Revisiting the nexus between economic growth and environment health: an empirical study on 180 nations

Sustainability is considered to be one of the biggest issues in the current time. This study aims to understand the role of sustainability further by revisiting the much-debated and intricate relationship between economic growth and environmental performance and to provide guidance to policymakers. Using a large sample of data from 180 countries over the period from 2002 to 2017 a measure that captures the various aspects of environmental performance, the study performs a test of the Environmental Kuznets Curve (EKC) hypothesis, which defines the relationship between economic growth and environmental deterioration. Controlling for several associated macroeconomic and governance variables, the results suggest that for certain regions, viz. Asia, Eastern Europe, and North America, higher economic growth, as proxied by per capita GDP, has a negative association with environmental performance (measured by Environmental Performance Indices, EPI), indicating that the former may prove detrimental to the later. The results suggest a unidirectional relationship between the two variables and are also robust to endogeneity concerns that are often emphasized in the EKC literature. The study documents similar results for lower-income and lower-middle-income countries. Interestingly, the authors also find that small-sized governments in developing nations have a positive association with environmental performance.

Losing the Public, for Better or for Worse: A Lesson from John Everett Gordon (1890-1983) and John Rodman Paul (1893-1971)

The Covid-19 pandemic has laid bare a tension around scientific expertise that has major implications for the effectiveness of health systems. Critical engagement with this tension, however, is largely missing from the lessons and programs consolidating in the wake of the emergency. Lacking good frameworks for discussing the tension, the vague term "public trust" has proliferated into a buzzword that stands in for more articulate discussion. The tension between experts and the public is not new, however. It is useful to look back to the 1930s, when health experts identifying as "new epidemiologists" imagined a new modern science of epidemiology that, some believed, would resolve evident failures in public cooperation. Historical analysis of different approaches to the production and use of epidemiological knowledge in these years reveals a debate about power at the heart of epidemiology, and a critical framework for discussing the tension around epidemiological expertise in public health.

Organising for One Health in a developing country

Globally, zoonotic diseases pose an enormous and growing public health challenge, and developing countries like India are at the epicentre of it. Although there is general recognition of this reality, governments around the world have struggled to organise appropriately to respond to it. The widely held view is that organising for One Health requires effective cross-sectoral collaboration, but the prerequisites to enable such collaboration appear almost unattainable. Perhaps an entirely different approach is needed, which is over and above effective collaborations between competing government ministries. The approach would have to recognise that while any organisational response will need to be able to address identified zoonotic diseases and respond effectively to them in times of crises, it would also be required to have the ability to shape the response to megatrends such as climate change, deforestation, and the underlying development models of the country. The paper analyses the success and failures associated with the way in which India, Bangladesh, Kenya, and Rwanda have organised for One Health. It also studies the underlying pathways through which zoonotic spillovers take place, and epidemics gather momentum. Based on these critical analyses, the paper concludes that attempts to build single overarching units to address these challenges have only been partially effective. Given the scale and complexity of the challenge, it recommends that, even at the risk of duplication and the very real possibility that unaddressed gaps will remain, an approach, which builds multiple sharply focused units, would have a greater chance of success.

Having a real say: findings from first nations community panels on pandemic influenza vaccine distribution

BACKGROUND

Recent deliberations by Australian public health researchers and practitioners produced an ethical framework of how decisions should be made to distribute pandemic influenza vaccine. The outcome of the deliberations was that the population should be considered in two categories, Level 1 and Level 2, with Level 1 groups being offered access to the pandemic influenza vaccine before other groups. However, the public health researchers and practitioners recognised the importance of making space for public opinion and sought to understand citizens values and preferences, especially First Nations peoples.

METHODS

We conducted First Nations Community Panels in two Australian locations in 2019 to assess First Nations people's informed views through a deliberative process on pandemic influenza vaccination distribution strategies. Panels were asked to make decisions on priority levels, coverage and vaccine doses.

RESULTS

Two panels were conducted with eighteen First Nations participants from a range of ages who were purposively recruited through local community networks. Panels heard presentations from public health experts, cross-examined expert presenters and deliberated on the issues. Both panels agreed that First Nations peoples be assigned Level 1 priority, be offered pandemic influenza vaccination before other groups, and be offered two doses of vaccine. Reasons for this decision included First Nations people's lives, culture and families are important; are at-risk of severe health outcomes; and experience barriers and challenges to accessing safe, quality and culturally appropriate healthcare. We found that communication strategies, utilising and upskilling the First Nations health workforce, and targeted vaccination strategies are important elements in pandemic preparedness and response with First Nations peoples.

CONCLUSIONS

First Nations Community Panels supported prioritising First Nations peoples for pandemic influenza vaccination distribution and offering greater protection by using a two-dose full course to fewer people if there are initial supply limitations, instead of one dose to more people, during the initial phase of the vaccine roll out. The methodology and findings can help inform efforts in planning for future pandemic vaccination strategies for First Nations peoples in Australia.

Association between quality of governance, antibiotic consumption, and antimicrobial resistance: an analysis of Italian regions

BACKGROUND

Emerging research has provided evidence suggesting the potential influence of governance on the development and spread of antimicrobial resistance (AMR), accounting for significant disparities observed both between and within countries. In our study, we conducted an ecological analysis to investigate the relationship between governance quality, antibiotic consumption, and AMR across Italian regions.

METHODS

By leveraging data from three distinct sources at the regional level, we compiled a comprehensive dataset comprising: AMR proportions for three specific pathogen-antibiotic combinations in the year 2021, antibiotic consumption data for systemic use in the year 2020, and the 2021 European Quality of Government Index (EQI) and its corresponding pillars. Employing mediation analysis, we investigated the potential mediating role of antibiotic consumption in the association between the EQI and an average measure of AMR.

RESULTS

Our analysis revealed substantial variation in the percentages of AMR across different regions in Italy, demonstrating a discernible North-to-South gradient concerning both antibiotic usage and governance quality. The EQI exhibited a statistically significant negative correlation with both antibiotic consumption and AMR percentages, encompassing both specific combinations and their average value. Regions characterized by higher levels of governance quality consistently displayed lower values of antibiotic consumption and AMR, while regions with lower governance quality tended to exhibit higher levels of antibiotic use and AMR. Furthermore, we observed a significant total effect of the EQI on average AMR (β = - 0.97; CI - 1.51; - 0.43). Notably, this effect was found to be mediated by antibiotic consumption, as evidenced by a significant indirect effect (β = - 0.89; CI - 1.45; - 0.32).

CONCLUSIONS

These findings draw attention to the regional disparities observed in AMR levels, antibiotic consumption patterns, and governance quality in Italy. Our study also highlights the mediating role of antibiotic consumption in the relationship between governance quality and AMR. This underscores the significance of implementing focused interventions and policies aimed at improving governance quality and promoting responsible antibiotic use.

A global perspective on the governance-health nexus

BACKGROUND

This study raises two key arguments: First, government health expenditure (GHE) and per capita out-of-pocket expenditures on healthcare (OPEH) are sensitive to contemporary good governance practices, giving policy importance to the exogeneity of healthcare determinants, i.e., governance for health rather than health governance. Second, it is the income level of countries that reflects the volatility of the governance spillovers on the subject.

METHODS

The present study constructs a composite governance index (CGI) and employs a set of panel data for 144 countries over the period from 2002 to 2020. To allow comparability and extract specific policy implications, the countries are classified as full, high-, middle-, and low-income panels. Meanwhile to delve into the short- and long-run effects of CGI on GHE and OPEH, the study employs the cross-sectionally augmented autoregressive distributed lags (CS-ARDL) model. Further, to establish a causal link between the variables, it uses the Dumitrescu-Hurlin panel causality technique.

RESULTS

The results indicate that CGI is significantly cointegrated with GHE and OPEH in all recipient panels. It indicates that while CGI has significantly positive impacts on GHE and OPEH, its effects vary according to the income level of the underlying economies. The findings support the idea of governance for health and show that CGI drives the stabilization and enhancement of GHE and OPEH in the long run. Furthermore, the findings reveal that economic growth, the age dependency ratio, and tax revenue have positive effects, while the crude death rate and the child mortality rate exert negative impacts on the subject. Finally, the results highlight a unidirectional causality running from CGI to GHE and OPEH, while no feedback response is evident.

CONCLUSIONS

Although an increase in GHE and OPEH is associated with the improvement of the population's healthcare, the results suggest the recognition of the importance and institutionalization of good governance to streamline this improvement through effective channelization, outreach, and social environment development for extensive health inclusion.

How to Build Healthy Societies: A Thematic Analysis of Relevant Conceptual Frameworks

BACKGROUND

As the Sustainable Development Goals deadline of 2030 draws near, greater attention is being given to health beyond the health sector, in other words, to the creation of healthy societies. However, action and reform in this area has not kept pace, in part due to a focus on narrower interventions and the lack of upstream action on health inequity. With an aim to guide action and political engagement for reform, we conducted a thematic analysis of concepts seeking to arrive at healthy societies.

METHODS

This paper drew on a qualitative thematic analysis of a purposive sample of 68 documents including political declarations, reports, peer reviewed literature and guidance published since 1974. Three independent reviewers extracted data to identify, discuss and critique public policy levers and 'enablers' of healthy societies, the "how."

RESULTS

The first lever concerned regulatory and fiscal measures. The second was intersectoral action. The final lever a shift in the global consensus around what signifies societal transformation and outcomes. The three enablers covered political leadership and accountability, popular mobilization and the generation and use of knowledge.

CONCLUSION

Documents focused largely on technical rather than political solutions. Even as the importance of political leadership was recognized, analysis of power was limited. Rights-based approaches were generally neglected as was assessing what worked or did not work to pull the levers or invest in the enablers. Frameworks typically failed to acknowledge or challenge prevailing ideologies, and did not seek to identify ways to hold or governments or corporations accountable for failures. Finally, ideas and approaches seem to recur again over the decades, without adding further nuance or analysis. This suggests a need for more upstream, critical and radical approaches to achieve healthy societies.

The Experiences of Strategic Purchasing of Healthcare in Nine Middle-Income Countries: A Systematic Qualitative Review

BACKGROUND

Efforts to move towards universal health coverage (UHC) aim to rebalance health financing in ways that increase efficiency, equity, and quality. Resource constraints require a shift from passive to strategic purchasing (SP). In this paper, we report on the experiences of SP in public sector health insurance schemes in nine middle-income countries to understand what extent SP has been established, the challenges and facilitators, and how it is helping countries achieve their UHC goals.

METHODS

We conducted a systematic search to identify papers on SP. Nine countries were selected for case study analysis. We extracted data from 129 articles. We used a common framework to compare the purchasing arrangements and key features in the different schemes. The evidence was synthesised qualitatively.

RESULTS

Five countries had health technology assessment (HTA) units to research what services to buy. Most schemes had reimbursement mechanisms that enabled some degree of cost control. However, we found evidenced-based changes to the reimbursement mechanisms only in Thailand and China. All countries have some form of mechanism for accreditation of health facilities, although there was considerable variation in what is done. All countries had some strategy for monitoring claims, but they vary in complexity and the extent of implementation; three countries have implemented e-claim processing enabling a greater level of monitoring. Only four countries had independent governance structures to provide oversight. We found delayed reimbursement (six countries), failure to provide services in the benefits package (four countries), and high out-of-pocket (OOP) payments in all countries except Thailand and Indonesia, suggesting the schemes were failing their members.

CONCLUSION

We recommend investment in purchaser and research capacity and a focus on strong governance, including regular engagement between the purchaser, provider and citizens, to build trusting relationships to leverage the potential of SP more fully, and expand financial protection and progress towards UHC.

Community participation as a premise for hangwurian city development in North Central Nigeria

The Hangwurian City Development Model evolved to create a linkage within the concepts of environmental awareness, urban governance, and management. Others are sustainable urban development, urban liveability, and inclusive physical development. These were measured from various indicators ranging from population, environmental knowledge, economic prosperity, quality of life, and safety. The research sorts the critical objective of analysing the significant level of the indicator variables'; and determine the predictive relevance of the indicator variables. The exploratory research employed the partial least square using SmartPLS to evaluate the variables, collecting quantitative data through the open data tool kit from three selected cities of Lokoja, Minna, and Lafia in North-Central Nigeria. The research sampled 399 respondents across the cities randomly selected amongst residents aged 18 years and more reliably targeted household heads as the unit of measurement is the household. The research findings show that most of the examined variables have Cronbach's Alpha above 0.7, and most of the retained variables have a significant value of greater or equal to 0.7. The average variance of the indicators where very substantial as most were within the 0.5 to 0.6 band. Most of the evaluated indicators have a significant performance index of between 50 and 65 %. The research recommended that this model be applied as a procedural model to guide city development at a regional scale. Hence, it was concluded that for city development to occur and evolve without ills which Hangwurian city development stands for, it must be viewed from the path linkage and significance of environment, governance, sustainability, liveability, and inclusion.

The impact of agriculture production and renewable energy consumption on CO2 emissions in developing countries: the role of governance

Environmental pollution has aggravated the climate change issues posing unusual challenges to the survival and growth of humanity, including extreme weather, loss of species, and sustainability of the ecosystem in developing countries. Unlike previous studies, this paper adds new dimension to the literature by incorporating corruption into agriculture production-environment nexus. This study adds new dimension to the literature by examining corruption, agriculture, and renewable energy on CO2 emissions. The study therefore examines the effects of governance (corruption) and agriculture production on CO2 emissions in 20 countries in Africa from 1990 to 2019. The study employed recent panel econometric approach which accounts for cross-sectional dependence in the variables. The findings of the fixed effect model and panel dynamic ordinary least squares (PDOLS) show that forest and renewable energy consumption decrease CO2 emissions. However, corruption, agriculture production, export, and urbanization escalate CO2 emissions in African countries covered in the paper. Moreover, the Dumitrescu-Hurlin Granger causality indicates a bidirectional causality between agriculture production and CO2 emissions, renewable energy use, agricultural output, and forest. Also, unidirectional Granger causality runs from corruption to forest and agriculture production. On these premises, consented efforts by governments should be made to support good institutions in order to promote good governance to avert pervasive consequences of corruption on the environment.

Research agenda for using artificial intelligence in health governance: interpretive scoping review and framework

BACKGROUND

The governance of health systems is complex in nature due to several intertwined and multi-dimensional factors contributing to it. Recent challenges of health systems reflect the need for innovative approaches that can minimize adverse consequences of policies. Hence, there is compelling evidence of a distinct outlook on the health ecosystem using artificial intelligence (AI). Therefore, this study aimed to investigate the roles of AI and its applications in health system governance through an interpretive scoping review of current evidence.

METHOD

This study intended to offer a research agenda and framework for the applications of AI in health systems governance. To include shreds of evidence with a greater focus on the application of AI in health governance from different perspectives, we searched the published literature from 2000 to 2023 through PubMed, Scopus, and Web of Science Databases.

RESULTS

Our findings showed that integrating AI capabilities into health systems governance has the potential to influence three cardinal dimensions of health. These include social determinants of health, elements of governance, and health system tasks and goals. AI paves the way for strengthening the health system's governance through various aspects, i.e., intelligence innovations, flexible boundaries, multidimensional analysis, new insights, and cognition modifications to the health ecosystem area.

CONCLUSION

AI is expected to be seen as a tool with new applications and capabilities, with the potential to change each component of governance in the health ecosystem, which can eventually help achieve health-related goals.

The effect of governance structures on optimal control of two-patch epidemic models

Infectious diseases continue to pose a significant threat to the health of humans globally. While the spread of pathogens transcends geographical boundaries, the management of infectious diseases typically occurs within distinct spatial units, determined by geopolitical boundaries. The allocation of management resources within and across regions (the "governance structure") can affect epidemiological outcomes considerably, and policy-makers are often confronted with a choice between applying control measures uniformly or differentially across regions. Here, we investigate the extent to which uniform and non-uniform governance structures affect the costs of an infectious disease outbreak in two-patch systems using an optimal control framework. A uniform policy implements control measures with the same time varying rate functions across both patches, while these measures are allowed to differ between the patches in a non-uniform policy. We compare results from two systems of differential equations representing transmission of cholera and Ebola, respectively, to understand the interplay between transmission mode, governance structure and the optimal control of outbreaks. In our case studies, the governance structure has a meaningful impact on the allocation of resources and burden of cases, although the difference in total costs is minimal. Understanding how governance structure affects both the optimal control functions and epidemiological outcomes is crucial for the effective management of infectious diseases going forward.

Deforestation, certification, and transnational palm oil supply chains: Linking Guatemala to global consumer markets

Although causal links between tropical deforestation and palm oil are well established, linking this land use change to where the palm oil is actually consumed remains a distinct challenge and research gap. Supply chains are notoriously difficult to track back to their origin (i.e., the 'first-mile'). This poses a conundrum for corporations and governments alike as they commit to deforestation-free sourcing and turn to instruments like certification to increase supply chain transparency and sustainability. The Roundtable on Sustainable Palm Oil (RSPO) offers the most influential certification system in the sector, but whether it actually reduces deforestation is still unclear. This study used remote sensing and spatial analysis to assess the deforestation (2009-2019) caused by oil palm plantation expansion in Guatemala, a major palm oil source for international consumer markets. Our results reveal that plantations are responsible for 28% of deforestation in the region and that more than 60% of these plantations encroach on Key Biodiversity Areas. RSPO-certified plantations, comprising 63% of the total cultivated area assessed, did not produce a statistically significant reduction in deforestation. Using trade statistics, the study linked this deforestation to the palm oil supply chains of three transnational conglomerates - Pepsico, Mondelēz International, and Grupo Bimbo - all of whom rely on RSPO-certified supplies. Addressing this deforestation and supply chain sustainability challenge hinges on three measures: 1) reform of RSPO policies and practices; 2) robust corporate tracking of supply chains; and 3) strengthening forest governance in Guatemala. This study offers a replicable methodology for a wide-range of investigations that seek to understand the transnational linkages between environmental change (e.g. deforestation) and consumption.

Climate change and public health in South America: a scoping review of governance and public engagement research

This scoping review examines peer-reviewed literature of governance and public engagement at the intersection of public health and climate change in South America. The review shows significant gaps in academic publications, particularly because health was mostly a secondary theme examined in the studies. The few studies about governmental interventions (e.g., policies and programs) suggest that these have not been effective. Regarding public engagement, no studies examined social media engagement with health and climate change, and only one examined news coverage. Finally, most articles focused primarily on individual countries, with few comparative or regional analyses of South America. Strategic action addressing climate change and its effects on public health needs to be based on empirical evidence.

Quantifying the advantages and acceptability of linking dialysis machines to an electronic medical record

AIM

To establish and quantify the time saved by redirecting nursing workload from recording and entering haemodynamic data during chronic dialysis sessions by linking dialysis machines directly to the electronic medical record.

METHODS

We developed a bespoke interface from the HL7 feed from the dialysis machines (largely Fresenius 5008) to our EMR system (Cerner). We quantified the time nurses spent with the patient, computer, dialysis machine and sorting our patient related issues by observation using independent observers in a time and motion study. We performed these observations before and after implementation of the computer interface. We established patient and nursing acceptance by survey. We established adequacy of observations by counting the number of patients who received the minimum number of observations recorded in the system before and after implementation.

RESULTS

Implementation of a dialysis machine direct EMR interface reduced the time the nurses spent with the computer significantly by ∼9 % (around 28 min, p < 0.05) per dialysis shift, and this was accompanied by a similar increase in time spent sorting out patient-related issues. The interface was well accepted by staff and patients. An immediate benefit was a ∼60 % improvement in the adequacy of recording vital signs in our dialysis patients. Then simply by showing these results to the nursing staff there was further improvement.

CONCLUSIONS

In these days of machine interconnectivity there is really no good reason why dialysis nurses should be used to transfer data between machines. It is far better to utilise their skills in helping patients with their medical issues. We have shown that such a link improves efficiency, patient and staff satisfaction and dialysis governance.

Promise and peril: how health system reforms impacted public health in three Canadian provinces

OBJECTIVES

Several Canadian provinces and territories have reformed their health systems by centralizing power, resources, and responsibilities. Our study explored motivating factors and perceived impacts of centralization reforms on public health systems and essential operations.

METHODS

A multiple case study design was used to examine three Canadian provinces that have undergone, or are in the process of undergoing, health system reform. Semi-structured interviews were conducted with 58 participants within public health at strategic and operational levels, from Alberta, Ontario, and Québec. Data were analyzed using a thematic analytical approach to iteratively conceptualize and refine themes.

RESULTS

Three major themes were developed to describe the context and impacts of health system centralization reforms on public health: (1) promising "value for money" and consolidating authority; (2) impacting intersectoral and community-level collaboration; and (3) deprioritizing public health operations and contributing to workforce precarity. Centralization highlighted concerns about the prioritization of healthcare sectors. Some core public health functions were reported to operate more efficiently, with less duplication of services, and improvements in program consistency and quality, particularly in Alberta. Reforms were also reported to have diverted funding and human resources away from core essential functions, and diminished the public health workforce.

CONCLUSION

Our study highlighted that stakeholder priorities and a limited understanding about public health systems influenced how reforms were implemented. Our findings support calls for modernized and inclusive governance, stable public health funding, and investment in the public health workforce, which may help inform future reforms.

Corporate Engagement Strategies in Northern Mining: Boliden, Sweden and Cameco, Canada

The role of corporations in societal outcomes continues to grow. Mining companies now face the expectation of not only providing economic benefits to communities, but act as a facilitator for social wellbeing and environmental stewardship. In the mining sector, this has placed renewed attention to defining corporate social responsibility and, in turn, how social license to operate is understood. These developments are particularly pertinent when mining operations affect Indigenous communities - where land use is central to livelihood. This study looks at the community engagement strategies of two mining companies in northern countries, Cameco (Canada) and Boliden (Sweden). By comparing their approaches, this paper explores the development of their practices over time and assess to what extent their corporate policy has translated into everyday practice and outcomes. The findings of demonstrate that high levels of trust are established when corporate approaches are built around transparency and collaboration - resulting in agreements that include long-term partnerships around socio-economic and environmental management.

The effect of institutional quality on agricultural value added in East Africa

This study investigates the effect of institutional quality on agricultural value added in East Africa. It uses a panel dataset spanning from 2000 to 2020, taken from seven East African countries. The data obtained from the World Bank, Mo Ibrahim Foundation, and FAO databases were analyzed using the bias-corrected LSDV model. The results show that voice and accountability has a negative significant effect on regional agricultural value-added, while government effectiveness has a positive significant effect on regional agricultural value-added. Besides, higher per capita gross domestic product, a lower proportion of rural population, and a higher proportion of education expenditure appeared to have significant incremental effects on agricultural value-added. The results imply that institutional quality has a vital role in dictating the growth of agricultural value-added in East Africa. In this region, effective institutions increase agricultural value-added. Governments and other development practitioners should thus work to enhance the effectiveness of the related institutions in the region. Strengthening and improving the performance of such institutions is essential for a sustained increase in agricultural value-added. This would be more operational if combined with increased expenditure in education and the low size of the rural population.

Stakeholder Involvement in the Governance of Human Genome Editing in Japan

Genome editing is a technology that can accurately and efficiently modify the genome of organisms, including the human genome. Although human genome editing (HGE) has many benefits, it also involves technical risks and ethical, legal, and social issues. Thus, the pros and cons of using this technology have been actively debated since 2015. Notably, the research community has taken an interest in the issue and has discussed it internationally. However, for the governance of HGE, the roles of government agencies and the general public are also important for an effective regulatory system. Here, we examine the roles of the research community, government, and public in the governance of HGE through an analysis of discussions in the Japanese Expert Panel on Bioethics. During the discussion of the research ethics review system, the professionalism of the research community and the pros and cons of state oversight have become issues for debate. Furthermore, through an examination of the overall policy-making process, three stakeholders are clearly involved in the governance of emerging medical technologies in the Expert Panel on Bioethics, a discussion forum established by government agencies. The contrast among these roles provides insight into the positive roles of government agencies and the research community and the conditions under which these roles are played. We also note that there are diverse actors in the public, which may have an impact on their participation. Our results may serve as a guide for countries and organizations to establish governance on emerging medical technologies.

Researching the future: scenarios to explore the future of human genome editing

BACKGROUND

Forward-looking, democratically oriented governance is needed to ensure that human genome editing serves rather than undercuts public values. Scientific, policy, and ethics communities have recognized this necessity but have demonstrated limited understanding of how to fulfill it. The field of bioethics has long attempted to grapple with the unintended consequences of emerging technologies, but too often such foresight has lacked adequate scientific grounding, overemphasized regulation to the exclusion of examining underlying values, and failed to adequately engage the public.

METHODS

This research investigates the application of scenario planning, a tool developed in the high-stakes, uncertainty-ridden world of corporate strategy, for the equally high-stakes and uncertain world of the governance of emerging technologies. The scenario planning methodology is non-predictive, looking instead at a spread of plausible futures which diverge in their implications for different communities' needs, cares, and desires.

RESULTS

In this article we share how the scenario development process can further understandings of the complex and dynamic systems which generate and shape new biomedical technologies and provide opportunities to re-examine and re-think questions of governance, ethics and values. We detail the results of a year-long scenario planning study that engaged experts from the biological sciences, bioethics, social sciences, law, policy, private industry, and civic organizations to articulate alternative futures of human genome editing.

CONCLUSIONS

Through sharing and critiquing our methodological approach and results of this study, we advance understandings of anticipatory methods deployed in bioethics, demonstrating how this approach provides unique insights and helps to derive better research questions and policy strategies.

Registering transparency: the making of the international clinical trial registry platform by the world health organization (2004-2006)

BACKGROUND

This paper examines the events and conditions that led to the creation of the International Clinical Trials Registry Platform (ICTRP) in 2006 by the World Health Organization (WHO), and how the WHO addressed the issue of transparency in global pharmaceutical research. Using historical textual analysis, I trace the scientific debates that advocated for the establishment of official clinical trial registries in medical journals, and the sequence of actions following the GSK Paxil scandal in 2004, identifying the major ethical and scientific arguments that led to the involvement of the WHO as a key actor in trial registration in the context of the Big Pharma business model.

RESULTS

Through the questions "Why register?" and "Why registries?" as a roadmap, I examine the issues of publication bias and selective reporting by the industry, scrutinizing two ways in which the practice of publication bias damaged transparency in industry-sponsored research. The first involved ethical concerns regarding human subject exploitation and concealing of negative results. The second addresses the deterioration of the certainty of evidence due to incomplete access to trials results. By reviewing the series of events that occurred between 2004 and 2006 -between the Paxil scandal and the launch of the ICTRP-, I analyze the actions taken by the different actors involved: (1) the International Committee of Medical Journal Editors (ICMJE) and the creation of the Ottawa Group; (2) the WHO, beginning with the Ministerial Summit on Health Research held in November of 2004, and (3) the responses of the pharmaceutical industry and specifically GSK to the call for transparency and trial registration.

CONCLUSIONS

The history of trial registration through the ICTRP as a dataveillance apparatus shows the difficulty of regulating a health enterprise turned into a global business. Moreover, it shows the challenges of globalization and how easier and faster it is to globalize business compared to good practices, raising the question of why it has been so hard to undo these trends. Indeed, the history of the movement for trial registration is not a history of regulation success, or at least not yet.

Equilibrium in the governance of cross-sectoral policies: how does it translate into practice?

BACKGROUND

There is growing interest from health researchers in the governance of Health in All Policies (HiAP). Furthermore, the COVID-19 pandemic has re-ignited managers' interest in HiAP governance and in health prevention activities that involve actors from outside health ministries. Since the dynamics of these multi-actor, multi-sectoral policies are complex, the use of systems theory is a promising avenue toward understanding and improving HiAP governance. We focus on the concept of equilibrium within systems theory, especially as it points to the need to strike a balance between actors that goes beyond synergies or mimicry-a balance that is essential to HiAP governance.

METHOD

We mobilized two sources of data to understand how the concept of equilibrium applies to HiAP governance. First, we reviewed the literature on existing frameworks for collaborative governance, both in general and for HiAP specifically, in order to extract equilibrium-related elements. Second, we conducted an in-depth case study over three years of an HiAP implemented in Quebec, Canada.

RESULTS

In total, we identified 12 equilibrium-related elements relevant to HiAP governance and related to knowledge, actors, learning, mindsets, sustainability, principles, coordination, funding and roles. The equilibria were both operational and conceptual in nature.

CONCLUSIONS

We conclude that policy makers and policy implementers could benefit from mobilizing these 12 equilibrium-related elements to enhance HiAP governance. Evaluators of HiAP may also want to consider and integrate them into their governance assessments.

Community-driven governance of FAIRness assessment: an open issue, an open discussion

Although FAIR Research Data Principles are targeted at and implemented by different communities, research disciplines, and research stakeholders (data stewards, curators, etc.), there is no conclusive way to determine the level of FAIRness intended or required to make research artefacts (including, but not limited to, research data) Findable, Accessible, Interoperable, and Reusable. The FAIR Principles cover all types of digital objects, metadata, and infrastructures. However, they focus their narrative on data features that support their reusability. FAIR defines principles, not standards, and therefore they do not propose a mechanism to achieve the behaviours they describe in an attempt to be technology/implementation neutral. Various FAIR assessment metrics and tools have been designed to measure FAIRness. Unfortunately, the same digital objects assessed by different tools often exhibit widely different outcomes because of these independent interpretations of FAIR. This results in confusion among the publishers, the funders, and the users of digital research objects. Moreover, in the absence of a standard and transparent definition of what constitutes FAIR behaviours, there is a temptation to define existing approaches as being FAIR-compliant rather than having FAIR define the expected behaviours. This whitepaper identifies three high-level stakeholder categories -FAIR decision and policymakers, FAIR custodians, and FAIR practitioners - and provides examples outlining specific stakeholders' (hypothetical but anticipated) needs. It also examines possible models for governance based on the existing peer efforts, standardisation bodies, and other ways to acknowledge specifications and potential benefits. This whitepaper can serve as a starting point to foster an open discussion around FAIRness governance and the mechanism(s) that could be used to implement it, to be trusted, broadly representative, appropriately scoped, and sustainable. We invite engagement in this conversation in an open Google Group fair-assessment-governance@googlegroups.com.

Recommitting to AACP Engaged Governance for the Common Good: Report of the 50th Anniversary Commission to Reimagine the AACP House of Delegates

The 50th Anniversary Commission to Reimagine the American Association of Colleges of Pharmacy (AACP) House of Delegates (HOD Commission) was charged to consider and recommend changes to the AACP Board of Directors and AACP HOD regarding a broad range of issues related to the HOD. The 2021-2022 HOD Commission met virtually many times throughout the year as 2 sub-groups and a full commission, using Basecamp for shared documents and timelines, and it provided interim reports to the Board of Directors in November and February. A survey of 2022 delegates was developed and administered; responses from 163 delegates informed final recommendations as described in the report. The HOD Commission affirms the need for and purpose of AACP's HOD and urges that all schools/colleges of pharmacy recommit to engaged governance for the common good.

Piercing the veil on the functioning and effectiveness of district health system governance structures: perspectives from a South African province

BACKGROUND

Leadership and governance are critical for achieving universal health coverage (UHC). In South Africa, aspirations for UHC are expressed through the proposed National Health Insurance (NHI) system, which underscores the importance of primary health care, delivered through the district health system (DHS). Consequently, the aim of this study was to determine the existence of legislated District Health Councils (DHCs) in Gauteng Province (GP), and the perceptions of council members on the functioning and effectiveness of these structures.

METHODS

This was a mixed-methods, cross-sectional study in GP's five districts. The population of interest was members of existing governance structures who completed an electronic-self-administered questionnaire (SAQ). Using a seven-point Likert scale, the SAQ focuses on members' perceptions on the functioning and effectiveness of the governance structures. In-depth interviews with the chairpersons of the DHCs and its technical committees complemented the survey. STATA® 13 and thematic analysis were used to analyze the survey data and interviews respectively.

RESULTS

Only three districts had constituted DHCs. The survey response rate was 73%. The mean score for perceived functioning of the structures was 4.5 (SD = 0.7) and 4.8. (SD = 0.7) for perceived effectiveness. The interviews found that a collaborative district health development approach facilitated governance. In contrast, fraught inter-governmental relations fueled by the complexity of governing across two spheres of government, political differences, and contestations over limited resources constrained DHS governance. Both the survey and interviews identified gaps in accountability to communities.

CONCLUSION

In light of South Africa's move toward NHI, strengthening DHS governance is imperative. The governance gaps identified need to be addressed to ensure support for the implementation of UHC reforms.

Health system governance assessment in protracted crisis settings: Northwest Syria

BACKGROUND

Since the withdrawal of government forces from Northwest Syria due to the conflict, several national initiatives have aimed to create alternative governance approaches to replace the central governmental system. One of the recent initiatives was the formulation of so-called 'Central Bodies' as institutional governance structures responsible for thematic planning and service provision; for example, the referral unit is responsible for planning and delivering medical referral services. However, the governance and administrative rules of procedures of these bodies could be immature or unsystematic. Assessing the governance of this approach cannot be condoned, especially with the urgent need for a methodical approach to strategic planning, achieving strategic humanitarian objectives, and efficiently utilizing available resources. Multiple governance assessment frameworks have been developed. However, none were created to be applied in protracted humanitarian settings. This research aims to assess the extent to which the existing health governance structure (central bodies) was capable of performing the governance functions in the absence of a legitimate government in Northwest Syria.

METHODS AND MATERIALS

A governance assessment framework was adopted after an extensive literature review and group discussions. Four principles for the governance assessment framework were identified; legitimacy, accountability and transparency, effectiveness and efficiency, and strategic vision. Focus Group Discussions were held to assess the levels of the selected principles on the governance thermometer scale. Qualitative and quantitative data were analyzed using NVivo 12 and SPSS 22 software programs, respectively.

RESULTS

The level of the four principles on the governance thermometer scale was between the lowest and middle quintiles; 'very poor or inactive' and 'fair and requires improvement', respectively. The results indicate that the governance approach of Central Bodies in NWS is underdeveloped and summons comprehensive systematic development. The poor internal mechanisms, poor planning and coordination, and the absence of strategic vision were among the most frequent challenges to developing the approach.

CONCLUSION

Humanitarian actors and donors should pay more attention to health governance approaches and tools in protracted crises. The central bodies must improve coordination with the stakeholders and, most importantly, strategic planning. Establishing or utilizing an independent planning committee, with financial and administrative independence, is crucial to maintain and improving contextual governance mechanisms in Northwest Syria.

Barriers to and Facilitators of Participation in Health and Social Care Governance: Categories and Cross-Cutting Themes from a Survey of SHAPES Project Partners

Good governance-aligned with human rights and rights-based care, participation, inclusion, and person-centredness-of digital care systems is integral to their ability to meet their objectives. To gain insight into existing governance structures and processes and participation experiences across Europe and lay foundations for the SHAPES Project's network governance (a healthy and active ageing Innovation Action consortium), our objectives included: 1) expand the list of known stakeholders, 2) explore how the range of stakeholders participate in health and social care governance, 3) develop an inventory of barriers and facilitators. Using an empirical, survey method, we consulted SHAPES Project partner organisations, with respondents invited to suggest specific participation barriers and facilitators. 16 organisations responded. Numerous additional stakeholders were identified. Circa 150 unique barriers and facilitators were reported, rationalised into 20 superordinate categories. Six cross-cutting themes were assembled: dimensionality and flux; power; opportunity and environments; interest, motivation, and choice; valuing governance participation, and duality. This work allows consideration of a wide range of stakeholders for the SHAPES collaborative governance model and future research, and for system design with the benefit of a detailed inventory of barriers and facilitators, and thematic contextualisation. Participation is modifiable and we suggest intervention targets and mechanisms.

Social wellbeing, values, and identity among Caiçara small-scale fishers in southeastern Brazil

Although much in the lives of members of the Caiçara small-scale fishing communities of Lázaro and Saco da Ribeira in Ubatuba, southeastern Brazil would suggest hardship, that population expresses a surprising degree of satisfaction with life. In this paper, we use a social wellbeing lens as applied through an ethnographic, mixed methods approach to reflect on this overall sense that lives rooted in small-scale fishing are well worth living despite their many challenges. We see the classic maritime anthropology theme of identity at the heart of meaning and life satisfaction. Identity provides core aspects of how people engage with their realities and anchors values that are reference points in work and social relations. With reference to the relational nuances revealed by the social wellbeing perspective, however, we show that Caiçara and small-scale fishing identities are not monolithic, but reflect gender and other social positions, and personal and familial experiences. These experiences include grappling with the complex effects of economic, social, political, and environmental changes. We conclude by arguing that fisheries policy that seeks to prioritize human wellbeing would benefit by adopting a social wellbeing perspective. Fisheries policy could thereby take into account identity, values, and relational elements of social life that give meaning and a sense of belonging to small-scale fishers, while also recognizing the cross-cutting and often contradictory variations in human experience that arise from social and economic differences. This social fabric of small-scale fishers' lives shapes their intentions and actions and is thus a necessary complication to the practice of fisheries management that its proponents need to consider.

The role of environmental degradation in macroeconomic instability: panel evidence from emerging economies

This study examines the role of environmental degradation in macroeconomic instability for a balanced panel sample of 22 emerging market economies from 1996 to 2019. Governance is included in the macroeconomic instability function as a moderating factor. Besides, bank credit and government spending are also included in the estimated function as control variables. The long-run results from using the PMG-ARDL method show that environmental degradation and bank credit induce macroeconomic instability, whereas governance and government spending reduce it. Interestingly, environmental degradation creates greater macroeconomic instability than the bank credit. We also find that governance being a moderating factor weakens the adverse impact of environmental degradation on macroeconomic instability. These findings are robust to the FGLS technique, suggesting that governments in emerging economies should prioritize environmental degradation and governance in mitigating climate change and ensuring macroeconomic stability in the long run.

Eight Strategies to Engineer Acceptance of Human Germline Modifications

Until recently, scientific consensus held firm that genetically manipulated embryos created through methods including Mitochondrial Replacement Therapy or human germline genome editing should not be used to initiate a pregnancy. In countries that have relevant laws pertaining to heritable human germline modifications, the vast majority prohibit or restrict this practice. In the last several years, scholars have observed a transformation of scientific and policy restrictions with insistent calls for creating a regulatory pathway. Multiple stakeholders highlight the role of social consensus and public engagement for governance of heritable human germline modifications. However, in the drive to gain public acceptance and lift restrictions, some proponents provide distorted or misleading narratives designed to influence public perception and incrementally shift the consensus. This article describes eight discrete strategies that proponents employ to influence framing, sway public opinion, and revise policymaking of human germline modifications in a manner that undermines honest engagement.

Integrated Care Policies and Politics in Belgium: Conceptual, Contextual and Governance Linkages for More Effective Integrated Care Policy Management Comment on "Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study"

The study on the management of integrated care (IC) policies in Belgium from Martens et al illustrates the complex process of the political and stakeholder game in a country whose governance is changing as a result of successive state reforms. We argue that the way forward for putting health back at the centre of IC policy design and management is to improve three types of connections. First, the conceptual connections should help to articulate the different IC policies into a coherent overall picture. Second, contextual connections should allow for the adaptation of policies to different country contexts. This requires a new form of governance, ie, a place-based and adaptive form of governance. This can be developed, provided that a third connection, between the different levels of governance, is fully revised.

Scarcity in abundance? Spatial inequalities in Rheumatoid Arthritis in a health system with financial equity

BACKGROUND

This paper estimates spatial inequalities of Rheumatoid Arthritis (RA) in Colombia and explores correlates of those disparities from a health system perspective.

METHODS

We apply descriptive epidemiology to healthcare administrative records for estimation of crude and age-standardized prevalences, and health systems thinking for identification of barriers to effective access in RA diagnosis.

RESULTS

The crude and age-standardized RA prevalence for Colombia in 2018 is estimated at 0.43% and 0.36%, respectively. In the contributory regime, the binding constraint is effective access to rheumatologists in rural and sparsely populated areas; this constraint in workforce affects service delivery, and ultimately comes from the lack of a differentiated model for effective provision of healthcare in those areas (governance).

CONCLUSIONS

There are opportunities for implementation of public health policies and health system interventions that would lead to a better identification of RA patients and the subsequent more precise estimation of RA prevalence, and most importantly, to reduce exposition to risk factors and accurate diagnosis and treatment of RA patients.

An exploratory review of investments by development actors in health workforce programmes and job creation

The World Health Organization's Global Strategy on Human Resources for Health: Workforce 2030 identified a projected shortfall of 18 million health workers by 2030, primarily in low- and middle-income countries. The need for investment was re-enforced by the 2016 report and recommendations of the United Nations High-Level Commission on Health Employment and Economic Growth. This exploratory policy tracing study has as objective to map and analyse investments by bilateral, multilateral and other development actors in human resources for health actions, programmes and health jobs more broadly since 2016. This analysis will contribute to the accountability of global human resources for health actions and its commitment by the international community. It provides insights in gaps, priorities and future policies' needs. The study follows an exploratory rapid review methodology, mapping and analysing the actions of four categories of development actors in implementing the ten recommendations of the United Nations High-Level Commission on Health Employment and Economic Growth. These four categories of actors include (A) bilateral agencies, (B) multilateral initiatives, (C) international financial institutions and (D) non-state actors. Analysing the data generated via this review, three trends can be observed. Firstly, while a broad range of human resources for health actions and outputs have been identified, data on programme outcomes and especially on their impacts are limited. Secondly, many of the programmatic human resources for health actions, often funded via bilateral or philanthropic grants and implemented by non-governmental organisations, seemed to be rather short-term in nature, focusing on in-service training, health security, technical and service delivery needs. Despite the strategic guidance and norms developed by multilateral initiatives, such as the International Labour Organization-Organisation for Economic Co-operation and Development-World Health Organization Working for Health programme, has it been for several development projects difficult to assess how their activities actually contributed to national human resources for health strategic development and health system reforms. Lastly, governance, monitoring and accountability between development actors and across the policy recommendations from the United Nations High-Level Commission on Health Employment and Economic Growth could be improved. There has been limited actionable progress made for the enablers required to transform the workforce, including in the domain of generating fiscal space for health that would strengthen jobs in the health sector, the development of health workforce partnerships and its global agenda, and the governance of international health workforce migration. In conclusion, one can observe that global health workforce needs are much recognised, especially given the impact of the Covid-19 pandemic. However, 20 years after the Joint Learning Initiative on Human Resources for Health, there is still an urgent need to take shared responsibility for international cooperative action for overcoming and addressing persistent underinvestment in the health workforce. Specific policy recommendations are provided to this end.

The evolution of information and communications technology in the fishery industry: The pathway for marine sustainability

There is reason for concern, given the history of technology in the seas. Too often, the extinction and contamination of marine species have been exacerbated by technical advancements and more potent fisheries equipment. By considering the roles of fisheries production, information and communication technology, human capital, governance, carbon dioxide emissions, and economic growth from 1990 to 2022, this paper seeks to investigate the dynamic effect of ICT on the sustainability of the fisheries industry in 27 European countries. The findings showed a substantial positive link between information and communication technology and the fisheries sector at higher quantiles using the new Method of Moments Quantile Regression (MMQR) with fixed effects. Additionally, in the EU27 nations, the impact of economic growth was favorably significant across most quantiles. The findings show that the EU14 developed nations have greater ICT and economic development than the EU13 underdeveloped countries, which significantly benefits fisheries sustainability. At lower quantiles, the data revealed a significant positive association between human capital and the fisheries sector. Results show that developing countries in the EU13 have more significant human capital than industrialized nations in the EU14, which considerably benefits fisheries sustainability. On the other hand, across all quantiles in the EU27 area, the findings revealed a substantial positive link between carbon dioxide emissions and the fisheries sector. EU14 developed countries have a larger significant positive magnitude between carbon dioxide emissions and fisheries output than the EU13 underdeveloped nations. To accomplish sustainable development objectives, this study provides policymakers insight into how to encourage technological transmission factors in the EU14 and EU13 nations via effective and environmentally friendly technology in the fisheries sector.

Do business strategies and environmental, social, and governance (ESG) performance mitigate the likelihood of financial distress? A multiple mediation model

This study explores the connection between business strategies, ESG performance, and the probability of bankruptcy. Using a sample comprising 1970 U.S. firm-year observations from 2016 to 2020, this study adopts several techniques to achieve its goals, including the partial least squares structural equation modeling (PLS-SEM) algorithm and additional analyses. The results demonstrate that a firm with a better cost leadership strategy has higher ESG performance. A sound cost leadership strategy and ESG performance negatively influence a firm's likelihood of financial distress. Using a mediating analysis model, we also find that financial and ESG performance mediate and mitigate the probability of experiencing financial distress through a cost leadership strategy, indicating that these are essential factors that cannot be ignored when mitigating bankruptcy probability. Financial performance also mediates and mitigates the probability of experiencing financial distress through the ESG path. This study adds to the existing body of knowledge by revealing the role of sound business strategies and ESG performance in mitigating the likelihood of financial distress, an under-explored topic. It also analyzes the mediation roles of financial and ESG performance to provide significant insights to companies' decision-makers in order to support them in their endeavors toward performance improvement and achieving best practices.

Mining and Sustainability in the Circumpolar North: The Role of Government in Advancing Corporate Social Responsibility

Corporate Social Responsibility (CSR) is recognized as important to fostering sustainable natural resource development in the Circumpolar North. Governments are playing an increasingly active role in promoting and shaping CSR initiatives, often in collaboration with Indigenous communities and industry. This paper explores the role of CSR in mining for improving socio-economic and environmental management practice. The article argues that government instituted regulations can lead to the development and implementation of CSR practices by mining companies. To examine the relationship between government requirements and CSR, we use two Northern case studies: Cameco Corporation's uranium mining operations located in Saskatchewan, Canada and Northern Iron's iron mining operation located in Troms and Finnmark county, Norway. Through an in-depth review of scholarly literature, document analysis, and semi-structured interviews, our findings suggest that the role of the state in the initiation and implementation of CSR is of much greater importance than is currently acknowledged in the literature. In the case of Cameco, the Mine Surface Lease Agreements agreed to by the corporation and the provincial government provided motivation for the development and implementation of their world-renowned CSR practices, resulting in a community-based environmental monitoring program and benefits for both the company and surrounding communities. With Northern Iron's operations in Kirkenes, working hour requirements instituted by the Norwegian Government allowed for significantly higher levels of local employment. Our findings suggest a greater role exists for government to facilitate the adoption of CSR policies, contributing in turn to improved socio-economic and environmental outcomes for Northern communities.

Political determinants of health: (re) examining the role of governance in reducing maternal mortality

Given change in the universal developmental agenda and the quality of governance in the last two decades, this paper re-examines the relationship between governance, health expenditure and maternal mortality using panel data for 184 countries from 1996 to 2019. By employing the 'dynamic panel data regression model', the study reveals that a one-point improvement in the governance index decreases maternal mortality by 10-21%. We also find that good governance can better translate health expenditure into improved maternal health outcomes through effective allocation and equitable distribution of available resources. These results are robust to alternative instruments, alternative dependent variables (such as infant mortality rate and life expectancy), estimation by different governance dimensions and at the sub-national level. Additional findings using 'Quantile regression' estimates show that the quality of governance matters more than the health expenditure in countries with a higher level of maternal mortality. While the 'Path regression' analysis exhibits the specific direct and indirect mechanisms through which the causal inference operates between governance and maternal mortality.

Participation in protected area governance: A systematic case survey of the evidence on ecological and social outcomes

Protected areas are considered key to conserving ecosystems and safeguarding biodiversity worldwide. Local stakeholders' involvement in decision-making in area-based conservation approaches may help to mitigate environmental inequalities and to improve social and ecological outcomes. However, sound and in-depth evidence on the relationship between participation and protected area outcomes is piecemeal. To synthesize the available knowledge, we provide evidence from a systematic literature review of 52 empirical case studies from the scientific literature examining the social and ecological outcomes of protected-area-related decision-making processes in which local stakeholders participated. In a first step, we defined factors that are linked to social and ecological protected area outcomes as success. Based on these factors, we then categorized success indicators which we quantitatively linked to features of participation. Our review provides evidence of the relationship between protected area successes and the following four features of participation: 1. Genuine devolution of power to the local level; 2. Involvement of diverse actors and multiple perspectives through fair and inclusive processes; 3. Long-term external support; 4. Devolution of rights. Even though the degree and form of participation require adjustment to specific local contexts, this overview of features provides sound evidence based on the relation between participatory decision-making and social and ecological effectiveness in protected areas. These insights can be used to design more effective participatory conservation interventions that meet both biodiversity conservation and human well-being.

Sales prices, social rigidity and the second home property market

Second homes are much valued as recreational resources and also as important commodities on the property market. This study examines the trading patterns and regional price development of Danish second homes from 1992 to 2020. Second home sales volumes and prices reflect the general economic booms and busts and also the possibilities to rent out the property on sharing platforms. However, across regional clusters and over time, property price developments suggest a significant social rigidity in preferences and prospects. The investment and financialization logics and the underlying guiding conspicuous consumption behavior has not changed as an effect of the increased demand during the early phases of the COVID-19 pandemic. When controlling for factors such as house and land plot size, building year, location attractiveness the strong social class and spatial rigidity is reproduced in the data. The shifting of wealth accumulated in the second homes between generations supports the same tendency, and taxation does not rebalance regional effects. Accordingly, only to a limited extent does owning a second home contribute to social equality, even if some second-home owners and policy makers tend to think otherwise. Economic measures in planning and governance portfolios are found to be negligible.

Stewardship; The Missing Loop of Rehabilitation in the Health System: A Policy Brief

Providing optimal rehabilitation services for people with disabilities has always been recognized as a major concern of health systems in all countries. Stewardship is one of the biggest challenges to provide rehabilitation services to people with disabilities in Iran. We advocate the Ministry of Health & Medical Education (MoHME) to take the lead as a steward of rehabilitation services in Iran, while the dedicated sections in the MoHME need to be determined, with a clear list of responsibilities and affiliations.

Is bureaucracy being busted in research ethics and governance for health services research in the UK? Experiences and perspectives reported by stakeholders through an online survey

BACKGROUND

It has long been noted that the chain from identification of need (research gap) to impact in the real world is both long and tortuous. This study aimed to contribute evidence about research ethics and governance arrangements and processes in the UK with a focus on: what works well; problems; impacts on delivery; and potential improvements.

METHODS

Online questionnaire widely distributed 20th May 2021, with request to forward to other interested parties. The survey closed on 18th June 2021. Questionnaire included closed and open questions related to demographics, role, study objectives.

RESULTS

Responses were received from 252 respondents, 68% based in universities 25% in the NHS. Research methods used by respondents included interviews/focus groups (64%); surveys/questionnaires (63%); and experimental/quasi experimental (57%). Respondents reported that participants in the research they conducted most commonly included: patients (91%); NHS staff (64%) and public (50%). Aspects of research ethics and governance reported to work well were: online centralised systems; confidence in rigorous, respected systems; and helpful staff. Problems with workload, frustration and delays were reported, related to overly bureaucratic, unclear, repetitive, inflexible and inconsistent processes. Disproportionality of requirements for low-risk studies was raised across all areas, with systems reported to be risk averse, defensive and taking little account of the risks associated with delaying or deterring research. Some requirements were reported to have unintended effects on inclusion and diversity, particularly impacting Patient and Public Involvement (PPI) and engagement processes. Existing processes and requirements were reported to cause stress and demoralisation, particularly as many researchers are employed on fixed term contracts. High negative impacts on research delivery were reported, in terms of timescales for completing studies, discouraging research particularly for clinicians and students, quality of outputs and costs. Suggested improvements related to system level changes / overall approach and specific refinements to existing processes.

CONCLUSIONS

Consultation with those involved in Health Services Research in the UK revealed a picture of overwhelming and increasing bureaucracy, delays, costs and demoralisation related to gaining the approvals necessary to conduct research in the NHS. Suggestions for improvement across all three areas focused on reducing duplication and unnecessary paperwork/form filling and reaching a better balance between risks of harm through research and harms which occur because research to inform practice is delayed or deterred.

COVID-19 vaccination and governance in the case of low, middle and high-income countries

BACKGROUND

Global crises, regardless of the place where they started to spread or of the factors that triggered them, require a comprehensive approach, primarily based on good communication, cooperation and mutual support. No individual and no institution should remain indifferent to crises but, on the contrary, be fully aware that any involvement in curbing them matters. Although humanity can be affected by various types of crises, in this paper we refer to the one related to COVID-19 pandemic. There are certain reasons that come to justify our choice: first of all, being a shock with a strong impact on people, its analysis should be performed from several angles; this may bring to light an image with its disparate propagation and measures to counteract it both in developed countries, and especially in those with a shortage of resources. Secondly, in the context of the emergence of vaccines against COVID-19, it is helpful to have an overview of COVID-19 through the lens of the relationship between the vaccination process and the elements that characterize governance, with a differentiated dashboard by country categories worldwide: low, middle and high-income countries. Our study is far from capturing the complexity arising from such social problem, but rather aims to outline the defining role of governance when it comes to providing firm reactions to the COVID-19 crisis.

METHODS

Given that our sample consists of a large number of countries, namely 170, first, examined all together, and then, split into three groups (high, middle and low-income), it is challenging to address governance in association with COVID-19 vaccination, in order to see how much they interact and how each of the six aggregate governance indicators of the World Bank (Worldwide Governance Indicators) is reflected in this process. Even if they do not oscillate strongly over relatively short periods of time, reporting on health issues requires a sequential inventory, considering closer time intervals, so as to be able to act promptly. Thus, to better distinguish how the COVID-19 vaccination process evolved in low, middle and high-income countries, but also how it was imprinted by governance, we present the situation quarterly (March, June, September and December), in 2021, the year when the immunization campaigns were the most intense at the global level. Regarding the applied methods, we mention both OLS regressions with robust estimators and a panel model, used to investigate the determinants of COVID-19 vaccination, some of them describing the good governance, as well as other dimensions.

RESULTS

The findings point out that the influence of governance on COVID-19 vaccination differs depending on whether a country belongs to high, middle or low-income typology: the strongest determinism of governance on vaccination is encountered in high-income countries, and the weakest in low-income ones; in some cases, governance does not matter significantly. However, exploring the three groups of states included in the research, it is observed that the most relevant factors in this relationship are government effectiveness, regulatory quality and control of corruption.

CONCLUSIONS

Besides the order of importance of governance indicators on COVID-19 vaccination, our study indicates that, overall, governance positively shapes the vaccination rate at the level of the chosen sample. In normative terms, these findings can be translated particularly by the fact that they can serve as information to raise awareness on the relevance of the existence of an institutional framework that allows the formulation of strategies according to the patterns of each country, especially since the actionable tools depend on the available resources. As a general conclusion, public policies should be designed in such a way as to strengthen trust in vaccination regulations and in governments, to reduce the multifaceted negative effects of this health crisis and to hope for its total end.

Assessing social contracts for urban adaptation through social listening on Twitter

Adapting to climate change impacts requires a coherent social contract in which different actors agree on a clear distribution of roles and responsibilities. An urgent requirement is to understand the imagined social contracts on expected roles and responsibilities, which is particularly relevant in cities where very diverse social groups come together. However, there is limited empirical evidence on these expectations as they are often tacit and hard to capture across large populations and heterogeneous groups. Here we assess the social contract on flood risk management in Mumbai, using the concept of social listening in combination with Twitter data. We find wide gaps between and within imagined social contracts. Sentiments such as frustration and apathy expressed in tweets explain these gaps and highlight the need to build trust for achieving accepted and effective social contracts for adaptation. Theoretical, empirical, and methodological lessons can be transferred to other cities and beyond.

Britain's harnessing of Thames river from the perspective of peace studies and its enlightenment-research based on the background of great stink in London

In recent years, novel coronavirus has been rampant all over the world, and environmental pollution has increasingly become an unavoidable problem. The history of human development seems to be always accompanied by environmental pollution. In 1858, the appearance of the big stink in London reflected the serious pollution of Thames River in the process of industrialization. The pollution of the Thames River has aroused widespread concern of all groups in Britain, and the long road of pollution control in Britain has brought profound historical lessons. However, what future generations need to really learn from it is to get rid of the dilemma of pollution before treatment. This study takes the Thames River as an analogy, positioning human destruction of nature as the intertwined of history, and pushing the debate on environmental science, peace science, and history to a climax in order to reach wise recommendations on environmental protection, which is very necessary on the contemporary stage. While promoting the progress of human civilization, strengthening the protection of the environment may be the best way to break the traditional dilemma.

Modelling cybersecurity regulations for automated vehicles

Technological advancements in Connected and Automated Vehicles (CAVs), particularly the integration of diverse stakeholder groups (communication service providers, road operators, automakers, repairers, CAV consumers, and the general public) and the pursuit of new economic opportunities, have resulted in the emergence of new technical, legal, and social challenges. The most pressing challenge is deterring criminal behaviour in both the physical and cyber realms through the adoption of CAV cybersecurity protocols and regulations. However, the literature lacks a systematic decision tool to analyze the impact of the potential cybersecurity regulations for dynamically interacting stakeholders, and to identify the leverage points to minimise the cyber-risks. To address this knowledge gap, this study uses systems theory to develop a dynamic modelling tool to analyze the indirect consequences of potential CAVs cybersecurity regulations in the medium to long term. It is hypothesized that CAVs Cybersecurity Regulatory Framework (CRF) is the property of the entire ITS stakeholders. The CRF is modelled using the System Dynamic based Stock-and-Flow-Model (SFM) technique. The SFM is founded on five critical pillars: the Cybersecurity Policy Stack, the Hacker's Capability, Logfiles, CAV Adopters, and intelligence-assisted traffic police. It is found that decision-makers should focus on three major leverage points: establishing a CRF grounded on automakers' innovation; sharing risks in eliminating negative externalities associated with underinvestment and knowledge asymmetries in cybersecurity; and capitalising on massive CAV-generated data in CAV operations. The formal integration of intelligence analysts and computer crime investigators to strengthen traffic police capabilities is pivotal. Recommendations for automakers include data-profiteering in CAV design, production, sales, marketing, safety enhancements and enabling consumer data transparency.Furthermore, CAVs-CRF necessitate a balanced approach to the trade-off between: i) data accessibility constraints on CAV automakers and ITS service providers; ii) regulator command and control thresholds; iii) automakers' business investment protection; and iv) consumers' data privacy guard.

Towards trust-based governance of health data research

Developments in medical big data analytics may bring societal benefits but are also challenging privacy and other ethical values. At the same time, an overly restrictive data protection regime can form a serious threat to valuable observational studies. Discussions about whether data privacy or data solidarity should be the foundational value of research policies, have remained unresolved. We add to this debate with an empirically informed ethical analysis. First, experiences with the implementation of the General Data Protection Regulation (GDPR) within a European research consortium demonstrate a gap between the aims of the regulation and its effects in practice. Namely, strictly formalised data protection requirements may cause routinisation among researchers instead of substantive ethical reflection, and may crowd out trust between actors in the health data research ecosystem; while harmonisation across Europe and data sharing between countries is hampered by different interpretations of the law, which partly stem from different views about ethical values. Then, building on these observations, we use theory to argue that the concept of trust provides an escape from the privacy-solidarity debate. Lastly, the paper details three aspects of trust that can help to create a responsible research environment and to mitigate the encountered challenges: trust as multi-agent concept; trust as a rational and democratic value; and trust as method for priority setting. Mutual cooperation in research-among researchers and with data subjects-is grounded in trust, which should be more explicitly recognised in the governance of health data research.

Framing the pandemic: Multiplying "crises" in Dutch healthcare governance during the emerging COVID-19 pandemic

In this paper we explore the impact of the emerging COVID-19 pandemic on the governance of healthcare in the Netherlands. In doing so, we re-examine the idea that a crisis necessarily leads to processes of transition and change by focusing on crisis as a specific language of organizing collective action instead. Framing a situation as a crisis of a particular kind allows for specific problem definitions, concurrent solutions and the inclusion and exclusion of stakeholders. Using this perspective, we examine the dynamics and institutional tensions involved in governing healthcare during the pandemic. We make use of multi-sited ethnographic research into the Dutch healthcare crisis organization as it responded to the COVID-19 pandemic, focusing on decision-making at the regional level. We tracked our participants through successive waves of the pandemic between March 2020 and August 2021 and identified three dominant framings of the pandemic-as-crisis: a crisis of scarcity, a crisis of postponed care and a crisis of acute care coordination. In this paper, we discuss the implications of these framings in terms of the institutional tensions that arose in governing healthcare during the pandemic: between centralized, top-down crisis management and local, bottom-up work; between informal and formal work; and between existing institutional logics.

Challenges and lessons learned for REDD+ finance and its governance

Discussion on reducing emissions from deforestation in developing countries began at the United Nations Framework Convention on Climate Change (UNFCCC) Conference of the Parties in 2005, and the agenda for "reducing emissions from deforestation and forest degradation, and the role of conservation, sustainable management of forests and enhancement of forest carbon stocks in developing countries (REDD+)" was introduced under the UNFCCC. The REDD+ framework was developed with the expectation that it would significantly contribute to climate change mitigation at a relatively low cost and produce benefits for both developed and developing countries. Finance is a key element of REDD+ implementation, and many financial sources, approaches, and mechanisms have supported REDD+-related activities in various developing countries. However, the comprehensive challenges and lessons learned for REDD+ finance and its governance have not been fully explored. This paper reviews the relevant literature to understand the challenges for REDD+ finance and its governance in two areas-(1) REDD+ finance aligned with the UNFCCC and (2) REDD+-related finance outside the UNFCCC-which have developed differently and have different implications. This paper first identifies the six key elements of REDD+ finance and its governance across the two fields, and then reviews the related challenges and lessons learned with respect to public and private finance. The challenges for REDD+ finance and its governance aligned with the UNFCCC include enhancing the performance of REDD+ finance using mainly public finance, such as results-based finance and the jurisdictional approach. In contrast, the challenges regarding REDD+-related finance outside the UNFCCC include enhancing the engagement of the private sector in REDD+ finance, mainly targeting the project level, and the relationship between voluntary carbon markets and other investment and finance mechanisms. This paper also identifies the common challenges across REDD+ finance and its governance in the two fields. These challenges include the need to enhance linkages between REDD+ and other objectives, such as carbon neutrality/net-zero, deforestation-free supply chains, and nature-based solutions, as well as the need to develop learning systems for REDD+ finance.

An overview of nursing and midwifery leadership, governance structures, and instruments in Africa

BACKGROUND

Investment in nursing and midwifery leadership and governance are key suggested approaches by the World Health Organization (WHO) Africa Regional Office to address the shortages in the nursing health workforce. However, there are few if any studies that have investigated the existence and operationalization of the nursing and midwifery leadership and governance structures in Africa. This paper fills this gap by, providing an overview of nursing and midwifery leadership, governance structures, and instruments in Africa.

METHODS

We conducted a descriptive cross-sectional study of the nursing and midwifery leadership, structures, and instruments in 16 African countries using quantitative methodology. Data was analyzed using SPSS IBM 21 statistical software. Data was summarized in frequencies and percentages and presented as tables and charts.

RESULTS

Only (9,56.25%) of the 16 countries included had retrievable evidence of all expected governance structures while (7, 43.75%) lacked one or more of the structures. A quarter (4, 25%) of the countries did not have a department of nursing and midwifery or chief nursing and midwifery officer at their Ministry of Health (MOH). The dominant gender representation across all the governance structures was female. Only Lesotho (1, 6.25%) had all expected nursing and midwifery governance instruments while the remaining (15, 93.75%) had either one or four of these instruments missing.

CONCLUSIONS

The lack of complete nursing and midwifery governance structures and instruments in various African countries is a matter of concern. Without these structures and instruments, the strategic direction and input of the nursing and midwifery profession cannot be maximized for the public good in relation to health outcomes. Addressing the existing gaps requires a multipronged approach with the need to strengthen regional collaboration, and advocacy, creating awareness, and advancing nursing and midwifery leadership training to enable nursing and midwifery governance capacity development in Africa.

The impact of geopolitical risk, governance, technological innovations, energy use, and foreign direct investment on CO2 emissions in the BRICS region

Geopolitical risk (GPR) and other social indicators have raised many somber environmental-related issues among government environmentalists, and policy analysts. To further elucidate whether or not these indicators influence the environmental quality, this study investigates the impact of GPR, corruption, and governance on environmental degradation proxies by carbon emissions (CO₂) in BRICS (Brazil, Russia, India, China, and South Africa) countries, namely Brazil, Russia, India, China, and South Africa, using data over the period 1990 to 2018. The cross-sectional autoregressive distributed lag (CS-ARDL), fully modified ordinary least square (FMOLS), and dynamic ordinary least square (DOLS) methods are used for empirical analysis. First and second-generation panel unit root tests report a mixed order of integration. The empirical findings show that government effectiveness, regulatory quality, the rule of law, foreign direct investment (FDI), and innovation have a negative effect on CO₂ emissions. In contrast, geopolitical risk, corruption, political stability, and energy consumption have a positive effect on CO₂ emissions. Based on the empirical outcomes, the present research invites the concentration of central authorities and policymakers of these economies toward redesigning more sophisticated strategies regarding these potential variables to protect the environment.