The Diaspora Human Genomics Institute Launches the Together for Change Initiative: A Transformative, Historic Partnership to Ensure Health Equity in a Time of Unprecedented Technological Advancements.

Human subjects research and drug and device development currently base their findings largely on the genetic data of the non-Hispanic White population, excluding People of Color. This practice puts People of Color at a distinct and potentially deadly disadvantage in being treated for sickness, disability, and disease, as seen during the COVID-19 pandemic. Major disparities exist in all chronic health conditions, including cancer. Data show that less than 2% of genetic information being studied today originates from people of African ancestry. If genomic datasets do not adequately represent People of Color, new drugs and genetic therapies may not work as well as for people of European descent. Addressing the urgent concern that historically marginalized people may again be excluded from the next technological leap affecting human health and the benefits it will bring will requires a paradigm shift. Thus, on behalf of underserved and marginalized people, we developed the Together for CHANGE (T4C) initiative as a unique collaborative public-private partnership to address the concern. The comprehensive programs designed in the T4C initiative, governed by the Diaspora Human Genomics Institute founded by Meharry Medical College, will transform the landscape of education and health care and positively affect global Black communities for decades to come.

How to optimize dust pollution control in opencast coal mines: Analysis of a joint social regulation model based on evolutionary game theory.

The carbon peaking and carbon neutrality goals drive innovation in pollution governance systems, unleashing the potential of social supervisory forces to achieve coordinated governance by multiple stakeholders. In order to improve dust pollution control in opencast coal mines, this study combines prospect theory with evolutionary game theory, analyzing the evolutionary game process of coordinated governance activities of coal mining enterprises, local regulators, and social camps in the management of dust pollution against the backdrop of national supervisions. The research indicates that the perceived value of dust pollution has a significant impact on the strategic choices of the three agents involved in the game. Coal mining enterprises tend to be risk averse, and by reducing the cost of dust pollution control and increasing the additional benefits of pollution control, it can promote pollution control behavior by coal mining enterprises. Local regulators are also risk averse, but not sensitive to risk benefits. Strengthening pollution subsidy incentives and environmental fines can help promote dust pollution control behavior by coal mining enterprises. However, increasing the strength of the rewards strategy is not conducive to local regulators' own regulatory responsibilities, and environmental fines have limited binding effects. The strategic choices of social camps' supervision have a restrictive effect on the strategic choices of coal mining enterprises and local regulators, promoting the evolution of equilibrium results in the direction of maximizing social benefits. When coal mining enterprises actively governance pollution, local regulators strictly regulated, and social camps do not monitor, the system reaches its optimal equilibrium state. The research results clarify the mechanism and specific effects of social supervision of opencast coal mine dust pollution control, guide the participation of the public in dust pollution control, and regulate the behavior strategies of coal mining enterprises and local regulators, providing the scientific basis for management.

Human-Centered Design Innovation to Help All Patients THRIVE: An Interview With J. Margo Brooks Carthon.

In this column, Dr J. Margo Brooks Carthon discusses her work to support access to quality healthcare services for patients in minority and less than affluent circumstances. Dr Brooks Carthon has worked in a collaborative known as THRIVE. The program has offered intensive wrap-around clinical and social services and has positively impacted the wellness of chronically ill individuals.

Equitable Access to State-of-the-Art Medical Technology-a Malaysian Mini-Public-Private Partnership Case Study.

BACKGROUND: The provision of equitable and affordable health care has become increasingly challenging as advanced technology is introduced, particularly in developing countries. We explored the hypothesis that focused, small-scale mini-public-private partnerships have a potential role in providing equitable and affordable access to advanced technology for the benefit of all patients in developing nations, particularly middle-income countries. METHODS: A clinician-led financial plan was developed at the University of Malaya to create the Centre for Image Guidance and Minimally Invasive Therapy (CIGMIT) to provide an integrated platform for high-end care for Malaysian patients of all ages, both public and private, requiring complex neurosurgical and spinal procedures and stereotactic and intensity-modulated radiotherapy. The challenges faced during development of the plan were documented together with an audit of patient throughput and analyses of financial risk and return. RESULTS: CIGMIT opened in 2015. Patient throughput, both public and private, progressively increased in all facilities. In 2015-2019, 37,724 patients used the Centre's facilities. CIGMIT has become progressively more profitable for the University of Malaya, the public and private hospitals, and the investor. CIGMIT has weathered the challenges posed by coronavirus disease 19. CONCLUSIONS: Focused, small-scale mini-public-private partnerships have a potential role in providing advanced technology for the benefit of patients in developing nations, particularly middle-income countries, subject to an approach that balances equity of access between public and private health care systems with fair reward.

The Botanical Safety Consortium: A public-private partnership to enhance the botanical safety toolkit.

Botanical dietary supplement use is widespread and growing, therefore, ensuring the safety of botanical products is a public health priority. This commentary describes the mission and objectives of the Botanical Safety Consortium (BSC) - a public-private partnership aimed at enhancing the toolkit for conducting the safety evaluation of botanicals. This partnership is the result of a Memorandum of Understanding between the US FDA, the National Institute of Environmental Health Sciences, and the Health and Environmental Sciences Institute. The BSC serves as a global forum for scientists from government, academia, consumer health groups, industry, and non-profit organizations to work collaboratively on adapting and integrating new approach methodologies (NAMs) into routine botanical safety assessments. The objectives of the BSC are to: 1) engage with a group of global stakeholders to leverage scientific safety approaches; 2) establish appropriate levels of chemical characterization for botanicals as complex mixtures; 3) identify pragmatic, fit-for-purpose NAMs to evaluate botanical safety; 4) evaluate the application of these tools via comparison to the currently available safety information on selected botanicals; 5) and integrate these tools into a framework that can facilitate the evaluation of botanicals. Initially, the BSC is focused on oral exposure from dietary supplements, but this scope could be expanded in future phases of work. This commentary provides an overview of the structure, goals, and strategies of this initiative and insights regarding our first objectives, namely the selection and prioritization of botanicals based on putative toxicological properties.

Evaluation of the partnership between international non-governmental organizations and the State in the health sector in Mozambique.

INTRODUCTION: Mozambique is one of the poorest nations in the world and its health budget is heavily dependent on external funding. Increasingly, donors prefer to direct their funds through international non-governmental organizations instead of direct donations to the State budget. In the current climate of increased emphasis on health system strengthening, a strong and stable partnership between government and international non-governmental organizations is pivotal for health system strengthening in Mozambique. METHODS: the study evaluates the current partnership through a standardized survey to healthcare workers employed by international non-governmental organizations in health (INGO, private) and the ministry of health (MOH, public). Results of the survey have been analyzed only descriptively and no statistical evaluations have been performed. RESULTS: out of the valid 109 responses obtained 55.1% were from MOH cadres and 45.0% from INGO cadres. Most have been in the health sector for more than 5 years. Most of the respondents recognize that INGOs assist the government in strengthening the health system (71.6%), see the internal brain drain to INGOs and salary scale difference as major problems (70.6% and 78.0%); 87.2% reported that the coordination between INGOs and government needs to be improved. MOH cadres perceived the migration of cadres to INGOs and the need for improving coordination as major issues more acutely than their INGO counterparts (80.0% vs. 59.2% and 88.3% vs. 85.7% respectively). INGOs were perceived to offer better quality health services by 51.4% of respondents (of these 69.4% were INGO respondents). The quality of health services was alike between INGOs and MOH for 33% of the respondents. CONCLUSION: through the various efforts outlined the MOH and INGOs are moving towards an environment of mutual accountability, joint planning and coordination as well as harmonization of activities; but there are still challenges to be addressed. Prioritization and increased funding of the planning unit and planning and cooperation directorate as well as strategies for workforce retention are urgently needed.

Building an advocacy model to improve the dementia-capability of health plans in California.

BACKGROUND: Given the high and growing prevalence of Alzheimer's disease and related dementias, and the intensity of this population's care needs, it is imperative that healthcare systems increase their capacity to effectively serve people living with dementia (PLwD). The Dementia Cal MediConnect (Dementia CMC) project proposes an advocacy model that may foster dementia-capable systems change. METHODS: The Dementia CMC project was a 5-year partnership (2013-2018) between local Alzheimer's organizations and 10 managed care health plans (HPs) in California's duals demonstration. It used an advocacy model with the following steps: (1) Identify dementia-capable best practices to set as systems change indicators; (2) Identify and leverage public policies in support of systems change indicators; (3) Identify and engage champions; (4) Develop and advocate for a business case to improve dementia care; (5) Identify gaps in dementia-capable practices; (6) Provide technical assistance, tools, and staff training to address the gaps in dementia-capable practices; and (7) Track systems change. Systems change data were collected through participant observation with HPs and interviews with key informants representing partnering organizations or government entities. RESULTS: Participating HPs reported making systems changes toward more dementia-capable practices such as: better pathways for detection and diagnosis; better identification, assessment, support, and engagement of caregivers; and improved systems of referral to community-based organizations (CBOs), including Alzheimer's CBOs. Some indicators of systems change were inconclusive due to flawed assumptions around HP's care coordination, and the availability of common electronic health records between HPs and providers. CONCLUSION: The application of this advocacy model in California has led to systems changes that can improve care for PLwD and their caregivers and should be replicated to expand the dementia-capability of other health systems. Continued efforts to refine indicators are needed to capture systems change in complex and changing health systems.

Impact of the collaboration mechanism of PPP projects based on consumer participation: A system dynamics model of tripartite evolutionary game.

Developing countries need a large number of social infrastructure projects (e.g. schools, medical care, nursing homes). But the government's finance to invest in these projects is limited. By using the public-private partnership (PPP) mode to attract social capital to invest in PPP projects, it can relieve the financial pressure and improve the operation efficiency. The cooperation between government and consumer can ensure the sustainable development of the project operation. A system dynamics model of tripartite evolutionary game is developed to analyze the interaction of participant's strategies and simulate the corresponding evolution process. We employ the scenario analysis method to investigate the impact of the key parameters in relation with PPP projects based on realistic scenario assumptions. The results reveal the effect of some policies including reverse effect, blocking effect and over-reliance effect. Specifically, the results show that high penalty can prevent social capital from providing low-quality services, the low cost of government regulation can promote social capital to provide high-quality services, compensation to consumer can increase the enthusiasm of consumer participating in supervision, appropriate difference between price and cost of high-quality service as social capital's profit can encourage social capital to provide high-quality service. These policy suggestions will contribute to the sustainable development of social infrastructures in PPP mode.

Building and Sustaining Effective Partnerships for Training the Next Generation of Global Health Leaders.

Introduction: Partnerships are essential to creating effective global health leadership training programs. Global pandemics, including the HIV/AIDS pandemic, and more recently the COVID-19 pandemic, have tested the impact and stability of healthcare systems. Partnerships must be fostered to prepare the next generation of leaders to collaborate effectively and improve health globally. Objectives: We provide key matrices that predict success of partnerships in building global health leadership capacity. We highlight opportunities and challenges to building effective partnerships and provide recommendations to promote development of equitable and mutually beneficial partnerships. Findings: Critical elements for effective partnership when building global health leadership capacity include shared strategic vision, transparency and excellent communication, as well as intentional monitoring and evaluation of the partnership, not just the project or program. There must be recognition that partnerships can be unpredictable and unequal, especially if the end is not defined early on. Threats to equitable and effective partnerships include funding and co-funding disparities between partners from high-income and low-income countries, inequalities, unshared vision and priorities, skewed decision-making levels, and limited flexibility to minimize inequalities and make changes. Further, imbalances in power, privilege, position, income levels, and institutional resources create opportunities for exploitation of partners, particularly those in low-income countries, which widens the disparities and limits success and sustainability of partnerships. These challenges to effective partnering create the need for objective documentation of disparities at all stages, with key milestones to assess success and the environment to sustain the partnerships and their respective goals. Conclusions: Developing effective and sustainable partnerships requires a commitment to equality from the start by all partners and an understanding that there will be challenges that could derail otherwise well-intended partnerships. Guidelines and training on evaluation of partnerships exist and should be used, including generic indicators of equity, mutual benefit, and the added value of partnering. Key Takeaways: Effective partnerships in building global health leadership capacity require shared strategic vision and intentional monitoring and evaluation of goalsInequalities in partnerships may arise from disparities in infrastructure, managerial expertise, administrative and leadership capacity, as well as limited mutual benefit and mutual respectTo promote equitable and effective partnerships, it is critical to highlight and monitor key measures for success of partnerships at the beginning of each partnership and regularly through the lifetime of the partnership.We recommend that partnerships should have legal and financial laws through executed memoranda of understanding, to promote accountability and facilitate objective monitoring and evaluation of the partnership itself.More research is needed to understand better the contextual predictors of the broader influence and sustainability of partnership networks in global health leadership training.

Understanding VA's Use of and Relationships With Community Care Providers Under the MISSION Act.

BACKGROUND: Congress has enacted 2 major pieces of legislation to improve access to care for Veterans within the Department of Veterans Affairs (VA). As a result, the VA has undergone a major transformation in the way that care is delivered to Veterans with an increased reliance on community-based provider networks. No studies have examined the relationship between VA and contracted community providers. This study examines VA facility directors' perspectives on their successes and challenges building relationships with community providers within the VA Community Care Network (CCN). OBJECTIVES: To understand who VA facilities partner with for community care, highlight areas of greatest need for partnerships in various regions, and identify challenges of working with community providers in the new CCN contract. RESEARCH DESIGN: We conducted a national survey with VA facility directors to explore needs, challenges, and expectations with the CCN. RESULTS: The most common care referred to community providers included physical therapy, chiropractic, orthopedic, ophthalmology, and acupuncture. Open-ended responses focused on 3 topics: (1) Challenges in working with community providers, (2) Strategies to maintain strong relationships with community providers, and (3) Re-engagement with community providers who no longer provide care for Veterans. CONCLUSIONS: VA faces challenges engaging with community providers given problems with timely reimbursement of community providers, low (Medicare) reimbursement rates, and confusing VA rules related to prior authorizations and bundled services. It will be critical to identify strategies to successfully initiate and sustain relationships with community providers.

Installation Management Command's COVID-19 Pandemic Efforts Rely on Multiple Collaborative Partnerships.

The Installation Management Command (IMCOM) delivers quality base support from the strategic support area, enabling readiness for a globally responsive Army. IMCOM has more than 75 installations, covering more than 13 million acres, in 17 time zones, 12 countries and 58 services. In early March 2020, the COVID-19 pandemic required IMCOM to shift focus in ensuring health protection measures were implemented early and quickly, which relied on medical expertise. The IMCOM Surgeon and the Deputy Surgeon serve as the command's key advisors for all matters related to health care and medical readiness. During the COVID-19 pandemic, the IMCOM Surgeon and the Deputy Surgeon were critical in the consolidation of various information from multiple organizations. They promoted the integration of force health protection principles during COVID-19 operations. All of the military members at IMCOM headquarters (HQ) were considered mission essential while other personnel were identified on a phasing structure in the early stages of the pandemic, which meant civilian personnel were instructed to telework.

Partnership among hospitals to reduce healthcare associated infections: a quasi-experimental study in Brazilian ICUs.

BACKGROUND: Healthcare-associated infections (HAIs) are relevant in developing countries where frequencies can be at least 3 times higher than in developed countries. The purpose of this research was to describe the intervention implemented in intensive care units (ICUs) to reduce HAIs through collaborative project and analyze the variation over 18 months in the incidence density (ID) of the three main HAIs: ventilator associated pneumonia (VAP), central line-associated bloodstream infections (CLABSIs) and catheter-related urinary tract infections (CAUTIs) and also the length of stay and mortality in these ICUs. METHODS: A quasi-experimental study in five public adult clinical-surgical ICUs, to reduce HAIs, through interventions using the BTS-IHI "Improvement Model", during 18 months. In the project, promoted by the Ministry of Health, Brazilian philanthropic hospitals certified for excellence (HE), those mostly private, certified as excellence and exempt from security contributions, regularly trained and monitored public hospitals in diagnostics, data collection and in developing cycles to improve quality and to prevent HAIs (bundles). In the analysis regarding the length of stay, mortality, the IDs of VAP, CLABSIs and CAUTIs over time, a Generalized Estimating Equation (GEE) model was applied for continuous variables, using the constant correlation (exchangeable) between assessments over time. The model estimated the average difference (ß coefficient of the model) of the measures analyzed during two periods: a period in the year 2017 (prior to implementing the project) and in the years 2018 and 2019 (during the project). RESULT: A mean monthly reduction of 0.427 in VAP ID (p = 0.002) with 33.8% decrease at the end of the period and 0.351 in CAUTI ID (p = 0.009) with 45% final decrease. The mean monthly reduction of 0.252 for CLABSIs was not significant (p = 0.068). Length of stay and mortality rates had no significant variation. CONCLUSIONS: Given the success in reducing VAP and CAUTIs in a few months of interventions, the achievement of the collaborative project is evident. This partnership among public hospitals/HE may be applied to other ICUs including countries with fewer resources.

The Smartphone Pandemic: How Big Tech and public health authorities partner in the digital response to Covid-19.

Digital technologies harnessed through smartphones have been deployed widely to support the response to Covid-19 internationally, often through partnerships between 'Big tech' and telecoms corporations and public health authorities. This paper provides an overview and critical analysis of the rapid rise of such new forms of public-private cooperation, focusing on their manifestation in the European region in the first phase of the pandemic. Drawing on a review of international media and documents, we discuss three main domains of public health action in which private technology companies and public health authorities have converged: contact-tracing, epidemic modelling and public health communication to manage the 'infodemic' of misinformation about the new coronavirus. Critics have raised concerns about how the digital response to Covid-19 may threaten privacy and enable greater state surveillance and control, and the possibility that semi-automated decision-making may exacerbate existing discrimination and inequalities. Our analysis extends such critiques by considering what the digital response to Covid-19 reveals about tech corporations' growing power to influence public health agendas. We discuss how they promote technical solutions to public health challenges that are politically seductive, but that have uncertain effectiveness and societal implications that warrant critical scrutiny.

Coletiva de imprensa sobre combate ao coronavírus

O Governador João Doria confirmou o envio de insumos da China para a produção de 8,6 milhões de doses da vacina do Butantan até o dia 3 de fevereiro. O anúncio ocorreu em entrevista coletiva realizada na manhã de hoje (26), no Palácio dos Bandeirantes, com a participação online do Embaixador da China no Brasil, Yang Wanming, da sede da Embaixada na Brasília (DF). “Nesses dois anos, nós ampliamos as relações econômicas, comerciais, institucionais, culturais, de cooperação e de solidariedade com a China”, disse o governador João Doria, que lembrou da cooperação da China com São Paulo já no início da pandemia no ano passado. “O governo da China ofereceu gratuitamente equipamentos de proteção individual, máscaras, aventais, insumos e colaborou muito para a destinação de equipamentos respiradores e monitores para uso do sistema hospitalar”, citou. O Diretor do Instituto Butantan, Dimas Covas, confirmou o envio de 5,4 mil litros de insumos para a produção de vacinas que deverão chegar ao Brasil no dia 3 de fevereiro. “Na sequência, há outro volume de 5,6 mil litros que está processo avançado de liberação, totalizando 11 mil litros, para a produção de vacinas”, frisou. Segundo o Diretor do Instituto Butantan, a chegada de 5,4 mil litros de insumos vai originar 8,6 milhões de doses até 20 dias depois que se cumprir o ciclo de controle de qualidade. Covas lembrou, no entanto, que as doses já produzidas com os insumos recebidos anteriormente começarão a ser liberados diariamente ao Ministério da Saúde a partir de sexta-feira, 29. O Embaixador chinês Yang Wanming destacou a parceria que existe entre a China com o Governo de São Paulo no enfrentamento da pandemia do coronavírus. “O Brasil é um país importante e um parceiro de grande significado para a China. Mantemos uma relação amistosa tradicional entre os dois países, incluindo o estado de São Paulo. Os avanços significativos da cooperação da Sinovac e o Instituto Butantan evidencia atitude científica e rigorosa dos pesquisadores de ambos os países, neste momento em que a Coronavac está sendo aplicada em todo o Brasil. Isso demonstra que a nossa cooperação beneficia não só os paulista como o povo brasileiro”, declarou. “A única forma de vencermos essa pandemia é através da cooperação dos povos. E a China tem sido uma grande parceria nossa, do Butantan, de São Paulo e do Brasil, indiscutivelmente”, lembrou Dimas Covas. “Gostaríamos de consolidar as cooperações entre as duas partes, já que a situação da pandemia é incerta e haverá demanda urgente e de longo prazo pelas vacinas. A parte chinesa está disposta a manter e apoiar em conjunto a parceria entre Sinovac e o Butantan, de modo que contribua para o controle da pandemia”, reforçou o Embaixador.

Escritório de São Paulo na China solicita liberação de insumos da vacina

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