scholarly journals Building Back Better after COVID-19: a systematic scoping review of wicked problems affecting developed countries and implications for global governance

2021 ◽  
Author(s):  
Robin van Kessel ◽  
Brian Li Han Wong
Keyword(s):  
Public Health ◽  
Demographic Change ◽  
Scoping Review ◽  
Wicked Problems ◽  
Developed Countries ◽  
Wicked Problem ◽  
List Type ◽  
Driving Mechanisms ◽  
New Findings ◽  
Complex Relationships

AbstractThe COVID-19 pandemic is a textbook example of a ‘wicked problem’, one which is complex, open-ended, unpredictable, or intractable and seems resistant to any solution. This presents a window of opportunity to explore other wicked problems and their implications after the pandemic. A systematic scoping review was conducted to investigate the COVID-19 aftermath and identify public health topics which may be of great significance in the years to come. Through the adoption of three megadrivers as fundamental drivers of change (globalisation, demographic change, and digitalisation), it narratively explored how different wicked problems – and the driving mechanisms which sustain them – persist. It further explored the implications of these public health topics on global (health) governance. While the wicked problems mapped in this article show a large variance in where their apparent roots lie, they share one factor in common: health. These wicked problems must be first and foremost addressed if we as a globalised world are to successfully and sustainably build back better from COVID-19.Summary BoxWhat is already known?-COVID-19 is a textbook example of a wicked problem; a problem that is complex, open-ended, unpredictable, or intractable and seems resistant to any solution;-Digitalisation, globalisation, and demographic change are seen as the three megadrivers of change and are theorised to create and sustain modern wicked problems;-The megadrivers respectively have complex relationships with health; this includes both positive and negative associations.What are the new findings?-A series of wicked problems exist in multiple domains of society that continue to obstruct the progress of the 2030 Agenda for Sustainable Development;-These wicked problems each have roots in the three megadrivers: digitalisation, globalisation, and demographic change;-There exists a complex interrelation between the megadrivers, wicked problems, and health.What do the new findings imply?-It currently remains unclear to what extent wicked problems and megadrivers respectively affect health outcomes; therefore, further research is indicated;-A ‘once in a generation’ opportunity has presented itself to build back better from the COVID-19 pandemic by addressing the existing wicked problems; therefore, governance mechanisms should follow and adapt accordingly;-Wicked problems have bidirectional implications for modern policy; this has created an environment for wicked problems to manifest and sustain themselves, which in turn produce further policies that sustain wicked problems.

scholarly journals Economic and social impacts of COVID-19 and public health measures: results from an anonymous online survey in Thailand, Malaysia, the United Kingdom, Italy and Slovenia

2020 ◽  
Author(s):  
Anne Osterrieder ◽  
Giulia Cuman ◽  
Wirichada Pan-ngum ◽  
Phaik Kin Cheah ◽  
Phee-Kheng Cheah ◽  
...  
Keyword(s):  
Public Health ◽  
Online Survey ◽  
Social Groups ◽  
List Type ◽  
Health Measures ◽  
The United Kingdom ◽  
New Findings ◽  
Education Levels ◽  
Lower Education ◽  
Economic And Social Impacts

AbstractIn the absence of a vaccine and widely available treatments for COVID-19, governments have relied primarily on non-pharmaceutical interventions to curb the pandemic. To aid understanding of the impact of these public health measures on different social groups we conducted a mixed-methods study in five countries (‘SEBCOV - Social, ethical and behavioural aspects of COVID-19’). Here we report the results of the SEBCOV anonymous online survey of adults.Overall, 5,058 respondents from Thailand, Malaysia, the United Kingdom, Italy and Slovenia completed the self-administered survey between May and June 2020. Post-stratification weighting was applied, and associations between categorical variables assessed.Among the five countries, Thai respondents appeared to have been most, and Slovenian respondents least, affected economically. Overall, lower education levels, larger households, having children under 18 in the household, being 65 years or older and having flexible/no income were associated with worse economic impact. Regarding social impact, respondents expressed most concern about their social life, physical health, and mental health and wellbeing.There were large differences between countries in terms of voluntary behavioural change, and in compliance and agreement with COVID-19 restrictions. Overall, self-reported compliance was higher among respondents reporting a high understanding of COVID-19. UK respondents felt able to cope the longest and Thai respondents the shortest with only going out for essential needs or work, with 60% and 26% respectively able to cope with 29 days or longer. Many respondents reported seeing news that seemed fake to them, the proportion varying between countries, and with education level and self-reported levels of understanding of COVID-19.Our data showed that COVID-19 public health measures have uneven economic and social impacts on people from different countries and social groups. Understanding the factors associated with these impacts can help to inform future public health interventions and mitigate their negative consequences on people’s lives.SummaryWhat is already known?COVID-19 public health measures and lockdowns most negatively affect those who are socio-economically disadvantaged.Misinformation about COVID-19 is widespread.What are the new findings?In the countries in which we conducted our survey, lower education levels, larger households, having children under 18 in the household, being 65 years or older and having flexible/no income were associated with worse economic impact.There were large differences between countries in terms of voluntary change of behaviour, as well as compliance and agreement with COVID-19 related public health measures.Younger age and lower education levels appear to be associated with lower self-perceived levels of understanding of COVID-19.A significant proportion of the population received conflicting information and news that seemed fake to them, in particular about coronavirus being an engineered modified virus.What do the new findings imply?Our findings imply that there are significant differences in how people from different social groups and different countries experienced COVID-19 and related public health measures, and any support initiatives should take this into account.Our findings confirm that communication around COVID-19 could be improved, and help identify specific areas to target (e.g. origin of virus) and specific groups of people who may benefit most from improved communication (e.g. younger people, those with lower levels education).

scholarly journals Feasibility, Acceptability, and Effectiveness of Non-Pharmaceutical Interventions for Infectious Disease Prevention and Control in Crisis-Affected Settings and Informal Settlements: A Scoping Review

2021 ◽  
Author(s):  
Jonathan A. Polonsky ◽  
Sangeeta Bhatia ◽  
Keith Fraser ◽  
Arran Hamlet ◽  
Janetta Skarp ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Scoping Review ◽  
Prevention And Control ◽  
Informal Settlements ◽  
Evidence Base ◽  
List Type ◽  
Resource Limitations ◽  
New Findings ◽  
And Control ◽  
Pharmaceutical Interventions

AbstractIntroductionNon-pharmaceutical interventions (NPIs) are a crucial suite of measures to prevent and control infectious disease outbreaks. They are particularly important for crisis-affected populations that typically reside in settings characterised by overcrowding, inadequate access to healthcare and resource limitations. To describe the landscape of research and identify evidence gaps concerning the acceptability, feasibility, and effectiveness of NPIs among crisis-affected populations and informal settings, we conducted a systematic scoping review of the published evidence.MethodsWe systematically reviewed peer-reviewed articles published between 1970 and 2020 to collate available evidence on the feasibility, acceptability, and effectiveness of NPIs in crisis-affected populations and informal settlements. We performed quality assessments of each study using a standardised questionnaire.ResultsOur review included 158 studies published in 85 peer-reviewed articles. Most research used low quality study designs. The acceptability, feasibility, and effectiveness of NPIs was highly context dependent. In general, simple and cost-effective interventions such as community-level environmental cleaning and provision of water, sanitation and hygiene services, and distribution of items for personal protection such as insecticide-treated nets, were both highly feasible and acceptable. Logistical, financial, and human resource constraints affected both the implementation and sustainability of measures. Community engagement emerged as a strong factor contributing to the effectiveness of NPIs. Conversely, measures that involve potential restriction on personal liberty such as case isolation were found to be less acceptable to the community.ConclusionOverall, the evidence base was patchy, with substantial knowledge gaps between differing between settings and pathogens. Although implementation of NPIs presents unique practical challenges, it is critical that the lessons learned are shared with the wider community to build a robust evidence base.Summary boxWhat is already known?- NPIs are a crucial suite of tools for the prevention and control of infectious diseases, either as a complement to, or in the absence of, effective pharmaceutical interventions (i.e., therapeutics and vaccination).- Despite being disproportionately vulnerable, crisis-affected populations and those living in informal settlements are often neglected by research and guidance. NPIs are, however, vital and adaptation is necessary within these settings due to poor living conditions and resource limitations that intensify disease transmission risk.What are the new findings?- We conducted a scoping review to produce a landscape analysis of the existing evidence concerning NPIs within crisis-affected settings and informal settlements.- The existing evidence is patchy, uneven, occasionally contradictory, and of generally low quality, but building over time.- Although limited, some findings are generalisable across settings, populations and NPIs.What do the new findings imply?- There is a need for greater investments in research to strengthen the guidance and policies on NPIs in these settings.- In particular, upstream pilot feasibility and acceptability studies should be conducted prior to the widespread roll-out of interventions to ensure they are feasible, acceptable, and ultimately effective for the target populations.

scholarly journals Surgery & COVID-19: A rapid scoping review of the impact of COVID-19 on surgical services during public health emergencies

2020 ◽  
Author(s):  
Connor M O’Rielly ◽  
Joshua S Ng-Kamstra ◽  
Ania Kania-Richmond ◽  
Joseph C Dort ◽  
Jonathan White ◽  
...  
Keyword(s):  
Public Health ◽  
Scoping Review ◽  
Grey Literature ◽  
Healthcare Systems ◽  
List Type ◽  
Surgical Capacity ◽  
Public Health Emergencies ◽  
Surgical Services ◽  
Competing Interests ◽  
The Impact

ABSTRACTBackgroundHealthcare systems globally have been challenged by the COVID-19 pandemic, necessitating the reorganization of surgical services to free capacity within healthcare systems.ObjectivesTo understand how surgical services have been reorganized during and following public health emergencies, and the consequences of these changes for patients, healthcare providers and healthcare systems.MethodsThis rapid scoping review searched academic databases and grey literature sources to identify studies examining surgical service delivery during public health emergencies including COVID-19, and the impact on patients, providers and healthcare systems. Recommendations and guidelines were excluded. Screening was completed in partial (title, abstract) or complete (full text) duplicate following pilot reviews of 50 articles to ensure reliable application of eligibility criteria.ResultsOne hundred and thirty-two studies were included in this review; 111 described reorganization of surgical services, 55 described the consequences of reorganizing surgical services and six reported actions taken to rebuild surgical capacity in public health emergencies. Reorganizations of surgical services were grouped under six domains: case selection/triage, PPE regulations and practice, workforce composition and deployment, outpatient and inpatient patient care, resident and fellow education, and the hospital or clinical environment. Service reorganizations led to large reductions in non-urgent surgical volumes, increases in surgical wait times, and impacted medical training (i.e., reduced case involvement) and patient outcomes (e.g., increases in pain). Strategies for rebuilding surgical capacity were scarce, but focused on the availability of staff, PPE, and patient readiness for surgery as key factors to consider before resuming services.ConclusionsReorganization of surgical services in response to public health emergencies appears to be context-dependent and has far-reaching consequences that must be better understood in order to optimize future health system responses to public health emergencies.ARTICLE SUMMARYStrengths and limitations of the studyThis rapid scoping review provides an exhaustive and rigorous summary of the academic and grey literature regarding modifications to surgical services in response to public health emergencies, especially COVID-19.This study did not limit studies based on location or language of publication to ensure a worldwide pandemic had contributions from worldwide voices.Both quantitative and qualitative outcomes were included, with a mix of inductive and deductive data abstraction approaches to provide a comprehensive understanding of surgical services during public health emergencies.Studies with potential relevance to this question are emerging at an unprecedented rate in response to the COVID-19 pandemic and as such, some may not be included in the current review.Original protocol for the studyAs requested, the original unpublished protocol for this study is included as a supplementary file.Funding statementThis study did not receive grant from any funding agency in the public, commercial or not-for-profit sectors.Competing interest statementAll authors declare that they have no competing interests in accordance with the International Committee of Medical Journal Editors uniform declaration of competing interests.

scholarly journals Identifying Environmental Determinants Relevant to Health and Wellbeing in Remote Australian Indigenous Communities: A Scoping Review of Grey Literature

2021 ◽  
Vol 18 (8) ◽  
pp. 4167
Author(s):  
Amal Chakraborty ◽  
Mark Daniel ◽  
Natasha J. Howard ◽  
Alwin Chong ◽  
Nicola Slavin ◽  
...  
Keyword(s):  
Public Health ◽  
Chronic Diseases ◽  
Scoping Review ◽  
Classification System ◽  
Grey Literature ◽  
Indigenous Communities ◽  
Environmental Indicators ◽  
Health Concern ◽  
Environmental Determinants ◽  
Health And Wellbeing

The high prevalence of preventable infectious and chronic diseases in Australian Indigenous populations is a major public health concern. Existing research has rarely examined the role of built and socio-political environmental factors relating to remote Indigenous health and wellbeing. This research identified built and socio-political environmental indicators from publicly available grey literature documents locally-relevant to remote Indigenous communities in the Northern Territory (NT), Australia. Existing planning documents with evidence of community input were used to reduce the response burden on Indigenous communities. A scoping review of community-focused planning documents resulted in the identification of 1120 built and 2215 socio-political environmental indicators. Indicators were systematically classified using an Indigenous indicator classification system (IICS). Applying the IICS yielded indicators prominently featuring the “community infrastructure” domain within the built environment, and the “community capacity” domain within the socio-political environment. This research demonstrates the utility of utilizing existing planning documents and a culturally appropriate systematic classification system to consolidate environmental determinants that influence health and disease occurrence. The findings also support understanding of which features of community-level built and socio-political environments amenable to public health and social policy actions might be targeted to help reduce the prevalence of infectious and chronic diseases in Indigenous communities.

scholarly journals Artificial intelligence for good health: a scoping review of the ethics literature

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Kathleen Murphy ◽  
Erica Di Ruggiero ◽  
Ross Upshur ◽  
Donald J. Willison ◽  
Neha Malhotra ◽  
...  
Keyword(s):  
Public Health ◽  
Artificial Intelligence ◽  
Global Health ◽  
Population Health ◽  
Health Systems ◽  
Scoping Review ◽  
Industrial Revolution ◽  
Ethical Issues ◽  
Grey Literature ◽  
Ethical Implications

Abstract Background Artificial intelligence (AI) has been described as the “fourth industrial revolution” with transformative and global implications, including in healthcare, public health, and global health. AI approaches hold promise for improving health systems worldwide, as well as individual and population health outcomes. While AI may have potential for advancing health equity within and between countries, we must consider the ethical implications of its deployment in order to mitigate its potential harms, particularly for the most vulnerable. This scoping review addresses the following question: What ethical issues have been identified in relation to AI in the field of health, including from a global health perspective? Methods Eight electronic databases were searched for peer reviewed and grey literature published before April 2018 using the concepts of health, ethics, and AI, and their related terms. Records were independently screened by two reviewers and were included if they reported on AI in relation to health and ethics and were written in the English language. Data was charted on a piloted data charting form, and a descriptive and thematic analysis was performed. Results Upon reviewing 12,722 articles, 103 met the predetermined inclusion criteria. The literature was primarily focused on the ethics of AI in health care, particularly on carer robots, diagnostics, and precision medicine, but was largely silent on ethics of AI in public and population health. The literature highlighted a number of common ethical concerns related to privacy, trust, accountability and responsibility, and bias. Largely missing from the literature was the ethics of AI in global health, particularly in the context of low- and middle-income countries (LMICs). Conclusions The ethical issues surrounding AI in the field of health are both vast and complex. While AI holds the potential to improve health and health systems, our analysis suggests that its introduction should be approached with cautious optimism. The dearth of literature on the ethics of AI within LMICs, as well as in public health, also points to a critical need for further research into the ethical implications of AI within both global and public health, to ensure that its development and implementation is ethical for everyone, everywhere.

PP159 Telemedicine In Paraguay: Contributions Of The Institute Of Health Sciences Research, National University Of Asunción

2020 ◽  
Vol 36 (S1) ◽  
pp. 18-18
Author(s):  
Ronald Rivas ◽  
Pedro Galván
Keyword(s):  
Public Health ◽  
Biomedical Engineering ◽  
List Type ◽  
Telemedicine System ◽  
Cellular Telephony ◽  
Imaging Department ◽  
Number Of Patients ◽  
Computed Tomography Scans ◽  
National University ◽  
Development And Validation

IntroductionThe modalities of telemedicine that have been developed and applied so far by the Department of Biomedical Engineering and Imaging at the National University of Asunción (IICS-UNA) are as follows: (i) telediagnosis: the remote sending of data, signals, and images for diagnostic purposes; (ii) general telediagnostic imaging; (iii) telemonitoring (including telemetry): remote monitoring of vital parameters to provide automatic or semi-automatic surveillance or alarm services in emergencies, epidemiology, or tele-public health; and (iv) tele-education: the use of telematic networks to provide virtual platforms for educating and training health professionals.MethodsWe conducted a comprehensive review of the scientific works developed by the IICS-UNA in order to evaluate the systematic implementation of Telemedicine in Paraguay. Documents, pilot projects (satellite telegraphy), telediagnostic research, telematics, tele-education, published articles, and statistical data (number of patients attending or studies performed, etcetera) relating to the implementation of the National Telemedicine System by the Ministry of Public Health and Social Welfare since 1999 were reviewed.ResultsImplementation of the telemedicine system has meant that 472,038 patients have attended referral centers nationwide, with 297,999 electrocardiographs, 165,323 computed tomography scans, and 8,697 electroencephalograms being conducted. Projects developed within the framework of the Telemedicine Research Line have included the following: (i)Development and validation of a clinical telemicroscopy system based on cellular telephony;(ii)Implementation of a telemetry system for temperature monitoring of the collection of biological samples from a biomedical research center; and(iii)Production and development of a virtual campus at the National University of Asunción.ConclusionsGiven the current healthcare environment, developing a line of research based on telemedicine is a proactive step, since telemedicine provides an alternative solution to the problem of access to the health system. That is why the IICS-UNA Biomedical Engineering and Imaging Department has developed telemedicine as one of its main lines of research.

scholarly journals Aspartame and cancer – new evidence for causation

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Philip J. Landrigan ◽  
Kurt Straif
Keyword(s):  
Public Health ◽  
Cancer Risk ◽  
Malignant Tumors ◽  
Daily Intake ◽  
Immunohistochemical Analysis ◽  
International Agency ◽  
Advisory Group ◽  
Malignant Neoplasms ◽  
Acceptable Daily Intake ◽  
New Findings

Abstract Background Aspartame is one of the world’s most widely used artificial sweeteners and is an ingredient in more than 5000 food products globally. A particularly important use is in low-calorie beverages consumed by children and pregnant women. The Ramazzini Institute (RI) reported in 2006 and 2007 that aspartame causes dose-related increases in malignant tumors in multiple organs in rats and mice. Increased cancer risk was seen even at low exposure levels approaching the Acceptable Daily Intake (ADI). Prenatal exposures caused increased malignancies in rodent offspring at lower doses than in adults. These findings generated intense controversy focused on the accuracy of RI’s diagnoses of hematopoietic and lymphoid tissue tumors (HLTs). Critics made the claim that pulmonary lesions observed in aspartame-exposed animals were inflammatory lesions caused by Mycoplasma infection rather than malignant neoplasms. Methods To address this question, RI subjected all HLTs from aspartame-exposed animals to immunohistochemical analysis using a battery of markers and to morphological reassessment using the most recent Internationally Harmonized Nomenclature and Diagnostic (INHAND) criteria. Findings This immunohistochemical and morphological re-evaluation confirmed the original diagnoses of malignancy in 92.3% of cases. Six lesions originally diagnosed as lymphoma (8% of all HLTs) were reclassified: 3 to lymphoid hyperplasia, and 3 to chronic inflammation with fibrosis. There was no evidence of Mycoplasma infection. Interpretation These new findings confirm that aspartame is a chemical carcinogen in rodents. They confirm the very worrisome finding that prenatal exposure to aspartame increases cancer risk in rodent offspring. They validate the conclusions of the original RI studies. These findings are of great importance for public health. In light of them, we encourage all national and international public health agencies to urgently reexamine their assessments of aspartame’s health risks - especially the risks of prenatal and early postnatal exposures. We call upon food agencies to reassess Acceptable Daily Intake (ADI) levels for aspartame. We note that an Advisory Group to the International Agency for Research on Cancer has recommended high-priority reevaluation of aspartame’s carcinogenicity to humans.

scholarly journals Strategies for reducing out of pocket payments in the health system: a scoping review

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Faride Sadat Jalali ◽  
Parisa Bikineh ◽  
Sajad Delavari
Keyword(s):  
Health System ◽  
Health Systems ◽  
Scoping Review ◽  
Health Financing ◽  
Developed Countries ◽  
Vulnerable Groups ◽  
System A ◽  
Out Of Pocket Payments ◽  
Review Study ◽  
Developing And Developed Countries

Abstract Background Direct out-of-pocket payments (OOP) are among the most important financing mechanisms in many health systems, especially in developing countries, adversely affecting equality and leading vulnerable groups to poverty. Therefore, this scoping review study was conducted to identify the strategies involving OOP reduction in health systems. Methods Articles published in English on strategies related to out-of-pocket payments were Searched and retrieved in the Web of Science, Scopus, PubMed, and Embase databases between January 2000 and November 2020, following PRISMA guidelines. As a result, 3710 papers were retrieved initially, and 40 were selected for full-text assessment. Results Out of 40 papers included, 22 (55%) and 18 (45%) of the study were conducted in developing and developed countries, respectively. The strategies were divided into four categories based on health system functions: health system stewardship, creating resources, health financing mechanisms, and delivering health services.As well, developing and developed countries applied different types of strategies to reduce OOP. Conclusion The present review identified some strategies that affect the OOP payments According to the health system functions framework. Considering the importance of stewardship, creating resources, the health financing mechanisms, and delivering health services in reducing OOP, this study could help policymakers make better decisions for reducing OOP expenditures.

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