A comparative analysis of policies addressing rural oral health in eight English-speaking OECD countries.

PubMed

Crocombe, Leonard A; Goldberg, Lynette R; Bell, Erica; Seidel, Bastian

2017-01-01

Oral health is fundamental to overall health. Poor oral health is largely preventable but unacceptable inequalities exist, particularly for people in rural areas. The issues are complex. Rural populations are characterised by lower rates of health insurance, higher rates of poverty, less water fluoridation, fewer dentists and oral health specialists, and greater distances to access care. These factors inter-relate with educational, attitudinal, and system-level issues. An important area of enquiry is whether and how national oral health policies address causes and solutions for poor rural oral health. The purpose of this study was to examine a series of government policies on oral health to (i) determine the extent to which such policies addressed rural oral health issues, and (ii) identify enabling assumptions in policy language about problems and solutions regarding rural communities. Eight current oral health policies were identified from Australia, New Zealand, Canada, the USA, England, Scotland, Northern Ireland, and Wales. Validated content and critical discourse analyses were used to document and explore the concepts in these policy documents, with a particular focus on the frequency with which rural oral health was mentioned, and the enabling assumptions in policy language about rural communities. Seventy-three concepts relating to oral health were identified from the textual analysis of the eight policy documents. The rural concept addressing oral health issues occurred in only 2% of all policies and was notably absent from the oral health policies of countries with substantial rural populations. It occurred most frequently in the policy documents from Australia and Scotland, less so in the policy documents from Canada, Wales, and New Zealand, and not at all in the oral health policies from the US, England, and Northern Ireland. Thus, the oral health needs of rural communities were generally not the focus of, nor included in, the oral health policy

Health Care Reform and Concurrent Curative Care for Terminally Ill Children: A Policy Analysis

PubMed Central

Lindley, Lisa C.

2012-01-01

Within the Patient Protection and Affordable Care Act of 2010 or health care reform, is a relatively small provision about concurrent curative care that significantly affects terminally ill children. Effective on March 23, 2010, terminally ill children, who are enrolled in a Medicaid or state Children’s Health Insurance Plans (CHIP) hospice benefit, may concurrently receive curative care related to their terminal health condition. The purpose of this article was to conduct a policy analysis of the concurrent curative care legislation by examining the intended goals of the policy to improve access to care and enhance quality of end of life care for terminally ill children. In addition, the policy analysis explored the political feasibility of implementing concurrent curative care at the state-level. Based on this policy analysis, the federal policy of concurrent curative care for children would generally achieve its intended goals. However, important policy omissions focus attention on the need for further federal end of life care legislation for children. These findings have implications nurses. PMID:22822304

Framing health and foreign policy: lessons for global health diplomacy.

PubMed

Labonté, Ronald; Gagnon, Michelle L

2010-08-22

Global health financing has increased dramatically in recent years, indicative of a rise in health as a foreign policy issue. Several governments have issued specific foreign policy statements on global health and a new term, global health diplomacy, has been coined to describe the processes by which state and non-state actors engage to position health issues more prominently in foreign policy decision-making. Their ability to do so is important to advancing international cooperation in health. In this paper we review the arguments for health in foreign policy that inform global health diplomacy. These are organized into six policy frames: security, development, global public goods, trade, human rights and ethical/moral reasoning. Each of these frames has implications for how global health as a foreign policy issue is conceptualized. Differing arguments within and between these policy frames, while overlapping, can also be contradictory. This raises an important question about which arguments prevail in actual state decision-making. This question is addressed through an analysis of policy or policy-related documents and academic literature pertinent to each policy framing with some assessment of policy practice. The reference point for this analysis is the explicit goal of improving global health equity. This goal has increasing national traction within national public health discourse and decision-making and, through the Millennium Development Goals and other multilateral reports and declarations, is entering global health policy discussion. Initial findings support conventional international relations theory that most states, even when committed to health as a foreign policy goal, still make decisions primarily on the basis of the 'high politics' of national security and economic material interests. Development, human rights and ethical/moral arguments for global health assistance, the traditional 'low politics' of foreign policy, are present in discourse but do

Framing health and foreign policy: lessons for global health diplomacy

PubMed Central

2010-01-01

Global health financing has increased dramatically in recent years, indicative of a rise in health as a foreign policy issue. Several governments have issued specific foreign policy statements on global health and a new term, global health diplomacy, has been coined to describe the processes by which state and non-state actors engage to position health issues more prominently in foreign policy decision-making. Their ability to do so is important to advancing international cooperation in health. In this paper we review the arguments for health in foreign policy that inform global health diplomacy. These are organized into six policy frames: security, development, global public goods, trade, human rights and ethical/moral reasoning. Each of these frames has implications for how global health as a foreign policy issue is conceptualized. Differing arguments within and between these policy frames, while overlapping, can also be contradictory. This raises an important question about which arguments prevail in actual state decision-making. This question is addressed through an analysis of policy or policy-related documents and academic literature pertinent to each policy framing with some assessment of policy practice. The reference point for this analysis is the explicit goal of improving global health equity. This goal has increasing national traction within national public health discourse and decision-making and, through the Millennium Development Goals and other multilateral reports and declarations, is entering global health policy discussion. Initial findings support conventional international relations theory that most states, even when committed to health as a foreign policy goal, still make decisions primarily on the basis of the 'high politics' of national security and economic material interests. Development, human rights and ethical/moral arguments for global health assistance, the traditional 'low politics' of foreign policy, are present in discourse but do

Government, politics and health policy: A quantitative analysis of 30 European countries.

PubMed

Mackenbach, Johan P; McKee, Martin

2015-10-01

Public health policies are often dependent on political decision-making, but little is known of the impact of different forms of government on countries' health policies. In this exploratory study we studied the association between a wide range of process and outcome indicators of health policy and four groups of political factors (levels of democracy, e.g. voice and accountability; political representation, e.g. voter turnout; distribution of power, e.g. constraints on the executive; and quality of government, e.g. absence of corruption) in contemporary Europe. Data on 15 aspects of government and 18 indicators of health policy as well as on potential confounders were extracted from harmonized international data sources, covering 30 European countries and the years 1990-2010. In a first step, multivariate regression analysis was used to relate cumulative measures of government to indicators of health policy, and in a second step panel regression with country fixed effects was used to relate changes in selected measures of government to changes in indicators of health policy. In multivariate regression analyses, measures of quality of democracy and quality of government had many positive associations with process and outcome indicators of health policy, while measures of distribution of power and political representation had few and inconsistent associations. Associations for quality of democracy were robust against more extensive control for confounding variables, including tests in panel regressions with country fixed effects, but associations for quality of government were not. In this period in Europe, the predominant political influence on health policy has been the rise of levels of democracy in countries in the Central & Eastern part of the region. In contrast to other areas of public policy, health policy does not appear to be strongly influenced by institutional features of democracy determining the distribution of power, nor by aspects of political

School Health Promotion Policies and Adolescent Risk Behaviors in Israel: A Multilevel Analysis.

PubMed

Tesler, Riki; Harel-Fisch, Yossi; Baron-Epel, Orna

2016-06-01

Health promotion policies targeting risk-taking behaviors are being implemented across schools in Israel. This study identified the most effective components of these policies influencing cigarette smoking and alcohol consumption among adolescents. Logistic hierarchical linear model (HLM) analysis of data for 5279 students in 95 Jewish public schools from the Health Behavior in School-Aged Children (HBSC) 2010-2011 survey in Israel enabled simultaneous estimation of the relationship between student- and school-level variables (health promotion policy) to alcohol consumption and smoking behavior. Principals of participating schools also were interviewed to ascertain their degree of adoption and implementation of a health promotion policy. Most of the variance in adolescent risk behaviors is explained by student-level variables: negative perceptions of school, lack of parental support for school issues, and more time spent with friends. Among the school-level policy measures, parental participation in health promotion intervention programs was repeatedly associated with lower rates of risk behaviors, over and above student characteristics. School health promotion policies should focus on parents' involvement in intervention programs and should seek to improve students' perceptions of school and their sense of well-being to promote resilience. Further research is needed to identify additional factors that may increase the effectiveness of school health promotion policies. © 2016, American School Health Association.

Strengthening the health workforce and rolling out universal health coverage: the need for policy analysis.

PubMed

Koon, Adam D; Mayhew, Susannah H

2013-07-24

This article opens a debate about how to think about moving forward with the emerging twin movements of human resources for health (HRH) and universal health coverage (UHC). There is sufficient evidence to warrant these movements, but actors and the policy process significantly affect which policies are adopted and how they are implemented. How exactly this occurs in low- and middle-income countries (LMICs) is not very well understood. Furthermore, it is not clear whether actors will mobilize for or against the emergent HRH and UHC agendas. Policy analysis should help illuminate potential strategies to account for multiple interests and divergent values in volatile stakeholder environments. We argue that not only should the movement for UHC be paired with current efforts to address the human resources crisis, but also, for both to succeed, we need to know more about how health policy works in LMICs.

Development of oral health policy in Nigeria: an analysis of the role of context, actors and policy process.

PubMed

Etiaba, Enyi; Uguru, Nkoli; Ebenso, Bassey; Russo, Giuliano; Ezumah, Nkoli; Uzochukwu, Benjamin; Onwujekwe, Obinna

2015-05-06

In Nigeria, there is a high burden of oral health diseases, poor coordination of health services and human resources for delivery of oral health services. Previous attempts to develop an Oral Health Policy (OHP) to decrease the oral disease burden failed. However, a policy was eventually developed in November 2012. This paper explores the role of contextual factors, actors and the policy process in the development of the OHP and possible reasons why the current approved OHP succeeded. The study was undertaken across Nigeria; information gathered through document reviews and in-depth interviews with five groups of purposively selected respondents. Analysis of the policy development process was guided by the policy triangle framework, examining context, policy process and actors involved in the policy development. The foremost enabling factor was the yearning among policy actors for a policy, having had four failed attempts. Other factors were the presence of a democratically elected government, a framework for health sector reform instituted by the Federal Ministry of Health (FMOH). The approved OHP went through all stages required for policy development unlike the previous attempts. Three groups of actors played crucial roles in the process, namely academics/researchers, development partners and policy makers. They either had decision making powers or influenced policy through funding or technical ability to generate credible research evidence, all sharing a common interest in developing the OHP. Although evidence was used to inform the development of the policy, the complex interactions between the context and actors facilitated its approval. The OHP development succeeded through a complex inter-relationship of context, process and actors, clearly illustrating that none of these factors could have, in isolation, catalyzed the policy development. Availability of evidence is necessary but not sufficient for developing policies in this area. Wider socio

A critical analysis of Child and Adolescent Mental Health Services policy in England.

PubMed

Callaghan, Jane Em; Fellin, Lisa Chiara; Warner-Gale, Fiona

2017-01-01

Policy on Child and Adolescent Mental Health Services (CAMHS) in England has undergone radical changes in the last 15 years, with far reaching implications for funding models, access to services and service delivery. Using corpus analysis and critical discourse analysis, we explore how childhood, mental health and CAMHS are constituted in 15 policy documents, 9 pre-2010 and 6 post-2010. We trace how these constructions have changed over time and consider the practice implications of these changes. We identify how children's distress is individualised, through medicalising discourses and shifting understandings of the relationship between socio-economic context and mental health. This is evidenced in a shift from seeing children's mental health challenges as produced by social and economic inequities to a view that children's mental health must be addressed early to prevent future socio-economic burden. We consider the implications of CAMHS policies for the relationship between children, families, mental health services and the state. The article concludes by exploring how concepts of 'parity of esteem' and 'stigma reduction' may inadvertently exacerbate the individualisation of children's mental health.

Using secondary analysis of qualitative data of patient experiences of health care to inform health services research and policy.

PubMed

Ziebland, Sue; Hunt, Kate

2014-07-01

Qualitative research is recognized as an important method for including patients' voices and experiences in health services research and policy-making, yet the considerable potential to analyse existing qualitative data to inform health policy and practice has been little realized. This failure may partly be explained by: a lack of awareness amongst health policy makers of the increasing wealth of qualitative data available; and around 15 years of internal debates among qualitative researchers on the strengths, limitations and validity of re-use of qualitative data. Whilst acknowledging the challenges of qualitative secondary data analysis, we argue that there is a growing imperative to be pragmatic and to undertake analysis of existing qualitative data collections where they have the potential to contribute to health policy formulation. Time pressures are inherent in the policy-making process and in many circumstances it is not possible to seek funding, conduct and analyse new qualitative studies of patients' experiences in time to inform a specific policy. The danger then is that the patient voice, and the experiences of relatives and carers, is either excluded or included in a way that is easily dismissed as 'unrepresentative'. We argue that secondary analysis of qualitative data collections may sometimes be an effective means to enable patient experiences to inform policy decision-making. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

A modelling tool for policy analysis to support the design of efficient and effective policy responses for complex public health problems.

PubMed

Atkinson, Jo-An; Page, Andrew; Wells, Robert; Milat, Andrew; Wilson, Andrew

2015-03-03

In the design of public health policy, a broader understanding of risk factors for disease across the life course, and an increasing awareness of the social determinants of health, has led to the development of more comprehensive, cross-sectoral strategies to tackle complex problems. However, comprehensive strategies may not represent the most efficient or effective approach to reducing disease burden at the population level. Rather, they may act to spread finite resources less intensively over a greater number of programs and initiatives, diluting the potential impact of the investment. While analytic tools are available that use research evidence to help identify and prioritise disease risk factors for public health action, they are inadequate to support more targeted and effective policy responses for complex public health problems. This paper discusses the limitations of analytic tools that are commonly used to support evidence-informed policy decisions for complex problems. It proposes an alternative policy analysis tool which can integrate diverse evidence sources and provide a platform for virtual testing of policy alternatives in order to design solutions that are efficient, effective, and equitable. The case of suicide prevention in Australia is presented to demonstrate the limitations of current tools to adequately inform prevention policy and discusses the utility of the new policy analysis tool. In contrast to popular belief, a systems approach takes a step beyond comprehensive thinking and seeks to identify where best to target public health action and resources for optimal impact. It is concerned primarily with what can be reasonably left out of strategies for prevention and can be used to explore where disinvestment may occur without adversely affecting population health (or equity). Simulation modelling used for policy analysis offers promise in being able to better operationalise research evidence to support decision making for complex problems

Implementing Health Policy: Lessons from the Scottish Well Men's Policy Initiative.

PubMed

Douglas, Flora; van Teijlingen, Edwin; Smith, Cairns; Moffat, Mandy

2015-01-01

Little is known about how health professionals translate national government health policy directives into action. This paper examines that process using the so-called Well Men's Services (WMS) policy initiative as a 'real world' case study. The WMS were launched by the Scottish Government to address men's health inequalities. Our analysis aimed to develop a deeper understanding of policy implementation as it naturally occurred, used an analytical framework that was developed to reflect the 'rational planning' principles health professionals are commonly encouraged to use for implementation purposes. A mixed-methods qualitative enquiry using a data archive generated during the WMS policy evaluation was used to critically analyze (post hoc) the perspectives of national policy makers, and local health and social care professionals about the: (a) 'policy problem', (b) interventions intended to address the problem, and (c) anticipated policy outcomes. This analysis revealed four key themes: (1) ambiguity regarding the policy problem and means of intervention; (2) behavioral framing of the policy problem and intervention; (3) uncertainty about the policy evidence base and outcomes, and; (4) a focus on intervention as outcome . This study found that mechanistic planning heuristics (as a means of supporting implementation) fails to grapple with the indeterminate nature of population health problems. A new approach to planning and implementing public health interventions is required that recognises the complex and political nature of health problems; the inevitability of imperfect and contested evidence regarding intervention, and, future associated uncertainties.

Can conditional health policies be justified? A policy analysis of the new NHS dental contract reforms.

PubMed

Laverty, Louise; Harris, Rebecca

2018-06-01

Conditional policies, which emphasise personal responsibility, are becoming increasingly common in healthcare. Although used widely internationally, they are relatively new within the UK health system where there have been concerns about whether they can be justified. New NHS dental contracts include the introduction of a conditional component that restricts certain patients from accessing a full range of treatment until they have complied with preventative action. A policy analysis of published documents on the NHS dental contract reforms from 2009 to 2016 was conducted to consider how conditionality is justified and whether its execution is likely to cause distributional effects. Contractualist, paternalistic and mutualist arguments that reflect notions of responsibility and obligation are used as justification within policy. Underlying these arguments is an emphasis on preserving the finite resources of a strained NHS. We argue that the proposed conditional component may differentially affect disadvantaged patients, who do not necessarily have access to the resources needed to meet the behavioural requirements. As such, the conditional component of the NHS dental contract reform has the potential to exacerbate oral health inequalities. Conditional health policies may challenge core NHS principles and, as is the case with any conditional policy, should be carefully considered to ensure they do not exacerbate health inequities. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Policy mapping for establishing a national emergency health policy for Nigeria

PubMed Central

Aliyu, Zakari Y

2002-01-01

Background The number of potential life years lost due to accidents and injuries though poorly studied has resulted in tremendous economic and social loss to Nigeria. Numerous socio-cultural, economic and political factors including the current epidemic of ethnic and religious conflicts act in concert in predisposing to and enabling the ongoing catastrophe of accident and injuries in Nigeria. Methods Using the "policymaker", Microsoft-Windows® based software, the information generated on accidents and injuries and emergency health care in Nigeria from literature review, content analysis of relevant documents, expert interviewing and consensus opinion, a model National Emergency Health Policy was designed and analyzed. A major point of analysis for the policy is the current political feasibility of the policy including its opportunities and obstacles in the country. Results A model National Emergency Health Policy with policy goals, objectives, programs and evaluation benchmarks was generated. Critical analyses of potential policy problems, associated multiple players, diverging interests and implementation guidelines were developed. Conclusions "Political health modeling" a term proposed here would be invaluable to policy makers and scholars in developing countries in assessing the political feasibility of policy managing. Political modeling applied to the development of a NEHP in Nigeria would empower policy makers and the policy making process and would ensure a sustainable emergency health policy in Nigeria. PMID:12181080

Shaping Policy Change in Population Health: Policy Entrepreneurs, Ideas, and Institutions

PubMed Central

Béland, Daniel; Katapally, Tarun R.

2018-01-01

Political realities and institutional structures are often ignored when gathering evidence to influence population health policies. If these policies are to be successful, social science literature on policy change should be integrated into the population health approach. In this contribution, drawing on the work of John W. Kingdon and related scholarship, we set out to examine how key components of the policy change literature could contribute towards the effective development of population health policies. Shaping policy change would require a realignment of the existing school of thought, where the contribution of population health seems to end at knowledge translation. Through our critical analysis of selected literature, we extend recommendations to advance a burgeoning discussion in adopting new approaches to successfully implement evidence-informed population health policies. PMID:29764101

Are national policies on global health in fact national policies on global health governance? A comparison of policy designs from Norway and Switzerland.

PubMed

Jones, Catherine M; Clavier, Carole; Potvin, Louise

2017-01-01

Since the signing of the Oslo Ministerial Declaration in 2007, the idea that foreign policy formulation should include health considerations has gained traction on the United Nations agenda as evidenced by annual General Assembly resolutions on global health and foreign policy. The adoption of national policies on global health (NPGH) is one way that some member states integrate health and foreign policymaking. This paper explores what these policies intend to do and how countries plan to do it. Using a most similar systems design, we carried out a comparative study of two policy documents formally adopted in 2012. We conducted a directed qualitative content analysis of the Norwegian White Paper on Global health in foreign and development policy and the Swiss Health Foreign Policy using Schneider and Ingram's policy design framework. After replicating analysis methods for each document, we analysed them side by side to explore the commonalities and differences across elements of NPGH design. Analyses indicate that NPGH expect to influence change outside their borders. Targeting the international level, they aim to affect policy venues, multilateral partnerships and international institutions. Instruments for supporting desired changes are primarily those of health diplomacy, proposed as a tool for negotiating interests and objectives for global health between multiple sectors, used internally in Switzerland and externally in Norway. Findings suggest that NPGH designs contribute to constructing the global health governance system by identifying it as a policy target, and policy instruments may elude the health sector actors unless implementation rules explicitly include them. Research should explore how future NPGH designs may construct different kinds of targets as politicised groups of actors on which national governments seek to exercise influence for global health decision-making.

Are national policies on global health in fact national policies on global health governance? A comparison of policy designs from Norway and Switzerland

PubMed Central

Clavier, Carole; Potvin, Louise

2017-01-01

Background Since the signing of the Oslo Ministerial Declaration in 2007, the idea that foreign policy formulation should include health considerations has gained traction on the United Nations agenda as evidenced by annual General Assembly resolutions on global health and foreign policy. The adoption of national policies on global health (NPGH) is one way that some member states integrate health and foreign policymaking. This paper explores what these policies intend to do and how countries plan to do it. Methods Using a most similar systems design, we carried out a comparative study of two policy documents formally adopted in 2012. We conducted a directed qualitative content analysis of the Norwegian White Paper on Global health in foreign and development policy and the Swiss Health Foreign Policy using Schneider and Ingram's policy design framework. After replicating analysis methods for each document, we analysed them side by side to explore the commonalities and differences across elements of NPGH design. Results Analyses indicate that NPGH expect to influence change outside their borders. Targeting the international level, they aim to affect policy venues, multilateral partnerships and international institutions. Instruments for supporting desired changes are primarily those of health diplomacy, proposed as a tool for negotiating interests and objectives for global health between multiple sectors, used internally in Switzerland and externally in Norway. Conclusion Findings suggest that NPGH designs contribute to constructing the global health governance system by identifying it as a policy target, and policy instruments may elude the health sector actors unless implementation rules explicitly include them. Research should explore how future NPGH designs may construct different kinds of targets as politicised groups of actors on which national governments seek to exercise influence for global health decision-making. PMID:28589007

Health adaptation policy for climate vulnerable groups: a 'critical computational linguistics' analysis.

PubMed

Seidel, Bastian M; Bell, Erica

2014-11-28

Many countries are developing or reviewing national adaptation policy for climate change but the extent to which these meet the health needs of vulnerable groups has not been assessed. This study examines the adequacy of such policies for nine known climate-vulnerable groups: people with mental health conditions, Aboriginal people, culturally and linguistically diverse groups, aged people, people with disabilities, rural communities, children, women, and socioeconomically disadvantaged people. The study analyses an exhaustive sample of national adaptation policy documents from Annex 1 ('developed') countries of the United Nations Framework Convention on Climate Change: 20 documents from 12 countries. A 'critical computational linguistics' method was used involving novel software-driven quantitative mapping and traditional critical discourse analysis. The study finds that references to vulnerable groups are relatively little present or non-existent, as well as poorly connected to language about practical strategies and socio-economic contexts, both also little present. The conclusions offer strategies for developing policy that is better informed by a 'social determinants of health' definition of climate vulnerability, consistent with best practice in the literature and global policy prescriptions.

Human Dignity as Leading Principle in Public Health Ethics: A Multi-Case Analysis of 21st Century German Health Policy Decisions

PubMed Central

Winter, Sebastian F.; Winter, Stefan F.

2018-01-01

Background: There is ample evidence that since the turn of the millennium German health policy made a considerable step towards prevention and health promotion, putting the strategies of ‘personal empowerment’ and ‘settings based approach’ high on the federal government’s agenda. This phenomenon has challenged the role of ethics in health policy. Concurrently, increasing relevance of the Concept of Human Dignity for health and human rights has been discussed. However, a direct relationship between Human Dignity and Public Health Ethics (PHE) has surprisingly not yet been established. Methods: We here conduct a systematic ethical analysis of eminent German health prevention policy case-examples between the years 2000–2016. Specifically, our analysis seeks to adapt and apply the principalism (autonomy, beneficence, justice)-based Concept of Human Dignity of Italian philosopher Corrado Viafora, contextualizing it with the emerging field of PHE. To further inform this health policy analysis, index databases (PubMed, Google Scholar) were searched to include relevant published and grey literature. Results: We observe a systematic approach of post-millennial health policy decisions on prevention and on defined health targets in Germany, exemplified by (1) the fostering of the preparedness against pandemic infectious diseases, (2) the development and implementation of the first cancer vaccination, (3) major legal provisions on non-smokers protection in the public domain, (4) acts to strengthen long term care (LTC) as well as (5) the new German E-Health legislation. The ethical analysis of these health prevention decisions exhibits their profound ongoing impact on social justice, probing their ability to meet the underlying Concept of Human Dignity in order to fulfill the requirements of the principle of non-maleficence. Conclusion: The observed health policy focus on prevention and health promotion has sparked new public debates about the formation of

The politics of public health policy.

PubMed

Oliver, Thomas R

2006-01-01

Politics, for better or worse, plays a critical role in health affairs. The purpose of this article is to articulate a role for political analysis of public health issues, ranging from injury and disease prevention to health care reform. It begins by examining how health problems make it onto the policy agenda. Perceptions regarding the severity of the problem, responsibility for the problem, and affected populations all influence governmental responses. Next, it considers how bounded rationality, fragmented political institutions, resistance from concentrated interests, and fiscal constraints usually lead political leaders to adopt incremental policy changes rather than comprehensive reforms even when faced with serious public health problems. It then identifies conditions under which larger-scale transformation of health policy can occur, focusing on critical junctures in policy development and the role of policy entrepreneurs in seizing opportunities for innovation. Finally, it reviews the challenges confronting officials and agencies who are responsible for implementing and administering health policies. Public health professionals who understand the political dimensions of health policy can conduct more realistic research and evaluation, better anticipate opportunities as well as constraints on governmental action, and design more effective policies and programs.

School Health Promotion Policies and Adolescent Risk Behaviors in Israel: A Multilevel Analysis

ERIC Educational Resources Information Center

Tesler, Riki; Harel-Fisch, Yossi; Baron-Epel, Orna

2016-01-01

Background: Health promotion policies targeting risk-taking behaviors are being implemented across schools in Israel. This study identified the most effective components of these policies influencing cigarette smoking and alcohol consumption among adolescents. Methods: Logistic hierarchical linear model (HLM) analysis of data for 5279 students in…

Applying Critical Discourse Analysis in Health Policy Research: Case Studies in Regional, Organizational, and Global Health.

PubMed

Evans-Agnew, Robin A; Johnson, Susan; Liu, Fuqin; Boutain, Doris M

2016-08-01

Critical discourse analysis (CDA) is a promising methodology for policy research in nursing. As a critical theoretical methodology, researchers use CDA to analyze social practices and language use in policies to examine whether such policies may promote or impede social transformation. Despite the widespread use of CDA in other disciplines such as education and sociology, nursing policy research employing CDA methodology is sparse. To advance CDA use in nursing science, it is important to outline the overall research strategies and describe the steps of CDA in policy research. This article describes, using exemplar case studies, how nursing and health policy researchers can employ CDA as a methodology. Three case studies are provided to discuss the application of CDA research methodologies in nursing policy research: (a) implementation of preconception care policies in the Zhejiang province of China, (b) formation and enactment of statewide asthma policy in Washington state of the United States, and (c) organizational implementation of employee antibullying policies in hospital systems in the Pacific Northwest of the United States. Each exemplar details how CDA guided the examination of policy within specific contexts and social practices. The variations of the CDA approaches in the three exemplars demonstrated the flexibilities and potentials for conducting policy research grounded in CDA. CDA provides novel insights for nurse researchers examining health policy formation, enactment, and implementation. © The Author(s) 2016.

Health labour market policies in support of universal health coverage: a comprehensive analysis in four African countries.

PubMed

Sousa, Angelica; Scheffler, Richard M; Koyi, Grayson; Ngah, Symplice Ngah; Abu-Agla, Ayat; M'kiambati, Harrison M; Nyoni, Jennifer

2014-09-26

Progress toward universal health coverage in many low- and middle-income countries is hindered by the lack of an adequate health workforce that can deliver quality services accessible to the entire population. We used a health labour market framework to investigate the key indicators of the dynamics of the health labour market in Cameroon, Kenya, Sudan, and Zambia, and identified the main policies implemented in these countries in the past ten years to address shortages and maldistribution of health workers. Despite increased availability of health workers in the four countries, major shortages and maldistribution persist. Several factors aggravate these problems, including migration, an aging workforce, and imbalances in skill mix composition. In this paper, we provide new evidence to inform decision-making for health workforce planning and analysis in low- and middle-income countries. Partial health workforce policies are not sufficient to address these issues. It is crucial to perform a comprehensive analysis in order to understand the dynamics of the health labour market and develop effective polices to address health workforce shortages and maldistribution as part of efforts to attain universal health coverage.

Advancing team-based primary health care: a comparative analysis of policies in western Canada.

PubMed

Suter, Esther; Mallinson, Sara; Misfeldt, Renee; Boakye, Omenaa; Nasmith, Louise; Wong, Sabrina T

2017-07-17

We analyzed and compared primary health care (PHC) policies in British Columbia, Alberta and Saskatchewan to understand how they inform the design and implementation of team-based primary health care service delivery. The goal was to develop policy imperatives that can advance team-based PHC in Canada. We conducted comparative case studies (n = 3). The policy analysis included: Context review: We reviewed relevant information (2007 to 2014) from databases and websites. Policy review and comparative analysis: We compared and contrasted publically available PHC policies. Key informant interviews: Key informants (n = 30) validated narratives prepared from the comparative analysis by offering contextual information on potential policy imperatives. Advisory group and roundtable: An expert advisory group guided this work and a key stakeholder roundtable event guided prioritization of policy imperatives. The concept of team-based PHC varies widely across and within the three provinces. We noted policy gaps related to team configuration, leadership, scope of practice, role clarity and financing of team-based care; few policies speak explicitly to monitoring and evaluation of team-based PHC. We prioritized four policy imperatives: (1) alignment of goals and policies at different system levels; (2) investment of resources for system change; (3) compensation models for all members of the team; and (4) accountability through collaborative practice metrics. Policies supporting team-based PHC have been slow to emerge, lacking a systematic and coordinated approach. Greater alignment with specific consideration of financing, reimbursement, implementation mechanisms and performance monitoring could accelerate systemic transformation by removing some well-known barriers to team-based care.

Mental health policy in Eastern Europe: a comparative analysis of seven mental health systems

PubMed Central

2014-01-01

Background The objective of this international comparative study is to describe and compare the mental health policies in seven countries of Eastern Europe that share their common communist history: Bulgaria, the Czech Republic, Hungary, Moldova, Poland, Romania, and Slovakia. Methods The health policy questionnaire was developed and the country-specific information was gathered by local experts. The questionnaire includes both qualitative and quantitative information on various aspects of mental health policy: (1) basic country information (demography, health, and economic indicators), (2) health care financing, (3) mental health services (capacities and utilisation, ownership), (4) health service purchasing (purchasing organisations, contracting, reimbursement of services), and (5) mental health policy (policy documents, legislation, civic society). Results The social and economic transition in the 1990s initiated the process of new mental health policy formulation, adoption of mental health legislation stressing human rights of patients, and a strong call for a pragmatic balance of community and hospital services. In contrast to the development in the Western Europe, the civic society was suppressed and NGOs and similar organizations were practically non-existent or under governmental control. Mental health services are financed from the public health insurance as any other health services. There is no separate budget for mental health. We can observe that the know-how about modern mental health care and about direction of needed reforms is available in documents, policies and programmes. However, this does not mean real implementation. Conclusions The burden of totalitarian history still influences many areas of social and economic life, which also has to be taken into account in mental health policy. We may observe that after twenty years of health reforms and reforms of health reforms, the transition of the mental health systems still continues. In spite of

Making sense of the global health crisis: policy narratives, conflict, and global health governance.

PubMed

Ney, Steven

2012-04-01

Health has become a policy issue of global concern. Worried that the unstructured, polycentric, and pluralist nature of global health governance is undermining the ability to serve emergent global public health interests, some commentators are calling for a more systematic institutional response to the "global health crisis." Yet global health is a complex and uncertain policy issue. This article uses narrative analysis to explore how actors deal with these complexities and how uncertainties affect global health governance. By comparing three narratives in terms of their basic assumptions, the way they define problems as well as the solutions they propose, the analysis shows how the unstructured pluralism of global health policy making creates a wide scope of policy conflict over the global health crisis. This wide scope of conflict enables effective policy-oriented learning about global health issues. The article also shows how exclusionary patterns of cooperation and competition are emerging in health policy making at the global level. These patterns threaten effective learning by risking both polarization of the policy debate and unanticipated consequences of health policy. Avoiding these pitfalls, the analysis suggests, means creating global health governance regimes that promote openness and responsiveness in deliberation about the global health crisis.

Personalized health care and health information technology policy: an exploratory analysis.

PubMed

Wald, Jonathan S; Shapiro, Michael

2013-01-01

Personalized healthcare (PHC) is envisioned to enhance clinical practice decision-making using new genome-driven knowledge that tailors diagnosis, treatment, and prevention to the individual patient. In 2012, we conducted a focused environmental scan and informal interviews with fifteen experts to anticipate how PHC might impact health Information Technology (IT) policy in the United States. Findings indicatedthat PHC has a variable impact on current clinical practice, creates complex questions for providers, patients, and policy-makers, and will require a robust health IT infrastructure with advanced data architecture, clinical decision support, provider workflow tools, and re-use of clinical data for research. A number of health IT challenge areas were identified, along with five policy areas including: interoperable clinical decision support, standards for patient values and preferences, patient engagement, data transparency, and robust privacy and security.

Pakistan's maternal and child health policy: analysis, lessons and the way forward.

PubMed

Siddiqi, S; Haq, I U; Ghaffar, A; Akhtar, T; Mahaini, R

2004-07-01

An estimated 400,000 infant and 16,500 maternal deaths occur annually in Pakistan. These translate into an infant mortality rate and maternal mortality ratio that should be unacceptable to any state. Disease states including communicable diseases and reproductive health (RH) problems, which are largely preventable account for over 50% of the disease burden. The analysis of Pakistan's maternal and child health (MCH) and family planning (FP) policy covers the period 1990-2002, and focuses on macroeconomic influences, priority programs and gaps, adequacy of resources, equity and organizational aspects, and the process of policy formulation. The overall MCH/FP policy is well directed. MCH/FP has been a priority in all policies; resource allocation, although unacceptably low, has substantially increased during the last decade; and there is a progressive shift from MCH to the reproductive health (RH) agenda. Areas in need of improvement include greater use of evidence as a basis for policy; increased priority to nutrition programs, measures to reduce neonatal and perinatal mortality, provision of emergency obstetric care, availability of skilled birth attendants, and a clear policy on integrated management of childhood illnesses. Enhanced planning capacity, development of a balanced human resource, improved governance to reduce staff absenteeism and frequent transfers, and a greater role of the private sector in the provision of services are some organizational aspects that need the governments' consideration. There are several lessons to be learnt: (i) Ministries of Health need sustained stewardship and well-documented evidence to protect cuts in resource allocation; (ii) frequent policy announcement sends inappropriate signals to managers and weakens on-going implementation; (iii) MCH/FP policies unless informed by evidence and participation of interest groups are unlikely to address gaps in programs; (iv) distributional and equity objectives of MCH/FP be addressed

Australia's national men's health policy: masculinity matters.

PubMed

Saunders, Margo; Peerson, Anita

2009-08-01

The development of Australia's first national men's health policy provides an important opportunity for informed discussions of health and gender. It is therefore a concern that the stated policy appears to deliberately exclude hegemonic masculinity and other masculinities, despite evidence of their major influence on men's health-related values, beliefs, perspectives, attitudes, motivations and behaviour. We provide an evidence-based critique of the proposed approach to a national men's health policy which raises important questions about whether the new policy can achieve its aims if it fails to acknowledge 'masculinity' as a key factor in Australian men's health. The national men's health policy should be a means to encourage gender analysis in health. This will require recognition of the influence of hegemonic masculinity, and other masculinities, on men's health. Recognising the influence of 'masculinity' on men's health is not about 'blaming' men for 'behaving badly', but is crucial to the development of a robust, meaningful and comprehensive national men's health policy.

A comparative analysis of early child health and development services and outcomes in countries with different redistributive policies

PubMed Central

2013-01-01

Background The social environment is a fundamental determinant of early child development and, in turn, early child development is a determinant of health, well-being, and learning skills across the life course. Redistributive policies aimed at reducing social inequalities, such as a welfare state and labour market policies, have shown a positive association with selected health indicators. In this study, we investigated the influence of redistributive policies specifically on the social environment of early child development in five countries with different political traditions. The objective of this analysis was to highlight similarities and differences in social and health services between the countries and their associations with other health outcomes that can inform better global early child development policies and improve early child health and development. Methods Four social determinants of early child development were selected to provide a cross-section of key time periods in a child’s life from prenatal to kindergarten. They included: 1) prenatal care, 2) maternal leave, 3) child health care, and 4) child care and early childhood education. We searched international databases and reports (e.g. Organization for Economic Cooperation and Development, World Bank, and UNICEF) to obtain information about early child development policies, services and outcomes. Results Although a comparative analysis cannot claim causation, our analysis suggests that redistributive policies aimed at reducing social inequalities are associated with a positive influence on the social determinants of early child development. Generous redistributive policies are associated with a higher maternal leave allowance and pay and more preventive child healthcare visits. A decreasing trend in infant mortality, low birth weight rate, and under five mortality rate were observed with an increase in redistributive policies. No clear influence of redistributive policies was observed on

A comparative analysis of early child health and development services and outcomes in countries with different redistributive policies.

PubMed

van den Heuvel, Meta; Hopkins, Jessica; Biscaro, Anne; Srikanthan, Cinntha; Feller, Andrea; Bremberg, Sven; Verkuijl, Nienke; Flapper, Boudien; Ford-Jones, Elizabeth Lee; Williams, Robin

2013-11-06

The social environment is a fundamental determinant of early child development and, in turn, early child development is a determinant of health, well-being, and learning skills across the life course. Redistributive policies aimed at reducing social inequalities, such as a welfare state and labour market policies, have shown a positive association with selected health indicators. In this study, we investigated the influence of redistributive policies specifically on the social environment of early child development in five countries with different political traditions. The objective of this analysis was to highlight similarities and differences in social and health services between the countries and their associations with other health outcomes that can inform better global early child development policies and improve early child health and development. Four social determinants of early child development were selected to provide a cross-section of key time periods in a child's life from prenatal to kindergarten. They included: 1) prenatal care, 2) maternal leave, 3) child health care, and 4) child care and early childhood education. We searched international databases and reports (e.g. Organization for Economic Cooperation and Development, World Bank, and UNICEF) to obtain information about early child development policies, services and outcomes. Although a comparative analysis cannot claim causation, our analysis suggests that redistributive policies aimed at reducing social inequalities are associated with a positive influence on the social determinants of early child development. Generous redistributive policies are associated with a higher maternal leave allowance and pay and more preventive child healthcare visits. A decreasing trend in infant mortality, low birth weight rate, and under five mortality rate were observed with an increase in redistributive policies. No clear influence of redistributive policies was observed on breastfeeding and immunization

[Policy analysis: study of public policy of environmental health in a metropolis of northeastern Brazil].

PubMed

Lyra, Tereza Maciel; Araújo Júnior, José Luiz do Amaral Correa de

2014-09-01

The analysis of health policies has improved in Brazil despite a plethora of different methodological approaches. Based on the model developed by Walt and Gilson in 1994, the Environmental Health Program (EHP) of Recife as a policy based on the Health Promotion principles of the Unified Health System (SUS) and Agenda 21 was analyzed. An attempt was made to understand the context during the development and implementation of the EHP, the drafting process and which actors influenced the EHP agenda content and proposal. A qualitative case study was conducted, with semi-structured interviews with key actors. In terms of context, the findings include the influence of the municipal election, the socio-sanitary characteristics of Recife, the choice of the Secretary of Health and the management teams, acceptance by the technicians and the funding increase. In terms of the process, the acceptance of the managers must be stressed. Regarding the actors, the managers, sector technicians, non-sectorial actors with viability studies stood out. The content of the EHP coincided with the SUS and Health Promotion principles. Implementation was influenced by the dengue fever epidemic (2002), and cultural institutional factors that put pressure on the order of implementation of the planned actions.

Approaches to developing the capacity of health policy analysis institutes: a comparative case study.

PubMed

Bennett, Sara; Corluka, Adrijana; Doherty, Jane; Tangcharoensathien, Viroj

2012-03-05

To review and assess (i) the factors that facilitate the development of sustainable health policy analysis institutes in low and middle income countries and (ii) the nature of external support for capacity development provided to such institutes. Comparative case studies of six health policy analysis institutes (3 from Asia and 3 from Africa) were conducted. In each region an NGO institute, an institute linked to government and a university based institute were included. Data collection comprised document review, semi-structured interviews with stakeholders and discussion of preliminary findings with institute staff. The findings are organized around four key themes: (i) Financial resources: three of the institutes had received substantial external grants at start-up, however two of these institutes subsequently collapsed. At all but one institute, reliance upon short term, donor funding, created high administrative costs and unpredictability. (ii) Human resources: the retention of skilled human resources was perceived to be key to institute success but was problematic at all but one institute. In particular staff often moved to better paid positions elsewhere once having acquired necessary skills and experience, leaving remaining senior staff with heavy workloads. (iii) Governance and management: board structures and roles varied according to the nature of institute ownership. Boards made important contributions to organizational capacity through promoting continuity, independence and fund raising. Routine management systems were typically perceived to be strong. (iv) Networks: linkages to policy makers helped promote policy influences. External networks with other research organizations, particularly where these were longer term institutional collaborations helped promote capacity. The development of strong in-country analytical and research capacity to guide health policy development is critical, yet many health policy analysis institutes remain very fragile. A

Thoughts About Health Policy Content in Baccalaureate Nursing Programs.

PubMed

Waddell, Ashley; Adams, Jeffrey M; Fawcett, Jacqueline

2016-10-01

We describe a framework used to analyze health policy content in baccalaureate nursing program courses that combines the conceptual model for nursing and health policy and the Adams influence model to account for knowledge and skills needed for health policy work. Our analysis of health policy content in courses in one baccalaureate nursing program focused on what policies were emphasized and how educational content supported the development of personal influence. The analysis revealed course content focused on public sources of health policies and lack of overt course content about policies from organizational and professional sources. Additionally, we identified little course content about the development of personal influence skills except for communication and message articulation components. As the nursing profession continues to build influence in the policy arena, educators must continue to prepare future nurses for such work. © The Author(s) 2016.

Evidence-based health policy-making, hospital funding and health insurance.

PubMed

Palmer, G R

2000-02-07

An important goal of health services research is to improve the efficiency and effectiveness of health services through a quantitative and evidence-based approach. There are many limitations to the use of evidence in health policy-making, such as differences in what counts as evidence between the various disciplines involved, and a heavy reliance on theory in social science disciplines. Community and interest group values, ideological positions and political assessments inevitably intrude into government health policy-making. The importance of these factors is accentuated by the current absence of evidence on the impact of policy options for improving the health status of the community, and ensuring that efficiency and equity objectives for health services are also met. Analysis of recent hospital funding and private health insurance initiatives shows the limited role of evidence in the making of these decisions. Decision-making about health policy might be improved in the future by initiatives such as greater exposure of health professionals to educational inputs with a policy focus; increased contribution of doctors to health services research via special postgraduate programs; and establishing a national, multidisciplinary centre for health policy research and evaluation.

Shaping Policy Change in Population Health: Policy Entrepreneurs, Ideas, and Institutions.

PubMed

Béland, Daniel; Katapally, Tarun R

2018-01-14

Political realities and institutional structures are often ignored when gathering evidence to influence population health policies. If these policies are to be successful, social science literature on policy change should be integrated into the population health approach. In this contribution, drawing on the work of John W. Kingdon and related scholarship, we set out to examine how key components of the policy change literature could contribute towards the effective development of population health policies. Shaping policy change would require a realignment of the existing school of thought, where the contribution of population health seems to end at knowledge translation. Through our critical analysis of selected literature, we extend recommendations to advance a burgeoning discussion in adopting new approaches to successfully implement evidence-informed population health policies. © 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Informing policy makers about future health spending: a comparative analysis of forecasting methods in OECD countries.

PubMed

Astolfi, Roberto; Lorenzoni, Luca; Oderkirk, Jillian

2012-09-01

Concerns about health care expenditure growth and its long-term sustainability have risen to the top of the policy agenda in many OECD countries. As continued growth in spending places pressure on government budgets, health services provision and patients' personal finances, policy makers have launched forecasting projects to support policy planning. This comparative analysis reviewed 25 models that were developed for policy analysis in OECD countries by governments, research agencies, academics and international organisations. We observed that the policy questions that need to be addressed drive the choice of forecasting model and the model's specification. By considering both the level of aggregation of the units analysed and the level of detail of health expenditure to be projected, we identified three classes of models: micro, component-based, and macro. Virtually all models account for demographic shifts in the population, while two important influences on health expenditure growth that are the least understood include technological innovation and health-seeking behaviour. The landscape for health forecasting models is dynamic and evolving. Advances in computing technology and increases in data granularity are opening up new possibilities for the generation of system of models which become an on-going decision support tool capable of adapting to new questions as they arise. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Global health in foreign policy--and foreign policy in health? Evidence from the BRICS.

PubMed

Watt, Nicola F; Gomez, Eduardo J; McKee, Martin

2014-09-01

Amidst the growing literature on global health, much has been written recently about the Brazil, Russia, India, China, South Africa (BRICS) countries and their involvement and potential impact in global health, particularly in relation to development assistance. Rather less has been said about countries' motivations for involvement in global health negotiations, and there is a notable absence of evidence when their motivations are speculated on. This article uses an existing framework linking engagement in global health to foreign policy to explore differing levels of engagement by BRICS countries in the global health arena, with a particular focus on access to medicines. It concludes that countries' differing and complex motivations reinforce the need for realistic, pragmatic approaches to global health debates and their analysis. It also underlines that these analyses should be informed by analysis from other areas of foreign policy. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

Physical inactivity as a policy problem: applying a concept from policy analysis to a public health issue.

PubMed

Rütten, Alfred; Abu-Omar, Karim; Gelius, Peter; Schow, Diana

2013-03-07

Despite the recent rapid development of policies to counteract physical inactivity (PI), only a small number of systematic analyses on the evolution of these policies exists. In this article we analyze how PI, as a public health issue, "translates" into a policy-making issue. First, we discuss why PI has become an increasingly important public health issue during the last two decades. We then follow Guy Peters and conceptualize PI as a "policy problem" that has the potential to be linked to policy instruments and policy impact. Analysis indicates that PI is a policy problem that i) is chronic in nature; ii) involves a high degree of political complexity; iii) can be disaggregated into smaller scales; iv) is addressed through interventions that can be difficult to "sell" to the public when their benefits are not highly divisible; v) cannot be solved by government spending alone; vi) must be addressed through a broad scope of activities; and vii) involves interdependencies among both multiple sectors and levels of government.We conclude that the new perspective on PI proposed in this article might be useful and important for i) describing and mapping policies to counteract PI in different contexts; ii) evaluating whether or not existing policy instruments are appropriate to the policy problem of PI, and iii) explaining the factors and processes that underlie policy development and implementation. More research is warranted in all these areas. In particular, we propose to focus on comparative analyses of how the problem of PI is defined and tackled in different contexts, and on the identification of truly effective policy instruments that are designed to "solve" the PI policy problem.

Developing an Evidence Base for Policies and Interventions to Address Health Inequalities: The Analysis of “Public Health Regimes”

PubMed Central

Asthana, Sheena; Halliday, Joyce

2006-01-01

Systematic reviews have become an important methodology in the United Kingdom by which research informs health policy, and their use now extends beyond evidence-based medicine to evidence-based public health and, particularly, health inequalities policies. This article reviews the limitations of systematic reviews as stand-alone tools for this purpose and suggests a complementary approach to make better use of the evidence. That is, systematic reviews and other sources of evidence should be incorporated into a wider analytical framework, the public health regime (defined here as the specific legislative, social, political, and economic structures that have an impact on both public health and the appropriateness and effectiveness of public health interventions adopted). At the national level this approach would facilitate analysis at all levels of the policy framework, countering the current focus on individual interventions. It could also differentiate at the international level between those policies and interventions that are effective in different contexts and are therefore potentially generalizable and those that depend on particular conditions for success. PMID:16953811

Shaping innovation in health care: A content analysis of innovation policies in the English NHS, 1948-2015.

PubMed

Farchi, Tomas; Salge, Torsten-Oliver

2017-11-01

Governments around the world seek to design policies that enhance the innovative capacity of public service. Hence, identifying the underlying meanings attributed to innovation concepts in public policies is critical, as these very understandings inform not only the policy discourses, but also the overall institutional landscape regulating innovation activities. This paper examines such fundamental definitional aspects in the specific context of the National Health Service in England. For this purpose, it traces the evolution of the innovation concept in policy discourse based on the analysis of 21 key policy documents published or commissioned by the English Department of Health between 1948 and 2015. Systematic analysis of these texts reveals that policymakers' conception of healthcare innovation broadened considerably over time. English health innovation policy initially focused on basic biomedical research. Subsequently, it entered a transitional period, zeroing in on science- and technology-based innovation. Finally, this focus gradually shifted to a broader conception of innovation translating into health, economic, and service design benefits. Copyright © 2017 Elsevier Ltd. All rights reserved.

A policy analysis of the problem of the reproductive health of women in the workplace.

PubMed

Kotch, J B; Ossler, C C; Howze, D C

1984-06-01

Many occupations in which women comprise the majority of the workforce involve exposure to biological, physical, and chemical hazards. Potential reproductive effects of work-related substances include impaired reproductive capacity, mutagenesis, teratogenesis, and transplacental carcinogenesis. However, female-dominated occupations tend to be only minimally regulated by the US Occupational Safety and Health Administration, and the corporate response to the issue of reproductive and fetal health has been to institute "protective discrimination policies" such as the demotion or exclusion of women of childbearing age from certain jobs. This article rates the effectiveness of alternate policy responses to increase women's occupational health and safety through use of a series of analysis criteria: equity, efficiency, preference satisfaction, right to privacy, avoidance of stigma, and unintended consequences. Policy options include the following: 1) do nothing, 2) leave current policies intact while supporting a research program to document the health consequences of specific occupational risks to women's reproductive health, 3) restrict women for who pregnancy is not ruled out from occupations or work areas known or suspected to be hazardous, 4) improve working conditions for all women, and 5) improve working conditions for all workers. Policy analysis suggests the working conditions of all workers should be improved. This alternative reduces inequity, eliminates stigma, maintains privacy, and honors preferences. Implementation of this policy would be expensive, requiring an increase in knowledge of the effects of industrial substances on female and male reproductive health, expansion of the technical capacity to control occupational hazards, and an increase in the resources of programs that monitor and regulate occupational health. However, this approach is in accord with growing concern that workers should not have to compromise their health to keep their jobs.

[Workplace health promotion in public health policies in Poland].

PubMed

Puchalski, Krzysztof; Korzeniowska, Elzbieta

2008-01-01

In this paper the author analyses how far in Poland the idea of workplace health promotion (WHP) does exist in the area of public health understood in its broadest sense. The analysis encapsulates the following issues: (a) the national legislative policy, (b) strategies, programs and projects concerning health issues launched or coordinated by the state or local administration, (c) grassroots initiatives for health promotion supported by local and regional administration, (d) civic projects or business strategies for health. In addition, the author emphasizes the marginalization of workplace health promotion and lack of cohesive policy in this field as well as, the fact that health problems of the working population arising from current demographic, technological, economic and social changes that could be dealt with through developing and implementing WHP projects are not yet fully perceived by public health policy makers.

Public health policy research: making the case for a political science approach.

PubMed

Bernier, Nicole F; Clavier, Carole

2011-03-01

The past few years have seen the emergence of claims that the political determinants of health do not get due consideration and a growing demand for better insights into public policy analysis in the health research field. Several public health and health promotion researchers are calling for better training and a stronger research culture in health policy. The development of these studies tends to be more advanced in health promotion than in other areas of public health research, but researchers are still commonly caught in a naïve, idealistic and narrow view of public policy. This article argues that the political science discipline has developed a specific approach to public policy analysis that can help to open up unexplored levers of influence for public health research and practice and that can contribute to a better understanding of public policy as a determinant of health. It describes and critiques the public health model of policy analysis, analyzes political science's specific approach to public policy analysis, and discusses how the politics of research provides opportunities and barriers to the integration of political science's distinctive contributions to policy analysis in health promotion.

Immigration Policies and Mental Health Morbidity among Latinos: A State-Level Analysis

PubMed Central

Hatzenbuehler, Mark L.; Prins, Seth; Flake, Morgan; Philbin, Morgan; Frazer, Somjen; Hagen, Daniel; Hirsch, Jennifer

2017-01-01

Rationale Despite abundant state-level policy activity in the U.S. related to immigration, no research has examined the mental health impact of the overall policy climate for Latinos, taking into account both inclusionary and exclusionary legislation. Objective To examine associations between the state-level policy climate related to immigration and mental health outcomes among Latinos. Methods We created a multi-sectoral policy climate index that included 14 policies in four domains (immigration, race/ethnicity, language, and agricultural worker protections). We then examined the relation of this policy climate index to two mental health outcomes (days of poor mental health and psychological distress) among Latinos from 31 states in the 2012 Behavioral Risk Factor Surveillance System (BRFSS), a population-based health survey of non-institutionalized individuals aged 18 years or older. Results Individuals in states with more exclusionary immigration policies had higher rates of poor mental health days than participants in states with less exclusionary policies (RR: 1.05, 95% CI: 1.00, 1.10). The association between state policies and the rate of poor mental health days was significantly higher among Latinos versus non-Latinos (RR for interaction term: 1.03, 95% CI: 1.01, 1.06). Furthermore, Latinos in states with more exclusionary policies had 1.14 (95% CI: 1.04, 1.25) times the rate of poor mental health days than Latinos in states with less exclusionary policies. Results were robust to individual- and state-level confounders. Sensitivity analyses indicated that results were specific to immigration policies, and not indicators of state political climate or of residential segregation. No relationship was observed between the immigration policy index and psychological distress. Conclusion These results suggest that restrictive immigration policies may be detrimental to the mental health of Latinos in the United States. PMID:28043019

Structural analysis of health-relevant policy-making information exchange networks in Canada.

PubMed

Contandriopoulos, Damien; Benoît, François; Bryant-Lukosius, Denise; Carrier, Annie; Carter, Nancy; Deber, Raisa; Duhoux, Arnaud; Greenhalgh, Trisha; Larouche, Catherine; Leclerc, Bernard-Simon; Levy, Adrian; Martin-Misener, Ruth; Maximova, Katerina; McGrail, Kimberlyn; Nykiforuk, Candace; Roos, Noralou; Schwartz, Robert; Valente, Thomas W; Wong, Sabrina; Lindquist, Evert; Pullen, Carolyn; Lardeux, Anne; Perroux, Melanie

2017-09-20

Health systems worldwide struggle to identify, adopt, and implement in a timely and system-wide manner the best-evidence-informed-policy-level practices. Yet, there is still only limited evidence about individual and institutional best practices for fostering the use of scientific evidence in policy-making processes The present project is the first national-level attempt to (1) map and structurally analyze-quantitatively-health-relevant policy-making networks that connect evidence production, synthesis, interpretation, and use; (2) qualitatively investigate the interaction patterns of a subsample of actors with high centrality metrics within these networks to develop an in-depth understanding of evidence circulation processes; and (3) combine these findings in order to assess a policy network's "absorptive capacity" regarding scientific evidence and integrate them into a conceptually sound and empirically grounded framework. The project is divided into two research components. The first component is based on quantitative analysis of ties (relationships) that link nodes (participants) in a network. Network data will be collected through a multi-step snowball sampling strategy. Data will be analyzed structurally using social network mapping and analysis methods. The second component is based on qualitative interviews with a subsample of the Web survey participants having central, bridging, or atypical positions in the network. Interviews will focus on the process through which evidence circulates and enters practice. Results from both components will then be integrated through an assessment of the network's and subnetwork's effectiveness in identifying, capturing, interpreting, sharing, reframing, and recodifying scientific evidence in policy-making processes. Knowledge developed from this project has the potential both to strengthen the scientific understanding of how policy-level knowledge transfer and exchange functions and to provide significantly improved advice

Human resources for health policies: a critical component in health policies.

PubMed

Dussault, Gilles; Dubois, Carl-Ardy

2003-04-14

In the last few years, increasing attention has been paid to the development of health policies. But side by side with the presumed benefits of policy, many analysts share the opinion that a major drawback of health policies is their failure to make room for issues of human resources. Current approaches in human resources suggest a number of weaknesses: a reactive, ad hoc attitude towards problems of human resources; dispersal of accountability within human resources management (HRM); a limited notion of personnel administration that fails to encompass all aspects of HRM; and finally the short-term perspective of HRM.There are three broad arguments for modernizing the ways in which human resources for health are managed:bullet; the central role of the workforce in the health sector;bullet; the various challenges thrown up by health system reforms;bullet; the need to anticipate the effect on the health workforce (and consequently on service provision) arising from various macroscopic social trends impinging on health systems.The absence of appropriate human resources policies is responsible, in many countries, for a chronic imbalance with multifaceted effects on the health workforce: quantitative mismatch, qualitative disparity, unequal distribution and a lack of coordination between HRM actions and health policy needs.Four proposals have been put forward to modernize how the policy process is conducted in the development of human resources for health (HRH):bullet; to move beyond the traditional approach of personnel administration to a more global concept of HRM;bullet; to give more weight to the integrated, interdependent and systemic nature of the different components of HRM when preparing and implementing policy;bullet; to foster a more proactive attitude among human resources (HR) policy-makers and managers;bullet; to promote the full commitment of all professionals and sectors in all phases of the process.The development of explicit human resources policies is

Human resources for health policies: a critical component in health policies

PubMed Central

Dussault, Gilles; Dubois, Carl-Ardy

2003-01-01

In the last few years, increasing attention has been paid to the development of health policies. But side by side with the presumed benefits of policy, many analysts share the opinion that a major drawback of health policies is their failure to make room for issues of human resources. Current approaches in human resources suggest a number of weaknesses: a reactive, ad hoc attitude towards problems of human resources; dispersal of accountability within human resources management (HRM); a limited notion of personnel administration that fails to encompass all aspects of HRM; and finally the short-term perspective of HRM. There are three broad arguments for modernizing the ways in which human resources for health are managed: • the central role of the workforce in the health sector; • the various challenges thrown up by health system reforms; • the need to anticipate the effect on the health workforce (and consequently on service provision) arising from various macroscopic social trends impinging on health systems. The absence of appropriate human resources policies is responsible, in many countries, for a chronic imbalance with multifaceted effects on the health workforce: quantitative mismatch, qualitative disparity, unequal distribution and a lack of coordination between HRM actions and health policy needs. Four proposals have been put forward to modernize how the policy process is conducted in the development of human resources for health (HRH): • to move beyond the traditional approach of personnel administration to a more global concept of HRM; • to give more weight to the integrated, interdependent and systemic nature of the different components of HRM when preparing and implementing policy; • to foster a more proactive attitude among human resources (HR) policy-makers and managers; • to promote the full commitment of all professionals and sectors in all phases of the process. The development of explicit human resources policies is a crucial link

Analysis of Existing International Policy Evidence in Public Health Genomics: Mapping Exercise

PubMed Central

Syurina, Elena V.; in den Bäumen, Tobias Schulte; Feron, Frans J.M.; Brand, Angela

2012-01-01

Background In the last decades we have seen a constant growth in the fields of science related to the use of genome-based health information. However, there is a gap between basic science research and the Public Health everyday practice. For a successful introduction of genome-based technologies policy actions on the international level are needed. This work represents the initial stage of the PHGEN II (Public Health Genomics European Network II) project. In order to prepare a base for bridging genomics and Public Health, an inventory study of the existing legislative base dealing with controversies of genome-based knowledge was conducted. The work results in the mapping of the most and the least legislatively covered areas and some preliminary conclusions about the existing gaps. Design and Methods The collection of the evidence-based policies was done through the PHGEN II project. The mapping covered the meta-level (international, European general guidelines). The expert opinion of the partners of the project was required to reflect on and grade the collected evidence. Results An analysis of the evidence was made by the area of coverage: using the list of important policy areas for successful introduction of genome-based technologies into Public Health and the Public Health Genomics Wheel (originally Public Health Wheel developed by Institute of Medicine). Conclusions Severe inequalities in coverage of important issues of Public Health Genomics were found. The most attention was paid to clinical utility and clinical validity of the screening and the protection of human subjects. Important areas such as trade agreements, Public Health Genomics literacy, insurance issues, behaviour modification in response to genomics results etc. were paid less attention to. For the successful adoption of new technologies on the Public Health level the focus should be not only on the translation to clinical practice, but the translation from bench to Public Health policy and back

Developing effective policy strategies to retain health workers in rural Bangladesh: a policy analysis.

PubMed

Rawal, Lal B; Joarder, Taufique; Islam, Sheikh Md Shariful; Uddin, Aftab; Ahmed, Syed Masud

2015-05-20

Retention of human resources for health (HRH), particularly physicians and nurses in rural and remote areas, is a major problem in Bangladesh. We reviewed relevant policies and provisions in relation to HRH aiming to develop appropriate rural retention strategies in Bangladesh. We conducted a document review, thorough search and review of relevant literature published from 1971 through May 2013, key informant interviews with policy elites (health policy makers, managers, researchers, etc.), and a roundtable discussion with key stakeholders and policy makers. We used the World Health Organization's (WHO's) guidelines as an analytical matrix to examine the rural retention policies under 4 domains, i) educational, ii) regulatory, iii) financial, and iv) professional and personal development, and 16 sub-domains. Over the past four decades, Bangladesh has developed and implemented a number of health-related policies and provisions concerning retention of HRH. The district quota system in admissions is in practice to improve geographical representation of the students. Students of special background including children of freedom fighters and tribal population have allocated quotas. In private medical and nursing schools, at least 5% of seats are allocated for scholarships. Medical education has a provision for clinical rotation in rural health facilities. Further, in the public sector, every newly recruited medical doctor must serve at least 2 years at the upazila level. To encourage serving in hard-to-reach areas, particularly in three Hill Tract districts of Chittagong division, the government provides an additional 33% of the basic salary, but not exceeding US$ 38 per month. This amount is not attractive enough, and such provision is absent for those working in other rural areas. Although the government has career development and promotion plans for doctors and nurses, these plans are often not clearly specified and not implemented effectively. The government is

An analysis of policy success and failure in formal evaluations of Australia's national mental health strategy (1992-2012).

PubMed

Grace, Francesca C; Meurk, Carla S; Head, Brian W; Hall, Wayne D; Harris, Meredith G; Whiteford, Harvey A

2017-05-30

Heightened fiscal constraints, increases in the chronic disease burden and in consumer expectations are among several factors contributing to the global interest in evidence-informed health policy. The present article builds on previous work that explored how the Australian Federal Government applied five instruments of policy, or policy levers, to implement a series of reforms under the Australian National Mental Health Strategy (NMHS). The present article draws on theoretical insights from political science to analyse the relative successes and failures of these levers, as portrayed in formal government evaluations of the NMHS. Documentary analysis of six evaluation documents corresponding to three National Mental Health Plans was undertaken. Both the content and approach of these government-funded, independently conducted evaluations were appraised. An overall improvement was apparent in the development and application of policy levers over time. However, this finding should be interpreted with caution due to variations in evaluation approach according to Plan and policy lever. Tabulated summaries of the success and failure of each policy initiative, ordered by lever type, are provided to establish a resource that could be consulted for future policy-making. This analysis highlights the complexities of health service reform and underscores the limitations of narrowly focused empirical approaches. A theoretical framework is provided that could inform the evaluation and targeted selection of appropriate policy levers in mental health.

The policy process for health promotion.

PubMed

Söderberg, Erik; Wikström, Ewa

2015-08-01

The paper aims to contribute to our understanding of the policy process in health promotion by addressing the following questions: What are the characteristics of the policy process in health promotion? How do policy entrepreneurs influence project implementation? This is a qualitative study with an explorative case study design that uses three different data sources: qualitative interviews, written documents and observations. The paper examines several factors (determinants) that influence the policy process and that, to a lesser extent, are addressed by current models in health policy research. Legitimacy, financial capacity, available structure and political timing are all important determinants that influence the policy process. Policy entrepreneurs, with established networks and knowledge of the environment and its procedures, create legitimacy and provide opportunities for action; however, indistinct organizational boundaries among roles and poorly defined individual responsibilities create policy process uncertainty. As a result, there are lengthy discussions and few decisions, both of which delay the progress of a project. This paper's theoretical contribution is its analysis of the relationship of policy-making to linear models, via a discussion of policy entrepreneurs, and their importance in the policy process. The paper concludes that we need to consider the influence of policy entrepreneurs, whom build legitimacy and seize action opportunities by coupling the three streams in the policy process, as they help bring projects to fruition. Furthermore, the study points to the importance of policy entrepreneurs throughout the policy process. The paper has practical implications for practitioners whom work with the implementation of community policies. © 2015 the Nordic Societies of Public Health.

The impact of corporate practices on health: implications for health policy.

PubMed

Freudenberg, Nicholas; Galea, Sandro

2008-04-01

Although corporate practices play a substantial role in shaping health and health behavior, public health researchers have rarely systematically studied these practices as a social determinant of health. We consider case studies of three products - trans fat, a food additive and a preservative; Vioxx, a pain killer; and sports utility vehicles - to illustrate the role of corporate policies and practices in the production of health and disease and the implications for health policy. In recent years, public health advocates, researchers, and lawyers have used strategies to reduce the adverse health impact of corporate practices. Systematic analysis of these experiences yields insights that can guide the development of health policies that increase opportunities for primary prevention by discouraging harmful corporate practices.

Assessment of health risks of policies

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ádám, Balázs, E-mail: badam@cmss.sdu.dk; Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, P.O. Box 9, H-4012 Debrecen; Molnár, Ágnes, E-mail: MolnarAg@smh.ca

The assessment of health risks of policies is an inevitable, although challenging prerequisite for the inclusion of health considerations in political decision making. The aim of our project was to develop a so far missing methodological guide for the assessment of the complex impact structure of policies. The guide was developed in a consensual way based on experiences gathered during the assessment of specific national policies selected by the partners of an EU project. Methodological considerations were discussed and summarized in workshops and pilot tested on the EU Health Strategy for finalization. The combined tool, which includes a textual guidancemore » and a checklist, follows the top-down approach, that is, it guides the analysis of causal chains from the policy through related health determinants and risk factors to health outcomes. The tool discusses the most important practical issues of assessment by impact level. It emphasises the transparent identification and prioritisation of factors, the consideration of the feasibility of exposure and outcome assessment with special focus on quantification. The developed guide provides useful methodological instructions for the comprehensive assessment of health risks of policies that can be effectively used in the health impact assessment of policy proposals. - Highlights: • Methodological guide for the assessment of health risks of policies is introduced. • The tool is developed based on the experiences from several case studies. • The combined tool consists of a textual guidance and a checklist. • The top-down approach is followed through the levels of the full impact chain. • The guide provides assistance for the health impact assessment of policy proposals.« less

Privacy policy analysis for health information networks and regional health information organizations.

PubMed

Noblin, Alice M

2007-01-01

Regional Health Information Organizations (RHIOs) are forming in response to President George W. Bush's 2004 mandate that medical information be made available electronically to facilitate continuity of care. Privacy concerns are a deterrent to widespread acceptance of RHIOs. The Health Information Portability and Accountability Act of 1996 provides some guidelines for privacy protection. However, most states have stricter guidelines, causing difficulty when RHIOs form across these jurisdictions. This article compares several RHIOs including their privacy policies where available. In addition, studies were reviewed considering privacy concerns of people in the United States and elsewhere. Surveys reveal that Americans are concerned about the privacy of their personal health information and ultimately feel it is the role of the government to provide protection. The purpose of this article is to look at the privacy issues and recommend a policy that may help to resolve some of the concerns of both providers and patients. Policy research and action are needed to move the National Health Information Network toward reality. Efforts to provide consistency in privacy laws are a necessary early step to facilitate the construction and maintenance of RHIOs and the National Health Information Network.

Nurses' policy influence: A concept analysis.

PubMed

Arabi, Akram; Rafii, Forough; Cheraghi, Mohammad Ali; Ghiyasvandian, Shahrzad

2014-05-01

Nurses' influence on health policy protects the quality of care by access to required recourses and opportunities. This is a new and important concept for nursing; however, research studies on policy influence of nurses in health care sector are lacking a basic conceptual understanding of what this concept represents. The aim of this paper is to clarify the concept of nurses' policy influence and to propose the definition of this concept, considering the context of Iran. The eight stages of Walker and Avant approach was used to guide this concept analysis. Various databases and internet engines were searched to find all related information about the concept. Textbooks were also searched manually. English language literature reports published between 1990 and 2012 were reviewed. Based on the analysis undertaken, nurses' policy influence is nurses' ability in influencing decisions and affairs related to health through political knowledge, effective communication, and collaboration with other members of the health team, which results in the improvement of nurses' job environment and increases patient outcomes. This is a dynamic process situated on a spectrum and is accompanied with nurses' knowledge, competency, power, and advocacy, and also their ability to change. Nurses have individual views on health care issues and influence health care policies in different ways. With a common understanding of nurses' policy influence as a concept, nurses will recognize the importance of policy making in the health sector and their influence on this process and also on patients' outcomes.

Is health recognized in the EU's policy process? An analysis of the European Commission's impact assessments.

PubMed

Ståhl, Timo P

2010-04-01

The European Commission has an Impact Assessment (IA) procedure that aims to inform decision-makers of the all important impacts that decisions may have. This article studies how health is considered in the IA procedure and how it is reflected in the reports: what aspects, whose and simply in what context health is mentioned in the IA reports. Half of the Commissions IAs from 2006 were studied. The analysis was text based and informed by content analysis. In total, 48 reports by 17 DGs were analysed. Five DGs (29%) and 10 reports (21%) made no reference to human health, public health or health systems. Five DGs were clearly considering health impacts more often than others; DG EMPL, SANCO, AGRI, ELARG and ENV. Health systems/services were most often and human health next most common referred to (39% and 29% of all, respectively). Health impacts were usually referred to in the sections on the definition of problems and the analysis of impacts. Seldom were they reported on in the sections on policy options, comparing options, or in the monitoring and evaluation sections. The results partly support concerns about the potential neglect of health impacts. The results also suggest that health is not considered an important factor when discussing alternative policy choices, and neither does it seem to be an important objective. There is a clear need for further exploration on ways in which health could be more appropriately considered when impacts of other policies are considered by the various DGs.

Public Health Professionals as Policy Entrepreneurs: Arkansas's Childhood Obesity Policy Experience

PubMed Central

Craig, Rebekah L.; Felix, Holly C.; Phillips, Martha M.

2010-01-01

In response to a nationwide rise in obesity, several states have passed legislation to improve school health environments. Among these was Arkansas's Act 1220 of 2003, the most comprehensive school-based childhood obesity legislation at that time. We used the Multiple Streams Framework to analyze factors that brought childhood obesity to the forefront of the Arkansas legislative agenda and resulted in the passage of Act 1220. When 3 streams (problem, policy, and political) are combined, a policy window is opened and policy entrepreneurs may advance their goals. We documented factors that produced a policy window and allowed entrepreneurs to enact comprehensive legislation. This historical analysis and the Multiple Streams Framework may serve as a roadmap for leaders seeking to influence health policy. PMID:20864715

The human factor: re-organisations in public health policy.

PubMed

Oliver, Kathryn; Everett, Martin; Verma, Arpana; de Vocht, Frank

2012-06-01

Public health policy-making activities are currently split between local authority and NHS organisations. Despite an increasing body of research on evidence-based policy (EBP), few studies explore the process of policy-making. Little is known about how policies are made in a local context, or how (scientific) evidence is used. Previous research has ignored the 'human element' in EBP. Social network analysis (SNA) techniques are becoming increasingly important in health policy. This paper describes an innovative study giving a fresh perspective on policy-making processes in public health. A social network analysis of public health policy making networks in Greater Manchester based on publicly available data (documents, websites and meeting papers) and an electronic survey, asking actors to nominate those who influenced their own views, those who were powerful, and those who were a source of evidence or information. Policy-making networks are described. Formal executive roles are loosely related to perceived influence and power. Evidence-seeking networks are less coherent, with key organisations not represented. These data indicate the importance of collaboration and good relationships between researchers and policy-makers, but few academic researchers with a direct impact on health policy were identified within the networks. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

'Including health in systems responsible for urban planning': a realist policy analysis research programme.

PubMed

Harris, Patrick; Friel, Sharon; Wilson, Andrew

2015-07-23

Realist methods are increasingly being used to investigate complex public health problems. Despite the extensive evidence base clarifying the built environment as a determinant of health, there is limited knowledge about how and why land-use planning systems take on health concerns. Further, the body of research related to the wider determinants of health suffers from not using political science knowledge to understand how to influence health policy development and systems. This 4-year funded programme of research investigates how the land-use planning system in New South Wales, Australia, incorporates health and health equity at multiple levels. The programme uses multiple qualitative methods to develop up to 15 case studies of different activities of the New South Wales land-use planning system. Comparison cases from other jurisdictions will be included where possible and useful. Data collection includes publicly available documentation and purposively sampled stakeholder interviews and focus groups of up to 100 participants across the cases. The units of analysis in each case are institutional structures (rules and mandates constraining and enabling actors), actors (the stakeholders, organisations and networks involved, including health-focused agencies), and ideas (policy content, information, and framing). Data analysis will focus on and develop propositions concerning the mechanisms and conditions within and across each case leading to inclusion or non-inclusion of health. Data will be refined using additional political science and sociological theory. Qualitative comparative analysis will compare cases to develop policy-relevant propositions about the necessary and sufficient conditions needed to include health issues. Ethics has been approved by Sydney University Human Research Ethics Committee (2014/802 and 2015/178). Given the nature of this research we will incorporate stakeholders, often as collaborators, throughout. We outline our research translation

Health and foreign policy in question: the case of humanitarian action.

PubMed

Thieren, Michel

2007-03-01

Health has gained recognition as a foreign policy concern in recent years. Political leaders increasingly address global health problems within their international relations agendas. The confluence of health and foreign policy has opened these issues to analysis that helps clarify the tenets and determinants of this linkage, offering a new framework for international health policy. Yet as health remains profoundly bound to altruistic values, caution is required before generalizing about the positive outcomes of merging international health and foreign policy principles. In particular, the possible side-effects of this framework deserve further consideration. This paper examines the interaction of health and foreign policy in humanitarian action, where public health and foreign policy are often in direct conflict. Using a case-based approach, this analysis shows that health and foreign policy need not be at odds in this context, although there are situations where altruistic and interest-based values compete. The hierarchy of foreign policy functions must be challenged to avoid misuse of national authority where health interventions do not coincide with national security and domestic interests.

Inclusion of vulnerable groups in health policies: Regional policies on health priorities in Africa

PubMed Central

Eide, Arne Henning; Amin, Mutamad; MacLachlan, Malcom; Mannan, Hasheem

2013-01-01

Background If access to equitable health care is to be achieved for all, policy documents must mention and address in some detail different needs of groups vulnerable to not accessing such health care. If these needs are not addressed in the policy documents, there is little chance that they will be addressed at the stage of implementation. Objectives This paper reports on an analysis of 11 African Union (AU) policy documents to ascertain the frequency and the extent of mention of 13 core concepts in relation to 12 vulnerable groups, with a specific focus on people with disabilities. Method The paper applied the EquiFrame analytical framework to the 11 AU policy documents. The 11 documents were analysed in terms of how many times a core concept was mentioned and the extent of information on how the core concept should be addressed at the implementation level. Each core concept mention was further analysed in terms of the vulnerable group in referred to. Results The analysis of regional AU policies highlighted the broad nature of the reference made to vulnerable groups, with a lack of detailed specifications of different needs of different groups. This is confirmed in the highest vulnerable group mention being for ‘universal’. The reading of the documents suggests that vulnerable groups are homogeneous in their needs, which is not the case. There is a lack of recognition of different needs of different vulnerable groups in accessing health care. Conclusion The need for more information and knowledge on the needs of all vulnerable groups is evident. The current lack of mention and of any detail on how to address needs of vulnerable groups will significantly impair the access to equitable health care for all. PMID:28729986

An analysis of local government health policy against state priorities and a social determinants framework.

PubMed

Browne, Geoffrey R; Davern, Melanie T; Giles-Corti, Billie

2016-04-01

Victorian local governments are required to develop Municipal Public Health and Wellbeing Plans that incorporate state-level health planning priorities and address the social determinants of health. This paper describes a novel method for evaluating councils' performance against these requirements. Deductive content analysis was used to categorise all actions in 14 local government MPHWPs against Victorian state priorities as well as against social determinants of health policy areas. More than 1,000 actions were identified. However, fewer than half directly addressed a state priority, with many actions addressing policy areas known to be broader determinants of health. In particular, there was a marked focus on leisure and culture, and on building social cohesion through changes to living and working conditions. Councils are working beyond state priorities and there was a clear emphasis on addressing the diverse upstream 'causes of the causes' of health, rather than health promotion behaviour change programs. The approach for data analysis and presentation provides a useful method for rapid appraisal of health and wellbeing actions relative to councils', and the State's, responsibility and efficacy in public health. © 2015 Public Health Association of Australia.

The emergence of global health partnerships as facilitators of access to medication in Africa: a narrative policy analysis.

PubMed

Ngoasong, Michael Zisuh

2009-03-01

Over the last decade global health partnerships (GHPs) have been formed to provide a better policy response to Africa's health problems. This paper uses narrative policy analysis to explain the historical processes and challenges facing national and global health policy in facilitating access to medication in African countries. An overview of the historical context of events leading to the creation of GHPs is followed by a content and context analysis of two GHPs - Roll Back Malaria partnership and the Accelerating Access Initiative. The historical narratives implicitly reflect the context in which policy decisions are produced and implemented. The deployment of GHPs in Africa reflects a convergence of the competing and conflicting narratives, in relating to strategies previously promoted by various multilateral and bilateral development agencies, international civil society organizations, and the private commercial industry to facilitate access to medication.

A retrospective health policy analysis of the development and implementation of the voluntary health insurance system in Lebanon: learning from failure.

PubMed

El-Jardali, Fadi; Bou-Karroum, Lama; Ataya, Nour; El-Ghali, Hana Addam; Hammoud, Rawan

2014-12-01

Public policymaking is complex and suffers from limited uptake of research evidence, particularly in the Eastern Mediterranean Region (EMR). In-depth case studies examining health policymaking in the EMR are lacking. This retrospective policy analysis aims at generating insights about how policies are being made, identifying factors influencing policymaking and assessing to what extent evidence is used in this process by using the Lebanese Voluntary Health Insurance policy as a case study. The study examined the policymaking process through a policy tracing technique that covered a period of 12 years. The study employed a qualitative research design using a case study approach and was conducted in two phases over the course of two years. Data was collected using multiple sources including: 1) a comprehensive and chronological media review; 2) twenty-two key informant interviews with policymakers, stakeholders, and journalists; and 3) a document review of legislations, minutes of meetings, actuarial studies, and official documents. Data was analyzed and validated using thematic analysis. Findings showed that the voluntary health insurance policy was a political decision taken by the government to tackle an urgent political problem. Evidence was not used to guide policy development and implementation and policy implementers and other stakeholders were not involved in policy development. Factors influencing policymaking were political interests, sectarianism, urgency, and values of policymakers. Barriers to the use of evidence were lack of policy-relevant research evidence, political context, personal interests, and resource constraints. Findings suggest that policymakers should be made more aware of the important role of evidence in informing public policymaking and the need for building capacity to develop, implement and evaluate policies. Study findings are likely to matter in light of the changes that are unfolding in some Arab countries and the looming

Advancing Strategies for Agenda Setting by Health Policy Coalitions: A Network Analysis of the Canadian Chronic Disease Prevention Survey.

PubMed

McGetrick, Jennifer Ann; Raine, Kim D; Wild, T Cameron; Nykiforuk, Candace I J

2018-06-11

Health in all policies can address chronic disease morbidity and mortality by increasing population-level physical activity and healthy eating, and reducing tobacco and alcohol use. Both governmental and nongovernmental policy influencers are instrumental for health policy that modifies political, economic, and social environments. Policy influencers are informed and persuaded by coalitions that support or oppose changing the status quo. Empirical research examining policy influencers' contact with coalitions, as a social psychological exposure with health policy outcomes, can benefit from application of health communication theories. Accordingly, we analyzed responses to the 2014 Chronic Disease Prevention Survey for 184 Canadian policy influencers employed in provincial governments, municipalities, large workplaces, school boards, and the media. In addition to contact levels with coalitions, respondents' jurisdiction, organization, and ideology were analyzed as potential moderators. Calculating authority score centrality using network analysis, we determined health policy supporters to be more central in policy influencer networks, and theorized their potential to impact health policy public agenda setting via priming and framing processes. We discuss the implications of our results as presenting opportunities to more effectively promote health policy through priming and framing by coordinating coalitions across risk behaviors to advance a societal imperative for chronic disease prevention.

Structural integration and performance of inter-sectoral public health-related policy networks: An analysis across policy phases.

PubMed

Peters, D T J M; Raab, J; Grêaux, K M; Stronks, K; Harting, J

2017-12-01

Inter-sectoral policy networks may be effective in addressing environmental determinants of health with interventions. However, contradictory results are reported on relations between structural network characteristics (i.e., composition and integration) and network performance, such as addressing environmental determinants of health. This study examines these relations in different phases of the policy process. A multiple-case study was performed on four public health-related policy networks. Using a snowball method among network actors, overall and sub-networks per policy phase were identified and the policy sector of each actor was assigned. To operationalise the outcome variable, interventions were classified by the proportion of environmental determinants they addressed. In the overall networks, no relation was found between structural network characteristics and network performance. In most effective cases, the policy development sub-networks were characterised by integration with less interrelations between actors (low cohesion), more equally distributed distances between the actors (low closeness centralisation), and horizontal integration in inter-sectoral cliques. The most effective case had non-public health central actors with less connections in all sub-networks. The results suggest that, to address environmental determinants of health, sub-networks should be inter-sectorally composed in the policy development rather than in the intervention development and implementation phases, and that policy development actors should have the opportunity to connect with other actors, without strong direction from a central actor. Copyright © 2017 Elsevier B.V. All rights reserved.

An analysis of policy levers used to implement mental health reform in Australia 1992-2012.

PubMed

Grace, Francesca C; Meurk, Carla S; Head, Brian W; Hall, Wayne D; Carstensen, Georgia; Harris, Meredith G; Whiteford, Harvey A

2015-10-24

Over the past two decades, mental health reform in Australia has received unprecedented government attention. This study explored how five policy levers (organisation, regulation, community education, finance and payment) were used by the Australian Federal Government to implement mental health reforms. Australian Government publications, including the four mental health plans (published in 1992, 1998, 2003 and 2008) were analysed according to policy levers used to drive reform across five priority areas: [1] human rights and community attitudes; [2] responding to community need; [3] service structures; [4] service quality and effectiveness; and [5] resources and service access. Policy levers were applied in varying ways; with two or three levers often concurrently used to implement a single initiative or strategy. For example, changes to service structures were achieved using various combinations of all five levers. Attempts to improve service quality and effectiveness were instead made through a single lever-regulation. The use of some levers changed over time, including a move away from prescriptive, legislative use of regulation, towards a greater focus on monitoring service standards and consumer outcomes. Patterns in the application of policy levers across the National Mental Health Strategy, as identified in this analysis, represent a novel way of conceptualising the history of mental health reform in Australia. An improved understanding of the strategic targeting and appropriate utilisation of policy levers may assist in the delivery and evaluation of evidence-based mental health reform in the future.

Policy Interpretation Network on Children's Health and Environment.

PubMed

van den Hazel, Peter; Zuurbier, Moniek; Bistrup, Marie Louise

2006-10-01

The main objective of PINCHE is to provide policy recommendations aiming at protecting children's health and environment based on completed scientific research. The project focused on four themes: indoor and outdoor air pollutants, carcinogens, neurotoxicants, and noise. The data were evaluated in workpackages on exposure assessment, epidemiology, toxicology, and risk and health impact assessment. The data were analysed according to a framework of questions. The workpackage on socioeconomic factors studied the influence of socioeconomic status on exposures and on health effects. In the workpackage on science-policy interface, recommendations on how to improve children's environmental health were formulated. The policy recommendations resulting from the analysis were grouped according to relevant policy levels: European Commission or the European Parliament, member states and other stakeholders at regional or local level. These recommendations are general guidelines for taking action. Regional differences and variation must be reflected when policy is actually implemented. In addition, recommendations related to education and personal behaviour are presented in the reports. The policy recommendations are important input for policy advisers, policy makers and public health authorities at all policy levels. The recommendations are also of direct relevance to interest groups, such as environmental NGOs including child health and advocacy groups. The policy recommendations for each policy level were prioritized. High priorities were given to reduce exposure to environmental tobacco smoke, transport related air pollution, indoor air and mercury.

A Model for Training Public Health Workers in Health Policy: the Nebraska Health Policy Academy

PubMed Central

Brandert, Kathleen; McCarthy, Claudine; Grimm, Brandon; Svoboda, Colleen; Palm, David

2014-01-01

There is growing recognition that health goals are more likely to be achieved and sustained if programs are complemented by appropriate changes in the policies, systems, and environments that shape their communities. However, the knowledge, skills, and abilities needed to create and implement policy are among the major needs identified by practitioners at both the state and local levels. This article describes the structure and content of the Nebraska Health Policy Academy (the Academy), a 9-month program developed to meet the demand for this training. The Academy is a competency-based training program that aims to increase the capacity of Nebraska’s state and local public health staff and their community partners to use public health policy and law as a public health tool. Our initiative allows for participation across a large, sparsely populated state; is grounded in adult learning theory; introduces the key principles and practices of policy, systems, and environmental change; and is offered free of charge to the state’s public health workforce. Challenges and lessons learned when offering workforce development on public health policy efforts are discussed. PMID:24831286

The terrain of health policy analysis in low and middle income countries: a review of published literature 1994–2007

PubMed Central

Gilson, Lucy; Raphaely, Nika

2008-01-01

This article provides the first ever review of literature analysing the health policy processes of low and middle income countries (LMICs). Based on a systematic search of published literature using two leading international databases, the article maps the terrain of work published between 1994 and 2007, in terms of policy topics, lines of inquiry and geographical base, as well as critically evaluating its strengths and weaknesses. The overall objective of the review is to provide a platform for the further development of this field of work. From an initial set of several thousand articles, only 391 were identified as relevant to the focus of inquiry. Of these, 164 were selected for detailed review because they present empirical analyses of health policy change processes within LMIC settings. Examination of these articles clearly shows that LMIC health policy analysis is still in its infancy. There are only small numbers of such analyses, whilst the diversity of policy areas, topics and analytical issues that have been addressed across a large number of country settings results in a limited depth of coverage within this body of work. In addition, the majority of articles are largely descriptive in nature, limiting understanding of policy change processes within or across countries. Nonetheless, the broad features of experience that can be identified from these articles clearly confirm the importance of integrating concern for politics, process and power into the study of health policy. By generating understanding of the factors influencing the experience and results of policy change, such analysis can inform action to strengthen future policy development and implementation. This article, finally, outlines five key actions needed to strengthen the field of health policy analysis within LMICs, including capacity development and efforts to generate systematic and coherent bodies of work underpinned by both the intent to undertake rigorous analytical work and concern

Perinatal legislative policies and health outcomes.

PubMed

Lorch, Scott A

2017-10-01

Perinatal epidemiology examines the variation and determinants of pregnancy outcomes from a maternal and neonatal perspective. However, improving public and population health also requires the translation of this evidence base into substantive public policies. Assessing the impact of such public policies requires sufficient data to include potential confounding factors in the analysis, such as coexisting medical conditions and socioeconomic status, and appropriate statistical and epidemiological techniques. This review will explore policies addressing three areas of perinatal medicine-elective deliveries prior to 39 weeks' gestation; perinatal regionalization; and mandatory paid maternity leave policies-to illustrate the challenges when assessing the impact of specific policies at the patient and population level. Data support the use of these policies to improve perinatal health, but with weaker and less certain effect sizes when compared to the initial patient-level studies. Improved data collection and epidemiological techniques will allow for improved assessment of these policies and the identification of potential areas of improvement when translating patient-level studies into public policies. Copyright © 2017 Elsevier Inc. All rights reserved.

Global Health and Foreign Policy

PubMed Central

Feldbaum, Harley; Lee, Kelley; Michaud, Joshua

2010-01-01

Health has long been intertwined with the foreign policies of states. In recent years, however, global health issues have risen to the highest levels of international politics and have become accepted as legitimate issues in foreign policy. This elevated political priority is in many ways a welcome development for proponents of global health, and it has resulted in increased funding for and attention to select global health issues. However, there has been less examination of the tensions that characterize the relationship between global health and foreign policy and of the potential effects of linking global health efforts with the foreign-policy interests of states. In this paper, the authors review the relationship between global health and foreign policy by examining the roles of health across 4 major components of foreign policy: aid, trade, diplomacy, and national security. For each of these aspects of foreign policy, the authors review current and historical issues and discuss how foreign-policy interests have aided or impeded global health efforts. The increasing relevance of global health to foreign policy holds both opportunities and dangers for global efforts to improve health. PMID:20423936

Global health and foreign policy.

PubMed

Feldbaum, Harley; Lee, Kelley; Michaud, Joshua

2010-01-01

Health has long been intertwined with the foreign policies of states. In recent years, however, global health issues have risen to the highest levels of international politics and have become accepted as legitimate issues in foreign policy. This elevated political priority is in many ways a welcome development for proponents of global health, and it has resulted in increased funding for and attention to select global health issues. However, there has been less examination of the tensions that characterize the relationship between global health and foreign policy and of the potential effects of linking global health efforts with the foreign-policy interests of states. In this paper, the authors review the relationship between global health and foreign policy by examining the roles of health across 4 major components of foreign policy: aid, trade, diplomacy, and national security. For each of these aspects of foreign policy, the authors review current and historical issues and discuss how foreign-policy interests have aided or impeded global health efforts. The increasing relevance of global health to foreign policy holds both opportunities and dangers for global efforts to improve health.

Power and Agenda-Setting in Tanzanian Health Policy: An Analysis of Stakeholder Perspectives

PubMed Central

Fischer, Sara Elisa; Strandberg-Larsen, Martin

2016-01-01

Background: Global health policy is created largely through a collaborative process between development agencies and aid-recipient governments, yet it remains unclear whether governments retain ownership over the creation of policy in their own countries. An assessment of the power structure in this relationship and its influence over agenda-setting is thus the first step towards understanding where progress is still needed in policy-making for development. Methods: This study employed qualitative policy analysis methodology to examine how health-related policy agendas are adopted in low-income countries, using Tanzania as a case study. Semi-structured, in-depth, key informant interviews with 11 policy-makers were conducted on perspectives of the agenda-setting process and its actors. Kingdon’s stream theory was chosen as the lens through which to interpret the data analysis. Results: This study demonstrates that while stakeholders each have ways of influencing the process, the power to do so can be assessed based on three major factors: financial incentives, technical expertise, and influential position. Since donors often have two or all of these elements simultaneously a natural power imbalance ensues, whereby donor interests tend to prevail over recipient government limitations in prioritization of agendas. One way to mediate these imbalances seems to be the initiation of meaningful policy dialogue. Conclusion: In Tanzania, the agenda-setting process operates within a complex network of factors that interact until a "policy window" opens and a decision is made. Power in this process often lies not with the Tanzanian government but with the donors, and the contrast between latent presence and deliberate use of this power seems to be based on the donor ideology behind giving aid (defined here by funding modality). Donors who used pooled funding (PF) modalities were less likely to exploit their inherent power, whereas those who preferred to maintain maximum

Power and Agenda-Setting in Tanzanian Health Policy: An Analysis of Stakeholder Perspectives.

PubMed

Fischer, Sara Elisa; Strandberg-Larsen, Martin

2016-02-09

Global health policy is created largely through a collaborative process between development agencies and aid-recipient governments, yet it remains unclear whether governments retain ownership over the creation of policy in their own countries. An assessment of the power structure in this relationship and its influence over agenda-setting is thus the first step towards understanding where progress is still needed in policy-making for development. This study employed qualitative policy analysis methodology to examine how health-related policy agendas are adopted in low-income countries, using Tanzania as a case study. Semi-structured, in-depth, key informant interviews with 11 policy-makers were conducted on perspectives of the agenda-setting process and its actors. Kingdon's stream theory was chosen as the lens through which to interpret the data analysis. This study demonstrates that while stakeholders each have ways of influencing the process, the power to do so can be assessed based on three major factors: financial incentives, technical expertise, and influential position. Since donors often have two or all of these elements simultaneously a natural power imbalance ensues, whereby donor interests tend to prevail over recipient government limitations in prioritization of agendas. One way to mediate these imbalances seems to be the initiation of meaningful policy dialogue. In Tanzania, the agenda-setting process operates within a complex network of factors that interact until a "policy window" opens and a decision is made. Power in this process often lies not with the Tanzanian government but with the donors, and the contrast between latent presence and deliberate use of this power seems to be based on the donor ideology behind giving aid (defined here by funding modality). Donors who used pooled funding (PF) modalities were less likely to exploit their inherent power, whereas those who preferred to maintain maximum control over the aid they provided (ie, non

Cervical cancer and the global health agenda: Insights from multiple policy-analysis frameworks

PubMed Central

Parkhurst, Justin O.; Vulimiri, Madhulika

2013-01-01

Cervical cancer is the second leading cause of cancer deaths for women globally, with an estimated 88% of deaths occurring in the developing world. Available technologies have dramatically reduced mortality in high-income settings, yet cervical cancer receives considerably little attention on the global health policy landscape. The authors applied four policy-analysis frameworks to literature on global cervical cancer to explore the question of why cervical cancer may not be receiving the international attention it may otherwise warrant. Each framework explores the process of agenda setting and discerns factors that either facilitate or hinder policy change in cases where there is both a clear problem and a potential effective solution. In combination, these frameworks highlight a number of crucial elements that may be needed to raise the profile of cervical cancer on global health agendas, including improving local (national or sub-national) information on the condition; increasing mobilisation of affected civil society groups; framing cervical cancer debates in ways that build upon its classification as a non-communicable disease (NCD) and an issue of women's rights; linking cervical cancer screening to well-funded services such as those for HIV treatment in some countries; and identifying key global policy windows of opportunity to promote the cervical cancer agenda, including emerging NCD global health discussions and post-2015 reviews of the Millennium Development Goals. PMID:24236409

Cervical cancer and the global health agenda: Insights from multiple policy-analysis frameworks.

PubMed

Parkhurst, Justin O; Vulimiri, Madhulika

2013-01-01

Cervical cancer is the second leading cause of cancer deaths for women globally, with an estimated 88% of deaths occurring in the developing world. Available technologies have dramatically reduced mortality in high-income settings, yet cervical cancer receives considerably little attention on the global health policy landscape. The authors applied four policy-analysis frameworks to literature on global cervical cancer to explore the question of why cervical cancer may not be receiving the international attention it may otherwise warrant. Each framework explores the process of agenda setting and discerns factors that either facilitate or hinder policy change in cases where there is both a clear problem and a potential effective solution. In combination, these frameworks highlight a number of crucial elements that may be needed to raise the profile of cervical cancer on global health agendas, including improving local (national or sub-national) information on the condition; increasing mobilisation of affected civil society groups; framing cervical cancer debates in ways that build upon its classification as a non-communicable disease (NCD) and an issue of women's rights; linking cervical cancer screening to well-funded services such as those for HIV treatment in some countries; and identifying key global policy windows of opportunity to promote the cervical cancer agenda, including emerging NCD global health discussions and post-2015 reviews of the Millennium Development Goals.

Unpacking "Health Reform" and "Policy Capacity": Comment on "Health Reform Requires Policy Capacity".

PubMed

Legge, David; Gleeson, Deborah H

2015-07-20

Health reform is the outcome of dispersed policy initiatives in different sectors, at different levels and across time. Policy work which can drive coherent health reform needs to operate across the governance structures as well as the institutions that comprise healthcare systems. Building policy capacity to support health reform calls for clarity regarding the nature of such policy work and the elements of policy capacity involved; and for evidence regarding effective strategies for capacity building. © 2015 by Kerman University of Medical Sciences.

Advanced nursing training in health policy: designing and implementing a new program.

PubMed

Harrington, Charlene; Crider, Mark C; Benner, Patricia E; Malone, Ruth E

2005-05-01

Although the nursing profession has a growing role in the health policy arena, the rapidly changing health care environment means that clinicians need a sophisticated understanding of health policy. Nurses are assuming leadership roles in advocacy, research, analysis, and policy development, implementation, and evaluation, contributing to a growing need to educate nurses to specialize in health policy research and analysis. This article provides an overview of a new master's and doctoral educational program specializing in health policy for advanced practice nurses who are culturally diverse and sensitive to issues of diversity. The program, currently in its third year of operation at the University of California San Francisco, School of Nursing, is addressing the gap in nursing education and practice expertise in health policy. The program is supported through funding by the Department of Health and Human Services Health Resources and Services Administration, Advanced Nurse Training program.

Whose policy is it anyway? International and national influences on health policy development in Uganda.

PubMed

Okuonzi, S A; Macrae, J

1995-06-01

As national resources for health decline, so dependence on international resources to finance the capital and recurrent costs is increasing. This dependence, combined with an increasing emphasis on policy-based, as opposed to project-based, lending and grant-making has been accompanied by greater involvement of international actors in the formation of national health policy. This paper explores the process of health policy development in Uganda and examines how major donors are influencing and conflicting with national policy-making bodies. Focusing on two examples of user fees and drugs policies, it argues that while the content of international prescriptions to strengthen the health system may not be bad in itself, the process by which they are applied potentially threatens national sovereignty and weakens mechanisms for ensuring accountability. It concludes by proposing that in order to increase the sustainability of policy reforms, much greater emphasis should be placed on strengthening national capacity for policy analysis and research, building up policy networks and enhancing the quality of information available to the public concerning key policy changes.

Incorporating Economic Policy Into A 'Health-In-All-Policies' Agenda.

PubMed

Rigby, Elizabeth; Hatch, Megan E

2016-11-01

Recognizing the health effects of nonhealth policies, scholars and others seeking to improve Americans' health have advocated the implementation of a culture of health-which would call attention to and prioritize health as a key outcome of policy making across all levels of government and in the private sector. Adopting this "health-in-all-policies" lens, policy makers are paying increasing attention to health impacts as they debate policies in areas such as urban planning, housing, and transportation. Yet the health impacts of economic policies that shape the distribution of income and wealth are often overlooked. Pooling data from all fifty states for the period 1990-2010, we provide a broad portrait of how economic policies affect health. Overall, we found better health outcomes in states that enacted higher tax credits for the poor or higher minimum wage laws and in states without a right-to-work law that limits union power. Notably, these policies focus on increasing the incomes of low-income and working-class families, instead of on shaping the resources available to wealthier individuals. Incorporating these findings into a health-in-all-policies agenda will require leadership from the health sector, including a willingness to step into core and polarizing debates about redistribution. Project HOPE—The People-to-People Health Foundation, Inc.

Documentary analysis of risk-assessment and safety-planning policies and tools in a mental health context.

PubMed

Higgins, Agnes; Doyle, Louise; Morrissey, Jean; Downes, Carmel; Gill, Ailish; Bailey, Sive

2016-08-01

Despite the articulated need for policies and processes to guide risk assessment and safety planning, limited guidance exists on the processes or procedures to be used to develop such policies, and there is no body of research that examines the quality or content of the risk-management policies developed. The aim of the present study was to analyse the policies of risk and safety management used to guide mental health nursing practice in Ireland. A documentary analysis was performed on 123 documents received from 22 of the 23 directors of nursing contacted. Findings from the analysis revealed a wide variation in how risk, risk assessment, and risk management were defined. Emphasis within the risk documentation submitted was on risk related to self and others, with minimal attention paid to other types of risks. In addition, there was limited evidence of recovery-focused approaches to positive risk taking that involved service users and their families within the risk-related documentation. Many of the risk-assessment tools had not been validated, and lacked consistency or guidance in relation to how they were to be used or applied. The tick-box approach and absence of space for commentary within documentation have the potential to impact severely on the quality of information collected and documented, and subsequent clinical decision-making. Managers, and those tasked with ensuring safety and quality, need to ensure that policies and processes are, where possible, informed by best evidence and are in line with national mental health policy on recovery. © 2016 Australian College of Mental Health Nurses Inc.

CrowdHEALTH: Holistic Health Records and Big Data Analytics for Health Policy Making and Personalized Health.

PubMed

Kyriazis, Dimosthenis; Autexier, Serge; Brondino, Iván; Boniface, Michael; Donat, Lucas; Engen, Vegard; Fernandez, Rafael; Jimenez-Peris, Ricardo; Jordan, Blanca; Jurak, Gregor; Kiourtis, Athanasios; Kosmidis, Thanos; Lustrek, Mitja; Maglogiannis, Ilias; Mantas, John; Martinez, Antonio; Mavrogiorgou, Argyro; Menychtas, Andreas; Montandon, Lydia; Nechifor, Cosmin-Septimiu; Nifakos, Sokratis; Papageorgiou, Alexandra; Patino-Martinez, Marta; Perez, Manuel; Plagianakos, Vassilis; Stanimirovic, Dalibor; Starc, Gregor; Tomson, Tanja; Torelli, Francesco; Traver-Salcedo, Vicente; Vassilacopoulos, George; Wajid, Usman

2017-01-01

Today's rich digital information environment is characterized by the multitude of data sources providing information that has not yet reached its full potential in eHealth. The aim of the presented approach, namely CrowdHEALTH, is to introduce a new paradigm of Holistic Health Records (HHRs) that include all health determinants. HHRs are transformed into HHRs clusters capturing the clinical, social and human context of population segments and as a result collective knowledge for different factors. The proposed approach also seamlessly integrates big data technologies across the complete data path, providing of Data as a Service (DaaS) to the health ecosystem stakeholders, as well as to policy makers towards a "health in all policies" approach. Cross-domain co-creation of policies is feasible through a rich toolkit, being provided on top of the DaaS, incorporating mechanisms for causal and risk analysis, and for the compilation of predictions.

Analysis of selected policies towards universal health coverage in Uganda: the policy implementation barometer protocol.

PubMed

Hongoro, Charles; Rutebemberwa, Elizeus; Twalo, Thembinkosi; Mwendera, Chikondi; Douglas, Mbuyiselo; Mukuru, Moses; Kasasa, Simon; Ssengooba, Freddie

2018-01-01

Policy implementation remains an under researched area in most low and middle income countries and it is not surprising that several policies are implemented without a systematic follow up of why and how they are working or failing. This study is part of a larger project called Supporting Policy Engagement for Evidence-based Decisions (SPEED) for Universal Health Coverage in Uganda. It seeks to support policymakers monitor the implementation of vital programmes for the realisation of policy goals for Universal Health Coverage. A Policy Implementation Barometer (PIB) is proposed as a mechanism to provide feedback to the decision makers about the implementation of a selected set of policy programmes at various implementation levels (macro, meso and micro level). The main objective is to establish the extent of implementation of malaria, family planning and emergency obstetric care policies in Uganda and use these results to support stakeholder engagements for corrective action. This is the first PIB survey of the three planned surveys and its specific objectives include: assessment of the perceived appropriateness of implementation programmes to the identified policy problems; determination of enablers and constraints to implementation of the policies; comparison of on-line and face-to-face administration of the PIB questionnaire among target respondents; and documentation of stakeholder responses to PIB findings with regard to corrective actions for implementation. The PIB will be a descriptive and analytical study employing mixed methods in which both quantitative and qualitative data will be systematically collected and analysed. The first wave will focus on 10 districts and primary data will be collected through interviews. The study seeks to interview 570 respondents of which 120 will be selected at national level with 40 based on each of the three policy domains, 200 from 10 randomly selected districts, and 250 from 50 facilities. Half of the respondents at

Adding home health care to the discussion on health information technology policy.

PubMed

Ruggiano, Nicole; Brown, Ellen L; Hristidis, Vagelis; Page, Timothy F

2013-01-01

The potential for health information technology to improve the efficiency and effectiveness of health care has resulted in several U.S. policy initiatives aimed at integrating health information technology into health care systems. However, home health care agencies have been excluded from incentive programs established through policies, raising concerns on the extent to which health information technology may be used to improve the quality of care for older adults with chronic illness and disabilities. This analysis examines the potential issues stemming from this exclusion and explores potential opportunities of integrating home health care into larger initiatives aimed at establishing health information technology systems for meaningful use.

The Case for "Environment in All Policies": Lessons from the "Health in All Policies" Approach in Public Health.

PubMed

Browne, Geoffrey R; Rutherfurd, Ian D

2017-02-01

Both public health, and the health of the natural environment, are affected by policy decisions made across portfolios as diverse as finance, planning, transport, housing, education, and agriculture. A response to the interdependent character of public health has been the "health in all policies" (HiAP) approach. With reference to parallels between health and environment, this paper argues that lessons from HiAP are useful for creating a new integrated environmental management approach termed "environment in all polices" (EiAP). This paper covers the theoretical foundations of HiAP, which is based on an understanding that health is strongly socially determined. The paper then highlights how lessons learned from HiAP's implementation in Finland, California, and South Australia might be applied to EiAP. It is too early to learn from evaluations of HiAP, but it is apparent that there is no single tool kit for its application. The properties that are likely to be necessary for an effective EiAP approach include a jurisdiction-specific approach, ongoing and strong leadership from a central agency, independent analysis, and a champion. We then apply these properties to Victoria (Australia) to demonstrate how EiAP might work. We encourage further exploration of the feasibility of EiAP as an approach that could make explicit the sometimes surprising environmental implications of a whole range of strategic policies. Citation: Browne GR, Rutherfurd ID. 2017. The case for "environment in all policies": lessons from the "health in all policies" approach in public health. Environ Health Perspect 125:149-154; http://dx.doi.org/10.1289/EHP294.

Evaluating Diabetes Health Policies Using Natural Experiments

PubMed Central

Ackermann, Ronald T.; Duru, O. Kenrik; Albu, Jeanine B.; Schmittdiel, Julie A.; Soumerai, Stephen B.; Wharam, James F.; Ali, Mohammed K.; Mangione, Carol M.; Gregg, Edward W.

2016-01-01

The high prevalence and costs of type 2 diabetes makes it a rapidly evolving focus of policy action. Health systems, employers, community organizations, and public agencies have increasingly looked to translate the benefits of promising research interventions into innovative polices intended to prevent or control diabetes. Though guided by research, these health policies provide no guarantee of effectiveness and may have opportunity costs or unintended consequences. Natural experiments use pragmatic and available data sources to compare specific policies to other policy alternatives or predictions of what would likely have happened in the absence of any intervention. The Natural Experiments for Translation in Diabetes (NEXT-D) Study is a network of academic, community, industry, and policy partners, collaborating to advance the methods and practice of natural experimental research, with a shared aim of identifying and prioritizing the best policies to prevent and control diabetes. This manuscript describes the NEXT-D Study group's multi-sector natural experiments in areas of diabetes prevention or control as case examples to illustrate the selection, design, analysis, and challenges inherent to natural experimental study approaches to inform development or evaluation of health policies. PMID:25998925

The evolution of health-policy making in Italy.

PubMed

France, George; Taroni, Francesco

2005-01-01

An analysis of the dynamics of health care policy in Italy suggests that in recent years the pace of change in the health care system has accelerated. Although the basic features of universalism, comprehensiveness, and funding from general taxation have remained remarkably constant, the capacity to innovate policy tools and their settings and to take account of domestic and international experience seems to have increased. The political will and capacity to combat entrenched interests may also have increased, although implementation is still weak. The imperative to contain public expenditure has heavily conditioned health policy and will continue to do so. This has occurred mainly at the national level, but as the principal locus of health-policy making progressively shifts to the regions, so too will the constraining effect of this imperative move downward. If the decentralization process continues, problems could arise due to interregional differences in capacities to formulate and implement appropriate policies and to tackle special interest groups.

Tobacco control, global health policy and development: towards policy coherence in global governance

PubMed Central

Collin, Jeff

2015-01-01

The WHO Framework Convention on Tobacco Control (FCTC) demonstrates the international political will invested in combating the tobacco pandemic and a newfound prominence for tobacco control within the global health agenda. However, major difficulties exist in managing conflicts with foreign and trade policy priorities, and significant obstacles confront efforts to create synergies with development policy and avoid tensions with other health priorities. This paper uses the concept of policy coherence to explore congruence and inconsistencies in objectives, policy, and practice between tobacco control and trade, development and global health priorities. Following the inability of the FCTC negotiations to satisfactorily address the relationship between trade and health, several disputes highlight the challenges posed to tobacco control policies by multilateral and bilateral agreements. While the work of the World Bank has demonstrated the potential contribution of tobacco control to development, the absence of non-communicable diseases from the Millennium Development Goals has limited scope to offer developing countries support for FCTC implementation. Even within international health, tobacco control priorities may be hard to reconcile with other agendas. The paper concludes by discussing the extent to which tobacco control has been pursued via a model of governance very deliberately different from those used in other health issues, in what can be termed ‘tobacco exceptionalism’. The analysis developed here suggests that non-communicable disease (NCD) policies, global health, development and tobacco control would have much to gain from re-examining this presumption of difference. PMID:22345267

Tobacco control, global health policy and development: towards policy coherence in global governance.

PubMed

Collin, Jeff

2012-03-01

The WHO Framework Convention on Tobacco Control (FCTC) demonstrates the international political will invested in combating the tobacco pandemic and a newfound prominence for tobacco control within the global health agenda. However, major difficulties exist in managing conflicts with foreign and trade policy priorities, and significant obstacles confront efforts to create synergies with development policy and avoid tensions with other health priorities. This paper uses the concept of policy coherence to explore congruence and inconsistencies in objectives, policy, and practice between tobacco control and trade, development and global health priorities. Following the inability of the FCTC negotiations to satisfactorily address the relationship between trade and health, several disputes highlight the challenges posed to tobacco control policies by multilateral and bilateral agreements. While the work of the World Bank has demonstrated the potential contribution of tobacco control to development, the absence of non-communicable diseases from the Millennium Development Goals has limited scope to offer developing countries support for FCTC implementation. Even within international health, tobacco control priorities may be hard to reconcile with other agendas. The paper concludes by discussing the extent to which tobacco control has been pursued via a model of governance very deliberately different from those used in other health issues, in what can be termed 'tobacco exceptionalism'. The analysis developed here suggests that non-communicable disease (NCD) policies, global health, development and tobacco control would have much to gain from re-examining this presumption of difference.

Coherence between health policy and human resource strategy: lessons from maternal health in Vietnam, India and China.

PubMed

Martineau, Tim; Mirzoev, Tolib; Pearson, Stephen; Ha, Bui Thi Thu; Xu, Qian; Ramani, K V; Liu, Xiaoyun

2015-02-01

The failure to meet health goals such as the Millennium Development Goals (MDG) is partly due to the lack of appropriate resources for the effective implementation of health policies. The lack of coherence between the health policies and human resource (HR) strategy is one of the major causes. This article explores the relationship and the degree of coherence between health policy--in this case maternal health policy--processes and HR strategy in Vietnam, China and India in the period 2005-09. Four maternal health policy case studies were explored [skilled birth attendance (SBA), adolescent and sexual reproductive health, domestic violence and medical termination of pregnancy] across three countries through interviews with key respondents, document analysis and stakeholder meetings. Analysis for coherence between health policy and HR strategy was informed by a typology covering 'separation', 'fit' and 'dialogue'. Regarding coherence we found examples of complete separation between health policy and HR strategy, a good fit with the SBA policy though modified through 'dialogue' in Vietnam, and in one case a good fit between policy and strategy was developed through successive evaluations. Three key influences on coherence between health policy and HR strategy emerge from our findings: (1) health as the lead sector, (2) the nature of the policy instrument and (3) the presence of 'HR champions'. Finally, we present a simple algorithm to ensure that appropriate HR related actors are involved; HR is considered at the policy development stage with the option of modifying the policy if it cannot be adequately supported by the available health workforce; and ensuring that HR strategies are monitored to ensure continued coherence with the health policy. This approach will ensure that the health workforce contributes more effectively to meeting the MDGs and future health goals. Published by Oxford University Press in association with The London School of Hygiene and Tropical

Obesity Policy Action framework and analysis grids for a comprehensive policy approach to reducing obesity.

PubMed

Sacks, G; Swinburn, B; Lawrence, M

2009-01-01

A comprehensive policy approach is needed to control the growing obesity epidemic. This paper proposes the Obesity Policy Action (OPA) framework, modified from the World Health Organization framework for the implementation of the Global Strategy on Diet, Physical Activity and Health, to provide specific guidance for governments to systematically identify areas for obesity policy action. The proposed framework incorporates three different public health approaches to addressing obesity: (i) 'upstream' policies influence either the broad social and economic conditions of society (e.g. taxation, education, social security) or the food and physical activity environments to make healthy eating and physical activity choices easier; (ii) 'midstream' policies are aimed at directly influencing population behaviours; and (iii) 'downstream' policies support health services and clinical interventions. A set of grids for analysing potential policies to support obesity prevention and management is presented. The general pattern that emerges from populating the analysis grids as they relate to the Australian context is that all sectors and levels of government, non-governmental organizations and private businesses have multiple opportunities to contribute to reducing obesity. The proposed framework and analysis grids provide a comprehensive approach to mapping the policy environment related to obesity, and a tool for identifying policy gaps, barriers and opportunities.

Use of Comparative Case Study Methodology for US Public Health Policy Analysis: A Review.

PubMed

Dinour, Lauren M; Kwan, Amy; Freudenberg, Nicholas

There is growing recognition that policies influence population health, highlighting the need for evidence to inform future policy development and reform. This review describes how comparative case study methodology has been applied to public health policy research and discusses the methodology's potential to contribute to this evidence. English-language, peer-reviewed articles published between 1995 and 2012 were sought from 4 databases. Articles were included if they described comparative case studies addressing US public health policy. Two researchers independently assessed the 20 articles meeting review criteria. Case-related characteristics and research design tactics utilized to minimize threats to reliability and validity, such as the use of multiple sources of evidence and a case study protocol, were extracted from each article. Although comparative case study methodology has been used to analyze a range of public health policies at all stages and levels, articles reported an average use of only 3.65 (out of 10) research design tactics. By expanding the use of accepted research design tactics, public health policy researchers can contribute to expanding the evidence needed to advance health-promoting policies.

Policies on Conflicts of Interest in Health Care Guideline Development: A Cross-Sectional Analysis

PubMed Central

Morciano, Cristina; Basevi, Vittorio; Faralli, Carla; Hilton Boon, Michele; Tonon, Sabina; Taruscio, Domenica

2016-01-01

Objective To assess whether organisations that develop health care guidelines have conflict of interest (COI) policies and to review the content of the available COI policies. Methods Survey and content analysis of COI policies available in English, French, Spanish, and Italian conducted between September 2014 and June 2015. A 24-item data abstraction instrument was created on the basis of guideline development standards. Results The survey identified 29 organisations from 19 countries that met the inclusion criteria. From these organisations, 19 policies were eligible for inclusion in the content analysis. Over one-third of the policies (7/19, 37%) did not report or did not clearly report whether disclosure was a prerequisite for membership of the guideline panel. Strategies for the prevention of COI such as divestment were mentioned by only two organisations. Only 21% of policies (4/19) used criteria to determine whether an interest constitutes a COI and to assess the severity of the risk imposed. Conclusions The finding that some organisations, in contradiction of widely available standards, still do not have COI policies publicly available is concerning. Also troubling were the findings that some policies did not clearly report critical steps in obtaining, managing and communicating disclosure of relationships of interest. This in addition to the variability encountered in content and accessibility of COI policies may cause confusion and distrust among guideline users. It is in the interest of guideline users and developers to design an agreed-upon, comprehensive, clear, and accessible COI policy. PMID:27846255

The Promise (and Pitfalls) of Public Health Policy Surveillance.

PubMed

Hodge, James G

2016-12-01

Though public health policy surveillance is an integral tool in correlating the law to scientifically based public health law studies, drawing accurate legal conclusions from collected data can be challenging. Data may be of poor quality, inaccessible to law and policy makers, or inapplicable to other jurisdictions over time and place. As Burris et al. (2016) advocate, modern, sophisticated, and interactive data collection systems would render more precise legal analysis tied to public health improvements. Although policy surveillance is promising, public health officials, health care providers, attorneys, and researchers must be skilled and prepared to successfully navigate and resolve potential pitfalls for its benefits to be fully realized. Among the significant challenges related to policy surveillance are: (1) timing; (2) agenda setting; (3) predictable misuse; and (4) politics inherent in a federalist public health legal infrastructure. As public health data infrastructure is developed, better legal approaches must be simultaneously crafted to achieve optimal public health outcomes. Copyright © 2016 by Duke University Press.

Health system strengthening in Cambodia-a case study of health policy response to social transition.

PubMed

Grundy, John; Khut, Qiu Yi; Oum, Sophal; Annear, Peter; Ky, Veng

2009-10-01

Cambodia, following decades of civil conflict and social and economic transition, has in the last 10 years developed health policy innovations in the areas of health contracting, health financing and health planning. This paper aims to outline recent social, epidemiological and demographic health trends in Cambodia, and on the basis of this outline, to analyse and discuss these policy responses to social transition. Sources of information included a literature review, participant observation in health planning development in Cambodia between 1993 and 2008, and comparative analysis of demographic health surveys between 2000 and 2005. In Cambodia there have been sharp but unequal improvements in child mortality, and persisting high maternal mortality rates. Data analysis demonstrates associations between location, education level and access to facility based care, suggesting the dominant role of socio-economic factors in determining access to facility based health care. These events are taking place against a background of rapid social transition in Cambodian history, including processes of decentralization, privatization and the development of open market economic systems. Primary policy responses of the Ministry of Health to social transition and associated health inequities include the establishment of health contracting, hospital health equity funds and public-private collaborations. Despite the internationally recognized health policy flexibility and innovation demonstrated in Cambodia, policy response still lags well behind the reality of social transition. In order to minimize the delay between transition and response, new policy making tactics are required in order to provide more flexible and timely responses to the ongoing social transition and its impacts on population health needs in the lowest socio-economic quintiles.

Health Policy Responsiveness: Lessons Learned from Maryland and Prince George's County.

PubMed

Sogie-Thomas, Byron; Sankofa, John; Reed, Crystal; Mfume, Kweisi; Doamekpor, Lauren Abla

2018-04-01

Effective, timely, and intentional policy efforts can significantly impact and improve the public's health and reduce racial and ethnic health disparities across the nation. Creating and implementing responsive policies at the state and county level is essential to supporting community efforts to improve health behaviors and health outcomes, particularly for communities of color who bear the brunt of disease risk and negative health outcomes. Using policy examples from the State of Maryland and Prince George's County, the largest and wealthiest predominately African-American county in the USA, this case study highlights the importance of state and county policy action when presented with opportunities to affect long-lasting, positive change. We examine each jurisdiction's policy response through the lens of timeliness, intentionality, and effectiveness. At first glance, it would appear that Maryland responded effectively to the rise in tobacco use. Similarly, at face value, it appears that Prince George's County's unchecked rise in obesity rates among African-Americans is an example of nonresponsiveness among local policymakers in the face of an obesity epidemic. However-guided by a more nuanced understanding of "policy responsiveness"-this analysis uncovers a more revealing picture, with important strengths and limitations seen in both policy situations. This analysis raises critical questions about the determinants of jurisdictions' health policy capacity and how policymakers might best be supported in their efforts to build an arsenal of health policies that are timely, effective, and intentional in meeting the needs of vulnerable communities.

Manifestations of integrated public health policy in Dutch municipalities.

PubMed

Peters, Dorothee; Harting, Janneke; van Oers, Hans; Schuit, Jantine; de Vries, Nanne; Stronks, Karien

2016-06-01

Integrated public health policy (IPHP) aims at integrating health considerations into policies of other sectors. Since the limited empirical evidence available may hamper its further development, we systematically analysed empirical manifestations of IPHP, by placing policy strategies along a continuum of less-to-more policy integration, going from intersectoral action (IA) to healthy public policy (HPP) to health in all policies (HiAP). Our case study included 34 municipal projects of the Dutch Gezonde Slagkracht Programme (2009-15), which supports the development and implementation of IPHP on overweight, alcohol and drug abuse, and smoking. Our content analysis of project application forms and interviews with all project leaders used a framework approach involving the policy strategies and the following policy variables: initiator, actors, policy goals, determinants and policy instruments. Most projects showed a combination of policy strategies. However, manifestations of IPHP in overweight projects predominantly involved IA. More policy integration was apparent in alcohol/drugs projects (HPP) and in all-theme projects (HiAP). More policy integration was related to broad goal definitions, which allowed for the involvement of actors representing several policy sectors. This enabled the implementation of a mix of policy instruments. Determinants of health were not explicitly used as a starting point of the policy process. If a policy problem justifies policy integration beyond IA, it might be helpful to start from the determinants of health (epidemiological reality), systematically transform them into policy (policy reality) and set broad policy goals, since this gives actors from other sectors the opportunity to participate. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Strengthening post-graduate educational capacity for health policy and systems research and analysis: the strategy of the Consortium for Health Policy and Systems Analysis in Africa.

PubMed

Erasmus, Ermin; Lehmann, Uta; Agyepong, Irene Akua; Alwar, John; de Savigny, Don; Kamuzora, Peter; Mirzoev, Tolib; Nxumalo, Nonhlanhla; Tomson, Göran; Uzochukwu, Benjamin; Gilson, Lucy

2016-04-12

The last 5-10 years have seen significant international momentum build around the field of health policy and systems research and analysis (HPSR + A). Strengthening post-graduate teaching is seen as central to the further development of this field in low- and middle-income countries. However, thus far, there has been little reflection on and documentation of what is taught in this field, how teaching is carried out, educators' challenges and what future teaching might look like. Contributing to such reflection and documentation, this paper reports on a situation analysis and inventory of HPSR + A post-graduate teaching conducted among the 11 African and European partners of the Consortium for Health Policy and Systems Analysis in Africa (CHEPSAA), a capacity development collaboration. A first questionnaire completed by the partners collected information on organisational teaching contexts, while a second collected information on 104 individual courses (more in-depth information was subsequently collected on 17 of the courses). The questionnaires yielded a mix of qualitative and quantitative data, which were analysed through counts, cross-tabulations, and the inductive grouping of material into themes. In addition, this paper draws information from internal reports on CHEPSAA's activities, as well as its external evaluation. The analysis highlighted the fluid boundaries of HPSR + A and the range and variability of the courses addressing the field, the important, though not exclusive, role of schools of public health in teaching relevant material, large variations in the time investments required to complete courses, the diversity of student target audiences, the limited availability of distance and non-classroom learning activities, and the continued importance of old-fashioned teaching styles and activities. This paper argues that in order to improve post-graduate teaching and continue to build the field of HPSR + A, key questions need to be

Mental health in Zimbabwe: a health systems analysis.

PubMed

Kidia, Khameer; Machando, Debra; Mangezi, Walter; Hendler, Reuben; Crooks, Megan; Abas, Melanie; Chibanda, Dixon; Thornicroft, Graham; Semrau, Maya; Jack, Helen

2017-11-01

There has been little external analysis of Zimbabwe's mental health system. We did a systems analysis to identify bottlenecks and opportunities for mental health service improvement in Zimbabwe and to generate cost-effective, policy-relevant solutions. We combined in-depth interviews with a range of key stakeholders in health and mental health, analysis of mental health laws and policies, and publicly available data about mental health. Five themes are key to mental health service delivery in Zimbabwe: policy and law; financing and resources; criminal justice; workforce, training, and research; and beliefs about mental illness. We identified human resources, rehabilitation facilities, psychotropic medication, and community mental health as funding priorities. Moreover, we found that researchers should prioritise measuring the economic impact of mental health and exploring substance use, forensic care, and mental health integration. Our study highlights forensic services as a central component of the mental health system, which has been a neglected concept. We also describe a tailored process for mental health systems that is transferable to other low-income settings and that garners political will, builds capacity, and raises the profile of mental health. Copyright © 2017 Elsevier Ltd. All rights reserved.

Paucity of qualitative research in general medical and health services and policy research journals: analysis of publication rates.

PubMed

Gagliardi, Anna R; Dobrow, Mark J

2011-10-12

Qualitative research has the potential to inform and improve health care decisions but a study based on one year of publications suggests that it is not published in prominent health care journals. A more detailed, longitudinal analysis of its availability is needed. The purpose of this study was to identify, count and compare the number of qualitative and non-qualitative research studies published in high impact health care journals, and explore trends in these data over the last decade. A bibliometric approach was used to identify and quantify qualitative articles published in 20 top general medical and health services and policy research journals from 1999 to 2008. Eligible journals were selected based on performance in four different ranking systems reported in the 2008 ISI Journal Citation Reports. Qualitative and non-qualitative research published in these journals were identified by searching MEDLINE, and validated by hand-searching tables of contents for four journals. The total number of qualitative research articles published during 1999 to 2008 in ten general medical journals ranged from 0 to 41, and in ten health services and policy research journals from 0 to 39. Over this period the percentage of empirical research articles that were qualitative ranged from 0% to 0.6% for the general medical journals, and 0% to 6.4% for the health services and policy research journals. This analysis suggests that qualitative research it is rarely published in high impact general medical and health services and policy research journals. The factors that contribute to this persistent marginalization need to be better understood.

Draft national health policy 2015: A critical appraisal.

PubMed

Ahmed, Faruque U

2016-01-01

Revising a health policy of any country is a periodic procedure dependent on the change of demographic profile, current health status of the population including epidemiological changes in disease prevalence pattern, and progress made under the earlier policies. Along with it, newer research revelation of the natural history of the existing and emerging health problems, availability of newer technology as well as changing sociopolitical commitment to improve the health status of the population are the driving forces in the change of policy. Draft National Health Policy (NHP) 2015 is an attempt for the same. A review of the draft has been undertaken. The chapter on introduction is crisp and clear. Situation analysis of the draft is sketchy and without any reference of sources. Shifting the health goal is without any basis, and the objectives defined for the policy change are incongruous with the introduction. A detailed description does not give a clear picture but rather confuses the reader as it talks of comprehensive universal health-care services to be provided with a holistic concept but maximum emphasis is made in the implementation of a national program. Private health-care services are an area to reckon but except for mere references on the involvement in private-public mode, nothing concrete is observed, especially in the primary care level. Involvement envisaged in the secondary and tertiary levels is nebulous. The implementation health insurance program as well as regulatory mechanISM with the existing is also not defined exclusively in the context of a newer health policy.

Integrating Information and Communication Technology for Health Information System Strengthening: A Policy Analysis.

PubMed

Marzuki, Nuraidah; Ismail, Saimy; Al-Sadat, Nabilla; Ehsan, Fauziah Z; Chan, Chee-Khoon; Ng, Chiu-Wan

2015-11-01

Despite the high costs involved and the lack of definitive evidence of sustained effectiveness, many low- and middle-income countries had begun to strengthen their health information system using information and communication technology in the past few decades. Following this international trend, the Malaysian Ministry of Health had been incorporating Telehealth (National Telehealth initiatives) into national health policies since the 1990s. Employing qualitative approaches, including key informant interviews and document review, this study examines the agenda-setting processes of the Telehealth policy using Kingdon's framework. The findings suggested that Telehealth policies emerged through actions of policy entrepreneurs within the Ministry of Health, who took advantage of several simultaneously occurring opportunities--official recognition of problems within the existing health information system, availability of information and communication technology to strengthen health information system and political interests surrounding the national Multimedia Super Corridor initiative being developed at the time. The last was achieved by the inclusion of Telehealth as a component of the Multimedia Super Corridor. © 2015 APJPH.

Health Policy, Health Systems Research and Analysis Capacity Assessment of the School of Public Health, University of Ghana.

PubMed

Agyepong, I A; Anniah, K; Aikins, M; Akweongo, P; Esena, R; Mirzoev, T

2015-09-01

Health Policy and Systems Research and Analysis (HPSR&A) is an applied science that deals with complexity as it tries to provide lessons, tools and methods to understand and improve health systems and health policy. It is defined by the kinds of questions asked rather than a particular methodology. Our objective was to assess capacity and capacity strengthening needs for HPSR&A conduct and teaching in the University of Ghana School of Public Health (UG-SPH). We conceptualized dynamically inter-related levels of capacity as contextual, institutional and individual. The study had a cross sectional, mixed methods design. Data collection involved desk review, ,an in-depth interview, focus group discussions (FGD) and an interviewer administered questionnaire with closed and open ended items. Netmap was used as a tool in the FGD. At all levels, HPSR&A capacity exists in Ghana but is somewhat fragile. The fragility reflects in part contextual challenges related to national income and priorities as well as the fact that globally HPSR&A remains an emerging field. At the contextual level, Institutions involved in some way or other in HPSR&A were part of larger organizations with broader mandates. Only a handful of SPH staff indicated that they specifically do teaching and /or research related to HPSR&A. There is a need to raise awareness of the field of HPSR&A and its potential contributions to health sector development; build upon already existing contextual, institutional and individual capacity; and also attract and develop the next generation of researchers and teachers.

A Call for Greater Transparency in Health Policy Development: Observations from an Analysis of Child and Adolescent Mental Health Policy

ERIC Educational Resources Information Center

Gibson, Jenny; Kelvin, Raphael; Goodyer, Ian

2015-01-01

In this paper we describe a systematic attempt to determine whether child and adolescent mental health policy demonstrably draws upon peer-reviewed evidence, and to discover which other sources of evidence could be considered influential in policy development. In brief, we found that the scientific evidence base had been underutilised. However,…

Health policy--why research it and how: health political science.

PubMed

de Leeuw, Evelyne; Clavier, Carole; Breton, Eric

2014-09-23

The establishment of policy is key to the implementation of actions for health. We review the nature of policy and the definition and directions of health policy. In doing so, we explicitly cast a health political science gaze on setting parameters for researching policy change for health. A brief overview of core theories of the policy process for health promotion is presented, and illustrated with empirical evidence. The key arguments are that (a) policy is not an intervention, but drives intervention development and implementation; (b) understanding policy processes and their pertinent theories is pivotal for the potential to influence policy change; (c) those theories and associated empirical work need to recognise the wicked, multi-level, and incremental nature of elements in the process; and, therefore, (d) the public health, health promotion, and education research toolbox should more explicitly embrace health political science insights. The rigorous application of insights from and theories of the policy process will enhance our understanding of not just how, but also why health policy is structured and implemented the way it is.

Let's dance: Organization studies, medical sociology and health policy.

PubMed

Currie, Graeme; Dingwall, Robert; Kitchener, Martin; Waring, Justin

2012-02-01

This Special Issue of Social Science & Medicine investigates the potential for positive inter-disciplinary interaction, a 'generative dance', between organization studies (OS), and two of the journal's traditional disciplinary foundations: health policy and medical sociology. This is both necessary and timely because of the extent to which organizations have become a neglected topic within medical sociology and health policy analysis. We argue there is need for further and more sustained theoretical and conceptual synergy between OS, medical sociology and health policy, which provides, on the one-hand a cutting-edge and thought-provoking basis for the analysis of contemporary health reforms, and on the other hand, enables the development and elaboration of theory. We emphasize that sociologists and policy analysts in healthcare have been leading contributors to our understanding of organizations in modern society, that OS enhances our understanding of medical settings, and that organizations remain one of the most influential actors of our time. As a starting point to discussion, we outline the genealogy of OS and its application to healthcare settings. We then consider how medical sociology and health policy converge or diverge with the concerns of OS in the study of healthcare settings. Following this, we focus upon the material environment, specifically the position of business schools, which frames the generative dance between OS, medical sociology and health policy. This sets the context for introducing the thirteen articles that constitute the Special Issue of Social Science & Medicine. Copyright © 2011 Elsevier Ltd. All rights reserved.

Reproductive Health Policy in Tunisia

PubMed Central

Goicolea, Isabel; Hernandez, Alison

2016-01-01

Abstract Although Tunisia is regarded as a pioneer in the Middle East and North Africa in terms of women’s status and rights, including sexual and reproductive health and rights, evidence points to a number of persisting challenges. This article uses the Health Rights of Women Assessment Instrument (HeRWAI) to analyze Tunisia’s reproductive health policy between 1994 and 2014. It explores the extent to which reproductive rights have been incorporated into the country’s reproductive health policy, the gaps in the implementation of this policy, and the influence of this policy on gender empowerment. Our results reveal that progress has been slow in terms of incorporating reproductive rights into the national reproductive health policy. Furthermore, the implementation of this policy has fallen short, as demonstrated by regional inequities in the accessibility and availability of reproductive health services, the low quality of maternal health care services, and discriminatory practices. Finally, the government’s lack of meaningful engagement in advancing gender empowerment stands in the way as the main challenge to gender equality in Tunisia. PMID:28559685

A critical analysis of the Australian Defence Force policy on maternal health care.

PubMed

Montalban, Maureen

2017-08-01

To critically analyse the Australian Defence Force (ADF) policy on maternal health care: Health Directive No 235 - Management of pregnant members in the Australian Defence Force. Bacchi's 'What's the problem represented to be' framework was used to analyse Health Directive No 235. This paper critically examines the representation of pregnancy and birth, the resulting effects and considers alternate representations. The ADF's policy on maternal healthcare considers pregnancy as a health issue that requires specialist intervention and care, also known as the medicalisation of birth. Current research emphasises women-centred care; a model of care not contained in the ADF policy. The problematisation of pregnancy in the ADF restricts women's choices regarding their maternal healthcare provider. This is contrary to the healthcare rights of Australians and likely contributes to health inequalities of ADF women. Implications for public health: A research gap regarding ADF women's knowledge and wishes regarding their maternal health care has been identified. Future research can inform any alterations to the ADF policy on maternal healthcare. © 2017 The Authors.

Political cultures, health systems and health policy.

PubMed

Atkinson, Sarah

2002-07-01

Policies for restructuring national health systems in low- and middle-income countries tend to follow similar packages of prescriptions along the lines of those discussed in the World Development Report of 1993. An ubiquitous reform measure is that of decentralisation. Research on decentralised health care in Northeast Brazil demonstrates the critical role played by informal aspects of health system management and the political cultures of the wider context on the implementation of policy and the performance of local health systems. Discussion of incorporating these results into policy making highlights a number of points. Health systems research has failed to take seriously the role of the cultural for various reasons, particularly because of the challenge it makes to our own fundamental values and because of the difficulties of including it into approaches based on rational systems models. At the same time, health system researchers cannot easily draw upon and operationalise more complex and sophisticated explorations of the nature of the cultural domain. Nonetheless, without a concerted effort to engage with this literature, to bridge the gap to the applied policy world and tackle the challenge of incorporating considerations of political culture into policy making, health system management through decentralisation is likely to increase inequalities between local districts rather than the opposite.

Evaluating health policy capacity: Learning from international and Australian experience

PubMed Central

Gleeson, Deborah H; Legge, David G; O'Neill, Deirdre

2009-01-01

Background The health sector in Australia faces major challenges that include an ageing population, spiralling health care costs, continuing poor Aboriginal health, and emerging threats to public health. At the same time, the environment for policy-making is becoming increasingly complex. In this context, strong policy capacity – broadly understood as the capacity of government to make "intelligent choices" between policy options – is essential if governments and societies are to address the continuing and emerging problems effectively. Results This paper explores the question: "What are the factors that contribute to policy capacity in the health sector?" In the absence of health sector-specific research on this topic, a review of Australian and international public sector policy capacity research was undertaken. Studies from the United Kingdom, Canada, New Zealand and Australia were analysed to identify common themes in the research findings. This paper discusses these policy capacity studies in relation to context, models and methods for policy capacity research, elements of policy capacity and recommendations for building capacity. Conclusion Based on this analysis, the paper discusses the organisational and individual factors that are likely to contribute to health policy capacity, highlights the need for further research in the health sector and points to some of the conceptual and methodological issues that need to be taken into consideration in such research. PMID:19245704

Policy Surveillance: A Vital Public Health Practice Comes of Age.

PubMed

Burris, Scott; Hitchcock, Laura; Ibrahim, Jennifer; Penn, Matthew; Ramanathan, Tara

2016-12-01

Governments use statutes, regulations, and policies, often in innovative ways, to promote health and safety. Organizations outside government, from private schools to major corporations, create rules on matters as diverse as tobacco use and paid sick leave. Very little of this activity is systematically tracked. Even as the rest of the health system is working to build, share, and use a wide range of health and social data, legal information largely remains trapped in text files and pdfs, excluded from the universe of usable data. This article makes the case for the practice of policy surveillance to help end the anomalous treatment of law in public health research and practice. Policy surveillance is the systematic, scientific collection and analysis of laws of public health significance. It meets several important needs. Scientific collection and coding of important laws and policies creates data suitable for use in rigorous evaluation studies. Policy surveillance addresses the chronic lack of readily accessible, nonpartisan information about status and trends in health legislation and policy. It provides the opportunity to build policy capacity in the public health workforce. We trace its emergence over the past fifty years, show its value, and identify major challenges ahead.

The future of European health policies.

PubMed

Koivusalo, Meri Tuulikki

2005-01-01

The role of the European Union in health policies is changing. The European social model is under threat due to shifts in E.U. policies on liberalization of service provision, limited public budgets, a focus on the health sector as a productive sector in the context of broader European policies and the Lisbon strategy, and changes in the context of the new Constitutional Treaty. These changes are evident in a new reflection paper on European health strategy and its focus. E.U. health policies are at a critical juncture. The danger is that the current processes will lead European health policies and the health systems of member states more in the direction of U.S. health policies and the commercialization of health systems than toward improvement of the current situation.

Innovation in health policy: responding to the health society.

PubMed

Kickbusch, Ilona

2007-01-01

The 21st century health society is characterized by 2 major social processes: the expansion of the territory of health and the expansion of the reflexivity of health. The boundaries of what we call the <health system> are becoming increasingly fluid and health has become integral to how we live our everyday life. Health itself has become a major economic and social driving force in society. This shifts the pressure for policy innovation from a focus on the existing health system to a reorganization of how we approach health in 21st century societies. The dynamics of the health society challenge the way we conceptualize and locate health in the policy arena, the mechanisms through which we conduct health policy and they redefine who should be involved in the policy process. This concern is beginning to be addressed within government through joined up government approaches, beyond government through making health everybody's business and beyond nation states as a new interface between domestic and foreign policy.

Green politics in Germany: what is Green health care policy?

PubMed

Wörz, M; Wismar, M

2001-01-01

For the first time ever, a Green party has governed in Germany. From September 1998 to January 2001 the German Green party, Bündnis 90/Die Grünen, held the Federal Ministry of Health. Little has been said so far about Bündnis 90/Die Grünen and its relation to health policy. This article is intended to fill that void. An analysis of the health policy program of the Greens reveals that it centers around moving the health sector toward more comprehensiveness and decentralization, strengthened patients' rights, increased use of preventive and alternative medicine, and a critique of the German cost-containment debate and policy. The current health policy program of the Greens is closest to that of the Party of Democratic Socialism, and to a lesser extent it has affinities to the program of the Social Democratic Party. The health policy program of Bündnis 90/Die Grünen is furthest from those of the Christian Democratic Union and the Free Democratic Party. The health care reforms passed in 1998 and 1999 were not a shift toward a "Green paradigm" of health care policy, because they included no fundamental changes. In addition, cost-containment is still a major political goal in German health care policy.

Adoption of the National CLAS Standards by State Mental Health Agencies: A Nationwide Policy Analysis.

PubMed

Aggarwal, Neil Krishan; Cedeno, Kryst; John, Dolly; Lewis-Fernandez, Roberto

2017-08-01

This study reports the extent to which states have adopted the national culturally and linguistically appropriate services (CLAS) standards. Officials from public mental health agencies in the 50 states, Washington, D.C., and Puerto Rico were contacted between January and June 2016 to obtain information about adoption of CLAS standards in current policies. Each policy was coded through thematic analysis to determine its correspondence with any of the 14 national CLAS standards, which are grouped into three domains. Officials from 47 states and territories (90%) responded. Eight states (17%) reported adopting all national CLAS standards. Ten (23%) had adopted no CLAS policies, five (12%) had adopted policies under one domain, three (7%) under two domains, and 25 (58%) under all three domains. Most states do not have policies that meet all CLAS standards, raising questions about how CLAS standards should be adopted.

Evidence-Informed Health Policies in Eastern Mediterranean Countries: Comparing Views of Policy Makers and Researchers

ERIC Educational Resources Information Center

El-Jardali, Fadi; Lavis, John N.; Jamal, Diana; Ataya, Nour; Dimassi, Hani

2014-01-01

The objective of this paper is to conduct comparative analysis about the views and practices of policy makers and researchers on the use of health systems evidence in policy making in selected Eastern Mediterranean countries. We analysed data from two self-reported surveys, one targeted at policy makers and the other at researchers. Results show a…

A thematic review and a policy-analysis agenda of Electronic Health Records in the Greek National Health System.

PubMed

Emmanouilidou, Maria; Burke, Maria

2013-01-01

The increasing pressure to improve healthcare outcomes and reduce costs is driving the current agenda of governments at worldwide level and calls for a fundamental reform of the status quo of health systems. This is especially the case with the Greek NHS (National Health System), a system in continuous crisis, and with the recent ongoing financial turbulence under intensive scrutiny. Technological innovations and Electronic Health Records (EHR) in particular, are recognised as key enablers in mitigating the existing burdens of healthcare. As a result, EHR is considered a core component in technology-driven reform processes. Nonetheless, the successful implementation and adoption of EHR proves to be a challenging task due to a mixture of technological, organisational and political issues. Drawing upon experiences within the European Union (EU) healthcare setting and the Greek NHS the paper proposes a conceptual framework as a policy-analysis agenda for EHR interventions in Greece. While the context of discussion is Greece, the paper aims to also derive useful insights to healthcare policy-makers around the globe. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Can policy analysis theories predict and inform policy change? Reflections on the battle for legal abortion in Indonesia

PubMed Central

Surjadjaja, Claudia; Mayhew, Susannah H

2011-01-01

The relevance and importance of research for understanding policy processes and influencing policies has been much debated, but studies on the effectiveness of policy theories for predicting and informing opportunities for policy change (i.e. prospective policy analysis) are rare. The case study presented in this paper is drawn from a policy analysis of a contemporary process of policy debate on legalization of abortion in Indonesia, which was in flux at the time of the research and provided a unique opportunity for prospective analysis. Applying a combination of policy analysis theories, this case study provides an analysis of processes, power and relationships between actors involved in the amendment of the Health Law in Indonesia. It uses a series of practical stakeholder mapping tools to identify power relations between key actors and what strategic approaches should be employed to manage these to enhance the possibility of policy change. The findings show how the moves to legalize abortion have been supported or constrained according to the balance of political and religious powers operating in a macro-political context defined increasingly by a polarized Islamic-authoritarian—Western-liberal agenda. The issue of reproductive health constituted a battlefield where these two ideologies met and the debate on the current health law amendment became a contest, which still continues, for the larger future of Indonesia. The findings confirm the utility of policy analysis theories and stakeholder mapping tools for predicting the likelihood of policy change and informing the strategic approaches for achieving such change. They also highlight opportunities and dilemmas in prospective policy analysis and raise questions about whether research on policy processes and actors can or should be used to inform, or even influence, policies in ‘real-time’. PMID:21183461

Can policy analysis theories predict and inform policy change? Reflections on the battle for legal abortion in Indonesia.

PubMed

Surjadjaja, Claudia; Mayhew, Susannah H

2011-09-01

The relevance and importance of research for understanding policy processes and influencing policies has been much debated, but studies on the effectiveness of policy theories for predicting and informing opportunities for policy change (i.e. prospective policy analysis) are rare. The case study presented in this paper is drawn from a policy analysis of a contemporary process of policy debate on legalization of abortion in Indonesia, which was in flux at the time of the research and provided a unique opportunity for prospective analysis. Applying a combination of policy analysis theories, this case study provides an analysis of processes, power and relationships between actors involved in the amendment of the Health Law in Indonesia. It uses a series of practical stakeholder mapping tools to identify power relations between key actors and what strategic approaches should be employed to manage these to enhance the possibility of policy change. The findings show how the moves to legalize abortion have been supported or constrained according to the balance of political and religious powers operating in a macro-political context defined increasingly by a polarized Islamic-authoritarian-Western-liberal agenda. The issue of reproductive health constituted a battlefield where these two ideologies met and the debate on the current health law amendment became a contest, which still continues, for the larger future of Indonesia. The findings confirm the utility of policy analysis theories and stakeholder mapping tools for predicting the likelihood of policy change and informing the strategic approaches for achieving such change. They also highlight opportunities and dilemmas in prospective policy analysis and raise questions about whether research on policy processes and actors can or should be used to inform, or even influence, policies in 'real-time'.

European Union health policy and its implications for national convergence.

PubMed

Cucic, S

2000-06-01

This paper explores the relevance for health care of European Union (EU) legislation, regulation and policies. Reports, communications and other materials of the European Commission and other relevant European bodies are screened for their implications for health care, primarily on the national health system level. The paper provides a brief overview of EU history and its main institutions, followed by an analysis of health (care)-related provisions in the EU's main legal documents--its treaties. The impact of the EU actions on health protection is considered with regard to both actions in the field of public health and health protection requirements in its policies. In the public health area, information systems that are now being developed are discussed, followed by an outline of health protection requirements in EU policies that can have an impact on health systems. These policies are then analysed using the political factions model. Finally an attempt is made to predict future developments, stressing the need for a far-reaching synchronization of national systems.

Health financing for universal coverage and health system performance: concepts and implications for policy

PubMed Central

2013-01-01

Abstract Unless the concept is clearly understood, “universal coverage” (or universal health coverage, UHC) can be used to justify practically any health financing reform or scheme. This paper unpacks the definition of health financing for universal coverage as used in the World Health Organization’s World health report 2010 to show how UHC embodies specific health system goals and intermediate objectives and, broadly, how health financing reforms can influence these. All countries seek to improve equity in the use of health services, service quality and financial protection for their populations. Hence, the pursuit of UHC is relevant to every country. Health financing policy is an integral part of efforts to move towards UHC, but for health financing policy to be aligned with the pursuit of UHC, health system reforms need to be aimed explicitly at improving coverage and the intermediate objectives linked to it, namely, efficiency, equity in health resource distribution and transparency and accountability. The unit of analysis for goals and objectives must be the population and health system as a whole. What matters is not how a particular financing scheme affects its individual members, but rather, how it influences progress towards UHC at the population level. Concern only with specific schemes is incompatible with a universal coverage approach and may even undermine UHC, particularly in terms of equity. Conversely, if a scheme is fully oriented towards system-level goals and objectives, it can further progress towards UHC. Policy and policy analysis need to shift from the scheme to the system level. PMID:23940408

Health financing for universal coverage and health system performance: concepts and implications for policy.

PubMed

Kutzin, Joseph

2013-08-01

Unless the concept is clearly understood, "universal coverage" (or universal health coverage, UHC) can be used to justify practically any health financing reform or scheme. This paper unpacks the definition of health financing for universal coverage as used in the World Health Organization's World health report 2010 to show how UHC embodies specific health system goals and intermediate objectives and, broadly, how health financing reforms can influence these. All countries seek to improve equity in the use of health services, service quality and financial protection for their populations. Hence, the pursuit of UHC is relevant to every country. Health financing policy is an integral part of efforts to move towards UHC, but for health financing policy to be aligned with the pursuit of UHC, health system reforms need to be aimed explicitly at improving coverage and the intermediate objectives linked to it, namely, efficiency, equity in health resource distribution and transparency and accountability. The unit of analysis for goals and objectives must be the population and health system as a whole. What matters is not how a particular financing scheme affects its individual members, but rather, how it influences progress towards UHC at the population level. Concern only with specific schemes is incompatible with a universal coverage approach and may even undermine UHC, particularly in terms of equity. Conversely, if a scheme is fully oriented towards system-level goals and objectives, it can further progress towards UHC. Policy and policy analysis need to shift from the scheme to the system level.

Paucity of qualitative research in general medical and health services and policy research journals: analysis of publication rates

PubMed Central

2011-01-01

Background Qualitative research has the potential to inform and improve health care decisions but a study based on one year of publications suggests that it is not published in prominent health care journals. A more detailed, longitudinal analysis of its availability is needed. The purpose of this study was to identify, count and compare the number of qualitative and non-qualitative research studies published in high impact health care journals, and explore trends in these data over the last decade. Methods A bibliometric approach was used to identify and quantify qualitative articles published in 20 top general medical and health services and policy research journals from 1999 to 2008. Eligible journals were selected based on performance in four different ranking systems reported in the 2008 ISI Journal Citation Reports. Qualitative and non-qualitative research published in these journals were identified by searching MEDLINE, and validated by hand-searching tables of contents for four journals. Results The total number of qualitative research articles published during 1999 to 2008 in ten general medical journals ranged from 0 to 41, and in ten health services and policy research journals from 0 to 39. Over this period the percentage of empirical research articles that were qualitative ranged from 0% to 0.6% for the general medical journals, and 0% to 6.4% for the health services and policy research journals. Conclusions This analysis suggests that qualitative research it is rarely published in high impact general medical and health services and policy research journals. The factors that contribute to this persistent marginalization need to be better understood. PMID:21992238

Systematic reviews addressing identified health policy priorities in Eastern Mediterranean countries: a situational analysis.

PubMed

El-Jardali, Fadi; Akl, Elie A; Karroum, Lama Bou; Kdouh, Ola; Akik, Chaza; Fadlallah, Racha; Hammoud, Rawan

2014-08-20

Systematic reviews can offer policymakers and stakeholders concise, transparent, and relevant evidence pertaining to pressing policy priorities to help inform the decision-making process. The production and the use of systematic reviews are specifically limited in the Eastern Mediterranean region. The extent to which published systematic reviews address policy priorities in the region is still unknown. This situational analysis exercise aims at assessing the extent to which published systematic reviews address policy priorities identified by policymakers and stakeholders in Eastern Mediterranean region countries. It also provides an overview about the state of systematic review production in the region and identifies knowledge gaps. We conducted a systematic search of the Health System Evidence database to identify published systematic reviews on policy-relevant priorities pertaining to the following themes: human resources for health, health financing, the role of the non-state sector, and access to medicine. Priorities were identified from two priority-setting exercises conducted in the region. We described the distribution of these systematic reviews across themes, sub-themes, authors' affiliations, and countries where included primary studies were conducted. Out of the 1,045 systematic reviews identified in Health System Evidence on selected themes, a total of 200 systematic reviews (19.1%) addressed the priorities from the Eastern Mediterranean region. The theme with the largest number of systematic reviews included was human resources for health (115) followed by health financing (33), access to medicine (27), and role of the non-state sector (25). Authors based in the region produced only three systematic reviews addressing regional priorities (1.5%). Furthermore, no systematic review focused on the Eastern Mediterranean region. Primary studies from the region had limited contribution to systematic reviews; 17 systematic reviews (8.5%) included primary

Systematic reviews addressing identified health policy priorities in Eastern Mediterranean countries: a situational analysis

PubMed Central

2014-01-01

Background Systematic reviews can offer policymakers and stakeholders concise, transparent, and relevant evidence pertaining to pressing policy priorities to help inform the decision-making process. The production and the use of systematic reviews are specifically limited in the Eastern Mediterranean region. The extent to which published systematic reviews address policy priorities in the region is still unknown. This situational analysis exercise aims at assessing the extent to which published systematic reviews address policy priorities identified by policymakers and stakeholders in Eastern Mediterranean region countries. It also provides an overview about the state of systematic review production in the region and identifies knowledge gaps. Methods We conducted a systematic search of the Health System Evidence database to identify published systematic reviews on policy-relevant priorities pertaining to the following themes: human resources for health, health financing, the role of the non-state sector, and access to medicine. Priorities were identified from two priority-setting exercises conducted in the region. We described the distribution of these systematic reviews across themes, sub-themes, authors’ affiliations, and countries where included primary studies were conducted. Results Out of the 1,045 systematic reviews identified in Health System Evidence on selected themes, a total of 200 systematic reviews (19.1%) addressed the priorities from the Eastern Mediterranean region. The theme with the largest number of systematic reviews included was human resources for health (115) followed by health financing (33), access to medicine (27), and role of the non-state sector (25). Authors based in the region produced only three systematic reviews addressing regional priorities (1.5%). Furthermore, no systematic review focused on the Eastern Mediterranean region. Primary studies from the region had limited contribution to systematic reviews; 17 systematic reviews

Are Sexual and Reproductive Health Policies Designed for All? Vulnerable Groups in Policy Documents of Four European Countries and Their Involvement in Policy Development

PubMed Central

Ivanova, Olena; Dræbel, Tania; Tellier, Siri

2015-01-01

Background: Health policies are important instruments for improving population health. However, experience suggests that policies designed for the whole population do not always benefit the most vulnerable. Participation of vulnerable groups in the policy-making process provides an opportunity for them to influence decisions related to their health, and also to exercise their rights. This paper presents the findings from a study that explored how vulnerable groups and principles of human rights are incorporated into national sexual and reproductive health (SRH) policies of 4 selected countries (Spain, Scotland, Republic of Moldova, and Ukraine). It also aimed at discussing the involvement of vulnerable groups in SRH policy development from the perspective of policy-makers. Methods: Literature review, health policy analysis and 5 semi-structured interviews with policy-makers were carried out in this study. Content analysis of SRH policies was performed using the EquiFrame analytical framework. Results: The study revealed that vulnerable groups and core principles of human rights are differently addressed in SRH policies within 4 studied countries. The opinions of policy-makers on the importance of mentioning vulnerable groups in policy documents and the way they ought to be mentioned varied, but they agreed that a clear definition of vulnerability, practical examples, and evidences on health status of these groups have to be included. In addition, different approaches to vulnerable group’s involvement in policy development were identified during the interviews and the range of obstacles to this process was discussed by respondents. Conclusion: Incorporation of vulnerable groups in the SRH policies and their involvement in policy development were found to be important in addressing SRH of these groups and providing an opportunity for them to advocate for equal access to healthcare and exercise their rights. Future research on this topic should include

Are Sexual and Reproductive Health Policies Designed for All? Vulnerable Groups in Policy Documents of Four European Countries and Their Involvement in Policy Development.

PubMed

Ivanova, Olena; Dræbel, Tania; Tellier, Siri

2015-08-12

Health policies are important instruments for improving population health. However, experience suggests that policies designed for the whole population do not always benefit the most vulnerable. Participation of vulnerable groups in the policy-making process provides an opportunity for them to influence decisions related to their health, and also to exercise their rights. This paper presents the findings from a study that explored how vulnerable groups and principles of human rights are incorporated into national sexual and reproductive health (SRH) policies of 4 selected countries (Spain, Scotland, Republic of Moldova, and Ukraine). It also aimed at discussing the involvement of vulnerable groups in SRH policy development from the perspective of policy-makers. Literature review, health policy analysis and 5 semi-structured interviews with policy-makers were carried out in this study. Content analysis of SRH policies was performed using the EquiFrame analytical framework. The study revealed that vulnerable groups and core principles of human rights are differently addressed in SRH policies within 4 studied countries. The opinions of policy-makers on the importance of mentioning vulnerable groups in policy documents and the way they ought to be mentioned varied, but they agreed that a clear definition of vulnerability, practical examples, and evidences on health status of these groups have to be included. In addition, different approaches to vulnerable group's involvement in policy development were identified during the interviews and the range of obstacles to this process was discussed by respondents. Incorporation of vulnerable groups in the SRH policies and their involvement in policy development were found to be important in addressing SRH of these groups and providing an opportunity for them to advocate for equal access to healthcare and exercise their rights. Future research on this topic should include representatives of vulnerable communities which could

Being around and knowing the players: networks of influence in health policy.

PubMed

Lewis, Jenny M

2006-05-01

The accumulation and use of power is crucial to the health policy process. This paper examines the power of the medical profession in the health policy arena, by analysing which actors are perceived as influential, and how influence is structured in health policy. It combines an analysis of policy networks and social networks, to examine positional and personal influence in health policy in the state of Victoria, Australia. In the sub-graph of the influence network examined here, those most widely regarded as influential are academics, medically qualified and male. Positional actors (the top politician, political advisor and bureaucrat in health and the top nursing official) form part of a core group within this network structure. A second central group consists of medical influentials working in academia, research institutes and health-related NGOs. In this network locale overall, medical academics appear to combine positional and personal influence, and play significant intermediary roles across the network. While many claim that the medical profession has lost power in health policy and politics, this analysis yields few signs that the power of medicine to shape the health policy process has been greatly diminished in Victoria. Medical expertise is a potent embedded resource connecting actors through ties of association, making it difficult for actors with other resources and different knowledge to be considered influential. The network concepts and analytical techniques used here provide a novel means for uncovering different types of influence in health policy.

Dangerousness and mental health policy.

PubMed

Hewitt, J L

2008-04-01

Mental health policy development in the UK has become increasingly dominated by the assumed need to prevent violence and alleviate public concerns about the dangers of the mentally ill living in the community. Risk management has become the expected focus of contemporary mental health services, and responsibility has increasingly been devolved to individual service professionals when systems fail to prevent violence. This paper analyses the development of mental health legislation and its impact on services users and mental health professionals at the micro level of service delivery. Historical precedence, media influence and public opinion are explored, and the reification of risk is questioned in practical and ethical terms. The government's newest proposals for compulsory treatment in the community are discussed in terms of practical efficacy and therapeutic impact. Dangerousness is far from being an objectively observable phenomenon arising from clinical pathology, but is a formulation of what is partially knowable through social analysis and unknowable by virtue of its situation in individual psychic motivation. Risk assessment can therefore never be completely accurate, and the solution of a 'better safe than sorry' approach to mental health policy is ethically and pragmatically flawed.

[Health policies and politicized health? An analysis of sexual and reproductive health policies in Peru from the perspective of medical ethics, quality of care, and human rights].

PubMed

Miranda, J Jaime; Yamin, Alicia Ely

2008-01-01

Health professionals view medical ethics as a discipline that provides the basis for more adequate patient care. In recent years the concepts of quality of care and human rights - with their attending discourses - have joined the concept of medical ethics among the paradigms to consider in care for humans both at the individual and health policy levels. The current study seeks to analyze such paradigms, based on a case study of sexual and reproductive health policies in Peru in the last 10 years.

Transport policy and health inequalities: a health impact assessment of Edinburgh's transport policy.

PubMed

Gorman, D; Douglas, M J; Conway, L; Noble, P; Hanlon, P

2003-01-01

Health impact assessment (HIA) can be used to examine the relationships between inequalities and health. This HIA of Edinburgh's transport policy demonstrates how HIA can examine how different transport policies can affect different population groupings to varying degrees. In this case, Edinburgh's economy is based on tourism, financial services and Government bodies. These need a good transport infrastructure, which maintains a vibrant city centre. A transport policy that promotes walking, cycling and public transport supports this and is also good for health. The HIA suggested that greater spend on public transport and supporting sustainable modes of transport was beneficial to health, and offered scope to reduce inequalities. This message was understood by the City Council and influenced the development of the city's transport and land-use strategies. The paper discusses how HIA can influence public policy.

Perspectives on health policy dialogue: definition, perceived importance and coordination.

PubMed

Nabyonga-Orem, Juliet; Ousman, Kevin; Estrelli, Yolanda; Rene, Adzodo K M; Yakouba, Zina; Gebrikidane, Mesfin; Mamoud, Drave; Kwamie, Aku

2016-07-18

Countries in the World Health Organization African Region have witnessed an increase in global health initiatives in the recent past. Although these have provided opportunities for expanding coverage of health interventions; their poor alignment with the countries' priorities and weak coordination, are among the challenges that have affected their impact. A well-coordinated health policy dialogue provides an opportunity to address these challenges, but calls for common understanding among stakeholders of what policy dialogue entails. This paper seeks to assess stakeholders' understanding and perceived importance of health policy dialogue and of policy dialogue coordination. This was a cross-sectional descriptive study using qualitative methods. Interviews were conducted with 90 key informants from the national and sub-national levels in Lusophone Cabo Verde, Francophone Chad, Guinea and Togo, and Anglophone Liberia using an open-ended interview guide. The interviews were transcribed verbatim, coded and then put through inductive thematic content analysis using QRS software Version 10. There were variations in the definition of policy dialogue that were not necessarily linked to the linguistic leaning of respondents' countries or whether the dialogue took place at the national or sub-national level. The definitions were grouped into five categories based on whether they had an outcome, operational, process, forum or platform, or interactive and evidence-sharing orientation. The stakeholders highlighted multiple benefits of policy dialogue including ensuring stakeholder participation, improving stakeholder harmonisation and alignment, supporting implementation of health policies, fostering continued institutional learning, providing a guiding framework and facilitating stakeholder analysis. Policy dialogue offers the opportunity to improve stakeholder participation in policy development and promote aid effectiveness. However, conceptual clarity is needed to ensure

Health Policy Brief: Global Mental Health and the United Nations' Sustainable Development Goals.

PubMed

Cratsley, Kelso; Mackey, Tim K

2018-01-25

Increased awareness of the importance of mental health for global health has led to a number of new initiatives, including influential policy instruments issued by the World Health Organization (WHO) and the United Nations (UN). This policy brief describes two WHO instruments, the Mental Health Action Plan for 2013-2020 (World Health Organization, 2013) and the Mental Health Atlas (World Health Organization, 2015), and presents a comparative analysis with the Sustainable Development Goals (SDGs) of the UN's 2030 Agenda for Sustainable Development (United Nations, 2015). The WHO's Action Plan calls for several specific objectives and targets, with a focus on improving global mental health governance and service coverage. In contrast, the UN's Sustainable Development Goals include only one goal specific to mental health, with a single indicator tracking suicide mortality rates. The discrepancy between the WHO and UN frameworks suggests a need for increased policy coherence. Improved global health governance can provide the basis for ensuring and accelerating progress in global mental health. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Big Data for Public Health Policy-Making: Policy Empowerment.

PubMed

Mählmann, Laura; Reumann, Matthias; Evangelatos, Nikolaos; Brand, Angela

2018-04-04

Digitization is considered to radically transform healthcare. As such, with seemingly unlimited opportunities to collect data, it will play an important role in the public health policy-making process. In this context, health data cooperatives (HDC) are a key component and core element for public health policy-making and for exploiting the potential of all the existing and rapidly emerging data sources. Being able to leverage all the data requires overcoming the computational, algorithmic, and technological challenges that characterize today's highly heterogeneous data landscape, as well as a host of diverse regulatory, normative, governance, and policy constraints. The full potential of big data can only be realized if data are being made accessible and shared. Treating research data as a public good, creating HDC to empower citizens through citizen-owned health data, and allowing data access for research and the development of new diagnostics, therapies, and public health policies will yield the transformative impact of digital health. The HDC model for data governance is an arrangement, based on moral codes, that encourages citizens to participate in the improvement of their own health. This then enables public health institutions and policymakers to monitor policy changes and evaluate their impact and risk on a population level. © 2018 S. Karger AG, Basel.

Influencing policy change: the experience of health think tanks in low- and middle-income countries

PubMed Central

Bennett, Sara; Corluka, Adrijana; Doherty, Jane; Tangcharoensathien, Viroj; Patcharanarumol, Walaiporn; Jesani, Amar; Kyabaggu, Joseph; Namaganda, Grace; Hussain, A M Zakir; de-Graft Aikins, Ama

2012-01-01

In recent years there has been a growth in the number of independent health policy analysis institutes in low- and middle-income countries which has occurred in response to the limitation of government analytical capacity and pressures associated with democratization. This study aimed to: (i) investigate the contribution made by health policy analysis institutes in low- and middle-income countries to health policy agenda setting, formulation, implementation and monitoring and evaluation; and (ii) assess which factors, including organizational form and structure, support the role of health policy analysis institutes in low- and middle-income countries in terms of positively contributing to health policy. Six case studies of health policy analysis institutes in Bangladesh, Ghana, India, South Africa, Uganda and Vietnam were conducted including two NGOs, two university and two government-owned policy analysis institutes. Case studies drew on document review, analysis of financial information, semi-structured interviews with staff and other stakeholders, and iterative feedback of draft findings. Some of the institutes had made major contributions to policy development in their respective countries. All of the institutes were actively engaged in providing policy advice and most undertook policy-relevant research. Relatively few were engaged in conducting policy dialogues, or systematic reviews, or commissioning research. Much of the work undertaken by institutes was driven by requests from government or donors, and the primary outputs for most institutes were research reports, frequently combined with verbal briefings. Several factors were critical in supporting effective policy engagement. These included a supportive policy environment, some degree of independence in governance and financing, and strong links to policy makers that facilitate trust and influence. While the formal relationship of the institute to government was not found to be critical, units within

Influencing policy change: the experience of health think tanks in low- and middle-income countries.

PubMed

Bennett, Sara; Corluka, Adrijana; Doherty, Jane; Tangcharoensathien, Viroj; Patcharanarumol, Walaiporn; Jesani, Amar; Kyabaggu, Joseph; Namaganda, Grace; Hussain, A M Zakir; de-Graft Aikins, Ama

2012-05-01

In recent years there has been a growth in the number of independent health policy analysis institutes in low- and middle-income countries which has occurred in response to the limitation of government analytical capacity and pressures associated with democratization. This study aimed to: (i) investigate the contribution made by health policy analysis institutes in low- and middle-income countries to health policy agenda setting, formulation, implementation and monitoring and evaluation; and (ii) assess which factors, including organizational form and structure, support the role of health policy analysis institutes in low- and middle-income countries in terms of positively contributing to health policy. Six case studies of health policy analysis institutes in Bangladesh, Ghana, India, South Africa, Uganda and Vietnam were conducted including two NGOs, two university and two government-owned policy analysis institutes. Case studies drew on document review, analysis of financial information, semi-structured interviews with staff and other stakeholders, and iterative feedback of draft findings. Some of the institutes had made major contributions to policy development in their respective countries. All of the institutes were actively engaged in providing policy advice and most undertook policy-relevant research. Relatively few were engaged in conducting policy dialogues, or systematic reviews, or commissioning research. Much of the work undertaken by institutes was driven by requests from government or donors, and the primary outputs for most institutes were research reports, frequently combined with verbal briefings. Several factors were critical in supporting effective policy engagement. These included a supportive policy environment, some degree of independence in governance and financing, and strong links to policy makers that facilitate trust and influence. While the formal relationship of the institute to government was not found to be critical, units within

The policies-inequality feedback and health: the case of globalisation.

PubMed

De Vogli, R; Gimeno, D; Mistry, R

2009-09-01

Major research contributions aimed at explaining the association between economic inequality and health have concentrated on the plausibility of the material deprivation and psychosocial factors pathways. However, little work has analysed the reciprocal associations between public policies and inequality and their effect on health. A conceptual framework was first proposed explaining how the public policies-inequality feedback can influence health outcomes via material deprivation and psychosocial factors. Then, a critical review of the literature was conducted and an analysis of the health effects of the globalisation-inequality feedback as a case study. Different bodies of evidence seem to give support to the hypothesis of a public policies-inequality feedback influencing health-related outcomes. This seems to be particularly true when considering globalisation policies. Since the widespread adoption of the so-called "Washington Consensus", economic inequalities have sharply increased worldwide. The rise in inequality has, in turn, further consolidated the adoption of these policies through an increasing "democratic deficit". The reciprocal effects of globalisation and inequality have produced adverse health outcomes between and within societies through both material deprivation and psychosocial stress. Public policies and economic inequality are inextricably interrelated and can affect health through multiple, indirect, reciprocal pathways.

Accounting for health in climate change policies: a case study of Fiji

PubMed Central

Morrow, Georgina; Bowen, Kathryn

2014-01-01

Background Climate change is expected to affect the health of most populations in the coming decades, having the greatest impact on the poorest and most disadvantaged people in the world. The Pacific islands, including Fiji, are particularly vulnerable to the effects of climate change. Objective The three major health impacts of climate change in Fiji explored in this study were dengue fever, diarrhoeal disease, and malnutrition, as they each pose a significant threat to human health. The aim of this study was to investigate to what extent the Fiji National Climate Change Policy, and a selection of relevant sectoral policies, account for these human health effects of climate change. Design The study employed a three-pronged policy analysis to evaluate: 1) the content of the Fijian National Climate Change Policy and to what extent health was incorporated within this; 2) the context within which the policy was developed; 3) the relevant processes; and 4) the actors involved. A selection of relevant sectoral policies were also analysed to assess the extent to which these included climate change and health considerations. Results The policy analysis showed that these three health impacts of climate change were only considered to a minor extent, and often indirectly, in both the Fiji National Climate Change Policy and the corresponding National Climate Change Adaptation Strategy, as well as the Public Health Act. Furthermore, supporting documents in relevant sectors including water and agriculture made no mention of climate change and health impacts. Conclusions The projected health impacts of climate change should be considered as part of reviewing the Fiji National Climate Change Policy and National Climate Change Adaptation Strategy, and the Public Health Act. In the interest of public health, this should include strategies for combating dengue fever, malnutrition, and water-borne disease. Related sectoral policies in water and agriculture should also be revised to

Accounting for health in climate change policies: a case study of Fiji.

PubMed

Morrow, Georgina; Bowen, Kathryn

2014-01-01

Climate change is expected to affect the health of most populations in the coming decades, having the greatest impact on the poorest and most disadvantaged people in the world. The Pacific islands, including Fiji, are particularly vulnerable to the effects of climate change. The three major health impacts of climate change in Fiji explored in this study were dengue fever, diarrhoeal disease, and malnutrition, as they each pose a significant threat to human health. The aim of this study was to investigate to what extent the Fiji National Climate Change Policy, and a selection of relevant sectoral policies, account for these human health effects of climate change. The study employed a three-pronged policy analysis to evaluate: 1) the content of the Fijian National Climate Change Policy and to what extent health was incorporated within this; 2) the context within which the policy was developed; 3) the relevant processes; and 4) the actors involved. A selection of relevant sectoral policies were also analysed to assess the extent to which these included climate change and health considerations. The policy analysis showed that these three health impacts of climate change were only considered to a minor extent, and often indirectly, in both the Fiji National Climate Change Policy and the corresponding National Climate Change Adaptation Strategy, as well as the Public Health Act. Furthermore, supporting documents in relevant sectors including water and agriculture made no mention of climate change and health impacts. The projected health impacts of climate change should be considered as part of reviewing the Fiji National Climate Change Policy and National Climate Change Adaptation Strategy, and the Public Health Act. In the interest of public health, this should include strategies for combating dengue fever, malnutrition, and water-borne disease. Related sectoral policies in water and agriculture should also be revised to consider climate change and its impact on human

Media and politics: Empirical data on their cross-influence in health policy.

PubMed

2011-01-01

OBJECTIVES: Despite the central influence of public policies on health and welfare, relatively little is known about actual health care policy-making processes. This presentation will offer preliminary results from a federally funded project aimed at gaining insights into the interrelations among interest-group strategies, media discourses and political debates in health care. The policy debate on health care privatization in Quebec is used as a case study. APPROACH: Two sources of data were used: media sources and political debates. Media sources were the six main provincial newspapers in Quebec, two national newspapers and The Canadian Press, as well as transcripts from specific news-related programs of three national television stations and two national radio stations. Political debates were obtained through transcripts of all question periods in the Parliament and debates in the standing committee on health. Sources were systematically searched to identify all relevant data. Multiple search syntaxes were developed and tested to maximize sensitivity and specificity. All data was entered and coded into qualitative analysis software. RESULTS: Data was analyzed longitudinally from June 2005 to January 1, 2010. Four levels of results will be presented: 1) Descriptive analysis of the interest groups involved, their policy preferences and the rhetoric they employed to support their views. 2) Descriptive analysis of the main policy proposals that structured the debate as well as of the coalition of groups behind those proposals. 3) Graphic longitudinal analysis of the intensity of the debate and of the relative importance and evolution of various policy proposals. 4) Preliminary results on the nature, direction and level of inter-influence between the policy and media agendas. CONCLUSION: This presentation provides empirical evidence on current policy-making processes in health care. It shows, unsurprisingly, that policy-making is a circumvoluted process of inter

Is Aboriginal nutrition a priority for local government? A policy analysis.

PubMed

Helson, Catherine; Walker, Ruth; Palermo, Claire; Rounsefell, Kim; Aron, Yudit; MacDonald, Catherine; Atkinson, Petah; Browne, Jennifer

2017-11-01

The present study aimed to explore how Australian local governments prioritise the health and well-being of Aboriginal populations and the extent to which nutrition is addressed by local government health policy. In the state of Victoria, Australia, all seventy-nine local governments' public health policy documents were retrieved. Inclusion of Aboriginal health and nutrition in policy documents was analysed using quantitative content analysis. Representation of Aboriginal nutrition 'problems' and 'solutions' was examined using qualitative framing analysis. The socio-ecological framework was used to classify the types of Aboriginal nutrition issues and strategies within policy documents. Victoria, Australia. Local governments' public health policy documents (n 79). A small proportion (14 %, n 11) of local governments addressed Aboriginal health and well-being in terms of nutrition. Where strategies aimed at nutrition existed, they mostly focused on individual factors rather than the broader macroenvironment. A limited number of Victorian local governments address nutrition as a health issue for their Aboriginal populations in policy documents. Nutrition needs to be addressed as a community and social responsibility rather than merely an individual 'behaviour'. Partnerships are required to ensure Aboriginal people lead government policy development.

Health services analysis as a tool for evidence-based policy decisions: the case of the Ministry of Health and Social Security in Mexico.

PubMed

Kroeger, Axel; Hernandez, Juan Manuel

2003-12-01

To describe the strengths and weaknesses of two Mexican health care providers for poor populations [Ministry of Health (MoH) and Social Security (SS)] in order to facilitate policy decisions about the future of the two systems. In four Mexican states we conducted (i) a household interview survey in 10 724 households; (ii) a user satisfaction survey in 1319 households; (iii) a satisfaction survey of 236 health workers; (iv) in-depth interviews with 190 health workers; (v) 188 focus-group discussions with different population groups; (vi) a document analysis. Both systems serve populations with similar characteristics of poverty. The availability of resources was better in the MoH system; SS care was better concerning process indicators (family planning, antenatal care; in-service delivery of drugs, staff productivity, user satisfaction and staff motivation), efficiency and effectiveness (reduction of morbidity and mortality). Possible explanatory factors for the better performance of the SS system were strong supervision, regular communication, joint data analysis and annual population surveys. Better service organization makes a difference regarding efficiency and effectiveness. Policy-makers, deciding on which kind of health services are best for the poor, should take into account health services' analyses.

Macroeconomic policies and increasing social-health inequality in Iran.

PubMed

Zaboli, Rouhollah; Seyedin, Seyed Hesam; Malmoon, Zainab

2014-08-01

Health is a complex phenomenon that can be studied from different approaches. Despite a growing research in the areas of Social Determinants of Health (SDH) and health equity, effects of macroeconomic policies on the social aspect of health are unknown in developing countries. This study aimed to determine the effect of macroeconomic policies on increasing of the social-health inequality in Iran. This study was a mixed method research. The study population consisted of experts dealing with social determinants of health. A purposive, stratified and non-random sampling method was used. Semi-structured interviews were conducted to collect the data along with a multiple attribute decision-making method for the quantitative phase of the research in which the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) was employed for prioritization. The NVivo and MATLAB softwares were used for data analysis. Seven main themes for the effect of macroeconomic policies on increasing the social-health inequality were identified. The result of TOPSIS approved that the inflation and economic instability exert the greatest impact on social-health inequality, with an index of 0.710 and the government policy in paying the subsidies with a 0.291 index has the lowest impact on social-health inequality in the country. It is required to invest on the social determinants of health as a priority to reduce health inequality. Also, evaluating the extent to which the future macroeconomic policies impact the health of population is necessary.

Public policy involvement by health commissioners.

PubMed

Thompson, Amy; Boardley, Debra; Kerr, Dianne; Greene, Tiffany; Jenkins, Melissa

2009-08-01

The purpose of this national study was to determine advocacy activities and level of involvement of health commissioners regarding public policy. Benefits, barriers, and perceived outcomes of advocacy efforts were also explored. A previously validated (Holtrop et al., Am J Health Behav 24(2):132-142, 2000) four-page survey was mailed to 700 health commissioners, who were randomly selected from the National Association of County and City Health Officials (NACCHO) database. A three-wave mailing was performed which yielded a 50% response rate. Of these respondents, the majority (70%) were female and (88%) Caucasian. Overall, 31% of health commissioners reported being involved in influencing public policy in the last 4 years. The most common reported activities engaged in by health commissioners included voting (84%), and providing policy information to consumers or other professionals (77%). Perceived barriers to influencing policy were time, (64%), and other priorities (46%). Perceived benefits to influencing policy included improving the health of the public (94%) and making a difference in others' lives (87%). Only 15% perceived their knowledge regarding the process of changing public policy was excellent. Although health commissioners are often spokespersons for health agencies and communities, their public policy involvement is marginal. Professional preparation programs and continuing education opportunities should focus on advocacy, public policy development, and removing barriers to action.

[Policies to reduce health inequalities].

PubMed

Borrell, Carme; Artazcoz, Lucía

2008-01-01

This paper reviews policies to reduce social inequalities in health and presents some examples. Previously it presents the model on social determinants of health inequalities. The model described on the determinants of health inequalities is used by the Commission on Social Determinants of Health of the World Health Organisation that contains three main elements: the socio-economic and political context, socioeconomic status and intermediary factors. It describes 10 principles to keep in mind to launch interventions aimed at reducing inequalities in health and describes various policies depending on different "entry points" considered in the conceptual model. Finally we present two examples: The Public Health Policy of Sweden and the programme "Barrio Adentro" in Venezuela.

Intersectional policy analysis of self-directed mental health care in Canada.

PubMed

Cook, Judith A; Morrow, Marina; Battersby, Lupin

2017-06-01

Recovery from mental illness is influenced by one's social location along multiple dimensions of identity, such as race, class, gender, age, and ability, and by how these social locations are expressed through structural and institutional barriers. This project was developed using an intersectional policy analysis framework designed to promote equity across identity locations-called the multistrand method-to examine the potential use of self-directed care financing approaches in the Canadian mental health system. A panel of 16 diverse stakeholders came together 4 times at structured 6-hr meetings to examine the evidence for self-directed care and explore its application in the Canadian context. Telephone interviews with evidence panel members were conducted to assess their perceptions of the group process and outcomes. Our analysis revealed ways that intersecting strand locations might differentially influence the degree of choice and recovery experienced by self-directed care participants. Individualized resource allocation, draining financial resources from ethnically specific services, unevenness in acceptance of the recovery orientation, and paucity of service options in different geographical regions were identified as contexts in which self-directed care policies could promote inequity. However, greater peer involvement in the model's implementation, use of indigenous community supports, purchase of material goods by economically disenfranchised persons, and access to services from ethnically diverse clinicians in the private sector were identified as equity-promoting model features. By couching their analysis at the level of unique socially-situated perspectives, the group developed detailed policy recommendations and insights into both the potential and limitations of self-directed care. The knowledge gained from our project can be used to develop uniquely Canadian self-directed care models tailored to promote recovery through empowerment and self

Health Care Organizations and Policy Leadership: Perspectives on Nonsmoker-Only Hiring Policies.

PubMed

McDaniel, Patricia A; Malone, Ruth E

2018-02-01

To explore employers' decisions to base hiring policies on tobacco or nicotine use and community perspectives on such policies, and analyze the implications for organizational identity, community engagement, and health promotion. From 2013 to 2016, 11 executives from six health care organizations and one non-health-care organization with nonsmoker-only hiring policies were interviewed about why and how their policies were created and implemented, concerns about the policies, and perceptions of employee and public reactions. Focus groups were conducted with community members (n = 51) who lived in or near cities where participating employers were based, exploring participants' opinions about why an employer would stop hiring smokers and their support (or not) for such a policy. Most employers excluded from employment those using all forms of nicotine. Several explained their adoption of the policy as a natural extension of a smoke-free campus and as consistent with their identity as health care organizations. They regarded the policy as promoting health. No employer mentioned engaging in a community dialogue before adopting the policy or reported efforts to track the policy's impact on rejected applicants. Community members understood the cost-saving appeal of such policies, but most opposed them. They made few exceptions for health care organizations. Policy decisions undertaken by health care organizations have influence beyond their immediate setting and may establish precedents that others follow. Nonsmoker-only hiring policies may fit with a health care organization's institutional identity but may not be congruent with community values or promote public health.

Public Policy and Health Informatics.

PubMed

Bell, Katherine

2018-05-01

To provide an overview of the history of electronic health policy and identify significant laws that influence health informatics. US Department of Health and Human Services. The development of health information technology has influenced the process for delivering health care. Public policy and regulations are an important part of health informatics and establish the structure of electronic health systems. Regulatory bodies of the government initiate policies to ease the execution of electronic health record implementation. These same bureaucratic entities regulate the system to protect the rights of the patients and providers. Nurses should have an overall understanding of the system behind health informatics and be able to advocate for change. Nurses can utilize this information to optimize the use of health informatics and campaign for safe, effective, and efficient health information technology. Copyright © 2018 Elsevier Inc. All rights reserved.

Health Policy Training: A Review of the Literature

PubMed Central

Heiman, Harry J.; Smith, L. Lerissa; McKool, Marissa; Mitchell, Denise N.; Roth Bayer, Carey

2015-01-01

The context within which health care and public health systems operate is framed by health policies. There is growing consensus about the need for increased health policy leadership and a health professional workforce prepared to assume these leadership roles. At the same time, there is strong evidence supporting the need for a broader policy lens and the need to intentionally target health disparities. We reviewed the published literature between 1983 and 2013 regarding health policy training. From 5124 articles identified, 33 met inclusion criteria. Articles varied across common themes including target audience, goal(s), health policy definition, and core curricular content. The majority of articles were directed to medical or nursing audiences. Most articles framed health policy as health care policy and only a small number adopted a broader health in all policies definition. Few articles specifically addressed vulnerable populations or health disparities. The need for more rigorous research and evaluation to inform health policy training is compelling. Providing health professionals with the knowledge and skills to engage and take leadership roles in health policy will require training programs to move beyond their limited health care-oriented health policy framework to adopt a broader health and health equity in all policies approach. PMID:26703657

Health Policy Training: A Review of the Literature.

PubMed

Heiman, Harry J; Smith, L Lerissa; McKool, Marissa; Mitchell, Denise N; Roth Bayer, Carey

2015-12-23

The context within which health care and public health systems operate is framed by health policies. There is growing consensus about the need for increased health policy leadership and a health professional workforce prepared to assume these leadership roles. At the same time, there is strong evidence supporting the need for a broader policy lens and the need to intentionally target health disparities. We reviewed the published literature between 1983 and 2013 regarding health policy training. From 5124 articles identified, 33 met inclusion criteria. Articles varied across common themes including target audience, goal(s), health policy definition, and core curricular content. The majority of articles were directed to medical or nursing audiences. Most articles framed health policy as health care policy and only a small number adopted a broader health in all policies definition. Few articles specifically addressed vulnerable populations or health disparities. The need for more rigorous research and evaluation to inform health policy training is compelling. Providing health professionals with the knowledge and skills to engage and take leadership roles in health policy will require training programs to move beyond their limited health care-oriented health policy framework to adopt a broader health and health equity in all policies approach.

History Matters: The Critical Contribution of Historical Analysis to Contemporary Health Policy and Health Care.

PubMed

Sheard, Sally

2018-06-01

History is popular with health policymakers, if the regularity with which they invoke historical anecdotes to support policy change is used as an indicator. Yet the ways in which they 'use' history vary enormously, as does its impact. This paper explores, from the perspective of a UK academic historian, the development of 'applied' history in health policy. It draws on personal experience of different types and levels of engagement with policymakers, and highlights mechanisms through which this dialogue and partnership can be made more efficient, effective, and intellectually rewarding for all involved.

Personal and political histories in the designing of health reform policy in Bolivia.

PubMed

Bernstein, Alissa

2017-03-01

While health policies are a major focus in disciplines such as public health and public policy, there is a dearth of work on the histories, social contexts, and personalities behind the development of these policies. This article takes an anthropological approach to the study of a health policy's origins, based on ethnographic research conducted in Bolivia between 2010 and 2012. Bolivia began a process of health care reform in 2006, following the election of Evo Morales Ayma, the country's first indigenous president, and leader of the Movement Toward Socialism (Movimiento al Socialism). Brought into power through the momentum of indigenous social movements, the MAS government platform addressed racism, colonialism, and human rights in a number of major reforms, with a focus on cultural identity and indigeneity. One of the MAS's projects was the design of a new national health policy in 2008 called The Family Community Intercultural Health Policy (Salud Familiar Comunitaria Intercultural). This policy aimed to address major health inequities through primary care in a country that is over 60% indigenous. Methods used were interviews with Bolivian policymakers and other stakeholders, participant observation at health policy conferences and in rural community health programs that served as models for aspects of the policy, and document analysis to identify core premises and ideological areas. I argue that health policies are historical both in their relationship to national contexts and events on a timeline, but also because of the ways they intertwine with participants' personal histories, theoretical frameworks, and reflections on national historical events. By studying the Bolivian policymaking process, and particularly those who helped design the policy, it is possible to understand how and why particular progressive ideas were able to translate into policy. More broadly, this work also suggests how a uniquely anthropological approach to the study of health policy

Using Win-Win Strategies to Implement Health in All Policies: A Cross-Case Analysis

PubMed Central

Molnar, Agnes; Renahy, Emilie; O’Campo, Patricia; Muntaner, Carles; Freiler, Alix; Shankardass, Ketan

2016-01-01

Background In spite of increasing research into intersections of public policy and health, little evidence shows how policy processes impact the implementation of Health in All Policies (HiAP) initiatives. Our research sought to understand how and why strategies for engaging partners from diverse policy sectors in the implementation of HiAP succeed or fail in order to uncover the underlying social mechanisms contributing to sustainable implementation of HiAP. Methods In this explanatory multiple case study, we analyzed grey and peer-review literature and key informant interviews to identify mechanisms leading to implementation successes and failures in relation to different strategies for engagement across three case studies (Sweden, Quebec and South Australia), after accounting for the role of different contextual conditions. Findings Our results yielded no support for the use of awareness-raising or directive strategies as standalone approaches for engaging partners to implement HiAP. However, we found strong evidence that mechanisms related to “win-win” strategies facilitated implementation by increasing perceived acceptability (or buy-in) and feasibility of HiAP implementation across sectors. Win-win strategies were facilitated by mechanisms related to several activities, including: the development of a shared language to facilitate communication between actors from different sectors; integrating health into other policy agendas (eg., sustainability) and use of dual outcomes to appeal to the interests of diverse policy sectors; use of scientific evidence to demonstrate the effectiveness of HiAP; and using health impact assessment to make policy coordination for public health outcomes more feasible and to give credibility to policies being developed by diverse policy sectors. Conclusion Our findings enrich theoretical understanding in an under-unexplored area of intersectoral action. They also provide policy makers with examples of HiAP across wealthy

Comparative Logic Modeling for Policy Analysis: The Case of HIV Testing Policy Change at the Department of Veterans Affairs

PubMed Central

Langer, Erika M; Gifford, Allen L; Chan, Kee

2011-01-01

Objective Logic models have been used to evaluate policy programs, plan projects, and allocate resources. Logic Modeling for policy analysis has been used rarely in health services research but can be helpful in evaluating the content and rationale of health policies. Comparative Logic Modeling is used here on human immunodeficiency virus (HIV) policy statements from the Department of Veterans Affairs (VA) and Centers for Disease Control and Prevention (CDC). We created visual representations of proposed HIV screening policy components in order to evaluate their structural logic and research-based justifications. Data Sources and Study Design We performed content analysis of VA and CDC HIV testing policy documents in a retrospective case study. Data Collection Using comparative Logic Modeling, we examined the content and primary sources of policy statements by the VA and CDC. We then quantified evidence-based causal inferences within each statement. Principal Findings VA HIV testing policy structure largely replicated that of the CDC guidelines. Despite similar design choices, chosen research citations did not overlap. The agencies used evidence to emphasize different components of the policies. Conclusion Comparative Logic Modeling can be used by health services researchers and policy analysts more generally to evaluate structural differences in health policies and to analyze research-based rationales used by policy makers. PMID:21689094

Politics, policies and processes: a multidisciplinary and multimethods research programme on policies on the social determinants of health inequity in Australia

PubMed Central

Baum, Fran; Friel, Sharon

2017-01-01

Introduction The development and implementation of multisectoral policy to improve health and reduce health inequities has been slow and uneven. Evidence is largely focused on the facts of health inequities rather than understanding the political and policy processes. This 5-year funded programme of research investigates how these processes could function more effectively to improve equitable population health. Methods and analysis The programme of work is organised in four work packages using four themes (macroeconomics and infrastructure, land use and urban environments, health systems and racism) related to the structural drivers shaping the distribution of power, money and resources and daily living conditions. Policy case studies will use publicly available documents (policy documents, published evaluations, media coverage) and interviews with informants (policy-makers, former politicians, civil society, private sector) (~25 per case). NVIVO software will be used to analyse the documents to see how ‘social and health equity’ is included and conceptualised. The interview data will include qualitative descriptive and theory-driven critical discourse analysis. Our quantitative methodological work assessing the impact of public policy on health equity is experimental that is in its infancy but promises to provide the type of evidence demanded by policy-makers. Ethics and dissemination Our programme is recognising the inherently political nature of the uptake, formulation and implementation of policy. The early stages of our work indicate its feasibility. Our work is aided by a Critical Policy Reference Group. Multiple ethics approvals have been obtained with the foundation approval from the Social and Behavioural Ethics Committee, Flinders University (Project No: 6786). The theoretical, methodological and policy engagement processes established will provide improved evidence for policy-makers who wish to reduce health inequities and inform a new generation of

Improving adolescent health policy: incorporating a framework for assessing state-level policies.

PubMed

Brindis, Claire D; Moore, Kristin

2014-01-01

Many US policies that affect health are made at the state, not the federal, level. Identifying state-level policies and data to analyze how different policies affect outcomes may help policy makers ascertain the usefulness of their public policies and funding decisions in improving the health of adolescent populations. A framework for describing and assessing the role of federal and state policies on adolescent health and well-being is proposed; an example of how the framework might be applied to the issue of teen childbearing is included. Such a framework can also help inform analyses of whether and how state and federal policies contribute to the variation across states in meeting adolescent health needs. A database on state policies, contextual variables, and health outcomes data can further enable researchers and policy makers to examine how these factors are associated with behaviors they aim to impact.

Engaging trainees in shaping the future of health policy.

PubMed

Atkinson, Stephen; Sachedina, Nabihah; King, Judith; Mak, Matthew; Morganstein, Louise; Mytton, Oliver T; Thomas, Justyn

2011-04-01

This paper presents an analysis of the views and ideas generated at a recent health policy discussion for doctors in training. This provides an illustration of the creativity and enthusiasm that trainees can bring to the policy sphere by providing unique insights and a fresh perspective.

A qualitative analysis of environmental policy and children's health in Mexico

PubMed Central

2010-01-01

Background Since Mexico's joining the North American Free Trade Agreement (NAFTA) and the Organization for Economic Cooperation and Development (OECD) in 1994, it has witnessed rapid industrialization. A byproduct of this industrialization is increasing population exposure to environmental pollutants, of which some have been associated with childhood disease. We therefore identified and assessed the adequacy of existing international and Mexican governance instruments and policy tools to protect children from environmental hazards. Methods We first systematically reviewed PubMed, the Mexican legal code and the websites of the United Nations, World Health Organization, NAFTA and OECD as of July 2007 to identify the relevant governance instruments, and analyzed the approach these instruments took to preventing childhood diseases of environmental origin. Secondly, we interviewed a purposive sample of high-level government officials, researchers and non-governmental organization representatives, to identify their opinions and attitudes towards children's environmental health and potential barriers to child-specific protective legislation and implementation. Results We identified only one policy tool describing specific measures to reduce developmental neurotoxicity and other children's health effects from lead. Other governance instruments mention children's unique vulnerability to ozone, particulate matter and carbon monoxide, but do not provide further details. Most interviewees were aware of Mexican environmental policy tools addressing children's health needs, but agreed that, with few exceptions, environmental policies do not address the specific health needs of children and pregnant women. Interviewees also cited state centralization of power, communication barriers and political resistance as reasons for the absence of a strong regulatory platform. Conclusions The Mexican government has not sufficiently accounted for children's unique vulnerability to

Using Health Conditions for Laughs and Health Policy Support: The Case of Food Allergies.

PubMed

Abo, Melissa M; Slater, Michael D; Jain, Parul

2017-07-01

Health conditions are sometimes included in entertainment media comedies as a context for and as a source of humor. Food allergies are a typical case in point: They are potentially life-threatening yet may be used in humorous contexts. We conducted a content analysis of food allergies in entertainment media and tested the effects of humorous portrayals from an exemplar entertainment program. The content analysis confirmed that when food allergies were portrayed in television and the movies, it was most frequently in a humorous context and often contained inaccurate information. A follow-up experiment showed viewing a humorous portrayal of food allergies had an indirect negative effect on related health policy support via decreased perceived seriousness of food allergies. Inclusion of an educational video eliminated this effect on reduced policy support, with cognitive dissonance as a mediator. Findings support the hypothesis that portraying a health condition in a humorous context may reduce perceptions of seriousness and willingness to support public health policies to address risks associated with the condition, supporting and extending prior research findings.

An intersectionality-based policy analysis framework: critical reflections on a methodology for advancing equity.

PubMed

Hankivsky, Olena; Grace, Daniel; Hunting, Gemma; Giesbrecht, Melissa; Fridkin, Alycia; Rudrum, Sarah; Ferlatte, Olivier; Clark, Natalie

2014-12-10

In the field of health, numerous frameworks have emerged that advance understandings of the differential impacts of health policies to produce inclusive and socially just health outcomes. In this paper, we present the development of an important contribution to these efforts - an Intersectionality-Based Policy Analysis (IBPA) Framework. Developed over the course of two years in consultation with key stakeholders and drawing on best and promising practices of other equity-informed approaches, this participatory and iterative IBPA Framework provides guidance and direction for researchers, civil society, public health professionals and policy actors seeking to address the challenges of health inequities across diverse populations. Importantly, we present the application of the IBPA Framework in seven priority health-related policy case studies. The analysis of each case study is focused on explaining how IBPA: 1) provides an innovative structure for critical policy analysis; 2) captures the different dimensions of policy contexts including history, politics, everyday lived experiences, diverse knowledges and intersecting social locations; and 3) generates transformative insights, knowledge, policy solutions and actions that cannot be gleaned from other equity-focused policy frameworks. The aim of this paper is to inspire a range of policy actors to recognize the potential of IBPA to foreground the complex contexts of health and social problems, and ultimately to transform how policy analysis is undertaken.

Framing and the health policy process: a scoping review

PubMed Central

Koon, Adam D; Hawkins, Benjamin; Mayhew, Susannah H

2016-01-01

Framing research seeks to understand the forces that shape human behaviour in the policy process. It assumes that policy is a social construct and can be cast in a variety of ways to imply multiple legitimate value considerations. Frames provide the cognitive means of making sense of the social world, but discordance among them forms the basis of policy contestation. Framing, as both theory and method, has proven to generate considerable insight into the nature of policy debates in a variety of disciplines. Despite its salience for understanding health policy debates; however, little is known about the ways frames influence the health policy process. A scoping review using the Arksey and O’Malley framework was conducted. The literature on framing in the health sector was reviewed using nine health and social science databases. Articles were included that explicitly reported theory and methods used, data source(s), at least one frame, frame sponsor and evidence of a given frame’s effect on the health policy process. A total of 52 articles, from 1996 to 2014, and representing 12 countries, were identified. Much of the research came from the policy studies/political science literature (n = 17) and used a constructivist epistemology. The term ‘frame’ was used as a label to describe a variety of ideas, packaged as values, social problems, metaphors or arguments. Frames were characterized at various levels of abstraction ranging from general ideological orientations to specific policy positions. Most articles presented multiple frames and showed how actors advocated for them in a highly contested political process. Framing is increasingly an important, yet overlooked aspect of the policy process. Further analysis on frames, framing processes and frame conflict can help researchers and policymakers to understand opaque and highly charged policy issues, which may facilitate the resolution of protracted policy controversies. PMID:26873903

International institutions and China's health policy.

PubMed

Huang, Yanzhong

2015-02-01

This article examines the role of international institutional actors in China's health policy process. Particular attention is paid to three major international institutional actors: the World Bank, the World Health Organization, and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Through process tracing and comparative case studies, the article looks at how international institutions contribute to policy change in China and seeks to explain different outcomes in the relationship between international institutions and China's health policies. It finds that despite the opaque and exclusive authoritarian structure in China, international institutions play a significant role in the country's domestic health governance. By investing their resources and capabilities selectively and strategically, international institutions can change the preferences of government policy makers, move latent public health issues to the government's agenda, and affect the timing of government action and the content of policy design. Furthermore, the study suggests that different outcomes in the relationship between China's health policies and global health governance can be explained through the seriousness of the externalities China faces. Copyright © 2015 by Duke University Press.

Macroeconomic policies and increasing social-health inequality in Iran

PubMed Central

Zaboli, Rouhollah; Seyedin, Seyed Hesam; Malmoon, Zainab

2014-01-01

Background: Health is a complex phenomenon that can be studied from different approaches. Despite a growing research in the areas of Social Determinants of Health (SDH) and health equity, effects of macroeconomic policies on the social aspect of health are unknown in developing countries. This study aimed to determine the effect of macroeconomic policies on increasing of the social-health inequality in Iran. Methods: This study was a mixed method research. The study population consisted of experts dealing with social determinants of health. A purposive, stratified and non-random sampling method was used. Semi-structured interviews were conducted to collect the data along with a multiple attribute decision-making method for the quantitative phase of the research in which the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) was employed for prioritization. The NVivo and MATLAB softwares were used for data analysis. Results: Seven main themes for the effect of macroeconomic policies on increasing the social-health inequality were identified. The result of TOPSIS approved that the inflation and economic instability exert the greatest impact on social-health inequality, with an index of 0.710 and the government policy in paying the subsidies with a 0.291 index has the lowest impact on social-health inequality in the country. Discussion: It is required to invest on the social determinants of health as a priority to reduce health inequality. Also, evaluating the extent to which the future macroeconomic policies impact the health of population is necessary. PMID:25197677

Pedestrian paths: why path-dependence theory leaves health policy analysis lost in space.

PubMed

Brown, Lawrence D

2010-08-01

Path dependence, a model first advanced to explain puzzles in the diffusion of technology, has lately won allegiance among analysts of the politics of public policy, including health care policy. Though the central premise of the model--that past events and decisions shape options for innovation in the present and future--is indisputable (indeed path dependence is, so to speak, too shallow to be false), the approach, at least as applied to health policy, suffers from ambiguities that undercut its claims to illuminate policy projects such as managed care, on which this article focuses. Because path dependence adds little more than marginal value to familiar images of the politics of policy--incrementalism, for one--analysts might do well to put it on the back burner and pursue instead "thick descriptions" that help them to distinguish different degrees of openness to exogenous change among diverse policy arenas.

Tackling Health Inequalities in the United Kingdom: The Progress and Pitfalls of Policy

PubMed Central

Exworthy, Mark; Blane, David; Marmot, Michael

2003-01-01

Goal Assess the progress and pitfalls of current United Kingdom (U.K.) policies to reduce health inequalities. Objectives (1) Describe the context enabling health inequalities to get onto the policy agenda in the United Kingdom. (2) Categorize and assess selected current U.K. policies that may affect health inequalities. (3) Apply the “policy windows” model to understand the issues faced in formulating and implementing such policies. (4) Examine the emerging policy challenges in the U.K. and elsewhere. Data Sources Official documents, secondary analyses, and interviews with policymakers. Study Design Qualitative, policy analysis. Data Collection 2001–2002. The methods were divided into two stages. The first identified policies which were connected with individual inquiry recommendations. The second involved case-studies of three policies areas which were thought to be crucial in tackling health inequalities. Both stages involved interviews with policy-makers and documentary analysis. Principal Findings (1) The current U.K. government stated a commitment to reducing health inequalities. (2) The government has begun to implement policies that address the wider determinants. (3) Some progress is evident but many indicators remain stubborn. (4) Difficulties remain in terms of coordinating policies across government and measuring progress. (5) The “policy windows” model explains the limited extent of progress and highlights current and possible future pitfalls. (6) The U.K.'s experience has lessons for other governments involved in tackling health inequalities. Conclusions Health inequalities are on the agenda of U.K. government policy and steps have been made to address them. There are some signs of progress but much remains to be done including overcoming some of the perverse incentives at the national level, improving joint working, ensuring appropriate measures of performance/progress, and improving monitoring arrangements. A conceptual policy model aids

Mental health policy developments in Latin America.

PubMed Central

Alarcón, R. D.; Aguilar-Gaxiola, S. A.

2000-01-01

New assessment guidelines for measuring the overall impact of mental health problems in Latin America have served as a catalyst for countries to review their mental health policies. Latin American countries have taken various steps to address long-standing problems such as structural difficulties, scarce financial and human resources, and social, political, and cultural obstacles in the implementation of mental health policies and legislation. These policy developments, however, have had uneven results. Policies must reflect the desire, determination, and commitment of policy-makers to take mental health seriously and look after people's mental health needs. This paper describes the development of mental health policies in Latin American countries, focusing on published data in peer-reviewed journals, and legislative change and its implementation. It presents a brief history of mental health policy developments, and analyzes the basis and practicalities of current practice. PMID:10885167

Health manpower planning in Slovenia: a policy analysis of the changes in roles of stakeholders and methodologies.

PubMed

Albreht, Tit; Klazinga, Niek

2002-12-01

A heightened awareness about medical manpower issues can be observed in countries that are in a state of political, economic, and social transition. Slovenia entered the transition process in 1989 and became an independent country in 1991. Transition and independence influenced its health care in several ways. It changed the health care system and its financing (by introducing a Bismarckian style of social insurance). It then redistributed power from the Ministry of Health to several stakeholders. A major change occurred in the labor market in health care when the flow of health professionals from the newly independent countries greatly decreased. The decrease was partly due to the consequences of the war in the Balkans and partly due to independent labor legislation in Slovenia. Transitional changes brought new stakeholders to the scene, with a resulting redistribution of responsibilities for health manpower policies and the use of various methodologies. This policy analysis offers a detailed description of the contextual framework, quantitative data on medical manpower development, and, most important, interviews with representatives of the key stakeholders and study of relevant policy documents. We conclude that all stakeholders underpin the need for a structured approach toward health manpower planning in the form of a more coherent system of planning, decision making, and control. A compromise on mutual responsibilities between the less dominant Ministry of Health and the two new powerful stakeholders, the Health Insurance Institute of Slovenia and the Medical Chamber of Slovenia, seems necessary.

[Health examination of asylum seekers: A nationwide analysis of state policies in Germany : § 62 of the asylum law].

PubMed

Wahedi, Katharina; Nöst, Stefan; Bozorgmehr, Kayvan

2017-01-01

A health examination of newly arrived asylum seekers, aimed at detecting infectious diseases and preventing disease outbreaks in accommodation facilities, is mandated by national law in all German states. Due to the decentralized German federal system, different state policies are in place and lead to substantial variation in the content and implementation of the health examination. To compare health examination policies in the 16 German states with a focus on conducted tests, preventive measures and the general procedure. A comparative content analysis of policy documents addressing the health examination was conducted. Relevant documents were identified through a nationwide search (conducted June-October 2015) through public sources, inquiries at responsible authorities and interviews with representatives of public health services. In the study period, relevant policy documents for 13 states were identified, of which eight were administrative decrees of the responsible state ministries. Policies differed strongly with respect to the content of the health examination and the selection of compulsory screening measures. We identified three main groups: (A) states with compulsory screening limited to measures enshrined in federal law, (B) states with extended tuberculosis screening for children and pregnant women, and (C) states with extended mandatory screening measures for further infectious diseases beyond tuberculosis. Considerable differences were also found with regard to the implementation of the examinations, and the purchasing and re-imbursement policies. The stark heterogeneity in health examination policies between the states cannot be rationally explained from a public health perspective. The indication for certain measures remains unclear. A broad discussion of the medical necessity of screening tests, combined with further systematic analyses, is necessary in order to develop nationwide evidence-based recommendations and decision-making tools for

Privacy and health in the information age: a content analysis of health web site privacy policy statements.

PubMed

Rains, Stephen A; Bosch, Leslie A

2009-07-01

This article reports a content analysis of the privacy policy statements (PPSs) from 97 general reference health Web sites that was conducted to examine the ways in which visitors' privacy is constructed by health organizations. PPSs are formal documents created by the Web site owner to describe how information regarding site visitors and their behavior is collected and used. The results show that over 80% of the PPSs in the sample indicated automatically collecting or requesting that visitors voluntarily provide information about themselves, and only 3% met all five of the Federal Trade Commission's Fair Information Practices guidelines. Additionally, the results suggest that the manner in which PPSs are framed and the use of justifications for collecting information are tropes used by health organizations to foster a secondary exchange of visitors' personal information for access to Web site content.

Health policy and systems research collaboration pathways: lessons from a network science analysis.

PubMed

English, Krista M; Pourbohloul, Babak

2017-08-28

The 2004 Mexico Declaration, and subsequent World Health Assembly resolutions, proposed a concerted support for the global development of health policy and systems research (HPSR). This included coordination across partners and advocates for the field of HPSR to monitor the development of the field, while promoting decision-making power and implementing responsibilities in low- and middle-income countries (LMICs). We used a network science approach to examine the structural properties of the HPSR co-authorship network across country economic groups in the PubMed citation database from 1990 to 2015. This analysis summarises the evolution of the publication, co-authorship and citation networks within HPSR. This method allows identification of several features otherwise not apparent. The co-authorship network has evolved steadily from 1990 to 2015 in terms of number of publications, but more importantly, in terms of co-authorship network connectedness. Our analysis suggests that, despite growth in the contribution from low-income countries to HPSR literature, co-authorship remains highly localised. Lower middle-income countries have made progress toward global connectivity through diversified collaboration with various institutions and regions. Global connectivity of the upper middle-income countries (UpperMICs) are almost on par with high-income countries (HICs), indicating the transition of this group of countries toward becoming major contributors to the field. Network analysis allows examination of the connectedness among the HSPR community. Initially (early 1990s), research groups operated almost exclusively independently and, despite the topic being specifically on health policy in LMICs, HICs provided lead authorship. Since the early 1990s, the network has evolved significantly. In the full set analysis (1990-2015), for the first time in HPSR history, more than half of the authors are connected and lead authorship from UpperMICs is on par with that of HICs

State Size and Government Level Matter Most: A Structural Equation Model of Local Health Department Policy Behaviors.

PubMed

Meyerson, Beth E; Sayegh, M Aaron

2016-01-01

To explore relationships between local health department policy behaviors, levels of government activity, policy focus areas, and selected health department characteristics. Cross-sectional analysis of secondary data from the 2013 National Association of County & City Health Officials (NACCHO) Profile Survey. Local health departments throughout the United States. A total of 2000 local health departments responding to the 2013 Profile Survey of Local Health Departments. Survey data were gathered by the NACCHO. Secondary analysis of reported policy behaviors for the 2013 NACCHO Profile Survey. A structural equation model tested effects on and between state population size, rurality, census region and policy focus, and the latent variables of policy behavior formed from a confirmatory factor analysis. Policy behaviors, levels of government activity (local, state, and federal), policy focus areas, and selected local health department characteristics. The majority (85.1%) of health departments reported at least one of the possible policy behaviors. State population size increased the probability of local policy behavior, and local behavior increased the probability of state policy behavior. State size increased the likelihood of federal policy behavior and the focus on tobacco, emergency preparedness, and obesity/chronic disease. However, the more rural a state was, the more likely policy behavior was at the state and federal levels and not at local levels. Specific policy behaviors mattered less than the level of government activity. Size of state and rurality of health departments influence the government level of policy behavior.

A general health policy model: update and applications.

PubMed Central

Kaplan, R M; Anderson, J P

1988-01-01

This article describes the development of a General Health Policy Model that can be used for program evaluation, population monitoring, clinical research, and policy analysis. An important component of the model, the Quality of Well-being scale (QWB) combines preference-weighted measures of symptoms and functioning to provide a numerical point-in-time expression of well-being, ranging from 0 for death to 1.0 for asymptomatic optimum functioning. The level of wellness at particular points in time is governed by the prognosis (transition rates or probabilities) generated by the underlying disease or injury under different treatment (control) variables. Well-years result from integrating the level of wellness, or health-related quality of life, over the life expectancy. Several issues relevant to the application of the model are discussed. It is suggested that a quality of life measure need not have separate components for social and mental health. Social health has been difficult to define; social support may be a poor criterion for resource allocation; and some evidence suggests that aspects of mental health are captured by the general measure. Although it has been suggested that measures of child health should differ from those used for adults, we argue that a separate conceptualization of child health creates new problems for policy analysis. After offering several applications of the model for the evaluation of prevention programs, we conclude that many of the advantages of general measures have been overlooked and should be given serious consideration in future studies. PMID:3384669

Australian television news coverage of alcohol, health and related policies, 2005 to 2010: implications for alcohol policy advocates.

PubMed

Fogarty, Andrea S; Chapman, Simon

2012-12-01

To describe television news coverage between 2005 and 2010 of alcohol, health and relevant alcohol-control policies, with a view to informing policy advocacy. A content analysis of all alcohol stories archived by the Australian Health News Research Collaboration. We recorded what triggered a news item, the main topics covered, whether risks to health were communicated, whether alcohol-control policies were featured and which news-actors appeared. We identified 612 stories, where 69.2% were triggered by a particular newsworthy incident or the release of new findings. The most frequently reported alcohol stories were focused on associated harms (30.2%) and 'binge drinking' (19.0%). A majority (75.3%) reported a variety of positive and negative health effects, yet mainly focused on short-term consequences. Combined, 63% mentioned an alcohol-control policy, yet no one particular policy was featured in more than 10% of all stories. The most commonly featured news-actors included public-health professionals (50.0%), members of affected communities (28.4%) and government representatives (24.3%) Problems related to alcohol were well-established foci of news attention and reportage and covered a broad spectrum of issues related to public health goals, yet less coverage centred on long-term health consequences or effective policy solutions. Future policy advocacy could focus on moving the debate away from simple problem definition to better communication of long-term health risks, existing policies, and evidence of their effectiveness and arguments for their adoption. Future research might consider audience understanding of the information. © 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia.

Adapting public policy theory for public health research: A framework to understand the development of national policies on global health.

PubMed

Jones, Catherine M; Clavier, Carole; Potvin, Louise

2017-03-01

National policies on global health appear as one way that actors from health, development and foreign affairs sectors in a country coordinate state action on global health. Next to a burgeoning literature in which international relations and global governance theories are employed to understand global health policy and global health diplomacy at the international level, little is known about policy processes for global health at the national scale. We propose a framework of the policy process to understand how such policies are developed, and we identify challenges for public health researchers integrating conceptual tools from political science. We developed the framework using a two-step process: 1) reviewing literature to establish criteria for selecting a theoretical framework fit for this purpose, and 2) adapting Real-Dato's synthesis framework to integrate a cognitive approach to public policy within a constructivist perspective. Our framework identifies multiple contexts as part of the policy process, focuses on situations where actors work together to make national policy on global health, considers these interactive situations as spaces for observing external influences on policy change and proposes policy design as the output of the process. We suggest that this framework makes three contributions to the conceptualisation of national policy on global health as a research object. First, it emphasizes collective action over decisions of individual policy actors. Second, it conceptualises the policy process as organised interactive spaces for collaboration rather than as stages of a policy cycle. Third, national decision-making spaces are opportunities for transferring ideas and knowledge from different sectors and settings, and represent opportunities to identify international influences on a country's global health policy. We discuss two sets of challenges for public health researchers using interdisciplinary approaches in policy research. Copyright �

Trade policy and public health.

PubMed

Friel, Sharon; Hattersley, Libby; Townsend, Ruth

2015-03-18

Twenty-first-century trade policy is complex and affects society and population health in direct and indirect ways. Without doubt, trade policy influences the distribution of power, money, and resources between and within countries, which in turn affects the natural environment; people's daily living conditions; and the local availability, quality, affordability, and desirability of products (e.g., food, tobacco, alcohol, and health care); it also affects individuals' enjoyment of the highest attainable standard of health. In this article, we provide an overview of the modern global trade environment, illustrate the pathways between trade and health, and explore the emerging twenty-first-century trade policy landscape and its implications for health and health equity. We conclude with a call for more interdisciplinary research that embraces complexity theory and systems science as well as the political economy of health and that includes monitoring and evaluation of the impact of trade agreements on health.

The utilisation of health research in policy-making: concepts, examples and methods of assessment

PubMed Central

Hanney, Stephen R; Gonzalez-Block, Miguel A; Buxton, Martin J; Kogan, Maurice

2003-01-01

The importance of health research utilisation in policy-making, and of understanding the mechanisms involved, is increasingly recognised. Recent reports calling for more resources to improve health in developing countries, and global pressures for accountability, draw greater attention to research-informed policy-making. Key utilisation issues have been described for at least twenty years, but the growing focus on health research systems creates additional dimensions. The utilisation of health research in policy-making should contribute to policies that may eventually lead to desired outcomes, including health gains. In this article, exploration of these issues is combined with a review of various forms of policy-making. When this is linked to analysis of different types of health research, it assists in building a comprehensive account of the diverse meanings of research utilisation. Previous studies report methods and conceptual frameworks that have been applied, if with varying degrees of success, to record utilisation in policy-making. These studies reveal various examples of research impact within a general picture of underutilisation. Factors potentially enhancing utilisation can be identified by exploration of: priority setting; activities of the health research system at the interface between research and policy-making; and the role of the recipients, or 'receptors', of health research. An interfaces and receptors model provides a framework for analysis. Recommendations about possible methods for assessing health research utilisation follow identification of the purposes of such assessments. Our conclusion is that research utilisation can be better understood, and enhanced, by developing assessment methods informed by conceptual analysis and review of previous studies. PMID:12646071

Exploring perceptions of community health policy in Kenya and identifying implications for policy change.

PubMed

McCollum, Rosalind; Otiso, Lilian; Mireku, Maryline; Theobald, Sally; de Koning, Korrie; Hussein, Salim; Taegtmeyer, Miriam

2016-02-01

Global interest and investment in close-to-community health services is increasing. Kenya is currently revising its community health strategy (CHS) alongside political devolution, which will result in revisioning of responsibility for local services. This article aims to explore drivers of policy change from key informant perspectives and to study perceptions of current community health services from community and sub-county levels, including perceptions of what is and what is not working well. It highlights implications for managing policy change. We conducted 40 in-depth interviews and 10 focus group discussions with a range of participants to capture plural perspectives, including those who will influence or be influenced by CHS policy change in Kenya (policymakers, sub-county health management teams, facility managers, community health extension worker (CHEW), community health workers (CHWs), clients and community members) in two purposively selected counties: Nairobi and Kitui. Qualitative data were digitally recorded, transcribed, translated and coded before framework analysis. There is widespread community appreciation for the existing strategy. High attrition, lack of accountability for voluntary CHWs and lack of funds to pay CHW salaries, combined with high CHEW workload were seen as main drivers for strategy change. Areas for change identified include: lack of clear supervisory structure including provision of adequate travel resources, current uneven coverage and equity of community health services, limited community knowledge about the strategy revision and demand for home-based HIV testing and counselling. This in-depth analysis which captures multiple perspectives results in robust recommendations for strategy revision informed by the Five Wonders of Change Framework. These recommendations point towards a more people-centred health system for improved equity and effectiveness and indicate priority areas for action if success of policy change through

Domestic violence against women, public policies and community health workers in Brazilian Primary Health Care.

PubMed

Signorelli, Marcos Claudio; Taft, Angela; Pereira, Pedro Paulo Gomes

2018-01-01

Domestic violence creates multiple harms for women's health and is a 'wicked problem' for health professionals and public health systems. Brazil recently approved public policies to manage and care for women victims of domestic violence. Facing these policies, this study aimed to explore how domestic violence against women is usually managed in Brazilian primary health care, by investigating a basic health unit and its family health strategy. We adopted qualitative ethnographic research methods with thematic analysis of emergent categories, interrogating data with gender theory and emergent Brazilian collective health theory. Field research was conducted in a local basic health unit and the territory for which it is responsible, in Southern Brazil. The study revealed: 1) a yawning gap between public health policies for domestic violence against women at the federal level and its practical application at local/decentralized levels, which can leave both professionals and women unsafe; 2) the key role of local community health workers, paraprofessional health promotion agents, who aim to promote dialogue between women experiencing violence, health care professionals and the health care system.

Evaluation of caregiver-friendly workplace policy (CFWPs) interventions on the health of full-time caregiver employees (CEs): implementation and cost-benefit analysis.

PubMed

Williams, Allison M; Tompa, Emile; Lero, Donna S; Fast, Janet; Yazdani, Amin; Zeytinoglu, Isik U

2017-09-20

Current Canadian evidence illustrating the health benefits and cost-effectiveness of caregiver-friendly workplace policies is needed if Canadian employers are to adopt and integrate caregiver-friendly workplace policies into their employment practices. The goal of this three-year, three study research project is to provide such evidence for the auto manufacturing and educational services sectors. The research questions being addressed are: What are the impacts for employers (economic) and workers (health) of caregiver-friendly workplace policy intervention(s) for full-time caregiver-employees? What are the impacts for employers, workers and society of the caregiver-friendly workplace policy intervention(s) in each participating workplace? What contextual factors impact the successful implementation of caregiver-friendly workplace policy intervention(s)? Using a pre-post-test comparative case study design, Study A will determine the effectiveness of newly implemented caregiver-friendly workplace policy intervention(s) across two workplaces to determine impacts on caregiver-employee health. A quasi-experimental pre-post design will allow the caregiver-friendly workplace policy intervention(s) to be tested with respect to potential impacts on health, and specifically on caregiver employee mental, psychosocial, and physical health. Framed within a comparative case study design, Study B will utilize cost-benefit and cost-effectiveness analysis approaches to evaluate the economic impacts of the caregiver-friendly workplace policy intervention(s) for each of the two participating workplaces. Framed within a comparative case study design, Study C will undertake an implementation analysis of the caregiver-friendly workplace policy intervention(s) in each participating workplace in order to determine: the degree of support for the intervention(s) (reflected in the workplace culture); how sex and gender are implicated; co-workers' responses to the chosen intervention(s), and

Financing and funding health care: Optimal policy and political implementability.

PubMed

Nuscheler, Robert; Roeder, Kerstin

2015-07-01

Health care financing and funding are usually analyzed in isolation. This paper combines the corresponding strands of the literature and thereby advances our understanding of the important interaction between them. We investigate the impact of three modes of health care financing, namely, optimal income taxation, proportional income taxation, and insurance premiums, on optimal provider payment and on the political implementability of optimal policies under majority voting. Considering a standard multi-task agency framework we show that optimal health care policies will generally differ across financing regimes when the health authority has redistributive concerns. We show that health care financing also has a bearing on the political implementability of optimal health care policies. Our results demonstrate that an isolated analysis of (optimal) provider payment rests on very strong assumptions regarding both the financing of health care and the redistributive preferences of the health authority. Copyright © 2015 Elsevier B.V. All rights reserved.

HIV policy implementation in two health and demographic surveillance sites in Uganda: findings from a national policy review, health facility surveys and key informant interviews.

PubMed

McRobie, Ellen; Wringe, Alison; Nakiyingi-Miiro, Jessica; Kiweewa, Francis; Lutalo, Tom; Nakigozi, Gertrude; Todd, Jim; Eaton, Jeffrey William; Zaba, Basia; Church, Kathryn

2017-04-05

Successful HIV testing, care and treatment policy implementation is essential for realising the reductions in morbidity and mortality those policies are designed to target. While adoption of new HIV policies is rapid, less is known about the facility-level implementation of new policies and the factors influencing this. We assessed implementation of national policies about HIV testing, treatment and retention at health facilities serving two health and demographic surveillance sites (HDSS) (10 in Kyamulibwa, 14 in Rakai). Ugandan Ministry of Health HIV policy documents were reviewed in 2013, and pre-determined indicators were extracted relating to the content and nature of guidance on HIV service provision. Facility-level policy implementation was assessed via a structured questionnaire administered to in-charge staff from each health facility. Implementation of policies was classified as wide (≥75% facilities), partial (26-74% facilities) or minimal (≤25% facilities). Semi-structured interviews were conducted with key informants (policy-makers, implementers, researchers) to identify factors influencing implementation; data were analysed using the Framework Method of thematic analysis. Most policies were widely implemented in both HDSS (free testing, free antiretroviral treatment (ART), WHO first-line regimen as standard, Option B+). Both had notable implementation gaps for policies relating to retention on treatment (availability of nutritional supplements, support groups or isoniazid preventive therapy). Rakai implemented more policies relating to provision of antiretroviral treatment than Kyamulibwa and performed better on quality of care indicators, such as frequency of stock-outs. Factors facilitating implementation were donor investment and support, strong scientific evidence, low policy complexity, phased implementation and effective planning. Limited human resources, infrastructure and health management information systems were perceived as major

The GREENH-City interventional research protocol on health in all policies.

PubMed

Porcherie, Marion; Vaillant, Zoé; Faure, Emmanuelle; Rican, Stéphane; Simos, Jean; Cantoreggi, Nicola Luca; Heritage, Zoé; Le Gall, Anne Roue; Cambon, Linda; Diallo, Thierno Amadou; Vidales, Eva; Pommier, Jeanine

2017-10-18

This paper presents the research protocol of the GoveRnance for Equity, EnviroNment and Health in the City (GREENH-City) project funded by the National Institute for Cancer (Subvention N°2017-003-INCA). In France, health inequities have tended to increase since the late 1980s. Numerous studies show the influence of social, economic, geographic and political determinants on health inequities across the life course. Exposure to environmental factors is uneven across the population and may impact on health and health inequities. In cities, green spaces contribute to creating healthy settings which may help tackle health inequities. Health in All Policies (HiAP) represents one of the key strategies for addressing social and environmental determinants of health inequities. The objective of this research is to identify the most promising interventions to operationalize the HiAP approaches at the city level to tackle health inequities through urban green spaces. It is a participatory interventional research to analyze public policy in real life setting (WHO Healthy Cities). It is a mixed method systemic study with a quantitative approach for the 80 cities and a comparative qualitative multiple case-studies of 6 cities. The research combines 3 different lens: 1/a political analysis of how municipalities apply HiAP to reduce social inequities of health through green space policies and interventions 2/a geographical and topological characterization of green spaces and 3/ on-site observations of the use of green spaces by the inhabitants. City profiles will be identified regarding their HiAP approaches and the extent to which these cities address social inequities in health as part of their green space policy action. The analysis of the transferability of the results will inform policy recommendations in the rest of the Health City Network and widely for the French municipalities. The study will help identify factors enabling the implementation of the HiAP approach at a

Conditions for addressing environmental determinants of health behavior in intersectoral policy networks: A fuzzy set Qualitative Comparative Analysis.

PubMed

Peters, D T J M; Verweij, S; Grêaux, K; Stronks, K; Harting, J

2017-12-01

Improving health requires changes in the social, physical, economic and political determinants of health behavior. For the realization of policies that address these environmental determinants, intersectoral policy networks are considered necessary for the pooling of resources to implement different policy instruments. However, such network diversity may increase network complexity and therefore hamper network performance. Network complexity may be reduced by network management and the provision of financial resources. This study examined whether network diversity - amidst the other conditions - is indeed needed to address environmental determinants of health behavior. We included 25 intersectoral policy networks in Dutch municipalities aimed at reducing overweight, smoking, and alcohol/drugs abuse. For our fuzzy set Qualitative Comparative Analysis we used data from three web-based surveys among (a) project leaders regarding network diversity and size (n = 38); (b) project leaders and project partners regarding management (n = 278); and (c) implementation professionals regarding types of environmental determinants addressed (n = 137). Data on budgets were retrieved from project application forms. Contrary to their intentions, most policy networks typically addressed personal determinants. If the environment was addressed too, it was mostly the social environment. To address environmental determinants of health behavior, network diversity (>50% of the actors are non-public health) was necessary in networks that were either small (<16 actors) or had small budgets (<€183,172), when both were intensively managed. Irrespective of network diversity, environmental determinants also were addressed by small networks with large budgets, and by large networks with small budgets, when both provided network management. We conclude that network diversity is important - although not necessary - for resource pooling to address environmental determinants of health behavior

[Strategic planning and mental health policies].

PubMed

Tonini, Nelsi Salete; Kantorski, Luciane Prado

2007-03-01

This article discusses how mental health policies are prioritized in the process of strategic planning of mental health actions within the context of Brazilian psychiatric reform. The theoretical support of strategic planning provide health professionals, particularly those involved in metal health, with elements fir deepening discussions on existing mental health actions and policies.

State health policy for terrorism preparedness.

PubMed

Ziskin, Leah Z; Harris, Drew A

2007-09-01

State health policy for terrorism preparedness began before the terrorist attacks on September 11, 2001, but was accelerated after that day. In a crisis atmosphere after September 11, the states found their policies changing rapidly, greatly influenced by federal policies and federal dollars. In the 5 years since September 11, these state health policies have been refined. This refinement has included a restatement of the goals and objectives of state programs, the modernization of emergency powers statutes, the education and training of the public health workforce, and a preparation of the health care system to better care for victims of disasters, including acts of terrorism.

State Health Policy for Terrorism Preparedness

PubMed Central

Ziskin, Leah Z.; Harris, Drew A.

2007-01-01

State health policy for terrorism preparedness began before the terrorist attacks on September 11, 2001, but was accelerated after that day. In a crisis atmosphere after September 11, the states found their policies changing rapidly, greatly influenced by federal policies and federal dollars. In the 5 years since September 11, these state health policies have been refined. This refinement has included a restatement of the goals and objectives of state programs, the modernization of emergency powers statutes, the education and training of the public health workforce, and a preparation of the health care system to better care for victims of disasters, including acts of terrorism. PMID:17666689

Evidence for informing health policy development in Low-income Countries (LICs): perspectives of policy actors in Uganda

PubMed Central

Nabyonga-Orem, Juliet; Mijumbi, Rhona

2015-01-01

Background: Although there is a general agreement on the benefits of evidence informed health policy development given resource constraints especially in Low-Income Countries (LICs), the definition of what evidence is, and what evidence is suitable to guide decision-making is still unclear. Our study is contributing to filling this knowledge gap. We aimed to explore health policy actors’ views regarding what evidence they deemed appropriate to guide health policy development. Methods: Using exploratory qualitative methods, we conducted interviews with 51 key informants using an in-depth interview guide. We interviewed a diverse group of stakeholders in health policy development and knowledge translation in the Uganda health sector. Data were analyzed using inductive content analysis techniques. Results: Different stakeholders lay emphasis on different kinds of evidence. While donors preferred international evidence and Ministry of Health (MoH) officials looked to local evidence, district health managers preferred local evidence, evidence from routine monitoring and evaluation, and reports from service providers. Service providers on the other hand preferred local evidence and routine monitoring and evaluation reports whilst researchers preferred systematic reviews and clinical trials. Stakeholders preferred evidence covering several aspects impacting on decision-making highlighting the fact that although policy actors look for factual information, they also require evidence on context and implementation feasibility of a policy decision. Conclusion: What LICs like Uganda categorize as evidence suitable for informing policy encompasses several types with no consensus on what is deemed as most appropriate. Evidence must be of high quality, applicable, acceptable to the users, and informing different aspects of decision-making. PMID:25905479

Evidence for informing health policy development in Low-income Countries (LICs): perspectives of policy actors in Uganda.

PubMed

Nabyonga-Orem, Juliet; Mijumbi, Rhona

2015-03-08

Although there is a general agreement on the benefits of evidence informed health policy development given resource constraints especially in Low-Income Countries (LICs), the definition of what evidence is, and what evidence is suitable to guide decision-making is still unclear. Our study is contributing to filling this knowledge gap. We aimed to explore health policy actors' views regarding what evidence they deemed appropriate to guide health policy development. Using exploratory qualitative methods, we conducted interviews with 51 key informants using an in-depth interview guide. We interviewed a diverse group of stakeholders in health policy development and knowledge translation in the Uganda health sector. Data were analyzed using inductive content analysis techniques. Different stakeholders lay emphasis on different kinds of evidence. While donors preferred international evidence and Ministry of Health (MoH) officials looked to local evidence, district health managers preferred local evidence, evidence from routine monitoring and evaluation, and reports from service providers. Service providers on the other hand preferred local evidence and routine monitoring and evaluation reports whilst researchers preferred systematic reviews and clinical trials. Stakeholders preferred evidence covering several aspects impacting on decision-making highlighting the fact that although policy actors look for factual information, they also require evidence on context and implementation feasibility of a policy decision. What LICs like Uganda categorize as evidence suitable for informing policy encompasses several types with no consensus on what is deemed as most appropriate. Evidence must be of high quality, applicable, acceptable to the users, and informing different aspects of decision-making. © 2015 by Kerman University of Medical Sciences.

Framing and the health policy process: a scoping review.

PubMed

Koon, Adam D; Hawkins, Benjamin; Mayhew, Susannah H

2016-07-01

Framing research seeks to understand the forces that shape human behaviour in the policy process. It assumes that policy is a social construct and can be cast in a variety of ways to imply multiple legitimate value considerations. Frames provide the cognitive means of making sense of the social world, but discordance among them forms the basis of policy contestation. Framing, as both theory and method, has proven to generate considerable insight into the nature of policy debates in a variety of disciplines. Despite its salience for understanding health policy debates; however, little is known about the ways frames influence the health policy process. A scoping review using the Arksey and O'Malley framework was conducted. The literature on framing in the health sector was reviewed using nine health and social science databases. Articles were included that explicitly reported theory and methods used, data source(s), at least one frame, frame sponsor and evidence of a given frame's effect on the health policy process. A total of 52 articles, from 1996 to 2014, and representing 12 countries, were identified. Much of the research came from the policy studies/political science literature (n = 17) and used a constructivist epistemology. The term 'frame' was used as a label to describe a variety of ideas, packaged as values, social problems, metaphors or arguments. Frames were characterized at various levels of abstraction ranging from general ideological orientations to specific policy positions. Most articles presented multiple frames and showed how actors advocated for them in a highly contested political process. Framing is increasingly an important, yet overlooked aspect of the policy process. Further analysis on frames, framing processes and frame conflict can help researchers and policymakers to understand opaque and highly charged policy issues, which may facilitate the resolution of protracted policy controversies. © The Author 2016. Published by Oxford

Is it a policy crisis or it is a health crisis? The Egyptian context--analysis of the Egyptian health policy for the H1N1 flu pandemic control.

PubMed

Seef, Sameh; Jeppsson, Anders

2013-01-01

A new influenza virus that was first detected in people in April 2009, was initially referred to colloquially as "swine flu", since it contained genes from swine, avian and human influenza viruses. It can, however, not be transmitted by eating pork or dealing with pigs. In Egypt, several hundred thousand pigs were killed in May, in spite of advice from global health authorities that such an action was unnecessary. Pigs are raised and consumed mainly by the Christian minority, which constitute some 10% of the population. Health Ministry estimated there were between 300,000-350,000 pigs in Egypt. This paper will analyze the Egyptian health policy for controlling the pandemic H1N1 flu, exploring its context, content, process, and actors. The analysis is based on the Leichter Context, which refers to systemic factors-political, economic and social, both national and international-that may have an effect on health policy, and is based on data collected from literature review and policy documents. The International health officials said the swine flu virus that has caused worldwide fear is not transmitted by pigs, and that pig slaughters do nothing to stop its spread. The WHO stopped using the term "swine flu" to avoid confusion. In Egypt, even the editor of a pro-government newspaper criticized the order to slaughter: "Killing (pigs) is not a solution, otherwise, we should kill the people, because the virus spreads through them," wrote Abdullah Kamal of the daily Rose El-Youssef. The World Health organization also criticized the decision. The extinction of the Egyptian pigs is an example of how a health issue can be used to persecute a minority within a country. Although the current influenza has nothing whatsoever to do with pigs, the previous name of the epidemic was used as an argument to violate the rights of the Christian minority in Egypt.

Navigating public health chemicals policy in Australia: a policy maker's and practitioner's guide.

PubMed

Capon, Adam; Smith, Wayne; Gillespie, James A

2013-03-01

Chemicals are ubiquitous in everyday life. Environmental health practitioners rely on a complex web of regulators and policy bodies to ensure the protection of public health, yet few understand the full extent of this web. A lack of understanding can hamper public health response and impede policy development. In this paper we map the public health chemicals policy landscape in Australia and conclude that an understanding of this system is essential for effective environmental health responses and policy development.

Policy Capacity for Health Reform: Necessary but Insufficient: Comment on "Health Reform Requires Policy Capacity".

PubMed

Adams, Owen

2015-09-04

Forest and colleagues have persuasively made the case that policy capacity is a fundamental prerequisite to health reform. They offer a comprehensive life-cycle definition of policy capacity and stress that it involves much more than problem identification and option development. I would like to offer a Canadian perspective. If we define health reform as re-orienting the health system from acute care to prevention and chronic disease management the consensus is that Canada has been unsuccessful in achieving a major transformation of our 14 health systems (one for each province and territory plus the federal government). I argue that 3 additional things are essential to build health policy capacity in a healthcare federation such as Canada: (a) A means of "policy governance" that would promote an approach to cooperative federalism in the health arena; (b) The ability to overcome the "policy inertia" resulting from how Canadian Medicare was implemented and subsequently interpreted; and (c) The ability to entertain a long-range thinking and planning horizon. My assessment indicates that Canada falls short on each of these items, and the prospects for achieving them are not bright. However, hope springs eternal and it will be interesting to see if the July, 2015 report of the Advisory Panel on Healthcare Innovation manages to galvanize national attention and stimulate concerted action. © 2016 by Kerman University of Medical Sciences.

Childhood Diabesity: International Applications for Health Education and Health Policy

ERIC Educational Resources Information Center

Pinzon-Perez, Helda; Kotkin-Jaszi, Suzanne; Perez, Miguel A.

2010-01-01

Health policy has a direct impact on health education initiatives, health care delivery, resource allocation, and quality of life. Increasing rates in the epidemics of obesity and obesity-dependent diabetes mellitus (aka diabesity) suggest that health policy changes should be included in health education and disease prevention strategies. Health…

Mental health policy development in Africa.

PubMed Central

Gureje, O.; Alem, A.

2000-01-01

Mental health issues are usually given very low priority in health service policies. Although this is changing, African countries are still confronted with so many problems caused by communicable diseases and malnutrition that they have not waken up to the impact of mental disorders. Every country must formulate a mental health policy based on its own social and cultural realities. Such policies must take into account the scope of mental health problems, provide proven and affordable interventions, safeguard patients' rights, and ensure equity. PMID:10885166

The making of evidence-informed health policy in Cambodia: knowledge, institutions and processes.

PubMed

Liverani, Marco; Chheng, Kannarath; Parkhurst, Justin

2018-01-01

In global health discussions, there have been widespread calls for health policy and programme implementation to be informed by the best available evidence. However, recommendations in the literature on knowledge translation are often decontextualised, with little attention to the local systems of institutions, structures and practices which can direct the production of evidence and shape whether or how it informs health decisions. This article explores these issues in the country setting of Cambodia, where the Ministry of Health has explicitly championed the language of evidence-based approaches to policy and planning. Research for this paper combined multiple sources and material, including in-depth interviews with key informants in Phnom Penh and the analysis of documentary material and publications. Data collection and analysis focused on two key domains in evidence advisory systems: domestic capacities to generate health policy-relevant evidence and institutional mechanisms to monitor, evaluate and incorporate evidence in the policy process. We identified a number of structural arrangements that may increasingly work to facilitate the supply of health-related data and information, and their use to inform policy and planning. However, other trends and features appear to be more problematic, including gaps between research and public health priorities in the country, the fragmented nature of research activities and information systems, the lack of a national policy to support and guide the production and use of evidence for health policy, and challenges to the use of evidence for intersectoral policy-making. In Cambodia, as in other low/middle-income countries, continued investments to increase the supply and quality of health data and information are needed, but greater attention should be paid to the enabling institutional environment to ensure relevance of health research products and effective knowledge management.

Health services financing and delivery: analysis of policy options for Dubai, United Arab Emirates

PubMed Central

Hamidi, Samer

2015-01-01

Introduction A national health account (NHA) provides a systematic approach to mapping the flow of health sector funds within a specified health system over a defined time period. This article attempts to present a profile of health system financing in Dubai, United Arab Emirates using data from NHAs, and to compare the functional structures of financing schemes in Dubai with schemes in Qatar and selected member countries of the Organization for Economic Cooperation and Development (OECD). Methods The author analyzed secondary data published in NHAs of Dubai and Qatar and data collected by the OECD countries and publicly available from Eurostat (Statistical Office of the European Union) of 25 OECD countries for comparative analysis. All health financing indicators used were as defined in the international System of Health Accounts (SHA). Results In Dubai, spending on inpatient care was the highest-costing component, with 30% of current health expenditures (CHE). Spending on outpatient care was the second highest-costing component and accounted for about 23% of the CHE. Household spending accounted for about 22% of CHE (equivalent to US$187 per capita), compared to an average of 20% of CHE of OECD countries. Dubai spent 0.02% of CHE on long-term care, compared to an average of 11% of CHE of OECD countries. Dubai spent about 6% of CHE on prevention and public health services, compared to an average of 3.2% of CHE of OECD countries. Conclusion The findings point to potential opportunities for growth and improvement in several health policy issues in Dubai, including increasing focus and funding of preventive services; shifting from inpatient care to day surgery, outpatient, and home-based services and strengthening long-term care; and introducing cost-containment measures for pharmaceuticals. More investment in the translation of NHA data into policy is suggested for future researchers. PMID:25750545

Policy Capacity Meets Politics: Comment on "Health Reform Requires Policy Capacity".

PubMed

Fafard, Patrick

2015-07-22

It is difficult to disagree with the general argument that successful health reform requires a significant degree of policy capacity or that all players in the policy game need to move beyond self-interested advocacy. However, an overly broad definition of policy capacity is a problem. More important perhaps, health reform inevitably requires not just policy capacity but political leadership and compromise. © 2015 by Kerman University of Medical Sciences.

Understanding Evidence-Based Public Health Policy

PubMed Central

Chriqui, Jamie F.; Stamatakis, Katherine A.

2009-01-01

Public health policy has a profound impact on health status. Missing from the literature is a clear articulation of the definition of evidence-based policy and approaches to move the field forward. Policy-relevant evidence includes both quantitative (e.g., epidemiological) and qualitative information (e.g., narrative accounts). We describe 3 key domains of evidence-based policy: (1) process, to understand approaches to enhance the likelihood of policy adoption; (2) content, to identify specific policy elements that are likely to be effective; and (3) outcomes, to document the potential impact of policy. Actions to further evidence-based policy include preparing and communicating data more effectively, using existing analytic tools more effectively, conducting policy surveillance, and tracking outcomes with different types of evidence. PMID:19608941

Exploring the influence of context and policy on health district productivity in Cambodia.

PubMed

Ensor, Tim; So, Sovannarith; Witter, Sophie

2016-01-01

Cambodia has been reconstructing its economy and health sector since the end of conflict in the 1990s. There have been gains in life expectancy and increased health expenditure, but Cambodia still lags behind neighbours One factor which may contribute is the efficiency of public health services. This article aims to understand variations in efficiency and the extent to which changes in efficiency are associated with key health policies that have been introduced to strengthen access to health services over the past decade. The analysis makes use of data envelopment analysis (DEA) to measure relative efficiency and changes in productivity and regression analysis to assess the association with the implementation of health policies. Data on 28 operational districts were obtained for 2008-11, focussing on the five provinces selected to represent a range of conditions in Cambodia. DEA was used to calculate efficiency scores assuming constant and variable returns to scale and Malmquist indices to measure productivity changes over time. This analysis was combined with qualitative findings from 17 key informant interviews and 19 in-depth interviews with managers and staff in the same provinces. The DEA results suggest great variation in the efficiency scores and trends of scores of public health services in the five provinces. Starting points were significantly different, but three of the five provinces have improved efficiency considerably over the period. Higher efficiency is associated with more densely populated areas. Areas with health equity funds in Special Operating Agency (SOA) and non-SOA areas are associated with higher efficiency. The same effect is not found in areas only operating voucher schemes. We find that the efficiency score increased by 0.12 the year any of the policies was introduced. This is the first study published on health district productivity in Cambodia. It is one of the few studies in the region to consider the impact of health policy changes

The Oregon Public Health Policy Institute: Building Competencies for Public Health Practice.

PubMed

Luck, Jeff; Yoon, Jangho; Bernell, Stephanie; Tynan, Michael; Alvarado, Carla Sarai; Eversole, Tom; Mosbaek, Craig; Beathard, Candice

2015-08-01

The Oregon Public Health Policy Institute (PHPI) was designed to enhance public health policy competencies among state and local health department staff. The Oregon Health Authority funded the College of Public Health and Human Sciences at Oregon State University to develop the PHPI curriculum in 2012 and offer it to participants from 4 state public health programs and 5 local health departments in 2013. The curriculum interspersed short instructional sessions on policy development, implementation, and evaluation with longer hands-on team exercises in which participants applied these skills to policy topics their teams had selected. Panel discussions provided insights from legislators and senior Oregon health experts. Participants reported statistically significant increases in public health policy competencies and high satisfaction with PHPI overall.

The Oregon Public Health Policy Institute: Building Competencies for Public Health Practice

PubMed Central

Yoon, Jangho; Bernell, Stephanie; Tynan, Michael; Alvarado, Carla Sarai; Eversole, Tom; Mosbaek, Craig; Beathard, Candice

2015-01-01

The Oregon Public Health Policy Institute (PHPI) was designed to enhance public health policy competencies among state and local health department staff. The Oregon Health Authority funded the College of Public Health and Human Sciences at Oregon State University to develop the PHPI curriculum in 2012 and offer it to participants from 4 state public health programs and 5 local health departments in 2013. The curriculum interspersed short instructional sessions on policy development, implementation, and evaluation with longer hands-on team exercises in which participants applied these skills to policy topics their teams had selected. Panel discussions provided insights from legislators and senior Oregon health experts. Participants reported statistically significant increases in public health policy competencies and high satisfaction with PHPI overall. PMID:26066925

Policy initiation and political levers in health policy: lessons from Ghana’s health insurance

PubMed Central

2012-01-01

Background Understanding the health policy formulation process over the years has focused on the content of policy to the neglect of context. This had led to several policy initiatives having a still birth or ineffective policy choices with sub-optimal outcomes when implemented. Sometimes, the difficulty has been finding congruence between different values and interests of the various stakeholders. How can policy initiators leverage the various subtle mechanisms that various players draw on to leverage their interests during policy formulation. This paper attempts to conceptualise these levers of policy formulation to enhance an understanding of this field of work based on lived experience. Methodology This is a qualitative participant observation case study based on retrospective recollection of the policy process and political levers involved in developing the Ghana National Health Insurance Scheme. The study uses a four-concept framework which is agenda setting, symbols manipulation, constituency preservation and coalition building to capture the various issues, negotiations and nuanced approaches used in arriving at desired outcomes. Results Technical experts, civil society, academicians and politicians all had significant influence on setting the health insurance agenda. Each of these various stakeholders carefully engaged in ways that preserved their constituency interests through explicit manoeuvres and subtle engagements. Where proposals lend themselves to various interpretations, stakeholders were quick to latch on the contentious issues to preserve their constituency and will manipulate the symbols that arise from the proposals to their advantage. Where interests are contested and the price of losing out will leave government worse off which will favour its political opponent, it will push for divergent interests outside parliamentary politics through intense negotiations to build coalitions so a particular policy may pass. Conclusions This paper has

Health Policies and Black Americans.

ERIC Educational Resources Information Center

Willis, David P., Ed.

This collection of essays focuses on the impact of health policy on black Americans by examining the relation between public policy and the distribution of health needs and effects. The book includes an introduction by David P. Willis and is divided into seven sections. Section I, "Who Are Black Americans?" includes the following…

Participation and coordination in Dutch health care policy-making. A network analysis of the system of intermediate organizations in Dutch health care.

PubMed

Lamping, Antonie J; Raab, Jörg; Kenis, Patrick

2013-06-01

This study explores the system of intermediate organizations in Dutch health care as the crucial system to understand health care policy-making in the Netherlands. We argue that the Dutch health care system can be understood as a system consisting of distinct but inter-related policy domains. In this study, we analyze four such policy domains: Finances, quality of care, manpower planning and pharmaceuticals. With the help of network analytic techniques, we describe how this highly differentiated system of >200 intermediate organizations is structured and coordinated and what (policy) consequences can be observed with regard to its particular structure and coordination mechanisms. We further analyze the extent to which this system of intermediate organizations enables participation of stakeholders in policy-making using network visualization tools. The results indicate that coordination between the different policy domains within the health care sector takes place not as one would expect through governmental agencies, but through representative organizations such as the representative organizations of the (general) hospitals, the health care consumers and the employers' association. We further conclude that the system allows as well as denies a large number of potential participants access to the policy-making process. As a consequence, the representation of interests is not necessarily balanced, which in turn affects health care policy. We find that the interests of the Dutch health care consumers are well accommodated with the national umbrella organization NPCF in the lead. However, this is no safeguard for the overall community values of good health care since, for example, the interests of the public health sector are likely to be marginalized.

Policies and Processes for Social Inclusion: Using EquiFrame and EquIPP for Policy Dialogue Comment on "Are Sexual and Reproductive Health Policies Designed for All? Vulnerable Groups in Policy Documents of Four European Countries and Their Involvement in Policy Development".

PubMed

MacLachlan, Malcolm; Mannan, Hasheem; Huss, Tessy; Munthali, Alister; Amin, Mutamad

2015-11-16

The application of EquiFrame in the analysis of sexual and reproductive health policies by Ivanova et al to a new thematic area, their selection of only some of the Core Concepts of human rights in health service provision and the addition of new vulnerable groups relevant to the purpose of their analysis, are all very welcome developments. We also applaud their application of EquiFrame to policies in countries where it has not previously been used, along with their use of interviews with policy-makers to produce a deeper understanding of policy processes. We argue that clear justification for the inclusion of additional, or replacement of some exiting vulnerable groups within EquiFrame should be accompanied by clear definitions of such groups, along with the evidence-base that justifies their classification as a vulnerable or marginalised group. To illustrate the versatility of EquiFrame, we summarise a range of ways in which it has been used across a number of regions; including a brief Case Study of its use to develop the National Health Policy of Malawi. While EquiFrame focuses on policy content, we preview a new policy analysis tool - Equity and Inclusion in Policy Processes (EquIPP) - which assesses the extent of equity and inclusion in broader policy processes. Together, EquiFrame and EquIPP can be used to help governments and civil society ensure that policies are addressing the much stronger emphasis on social inclusion, now apparent in the Sustainable Development Goals (SDGs). © 2016 by Kerman University of Medical Sciences.

Introduction of male circumcision for HIV prevention in Uganda: analysis of the policy process.

PubMed

Odoch, Walter Denis; Kabali, Kenneth; Ankunda, Racheal; Zulu, Joseph Mumba; Tetui, Moses

2015-06-20

Health policy analysis is important for all health policies especially in fields with ever changing evidence-based interventions such as HIV prevention. However, there are few published reports of health policy analysis in sub-Saharan Africa in this field. This study explored the policy process of the introduction of male circumcision (MC) for HIV prevention in Uganda in order to inform the development processes of similar health policies. Desk review of relevant documents was conducted between March and May 2012. Thematic analysis was used to analyse the data. Conceptual frameworks that demonstrate the interrelationship within the policy development processes and influence of actors in the policy development processes guided the analysis. Following the introduction of MC on the national policy agenda in 2007, negotiation and policy formulation preceded its communication and implementation. Policy proponents included academic researchers in the early 2000s and development partners around 2007. Favourable contextual factors that supported the development of the policy included the rising HIV prevalence, adoption of MC for HIV prevention in other sub-Saharan African countries, and expertise on MC. Additionally, the networking capability of proponents facilitated the change in position of non-supportive or neutral actors. Non-supportive and neutral actors in the initial stages of the policy development process included the Ministry of Health, traditional and Muslim leaders, and the Republican President. Using political authority, legitimacy, and charisma, actors who opposed the policy tried to block the policy development process. Researchers' initial disregard of the Ministry of Health in the research process of MC and the missing civil society advocacy arm contributed to delays in the policy development process. This study underscores the importance of securing top political leadership as well as key implementing partners' support in policy development processes

Policy for Promotion of Women's Mental Health: Insight from Analysis of Policy on Postnatal Depression in Mexico.

PubMed

Place, Jean Marie S; Billings, Deborah L; Frongillo, Edward A; Blake, Christine E; Mann, Joshua R; deCastro, Filipa

2016-03-01

This article critically examines federal, state and facility-level policies, as well as clinical practice guidelines regarding postnatal depression in Mexico. Thirteen documents including national health plans, national action plans, federal and state laws and regulations, clinical practice guidelines, and public-sector healthcare facility policies were collected and evaluated according to whether they included a statement of intent and/or actions related to the care of women at risk for or experiencing postnatal depression. While postnatal depression is included in several policies in Mexico, it is not addressed in ways that guide actions to manage postnatal depression. Specific direction on postnatal depression in policies would bridge a gap in maternal mental healthcare given that medication, treatment, and timing of interventions is unique in the postpartum context.

Cross-national diffusion of mental health policy

PubMed Central

Shen, Gordon C

2014-01-01

Background: Following the tenets of world polity and innovation diffusion theories, I focus on the coercive and mimetic forces that influence the diffusion of mental health policy across nations. International organizations’ mandates influence government behavior. Dependency on external resources, namely foreign aid, also affects governments’ formulation of national policy. And finally, mounting adoption in a region alters the risk, benefits, and information associated with a given policy. Methods: I use post-war, discrete time data spanning 1950 to 2011 and describing 193 nations’ mental health systems to test these diffusion mechanisms. Results: I find that the adoption of mental health policy is highly clustered temporally and spatially. Results provide support that membership in the World Health Organization (WHO), interdependence with neighbors and peers in regional blocs, national income status, and migrant sub-population are responsible for isomorphism. Aid, however, is an insufficient determinant of mental health policy adoption. Conclusion: This study examines the extent to which mental, neurological, and substance use disorder are addressed in national and international contexts through the lens of policy diffusion theory. It also adds to policy dialogues about non-communicable diseases as nascent items on the global health agenda. PMID:25337601

Associations between state minimum wage policy and health care access: a multi-level analysis of the 2004 Behavioral Risk Factor survey.

PubMed

McCarrier, Kelly P; Martin, Diane P; Ralston, James D; Zimmerman, Frederick J

2010-05-01

Minimum wage policies have been advanced as mechanisms to improve the economic conditions of the working poor. Both positive and negative effects of such policies on health care access have been hypothesized, but associations have yet to be thoroughly tested. To examine whether the presence of minimum wage policies in excess of the federal standard of $5.15 per hour was associated with health care access indicators among low-skilled adults of working age, a cross-sectional analysis of 2004 Behavioral Risk Factor Surveillance System data was conducted. Self-reported health insurance status and experience with cost-related barriers to needed medical care were adjusted in multi-level logistic regression models to control for potential confounding at the state, county, and individual levels. State-level wage policy was not found to be associated with insurance status or unmet medical need in the models, providing early evidence that increased minimum wage rates may neither strengthen nor weaken access to care as previously predicted.

Assessment of the Status of National Oral Health Policy in India.

PubMed

Kothia, Nandita Rani; Bommireddy, Vikram Simha; Devaki, Talluri; Vinnakota, Narayana Rao; Ravoori, Srinivas; Sanikommu, Suresh; Pachava, Srinivas

2015-07-26

National oral health policy was conscripted by the Indian Dental Association (IDA) in 1986 and was accepted as an integral part of National Health Policy (NHP) by the Central Council of Health and Family Welfare in one of its conferences in the year 1995. Objectives of this paper were to find out the efforts made or going on towards its execution, its current status and recent oral health-related affairs or programs, if any. Literature search was done using the institutional library, web-based search engines like 'Google' and 'PubMed' and also by cross referencing. It yielded 108 articles, of which 50 were excluded as they were not pertinent to the topic. Twenty-four were of global perspective rather than Indian and hence were not taken into account and finally 34 articles were considered for analyses. Documents related to central and state governments of India were also considered. All the articles considered for analysis were published within the past 10 years with gradual increase in number which depicts the researchers' increasing focus towards oral health policy. Criticisms, suggestions and recommendations regarding national oral health programs, dental manpower issues, geriatric dentistry, public health dentistry, dental insurance, oral health inequality, and public-private partnerships have taken major occupancies in the articles. Proposals like "model for infant and child oral health promotion" and "oral health policy phase 1 for Karnataka" were among the initiatives towards national oral health policy. The need for implementation of the drafted oral health policy with modification that suits the rapidly changing oral health system of this country is inevitable. © 2015 by Kerman University of Medical Sciences.

Assessment of the Status of National Oral Health Policy in India

PubMed Central

Kothia, Nandita Rani; Bommireddy, Vikram Simha; Devaki, Talluri; Vinnakota, Narayana Rao; Ravoori, Srinivas; Sanikommu, Suresh; Pachava, Srinivas

2015-01-01

Background: National oral health policy was conscripted by the Indian Dental Association (IDA) in 1986 and was accepted as an integral part of National Health Policy (NHP) by the Central Council of Health and Family Welfare in one of its conferences in the year 1995. Objectives of this paper were to find out the efforts made or going on towards its execution, its current status and recent oral health-related affairs or programs, if any. Methods: Literature search was done using the institutional library, web-based search engines like ‘Google’ and ‘PubMed’ and also by cross referencing. It yielded 108 articles, of which 50 were excluded as they were not pertinent to the topic. Twenty-four were of global perspective rather than Indian and hence were not taken into account and finally 34 articles were considered for analyses. Documents related to central and state governments of India were also considered. Results: All the articles considered for analysis were published within the past 10 years with gradual increase in number which depicts the researchers’ increasing focus towards oral health policy. Criticisms, suggestions and recommendations regarding national oral health programs, dental manpower issues, geriatric dentistry, public health dentistry, dental insurance, oral health inequality, and public-private partnerships have taken major occupancies in the articles. Proposals like "model for infant and child oral health promotion" and "oral health policy phase 1 for Karnataka" were among the initiatives towards national oral health policy. Conclusion: The need for implementation of the drafted oral health policy with modification that suits the rapidly changing oral health system of this country is inevitable. PMID:26340486

The politics of EPSDT policy in the 1990s: policy entrepreneurs, political streams, and children's health benefits.

PubMed

Sardell, A; Johnson, K

1998-01-01

The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program, which was designed to ensure that Medicaid-eligible children receive comprehensive health services, is the only national attempt to provide a right to these services. The political factors that have shaped national EPSDT policy during the past decade are described, based on a conceptual framework developed by John W. Kingdon. The analysis focuses on the roles of two distinct sets of policy entrepreneurs: child health advocates and fiscally conservative governors. Their activities are described in relation to the larger political environment, or "political stream," from the period of the expansion of Medicaid eligibility for pregnant women and children in the late 1980s to the enactment of a new State Children's Health Insurance Program (SCHIP) in 1997. The relative saliency of eligibility and benefit issues in children's health policies had a major influence on the politics and outcomes.

Integrating ethics, health policy and health systems in low- and middle-income countries: case studies from Malaysia and Pakistan.

PubMed

Hyder, Adnan A; Merritt, Maria; Ali, Joseph; Tran, Nhan T; Subramaniam, Kulanthayan; Akhtar, Tasleem

2008-08-01

Scientific progress is a significant basis for change in public-health policy and practice, but the field also invests in value-laden concepts and responds daily to sociopolitical, cultural and evaluative concerns. The concepts that drive much of public-health practice are shaped by the collective and individual mores that define social systems. This paper seeks to describe the ethics processes in play when public-health mechanisms are established in low- and middle-income countries, by focusing on two cases where ethics played a crucial role in producing positive institutional change in public-health policy. First, we introduce an overview of the relationship between ethics and public health; second, we provide a conceptual framework for the ethical analysis of health system events, noting how this approach might enhance the power of existing frameworks; and third, we demonstrate the interplay of these frameworks through the analysis of a programme to enhance road safety in Malaysia and an initiative to establish a national ethics committee in Pakistan. We conclude that, while ethics are gradually being integrated into public-health policy decisions in many developing health systems, ethical analysis is often implicit and undervalued. This paper highlights the need to analyse public-health decision-making from an ethical perspective.

The determinants of policy for population health.

PubMed

Fox, Daniel M

2006-10-01

Many advocates of policy to implement the findings of research on the multiple determinants of health accord scant attention to the determinants of health policy in democratic countries. The principle determinants of the allocation of scarce resources to improving health include: the priorities of voters; the diffusion of responsibility for improving health; the absence of evidence about matters of consequence to policy makers; the arraying of some evidence in ways that frustrate policy making; resistance to addressing determinants other than clinical services and traditional public health practices among many professionals in these fields, as well as by industries that supply the health sector; and the special political influence of persons who suffer serious chronic disease and of members of their families.

Human rights and correctional health policy: a view from Europe.

PubMed

Rogan, Mary

2017-03-13

Purpose Correctional healthcare should promote the protection of human rights. The purpose of this paper is to bring a discussion of human rights into debates on how such policy should be best organized. Design/methodology/approach The paper achieves its aim by providing an analysis of European prison law and policy in the area of prison health, through assessing decisions of the European Court of Human Rights, as well as policies created by the European Committee for the Prevention of Torture. Findings The paper describes the position of the European Court of Human Rights on the topics of access to healthcare, ill health and release from prison, mental illness in prison, and the duty to provide rehabilitative programming for those seeking to reduce their level of "risk." It also argues that human rights law can be a source of practical reform, and that legal frameworks have much to offer healthcare leaders seeking to uphold the dignity of those in their care. Originality/value This paper will provide a rare example of the engagement of human rights law with correctional health policy. It provides practical recommendations arising out of an analysis of European human rights law in the area of prisons.

[Crisis and the independence of public health policies. SESPAS report 2014].

PubMed

Hernández Aguado, Ildefonso; Lumbreras Lacarra, Blanca

2014-06-01

Independence in the formulation of public health policies can be affected by various agents with objectives contrary to population health, such as large corporations. This lack of independence may be exacerbated by the economic crisis due to lower funding for health regulatory bodies or other measures designed to protect health. Large corporations have influenced the formulation of certain policies with an impact on health, such as those related to the tobacco industry, the chemical industry, nutrition, alcohol, pharmaceuticals, and health technology. The main areas in which these companies can influence policies are science, education, politics, and society in general. In this scenario, public health associations should take an active role in ensuring the independence of political decisions via actions such as the following: supporting strategies that guarantee the independence of public health policies and apply criteria of impartiality and transparency; rejecting those public-private partnerships launched to prevent health problems partly caused by these corporations; establishing partnerships to achieve independent training of health professionals and an institution with scientific authority in order to improve public health communication and counteract the lack of sound public health information; promoting a critical analysis of the definition of health problems and their solutions, and establishing related agendas (scientific, political and media) and alliances, so that continuing training for health professionals is independent. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

[Sociopolitical determinants of international health policies].

PubMed

De Vos, Pol; Van der Stuyft, Patrick

2013-04-01

For decades, two opposing logics dominate the health policy debate: A comprehensive health care approach, with the 1978 Alma Ata Declaration as its cornerstone, and private competition logic, emphasizing the role of the private sector. We present this debate and its influence on international health policies in the context of changing global economic and sociopolitical power relations. The neoliberal approach is illustrated with Chile's health sector reform in the 1980s and the Colombian reform since 1993. The comprehensive 'public logic' is shown through the social insurance models in Costa Rica and in Brazil, and through the national public health systems in Cuba since 1959, and in Nicaragua -during the 1980s. These experiences emphasize that health (care) systems do not naturally gravitate towards greater fairness and efficiency, but that they require deliberate policy decisions.

Is it a policy crisis or it is a health crisis? The Egyptian context - Analysis of the Egyptian health policy for the H1N1 flu pandemic control

PubMed Central

Seef, Sameh; Jeppsson, Anders

2013-01-01

A new influenza virus that was first detected in people in April 2009, was initially referred to colloquially as “swine flu”, since it contained genes from swine, avian and human influenza viruses. It can, however, not be transmitted by eating pork or dealing with pigs. In Egypt, several hundred thousand pigs were killed in May, in spite of advice from global health authorities that such an action was unnecessary. Pigs are raised and consumed mainly by the Christian minority, which constitute some 10% of the population. Health Ministry estimated there were between 300,000-350,000 pigs in Egypt. This paper will analyze the Egyptian health policy for controlling the pandemic H1N1 flu, exploring its context, content, process, and actors. The analysis is based on the Leichter Context, which refers to systemic factors-political, economic and social, both national and international-that may have an effect on health policy, and is based on data collected from literature review and policy documents. The International health officials said the swine flu virus that has caused worldwide fear is not transmitted by pigs, and that pig slaughters do nothing to stop its spread. The WHO stopped using the term “swine flu” to avoid confusion. In Egypt, even the editor of a pro-government newspaper criticized the order to slaughter: “Killing (pigs) is not a solution, otherwise, we should kill the people, because the virus spreads through them,” wrote Abdullah Kamal of the daily Rose El-Youssef. The World Health organization also criticized the decision. The extinction of the Egyptian pigs is an example of how a health issue can be used to persecute a minority within a country. Although the current influenza has nothing whatsoever to do with pigs, the previous name of the epidemic was used as an argument to violate the rights of the Christian minority in Egypt. PMID:23565306

Rethinking the evaluation and measurement of Health in all policies.

PubMed

Bauman, Adrian E; King, Lesley; Nutbeam, Don

2014-06-01

Current international attention to Health in all policies (HiAP) has its origins in a more sophisticated understanding of the impact of public policies on health, and a recognition that policies across government have an impact on the social and environmental determinants of health and related inequalities in health. As an emerging field, there has been limited attention focused on comprehensive approaches to the evaluation of HiAP to date, and the research focus around HiAP has mainly examined the processes of cross-sectoral policy development, rather than their health-related impacts or outcomes. The purpose of this paper is to explore issues in assessing the implementation of HiAP and describe an expanded evaluation framework for assessing the potential intermediate and end-point effects of HiAP actions, using a planning logic model for 'complex programs'. This meets the needs of public sector policy-makers who express an interest in understanding the relationship between HiAP and health-related and social outcomes. The paper proposes applying a contribution analysis method to estimate and model the anticipated impacts of HiAP policies on intermediate and longer term outcomes, in advance of empirical studies of these outcomes, and as an innovative input into HiAP and evaluation planning. A broader long-term evaluation framework will enhance the political saliency of HiAP initiatives, especially from governments considering HiAP approaches in financially constrained environments. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Health reform requires policy capacity

PubMed Central

Forest, Pierre-Gerlier; Denis, Jean-Louis; Brown, Lawrence D.; Helms, David

2015-01-01

Among the many reasons that may limit the adoption of promising reform ideas, policy capacity is the least recognized. The concept itself is not widely understood. Although policy capacity is concerned with the gathering of information and the formulation of options for public action in the initial phases of policy consultation and development, it also touches on all stages of the policy process, from the strategic identification of a problem to the actual development of the policy, its formal adoption, its implementation, and even further, its evaluation and continuation or modification. Expertise in the form of policy advice is already widely available in and to public administrations, to well-established professional organizations like medical societies and, of course, to large private-sector organizations with commercial or financial interests in the health sector. We need more health actors to join the fray and move from their traditional position of advocacy to a fuller commitment to the development of policy capacity, with all that it entails in terms of leadership and social responsibility. PMID:25905476

Health systems and policy research evidence in health policy making in Israel: what are researchers' practices in transferring knowledge to policy makers?

PubMed

Ellen, Moriah E; Lavis, John N; Sharon, Assaf; Shemer, Joshua

2014-12-10

Ensuring the use of research evidence in health system management and policy decisions is an important challenge in this century. Knowledge transfer and exchange (KTE) has emerged as a paradigm to address the challenges and start closing the 'know-do' gap. This area of work is gaining momentum in most developed countries, yet, to date, no work has been performed in Israel within this area. The purpose of this study was to identify which KTE activities health systems and policy researchers in Israel have undertaken. A cross-sectional web-based survey of researchers who have conducted health systems and policy research in Israel was developed. The survey consisted of a demographics section, quantitative scales, and open-ended questions. The survey was sent to all health systems and policy researchers in Israel (n = 125). The study response rate (28%) was relatively low as compared to other studies in the same field (range of 42% to 88%). Our survey found that more than a third of the health systems and policy researchers in Israel reported that they were frequently or always involved in the following KTE activities: interactions with target audience through the research process (i.e., during developing a research question or executing the research; 35% to 42%) or through formal or informal meetings during conferences, workshops, or conversations (40%). Less than half of the health systems and policy researchers in Israel are engaged in bridging activities aimed to facilitate target audiences to use research. This is a fairly new area in Israel and therefore the level of engagement of researchers in KTE activities is not very high. The low response rates could be because KTE is a new field in Israel and minimal KTE initiatives have been undertaken. It is preferable to have higher response rates, yet, after several initiatives, this was the outcome. While the findings are relevant, they may not reflect the total population of health system and policy researchers in

Towards health in all policies for childhood obesity prevention.

PubMed

Hendriks, Anna-Marie; Kremers, Stef P J; Gubbels, Jessica S; Raat, Hein; de Vries, Nanne K; Jansen, Maria W J

2013-01-01

The childhood obesity epidemic can be best tackled by means of an integrated approach, which is enabled by integrated public health policies, or Health in All Policies. Integrated policies are developed through intersectoral collaboration between local government policy makers from health and nonhealth sectors. Such intersectoral collaboration has been proved to be difficult. In this study, we investigated which resources influence intersectoral collaboration. The behavior change wheel framework was used to categorize motivation-, capability-, and opportunity-related resources for intersectoral collaboration. In-depth interviews were held with eight officials representing 10 non-health policy sectors within a local government. Results showed that health and non-health policy sectors did not share policy goals, which decreased motivation for intersectoral collaboration. Awareness of the linkage between health and nonhealth policy sectors was limited, and management was not involved in creating such awareness, which reduced the capability for intersectoral collaboration. Insufficient organizational resources and structures reduced opportunities for intersectoral collaboration. To stimulate intersectoral collaboration to prevent childhood obesity, we recommend that public health professionals should reframe health goals in the terminology of nonhealth policy sectors, that municipal department managers should increase awareness of public health in non-health policy sectors, and that flatter organizational structures should be established.

Towards Health in All Policies for Childhood Obesity Prevention

PubMed Central

Hendriks, Anna-Marie; Kremers, Stef P. J.; Gubbels, Jessica S.; Raat, Hein; de Vries, Nanne K.; Jansen, Maria W. J.

2013-01-01

The childhood obesity epidemic can be best tackled by means of an integrated approach, which is enabled by integrated public health policies, or Health in All Policies. Integrated policies are developed through intersectoral collaboration between local government policy makers from health and nonhealth sectors. Such intersectoral collaboration has been proved to be difficult. In this study, we investigated which resources influence intersectoral collaboration. The behavior change wheel framework was used to categorize motivation-, capability-, and opportunity-related resources for intersectoral collaboration. In-depth interviews were held with eight officials representing 10 non-health policy sectors within a local government. Results showed that health and non-health policy sectors did not share policy goals, which decreased motivation for intersectoral collaboration. Awareness of the linkage between health and nonhealth policy sectors was limited, and management was not involved in creating such awareness, which reduced the capability for intersectoral collaboration. Insufficient organizational resources and structures reduced opportunities for intersectoral collaboration. To stimulate intersectoral collaboration to prevent childhood obesity, we recommend that public health professionals should reframe health goals in the terminology of nonhealth policy sectors, that municipal department managers should increase awareness of public health in non-health policy sectors, and that flatter organizational structures should be established. PMID:24490059

Applying the World Health Organization Mental Health Action Plan to evaluate policy on addressing co-occurrence of physical and mental illnesses in Australia.

PubMed

Happell, Brenda; Platania-Phung, Chris; Webster, Stephanie; McKenna, Brian; Millar, Freyja; Stanton, Robert; Galletly, Cherrie; Castle, David; Furness, Trentham; Liu, Dennis; Scott, David

2015-09-01

The aim of the present study was to document Australian policies on the physical health of people with mental illness and evaluate the capacity of policy to support health needs. A search of state and federal policies on mental and physical illness was conducted, as well as detailed analysis of policy content and the relationships between policies, by applying the World Health Organization Mental Health Action Plan 2013-2020 as an evaluative framework. National policy attention to the physical health of people with mental illness has grown, but there is little interconnection at the national and state levels. State policies across the country are inconsistent, and there is little evidence of consistent policy implementation. A coherent national health policy framework on addressing co-occurring physical and mental illnesses that includes healthcare system reforms and ensuring the interconnectedness of other relevant services should be prioritised.

[Policies and mental health action plans in OECD: lessons for Quebec?].

PubMed

Thiebaut, Georges-Charles; Farand, Lambert; Fleury, Marie-Josée

2014-01-01

The objectives of this research are: 1) to provide a conceptual framework for analyzing mental health policies; 2) to compare mental health policies across a sample of OECD jurisdictions; 3) to describe configurations of mental health policies; 4) to identify practical implications for the Province of Quebec. This research is a comparative synthetic study of mental health policies. The web sites of the Ministries of health of the thirty-four OECD countries and ten Canadian Provinces were searched for mental health policies proposed within the last fifteen years. Twenty one such policies (with an English or French version) were retrieved, covering thirteen OECD countries, six Canadian Provinces and the WHO. Content analysis was performed based on the categories (differentiation, integration, governance) and sub-categories of the aforementioned conceptual framework. Eight policies that together cover the variations encountered between all policies were used to identify typical configurations. A conceptual framework derived from Parsons' Theory of Social Action posits that social action systems must exhibit a level of internal differentiation that corresponds to the heterogeneity of their external environment and also a level of integration that allows them to remain coherent despite the complexity of their environment. Governance mechanisms help them maintain an equilibrium between differentiation and integration.In terms of differentiation, mental health policies exhibit much variation between the needs and the groups that are prioritized (age, gender, ethnicity, culture, etc.), the types of interventions that are proposed (promotion, prevention, treatment, rehabilitation, etc.), the systemic levels at which interventions take place (society, government as a whole, health care system, organizations, programs, individuals), and the level of specification and scientific basis of proposed interventions. In terms of integration, policies promote various mechanisms

The Politics of EPSDT Policy in the 1990s: Policy Entrepreneurs, Political Streams, and Children's Health Benefits

PubMed Central

Sardell, Alice; Johnson, Kay

1998-01-01

The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program, which was designed to ensure that Medicaid-eligible children receive comprehensive health services, is the only national attempt to provide a right to these services. The political factors that have shaped national EPSDT policy during the past decade are described, based on a conceptual framework developed by John W. Kingdon. The analysis focuses on the roles of two distinct sets of policy entrepreneurs: child health advocates and fiscally conservative governors. Their activities are described in relation to the larger political environment, or “political stream,” from the period of the expansion of Medicaid eligibility for pregnant women and children in the late 1980s to the enactment of a new State Children’s Health Insurance Program (SCHIP) in 1997. The relative saliency of eligibility and benefit issues in children’s health policies had a major influence on the politics and outcomes. PMID:9614420

Do Social and Economic Policies Influence Health? A Review

PubMed Central

Joshi, Pamela; Geronimo, Kimberly; Acevedo-Garcia, Dolores

2014-01-01

Although social and economic policies are not considered part of health services infrastructure, such policies may influence health and disease by altering social determinants of health (SDH). We review social and economic policies in the US that have measured health outcomes among adults in four domains of SDH including housing and neighborhood, employment, family strengthening/marriage, and income supplementation. The majority of these policies target low-income populations. These social policies rarely consider health as their initial mission or outcomes. When measuring health, the programs document mental health and physical health benefits more than half the time, although some effects fade with time. We also find considerable segregation of program eligibility by gender and family composition. Policy makers should design future social policies to evaluate health outcomes using validated health measures; to target women more broadly across the socioeconomic spectrum; and to consider family caregiving responsibilities as ignoring them can have unintended health effects. PMID:25984439

Sustainability and power in health promotion: community-based participatory research in a reproductive health policy case study in New Mexico.

PubMed

Mendes, Rosilda; Plaza, Veronica; Wallerstein, Nina

2016-03-01

Health promotion programs are commonly viewed as value-free initiatives which seek to improve health, often through behavior change. An opposing view has begun to emerge that health promotion efforts, especially ones seeking to impact health policy and social determinants of health, are vulnerable to political contexts and may depend on who is in power at the time. This community-based participatory research study attempts to understand these interactions by applying a conceptual model focused on the power context, diverse stakeholder roles within this context, and the relationship of political levers and other change strategies to the sustainability of health promotion interventions aimed at health policy change. We present a case study of a health promotion coalition, New Mexico for Responsible Sex Education (NMRSE), as an example of power dynamics and change processes. Formed in 2005 in response to federal policies mandating abstinence-only education, NMRSE includes community activists, health promotion staff from the New Mexico Department of Health, and policy-maker allies. Applying an adapted Mayer's 'power analysis' instrument, we conducted semi-structured stakeholder interviews and triangulated political-context analyses from the perspective of the stakeholders.We identified multiple understandings of sustainability and health promotion policy change, including: the importance of diverse stakeholders working together in coalition and social networks; their distinct positions of power within their political contexts; the role of science versus advocacy in change processes; the particular challenges for public sector health promotion professionals; and other facilitators versus barriers to action. One problem that emerged consisted of the challenges for state employees to engage in health promotion advocacy due to limitations imposed on their activities by state and federal policies. This investigation's results include a refined conceptual model, a power-analysis

Aligning Food Systems Policies to Advance Public Health

PubMed Central

Muller, Mark; Tagtow, Angie; Roberts, Susan L.; MacDougall, Erin

2009-01-01

The involvement of public health professionals in food and agricultural policy provides tremendous opportunities for advancing the public's health. It is particularly challenging, however, for professionals to understand and consider the numerous policy drivers that impact the food system, which range from agricultural commodity policies to local food safety ordinances. Confronted with this complexity in the food system, policy advocates often focus on narrow objectives with disregard for the larger system. This commentary contends that, in order to be most effective, public health professionals need to consider the full range of interdependent policies that affect the system. Food policy councils have proven to be an effective tool, particularly at the local and state level, for developing comprehensive food systems policies that can improve public health. PMID:23144671

Data Speak: Influencing School Health Policy through Research

ERIC Educational Resources Information Center

Ryberg, Jacalyn Wickline; Keller, Teresa; Hine, Beverly; Christeson, Elisabeth

2003-01-01

School nurses occupy a unique position in relation to school health policy. In addition to facing the demands of promoting and maintaining the health of students, they collect the information that is used to document the implementation of school health policy. Effective school health policy is guided by reliable, credible data regarding what…

Understanding and benchmarking health service achievement of policy goals for chronic disease

PubMed Central

2012-01-01

Background Key challenges in benchmarking health service achievement of policy goals in areas such as chronic disease are: 1) developing indicators and understanding how policy goals might work as indicators of service performance; 2) developing methods for economically collecting and reporting stakeholder perceptions; 3) combining and sharing data about the performance of organizations; 4) interpreting outcome measures; 5) obtaining actionable benchmarking information. This study aimed to explore how a new Boolean-based small-N method from the social sciences—Qualitative Comparative Analysis or QCA—could contribute to meeting these internationally shared challenges. Methods A ‘multi-value QCA’ (MVQCA) analysis was conducted of data from 24 senior staff at 17 randomly selected services for chronic disease, who provided perceptions of 1) whether government health services were improving their achievement of a set of statewide policy goals for chronic disease and 2) the efficacy of state health office actions in influencing this improvement. The analysis produced summaries of configurations of perceived service improvements. Results Most respondents observed improvements in most areas but uniformly good improvements across services were not perceived as happening (regardless of whether respondents identified a state health office contribution to that improvement). The sentinel policy goal of using evidence to develop service practice was not achieved at all in four services and appears to be reliant on other kinds of service improvements happening. Conclusions The QCA method suggested theoretically plausible findings and an approach that with further development could help meet the five benchmarking challenges. In particular, it suggests that achievement of one policy goal may be reliant on achievement of another goal in complex ways that the literature has not yet fully accommodated but which could help prioritize policy goals. The weaknesses of QCA can be

Health policy and systems research and analysis in Nigeria: examining health policymakers' and researchers' capacity assets, needs and perspectives in south-east Nigeria.

PubMed

Uzochukwu, Benjamin; Mbachu, Chinyere; Onwujekwe, Obinna; Okwuosa, Chinenye; Etiaba, Enyi; Nyström, Monica E; Gilson, Lucy

2016-02-24

Health policy and systems research and analysis (HPSR+A) has been noted as central to health systems strengthening, yet the capacity for HPSR+A is limited in low- and middle-income countries. Building the capacity of African institutions, rather than relying on training provided in northern countries, is a more sustainable way of building the field in the continent. Recognising that there is insufficient information on African capacity to produce and use HPSR+A to inform interventions in capacity development, the Consortium for Health Policy and Systems Analysis in Africa (2011-2015) conducted a study with the aim to assess the capacity needs of its African partner institutions, including Nigeria, for HPSR+A. This paper provides new knowledge on health policy and systems research assets and needs of different stakeholders, and their perspectives on HPSR+A in Nigeria. This was a cross-sectional study conducted in the Enugu state, south-east Nigeria. It involved reviews and content analysis of relevant documents and interviews with organizations' academic staff, policymakers and HPSR+A practitioners. The College of Medicine, University of Nigeria, Enugu campus (COMUNEC), was used as the case study and the HPSR+A capacity needs were assessed at the individual, unit and organizational levels. The HPSR+A capacity needs of the policy and research networks were also assessed. For academicians, lack of awareness of the HPSR+A field and funding were identified as barriers to strengthening HPSR+A in Nigeria. Policymakers were not aware of the availability of research findings that could inform the policies they make nor where they could find them; they also appeared unwilling to go through the rigors of reading extensive research reports. There is a growing interest in HPSR+A as well as a demand for its teaching and, indeed, opportunities for building the field through research and teaching abound. However, there is a need to incorporate HPSR+A teaching and research at an

Model Child Care Health Policies.

ERIC Educational Resources Information Center

Aronson, Susan; Smith, Herberta

Drawn from a review of policies at over 100 child care programs nationwide, the model health policies presented in this report are intended for adaptation and selective use by out-of-home child care facilities. Following an introduction, the report presents model policy forms with blanks for adding individualized information for the following…

Health policy evolution in Lao People's Democratic Republic: context, processes and agency.

PubMed

Jönsson, Kristina; Phoummalaysith, Bounfeng; Wahlström, Rolf; Tomson, Göran

2015-05-01

During the last 20 years Lao People's Democratic Republic has successfully developed and adopted some 30 health policies, strategies, decrees and laws in the field of health. Still, the implementation process remains arduous. This article aims at discussing challenges of health policy development and effective implementation by contextualizing the policy evolution over time and by focusing particularly on the National Drug Policy and the Health Care Law. Special attention is given to the role of research in policymaking. The analysis was guided by the conceptual framework of policy context, process, content and actors, combined with an institutional perspective, and showed that effective implementation of a health policy is highly dependent on both structures and agency of those involved in the policy process. The National Drug Policy was formulated and adopted in a short period of time in a resource-scarce setting, but with dedicated policy entrepreneurs and support of concerned international collaborators. Timely introduction of operational health systems research played a crucial role to support the implementation, as well as the subsequent revision of the policy. The development of the Health Care Law took several years and once adopted, the implementation was delayed by institutional legacies and issues concerning the choice of institutional design and financing, despite strong support of the law among the policymakers. Among many factors, timing of the implementation appeared to be of crucial importance, in combination with strong leadership. These two examples show that more research, that problematizes the complex policy environment in combination with improved communication between researchers and policymakers, is necessary to inform about measures for effective implementation. A way forward can be to strengthen the domestic research capacity and the international research collaboration regionally as well as globally. Published by Oxford University Press

Policy development and challenges of global mental health: a systematic review of published studies of national-level mental health policies.

PubMed

Zhou, Wei; Yu, Yu; Yang, Mei; Chen, Lizhang; Xiao, Shuiyuan

2018-05-18

Mental health policy can be an essential and powerful tool to improve a population's mental health. However, around one third of countries do not possess a mental health policy, and there are large disparities in population coverage rates between high- and low-income countries. The goal of this study is to identify the transition and implementation challenges of mental health policies in both high-income countries (HICs) as well as middle- and low-income countries (MLICs). PubMed, Cochrane Library and Campbell Library were searched from inception to 31 December 2017, for studies on implemented mental health policies at the national level. Abstracts and the main texts of papers were double screened, and extracted data were analysed through thematic synthesis. A total of 93 papers were included in this study, covering 24 HICs, 28 MLICs and 5 regions. Studies on mental health policies, especially those of MLICs, kept increasing, but MLICs were still underrepresented in terms of publication quantity and study frequency. Based on the included studies, nine policy domains were summarized: service organizing, service provision, service quality, human resources, legislation and human rights, advocacy, administration, surveillance and research, and financing and budgeting. HICs incrementally enriched their policy content in all domains over centuries of development; following HICs' experience, mental health policies in MLICs have boomed since the 1990s and quickly extended to all domains. Implementation problems in HICs were mainly related to service organizing and service provision; for MLICs, more severe implementation problems converged on financing and budgeting, administration and human resources. Mental health policy developments in both HICs and MLICs present a process of diversification and enrichment. In terms of implementation, MLICs are faced with more and greater challenges than HICs, especially in funding, human resources and administration. Therefore, future

Policy Options to Reduce Fragmentation in the Pooling of Health Insurance Funds in Iran

PubMed Central

Bazyar, Mohammad; Rashidian, Arash; Kane, Sumit; Vaez Mahdavi, Mohammad Reza; Akbari Sari, Ali; Doshmangir, Leila

2016-01-01

There are fragmentations in Iran’s health insurance system. Multiple health insurance funds exist, without adequate provisions for transfer or redistribution of cross subsidy among them. Multiple risk pools, including several private secondary insurance schemes, have resulted in a tiered health insurance system with inequitable benefit packages for different segments of the population. Also fragmentation might have contributed to inefficiency in the health insurance systems, a low financial protection against healthcare expenditures for the insured persons, high coinsurance rates, a notable rate of insurance coverage duplication, low contribution of well-funded institutes with generous benefit package to the public health insurance schemes, underfunding and severe financial shortages for the public funds, and a lack of transparency and reliable data and statistics for policy-making. We have conducted a policy analysis study, including qualitative interviews of key informants and document analysis. As a result we introduce three policy options: keeping the existing structural fragmentations of social health insurance (SHI)schemes but implementing a comprehensive "policy integration" strategy; consolidation of existing health insurance funds and creating a single national health insurance scheme; and reducing fragmentation by merging minor well-resourced funds together and creating two or three large insurance funds under the umbrella of the existing organizations. These policy options with their advantages and disadvantages are explained in the paper. PMID:27239868

Policy Options to Reduce Fragmentation in the Pooling of Health Insurance Funds in Iran.

PubMed

Bazyar, Mohammad; Rashidian, Arash; Kane, Sumit; Vaez Mahdavi, Mohammad Reza; Akbari Sari, Ali; Doshmangir, Leila

2016-02-11

There are fragmentations in Iran's health insurance system. Multiple health insurance funds exist, without adequate provisions for transfer or redistribution of cross subsidy among them. Multiple risk pools, including several private secondary insurance schemes, have resulted in a tiered health insurance system with inequitable benefit packages for different segments of the population. Also fragmentation might have contributed to inefficiency in the health insurance systems, a low financial protection against healthcare expenditures for the insured persons, high coinsurance rates, a notable rate of insurance coverage duplication, low contribution of well-funded institutes with generous benefit package to the public health insurance schemes, underfunding and severe financial shortages for the public funds, and a lack of transparency and reliable data and statistics for policy-making. We have conducted a policy analysis study, including qualitative interviews of key informants and document analysis. As a result we introduce three policy options: keeping the existing structural fragmentations of social health insurance (SHI)schemes but implementing a comprehensive "policy integration" strategy; consolidation of existing health insurance funds and creating a single national health insurance scheme; and reducing fragmentation by merging minor well-resourced funds together and creating two or three large insurance funds under the umbrella of the existing organizations. These policy options with their advantages and disadvantages are explained in the paper. © 2016 by Kerman University of Medical Sciences.

How to improve collaboration between the public health sector and other policy sectors to reduce health inequalities? - A study in sixteen municipalities in the Netherlands.

PubMed

Storm, Ilse; den Hertog, Frank; van Oers, Hans; Schuit, Albertine J

2016-06-22

The causes of health inequalities are complex. For the reduction of health inequalities, intersectoral collaboration between the public health sector and both social policy sectors (e.g. youth affairs, education) and physical policy sectors (e.g. housing, spatial planning) is essential, but in local practice difficult to realize. The aim of this study was to examine the collaboration between the sectors in question more closely and to identify opportunities for improvement. A qualitative descriptive analysis of five aspects of collaboration within sixteen Dutch municipalities was performed to examine the collaboration between the public health sector and other policy sectors: 1) involvement of the sectors in the public health policy network, 2) harmonisation of objectives, 3) use of policies by the relevant sectors, 4) formalised collaboration, and 5) previous experience. Empirical data on these collaboration aspects were collected based on document analysis, questionnaires and interviews. The study found that the policy workers of social sectors were more involved in the public health network and more frequently supported the objectives in the field of health inequality reduction. Both social policy sectors and physical policy sectors used policies and activities to reduce health inequalities. More is done to influence the determinants of health inequality through policies aimed at lifestyle and social setting than through policies aimed at socioeconomic factors and the physical environment. Where the physical policy sectors are involved in the public health network, the collaboration follows a very similar pattern as with the social policy sectors. All sectors recognise the importance of good relationships, positive experiences, a common interest in working together and coordinated mechanisms. This study shows that there is scope for improving collaboration in the field of health inequality reduction between the public health sector and both social policy sectors

A Staged Approach to Educating Nurses in Health Policy.

PubMed

Ellenbecker, Carol Hall; Fawcett, Jacqueline; Jones, Emily J; Mahoney, Deborah; Rowlands, Beth; Waddell, Ashley

2017-02-01

Nurse leaders and health-care experts agree that nurses have a responsibility to address the health problems facing the nation by participating in health policy development. However, nurses have not fully realized their potential when it comes to engaging in health policy advocacy and leadership. Nurse leaders, professional nursing organizations, accrediting bodies, and the Institute of Medicine have all identified the need to educate nurses in heath policy. Valuable recommendations for content and learning activities in health policy have been made. We argue that nursing education in health policy and the many recommendations offered have been broad and overly ambitious. This article presents a proposal for a staged approach to educating nurses. This approach would tailor content to the role of the nurse at each level of nursing education. The focus of health policy content would progress from the organizational level to local, state, and finally national level health policies. The goal of this approach is to better prepare all levels of nursing students to participate in shaping effective health policies.

Helping Health Care Providers and Clinical Scientists Understand Apparently Irrational Policy Decisions.

PubMed

Demeter, Sandor J

2016-12-21

Health care providers (HCP) and clinical scientists (CS) are generally most comfortable using evidence-based rational decision-making models. They become very frustrated when policymakers make decisions that, on the surface, seem irrational and unreasonable. However, such decisions usually make sense when analysed properly. The goal of this paper to provide a basic theoretical understanding of major policy models, to illustrate which models are most prevalent in publicly funded health care systems, and to propose a policy analysis framework to better understand the elements that drive policy decision-making. The proposed policy framework will also assist HCP and CS achieve greater success with their own proposals.

Enhancing Evidence-Based Public Health Policy: Developing and Using Policy Narratives.

PubMed

Troy, Lisa M; Kietzman, Kathryn G

2016-06-01

Academic researchers and clinicians have a critical role in shaping public policies to improve the health of an aging America. Policy narratives that pair personal stories with research statistics are a powerful tool to share knowledge generated in academic and clinical settings with policymakers. Effective policy narratives rely on a trustworthy and competent narrator and a compelling story that highlights the personal impact of policies under consideration and academic research that bolsters the story. Awareness of the cultural differences in the motivations, expectations, and institutional constraints of academic researchers and clinicians as information producers and U.S. Congress and federal agencies as information users is critical to the development of policy narratives that impact policy decisions. The current article describes the development and use of policy narratives to bridge cultures and enhance evidence-based public health policies that better meet the needs of older adults. [Journal of Gerontological Nursing, 42(6), 11-17.]. Copyright 2016, SLACK Incorporated.

Ethics in American Health 1: Ethical Approaches to Health Policy

PubMed Central

2008-01-01

I trace the evolution of ethical approaches to health policy in the United States and examine a number of critical unresolved issues pertaining to the current set of frameworks. Several themes emerge. First, fair procedures claim more attention than substantive and procedural principles. Second, in the case of public deliberation, more focus has been placed on factors such as procedural mechanisms than on understanding how individuals and groups value different aspects of health and agree on health-related decisions. Third, the nation needs workable frameworks to guide collective choices about valuable social ends and their trade-offs; purely procedural strategies are limited in illuminating overarching health policy and ethics questions. There is a need to integrate consequential and procedural approaches to health ethics and policy. PMID:18703449

Ethics in American health 1: ethical approaches to health policy.

PubMed

Ruger, Jennifer Prah

2008-10-01

I trace the evolution of ethical approaches to health policy in the United States and examine a number of critical unresolved issues pertaining to the current set of frameworks. Several themes emerge. First, fair procedures claim more attention than substantive and procedural principles. Second, in the case of public deliberation, more focus has been placed on factors such as procedural mechanisms than on understanding how individuals and groups value different aspects of health and agree on health-related decisions. Third, the nation needs workable frameworks to guide collective choices about valuable social ends and their trade-offs; purely procedural strategies are limited in illuminating overarching health policy and ethics questions. There is a need to integrate consequential and procedural approaches to health ethics and policy.

Universal Health Insurance Coverage in Vietnam: A Stakeholder Analysis From Policy Proposal (1989) to Implementation (2014).

PubMed

Hoang, Chi K; Hill, Peter; Nguyen, Huong T

In 1989, health insurance (HI) was introduced in Vietnam and began to be implemented in 1992. There was limited progress until the 2014 Law on HI that was revised with the aim of universal health insurance coverage (UHIC) by 2020. This article explores stakeholder roles and positions from the initial introduction of HI to the implementation of the Master Plan accelerating UHIC. To better understand the influence of stakeholders in accelerating UHIC to achieve equity in health care. Using a qualitative study design, we conducted content analysis of HI-related documents and interviewed social security and health system key informants, government representatives, and community stakeholders to determine their positions and influence on UHIC. Our findings demonstrate different levels of support of stakeholders that influence in the HI formulation and implementation, from opposition when HI was first introduced in 1989 to collaboration of stakeholders from 2013 when the Master Plan for UHIC was implemented. Despite an initial failure to secure the support of the Parliament for a Law on HI, a subsequent series of alternative legislative strategies brought limited increases in HI coverage. With government financial subsidization, the involvement of multiple stakeholders, political commitment, and flexible working mechanisms among stakeholders have remained important, with an increasing recognition that HI is not only a technical aspect of the health system but also a broader socioeconomic and governance issue. The different levels of power and influence among stakeholders, together with their commercial and political interests and their different perceptions of HI, have influenced stakeholders' support or opposition to HI policies. Despite high-level policy support, stakeholders' positions may vary, depending on their perceptions of the policy implications. A shift in government stakeholder positions, especially at the provincial level, has been necessary to accelerate

Policy silences: why Canada needs a National First Nations, Inuit and Métis health policy.

PubMed

Lavoie, Josée G

2013-12-27

Despite attempts, policy silences continue to create barriers to addressing the healthcare needs of First Nations, Inuit and Métis. The purpose of this article is to answer the question, if what we have in Canada is an Aboriginal health policy patchwork that fails to address inequities, then what would a Healthy Aboriginal Health Policy framework look like? The data collected included federal, provincial and territorial health policies and legislation that contain Aboriginal, First Nation, Inuit and/or Métis-specific provisions available on the internet. Key websites included the Parliamentary Library, federal, provincial and territorial health and Aboriginal websites, as well as the Department of Justice Canada, Statistics Canada and the Aboriginal Canada Portal. The Indian Act gives the Governor in Council the authority to make health regulations. The First Nations and Inuit Health Branch (FNIHB) of Health Canada historically provided health services to First Nations and Inuit, as a matter of policy. FNIHB's policies are few, and apply only to Status Indians and Inuit. Health legislation in 2 territories and 4 provinces contain no provision to clarify their responsibilities. In provinces where provisions exist, they broadly focus on jurisdiction. Few Aboriginal-specific policies and policy frameworks exist. Generally, these apply to some Aboriginal peoples and exclude others. Although some Aboriginal-specific provisions exist in some legislation, and some policies are in place, significant gaps and jurisdictional ambiguities remain. This policy patchwork perpetuates confusion. A national First Nation, Inuit and Métis policy framework is needed to address this issue.

Effects of Targeted Subsidies Policy on Health Behavior in Iranian Households: A Qualitative Study

PubMed Central

DOSHMANGIR, Leila; DOSHMANGIR, Parinaz; ABOLHASSANI, Nazanin; MOSHIRI, Esmaeil; JAFARI, Mehdi

2015-01-01

Background: This study aimed to explore the effects of national targeted subsidies policy on health behavior of Iranian households. Methods: In this qualitative study, data were collected between January 2012 and December 2013 through face-to-face interviews (23 experts in national and provincial levels of health system and 18 household heads) and through a comprehensive and purposive document analysis. The data was analyzed using a thematic analysis method (inductive-deductive) and assisted by Atlas-ti software. Results: Rising health care costs, removing some food subsidies and the increase in price of most goods and services due to the implementation of economic policy of targeted subsidies have led to significant changes in the demand for health services, changes in the consumption trends of goods and services affecting health as well as changes in the health habits of households. Conclusion: Targeted subsidies and the cash subsidy policy have some negative effects on population health behavior especially among poor people. Hence, maintaining or increasing the cash subsidy is not an efficient allocation of resources toward health care system. So, it is necessary to identify appropriate strategies and policies and apply interventions in order to moderate negative effects and enhance positive effects resulted from implementing this economic reform on population health behavior. PMID:26056676

Understanding the Research–Policy Divide for Oral Health Inequality

PubMed Central

Bell, Erica; Crocombe, Leonard; Campbell, Steven; Goldberg, Lynette R.; Seidel, Bastian M.

2014-01-01

Background: No studies exist of the congruence of research in oral health to policy. This study aimed to examine the broad congruence of oral health research to policy, and implications for developing oral health research that is more policy relevant, particularly for the wider challenge of addressing unequal oral health outcomes, rather than specific policy translation issues. Methods: Bayesian-based software was used in a multi-layered method to compare the conceptual content of 127,193 oral health research abstracts published between 2000–2012 with eight current oral health policy documents from Organisation for Economic Co-operation and Development countries. Findings: Fifty-five concepts defined the research abstracts, of which only eight were policy-relevant, and six of which were minor research concepts. Conclusions The degree of disconnection between clinical concepts and healthcare system and workforce development concepts was striking. This study shows that, far from being “lost in translation,” oral health research and policy are so different as to raise doubts about the extent to which research is policy-relevant and policy is research-based. The notion of policy relevance encompasses the lack of willingness of policy makers to embrace research, and the need for researchers to develop research that is, and is seen to be, policy-relevant. PMID:25617516

An analysis of Liberia's 2007 national health policy: lessons for health systems strengthening and chronic disease care in poor, post-conflict countries

PubMed Central

2011-01-01

Background Globally, chronic diseases are responsible for an enormous burden of deaths, disability, and economic loss, yet little is known about the optimal health sector response to chronic diseases in poor, post-conflict countries. Liberia's experience in strengthening health systems and health financing overall, and addressing HIV/AIDS and mental health in particular, provides a relevant case study for international stakeholders and policymakers in other poor, post-conflict countries seeking to understand and prioritize the global response to chronic diseases. Methods We conducted a historical review of Liberia's post-conflict policies and their impact on general economic and health indicators, as well as on health systems strengthening and chronic disease care and treatment. Key sources included primary documents from Liberia's Ministry of Health and Social Welfare, published and gray literature, and personal communications from key stakeholders engaged in Liberia's Health Sector Reform. In this case study, we examine the early reconstruction of Liberia's health care system from the end of conflict in 2003 to the present time, highlight challenges and lessons learned from this initial experience, and describe future directions for health systems strengthening and chronic disease care and treatment in Liberia. Results Six key lessons emerge from this analysis: (i) the 2007 National Health Policy's 'one size fits all' approach met aggregate planning targets but resulted in significant gaps and inefficiencies throughout the system; (ii) the innovative Health Sector Pool Fund proved to be an effective financing mechanism to recruit and align health actors with the 2007 National Health Policy; (iii) a substantial rural health delivery gap remains, but it could be bridged with a robust cadre of community health workers integrated into the primary health care system; (iv) effective strategies for HIV/AIDS care in other settings should be validated in Liberia and

Relevance of gender-sensitive policies and general health indicators to compare the status of South Asian women's health.

PubMed

Gill, Roopan; Stewart, Donna E

2011-01-01

despite goals for gender equity in South Asia, the relationship between gender-sensitive policies and the empowerment of women is complex and requires an analysis of how policies align with a broad set of social, cultural, political, and economic indicators that relate to women's health. through a review of four documents under the umbrella of the World Health Organization and the United Nations, a list of 17 gender-sensitive policy and 17 general health indicators was generated with a focus on health, education, economic, and political empowerment and violence against women. A series of policy documents and international and national databases that are accessible in the public domain were the major tools used to find supporting documentation to address women's health outcomes in Bangladesh, India, Nepal, Pakistan, and Sri Lanka. all five South Asian countries had several gender-sensitive policies that were measurable by indicators that contribute to health. Examination of political and economic status, birth sex ratios, human trafficking, illiteracy rates, maternal mortality rates, contraception prevalence, fertility rates, knowledge of HIV/AIDS prevention, access to skilled birth attendants, and microfinance show that large gender inequities still prevail despite the presence of gender-sensitive policies. in many cases, the presence of gender-sensitive policies did not reflect the realization of gender equity over a wide range of indicators. Although the economic, political, social, and cultural climates of the five countries may differ, the integration of women's needs into the formulation, implementation, and monitoring of policies is a universal necessity to achieve positive outcomes. 2011 Jacobs Institute of Women's Health. Published by Elsevier Inc.

Development of evidence-based health policy documents in developing countries: a case of Iran.

PubMed

Imani-Nasab, Mohammad Hasan; Seyedin, Hesam; Majdzadeh, Reza; Yazdizadeh, Bahareh; Salehi, Masoud

2014-02-07

Evidence-based policy documents that are well developed by senior civil servants and are timely available can reduce the barriers to evidence utilization by health policy makers. This study examined the barriers and facilitators in developing evidence-based health policy documents from the perspective of their producers in a developing country. In a qualitative study with a framework analysis approach, we conducted semi-structured interviews using purposive and snowball sampling. A qualitative analysis software (MAXQDA-10) was used to apply the codes and manage the data. This study was theory-based and the results were compared to exploratory studies about the factors influencing evidence-based health policy-making. 18 codes and three main themes of behavioral, normative, and control beliefs were identified. Factors that influence the development of evidence-based policy documents were identified by the participants: behavioral beliefs included quality of policy documents, use of resources, knowledge and innovation, being time-consuming and contextualization; normative beliefs included policy authorities, policymakers, policy administrators, and co-workers; and control beliefs included recruitment policy, performance management, empowerment, management stability, physical environment, access to evidence, policy making process, and effect of other factors. Most of the cited barriers to the development of evidence-based policy were related to control beliefs, i.e. barriers at the organizational and health system levels. This study identified the factors that influence the development of evidence-based policy documents based on the components of the theory of planned behavior. But in exploratory studies on evidence utilization by health policymakers, the identified factors were only related to control behaviors. This suggests that the theoretical approach may be preferable to the exploratory approach in identifying the barriers and facilitators of a behavior.

Health impact assessment of agriculture and food policies: lessons learnt from the Republic of Slovenia.

PubMed

Lock, Karen; Gabrijelcic-Blenkus, Mojca; Martuzzi, Marco; Otorepec, Peter; Wallace, Paul; Dora, Carlos; Robertson, Aileen; Zakotnic, Jozica Maucec

2003-01-01

The most important public health priority in agricultural policy-making is currently food safety, despite the relatively higher importance of food security, nutrition, and other agricultural-related health issues in terms of global burden of disease. There is limited experience worldwide of using health impact assessment (HIA) during the development of agriculture and food policies, which perhaps reflects the complex nature of this policy sector. This paper presents methods of HIA used in the Republic of Slovenia, which is conducting a HIA of proposed agricultural and food policies due to its accession to the European Union. It is the first time that any government has attempted to assess the health effects of agricultural policy at a national level. The HIA has basically followed a six-stage process: policy analysis; rapid appraisal workshops with stakeholders from a range of backgrounds; review of research evidence relevant to the agricultural policy; analysis of Slovenian data for key health-related indicators; a report on the findings to a key cross-government group; and evaluation. The experience in Slovenia shows that the HIA process has been a useful mechanism for raising broader public health issues on the agricultural policy agenda, and it has already had positive results for policy formation. HIA is one useful approach to more integrated policy-making across sectors, but clearly it is not the only mechanism to achieve this. A comparison of the approach used in Slovenia with HIA methods in other countries and policy contexts shows that there are still many limitations with HIA application at a government level. Lessons can be learnt from these case studies for future development and application of HIA that is more relevant to policy-makers, and assists them in making more healthy policy choices.

Health impact assessment of agriculture and food policies: lessons learnt from the Republic of Slovenia.

PubMed Central

Lock, Karen; Gabrijelcic-Blenkus, Mojca; Martuzzi, Marco; Otorepec, Peter; Wallace, Paul; Dora, Carlos; Robertson, Aileen; Zakotnic, Jozica Maucec

2003-01-01

The most important public health priority in agricultural policy-making is currently food safety, despite the relatively higher importance of food security, nutrition, and other agricultural-related health issues in terms of global burden of disease. There is limited experience worldwide of using health impact assessment (HIA) during the development of agriculture and food policies, which perhaps reflects the complex nature of this policy sector. This paper presents methods of HIA used in the Republic of Slovenia, which is conducting a HIA of proposed agricultural and food policies due to its accession to the European Union. It is the first time that any government has attempted to assess the health effects of agricultural policy at a national level. The HIA has basically followed a six-stage process: policy analysis; rapid appraisal workshops with stakeholders from a range of backgrounds; review of research evidence relevant to the agricultural policy; analysis of Slovenian data for key health-related indicators; a report on the findings to a key cross-government group; and evaluation. The experience in Slovenia shows that the HIA process has been a useful mechanism for raising broader public health issues on the agricultural policy agenda, and it has already had positive results for policy formation. HIA is one useful approach to more integrated policy-making across sectors, but clearly it is not the only mechanism to achieve this. A comparison of the approach used in Slovenia with HIA methods in other countries and policy contexts shows that there are still many limitations with HIA application at a government level. Lessons can be learnt from these case studies for future development and application of HIA that is more relevant to policy-makers, and assists them in making more healthy policy choices. PMID:12894321

Pathways of undue influence in health policy-making: a main actor's perspective.