Defining a public health approach to substance use: Perspectives from professionals and practitioners across Canada.

BACKGROUND: While increasingly referenced in the literature and policy discussions, a "public health approach" (PHA) to substance use has been inconsistently defined or remained undefined. As part of a larger project on building the capacity to implement a PHA to substance use, we aimed to understand how professionals and practitioners across Canada who work with or whose work directly impacts the lives of people who use substances conceptualize a PHA. METHODS: We conducted a cross-sectional national online survey of public health professionals, public safety professionals, health and social service providers, and other relevant professionals and practitioners. The survey contained closed- and open-ended questions designed to gauge familiarity and comfort with application of a PHA to substance use, and perspectives on an organizational definition of such an approach. Survey recruitment was active between May and July 2021. Data analysis included descriptive statistics and thematic analysis. RESULTS: A total of 1041 surveys were completed. Most respondents (76 %) reported having heard of a PHA to substance use, as it was defined. Over half (54 %) indicated a high level of comfort with applying such an approach within their work. In relation to defining a PHA to substance use, the following thematic suggestions emerged from respondent's open-ended answers: explicitly recognize people with lived/living experience of substance use; incorporate trauma-informed understanding and acknowledge the varied underlying reasons for substance use; decolonize approaches to substance use and empower communities; and consider a more critical appraisal of a PHA and the terminology in its definition. CONCLUSION: Empirically unpacking multi-stakeholder understandings of a PHA to substance use can help to inform a more cohesive definition and build the consensus needed for more effective, coordinated, and community-led responses to substance use. Future work, especially qualitative research, will provide richer and more practical understandings of a PHA to substance use.

Ethical Decision Making in Disaster and Emergency Management: A Systematic Review of the Literature.

Ethical decision making in disaster and emergency management requires more than good intentions; it also asks for careful consideration and an explicit, systematic approach. The decisions made by leaders and the effects they have in a disaster must carry the confidence of the community to which they serve. Such decisions are critical in settings where resources are scarce; when decisions are perceived as unjust, the consequences may erode public trust, result in moral injury to staff, and cause community division. To understand how decisions in these settings are informed by ethics, a systematic literature review was conducted to determine what ethical guidance informs decision making in disaster and emergency management. This study found evidence of ethical guidance to inform decision making in disaster management in the humanitarian system, based on humanitarian principles. Evidence of the application of an ethical framework to guide or reference decision making was varied or absent in other emergency management agencies or systems. Development and validation of ethical frameworks to support decision making in disaster management practice is recommended.

Death at sea-the true rate of occupational fatality within the Australian commercial fishing industry.

Although the safety performance of the Australian commercial fishing industry has been the subject of multiple investigations, it has ultimately remained undefined. While most Australian industries notify industry regulators of significant workplace incidents and injuries in their operations, the majority of persons in the commercial fishing industry are contractors who are paid piecework and in some jurisdictions specifically excluded from the worker compensation legislation, meaning that most occupational injuries, including fatalities, are not captured in the centralized worker compensation data sets. This study presents the analysis of a systematic review of industry databases, published academic, and, Australian coroners reports to assist improve the definition of the nation's commercial fishing industry safety performance. The analysis shows occupational fatality rates are significantly higher than currently reported, and recurring factors contributing to deaths at sea remain unaddressed. The study is significant as it demonstrates how workplace injuries and deaths can be hidden within data sets applying broad industry classification and provides a foundation for future research in Australian fishing and other industries.

Public health approaches to substance use: a scoping review protocol.

OBJECTIVE: The aim of this scoping review is to describe how a public health approach to legal and illegal psychoactive substance use has been previously defined, and to identify its core values, concepts, activities, and goals. INTRODUCTION: Jurisdictions globally are increasingly endorsing a public health approach to addressing psychoactive substance use. However, there is currently no agreed definition of this approach, and this term has been applied inconsistently in the literature, policy, and practice. A critical first step toward advancing a public health approach to substance use is identifying and articulating its core components. INCLUSION CRITERIA: This review will consider all peer-reviewed and gray literature in English focused on conceptualizing, defining, or describing a public health approach to substance use. Our review does not place limitations on populations, psychoactive substance types, or other contextual factors. METHODS: We will search PROSPERO, MEDLINE, Embase, PsycINFO, Cochrane Library, CINAHL, and Scopus, as well as health and social science databases; websites of prominent nonprofit, civil society, and government agencies/organizations in public health and substance use fields; and reference lists of included articles. Two independent reviewers will screen titles/abstracts of peer-reviewed literature, and 1 reviewer will screen titles/abstracts of gray literature. Two independent reviewers will conduct the full-text screening. A data extraction sheet will be pilot tested through double extraction. Findings will be presented as a narrative summary supported by tables and diagrams and, if feasible, a conceptual framework for understanding and applying a public health approach to substance use. SCOPING REVIEW REGISTRATION NUMBER: Open Science Framework https://osf.io/sv25e.

Strengthening collaborations at the public health system-academic interface: a call to action.

In Canada and globally, the COVID-19 pandemic has highlighted the importance of reliable and responsive public health systems. The pandemic has required decisive leadership and collaboration across all sectors of society informed by the best available evidence. In this commentary, we argue that in order to create a robust public health system equipped to address current and future public health challenges, we must prioritize and invest in stronger relationships between public health practice and academia. We briefly review key recommendations following the SARS outbreak, particularly those calling for stronger linkages between public health academia and practice settings in Canada. We then propose key actions for strengthening these linkages. Echoing other COVID-19-related calls, which request long-term reinvestment in public health education and training, we recommend the following actions: (1) Improve collaboration between education programs and public health agencies to address system needs (e.g., surge capacity) and persisting health inequities; (2) Fund a pan-Canadian public health training initiative that builds on a renewed set of public health competencies to address priority training needs (e.g., equity-oriented leadership); and (3) Prepare a cadre of certified public health leaders who can progress along public health career pathways, including those already in practice.

RéSUMé: Au Canada et ailleurs dans le monde, la pandémie de COVID-19 a montré qu'il est important d'avoir des systèmes de santé publique fiables et réactifs. La pandémie nécessite un leadership décisif et une collaboration entre tous les secteurs de la société, éclairés par les meilleures preuves disponibles. Dans ce commentaire, nous faisons valoir que pour créer un système de santé publique robuste capable de relever les défis actuels et futurs, il faut privilégier des liens plus forts entre les praticiens de la santé publique et les milieux universitaires et y consacrer les investissements nécessaires. Nous passons brièvement en revue les principales recommandations qui ont suivi la crise du SRAS, en particulier celles qui réclamaient le renforcement des liens entre les facultés de santé publique et les milieux de pratique au Canada. Nous proposons ensuite des mesures clés pour renforcer ces liens. Faisant écho à d'autres appels à l'action liés à la COVID-19, qui préconisent un réinvestissement à long terme dans l'enseignement et la formation en santé publique, nous recommandons les mesures suivantes: 1) Améliorer la collaboration entre les programmes d'enseignement et les organismes de santé publique pour aborder les besoins des systèmes (p. ex. leur capacité d'appoint) et les inégalités persistantes en santé; 2) Financer une initiative pancanadienne de formation en santé publique qui s'appuie sur un ensemble renouvelé de compétences en santé publique pour répondre aux besoins prioritaires en matière de formation (p. ex. le leadership axé sur l'équité); et 3) Préparer un groupe de dirigeants de santé publique agréés pouvant progresser dans les carrières de la santé publique, y compris des personnes qui exercent déjà la profession.

A National Survey of Educational and Training Preferences and Practices for Public Health Nurses in Canada.

BACKGROUND: The effective mix of public health professionals has been the focus of recent policies and literature. Information is limited on the preferences for training and continuing education of the Canadian Public Health Workforce. This information could assist in surge capacity efforts and help in evaluating the success of workforce development strategies and recruitment/retention efforts. METHOD: The Canadian Public Health Workforce Survey was conducted in 2015 by the Canadian Public Health Association in collaboration with the Public Health Agency of Canada (PHAC). The survey was conducted to inform an ongoing evaluation of the PHAC's workforce development. This article reports on a subset of the survey: public health nurses (PHNs). RESULTS: The response rate to the survey was approximately 40% (2,075 participants); 470 respondents (22.7%) were PHNs. Challenges faced by PHNs to pursuing continuing education include a lack of targeted training, resources, and coordinated training efforts. CONCLUSION: The results provide insight into potential direction to support the work of PHNs in practice including a need for a coordinated approach to continuing education. Future educational strategies should consider tailored education strategies for PHNs. [J Contin Educ Nurs. 2020;51(1):25-31.].

'Communities are attempting to tackle the crisis': a scoping review on community plans to prevent and reduce opioid-related harms.

OBJECTIVES: We sought to understand the implementation of multifaceted community plans to address opioid-related harms. DESIGN: Our scoping review examined the extent of the literature on community plans to prevent and reduce opioid-related harms, characterise the key components, and identify gaps. DATA SOURCES: We searched MEDLINE, Embase, PsycINFO, CINHAL, SocINDEX and Academic Search Primer, and three search engines for English language peer-reviewed and grey literature from the past 10 years. ELIGIBILITY CRITERIA: Eligible records addressed opioid-related harms or overdose, used two or more intervention approaches (eg, prevention, treatment, harm reduction, enforcement and justice), involved two or more partners and occurred in an Organisation for Economic Co-operation and Development country. DATA EXTRACTION AND SYNTHESIS: Qualitative thematic and quantitative analysis was conducted on the charted data. Stakeholders were engaged through fourteen interviews, three focus groups and one workshop. RESULTS: We identified 108 records that described 100 community plans in Canada and the USA; four had been evaluated. Most plans were provincially or state funded, led by public health and involved an average of seven partners. Commonly, plans used individual training to implement interventions. Actions focused on treatment and harm reduction, largely to increase access to addiction services and naloxone. Among specific groups, people in conflict with the law were addressed most frequently. Community plans typically engaged the public through in-person forums. Stakeholders identified three key implications to our findings: addressing equity and stigma-related barriers towards people with lived experience of substance use; improving data collection to facilitate evaluation; and enhancing community partnerships by involving people with lived experience of substance use. CONCLUSION: Current understanding of the implementation and context of community opioid-related plans demonstrates a need for evaluation to advance the evidence base. Partnership with people who have lived experience of substance use is underdeveloped and may strengthen responsive public health decision making.

Development and release of a national immunization app for Canada (ImmunizeCA).

Digital technology has created an opportunity to reenvision the traditional immunization paper record. We describe our experience developing a government endorsed mobile immunization record in Canada. The smartphone app, ImmunizeCA is designed to assist individuals in managing their own health information. It allows individuals to store their and their family's immunization records on their smartphone. The app, which is populated by data provided by the user, contains all 13 provincial and territorial schedules, immunization information and outbreak alerts on vaccine preventable diseases. Our experience suggests mobile apps can serve as a mechanism to empower users, increase participation in the process of immunization, potentially improve immunization rates and address jurisdictional obstacles. Key measures of success will include long term uptake, acceptability as an official record, enabling data flow permitting integration with immunization information systems and the ability to rapidly iterate to address changes to both immunization practice and mobile technology.