Case 16 : Don’t Miss the Bus

Dr. Philip Singe is the Chief Medical Officer of Health in the fictional Region of King in Ontario, Canada. Upon learning that Ottawa Public Health is offering a walking school bus program, Dr. Singe asks Vincent Randall to investigate the evidence. In charge of the health promotion portfolio at King Region Public Health (KRPH), Vincent Randall has been asked to apply the principles of evidence-based public health to identify and appraise the evidence on walking school buses. KRPH may suggest a similar initiative to the King Region School Board during an upcoming meeting. Given the short timeframe of one week, Vincent is likely to begin his search by identifying systematic reviews of the literature that are pertinent to the walking school bus program. The scenario depicted in the case is a common occurrence in public health organizations. In the process of developing new programs, the practices of other organizations and the opinions of leaders in the field can be influential. The case provides students with the opportunity to apply evidence-based practices to program and policy development in order to critically assess program options

Case 9 : Managing Expectations: Lyme Disease

Increasing cases of Lyme disease are creating public outcry. The Public Health Agency of Canada (PHAC) has been tasked with the surveillance and guidance for this tick-borne disease but has not seen additional funding. Evidence-based analysis has indicated the most impactful use of resources would be spent on prevention and awareness. Despite this information, the push for increasing the healthcare budget to allow for more Lyme disease funding is growing. A desire to increase resources for acute care in the hopes of better diagnostic testing, more freely prescribed antibiotics, and dedicated Lyme clinics is being put forward from advocacy groups. As climate change worsens, Lyme incidences rising in the foreseeable future is probable. As the president of PHAC, managing different stakeholders within and outside of the organization while managing expectations is crucial. The ability to engage and inform while maintaining a positive public perception is key, as this will lay the framework for other initiatives to launch in the future. Balancing this delicate situation while maintaining an evidence-based approach will take caution and strategic skills

Case 7 : Population Health Surveillance in Finland: Threats to Historically Dependable Surveillance Methodology

The case outlines the challenges that the National Institute for Health and Welfare in Helsinki, Finland is facing in light of an ongoing national health care reform. The health care reform has taken precedence over other research activities, and the Institute is anticipating changes to population health surveillance methods. The Institute elected a new Director General in the fall of 2018 who will influence decisions about which population surveillance data collection methods are used. The Health Monitoring Unit at the Institute fears that the Director General will decide that all surveillance data will be collected using administrative patient registries with the consequent elimination of population health surveys. The team responsible for the 2017 National FinHealth population health survey must determine how they can advocate for the continued use of survey data in population health surveillance

Case 10 : Babies and Budgets: Balancing Costs and Consequences in Postpartum Screening

Dr. Philip Singe, the Medical Officer of Health at the King Public Health Unit, is in a meeting with Praveen Gill, manager of the Healthy Babies, Healthy Children (HBHC) program, and Vanessa Thomas, the director of the Family Health portfolio. The group is discussing options for delivering postpartum screening services under the provincially funded HBHC program. While program costs have increased steadily, funding from the provincial Ministry responsible for oversight of HBHC has been stagnant. The group must decide whether or not to cut costs by reducing the number of staff responsible for screening. Faced with the challenge of maintaining the effectiveness of screening services, the group weighs each option. Using expert opinion and historical information, the team must forecast costs and consequences to compare options systematically. The case includes worksheets for budgeting and cost-consequence analysis. Instructors can obtain a copy of the answer key from the MPH Program Office

Case 1 : Deciding Value for Money: Improving Prenatal Genetic Screening in Ontario

Since 1993, the Ontario Ministry of Health and Long-Term Care (MOHLTC) has financed prenatal genetic screening through its provincial health insurance plan. In 2013, a new technology became available. Non-invasive prenatal testing (NIPT) promises improved accuracy and screening safety at a higher cost than other screening tests. Since 2013, pregnant women in Ontario have been paying for the test themselves. In March 2014, the Ministry appointed a Prenatal Genetic Screening Group (PGSG), to make recommendations on making NIPT available through the provincial health insurance plan. The Ministry requested an economic evaluation, appraising the value of NIPT

Case 5 : The Precision of Aid: Remembering the Forgotten Disease in the Horn of Africa

The district of Burao, Somaliland is in its 16th epidemiologic week in the midst of a cholera outbreak. The Somaliland Ministry of Health, in need of emergency relief, has requested that humanitarian organizations come to its aid. Eve Tinuviel has been deployed to Burao as a member of the Canadian Red Cross, where she serves as a global health advisor responsible for emergency health services. Eve’s main responsibility is to analyze disease surveillance data, triangulating data from different sources. A Health Cluster Coordination meeting amongst different health and humanitarian organizations reveals gaps in the epidemic response. The scarcity of resources and volunteers, and more importantly the incompleteness and inadequacy of the passive surveillance data, threaten Eve’s ability to trace newly affected individuals, identify the origins of the disease and develop strategies to help the affected communities

Case 11 : United Hearts: Fostering Interdisciplinary Collaboration for the Detection of Critical Heart Defects in Newborns

Newborn Screening Ontario (NSO) prepares to implement screening for critical congenital heart defects (CCHDs) in all newborns born in Ontario. Janet Marcadier, a genetic counsellor at NSO, recognizes the particular challenges of implementing a point-of-care newborn screening test that will be performed by submitters (nurses, midwives) across the province. The other 29 conditions screened for by NSO do not involve a point-of-care test but rather testing is done in the NSO laboratory. While standardization for a provincial program is important, there are many contextual factors that will impact CCHD screening implementation at each specific birth site. Interdisciplinary collaboration among health care providers will be essential in implementation. How could NSO foster interdisciplinary collaboration through implementation planning? NSO needs to consider how primary care teams are often dynamic and include different health care providers depending on the needs of the patient. Would interdisciplinary collaboration help to ensure screening compliance among submitters? By applying concepts of implementation research, context-specific protocols can be developed for interdisciplinary teams at different birth sites in Ontario

Are COVID-19 models blind to the social determinants of health? A systematic review protocol

Introduction Infectious disease models are important tools to inform public health policy decisions. These models are primarily based on an average population approach and often ignore the role of social determinants in predicting the course of a pandemic and the impact of policy interventions. Ignoring social determinants in models may cause or exacerbate inequalities. This limitation has not been previously explored in the context of the current pandemic, where COVID-19 has been found to disproportionately affect marginalised racial, ethnic and socioeconomic groups. Therefore, our primary goal is to identify the extent to which COVID-19 models incorporate the social determinants of health in predicting outcomes of the pandemic. Methods and analysis We will search MEDLINE, EMBASE, Cochrane Library and Web of Science databases from December 2019 to August 2020. We will assess all infectious disease modelling studies for inclusion of social factors that meet the following criteria: (a) focused on human spread of SARS-CoV-2; (b) modelling studies; (c) interventional or non-interventional studies; and (d) focused on one of the following outcomes: COVID-19-related outcomes (eg, cases, deaths), non-COVID-19-related outcomes (ie, impacts of the pandemic or control policies on other health conditions or health services), or impact of the pandemic or control policies on economic outcomes. Data will only be extracted from models incorporating social factors. We will report the percentage of models that considered social factors, indicate which social factors were considered, and describe how social factors were incorporated into the conceptualisation and implementation of the infectious disease models. The extracted data will also be used to create a narrative synthesis of the results. Ethics and dissemination Ethics approval is not required as only secondary data will be collected. The results of this systematic review will be disseminated through peer-reviewed publication and conference proceedings. PROSPERO registration number CRD42020207706