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Kim J, de Leeuw E, Harris-Roxas B, Sainsbury P. Five urban health research traditions: A meta-narrative review. Soc Sci Med 2023; 336:116265. [PMID: 37820495 DOI: 10.1016/j.socscimed.2023.116265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/10/2023] [Accepted: 09/22/2023] [Indexed: 10/13/2023]
Abstract
Urban health scholars explore the connection between the urban space and health through ontological perspectives that are shaped by their disciplinary traditions. Without explicit recognition of the different approaches, there are barriers to collaboration. This paper maps the terrain of the urban health scholarship to identify key urban health research traditions; and to articulate the main features distinguishing these different traditions. We apply a meta-narrative review guided by a bibliometric co-citation network analysis to the body of research on urban health retrieved from the Web of Science Core Collection. Five urban health research traditions were identified: (1) sustainable urban development, (2) urban ecosystem services, (3) urban resilience, (4) healthy urban planning, and (5) urban green spaces. Each research tradition has a different conceptual and thematic perspective to addressing urban health. These include perspectives on the scale of the urban health issue of interest, and on the conceptualisation of the urban context and health. Additionally, we developed a framework to allow for better differentiation between the differing research traditions based on (1) perspectives of the urban system as complicated or complex, (2) the preferred locus of change as a function of structure and agency and (3) the geographic scale of the urban health issue that is addressed. These dimensions have even deeper implications for transdisciplinary collaboration as they are underpinned by paradigmatic differences, rather than disciplinary differences. We conclude that it is essential for urban health researchers to reflect on the different urban health approaches and seek coherence by understanding their similarities and differences. Such endeavours are required to produce and interpret transdisciplinary knowledge for the goal of improving health by transforming urban systems.
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Affiliation(s)
- Jinhee Kim
- Centre for Primary Health Care & Equity, University of New South Wales, Australia.
| | - Evelyne de Leeuw
- Centre for Primary Health Care & Equity, University of New South Wales, Australia; Chaire d'Excellence en Recherche Canada 'Une Seule Santé Urbaine', École de Santé Publique Université de Montréal ESPUM, Québec, Canada; Healthy Urban Environments (HUE) Collaboratory, Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise SPHERE, Australia.
| | - Ben Harris-Roxas
- School of Population Health, University of New South Wales, Australia.
| | - Peter Sainsbury
- School of Medicine Sydney, University of Notre Dame, Australia.
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Kim J, Harris-Roxas B, de Leeuw E, Lilley D, Crimeen A, Sainsbury P. Protocol for a meta-narrative review on research paradigms addressing the urban built environment and human health. Syst Rev 2021; 10:311. [PMID: 34895329 PMCID: PMC8665591 DOI: 10.1186/s13643-021-01848-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 10/28/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Urban health is a field of research and practice that has attracted the interest of various disciplines. While it is encouraged for diverse disciplines to contribute to a multidisciplinary field of study such as urban health, this often results in tensions, conflicts or competition between the different traditions that stem from different epistemological backgrounds. This meta-narrative review aims to identify and describe the multiple paradigms and articulate the underlying epistemological, ontological, methodological, and aetiological differences in their approaches. Articulating the paradigms not only contributes to the advancement of research, but also provides a framework for understanding the different policy beliefs and ideas policy actors hold and apply in the policy process. METHODS We apply the meta-narrative method to systematic literature review which includes the following six iterative phases. The planning phase includes the finalisation of the review protocol and assembly of review team. The search phase includes a comprehensive literature search in key databases and a double-sided systematic snowballing method. We will search multidisciplinary databases including Web of Science, Scopus and ProQuest, and topic-specific databases including Urban Studies Abstracts (EBSCO), MEDLINE, and EMBASE from their inception onwards. Bibliometric analyses of this literature will be used to triangulate the mapping of the paradigms. The mapping phase includes identifying the dominant paradigms and landmark publications through agreement with the review team. In the appraisal phase, the literature will be assessed by their respective quality standards, followed by data extraction to identify the individual narratives in the conceptual, theoretical, methodological, and instrumental dimensions of each paradigm. The synthesis phase will review the data to compare and contrast and identify the overarching meta-narratives. The recommendation phase will include dissemination of the findings from the review. DISCUSSION The meta-narrative review will reveal the how the different paradigms conceptualise, frame and prioritise urban health issues, their preferred methodologies to study the phenomenon, and the nature of the solutions to improve human health. This review will assist researchers and practitioners in understanding and interpreting evidence produced by other traditions that study urban health. Through this, urban health researchers and practitioners will be able to seek coherence in understanding, explaining, and exploring the urban health phenomenon. SYSTEMATIC REVIEW REGISTRATION Open Science Framework ( https://osf/io/tn8vk ).
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Affiliation(s)
- Jinhee Kim
- Centre for Health Equity Training, Research and Evaluation (CHETRE), Part of the UNSW Australia Research Centre for Primary Health Care & Equity, A Unit of Population Health, South Western Sydney Local Health District, NSW Health, A member of the Ingham Institute, Sydney, Australia.
| | - Ben Harris-Roxas
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Evelyne de Leeuw
- Centre for Health Equity Training, Research and Evaluation (CHETRE), Part of the UNSW Australia Research Centre for Primary Health Care & Equity, A Unit of Population Health, South Western Sydney Local Health District, NSW Health, A member of the Ingham Institute, Sydney, Australia.,Healthy Urban Environments (HUE) Collaboratory, Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise SPHERE, Sydney, Australia
| | - David Lilley
- Centre for Health Equity Training, Research and Evaluation (CHETRE), Part of the UNSW Australia Research Centre for Primary Health Care & Equity, A Unit of Population Health, South Western Sydney Local Health District, NSW Health, A member of the Ingham Institute, Sydney, Australia.,City Futures Research Centre, UNSW Arts, Design & Architecture, Sydney, Australia
| | - Alana Crimeen
- Centre for Health Equity Training, Research and Evaluation (CHETRE), Part of the UNSW Australia Research Centre for Primary Health Care & Equity, A Unit of Population Health, South Western Sydney Local Health District, NSW Health, A member of the Ingham Institute, Sydney, Australia.,UNSW Arts, Design & Architecture, Sydney, Australia
| | - Peter Sainsbury
- School of Medicine, University of Notre Dame Australia, Sydney, Australia
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Harris P, Fisher M, Friel S, Sainsbury P, Harris E, De Leeuw E, Baum F. City deals and health equity in Sydney, Australia. Health Place 2021; 73:102711. [PMID: 34814070 DOI: 10.1016/j.healthplace.2021.102711] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 11/15/2022]
Abstract
'City Deals' are new governance instruments for urban development. Vast evidence exists on the relationship between urban factors and health equity, but little research applies a health equity lens to urban policy-making. This paper does precisely that for the Western Sydney City Deal (WSCD) in Australia. We conducted a critical discourse analysis of publicly available documents and interviews with the WSCD's main architects, applying insights from relevant theories. We find 'pro-growth' discourse to encourage economic investment dominates any references to disadvantage. Interviewees maintained the WSCDs fundamental purpose is to rebalance urban investment toward the historically disadvantaged West. However, the WSCD makes limited reference to health and none to equity. Institutionalised governance practices that favour private investments in infrastructure remain the dominant force behind the WSCD. We document how a shift to 'place-based' infrastructure has promise for equity but struggles to overcome institutionalised approaches to urban investments.
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Affiliation(s)
- Patrick Harris
- Centre for Health Equity Training, Research & Evaluation (CHETRE), Part of the UNSW Australia Research Centre for Primary Health Care & Equity, A Unit of Population Health, South Western Sydney Local Health District, NSW Health A Member of the Ingham Institute, Liverpool Hospital Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.
| | - Matt Fisher
- Southgate Institute for Health, Society and Equity, Flinders University, Australia
| | - Sharon Friel
- REGNET, Australian National University Sydney University, School of Public Health, Australia
| | - Peter Sainsbury
- Centre for Health Equity Training, Research & Evaluation (CHETRE), Part of the UNSW Australia Research Centre for Primary Health Care & Equity, A Unit of Population Health, South Western Sydney Local Health District, NSW Health A Member of the Ingham Institute, Liverpool Hospital Locked Bag 7103, Liverpool BC, NSW, 1871, Australia
| | - Elizabeth Harris
- Health and Equity Research and Development Unit, Sydney Local Health District and Centre for Primary Health Care and Equity, UNSW, Australia
| | - Evelyne De Leeuw
- Centre for Health Equity Training, Research & Evaluation (CHETRE), Part of the UNSW Australia Research Centre for Primary Health Care & Equity, A Unit of Population Health, South Western Sydney Local Health District, NSW Health A Member of the Ingham Institute, Liverpool Hospital Locked Bag 7103, Liverpool BC, NSW, 1871, Australia
| | - Fran Baum
- Southgate Institute for Health, Society and Equity, Flinders University, Australia
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Riley E, Sainsbury P, McManus P, Colagiuri R, Viliani F, Dawson A, Duncan E, Stone Y, Pham T, Harris P. Including health impacts in environmental impact assessments for three Australian coal-mining projects: a documentary analysis. Health Promot Int 2021; 35:449-457. [PMID: 31056656 DOI: 10.1093/heapro/daz032] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Notwithstanding the historical benefits of coal in aiding human and economic development, the negative health and environmental impacts of coal extraction and processing are of increasing concern. Environmental impact assessments (EIAs) are a regulated policy mechanism that can be used to predict and consider the health impacts of mining projects to determine if consent is given. The ways in which health is considered within EIA is unclear. This research investigated 'How and to what extent are health, well-being and equity issues considered in Environmental Impact Assessments (EIAs) of major coal mining projects in New South Wales, Australia'. To this end we developed and applied a comprehensive coding framework designed to interrogate the publicly available environmental impact statements (EISs) of three mines in New South Wales (NSW), Australia, for their inclusion of health, well-being and equity issues. Analysis of the three EISs demonstrates that: the possible impacts of each mine on health and well-being were narrowly and inadequately considered; when health and well-being were considered there was a failure to assess the possible impacts specific to the particular mine and the communities potentially affected; the cumulative impacts on human health of multiple mines in the same geographical area were almost completely ignored; the discussions of intragenerational and intergenerational equity did not demonstrate a sound understanding of equity and, it is essential that governments' requirements for the EIA include detailed analysis of the health, well-being, equity and cumulative impacts specific to the proposed mine and relevant communities.
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Affiliation(s)
- Emily Riley
- Level 2 The Hub, Charles Perkins Centre D17, The University of Sydney, NSW 2006, Australia
| | | | | | - Ruth Colagiuri
- Level 2 The Hub, Charles Perkins Centre D17, The University of Sydney, NSW 2006, Australia
| | | | - Angus Dawson
- Sydney Health Ethics, Sydney School of Public Health, The University of Sydney, Level 1, Medical Foundation Building K25, NSW 2006, Australia
| | | | | | - Tracy Pham
- Level 2 The Hub, Charles Perkins Centre D17, The University of Sydney, NSW 2006, Australia
| | - Patrick Harris
- Level 2 The Hub, Charles Perkins Centre D17, The University of Sydney, NSW 2006, Australia
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van Eyk H, Friel S, Sainsbury P, Boyd-Caine T, Harris P, MacDougall C, Delany-Crowe T, Musolino C, Baum F. How do advisory groups contribute to healthy public policy research? Int J Public Health 2020; 65:1581-1591. [PMID: 33057731 DOI: 10.1007/s00038-020-01504-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/25/2020] [Accepted: 10/03/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES This paper reflects on experiences of Australian public health researchers and members of research policy advisory groups (PAGs) in working with PAGs. It considers their benefits and challenges for building researcher and policy actor collaboration and ensuring policy relevance of research. METHODS Four research projects conducted between 2015 and 2020 were selected for analysis. 68 PAG members from Australian federal, state and local governments, NGOs and academics participated in providing feedback. Thematic analysis of participant feedback and researchers' critical reflections on the effectiveness and capacity of PAGs to support research translation was undertaken. RESULTS PAGs benefit the research process and can facilitate knowledge translation. PAG membership changes, differing researcher and policy actor agendas, and researchers' need to balance policy relevance and research independence are challenges when working with PAGs. Strategies to improve the function of health policy research PAGs are identified. CONCLUSIONS The paper suggests a broader adapted approach for gaining the benefits and addressing the challenges of working with PAGs. It opens theoretical and practical discussion of PAGs' role and how they can increase research translation into policy.
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Affiliation(s)
- Helen van Eyk
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia.
| | - Sharon Friel
- School of Regulation and Global Governance, Australian National University, Canberra, ACT, Australia
| | - Peter Sainsbury
- Sydney Medical School, University of Notre Dame, Sydney, NSW, Australia
| | | | - Patrick Harris
- Centre for Health Equity Training, Research and Evaluation (CHETRE). University of New South Wales Australia Research Centre for Primary Health Care and Equity. Population Health, South Western Sydney Local Health District, NSW Health, Ingham Institute, Liverpool Hospital, Sydney, NSW, Australia
| | - Colin MacDougall
- 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
| | - Connie Musolino
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Fran Baum
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia
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Harris P, Kent J, Sainsbury P, Riley E, Sharma N, Harris E. Healthy urban planning: an institutional policy analysis of strategic planning in Sydney, Australia. Health Promot Int 2020; 35:1251. [PMID: 31504511 DOI: 10.1093/heapro/daz089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Patrick Harris
- Menzies Centre for Health Policy, School of Public Health, Sydney Medical School, Level 6 The Hub, Charles Perkins Centre D17
| | - Jennifer Kent
- Urban and Regional Planning, Faculty of Architecture, Design and Planning, The University of Sydney, Sydney, NSW 2006, Australia
| | - Peter Sainsbury
- Population Health, South Western Sydney Local Health District
| | - Emily Riley
- Menzies Centre for Health Policy, School of Public Health, Sydney Medical School, Level 6 The Hub, Charles Perkins Centre D17
| | - Nila Sharma
- Menzies Centre for Health Policy, School of Public Health, Sydney Medical School, Level 6 The Hub, Charles Perkins Centre D17
| | - Elizabeth Harris
- Health and Equity Research and Development Unit, Sydney Local Health District and Centre for Primary Health Care and Equity, UNSW
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Abstract
Abstract
Background
While public health and urban planning share a historical connection in the mid-19th century, when public health and sanitation became a key guiding principle for urban planning, the two disciplines evolved in separate ways after major technological and social developments such as the development of germ theory and the ascent of biomedicine. Recently, urban planners and public health experts globally are calling for a reconnection between the health and urban planning spheres. However, there are different schools of thought around how to address health in the urban context that originates from different worldviews and epistemological traditions of the disciplines.
Methods
This study is a narrative review that explores the core beliefs and assumptions of the different research traditions that are observed around health in the urban context.
Results
The study identifies three main traditions. The 'urban health science' tradition is characterized by the pathogenic and epidemiological analysis of urban problems, suggesting predominantly technological solutions to these issues. Scholars of this tradition emphasize that urban health requires straight Cartesian causal thinking to inform interventions to promote the health of urban populations. The 'healthy cities movement' tradition is based on the principles of the Ottawa Charter for Health Promotion with strong roots in social movements, and takes a value-based approach to solutions that embraces the principles of solidarity, equity, sustainability and empowerment. While these two traditions originate from the discipline of public health, the third 'healthy urban planning' tradition emerged from the urban planning discipline and proposes to include health as objectives in the spatial development of cities.
Conclusions
This study identifies the core beliefs and assumptions of the paradigms of urban health and highlights areas where beliefs and assumptions epistemologically or practically overlap and interface.
Key messages
Scholars from different epistemological traditions possess different worldview on the problem definition and solution to urban health. The three paradigms on urban health are not mutually exclusive, rather each could learn from each other to promote the health of urban citizens.
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Affiliation(s)
- J Kim
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - E de Leeuw
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - B Harris-Roxas
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - P Sainsbury
- School of Public Health, University of Sydney, Sydney, Australia
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Sainsbury P, Charlesworth K, Madden L, Capon A, Stewart G, Pencheon D. Climate change is a health issue: what can doctors do? Intern Med J 2020; 49:1044-1048. [PMID: 31387149 DOI: 10.1111/imj.14380] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 01/11/2019] [Accepted: 01/11/2019] [Indexed: 11/30/2022]
Abstract
The visit to Australia by Dr David Pencheon, Founding Director of the National Health Service (NHS) Sustainable Development Unit, in April-May 2018 generated considerable interest and engagement. Dr Pencheon's overarching messages were that climate change is a health issue and that doctors and health systems have an opportunity, and responsibility, to lead climate action. This article distils Dr Pencheon's presentations into three themes: (i) carbon accounting; (ii) transformational change in our systems of healthcare; and (iii) a health system fit for the future. For each theme, we highlight promising initiatives that are already underway in Australia that are starting to transform our health system into one fit for a future environmentally sustainable world. We suggest practical ways in which doctors can lead the transformation through personal action and influence broader systems.
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Affiliation(s)
- Peter Sainsbury
- School of Medicine, Sydney, The University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - Kate Charlesworth
- Primary, Integrated and Community Health, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Lynne Madden
- Learning and Teaching, School of Medicine, Sydney, The University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - Anthony Capon
- Planetary Health Platform, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Greg Stewart
- Primary, Integrated and Community Health, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - David Pencheon
- Health and Sustainable Development, Medical School, University of Exeter, Exeter, UK
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McGreevy M, Harris P, Delany-Crowe T, Fisher M, Sainsbury P, Baum F. Erratum to “Can health and health equity be advanced by urban planning strategies designed to advance global competitiveness? Lessons from two Australian case studies” [Soc. Sci. Med. 242 (2019) 112594]. Soc Sci Med 2020; 244:112694. [DOI: 10.1016/j.socscimed.2019.112694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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McGreevy M, Harris P, Delany-Crowe T, Fisher M, Sainsbury P, Baum F. Can health and health equity be advanced by urban planning strategies designed to advance global competitiveness? Lessons from two Australian case studies. Soc Sci Med 2019; 242:112594. [DOI: 10.1016/j.socscimed.2019.112594] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/01/2019] [Accepted: 10/08/2019] [Indexed: 11/16/2022]
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Harris P, Kent J, Sainsbury P, Riley E, Sharma N, Harris E. Healthy urban planning: an institutional policy analysis of strategic planning in Sydney, Australia. Health Promot Int 2019; 35:649-660. [DOI: 10.1093/heapro/daz056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Abstract
Rapid urbanization requires health promotion practitioners to understand and engage with strategic city planning. This policy analysis research investigated how and why health was taken up into strategic land use planning in Sydney, Australia, between 2013 and 2018. This qualitative study develops two case studies of consecutive instances of strategic planning in Sydney. Data collection was done via in-depth stakeholder interviews (n = 11) and documentary analysis. Data collection and analysis revolved around core categories underpinning policy institutions (actors, structures, ideas, governance and power) to develop an explanatory narrative of the progress of ‘health’ in policy discourse over the study period. The two strategic planning efforts shifted in policy discourse. In the earlier plan, ‘healthy built environments’ was positioned as a strategic direction, but without a mandate for action the emphasis was lost in an economic growth agenda. The second effort shifted that agenda to ecological sustainability, a core aspect of which was ‘Liveability’, having greater potential for health promotion. However, ‘health’ remained underdeveloped as a core driver for city planning remaining without an institutional mandate. Instead, infrastructure coordination was the defining strategic city problem and this paradigm defaulted to emphasizing ‘health precincts’ rather than positioning health as core for the city. This research demonstrates the utility in institutional analysis to understanding positioning health promotion in city planning. Despite potential shifts in policy discourse and a more sophisticated approach to planning holistically, the challenge remains of embedding health within the institutional mandates driving city planning.
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Affiliation(s)
- Patrick Harris
- Menzies Centre for Health Policy, School of Public Health, Sydney Medical School, Level 6 The Hub, Charles Perkins Centre D17
| | - Jennifer Kent
- Urban and Regional Planning, Faculty of Architecture, Design and Planning, The University of Sydney, Sydney, NSW 2006, Australia
| | - Peter Sainsbury
- Population Health, South Western Sydney Local Health District
| | - Emily Riley
- Menzies Centre for Health Policy, School of Public Health, Sydney Medical School, Level 6 The Hub, Charles Perkins Centre D17
| | - Nila Sharma
- Menzies Centre for Health Policy, School of Public Health, Sydney Medical School, Level 6 The Hub, Charles Perkins Centre D17
| | - Elizabeth Harris
- Health and Equity Research and Development Unit, Sydney Local Health District and Centre for Primary Health Care and Equity, UNSW
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Rychetnik L, Sainsbury P, Stewart G. How Local Health Districts can prepare for the effects of climate change: an adaptation model applied to metropolitan Sydney. AUST HEALTH REV 2018; 43:601-610. [PMID: 30573003 DOI: 10.1071/ah18153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/29/2018] [Indexed: 11/23/2022]
Abstract
Climate change adaptation can be defined as a form of risk management (i.e. assessing climate change-related risks and responding appropriately so that the risks can be pre-emptively minimised and managed as they arise). Adapting to climate change by hospital and community health services will entail responding to changing health needs of the local population, and to the likely effects of climate change on health service resources, workforce and infrastructure. In this paper we apply a model that health services can use to predict and respond to climate change risks and illustrate this with reference to Sydney's Local Health Districts (LHDs). We outline the climate change predictions for the Sydney metropolitan area, discuss the resulting vulnerabilities for LHDs and consider the potential of LHDs to respond. Three 'core business' categories are examined: (1) ambulance, emergency and acute health care; (2) routine health care; and (3) population and preventative health services. We consider the key climate change risks and vulnerabilities of the LHDs' workforce, facilities and finances, and some important transboundary issues. Many Australian health services have existing robust disaster plans and management networks. These could be expanded to incorporate local climate and health adaptation plans.
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Affiliation(s)
- Lucie Rychetnik
- School of Medicine Sydney, University of Notre Dame Australia
| | | | - Greg Stewart
- Primary Integrated and Community Health, South Eastern Sydney Local Health District. Email
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Charlesworth KE, Stewart GJ, Sainsbury P. Addressing the carbon footprint of health organisations: eight lessons for implementation. Public Health Res Pract 2018; 28:2841830. [PMID: 30652191 DOI: 10.17061/phrp2841830] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The scientific evidence for global warming is overwhelming. Health organisations, as large carbon polluters, are at significant 'carbon risk' and must act to reduce their carbon emissions. Many environmental sustainability initiatives, if properly implemented, would not only reduce harm, waste and pollution but also deliver health, social and financial benefits. METHOD We have been involved for more than a decade in efforts to reduce the greenhouse gas emissions of New South Wales (NSW) Health organisations in which we have worked. We draw on our collective experience to offer eight key lessons about implementing environmental sustainability initiatives in health organisations. RESULTS Sustainability plans have been developed in at least three Area Health Services/Local Health Districts in NSW, but in each case they have been imperfectly implemented. LESSONS LEARNT Based on our experience, we offer eight key lessons relating to leadership, engagement and developing networks, data, complex adaptive systems, broadening the issue, and political factors.
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Affiliation(s)
- Kate E Charlesworth
- Primary Integrated and Community Health, South Eastern Sydney Local Health District, NSW, Australia,
| | - Gregory J Stewart
- Primary Integrated and Community Health, South Eastern Sydney Local Health District, NSW, Australia
| | - Peter Sainsbury
- School of Public Health, University of Sydney, NSW, Australia
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Arabena K, Armstrong F, Berry H, Brooks P, Capon T, Crabb B, Demaio A, Doherty P, Lewin S, Lo S, Lopez A, McMichael C, McPake B, Moodie R, Nolan T, Ruff T, Sainsbury P, Selvey L, Shearman D, Stanley F, Talley NJ, Watts N. Australian health professionals' statement on climate change and health. Lancet 2018; 392:2169-2170. [PMID: 30497656 DOI: 10.1016/s0140-6736(18)32610-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 10/18/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Kerry Arabena
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | | | - Helen Berry
- School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia
| | - Peter Brooks
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Tony Capon
- School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia
| | | | - Alessandro Demaio
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Peter Doherty
- Doherty Institute, University of Melbourne, Melbourne, VIC, Australia
| | - Sharon Lewin
- Doherty Institute, University of Melbourne, Melbourne, VIC, Australia
| | - Selina Lo
- School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia; The Lancet, London, UK.
| | - Alan Lopez
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Celia McMichael
- School of Geography, University of Melbourne, Melbourne, VIC, Australia
| | - Barbara McPake
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Rob Moodie
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Terry Nolan
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Tilman Ruff
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; International Physicians for the Prevention of Nuclear War, Malden, MA, USA
| | | | - Linda Selvey
- University of Queensland, Brisbane, QLD, Australia
| | - David Shearman
- University of Adelaide, Adelaide, SA, Australia; Doctors for the Environment Australia, College Park, SA, Australia
| | - Fiona Stanley
- University of Western Australia, Perth, WA, Australia
| | | | - Nick Watts
- Institute for Global Health, University College London, London, UK; Lancet Countdown for Climate Change and Health, London, UK
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Riley E, Harris P, Kent J, Sainsbury P, Lane A, Baum F. Including Health in Environmental Assessments of Major Transport Infrastructure Projects: A Documentary Analysis. Int J Health Policy Manag 2018. [PMID: 29524938 PMCID: PMC5819374 DOI: 10.15171/ijhpm.2017.55] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Transport policy and practice impacts health. Environmental Impact Assessments (EIAs) are regulated public policy mechanisms that can be used to consider the health impacts of major transport projects before they are approved. The way health is considered in these environmental assessments (EAs) is not well known. This research asked: How and to what extent was human health considered in EAs of four major transport projects in Australia.
Methods: We developed a comprehensive coding framework to analyse the Environmental Impact Statements (EISs) of four transport infrastructure projects: three road and one light rail. The coding framework was designed to capture how health was directly and indirectly included.
Results: We found that health was partially considered in all four EISs. In the three New South Wales (NSW) projects, but not the one South Australian project, this was influenced by the requirements issued to proponents by the government which directed the content of the EIS. Health was assessed using human health risk assessment (HHRA). We found this to be narrow in focus and revealed a need for a broader social determinants of health approach, using multiple methods. The road assessments emphasised air quality and noise risks, concluding these were minimal or predicted to improve. The South Australian project was the only road project not to include health data explicitly. The light rail EIS considered the health benefits of the project whereas the others focused on risk. Only one project considered mental health, although in less detail than air quality or noise.
Conclusion: Our findings suggest EIAs lag behind the known evidence linking transport infrastructure to health. If health is to be comprehensively included, a more complete model of health is required, as well as a shift away from health risk assessment as the main method used. This needs to be mandatory for all significant developments. We also found that considering health only at the EIA stage may be a significant limitation, and there is a need for health issues to be considered when earlier, fundamental decisions about the project are being made.
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Affiliation(s)
- Emily Riley
- Menzies Centre for Health Policy, Sydney, NSW, Australia.,School of Public Health, and Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Patrick Harris
- Menzies Centre for Health Policy, Sydney, NSW, Australia.,School of Public Health, and Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Jennifer Kent
- Urban and Regional Planning, Faculty of Architecture, Design, and Planning, The University of Sydney, Sydney, NSW, Australia
| | - Peter Sainsbury
- Population Health, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Anna Lane
- Southgate Institute for Health, Society, and Equity, Flinders University, Bedford Park, SA, Australia
| | - Fran Baum
- Southgate Institute for Health, Society, and Equity, Flinders University, Bedford Park, SA, Australia
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Harris P, Kent J, Sainsbury P, Marie-Thow A, Baum F, Friel S, McCue P. Creating ‘healthy built environment’ legislation in Australia; a policy analysis. Health Promot Int 2017; 33:1090-1100. [DOI: 10.1093/heapro/dax055] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Patrick Harris
- Menzies Centre for Health Policy, School of Public Health, Sydney Medical School, The University of Sydney, Level 6 The Hub, Charles Perkins Centre D17, Camperdown, NSW, Australia
| | - Jennifer Kent
- Urban and Regional Planning, Faculty of Architecture, Design and Planning, The University of Sydney, Australia
| | - Peter Sainsbury
- Population Health, South Western Sydney Local Health District, Australia
| | - Anne Marie-Thow
- Menzies Centre for Health Policy, School of Public Health, Sydney Medical School, The University of Sydney, Level 6 The Hub, Charles Perkins Centre D17, Camperdown, NSW, Australia
| | - Fran Baum
- Southgate Institute for Health, Society and Equity, Flinders University, Australia
| | - Sharon Friel
- REGNET, Australian National University, Australia
| | - Peter McCue
- NSW Department of Sport and Recreation, Australia
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Sainsbury P. Book Review: Prevention Diaries. Int J Epidemiol 2017. [DOI: 10.1093/ije/dyx062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Affiliation(s)
- Jacqueline Grad
- MRC Clinical Psychiatry Research Unit, Graylingwell Hospital, Chichester
| | - Peter Sainsbury
- MRC Clinical Psychiatry Research Unit, Graylingwell Hospital, Chichester
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Sainsbury P. Development and oversight of ethical health promotion quality assurance and evaluation activities involving human participants. Health Promot J Austr 2016; 26:176-181. [PMID: 26536392 DOI: 10.1071/he15045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 09/17/2015] [Indexed: 11/23/2022] Open
Abstract
ISSUE ADDRESSED This paper considers the role of ethics and ethics review processes in the development of health promotion quality assurance and evaluation activities involving human participants. CONTENT The Australian National Health and Medical Research Council (NHMRC) National Statement on Ethical Conduct in Human Research and associated documents provide the framework for the ethical conduct and independent review of research (including quality assurance and evaluation) involving humans in Australia. Identifying the level of risk to which participants may be exposed by participation in quality assurance and evaluation activities is essential for health promotion workers undertaking such activities. Organisations can establish processes other than review by a Human Research Ethics Committee for negligible and low risk research activities. Health promotion quality assurance and evaluation activities often involve negligible and low risk to participants. Seven triggers that indicate the need for ethics review of quality assurance and evaluation activities and a procedural checklist for developing ethical quality assurance and evaluation activities are provided. CONCLUSION Health promotion workers should be familiar with the NHMRC's National Statement on Ethical Conduct in Human Research. When ethical considerations underpin the planning and conduct of all quality assurance and evaluation from the very beginning, the activity is the better for it, independent 'ethics approval' can mostly be secured without much trouble and workers' frustration levels are reduced. So what? Health promotion quality assurance and evaluation activities must be ethically justified. Health promotion workers should be familiar with the NHMRC's National Statement on Ethical Conduct in Human Research and should use it when developing health promotion quality assurance and evaluation activities.
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Affiliation(s)
- Peter Sainsbury
- Population Health, South Western Sydney Local Health District, Locked Bag 7279, Liverpool, NSW 1871, Australia. Email
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Sainsbury P. Depression and suicide prevention. Bibl Psychiatr 2015; 162:17-32. [PMID: 7103922 DOI: 10.1159/000406247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Affiliation(s)
- Colin D. Butler
- Faculty of Health, University of Canberra, Australian Capital Territory
- NCEPH, Australian National University, Australian Capital Territory
| | - Peter Sainsbury
- School of Public Health, University of Sydney, New South Wales
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Affiliation(s)
- Peter Sainsbury
- Social Health Research Unit, Division of Population Health, Central Sydney Area Health Service and School of Public Health, University of Sydney, Australia
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Affiliation(s)
- Harrison Ng Chok
- Centre for Primary Health Care and Equity, University of New South Wales
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Harris P, Haigh F, Thornell M, Molloy L, Sainsbury P. Housing, health and master planning: rules of engagement. Public Health 2014; 128:354-9. [PMID: 24656725 DOI: 10.1016/j.puhe.2014.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 01/14/2014] [Accepted: 01/14/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Knowledge about health focussed policy collaboration to date has been either tactical or technical. This article focusses on both technical and tactical issues to describe the experience of cross-sectoral collaboration between health and housing stakeholders across the life of a housing master plan, including but not limited to a health impact assessment (HIA). STUDY DESIGN A single explanatory case study of collaboration on a master plan to regenerate a deprived housing estate in Western Sydney was developed to explain why and how the collaboration worked or did not work. METHODS Data collection included stakeholder interviews, document review, and reflections by the health team. Following a realist approach, data was analysed against established public policy theory dimensions. RESULTS Tactically we did not know what we were doing. Despite our technical knowledge and skills with health focussed processes, particularly HIA, we failed to appreciate complexities inherent in master planning. This limited our ability to provide information at the right points. Eventually however the HIA did provide substantive connections between the master plan and health. We use our analysis to develop technical and tactical rules of engagement for future cross-sectoral collaboration. CONCLUSIONS This case study from the field provides insight for future health focussed policy collaboration. We demonstrate the technical and tactical requirements for future intersectoral policy and planning collaborations, including HIAs, with the housing sector on master planning. The experience also suggested how HIAs can be conducted flexibly alongside policy development rather than at a specific point after a policy is drafted.
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Affiliation(s)
- P Harris
- Centre for Health Equity Training, Research and Evaluation, Part of the Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052, Australia.
| | - F Haigh
- Centre for Health Equity Training, Research and Evaluation, Part of the Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052, Australia
| | - M Thornell
- Population Health, South Western Sydney & Sydney Local Health Districts, Sydney, Australia
| | - L Molloy
- Faculty of the Built Environment, University of New South Wales, Australia
| | - P Sainsbury
- Population Health, South Western Sydney & Sydney Local Health Districts, Sydney, Australia
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Harris P, Sainsbury P, Kemp L. The fit between health impact assessment and public policy: practice meets theory. Soc Sci Med 2014; 108:46-53. [PMID: 24608119 DOI: 10.1016/j.socscimed.2014.02.033] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 01/31/2014] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE AND SETTING The last decade has seen increased use of health impact assessment (HIA) to influence public policies developed outside the Health sector. HIA has developed as a structured, linear and technical process to incorporate health, broadly defined, into policy. This is potentially incongruent with complex, non-linear and tactical policy making which does not necessarily consider health. HIA research has however not incorporated existing public policy theory to explain practitioners' experiences with HIA and policy. This research, therefore, used public policy theory to explain HIA practitioners' experiences and investigate 'What is the fit between HIA and public policy?' METHODS Empirical findings from nine in-depth interviews with international HIA practitioners were re-analysed against public policy theory. We reviewed the HIA literature for inclusion of public policy theories then compared these for compatibility with our critical realist methodology and the empirical data. The theory 'Policy Cycles and Subsystems' (Howlett et al., 2009) was used to re-analyse the empirical data. FINDINGS HIAs for policy are necessarily both tactical and technical. Within policy subsystems using HIA to influence public policy requires tactically positioning health as a relevant public policy issue and, to facilitate this, institutional support for collaboration between Public Health and other sectors. HIA fits best within the often non-linear public policy cycle as a policy formulation instrument. HIA provides, tactically and technically, a space for practical reasoning to navigate facts, values and processes underlying the substantive and procedural dimensions of policy. CONCLUSIONS Re-analysing empirical experiential data using existing public policy theory provided valuable explanations for future research, policy and practice concerning why and how HIA fits tactically and technically with the world of public policy development. The use of theory and empiricism opens up important possibilities for future research in the search for better explanations of complex practical problems.
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Affiliation(s)
- Patrick Harris
- Centre for Health Equity Training, Research and Evaluation, Part of the Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Peter Sainsbury
- Population Health Directorate, South Western Sydney & Sydney Local Health Districts, Sydney, Australia
| | - Lynn Kemp
- Centre for Health Equity Training, Research and Evaluation, Part of the Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052, Australia
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Khan M, Thappar S, Taylor S, Scally A, Sainsbury P. The impact of a short psychological intervention on quality of life and angina control in patients with chronic refractory angina. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Harris PJ, Kemp LA, Sainsbury P. The essential elements of health impact assessment and healthy public policy: a qualitative study of practitioner perspectives. BMJ Open 2012; 2:e001245. [PMID: 23166121 PMCID: PMC3533118 DOI: 10.1136/bmjopen-2012-001245] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 10/15/2012] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES This study uses critical realist methodology to identify the essential and contingent elements of Health Impact Assessment (HIA) and Healthy Public Policy (HPP) as operationalised by practitioners. DESIGN Data collection-qualitative interviews and a workshop were conducted with HIA and HPP practitioners working in differing contexts. DATA ANALYSIS Critical realist analytical questions identified the essential elements of HIA and HPP, the relationship between them, and the influences of public policy and other contingencies on the practice of both. PARTICIPANTS Nine interviews were conducted with purposively sampled participants working in Europe, USA and Australasia. 17 self-selected participants who worked in Europe, South East Asia and Australasia attended the workshop. RESULTS The results clarify that HIA and HPP are different but mutually supporting. HIA has four characteristics: assessing a policy proposal to predict population health and equity impacts, a structured process for stakeholder dialogue, making recommendations and flexibly adapting to the policy process. HPP has four characteristics: concern with a broad definition of health, designing policy to improve people's health and reduce health inequities, intersectoral collaboration and influencing the policy cycle from inception to completion. HIA brings to HPP prediction about a policy's broad health impacts, and a structured space for intersectoral engagement, but is one approach within a broader suite of HPP activities. Five features of public policy and seven contingent influences on HIA and HPP practice are identified. CONCLUSIONS This study clarifies the core attributes of HIA and HPP as separate yet overlapping while subject to wider influences. This provides the necessary common language to describe the application of both and avoid conflated expectations of either. The findings present the conceptual importance of public policy and the institutional role of public health as distinct and important influences on the practice of HIA and HPP.
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Affiliation(s)
- Patrick John Harris
- Centre for Health Equity Training, Research and Evaluation, Part of the Centre for Primary Health Care and Equity, University of New South Wales, A Unit of Population Health, Sydney and Sydney South West Local Health Disctricts, NSW Health, Sydney, New South Wales, Australia
| | - Lynn Amanda Kemp
- Centre for Health Equity Training, Research and Evaluation, Part of the Centre for Primary Health Care and Equity, University of New South Wales, A Unit of Population Health, Sydney and Sydney South West Local Health Disctricts, NSW Health, Sydney, New South Wales, Australia
| | - Peter Sainsbury
- Population Health Directorate, South Western Sydney & Sydney Local Health Districts, NSW Health, Sydney, New South Wales, Australia
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Carter SM, Kerridge I, Sainsbury P, Letts JK. Public health ethics: informing better public health practice. N S W Public Health Bull 2012; 23:101-6. [PMID: 22738618 DOI: 10.1071/nb12066] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Public health ethics has emerged and grown as an independent discipline over the last decade. It involves using ethical theory and empirical analyses to determine and justify the right thing to do in public health. In this paper, we distinguish public health ethics from clinical ethics, research ethics, public health law and politics. We then discuss issues in public health ethics including: how to weigh up the benefits, harms and costs of intervening; how to ensure that public health interventions produce fair outcomes; the potential for public health to undermine or promote the rights of citizens; and the significance of being transparent and inclusive in public health interventions. We conclude that the explicit and systematic consideration of ethical issues will, and should, become central to every public health worker's daily practice.
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Affiliation(s)
- Stacy M Carter
- Centre for Values, Ethics and the Law in Medicine, The University of Sydney.
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Sainsbury P. Validity of claims in a disclaimer. Aust N Z J Public Health 2011; 35:581; discussion 581. [PMID: 22151173 DOI: 10.1111/j.1753-6405.2011.00793.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Sainsbury P. 9/11 irrelevant for public health. Aust N Z J Public Health 2011; 35:315. [PMID: 21806719 DOI: 10.1111/j.1753-6405.2011.00718.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abstract
BACKGROUND Children diagnosed with chronic kidney disease (CKD) depend on their parents for complex, continuous and intensive support. The study aimed to explore the experiences of parents who have children with CKD. METHODS Parents of 20 children with CKD, recruited from two paediatric hospitals in Australia, participated in an in-depth interview, qualitative study. RESULTS Four major themes were identified: (1) absorbing the clinical environment: parents struggled to accept the diagnosis and permanence of CKD, felt traumatized watching their child undergo invasive clinical procedures, battled to meet appointments, negotiated with staff for their child's needs and felt disempowered; (2) medicalizing parenting: parents became caregivers, a role which was stressful, exhausting and overwhelming. Dialysis was unrelenting and consumed the time, thoughts and energy of parents who felt at fault if their child developed infections and other complications. Parents struggled with their child's psychological problems and episodic aggressive behaviour; (3) disrupting family norms: CKD caused spousal tension, sibling neglect and influenced family planning; (4) coping strategies and support structures: Parents depended on support from their health care providers and valued meeting and learning from other parents of CKD children. Parents also expressed information needs and suggested methods of communicating information. CONCLUSIONS Despite facing profound and pervasive difficulties, parents strived to fulfil their dual parental and health care provider responsibilities. Parents appear to need better support structures to help them cope with the difficulties encountered during all stages of their child's illness.
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Affiliation(s)
- A Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia.
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Carter SM, Ritchie JE, Sainsbury P. Doing good qualitative research in public health: not as easy as it looks. N S W Public Health Bull 2009; 20:105-111. [PMID: 19735621 DOI: 10.1071/nb09018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In this paper, we discuss qualitative research for public health professionals. Quality matters in qualitative research, but the principles by which it is judged are critically different from those used to judge epidemiology. Compared to quantitative research, good quality qualitative studies serve different aims, answer distinct research questions and have their own logic for sampling, data collection and analysis. There is, however, no need for antagonism between qualitative research and epidemiology; the two are complementary. With theoretical and methodological guidance from experienced qualitative researchers, public health professionals can learn how to make the most of qualitative research for themselves.
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Affiliation(s)
- Stacy M Carter
- Centre for Values, Ethics and the Law in Medicine, University of Sydney, Australia.
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Harris E, Harris MF, Madden L, Wise M, Sainsbury P, Macdonald J, Gill B. Working in disadvantaged communities: What additional competencies do we need? Aust New Zealand Health Policy 2009; 6:10. [PMID: 19393091 PMCID: PMC2684114 DOI: 10.1186/1743-8462-6-10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 04/24/2009] [Indexed: 11/10/2022]
Abstract
BACKGROUND Residents of socioeconomically disadvantaged locations are more likely to have poor health than residents of socioeconomically advantaged locations and this has been comprehensively mapped in Australian cities. These inequalities present a challenge for the public health workers based in or responsible for improving the health of people living in disadvantaged localities. The purpose of this study was to develop a generic workforce needs assessment tool and to use it to identify the competencies needed by the public health workforce to work effectively in disadvantaged communities. METHODS A two-step mixed method process was used to identify the workforce needs. In step 1 a generic workforce needs assessment tool was developed and applied in three NSW Area Health Services using focus groups, key stakeholder interviews and a staff survey. In step 2 the findings of this needs assessment process were mapped against the existing National Health Training Package (HLT07) competencies, gaps were identified, additional competencies described and modules of training developed to fill identified gaps. RESULTS There was a high level of agreement among the AHS staff on the nature of the problems to be addressed but less confidence indentifying the work to be done. Processes for needs assessments, community consultations and adapting mainstream programs to local needs were frequently mentioned as points of intervention. Recruiting and retaining experienced staff to work in these communities and ensuring their safety were major concerns. Workforce skill development needs were seen in two ways: higher order planning/epidemiological skills and more effective working relationships with communities and other sectors. Organisational barriers to effective practice were high levels of annual compulsory training, balancing state and national priorities with local needs and giving equal attention to the population groups that are easy to reach and to those that are difficult to engage. A number of additional competency areas were identified and three training modules developed. CONCLUSION The generic workforce needs assessment tool was easy to use and interpret. It appears that the public health workforce involved in this study has a high level of understanding of the relationship between the social determinants and health. However there is a skill gap in identifying and undertaking effective intervention.
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Affiliation(s)
- Elizabeth Harris
- Centre for Health Equity Training, Research and Evaluation, University of New South Wales, Sydney, NSW, Australia.
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Tong A, Sainsbury P, Chadban S, Walker RG, Harris DC, Carter SM, Hall B, Hawley C, Craig JC. Patients' experiences and perspectives of living with CKD. Am J Kidney Dis 2009; 53:689-700. [PMID: 19216015 DOI: 10.1053/j.ajkd.2008.10.050] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Accepted: 10/31/2008] [Indexed: 11/11/2022]
Abstract
Explicit incorporation of patients' values and preferences is important in health care decision making. However, there are few data about this topic for patients with chronic kidney disease (CKD). We conducted 9 focus groups (3 each for CKD stages 1 to 5, CKD stage 5D, and CKD stages 1 to 5T). Five major themes were identified: (1) personal meaning of CKD, (2) managing and monitoring health, (3) lifestyle consequences, (4) family impact, and (5) informal support structures. Patients had to adjust to the disruptive and permanent implications of the illness on their physical health, identity, emotions, family, lifestyle, relationships, and employment. The overwhelming fatigue, complex treatment regimens, side effects, and liquid and diet restrictions constrained patients' lives. Patients appreciated specialist care, but described the health care system as nonintegrated and believed they received insufficient information and psychosocial support. Choice of treatments was based on lifestyle, family impact, and physical comfort, seldom on clinical outcomes. Time was needed to comprehend the diagnosis, cope with uncertainty, integrate their treatment regimen into their daily routine, and reestablish a sense of normality in their lives. Rather than focusing on clinical targets, greater attention may need to be given to providing information and psychosocial and practical support at a patient-level not organ-specific level, to maximize patient quality of life.
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Affiliation(s)
- Allison Tong
- NHMRC Centre for Clinical Research Excellence in Renal Medicine, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia.
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Affiliation(s)
- Peter Sainsbury
- Sydney South West Area Health Service, Locked Bag 7008, Liverpool, NSW 1871, Australia.
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Alperstein G, Sainsbury P, O'Grady S. Implementing a strategic plan for child health: a Sydney case study. J Paediatr Child Health 2008; 44:630-5. [PMID: 18717772 DOI: 10.1111/j.1440-1754.2008.01371.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of this paper is to describe the implementation of a strategic plan, Health Gain for Children and Youth of Central Sydney, over a 10-year period to December 2005. METHODS Descriptive information was obtained from the records and minutes of all relevant committees, interviews with key workers who were involved with the committees, managers and senior health professionals, and from the involvement of the authors throughout the process of the implementation. RESULTS An implementation steering committee was established to oversee the implementation of the plan. Rather than adopting a uniform approach to assigning responsibility for the implementation of each strategy in the plan or developing specific costs and time frames for each strategy, a more pragmatic, flexible and opportunistic approach was taken. Most of the plan's strategies were implemented over a 7-year time frame using a combination of service reorientation and implementation of new programmes, some of which were funded from sources not anticipated during the development of the plan. Implementation required a dedicated driver, commitment at senior level and participation by many staff at many levels. Outcomes, monitored through data collected at 5-year intervals, revealed positive trends in a number of child and youth health indicators. CONCLUSIONS The successful implementation of the strategic plan required pragmatism, flexibility, opportunism and the commitment and involvement of staff at all organisational levels. It is envisaged that this approach provides a firm base for future evidence-based developments to benefit the health and well-being of children, youth and their families and reduce health inequities.
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Affiliation(s)
- Garth Alperstein
- Sydney South West Area Health Service, Community Health Services, Camperdown, New South Wales, Australia.
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Tong A, Sainsbury P, Craig JC. Support interventions for caregivers of people with chronic kidney disease: a systematic review. Nephrol Dial Transplant 2008; 23:3960-5. [PMID: 18658178 DOI: 10.1093/ndt/gfn415] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A growing number of patients with chronic kidney disease (CKD) rely on non-professional healthcare providers, such as family and friends, to manage their long-term condition throughout the trajectory of CKD. These informal caregivers can experience stress, depression, lack of confidence and poor quality of life. Yet, the needs of caregivers are often neglected and under-prioritized. The objective of this review is to evaluate the effectiveness of interventions aimed at providing support to caregivers of people with CKD. METHODS We conducted a systematic review of studies that evaluated any intervention for informal caregivers of CKD patients. We searched five electronic databases (up to January Week 5, 2008) including Medline, EMBASE, PsychINFO, CINAHL, Cochrane Central Register and reference lists of relevant articles. RESULTS Three studies were identified that evaluated an intervention for caregivers of CKD patients. All three only assessed the effect of educational material on caregivers' knowledge. Two evaluated information provided to caregivers of dialysis patients using a pre- and post-test study design. The other study used participatory action research methods to develop and evaluate an information handbook for transplant patients and their caregivers. Studies consistently found that the provision of information improved caregivers' knowledge. No other outcomes were reported. CONCLUSIONS Despite the growing recognition of the burden and adverse effects of CKD on caregivers, no high-quality evidence is available about the effect of information or support interventions on the physical or psychosocial well-being of informal caregivers and the patients. More attention towards the development and evaluation of services that respond to the support and informational needs of caregivers is needed, and this may also lead to improved outcomes for patients.
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Affiliation(s)
- Allison Tong
- NHMRC Centre for Clinical Research Excellence in Renal Medicine, Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW 2145, Australia.
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Tong A, Sainsbury P, Carter SM, Hall B, Harris DC, Walker RG, Hawley CM, Chadban S, Craig JC. Patients' priorities for health research: focus group study of patients with chronic kidney disease. Nephrol Dial Transplant 2008; 23:3206-14. [DOI: 10.1093/ndt/gfn207] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tong A, Chapman S, Sainsbury P, Craig JC. An analysis of media coverage on the prevention and early detection of CKD in Australia. Am J Kidney Dis 2008; 52:159-70. [PMID: 18468753 DOI: 10.1053/j.ajkd.2008.02.304] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Accepted: 02/25/2008] [Indexed: 11/11/2022]
Abstract
News media raise public awareness about health and can influence public policy agenda. Recently, nephrologists have sought to make prevention and early detection of chronic kidney disease (CKD) a health care priority. We assessed the extent and manner in which Australian television news and newspapers cover CKD prevention or early detection. Electronic news databases for print media and television programs were searched (May 2005 to March 2007) for items referring to CKD prevention or early detection. We analyzed all relevant items for spokespeople, main news frame, focus of responsibility, proposed solutions, and trigger/reason for publication. Of 2,439 newspaper articles and 10,430 television broadcasts retrieved, only 214 articles (8.77%) and 7 broadcasts (0.06%) were eligible. Kidney transplantation dominated CKD-related news. Lay person or high-profile advocates were virtually absent. Risks of cardiovascular disease and mortality conferred by CKD were not emphasized by news reports; instead, CKD received peripheral mention as a secondary consequence of diabetes or obesity. Few reports cited the economic consequences of CKD. The media focused on lifestyle causes and solutions, whereas nonlifestyle causes and screening and prevention strategies were rarely mentioned. Kidney health professionals need to actively engage with the media in efforts to amplify desired messages on CKD prevention or early detection. Medical journals, research institutions, universities, hospitals, and advocacy groups should issue press releases that highlight newsworthy aspects of this topic. Extending news media coverage can help exert an influence on health policies and agenda setting and increase public awareness to improve prevention and early detection of CKD.
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Affiliation(s)
- Allison Tong
- NHMRC Centre for Clinical Research Excellence in Renal Medicine, Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia.
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Abstract
ISSUE ADDRESSED Promoting mental health is a relatively new initiative being taken across the world, stimulated by concerns about the global burden of mental illness, inequalities in mental health and debate about the relationship between quality of life and economic growth. Social factors influence the health of populations but the distribution of these is determined by people who exercise political power through societies' institutions of governance. Inequalities in health (and mental health) arise from the unequal distribution of these social determinants of health. This paper aims to stimulate interest and debate on the role of democracy, a mechanism for allocating political power, as a determinant of health and of mental health in particular. METHODS AND RESULTS Drawing principally on the political science literature, we briefly describe the development of democracy in some of its commoner current forms and relate this to the spread of political power and participation in collective decision making and improvements in public health over the past 200 years. We conducted a non-systematic literature search and identified 34 studies examining the link between democracy and health. Despite methodological weaknesses, these papers suggest that there is a weak empirical link between democracy and health, including mental health. We suggest mechanisms that might account for this. CONCLUSIONS Historical, theoretical and empirical evidence suggests that democracy is a (frequently forgotten) determinant of health.
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Affiliation(s)
- Marilyn Wise
- Australian Centre for Health Promotion, School of Public Health, University of Sydney, New South Wales.
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Tong A, Lowe A, Sainsbury P, Craig JC. Experiences of parents who have children with chronic kidney disease: a systematic review of qualitative studies. Pediatrics 2008; 121:349-60. [PMID: 18245427 DOI: 10.1542/peds.2006-3470] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The objective of this study was to describe the experiences of parents who have children with chronic kidney disease. METHODS We conducted a systematic review and meta-ethnography of studies that had used in-depth interviews or focus groups to explore experiences of parents with children who have chronic kidney disease (predialysis, hemodialysis, peritoneal dialysis, or after kidney transplantation). We searched 5 electronic databases (through to August 2005), Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Sociofile/Sociological Abstract, and reference lists of relevant articles. RESULTS Sixteen articles that reported the experiences of parents of 358 children with chronic kidney disease were included. Ten themes emerged, which we grouped into 3 interrelated clusters: intrapersonal (living with constant uncertainty, stress, and maintaining vigilance despite experiencing fatigue), interpersonal (medicalization of the parental role, dependence on and conflict with staff, and disrupted peer relationships), and external issues (management of the medical regimen, pursuit of information, organizing transportation, accommodation and finances, adhering to the child's liquid and diet restrictions, and balancing medical care with domestic responsibilities). CONCLUSIONS In addition to "normal" parental roles, being a parent of a child with chronic kidney disease demands a high-level health care provider, problem solving, information seeking, and financial and practical skills at a time when the capacity to cope is threatened by physical tiredness, uncertainty, and disruption to peer support within and outside the family structure. Parents of children with chronic kidney disease need multidisciplinary care, which may lead to improved outcomes for their children.
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Affiliation(s)
- Allison Tong
- NHMRC Centre for Clinical Research Excellence in Renal Medicine, Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW 2145, Australia.
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Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007. [PMID: 17872937 DOI: 10.1037/t74064-000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. OBJECTIVE To develop a checklist for explicit and comprehensive reporting of qualitative studies (in depth interviews and focus groups). METHODS We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. RESULTS Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. CONCLUSIONS The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.
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Affiliation(s)
- Allison Tong
- School of Public Health, University of Sydney, NSW, Australia.
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Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007; 19:349-57. [PMID: 17872937 DOI: 10.1093/intqhc/mzm042] [Citation(s) in RCA: 17655] [Impact Index Per Article: 1038.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. OBJECTIVE To develop a checklist for explicit and comprehensive reporting of qualitative studies (in depth interviews and focus groups). METHODS We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. RESULTS Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. CONCLUSIONS The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.
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Affiliation(s)
- Allison Tong
- School of Public Health, University of Sydney, NSW, Australia.
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Choi BCK, Frank J, Mindell JS, Orlova A, Lin V, Vaillancourt ADMG, Puska P, Pang T, Skinner HA, Marsh M, Mokdad AH, Yu SZ, Lindner MC, Sherman G, Barreto SM, Green LW, Svenson LW, Sainsbury P, Yan Y, Zhang ZF, Zevallos JC, Ho SC, de Salazar LM. Vision for a global registry of anticipated public health studies. Am J Public Health 2007; 97 Suppl 1:S82-7. [PMID: 17413073 PMCID: PMC1855000 DOI: 10.2105/ajph.2005.081711] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2006] [Indexed: 11/04/2022]
Abstract
In public health, the generation, management, and transfer of knowledge all need major improvement. Problems in generating knowledge include an imbalance in research funding, publication bias, unnecessary studies, adherence to fashion, and undue interest in novel and immediate issues. Impaired generation of knowledge, combined with a dated and inadequate process for managing knowledge and an inefficient system for transferring knowledge, mean a distorted body of evidence available for decisionmaking in public health. This article hopes to stimulate discussion by proposing a Global Registry of Anticipated Public Health Studies. This prospective, comprehensive system for tracking research in public health could help enhance collaboration and improve efficiency. Practical problems must be discussed before such a vision can be further developed.
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Affiliation(s)
- Bernard C K Choi
- Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada. Bernard_
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Bagley P, Lin V, Sainsbury P, Wise M, Keating T, Roger K. In what ways does the mandatory nature of Victoria's municipal public health planning framework impact on the planning process and outcomes? Aust New Zealand Health Policy 2007; 4:4. [PMID: 17376248 PMCID: PMC1851012 DOI: 10.1186/1743-8462-4-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Accepted: 03/22/2007] [Indexed: 11/27/2022]
Abstract
Background Systems for planning are a critical component of the infrastructure for public health. Both in Australia and internationally there is growing interest in how planning processes might best be strengthened to improve health outcomes for communities. In Australia the delivery of public health varies across states, and mandated municipal public health planning is being introduced or considered in a number of jurisdictions. In 1988 the Victorian State government enacted legislation that made it mandatory for each local government to produce a Municipal Public Health Plan, offering us a 20-year experience to consider. Results In-depth interviews were undertaken with those involved in public health planning at the local government level, as part of a larger study on local public health infrastructure and capacity. From these interviews four significant themes emerge. Firstly, there is general agreement that the Victorian framework of mandatory public health planning has led to improvements in systems for planning. However, there is some debate about the degree of that improvement. Secondly, there is considerable variation in the way in which councils approach planning and the priority they attach to the process. Thirdly, there is concern that the focus is on producing a plan rather than on implementing the plan. Finally, some tension over priorities is evident. Those responsible for developing Municipal Public Health Plans express frustration over the difficulty of having issues they believe are important addressed through the MPHP process. Conclusion There are criticisms of Victoria's system for public health planning at the local government level. Some of these issues may be specific to the arrangement in Victoria, others are problems encountered in public health planning generally. In Victoria where the delivery structure for public health is diverse, a system of mandatory planning has created a minimum standard. The implementation of the framework was slow and factors in the broader political environment had a significant impact. Work done in recent years to support the process appears to have led to improvements. There are lessons for other states as they embark upon mandated public health plans.
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Affiliation(s)
| | - Vivian Lin
- La Trobe University, Melbourne, Australia
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- National Public Health Partnership, Melbourne, Australia
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Bowen S, Zwi A, Sainsbury P. What evidence informs government population health policy? Lessons from early childhood intervention policy in Australia. N S W Public Health Bull 2006; 16:180-4. [PMID: 16778918 DOI: 10.1071/nb05050] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
CONTEXT The world has started to feel the impact of a global chronic disease epidemic, which is putting pressure on our health care systems. If uncurbed, a new generation of "diseases of comfort" (such as those chronic diseases caused by obesity and physical inactivity) will become a major public health problem in this and the next century. OBJECTIVE To describe the concept, causes, and prevention and control strategies of diseases of comfort. METHODS Brokered by a senior research scientist specialised in knowledge translation, a chair, a president, and a past president of national public health associations contributed their views on the subject. RESULTS Diseases of comfort have emerged as a price of living in a modern society. It is inevitable that these diseases will become more common and more disabling if human "progress" and civilisation continue toward better (more comfortable) living, without necessarily considering their effects on health. Modern technology must be combined with education, legislation, intersectoral action, and community involvement to create built and social environments that encourage, and make easy, walking, physical activity, and nutritious food choices, to reduce the health damaging effects of modern society for all citizens and not only the few. CONCLUSIONS Public health needs to be more passionate about the health issues caused by human progress and adopt a health promotion stance, challenging the assumptions behind the notion of social "progress" that is giving rise to the burden of chronic disease and developing the skills to create more health promoting societies in which individual health thrives.
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Affiliation(s)
- Bernard C K Choi
- Centre for Chronic Disease Prevention and Control (CCDPC), Public Health Agency of Canada (PHAC), Government of Canada, AL no 6701A, 120 Colonnade Road, Ottawa, Ontario K1A 1B4, Canada.
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