Syndemic health crises-The growing role of National Public Health Institutes in shaping a coordinated response.

Countries across the world are experiencing syndemic health crises where infectious pathogens including COVID-19 interact with epidemics of communicable and non-communicable diseases. Combined with war, environmental instability and the effects of soaring inflation, a public health crisis has emerged requiring an integrated response. Increasingly, national public health institutes (NPHIs) are at the forefront of leading this, as demonstrated at the 2022 Annual Meeting of the International Association of National Public Health Institutes (IANPHI). These effects are particularly evident where conflict is exacerbating health crises in Ukraine and Somalia. In Ukraine, medical and public health workers have been killed and infrastructure destroyed, which require major efforts to rebuild to international standards. In Somalia, these crises are magnified by the effects of climate change, leading to greater food insecurity, heat-related deaths and famine. National public health institutes are crucial in these contexts and many others to support integrated political responses where health challenges span local, national and international levels and involve multiple stakeholders. This can be seen in strengthening of Integrated Disease Surveillance and work towards the Sustainable Development Goals. National public health institutes also provide integration through the international system, working jointly to build national capacities to deliver essential public health functions. In this context, the 2022 IANPHI Annual meeting agreed the Stockholm Statement, highlighting the role that NPHIs play in tackling the causes and effects of interconnected global and local challenges to public health. This represents an important step in addressing complex health crises and syndemics which require whole-of-society responses, with NPHIs uniquely placed to work across sectors and provide system leadership in response.

African National Public Health Institutes Responses to COVID-19: Innovations, Systems Changes, and Challenges.

National public health institutes (NPHIs)-science-based governmental agencies typically part of, or closely aligned with, ministries of health-have played a critical part in many countries' responses to the COVID-19 pandemic. Through listening sessions with NPHI leadership, we captured the experiences of NPHIs in Africa. Our research was further supplemented by a review of the literature. To address issues related to COVID-19, NPHIs in Africa developed a variety of innovative approaches, such as working with the private sector to procure and manage vital supplies and address key information needs. Creative uses of technology, including virtual training and messaging from drones, contributed to sharing information and battling misinformation. Positive impacts of the pandemic response include increased laboratory capacity in many countries, modernized surveillance systems, and strengthened public-private partnerships; much of this enhanced capacity is expected to persist beyond the pandemic. However, several challenges remain, including the lack of staff trained in areas like bioinformatics (essential for genomic analysis) and the need for sustained relationships and data sharing between NPHIs and agencies not traditionally considered public health (eg, those related to border crossings), as well as the impact of the pandemic on prevention and control of non-COVID-19 conditions-both infectious and noncommunicable. Participants in the listening sessions also highlighted concerns about inequities in access to, and quality of, the public health services and clinical care with resultant disproportionate impact of the pandemic on certain populations. COVID-19 responses and challenges highlight the need for continued investment to strengthen NPHIs and public health infrastructure to address longstanding deficiencies and ensure preparedness for the next public health crisis.

[Horizon scanning in preparation for future health threats: a pilot exercise conducted by the French Institute for Public Health Surveillance in 2014]. / La veille prospective, une démarche de préparation aux futures menaces de la santé publique : exercice mené à l'Institut de veille sanitaire en 2014.

Background: Health surveillance is a reactive process, with no real hindsight for dealing with signals and alerts. It may fail to detect more radical changes with a major medium-term or long-term impact on public health. To increase proactivity, the French Institute for Public Health Surveillance has opted for a prospective monitoring approach.Methods: Several steps were necessary: 1) Identification of public health determinants. 2) Identification of key variables based on a combination of determinants. Variables were classified into three groups (health event trigger factors, dissemination factors and response factors) and were submitted to future development assumptions. 3) Identification, in each of the three groups, of micro-scenarios derived from variable trends. 4) Identification of macro-scenarios, each built from the three micro-scenarios for each of the three groups. 5) Identification of issues for the future of public health.Results: The exercise identified 22 key variables, 17 micro-scenarios and 5 macro-scenarios. The topics retained relate to issues on social and territorial health inequalities, health burden, individual and collective responsibilities in terms of health, ethical aspects, emerging phenomena, 'Big data', data mining, new health technologies, interlocking of analysis scales.Conclusions: The approach presented here guides the programming of activities of a health safety agency, particularly for monitoring and surveillance. By describing possible future scenarios, health surveillance can help decision-makers to influence the context towards one or more favourable futures.

Risk management measures for chemicals in consumer products: documentation, assessment, and communication across the supply chain.

This paper analyzes the way risk management measures (RMMs) for consumer products have been used to date in authority and industry risk assessments. A working concept for consumer product RMMs is developed, aimed at controlling, limiting or avoiding exposures, and helping to insure the safe use (or handling) of a substance as part of a consumer product. Particular focus is placed on new requirements introduced by REACH (registration, evaluation, and authorization of chemicals). A RMMs categorization approach is also developed, dividing consumer product RMMs into those that are product integrated and those that are communicated to consumers. For each of these categories, RMMs for normal use, accidental use or misuse need to be distinguished. The level of detail for documenting, assessing and communicating RMMs across supply chains can vary, depending on the type of the assessment (tiered approach). Information on RMMs was collected from published sources to demonstrate that a taxonomical approach using standard descriptors for RMMs libraries is needed for effective information exchange across supply chains.