A global research agenda on public health and social measures during emergencies.

The importance of strong coordination for research on public health and social measures was highlighted at the Seventy-fourth World Health Assembly in 2021. This article describes efforts undertaken by the World Health Organization (WHO) to develop a global research agenda on the use of public health and social measures during health emergencies. This work includes a multistep process that started with a global technical consultation convened by WHO in September 2021. The consultation included experts from around the world and from a wide range of disciplines, such as public health, education, tourism, finance and social sciences, and aimed to identify research and implementation approaches based on lessons learnt during the coronavirus disease 2019 pandemic. To prepare for future epidemics and pandemics, it is essential to adopt a more robust, comparable and systematic research approach to public health and social measures. Such comprehensive approach will better inform agile, balanced and context-specific implementation decisions during future emergencies. This article describes the methods used to develop global research priorities for public health and social measures and the next steps needed.

La soixante-quatorzième Assemblée mondiale de la Santé en 2021 a souligné l'importance d'une coordination solide pour la recherche sur la santé publique et les mesures sociales. Le présent article décrit les efforts entrepris par l'Organisation mondiale de la santé (OMS) pour élaborer un programme de recherche mondial sur l'utilisation des mesures de santé publique et des mesures sociales lors de situations d'urgence sanitaire. Ce travail comprend un processus en plusieurs étapes qui a commencé par une consultation technique mondiale organisée par l'OMS en septembre 2021. La consultation a réuni des experts du monde entier issus d'un large éventail de disciplines telles que la santé publique, l'éducation, le tourisme, la finance et les sciences sociales. Elle visait à identifier des approches de recherche et de mise en œuvre fondées sur les enseignements tirés de la pandémie de maladie à coronavirus de 2019. Pour se préparer aux futures épidémies et pandémies, il est essentiel d'adopter une approche de recherche plus solide, comparable et systématique en matière de santé publique et de mesures sociales. Cette approche globale permettra de mieux éclairer les décisions de mise en œuvre agiles, équilibrées et adaptées au contexte lors des futures situations d'urgence. Le présent article décrit les méthodes appliquées pour définir les priorités mondiales de recherche en matière de santé publique et de mesures sociales, ainsi que les prochaines étapes à franchir.

En la 74.ª Asamblea Mundial de la Salud, celebrada en 2021, se destacó la importancia de una sólida coordinación en la investigación sobre salud pública y medidas sociales. Este artículo describe los esfuerzos que ha emprendido la Organización Mundial de la Salud (OMS) para desarrollar un programa mundial de investigación sobre el uso de medidas sociales y de salud pública durante las emergencias sanitarias. Este trabajo incluye un proceso de varios pasos que comenzó con una consulta técnica mundial que convocó la OMS en septiembre de 2021. La consulta incluyó a expertos de todo el mundo y de una gran variedad de disciplinas, como la salud pública, la educación, el turismo, las finanzas y las ciencias sociales, y tuvo como objetivo identificar enfoques de investigación y aplicación basados en las lecciones aprendidas durante la pandemia de la enfermedad por coronavirus de 2019. Para prepararse ante futuras epidemias y pandemias, es esencial adoptar un enfoque de investigación más sólido, comparable y sistemático en materia de salud pública y medidas sociales. Este enfoque integral informará mejor las decisiones de aplicación ágiles, equilibradas y adaptadas al contexto durante futuras emergencias. En este artículo se describen los métodos utilizados para elaborar las prioridades mundiales de investigación sobre salud pública y medidas sociales, así como los próximos pasos necesarios.

Action on the social determinants for advancing health equity in the time of COVID-19: perspectives of actors engaged in a WHO Special Initiative.

Since the 2008 publication of the reports of the Commission on Social Determinants of Health and its nine knowledge networks, substantial research has been undertaken to document and describe health inequities. The COVID-19 pandemic has underscored the need for a deeper understanding of, and broader action on, the social determinants of health. Building on this unique and critical opportunity, the World Health Organization is steering a multi-country Initiative to reduce health inequities through an action-learning process in 'Pathfinder' countries. The Initiative aims to develop replicable and reliable models and practices that can be adopted by WHO offices and UN staff to address the social determinants of health to advance health equity. This paper provides an overview of the Initiative by describing its broad theory of change and work undertaken in three regions and six Pathfinder countries in its first year-and-a-half. Participants engaged in the Initiative describe results of early country dialogues and promising entry points for implementation that involve model, network and capacity building. The insights communicated through this note from the field will be of interest for others aiming to advance health equity through taking action on the social determinants of health, in particular as regards structural determinants.

Planetary health benefits from strengthening health workforce education on the social determinants of health.

Social inequalities are perpetuating unhealthy living and working conditions and behaviours. These causes are commonly called 'the social determinants of health'. Social inequalities are also impacting climate change and vice-versa, which, is causing profound negative impacts on planetary health. Achieving greater sustainability for human and planetary health demands that the health sector assumes a greater leadership role in addressing social inequalities. This requires equipping health and social care workers to better understand how the social determinants of health impact patients and communities. Integration of the social determinants of health into education and training will prepare the workforce to adjust clinical practice, define appropriate public health programmes and leverage cross-sector policies and mechanisms being put in place to address climate change. Educators should guide health and social workforce learners using competency-based approaches to explore critical pathways of social determinants of health, and what measurements and interventions may apply according to the structural and intermediary determinants of health and health equity. Key institutional and instructional reforms by decision-makers are also needed to ensure that the progressive integration and strengthening of education and training on the social determinants of health is delivered equitably, including by ensuring the leadership and participation of marginalized and minority groups. Training on the social determinants of health should apply broadly to three categories of health and social workforce learners, namely, those acting on global or national policies; those working in districts and communities; and those providing clinical services to individual families and patients.

Are rhetorical commitments to adolescents reflected in planning documents? An exploratory content analysis of adolescent sexual and reproductive health in Global Financing Facility country plans.

BACKGROUND: The Global Financing Facility (GFF) offers an opportunity to close the financing gap that holds back gains in women, children's and adolescent health. However, very little work exists examining GFF practice, particularly for adolescent health. As momentum builds for the GFF, we examine initial GFF planning documents to inform future national and multi-lateral efforts to advance adolescent sexual and reproductive health. METHODS: We undertook a content analysis of the first 11 GFF Investment Cases and Project Appraisal Documents available on the GFF website. The countries involved include Bangladesh, Cameroon, Democratic Republic of Congo, Ethiopia, Guatemala, Kenya, Liberia, Mozambique, Nigeria, Tanzania and Uganda. RESULTS: While several country documents signal understanding and investment in adolescents as a strategic area, this is not consistent across all countries, nor between Investment Cases and Project Appraisal Documents. In both types of documents commitments weaken as one moves from programming content to indicators to investment. Important contributions include how teenage pregnancy is a universal concern, how adolescent and youth friendly health services and school-based programs are supported in several country documents, how gender is noted as a key social determinant critical for mainstreaming across the health system, alongside the importance of multi-sectoral collaboration, and the acknowledgement of adolescent rights. Weaknesses include the lack of comprehensive analysis of adolescent health needs, inconsistent investments in adolescent friendly health services and school based programs, missed opportunities in not supporting multi-component and multi-level initiatives to change gender norms involving adolescent boys in addition to adolescent girls, and neglect of governance approaches to broker effective multi-sectoral collaboration, community engagement and adolescent involvement. CONCLUSION: There are important examples of how the GFF supports adolescents and their sexual and reproductive health. However, more can be done. While building on service delivery approaches more consistently, it must also fund initiatives that address the main social and systems drivers of adolescent health. This requires capacity building for the technical aspects of adolescent health, but also engaging politically to ensure that the right actors are convened to prioritize adolescent health in country plans and to ensure accountability in the GFF process itself.

Primary health care, the Declaration of Astana and COVID-19.

Four decades after the Declaration of Alma-Ata, its vision of health for all and strategy of primary health care are still an inspiration to many people. In this article we evaluate the current status of primary health care in the era of the Declaration of Astana, the sustainable development goals, universal health coverage and the coronavirus disease 2019 pandemic. We consider how best to guide greater application of the primary health care strategy, reflecting on tensions that remain between the political vision of primary health care and its implementation in countries. We also consider what is required to support countries to realize the aspirations of primary health care, arguing that national needs and action must dominate over global preoccupations. Changing contexts and realities need to be accommodated. A clear distinction is needed between primary health care as an inspirational vision and set of values for health development, and primary health care as policy and implementation space. To achieve this vision, political action is required. Stakeholders beyond the health sector will often need to lead, which is challenging because the concept of primary health care is poorly understood by other sectors. Efforts on primary health care as policy and implementation space might focus explicitly on primary care and the frontline of service delivery with clear links and support to complementary work on social determinants and building healthy societies. Such efforts can be partial but important implementation solutions to contribute to the much bigger political vision of primary health care.

Quarante ans après la Déclaration d'Alma-Ata, sa vision en matière de santé universelle et sa stratégie de soins de santé primaires demeurent une inspiration pour de nombreuses personnes. Dans cet article, nous évaluons l'état actuel des soins de santé primaires à l'ère de la Déclaration d'Astana, des objectifs de développement durable, de la couverture maladie universelle et de la pandémie de maladie à coronavirus 2019 (COVID-19). Nous tentons de déterminer quel est le meilleur moyen de favoriser une application plus vaste de la stratégie de soins de santé primaires, en tenant compte des tensions qui subsistent entre la vision politique des soins de santé primaires et leur mise en œuvre dans les différents pays. Nous identifions également les éléments qui aident les pays à concrétiser les aspirations liées aux soins de santé primaires, et affirmons que les besoins et actions à l'échelle nationale doivent primer sur les préoccupations internationales. L'évolution des contextes et des réalités doit être prise en considération. Il est impératif d'opérer une nette distinction entre les soins de santé primaires comme source d'inspiration et ensemble de valeurs guidant le développement sanitaire d'une part, et comme espace politique et de mise en œuvre de l'autre. Pour y parvenir, des actes politiques sont indispensables. Des intervenants n'appartenant pas au secteur de la santé devront souvent prendre l'initiative, ce qui représente un défi car le concept des soins de santé primaires suscite l'incompréhension dans les autres secteurs. Les efforts en matière d'espace politique et de mise en œuvre pourraient se concentrer explicitement sur les soins de santé primaires et la première ligne des prestations de service, avec des liens clairement établis et un soutien aux travaux complémentaires consacrés aux déterminants sociaux et à la création d'une société saine. De tels efforts peuvent offrir des solutions partielles mais essentielles à l'élaboration d'une vision politique bien plus large des soins de santé primaires.

Cuatro décadas después de la Declaración de Almá Atá, su visión de la salud para todos y su estrategia de atención primaria de salud siguen siendo una inspiración para muchas personas. En este artículo se evalúa el estado actual de la atención primaria de salud en la era de la Declaración de Astaná, los objetivos de desarrollo sostenible, la cobertura sanitaria universal y la pandemia de la enfermedad por coronavirus de 2019. Se analiza la mejor manera de orientar una mayor aplicación de la estrategia de atención primaria de salud al estudiar las tensiones que subsisten entre la visión política de la atención primaria de salud y su aplicación en los países. También se analiza lo que se requiere para ayudar a los países a materializar las aspiraciones de la atención primaria de salud al argumentar que las necesidades y las medidas nacionales deben prevalecer sobre las preocupaciones mundiales. Se deben tener en cuenta los contextos y las realidades cambiantes. Hay que establecer una clara diferencia entre la atención primaria de salud como visión inspiradora y conjunto de valores para el desarrollo de la salud, y la atención primaria de salud como entorno normativo y de aplicación. Por consiguiente, se requiere la adopción de medidas políticas para hacer realidad esta visión. Con frecuencia, las partes interesadas que no pertenecen al sector sanitario tendrán que tomar la iniciativa, lo que supone un reto porque el concepto de atención primaria de salud no se comprende bien en otros sectores. Los esfuerzos relacionados con la atención primaria como entorno normativo y de aplicación se podrían centrar de manera explícita en la atención primaria y en la prestación de servicios de primera línea a través de vínculos claros y el apoyo a la labor complementaria sobre los determinantes sociales y la construcción de sociedades sanas. Esos esfuerzos pueden ser soluciones parciales pero importantes de aplicación para contribuir a la visión política mucho más amplia de la atención primaria de salud.

Governing multisectoral action for health in low- and middle-income countries.

Kumanan Rasanathan and colleagues argue that the potential of multisectoral collaboration for improving health remains untapped in many low- and middle-income countries.

Water, sanitation and hygiene interventions for acute childhood diarrhea: a systematic review to provide estimates for the Lives Saved Tool.

BACKGROUND: In the Sustainable Development Goals (SDGs) era, there is growing recognition of the responsibilities of non-health sectors in improving the health of children. Interventions to improve access to clean water, sanitation facilities, and hygiene behaviours (WASH) represent key opportunities to improve child health and well-being by preventing the spread of infectious diseases and improving nutritional status. METHODS: We conducted a systematic review of studies evaluating the effects of WASH interventions on childhood diarrhea in children 0-5 years old. Searches were run up to September 2016. We screened the titles and abstracts of retrieved articles, followed by screening of the full-text reports of relevant studies. We abstracted study characteristics and quantitative data, and assessed study quality. Meta-analyses were performed for similar intervention and outcome pairs. RESULTS: Pooled analyses showed diarrhea risk reductions from the following interventions: point-of-use water filtration (pooled risk ratio (RR): 0.47, 95% confidence interval (CI): 0.36-0.62), point-of-use water disinfection (pooled RR: 0.69, 95% CI: 0.60-0.79), and hygiene education with soap provision (pooled RR: 0.73, 95% CI: 0.57-0.94). Quality ratings were low or very low for most studies, and heterogeneity was high in pooled analyses. Improvements to the water supply and water disinfection at source did not show significant effects on diarrhea risk, nor did the one eligible study examining the effect of latrine construction. CONCLUSIONS: Various WASH interventions show diarrhea risk reductions between 27% and 53% in children 0-5 years old, depending on intervention type, providing ample evidence to support the scale-up of WASH in low and middle-income countries (LMICs). Due to the overall low quality of the evidence and high heterogeneity, further research is required to accurately estimate the magnitude of the effects of these interventions in different contexts.

Research on health equity in the SDG era: the urgent need for greater focus on implementation.

BACKGROUND: The tremendous increase in knowledge on inequities in health and their drivers in recent decades has not been matched by improvements in health inequities themselves, or by systematic evidence of what works to reduce health inequities. Within health equity research there is a skew towards diagnostic studies in comparison to intervention studies showing evidence of how interventions can reduce disparities. MAIN TEXT: The lack of sufficient specific evidence on how to implement specific policies and interventions in specific contexts to reduce health inequities creates policy confusion and partly explains the lack of progress on health inequities. In the field of research on equity in health, the time has come to stop focusing so much energy on prevalence and pathways, and instead shift to proposing and testing solutions. Four promising approaches to do so are implementation research, natural experimental policy studies, research on buy-in by policy-makers to action on health inequities, and geospatial analysis. CONCLUSION: The case for action on social determinants and health inequities has well and truly been made. The community of researchers on health equity now need to turn their attention to supporting implementation efforts towards achievements of the Sustainable Development Goals and substantive reductions in health inequities.

Why the Convention on the Rights of the Child must become a guiding framework for the realization of the rights of children affected by tuberculosis.

BACKGROUND: Until recently, paediatric tuberculosis (TB) has been relatively neglected by the broader TB and the maternal and child health communities. Human rights-based approaches to children affected by TB could be powerful; however, awareness and application of such strategies is not widespread. DISCUSSION: We summarize the current challenges faced by children affected by TB, including: consideration of their family context; the limitations of preventive, diagnostic and treatment options; paucity of paediatric-specific research; failure in implementation of interventions; and stigma. We examine the articles of the Convention on the Rights of the Child (CRC) and relate them to childhood TB. Specifically, we focus on the five core principles of the CRC: children's inherent right to life and States' duties towards their survival and development; children's right to enjoyment of the highest attainable standard of health; non-discrimination; best interests of the child; and respect for the views of the child. We highlight where children's rights are violated and how a human rights-based approach should be used as a tool to help children affected by TB, particularly in light of the Sustainable Development Goals and their focus on universality and leaving no one behind. The article aims to bridge the gap between those providing paediatric TB clinical care and conducting research, and those working in the fields of human rights policy and advocacy to promote a human rights-based approach for children affected by TB based upon the Convention on the Rights of the Child.

Climate change, cash transfers and health.

The forecast consequences of climate change on human health are profound, especially in low- and middle-income countries and among the most disadvantaged populations. Innovative policy tools are needed to address the adverse health effects of climate change. Cash transfers are established policy tools for protecting population health before, during and after climate-related disasters. For example, the Ethiopian Productive Safety Net Programme provides cash transfers to reduce food insecurity resulting from droughts. We propose extending cash transfer interventions to more proactive measures to improve health in the context of climate change. We identify promising cash transfer schemes that could be used to prevent the adverse health consequences of climatic hazards. Cash transfers for using emission-free, active modes of transport - e.g. cash for cycling to work - could prevent future adverse health consequences by contributing to climate change mitigation and, at the same time, improving current population health. Another example is cash transfers provided to communities that decide to move to areas in which their lives and health are not threatened by climatic disasters. More research on such interventions is needed to ensure that they are effective, ethical, equitable and cost-effective.

Les conséquences attendues du changement climatique sur la santé humaine sont importantes, en particulier dans les pays à revenu faible et intermédiaire et pour les populations les plus défavorisées. Des moyens d'intervention innovants sont nécessaires pour lutter contre les effets néfastes du changement climatique sur la santé. Les transferts d'argent sont des moyens d'intervention éprouvés pour protéger la santé de la population avant, pendant et après les catastrophes climatiques. Le Programme de création de dispositifs de sécurité productifs de l'Éthiopie, par exemple, prévoit des transferts d'argent pour réduire l'insécurité alimentaire découlant des périodes de sécheresse. Nous proposons d'inclure les opérations de transfert d'argent dans des actions plus préventives en vue d'améliorer la santé dans le contexte du changement climatique. Nous avons identifié différents systèmes de transfert d'argent prometteurs qui pourraient être utilisés pour éviter les conséquences néfastes des risques liés au climat sur la santé. Les transferts d'argent visant l'utilisation de moyens de transport actifs et sans émissions ­ pour se rendre au travail à vélo par ex. ­ pourraient prévenir les futures conséquences néfastes sur la santé en contribuant à l'atténuation du changement climatique et en améliorant ainsi l'état actuel de la santé de la population. Un autre exemple concerne les transferts d'argent accordés aux communautés qui décident de s'établir dans des régions où leur vie et leur santé ne sont pas menacées par des catastrophes climatiques. Davantage de recherches sur ces opérations sont nécessaires pour prouver leur efficacité, leur caractère éthique et équitable ainsi que leur rentabilité.

Las consecuencias previstas del cambio climático en la salud humana son severas, especialmente en los países de ingresos bajos y medios y entre los grupos más desfavorecidos. Se necesitan instrumentos normativos innovadoras para afrontar los efectos adversos sobre la salud que el cambio climático produce. Las transferencias de efectivo son instrumentos normativos establecidos para proteger la salud de la población antes, durante y después de los desastres relacionados con el clima. Por ejemplo, el Programa "Red de Seguridad Productiva" de Etiopía proporciona transferencias de efectivo para reducir la inseguridad alimentaria derivada de las sequías. Nosotros proponemos extender las intervenciones de transferencias de efectivo a medidas más proactivas para mejorar la salud en el contexto del cambio climático. Identificamos planes prometedores de transferencia de efectivo que podrían utilizarse para prevenir las consecuencias adversas sobre la salud provocadas por los riesgos climáticos. Las transferencias de efectivo para usar modos de transporte activos y libres de emisiones (por ejemplo, dinero para ir al trabajo en bicicleta) podrían prevenir futuras consecuencias adversas sobre la salud, contribuyendo a la mitigación del cambio climático y, al mismo tiempo, mejorando la salud actual de la población. Otro ejemplo son las transferencias de efectivo realizadas a comunidades que deciden trasladarse a zonas dónde sus vidas y su salud no estén amenazadas por los desastres climáticos. Es necesario llevar a cabo más investigaciones en estas intervenciones para garantizar que sean efectivas, éticas, equitativas y costoefectivas.

The cost of inaction on health equity and its social determinants.

Rising levels of inflation, debt and macrofiscal tightening are putting expenditures on the social sectors including health under immense scrutiny. Already, there are worrying signs of reductions in social sector investments. However, even before the pandemic, evidence showed the significant returns on investments in health equity and its social determinants. Emerging data and trends show that these potential returns have increased during the COVID-19 pandemic - investments in social determinants can mitigate widespread reductions in human capital and the increasing likelihood of costly syndemics, while promoting access to healthcare innovations that have thus far been inequitably distributed. Therefore, we argue that, despite immediate fiscal pressures, this is exactly the time to invest in health equity and its broader social determinants, as the returns on such investments have never been greater.