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Buse K, McKee M. UK political parties pledge to strengthen security-yet ignore health security. BMJ 2024; 385:q1359. [PMID: 38901847 DOI: 10.1136/bmj.q1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Affiliation(s)
- Kent Buse
- Healthier Societies Program, The George Institute for Global Health, Imperial College London, UK
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
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2
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Oliver D. David Oliver: Will the actions pledged in Labour's election manifesto save health and social care? BMJ 2024; 385:q1326. [PMID: 38897631 DOI: 10.1136/bmj.q1326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
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3
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Van Berkel J, de Bruijn EJ, Waardenburg M, la Grouw Y, van Bennekom E, van der Horst H, Tonnon S, Haggenburg-Mohammed M, Haveman-Nies A, Madern T, Knoef M, de Vet E. Realist Approach to Social Policies (RASP) study to reduce socioeconomic health inequalities through systems change: protocol for a research project combining mixed-methods realist research with institutional action research. BMJ Open 2024; 14:e088571. [PMID: 38871658 DOI: 10.1136/bmjopen-2024-088571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION Health inequalities are rooted in inequality in vital resources for health, including financial resources, a supportive informal network, a stable living situation, work or daytime activities or education and literacy. About 25% of Dutch citizens experience deprivation of such resources. Social policy consists of crucial instruments for improving resources in those groups but can also have adverse effects and lead to additional burdens. This project aims to contribute to the reduction of health inequalities through (1) a better understanding of how social policy interventions can contribute to reducing health inequality through the redistribution of burdens and resources and (2) developing anticipatory governance strategies to implement those insights, contributing to a change in social policy systems. METHODS AND ANALYSIS Two systems approaches are combined for establishing a systems change in the Netherlands. First, a realist approach enables insights into what in social policy interventions may impact health outcomes, for whom and under what circumstances. Second, an institutional approach enables scaling up these insights, by acknowledging the crucial role of institutional actors for accomplishing a systems change. Together with stakeholders, we perform a realist review of the literature and identify existing promising social policy interventions. Next, we execute mixed-methods realist evaluations of selected social policy interventions in seven municipalities, ranging from small, mid-size to large, and in both urban and rural settings. Simultaneously, through action research with (national) institutional actors, we facilitate development of anticipatory governance strategies. ETHICS AND DISSEMINATION This study is not liable to the Medical Research Involving Subjects Act (WMO). Informed consent to participate in the study is obtained from participants for the use of all forms of personally identifiable data. Dissemination will be codeveloped with target populations and includes communication materials for citizens, education materials for students, workshops, infographics and decision tools for policy-makers and publications for professionals.
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Affiliation(s)
- Jantien Van Berkel
- Interdisciplinary Social Science, Public Health, Utrecht University, Utrecht, The Netherland
- Consumption and Healthy Lifestyles, Wageningen Universiteit en Research, Wageningen, The Netherland
| | - Ernst-Jan de Bruijn
- Institute of Tax Law and Economics | Department of Economics, Leiden University, Leiden, The Netherland
| | - Maikel Waardenburg
- Law, Economics and Governance, School of Governance, Utrecht University, Utrecht, The Netherland
| | - Yvonne la Grouw
- Law, Economics and Governance, School of Governance, Utrecht University, Utrecht, The Netherland
| | - Eline van Bennekom
- Interdisciplinary Social Science, Public Health, Utrecht University, Utrecht, The Netherland
- Consumption and Healthy Lifestyles, Wageningen Universiteit en Research, Wageningen, The Netherland
| | - Hilje van der Horst
- Consumption and Healthy Lifestyles, Wageningen Universiteit en Research, Wageningen, The Netherland
| | - Susanne Tonnon
- Debt and Collection, Hogeschool Utrecht, Utrecht, The Netherland
| | | | - Annemien Haveman-Nies
- Consumption and Healthy Lifestyles, Wageningen Universiteit en Research, Wageningen, The Netherland
- AGORA Academische Werkplaats, GGD Noord en Oost Gelderland, Warnsveld, The Netherland
| | - Tamara Madern
- Debt and Collection, Hogeschool Utrecht, Utrecht, The Netherland
| | - Marike Knoef
- Institute of Tax Law and Economics | Department of Economics, Leiden University, Leiden, The Netherland
- Tilburg School of Economics and Management, Tilburg University, Tilburg, The Netherland
| | - Emely de Vet
- Consumption and Healthy Lifestyles, Wageningen Universiteit en Research, Wageningen, The Netherland
- Tilburg School of Humanities and Digital Sciences, Liberal Arts and Sciences, Tilburg University, Tilburg, The Netherland
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Oliver D. David Oliver: What the party manifestos should cover on health and social care but probably won't. BMJ 2024; 385:q1202. [PMID: 38839095 DOI: 10.1136/bmj.q1202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
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5
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Hiam L, Klaber B, Sowemimo A, Marmot M. NHS and the whole of society must act on social determinants of health for a healthier future. BMJ 2024; 385:e079389. [PMID: 38604669 DOI: 10.1136/bmj-2024-079389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Affiliation(s)
| | - Bob Klaber
- Research, Innovation, Imperial College Healthcare NHS Trust, London, UK
- School of Public Health, Imperial College London, London, UK
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D'Andreamatteo A, Neri F, Antonucci G, Sargiacomo M. Immigration, policies of integration and healthcare expenditure: A longitudinal analysis of the INHS (2002‒2018). Health Policy 2024; 142:104960. [PMID: 38377670 DOI: 10.1016/j.healthpol.2023.104960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 11/22/2023] [Accepted: 12/05/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND Immigration has become a structural phenomenon in Italy, a country reputed as being 'immigrant-friendly'. The increase in the proportion of immigrants has led to increasing efforts to design and implement health policies throughout the country while controlling public spending. METHOD Being interested in both the cross-sectional and time series dimensions of analysis, we used a PVAR (Panel Vector Autoregression) model, which combines the VAR technique with panel data models, to estimate the impact of regular immigration on health expenditure. FINDINGS Our results confirm that an increase in the share of regular immigrants in the total population decreases the amount of aggregate public health expenditure. CONCLUSION Despite the intense activity by Italian governments on social and health integration policies for immigrants, policymakers may focus more on the implementation of national policies at regional and local levels, on their costs and with a specific focus on undocumented immigrants.
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Affiliation(s)
- Antonio D'Andreamatteo
- Department of Management and Business Administration Gabriele d'Annunzio University of Chieti-Pescara, Italy.
| | - Francesca Neri
- Department of Management and Business Administration Gabriele d'Annunzio University of Chieti-Pescara, Italy.
| | - Gianluca Antonucci
- Department of Management and Business Administration Gabriele d'Annunzio University of Chieti-Pescara, Italy.
| | - Massimo Sargiacomo
- Department of Management and Business Administration Gabriele d'Annunzio University of Chieti-Pescara, Italy.
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Mirza I, Ameda IM, Ba AE, Traore C, Hagos MT, Gbaya AA, Schreiber B. COVID-19 Vaccination Integration: Efforts in 11 African Countries to Strengthen the Primary Health Care System. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300251. [PMID: 38151298 PMCID: PMC10948128 DOI: 10.9745/ghsp-d-23-00251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/04/2023] [Indexed: 12/29/2023]
Abstract
Efforts to integrate COVID-19 vaccination into the primary health care system in 11 African countries have been initiated through partnerships, collaborations, and leveraging existing infrastructure.
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Affiliation(s)
| | - Ida-Marie Ameda
- UNICEF Eastern and Southern Africa, Regional Office, Nairobi, Kenya
| | | | - Celestin Traore
- UNICEF Western and Central Africa, Regional Office, Dakar, Senegal
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8
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Song C, Fang L, Xie M, Tang Z, Zhang Y, Tian F, Wang X, Lin X, Liu Q, Xu S, Pan J. Revealing spatiotemporal inequalities, hotspots, and determinants in healthcare resource distribution: insights from hospital beds panel data in 2308 Chinese counties. BMC Public Health 2024; 24:423. [PMID: 38336709 DOI: 10.1186/s12889-024-17950-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Ensuring universal health coverage and equitable access to health services requires a comprehensive understanding of spatiotemporal heterogeneity in healthcare resources, especially in small areas. The absence of a structured spatiotemporal evaluation framework in existing studies inspired us to propose a conceptual framework encompassing three perspectives: spatiotemporal inequalities, hotspots, and determinants. METHODS To demonstrate our three-perspective conceptual framework, we employed three state-of-the-art methods and analyzed 10 years' worth of Chinese county-level hospital bed data. First, we depicted spatial inequalities of hospital beds within provinces and their temporal inequalities through the spatial Gini coefficient. Next, we identified different types of spatiotemporal hotspots and coldspots at the county level using the emerging hot spot analysis (Getis-Ord Gi* statistics). Finally, we explored the spatiotemporally heterogeneous impacts of socioeconomic and environmental factors on hospital beds using the Bayesian spatiotemporally varying coefficients (STVC) model and quantified factors' spatiotemporal explainable percentages with the spatiotemporal variance partitioning index (STVPI). RESULTS Spatial inequalities map revealed significant disparities in hospital beds, with gradual improvements observed in 21 provinces over time. Seven types of hot and cold spots among 24.78% counties highlighted the persistent presence of the regional Matthew effect in both high- and low-level hospital bed counties. Socioeconomic factors contributed 36.85% (95% credible intervals [CIs]: 31.84-42.50%) of county-level hospital beds, while environmental factors accounted for 59.12% (53.80-63.83%). Factors' space-scale variation explained 75.71% (68.94-81.55%), whereas time-scale variation contributed 20.25% (14.14-27.36%). Additionally, six factors (GDP, first industrial output, local general budget revenue, road, river, and slope) were identified as the spatiotemporal determinants, collectively explaining over 84% of the variations. CONCLUSIONS Three-perspective framework enables global policymakers and stakeholders to identify health services disparities at the micro-level, pinpoint regions needing targeted interventions, and create differentiated strategies aligned with their unique spatiotemporal determinants, significantly aiding in achieving sustainable healthcare development.
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Affiliation(s)
- Chao Song
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
- Institute for Healthy Cities and West China Research Centre for Rural Health Development, Sichuan University, Chengdu, Sichuan, China
- West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, Sichuan, China
| | - Lina Fang
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
- Institute for Healthy Cities and West China Research Centre for Rural Health Development, Sichuan University, Chengdu, Sichuan, China
| | - Mingyu Xie
- School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhangying Tang
- State Key Laboratory of Oil and Gas Reservoir Geology and Exploitation, School of Geoscience and Technology, Southwest Petroleum University, Chengdu, Sichuan, China
| | - Yumeng Zhang
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
- Institute for Healthy Cities and West China Research Centre for Rural Health Development, Sichuan University, Chengdu, Sichuan, China
| | - Fan Tian
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiuli Wang
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
- Institute for Healthy Cities and West China Research Centre for Rural Health Development, Sichuan University, Chengdu, Sichuan, China
| | - Xiaojun Lin
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
- Institute for Healthy Cities and West China Research Centre for Rural Health Development, Sichuan University, Chengdu, Sichuan, China
- West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, Sichuan, China
| | - Qiaolan Liu
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shixi Xu
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Jay Pan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.
- China Center for South Asian Studies, Sichuan University, Chengdu, Sichuan, China.
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Loffreda G, Arakelyan S, Bou-Orm I, Holmer H, Allen LN, Witter S, Ager A, Diaconu K. Barriers and Opportunities for WHO "Best Buys" Non-communicable Disease Policy Adoption and Implementation From a Political Economy Perspective: A Complexity Systematic Review. Int J Health Policy Manag 2024; 13:7989. [PMID: 38618832 PMCID: PMC11016278 DOI: 10.34172/ijhpm.2023.7989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 12/30/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Improving the adoption and implementation of policies to curb non-communicable diseases (NCDs) is a major challenge for better global health. The adoption and implementation of such policies remain deficient in various contexts, with limited insights into the facilitating and inhibiting factors. These policies have traditionally been treated as technical solutions, neglecting the critical influence of political economy dynamics. Moreover, the complex nature of these interventions is often not adequately incorporated into evidence for policy-makers. This study aims to systematically review and evaluate the factors affecting NCD policy adoption and implementation. METHODS We conducted a complex systematic review of articles discussing the adoption and implementation of World Health Organization's (WHO's) "best buys" NCD policies. We identified political economy factors and constructed a causal loop diagram (CLD) program theory to elucidate the interplay between factors influencing NCD policy adoption and implementation. A total of 157 papers met the inclusion criteria. RESULTS Our CLD highlights a central feedback loop encompassing three vital variables: (1) the ability to define, (re)shape, and pass appropriate policy into law; (2) the ability to implement the policy (linked to the enforceability of the policy and to addressing NCD local burden); and (3) ability to monitor progress, evaluate and correct the course. Insufficient context-specific data impedes the formulation and enactment of suitable policies, particularly in areas facing multiple disease burdens. Multisectoral collaboration plays a pivotal role in both policy adoption and implementation. Effective monitoring and accountability systems significantly impact policy implementation. The commercial determinants of health (CDoH) serve as a major barrier to defining, adopting, and implementing tobacco, alcohol, and diet-related policies. CONCLUSION To advance global efforts, we recommend focusing on the development of robust accountability, monitoring, and evaluation systems, ensuring transparency in private sector engagement, supporting context-specific data collection, and effectively managing the CDoH. A system thinking approach can enhance the implementation of complex public health interventions.
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Affiliation(s)
- Giulia Loffreda
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, UK
| | - Stella Arakelyan
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, UK
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Musselburgh, UK
| | - Ibrahim Bou-Orm
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, UK
| | - Hampus Holmer
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Luke N. Allen
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Sophie Witter
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, UK
| | - Alastair Ager
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, UK
| | - Karin Diaconu
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, UK
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Hagenaars LL, Maani N, Schmidt LA. Is the commercial determinants conversation confined to the health sciences? Potentially, and that's a problem. Global Health 2024; 20:3. [PMID: 38167207 PMCID: PMC10759639 DOI: 10.1186/s12992-023-00989-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/06/2023] [Indexed: 01/05/2024] Open
Abstract
The commercial determinants of health (CDoH) are attracting increased interest and are of great importance when discussing how trade affects health. Through a citation analysis of recent foundational CDoH documents (a Lancet paper series and an Oxford University textbook), we find that fully 71% of all citations reference the health sciences. The health sciences may be well suited to documenting the specific pathways of how commercial (by)products and practices harm human health. However, to operationalize upstream solutions for mitigating these harms, our citation analysis suggests that the field can engage political scientists, economists, sociologists, the trade law and business, as well as advocates in civil society and journalism, more so than it currently does. With CDoH explicitly referring to the interaction between commerce and health, CDoH researchers might be uniquely positioned to get health on the agenda of others, which requires that CDoH methods, datasets, evidence reviews, and proposed interventions are drawn from the widest possible range of sources.
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Affiliation(s)
- Luc Louis Hagenaars
- University of California San Francisco School of Medicine, Philip R. Lee Institute for Health Policy Studies, Campus Box 0936, 490 Illinois Street, Floor 7, San Francisco, CA, 94158, USA.
- Department of Public Health, Amsterdam UMC Location AMC, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands.
| | - Nason Maani
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, 15a George Square, Edinburgh, UK
| | - Laura Anne Schmidt
- University of California San Francisco School of Medicine, Philip R. Lee Institute for Health Policy Studies, Campus Box 0936, 490 Illinois Street, Floor 7, San Francisco, CA, 94158, USA
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Goldstein S, Mabry RM, Friedman EA, Sales ALLDF, Castro A. Achieving and Maintaining Equitable Health Outcomes for all, Including for Future Generations. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2024; 54:65-67. [PMID: 37964546 DOI: 10.1177/27551938231214984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Sustainable health equity means achieving and maintaining equitable health outcomes for all people, including for future generations. It encompasses realizing the right to health, setting the conditions for leading a healthy life, and fulfilling the full range of human rights. Achieving sustainable health equity requires that public services be designed and provided, and public policies be developed through empowering, inclusive, participatory, accountable, and democratic processes and mechanisms.
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Affiliation(s)
- Susan Goldstein
- SAMRC Centre for Health Economics and Decision Science PRICELESS SA, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Eric A Friedman
- O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, USA
| | | | - Arachu Castro
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA
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Morgan MJ, Stratford E, Harpur S, Rowbotham S. Local government's roles in community health and wellbeing in Australia: Insights from Tasmania. Health Promot J Austr 2023. [PMID: 38050655 DOI: 10.1002/hpja.831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/18/2023] [Accepted: 11/15/2023] [Indexed: 12/06/2023] Open
Abstract
ISSUE ADDRESSED Local governments are well-placed to respond to communities' health and wellbeing needs. However, in the Australian state of Tasmania, the sector's roles in that respect are unclear. METHODS We interviewed 10 municipal personnel in Tasmania to understand their views on local governments' community health and wellbeing functions. RESULTS Participants had an integrative understanding of community health and wellbeing and recognised that collective effort from all tiers of government, community members, and other place-based stakeholders would improve outcomes. They identified several roles local governments have to support and drive such improvements, including in relation to diverse place-specific determinants of health and wellbeing. Capacity and capability to fulfil what is needed varied, with rural and remote councils generally less able than urban counterparts to respond consistently or comprehensively to community members' complex needs. However, in the presence of clear expectations and parameters, and appropriate support from other tiers of government, participants were eager for their councils to do more to improve their communities' health and wellbeing, including via a mandate in legislation. CONCLUSION Local governments have the potential to do more to improve health and wellbeing outcomes in Tasmania, and the greatest gains could be made by addressing spatial inequalities faced by the sector. That insight is extensible to other comparable jurisdictions. SO WHAT?: We argue the need both for a shared societal goal of equitable wellbeing supported by all tiers of government and for actions proportionate to the needs of council areas.
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Affiliation(s)
- Michelle J Morgan
- School of Geography, Planning, and Spatial Sciences, University of Tasmania, Hobart, Tasmania, Australia
- Department of Health, Public Health Services, Tasmanian Government, Hobart, Tasmania, Australia
| | - Elaine Stratford
- School of Geography, Planning, and Spatial Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | - Siobhan Harpur
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Samantha Rowbotham
- School of Geography, Planning, and Spatial Sciences, University of Tasmania, Hobart, Tasmania, Australia
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
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Wahl B, Nama N, Pandey RR, Garg T, Mishra AM, Srivastava S, Ali S, Verma SK, Erchick DJ, Sauer M, Venkatesh U, Koparkar A, Kishore S. Neonatal, Infant, and Child Mortality in India: Progress and Future Directions. Indian J Pediatr 2023; 90:1-9. [PMID: 37695418 DOI: 10.1007/s12098-023-04834-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/08/2023] [Indexed: 09/12/2023]
Abstract
In India, considerable progress has been made in reducing child mortality rates. Despite this achievement, wide disparities persist across and socio-economic strata, and persistent challenges, such as malnutrition, poor sanitation, and lack of clean water. This paper provides a comprehensive review of the state of child health in India, examining key risk factors and causes of child mortality, assessing the coverage of child health interventions, and highlighting critical public health programs and policies. The authors also discuss future directions and recommendations for bolstering ongoing efforts to improve child health. These include state- and region-specific interventions, prioritizing social determinants of health, strengthening data systems, leveraging existing programs like the National Health Mission (NHM) and Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), and the proposed Public Health Management Cadre (PHMC). The authors argue that reducing child mortality requires not only scaled-up interventions but a comprehensive approach that addresses all dimensions of health, from social determinants to system strengthening.
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Affiliation(s)
- Brian Wahl
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
- Johns Hopkins India, Lucknow, Uttar Pradesh, India.
| | - Norah Nama
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Raghukul Ratan Pandey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Johns Hopkins India, Lucknow, Uttar Pradesh, India
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Tushar Garg
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Johns Hopkins India, Lucknow, Uttar Pradesh, India
| | - Aman Mohan Mishra
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Johns Hopkins India, Lucknow, Uttar Pradesh, India
| | - Swati Srivastava
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Johns Hopkins India, Lucknow, Uttar Pradesh, India
| | - Sana Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Johns Hopkins India, Lucknow, Uttar Pradesh, India
| | - Shival Kishore Verma
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Johns Hopkins India, Lucknow, Uttar Pradesh, India
| | - Daniel J Erchick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Molly Sauer
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - U Venkatesh
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Gorakhpur, India
| | - Anil Koparkar
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Gorakhpur, India
| | - Surekha Kishore
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Gorakhpur, India
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Nava M, Crago C, Cañizares M, Scott G, Vazquez CE. Advancing shared accountability for meaningful community engagement with socially vulnerable communities: Lessons learned from COVID-19 health education and general outreach in an urban region. TRANSFORMATIVE SOCIAL WORK 2023; 1:10.55016/ojs/tsw.v1i1.77548. [PMID: 38469126 PMCID: PMC10926231 DOI: 10.55016/ojs/tsw.v1i1.77548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
As COVID-19 public health emergency measures come to an end, socially vulnerable communities have reduced access to resources that address social and health disparities created or exacerbated by the pandemic. Social workers must uphold access to healthcare as a human right in the post-pandemic era by reducing social vulnerability and strengthening community resilience to respond to future health emergencies and natural disasters. This paper draws on the experiences of a team of social work researchers, students, and practitioners engaged in efforts to disseminate information on COVID preventive measures and broker access to local health and social resources. This project, based in one of the fastest-growing metropolitan areas in the United States, formed part of the federal research response to promote community engagement in regions most disproportionately impacted by the COVID-19 pandemic. Through participation in health fairs and community events that targeted persons with limited access to healthcare resources, we gathered critical insights on how to build community capacity for meaningful community engagement. Drawing on a conceptual model for evaluating community engagement strategies, we describe three main barriers to collaborative community outreach: weak organizational communication and coordination, inconsistent strategies for requesting on-site health services, and low neighborhood awareness of outreach events. We advance strategies for improvement that engage community-based organizations, health systems, backbone organizations, and community members in targeted activities to build community resilience. This includes inter-organizational communication during outreach event planning, formal processes to promote greater use of mobile health services, centralized event communication, and grassroots outreach event promotion.
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Affiliation(s)
- Marcela Nava
- School of Social Work, University of Texas at Arlington, Arlington, Texas, United States
| | - Caleb Crago
- School of Social Work, University of Texas at Arlington, Arlington, Texas, United States
| | - Monica Cañizares
- School of Social Work, University of Texas at Arlington, Arlington, Texas, United States
| | - Gabrielle Scott
- School of Social Work, University of Texas at Arlington, Arlington, Texas, United States
| | - Christian E. Vazquez
- School of Social Work, University of Texas at Arlington, Arlington, Texas, United States
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Nava M, English AS, Fulmer L, Sanchez K. An action research partnership in an urban Texas county to explore barriers and opportunities for collaborative community health needs assessments. Front Public Health 2023; 11:1244143. [PMID: 37900035 PMCID: PMC10613110 DOI: 10.3389/fpubh.2023.1244143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/19/2023] [Indexed: 10/31/2023] Open
Abstract
Background The Affordable Care Act mandated triennial community health needs assessments (CHNAs) for greater nonprofit hospital accountability in responding to community health needs. Over 10 years later, hospital spending on community benefits remains largely unchanged. While greater collaboration in CHNA implementation can increase hospital investment in community-based initiatives, nonprofit hospitals in conservative states are subject to policy, political, and economic factors that inhibit public health partnerships and magnify existing disparities in health care access. This participatory action research study explores the decision-making environment of collaborative CHNA implementation within a group of nonprofit hospitals in a north Texas urban county. Methods In 2017 faculty from an urban anchor institution initiated an academic-community partnership with a coalition of nonprofit hospitals, public health departments, and academic institutions. An interdisciplinary research team engaged in multi-method document review and qualitative data collection to describe historical barriers for local CHNA processes and develop practical strategies for joint CHNA initiatives. Local CHNA documents were first reviewed through team-based content analysis and results applied to develop a qualitative study protocol. Key informants were recruited from county-based nonprofit hospitals, community-based nonprofit organizations, and public health systems. Seventeen senior- and mid-level professionals participated in semi-structured research interviews to describe their perspectives relating to CHNA-related planning and implementation decisions. Through iterative data collection and analysis, the research team explored CHNA-related knowledge, experiences, and processes. A constructivist lens was subsequently applied to examine historical barriers and future opportunities for local collaboration. Results Findings reveal CHNA implementation is a multi-stage cyclical process in organizational environments with accountability to a wide range of public and private stakeholders. This promotes varied levels of inclusivity and conservatism in data collection and community benefit implementation. Decisions to collaborate are hindered by competing priorities, including compliance with existing guidelines, administrative simplicity, alignment with health care service delivery, and efficient resource use. Efforts to promote greater CHNA collaboration may be facilitated through intentional alignment with organizational priorities and clearly communicated benefits of participation for leaders in both public and private nonprofit health systems. Discussion We consider implications for policymakers and health systems in restrictive political environments and advance a conceptual framework for greater CHNA collaboration.
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Affiliation(s)
- Marcela Nava
- School of Social Work, The University of Texas at Arlington, Arlington, TX, United States
| | - Amanda S. English
- Institute for Implementation Science, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Linda Fulmer
- Institute for Implementation Science, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Katherine Sanchez
- Institute for Implementation Science, The University of Texas Health Science Center at Houston, Houston, TX, United States
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Li R, Zhang K, Li SM, Zhang Y, Tian J, Lu Z, Li H, Wang L, Wan X, Zhang F, Li L, Jin ZB, Wang N, Liu H. Implementing a digital comprehensive myopia prevention and control strategy for children and adolescents in China: a cost-effectiveness analysis. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 38:100837. [PMID: 37520278 PMCID: PMC10372367 DOI: 10.1016/j.lanwpc.2023.100837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/30/2023] [Accepted: 06/19/2023] [Indexed: 08/01/2023]
Abstract
Background Children and adolescents' myopia is a major public problem. Although the clinical effect of various interventions has been extensively studied, there is a lack of national-level and integral assessments to simultaneously quantify the economics and effectiveness of comprehensive myopia prevention and control programs. We aimed to compare the cost-effectiveness between traditional myopia prevention and control strategy, digital comprehensive myopia prevention and control strategy and school-based myopia screening program in China. Methods A Markov model was used to compare the cost-utility and cost-effectiveness among school-based myopia screening, traditional myopia prevention and control strategy, and digital comprehensive myopia prevention and control strategy among 6 to 18-year-old rural and urban schoolchildren. Parameters were collected from published sources. The primary outcomes were quality-adjusted life-year, disability-adjusted life-year, incremental cost-utility ratio, and incremental cost-effectiveness ratio. Extensive sensitivity analyses were performed to test the robustness and sensitivity of base-case analysis. Findings Compared with school-based myopia screening strategy, after implementing digital comprehensive myopia prevention and control strategy, the prevalence of myopia among 18-year-old students in rural and urban areas was reduced by 3.79% and 3.48%, respectively. The incremental cost-utility ratio per quality-adjusted life-year gained with the digital myopia management plan ($11,301 for rural setting, and $10,707 for urban setting) was less than 3 times the per capita gross domestic product in rural settings ($30,501) and less than 1 time the per capita gross domestic product in urban settings ($13,856). In cost-effectiveness analysis, the incremental cost-effectiveness ratio produced by digital comprehensive myopia management strategy ($37,446 and $41,814 per disability-adjusted life-year averted in rural and urban settings) slightly exceeded the cost-effectiveness threshold. When assuming perfect compliance, full coverage of outdoor activities and spectacles satisfied the cost-effectiveness threshold, and full coverage of outdoor activities produced the lowest cost ($321 for rural settings and $808 for urban settings). Interpretations Health economic evidence confirmed the cost-effectiveness of promoting digital comprehensive myopia prevention and control strategies for schoolchildren at the national level. Sufficient evidence provides an economic and public health reference for further action by governments, policy-makers and other myopia-endemic countries. Funding National Natural Science Foundation of China, NSFC (82171051), Beijing Natural Science Foundation (JQ20029), Capital Health Research and Development of Special (2020-2-1081), National Natural Science Foundation of China, NSFC (82071000), National Natural Science Foundation of China, NSFC (8197030562).
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Affiliation(s)
- Ruyue Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Kaiwen Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Shi-Ming Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Yue Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Jiaxin Tian
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Zhecheng Lu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Huiqi Li
- School of Medical Technology, Beijing Institute of Technology, Beijing, 102488, China
| | - Liyuan Wang
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150000, China
| | - Xiuhua Wan
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Fengju Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Li Li
- Department of Ophthalmology, National Key Discipline of Pediatrics, Ministry of Education, Beijing Children's Hospital, Capital Medical University, Beijing, 100000, China
| | - Zi-Bing Jin
- Beijing Institute of Ophthalmology, Beijing, 100730, China
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Ningli Wang
- Beijing Institute of Ophthalmology, Beijing, 100730, China
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
- School of Medical Technology, Beijing Institute of Technology, Beijing, 102488, China
- National Institute of Health Data Science at Peking University, Beijing, 100000, China
| | - Hanruo Liu
- Beijing Institute of Ophthalmology, Beijing, 100730, China
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
- School of Medical Technology, Beijing Institute of Technology, Beijing, 102488, China
- National Institute of Health Data Science at Peking University, Beijing, 100000, China
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Castro-Sánchez E. Nursing care towards the global challenges of the climate crisis: If not now, when? ENFERMERIA CLINICA (ENGLISH EDITION) 2023; 33:247-250. [PMID: 37392998 DOI: 10.1016/j.enfcle.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/28/2023] [Indexed: 07/03/2023]
Affiliation(s)
- Enrique Castro-Sánchez
- Brunel University London, College of Business, Arts, and Social Sciences, Uxbridge, United Kingdom; Imperial College London, NIHR Health Protection Research Unit in Healthcare-Associated Infection and Antimicrobial Resistance, London, United Kingdom; Global health and Sustainable Human Development Research Group, University of the Balearic Islands, Palma de Mallorca, Spain.
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Gu K, Zhou M, Luo W, Liu Y, Dou P, Huang C, Di Q. Long-term exposure to fine particulate matter and cardiovascular disease: The mitigation role of environmental concerns. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 875:162656. [PMID: 36894102 DOI: 10.1016/j.scitotenv.2023.162656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/05/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
Although it is widely acknowledged that environmental concerns can reduce PM2.5 pollution, few studies have empirically estimated whether environmental concerns could bring health benefits by mitigating PM2.5 pollution. Here, we quantified government and media environmental concerns with text-mining algorithm, matched with cohort data along with high-resolution gridded PM2.5 data. Accelerated failure time model and mediation model were used to explore the association between PM2.5 exposure and onset time to cardiovascular events, and the mitigation effect of environmental concerns. Every 1 μg/m3 increase in PM2.5 exposure was associated with shortened time to stroke and heart problem, with time ratios of 0.9900 and 0.9986, respectively. Each 1 unit increase in government and media environmental concerns, as well as their synergistic effect decreased PM2.5 pollution by 0.32 %, 0.25 % and 0.46 %, respectively; and decrease PM2.5 resulted in prolonged onset time to cardiovascular events. Mediation analysis revealed that reduced PM2.5 mediated up to 33.55 % of the association between environmental concerns and onset time to cardiovascular events, suggesting that other mediation pathways were also possible. Associations of PM2.5 exposure and environmental concerns with stroke and heart problem were similar in different subgroups. Overall, environmental concerns reduce risks of cardiovascular disease by mitigating PM2.5 pollution and other pathways in a real-world data set. This study provides insights for low-and-middle-income countries to address air pollution and improve health co-benefit.
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Affiliation(s)
- Kuiying Gu
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China; Institute of Healthy China, Tsinghua University, Beijing 100084, China
| | - Miao Zhou
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China
| | - Wei Luo
- Geography Department, Saw Swee Hock School of Public Health, National University of Singapore, 117576, Singapore
| | - Yu Liu
- Institute of Remote Sensing and Geographical Information Systems, School of Earth and Space Sciences, Peking University, Beijing 100084, China
| | - Pengyue Dou
- Mailman School of Public Health, Columbia University, New York 10032, USA
| | - Cunrui Huang
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China; Institute of Healthy China, Tsinghua University, Beijing 100084, China.
| | - Qian Di
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China; Institute of Healthy China, Tsinghua University, Beijing 100084, China.
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Green L, Ashton K, Parry-Williams L, Dyakova M, Clemens T, Bellis MA. Facilitators, Barriers and Views on the Role of Public Health Institutes in Promoting and Using Health Impact Assessment-An International Virtual Scoping Survey and Expert Interviews. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13367. [PMID: 36293948 PMCID: PMC9602578 DOI: 10.3390/ijerph192013367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/06/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
Public health institutes have an important role in promoting and protecting the health and well-being of populations. A key focus of such institutes are the wider determinants of health, embracing the need to advocate for 'Health in All Policies' (HiAP). A valuable tool to support this is the health impact assessment. This study aims to support public health institutes to advocate more successfully for the use of health impact assessments and HiAP in order to promote and protect health, well-being and equity. During July 2021, a quantitative online survey was undertaken across international networks with 17 valid responses received. Semi-structured interviews were also administered with nine expert representatives and analysed thematically. In total, 64.7% (n = 11) of survey respondents were aware of health impact assessments and 47.1% (n = 8) currently conducted health impact assessments. It was noted that there are differing approaches to HIAs, with a need for a clear set of standards. Barriers to use included lack of knowledge, training and resources. Overall, 64.7% (n = 11) of survey respondents would like to do more to develop knowledge and capacity around health impact assessments. The results from this study can serve as a platform to help build knowledge, networks and expertise, to help support a 'Health in All Policies' approach and address inequalities which exist in all societies.
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Affiliation(s)
- Liz Green
- Policy and International Health, WHO Collaborating Centre on ‘Investment in Health and Well-Being’, Public Health Wales, Cardiff CF10 4BZ, UK
- Department of International Health, Care and Public Health Research Institute CAPHRI, Maastricht University, Duboisdomein 30, 6229 GT Maastricht, The Netherlands
| | - Kathryn Ashton
- Policy and International Health, WHO Collaborating Centre on ‘Investment in Health and Well-Being’, Public Health Wales, Cardiff CF10 4BZ, UK
- Department of International Health, Care and Public Health Research Institute CAPHRI, Maastricht University, Duboisdomein 30, 6229 GT Maastricht, The Netherlands
| | - Lee Parry-Williams
- Policy and International Health, WHO Collaborating Centre on ‘Investment in Health and Well-Being’, Public Health Wales, Cardiff CF10 4BZ, UK
| | - Mariana Dyakova
- Policy and International Health, WHO Collaborating Centre on ‘Investment in Health and Well-Being’, Public Health Wales, Cardiff CF10 4BZ, UK
| | - Timo Clemens
- Department of International Health, Care and Public Health Research Institute CAPHRI, Maastricht University, Duboisdomein 30, 6229 GT Maastricht, The Netherlands
| | - Mark A. Bellis
- Policy and International Health, WHO Collaborating Centre on ‘Investment in Health and Well-Being’, Public Health Wales, Cardiff CF10 4BZ, UK
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