Truth,belief and the cultural politics of obesity scholarship and public health policy

A number of debates centring on the so-called ‘obesity epidemic’ have sprung up in the last 10 years. Although debate is the normal state of affairs in any scientific endeavour, my focus here is on two broad camps we might call ‘alarmists’ and ‘sceptics’. While alarmists have characterised the ‘obesity epidemic’ as a looming global health catastrophe, sceptics have argued that the consequences of rising obesity levels have either been greatly exaggerated or are unclear. In focusing on obesity, my intention is not to prove the case of one camp or the other but rather to construct a kind of anatomy of the obesity controversy. In this essay, I want to move beyond the idea of there being two camps in debates about obesity and provide a more complex account of the different groups that make up both sides. My interest in this research is to explore the idea that belief matters more than truth. In the context of debates about obesity, nothing could be more irrelevant than the ‘truth’ of fatness. The energising principle will be what people, particularly but not only politicians and journalists, can be made to believe.     

公共卫生与传染病中的经济学

本文从经济学的观点来讨论传染病的预防和控制.描述了传染病固有的经济学特点,研究个人和政府在传染病预防和控制中所要达到的目标和所面临的约束,并分析市场失灵和政府失灵的情况,指出成本效益分析方法的局限性.     

湖南省2011—2020年突发公共卫生事件流行特征研究

目的 分析湖南省突发公共卫生事件的流行病学特征,为有效防控突发公共卫生事件提供科学依据。 方法 收集湖南省2011—2020年通过“突发公共卫生事件管理信息系统”上报的突发公共卫生事件资料,应用描述流行病学方法进行分析。 结果 2011—2020年湖南省14个市州均有突发公共卫生事件报告,共计1 962起,报告病例58 355例,死亡174人,病死率为0.30%。事件级别以Ⅳ级和未分级为主,分别占48.88%和48.42%。事件类型以传染病事件为主,占88.94%;其次为突发中毒事件,占7.85%。发生场所以学校为主,占57.08%,累计发病52 183例,占全省突发公共卫生事件发病总数的89.24%。 结论 湖南省突发公共卫生事件主要以传染病为主,应提升突发公共卫生事件的监测和预警能力,重点关注学校突发公共卫生事件。     

2010—2018年南宁市兴宁区学校传染病突发公共卫生事件特征及其影响因素分析

目的对2010—2018年南宁市兴宁区学校传染病突发公共卫生事件进行分析,探讨影响疫情暴发的相关因素,为制定防控策略提供参考。方法收集2010—2018年南宁市兴宁区学校传染病暴发疫情资料,采用描述性流行病学方法分析疫情特征,应用多元回归分析方法分析影响疫情控制效果的相关因素。结果南宁市兴宁区2010—2018年共报告学校传染病突发公共卫生事件26起,报告病例1262例,罹患率为8.05%。事件以流感、水痘等呼吸道传染病为主(73.08%),以学校主动报告发现为主(46.16%),3—5月和9—12月是学校传染病突发公共卫生事件发病高峰,小学和幼儿园是主要发病场所(80.77%);首例病例发病到接到报告时间中位数为9.00d,疫情持续时间中位数为22.50d;乡镇学校学生罹患率高于市区学生罹患率(χ^2=103.327,P=0.000),幼儿园儿童(9.66%)罹患率高于小学(8.79%)和中学(6.05%),差异有统计学意义(χ^2=40.631,P=0.000);疾病潜伏期(rp=0.899,P=0.015)、疫情报告及时性(t=5.008,P=0.000)、总病例数(t=5.736,P=0.000)、接到报告时发现的病例数(t=-4.253,P=0.000)对疫情控制效果有影响。结论流行性感冒、水痘和手足口病是兴宁区学校突发公共卫生事件的好发病种,提高疫情报告及时性,及早采取措施是控制学校传染病突发公共卫生事件的关键。     

公共卫生危机管理探讨

本文以社会学、心理学的相关原理为理论基点 ,论述了危机、卫生危机及公共卫生危机的概念、因素和影响 ,探讨了政府在公共卫生危机管理中应对策略 ,以资政府相关组织借鉴。     

福建省2004-2013年传染病突发事件流行特征分析

目的 掌握福建省传染病类突发公共卫生事件的流行病学特征。方法 应用重复测量模型,对福建省2004-2013年报告的282起传染病类突发公共卫生事件进行分析。结果 福建省2004-2013年报告传染病类突发公共卫生事件累计282起,其中IV级事件264起,主要病因为水痘(69起)、霍乱(59起)、流行性腮腺炎(52起)、流行性感冒(39起)和风疹(21起);各地区报告事件起数和罹患率差异无统计学意义(F=1.07,P=0.3942,F=0.98,P=0.4585);在时间分布上呈现2个高峰特点,主峰出现在4-5月份(77起),亚峰出现在11-12月份(55起);事件的好发场所为学校(183起),其中以小学(116起)、中学(38起)最高发。结论 福建省各地区传染病类突发公共卫生事件的威胁严重性基本一致,以肠道和呼吸道传染病为主。     

Ten years of Pan-InfORM: modelling research for public health in Canada

Modelling and simulation methods can play an important role in guiding public health responses to infectious diseases and emerging health threats by projecting the plausible outcomes of decisions and interventions. The 2003 SARS epidemic marked a new chapter in disease modelling in Canada as it triggered a national discussion on the utility and uptake of modelling research in local and pandemic outbreaks. However, integration and application of model-based outcomes in public health requires knowledge translation and contextualization. We reviewed the history and performance of Pan-InfORM (Pandemic Influenza Outbreak Research Modelling), which created a national infrastructure in Canada with a mandate to develop innovative knowledge translation methodologies to inform policy makers through modelling frameworks that bridge the gaps between theory, policy, and practice. This review demonstrates the importance of a collaborative infrastructure as a “Community of Practice” to guide public health responses, especially in the context of emerging diseases with substantial uncertainty, such as the COVID-19 pandemic. Dedicated resources to modelling and knowledge translation activities can help create synergistic strategies at the global scale and optimize public health responses to protect at-risk populations and quell socioeconomic and health burden.     

A review of UK housing policy: ideology and public health

OBJECTIVES: The aim of this paper is to review UK public health policy, with a specific reference to housing as a key health determinant, since its inception in the Victorian era to contemporary times. REVIEW: This paper reviews the role of social and private housing policy in the development of the UK public health movement, tracing its initial medical routes through to the current socio-economic model of public health. The paper establishes five distinct ideologically and philosophically driven eras, placing public health and housing within liberal (Victorian era), state interventionist (post World War 1; post World War 2), neoliberal (post 1979) and "Third Way" (post 1997) models, showing the political perspective of policy interventions and overviewing their impact on public health. The paper particularly focuses on the contemporary model of public health since the Acheson Report, and how its recommendations have found their way into policy, also the impact on housing practice. CONCLUSIONS: Public health is closely related to political ideology, whether driven by the State, individual or partnership arrangements. The current political system, the Third Way, seeks to promote a sustainable "social contract" between citizens and the State, public, private and voluntary organizations in delivering community-based change in areas where health inequalities can be most progressively and successfully addressed.     

2016—2019年新沂市突发公共卫生事件流行特征分析

目的 分析与掌握2016—2019年新沂市突发公共卫生事件流行特征。方法 收集并整理“突发公共卫生事件管理信息系统”中新沂市突发公共卫生事件的基线资料,对事件的分布特征进行描述分析。结果 2016—2019年新沂市突发公共卫生事件共报告29起,全部为传染病事件,其中乙类占3.45%(1/29),丙类占72.41%(21/29),其他类占24.14%(7/29)。病例累计2088人,波及人口为91272人,罹患率为22.8‰,未出现死亡病例。报告月份为3—6月,10月—次年1月 。学校作为突发公共卫生事件发生的主要场所应予以高度关注。以流行性腮腺炎疫情最严重,持续时间最长。结论 预防控制学校呼吸道传染病疫情为新沂市突发公共卫生事件防控的重点工作。     

BSE safety standards: An evaluation of public health policies of Japan, Europe, and USA

Since the advent of bovine spongiform encephalopathy (BSE) in the United Kingdom in 1986, new BSE cases have recently become rare. However, in Japan and the United States, positive cases have started to be seen recently. The rise in BSE cases paved the way for the human form of this disease, the variant Creutzfeldt-Jakob disease (vCJD). The observed trends in the UK may be attributed to effective implementation of public health policies coupled with increased vigilance through advancement in science and technology, or they may well be a reflection of the natural disease progression. We aim to discuss the BSE chronology of events, and compare examination methods, costs and cost-efficiency, management, and public policies of Japan, Europe, and the USA.     

2011—2020年无锡市惠山区学校及托幼机构突发公共卫生事件流行特征分析

目的 掌握无锡市惠山区学校及托幼机构突发公共卫生事件的流行病学特点,为控制和减少类似事件的发生提供科学依据。方法 从《中国疾病预防控制信息系统》中收集2011—2020年惠山区报告的学校突发公共卫生事件相关数据,率的比较采用χ²检验,报告敏感性与事件控制效果的相关性研究采用Spearman秩相关分析。结果2011—2020年惠山区学校及托幼机构共报告突发公共卫生事件65起,均为传染病事件。以呼吸道传染病事件为主(64.62%),疾病种类以水痘事件最多(63.08%)。小学与幼儿园为事件发生的主要场所,分别占44.62%、35.38%,幼儿园罹患率3.48%,高于其他学校的1.08%(χ²=619.920,P<0.001)。事件发生存在春季和秋冬季高发现象。农村学校罹患率(1.80%)高于城区(1.28%),差异有统计学意义(χ²=38.387,P<0.001)。65起事件报告敏感性中位数(M)为15.22(1.76～63.77)d,事件持续时间M为31.21(3.75～111.29)d,两者呈正相关(r     

‘Zero Leprosy’ and other endgame strategies: Rhetoric vs. realism in public health campaigns

ABSTRACT

For over half a century, many public health campaigns related to infectious disease have focused on disease ‘eradication,’ rather than ‘control’ or ‘management.’ In this article, I will focus on the example of a recent global leprosy (Hansen’s Disease) control campaign, Triple Zero. Drawing on examples from other public health initiatives, this article explores how the language of ‘zero disease’ or ‘endgame strategies’ is appealing to certain audiences but how it can also be misleading and have unexpected and unintended consequences. Depending on the specific characteristics of the disease, the disease vectors, and the circumstances of transmission, ‘zero’ disease is rarely an achievable goal. In addition, when a disease is said to reach ‘zero,’ it is important to consider the possible implications for people with social, physical, or emotional sequeläe from the disease and who still may require follow-up treatment and care.     

公共卫生循证决策国际经验及新形势下中国发展思考

随着从疾病治疗到预防的新公共卫生形势的到来,公共卫生领域开展科学决策和实践的重要性愈发凸显,通过剖析发达国家循证公共卫生发展历史和经验发现,虽然中国公共卫生领域循证决策取得了一些成果,但仍处于起步阶段,存在一些亟待解决的问题。据此根据国外发展经验,对中国循证公共卫生理论建立、证据积累和数据库建立等方面提出建议,以期促进公共卫生领域循证决策的应用和推广。     

How investment in public health has impacted the prevalence of tuberculosis in China: A study of provincial variations between 2005 and 2015

How do public investments in public health actually impact health outcomes? This question has not been investigated enough, especially regarding infectious diseases. This study investigates the correlations between public health expenditure and the incidence of tuberculosis in China using a provincial panel dataset. The analysis focuses on the correlations between public health expenditure and tuberculosis incidence, using the fixed effects models and Two Stage Least Squares (2SLS) method. Overall, a 10% increase of public health expenditure per capita is associated with a 0.0019% decrease of tuberculosis incidence. A series of robustness tests show that the correlation between public health expenditure and TB incidence is valid. Future research should focus more on the performance of public health, particularly infectious diseases like tuberculosis, and provide references for health policymakers.     

2017—2020年上海市传染病类公共卫生苗子事件监测分析

[目的]了解上海市传染病类公共卫生苗子事件的流行病学特征,探讨传染病类公共卫生苗子事件监测的效果,为完善苗子事件监测系统提出建议,为传染病综合监测防控策略提供依据.[方法]统计2017—2020年上海市16个区的传染病类公共卫生苗子事件相关数据,与同期上海市报告的传染病突发公共卫生事件数据进行比较分析.[结果]2017...     

The future of public health nutrition: a critical policy analysis of Eat Well Australia

Objective: To better understand how public health nutrition has been represented during the past decade in Australia this paper critically analyses Eat Well Australia: An Agenda for Action for Public Health Nutrition 2000 – 2010 and its accompanying National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan. Method: The paper uses an interpretive approach, drawing on Bacchi's method of problem representation, to examine the strategies being offered within the policy. It uses this framework to uncover how public health nutrition has been represented and examines if the representation provided considers all aspects of the issue. The paper also considers how contextual factors affected policy development through examination of publicly available documents. Results: The problem is represented as being both an individual one and one due to social, structural and economic circumstances. There is a large focus on collaboration, research and capacity building. The context of the policy's development has affected the solutions contained within. Conclusion: The policy's proposed actions reflect the policy‐making environment in which it was conceived. A manifestation of this was unclear division of roles and responsibilities, lack of dedicated resources and inadequate focus on the social determinants of health. Implications: As the policy's timeframe is drawing to its end, critical reflection on how the problem of nutrition has been represented over the previous decade provides greater insight and awareness to direct future public health nutrition work.     

Working for the public health: politics,localism and epistemologies of practice

The recent move of public health back to English local government has reignited debates about the role of a medicalised public health profession. The explicit policy rationale for the move was that local government is the arena in which the social determinants of health can be addressed, and that public health specialists could provide neutral evidence to support action on these. However, if a discourse of ‘evidence‐based’ policy is in principle (if not practice) relatively unproblematic within the health arena, within the more overtly politicised local government space, rather different policy imperatives come to the fore. Responding to calls for research on evidence in practice, this article draws on ethnographic data of local authorities in the first year of the reorganised public health function. Focusing on alcohol policy, we explore how decisions that affect public health are rationalised and enacted through discourses of localism, empiricism and holism. These frame policy outcomes as inevitably plural and contingent: a framing which sits uneasily with normative discourses of evidence‐based policy. We argue that locating public health in local government necessitates a refocusing of how evidence for public health is conceptualised, to incorporate multiple, and political, understandings of health and wellbeing.