When worlds collide: observations on the integration of epidemiology and transportation behavioral analysis in the study of walking

Since obesity has emerged as a public health crisis in the United States, the factors that influence physical activity are of interest to both epidemiologists and transportation researchers. This article describes different approaches taken by the two disciplines to this issue. "Utilitarian" walking to accomplish a task, as opposed to structured exercise, could be a highly sustainable way for people to achieve recommended levels of physical activity. Transportation planners have begun to investigate factors of urban form and transportation services that influence the choice to walk. Epidemiologists have become more aware of the importance of factors in the built and social environment that could influence health behaviors like walking. Few transportation studies focus on the generation of the utilitarian walk trip as the key variable; rather, they include it in more general discussions of urban form. Likewise, most epidemiologic studies have not focused on utilitarian walking, but have folded it into an overall measure of physical activity that emphasizes structured exercise. Further transportation research should examine the effects of improved mobility services in addition to alterations of the built environment. Integration of epidemiologic and transportation behavioral research could enhance our understanding of the role of urban and transportation factors on physical activity.     

Regionalization in local public health systems: public health preparedness in the Washington metropolitan area

The Washington metropolitan area was closely examined to understand how these regional preparedness structures have been organized, implemented, and governed, as well as to assess the likely impact of such regional structures on public health preparedness and public health systems more generally. It was found that no single formal regional structure for the public health system exists in the Washington metropolitan area, although the region is designated by the Department of Homeland Security as the National Capital Region (NCR). In fact, the vast majority of preparedness planning and response activities in this area are the result of voluntary self-organization through both governmental and nongovernmental organizations. Some interviewed felt that this was an optimal arrangement, as personal relationships prove crucial in responding to a public health emergency and an informal response is often more timely than a formal response. The biggest challenge for public health preparedness in the NCR is incorporating all federal government agencies in the area in NCR preparedness planning.     

Mainstreaming social justice: human rights and public health

Our interest in a human rights and health discourse emerges from our efforts as social scientists to bring a meaningful social justice perspective to the realm of public health. In Canada, as in many countries, "health" is still firmly within the domain of the biomedical and the clinical. While considerable effort has been made to include more social, economic, and cultural perspectives, efforts to frame these issues as political phenomena have tended to be polarized into either a rich body of theoretical literature or case studies of interventions which have in varying degrees incorporated a social justice approach. What is still missing is a framework of discourse that allows various concepts of social justice to inform policy, intervention strategies, evaluation and evidence-based measures of effectiveness. This commentary examines the human rights discourse as conceptual space from which to build this framework.     

Homeless encampments: connecting public health and human rights

The COVID-19 pandemic is exacerbating longstanding issues related to homelessness, including lack of affordable housing, unemployment, poverty, wealth inequality, and ongoing impacts of colonization. Homelessness is often accompanied by narratives rooted in individual blame, criminalization, and reinforcement of substance use and mental health-related stigma. Visible homelessness, in the form of encampments, is a manifestation of government policy failures that neglect to uphold the human right to housing, and demonstrate eroding investments in affordable housing, income and systemic supports. Encampments make visible that some in our community lack basic determinants of health such as food, water, sanitation, safety, and the right to self-determination. In order for public health to effectively and equitably promote health and enact commitments to social justice, we argue that public health must adopt a human rights approach to housing and to homeless encampments. Embracing a human rights perspective means public health would advocate first and foremost for adequate housing and other resources rooted in self-determination of encampment residents. In the absence of housing, public health would uphold human rights through the provision of public health resources and prohibition on evictions of encampments until adequate housing is available.     

Purchasing and public health: the state of the union

The purchasing role of health authorities has been in existence for two years and public health physicians are expected to play a central part within this role. While the first year was dedicated to maintaining a "steady state", differences are now appearing between authorities is the way in which purchasing is managed. Based on the views of senior managers and public health physicians working in purchasing authorities, considers how the purchasing process is developing and reports how public health medicine is perceived to be contributing to it. Identifies sub-regional resource allocation as a major factor influencing the purchasing process. Conflicting views were found on the purchasing role of public health medicine, in particular with respect to health needs assessment. As purchasing evolves it remains unclear whether pubic health medicine will come to fulfil a largely technical role, or a more wider one in which it acts as advocate for the population's health.     

Nurses and public health: evolution of missions and trainings

Reflection upon the role of nurses in public health is not something new; however, over the past few years, a questioning and similar reports have sprung up pointing to the difficulty perceived by nurses in reconciling their professional practice and public health. Currently, in light of the evolution of public health, where does the practice of nursing fit into public health practice? What are the potential movements and trends in terms of training? The goal of this paper is to present a number of possible avenues for thought on the subject, namely concerning the training and the allocation of competencies. It would be undoubtedly a pity to conceive of public health training today being intended only for nurses. It is rather preferable that post-graduate public health training is aimed at a variety of professional categories, regardless of their initial training or degree course. The development of schools of public health to which nurses could have access in the same way that other health professionals or from the social and educational fields do is critical. Above and beyond what is at stake for specialisation, and even independent of the implication of nurses in public health work, the current trend to re-balance the work and tasks of both nurses and doctors constitutes a significant challenge for public health.     

Reproductive and sexual health benefits in private health insurance plans in Washington State

CONTEXT: Although unintended pregnancy and sexually transmitted diseases (STDs) are considerable problems in the United States, private health insurance plans are inconsistent in their coverage of reproductive and sexual health services needed to address these problems. METHODS: A survey administered to a market-representative sample of 12 health insurance carriers in Washington State assessed benefit coverage for gynecologic services, maternity services, contraceptive services, pregnancy termination, infertility services, reproductive cancer screening, STD services, HIV and AIDS services, and sterilization, as well as for the existence of confidentiality policies. "Core" services in each category were defined based on U.S. Preventive Services Task Force and other recommendations. RESULTS: Of the 91 top-selling plans on which data were collected, 8% were indemnity plans, 14% were point-of-service plans, 21% were preferred-provider organization plans and 57% were health maintenance organization (HMO)-type products; they had a combined enrollment of 1.4 million individuals. Coverage of core services varied widely by type of plan. While a high proportion of plans covered core gynecologic, maternity, reproductive cancer screening, STD and HIV and AIDS services, nearly half of plans did not cover any kind of contraceptive method. Approximately 13% of female enrollees did not have core coverage for gyneco!ogic services, 19% for matemity services, 75% for contraception, 37% for sterilization and 53% for pregnancy termination; 98% of women and men were not covered for infertility treatment. Most carriers did not have specific policies for maintaining privacy of sensitive health information. Overall, benefit coverage was lower for indemnity, preferred-provider organization and HMO plans in Washington State than has previously been seen nationally. CONCLUSIONS: A sizable proportion of women and men in Washington State who rely on private-sector health insurance lack comprehensive coverage for key reproductive and sexual health services.     

Imprisonment and women's health: concerns about gender sensitivity, human rights and public health

The health of prisoners is among the poorest of any population group and the apparent inequalities pose both a challenge and an opportunity for country health systems. The high rates of imprisonment in many countries, the resulting overcrowding, characteristics of prison populations and the disproportionate prevalence of health problems in prison should make prison health a matter of public health importance.Women prisoners constitute a minority within all prison systems and their special health needs are frequently neglected. The urgent need to review current services is clear from research, expert opinion and experience from countries worldwide. Current provision of health care to imprisoned women fails to meet their needs and is, in too many cases, far short of what is required by human rights and international recommendations. The evidence includes a lack of gender sensitivity in policies and practices in prisons, violations of women's human rights and failure to accept that imprisoned women have more and different health-care needs compared with male prisoners, often related to reproductive health issues, mental health problems, drug dependencies and histories of violence and abuse. Additional needs stem from their frequent status as a mother and usually the primary carer for her children.National governments, policy-makers and prison management need to address gender insensitivity and social injustice in prisons. There are immediate steps which could be taken to deal with public health neglect, abuses of human rights and failures in gender sensitivity.     

Going beyond The three worlds of welfare capitalism: regime theory and public health research

International research on the social determinants of health has increasingly started to integrate a welfare state regimes perspective. Although this is to be welcomed, to date there has been an over-reliance on Esping-Andersen's The three worlds of welfare capitalism typology (1990). This is despite the fact that it has been subjected to extensive criticism and that there are in fact a number of competing welfare state typologies within the comparative social policy literature. The purpose of this paper is to provide public health researchers with an up-to-date overview of the welfare state regime literature so that it can be reflected more accurately in future research. It outlines The three worlds of welfare capitalism typology, and it presents the criticisms it received and an overview of alternative welfare state typologies. It concludes by suggesting new avenues of study in public health that could be explored by drawing upon this broader welfare state regimes literature.     

Work-related falls among union carpenters in Washington State before and after the Vertical Fall Arrest Standard

BACKGROUND: Washington State enacted a change in their fall standard for the construction industry in 1991, preceding the Safety Standard for Fall Protection in the Construction Industry promulgated by Federal OSHA in 1994. METHODS: We evaluated changes in the rate of falls from elevations and measures of severity among a large cohort of union carpenters after the fall standard change in Washington State, taking into account the temporal trends in their overall injury rates. RESULTS: There was a significant decrease in the rate of falls from height after the standard went into effect, even after adjusting for the overall decrease in work-related injuries among this cohort. Much of the decrease was immediate, likely representing the publicity surrounding fatal falls and subsequent promulgation of the standard. The greatest decrease was seen between 3 and 3(1/2) years after the standard went into effect. There was a significant reduction in mean paid lost days per event after the standard change and there was a significant reduction in mean cost per fall when adjusting for age and the temporal trend for costs among non-fall injuries. CONCLUSIONS: Through the use of observational methods we have demonstrated significant effects of the Washington State Vertical Fall Arrest Standard among carpenters in the absence of a control or comparison group. Without controlling for the temporal trend in overall injury rates, the rate of decline in falls appeared significantly greater, but the more pronounced, but delayed, decline was not seen. The analyses demonstrate potential error in failing to account for temporal patterns or assuming that a decline after an intervention is related to the intervention.