Mainstreaming nature in US federal policy.

Integrated policy changes must be cross-sectoral, appropriate, strategic, and evidence-based.

Examining the Contextual Factors Influencing Intersectoral Action for the SDGs: Insights From Canadian Federal Policy Leaders.

BACKGROUND: The interdependent and intersecting nature of the Sustainable Development Goals (SDGs) require collaboration across government sectors, and it is likely that departments with few past interactions will find themselves engaged in joint missions on SDG projects. Intersectoral action (IA) is becoming a common framework for different sectors to work together. Understanding the factors in the environment external to policy teams enacting IA is crucial for making progress on the SDGs. METHODS: Interviews [n=17] with senior public servants leading SDG work in nine departments in the federal government of Canada were conducted to elicit information about issues affecting how departments engage in IA for the SDGs. Transcripts were coded based on a set of factors identified in a background review of 20 documents related to Canada's progress on SDGs. Iterative group thematic analysis by the authors illuminated a set of domestic and global contextual factors affecting IA processes for the SDGs. RESULTS: The mechanisms for successful IA were identified as facilitative governance, leadership by a central coordinating office, supportive staff, flexible and clear reporting structures, adequate resources, and targeted skills development focused on collaboration and cross-sector learning. Factors that affect IA positively include alignment of the SDG agenda with domestic and global political priorities, and the co-occurrence of social issues such as Indigenous rights and gender equity that raise awareness of and support for related SDGs. Factors that affect IA negatively include competing conceptual frameworks for approaching shared priorities, lack of capacity for "big picture" thinking among bureaucratic staff, and global disruptions that shift national priorities away from the SDGs. CONCLUSION: IA is becoming a normal way of working on problems that cross otherwise separate government accountabilities. The success of these collaborations can be impacted by contextual factors beyond any one department's control.

Can 'cow flu' be eliminated-or is it too late?

Feeble government response and lack of industry cooperation hamper U.S. control efforts.

Upholding Tribal Sovereignty in Federal, State, and Local Emergency Vaccine Distribution Plans.

Cross jurisdictional collaboration efforts and emergency vaccine plans that are consistent with Tribal sovereignty are essential to public health emergency preparedness. The widespread adoption of clearly written federal, state, and local vaccine plans that address fundamental assumptions in vaccine distribution to Tribal nations is imperative for future pandemic response.

Federal transfers to municipalities through parliamentary amendments: implications for SUS funding. / Transferências federais por emendas parlamentares aos municípios: implicações para o financiamento do SUS.

The present article analyzes the transfers from parliamentary amendments by the Ministry of Health to municipalities to finance public health actions and services from 2015 to 2021. A descriptive and exploratory study was carried out with secondary data, including all Brazilian cities. Resources from amendments showed an increase, particularly from 2018 onwards, indicating the expansion of their relevance for financing SUS. From 2016 to 2021, over 80% was allocated to municipalities, representing 9.5% of all federal transfers, with 91.2% for operational expenses. Transfers from amendments differ from regular transfers due to greater instability and per capita variation among the amounts collected by municipalities and due to the fact that they allocate most resources to the Northeast and primary care to the detriment of the Southeast and medium and high complexity care. These transfers represent a differentiated modality of resource allocation in SUS that produces new distortions and asymmetries, with implications for intergovernmental relations, as well as between the executive and legislative powers, increasing the risk of the discontinuity of actions and services and imposing challenges for the municipal management.

O artigo tem como objetivo analisar as transferências por emendas parlamentares do Ministério da Saúde aos municípios para o financiamento de ações e serviços públicos de saúde, de 2015 a 2021. Foi realizado estudo descritivo e exploratório com dados secundários, abrangendo a totalidade de municípios brasileiros. Os recursos provenientes de emendas apresentaram aumento, em especial a partir de 2018, indicando a expansão de sua relevância para o financiamento do SUS. No período de 2016 a 2021, mais de 80% foram alocados aos municípios, representando 9,5% dos repasses federais, com 91,2% de natureza de custeio. As transferências por emendas diferem dos repasses regulares por possuir maior instabilidade e variação per capita entre os montantes captados pelos municípios, e por destinar a maior parte dos recursos ao Nordeste e à atenção primária, em detrimento do Sudeste e da média e alta complexidade. Configura-se uma modalidade diferenciada de alocação de recursos no SUS que produz novas distorções e assimetrias, com implicações para as relações intergovernamentais e entre os poderes executivo e legislativo, ampliando o risco de descontinuidade de ações e serviços e impondo desafios para as gestões municipais.

United States Federal Policies Contributing to Health and Health Care Inequities in Puerto Rico.

Puerto Rico, a territory of the United States since 1898, has recently experienced an increasing frequency and intensity of natural disasters and public health emergencies. In 2022, Hurricane Fiona became the latest storm to attract media attention and cast a light on Puerto Rico's deteriorating conditions, including infrastructural failings, health care provider shortages, and high levels of chronic illness. Although recent events have been uniquely devastating, decades of inequitable US federal policy practices have fueled the persistence of health inequities in the territory. Here we demonstrate how existing health and health care inequities in Puerto Rico have been exacerbated by compounding disasters but are rooted in the differential treatment of the territory under US federal policies. Specifically, we focus on the unequal US Federal Emergency Management Agency response to disasters in the territory, the lack of parity in federal Medicaid funding for Puerto Rico, and Puerto Rico's limited political power as a territory of the United States. We also provide empirically supported policy recommendations aimed at reducing health and health care inequities in the often-forgotten US territory of Puerto Rico. (Am J Public Health. 2024;114(S6):S478-S484. https://doi.org/10.2105/AJPH.2024.307585) [Formula: see text].

The relationship between trust in federal oversight of vaccine safety and willingness to participate in COVID-19 clinical trials: a repeated measures study of Philadelphia residents (September 2021 - March 2023).

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) pandemic precipitated an urgent need for clinical trials to discover safe and efficacious treatments. We examined how COVID-19 experiences, clinical trial awareness, and trust in the vaccine safety process were associated with willingness to participate in COVID-19 clinical trials. The objective was to investigate the relationship between trust in federal oversight of vaccine safety and willingness to participate in clinical trials for COVID-19 treatment across four distinct time points over an 18-month period during the COVID-19 pandemic. METHODS: We used four waves of data collected from September 2021 to March 2023 among 582 Philadelphia residents (with a missing data rate of 0.9%). Generalized estimating equations estimated the association between willingness to participate in COVID-19 clinical trials and participants' trust in the federal government's oversight of COVID-19 vaccine safety, COVID-19-related variables (COVID-19 related health challenges, history of COVID-19 infection), awareness of clinical trials and how to enroll in them, and sociodemographic characteristics (age, race/ethnicity, sexual orientation, gender, parental status, education, and insurance). RESULTS: On average, willingness to participate in a COVID-19 clinical trial was positively associated with greater trust in the federal government's oversight of vaccine safety [ß = 0.34, 95% confidence interval (CI): 0.15-0.53], having COVID-19 (ß = 0.40, 95% CI: 0.08-0.73), awareness of clinical trials (ß = 0.38, 95% CI: 0.04-0.73), and knowledge of how to enroll (ß = 0.83, 95% CI: 0.44-1.23). Among sociodemographic characteristics, race/ethnicity (p = 0.001) and gender (p = 0.018) were identified as predictors for COVID-19 trial willingness. CONCLUSION: Willingness to participate in clinical trials may be bolstered by strengthening the public's trust in the federal government's role within vaccine safety oversight, increasing the perceived relevance of clinical trials to individuals' health and well-being, and offering tailored information to educate diverse communities about ongoing trials and how to enroll in them.

Post-January 6th deplatforming reduced the reach of misinformation on Twitter.

The social media platforms of the twenty-first century have an enormous role in regulating speech in the USA and worldwide1. However, there has been little research on platform-wide interventions on speech2,3. Here we evaluate the effect of the decision by Twitter to suddenly deplatform 70,000 misinformation traffickers in response to the violence at the US Capitol on 6 January 2021 (a series of events commonly known as and referred to here as 'January 6th'). Using a panel of more than 500,000 active Twitter users4,5 and natural experimental designs6,7, we evaluate the effects of this intervention on the circulation of misinformation on Twitter. We show that the intervention reduced circulation of misinformation by the deplatformed users as well as by those who followed the deplatformed users, though we cannot identify the magnitude of the causal estimates owing to the co-occurrence of the deplatforming intervention with the events surrounding January 6th. We also find that many of the misinformation traffickers who were not deplatformed left Twitter following the intervention. The results inform the historical record surrounding the insurrection, a momentous event in US history, and indicate the capacity of social media platforms to control the circulation of misinformation, and more generally to regulate public discourse.

The role of hesitancy and infrastructure in the equity and efficiency of COVID-19 vaccine administration.

After the first COVID-19 vaccines received emergency use authorization from the U.S. FDA in December 2020, U.S. states employed vaccine eligibility and administration plans (VEAPs) that determined when subgroups of residents would become eligible to receive the vaccine while the vaccine supply was still limited. During the implementation of these plans, public concern grew over whether the VEAPs and vaccine allocations from the federal government were resulting in an equitable and efficient vaccine distribution. In this study, we collected data on five states' VEAPs, federal vaccine allocations, vaccine administration, and vaccine hesitancy to assess the equity of vaccine access and vaccine administration efficiency that manifested during the campaign. Our results suggest that residents in states which opened eligibility to the vaccine sooner had more competition among residents to receive the vaccine than occurred in other states. Regardless of states' VEAPs, there was a consistent inefficiency in vaccine administration among all five states that could be attributed to both state and federal infrastructure deficits. A closer examination revealed a misalignment between federal vaccine allocations and the total eligible population in the states throughout the campaign, even when accounting for hesitancy. We conclude that in order to maximize the efficiency of future mass-vaccination campaigns, the federal and state governments should design adaptable allocation policies and eligibility plans that better match the true, real-time supply and demand for vaccines by accounting for vaccine hesitancy and manufacturing capacity. Further, we discuss the challenges of implementing such strategies.