Identifying pneumonia outbreaks of public health importance: can emergency department data assist in earlier identification?

OBJECTIVE: To retrospectively review the performance of a near real-time Emergency Department (ED) Syndromic Surveillance System operating in New South Wales for identifying pneumonia outbreaks of public health importance. METHODS: Retrospective data was obtained from the NSW Emergency Department data collection for a rural hospital that has experienced a cluster of pneumonia diagnoses among teenage males in August 2006. ED standard reports were examined for signals in the overall count for each respiratory syndrome, and for elevated counts in individual subgroups including; age, sex and admission to hospital status. RESULTS: Using the current thresholds, the ED syndromic surveillance system would have trigged a signal for pneumonia syndrome in children aged 5-16 years four days earlier than the notification by a paediatrician and this signal was maintained for 14 days. CONCLUSION: If the ED syndromic surveillance system had been operating it could have identified the outbreak earlier than the paediatrician's notification. This may have permitted an earlier public health response. IMPLICATIONS: By understanding the behaviour of syndromes during outbreaks of public health importance, response protocols could be developed to facilitate earlier implementation of control measures.     

Operationalizing the ‘population health’ approach to permit consideration and minimization of unintended harms of public health interventions: a malaria control example

To achieve elimination of malaria, both ‘populations at risk’ strategies and ‘population health’ approaches to intervention are required. While the ‘populations at risk’ vs. ‘population health’ debate is not new to public health, here we advance the discussion by identifying how the ‘population health approach’, coupled with concepts from theories of unintended harms, could be used to identify and guide efforts to minimize unintended harm associated with ‘populations at risk’ strategies, using malaria as an example. We begin by reviewing unintended harm and present the presumptive diagnosis and treatment of malaria clinical practice guideline (PDTM-CPG) as an example of a ‘populations at risk’ strategy for malaria control. We then consider the value of the ‘population health’ approach for identifying and minimizing cultural and economic unintended harms associated with the PDTM-CPG. We outline several concepts that are helpful in terms of the identification and mitigation of unintended harm. Specifically, the ‘population health approach’ emphasizes structural determinants of health that are key to enhancing intervention impact and reducing inequities, while theories of unintended harms emphasize factors that play into the selection and impact of interventions; namely, the breadth and depth of the knowledge base, contextual considerations, basic values, and the perceived need for immediate action. Finally, based on these key concepts, we identify practical discussion questions for district, national, and international public health planners and policy-makers to reflect upon when engaging in intervention design or adaptation. These questions are intended to maximize efforts to achieve malaria elimination while minimizing unintended harms.     

Grand challenges of public health: How can health information systems support facing them?

Objectives

Achieving Universal Health Coverage (UHC) and establishing robust Civil Registration and Vital Statistics (CRVS) systems are two urgent priorities and grand challenges of global health, especially in Low and Middle Income Countries (LMICs). It is argued that addressing both these priorities requires strong supportive Health Information Systems (HIS), which to date have been elusive to develop.

Teen pregnancy: a public health issue or political football?

Politicians in the US have made adolescent parents the scapegoat of changing cultural patterns by suggesting punitive solutions to nonmarital births rather than addressing underlying causes of premature child-bearing. It is known that the percentages of young people of all races and all social classes reporting early, nonmarital sexual intercourse have increased dramatically, while adolescent fertility rates peaked in the 1950s. Improved access to contraception and abortion caused a decline in teen pregnancy and birth rates from 1970 to 1986. During 1986-91, service providers could not match growing demand, and the birth rate increased 25%. Increased rates of sexual activity have also led to increases in the incidence of sexually transmitted diseases (STDs) and HIV/AIDS among adolescents. This situation was exacerbated by Reagan and Bush policies, which reduced funding for services to adolescents and supported abstinence-only sex education courses. The concern voiced by policy-makers today centers on nonmarital childbearing by low-income adolescents who will rely on public assistance to survive. A proper response to this situation would involve the following policy actions: 1) mandating comprehensive sexuality education from kindergarten through high school, 2) funding mentoring programs, 3) improving economic and educational opportunities, 4) expanding STD and HIV/AIDS prevention programs, 5) increasing access to confidential health services (including mental health care and substance abuse treatment), 6) expanding child sexual abuse prevention and intervention programs, and 7) increasing access to and acceptability of teen contraceptive usage and abortion.     

Evaluating the unintended health consequences of poverty alleviation strategies: or what is the relevance of Mohammed Yunus to public health?

Public health researchers are increasingly shifting their attention away from merely documenting those factors that determine health--a solid evidence base on health determinants now exists--to improving our understanding of how various interventions influence population health. This paper argues for greater investigations of the potential unintended health benefits associated with participation in a poverty alleviation strategy (PAS) in low-income countries. We focus on microcredit, a PAS that has been spreading across the developing world. Microcredit aims to address the "credit gap" between the poor and the better off by offering an alternative for the poor to acquire loans: small groups are formed and loans are allocated to members based on group solidarity instead of formal collateral. We argue that microcredit corresponds with activities that will help build up health capital (e.g., greater access to resources) and describe the main pathways from microcredit participation to health. We advocate that microcredit and other potential pro-health PAS be included among the range of interventions considered by public health researchers in improving the health of the poor.     

Facing the facelessness of public health: what's the public got to do with it?

Despite compelling statistics that show we could eliminate 80%of all heart disease and strokes, 90% of all diabetes, and 60% of all cancers with basic lifestyle changes, we have failed to motivate the public to make these changes and failed to motivate policy makers to make healthy choices the easiest choice. Dr. Katz suggests we have failed because we have focused too much on statistics and too little on passion. He implores all of us to tap into people's passion by connecting each of these statistics with a human story.     

Influencing public health policy: to what extent can public action defining the policy concerns of government?

Aim  

The aim of this paper is to provide a discussion on how the public health policy process can be influenced by both civil society groups and by public health practitioners.     

Ethical oversight of public health research: can rules and IRBs make a difference in developing countries?

Controversies in the conduct of international research continue to pose challenges for the system of ethical review, particularly for developing countries. Although the concept of vulnerability is key to addressing these challenges, ethical review has typically ignored the agency of vulnerable participants and groups in determining what kind of review process is needed. Concurrent with developments shaping the new public health that seek to operationalize empowerment of communities by placing them as initiators and organizers of their own health, ethical review of public health research must find ways to recognize the agency of vulnerable individuals, groups, and communities in the review process if it is to address effectively the ethical dilemmas currently evident in collaborative international research.     

Promoting evidence-based public health policy: can we have better evidence and more action?

Evidence-based approaches (those explicitly linked to the best available scientific evidence and reflecting community preferences and feasibility) are increasingly used to inform health policy decision making on the burden of a disease attributable to particular causes, interventions and policies that might work to confront those causes, and issues of community fit and feasibility. This paper introduces several tools for evidence-based public health: the health impact assessment, the systematic review, and a portfolio for assuring community fit and feasibility. Discussion of these tools serves as a springboard to consider how to better bring scientific evidence to bear on real-life health issues.     

Should public health interventions aimed at reducing childhood overweight and obesity be gender-focused?

Background  

Overweight in childhood is a major public health concern that calls for immediate preventative action. An increasing number of reports suggest that gender specific approaches to prevention may be more effective. However, there is a paucity of information to guide gender-sensitive health promotion and population health interventions for the prevention of overweight in childhood. In the present study, we sought to determine gender-differentials in overweight and underlying behaviors, nutrition and physical activity, among pre-adolescents in Alberta, Canada, to inform the discussion on gender-focused interventions for chronic disease prevention.     

Multidisciplinary public health: what sort of victory?

Multidisciplinary public health (MDPH) has been a phenomenon in the UK of the 1990s and the early 21st century. Its achievement has been seen as a victory for non medical interests. While acknowledging this, the paper questions what sort of victory this represents. Public health in its sanitary phase in the mid-19th century was, after all, what passed for multidisciplinary with its mix of engineers, doctors and statisticians. Is the present simply a return to the sanitary phase? The paper argues that it is not, and that contemporary public health badly needs clearer definition. It identifies three dimensions of recent public health. Public health can be an occupation; a discourse or movement, and also an institutional location of which public health research is part. Looked at in this frame, public health has been multidisciplinary in the post war period. The development of public health research out of social medicine in the 1950s was multidisciplinary. Public health campaigning, separate from public health professionals, has also been multidisciplinary since the 1970s. Public health as an occupation has been preoccupied with its professional positioning. Will the wider multidisciplinary impetus of public health now be lost in a preoccupation with status?     

Service role of schools of public health: in between research and education?

This paper is meant to serve as a basis for discussion regarding the service or external role of schools of public health (SPHs). A number of countries in Eastern Europe are developing and establishing their own SPHs, at the same time trying to come to terms with the development of the public health function, its organisation, and its core activities in their respective countries. Although the position and the role of a school of public health cannot be seen outside the context in which it is functioning, including it's institutional setting, a thorough analysis of this context would be beyond the scope of this paper. The paper therefore concentrates on the roles of a school of public health, specifically the service role, and will seek to define that role. Further, the paper will look at how this role has been translated into the mission and policies of the SPH and how this role is operationalised. Finally, points for consideration and actions to be taken are suggested when defining the service role of a SPH.