Environmental quality as a public health issue

Mercury is a persistent, bio-accumulative toxin that has been linked to numerous health effects in wildlife and humans. Mercury is a potent neurotoxin which may also harm the brain, kidneys and lungs. The unborn child and young infants are at special risk of brain damage from mercury exposure. Hospitals' use of mercury in chemical solutions, thermometers, blood pressure gauges, batteries, and fluorescent lamps make them large contributors to the overall mercury emission into the environment. Most hospitals recognize the dangers of mercury. In a recent survey, 4 out of 5 hospitals asked have policies in place to eliminate the use of mercury containing products and 62% require vendors to disclose the presence of mercury in chemicals that the hospital purchases. Only 12% distribute mercury-containing thermometers to new parent. Ninety two percent teach their employees about the health and environmental effects of mercury and 46 percent teach all employees how to clean up mercury spills. However, the same study showed that many hospitals have not implemented those policies. Forty two percent were not aware if they still purchased items containing mercury. In addition, 49% still purchase mercury thermometers, 44% purchase mercury gastrointestinal diagnostic equipment, and 64% still purchase mercury lab thermometers.     

Hepatitis B--an important public health issue

Hepatitis B is one of the most common infectious diseases in the world. It has been estimated that 350 million people worldwide are chronic hepatitis B virus (HBV) carriers. The global prevalence of chronic HBV infection varies widely, from high ( > 8%, e.g., Africa, Asia and the Western Pacific) to intermediate (2-7% e.g., Southern and Eastern Europe) and low (< 2%, e.g., Western Europe, North America and Australia). The predominant routes of transmission vary according to the endemicity of the HBV infection. In areas of high endemicity, perinatal transmission is the main route of transmission, whereas in areas of low endemicity, sexual contact amongst high-risk adults is predominant. Between one-third and one-quarter of people infected chronically with HBV are expected to develop progressive liver disease (including cirrhosis and primary liver cancer). Although mass vaccination programs have begun to control the spread of HBV infection, therapeutic intervention is the only option for those with established chronic HBV-associated liver disease. Until recently, the only treatment for chronic hepatitis B was the immune modulator, interferon (IFN) alpha. However, IFN alpha treatment has several disadvantages; it is expensive, it must be administered by injection, there are side-effects, and IFN alpha is poorly tolerated. Lamivudine, a nucleoside analogue, is the first effective, and well tolerated, oral treatment for chronic hepatitis B. In conclusion, although we are still some way from eradicating or curing chronic hepatitis B, the advent of lamivudine allows new populations to benefit from therapy and helps to address the global public health problem of hepatitis B.     

Healthcare crisis in Russia: a public health issue.

The situation in Russia shows the long-term problems of under-funding and under-valuing healthcare staff. On a recent visit, the authors found no cohesive public health strategy, without which the people are unable to develop health conscious attitudes.     

Participatory action as a research method with public health nurses

Aim

This article explores and describes participatory action research (PAR) as a preferred method in addressing nursing practice issues. This is the first study that used PAR with public health nurses (PHNs) in Canada to develop a professional practice model.

Background

Participatory action research is a sub‐category of action research that incorporates feminist and critical theory with foundations in the field of social psychology. For nurses, critical analysis of long‐established beliefs and practices through PAR contributes to emancipatory knowledge regarding the impact of traditional hierarchies on their practice.

Design

This study used participatory action, a non‐traditional but systematic research method, which assisted participants to develop a solution to a long‐standing organizational issue.

Method

The stages of generating concerns, participatory action, acting on concerns, reflection and evaluation were implemented from 2012 ‐ 2013 in an urban Canadian city, to develop a professional practice model for PHNs.

Findings

Four sub‐themes specific to PAR are discussed. These are “participatory action research engaged PHNs in development of a professional practice model;” “the participatory action research cycles of “Look, Think, Act” expanded participants’ views;” “participatory action research increased awareness of organizational barriers;” and “participatory action research promoted individual empowerment and system transformation.”

Conclusions

This study resulted in individual and system change that may not have been possible without the use of PAR. The focus was engagement of participants and recognition of their lived experience, which facilitated PHNs’ empowerment, leadership and consciousness‐raising.     

The global movement towards a public health approach to substance use disorders

Drug misuse is a global problem. Markets that supply illegal drugs often span international borders. However, each country has different primary drugs of use, populations that are using and consequences of use. The policy approach of each country to addressing substance use disorders can be characterized along a continuum between purely public health approaches and purely law enforcement approaches. Historically, a law enforcement approach has been the primary strategy in much of the world. However, there is a growing movement towards use of a public health approach. This article provides four case examples, Ukraine, Philippines, Nigeria and Peru, where there is movement to develop addiction public health infrastructure. The work varies by country, but includes regulatory changes, workforce development and resource allocation all of which are supported by the United Nations Office on Drugs and Crime (UNODC) and multi-national organizations that provide training and technical assistance, funded primarily by the European Union and United States governments. All four countries highlighted have barriers to moving towards a more public health approach which may include popularity of the law enforcement approach, turbulent government environments, and economics of being a drug producing nation. However, whether starting from the top down with changed policies, such as Ukraine or from the bottom up with training community members as in the Philippines, each country provides an example of how donor resources can be applied to make the transition towards a more humane and evidence-based approach to addressing substance use disorders.

Key Messages

1. While the primary approach to addressing drug use has focussed resources on law enforcement for over 100 years, many countries are adopting elements of a public health approach including prevention and treatment of the harms of drug use including substance use disorders.
2. There is a growing global movement to make policy towards drugs and drug users more humane and evidence-based.
3. Donor nation resources can be applied in a variety of combinations to improve care and outcomes for people who use drugs in low- and middle-income countries.