Applying precaution to environmental health issues at the local level: A proposed guide based on the research and experiences of Toronto Public Health

2012 ◽  
Vol 55 (01) ◽  
pp. 11-18 ◽  
Author(s):  
Loren Vanderlinden ◽  
Donald C. Cole ◽  
Monica Hau ◽  
Monica Campbell ◽  
Ronald Macfarlane ◽  
...  
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Environmental Health ◽  
Local Level ◽  
Health Issues ◽  
Support Tool ◽  
Case Examples ◽  
Trade Offs ◽  
Health Practitioners ◽  
Public Health Practitioners

While the Precautionary Principle (PP) is an important policy innovation relevant to public health, practitioners do not agree on how or when it should be applied. Action on environmental health issues at Toronto Public Health (TPH) has clearly been informed by the PP. We have recently developed a guide to applying precaution that can be used to assist local public health practitioners in decision making to address environmental health hazards in the community. We applied the Guide retrospectively to TPH case examples involving education, program, policy, legislative, and advocacy interventions to manage exposures to environmental hazards. This exercise served to refine the Guide and increase our understanding of how and when TPH has applied precaution in the past. Our Guide promises to be a useful decision making support tool that will help users (1) assess what degree of precaution is appropriate for a given context; (2) systematically document evidence about harms and exposures (including uncertainties) while making the assumptions about evidence more explicit and transparent; (3) highlight potential trade-offs (including consideration of both risks and benefits), explore alternatives, and assess feasibility of interventions; (4) plan adequate communication and stakeholder engagement; and (5) institute monitoring and evaluation so as to ensure interventions still meet users’ needs. We see the Guide as a tool that deepens the process of learning and enquiry on issue management in environmental health practice. We urge others to share their applications of the PP using our Guide to promote mutual learning.

scholarly journals Acceptability and utilization of evidence for decision-making: helminth control, sub-Saharan Africa

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
G Pearson ◽  
B D’Souza ◽  
C Fergus
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Global Health ◽  
Disease Control ◽  
Local Level ◽  
Health Interventions ◽  
Local Public Health ◽  
Health Practitioners ◽  
Decision Making Processes ◽  
Public Health Practitioners

Abstract Background Public health practitioners are part of a larger global health system, responsible for the implementation of disease-specific health interventions, largely financed by external actors through a variety of mechanisms. Emphasis on the need for evidence-informed decision-making often includes rhetoric for the localization of this approach to assist practitioners in resource allocation. In practice its realisation is challenging. This research addresses the following: what are the evidence needs of local public health practitioners? How acceptable are, for example, modeled disease estimates? What decision-making processes occur for implementation? How do evidence and decision-making processes interact? Methods Examining mass drug administration (MDA) for schistosomiasis and soil-transmitted helminths (STH) in the African Great Lakes region (Kenya, Malawi, Tanzania and Uganda), we use qualitative approaches to collect data, including a series of 4 workshops with district- and national-level MoH personnel, key informant interviews and e-survey questionnaires from a sample of relevant local and global organisations including NGOs. Coded data are analysed thematically. Results Preliminary results provide important insights into the sources, types and format of evidence which local public health practitioners find acceptable and useful for decision-making when implementing disease control measures. Conclusions A variety of factors influence local level decision-making with implications for policy aimed at disease control, such as MDA for schistosomiasis and STH, and global health policy and practice more broadly. First, processes of decision-making at different localities are heterogenous and evidence needs of local practitioners are not well understood. Second, evidence development and knowledge synthesis on health interventions are rarely linked in ways that feedback and respond to local implementation, decision-making practices and public health practitioners. Key messages Evidence needs of local public health practitioners need to be accounted for when producing and synthesising evidence. Multiple factors influence local level decision-making with implications for public health disease control policy.

scholarly journals Decision-making for active living infrastructure in new communities: a qualitative study in England

2019 ◽  
Vol 42 (3) ◽  
pp. e249-e258 ◽  
Author(s):  
A Le Gouais ◽  
L Foley ◽  
D Ogilvie ◽  
C Guell
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Local Government ◽  
Qualitative Study ◽  
Local Level ◽  
Active Living ◽  
Structured Interviews ◽  
Health Practitioners ◽  
Post Hoc ◽  
Public Health Practitioners

ABSTRACT Background Urban design can influence population levels of physical activity and subsequent health impacts. This qualitative study investigates local level decision-making for ‘active living’ infrastructure (ALI)—walking and cycling infrastructure and open spaces in new communities. Methods Thirty-five semi-structured interviews with stakeholders, and limited ethnographic observations, were conducted with local government and private sector stakeholders including urban and transport planners, public health practitioners, elected councillors and developers. Interview transcripts were coded and analysed thematically. Results Public health practitioners in local government could act as knowledge brokers and leaders to motivate non-health stakeholders such as urban and transport planners to consider health when designing and building new communities. They needed to engage at the earliest stages and be adequately resourced to build relationships across sectors, supporting non-health outcomes such as tackling congestion, which often had greater political traction. ‘Evidence’ for decision-making identified problems (going beyond health), informed solutions, and also justified decisions post hoc, although case study examples were not always convincing if not considered contextually relevant. Conclusion We have developed a conceptual model with three factors needed to bridge the gap between evidence and ALI being built: influential public health practitioners; supportive policies in non-health sectors; and adequate resources.

scholarly journals Participatory systems mapping for localised evidence and decision-making: helminth control, SSA

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
G Pearson ◽  
M Parker ◽  
E Storer ◽  
T Allen ◽  
C Fergus
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Knowledge Production ◽  
Health Interventions ◽  
Informed Decision Making ◽  
Local Implementation ◽  
Health Practitioners ◽  
Participatory Systems ◽  
Systems Mapping ◽  
Public Health Practitioners

Abstract Background Evidence-informed decision-making to assist public health practitioners in local-level programme implementation requires adaptive approaches to research, policy and practice. To address these needs there is focus on using participatory methods. Adopting such methods, this research asks: what are the evidence needs of local public health practitioners? How do evidence and decision-making processes interact? We reflect on the process of using Participatory Systems Mapping (PSM) and implications for localising evidence-informed decision-making. Methods We conducted workshops with district and national-level MoH personnel in Uganda and Malawi using PSM to elicit insights into local modes of schistosomiasis transmission and control, and group discussions on evidence needs and use in implementing control programmes. PSM maps are analysed, triangulated with thematic analysis of group discussion transcripts. Results Analysing PSM outputs alongside discussions on evidence provides critical methodological and policy insights with implications for localised evidence and decision-making. Further insights into the local dynamics of public health decision-making are gained by triangulating PSM with discussions on the meanings and importance of 'factors' identified. Information which is accessible and useful for local practitioner's decision-making in implementing disease control measures does not always align with academic production and dissemination of evidence, nor across levels where policy is produced or implemented. Conclusions An array of factors influence local decision-making with implications for global health policies and practices such as for schistosomiasis control. Processes of decision-making and evidence needs of local practitioners need to be better understood within broader context. Evidence and knowledge production on health interventions rarely feedback or respond to local implementation needs, decision-making practices and public health practitioners. Key messages Processes of decision-making and evidence needs of local practitioners need to be better understood within broader context. Evidence and knowledge production on health interventions rarely feedback or respond to local implementation needs, decision-making practices and public health practitioners.

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 Building Healthy Community Environments: A Public Health Approach

2018 ◽  
Vol 133 (1_suppl) ◽  
pp. 35S-43S ◽  
Author(s):  
Kirsten Koehler ◽  
Megan Latshaw ◽  
Thomas Matte ◽  
Daniel Kass ◽  
Howard Frumkin ◽  
...  
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Built Environment ◽  
Environmental Health ◽  
Chronic Diseases ◽  
Environmental Quality ◽  
Burden Of Disease ◽  
Systems Approach ◽  
Health Impact ◽  
Health Practitioners

Environmental quality has a profound effect on health and the burden of disease. In the United States, the environment-related burden of disease is increasingly dominated by chronic diseases. At the local level, public health practitioners realize that many policy decisions affecting environmental quality and health transcend the authorities of traditional health department programs. Healthy decisions about the built environment, including housing, transportation, and energy, require broad collaborative efforts. Environmental health professionals have an opportunity to address the shift in public health burden toward chronic diseases and play an important role in the design of healthy communities by bringing data and tools to decision makers. This article provides a guide for community leaders to consider the public health effects of decisions about the built environment. We present a conceptual framework that represents a shift from compartmentalized solutions toward an inclusive systems approach that encourages partnership across disciplines and sectors. We discuss practical tools to assist with environmental decision making, such as Health Impact Assessments, environmental public health tracking, and cumulative risk assessment. We also identify priorities in research, practice, and education to advance the role of public health in decision making to improve health, such as the Health Impact Assessment, as a core competency for environmental health practitioners. We encourage cross-disciplinary communication, research, and education that bring the fields of planning, transportation, and energy in closer collaboration with public health to jointly advance the systems approach to today’s environmental challenges.

A Framework for Training Public Health Practitioners in Crisis Decision-Making

2015 ◽  
Vol 10 (1) ◽  
pp. 165-173 ◽  
Author(s):  
Harvey Kayman ◽  
Tea Logar
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Emergency Preparedness ◽  
Public Health Emergency ◽  
Public Health Emergencies ◽  
Health Practitioners ◽  
Emergency Preparedness And Response ◽  
Public Health Emergency Preparedness ◽  
Public Health Practitioners ◽  
And Training

AbstractThree sets of issues tend to be overlooked in public health emergency preparedness and response, which can be addressed with new training protocols. The first issue is procedural and concerns the often intuitive (as opposed to deliberative) nature of effective crisis decision-making. The second issue is substantive and pertains to the incorporation and prioritization of ethical, political, and logistical concerns in public health emergency guidelines. The third issue is affective and concerns human feelings and human frailty, which can derail the most well designed and best practiced procedural and substantive approaches to emergency response. This article offers an outline for a decision-making framework for public health emergencies that addresses and incorporates these issues within relevant guidelines and training. (Disaster Med Public Health Preparedness. 2016;10:165–173)

scholarly journals A new tool to assess community-level evidence to inform public health decision making

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E Clark ◽  
S Snelling ◽  
J Beyers ◽  
C Howarth ◽  
S Neil-Sztramko ◽  
...  
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Quality Assessment ◽  
Community Level ◽  
Public Health Decision ◽  
Political Preferences ◽  
Health Practitioners ◽  
Health Decision ◽  
Public Health Practitioners

Abstract Background As public health responds to evolving challenges around the globe, it is critical to draw on community-level evidence to inform decisions on emerging needs. There are existing tools for assessing the quality of research evidence, but none that explicitly focus on quality assessment of evidence from community sources, including local health status and ever-changing community and political preferences and actions. Methods The National Collaborating Centre for Methods and Tools (NCCMT) in Canada has developed new tools, called Quality Assessment of Community Evidence (QACE), to help public health decision makers assess the quality of community evidence. The QACE tools were drafted through extensive review of existing frameworks, tools and measures for appraising population health and community evidence, and diverse key informants. We identified three consistent themes that became the core dimensions in these tools. By using the QACE tools, practitioners can answer the question: “Is the quality of this evidence about local context, community needs and political preferences good enough to influence decision making?” Results The QACE tools provide probing questions for each of three dimensions: relevant, trustworthy and equity-informed. Supplementary resources help users delve more deeply into different aspects of quality assessment. The QACE tools are intended for public health practitioners who provide and use evidence to support or make decisions about public health practice and policy, including public health practitioners, senior leaders, policy makers and funders. Conclusions The QACE tool is a new addition to the public health toolbox for evidence-informed decision making, providing questions to ask about evidence from community sources. By using the tool as part of a decision-making process, public health practitioners can be assured that their decisions are based on the best-available evidence for their communities. Key messages The new Quality Assessment of Community Evidence (QACE) tools fill the gap in assessing quality of community-level evidence for public health decision-makers. Community evidence, including local health status and needs and community and political preferences and actions, should be assessed for quality in three critical domains.

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.

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