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Fischer T, Mauer N, Tille F. A Framework for Studying EU Health Policy through a Political Determinants of Health Lens: The Case of the European Health Union. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2024; 49:691-720. [PMID: 38567767 DOI: 10.1215/03616878-11257056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
CONTEXT The COVID-19 pandemic has highlighted how the European Union (EU) impacts national health systems and people's health. In November 2020, the European Commission launched the European Health Union (EHU) to better coordinate and maximize EU member states' abilities to deal with cross-border health threats. This article scrutinizes the early institutionalization of the EHU and its implications for EU health policy as a political determinant of health (PDoH). METHODS The article explores how EU health policy may be appreciated from a PDoH perspective. It draws from EU documents and existing research to analyze the early-stage institutionalization of the EHU. The study complements this policy output-focused perspective with an outcome-based exploratory assessment of EU health policy as a PDoH focusing on three examples: joint vaccine procurement, health reforms and investments under the Recovery and Resilience Facility, and the development of a European Health Data Space. FINDINGS The article shows that the policy change triggered by the EHU and the potential impact on citizens' health are not necessarily congruent. Modest change can have a potentially strong impact on health outcomes and vice versa. CONCLUSIONS The article argues that the PDoH perspective provides a useful approach that is complementary to policy output-based perspectives, allowing for a more comprehensive assessment of the EU's role in health.
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Affiliation(s)
| | - Nicole Mauer
- European Observatory on Health Systems and Policies
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Mberu B, Simiyu S, Gutema FD, Sewell D, Busienei PJ, Tumwebaze IK, Baker KK. Landscape analysis of the Kenyan policy on the treatment and prevention of diarrheal disease among under-5 children. BMJ Open 2024; 14:e081906. [PMID: 39160109 PMCID: PMC11337661 DOI: 10.1136/bmjopen-2023-081906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 07/29/2024] [Indexed: 08/21/2024] Open
Abstract
OBJECTIVE Diarrhoea remains a leading cause of morbidity and death among under-5 children in Kenya, despite multipronged policy and programme initiatives to increase access to treatment. This study interrogates the comprehensiveness and adequacy of Kenya's policies, frameworks and action plans for diarrheal management and prevention. The study seeks to identify policy and practice gaps that need to be filled to strengthen diarrhoea treatment and prevention among under-5 children in Kenya. DESIGN Our study is a landscape analysis, which seeks to identify the gaps in the current Kenya diarrheal policy, frameworks and action plans. The critical questions included their comprehensiveness, the availability of elaborate treatment, management and prevention solutions, together with updatedness, building on evidence from extant literature on key pathways to infection relating to man-animal environmental interaction, which are critical in enteric infection prevention initiatives. DATA SOURCES We conducted an internet search of databases of Government of Kenya's Ministry of Health; relevant websites/publications of international organisations and groups (Centre for Disease Control and Prevention, UNICEF and WHO) and published and grey literature (Google searches, Google Scholar and PubMed). ELIGIBILITY CRITERIA Included are publicly available key national diarrheal policy frameworks, plans, strategies, laws, institutional frameworks and operational guidelines that inform pertinent questions on the adequacy of policy and practice and preventive policy updates and actions. Further, peer-reviewed and grey literature on diarrheal morbidity and mortality and diarrheal prevention and management are included. The analysis excluded any information that was not referenced on the internet nor obtained from the internet. DATA EXTRACTION AND SYNTHESIS The review team extracted the key provisions of the policy guidelines guided by a checklist and questions around the adequacy of existing national policies in addressing the determinants, prevention and treatment interventions of enteric infections and diarrhoea among under-5 children in the country. The checklist covered Kenyan background and diarrhoea situation analysis, policy objectives, policy strategies and policy implementation. RESULTS The analysis identified a corpus of strategies for the management of diarrhoea at multiple levels: health facilities, communities and households. The policies highlighted advocacy, health communication and social mobilisation, as well as logistics management and prevention strategies. However, the triangulation of evidence from the policy provisions and extant literature identified critical policy gaps in diarrhoea prevention and management in Kenya, particularly the lack of focus on zoonotic pathways to enteric infection, environment-pathogen linkages and operationalisation of the roles of social determinants of health and related services. The policy documents had limited focus on rapid diagnosis, vaccine development and deployment, together with weak funding commitment towards implementation and unclear pathways to funding responsibilities. CONCLUSION Policies are central to guiding programmatic actions towards effective enteric and diarrhoea prevention and management measures in Kenya. This study shows the need for policy updates to reflect pathways to enteric infections not covered in the current policy guidelines. Further, there is a need to strengthen the treatment and management of infection through rapid diagnosis, vaccine development and deployment, and strong funding commitment towards implementation together with clear funding responsibilities. Together, these will be vital in strengthening the current policy provisions and addressing other pathways to the prevention of enteric infections relating to zoonotic, environment-pathogen linkages and social determinants of health in Kenya and other low-income and middle-income countries. TRIAL REGISTRATION NUMBER NCT05322655.
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Affiliation(s)
- Blessing Mberu
- Population Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya
- Demography and Population Studies, University of the Witwatersrand Johannesburg School of Social Sciences, Johannesburg, South Africa
| | - Sheillah Simiyu
- Population Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya
| | - Fanta D Gutema
- Department of Occupational and Environmental Health, The University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Daniel Sewell
- Department of Biostatistics, The University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Phylis J Busienei
- Population Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya
| | - Innocent K Tumwebaze
- Population Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya
| | - Kelly K Baker
- Department of Occupational and Environmental Health, The University of Iowa College of Public Health, Iowa City, Iowa, USA
- Center for Climate Change and Health Equity, University at Buffalo, Buffalo, New York, USA
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Talagala I, Abeysena C, Wickremasinghe R. Content analysis of policy documents related to non-communicable diseases prevention and control in Sri Lanka: a developing country in the South-East Asia. F1000Res 2024; 13:171. [PMID: 39211420 PMCID: PMC11358681 DOI: 10.12688/f1000research.144221.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 09/04/2024] Open
Abstract
Background Health policies form the foundation for provisioning best level care and are important for all stakeholders including patients and healthcare providers. Health policy analysis and evaluation allows policy makers to improve an existing policy, terminate a non-effective policy and to successfully implement future policies.The objective was to assess the coherence between the two local policy documents on NCD prevention and control in Sri Lanka, the national NCD policy (NCD policy) and the multisectoral action plan (MSAP), and to assess the consistency of MSAP with the global action plan for NCDs. Methods The content analysis of the NCD policy and MSAP of Sri Lanka was conducted based on the modified criteria developed to the 'Analysis of determinants of policy impact' model, by two reviewers independently. Coherence between MSAP and the global NCD action plan were also assessed by two reviewers independently. Consensus for discrepancy was achieved through discussion. Results Accessibility was the strongest criteria for the NCD policy, while, resources and obligations were the weakest. Goals and monitoring and evaluation criteria were the strongest in the MSAP. Requirement for improvement were identified in policy background, goals, monitoring and evaluation, and public opportunities for the NCD policy. Accessibility, policy background, resources, public opportunities and obligations require further improvement in the MSAP. The MSAP is well coherent with the global road map for NCD prevention and control. Conclusion Policy documents related to NCD prevention and control in Sri Lanka are coherent with the global action plan, while, there are areas within the local policy documents that need to be improved to enhance the coherence between the local documents. Lessons learnt by this activity need to be utilized by Sri Lanka and other countries to improve the uniformity between the NCD policy documents within the country as well as internationally.
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Affiliation(s)
- Ishanka Talagala
- Department of Community Medicine and Family Medicine, Faculty of Medicine, University of Moratuwa, Moratuwa, Sri Lanka
| | - Chrishantha Abeysena
- Post Graduate Institute of Indigenous Medicine, University of Colombo, Colombo, Sri Lanka
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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Natora AH, Oxley J, Barclay L, Taylor K, Bolam B, Haines TP. Improving Policy for the Prevention of Falls Among Community-Dwelling Older People-A Scoping Review and Quality Assessment of International National and State Level Public Policies. Int J Public Health 2022; 67:1604604. [PMID: 35832390 PMCID: PMC9272743 DOI: 10.3389/ijph.2022.1604604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 05/16/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives: Effective public policy to prevent falls among independent community-dwelling older adults is needed to address this global public health issue. This paper aimed to identify gaps and opportunities for improvement of future policies to increase their likelihood of success. Methods: A systematic scoping review was conducted to identify policies published between 2005-2020. Policy quality was assessed using a novel framework and content criteria adapted from the World Health Organization's guideline for Developing policies to prevent injuries and violence and the New Zealand Government's Policy Quality Framework. Results: A total of 107 articles were identified from 14 countries. Content evaluation of 25 policies revealed that only 54% of policies met the WHO criteria, and only 59% of policies met the NZ criteria. Areas for improvement included quantified objectives, prioritised interventions, budget, ministerial approval, and monitoring and evaluation. Conclusion: The findings suggest deficiencies in a substantial number of policies may contribute to a disconnect between policy intent and implementation. A clear and evidence-based model falls prevention policy is warranted to enhance future government efforts to reduce the global burden of falls.
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Affiliation(s)
- Aleksandra H. Natora
- Accident Research Centre, Monash University, Clayton, VIC, Australia
- Department of Health, State Government of Victoria, Melbourne, VIC, Australia
| | - Jennifer Oxley
- Accident Research Centre, Monash University, Clayton, VIC, Australia
| | - Linda Barclay
- Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing & Health Sciences, Monash University, Frankston, VIC, Australia
| | - Kelvin Taylor
- Accident Research Centre, Monash University, Clayton, VIC, Australia
| | - Bruce Bolam
- Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, VIC, Australia
| | - Terry P. Haines
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing & Health Sciences, Monash University, Frankston, VIC, Australia
- National Centre for Healthy Ageing, Faculty of Medicine, Nursing & Health Sciences, Monash University, Frankston, VIC, Australia
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Siagian RC, Ayuningtyas D, Soewondo P, Thabrany H, Achadi A, Bachtiar NS. Assessment of country readiness for drug development: A qualitative study in Indonesia. WORLD MEDICAL & HEALTH POLICY 2021. [DOI: 10.1002/wmh3.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Ria C. Siagian
- Biological Products Registration Badan Pengawas Obat dan Makanan Jakarta Indonesia
| | - Dumilah Ayuningtyas
- Department of Health Policy and Administration Faculty of Public Health Universitas Indonesia Depok Jawa Barat Indonesia
| | - Prastuti Soewondo
- Department of Health Policy and Administration Faculty of Public Health Universitas Indonesia Depok Jawa Barat Indonesia
| | - Hasbullah Thabrany
- Department of Health Policy and Administration Faculty of Public Health Universitas Indonesia Depok Jawa Barat Indonesia
| | - Anhari Achadi
- Department of Health Policy and Administration Faculty of Public Health Universitas Indonesia Depok Jawa Barat Indonesia
| | - Novilia S. Bachtiar
- Surveillance and Clinical Trial Division PT. Bio Farma Bandung West Java Indonesia
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Aligning Best Practices: A Guiding Framework as a Valuable Tool for Public Health Workforce Development with the Example of Ukraine. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179246. [PMID: 34501834 PMCID: PMC8431433 DOI: 10.3390/ijerph18179246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 11/25/2022]
Abstract
Background: At present, in Ukraine, there is an insufficient capacity for up-to-date surveillance of the health status of the general population; public health (PH) promotion and disease prevention activities are scarce. Additionally, there is an urgent need to ensure, develop and support an efficient public health workforce (PHW) and appropriately address existing health issues. Ukraine currently introduces PH system reforms in line with its current burden of disease, the epidemiological profile and the Essential Public Health Services (EPHOs). This analysis aims to propose a pragmatic framework to provide guidance and recommendations related to the development, support and planning of the PHW in Ukraine. Methods: We constructed a framework based on a previously published scoping review and analyzed various policy analysis approaches. In line with the recommendations found in the literature and the best practices used elsewhere, this method enabled the construction of a framework for facilitating successful PHW development. In addition, an expert workshop was held, serving as a reality check for identifying crucial areas of the PH system in Ukraine. Results: The proposed framework includes a country’s background, the evidence and available policy options, such as the health system (including core functions, organizational resources, regulations and norms), health system capacities (including human resources; PH capacity assessment; datasets and databases; forecasting strategies; licensing, accreditation and quality assurance) and capacity building (including PH education, training, core competencies and ethical and professional codes of conduct). To facilitate and support effective implementation of the framework, we propose (1) implementing strategies to facilitate changes in attitude, behavior and practices among the citizens; (2) implementing strategies to facilitate the necessary behavioral changes in the PHW; (3) implementing strategies to facilitate the necessary organizational and institutional changes; (4) implementing strategies to facilitate system changes and (5) identification of potential barriers and obstacles for the implementation of these strategies. Conclusion: The report highlights the practical tactics and best practices for providing suggestions for PHW support and planning. The employment of prominent analytical tools and procedures in policymaking processes suggests an effective strategy for PHW development in Ukraine.
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Bullock HL, Lavis JN, Wilson MG, Mulvale G, Miatello A. Understanding the implementation of evidence-informed policies and practices from a policy perspective: a critical interpretive synthesis. Implement Sci 2021. [PMID: 33588878 DOI: 10.1186/s13012‐021‐01082‐7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The fields of implementation science and knowledge translation have evolved somewhat independently from the field of policy implementation research, despite calls for better integration. As a result, implementation theory and empirical work do not often reflect the implementation experience from a policy lens nor benefit from the scholarship in all three fields. This means policymakers, researchers, and practitioners may find it challenging to draw from theory that adequately reflects their implementation efforts. METHODS We developed an integrated theoretical framework of the implementation process from a policy perspective by combining findings from these fields using the critical interpretive synthesis method. We began with the compass question: How is policy currently described in implementation theory and processes and what aspects of policy are important for implementation success? We then searched 12 databases as well as gray literature and supplemented these documents with other sources to fill conceptual gaps. Using a grounded and interpretive approach to analysis, we built the framework constructs, drawing largely from the theoretical literature and then tested and refined the framework using empirical literature. RESULTS A total of 11,434 documents were retrieved and assessed for eligibility and 35 additional documents were identified through other sources. Eighty-six unique documents were ultimately included in the analysis. Our findings indicate that policy is described as (1) the context, (2) a focusing lens, (3) the innovation itself, (4) a lever of influence, (5) an enabler/facilitator or barrier, or (6) an outcome. Policy actors were also identified as important participants or leaders of implementation. Our analysis led to the development of a two-part conceptual framework, including process and determinant components. CONCLUSIONS This framework begins to bridge the divide between disciplines and provides a new perspective about implementation processes at the systems level. It offers researchers, policymakers, and implementers a new way of thinking about implementation that better integrates policy considerations and can be used for planning or evaluating implementation efforts.
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Affiliation(s)
- Heather L Bullock
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada.
| | - John N Lavis
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada.,McMaster Health Forum, Hamilton, Canada
| | - Michael G Wilson
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada.,McMaster Health Forum, Hamilton, Canada
| | - Gillian Mulvale
- DeGroote School of Business, McMaster University, Burlington, Canada
| | - Ashleigh Miatello
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada
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Bullock HL, Lavis JN, Wilson MG, Mulvale G, Miatello A. Understanding the implementation of evidence-informed policies and practices from a policy perspective: a critical interpretive synthesis. Implement Sci 2021; 16:18. [PMID: 33588878 PMCID: PMC7885555 DOI: 10.1186/s13012-021-01082-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 01/07/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The fields of implementation science and knowledge translation have evolved somewhat independently from the field of policy implementation research, despite calls for better integration. As a result, implementation theory and empirical work do not often reflect the implementation experience from a policy lens nor benefit from the scholarship in all three fields. This means policymakers, researchers, and practitioners may find it challenging to draw from theory that adequately reflects their implementation efforts. METHODS We developed an integrated theoretical framework of the implementation process from a policy perspective by combining findings from these fields using the critical interpretive synthesis method. We began with the compass question: How is policy currently described in implementation theory and processes and what aspects of policy are important for implementation success? We then searched 12 databases as well as gray literature and supplemented these documents with other sources to fill conceptual gaps. Using a grounded and interpretive approach to analysis, we built the framework constructs, drawing largely from the theoretical literature and then tested and refined the framework using empirical literature. RESULTS A total of 11,434 documents were retrieved and assessed for eligibility and 35 additional documents were identified through other sources. Eighty-six unique documents were ultimately included in the analysis. Our findings indicate that policy is described as (1) the context, (2) a focusing lens, (3) the innovation itself, (4) a lever of influence, (5) an enabler/facilitator or barrier, or (6) an outcome. Policy actors were also identified as important participants or leaders of implementation. Our analysis led to the development of a two-part conceptual framework, including process and determinant components. CONCLUSIONS This framework begins to bridge the divide between disciplines and provides a new perspective about implementation processes at the systems level. It offers researchers, policymakers, and implementers a new way of thinking about implementation that better integrates policy considerations and can be used for planning or evaluating implementation efforts.
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Affiliation(s)
- Heather L Bullock
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada.
| | - John N Lavis
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada.,McMaster Health Forum, Hamilton, Canada
| | - Michael G Wilson
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada.,McMaster Health Forum, Hamilton, Canada
| | - Gillian Mulvale
- DeGroote School of Business, McMaster University, Burlington, Canada
| | - Ashleigh Miatello
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada
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A predictive policy model to forecast outcomes of drug development in developing countries. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2019. [DOI: 10.1108/ijhg-11-2018-0061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The World Health Organization has pointed out that the majority of developing countries currently rely on imported drugs, in spite of the fact that there is potential for them to produce their own drugs. The purpose of this paper is to present a framework as an innovation policy model that can strategically predict the outcome of drug development investment in developing countries.
Design/methodology/approach
In order to explore a model relevant to the policy-making process, the literature was systematically reviewed with a focus on the impact of policy changes on drug development in developing countries.
Findings
An innovation policy model consists of the relational influences of contextual variables of pharma capabilities, innovation incentives and political factors affecting drug development in developing countries, derived from a dissenting policy-making perspective. This was built to test two hypotheses of a positive relationship between the above variables; and a perspectives gap between the pharmaceutical companies and the policymakers. These hypotheses address issues related to the lack of drug development in developing countries.
Research limitations/implications
This paper presents a conceptual framework for the evaluation and provides examples of its use, but it is currently at a relatively early stage of research. Further work is currently underway and will later be presented to the same journal.
Social implications
Domestic drug development in developing countries needs to be feasible in order to ensure drug security. This predictive policy model provides a comprehensive approach to health policy reforms to examine innovation strategies.
Originality/value
This model includes measures to explore whether pharma capabilities, innovation incentives and/or political factors have an effect on domestic drug development in developing countries. It bridges the policy implementation’s operational process between pharmaceutical companies and policymakers.
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Mahimbo A, Seale H, Heywood AE. Immunisation for refugees in Australia: a policy review and analysis across all States and Territories. Aust N Z J Public Health 2017; 41:635-640. [PMID: 28898492 DOI: 10.1111/1753-6405.12710] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/01/2017] [Accepted: 06/01/2017] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Although people of refugee background are likely to be under-immunised before and after resettlement, no study to date has evaluated refugee specific immunisation policies in Australia. We developed a framework to analyse immunisation policies across Australia to highlight the strengths and gaps so as to inform development of more effective refugee specific immunisation policies. METHODS We sourced publicly available immunisation policy documents from state and territory government websites. Content analysis of seven policy documents was undertaken using a developed framework comprising crucial policy determinants. RESULTS Immunisation policy differed substantially across the jurisdictions. While most policies did not highlight the importance of data collection on immunisation for refugees and the public funding of vaccines for refugees, policy determinants such as accessibility and obligations were fulfilled by most jurisdictions. CONCLUSION Our findings indicate stark differences in immunisation policy for people of refugee background across Australia. Highlighted gaps demonstrate the need to revise current policies so that they are aligned with their intended outcome of enhancing uptake of vaccines and improving immunisation coverage among resettled refugees in Australia. Implications for public health: Immunisation policy development for refugees needs to be robust enough to ensure equitable health services to this group.
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Affiliation(s)
- Abela Mahimbo
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, New South Wales
| | - Holly Seale
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, New South Wales
| | - Anita E Heywood
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, New South Wales
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Rütten A, Gelius P. Building policy capacities: an interactive approach for linking knowledge to action in health promotion. Health Promot Int 2013; 29:569-82. [PMID: 23468466 DOI: 10.1093/heapro/dat006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This article outlines a theoretical framework for an interactive, research-driven approach to building policy capacities in health promotion. First, it illustrates how two important issues in the recent public health debate, capacity building and linking scientific knowledge to policy action, are connected to each other theoretically. It then introduces an international study on an interactive approach to capacity building in health promotion policy. The approach combines the ADEPT model of policy capacities with a co-operative planning process to foster the exchange of knowledge between policy-makers and researchers, thus improving intra- and inter-organizational capacities. A regional-level physical activity promotion project involving governmental and public-law institutions, NGOs and university researchers serves as a case study to illustrate the potential of the approach for capacity building. Analysis and comparison with a similar local-level project indicate that the approach provides an effective means of linking scientific knowledge to policy action and to planning concrete measures for capacity building in health promotion, but that it requires sufficiently long timelines and adequate resources to achieve adequate implementation and sustainability.
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Affiliation(s)
- Alfred Rütten
- Institute of Sport Science and Sport, University of Erlangen-Nürnberg, Gebbertstraβe 123b, 91058 Erlangen, Germany
| | - Peter Gelius
- Institute of Sport Science and Sport, University of Erlangen-Nürnberg, Gebbertstraβe 123b, 91058 Erlangen, Germany
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Rütten A. Evidence-based policy revisited: orientation towards the policy process and a public health policy science. Int J Public Health 2012; 57:455-7. [PMID: 22159625 DOI: 10.1007/s00038-011-0321-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Alfred Rütten
- Institute of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nuremberg, Gebberstr. 123b, 91058, Erlangen, Germany.
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Rütten A, Abu-Omar K, Gelius P, Dinan-Young S, Frändin K, Hopman-Rock M, Young A. Policy assessment and policy development for physical activity promotion: results of an exploratory intervention study in 15 European nations. Health Res Policy Syst 2012; 10:14. [PMID: 22512780 PMCID: PMC3353837 DOI: 10.1186/1478-4505-10-14] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 04/18/2012] [Indexed: 11/10/2022] Open
Abstract
Background Purpose of the study was to test a theoretical model to assess and develop policies for the promotion of physical activity among older people as part of an international intervention study. Methods 248 semi-standardized interviews with policy-makers were conducted in 15 European nations. The questionnaire assessed policy-makers' perceptions of organizational goals, resources, obligations, as well as organizational, political and public opportunities in the area of physical activity promotion among older people. In order to develop policies, workshops with policy-makers were conducted. Workshop outputs and outcomes were assessed for four nations nine months after the workshops. Results Policy assessment: Results of the policy assessment were diverse across nations and policy sectors. For example, organizational goals regarding actions for physical activity promotion were perceived as being most favorably by the sports sector. Organizational obligations for the development of such policies were perceived as being most favorably by the health sector. Policy development: The workshops resulted in different outputs: a national intersectoral action plan (United Kingdom), a national alliance (Sweden), an integrated policy (the Netherlands), and a continuing dialogue (Germany). Conclusions Theory-driven policy assessment and policy-maker workshops might be an important means of scientific engagement in policy development for health promotion.
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Affiliation(s)
- Alfred Rütten
- Institute of Sport Science and Sport, University of Erlangen-Nuremberg, Gebbertstraße 123b, 91058 Erlangen, Germany.
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Determinants of effective health promotion actions in local contexts: a study of the perceptions of municipal politicians. Int J Public Health 2011; 57:787-95. [DOI: 10.1007/s00038-011-0328-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 10/06/2011] [Accepted: 12/06/2011] [Indexed: 10/14/2022] Open
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Langer EM, Gifford AL, Chan K. Comparative Logic Modeling for policy analysis: the case of HIV testing policy change at the Department of Veterans Affairs. Health Serv Res 2011; 46:1628-45. [PMID: 21689094 DOI: 10.1111/j.1475-6773.2011.01283.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Logic models have been used to evaluate policy programs, plan projects, and allocate resources. Logic Modeling for policy analysis has been used rarely in health services research but can be helpful in evaluating the content and rationale of health policies. Comparative Logic Modeling is used here on human immunodeficiency virus (HIV) policy statements from the Department of Veterans Affairs (VA) and Centers for Disease Control and Prevention (CDC). We created visual representations of proposed HIV screening policy components in order to evaluate their structural logic and research-based justifications. DATA SOURCES AND STUDY DESIGN We performed content analysis of VA and CDC HIV testing policy documents in a retrospective case study. DATA COLLECTION Using comparative Logic Modeling, we examined the content and primary sources of policy statements by the VA and CDC. We then quantified evidence-based causal inferences within each statement. PRINCIPAL FINDINGS VA HIV testing policy structure largely replicated that of the CDC guidelines. Despite similar design choices, chosen research citations did not overlap. The agencies used evidence to emphasize different components of the policies. CONCLUSION Comparative Logic Modeling can be used by health services researchers and policy analysts more generally to evaluate structural differences in health policies and to analyze research-based rationales used by policy makers.
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Affiliation(s)
- Erika M Langer
- Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA
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Cheung KK, Mirzaei M, Leeder S. Health policy analysis: a tool to evaluate in policy documents the alignment between policy statements and intended outcomes. AUST HEALTH REV 2011; 34:405-13. [PMID: 21108900 DOI: 10.1071/ah09767] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Accepted: 02/15/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Health policy analysis remains surprisingly undeveloped in Australia given the power that policy exercises over the direction of public health. This paper describes the use of a policy analysis tool to evaluate the alignment between policy statements and intended outcomes of principal chronic illness policy documents in New South Wales (NSW) from 1999 to 2008. In doing so, it demonstrates the utility of a set of predefined criteria for use in retrospective policy analysis and potential for use in reviewing policy proposals and making future health policies. METHODS We analysed the major health policy for the care of people with chronic disease in NSW, the Chronic Care Program, using a modified set of existing criteria derived from the logic of events theoretical framework, which conceptualises the connection between policy determinants and outcomes. A document map was also developed to identify linkages between the policy documents analysed. RESULTS Internal validity, the alignment between policy statements and intended outcomes, was highest for policy background and goal-setting criteria, and lowest for accessibility, resources, public opportunities and monitoring and evaluation criteria. The use of document mapping was vital in determining linkages between the closely related policy documents of this complex initiative. CONCLUSIONS The use of predefined criteria to identify in policy documents where policy statements are not consistent with intended outcomes, in conjunction with policy mapping, are useful methods of analysing complex policy initiatives. In the Australian context, the use of a validated policy-analysis tool might help achieve greater consistency. IMPLICATIONS The use of a tool during policy development to identify in policy documents where statements are not consistent with intended outcomes may increase the likelihood of the successful implementation of future health policy. The tool can also assist those who make and review future policies.
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Affiliation(s)
- K Katherine Cheung
- Faculty of Medicine, The University of Sydney, Sydney, NSW 2006, Australia
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Bernier NF, Clavier C. Public health policy research: making the case for a political science approach. Health Promot Int 2011; 26:109-16. [DOI: 10.1093/heapro/daq079] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rütten A, Gelius P, Abu-Omar K. Policy development and implementation in health promotion--from theory to practice: the ADEPT model. Health Promot Int 2010; 26:322-9. [PMID: 21177769 DOI: 10.1093/heapro/daq080] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
There is a growing interest among health promotion researchers to better understand and influence the policy process. However, at this point in time, theoretical concepts enabling researchers to do so are still rare and underused, suggesting a need for new, easy-to-use concepts to explain successes or failures of health promotion policies. This article presents the ADEPT (Analysis of Determinants of Policy Impact) approach, which aims to explain and influence policy development and policy impact implementation with four determinants: goals, obligations, resources and opportunities. ADEPT provides a detailed operationalization for both quantitative and qualitative use. An empirical test of the ADEPT model using a quantitative survey of 719 policy-makers from four health promotion policy fields and six European nations indicated that both policy outputs and policy outcomes are influenced by the four determinants. The approach has, in the meantime, been successfully utilized to analyze and initiate policy development in a number of health promotion projects. Despite a number of limitations, ADEPT provides an easy-to-use, theory-based and parsimonious tool for understanding and influencing policy processes in health promotion. Moreover, as it identifies potential 'levers of influence' and can easily be connected to existing methods of community development or capacity building, it is a particularly powerful tool for policy development.
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Affiliation(s)
- Alfred Rütten
- Institute of Sport Science and Sport, University of Erlangen-Nürnberg, Gebbertstraße 123b, 91058 Erlangen, Germany.
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Bowen SAK, Saunders RP, Richter DL, Hussey J, Elder K, Lindley L. Assessing levels of adaptation during implementation of evidence-based interventions: introducing the Rogers-Rütten framework. HEALTH EDUCATION & BEHAVIOR 2010; 37:815-30. [PMID: 21051771 DOI: 10.1177/1090198110366002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Most HIV-prevention funding agencies require the use of evidence-based behavioral interventions, tested and proven to be effective through outcome evaluation. Adaptation of programs during implementation is common and may be influenced by many factors, including agency mission, time constraints, and funding streams. There are few theoretical frameworks to understand how these organizational and program-related factors influence the level of adaptation. This study used constructs from both Rogers's diffusion theory and Rütten's framework for policy analysis to create a conceptual framework that identifies determinants hypothesized to affect the level of adaptation. Preliminary measures of these constructs were also developed. This framework and its measures assess organizational and program-related factors associated with adaptation and could serve as a model to assess implementation and adaptation in fields outside of HIV prevention.
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Affiliation(s)
- Shelly-Ann K Bowen
- Bureau of Community Health and Chronic Disease Prevention, South Carolina Department of Health and Environmental Control, Columbia, USA.
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Breton E, De Leeuw E. Theories of the policy process in health promotion research: a review. Health Promot Int 2010; 26:82-90. [DOI: 10.1093/heapro/daq051] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Brownson RC, Chriqui JF, Stamatakis KA. Understanding evidence-based public health policy. Am J Public Health 2009; 99:1576-83. [PMID: 19608941 PMCID: PMC2724448 DOI: 10.2105/ajph.2008.156224] [Citation(s) in RCA: 331] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2009] [Indexed: 11/04/2022]
Abstract
Public health policy has a profound impact on health status. Missing from the literature is a clear articulation of the definition of evidence-based policy and approaches to move the field forward. Policy-relevant evidence includes both quantitative (e.g., epidemiological) and qualitative information (e.g., narrative accounts). We describe 3 key domains of evidence-based policy: (1) process, to understand approaches to enhance the likelihood of policy adoption; (2) content, to identify specific policy elements that are likely to be effective; and (3) outcomes, to document the potential impact of policy. Actions to further evidence-based policy include preparing and communicating data more effectively, using existing analytic tools more effectively, conducting policy surveillance, and tracking outcomes with different types of evidence.
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Affiliation(s)
- Ross C Brownson
- Prevention Research Center in St Louis, the George Warren Brown School of Social Work, MO, USA.
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Rütten A, Röger U, Abu-Omar K, Frahsa A. Assessment of organizational readiness for health promotion policy implementation: test of a theoretical model. Health Promot Int 2009; 24:243-51. [PMID: 19493861 DOI: 10.1093/heapro/dap016] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Models explaining the engagement of organizations in different policy sectors in health promotion policy implementation often utilize retrospective data. The current study attempted to model determinants of organizational readiness (goals, resources, obligation, opportunities) in supporting health policy implementation prospectively. Twenty qualitative interviews with representatives of organizations from different policy sectors, levels of government and organizational legal entities were conducted at the beginning of a project for the promotion of physical activity among women in difficult life situations. Organizational support in developing, implementing and disseminating the project was documented over 36 months. Results indicated that in most organizations, determinants were not favorable for health promotion policy action for physical activity among women in difficult life situations. Six organizations did not report any favorable determinant, and two organizations reported four. The other 12 organizations reported positive results for some of the determinants. Project work received support from 6 out of the 20 organizations. A case study of three organizations indicated that engagement or disengagement of organizations in health promotion policy actions might be partly explained by the theoretical model. The prospective assessment of organizational readiness in implementing health promotion policy is highly relevant for health promotion. Considering the proposed theoretical framework may aid in advancing our understanding of factors that are related to organizational engagement in health promotion actions.
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Affiliation(s)
- A Rütten
- Institute of Sport Science and Sport, University of Erlangen Nuremberg, Gebbertstrasse 123b, Erlangen 91058, Germany.
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