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Almost one-fifth of Botswana’s population is infected with HIV. The Inter-Ministerial National Structural Intervention Trial is a trial to test the impact on HIV rates of a structural intervention that refocuses government structural support programs in favor of young women. Ensuring that the intervention reaches all vulnerable young women in any given community is a challenge. Door-to-door recruitment was inefficient in previous work, so we explored innovative ways to reach this population. We sought to understand the support networks of marginalized young women, and to test the possibility of using social networks to support universal recruitment in this population. Ego-centric and sociometric analyses were used to describe the support networks of marginalized young women. Marginalized young women go to other women and relatives for support, and they communicate face to face rather than using social media. Network maps show how young women were connected to each other. Lessons from the pilot include a better understanding of how to use social networks as a recruitment method, such as the time required and the types of community members that can help. Social networks could help reach other hard-to-reach populations.

In this article, the authors posit that programs promoting nurturing parent-child relationships influence outcomes of parents and young children living in poverty through two primary mechanisms: (a) strengthening parents' social support and (b) increasing positive parent-child interactions. The authors discuss evidence for these mechanisms as catalysts for change and provide examples from selected parenting programs that support the influence of nurturing relationships on child and parenting outcomes. The article focuses on prevention programs targeted at children and families living in poverty and closes with a discussion of the potential for widespread implementation and scalability for public health impact.

Since their introduction two decades ago, Community Wildfire Protection Plans (CWPPs) have become a common planning tool for improving community preparedness and risk mitigation in fire-prone regions, and for strengthening coordination among federal and state land management agencies, local government, and residents. While CWPPs have been the focus of case studies, there are limited large-scale studies to understand the extent of, and factors responsible for, variation in stakeholder participation—a core element of the CWPP model. This article describes the scale and scope of participation in CWPPs across the western United States. We provide a detailed account of participants in over 1,000 CWPPs in 11 states and examine how levels of participation and stakeholder diversity vary as a function of factors related to planning process, planning context, and the broader geographic context in which plans were developed. We find that CWPPs vary substantially both by count and diversity of participants and that the former varies as a function of the geographic scale of the plan, while the latter varies largely as a function of the diversity of landowners within the jurisdiction. More than half of participants represented local interests, indicating a high degree of local engagement in hazard mitigation. Surprisingly, plan participation and diversity were unrelated to wildfire hazard. These findings suggest that CWPPs have been largely successful in their intent to engage diverse stakeholders in preparing for and mitigating wildfire risk, but that important challenges remain. We discuss the implications of this work and examine how the planning process and context for CWPPs may be changing.

Objective To investigate whether the English health inequalities strategy was associated with a decline in geographical health inequalities, compared with trends before and after the strategy.Design Time trend analysis.Setting Two groups of lower tier local authorities in England. The most deprived, bottom fifth and the rest of England.Intervention The English health inequalities strategy—a cross government strategy implemented between 1997 and 2010 to reduce health inequalities in England. Trends in geographical health inequalities were assessed before (1983-2003), during (2004-12), and after (2013-15) the strategy using segmented linear regression.Main outcome measure Geographical health inequalities measured as the relative and absolute differences in male and female life expectancy at birth between the most deprived local authorities in England and the rest of the country.Results Before the strategy the gap in male and female life expectancy between the most deprived local authorities in England and the rest of the country increased at a rate of 0.57 months each year (95% confidence interval 0.40 to 0.74 months) and 0.30 months each year (0.12 to 0.48 months). During the strategy period this trend reversed and the gap in life expectancy for men reduced by 0.91 months each year (0.54 to 1.27 months) and for women by 0.50 months each year (0.15 to 0.86 months). Since the end of the strategy period the inequality gap has increased again at a rate of 0.68 months each year (−0.20 to 1.56 months) for men and 0.31 months each year (−0.26 to 0.88) for women. By 2012 the gap in male life expectancy was 1.2 years smaller (95% confidence interval 0.8 to 1.5 years smaller) and the gap in female life expectancy was 0.6 years smaller (0.3 to 1.0 years smaller) than it would have been if the trends in inequalities before the strategy had continued.Conclusion The English health inequalities strategy was associated with a decline in geographical inequalities in life expectancy, reversing a previously increasing trend. Since the strategy ended, inequalities have started to increase again. The strategy may have reduced geographical health inequalities in life expectancy, and future approaches should learn from this experience. The concerns are that current policies are reversing the achievements of the strategy.

AbstractObjectiveTo estimate the impact of the UK government’s sugar reduction programme on child and adult obesity, adult disease burden, and healthcare costs.DesignModelling study.SettingSimulated scenario based on National Diet and Nutrition Survey waves 5 and 6, England.Participants1508 survey respondents were used to model weight change among the population of England aged 4-80 years.Main outcome measuresCalorie change, weight change, and body mass index change were estimated for children and adults. Impact on non-communicable disease incidence, quality adjusted life years, and healthcare costs were estimated for adults. Changes to disease burden were modelled with the PRIMEtime-CE Model, based on the 2014 population in England aged 18-80.ResultsIf the sugar reduction programme was achieved in its entirety and resulted in the planned sugar reduction, then the calorie reduction was estimated to be 25 kcal/day (1 kcal=4.18 kJ=0.00418 MJ) for 4-10 year olds (95% confidence interval 23 to 26), 25 kcal/day (24 to 28) for 11-18 year olds, and 19 kcal/day (17 to 20) for adults. The reduction in obesity could represent 5.5% of the baseline obese population of 4-10 year olds, 2.2% of obese 11-18 year olds, and 5.5% of obese 19-80 year olds. A modelled 51 729 quality adjusted life years (95% uncertainty interval 45 768 to 57 242) were saved over 10 years, including 154 550 (132 623 to 174 604) cases of diabetes and relating to a net healthcare saving of £285.8m (€332.5m, $373.5m; £249.7m to £319.8m).ConclusionsThe UK government’s sugar reduction programme could reduce the burden of obesity and obesity related disease, provided that reductions in sugar levels and portion sizes do not prompt unanticipated changes in eating patterns or product formulation.

Public health practitioners have little guidance around how to plan for the sustainability of donor sponsored programs after the donor withdraws. The literature is broad and provides no consensus on a definition of sustainability. This study used a mixed-methods methodology to assess program sustainability factors to inform donor-funded programs. This study examined 61 health facilities in the Western Cape, South Africa, supported by four PEPFAR-funded non-governmental organizations from 2007 to 2012. Retention in care (RIC) was used to determine health facility performance. Sustainability was measured by comparing RIC during PEPFAR direct service (20072012), to RIC in the post PEPFAR period (2013 to 2015). Forty-three semi-structured in-depth interviews were conducted with key informants. The qualitative data were used to examine how predictor variables were operationalized at a health facility and NGO level. Our qualitative results suggest the following lessons for the sustainability of future programs: Sufficient and stable resources (i.e., financial, human resources, technical expertise, equipment, physical space)Investment in organizations that understand the local context and have strong relationships with local government.Strong leadership at a health facility levelJoint planning/coordination and formalized skill transferLocal positive perceived value of the programPartnerships. Sustainability is complex, context dependent, and is reliant on various processes and outcomes. This study suggests additional health facility and community level staff should be employed in the health system to ensure RIC sustainability. Sustainability requires joint donor coordination with experienced local organizations with strong managers before during and after program implementation. If the program is as large as the South African HIV effort some dedicated additional resources in the long term would be required.

The COVID-19 pandemic has triggered a significant growth in government surveillance techniques globally, primarily through the use of cell phone applications. However, although these applications can have actionable effects on public health efforts to control pandemics, the participatory or voluntary nature of these measures is obscuring the relationship between health information and traditional government surveillance techniques, potentially preventing effective oversight. Public health measures have traditionally been resistant to the integration of government-led intelligence techniques, such as signals intelligence (SIGINT), because of ethical and legal issues arising from the nature of surveillance techniques. We explore this rise of participatory SIGINT and its nature as an extension of biosurveillance through 3 drivers: the rise of surveillance capitalism, the exploitation of a public health crisis to obscure state of exception politics with a moral imperative, and the historically enduring nature of emergency-implemented surveillance measures. We conclude that although mobile applications may indeed be useful in containing pandemics, they should be subject to similar oversight and regulation as other government intelligence collection techniques.

This paper aims to explore several ways to construct a scientific and comprehensive early warning system (EWS) for local government debt risk in China. In order to achieve this goal, this paper studies the local government debt risk from multiple perspectives, i.e., individual risk, contagion risk, static risk and dynamic risk. Firstly, taking China’s 30 provinces over the period of 2010~ 2018 as a sample, this paper establishes early warning indicators for individual risk of local government debt, and uses the network model to establish early warning indicators for contagion risk of local government debt. Then, this paper applies the criteria importance though intercrieria correlation (CRITIC) method and coefficient of variation method to obtain the proxy variable Ⅰ, which combines the above two risks. Secondly, based on the proxy variable Ⅰ, both the Markov-switching autoregressive (MS-AR) model and coefficient of variation method are used to obtain the proxy variable Ⅱ, which comprehensively considers the individual risk, contagion risk, static risk and dynamic risk of local government debt. Finally, machine learning algorithms are adopted to generalize the EWS designed in this paper. The results show that: (1) From different perspectives of local government debt risk, the list of provinces that require early warning is different; (2) The support vector machines can well generalize our EWS.

In 2014, the National Institutes of Health (NIH) began funding an ambitious research program, the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative, with the singular focus of advancing our understanding of brain circuits though development and application of breakthrough neurotechnologies. As we approach the halfway mark of this 10-year effort aimed at revolutionizing our understanding of information processing in the human brain, it is timely to review the progress and the future trajectory of BRAIN Initiative research.

Economic analysis of interventions to reduce non-communicable diseases can encourage countries to increase investment, say Melanie Bertram and colleagues