8.Q. Workshop: WHO’s activities to strengthen the evidence of public health and social measures

Abstract   Public health and social measures (PHSM) are key to reducing the spread of infectious diseases like COVID-19, especially in the early stages of an outbreak. PHSM include non-pharmaceutical actions that individuals, communities, and governments take to reduce person-to-person contact and/or make them safer. PHSM reduce the pressure on the health care system to allow for the continuation of essential services and buy time for the development and dissemination of treatments and vaccines. While a combination of PHSM has proven to be effective in reducing transmission during the COVID-19 pandemic, the evidence on the relative effectiveness and broader health, social and economic impact of individual interventions is still scarce. However, PHSM packages such as lockdowns can have severe unintended consequences for individuals and societies including economic hardship, decreased mental health and wellbeing and exacerbated social and health inequity; therefore, precision in PHSM decisions and implementation is needed. This requires a strengthened evidence base as well as tools that support countries in making balanced decisions about PHSM with the best possible cost-benefit ratio. WHO works with multisectoral partners to achieve effective and context- specific PHSM implementation while maximizing the benefits of PHSM and keeping their health, social and economic burden to a minimum and justifiable. In the WHO Regional Office for Europe, PHSM are a key pillar in the COVID-19 response. The office provides, amongst others, a PHSM monitoring dashboard to track the severity of implementation across all 53 Member States as well as a calibration tool and related capacity building to guide countries in their implementation decisions as the pandemic situation evolves. The WHO has further launched a global initiative in 2021 to measure the effectiveness and impact of PHSM and improve precision in future PHSM decisions and policies. The initiative aims at providing robust data and research evidence on PHSM through a global conceptual model and research agenda, a central research monitoring system and harmonized data collection mechanisms during health emergencies. It further seeks to integrate PHSM into emergency preparedness and response assessments and yield a decision-making tool to facilitate evidence-informed and context-specific PHSM implementation. This workshop will provide an overview of WHO's activities in advancing PHSM research and implementation for better decision-making during future emergencies. Three presentations by the WHO Secretariat at the regional and global levels will focus on the strategic approach and the main deliverables of the respective initiatives so far. The presentation by the University of Munich will provide in-depth insights into the conceptual model on PHSM. The workshop will actively solicit feedback from participants on planned activities and results gathered to-date. Key messages • The lack of evidence on PHSM effectiveness and impact hampered an evidence-driven implementation approach during the COVID-19 pandemic. • WHO works to achieve effective and context- specific PHSM implementation to maximize the benefits of PHSM while keeping their health, social and economic burden to a minimum and justifiable.

The concept of wicked problems is recognised since the 1970s, and social determinants of health (SDOH) account for various difficulties. Fixing or solving wicked problems is challenging due to the complexity. The diverse nature of problems can mean that a solution for one group may result in unintended consequences for others. Healthcare itself is a complex adaptive system. An intersectionality lens may assist in navigating 'the messiness,' to reduce inequity and enable voices of those experiencing problems to be involved. COVID-19 amplified difficulties of marginalised populations including 'othering'. Homelessness is a complex global public health challenge, with limited reliable prevalence data and no universally agreed definition. Being homeless is associated with negative impacts on health and wellbeing, and an absence of belonging. Considering solutions requires a problem-solving focus. Design thinking is a human-centric problem-solving approach focusing on empathy, brainstorming ideas, and prototyping iterative solutions. Equity focused design thinking is a framework to develop people-centred solutions and reflect on the influence of own biases and beliefs on systems. Acknowledging the theme of the conference 'Strengthening health systems: improving population health and being prepared for the unexpected' we propose a 60-minute skillsbuilding workshop. We will use a live design sprint format to facilitate collaborative learning for attendees, as an alternative to oral presentations, to explore the intersectionality of design thinking and equity using the Stanford D model. The value of this workshop is knowledge generation and dissemination using an equity lens to adopt creative methods for engagement to produce end-user solutions. Objectives: -To introduce design thinking approaches to consider solutions for homelessness. -To facilitate an experiential approach to support learning and collaboration.
-To explore the application of design thinking using an equity focus as a tool to challenge mindsets and create problemsolving in public health. Format: Working in groups use Stanford D model equity-centred framework (Notice, Empathize, Define, Ideate, Prototype, Test, Reflect). Introduction (10 min) -Homelessness 'a wicked problem' -Design thinking and equity focus explanation and plan for session Phases of Design thinking (30-40 min) -Noticing: awareness of own values, biases, assumptions -Empathizing: Understanding homelessness from the perspective of the user -Defining: The specific user challenge -Ideate: Brainstorm solutions -Prototype and test: Propose and pitch low fidelity solutions Final reflection & summary (10 min) -Insights and learning, networking, and collaboration. Key messages: Equity focused design thinking methods provide approaches to increase awareness of the impact of biases and beliefs. Human-centred design is an agile approach to creating service and systems developments for marginalised populations. Public health and social measures (PHSM) are key to reducing the spread of infectious diseases like COVID-19, especially in the early stages of an outbreak. PHSM include nonpharmaceutical actions that individuals, communities, and governments take to reduce person-to-person contact and/or make them safer. PHSM reduce the pressure on the health care system to allow for the continuation of essential services and buy time for the development and dissemination of treatments and vaccines. While a combination of PHSM has proven to be effective in reducing transmission during the COVID-19 pandemic, the evidence on the relative effectiveness and broader health, social and economic impact of individual interventions is still scarce. However, PHSM packages such as lockdowns can have severe unintended consequences for individuals and societies including economic hardship, decreased mental health and wellbeing and exacerbated social and health inequity; therefore, precision in PHSM decisions and implementation is needed. This requires a strengthened evidence base as well as tools that support countries in making balanced decisions about PHSM with the best possible costbenefit ratio. WHO works with multisectoral partners to achieve effective and context-specific PHSM implementation while maximizing the benefits of PHSM and keeping their health, social and economic burden to a minimum and justifiable. In the WHO Regional Office for Europe, PHSM are a key pillar in the COVID-19 response. The office provides, amongst others, a PHSM monitoring dashboard to track the severity of implementation across all 53 Member States as well as a calibration tool and related capacity building to guide countries in their implementation decisions as the pandemic situation evolves. The WHO has further launched a global initiative in 2021 to measure the effectiveness and impact of PHSM and improve precision in future PHSM decisions and policies. The initiative aims at providing robust data and research evidence on PHSM through a global conceptual 15th European Public Health Conference 2022 model and research agenda, a central research monitoring system and harmonized data collection mechanisms during health emergencies. It further seeks to integrate PHSM into emergency preparedness and response assessments and yield a decision-making tool to facilitate evidence-informed and context-specific PHSM implementation. This workshop will provide an overview of WHO's activities in advancing PHSM research and implementation for better decision-making during future emergencies. Three presentations by the WHO Secretariat at the regional and global levels will focus on the strategic approach and the main deliverables of the respective initiatives so far. The presentation by the University of Munich will provide in-depth insights into the conceptual model on PHSM. The workshop will actively solicit feedback from participants on planned activities and results gathered to-date.

Key messages:
The lack of evidence on PHSM effectiveness and impact hampered an evidence-driven implementation approach during the COVID-19 pandemic. WHO works to achieve effective and context-specific PHSM implementation to maximize the benefits of PHSM while keeping their health, social and economic burden to a minimum and justifiable.
Abstract citation ID: ckac129.533 The WHO initiative to measure the effectiveness and impact of PHSM -key activities in 2022 Ramona Ludolph R Ludolph 1 , R Takahashi 1 , T Nguyen 1 , S Briand 1 1 High Impact Events Preparedness Unit, WHO, Geneva, Switzerland Contact: ludolphr@who.int The presentation will focus on two main outcomes of the WHO initiative: a global research agenda to steer future evidence generation on PHSM, and a central monitoring system for PHSM research. In September 2021, a global technical consultation with over 60 global experts was organized to review the existing evidence on PHSM and identify the initiative's priorities. The consultation provided an opportunity to have an initial discussion on potential research priorities. This became the basis for an iterative online consultation process. The draft research agenda includes seven main research themes including effectiveness, unintended consequences, methodological challenges and implementation considerations affecting the uptake of and adherence to PHSM. Workshop participants will be invited to comment on the suggested themes and propose additional priority questions for the research agenda. The central research monitoring system will consist of a global repository of primary studies and reviews investigating the effectiveness and broader multisectoral impact of PHSM. Indexed studies will be mapped against the key themes of the research agenda, facilitating real-time monitoring and evaluation of its progress. An AI-based mechanism for automated updating of systematic reviews will complement the database. This one-stop shop will allow researchers and decision-makers worldwide to access the latest evidence on PHSM and keep track of the synthesized effectiveness and impact of different interventions and combinations. The platform will further provide a protected working interface. This monitoring system for PHSM research enables timely access to and utilization of evidence indecisionmaking processes during health emergencies and fosters international collaboration on the analysis and interpretation of data. Workshop participants will be invited to review the alpha version of the platform. Issue/problem: In the context of the COVID-19 pandemic, public health and social measures (PHSM) are being implemented worldwide, but in very different ways. This is also due to a lacking common understanding of PHSM so far. As a result, there are limited insights regarding their components, implementation and effectiveness as well as impacts beyond health of PHSM.
Description of the problem: The project contributes to the WHO PHSM initiative. A logic model is being developed that offers a shared language and understanding of how PHSM are intended to achieve transmission-related outcomes, but also that non-intended consequences need to be considered. The overall approach is informed by a system-based logic model template and a staged approach to logic modeling. The development process is making use of (i) existing COVID PHSM taxonomies and related literature, (ii) existing theoretical frameworks related to complex interventions in complex systems, (iii) consultations with WHO staff and the according PHSM steering group, and (v) iterative brainstorming within the working group.

Results:
The initial logic model is rooted in a complexity perspective which recognises that (i) all measures have both intended and unintended consequences for health and society and (ii) all elements within the logic model are interconnected and interact with each other. All PHSM operate through two basic mechanisms: reducing contacts and making contacts safer. Taken together, these two mechanisms work to reduce transmission-relevant contacts. Any specific PHSM is defined by a combination of the measure itself, the population and/or setting targeted and the mode of enactment. The central hub of the logic model connects and integrates all elements. The initial logic model was applied to school and travel measures as examples.

Main messages:
The PHSM logic model is a conceptual basis to facilitate research on PHSM, monitoring and evaluation of PHSM, and evidence-informed decision-making.