The application of epidemiology in national veterinary services: Challenges and threats in Brazil.

The application of epidemiology in national veterinary services must take place at the interface between science and politics. Animal health policy development and implementation require attention to macro-epidemiology, the study of economic, social and policy inputs that affect the distribution and impact of animal or human disease at the national level. The world has changed fast over the last three decades including the delivery of veterinary services, their remit and the challenges addressed by public and animal health policies. Rethinking the role of public services and how to make public programs more efficient has been at the heart of the political discussion. The WTO through its SPS Agreement has changed the way in which national veterinary services operate and how trade decisions are made. Most low and middle income countries are still struggling to keep up with the new international scene. Some of these countries, such as Brazil, have very important livestock industries and are key to the global food systems. Over the last two decades, Brazil became a leading player in exports of livestock products, including poultry, and this created a strong pressure on the national veterinary services to respond to trade demands, leading to focus animal health policies on the export-driven sector. During the same period, Brazil has gone a long way in the direction of integrating epidemiology with veterinary services. Epidemiology groups grew at main universities and have been working with government to provide support to animal health policy. The scope and quality of the applied epidemiological work improved and focused on complex data analysis and development of technologies and tools to solve specific disease problems. Many public veterinary officers were trained in modern epidemiological methods. However, there are important institutional bottlenecks that limit the impact of epidemiology in evidence-based decision making. More complex challenges require high levels of expertise in veterinary epidemiology, as well as institutional models that provide an appropriate environment for building and sustaining capacity in national veterinary services. Integrating epidemiology with animal health policy is a great opportunity if epidemiologists can understand the real issues, including the socio-economic dimensions of disease management, and focus on innovation and production of knowledge. It may be a trap if epidemiologists are restricted to answering specific decision-making questions and policy makers perceive their role exclusively as data analysts or providers of technological solutions. Fostering solutions for complex issues is key to successful integration with policy making.

A Scan of CDC-Authored Articles on Legal Epidemiology, 2011-2015.

OBJECTIVE: The Centers for Disease Control and Prevention (CDC) conducts research on legal epidemiology, the scientific study of law as a factor in the cause, distribution, and prevention of disease. This study describes a scan of articles written by CDC staff members to characterize the frequency and key features of legal epidemiology articles and their distribution across CDC departments and divisions. METHODS: CDC librarians searched an internal repository for journal articles by CDC staff published from January 1, 2011, to May 31, 2015. Researchers reviewed and coded the abstracts to produce data on key features of the articles. RESULTS: Researchers identified 158 CDC-authored legal epidemiology articles published in 83 journals, most frequently in Preventing Chronic Disease (14 publications), Journal of Public Health Management Practice (10 publications), and Morbidity and Mortality Weekly Report (9 publications). Most articles concerned the use and impact of law as a deliberate tool of intervention. Thirteen articles addressed the legal infrastructure of public health, and 3 assessed the incidental or unintended effects of nonhealth laws. CDC-authored articles encompassed policy making, implementation, and impact. Literature reviews and studies mapping laws across multiple jurisdictions constituted one-quarter of all publications. Studies addressed laws at the international, national, state, local, and organizational levels. CONCLUSION: Results of the scan can be used to identify opportunities for the agency to better support research, professional development, networking, publication, and tracking of publication in this emerging field.

A Transdisciplinary Approach to Public Health Law: The Emerging Practice of Legal Epidemiology.

Public health law has roots in both law and science. For more than a century, lawyers have helped develop and implement health laws; over the past 50 years, scientific evaluation of the health effects of laws and legal practices has achieved high levels of rigor and influence. We describe an emerging model of public health law that unites these two traditions. This transdisciplinary model adds scientific practices to the lawyerly functions of normative and doctrinal research, counseling, and representation. These practices include policy surveillance and empirical public health law research on the efficacy of legal interventions and the impact of laws and legal practices on health and health system operation. A transdisciplinary model of public health law, melding its legal and scientific facets, can help break down enduring cultural, disciplinary, and resource barriers that have prevented the full recognition and optimal role of law in public health.

[The use of sensitive data in epidemiology: remarks on the difficulties when interpreting the Italian legislation]. / Il trattamento dei dati sensibili in epidemiologia: riflessioni sulle difficoltà interpretative della normativa.

In recent years, the impact of the Italian legislation on the use of personal data (Legislative Decree 196/2003 and successive regulations) on epidemiological research has highlighted the need for reaching a balance between protecting sensitive data and making these data available for public health purposes. Complying with this legislation constitutes a number of challenges in the field of epidemiology, especially with respect to the use for research of health data that have been collected for purposes other than research. Based on the difficulties experienced by the National Center of Epidemiology, Surveillance and Health Promotion of the Italian National Institute of Health, in the present work we aim to promote what we feel is a more rational approach to the concept of "use of sensitive data". In particular, we address the importance of these data for research, the concept of identifiability as defined in current legislation, informed consent, and the lawful use of the data. Given that data networks have been replacing static archives, it is more realistic to strive for the protection of data confidentiality, as opposed to performing irreversible anonymization of data. We also stress the role that research and health institutions should play in clearly communicating to law and policy makers the importance of the data routinely collected by healthcare facilities in performing epidemiological research and surveillance, stressing the invaluable impact of these activities on the health of the population. We also emphasize the importance of strengthening the concept that public health prevention also begins with epidemiological research and surveillance.

[Features of the regulation of legal relations in the field of sanitary and epidemiological welfare in the Eurasian Economic Community member-states].

The aim of this work was identification of both general trends and approaches, and the differences in the regulation of relations in the field of sanitary and epidemiological welfare of the population, determination of the necessary measures to harmonize legislation states in the countries - members of the Eurasian Economic Community (EurAsEC) in the noted sphere. As a result of the present research recommendations about unification and harmonization of legislations in member states of EurAsEC are developed for formation of uniform economic policy in noted sphere.

Prevention, communication and equity in environmental epidemiology: ethical issues.

In environmental epidemiology research, decisions about when and how to intervene requires adequate ethical reflection. In fact, different kinds of issues may arise about: research methods and knowledge production; management of the results in terms of their overall assessments or for the implementation of preventive actions; reclamation intervention. In this contribution we propose to consider three topics we regard as crucial to this ethical debate: the reporting of conclusive research data; the correct application of the precautionary principle; and the environmental equity issues.

[The tasks of the Federal Service for the implementation of the legislation of the Russian Federation aimed at optimizing the compliance and enforcement].

The priority of the Federal Service's activity in protecting consumer rights and human welfare is to execute a number of basic documents recently endorsed and directed towards observing the legislation on the optimization of supervision and control activities. To implement measures on the professional orientation and prehigher education preparation of schoolchildren and on the assistance with their entrance into the medical prophylaxis faculties of higher medical educational establishments within the framework of target enrollment, etc. is an urgent problem for the agencies and bodies of the Russian Inspectorate for the Protection of Consumer Rights and Human Welfare. Interaction with civil society has recently been activated, which is required to ensure the transparency of the Service's work, to enhance its efficiency, and to optimize supervision. Public reception rooms have been set up, the function of which is to receive citizens, the representatives of legal persons, and individual employers concerning the matters of sanitary-and-epidemiological well-being, protection of the rights of consumers and a consumer market, and the activities of the agencies and bodies of the Russian Inspectorate for the Protection of Consumer Rights and Human Welfare. The better activities of the agencies and bodies of the Service will call for a set of complex tasks to be accomplished in the immediate future. The end result will depend on how competently, responsibly, and cooperatively the appropriate measures will be carried out in all the agencies of the Federal service.

El papel de la epidemiología en la definición de políticas. Hacia la salud pública que se necesita. Informe SESPAS 2008 / The role of epidemiology in policy definition. Toward the public health required. 2008 SESPAS Report

La epidemiología ocupa ya un papel relevante en la definiciónde políticas públicas y corporativas, tanto en España comoen otros países desarrollados, especialmente en los últimosaños, en que como consecuencia de la entronización por laOrganización Mundial de la Salud de la noción de determinantessociales de la salud, la conexión entre la salud y loconstruido socialmente se ha hecho más evidente.El uso de la epidemiología, sin embargo, suele verse restringidoal desarrollo y la evaluación de políticas originadas en burocraciassanitarias y con la mejora de la salud como único objetivosocial; son las llamadas políticas directas de salud. Estosupone una visión reduccionista del tema, ya que la salud segana y se pierde por políticas extrasanitarias primordialmente.Para ampliar el papel de la epidemiología como herramientapara las políticas, necesitaríamos tener una visión de las exposicionesy los efectos más allá de la esfera sanitaria y de losfactores de riesgo –biológicos y conductuales– propuestos porel paternalismo médico. Hay que tener una actitud más participativaque prescriptiva, desarrollar más estudios de evaluacióndel impacto en salud y empezar a valorar también el efecto sobrela salud de las decisiones de las instituciones que derivan delpoder político. Es decir, construir una epidemiología política.Para esta tarea, quizás clave para desarrollar la salud públicaque necesitamos, los salubristas deberían ser más visiblesy más creíbles, tender más a la independencia del poderpolítico, y suministrar información directamente a la poblacióny otros interesados (transparencia), desarrollando su profesionalizaciónplena (competencia) más como redes de profesionalesque como pirámides burocráticas(AU)

Epidemiology already plays a substantial role in the definitionof public and corporate policies in Spain as well as in otherdeveloped countries. The World Health Organization reinforcedthe position of epidemiology by enshrining the notion ofsocial health determinants and, as a result, the connection betweenhealth and social constructs has become more visible.However, the use of epidemiology is usually restricted to thedevelopment and evaluation of policies originating in healthbureaucracies with health improvement as the only public objective;these are called direct health policies. This view is somewhatreductionistic insofar as health gains and losses occurmainly due to policies outside the health sector.To expand the role of epidemiology as a tool to shape policies,we need a view of exposures and effects beyond healthcareand the biological and behavioral risk factors proposedby medical paternalism. Also required are an attitude thatis more participative than prescriptive and the developmentof more health impact assessments. In addition, the health effectsof the decisions taken by politically-empowered institutionsshould be included in the epidemiologist’s tool kit. In otherwords, a political epidemiology should be constructed.For this endeavor, which may be crucial to attain the publichealth required, public health practitioners should be more visibleand credible, have greater independence from politicalpower, provide information directly to the public and other stakeholders (greater transparency), and further develop the professionalizationof public health (greater competence) by workingincreasingly in networks of professionals rather than inbureaucratic pyramids(AU)