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Moradzadeh M, Karamouzian M, Najafizadeh S, Yazdi-Feyzabadi V, Haghdoost AA. International Journal of Health Policy and Management (IJHPM): A Decade of Advancing Knowledge and Influencing Global Health Policy (2013-2023). Int J Health Policy Manag 2023; 12:8124. [PMID: 37579384 PMCID: PMC10425691 DOI: 10.34172/ijhpm.2023.8124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/23/2023] [Indexed: 08/16/2023] Open
Affiliation(s)
- Mina Moradzadeh
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Karamouzian
- Centre On Drug Policy Evaluation, St. Michael’s Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV, Kerman University of Medical Sciences, Kerman, Iran
| | - Sahar Najafizadeh
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Vahid Yazdi-Feyzabadi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali-Akbar Haghdoost
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Cairney P, St.Denny E, Boswell J. Why is health improvement policy so difficult to secure? OPEN RESEARCH EUROPE 2022; 2:76. [PMID: 37645286 PMCID: PMC10445925 DOI: 10.12688/openreseurope.14841.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 08/31/2023]
Abstract
Many governments seek to improve population health, and some seek to reduce health inequalities. Yet, there remains a large gap between their policy statements and actual outcomes. Perennial questions in public health research include: why is this gap so large, why does it endure, and what can be done to close it? This essay uses political science and policy studies insights to address these questions, focusing on the distinctive issues that relate to (1) broad aims like 'prevention', (2) specific strategies for health improvement, or (3) new events. On the one hand, the idea of 'prevention' has widespread appeal, when governments think they can save money or reduce inequalities by preventing problems happening or worsening. While health protection seeks to inoculate populations against communicable diseases, health improvement strategies, including 'Health in All Policies' (HiAP), primarily address non-communicable diseases (NCDs). Further, the coronavirus disease 2019 (COVID-19) pandemic highlights the unequal spread of ill health, showing that preventive health ideas should be at the core of policy. On the other hand, there is a large gap between rhetorical and substantive commitment to prevention, a continuous HiAP implementation gap, and a tendency for COVID-19 health protection to overshadow health improvement. Explaining each problem clearly helps to identify the factors that generally undermine prevention policies and those specific to more detailed strategies like HiAP or events like COVID-19. We do not prioritise leadership or 'political will' as the policymaking problem. Instead, we identify the systemic factors that apply to even the most sincere, competent, and energetic policymakers. Health improvement policy is typically undermined by a lack of: clarity about what prevention means in practice; congruity between the prevention agenda (emphasising the need for major change to policy and policymaking) and routine government business; and, capacity to overcome obstacles to policy change.
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Affiliation(s)
- Paul Cairney
- Division of History, Heritage, and Policy, University of Stirling, Stirling, Stirling, FK94LA, UK
| | - Emily St.Denny
- Department of Political Science, University of Copenhagen, Copenhagen, DK-1353, Denmark
| | - John Boswell
- Politics and International Relations, University of Southampton, Southampton, SO17 1BJ, UK
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Hernantes N, Bermejo-Martins E, Øvergård KI, Pumar-Mendez MJ, Lopez-Dicastillo O, Iriarte-Roteta A, Antoñanzas-Baztan E, Mujika A. Theory-based capacity building intervention for intersectoral action for health at local governments: An exploratory pilot study. J Adv Nurs 2022; 78:1798-1814. [PMID: 35436006 PMCID: PMC9322672 DOI: 10.1111/jan.15247] [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: 10/01/2021] [Revised: 02/24/2022] [Accepted: 03/23/2022] [Indexed: 11/29/2022]
Abstract
Aim To design, implement and evaluate a nurse‐led capacity building intervention (PromoGOB) for intersectoral action for health at local governments. Design The programme was based on theories of the policy process and organizational change and facilitated by a nurse developing a health broker role. A complex intervention perspective was adopted in carrying out the study. The intervention was evaluated using a mixed method embedded design. Methods Quantitative component relied on a specific questionnaire. This tool, designed and piloted ad hoc, measured the capacity in terms of knowledge, awareness, resources, skills, and commitment, both at sectoral and government levels. For the qualitative component, semi‐structured interviews were conducted. These explored the perceived capacity and feasibility and acceptability issues. The programme was initiated at the end of October 2019, and it lasted a total of 5 weeks. Nineteen individuals representing various sectors at a local government in northern Spain participated in the study. The data analysis was concluded by the end of March 2020. Findings PromoGOB positively influenced participants' capacity for addressing health promotion. Awareness component, intersectoral work and the nurse as health broker were essential in the programme. The necessity of political participation was identified as an issue to be prioritized in future studies. Conclusion This study highlights the relevance of capacity building at local governments and the role that nurses can play in it. Further work should be undertaken to continue developing Health in All Policies approach at local level. Impact This study offers a starting point for nurses to get involved in the policy process of health promotion, performing a specific role as health brokers, building capacity at local governments for addressing social determinants of health, and delving into theories and concepts of the Health in All Policies field.
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Affiliation(s)
- Naia Hernantes
- Department of Nursing II, Faculty of Medicine and Nursing, University of the Basque Country, Donostia-San Sebastián, Spain.,School of Nursing, University of Navarra, Pamplona, Spain
| | - Elena Bermejo-Martins
- School of Nursing, University of Navarra, Pamplona, Spain.,Navarra Institute for Health Research, Idisna. Pamplona, Spain
| | - Kjell Ivar Øvergård
- Research group for Health Promotion in Settings, Department of Health-, Social-, and Welfare Studies, University of South-Eastern Norway, Kongsberg, Norway
| | - María Jesús Pumar-Mendez
- Navarra Institute for Health Research, Idisna. Pamplona, Spain.,Department of Health Sciences, Faculty of Health Sciences, Public University of Navarra, Pamplona, Spain
| | - Olga Lopez-Dicastillo
- Navarra Institute for Health Research, Idisna. Pamplona, Spain.,Department of Health Sciences, Faculty of Health Sciences, Public University of Navarra, Pamplona, Spain
| | - Andrea Iriarte-Roteta
- School of Nursing, University of Navarra, Pamplona, Spain.,Department of Health Sciences, Faculty of Health Sciences, Public University of Navarra, Pamplona, Spain.,Osasunbidea Health Care Service, Navarra, Spain
| | - Elena Antoñanzas-Baztan
- Department of Health Sciences, Faculty of Health Sciences, Public University of Navarra, Pamplona, Spain.,Osasunbidea Health Care Service, Navarra, Spain.,Government of Navarra, Department of Health, Navarra, Spain
| | - Agurtzane Mujika
- Department of Nursing II, Faculty of Medicine and Nursing, University of the Basque Country, Donostia-San Sebastián, Spain
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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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5
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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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Friel S, Townsend B, Fisher M, Harris P, Freeman T, Baum F. Power and the people's health. Soc Sci Med 2021; 282:114173. [PMID: 34192622 DOI: 10.1016/j.socscimed.2021.114173] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/28/2021] [Accepted: 06/20/2021] [Indexed: 10/21/2022]
Abstract
Public policy plays a central role in creating and distributing resources and conditions of daily life that matter for health equity. Policy agendas have tended to focus on health care delivery and individualised interventions. Asking why there is a lack of policy action on structural drivers of health inequities raises questions about power inequities in policy systems that maintain the status quo. In this paper we investigate the power dynamics shaping public policy and implications for health equity. Using a Health Equity Power Framework (HEPF), we examined data from 158 qualitative interviews with government, industry and civil society actors across seven policy case studies covering areas of macroeconomics, employment, social protection, welfare reform, health care, infrastructure and land use planning. The influence of structures of capitalism, neoliberalism, sexism, colonisation, racism and biomedicalism were widely evident, manifested through the ideologies, behaviours and discourses of state, market, and civil actors and the institutional spaces they occupied. Structurally less powerful public interest actors made creative use of existing or new institutional spaces, and used network, discursive and moral power to influence policy, with some success in moderating inequities in structural and institutional forms of power. Our hope is that the methodological advancement and empirical data presented here helps to illuminate how public interest actors can navigate structural power inequities in the policy system in order to disrupt the status quo and advance a comprehensive policy agenda on the social determinants of health equity. However, this analysis highlights the unrealistic expectation of turning health inequities around in a short time given the long-term embedded power dynamics and inequities within policy systems under late capitalism. Achieving health equity is a power-saturated long game.
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Affiliation(s)
- Sharon Friel
- Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Fellows Road, Canberra ACT, 2601, Australia.
| | - Belinda Townsend
- Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Fellows Road, Canberra ACT, 2601, Australia.
| | - Matthew Fisher
- Southgate Institute for Society, Equity and Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Patrick Harris
- Centre for Health Equity Training, Research & Evaluation, Australia Research Centre for Primary Health Care & Equity, University of New South Wales, Liverpool, NSW, 1871, Australia.
| | - Toby Freeman
- Southgate Institute for Society, Equity and Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Fran Baum
- Southgate Institute for Society, Equity and Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
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Cherry E, Stancliffe RJ, Emerson E, Tichá R. Policy Implications, Eligibility, and Demographic Characteristics of People With Intellectual Disability Who Access Self-Directed Funding in the United States. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 59:123-140. [PMID: 33793785 DOI: 10.1352/1934-9556-59.2.123] [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: 01/10/2019] [Accepted: 02/17/2020] [Indexed: 06/12/2023]
Abstract
This study identifies factors (state of residence, personal characteristics, and living situation) associated with access to self-directed funding (SDF) for adults with intellectual disability in the United States. Data from 10,033 participants from 26 states in the 2012-2013 National Core Indicators Adult Consumer Survey were analyzed. We examined state, age group, residence type, disability diagnoses, mental health status, and type of disability support funding used. Availability of SDF for people with ID varied by state and aligned mostly with state-by-state policy data on SDF eligibility and availability. The results of a logistic regression analysis demonstrated that access to SDF was lower in older adults and higher for people who lived in their parents' or relatives' home, an independent home, and with certain personal characteristics. Potential influences from policy and practice, and approaches to increase access to SDF are discussed.
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Affiliation(s)
- Elizabeth Cherry
- Elizabeth Cherry and Roger J. Stancliffe, The University of Sydney, Centre for Disability Research and Policy, Faculty of Medicine and Health, AU
| | - Roger J Stancliffe
- Elizabeth Cherry and Roger J. Stancliffe, The University of Sydney, Centre for Disability Research and Policy, Faculty of Medicine and Health, AU
| | - Eric Emerson
- Eric Emerson, The University of Sydney, Centre for Disability Research and Policy, Faculty of Medicine and Health, AU; and Lancaster University, Centre for Disability Research, Faculty of Health and Medicine, UK; and
| | - Renata Tichá
- Renata Tichá, Research and Training Center on Community Living, Institute on Community Integration, University of Minnesota, US
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9
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Abstract
Purpose
The purpose of this paper is to examine the enactment of collaborative governance as a policy strategy in healthcare – in particular its effects in coordinating multiple collaborative initiatives dedicated to improve the performance of health organizations. It studies overarching governance mechanisms that serve as platforms at a meta-level between policy and frontline practice.
Design/methodology/approach
Four collaborative governance arrangements dedicated to improve health outcomes in the Netherlands are analyzed in a comparative case-study design, based on extensive document analysis (n=121) and interviews (n=56) with key stakeholders in the field, including the Dutch Ministry of Health, health organizations and other actors.
Findings
The studied policy-based governance mechanisms for the coordination of multiple micro-level collaborative initiatives function partly as platforms in bringing actors and resources together successfully. They do so, by fostering evolvability (the capacity to generate diversity in emergent ways) in relation to goal-setting and intermediation between actors. Yet, they marginalize open access to participants through high selectivity and deliberate exclusion strategies for certain actors, contrary to a platform logic of action.
Research limitations/implications
While the collaborative governance literature focuses on these dimensions as independent elements, findings reveal both trade-offs and interdependencies between studied dimensions of coordination associated with platforms, that need to be negotiated and managed.
Practical implications
Selectivity and exclusion in collaborative arrangements may negatively affect relational bonds and ties between actors, which challenges the application of collaborative governance as a policy strategy in pursuit of health objectives.
Originality/value
Responding to recent calls in the literature, this study applies ideas from public administration to the field of health organization and management to avert failures in the translation of policy ambitions into health practice.
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Malbon E, Carey G, Meltzer A. Personalisation schemes in social care: are they growing social and health inequalities? BMC Public Health 2019; 19:805. [PMID: 31234807 PMCID: PMC6591823 DOI: 10.1186/s12889-019-7168-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 06/13/2019] [Indexed: 11/21/2022] Open
Abstract
Background The connection between choice, control and health is well established in the literature on the social determinants of health, which includes choice and control of vital health and social services. However, even in the context of universal health and social care schemes, the ability to exercise choice and control can be distributed unequally. This paper uses the case of the Australian National Disability Insurance Scheme (NDIS) to examine these issues. The NDIS is a major policy reform based on an international trend towards personalisation in social care. It aims to increase choice and control over services and supports for people who have or acquire a permanent disability, thereby boosting citizen empowerment and improving health and social outcomes. Methods The research is a structured review of empirical evidence on the administration and outcomes of the NDIS to identify how social factors constrain or enable the ability of individuals to exercise choice within personalised care schemes. Results We show how social determinants of health at the individual level can collide with the complexity of policy delivery systems to entrench health inequalities. Conclusion Many social policy reforms internationally focus on improving empowerment through enabling choice and control. However, if administrative systems do not take account of existing structural inequities, then such schemes are likely to entrench or grow social inequality. Our research indicates that more attention must be given to the design of policy delivery systems for personalisation schemes to ensure health equity.
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Affiliation(s)
| | - Gemma Carey
- Centre for Social Impact, UNSW, Kensington, Australia.
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Lehne G, Voelcker-Rehage C, Meyer J, Bammann K, Gansefort D, Brüchert T, Bolte G. Equity Impact Assessment of Interventions to Promote Physical Activity among Older Adults: A Logic Model Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E420. [PMID: 30717136 PMCID: PMC6388141 DOI: 10.3390/ijerph16030420] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/23/2019] [Accepted: 01/30/2019] [Indexed: 11/16/2022]
Abstract
Reducing social inequalities in health and health determinants, including physical activity (PA), is a major challenge for public health. PA-promoting interventions are increasingly implemented. Little is known, however, about the impact of these interventions on social inequalities. For prioritizing interventions most likely to be effective in reducing inequalities, studies of PA interventions need to conduct equity impact assessments. The aim of this article is to describe the development of a logic model framework for equity impact assessments of interventions to promote PA. The framework was developed within the prevention research network AEQUIPA-Physical activity and health equity: primary prevention for healthy ageing, informed by an equity-focused systematic review, expert interviews, exploratory literature searches, and joint discussions within the network. The framework comprises a general equity-focused logic model to be adapted to specific interventions. The intervention-specific equity-focused logic models illustrate the key elements relevant for assessing social inequalities in study participation, compliance with and acceptance of interventions, as well as the efficacy of interventions. Future work within AEQUIPA will reveal which key elements are most critical for the interventions' equity impacts. Equity impact assessments are beneficial for prioritizing interventions most likely to be effective in reducing health inequalities.
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Affiliation(s)
- Gesa Lehne
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, 28359 Bremen, Germany.
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany.
| | - Claudia Voelcker-Rehage
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09126 Chemnitz, Germany.
| | - Jochen Meyer
- OFFIS-Institute for Information Technology, 26121 Oldenburg, Germany.
| | - Karin Bammann
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany.
- Working Group Epidemiology of Demographic Change, Institute of Public Health and Nursing Research, University of Bremen, 28359 Bremen, Germany.
| | - Dirk Gansefort
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, 28359 Bremen, Germany.
| | - Tanja Brüchert
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, 28359 Bremen, Germany.
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany.
| | - Gabriele Bolte
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, 28359 Bremen, Germany.
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany.
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Synnevåg ES, Amdam R, Fosse E. Intersectoral Planning for Public Health: Dilemmas and Challenges. Int J Health Policy Manag 2018; 7:982-992. [PMID: 30624872 PMCID: PMC6326631 DOI: 10.15171/ijhpm.2018.59] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 06/17/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Intersectoral action is often presented as essential in the promotion of population health and health equity. In Norway, national public health policies are based on the Health in All Policies (HiAP) approach that promotes whole-of-government responsibility. As part of the promotion of this intersectoral responsibility, planning is presented as a tool that every Norwegian municipality should use to integrate public health policies into their planning and management systems. Although research on implementing the HiAP approach is increasing, few studies apply a planning perspective. To address this gap in the literature, our study investigates how three Norwegian municipalities experience the use of planning as a tool when implementing the HiAP approach. METHODS To investigate planning practices in three Norwegian municipalities, we used a qualitative multiple case study design based on face-to-face interviews. When analysing and discussing the results, we used the dichotomy of instrumental and communicative planning approaches, in addition to a collaborative planning approach, as the theoretical framework. RESULTS The municipalities encounter several dilemmas when using planning as a tool for implementing the HiAP approach. Balancing the use of qualitative and quantitative knowledge and balancing the use of structural and processual procedures are two such dilemmas. Other dilemmas include balancing the use of power and balancing action and understanding in different municipal contexts. They are also faced with the dilemma of whether to place public health issues at the forefront or to present these issues in more general terms. CONCLUSION We argue that the dilemmas experienced by the municipalities might be explained by the difficult task of combining instrumental and communicative planning approaches because the balance between them is seldom fixed.
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Affiliation(s)
- Ellen Strøm Synnevåg
- Faculty of Social Sciences and History, Volda University College, Volda, Norway
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Roar Amdam
- Faculty of Social Sciences and History, Volda University College, Volda, Norway
| | - Elisabeth Fosse
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
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Rasanathan K, Atkins V, Mwansambo C, Soucat A, Bennett S. Governing multisectoral action for health in low-income and middle-income countries: an agenda for the way forward. BMJ Glob Health 2018; 3:e000890. [PMID: 30364321 PMCID: PMC6195143 DOI: 10.1136/bmjgh-2018-000890] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/23/2018] [Accepted: 08/17/2018] [Indexed: 11/16/2022] Open
Abstract
Drawing on experiences reviewed in the accompanying supplement and other literature, we present an agenda for the way forward for policy-makers, managers, civil society and development partners to govern multisectoral action for health in low-income and middle-income countries and consider how such an agenda might be realised. We propose the following key strategies: understand the key actors and political ecosystem, including type of multisectoral action required and mapping incentives, interests and hierarchies; frame the issue in the most strategic manner; define clear roles with specific sets of interventions according to sector; use existing structures unless there is a compelling reason not to do so; pay explicit attention to the roles of non-state sectors; address conflicts of interest and manage tradeoffs; distribute leadership; develop financing and monitoring systems to encourage collaboration; strengthen implementation processes and capacity; and support mutual learning and implementation research. To support countries to strengthen governance for multisectoral action, the global community can assist by further developing technical tools and convening peer learning by policy-makers (particularly from beyond the health sector), supporting knowledge management and sharing of experiences in multisectoral action beyond health, developing an agenda for and execution of implementation research and, finally, driving multilateral and bilateral development partners to transcend their own silos and work in a more multisectoral manner.
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Affiliation(s)
| | | | | | | | - Sara Bennett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Couture J, Breux S. The differentiated effects of health on political participation. Eur J Public Health 2018; 27:599-604. [PMID: 28108593 DOI: 10.1093/eurpub/ckw245] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Several studies have shown that an individual's state of health can significantly affect their decision to vote, but analysis is often only done on a single level of government; the national level. However, prior research has shown that the determining factors for voting can differ according to the level of government being considered. Our analysis is the first attempt to take a comprehensive look at the magnitude of health and political participation in a same country on different levels. Methods Based on Canadian General Social Survey-Social Identity (2013; N = 27 695), we examined both the direct and indirect effect of self-rated health and self-rated mental health on (1) national voter turnout; (2) local voter turnout and (3) other forms of political participation. Results The results show that health has a different effect on turnout depending the level of government. While health certainly affects participation on both levels of government, general health significantly affects national electoral participation levels while mental health more significantly affects electoral participation on the municipal level. Additionally, people who consider their mental health to be poorer, are more likely to sign an online petition. Conclusions These elements highlight the necessity of questioning the cost of voting according to the level of government, and that further research into the potential offered by Internet and remote voting, is worthwhile-despite the opinions of critics who eschew these means of voting.
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Affiliation(s)
- Jérôme Couture
- Département de Science Politique, Université Laval, Québec, Qc, Canada and INRS-UCS, Montreal, QC, Canada
| | - Sandra Breux
- Institut National de Recherche Scientifique, Centre Urbanisation Culture et Société, Montreal, QC, Canada
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Lawless A, Baum F, Delany-Crowe T, MacDougall C, Williams C, McDermott D, Eyk HV. 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; 7:510-521. [PMID: 29935128 PMCID: PMC6015512 DOI: 10.15171/ijhpm.2017.121] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 10/07/2017] [Indexed: 11/22/2022] Open
Abstract
Background: The importance of evaluating policy processes to achieve health equity is well recognised but such evaluation encounters methodological, theoretical and political challenges. This paper describes how a program theorybased evaluation framework can be developed and tested, using the example of an evaluation of the South Australian Health in All Policies (HiAP) initiative.
Methods: A framework of the theorised components and relationships of the HiAP initiative was produced to guide evaluation. The framework was the product of a collaborative, iterative process underpinned by a policy-research partnership and drew on social and political science theory and relevant policy literature.
Results: The process engaged key stakeholders to capture both HiAP specific and broader bureaucratic knowledge and was informed by a number of social and political science theories. The framework provides a basis for exploring the interactions between framework components and how they shape policy-making and public policy. It also enables an assessment of HiAP’s success in integrating health and equity considerations in policies, thereby laying a foundation for predicting the impacts of resulting policies.
Conclusion: The use of a program theory-based evaluation framework developed through a consultative process and informed by social and political science theory has accommodated the complexity of public policy-making. The framework allows for examination of HiAP processes and impacts, and for the tracking of contribution towards distal outcomes through the explicit articulation of the underpinning program theory.
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Affiliation(s)
- Angela Lawless
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Fran Baum
- Southgate Institute for Health Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Toni Delany-Crowe
- Southgate Institute for Health Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Colin MacDougall
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | | | - Dennis McDermott
- The Poche Centre for Indigenous Health and Well-being, Flinders University, Adelaide, SA, Australia
| | - Helen van Eyk
- Southgate Institute for Health Society and Equity, Flinders University, Adelaide, SA, Australia
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Carey G, Malbon E, Reeders D, Kavanagh A, Llewellyn G. Redressing or entrenching social and health inequities through policy implementation? Examining personalised budgets through the Australian National Disability Insurance Scheme. Int J Equity Health 2017; 16:192. [PMID: 29110663 PMCID: PMC5674687 DOI: 10.1186/s12939-017-0682-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/09/2017] [Indexed: 11/29/2022] Open
Abstract
Background Increasing attention is being given to political agenda setting for the social determinants of health. While designing policies that can improve the social determinants of health is critical, so too is ensuring these policies are appropriately administered and implemented. Many policies have the potential to entrench or even expand inequities during implementation. At present little attention has been given to this in the social determinants of health literature. There is an international trend in the personalisation of funding for care services, from the National Health Service in the England to the Brukerstyrt Personlig Assistanse in Norway. Part of this trend is the Australian National Disability Insurance Scheme (NDIS). The NDIS has the potential to secure gains in health for hundreds of thousands of Australians living with a disability. However, policies are only as good as their implementation. Methods As part of a longitudinal study on the implementation of the Australian NDIS, we conducted a systematic document search of policy documents pertaining to the Scheme on the websites of government departments with auspice over the design and implementation of the scheme with the aim of examining issues of equity. Results and discussion Scheme architects have argued that the NDIS has the potential to replace a piecemeal and fragmented set of state-determined services with an empowering model of user choice and control. However, without careful attention to both existing inequities and, diversity and difference across populations (e.g. different disability types and different localities), market based approaches such as the NDIS have the serious potential to entrench or even widen inequities. Conclusions The research concluded that ‘personalisation’ approaches can widen inequities and inequalities unless careful consideration is given at both policy design and implementation stages.
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Affiliation(s)
- Gemma Carey
- Centre for Public Service Research, UNSW Canberra, Canberra, Australia.
| | - Eleanor Malbon
- Centre for Public Service Research, UNSW Canberra, Canberra, Australia
| | - Daniel Reeders
- Centre for Public Service Research, UNSW Canberra, Canberra, Australia
| | - Anne Kavanagh
- School of Population Health, University of Melbourne, Melbourne, Australia
| | - Gwynnyth Llewellyn
- Centre for Disability Research and Policy, University of Sydney, Sydney, Australia
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Remme M, Martinez-Alvarez M, Vassall A. Cost-Effectiveness Thresholds in Global Health: Taking a Multisectoral Perspective. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:699-704. [PMID: 28408014 DOI: 10.1016/j.jval.2016.11.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 11/13/2016] [Accepted: 11/13/2016] [Indexed: 05/21/2023]
Abstract
Good health is a function of a range of biological, environmental, behavioral, and social factors. The consumption of quality health care services is therefore only a part of how good health is produced. Although few would argue with this, the economic framework used to allocate resources to optimize population health is applied in a way that constrains the analyst and the decision maker to health care services. This approach risks missing two critical issues: 1) multiple sectors contribute to health gain and 2) the goods and services produced by the health sector can have multiple benefits besides health. We illustrate how present cost-effectiveness thresholds could result in health losses, particularly when considering health-producing interventions in other sectors or public health interventions with multisectoral outcomes. We then propose a potentially more optimal second best approach, the so-called cofinancing approach, in which the health payer could redistribute part of its budget to other sectors, where specific nonhealth interventions achieved a health gain more efficiently than the health sector's marginal productivity (opportunity cost). Likewise, other sectors would determine how much to contribute toward such an intervention, given the current marginal productivity of their budgets. Further research is certainly required to test and validate different measurement approaches and to assess the efficiency gains from cofinancing after deducting the transaction costs that would come with such cross-sectoral coordination.
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Affiliation(s)
- Michelle Remme
- Social and Mathematical Epidemiology (SaME) Group, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
| | - Melisa Martinez-Alvarez
- Social and Mathematical Epidemiology (SaME) Group, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Anna Vassall
- Social and Mathematical Epidemiology (SaME) Group, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Clavier C. Implementing Health in All Policies - Time and Ideas Matter Too! Comment on "Understanding the Role of Public Administration in Implementing Action on the Social Determinants of Health and Health Inequities". Int J Health Policy Manag 2016; 5:609-610. [PMID: 27694654 DOI: 10.15171/ijhpm.2016.81] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 06/11/2016] [Indexed: 11/09/2022] Open
Abstract
Carey and Friel suggest that we turn to knowledge developed in the field of public administration, especially new public governance, to better understand the process of implementing health in all policies (HiAP). In this commentary, I claim that theories from the policy studies bring a broader view of the policy process, complementary to that of new public governance. Drawing on the policy studies, I argue that time and ideas matter to HiAP implementation, alongside with interests and institutions. Implementing HiAP is a complex process considering that it requires the involvement and coordination of several policy sectors, each with their own interests, institutions and ideas about the policy. Understanding who are the actors involved from the various policy sectors concerned, what context they evolve in, but also how they own and frame the policy problem (ideas), and how this has changed over time, is crucial for those involved in HiAP implementation so that they can relate to and work together with actors from other policy sectors.
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Affiliation(s)
- Carole Clavier
- Departement of Political Science, Universite du Quebec a Montreal, Montréal, QC, Canada
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Carey G. Re-Conceptualising Public Health Interventions in Government: A Response to Recent Commentaries. Int J Health Policy Manag 2016; 5:569-570. [PMID: 27694686 DOI: 10.15171/ijhpm.2016.91] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 07/02/2016] [Indexed: 11/09/2022] Open
Affiliation(s)
- Gemma Carey
- Business School, University of New South Wales, Canberra, ACT, Australia
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O'Flynn J. From Headline to Hard Grind: The Importance of Understanding Public Administration in Achieving Health OutcomesComment on "Understanding the Role of Public Administration in Implementing Action on the Social Determinants of Health and Health Inequities". Int J Health Policy Manag 2016; 5:439-442. [PMID: 27694672 DOI: 10.15171/ijhpm.2016.49] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 04/27/2016] [Indexed: 11/09/2022] Open
Abstract
Many public policy programs fail to translate ambitious headlines to on-the-ground action. The reasons for this are many and varied, but for public administration and management scholars a large part of the gap between ambition and achievement is the challenge associated with the operation of the machinery of government itself, and how it relates to the other parties that it relies on to fulfill these outcomes. In their article, Carey and Friel set out key reasons why public health scholars should seek to better understand important ideas in public administration. In commenting on their contribution, I draw out two critical questions that are raised by this discussion: (i) what are boundaries and what forms do they take? and (ii) why work across boundaries? Expanding on these key questions extends the points made by Carey and Friel on the importance of understanding public administration and will better place public health scholars and practitioners to realise health outcomes.
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Affiliation(s)
- Janine O'Flynn
- Melbourne School of Government, University of Melbourne, Melbourne, VIC, Australia
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Breton E. A Sophisticated Architecture Is Indeed Necessary for the Implementation of Health in All Policies but not Enough Comment on "Understanding the Role of Public Administration in Implementing Action on the Social Determinants of Health and Health Inequities". Int J Health Policy Manag 2016; 5:383-5. [PMID: 27285517 DOI: 10.15171/ijhpm.2016.28] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 02/28/2016] [Indexed: 11/09/2022] Open
Abstract
In this commentary, I argue that beyond a sophisticated supportive architecture to facilitate implementation of actions on the social determinants of health (SDOH) and health inequities, the Health in All Policies (HiAP) project faces two main barriers: lack of awareness within policy networks on the social determinants of population health, and a tendency of health actors to neglect investing in other sectors' complex problems.
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Affiliation(s)
- Eric Breton
- EHESP School of Public Health, Paris, France.,CNRS, UMR Centre for Research on Political Action in Europe (CRAPE), Rennes, France
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de Leeuw E. We Need Action on Social Determinants of Health - but Do We Want It, too? Comment on "Understanding the Role of Public Administration in Implementing Action on the Social Determinants of Health and Health Inequities". Int J Health Policy Manag 2016; 5:379-82. [PMID: 27285516 PMCID: PMC4885729 DOI: 10.15171/ijhpm.2016.25] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 02/24/2016] [Indexed: 11/09/2022] Open
Abstract
Recently a number of calls have been made to mobilise the arsenal of political science insights to investigate - and point to improvements in - the social determinants of health (SDH), and health equity. Recently, in this journal, such a rallying appeal was made for the field of public administration. This commentary argues that, although scholarly potential should justifiably be redirected to resolve these critical issues for humanity, a key ingredient in taking action may have been neglected. This factor is 'community.' Community health has been a standard element of the public health and health promotion, even political, repertoire for decades now. But this commentary claims that communities are insufficiently charged, equipped or appreciated to play the role that scholarship attributes (or occasionally avoids to identify) to them. Community is too important to not fully engage and understand. Rhetorical tools and inquiries can support their quintessential role.
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Affiliation(s)
- Evelyne de Leeuw
- Centre for Health Equity Training Research and Evaluation (CHETRE), University of New South Wales, Sydney, NSW, Australia
- South Western Sydney Local Health District, Liverpool, NSW, Australia
- Ingham Institute, Liverpool, NSW, Australia
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