en état de siège On assiste depuis quelques mois à plusieurs attaques en règle qui visent directement la capacité de la santé publique canadienne à réaliser l’ensemble de ses mandats qui sont de prévenir la maladie et surveiller, protéger et promouvoir la santé des Canadiens et des Canadiennes. Ces attaques proviennent d’un nombre croissant et varié d’institutions et trouvent malheureusement un large écho dans la presse. Dans les pages du Globe and Mail, Peter Shawn Taylor concluait par des mots très durs son exhortation à l’endroit de la santé publique de se concentrer sur les problèmes des maladies transmissibles. « It is not the job of public health to have an opinion on taxes, economic policy, free trade or corporate control. Neither should it be their business to interfere in the freely-made choices of adults.”1 La semaine suivante dans la version tablette de La Presse, Alain Dubuc proposait de mettre des balises à la santé publique « pour éviter que la santé publique utilise son autorité morale du savoir médical dans des domaines qui ne relèvent pas directement des sciences de la santé (...) et pour éviter qu’elles (les Directions de santé publique) quittent le domaine de l’analyse pour entrer sur le terrain du militantisme et de l’action sociale »2. Bien que certaines voix discordantes se soient exprimées3, cette convergence des opinions n’est pas l’effet du hasard. Le gouvernement fédéral et plusieurs gouvernements provinciaux, dont celui du Québec, s’acharnent depuis plusieurs mois et de multiples façons à affaiblir la santé publique canadienne et l’assujettir à son agenda politique néo-libéral. Sous prétexte de coupures budgétaires et d’amélioration de l’efficience, les gouvernements imposent des façons de faire et des modes d’organisation qui musèlent la santé publique. Dans sa version moderne, la santé publique est un instrument de l’État et non des partis politiques. Au Canada actuellement, plusieurs partis politiques au pouvoir cherchent à affaiblir la santé publique, cet empêcheur de tuer en rond. L’intensité, la convergence et la généralisation des attaques dont la santé publique est l’objet depuis quelques mois confirment que les efforts de ces gouvernements ont porté fruit : moins bien protégée, la santé publique est devenue une cible facile. Le gouvernement du Canada cherche à affaiblir la santé publique canadienne lorsqu’il dépouille l’Administrateur en chef de l’Agence de santé publique du Canada de son pouvoir d’agir en le déchargeant de ses responsabilités organisationnelles. Dans les faits, il ne dirige plus l’Agence. Cette responsabilité revient maintenant à un Président qui décidera des priorités de l’Agence sans avoir la compétence technique pour prendre les décisions sanitaires. Le médecin en chef du Canada, celui dont l’unique patient est une population de plus de 30 millions de personnes, devient un simple conseiller. Il n’a plus les moyens de définir les priorités et d’orienter les actions de l’Agence. Il ne peut donc opérer les solutions qu’il juge les plus appropriées en fonction de son diagnostic. D’ailleurs, en mettant plus de 16 mois pour combler le poste laissé vacant par la démission pour raisons de santé du docteur David Butler-Jones, le gouvernement Harper ne pouvait être plus clair dans son message : la santé publique peut attendre! Le gouvernement du Québec cherche à affaiblir la santé publique canadienne lorsqu’il nomme au poste de Directeur de Canadian public health under siege Over the past few months, we have seen numerous attacks that directly target the ability of Canadian public health to fulfill its mandate, namely to prevent illness and to monitor, protect and promote the health of Canadians. These attacks come from a growing number and variety of organizations and, unfortunately, are widely echoed in the press. In the pages of the Globe and Mail, Peter Shawn Taylor concluded his exhortation for public health to concentrate on transmissible disease problems with these strong words... “It is not the job of public health to have an opinion on taxes, economic policy, free trade or corporate control. Neither should it be their business to interfere in the freely-made choices of adults.”1 The following week, in the online version of La Presse, Alain Dubuc proposed placing limits on public health “to prevent public health from using its medical-knowledge moral authority in fields that do not relate to health sciences... and to prevent them (public health authorities) from straying from the field of analysis into the area of militancy and social action.”2 [translation] Although some dissenting opinions have been expressed,3 this convergence of opinion does not happen by chance. For a number of months, the Federal Government and several provincial governments, including Québec’s, have sought to weaken Canadian public health in many ways and to subject it to their neo-liberal agenda. Under the pretext of austerity measures and increased efficiency, governments impose ways of doing things and organizational models that muzzle public health. In its modern version, public health is an instrument of the State and not of political parties. In Canada today, several of the political parties in power are trying to weaken public health, this perpetual spoilsport. The intensity of, the convergence of attitudes toward and the widespread participation in the attacks to which public health has been subjected for many months, confirm that the efforts of these governments have borne fruit. Less well protected as a result, public health has become an easy target. The Government of Canada seeks to weaken public health when it strips the Chief Public Health Officer of the Public Health Agency of Canada of his power to act, by removing his organizational responsibilities. In fact, the CPHO no longer runs the Agency. This responsibility now rests with a President who will decide on Agency’s priorities without having the technical competence to make health decisions. Canada’s chief public health officer, whose sole patient is a population of over 30 million people, becomes a simple advisor. He no longer has the means to define priorities and to direct the Agency’s actions. As a result, he cannot implement the solutions he believes to be the most appropriate to tackle the issues. Further, by taking more than 16 months to fill the position left vacant by the resignation for health reasons of Dr. David Butler-Jones, the Harper Government could not be clearer in its message: public health can wait! The Québec Government seeks to weaken Canadian public health when they appoint, as Director of Public Health, individuals who do not have the applicable, accredited training for that position. In Canada, responsibility for public health is

La Santé Publique Canadienne En éTat De siège/Canadian Public Health under Siege

Background The COVID-19 pandemic has caused disruptions to the functioning of societies and their health systems. Prior to the pandemic, health systems in low- and middle-income countries (LMIC) were particularly stretched and vulnerable. The International Society of Global Health (ISoGH) sought to systematically identify priorities for health research that would have the potential to reduce the impact of the COVID-19 pandemic in LMICs. Methods The Child Health and Nutrition Research Initiative (CHNRI) method was used to identify COVID-19-related research priorities. All ISoGH members were invited to participate. Seventy-nine experts in clinical, translational, and population research contributed 192 research questions for consideration. Fifty-two experts then scored those questions based on five pre-defined criteria that were selected for this exercise: 1) feasibility and answerability; 2) potential for burden reduction; 3) potential for a paradigm shift; 4) potential for translation and implementation; and 5) impact on equity. Results Among the top 10 research priorities, research questions related to vaccination were prominent: health care system access barriers to equitable uptake of COVID-19 vaccination (ranked 1st), determinants of vaccine hesitancy (4th), development and evaluation of effective interventions to decrease vaccine hesitancy (5th), and vaccination impacts on vulnerable population/s (6th). Health care delivery questions also ranked highly, including: effective strategies to manage COVID-19 globally and in LMICs (2nd) and integrating health care for COVID-19 with other essential health services in LMICs (3rd). Additionally, the assessment of COVID-19 patients’ needs in rural areas of LMICs was ranked 7th, and studying the leading socioeconomic determinants and consequences of the COVID-19 pandemic in LMICs using multi-faceted approaches was ranked 8th. The remaining questions in the top 10 were: clarifying paediatric case-fatality rates (CFR) in LMICs and identifying effective strategies for community engagement against COVID-19 in different LMIC contexts. Interpretation Health policy and systems research to inform COVID-19 vaccine uptake and equitable access to care are urgently needed, especially for rural, vulnerable, and/or marginalised populations. This research should occur in parallel with studies that will identify approaches to minimise vaccine hesitancy and effectively integrate care for COVID-19 with other essential health services in LMICs. ISoGH calls on the funders of health research in LMICs to consider the urgency and priority of this research during the COVID-19 pandemic and support studies that could make a positive difference for the populations of LMICs.

https://jogh.org/wp-content/uploads/2022/05/jogh-12-09003.pdf

Research priorities to reduce the impact of COVID-19 in low- and middle-income countries

Background: The first national COVID-19 lockdown in the United Kingdom between March to July 2020 resulted in sudden and unprecedented disruptions to daily life. This study sought to understand the impact of COVID-19 non-pharmaceutical interventions (NPIs), such as social distancing and quarantine, on people’s lived experiences, focusing on social connections and relationships. Methods: Data were generated through 20 in-depth online and telephone interviews, conducted between May and July 2020, and analysed using thematic analysis informed by an ecological framework. Results: Findings show that the use of NPIs impacted social relationships and sociality at every level, disrupting participant’s sense of self; relationships with their partners, household members, neighbours, and communities; and polarising social and political views. However, experiences of personal meaning-making and reflection, and greater social connectedness, solidarity, and compassion – despite physical distance – were also common. Conclusions: Participant’s lived experiences of the first UK lockdown underscore the interconnectedness of relationships at the individual, community and societal level and point towards the important role of trust, social cohesion, and connectedness in coping with pandemic stress and adversity. Where infectious disease prevention measures rupture sociality, support for social connection at every relational level is likely to help build resilience in light of ongoing COVID-19 restrictions.

/pdf/between-division-and-connection-a-qualitative-study-of-the-1m2hhw4l.pdf

Between division and connection: a qualitative study of the impact of COVID-19 restrictions on social relationships in the United Kingdom

Following the first Thai COVID-19 case in January 2020, the Thai government introduced several non-pharmaceutical interventions (NPIs) in March 2020 (e.g., contact tracing, travel restrictions, closure of businesses, curfews, stay at home orders) to control COVID-19 transmissions. This study aimed to understand the views and experiences of a small number of Thai residents related to public health measures implemented during the first COVID-19 wave in Thailand. A total of 28 remote in-depth interviews with Thai residents (18–74 years old) were conducted between 8 May and 21 July 2020. Interviews were audio recorded, transcribed, and analysed using thematic analysis based on the Framework Method. Our results describe participants’ views, challenges, and coping strategies relating to COVID-19 restrictions. Most participants expressed support for the introduction of strict public health measures, while some criticized lacking enforcement or rational of certain measures. Participants identified four major challenges, namely financial hardship; social isolation and loneliness; stigma and shaming; and fear of COVID-19 infection. Strategies adopted to address these challenges included practical coping strategies (e.g., reducing risks and fear of COVID-19 infection; mitigating financial, social, and mental health impacts), and embedded socio-cultural ways of coping (e.g., turning to religion; practicing acceptance; kindness, generosity and sharing (‘Namjai’); ‘making merit’ (‘Tham-bun’)). The challenges identified from this study, in particular the role of stigma and discrimination, may be relevant to other infectious disease outbreaks beyond COVID-19. Findings from this study underscore the need for policies and interventions that mitigate the negative impacts of NPIs on the public, particularly on vulnerable groups, and highlight the importance of considering socio-cultural context to support community resilience in times of crisis. Our findings remain relevant in light of low COVID-19 vaccine availability and the potential need to implement further public health restrictions in Thailand and elsewhere against COVID-19 or future infectious disease threats.

/pdf/like-a-wake-up-call-for-humankind-views-challenges-and-1cxyyiry.pdf

“Like a wake-up call for humankind”: Views, challenges, and coping strategies related to public health measures during the first COVID-19 lockdown in Thailand

We are pleased to present, and reflect on, the CJPH special section on the topic of ‘Why public health matters today’. The important papers presented here were selected from among over 25 initial submissions to the call, first posted in December 2017. Collectively, they offer a window into what public health is and means, from the point of view of the Canadian public health community today. The collection begins with an invited commentary from our national research funding organization, CIHR’s Institute of Population and Public Health. Based on the observation that governments worldwide underinvest in public health, Hoffman et al. (2019) argue that we must work to build a case for investing in public health that is based on a sophisticated understanding of how the political system works. Building a political case for public health, according to these authors, involves making public health visible, navigating complex decision-making processes, and differentiating between policy instruments. Reflecting on why public health matters today, Baugh et al. (2019) point out that the very nature of public health—namely, its grounding in sciences of biomedicine and epidemiology, combined with moral imperatives of social advocacy—gives it a unique position from which to address the social determinants of health. Continuing with the theme of the intersection of public health and social policy, McLaren (2019) revisits the important work of Geoffrey Rose from the perspective of that intersection and argues for the continued value of the population-level approach to prevention, as a foundation of public health, vis-à-vis the social determinants of health and health equity. Arnason et al. (2019) provide an empirical illustration of Rose’s population-level approach in practice. These authors estimate the preventive effect of a municipal transportation policy—the Transportation Master Plan of the city of Ottawa, Ontario—on diabetes incidence, via its impact on increasing physical activity through active transportation. This compelling study illustrates the importance for health of public policy outside of the health care sector, and of a health in all policies approach (Dutton et al. 2018; Kershaw 2018) as part of a robust public health practice. Several submissions considered challenges and opportunities for public health practitioners. In an important empirical paper, Power et al. (2019) examine the ability of Public Health Units in Ontario to address and advocate for the social determinants of health and health equity, focusing on food insecurity. The paper makes a powerful case for the reinstatement (it was removed in 2018) of Nutritious FoodBasket costing as amandatory requirement for the Public Health Units, arguing that the 2018 decision further compromised public health units’ already-limited capacity to advance health equity. Andruszkiewicz et al. (2019) consider the relationships between local public health agencies (also in Ontario) and local community organizations, focusing on the issue of data sharing to advance health equity. Their findings shed light on how local public health agencies might strengthen their role in data sharing, by drawing on public health core competencies of assessment, analysis, communication, and collaboration. Marsters and Sim (2019) articulate the value of storytelling for public health today, in terms of providing a mechanism for professional reflection to enable transformative change and to articulate the value of public health. Both, the authors argue, are critical in the currently challenging public health environment. Three papers consider public health’s interface with academia. The current cohort of CIHR/PHAC Applied Public Health Chairs (McLaren et al. 2019) discusses why applied research, spanning CIHR pillars 3 (health systems and services) and 4 (population health), is a core component of public health today and identifies attributes needed to sustain its * Lindsay McLaren lmclaren@ucalgary.ca

/pdf/public-health-matters-but-we-need-to-make-the-case-2pb2rs6z5s.pdf

Public health matters—but we need to make the case

Background: The coronavirus disease 2019 (COVID-19) has resulted in an unprecedented research response, demonstrating exceptional examples of rapid research and collaboration. There is however a need for greater coordination, with limited resources and the shifting global nature of the pandemic resulting in a proliferation of research projects underpowered and unable to achieve their aims. Methods: The UK Collaborative on Development Research (UKCDR) and Global Research Collaboration for Infectious Disease Preparedness (GloPID-R), two funder coordination groups have collaborated to develop a live database of funded research projects across the world relating to COVID-19. Drawing data continually from their members and further global funding bodies, as of 15 th July 2021 the database contains 12,419 projects, funded by 255 funders, taking place across 149 countries representing an investment of at least $4.9 billion. To our knowledge it is one of the most comprehensive databases. The database is aligned to the World Health Organisation and GloPID-R Global Research Roadmap: 2019 Novel Coronavirus. It is being used by the WHO, governments and multi-lateral policy makers, research funders and researchers. This living mapping review aims to supplement the database by providing an open accessible and frequently updated resource summarising the characteristics of the COVID-19 funded research portfolio. Both descriptive and thematic analysis will be presented and updated frequently to aid interpretation of the global COVID-19 funded research portfolio. Results: In this version five analysis we provide an updated detailed descriptive analysis of the database (three months after version four) and focus our thematic analysis on research gaps, research areas in need of coordination, study populations and research locations (with a focus on resource-limited countries). Conclusions: As the global funding response to COVID-19 plateaus, this living mapping review helps both funders and researchers to prioritise resources to areas where there is continued unmet research need.

https://wellcomeopenresearch.org/articles/5-209/v5/pdf

A living mapping review for COVID-19 funded research projects: one year update.

Governments around the world vastly underinvest in public health, despite ever growing evidence demonstrating its economic and social benefits. Challenges in securing greater public health investment largely stem from the necessity for governments to demonstrate visible impacts within an election cycle, whereas public health initiatives operate over the long term and generally involve prevention, statistical lives and underlying conditions. It is time for the public health community to rethink its strategies and craft political wins by building a political case for investing in public health-which extends far beyond mere economic and social arguments. These strategies need to make public health visible, account for the complexities of policymaking networks and adapt knowledge translation efforts to the appropriate policy instrument.

/pdf/building-the-political-case-for-investing-in-public-health-zhnbyxzj8a.pdf

Building the political case for investing in public health and public health research.

During the height of the COVID-19 pandemic, personal support workers (PSWs) were heralded as healthcare ‘heroes’ as many of them cared for high-risk, vulnerable older populations, and worked in long-term care, which experienced a high number of COVID-19 outbreaks and deaths. While essential to the healthcare workforce, there is little understanding of PSW working conditions during the pandemic. The aim of our study was to examine the working conditions (including job security, work policies, and personal experiences) for PSWs in the Greater Toronto Area during the COVID-19 pandemic from the perspectives of PSWs. This study used a mixed-methods design. From June to December 2020, we conducted a survey of 634 PSWs to understand their working conditions during the COVID-19 pandemic. Semi-structured interviews with 31 survey respondents were conducted from February to May 2021 to understand in greater depth how working conditions were impacting the well-being of PSWs. We found PSWs faced a range of challenges related to COVID-19, including anxiety about contracting COVID-19, reduced work hours, taking leaves of absences, concerns about job security, and losing childcare. While the COVID-19 pandemic highlighted the PSW workforce and their importance to the healthcare system (especially in the long-term care system), pre-existing poor work conditions of insecure jobs with no paid sick days and benefits exacerbated COVID-19–related challenges. Despite these hardships, PSWs were able to rely on their mental resilience and passion for their profession to cope with challenges. Significant changes need to be made to improve PSW working conditions. Better compensation, increased job security, decreased workload burden, and mental health supports are needed.

/pdf/the-working-conditions-for-personal-support-workers-in-the-3owrvqdc.pdf

A Morgan Lay

Papers

A living mapping review for COVID-19 funded research projects: one year update.

Building the political case for investing in public health and public health research.

The working conditions for personal support workers in the Greater Toronto Area during the COVID-19 pandemic: a mixed-methods study