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Plowright RK, Ahmed AN, Coulson T, Crowther TW, Ejotre I, Faust CL, Frick WF, Hudson PJ, Kingston T, Nameer PO, O'Mara MT, Peel AJ, Possingham H, Razgour O, Reeder DM, Ruiz-Aravena M, Simmons NB, Srinivas PN, Tabor GM, Tanshi I, Thompson IG, Vanak AT, Vora NM, Willison CE, Keeley ATH. Ecological countermeasures to prevent pathogen spillover and subsequent pandemics. Nat Commun 2024; 15:2577. [PMID: 38531842 DOI: 10.1038/s41467-024-46151-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/16/2024] [Indexed: 03/28/2024] Open
Abstract
Substantial global attention is focused on how to reduce the risk of future pandemics. Reducing this risk requires investment in prevention, preparedness, and response. Although preparedness and response have received significant focus, prevention, especially the prevention of zoonotic spillover, remains largely absent from global conversations. This oversight is due in part to the lack of a clear definition of prevention and lack of guidance on how to achieve it. To address this gap, we elucidate the mechanisms linking environmental change and zoonotic spillover using spillover of viruses from bats as a case study. We identify ecological interventions that can disrupt these spillover mechanisms and propose policy frameworks for their implementation. Recognizing that pandemics originate in ecological systems, we advocate for integrating ecological approaches alongside biomedical approaches in a comprehensive and balanced pandemic prevention strategy.
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Affiliation(s)
- Raina K Plowright
- Department of Public and Ecosystem Health, Cornell University, Ithaca, NY, 14853, USA.
| | - Aliyu N Ahmed
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Tim Coulson
- Department of Biology, University of Oxford, Oxford, OX1 3SZ, UK
| | - Thomas W Crowther
- Department of Environmental Systems Science, ETH Zürich, Zürich, 8092, Switzerland
| | - Imran Ejotre
- Department of Biology, Muni University, P.O. Box 725, Arua, Uganda
| | - Christina L Faust
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Winifred F Frick
- Bat Conservation International, Austin, TX, 78746, USA
- Department of Ecology and Evolutionary Biology, University of California, Santa Cruz, CA, 95064, USA
| | - Peter J Hudson
- Centre for Infectious Disease Dynamics, Pennsylvania State University, State College, PA, 16801, USA
| | - Tigga Kingston
- Department of Biological Sciences, Texas Tech University, Lubbock, TX, 79409-3131, USA
| | - P O Nameer
- College of Climate Change and Environmental Science, Kerala Agricultural University, Kerala, 680 656, India
| | | | - Alison J Peel
- Centre for Planetary Health and Food Security, Griffith University, Nathan, QLD, 4111, Australia
| | - Hugh Possingham
- School of Biological Sciences, University of Queensland, Brisbane, QLD, 4072, Australia
| | - Orly Razgour
- Biosciences, University of Exeter, Exeter, EX4 4PS, UK
| | - DeeAnn M Reeder
- Department of Biology, Bucknell University, Lewisburg, PA, 17937, USA
| | - Manuel Ruiz-Aravena
- Department of Public and Ecosystem Health, Cornell University, Ithaca, NY, 14853, USA
- Centre for Planetary Health and Food Security, Griffith University, Nathan, QLD, 4111, Australia
- Department of Wildlife, Fisheries and Aquaculture, Mississippi State University, Starkville, USA
| | - Nancy B Simmons
- Department of Mammalogy, Division of Vertebrate Zoology, American Museum of Natural History, New York City, NY, 10024, USA
| | | | - Gary M Tabor
- Center for Large Landscape Conservation, Bozeman, MT, 59771, USA
| | - Iroro Tanshi
- Department of Biology, University of Washington, Seattle, WA, 98195, USA
- Small Mammal Conservation Organization, Benin City, 300251, Nigeria
- Department of Animal and Environmental Biology, University of Benin, Benin City, 300000, Nigeria
| | | | - Abi T Vanak
- Centre for Policy Design, Ashoka Trust for Research in Ecology and the Environment, Bengaluru, Karnataka, 560064, India
- School of Life Sciences, University of KwaZulu-Natal, Durban, 4041, South Africa
| | - Neil M Vora
- Conservation International, Arlington, VA, 22202, USA
| | - Charley E Willison
- Department of Public and Ecosystem Health, Cornell University, Ithaca, NY, 14853, USA
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Willison CE, Falkenbach M, Greer SL, Singer PM. Backsliding among indicators of democratic stability relevant to public health: Risks in OECD nations. World Med & Health Policy 2022. [DOI: 10.1002/wmh3.558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Charley E. Willison
- Department of Public and Ecosystem Health Cornell University Ithaca New York USA
| | - Michelle Falkenbach
- Department of Public and Ecosystem Health Cornell University Ithaca New York USA
| | - Scott L. Greer
- Department of Health Management and Policy University of Michigan Ann Arbor Michigan USA
| | - Phillip M. Singer
- Department of Political Science University of Utah Salt Lake City Utah USA
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Willison CE, Singer PM, Creary MS, Vaziri S, Stott J, Greer SL. How do you solve a problem like Maria? The politics of disaster response in Puerto Rico, Florida and Texas. World Med & Health Policy 2022; 14:490-506. [PMID: 36247081 PMCID: PMC9545961 DOI: 10.1002/wmh3.476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 07/01/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Charley E. Willison
- Department of Population Medicine and Diagnostic Sciences Cornell University Ithaca New York USA
| | - Phillip M. Singer
- Department of Political Science University of Utah Salt Lake City Utah USA
| | - Melissa S. Creary
- Department of Health Management and Policy, School of Public Health University of Michigan Ann Arbor Michigan USA
| | - Soha Vaziri
- Department of Health Management and Policy, School of Public Health University of Michigan Ann Arbor Michigan USA
| | - Jerry Stott
- Department of Political Science University of Utah Salt Lake City Utah USA
| | - Scott L. Greer
- Department of Health Management and Policy, School of Public Health University of Michigan Ann Arbor Michigan USA
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Counts NZ, Taylor LA, Willison CE, Galea S. Healthcare lobbying on upstream social determinants of health in the US. Prev Med 2021; 153:106751. [PMID: 34343593 PMCID: PMC8694571 DOI: 10.1016/j.ypmed.2021.106751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 07/19/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
Healthcare stakeholders are increasingly investing to address social determinants of health (SDOH) as they seek to improve health outcomes and reduce total healthcare costs in their communities. Policy heavily shapes SDOH, and healthcare lobbying on SDOH issues may offer large impacts through positive policy change. Federal lobbying disclosures from the ten highest spending health insurance and healthcare provider organizations and related associations between 2015 and 2019 were reviewed to identify lobbying reported on the salient SDOH issues, defined based on the Accountable Health Communities Model health-related social needs screening tool. Five of the organizations reported lobbying on some SDOH issues, including financial strain, employment, food insecurity, and interpersonal safety, but none reported lobbying on other issues, such as non-healthcare-related employment, housing instability, transportation, or education. Lobbying has been a missed opportunity for addressing SDOH. Healthcare organizations have the opportunity to expand their lobbying on upstream SDOH policy issues to increase the impact of their SDOH strategy and further improve population health.
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Affiliation(s)
- Nathaniel Z Counts
- Mental Health America, Alexandria, VA, United States of America; Albert Einstein College of Medicine, The Bronx, NY, United States of America.
| | - Lauren A Taylor
- NYU Grossman School of Medicine, New York, NY, United States of America
| | | | - Sandro Galea
- Boston University School of Public Health, Boston, MA, United States of America
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Willison CE, Lillvis D, Mauri A, Singer PM. Technically Accessible, Practically Ineligible: The Effects of Medicaid Expansion Implementation on Chronic Homelessness. J Health Polit Policy Law 2021; 46:1019-1052. [PMID: 34075407 PMCID: PMC9648193 DOI: 10.1215/03616878-9349142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
CONTEXT Homeless policy advocates viewed Medicaid expansion as an opportunity to enhance health care access for this vulnerable population. We studied Medicaid expansion implementation to assess the extent to which broadening insurance eligibility affected the functioning of municipal homelessness programs targeting chronic homelessness in the context of two separate governance systems. METHODS We employed a comparative case study of San Francisco, California, and Shreveport, Louisiana, which were selected as exemplar cases from a national sample of cities across the United States. We conducted elite interviews with a range of local-level stakeholders and combined this data with primary-source documentation. FINDINGS Medicaid expansion did not substantially enhance the functioning of homelessness programs and policies because of Medicaid access challenges and governance conflicts. Administrative burden and funding limitations contributed to limited provider networks, inadequate service coverage, and lack of linkages between Medicaid enrollment and homelessness programming. Governance conflicts reinforced these functional challenges, with homelessness under the administration of local municipalities and nongovernmental organizations while states administer Medicaid. CONCLUSIONS Improving access to health care services for persons experiencing homelessness cannot occur without intentional coordination between sectors and levels of government and thus necessitates the development of targeted policies and programs to overcome these challenges.
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Rozier MD, Willison CE, Anspach RR, Howell JD, Greer AL, Greer SL. Paradoxes of professional autonomy: a qualitative study of U.S. neonatologists from 1978-2017. Sociol Health Illn 2020; 42:1821-1836. [PMID: 33247848 DOI: 10.1111/1467-9566.13169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/06/2020] [Accepted: 07/12/2020] [Indexed: 06/12/2023]
Abstract
The professional autonomy of physicians often requires they take responsibility for life and death decisions, but they must also find ways to avoid bearing the full weight of such decisions. We conducted in-person, semi-structured interviews with neonatologists (n = 20) in four waves between 1978 and 2017 in a single Midwestern U.S. city. Using open coding analysis, we found over time that neonatologists described changes in their sense of professional autonomy and responsibility for decisions with life and death consequences. Through the early 1990s, as neonatology consolidated as a profession, physicians simultaneously enjoyed high levels of professional discretion and responsibility and were often constrained by bioethics and the law. By 2010s, high involvement of parents and collaboration with multiple subspecialties diffused the burden felt by individual practitioners, but neonatology's professional autonomy was correlatively diminished. Decision-making in the NICU over four decades reveal a complex relationship between the professional autonomy of neonatologist and the burden they bear, with some instances of ceding autonomy as a protective measure and other situations of unwelcomed erosion of professional autonomy that neonatologists see as complicating provision of care.
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Affiliation(s)
- Michael D Rozier
- Department of Health Management and Policy, Saint Louis University, St. Louis, Missouri, USA
| | - Charley E Willison
- Department of Health Care Policy, Harvard University, Cambridge, Massachusetts, USA
| | - Renee R Anspach
- Department of Sociology, University of Michigan, Ann Arbor, Michigan, USA
| | - Joel D Howell
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of History, University of Michigan, Ann Arbor, Michigan, USA
| | - Ann L Greer
- Department of Sociology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Scott L Greer
- Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan, USA
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Abstract
Abstract
Background
In the United States, political regimes directly influence health policy agenda setting, adoption and reform. The priorities of health policy shift across administrations and over time as political parties evolve, polarization occurs, and key political actors change. What is less clear is the degree to which other ideologies - such as nationalism and populism - shape the types of policies that are pursued and adopted in health care. We hypothesize that trends in nationalism and populism in the US across presidential administrations influence the scope of access across different populations in health policies. Additionally, we argue that the rise of populism and nationalism in the United States under the Trump administration has led to restrictions on accessing health programs through targeted limitations placed on certain populations.
Methods
We apply a comparative historical analysis framework to track changes in healthcare policy over time that reflect populist or nationalist agendas. We analyze health policies enacted and pursued by presidential administrations as well as trends in populism and nationalism across presidential administrations in the U.S.
Results
Results demonstrate that as populist sentiments rise, a parallel trend of increased othering in health policies takes place. This othering appears to reflect policies targeting supporters through both policy spoils and values while constraining opposing groups (e.g. increased restrictions on out-group members such racial/ethnic minorities).
Conclusions
Our results highlight the tension that exists in populist and nationalist health policy. Populist and nationalist leaders need to strike a balance between ensuring that their “people” continue to have access to health programs, requiring targeted limits placed within programs. Much of the limitations placed on populations are accomplished through submerged mechanisms and by devolving administration and governance to state and local governments.
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Affiliation(s)
- C E Willison
- Department of Health Care Policy, Harvard University, Boston, USA
| | - P M Singer
- Political Science Department, University of Utah, Salt Lake City, USA
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Progovac AM, Cortés DE, Chambers V, Adams LB, Jean‐Claude S, Willison CE, Flores M, Creedon TB, Cook BL. Addressing Major Health Disparities Related to Coronavirus for People With Behavioral Health Conditions Requires Strength-Based Capacity Building and Intentional Community Partnership. World Med Health Policy 2020; 12:242-255. [PMID: 32904922 PMCID: PMC7461022 DOI: 10.1002/wmh3.364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/27/2020] [Indexed: 11/07/2022]
Abstract
Far from being an equalizer, as some have claimed, the COVID‐19 pandemic has exposed just how vulnerable many of our social, health, and political systems are in the face of major public health shocks. Rapid responses by health systems to meet increased demand for hospital beds while continuing to provide health services, largely via a shift to telehealth services, are critical adaptations. However, these actions are not sufficient to mitigate the impact of coronavirus for people from marginalized communities, particularly those with behavioral health conditions, who are experiencing disproportional health, economic, and social impacts from the evolving pandemic. Helping these communities weather this storm requires partnering with existing community‐based organizations and local governments to rapidly and flexibly meet the needs of vulnerable populations.
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Affiliation(s)
- Phillip M Singer
- Phillip M. Singer is with the Political Science Department, University of Utah, Salt Lake City. Charley E. Willison is with the Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
| | - Charley E Willison
- Phillip M. Singer is with the Political Science Department, University of Utah, Salt Lake City. Charley E. Willison is with the Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
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Affiliation(s)
- Charley E Willison
- Both authors are doctoral candidates in the Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
| | - Phillip M Singer
- Both authors are doctoral candidates in the Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
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Willison CE, Singer PM, Creary MS, Greer SL. Quantifying inequities in US federal response to hurricane disaster in Texas and Florida compared with Puerto Rico. BMJ Glob Health 2019; 4:e001191. [PMID: 30775009 PMCID: PMC6350743 DOI: 10.1136/bmjgh-2018-001191] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/25/2018] [Accepted: 12/03/2018] [Indexed: 11/23/2022] Open
Abstract
If disaster responses vary in their effectiveness across communities, health equity is affected. This paper aims to evaluate and describe variation in the federal disaster responses to 2017 Hurricanes Harvey, Irma and Maria, compared with the need and severity of storm damage through a retrospective analysis. Our analysis spans from landfall to 6 months after landfall for each hurricane. To examine differences in disaster responses across the hurricanes, we focus on measures of federal spending, federal resources distributed and direct and indirect storm-mortality counts. Federal spending estimates come from congressional appropriations and Federal Emergency Management Agency (FEMA) records. Resource estimates come from FEMA documents and news releases. Mortality counts come from National Oceanic and Atmospheric Administration (NOAA) reports, respective vital statistics offices and news articles. Damage estimates came from NOAA reports. In each case, we compare the responses and the severity at critical time points after the storm based on FEMA time logs. Our results show that the federal government responded on a larger scale and much more quickly across measures of federal money and staffing to Hurricanes Harvey and Irma in Texas and Florida, compared with Hurricane Maria in Puerto Rico. The variation in the responses was not commensurate with storm severity and need after landfall in the case of Puerto Rico compared with Texas and Florida. Assuming that disaster responses should be at least commensurate to the degree of storm severity and need of the population, the insufficient response received by Puerto Rico raises concern for growth in health disparities and increases in adverse health outcomes.
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Affiliation(s)
- Charley E Willison
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Phillip M Singer
- Department of Political Science, University of Utah, Salt Lake City, Utah, USA
| | - Melissa S Creary
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Scott L. Greer
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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