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Kriegner S, Ottersen T, Røttingen JA, Gopinathan U. Promoting Intersectoral Collaboration Through the Evaluations of Public Health Interventions: Insights From Key Informants in 6 European Countries. Int J Health Policy Manag 2021; 10:67-76. [PMID: 32610746 PMCID: PMC7947666 DOI: 10.34172/ijhpm.2020.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 02/01/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Intersectoral collaboration is critical to the successful implementation of many public health interventions (PHIs). Little attention has been paid to whether and how processes at the stage of evaluation can promote intersectoral collaboration. The objective of this study was to examine European experiences and views on whether and how the evaluation of PHIs promote intersectoral collaboration. METHODS A qualitative study design was used. We conducted semi-structured interviews with 15 individuals centrally involved in the evaluation of PHIs in 6 European countries (Austria, Denmark, England, Germany, Norway, and Switzerland). Questions pertained to current processes for evaluating PHIs in the country and current and potential strategies for promoting intersectoral collaboration. Transcripts were analyzed using thematic analysis to identify key themes responding to our primary objective. RESULTS Experiences with promoting intersectoral collaboration through the evaluation of PHIs could be summarized in 4 themes: (1) Early involvement of non-health sectors in the evaluative process and inclusion of non-health benefits can promote intersectoral collaboration, but should be combined with greater influence of these sectors in shaping PHIs; (2) Harmonization of methodological approaches may enable comparison of results and facilitate intersectoral collaboration, but should not be an overriding goal; (3) Involvement in health impact assessments (HIAs) can promote intersectoral collaboration, but needs to be incentivized and be conducted without putting overwhelming demands on non-health sectors; (4) A designated body for evaluating PHIs may promote intersectoral collaboration, but its design needs to take account of realities of policy-making. CONCLUSION The full potential for promoting intersectoral collaboration through the evaluation of PHIs appears currently unrealized in the settings we studied. To further promote intersectoral collaboration, evaluators and decision-makers may consider the full range of strategies characterized in this study. This may be most effective if the strategies are deployed so that they reinforce each other, value outcomes beyond health, and are tailored to maximize political priority for PHIs across sectors.
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Affiliation(s)
- Sabrina Kriegner
- Oslo Group on Global Health Policy, Department of Community Medicine and Global Health and Centre for Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Trygve Ottersen
- Oslo Group on Global Health Policy, Department of Community Medicine and Global Health and Centre for Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Unni Gopinathan
- Oslo Group on Global Health Policy, Department of Community Medicine and Global Health and Centre for Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
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From monitoring to action: utilising health survey data in national policy development and implementation in Finland. ACTA ACUST UNITED AC 2019; 77:48. [PMID: 31749964 PMCID: PMC6852713 DOI: 10.1186/s13690-019-0374-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/23/2019] [Indexed: 12/27/2022]
Abstract
Background Health interview and examination surveys provide valuable information for policy, practice and research purposes. Appropriate use of high-quality, representative and timely population data can indirectly help the citizens to live healthier and longer lives. The aim of this study was to review how health survey data have supported health policy making, health research and everyday health care in Finland. Methods Data were collected by focused interviews with ten Finnish senior experts from the Ministry of Social Affairs and Health, political parties, National Institute for Health and Welfare, universities, and health associations. Results Most interviewees agreed that health surveys have positively affected the health of the population over the past 50 years - through health strategies, care guidelines, legislation, research, prevention programs, risk calculators, and healthier products on the market. There is also a need for further development: the latest research results should be provided in a nutshell for politicians, and effective tools should be developed more for health care professionals’ use. The coverage of health information on children, adolescents, oldest old, disabled persons, migrants and ethnic minorities should be improved. Conclusions Sound health policy and its successful implementation require extensive national cooperation and new communication strategies between policy makers, researchers, health care professionals, health service providers - and citizens. The future health information system in Finland should better cover all population groups. To obtain more comprehensive health information, the possibilities for register linkages should be secured and register data should be further evaluated and developed to serve health monitoring purposes.
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Kennedy-Hendricks A, Bluestein J, Kral AH, Barry CL, Sherman SG. Establishing Sanctioned Safe Consumption Sites in the United States: Five Jurisdictions Moving the Policy Agenda Forward. Psychiatr Serv 2019; 70:294-301. [PMID: 30755131 DOI: 10.1176/appi.ps.201800398] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Safe consumption sites enable use of preobtained drugs in hygienic settings where trained staff are available to respond to overdoses and connect individuals with health and social services. This study examined efforts to advance policies to establish safe consumption sites in the United States, where no sanctioned sites exist. METHODS Between April and July 2018, the authors conducted 25 telephone interviews with a purposive sample of key informants in five communities considering safe consumption site implementation. Participants included organizers and advocates, government officials, and personnel with social service and health organizations. Interview notes were analyzed by using hybrid inductive-deductive coding. RESULTS Key strategies for organizing support for safe consumption sites included involving people who use drugs, engaging diverse partners, supporting allies in related causes, and using various tactics to garner support from policy makers. Major barriers to adoption included identifying the right locations, uncertainty about the federal response, mistrust arising from racial injustice in drug policy, and financing. Participants identified facilitators of progress toward safe consumption site adoption, such as building on existing harm reduction programs, securing political champions, and exposing community officials to programs operating internationally. CONCLUSIONS A window of opportunity may be opening to advance policy related to safe consumption sites; whether sanctioned sites become part of the broader policy strategy for addressing drug use and overdose in the United States will depend on the experiences of the first sites. Organizing around this issue may facilitate engagement among people who use drugs in broader conversations about drug policy.
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Affiliation(s)
- Alene Kennedy-Hendricks
- Department of Health Policy and Management (Kennedy-Hendricks, Bluestein, Barry), Center for Mental Health and Addiction Policy Research (Kennedy-Hendricks, Bluestein, Barry, Sherman), and Department of Health Behavior and Society (Sherman), all at Johns Hopkins Bloomberg School of Public Health, Baltimore; Behavioral Health and Criminal Justice Division, RTI International, San Francisco (Kral)
| | - Jenna Bluestein
- Department of Health Policy and Management (Kennedy-Hendricks, Bluestein, Barry), Center for Mental Health and Addiction Policy Research (Kennedy-Hendricks, Bluestein, Barry, Sherman), and Department of Health Behavior and Society (Sherman), all at Johns Hopkins Bloomberg School of Public Health, Baltimore; Behavioral Health and Criminal Justice Division, RTI International, San Francisco (Kral)
| | - Alex H Kral
- Department of Health Policy and Management (Kennedy-Hendricks, Bluestein, Barry), Center for Mental Health and Addiction Policy Research (Kennedy-Hendricks, Bluestein, Barry, Sherman), and Department of Health Behavior and Society (Sherman), all at Johns Hopkins Bloomberg School of Public Health, Baltimore; Behavioral Health and Criminal Justice Division, RTI International, San Francisco (Kral)
| | - Colleen L Barry
- Department of Health Policy and Management (Kennedy-Hendricks, Bluestein, Barry), Center for Mental Health and Addiction Policy Research (Kennedy-Hendricks, Bluestein, Barry, Sherman), and Department of Health Behavior and Society (Sherman), all at Johns Hopkins Bloomberg School of Public Health, Baltimore; Behavioral Health and Criminal Justice Division, RTI International, San Francisco (Kral)
| | - Susan G Sherman
- Department of Health Policy and Management (Kennedy-Hendricks, Bluestein, Barry), Center for Mental Health and Addiction Policy Research (Kennedy-Hendricks, Bluestein, Barry, Sherman), and Department of Health Behavior and Society (Sherman), all at Johns Hopkins Bloomberg School of Public Health, Baltimore; Behavioral Health and Criminal Justice Division, RTI International, San Francisco (Kral)
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Smith MJ, Thompson A, Upshur REG. Is 'health equity' bad for our health? A qualitative empirical ethics study of public health policy-makers' perspectives. Canadian Journal of Public Health 2018; 109:633-642. [PMID: 30465285 DOI: 10.17269/s41997-018-0128-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 08/23/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES 'Social justice' and 'health equity' are core values in public health. Yet, despite their normative character, the numerous normative accounts of social justice and equity are rarely acknowledged, meaning that these values are often unaccompanied by an explanation of what they require in practice. The objective of this study was to bridge this normative scholarship with information about how these 'core values' are integrated and interpreted by Canadian public health policy-makers. METHODS Twenty qualitative interviews with public health policy-makers recruited from public health organizations in Canada, analyzed using an 'empirical ethics' methodology that combined empirical data with normative ethical analysis involving theories of justice. FINDINGS Participants viewed health equity and social justice as distinct, where the former was perceived as 'clearer'. Health equity was conceptualized as focusing attention to 'proximal' disparities in access to services and 'materialistic' determinants of health, whereas social justice was conceptualized as focusing on structural issues that lead to disadvantage. Health equity was characterized as 'neutral' and 'comfortable', whereas social justice was characterized as 'political' and 'uncomfortable'. CONCLUSION These findings indicate that health equity dominates the discursive space wherein justice-based considerations are brought to bear on public health activities. As a result, 'uncomfortable' justice-based considerations of power imbalances and systematic disadvantage can be eschewed in practice in favour of attending to 'proximal' inequities. These findings reveal the problematic ways in which considerations of justice and equity are, and are not, being taken up in public health policy, which in turn may have negative implications for the public's health.
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Affiliation(s)
- Maxwell J Smith
- School of Health Studies, Faculty of Health Sciences, Western University, Arthur and Sonia Labatt Health Sciences Building, Room 331, 1151 Richmond Street, London, ON, N6A 5B9, Canada.
| | - Alison Thompson
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada
| | - Ross E G Upshur
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5G 1L4, Canada
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Gagnon F, Bergeron P, Clavier C, Fafard P, Martin E, Blouin C. Why and How Political Science Can Contribute to Public Health? Proposals for Collaborative Research Avenues. Int J Health Policy Manag 2017; 6:495-499. [PMID: 28949461 PMCID: PMC5582435 DOI: 10.15171/ijhpm.2017.38] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 03/15/2017] [Indexed: 11/09/2022] Open
Abstract
Written by a group of political science researchers, this commentary focuses on the contributions of political science to public health and proposes research avenues to increase those contributions. Despite progress, the links between researchers from these two fields develop only slowly. Divergences between the approach of political science to public policy and the expectations that public health can have about the role of political science, are often seen as an obstacle to collaboration between experts in these two areas. Thus, promising and practical research avenues are proposed along with strategies to strengthen and develop them. Considering the interdisciplinary and intersectoral nature of population health, it is important to create a critical mass of researchers interested in the health of populations and in healthy public policy that can thrive working at the junction of political science and public health.
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Affiliation(s)
- France Gagnon
- School of Administrative Sciences, TÉLUQ, Université du Québec, Quebec City, QC, Canada
| | - Pierre Bergeron
- Department of Social and Preventive Medicine, Université Laval, Quebec City, QC, Canada
| | - Carole Clavier
- Department of Political Science, Université du Québec à Montréal, Montréal, QC, Canada
| | - Patrick Fafard
- School of Public and International Affairs, University of Ottawa, Ottawa, ON, Canada
| | | | - Chantal Blouin
- Department of Social and Preventive Medicine, Université Laval, Quebec City, QC, Canada
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Canadian harm reduction policies: A comparative content analysis of provincial and territorial documents, 2000–2015. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 45:9-17. [DOI: 10.1016/j.drugpo.2017.03.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 02/08/2017] [Accepted: 03/22/2017] [Indexed: 11/22/2022]
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Fafard P. Beyond the usual suspects: using political science to enhance public health policy making. J Epidemiol Community Health 2015; 69:1129-32. [DOI: 10.1136/jech-2014-204608] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 01/31/2015] [Indexed: 11/03/2022]
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Mendes R, Plaza V, Wallerstein N. Sustainability and power in health promotion: community-based participatory research in a reproductive health policy case study in New Mexico. Glob Health Promot 2014; 23:61-74. [PMID: 25432963 DOI: 10.1177/1757975914550255] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 07/22/2014] [Indexed: 11/15/2022]
Abstract
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 instrument, and new understandings of the intersection of power and stakeholder strategies in the sustainability of health promotion and health in all policies.
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Affiliation(s)
- Rosilda Mendes
- Universidade Federal de São Paulo - Campus Baixada Santista, Brazil
| | | | - Nina Wallerstein
- University of New Mexico - Public Health Program, Albuquerque, New Mexico, USA
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Guta A, Strike C, Flicker S, Murray SJ, Upshur R, Myers T. Governing through community-based research: lessons from the Canadian HIV research sector. Soc Sci Med 2014; 123:250-61. [PMID: 25074512 DOI: 10.1016/j.socscimed.2014.07.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 05/22/2014] [Accepted: 07/12/2014] [Indexed: 11/20/2022]
Abstract
The "general public" and specific "communities" are increasingly being integrated into scientific decision-making. This shift emphasizes "scientific citizenship" and collaboration between interdisciplinary scientists, lay people, and multi-sector stakeholders (universities, healthcare, and government). The objective of this paper is to problematize these developments through a theoretically informed reading of empirical data that describes the consequences of bringing together actors in the Canadian HIV community-based research (CBR) movement. Drawing on Foucauldian "governmentality" the complex inner workings of the impetus to conduct collaborative research are explored. The analysis offered surfaces the ways in which a formalized approach to CBR, as promoted through state funding mechanisms, determines the structure and limits of engagement while simultaneously reinforcing the need for finer grained knowledge about marginalized communities. Here, discourses about risk merge with notions of "scientific citizenship" to implicate both researchers and communities in a process of governance.
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Reducing the adverse impact of injection drug use in Canada. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2013; 23:106-7. [PMID: 23997772 DOI: 10.1155/2012/297530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Murphy K, Fafard P, O'Campo P. Introduction--Knowledge translation and urban health equity: advancing the agenda. J Urban Health 2012; 89:875-80. [PMID: 22585449 PMCID: PMC3531354 DOI: 10.1007/s11524-012-9693-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In 2011, an interdisciplinary symposium was organized in Toronto, Canada to investigate prevailing models of health policy change in the knowledge translation literature and to assess the applicability of these models for equity-focused urban health research. The papers resulting from the symposium have been published together, in the Journal of Urban Health, along with this introductory essay. This essay describes how the different papers grapple in different ways with how to understand and to bridge the gaps between urban health research and action. The breadth of perspectives reflected in the papers (e.g., social epidemiology, public health, political science, sociology, critical labor studies, and educational psychology) shed much light on core tensions in the relationship between KT and health equity. The first tension is whether the content of evidence or the context of decision making is the strong determinate of research impact in relation to health equity policy. The second tension is whether relationships between health equity researchers and decision makers are best viewed in terms of collaboration or of conflict. The third concerns the role that power plays in evidence-based policy making, when the issues at stake are not only empirical but also normative.
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Affiliation(s)
- Kelly Murphy
- Li Ka Shing Knowledge Institute, Keenan Research Centre of St. Michael's Hospital, Toronto, ON, Canada.
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Murphy K, Fafard P. Taking power, politics, and policy problems seriously: the limits of knowledge translation for urban health research. J Urban Health 2012; 89:723-32. [PMID: 22678649 PMCID: PMC3535140 DOI: 10.1007/s11524-012-9694-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Knowledge translation (KT) is a growing movement in clinical and health services research, aimed to help make research more relevant and to move research into practice and policy. This paper examines the conventional model of policy change presented in KT and assesses its applicability for increasing the impact of urban health research on urban health policy. In general, KT conceptualizes research utilization in terms of the technical implementation of scientific findings, on the part of individual decision-makers who can be "targeted" for a KT intervention, in a context that is absent of political interests. However, complex urban health problems and interventions infrequently resemble this single decision, single decision-maker model posited by KT. In order to clarify the conditions under which urban health research is more likely or not to have an influence on public policy development, we propose to supplement the conventional model with three concepts drawn from the social science: policy stages, policy networks, and a discourse analysis approach for theorizing power in policy-making.
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Affiliation(s)
- Kelly Murphy
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, Keenan Research Centre, St. Michael`s Hospital, Toronto, ON, Canada.
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