For decades, marginalized communities have been naming the harms of policing—and the systemic racism that undergirds it—for health and well-being. Only recently have policing practices and racism within policing gained more widespread attention in public health. Building on social justice and emancipatory traditions in health education, we argue that health educators are uniquely prepared to use the evidence base to reframe narratives that drive aggressive policing and their disproportionate impacts on communities of color, promote disinvestment in militarized policing, and build relationships with community-based organizations and community organizers developing community-centered approaches to safety. Using public health institutions and institutions of higher education as examples, we suggest specific strategic actions that health educators can take to address policing as a public health issue. Health educators are uniquely poised to work with diverse community and institutional partners to support social movements that create community-centered, equitable approaches to public safety and health.
AbstractWe assess the effect of CHARM, a gender equity and family planning counseling intervention for husbands in rural India, on men's gender ideology. We used a two‐armed cluster randomized control trial design and collected survey data from husbands (n=1081) at baseline, 9 months, and 18 months. We used a continuous measure of support for gender equity and a dichotomous measure of equitable attitudes toward women's role in household decision‐making. To assess differences on these outcomes, we used generalized linear mixed models. After controlling for socio‐demographic factors, men who received the CHARM intervention were significantly more likely than men in the control group to have equitable attitudes toward household decision‐making at 9‐months follow‐up; there was a non‐significant difference between the groups for the measure of support for gender equity. For household decision‐making, differences were not sustained at 18‐months follow‐up. Given the role of husbands' gender ideology in women's contraceptive use, the CHARM intervention represents a promising approach for challenging root causes of women's unmet need for contraception.
The Rio Grande/Bravo is an arid river basin shared by the United States and Mexico, the fifth-longest river in North America, and home to more than 10.4 million people. By crossing landscapes and political boundaries, the Rio Grande/Bravo brings together cultures, societies, ecosystems, and economies, thereby forming a complex social-ecological system. The Rio Grande/Bravo supplies water for the human activities that take place within its territory. While there have been efforts to implement environmental flows (flows necessary to sustain riparian and aquatic ecosystems and human activities), a systematic and whole-basin analysis of these efforts that conceptualizes the Rio Grande/Bravo as a single, complex social-ecological system is missing. Our objective is to address this research and policy gap and shed light on challenges, opportunities, and success stories for implementing environmental flows in the Rio Grande/Bravo. We introduce the physical characteristics of the basin and summarize the environmental flows studies already done. We also describe its water governance framework and argue it is a distributed and nested governance system across multiple political jurisdictions and spatial scales. We describe the environmental flows legal framework and argue that the authority over different aspects of environmental flows is divided across different agencies and institutions. We discuss the prioritization of agricultural use within the governance structure without significant provisions for environmental flows. We introduce success stories for implementing environmental flows that include leasing of water rights or voluntary releases for environmental flow purposes, municipal ordinances to secure water for environmental flows, nongovernmental organizations representing the environment in decision-making processes, and acquiring water rights for environmental flows, among others initiatives. We conclude that environmental flows are possible and have been implemented but their implementation has not been systematic and permanent. There is an emerging whole-basin thinking among scientists, managers, and citizens that is helping find common-ground solutions to implementing environmental flows in the Rio Grande/Bravo basin.
The Rio Grande/Bravo is an arid river basin shared by the United States and Mexico, the fifth-longest river in North America, and home to more than 10.4 million people. By crossing landscapes and political boundaries, the Rio Grande/Bravo brings together cultures, societies, ecosystems, and economies, thereby forming a complex social-ecological system. The Rio Grande/Bravo supplies water for the human activities that take place within its territory. While there have been efforts to implement environmental flows (flows necessary to sustain riparian and aquatic ecosystems and human activities), a systematic and whole-basin analysis of these efforts that conceptualizes the Rio Grande/Bravo as a single, complex social-ecological system is missing. Our objective is to address this research and policy gap and shed light on challenges, opportunities, and success stories for implementing environmental flows in the Rio Grande/Bravo. We introduce the physical characteristics of the basin and summarize the environmental flows studies already done. We also describe its water governance framework and argue it is a distributed and nested governance system across multiple political jurisdictions and spatial scales. We describe the environmental flows legal framework and argue that the authority over different aspects of environmental flows is divided across different agencies and institutions. We discuss the prioritization of agricultural use within the governance structure without significant provisions for environmental flows. We introduce success stories for implementing environmental flows that include leasing of water rights or voluntary releases for environmental flow purposes, municipal ordinances to secure water for environmental flows, nongovernmental organizations representing the environment in decision-making processes, and acquiring water rights for environmental flows, among others initiatives. We conclude that environmental flows are possible and have been implemented but their implementation has not been systematic and permanent. There is an emerging whole-basin thinking among scientists, managers, and citizens that is helping find common-ground solutions to implementing environmental flows in the Rio Grande/Bravo basin.
Environmental flows (e-flows) are powerful tools for sustaining freshwater biodiversity and ecosystem services, but their widespread implementation faces numerous social, political, and economic barriers. These barriers are amplified in water-limited systems where strong trade-offs exist between human water needs and freshwater ecosystem protection. We synthesize the complex, multidisciplinary challenges that exist in these systems to help identify targeted solutions to accelerate the adoption and implementation of environmental flows initiatives. We present case studies from three water-limited systems in North America and synthesize the major barriers to implementing environmental flows. We identify four common barriers: (a) lack of authority to implement e-flows in water governance structures, (b) fragmented water governance in transboundary water systems, (c) declining water availability and increasing variability under climate change, and (d) lack of consideration of non-biophysical factors. We then formulate actionable recommendations for decision makers facing these barriers when working towards implementing environmental flows: (a) modify or establish a water governance framework to recognize or allow e-flows, (b) strive for collaboration across political jurisdictions and social, economic, and environmental sectors, and (c) manage adaptively for climate change in e-flows planning and recommendations.
Environmental flows (e-flows) are powerful tools for sustaining freshwater biodiversity and ecosystem services, but their widespread implementation faces numerous social, political, and economic barriers. These barriers are amplified in water-limited systems where strong trade-offs exist between human water needs and freshwater ecosystem protection. We synthesize the complex, multidisciplinary challenges that exist in these systems to help identify targeted solutions to accelerate the adoption and implementation of environmental flows initiatives. We present case studies from three water-limited systems in North America and synthesize the major barriers to implementing environmental flows. We identify four common barriers: (a) lack of authority to implement e-flows in water governance structures, (b) fragmented water governance in transboundary water systems, (c) declining water availability and increasing variability under climate change, and (d) lack of consideration of non-biophysical factors. We then formulate actionable recommendations for decision makers facing these barriers when working towards implementing environmental flows: (a) modify or establish a water governance framework to recognize or allow e-flows, (b) strive for collaboration across political jurisdictions and social, economic, and environmental sectors, and (c) manage adaptively for climate change in e-flows planning and recommendations.
U-BIOPRED is a European Union consortium of 20 academic institutions, 11 pharmaceutical companies and six patient organisations with the objective of improving the understanding of asthma disease mechanisms using a systems biology approach.This cross-sectional assessment of adults with severe asthma, mild/moderate asthma and healthy controls from 11 European countries consisted of analyses of patient-reported outcomes, lung function, blood and airway inflammatory measurements.Patients with severe asthma (nonsmokers, n=311; smokers/ex-smokers, n=110) had more symptoms and exacerbations compared to patients with mild/moderate disease (n=88) (2.5 exacerbations versus 0.4 in the preceding 12 months; p
Background: Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods: This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings: Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16-30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77-0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50-0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80-0·88; p<0·001), and full lockdowns (0·57, 0·54-0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation: Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services.
Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long- term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.