On the imperative of thinking through the ethical,health equity,and social justice possibilities and limits of digital technologies in public health

The COVID-19 pandemic has demonstrated both the positive and negative use, usefulness, and impact of digital technologies in public health. Digitalization can help advance and sustain the core functions of public health, including health promotion and prevention, epidemiological surveillance, and response to emergent health issues. Digital technologies are thus—in some areas of public discourse—presented as being both necessary and inevitable requirements to address routine and emergency public health issues. However, the circumstances, ways, and extent to which they apply remain a subject of critical reflection and empirical investigation. In this commentary, we argue that we must think through the use of digital technologies in public health and that their usefulness must be assessed in relation to their short- and long-term ethical, health equity, and social justice implications. Neither a sense of digital technological optimism and determinism nor the demands of addressing pressing public health issues should override critical assessment before development and implementation. The urgency of addressing public health emergencies such as the ongoing COVID-19 pandemic requires prompt and effective action, including action facilitated by digital technologies. Nevertheless, a sense of urgency cannot be an excuse or a substitute for a critical assessment of the tools employed.     

学术期刊在突发公共卫生事件中的社会责任与思考——以新冠肺炎疫情为例

【目的】 通过分析学术期刊在突发公共卫生事件中可承担的社会责任,总结学术期刊工作者抗击新冠疫情的做法,为学术期刊更好地在公共卫生事件中发挥作用、履行社会责任提供参考。【方法】 通过文献查阅、案例搜集、数据统计分析等方法,总结新冠疫情暴发以来学术期刊结合工作特点为抗击疫情所作的贡献。【结果】 学术期刊在抗击疫情过程中做了很多工作,医学类期刊审稿时效和质量并举,确保最新科研成果以最快速度、高质量发表;非医学类期刊积极融入,结合专业特色策划选题,引导经济社会正向发展;新型出版模式能有效缩短出版周期,优化疫情防控的学术支撑平台;综合利用各种新媒体资源,丰富服务内容,提升服务效果。【结论】 学术期刊应在新冠肺炎疫情防控中承担相应的社会责任,在疫情过后也应继续发挥其抗疫成果传播和精神引领作用。     

社会医疗保险制度下公立医院财政补助机制

我国医疗卫生体制已从公共融合向公共契约模式转变，社会医疗保险的迅速推进使基本医疗需方投入为主成为实际的政策选择。在社会医疗保险制度框架下，公立医院仍有部分支出不能由社会医疗保险支付，需要财政补助予以保障。政府财政补助应与公立医院绩效评估机制相联系，以对公立医院经营者形成有效的激励约束机制。     

政府承担公共卫生职能的目标定位和范畴界定

针对政府公共卫生的管理职能和方式等两个问题，对政府承担公共卫生职能的目标定位和政府强化公共卫生管理职能进行了研究，提出了政府应保障民众最基本的医疗需求和公共卫生，进而提出政府应强化对公共卫生的筹资和分配，落实公共卫生体系建设和发展5项重点干预的建议。     

Revisiting the social determinants of health agenda from the global South

ABSTRACT

In an effort to provide an overview of the conceptual debates shaping the mobilisation around social determinants of health and health inequities and challenge the apparent consensus for equity in health, this essay compares two of the most influential approaches in the field: the WHO Commission on Social Determinants of Health approach (CSDH), strongly influenced by European Social Medicine, and the Latin American Social Medicine and Collective Health (LASM-CH) ‘Social determination of the health-disease process’ approach, hitherto largely invisibilized. It is argued that the debates shaping the equity in health agenda do not merely reflect conceptual differences, but essentially different ethical-political proposals that define the way health inequities are understood and proposed to be transformed. While the health equity agenda probably also gained momentum due to the broad political alliance it managed to consolidate, it is necessary to make differences explicit as this allows for an increase in the breadth and specificity of the debate, facilitating the recognition of contextually relevant proposals towards the reduction of health inequities.     

我国公共卫生服务均等化的实证研究：重庆市公共卫生服务券的分析与评价

发放公共卫生服务券是公共卫生服务制度的一种创新,是实现公共卫生服务均等化的手段之一。由原来投入供方的机制,转变为投向需方,确保居民获得基本公共卫生服务机会的公平性和可及性, 促进卫生机构之间的公平竞争。通过现场考察和座谈,本文总结了重庆市公共卫生服务券制度的现状,分析了制度的优点和存在的问题。作者认为对该项制度需要进行长期的实践和对比评价,有很多理论问题值得进一步探讨。     

Human rights,transitional justice,public health and social reconstruction

Mass violence, armed conflict, genocide, and complex humanitarian emergencies continue to create major social and public health disasters at the dawn of the 21st Century. Transitional justice, a set of policies designed to address the effects of war on traumatized communities and bring justice, lies at the nexus of public health, conflict, and social reconstruction. Despite the paucity of empirical evidence, advocates of transitional justice have claimed that it can alleviate the effects of trauma, deter future violence, and bring about social reconstruction in war-affected communities. Empirical evidence – including new data and analyses presented in this article – suggests a link between trauma, mental health and attitudes towards and responses to transitional justice programs, but there has been little theoretical discussion about the intersection between public health and transitional justice, and even less empirical research to generate discussion between these two fields. Yet, public health professionals have an important role to play in assessing the impact of transitional justice on communities affected by mass violence. In this paper, we offer a conceptual model for future research that seeks to examine the relationship between transitional justice programs and their potential value to the fields of medicine and public health and discuss the methodological issues and challenges to a comprehensive evaluation of this relationship. To illustrate the discussion, we examine new data and analyses from two cases of contemporary conflicts, eastern Democratic Republic of Congo (DRC) and northern Uganda.     

Use of social and behavioral sciences by public health departments in major cities

Individual behavior and social contexts are critical determinants of health. We surveyed commissioners or their designees in 22 departments of health serving US cities of at least 500,000 people to examine their use of scientific approaches to influence individual behavior and social contexts. Each department used behavioral or social science in its work, but only four departments were indged to have integrated these approaches throughout their operations, using both centralized and decentralized structures. Degree of integration was unrelated to collaboration with universities or communities but was related to use of explicit theories. Behavioral and social sciences were employed most frequently in the areas of HIV/AIDS and maternal and child health and in the service of changing individual behavior rather than larger contexts, although across departments many health problems and approaches were involved. Commissioners generally found the approaches valuable, but articulated barriers to more widespread adoption.     

A public health model of the social determinants of health

Summary As we move forward in the new century, epidemiologists and public health practitioners are faced with the challenge of reviewing the current direction of epidemiology and its links with public health. While the history of epidemiology has been a successful and productive one, there is a danger that modern epidemiology is becoming too narrow in its scope, concerned primarily with the analysis of risk factors in individuals, while ignoring sociological and ecological perspectives of health. We argue that a theoretical framework to guide the practice of epidemiology is needed which encompasses a role for social determinants of health while simultaneously also acknowledging the importance of behaviour and biology, and the inter-connectedness of all these factors. This paper presents a public health model of social determinants of health, which provides a framework for testing the causal pathways linking social determinant variables with health care system attributes, disease inducing behaviours and health outcomes. This approach provides an improved opportunity to identify and evaluate evidence-based public health interventions, and facilitates stronger links between modern epidemiology and public health practice.     

公立医疗机构公益性评价工具的研究与实践

阐述了公立医疗机构公益性评价工具的重要意义,介绍了公益性评价工具的形成过程与方法,论述了公益性评价工具的评价角度、结构组成、指标选取原则与实施步骤,为建立以公益性为核心的公立医疗机构绩效评价体系提供了坚实的理论基础。     

Canada: a land of missed opportunity for addressing the social determinants of health

The first 25 years of universal public health insurance in Canada saw major reductions in income-related health inequalities related to conditions most amenable to medical treatment. While equity issues related to health care coverage and access remain important, the social determinants of health (SDH) represent the next frontier for reducing health inequalities, a point reinforced by the work of the World Health Organization's Commission on Social Determinants of Health. In this regard, Canada's recent performance suggests a bleak prognosis. Canada's track record since the 1980s in five respects related to social determinants of health: (a) the overall redistributive impact of tax and transfer policies; (b) reduction of family and child poverty; (c) housing policy; (d) early childhood education and care; and (e) urban/metropolitan health policy have reduced Canada's capacity to reduce existing health inequalities. Reasons for this are explored and means of advancing this agenda are outlined.     

Hyalohyphomycosis and phaeohyphomycosis: Two global disease entities of public health importance

Two relatively new opportunistic diseases — hyalohyphomycosis and phaeohyphomycosis — are the byproduct, in most cases, of the progress being made in combating microbial and non-microbial diseases. Immunologically impaired hosts have become vulnerable to infection by fungi that were long considered to be innocuous. The currently known etiologic agents of these two diseases are listed and pertinent literature references are cited. The basic histologic differences between phaeohyphomycosis and chromoblastomycosis was emphasized and illustrated.     

Ethical responsibilities of health research funders to advance global health justice

Research funders from high-income countries have an ethical obligation to support health research in low and middle-income countries that promotes justice in global health. Conceptual work from bioethics proposes funders should do so through their design of grants programs, investments, and grants management. That work has begun to specify the content of funders’ ethical responsibility with regards to health systems research, but it has thus far not been informed by their practice. As a first step to bridge that gap, this paper focuses on health systems research funders’ design of grants programs. It aims to test the content of funders’ proposed ethical responsibility against recent empirical work describing how they design their health systems research grants programs to help address global health disparities. Based on that analysis, recommendations are made for how to better articulate the content of health systems research funders’ obligation. Such recommendations may be pertinent to funders of other types of international research. The paper also provides an initial picture of how well health systems research grants programs’ designs may align with the ideals of global health justice.     

公共卫生政府间责任与预算管理改革探讨

在公共卫生的政府间责任分担上,存在着理论划分与预算管理制度相分离的问题。预算改革迟滞是发生这一分离的根源,这一分离不仅导致政府间责任不能落实,并且误导人们陷入理论争论而缺乏对实践操作所需现实条件的关注。要实现两者的衔接,须进一步归类公共卫生服务,针对公共卫生的不同功能实行不同预算管理,将理论划分转换成预算科目,保障公共卫生政府间投入责任。     

Critical appraisal for public health: a new checklist

OBJECTIVES: There have been a number of attempts to develop critical appraisal tools, but few have had a public health focus. This paper describes a new checklist with public health aspects. STUDY DESIGN: Review of previous appraisal instruments and pilot test of new checklist. METHODS: Criteria of particular reference to public health practice were added to well-established appraisal criteria. The checklist was piloted with 21 public health professionals, research staff or postgraduate students. RESULTS: The checklist is organized using the 'ask', 'collect', 'understand' and 'use' categories of the Population Health Evidence Cycle. Readers are asked to assess validity, completeness and transferability of the data as they relate to: the study question; key aspects of the methodology; possible public health implications of the key results; and the implications for implementation in their own public health practice. Of the 21 public health professionals that piloted the checklist, 20 said that they found the checklist useful and 18 would use it or recommend it in the future. Participants were prepared to commit to the majority of the questions, and there was good agreement with a consensus of 'correct' answers. CONCLUSIONS: The public health critical appraisal checklist adds public health aspects that were missing from previous critical appraisal tools.     

公共卫生和公共卫生突发事件

该文从理论角度阐述什么是现代公共卫生观念 ,公共卫生应在公共卫生突发事件处理中发挥什么作用和怎样发挥作用 ,希望对确定我国现代公共卫生理论体系有所启发     

New questions,new data,old interventions: The health effects of a guaranteed annual income

Objectives

This study investigates whether administration data from universal health insurance can yield new insight from an old intervention. Specifically, did a guaranteed annual income experiment from the 1970s, designed to investigate labor market outcomes, reduce hospitalization rates?

Method

The study re-examined the saturation site of a guaranteed annual income experiment in Dauphin, Manitoba (CANADA) conducted between 1974 and 1979 (MINCOME). We used health administration data generated by the universal government health insurance plan to identify subjects (approximately 12,500 residents of Dauphin and its rural municipality). We used propensity-score matching to select 3 controls for each subject from this database, matched on geography of residence, age, sex, family size and type. Outcome measures were hospital separations and physician claims.

Results

Hospital separations declined 8.5% among subjects relative to controls during the experimental period. Accident and injury codes and mental health codes were most responsible for the decline.

Conclusions

Even though MINCOME was designed to measure the impact of a GAI on the number of hours worked, one can re-visit old experiments with new data to determine the health impact of population interventions designed for other purposes. We determined that hospitalization rates declined significantly after the introduction of a guaranteed income.     

Promoting social responsibility for health: health impact assessment and healthy public policy at the community level

The 1997 Jakarta Declaration on Health Promotion into the 21st Century called for new responses to address the emerging threats to health. The declaration placed a high priority on promoting social responsibility for health, and it identified equity-focused health impact assessment as a high priority for action. This theme was among the foci at the 2000 Fifth Global Conference on Health Promotion held in Mexico. This paper, which is an abbreviation of a technical report prepared for the Mexico conference, advances arguments for focusing on health impact assessment at the local level. Health impact assessment identifies negative health impacts that call for policy responses, and identifies and encourages practices and policies that promote health. Health impact assessment may be highly technical and require sophisticated technology and expertise. But it can also be a simple, highly practical process, accessible to ordinary people, and one that helps a community come to grips with local circumstances that need changing for better health. To illustrate the possibilities, this paper presents a case study, the People Assessing Their Health (PATH) project from Eastern Nova Scotia, Canada. It places ordinary citizens, rather than community elites, at the very heart of local decision-making. Evidence from PATH demonstrates that low technology health impact assessment, done by and for local people, can shift thinking beyond the illness problems of individuals. It can bring into consideration, instead, how programmes and policies support or weaken community health, and illuminate a community's capacity to improve local circumstances for better health. This stands in contrast to evidence that highly technological approaches to community-level health impact assessment can be self-defeating. Further development of simple, people-centred, low technology approaches to health impact assessment at the local level is called for.     

New competencies for public health graduates: a useful tool for course design

Objective: The objective of this paper is to provide a brief overview and context for the new Australian Network of Public Health Institutions (ANAPHI) Foundation Competencies for Master of Public Health Graduates in Australia, and to outline the current status of the quality agenda for public health training and competency standards for Master of Public Health (MPH) education in Australia. Approach: We summarise the complex history and process of developing competency standards for Master of Public Health courses in Australia, including the logic for a competency‐based set of training guidelines. An abridged example of a competency and its underpinning knowledge is provided. Conclusions and implications: This set of competency standards will be useful for MPH course designers, and critical to maintaining the standard of MPH courses in the current (and changing) health policy context, both in Australia and internationally.