scholarly journals Public health for a sustainable future: the need for an engaged ecosocial approach

2017 ◽  
Vol 41 (spe) ◽  
pp. 14-21 ◽  
Author(s):  
Astrid Brousselle ◽  
Samantha Gontijo Guerra
Keyword(s):  
Public Health ◽  
Natural Resources ◽  
Human Health ◽  
Population Health ◽  
Environmental Issues ◽  
Ecological Approach ◽  
Public Health Action ◽  
Economic Changes ◽  
Intensive Exploitation ◽  
Health Action

ABSTRACT The way in which we have structured our societies has made possible major advances in population health. However, this model, based on intensive exploitation of natural resources, is now the source of the greatest threats to human health. Today's environmental issues call for bringing to public health an ecological approach whose actions address not only population health, but also ecological, social, and economic changes - i.e., an ecosocial approach to health. Here we examine the implications, for public health action, of adopting such an approach.

scholarly journals Using natural experimental studies to guide public health action: turning the evidence-based medicine paradigm on its head

2019 ◽  
Vol 74 (2) ◽  
pp. 203-208 ◽  
Author(s):  
David Ogilvie ◽  
Jean Adams ◽  
Adrian Bauman ◽  
Edward W. Gregg ◽  
Jenna Panter ◽  
...  
Keyword(s):  
Public Health ◽  
Population Health ◽  
Controlled Trial ◽  
Experimental Studies ◽  
Health Interventions ◽  
Evidence Based ◽  
Natural Experiments ◽  
Public Health Action ◽  
Randomised Study ◽  
Health Action

Despite smaller effect sizes, interventions delivered at population level to prevent non-communicable diseases generally have greater reach, impact and equity than those delivered to high-risk groups. Nevertheless, how to shift population behaviour patterns in this way remains one of the greatest uncertainties for research and policy. Evidence about behaviour change interventions that are easier to evaluate tends to overshadow that for population-wide and system-wide approaches that generate and sustain healthier behaviours. Population health interventions are often implemented as natural experiments, which makes their evaluation more complex and unpredictable than a typical randomised controlled trial (RCT). We discuss the growing importance of evaluating natural experiments and their distinctive contribution to the evidence for public health policy. We contrast the established evidence-based practice pathway, in which RCTs generate ‘definitive’ evidence for particular interventions, with a practice-based evidence pathway in which evaluation can help adjust the compass bearing of existing policy. We propose that intervention studies should focus on reducing critical uncertainties, that non-randomised study designs should be embraced rather than tolerated and that a more nuanced approach to appraising the utility of diverse types of evidence is required. The complex evidence needed to guide public health action is not necessarily the same as that which is needed to provide an unbiased effect size estimate. The practice-based evidence pathway is neither inferior nor merely the best available when all else fails. It is often the only way to generate meaningful evidence to address critical questions about investing in population health interventions.

Public Health Action to Control Hazards: How Good Should the Evidence Be?

2002 ◽  
Vol 12 (1) ◽  
pp. 17-25 ◽  
Author(s):  
John W. Frank ◽  
Geoffrey Lomax
Keyword(s):  
Public Health ◽  
Population Health ◽  
Health Hazard ◽  
Public Health Action ◽  
Potential Health ◽  
Clinical Interventions ◽  
Hazard Control ◽  
Health Action ◽  
Abatement Policies ◽  
Public Health Protection

At the OSHA hearings regarding the Proposed Ergonomics Standard, confusion occurred between appropriate scientific evidentiary criteria for initiating clinical interventions for individual patients as opposed to the evidence needed to justify public health protection interventions directed at controlling hazardous exposures for entire populations. We assert that clinical interventions have little relevance to the standard proposed at that time. We summarize for the record why this prerequisite is neither technically feasible nor ethically appropriate for public (population) health action to control hazards. Further, we advocate reasonable cause criteria for public health hazard control as the appropriate basis for deciding whether to proceed with implementing abatement policies, for a potential health threat to a population.

scholarly journals Using natural experimental studies to guide public health action: turning the evidence-based medicine paradigm on its head

2019 ◽  
Author(s):  
David Ogilvie ◽  
Jean Adams ◽  
Adrian Bauman ◽  
Edward Gregg ◽  
Jenna Panter ◽  
...  
Keyword(s):  
Public Health ◽  
Population Health ◽  
Controlled Trial ◽  
Experimental Studies ◽  
Health Interventions ◽  
Evidence Based ◽  
Natural Experiments ◽  
Public Health Action ◽  
Randomised Study ◽  
Health Action

Despite smaller effect sizes, interventions delivered at population level to prevent non-communicable diseases generally have greater reach, impact and equity than those delivered to high risk groups. Nevertheless, how to shift population behaviour patterns in this way remains one of the greatest uncertainties for research and policy. Evidence about behaviour change interventions that are easier to evaluate tends to overshadow that for population- and system-wide approaches that generate and sustain healthier behaviours. Population health interventions are often implemented as natural experiments, which makes their evaluation more complex and unpredictable than a typical randomised controlled trial (RCT). We discuss the growing importance of evaluating natural experiments, and their distinctive contribution to the evidence for public health policy. We contrast the established evidence-based practice pathway, in which RCTs generate ‘definitive’ evidence for particular interventions, with a practice-based evidence pathway in which evaluation can help adjust the compass bearing of existing policy. We propose that intervention studies should focus on reducing critical uncertainties, that non-randomised study designs should be embraced rather than tolerated, and that a more nuanced approach to appraising the utility of diverse types of evidence is required. The complex evidence needed to guide public health action is not necessarily the same as that which is needed to provide an unbiased effect size estimate. The practice-based evidence pathway is neither inferior, nor merely the best available when all else fails. It is often the only way to generate meaningful evidence to address critical questions about investing in population health interventions.

Estimating the number of cases during COVID-19 pandemics using a web-based tool: first week results of “COVID-19 TRENDS” social media project in the Araba-Alava province in Basque country, Spain. (Preprint)

2020 ◽  
Author(s):  
Ignacio Garitano ◽  
Manuel Linares ◽  
Laura Santos ◽  
Ruth Gil ◽  
Elena Lapuente ◽  
...  
Keyword(s):  
Public Health ◽  
Social Media ◽  
Response Rate ◽  
Basque Country ◽  
Case Definition ◽  
Public Health Action ◽  
Web Based ◽  
Health Action ◽  
Estimate Number ◽  
Media Project

UNSTRUCTURED On 28th February a case of COVID-19 was declared in Araba-Álava province, Spain. In Spain, a confinement and movement restrictions were established by Spanish Government at 14th March 2020. We implemented a web-based tool to estimate number of cases during the pandemic. We present the results in Áraba-Álava province. We reached a response rate of 10,3% out a 331.549 population. We found that 22,4 % fulfilled the case definition. This tool rendered useful to inform public health action.

scholarly journals Reconciling Epidemiology’s Aspirations and Capabilities

2020 ◽  
Author(s):  
David A Savitz
Keyword(s):  
Public Health ◽  
Epidemiologic Studies ◽  
Public Health Importance ◽  
Public Health Action ◽  
Action Current ◽  
Current Trends ◽  
The Face ◽  
Health Action ◽  
New Challenges ◽  
Health Applications

Abstract Interpreting the results of epidemiologic studies calls for objectivity and rigorous scrutiny, acknowledging the limitations that temper the applicability of the findings to public health action. Current trends have posed new challenges to balancing goal of scientific objectivity and validity with public health applications. The ongoing tension between epidemiology’s aspirations and capability has several sources: the need to overpromise in research proposals, compromising methodologic rigor because of public health importance, defending findings in the face of hostile critics, and appealing to core constituencies who have specific expectations from the research.

scholarly journals Risk factors, symptom reporting, healthcare-seeking behaviour and adherence to public health guidance: protocol for Virus Watch, a prospective community cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e048042
Author(s):  
Andrew Hayward ◽  
Ellen Fragaszy ◽  
Jana Kovar ◽  
Vincent Nguyen ◽  
Sarah Beale ◽  
...  
Keyword(s):  
Public Health ◽  
Cohort Study ◽  
Online Survey ◽  
Respiratory Infections ◽  
Advisory Group ◽  
Antibody Testing ◽  
Public Health Action ◽  
Nasal Swabs ◽  
Health Action ◽  
Minority Ethnic

IntroductionThe coronavirus (COVID-19) pandemic has caused significant global mortality and impacted lives around the world. Virus Watch aims to provide evidence on which public health approaches are most likely to be effective in reducing transmission and impact of the virus, and will investigate community incidence, symptom profiles and transmission of COVID-19 in relation to population movement and behaviours.Methods and analysisVirus Watch is a household community cohort study of acute respiratory infections in England and Wales and will run from June 2020 to August 2021. The study aims to recruit 50 000 people, including 12 500 from minority ethnic backgrounds, for an online survey cohort and monthly antibody testing using home fingerprick test kits. Nested within this larger study will be a subcohort of 10 000 individuals, including 3000 people from minority ethnic backgrounds. This cohort of 10 000 people will have full blood serology taken between October 2020 and January 2021 and repeat serology between May 2021 and August 2021. Participants will also post self-administered nasal swabs for PCR assays of SARS-CoV-2 and will follow one of three different PCR testing schedules based on symptoms.Ethics and disseminationThis study has been approved by the Hampstead National Health Service (NHS) Health Research Authority Ethics Committee (ethics approval number 20/HRA/2320). We are monitoring participant queries and using these to refine methodology where necessary, and are providing summaries and policy briefings of our preliminary findings to inform public health action by working through our partnerships with our study advisory group, Public Health England, NHS and government scientific advisory panels.

scholarly journals Time to dismiss the idea of a structural fix within government? An analysis of intersectoral action for health in Danish municipalities

2018 ◽  
Vol 46 (22_suppl) ◽  
pp. 48-57 ◽  
Author(s):  
Ditte H. Holt ◽  
Gemma Carey ◽  
Morten H. Rod
Keyword(s):  
Public Health ◽  
Boundary Spanning ◽  
Governance Structures ◽  
Intersectoral Action ◽  
Structural Reorganization ◽  
Organizational Boundaries ◽  
Public Health Action ◽  
Process Consulting ◽  
Health Action

Aims: This paper examines the role of organizational structure within government(s) in attempts to implement intersectoral action for health in Danish municipalities. We discuss the implications of structural reorganization and the governance structures that are established in order to ensure coordination and integration between policy sectors. Methods: The paper is based on 49 interviews with civil servants from health and non-health sectors of 10 municipalities. Based on participants’ experiences, cases have been described and analyzed in an iterative process consulting the literature on Health in All Policies and joined-up government. Results: Continuous and frequent processes of reorganizing were widespread in the municipalities. However, they appeared to have little effect on policy change. The two most common governance structures established to transcend organizational boundaries were the central unit and the intersectoral committee. According to the experiences of participants, paradoxically both of these organizational solutions tend to reproduce the organizational problems they are intended to overcome. Even if structural reorganization may succeed in dissolving some sector boundaries, it will inevitably create new ones. Conclusions: It is time to dismiss the idea that intersectoral action for health can be achieved by means of a structural fix. Rather than rearranging organizational boundaries it may be more useful to seek to manage the silos which exist in any organization, e.g. by promoting awareness of their implications for public health action and by enhancing the boundary spanning skills of public health officers.

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