1
|
Waller D, Kang M, Gibson S, Brooks F, Medlow S, Steinbeck K, Perry L. Development and implementation of Australian State, territory, and national policy on the health and wellbeing of adolescents and young adults: An exploration of policy actor perspectives using the Consolidated Framework for Implementation Research. Aust N Z J Public Health 2024; 48:100112. [PMID: 38198902 DOI: 10.1016/j.anzjph.2023.100112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 09/20/2023] [Accepted: 11/21/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVES Government policies that support the health and wellbeing of young people (aged 10 to 25) can have important individual and societal impacts. The aim of this study was to explore policy actor perspectives on the development and implementation of Australian government policies focussed on the health and wellbeing of young people. METHODS We utilised a qualitative research design consisting of semi-structured interviews with policy actors with experience working with Australian youth health policies. Our interview guide and analyses were informed by the Consolidated Framework for Implementation Research (CFIR). We interviewed 19 participants from various national, state, and territory bodies. RESULTS Several specific barriers and facilitators to policy development and implementation were identified using the Consolidated Framework for Implementation Research. Key policy development barriers were limited available resources (e.g. staffing and funding) and low relative priority within health and political systems. Key policy implementation barriers were limited available resources, limited policy compatibility with health services, cosmopolitanism issues related to interagency collaboration, and a lack of policy evaluation. Meaningful engagement of young people could also be improved. CONCLUSIONS Although Australian youth health policies are perceived as evidence-based and comprehensively developed, the ability to promote implementation remains stalled. IMPLICATIONS FOR PUBLIC HEALTH The development of policy implementation plans, monitoring and evaluation mechanisms, funding and resources, and a strong commitment to removing barriers to working across multiple departments and systems is required to improve outcomes for young people.
Collapse
Affiliation(s)
- Daniel Waller
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, 2006, Australia; The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, 2145, Australia.
| | - Melissa Kang
- The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, 2145, Australia
| | - Sally Gibson
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, 2006, Australia
| | - Fiona Brooks
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, 2007, Australia; Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, 0627, New Zealand
| | - Sharon Medlow
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, 2006, Australia; The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, 2145, Australia
| | - Katharine Steinbeck
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, 2006, Australia; The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, 2145, Australia
| | - Lin Perry
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, 2007, Australia
| |
Collapse
|
2
|
Layani G, Tremblay A, Lussier MT, Godbout I, Bihan H, Gosselin C, Pierre M, Motulsky A, Brault I, Rodrigues I, Kaczorowski J, Vanier MC, Yapi SM. Cross-Sector Collaboration to Improve Access to Community Services for People Living With Diabetes: Contributions From Actor-Network Theory. Health Serv Insights 2024; 17:11786329231222408. [PMID: 38288094 PMCID: PMC10823851 DOI: 10.1177/11786329231222408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 12/07/2023] [Indexed: 01/31/2024] Open
Abstract
Diabetes is a global public health issue. The Public Health Agency of Canada published a Diabetes Framework 2022 which recommends collaborative work across sectors to mitigate the impact of diabetes on health and quality of life. Since 2020, the INMED-COMMUNITY pathway has been implemented in Laval, Québec developing collaboration between healthcare and community sectors through a participatory action research approach. The aim of this article is to gain a better understanding of the INMED-COMMUNITY pathway implementation process, based on the mobilization of network actor theory. Qualitative analysis of semi-structured interviews conducted from January to March 2023 with 12 participants from 3 different sectors (community, health system, research), were carried out using actor-network theory. The results explored the conditions for effective intersectoral collaboration in a participatory action research approach to implement the INMED-COMMUNITY pathway. These were: (1) contextualization of the project, (2) a consultation approach involving various stakeholders, (3) creation of new partnerships, (4) presence of a project coordinator, and (5) mobilization of stakeholders around a common definition of diabetes. Mediation supported by a project coordinator contributed to the implementation of an intersectoral collaborative health intervention, largely due to early identification of controversies.
Collapse
Affiliation(s)
- Géraldine Layani
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montreal, Montreal, QC, Canada
- Research Centre of the University of Montreal, Montréal, QC, Canada
- Pôle 1, Centre de recherche des pratiques cliniques et organisationnelles du Centre intégré de santé et de services sociaux de Laval, Laval, QC, Canada
| | | | - Marie-Thérèse Lussier
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montreal, Montreal, QC, Canada
- Research Centre of the University of Montreal, Montréal, QC, Canada
| | | | - Hélène Bihan
- Avicenne hospital, Bobigny, France
- Health Education and Practices Laboratory, Université Paris 13, Paris, France
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
| | - Claire Gosselin
- Research Centre of the University of Montreal, Montréal, QC, Canada
| | - Mégane Pierre
- Research Centre of the University of Montreal, Montréal, QC, Canada
| | - Aude Motulsky
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
- Department of Management, School of Public Health, Université de Montréal, Montreal, QC, Canada
| | - Isabelle Brault
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
- Department of Management, School of Public Health, Université de Montréal, Montreal, QC, Canada
| | - Isabel Rodrigues
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montreal, Montreal, QC, Canada
- Pôle 1, Centre de recherche des pratiques cliniques et organisationnelles du Centre intégré de santé et de services sociaux de Laval, Laval, QC, Canada
| | - Janusz Kaczorowski
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montreal, Montreal, QC, Canada
- Research Centre of the University of Montreal, Montréal, QC, Canada
| | - Marie-Claude Vanier
- Pôle 1, Centre de recherche des pratiques cliniques et organisationnelles du Centre intégré de santé et de services sociaux de Laval, Laval, QC, Canada
- Health Education and Practices Laboratory, Université Paris 13, Paris, France
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
| | | |
Collapse
|
3
|
Chiari APG, Senna MIB, Gomes VE, Freire MDSM, Soares ARDS, Alves CRL, Cury GC, Ferreira RC. Intersectoral Collaboration to Promote Child Development: The Contributions of the Actor-Network Theory. QUALITATIVE HEALTH RESEARCH 2023; 33:451-467. [PMID: 37010148 PMCID: PMC10126467 DOI: 10.1177/10497323231153534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
An integrated intersectoral care model promises to meet complex needs to promote early child development and address health determinants and inequities. Nevertheless, there is a lack of understanding of actors' interactions in producing intersectoral collaboration networks. The present study aimed to analyze the intersectoral collaboration in the social protection network involved in promoting early child growth and development in Brazilian municipalities. Underpinned by the tenets of actor-network theory, a case study was conducted with data produced from an educational intervention, entitled "Projeto Nascente." Through document analysis (ecomaps), participant observation (in Projeto Nascente seminars), and interviews (with municipal management representatives), our study explored and captured links among actors; controversies and resolution mechanisms; the presence of mediators and intermediaries; and an alignment of actors, resources, and support. The qualitative analysis of these materials identified three main themes: (1) agency fragility for intersectoral collaboration, (2) attempt to form networks, and (3) incorporation of fields of possibilities. Our findings revealed that intersectoral collaboration for promoting child growth and development is virtually non-existent or fragile, and local potential is missed or underused. These results emphasized the scarcity of action by mediators and intermediaries to promote enrollment processes to intersectoral collaboration. Likewise, existing controversies were not used as a mechanism for triggering changes. Our research supports the need to mobilize actors, resources, management, and communication tools that promote processes of interessement and enrollment in favor of intersectoral collaboration policies and practices for child development.
Collapse
Affiliation(s)
- Antônio Paulo Gomes Chiari
- Universidade Federal de Minas
Gerais, Belo Horizonte, Brazil
- Antônio Paulo Gomes Chiari, Department of Social
and Preventive Dentistry, Universidade Federal de Minas Gerais, Av. Presidente Antônio
Carlos, 6627, Belo Horizonte 31270-901, Brazil.
| | | | | | | | | | | | | | | |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Greer SL, Falkenbach M, Siciliani L, McKee M, Wismar M, Figueras J. From Health in All Policies to Health for All Policies. Lancet Public Health 2022; 7:e718-e720. [PMID: 35907422 PMCID: PMC9330081 DOI: 10.1016/s2468-2667(22)00155-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/09/2022] [Accepted: 06/09/2022] [Indexed: 12/14/2022]
Abstract
Worldwide responses to the COVID-19 pandemic have shown that it is possible for politicians to come together across departmental boundaries. To this end, in many countries, heads of government and their health ministers work closely with all other ministries, departments, and sectors, including social affairs, internal affairs, foreign affairs, research and education, transport, agriculture, business, and state aid. In this Viewpoint, we ask if and how the Sustainable Development Goals (SDGs) can support intersectoral collaboration to promote health, since governments have already committed to achieving them. We contend that SDGs can do so, ultimately advancing health while offering co-benefits across society.
Collapse
Affiliation(s)
- Scott L Greer
- Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Michelle Falkenbach
- Department of Public and Ecosystem Health, Cornell University, Ithaca, NY, USA,Correspondence to: Dr Michelle Falkenbach, Department of Public and Ecosystem Health, Cornell University, Ithaca, NY 14853, USA
| | - Luigi Siciliani
- Department of Economics and Related Studies, University of York, York, UK
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Matthias Wismar
- European Observatory on Health Systems and Policies, Brussels, Belgium
| | - Josep Figueras
- European Observatory on Health Systems and Policies, Brussels, Belgium
| |
Collapse
|
6
|
Lanford D, Petiwala A, Landers G, Minyard K. Aligning healthcare, public health and social services: A scoping review of the role of purpose, governance, finance and data. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:432-447. [PMID: 34018268 PMCID: PMC9291477 DOI: 10.1111/hsc.13374] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/28/2021] [Accepted: 03/10/2021] [Indexed: 06/01/2023]
Abstract
Organisations spanning social services, public health and healthcare have increasingly experimented with collaboration as a tool for improving population health and reducing health disparities. While there has been progress, the results have fallen short of expectations. Reflecting on these shortcomings, the Robert Wood Johnson Foundation (RWJF) recently proposed a new framework for cross-sector alignment intended to move the field towards improved outcomes. A central idea in this framework is that collaboratives will be more effective and sustainable if they develop collaborative systems in four core areas: shared purpose, governance, finance and shared data. The goal of this paper is to provide a foundation for research on the four core areas of the cross-sector alignment framework. Accordingly, this study is based on two guiding questions: (1) how are collaboratives currently implementing systems in the four core areas identified in the framework, and (2) what strategies does the literature offer for creating sustainable systems in these four areas? Given the emergent nature of research on health-oriented cross-sector collaboration and the broad research questions, we conducted a systematic scoping review including 179 relevant research papers and reports published internationally from the years 2010-2020. We identified the main contributions and coded each based on its relevance to the cross-sector alignment framework. We found that most papers focused on programme evaluations rather than theory testing, and while many strategies were offered, they tended to reflect a focus on short-term collaboration. The results also demonstrate that starting points and resource levels vary widely across individuals and organisations involved in collaborations. Accordingly, identifying and comparing distinct pathways by which different parties might pursue cross-sector alignment is an imperative for future work. More broadly, the literature is ripe with observations that could be assessed systematically to produce a firm foundation for research and practice.
Collapse
Affiliation(s)
- Daniel Lanford
- Georgia Health Policy CenterAndrew Young School of Policy StudiesGeorgia State UniversityAtlantaGAUSA
| | - Aliza Petiwala
- Georgia Health Policy CenterAndrew Young School of Policy StudiesGeorgia State UniversityAtlantaGAUSA
| | - Glenn Landers
- Georgia Health Policy CenterAndrew Young School of Policy StudiesGeorgia State UniversityAtlantaGAUSA
| | - Karen Minyard
- Georgia Health Policy CenterAndrew Young School of Policy StudiesGeorgia State UniversityAtlantaGAUSA
| |
Collapse
|
7
|
Khalturina DA, Zykov VA, Zubkova TS. “Health in All Policies” Approach and Health Impact Assessment in Russia and the world. Public Health 2022. [DOI: 10.21045/2782-1676-2021-1-4-15-33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study presents analysis of the international and Russian experience of implementation of “health in all policies” approach into legislation, as well as of health impact assessment. Certain steps towards the implementation of this approach have already been made in Russia, however, in general, there is still a lot to be done. It was revealed that the current system regulatory impact assessment (RIA) in Russia has a narrow focus and is focused on protecting the interests of business, which does not correspond to the well-established world practice, which presupposes complex RIA, including the impact of regulation on public health. Recommendations for strengthening the principle of “health by all policies” in Russian legislation and the introduction of the practice of assessing the regulatory impact on public health in Russia are presented.
Collapse
Affiliation(s)
- D. A. Khalturina
- Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation
| | - V. A. Zykov
- Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation
| | - T. S. Zubkova
- Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation
| |
Collapse
|
8
|
Cairney P, St Denny E, Mitchell H. The future of public health policymaking after COVID-19: a qualitative systematic review of lessons from Health in All Policies. OPEN RESEARCH EUROPE 2021; 1:23. [PMID: 37645203 PMCID: PMC10445916 DOI: 10.12688/openreseurope.13178.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 08/31/2023]
Abstract
Background: 'Health in All Policies' (HiAP) describes the pursuit of health equity. It has five main elements: treat health as a human right; identify evidence of the 'social determinants' of health inequalities, recognise that most powers to affect health are not held by health departments, promote intersectoral policymaking and collaboration inside and outside of government, and generate political will. Studies describe its potential but bemoan a major implementation gap. Some HiAP scholars learn from policymaking research how to understand this gap, but the use of policy theories is patchy. In that context, our guiding research question is: How does HiAP research use policy theory to understand policymaking? It allows us to zoom-out to survey the field and zoom-in to identify: the assumed and actual causes of policy change, and transferable lessons to HiAP scholars and advocates. Methods: Our qualitative systematic review (two phases, 2018 and 2020) identified 4972 HiAP articles. Of these, 113 journal articles (research and commentary) provide a non-trivial reference to policymaking (at least one reference to a policymaking concept). We use the 113 articles to produce a general HiAP narrative and explore how the relatively theory-informed articles enhance it. Results: Most articles focus on policy analysis (identifying policy problems and solutions) rather than policy theory (explaining policymaking dynamics). They report a disappointing gap between HiAP expectations and policy outcomes. Theory-informed articles contribute to a HiAP playbook to close that gap or a programme theory to design and evaluate HiAP in new ways. Conclusions: Few HiAP articles use policy theories for their intended purpose. Policy theories provide lessons to aid critical reflection on power, political dilemmas, and policymaking context. HiAP scholars seek more instrumental lessons, potentially at the cost of effective advocacy and research.
Collapse
Affiliation(s)
- Paul Cairney
- History, Heritage, and Politics, University of Stirling, Stirling, FK94LA, UK
| | - Emily St Denny
- Department of Political Science, University of Copenhagen, Copenhagen, DK-1353, Denmark
| | - Heather Mitchell
- History, Heritage, and Politics, University of Stirling, Stirling, FK94LA, UK
- Faculty of Health Sciences, University of Stirling, Stirling, FK94LA, UK
| |
Collapse
|
9
|
Cairney P, St Denny E, Mitchell H. The future of public health policymaking after COVID-19: a qualitative systematic review of lessons from Health in All Policies. OPEN RESEARCH EUROPE 2021; 1:23. [PMID: 37645203 PMCID: PMC10445916 DOI: 10.12688/openreseurope.13178.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 08/31/2023]
Abstract
Background: 'Health in All Policies' (HiAP) describes the pursuit of health equity. It has five main elements: treat health as a human right; identify evidence of the 'social determinants' of health inequalities, recognise that most powers to affect health are not held by health departments, promote intersectoral policymaking and collaboration inside and outside of government, and generate political will. Studies describe its potential but bemoan a major implementation gap. Some HiAP scholars learn from policymaking research how to understand this gap, but the use of policy theories is patchy. In that context, our guiding research question is: How does HiAP research use policy theory to understand policymaking? It allows us to zoom-out to survey the field and zoom-in to identify: the assumed and actual causes of policy change, and transferable lessons to HiAP scholars and advocates. Methods: Our qualitative systematic review (two phases, 2018 and 2020) identified 4972 HiAP articles. Of these, 113 journal articles (research and commentary) provide a non-trivial reference to policymaking (at least one reference to a policymaking concept). We use the 113 articles to produce a general HiAP narrative and explore how the relatively theory-informed articles enhance it. Results: Most articles focus on policy analysis (identifying policy problems and solutions) rather than policy theory (explaining policymaking dynamics). They report a disappointing gap between HiAP expectations and policy outcomes. Theory-informed articles contribute to a HiAP playbook to close that gap or a programme theory to design and evaluate HiAP in new ways. Conclusions: Few HiAP articles use policy theories for their intended purpose. Policy theories provide lessons to aid critical reflection on power, political dilemmas, and policymaking context. HiAP scholars seek more instrumental lessons, potentially at the cost of effective advocacy and research.
Collapse
Affiliation(s)
- Paul Cairney
- History, Heritage, and Politics, University of Stirling, Stirling, FK94LA, UK
| | - Emily St Denny
- Department of Political Science, University of Copenhagen, Copenhagen, DK-1353, Denmark
| | - Heather Mitchell
- History, Heritage, and Politics, University of Stirling, Stirling, FK94LA, UK
- Faculty of Health Sciences, University of Stirling, Stirling, FK94LA, UK
| |
Collapse
|