Publications

2016
Hoffman, S.J., 2016. Why we need to boost public health spending. The Toronto Star. Article
Tam, V., Edge, J.S. & Hoffman, S.J., 2016. Empirically evaluating the WHO global code of practice on the international recruitment of health personnel’s impact on four high-income countries four years after adoption. Globalization and Health , 12 (62) , pp. 1-12. PDFAbstract

 

Background

Shortages of health workers in low-income countries are exacerbated by the international migration of health workers to more affluent countries. This problem is compounded by the active recruitment of health workers by destination countries, particularly Australia, Canada, UK and USA. The World Health Organization (WHO) adopted a voluntary Code of Practice in May 2010 to mitigate tensions between health workers’ right to migrate and the shortage of health workers in source countries. The first empirical impact evaluation of this Code was conducted 11-months after its adoption and demonstrated a lack of impact on health workforce recruitment policy and practice in the short-term. This second empirical impact evaluation was conducted 4-years post-adoption using the same methodology to determine whether there have been any changes in the perceived utility, applicability, and implementation of the Code in the medium-term.

Methods

Forty-four respondents representing government, civil society and the private sector from Australia, Canada, UK and USA completed an email-based survey evaluating their awareness of the Code, perceived impact, changes to policy or recruitment practices resulting from the Code, and the effectiveness of non-binding Codes generally. The same survey instrument from the original study was used to facilitate direct comparability of responses. Key lessons were identified through thematic analysis.

Results

The main findings between the initial impact evaluation and the current one are unchanged. Both sets of key informants reported no significant policy or regulatory changes to health worker recruitment in their countries as a direct result of the Code due to its lack of incentives, institutional mechanisms and interest mobilizers. Participants emphasized the existence of previous bilateral and regional Codes, the WHO Code’s non-binding nature, and the primacy of competing domestic healthcare priorities in explaining this perceived lack of impact.

Conclusions

The Code has probably still not produced the tangible improvements in health worker flows it aspired to achieve. Several actions, including a focus on developing bilateral codes, linking the Code to topical global priorities, and reframing the Code’s purpose to emphasize health system sustainability, are proposed to improve the Code’s uptake and impact.

Keywords

Health worker recruitment Migration Health systems sustainability Impact evaluation World Health Organization

 

Fafard, P. & Forest, P.-G., 2016. The loss of that which never was: Evaluating changes to the senior management of the Public Health Agency of Canada. Canadian Public Administration , 59 (3) , pp. 448-466. ArticleAbstract

In the fall of 2014, the Government of Canada formally split the role of the Chief Public Health Officer (CPHO) into two positions: the CPHO and the President of the Public Health Agency of Canada. Despite concerns raised by the public health community, these changes are consistent with the CPHO's authority. However, the nature of responsible government means that the CPHO cannot simultaneously serve as an independent advocate for policies and programs that might prevent disease and as a senior advisor to the government of the day.

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À l'automne 2014, le gouvernement du Canada a annoncé le dédoublement officiel du rôle de l'Administrateur en chef de la santé publique (ACSP) en deux postes : l'ACSP et le président de l'Agence de la santé publique du Canada. Malgré les inquiétudes exprimées dans les milieux de la santé publique, ces changements sont compatibles avec le mandat original de l'ACSP. La nature d'un gouvernement responsable suppose que l'ACSP ne peut à la fois s'instituer en champion indépendant de politiques ou de programmes favorables à la santé et conserver son rôle de conseiller principal du gouvernement du jour.

Hoffman, S.J. & Flood, C., 2016. Forging a new deal for doctors requires a new approach. The Toronto Star. Article
Mendelson, M., et al., 2016. A global antimicrobial fund for low-and middle-income countries. International Journal of Infectious Diseases , 51 , pp. 70-72. PDF
Suryavanshi, T. & Hoffman, S.J., 2016. Pokémon Go shows better way to promote healthy behaviours. Vancouver Sun. Article
Lab, G.S., 2016. Concept Note - Optimizing the Institutional Design of Scientific Advisory Committees for Quality, Salience, and Legitimacy. panels_-_concept_note.pdf
Ottersen, T., Hoffman, S.J. & Groux, G., 2016. Ebola again shows the international health regulations are broken: What can be done differently to prepare for the next epidemic?. American Journal of Law and Medicine , 42 (2-3) , pp. 356-392. PDFAbstract

Epidemics are among the greatest threats to humanity, and the International Health Regulations are the world's key legal instrument for addressing this threat. Since their revision in 2005, the IHR have faced two big tests: the 2009 H1N1 influenza pandemic and the 2014 Ebola epidemic in West Africa. Both exposed major shortcomings of the IHR, and both offered profound lessons for the future.

The objective of this Article is twofold. First, we seek to compare the lessons learned from H1N1 and Ebola for reforming the IHR in order to test the hypothesis that they are similar. Second, we seek to examine the barriers to implementing these lessons and to identify strategies for overcoming those barriers.

We find that the lessons from H1N1 and Ebola are indeed similar, and that opportunities to act on lessons from H1N1 were woefully missed. We identify many political barriers to global collective action and implementation of lessons for the IHR. On that basis, we describe strategies to overcome these barriers, which will hopefully be deployed now to reform the IHR before the policy window following Ebola closes, and before the inevitable next epidemic comes. The emerging threat of the Zika virus underscores that we have no time to waste.

aljm_ebola_shows_international_health_regulations_broken_2016.pdf
Laxminarayan, R., et al., 2016. UN High-Level Meeting on antimicrobials—what do we need?. The Lancet , 388 , pp. 218-220. PDF
Hoffman, S.J., et al., 2016. Clinicians’ knowledge and practices regarding family planning and intrauterine devices in China, Kazakhstan, Laos and Mexico. Reproductive Health , 13 (7) , pp. 1-12. ArticleAbstract

Background

It is widely agreed that the practices of clinicians should be based on the best available research evidence, but too often this evidence is not reliably disseminated to people who can make use of it. This “know-do” gap leads to ineffective resource use and suboptimal provision of services, which is especially problematic in low- and middle-income countries (LMICs) which face greater resource limitations. Family planning, including intrauterine device (IUD) use, represents an important area to evaluate clinicians’ knowledge and practices in order to make improvements.

Methods

A questionnaire was developed, tested and administered to 438 individuals in China (n = 115), Kazakhstan (n = 110), Laos (n = 105), and Mexico (n = 108). The participants responded to ten questions assessing knowledge and practices relating to contraception and IUDs, and a series of questions used to determine their individual characteristics and working context. Ordinal logistic regressions were conducted with knowledge and practices as dependent variables.

Results

Overall, a 96 % response rate was achieved (n = 438/458). Only 2.8 % of respondents were able to correctly answer all five knowledge-testing questions, and only 0.9 % self-reported “often” undertaking all four recommended clinical practices and “never” performing the one practice that was contrary to recommendation. Statistically significant factors associated with knowledge scores included: 1) having a masters or doctorate degree; and 2) often reading scientific journals from high-income countries. Significant factors associated with recommended practices included: 1) training in critically appraising systematic reviews; 2) training in the care of patients with IUDs; 3) believing that research performed in their own country is above average or excellent in quality; 4) being based in a facility operated by an NGO; and 5) having the view that higher quality available research is important to improving their work.

Conclusions

This analysis supports previous work emphasizing the need for improved knowledge and practices among clinicians concerning the use of IUDs for family planning. It also identifies areas in which targeted interventions may prove effective. Assessing opportunities for increasing education and training programs for clinicians in research and IUD provision could prove to be particularly effective.

Keywords: Family planning, Intrauterine device, Global health, Knowledge translation, Health professionals, Medical education, Systematic reviews, Health systems, Health human resources
Hoffman, S.J. & Justicz, V., 2016. Automatically quantifying the scientific quality and sensationalism of news records mentioning pandemics: validating a maximum entropy machine-learning model. Journal of Clinical Epidemiology , 75 , pp. 47-55. PDFAbstract

Objective

To develop and validate a method for automatically quantifying the scientific quality and sensationalism of individual news records.

Study design

After retrieving 163,433 news records mentioning the Severe Acute Respiratory Syndrome (SARS) and H1N1 pandemics, a maximum entropy model for inductive machine learning was used to identify relationships among 500 randomly sampled news records that correlated with systematic human assessments of their scientific quality and sensationalism. These relationships were then computationally applied to automatically classify 10,000 additional randomly sampled news records. The model was validated by randomly sampling 200 records and comparing human assessments of them to the computer assessments.

Results

The computer model correctly assessed the relevance of 86% of news records, the quality of 65% of records, and the sensationalism of 73% of records, as compared to human assessments. Overall, the scientific quality of SARS and H1N1 news media coverage had potentially important shortcomings, but coverage was not too sensationalizing. Coverage slightly improved between the two pandemics.

Conclusion

Automated methods can evaluate news records faster, cheaper, and possibly better than humans. The specific procedure implemented in this study can at the very least identify subsets of news records that are far more likely to have particular scientific and discursive qualities.

Keywords

  • Health communication
  • Mass media
  • News
  • Pandemics
  • Machine learning
  • Validation studies
Hoffman, S.J. & Habibi, R., 2016. International legal barriers to Canada’s marijuana plans. Canadian Medical Association Journal , 188 (8) , pp. 1-2. Article
Hoffman, S.J., et al., 2016. Surveying the knowledge and practices of health professionals in China, India, Iran, and Mexico on treating tuberculosis. American Journal of Tropical Medicine & Hygiene , 94 (5) , pp. 959-970. ArticleAbstract

Research evidence continues to reveal findings important for health professionals' clinical practices, yet it is not consistently disseminated to those who can use it. The resulting deficits in knowledge and service provision may be especially pronounced in low- and middle-income countries that have greater resource constraints. Tuberculosis treatment is an important area for assessing professionals' knowledge and practices because of the effectiveness of existing treatments and recognized gaps in professionals' knowledge about treatment. This study surveyed 384 health professionals in China, India, Iran, and Mexico on their knowledge and practices related to tuberculosis treatment. Few respondents correctly answered all five knowledge questions (12%) or self-reported performing all five recommended clinical practices “often or very often” (3%). Factors associated with higher knowledge scores included clinical specialization and working with researchers. Factors associated with better practices included training in the care of tuberculosis patients, being based in a hospital, trusting reviews of randomized controlled double-blind trials, and reading summaries of articles, reports, and reviews. This study highlights several strategies that may prove effective in improving health professionals' knowledge and practices related to tuberculosis treatment. Facilitating interactions with researchers and training in acquiring systematic reviews may be especially helpful.

Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the decisions, policies, or views of the World Health Organization.

Danik, M.E., et al., 2016. Assessing the political feasibility of an international agreement on antimicrobial resistance S. J. Hoffman & L. Sritharan, ed., Ottawa: Global Strategy Lab. PDFAbstract

This report was commissioned by the Norwegian Institute of Public Health and focused on the political feasibility of an international agreement on antimicrobial resistance.  The major finding was that a comprehensive response to AMR would commit all countries to act simultaneously on access, conservation and innovation. However, such an agreement is not immediately politically feasible without additional incentives and supports; instead a core groups of specialized countries could act to create the basis of an agreement before inviting other countries to join.

Hoffman, S.J., et al., 2016. International law’s effects on health and its social determinants: protocol for a systematic review, meta-analysis, and meta-regression analysis. Systematic Reviews , 5 (64) , pp. 1-9. PDFAbstract
Background: In recent years, there have been numerous calls for global institutions to develop and enforce new international laws. International laws are, however, often blunt instruments with many uncertain benefits, costs, risks of harm, and trade-offs. Thus, they are probably not always appropriate solutions to global health challenges. Given these uncertainties and international law’s potential importance for improving global health, the paucity of synthesized evidence addressing whether international laws achieve their intended effects or whether they are superior in comparison to other approaches is problematic.

Methods: Ten electronic bibliographic databases were searched using predefined search strategies, including MEDLINE, Global Health, CINAHL, Applied Social Sciences Index and Abstracts, Dissertations and Theses, International Bibliography of Social Sciences, International Political Science Abstracts, Social Sciences Abstracts, Social Sciences Citation Index, PAIS International, and Worldwide Political Science Abstracts. Two reviewers will independently screen titles and abstracts using predefined inclusion criteria. Pairs of reviewers will then independently screen the full-text of articles for inclusion using predefined inclusion criteria and then independently extract data and assess risk of bias for included studies. Where feasible, results will be pooled through subgroup analyses, meta-analyses, and meta-regression techniques.

Discussion: The findings of this review will contribute to a better understanding of the expected benefits and possible harms of using international law to address different kinds of problems, thereby providing important evidence-informed guidance on when and how it can be effectively introduced and implemented by countries and global institutions.

Systematic review registration: PROSPERO CRD42015019830

Keywords: International cooperation Global health Social determinants of health Public policy Jurisprudence Treaties

Dutchak, M., et al., 2016. Learning from Ebola to improve humanitarian organizations’ legal preparedness for future epidemics. S. J. Hoffman & L. Sritharan, ed., Ottawa: Global Strategy Lab. PDFAbstract

This report provides options for navigating five key issues faced by humanitarian organizations when responding to an epidemic: training, communication of risk, insurance, medical evacuation and reintegration. Options focus on practices that a humanitarian organization ought to adopt when interacting with its employees, since employees are owed a legal duty of care that, when ignored, makes an organization vulnerable to legal action. The options were identified by studying the successes and shortcomings of the Ebola response, and are meant to equip humanitarian organizations with the tools necessary to respond to future epidemics in a way that is efficient and that mitigates their liability.

Copija, W., et al., 2016. Opportunities for Canada to Improve Global Access to Medicines S. J. Hoffman & L. Sritharan, ed., Ottawa: Global Strategy Lab. PDFAbstract

This report explores a number of drug development and delivery models for the Canadian government to consider implementing as it looks to improve access to essential medicines both domestically and internationally.The Office ofInternational Affairs for the Health Portfolio (OIA-HP) commissioned the research of four market-level case studies, which focus on innovative financing and collaborative initiatives, and one patient-level case study, which considers international legislation as a model to improve Canada’s purchasing power. The Innovative Medicines Initiative (IMI), the International Finance Facility for Immunization (IFFIm), Open Source Drug Discovery (OSDD), Drugs for Neglected Diseases Initiative (DNDi), and Australia’s Pharmaceutical Benefits Scheme (PBS) were specifically selected based on their relevance to Canada’s strong pharmaceutical industry, commitment to R&D and global aid, and domestic health needs.

Hoffman, S.J., et al., 2016. The UN Convention on the Rights of Persons with Disabilities and its Impact on Mental Health Law and Policy in Canada, Toronto: Lexis Nexis. BookAbstract

Mental health issues pose critical challenges for Canada's systems of justice and health care. Problems with mental health are common, but often neglected due to stigma and the vulnerability of those living with these conditions. This is evident within our legal system. Every day in our courts we see played out the struggle to protect the human rights and dignity of individual Canadians with mental health challenges, to access adequate mental health care and social support, and to provide genuinely helpful responses to criminal behaviour associated with mental health problems. Law and Mind: Mental Health Law and Policy in Canada provides a comprehensive analysis of the most important cases and key debates at the intersection of mental health law and policy.

Written by a group of Canada's leading experts on mental health law, this volume provides practitioners, researchers and policy-makers with valuable insight into this challenging and important area of the law.

Features and benefits
Law and Mind: Mental Health Law and Policy in Canada is an important resource for understanding the complexities of mental health law and related policy issues in Canada.

Law students, practising lawyers and policy-makers alike will benefit from the broad range of topics covered in this comprehensive text. Topics addressed include the law surrounding the funding and administration of mental health care in Canada, the principles of mental health law related to hospitalization and consent to treatment, the components of the criminal law of mental disorder, and mental health issues in the policing and correctional contexts. In addition, the authors offer focused treatment of mental health law issues facing specific populations, including children, the elderly, refugees and ethnic minorities.

This text is written by leading mental health law experts who bring years of practice, research and expertise to provide readers with a comprehensive resource which:

  • Presents the legal issues related to mental health in a comprehensive manner
  • Enables students and lawyers to learn this challenging subject matter quickly and effectively
  • Analyzes recent changes and developments in the law
  • Provides current information so lawyers can properly advise their clients
  • Discusses pressing and emerging mental health issues that are relevant to practitioners and their clients

Essential reading
This new release will be particularly useful for:

  • Health lawyers advising clients and in-house lawyers at health service providers as it is an up-to-date resource on mental health law and policy
  • Students looking for a comprehensive resource on mental health law written by leading academics
  • Government health workers and policymakers who need to consult a reliable reference volume
  • Law libraries that want to stock essential guides for lawyers and students
Gulati, N., et al., 2016. Using International Instruments to Address Antimicrobial Resistance S. J. Hoffman & L. Sritharan, ed., Ottawa: Global Strategy Lab. PDFAbstract

Antimicrobial resistance (AMR) is a global health concern that poses a serious threat to the control of infectious disease. A continuous increase in rates of AMR poses a challenge to the global community and impedes progress previously made in improving health outcomes. This report examines how AMR can be addressed using international instruments, and the appropriate role of the World Health Organization (WHO) in this task. It is recommended that global collective action on AMR be achieved by implementing a Treaty under Article 19 and a Regulation under Article 21 of the WHO’s Constitution. This suite of international instruments can be used to address the greatest proportion of issues that currently impede AMR’s resolution and can mobilize the most effective action. This report further establishes that the WHO has legal authority under its Constitution to create these international instruments to address AMR.

Fafard, P. & Hoffman, S.J., 2016. Health ministers must spend smarter and negotiate wiser. The Hill Times. Article

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