A three-layer system to win the war against COVID-19 and invest in health systems of the future

The COVID-19 pandemic taught us many lessons, most critically that its human and economic toll would have been significantly smaller if countries had in place strong layers of defence that would have either prevented the spillover of the SARS-CoV-2 into a human population in the first place, or, failing that, contained the outbreak to avert its global spread. Further, the brunt of COVID-19 impacts on some countries considered ‘most prepared’ for pandemics underscored the need for an integrated approach to ensure resilience to future epidemics. Consequently, as countries plan ahead to prevent future pandemics, they should give priority to investments that transform their systems, particularly in the precrises phase, to preparedness and response through a multilayered defence. We propose a three-layered approach for post-COVID-19 investments in public health functions and service delivery, particularly at the community and precrises levels. This framework highlights the interventions that enable countries to better prevent, detect and contain epidemic threats, and that strengthen the efficient use of limited resources towards high-impact precrises systems.

People with disabilities

This chapter addresses the developing field of disability in public health. Disability is traditionally associated with morbidity and mortality as negative public health outcomes. Primary prevention activities addressing birth defects, developmental disabilities, injuries, and chronic illnesses associated with disabling conditions are the foundation of public health. Public health is developing rapidly in promoting the health and well-being of the population of people living with disabling conditions. This chapter outlines the essential public health functions of assessment, policy development, and assurance for this population across countries and age groups. The WHO’s International Classification of Functioning, Disability and Health (ICF) provides the framework for the conceptual and scientific issues. Finally, the chapter discusses directions for public health and disability to develop more closely. Recommendations are made for improving communication, cooperation, and coordination of activities between the public health and disability communities. The fundamental tenet of the chapter is that people with disabilities should be included in planning, development, and implementation of all public health activities.

What are Digital Public Health Interventions? First Steps Towards a Definition and an Intervention Classification Framework (Preprint)

UNSTRUCTURED Digital Public Health (DiPH) presents itself as an emerging field for population-based research and practice. The fast development of digital technologies provides a fundamentally new understanding of improving Public Health by using digitalization, especially in prevention and health promotion. The first step towards a better understanding of DiPH is to conceptualize the subject of assessment by answering what DiPH interventions are. This is important as one cannot evaluate tools if one does not know what precisely an intervention in this field can be. Therefore, this paper aims to give the first definition for DiPH interventions. We will merge leading models for Public Health functions by the WHO, a framework for digital health technologies by the National Institute for Care and Excellence (NICE), and a user-centered approach to intervention development. Together, they provide us with an overview of functions and areas of use for DiPH interventions. Nevertheless, one must keep in mind that Public Health functions can differ between different healthcare systems, limiting our new framework's universal validity. We conclude that a DiPH intervention should address essential Public Health functions by digital means. Furthermore, it should include members of the target-group in the development process to improve social acceptance and achieve a population health impact.

Essentials public health functions and public health genomics in Ecuador

Aim: This paper aims to analyze the EPHF in MG in Ecuador as a framework for integrating it into clinical practice. It also aims to contribute to the scientific and social debate on the MG role, considering it the most advanced science field today. Context: the Essentials Public Health Functions (EPHF) are actions for specific purposes necessary to achieve the central objective of Public Health (PH), which is to improve, promote, protect, and restore the population's health through collective action. Medical Genetics (MG) and Genomics are still in construction between public policies, especially in developing countries, and deserve an in-depth approach in this context. Discussion: We understand collective health as an inter-institutional and interdisciplinary social practice, which involves both the State and civil society, aims at protecting and improving people's health. It implies population or community interventions; it includes the responsibility to ensure access and health care quality. Within this practice are the EPHF, defined as actions carried out for specific purposes necessary to achieve the PH Practice's central objective. Each function's operation depends on a sufficient definition of contents, objectives, and activities and on the specific assignment of who is responsible for their execution. Conclusion: The EPHF guides public health policies in Latin America and Ecuador. From this perspective, medical genetics and genomics must be included as a priority in the country's public policy. In this review, we propose the activities to be implemented in this context. This challenge requires political and scientific leadership.

No Two Workforces Are the Same: A Systematic Review of Enumerations and Definitions of Public Health Workforces

The delivery and coordination of public health functions is essential to national and global health, however, there are considerable problems in defining the people who work in public health, as well as estimating their number. Therefore, the aim of this systematic review was to identify and explore research which has defined and enumerated public health workforces. In particular, how were such workforces defined? Who was included in these workforces? And how did researchers make judgments about the size of a workforce? In this systematic review, we identified 82 publications which enumerated a public health workforce between 2000 and November 2018. Most workforce definitions were unique and study-specific and included workers based on their occupation or their place of work. Common occupations included public health nurses and physicians, epidemiologists, and community health workers. National workforces varied by size, with the United States and Switzerland having the largest public health workforces per-capita, although definitions used varied substantially. Normative assessments (e.g., assessments of ideal workforce size) were informed through opinion, benchmarks or “service-target” models. There are very few regular, consistent enumerations within countries, and fewer still which capture a substantial proportion of the public heath workforce. Assessing the size of the public health workforce is often overlooked and would be aided by fit-for-purpose data, alignment of occupations and functions to international standards, and transparency in normative methods.

A renewed framework for the essential public health functions in the Americas

This report presents the results of a consensus decision making process conducted to elaborate a renewed conceptual framework of the essential public health functions for the Americas. The emerging framework consists of four pillars encompassing action-oriented components relating to the new scope and concerns of public health. The four pillars call for adopting a human rights approach to public health, addressing the social determinants of health, ensuring access to both individuals and population-based services, and expanding the stewardship role of health authorities through a collaborative implementation of public health functions. Public health functions were conceptualized as a set of capacities that are part of an integrated policy cycle the encompasses four stages: assessment, policy development, allocation of resources, and access. The framework provides a road map for evaluation and development by health authorities of integrated enabling public health policies through intersectoral collaboration. The application of the framework would require engaging countries working to improve public health through national assessments and systematic incorporation of these findings into quality improvement efforts and sectoral and intersectoral decision-making processes around policy and investments priorities promoted by governments. Work is ongoing in the definition of a list of public health functions that gives operational clarity to each dimension of this framework and guides performance evaluation.

Addressing social determinants of noncommunicable diseases in primary care: a scoping review

Background Noncommunicable diseases (NCDs) are the leading cause of global mortality, and their risk factors largely manifest at the community level. In collaboration with public health, primary care is well placed to assess and address the local social determinants of NCDs (SDONCDs). Post-Astana, many countries are reorienting their primary care systems to incorporate these traditional public health functions, but there is little evidence to guide reform. We aimed to collate examples of primary care organisations that already engage in this activity. Methods Following Cochrane guidance, PubMed, MEDLINE, Embase & HMIC were searched from inception to 28/7/2019, along with hand-searching of references for any study designs that examined international primary care organisation(s) that addressed local SDONCDs. Independent dual review was used for screening, data extraction, and quality assessment - for which we used ROBINS-i. Results Searches identified 666 studies of which 17 studies from Canada, South Africa, UK, and USA were included. All used descriptive study designs. Individual-level surveys and interviews were the most common SDONCD data collection methods reported. Fewer studies collated population-level data held by external agencies. Actions ranged from individual-level interventions to novel representation of primary care organisations on system-level policy and planning committees. Several enablers and barriers to collecting and mobilising social determinant data within well- and under-resourced primary care settings were identified. Conclusions Several models of integrated public health and primary care already exist that fulfil the Astana mandate of developing place-based preventive services, tailored to local needs. Public health input at this granular level is required to support primary care services as they extend their scope of practice, and to assist with monitoring and evaluation of new initiatives to mitigate unmet health and social needs. Key messages Primary care organisations are increasingly being encouraged to assess and address local social determinants of noncommunicable diseases but there is weak evidence to guide reform. The different approaches described in our review can help policymakers tasked with integrating public health functions into primary care.

An Industrial Accident

Emergency physicians and emergency departments serve critical public health functions at all times and particularly during public health emergencies or disasters. Public health emergencies and disasters transform standards of care into crisis standards of care. In addition to traditional tenets of bioethics, during events requiring crisis standards of care, the emergency physician faces the dilemmas of balancing responsibilities of how to allocate scarce resources to individual patients with obligations to the community and with personal and professional autonomy. Crisis standards of care permit emergency physicians to allocate scarce resources to provide necessary treatments to patients most likely to benefit. In crisis standard-of-care situations, emergency physicians must adhere to ethical and professional norms. The emergency physician should focus on how to best use the available resources with the recognition that not all patients might be able to be treated.

Addressing Health Equity in Public Health Practice: Frameworks, Promising Strategies, and Measurement Considerations

This review describes the context of health equity and options for integrating equity into public health practice. We first discuss how the conceptualization of health equity and how equity considerations in US public health practice have been shaped by multidisciplinary engagements. We then discuss specific ways to address equity in core public health functions, provide examples of relevant frameworks and promising strategies, and discuss conceptual and measurement issues relevant to assessing progress in moving toward health equity. Challenges and opportunities and their implications for future directions are identified.