Kampala manifesto: Building community-based One Health approaches to disease surveillance and response-The Ebola Legacy-Lessons from a peer-led capacity-building initiative.

OVERVIEW: International activities to respond to the Ebola crisis in West Africa were mainly developed and focussed around the biomedical paradigm of Western health systems. This approach was often insensitive to societal perception, attitude, and behavioural determinants and clashed with community-based health traditions, narratives, and roles, e.g., of community health workers. In this peer-led capacity-building initiative, these deficiencies were identified and analysed. Innovative, more locally focussed, community-based solutions were articulated. The new approaches described put local people at the centre of all preparedness, response, and recovery strategies. This paradigm shift reframed the role of communities from victims to active managers of their response and reacknowledged the strength of community-based One Health. We conclude that strategies should aim at empowering, not just engaging, communities. Communities can improve short-term crisis management and build longer-term resilience and capacities that are much needed in the current global health climate. BACKGROUND: The Ebola outbreak in West Africa, 2014-2016, was unprecedented in scale, extent, and duration. The international community was slow to step up its assistance in this global public health emergency and then faltered when its infection control management approaches clashed with West African realities [1]. Outbreak response evaluations have identified the need to better integrate social science intelligence [2], better collaborate with communities [3,4], more effectively draw on the strength of community health workers [5], and critically question the paradigm of Western health systems, which focus on imposing 'evidence-based' solutions that lack external validity in affected communities; i.e., they too often recommend actions that are inconsistent with, ignore, or violate traditional behaviours [6]. While there appears to be a consensus now on what needs to be done, how to achieve these goals remains a challenge.

Vaccine hesitancy among healthcare workers in Europe: A qualitative study.

Healthcare workers (HCWs) are often referred to as the most trusted source of vaccine-related information for their patients. However, the evidence suggests that a number of HCWs are vaccine-hesitant. This study consists of 65 semi-structured interviews with vaccine providers in Croatia, France, Greece, and Romania to investigate concerns HCWs might have about vaccination. The results revealed that vaccine hesitancy is present in all four countries among vaccine providers. The most important concern across all countries was the fear of vaccine side effects. New vaccines were singled out due to perceived lack of testing for vaccine safety and efficacy. Furthermore, while high trust in health authorities was expressed by HCWs, there was also strong mistrust of pharmaceutical companies due to perceived financial interests and lack of communication about side effects. The notion that it is a doctor's responsibility to respond to hesitant patients was reported in all countries. Concerns were also seen to be country- and context-specific. Strategies to improve confidence in vaccines should be adapted to the specific political, social, cultural and economic context of countries. Furthermore, while most interventions focus on education and improving information about vaccine safety, effectiveness, or the need for vaccines, concerns raised in this study identify other determinants of hesitancy that need addressing. The representativeness of the views of the interviewed HCWs must be interpreted with caution. This a qualitative study with a small sample size that included geographical areas where vaccination uptake was lower or where hesitancy was more prevalent and it reflects individual participants' beliefs and attitudes toward the topic. As HCWs have the potential of influencing patient vaccination uptake, it is crucial to improve their confidence in vaccination and engage them in activities targeting vaccine hesitancy among their patients.

Risk communication as a core public health competence in infectious disease management: Development of the ECDC training curriculum and programme.

Risk communication has been identified as a core competence for guiding public health responses to infectious disease threats. The International Health Regulations (2005) call for all countries to build capacity and a comprehensive understanding of health risks before a public health emergency to allow systematic and coherent communication, response and management. Research studies indicate that while outbreak and crisis communication concepts and tools have long been on the agenda of public health officials, there is still a need to clarify and integrate risk communication concepts into more standardised practices and improve risk communication and health, particularly among disadvantaged populations. To address these challenges, the European Centre for Disease Prevention and Control (ECDC) convened a group of risk communication experts to review and integrate existing approaches and emerging concepts in the development of a training curriculum. This curriculum articulates a new approach in risk communication moving beyond information conveyance to knowledge- and relationship-building. In a pilot training this approach was reflected both in the topics addressed and in the methods applied. This article introduces the new conceptual approach to risk communication capacity building that emerged from this process, presents the pilot training approach developed, and shares the results of the course evaluation.

Marburg biosafety and biosecurity scale (MBBS): a framework for risk assessment and risk communication.

Current risk assessment and risk communication of biosafety and biosecurity concerns lack a convenient metric and conceptual framework. The absence of such a systematic tool makes communication more difficult and can lead to ambiguous public perception of and response to laboratory biosafety incidents and biosecurity threats. A new 7-category scoring scale is proposed for incidents and situations in laboratories related to the handling of human and animal pathogens. The scale aims to help clarify risk categories, facilitate coordination and communication, and improve public understanding of risk related to biosafety and biosecurity.

The role of health systems and policy in producing behavior and social change to enhance child survival and development in low- and middle-income countries: an examination of the evidence.

Evidence-based behavior change interventions addressing health systems must be identified and disseminated to improve child health outcomes. Studies of the efficacy of such interventions were identified from systematic searches of the published literature. Two hundred twenty-nine of the initially identified references were judged to be relevant and were further reviewed for the quality and strength of the evidence. Studies were eligible if an intervention addressed policy or health systems interventions, measured relevant behavioral or health outcomes (e.g., nutrition, childhood immunization, malaria prevention and treatment), used at least a moderate quality research design, and were implemented in low- or middle-income countries. Policy or systems interventions able to produce behavior change reviewed included media (e.g., mass media, social media), community mobilization, educational programs (for caregivers, communities, or providers), social marketing, opinion leadership, economic incentives (for both caregiver and provider), health systems strengthening/policy/legislation, and others. Recommendations for policy, practice, and research are given based on fairly strong data across the areas of health service delivery, health workforce, health financing, governance and leadership, and research.

Санитарная грамотность: убедительные факты

Сегодня, когда общества становятся все более многогранными, а людей все чаще буквально забрасывают как правдивой, так и ложной информацией по вопросам здравоохранения, важность медико-санитарной грамотности трудно переоценить. У людей, обладающих прочными навыками в области медико-санитарной грамотности, лучше здоровье и благополучие, тогда как те, у кого подобные навыки находятся на низком уровне, как правило, практикуют более рискованное поведение и менее здоровы. Данный доклад основывается на фактических данных, полученных в результате проведенного недавно Европейского опросного исследования в области медико-санитарной грамотности. В нем определены эффективные практические шаги, которые могут предпринять органы управления общественным здравоохранением и другими направлениями в рамках сектора охраны здоровья, активисты и заинтересованные стороны для повышения медико-санитарной грамотности в самых различных контекстах: в образовательных учреждениях, на рабочих местах, в сфере коммерческой деятельности и торговли, в системах здравоохранения, в новых и традиционных медийных средствах и на политической арене. Этот доклад может использоваться в качестве инструмента для расширения осведомленности, стимулирования дебатов и исследований и, прежде всего, для обоснования разработки политики и осуществления практических действий.

The Digital Health Scorecard: A New Health Literacy Metric for NCD Prevention and Care.

According to the World Health Organization, 3 out of 5 deaths worldwide are due to common, chronic conditions, such as heart and respiratory diseases, cancer, and diabetes. These noncommunicable diseases (NCDs) are linked to multiple lifestyle risk factors, including smoking, the harmful use of alcohol, and physical inactivity. They are associated with other "intermediate" risk factors, such as elevated body mass index (BMI), hypertension, hyperlipidemia, and hyperglycemia. Taking action to reduce these 7 risk factors can help people protect themselves against leading causes of death. All of these risk factors are measurable and modifiable, but globally available, cost-effective, and easy-to-use outcome metrics that can drive action on all levels do not yet exist. The Digital Health Scorecard is being proposed as a dynamic, globally available digital tool to raise public, professional, and policy maker NCD health literacy (the motivation and ability to access, understand, communicate, and use information to improve health and reduce the incidence of NCD). Its aim is to motivate and empower individuals to make the behavioral and choice changes needed to improve their health and reduce NCD risk factors by giving unprecedented access to global data intelligence, creating awareness, making links to professional and community-based support services and policies, and providing a simple way to measure and track risk changes. Moreover, it provides health care professionals, communities, institutions, workplaces, and nations with a simple metric to monitor progress toward agreed local, national, and global NCD targets.

Health literacy: the solid facts

This publication makes the case for policy action to strengthen health literacy. Evidence, including the results of the European Health Literacy Survey, is presented that supports a wider and relational whole-of-society approach to health literacy that considers both an individual’s level of health literacy and the complexities of the contexts within which people act. The data from the European Health Literacy Survey show that nearly half the Europeans surveyed have inadequate or problematic health literacy. Weak health literacy skills are associated with riskier behaviour, poorer health, less self-management and more hospitalization and costs. Strengthening health literacy has been shown to build individual and community resilience, help address health inequities and improve health and well-being. Practical and effective ways public health and other sectoral authorities and advocates can take action to strengthen health literacy in a variety of settings are identified. Specific evidence is presented for educational settings, workplaces, marketplaces, health systems, new and traditional media and political arenas.

Health Literacy

This publication makes the case for policy action to strengthen health literacy. Evidence, including the results of the European Health Literacy Survey, is presented that supports a wider and relational whole-of-society approach to health literacy that considers both an individual’s level of health literacy and the complexities of the contexts within which people act. The data from the European Health Literacy Survey show that nearly half the Europeans surveyed have inadequate or problematic health literacy. Weak health literacy skills are associated with riskier behaviour, poorer health, less self-management and more hospitalization and costs. Strengthening health literacy has been shown to build individual and community resilience, help address health inequities and improve health and well-being. Practical and effective ways public health and other sectoral authorities and advocates can take action to strengthen health literacy in a variety of settings are identified. Specific evidence is presented for educational settings, workplaces, marketplaces, health systems, new and traditional media and political arenas.

NCD health literacy--what can hospitals do?

Noncommunicable disease (NCD) health literacy is a person's ability to access, understand and use information to prevent, treat and manage chronic illness. Poor health literacy is shown to be associated with riskier behaviour, poor health choices and poorer health. Hospitals can play an important role in enhancing people's NCD health literacy all the way along a patient's "NCD journey" from prevention to management by aligning their communications to the health literacy capacities of their users. The authors suggest training providers to communicate more effectively with patients, making their systems easier to navigate, simplifying written materials, incorporating the use of technology and mobile-health, and using individual and system level scorecards and checklists.

The social nature of chronic noncommunicable diseases and how to tackle them through communication technology, training, and outreach.

As world leaders prepare for the United Nations High Level Meeting on Noncommunicable Diseases, to take place in September 2011, international organizations, nongovernmental organizations, and economic and business fora have created new alliances and initiatives to accelerate research, advocacy, and political commitment. This article argues that the time is propitious to reflect on the social nature of the most common behavioral noncommunicable disease determinants, including tobacco and alcohol use, physical inactivity, and unhealthy diet. Evidence is presented related to the fact that these diseases are profoundly rooted in social and community ties and points to the need for a modern communication strategy to serve as a linchpin of any successful action to address these public health threats. Several proposals, aimed at promoting health literacy, strengthening health workforce skills, capturing the power of new media and technologies, and targeting vulnerable groups, are discussed.

Addressing the socioeconomic safety divide: a policy briefing

Injury and violence are a leading cause of death and disability in the WHO European Region.Wealth is a major determinant of health, and there is a steep social gradient of ill health due toinjuries and violence. People in low- and middle-income countries and more deprived people inhigh-income countries are worse off. Social and economic policies affect families’ susceptibility toinjury by affecting social and physical environments. This policy briefing summarizes evidence onthe socioeconomic safety divide from a large systematic review. It then provides messages for policy-makers, researchers and public health advocates and safety planners on what can be done toaddress this safety divide. Action for preventing injury and violence needs to be intersectoral.Governments need to aim for equity across all types of government policies to address the unevendistribution of injuries. Action needs to be taken both to reduce injuries and violence universally in the population using passive interventions to make the social and physical environmentinherently safer and to target disadvantaged populations. Addressing this important cause ofinequity in health is a matter of social justice.

Protecting health in Europe from climate change

There is now scientific consensus that climate change affects health through changing weather patterns (for example, more intense and frequent extreme events) and indirectly through changes in water, air, food quality and quantity, ecosystems,agriculture, livelihoods and infrastructure. The effects will be unevenly distributed, and the people at greatest risk include the poor, very young, elderly and/or ill. Climate change can also pose a threat to health security. Failure to respond could be very costly in terms of disease, health care expenditure and lost productivity. This publication intends to stimulate debate and support an active response by providing up-to-date information on the health effects, as well as practical guidance on specific actions that decision-makers at different levels in health and other sectors can take now.As long as climate change is not too rapid or strong, many of the health effects can be controlled by strengthening health systems. This can include strengthening preparedness, public health services and health security, advocating action in other sectors to benefit health, better informing citizens and leading by example. Health systems need to strengthen their capacity to assess potential climate-related health effects, to review their capacities to cope, and develop and implement adaptationand mitigation strategies, and to strengthen a range of key areas of work – from disease surveillance and control to disasterrisk reduction – that are essential for rapid detection of and action against climate-related risks.