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Reflections on Public Health

Lello Guluma

Mph '19, health behavior and health education.

May 2, 2019

Lello Guluma’s interest in STEM started at a young age. She enjoyed the certainty of math and science, stating that “it seemed like every problem that I was given, there was a definite answer and you just have to figure that out.” Growing up in East Lansing, Michigan, she was specifically interested in space and dreamed of working for NASA.

By the time she started undergraduate studies at the University of Michigan, she had switched gears, planning to pursue a pre-med track. With an open mind and desire to explore all her options, Guluma registered for Kenneth Warner ’s Public Health 200 course freshman year after an advisor suggested it. Of that course, she says, “I loved it and it was absolutely amazing.”

Guluma recalls the impact public health has on communities as the factor that piqued her interest and ultimately put her on the track to obtain a bachelor's degree in International Studies and Program in the Environment with a focus in global health—all with the long-term goal of a master's degree in public health.

Coming into Michigan Public Health, Guluma considered multiple degree tracks but ultimately chose Health Behavior and Health Education because of the challenges that the discipline addresses and its foundation within public health. She says, “changing behavior is a really hard thing to do, but behavior and education underlies a lot of public health issues. If we can get people to change behavior and make the adjustments we discuss in this field, it would address a number of issues across the disciplines.”

She says staying at Michigan for her master's degree was an easy choice. As an undergraduate, Guluma was able to participate in community-based programs. She saw tremendous opportunities to further her experience with community-based participatory research at Michigan Public Health, and to work with faculty like Barbara Israel , who would become her advisor.

Reflecting on her original interest in STEM in comparison to her public health journey so far, Guluma says, “I feel like we often deal with a lot of uncertainty in public health, but I've learned to embrace that uncertainty because life itself is full of uncertainty but there are still questions to ask and answers to be discovered.”

While Guluma says that she’s had a good experience overall, she also admits making the transition from undergraduate to graduate education has had highs and lows. She found it hard at first because the transition came with a loss of community as friends moved away from Ann Arbor. However, from an academic perspective, she says it was both challenging and rewarding. While she’s found the program to meet her original expectations overall, she’s found it surprisingly fun as well. Of her coursework, she says, “it reminded me why I became interested in Health Behavior and Health Education and what is exciting about public health.”

Citing the program as what’s set her up for the future, Guluma is looking forward to starting her professional career after graduation. She’ll be moving to Washington, D.C. to start a position with Mathematica Policy Research , where she’ll be working on domestic health policy issues. She hopes to focus her career on health disparities and social determinants of health.

On behalf of her peers in the School of Public Health, Guluma offered the following remarks to the School of Public Health community gathered for the 2019 graduation ceremony.

What does it take for a community to thrive? I found public health as a part of the solution; further improving lives and communities through access to education. For me, public health was—and is—the key for answering large societal issues.

Lello Guluma, MPH Remarks on Behalf of Students Thursday, May 2, 2019

Good afternoon. I am deeply honored to be able to share this moment with you and my reflections on my public health education.

I have dreamt of this moment since sitting in my dorm room in 2013, inspired and wide-eyed. I was fresh from a public health 200 class with Ken Warner, a distinguished professor emeritus from the Department of Health Management and Policy and former dean of the School of Public Health. I said to my roommate, “I think I’ve found my passion.” I think about that moment often and sometimes chuckle at the innocence of the situation. After all, I was 17 and had found my lifelong passion, right?

Reflecting on my journey to this discipline, I realized I didn’t find public health. Rather, public health found me. Just months earlier I had embarked on my first trip outside of the United States. My mother took my brother and I to meet our extended family in Ethiopia for the first time.

A particularly powerful experience for me was meeting my paternal cousins. My cousins grew up on the same farm that my father was raised—a community named Jarso-Siree in a region called Oromia. My father is the eldest son of his father, a title that provided him certain opportunities while he was growing up. One of which resulted in him being the first in his family to earn a formal education. Now, several years later, all of my cousins are provided that same opportunity. During our trip, my cousins and I walked the path my father took when he was young—from the farm into town every day for school. The same path my cousins take to school.

I was in complete awe of my first trip to Ethiopia, however, deeply humbled. I grew up worlds—and literally an ocean—apart from this reality. My cousins walked, sometimes hours, just to get to school to earn an education. My elementary school was just down the street. When they came home, they cooked, cleaned, and harvested crops. I spent my afternoons doing homework or playing with friends.

This journey, both literal and figurative, showed me what the conditions were like to access a primary school and attain an education. The possibilities that an education offers far outweigh any obstacles like distance or competing priorities. I saw that for this community, education was key for financial security, health, well-being, and women’s empowerment. I did not realize it then, but their journey sparked a thought in me: What does it take for a community to thrive? I found public health as a part of the solution, further improving lives and communities through access to education.

For me, public health was—and is—the key for answering large societal issues. Public health is political and personal. I believed public health would give me the tools to figure these problems out. However, looking back on the past two years, public health is more than just coming up with solutions to problems.

Public health is collaboration. Working with other people, sometimes very different than us, towards a common goal.

Public health interdisciplinary. Knowing that we don’t always have the answers and should lean into our peers, colleagues, community members, and friends.

Public health is empowerment; because maybe the best answer doesn’t and shouldn’t come from researchers, but rather the community.

Public health is political; recognizing that Black Lives Matter; climate change is real; knowing Flint still doesn’t have clean water; that so many undocumented people go without access to healthcare; and so much more.

Public health is the relentless pursuit of a more just, equitable, liberating, and healthier world, both individually and collectively.

Public health is me. A first-generation girl from a family of immigrants. Reflecting that public health has the power to change not only her life, but her family's lives, for the better. Relentlessly pursuing an education that would allow her to do so.

It has been said, “Hope is like a path in the countryside: originally there was no path— yet, as people are walking all the time in that same spot, a way appears.”

Public health is hope and we are all walking along that path.

Public health is you all, Class of 2019, and your respective journeys that brought you here to this very moment.

Congratulations and Go Blue!

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Reflective notes

CPD is formative and it is about what it achieves for you and your practice rather than the summary of a learning event. That is why FPH does not credit specific CPD activity but relies on its members to select appropriate activity and reflect upon it. Reflective notes are at the core of FPH’s CPD programme. These do not have to be lengthy but should reflect on how the learning was relevant and how it will impact on your practice.

FPH CPD Advisers Committee has adopted the view that, in verifying the CPD of any given public health professional, the use of reflective notes written by the public health professional about their learning is the most discriminating form of evidence of effective CPD. This is confirmed by the Academy of Medical Royal Colleges.

It is even more important to take time systematically to reflect on learning as this is more likely to embed the learning within subsequent practice. Reflection should occur as soon as possible following the event – to be contemporaneous and meaningful.

Construction of reflective notes

There are four elements to be completed in each reflective note for each CPD activity claimed

Why did I choose this activity for my CPD? (Focuses on how the activity relates to your learning needs as identified through reflection on your practice and described in your PDP)
What did I learn from this activity or event? (Focuses on your thoughts at the time of the activity and critically analyses any new learning that took place)
So what am I going to do to apply this learning in my work? (Focuses on the significance of what happened and why this may influence future learning or practice)
Now what am I going to do to further develop this learning and/or meet any gaps in my knowledge, skills or understanding? (Focuses on future actions and plans for further development, if necessary)

For further information and tips on writing effective reflective notes, please see: Tips on Writing Effective Reflective Notes .

The Academy of Medical Royal Colleges in collaboration with COPMeD developed guidance on reflection, entitled 'Facilitating Reflection' which you can access here . This document includes tips to support supervisors in guiding supervisees in their reflective practice.

The GMC, along with eight other healthcare regulators, also published a joint statement on the importance and benefits of being a reflective practitioner. The statement can be found here .

You can also find examples of good quality reflective notes. We have also included examples of reflective notes on climate and health and further resources on climate and health can be found on the Sustainable Development SIG pages.

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Home — Essay Samples — Life — Career Choice — Why I Chose Public Health: A Path to Fulfillment and Impact

Why I Chose Public Health: a Path to Fulfillment and Impact

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Published: Sep 7, 2023

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A desire to address health disparities, promoting preventive health measures, furthering education and research, contributing to policy and advocacy, fulfillment and reward in public health, conclusion: a journey of purpose.

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Critical health literacy: reflection and action for health

Thomas abel.

Institute of Social and Preventive Medicine University of Bern, Bern, Switzerland

Richard Benkert

Health literacy research is growing rapidly and broadly; however, conceptual advances in critical health literacy (CHL) seem hampered by a lack of a clear definition. In this paper, we refer to key features of the concept as identified in earlier works, offer a new definition of CHL and briefly discuss its theoretical roots. Reflection and action are suggested as the two constituent components of CHL. Consequences for future research are also discussed.

In public health and health promotion, health literacy is considered an important resource for individual and collective empowerment ( Nutbeam, 2000 ; Kickbusch, 2001 ). Among the different types of health literacies, critical health literacy (CHL) has recently gained increased attention in health research with the number of publications substantially increasing since 2010 ( Benkert and Abel, 2022 ). It was originally drawn from the concept of critical literacy, which focused on individuals’ abilities to analyse and use information as a means of greater autonomy and empowerment ( Nutbeam, 2000 ; Sykes et al., 2013 ). Beyond this, CHL was also introduced to address socio-political dimensions of health literacy ( Sykes et al., 2013 ). These socio-politico dimensions refer to agency as the ability to bring about social and political change and—through an improved capacity to act on the social determinants of health (SDOH)—overcome ‘structural barriers to health’ ( Nutbeam, 2000 , p. 267). Thus, CHL is not limited to achieving individual health benefits; it also entails empowering communities and reducing social health inequalities.

Although Nutbeam’s foundational work introduced the concept of CHL, he did so without providing a concise definition. In principle, this openness could have meant opportunities to develop definitions of CHL that address its distinct features and account for dynamic, evolving contexts. However, without such attempts and a concise definition, later works addressing CHL often fell back onto notions of ‘critical literacy’ losing socio-political dimensions originally considered a key component of CHL ( Sykes et al., 2013 ). Over time, as Sykes and colleagues (2013) pointed out, critical literacy has almost become the de facto definition of CHL. Yet, although the definition of critical literacy alludes to greater individual control over life events, consequent notions of CHL tend to ‘lack... specific reference to social and political action and existence at a population level’ ( Sykes et al., 2013 , p. 8). Therefore, ‘these elements are in danger of becoming lost so distorting the original meaning and emphasis’ ( Sykes et al., 2013 , p. 8). Although there are many descriptions of what CHL entails, to the best of our knowledge to date, there is still no clear definition of this term that accounts for its conceptual origins regarding empowerment and social inequality.

Current CHL approaches address an awareness of social and cultural conditions as prerequisite to acquire competencies required to act for reducing health inequalities ( Chinn, 2011 ); however, these approaches, and health literacy research in general, including research on CHL, often omit theoretical support ( Pinheiro, 2021 ). Referring to CHL’s theoretical underpinnings, Pithara (2020) notes that ‘CHL adopts an emancipatory, empowerment-led understanding, where people are cognizant of social, economic and environmental determinants of health and are able to tackle these through community action’ (p. 2). Intervention frameworks have been designed to promote awareness, understanding and reflection by educating individuals and communities about SDOH; thereby contextualizing CHL and teaching community members how to empower people to ameliorate health inequalities ( Mogford et al., 2011 ). Yet, until today, CHL’s basic role in the social reproduction of health inequalities remains an open issue. With socio-political features of CHL as a core attribute ( Nutbeam, 2000 ; Sykes et al., 2013 ), it seems warranted that social theories would guide CHL research and practice; still, theoretical frames in CHL research are markedly absent. One noticeable exception is the work of Sykes and Wills (2018 , 2019 ). These authors suggest a socio-critical approach, tracing the concept of CHL back to the idea of ‘critical consciousness’ developed by Brazilian educator and philosopher Paulo Freire.

In what follows, we present our definition of CHL and briefly revisit Freire’s Pedagogy of the Oppressed (1970/2005) as it provides theoretical support for CHL’s socio-emancipatory function. We provide examples of how the new definition can illuminate current CHL assessments. We then refer to Pierre Bourdieu’s ‘theory of practice,’ as an example of a theoretically meaningful application of our new definition of CHL within the broader health inequality discourse. Our definition of CHL is meant as a starting point for further discussion, development, and application in future research about CHL and social health inequality.

DEFINING CRITICAL HEALTH LITERACY

Building upon those earlier works referenced above, we focus on reflection and action as two constituent components for our definition of CHL for public health and health promotion. We define CHL as the ability to reflect upon health determining factors and processes and to apply the results of the reflection into individual or collective actions for health in any given context . Developed with a focus on empowerment and health inequalities, our definition is suitable and flexible to serve a wide range of research questions and address more specific forms of CHL that can consider the social contexts in which CHL operates. For both purposes, reflection and action remain the two major constituent components of CHL, which allow addressing individual and collective agency and its structural conditions.

ROOTS OF REFLECTION AND ACTION FROM PAULO FREIRE

Providing useful theoretical grounding for conceptualizing CHL, health literacy scholars have drawn from Freire’s (1970 / 2005 ) critical pedagogy work ( Gould et al., 2010 ; Chinn, 2011 ; Mogford et al., 2011 ; Estacio, 2013 ; Sykes et al., 2013 ; Renwick 2017 ; Sykes and Wills, 2018 ). We argue the social conditions of health find strong anchoring among Freire’s components: reflection and action. Freire explores how oppression is socially installed and how to liberate from it. He challenges traditional approaches in education, which he calls the ‘education as the practice of domination’ in a hierarchically structured society ( Freire, 1970 / 2005 , p. 81). According to the so-called ‘banking concept’ of education, students are treated as recipients of knowledge or ‘depositories’, deprived of the possibility to acquire ‘critical consciousness’ ( Freire, 1970 / 2005 , pp. 72, 73, 83) and thus depleted of the ability to liberate themselves from dominating systems.

For Freire, empowerment in general presupposes that social determinants are questioned. He advocates for a ‘problem-posing education’ pedagogical theory in which education is understood as ‘the practice of freedom’ and where students are treated as people who are educated into being ‘critical thinkers’ in a participatory and dialogical way of learning ( Freire, 1970 / 2005 , p. 81). He explains, ‘In problem-posing education, people develop their power to perceive critically the way they exist in the world with which and in which they find themselves’ ( Freire, 1970 / 2005 , p. 83). In other words, all individuals need to acquire a critical attitude towards the socio-cultural reality that shapes their lives— reflection . Furthermore, individuals must also develop the ability to change their life-world through action . With reference to Prilleltensky (1989 , p. 800), Jemal (2017) notes that ‘the process whereby people achieve an illuminating awareness both of the socio-economic and cultural circumstances that shape their lives and their capacity to transform that reality is parallel with an empowerment process’ (p. 3). A person’s capability to reflect upon their world and the action it takes to change it are considered central instruments for empowerment ( Freire, 1970 / 2005 , p. 79).

Reflection and action have been conceptualized as the two main components of Freire’s critical consciousness. Reflection means ‘examining everyday realities to analyse relationships between personal contexts and the wider social forces of structural oppression (e.g. social, economic and political environments) that restrict access to opportunity and resources, and thus, sustain inequity and perpetuate injustice that limit well-being and human agency’ ( Jemal, 2017 , p. 6). Action refers to ‘the overt engagement in individual or collective action taken to produce socio-political change of the unjust aspects (e.g., institutional policies and practices) of society that cause unhealthy conditions’ ( Jemal, 2017 , p. 6). Others describe critical action as an ‘individual’s objective ability or potency to act given structural constraints’ ( Campbell and MacPhail, 2002 , p. 333). In fact, the ability of individuals or communities to reflect and act with the aim of improving structural conditions for health was already addressed in Nutbeam’s (2000) first delineation of CHL. He puts it like this: CHL ‘reflects the cognitive and skills development outcomes which are oriented towards supporting effective social and political action, as well as individual action’ (p. 265). In a further remark, he states, implying reference to reflection, that CHL encompasses the ‘development of skills which investigate the political feasibility and organizational possibility of various forms of action to address social, economic and environmental determinants of health’ ( Nutbeam, 2000 , p. 265). In this regard, it has been pointed out that CHL is linked to understanding the determinants and policy context of health, as well as of opportunities to challenge these determinants and policies. At the same time, it is linked to motivation and actual action at political and broader social levels ( Sykes et al., 2013 , p. 5).

CONSEQUENCES FOR CRITICAL HEALTH LITERACY ASSESSMENTS

Several studies have provided empirical measures assessing selected aspects of CHL (e.g. Ishikawa et al., 2008 ; Osborne et al., 2013 ; Abel et al., 2015 ). Most of these, however, were focused on assessing individuals’ abilities to critically evaluate information or their critical literacy. From a theoretical perspective, empirical measures of empowerment linked to reflection and action that could address social forces at structural and individual levels in comprehensive, theoretically coherent ways are missing.

While reflection and action have rarely been measured explicitly in CHL research to date, some empirical instruments are available, addressing single elements of empowerment and political components of CHL, such as Chinn and McCarthy’s (2013) All Aspects of Health Literacy Scale (AAHLS); Matsumoto and Nakayama’s (2017) Health Literacy on the Social Determinants of Health Questionnaire (HL-SDHQ); and Shannon and Parker’s (2020) Health Communication Questionnaire. In this respect, our definition of CHL might prove useful to illuminate previous findings. For example, Matsumoto and Nakayama (2017) addressed socio-political dimensions of CHL and the ability to bring about health-relevant changes at the population level (i.e. community empowerment). Their HL-SDHQ tool points to a more advanced assessment of CHL since it includes items about an individual’s ‘ability to cooperate in the creation of a fair society in which everyone can live a healthy life’ (p. 6) or to ‘involve oneself in politics and public administration on various health-related issues’ (p. 7). Applying our new definition of CHL can facilitate a focused interpretation of their findings. For instance, those two items clearly addressing the ‘action’ part of CHL, while also encouraging researchers to pursue theory-guided assessments.

Another example of how the new definition of CHL can illuminate previous findings comes from Chinn and McCarthy’s (2013) AAHLS instrument. This measure contains questions that indirectly provide information about reflection and action. For instance, one question elicits the ‘perceived possibilities’ of the individual’s contribution to community health, alluding to ‘reflection.’ Another question from the AAHLS deals with active participation in health-promoting processes, implying the action part of CHL. Reflection and action and their acquisition and application are dependent on the context in which people strive for better health ( Abel, 2008a ; Nutbeam, 2009 ; Pithara, 2020 ; Pinheiro, 2021 ). Recent studies have used qualitative research methods for deeper understandings of inequality dynamics in the context of health care, including the application of CHL ( de Wit et al., 2017 ; Dubbin et al., 2021 ). Insights obtained via qualitative methods and analyses may also provide evidence for interventions for improving CHL, spurring community empowerment and reducing health inequalities ( Gould et al., 2010 ; Mogford et al., 2011 ).

Since any definition of CHL for health research should facilitate empirical study by providing theoretical guidance without restricting the breadth of immanent research questions, our definition above is kept sufficiently broad to support empirical measures for different health themes and fields (e.g. health-relevant lifestyles and consumer markets, healthcare contexts, workplace, and housing conditions). Moreover, previous empirical approaches to health literacy have been subject to basic criticism for measures that tend to address health issues from class-biased or context-insensitive perspectives ( Abel, 2008a ; Pinheiro, 2021 ), such as those addressing health lifestyle items that are out of reach or less relevant for health in materially deprived living conditions. For example, measures assessing individuals’ knowledge about selecting healthy, yet often more expensive foods or risks overestimating agency, while downplaying the role of structural constraints for action and reflection. Thus, definitions of CHL that aim at supporting empirical study should facilitate a broad range of research questions about inequality, while also avoiding conceptual biases.

CRITICAL HEALTH LITERACY AND THE REPRODUCTION OF INEQUALITY—PIERRE BOURDIEU

Considering our definition of CHL, questions about social inequalities and inequities arise: how does CHL affect health, health behaviours and their social conditions? What are the individual and communal conditions in which CHL can best be acquired? What are the social, economic and cultural resources needed for a successful application of CHL in various contexts, such as healthcare systems, workplaces and leisure time activities? Such questions refer directly to unequal and inequitable chances for an individual’s agency to achieve good health. They also lead to basic questions about structural factors and processes, including broader questions about how CHL ties into the dynamics of reproducing social inequalities at the population level.

Theoretical guidance seems warranted to address these larger questions and anchor the concept of CHL firmly within social health inequality discourse. To assist more comprehensive understandings of links between a person’s structural living conditions and their chances to reflect upon and act on SDOH (i.e. their CHL), we call upon Pierre Bourdieu’s theory of practice ( Bourdieu, 1977a ; Bourdieu and Passeron, 1990 ) and his concepts of habitus and capital ( Abel and Frohlich, 2012 ). Bourdieu’s theory of practice has been successfully applied to study how health inequalities are reproduced ( Williams, 1995 ; Veenstra 2007 ; Schori et al. 2014 ; Jeong and Veenstra, 2017 ), including social patterning of health lifestyles, beliefs and health behaviours ( Cockerham et al., 1997 ; De Clercq et al., 2017 ; Gagné et al., 2018 ; Kandt, 2018 ).

The concepts of habitus and capital bear specific relevance for theoretically grounding CHL. In a Bourdieusian approach, reflection and action are primarily of social origin. They can be explained as an expression of the habitus that ‘serves as a cognitive map or set of perceptions that routinely guides and evaluates a person’s choices and options’ ( Cockerham, 2005 , p. 61). The habitus ties an individual’s reflection to action and operates as a constant, yet dynamic and flexible filter and guide across different contexts. Researchers of health inequality have used this concept to explain the reproduction of inequalities via health-relevant social practices and lifestyles ( Cockerham, 2005 ; Veenstra, 2018 ). Habitus and health lifestyles are closely tied to the availability of economic, social and cultural capital; therefore, they are inextricably linked to an individual’s social position in a ‘field of struggles’ ( Bourdieu and Wacquant, 1992 , p. 101), such as those over resources needed to live healthy lives or achieve good health across different contexts ( Khawaja and Mowafi, 2006 ; Missinne et al., 2014 ; Deshmukh et al., 2015 ; Paccoud et al., 2020 ).

Among the different forms of capital, cultural capital bears special importance for health literacy research ( Abel, 2007 ; Adkins and Corus, 2009 ). Cultural capital allows an individual to succeed in the competition over privilege, power, and status ( Bourdieu and Passeron, 1990 ; Bourdieu, 1977b ). Applied to health, the concept of cultural capital addresses issues of unequal distribution of health and its resources in a theoretically coherent way ( Abel, 2008b ; Shim, 2010 ; Veenstra and Abel, 2019 ). Cultural capital comes in three different types, namely, institutionalized, objectivized and embodied cultural capital. Educational degrees and other formal qualifications, typically issued by accredited institutions of higher education, are the most widely used measures of institutionalized cultural capital . Material forms, objects or goods of cultural value signifying higher or superior social status (e.g. art in the home, possession of highbrow books or clothes) indicate an individual’s objectivized cultural capital . Finally, e mbodied cultural capital refers to various kinds of behaviours, skills and socially relevant, valued knowledge acquired through formal and informal education in schools, families, sport clubs, etc. ( Abel, 2007 , 2008b ; Oude Groeniger et al., 2020 ). It comprises health-relevant tastes, preferences and dispositions that are physically embodied, part of the habitus and practised through lifestyles ( Cockerham, 2005 ). Health literacy broadly defined can be understood as part of this embodied cultural capital, and with it, CHL addresses social conditions and processes operating in the reproduction of health inequalities ( Abel, 2007 ). Explaining CHL as part of an individual’s cultural capital, health-related habitus and lifestyles— with the latter structured along the lines of social class, status or milieu—thus provides a theoretically coherent way of linking CHL to the prevailing social structures of health inequalities.

Moreover, a theoretical approach via cultural capital identifies two interrelated functions of CHL. First, being part of an individual’s cultural capital, CHL can strengthen individual and collective agency, operating as a resource for individuals in their pursuit of better health. Second, since chances to acquire and use CHL are unequally distributed along the lines of established social hierarchies (e.g. via educational systems), it operates as a transmitter of collective inequality in different contexts. For example, contexts where there is group-based competition over health resources and power, community struggle over environmental resources ( King et al., 2021 ), or patients’ struggles over access to quality health services ( Shim, 2010 ; Rasmussen et al., 2021 ).

From its beginning, CHL has been discussed as a concept that illuminates the factors and processes at work when individuals actively deal with health matters by critically considering the social conditions of health. However, in the absence of a clear definition of CHL most research approaches showed a neglect of the concept’s focus on social conditions and socio-political features ( Sykes et al., 2013 ; Chinn, 2011 ; Chinn and McCarthy, 2013 ; Guzys et al., 2015 ; Diviani, 2019 ). The new definition we offer in this paper is geared towards two components of individual and collective agency: reflection and action on health matters. It considers SDOH as structural factors and recognizes contextual conditions for people to acquire and apply CHL.

Along with Freire and other critical researchers, we propose that reflection and action need to be linked conceptually and practically to reach empowerment for health ( Rubinelli et al., 2009 ; Chinn, 2011 ; Mogford et al., 2011 ; Estacio, 2013 ; Sykes et al., 2013 ; Renwick, 2017 ; Sykes and Wills, 2018 ). This is because action without purposeful reflection runs the risk of mere ‘activism’ ( Freire, 1970 / 2005 , p. 88); and reflection without action might result in intellectual discovery only or what Freire identified as empty ‘verbalism’ (p. 87). CHL should capture the interplay of reflection and action, particularly in times when the contextual conditions for health become more and more complex. Many healthcare systems today increasingly turn into diversified markets with vested interest groups competing over profits and patients or consumers, making it progressively difficult for individuals and whole population groups to critically choose and act according to that choice (e.g. selecting healthcare services and insurance plans). CHL can and should address the SDOH but also the basic principles of power, whether economic markets or political systems.

We further suggested that Bourdieu’s theory of practice might be a viable option for anchoring CHL to the broader health inequality discourse. Again, our discussion is meant only as a starting point. Future studies might show how Bourdieu’s work can provide further and more specific contributions to situate CHL firmly in the context of social reproduction. However, other social theories can provide support for applying the new definition of CHL in health inequality research. Linking reflection and action to understand the basic components of agency and how it contributes to social reproduction or how it may lead to social change, opens CHL to insights from capabilities theory ( Sen, 1985 / 1993 ; Robeyns, 2005 ; Abel and Frohlich, 2012 ; Pithara 2020 ) and health lifestyle theory ( Cockerham, 2005 ). These theories both address fundamental issues of structure and agency in health inequalities. Future studies might explore questions about CHL’s role in individuals’ freedom to achieve health or the importance of CHL for the practice of health lifestyles to achieve better health and social status.

Our new definition also seeks to overcome some of the theoretical limitations previous approaches faced. Defined this way, CHL avoids individual reductionism —a point of critique for previous health literacy approaches ( Guzys et al., 2015 ). By stressing reflection and action on social factors that determine health, as well as including the contextual conditions, individuals and communities strive for better health within, these can safeguard against risks of individualizing health literacy approaches. From our new definition, questions for future studies arise, such as how reflection can strengthen contextualizing health actions and strengthen individuals as agents and experts for health in their own life worlds. The focus on refection and action under conditions of social inequality suggests even farther-reaching topics. For instance, CHL theory and measurement might need to consider issues of intersectionality when addressing questions about what form of health inequities are at stake in specific contexts. Drawing on works from Crenshaw (1991) and those writing drawing from intersectionality theory ( Collins, 2015 ) might also help advance the concept of CHL and augment critical discussions of health literacy in general.

The new definition also avoids too much normativity and the risks that come with it. As Huber et al. (2012) note:

the health literacy movement, at least in its current form, operates in a top-down model, where the establishment is primarily prescribing action plans designed to identify individuals with limited or low health literacy and provide interventions that seek to improve one’s ability to comprehend and use health information in appropriate ways. (p. 440)

Our definition of CHL points to a different direction, namely critical reflection by individuals opposing highly normative ‘prescriptions’ and instead, critically thinking about health, its social conditions, and the manifold interests of those involved in its production and distribution. When applied in research about SDOH, our new definition might be helpful to overcome the prevailing divides into ‘structural versus behavioural factors’ and ‘material versus non-material factors’ ( Macintyre, 1997 ). Both divides are implicitly opposed by our definition that links structure and agency and stresses critical reflection and action relevant at all levels.

Although our discussion above has pointed to pending issues in theory development, the new definition of CHL also has implications for empirical research. Empirical studies on CHL can benefit from a theory-based definition in the development of new assessment tools in several ways. First, reflection and action define a clear focus for developing new indicators (quantitative approaches) and for observing systematically (qualitative approaches). For example, the new definition does not include value-laden criteria, for example, for what is a ‘high or low’ CHL. This will allow and ideally encourage future studies to develop measures of CHL that account for contextual variation in the meaning and effectiveness of reflection and action. For current studies on CHL exploring the importance of reflection and action for health (e.g. Haugen et al. 2022 ), the new definition may provide additional theoretical support for their empirical measures. The interplay between reflection and action will present a key challenge for future research then—ideally addressed through mixed-methods approaches. Second, a focus on the social conditions of health allows empirical research on CHL to integrate (i.e. draw from and feedback into) established research fields such as the ‘SDOH’, ‘social class, capital and health’ theory, or ‘health lifestyles’ research. Third, the basic proposition that CHL includes yet goes beyond the individual to account for collective patterns in the acquisition and application of CHL requires that data should be collected on each societal level, ranging from individuals to families to communities and even countries (e.g. EU Health Literacy Survey). Similarly, interventions should lay a focus on the social conditions that facilitate CHL at all relevant levels. Together, these three points indicate how applying our new definition of CHL can assist and complement future empirical studies in developing new measures and producing knowledge relevant for interventions that aim to strengthen individual and collective agency to reduce social health inequalities.

CONCLUSIONS

Defining CHL based on reflection and action as its two constituent components can provide a focus for its application in research on health inequalities. Guidance from social theory can facilitate coherence in its definition and strengthen its application in empirical studies. Our definition and brief discussion may serve as a starting point for advancements needed to utilize and realize the full potential of CHL in future health promotion research and practice.

Acknowledgement

We thank Kristin Marie Bivens for her editorial guidance and support.

Contributor Information

Thomas Abel, Institute of Social and Preventive Medicine University of Bern, Bern, Switzerland.

Richard Benkert, Institute of Social and Preventive Medicine University of Bern, Bern, Switzerland.

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Reflections on Public Health Leadership

Editor(s): Baker, Edward L. MD, MPH, MSc, Column Editor

Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana.

Correspondence: Edward L. Baker, MD, MPH, MSc, 25 Vassal Lane, Cambridge, MA 02138 ( [email protected] ).

The author declares no conflicts of interest.

As we celebrate the 25th anniversary of the Journal of Public Health Management & Practice ( JPHMP ), it seems useful to begin with a brief acknowledgement of the central leadership role played by Dr Lloyd Novick in this “labor of love” for public health practitioners. Given his deep experience in the practice world, his extraordinary editorial eyes and ears, and his vast network of public health colleagues, Lloyd has been the perfect leader for the entire 25-year life span of the journal—an exceptional “run” in many ways. As noted in the classic text on Leadership by Northouse, 1 effective leaders exemplify the central leadership traits of intelligence, integrity, and determination; Lloyd's modeling of these and other exceptional leadership traits has been central to the journal's success as the “go-to resource” for public health practitioners for a quarter of a century.

The Management Moment Column

In 2004, we approached Dr Novick with the idea of a column focusing on the practice of public health management and leadership. The idea (for which Dr Janet Porter deserves full credit) was to provide public health practitioners with succinct columns on topics that relate to day-to-day public health practice—in a way modeled after the highly acclaimed Harvard Business Review . Now, nearly 15 years later, this partnership with the journal has produced a wide range of short columns on topics such as guiding principles of leadership, 2 having better meetings, 3 building the informatics-savvy health department, 4 crafting better messages for public health in turbulent times, 5 success as a state health director, 6 and a new public health informatics incubator initiative. 7 These columns have been positively received and are now used in leadership development programs and in academic courses on leadership in schools of public health. A book containing a number of these columns was published a few years ago. 8 We are most grateful to Dr Novick, Dr Moore, and Sheryl Monks for their encouragement and support for these many years.

What Are the Most Important “Take-Home Messages” From These Columns?

Practitioners and students valued and utilized our succinct treatment of guiding principles and best practices in leadership and management . From guidance on how to manage conflict within the organization, how to have better meetings, or how to coach for development of emerging leaders, readers of these columns have indicated that they value these brief, evidence-based suggestions on ways to enhance organizational effectiveness. Often, formal educational experiences in schools of public health may fall short in addressing the need for practical leadership and management guidance; as a result, by offering these columns, the journal serves the needs of readers who are busy practitioners with limits on time to read and incorporate suggestions into their practice. Furthermore, topics such as succession planning in public health agencies, managing the boss, and transitioning into a new position represent common challenges faced by public health leaders for which we found little in the public health literature; therefore, we decided that a succinct discussion might prove useful.
Leadership challenges faced by state health officials (SHOs) deserved particular focus . In 2017, a unique opportunity arose to share early findings of the first ever research project on SHOs, led by Dr Paul Halverson, founding Dean of the Fairbanks School of Public Health in Indiana. In a series of columns, we shared concepts regarding the definition of success for an SHO, information on what they wish they had known before taking the job and ways to avoid premature “derailment.” Although focused on the directors of state public health agencies, our research findings are broadly applicable to others in leadership positions throughout the public health system. These columns are now being used as part of training and orientation of new and current SHOs by the Association of State and Territorial Health Officials. In 2013, a timely column by John Auerbach 9 (a former SHO) provided a unique insight into the leadership challenges faced in the development of the 2007 Massachusetts health reform effort as public health took a seat at the table in this historic time.
Informatics has become a cornerstone of public health practice and deserved special attention as a leadership and management imperative . Following the development of the concept of “the Informatics-Savvy Health Department” by Martin LaVenture, Bill Brand, and colleagues, a series of columns was created to highlight and summarize the strategies needed for a health agency to become “informatics savvy.” These 3 strategies are (1) ensuring a clear vision and strategy supported by effective internal leadership and governance, (2) developing a skilled workforce, and (3) creating well-designed and effectively used information systems. To achieve the goal of becoming informatics savvy, a robust business plan is needed, which was the focus of another column in this series. Finally, our most recent call to action highlights the urgent need for widespread adoption of the “informatics-savvy approach,” as has been done in a few leading health agencies across the nation. In another informatics-related column, we profiled a promising approach to augmenting the skills of the informatics workforce through academic-practice partnerships—public health informatics incubators 7 ; this approach has recently been endorsed by a Centers for Disease Control and Prevention think tank as meriting further study.
Public health is faced with unique messaging challenges in these turbulent political times that deserved our attention . As we all know, the unprecedented political and social upheavals of our times call for a fresh look at the communication challenges faced by public health operating in these polarized environments. To assist public health leaders as they navigate these “troubled waters,” we created 2 columns led by Gene Matthews and colleagues delineating concepts underlying better public health messages based on Moral Foundations Theory. In addition, these columns have been used to assist public health leaders by providing practical suggestions for bridging the gaps between a range of perspectives leading to tangible policy change in surprising situations 5 (eg, legislation authorizing needle exchange in North Carolina).

As a result of the ongoing support and encouragement of Dr Novick and JPHMP colleagues and staff, the creation of our series of management moment columns has been a true pleasure and a privilege. One aspect of personal pride has been that we have been able to help in sharing the ideas and insights of my public health colleagues and in giving a forum through which their ideas and insights can reach a broader audience and thereby enrich and inform the practice of public health. Readers of this column are also invited follow my new interview series of the same name on JPHMPDirect.com , where I will be talking with public health leaders who have been part of Management Moments. My hope is that we may continue to share more words of wisdom in the months to come. For this opportunity, I am most grateful.

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Public Health: Reflective Practice in Midwifery Essay Guide

Reflection isn't just about looking back; it's about learning, growing, and evolving in the realm of midwifery

Public Health in Midwifery: Navigating the Reflective Landscape

In the ever-evolving field of midwifery, the significance of public health remains paramount. But how do professionals in the field reflect upon and enhance their practice in alignment with public health principles? This blog sheds light on the intricate dance of reflection and learning within midwifery.

Understanding the Importance of Reflection

Reflection isn't just about looking back; it's about learning, growing, and evolving. In the realm of midwifery, it enables professionals to identify crucial learning outcomes from modules related to public health. By exploring and evaluating the value of reflection, midwives can enhance both their knowledge and practice, aligning more closely with best practices in public health.

The 4 Pillars of Reflective Practice

Identifying Feelings and Emotions: Reflecting on one's feelings during specific scenarios—be it the joy of successful teamwork or the stress of missed sessions—provides a starting point. It allows midwives to understand their reactions and pave the way for improvement.

Learning from Experience: Every experience, good or bad, is a lesson. Evaluating these experiences, especially those related to public health promotions, aids in discerning what works and what requires change.

Incorporating Multiple Perspectives: Understanding the psychological, social, cultural, political, and economic influences on a woman and her family is crucial. By analyzing these factors, midwives can tailor their approach to cater to individual needs.

Relating to Public Health Theory: This isn't just about theory; it's about application. Midwives should understand the significance of communication, the essence of multi-agency working, and the impact of health promotion models in public health.

Reflecting Forward

At the heart of reflective practice lies the future. How does one's reflection today impact their practice tomorrow? As midwives conclude their reflections, it's essential to tie all insights together, relating them to module learning outcomes. The goal? To ensure that past experiences shape a more informed, effective, and empathetic future in midwifery.

In Conclusion

Reflection is a powerful tool in the hands of midwifery professionals. It not only bridges the gap between theory and practice but also reinforces the pivotal role of public health in the domain. As professionals navigate their journey, integrating reflection with action can lead to enhanced outcomes, both for themselves and the families they serve.

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PHGT 512 Public Health Essay

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Master of Public Health students will write a personal reflection essay that defines public health in their own words. The essay needs to identify their interest in the field and their future goals, which will assist staff and faculty with career advising and help better prepare students for the field.

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The purpose of the Public Health essay is to allow the student to articulate their understanding of public health and how obtaining a Master of Public Health degree aligns with their personal calling to the field of public health. The essay will provide a framework for advising elective selection and helping students find an appropriate practicum experience.

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After reading the Course Syllabus and Student Expectations , the student will complete the related checklist found in the Course Overview.

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For this assignment, the student will provide a written self-reflection of at least 1,000 words presenting a personal, but professional explanation for each of the prompts outlined within the Public Health Essay template and submit it as a draft. (CLO: A, C, D, F)

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Reflection as part of continuous professional development for public health professionals - further evidence

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J.A. Reid, Reflection as part of continuous professional development for public health professionals - further evidence, Journal of Public Health , Volume 37, Issue 2, June 2015, Page 360, https://doi.org/10.1093/pubmed/fdu017

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The article by Jayatilleke and Mackie 1 on reflective practice in public health offers a useful and timely overview of a key topical challenge for public health professionals; particularly given its current prominence in appraisal and revalidation processes. The authors advise that evidence of reflective practice is growing in allied health professions but not in public health. It may be argued that with regard to ‘reflective continuing professional development (CPD)’ there has been however relatively little evaluation despite the opportunities and methods that were proposed from several interested public health colleagues in 1997. 2

There was however notable absence of reference to the research report covering the Faculty of Public Health (FPH) pilot project of CPD diaries in 1996. 3 That FPH report, while acknowledging mixed enthusiasm for CPD diary keeping and reflective notes, identified various styles of public health reflection. The diary entries were built around the first FPH ‘reflective cycle’, using the following steps: identification of needs and problems, discussion with colleagues/design of plan, CPD activities/diary keeping, evaluation of process and outcomes, feedback to colleagues and revision of framework/priorities for future CPD. The diary review showed interesting examples of reflective practice and that ‘some public health doctors are seeking more reflective and practice-based approaches to professional learning’. 4 Jayatilleke's and Mackie's conclusions may be because of their restricted literature search criteria and methods. It would be incomplete to fail to recognize such historical evidence of how FPH public health specialists then filled in diaries and reflected on their CPD (S. Brigley, personal communication).

Diary keeping is a useful tool for reflective practice. For instance, there was a helpful analysis of unstructured daily work diaries kept by public health nurse practitioners in Finland, which illustrated work pressures and dilemmas, and scope for support and further skills. 5 Analysis of ‘reflective journaling’ was used to help evaluate a programme for medical practitioners gaining global health competencies that are of relevance for public health. 6 Localized analysis of public health CPD programmes may add to our understandings and gather feedback and reflections. 7 Reflective inputs played a role in one local public health department conducting their practical model of risk analysis. 8 While I agree that empirical evidence is still limited and that this echoes earlier comments made in 1996 on paucity of relevant research, 9 it would nevertheless be prudent nowadays to take a wider view of public health practice and of our ‘wider workforce’, and also of the varied literature on public health CPD, before concluding that there is so little evidence on reflective practice in public health. Newer opportunities and tools for reflective self-awareness, including colleague feedback and self-assessment, could also be part of future research. 10

Jayatilleke N Mackie A . Reflection as part of continuous professional development for public health professionals: a literature review . J Public Health 2013 ; 35 : 308 – 12 .

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Brigley S Littlejohns P Young Y et al. Continuing medical education: the question of evaluation . Med Educ 1997 ; 31 : 67 – 71 .

Brigley S Littlejohns P McEwen J et al. An evaluation of the pilot continuing professional development diary . London : Faculty of Public Health Medicine of the Royal Colleges of Physicians of the United Kingdom 1997 .

Brigley S . Continuing education in the medical professions: professional development or bureaucratic convenience? Teach Dev 1997 ; 1 : 175 – 90 .

Jakonen S Tossavainen K Tupala M et al. Health and society in Finland: public health nurses’ daily practice . Br J Community Nurs 2002 ; 7 : 265 – 72 .

Castillo J Goldenhar LM Baker RC et al. Reflective practice and competencies in global health training: lessons for serving diverse patient populations . J Grad Med Educ 2010 ; 2 (3) : 449 – 55 .

Peninsula Teaching Public Health Network . Evaluation of the Peninsula public health continuing professional development programme. NHS Plymouth 2009 .

Suckling R Ferris M Price C . Risk identification, assessment and management in public health practice; a practical approach in one public health department . J Public Health Med 2003 ; 25 : 138 – 43 .

Young Y Brigley S Littlejohns P et al. Continuing education for public health medicine—is it just another paper exercise? J Public Health Med 1996 ; 18 : 357 – 63 .

Morgan G . Reflective practice and self-awareness . Perspect Public Health 2009 ; 129 : 161 – 2 .

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Public Health

Education resources for public health students.

Reflection on reflection in public health

As the year 2021 is coming to an end ,I could reflect that I pen down this page long time back,perhaps in 2017 . I would suggest people to use a model and add a reference in your reflection. If you have difficulty understanding reflection in publichealth ,feel free to send your queries in the drop box

Recently, I pen down an example of a reflection on health promotion and public health strategies . Click the link below to read the reflective piece Reflection in public health: example For any further clarification for the topic of reflection, feel free to write me in the comment box below

One of the critical components of public health studies is to demonstrate an understanding of a concept in public health. Often, the method that is used to evaluate such skills is the reflective discussion. Your reflection should include: 1. a brief outline of the topic 2. reference to material 3. interpretation related to public health 4. connecting personal observations 5. suggesting how you are going to navigate the reading in your career pathway

For public health students, it is necessary to understand the concept of analysis for reflective discussion. For instance, narrating an experience is not considered as a thoughtful discussion. In the same way, writing an essay of the topic is not an academic reflection.

Then, what, exactly, is a reflection?

Reflective pieces need to demonstrate one’s understanding of the subject material. A good thinking point is that it can enrich one’s experience because it entails the components of the topic. Therefore, a reflection is a superimposed picture of one’s experience and is part of the subject material.

For instance, writing a reflection on health advocacy in public health may have multiple answers; however, core material would be drawn from a good research paper on advocacy in public health. To make it clearer, let’s assume you work in a hospital where a lot of patients are admitted and treated for malaria. The wrong ways of doing a reflection are describing all medicine for malaria and elaborating on what is malaria. On the other hand, correct way of presenting the scenario in the reflective piece would be to think deeply about the meaning of advocacy and how the people involved are linked to advocacy. Additionally, what did you witness in that area which was responsible for the high number of patients in the hospital for malaria? As a public health professional, what would you like to do, or how can current knowledge of advocacy help you to fight this disease? Do you think that advising of mosquito net could have reduced the problem? It may be possible. If a health provider works with local members in the community to raise awareness about malaria, it will help to reduce the cases of malaria.

Hence, to write a good piece of reflective discussion, one needs to analyse the subject material and demonstrate understanding via examples from one’s own experiences.

One of the ways to navigate writing is to clearly show the gap in the knowledge in the initial part of the paper. For instance, one can write: ” Attending leadership lectures at the University has helped me to understand the difference between a team, coalition and partnership. Before this lecture, I was not sure about the relationship of these three terminologies and was unaware of deeper details of a model of collaboration. This paper will examine the concept of teamwork and cooperation in the field of public health and explore how this learning helps me to navigate my thinking about collaboration.”

I hope this information will help future public health students to develop their papers on reflection Hence, to write a good piece of reflective discussion one need to analyse the subject material and demonstrate understanding via examples from own experiences.

Here is an example of complete reflection from my university work . A piece of reflective assignment done during my post graduation days . This piece can help you to understand how to develop a reflective assignment. I am providing my original work in word document without much editing ,in order to give an idea how we navigate a reflection in university assignments . complete reflection example Here is another example of reflection on health promotion and Strategies. Click the link to see the reflective piece Public health Strategies and health promotion_ reflection

Few points : Although there are several ways of doing reflection ,I am suggesting just one:

Identify a specific area or topic you want to talk about
What are the key concern or skill needed for that topic
What you previously know about the topic ?For example , you were completely unaware of the topic or you had little bit idea but now you understand it better .
Support your arguments with literature . Each argument and thought should clearly referenced with peer review literature
Finally, mention where all these understanding is shaping you . The last bit is about your achievement in the area. You need to clearly tell your examiner that you like the process or not ,but why ? The last few lines should tell reader about how you going to use the knowledge in future .

Feel free to ask your questions on reflection in public health at the comment box below

Click below for more examples;

A reflective discussion:traditional leadership versus strategic leadership

Reflection in public health: example

Hope these point help you to develop your reflection . All the best .

U.S. Food and Drug Administration

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CDRH Strategic Priorities and Updates

Discussion Paper: Health Equity For Medical Devices

The U.S. Food and Drug Administration's (FDA's) Center for Devices and Radiological Health (CDRH) has developed a discussion paper, Health Equity For Medical Devices , and seeks input from the public on advancing health equity on the context of medical devices.

About the Discussion Paper

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The FDA recognizes the urgent public health need for innovative technologies that help to reduce barriers to achieving health equity and that help to improve health outcomes across diverse populations.

The FDA’s Center for Devices and Radiological Health (CDRH) is providing this discussion paper to receive public input on advancing health equity in the context of medical devices.

Clinical studies often play a critical role in understanding the safety and effectiveness of new medical devices in the populations that are intended to use them.

In this discussion paper, CDRH describes factors and considerations that may be important for sponsors and other relevant parties as they develop medical device clinical studies and seeks feedback from the public. Specifically, the discussion paper request feedback on possible considerations that may help inform the design of a clinical study that adequately reflects the intended use population for a particular medical device. Consistent with CDRH’s 2022 to 2025 Strategic Priority: Advancing Health Equity , the discussion paper is intended to spur discussions about reducing barriers to achieving health equity and strategies that may help improve outcomes across diverse populations.

The discussion paper:

Discusses three considerations (disease burden or condition; physiology, anatomy, and pathophysiology; and technology) that may help inform design of a clinical study that adequately reflects the intended use population for a particular medical device.
Discusses two important areas of consideration when evaluating whether clinical data are generalizable to, and representative of, the intended use population identified for a particular device.
Poses key questions to facilitate public feedback.

The FDA is seeking input on these considerations and on the related questions posed in the discussion paper.

Submitting Comments on the Discussion Paper

As part of its commitment to health equity, CDRH is sharing Discussion Paper: Health Equity For Medical Devices for public comment. The FDA encourages stakeholders to provide comments in the Federal Register under docket number FDA-2024-N-3616. The last day to submit comments is October 4, 2024.

Submit Comments

Protecting the public from abusive AI-generated content 

Jul 30, 2024 | Brad Smith - Vice Chair & President

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AI-generated deepfakes are realistic, easy for nearly anyone to make, and increasingly being used for fraud, abuse, and manipulation – especially to target kids and seniors. While the tech sector and non-profit groups have taken recent steps to address this problem, it has become apparent that our laws will also need to evolve to combat deepfake fraud. In short, we need new laws to help stop bad actors from using deepfakes to defraud seniors or abuse children.  

While we and others have rightfully been focused on deepfakes used in election interference, the broad role they play in these other types of crime and abuse needs equal attention. Fortunately, members of Congress have proposed a range of legislation that would go a long way toward addressing the issue, the Administration is focused on the problem, groups like AARP and NCMEC and deeply involved in shaping the discussion, and industry has worked together and built a strong foundation in adjacent areas that can be applied here.  

One of the most important things the U.S. can do is pass a comprehensive deepfake fraud statute to prevent cybercriminals from using this technology to steal from everyday Americans. 

We don’t have all the solutions or perfect ones, but we want to contribute to and accelerate action. That’s why today we’re publishing 42 pages on what’s grounded us in understanding the challenge as well as a comprehensive set of ideas including endorsements for the hard work and policies of others. Below is the foreword I’ve written to what we’re publishing. 

____________________________________________________________________________________

The below is written by Brad Smith for Microsoft’s report Protecting the Public from Abusive AI-Generated Content. Find the full copy of the report here: https://aka.ms/ProtectThePublic

“The greatest risk is not that the world will do too much to solve these problems. It’s that the world will do too little. And it’s not that governments will move too fast. It’s that they will be too slow.”  

Those sentences conclude the book I coauthored in 2019 titled “Tools and Weapons.” As the title suggests, the book explores how technological innovation can serve as both a tool for societal advancement and a powerful weapon. In today’s rapidly evolving digital landscape, the rise of artificial intelligence (AI) presents both unprecedented opportunities and significant challenges. AI is transforming small businesses, education, and scientific research; it’s helping doctors and medical researchers diagnose and discover cures for diseases; and it’s supercharging the ability of creators to express new ideas. However, this same technology is also producing a surge in abusive AI-generated content, or as we will discuss in this paper, abusive “synthetic” content. 

Five years later, we find ourselves at a moment in history when anyone with access to the Internet can use AI tools to create a highly realistic piece of synthetic media that can be used to deceive: a voice clone of a family member, a deepfake image of a political candidate, or even a doctored government document. AI has made manipulating media significantly easier—quicker, more accessible, and requiring little skill. As swiftly as AI technology has become a tool, it has become a weapon. As this document goes to print, the U.S. government recently announced it successfully disrupted a nation-state sponsored AI-enhanced disinformation operation. FBI Director Christopher Wray said in his statement, “Russia intended to use this bot farm to disseminate AI-generated foreign disinformation, scaling their work with the assistance of AI to undermine our partners in Ukraine and influence geopolitical narratives favorable to the Russian government.” While we should commend U.S. law enforcement for working cooperatively and successfully with a technology platform to conduct this operation, we must also recognize that this type of work is just getting started. 

The purpose of this white paper is to encourage faster action against abusive AI-generated content by policymakers, civil society leaders, and the technology industry. As we navigate this complex terrain, it is imperative that the public and private sectors come together to address this issue head-on. Government plays a crucial role in establishing regulatory frameworks and policies that promote responsible AI development and usage. Around the world, governments are taking steps to advance online safety and address illegal and harmful content. 

The private sector has a responsibility to innovate and implement safeguards that prevent the misuse of AI. Technology companies must prioritize ethical considerations in their AI research and development processes. By investing in advanced analysis, disclosure, and mitigation techniques, the private sector can play a pivotal role in curbing the creation and spread of harmful AI-generated content, thereby maintaining trust in the information ecosystem. 

Civil society plays an important role in ensuring that both government regulation and voluntary industry action uphold fundamental human rights, including freedom of expression and privacy. By fostering transparency and accountability, we can build public trust and confidence in AI technologies. 

The following pages do three specific things: 1) illustrate and analyze the harms arising from abusive AI-generated content, 2) explain what Microsoft’s approach is, and 3) offer policy recommendations to begin combating these problems. Ultimately, addressing the challenges arising from abusive AI-generated content requires a united front. By leveraging the strengths and expertise of the public, private, and NGO sectors, we can create a safer and more trustworthy digital environment for all. Together, we can unleash the power of AI for good, while safeguarding against its potential dangers. 

Microsoft’s responsibility to combat abusive AI-generated content  

Earlier this year, we outlined a comprehensive approach to combat abusive AI-generated content and protect people and communities, based on six focus areas: 

A strong safety architecture. 
Durable media provenance and watermarking. 
Safeguarding our services from abusive content and conduct.    
Robust collaboration across industry and with governments and civil society. 
Modernized legislation to protect people from the abuse of technology. 
Public awareness and education.

Core to all six of these is our responsibility to help address the abusive use of technology. We believe it is imperative that the tech sector continue to take proactive steps to address the harms we are seeing across services and platforms. We’ve taken concrete steps, including: 

Implementing a safety architecture that includes red team analysis, preemptive classifiers, blocking of abusive prompts, automated testing, and rapid bans of users who abuse the system. 
Automatically attaching provenance metadata to images generated with OpenAI’s DALL-E 3 model in Azure OpenAI Service, Microsoft Designer, and Microsoft Paint. 
Developing standards for content provenance and authentication through the Coalition for Content Provenance and Authenticity (C2PA) and implementing the C2PA standard so that content carrying the technology is automatically labelled on LinkedIn. 
Taking continued steps to protect users from online harms, including by joining the Tech Coalition’s Lantern program and expanding PhotoDNA’s availability. 
Launching new detection tools like Azure Operator Call Protection for our customers to detect potential phone scams using AI. 
Executing our commitments to the new Tech Accord to combat deceptive use of AI in elections.

Protecting Americans through new legislative and policy measures   

This February, Microsoft and LinkedIn joined dozens of other tech companies to launch the Tech Accord to Combat Deceptive Use of AI in 2024 Elections at the Munich Security Conference. The Accord calls for action across three key pillars that we utilized to inspire the additional work found in this white paper: addressing deepfake creation, detecting and responding to deepfakes, and promoting transparency and resilience. 

In addition to combating AI deepfakes in our elections, it is important for lawmakers and policymakers to take steps to expand our collective abilities to (1) promote content authenticity, (2) detect and respond to abusive deepfakes, and (3) give the public the tools to learn about synthetic AI harms. We have identified new policy recommendations for policymakers in the United States. As one thinks about these complex ideas, we should also remember to think about this work in straightforward terms. These recommendations aim to: 

Protect our elections.  
Protect seniors and consumers from online fraud.  
Protect women and children from online exploitation.

Along those lines, it is worth mentioning three ideas that may have an outsized impact in the fight against deceptive and abusive AI-generated content. 

First, Congress should enact a new federal “deepfake fraud statute.” We need to give law enforcement officials, including state attorneys general, a standalone legal framework to prosecute AI-generated fraud and scams as they proliferate in speed and complexity. 
Second, Congress should require AI system providers to use state-of-the-art provenance tooling to label synthetic content. This is essential to build trust in the information ecosystem and will help the public better understand whether content is AI-generated or manipulated. 
Third, we should ensure that our federal and state laws on child sexual exploitation and abuse and non-consensual intimate imagery are updated to include AI-generated content. Penalties for the creation and distribution of CSAM and NCII (whether synthetic or not) are common-sense and sorely needed if we are to mitigate the scourge of bad actors using AI tools for sexual exploitation, especially when the victims are often women and children.

These are not necessarily new ideas. The good news is that some of these ideas, in one form or another, are already starting to take root in Congress and state legislatures. We highlight specific pieces of legislation that map to our recommendations in this paper, and we encourage their prompt consideration by our state and federal elected officials. 

Microsoft offers these recommendations to contribute to the much-needed dialogue on AI synthetic media harms. Enacting any of these proposals will fundamentally require a whole-of-society approach. While it’s imperative that the technology industry have a seat at the table, it must do so with humility and a bias towards action. Microsoft welcomes additional ideas from stakeholders across the digital ecosystem to address synthetic content harms. Ultimately, the danger is not that we will move too fast, but that we will move too slowly or not at all. 

Tags: AI , elections , generative ai , LinkedIn , Online Safety , Responsible AI

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Guest Essay

14 Questions About Our Leaders’ Health

A black-and-white photo of a closed medical file with a few papers sticking out a bit around the edges.

By Robert Klitzman

Dr. Klitzman is a physician and a professor of psychiatry at Columbia University.

There’s been enormous debate about the health of America’s president and that of the candidates for that job. Many questions remain unanswered.

Donald Trump recently survived an assassination attempt, and there’s been little information offered about his condition in its aftermath. President Biden’s age and cognitive health have been the subject of much discussion, and he just had Covid-19. And little is known about the overall health of the new presumptive Democratic nominee, Kamala Harris.

Like all of us, these individuals have rights to medical privacy. But, given that the president is the most powerful person in the world and can alter our lives, voters want to know whether their leaders can perform the job, and do so effectively. Ideally, officials and candidates voluntarily provide this information. But some past presidents’ physicians have released only incomplete reports, or have obfuscated the truth .

Below is a partial list of questions that I and many other medical professionals (and Americans) have about Mr. Trump, Mr. Biden and Ms. Harris right now.

For Donald Trump:

1) Has Mr. Trump taken any cognitive tests in the last six years. If so, which ones? And what were the results?

Mr. Trump has been making cognitive errors, mixing up the names of Nikki Haley and Nancy Pelosi , as well as of Kim Jong-un and Xi Jinping . He said he “aced” a cognitive test four years ago. Doctors have said that the test Mr. Trump is likely referring to was not definitive, nor diagnostic.

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Explosion at Tuapse Oil Refinery in Russia’s Krasnodar Krai; UAVs Spotted Prior

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1- UAVs flying over Krasnodar Krai 2- Explosion at Tuapse oil refinery.

Explosion at Tuapse Oil Refinery in Russia Raises Concerns

In a recent and concerning development, several unmanned aerial vehicles (UAVs) were spotted flying over Russia’s Krasnodar Krai region just moments before a massive explosion occurred at the Tuapse oil refinery. This incident has raised questions about potential security threats and the safety of oil facilities in the area.

Unmanned Aerial Vehicles Spotted Before Explosion

Eyewitnesses reported seeing multiple UAVs in the skies above Krasnodar Krai shortly before the blast at the Tuapse oil refinery. These unmanned aircraft were observed maneuvering in a manner that suggested a coordinated operation. The presence of these drones has sparked speculation about possible malicious intent, with concerns of potential sabotage or terrorist activity.

Increased Security Measures Urgently Needed

The incident at the Tuapse oil refinery highlights the need for enhanced security measures at critical infrastructure sites. Authorities must investigate the incident thoroughly and take immediate steps to prevent similar occurrences in the future. The safety of oil refineries and other vital installations is of paramount importance, not only to Russia but also to the global energy network.

Impact on Oil Production and Supply

The explosion at the Tuapse oil refinery raises concerns about its impact on oil production and supply. The facility plays a crucial role in meeting Russia’s domestic energy demands and also contributes to global oil markets. Any disruption in its operations could result in a shortage of refined petroleum products, leading to potential price increases and supply chain challenges.

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Investigation underway.

Authorities have launched a detailed investigation into the incident at the Tuapse oil refinery. They are examining surveillance footage, analyzing witness accounts, and exploring potential motives behind the explosion. Identifying the individuals or groups responsible for this act of sabotage is crucial for maintaining the security and stability of the region.

Oil Refinery Safety and Security Measures

The Tuapse oil refinery incident has shed light on the need for comprehensive safety and security measures at similar facilities worldwide. Oil refineries are attractive targets for various threats, including terrorism and industrial accidents. Implementing robust security protocols, including advanced surveillance systems, access control measures, and regular safety drills, is essential to safeguarding these critical installations.

International Cooperation for Enhanced Security

Ensuring the safety of oil refineries and other critical infrastructure requires international cooperation. Sharing best practices, intelligence, and technological advancements can help countries strengthen their security systems and prevent potential threats. Collaborative efforts among nations facing similar challenges will contribute to a safer and more secure energy landscape globally.

The explosion at the Tuapse oil refinery in Russia’s Krasnodar Krai region has raised concerns about the security of oil facilities and the potential for sabotage. The presence of unmanned aerial vehicles before the blast has added another layer of intrigue to the investigation. It is imperative that authorities take swift action to enhance security measures and identify those responsible for this incident. The safety of oil refineries and critical infrastructure must be prioritized to ensure uninterrupted oil production and supply, both in Russia and across the world..

https://twitter.com/raviagrawal3/status/1750286795131236420

@raviagrawal3 said Breaking Ukraine Russia 1-Several UAVs were flying over Russia's Krasnodar Krai before the explosion at the Tuapse oil refinery. 2-Another close-up footage of the Tuapse oil refinery, Krasnodar Krai, Russia,

RELATED STORY.

1- UAVs flying over Krasnodar Krai before explosion at Tuapse oil refinery 2- Close-up footage of Tuapse oil refinery, Krasnodar Krai, Russia.

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Gastrointestinal Drugs Advisory Committee; Notice of Meeting; Establishment of a Public Docket; Request for Comments-Supplemental New Drug Application 207999 S-011 for OCALIVA (obeticholic acid) Oral Tablets

A Notice by the Food and Drug Administration on 08/12/2024

This document has been published in the Federal Register . Use the PDF linked in the document sidebar for the official electronic format.

Document Details Published Content - Document Details Agencies Department of Health and Human Services Food and Drug Administration Agency/Docket Number Docket No. FDA-2024-N-3569 Document Citation 89 FR 65635 Document Number 2024-17926 Document Type Notice Pages 65635-65637 (3 pages) Publication Date 08/12/2024 Published Content - Document Details
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Document Dates Published Content - Document Dates Dates Text The meeting will be held on September 13, 2024, from 8:30 a.m. to 5 p.m. Eastern Time. Published Content - Document Dates

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Department of Health and Human Services

Food and drug administration.

[Docket No. FDA-2024-N-3569]

Food and Drug Administration, HHS.

Notice; establishment of a public docket; request for comments.

The Food and Drug Administration (FDA) announces a forthcoming public advisory committee meeting of the Gastrointestinal Drugs Advisory Committee (the Committee). The general function of the Committee is to provide advice and recommendations to FDA on regulatory issues. The meeting will be open to the public. FDA is establishing a docket for public comment on this document.

The meeting will be held on September 13, 2024, from 8:30 a.m. to 5 p.m. Eastern Time.

The public may attend the meeting at the FDA White Oak Campus, 10903 New Hampshire Ave., Bldg. 31 Conference Center, the Great Room (Rm. 1503), Silver Spring, MD 20993-0002. The public will also have the option to participate, and the advisory committee meeting will be heard, viewed, captioned, and recorded through an online teleconferencing and/or video conferencing platform.

Answers to commonly asked questions about FDA advisory committee meetings, including information regarding special accommodations due to a disability, visitor parking, and transportation, may be accessed at: https://www.fda.gov/AdvisoryCommittees/AboutAdvisoryCommittees/ucm408555.htm .

FDA is establishing a docket for public comment on this meeting. The docket number is FDA-2024-N-3569. The docket will close on September 12, 2024. Please note that late, untimely filed comments will not be considered. The https://www.regulations.gov electronic filing system will accept comments until 11:59 p.m. Eastern Time at the end of September 12, 2024. Comments received by mail/hand delivery/courier (for written/paper submissions) will be considered timely if they are received on or before that date.

Comments received on or before August 29, 2024, will be provided to the Committee. Comments received after that date will be taken into consideration by FDA. In the event that the meeting is cancelled, FDA will continue to evaluate any relevant applications or information, and consider any comments submitted to the docket, as appropriate.

You may submit comments as follows:

Submit electronic comments in the following way:

Federal eRulemaking Portal: https://www.regulations.gov . Follow the instructions for submitting comments. Comments submitted electronically, including attachments, to https://www.regulations.gov will be posted to the docket unchanged. Because your comment will be made public, you are solely responsible for ensuring that your comment does not include any confidential information that you or a third party may not wish to be posted, such as medical information, your or anyone else's Social Security number, or confidential business information, such as a manufacturing process. Please note that if you include your name, contact information, or other information that identifies you in the body of your comments, that information will be posted on https://www.regulations.gov .
If you want to submit a comment with confidential information that you do not wish to be made available to the public, submit the comment as a written/paper submission and in the manner detailed (see “Written/Paper Submissions” and “Instructions”).

Submit written/paper submissions as follows:

Mail/Hand Delivery/Courier (for written/paper submissions): Dockets Management Staff (HFA-305), Food and Drug Administration, 5630 Fishers Lane, Rm. 1061, Rockville, MD 20852.
For written/paper comments submitted to the Dockets Management Staff, FDA will post your comment, as well as any attachments, except for information submitted, marked and identified, as confidential, if submitted as detailed in “Instructions.”

Instructions: All submissions received must include the Docket No. FDA-2024-N-3569 for “Gastrointestinal Drugs Advisory Committee; Notice of Meeting; Establishment of a Public Docket; Request for Comments—Supplemental New Drug Application 207999 S-011 for OCALIVA (obeticholic acid) Oral Tablets.” Received comments, those filed in a timely manner (see ADDRESSES ), will be placed in the docket and, except for those submitted as “Confidential Submissions,” publicly viewable at https://www.regulations.gov or at the Dockets Management Staff between 9 a.m. and 4 p.m., Monday through Friday, 240-402-7500.

Confidential Submissions—To submit a comment with confidential information that you do not wish to be made publicly available, submit your comments only as a written/paper submission. You should submit two copies total. One copy will include the information you claim to be confidential with a heading or cover note that states “THIS DOCUMENT CONTAINS CONFIDENTIAL INFORMATION.” FDA will review this copy, including the claimed confidential information, in its consideration of comments. The second copy, which will have the claimed confidential information redacted/blacked out, will be available for public viewing and posted on https://www.regulations.gov . Submit both copies to the Dockets Management Staff. If you do not wish your name and contact information be made publicly available, you can provide this information on the cover sheet and not in the body of your comments and you must identify the information as “confidential.” Any information marked as “confidential” will not be disclosed except in accordance with 21 CFR 10.20 and other applicable disclosure law. For more information about FDA's posting of comments to public dockets, see 80 FR 56469 , September 18, 2015, or access the information at: https://www.govinfo.gov/content/pkg/FR-2015-09-18/pdf/2015-23389.pdf .

Docket: For access to the docket to read background documents or the electronic and written/paper comments received, go to https://www.regulations.gov and insert the docket number, found in brackets in the heading of this document, into the “Search” box and follow the prompts and/or go to the Dockets Management Staff, 5630 Fishers Lane, Rm. 1061, Rockville, MD 20852, 240-402-7500.

Jessica Seo, Center for Drug Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Ave., Bldg. 31, Rm. 2417, Silver Spring, MD 20993-0002, 301-796-7699, email: [email protected] , or FDA Advisory Committee Information Line, 1-800-741-8138 (301-443-0572 in the Washington, DC area). A notice in the Federal Register about last-minute modifications that impact a previously announced advisory committee meeting cannot always be published quickly enough to provide timely notice. Therefore, you should always check FDA's website at https://www.fda.gov/AdvisoryCommittees/default.htm and scroll down to the appropriate advisory committee meeting link, or call the advisory committee information line to learn about possible modifications before the meeting.

Agenda: The Committee will discuss supplemental new drug application (sNDA) 207999 S-011, for OCALIVA (obeticholic acid) 5 mg titrated to 10 mg oral tablets, administered once a day, submitted by Intercept Pharmaceuticals, Inc., to fulfill the accelerated approval postmarketing requirements specified in the OCALIVA approval letter dated May 27, 2016. The sNDA included data proposed to describe and verify clinical benefit for the indication for the treatment of adult patients with primary biliary cholangitis without cirrhosis or with compensated cirrhosis who do not have evidence of portal hypertension, either in combination with ursodeoxycholic acid (UDCA) with an inadequate response to UDCA or as monotherapy in patients unable to tolerate UDCA.

FDA intends to make background material available to the public no later than 2 business days before the meeting. If FDA is unable to post the background material on its website prior to the meeting, the background material will be made publicly available on FDA's website at the time of the advisory committee meeting. Background material and the link to the online teleconference and/or video conference meeting will be available at the location of the advisory committee meeting and at https://www.fda.gov/AdvisoryCommittees/Calendar/default.htm . Scroll down to the appropriate advisory committee meeting link. The meeting presentations will also be heard, viewed, captioned, and recorded through an online teleconferencing and/or video conferencing platform. The online presentation of materials will include slide presentations with audio and video components in a manner that most closely resembles an in-person advisory committee meeting.

Procedure: Interested persons may present data, information, or views, orally or in writing, on issues pending before the Committee. All electronic and written submissions to the Docket (see ADDRESSES ) on or before August 29, 2024, will be provided to the Committee. Oral presentations from the public will be scheduled between approximately 1:30 p.m. to 2:30 p.m. Eastern Time. Those individuals interested in making formal oral presentations should notify the contact person and submit a brief statement of the general nature of the evidence or arguments they wish to present, the names and addresses of proposed participants, whether they would like to present online or in-person, and an indication of the approximate time requested to make their presentation on or before August 21, 2024. Time allotted for each presentation may be limited. If the number of registrants requesting to speak is greater than can be reasonably accommodated during the scheduled open public hearing session, FDA may conduct a lottery to determine the speakers for the scheduled open public hearing session. Similarly, room for interested persons to participate in-person may be limited. If the number of registrants requesting to speak in-person during the open public hearing is greater than can be reasonably accommodated in the venue for the in-person portion of the advisory committee meeting, FDA may conduct a lottery to determine the speakers who will be invited to participate in-person. The contact person will notify interested persons regarding their request to speak by August 22, 2024. Persons attending FDA's advisory committee meetings are advised that FDA is not responsible for providing access to electrical outlets.

For press inquiries, please contact the Office of Media Affairs at [email protected] or 301-796-4540.

FDA welcomes the attendance of the public at its advisory committee meetings and will make every effort to accommodate persons with disabilities. If you require accommodations due to a disability, please contact Jessica Seo (see FOR FURTHER INFORMATION CONTACT ) at least 7 days in advance of the meeting.

FDA is committed to the orderly conduct of its advisory committee meetings. Please visit our website at https://www.fda.gov/AdvisoryCommittees/AboutAdvisoryCommittees/ucm111462.htm for procedures on public conduct during advisory committee meetings.

Notice of this meeting is given under the Federal Advisory Committee Act ( 5 U.S.C. 1001 et seq. ). This meeting notice also serves as notice that, pursuant to 21 CFR 10.19 , the requirements in 21 CFR 14.22(b) , (f) , and (g) relating to the location of advisory committee meetings are hereby waived to allow for this meeting to take place using an online meeting platform in conjunction with the physical meeting room (see location). This waiver is in the interest of allowing greater transparency and opportunities for public participation, in addition to convenience for advisory committee members, speakers, and guest speakers. The conditions for issuance of a waiver under 21 CFR 10.19 are met.

Dated: August 7, 2024.

Lauren K. Roth,

Associate Commissioner for Policy.

[ FR Doc. 2024-17926 Filed 8-9-24; 8:45 am]

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New Mexico recruiting Texas health care workers in response to state’s tough abortion laws

The new mexico department of health has taken out newspaper ads and posted billboards across the lone star state..

11:25 AM on Aug 5, 2024 CDT

In Houston, billboards for the New Mexico initiative popped up two weeks ago and will remain...

New Mexico is appealing directly to Texas health care providers in a multi-city campaign urging them to ditch the Lone Star State over abortion restrictions.

As part of a new “Free to Provide” initiative, the New Mexico Department of Health ran full-page ads in five major Texas papers Sunday — including The Dallas Morning News — that featured a letter from New Mexico Gov. Michelle Lujan Grisham referencing Texas’ abortion laws that are among the country’s strictest.

“You took your oath with patients — not politicians — in mind,” Lujan Grisham said in the open letter. “I certainly respect those of you who remain committed to caring for patients in Texas, but I also invite those of you who can no longer tolerate these restrictions to consider practicing next door in New Mexico.”

Related: New Mexico group creates haven for Texas abortion seekers

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Texas’ abortion legislation bans the procedure in all cases except to protect the life of the mother. Abortion is legal in New Mexico, which also has a so-called shield law to protect abortion providers from investigations by other states.

More than 14,200 Texans traveled to New Mexico for abortion care in 2023, according to a recent analysis by the Guttmacher Institute. Kansas, the state with the next-highest number of Texas abortion patients, saw over 6,600 in the same year.

Texas patients “far and away” outnumber patients who are coming to New Mexico from other states, New Mexico Department of Health Cabinet Secretary Patrick Allen said in an interview. The state, like most others, is hurting for more physicians across nearly all specialties.

Related: State medical board adopts rules on how doctors can work under abortion bans

“We think that’s sort of an obvious opportunity. The legal circumstances are pretty dramatic in Texas,” Allen said. “People who live in Texas have maybe got some affinity with living in the Southwest, and so we don’t think it’s a huge leap for them, culturally, to think about New Mexico.”

Andrew Mahaleris, press secretary for Texas Gov. Greg Abbott, pushed back at the advertisements in a statement Monday.

“People and businesses vote with their feet, and continually they are choosing to move to Texas more than any other state in the country,” Mahaleris said. “Gov. Lujan Grisham should focus on her state’s rapidly declining population instead of political stunts.”

The campaign, which has cost around $400,000, also ran ads in the Austin-American Statesman, Houston Chronicle, San Antonio Express-News and Fort Worth Star-Telegram . Billboards for the initiative popped up around the Texas Medical Center in Houston two weeks ago and will remain up for at least two more weeks, Allen said.

Already, Texas is struggling to recruit medical residents in the wake of the Dobbs decision that undid federal abortion protections. In the 2023-24 application cycle, residency applications fell 16% for Texas OB-GYN programs and 12.6% for family medicine, according to Association of American Medical Colleges data . Applications across all specialties in the state dropped 11.7%.

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Gastrointestinal Drugs Advisory Committee; Notice of Meeting; Establishment of a Public Docket; Request for Comments-Supplemental New Drug Application 207999 S-011 for OCALIVA (obeticholic acid) Oral Tablets

Electronic Submissions

Protecting the public from abusive AI-generated content 