Assessment of public perspectives and barriers towards dengue preventive practices using the Health Belief Model in Puducherry,India:A cross-sectional study

Objective:To assess the perspectives and barriers towards dengue preventive practices among the residents of Puducherry,India.Methods:A cross-sectional survey was conducted in 300 households in Puducherry,using a population-proportionate(7:3)distribution from urban and rural areas by grid sampling.One adult interview per household was conducted and the participants were selected using a KISH grid.A semi-structured questionnaire based on the Health Belief Model(HBM)with additional questions on knowledge assessment was used.Knowledge was assessed based on the correctness of answers and the HBM scores were calculated on a 5-point Likert scale.Participants were categorized based on the median score under each domain.Logistic regression was used for adjusted analysis and models were built to predict the performances in each domain.Results:Four percent of the participants lacked basic knowledge regarding dengue transmission.While 208(69.3%)participants did not consider themselves at risk of contracting dengue within the next year,majority perceived dengue as a disease with low severity.Around 49.3%(148)were skeptical about the benefit of time and money spent on dengue prevention.Inadequate government efforts were stated as the major barrier(47.0%)and frequent reminders(142,47.3%)as the major cue to action.Age above 50 years(aOR 1.78,95%CI 1.04-3.06,P=0.037)and rural locality(aOR 2.68,95%CI 1.52-4.71,P=0.001)were found to be significantly associated with poor knowledge scores.Urban participants had a significantly higher chance to perceive low susceptibility as compared to the rural counterparts(aOR 1.74,95%CI 1.05-2.9,P=0.03).Participants with less than a high school education had low perceived benefits(aOR 2.46,95%CI 1.52-3.96,P<0.001)and low self-efficacy scores(aOR 2.66,95%CI 1.61-4.39,P<0.001).Conclusions:This study identifies key gaps in dengue prevention,including low perceived susceptibility,mild disease perception,limited knowledge of breeding sites,and overreliance on government efforts.Tailoring interventions to community needs,stratified to factors influencing the community perspectives can significantly improve dengue prevention efforts.

Dynamic analysis of major public health emergency transmission considering the dual-layer coupling of community–resident complex networks

We construct a dual-layer coupled complex network of communities and residents to represent the interconnected risk transmission network between communities and the disease transmission network among residents. It characterizes the process of infectious disease transmission among residents between communities through the SE2IHR model considering two types of infectors. By depicting a more fine-grained social structure and combining further simulation experiments, the study validates the crucial role of various prevention and control measures implemented by communities as primary executors in controlling the epidemic. Research shows that the geographical boundaries of communities and the social interaction patterns of residents have a significant impact on the spread of the epidemic, where early detection, isolation and treatment strategies at community level are essential for controlling the spread of the epidemic. In addition, the study explores the collaborative governance model and institutional advantages of communities and residents in epidemic prevention and control.

Ancylostoma ceylanicum and other zoonotic canine hookworms:neglected public and animal health risks in the Asia-Pacific region

Zoonotic hookworm infections remain a significant public health problem,causing nearly 500 milion cases globally and approximately four million disability-adjusted life years lost annually.More than one-fth of these cases are attrib-uted to Ancylostoma ceylanicum,an emerging zoonotic health issue in the Asia-Pacific region.This review presents key research gaps regarding the epidemiology,diagnosis,control,prevention and elimination of A.ceylanicum and other canine zoonotic hookworms as neglected health threats.A.ceylanicum is the second most prevalent human hook-worm in the region;it is the most common hookworm among dogs and cats-reservoirs of zoonotic infections.Previous population genetic and phylogenetic analyses revealed that A.ceylanicum has three possible transmis-sion dynamics:zoonotic,animal-only,and human-only pathways.The actual burden of zoonotic ancylostomiasis in most endemic countries remains unknown due to the use of parasitological techniques(e.g.,Kato-Katz thick smear and floatation techniques)that have reduced diagnostic performance and do not allow accurate species identifica-tion in helminth surveys.The emergence of benzimidazole resistance in soil-transmitted helminths(STHs),includ-ing hookworms,is a concern due to the protracted implementation of mass drug administration(MDA).Resistance is conferred by single nucleotide polymorphisms(SNPs)that occur in theβ-tubulin isotype 1 gene.These mutations have been reported in drug-resistant A.caninum but have not been found in A.ceylanicum in the field.A.ceylanicum remains understudied in the Asia-Pacific region.The zoonotic nature of the parasite warrants investigation of its occur-rence in human and animal reservoir hosts to understand the dynamics of zoonotic transmission in different endemic foci.The detection of benzimidazole resistance-associated SNPs in zoonotic hookworms from Asia-Pacific countries has yet to be thoroughly explored.Considering the high level of hookworm endemicity in the region,the circulation of resistant isolates between humans and animals potentially presents a significant One Health threat that can under-mine current MDA and proposed animal deworming-based control efforts.

REDISSE in Benin and Lessons Learned for the Management of Public Health Emergencies after Five Years of Implementation

Introduction: Benin was embarked on phase 3 of the REDISSE Benin project (Regional Disease Surveillance Systems Enhancement) which began in 2018. The objectives were in five key components namely, Surveillance and health information;Laboratory capacity building;Emergency preparedness and response;Human resources management for effective disease surveillance and epidemic preparedness;and Institutional Capacity Building, Project Management, Coordination and Advocacy. After five years of implementation, this study aimed at the documentation of lessons learned and best practices. Methods: A descriptive cross-sectional study. Apart from individual semi-structured interviews, a thematic workshops bringing together the project’s main stakeholders recruited on an exhaustive way by component to identify and validate lessons learned, good practices and propose improvement mechanisms to be taken into account by the sector. Criteria were set up and used to validate best practices and lessons learned. Results: A total 54 (Surveillance workshop), 47 (Preparedness & response workshop), 53 (Human Resources workshop), 26 (Laboratories workshop) participated to the thematic workshops, and five interviews. The good practices (33: 9 for animal health, 7 for human health and 17 crosscutting) and lessons learned (10: 3 for animal health and 7 for human health) have been identified and have been the subject, depending on the case, of proposals for improvement or conditions necessary for their maintenance. Discussion: The richness of a project lies not only in the immediate achievement of its results, but also and above all, in its usefulness for similar interventions, whether in the local, regional, national or international context. It is in this context that the REDISSE project has set out to make public the various lessons learned and best practices from the implementation of its activities over a period of some five consecutive years.

Greenway Non-mortorized System Planning from the Perspective of Public Health

The important role of greenway non-mortorized systems in urban sustainable development was summarized,pointing out their potential value in improving the ecological environment,promoting healthy living,and enhancing community connections.Based on the analysis on some cases of urban greenway construction in China,specific transformation models and strategies were proposed for greenway construction,which could integrate green spaces with non-mortorized system,so as to enhance the comprehensive efficiency of urban linear spaces.

Principle for the Installation of Accommodation for Sick guards in Public Health Establishments in Brazzaville in the Republic of Congo

The results of scientific studies of human social facts in the field of health show that the management of a patient should involve the patient’s entourage,whatever the status or size of the health establishment.In healthcare establishments in the Congo,the following are recognised as being responsible for medical care:specialist doctors,doctors,midwives,nurses and care assistants.The patient’s family and close friends are responsible for looking after the patient and financing care.The hospital infrastructure does not provide any space for the patient warden who accompany the patient during reception and hospitalisation.This makes Congolese hospitals inefficient for patient care.How can we integrate the function of the Sick guard and the assistance of the family,in order to reduce the mortality rate and repair the harm caused to patients requiring the presence of relatives during their stay in hospital,which is considered to be a dangerous place?This article examines the functional principles for configuring the space that patient warden would occupy in the patient care system.On the basis of a documentary analysis of sociological and architectural studies of existing facilities,this article proposes a typical accommodation model with the spaces needed to ensure the well-being and effectiveness of the patient warden with the patient.These are rooms with minimum space for 2 to 4 individual beds,equipped with toilets and showers.The accommodation has a dining area,kitchen and laundry facilities.In the future,this accommodation will become part of the hospital estate and may be occupied by orderlies and patient warden recruited by the hospital administration.

Comprehensive Analysis of Cancer Incidence and Mortality Trends in Costa Rica: Implications for Public Health

This commentary delves into the evolving landscape of cancer incidence and mortality in Costa Rica, presenting a comprehensive analysis of the data. Key findings reveal a concerning upward trajectory in cancer incidence rates, placing Costa Rica at the forefront within Central America. While prostate cancer and breast cancer dominate, disparities emerge when scrutinizing gender-specific trends. Notably, stomach and cervical cancers show declines, potentially attributed to targeted interventions. However, colorectal and liver cancers witness mortality increases, necessitating strategic responses. Geographical disparities persist across provinces, highlighting the need for equitable healthcare access. In conclusion, this commentary underscores the urgency of addressing the burgeoning cancer burden in Costa Rica, calling for evidence-based interventions and collaborative efforts on a global scale.

Identification and Optimisation of Cycling Life Circle in High Density Communities with Public Health Support: A Case Study of Tiantongyuan in Beijing

In recent years,the compact development of high-density cities has sparked ongoing interest in healthy urban environments and public well-being.This study examines the relationship between cycling behaviors and the built environment of streets in Tiantongyuan Community,a typical high-density area in Beijing,China.By observing street spaces and summarizing residents’travel modes and behaviors,the study evaluates the impact of street design on cycling habits.In order to reveal the riding behavior characteristics of residents in different time periods and different street spaces,tools such as track recording APPs and the Gopro Motion Camera are employed to collect street view pictures and riding track data comprehensively,analyzing the various travel purposes of residents in Tiantongyuan community and the riding OD activity tracks of the main entrances and exits of the community.Meanwhile,by conducting the questionnaire survey of residents’travel demands and OD data of Baidu,and utilizing geographic information system(GIS)for data visualization,this study further investigates the distribution characteristics of cycling hotspots,cycling paths and cycling space,accurately identifies the cycling life circle of this community based on the spatial and temporal scales,and further puts forward the optimization strategy of the cycling network.Some cycling-friendly street space optimization strategies are suggested to deeply analyze the mechanism of the built environment of street space in high-density communities on the cycling activities and health of urban residents,with a view to provide accurate data support for the renewal of street cycling space.

Linking Perceived Risk of Public Health Emergency to Psychological Distress among Chinese College Students: The Chain Mediation Role of Balanced Time Perspective and Negative Coping Styles

Background:With public health emergencies(PHE)worldwide increasing,the perceived risk of PHE has been one of the critical factors influencing college students’psychological distress.However,the mechanisms by which the perceived risk of PHE affects college students’psychological distress are not clear.The study’s purpose was to investigate the mediation roles of deviation from a balanced time perspective(DBTP)and negative coping styles between the perceived risk of PHE and psychological distress.Methods:A convenience sampling method was used to survey 1054 Chinese college students with self-reporting.Data was collected using the Public Risk Perception Scale(PRPS),the Zimbardo Time Perspective Inventory(ZTPI),the Simplified Coping Style Questionnaire(SCSQ),the PHE Anxiety Scale,and the Chinese version of the Patient Health Questionnaire(PHQ).The associations between the perceived risk of PHE,DBTP,negative coping styles,and psychological distress were clarified using the correlation analysis.Additionally,the mediating roles of DBTP and negative coping styles between the perceived risk of PHE and psychological distress were investigated using a structural equation model.Results:The findings revealed low to moderate correlations between the variables studied.Students’perceived risk of PHE was a positive predictor of their psychological distress(b=0.219,p<0.01).DBTP and negative coping styles played chain mediation roles between them with the effect being 0.009 and a 95%Boot CI of[0.003,0.023].This chain mediation model had an excellent fit index(χ^(2)/df=4.732,CFI=0.973,TLI=0.930,RMSEA=0.048,SRMR=0.047).Conclusion:These findings showed how the perceived risk of PHE affected college students’psychological distress.Specifically,these results suggested that improving students’mental ability to switch effectively among different time perspectives depending on task features and situational considerations and reducing their negative coping styles might be effective ways to promote their mental health.

Work experience of special workers returning to work after the public health emergency:taking ICU nurses who have been infected with COVID-19 as example

Objective:The occurrence of some public health events inevitably endangers medical personnel,and medical personnel,as a special group,have to resume work on time to treat patients.This coronavirus disease-2019(COVID-19)infection is a good example,and what intensive care unit(ICU)nurses experience as the primary caregivers of critically ill patients after COVID-19 infection is our focus.To explore the work experience of ICU nurses after recovery from COVID-19,and to provide a theoretical basis for the intervention to improve the physical and mental health level and work experience of special workers in public health emergencies.Methods:We conducted an explorative descriptive study using an inductive thematic analysis.Using the maximum differential sampling method,a semi-structured interview was conducted among 13 ICU nurses suffered from COVID-19 in a tertiary grade A hospital in Qingdao,Shandong Province.This study carried on the theme analysis according to the inductive content analysis method and used MAXQDA 2020 Analytics Pro(VERBI Software GmbH,Berlin,Germany)to manage and summarize the interview data.Results:After being infected by the virus,SARS-Coronavirus-2(SARS-CoV-2),the pathogen of COVID-19,the work experience of ICU nurses was extracted from the following 5 themes:(1)Stress and challenge caused by the change of work focus;(2)downsizing,overtime,taking up work with illness,and physical discomfort;(3)dedication and family debt;(4)unknown fear and helplessness;and(5)professional responsibility and sense of benefit.Conclusions:Under the pressure of COVID-19,ICU nurses face multiple pressures and challenges,and their emotions are complex.We suggest that nursing managers should take corresponding measures to alleviate nurses'physical and psychological pressure and improve their work experience.

Assessing healthcare workers’knowledge and confidence in the diagnosis,management and prevention of Monkeypox

BACKGROUND Monkeypox(Mpox),is a disease of global public health concern,as it does not affect only countries in western and central Africa.AIM To assess Burundi healthcare workers(HCWs)s’level of knowledge and confidence in the diagnosis and management of Mpox.METHODS We conducted a cross-sectional study via an online survey designed mainly from the World Health Organization course distributed among Burundi HCWs from June-July 2023.The questionnaire comprises 8 socioprofessional-related questions,22 questions about Mpox disease knowledge,and 3 questions to assess confidence in Mpox diagnosis and management.The data were analyzed via SPSS software version 25.0.A P value<0.05 was considered to indicate statistical significance.RESULTS The study sample comprised 471 HCWs who were mainly medical doctors(63.9%)and nurses(30.1%).None of the 22 questions concerning Mpox knowledge had at least 50%correct responses.A very low number of HCWs(17.4%)knew that Mpox has a vaccine.The confidence level to diagnose(21.20%),treat(18.00%)or prevent(23.30%)Mpox was low among HCWs.The confidence level in the diagnosis of Mpox was associated with the HCWs’age(P value=0.009),sex(P value<0.001),work experience(P value=0.002),and residence(P value<0.001).The confidence level to treat Mpox was significantly associated with the HCWs’age(P value=0.050),sex(P value<0.001),education(P value=0.033)and occupation(P value=0.005).The confidence level to prevent Mpox was associated with the HCWs’education(P value<0.001),work experience(P value=0.002),residence(P value<0.001)and type of work institution(P value=0.003).CONCLUSION This study revealed that HCWs have the lowest level of knowledge regarding Mpox and a lack of confidence in the ability to diagnose,treat or prevent it.There is an urgent need to organize continuing medical education programs on Mpox epidemiology and preparedness for Burundi HCWs.We encourage future researchers to assess potential hesitancy toward Mpox vaccination and its associated factors.

Reevaluating health metrics:Unraveling the limitations of disabilityadjusted life years as an indicator in disease burden assessment

In 1993,the World Bank released a global report on the efficacy of health promotion,introducing the disability-adjusted life years(DALY)as a novel indicator.The DALY,a composite metric incorporating temporal and qualitative data,is grounded in preferences regarding disability status.This review delineates the algorithm used to calculate the value of the proposed DALY synthetic indicator and elucidates key methodological challenges associated with its application.In contrast to the quality-adjusted life years approach,derived from multi-attribute utility theory,the DALY stands as an independent synthetic indicator that adopts the assumptions of the Time Trade Off utility technique to define Disability Weights.Claiming to rely on no mathematical or economic theory,DALY users appear to have exempted themselves from verifying whether this indicator meets the classical properties required of all indicators,notably content validity,reliability,specificity,and sensitivity.The DALY concept emerged primarily to facilitate comparisons of the health impacts of various diseases globally within the framework of the Global Burden of Disease initiative,leading to numerous publications in international literature.Despite widespread adoption,the DALY synthetic indicator has prompted significant methodological concerns since its inception,manifesting in inconsistent and non-reproducible results.Given the substantial diffusion of the DALY indicator and its critical role in health impact assessments,a reassessment is warranted.This reconsideration is imperative for enhancing the robustness and reliability of public health decisionmaking processes.

Reviewing the application and development of DEA and the combination of various research methods in public health

文章根据数据包络分析方法（ DEA） 在公共卫生中的使用情况,介绍了多元线性回归分析、SFA模 型、Malmquist指数分析、Bootstrap分析、Tobi t回归分析与DEA的组合方式,并对 DEA在公共卫生中的发展做出进一步讨论.

Aflatoxins,hepatocellular carcinoma and public health

Hepatocellular carcinoma(HCC) is one of the leading causes of cancer deaths worldwide,primarily affecting populations in the developing countries.Aflatoxin,a food contaminant produced by the fungi Aspergillus flavus and Aspergillus parasiticus,is a known human carcinogen that has been shown to be a causative agent in the pathogenesis of HCC.Aflatoxin can affect a wide range of food commodities including corns,oilseeds,spices,and tree nuts as well as milk,meat,and dried fruit.Many factors affect the growth of Aspergillus fungi and the level of aflatoxin contamination in food.Drought stress is one of the factors that increase susceptibility of plants to Aspergillus and thus aflatoxin contamination.A recent drought is thought to be responsible for finding of trace amounts of aflatoxin in some of the corn harvested in the United States.Although it's too soon to know whether aflatoxin will be a significant problem,since United States is the world's largest corn producer and exporter,this has raised alarm bells.Strict regulations and testing of finished foods and feeds in the United States should prevent a major health scare,and prevent human exposure to deleterious levels of aflatoxin.Unfortunately,such regulations and testing are not in place in many countries.The purpose of this editorial is to summarize the current knowledge on association of aflatoxin and HCC,encourage future research and draw attention to this global public health issue.

Epidemiological, laboratory, diagnostic and public health aspects of human brucellosis in western Iran

Objective:To determine brucellosis's epidemiologic,laboratory,diagnostic and public health features considering brucellosis is endemic in Azna County,western Iran.Methods:This descriptive cross-sectional study was investigated on 43 patients with brucellosis in Azna County. The subjects were the patients with symptoms correspondent with brucellosis and positive Wright and 2ME tests. A questionnaire about demographic,epidemiological and laboratory findings was filled in. Afterwards,patients were treated using usual antimicrobial drugs regimen. The collected data were analyzed by SPSS software version 16.Results:Forty-three subjects were found to be positive in laboratory tests. Incidence of Brucellosis was 59.31 per hundred thousand population. About 34.9% of patients were female and 65.1%male. Nearly 95.2% of human cases were living in rural and 4.8%in urban areas. Around 20.9%of patients had history of animal contact. The commonest transmission was unpasteurized dairy products(79.1%). The most contagious seasons were summer and spring(60.3%). The most common age group was 15-24(27.9%),and about 60.5%of the patients were between 15-44 years old. Disease was more common among housewives(30.2%) and farmers(20.9%). The majority of the patients had Wright test titre=1:320(54.1%) and 2ME test titre=1:160(56.1%) in serological titration.Doxycycline with Rifampin was used for treatment of the greatest of patients(60.4%).Conclusions:In order to control this zoonotic disease,close cooperation of health and veterinary organizations is necessary.

Childhood constipation as an emerging public health problem

Functional constipation(FC) is a significant health problem in children and contrary to common belief, has serious ramifications on the lives of children and their families. It is defined by the Rome criteria which encourage the use of multiple clinical features for diagnosis. FC in children has a high prevalence(0.7%-29%) worldwide, both in developed and developing countries. Biopsychosocial risk factors such as psychological stress, poor dietary habits, obesity and child maltreatment are commonly identified predisposing factors for FC. FC poses a significant healthcare burden on the already overstretched health budgets of many countries in terms of out-patient care, in-patient care, expenditure for investigations and prescriptions. Complications are common and range from minor psychological disturbances, to lower health-related quality of life. FC in children also has a significant impact on families. Many paediatric clinical trials have poor methodological quality, and drugs proved to be useful in adults, are not effective in relieving symptoms in children. A significant proportion of inadequately treated children have similar symptoms as adults. These factors show that constipation is an increasing public health problem across the world with a significant medical, social and economic impact. This article highlights the potential public health impact of FC and the possibility of overcoming this problem by concentrating on modifiable risk factors rather than expending resources on high cost investigations and therapeutic modalities.

Clinical relevance and public health significance of hepatitis B virus genomic variations

Ten hepatitis B virus （HBV） genotypes （A-J） and 34 HBV subgenotypes have been identified so far. HBV genotypes and subgenotypes have distinct geographical distributions, and have been shown to differ with regard to clinical outcome, prognosis, and response to interferon treatment. Infection with subgenotype A2 is frequently associated with high viral load, resulting in acute infection via horizontal transmission. Genotypes A and B are more sensitive to interferon treatment than genotypes D and C, respectively. Genotype B is more frequent in acute hepatitis than genotype C, whereas genotype C （C2） is more frequently associated with an increased risk of hepatocellular carcinoma （HCC）, mostly cirrhotic, as compared with genotype B （B2）. Genotype mixture is associated with high viral load and worse outcome of HBV infection. HBV mutations in the S genes, especially amino acids substitution at position 145 （G145R）, are associated with immune escape, whereas mutations in the PreS or S genes which impair HBsAg secretion could present a risk to blood safety. HBV variants harboring mutations in the viral polymerase gene that confer resistance to nucleoside analogs may be selected during antiviral therapy. Different genotypes have distinct mutation patterns in the PreS and EnhH/BCP/Precore regions. PreS deletions, C1653T, T1753V, and A1762T/G1764A are associated with an increased risk of HCC. HCC- associated HBV mutants may not transmit via motherto-child transmission, and are likely generated during HBV-induced pathogenesis. Examination of HBV mutations alone or in combination and host genetic suscep-tibility will be helpful in classifying the HBV-infected subjects who will develop HCC and need active antiviral treatments.

Analysis of good practice of Public Health Emergency Operations Centers

Objective: To study the public health Emergency Operations Centers(EOCs)in the US, the European Union, the UK and Australia, and summarize the good practice for the improvement of National Health Emergency Response Command Center in Chinese National Health and Family Planning Commission. Methods: Literature review was conducted to explore the EOCs of selected countries. Results: The study focused on EOC function, organizational structure, human resources and information management. The selected EOCs had the basic EOC functions of coordinating and commanding as well as the public health related functions such as monitoring the situation, risk assessment, and epidemiological briefings. The organizational structures of the EOCs were standardized, scalable and flexible. Incident Command System was the widely applied organizational structure with a strong preference. The EOCs were managed by a unit of emergency management during routine time and surge staff were engaged upon emergencies. The selected EOCs had clear information management framework including information collection, assessment and dissemination. Conclusions: The performance of National Health Emergency Response Command Center can be improved by learning from the good practice of the selected EOCs, including setting clear functions, standardizing the organizational structure, enhancing the human resource capacity and strengthening information management.

Anthrax: A disease of biowarfare and public health importance

Bioterrorism has received a lot of attention in the first decade of this century. Biological agents are considered attractive weapons for bioterrorism as these are easy to obtain, comparatively inexpensive to produce and exhibit widespread fear and panic than the actual potential of physical damage. Bacillus anthracis(B. anthracis), the etiologic agent of anthrax is a Gram positive, spore forming, non-motile bacterium. This is supposed to be one of the most potent BW agents because its spores are extremely resistant to natural conditions and can survive for several decades in the environment. B.anthracis spores enter the body through skin lesion(cutaneous anthrax), lungs(pulmonary anthrax), or gastrointestinal route(gastrointestinal anthrax) and germinate, giving rise to the vegetative form. Anthrax is a concern of public health also in many countries where agriculture is the main source of income including India. Anthrax has been associated with human history for a very long time and regained its popularity after Sept 2001 incidence in United States. The present review article describes the history, biology, life cycle, pathogenicity, virulence, epidemiology and potential of B. anthracis as biological weapon.

Examining Inequality in the Public Health Workforce Distribution in the Centers for Disease Control and Prevention(CDCs) System in China, 2008–2017

Objective Allocation of human resources to address inequalities in the public health system has increasingly attracted societal and political attention.Using the Centers for Disease Control and Prevention(CDCs)system of China as an example,we evaluated inequality in the public health workforce distribution across different regions in China between 2008 and 2017,with the aim of providing information for policymakers to support resource allocation and address growing health inequities.Methods We used three standard public health workforce inequality indices-Gini coefficient,Theil L,and Theil T-and spatial autocorrelation analysis to explore spatial clusters of the workforce in different provinces,visualized with geographical tools.Results The aggregate workforce-to-population ratio decreased from 1.47 to 1.42 per 10,000 population from 2008 to 2017,and was consistently lower than the National Health Commission’s(NHC)recommended critical shortage threshold of 1.75.The workforce distribution inequality indices varied by regional socioeconomic and health system development.Geographic clustering of CDCs workforce distribution was evident,with H–H and L–L clusters in western China and the Guangdong-Fujian region,respectively.Conclusions Our study addressed key issues for government and policymakers in allocation of public health human resources.There is an urgent need for careful identification of analytic questions that will help carry out public health functions in the new era,alongside policy implications for an equitable distribution of the public health workforce focusing on the western region and low–low cluster areas.