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Normative leadership is a core function of the World Health Organization's (WHO) mandate, as outlined in its founding principles. (1) This leadership role is realized by developing evidence-based and ethically [...]

As of 19 March 2021, 121 million cases and over 2.6 million deaths due to coronavirus disease 2019 (COVID-19) had been reported to the World Health Organization. While heads of [...]

The article discusses principles underlying the position proposed by the World Health Organization Registry Platform Working Group on the Reporting of Findings of Clinical Trials which states that the findings of all clinical trials must be made publicly available. According to the authors, a significant proportion of health-care research remains unpublished and some researchers do not make all of their results available. They contend that the report is the start of a consultation process on how transparency can be achieved, with the intention that greater accessibility to the findings of clinical trials will lead to improvements in health care.

The article focuses on the innovative strategies being implemented to address various issues related to the communicable diseases in South-East Asia. It states that Multidrug-resistant malaria, including artemisinin resistance at the border of Cambodia and Thailand, threatens to jeopardize the provision of effective antimalarial treatment worldwide. According to the article, the social insurance scheme in Thailand, national rural health mission in India, and the partnership between the government and non government in Bangladesh are examples of those who are taking steps to address the concerns of the poor and to ensure equity and social justice in health area.

The authors offer observation on health impacts of climate change and geopolitics. Topics discussed include increase in global carbon dioxide emissions in 2018, direct health effects of the main drivers of climate changes like fossil fuel, and how climate change affects agriculture. It also mentions goal set by the 2015 Paris Agreement and ways geopolitics influenced the allocation of foreign assistance.

The authors provide invitation for practitioners and researchers to submit reports on the opportunities that behavioural and social sciences offer in achieving health for all. Topics mentioned include the challenge of factoring behavioural evidence into health policies and programmes, the need for global community of experts to offer easy access to evidence, tools, expertise, and examples of use, and a multidisciplinary technical advisory group for behavioural insights and sciences for health.

Despite widespread acknowledgement that trust is important in a pandemic, few concrete proposals exist on how to incorporate trust into preparing for the next health crisis. One reason is that building trust is rightly perceived as slow and challenging. Although trust in public institutions and one another is essential in preparing for a pandemic, countries should plan for the possibility that efforts to instil or restore trust may fail. Incorporating trust into pandemic preparedness means acknowledging that polarization, partisanship and misinformation may persist and engaging with communities as they currently are, not as we would wish them to be. This paper presents a practical policy agenda for incorporating mistrust as a risk factor in pandemic preparedness and response planning. We propose two sets of evidence-based strategies: (i) strategies for ensuring the trust that already exists in a community is sustained during a crisis, such as mitigating pandemic fatigue by health interventions and honest and transparent sense-making communication; and (ii) strategies for promoting cooperation in communities where people mistrust their governments and neighbours, sometimes for legitimate, historical reasons. Where there is mistrust, pandemic preparedness and responses must rely less on coercion and more on tailoring local policies and building partnerships with community institutions and leaders to help people overcome difficulties they encounter in cooperating with public health guidance. The regular monitoring of interpersonal and government trust at national and local levels is a way of enabling this context-specific pandemic preparedness and response planning. [ABSTRACT FROM AUTHOR]

Climate change poses significant risks to health and health systems, with the greatest impacts in low- and middle-income countries - which are least responsible for greenhouse gas emissions. The Conference of Parties 28 at the 2023 United Nations Climate Change Conference led to agreement on the need for holistic and equitable financing approaches to address the climate and health crisis. This paper provides an overview of existing climate finance mechanisms - that is, multilateral funds, voluntary market-based mechanisms, taxes, microlevies and adaptive social protection. We discuss these approaches' potential use to promote health, generate additional health sector resources and enhance health system sustainability and resilience, and also explore implementation challenges. We suggest that public health practitioners, policy-makers and researchers seize the opportunity to leverage climate funding for better health and sustainable, climate-resilient health systems. Emphasizing the wider benefits of investing in health for the economy can help prioritize health within climate finance initiatives. Meaningful progress will require the global community acknowledging the underlying political economy challenges that have so far limited the potential of climate finance to address health goals. To address these challenges, we need to restructure financing institutions to empower communities at the frontline of the climate and health crisis and ensure their needs are met. Efforts from global and national level stakeholders should focus on mobilizing a wide range of funding sources, prioritizing co-design and accessibility of financing arrangements. These stakeholders should also invest in rigorous monitoring and evaluation of initiatives to ensure relevant health and well-being outcomes are addressed. [ABSTRACT FROM AUTHOR]

The authors report on the plan of the "Bulletin of the World Health Organization" (WHO) to publish a theme issue on new ethical challenges of digital technologies, machine learning, and artificial intelligence in public health. The aim is to show ethical and governance matters that artificial intelligence applications are raising in public health. The deadline for submission is May 15, 2019. WHO Member States are said to be adopting the use of digital technologies in the health sector.

Public health policy often involves implementing cost-efficient, large-scale interventions. When mandating or forbidding a specific behaviour is not permissible, public health professionals may draw on behaviour change interventions to achieve socially beneficial policy objectives. Interventions can have two main effects: (i) a direct effect on people initially targeted by the intervention; and (ii) an indirect effect mediated by social influence and by the observation of other people's behaviour. However, people's attitudes and beliefs can differ markedly throughout the population, with the result that these two effects can interact to produce unexpected, unhelpful and counterintuitive consequences. Public health professionals need to understand this interaction better. This paper illustrates the key principles of this interaction by examining two important areas of public health policy: tobacco smoking and vaccination. The example of antismoking campaigns shows when and how public health professionals can amplify the effects of a behaviour change intervention by taking advantage of the indirect pathway. The example of vaccination campaigns illustrates how underlying incentive structures, particularly anticoordination incentives, can interfere with the indirect effect of an intervention and stall efforts to scale up its implementation. Recommendations are presented on how public health professionals can maximize the total effect of behaviour change interventions in heterogeneous populations based on these concepts and examples. [ABSTRACT FROM AUTHOR]

A robust health infrastructure in every country is the most effective long-term preparedness strategy for global health emergencies. This includes not only health systems and their human resources, but also countries' legal infrastructure for health: the laws and policies that empower, obligate and sometimes limit government and private action. The law is also an important tool in health promotion and protection. Public health professionals play important roles in health law - from the development of policies, through their enforcement, to the scientific evaluation of the health impact of laws. Member States are already mandated to communicate their national health laws and regulations to the World Health Organization (WHO). In this paper we propose that WHO has the authority and credibility to support capacity-building in the area of health law within Member States, and to make national laws easier to access, understand, monitor and evaluate. We believe a strong case can be made to donors for the funding of a public health law centre or unit, that has adequate staffing, is robustly networked with its regional counterparts and is integrated into the main work of WHO. The mission of the unit or centre would be to define and integrate scientific and legal expertise in public health law, both technical and programmatic, across the work of WHO, and to conduct and facilitate global health policy surveillance.

Philip Morris has recently brought claims against Australia (2011) and Uruguay (2010) under international investment agreements (IIAs). The claims allege that Philip Morris is entitled to compensation following the introduction of innovative tobacco packaging regulations to reduce smoking and prevent noncommunicable diseases (NCDs). Since tobacco control measures are often viewed as a model for public health nutrition measures, the claims raise the question of how investment law governs the latter. This paper begins to answer this question and to explain how governments can proactively protect policy space for public health nutrition in an era of expanding IIAs. The authors first consider the main interventions proposed to reduce diet-related NCDs and their intersection with investment in the food supply chain. They then review the nature of investment regimes and relevant case law and examine ways to maximize policy space for public health nutrition intervention within this legal context. As foreign investment increases across the food-chain and more global recommendations discouraging the consumption of unhealthful products are issued, investment law will increase in importance as part of the legal architecture governing the food supply. The implications of investment law for public health nutrition measures depend on various factors: the measures themselves, the terms of the applicable agreements, the conditions surrounding the foreign investment and the policies governing agricultural support. This analysis suggests that governments should adopt proactive measures--e.g. the clarification of terms and reliance on exceptions--to manage investment and protect their regulatory autonomy with respect to public health nutrition.

The World Health Organization developed the Tricycle surveillance programme to obtain a global picture of antimicrobial resistance, especially in countries with limited surveillance capacity. The programme was developed within a One Health perspective. Tricycle provides a framework for applying a standardized technical protocol to determining the prevalence of extended-spectrum [beta]-lactamase (ESBL)-producing Escherichia coli in three sectors: the human, animal and environment sectors. Regular use of the protocol would enable information to be obtained on time trends and on inter- and intraregional variations, thereby generating dynamic data on antibacterial resistance for decision-makers. To date, 19 countries have begun implementing the Tricycle protocol, while other countries will start implementation in the coming years. The Network for Enhancing Tricycle ESBL Surveillance Efficiency (NETESE) was established to support countries implementing the Tricycle protocol. Currently, NETESE includes representatives from 15 institutions in eight low- or middle-income countries at different stages of Tricycle protocol implementation, and from four European countries involved in devising the protocol. This paper describes the Tricycle protocol, reports the initial experiences of NETESE participants with its implementation and discusses future challenges and opportunities. L'Organisation mondiale de la Sante a developpe le programme de surveillance Tricycle afin d'avoir une vue globale de la resistance aux antimicrobiens, en particulier dans les pays oU les capacites de surveillance sont limitees. Ce programme a ete mis au point selon l'approche <>. Tricycle etablit le cadre d'application d'un protocole technique standardise qui vise a mesurer la prevalence de souches d'Escherichia coli productrices de [beta]-lactamase a spectre etendu (BLSE) dans trois secteurs: humain, animal et environnemental. Lusage regulier du protocole permettrait d'obtenir des informations sur l'evolution dans le temps et les variations inter- et intraregionales, ce qui genererait des donnees dynamiques sur la resistance aux antimicrobiens pour les decideurs. A ce jour, 19 pays se sont lances dans la mise en place du protocole Tricycle, tandis que d'autres prevoient de le faire dans les annees a venir. Le reseau NETESE (Network for Enhancing Tricycle ESBL Surveillance Efficiency) a ete cree pour les aider a appliquer ce protocole. Actuellement, le reseau NETESE reunit des representants de 15 institutions dans huit pays a revenu faible ou intermediaire a differents stades de mise en oeuvre du protocole Tricycle, ainsi que quatre pays europeens impliques dans sa conception. Le present document decrit le protocole Tricycle, partage les premieres experiences des participants au reseau NETESE en matiere de deploiement, et aborde les futurs defis et opportunites qui y sont lies. La Organizacion Mundial de la Salud desarrollo el programa de vigilancia Tricycle para obtener un panorama global de la resistencia a los antimicrobianos, especialmente en paises con una capacidad de vigilancia limitada. El programa se creo desde la perspectiva One Health. Tricycle proporciona un marco que permite aplicar un protocolo tecnico estandarizado con el fin de determinar la prevalencia de Escherichia coli productora de [beta]-lactamasa de espectro extendido (ESBL) en tres sectores: el humano, el animal y el medio ambiente. El uso habitual del protocolo permitiria obtener informacion sobre las tendencias temporales y las variaciones inter e intrarregionales, generando asi datos dinamicos sobre la resistencia a los antibacterianos que resultarian utiles para los responsables de la toma de decisiones. Hasta la fecha, 19 paises han comenzado a implementar el protocolo Tricycle, mientras que otros paises comenzaran a aplicarlo en los proximos anos. La red NETESE (Network for Enhancing Tricycle ESBL Surveillance Efficiency), se creo para apoyar a los paises que implementan el protocolo Tricycle. Actualmente, NETESE esta formada por representantes de 15 instituciones de ocho paises con ingresos medios o bajos, que se encuentran en diferentes etapas de implementacion del protocolo Tricycle. Tambien incluye a representantes de cuatro paises europeos que intervienen en el diseno del protocolo. El presente documento describe el protocolo Tricycle, recoge las primeras experiencias de los participantes de NETESE durante la implementacion de dicho protocolo, y aborda tanto los retos como las oportunidades futuras. [phrase omitted], Introduction To provide a picture of antimicrobial resistance in humans, animals and the environment in all countries, especially those with limited surveillance capacity, the World Health Organization (WHO) Advisory Group [...]

In China, alcohol consumption is increasing faster than anywhere else in the world. A steady increase in alcohol production has also been observed in the country, together with a rise in alcohol-related harm. Despite these trends, China's policies on the sale and consumption of alcoholic beverages are weak compared with those of other countries in Asia. Weakest of all are its policies on taxation, drink driving laws, alcohol sale to minors and marketing licenses. The authors of this descriptive paper draw attention to the urgent need for public health professionals and government officials in China to prioritize population surveillance, research and interventions designed to reduce alcohol use disorders. They describe China's current alcohol policies and recent trends in alcohol-related harm and highlight the need for health officials to conduct a thorough policy review from a public health perspective, using as a model the World Health Organization's global strategy to reduce the harmful use of alcohol.

Objective: To synthesize findings from recent studies of strategies to deliver insecticide-treated nets (ITNs) at scale in malaria-endemic areas., Methods: Databases were searched for studies published between January 2000 and December 2010 in which: subjects resided in areas with endemicity for Plasmodium falciparum and Plasmodium vivax malaria; ITN delivery at scale was evaluated; ITN ownership among households, receipt by pregnant women and/or use among children aged < 5 years was evaluated; and the study design was an individual or cluster-randomized controlled design, nonrandomized, quasi-experimental, before-and-after, interrupted time series or cross-sectional without temporal or geographical controls. Papers describing qualitative studies, case studies, process evaluations and cost-effectiveness studies linked to an eligible paper were also included. Study quality was assessed using the Cochrane risk of bias checklist and GRADE criteria. Important influences on scaling up were identified and assessed across delivery strategies., Findings: A total of 32 papers describing 20 African studies were reviewed. Many delivery strategies involved health sectors and retail outlets (partial subsidy), antenatal care clinics (full subsidy) and campaigns (full subsidy). Strategies achieving high ownership among households and use among children < 5 delivered ITNs free through campaigns. Costs were largely comparable across strategies; ITNs were the main cost. Cost-effectiveness estimates were most sensitive to the assumed net lifespan and leakage. Common barriers to delivery included cost, stock-outs and poor logistics. Common facilitators were staff training and supervision, cooperation across departments or ministries and stakeholder involvement., Conclusion: There is a broad taxonomy of strategies for delivering ITNs at scale.

Tropical storms, such as cyclones, hurricanes and typhoons, present major threats to coastal communities. Around two million people worldwide have died and millions have been injured over the past two centuries as a result of tropical storms. Bangladesh is especially vulnerable to tropical cyclones, with around 718 000 deaths from them in the past 50 years. However, cyclone-related mortality in Bangladesh has declined by more than 100-fold over the past 40 years, from 500 000 deaths in 1970 to 4234 in 2007. The main factors responsible for these reduced fatalities and injuries are improved defensive measures, including early warning systems, cyclone shelters, evacuation plans, coastal embankments, reforestation schemes and increased awareness and communication. Although warning systems have been improved, evacuation before a cyclone remains a challenge, with major problems caused by illiteracy, lack of awareness and poor communication. Despite the potential risks of climate change and tropical storms, little empirical knowledge exists on how to develop effective strategies to reduce or mitigate the effects of cyclones. This paper summarizes the most recent data and outlines the strategy adopted in Bangladesh. It offers guidance on how similar strategies can be adopted by other countries vulnerable to tropical storms. Further research is needed to enable countries to limit the risks that cyclones present to public health.

In a globalizing world, public health is no longer confined to national borders. In recent years we have observed an increasing movement of patients across international borders. The full extent of this trend is yet unknown, as data are sparse and anecdotal. If this trend continues, experts are convinced that it will have major implications for public health systems around the globe. Despite the growing importance of medical travel, we still have little empirical evidence on its impact on public health, especially on health systems. This paper summarizes the most recent debates on this topic. It discusses the main forces that drive medical travel and its implications on health systems, in particular the impacts on access to health care, financing and the health workforce. This paper also offers guidance on how to define medical travel and how to improve data collection. It advocates for more scientific research that will enable countries to harness benefits and limit the potential risks to public health arising from medical travel.

China is experiencing a syphilis epidemic of enormous proportions. The regions most heavily affected by syphilis correspond to regions where sexually transmitted HIV infection is also a major public health threat. Many high-risk patients in China fail to receive routine syphilis screening. This missed public health opportunity stems from both a failure of many high-risk individuals to seek clinical care and a disconnect between policy and practice. New point-of-care syphilis testing enables screening in non-traditional settings such as community organizations or sex venues. This paper describes the current Chinese syphilis policies, suggests a spatiotemporal framework (based on targeting high-risk times and places) to improve screening and care practices, and emphasizes a syphilis control policy extending beyond the clinical setting.

This paper examines two innovative educational initiatives for the Ecuadorian public health workforce: a Canadian-funded Masters programme in ecosystem approaches to health that focuses on building capacity to manage environmental health risks sustainably; and the training of Ecuadorians at the Latin American School of Medicine in Cuba (known as Escuela Latinoamericana de Medicina in Spanish). We apply a typology for analysing how training programmes address the needs of marginalized populations and build capacity for addressing health determinants. We highlight some ways we can learn from such training programmes with particular regard to lessons, barriers and opportunities for their sustainability at the local, national and international levels and for pursuing similar initiatives in other countries and contexts. We conclude that educational efforts focused on the challenges of marginalization and the determinants of health require explicit attention not only to the knowledge, attitudes and skills of graduates but also on effectively engaging the health settings and systems that will reinforce the establishment and retention of capacity in low- and middle-income settings where this is most needed.

Scientific progress is a significant basis for change in public-health policy and practice, but the field also invests in value-laden concepts and responds daily to sociopolitical, cultural and evaluative concerns. The concepts that drive much of public-health practice are shaped by the collective and individual mores that define social systems. This paper seeks to describe the ethics processes in play when public-health mechanisms are established in low- and middle-income countries, by focusing on two cases where ethics played a crucial role in producing positive institutional change in public-health policy. First, we introduce an overview of the relationship between ethics and public health; second, we provide a conceptual framework for the ethical analysis of health system events, noting how this approach might enhance the power of existing frameworks; and third, we demonstrate the interplay of these frameworks through the analysis of a programme to enhance road safety in Malaysia and an initiative to establish a national ethics committee in Pakistan. We conclude that, while ethics are gradually being integrated into public-health policy decisions in many developing health systems, ethical analysis is often implicit and undervalued. This paper highlights the need to analyse public-health decision-making from an ethical perspective.

There is growing recognition of the public-health burden of intimate partner violence (IPV) and the potential for the health sector to identify and support abused women. Drawing upon models of health-sector integration, this paper reviews current initiatives to integrate responses to IPV into the health sector in low- and middle-income settings. We present a broad framework for the opportunities for integration and associated service and referral needs, and then summarize current promising initiatives. The findings suggest that a few models of integration are being replicated in many settings. These often focus on service provision at a secondary or tertiary level through accident and emergency or women's health services, or at a primary level through reproductive or family-planning health services. Challenges to integration still exist at all levels, from individual service providers' attitudes and lack of knowledge about violence to managerial and health systems' challenges such as insufficient staff training, no clear policies on IPV, and lack of coordination among various actors and departments involved in planning integrated services. Furthermore, given the variety of locations where women may present and the range and potential severity of presenting health problems, there is an urgent need for coherent, effective referral within the health sector, and the need for strong local partnership to facilitate effective referral to external, non-health services.

Governments, international agencies and corporations are increasingly investing in traditional herbal medicine research. Yet little literature addresses ethical challenges in this research. In this paper, we apply concepts in a comprehensive ethical framework for clinical research to international traditional herbal medicine research. We examine in detail three key, underappreciated dimensions of the ethical framework in which particularly difficult questions arise for international herbal medicine research: social value, scientific validity and favourable risk-benefit ratio. Significant challenges exist in determining shared concepts of social value, scientific validity and favourable risk-benefit ratio across international research collaborations. However, we argue that collaborative partnership, including democratic deliberation, offers the context and process by which many of the ethical challenges in international herbal medicine research can, and should be, resolved. By "cross-training" investigators, and investing in safety-monitoring infrastructure, the issues identified by this comprehensive framework can promote ethically sound international herbal medicine research that contributes to global health.

Most scarcities that underpin health disparities within and among countries are not natural; rather, they result from policy choices and the operation of social institutions. Using examples from the United States of America: the Chicago heat wave and hurricane Katrina, this paper develops "denaturalizing scarcity" as a strategy for enquiry to inform public-health ethics in an interconnected world. It first describes some of the resource scarcities that are of greatest concern from a public-health perspective, and then outlines two (not mutually exclusive) lines of ethical reasoning that demonstrate their importance. One of these involves the multiple relationships that link rich and poor across national borders in today's interconnected world. The paper then briefly describes ways in which globalization and the associated institutions are linked to health-threatening scarcities. The paper concludes that denaturalizing scarcity represents a valuable alternative to mainstream health ethics, directing our attention instead to why some settings are "resource poor" and others are not.

Problem: In 2003, the goal of the Kenyan Ministry of Health was to avail antiretroviral treatment (ART) to 50% of the estimated 250 000 eligible individuals by the end of 2005. By July 2005, 45 000 adults and more than 2000 children were on treatment. A study was conducted to determine the barriers to identification of HIV-infected children., Approach: Existing government policies were reviewed and the ART register of the Kenya National AIDS Control Programme was used to identify facilities providing ART. This paper reports the findings around diagnosis and staging of HIV infection in children., Local Setting: At the time of the study, 58 health facilities were providing ART to children. Only one institution had achieved universal HIV testing in the antenatal clinics. Six facilities systematically followed up HIV-exposed children. HIV antibody testing was not readily available to the children. Although four research centres were capable of carrying out diagnostic HIV polymerase chain reaction (PCR), the services were restricted to research purposes. Other constraints were inadequate physical infrastructure, inadequate systems for quality control in the laboratories and shortage of staff., Lessons Learnt: The policy framework to support identification of HIV-infected children had been established, albeit with narrow focus on sick children. The assessment identified the weaknesses in the structures for systematic diagnosis of HIV through laboratory or clinical-based algorithms. The researchers concluded that health staff training and implementation of a systematic standard approach to identification of HIV-infected children is urgently required.

Dental caries remain a public health problem for many developing countries and for underprivileged populations in developed countries. This paper outlines the historical development of public health approaches to the use of fluoride and comments on their effectiveness. Early research and development was concerned with waterborne fluorides, both naturally occurring and added, and their effects on the prevalence and incidence of dental caries and dental fluorosis. In the latter half of the 20th century, the focus of research was on fluoride toothpastes and mouth rinses. More recently, systematic reviews summarizing these extensive databases have indicated that water fluoridation and fluoride toothpastes both substantially reduce the prevalence and incidence of dental caries. We present four case studies that illustrate the use of fluoride in modern public health practice, focusing on: recent water fluoridation schemes in California, USA; salt fluoridation in Jamaica; milk fluoridation in Chile; and the development of "affordable" fluoride toothpastes in Indonesia. Common themes are the concern to reduce demands for compliance with fluoride regimes that rely upon action by individuals and their families, and the issue of cost. We recommend that a community should use no more than one systemic fluoride (i.e. water or salt or milk fluoridation) combined with the use of fluoride toothpastes, and that the prevalence of dental fluorosis should be monitored in order to detect increases in or higher-than-acceptable levels.

Asthma is a very common chronic disease that occurs in all age groups and is the focus of various clinical and public health interventions. Both morbidity and mortality from asthma are significant. The number of disability-adjusted life years (DALYs) lost due to asthma worldwide is similar to that for diabetes, liver cirrhosis and schizophrenia. Asthma management plans have, however, reduced mortality and severity in countries where they have been applied. Several barriers reduce the availability, affordability, dissemination and efficacy of optimal asthma management plans in both developed and developing countries. The workplace environment contributes significantly to the general burden of asthma. Patients with occupational asthma have higher rates of hospitalization and mortality than healthy workers. The surveillance of asthma as part of a global WHO programme is essential. The economic cost of asthma is considerable both in terms of direct medical costs (such as hospital admissions and the cost of pharmaceuticals) and indirect medical costs (such as time lost from work and premature death). Direct costs are significant in most countries. In order to reduce costs and improve quality of care, employers and health plans are exploring more precisely targeted ways of controlling rapidly rising health costs. Poor control of asthma symptoms is a major issue that can result in adverse clinical and economic outcomes. A model of asthma costs is needed to aid attempts to reduce them while permitting optimal management of the disease. This paper presents a discussion of the burden of asthma and its socioeconomic implications and proposes a model to predict the costs incurred by the disease.

Health impact assessment (HIA) is a multidisciplinary aid to decision-making that assesses the impact of policy on public health and on health inequalities. Its purpose is to assist decision-makers to maximize health gains and to reduce inequalities. The 1999 Gothenburg Consensus Paper (GCP) provides researchers with a rationale for establishing community participation as a core value of HIA. According to the GCP, participation in HIA empowers people within the decision-making process and redresses the democratic deficit between government and society. Participation in HIA generates a sense that health and decision-making is community-owned, and the personal experiences of citizens become integral to the formulation of policy. However, the participatory and empowering dimensions of HIA may prove difficult to operationalize. In this review of the participation strategies adopted in key applications of HIA in the United Kingdom, we found that HIA's aim of influencing decision-making creates tension between its participatory and knowledge-gathering dimensions. Accordingly, researchers have decreased the participatory dimension of HIA by reducing the importance attached to the community's experience of empowerment, ownership and democracy, while enlarging its knowledge-gathering dimension by giving pre-eminence to "expert" and "research-generated" evidence. Recent applications of HIA offer a serviceable rationale for participation as a means of information gathering and it is no longer tenable to uphold HIA as a means of empowering communities and advancing the aims of participatory democracy.

The most important public health priority in agricultural policy-making is currently food safety, despite the relatively higher importance of food security, nutrition, and other agricultural-related health issues in terms of global burden of disease. There is limited experience worldwide of using health impact assessment (HIA) during the development of agriculture and food policies, which perhaps reflects the complex nature of this policy sector. This paper presents methods of HIA used in the Republic of Slovenia, which is conducting a HIA of proposed agricultural and food policies due to its accession to the European Union. It is the first time that any government has attempted to assess the health effects of agricultural policy at a national level. The HIA has basically followed a six-stage process: policy analysis; rapid appraisal workshops with stakeholders from a range of backgrounds; review of research evidence relevant to the agricultural policy; analysis of Slovenian data for key health-related indicators; a report on the findings to a key cross-government group; and evaluation. The experience in Slovenia shows that the HIA process has been a useful mechanism for raising broader public health issues on the agricultural policy agenda, and it has already had positive results for policy formation. HIA is one useful approach to more integrated policy-making across sectors, but clearly it is not the only mechanism to achieve this. A comparison of the approach used in Slovenia with HIA methods in other countries and policy contexts shows that there are still many limitations with HIA application at a government level. Lessons can be learnt from these case studies for future development and application of HIA that is more relevant to policy-makers, and assists them in making more healthy policy choices.

This paper outlines the potential offered by technological progress in the information and communication technologies (ICTs) industries for the health sector in developing countries, presents some examples of positive experiences in India, and considers the difficulties in achieving this potential. The development of ICTs can bring about improvements in health in developing countries in at least three ways: as an instrument for continuing education they enable health workers to be informed of and trained in advances in knowledge; they can improve the delivery of health and disaster management services to poor and remote locations; and they can increase the transparency and efficiency of governance, which should, in turn, improve the availability and delivery of publicly provided health services. These potential benefits of ICTs do not necessarily require all the final beneficiaries to be reached directly, thus the cost of a given quantum of effect is reduced. Some current experiments in India, such as the use of Personal Digital Assistants by rural health workers in Rajasthan, the disaster management project in Maharashtra and the computerized village offices in Andhra Pradesh and Pondicherry, suggest creative ways of using ICTs to improve the health conditions of local people. However, the basic difficulties encountered in using ICTs for such purposes are: an inadequate physical infrastructure; insufficient access by the majority of the population to the hardware; and a lack of the requisite skills for using them. We highlight the substantial cost involved in providing wider access, and the problem of resource allocation in poor countries where basic infrastructure for health and education is still lacking. Educating health professionals in the possible uses of ICTs, and providing them with access and "connectivity", would in turn spread the benefits to a much wider set of final beneficiaries and might help reduce the digital divide.

Health care is a basic service essential in any effort to combat poverty, and is often subsidized with public funds to help achieve that aim. This paper examines public spending on curative health care in several African countries and finds that this spending favours mostly the better-off rather than the poor. It concludes that this targeting problem cannot be solved simply by adjusting the subsidy allocations. The constraints that prevent the poor from taking advantage of these services must also be addressed if the public subsidies are to be effective in reaching the poor.

The contamination of groundwater by arsenic in Bangladesh is the largest poisoning of a population in history, with millions of people exposed. This paper describes the history of the discovery of arsenic in drinking-water in Bangladesh and recommends intervention strategies. Tube-wells were installed to provide "pure water" to prevent morbidity and mortality from gastrointestinal disease. The water from the millions of tube-wells that were installed was not tested for arsenic contamination. Studies in other countries where the population has had long-term exposure to arsenic in groundwater indicate that 1 in 10 people who drink water containing 500 micrograms of arsenic per litre may ultimately die from cancers caused by arsenic, including lung, bladder and skin cancers. The rapid allocation of funding and prompt expansion of current interventions to address this contamination should be facilitated. The fundamental intervention is the identification and provision of arsenic-free drinking water. Arsenic is rapidly excreted in urine, and for early or mild cases, no specific treatment is required. Community education and participation are essential to ensure that interventions are successful; these should be coupled with follow-up monitoring to confirm that exposure has ended. Taken together with the discovery of arsenic in groundwater in other countries, the experience in Bangladesh shows that groundwater sources throughout the world that are used for drinking-water should be tested for arsenic.

The authors comment on the article "Time for a causal systems map of physical activity" by J. Nuzzo and colleagues. Topics discussed include argument of the authors regarding criticisms of their paper, description of the initial physical activity system map they included in their paper, and core challenge inherent in a complex systems approach to physical activity promotion.

This paper explores the possibility of integrating knowledge mapping into a conceptual framework that could serve as a tool for understanding the many complex processes, resources and people involved in a health system, and for identifying potential gaps within knowledge translation processes in order to address them. After defining knowledge mapping, this paper presents various examples of the application of this process in health, before looking at the steps that need to be taken to identify potential gaps, to determine to what extent these gaps affect the knowledge translation process and to establish their cause. This is followed by proposals for interventions aimed at strengthening the overall process. Finally, potential limitations on the application of this framework at the country level are addressed. [ABSTRACT FROM AUTHOR]

This paper examines the policy options for the regultion of dual job holding by medical professionals in highly resource-constrained settings. Such activity is generally driven by a lack of resources in the public sector and low pay, and has been associated with the unauthorized use of public resources and corruption. It is also typically poorly regulated; regulations are either lacking, or when they exists, are vague or poorly implemented because of low regulatory capacity. This paper draws on the limited evidence available on this topic to assess a number of regulatory options in relation to the objectives of quality of care and access to services, as well as some of the policy constraints that can undermine implementation in resource-poor settings. The approach taken in highlighting these broader social objectives seeks to avoid the value judgements regarding dual working and some of its solution to issues such as limited public sector resources (and incomes), low regulatory capacity and the interplay between market forces and human resources. This paper therefore offers some support for policies that allow for the official recognition of such activity and embrace a degree of professional self-regulation. In providing clearer policy guidance, future research in this area needs to adopt a more evaluative approach than that which has been used to date. [ABSTRACT FROM AUTHOR]

Evidence-based reviews of published literature can be subject to several biases. Grey literature, however, can be of poor quality and expensive to access. Effective search strategies also vary by topic and are rarely known in advance. This paper complements a systematic review of the published literature on the costs and effects of expanding immunization services in developing countries. The quality of data on the effectiveness and cost-effectiveness of strategies to increase immunization coverage is shown to be similar across literatures, but the quality of information on costing is much lower in the grey literature. After excluding poorer quality studies from this review we found the quantity of available evidence almost doubled, particularly for more complex health-system interventions and cost or cost-effectiveness analyses. Interventions in the grey literature are more up to date and cover a different geographical spread. Consequently the conclusions of the published and grey literatures differ, although the number of papers is still too low to account for differences across types of interventions. We recommend that in future researchers consider using non- English keywords in their searches. [ABSTRACT FROM AUTHOR]

This paper reviews the health dimension and sociocultural, economic, and ecological determinants of health in existing global scenario studies. Not even half of the 31 scenarios reviewed gave a good description of future health developments and the different scenario studies did not handle health in a consistent way. Most of the global driving forces of health are addressed adequately in the selected scenarios, however, and it therefore would have been possible to describe the future developments in health as an outcome of these multiple driving forces. To provide examples on how future health can be incorporated in existing scenarios, we linked the sociocultural, economic, and environmental developments described in three sets of scenarios (special report on emission scenarios (SRES), global environmental outlook-3 (GEO3), and world water scenarios (WWS)) to three potential, but imaginary, health futures ("age of emerging infectious diseases", "age of medical technology", and "age of sustained health"). This paper provides useful insights into how to deal with future health in scenarios and shows that a comprehensive picture of future health evolves when all important driving forces and pressures are taken into account. [ABSTRACT FROM AUTHOR]

This paper discusses the reasons for skill mix among health workers being important for health systems. It examines the evidence base (identifying its limitations), summarizes the main findings from a literature review, and highlights the evidence on skill mix that is available to inform health system managers, health professionals, health policy-makers and other stakeholders. Many published studies are merely descriptive accounts or have methodological weaknesses. With few exceptions, the published analytical studies were undertaken in the USA, and the findings may not be relevant to other health systems. The results from even the most rigorous of studies cannot necessarily be applied to a different setting. This reflects the basis on which skill mix should be examined — identifying the care needs of a specific patient population and using these to determine the required skills of staff. It is therefore not possible to prescribe in detail a “universal” ideal mix of health personnel. With these limitations in mind, the paper examines two main areas in which investigating current evidence can make a significant contribution to a better understanding of skill mix. [ABSTRACT FROM AUTHOR]

This section looks back to some ground-breaking contributions to public health, reproducing them in their original form and adding a commentary on their significance from a modern-day perspective. To complement the debate on global population ageing and its implications for all societies, Alexandre Kalache, Isabella Aboderin, & Irene Hoskins review the 1980 paper by James F. Fries on the compression of morbidity. The original paper is reproduced by permission of The New England Journal of Medicine. [ABSTRACT FROM AUTHOR]

The World Health Organization recommends economic measures such as taxes on tobacco, alcohol and unhealthy foods and beverages as part of a comprehensive strategy for prevention of noncommunicable diseases. However, progress in adopting these so-called health taxes has been hampered, in part, by different approaches and perceptions of key issues in different sectors of government. Health promotion is the responsibility of health policy-makers, while taxation is the mandate of finance ministries. Thus, strengthening cooperation between health and finance policy-makers is central to the successful adoption and implementation of effective health taxes. In this paper we identify the shared concerns of finance and health policy-makers about health taxes with the aim of enabling more effective cross-sector cooperation towards both additional financing for health systems and changes in unhealthy behaviours. For example, new approaches to supporting health taxation include the growing priority for health-system financing due to the growing burden of noncommunicable diseases, and the need to address the health and economic damage due to the coronavirus disease 2019 pandemic. As a result, high-level efforts to achieve progress on health taxes are gaining momentum and represent important progress towards using the combined expertise of health and finance policy-makers. L'Organisation mondiale de la Sante recommande l'adoption de mesures economiques telles que des taxes sur le tabac, l'alcool ainsi que les boissons et aliments nocifs pour la sante dans le cadre d'une vaste strategie de prevention des maladies non transmissibles. Cependant, les progres en la matiere ont rencontre des obstacles, notamment en raison de la difference d'approche et de perception des principaux enjeux a divers niveaux du gouvernement. La promotion de la sante releve de la politique sanitaire, tandis que la taxation est la mission du ministere des Finances. Accentuer la cooperation entre les responsables de la sante et des finances est donc indispensable a la reussite de l'instauration et de la mise en oeuvre de taxes sanitaires efficaces. Dans le present document, nous identifions les preoccupations partagees tant par les responsables de la sante que par ceux des finances concernant les taxes sanitaires, dans le but d'intensifier la collaboration entre les secteurs. Objectif: debloquer des fonds supplementaires pour les systemes de sante et favoriser l'abandon des comportements nuisibles a la sante. Parmi les nouvelles approches de soutien aux taxes sanitaires, citons par exemple une plus grande priorite accordee au financement du systeme de sante afin de reduire la charge croissante que font peser les maladies non transmissibles, et la necessite de reparer les degats economiques et sanitaires causes par la pandemie de maladie a coronavirus 2019. Ainsi, les efforts visant a developper les taxes sanitaires gagnent du terrain et representent une avancee considerable vers une valorisation de l'expertise conjointe entre ministere de la Sante et ministere des Finances. [phrase omitted] La Organizacion Mundial de la Salud recomienda la adopcion de medidas economicas como los impuestos sobre el tabaco, el alcohol y los alimentos y bebidas poco saludables como parte de una estrategia global de prevencion de las enfermedades no transmisibles. Sin embargo, los avances en la adopcion de estos llamados impuestos saludables se han retrasado, en parte, por los diferentes enfoques y percepciones de las cuestiones clave en los distintos sectores del gobierno. La promocion de la salud es competencia de los responsables de formular las politicas sanitarias, mientras que la fiscalidad es el mandato de los ministerios de Hacienda. Por lo tanto, el fortalecimiento de la cooperacion entre los responsables de formular las politicas sanitarias y financieras es fundamental para el exito de la adopcion y aplicacion de sistemas fiscales sanitarios eficaces. En este documento, se identifican las preocupaciones que comparten los responsables de formular las politicas financieras y sanitarias en relacion con los impuestos saludables, con el fin de permitir una cooperacion intersectorial mas eficaz, tanto en lo que respecta a la financiacion adicional de los sistemas sanitarios como a la modificacion de los comportamientos poco saludables. Por ejemplo, entre los enfoques nuevos para apoyar la fiscalidad sanitaria se encuentran la creciente prioridad de la financiacion de los sistemas sanitarios debido a una mayor carga de enfermedades no transmisibles, y la necesidad de solucionar los danos sanitarios y economicos debidos a la pandemia de la enfermedad por coronavirus de 2019. En consecuencia, los esfuerzos de alto nivel para lograr avances en materia de impuestos saludables estan cobrando impulso y representan un avance importante hacia el uso de la experiencia combinada de los responsables de formular las politicas sanitarias y financieras., Introduction Health taxes are those imposed on products that have a negative public health impact. Many countries apply health taxes to products such as tobacco, alcohol and sugar-sweetened beverages that [...]

The Global strategy for women's, children's and adolescents' health (2016-2030) recognizes that people have a central role in improving their own health. We propose that community participation, particularly communities working together with health services (co-production in health care), will be central for achieving the objectives of the global strategy. Community participation specifically addresses the third of the key objectives: to transform societies so that women, children and adolescents can realize their rights to the highest attainable standards of health and well-being. In this paper, we examine what this implies in practice. We discuss three interdependent areas for action towards greater participation of the public in health: improving capabilities for individual and group participation; developing and sustaining people-centred health services; and social accountability. We outline challenges for implementation, and provide policy-makers, programme managers and practitioners with illustrative examples of the types of participatory approaches needed in each area to help achieve the health and development goals. [ABSTRACT FROM AUTHOR]

Low fruit and vegetable consumption is an important contributor to the global burden of disease. In the wake of the United Nations High-level Meeting on Non-Communicable Diseases (NCDs), held in September 2011, a rise in the consumption of fruits and vegetables is foreseeable and this increased demand will have to be met through improved supply. The World Health Organization, the Food and Agriculture Organization and the World Bank have highlighted the potential for developing countries to benefit nutritionally and economically from the increased production and export of fruit and vegetables. Aid for Trade, launched in 2005 as an initiative designed to link development aid and trade holistically, offers an opportunity for the health and trade sectors to work jointly to enhance health and development. The Aid for Trade work programme stresses the importance of policy coherence across sectors, yet the commonality of purpose driving the Aid for Trade initiative and NCD prevention efforts has not been explored. In this paper food supply chain analysis was used to show health policy-makers that Aid for Trade can provide a mechanism for increasing the supply of fruits and vegetables in developing countries. Aid for Trade is an existing funding channel with clear accountability and reporting mechanisms, but its priorities are determined with little or no input from the health sector. The paper seeks to enable public health policy-makers, practitioners and advocates to improve coherence between trade and public health policies by highlighting Aid for Trade's potential role in this endeavour. La faible consommation de fruits et de legumes contribue de maniere significative a la charge mondiale de morbidite. Au lendemain de la Reunion de haut niveau des Nations Unies sur les maladies non transmissibles (MNT), qui s'est tenue en septembre 2011, une hausse de la consommation de fruits et de legumes est a prevoir, et cette demande accrue devra etre satisfaite par une offre accrue. L'Organisation mondiale de la Sante, l'Organisation des Nations Unies pour l'alimentation et l'agriculture et la Banque mondiale ont mis en evidence le potentiel existant, pour les pays en voie de developpement, a beneficier sur le plan nutritionnel et economique de l'augmentation de la production et de l'exportation de fruits et de legumes. L'Aide pour le commerce, lancee en 2005 en tant qu'initiative visant a lier de maniere holistique l'aide au developpement et le commerce, permet aux secteurs de la sante et du commerce de travailler conjointement afin d'ameliorer la sante et de renforcer le developpement. Le programme de travail de l'Aide pour le commerce met l'accent sur l'importance de la coherence des politiques intersectorielles, pourtant l'objectif commun motivant l'initiative de l'Aide pour le commerce et les efforts de prevention lies aux MNT n'a pas ete etudie. Dans ce document de travail, l'analyse de la chaine de l'approvisionnement alimentaire ete utilisee pour montrer aux decideurs des politiques de sante que l'Aide pour le commerce peut fournir un mecanisme d'augmentation de l'offre en fruits et legumes dans les pays en voie de developpement. LAide pour le commerce est un canal de financement preexistant, aux responsabilites et aux mecanismes declaratifs clairs. Toutefois ses priorites sont determinees avec peu ou pas d'apport de la part du secteur de la sante. Ce document de travail vise a permettre aux decideurs de la sante publique, aux praticiens et aux defenseurs d'ameliorer la coherence entre commerce et politiques de sante publique, en mettant en avant le role potentiel de l'Aide pour le commerce dans cette entreprise. El consumo bajo de fruta y verdura contribuye de forma importante a la carga de morbilidad en el mundo. A raiz de la reunion de alto nivel de las Naciones Unidas sobre enfermedades no transmisibles, celebrada en septiembre de 2011, se preve un aumento en el consumo de fruta y verdura, y se debera hacer frente a esa demanda mayor incrementando el suministro. La Organizacion Mundial de la Salud, la Organizacion de las Naciones Unidas para la Agricultura y la Alimentacion y el Banco Mundial han destacado la posibilidad que tienen los paises en desarrollo de beneficiarse economica y nutricionalmente de este aumento de la produccion y exportacion de fruta y verdura. Ayuda para el Comercio, que comenzo en el ano 2005 como una iniciativa disenada para unir por completo la ayuda al desarrollo y el comercio, ofrece a los sectores de la salud y del comercio la oportunidad de trabajar juntos para mejorar la salud y el desarrollo. El programa de trabajo de Ayuda para el Comercio enfatiza la importancia de la coherencia de las estrategias en todos los sectores, aunque la mayor parte del objetivo de la iniciativa Ayuda para el Comercio y los esfuerzos de prevencion de enfermedades no transmisibles no se han examinado todavia. En este articulo se empleo un analisis de la cadena de suministro de alimentos para mostrar a los legisladores que Ayuda para el Comercio puede proporcionar un instrumento para incrementar el suministro de fruta y verdura en los paises en desarrollo. Ayuda para el Comercio es un canal de financiacion existente con una responsabilidad clara y mecanismos de presentacion de informes, pero sus prioridades estan poco o nada condicionadas por aportaciones del sector sanitario. El presente documento pretende permitir a los legisladores de la sanidad publica, medicos y abogados mejorar la coherencia entre las estrategias comerciales y de salud publica destacando el posible papel de Ayuda para el Comercio en este empeno., Introduction The United Nations General Assembly and the World Health Organization have encouraged intersectoral collaboration in the fight against non-communicable diseases (NCDs). (1) However, few constructive opportunities for practical intersectoral [...]

The coronavirus disease 2019 (COVID-19) pandemic has affected children's risk of violence in their homes, communities and online, and has compromised the ability of child protection systems to promptly detect and respond to cases of violence. However, the need to strengthen violence prevention and response services has received insufficient attention in national and global pandemic response and mitigation strategies. In this paper, we summarize the growing body of evidence on the links between the pandemic and violence against children. Drawing on the World Health Organization's INSPIRE framework to end violence against children, we illustrate how the pandemic is affecting prevention and response efforts. For each of the seven INSPIRE strategies we identify how responses to the pandemic have changed children's risk of violence. We offer ideas for how governments, policy-makers, and international and civil society organizations can address violence in the context of a protracted COVID-19 crisis. We conclude by highlighting how the current pandemic offers opportunities to improve existing child protection systems to address violence against children. We suggest enhanced multisectoral coordination across the health, education, law enforcement, housing, child and social protection sectors. Actions need to prioritize the primary prevention of violence and promote the central role of children and adolescents in decision-making and programme design processes. Finally, we stress the continued need for better data and evidence to inform violence prevention and response strategies that can be effective during and beyond the COVID-19 pandemic. La pandemie de maladie a coronavirus 2019 (COVID-19) a eu un impact sur le risque de violence a l'egard des enfants a domicile, au sein de leur communaute et en ligne. Elle a egalement empeche les systemes de protection de l'enfance d'identifier rapidement les situations de ce typeetd'y reagirdesque possible. Pourtant, la necessitede renforcer les services de prevention et d'action en la matiere n'a pas ete suffisamment prise en compte dans les strategies nationales et internationales d'intervention et d'attenuation des effets de la pandemie. Le present document reprend l'accumulation de preuves confirmant les liens entre pandemie et violence a l'egard des enfants. En nous inspirant du cadre INSPIRE de l'Organisation mondiale de la Sante visant a mettre fin a la violence a l'encontre des enfants, nous illustrons la facon dont la pandemie affecte les efforts de prevention et d'action. Pour chacune des sept strategies INSPIRE, nous determinons comment les mesures de lutte contre la pandemie ont influence le risque de violence envers les enfants. Nous formulons des pistes pour que les gouvernements, les legislateurs, les institutions Internationales et les organisations de la societe civile puissent remedier a cette violence dans un contexte de crise prolongee due a la COVID-19. En guise de conclusion, nous mettons en lumiere les opportunites qu'offre la pandemie actuelle d'ameliorer les systemes existants de protection de l'enfance pour mieux combattre la violence envers les enfants. Nous suggerons d'accroitre la collaboration entre les secteurs de la sante, de l'education, du maintien de l'ordre, du logement, des droits de l'enfant et de la protection sociale. Les actions entreprises doivent sefocaliser sur la prevention primaire de la violence et promouvoir le role central des enfants et adolescents dans les processus de conception de programmes et de prise de decisions. Enfin, nous soulignons le besoin permanent de donnees et de preuves fiables pour orienter les strategies de prevention et d'intervention face a la violence, afin degarantir leur efficacite pendantetapres la pandemie de COVID-19. La pandemia de la enfermedad porcoronavirus (COVID-19) ha afectado al riesgo de violencia infantil que sufren los ninos en sus hogares, comunidades y en linea, y ha puesto en peligro la capacidad de los sistemas de proteccion infantil para detectar y responder rapidamente a los casos de violencia. Sin embargo, la necesidad de reforzar los servicios de prevencion y respuesta a la violencia no ha recibido suficiente atencion en las estrategias nacionales y mundiales de respuesta y mitigacion de la pandemia. En este documento, resumimos el creciente conjunto de pruebas sobre los vinculos entre la pandemia y la violencia infantil. Basandonos en el marco INSPIRE de la Organizacion Mundial de la Salud para poner fin a la violencia Infantil, ilustramos como la pandemia esta afectando a los esfuerzos de prevencion y respuesta. Para cada una de las siete estrategias de INSPIRE, identificamos como las respuestas a la pandemia han cambiado el riesgo de violencia infantil. Ofrecemos ideas sobre como los gobiernos, los responsables politicos y las organizaciones internacionales y de la sociedad civil pueden abordar la violencia en el contexto de una crisis prolongada de COVID-19. Concluimos destacando como la pandemia actual ofrece oportunidades para mejorar los sistemas de proteccion infantil existentes para abordar este tipo de violencia. Sugerimos una mayor coordinacion multisectorial en los sectores de la salud, la educacion, la aplicacion de la ley, la vivienda y la proteccion social infantil. Las acciones deben priorizar la prevencion primaria de la violencia y promover el papel central de los ninos y adolescentes en los procesos de toma de decisiones y en el diseno de programas. Por ultimo, subrayamos la necesidad permanente de contar con mejores datos y pruebas para fundamentar las estrategias de prevencion y respuesta a la violencia que puedan ser eficaces durante la pandemia de COVID-19 y seguir vigentes cuando esta pase. [phrase omitted], Introduction Throughout the coronavirus disease 2019 (COVID-19) pandemic, children have often been referred to as silent spreaders, low-risk or invisible carriers of the disease. These descriptions negate the well-documented adverse [...]