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• v.110(3); 2019 Jun

Language: English | French

Why public health matters today and tomorrow: the role of applied public health research

Lindsay mclaren.

1 University of Calgary, Calgary, Canada

Paula Braitstein

2 University of Toronto, Toronto, Canada

David Buckeridge

3 McGill University, Montreal, Canada

Damien Contandriopoulos

4 University of Victoria, Victoria, Canada

Maria I. Creatore

5 CIHR Institute of Population & Public Health and University of Toronto, Toronto, Canada

Guy Faulkner

6 University of British Columbia, Vancouver, Canada

David Hammond

7 University of Waterloo, Waterloo, Canada

Steven J. Hoffman

8 CIHR Institute of Population & Public Health and York University, Toronto, Canada

Yan Kestens

9 Université de Montréal, Montreal, Canada

Scott Leatherdale

Jonathan mcgavock.

10 University of Manitoba and the Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada

Wendy V. Norman

11 University of British Columbia, Vancouver, Canada

Candace Nykiforuk

12 University of Alberta, Edmonton, Canada

Valéry Ridde

13 IRD (French Institute For Research on Sustainable Development), CEPED (IRD-Université Paris Descartes), ERL INSERM SAGESUD, Université Paris Sorbonne Cités, Paris, France

14 University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada

Janet Smylie

Public health is critical to a healthy, fair, and sustainable society. Realizing this vision requires imagining a public health community that can maintain its foundational core while adapting and responding to contemporary imperatives such as entrenched inequities and ecological degradation. In this commentary, we reflect on what tomorrow’s public health might look like, from the point of view of our collective experiences as researchers in Canada who are part of an Applied Public Health Chairs program designed to support “innovative population health research that improves health equity for citizens in Canada and around the world.” We view applied public health research as sitting at the intersection of core principles for population and public health: namely sustainability, equity, and effectiveness. We further identify three attributes of a robust applied public health research community that we argue are necessary to permit contribution to those principles: researcher autonomy, sustained intersectoral research capacity, and a critical perspective on the research-practice-policy interface. Our intention is to catalyze further discussion and debate about why and how public health matters today and tomorrow, and the role of applied public health research therein.

Résumé

La santé publique est essentielle à une société saine, juste et durable. Pour donner forme à cette vision, il faut imaginer une communauté de la santé publique capable de préserver ses valeurs fondamentales tout en s’adaptant et en réagissant aux impératifs du moment, comme les inégalités persistantes et la dégradation de l’environnement. Dans notre commentaire, nous esquissons un portrait possible de la santé publique de demain en partant de notre expérience collective de chercheurs d’un programme canadien de chaires en santé publique appliquée qui visent à appuyer « la recherche innovatrice sur la santé de la population en vue d’améliorer l’équité en santé au Canada et ailleurs ». Nous considérons la recherche appliquée en santé publique comme se trouvant à la croisée des principes fondamentaux de la santé publique et des populations, à savoir : la durabilité, l’équité et l’efficacité. Nous définissons aussi les trois attributs d’une solide communauté de recherche appliquée en santé publique nécessaires selon nous au respect de ces principes : l’autonomie des chercheurs, une capacité de recherche intersectorielle soutenue et une perspective critique de l’interface entre la recherche, la pratique et les politiques. Nous voulons susciter des discussions et des débats approfondis sur l’importance de la santé publique pour aujourd’hui et pour demain et sur le rôle de la recherche appliquée en santé publique.

Introduction

Public health is critical to a healthy, fair, and sustainable society. Public health’s role in this vision stems from its foundational values of social justice and collectivity (Rutty and Sullivan 2010 ) and—we argue—from its position at the interface of research, practice, and policy.

Realizing this vision requires imagining a public health community that can maintain that foundational core, embrace opportunities of our changing world, and predict and adapt to emerging challenges in a timely manner. Unprecedented ecosystem disruption creates far-reaching health implications for which the public health community is unprepared (CPHA 2015 ; Whitmee et al. 2015 ). Human displacement is at its highest levels on record; those forced from home include “stateless people,” who are denied access to basic rights such as education, health care, employment, and freedom of movement ( http://www.unhcr.org/figures-at-a-glance.html ). Significant growth in urban populations creates an urgent need to improve urban environments, including policies to reduce air pollution and prevent sprawl (CPHA 2015 ; Frumkin et al. 2004 ), to reduce the substantial burden of morbidity and mortality attributable to behaviours such as physical inactivity, which negatively impact quality and quantity of life (Manuel et al. 2016 ). Significant and entrenched forms of economic, social, political, and historical marginalization and exclusion (TRC 2015 ), coupled with inequitable and unsustainable patterns of resource consumption and technological development (CPHA 2015 ; Whitmee et al. 2015 ), cause and perpetuate health inequities. These inequities underlie the now longstanding recognition that the unequal distributions of health-damaging experiences are the main determinants of health (CSDH 2008 ; Ridde 2004 ).

These imperatives demand a broadly characterized public health community. A now classic definition of public health is the science and art of preventing disease, prolonging life, and promoting health through the organized efforts of society (Last 2001 ). Public health, conceptualized in this manner, engages multiple sectors, embraces inclusion and empowerment (Ridde 2007 ), and demands navigating diverse political and economic agendas. Across Canada, a large and growing proportion of provincial spending is devoted to health care, while the proportion devoted to social spending (i.e., the social determinants of health) is small, flat-lining, and in some places declining (Dutton et al. 2018 ). Recent discourse has highlighted a weakening of formal public health infrastructure (Guyon et al. 2017 ) and points of fracture within the field (Lucyk and McLaren 2017 ). Efforts to strengthen public health, in its broadest sense, and to work towards unity of purpose (Talbot 2018 ) are needed now more than ever. What might such efforts look like?

We reflect on this question from our perspectives as researchers who are part of an Applied Public Health Chairs (APHC) program designed to support “innovative population health research that improves health equity for citizens in Canada and around the world.” 1 The applied dimension 2 is facilitated through the program’s focus on “interdisciplinary collaborations and mentorship of researchers and decision makers in health and other sectors” ( http://www.cihr-irsc.gc.ca/e/48898.html ). The APHC program (Box 1) is part of a broader set of efforts to address gaps in public health capacity, including research. Cross-cutting themes for the 2014 cohort (Box 2) include the following: healthy public policy, supportive environments (e.g., cities), diverse methodological approaches, global health, and health equity; many of which 3 align with a Public Health Services and Systems Research perspective in that they “identif[y] the implementation strategies that work, building evidence to support decision-making across the public health sphere” ( http://www.publichealthsystems.org/ ). Applied public health research is broad and could span CIHR Pillars 4 (social, cultural, environmental, and population health research) and 3 (health services research); the 2014 APHC cohort is predominantly aligned with Pillar 4.

The APHC program represents a significant Canadian investment in public health, and thus provides an important vantage point from which to reflect on why public health matters today, and tomorrow.

Box 1 The Applied Public Health Chairs program

Box 2 2014 cohort of Applied Public Health Chairs

More details available at: http://www.cihr-irsc.gc.ca/e/48898.html

Our proposal

We propose that applied public health research is a critical component of a robust population and public health community. As illustrated in Fig.  1 , we view applied public health research as sitting at the nexus of three core principles: (1) sustainability, (2) equity, and (3) effectiveness, which align with a vision of public health as critical to a healthy, fair, and sustainable society. By sustainability , we mean an approach or way of thinking, about public health in particular (e.g., Schell et al. 2013 ) and population well-being more broadly ( https://sustainabledevelopment.un.org/sdgs ) that emphasizes “meet[ing] the needs of the present generation without compromising the ability of future generations to meet their own needs” (Brundtland et al. 1987 ). Sustainability has social, economic, environmental, and political dimensions. We define equity as a worldview concerned with the embedded or systemic—and often invisible—drivers of unfair distributions of health-damaging experiences. In Canada and elsewhere, inequity is entrenched in legacies of colonial, structural racism designed to sustain inequitable patterns of power and wealth. Equity transcends diverse axes and perspectives, and an equity lens is action-oriented (Ridde 2007 ). Finally, effectiveness refers to impact or benefits for population well-being, as demonstrated by rigorous research. Explicit core values (e.g., equity), while important, are insufficient without translation to demonstrable outcomes (Potvin and Jones 2011 ). These core principles—sustainability, equity, and effectiveness—overlap and are mutually reinforcing; for example, the inequitable concentration of power, wealth, and exploitation of resources precludes sustainability.

Visual depiction of the role and attributes of applied public health research, vis-à-vis core population and public health principles of equity, sustainability, and effectiveness

Although these principles are applicable to the public health community broadly (i.e., including but not limited to researchers), applied public health researchers are uniquely situated to embrace sustainability, equity, and effectiveness when asking questions and generating policy- and practice-relevant knowledge, as illustrated below. Drawing on our collective experiences, we describe three necessary attributes of applied public health research that support our model in Fig.  1 : researcher autonomy, sustained intersectoral research capacity; and a critical perspective on the research-practice-policy interface. We assert that applied public health research is best positioned to contribute meaningfully to the principles of sustainability, effectiveness, and equity if the attributes described below are in place.

Researcher autonomy

Researcher autonomy is a precondition for innovation and independent thinking, and for building and sustaining the conditions for collective efforts. Our working definition of researcher autonomy is the capacity to devote time and energy to activities that, at the researcher’s discretion, facilitate research that embraces principles of sustainability, effectiveness, and equity. Autonomy, beyond the scope of general academic independence, provides the freedom to build and nurture partnerships, and to navigate among universities, health care systems, governments, communities, and across sectors. Effective and respectful partnerships are critical to rigorous intersectoral work and can provide an important platform to discuss systemic forms of inequity (e.g., Olivier et al. 2016 ; Morton Ninomiya et al. 2017 ). Recognizing a potential tension around the role of the researcher in an applied public health context, we deliberately selected the word “autonomy,” which we view as conducive to meaningful collaboration (although that may be experienced differently by different researchers), rather than “independence” which can be seen as contrary to such collaboration. Yet despite their importance, the time and resources to form and sustain those relationships are often not accommodated within funding and academic structures.

Autonomy, when coupled with resources and recognition, permits applied public health researchers to balance foundations of public health with current policy relevance. Although many of us have research programs with particular thematic foci (e.g., physical activity, dental health, HIV), autonomy provides space and credibility to connect those focal issues to enduring and evolving problems in public health (e.g., determinants of population well-being and equity), and to inform the contemporary policy context. Examples include research on health implications of neighbourhood gentrification in urban settings (Steinmetz-Wood et al. 2017 ); using community water fluoridation as a window into public and political understanding and acceptance of public health interventions that are universal in nature (McLaren and Petit 2018 ); and using innovative sampling methods to identify how census methods can perpetuate exclusion (Rotondi et al. 2017 ). That latter work, which estimated that the national census undercounts urban Indigenous populations in Toronto by a factor of approximately 2–4, provides impetus to work towards an inclusive system that respects individual and collective data sovereignty, and that is accountable to the communities from whom data are collected.

These implications of autonomy are consistent with calls for greater reflexivity in public health research (Tremblay and Parent 2014 ).

Insight : To strengthen applied public health research in Canada, researcher autonomy – whereby researchers have the credibility and protected time to set their own agendas in partnerships with the communities they serve – must be privileged.

Sustained intersectoral research capacity

Applied public health research requires funding for resources and infrastructure that are essential to sustain an intersectoral research program, but for which operating funds are otherwise not readily available. Examples include ongoing cohort studies (e.g., Leatherdale et al. 2014 ), research software platforms (e.g., Shaban-Nejad et al. 2017 ), meaningful public sector engagement in developing public health priorities, and knowledge translation activities.

Partnerships, also considered under researcher autonomy above, are one form of intersectoral research capacity. In applied public health research, having strong partnerships in place permits timely response to research opportunities that arise quickly in real-world settings. Examples in our cohort include instances where researchers were able to mobilize for rapid response funding competitions in areas of environment and health, communicable disease in the global South, and Indigenous training networks, because collaborative teams and potential for knowledge co-creation and transfer were already in place.

Insight : A robust applied public health research community requires sustained funding to support foundations of a credible and internationally-competitive research program (e.g., cohort studies, research software platforms, meaningful public sector engagement) that are difficult to resource via usual operating grant channels.

A critical perspective on the research-practice-policy interface

One barrier to evidence-based policy in applied public health is an assumption that evidence is the most important factor in making policy decisions, versus a more holistic view of the policymaking process where evidence is one of many factors, as discussed in recent work (Fafard and Hoffman 2018 ; O’Neill et al. 2019 ; Ridde and Yaméogo 2018 ).

Applied public health research is ideally positioned to embrace a critical perspective on the research-practice-policy interface. Several recent trends are promising in that regard. These include the following: substantive efforts to bridge public health and social science scholarship ( http://www.cihr-irsc.gc.ca/e/50604.html ), growing success by Pillar 4 researchers (including applied public health) in CIHR’s open funding competitions ( http://www.cihr-irsc.gc.ca/e/50488.html ), and the CIHR Health System Impact Fellowship initiative ( http://www.cihr-irsc.gc.ca/e/50612.html ), which could facilitate the placement of doctoral and post-doctoral academic researchers within the public health system and related (e.g., public, NGO) organizations.

Insight : Applied public health researchers are ideally positioned to embrace and model a sophisticated and interdisciplinary perspective on the research-practice-policy interface. To do so, opportunities for researchers (including trainees) to gain skills and experience to navigate the policy context are needed.

Against the backdrop of discourse about a weakening of public health infrastructure and fracture within the field (Guyon et al. 2017 ; Lucyk and McLaren 2017 ), we believe that there is value in working towards a unity of purpose (Talbot 2018 ). This commentary was prompted by a shared belief that through our experience with the Applied Public Health Chair Program, we have seen a glimpse of what is needed to achieve a population and public health community that is positioned to tackle societal imperatives, which includes an important role for applied public health research, spanning CIHR Pillars 3 and 4. Anchored in principles of sustainability, equity, and effectiveness, we assert a strong need for applied research infrastructure that privileges and supports: researcher autonomy, sustained funding to support foundations of a credible and internationally competitive research program, and opportunities for researchers (including trainees) to gain skills and experience to navigate the policy context. We welcome and invite further discussion and debate.

1 Under CIHR-IPPH’s mandate, population health research refers to “research into the complex biological, social, cultural, and environmental interactions that determine the health of individuals, communities, and global populations.”

2 Applied may be defined as follows: “put to practical use,” as opposed to being theoretical ( https://www.merriam-webster.com/dictionary/applied ).

3 For example: https://uwaterloo.ca/compass-system/ (Leatherdale); http://cart-grac.ubc.ca/ (Norman); http://www.healthsystemsglobal.org/ (Ridde).

The original version of this article was revised due to a retrospective Open Access order.

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Change history

The article ���Why public health matters today and tomorrow: the role of applied public health research,��� written by Lindsay McLaren et al., was originally published Online First without Open Access.

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Tuberculosis is one of the most dangerous contentious diseases which has led to loss of life for many people despite the fact that the disease is curable . The bacterial responsible for causing tuberculosis has been living amongst human population for a quite long time dating back to numerous centuries ago when it was discovered. Since then, there have been efforts and different types of drugs and preventive measures that have been applied to curb its spread all being in […]

Ebola Research Paper

Ebola is a rare and deadly disease that harvests in people and in-non human primates. Ebola is classified as a virus as it needs a host to survive. Ebola was first discovered in 1976 near the Ebola River in what is now Democratic Republic of Congo. Since then the virus has been infecting people from time to time and causing outbreaks in several african countries. There were 2 major outbreaks of Ebola. The first epidemic happened in 2014 and ended […]

Ebola Outbreak in West Africa

Introduction The 2014-2016 Ebola epidemic in West Africa exposed a divide between the planning of the global health community and the reality of controlling an infectious disease outbreak. Public health planners planned, prepared, and strategized about combating emerging infectious diseases and bioterrorism attacks, yet as the reality of the containment effort set in, the infection rate climbed out of control as the disease migrated from the rural area of origin to major urban centers in West Africa. Front-line doctors and […]

Understanding Breast Cancer

This paper will clarify what Breast Cancer is. It will explain the symptoms, treatment options, and other useful information regarding this disease. The first thing to know about Breast Cancer is understanding what it is. According to the Cancer.org website, breast cancer begins when cells in the bosom begin to spread out of control. The tumor that is formed from these cells may be detected on an x-ray or can be felt as a lump. Malignancy can advance into neighboring […]

The Progress of Childhood Diseases

This research paper is about the progress of medicine in childhood diseases. The purpose of this paper will go over the childhood diseases and illness that control of human lives and morality rate. It on focus on childhood disease improvement of medicines and vaccinations that associate with certain illness and diseases. The discoveries in vaccination plays a role in treatments in different illness and diseases in childhood diseases. “Strategic vaccination campaigns have virtually eliminated diseases that previously were common in […]

Chronic and Complex Infections

The aim of this paper is to assess the management of chronic diseases and measures taken to curb, prevent, and educate society concerning issues of various chronic diseases. The paper attempts to highlight key factors affecting healthcare systems in the task of tackling some of the diverse and adverse chronic illnesses, as well as corrective measures that should be taken to fully develop a functional unit system. It also outlines some of the risk-associated factors in relation to public health […]

An Issue of Nutrition and Diabetes

The article I've reviewed is called, "Nutrition Therapy Recommendations for the Management of Adults with Diabetes".  My decision to review this article is based upon interest in links with nutrition and chronic disease.  A National Center for Health Statistics study (Table 18) identified eight of the top ten killers in America as chronic diseases.  I've read multiple books that link the two and this article conducted a systematic review of 228 articles or studies.  The article goes fairly in depth […]

Connection between Genetics and Diabetes

Each single person has a specific set of genes; however, these genetics are greatly influenced by their families. Genetics can also be affected via one's environmental surroundings, as well. These genetics are associated with most diseases, such as cancer, kidney diseases, and psychologic diseases. Diabetes is no different. Genetics are not the only causative factor in diabetes, but it can alert healthcare members to look for this disease due to predisposition. According to the American Diabetes Association (2018), "Type 1 […]

Methicillin-Resistant Staphylococcus Aureus

Abstract Methicillin-Resistant Staphylococcus aureus (MRSA) is linked with difficult-to-cure contagions and high levels of illness. It has become widespread globally in the healthcare setting, and community-associated Methicillin-Resistant Staphylococcus aureus is spreading in the society at large. This paper offers a literature review of Methicillin-Resistant Staphylococcus aureus (MRSA) as it applies to the hospitals and the community. It will provide an overview of this health infection with the provision of prevalence and susceptibility of Methicillin-Resistant Staphylococcus aureus in the world. It […]

A Closer Look at the Effects of Smoking

 Imagine this: you are taking a stroll at a park. There is a slight breeze and the sun is high up in the sky. Suddenly, you are overwhelmed by a foul smell. You look around to find the source of the smell and find a young man in his early twenties smoking a cigarette about 15 feet away from you. After approaching this man to ask him why he smokes, you learn that he began smoking at a young age […]

The Spread of Ebola Virus

The Ebola Virus Disease is a disease that has existed for many years. It was first discovered in 1976 near the Ebola River that we know now as the Democratic Republic of Congo. The virus has been contaminating people since than leading it to spread to several African countries. It is a very rare and deadly disease affecting people and nonhumans. Such as monkeys, chimpanzees and gorillas and many more animals. It's a disease being transmitted to people from wild […]

Childhood Immunization

Introduction Nothing concerns a health care provider more than walking into a patient’s room to take a history and realizing that the child or adult you are attempting to treat never received vaccinations. Unfortunately, this situation and the number of “anti-vaxxers” in the United States are becoming a prevailing trend. This is regrettably proven by the increase in certain preventable yet deadly diseases like measles. In fact, “The largest measles outbreak in the United States in more than 20 years […]

Ebola Epidemic in West Africa

The most recent Ebola epidemic in West Africa in 2014 - 2015 had a weak international response and was a moment of crisis in global health leadership. Certainly, the outbreak was catastrophic, with a total of 28,000 cases and 11,000 deaths, which totaled more than all previous outbreaks (Camacho, 2014). As a result, there was a downturn in the economy and the impact of those lives lost was felt by those who survived the epidemic. As argued by Piot, the […]

An Evolution of Diabetes

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Writing Guide

Writing serves as a useful skill for anyone in the field of public health — students and professionals alike. Public health students must enroll in writing-intensive courses that require essays and research papers. Once students graduate, they put their skills to use writing reports on community health. They may compose presentations, research studies, or press releases, depending on their jobs. Those who stay in academia continue to write research papers throughout their careers.

Students should begin cultivating a clear and concise writing style long before they graduate.

They should also learn how to use standardized citations. Understanding how to properly cite sources will help students as they conduct research and publish their findings. Citations also help students and researchers avoid plagiarism.

This guide explains how to write a public health report, a research paper, and an exam essay. The page also advises students on how to conduct research online and find trustworthy sources. Students can review citation style guides and public health writing samples.

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Types of writing public health students will do in school, personal statements.

When applying to a public health program, schools often require students to submit personal statements. Schools may either ask students to write a general personal essay answer a certain prompt. Usually, prompts center around applicants’ interest in public health or about the public health field in general. Students might come across a prompt similar to this one: “Identify a public health issue in the U.S., and how you would work to rectify it as a public health professional.” Alternately, students may encounter this common topic: “What drove you to pursue a career in public health?”

Schools look for essays that are honest, well-written, and well-organized. Students should get the reader’s attention with an anecdote illustrating their commitment to public health. Was it an experience with adversity or discrimination that prompted you to pursue this career? Did you learn about the importance of public health while volunteering or traveling? Include those details in the story.

Students should also demonstrate their current knowledge of public health. They may write about their career goals as well. However, students should avoid writing exaggerations, falsehoods, or superlatives. People who read admissions essays can typically sense when applicants are stretching the truth. If the school makes the personal statement optional, students should still consider writing one. A personal statement demonstrates commitment and hard work, and may help make up for flawed or weak admissions materials.

In some public health courses, professors require students to answer essay questions during exams. This can be intimidating since students do not usually know the prompt until they actually start the exam. Students have a limited amount of time to write the essay, typically one or two hours. Students should allot their time accordingly. Some students do not plan their work before they begin writing; this can lead to sloppy essays with weak supporting points, disorganized information, and tangents unrelated to the prompt.

For a 60-minute time frame, students may give themselves 10 minutes to brainstorm, plan, and outline.

During the brainstorming process, students should write their thesis statement.

Then they should jot down three points that support the thesis. These ideas will serve as the three body paragraphs. Students may give themselves five minutes to write the introduction, 30 minutes to write the body, and then five minutes to write the conclusion. They then have 10 minutes to proofread. Students often inadvertently miss this step, but proofreading may make or break the essay.

Students should begin planning long before the day of the essay. Students ought to review the material well enough to be prepared for any prompt. They should carefully look over their lecture notes to determine which points the professor emphasized during classes. These points will likely prove significant when it comes time for the exam. Students should also make sure that they actually answer the prompt instead of rushing and jumping to assumptions.

Research Papers

In a research paper, students examine the existing research, theories, case studies, and ideas about a particular topic. Students have several weeks to write research papers, which may seem like a huge amount of time. However, research papers demand a lot of work, so students should start early. Professors rarely assign strict, narrow prompts for research papers. Instead, they usually give students a topic or range of topics, and students choose their focus. Public health topics may include how poverty or race affects access to healthcare; opioid abuse; the social consequences of HIV/AIDS; childhood obesity; or maternal mortality in third world countries.

Students should start by brainstorming a list of points and ideas they will investigate. Then comes the most time-intensive and significant part of a research paper: the research itself. Students ought to use multiple different resources to help them craft their arguments. Options include online databases, academic journals, and their college library. Make sure you keep track of citations and sources as you go.

Students should also make sure their essays are well-structured. A well-written thesis unites the main points of the paper. Unlike essays, research papers usually include more than five paragraphs. Students may break down their arguments into different sections. A research paper must include a works cited or bibliography that credits all sources. The exact length of the paper and number of sources depends on the professor’s expectations.

Over the course of their academic careers, public health students write many kinds of essays. Professors often assign persuasive essays, in which the student must make a convincing argument; expository essays, in which the student explores and explains an idea; narrative essays, in which the student tells a story; comparative essays, in which the students analyzes two different viewpoints; and cause and effect essays, in which the student must explain the logic behind why certain events or phenomena occur.

• Narrative: In a narrative essay, the author tells a meaningful story. Studying public health, you probably won’t write many narratives. However, narrative essays can support an argument or prove a point. For instance, if you argue that every community should have a free clinic, you might tell a personal story about your experience growing up in a low-income neighborhood with no access to healthcare. Make sure your essay demonstrates a clear plot, follows an organized structure, and includes many details.
• Expository: When professors assign expository essays, they expect students to explain or describe a concept. These essays help professors evaluate whether students have a firm grasp on a topic. Expository essay often include five paragraphs: an introduction with a thesis statement, three main points backing that thesis statement, and a conclusion. Students should do plenty of planning and research before writing to ensure they adequately address the prompt and include enough evidence.
• Persuasive: Persuasive essays appear commonly in academic assignments. Students first develop an argument as a thesis statement. Then, they generate a cogent defense of that argument by researching supporting evidence. Students should be able to anticipate arguments against their thesis statement and include counterpoints. In persuasive essays, students not only demonstrate their knowledge of the course material, but also prove their critical thinking skills by developing their case.
• Comparative: A comparative essay requires students to compare and contrast two ideas, viewpoints, or things. For example, public health students may compare two texts, theories, public health systems, or positions on an issue. First of all, students should create a list of similarities and differences between the two items. After that, they can develop a thesis statement on whether the similarities outweigh the differences or vice versa. Finally, they should organize the essay. They can either defend their thesis statement by listing each point of comparison, or they can split the essay in half by discussing subject one and then subject two.
• Cause and Effect: These essays require students to explain how one event or theory leads to a specific consequence. For instance, a public health student might argue that abstinence-only education in public schools leads to a higher rate of teenage pregnancies. Students should remember that just because one event follows another, those two events do not necessarily influence one another. In other words, correlation does not equal causation. In the analysis portion of the essay, students must explain specific reasons why they think the two events are connected using data and other evidence.

Citations Guide for Public Health Students

In public health writing, just as any other discipline, students must cite their sources. If students use ideas, theories, or research without crediting the original source — even unintentionally — then they have plagiarised. An accusation of plagiarism could follow the student throughout their education and professional career. Professors may fail students who plagiarise, sinking their GPA. Plagiarism accusations can also ruin a student’s credibility. Fortunately, students can avoid plagiarism by properly giving credit for their data and ideas. Common citation styles include those listed below.

American Psychological Association (APA) Style

Students in the social sciences use APA style when writing their essays and research papers. Business and nursing students also commonly use APA style. APA prefers active voice over passive voice, as well as concise language over flowery words. Research papers written in APA style should include a title page, abstract, and a reference page. In-text citations list the author’s name, year of publication, and page number if applicable. Below is an example of how to cite a source using APA style.

In-text citation:

In Milwaukee, poor neighbourhoods were segregated by design (Desmond, 2017, p. 249).

On the works cited page:

Desmond, M. (2017). Evicted: Poverty and profit in the American city . London: Penguin Books.

Chicago Manual of Style (CMS)

History students and students of the natural sciences typically use Chicago, or Turabian, style in their research. Papers written in Chicago style include three sections: the title page, the main body, and a references page. This style also uses footnotes to source information and provide more context. In-text citations list the author’s name, the date of publication, and the page where the student found the data. Unlike APA style, though, the in-text citation does not use a “p.” before the page number. See the example below:

In Milwaukee, poor neighbourhoods were segregated by design (Desmond 2017, 249).

Desmond, Matthew. Evicted: Poverty and Profit in the American City . London: Penguin Books, 2017.

Modern Language Association (MLA) Format

Students of the humanities — including literature, foreign languages, and cultural studies — use MLA style in their research papers. Unlike APA and Chicago style, MLA style does not require students to add a title page. MLA papers also do not include an abstract. Students only need to include the paper itself and a works cited page that corresponds with in-text citations. When adding citations in the body of the text, MLA includes the author’s last name and the page number in parentheses. This style does not list the publication year. You can find an example of MLA citation below:

In Milwaukee, poor neighbourhoods were segregated by design (Desmond 249).

Associated Press (AP) Style

Journalists use Associated Press, or AP style, in their work. AP style standardizes grammar and spelling usage across news media and mass communications. Students rarely use AP style, unless they are writing an article in their subject area for a newspaper or magazine. AP style prioritizes brevity and conciseness above all else. Therefore, it includes several rules that differ from other writing styles. For instance, AP style eliminates the last comma in a list of items (for example: “She dressed in capris, a tank top and sandals”). Since students and professors do not use AP style for academic papers, AP style does not include a reference page like other style guides. Instead, AP style simply uses non-parenthetical in-text citations.

“People who live in low-income communities lack opportunities to exercise,” said Lydia Homerton, professor of public health at Hero College.

The Best Writing Style for Public Health Majors

Professionals in the public health field use APA, the most common style in the social sciences. Professors expect students to use APA style as well. Public health research follows a standardized system of citing sources, making it easier for students and professionals in the field to conduct further research. Students should add a title page and abstract before the essay, as well as a list of references in the back.

Common Writing Mistakes Students Make

Active vs. passive voice.

When writing essays and research papers, students should use active voice and avoid passive voice. Learning the difference between passive and active constructions can be tricky. First of all, students should be able to identify the subject in a sentence. The subject is the noun performing an action. Take this sentence: “The woman catches the keys.” In this case, the woman is the subject of the sentence because she is the one performing the action, catching. The sentence “The woman catches the keys” is active because it focuses on the subject and the action. You can identify an active sentence by checking if the first noun is a subject performing an action.

By contrast, examine this sentence: “The keys were caught by the woman.” The first noun, “keys,” is not performing an action. Instead, it is being acted upon. The subject performing the action — the woman — is at the end of the sentence and not the beginning. This sentence uses passive voice instead of active voice. Some passive sentences do not include a subject at all. For example, “The keys were caught.”

Active voice makes writing more concise and easy to understand. Active sentences often include more information, especially about the subject performing an action. In research papers, students should use active voice whenever possible. However, sometimes it is clear that the author is the one performing the action, so active voice is not necessary. For instance, a researcher might write “the experiment was conducted Friday” instead of “I conducted the experiment Friday.”

Punctuation

Incorrect punctuation confuses readers. The wrong punctuation can change or obfuscate the meaning of a sentence, paragraph, or the entire essay. Publishers, professors, and other researchers often look down on papers with incorrect grammar, even if the content includes important or accurate research. Consequently, students should always use proper grammar in their essays.

The wrong punctuation can change or obfuscate the meaning of a sentence, paragraph, or the entire essay.

While students make many different errors with punctuation, most common errors revolve around colons and commas. Understand the difference between colons and semicolons. Both punctuation marks separate two parts of a sentence. Students should use colons when introducing a list. (“He ate lots of meat: pork, chicken, steak, veal, and duck.”) Colons can also introduce an appositive or new idea. (“She finally gave him the gift: a new computer.”) Semicolons, on the other hand, connect two complete, independent sentences. These sentences should be separate but related. (“He ate a lot of meat; he was ravenous.”)

Students should also take care to avoid comma splices. A comma splice occurs when writers connect two independent sentences using a comma. The following sentence includes a comma splice: “She danced with her boyfriend, he was very clumsy.” Instead, students could add an “and” to connect the two sentences. (“She danced with her boyfriend, and he was very clumsy.”) Alternately, writers could connect the sentences with a semicolon. (“She danced with her boyfriend; he was very clumsy.”) Lastly, writers could separate the two sentences with a period.

Proper grammar helps readers understand your essays. Proper grammar also gives your essay credibility. If you have a perfectly-argued essay, but your paper includes multiple grammar mistakes, the reader will likely be skeptical of the entire argument.

Understand the difference between there/their/they’re. “There” refers to a place. (“The dog is over there.”) Their shows possession. (“This is their house.”) “They’re” is a contraction for “they are.” (“They’re eating at the diner.”)

Also learn the difference between it’s and its. “It’s” is the contraction for “it is.” (“It’s hot outside.”) “Its” shows possession. (“The bird eats in its cage.”)

Make sure your sentences include proper subject-verb agreement. In other words, if the subject of a sentence is plural, the verb should also be plural. For example, use “The boy and his sisters are eating breakfast” instead of “The boy and his sisters is eating breakfast.”

Writing Resources for Public Health Students

• Guide to Improving Scientific Writing in Public Health : This guide from the World Health Organization and the Pan American Health Organization teaches students how to write about complicated scientific material in a way that’s easy for readers to understand. The guide includes tips on vocabulary and format.
• Argument, Structure, and Credibility in Public Health Writing : Written by a professor at Harvard’s School of Public Health, this essay breaks down how to make effective arguments in public health writing. The page includes flow charts and figures to help illustrate exactly how public health essays should be organized.
• Purdue Online Writing Lab APA Style Guide : Purdue’s Online Writing Lab includes style guides for all writing and citation styles, including APA. The style guides help students understand how to format papers, use in-text citations, and create reference pages.
• Award-Winning Health Articles : One of the best ways to improve your writing is to read good examples. This page lists nine award-winning public health writing samples.
• The Women’s and Children’s Health Policy Center Writing Skills Guide : This website links to several modules on writing public health documents. Lessons include policy briefs and memos.

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Influence of eye-related behavior on myopia among junior middle school students under the background of double reduction during the COVID-19 pandemic

To investigate the changes in the unhealthy eye-related behaviors of junior middle school students during the COVID-19 pandemic and the double reduction policy and its relationship with myopia.

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Why Study Public Health?

Why Is Public Health Important?

The field of public health plays a critical role in the promotion of health, prevention of disease, and empowerment of individuals to manage illness and disabilities. Every scientific finding, awareness campaign, and new policy has the potential to positively impact the lives of millions of people around the world . A unique blend of research, inquiry, and action, public health brings together people from across disciplines, backgrounds, and perspectives to discover the root causes of health problems and develop long-lasting, innovative solutions that improve everyone’s quality of life.

While the field of medicine traditionally aims to treat diseases and injuries, public health aims to proactively prevent them and keep populations healthy. In doing so, public health practitioners discover and share health interventions that ensure health and equity now and far into the future.    

What Will You Learn in a Public Health Degree Program?

In a public health degree program, you’ll learn how the conditions in the places where people live, learn, work, grow, and play affect their health outcomes. You’ll learn how public health professionals collaborate to uncover these conditions and build interventions that address them. Depending on your interests and passions, your coursework in Michigan Public Health’s six departments can explore the science behind the spread and control of disease, environmental impacts on human health, how policy and data can transform the health of populations, and the ways diet and nutrition shape our lives and our health. 

What Can You Do with a Public Health Degree?

A public health degree gives you the professional foundation and transferable skills you need to understand and work on a wide range of issues in a variety of industries and fields, including issues you see in the news every day, from COVID-19 to health care policy, firearm safety, and racism. Those with public health degrees keep communities healthy, protect workers, prevent and address pandemics, pursue social justice, drive public policy, spearhead disaster relief, ensure access to healthcare, and so much more. Public health professionals are at the forefront of research, practice, and service in nonprofits, community organizations, higher education, government, private industry, and health care. Discover jobs and careers in public health by learning more about our alumni .

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The Public Health Problems Essay

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Public health involves the prevention of diseases to prolong life and the promotion of good health of the people through some given guidelines or interventions. The field of public health has raised a lot of concern to many nations. This is so because of many challenges and issues, which are yet to be addressed.

For a long time, public health issues have been ignored. Although many nations have put efforts to address some of these issues, much is yet to be done. One of the main public health problems is violence. The purpose of this research is to explore how to address violence as one of the public health problems.

Violence and especially domestic violence, is an issue that has raised the attention of many researchers and scholars. Their main aim is to come up with effective strategies for addressing the problem. This issue is a big challenge in the field of public health. Addressing the issue in the clinical institutions should be taken with a lot of concern if any success is to be realized. Nurses should be equipped with the relevant training on how to handle cases of violence among the patients.

According to the World Health Organization, domestic violence affects men and women equally, and its impacts are devastating. Researches show that many marriages are experiencing divorce due to domestic violence. More research should be done to come up with the relevant training that should be given to the nurses to enhance their capacity in addressing the issue on their clients.

The authority that is mandated with enforcing the public health laws and regulations should ensure that such laws are effectively implemented. The people caught breaking these laws should be punished severely to serve as a learning lesson for others with such related intentions. They can be prosecuted or arrested and fined for the offense committed. The right ethical behaviors should be provided to the public to help them make ethical decisions that do not cause any form of violence.

The factors attributed to violence should also be addressed as they form part of the exact causes of the problem. Some of these factors include poor housing or living conditions and inability to access quality health care services. These factors stimulate violence; hence dealing with them adequately will help solve the problem.

All the public health authorities and practitioners should also team up in addressing the problem. The team should apply strategies like awareness creation on domestic violence as a public health problem and the impacts it poses to society. When creating awareness, the team should also sensitize the public on the punishments that are associated with domestic violence crimes. This way, society will be informed and will try all ways possible to avoid any form of domestic violence.

I think this approach to solving the problem is very effective because addressing the root cause of a problem should start with the parties involved. The code of ethics given to various public health practitioners is not effective in addressing this public health issue.

The battle towards achieving success in addressing the problem is not a one man’s effort, but it calls for a collaborative approach. Public participation is very crucial towards addressing the problem. Combined, I believe these efforts should solve this public health problem effectively.

• Violence Against Women as a Public Health Concern
• Guilty until Proven Otherwise: Domestic Violence Cases
• Domestic Violence: Predicting and Solutions
• Children's Rights: Global and Cultural View
• Health Law: The Never-Ending War on Drugs
• Debate on the Legal Drinking Age
• The Effect of Meaningful Use on Healthcare Organizations
• Medicare: Who Should Pay?
• Chicago (A-D)
• Chicago (N-B)

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Home — Application Essay — National Universities — Why I Chose Public Health

Why I Chose Public Health

• University: Harvard University

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Published: Feb 15, 2024

Words: 674 | Pages: 1 | 4 min read

I have been driven by a passion for improving the well-being and quality of life for individuals and communities. This desire has led me to pursue a career in public health. In this essay, I will outline the reasons why I chose public health as my field of study and how I believe it aligns with my values and aspirations.

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One of the primary reasons I chose public health is its inherent focus on social justice. Public health recognizes that health disparities exist due to various social determinants, including socioeconomic status, race, and access to healthcare. By addressing these underlying factors, public health strives to create a more equitable society where everyone has the opportunity to lead a healthy life.

I firmly believe that health is a fundamental human right, and it should not be determined by one's background or circumstances. Public health offers me the platform and tools to challenge the status quo, advocate for marginalized groups, and work towards eliminating health disparities.

Another aspect that attracted me to public health is its interdisciplinary nature. Public health encompasses a wide range of disciplines, including epidemiology, biostatistics, environmental health, health policy, and social and behavioral sciences. This multidisciplinary approach allows me to explore and understand health issues from various angles.

I find great value in the intersectionality of different disciplines, as it enables a comprehensive understanding of complex health challenges. By collaborating with professionals from diverse backgrounds, I can leverage their expertise and perspectives to develop innovative and effective solutions for public health issues. This interdisciplinary nature of public health ensures that I am constantly learning, adapting, and broadening my knowledge base.

Choosing public health also stems from my desire to make a tangible impact on individuals and communities. Public health interventions have the power to save lives, prevent diseases, and improve overall well-being on a large scale. It is not merely about providing immediate treatment but rather focusing on prevention and health promotion.

By working in public health, I can contribute to the development and implementation of evidence-based strategies that address the root causes of health issues. Whether it is designing preventive programs, conducting research on emerging diseases, or advocating for policy changes, public health allows me to translate my passion into concrete actions that positively influence the lives of others.

Public health also offers a global perspective, which resonates deeply with my personal experiences and aspirations. The interconnectedness of health transcends national boundaries, making it crucial to consider global health issues with a holistic approach.

I have witnessed firsthand the impact of health disparities in developing countries during volunteer experiences abroad. These experiences have motivated me to address global health inequities and work towards empowering communities to achieve better health outcomes.

Public health equips me with the skills and knowledge to address challenges in both local and global contexts. It allows me to engage in meaningful work that transcends borders and contribute to the well-being of diverse populations.

Lastly, I chose public health because it is a field that is constantly evolving and adapting to new challenges and discoveries. The emergence of new diseases, advancements in technology, and changing societal dynamics necessitate ongoing innovation in public health.

I am drawn to the dynamic nature of public health, as it requires continuous learning and staying up-to-date with the latest research and best practices. This ever-evolving landscape presents exciting opportunities for me to contribute to emerging fields such as digital health, genomics, and health informatics.

By choosing public health, I am embarking on a journey of lifelong learning and growth, where I can actively contribute to the generation of new knowledge and drive positive change.

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In summary, I chose public health because it aligns with my values of social justice and equity, offers interdisciplinary collaboration, provides opportunities for tangible impact, presents a global perspective, and embraces the constant evolution of the field. Public health offers me the platform to address pressing health issues and work towards creating a healthier, more equitable society. I am eager to harness my passion, skills, and knowledge in public health to make a lasting difference in the lives of individuals and communities.

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Health, well-being and education: Building a sustainable future. The Moscow statement on Health Promoting Schools

Health Education

ISSN : 0965-4283

Article publication date: 18 March 2020

Issue publication date: 4 June 2020

The purpose of this paper is to introduce the official statement of the Fifth European Conference on Health-Promoting Schools.

Design/methodology/approach

The Fifth European Conference on Health-Promoting Schools was held on 20–22 November 2019 in Moscow, Russian Federation, with over 450 participants from 40 countries. A writing group was established to prepare a draft version of the statement before the conference. On the basis of an online and offline feedback process, the opinions of the participants were collected during the conference and included in the finalisation of the statement.

The final conference statement comprises six thematic categories (values and principles; environment, climate and health; schools as part of the wider community; non-communicable diseases (NCDs); evidence base; and digital media), with a total of 23 recommendations and calls for action.

Originality/value

The recommendations and calls for action reflect current challenges for Health Promoting Schools in Europe. They are addressed to all actors in governmental, non-governmental and other organisations at international, national and regional levels involved in health promotion in schools and are to be applied for the further development of the concept.

• Health Promoting Schools
• Social change
• Child and adolescent health
• School health promotion

Dadaczynski, K. , Jensen, B.B. , Viig, N.G. , Sormunen, M. , von Seelen, J. , Kuchma, V. and Vilaça, T. (2020), "Health, well-being and education: Building a sustainable future. The Moscow statement on Health Promoting Schools", Health Education , Vol. 120 No. 1, pp. 11-19. https://doi.org/10.1108/HE-12-2019-0058

Emerald Publishing Limited

Copyright © Kevin Dadaczynski, Bjarne Bruun Jensen, Nina Grieg Viig, Marjorita Sormunen, Jesper von Seelen, Vladislav Kuchma and Teresa Vilaça

Published in Health Education . Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at: http://creativecommons.org/licences/by/4.0/legalcode

1. The Health Promoting Schools approach and its development

The Ottawa Charter, adopted in 1986, was a milestone in the development of a holistic and positive understanding of health that requires actions at different levels, from healthy public policy to the development of personal skills, using different strategies, such as enabling and advocacy approaches ( WHO, 1986 ). The charter can also be regarded as marking the birth of whole-school approaches to health that have been established in Europe and internationally under the term Health Promoting Schools ( Stewart Burgher et al. , 1999 ).

A Health Promoting Schools reflects a holistic approach that moves beyond individual behaviour change by also aiming at organisational change through strengthening the physical and social environment, including interpersonal relationships, school management, policy structures and teaching and learning conditions. This approach can be seen as the result of overcoming traditional health education at school, which aimed to influence students' knowledge, attitudes and behaviour ( Clift and Jensen, 2005 ). In accordance with a social-ecological perspective, health is considered to be the result of a complex interplay of individual, social, socio-economic and cultural factors ( Dahlgreen and Whitehead, 1991 ). Since the early 1990, actions on school health promotion have been coordinated in national networks and the European network on Health Promoting Schools as a WHO supported network. The current work on school health promotion on a European level is organised through the Schools for Health in Europe Network Foundation (SHE), with national representatives from 36 countries.

Values of the Health Promoting Schools approach

Health Promoting Schools ensure equal access for all to the full range of educational and health opportunities. This in the long term makes a significant impact in reducing inequalities in health and in improving the quality and availability of lifelong learning.

Sustainability

Health Promoting Schools acknowledge that health, education and development are closely linked. Schools act as places of academic learning. They support and develop a positive view of pupils' future role in society. Health Promoting Schools develop best when efforts and achievements are implemented in a systematic and continuous way. Desirable and sustainable health and educational outcomes occur mostly in the medium or long term.

Health Promoting Schools celebrate diversity and ensure that schools are communities of learning, where all feel trusted and respected. Good relationships among pupils, between pupils and school staff and between school, parents and the school community are important.

Empowerment

Health Promoting Schools enable children and young people, school staff and all members of the school community to be actively involved in setting health-related goals and in taking actions at school and community level to reach the goals.

Health Promoting Schools are based on democratic values and practise the exercising of rights and taking responsibility.

Pillars of the Health Promoting Schools approach

Whole-school approach to health

Taking a participatory and action-oriented approach to health education in the curriculum;

Taking into account the pupil's own concept of health and well-being;

Developing healthy school policies;

Developing the physical and social environment of the school;

Developing life competencies and health literacy;

Making effective links with home and the community; and

Making efficient use of health services.

Participation

A sense of ownership is fostered by pupils, staff and parents through participation and meaningful engagement, which is a prerequisite for the effectiveness of health-promoting activities in schools.

School quality

Health Promoting Schools support better teaching and learning processes. Healthy pupils learn better, and healthy staff work better and have greater job satisfaction. The school's main task is to maximise educational outcomes. Health Promoting Schools support schools in achieving their educational and social goals.

School health promotion in Europe is informed by existing and emerging research and evidence focused on effective approaches and practice in school health promotion, both on health topics (such as mental health, eating and substance use) and on the whole-school approach.

Schools and communities

Health Promoting Schools engage with the wider community. They endorse collaboration between the school and the community and are active agents in strengthening social capital and health literacy.

Since the establishment of the European network of Health Promoting Schools, four European conferences on Health Promoting Schools have been organised. The resolution of the first conference, held in Thessaloniki, Greece, in 1997, stated that every child and young person in Europe had the right to be educated in a Health Promoting Schools and urged governments in all European countries to adopt the Health Promoting Schools approach ( ENHPS, 1997 ). The Egmont Agenda was published in 2002 as a result of the Second European Conference on Health Promoting Schools in The Netherlands and emphasised conditions, programming and evaluation as being essential to developing and sustaining Health Promoting Schools ( ENHPS, 2002 ).

Seven years later, the Third European Conference on Health Promoting Schools was held in Vilnius, Lithuania ( SHE Network, 2009 ). The conference and its resolution marked an important milestone in the development of the Health Promoting Schools approach by highlighting that education and health have shared interests and complement each other. Based on this, joint actions beyond sectoral responsibilities were urged.

The Fourth European Conference was held in Odense, Denmark, in 2013 and resulted in The Odense Statement, which recognised the core values and pillars of school health promotion as a strong contributor to the aims and objectives of the WHO policy framework for health and well-being in Europe, Health 2020 and the EU2020 strategy for inclusive and sustainable growth ( SHE Network, 2013 ).

2. Recent societal challenges

Since the establishment of the Health Promoting School approach in the late 1980s, the world has seen constant societal change, with progressively faster dynamics during recent years. The changes have not only altered substantially the conditions in which people grow up and live, but have also affected behaviours in relation to health, social cohabitation, learning and working. Wars and violence, often rooted in cultural and religious differences or political and economic crisis, and climate change alter significantly the environmental and societal determinants of health ( Mucci et al. , 2016 ; Watts et al. , 2019 ).

Often, it is countries that already are experiencing political and socio-economic instability that feel the effects most ( Reibling et al. , 2017 ). An increase in international migration, commonly in perilous circumstances for migrants and refugees ( Silove et al. , 2017 ), is the consequence, raising social tensions and challenges in many countries, some of which are undergoing political developments characterised by protectionism and isolationism that can partly be seen as a countermovement to the idea, values and principles of Europe ( Harteveld et al. , 2018 ).

In many cases, uncertainty has replaced political, economic, social and individual stability, raising concern and anxiety about the future in young people and adults. This has led to an unprecedented social (grassroots) movement of participation, primarily driven by young people who are demanding social, political, ecological and economic change ( O'Brien, Selboe and Hayward, 2018 ).

These developments should not be seen as being separate from school health promotion, the aim of which is to support young people to develop healthy and self-determined lifestyles and enable them to co-create their social, physical and ecological environments and the determinants of health positively and sustainably ( Clift and Jensen, 2005 ; Simovska and McNamara, 2015 ). As the conditions for growing up and living together change, the question arises of how schools, as places for health-related teaching, learning and development, need to adapt.

Where does the Health Promoting School approach stand today, more than 30 years after the Ottawa Charter on health promotion? Can the Health Promoting School, with its holistic orientation, deliver on its promise of addressing health inequalities and improving children's and young people's health, well-being and academic achievement? To what extent can school health promotion be implemented systematically in schools and be linked to local communities?

These and more questions were raised and discussed during the Fifth European Conference on Health Promoting School, culminating in recommendations for the future development of the Health Promoting School approach.

3. The Fifth European Conference on Health Promoting Schools

The Fifth European Conference on Health Promoting Schools was held on 20–22 November 2019 in Moscow, Russian Federation, with over 450 participants from 40 countries.

A range of topics was addressed through more than 160 contributions and nine keynote presentations focusing on conceptual aspects of the Health Promoting School approach, implementation and dissemination and current social change processes, such as digitisation and heterogeneity.

Holistic approaches to school-based health promotion and health education (such as organizational change and environmental approaches to school health promotion and strategies to promote individual and organizational health literacy in schools);

Implementation and dissemination of school-based health promotion and health education (facilitators and barriers to implementing interventions in school-based health promotion and professional development and capacity-building of, for example, teachers, non-teaching school staff, school health services, parents and external professionals);

Networking and intersectoral collaboration in school-based health promotion and health education (schools as part of the wider community, and multisectoral partnerships at local, national and international levels);

Innovative approaches to dealing with heterogeneity, inclusion and special needs (pupils' and teachers' health in inclusive schooling, school-based health promotion and education for refugees, students with special needs and innovative approaches to school-based health services); and

Digital media and information and communications technology (ICT) in school health promotion and health education (practical approaches to ICT use in school-based health promotion and digital devices and media as a target for interventions and a means to promote health and well-being).

4. Recommendations for action

Be based on democratic processes and foster equal access, active involvement and participation;

Take into account the needs and background of all young people regardless of their gender, geographical, cultural and social background or religious beliefs: in that sense, a Health Promoting School can be seen as an inclusive school that celebrates heterogeneity and diversity as an enriching dimension for mutual learning, respect and acceptance;

Reflect a whole-school approach addressing different target groups and combining classroom activities with development of school policies, the physical, social and cultural environment of the school and the necessary capacities needed: we welcome new and established concepts and approaches within school-based health promotion, such as health literacy, salutogenesis, action competence and life skills, which should complement each other and be integrated in the holistic framework of the Health Promoting School approach; and

Be systematically linked with educational goals and school quality as part of a so-called add-in approach: based on rich evidence, a Health Promoting School can be regarded as a school that not only promotes and maintains health, but also strives for successful learning for pupils and working conditions for teaching and non-teaching staff, and involves parents and families in the school's daily life.

Urge all stakeholders in health and climate/sustainability education to work together systematically to support young people to grow up and live healthily and sustainably;

Urge all stakeholders to support and empower young people to raise their voice and make a lasting contribution to shaping a healthy and sustainable future for themselves and their fellow human beings;

Call for actions to link planetary health and the Health Promoting School approach more explicitly by, for instance, integrating the impact of human action on the environment and its health consequences into school curricula and everyday life; and

Call for realignment of health-promotion research agendas to address environmental challenges in, with and through schools.

All actors to move from a single-setting approach to an integrated multi-setting approach that systematically links actions at school level with actions in the local community: these actions should not be implemented in isolation, but in a coordinated fashion to create synergies and avoid discontinuities;

Intersectoral collaboration among different actors and professions, such as teachers, school health services and social and youth-care services: this requires professional development, and that existing local networks and their leadership capacities be strengthened to align sectoral policies and enable the development of a common vision and language; and

All actors to strengthen links with existing national and regional cooperation mechanisms, such as Health Promoting School networks and healthy city or healthy region networks, by pursuing joint objectives and actions.

A resource-oriented intervention approach (as described in the SHE values and pillars) be taken to tackle NCDs rather than a traditional top-down and disease-oriented approach, which normally dominates interventions related to risk factors;

Young people be viewed as part of the solution and not only as part of the problem of NCDs – we need to work with young people as powerful agents of healthy change and not as victims and recipients of risk factors;

A school environment that promotes healthy practices in areas like healthy eating, physical activity, social and emotional well-being and good hygiene be created; and

Commercial determinants are addressed by empowering young people to become critical and responsible citizens who are able to understand and critically reflect on media advertising and market mechanisms through, for instance, consumer education.

Call for evaluation approaches that reflect the complexity of the Health Promoting School by, for example, applying mixed-methods designs and considering graded health and educational outcomes;

Demand that the available scientific evidence be reviewed and evaluated using existing tools and be translated into recommendations for practical action;

Urge that a one-sided focus on outcomes research be augmented by focusing also on implementation to identify the conditions under which interventions can be effective, systematically linking both research perspectives; and

Call for systematic and strong partnerships between researchers and practitioners who develop and implement innovative interventions in school health promotion and those who conduct empirical surveys on child and adolescent health (such as the Health Behaviour in School-aged Children (HBSC) study) and the health of teaching and non-teaching staff. By sharing available social-epidemiological data, previously untried evaluation potential can be exploited.

Call on all actors in school health promotion to use the possibilities of digital media in the context of research, development, implementation and exchange of innovative interventions and good practice;

Urge all actors to use digital media as a supplement to, and not as a substitute for, non-digital (face-to-face) school health-promotion actions;

Call on all actors to ensure that the use of digital media does not lead to a step back to individual and behavioural prevention, but rather is used at organisational level to, for instance, build capacity, communicate with partners outside the school and promote low-threshold participation in change processes within the school; and

Call for actions to empower individuals and whole-school systems to deal effectively with health information complexity, including its critical assessment, selection and use and to take responsibility for providing suitable and reliable health information.

The Health Promoting School approach

Buijs , G.J. ( 2009 ), “ Better schools through health: networking for health promoting schools in Europe ”, European Journal of Education , Vol. 44 No. 4 , pp. 507 - 520 .

Clift , S. and Jensen , B.B. ( 2005 ), The Health Promoting School: International Advances in Theory, Evaluation and Practice , Danish University of Education Press , Copenhagen .

Dahlgren , G. and Whitehead , M. ( 1981 ), Policies and Strategies to Promote Social Equality in Health , Institute of Future Studies , Stockholm .

European Network of Health Promoting Schools (ENHPS) ( 2002 ), The Egmond Agenda. A New Tool to Help Establish and Develop Health Promotion in Schools and Related Sectors across Europe , available at: https://tinyurl.com/y2py8wzr ( accessed 19 November 2019 ).

European Network of Health Promoting Schools (ENHPS) ( 1997 ), “ Conference resolution ”, available at: https://tinyurl.com/wcunrec ( accessed 19 November 2019 ).

Harteveld , E. , Schaper , J. , De Lange , S.L. and Van Der Brug , W. ( 2018 ), “ Blaming Brussels? the impact of (news about) the refugee crisis on attitudes towards the EU and national politics ”, JCMS: Journal of Common Market Studies , Vol. 56 No. 1 , pp. 157 - 177 .

Mucci , N. , Giorgi , G. , Roncaioli , M. , Perez , J.F. and Arcangeli , G. ( 2016 ), “ The correlation between stress and economic crisis: a systematic review ”, Neuropsychiatric Disease and Treatment , Vol. 12 , pp. 983 - 993 .

O'Brien , K. , Selboe , E. and Hayward , B. ( 2018 ), “ Exploring youth activism on climate change: dutiful, disruptive, and dangerous dissent ”, Ecology and Society , Vol. 23 No. 3 , p. 42 .

Reibling , N. , Beckfield , J. , Huijts , T. , Schmidt-Catran , A. , Thomson , K.H. and Wendt , C. ( 2017 ), “ Depressed during the depression: has the economic crisis affected mental health inequalities in Europe? findings from the European social survey (2014) special module on the determinants of health ”, The European Journal of Public Health , Vol. 27 Suppl 1 , pp. 47 - 54 .

Schools for Health in Europe (SHE) Network ( 2013 ), “ The Odense Statement. Our ABC for equity, education and health ”, available at: https://tinyurl.com/rk8rh5e ( accessed 19 November 2019 ).

Schools for Health in Europe (SHE) Network ( 2009 ), “ Better schools through health: the Third European Conference on Health Promoting Schools. Vilnius resolution ”, available at: https://tinyurl.com/qskr692 ( accessed 19 November 2019 ).

Silove , D. , Ventevogel , P. and Rees , S. ( 2017 ), “ The contemporary refugee crisis: an overview of mental health challenges ”, World Psychiatry , Vol. 16 No. 2 , pp. 130 - 139 .

Simovska , V. and McNamara , P. (Eds) ( 2015 ), Schools for Health and Sustainability , Springer , Dordrecht .

Stewart Burgher , M. , Barnekow , V. and Rivett , D. ( 1999 ), The European Network of Health Promoting Schools. The Alliance of Education and Health , WHO Regional Office for Europe , Copenhagen .

Watts , N. , Amann , M. , Arnell , N. , Ayeb-Karlsson , S. , Belesova , K. , Boykoff , M. , … and Chambers , J. ( 2019 ), “ The 2019 report of the Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate ”, The Lancet , Vol. 394 No. 10211 , pp. 1836 - 1878 .

WHO ( 2016 ), Declaration: Partnerships for the Health and Well-Being of Our Young and Future Generations. Working Together for Better Health and Well-Being: Promoting Intersectoral and Interagency Action for Health and Well-Being in the WHO European Region , WHO Regional Office for Europe , Copenhagen .

WHO ( 1986 ), “ Ottawa Charter for Health Promotion ”, available at: https://tinyurl.com/mohfbn6 ( accessed 19 November 2019 ).

Acknowledgements

This publication has received funding under an operating grant from the European Union's Health Programme.

Corresponding author

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• Grad School
• Sample Essays
• The Public Health Student

What if people lived healthier lives, practiced preventive medicine, and took precautions against illness and disease? My days in the physical therapy department often made me think about the prevention of injuries as well as the injuries themselves. I was already doubting my future career choice as a physical therapist. Although I loved the science of it and helping people, the lack of variety within the field and its limited options for growth bothered me. I needed a career that helped a large number of people, emphasized prevention and primary care rather than tertiary care, and would continually challenge and motivate me to improve. Knowing that I really did not want to pursue physical therapy as I had originally planned, my thoughts wandered to the area of public health, particularly health management.

My first true introduction to the public health arena came in a class offered through the Big U School of Public Health. As I listened to experts speak about contemporary health issues, I was intrigued. The world of "capitation," "rationing of care," and Medicaid fascinated me as I saw the range of problems that public health professionals were trying to solve in innovative ways. This one semester class provided me with a basic but thorough understanding of the issues faced in health care today. In the last two years I have continued to learn about public health both through coursework and work in the field.

Because field experience is such a valuable learning tool, I searched for a research assistant position that would allow me to view public health at a different level. I worked on a project at a county health clinic in Englewood, a low-income, minority community. The program attempted to increase treatment compliance rates for adolescents diagnosed with tuberculosis who must complete a six-month medical program. Working for the county exposed me to a different side of health care that I had previously seen. Service and organization were not assets of the county and yet its role in the public health "ecosystem" was and is critical. Its job of immunizing thousands and interacting with all members of the community is often forgotten, but is important for keeping an entire community healthy.

My work at the county health clinic as well as my knowledge of some areas of public health led me to accept an internship in Washington D.C. this past summer. The internship provided me with a greater understanding of a federal public health agency’s operations and allowed me to contribute in a variety of ways to the XYZ Department in which I worked. Most importantly I worked on "policy issues" which involved identifying and summarizing problems that were out of the ordinary as well as documenting resolved issues in order to establish protocols to increase the department’s efficiency. In addition I served on a scientific review panel which was responsible for editing a seventy-page proposed regulation before its submission.

Along with my duties at XYZ, I attended seminars and met with public health leaders at different functions and events. All these activities confirmed my growing interest in preventive medicine, outcomes and effectiveness, and quality of care, particularly within the private/managed care sector. These are my strongest interests because I believe they are fundamental to our nation’s health. We must achieve efficiency and access without sacrificing quality.

The University of ____ would help me achieve my goals of furthering my public health education through the specialized coursework offered as part of its health administration program. [The client provides specifics here about the program’s specific appeal and strengths]

Since rejecting physical therapy as a career possibility my interest in public health has only grown. I welcome the challenge of serving a large community and participating in such a dynamic and challenging field. What if an aspirin a day could prevent heart attacks? What if abandoning unnecessary procedures saved thousands of dollars, which then allowed a hospital to treat other patients needing care? What if every person was guaranteed care and that care was good? I would like to find answers for these questions during my career as a public health graduate student and professional.

Other Sample Essays

• Open access
• Published: 01 June 2024

Biomarkers for personalised prevention of chronic diseases: a common protocol for three rapid scoping reviews

• E Plans-Beriso   ORCID: orcid.org/0000-0002-9388-8744 1 , 2   na1 ,
• C Babb-de-Villiers 3   na1 ,
• D Petrova 2 , 4 , 5 ,
• C Barahona-López 1 , 2 ,
• P Diez-Echave 1 , 2 ,
• O R Hernández 1 , 2 ,
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• H Turner 3 ,
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• E García-Esquinas 1 , 2 ,
• V Jiménez-Planet 7 ,
• V Moreno 2 , 8 , 9 ,
• F Rodríguez-Artalejo 2 , 10 , 11 ,
• M J Sánchez 2 , 4 , 5 ,
• M Pollan-Santamaria 1 , 2 ,
• L Blackburn 3 ,
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Systematic Reviews volume  13 , Article number:  147 ( 2024 ) Cite this article

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Introduction

Personalised prevention aims to delay or avoid disease occurrence, progression, and recurrence of disease through the adoption of targeted interventions that consider the individual biological, including genetic data, environmental and behavioural characteristics, as well as the socio-cultural context. This protocol summarises the main features of a rapid scoping review to show the research landscape on biomarkers or a combination of biomarkers that may help to better identify subgroups of individuals with different risks of developing specific diseases in which specific preventive strategies could have an impact on clinical outcomes.

This review is part of the “Personalised Prevention Roadmap for the future HEalThcare” (PROPHET) project, which seeks to highlight the gaps in current personalised preventive approaches, in order to develop a Strategic Research and Innovation Agenda for the European Union.

To systematically map and review the evidence of biomarkers that are available or under development in cancer, cardiovascular and neurodegenerative diseases that are or can be used for personalised prevention in the general population, in clinical or public health settings.

Three rapid scoping reviews are being conducted in parallel (February–June 2023), based on a common framework with some adjustments to suit each specific condition (cancer, cardiovascular or neurodegenerative diseases). Medline and Embase will be searched to identify publications between 2020 and 2023. To shorten the time frames, 10% of the papers will undergo screening by two reviewers and only English-language papers will be considered. The following information will be extracted by two reviewers from all the publications selected for inclusion: source type, citation details, country, inclusion/exclusion criteria (population, concept, context, type of evidence source), study methods, and key findings relevant to the review question/s. The selection criteria and the extraction sheet will be pre-tested. Relevant biomarkers for risk prediction and stratification will be recorded. Results will be presented graphically using an evidence map.

Inclusion criteria

Population: general adult populations or adults from specific pre-defined high-risk subgroups; concept: all studies focusing on molecular, cellular, physiological, or imaging biomarkers used for individualised primary or secondary prevention of the diseases of interest; context: clinical or public health settings.

Systematic review registration

https://doi.org/10.17605/OSF.IO/7JRWD (OSF registration DOI).

Peer Review reports

In recent years, innovative health research has moved quickly towards a new paradigm. The ability to analyse and process previously unseen sources and amounts of data, e.g. environmental, clinical, socio-demographic, epidemiological, and ‘omics-derived, has created opportunities in the understanding and prevention of chronic diseases, and in the development of targeted therapies that can cure them. This paradigm has come to be known as “personalised medicine”. According to the European Council Conclusion on personalised medicine for patients (2015/C 421/03), this term defines a medical model which involves characterisation of individuals’ genotypes, phenotypes and lifestyle and environmental exposures (e.g. molecular profiling, medical imaging, lifestyle and environmental data) for tailoring the right therapeutic strategy for the right person at the right time, and/or to determine the predisposition to disease and/or to deliver timely and targeted prevention [ 1 , 2 ]. In many cases, these personalised health strategies have been based on advances in fields such as molecular biology, genetic engineering, bioinformatics, diagnostic imaging and new’omics technologies, which have made it possible to identify biomarkers that have been used to design and adapt therapies to specific patients or groups of patients [ 2 ]. A biomarker is defined as a substance, structure, characteristic, or process that can be objectively quantified as an indicator of typical biological functions, disease processes, or biological reactions to exposure [ 3 , 4 ].

Adopting a public health perspective within this framework, one of the most relevant areas that would benefit from these new opportunities is the personalisation of disease prevention. Personalised prevention aims to delay or avoid the occurrence, progression and recurrence of disease by adopting targeted interventions that take into account biological information, environmental and behavioural characteristics, and the socio-economic and cultural context of individuals. These interventions should be timely, effective and equitable in order to maintain the best possible balance in lifetime health trajectory [ 5 ].

Among the main diseases that merit specific attention are chronic noncommunicable diseases, due to their incidence, their mortality or disability-adjusted life years [ 6 , 7 , 8 , 9 ]. Within the European Union (EU), in 2021, one-third of adults reported suffering from a chronic condition [ 10 ]. In addition, in 2019, the leading causes of mortality were cardiovascular disease (CVD) (35%), cancer (26%), respiratory disease (8%), and Alzheimer's disease (5%) [ 11 ]. For all of the above, in 2019, the PRECeDI consortium recommended the identification of biomarkers that could be used for the prevention of chronic diseases to integrate personalised medicine in the field of chronicity. This will support the goal of stratifying populations by indicating an individuals’ risk or resistance to disease and their potential response to drugs, guiding primary, secondary and tertiary preventive interventions [ 12 ]; understanding primary prevention as measures taken to prevent the occurrence of a disease before it occurs, secondary prevention as actions aimed at early detection, and tertiary prevention as interventions to prevent complications and improve quality of life in individuals already affected by a disease [ 4 ].

The “Personalised Prevention roadmap for the future HEalThcare” (PROPHET) project, funded by the European Union’s Horizon Europe research and innovation program and linked to ICPerMed, seeks to assess the effectiveness, clinical utility, and existing gaps in current personalised preventive approaches, as well as their potential to be implemented in healthcare settings. It also aims to develop a Strategy Research and Innovation Agenda (SRIA) for the European Union. This protocol corresponds to one of the first steps in the PROPHET, namely a review that aims to map the evidence and highlight the evidence gaps in research or the use of biomarkers in personalised prevention in the general adult population, as well as their integration with digital technologies, including wearable devices, accelerometers, and other appliances utilised for measuring physical and physiological functions. These biomarkers may be already available or currently under development in the fields of cancer, CVD, and neurodegenerative diseases.

There is already a significant body of knowledge about primary and secondary prevention strategies for these diseases. For example, hypercholesterolemia or dyslipidaemia, hypertension, smoking, diabetes mellitus and obesity or levels of physical activity are known risk factors for CVD [ 6 , 13 ] and neurodegenerative diseases [ 14 , 15 , 16 ]; for cancer, a summary of lifestyle preventive actions with good evidence is included in the European code against cancer [ 17 ]. The question is whether there is any biomarker or combination of biomarkers that can help to better identify subgroups of individuals with different risks of developing a particular disease, in which specific preventive strategies could have an impact on clinical outcomes. Our aim in this context is to show the available research in this field.

Given the context and time constraints, the rapid scoping review design is the most appropriate method for providing landscape knowledge [ 18 ] and provide summary maps, such as Campbell evidence and gap map [ 19 ]. Here, we present the protocol that will be used to elaborate three rapid scoping reviews and evidence maps of research on biomarkers investigated in relation to primary or secondary prevention of cancer, cardiovascular and neurodegenerative diseases, respectively. The results of these three rapid scoping reviews will contribute to inform the development of the PROPHET SRIA, which will guide the future policy for research in this field in the EU.

Review question

What biomarkers are being investigated in the context of personalised primary and secondary prevention of cancer, CVD and neurodegenerative diseases in the general adult population in clinical or public health settings?

Three rapid scoping reviews are being conducted between February and June 2023, in parallel, one for each disease group included (cancer, CVD and neurodegenerative diseases), using a common framework and specifying the adaptations to each disease group in search terms, data extraction and representation of results.

This research protocol, designed according to Joanna Briggs Institute (JBI) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist [ 20 , 21 , 22 ] was uploaded to the Open Science Framework for public consultation [ 23 ], with registration DOI https://doi.org/ https://doi.org/10.17605/OSF.IO/7JRWD . The protocol was also reviewed by experts in the field, after which modifications were incorporated.

Eligibility criteria

Following the PCC (population, concept and context) model [ 21 , 22 ], the included studies will meet the following eligibility criteria (Table  1 ):

Rationale for performing a rapid scoping review

As explained above, these scoping reviews are intended to be one of the first materials produced in the PROPHET project, so that they can inform the first draft of the SRIA. Therefore, according to the planned timetable, the reviews should be completed in only 4 months. Thus, following recommendations from the Cochrane Rapid Review Methods Group [ 24 ] and taking into account the large number of records expected to be assessed, according to the preliminary searches, and in order to meet these deadlines, specific restrictions were defined for the search—limited to a 3-year period (2020–2023), in English only, and using only MEDLINE and EMBASE as possible sources—and it was decided that the title-abstract and full-text screening phase would be carried out by a single reviewer, after an initial training phase with 10% of the records assessed by two reviewers to ensure concordance between team members. This percentage could be increased if necessary.

Rationale for population selection

These rapid scoping reviews are focused on the general adult population. In addition, they give attention to studies conducted among populations that present specific risk factors relevant to the selected diseases or that include these factors among those considered in the study.

For cancer, these risk (or preventive) factors include smoking [ 25 ], obesity [ 26 ], diabetes [ 27 , 28 , 29 ], Helicobacter pylori infection/colonisation [ 30 ], human papillomavirus (HPV) infection [ 30 ], human immunodeficiency virus (HIV) infection [ 30 ], alcohol consumption [ 31 ], liver cirrhosis and viral (HVB, HVC, HVD) hepatitis [ 32 ].

For CVD, we include hypercholesterolemia or dyslipidaemia, arterial hypertension, smoking, diabetes mellitus, chronic kidney disease, hyperglycaemia and obesity [ 6 , 13 ].

Risk groups for neurodegenerative diseases were defined based on the following risk factors: obesity [ 15 , 33 ], arterial hypertension [ 15 , 33 , 34 , 35 ], diabetes mellitus [ 15 , 33 , 34 , 35 ], dyslipidaemia [ 33 ], alcohol consumption [ 36 , 37 ] and smoking [ 15 , 16 , 33 , 34 ].

After the general search, only relevant and/or disease-specific subpopulations will be used for each specific disease. On the other hand, pregnancy is an exclusion criterion, as the very specific characteristics of this population group would require a specific review.

Rationale for disease selection

The search is limited to diseases with high morbidity and mortality within each of the three disease groups:

Cancer type

Due to time constraints, we only evaluate those malignant neoplasms with the greatest mortality and incidence rates in Europe, which according to the European Cancer Information System [ 38 ] are breast, prostate, colorectum, lung, bladder, pancreas, liver, stomach, kidney, and corpus uteri. Additionally, cervix uteri and liver cancers will also be included due to their preventable nature and/or the existence of public health screening programs [ 30 , 31 ].

We evaluate the following main causes of deaths: ischemic heart disease (49.2% of all CVD deaths), stroke (35.2%) (this includes ischemic stroke, intracerebral haemorrhage and subarachnoid haemorrhage), hypertensive heart disease (6.2%), cardiomyopathy and myocarditis (1.8%), atrial fibrillation and flutter (1.7%), rheumatic heart disease (1.6%), non-rheumatic valvular heart disease (0.9%), aortic aneurism (0.9%), peripheral artery disease (0.4%) and endocarditis (0.4%) [ 6 ].

In this scoping review, specifically in the context of CVD, rheumatic heart disease and endocarditis are not considered because of their infectious aetiology. Arterial hypertension is a risk factor for many cardiovascular diseases and for the purposes of this review is considered as an intermediary disease that leads to CVD.

• Neurodegenerative diseases

The leading noncommunicable neurodegenerative causes of death are Alzheimer’s disease or dementia (20%), Parkinson’s disease (2.5%), motor neuron diseases (0.4%) and multiple sclerosis (0.2%) [ 8 ]. Alzheimer’s disease, vascular dementia, frontotemporal dementia and Lewy body disease will be specifically searched, following the pattern of European dementia prevalence studies [ 39 ]. Additionally, because amyotrophic lateral sclerosis is the most common motor neuron disease, it is also included in the search [ 8 , 40 , 41 ].

Rationale for context

Public health and clinical settings from any geographical location are being considered. The searches will only consider the period between January 2020 and mid-February 2023 due to time constraints.

Rationale for type of evidence

Qualitative studies are not considered since they cannot answer the research question. Editorials and opinion pieces, protocols, and conference abstracts will also be excluded. Clinical practice guidelines are not included since the information they contain should be in the original studies and in reviews on which they are based.

Pilot study

We did a pilot study to test and refine the search strategies, selection criteria and data extraction sheet as well as to get used to the software—Covidence [ 42 ]. The pilot study consisted of selecting from the results of the preliminary search matrix 100 papers in order of best fit to the topic, and 100 papers at random. The team comprised 15 individual reviewers (both in the pilot and final reviews) who met daily to revise, enhance, and reach consensus on the search matrices, criteria, and data extraction sheets.

Regarding the selected databases and the platforms used, we conducted various tests, including PubMed/MEDLINE and Ovid/MEDLINE, as well as Ovid/Embase and Elsevier/Embase. Ultimately, we chose Ovid as the platform for accessing both MEDLINE and Embase, utilizing thesaurus Mesh and EmTrees. We manually translated these thesauri to ensure consistency between them. Given that the review team was spread across the UK and Spain, we centralised the search results within the UK team's access to the Ovid license to ensure consistency. Additionally, using Ovid exclusively for accessing both MEDLINE and Embase streamlined the process and allowed for easier access to preprints, which represent the latest research in this rapidly evolving field.

Identification of research

The searches are being conducted in MEDLINE via Ovid, Embase via Ovid and Embase preprints via Ovid. We also explored the feasibility of searching in CDC-Authored Genomics and Precision Health Publications Databases [ 43 ] . However, the lack of advanced tools to refine the search, as well as the unavailability of bulk downloading prevented the inclusion of this data source. Nevertheless, a search with 15 records for each disease group showed a full overlap with MEDLINE and/or Embase.

Search strategy definition

An initial limited search of MEDLINE via PubMed and Ovid was undertaken to identify relevant papers on the topic. In this step, we identified keytext words in their titles and abstracts, as well as thesaurus terms. The SR-Accelerator, Citationchaser, and Yale Mesh Analyzer tools were used to assist in the construction of the search matrix. With all this information, we developed a full search strategy adapted for each included database and information source, optimised by research librarians.

Study evidence selection

The complete search strategies are shown in Additional file 3. The three searches are being conducted in parallel. When performing the search, no limits to the type of study or setting are being applied.

Following each search, all identified citations will be collated and uploaded into Covidence (Veritas Health Innovation, Melbourne, Australia, available at www.covidence.org ) with the citation details, and duplicates will be removed.

In the title-abstract and full-text screening phase, the first 10% of the papers will be evaluated by two independent reviewers (accounting for 200 or more papers in absolute numbers in the title-abstract phase). Then, a meeting to discuss discrepancies will lead to adjusting inclusion and exclusion criteria and to acquire consistency between reviewers’ decisions. After that, the full screening of the search results will be performed by a single reviewer. Disagreements that arise between reviewers at each stage of the selection process will be resolved through discussion, or with additional reviewers. We maintain an active forum to facilitate permanent contact among reviewers.

The results of the searches and the study inclusion processes will be reported and presented in a flow diagram following the PRISMA-ScR recommendations [ 22 ].

Expert consultation

The protocol has been refined after consultation with experts in each field (cancer, CVD, and neurodegenerative diseases) who gave input on the scope of the reviews regarding the diverse biomarkers, risk factors, outcomes, and types of prevention relevant to their fields of expertise. In addition, the search strategies have been peer-reviewed by a network of librarians (PRESS-forum in pressforum.pbworks.com) who kindly provided useful feedback.

Data extraction

We have developed a draft data extraction sheet, which is included as Additional file 4, based on the JBI recommendations [ 21 ]. Data extraction will include citation details, study design, population type, biomarker information (name, type, subtype, clinical utility, use of AI technology), disease (group, specific disease), prevention (primary or secondary, lifestyle if primary prevention), and subjective reviewer observations. The data extraction for all papers will be performed by two reviewers to ensure consistency in the classification of data.

Data analysis and presentation

The descriptive information about the studies collected in the previous phase will be coded according to predefined categories to allow the elaboration of visual summary maps that can allow readers and researchers to have a quick overview of their main results. As in the previous phases, this process will be carried out with the aid of Covidence.

Therefore, a summary of the extracted data will be presented in tables as well as in static and, especially, through interactive evidence gap maps (EGM) created using EPPI-Mapper [ 44 ], an open-access web application developed in 2018 by the Evidence for Policy and Practice Information and Coordinating Centre (EPPI-Centre) and Digital Solution Foundry, in partnership with the Campbell Collaboration, which has become the standard software for producing visual evidence gap maps.

Tables and static maps will be made by using R Studio, which will also be used to clean and prepare the database for its use in EPPI-Mapper by generating two Excel files: one containing the EGM structure (i.e. what will be the columns and rows of the visual table) and coding sets, and another containing the bibliographic references and their codes that reviewers had added. Finally, we will use a Python script to produce a file in JSON format, making it ready for importation into EPPI-Reviewer.

The maps are matrixes with biomarker categories/subcategories defining the rows and diseases serving as columns. They define cells, which contain small squares, each one representing each paper included in it. We will use a code of colours to reflect the study design. There will be also a second sublevel in the columns, depending on the map. Thus, for each group of diseases, we will produce three interactive EGMs: two for primary prevention and one for secondary prevention. For primary prevention, the first map will stratify the data to show whether any or which lifestyle has been considered in each paper in combination with the studied biomarker. The second map for primary prevention and the map for secondary prevention will include, as a second sublevel, the subpopulations in which the biomarker has been used or evaluated, which are disease-specific (i.e. cirrhosis for hepatic cancer) researched. The maps will also include filters that allow users to select records based on additional features, such as the use of artificial intelligence in the content of the papers. Furthermore, the EGM, which will be freely available online, will enable users to view and export selected bibliographic references and their abstracts. An example of these interactive maps with dummy data is provided in Additional file 5.

Finally, we will elaborate on two scientific reports for PROPHET. The main report, which will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) recommendations, will summarise the results of the three scoping reviews, will provide a general and global interpretation of the results and will comment on their implication for the SRIA, and will discuss the limitations of the process. The second report will present the specific methodology for the dynamic maps.

This protocol summarises the procedure to carry out three parallel rapid scoping reviews to provide an overview of the available research and gaps in the literature on biomarkers for personalised primary and secondary prevention for the three most common chronic disease groups: cancer, CVD and neurodegenerative diseases. The result will be a common report for the three scoping reviews and the online publication of interactive evidence gap maps to facilitate data visualisation.

This work will be complemented, in a further step of the PROPHET project, by a subsequent mapping report on the scientific evidence for the clinical utility of biomarkers. Both reports are part of an overall mapping effort to characterise the current knowledge and environment around personalised preventive medicine. In this context, PROPHET will also map personalised prevention research programs, as well as bottlenecks and challenges in the adoption of personalised preventive approaches or in the involvement of citizens, patients, health professionals and policy-makers in personalised prevention. The overall results will contribute to the development of the SRIA concept paper, which will help define future priorities for personalised prevention research in the European Union.

In regard to this protocol, one of the strengths of this approach is that it can be applied in the three scoping reviews. This will improve the consistency and comparability of the results between them, allowing for better leveraging of efforts; it also will facilitate the coordination among the staff conducting the different reviews and will allow them to discuss them together, providing a more global perspective as needed for the SRIA. In addition, the collaboration of researchers with different backgrounds, the inclusion of librarians in the research team, and the specific software tools used have helped us to guarantee the quality of the work and have shortened the time invested in defining the final version of this protocol. Another strength is that we have conducted a pilot study to test and refine the search strategy, selection criteria and data extraction sheet. In addition, the selection of the platform of access to the bibliographic databases has been decided after a previous evaluation process (Ovid-MEDLINE versus PubMed MEDLINE, Ovid-Embase versus Elsevier-Embase, etc.).

Only 10% of the papers will undergo screening by two reviewers, and if time permits, we will conduct kappa statistics to assess reviewer agreement during the screening phases. Additionally, ongoing communication and the exchange and discussion of uncertainties will ensure a high level of consensus in the review process.

The main limitation of this work is the very broad field it covers: personalised prevention in all chronic diseases; however, we have tried to maintain decisions to limit it to the chronic diseases with the greatest impact on the population and in the last 3 years, making a rapid scoping review due to time constraints following recommendations from the Cochrane Rapid Review Methods Group [ 24 ]; however, as our aim is to identify gaps in the literature in an area of growing interest (personalisation and prevention), we believe that the records retrieved will provide a solid foundation for evaluating available literature. Additionally, systematic reviews, which may encompass studies predating 2020, have the potential to provide valuable insights beyond the temporal constraints of our search.

Thus, this protocol reflects the decisions set by the PROPHET's timetable, without losing the quality and rigour of the work. In addition, the data extraction phase will be done by two reviewers in 100% of the papers to ensure the consistency of the extracted data. Lastly, extending beyond these three scoping reviews, the primary challenge resides in amalgamating their findings with those from numerous other reviews within the project, ultimately producing a cohesive concept paper in the Strategy Research and Innovation Agenda (SRIA) for the European Union, firmly rooted in evidence-based conclusions.

Council of European Union. Council conclusions on personalised medicine for patients (2015/C 421/03). Brussels: European Union; 2015 dic. Report No.: (2015/C 421/03). Disponible en: https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:52015XG1217(01)&from=FR .

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Acknowledgements

We are grateful for the library support received from Teresa Carretero (Instituto de Salud Carlos III, ISCIII) and, from Concepción Campos-Asensio (Hospital Universitario de Getafe, Comité ejecutivo BiblioMadSalud) for the seminar on the Scoping Reviews methodology and for their continuous teachings through their social networks.

Also, we would like to thank Dr. Héctor Bueno (Centro Nacional de Investigaciones Cardiovasculares (CNIC), Hospital Universitario 12 de Octubre) and Dr. Pascual Sánchez (Fundación Centro de Investigación de Enfermedades Neurológicas (CIEN)) for their advice in their fields of expertise.

The PROPHET project has received funding from the European Union’s Horizon Europe research and innovation program under grant agreement no. 101057721. UK participation in Horizon Europe Project PROPHET is supported by UKRI grant number 10040946 (Foundation for Genomics & Population Health).

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Plans-Beriso E and Babb-de-Villiers C contributed equally to this work.

Kroese M and Pérez-Gómez B contributed equally to this work.

Authors and Affiliations

Department of Epidemiology of Chronic Diseases, National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain

E Plans-Beriso, C Barahona-López, P Diez-Echave, O R Hernández, E García-Ovejero, O Craciun, P Fernández-Navarro, N Fernández-Larrea, E García-Esquinas, M Pollan-Santamaria & B Pérez-Gómez

CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain

E Plans-Beriso, D Petrova, C Barahona-López, P Diez-Echave, O R Hernández, N F Fernández-Martínez, P Fernández-Navarro, N Fernández-Larrea, E García-Esquinas, V Moreno, F Rodríguez-Artalejo, M J Sánchez, M Pollan-Santamaria & B Pérez-Gómez

PHG Foundation, University of Cambridge, Cambridge, UK

C Babb-de-Villiers, H Turner, L Blackburn & M Kroese

Instituto de Investigación Biosanitaria Ibs. GRANADA, Granada, Spain

D Petrova, N F Fernández-Martínez & M J Sánchez

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Oncology Data Analytics Program, Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat, Barcelona, 08908, Spain

Colorectal Cancer Group, ONCOBELL Program, Institut de Recerca Biomedica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, 08908, Spain

Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain

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BPG and MK supervised and directed the project. EPB and CBV coordinated and managed the development of the project. CBL, PDE, ORH, CBV and EPB developed the search strategy. All authors reviewed the content, commented on the methods, provided feedback, contributed to drafts and approved the final manuscript.

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Additional file 1: glossary., additional file 2: glossary of biomarkers that may define high risk groups., additional file 3: search strategy., additional file 4: data extraction sheet., additional file 5: example of interactive maps in cancer and primary prevention., rights and permissions.

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Plans-Beriso, E., Babb-de-Villiers, C., Petrova, D. et al. Biomarkers for personalised prevention of chronic diseases: a common protocol for three rapid scoping reviews. Syst Rev 13 , 147 (2024). https://doi.org/10.1186/s13643-024-02554-9

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The power of storytelling in public health

May 31, 2024 — A popular course at Harvard T.H. Chan School of Public Health teaches students to harness the power of storytelling to motivate others to join them in translating public health research into societal change.

Predrag “Pedja” Stojicic , the course instructor and a faculty affiliate at the FXB Center for Health and Human Rights , said such storytelling helps bridge the disconnect between academic work in public health and its implementation in society.

“We help students make their own values explicit in order to create personal and collective agency,” he said. “They learn to build an emotional connection with people to translate public health science into an ability to do things.”

Students are embracing the storytelling challenge. In three years, HPM 562, “Narrative Leadership: Using Storytelling to Mobilize Collective Action in Public Health,” has grown from a small pilot project to a class now capped at 50 students focused on engaging hearts and minds to improve health.

Students learn to craft a public narrative that can inspire collective support for a call to action. First, a student identifies the core values that led them to pursue public health and shares that in story form, known as the story of self . Second, they identify and tell the story of the values of the community they aim to impact, known as the story of us . And finally, they weave these elements together to produce an integrated call-to-action story, known as the story of now .

The public narratives are an eclectic mix. One recent student called on colleagues to adopt a more strategic approach to tackling pressing public health issues. Another student called for more humane nurse-to-patient staffing ratios. A third called for heightened protections for queer-identifying students in public schools. These calls to action help students learn a narrative framework that can be used throughout their public health careers.

Opening yourself to big questions

Years ago, Stojicic took an online course with Harvard Kennedy School professor Marshall Ganz, who popularized narrative leadership as a tool in community organizing and social movements. As a young physician in Belgrade, Stojicic was struggling against corruption in health care. He learned to ask his fellow organizers to articulate the values behind their work against corruption, always leaving them with: “Can you tell us that through story?”

“The moment we started applying public narrative in our anti-corruption campaigns in Serbia, it was magical. We learned to lead and to inspire collective action through the power of story,” he said.

Now his students are learning to harness the same powerful tools.

Hailey Hernandez, MPH ’23, said her time as a student and teaching fellow in HPM 562 enabled her to clearly identify why she cares so much about the health of marginalized communities, leading her to call on her classmates and colleagues to tackle problems in public health in targeted ways. Hernandez was the student speaker at Harvard Chan School’s 2023 Convocation.

“The course is a transformative experience because it gives you the time and space to reset. Many of us knew even as kids what we wanted to do and why we wanted to do it,” she said. “The course is about unlocking this natural storytelling ability in people. You look at yourself, and then you look at the world around you and what you’re doing, and you connect the dots.”

Stojicic said students learn to identify the authentic values that motivate the work they do in public health. “It’s about opening yourself to big questions: What is the reason why I care about these things?” Stojicic said.

Connecting heart and mind

Kiran Zindani, MPH ’24, took the class last fall. After serving as a nurse through the COVID-19 pandemic, she enrolled at Harvard Chan School to transition to the business side of health care and make an impact on a broader scale.

In the course, Zindani explored her background as a Pakistani and an American and the difficulties involved in choosing nursing rather than medicine in a culture where the latter is more highly valued. She explored the idea of holding multiple identities and multiple values at the same time, producing a final public narrative that brought people into the fast-paced nature of nursing and the life and death situations she dealt with during COVID-19, while also calling for mandated nurse-to-patient staffing ratios in hospitals.

“I really did leave it all on the table,” said Zindani. “The power of the course for me was that I stopped trying to mold what I write into this idea of what I thought people expected of me—whether it was my family, my community, my school, my jobs. Moving forward as a leader leaving Harvard Chan School, I’m not scared to be myself anymore.”

For Nick Birk, a first-year doctoral student in biostatistics, the structured reflection around what motivates him was extremely helpful. For his story of self, Birk wrote about discovering he was gay while growing up in Texas and the trials involved in navigating his sexuality in a hostile environment. For his story of us , he wrote about the values around equity and inclusion that unite public health students. For his story of now , he called for public high school administrators to create supports for queer-identifying students.

“This course helped me remember why I’m here and what I believe in,” Birk said. “Now I know how to use narrative storytelling to put my academic work in context and communicate it in a way that inspires action. And I learned that to do that well, you have to step back and remember what motivates you.”

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This research explores the experiences of men and women in the King County Drug Diversion Court, a rehabilitative program for drug-related offenses. Participants undergo a five-phase program with the potential for charge dismissal, but concerns about coercion persist. Participants must maintain sobriety, undergo frequent tests, attend support meetings, communicate with case managers, find employment, and fulfill familial duties.

The study investigates how gender influences these obligations’ fulfillment, especially considering the court’s predominantly male population. Through nine semi-structured interviews, I examined participants’ experiences with the criminal justice system, focusing on gender impacts. Findings reveal nuanced gendered experiences, informing justice system reform. By combining qualitative interviews and existing research, this study sheds light on gender dynamics within the court, contributing to policy and practice for a fairer criminal justice system.

Evelyn Erickson (Chemical Engineering), "Tandem dechlorination and hydrogenolysis of waste PVC plastic into value added chemicals "

Plastic waste is a serious problem with detrimental environmental impacts, within this mixed plastics pose a significant challenge in depolymerization. My project focuses on polyvinyl chloride (PVC), a particularly difficult plastic to break down due to the chlorine atom. Chlorine can poison catalysts and release harmful by products like hydrochloric acid or chlorine gas.

I have been working to dechlorinate PVC and then further break down this waste plastic to form value added products. Once dechlorinated PVC becomes a hydrocarbon and can be treated similar to other waste plastics like polyethylene and polypropylene. This tandem dechlorination and depolymerization occur in a single step through a strong amine base and ruthenium catalyst helping to activate the reaction.

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This research stems from concerns about the efficiency of modern diets, which increasingly rely on supplements rather than natural food sources. I analyzed data and reviewed information to compare the effectiveness of phytochemical supplements and whole fruits and vegetables. The study emphasized that while phytochemicals are used in various therapies, their individual effects cannot be compared to the combined benefits of whole foods based on current scientific developments. I have placed the results in a booklet to be printed and disseminated in the future to enable more people to plan their diets wisely and incorporate phytochemicals flexibly into their daily routines.

Hayden Goldberg (Public Health-Global Health, Biochemistry), "An Evaluation of Agricultural Safety and Health in Pesticide Application Technology"

The use of pesticides in the Pacific Northwest is essential in the process of safeguarding public health, most notably by mitigating pests, protecting our food supply, and aiding in produce distribution. However, long-term exposure to pesticides can result in illness for those handling the substances as well as their families. Newer methods, such as aerial drone spraying involve the use of emerging technologies that are poised to change the landscape of the agricultural industry and health outcomes of farmworkers.

This project will be assessing thoughts regarding adoption of these technologies. Through the creation of an electronic survey, I will be obtaining a variety of responses from individuals involved in the application of pesticides on farms. I will then analyze responses both quantitatively and qualitatively. The main objective of my research project is to capture the attitudes of the pesticide application technologies to inform policy, regulations, and decision-making regarding their uses.

Please visit our funding page to learn more about these awards.

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Japan's MUFG, SMFG to more than $8.5 bln of Toyota shares, Bloomberg reports

Mitsubishi UFJ Financial Group and Sumitomo Mitsui Financial Group are considering selling 1.32 trillion yen ($8.5 billion) worth of strategic shareholdings in Toyota Motor , Bloomberg News reported on Friday, citing sources.