Why we struggle to make progress in obesity prevention and how we might overcome policy inertia: Lessons from the complexity and political sciences

Despite evidence for the effectiveness of policies that target obesogenic environments, their adoption remains deficient. Using methods and concepts from complexity and political science (Stock-and-Flow analysis and Punctuated Equilibrium Theory) and a qualitative literature review, we developed system maps to identify feedback loops that hinder policymaking on mitigating obesogenic environments and feedback loops that could trigger and sustain policy change. We found numerous self-reinforcing feedback loops that buttress the assumption that obesity is an individual problem, strengthening the biomedical and commercial weight-loss sectors' claim to "ownership" over solutions. That is, improvements in therapies for individuals with obesity reinforces policymakers' reluctance to target obesogenic environments. Random events that focus attention on obesity (e.g., celebrities dismissing soda) could disrupt this cycle, when actors from outside the medical and weight-loss sector (e.g., anti-weight stigma activists) successfully reframe obesity as a societal problem, which requires robust and politically relevant engagement with affected communities prior to such events taking place. Sustained prioritization of policies targeting obesogenic environments requires shared problem ownership of affected communities and nonhealth government sectors, by emphasizing cobenefits of policies that target obesogenic environments (e.g., ultraprocessed food taxation for raising revenue) and solutions that are meaningful for affected communities.

Promoting Pro-Environmental Behavior in Policymaking: A Text-Mining Approach for Literature Review

The impact of pro-environmental behavior on policymaking has been an exciting area of research. While the relationship between pro-environmental behavior and policymaking has been explored in numerous studies, there needs to be more synthesis on this topic. This is the first text-mining study of pro-environmental effects in which policymaking is a significant factor. In response, this study, for the first time, takes a novel approach by using text mining in R programming to analyze 30 publications from the Scopus database on pro-environmental behavior in policymaking, highlighting major research themes and prospective research areas for future investigation. Results from text mining yielded 10 topic models, which are presented with a synopsis of the published research and a list of the primary authors, as well as a posterior probability via latent Dirichlet allocation (LDA). Additionally, the study conducts a trend analysis of the top 10 journals with the highest impact factor, considering the influence of each journal's mean citation. The study offers an overview of the impacts of pro-environmental behavior in policymaking, showing the most relevant and frequently discussed themes, introduces the scientific visualization of papers published in the Scopus database, and proposes future study directions. These findings can help researchers and environmental specialists better understand how pro-environmental behavior can be fostered more effectively through policymaking.

Hospital capacities and response to COVID-19 pandemic surges in Iran: A quantitative model-based study

The coronavirus 2019 (COVID-19) pandemic resulted in serious limitations for healthcare systems, and this study aimed to investigate the impact of COVID-19 surges on in-patient care capacities in Iran employing the Adaptt tool. Using a cross-sectional study design, our study was carried out in the year 2022 using 1-year epidemiologic (polymerase chain reaction-positive COVID-19 cases) and hospital capacity (beds and human resource) data from the official declaration of the pandemic in Iran in February 2020. We populated several scenarios, and in each scenario, a proportion of hospital capacity is assumed to be allocated to the COVID-19 patients. In most of the scenarios, no significant shortage was found in terms of bed and human resources. However, considering the need for treatment of non- COVID-19 cases, in one of the scenarios, it can be observed that during the peak period, the number of required and available specialists is exactly equal, which was a challenge during surge periods and resulted in extra hours of working and workforce burnout in hospitals. The shortage of intensive care unit beds and doctors specializing in internal medicine, infectious diseases, and anesthesiology also requires more attention for planning during the peak days of COVID-19.

Healthcare provider cost of antimicrobial resistance in two teaching hospitals in Ghana

Understanding the healthcare provider costs of antimicrobial resistance (AMR) in lower-middle-income countries would motivate healthcare facilities to prioritize reducing the AMR burden. This study evaluates the extra length of stay and the associated healthcare provider costs due to AMR to estimate the potential economic benefits of AMR prevention strategies. We combined data from a parallel cohort study with administrative data from the participating hospitals. The parallel cohort study prospectively matched a cohort of patients with bloodstream infections caused by third-generation cephalosporin-resistant enterobacteria and methicillin-resistant Staphylococcus aureus (AMR cohort) with two control arms: patients infected with similar susceptible bacteria and a cohort of uninfected controls. Data collection took place from June to December 2021. We calculated the cost using aggregated micro-costing and step-down costing approaches and converted costs into purchasing power parity in international US dollars, adjusting for surviving patients, bacterial species and cost centres. We found that the AMR cohort spent a mean of 4.2 extra days (95% CI: 3.7-4.7) at Hospital 1 and 5.5 extra days (95% CI: 5.1-5.9) at Hospital 2 compared with the susceptible cohort. This corresponds to an estimated mean extra cost of $823 (95% CI: 812-863) and $946 (95% CI: US$929-US$964) per admission, respectively. For both hospitals, the estimated mean annual extra cost attributable to AMR was approximately US$650 000. The cost varies by organism and type of resistance expressed. The result calls for prioritization of interventions to mitigate the spread of AMR in Ghana.

From Strategy to Synergy: Paving Ontario's Proactive Path in Precision Medicine with Collaboration and Visionary Leadership

Ontario is shifting to a Precision Medicine (PM) model, which emphasizes tailored patient care, an initiative reflected in the formation of Ontario Health Teams. However, this shift faces significant data governance, policy formulation, and technology integration hurdles. To overcome these barriers, we advocate for a comprehensive PM framework to orchestrate collaboration among healthcare providers, policymakers, and technologists. This framework enhances data management, propels digital health innovations, and uphold ethical standards in AI applications. Effective deployment of this framework is crucial for actualizing PM's promise in Ontario, potentially revolutionizing healthcare delivery.

From Blueprint to Best Practice: Gauging the Efficacy of Digital Health Solutions

The surge of AI-driven technologies in the digital health market demands a concurrent evolution in evaluation standards, a pace currently lagging behind innovation. This paper explores the pivotal inadequacies within existing evaluation models, highlighting the necessity for refined methodologies that align with the unique complexities of digital health. We critically examine the initiatives of key entities such as Health Canada, CADTH, and CNDHE, pinpointing the deficiencies in addressing the volatility and intricacies of AI applications. To bridge these gaps, we advocate for a nuanced evaluation paradigm, proposing the establishment of an oversight body, implementing detailed category-specific criteria, and a robust six-step evaluation framework tailored for AI health solutions. The paper culminates by underscoring the indispensable role of strategic leadership and agile policymaking in cultivating a resilient digital health environment that prioritizes patient care without compromising the ingenuity of technological advances.

Rates of Laser Trabeculoplasty by Ophthalmologists and Optometrists: A Comparative Analysis of the CMS Medicare Public Use File

Purpose

To provide a comparative analysis of rates of laser trabeculoplasty (LTP) among eye care providers in the USA.

Methods

This retrospective cohort analysis utilized the Centers for Medicare and Medicaid Services (CMS) Public Use File (PUF), 2015-2018. We used CPT code 65855 to select eye care providers who performed LTP in three key US states (KY, LA, and OK). Primary outcomes were eye provider differences in provider count, service count, unique beneficiary count, and Medicare-allowed payments. Asymptotic two-sided chi-squared tests were executed. Statistical significance was achieved at p<0.05.

Results

The sum of Medicare-allowed payments for LTP in all three states in 2018 was roughly 26% lower than in 2015. The proportion of Medicare-allowed payments furnished by optometrists increased from 11.3% to 17.9% between 2015 and 2018 (p<0.001). Relative to ophthalmologists, we observed significant increases in optometric Medicare-allowed payments in KY, LA, OK, and the all-inclusive tri-state cohort (all p<0.001). Furthermore, significant optometric increases in number of providers performing LTP (p=0.007), number of unique Medicare beneficiaries seen (p<0.001), and number of LTP services billed (p<0.001) were observed relative to ophthalmologists.

Conclusion

The recent expansion of surgical authority by optometrists in key US states is creating a tangible impact on ophthalmologic and optometric practice patterns. The findings of this study may act as provision for policymakers in the context of continually evolving guidelines for optometric surgical expansion.

Older people's health promotion policies challenges: Making an avenue for policy responses in a developing country

BACKGROUND

Older people's health policies suffer from many challenges in Iran. The issue is more highlighted considering the increasing rate of the older population in the country. This study aimed to explore the challenges of older people's health policies in Iran as well as make an avenue for policy responses.

MATERIALS AND METHODS

This study was a qualitative study that was conducted using conventional content analysis in 2020-2021 in Iran. The purposive and snowball sampling methods were used for semi-structured interviews with 30 selected participants. Data were analyzed through the content analysis approach using Granheim and Landman's five-step thematic method.

RESULTS

The results of analyzing the data were categorized into four main themes, 16 sub-themes, and 70 final codes. The main themes were executive, policymaking, intra- and inter-sectoral, and environmental challenges.

CONCLUSIONS

Older people are facing challenges in receiving appropriate and timely care. In order to achieve a wide national policy dialogue for covering all older people's health needs in policy agendas and better formulation and implementation of the policies, it is necessary for Iranian health policymakers to address executive challenges and apply effective strategies.

When and Why Do People Accept Public-Policy Interventions? An Integrative Public-Policy-Acceptance Framework

The successful introduction of public policies to prompt behavior change hinges on the degree to which citizens endorse the proposed policies. Although there is a large body of research on psychological determinants of public policy acceptance, these determinants have not yet been synthesized into an integrative framework that proposes hypotheses about their interplay. In this article, we develop a review-based, integrative public-policy-acceptance framework that introduces the desire for governmental support as a motivational foundation in public-policy acceptance. The framework traces the route from problem awareness to policy acceptance and, ultimately, policy compliance. We propose this relationship to be mediated by a desire for governmental support. We integrate numerous key variables assumed to qualify the relationship between problem awareness and the desire for governmental support, such as control attributions, trust, and value fit, as well as the relationship between the desire for governmental support and policy acceptance, such as perceived policy effectiveness, intrusiveness, and fairness. We exemplify the use of the proposed framework by applying it to climate policies.

Perspectives of California Legislators on Institutional Barriers and Facilitators to Non-Partisan Research Evidence Use in State Health Policymaking

BACKGROUND

Bridging the translational gap between research evidence and health policy in state legislatures requires understanding the institutional barriers and facilitators to non-partisan research evidence use. Previous studies have identified individual-level barriers and facilitators to research evidence use, but limited perspectives exist on institutional factors within legislatures that influence non-partisan research evidence use in health policymaking.

OBJECTIVE

We describe the perspectives of California state legislators and legislative staff on institutional barriers and facilitators of non-partisan research evidence use in health policymaking and explore potential solutions for enhancing use.

DESIGN

Case study design involving qualitative interviews.

PARTICIPANTS

We interviewed 24 California state legislators, legislative office staff, and legislative research staff.

APPROACH

Semi-structured recorded interviews were conducted in person or by phone to identify opportunities for enhancing non-partisan research evidence use within state legislatures. We conducted thematic analyses of interview transcripts to identify (1) when research evidence is used during the policymaking process, (2) barriers and facilitators operating at the institutional level, and (3) potential solutions for enhancing evidence use.

RESULTS

Institutional barriers to non-partisan research evidence use in health policymaking were grouped into three themes: institutional policies, practices, and priorities. Interviews also revealed institutional-level facilitators of research evidence use, including (1) access and capacity to engage with research evidence, and (2) perceived credibility of research evidence. The most widely supported institutional-level solution for enhancing evidence-based health policymaking in state legislatures involved establishing independent, impartial research entities to provide legislators with trusted evidence to inform decision-making.

CONCLUSIONS

Potential institutional-level changes within state legislatures may enhance evidence use in health policymaking, leading to improved health outcomes and lower healthcare costs for states.

Child Rights during the COVID-19 Pandemic: Learning from Child Health-and-Rights Professionals across the World

The COVID-19 pandemic underscores the importance of a child rights-based approach to policymaking and crisis management. Anchored in the United Nations Convention on the Rights of the Child, the 3P framework-provision, protection, and participation-forms the foundation for health professionals advocating for children's rights. Expanding it with two additional domains-preparation and power-into a 5P framework has the potential to enhance child rights-based policies in times of crisis and future pandemics. The study aimed to (1) gather perspectives from child health-and-rights specialists on how children's rights were highlighted during the early phase of the pandemic in their respective settings; and (2) evaluate the usefulness of the 5P framework in assessing children's visibility and rights. A qualitative survey was distributed among child health-and-rights professionals; a total of 68 responses were analysed in Atlas.ti 9 from a multi-disciplinary group of policymakers and front-line professionals in eight world regions. As framed by the 5Ps, children's rights were generally not safeguarded in the initial pandemic response and negatively impacted children's health and wellbeing. Further, children lacked meaningful opportunities to raise their concerns to policymakers. The 5P framework holds the potential to shape an ethical child rights-based decision-making framework for future crises, both nationally and globally.

Digital impact of world hepatitis day: Formulating evidence-based recommendations for promoting healthcare awareness events

BACKGROUND

Social media applications provide room for public interaction and forming communities, thus helping disseminate health-related information. Since 2010, World Hepatitis Day has been observed on July 28 with endorsement from the World Health Organization. This study aimed to ascertain the global digital impact of World Hepatitis Day on Twitter (an online microblogging social network) and on the web (web searches and news) to formulate evidence-based recommendations for promoting future policy development.

MATERIALS AND METHODS

We analyzed publicly available data from Twitter, a popular microblogging social network on the internet (data accessed from India). Three social media assessment tools (Sprout social, SocioViz and Symplur) and Google Trends were used to obtain data about the tweets and global impressions worldwide about World Hepatitis Day. A time frame from July 27th, 2022 to July 29th, 2022 was taken into account for all the tweets in various time zones around the world.

RESULTS

"#WorldHepatitisDay" and "#Hepatitis" received 519.16 million and 412.37 million impressions in the defined timeframe, respectively. A total of 39,069 tweets were posted about World Hepatitis Day, an increase of 24.1% compared to the previous year. On social network analysis, 93 of the top 100 influencers collaborated among themselves, which helped in the wider dissemination of awareness.

CONCLUSIONS

World Hepatitis Day 2022 was an impactful healthcare awareness event on Twitter for the global audience and sets forth an example of the effective utilization of resources. Future policies shall inculcate constructive feedback from our findings and must be inclusive of all the underrepresented communities.

Reviewing the National Health Services Quality Policies and Strategies of the Iranian Health System: A Document Analysis

Background

High-quality health care is an important component of efforts to reach Universal Health Coverage (UHC). Given this pivotal fact, poor quality of care is a significant bottleneck in the endeavors of Iran to UHC. This study was part of a broader qualitative study and aimed to provide supplementary data about the documents related to the National Quality Policies and Strategies (NQPS) health services in the health system of Iran to determine the degree of alignment with the World Health Organization (WHO) approach for NQPS, and to track change and development over time.

Methods

This document analysis was performed following the READ approach for systematic document analysis in health policy research. Furthermore, qualitative content analysis following parallel forms of the mixed analysis in which the textual material proceeded with different inductive and deductive content-analytical procedures simultaneously, applying the WHO practical approach for NQPS, was selected.

Results

The 15 included records that met the inclusion criteria were released in the post-Islamic Revolution period. The Ministry of Health was found as the most responsible authority for publishing the NQPS among the other authorities. Furthermore, 67% of NQPS was aligned with the goals and priorities of a broader national plan or policy. Contradictions, variations, and ambiguities were also found in the literature circumstances of the NQPS. There was no NQPS concentrated on the entire pathway of care in the Iranian health system, which developed according to the WHO approach for NQPS.

Conclusions

Qualitative analysis of the current NQPSs based on the eight inter-dependent elements and critical supplements, the technical perspective of broad stakeholders, community engagement, and steady commitment of policymakers are our recommendations for future efforts towards having NQPS.

Relevance of the COVID-19 rapid response system to public health policymaking in Islamic Republic of Iran

BACKGROUND

The COVID-19 pandemic has increased awareness of the need for high-quality and timely evidence to support policy- and decision-making in emergency situations.

AIMS

To describe the experiences of the National Institute of Health Research (NIHR), Islamic Republic of Iran, in adopting evidence-informed policymaking during the COVID-19 pandemic.

METHODS

During the COVID-19 pandemic, NIHR institutionalized a rapid response system that was backed up by evidence-informed policy- and decision-making. Activities included establishment of a preparedness and response management committee, gathering and providing timely pandemic information to policymakers, establishing a timeline of actions and activities, and a feedback system for policy responses and queries.

RESULTS

The COVID-19 rapid response committee addressed the questions of 40 policymakers by synthesizing and analysing evidence and making it available to relevant stakeholders. It developed and disseminated knowledge products to provide relevant information. We identified the need for more timely data and more reliable research evidence for pandemic management.

CONCLUSION

National institutions responding to health emergencies need to take responsibility for establishing and managing a robust rapid response systems that can provide valid and timely evidence to policymakers. Over time, their capacity should be monitored, evaluated and strengthened to adapt and respond appropriately to pandemics, outbreaks and epidemics.

The evidence governance system in Oman

Background

In addition to the general question about what works, policymakers consider whether health interventions will work in their context, and consider the social values such as affordability, acceptability, equity, equality, and human rights.

Aims

To highlight the importance of having and using an evidence governance system to inform health policymaking in Oman.

Methods

We reviewed the literature and analysed local documents on evidence governance systems in Oman.

Results

The Government of Oman has shown increasing interest in research and innovation in the past few decades. This interest was reinforced through the announcement in November 2021 of the intention to establish a decision-making support unit. Oman's strategies for evidence-informed policymaking provide direct and well-integrated channels for expert advice, however, the capacity for implementation remains challenging, and there is a lack of clarity in the evidence use mandate. It is not clear how evidence was selected, synthesized and used to inform some of the government policies on health. This can limit the scope of operation and subsequent achievements.

Conclusion

Efforts to strengthen evidence-informed policymaking should focus on building a system for good governance of evidence to ensure that rigorous, systematic, and technically valid evidence is used for policymaking.

Ecological restoration for sustainable development in China

Facing the need for transdisciplinary research to promote ecological restoration that achieves both social and ecological benefits, research on past restoration efforts that have directly or indirectly contributed to regional or national sustainable development warrants reassessment. Using China as an example, in this review, we address three basic research questions that can be summarized as follows: ecological restoration-of what, for whom and to what purpose? Accordingly, a 'landscape pattern-ecosystem service-sustainable development' co-evolutionary framework is proposed here to describe landscape-scale ecological restoration and its impact on landscape patterns and ecological processes, ecosystem services for human well-being, sustainable livelihoods and socioeconomic development. From the strategic pattern of national ecological security to the pattern of major projects to protect and restore major national ecosystems, the spatial pattern of China's ecological restoration is more geographically integrative. From major function-oriented zoning to systematic ecological protection and restoration, and for the purpose of achieving the Beautiful China Initiative, there are three stages of ecosystem services management: classification, synergy and integration, respectively. The difference in geographic processes should be considered in the key requirements of ecological restoration for China's five national strategies for regional sustainable-development strategies. Deepening understanding of the relationship between humans and nature in different geographical contexts is a scientific prerequisite to support policymaking related to ecological restoration. To promote greater harmony between humans and nature, we propose four important research directions: (i) understanding coupling processes among key components, (ii) identifying ecosystem service flows, (iii) evaluating social-ecological benefits and (iv) supporting adaptive management for regional sustainable development.

Let's Match: Making Cannabis Policy Guided by Research

PURPOSE

The growth and increasing sophistication of the legal cannabis industry necessitates further scientific inquiry to establish an evidence-based policy path forward. However, policymakers must balance public demand for cannabis reform with the lack of scientific consensus on key issues. This Commentary discusses Massachusetts' statutory provisions supporting cannabis research, advances in social equity driven by data, and critical policy issues, which invite questions without clear scientific answers.

FINDINGS

Although the full breadth of inquiry needed cannot possibly be contained in a single article, this Commentary poses questions in 2 pertinent issue areas that affect adult and medical use. First, we discuss the current limitations on determining the scope and severity of cannabis-impaired driving and detecting impairment at any one point in time. Although experimental studies have found varying levels of impairment on driving ability, observational data have been inconclusive regarding the extent of traffic incidents involving cannabis impairment. A precise threshold for impairment and manner of detection must be established to develop just enforcement measures. Second, we discuss the lack of clinical standardization in medical cannabis use. In the absence of a consistent clinical framework, medical cannabis patients face undue burdens that limit access to treatment. A more well-defined clinical structure is needed to enhance use of and access to therapeutic cannabis treatment models.

IMPLICATIONS

Cannabis policy reform has gone forward at the will of voters despite the status of cannabis as a Schedule I controlled substance at the federal level, which has limited opportunities to research cannabis because it is commercially available. The implication of such limitations is realized by states leading cannabis reform, where unanswered questions present an opportunity for the scientific community to inform an evidence-based path forward in cannabis policy.

Using the Veil of Ignorance to align AI systems with principles of justice

The philosopher John Rawls proposed the Veil of Ignorance (VoI) as a thought experiment to identify fair principles for governing a society. Here, we apply the VoI to an important governance domain: artificial intelligence (AI). In five incentive-compatible studies (N = 2, 508), including two preregistered protocols, participants choose principles to govern an Artificial Intelligence (AI) assistant from behind the veil: that is, without knowledge of their own relative position in the group. Compared to participants who have this information, we find a consistent preference for a principle that instructs the AI assistant to prioritize the worst-off. Neither risk attitudes nor political preferences adequately explain these choices. Instead, they appear to be driven by elevated concerns about fairness: Without prompting, participants who reason behind the VoI more frequently explain their choice in terms of fairness, compared to those in the Control condition. Moreover, we find initial support for the ability of the VoI to elicit more robust preferences: In the studies presented here, the VoI increases the likelihood of participants continuing to endorse their initial choice in a subsequent round where they know how they will be affected by the AI intervention and have a self-interested motivation to change their mind. These results emerge in both a descriptive and an immersive game. Our findings suggest that the VoI may be a suitable mechanism for selecting distributive principles to govern AI.

The utilization of systematic review evidence in formulating India's National Health Programme guidelines between 2007 and 2021

Evidence-informed policymaking integrates the best available evidence on programme outcomes to guide decisions at all stages of the policy process and its importance becomes more pronounced in resource-constrained settings. In this paper, we have reviewed the use of systematic review evidence in framing National Health Programme (NHP) guidelines in India. We searched official websites of the different NHPs, linked to the main website of the Ministry of Health and Family Welfare (MoHFW), in December 2020 and January 2021. NHP guideline documents with systematic review evidence were identified and information on the use of this evidence was extracted. We classified the identified systematic review evidence according to its use in the guideline documents and analysed the data to provide information on the different factors and patterns linked to the use of systematic review evidence in these documents. Systematic reviews were mostly visible in guideline documents addressing maternal and newborn health, communicable diseases and immunization. These systematic reviews were cited in the guidelines to justify the need for action, to justify recommendations for action and opportunities for local adaptation, and to highlight implementation challenges and justify implementation strategies. Guideline documents addressing implementation cited systematic reviews about the problems and policy options more often than citing systematic reviews about implementation. Systematic reviews were linked directly to support statements in few guideline documents, and sometimes the reviews were not appropriately cited. Most of the systematic reviews providing information on the nature and scale of the policy problem included Indian data. It was seen that since 2014, India has been increasingly using systematic review evidence for public health policymaking, particularly for some of its high-priority NHPs. This complements the increasing investment in research synthesis centres and procedures to support evidence-informed decision making, demonstrating the continued evolution of India's evidence policy system.

Elements of the educational policy model in schools (a systematic review)

Educational policymaking is a kind of public policy that is done in order to achieve the goals of the educational system in fields areas such as education and students' health. The purpose of this study was to determine the components of educational policymaking model in education. The method of the present study is systematic review. This is done using the SPIDER framework. The statistical population of the study included all related Persian and English articles published in the years 2010-2021 consisting of 98 articles that are indexed in ScienceDirect, Sage, Springer, Wiley, Eric, and PMC English language databases and SID, Irandoc, and Magiran Persian language databases. The research sample included 52 articles selected in the article screening stage. The number of Persian language references was 12 and English language references was 40. Sterberg thematic analysis was used for coding the selected texts of articles. Results of coding the selected texts of the articles showed that the components of the educational policymaking model are included in 11 themes: quiddity of policy and public policy, educational policy's necessity, quiddity of educational policy, process of educational policy, consequences, factors, obstacles, stakeholders, evaluation criteria, and change in educational policies. Paying attention to all the dimensions and factors interacting in educational policy can lead to better education and improve the quality of education in all dimensions, especially in the field of health education.

Engaging stakeholders to identify gaps and develop strategies to inform evidence use for health policymaking in Nigeria

Introduction

recent efforts to bridge the evidence-policy gap in low-and middle-income countries have seen growing interest from key audiences such as government, civil society, international organizations, private sector players, academia, and media. One of such engagement was a two-day virtual participant-driven conference (the convening) in Nigeria. The aim of the convening was to develop strategies for improving evidence use in health policy. The convening witnessed a participant blend of health policymakers, researchers, political policymakers, philanthropists, global health practitioners, program officers, students, and the media.

Methods

in this study, we analyzed conversations at the convening with the aim to disseminate findings to key stakeholders in Nigeria. The recordings from the convening were transcribed and analyzed inductively to identify emerging themes, which were interpreted, and inferences are drawn.

Results

a total of 630 people attended the convening. Participants joined from 13 countries. Participants identified poor collaboration between researchers and policymakers, poor community involvement in research and policy processes, poor funding for research, and inequalities as key factors inhibiting the use of evidence for policymaking in Nigeria. Strategies proposed to address these challenges include the use of participatory and embedded research methods, leveraging existing systems and networks, advocating for improved funding and ownership for research, and the use of context-sensitive knowledge translation strategies.

Conclusion

overall, better interaction among the various stakeholders will improve the evidence generation, translation, and use in Nigeria. A road map for the dissemination of findings from this conference has been developed for implementation across the strata of the health system.

Policy space and pro-health equity national policymaking: a case study of Myanmar during political transition (2006-16)

Health equity is central to achieving sustainable development goals and COVID-19 has emphasized its importance. Ensuring health equity is prominent in policy discussions and decision-making is a critical challenge in all countries. Understanding the policy space for actors to promote health equity in the policy process may help to strengthen prioritization of equity in policy and programme discussions and decisions. Authors developed a conceptual framework for policy space based on a narrative literature review. This comprised five key elements and their associated factors, i.e. context, policy circumstances, policy characteristics, actor engagement and policy spaces. Authors then applied it in Myanmar during a period of political transition, using a qualitative case study design. Findings showed that political transition provided an important 'policy window' to develop more equitable health policy in Myanmar. Changing policy circumstances offered opportunities for advancing pro-equity policy. However, lack of visibility of health equity and long-standing inequalities were important challenges to policy space. Within a changing context, actors at individual and organizational levels used a range of policy spaces to advance pro-equity health policy. Learning from using the framework in Myanmar was incorporated into a revised framework. Application of this revised framework could provide valuable insights into the opportunities to promote a pro-health equity approach across policy and programme discussions and decision-making for actors trying to promote equity in other transition and non-transition contexts.

Do tax policies discriminate against female traders? A gender framework to study informal marketplaces in Nigeria

Scholars have long debated formalizing the informal sector through taxation, but how do these processes affect gender inequalities? Our study in Nigerian markets contributes a gender framework to the equitable taxation literature on formalization. The study draws on a survey of 451 traders in 12 markets, key informant interviews, and ethnographic research in four markets of two states. We find that in at least two situations taxation policies discriminated against women implicitly: (1) male tax collectors had higher incidences of harassment on all traders and (2) taxing traders with flat taxes penalized women, as they earned less than men but were taxed the same.

A time-motion study of the COVID-19 vaccination process in an urban primary health center of Odisha, India

Vaccination is a critical tool in protecting against COVID-19. It is essential to know the time for each activity in a COVID-19 vaccination process for better management, especially during a pandemic. Thus, we conducted a time-motion study to identify activities that led to delayed/increased waiting time in an urban primary health center in Bhubaneswar, India. We observed 196 COVID-19 vaccine beneficiaries over one month (June 2021) from when they arrived at the vaccination center until they left the center. A data collection form and a Stopwatch were used to estimate the time taken for various activities involved in COVID-19 vaccine delivery. The time taken was expressed in mean and median. We also compared the time taken during the first and second doses using the Mann-Whitney U test. The total mean time spent at the vaccination center was 40:56 ± 20:52 minutes. The activity that took the longest was 'waiting time in queue before vaccination', which was 34:22 ± 20:56 min constituting 82% of the total time. The activity that took longer for the second dose than the first was the beneficiary verification in the Co-WIN portal with a median of 27 seconds and 36 seconds, respectively (p < .001). This study will help program managers formulate better strategies to improve the vaccination process making it more efficient.

A Systematic Review of Physical Activity Intervention Programs in ASEAN Countries: Efficacy and Future Directions

A systematic review was conducted on the efficacy of interventions to improve physical activity. PubMed, Scopus and Web of Science were scanned for eligible studies published from 1978 to August 2021, resulting in a total of 52 relevant studies for review. The Downs and Black checklist was used as a quality assessment ool for a risk of bias assessment. The 52 studies were then broadly categorised into three major approach types: informational, behavioural and/or social, as well as direct. Within each major approach, studies were further sub-categorised into more specific intervention types before being assessed for their efficacy and applicability. Overall, the intervention types that seemed to be the most efficacious in increasing physical activity levels were those that involved home-based information provision, community-wide campaigns, incentivised change, individually adapted health behaviour programs, family-based social support interventions and the provision of self-monitoring tools. However, the results must be interpreted holistically, as many of the successful interventions included more than one approach type and success is likely contingent on effectively addressing several concurrent facets. The systematic review is registered on PROSPERO. Registration number: 282752.

Policy and political perceptions of risk: the challenges to building resilient energy systems

Decisions relating to energy systems resilience must take into account a range of environmental and societal transitions together with an array of future threats. These must be assessed broadly and systematically but also must consider how risks and vulnerabilities are linked, and that small events can cascade across a system and between systems to escalate into large-scale collapse. Developing resilience involves not only identifying such threats and potential points of failure but acting upon them with an appropriate level of future planning. Decision-making in complex systems is often affected by cognitive biases and runs into contestation and obstacles of politics, policy complexities and differing views of potential futures. This paper discusses the challenges to building resilient systems for the future, given the inevitable biases and differing risk perspectives of decision-makers at all levels that often confound expert analysis. This article is part of the theme issue 'Developing resilient energy systems'.

Phylogenetics of Historical Host Switches in a Bacterial Plant Pathogen

Xylella fastidiosa is an insect-transmitted bacterial plant pathogen found across the Americas and, more recently, worldwide. X. fastidiosa infects plants of at least 563 species belonging to 82 botanical families. While the species X. fastidiosa infects many plants, particular strains have increased plant specificity. Understanding the molecular underpinnings of plant host specificity in X. fastidiosa is vital for predicting host shifts and epidemics. While there may exist multiple genetic determinants of host range in X. fastidiosa, the drivers of the unique relationships between X. fastidiosa and its hosts should be elucidated. Our objective with this study was to predict the ancestral plant hosts of this pathogen using phylogenetic and genomic methods based on a large data set of pathogen whole-genome data from agricultural hosts. We used genomic data to construct maximum-likelihood (ML) phylogenetic trees of subsets of the core and pan-genomes. With those trees, we ran ML ancestral state reconstructions of plant host at two taxonomic scales (genus and multiorder clades). Both the core and pan-genomes were informative in terms of predicting ancestral host state, giving new insight into the history of the plant hosts of X. fastidiosa. Subsequently, gene gain and loss in the pan-genome were found to be significantly correlated with plant host through genes that had statistically significant associations with particular hosts. IMPORTANCE Xylella fastidiosa is a globally important bacterial plant pathogen with many hosts; however, the underpinnings of host specificity are not known. This paper contains important findings about the usage of phylogenetics to understand the history of host specificity in this bacterial species, as well as convergent evolution in the pan-genome. There are strong signals of historical host range that give us insights into the history of this pathogen and its various invasions. The data from this paper are relevant in making decisions for quarantine and eradication, as they show the historical trends of host switching, which can help us predict likely future host shifts. We also demonstrate that using multilocus sequence type (MLST) genes in this system, which is still a commonly used process for policymaking, does not reconstruct the same phylogenetic topology as whole-genome data.

The success of Australia's 'No Jab, No Pay' policy at a local level; retrospective clinical audit of a single medical practice assessing incidence of catch-up vaccinations

Vaccination is a vital health care initiative to prevent individual and population infection. To increase vaccination rates the federal government implemented the 'No Jab, No Pay' policy, where eligibility for several government benefits required children to be fully vaccinated by removing 'conscientious objections' and expanding the age range of children whose families receive benefits. This study assesses the impact of this policy at a local area within a single medical practice community in NSW, Australia. A retrospective clinical audit was performed between 2012 and 2017 on a single general practice's vaccination records for children ≤19 years. Catch-up vaccinations were assessed based on age at vaccination. Incidence of catch-up vaccinations was assessed for each of four years before and two years after the implementation of the 'No Jab, No Pay' policy in January 2016, along with the age of children and vaccination(s) given. Catch-up vaccinations were assessed temporally either side of implementation of 'No Jab, No Pay'. Comparing the average annual vaccination catch-up incidence rate of 6.2% pre-implementation (2012-2015), there was an increase to 9.2% in 2016 (p < .001) and 7.8% in 2017 (p = .027). Secondary outcome measurement of catch-up vaccination incidence rates before (2012-2015) and after (2016-2017) 'No Jab, No Pay' implementation showed statistically significant increases for children aged 8-11 years (3.2%-5.6%, p = .038), 12-15 years (7.5%-14.7%, p < .001) and 16-19 years (3.3%-10.2%, p < .001) along with a statistically significant reduction in children aged 1-3 years (11.4%-6.2%, p = .015). Also, catch-up rates for DTPa significantly increased after program implementation. This study demonstrates that the Australian federal government vaccination policy 'No Jab, No Pay' was coincident with an increase in catch-up vaccinations within a rural NSW community served by one medical practice, especially for older children.

Speaking Truth to Power and Power to Truth: Reflections from the Pandemic

The complex relationship between science and politics has been a perennial issue in public administration. In this debate it is important to distinguish between ‘good’ and ‘bad’ politics, and between ‘good’ and ‘bad’ science. The Covid-19 pandemic has valorised the importance of science in shaping governmental responses, and has tended to contrast politics negatively with science. However, technocratic approaches to policymaking downplay the importance of politics in policymaking. Two case studies, of countries where there have been markedly different pandemic outcomes are used to illustrate the relationship between science and politics during this public health crisis – New Zealand and Brazil. In New Zealand there has been a positive and effective, if technocratic, relationship between science and politics, while in Brazil the relationship between the two domains has been fraught.

Predicting the Travel Distance of Patients to Access Healthcare Using Deep Neural Networks

OBJECTIVE

Improving geographical access remains a key issue in determining the sufficiency of regional medical resources during health policy design. However, patient choices can be the result of the complex interactivity of various factors. The aim of this study is to propose a deep neural network approach to model the complex decision of patient choice in travel distance to access care, which is an important indicator for policymaking in allocating resources.

METHOD

We used the 4-year nationwide insurance data of Taiwan and accumulated the possible features discussed in earlier literature. This study proposes the use of a convolutional neural network (CNN)-based framework to make predictions. The model performance was tested against other machine learning methods. The proposed framework was further interpreted using Integrated Gradients (IG) to analyze the feature weights.

RESULTS

We successfully demonstrated the effectiveness of using a CNN-based framework to predict the travel distance of patients, achieving an accuracy of 0.968, AUC of 0.969, sensitivity of 0.960, and specificity of 0.989. The CNN-based framework outperformed all other methods. In this research, the IG weights are potentially explainable; however, the relationship does not correspond to known indicators in public health.

CONCLUSIONS

Our results demonstrate the feasibility of the deep learning-based travel distance prediction model. It has the potential to guide policymaking in resource allocation. Clinical and Translational Impact Statement- Deep learning technology is feasible in investigating the distance that patients would travel while accessing care. It is a tool that integrates complex interactive variables with highly imbalanced data distributions.

E-learning readiness and perceived stress among the university students of Bangladesh during COVID-19: a countrywide cross-sectional study

BACKGROUND

The COVID-19 pandemic has compelled all educational institutions from the conventional campus-based education system to e-learning worldwide. However, adapting to this new platform, e-learning readiness may cause perceived stress among students. This study aimed to examine the association between e-learning readiness and perceived e-learning stress and the relationship between sociodemographic and e-learning related factors.

RESULTS

A cross-sectional study was employed, where 1145 e-learning enrolled university students were surveyed. The result indicated that nearly 91% of students reported moderate (76.07%) to the higher level (14.85%) of perceived e-learning stress, whereas more than half of them (58.17%) were at the sub-optimum level of readiness. Furthermore, it was found that students with the sub-optimum level of readiness compared to optimum had a significantly higher chance of reporting moderate and high level of perceived e-learning stress. Besides, parents' highest education, residence, students' preference in (e-learning or learning format), and having any eye problems were associated with perceived e-learning stress.

CONCLUSIONS

A sudden introduction of e-learning during the COVID-19 catastrophe has brought about challenges, including the students' readiness, that might exacerbate the perceived stress level in different ways. This study reported that most of the students were at sub-optimal levels of readiness and suffered from moderate to high levels of perceived e-learning stress. The findings should integrate into the education monitoring system to enhance students' coping strategies, incite readiness, straighten, and nourish existing policies.Key messagesThe moderate and higher level of e-learning stress was 76% and 15%, respectively.Here, 58% of students were at the sub-optimum level of e-learning readiness.Students' sub-optimum level of e-learning readiness was significantly associated with the perceived moderate and high level of e-learning stress.

The Populations' Resilience Toward the Policymaking Discrepancies in the Pandemic Covid-19 Period

The world is in the midst of a crisis unlike any other in recent memory. COVID-19 is a pandemic that is urgent, global in scope, and has huge consequences. The policy sciences provide insights into unfolding trends, and this article uses the lessons of the literature to better understanding the policymaking shifts and population acceptability of COVID-19. The author attempts to investigate how policymakers' emotions and narratives affect policy decisions and form policymaker-population relationships. The author addresses policymaking processes, transitions, interpretations of policy responses, policy implementation through multilateral topics and evaluating policy progress and failure. Trust is linked to cultural norms, values, and faiths in policy literature, and it is seen as a component of key social and economic policy outcomes. The author ends by identifying understudied facets of policymaking that need to be addressed during pandemics.

Effective factors on establishment of knowledge translation in the health system policy-making: A protocol for systematic review

Despite the importance and position of evidence-based policymaking in the proper management of the health system, studies show that the lack or improper and untimely use of evidence are still one of the main challenges of health systems. Knowledge translation as a solution to this challenge is a process that includes a period of time that starts of decision to choose the research topic and continue to publish of research results, in which the interaction of the researchers and stakeholders is the key factor and the main axis of the process. Since the recognition and promotion of knowledge translation processes resulting from research in health system policy-making will lead to the improvement of the health system, this review protocol was designed to identify factors affecting knowledge translation implementation, including barriers and facilitators of this process. Identifying these factors can be used as a guide for health system decision-makers and research managers in planning to select appropriate policies for deployment of the knowledge translation process to increase the use of research results in the health system.

Review of Methods of Studying Collective Intelligence in Policymaking

The domain of policymaking, which used to be limited to small groups of specialists, is now increasingly opening up to the participation of wide collectives, which are not only influencing government decisions, but also enhancing citizen engagement and transparency, improving service delivery and gathering the distributed wisdom of diverse participants. Although collective intelligence has become a more common approach to policymaking, the studies on this subject have not been conducted in a systematic way. Nevertheless, we hypothesized that methods and strategies specific to different types of studies in this field could be identified and analyzed. Based on a systematic literature review, as well as qualitative and statistical analyses, we identified 15 methods and revealed the dependencies between them. The review indicated the most popular approaches, and the underrepresented ones that can inspire future research.

Recommendations for school-going students post CoVid-19 in Bangladesh

The CoVid-19 pandemic caused by SARS-CoV-2 has taken more lives than any other pandemic so far, with non-pharmacological interventions such as lockdown, school closures, and travel bans, especially social distance, abounding around the world. With limited resources, these interventions pose the ultimate challenge to the education system in developing countries like Bangladesh, especially in providing uninterrupted education for all children in rural areas, where a significant number of students are enrolled in this area. However, the initiative to close schools for an extended period has affected children physically, emotionally, socially, and in various ways. Noteworthy, it demands to reopen to protect the future of children. Schools have reopened in many countries around the world. It is of interest to document recommendations for school-going students post CoVid-19 in Bangladesh using evidence-based data, information, and knowledge. We document such data in the context of Bangladesh to take such policy initiatives.

Stakeholders' participation in environmental regulation: A case study of the sectoral agreement of packaging reverse logistics in Brazil

This paper discusses the role of stakeholders' participation in decision-making of waste policies, exploring the case of the sectoral agreement (SA) of packaging in Brazil. This case represents a robust step to introduce circular economy for packaging in Brazil and Latin America. Since the enactment of the Brazilian National Solid Waste Policy in 2010, a series of agreements were created to introduce an alternative model of extended producer responsibility in the country. This historical analysis evaluates the decision-making and the outcomes of its participatory process. Three qualitative research methods were applied: 76 interviews with stakeholders at the three levels of governance; observation of five events during the negotiation process and analysis of government documents. The results show that stakeholders' participation was crucial throughout the policy design, contributing directly and indirectly to the outcomes of the SA, with knowledge exchange, creation of networks and by pressuring solid waste management issue onto the government's agenda. However, the participatory process is not straightforward, and during the agreement process, some advancements seem to be jeopardised, with risk of participation being exploited to legitimise political interests. At the end, research points out that participation needs to be promoted and expanded throughout all the stages of the policy cycle, bringing together also other stakeholders such as local governments and civil society.

Engaging Ethicists in Animal Research Policymaking

The significance of ethical considerations for animal research policy has long been acknowledged, but the role of philosophical ethics in the policymaking process has been less clear. By comparing the ethical framework of animal research policy with that for human subjects research, this article considers how the legacies of these two policy areas influence current policy and suggests that ethicists and ethical scholarship have been underutilized in developing animal research policy. An important aspect of policymaking is gathering and responding to input provided by various stakeholders. Given their expertise in a highly relevant area, ethicists should be considered key stakeholders in animal research policy deliberations. This article explores the role of ethicists and ethical scholarship in influencing animal research policy and suggests that a more robust engagement with the professional ethics community throughout the deliberative process is vital for policymakers to adequately account for ethical considerations.

HIV/AIDS policy-making in Iran: A stakeholder analysis

INTRODUCTION

The present study aims to identify and analyze HIV/AIDS stakeholders in Iran.

METHODS

This qualitative stakeholder analysis was conducted in 2018 nationwide, both retrospectively and prospectively. Purposive sampling was applied and followed by snowball sampling until data saturation. Data were analyzed using framework analysis. Also, MAXQDA (Version 11) and Policy Maker software (version 4) was applied.

FINDINGS

A total of 44 stakeholders were identified and categorized into 23 active and 21 inactive stakeholders. The Ministry of Education and Iran Broadcasting have moderate participation in this regard. Supreme Council of Health and NGOs have low participation. The Ministry of Health (MoH), State Welfare Organization, Blood Transfusion Organization, and the State Prisons are interested in HIV/AIDS policymaking. The MoH is the main body responsible for the stewardship of HIV/AIDS in Iran but does not have enough authority to handle the issue.

CONCLUSION

Considering multidimensional nature of HIV/AIDS, there are many stakeholders regarding HIV/AIDS control. The process of HIV/AIDS -policy making is fragmented in Iran. Despite multiple active and potential stakeholders in this field, there is no integrated system to involve all stakeholders in the process of HIV/AIDS policy-making. Therefore, given the importance of the issue, an upstream entity is needed to coordinate and mobilize all stakeholders associated with managing and controlling HIV/AIDS.

Thematic analysis of the policies of Iran's health higher education

BACKGROUND

In 1985, the Iranian parliament approved the integration of Medical Education and Health Services and the establishment of the Ministry of Health and Medical Education, which has since been the policymaker of Health Higher Education in Iran. The policies are not based on a codified framework and many were abolished at some point. Some critical issues are not addressed and some activities overlap. The purpose of the present study was to identify the content themes of core policies in the Iranian Health Higher Education system and provide a detailed policy orientation taxonomy.

MATERIALS AND METHODS

This qualitative study was conducted in 2019 using the thematic content analysis of documents relevant to Higher Education and Health Higher Education, including upstream documents, and documents and enactments of the Deputy Minister of Education and its policy centers.

RESULTS

From 586 policy documents, six main themes or six core policy orientations in the Health Higher Education System were identified, including Development of Medical Education System Policies; Ensuring the Alignment of Operations with Policies; Policies Related to Medical Education Development; Value-orientation; Networking and Development of Medical Education System Interactions; and the Development of Research, Management, and Translation of Medical Education knowledge.

CONCLUSION

Developing a taxonomy of Health Higher Education policy orientations helps policymakers identify the neglected and overstressed areas. It can provide education policymakers with categorized and comprehensive information to quickly access accurate information, make informed decisions, avoid mistakes, and increase productivity.

The Significance of Enabling Human Consideration in Policymaking: How to Get the E-Ferry That You Want

There is broad agreement in literature and policy that the transport sector needs to maximise electric mobility, in order to lower both energy consumption and greenhouse gas emissions. This ongoing transformation continues to require a high degree of technological innovation. Consequently, policymakers are striving to reward innovation in procurement tender contracts, in order to achieve sustainable innovation. At the same time, such contracts are often designed with a principle of technology neutrality in mind, to prevent any distortion of the market logic. This article suggests that it is misguided to try to perfect the logic of the tender system and that articulating contract that rewards innovation is no guarantee of a sustainable solution. Rather than being technological, the problem should be seen as moral: the mounting environmental challenge. Policymakers thus have clear ideas about the action needed based on what they, through moral conviction, consider to be appropriate action. This case study-conducted as a part of the EU H2020-funded ECHOES Project under Work Package 6-on the electrification of the Flakk-Rørvik ferry connexion reveals how policymakers were able to achieve the intended results: in this case, an e-ferry rather than a biodiesel ferry, in spite of, rather than because of, the tender system logic. They achieved this by involving stakeholders in the process with a continuous and uninterrupted dialogue. The project stakeholders were able to intervene in the tender system logic in favour of human considerations. We argue that this project was a success because human judgement, not system logic, was the driving force. By extension, we argue that systems will only allow policymakers to pursue moral issues to the degree that they allow human intervention.

Policy dialogue to support maternal newborn child health evidence use in policymaking: The lessons learnt from the Nigeria research days first edition

The use of evidence in decision-making and practice can be improved through diverse interventions, including policy dialogue. The Department of Family Health, Federal Ministry of Health of Nigeria initiated and organized the Nigeria Research Days (NRD), to serve as a platform for exchange between researchers and policymakers for improving maternal, new-born and child health. The study reports on the conceptualization, organization and lessons learned from the first edition. A cross-sectional study was designed to assess the effectiveness of a policy dialogue during the NRDs. Data were collected from the feasibility and workshop evaluation surveys. A descriptive analysis of data was performed. As a result, the Nigeria Research Days meets all the criteria for a successful policy dialogue. The participants positively rated the content and format of the meeting and made suggestions for improvement. They were willing to implement the recommendations of the final communiqué. The lessons learned from this first edition will be used to improve future editions.

Governing Personalized Health: A Scoping Review

Genetic research is advancing rapidly. One important area for the application of the results from this work is personalized health. These are treatments and preventive interventions tailored to the genetic profile of specific groups or individuals. The inclusion of personalized health in existing health systems is a challenge for policymakers. In this article, we present the results of a thematic scoping review of the literature dealing with governance and policy of personalized health. Our analysis points to four governance challenges that decisionmakers face against the background of personalized health. First, researchers have highlighted the need to further extend and harmonize existing research infrastructures in order to combine different types of genetic data. Second, decisionmakers face the challenge to create trust in personalized health applications, such as genetic tests. Third, scholars have pointed to the importance of the regulation of data production and sharing to avoid discrimination of disadvantaged groups and to facilitate collaboration. Fourth, researchers have discussed the challenge to integrate personalized health into regulatory-, financing-, and service provision structures of existing health systems. Our findings summarize existing research and help to guide further policymaking and research in the field of personalized health governance.

The Experience of Greece as a Model to Contain COVID-19 Infection Spread

The severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) emerged in late 2019 and has caused a pandemic known as corona virus disease 2019 (COVID-19), responsible for the death of more than 2 million people worldwide. The outbreak of COVID-19 has posed an unprecedented threat on human lives and public safety. The aim of this review is to describe key aspects of the bio-pathology of the novel disease, and discuss aspects of its spread, as well as targeted protective strategies that can help shape the outcome of the present and future health crises. Greece is used as a model to inhibit SARS-COV-2 spread, since it is one of the countries with the lowest fatality rates among nations of the European Union (E.U.), following two consecutive waves of COVID-19 pandemic. Furthermore, niche research technological approaches and scientific recommendations that emerged during the COVID-19 era are discussed.

Is Obesity Policy in England Fit for Purpose? Analysis of Government Strategies and Policies, 1992-2020

Policy Points This analysis finds that government obesity policies in England have largely been proposed in a way that does not readily lead to implementation; that governments rarely commission evaluations of previous government strategies or learn from policy failures; that governments have tended to adopt less interventionist policy approaches; and that policies largely make high demands on individual agency, meaning they rely on individuals to make behavior changes rather than shaping external influences and are thus less likely to be effective or equitable. These findings may help explain why after 30 years of proposed government obesity policies, obesity prevalence and health inequities still have not been successfully reduced. If policymakers address the issues identified in this analysis, population obesity could be tackled more successfully, which has added urgency given the COVID-19 pandemic.

CONTEXT

In England, the majority of adults, and more than a quarter of children aged 2 to 15 years live with obesity or excess weight. From 1992 to 2020, even though the government published 14 obesity strategies in England, the prevalence of obesity has not been reduced. We aimed to determine whether such government strategies and policies have been fit for purpose regarding their strategic focus, nature, basis in theory and evidence, and implementation viability.

METHOD

We undertook a mixed-methods study, involving a document review and analysis of government strategies either wholly or partially dedicated to tackling obesity in England. We developed a theory-based analytical framework, using content analysis and applied thematic analysis (ATA) to code all policies. Our interpretation drew on quantitative findings and thematic analysis.

FINDINGS

We identified and analyzed 14 government strategies published from 1992 to 2020 containing 689 wide-ranging policies. Policies were largely proposed in a way that would be unlikely to lead to implementation; the majority were not interventionist and made high demands on individual agency, meaning that they relied on individuals to make behavior changes rather than shaping external influences, and are thus less likely to be effective or to reduce health inequalities.

CONCLUSIONS

The government obesity strategies' failure to reduce the prevalence of obesity in England for almost 30 years may be due to weaknesses in the policies' design, leading to a lack of effectiveness, but they may also be due to failures of implementation and evaluation. These failures appear to have led to insufficient or no policy learning and governments proposing similar or identical policies repeatedly over many years. Governments should learn from their earlier policy failures. They should prioritize policies that make minimal demands on individuals and have the potential for population-wide reach so as to maximize their potential for equitable impacts. Policies should be proposed in ways that readily lead to implementation and evaluation.

The Weight of Words: Co-Analysis of Thick Ethnographic Description and "Friction" as Methodological Strategies in a Health Policy Research Partnership

Co-production partnerships between policymakers, practitioners, and researchers are designed to facilitate production of relevant and readily usable research in health policy and practice contexts. We describe methodological strategies for in-depth collaborative analysis based on a co-produced ethnography of health promotion practice, involving ethnographic researchers and government-based research partners. We draw on a co-production dialogue to reflect critically on the role and value of co-analyzing research findings using thick ethnographic descriptions. The ambiguity of ethnographic imagery allowed flexibility in interpretation of findings and also generated friction. Specific ethnographic images became focal points for productive friction that crystallized ethical and analytical imperatives underpinning the diverse expertise in the team. To make the most of co-analysis of thick ethnographic descriptions, we assert that friction points must be reflexively considered as key learning opportunities for (a) higher order analysis informed by diverse analytical perspectives and (b) more cohesive and useful interpretations of research findings.

Lessons Learned from Strategies for Promotion of Evidence-to-Policy Process in Health Interventions in the ECOWAS Region: A Rapid Review

Context:

The West African Health Organization (WAHO) is vigorously supporting evidence-informed policymaking (EIPM) in the countries of West Africa. EIPM is increasingly recognized as one of the key strategies that can contribute to health systems strengthening and the improvement of health outcomes. The purpose of this rapid review is to examine two key examples of evidence-based strategies used to successfully implement health interventions in each of the West African countries and to highlight the lessons learned.

Methods:

A rapid review technique, defined as a type of knowledge synthesis in which systematic review processes are accelerated and methods are streamlined to complete the review more quickly, was used. A PubMed search was conducted using the combination of the following keywords: Health, policy making, evidence, plus name of each of the 15 countries to identify studies that described the process of use of evidence in policymaking in health interventions. Two examples of the publications that fulfilled the study inclusion criteria were selected.

Results:

Among the key processes used by the countries to promote EIPM in health interventions include policy cycle mechanism and political prioritization, rapid response services, technical advisory group and steering committees (SCs), policy dialog, capacity-strengthening mechanisms, local context evidence and operational guidelines, multisectoral action and consultative process.

Conclusion:

Various degrees of success have been achieved in by West African countries in the promotion of EIPM. As the science of EIPM continues to evolve and better understanding of the process is gained among policymakers, more studies on effective strategies to improve the evidence-to-policy process are advocated.

Political Discourse and Aging in a Neoliberal Singapore: Models of Citizenship, Older Adults and Policy Initiatives

Singapore now faces one of the fastest aging populations in the world, leading the country's political leaders to fear the implications of population aging for the country's economic viability. We analyzed National Day Rally speeches from 2011 to 2015 by Prime Minister Lee Hsien Loong to examine how policymakers conceptualized the challenges related to its aging population. Findings point to the government's manifest and latent emphasis on its economic viability when developing social policies to address the well-being of its aging population. Its approaches to welfare provision are informed by a neoliberalist agenda that requires its citizens to exercise personal responsibility and self-reliance, and to rely on their family and community for mutual assistance. Despite its highly interventionist approach, the government is clear about its residual role in the provision of safety nets. A neoliberalist reconceptualization of citizenship serves to restrict older citizen's claims to basic social assistance.

Health information technology foresight for Iran: A Delphi study of experts' views to inform future policymaking

BACKGROUND

Policymakers require a systematic approach when planning for information technology needs in healthcare.

OBJECTIVE

The aim of this study was to obtain experts' predictions of future health information technology (HIT) needs until 2025 for Iran in relation to the relative importance of key technologies, expected timeframe of realisation, areas that may be impacted upon and obstacles to achieving these goals.

METHOD

This article presents results from the third phase (a Delphi study) of a larger mixed-method study. Policymakers from the Iranian Ministry of Health and faculty members from different medical universities across the country who were expert in the field of HIT were invited to participate (n = 61).

RESULTS

Participants (39) completed the first-round questionnaire and 24 completed the second. The development of personal health records (n = 32, 82.0%), the development of clinical decision-making systems (n = 30, 76.9%) and the use of business intelligence for collecting and analysing clinical and financial data (n = 32, 82.0%) were predicted to occur after 2025. The healthcare areas predicted to experience the greatest impact from most HITs were facilitating patient-provider communication and improving healthcare quality. Key barriers to achieving HITs were related to weaknesses in planning and limited financial resources for most technologies.

CONCLUSION

By identifying the areas of impact and the barriers to achieving the HIT goals, more accurate planning is possible and resources can be allocated according to priorities.

From "Honeymoon Period" to "Stable Marriage": The Rise of Management Consultants in British Health Policymaking

Since the creation of the National Health Service in 1948, different groups of experts have competed to inform the development of British health policy. This article analyzes the long-term rise of one of these groups-management consultants. The scale and regularity of their engagement has increased considerably over time, strikingly in recent years, and the functions fulfilled by consultants have become ever more diverse. At important moments they were often seen by policymakers-particularly when there was understood to be a lack of internal expertise-as possessors and imparters of important knowledge. Firms and individuals worked consciously to integrate themselves into emerging health policy networks. But there has often been relatively little consideration of their real suitability for work in the health field. Many debates around the use of external consultants today-accountability, value for money, dependency-were foreshadowed during earlier periods, with implications for current policymakers.

Underlying Principles of a Covid-19 Behavioral Vaccine for a Sustainable Cultural Change

Until pharmacological measures are effective at containing the COVID-19 outbreak, adopting protective behaviors is paramount. In this work, we aim at informing interventions to limit the spread of the contagion and prepare against any future outbreaks by developing a behavioral framework to interpret and prescribe both the individual and large-scale uptake of non-pharmaceutical measures. First, we analyze the barriers and facilitators to adherence to protective behaviors according to a three-term contingency by exploring potential gaps in terms of setting stimuli, motivating operations, delayed consequences, and positive or negative consequences. We explore their roles in the likelihood of individual compliance to protective behaviors, taking physical distancing as an example of functional analysis. Second, we interpret contagion control as the cumulative effect of large-scale adherence to protective behaviors. We explore the interrelations between societal problems caused or amplified by similar behaviors presented by many individuals and the coordination of agents or agencies aiming at promoting large-scale behavioral change. Then, we highlight the potential of developing a behavioral vaccine, and practical steps for applying it to promote sustainable cultural change that may protect against health, social, and economic losses in future outbreaks.