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Article

Collective Health: Theory and Practice. Innovations From Latin America  

Ligia Maria Vieira-da-Silva

Throughout history, knowledge and practices on the health of populations have had different names: medical police, public health, social medicine, community health, and preventive medicine. To what extent is the Brazilian collective health, established in the 1970s, identified with and differentiated from these diverse movements that preceded it? The analysis of the socio-genesis of a social field allows us to identify the historical conditions that made possible both theoretical formulations and the achievement of technical and social practices. Collective health, a product of transformations within the medical field, constituted a rupture in relation to preventive medicine and public health and hygiene, being part of a social medicine movement in Latin America that, in turn, had identification with European social medicine in the 19th century. Focused on the development of a social theory of health that would support the process of sanitary reform, collective health has been built as a space involving several fields: scientific, bureaucratic, and political. Thus, it brought together health professionals and social scientists from universities, health care services, and social movements. Its scientific subfield has developed, and the sanitary reform project has had several successes related to the organization of a unified health system, which has ensured universal coverage for the population in Brazil. It has incorporated into and dialogued with several reformist movements in international public health, such as health promotion and the pursuit of health equity. Its small relative autonomy stems from subordination to other dominant fields and its dependence on the state and governments. However, its consolidation corresponded to the strengthening of a pole focused on the collective and universal interest, where health is not understood as a commodity, but as a right of citizenship.

Article

Public Health Impact of Breastfeeding  

Colin Binns and Mi Kyung Lee

Breastfeeding is one of the best public health “buys” available for countries at all levels of development. In the first year of life, appropriate infant nutrition (exclusive breastfeeding to around 6 months) reduces infant mortality and hospital admissions by 50% or more. Early life nutrition has important influences, including on childhood illnesses, obesity, cognitive development, hospitalizations, and later chronic disease. Breastfeeding is consistent with the historical cultural practices of all societies, and its benefits of breastfeeding last a lifetime. While the development of infant formula has been of benefit to some infants, its inappropriate promotion has resulted in a decline of breastfeeding, and, as a result, health gains in many countries have not been as great as they could have been. The health benefits of breastfeeding will provide some protection against the effects of climate change, which will cause a decline in potable water supplies and increases in the incidence of some infections. Infant formula production has very high environmental costs, while breastfeeding as well as being the best infant feeding intervention also has very low environmental impact. An important part of the sustainable development agenda must be to promote breastfeeding and its benefits and to reverse the inappropriate promotion and use of infant formula.

Article

The Role of Historically Black Colleges and Universities in Advancing Health Equity  

Orlando L. Taylor, Nicole L. Retland, Briana Jeffreys, Elaine Meredith, Melissa E. Wynn, and Pamela L. Carter-Nolan

The end of the Civil War marked a period when America’s medical practitioners considered the Black populace to be unworthy of proper health care on par with that of its White populace. Although slavery had officially ended, its vestiges remained prevalent in the lives of formerly enslaved persons. Indeed, lingering health issues permeated the generations that have followed, such that diseases that are highly treatable have often resulted in premature illness and death. Historically, the health-care industry has even blamed the formerly enslaved and subsequent generations for their own health conditions. In the early post–Civil War years, state and local statutes legalizing segregation in the American South (known as the Jim Crow laws) cemented these views and perpetuated unfair and unequal health-care conditions. In more recent years, COVID-19 exacerbated an already dire situation, and a disproportionate share of illness and death has occurred among African Americans and other underrepresented masses. Historically Black colleges and universities (HBCUs) can lead the way in bringing some semblance of equality to this situation. Primarily increasing the fiscal resources of HBCUs so that they can further advance the education of a more diverse health-care workforce is a critical component for providing culturally sensitive health care for the nation. HBCUs already play a disproportionate role in these efforts andwill likely continue their role to effect much-needed change in the prevalence of treatable illnesses and deadly diseases among America’s Black population. While continuing their historic mission to educate the Black populace of the United States, resulting from generations of racial exclusionary and discriminatory practices by predominantly White institutions, HBCUs continue to provide compassionate culturally sensitive education in the public health-care field. Moreover, they provide real-time testimony for the nation’s higher education enterprise on how to provide equality in health-care education.

Article

Community Empowerment and Health Equity  

Jennie Popay

Empowerment features prominently in public health and health promotion policy and practice aimed at improving the social determinants of health that impact communities and groups that are experiencing disadvantage and discrimination. This raises two important questions. How should empowerment be understood from the perspective of health and health equity and how can public health practitioners support empowerment for greater health equity? Many contemporary definitions link empowerment to improvements in individual self-care and/or the adoption of “healthier” lifestyles. In contrast, from a health equity perspective community empowerment is understood as sociopolitical processes that engage with power dynamics and result in people bearing the brunt of social injustice exercising greater collective control over decisions and actions that impact their lives and health. There is growing evidence that increased collective control at the population level is associated with improved social determinants of health and population health outcomes. But alongside this, there is also evidence that many contemporary community interventions are not “empowering” for the people targeted and may actually be having negative impacts. To achieve more positive outcomes, existing frameworks need to be used to recenter power in the design, implementation, and evaluation of local community initiatives in the health field. In addition, health professionals and agencies must act to remove barriers to the empowerment of disadvantaged communities and groups. They can do this by taking experiential knowledge more seriously, by challenging processes that stigmatize disadvantaged groups, and by developing sustainable spaces for the authentic participation of lay communities of interest and place in decisions that have an impact on their lives.

Article

Urban Homelessness Policy in OECD Nations  

Charley E. Willison and Amanda I. Mauri

Homelessness is a public health challenge for modern governments. Homelessness emerged as a formal policy problem for rich nations in the mid- to late 20th century as nations developed stable economies and democracies, including housing and job markets, and social welfare mechanisms to protect citizens from disenfranchisement. In early 21st-century Organisation for Economic Co-operation and Development (OECD) nations, homelessness arises most often among at-risk or vulnerable populations, such as historically marginalized groups and/or persons with constrained access to welfare state mechanisms, such as immigrants or refugees. Thus, homelessness in OECD nations is very different from informal housing or mass poverty in poor nations and/or non-democratic regimes. Homelessness affects individual and population health, requiring complex policy solutions across multiple domains of health, as well as intergovernmental coordination. Policy responses to homelessness vary across OECD nations in their approach and efficacy. There are four key factors influencing how OECD nations respond to homelessness: (a) the strength and inclusivity of the welfare state; (b) degrees of decentralization in homeless policy governance; (c) the strength, capacity, and inclusivity of the health and behavioral healthcare systems; and (d) the role of federated structures in health and welfare state policy. Overall, nations with weaker welfare states and health/behavioral healthcare systems face greater risks of homelessness. The inclusivity of these systems also shapes who may be eligible for protection or experience homelessness. Local governments, especially those in large metropolitan areas, are the frontline providers of homelessness services. Yet local governments are constrained at both ends: Policies designed, delivered, and funded at larger units of government—such as welfare state provisions—influence many of the determinants of homelessness, such as housing, and the resources available to subnational actors to combat homelessness. Local actors are also constrained by the degree of decentralization. Devolution of homelessness policy to smaller units of government or even solely to nongovernmental actors, through federated mechanisms or decentralization, may create barriers to locally tailored solutions by perpetuating disparities across jurisdictions and/or constraining authority and resources necessary to design or deliver homeless policy.

Article

Advancements in Social Sciences Applied to Health in Latin America and the Caribbean  

Aurea Maria Zöllner Ianni and Patricia Tavares Ribeiro

The second half of the 20th century saw the development of social thought in health in Latin America and the Caribbean in which the social sciences had a central role. Such an innovative development was based on the understanding that health and disease are social processes that require the understanding of different health contexts. The origins of this development dates back to the renewal of medical teaching in Latin America, which had important support from the Pan-American Health Organization. The so-called field of social sciences in health then took shape, especially beginning in the 1970s and 1980s. The social sciences became part of teaching and assistance activities in social medicine and public health in many countries and contributed to consolidating postgraduate programs and networks of professors, researchers, professionals, and government agents who were active in public health actions and policies. Regarding Latin American realities, the issues of inequality in incidences of sickness and death and in the healthcare delivered to populations became relevant during this time. In close dialogue with relevant social groups, these actors have been significant in constructing responses to health problems in the region. Given the profound political, social, economic, environmental, and sanitary changes that took place in the transition from the 20th to the 21st century, social thought has attempted to meet the new empirical as well as theoretical and conceptual challenges to social sciences as applied to health. The analysis of the trajectory of this regional development, its details, advancements, and limits, is an important endeavor that should help to encourage suggestions toward bettering public health as well as fairness in these times of uncertainties and of new risks for humanity, as evidenced in an unprecedented way in the handling of the Covid-19 pandemic.

Article

Religion, Aging, and Public Health  

Jeff Levin and Ellen Idler

Religion, in both its personal and institutional forms, is a significant force influencing the health of populations across the life course. Decades of research have documented that expressions of faith and the practice of spiritual pursuits exhibit significantly protective effects for physical and mental health, psychological well-being, and population rates of morbidity, mortality, and disability. This finding has been observed across sociodemographic categories, across nations and cultures, across specific disease outcomes, and regardless of one’s religious affiliation. A salutary religious effect on health and well-being is especially apparent among older adults, but is also observed across generations and age cohorts. Moreover, this association has been persistently found for various religious indicators, including attendance at worship services, prayer and other private practices, subjective feelings of religiosity, and numerous measures of religious behaviors, attitudes, beliefs, and experiences. Finally, a protective or primary preventive effect of religion has been observed in clinical, epidemiologic, social, and behavioral studies, regardless of research design or methodology. Faith-based organizations also have contributed to the health of populations, in partnerships or alliances with medical institutions and public health agencies, many of these dating back many decades. Examples include congregational health promotion and disease prevention programs and community-wide interventions, especially targeting the health and well-being of older congregants and those in less well-resourced communities, as well as faith–health partnerships in healthcare delivery, public health policymaking, and legislative advocacy for healthcare reform. Religious denominations and institutions also play a substantial role in global health development throughout the world, individually and in partnership with national health ministries, transnational medical mission organizations, and established nongovernmental agencies. These efforts focus on a wide range of goals and objectives, including building public health infrastructure, addressing ongoing environmental health needs, and responding to acute public health challenges and crises, such as infectious disease outbreaks. Constituencies include at-risk populations and cohorts throughout the life course, and programming ranges from perinatal care to maternal and child healthcare to geriatric medicine.

Article

The People’s Health Movement  

Ravi Narayan, Claudio Schuftan, Brendan Donegan, Thelma Narayan, and Rajeev B. R.

The People’s Health Movement (PHM) is a vibrant global network bringing together grass-roots health activists, public interest civil society organizations, issue-based networks, academic institutions, and individuals from around the world, particularly the Global South. Since its inception in 2000, the PHM has played a significant role in revitalizing Health for All (HFA) initiatives, as well as addressing the underlying social and political determinants of health with a social justice perspective, at global, national, and local levels. The PHM is part of a global social movement—the movement for health. For more than a century, people across the world have been expressing doubts about a narrowly medical vision of health care, and calling for focus on the links between poor health and social injustice, oppression, exploitation, and domination. The PHM grew out of engagement with the World Health Organization by a number of existing civil society networks and associations. Having recognized the need for a larger coalition, representatives of eight networks and institutions formed an international organizing committee to facilitate the first global People’s Health Assembly in Savar, Bangladesh, in the year 2000. The eight groups were the International People’s Health Council, Consumer International, Health Action International, the Third World Network, the Asian Community Health Action Network, the Women’s Global Network for Reproductive Rights, the Dag Hammarskjold Foundation and Gonoshasthaya Kendra. All these groups consistently raised and opposed the selectivization and verticalization of Primary Health Care (PHC) that followed Alma Ata leading to what was called Selective PHC (i.e., not the original comprehensive PHC). These groups came together to organize the committee for the first People’s Health Assembly and then to form the Charter Committee that led to the People’s Health Charter, which finally led to the actual PHM. Within PHM, members engage critically and constructively in health initiatives, health policy critique, and formulation, thus advancing people’s demands. The PHM builds capacities of community activists to participate in monitoring health-related policies, the governance of health systems, and keeping comprehensive PHC as a central strategy in world debate. The PHM ensures that people’s voices become part of decision-making processes. The PHM has an evolving presence in over 80 countries worldwide, consisting of groups of individuals and/or well-established PHM circles with their own governance and information-sharing mechanisms. It additionally operates through issue-based circles across countries.

Article

Firearm Injuries and Public Health  

Linda Dahlberg, Alexander Butchart, James Mercy, and Thomas Simon

An important function of public health is to prevent injuries or to lessen their impact when they occur. An estimated 251,000 people worldwide die each year from a firearm-related death and many more suffer nonfatal injuries with consequences that can last a lifetime. Firearm injuries, which include those that are intentionally self-inflicted, unintentional, or from an act of interpersonal violence, are heavily concentrated in the Americas, driven largely by firearm homicides. Firearm-related deaths and injuries disproportionately impact males and younger populations and are associated with factors such as access, substance use, adverse childhood experiences, involvement in high-risk social networks, drug trafficking, density of alcohol outlets, and neighborhood and social disadvantage. While progress is being made to understand firearm injuries and how to effectively prevent them, much more needs to be done to improve the availability and timeliness of data; apply the knowledge that is generated to effectively reduce firearm-related injuries, deaths, and costs; strengthen the scientific infrastructure; and move countries closer to achieving the violence-related targets in the 2030 Sustainable Development Goals.

Article

Public Health and the UN Sustainable Development Goals  

Claire E. Brolan

The COVID-19 crisis—the most catastrophic international public health emergency since the Spanish influenza 100 years ago—provides impetus to review the significance of public and global health in the context of Sustainable Development Goal (SDG) achievement. When countries unanimously adopted the 17 SDGs in September 2015, stakeholders had mixed views on global health goal SDG 3 (Good Health and Well-Being). Concern arose over the feasibility of achieving SDG 3 by 2030 when countries pursued its nine targets and four means of implementation with sixteen other ambitious global goals. Nonetheless, health surely cuts across the SDG framework: for instance, the underlying health determinants are expressed in many goals as is urban and planetary health. Although health (and its different constructions) is central to overall SDG achievement, SDG success depends on a paradigm shift toward whole-of-government policy and planning. Indeed, the 2030 Agenda echoes calls for a Health in All Policies (HiAP) approach to public health programming. This depends on another paradigm shift in public health tertiary education, practitioner training, and policy skills development within and beyond ministries of health. Added to this are the underlying problematics around SDG health financing, human resources for health, health target and indicator localization for equitable country responses that leave no one behind, strengthening civil registration and vital statistics systems for inclusive and accountable health implementation, and the sidelining of human rights from SDG metrics. While COVID-19 has derailed SDG efforts, it could also be the ultimate game changer for intergenerational human and environmental health transformation. Yet strong global health governance and rights-based approaches remain key.

Article

Cities, Health, and Intersectorialities  

Marco Akerman, Gabriela Murillo Sancho, and Samuel Jorge Moysés

Cities have been considered in many places and times a cornerstone of innovation and wealth creation in society, fostering the privilege of more comfortable lives, with existential dignity and producing healthier generations, as well as an important source of pathogenic determinants. The concept of health in cities and its intersectoral relationships unfolds in a new era of urban sociability, mediated by technologies that connect citizens in social networks and in many services provided by digital platforms. All changes have their respective economic and cost-effective impacts. Healthy cities, or smart and sustainable cities, intend to express well-being and the fulfillment of good health among people who enjoy social inclusion, effectively using policies and services concentrated in the most developed cities. However, the extent of the challenges that permeate the current urban civilization cycle is also related to the social inequities manifested in health problems and public mismanagement in cities around the world. It is necessary to think about the integration of the intersectoral habitus of conceptualizing health promotion, considering all its inclusive scope of diversity, without leaving any social and identity group out, with a view to the full realization of healthy cities. There is an ethical, political, and cultural imperative to urgently adopt an ecosocial approach to promoting the health of populations in cities around the world, recognizing the interactions between ecological determinants (all planetary systems and living species) and the very internal dispositions of what constitutes human health.

Article

Disability and Rural Health  

Rayna Sage, Genna Mashinchi, and Craig Ravesloot

The ways in which disability impacts people and their health in rural places are a result of the interaction between the person and the rural environment in which they live. Disability is defined as ongoing difficulties engaging in daily activities and social roles due to physical or mental conditions. The United Nations Convention on the Rights of People with Disabilities (UN-CRPD) implemented policy in 2008 that recognized that disabled people are worthy of autonomy and dignity. The social and physical environment are constructed in ableist ways that make it difficult for people with disabilities to realize their independence and this is particularly true in many rural places. Person–environment fit and urbanormativity (the favoring of urban spaces at the expense of rural ones) are important concepts in understanding the experiences of rural disabled people. There is little existing research regarding the epidemiology of disability and rural health, but rural people report higher and earlier rates of disability than urban people and rural places have higher rates of older adults with higher rates of disability. Furthermore, rural people with disabilities experience various secondary health conditions and higher rates of mortality compared to urban people with disabilties. The lack of access to health care and advocacy help explain some of the differences in health outcomes when comparing rural and urban people. The disability rights movement led to the creation of different types of advocacy and service organizations across the globe to address these disparities. An important way to improve the experiences and health of rural people with disabilities is to ensure they have access to quality and dependable in-home services and community-based rehabilitation, which currently tend to be under-funded with dramatic worker shortages in many rural places. A final promising approach to improving the health of rural disabled people is through evidence-based health promotion programming that targets early indicators of health problemsand recovery and health-sustaining efforts following a health problem.

Article

Urban Health and Healthy Cities Today  

Evelyne de Leeuw, Jean Simos, and Julien Forbat

The authors of this article purport that for current understanding of Healthy Cities it is useful to appreciate other global networks of local governments and communities. In a context where the local level is increasingly acknowledged as decisive in designing and implementing policies capable of tackling global threats such as climate change and their health-related aspects, understanding how thousands of cities across the world have decided to respond to those challenges appears essential. Starting with the concept of “healthy cities” in the 1980s, the trend toward promoting better living conditions in urban settings has rapidly grown to encompass today countless “theme cities” networks. Each network tends to focus on more or less specific issues related to well-being and quality of life. These various networks are thus not limited to more or less competing labels (Healthy Cities, Smart Cities, or Inclusive Cities, for instance), but entail significant differences in their approaches to the promotion of health in the urban context. The aim of this article is to systematically typify these “theme cities.” A typology of “theme cities” networks has several objectives. First, it describes the health aspects that are considered by the networks. Are they adopting a systemic perspective on all health determinants, such as Healthy Cities, or are they focusing on “hardware” determinants like Smart Cities? Second, it highlights the key characteristics of the networks. For instance, are they pushing for technological solutions to health problems, like Smart Cities, or are they aiming at strengthening communities in order to mitigate their detrimental effects, like Creative Cities? Third, the typology has the potential to be used as an analytical tool, for example, in the comparison of the results obtained by different types of networks in urban health issues. Finally, the typology offers a tool to enhance both transparency and participation in the policymaking process taking place when selecting and engaging in a network. Indeed, by clarifying the terms of the debate, decisions can be made more explicit and achieve a greater level of congruence with the overall objectives of the city. Indeed, Healthy Cities today need to make alliances with other theme networks, and this typology gives the keys to find which networks are the “natural best allies,” avoiding mutually harmful antagonisms. In that sense, the typology developed should be of interest to any actor involved in health promotion at the city level, whether in an existing “theme cities” policy process or as willing to participate in such a program, and to scholars interested in better understanding the main drivers of “theme cities” networks, a rapidly growing field of study.

Article

Migrant Health in Refugee Camps: A Neglected Public Health Issue  

Manuela Valenti

There are 1 billion migrants in the world today, which means that one in seven of the world’s population are migrants. Of these, 272 million are international migrants and 763 million are internal migrants. It is estimated that around 70 million of the world’s migrants, both internal and international, have been forcibly displaced. Many things force people to leave their homes in search of a better future: war, poverty, persecution, climate change, desertification, urbanization, globalization, inequality, and lack of job prospects. Migrants remain among the most vulnerable members of society even when their living conditions improve after migration. Migrant women and children are a particularly vulnerable group and have a great need for basic and preventive health care. Many refugees and migrants are young and in good health, but hard living conditions and difficulty accessing basic health care can affect their state of health. Many of them face inhuman journeys during migration and live in refugee camps with very low standards of hygiene; when they find a job, they are often exploited. All these things can also affect their mental health. Migrants struggle with similar challenges as other marginalized groups when it comes to access to health care, but they face the additional barriers of mobility, language barriers, cultural differences, lack of familiarity with local health care services, and limited eligibility for publicly and privately funded health care. Governments should provide affordable preventive and basic health care to refugees and migrants not only because it is a human right but also because in the long term it can lower the costs of the whole health care system.

Article

Global Public Health Impact of Vaccines in Children  

Peter McIntyre and Tony Walls

From the first vaccine (cowpox, developed by Edward Jenner in 1796), more than 100 years elapsed before additional vaccines for broad population use (diphtheria toxoid, tetanus toxoid, and whole cell pertussis) became available between 1920 and 1940. Then followed inactivated polio vaccine in the 1950s, and live attenuated vaccines for measles, mumps, rubella, and polio in the 1960s. In 1979, global elimination of smallpox was formally certified, with the last human case occurring in Somalia, almost 200 years after Jenner administered cowpox vaccine to James Phipps. In 2019, global elimination is tantalizingly close for maternal and neonatal tetanus and polio. Despite recent outbreaks, elimination has also been achieved at country and regional levels for measles and rubella and, if achieved globally, will offer, as it has for smallpox, large reductions in child mortality and morbidity and in health system costs. Short of elimination, it is important to define the public health impact of vaccines broadly and at the population level. These broader impacts include benefits to families flowing from prevention of long-term sequelae of infection in children, and to populations and health systems from reduced transmission of infection. Importantly, well-delivered vaccination programs will have a substantial impact by improving equality in health outcomes across populations. Broader impacts include reductions in syndromic disease beyond laboratory-proven infection (e.g., diarrhea and pneumonia), indirect reductions in disease in those not immunized (within and beyond age cohorts targeted by vaccine programs), and improvements in other health services driven by the infrastructure for vaccine delivery. Measurement of these broader impacts can be challenging and must also acknowledge the potential for trade-offs, such as replacement disease due to non-vaccine strains, as documented for pneumococcal infection. The realization of the benefits of vaccines globally for all children began with the Expanded Program on Immunization (EPI) initiated by the World Health Organization (WHO) in 1974. The EPI focused on improving coverage of six already available but grossly underutilized vaccines—diphtheria–tetanus–pertussis (DTP), polio, measles, and Bacille Calmette–Guerin (BCG). Through the EPI, estimated global coverage for 3 doses of DTP increased from around 20% to over 85%. Subsequent to the EPI, the Global Alliance for Vaccines and Immunization (GAVI), the Global Immunization Vision and Strategy (GIVS), and, most recently, the Global Vaccine Action Plan (GVAP) have aimed to improve access to additional vaccines in the poorest countries. These include Haemophilus influenzae type b (Hib), hepatitis B, pneumococcal conjugate, rotavirus, and human papillomavirus (HPV) vaccines, all introduced in high-income countries from the 1990s. In this chapter, the scope and methodological issues in measuring public health impact are reviewed, and estimates of the global public health impact of individual vaccines in children summarized, concluding with potential future benefits to global child health from expanded maternal vaccination and vaccines under development.

Article

Infectious Diseases Among Migrant Populations  

Silvia Declich, Maria Grazia Dente, Christina Greenaway, and Francesco Castelli

Increasing human mobility, of which migration is a component, is a key driver of microorganism circulation. Migration is a minor component of all human mobility, with most movement due to international tourism, travel for work, business, or study, and military operations abroad. Migration flows from southern low-income countries to the industrialized north have steadily increased as a consequences of a complex array of distal and proximal factors such as economic inequality, climate change, political turbulence, war and persecution, and family reunification. This has raised concerns about the potential transmission and reintroduction of microorganisms and infectious diseases into high-income host countries from migrants with asymptomatic infections such as tuberculosis, HIV, viral hepatitis, malaria, Chagas disease, and arboviral infections. These factors contribute to the mounting hostile attitude sometimes observed in receiving countries and deserve careful scientific assessment to inform policies and interventions. The available evidence does not support the hypothesis that migrants constitute a relevant infectious public health risk for the local population, although careful epidemiological surveillance is mandatory, especially where competent vectors for specific infection are present in the destination area, where certain diseases may potentially be introduced or reintroduced. The greatest risk of infectious diseases is to the migrants themselves due to increased risk of exposure within their own communities and from the burden of undetected and untreated infections caused by marginalization and poor living conditions. The health conditions vary at the different stages of settlement and interventions need to be tailored accordingly. In the early arrival phase the main health concerns are psychological, traumatic, and chronic conditions. Crowded unhygienic living conditions often experienced by migrants in reception camps coupled with low vaccination rate may facilitate the transmission of respiratory or gastrointestinal infections or vaccine-preventable diseases. After resettlement, undetected infections and the lack of access to health care due to social marginalization may lead to the reactivation or progression of infections such as tuberculosis, viral hepatitis, HIV, and chronic helminthiasis. These outcomes could be prevented through screening and treatment and would benefit both migrants and the host populations. Pretravel interventions that increase the awareness of the possible infectious risks in their countries of origin are critical to decrease travel-related infection among visiting friends and relatives, especially those traveling with children. Migrant-friendly health systems that ensure prompt access to diagnosis and treatment, regardless of legal status, are the best interventions to limit the burden and transmission of infections in this population.

Article

Regional Studies of Indigenous Health: Europe and Russia  

Peter Bjerregaard

The indigenous peoples of Europe and Russia comprise the Inuit in Greenland, the Sami in northern Norway, Sweden, Finland and Russia and forty officially recognized ethnic minority groups in northern Russia plus a few larger-population indigenous peoples in Russia. While the health of the Inuit and Sami has been well studied, information about the health of the indigenous peoples of Russia is considerably scarcer. The overall health of the Sami is in many aspects not very different from that of their non-indigenous neighbors in northern Scandinavia; the health of the Inuit is similar across Greenland and North America and far less favorable than that of Denmark, southern Canada and the lower 48 American states, respectively; the health of the indigenous peoples of the Russian north is poor, partly due to poverty and alcohol.

Article

Health Workforce: Situations and Challenges in Latin America, the Caribbean, and Brazil  

Maria Helena Machado, Renato Penha de Oliveira Santos, Pedro Miguel dos Santos Neto, Vanessa Gabrielle Diniz Santana, and Francisco Eduardo de Campos

The greatest challenge in the development of universal health systems worldwide is to increase organization, training, and regulation of the health workforce (HWF). To accomplish this, the World Health Organization (WHO) has pointed out several strategies utilized since the beginning of the 2000s. One of the world regions with the greatest internal HWF disparities is the Americas, more specifically Latin America and the Caribbean. Brazil is another of the countries in this region that presents great inequities in its HWF distribution, although its Unified Health System (Sistema Único de Saúde, or SUS), created after 1988, is one of the largest universal health systems in the world. It is worth noting that Latin America, the Caribbean, and Brazil historically have high levels of social inequality and have recently become regions severely affected by the COVID-19 pandemic. Despite some advances in the formation and distribution of HWF in Latin America and the Caribbean in the last 10 years, structural problems persist in the health systems of several countries in this region, such as Brazil. The COVID-19 pandemic aggravated some problems such as the distribution of specialized health workers in intensive care units and the precarious working conditions in several public health services that were organized to face the pandemic.

Article

Child Development, Major Disruptive Events—Public Health Implications  

Tracy Vaillancourt and Peter Szatmari

The COVID-19 pandemic has upended nearly all the safeguarding systems in the lives of children and youth, such as family life, school, extracurricular activities, sports, unstructured social opportunities, health care, and church. With many of the typical promotive and protective factors disrupted all at once, and for so long, the mental health of children and youth has deteriorated in many areas, but not all, and for many children and youth, but not all. It is important to acknowledge, however, that the mental health of children and youth was in crisis before the pandemic, with 1 in 7 children and youth worldwide having a mental disorder. Given the continued decline in this area of health, children and youth may well be on the cusp of a “generational catastrophe” that could involve lasting harms if immediate action is not taken. Of particular concern are marginalized and vulnerable children and youth—they are the ones unduly enduring the brunt of this global crisis. Accordingly, child and youth mental health recovery must be prioritized, along with the reduction of inequity within and across countries. A commitment to public health strategies that never include harming children and youth as a tolerated side effect must also be made.

Article

Digital Public Health: Quality, Interoperability and Capability Maturity  

Siaw-Teng Liaw

Digitalization was accelerated to address the access, safety and quality needs of health professionals and citizens during care provision in the presence of human, animal and environmental vectors of pandemic infections. Digital transformation will harness cloud computing, artificial intelligence (AI), data networks and personalized digital agents, sensors, and visualization tools to monitor and enhance the care of individuals, populations and communities. A sociotechnical, multidisciplinary, and enterprise-wide approach is essential to improve the quintuple aims of cost-effectiveness, provider and patient well-being, and equity. Digitally competent health professionals and digitally mature health organizations are necessary to produce and use high-quality interoperable digital data and technologies to improve decisions and practice. The maturity of five essential digital health foundations (infrastructure, tools/agents, readiness to share information, enablers of trust and adoption, and quality improvement) is assessed across the micro–meso–macro continuum. The Digital Health Profile and Maturity Assessment Toolkit Maturity Model illustrates a sociotechnical capability maturity approach to assess how organizations manage, govern, improve, and sustain the ethical and safe production, use and sharing of digital health tools and data in the real world. The linkage and convergence of real-word data (RWD) from public health, clinical and managerial practice highlights potential cost-efficiencies in integrated data collection, reporting, aggregation, analysis, and use. Challenges include access, quality, and interoperability of RWD and tools. AI-driven data analytics is increasingly being used, despite misgivings about trustworthiness, biases and fairness of software agents, algorithms, and training data sets. The sociotechnical approach emphasizes leadership, inclusive governance, mutual trust, and reciprocity within a cocreation paradigm; communities of learning and practice operating within regulatory frameworks that promote quality, safety, and equitable access to digital tools and data; quality improvement and professional development programs aimed to improve digital health maturity; and science and digital health diplomacy to harmonize the multiplicity of actors and technology in digital public health ecosystems and global supply chains. Learning organizations that “think small and big simultaneously” within a standards-based cocreation paradigm will create the digital assets and social capital necessary for the national and global digital public health enterprise.