Commercial Tobacco Endgame Goals: Early experiences from six countries.

INTRODUCTION: Tobacco use is a major threat to health globally. A number of countries have adopted 'endgame goals' to minimise smoking prevalence. The INSPIRED project aims to describe and compare the experiences of the first six countries to adopt an endgame goal. METHODS: Data were collected on the initial experiences of endgame goals in Canada, Finland, Ireland, New Zealand (Aotearoa), Scotland, and Sweden up to 2018. Information was collated on the nature of the endgame goals, associated interventions and strategies, potential enablers and barriers, and perceived advantages and disadvantages. RESULTS: The INSPIRED countries had relatively low smoking prevalences and moderate to strong smokefree policies. Their endgame goals aimed for smoking prevalences of 5% or less. Target dates ranged from 2025 to 2035. Except for New Zealand (Aotearoa), all countries had an action plan to support their goal by 2018. However, none of the plans incorporated specific endgame measures. Lack of progress in reducing inequities was a key concern, despite the consideration of equity in all of the country's goals and/or action plans. Experience with endgame goals was generally positive, however participants thought additional interventions would be required to equitably meet their endgame goal. CONCLUSIONS: There was variation in the nature and approach to endgame goals. This suggests that countries should consider adopting endgame goals and strategies to suit their social, cultural, and political contexts. The experiences of the INSPIRED countries suggest that further and more significant interventions will be required for the timely and equitable achievement of endgame goals. IMPLICATIONS: By 2018, six countries (Canada, Finland, Ireland, New Zealand (Aotearoa), Scotland, and Sweden) had introduced government-endorsed 'endgame goals', to rapidly reduce smoking prevalence to very low levels by a specified date. The nature and implementation of endgame goals was variable. Early experiences with the goals were generally positive, but progress in reducing smoking prevalence was insufficient, particularly for priority groups. This finding suggests more significant interventions ('endgame interventions') and measures to reduce inequities need to be implemented to achieve endgame goals. Variation in the nature and experience of endgame goals demonstrates the importance of designing endgame strategies that suit distinct social, cultural, and political contexts.

A Culturally Humble Approach to Designing a Sports-Based Youth Development Program With African-Australian Community.

This article draws on the concept of cultural humility, to describe and analyze a decolonizing approach to co-designing a primary prevention basketball program for young African-Australian people in Melbourne, Australia. We explore the potential for genuine collaboration and power-sharing with a culturally diverse community through collaboratively developing the co-design process and resultant program design. This article highlights the central role of UBUNTU in the co-design process, prioritizing African ways of knowing, being, and doing within a Westernized social work and design context. Through reporting on the stages of program design, we offer an example of how Indigenous knowledges and philosophies such as UBUNTU might be incorporated into co-design through cultural humility. We suggest this allows for a transformation of design tools and processes in ways that undermine oppressive and marginalizing power imbalances in design and social work.

Taking global leadership in banning menthol and other flavours in tobacco: Canada's experience.

Measures to ban or restrict menthol and other flavours in tobacco products are under consideration or newly implemented in an increasing number of jurisdictions across the world. As one of the world leaders, Canada's experience in successfully developing and implementing such measures can be instructive for other jurisdictions. This paper explores the history of how Canada was able to implement tobacco flavour bans including menthol, examines some of the challenges and presents lessons learnt for other jurisdictions. The crucial motivation for these bans emerged from surveillance data showing high rates of flavoured tobacco use by youth, including menthol cigarette smoking, that was publicised by non-governmental organisations. Further data showed that early legislation in 2009 contained loopholes (cigar size exemptions and menthol exemptions) that limited the benefits of the legislation. Leadership by the provinces created an environment in which the federal ban on menthol ingredients in 2017 was a clear and obvious step to ensure implementation across the country. The Canadian measures have been successful at reducing the use of flavoured tobacco including menthol cigarettes and facilitating smoking cessation. Lessons learnt include the downsides of exemptions, the lack of a contraband issue (despite an existing supply in Canada), the benefits of availability of youth flavour prevalence data and the success of subnational regulations to advance national regulation.

Perspective on Cancer Control: Whither the Tobacco Endgame for Canada?

Aims: In 2014, in response to evidence that Canada's tobacco use would lead, inexorably, to substantial morbidity and mortality for the foreseeable future, a group of experts convened to consider the development of a "Tobacco Endgame" for Canada. The "Tobacco Endgame" defines a time frame in which to eliminate structural, political, and social dynamics that sustain tobacco use, leading to improved population health. Strategies: A series of Background Papers describing possible measures that could contribute to the creation of a comprehensive endgame strategy for Canada was prepared in advance of the National Tobacco Endgame Summit hosted at Queen's University in 2016. At the summit, agreement was reached to work together to achieve <5% tobacco use by 2035 (<5 by '35). A report of the proceedings was shared widely. Achievements: Progress since 2016 has been mixed. The Summit report was followed by a national forum convened by Health Canada in March 2017, and in 2018, the Canadian Government adopted "<5 × '35" tobacco use target in a renewed Canadian tobacco reduction strategy. Tobacco use has declined in the last 5 years, but at a rate slower than that which will be needed to achieve the <5 by '35 goal. There remain > 5 million smokers in Canada, signaling that smoking-related diseases will continue to be an enormous health burden. Furthermore, the landscape of new products (e-cigarettes and cannabis) has created additional risks and opportunities. Future directions: A bold, reinvigorated tobacco control strategy is needed that significantly advances ongoing policy developments, including full implementation of the key demand-reduction policies of the WHO Framework Convention on Tobacco Control. Formidable, new disruptive policies and regulations will be needed to achieve Canada's Endgame goal.

Challenges of Forecasting Physician Workforce Needs Amid Delivery System Transformation.

As population growth and the aging of the overall population increase demand for health care, policymakers and analysts grapple with whether sufficient health care providers, particularly physicians, will be available to meet that demand. Some argue there are too few physicians already; others say our current supply-demand problems lie with efficiency. But suppose both are correct? Perhaps the real challenge is to understand how the provision of health care services is changing in response to market forces such as payment changes, patients' expectations, provider distributions, and technology innovations. This issue brief revisits what is known about evolving practice organizations, professional mixes, information technology support, and the implications of these and other factors for physician workforce policies.

Once A Welfare Add-On, Medicaid Takes Charge In Reinventing Care.

States around the country have seized on Medicaid as a force for health system transformation.

Health workforce needs: projections complicated by practice and technology changes.

As population growth and the aging of the overall population increase demand for health care, policymakers and analysts posit whether sufficient health care providers will be able to meet that demand. Some argue there are too few providers already; others say our current supply-demand problems lie with efficiency. But suppose both are correct? Perhaps the real challenge is to understand how physician practices are changing in response to market forces such as payment changes, provider distributions, and technology innovations. This issue brief reviews what is known about evolving practice organizations, professional mixes, information technology support, and the implications of these and other factors for public workforce policies.

Stimulus bill implementation: expanding meaningful use of health IT.

The American Recovery and Reinvestment Act authorizes an estimated $38 billion in incentives and supports for health information technology (IT) from 2009 to 2019. After years of sluggish HIT adoption, this crisis-driven investment of public funds creates a unique opportunity for rapid diffusion of a technology that is widely expected to improve care, save money, and facilitate transformation of the troubled U.S. health system. Achieving maximal effect from the stimulus funds is nevertheless a difficult challenge. The Recovery Act strengthens the federal government's leadership role in promoting HIT. But successful adoption and utilization across the health system will also require development of a supportive infrastructure and broad-based efforts by providers, vendors, state-based agencies, and other health system stakeholders. Optimal use of IT for health care may require extensive reengineering of medical practice and of existing systems of payment. The future course of HIT adoption will also be subject to the effects of any health care reform legislation and of technological innovation in the fast-changing world of electronic communications

Incidence of venous thromboembolism in patients with traumatic brain injury.

BACKGROUND: Traumatic brain injury (TBI) may be a risk factor for venous thromboembolism (VTE). This study was designed to review the incidence of VTE in critically injured patients with an isolated TBI using a standardized venous duplex color-flow Doppler imaging program and to compare it with the overall and high-risk trauma populations. METHODS: Trauma patients who underwent lower-extremity surveillance color-flow Doppler imaging for VTE were identified. Analyses included patient demographics, characteristics of TBI, VTE risk factors, prophylaxis, incidence, location, and patient outcome. RESULTS: A total of 5,787 patients were admitted during the study period. Of these, 539 (9%) were deemed high risk for VTE. The incidence of VTE in patients with isolated TBI (88, 16%) was 25%. All patients and the high-risk population had incidences of 2% and 17%, respectively. CONCLUSIONS: The incidence of VTE in isolated TBI is greatest in patients with intraparenchymal hemorrhage. Early VTE prophylaxis is warranted in TBI patients.