The Troubling State of Public Health.

The COVID-19 pandemic has revealed cracks in the nation's public health infrastructure.

Monitoring vested health partnerships.

SETTING: This article is based on the experience of the Public Health Agency of Canada Innovation Strategy (PHAC-IS) federal funding program in building Canadian population health partnerships. INTERVENTION: The PHAC-IS addressed complex public health issues by funding evidence-based population health interventions in communities across Canada. These interventions were multifaceted and required the development of diverse "vested" partners to sustain systemic impact. This article explores the key elements of a vested partnership that affect systems change, and how to monitor the effects and achievements of vested partnerships as greater than what individual partners can achieve on their own. OUTCOMES: Vested health partnerships have diverse partners that fit the system they are trying to change, a clear, public sectoral agenda, partner alignment, and pooling of both human and financial assets. A vested health partnership assumes strength in the diversity and governance of the partnership as well as in how it demonstrates collaborative systems change. It is important to monitor and measure both the partners and the synergy and collective impact of the partnership. IMPLICATIONS: Short-term reach may need to be compromised for the brokering required to establish broad vested partners. Alignment, vestedness, and outcome measurement seem linked since strong partners that grow and adapt together change the way each sees and monitors the solution. Sophisticated partnerships, like a murmuration of starlings, act in concert to push learning and change practices, policies and societal norms. Capturing the movement of the flock is as important as counting the birds.

RéSUMé: MISE EN SITUATION: Le présent article se fonde sur l'expérience du programme de financement fédéral de la Stratégie d'innovation de l'Agence de la santé publique du Canada (SI de l'ASPC) en matière d'établissement de partenariats canadiens en santé de la population. INTERVENTION: La SI de l'ASPC s'attaque à des problèmes de santé publique complexes en finançant des interventions en santé de la population fondées sur des données probantes qui sont mises en œuvre dans les collectivités canadiennes. Ces interventions à multiples facettes ont demandé l'établissement de divers partenariats « acquis ¼ pour assurer une incidence systémique. Le présent article aborde les éléments clés d'un partenariat acquis favorisant les changements systémiques et explique comment évaluer les effets et les réalisations des partenariats acquis, qui sont supérieurs à ce que peut réaliser de façon individuelle un partenaire. RéSULTATS: Les partenariats de santé acquis réunissent divers partenaires qui font partie du système qu'ils s'emploient à changer et demandent l'établissement d'un programme sectoriel public clair, l'harmonisation des partenaires et la mise en commun des ressources humaines et financières. Un partenariat de santé acquis tire profit de sa diversité et sa structure de gouvernance ainsi que de la façon dont il peut favoriser un changement systémique collaboratif. Il est important de surveiller et de mesurer autant les partenaires que la synergie et l'incidence générale du partenariat. INCIDENCE: Une portée immédiate peut devoir être compromise pour négocier l'établissement de vastes partenariats acquis. L'harmonisation l'engagement et la mesure des résultats semblent être liés puisque de solides partenaires qui grandissent et s'adaptent ensemble changent la façon dont chacun perçoit la solution et la surveille. Les partenariats sophistiqués, comme une nuée d'étourneaux en vol, font un mouvement commun favorisant l'apprentissage et la modification des pratiques, des politiques et des normes sociales. Comprendre le mouvement collectif est tout aussi important que le dénombrement des oiseaux.

Saúde em Pauta 01 Bloco 2

Programa exibido na Tv Aperipê 6.1 - 18.05.2019

Credenciamentos Carretas Itinerantes

Media briefing on COVID-19 - 07/09/2020

Public Health Interventions with Harms and Benefits: A Graphical Framework for Evaluating Tradeoffs.

BACKGROUND: Evaluations of public health interventions typically report benefits and harms aggregated over the population. However, benefits and harms are not always evenly distributed. Examining disaggregated outcomes enables decision makers to consider health benefits and harms accruing to both intended intervention recipients and others in the population. METHODS: We provide a graphical framework for categorizing and comparing public health interventions that examines the distribution of benefit and harm between and within population subgroups for a single intervention and compares distributions of harm and benefit for multiple interventions. We demonstrate the framework through a case study of a hypothetical increase in the price of meat (5%, 10%, 25%, or 50%) that, via elasticity of demand, reduces consumption and consequently reduces body mass index. We examine how inequalities in benefits and harms (measured by quality-adjusted life-years) are distributed across a population of white and black males and females. RESULTS: A 50% meat price increase would yield the greatest net benefit to the population. However, because of reduced consumption among low-weight individuals, black males would bear disproportionate harm relative to the benefit they receive. With increasing meat price, the distribution of harm relative to benefit becomes less "internal" to those receiving benefit and more "distributed" to those not receiving commensurate benefit. When we segment the population by sex only, this result does not hold. CONCLUSIONS: Disaggregating harms and benefits to understand their differential impact on subgroups can strongly affect which decision alternative is deemed optimal, as can the approach to segmenting the population. Our framework provides a useful tool for illuminating key tradeoffs relevant to harm-averse decision makers and those concerned with both equity and efficiency.

Leveraging Health Department Capacities, Partnerships, and Health Insurance for Infectious Disease Response in Massachusetts, 2014-2018.

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.

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