Global health: time for radical change?

CCL2-CCR2 signaling axis in obesity and metabolic diseases

Obesity and metabolic diseases, such as insulin resistance, type 2 diabetes, nonalcoholic fatty liver disease, and cardiovascular ailments, represent formidable global health challenges, bearing considerable implications for both morbidity and mortality rates. It has become increasingly evident that chronic, low-grade inflammation plays a pivotal role in the genesis and advancement of these conditions. The involvement of C-C chemokine ligand 2 (CCL2) and its corresponding receptor, C-C chemokine receptor 2 (CCR2), has been extensively documented in numerous inflammatory maladies. Recent evidence indicates that the CCL2/CCR2 pathway extends beyond immune cell recruitment and inflammation, exerting a notable influence on the genesis and progression of metabolic syndrome. The present review seeks to furnish a comprehensive exposition of the CCL2-CCR2 signaling axis within the context of obesity and metabolic disorders, elucidating its molecular mechanisms, functional roles, and therapeutic implications.

Addressing the paradox: Health expansion threatening sustainable healthcare

We need to address the paradox that health expansion threatens sustainable healthcare as anti-aging drugs are on the trail from trial to the market and come together with health enhancement measures changing demography and the health of populations. This poses global, social, and professional problems, and challenges clinical medicine as well as health policy. To handle the emerging challenges, we need to address four crucial issues: (1) injustice (access), (2) sustainability, (3) basic human rights, and (4) eugenics. To do so we need to differentiate between health improvements and health enhancements and reinforce medicine's strongest moral appeal: to reduce suffering.

A health systems approach to critical care delivery in low-resource settings: a narrative review

There is a high burden of critical illness in low-income countries (LICs), adding pressure to already strained health systems. Over the next decade, the need for critical care is expected to grow due to ageing populations with increasing medical complexity; limited access to primary care; climate change; natural disasters; and conflict. In 2019, the 72nd World Health Assembly emphasised that an essential part of universal health coverage is improved access to effective emergency and critical care and to "ensure the timely and effective delivery of life-saving health care services to those in need". In this narrative review, we examine critical care capacity building in LICs from a health systems perspective. We conducted a systematic literature search, using the World Heath Organisation (WHO) health systems framework to structure findings within six core components or "building blocks": (1) service delivery; (2) health workforce; (3) health information systems; (4) access to essential medicines and equipment; (5) financing; and (6) leadership and governance. We provide recommendations using this framework, derived from the literature identified in our review. These recommendations are useful for policy makers, health service researchers and healthcare workers to inform critical care capacity building in low-resource settings.

How Effective Altruism Can Help Psychologists Maximize Their Impact

Although many psychologists are interested in making the world a better place through their work, they are often unable to have the impact that they would like. Here, we suggest that both individuals and psychology as a field can better improve human welfare by incorporating ideas from effective altruism, a growing movement whose members aim to do the most good by using science and reason to inform their efforts. In this article, we first briefly introduce effective altruism and review important principles that can be applied to how psychologists approach their work, such as the importance, tractability, and neglectedness framework. We then review how effective altruism can inform individual psychologists' choices. Finally, we close with a discussion of ideas for how psychology, as a field, can increase its positive impact. By applying insights from effective altruism to psychological science, we aim to integrate a new theoretical framework into psychological science, stimulate new areas of research, start a discussion on how psychology can maximize its impact, and inspire the psychology community to do the most good.

Perspectives of Healthcare Providers towards Remote Medical Interpreting Services in Japan

Language support is necessary for effective healthcare as language obstacles have a negative impact on patient outcomes. Medical facilities dealing with novel coronavirus disease (COVID-19) were forced to restrict the number of healthcare professionals on the field, and medical interpreters were no exception. This has prompted the introduction of remote medical interpreting systems, which do not necessitate the presence of an interpreter onsite. However, as the dominant trend in offering linguistic help was face-to-face medical interpreting, healthcare staff are also battling with its utilization. We conducted a single-centered, retrospective study by examining written responses taken from April 2018 to March 2020 and a total of 236 healthcare employees in Japan, to identify the primary reasons of such challenges. Remote medical interpreting was frequently employed by a range of professions in many departments across various languages, and the majority of users were satisfied with the experience. The qualitative analysis based on the free opinions of the healthcare professionals unraveled three main concerns towards remote medical interpreting: connection to the interpreting providers; coordination of the remote interpreting coordinators, and quality of interpreting. Therefore, increasing the use of remote medical interpreting while simultaneously training interpreters by enhancing the skills required in Japanese medical facilities would be necessary.

Tripla carga de doenças no Brasil, 1990-2021

Objetivo: descrever a evolução temporal pela tripla carga de doenças no Brasil, comparando a mortalidade do Sistema de Informação de Mortalidade (SIM) e estudo de Carga Global de Doenças (GBD). Método: estudo descritivo e exploratório sobre a evolução temporal das taxas e a distribuição proporcional de óbitos para doenças infecciosas, crônicas não transmissíveis (DCNT) e causas externas usando duas fontes de dados, 1990 a 2021. As taxas no SIM foram ajustadas pelo método direto por idade e suavizadas por média móvel. As estimativas do GBD corrigem subregistro e causas garbage. Resultados: o Brasil registrou 817.284 óbitos (1990) e 1.349.801 (2019) no SIM, corrigidos em 17,7% e 1,9% no GBD para os respectivos anos. Neste período, as taxas de mortalidade diminuíram nas duas fontes, respectivamente: DCNT -16,8% (433,7 a 360,7) e -34% (720,5 a 474,6); infeciosas -20,2% (86 para 68,6) e -57,2% (198,5 para 84,9); causas externas -17,3% (77,4 para 64) e -27% (100,9 para 73,7). O SIM mostrou redução -79,2% (138,6 para 28,8) para as taxas de causas mal definidas (CMD). Os fatores de correção do GBD foram maiores nos anos anteriores a 2005. Após 2019, as taxas de infeciosas e CMD no SIM aumentaram respectivamente 207% (68,6 para 210,7) e 30,2% (28,8 para 37,5). Conclusão: o avanço da transição epidemiológica da carga de doenças e melhoria da qualidade do dado de óbito no Brasil foram interrompidos pela COVID-19, aumentando a carga das doenças infecciosas.

The prevalence of chronic diseases in international immigrants: a systematic review and meta-analysis

Aims:

The purpose of this study is systematically to review and synthesise available prevalence data of major chronic diseases in international immigrants.

Methods:

Four electronic databases were searched to retrieve peer-reviewed original articles published in English between January 2000 and December 2020. Cross-sectional, cohort, or longitudinal studies that reported the prevalence of cardiovascular disease, any type of cancer, chronic obstructive pulmonary disease, and type 2 diabetes among immigrant adults were included. We calculated pooled prevalence using random-effects meta-analyses.

Results:

Of 13,363 articles retrieved, 24 met the eligibility criteria. The pooled prevalence of diabetes was 9.0% (95% confidence interval (CI) 7.6–10.4) with a higher prevalence in North American countries 11.1% (95% CI 8.0–14.1) than in the other destination countries: 6.6% (95% CI 5.1–8.1) including Italy, Sweden, The Netherlands, Australia, and Israel. The pooled prevalence of cardiovascular diseases and respiratory diseases was 7.7% (95% CI 5.7–9.6) and 6.5% (95% CI 2.3–10.7), respectively. Only two articles reported the prevalence of cancers (2.7% and 3.8%). We found high heterogeneity among all studies regardless of the disease.

Conclusions:

The prevalence of diabetes was higher than other chronic diseases in international immigrants. There is a strong need to enhance health information systems to understand the magnitude of chronic diseases among different immigrant subgroups.

GBD 2019 Indonesia Subnational Collaborators. The state of health in Indonesia's provinces, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

BACKGROUND

Analysing trends and levels of the burden of disease at the national level can mask inequalities in health-related progress in lower administrative units such as provinces and districts. We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to analyse health patterns in Indonesia at the provincial level between 1990 and 2019. Long-term analyses of disease burden provide insights on Indonesia's advance to universal health coverage and its ability to meet the United Nations Sustainable Development Goals by 2030.

METHODS

We analysed GBD 2019 estimated cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), life expectancy at birth, healthy life expectancy, and risk factors for 286 causes of death, 369 causes of non-fatal health loss, and 87 risk factors by year, age, and sex for Indonesia and its 34 provinces from 1990 to 2019. To generate estimates for Indonesia at the national level, we used 138 location-years of data to estimate Indonesia-specific demographic indicators, 317 location-years of data for Indonesia-specific causes of death, 689 location-years of data for Indonesia-specific non-fatal outcomes, 250 location-years of data for Indonesia-specific risk factors, and 1641 location-years of data for Indonesia-specific covariates. For subnational estimates, we used the following source counts: 138 location-years of data to estimate Indonesia-specific demographic indicators; 5848 location-years of data for Indonesia-specific causes of death; 1534 location-years of data for Indonesia-specific non-fatal outcomes; 650 location-years of data for Indonesia-specific risk factors; and 16 016 location-years of data for Indonesia-specific covariates. We generated our GBD 2019 estimates for Indonesia by including 1 915 207 total source metadata rows, and we used 821 total citations.

FINDINGS

Life expectancy for males across Indonesia increased from 62·5 years (95% uncertainty interval 61·3-63·7) to 69·4 years (67·2-71·6) between 1990 and 2019, a positive change of 6·9 years. For females during the same period, life expectancy increased from 65·7 years (64·5-66·8) to 73·5 years (71·6-75·6), an increase of 7·8 years. There were large disparities in health outcomes among provinces. In 2019, Bali had the highest life expectancy at birth for males (74·4 years, 70·90-77·9) and North Kalimantan had the highest life expectancy at birth for females (77·7 years, 74·7-81·2), whereas Papua had the lowest life expectancy at birth for males (64·5 years, 60·9-68·2) and North Maluku had the lowest life expectancy at birth for females (64·0 years, 60·7-67·3). The difference in life expectancy for males between the highest-ranked and lowest-ranked provinces was 9·9 years and the difference in life expectacy for females between the highest-ranked and lowest-ranked provinces was 13·7 years. Age-standardised death, YLL, and YLD rates also varied widely among the provinces in 2019. High systolic blood pressure, tobacco, dietary risks, high fasting plasma glucose, and high BMI were the five leading risks contributing to health loss measured as DALYs in 2019.

INTERPRETATION

Our findings highlight that Indonesia faces a double burden of communicable and non-communicable diseases that varies across provinces. From 1990 to 2019, Indonesia witnessed a decline in the infectious disease burden, although communicable diseases such as tuberculosis, diarrhoeal diseases, and lower respiratory infections have remained a main source of DALYs in Indonesia. During that same period, however, all-ages death and disability rates from non-communicable diseases and exposure to their risk factors accounted for larger shares of health loss. The differences in health outcomes between the highest-performing and lowest-performing provinces have also widened since 1990. Our findings support a comprehensive process to revisit current health policies, examine the root causes of variation in the burden of disease among provinces, and strengthen programmes and policies aimed at reducing disparities across the country.

FUNDING

The Bill & Melinda Gates Foundation and the Government of Indonesia.

TRANSLATION

For the Bahasa Indonesia translation of the abstract see Supplementary Materials section.

Perinatal Depression as a Growing Mental Health Concern: A Systematic Review

Mental health today, is a rising concern the world over. In order to focus prevention strategies and treatment options, it is important to study the types, and attributes, of illnesses under mental health. Among all types, depression is found to be the major contributor to the global burden of this disease and it is found to affect more women than men. Among women, perinatal depression is a serious and highly prevalent form of depression that affects women of childbearing age. Perinatal depression comprises of antenatal depression (AD) and postnatal depression (PD). AD is a precursor of PD and while it negatively impacts the health of the woman herself, it also has potential adverse effects on the health and socio-psychological development of the new born. Research from low- and middle-income countries (LMICs) finds prevalence of AD at 25.8%, and of PD at 19.7%. In spite of this, while studies on PD are available, studies and understanding of AD are limited and have not received the desired attention of the scientific community. Various global and local organisations have done policy advocacy on mental health, and to some extent within this framework, on perinatal depression, however, focus is still required in the LMICs for strengthening health systems for prevention and treatment.

Mortality from acute types of coronary artery disease in men and women in Russia in 2015 and 2019

Aim. To comparison standardized mortality rates (SMRs) among men and women from acute types of coronary artery disease (CAD) and their regional variability in Russia in 2015 and 2019.

Material and methods. The Federal State Statistics Service (Rosstat) data on the population and the number of deaths from CAD based on the brief nomenclature of death causes using the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) in 2015 and 2019 in 82 Russian subjects are presented. For each sex, SMR was calculated for acute (primary) and recurrent myocardial infarction (MI) (I21-I22), for other types of acute CAD (I20, I24.1-9), as well as average regional SMRs, coefficient of variation (CV).

Results. The average regional SMR for each of the acute CAD types among men was significantly higher than among women both in 2015 (p<0,0001) and in 2019 (p<0,0001). For the period of 2015-2019 in men, SMR from all acute CAD types decreased by 22,5%, from acute MI — by 7,4%, from recurrent MI — by 22,2% and from other acute CAD types — by 25,8%, while in women, these figures were 11,8, 8,8, 19,0 and 29,7%, respectively. The men-to-women SMR ratio in 2015 and 2019 were 2,79/2,72 for all acute CAD types, 2,58/2,55 for all MI cases, and 3,36/4,18 for other acute CAD types. The minimum CV values (41,9% among men in 2019 and 44,7% among women in 2015) were recorded for acute MI, while the maximum CV values (129,3% among men and 158,6% among women in 2019) for other acute CAD types.

Conclusion. Over the period of 2015-2019, the average regional SMR from acute CAD types in men and women decreased in Russia, with a more noticeable decrease for men. Greater regional variability in mortality, especially for other acute CAD types, poses the problem of finding organizational, methodological and strategic solutions to clarify the criteria for coding and refine the logistics schemes for providing healthcare for doubtful or uncertain diagnostic signs of acute CAD.

Global mental health: insights from an experience of cooperation between Brazil and Italy

Recognizing the central role of mental health in global health and affirming the complexity of the universalization of care policy, this paper discusses aspects of global mental health in Brazil and Italy - two countries that are a potential reference for exchange between the global North and South. Using ethnographic and action research methodologies, we conducted a study of a virtual community of practice composed of Brazilians and Italians interested in community mental health care. The results are presented in scenes that provide insights for the international debate in three categories: the doctor-centered approach to care; the institutionalization of care and medicalization of suffering; and the contribution of community practices and non-specialized local knowledge. The locally situated scenes cast light on globally shared critical knots, elucidating a plural set of relationships that run through work processes and mental health care. The sharing of knowledge and experiences highlight what should be universalized: opportunities for horizontal exchange, rather than the production of national identities that radiate universalizing practices and policies.

Projecting the cost of introducing typhoid conjugate vaccine (TCV) in the national immunization program in Malawi using a standardized costing framework

Background

There is a substantial typhoid burden in sub-Saharan Africa, and TCV has been introduced in two African countries to date. Decision-makers in Malawi decided to introduce TCV and applied for financial support from Gavi, the Vaccine Alliance in 2020. The current plan is to introduce TCV as part of the national immunization program in late 2022. The introduction will include a nationwide campaign targeting all children aged 9 months to 15 years. Following the campaign, TCV will be provided through routine immunization at 9 months. This study aims to estimate the cost of TCV introduction and recurrent delivery as part of the national immunization program.

Methods

This costing analysis is conducted from the government's perspective and focuses on projecting the incremental cost of TCV introduction and delivery for Malawi’s existing immunization program before vaccine introduction. The study uses a costing tool developed by Levin & Morgan through a partnership between the International Vaccine Institute and the World Health Organization and leverages primary and secondary data collected through key informant interviews with representatives of the Malawi Expanded Programme on Immunization team at various levels.

Results

The total financial and economic costs of TCV introduction over three years in Malawi are projected to be US$8.5 million and US$29.8 million, respectively. More than two-thirds of the total cost is made up of recurrent costs. Major cost drivers include the procurement of vaccines and injection supplies and service delivery costs. Without vaccine cost, we estimate the cost per child immunized to be substantially lower than US$1.

Discussion

Findings from this analysis may be used to assess the economic implications of introducing TCV in Malawi. Major cost drivers highlighted by the analysis may also inform decision-makers in the region as they assess the value and feasibility of TCV introduction in their national immunization program.

Prevalence and predictors of hypertension: Evidence from a study of rural India

Background:

Raised blood pressure (BP) is the leading global risk factor for cardiovascular diseases and a major cause of premature death. Worldwide, one in four men and one in five women are hypertensive. For effective preventive strategy, understanding of predictors of hypertension is necessary.

Objective:

To assess prevalence and predictors of hypertension in the rural adult Indian population.

Material and Methods:

This cross-sectional study was carried out on 425 rural subjects (25–64 years) of the Varanasi district in India selected through multistage sampling. Blood pressure of each subject was measured using a standard technique. Sociodemographic data and predictors of hypertension were assessed by interviewing subjects with help of a predesigned and pretested proforma.

Results:

Prevalence of hypertension was 31.5% (95% CI: 27.1–35.9). There existed a significant (P < 0.05) association of BP with age, educational status, occupation, socioeconomic class, tobacco consumption, waist circumference, waist-hip ratio, and nutritional status. No significant association was found with gender, religion, caste, marital status, type and size of family, family without NCDs, awareness of screening camps for NCDs and national program for prevention and control of cancer, diabetes, cardiovascular diseases and stroke, and alcohol consumption. Significant association of education, nutritional, and occupational status obtained in univariate analysis got eliminated in the logistic model. Risk of hypertension was higher in the 45–64 years age group (AOR: 3.06; 95% CI: 1.75–5.35) and in socioeconomic class IV and V (AOR: 2.24; 95% CI: 1.17–4.31).

Conclusion:

Prevalence of hypertension in the rural population was high and most of the observed predictors were modifiable.

Noncommunicable diseases, climate change and iniquities: What COVID-19 has taught us about syndemic

BACKGROUND

COVID-19 is generating clinical challenges, lifestyle changes, economic consequences. The pandemic imposes to familiarize with concepts as prevention, vulnerability and resilience.

METHODS

We analysed and reviewed the most relevant papers in the MEDLINE database on syndemic, noncommunicable diseases, pandemic, climate changes, pollution, resilience, vulnerability, health costs, COVID-19.

RESULTS

We discuss that comprehensive strategies must face multifactorial consequences since the pandemic becomes syndemic due to interactions with noncommunicable diseases, climate changes and iniquities. The lockdown experience, on the other hand, demonstrates that it is rapidly possible to reverse epidemiologic trends and to reduce pollution. The worst outcome is evident in eight highly industrialized nations, where 12% of the world population experienced about one-third of all COVID-19-deaths worldwide. Thus, a great economic power has not been fully protective, and a change of policy is obviously needed to avoid irreversible consequences.

CONCLUSIONS

We are accumulating unhealthy populations living in unhealthy environments and generating unhealthy offspring. The winning policy should tackle structural inequities through a syndemic approach, to protect vulnerable populations from present and future harms.

ICD-11: an international classification of diseases for the twenty-first century

BACKGROUND

The International Classification of Diseases (ICD) has long been the main basis for comparability of statistics on causes of mortality and morbidity between places and over time. This paper provides an overview of the recently completed 11th revision of the ICD, focusing on the main innovations and their implications.

MAIN TEXT

Changes in content reflect knowledge and perspectives on diseases and their causes that have emerged since ICD-10 was developed about 30 years ago. Changes in design and structure reflect the arrival of the networked digital era, for which ICD-11 has been prepared. ICD-11's information framework comprises a semantic knowledge base (the Foundation), a biomedical ontology linked to the Foundation and classifications derived from the Foundation. ICD-11 for Mortality and Morbidity Statistics (ICD-11-MMS) is the primary derived classification and the main successor to ICD-10. Innovations enabled by the new architecture include an online coding tool (replacing the index and providing additional functions), an application program interface to enable remote access to ICD-11 content and services, enhanced capability to capture and combine clinically relevant characteristics of cases and integrated support for multiple languages.

CONCLUSIONS

ICD-11 was adopted by the World Health Assembly in May 2019. Transition to implementation is in progress. ICD-11 can be accessed at icd.who.int.

COVID and Climate: Similarities and differences

The cases of COVID-19 and climate change highlight the central role of scientific research which supposedly guides political decision-making. Models and scenarios assume a central role. However, science cannot tell us what to do. While it provides important facts and metrics, uncertainties remain and decisions are based on considerations pertaining to fundamental values. Apart from these similarities, my aim is to emphasize some significant differences. They relate to policy goals, international cooperation, data and metrics, values, and the time horizons involved. This article is categorized under:Social Status of Climate Change Knowledge > Climate Science and Decision Making.

COVID-19 Pandemic as an Excellent Opportunity for Global Health Diplomacy

Undoubtedly, the COVID-19 pandemic is not the first and most frightening global pandemic, and it may not be the last. At the very least, this phenomenon has though seriously challenged the health systems of the world; it has created a new perspective on the value of national, regional, and international cooperation during crises. The post-coronavirus world could be a world of intensified nationalist rivalries on the economic revival and political influence. However, strengthening cooperation among nations at different levels will lead to the growth of health, economy, and security. The current situation is a touchstone for international actors in coordinating the efforts in similar future crises. At present, this pandemic crisis cannot be resolved except through joint international cooperation, global cohesion, and multilateralism. This perspective concludes that the pandemic could be an excellent opportunity for the scope of global health diplomacy (GHD) and how it can be applied and practiced for strengthening five global arenas, namely (1) International Cooperation and Global Solidarity, (2) Global Economy, Trade and Development, (3) Global Health Security, (4) Strengthening health systems, and (5) Addressing inequities to achieve the global health targets. GHD proves to be very useful for negotiating better policies, stronger partnerships, and achieving international cooperation in this phase with many geopolitical shifts and nationalist mindset among many nations at this stage of COVID-19 vaccine roll-out.

Evaluating Local Multilingual Health Care Information Environments on the Internet: A Pilot Study

For foreign-born populations, difficulty in finding health care information in their primary language is a structural barrier to accessing timely health care. While such information may be available at a national level, it may not always be relevant or appropriate to the living situations of these people. Our objective was to explore the quality of online multilingual health information environments by pilot-testing a framework for assessing such information at the prefectural level in Japan. The framework consisted of five health care domains (health system, hospitals, emergency services, medical interpreters, and health insurance). Framework scores varied considerably among prefectures; many resources were machine-translated. These scores were significantly associated with foreign population proportion and the number of hospitals in each prefecture. Our multilingual health care information environment (MHCIE) framework provides a measure of health access inclusivity, which has not been quantified before. It is adaptable to other international contexts, but further validation is required.

Alkaloids in Contemporary Drug Discovery to Meet Global Disease Needs

An overview is presented of the well-established role of alkaloids in drug discovery, the application of more sustainable chemicals, and biological approaches, and the implementation of information systems to address the current challenges faced in meeting global disease needs. The necessity for a new international paradigm for natural product discovery and development for the treatment of multidrug resistant organisms, and rare and neglected tropical diseases in the era of the Fourth Industrial Revolution and the Quintuple Helix is discussed.

A Sustainability Compass for policy navigation to sustainable food systems

Growing acknowledgement that food systems require transformation, demands comprehensive sustainability assessments that can support decision-making and sustainability governance. To do so, assessment frameworks must be able to make trade-offs and synergies visible and allow for inclusive negotiation on food system outcomes relevant to diverse food system actors. This paper reviews literature and frameworks and builds on stakeholder input to present a Sustainability Compass made up of a comprehensive set of metrics for food system assessments. The Compass defines sustainability scores for four societal goals, underpinned by areas of concern. We demonstrate proof of concept of the operationalization of the approach and its metrics. The Sustainability Compass is able to generate comprehensive food system insights that enables reflexive evaluation and multi-actor negotiation for policy making.

Smart Visualization of Mixed Data

In this work, we propose a new protocol that integrates robust classification and visualization techniques to analyze mixed data. This protocol is based on the combination of the Forward Search Distance-Based (FS-DB) algorithm (Grané, Salini, and Verdolini 2020) and robust clustering. The resulting groups are visualized via MDS maps and characterized through an analysis of several graphical outputs. The methodology is illustrated on a real dataset related to European COVID-19 numerical health data, as well as the policy and restriction measurements of the 2020–2021 COVID-19 pandemic across the EU Member States. The results show similarities among countries in terms of incidence and the management of the emergency across several waves of the disease. With the proposed methodology, new smart visualization tools for analyzing mixed data are provided.

Current Activities Centered on Healthy Living and Recommendations for the Future: A Position Statement from the HL-PIVOT Network

We continue to increase our cognizance and recognition of the importance of healthy living (HL) behaviors and HL medicine (HLM) to prevent and treat chronic disease. The continually unfolding events precipitated by the coronavirus disease 2019 (COVID-19) pandemic have further highlighted the importance of HL behaviors, as indicated by the characteristics of those who have been hospitalized and died from this viral infection. There has already been recognition that leading a healthy lifestyle, prior to the COVID-19 pandemic, may have a substantial protective effect in those who become infected with the virus. Now more than ever, HL behaviors and HLM are essential and must be promoted with a renewed vigor across the globe. In response to the rapidly evolving world since the beginning of the COVID-19 pandemic, and the clear need to change lifestyle behaviors to promote human resilience and quality of life, the HL for Pandemic Event Protection (HL-PIVOT) network was established. The 4 major areas of focus for the network are: (1) knowledge discovery and dissemination; (2) education; (3) policy; (4) implementation. This HL-PIVOT network position statement provides a current synopsis of the major focus areas of the network, including leading research in the field of HL behaviors and HLM, examples of best practices in education, policy, and implementation, and recommendations for the future.