Overdose Education and Naloxone Distribution Programmes and the Ethics of Task Shifting

2018 ◽  
Vol 11 (2) ◽  
pp. 151-164 ◽  
Author(s):  
Daniel Z Buchman ◽  
Aaron M Orkin ◽  
Carol Strike ◽  
Ross E G Upshur
Keyword(s):  
Vulnerable Populations ◽  
Emergency Services ◽  
Healthcare Services ◽  
Task Shifting ◽  
People Who Use Drugs ◽  
Lay Persons ◽  
Health Practitioners ◽  
Mainstream Healthcare ◽  
Health Related ◽  
Public Health Practitioners

Abstract North America is in the grips of an epidemic of opioid-related poisonings. Overdose education and naloxone distribution (OEND) programmes emerged as an option for structurally vulnerable populations who could not or would not access mainstream emergency medical services in the event of an overdose. These task shifting programmes utilize lay persons to deliver opioid resuscitation in the context of longstanding stigmatization and marginalization from mainstream healthcare services. OEND programmes exist at the intersection of harm reduction and emergency services. One goal of OEND programmes is to help redress the health-related inequities common among people who use drugs, which include minimizing the gap between people who use drugs and the formal healthcare system. However, if this goal is not achieved these inequities may be entrenched. In this article, we consider the ethical promises and perils associated with OEND as task shifting. We argue that public health practitioners must consider the ethical aspects of task shifting programmes that may inadvertently harm already structurally vulnerable populations. We believe that even if OEND programmes reduce opioid-related deaths, we nevertheless question if, by virtue of its existence, OEND programmes might also unintentionally disenfranchise structurally vulnerable populations from comprehensive healthcare services, including mainstream emergency care.

Human Rights Treaty Bodies

2018 ◽  
Author(s):  
Benjamin Mason Meier ◽  
Virgínia Brás Gomes
Keyword(s):  
Public Health ◽  
Human Rights ◽  
Global Health ◽  
International Institutions ◽  
Health Issues ◽  
Health Practitioners ◽  
Treaty Body ◽  
Health Related ◽  
Public Health Practitioners

This chapter assesses the role of human rights treaty bodies in monitoring, interpreting, and adjudicating health-related human rights obligations, facilitating accountability for the realization of human rights in health policy. With each core human rights treaty having its own corresponding human rights treaty body, these international institutions influence states and galvanize advocates to take action to realize human rights across a range of global health issues. Describing treaty body efforts to monitor state implementation, interpret human rights, and adjudicate individual complaints, this chapter examines the evolving composition and functions of these treaty bodies and analyzes their effectiveness in facilitating the implementation of human rights as a basis for global health. Given recent United Nations efforts to strengthen treaty body functions and streamline monitoring processes, treaty bodies provide complementary approaches for public health practitioners to support accountability for the implementation of health-related human rights.

scholarly journals Needs management in families affected by childhood-onset dystrophinopathies

2019 ◽  
Vol 7 ◽  
pp. 205031211983447 ◽  
Author(s):  
Kristin M Conway ◽  
Katy Eichinger ◽  
Christina Trout ◽  
Paul A Romitti ◽  
Katherine D Mathews ◽  
...  
Keyword(s):  
Psychosocial Support ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
The United States ◽  
Research Network ◽  
Childhood Onset ◽  
Psychosocial Services ◽  
Health Practitioners ◽  
The Many ◽  
Public Health Practitioners

Purpose: To collect information about the needs of families affected by childhood-onset dystrophinopathies residing in the United States. Methods: Individuals with an eligible dystrophinopathy were identified by the Muscular Dystrophy Surveillance, Tracking, and Research network. Between September 2008 and December 2012, 272 caregivers completed a 48-item survey about needs related to information, healthcare services, psychosocial issues, finances, caregiver demographics, and the individual’s functioning. Results: Overall, at least 80% of the survey items were identified as needs for more than one-half of caregivers. Among the needs identified, physical health and access to information were currently managed for most caregivers. Items identified as needed but managed less consistently were funding for needs not covered by insurance and psychosocial support. Conclusions: Healthcare providers, public health practitioners, and policymakers should be aware of the many needs reported by caregivers, and focus on addressing gaps in provision of needed financial and psychosocial services.

scholarly journals The Middle–Out Perspective — an approach to formalise 'normal practice' in public health advocacy

2021 ◽  
Author(s):  
Jennifer S Mindell ◽  
Yael Parag ◽  
Suzanne E. Bartington ◽  
Laura Stoll ◽  
James G. Barlow ◽  
...  
Keyword(s):  
Public Health ◽  
Health Outcomes ◽  
Public Health Issue ◽  
Formal Approach ◽  
Traditional Health ◽  
Health Practitioners ◽  
Health Related ◽  
Societal Changes ◽  
Public Health Advocacy ◽  
Public Health Practitioners

Background: The Middle–Out Perspective (MOP) provides a lens to examine how actors positioned between government (top) and individuals (bottom) act to promote broader societal changes from the middle–out (rather than the top–down or bottom–up). The MOP has been used in recent years in the fields of energy, climate change, and development studies. Public health practitioners involved with advocacy activities and creating alliances to amplify health promotion actions will be familiar with the general MOP concept if not the formal name. Methods: This paper introduces the MOP conceptual framework and customises it for a public health audience by positioning it among existing concepts and theories for actions within public health. Using two UK case studies (increasing signalised crossing times for pedestrians and the campaign for smoke–free legislation), we illustrate who middle actors are and what they can do to result in better public health outcomes. Results: These cases studies show that involving a wider range of middle actors, including those not traditionally involved in improving the public's health, can broaden the range and reach of organisations and individuals involving in advocating for public health measures. They also demonstrate that middle actors are not neutral. They can be recruited to improve public health outcomes, but they may also be exploited by commercial interests to block healthy policies or even promote a health-diminishing agenda. Conclusions: Using the MOP as a formal approach can help public health organisations and practitioners consider potential 'allies' from outside traditional health-related bodies or professions. Formal mapping can expand the range of who are considered potential middle actors for a particular public health issue. By applying the MOP, public health organisations and staff can enlist the additional leverage that is brought to bear by involving additional middle actors in improving the public's health.

Health-Related Education for Sustainability: Public Health Workforce Needs and the Role of Higher Education

2016 ◽  
Vol 32 (2) ◽  
pp. 192-205 ◽  
Author(s):  
Rebecca Patrick ◽  
Jonathan Kingsley ◽  
Teresa Capetola
Keyword(s):  
Public Health ◽  
Workforce Development ◽  
Environmental Sustainability ◽  
Knowledge Exchange ◽  
Education For Sustainability ◽  
Public Health Workforce ◽  
Health Practitioners ◽  
Health Related ◽  
Public Health Practitioners

AbstractPublic health practitioners have important roles to play in addressing environmental sustainability imperatives that have an impact on human health. Yet, to date, the extent to which practitioners are willing and able to address these issues is an understudied subject. This article draws on the findings of two qualitative studies involving 49 interviews with public health and/or sustainability practitioners and academics from Australia to highlight the capacity-building needs of the sector within the ‘health and sustainability’ space. The findings of this study raise several issues for workforce development and partnership building, contending that content on environmental sustainability should be integrated into all university courses. Underscoring gaps and opportunities, the article also reflects themes in the literature in relation to health-related education for sustainability; in particular, requirements for generic and transferable professional competencies and the role of universities in knowledge exchange and creation.

The Cedar Project: Child Welfare and Health Related Vulnerabilities in a Cohort of Young Aboriginal People Who Use Drugs in Two Canadian Cities

2009 ◽  
Author(s):  
Katharina Patterson ◽  
Adam Clarkson ◽  
Chris G. Richardson ◽  
Cari Miller ◽  
Akm Moniruzzaman ◽  
...  
Keyword(s):  
Child Welfare ◽  
Aboriginal People ◽  
People Who Use Drugs ◽  
Health Related

scholarly journals Building trust and enhancing localization to improve access to women’s health services in Afghanistan

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
F R Rab ◽  
S S Stranges ◽  
A D Thind ◽  
S S Sohani
Keyword(s):  
Health Care ◽  
Health Services ◽  
Vulnerable Populations ◽  
Time Trend ◽  
Health Workers ◽  
Healthcare Services ◽  
Delivery Of Healthcare ◽  
Care Services ◽  
Women And Children ◽  
Delivery Of Health Services

Abstract Background Over 34 million people in Afghanistan have suffered from death and devastation for the last four decades as a result of conflict. Women and children have borne the brunt of this devastation. Afghanistan has some of the poorest health indicators in the world for women and children. In the midst of armed conflict, providing essential healthcare in remote regions in the throws of conflict remains a challenge, which is being addressed the Mobile Health Teams through Afghan Red Crescent (ARCS). To overcome socio-cultural barriers, ARCS MHTs have used local knowledge to hire female staff as part of the MHTs along with their male relatives as part of MHT staff. The present study was conducted to explore the impact of engaging female health workers as part of MHTs in conflict zones within Afghanistan on access, availability and utilization of maternal and child health care. Methods Quantitative descriptive and time-trend analysis were used to evaluate impact of introduction of female health workers. Qualitative data is being analyzed to assess the possibilities and implications of engaging female health workers in the delivery of health services. Results Preliminary results show a 96% increase in uptake of services for expectant mothers over the last four years. Average of 18 thousand services provided each month by MHTs, 70% for women and children. Service delivery for women and children significantly increased over time (p < 0.05) after inclusion of female health workers in MHTs. Delivery of maternity care services showed a more significant increase (p < 0.001). Time trend and qualitative analyses is ongoing. Conclusions Introduction of female health workers significantly improved uptake of health care services for women and children especially in extremely isolated areas controlled by armed groups in Afghanistan. Engaging with local stakeholders is essential for delivery of health services for vulnerable populations in fragile settings like Afghanistan. Key messages Understanding cultural norms results in socially acceptable solutions to barriers in delivery of healthcare services and leads to improvements in access for women and children in fragile settings. Building local partnerships and capacities and using local resources result in safe, efficient and sustainable delivery of healthcare services for vulnerable populations in fragile settings.

scholarly journals What makes a ‘successful’ collaborative research project between public health practitioners and academics? A mixed-methods review of funding applications submitted to a local intervention evaluation scheme

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Peter van der Graaf ◽  
Lindsay Blank ◽  
Eleanor Holding ◽  
Elizabeth Goyder
Keyword(s):  
Public Health ◽  
Health Research ◽  
Collaborative Research ◽  
Online Survey ◽  
Public Health Practice ◽  
Rapid Review ◽  
Success Rates ◽  
Evaluation Scheme ◽  
Health Practitioners ◽  
Public Health Practitioners

Abstract Background The national Public Health Practice Evaluation Scheme (PHPES) is a response-mode funded evaluation programme operated by the National Institute for Health Research School for Public Health Research (NIHR SPHR). The scheme enables public health professionals to work in partnership with SPHR researchers to conduct rigorous evaluations of their interventions. Our evaluation reviewed the learning from the first five years of PHPES (2013–2017) and how this was used to implement a revised scheme within the School. Methods We conducted a rapid review of applications and reports from 81 PHPES projects and sampled eight projects (including unfunded) to interview one researcher and one practitioner involved in each sampled project (n = 16) in order to identify factors that influence success of applications and effective delivery and dissemination of evaluations. Findings from the review and interviews were tested in an online survey with practitioners (applicants), researchers (principal investigators [PIs]) and PHPES panel members (n = 19) to explore the relative importance of these factors. Findings from the survey were synthesised and discussed for implications at a national workshop with wider stakeholders, including public members (n = 20). Results Strengths: PHPES provides much needed resources for evaluation which often are not available locally, and produces useful evidence to understand where a programme is not delivering, which can be used to formatively develop interventions. Weaknesses: Objectives of PHPES were too narrowly focused on (cost-)effectiveness of interventions, while practitioners also valued implementation studies and process evaluations. Opportunities: PHPES provided opportunities for novel/promising but less developed ideas. More funded time to develop a protocol and ensure feasibility of the intervention prior to application could increase intervention delivery success rates. Threats: There can be tensions between researchers and practitioners, for example, on the need to show the 'success’ of the intervention, on the use of existing research evidence, and the importance of generalisability of findings and of generating peer-reviewed publications. Conclusions The success of collaborative research projects between public health practitioners (PHP) and researchers can be improved by funders being mindful of tensions related to (1) the scope of collaborations, (2) local versus national impact, and (3) increasing inequalities in access to funding. Our study and comparisons with related funding schemes demonstrate how these tensions can be successfully resolved.

scholarly journals After Action Review of the 2019 measles outbreak in Clark County, Washington, U.S.A

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Stoto ◽  
R Piltch-Loeb ◽  
R Wolfe ◽  
R Albrandt ◽  
A Melnick
Keyword(s):  
Public Health ◽  
Religious Community ◽  
Local Health ◽  
Mutual Aid ◽  
Social Distancing ◽  
Clark County ◽  
After Action Review ◽  
Measles Outbreak ◽  
Health Practitioners ◽  
Public Health Practitioners

Abstract Issue Clark County experienced a measles outbreak that challenged public health authorities. Description of the practice: We conducted a formal After Action Review with state and local health officials, school officials, and others to identify lessons for public health practitioners facing future outbreaks. Results Following the early identification of measles in a child who had recently arrived from Ukraine, active surveillance identified 71 confirmed cases, most in unvaccinated persons under 18 years of age. 4,138 contacts were traced and public health personnel made daily monitoring calls to 816. 53 potential exposure sites in healthcare facilities, schools and other public places were identified and communicated to the public. As a social distancing measure, unvaccinated students, teachers, and staff were excluded from schools in which exposure had occurred. Ascertaining susceptibility status was challenging. The national anti-vaccination sentiment and a parallel outbreak in a New York religious community created challenges in representing community risk while avoiding stigmatization of a community in which the first reported case was identified. Rather than respond to every false claim on social media, the health department developed talking points about emerging issues and engaged the community in dialogue. Lessons Responding to the measles outbreak required innovative approaches to surveillance and contact tracing, social distancing (school exclusions), and emergency risk communication. The response required extensive coordinated efforts of the county and state health departments, school systems, and many other organizations. Mutual aid enabled an influx of resources but managing the surge of responders proved challenging. Key messages Public health emergencies require effective emergency management practices. Carefully conducted After Action Reviews of health emergencies can help public health practitioners identify challenges and innovative practices.

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