Beautiful Ruin: Creating Healthfields

Multiple programs promote redevelopment of land reuse sites, which are environmentally impacted or potentially contaminated sites. Historically, such programs have focused primarily on economic development. However, public health is an important consideration to address not only sustainable redevelopment but also health inequity and disparities. The Agency for Toxic Substances and Disease Registry’s (ATSDR) Land Reuse Health Program is a special program to promote broad public health improvements through safe land reuse and redevelopment. Land reuse sites are virtually in every community in the U.S. and are a global problem. Brownfields are the greatest number of land reuse sites. With estimates of over 450,000 land reuse sites across the U.S., most communities suffer the burden of blight and contamination associated with these sites. ATSDR promotes and practices Healthfields Redevelopment: The safe reuse of environmentally distressed land to reduce exposures to contaminants and to improve overall health in the community. In this chapter, I highlight Navajo Nation Healthfields activities using ATSDR’s 5-step Land Reuse Strategy to Safely Reuse Land and Improve Health (5-step Land Reuse Model) and describe some of ATSDR’s Healthfields projects and related tools and resources for communities to create their own Healthfields practice.

Intra-host evolution provides for continuous emergence of SARS-CoV-2 variants

Variants of concern (VOC) in SARS-CoV-2 refer to viral genomes that differ significantly from the ancestor virus and that show the potential for higher transmissibility and/or worse clinical progression. VOC have the potential to disrupt ongoing public health measures and vaccine efforts. Yet, little is known regarding how frequently different viral variants emerge and under what circumstances. We report a longitudinal study to determine the degree of SARS-CoV-2 sequence evolution in 94 COVID-19 cases and to estimate the frequency at which highly diverse variants emerge. 2 cases accumulated 9 single-nucleotide variants (SNVs) over a two-week period and 1 case accumulated 23 SNVs over a three-week period, including three non-synonymous mutations in the Spike protein (D138H, E554D, D614G). We estimate that in 2% of COVID cases, viral variants with multiple mutations, including in the Spike glycoprotein, can become the dominant strains in as little as one month of persistent in patient virus replication. This suggests the continued local emergence of VOC independent of travel patterns. Surveillance by sequencing for (i) viremic COVID-19 patients, (ii) patients suspected of re-infection, and (iii) patients with diminished immune function may offer broad public health benefits.

The training of school-doctors in France: ways of improvement, lessons to share

In France protection & prevention of students' health in schools is taken care of by school-doctors, in partnership. They follow a specific training for a year before becoming civil servants in the Ministry of Education. Around 1000 school-doctors are currently in post; 20-30 new school-doctors are trained each year. The training alternates academic sessions & supervised medical work in schools, under the responsibility of experienced mentors. Since 15 years, this training has been revised to improve its relevance in a Public health perspective, mainly by adding a strong health promotion component. The current organisation aims at (1) individualising the training, capitalising on the knowledge & competencies of trainees, leading to an individual scheme defined with the national coordinators (a school-doctor and a pedagogical engineer) between 8 & 16 weeks of academic sessions given at the French school of Public health; (2) articulating academic contents with pragmatic & professional skills; (3) integrating pedagogical innovations to maximise the development of the 10 competencies identified as core to school-doctors; (4) giving school-doctors a broad Public health perspective, with research and health promotion expertise, while fostering their specific and particular medical practice in the global context of schools. Each year improvements are implemented to answer the feed-back from trainees and professionals involved in the training. A closer articulation between local heads of school-doctors and the national level of their training has been fostered to improve coherence between academic & technical content while meeting ministerial requirements. The overall involvement & satisfaction of trainees are monitored. There is still space to improve the training of qualified school-doctors to promote the health of school-students in a Public heath perspective, in a time in France where health inequalities need to be better addressed and where the medical demography is critical. Key messages In a time of lack of medical doctors, school-doctors are important public-health actors for children and adolescent, with a very crucial position at the articulation of the health and school systems. The training of school-doctors must meet the challenge to accommodate pedagogical requirements & changes in their practice due to vacant posts while fulfilling ministerial expectations.

Ebola, quarantine, and the need for a new ethical framework

Quarantine is a broad public health strategy used to control infectious diseases outbreaks. An arguably most aggressive public health intervention, quarantine limits the asymptomatic individuals’ liberty and can result in significant harm. Quarantine was used in an attempt to control several Ebola outbreaks during the Ebola epidemic in West Africa in 2014. The most concerning quarantine intervention occurred at West Point, a slum of 75,000 people in the capital Liberian capital, Monrovia. This work critically reviews present ethical frameworks in public health for the examination of outbreaks in West Africa. This work utilizes the nine public health ethical principles described by Kerridge, Lowe and Stewart to argue that the quarantine at West Point was not ethically justified; and, it concludes that a new ethical framework for quarantine is required to address future outbreaks in the West African context.

The opioid crisis: a contextual, social-ecological framework

The prevalence of opioid use and misuse has provoked a staggering number of deaths over the past two and a half decades. Much attention has focused on individual risks according to various characteristics and experiences. However, broader social and contextual domains are also essential contributors to the opioid crisis such as interpersonal relationships and the conditions of the community and society that people live in. Despite efforts to tackle the issue, the rates of opioid misuse and non-fatal and fatal overdose remain high. Many call for a broad public health approach, but articulation of what such a strategy could entail has not been fully realised. In order to improve the awareness surrounding opioid misuse, we developed a social-ecological framework that helps conceptualise the multivariable risk factors of opioid misuse and facilitates reviewing them in individual, interpersonal, communal and societal levels. Our framework illustrates the multi-layer complexity of the opioid crisis that more completely captures the crisis as a multidimensional issue requiring a broader and integrated approach to prevention and treatment.

Sedentary Behavior and Public Health: Integrating the Evidence and Identifying Potential Solutions

In developed and developing countries, social, economic, and environmental transitions have led to physical inactivity and large amounts of time spent sitting. Research is now unraveling the adverse public health consequences of too much sitting. We describe improvements in device-based measurement that are providing new insights into sedentary behavior and health. We consider the implications of research linking evidence from epidemiology and behavioral science with mechanistic insights into the underlying biology of sitting time. Such evidence has led to new sedentary behavior guidelines and initiatives. We highlight ways that this emerging knowledge base can inform public health strategy: First, we consider epidemiologic and experimental evidence on the health consequences of sedentary behavior; second, we describe solutions-focused research from initiatives in workplaces and schools. To inform a broad public health strategy, researchers need to pursue evidence-informed collaborations with occupational health, education, and other sectors.

The Mental Health Crisis on US Campuses

The authors address the growing mental health crisis on American campuses. They explore the results of surveys that indicate rising levels of anxiety and depression in addition to other mental health concerns among student populations, including some of the potential causes of this trend. The chapter concludes with a review of how campus health clinics are responding to this increasing demand for mental health care, including different public health approaches that have been found to be effective on various campuses. This broad public health approach provides the foundation for the development of programs that encourage students to spend time in nature as a response to mental health concerns.

The New Frontier: Dissemination of EBTs and Beyond

This chapter outlines challenges to the successful dissemination of evidence-based treatments and to the realization of a broad public health impact of scientifically informed treatments. Themes include focusing on treatment designs, service systems, and training models that emphasize flexible interfaces for individual differences and exception management routines for real-time challenges. Examples include (a) modular treatment systems that balance laboratory-derived structure and expertise with real-time feedback, client input, and supervisory guidance; (b) service systems to accommodate youth for whom no evidence-based treatment is available or one has failed to achieve the intended benefit; and (c) training models that allow multiple starting points and pathways or strategies to achieve competencies across many evidence-based treatments. It is contended that the field must adopt new architectures in these areas to retain the many gains made by the proliferation of evidence-based treatments while also advancing the ability of evidence to guide practice in working systems.

Suicide in Brazilian indigenous communities: clustering of cases in children and adolescents by household

OBJECTIVE: To estimate age and sex-specific suicide rates, compare suicide rates between indigenous communities, and quantify the frequency of intrafamilial suicide clustering. METHODS: We performed a retrospective cohort study involving 14,666 indigenous individuals in reservations in Dourados, state of Mato Grosso do Sul, Brazil, from 2003 through 2013 using national and local census. RESULTS: The overall suicide rate was 73.4 per 100,000 person-years. Adolescent males aged 15–19 and girls aged 10–14 had the highest rates for each sex at 289.3 (95%CI 187.5–391.2) and 85.3 (95%CI 34.9–135.7), respectively. Comparing the largest reservations, Bororo had a higher suicide rate than Jaguapiru (RR = 4.83, 95%CI 2.85–8.16) and had significantly lower socioeconomic indicators including income and access to electricity. Nine of 19 suicides among children under 15 occurred in household clusters. Compared with adult suicides, a greater proportion of child (OR = 5.12, 95%CI 1.89–13.86, p = 0.001) and adolescent (OR = 3.48, 95%CI 1.29–9.44, p = 0.017) suicides occurred within household clusters. CONCLUSIONS: High rates of suicide occur among children and adolescents in these indigenous reservations, particularly in poor communities. Nearly half of child suicides occur within household clusters. These findings underscore the need for broad public health interventions and focused mental health interventions in households following a suicide.

Pharmaceutical policy reform in Canada: lessons from history

Canada is the only country with a broad public health system that does not include universal, nationwide coverage for pharmaceuticals. This omission causes real hardship to those Canadians who are not well-served by the existing patchwork of limited provincial plans and private insurance. It also represents significant forgone benefits in terms of governments’ ability to negotiate drug prices, make expensive new drugs available to patients on an equitable basis, and provide integrated health services regardless of therapy type or location. This paper examines Canada’s historical failure to adopt universal pharmaceutical insurance on a national basis, with particular emphasis on the role of public and elite ideas about its supposed lack of affordability. This legacy provides novel lessons about the barriers to reform and potential methods for overcoming them. The paper argues that reform is most likely to be successful if it explicitly addresses entrenched ideas about pharmacare’s affordability and its place in the health system. Reform is also more likely to achieve universal coverage if it is radical, addressing various components of an effective pharmaceutical program simultaneously. In this case, an incremental approach is likely to fail because it will not allow governments to contain costs and realize the social benefits that come along with a universal program, and because it means forgoing the current promising conditions for achieving real change.