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Schultz S, Zorbas C, Peeters A, Yoong S, Backholer K. Strengthening local government policies to address health inequities: perspectives from Australian local government stakeholders. Int J Equity Health 2023; 22:119. [PMID: 37344850 DOI: 10.1186/s12939-023-01925-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/30/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND With their close connection to community and increasing preventive health remit, local governments are well positioned to implement policies and programs to address health inequities. Nevertheless, there is a lack of evidence of equity-focused policy action in this sector. We aimed to understand how local government representatives approach equity in the development and implementation of health and wellbeing policies and programs, and to identify potential enablers for strengthening an equity focus. METHODS We conducted semi-structured interviews (June 2022-January 2023) with 29 health directorate representatives from 21 local governments in Victoria, Australia. Representatives were recruited from urban, regional and rural local government areas, with varying levels of socioeconomic position. Data was analysed inductively using Braun and Clarke's reflexive thematic analysis, informed by social determinants of health theory and a public policy decision making framework. RESULTS Local governments approach health equity in different ways including focusing on priority populations, disadvantaged geographic areas, or by targeting the upstream determinants of health, such as housing and employment. Enabling factors for more equity-oriented local government policy action included those internal to local governments: (i) having a clear conceptualisation of equity, (ii) fostering a strong equity-centric culture, and (iii) developing organisational-wide competency in health equity. External factors related to key stakeholder groups that support and/or influence local governments included: (iv) strong support from community, (v) state government leadership and legislation, and (vi) supportive local partners, networks and NGO's. CONCLUSIONS Local governments have a responsibility to implement policies and programs that improve health and reduce health inequities. Local government's capacity to leverage resources, structures, processes and relationships, internally and across sectors and community, will be key to strengthening equity-oriented local government health policies and programs.
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Affiliation(s)
- Sally Schultz
- Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
| | - Christina Zorbas
- Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Anna Peeters
- Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Serene Yoong
- Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Kathryn Backholer
- Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
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2
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Such E, Smith K, Woods HB, Meier P. Governance of Intersectoral Collaborations for Population Health and to Reduce Health Inequalities in High-Income Countries: A Complexity-Informed Systematic Review. Int J Health Policy Manag 2022; 11:2780-2792. [PMID: 35219286 PMCID: PMC10105187 DOI: 10.34172/ijhpm.2022.6550] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 01/30/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND A 'Health in All Policies' (HiAP) approach has been widely advocated as a way to involve multiple government sectors in addressing health inequalities, but implementation attempts have not always produced the expected results. Explaining how HiAP-style collaborations have been governed may offer insights into how to improve population health and reduce health inequalities. METHODS Theoretically focused systematic review. Synthesis of evidence from evaluative studies into a causal logic model. RESULTS Thirty-one publications based on 40 case studies from nine high-income countries were included. Intersectoral collaborations for population health and equity were multi-component and multi-dimensional with collaborative activity spanning policy, strategy, service design and service delivery. Governance of intersectoral collaboration included structural and relational components. Both internal and external legitimacy and credibility delivered collaborative power, which in turn enabled intersectoral collaboration. Internal legitimacy was driven by multiple structural elements and processes. Many of these were instrumental in developing (often-fragile) relational trust. Internal credibility was supported by multi-level collaborations that were adequately resourced and shared power. External legitimacy and credibility was created through meaningful community engagement, leadership that championed collaborations and the identification of 'win-win' strategies. External factors such as economic shocks and short political cycles reduced collaborative power. CONCLUSION This novel review, using systems thinking and causal loop representations, offers insights into how collaborations can generate internal and external legitimacy and credibility. This offers promise for future collaborative activity for population health and equity; it presents a clearer picture of what structural and relational components and dynamics collaborative partners can focus on when planning and implementing HiAP initiatives. The limits of the literature base, however, does not make it possible to identify if or how this might deliver improved population health or health equity.
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Affiliation(s)
- Elizabeth Such
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | | | - Petra Meier
- MRC/CSA Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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3
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Pérez G, Pasarín MI, Puig-Barrachina V, Pérez K, Rodríguez-Sanz M, Artazcoz L, Borrell C. Tackling health inequalities in a public health organization: the case of the Barcelona Public Health Agency. Int J Equity Health 2022; 21:129. [PMID: 36088347 PMCID: PMC9463672 DOI: 10.1186/s12939-022-01724-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/29/2022] [Indexed: 11/25/2022] Open
Abstract
Background Municipalities are important actors in the implementation of policies to tackle health inequalities, which requires political will, the availability of financial support, and technical and human resources. With the aim of aligning with local government political priorities, in 2017 the Barcelona Public Health Agency (Agència de Salut Pública de Barcelona, henceforth ASPB), which is responsible for the public health functions of the city, launched a strategy to improve the approach to tackling health inequalities in all its services. The objectives of this study were to show how social health inequalities were addressed in the ASPB from 2017 to 19 and to describe which actions were proposed after a participatory process aiming to create a plan to systematically incorporate health inequalities in ASPB actions. Methods The ASPB has 304 workers, 8 directors and 20 services or departments. Participatory methodologies were carried out: 1) semi-structured interviews with department heads (N = 12, 60%); 2) world cafe workshops open to a group of workers (N = 63, 37%); 3) a Quick and Colorful voting session open to a group of workers (N = 108, 63%); and 4) Hanlon matrix with 19 actions to be prioritized (N = 12 services, 60%). Results Semi-structured interviews and world cafe workshops provided 40 potential actions. After a step by step process of participatory prioritization, seven lines of action emerged: 1) to make progress in collaborative networking; 2) to promote policy evaluation; 3) to increase the ability of the ASPB to evaluate policies to reduce health inequalities; 4) to incorporate the axes of inequalities in all ASPB products; 5) to improve information on vulnerable groups; 6) to incorporate the gender perspective; and 7) to participate in an internal training plan to address health inequalities. Conclusions The participation of ASPB public health professionals and staff allowed the organization to design a shared plan of actions to address health inequalities. This experience could be useful for other municipalities whose political agendas include tackling inequalities in health.
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Grootjans SJM, Stijnen MMN, Kroese MEAL, Ruwaard D, Jansen MWJ. Collaborative governance at the start of an integrated community approach: a case study. BMC Public Health 2022; 22:1013. [PMID: 35590241 PMCID: PMC9118649 DOI: 10.1186/s12889-022-13354-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We studied collaborative governance at the start of an integrated community approach aiming to improve population health, quality of care, controlling health care costs and improving professional work satisfaction. Our objective was to investigate which characteristics of collaborative governance facilitate or hamper collaboration in the starting phase. This question is of growing importance for policymakers and health initiatives, since on a global scale there is a shift towards 'population health management' where collaboration between stakeholders is a necessity. In addition, it is crucial to investigate collaborative governance from the beginning, since it offers opportunities for sustainability of collaboration later on in the process. METHODS We performed a qualitative case study in four deprived neighbourhoods in the city of Maastricht, the Netherlands. An integrated community approach was implemented, involving various stakeholders from the public and private health sectors and provincial and local authorities. Data was collected from December 2016 to December 2018, with a triangulation of methods (50 observations, 24 interviews and 50 document reviews). The Integrative Framework for Collaborative Governance guided data collection and analysis. RESULTS We focused on the dynamics within the collaborative governance regime, consisting of principled engagement, shared motivation and capacity for joint action. We found that shared goalsetting, transparency, being physically present, informal meetings, trust and leadership are key aspects at the start of collaborative governance. An extensive accountability structure can both hamper (time-consuming which hinders innovation) and facilitate (keep everybody on board) collaboration. The characteristics we found are of significance for policy, practice and research. Policymakers and practitioners can use our lessons learned for implementing similar (population health) initiatives. This case study contributes to the already existing literature on collaborative governance adding to the knowledge gap on the governance of population health approaches. TRIAL REGISTRATION NTR6543 , registration date; 25 July 2017.
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Affiliation(s)
- Sanneke J M Grootjans
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, The Netherlands.
| | - M M N Stijnen
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, The Netherlands.,Living Lab Public Health Limburg, Public Health Service South Limburg (GGD Zuid Limburg), Het Overloon 2, 6411 TE, Heerlen, The Netherlands
| | - M E A L Kroese
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, The Netherlands
| | - D Ruwaard
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, The Netherlands
| | - M W J Jansen
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, The Netherlands.,Living Lab Public Health Limburg, Public Health Service South Limburg (GGD Zuid Limburg), Het Overloon 2, 6411 TE, Heerlen, The Netherlands
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Gonçalves C, Santinha G, Santiago A, Barros G. Collaborative place-based health governance systems: stakeholders' perceptions in the Portuguese Baixo Vouga sub-region. CIENCIA & SAUDE COLETIVA 2021; 26:2415-2430. [PMID: 34133623 DOI: 10.1590/1413-81232021266.1.40822020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/05/2020] [Indexed: 11/22/2022] Open
Abstract
This study aimed to assess the Baixo Vouga sub-region (Portugal) governance system through 15 interviews with leaders of institutions with decision-making power and provide healthcare. The interviews were subjected to a content analysis, organized in matrices by cases, categories, subcategories, and indicators. Recording units were extracted from the interviews to produce data for each indicator. A Collaborative Place-based Governance Framework systematizing operational definitions of collaborative governance was implemented to serve as a benchmark for assessing the collaborative and place-based dimensions. The Baixo Vouga sub-Region governance system is collaborative because it is based on a shared structure of principles that translates into the services provided. It has a multilevel and multisector collaboration, and can undertake shared decisions. These dimensions could be reinforced through increased participation, autonomy, subsidiarity if more place-based information and practical knowledge were sought. The system would also benefit from an extensive adoption of bottom-up methods to formulate and implement policies.
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Affiliation(s)
- Carlos Gonçalves
- Departamento de Ciências Sociais, Políticas e do Território, Unidade de Investigação em Governança, Competitividade e Políticas Públicas (GOVCOPP), Universidade de Aveiro. Campus Universitário de Santiago. 3810-193 Aveiro Portugal.
| | - Gonçalo Santinha
- Departamento de Ciências Sociais, Políticas e do Território, Unidade de Investigação em Governança, Competitividade e Políticas Públicas (GOVCOPP), Universidade de Aveiro. Campus Universitário de Santiago. 3810-193 Aveiro Portugal.
| | - Anabela Santiago
- Departamento de Ciências Sociais, Políticas e do Território, Unidade de Investigação em Governança, Competitividade e Políticas Públicas (GOVCOPP), Universidade de Aveiro. Campus Universitário de Santiago. 3810-193 Aveiro Portugal.
| | - Gonçalo Barros
- Departamento de Ciências Sociais, Políticas e do Território, Unidade de Investigação em Governança, Competitividade e Políticas Públicas (GOVCOPP), Universidade de Aveiro. Campus Universitário de Santiago. 3810-193 Aveiro Portugal.
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6
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Steenkamer B, Drewes H, Putters K, van Oers H, Baan C. Reorganizing and integrating public health, health care, social care and wider public services: a theory-based framework for collaborative adaptive health networks to achieve the triple aim. J Health Serv Res Policy 2020; 25:187-201. [PMID: 32178546 DOI: 10.1177/1355819620907359] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Population health management (PHM) refers to large-scale transformation efforts by collaborative adaptive health networks that reorganize and integrate services across public health, health care, social care and wider public services in order to improve population health and quality of care while at the same time reducing cost growth. However, a theory-based framework that can guide place-based approaches towards a comprehensive understanding of how and why strategies contribute to the development of PHM is lacking, and this review aims to contribute to closing this gap by identifying the key components considered to be key to successful PHM development. METHODS We carried out a scoping realist review to identify configurations of strategies (S), their outcomes (O), and the contextual factors (C) and mechanisms (M) that explain how and why these outcomes were achieved. We extracted theories put forward in included studies and that underpinned the formulated strategy-context-mechanism-outcome (SCMO) configurations. Iterative axial coding of the SCMOs and the theories that underpin these configurations revealed PHM themes. RESULTS Forty-one studies were included. Eight components were identified: social forces, resources, finance, relations, regulations, market, leadership, and accountability. Each component consists of three or more subcomponents, providing insight into (1) the (sub)component-specific strategies that accelerate PHM development, (2) the necessary contextual factors and mechanisms for these strategies to be successful and (3) the extracted theories that underlie the (sub)component-specific SCMO configurations. These theories originate from a wide variety of scientific disciplines. We bring these (sub)components together into what we call the Collabroative Adaptive Health Network (CAHN) framework. CONCLUSIONS This review presents the strategies that are required for the successful development of PHM. Future research should study the applicability of the CAHN framework in practice to refine and enrich identified relationships and identify PHM guiding principles.
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Affiliation(s)
- Betty Steenkamer
- Researcher, Tranzo, Tilburg School of Social and Behavioural Sciences, Tilburg University, the Netherlands
| | - Hanneke Drewes
- Senior Researcher, Department of Quality of Care and Health Economics, National Institute for Public Health and the Environment (RIVM), the Netherlands
| | - Kim Putters
- Professor, Erasmus School of Health Policy & Management, Erasmus University, the Netherlands.,Director, The Netherlands Institute for Social Research, the Netherlands
| | - Hans van Oers
- Professor, Tranzo, Tilburg School of Social and Behavioural Sciences, Tilburg University, the Netherlands.,Chief Science Officer, National Institute for Public Health and the Environment (RIVM), the Netherlands
| | - Caroline Baan
- Professor, Tranzo, Tilburg School of Social and Behavioural Sciences, Tilburg University, the Netherlands.,Chief Science Officer, National Institute for Public Health and the Environment (RIVM), the Netherlands
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7
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Borrell C, Pasarín MI, Díez E, Pérez K, Malmusi D, Pérez G, Artazcoz L. [Health inequalities as a political priority in Barcelona]. GACETA SANITARIA 2019; 34:69-76. [PMID: 31288951 DOI: 10.1016/j.gaceta.2019.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 04/11/2019] [Accepted: 04/12/2019] [Indexed: 10/26/2022]
Abstract
There is a wealth of information and research on health inequalities in Barcelona, but this issue has not been clearly prioritised on the political agenda. The arrival in government of a new left-wing party (Barcelona en Comú) in 2015, gave an important boost to the political agenda to reduce inequalities and health inequalities. The aim of this review is to describe the progress made in relation to health inequalities in these four years and especially in the areas involving public health. With respect to evidence and communication on health inequalities, the progress made is presented in the Barcelona annual health report and the creation of the Observatory on Health, Inequalities and Impacts of Municipal Policies. The policies presented refer to different municipal strategies, the Health Plan, the promotion of the Barcelona Health in the Neighbourhoods programme and the Plan for Tackling Inequalities in the Barcelona Public Health Agency. The combination of political will, technical capacity and the drive of citizens have facilitated progress in the city of Barcelona in policies to reduce social inequalities in health.
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Affiliation(s)
- Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, España; Departamento de Ciencias Experimentales y de la Salud, Universitat Pompeu Fabra, Barcelona, España.
| | - M Isabel Pasarín
- Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, España; Departamento de Ciencias Experimentales y de la Salud, Universitat Pompeu Fabra, Barcelona, España
| | - Elia Díez
- Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, España; Departamento de Ciencias Experimentales y de la Salud, Universitat Pompeu Fabra, Barcelona, España
| | - Katherine Pérez
- Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, España
| | - Davide Malmusi
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, España; Direcció de Serveis de Salut, Ajuntament de Barcelona, Barcelona, España
| | - Glòria Pérez
- Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, España; Departamento de Ciencias Experimentales y de la Salud, Universitat Pompeu Fabra, Barcelona, España
| | - Lucía Artazcoz
- Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, España; Departamento de Ciencias Experimentales y de la Salud, Universitat Pompeu Fabra, Barcelona, España
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Yang J, Siri JG, Remais JV, Cheng Q, Zhang H, Chan KKY, Sun Z, Zhao Y, Cong N, Li X, Zhang W, Bai Y, Bi J, Cai W, Chan EYY, Chen W, Fan W, Fu H, He J, Huang H, Ji JS, Jia P, Jiang X, Kwan MP, Li T, Li X, Liang S, Liang X, Liang L, Liu Q, Lu Y, Luo Y, Ma X, Schwartländer B, Shen Z, Shi P, Su J, Wu T, Yang C, Yin Y, Zhang Q, Zhang Y, Zhang Y, Xu B, Gong P. The Tsinghua-Lancet Commission on Healthy Cities in China: unlocking the power of cities for a healthy China. Lancet 2018; 391:2140-2184. [PMID: 29678340 PMCID: PMC7159272 DOI: 10.1016/s0140-6736(18)30486-0] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 12/05/2017] [Accepted: 12/07/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Jun Yang
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China; Joint Center for Global Change Studies (JCGCS), Beijing, China; Center for Healthy Cities, Institute for China Sustainable Urbanization, Tsinghua University, Beijing, China
| | - José G Siri
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
| | - Justin V Remais
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Qu Cheng
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China
| | - Han Zhang
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China
| | - Karen K Y Chan
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China
| | - Zhe Sun
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China
| | - Yuanyuan Zhao
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China
| | - Na Cong
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China
| | - Xueyan Li
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China
| | - Wei Zhang
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China
| | - Yuqi Bai
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China; Joint Center for Global Change Studies (JCGCS), Beijing, China; Center for Healthy Cities, Institute for China Sustainable Urbanization, Tsinghua University, Beijing, China
| | - Jun Bi
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing, China
| | - Wenjia Cai
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China; Joint Center for Global Change Studies (JCGCS), Beijing, China; Center for Healthy Cities, Institute for China Sustainable Urbanization, Tsinghua University, Beijing, China
| | - Emily Y Y Chan
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Wanqing Chen
- National Office for Cancer Prevention and Control, National Central Cancer Registry Cancer Institute/Hospital, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College National Cancer Center, Beijing, China
| | - Weicheng Fan
- Institute of Public Safety Research, Department of Engineering Physics, Tsinghua University, Beijing, China
| | - Hua Fu
- Fudan Health Communication Institute, School of Public Health, Fudan University, Shanghai, China
| | - Jianqing He
- China National Engineering Research Center for Human Settlements, Beijing, China
| | - Hong Huang
- Institute of Public Safety Research, Department of Engineering Physics, Tsinghua University, Beijing, China
| | - John S Ji
- Environmental Research Center, Duke Kunshan University, Kunshan, China; Nicholas School of the Environment, Duke University, Durham, NC, USA; Harvard Center Shanghai, Asia-Pacific Research Center, Harvard Business School, Boston, MA, USA
| | - Peng Jia
- Department of Earth Observation Science, Faculty of Geo-information Science and Earth Observation (ITC), University of Twente, Enschede, Netherlands
| | | | - Mei-Po Kwan
- Department of Geography and Geographic Information Science, University of Illinois at Urbana-Champaign, Urbana, IL, USA; Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, Netherlands
| | - Tianhong Li
- Department of Internal Medicine, Division of Hematology & Oncology, University of California Davis School of Medicine, UC Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Xiguang Li
- School of Journalism and Communication, Tsinghua University, Beijing, China
| | - Song Liang
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Xiaofeng Liang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lu Liang
- Center for Healthy Cities, Institute for China Sustainable Urbanization, Tsinghua University, Beijing, China; Arkansas Forest Resources Center, University of Arkansas Division of Agriculture, School of Forestry and Natural Resources, University of Arkansas at Monticello, Monticello, AR, USA
| | - Qiyong Liu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yongmei Lu
- Department of Geography, Texas State University, San Marcos, TX, USA
| | - Yong Luo
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China; Joint Center for Global Change Studies (JCGCS), Beijing, China
| | - Xiulian Ma
- Chinese Academy of Governance, Beijing, China
| | | | | | - Peijun Shi
- Joint Center for Global Change Studies (JCGCS), Beijing, China; State Key Laboratory of Earth Surface Processes and Resource Ecology/Academy of Disaster Reduction and Emergency Management, Beijing Normal University, Beijing, China
| | - Jing Su
- School of Medicine, Tsinghua University, Beijing, China
| | - Tinghai Wu
- School of Architecture, Tsinghua University, Beijing, China
| | - Changhong Yang
- Institute for Public Health Information, Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Yongyuan Yin
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China
| | - Qiang Zhang
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China; Joint Center for Global Change Studies (JCGCS), Beijing, China
| | - Yinping Zhang
- Bureau of Disease Prevention and Control, National Health and Family Planning Commission, Beijing, China
| | - Yong Zhang
- Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Department of Building Science, Tsinghua University, Beijing, China
| | - Bing Xu
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China; Joint Center for Global Change Studies (JCGCS), Beijing, China; Center for Healthy Cities, Institute for China Sustainable Urbanization, Tsinghua University, Beijing, China.
| | - Peng Gong
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China; Joint Center for Global Change Studies (JCGCS), Beijing, China; Center for Healthy Cities, Institute for China Sustainable Urbanization, Tsinghua University, Beijing, China.
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Beran D, Aebischer Perone S, Alcoba G, Bischoff A, Bussien CL, Eperon G, Hagon O, Heller O, Jacquerioz Bausch F, Perone N, Vogel T, Chappuis F. Partnerships in global health and collaborative governance: lessons learnt from the Division of Tropical and Humanitarian Medicine at the Geneva University Hospitals. Global Health 2016; 12:14. [PMID: 27129684 PMCID: PMC4850714 DOI: 10.1186/s12992-016-0156-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 04/21/2016] [Indexed: 11/23/2022] Open
Abstract
Background In 2007 the “Crisp Report” on international partnerships increased interest in Northern countries on the way their links with Southern partners operated. Since its establishment in 2007 the Division of Tropical and Humanitarian Medicine at the Geneva University Hospitals has developed a variety of partnerships. Frameworks to assess these partnerships are needed and recent attention in the field of public management on collaborative governance may provide a useful approach for analyzing international collaborations. Methods Projects of the Division of Tropical and Humanitarian Medicine were analyzed by collaborators within the Division using the model proposed by Emerson and colleagues for collaborative governance, which comprises different components that assess the collaborative process. Results International projects within the Division of Tropical and Humanitarian Medicine can be divided into four categories: Human resource development; Humanitarian response; Neglected Tropical Diseases and Noncommunicable diseases. For each of these projects there was a clear leader from the Division of Tropical and Humanitarian Medicine as well as a local counterpart. These individuals were seen as leaders both due to their role in establishing the collaboration as well as their technical expertise. Across these projects the actual partners vary greatly. This diversity means a wide range of contributions to the collaboration, but also complexity in managing different interests. A common definition of the collaborative aims in each of the projects is both a formal and informal process. Legal, financial and administrative aspects of the collaboration are the formal elements. These can be a challenge based on different administrative requirements. Friendship is part of the informal aspects and helps contribute to a relationship that is not exclusively professional. Conclusion Using collaborative governance allows the complexity of managing partnerships to be presented. The framework used highlights the process of establishing collaborations, which is an element often negated by other more traditional models used in international partnerships. Applying the framework to the projects of the Division of Tropical and Humanitarian Medicine highlights the importance of shared values and interests, credibility of partners, formal and informal methods of management as well as friendship.
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Affiliation(s)
- David Beran
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland. .,Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | | | - Gabriel Alcoba
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Alexandre Bischoff
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Claire-Lise Bussien
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Gilles Eperon
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Olivier Hagon
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Olivia Heller
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | - Nicolas Perone
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Thomas Vogel
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Anderson LM, Adeney KL, Shinn C, Safranek S, Buckner‐Brown J, Krause LK. Community coalition-driven interventions to reduce health disparities among racial and ethnic minority populations. Cochrane Database Syst Rev 2015; 2015:CD009905. [PMID: 26075988 PMCID: PMC10656573 DOI: 10.1002/14651858.cd009905.pub2] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Racial and ethnic disparities in health status are pervasive at all stages of the life cycle. One approach to reducing health disparities involves mobilizing community coalitions that include representatives of target populations to plan and implement interventions for community level change. A systematic examination of coalition-led interventions is needed to inform decision making about the use of community coalition models. OBJECTIVES To assess effects of community coalition-driven interventions in improving health status or reducing health disparities among racial and ethnic minority populations. SEARCH METHODS We searched MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, Social Science Citation Index, Dissertation Abstracts, System for Information on Grey Literature in Europe (SIGLE) (from January 1990 through September 30, 2013), and Global Health Library (from January 1990 through March 31, 2014). SELECTION CRITERIA Cluster-randomized controlled trials, randomized controlled trials, quasi-experimental designs, controlled before-after studies, interrupted time series studies, and prospective controlled cohort studies. Only studies of community coalitions with at least one racial or ethnic minority group representing the target population and at least two community public or private organizations are included. Major outcomes of interest are direct measures of health status, as well as lifestyle factors when evidence indicates that these have an effect on the direct measures performed. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias for each study. MAIN RESULTS Fifty-eight community coalition-driven intervention studies were included. No study was considered to be at low risk of bias. Behavioral change outcomes and health status change outcomes were analyzed separately. Outcomes are grouped by intervention type. Pooled effects across intervention types are not presented because the diverse community coalition-led intervention studies did not examine the same constructs or relationships, and they used dissimilar methodological designs. Broad-scale community system level change strategies led to little or no difference in measures of health behavior or health status (very low-certainty evidence). Broad health and social care system level strategies leds to small beneficial changes in measures of health behavior or health status in large samples of community residents (very low-certainty evidence). Lay community health outreach worker interventions led to beneficial changes in health behavior measures of moderate magnitude in large samples of community residents (very low-certainty evidence). Lay community health outreach worker interventions may lead to beneficial changes in health status measures in large samples of community residents; however, results were not consistent across studies (low-certainty evidence). Group-based health education led by professional staff resulted in moderate improvement in measures of health behavior (very low-certainty evidence) or health status (low-certainty evidence). Adverse outcomes of community coalition-led interventions were not reported. AUTHORS' CONCLUSIONS Coalition-led interventions are characterized by connection of multi-sectoral networks of health and human service providers with ethnic and racial minority communities. These interventions benefit a diverse range of individual health outcomes and behaviors, as well as health and social care delivery systems. Evidence in this review shows that interventions led by community coalitions may connect health and human service providers with ethnic and racial minority communities in ways that benefit individual health outcomes and behaviors, as well as care delivery systems. However, because information on characteristics of the coalitions themselves is insufficient, evidence does not provide an explanation for the underlying mechanisms of beneficial effects. Thus, a definitive answer as to whether a coalition-led intervention adds extra value to the types of community engagement intervention strategies described in this review remains unattainable.
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Affiliation(s)
- Laurie M Anderson
- University of WashingtonDepartment of Epidemiology, School of Public HealthP.O. Box 357236SeattleWAUSA98195‐7236
| | - Kathryn L Adeney
- Washington State Institute for Public PolicyEpidemiology and Public Health110 Fifth Avenue SE, Suite 214SeattleWAUSA98504
| | - Carolynne Shinn
- New Hampshire Department of Health and Human ServicesNew Hampshire Division of Public Health ServicesConcordNew HampshireUSA03301‐3852
| | - Sarah Safranek
- University of WashingtonHealth Sciences Library1959 NE Pacific StreetSeattleWAUSA98195‐7155
| | - Joyce Buckner‐Brown
- Centers for Disease Control and PreventionNational Center for Chronic Disease Prevention and Health Promotion, Division of Community Health, Research Surveillance & Evaluation Branch4770 Buford Hwy NE, Mailstop K81AtlantaGeorgiaUSA30341
| | - L Kendall Krause
- Bill & Melinda Gates FoundationEpidemiology and Surveillance DivisionSeattleWAUSA
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11
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Peters D, Harting J, van Oers H, Schuit J, de Vries N, Stronks K. Manifestations of integrated public health policy in Dutch municipalities. Health Promot Int 2014; 31:290-302. [PMID: 25500994 DOI: 10.1093/heapro/dau104] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Integrated public health policy (IPHP) aims at integrating health considerations into policies of other sectors. Since the limited empirical evidence available may hamper its further development, we systematically analysed empirical manifestations of IPHP, by placing policy strategies along a continuum of less-to-more policy integration, going from intersectoral action (IA) to healthy public policy (HPP) to health in all policies (HiAP). Our case study included 34 municipal projects of the Dutch Gezonde Slagkracht Programme (2009-15), which supports the development and implementation of IPHP on overweight, alcohol and drug abuse, and smoking. Our content analysis of project application forms and interviews with all project leaders used a framework approach involving the policy strategies and the following policy variables: initiator, actors, policy goals, determinants and policy instruments. Most projects showed a combination of policy strategies. However, manifestations of IPHP in overweight projects predominantly involved IA. More policy integration was apparent in alcohol/drugs projects (HPP) and in all-theme projects (HiAP). More policy integration was related to broad goal definitions, which allowed for the involvement of actors representing several policy sectors. This enabled the implementation of a mix of policy instruments. Determinants of health were not explicitly used as a starting point of the policy process. If a policy problem justifies policy integration beyond IA, it might be helpful to start from the determinants of health (epidemiological reality), systematically transform them into policy (policy reality) and set broad policy goals, since this gives actors from other sectors the opportunity to participate.
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Affiliation(s)
- Dorothee Peters
- Department of Public Health, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Janneke Harting
- Department of Public Health, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Hans van Oers
- Faculty of Social Sciences, University of Tilburg, PO Box 90153, 5000 LE Tilburg, The Netherlands National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, The Netherlands
| | - Jantine Schuit
- National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, The Netherlands Department of Health Sciences and EMGO institute for Health and Care Research, VU University Amsterdam, De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands
| | - Nanne de Vries
- Department of Health Promotion, CAPHRI School of Public Health and Primary Care, University of Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Karien Stronks
- Department of Public Health, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
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