The 2021 Resolution on Oral Health by the 74th World Health Assembly supports an important health policy direction: inclusion of oral health in universal health coverage. Many healthcare systems worldwide have not yet addressed oral diseases effectively. The adoption of value-based healthcare (VBHC) reorients health services towards outcomes. Evidence indicates that VBHC initiatives are improving health outcomes, client experiences of healthcare, and reducing costs to healthcare systems. No comprehensive VBHC approach has been applied to the oral health context. Dental Health Services Victoria (DHSV), an Australian state government entity, commenced a VBHC agenda in 2016 and is continuing its efforts in oral healthcare reform. This paper explores a VBHC case study showing promise for achieving universal health coverage that includes oral health. DHSV applied the VBHC due to its flexibility in scope, consideration of a health workforce with a mix of skills, and alternative funding models other than fee-for-service.
We investigated the macroeconomic determinants of neonatal, infant, and under-five mortalities in Bangladesh for the period 1991–2018 and discuss implications of the United Nations’ Sustainable Development Goal 3 (SDG 3) and Millennium Development Goal 4 (MDG 4) for developing countries. We used annual time series data and the econometric techniques of Fully Modified Ordinary Least Squares (FMOLS) and Dynamic Ordinary Least Squares (DOLS) regressions for analysis. Determinants most effective in combating neonatal, infant, and under-five mortalities include variables such as ‘protecting newborns against tetanus’, ‘increasing healthcare expenditure’, and ‘making sure births are attended by skilled healthcare staff’. Employing more healthcare workers and assuring more and improved healthcare provisions can further reduce the neonatal, infant, and under-five mortalities. Developing countries with similar macroeconomic profiles can achieve similar SDG 3 and MDG 4 outcomes by emulating the policies and strategies Bangladesh applied to reducing child mortalities over the last three decades.
Recent health policies in the United Kingdom (UK) and internationally have focussed on digitisation of healthcare. We examined UK policies for evidence of government action addressing health inequalities and digital health, using cardiometabolic disease as an exemplar. Using a systematic search methodology, we identified 87 relevant policy documents published between 2010 and 2022. We found increasing emphasis on digital health, including for prevention, diagnosis and management of cardiometabolic disease. Several policies also focused on tackling health inequalities and improving digital access. The COVID-19 pandemic amplified inequalities. No policies addressed ethnic inequalities in digital health for cardiometabolic disease, despite high prevalence in minority ethnic communities. Our findings suggest that creating opportunities for digital inclusion and reduce longer-term health inequalities, will require future policies to focus on: the heterogeneity of ethnic groups; cross-sectoral disadvantages which contribute to disease burden and digital accessibility; and disease-specific interventions which lend themselves to culturally tailored solutions.
The online version of this article contains supplementary material available 10.1057/s41271-023-00410-z.
Experience of serious violations of International Humanitarian Law (IHL) results in complex physical disability and psychosocial trauma amplifying poverty and multi-generational trauma and impeding long-term recovery. We use data from a representative sample of victims in the case Prosecutor V. Dominic Ongwen brought before the International Criminal Court. Thirteen years after the 2004 massacre, the victims were significantly worse off than the general war-affected population that did not experience serious violations of IHL. The differences in health and wellbeing persisted for individuals and their households, including children born after the massacre. The victims have significantly lower availability of appropriate health services and medications, including significantly greater distance to travel to these services. These findings call attention to the needs of people having experienced IHL violations, for provision of physical and emotional trauma care to allow for recovery, and better understanding of the short- and long-term impacts of IHL violations.
Chronic disease pandemics have challenged societies and public health throughout history and remain ever-present. Despite increased knowledge, awareness and advancements in medicine, technology, and global initiatives the state of global health is declining. The coronavirus disease 2019 (COVID-19) pandemic has compounded the current perilous state of global health, and the long-term impact is yet to be realised. A coordinated global infrastructure could add substantial benefits to public health and yield prominent and consistent policy resulting in impactful change. To achieve global impact, research priorities that address multi-disciplinary social, environmental, and clinical must be supported by unified approaches that maximise public health. We present a call to action for established public health organisations and governments globally to consider the lessons from the COVID-19 pandemic and unite with true collaborative efforts to address current, longstanding, and growing challenges to public health.
International funding for HIV treatment and prevention drastically decreased when Vietnam transitioned from a low-income to a lower-middle-income country in 2010. Vietnam has attempted to fill the funding gap from both public and private sources to cover antiretroviral therapy (ART) treatment. However, policies that enable social health insurance to pay for ART treatment-related costs often exclude people living with HIV (PLHIV) without appropriate government documents from accessing the health insurance-funded ART program. The Vietnamese Ministry of Health might consider alternative approaches, such as implementing a universal health insurance program among PLHIV regardless of residency or documentation status, to expand coverage of ART treatment to achieve the UNAIDS 95–95–95 targets by 2030. This expanded universal care will increase the uptake of ART treatment among uninsured PLHIV as well as increase coverage of health insurance-funded ART among insured PLHIV. Most importantly, the proposed insurance scheme could significantly improve population health by reducing HIV new infections and providing economic benefits of ART treatment through increased productivity and decreased healthcare costs.
In presence of violent extremism, children in Pakistan are at high risk for child sexual abuse (CSA), especially after the COVID-19 pandemic. Effective approaches for preventing CSA include enhancing resilience resources in violence-affected societies. Previous research suggests that video-based curricula effectively enhances learning in primary schoolchildren. We pilot tested a video literacy program to build awareness in children, creating a ‘personal safety and space bubble’ as an educational approach for prevention of sexual abuse with an experimental 6 weeks long pre- and post-test design. We conducted qualitative interviews with students, teachers, and parents and identified themes using frequency analyses. Results showed a 96.7% increase in awareness about ‘personal safety and space bubble’. The pilot study is valuable for public health researchers and policy makers seeking to curtail sexual abuse in extreme violence affected Pakistan. Primary schools can use such interventional cartoons to enhance awareness about child sexual abuse.
By recognizing the structural causes of health and illness, public health has often been associated with values of compassion and solidarity, and a relational understanding of human agency. Rather than supporting the consistent integration and application of these insights, however, public health is now sometimes invoked more as a rhetorical move, used to construct issues as simple questions of neoliberal scientistic rationalism. Public health practitioners must reckon, therefore, with how the field can be discursively deployed in the public square, for multiple divergent political ends. If public health is always positioned as a value-neutral and detached scientific approach to addressing complex subjects, from drug use to pandemics, it not only fails to connect with the arguments of its critics, but further divorces what was once called the public health ‘movement’ from the strong and progressive political and theoretical positions it was founded upon and should advocate for today.
The spread of the COVID-19 pandemic has shown great heterogeneity between countries that merits investigation. There is a need to better highlight the variability in the pandemic trajectories in different geographic areas. By using openly available data from ‘GitHub’ COVID-19 dataset for Europe and from the official dataset of France for the period 2020 to 2021, I present the three COVID-19 waves in France and Europe in maps. The epidemic trends across areas display different evolutions for different time periods. National and European public health authorities will be able to improve allocation of resources for more effective public health measures based on geo-epidemiological analyses.
The COVID-19 pandemic unveiled the vulnerability of many African healthcare systems, amplifying inadequacies and constraints in the supply chain for medical products and technologies on the continent. Disruptions in the global supply chain due to the pandemic resulted in the continent’s population of over one billion people grappling with shortages in the supply of essential medicines. The shortages and their consequences set back achievement of Sustainable Development Goals and progress towards universal health coverage. A virtual meeting of global experts in medical products and supply chain identified as urgent the need for Africa to build capacity for a self-reliant public health system. Discussants challenged the governments of African countries to turn the continent from its current import driven economy to a continent of indigenous research and development, local production, and an exporter of its medical products and innovations.
We summarize and consolidate disparate sources of information about the practice of tattooing and its potential implications for military population health and policy. Each branch of the United States military has policies about tattoos for service members, but these have varied over time and do not cover health protection. The number of veterans receiving disability payments and the cost of those payments has been rising over time; the broad category of skin conditions accounts for 11% of disability claims. Any additional factor, such as tattoos that may increase the occurrence of adverse skin reactions, can substantially impact veteran benefit expenses and budgets. This may be a consideration for the military as it evaluates its policies related to tattoos among service members.
During the COVID-19 pandemic, authorities have imposed various social restrictions on a massive scale. This Viewpoint discusses current issues about the legality of restrictions and current knowledge about how to prevent the spread of Sars-Cov-2. Although vaccines are already available, other basic public health measures are needed to suppress the transmission of SARS-CoV-2 and reduce the COVID-19 related mortality: isolation, quarantine, and wearing of face masks. This Viewpoint shows that the emergency measures during a pandemic are important for protecting the public’s health, but they may only be legitimate if they are based in law, are in accordance with medical knowledge, and aim to limit the spread of infectious agents. We concentrate on a legal obligation to wear face masks as it became a most recognizable symbol of the pandemic. It was also one of the most criticized obligations and the subject of divergent views.
In the United States, science shapes federal health and safety protections, but political officials can and do politicize federal science and science-based safeguards. Many presidential administrations have politicized science, but under the administration of President Trump, these attacks on science—such as buried research, censored scientists, halted data collection—increased in number to unprecedented levels. Underserved communities bore the brunt of the harms. Such attacks disproportionately harm Black, Indigenous, low-income communities, and communities of color, all of whom have long been burdened by pollution exposure and other stressors. We analyze the effects on underserved communities of the Trump administration’s anti-science environmental and public health policy actions and offer policy recommendations for current and future administrations. Our goal is to strengthen scientific integrity, prioritize health disparity research, and meaningfully engage affected communities in federal rulemaking.
We strive to increase public (PH) and occupational health (OSH) inter-linkages by building a collaborative framework. Besides Covid-19 pandemic, recent approaches such as Human Exposome and Total Worker Health TM, have led to a shift to improving health of working population and consequently the total population. These health objectives can be best realised through primary care actors in specific contexts. Work, school, home and leisure are the four multi-stakeholder contexts in which health and healthcare (goal-oriented care) objectives needs to be set and defined. PH policy makers need to establish a shared decision-making process involving employees, employers and OSH representatives to set PH goals and align with OSH goals. The policy making process in OSH can serve as a potential way forward, as the decisions and policies are being decided centrally in consultation with social partners and governments. This process can then be mirrored on company level to adopt and implement.
The United Nations (UN) recognises free school meals as critical, yet widely disrupted by COVID-19. We investigate caregiver perceptions and responses to interruptions to the universal infant free school meal programme (UIFSM) in Cambridgeshire, England, using an opt-in online survey. From 586 responses, we find 21 per cent of respondents’ schools did not provide UIFSM after lockdown or advised caregivers to prepare packed lunches. Where provided, caregivers perceived a substantial decline in quality and variety of meals, influencing uptake. Direction to bring packed lunches, which caregivers reported to have contained ultra-processed foods of lower nutritional quality, influenced caregiver behaviour rather than safety concerns as claimed by industry. The quality and variety of meals, and school and government policy, had greater impact than concerns for safety. In the UK and at the international level, policymakers, local governments, and schools must act to reverse the trend of ultra-processed foods in packed lunches, while improving the perceived quality of meals provided at schools.
The World Breastfeeding Trends Initiative (WBTi) provides a participative framework to bridge the gaps in policies and programs on breastfeeding. This concurrent mixed-methods study investigated how and why carrying out WBTi evaluations in countries influences their breastfeeding policies and outcomes. We used data from WBTi’s Global Repository to evaluate performance scores in 98 countries and conducted semi-structured in-depth interviews to investigate the impact of WBTi process, using the Managing for Development Results structure and actor-network theory. Countries that conducted WBTi multiple times seem to have better breastfeeding policies and practices than countries that have assessed only once. The central feature of the process and its subsequent impact is the dialectical interaction between the technical and political elements of the WBTi exercise. We believe that WBTi’s framework is a promising monitoring and evaluation tool that could be used to engage dialogue in other public health areas.
This study examined community service provider (CSP) availability relative to neighborhood socioeconomic status and its association with health-related social needs in Eastern Kentucky, United States. We used GIS methods to generate 10-mile network service areas around addresses of 736 CSPs and 10,161 Medicaid and Medicare beneficiaries screened August 2018–April 2020 in 27-county study region. We observed wide variation in CSP availability and an inverse relationship between CSP availability and rates of unemployment, poverty, and federal Supplemental Nutrition Assistance Program. The CSPs appear to have higher availability in more affluent census block groups. We found a statistically significant negative relationship between CSP availability within 10 miles of a beneficiary’s resident and the presence of food, housing, transportation needs. Our findings suggest that healthcare providers, government entities, and non-profit organizations should consider geographic accessibility to those most in need when making referral and funding decisions, particularly in rural communities.
Türkiye introduced a family medicine-centered primary healthcare model in 2005 as part of the Health Transformation Program, which aimed to reduce household healthcare expenditures, improve access to health services, and reduce the crowding-out effect in first-stage hospital institutions. We investigate the impact of the family medicine program on household healthcare expenditures in Türkiye, focusing on doctor visits, medication prescriptions, and hospitalization expenditures. Using data from a large representative household survey, we employ a difference-in-differences approach combined with the entropy-balancing matching technique. Our robust findings show that living in a province exposed to the family medicine program reduced household doctor visit expenditures by over 40 percent. We also find a significant negative association between the family medicine program and expenditures regarding doctor visits and medication prescriptions in the long run. Greater efforts are now needed to ensure the quality of services offered by family health centers, such as improving the doctor-to-patient ratio.
Abuse of physician prescribed opioids contributes to health and economic burdens associated with dependency, overdose, and death. Since the 1900s, the United States (U.S.) Congress has legislated use and misuse of controlled substances. Under the U.S. Constitution, states developed prescription drug monitoring programs (PDMPs) that determine how the program is managed, what data to track, and what information to share with other states. Lack of a standard data set that allows providers to see prescribing data for designated controlled substances across state lines, limits benefits of state PDMPs. A federal PDMP with a standard minimal set of variables shared across states could enhance patient care. States would exercise their police powers while sharing standard data to decrease adverse consequences of the opioid epidemic.
Mental illnesses are a serious concern in India where every seventh person suffers from mental health problems—with women more affected than men. While the burden of perinatal mental illnesses grows, India lacks exclusive policies to address it. The COVID-19 pandemic has had an impact on routine antenatal care and institutional deliveries and has also affected the mental health of pregnant women and mothers. We evaluated existing policies. Policy options were evaluated against criteria like cost–benefit analysis, administrative feasibility, human resources, and equity along with the intended and unintended consequences. We propose three policy options: (1) strengthening and focused implementation of the existing national mental health program (NMHP), (2) integrating mental health in the ongoing Reproductive, Maternal, Newborn, Child and Adolescent Health Program, and (3) including a ‘maternal’ component in NMHP. We offered policy recommendations to fill the gap in addressing the maternal mental health challenge in India.
The Russian government has long struggled with the problem of excessive alcohol consumption. We examined the relationship between alcohol consumption and subjective poverty in Russia using the special survey of the Levada Analytical Center conducted in 2017. Subjective poverty represents an individual’s perception of personal well-being when an individual’s income is lower than the required not to feel poor. We found that the status of being subjectively poor was associated with the increased probability of consuming vodka for women and the probability of consuming beer for men. Results inform decision-makers about the importance of subjective poverty issues for understanding alcohol consumption.
In the absence of fully effective measures to prevent and treat COVID-19, the limited access to and hesitancy about vaccines, the prolongation of the on-going pandemic is likely. This underscores the need to continue to respond and maintain preparedness, preferably using a more sustainable approach. A sustainable management is particularly important in fragile, conflict-affected and vulnerable countries of sub-Saharan Africa given several peculiar challenges. This Viewpoint proposes policy options to guide transitioning from current COVID-19 emergency response interventions to longer-term and more sustainable responses in such settings. In the long term, a shift in policy from a vertical to a more effective approach should integrate response coordination, surveillance, case management, risk communication and operational support, among other elements, for better results. We call on public health policymakers, partners and donors to support full implementation of these policy options in a holistic manner to encompass all emerging public health threats.
Health mindset is a group of beliefs or assumptions that individuals hold about the causes of health and well-being. Strengthening our understanding of factors that shape mindset and how mindset shapes expectations for who can and should be responsible for health can inform the success and sustainability of solutions to current health crises including the COVID-19 pandemic, ongoing disparities in health outcomes, and gun violence. We first examined associations between personal characteristics and experiences with health mindset. Next, we examined the association between mindset and the belief that government involvement can help address pressing health questions, using obesity as an example of a health outcome that is shaped both by personal choices and factors outside one’s control. Going forward, it will be important to consider health mindset in broader transformations of the health system and population approaches to improving health.
We conducted a cross-sectional analysis in a convenient sample of Black adults in the United States (n = 269, ages 18–65) from diverse ethnic backgrounds (African-Americans, African immigrants, Afro-Caribbean immigrants). We examined mean differences in self-reported medical mistrust, use of mental health services, depression symptom severity, mental health knowledge and stigma behavior (or a desire for separation away from people living with a mental illness) according to ethnicity, citizenship status, age group, and gender. African Americans with moderate to severe depression symptoms had greater stigma behavior (mean = 12.2, SD = 3.2) than African Americans who screened in the minimal to mild depression range (mean = 13.1, SD = 3.5). Across the spectrum of depression, immigrants showed greater stigma than African Americans (p = 0.037). This is a pilot study that explores heterogeneity in the Black population in depression symptom severity and psychosocial factors related to mental health. Understanding these differences may contribute to how we approach needs and health system practices and policies at the individual, systemic, and structural level of mental health care.
We conducted a community-based cross-sectional survey of 416 participants from Meghalaya, India to assess knowledge, perceptions, and practices toward recommended COVID-19 preventive measures, and to explore health-seeking behavior and stigma during early phase of the pandemic. Most participants had knowledge of the signs and symptoms of COVID-19 (94%) and its spread (96%), and reported positive behavior change such as handwashing ≥ 6 times/day (41% pre-COVID-19 vs. 81% during COVID-19, P < 0.001), sneezing or coughing into sleeves (65% pre-COVID-19 vs. 89% during COVID-19, P < 0.001) and staying home if having flu-like symptoms (44% pre-COVID-19 vs. 94% during COVID-19, P < 0.001). We found delayed healthcare seeking for non-COVID-19 illnesses (16%). Fear of losing life was reported by 26% participants, as was discrimination toward migrant returnees, with 35% blaming returnees for the spread of COVID-19. We highlight the need for a holistic approach toward pandemic control, including social and mental health interventions, in public health strategies.
Personal injuries, illnesses, or deaths resulting from occupational accidents pose critical public health issues with severe social and economic implications. Studies on risk factors for occupational injuries in Africa have been indecisive. This study aimed to identify factors influencing occupational injuries at the regional level and to generate estimates of the contribution of each. Of 603 studies accessed we included 20 that fulfilled the eligibility criteria. Workers with temporary employment and those not receiving safety training had higher odds of incurring occupational injuries [AOR = 2.13, 95%CI (1.06, 3.21) and AOR = 1.98, 95%CI (1.21, 2.76), respectively]. Temporary workers often do not benefit from occupational health and safety services to avoid accidents and injuries at work. Use of proper personal protective equipment reduced the odds of sustaining an injury [AOR = 0.60, 95%CI (0.32, 0.88)]. We suggest focusing interventions on the identified modifiable factors to lessen the burden of work-related injuries.
Routine immunization rates in the United States (US) declined immediately after the US declared COVID-19 a public health emergency in March 2020. Decreases in childhood vaccination place children at risk for vaccine-preventable diseases and communities at risk for outbreaks from these diseases. The US Department of Health and Human Services (HHS) launched “Catch Up to Get Ahead” in August 2020 to promote routine childhood immunization. The decline in mean coverage of the combined 7-vaccine series among children aged 19–35 months was less in Indian Health Service (IHS) federal health centers that implemented “Catch Up to Get Ahead” compared to IHS federal health centers that did not. The effort to promote catch-up vaccination may have showed promise in minimizing the decline in childhood vaccination coverage during the pandemic. However, the effort was not enough to reach pre-pandemic levels, indicating the need for more robust and sustained efforts to catch children up on all delayed immunizations.
This study describes barriers to using the MyPlate visual as a resource for communicating dietary recommendations to Asian American participants of a federally funded nutrition education program. To identify potential barriers to using MyPlate, an interdisciplinary team collected quantitative (n = 349) and qualitative (n = 40) data via a cross-sectional survey and a series of focus group interviews with convenience samples of Cambodian, Filipino, Japanese, Chinese, Vietnamese, and Korean adult participants of a nutrition education class in downtown Los Angeles. Findings showed that 13.2% of the participants ate meals only on a plate, 30.7% were accustomed to eating only refined grains like white rice, and 22.4% did not customarily make half their meals to consist of fruits and vegetables. Food customs, preference, and taste vary across these subgroups. The heterogeneity and complexity of dietary practices among Asian subgroups suggest a need to better tailor nutrition education resources for use in these populations.
Most low- and middle-income countries lack the regulatory capacity to contain substandard and falsified (SF) medicines. Innovations for strengthening regulatory systems are needed to protect public health. We assessed the integrity of the antimicrobial supply chain in Bangladesh. We employed qualitative methods comprising policy content analysis, and literature and database reviews. Using a framework modified from the World Health Organization’s and the United States Pharmacopoeia’s, the Bangladesh National Drug Policy (BNDP), was evaluated for provisions on medicines quality assurance mechanisms. We used newspaper, peer-reviewed, and post-marketing surveillance reports to assess prevalence of SF antimicrobials. The BNDP contains provisions for quality assurance. Newspaper reports identified circulation of substandard antimicrobials. We identified only six peer-review studies testing antimicrobial product quality with three studies reporting out-of-specifications products. We suggest three strategies for strengthening the regulatory system: community-based surveillance, task shifting, and technology-enabled consumer participation.
A vaccines advisory group to the World Health Organization (WHO) identified complacency, inconvenience in accessing vaccines, and lack of confidence as key reasons for hesitancy. In childhood vaccination, the decision to take a vaccine relies on parents' decisions. Our study explored the relationship between parents' risk aversion and complete childhood vaccination status to identify whether demand contributes to vaccine hesitancy in Indonesia. We examined risk aversion using data from the fifth-wave Indonesian Family Life Survey (IFLS), focusing on parents with extreme risk aversion or fear of uncertainty. The logistic regression shows a negligible relationship between parents' risk aversion and childhood vaccination; nevertheless, parents who fear uncertainty tend to avoid vaccination. The results of this study encourage public health professionals and policymakers to properly design vaccine campaigns with careful consideration of the risk preference dimension of the targeted beneficiaries.
This study retrospectively reviews the medical service usage data of North Korean arrivals collected from 2015 to 2019. The purpose of this study is to understand the medical use status of North Korean arrivals and to design health policies for them. We reviewed 32,653 medical records of North Korean arrivals who visited the National Medical Center as outpatients and inpatients during a 5-year period. Among 1453 patients with an average age of 46.7 years, we found that among the treated patients, there were many women in their 40s and 50s who complained of psychiatric disorders. The most frequently visited department was psychiatry. The most frequently diagnosed disorder was unspecified depression. 88% of patients utilized Medical Care assistance type 1, which means that they are medical aid beneficiaries because they are usually in difficult economic circumstances. Medical examination and treatment fees of North Korean arrivals increased in general, and older patients paid more. Among North Korean arrivals, middle-aged women and mentally ill patients showed high medical needs. This study recommends that the government provide policy support to North Korean arrivals for professional psychiatric treatment and improvement of medical access. We also expect these results to be applied to the health problems of other refugees.
This longitudinal study aimed to compare 1-year mortality between users of home- and community-based services (HCBS) and residential facilities (nursing homes, group homes, and geriatric apartments) among non-hospitalized frail older adults in Japan. Using three nationwide data sources, we conducted a nationwide pooled cohort study of 1-year follow-up among certified users of long-term care insurance (LTCI) aged 65 years and older from 2007 through 2016 to compare 1-year mortality using a logistic regression model. Overall, compared to HCBS users, mortality was higher in residents in nursing homes and geriatric apartments but lower in group home residents. While mortality gradually increased over time among those in residential facilities, it remained at a level similar to that of HCBS users. Since 2006, Japan’s public health policy has been to increase end-of-life care in residential facilities. Our results indicate that this policy resulted in an increase in mortality in residential facilities, possibly due to accommodation of more severely ill people there, or a shift in their focus from transferring dying residents to hospitals to preserve the dignity of residents.
Public health experts often assume that any policy promoting healthful behavior change is inherently and self-evidently ethical. This assumption is incorrect. This Viewpoint describes why evaluating the ethics of a policy to promote healthful behavior change should require (1) valuing consequences for wellbeing proportionately to consequences for health, (2) valuing changes to the distributional equity of health and wellbeing together with their aggregate improvement, and (3) anticipating and surveilling for unintended consequences sufficiently important to offset benefits. I illustrate these three requirements through a hypothetical salt restriction policy, which is unethical if it evokes strong preferences that detract from wellbeing, disproportionately confers health benefits to those who are already healthy, or elicits unintended consequences that offset health benefits. I discuss why analogies of salt restriction mandates are inappropriate. In summary, public health decision-makers should employ more structured, explicit and comprehensive criteria when considering the ethical consequences of policies.
The link between policy design choices and health is an important, yet understudied area of public health research. I investigate the impact of the generosity, inclusion, and autonomy of state paid sick leave laws on influenza-like-illness (ILI) rates and its components using data from the Centers for Disease Control and state-level paid sick leave statutes. I found that paid sick leave policies that include small firms and that allow for a larger number of medical uses have lower ILI rates, relative to states with less comprehensive policies. States with policies that had more generous accrual rates and that included a wide variety of worker types (temporary, part-time, students) increased the total number of reported medical cases, relative to states with less comprehensive policies. Policymakers contemplating paid sick leave policies should consider these design choices in their goals to incentivize health care utilization and to reduce contagion.
Social vulnerability refers to the attributes of society that make people and places susceptible to natural disasters, adverse health outcomes, and social inequalities. Using a social vulnerability index (SVI), we investigated social vulnerability prevalence and its relationship with food insecurity in South Africa (SA). In this nationally representative cross-sectional survey, we calculated SVI scores from 3402 respondents (median age, 35 (26–46) years) using an SVI developed by the United States (US) Centers for Disease Control and prevention (CDC) adapted for a South African context. We measured food insecurity using a modified Community Childhood Hunger Identification Project. Findings classified 20.6% and 20.4% of adults as socially vulnerable and food insecure, respectively. The risk of food insecurity was almost threefold higher in the social vulnerability group (OR 2.76, 95% CI 2.76–2.77, p < 0.001) compared to their counterparts. The SVI could be a useful tool to guide government and policymakers in the facilitation of social relief initiatives for those most vulnerable.
Few studies assess consumer response to nutrition labeling, especially in less-developed countries. We analyzed the link between nutrition labeling and obesity in Ecuador using a representative cross-sectional sample of 29,770 individuals from the National Health and Nutrition Survey (ENSANUT) in 2018. Nutrition labeling reduced the probability of obesity in adolescent (12–18 years old) and adult (18–59 years old) people by 4% (CI: − 5.7, − 2.2) and 8.4% (CI: − 12.7, − 4.0), respectively. The magnitude of average treatment effect of using nutrition label on obesity ranged from 0.90 (CI: − 1.299, − 0.500) to 1 (CI: − 1.355, − 0.645) BMI points for adolescent, and from 1.16 (CI: − 1.554, − 0.766) to 1.80 (CI: − 2.791, − 0.811) BMI points for adult. The effect of nutrition labeling is greater among the less obese. We recommend that health policy makers and clinicians continue to promote nutrition labeling especially where obesity is not chronic, where nutrition labeling is most successful.
It can be argued that anti-immigrant policies, such as the 287(g) program, can have a direct impact on the health and well-being of the immigrant community in general, particularly undocumented immigrants in the United States. While there is yet to be a comprehensive and conclusive empirical assessment of this issue, what is known is that the immigrant community faces many stress factors and structural barriers that negatively impact health. We argue that it is urgent that public health responds to the unique experiences and challenges of the undocumented and wider immigrant community. In doing so, we propose three recommendations for addressing this issue: (1) Assess the causal relationship between anti-immigration policies and immigrant health, (2) Increase funding and access to health care services for immigrant communities in jurisdictions implementing anti-immigrant policies, and (3) For public health to engage in a conscious effort to service the undocumented immigrant community. Even though we focus specifically on the United States, our recommendations are applicable on a global scale since anti-immigration policies are prevalent across nations and are a pervasive human rights issue around the world.