policy, and with steering towards further research. Now is the prime time for international collaborative efforts on planning and actions to fight air pollution and climate change before it is too late.Copyright © ERS 2021.

Cost-Effectiveness Analysis of Nonpharmaceutical Interventions Combined with Inactivated Vaccination and Oral Medicine in China

Objectives: Various interventions were used to control the COVID-19 pandemic and protect population health, including vaccination, medication and nonpharmaceutical interventions (NPIs). This study aims to examine the cost-effectiveness of different combinations of NPIs (including social distancing, mask wearing, tracing-testing-isolation, mass testing, and lockdown), oral medicine (Paxlovid), and vaccination (including two-dose and three-dose vaccination) under the Delta and Omicron pandemic in China. Method(s): We constructed a Markov model using a SIRI structure with a one-week cycle length over one-year time horizon to estimate the cost-effectiveness of different combinations in China from societal perspective. Effectiveness of interventions, disease transition probabilities and costs were from published data, quality-adjusted life years (QALYs) gained and incremental cost-effectiveness ratios (ICER) and net monetary benefits were calculated for one-year time horizon. One-way and probabilistic sensitivity analyses were performed to test the robustness of the model. Scenario analysis was developed to examine different situations under the Omicron pandemic. Result(s): Under the Delta pandemic, implementing the combination of social distancing, mask wearing, mass testing and three-dose vaccination was the optimal strategy, with cost at $11165635.33 and utility of 94309.94 QALYs, and had 60% probability of being cost-effective compared with other strategies. Three-dose vaccination combinations were better than two-dose combinations. Under the Omicron pandemic, antigen testing was better than nucleic testing by avoiding cross infections;second, adding Paxlovid or lockdown to the combined intervention strategies could increase limited health outcomes at huge cost and thus were not cost-effective;last, encouraging patients to stay at home can save societal costs compared with concentrated quarantine at hospitals. Conclusion(s): Three-dose vaccination and self-quarantine of asymptomatic and mild cases can save total costs. Under the Omicron pandemic outbreak, antigen testing is a better way to control the pandemic, and adding Paxlovid or lockdown to intervention combinations is not cost-effective.Copyright © 2023

Comparative Study of Chemosensory Dysfunction in COVID-19 in 2 Geographically Distinct Regions.

OBJECTIVE: To directly compare the prevalence of chemosensory dysfunction (smell and taste) in geographically distinct regions with the same questionnaires. METHODS: A cross-sectional study was performed to evaluate the self-reported symptoms among adults (older than 18 years) who underwent COVID-19 testing at an ambulatory assessment center in Canada and at a hospital in Israel between March 16, 2020, and August 19, 2020. The primary outcome was the prevalence of self-reported chemosensory dysfunction (anosmia/hypomsia and dysgeusia/ageusia). Subgroup analysis was performed to evaluate the prevalence of chemosensory deficits among the outpatients. RESULTS: We identified a total of 350 COVID-19-positive patients (138 Canadians and 212 Israelis). The overall prevalence of chemosensory dysfunction was 47.1%. There was a higher proportion of chemosensory deficits among Canadians compared to Israelis (66.7% vs 34.4%, P < .01). A subgroup analysis for outpatients (never hospitalized) still identified a higher prevalence of chemosensory dysfunction among Canadians compared to Israelis (68.2% vs 36.1%, P < 0.01). A majority of patients recovered their sense of smell after 4 weeks of symptom onset. CONCLUSION: Although the prevalence of chemosensory deficit in COVID-19 was found to be similar to previously published reports, the prevalence can vary significantly across different geographical regions. Therefore, it is important to obtain regionally specific data so that the symptom of anosmia/dysgeusia can be used as a guide for screening for the clinical diagnosis of COVID-19.

The impact of the COVID-19 pandemic on inequalities in preventive health screenings: Trends and implications for U.S. population health.

The COVID-19 pandemic has profoundly impacted population well-being in the United States, exacerbating existing racial and socioeconomic inequalities in health and mortality. Importantly, as the pandemic disrupted the provision of vital preventive health screenings for cardiometabolic diseases and cancers, more research is needed to understand whether this disruption had an unequal impact across racialized and socioeconomic lines. We draw on the 2019 and 2021 National Health Interview Survey to explore whether the COVID-19 pandemic contributed to racialized and schooling inequalities in the reception of preventive screenings for cardiometabolic diseases and cancers. We find striking evidence that Asian Americans, and to a lesser extent Hispanic and Black Americans, reported decreased reception of many types of cardiometabolic and cancer screenings in 2021 relative to 2019. Moreover, we find that across schooling groups, those with a bachelor's degree or higher experienced the greatest decline in screening reception for most cardiometabolic diseases and cancers, and those with less than a high school degree experienced the greatest decline in screening reception for diabetes. Findings have important implications for health inequalities and U.S. population health in the coming decades. Research and health policy attention should be directed toward ensuring that preventive health care is a key priority for public health, particularly among socially marginalized groups who may be at increased risk of delayed diagnosis for screenable diseases.

Factors Influencing the Health of Participants in Religious Mass Gathering Ceremonies in Iraq: A Systematic Review

Introduction: In the last decade, the number of religious mass gathering ceremonies, which take place in Iraq, has increased considerably. Millions of participants visit the country annually from across the world to reach Karbala on foot or by other vehicles for participation in a religious ritual called Arbaeen, which lasts about 20 days. Unlike the Hajj mass gathering, another important annual religious mass gathering event of Muslims, an evidence-based review of scientific literature about influential factors on the health of participants in these ceremonies in Iraq has not been done.Methods: Using PRISMA guidelines and searching PubMed, Scopus, ISI_Web of Science, Cochrane Library, ProQuest, and Google Scholar databases, original English language studies focused on participants' health in religious ceremonies of Iraq until October 2021 were selected. The methodological quality of the studies and the risk of bias were checked using the Joanna Briggs Institute (JBI) checklists. In addition, the data from the Iraqi Ministry of Health and other organizations, including WHO and CDC, about Iraq's health condition and other resources were used to describe the related findings better and make health recommendations for the participants.Results: Thirty-two studies passed our criteria and were included for analysis. There was not any clinical trial. All of them were observational (cross-sectional) or qualitative (interview) research;the majority had low to moderate quality scores. Considering the limitations, the leading health risks of participants in religious ceremonies in Iraq include road accidents, insufficiency of Iraq's health system, cardiovascular disease, respiratory tract (including Covid-19) infections, unhealthy food and drink, gastrointestinal infections (including hepatitis), and zoonotic infections(leishmaniasis).Conclusion: Regarding the grandeur of Iraqi-related mass gatherings, preparation must begin before the events. Pre-participation examination, vaccination of high-risk individuals, and training of pilgrims and authorities on the health hazards are critical.

VACtrac: enhancing access immunization registry data for population outreach using the Bulk Fast Healthcare Interoperable Resource (FHIR) protocol.

COVID-19 vaccination uptake has been suboptimal, even in high-risk populations. New approaches are needed to bring vaccination data to the groups leading outreach efforts. This article describes work to make state-level vaccination data more accessible by extending the Bulk Fast Healthcare Interoperability Resource (FHIR) standard to better support the repeated retrieval of vaccination data for coordinated outreach efforts. We also describe a corresponding low-foot-print software for population outreach that automates repeated checks of state-level immunization data and prioritizes outreach by social determinants of health. Together this software offers an integrated approach to addressing vaccination gaps. Several extensions to the Bulk FHIR protocol were needed to support bulk query of immunization records. These are described in detail. The results of a pilot study, using the outreach tool to target a population of 1500 patients are also described. The results confirmed the limitations of current patient-by-patient approach for querying state immunizations systems for population data and the feasibility of a Bulk FHIR approach.

Assessment of antibody levels in a population vaccinated with Sputnik V

Objectives - The objective of our study was to assess humoral response in a population of health workers after vaccination with the first and second doses of Sputnik V. Methods - SARS-CoV-2 total antibodies (IgG and IgM) were measured, using the Centaur XPT autoanalyzer, Siemens, in 530 serum samples taken from health workers in Buenos Aires vaccinated with Sputnik V. Results - After 21 days of the first dose application, 10 individuals (1.9%) presented antibody levels <1.0 (non-reactive), while 520 subjects (98.1%) responded with antibody values >1.0 (reactive). The results, obtained 21 days after the second dose, show that only 2 individuals (0.38%) had antibody levels <1.0 (non-reactive) and 528 (99.6%) responded with antibody values >1.0 (reactive). Conclusion - This study results implied that two doses of Sputnik V vaccine generated a proper antibody response in virtually the entire studied population.Copyright © 2022, Russian Open Medical Journal.

Challenges and Strategies in Conducting Population Health Research during the COVID-19 Pandemic: Experience from a Nationwide Mixed-Methods Study in Bangladesh.

Introduction: Globally, the coronavirus (COVID-19) pandemic poses fundamental challenges in everyday life. Various controlling measures, including nationwide lockdowns, movement restrictions, travel bans, social distancing, and improved hygiene practices, have been widely introduced to curtail transmission of the disease. Notably, these measures have affected the execution of population health research that typically involves face-to-face data collection. This paper details a subjective reflective account of the challenges and mitigating strategies in conducting a nationwide study during the COVID-19 pandemic in 2021. Challenges and strategies: The research team faced a wide range of challenges in conducting this study. The major categories of challenges were defined as follows: (i) challenges relating to the COVID-19 pandemic, such as insufficient access to field sites; (ii) challenges related to contextual factors, such as cultural and gender sensitivity and extreme weather events; and (iii) challenges related to data quality and validity. The key mitigating strategies to overcoming these challenges included engaging a local-level field supervisor, hiring data collectors from respective study sites, incorporating team members' reviews of literature and experts' views to develop research instruments, modifying original research instruments, organizing regular meetings and debriefing, adjusting field operation plans, building gender-sensitive teams, understanding local norms and adopting culturally appropriate dress codes, and conducting interviews in local languages. Conclusions: This paper concludes that despite several COVID-19-related challenges coupled with contextual factors, data were successfully collected through timely and successful adaptations of several mitigating strategies. The strategies adopted in this study may be useful for overcoming unforeseeable challenges in planning and conducting future population-based health research in similar circumstances elsewhere.

Housing as a determinant of Inuit mental health: associations between improved housing measures and decline in psychological distress after rehousing in Nunavut and Nunavik.

INTERVENTION: In 2014-2015, more than 400 public housing units were constructed in Nunavut and Nunavik, two of the four Inuit regions in Canada. This provided the opportunity to assess the impact of improved housing conditions from a population health perspective in 12 Inuit communities where housing needs were the most severe. The aim of the research is to examine the associations between changes in housing conditions and changes in psychological distress pre-post rehousing. METHODS: A pre-post uncontrolled study was conducted in collaboration with Nunavut- and Nunavik-based organizations. Applicants at the top of public housing waitlists were recruited by local housing officers; participants completed questionnaires 1-6 months before rehousing, and 15-18 months after. Change in psychological distress was measured with the Kessler 6-item scale. Changes in three housing measures were examined: number of adults per household, number of children per household, and sense of home score. For each housing measure, a categorical variable stratified participants into three categories. The reference category included participants reporting significant change in the concerned housing measure; the two other categories included participants reporting little or no change. Associations were tested with linear multilevel regression models for change. RESULTS: A total of 102 Inuit adults completed the study. A reduction in the number of adults per household (living with 2 adults or less after rehousing) and an increase in sense of home were associated with significant decline in psychological distress pre-post rehousing (p < 0.001). CONCLUSION: Increased investments leading to such improvements in housing circumstances are promising ways to promote mental health in Inuit regions.

RéSUMé: INTERVENTION: En 2014-2015, plus de 400 logements sociaux ont été construits au Nunavut et au Nunavik, deux des quatre régions inuites du Canada, permettant ainsi d'évaluer l'impact de l'amélioration des conditions de logement sur la santé. Cette étude vise à examiner les associations entre les changements dans les conditions de logement et les changements dans la détresse psychologique avant et après le déménagement, dans 12 communautés inuites où les besoins en logement étaient les plus criants. MéTHODES: Une étude pré-post non contrôlée a été menée en collaboration avec des organisations du Nunavut et du Nunavik. Les participants figurant en tête des listes d'attente pour le logement social ont rempli les questionnaires de recherche 1-6 mois avant le déménagement et 15-18 mois après. Les changements de la détresse psychologique ont été mesurés à l'aide de l'échelle Kessler 6-item. Les changements des trois conditions de logement suivantes ont été examinés : le nombre d'adultes par ménage, le nombre d'enfants par ménage et le sentiment d'avoir un chez-soi. Pour chaque condition de logement, une variable catégorielle a été créée pour stratifier les participants ayant rapporté des changements (référence) et les participants n'ayant rapporté que peu ou pas de changement. Les associations ont été testées avec des modèles de régression linéaire multiniveaux. RéSULTATS: Un total de 102 adultes Inuit ont complété l'étude. Une réduction du nombre d'adultes par ménage (vivre avec 2 adultes ou moins après le déménagement) et une augmentation du sentiment d'avoir un chez-soi étaient associées à une baisse significative de la détresse psychologique (p < 0,001). CONCLUSION: Des investissements accrus menant à de telles améliorations des conditions de logement représentent une avenue prometteuse pour promouvoir la santé mentale dans les régions inuites.

Vehicle Design Strategies to Reduce the Risk of COVID-19 Transmission in Shared and Pooled Travel: Inventory, Typology, and Considerations for Research and Implementation

The global COVID-19 pandemic has given rise to a plethora of ideas for modifying and redesigning public transportation and shared mobility vehicles to protect workers and riders from contracting the disease while traveling. This research seeks to inventory these strategies, and to organize and distill them in a way that enables researchers, policymakers, and public transport and mobility service operators to more systematically and efficiently evaluate them. Through literature search and analysis, the COVID-19 risk-mitigating vehicle design (CRVD) typology was developed, articulating 12 categories of strategies (e.g., Seating Configuration, Barriers) and 12 mechanisms (e.g., physical distancing, physical separation) by which the strategies may reduce COVID-19 spread. A secondary contribution of this research is to gather opinions of experts in fields related to COVID-19 and its transmission, about the identified CRVD strategies and mitigation mechanisms. The typology and expert opinions serve as a launching point for further innovation and research to evaluate the effectiveness of CRVD strategies and their relationship to user preferences and travel behavior, within and beyond the current context. Public transport and shared mobility service operators can use the CRVD typology as a reference, in conjunction with industry guidance and emerging research on strategy effectiveness, to aid decision-making in their continued response to the pandemic as well as for future planning.

Beyond the biomedical, towards the agentic: A paradigm shift for population health science.

Life expectancy in the United States is decreasing. Health disparities are widening. Growing evidence for and integration of social and structural determinants into theory and practice has not yet improved outcomes. The COVID-19 pandemic reinforced the fact. In this paper, we argue that the biomedical model and its underlying scientific paradigm of causal determinism, which currently dominate population health, cannot meet population health needs. While criticism of the biomedical model is not new, this paper advances the field by going beyond criticism to recognize the need for a paradigm shift. In the first half of the paper, we present a critical analysis of the biomedical model and the paradigm of causal determinism. In the second half, we outline the agentic paradigm and present a structural model of health based on generalizable, group-level processes. We use the experience of the COVID-19 pandemic to illustrate the practical applications of our model. It will be important for future work to investigate the empirical and pragmatic applications of our structural model of population health.

EPH118 Healthcare Systems Sustainability and Resilience: Creating an Index

Objectives: The COVID-19 pandemic has highlighted the need for sustainable and resilient healthcare systems to protect population health. This requires measuring the relative progress of health systems towards becoming more sustainable and resilient. In this research, we design, construct and estimate a country-level healthcare system sustainability and resilience index (HSSRI) that reflects and combines the two dimensions. Method(s): The HSSRI aims to summarise the performance of a health system in the different domains contributing to its sustainability and resilience. These domains are: i) health system governance, ii) health system financing, iii) health system workforce, iv) medicines and technologies, v) health service delivery, vi) population health and social determinants, and vii) environmental sustainability. As part of our analyses, we conduct a rapid evidence assessment to identify indicators reflecting the domains included in the sustainability and resilience dimensions. We assess the domain indicators' suitability by the quantity and quality of the literature supporting their inclusion. The variables in each indicator are extracted from publicly available data sources, such as the OECD, World Bank, and others. The period covered is from 2000 to 2020. Weighted means of the indicators are used to construct the domains' indices in each dimension. We apply a geometric mean to combine the domain indices into one final index. Result(s): The HSSRI is piloted using data from five high-income countries, providing a credible instrument for measuring and reporting healthcare system sustainability and resilience. The results enable policy-makers and stakeholders to observe how different domains of sustainability and resilience have evolved across countries and time. Conclusion(s): The HSSRI will facilitate better understanding and monitoring of the healthcare system's relative weaknesses and strengths, and empower policy-makers to design interventions that improve its resilience and sustainability.Copyright © 2022

Measures of Greenspace Exposure and Their Association to Health-Related Outcomes for the Periods before and during the 2020 Lockdown: A Cross-Sectional Study in the West of England

Greenspaces are argued to be one of the important features in the urban environment that impact the health of the population. Previous research suggested either positive, negative, or no associations between greenspaces and health-related outcomes. This paper takes a step backward to, first, explore different quantitative spatial measures of evaluating greenspace exposure, before attempting to investigate the relationship between those measures and health-related outcomes. The study uses self-reported health data from an online cross-sectional survey conducted for residents in the West of England. This yielded data of greenspace use, physical activity, wellbeing (ICECAP-A score), and connectedness to nature for 617 participants, divided into two sets: health outcomes for the period before versus during the 2020 lockdown. The study uses the participants' postcodes (provided in the survey) to calculate eleven spatial measures of greenspace exposure using the software ArcGIS Pro 2.9.5. A total of 88 multivariate regression models were run while controlling for eleven confounders of the participants' characteristics. Results inferred 57 significant associations such that six spatial measures of greenspace exposure (NDVI R200m, NDVI R300m, NDVI R500m, Network Distance to nearest greenspace access, Euclidean Distance to nearest greenspace access, and Euclidean Distance to nearest 0.5 ha doorstep greenspace access) have significant association to at least one of the four health-related outcomes, suggesting a positive impact on population health when living in greener areas or being closer to greenspaces. Moreover, there are further significant associations between the frequency of use of greenspaces and increasing physical activity or feeling more connected to nature. Still, the residents' patterns of using greenspaces significantly changed during versus before lockdown and has impacted the relationships between health outcomes and the greenspace exposure measures.

Characteristics of the Health Service Psychologist Workforce

This article describes major employment and demographic trends in the health service psychologist workforce with information provided about clinical psychology where available. Workforce projections suggest the workforce is insufficiently sized and inadequately trained to respond to future health needs, such as those from Hispanic and older adult populations. Still, there are encouraging shifts toward greater racial/ethnic diversity in the workforce and increasing ratings of knowledge about working with diverse populations. Future directions consider implications for education and practice, such as the possible role of telehealth and the impact of the COVID-19 pandemic. © 2022 Elsevier Ltd. All rights reserved

Analysis of the Chemistry of Municipal Wastewaters for Forecasting the Conditions of Urban Population

The quality of wastewater and the socioeconomic aspects of the life of the population are shown to be interrelated. It is proposed to use municipal wastewater to diagnose the health of the population, to assess the feeding preferences of city dwellers, the use of alcohol, tobacco, medicines, and drugs, to assess the exposure of the population to the effect of hazardous chemicals (PAH, pesticides, preserving agents, plasticizers, etc.), and to timely reveal deceases (including COVID-19). The authors proposed several biomarkers, which are recommended to use to monitor the water-resource system as a component of the urban ecosystem.

How Has Population Health Been Amplified Through Integrated Indigenous Community Networks? Opportunities During the COVID-19 Pandemic

During the COVID-19 pandemic, the Colombian government failed to report statistics systematically separated by ethnicity. Moreover, municipalities with the highest proportion of indigenous populations have some of the highest hospitalization and death rates from COVID-19. Community self-organization in indigenous territories has strengthened community networks based on solidarity and reciprocity, thus managing individual and collective risks in regions neglected by public administrations. The Colombian National Indigenous Organization (ONIC) has systematically published a bulletin to analyze the National Institute of Health Information with data regarding the location of COVID-19 cases among indigenous communities, collected by diverse indigenous organizations. The ONIC has deployed territorial health actions nationwide and mobilized more than 60, 000 indigenous guards to form a sanitary cordon, accompanied by their traditional medicine and spiritual practices. Despite the high morbidity and mortality levels resulting from preexisting inequities, indigenous individuals organized in networks have maintained food sovereignty with reciprocity and solidarity practices. In contrast, government agencies have significant limitations in attending to the emergency, deepening social inequalities among vulnerable populations. The current pandemic provides an opportunity to recognize indigenous peoples' ancestral knowledge, including how they conceive health in an interconnected natural network. This chapter analyzes indigenous community networks as being necessary for the present and future to enhance population health. Thus, public health planning and social work could benefit by incorporating complex indigenous thinking to develop planetary intercultural health and well-being. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.