A guide to policy analysis as a research method

Transition of adolescents from paediatric to adult HIV care in South Africa: A policy review

The successful roll-out and improved delivery of antiretroviral therapy (ART) services has led to paediatric HIV patients surviving to reach adolescence. Adolescents living with HIV (ALHIV) are challenged when transitioning to adult HIV care programmes where they must negotiate new care pathways, changes in healthcare providers and self-manage their chronic condition, in addition to dealing with the psychological and physiological developmental changes of adolescence. The transition process needs to be well guided, to ensure that ALHIV on ART maintain optimal adherence and remain engaged in care. Viral suppression and retention in care are significantly lower for older adolescents (15-19 years) compared to children and younger adolescents under 15 years - coinciding with the post-transition period. Comprehensive and structured transition protocols may have a significant impact on positive health outcomes. In sub-Saharan Africa, there is a dearth of policies and implementation guidelines for ALHIV who are transitioning to adult HIV care. The current review reports on policies and guidelines for transitioning ALHIV to adult HIV care in South Africa. Eight policies were identified, which were developed at global (n = 2), national (n = 2) and provincial levels (n = 1), and guided implementation (n = 3). Current national and provincial policies provide guidance on when to transition a patient clinically to facilitate the switch to adult ART regimens. Although global policies and implementation guidelines emphasise specific and comprehensive care for ALHIV on ART, these are not carried over to national and provincial policies in South Africa. Further development of policies is required to guide comprehensive, adolescent-friendly transition processes for ALHIV on ART in South Africa.

Salience of Trust in Discussions and Recommendations of the United States' COVID-19 Health Equity Task Force

OBJECTIVE

The COVID-19 pandemic has further eroded trust in public health institutions across the United States. We examined the salience of trust in the federal government's discussions and recommendations of the US COVID-19 Health Equity Task Force (HETF).

METHODS

We conducted a thematic analysis of publicly available HETF documents, including the executive order, 8 meeting minutes, and 2 final deliverables. Given that trust operates at multiple levels of the socioecological continuum, we used an interpretive analytic approach to our inquiry.

RESULTS

We found that several barriers, facilitators, and influencers to trust were discussed during HETF meetings but few were mentioned consistently across all documents. Trust was most frequently mentioned by individuals in the public comments section of HETF meetings, more so than HETF members or representatives of federal agencies. Public commenters comprised 52% of total mentions of trust. However, these mentions did not make their way into the final HETF deliverables, signaling a potential disconnect between insights from public commenters and HETF representatives.

CONCLUSIONS

Our findings indicate that trust had limited prominence in HETF discussions and recommendations. To rebuild the public's trust, it is imperative that the federal government, in collaboration with state and local partners, further develop actionable mechanisms to foster trust as a pillar of public health practice. By ensuring ethical principles are applied in decision-making and implementation, gaps in (mis)trust may be bridged, ultimately boosting the efficacy of public health emergency response.

Social Health Insurance for Universal Health Coverage in Low and Middle-Income Countries (LMICs): a retrospective policy analysis of attainments, setbacks and equity implications of Kenya's social health insurance model

OBJECTIVES

To analyse the potential of the Social Health Insurance (SHI) model to support the achievement of Universal Health Coverage (UHC) in Low and Middle-Income Countries (LMICs) through a policy analysis case study of Kenya's National Health Insurance Fund (NHIF).

DESIGN

We used an adaptation of the policy triangle framework to perform a retrospective policy analysis of Kenya's NHIF, drawing from semistructured interviews and analysis of published documents and grey literature.

SETTING

We focused on Kenya's NHIF as a case study.

PARTICIPANTS

We conducted 21 interviews with key stakeholders including policy experts, healthcare providers and formal and informal sector workers. We then triangulated the interview findings with document analysis.

RESULTS

Only 17% of Kenya's population are currently covered by the SHI as of 2023. Only 27% of the informal economy is covered by the NHIF, implying very low uptake and/or retention rates. We found little stakeholder engagement in the policy implementation process and minimum adoption of expert advice. Our analysis suggest that political affiliations and positions of power heavily influence health financing policies in Kenya. Purchasing and payment of healthcare was found to be riddled with inefficiencies, including slow bureaucratic reimbursement procedures, little expertise by rural hospital clerks, misappropriations and favouritism of specific private healthcare providers. We also found that group-based parallel schemes and penalty payments for defaulted premiums widened the existing inequity gap in healthcare access.

CONCLUSION

Although the SHI system is perceived to increase coverage and the quality of health services in Kenya, substantial structural and contextual challenges appear to deter its suitability to finance the attainment of Universal Health Coverage. From Kenya's experience, we identify little informal sector participation, inefficiencies in purchasing and payment of healthcare services, as well lack of political goodwill, as key bottlenecks for the implementation of SHI schemes in LMICs. LMICs adopting SHI need to also implement co-financing arrangements that do not impose on the population to co-finance, strategic purchasing systems, political goodwill and good governance for the SHI systems to be beneficial.

Contextual factors impacting WHO Framework Convention on Tobacco Control implementation in Africa-a scoping review

According to the World Health Organization (WHO), tobacco use causes over 8 million deaths annually including 1.3 million due to second-hand exposure. Furthermore, data from the Tobacco Atlas show that the tobacco industry continues to target new markets in the WHO African region, one of two regions where absolute numbers of smokers continue to increase. Understanding context contributes to policy formulation and implementation ensuring relevance to a country's political economy. Focusing on the WHO African region, this scoping review (i) maps the extent of academic research examining contextual factors on the WHO Framework Convention on Tobacco Control (WHO FCTC) national-level implementation, and (ii) reports on contextual factors impacting the WHO FCTC implementation. Using a stepwise structured approach, we conducted a search across four academic databases, yielding 10 342 articles and 42 were selected for full data extraction. Leichter's four categories of context (situational, structural, cultural and exogenous) and the stages of heuristic policy model guided data extraction. Study findings indicated that situational contextual factors such as the burden of disease or its impact on health can push governments toward policy formulation. Structural contextual factors included political considerations, economic interests, funding, institutional congruence, strength of policy and institutional capacity as important. Cultural contextual factors included the influence of policy entrepreneurs, current social trends and public opinion. Exogenous contextual factors included the WHO FCTC, tobacco industry influence at the national-level and bi-lateral partnerships. Further understanding contextual factors affecting the WHO FCTC national implementation can strengthen policy formulation and align required support with the WHO FCTC Secretariat and other relevant bodies.

A historical review of promotions of physical activity for adolescents in China from 1949 to 2020

Promotions of physical exercise for adolescents have become key elements of the country's national sports and health campaigns in China. Specifically, these promotions have gone through four stages including Initial Institutionalization, Standardization and Legalization, Solidification and Publicization, and Comprehensiveness and Diversification, which are interpreted based on the Multiple Streams Framework with discussions of the role and dynamism of the problem streams, political streams, and policy streams included. The results reveal that the political streams, reified by the will of the governing party and the central government in particular, play a leading role in policy transformations. Consequently, identifications of existing problems and subsequent adoption of proper measures emerge as the key to generating policy developments in the promotion of physical exercise for adolescents in China.

Understanding the evolution of competing institutional logics in the marketization of care: A stage model analysis of Australia's National Disability Insurance Scheme

This study explores the marketization of healthcare through a stage model analysis, focusing on Australia's National Disability Insurance Scheme (NDIS). By employing mixed methods, including sentiment and frequency analysis as well as qualitative content analysis of policy documents and media coverage, we trace the NDIS's evolution and the interplay of competing social welfare and market logics over time. Our findings underline that the evolution and interplay between competing institutional logics follow a stage model of institutional change, detailing pre-emergence, orientation, contestation, consolidation, and normalization phases. Additionally, we observe a shift in dominant institutional logics across different stages, demonstrating the critical role of media and public sentiment in shaping discourse about the marketization of care, which intertwines with policy decision-making. Our findings emphasize the importance of adaptive engagement and communication strategies by policymakers to avoid marginalizing vulnerable groups as institutional logics evolve, especially in the latter stages of the process when a dominant logic has emerged. The study highlights the complex dynamics of institutional change and offers insights for both researchers and practitioners in the healthcare sector, shedding light on the coevolution of competing logics in the policy development and implementation process.

Where are the values in evaluating palliative care? Learning from community-based palliative care provision

Background

The World Health Organization Astana Declaration of 2018 sees primary healthcare as key to universal health coverage and gives further support to the goal of building sustainable models of community palliative care. Yet evaluating the benefits of such models continues to pose methodological and conceptual challenges.

Objective

To explore evaluation issues associated with a community-based palliative care approach in Kerala, India.

Design

An illuminative case study using a rapid evaluation methodology.

Methodology

Qualitative interviews, documentary analysis and observations of home care and community organising.

Results

We appraise a community palliative care programme in Kerala, India, using three linked 'canvases' of enquiry: (1) 'complex' multi-factorial community-based interventions and implications for evaluation; (2) 'axiological' orientations that foreground values in any evaluation process and (3) the status of evaluative evidence in postcolonial contexts. Three values underpinning the care process were significant: heterogeneity, voice and decentralisation. We identify 'objects of interest' related to first-, second- and third-order outcomes: (1) individuals and organisations; (2) unintended targets outside the core domain and (3) indirect, distal effects within and outside the domain.

Conclusion

We show how evaluation of palliative care in complex community circumstances can be successfully accomplished when attending to the significance of community care values.

Human Rights and Inclusion of Vulnerable Groups in Health and Well-Being Policy Documents Relevant to Children and Young People in Ireland

Children and young people constitute a structurally vulnerable group who often experience specific barriers when trying to exercise their rights, including the right to health. The aim of this study was to examine core concepts of human rights and inclusion of vulnerable groups in a sample of national health and well-being policy documents relevant to children and young people in Ireland. Using EquiFrame, a validated policy content analysis tool, 3 policy documents were analysed in relation to their commitment to 21 core concepts of human rights and inclusion of 13 vulnerable groups. The Overall Summary Ranking of each policy varied: 'Better Outcomes, Brighter Futures'-Moderate, 'Sláintecare'-Moderate, and the 'Wellbeing Policy Statement'-Low. Across all three documents, Core Concept Coverage was high while Core Concept Quality was low. The findings demonstrate that these documents cover a wide range of human rights but fail to provide specific policy actions to address human rights or an intention to monitor human rights.

Regulation of the sonography profession and patient safety: A comparative study between Australia and New Zealand with implications for statutory regulation

INTRODUCTION

The primary aim of statutory regulation in healthcare is patient safety. Few studies examine health professionals' perceptions of statutory regulation and its impact on patient safety. Statutory regulation of sonographers is different in Australia and New Zealand which affords a unique opportunity to compare and contrast regulation and its impact.

METHODS

An interpretive policy analysis investigated how statutory regulation in the sonography profession addresses patient safety in Australia and New Zealand. A framework analysis explored relevant statutory regulatory policy as well as interviews from sonographers.

RESULTS

Four policy documents were included. Thirty-one sonographers in Australia and nine in New Zealand took part in semi-structured interviews. Four themes described statutory regulation and its impact on patient safety: how statutory regulation is implemented in practice to address patient safety; factors contributing to implementation of statutory regulation; impact of statutory regulation on sonographers; and considerations for regulation.

CONCLUSION

Statutory regulation provides a reference point for safe practice but can be non-specific in defining sonographers' roles and outlining strategies that address patient safety. Sonographers' perspectives of how regulation of practice addresses patient safety was mixed. A gap exists in sonographers' understanding of the role of statutory regulation in patient safety.

IMPLICATIONS FOR PRACTICE

Regulatory authorities must consider how to effectively engage and educate both patients and practitioners about their role in patient safety. Practitioners should also take the opportunity to engage in understanding the role of statutory regulation in enhancing patient safety. A broader view of how Fitness-to-Practice in sonography is managed should be considered in light of the findings.

Social value framing of physical activity in European Member State policies: a content analysis

Background

Engagement in physical activity (PA) benefits physical and mental health as well as many other areas of society. In Europe however, 1/3 adults do not meet minimum PA recommendations. Social value, and its quantification through social return on investment (SROI) evidence, may be a useful framing to enhance PA promotion. This study aimed to assess the current use of social value framing of PA in European Union (EU) policies.

Methods

Content analysis of 45 EU member state policies which contain reference to PA was conducted to evaluate the presence of five social value domains and SROI evidence. Data was analysed using manual inductive coding, supported by DeepL translation and NVivo tools.

Results

Social value framing was present to a certain extent in existing policies, with improved health being the most commonly referenced benefit of PA, followed by reference to social and community and then environmental benefits. Acknowledgement of the positive impacts of PA on wellbeing and education was the least present. Reference to SROI evidence was also limited. Generally, policies lacked holistic recognition of the social value of PA. Policies from the health sector were particularly limited in recognising the wider benefits of PA, whilst those from the environmental sector acknowledged the widest range of co-benefits.

Conclusion

Adopting social value framing could be a useful approach for enhancing PA promotion. Whilst it is present to a certain extent in existing policy, this could be increased in terms of comprehensiveness to increase issue salience and multisectoral policy action.

Identity Disclosure Between Donor Family Members and Organ Transplant Recipients: A Description and Synthesis of Australian Laws and Guidelines

INTRODUCTION

The disclosure of information that identifies deceased organ donors and/or organ transplant recipients by organ donation agencies and transplant centres is regulated in Australia by state and territory legislation, yet a significant number of donor family members and transplant recipients independently establish contact with each other.

AIM

To describe and synthesize Australian laws and guidelines on the disclosure of identifying information.

METHOD

Legislation and guidelines relevant to organ donation and transplantation were obtained following a search of government and DonateLife network websites. Information about the regulation of identity disclosure was extracted and synthesised using a process guided by Walt and Gilson's (1994) policy analysis framework.

FINDINGS

Nineteen documents were examined. Six guidelines refer to and were consistent with current legislation. Four documents did not address identity disclosure. All jurisdictions prohibit healthcare professionals from disclosing identifying information. In three states, the prohibition extends to all members of the public including donor family members and transplant recipients.

CONCLUSION

Restrictions on identity disclosure have implications for public promotion of donation and transplantation where sharing of stories and images of organ donors and transplant recipients is common. Further research is required to understand the perspective of donor family members, transplant recipients, and healthcare professionals impacted by the current laws.

Why Violence Cannot be Prevented in Healthcare Settings in Türkiye?: A Retrospective Policy Analysis

Preventive policies have been devised with the aim of curbing health-related violence, and their efficacy is believed to furnish evidence for their continued implementation, thereby enhancing their effectiveness. This study undertakes a retrospective analysis of these policies in the context of Türkiye. A comprehensive examination involved the review of 26 documents, employing a progressive scanning approach for data collection. This methodology encompassed the utilization of gray literature databases (OECD iLibrary and WHO Iris), extensive Google searches, thorough website scans, and consultations with subject-matter experts. Data analysis was meticulously conducted within the framework of the Health Policy Triangle. The findings reveal active participation from diverse stakeholders, including governmental bodies, political entities, professional organizations, and trade unions, in various preventive initiatives aimed at mitigating health-related violence. Notably, the adoption of legislation for health violence prevention, perceived as a paramount achievement, can be attributed to persistent efforts by both the media and other influential actors and stakeholders. These endeavors have sustained the topic's prominence on the policy agenda, positioning it as a promising source for the development of novel violence prevention and management strategies. This study underscores the necessity for a comprehensive investigation into the working conditions, personal rights, and wage policies of healthcare workers, in light of documented factors that frequently precipitate violence. Concomitantly, it advocates for the development of effective mechanisms to address these issues.

Engaging with immigrant students' voices in the school environment: an analysis of policy documents through school websites

BACKGROUND

For students to feel happy and supported in school, it is important that their views are taken seriously and integrated into school policies. However, limited information is available how the voices of immigrant students are considered in European school contexts. This study generated evidence from written documents to ascertain how student voice practices are described at school websites.

METHODS

Between 2 March and 8 April 2021, we reviewed the policy documents publicly available on school websites. The schools located in areas of high immigration in six European countries: Austria, England, Finland, Germany, Romania, and Switzerland. The READ approach was used to guide the steps in the document analysis in the context of policy studies (1) ready the materials, 2) data extraction, 3) data analysis, 4) distil the findings). A combination of qualitative and quantitative approaches with descriptive statistics (n, %, Mean, SD, range) was used for analysis.

RESULTS

A total of 412 documents (305 schools) were extracted. Based on reviewing school websites, reviewers'strongly agreed' in seven documents (2%) that information related to seeking student voices could be easily found. On the contrary, in 247 documents (60%), reviewers strongly indicated that information related to seeking student voices was missing. No clear characteristics could be specified to identify those schools were hearing students' voices is well documented. The most common documents including statements related to student voice were anti-bullying or violence prevention strategies (75/412) and mission statements (72/412).

CONCLUSIONS

Our document analysis based on publicly accessible school websites suggest that student voices are less frequently described in school written policy documents. Our findings provide a baseline to further monitor activities, not only at school level but also to any governmental and local authorities whose intention is to serve the public and openly share their values and practices with community members. A deeper understanding is further needed about how listening to student voices is realized in daily school practices.

Differences in Antenatal Care Policies in England, Finland, and the Netherlands: A Framing analysis

BACKGROUND AND PURPOSE

The World Health Organization (WHO) states that good quality antenatal care should strive for both mother and child achieving their best possible health. On a policy level, in Europe these goals are reached with varying approaches. This research offers a fresh look on the underlying assumptions embedded in the ANC policies in three European countries.

METHODS

A framing analysis was conducted to publicly available ANC policies on uncomplicated pregnancies in Finland, England, and the Netherlands. Analysis was guided by van Hulst and Yanowa and included the following phases: a) Sense-making, b) Selecting, naming, and categorizing and c) Storytelling.

MAIN FINDINGS

Findings of this study demonstrate how ANC is organized with distinct frames. The Finnish ANC policies emphasized equity in care and instead of focusing on women, the ANC focused on the family. In England the pregnant woman was central, and it is seen as her responsibility to understand the ANC protocols. The ANC in the Netherlands focused on the pregnant woman's pregnancy experience and freedom.

CONCLUSION

The three studied countries had individual priorities and values guiding ANC provision. Despite each country being in line with the WHO ANC recommendations, areas requiring improvement should not be overlooked.

Waste management in primary healthcare centers in Saudi Arabia: a policy analysis

Medical waste poses high risks to healthcare workers, patients, the environment, and public health. Governments have adopted measures and enacted policies to ensure proper medical waste management. Through a retrospective policy analysis, we analyzed the waste management policy for primary healthcare centers in Saudi Arabia. By adopting Walt and Gilson's health policy analysis framework, we conducted a thematic analysis of documents to analyze the policy context, process, actors, and content. Contextual factors including accreditation, the Saudi Vision-2030 and the healthcare transformation plan contributed to the development of the policy. The policy was adapted from a regional policy that was enacted about 15 years ago. The policy content overlooked components relevant to the specific context of primary healthcare centers. Lack of training and cooperation among stakeholders challenged successful implementation and thus compliance with the policy. Respective stakeholders must take further actions to ensure implementation fidelity and sustainability of the policy.

Gaps and Challenges in Harnessing the Benefits and Opportunities of Indigenous Certification for a Sustainable Communal Commercial Lobster Fishery

The Marshall Decision of Canada's Supreme Court inspired the Mi'kmaq in the 1700s regarding recognizing fishing rights to the Mi'kmaq communities. Despite this recognition, the Mi'kmaq communities did not have access to commercial fisheries due to the denial of absolute recognition of territories and rights and underrepresentation and participation in resource allocation, governance, and decision-making processes. A potential approach to these issues is the development of third-party Indigenous community-based sustainability certification standards for the American lobster (Homarus americanus) commercial fishery of Nova Scotia by Mi'kmaq communities. An Indigenous certification is a market-based tool that focuses on a holistic approach to the sustainability of the resource, followed by independent accreditations and standards. This study identifies the gaps, challenges, and opportunities of Indigenous-based certifications for the American lobster commercial fishery. We adopt a participatory approach to conventional policy analysis and perform a secondary analysis of existing legal and scientific resources to glean valuable information for supporting the establishment of an Indigenous certification for the American lobster. Certification could provide benefits such as increased control over fisheries management, governance, rights, and socioeconomic interest, building capacity for Mi'kmaq communities, and improving stakeholder relationships. However, there are issues with the entry points of certification for Indigenous peoples related primarily to the dominant actors in accreditation. This study will support further research and engagement of the Mi'kmaq people toward developing an Indigenous certification scheme.

Perseverance, partnerships and passion: ingredients for successful local government policy to promote healthy and sustainable diets

BACKGROUND

Local government authorities are well-placed to invest in evidence-based food policies that promote a population-wide shift to healthy and sustainable diets. This study describes the contextual factors that facilitated or impeded policy-making related to healthy and sustainable diets within a 'best-performing' local government in Victoria, Australia.

METHODS

Guided by the Consolidated Framework for Implementation Research (CFIR), data from semi-structured interviews with individuals involved in developing the City of Greater Bendigo's Food System Strategy were analysed using the seven-stage Framework Method.

RESULTS

Semi-structured interviews (n = 24) were conducted with City of Greater Bendigo employees (n = 15) and key stakeholders working for local organisations (n = 6) or at a state or national level (n = 3). Interviewees mostly held positions of leadership (n = 20) and represented diverse areas of focus from health (n = 7), food systems (n = 4) and planning and public policy (n = 3). Data analysis revealed 12 cross-cutting themes; eight facilitating factors and four impeding factors. Facilitating factors included perseverance, community engagement, supportive state policy, effective leadership, a global platform and networks, partnerships, workforce capacity and passion, and the use of scientific evidence. Impeding factors included access to secure, ongoing financial resources, prohibitive state and federal policy, COVID-related disruptions to community engagement and competing stakeholder interests. Overall, this study suggests that the City of Greater Bendigo's success in developing an evidence-based local food system policy is built upon (i) a holistic worldview that embraces systems-thinking and credible frameworks, (ii) a sustained commitment and investment throughout the inner-setting over time, and (iii) the ability to establish and nurture meaningful partnerships with community groups, neighbouring local government areas and state-level stakeholders, built upon values of reciprocity and respect.

CONCLUSIONS

Despite insufficient resourcing and prohibitive policy at higher levels of government, this 'best performing' local government in Victoria, Australia developed an evidence-based food system policy by employing highly skilled and passionate employees, embracing a holistic worldview towards planetary health and harnessing global networks. Local government authorities aspiring to develop integrated food policy should nurture a workforce culture of taking bold evidence-informed policy action, invest in mechanisms to enable long-standing partnerships with community stakeholders and be prepared to endure a 'slow-burn' approach.

What are the core concerns of policy analysis? A multidisciplinary investigation based on in-depth bibliometric analysis

Policy analysis provides multiple methods and tools for generating and transforming policy-relevant information and supporting policy evolution to address emerging social problems. In this study, a bibliometric analysis of a large number of studies on historical policy analysis was performed to provide a comprehensive understanding of the distribution and evolution of policy problems in different fields among countries. The analysis indicates that policy analysis has been a great concern for scholars in recent two decades, and is involved in multiple disciplines, among which the dominant ones are medicine, environment, energy and economy. The major concerns of policy analysts and scholars are human health needs, environmental pressures, energy consumption caused by economic growth and urbanization, and the resulting demand for sustainable development. The multidisciplinary dialog implies the complicated real-world social problems that calls for more endeavors to develop a harmonious society. A global profiling for policy analysis demonstrates that the central policy problems and the corresponding options align with national development, for example, developing countries represented by China are faced with greater environmental pressures after experiencing extensive economic growth, while developed countries such as the USA and the UK pay more attention to the social issues of health and economic transformation. Exploring the differences in policy priorities among countries can provide a new inspiration for further dialog and cooperation on the development of the international community in the future.

Modelling the Health Policy Process: One Size Fits All or Horses for Courses?

A range of conceptual models for understanding the policy process have been applied to the health policy process, largely in particular sub areas or policy domains such as public health. However, these contributions appear to offer different rationales and present different frameworks for understanding the policy process. This Editorial critically examines articles that explore the health policy process with models from wider public policy and from health policy. It can be seen that very few of the wider models have been applied in studies of the health policy process. Conversely, some models feature in studies of the health policy process, but not in the wider policy process literature, which suggests that literature on the health policy process is semi-detached from the wider policy process literature. There seem to be two very different future research directions: focusing on 'home grown' models, or taking greater account of the wider policy process literature. Does 'one size fit all' or is it 'horses for courses'?

Banishment through Branding: From Montréal’s Red Light District to Quartier des Spectacles

This paper analyzes how the City of Montréal employed tools of urban planning—including a district plan, street redesign, rezoning, selective public consultation, expropriation, policing and surveillance—to spatially banish sex work from its historic district, using the red light symbol as a branding strategy. This coincided with a change in federal law (Bill C-36) and a policy shift to reposition sex workers as passive victims of sex trafficking. Using a case study design, this work explores the state’s refusal to recognize the agency of those engaged in embodied socio-economic exchanges and the safety and solidarity possible in public space. In interviews, sex workers described strategies of collective organizing, resistance and protest to hold the city accountable during this process of displacement. We consider how urban planning might support sex work, sex workers and economic autonomy.

Food labeling in the European Union: a review of existing approaches

Purpose

This review explores the phenomenon of front-of-pack nutrition labels (FoPNLs) in the European Union (EU). FoPNLs highlight the nutritional quality of food and non-alcoholic beverages and help consumers to make healthier choices. The review explores different types of FoPNLs and evaluates their effectiveness.

Design/methodology/approach

A policy analysis was conducted, relying on extant academic literature, grey literature and policy documents. The use of current FoPNLs is interpreted in light of national and economic interests.

Findings

Our review identifies and describes seven government endorsed FoPNLs that are currently used in the EU. Five are positive endorsement labels (Croatia, Czech Republic, Denmark, Lithuania, Slovenia and Sweden), which only provide a positive indication on more healthy products. The Keyhole is used in three EU countries (Denmark, Lithuania and Sweden), while the others are used in one country each. The Nutri-Score represents a summary label, which provides an overall grade of how healthy a product is. It is used in six countries (Belgium, France, Germany, Netherlands, Spain and Luxembourg). Finally, the Nutrinform battery is a nutrient-specific non-interpretive scheme, indicating the content of nutrients in a portion of a food product. All identified labels are only used on a voluntary basis, encouraging selective use.

Originality/value

This review contributes to a significant discussion about food labeling in the EU. It summarizes existing approaches and evaluates them in terms of their effectiveness. The current schemes in use reflect regional clustering. The most common scheme is the Nutri-Score. This is predominantly found in western EU states. Another major label is the Keyhole, with summary endorsement schemes being prevalent in northern EU states. The least common is Nutrinform, which has some support in southern EU states. The Nutri-score is most effective although economic interests are pushing for the Nutrinform battery in a small number of states. Finally, the review suggests that all existing FoPNLs are voluntary, these labels fail to provide consumers with adequate information about nutrition quality of food products. The EU needs to mobilize support to agree on a single one.

A Critical Analysis of Representations of Inequalities in Childhood Obesity in Australian Health Policy Documents

BACKGROUND

In Australia, childhood obesity follows a socioeconomic gradient whereby children with lower socioeconomic position are disproportionately burdened. To reduce these inequalities in childhood obesity requires a multi-component policy-driven response. Action to address health issues is underpinned by the ways in which they are represented as 'problems' in public policy. This study critically examines representations of inequalities in childhood obesity within Australian health policy documents published between 2000-2019.

METHODS

Australia's federal, state and territory government health department websites were searched for health policy documents including healthy weight, obesity, healthy eating, food and nutrition strategies; child and youth health strategies; and broader health and wellbeing, prevention and health promotion policies that proposed objectives or strategies for childhood obesity prevention. Thematic analysis of eligible documents was guided by a theoretical framework informed by problematization theory, ecological systems theory, and theoretical principles for equity in health policy.

RESULTS

Eighteen policy documents were eligible for inclusion. The dominant representation of inequalities in childhood obesity was one of individual responsibility. The social determinants of inequalities in childhood obesity were acknowledged, yet policy actions predominantly focused on individual determinants. Equity was positioned as a principle of policy documents but was seldom mentioned in policy actions.

CONCLUSION

Current representations of inequalities in childhood obesity in Australian health policy documents do not adequately address the underlying causes of health inequities. In order to reduce inequalities in childhood obesity future policies will need greater focus on health equity and the social determinants of health (SDoH).

Emergency contraception subsidy in Canada: a comparative policy analysis

BACKGROUND

In Canada, cost prohibits access to emergency contraception (EC) which may assist to prevent unintended pregnancy. The drug, ulipristal acetate (UPA-EC), is more clinically effective and cost-effective than the prior standard levonorgestrel (LNG-EC). We analyzed provincial EC subsidization policies and examined underlying decision-making processes.

METHODS

We undertook documentary analysis of provincial EC subsidization policies in publicly available drug formularies. We conducted semi-structured interviews with key informants to explore the processes underlying current policies.

RESULTS

Quebec is the only province to subsidize UPA-EC, whilst all ten provinces subsidize LNG-EC. As such, provincial EC subsidization policies do not align with the latest UPA-EC evidence. Interviews revealed that evidence was valued in the policymaking process and formulary decisions were made through interdisciplinary consensus.

CONCLUSIONS

We identify a gap between EC subsidization policies and the latest evidence. Institutional structures affect policies reflecting evolving evidence. Increasing interdisciplinary mechanisms may encourage evidence-based policies.

Public objectives and policy instruments for improving the quality of postgraduate education in China

This paper mainly introduces and studies public objectives and instruments in educational policies that authorities can use to improve and evaluate the quality of postgraduate cultivation in China. Under the political environment in the state, the standard for the quality of postgraduate education first includes graduate students in higher education institutions who support the leadership of the Communist Party of China (CPC), educational authorities formulate, and implement policies and regulations surrounding postgraduate education under the leadership of the Party committees as well. From the political perspective, moral cultivation should become an important indicator in the evaluation of the quality of postgraduate education. Specific policy instruments including examination and admission systems, graduation requirements, and performance evaluations are designed to increase knowledge and academic skills or allow students to better perform work in their future careers. Although these policy instruments have played some roles in improving the quality of postgraduate cultivation in practice, some associated social negative phenomena also appear in the field, such as academic misconduct, excessive academic and psychological pressure of postgraduate students, etc. The moral cultivation and psychological health should be measured and assessed while evaluating the quality of postgraduate education. The public objectives surrounding the higher education in political level could provide some useful and constructive recommendations to improve the evaluation system that guides the development of postgraduate education.

The expression of 'policy' in palliative care: A critical review

The importance of 'policy' within palliative care has steadily increased over the past 25 years. Whilst this has been welcomed within the palliative care field and seen as a route to greater recognition, we focus here on a more critical perspective that challenge the effectiveness of a 'policy turn' in palliative care. Applying Bacchi's "What's the Problem Represented to Be?" (WPR) framework to data from a systematic search, we address the research question, "in what ways has 'policy' been articulated in palliative care literature?". The paper describes the construction of 'the problem' context and reflects critically on the robustness and pragmatic utility of such representations. In particular, we identify five elements as prominent and problematic: (1) a lack of empirical evidence that connects policy to practice; (2) the dominance of 'Global North' approaches; (3) the use of a policy narrative based on 'catastrophe' in justifying the need for palliative care; (4) the use of idealistic and aspirational 'calls to action'; and (5) a disengaged and antagonistic orientation to existing health systems. We conclude by suggesting that the efficacy of palliative care policy could be enhanced via greater emphases on 'Global South' perspectives, 'assets-based' approaches and attention to pragmatic implementation.

Exploring Educational Planning, Teacher Beliefs, and Teacher Practices During the Pandemic: A Study of Science and Technology-Based Universities in China

With the spread of the COVID-19 pandemic worldwide, university teachers are coping with and adjusting to online teaching platforms. In this concurrent mixed-methods study, 10 science and technology universities as the research sites were first chosen, and educational planning in these sites during the pandemic was examined; then, eight selected teacher participants in these sites were interviewed to report how their beliefs and practices changed during the pandemic echoing the examined educational planning. The results show that educational planning and policies assisted teachers in accommodating the new demands and changes during the pandemic; teachers' beliefs and practices generally echoed the educational planning and policies, with certain tensions still existing. The discussion part of the study is centered around emergency remote teaching and planning, tensions between teacher beliefs and practices, and the shift from emergency remote teaching to regular, sustainable online schooling. The study provides administrators and teacher educators with insights on how emergency remote teaching can be planned and implemented during an unprecedented time.

Governing Data and Artificial Intelligence for Health Care: Developing an International Understanding

Background

Although advanced analytical techniques falling under the umbrella heading of artificial intelligence (AI) may improve health care, the use of AI in health raises safety and ethical concerns. There are currently no internationally recognized governance mechanisms (policies, ethical standards, evaluation, and regulation) for developing and using AI technologies in health care. A lack of international consensus creates technical and social barriers to the use of health AI while potentially hampering market competition.

Objective

The aim of this study is to review current health data and AI governance mechanisms being developed or used by Global Digital Health Partnership (GDHP) member countries that commissioned this research, identify commonalities and gaps in approaches, identify examples of best practices, and understand the rationale for policies.

Methods

Data were collected through a scoping review of academic literature and a thematic analysis of policy documents published by selected GDHP member countries. The findings from this data collection and the literature were used to inform semistructured interviews with key senior policy makers from GDHP member countries exploring their countries’ experience of AI-driven technologies in health care and associated governance and inform a focus group with professionals working in international health and technology to discuss the themes and proposed policy recommendations. Policy recommendations were developed based on the aggregated research findings.

Results

As this is an empirical research paper, we primarily focused on reporting the results of the interviews and the focus group. Semistructured interviews (n=10) and a focus group (n=6) revealed 4 core areas for international collaborations: leadership and oversight, a whole systems approach covering the entire AI pipeline from data collection to model deployment and use, standards and regulatory processes, and engagement with stakeholders and the public. There was a broad range of maturity in health AI activity among the participants, with varying data infrastructure, application of standards across the AI life cycle, and strategic approaches to both development and deployment. A demand for further consistency at the international level and policies was identified to support a robust innovation pipeline. In total, 13 policy recommendations were developed to support GDHP member countries in overcoming core AI governance barriers and establishing common ground for international collaboration.

Conclusions

AI-driven technology research and development for health care outpaces the creation of supporting AI governance globally. International collaboration and coordination on AI governance for health care is needed to ensure coherent solutions and allow countries to support and benefit from each other’s work. International bodies and initiatives have a leading role to play in the international conversation, including the production of tools and sharing of practical approaches to the use of AI-driven technologies for health care.

Implementing a digital human resources management tool in the government health sector in Bangladesh: a policy content analysis

INTRODUCTION

In Bangladesh, to address the challenges of ensuring adequate human resources for health (HRH), the government began implementing a digital tool for HRH management in 2017. However, evidence suggests institutionalizing such tools in low-and-middle-income countries is impeded by policy aspects like implementation strategy and poor regulatory framework. Therefore, we aimed to explore factors in the current policy landscape that might facilitate and challenge the implementation of the tool in Bangladesh.

METHODS

We conducted a review of policies related to ICT implementation and human resources management in the health sector in Bangladesh using qualitative content analysis method. Ten policies have been identified, and extensive reading was done to ascertain common themes and patterns. A document analysis matrix was developed to synthesize and help interpret the findings.

RESULTS

Regarding facilitators, strong upstream level commitments were reflected in the content of policies in terms of setting out specific objectives, targets, timelines, and budget allocation. However, the lack of explicit monitoring strategy and extent of stakeholders' engagement was not well-defined, ultimately creating chances for impeding downstream implementation. In addition, effective coordination among stakeholders and different HRH and ICT policies could be strengthened.

DISCUSSION

Findings support the current discourse that national commitment plays a vital role in the integration of ICTs in health services. However, well-defined monitoring strategy and inter-ministry and intra-ministry policy coordination are crucial.

First Nations Peoples' Participation in the Development of Population-Wide Food and Nutrition Policy in Australia: A Political Economy and Cultural Safety Analysis

BACKGROUND

Healthy and sustainable food systems underpin the well-being of Indigenous peoples. Increasingly governments are taking action to improve diets via population-wide policies. The United Nations Declaration on the Rights of Indigenous People states that Indigenous peoples have the right to participate in all decisions that affect them. We analysed Australian national food and nutrition policy processes to determine: (i) the participation of Aboriginal organisations, (ii) the issues raised in Aboriginal organisations' policy submissions, and (iii) the extent to which Aboriginal organisations' recommendations were addressed in final policy documents.

METHODS

Political economy and cultural safety lenses informed the study design. We analysed publicly-available documents for Australian population-wide food and nutrition policy consultations occurring 2008-2018. Data sources were policy documents, committee reports, terms of reference and consultation submissions. The submissions made by Aboriginal organisations were thematically analysed and key policy recommendations extracted. We examined the extent to which key recommendations made by Aboriginal organisations were included in the subsequent policy documents.

RESULTS

Five food and nutrition policy processes received submissions from Aboriginal organisations. Key themes centred on self-determination, culturally-appropriate approaches to health, and the need to address food insecurity and social determinants of health. These messages were underrepresented in final policy documents, and Aboriginal people were not included in any committees overseeing policy development processes.

CONCLUSION

This analysis suggests that very few Aboriginal organisations have participated in Australian population-wide food and nutrition policy processes and that these policy development processes are culturally unsafe. In order to operationalise First Nations peoples' right to self-determination, alternative mechanisms are required to redress the power imbalances preventing the full participation of Aboriginal and Torres Strait Islander peoples in population-wide food and nutrition policy decisions. This means reflecting on deeply embedded institutional structures and the normative assumptions upon which they rest.

Digital topics on cultural heritage investigated: how can data-driven and data-guided methods support to identify current topics and trends in digital heritage?

In research and policies, the identification of trends as well as emerging topics and topics in decline is an important source of information for both academic and innovation management. Since at present policy analysis mostly employs qualitative research methods, the following article presents and assesses different approaches – trend analysis based on questionnaires, quantitative bibliometric surveys, the use of computer-linguistic approaches and machine learning and qualitative investigations. Against this backdrop, this article examines digital applications in cultural heritage and, in particular, built heritage via various investigative frameworks to identify topics of relevance and trendlines, mainly for European Union (EU)-based research and policies. Furthermore, this article exemplifies and assesses the specific opportunities and limitations of the different methodical approaches against the backdrop of data-driven vs. data-guided analytical frameworks. As its major findings, our study shows that both research and policies related to digital applications for cultural heritage are mainly driven by the availability of new technologies. Since policies focus on meta-topics such as digitisation, openness or automation, the research descriptors are more granular. In general, data-driven approaches are promising for identifying topics and trendlines and even predicting the development of near future trends. Conversely, qualitative approaches are able to answer “why” questions with regard to whether topics are emerging due to disruptive innovations or due to new terminologies or whether topics are becoming obsolete because they are common knowledge, as is the case for the term “internet”.

National nutrition policy in high-income countries: is health equity on the agenda?

OBJECTIVE

Equity-oriented policy actions are a key public health principle. In this study, how equity and socioeconomic inequalities are represented in policy problematizations of population nutrition were examined.

DATA SOURCES

We retrieved a purposive sample of government nutrition-policy documents (n = 18) from high-income nations.

DATA SYNTHESIS

Thematic analysis of policy documents was informed by a multitheoretical understanding of equitable policies and Bacchi's "What's the Problem Represented to be?' analysis framework. Despite common rhetorical concerns about the existence of health inequalities, these concerns were often overshadowed by greater emphasis on lifestyle "problems" and reductionist policy actions. The notion that policy actions should be for all and reach everyone were seldom backed by specific actions. Rhetorical acknowledgements of the upstream drivers of health inequalities were also rarely problematized, as were government responsibilities for health equity and the role of policy and governance in reducing socioeconomic inequalities in nutrition.

CONCLUSION

To positively influence health equity outcomes, national nutrition policy will need to transition toward the prioritization of actions that uphold social justice and comprehensively address the upstream determinants of health.

A scoping review of theories and conceptual frameworks used to analyse health financing policy processes in sub-Saharan Africa

Health financing policies are critical policy instruments to achieve Universal Health Coverage, and they constitute a key area in policy analysis literature for the health policy and systems research (HPSR) field. Previous reviews have shown that analyses of policy change in low- and middle-income countries are under-theorised. This study aims to explore which theories and conceptual frameworks have been used in research on policy processes of health financing policy in sub-Saharan Africa and to identify challenges and lessons learned from their use. We conducted a scoping review of literature published in English and French between 2000 and 2017. We analysed 23 papers selected as studies of health financing policies in sub-Saharan African countries using policy process or health policy-related theory or conceptual framework ex ante. Theories and frameworks used alone were from political science (35%), economics (9%) and HPSR field (17%). Thirty-five per cent of authors adopted a 'do-it-yourself' (bricolage) approach combining theories and frameworks from within political science or between political science and HPSR. Kingdon's multiple streams theory (22%), Grindle and Thomas' arenas of conflict (26%) and Walt and Gilson's policy triangle (30%) were the most used. Authors select theories for their empirical relevance, methodological rational (e.g. comparison), availability of examples in literature, accessibility and consensus. Authors cite few operational and analytical challenges in using theory. The hybridisation, diversification and expansion of mid-range policy theories and conceptual frameworks used deductively in health financing policy reform research are issues for HPSR to consider. We make three recommendations for researchers in the HPSR field. Future research on health financing policy change processes in sub-Saharan Africa should include reflection on learning and challenges for using policy theories and frameworks in the context of HPSR.

Understanding "Internet Plus Healthcare" in China: Policy Text Analysis

Background

The combination of the internet and healthcare has excellent benefits and far-reaching positive effects in improving service efficiency and promoting social equity. The role of the “internet plus healthcare” (IPHC) has been recognized, especially during the COVID-19 pandemic. This new healthcare model is also familiar to people and shows a bright prospect.

Objective

This article seeks to accurately understand and fully grasp the characteristics of IPHC policies that can enlighten the formulation of future policies.

Methods

The content analysis method was used to analyze China’s IPHC policies collected from the Beida Fabao database and several official websites.

Results

We found that the development of IPHC policy has gone through 4 stages and is currently entering a phase of rapid development. IPHC policymakers are primarily health administrative departments. In addition, policy instruments are classified into either supply, environment, or demand, and policy themes can be summarized into 4 categories: facilities, technology, service, and management.

Conclusions

China’s IPHC policy has good prospects from the perspective of development trends. The health administrative departments mainly lead the development of China’s IPHC policy. It is suggested that these departments involve other stakeholders (ie, medical workers, medical industries, and technology sectors) in formulating policies. Policies prefer to use supply-based and environment-based policy instruments. The policy themes emphasize improving infrastructure construction and high-quality diagnostic and treatment services, strengthening the supporting role of information technology, and ensuring all stakeholders understand their responsibilities.

In the name of COVID-19: legitimizing the exclusion of community participation in Ecuador's health policy

Global shifts toward a disease-oriented, vertical approach to health has involved limiting the right for communities to participate in decision-making. Ecuador's authoritarian legacy has forced civil society and social organizations to adopt 'coping strategies', while large protests recently derived into violent struggles. The country has been severely hit by the COVID-19 pandemic amid corruption scandals involving hospital and food purchases by government during the response. This study critically examines how Ecuador's government took into consideration 'community participation' as a value and tenet of health promotion. Our systematic textual analysis focuses on 53 consecutive resolutions by the National Emergency Operations Committee (EOC) leading the decision-making processes, which, explicitly requires community participation. Results show that the 'lifecycle' of the central government's evolving policy framing centered on law enforcement and the private sector, followed by the social sector. Further, there is no evidence of stakeholders from civil society or organizations taking part in decision-making. Having legitimized the exclusion of community participation in Ecuador's response to the COVID-19 pandemic, it is possible that the government will fail to consider the wider social implications of its impact. In particular, the limits to local governments becoming informed and making decisions without mediation by the National EOC will further impede community participation in health decision-making in the future. This implies that local knowledge and experiences will also not inform health policy.

Jordan's Public Policy Response to COVID-19 Pandemic: Insight and Policy Analysis

The aim of this study was to gain an understanding of how the Jordanian government has responded and continues to respond to the COVID-19 pandemic. It utilizes the interpretive policy analysis approach through document analysis. The analysis showed that Jordan created social protection policies to assist people who lost their jobs or whose work was suspended due to the coronavirus. The economic policies build solidarity and facilitate the private sector’s recovery. The health care measures firmly applied included lockdown, wearing masks, and restrictions on gatherings and public events. Jordan uses hard power and imposes sanctions on any violation that threatens the lives of others.

Institutional Engagement Practices as Barriers to Public Health Capacity in Climate Change Policy Discourse: Lessons from the Canadian Province of Ontario

Public health engagement in the communication, discussion, and development of climate change policies is essential for climate change policy decisions and discourse. This study examines how the existing governance approaches impact, enable, or constrain the inclusion, participation, and deliberation of public health stakeholders in the climate change policy discourse. Using the case study of the Canadian Province of Ontario, we conducted semi-structured, key informant interviews of public health (11) and non-public health (13) participants engaged in climate change policies in the province. The study results reveal that engagement and partnerships on climate change policies occurred within and across public health and non-public health organizations in Ontario. These engagements impacted public health's roles, decisions, mandate, and capacities beyond the climate change discourse; enabled access to funds, expertise, and new stakeholders; built relationships for future engagements; supported knowledge sharing, generation, and creation; and advanced public health interests in political platforms and decision making. However, public health's participation and deliberation were constrained by a fragmented sectoral approach, a lack of holistic inter-organizational structures and process, political and bureaucratic influences, irregular and unestablished communication channels for public health integration, and identities and culture focused on functions, mandates, biased ideologies, and a lack of clear commitment to engage public health. We conclude by providing practical approaches for integrating public health into climate change discourse and policymaking processes and advancing public health partnerships and collaborative opportunities.

National Health Policy Reform for Primary Care in Chile: A Qualitative Analysis of the Health Program Documents

Introduction: Chilean policy makers reformed the national health policy for primary health care (PHC), shifting from the traditional biomedical model to the integral family and community health model with a biopsychosocial approach, to guide the delivery of PHC throughout the country. Purpose: To evaluate the implementation of the national health policy for PHC through an analysis of the program documents for PHC; and to identify to what extent the national health policy is expressed in each program document, and across all the documents. Methods: A qualitative document analysis with a purposive sample of program documents for PHC. The Chilean Ministry of Health website was systematically searched between October and December 2018 to identify relevant program documents. Thematic and content analysis were performed to identify evidence of the biopsychosocial approach to care delivery with each program document, including the types of interactions between professionals that contribute to person-centered or fragmented care. Results: The study included 13 PHC program documents. Three themes and 10 categories emerged from the data. Most program justifications focused on the biopsychosocial approach to care while including biomedical interventions and supporting independent professional work. Only 4 of the 13 programs were consistent in the justification, interventions, and types of stated professional interactions: 2 from the biopsychosocial and 2 from the biomedical perspectives. Conclusion: In terms of the national health policy for PHC in Chile, interprofessional collaboration and person-centered care processes and practices were partially aligned with the written content of the health program documents. As such, policy makers and health sector leaders are advised to analyze draft health program documents for consistency in translating national health policies into the written communications that define the actualization of the care model in PHC and direct professionals how to provide PHC to individuals and families.