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Gigger DR, Mosoff JM, Pinto M, Mapatano D, Mahar M, Minnick A. A Delphi study to assess the effect of changes in language between the first and second editions of the WHO's Joint External Evaluation. BMJ Glob Health 2024; 9:e013954. [PMID: 38740494 PMCID: PMC11097886 DOI: 10.1136/bmjgh-2023-013954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 03/29/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Countries use the WHO Joint External Evaluation (JEE) tool-part of the WHO International Health Regulations (2005) Monitoring and Evaluation Framework-for voluntary evaluation of global health security (GHS) capacities. After releasing the JEE first edition (E1) in 2016, WHO released the JEE second edition (E2) in 2018 with language changes to multiple indicators and associated capacity levels. To understand the effect of language changes on countries' ability to meet requirements in each edition, we conducted a Delphi study-a method where a panel of experts reach consensus on a topic through iterative, anonymous surveys-to solicit feedback from 40+ GHS experts with expertise in one or more of the 19 JEE technical areas. METHODS We asked experts first to compare the language changes for each capacity level within each indicator and identify how these changes affected the indicator overall; then to assess the ability of a country to achieve the same capacity level using E2 as compared with E1 using a Likert-style score (1-5), where '1' was 'significantly easier' and '5' was 'significantly harder'; and last to provide a qualitative justification for score selections. We analysed the medians and IQR of responses to determine where experts reached consensus. RESULTS Results demonstrate that 14 indicators and 49 capacity levels would be harder to achieve in E2. CONCLUSION Findings underscore the importance of considering how language alterations impact how the JEE measures GHS capacity and the feasibility of using the JEE to monitor changes in capacity over time.
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Affiliation(s)
- Danique R Gigger
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Meredith Pinto
- RTI International, Research Triangle Park, North Carolina, USA
| | - Dawn Mapatano
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michael Mahar
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anja Minnick
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Iwase M, Taniyama Y, Koyanagi YN, Kasugai Y, Oze I, Masuda N, Ito H, Matsuo K. A Century of Change: Unraveling the Impact of Socioeconomic/Historical Milestones on Age at Menarche and Other Female Reproductive Factors in Japan. J Epidemiol 2024:JE20230155. [PMID: 38191181 DOI: 10.2188/jea.je20230155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Reproductive factors such as age at menarche are known to be associated with disease risk, but data on trends in these factors in Japan are limited. In this study, we investigated secular trends in reproductive factors and explored their potential association with socioeconomic and historical events. METHODS We conducted a retrospective analysis of 62,005 Japanese women born between 1890 and 1991 using a survey conducted over 25 years. Trends in reproductive factors were analyzed using linear and joinpoint regression models, and their associations with major historical events involving Japan were evaluated. RESULTS We found that the age at menarche showed a significant downward trend (P-value<0.001) over the century. Three joinpoints were identified, in 1932 (15.23 years old), 1946 (13.48 years old), and 1959 (12.71 years old), which indicated that average age at menarche decreased by approximately 0.8% per year between 1932 and 1946, and then by 0.4% per year between 1946 and 1959, both of which were statistically significant. However, after 1959, age of menarche remained stable. Analyses of other reproductive factors found significant changes, including a decrease in parity and the number of babies breastfed, and an increase in age at first birth. CONCLUSION Age at menarche showed a long-term downward trend in Japan, with significant change points in annual percent change. Other factors showed secular changes in trends as well. These change points were observed at the same time as historical events, namely wars and economic development, suggesting that socioeconomic and environmental changes at the population level affect reproductive factors in females.
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Affiliation(s)
- Madoka Iwase
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center
- Department of Breast and Endocrine Surgery, Nagoya University Hospital
| | - Yukari Taniyama
- Division of Cancer Information and Control, Aichi Cancer Center
| | | | - Yumiko Kasugai
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center
| | - Isao Oze
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center
| | - Norikazu Masuda
- Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine
| | - Hidemi Ito
- Division of Cancer Information and Control, Aichi Cancer Center
- Division of Descriptive Cancer Epidemiology, Nagoya University Graduate School of Medicine
| | - Keitaro Matsuo
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center
- Division of Cancer Epidemiology, Nagoya University Graduate School of Medicine
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Sharma A. Raising awareness and mitigating risk of transmission of antimicrobial resistance during the upcoming 2024 Gangasagar religious mass gathering. New Microbes New Infect 2024; 56:101213. [PMID: 38223847 PMCID: PMC10784787 DOI: 10.1016/j.nmni.2023.101213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 01/16/2024] Open
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Gotsche CI, Meierkord A, Baruch J, Körner-Nahodilová L, Weishaar H, Hanefeld J. Approaches, challenges, and opportunities to strengthen the epidemic intelligence workforce: a scoping review. Public Health 2023; 225:353-359. [PMID: 37979312 DOI: 10.1016/j.puhe.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/30/2023] [Accepted: 09/16/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Weak surveillance systems have limited countries' ability to adequately respond to public health emergencies. Strengthening the human workforce in this field is considered an important opportunity to ensure the future response to infectious diseases outbreaks globally. A scoping review of the academic literature and relevant documents was conducted to identify approaches, challenges, and opportunities to strengthen the epidemic intelligence (EI) workforce. METHODS Five peer-reviewed databases were systematically searched, as well as Google as a grey literature source. English language articles and documents published between 2014 and 2022 were included. No geographical restrictions were set. RESULTS 37 articles and 20 documents were included in the review. Professional training, the acknowledgement of including a broad variety of disciplines into the workforce, the inclusion of communities, the pursuit of a One Health approach and the use of digital tools were identified as impeding and/or facilitating the EI workforce. The review shows that the field epidemiology training programme is a prominent approach for strengthening the EI workforce and that little evidence exists on how non-traditional disciplines (e.g., disciplines besides medicine, laboratory science, or epidemiology) contributing to surveillance may support the future EI workforce. CONCLUSION The identification of approaches, challenges, and opportunities of EI can inform future policy and practice on strengthening the EI workforce. The conduct of more high-quality studies is needed to guide this process. The potential benefits of integrating a wider range of disciplines than currently found in the surveillance workforce and of involving communities in disease surveillance needs to be further researched.
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Affiliation(s)
- C I Gotsche
- Robert Koch Institute, Centre for International Health Protection, Nordufer 20, Berlin, 13353, Germany; London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom.
| | - A Meierkord
- Robert Koch Institute, Centre for International Health Protection, Nordufer 20, Berlin, 13353, Germany; Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité Center for Global Health, Institute of International Health, Berlin, 13353, Germany
| | - J Baruch
- Robert Koch Institute, Centre for International Health Protection, Nordufer 20, Berlin, 13353, Germany
| | - L Körner-Nahodilová
- Robert Koch Institute, Centre for International Health Protection, Nordufer 20, Berlin, 13353, Germany
| | - H Weishaar
- Robert Koch Institute, Centre for International Health Protection, Nordufer 20, Berlin, 13353, Germany
| | - J Hanefeld
- Robert Koch Institute, Centre for International Health Protection, Nordufer 20, Berlin, 13353, Germany; London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom
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Robbiati C, Milano A, Declich S, Di Domenico K, Mancini L, Pizzarelli S, D'Angelo F, Riccardo F, Scavia G, Dente MG. One health adoption within prevention, preparedness and response to health threats: Highlights from a scoping review. One Health 2023; 17:100613. [PMID: 37588423 PMCID: PMC10425384 DOI: 10.1016/j.onehlt.2023.100613] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 08/18/2023] Open
Abstract
Introduction As the COVID-19 pandemic has demonstrated, the complexity of factors involved in the emergence of health threats requires a holistic One Health (OH) approach to enhance the effectiveness of prevention, preparedness, and response (PPR) strategies. Therefore, we conducted a scoping review to explore how the OH approach has been adopted in the context of PPR strategies to health threats, and the challenges and benefits deriving from its integration. Methods We defined the research questions and a strategy to guide the peer-reviewed and grey literature search to identify relevant articles and documents (identification). We assessed them for eligibility according to predefined criteria (screening) and finally included the ones that answered the research questions (inclusion). We performed a descriptive and thematic analysis of the results. Results A total of 138 records were included in the review (57 from the peer-reviewed literature and 81 from the grey literature). The OH approach was mainly adopted in prevention strategies, particularly within the governance area. Human and animal health were the most integrated disciplines in the OH approach, while environmental and social sciences were the less integrated. The most targeted threats were antimicrobial resistance and zoonoses, with the African region being the most represented. Conducive factors for the adoption of OH PPR strategies were identified in resolutions and guidance emanating from international organisations. Discussion The global governance of OH should utilise conducive factors, such as international resolutions and guidance, to enhance the adoption of multisectoral and multi-actor PPR strategies, that focus on national and international priorities and neglected threats, such as environmental hazards and pandemic risk. Integrated frameworks and metrics for the implementation and evaluation of OH PPR strategies need to be consolidated to contribute to the growing body of evidence supporting the adoption of the OH approach.
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Affiliation(s)
- Claudia Robbiati
- Istituto Superiore di Sanità (Italian National Institute of Health), National Center for Global Health, Rome, Italy
- Public Health and Infectious Diseases Dept., Sapienza University of Rome, Italy
| | - Alessia Milano
- Istituto Superiore di Sanità (Italian National Institute of Health), National Center for Global Health, Rome, Italy
- Public Health and Infectious Diseases Dept., Sapienza University of Rome, Italy
| | - Silvia Declich
- Istituto Superiore di Sanità (Italian National Institute of Health), National Center for Global Health, Rome, Italy
| | - Kevin Di Domenico
- Public Health and Infectious Diseases Dept., Sapienza University of Rome, Italy
- Istituto Superiore di Sanità (Italian National Institute of Health), Environment and Health Dept., Rome, Italy
| | - Laura Mancini
- Istituto Superiore di Sanità (Italian National Institute of Health), Environment and Health Dept., Rome, Italy
| | - Scilla Pizzarelli
- Istituto Superiore di Sanità (Italian National Institute of Health), Knowledge Unit (Documentation, Library), Rome, Italy
| | - Franca D'Angelo
- Istituto Superiore di Sanità (Italian National Institute of Health), National Center for Global Health, Rome, Italy
| | - Flavia Riccardo
- Istituto Superiore di Sanità (Italian National Institute of Health), Infectious Diseases Dept., Rome, Italy
| | - Gaia Scavia
- Istituto Superiore di Sanità (Italian National Institute of Health), Food Safety, Nutrition and Veterinary Public Health Dept., Rome, Italy
| | - Maria Grazia Dente
- Istituto Superiore di Sanità (Italian National Institute of Health), National Center for Global Health, Rome, Italy
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Ramírez Varela A, Touchton M, Miranda JJ, Grueso JM, Laajaj R, Carrasquilla G, Florez MV, Gaviria AMV, Hoyos AMO, Duarte EOV, Morales AV, Velasco N, Restrepo SR. Assessing pandemic preparedness, response, and lessons learned from the COVID-19 pandemic in four south American countries: agenda for the future. Front Public Health 2023; 11:1274737. [PMID: 38094236 PMCID: PMC10716458 DOI: 10.3389/fpubh.2023.1274737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
Introduction The COVID-19 pandemic emerged in a context that lacked adequate prevention, preparedness, and response (PPR) activities, and global, regional, and national leadership. South American countries were among world's hardest hit by the pandemic, accounting for 10.1% of total cases and 20.1% of global deaths. Methods This study explores how pandemic PPR were affected by political, socioeconomic, and health system contexts as well as how PPR may have shaped pandemic outcomes in Argentina, Brazil, Colombia, and Peru. We then identify lessons learned and advance an agenda for improving PPR capacity at regional and national levels. We do this through a mixed-methods sequential explanatory study in four South American countries based on structured interviews and focus groups with elite policy makers. Results The results of our study demonstrate that structural and contextual barriers limited PPR activities at political, social, and economic levels in each country, as well as through the structure of the health care system. Respondents believe that top-level government officials had insufficient political will for prioritizing pandemic PPR and post-COVID-19 recovery programs within their countries' health agendas. Discussion We recommend a regional COVID-19 task force, post-pandemic recovery, social and economic protection for vulnerable groups, improved primary health care and surveillance systems, risk communication strategies, and community engagement to place pandemic PPR on Argentina, Brazil, Colombia, and Peru and other South American countries' national public health agendas.
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Affiliation(s)
| | - Michael Touchton
- Faculty Lead for Global Health, Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, United States
| | - J. Jaime Miranda
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Rachid Laajaj
- Department of Economics, Universidad de los Andes, Bogotá, Colombia
| | | | - Martha Vives Florez
- Department of Biological Sciences, Universidad de los Andes, Bogotá, Colombia
| | | | | | | | | | - Nubia Velasco
- School of Business, Universidad de los Andes, Bogotá, Colombia
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Chicmana-Zapata V, Arotoma-Rojas I, Anza-Ramírez C, Ford J, Galappaththi EK, Pickering K, Sacks E, Togarepi C, Perera CD, van Bavel B, Hyams K, Akugre FA, Nkalubo J, Dharmasiri I, Nakwafila O, Mensah A, Miranda JJ, Zavaleta-Cortijo C. Justice implications of health and food security policies for Indigenous peoples facing COVID-19: a qualitative study and policy analysis in Peru. Health Policy Plan 2023; 38:ii36-ii50. [PMID: 37995268 PMCID: PMC10680992 DOI: 10.1093/heapol/czad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 06/22/2023] [Accepted: 07/05/2023] [Indexed: 11/25/2023] Open
Abstract
The spread of COVID-19 in Peru resulted in the declaration of a national health emergency, in which Indigenous peoples were identified as being particularly vulnerable due to their pre-existing poor health indicators and disadvantaged social conditions. The aim of this paper is to examine how the Peruvian government responded to the health and food needs of the Shawi and Ashaninka Indigenous peoples of Peru during the first 18 months of the pandemic (March 2020-August 2021). This study uses both official policy documents and real-world experiences to evaluate policy responses in terms of their immediate impact and their longer-term sustainability and contribution to the improvement of health, well-being and justice for Indigenous communities. Four health and food security responses were evaluated: the Amazon Health Plan and Indigenous Command; food aid; cash aid; and COVID-19 vaccination. We employed the Multidimensional Injustice Framework to analyse the justice implications of the design and implementation of responses. Data collection included 71 interviews with government officials (n = 7), Indigenous leaders (n = 31) and community members (n = 33). The results show how national and regional governments released policies to address the health and food needs of Indigenous peoples directly or indirectly, as part of a broader focus on vulnerable people. However, justice implications were not sufficiently addressed in the design or implementation of the responses. On the distributive dimension, Indigenous communities were prioritized to receive health goods and services, nevertheless, the distribution had shortcomings that impeded their collection and Indigenous food systems and livelihoods were largely overlooked. On the procedural dimension, Indigenous representatives were included to provide culturally sensitive feedback on health interventions, but without funding, and furthermore, the community members had only passive participation. This paper points out the importance of considering and addressing justice implications for more effective and fairer health and food policy responses to current and future health crises.
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Affiliation(s)
- Victoria Chicmana-Zapata
- Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martín de Porres, Lima 15102, Perú
| | - Ingrid Arotoma-Rojas
- Priestley International Centre for Climate, University of Leeds, Woodhouse, Leeds LS2 9JT, United Kingdom
| | - Cecilia Anza-Ramírez
- CRONICAS-Universidad Peruana Cayetano Heredia, Av. Armendáriz 445, Miraflores, Lima, 15074, Perú
| | - James Ford
- Priestley International Centre for Climate, University of Leeds, Woodhouse, Leeds LS2 9JT, United Kingdom
| | - Eranga K Galappaththi
- Department of Geography, Virginia Polytechnic Institute and State University, 238 Wallace Hall, Blacksburg, VA 24060, USA
| | - Kerrie Pickering
- Environmental Sustainability Research Centre, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON L2S 3A1, Canada
| | - Emma Sacks
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD 21205, USA
| | - Cecil Togarepi
- University of Namibia, Ogongo Campus, Private Bag X5507, Eliander Mwatale Street, Oshakati, Namibia
| | - Chrishma D Perera
- Department of Geography, Virginia Polytechnic Institute and State University, 238 Wallace Hall, Blacksburg, VA 24060, USA
| | | | - Keith Hyams
- University of Warwick, Coventry CV4 7AL, United Kingdom
| | - Francis A Akugre
- Institute for Environment and Sanitation Studies, University of Ghana, MR39+C4X, Annie Jiagge Rd, Accra, Ghana
| | - Jonathan Nkalubo
- Mulago National Referral Hospital and Uganda National Health Research Organization, Mulago Hospital Complex, Mulago Hill, P.O. Box 7051, Kampala, Uganda
| | - Indunil Dharmasiri
- Department of Geography, Virginia Polytechnic Institute and State University, 238 Wallace Hall, Blacksburg, VA 24060, USA
| | - Olivia Nakwafila
- University of Namibia, 340 Mandume Ndemufayo Avenue, Pioneerspark, Namibia
| | - Adelina Mensah
- Institute for Environment and Sanitation Studies, University of Ghana, MR39+C4X, Annie Jiagge Rd, Accra, Ghana
| | - Jaime J Miranda
- CRONICAS-Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martín de Porres, Lima 15102, Perú
| | - Carol Zavaleta-Cortijo
- Unidad de Ciudadania Intercultural y Salud Indígena (UCISI), Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martín de Porres, Lima 15102, Perú
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Kaneda Y, Shrestha R, Iwahashi K, Takahashi K. The rising threat of Mpox in Japan despite global decrease. J Public Health Policy 2023; 44:499-502. [PMID: 37620668 DOI: 10.1057/s41271-023-00427-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 08/26/2023]
Affiliation(s)
- Yudai Kaneda
- School of Medicine, Hokkaido University, Sapporo, Japan.
| | - Rajeev Shrestha
- Palliative Care and Chronic Disease, Green Pasture Hospital, Pokhara, Nepal
| | | | - Kenzo Takahashi
- Teikyo University Graduate School of Public Health, Tokyo, Japan
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Sullivan A, Ogunseitan O, Epstein J, Kuruchittham V, Nangami M, Kabasa D, Bazeyo W, Naigaga I, Kochkina O, Bikaako W, Ahmad N, Yawe A, Muhumuza C, Nuraini R, Wahyuni I, Adli R, Moonsom S, Huong L, Pham P, Kelly T, Wolking D, Smith W. International stakeholder perspectives on One Health training and empowerment: a needs assessment for a One Health Workforce Academy. ONE HEALTH OUTLOOK 2023; 5:8. [PMID: 37280666 DOI: 10.1186/s42522-023-00083-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 05/08/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND One Health is defined as an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals and ecosystems; this approach attracts stakeholders from multiple sectors, academic disciplines, and professional practices. The diversity of expertise and interest groups is frequently and simultaneously framed as (1) a strength of the One Health approach in the process of understanding and solving complex problems associated with health challenges such as pathogen spillovers and pandemics and (2) a challenge regarding consensus on essential functions of One Health and the sets of knowledge, skills, and perspectives unique to a workforce adopting this approach. Progress in developing competency-based training in One Health has revealed coverage of various topics across fundamental, technical, functional, and integrative domains. Ensuring that employers value the unique characteristics of personnel trained in One Health will likely require demonstration of its usefulness, accreditation, and continuing professional development. These needs led to the conceptual framework of a One Health Workforce Academy (OHWA) for use as a platform to deliver competency-based training and assessment for an accreditable credential in One Health and opportunities for continuing professional development. METHODS To gather information about the desirability of an OHWA, we conducted a survey of One Health stakeholders. The IRB-approved research protocol used an online tool to collect individual responses to the survey questions. Potential respondents were recruited from partners of One Health University Networks in Africa and Southeast Asia and international respondents outside of these networks. Survey questions collected demographic information, measured existing or projected demand and the relative importance of One Health competencies, and determined the potential benefits and barriers of earning a credential. Respondents were not compensated for participation. RESULTS Respondents (N = 231) from 24 countries reported differences in their perspectives on the relative importance of competency domains of the One Health approach. More than 90% of the respondents would seek to acquire a competency-based certificate in One Health, and 60% of respondents expected that earning such a credential would be rewarded by employers. Among potential barriers, time and funding were the most cited. CONCLUSION This study showed strong support from potential stakeholders for a OHWA that hosts competency-based training with opportunities for certification and continuing professional development.
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Affiliation(s)
| | - Oladele Ogunseitan
- Department of Population Health and Disease Prevention, University of California Irvine, Irvine, USA.
- Center for Innovation in Global Health, Stanford University, Stanford, USA.
| | | | - Vipat Kuruchittham
- Southeast Asia One Health University Network (SEAOHUN), Chiang Mai, Thailand
| | - Mabel Nangami
- Africa One Health University Network (AFROHUN), Kampala, Uganda
| | - David Kabasa
- Africa One Health University Network (AFROHUN), Kampala, Uganda
| | - William Bazeyo
- Africa One Health University Network (AFROHUN), Kampala, Uganda
| | - Irene Naigaga
- Africa One Health University Network (AFROHUN), Kampala, Uganda
| | - Olesya Kochkina
- Southeast Asia One Health University Network (SEAOHUN), Chiang Mai, Thailand
| | - Winnie Bikaako
- Africa One Health University Network (AFROHUN), Kampala, Uganda
| | - Nur Ahmad
- Universiti Putra Malaysia, Serdang, Malaysia
| | - Agnes Yawe
- Africa One Health University Network (AFROHUN), Kampala, Uganda
| | | | - Rahmi Nuraini
- Indonesia One Health University Network (INDOHUN), Depok, West Java, Indonesia
| | - Indira Wahyuni
- Indonesia One Health University Network (INDOHUN), Depok, West Java, Indonesia
| | - Raja Adli
- Malaysia One Health University Network (MyOHUN), Serdang, Malaysia
| | - Saengduen Moonsom
- THOHUN-National Coordinating Office, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Lai Huong
- Vietnam One Health University Network (VOHUN); and Hanoi University of Public Health, Hanoi, Vietnam
| | - Phuc Pham
- Vietnam One Health University Network (VOHUN), Hanoi, Vietnam
| | - Terra Kelly
- One Health Institute, School of Veterinary Medicine, University of California, Davis, USA
| | - David Wolking
- One Health Institute, School of Veterinary Medicine, University of California, Davis, USA
| | - Woutrina Smith
- One Health Institute, School of Veterinary Medicine, University of California, Davis, USA
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Hayman DTS, Barraclough RK, Muglia LJ, McGovern V, Afolabi MO, N'Jai AU, Ambe JR, Atim C, McClelland A, Paterson B, Ijaz K, Lasley J, Ahsan Q, Garfield R, Chittenden K, Phelan AL, Lopez Rivera A. Addressing the challenges of implementing evidence-based prioritisation in global health. BMJ Glob Health 2023; 8:e012450. [PMID: 37290897 PMCID: PMC10255200 DOI: 10.1136/bmjgh-2023-012450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/14/2023] [Indexed: 06/10/2023] Open
Abstract
Global health requires evidence-based approaches to improve health and decrease inequalities. In a roundtable discussion between health practitioners, funders, academics and policy-makers, we recognised key areas for improvement to deliver better-informed, sustainable and equitable global health practices. These focus on considering information-sharing mechanisms and developing evidence-based frameworks that take an adaptive function-based approach, grounded in the ability to perform and respond to prioritised needs. Increasing social engagement as well as sector and participant diversity in whole-of-society decision-making, and collaborating with and optimising on hyperlocal and global regional entities, will improve prioritisation of global health capabilities. Since the skills required to navigate drivers of pandemics, and the challenges in prioritising, capacity building and response do not sit squarely in the health sector, it is essential to integrate expertise from a broad range of fields to maximise on available knowledge during decision-making and system development. Here, we review the current assessment tools and provide seven discussion points for how improvements to implementation of evidence-based prioritisation can improve global health.
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Affiliation(s)
- David T S Hayman
- Molecular Epidemiology and Public Health Laboratory, Massey University, Palmerston North, New Zealand
| | - Rosemary K Barraclough
- Molecular Epidemiology and Public Health Laboratory, Massey University, Palmerston North, New Zealand
| | - Louis J Muglia
- Burroughs Wellcome Fund, Research Triangle Park, North Carolina, USA
| | - Victoria McGovern
- Burroughs Wellcome Fund, Research Triangle Park, North Carolina, USA
| | - Muhammed O Afolabi
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Alhaji U N'Jai
- Department of Microbiology, University of Sierra Leone College of Medicine and Allied Health Sciences, Freetown, Sierra Leone
- Department of Biological Sciences, University of Sierra Leone Fourah Bay College, Freetown, Sierra Leone
| | - Jennyfer R Ambe
- The Global Emerging Pathogens Treatment Consortium, Lagos, Nigeria
| | - Chris Atim
- Results for Development (R4D), Accra, Ghana
| | | | - Beverley Paterson
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Kashef Ijaz
- Health Programs, The Carter Center, Atlanta, Georgia, USA
| | | | - Qadeer Ahsan
- Australia Indonesia Health Security Partnership, Jakarta, Indonesia
| | | | | | - Alexandra L Phelan
- Center for Health Security, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Abigail Lopez Rivera
- US Department of Health and Human Services, Washington, District of Columbia, USA
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Elnaiem A, Mohamed-Ahmed O, Zumla A, Mecaskey J, Charron N, Abakar MF, Raji T, Bahalim A, Manikam L, Risk O, Okereke E, Squires N, Nkengasong J, Rüegg SR, Abdel Hamid MM, Osman AY, Kapata N, Alders R, Heymann DL, Kock R, Dar O. Global and regional governance of One Health and implications for global health security. Lancet 2023; 401:688-704. [PMID: 36682375 DOI: 10.1016/s0140-6736(22)01597-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/15/2022] [Accepted: 08/11/2022] [Indexed: 01/21/2023]
Abstract
The apparent failure of global health security to prevent or prepare for the COVID-19 pandemic has highlighted the need for closer cooperation between human, animal (domestic and wildlife), and environmental health sectors. However, the many institutions, processes, regulatory frameworks, and legal instruments with direct and indirect roles in the global governance of One Health have led to a fragmented, global, multilateral health security architecture. We explore four challenges: first, the sectoral, professional, and institutional silos and tensions existing between human, animal, and environmental health; second, the challenge that the international legal system, state sovereignty, and existing legal instruments pose for the governance of One Health; third, the power dynamics and asymmetry in power between countries represented in multilateral institutions and their impact on priority setting; and finally, the current financing mechanisms that predominantly focus on response to crises, and the chronic underinvestment for epidemic and emergency prevention, mitigation, and preparedness activities. We illustrate the global and regional dimensions to these four challenges and how they relate to national needs and priorities through three case studies on compulsory licensing, the governance of water resources in the Lake Chad Basin, and the desert locust infestation in east Africa. Finally, we propose 12 recommendations for the global community to address these challenges. Despite its broad and holistic agenda, One Health continues to be dominated by human and domestic animal health experts. Substantial efforts should be made to address the social-ecological drivers of health emergencies including outbreaks of emerging, re-emerging, and endemic infectious diseases. These drivers include climate change, biodiversity loss, and land-use change, and therefore require effective and enforceable legislation, investment, capacity building, and integration of other sectors and professionals beyond health.
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Affiliation(s)
- Azza Elnaiem
- Royal Free London NHS Foundation Trust, London, UK
| | - Olaa Mohamed-Ahmed
- UK Health Security Agency, London, UK; Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Alimuddin Zumla
- Department of Infection, Division of Infection and Immunity, University College London, London, UK; National Institute for Health and Care Research Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | | | - Tajudeen Raji
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Ammad Bahalim
- Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Logan Manikam
- Global Health Programme, Royal Institute of International Affairs, London, UK
| | - Omar Risk
- Department of Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, UK
| | | | | | - John Nkengasong
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Simon R Rüegg
- Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | | | | | - Nathan Kapata
- Zambia National Public Health Institute, Ministry of Health, Lusaka, Zambia
| | - Robyn Alders
- Global Health Programme, Royal Institute of International Affairs, London, UK; Development Policy Centre, Australian National University, Canberra, ACT, Australia
| | - David L Heymann
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard Kock
- Royal Veterinary College, University of London, London, UK
| | - Osman Dar
- Global Operations, London, UK; Global Health Programme, Royal Institute of International Affairs, London, UK
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12
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13
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Zinsstag J, Kaiser-Grolimund A, Heitz-Tokpa K, Sreedharan R, Lubroth J, Caya F, Stone M, Brown H, Bonfoh B, Dobell E, Morgan D, Homaira N, Kock R, Hattendorf J, Crump L, Mauti S, Del Rio Vilas V, Saikat S, Zumla A, Heymann D, Dar O, de la Rocque S. Advancing One human-animal-environment Health for global health security: what does the evidence say? Lancet 2023; 401:591-604. [PMID: 36682371 DOI: 10.1016/s0140-6736(22)01595-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 05/24/2022] [Accepted: 08/11/2022] [Indexed: 01/21/2023]
Abstract
In this Series paper, we review the contributions of One Health approaches (ie, at the human-animal-environment interface) to improve global health security across a range of health hazards and we summarise contemporary evidence of incremental benefits of a One Health approach. We assessed how One Health approaches were reported to the Food and Agricultural Organization of the UN, the World Organisation for Animal Health (WOAH, formerly OIE), and WHO, within the monitoring and assessment frameworks, including WHO International Health Regulations (2005) and WOAH Performance of Veterinary Services. We reviewed One Health theoretical foundations, methods, and case studies. Examples from joint health services and infrastructure, surveillance-response systems, surveillance of antimicrobial resistance, food safety and security, environmental hazards, water and sanitation, and zoonoses control clearly show incremental benefits of One Health approaches. One Health approaches appear to be most effective and sustainable in the prevention, preparedness, and early detection and investigation of evolving risks and hazards; the evidence base for their application is strongest in the control of endemic and neglected tropical diseases. For benefits to be maximised and extended, improved One Health operationalisation is needed by strengthening multisectoral coordination mechanisms at national, regional, and global levels.
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Affiliation(s)
- Jakob Zinsstag
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland.
| | - Andrea Kaiser-Grolimund
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; Institute of Social Anthropology, University of Basel, Basel, Switzerland
| | - Kathrin Heitz-Tokpa
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Rajesh Sreedharan
- Health Security Preparedness Department, Health Emergencies Programme, WHO, Geneva, Switzerland
| | | | | | | | - Hannah Brown
- Department of Anthropology, Durham University, Durham, UK
| | - Bassirou Bonfoh
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Emily Dobell
- Global Operations, UK Health Security Agency, London, UK
| | - Dilys Morgan
- Global Operations, UK Health Security Agency, London, UK
| | - Nusrat Homaira
- Centre for Child Health Research and Innovation, University of New South Wales, Sydney, NSW, Australia
| | - Richard Kock
- Royal Veterinary College, University of London, London, UK
| | - Jan Hattendorf
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Lisa Crump
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Stephanie Mauti
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Victor Del Rio Vilas
- Faculty of Medical Sciences, University of Surrey, Surrey, UK; Global Health Programme, Royal Institute of International Affairs, London, UK
| | - Sohel Saikat
- System Resilience and Essential Public Health Functions, Special Programme on Primary Health Care, WHO, Geneva, Switzerland
| | - Alimuddin Zumla
- Department of Infection, Division of Infection and Immunity, University College London, London, UK; National Institute for Health and Care Research Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - David Heymann
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Osman Dar
- Global Health Programme, Royal Institute of International Affairs, London, UK; Global Operations, UK Health Security Agency, London, UK
| | - Stéphane de la Rocque
- Health Security Preparedness Department, Health Emergencies Programme, WHO, Geneva, Switzerland
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