Politics of public health

The aim of public health is to improve and protect individuals and their communities, as well as promote evidence-based policy to drive decision-making across the larger health system. Researchers in academic institutions, government agencies, and the private sector provide the science to help policymakers make evidence-based health policy decisions, such as interventions to increase smoking cessation, or policies to improve access to preventive care services. In an ideal world, science (or evidence) drives policy, with politics playing a minimal or enabling role. However, this formula recognizes that public health policy is not only decided based on science (or evidence), but science itself is increasingly vulnerable to the political process, and to attacks by a wide array of players (e.g. politicians, industry leaders, and interest groups) that have vested interests to undermine scientific evidence in order to thwart the actions that would credibly follow that knowledge. Put differently, politics are key—and can be systematically analysed—in advancing or thwarting evidence-based policy.

Estimated impact of COVID-19 on preventive care service delivery: an observational cohort study

Background COVID-19 has caused significant healthcare service disruptions. Surgical backlogs have been estimated but not for other healthcare services. This study aims to estimate the backlog of preventive care services caused by COVID-19. Methods This observational study assessed preventive care screening rates at three primary care clinics in Ottawa, Ontario from March to November 2020 using data from 22,685 electronic medical records. The change in cervical cancer, colorectal cancer, and type 2 diabetes screening rates were crudely estimated using 2016 census data, estimating the volume of key services delayed by COVID-19 across Ontario and Canada. Results The mean percentage of patients appropriately screened for cervical cancer decreased by 7.5% (− 0.3% to − 14.7%; 95% CI), colorectal cancer decreased by 8.1% (− 0.3% to − 15.8%; 95% CI), and type 2 diabetes decreased by 4.5% (− 0.2% to − 8.7%; 95% CI). Crude estimates imply 288,000 cervical cancer (11,000 to 565,000; 95% CI), 326,000 colorectal cancer (13,000 to 638,000; 95% CI), and 274,000 type 2 diabetes screenings (13,000 to 535,000; 95% CI) may be overdue in Ontario. Nationally the deficits may be tripled these numbers. Re-opening measures have not reversed these trends. Interpretation COVID-19 decreased the delivery of preventive care services, which may cause delayed diagnoses, increased mortality, and increased health care costs. Virtual care and reopening measures have not restored the provision of preventive care services. Electronic medical record data could be leveraged to improve screening via panel management. Additional, system-wide primary care and laboratory capacity will be needed to restore pre-COVID-19 screening rates.

Estimated Impact of COVID-19 on Preventive Care Service Delivery: An Observational Cohort Study

Background: COVID-19 has caused significant healthcare service disruptions. Surgical procedure backlogs have been calculated but not those for other healthcare services. This study aims to estimate the backlog of key primary preventive care services caused by COVID-19. Methods: This observational study assessed preventive care screening rates at three primary care clinics in Ottawa, Ontario from March to November 2020 using data from 22,685 electronic medical records. The change in cervical cancer, colorectal cancer, and type 2 diabetes screening rates were extrapolated using 2016 census data, estimating the volume of key services delayed by COVID-19 across Ontario and Canada.Results: The mean percentage of patients appropriately screened for cervical cancer decreased by 7.5% (-0.3% to -14.7%; 95% CI), colorectal cancer decreased by 8.1% (-0.3% to -15.8%; 95% CI), and type 2 diabetes decreased by 4.5% (-0.2% to -8.7%; 95% CI). Extrapolation estimated that Ontarians delayed 288,000 cervical cancer (11,000 to 565,000; 95% CI), 326,000 colorectal cancer (13,000 to 638,000; 95% CI), and 274,000 type 2 diabetes screenings (13,000 to 535,000; 95% CI). Extrapolation to the Canadian population nearly triples these numbers. Re-opening measures have not reversed these trends.Interpretation: COVID-19 decreased the delivery of preventive care services, which may cause delayed diagnoses, increased mortality, and increased health care costs. Virtual care and reopening measures have not restored the provision of preventive care services. Electronic medical record data could be leveraged to improve screening via panel management. Additional, system-wide primary care and laboratory capacity will be needed to restore pre-COVID-19 screening rates.

Differences of expected intervention effects between participant-led and facilitator-led preventive care services in Japan

Objective To examine the effect of different management methods on the effectiveness of care preventive programmes for community-dwelling older adults. Methods This study comprised two facilitator-led (FL) and one participant-led (PL) preventive care classes in Japan. All participants received the intervention for approximately 12 weeks. Functional assessments, occupational dysfunctions, and subjective health were measured before and after the interventions. A two-way mixed design analysis of covariance (ANCOVA) was adopted to examine the effect of the interventions, adjusted for previous experiences with preventive care services. The level of significance was set at P < 0.05. Results Fourteen participants in the PL group (76.64 ± 6.48 years, 92.9% women) and 29 participants in the FL group (76.55 ± 5.75 years, 75.9% women) were included in the statistical analysis. ANCOVA showed significant group × time interaction effects in the Five Times Sit-to-Stand Test (FTSST), the Timed Up & Go (TUG), occupational deprivation of the Classification and Assessment of Occupational Dysfunction Scale, and self-rated health. Simple main effect tests showed that the TUG decreased significantly in the PL group, while occupational deprivation and self-rated health scores improved significantly. In contrast, FTSST scores significantly improved in the FL group. Conclusion PL-type management may be more appropriate for preventing social isolation and withdrawal, while FL-type management may be more appropriate for preventing physical frailty. Selecting not only adequate programmes but also an appropriate management type that matches the service purpose can help provide more effective care preventive services.

The Association Between Cognitive Function and Preventive Care Service Utilization Among U.S. Chinese Older Adults

Preventive healthcare utilization is an important aspect of medical practice that facilitates the identification of chronic diseases at an early stage and increases options for treatment. Cognitive function plays an important role in individuals’ utilization of preventive care services. However, our understanding of the relationship between cognitive function and preventive care utilization is limited, particularly in older minority aging populations. The study aims to assess the association between cognitive function and preventive healthcare utilization among U.S. Chinese older adults. Data were obtained from the Population Study of Chinese Elderly in Chicago (PINE). Five instruments were used to measure global cognition, including the Mini-Mental State Examination, East Boston Memory Test Immediate Recall and Delayed Recall, Digit Span Backwards, and Symbol Digit Modalities Test. Preventive care services included immunization (i.e. flu, pneumonia, and hepatitis B vaccines) and cancer screenings (i.e. colorectal, breast, cervical, and prostate). Multivariable regression analyses were used. The findings showed that higher level of global cognition was associated with higher utilization of pneumonia vaccination (OR=1.32, 95% CI= 1.14-1.52), hepatitis B vaccination (OR=1.24, 95% CI= 1.05-1.47), colon exam (OR=1.23, 95% CI= 1.07-1.41), mammogram (OR=1.46, 95% CI= 1.22-1.73), breast exam (OR=1.23, 95% CI= 1.04-1.46), and cervical exam (OR=1.38, 95% CI= 1.15-1.65). Future longitudinal studies are needed to elucidate potential mechanisms underlying the relationship between cognitive function and preventive care utilization among U.S. Chinese older adults. Study findings underscore the need to understand preventive care utilization patterns among U.S. Chinese older adults with low cognitive function.

Effect of Performance-based Financing on the Coverage of Antenatal Care and Immunization Services in Buea Health District, Cameroon

Introduction and Aim: Financing healthcare is a major factor in our society today which affects access to quality healthcare. The MDGs reached their deadline in 2015 but progress has been insufficient with reducing the morbidity and mortality rates of diseases. The healthcare system of Cameroon is characterized by low coverage for preventive care services. Innovative ways must be identified to fast track the coverage of MCH services. Lack of incentives affects the coverage of ANC and immunization services. The aim of this study was to assess the effect of PBF on the coverage of ANC and immunization services. Methods: An experimental study design was used and health facilities in the Buea Health District were randomly selected and assigned to one of four groups, three intervention groups (T1, C1 and C2) and one control group (C3). Using multistage sampling, a total of 434 postpartum mothers and 474 children participated in the study. An interviewer administered questionnaire was used and data was analyzed using EPI Info version 3.5.4 and STATA version 10.1 statistical software. Results: The mean age of the 434 postpartum mothers was 26.03. Supervision alone had significant effect on the four or more ANC visits (p=0.04). Both financing and supervision had statistically significant effect on the four or more ANC visits (p=0.003) and immunization. Financing and fixed per capita budgetary supplement did not have a significant effect on the coverage of ANC and immunization services. Conclusion: Both Financing and enforced supervision is necessary in order to improve the coverage of ANC and immunization services thus accelerating progress towards improving MCH.

Disparities in the Use of General Somatic Care among Individuals Treated for Severe Mental Disorders and the General Population in France

Individuals with severe mental illnesses (SMI) face a striking excess and premature mortality which has been demonstrated in several national contexts. This phenomenon, which constitutes a red-flag indicator of public health inequities, can be hypothesized to result from healthcare access issues which have been insufficiently documented so far. In this context, our objective was to explore patterns of general somatic healthcare use of individuals treated for SMI in comparison to those of the general population in France using national health administrative data and a matched case-control study. Differences in the use of general and specific somatic preventive care services, primary care, routine specialized somatic care and admissions to non-psychiatric hospital departments for somatic causes were described between cases and controls after adjustment on differing clinical needs, socio-economic status, and living environment. Our results show a lower use of general preventive care services and of routine specialized somatic care in the SMI population, despite more frequent comorbidities, and a higher occurrence of avoidable hospitalizations, despite higher contacts with primary care physicians. These findings suggest that the health system fails to address the specific needs of this vulnerable population and support the development of measures aimed at reducing this gap.