The people, process, and technology for population management in community health.

Population health expands the focus of health care from individual, in-person care to the proactive management of cohorts that can occur asynchronously from a clinical encounter. In its most successful form, the approach segments populations by defined characteristics and promotes outreach and engagement to deliver targeted interventions, even among those who have missed recent or routine care. The triple aim, supported by the Institutes for Health Care Improvement, emphasizes improving the health of populations, cost of care, and patient and care team experience and has influenced new approaches in primary care. In primary care settings such as community health centers, the goal of improving outcomes leverages technology to expand focus from point-of-care interventions to population-level approaches to deliver high-quality preventive services and chronic disease management that benefit entire families and communities. Developments in informatics have introduced technology tools for population management and underscored the need to align technology with effective processes and stakeholder engagement for success. Informed by a review of the literature and observations across multiple implementations of population health strategies in community health, in this conceptual paper, we describe the steps (process), domains of team expertise (people), and health information technology components (technology) that contribute to the success of a population health strategy. We also explore future opportunities to expand the reach and impact of population health through patient engagement, analytics, interventions to address social determinants of health, responses to emerging public health priorities, and prioritization-of-use cases by assessing community-specific needs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Hindsight is 2020? Lessons in global health governance one year into the pandemic.

Fourteen months into the SARS-CoV-2 pandemic, we identify key lessons in the global and national responses to the pandemic. The World Health Organization has played a pivotal technical, normative and coordinating role, but has been constrained by its lack of authority over sovereign member states. Many governments also mistakenly attempted to manage COVID-19 like influenza, resulting in repeated lockdowns, high excess morbidity and mortality, and poor economic recovery. Despite the incredible speed of the development and approval of effective and safe vaccines, the emergence of new SARS-CoV-2 variants means that all countries will have to rely on a globally coordinated public health effort for several years to defeat this pandemic.

Medicina de Familia, una especialidad amenazada / Family Medicine, a threatened specialty

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Superposition of COVID-19 waves, anticipating a sustained wave, and lessons for the future.

The 2019 coronavirus (COVID-19), also known as SARS-CoV-2, is highly pathogenic and virulent, and it spreads very quickly through human-to-human contact. In response to the growing number of cases, governments across the spectrum of affected countries have adopted different strategies in implementing control measures, in a hope to reduce the number of new cases. However, 5 months after the first confirmed case, countries like the United States of America (US) seems to be heading towards a trajectory that indicates a health care crisis. This is in stark contrast to the downward trajectory in Europe, China, and elsewhere in Asia, where the number of new cases has seen a decline ahead of an anticipated second wave. A data-driven approach reveals three key strategies in tackling COVID-19. Our work here has definitively evaluated these strategies and serves as a warning to the US, and more importantly, a guide for tackling future pandemics. Also see the video abstract here https://youtu.be/gPkCi2_7tWo.

Public Health Interventions with Harms and Benefits: A Graphical Framework for Evaluating Tradeoffs.

BACKGROUND: Evaluations of public health interventions typically report benefits and harms aggregated over the population. However, benefits and harms are not always evenly distributed. Examining disaggregated outcomes enables decision makers to consider health benefits and harms accruing to both intended intervention recipients and others in the population. METHODS: We provide a graphical framework for categorizing and comparing public health interventions that examines the distribution of benefit and harm between and within population subgroups for a single intervention and compares distributions of harm and benefit for multiple interventions. We demonstrate the framework through a case study of a hypothetical increase in the price of meat (5%, 10%, 25%, or 50%) that, via elasticity of demand, reduces consumption and consequently reduces body mass index. We examine how inequalities in benefits and harms (measured by quality-adjusted life-years) are distributed across a population of white and black males and females. RESULTS: A 50% meat price increase would yield the greatest net benefit to the population. However, because of reduced consumption among low-weight individuals, black males would bear disproportionate harm relative to the benefit they receive. With increasing meat price, the distribution of harm relative to benefit becomes less "internal" to those receiving benefit and more "distributed" to those not receiving commensurate benefit. When we segment the population by sex only, this result does not hold. CONCLUSIONS: Disaggregating harms and benefits to understand their differential impact on subgroups can strongly affect which decision alternative is deemed optimal, as can the approach to segmenting the population. Our framework provides a useful tool for illuminating key tradeoffs relevant to harm-averse decision makers and those concerned with both equity and efficiency.

Mapping of food industry strategies to influence public health policy, research and practice in South Africa.

OBJECTIVES: To identify the corporate political activity (CPA) of food industry actors in South Africa. METHODS: We studied the CPA of ten different food actors for the period Jan 2018-April 2019. We used a systematic approach and existing framework to collect and analyse information available in the public domain, including material from the industry, government, academia and civil society. RESULTS: Food industry actors in South Africa established multiple relationships with various parties in and outside the South African government. These included interactions between large food companies and the Department of Basic Education, the Department of Sport & Recreation, the Department of Health, and the Department of Agriculture. In addition, the food industry-sponsored community programs, with a focus on poverty alleviation and undernutrition. Moreover, food industry actors influenced science were directly involved in policy-making and helped frame the debate on diet and public health in South Africa. CONCLUSIONS: It is crucial that there is increased transparency, disclosure, and awareness of industry strategies, and that mechanisms to address and manage industry influence are strengthened in the country.