RESUMO
Public health laws and policies are uniquely able to mitigate the adverse and inequitable health impacts of climate change. This article summarizes some key considerations in developing such laws and policies and a variety of approaches local public health departments are using to increase climate resilience and health equity.
Assuntos
Mudança Climática , Equidade em Saúde , Política de Saúde , Governo Local , Saúde Pública , Equidade em Saúde/legislação & jurisprudência , Humanos , Política de Saúde/legislação & jurisprudência , Saúde Pública/legislação & jurisprudência , Estados Unidos , Administração em Saúde Pública/legislação & jurisprudênciaRESUMO
During public health emergencies, the work of prevention and control must be normalised, and coordination between economic development and epidemic prevention is crucial. However, in China, there is a lack of research on participatory governance in public health emergencies, particularly from a legal perspective. Existing studies are insufficient in terms of using legal texts and exploring legal governance in a normative sense, and there is an inadequate in-depth exploration of issues such as the legitimacy, path, motivation, and other aspects of participation. This article addresses these gaps by analysing the issues of participatory governance in public health emergencies from a legal perspective, using practical cases as examples. The research has shown that there are significant differences among the three types of organisations regarding their internal motivation, external incentives, and legal basis, and therefore it is necessary to distinguish different participation paths. Finally, we propose several measures to promote the active and sustained participation of organisation in governance, including cultivating the ability of organisations, emphasising organizational demands, seeking consensus, strengthening the guiding role of legislation, and broadening the channels of engagement.
Assuntos
Estudos de Casos Organizacionais , China , Humanos , Emergências , Saúde Pública/legislação & jurisprudência , Administração em Saúde Pública/legislação & jurisprudência , Participação da Comunidade/métodosRESUMO
Societies generally have reacted to deadly epidemics by strengthening health systems, including laws. Under American federalism (the constitutional division of power between states and the federal government), individual states hold primary public health powers. State legislatures have historically granted health officials wide-ranging authority. After the anthrax attacks in the United States in 2001, the US Centers for Disease Control and Prevention (CDC) supported the Model State Emergency Health Powers Act, which granted public health officials even more expansive powers to declare a health emergency and respond swiftly. But all that ended with COVID-19, as state legislatures and courts gutted this authority. The next pandemic could be far deadlier than COVID-19, but when the public looks to federal and state governments to protect them, they may find that health officials have their hands tied behind their backs.
Assuntos
Administração em Saúde Pública , Saúde Pública , Governo Estadual , Humanos , COVID-19/prevenção & controle , Governo Federal , Pandemias/prevenção & controle , Saúde Pública/legislação & jurisprudência , Estados Unidos , Administração em Saúde Pública/legislação & jurisprudênciaAssuntos
Pesquisa Biomédica/organização & administração , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/organização & administração , Prática de Saúde Pública , Eficácia de Vacinas , COVID-19/diagnóstico , Teste Sorológico para COVID-19 , Vacinas contra COVID-19 , Controle de Doenças Transmissíveis/métodos , Sistemas de Dados , Regulamentação Governamental , Política de Saúde/legislação & jurisprudência , Humanos , Imunização Secundária , Administração em Saúde Pública/legislação & jurisprudência , Administração em Saúde Pública/normas , Estados Unidos , Vacinação/estatística & dados numéricosAssuntos
COVID-19/epidemiologia , Regulamentação Governamental , Controle de Infecções , Saúde Global/legislação & jurisprudência , Prioridades em Saúde/legislação & jurisprudência , Prioridades em Saúde/organização & administração , Humanos , Controle de Infecções/legislação & jurisprudência , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Administração em Saúde Pública/legislação & jurisprudência , Administração em Saúde Pública/métodos , Pesquisa/legislação & jurisprudência , Pesquisa/organização & administração , SARS-CoV-2/fisiologia , Estados Unidos/epidemiologia , United States Food and Drug Administration/legislação & jurisprudência , United States Food and Drug Administration/organização & administraçãoRESUMO
We examined the documentation underlying the decision to permit the Southern District Health Board (SDHB) to join the National Bowel Screening Programme (NBSP) at a time when it was not providing an adequate colonoscopy service for symptomatic patients. A coordinated sequence of relevant Official Information Act 1982 (OIA) requests was lodged with the New Zealand Ministry of Health (MoH), which is responsible for determining the readiness of district health boards (DHBs) to join the NBSP. However, the MoH OIA process was obfuscating, unduly long and responded only after they anticipated imminent intervention by the Office of the Ombudsman. The amount of information provided was massive, partly irrelevant and presented in an inconvenient format. It revealed that the MoH readiness process was incomplete, and permission for the SDHB to join the NBSP was given prematurely without following due process and despite concerns expressed by some MoH staff. Subsequently, the MoH has failed to admit that they made errors in this case or have any weaknesses in their readiness assessment process. The MoH readiness process failed to determine that the SDHB was not ready to join the NBSP in 2018. Concerns have been expressed in the public media that such failures have occurred with the assessment of other DHBs. The process needs to be overhauled or replaced before further permissions are granted to DHBs. Requests for information under the OIA from the MoH, and similar public entities and agencies subject to the OIA, are too easily deferred, derailed or declined. The OIA is in need of revision.
Assuntos
Neoplasias Colorretais/prevenção & controle , Detecção Precoce de Câncer/normas , Administração em Saúde Pública/legislação & jurisprudência , Garantia da Qualidade dos Cuidados de Saúde/legislação & jurisprudência , Neoplasias Colorretais/diagnóstico , Eficiência Organizacional , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Humanos , Nova Zelândia , Avaliação de Processos e Resultados em Cuidados de SaúdeAssuntos
Mão de Obra em Saúde/estatística & dados numéricos , Administração em Saúde Pública/economia , Saúde Pública/legislação & jurisprudência , Medicina Estatal/economia , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/virologia , Gastos em Saúde/estatística & dados numéricos , Mão de Obra em Saúde/tendências , Humanos , Setor Privado/economia , Setor Privado/estatística & dados numéricos , Saúde Pública/normas , Administração em Saúde Pública/legislação & jurisprudência , Setor Público/economia , Setor Público/estatística & dados numéricos , SARS-CoV-2/isolamento & purificação , Medicina Estatal/organização & administração , Reino Unido/epidemiologiaAssuntos
COVID-19 , Distúrbios Civis/tendências , Controle de Doenças Transmissíveis/organização & administração , Administração em Saúde Pública/legislação & jurisprudência , Saúde Pública/tendências , Chile/epidemiologia , Humanos , Política , SARS-CoV-2 , Controle Social Formal , Determinantes Sociais da Saúde , Fatores SocioeconômicosRESUMO
BACKGROUND: The 2005 International Health Regulations (IHR (2005)) require States Parties to establish National Focal Points (NFPs) responsible for notifying the World Health Organization (WHO) of potential events that might constitute public health emergencies of international concern (PHEICs), such as outbreaks of novel infectious diseases. Given the critical role of NFPs in the global surveillance and response system supported by the IHR, we sought to assess their experiences in carrying out their functions. METHODS: In collaboration with WHO officials, we administered a voluntary online survey to all 196 States Parties to the IHR (2005) in Africa, Asia, Europe, and South and North America, from October to November 2019. The survey was available in six languages via a secure internet-based system. RESULTS: In total, 121 NFP representatives answered the 56-question survey; 105 in full, and an additional 16 in part, resulting in a response rate of 62% (121 responses to 196 invitations to participate). The majority of NFPs knew how to notify the WHO of a potential PHEIC, and believed they have the content expertise to carry out their functions. Respondents found training workshops organized by WHO Regional Offices helpful on how to report PHEICs. NFPs experienced challenges in four critical areas: 1) insufficient intersectoral collaboration within their countries, including limited access to, or a lack of cooperation from, key relevant ministries; 2) inadequate communications, such as deficient information technology systems in place to carry out their functions in a timely fashion; 3) lack of authority to report potential PHEICs; and 4) inadequacies in some resources made available by the WHO, including a key tool - the NFP Guide. Finally, many NFP representatives expressed concern about how WHO uses the information they receive from NFPs. CONCLUSION: Our study, conducted just prior to the COVID-19 pandemic, illustrates key challenges experienced by NFPs that can affect States Parties and WHO performance when outbreaks occur. In order for NFPs to be able to rapidly and successfully communicate potential PHEICs such as COVID-19 in the future, continued measures need to be taken by both WHO and States Parties to ensure NFPs have the necessary authority, capacity, training, and resources to effectively carry out their functions as described in the IHR.
Assuntos
Notificação de Doenças/legislação & jurisprudência , Regulamento Sanitário Internacional , Administração em Saúde Pública/legislação & jurisprudência , COVID-19 , Surtos de Doenças/prevenção & controle , Saúde Global , Humanos , Inquéritos e Questionários , Organização Mundial da SaúdeAssuntos
COVID-19/epidemiologia , Cirurgia Colorretal/instrumentação , Telemedicina/estatística & dados numéricos , COVID-19/diagnóstico , COVID-19/psicologia , COVID-19/virologia , Cirurgia Colorretal/estatística & dados numéricos , Humanos , Avaliação de Programas e Projetos de Saúde , Administração em Saúde Pública/legislação & jurisprudência , SARS-CoV-2/genética , Telemedicina/tendências , Estados Unidos/epidemiologiaAssuntos
COVID-19/etnologia , Emigrantes e Imigrantes/estatística & dados numéricos , Etnicidade/estatística & dados numéricos , Disparidades em Assistência à Saúde , Grupos Minoritários/estatística & dados numéricos , Defesa do Paciente , Viés , COVID-19/mortalidade , COVID-19/patologia , Confidencialidade/legislação & jurisprudência , França/epidemiologia , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/legislação & jurisprudência , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Morbidade , Mortalidade/etnologia , Pandemias , Defesa do Paciente/legislação & jurisprudência , Administração em Saúde Pública/legislação & jurisprudência , Administração em Saúde Pública/normas , Administração em Saúde Pública/tendências , SARS-CoV-2Assuntos
COVID-19/epidemiologia , Política de Saúde , Administração em Saúde Pública/legislação & jurisprudência , Idoso de 80 Anos ou mais , Luto , COVID-19/terapia , Família , Evolução Fatal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Administração em Saúde Pública/normas , SARS-CoV-2 , Grupos de Autoajuda , Reino Unido/epidemiologia , Adulto JovemRESUMO
Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, Italy has proven to be one of the countries with the highest coronavirus-linked death rate. To reduce the impact of SARS-CoV-2 coronavirus, the Italian Government decision-makers issued a series of law decrees that imposed measures limiting social contacts, stopped non-essential production activities, and restructured public health care in order to privilege assistance to patients infected with SARS-CoV-2. Health care services were substantially limited including planned hospitalization and elective surgeries. These substantial measures were criticized due to their impact on individual rights including freedom and autonomy, but were justified by the awareness that hospitals would have been unable to cope with the surge of infected people who needed treatment for COVID-19. The imbalance between the need to guarantee ordinary care and to deal with the pandemic, in a context of limited health resources, raises ethical concerns as well as clinical management issues. The emergency scenario caused by the COVID-19 pandemic, especially in the lockdown phase, led the Government and health care decision-makers to prioritize community safety above the individuals' rights. This new community-centered approach to clinical care has created tension among the practitioners and exposed health workers to malpractice claims. Reducing the morbidity and mortality rates of the COVID-19 pandemic is the priority of every government, but the legitimate question remains whether the policy that supports this measure could be less harmful for the health care system.
Assuntos
COVID-19/prevenção & controle , Política de Saúde , Direitos do Paciente , Administração em Saúde Pública/ética , Quarentena/ética , COVID-19/mortalidade , Emergências , Humanos , Itália/epidemiologia , Administração em Saúde Pública/legislação & jurisprudência , Quarentena/legislação & jurisprudência , SARS-CoV-2RESUMO
Mandatory and voluntary mask policies may have yet unknown social and behavioral consequences related to the effectiveness of the measure, stigmatization, and perceived fairness. Serial cross-sectional data (April 14 to May 26, 2020) from nearly 7,000 German participants demonstrate that implementing a mandatory policy increased actual compliance despite moderate acceptance; mask wearing correlated positively with other protective behaviors. A preregistered experiment (n = 925) further indicates that a voluntary policy would likely lead to insufficient compliance, would be perceived as less fair, and could intensify stigmatization. A mandatory policy appears to be an effective, fair, and socially responsible solution to curb transmissions of airborne viruses.
Assuntos
Infecções por Coronavirus/prevenção & controle , Máscaras/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Administração em Saúde Pública/legislação & jurisprudência , Betacoronavirus , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Estudos Transversais , Alemanha/epidemiologia , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Programas Obrigatórios/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Comportamento de Redução do Risco , SARS-CoV-2 , Comportamento Social , Programas Voluntários/estatística & dados numéricosRESUMO
Policies facilitating integration of public health programs can improve the public health response, but the literature on approaches to integration across multiple system levels is limited. We describe the efforts of the Massachusetts Department of Public Health to integrate its HIV, viral hepatitis, sexually transmitted infection (STI), and tuberculosis response through policies that mandated contracted organizations to submit specimens for testing to the Massachusetts State Public Health Laboratory; co-test blood specimens for HIV, hepatitis C virus (HCV), and syphilis; integrate HIV, viral hepatitis, and STI disease surveillance and case management in a single data system; and implement an integrated infectious disease drug assistance program. From 2014 through 2018, the number of tests performed by the Massachusetts State Public Health Laboratory increased from 16 321 to 33 674 for HIV, from 11 054 to 33 670 for HCV, and from 19 169 to 30 830 for syphilis. Service contracts enabled rapid response to outbreaks of HIV, hepatitis A, and hepatitis B. Key challenges included lack of a billing infrastructure at the Massachusetts State Public Health Laboratory; the need to complete negotiations with insurers and to establish a retained revenue account to receive health insurance reimbursements for testing services; and time to train testing providers in phlebotomy for required testing. Investing in laboratory infrastructure; creating billing mechanisms to maximize health insurance reimbursement; proactively engaging providers, community members, and other stakeholders; and building capacity to transform practices are needed. Using multilevel policy approaches to integrate the public health response to HIV, STI, viral hepatitis, and tuberculosis is feasible and adaptable to other public health programs.