Palliative care integration: a critical review of nurse migration effect in Jamaica

Background Provision of palliative care to individuals with late-stage serious illnesses is critical to reduce suffering. Palliative care is slowly gaining momentum in Jamaica but requires a highly skilled workforce, including nurses. Out-migration of nurses to wealthier countries negatively impacts the delivery of health care services and may impede palliative care capacity-building. This critical review aimed to explore the evidence pertaining to the nurse migration effect on the integration of palliative care services in Jamaica and to formulate hypotheses about potential mitigating strategies. Methods A comprehensive search in the PubMed, CINAHL, and ProQuest PAIS databases aimed to identify articles pertinent to nurse migration in the Caribbean context. Grant and Booth’s methodologic framework for critical reviews was used to evaluate the literature. This methodology uses a narrative, chronologic synthesis and was guided by the World Health Organization (WHO) Public Health Model and the Model of Sustainability in Global Nursing. Results Data from 14 articles were extracted and mapped. Poorer patient outcomes were in part attributed to the out-migration of the most skilled nurses. ‘Push-factors’ such as aggressive recruitment by wealthier countries, lack of continuing educational opportunities, disparate wages, and a lack of professional autonomy and respect were clear contributors. Gender inequalities negatively impacted females and children left behind. Poor working conditions were not necessarily a primary reason for nurse migration. Four main themes were identified across articles: (a) globalization creating opportunities for migration, (b) recruitment of skilled professionals from CARICOM by high income countries, (c) imbalance and inequities resulting from migration, and (d) mitigation strategies. Thirteen articles suggested education, partnerships, policy, and incentives as mitigation strategies. Those strategies directly align with the WHO Public Health Model drivers to palliative care integration. Conclusion Emerged evidence supports that nurse migration is an ongoing phenomenon that strains health systems in Caribbean Community and Common Market (CARICOM) countries, with Jamaica being deeply impacted. This critical review demonstrates the importance of strategically addressing nurse migration as part of palliative care integration efforts in Jamaica. Future studies should include targeted migration mitigation interventions and should be guided by the three working hypotheses derived from this review.

Policy in palliative care

This chapter describes all aspects of policy, including definitions, who is it that sets policy, how policy is made, how policy is implemented, the elements of effective policies, the differences between policies and regulations, the policies that are important for palliative care, global versus national policy differences, and barriers to the creation and implementation of palliative care policies. Understanding policy is important, as it is one of the fundamental building blocks of palliative care under the World Health Organization’s public health model. This model underscores the pre-eminence of policy, as it makes possible all the other elements. Palliative care professionals should understand the complexity inherent in policy and embrace it as an important area to master.

Charting a path towards a public health approach for gambling harm prevention

Aim Gambling harm is a serious public health issue affecting the health, financial security, and social well-being of millions of people and their close relations around the world. Despite its population health implications, gambling harm is not typically viewed and treated as a public health policy issue. This paper critically reviews the evolution of the public health perspective on gambling harm. It also considers how gambling harm can be operationalized within a public health model. Methods A critical historical review of the emerging public health perspective on gambling harm was conducted. Key documents covering three decades of development were reviewed and appraised through a process of deliberation and debate over source impact in the fields of research, policy, and programming internationally. Results The first decade mainly focused on identifying gambling harm and framing the public health issue. The second decade featured the expansion of health assessment and emerging areas of policy and program development. The third decade saw an increased focus on public health frameworks that advanced understanding of harm mechanics and impact. As reflected by the essential functions of a general public health model, gambling harm prevention efforts emphasize health promotion over other key functions like health assessment and surveillance. Conclusion Gambling harm is a public health issue requiring greater attention to health assessment and surveillance data development.

Hepatitis B virus infection and its prevention among the general Ghanaian population: Using the public health model of prevention approach

As a follow-up to the recently published Letter to the Editor in this journal titled ‘Hepatitis B infection and its prevention among healthcare workers in Ghana: More action required’ (1), I present in this current Letter as a discussion on hepatitis B virus (HBV) infection and its prevention among the general Ghanaian population.

Clemens Pirquet

This chapter traces the professional ascent of Clemens Pirquet, a central figure in the international postwar humanitarian relief effort in Austria and a contributing expert at the League of Nations Health Organization in the 1920s. Pirquet administered American Relief Administration resources in Austria between 1919 and 1922, using his own Pirquet System of Nutrition. Pirquet had worked at Johns Hopkins, and his postwar ascent suggests the postwar significance of prewar international networks. His career as a scientist also underscores the importance of depersonalized data and statistics for an emerging (American) postwar model of public health, as experts in science and public policy sought to universalize the ideal of humanitarian relief around the figure of the child. The Rockefeller Foundation financed much of this new public health model, and Foundation advisers knew Pirquet well. Meanwhile, local politics mattered, as Pirquet was engaged in a bitter rivalry with Socialist leadership of 1920s Vienna.