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South J, Woodall J, Stansfield J, Mapplethorpe T, Passey A, Bagnall AM. A qualitative synthesis of practice-based learning from case studies on COVID community champion programmes in England, UK. BMC Public Health 2024; 24:7. [PMID: 38166766 PMCID: PMC10759547 DOI: 10.1186/s12889-023-17470-1] [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: 08/01/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Community-based volunteering supports outbreak management by extending reach into at-risk communities. This paper examines the application of a 'community champions' model in England, UK, during the COVID-19 pandemic. Evidence pre-pandemic shows that community champion interventions tap into social networks to strengthen connections with disadvantaged communities. During the pandemic, the UK government set up a COVID community champions funding award scheme for local authorities to develop local programmes that addressed emerging inequalities. The study aim was to identify transferable learning on community engagement in the pandemic by undertaking a secondary qualitative synthesis of practice-based case studies of local COVID community champion programmes. METHODS A systematic staged approach for synthesis of practice-based case studies was used. In total, 16 COVID community champion case studies, which were written by practitioners involved in local programme implementation and published by the Local Government Association, were included. Case studies covered aims, programme development and delivery, examples of activities and a discussion of learning. Framework qualitative analysis methods were used to code and organise data prior to cross case analysis. The final stage produced an overarching thematic framework that best represented descriptive and interpretive themes. RESULTS The results provide an overview of common features of COVID community champion programmes and emergent learning. All local programmes aimed to reduce health inequalities by involving at-risk communities in local prevention efforts, adapting the approach to local priorities. Two levels of community engagement were volunteer mobilisation and subsequent community-based outreach activities. Elements of capacity building, such as training and creation of networks, were common. The synthesis of practice-based learning found that stronger relationships with communities were regarded as a key mechanism to support more equitable prevention strategies. Other learning themes related to champion roles, community engagement strategies and programme implementation. CONCLUSIONS By focusing on how community champion approaches were applied by local authorities in England during the COVID-19 pandemic, this study contributes to knowledge on volunteer mobilisation as a mechanism to improve public health communication and outreach. Notwithstanding the limitations of experiential evidence, the synthesis of practice-based learning highlights potentially transferable community engagement strategies for health protection and health improvement.
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Affiliation(s)
- Jane South
- School of Health, Centre for Health Promotion Research, Leeds Beckett University, Calverley Building, Portland Place, Leeds, LS1 3HE, UK.
| | - James Woodall
- School of Health, Centre for Health Promotion Research, Leeds Beckett University, Calverley Building, Portland Place, Leeds, LS1 3HE, UK
| | - Jude Stansfield
- School of Health, Centre for Health Promotion Research, Leeds Beckett University, Calverley Building, Portland Place, Leeds, LS1 3HE, UK
| | - Tom Mapplethorpe
- Corporate Strategy, Commissioning and Public Health, Kirklees Council, Huddersfield, HD1 9EL, UK
| | - Andrew Passey
- School of Health, Centre for Health Promotion Research, Leeds Beckett University, Calverley Building, Portland Place, Leeds, LS1 3HE, UK
| | - Anne-Marie Bagnall
- School of Health, Centre for Health Promotion Research, Leeds Beckett University, Calverley Building, Portland Place, Leeds, LS1 3HE, UK
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Guglielmin M, Shankardass K, Bayoumi A, O'campo P, Kokkinen L, Muntaner C. Tools for local health in all policies implementation: evidence from an explanatory case study of Kuopio, Finland. Scand J Public Health 2023; 51:1196-1204. [PMID: 35766538 DOI: 10.1177/14034948221090076] [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] [Indexed: 11/17/2022]
Abstract
AIMS This paper describes the use of three governance tools for health in all policies utilised to facilitate implementation in the municipality of Kuopio, Finland: impact assessments, a city mandate (the Kuopio strategy), and shared budgets. METHODS An explanatory case study was used. Data sources included semistructured interviews with 10 government employees and scholarly literature. Realist scientific methods were used to reveal mechanisms underlying the use of tools in health in all policies. RESULTS Strong evidence was found supporting initial and new theory/hypotheses regarding the use of each tool in achieving positive implementation outcomes. Impact assessments facilitated health in all policies by enhancing understanding of health implications. The Kuopio strategy aided in implementation by giving credence to health in all policies work via formal authority. Shared budgets promoted intersectoral discussions and understanding, and a sense of ownership, in addition to allowing time to be spent on health in all policies work and not financial deliberation. CONCLUSIONS Findings confirm the efficacious use of three governance tools in implementing health in all policies in Kuopio. Knowledge and evidence-based guidelines on local health in all policies implementation are needed as this policy approach continues to be recognised and adopted as a means to promote population health and health equity.
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Affiliation(s)
- Maria Guglielmin
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Canada
| | - Ketan Shankardass
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Ahmed Bayoumi
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, Canada
| | - Patricia O'campo
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Lauri Kokkinen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Carles Muntaner
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, Canada
- Bloomberg School of Nursing, University of Toronto, Toronto, Canada
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Guglielmin M, Shankardass K, O’Campo P, Bayoumi AM, Kokkinen L, Muntaner C. Developing a Research Agenda for HiAP Implementation: A Response to the Recent Commentaries. Int J Health Policy Manag 2023; 12:8326. [PMID: 38618764 PMCID: PMC10843367 DOI: 10.34172/ijhpm.2023.8326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/06/2023] [Indexed: 04/16/2024] Open
Affiliation(s)
- Maria Guglielmin
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Ketan Shankardass
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Patricia O’Campo
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ahmed M. Bayoumi
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Division of General Internal Medicine, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Lauri Kokkinen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Carles Muntaner
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Bloomberg School of Nursing University of Toronto, Toronto, ON, Canada
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Cash-Gibson L, Martinez-Herrera E, Benach J. Why and how has the United Kingdom become a high producer of health inequalities research over the past 50 years? A realist explanatory case study. Health Res Policy Syst 2023; 21:23. [PMID: 36959666 PMCID: PMC10037802 DOI: 10.1186/s12961-023-00968-w] [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: 02/02/2023] [Accepted: 02/17/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Evidence on health inequalities has been growing over the past few decades, yet the capacity to produce research on health inequalities varies between countries worldwide and needs to be strengthened. More in-depth understanding of the sociohistorical, political and institutional processes that enable this type of research and related research capacity to be generated in different contexts is needed. A recent bibliometric analysis of the health inequalities research field found inequalities in the global production of this type of research. It also found the United Kingdom to be the second-highest global contributor to this research field after the United States. This study aims to understand why and how the United Kingdom, as an example of a "high producer" of health inequalities research, has been able to generate so much health inequalities research over the past five decades, and which main mechanisms might have been involved in generating this specific research capacity over time. METHODS We conducted a realist explanatory case study, which included 12 semi-structured interviews, to test six theoretical mechanisms that we proposed might have been involved in this process. Data from the interviews and grey and scientific literature were triangulated to inform our findings. RESULTS We found evidence to suggest that at least four of our proposed mechanisms have been activated by certain conditions and have contributed to the health inequalities research production process in the United Kingdom over the past 50 years. Limited evidence suggests that two new mechanisms might have potentially also been at play. CONCLUSIONS Valuable learning can be established from this case study, which explores the United Kingdom's experience in developing a strong national health inequalities research tradition, and the potential mechanisms involved in this process. More research is needed to explore additional facilitating and inhibiting mechanisms and other factors involved in this process in this context, as well as in other settings where less health inequalities research has been produced. This type of in-depth knowledge could be used to guide the development of new health inequalities research capacity-strengthening strategies and support the development of novel approaches and solutions aiming to tackle health inequalities.
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Affiliation(s)
- Lucinda Cash-Gibson
- Department of Political and Social Sciences, Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Mercè Rodoreda 24 Building, Campus Ciutadella UPF, Ramon Trias Fargas, 25-27, 08003, Barcelona, Catalonia, Spain.
- Johns Hopkins University-Pompeu Fabra University Public Policy Center (UPF-BSM), Barcelona, Catalonia, Spain.
- UPF Barcelona School of Management (UPF-BSM), Barcelona, Spain.
| | - Eliana Martinez-Herrera
- Department of Political and Social Sciences, Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Mercè Rodoreda 24 Building, Campus Ciutadella UPF, Ramon Trias Fargas, 25-27, 08003, Barcelona, Catalonia, Spain
- Johns Hopkins University-Pompeu Fabra University Public Policy Center (UPF-BSM), Barcelona, Catalonia, Spain
- Research Group of Epidemiology, National School of Public Health "Héctor Abad Gómez", University of Antioquia, Calle 62 No. 52-59 Bloque 33 Segundo Piso, Medellín, Colombia
| | - Joan Benach
- Department of Political and Social Sciences, Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Mercè Rodoreda 24 Building, Campus Ciutadella UPF, Ramon Trias Fargas, 25-27, 08003, Barcelona, Catalonia, Spain
- Johns Hopkins University-Pompeu Fabra University Public Policy Center (UPF-BSM), Barcelona, Catalonia, Spain
- Ecological Humanities Research Group (GHECO), Universidad Autónoma, Madrid, Spain
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Vooren NJEV, Janssen LMS, Drewes HW, Baan CA, Bongers IMB. How to collaborate for health throughout the project timeline - a longitudinal study reflecting on implemented strategies in three projects for a healthy living environment. BMC Public Health 2023; 23:67. [PMID: 36627586 PMCID: PMC9831012 DOI: 10.1186/s12889-022-14898-9] [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: 07/20/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND When improving the health of local and regional populations, cross-sector collaboration between different policy domains, non-governmental organisations and citizens themselves is needed. Previously, enabling factors and strategies have been identified to improve cross-sector collaboration for health. However, few longitudinal studies have been conducted to understand how the implementation of strategies for cross-sector collaboration changes throughout the collaboration process. The aim of this study is therefore to learn more about the different strategies that were implemented throughout three cross-sector collaboration projects for a healthy living environment. METHODS The realist evaluation approach was used to understand how the implemented strategies worked, in which context, why and with what outcomes. Project partners were asked to reflect on their implemented strategies at two different moments in the project timelines, and quarterly updates with project leaders were held. In addition two reference panels were organised for data triangulation. RESULTS Three key insights for successful cross-sector collaboration throughout projects for a healthy living environment were identified, namely 1. Investing in trust among the partners and faith in the project has a positive influence on continuing the collaboration throughout the project; 2. Making stakeholders actively participate throughout the project requires additional strategies after the onset of the project, and 3. Defining roles, tasks, and other prerequisites at the start of the project helps in pursuing the project over time, but needs re-examination throughout the project. These key insights were based on multiple examples of implemented strategies, linked to context, mechanisms and outcomes. CONCLUSIONS This study shows the different strategies that can be employed as the collaboration in projects for a healthy living environment progresses. We found that 'trust' does not merely include the relationships built between the partners, but at the onset of projects can also be based on faith in the project itself. In addition, as it can be difficult to foresee the right investments and strategies at the onset of the project, frequent reflection moments to choose fitting strategies might benefit regional partners in their cross-sector collaboration for health.
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Affiliation(s)
- N. J. E. van Vooren
- Department of Quality of Care and Health Economics, National Institute for Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services, P.O. Box 1, 3720 BA Bilthoven, The Netherlands
- Tilburg University, Tranzo, Tilburg School of Social and Behavioural Sciences, PO Box 90153, Tilburg, 5000 LE The Netherlands
| | - L. M. S. Janssen
- Department of Quality of Care and Health Economics, National Institute for Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services, P.O. Box 1, 3720 BA Bilthoven, The Netherlands
| | - H. W. Drewes
- Department of Quality of Care and Health Economics, National Institute for Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services, P.O. Box 1, 3720 BA Bilthoven, The Netherlands
| | - C. A. Baan
- Tilburg University, Tranzo, Tilburg School of Social and Behavioural Sciences, PO Box 90153, Tilburg, 5000 LE The Netherlands
| | - I. M. B. Bongers
- Tilburg University, Tranzo, Tilburg School of Social and Behavioural Sciences, PO Box 90153, Tilburg, 5000 LE The Netherlands
- Mental Health Care Institute Eindhoven, de Kempen, PO Box 909, Eindhoven, 5600 AX The Netherlands
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Centralization and integration of public health systems: Perspectives of public health leaders on factors facilitating and impeding COVID-19 responses in three Canadian provinces. Health Policy 2023; 127:19-28. [PMID: 36456399 PMCID: PMC9681988 DOI: 10.1016/j.healthpol.2022.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 10/28/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022]
Abstract
The extent to which power, resources, and responsibilities for public health are centralized or decentralized within a jurisdiction and how public health functions are integrated or coordinated with health care services may shape pandemic responses. However, little is known about the impacts of centralization and integration on public health system responses to the COVID-19 pandemic. We examine how public health leaders perceive centralization and integration facilitated and impeded effective COVID-19 responses in three Canadian provinces. We conducted a comparative case study involving semi-structured interviews with 58 public health system leaders in three Canadian provinces with varying degrees of centralization and integration. Greater public health system centralization and integration was seen by public health leaders to facilitate more rapidly initiated and well-coordinated provincial COVID-19 responses. Decentralization may have enabled locally tailored responses in the context of limited provincial leadership. Opacity in provincial decision-making processes, jurisdictional ambiguity impacting Indigenous communities, and ineffectual public health investments were impediments across jurisdictions and thus appear to be less impacted by centralization and integration. Our study generates novel insights about potential structural facilitators and impediments of effective COVID-19 pandemic responses during the second year of the pandemic. Findings highlight key areas for future research to inform system design that support leaders to manage large-scale public health emergencies.
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Such E, Smith K, Woods HB, Meier P. Governance of Intersectoral Collaborations for Population Health and to Reduce Health Inequalities in High-Income Countries: A Complexity-Informed Systematic Review. Int J Health Policy Manag 2022; 11:2780-2792. [PMID: 35219286 PMCID: PMC10105187 DOI: 10.34172/ijhpm.2022.6550] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 01/30/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND A 'Health in All Policies' (HiAP) approach has been widely advocated as a way to involve multiple government sectors in addressing health inequalities, but implementation attempts have not always produced the expected results. Explaining how HiAP-style collaborations have been governed may offer insights into how to improve population health and reduce health inequalities. METHODS Theoretically focused systematic review. Synthesis of evidence from evaluative studies into a causal logic model. RESULTS Thirty-one publications based on 40 case studies from nine high-income countries were included. Intersectoral collaborations for population health and equity were multi-component and multi-dimensional with collaborative activity spanning policy, strategy, service design and service delivery. Governance of intersectoral collaboration included structural and relational components. Both internal and external legitimacy and credibility delivered collaborative power, which in turn enabled intersectoral collaboration. Internal legitimacy was driven by multiple structural elements and processes. Many of these were instrumental in developing (often-fragile) relational trust. Internal credibility was supported by multi-level collaborations that were adequately resourced and shared power. External legitimacy and credibility was created through meaningful community engagement, leadership that championed collaborations and the identification of 'win-win' strategies. External factors such as economic shocks and short political cycles reduced collaborative power. CONCLUSION This novel review, using systems thinking and causal loop representations, offers insights into how collaborations can generate internal and external legitimacy and credibility. This offers promise for future collaborative activity for population health and equity; it presents a clearer picture of what structural and relational components and dynamics collaborative partners can focus on when planning and implementing HiAP initiatives. The limits of the literature base, however, does not make it possible to identify if or how this might deliver improved population health or health equity.
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Affiliation(s)
- Elizabeth Such
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | | | - Petra Meier
- MRC/CSA Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Porcherie M, Thomas MF, Quidu F, Héritage Z, Vaillant Z, Simos J, Rican S, Cantoreggi N, Faure E, Gall ARL. How to Evaluate Health in All Policies at the Local Level: Methodological Insights Within Municipalities From the WHO French Healthy Cities Network. Int J Health Policy Manag 2022; 11:3060-3070. [PMID: 35942970 PMCID: PMC10105196 DOI: 10.34172/ijhpm.2022.6584] [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: 06/30/2021] [Accepted: 06/15/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This article proposes a method for analysing the degree of maturity of Health in All Policies (HiAP) among World Health Organization-French Healthy Cities Network (WHO-FHCN) as part of the GoveRnance for Equity, EnviroNment and Health in the City (GREENH-City) project. We focused on the creation or enhancement of health-promoting environments, and more specifically, public green spaces. METHODS We conducted a cross-sectional quantitative study guided by the evaluative framework of the HiAP maturity level developed by Storm et al mixed with a qualitative interpretation. A self-administered questionnaire was sent to elected officials and health department officers in the 85 member cities of the WHO-FHCN in 2017. Subsequently 58 cities were included in the analysis, which was based on a multiple correspondence analysis (MCA) and a hierarchical ascending classification (HAC). RESULTS Thirty-two criteria among a total of 100 were identified and were used to organize the cities into 8 groups which was then reduced to three profiles among the cities: a less advanced HiAP profile, an established HiAP profile and an advanced HiAP profile. This process allows us to identify 4 dimensions that make it possible to evaluate the level of maturity of cities in the HiAP process, namely: (1) the consideration of social inequalities in health and/or health issues in the policies/actions of the sector studied, (2) occasional intersectoral collaboration, ie, one-off initiatives between the health department and others sectors, (3) the existence of joint projects, ie, common projects between two or more sectors, (4) the existence of intersectoral bodies, in this case on the theme of urban green spaces including an intersectoral committee and/or working groups. CONCLUSION Four dimensions which allow to the measurement of the degree of progress in implementing health-all-policies are proposed. With a view to integrating knowledge into public action, this study carried out under real conditions offers a realistic method to evaluate HiAP.
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Affiliation(s)
- Marion Porcherie
- Department of Social Sciences, Ecole des Hautes Etudes en Santé Publique, Laboratoire Arènes URM CNRS 6051, Université Rennes 1, Rennes, France
| | - Marie-Florence Thomas
- Ecole des Hautes Etudes en Santé Publique, Leres, Irset UMR- Inserm S 1085, Rennes, France
| | - Frédérique Quidu
- Department of Social Sciences, Ecole des Hautes Etudes en Santé Publique, Laboratoire Arènes URM CNRS 6051, Université Rennes 1, Rennes, France
| | - Zoé Héritage
- Santé Publique France, Saint-Maurice, Paris, France
| | - Zoé Vaillant
- LADYSS, Université Paris-Nanterre, Nanterre, France
| | - Jean Simos
- Institut de Santé Globale, Université de Genève, Genève, Switzerland
| | | | - Nicola Cantoreggi
- Institut de Santé Globale, Université de Genève, Genève, Switzerland
| | | | - Anne Roué Le Gall
- Department of Health and Environment, Ecole des Hautes Etudes en Santé Publique, Laboratoire Arènes URM CNRS 6051, Université Rennes 1, Rennes, France
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Guglielmin M, Shankardass K, Bayoumi A, O’Campo P, Kokkinen L, Muntaner C. A Realist Explanatory Case Study Investigating How Common Goals, Leadership, and Committed Staff Facilitate Health in All Policies Implementation in the Municipality of Kuopio, Finland. Int J Health Policy Manag 2022; 11:2651-2659. [PMID: 35247936 PMCID: PMC9818123 DOI: 10.34172/ijhpm.2022.6355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 02/05/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Health in All Policies (HiAP) encompasses collaboration across government and the consideration of health in various governmental sector's policies and decisions. Despite increasing advocacy, interest, and uptake in HiAP globally, empirical and evaluative studies are underrepresented in this growing literature, particularly literature on HiAP implementation at the local level. Finland has been a pioneer in and champion for HiAP. METHODS A realist explanatory case study design was used to test hypotheses about how HiAP is implemented in Kuopio, Finland. Semi-structured interviews with ten government employees from various sectors were conducted. Data from interviews and literature were analyzed with the aims of uncovering explanatory mechanisms in the form of context-strategy-mechanism-outcome (CSMO) configurations related to implementation strategies. Evidence was evaluated for quality based on triangulation of sources and strength of evidence. We hypothesized that having or creating a common goal between sectors and having committed staff and local leadership would facilitate implementation. RESULTS Strong evidence supports our hypothesis that having or creating a common goal can aid in positive implementation outcomes at the local level. Common goals can be created by the strategies of having a city mandate, engaging in cross-sectoral discussions, and/or by working together. Policy and political elite leadership led to HiAP implementation success because leaders supported HiAP work, thus providing justification for using time to work intersectorally. How and why the wellbeing committee facilitated implementation included by providing opportunities for discussion and learning, which led to understanding of how non-health decisions impact community wellbeing, and by acting as a conduit for the communication of wellbeing goals to government employees. CONCLUSION At the municipal level, having or creating a common goal, leadership from policy and political elites, and the presence of committed staff can facilitate HiAP implementation. Inclusion of not only strategies for HiAP, but also the explanatory mechanisms, aids in elucidating how and why HiAP is successfully implemented in a local setting.
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Affiliation(s)
- Maria Guglielmin
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Ketan Shankardass
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ahmed Bayoumi
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Patricia O’Campo
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Lauri Kokkinen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Carles Muntaner
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Bloomberg School of Nursing University of Toronto, Toronto, ON, Canada
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An umbrella review of intersectoral and multisectoral approaches to health policy. Soc Sci Med 2022; 315:115469. [PMID: 36403353 DOI: 10.1016/j.socscimed.2022.115469] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/06/2022] [Accepted: 10/18/2022] [Indexed: 11/18/2022]
Abstract
Despite the widespread acceptance of the need for intersectoral and multisectoral approaches, knowledge around how to support, achieve, and sustain multisectoral action is limited. While there have been studies that seek to collate evidence on multisectoral action with a specific focus (e.g., Health in All Policies [HiAP]), we postulated that successes of working cross-sectorally to achieve health goals with one approach can glean insights and perhaps translate to other approaches which work across sectors (i.e., shared insights across HiAP, Healthy Cities, One Health, and other approaches). Thus, the goal of this study is to assemble evidence from systematic approaches to reviewing the literature (e.g., scoping review, systematic review) that collate findings on facilitators/enablers of and barriers to implementing various intersectoral and multisectoral approaches to health, to strengthen understanding of how to best implement health policies that work across sectors, whichever they may be. This umbrella review (i.e., review of reviews) was informed by the PRISMA guidelines for scoping reviews, yielding 10 studies included in this review. Enablers detailed are: (1) systems for liaising and engaged communication; (2) political leadership; (3) shared vision or common goals (win-win strategies); (4) education and access to information; and (5) funding. Barriers detailed were: (1) lack of shared vision across sectors; (2) lack of funding; (3) lack of political leadership; (4) lack of ownership and accountability; and (5) insufficient and unavailable indicators and data. These findings provide a rigorous evidence base for policymakers to inform intersectoral and multisectoral approaches to not only aid in the achievement of goals, such as the Sustainable Development Goals, but to work towards health equity.
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Sukhera J, Knaak S. A realist review of interventions to dismantle mental health and substance use related structural stigma in healthcare settings. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Mahabir DF, Shankardass K, Freiler A, O'Campo P, Brisbois B, Muntaner C. How and why buy-in for health in all policies was facilitated in Ecuador: a realist case study of Plan Nacional para el Buen Vivir. Int J Equity Health 2022; 21:108. [PMID: 35971174 PMCID: PMC9377301 DOI: 10.1186/s12939-022-01703-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 07/17/2022] [Indexed: 11/19/2022] Open
Abstract
Background In 2008, Ecuador introduced Plan Nacional para el Buen Vivir (PNBV; National Plan for Good Living), which was widely recognized as a promising example of Health in All Policies (HiAP) due to the integration of policy sectors on health and health equity objectives. PBNV was implemented through three successive plans (2009–2013, 2013–2017, 2017–2021). In a time of widening global health inequities, there is growing interest in understanding how politics and governance shape HiAP implementation. The objective of this study was to test specific hypotheses about how, why, to what extent, and under what circumstances HiAP was implemented in Ecuador. Methods An explanatory case study approach (HiAP Analysis using Realist Methods on International Case Studies—HARMONICS) was used to understand the processes that hindered or facilitated HiAP implementation. Realist methods and systems theory were employed to test hypotheses through analysis of empirical and grey literature, and 19 key informant interviews. This case study focused on processes related to buy-in for a HiAP approach by diverse policy sectors, particularly in relation to the strong mandate and transformative governance approach that were introduced by then-President Rafael Correa’s administration to support PNBV. Results The mandate and governance approach of the HiAP approach achieved buy-in for implementation across diverse sectors. Support for the hypotheses was found through direct evidence about buy-in for HiAP implementation by policy sectors; and indirect evidence about allocation of governmental resources for HiAP implementation. Key mechanisms identified included: influence of political elites; challenges in dealing with political opposition and ‘siloed’ ways of thinking; and the role of strategies and resources in motivating buy-in. Conclusion In Ecuador, political elites were a catalyst for mechanisms that impacted buy-in and government funding for HiAP implementation. They raised awareness among policy sectors initially opposed to PNBV about the rationale for changing governance practices, and they provided financial resources to support efforts related to PNBV. Specific mechanisms help explain these phenomena further. Future studies should examine ways that PNBV may have been an impediment to health equity for some marginalized groups while strengthening HiAP implementation.
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Affiliation(s)
- Deb Finn Mahabir
- MAP Centre for Urban Health Solutions, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
| | - Ketan Shankardass
- Department of Health Sciences, Wilfrid Laurier University, 75 University Avenue West, Waterloo, ON, N2L 3C5, Canada
| | - Alix Freiler
- MAP Centre for Urban Health Solutions, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Patricia O'Campo
- MAP Centre for Urban Health Solutions, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Ben Brisbois
- School of Health Sciences, University of Northern British Columbia, 3333 University Way, Prince George, British Columbia, V2N 4Z9, Canada
| | - Carles Muntaner
- Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada.,Dalla Lana School of Public Health, University of Toronto, Ontario, M5T 1P8, Canada
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Cain R, Greece JA, Galea S, Knox RA, Knight EK, Manco A, Parikh A, Jones DK. Improving health across sectors: Best practices for the implementation of health in all policies approaches. Prev Med Rep 2022; 29:101961. [PMID: 36161110 PMCID: PMC9501991 DOI: 10.1016/j.pmedr.2022.101961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/27/2022] Open
Abstract
Use strategic communications when engaging partners in Health in All Policies. Systematically integrate flexibility and communications into Health in All Policies. Context is critical when planning and implementing Health in All Policies.
Health is influenced by a broad range of factors beyond the typical remit of public health. It is therefore increasingly recognized that multiple sectors need to be engaged to improve population health. Health in All Policies (HiAP) is an approach to systematically consider health across policies and programs. This study assessed best practices and gaps in HiAP operationalization to inform practitioners aiming to incorporate HiAP in their work. We used Delaware as a model state to examine operationalization factors in a jurisdiction planning to implement HiAP. Methods included document review, key informant interviews, focus groups, and a questionnaire conducted in Delaware and virtually. Thematic analysis was used to analyze qualitative data to provide information on best practices and gaps in existing HiAP programs and context in Delaware. Descriptive statistics were used to examine collaboration in Delaware and to support or refute qualitative findings. We identified two gaps that can hinder HiAP implementation: 1) HiAP practitioners do not adequately use strategic communications to increase buy-in across sectors; 2) practitioners do not fully recognize the importance of being adaptable throughout HiAP implementation, which hinders sustainability. Qualitative findings from Delaware offer insight to these gaps and opportunities to address them. Refining the essential elements of HiAP to add: 1) strategic communications across sectors and 2) flexibility throughout HiAP implementation may point the way to more successful adoption of HiAP approaches across jurisdictions. This research demonstrated the importance of examining local perspectives on HiAP before implementation based on a jurisdiction’s context.
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14
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South J, Mapplethorpe T, Gledhill R, Marsh W, Stansfield J, Evans S, Mancini M, Outhwaite H. Learning from public health practice: the development of a library of community-centered practice examples. J Public Health (Oxf) 2022:6623459. [PMID: 35774035 DOI: 10.1093/pubmed/fdac065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/28/2022] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Valuable learning derived from public health practice can be captured through practice-based case studies, also known as practice examples. Practice examples of participatory interventions supplement the evidence base by providing information on the complexities of implementation in communities. This paper reports on a Public Health England project to build a bank of community-centered practice examples based on robust processes of collection and curation. METHODS The multidisciplinary project had three phases: (i) development and piloting a process to collect practice examples, (ii) refining review processes and gathering further examples via national and regional teams (iii) maintenance of an accessible collection on the library platform. RESULTS The project resulted in a searchable collection of 55 practice examples illustrating participatory approaches in public health practice. The collection shows diversity in terms of settings, population, focus and type of approach used to work with communities. A secondary outcome was the development of generic guidance and templates for further collections on public health topics. CONCLUSIONS This project illustrates how information on the implementation of community-centered approaches in real-life contexts can be gathered and disseminated through a transferable process. Having collections of practice examples supports knowledge exchange in public health as learning is shared.
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Affiliation(s)
- Jane South
- School of Health, Leeds Beckett University, Leeds LS1 3HE, UK.,Office for Health Improvement and Disparities, Department of Health and Social Care, London SW1H 0EU, UK
| | - Tom Mapplethorpe
- Office for Health Improvement and Disparities, Department of Health and Social Care, London SW1H 0EU, UK
| | - Rachel Gledhill
- UK Health Security Agency Knowledge and Library Services, UK Health Security Agency, London SW1H 0EU, UK
| | - Wendy Marsh
- UK Health Security Agency Knowledge and Library Services, UK Health Security Agency, London SW1H 0EU, UK
| | - Jude Stansfield
- School of Health, Leeds Beckett University, Leeds LS1 3HE, UK.,Office for Health Improvement and Disparities, Department of Health and Social Care, London SW1H 0EU, UK
| | - Sian Evans
- Local Knowledge and Intelligence Service (LKIS) East, Office for Health Improvement and Disparities, Department of Health and Social Care, Cambridge CB21 5XA, UK
| | - Michelle Mancini
- Office for Health Improvement and Disparities, North East and Yorkshire, Department of Health and Social Care, Newcastle NE15 8NY, UK
| | - Helen Outhwaite
- Improvement Directorate, NHS England and NHS Improvement, Leeds LS2 7UE, UK
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15
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Evaluating ‘Health in All Policies’ in Norwegian Municipalities. SOCIETIES 2022. [DOI: 10.3390/soc12030092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Health in All Policies (HiAP) approach has emerged as a central strategy for promoting health at local, regional, and state levels in different countries. Representing a complex and complicated strategy, evaluations of HIAP at the local level are scarce, and scholars call for more knowledge and critical discussions regarding how to evaluate at this level. In this conceptual paper, I discuss how summative and formative evaluation approaches might supplement each other when evaluating HiAP at the local level. First, I discuss the possibilities of using summative and formative evaluation of HiAP. Further, I discuss how formative-dialogue research might represent possibilities for evaluation by combining the two approaches. Finally, I ask if there has been a shift in the Norwegian evaluation discourse, from the promotion of summative evaluation alone to a combination of both summative and formative methods.
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16
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Amri M. Healthy Governance for Cities: Synergizing Health in All Policies (HiAP) and Healthy Cities Approaches. J Urban Health 2022; 99:231-234. [PMID: 35243599 PMCID: PMC8893240 DOI: 10.1007/s11524-022-00618-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Michelle Amri
- Takemi Program in International Health, Harvard University T H Chan School of Public Health, Boston, MA, USA.
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17
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Amri M, Chatur A, O'Campo P. Intersectoral and multisectoral approaches to health policy: an umbrella review protocol. Health Res Policy Syst 2022; 20:21. [PMID: 35168597 PMCID: PMC8845301 DOI: 10.1186/s12961-022-00826-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is widely recognized that one's health is influenced by a multitude of nonmedical factors, known as the social determinants of health (SDH). The SDH are defined as "the conditions in which people are born, grow, live, work and age, and which are shaped by the distribution of money, power and resources at global, national and local levels". Despite their influence on health, most of the SDH are targeted through government departments and ministries outside of the traditional health sector (e.g. education, housing). As such, the need for intersectoral and multisectoral approaches arises. Intersectoral and multisectoral approaches are thought to be essential to addressing many global health challenges our world faces today and achieving the Sustainable Development Goals. There are various ways of undertaking intersectoral and multisectoral action, but there are three widely recognized approaches (Health in All Policies [HiAP], Healthy Cities, and One Health) that each have a unique focus. However, despite the widespread acceptance of the need for intersectoral and multisectoral approaches, knowledge around how to support, achieve and sustain multisectoral action is limited. The goal of this study is to assemble evidence from systematic approaches to reviewing the literature (e.g. scoping review, systematic review) that collate findings on facilitators/enablers and barriers to implementing various intersectoral and multisectoral approaches to health, to strengthen understanding of how to best implement health policies that work across sectors, whichever they may be. METHODS An umbrella review (i.e. review of reviews) is to be undertaken to collate findings from the peer-reviewed literature, specifically from Ovid MEDLINE and Scopus databases. This umbrella review protocol was developed following the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P), and study design informed by the PRISMA guidelines for scoping reviews (PRISMA-ScR). DISCUSSION Countries that employ multisectoral approaches are better able to identify and address issues around poverty, housing and others, by working collaboratively across sectors, with multisectoral action by governments thought to be required to achieve health equity.
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Affiliation(s)
- Michelle Amri
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 1P8, Canada. .,Takemi Program in International Health, Harvard University, Boston, USA.
| | - Ali Chatur
- Health Studies, University College, University of Toronto, Toronto, Canada
| | - Patricia O'Campo
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 1P8, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
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18
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Galvez-Hernandez P, González-de Paz L, Muntaner C. Primary care-based interventions addressing social isolation and loneliness in older people: a scoping review. BMJ Open 2022; 12:e057729. [PMID: 35121608 PMCID: PMC8819903 DOI: 10.1136/bmjopen-2021-057729] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Primary care is well positioned to identify and address loneliness and social isolation in older adults, given its gatekeeper function in many healthcare systems. We aimed to identify and characterise loneliness and social isolation interventions and detect factors influencing implementation in primary care. DESIGN Scoping review using the five-step Arksey and O'Malley Framework. DATA SOURCES MEDLINE, CINAHL, EMBASE, COCHRANE databases and grey literature were searched from inception to June 2021. ELIGIBILITY CRITERIA Empirical studies in English and Spanish focusing on interventions addressing social isolation and loneliness in older adults involving primary care services or professionals. DATA EXTRACTION AND SYNTHESIS We extracted data on loneliness and social isolation identification strategies and the professionals involved, networks and characteristics of the interventions and barriers to and facilitators of implementation. We conducted a thematic content analysis to integrate the information extracted. RESULTS 32 documents were included in the review. Only seven articles (22%) reported primary care professionals screening of older adults' loneliness or social isolation, mainly through questionnaires. Several interventions showed networks between primary care, health and non-healthcare sectors, with a dominance of referral pathways (n=17). Two-thirds of reports did not provide clear theoretical frameworks, and one-third described lengths under 6 months. Workload, lack of interest and ageing-related barriers affected implementation outcomes. In contrast, well-defined pathways, collaborative designs, long-lasting and accessible interventions acted as facilitators. CONCLUSIONS There is an apparent lack of consistency in strategies to identify lonely and socially isolated older adults. This might lead to conflicts between intervention content and participant needs. We also identified a predominance of schemes linking primary care and non-healthcare sectors. However, although professionals and participants reported the need for long-lasting interventions to create meaningful social networks, durable interventions were scarce. Sustainability should be a core outcome when implementing loneliness and social isolation interventions in primary care.
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Affiliation(s)
- Pablo Galvez-Hernandez
- Lawrence S. Bloomberg Faculty of Nursing & Health Services and Policy Research Collaborative Specialization, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Luis González-de Paz
- Primary Healthcare Transversal Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), IDIBAPS, Barcelona, Spain
- Escola Superior d'Infermeria del Mar (ESIMar), Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Carles Muntaner
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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19
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Mondal S, Bhojani U, Lobbo S, Law S, Maioni A, Van Belle S. Using social network analysis to understand multisectoral governance in district-level tobacco control programme implementation in India. BMJ Glob Health 2022; 7:e006471. [PMID: 34992075 PMCID: PMC8739058 DOI: 10.1136/bmjgh-2021-006471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/20/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Interest in multisectoral policies has increased, particularly in the context of low-income and middle-income countries and efforts towards Sustainable Development Goals, with greater attention to understand effective strategies for implementation and governance. The study aimed to explore and map the composition and structure of a multisectoral initiative in tobacco control, identifying key factors engaged in policy implementation and their patterns of relationships in local-level networks in two districts in the state of Karnataka, India. METHODS Social network analysis (SNA) was used to examine the structure of two district tobacco control networks with differences in compliance with the India's national tobacco control law. The survey was administered to 108 respondents (n=51 and 57) in two districts, producing three distinct network maps about interaction, information-seeking and decision-making patterns within each district. The network measures of centrality, density, reciprocity, centralisation and E-I index were used to understand and compare across the two districts. RESULTS Members from the department of health, especially those in the District Tobacco Control Cell, were the most frequently consulted actors for information as they led district-level networks. The most common departments engaged beyond health were education, police and municipal. District 1's network displayed high centralisation, with a district nodal officer who exercised a central role with the highest in-degree centrality. The district also exhibited greater density and reciprocity. District 2 showed a more dispersed pattern, where subdistrict health managers had higher betweenness centrality and acted as brokers in the network. CONCLUSION Collaboration and cooperation among sectors and departments are essential components of multisectoral policy. SNA provides a mechanism to uncover the nature of relationships and key actors in collaborative dynamics. It can be used as a visual learning tool for policy planners and implementers to understand the structure of actual implementation and concentrate their efforts to improve and enhance collaboration.
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Affiliation(s)
- Shinjini Mondal
- Family Medicine, McGill University Faculty of Medicine, Montreal, Québec, Canada
- Institute of Public Health Bengaluru, Bangalore, Karnataka, India
| | - Upendra Bhojani
- Institute of Public Health Bengaluru, Bangalore, Karnataka, India
| | | | - Susan Law
- Institute for Better Health, Trillium Health Partners, Ontario, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Antonia Maioni
- Institute for Health and Social Policy, McGill University, Montreal, Québec, Canada
| | - Sara Van Belle
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Antwerpen, Belgium
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20
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Cash-Gibson L, Martinez-Herrera E, Benach J. What key conditions and mechanisms generate health inequalities research in different contexts? Study protocol for two realist explanatory case studies. EVALUATION AND PROGRAM PLANNING 2021; 89:101986. [PMID: 34390924 DOI: 10.1016/j.evalprogplan.2021.101986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 06/15/2021] [Accepted: 07/01/2021] [Indexed: 06/13/2023]
Abstract
Evidence on health inequalities has grown in recent decades, however, the capacity to generate health inequalities research is uneven, worldwide. A recent bibliometric analysis found notable inequalities of the global production of health inequalities scientific research across countries. What determines the capacity to produce high volumes of health inequalities scientific research, in different settings? What mechanisms are involved? To answer these questions requires in-depth knowledge on the health inequalities research production process, in different settings. We plan to conduct two realist explanatory case studies, to understand why and how particular settings (e.g. the United Kingdom and the city of Barcelona) have generated high volumes of health inequalities research over past decades, and identify the potential key contextual conditions and causal mechanisms involved. This study protocol outlines the rationale and methodology involved, highlights the strengths and limitations of the approach, and provides guidance on how to overcome certain operational challenges and ensure validity of research findings. Valuable learning may be derived from these case experiences, with implications for research, policy and practice. This work can serve as a tool for researcher and planners to guide the development of further case studies to evaluate health inequalities research capacities in other settings.
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Affiliation(s)
- Lucinda Cash-Gibson
- Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network, Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain; Johns Hopkins University - Pompeu Fabra University Public Policy Center, Barcelona, Catalonia, Spain.
| | - Eliana Martinez-Herrera
- Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network, Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain; Johns Hopkins University - Pompeu Fabra University Public Policy Center, Barcelona, Catalonia, Spain; Research Group of Epidemiology, National School of Public Health 'Héctor Abad Gómez', University of Antioquia, Medellín, Colombia.
| | - Joan Benach
- Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network, Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain; Johns Hopkins University - Pompeu Fabra University Public Policy Center, Barcelona, Catalonia, Spain; Transdisciplinary Research Group on Socioecological Transitions (GinTRANS2), Universidad Autónoma, Madrid, Spain.
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21
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Abbas SS, Shorten T, Rushton J. Meanings and Mechanisms of One Health Partnerships: Insights from a Critical Review of Literature on Cross-Government Collaborations. Health Policy Plan 2021; 37:385-399. [PMID: 34791224 PMCID: PMC8896336 DOI: 10.1093/heapol/czab134] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/10/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022] Open
Abstract
Complex health policy challenges such as antimicrobial resistance and other emerging infections are driven by activities in multiple sectors. Therefore, addressing these also requires joint efforts from multiple sectors as exemplified in the One Health approach. We undertake a critical review to examine the different ways in which multisector partnerships have been conceptualized across multiple disciplines and thematic areas. We started with a set of six articles from the disciplines of health, nutrition and public administration that reviewed conceptual frameworks within their respective fields. We conducted backward citation tracing using the bibliography of the six articles to identify other articles in the same and related fields that conceptualized multisector partnerships. We identified 58 articles published from 1967 to 2018 from the fields of global health, infectious diseases, management, nutrition and sustainability sciences indicating that multisector partnerships have been a topic of study across different fields for several decades. A thematic analysis of the 58 articles revealed that multisector partnerships assume a variety of forms and have been described in different ways. Partnerships can be categorized by scope, scale, formality and strength. Multisector partnerships emerge in conditions of dynamic uncertainty and sector failure when the information and resources required are beyond the capacities of any individual sector. Such partnerships are inherently political in nature and subsume multiple competing agendas of collaborating actors. Sustaining collaborations over a long period of time will require collaborative approaches like One Health to accommodate competing political perspectives and include flexibility to allow multisector partnerships to respond to changing external dynamics.
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Affiliation(s)
- Syed Shahid Abbas
- Institute of Development Studies, Brighton, UK.,Public Health Foundation of India, New Delhi, India
| | | | - Jonathan Rushton
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
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22
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Haynes A, Gilchrist H, Oliveira JS, Tiedemann A. Using Realist Evaluation to Understand Process Outcomes in a COVID-19-Impacted Yoga Intervention Trial: A Worked Example. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9065. [PMID: 34501654 PMCID: PMC8431647 DOI: 10.3390/ijerph18179065] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/17/2022]
Abstract
Realist evaluation offers a valuable way to understand how interventions function and thus how they can be improved and locally adapted. Consequently, realist evaluation is increasingly conducted in parallel with intervention trials. It comprises a clear philosophical foundation and view of causality, pragmatic mixed data collection methods, and a theory-driven approach in which hypothesised program theories are tested and refined. However, detailed methods for data analysis are seldom well-described in realist studies and no clear method for analysing and presenting realist evaluation data has yet emerged. In this methodological paper we use the worked example of our realist process evaluation of the SAGE yoga trial to illustrate an applied process of data analysis and presentation of findings. We show how we drew on other realist studies for ideas, provide examples of six key tasks involved in conducting a realist process evaluation (including coding data and structuring results) and describe strategies that did not work and our rationale for rejecting them. This detailed account of the decisions and methods that worked for us is intended to provide a practical and informed point of departure for researchers conducting a realist evaluation.
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Affiliation(s)
- Abby Haynes
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, NSW 2050, Australia; (H.G.); (J.S.O.); (A.T.)
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Heidi Gilchrist
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, NSW 2050, Australia; (H.G.); (J.S.O.); (A.T.)
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Juliana S. Oliveira
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, NSW 2050, Australia; (H.G.); (J.S.O.); (A.T.)
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Anne Tiedemann
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, NSW 2050, Australia; (H.G.); (J.S.O.); (A.T.)
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
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Cairney P, St Denny E, Mitchell H. The future of public health policymaking after COVID-19: a qualitative systematic review of lessons from Health in All Policies. OPEN RESEARCH EUROPE 2021; 1:23. [PMID: 37645203 PMCID: PMC10445916 DOI: 10.12688/openreseurope.13178.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 08/31/2023]
Abstract
Background: 'Health in All Policies' (HiAP) describes the pursuit of health equity. It has five main elements: treat health as a human right; identify evidence of the 'social determinants' of health inequalities, recognise that most powers to affect health are not held by health departments, promote intersectoral policymaking and collaboration inside and outside of government, and generate political will. Studies describe its potential but bemoan a major implementation gap. Some HiAP scholars learn from policymaking research how to understand this gap, but the use of policy theories is patchy. In that context, our guiding research question is: How does HiAP research use policy theory to understand policymaking? It allows us to zoom-out to survey the field and zoom-in to identify: the assumed and actual causes of policy change, and transferable lessons to HiAP scholars and advocates. Methods: Our qualitative systematic review (two phases, 2018 and 2020) identified 4972 HiAP articles. Of these, 113 journal articles (research and commentary) provide a non-trivial reference to policymaking (at least one reference to a policymaking concept). We use the 113 articles to produce a general HiAP narrative and explore how the relatively theory-informed articles enhance it. Results: Most articles focus on policy analysis (identifying policy problems and solutions) rather than policy theory (explaining policymaking dynamics). They report a disappointing gap between HiAP expectations and policy outcomes. Theory-informed articles contribute to a HiAP playbook to close that gap or a programme theory to design and evaluate HiAP in new ways. Conclusions: Few HiAP articles use policy theories for their intended purpose. Policy theories provide lessons to aid critical reflection on power, political dilemmas, and policymaking context. HiAP scholars seek more instrumental lessons, potentially at the cost of effective advocacy and research.
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Affiliation(s)
- Paul Cairney
- History, Heritage, and Politics, University of Stirling, Stirling, FK94LA, UK
| | - Emily St Denny
- Department of Political Science, University of Copenhagen, Copenhagen, DK-1353, Denmark
| | - Heather Mitchell
- History, Heritage, and Politics, University of Stirling, Stirling, FK94LA, UK
- Faculty of Health Sciences, University of Stirling, Stirling, FK94LA, UK
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Cairney P, St Denny E, Mitchell H. The future of public health policymaking after COVID-19: a qualitative systematic review of lessons from Health in All Policies. OPEN RESEARCH EUROPE 2021; 1:23. [PMID: 37645203 PMCID: PMC10445916 DOI: 10.12688/openreseurope.13178.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 08/31/2023]
Abstract
Background: 'Health in All Policies' (HiAP) describes the pursuit of health equity. It has five main elements: treat health as a human right; identify evidence of the 'social determinants' of health inequalities, recognise that most powers to affect health are not held by health departments, promote intersectoral policymaking and collaboration inside and outside of government, and generate political will. Studies describe its potential but bemoan a major implementation gap. Some HiAP scholars learn from policymaking research how to understand this gap, but the use of policy theories is patchy. In that context, our guiding research question is: How does HiAP research use policy theory to understand policymaking? It allows us to zoom-out to survey the field and zoom-in to identify: the assumed and actual causes of policy change, and transferable lessons to HiAP scholars and advocates. Methods: Our qualitative systematic review (two phases, 2018 and 2020) identified 4972 HiAP articles. Of these, 113 journal articles (research and commentary) provide a non-trivial reference to policymaking (at least one reference to a policymaking concept). We use the 113 articles to produce a general HiAP narrative and explore how the relatively theory-informed articles enhance it. Results: Most articles focus on policy analysis (identifying policy problems and solutions) rather than policy theory (explaining policymaking dynamics). They report a disappointing gap between HiAP expectations and policy outcomes. Theory-informed articles contribute to a HiAP playbook to close that gap or a programme theory to design and evaluate HiAP in new ways. Conclusions: Few HiAP articles use policy theories for their intended purpose. Policy theories provide lessons to aid critical reflection on power, political dilemmas, and policymaking context. HiAP scholars seek more instrumental lessons, potentially at the cost of effective advocacy and research.
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Affiliation(s)
- Paul Cairney
- History, Heritage, and Politics, University of Stirling, Stirling, FK94LA, UK
| | - Emily St Denny
- Department of Political Science, University of Copenhagen, Copenhagen, DK-1353, Denmark
| | - Heather Mitchell
- History, Heritage, and Politics, University of Stirling, Stirling, FK94LA, UK
- Faculty of Health Sciences, University of Stirling, Stirling, FK94LA, UK
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Yu N. WITHDRAWN: The role of medical and health policies in the health risk management system. Work 2021:WOR210115. [PMID: 34308892 DOI: 10.3233/wor-210115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Ahead of Print article withdrawn by publisher.
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Mondal S, Van Belle S, Maioni A. Learning from intersectoral action beyond health: a meta-narrative review. Health Policy Plan 2021; 36:552-571. [PMID: 33564855 PMCID: PMC8128009 DOI: 10.1093/heapol/czaa163] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 01/21/2023] Open
Abstract
Intersectoral action (ISA) is considered pivotal for achieving health and societal goals but remains difficult to achieve as it requires complex efforts, resources and coordinated responses from multiple sectors and organizations. While ISA in health is often desired, its potential can be better informed by the advanced theory-building and empirical application in real-world contexts from political science, public administration and environmental sciences. Considering the importance and the associated challenges in achieving ISA, we have conducted a meta-narrative review, in the research domains of political science, public administration, environmental and health. The review aims to identify theory, theoretical concepts and empirical applications of ISA in these identified research traditions and draw learning for health. Using the multidisciplinary database of SCOPUS from 1996 to 2017, 5535 records were identified, 155 full-text articles were reviewed and 57 papers met our final inclusion criteria. In our findings, we trace the theoretical roots of ISA across all research domains, describing the main focus and motivation to pursue collaborative work. The literature synthesis is organized around the following: implementation instruments, formal mechanisms and informal networks, enabling institutional environments involving the interplay of hardware (i.e. resources, management systems, structures) and software (more specifically the realms of ideas, values, power); and the important role of leaders who can work across boundaries in promoting ISA, political mobilization and the essential role of hybrid accountability mechanisms. Overall, our review reaffirms affirms that ISA has both technical and political dimensions. In addition to technical concerns for strengthening capacities and providing support instruments and mechanisms, future research must carefully consider power and inter-organizational dynamics in order to develop a more fulsome understanding and improve the implementation of intersectoral initiatives, as well as to ensure their sustainability. This also shows the need for continued attention to emergent knowledge bases across different research domains including health.
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Affiliation(s)
- Shinjini Mondal
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges Rd, Montreal, Quebec H3S 1Z1, Canada
| | - Sara Van Belle
- Department of Public Health, Health Policy Unit, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Antonia Maioni
- Department of Political Science, McGill University, 855 Sherbrooke Street West, Montreal, Quebec H3A 2T7, Canada
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van Vooren NJE, Drewes HW, de Weger E, Bongers IMB, Baan CA. Cross-Sector Collaboration for a Healthy Living Environment-Which Strategies to Implement, Why, and in Which Context? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176250. [PMID: 32867360 PMCID: PMC7504038 DOI: 10.3390/ijerph17176250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Working toward a healthy living environment requires organizations from different policy domains and nongovernment partners involved in public health and the living environment to collaborate across sectors. The aim of this study is to understand how this cross-sector collaboration for a healthy living environment can be achieved. METHODS The realist evaluation approach was used to investigate what strategies can be used in which contexts to achieve cross-sector collaboration. The "Collaborative Adaptive Health Networks" framework was used as a theoretical framework. Seventeen partners of three Dutch projects collaborating for a healthy living environment in different regions were interviewed about their experiences during the initiating phase of their projects. RESULTS Seven themes for achieving cross-sector collaboration were identified, namely creating a feeling of equivalence, building trust, bridging different perspectives, providing clarity regarding roles and tasks, creating commitment, creating active engagement, and understanding whom to engage and when. For each theme, the strategies that were used, and why, were specified. CONCLUSION This study provides new insights in how cross-sector collaboration for a healthy living environment can be achieved in different contexts. Whether the start of a cross-sectoral collaboration is successful is largely influenced by the choice of leadership and the interorganizational relations.
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Affiliation(s)
- Natascha J. E. van Vooren
- Department of Quality of Care and Health Economics, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands; (H.W.D.); (E.d.W.)
- Tranzo, Tilburg School of Social and Behavioural Sciences, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands; (I.M.B.B.); (C.A.B.)
- Correspondence: ; Tel.: +31-06-257-757-52
| | - Hanneke W. Drewes
- Department of Quality of Care and Health Economics, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands; (H.W.D.); (E.d.W.)
| | - Esther de Weger
- Department of Quality of Care and Health Economics, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands; (H.W.D.); (E.d.W.)
- Tranzo, Tilburg School of Social and Behavioural Sciences, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands; (I.M.B.B.); (C.A.B.)
| | - Inge M. B. Bongers
- Tranzo, Tilburg School of Social and Behavioural Sciences, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands; (I.M.B.B.); (C.A.B.)
- Mental Health Care Institute Eindhoven, de Kempen, P.O. Box 909, 5600 AX Eindhoven, The Netherlands
| | - Caroline A. Baan
- Tranzo, Tilburg School of Social and Behavioural Sciences, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands; (I.M.B.B.); (C.A.B.)
- National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands
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Tonelli M, Tang KC, Forest PG. Canada needs a "Health in All Policies" action plan now. CMAJ 2020; 192:E61-E67. [PMID: 31959656 DOI: 10.1503/cmaj.190517] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Marcello Tonelli
- Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Health Promotion Unit (Tang [retired]), World Health Organization, Geneva, Switzerland; School of Public Policy (Forest), University of Calgary, Calgary, Alta.
| | - Kwok-Cho Tang
- Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Health Promotion Unit (Tang [retired]), World Health Organization, Geneva, Switzerland; School of Public Policy (Forest), University of Calgary, Calgary, Alta
| | - Pierre-Gerlier Forest
- Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Health Promotion Unit (Tang [retired]), World Health Organization, Geneva, Switzerland; School of Public Policy (Forest), University of Calgary, Calgary, Alta
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Kokkinen L, Freiler A, Muntaner C, Shankardass K. How and why do win-win strategies work in engaging policy-makers to implement Health in All Policies? A multiple-case study of six state- and national-level governments. Health Res Policy Syst 2019; 17:102. [PMID: 31864364 PMCID: PMC6925500 DOI: 10.1186/s12961-019-0509-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 11/13/2019] [Indexed: 11/21/2022] Open
Abstract
Background Much of the research about Health in All Policies (HiAP) implementation is descriptive, and there have been calls for more evaluative evidence to explain how and why successes and failures have occurred. In this cross-case study of six state- and national-level governments (California, Ecuador, Finland, Norway, Scotland and Thailand), we tested hypotheses about win–win strategies for engaging policy-makers in HiAP implementation drawing on components identified in our previous systems framework. Methods We used two sources of data — key informant interviews and peer-reviewed and grey literature. Using a protocol, we created context–mechanism–outcome pattern configurations to articulate mechanisms that explain how win–win strategies work and fail in different contexts. We then applied our evidence for all cases to the systems framework. We assessed the quality of evidence within and across cases in terms of triangulation of sources and strength of evidence. We also strengthened hypothesis testing using replication logic. Results We found robust evidence for two mechanisms about how and why win–win strategies build partnerships for HiAP implementation — the use of shared language and the value of multiple outcomes. Within our cases, the triangulation was strong, both hypotheses were supported by literal and contrast replications, and there was no support against them. For the third mechanism studied, using the public-health arguments win–win strategy, we only found evidence from Finland. Based on our systems framework, we expected that the most important system components to using win–win strategies are sectoral objectives, and we found empirical support for this prediction. Conclusions We conclude that two mechanisms about how and why win–win strategies build partnerships for HiAP implementation — the use of shared language and the value of multiple outcomes — were found as relevant to the six settings. Both of these mechanisms trigger a process of developing synergies and releasing potentialities among different government sectors and these interactions between sectors often work through sectoral objectives. These mechanisms should be considered when designing future HiAP initiatives and their implementation to enhance the emergence of non-health sector policy-makers’ engagement.
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Affiliation(s)
- Lauri Kokkinen
- Faculty of Social Sciences, Tampere University, Arvo Ylpön katu 34, 33014, Tampere, Finland.
| | - Alix Freiler
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, 209 Victoria Street, Toronto, Ontario, M5B 1T8, Canada
| | - Carles Muntaner
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.,Bloomberg School of Nursing, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada
| | - Ketan Shankardass
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, 209 Victoria Street, Toronto, Ontario, M5B 1T8, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.,Department of Health Sciences, Wilfrid Laurier University, 75 University Ave W, Waterloo, Ontario, N2L 3C5, Canada
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Yao Q, Li X, Luo F, Yang L, Liu C, Sun J. The historical roots and seminal research on health equity: a referenced publication year spectroscopy (RPYS) analysis. Int J Equity Health 2019; 18:152. [PMID: 31615528 PMCID: PMC6792226 DOI: 10.1186/s12939-019-1058-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/23/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Health equity is a multidimensional concept that has been internationally considered as an essential element for health system development. However, our understanding about the root causes of health equity is limited. In this study, we investigated the historical roots and seminal works of research on health equity. METHODS Health equity-related publications were identified and downloaded from the Web of Science database (n = 67,739, up to 31 October 2018). Their cited references (n = 2,521,782) were analyzed through Reference Publication Year Spectroscopy (RPYS), which detected the historical roots and important works on health equity and quantified their impact in terms of referencing frequency. RESULTS A total of 17 pronounced peaks and 31 seminal works were identified. The first publication on health equity appeared in 1966. But the first cited reference can be traced back to 1801. Most seminal works were conducted by researchers from the US (19, 61.3%), the UK (7, 22.6%) and the Netherlands (3, 9.7%). Research on health equity experienced three important historical stages: origins (1800-1965), formative (1966-1991) and development and expansion (1991-2018). The ideology of health equity was endorsed by the international society through the World Health Organization (1946) declaration based on the foundational works of Chadwick (1842), Engels (1945), Durkheim (1897) and Du Bois (1899). The concept of health equity originated from the disciplines of public health, sociology and political economics and has been a major research area of social epidemiology since the early nineteenth century. Studies on health equity evolved from evidence gathering to the identification of cost-effective policies and governmental interventions. CONCLUSION The development of research on health equity is shaped by multiple disciplines, which has contributed to the emergence of a new stream of social epidemiology and political epidemiology. Past studies must be interpreted in light of their historical contexts. Further studies are needed to explore the causal pathways between the social determinants of health and health inequalities.
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Affiliation(s)
- Qiang Yao
- School of Political Science and Public Administration, Wuhan University, Wuhan, 430072 Hubei China
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086 Australia
| | - Xin Li
- School of Information Management, Wuhan University, Wuhan, 430072 Hubei China
| | - Fei Luo
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 Hubei China
| | - Lianping Yang
- School of Public Heath, Sun Yat-sen University, Guangzhou, 510275 Guangdong China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086 Australia
| | - Ju Sun
- School of Political Science and Public Administration, Wuhan University, Wuhan, 430072 Hubei China
- Institute of Health, Wuhan University, Wuhan, 430071 Hubei China
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Hurd-Kundeti G, Petersen AB, Somsamouth K, Singh PN. Air Pollution in a Nationally Representative Sample: Findings from the National Adult Tobacco Survey of Lao PDR. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3500. [PMID: 31546881 PMCID: PMC6765985 DOI: 10.3390/ijerph16183500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/07/2019] [Accepted: 09/16/2019] [Indexed: 12/21/2022]
Abstract
In Southeast Asia, household air pollution (HAP) from solid fuel use is the leading cause of disability-adjusted life years (DALYs), a risk which is compounded by exposure to other sources of indoor and outdoor air pollution including secondhand tobacco smoke (SHS). The purpose of this study was to measure the individual and combined prevalence of exposure to household and community sources of air pollution in a national sample of adults in Lao PDR. We analyzed data from the 2012 National Adult Tobacco Survey (NATSL) of Lao PDR-a multi-stage stratified cluster sample of 9706 subjects from 2822 households located in all 17 provinces. Our findings indicate a high prevalence of exposure to household air pollution from cooking fires (78%) and SHS exposure in the home (74.5%). More than a third (32.8%) reported exposure to both inside the home. Exposure to outdoor sources of smoke from cooking, trash, and crop fires was substantial (30.1% to 56.0%). The aggregation of exposures from multiple sources of household air pollution raises the need for initiatives that establish programmatic linkages in the health, environmental, and agricultural sectors to provide a comprehensive strategy to reduce risk factors for respiratory disease in Lao PDR and the region.
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Affiliation(s)
| | - Anne Berit Petersen
- Loma Linda University School of Nursing, 11262 Campus Street, Loma Linda, CA 92350, USA.
- Center for Health Research, Loma Linda University School of Public Health, 11234 Anderson St, Loma Linda, CA 92354, USA.
| | | | - Pramil N Singh
- Center for Health Research, Loma Linda University School of Public Health, 11234 Anderson St, Loma Linda, CA 92354, USA.
- Transdisciplinary Tobacco Research Program, Loma Linda University Cancer Center, 11234 Anderson St, Loma Linda, CA 92354, USA.
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Mundo W, Manetta P, Fort MP, Sauaia A. A Qualitative Study of Health in All Policies at the Local
Level. INQUIRY: A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2019. [PMCID: PMC6728655 DOI: 10.1177/0046958019874153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Health in All Policies (HiAP) encourage health-conscious policymaking in
non-health sectors; however, there are no standardized measures or guides for
assessing progress in HiAP implementation. The purpose of this study was to
describe how HiAP in local public health agencies (LPHAs) are implemented at the
local level in Colorado and identify challenges and opportunities for
implementation. We conducted semi-structured interviews with 13 key informants
identified through purposive sampling. Interviews were recorded, double-coded,
and analyzed using thematic analysis. The themes we identified relating to the
implementation of different HiAP approaches were as follows: the importance of
building trusting relationships, a need to understand the work of LPHAs and
public health, and LPHA structure and role clarity. Tools and tactics that
respondents identified in their implementation and practice of HiAP are sharing
data and data platforms, community dashboarding, providing services to partners,
sharing programs or services, attending meetings regularly, and measurement
instruments. This study demonstrates HiAP approach variation and the need for a
state-wide standardized framework for initiatives and progress. Future HiAP
implementation research should focus on county-level analysis using outcomes
that LPHAs are targeting based on their health priorities and should also
capture the activities of sectors outside of public health.
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Affiliation(s)
- William Mundo
- University of Colorado Anschutz Medical
Campus, Aurora, USA,William Mundo, Department of Health Systems,
Management & Policy, University of Colorado Anschutz Medical Campus, 13120
E. 19th Avenue, Box A-049, Room 5223-1, Aurora, CO 80045, USA.
| | - Peter Manetta
- University of Colorado Anschutz Medical
Campus, Aurora, USA,Colorado Association of Local Public
Health Officials, Denver, USA
| | | | - Angela Sauaia
- University of Colorado Anschutz Medical
Campus, Aurora, USA
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Zeeb H, Hilderink H, Forberger S. [Environment and the "Health in All Policies" approach-an overview]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 61:729-736. [PMID: 29691595 DOI: 10.1007/s00103-018-2733-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND One quarter of the global disease burden could be avoided with management strategies for environmental risk factors such as air and water pollution, food contamination, injuries and poor road safety. Many decisions influencing health are made outside the health sector; thus, the joint consideration and implementation of health and environmental factors in the relevant policies are becoming increasingly important. MATERIALS AND METHODS By means of a selective literature search, we identified important policy documents and selected research articles as a basis for the introduction and current discussion of the Health in All Policies (HiAP) approach. Parallels with the Environment in All Policies (EIAP) approach are debated. RESULTS AND CONCLUSIONS The consideration and reinforcement of environmental topics in HiAP and the link with health in the EiAP approach increase the chances of policies with mutually positive effects, especially with regard to the significance of social factors for health and the environment. The UN Sustainable Development Goals provide a good starting point for a joint strategy for reinforcing health and environmental aspects. Health and Environmental Impact Assessments are accepted procedures in many countries. The HiAP strategy implemented in South Australia provides a well-documented institutional approach to the integration and linkage of health and environmental issues. These examples can be used as well-established starting points for a definition of HiAP incorporating the equitable involvement of environmental issues. Barriers to this goal relate, for example, to the particular interests of the various participating sectors.
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Affiliation(s)
- Hajo Zeeb
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Achterstraße 30, 28359, Bremen, Deutschland. .,Health Sciences Bremen, Universität Bremen, Bremen, Deutschland.
| | - Henk Hilderink
- National Institute for Public Health and the Environment, RIVM, Bilthoven, Niederlande
| | - Sarah Forberger
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Achterstraße 30, 28359, Bremen, Deutschland
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Espinosa-González AB, Delaney BC, Marti J, Darzi A. The impact of governance in primary health care delivery: a systems thinking approach with a European panel. Health Res Policy Syst 2019; 17:65. [PMID: 31272472 PMCID: PMC6609383 DOI: 10.1186/s12961-019-0456-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 04/23/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Enhancing primary health care (PHC) is considered a policy priority for health systems strengthening due to PHC's ability to provide accessible and continuous care and manage multimorbidity. Research in PHC often focuses on the effects of specific interventions (e.g. physicians' contracts) in health care outcomes. This informs narrowly designed policies that disregard the interactions between the health functions (e.g. financing and regulation) and actors involved (i.e. public, professional, private), and their impact in care delivery and outcomes. The purpose of this study is to analyse the interactions between PHC functions and their impact in PHC delivery, particularly in providers' behaviour and practice organisation. METHODS Following a systems thinking approach with data obtained through a three-round European Delphi process, we developed a framework that captures (1) the interactions between PHC functions by analysing correlations between PHC characteristics of participating countries, (2) how actors involved shaped these interactions by identifying the actor and level of devolution (or fragmentation) in the analysis, and (3) their potential effect on care delivery by exploring panellists' opinions. RESULTS A total of 59 panellists from 24 countries participated in the first round and 76% of the initial panellists (22 countries) completed the last round. Findings show correlations between governance, financing and regulation based on their degree of decentralisation. This is supported by panellists, who agreed that the actors involved in health system governance determine the type of PHC financing (e.g. ownership or payment mechanisms) and regulation (e.g. competences or gatekeeping), and this may impact care delivery and outcomes. Governance in our framework is an overarching function whose impact in PHC delivery is mediated through the degree of decentralisation (both delegation and devolution) of PHC financing and regulation. CONCLUSIONS The application of this approach in policy implementation assessment intends to uncover limitations due to poor accountability and commitment to shared objectives. Its application in the design of health strategies helps foresee (and prevent) undesired or unexpected effects of narrow interventions. This approach will assist in the development of the realistic and long-term policies required for health systems strengthening.
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Affiliation(s)
- Ana Belén Espinosa-González
- Centre for Health Policy, IGHI, Department of Surgery and Cancer, Imperial College London, Room 1035, 10th Floor Queen Elizabeth Queen Mother Wing, St Mary’s Hospital South Wharf Road, London, W2 1NY United Kingdom
| | - Brendan C. Delaney
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Joachim Marti
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Kokkinen L, Muntaner C, O'Campo P, Freiler A, Oneka G, Shankardass K. Implementation of Health 2015 public health program in Finland: a welfare state in transition. Health Promot Int 2019; 34:258-268. [PMID: 29149295 DOI: 10.1093/heapro/dax081] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Our study sought to examine the implementation of Health 2015 [a public health programme prepared following the principles of Health in All Policies (HiAP)] between 2001 and 2015 in the context of welfare state restructuring. We used data from the realist multiple explanatory case study by HARMONICS, which focused on political factors (processes) that lead to the (un)successful implementation of programmes following the principles of HiAP. We analyzed data-key informant interviews, grey and scholarly literature-from our Finnish case to examine how Health 2015 implementation has been affected by the changing role of the state. We find that the dismantling of formal funding allocation decreased the capacity of national authorities to exert control over municipalities' health promotion work, diluting the financial arrangements regarding municipal obligations. As a result, most municipalities failed to contribute to Health 2015, resulting in losses for health promotion activities. Our results also point to joining the EU. Whereas the procedures for preparing Finland's unanimous positions on EU matters were useful in harmonizing ideologies on various policy issues between different ministries, joining the EU also increased commercial interests and the strength of the lobby system, leading to the prioritization of economic objectives over public health objectives. Finally, our informants also highlighted the changing relationship between the state and the market, manifested in market deregulation and increasing influence of pro-growth arguments during the implementation of Health 2015.
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Affiliation(s)
- Lauri Kokkinen
- Faculty of Social Sciences, University of Tampere, Tampere, Finland.,Finnish Institute of Occupational Health, Tampere, Finland
| | - Carles Muntaner
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Patricia O'Campo
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, Canada
| | - Alix Freiler
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, Canada
| | - Golda Oneka
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Ketan Shankardass
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, Canada.,Wilfrid Laurier University, Waterloo, Canada
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Do Healthy City Performance Awards Lead to Health in All Policies? A Case of Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16061061. [PMID: 30909635 PMCID: PMC6466376 DOI: 10.3390/ijerph16061061] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/04/2019] [Accepted: 03/20/2019] [Indexed: 11/30/2022]
Abstract
The Healthy Cities (HC) Project, which was introduced by the World Health Organization (WHO) in 1986, has been recognized as the best setting approach for health promotion. However, very few studies have addressed how to use HC approaches to establish public policies in non-health departments in cities. This paper describes the strategies for the HC Performance Awards used in Taiwan to draw attention from different departments and to sustain intersectoral collaboration for the purpose of establishing Health in All Policies (HiAP). The methods include: (1) setting up the Taiwan Healthy City Alliance; (2) establishing HC Innovation Performance Awards; (3) reviewing the award applications according to seven criteria; and (4) analyzing the topic content of the award applications. We collected 961 HC award applications during 2013–2016 to analyze their content. The results showed that the number of applications increased nearly every year while significantly more non-health departments applied for the awards compared to health departments (73.3% vs. 26.7%). The award rates of non-health departments have also increased twice from 13.9% in 2013 to 25.8% in 2016. By examining the topics of the award winners, we concluded that “HC Innovation Performance Awards” indeed provide a role and opportunity for political involvement, intersectoral collaboration, co-opetition and capacity building that is necessary for establishing health in all policies.
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Muntaner C, Augustinavicius J. Intersectionality: A Scientific Realist Critique. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:39-41. [PMID: 31543026 DOI: 10.1080/15265161.2018.1557296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Shankardass K, O'Campo P, Muntaner C, Bayoumi AM, Kokkinen L. Ideas for Extending the Approach to Evaluating Health in All Policies in South Australia Comment on "Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia". Int J Health Policy Manag 2018; 7:755-757. [PMID: 30078296 PMCID: PMC6077279 DOI: 10.15171/ijhpm.2018.25] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 03/07/2018] [Indexed: 11/09/2022] Open
Abstract
Since 2008, the government of South Australia has been using a Health in All Policies (HiAP) approach to achieve their strategic plan (South Australia Strategic Plan of 2004). In this commentary, we summarize some of the strengths and contributions of the innovative evaluation framework that was developed by an embedded team of academic researchers. To inform how the use of HiAP is evaluated more generally, we also describe several ideas for extending their approach, including: deeper integration of interdisciplinary theory (eg, public health sciences, policy and political sciences) to make use of existing knowledge and ideas about how and why HiAP works; including a focus on implementation outcomes and using developmental evaluation (DE) partnerships to strengthen the use of HiAP over time; use of systems theory to help understand the complexity of social systems and changing contexts involved in using HiAP; integrating economic considerations into HiAP evaluations to better understand the health, social and economic benefits and trade-offs of using HiAP.
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Affiliation(s)
- Ketan Shankardass
- Wilfrid Laurier University, Waterloo, ON, Canada.,Centre for Urban Health Solutions, Li Ka Shing Knowedge Institute, Toronto, ON, Canada
| | - Patricia O'Campo
- Centre for Urban Health Solutions, Li Ka Shing Knowedge Institute, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Carles Muntaner
- Bloomberg School of Nursing, University of Toronto, Toronto, ON, Canada
| | - Ahmed M Bayoumi
- Centre for Urban Health Solutions, Li Ka Shing Knowedge Institute, Toronto, ON, Canada.,Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Lauri Kokkinen
- Faculty of Social Sciences, University of Tampere, Tampere, Finland.,Finnish Institute of Occupational Health, Tampere, Finland
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Linzalone N, Ballarini A, Piccinelli C, Viliani F, Bianchi F. Institutionalizing Health Impact Assessment: A consultation with experts on the barriers and facilitators to implementing HIA in Italy. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2018; 218:95-102. [PMID: 29674162 DOI: 10.1016/j.jenvman.2018.04.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 03/08/2018] [Accepted: 04/07/2018] [Indexed: 06/08/2023]
Abstract
A Health Impact Assessment (HIA) is an evidence-based methodology that includes health promotion and protection goals in decision-making. HIA has been introduced and/or institutionalized to various extents in different countries. In order to promote HIA and preventive health assessments in Italy, a research methodology was followed to identify specific obstacles or facilitators. The experiences of various countries reported in the literature were analyzed in terms of facilitating or hindering the introduction and institutionalization of HIA. A consultation with the proponents of projects and plans in Italy was carried out with a multi-approach methodology in order to characterize the national context. A general implementation plan was drawn up from the international experiences. In Italy this is not yet in place. Specific areas of intervention need to be addressed, including: 1) data availability; 2) tools and methods; 3) engagement of stakeholders; 4) capacity building. The research suggests that the institutionalization of HIA in Italy rests on the government's commitment to providing specific legislation regarding HIA so that skills, intersectoral coordination and dedicated budgets can be built and maintained.
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Affiliation(s)
- Nunzia Linzalone
- Institute of Clinical Physiology, National Council of Research, Via Moruzzi, 1, 56127, Pisa, Italy.
| | - Adele Ballarini
- Regional Public Health Service, Emilia-Romagna Viale Moro, 21, 40127, Bologna, Italy.
| | - Cristiano Piccinelli
- Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10043, Turin, Italy; Center for Cancer Prevention of Piedmont Region, Via Santena 7, 10126, Turin, Italy.
| | | | - Fabrizio Bianchi
- Institute of Clinical Physiology, National Council of Research, Via Moruzzi, 1, 56127, Pisa, Italy.
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Buse CG, Lai V, Cornish K, Parkes MW. Towards environmental health equity in health impact assessment: innovations and opportunities. Int J Public Health 2018; 64:15-26. [PMID: 29911285 DOI: 10.1007/s00038-018-1135-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 06/05/2018] [Accepted: 06/07/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES As global environmental change drives inequitable health outcomes, novel health equity assessment methodologies are increasingly required. We review literatures on equity-focused HIA to clarify how equity is informing HIA practice, and to surface innovations for assessing health equity in relation to a range of exposures across geographic and temporal scales. METHODS A narrative review of the health equity and HIA literatures analysed English articles published between 2003 and 2017 across PubMed, PubMed Central, Biomed Central and Ovid Medline. Title and abstract reviews of 849 search results yielded 89 articles receiving full text review. RESULTS Considerations of equity in HIA increased over the last 5 years, but equity continues to be conflated with health disparities rather than their root causes (i.e. inequities). Lessons from six literatures to inform future HIA practice are described: HIA for healthy cities, climate change vulnerability assessment, cumulative health risk assessment, intersectionality-based policy analysis, corporate health impact assessment and global health impact assessment. CONCLUSIONS Academic reporting on incorporating equity in HIA practice has been limited. Nonetheless, significant methodological advancements are being made to examine the health equity implications of multiple environmental exposures.
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Affiliation(s)
- Chris G Buse
- School of Health Sciences, University of Northern British Columbia, Prince George, BC, Canada.
| | - Valerie Lai
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Katie Cornish
- School of Health Sciences, University of Northern British Columbia, Prince George, BC, Canada
| | - Margot W Parkes
- School of Health Sciences, University of Northern British Columbia, Prince George, BC, Canada
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Diderichsen F. The relevance of public health research for practice: A 30-year perspective. Scand J Public Health 2018; 46:58-66. [PMID: 29862908 DOI: 10.1177/1403494818765706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The Nordic context where public health responsibility is strongly devolved to municipalities raises specific demands on public health research. The demands for causal inference of disease aetiology and intervention efficacy is not different, but in addition there is a need for population health science that describes local prevalence, distribution and clustering of determinants. Knowledge of what interventions and policies work, for whom and under what conditions is essential, but instead of assuming context independence and demanding high external validity it is important to understand how contextual factors linked to groups and places modify both effects and implementation. More implementation studies are needed, but the infrastructure for that research in terms of theories and instruments for monitoring implementation is needed. Much of this was true also 30 years ago, but with increasing spending on both public health research and practice, the demands are increasing that major improvement of population health and health equity are actually achieved.
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Affiliation(s)
- Finn Diderichsen
- Department of Public Health, University of Copenhagen, Denmark; Oswaldo Cruz Foundation, Brazil
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Holt DH, Frohlich KL, Tjørnhøj-Thomsen T, Clavier C. Intersectoriality in Danish municipalities: corrupting the social determinants of health? Health Promot Int 2018; 32:881-890. [PMID: 27006364 DOI: 10.1093/heapro/daw020] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Action on the social determinants of health (SDH) through intersectoral policymaking is often suggested to promote health and health equity. This paper argues that the process of intersectoral policymaking influences how the SDH are construed and acted upon in municipal policymaking. We discuss how the intersectoral policy process legitimates certain practices in the setting of Danish municipal health promotion and the potential impact this can have for long-term, sustainable healthy public policy. Based on ethnographic fieldwork, we show how the intention of intersectoriality produces a strong concern for integrating health into non-health sectors to ensure productive collaboration. To encourage this integration, health is often framed as a means to achieve the objectives of non-health sectors. In doing so, the intersectoral policy process tends to favor smaller-scale interventions that aim to introduce healthier practices into various settings, e.g. creating healthy school environments for increased physical activity and healthy eating. While other more overarching interventions on the health impacts of broader welfare policies (e.g. education policy) tend to be neglected. The interventions hereby neglect to address more fundamental SDH. Based on these findings, we argue that intersectoral policymaking to address the SDH may translate into a limited approach to action on so-called 'intermediary determinants' of health, and as such may end up corrupting the broader SDH. Further, we discuss how this corruption affects the intended role of non-health sectors in tackling the SDH, as it may impede the overall success and long-term sustainability of intersectoral efforts.
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Affiliation(s)
- Ditte H Holt
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Katherine L Frohlich
- Department of Social and Preventive Medicine, School of Public Health and IRSPUM, University of Montreal, Quebec, Canada
| | - Tine Tjørnhøj-Thomsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Carole Clavier
- Department of Political Science, Universite du Quebec a Montreal, Quebec, Canada
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Gase L, Schooley T, Lee M, Rotakhina S, Vick J, Caplan J. A Practice-Grounded Approach for Evaluating Health in All Policies Initiatives in the United States. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 23:339-347. [PMID: 27598713 PMCID: PMC5334460 DOI: 10.1097/phh.0000000000000427] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To address the social determinants of health, an increasing number of public health practitioners are implementing Health in All Policies initiatives aimed at increasing cross-sectoral collaboration and integrating health considerations into decisions made by "nonhealth" sectors. Despite the growth in practice nationally and internationally, evaluation of Health in All Policies is a relatively new field. To help inform evaluation of Health in All Policies initiatives in the United States, this study sought to develop a practice-grounded approach, including a logic model and a set of potential indicators, which could be used to describe and assess Health in All Policies activities, outputs, and outcomes. DESIGN Methods included (a) a review of the literature on current Health in All Policies approaches, practices, and evaluations; and (b) consultation with experts with substantive knowledge in implementing or evaluating Health in All Policies initiatives. Feedback from experts was obtained through individual (n = 11) and group (n = 14) consultation. RESULTS The logic model depicts a range of potential inputs, activities, outputs, and outcomes of Health in All Policies initiatives; example indicators for each component of the logic model are provided. Case studies from California, Washington, and Nashville highlight emerging examples of Health in All Policies evaluation and the ways in which local context and goals inform evaluation efforts. CONCLUSION The tools presented in this article synthesize concepts present in the emerging literature on Health in All Policies implementation and evaluation. Practitioners and researchers can use the tools to facilitate dialogue among stakeholders, clarify assumptions, identify how they will assess progress, and implement data-driven ways to improve their Health in All Policies work.
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Affiliation(s)
- Lauren Gase
- Division of Chronic Disease and Injury Prevention, Los
Angeles County Department of Public Health, Los Angeles, California
| | - Taylor Schooley
- Division of Chronic Disease and Injury Prevention, Los
Angeles County Department of Public Health, Los Angeles, California
| | - Meredith Lee
- Health in All Policies Task Force, Office of Health Equity,
California Department of Public Health, Sacramento, California
| | | | - John Vick
- Division of Epidemiology and Research, Metro Nashville
Public Health Department, Nashville, Tennessee
| | - Julia Caplan
- Health in All Policies, Public Health Institute,
Sacramento, California
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Shankardass K, Muntaner C, Kokkinen L, Shahidi FV, Freiler A, Oneka G, M Bayoumi A, O'Campo P. The implementation of Health in All Policies initiatives: a systems framework for government action. Health Res Policy Syst 2018; 16:26. [PMID: 29544496 PMCID: PMC5856219 DOI: 10.1186/s12961-018-0295-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 02/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There has been a renewed interest in broadening the research agenda in health promotion to include action on the structural determinants of health, including a focus on the implementation of Health in All Policies (HiAP). Governments that use HiAP face the challenge of instituting governance structures and processes to facilitate policy coordination in an evidence-informed manner. Due to the complexity of government institutions and the policy process, systems theory has been proposed as a tool for evaluating the implementation of HiAP. METHODS Our multiple case study research programme (HiAP Analysis using Realist Methods On International Case Studies - HARMONICS) has relied on systems theory and realist methods to make sense of how and why the practices of policy-makers (including politicians and civil servants) from specific institutional environments (policy sectors) has either facilitated or hindered the implementation of HiAP. Herein, we present a systems framework for the implementation of HiAP based on our experience and empirical findings in studying this process. RESULTS We describe a system of 14 components within three subsystems of government. Subsystems include the executive (heads of state and their appointed political elites), intersectoral (the milieu of policy-makers and experts working with governance structures related to HiAP) and intrasectoral (policy-makers within policy sectors). Here, HiAP implementation is a process involving interactions between subsystems and their components that leads to the emergence of implementation outcomes, as well as effects on the system components themselves. We also describe the influence of extra-governmental systems, including (but not limited to) the academic sector, third sector, private sector and intergovernmental sector. Finally, we present a case study that applies this framework to understand the implementation of HiAP - the Health 2015 Strategy - in Finland, from 2001 onward. CONCLUSIONS This framework is useful for helping to explain how, why and under what circumstances HiAP has been successfully and unsuccessfully implemented in a sustainable manner. It serves as a tool for researchers to study this process, and for policy-makers and other public health actors to manage this process.
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Affiliation(s)
- Ketan Shankardass
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada. .,Department of Health Sciences, Wilfrid Laurier University, 75 University Ave W, Waterloo, ON, N2L 3C5, Canada.
| | - Carles Muntaner
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.,Bloomberg School of Nursing, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Lauri Kokkinen
- Finnish Institute of Occupational Health, PL 40, 00251, Helsinki, Finland
| | - Faraz Vahid Shahidi
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Alix Freiler
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada
| | - Goldameir Oneka
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Ahmed M Bayoumi
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.,Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Patricia O'Campo
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
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[A good investment: promoting health in cities and neighbourhoods]. GACETA SANITARIA 2018; 30 Suppl 1:74-80. [PMID: 27837799 DOI: 10.1016/j.gaceta.2016.04.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 04/10/2016] [Accepted: 04/18/2016] [Indexed: 10/20/2022]
Abstract
Local administration is responsible for health-related areas, and evidence of the health impact of urban policies is available. Barriers and recommendations for the full implementation of health promotion in cities and neighbourhoods have been described. The barriers to the promotion of urban health are broad: the lack of leadership and political will, reflectes the allocation of health outcomes to health services, as well as technical, political and public misconceptions about the root causes of health and wellbeing. Ideologies and prejudices, non-evidence-based policies, narrow sectoral cultures, short political periods, lack of population-based health information and few opportunities for participation limit the opportunities for urban health. Local policies on early childhood, healthy schools, employment, active transport, parks, leisure and community services, housing, urban planning, food protection and environmental health have great positive impacts on health. Key tools include the political prioritisation of health and equity, the commitment to «Health in All Policies» and the participation of communities, social movements and civil society. This requires well organised and funded structures and processes, as well as equity-based health information and capacity building in the health sector, other sectors and society. We conclude that local policies have a great potential for maximising health and equity and equity. The recommendations for carrying them out are increasingly solid and feasible.
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Holt DH, Rod MH, Waldorff SB, Tjørnhøj-Thomsen T. Elusive implementation: an ethnographic study of intersectoral policymaking for health. BMC Health Serv Res 2018; 18:54. [PMID: 29378655 PMCID: PMC5789672 DOI: 10.1186/s12913-018-2864-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 01/21/2018] [Indexed: 11/10/2022] Open
Abstract
Background For more than 30 years policy action across sectors has been celebrated as a necessary and viable way to affect the social factors impacting on health. In particular intersectoral action on the social determinants of health is considered necessary to address social inequalities in health. However, despite growing support for intersectoral policymaking, implementation remains a challenge. Critics argue that public health has remained naïve about the policy process and a better understanding is needed. Based on ethnographic data, this paper conducts an in-depth analysis of a local process of intersectoral policymaking in order to gain a better understanding of the challenges posed by implementation. To help conceptualize the process, we apply the theoretical perspective of organizational neo-institutionalism, in particular the concepts of rationalized myth and decoupling. Methods On the basis of an explorative study among ten Danish municipalities, we conducted an ethnographic study of the development of a municipal-wide implementation strategy for the intersectoral health policy of a medium-sized municipality. The main data sources consist of ethnographic field notes from participant observation and interview transcripts. Results By providing detailed contextual description, we show how an apparent failure to move from policy to action is played out by the ongoing production of abstract rhetoric and vague plans. We find that idealization of universal intersectoralism, inconsistent demands, and doubts about economic outcomes challenge the notion of implementation as moving from rhetoric to action. Conclusion We argue that the ‘myth’ of intersectoralism may be instrumental in avoiding the specification of action to implement the policy, and that the policy instead serves as a way to display and support good intentions and hereby continue the process. On this basis we expand the discussion on implementation challenges regarding intersectoral policymaking for health. Electronic supplementary material The online version of this article (10.1186/s12913-018-2864-9) contains supplementary material, which is available to authorized users.
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A scoping review of the implementation of health in all policies at the local level. Health Policy 2017; 122:284-292. [PMID: 29305241 DOI: 10.1016/j.healthpol.2017.12.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 11/29/2017] [Accepted: 12/12/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Health in All Policies (HiAP) is an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity. HiAP implementation can involve engagement from multiple levels of government; however, factors contributing or hindering HiAP implementation at the local level are largely unexplored. Local is defined as the city or municipal level, wherein government is uniquely positioned to provide leadership for health and where many social determinants of health operate. This paper presents the results of a scoping review on local HiAP implementation. METHODS Peer reviewed articles and grey literature were systematically searched using the Arksey and O'Malley framework. Characteristics of articles were then categorized, tallied and described. RESULTS 23 scholarly articles and four government documents were identified, ranging in publication year from 2002 to 2016 and originating from 14 countries primarily from North America and Europe. A wide range of themes emerged relating to HiAP implementation locally including: funding, shared vision, national leadership, ownership and accountability, local leadership and dedicated staff, Health Impact Assessment, and indicators. CONCLUSION Common themes were found in the literature regarding HiAP implementation locally. However, to better clarify these factors to contribute to theory development on HiAP implementation, further research is needed that specifically investigates the facilitators and barriers of HiAP locally within their political and policy context.
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Baum F, Delany-Crowe T, MacDougall C, Lawless A, van Eyk H, Williams C. Ideas, actors and institutions: lessons from South Australian Health in All Policies on what encourages other sectors' involvement. BMC Public Health 2017; 17:811. [PMID: 29037182 PMCID: PMC5644129 DOI: 10.1186/s12889-017-4821-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 10/04/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This paper examines the extent to which actors from sectors other than health engaged with the South Australian Health in All Policies (HiAP) initiative, determines why they were prepared to do so and explains the mechanisms by which successful engagement happened. This examination applies theories of policy development and implementation. METHODS The paper draws on a five year study of the implementation of HiAP comprising document analysis, a log of key events, detailed interviews with 64 policy actors and two surveys of public servants. RESULTS The findings are analysed within an institutional policy analysis framework and examine the extent to which ideas, institutional factors and actor agency influenced the willingness of actors from other sectors to work with Health sector staff under the HiAP initiative. In terms of ideas, there was wide acceptance of the role of social determinants in shaping health and the importance of action to promote health in all government agencies. The institutional environment was initially supportive, but support waned over the course of the study when the economy in South Australia became less buoyant and a health minister less supportive of health promotion took office. The existence of a HiAP Unit was very helpful for gaining support from other sectors. A new Public Health Act offered some promise of institutionalising the HiAP approach and ideas. The analysis concludes that a key factor was the operation of a supportive network of public servants who promoted HiAP, including some who were senior and influential. CONCLUSIONS The South Australian case study demonstrates that despite institutional constraints and shifting political support within the health sector, HiAP gained traction in other sectors. The key factors that encouraged the commitment of others sectors to HiAP were the existence of a supportive, knowledgeable policy network, political support, institutionalisation of the ideas and approach, and balancing of the economic and social goals of government.
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Affiliation(s)
- Fran Baum
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
| | - Toni Delany-Crowe
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
| | - Colin MacDougall
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Angela Lawless
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Helen van Eyk
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
| | - Carmel Williams
- Health Determinants and Policy, Department for Health and Ageing, Adelaide, Australia
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Synnevåg ES, Amdam R, Fosse E. Public health terminology: Hindrance to a Health in All Policies approach? Scand J Public Health 2017; 46:68-73. [PMID: 28927351 DOI: 10.1177/1403494817729921] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM National public health policies in Norway are based on a Health in All Policies (HiAP) approach. At the local level, this means that public health, as a cross-sectional responsibility, should be implemented in all municipal sectors by integrating public health policies in municipal planning and management systems. The paper investigates these local processes, focusing on the use of public health terminology and how this terminology is translated from national to local contexts. We ask whether the terms 'public health' and 'public health work' are suitable when implementing an HiAP approach. METHODS A qualitative case study based on analyses of interviews and planning documents was performed in three Norwegian municipalities. RESULTS The results present dilemmas associated with using public health terminology when implementing an HiAP approach. On the one hand, the terms are experienced as wide, complex, advanced and unnecessary. On the other hand, the terms are experienced as important for a systematic approach towards understanding public health ideology and cross-sectional responsibility. One municipality used alternative terminology. CONCLUSIONS This paper promotes debate about the appropriateness of using the terms 'public health' and 'public health work' at the local level. It suggests that adaptation is suitable and necessary, unless it compromises knowledge, responsibility and a systematic approach. This study concludes that the use of terminology is a central factor when implementing the Norwegian Public Health Act at the local level.
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Affiliation(s)
- Ellen S Synnevåg
- 1 Institute of Planning and Administration, Faculty of Social Sciences and History, Volda University College, Norway
| | - Roar Amdam
- 1 Institute of Planning and Administration, Faculty of Social Sciences and History, Volda University College, Norway
| | - Elisabeth Fosse
- 2 Department of Health Promotion and Development, University of Bergen, Norway
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