What the Puerto Rican hurricanes make visible: Chronicle of a public health disaster foretold.

García Márquez's novel, "Chronicle of a Death Foretold", narrates the multiple strands of a story leading up to a murder in a small Caribbean village. The novel shows both the incredulity of those who do not believe it possible that this tragic death could occur, and the impotence of those who see it coming but can do nothing to prevent it. Something akin to this double incapacity seems to be occurring today in Puerto Rico. In September 2017, the passage of Hurricanes Irma and María caused a public health disaster with large-scale death and destruction. Paradoxically, this catastrophe has made visible the need to evaluate the critical socio-environmental situation of this country, and to analyse the underlying social factors contributing to the problems caused by the hurricanes. Why did neither the US nor the Puerto Rican government react as expected when faced with such a serious situation? For decades, this country has been suppressed by colonial domination, exploitation of the workforce, and health discrimination. It has been a "laboratory", where colonial practices have institutionalized social control, racism, and inequality, with profound negative effects on society, quality of life and health equality. Poverty and unemployment have always been very high, and thousands of families live in precarious housing situations. Additionally, current labour reforms imposed as part of a neoliberal agenda, are eroding the job security and protections of the working population, while education, health, housing, pensions, energy, and land are being progressively privatized. What are the root causes of this situation? What future does the country await? To answer these questions, critical and comprehensive scrutiny of history showing what the hurricanes have helped to make visible is required. This shows that neoliberal colonialism has shaped the social features behind the principle health and inequality problems of the Puerto-Rican population.

Setting Targets for Emergency Preparedness for a Jurisdiction's Whole Health Care System: The Approach Taken by New York City's Department of Health and Mental Hygiene.

There is little existing in the literature that provides a definition of readiness for a jurisdiction's whole health care system. As defining readiness at the system level has proven to be challenging, an approach that provides a framework for planning and measuring health care readiness with broad utility is needed. The New York City Department of Health and Mental Hygiene (DOHMH) devised the Readiness Target Project. Nine areas or dimensions of readiness emerged from this work. Through focus groups and feedback from hospital stakeholders DOHMH developed a matrix of readiness areas outlining current state, target state, gaps, and recommendations to achieve readiness. The matrix is in use as a systematic approach to discover and close gaps in the readiness of the whole health care system and to provide that system a locally valid framework to drive continuous improvement. This paper describes a framework for planning and determining the status of health care readiness at the system level for the jurisdiction. (Disaster Med Public Health Preparedness. 2018;12:759-764)).

Of Mussels and Men.

Some species are more equal than others. Robert T. Paine (American ecologist, 1933-2016) discovered that if you remove starfish - what he called a "keystone species" - from a tide pool, the complex ecosystem collapses. Without the predator starfish, mussels choke out other animals and plants. This phenomenon is general. Sea otters eat the sea urchins that eat the kelp that provides food and habitat for other species. On the vast Serengeti plains, wildebeest "mow" the grass, protecting habitat for many other species. Understanding the "rules" that govern the numbers and diversity of species in an ecosystem is essential to efficient and sustainable management. But those same rules apply to us. Free of predation, humans are swarming over the planet, choking out other species. We are the planetary mussels. What next? A "mussel-bound" world, or perhaps renewed microbial predation?

State Size and Government Level Matter Most: A Structural Equation Model of Local Health Department Policy Behaviors.

OBJECTIVE: To explore relationships between local health department policy behaviors, levels of government activity, policy focus areas, and selected health department characteristics. DESIGN: Cross-sectional analysis of secondary data from the 2013 National Association of County & City Health Officials (NACCHO) Profile Survey. SETTING: Local health departments throughout the United States. PARTICIPANTS: A total of 2000 local health departments responding to the 2013 Profile Survey of Local Health Departments. Survey data were gathered by the NACCHO. METHODS: Secondary analysis of reported policy behaviors for the 2013 NACCHO Profile Survey. A structural equation model tested effects on and between state population size, rurality, census region and policy focus, and the latent variables of policy behavior formed from a confirmatory factor analysis. MAIN OUTCOME MEASURES: Policy behaviors, levels of government activity (local, state, and federal), policy focus areas, and selected local health department characteristics. RESULTS: The majority (85.1%) of health departments reported at least one of the possible policy behaviors. State population size increased the probability of local policy behavior, and local behavior increased the probability of state policy behavior. State size increased the likelihood of federal policy behavior and the focus on tobacco, emergency preparedness, and obesity/chronic disease. However, the more rural a state was, the more likely policy behavior was at the state and federal levels and not at local levels. Specific policy behaviors mattered less than the level of government activity. CONCLUSIONS: Size of state and rurality of health departments influence the government level of policy behavior.

Characteristics of Academic Health Departments: Initial Findings From a Cross-Sectional Survey.

Academic Health Departments (AHDs) represent collaborative relationships between public health academia and practice. The purpose of this study was to gain a better understanding of AHD characteristics, to document the extent of collaboration between organizations in an AHD, and to explore the benefits of AHDs. An electronic survey on the AHD was sent to members of the AHD Learning Community--a virtual learning community with 338 members. There were 110 valid responses to the survey, with 65 indicating they were currently in an AHD partnership. Thirty-two percent of AHDs had been established for more than 10 years; 64% were engaged in joint research activities; and, while 92% of respondents placed a high value on improving the competencies of students, almost half placed a high value on improving the competencies of faculty. This study can be a springboard for further research on the impact of AHDs on practice, academia, and ultimately community health.

New research findings since the 2007 Surgeon General's Call to Action to Prevent and Reduce Underage Drinking: a review.

OBJECTIVE: In 2007, the U.S. Department of Health and Human Services issued The Surgeon General's Call to Action to Prevent and Reduce Underage Drinking, a publication documenting a problem linked to nearly 5,000 injury deaths annually and poor academic performance, potential cognitive deficits, risky sexual behavior, physical and sexual assaults, and other substance use. This report reviews subsequent underage drinking and related traffic fatality trends and research on determinants, consequences, and prevention interventions. METHOD: New research reports, meta-analyses, and systematic literature reviews were examined. RESULTS: Since the Call to Action, reductions in underage frequency of drinking, heavy drinking occasions, and alcohol-related traffic deaths that began in the 1980s when the drinking age nationally became 21 have continued. Knowledge regarding determinants and consequences, particularly the effects of early-onset drinking, parental alcohol provision, and cognitive effects, has expanded. Additional studies support associations between the legal drinking age of 21, zero tolerance laws, higher alcohol prices, and reduced drinking and related problems. New research suggests that use/lose laws, social host liability, internal possession laws, graduated licensing, and night driving restrictions reduce traffic deaths involving underage drinking drivers. Additional studies support the positive effects of individually oriented interventions, especially screening and brief motivational interventions, web and face-to-face social norms interventions, college web-based interventions, parental interventions, and multicomponent community interventions. CONCLUSIONS: Despite reductions in underage alcohol consumption and related traffic deaths, underage drinking remains an enduring problem. Continued research is warranted in minimally studied areas, such as prospective studies of alcohol and brain development, policy studies of use/lose laws, internal possession laws, social host liability, and parent-family interventions.