Factors of the policy process influencing Health in All Policies in local government: A scoping review

Health Equity in All Urban Policies: A Case Study of Richmond, California

Local governments working in partnership with communities can institutionalize practices that promote health equity. We offer a case study of how one city in the US is implementing Health in All Policies (HiAP) with the explicit aim of promoting health equity. We use participant observations, original document reviews and interviews to describe how Richmond, California, is building new partnerships, programs and practices with community-based organizations and within government itself as part of the implementation of its HiAP Ordinance. We also report on indicators that were identified by community and government stakeholders for tracking progress toward improving place-based determinants of population health. We find that the responsibility for implementing Richmond's HiAP Ordinance rests on a new institution within local government and this entity is building new partnerships, promoting innovative policies and augmenting practices toward greater health equity. We also reveal how city governments and community partners can collaboratively track progress toward health equity using locally gathered data.

Use of the Delphi method as an instrument of community participation in health needs assessment

We conducted a comprehensive analysis of the usefulness of the Delphi technique for facilitating community participation in local health needs assessments within the Andalusian Local Health Action Network, Spain. We developed an ad hoc online questionnaire based on the Social Determinants of Health model and applied it to a panel of experts in two municipalities in the province of Seville (Andalusia, Spain) between May and June 2021. Our results reflected good panelist participation. The questionnaire successfully enabled the prioritization of both new and original items, some of which were incorporated into local health policies. We concluded that the Delphi method was effective for facilitating participation in local health needs assessments offering a replicable, cost-effective approach that accelerated local policy development and supported the implementation of Health in All Policies within local government.

To what extent is equity entrenched in HIV/AIDS-related policy documents in Ethiopia? A policy content analysis

INTRODUCTION

It is important to assess the extent of mentions of equity in policy and strategic documents for several reasons. First, it helps us understand the root causes of inequities, revealing both failures and successes. Second, it shows the readiness of stakeholders and leaders to take actions towards equity. Third, it identifies areas of improvement to plan strategies towards equity. The objective of this study was to assess the degree to which equity is incorporated in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)-related policy documents in Ethiopia.

METHODS

A policy content analysis was conducted on the basis of Marmot's social determinants of health framework. We have included policies, strategic plans, guidelines and reports on the basis of relevance to HIV/AIDS, timeliness and availability to the public. The search for documents took place between 1 March 2023 and 1 May 2023. The included documents in the content analysis were published between 1998 and 2022. These documents were accessed from Google, the Joint United Nations Programmes for HIV/AIDS, the WHO, the World Bank, the Ethiopian Federal Ministry of Health and the International Institute for Primary Health Care-Ethiopia websites. These documents were evaluated for mentioning equity in broader view or in relation to social categories (residence, occupation/employment, religion, sex/gender, ethnicity, education, income, region, age and multiple disadvantaged groups) and structural dimensions or health systems building blocks, such as health leadership and governance, workforce, financing, medical products and technologies and information systems. A Bardache's eightfold policy analysis guided the content analysis and synthesis of findings.

RESULTS

A total of 26 documents were reviewed and analysed. Mentions of equity in policy documents increased over time, but the level of mention varied among national plans, treatment guidelines and reports. Over time, the mentioning of equity increased in strategic plans and guidelines, while it decreased in reports. In the same documents, there seems to be a shift from equality to equity because mentions of (in)equity increased from 149 between 2011 and 2015 to 328 between 2016 and 2022, while (in)equality mentions declined from 117 to 53 during the same period. Equity was mentioned in relation to health system functions and/or social classes. Gender (in)equity was the most frequently mentioned issue, while (in)equity related to multiple disadvantaged groups, religion, employment status and social capital was less frequently mentioned. (In)equity is deeply embedded in health system governance, but it is least integrated into the health information system.

CONCLUSIONS

The mentioning and consideration of (in)equity in policy and strategic documents have increased over time, but not consistently or comprehensively. Growing emphasis has been placed on equity rather than equality. The shift from equality to equity in HIV/AIDS policy documents reflects a more nuanced understanding of the diverse needs of individuals and groups. More attention is given to gender issues and health system governance than to other dimensions of equity. It is vital that policy-makers revise their HIV/AIDS-related policy documents to promote health equity for all social strata, particularly among multiple disadvantaged groups. Health information systems should be designed in such a way that they generate and manage information to assess the extent of (in)equity and the progress towards equity in HIV/AIDS services.

Interrogating Healthy Community Discourse in Municipal Policies: Priorities of a Medium-Sized CMA in Ontario, Canada

The World Health Organization's Healthy Cities movement recommends action on the determinants of health and health equity. While economic and ecological circumstances have been studied with respect to health outcomes, research shows that the relationship between these broad determinants and population health is not always clear. Municipal governments, whose relative proximity to individuals means that they are optimally situated to address local health concerns, can demonstrate political will for healthy communities by developing health community policies. Therefore, the aim of this study is to interrogate how the idea of a 'healthy community' has been conceptualized by municipal governments in order to inform the future uptake of the concept. This study uses a post-structural policy analysis to examine government discourse on healthy communities in a medium-sized census metropolitan area (CMA) in Ontario, Canada. The findings highlight economic growth and ecological sustainability as priorities for fostering a healthy community. With emphasis on long-standing issues linking health outcomes to broader societal conditions, this study calls on municipal governments to explicitly consider the health impacts of healthy community strategies and adoption of a Health-in-All-Policies (HiAP) approach.

"Equity" in genomic health policies: a review of policies in the international arena

Introduction

The field of genomics is rapidly evolving and has made significant impact on the diagnosis and understanding of rare and genetic diseases, in guiding precision medicine in cancer treatment, and in providing personalized risk assessment for disease development and treatment responses. However, according to the literature, there is widespread socio economic and racial inequities in the diagnosis, treatment, and in the use of genomic medicine services. This policy review sets out to explore the concept of equity in access to genomic care, the level of inclusion of equity and how it is addressed and what mechanisms are in place to achieve equity in genomic care in the international health policy.

Methods

A systematic search for genomic policies was conducted using 3 databases. In addition, General and Specific Policy Repositories, Global Consortia in Genomic Medicine, WHO Collaborating Centers in Genomics, Australian Genomics, Public Policy Projects, Global Genomic Medicine Consortium (G2MC), G2MC conference Oct 2023 and National Human Genome Research Institute databases were searched using the inclusion and exclusion criteria. Seventeen policies were selected and analyzed using the EquiFrame.

Results

The Core Concept of access is highly cited in most of the selected policies. The CCs that are covered to a lesser degree are participation, quality, coordination of services, cultural responsiveness and non-discrimination. The CCs of liberty and entitlement are not addressed in any of the selected policies. The coverage of vulnerable communities in the policies varies from country to country.

Discussion

Genomic health science is rapidly evolving and presents a major challenge for policies to remain current and effectively address new discoveries in the field. There is a relative dearth of policies that focus on clinical genetic services which may reflect a gap in policy and policy research translation and implementation. Recommendations for countries, irrespective of their economic and social contexts, include conducting regular policy reviews to accommodate the advances in genomics field and inclusion of specific mechanisms to achieve equity in genomic health. Insights and experiences in achieving healthcare equity in HICs and LMICs can offer valuable lessons for each other.

The pathway to health in all policies through intersectoral collaboration on the health workforce: a scoping review

The health workforce (HWF) is a critical component of the health sector. Intersectoral/multisectoral collaboration and action is foundational to strengthening the HWF, enabling responsiveness to dynamic population health demands and supporting broader goals around social and economic development-such development underpins the need for health in all policies (HiAP). To identify what can be learned from intersectoral/multisectoral activity for HWF strengthening to advance HiAP, we carried out a scoping review. Our review included both peer-reviewed and grey literature. Search terms encompassed terminology for the HWF, intersectoral/multisectoral activities and governance or management. We carried out a framework analysis, extracting data around different aspects of HiAP implementation. With the aim of supporting action to advance HiAP, our analysis identified core recommendations for intersectoral/multisectoral collaboration for the HWF, organized as a 'pathway to HiAP'. We identified 93 documents-67 (72%) were journal articles and 26 (28%) were grey literature. Documents reflected a wide range of country and regional settings. The majority (80, 86%) were published within the past 10 years, reflecting a growing trend in publications on the topic of intersectoral/multisectoral activity for the HWF. From our review and analysis, we identified five areas in the 'pathway to HiAP': ensure robust coordination and leadership; strengthen governance and policy-making and implementation capacities; develop intersectoral/multisectoral strategies; build intersectoral/multisectoral information systems and identify transparent, resources financing and investment opportunities. Each has key practical and policy implications. Although we introduce a 'pathway', the relationship between the areas is not linear, rather, they both influence and are influenced by one another, reflecting their shared importance. Underscoring this 'pathway' is the shared recognition of the importance of intersectoral/multisectoral activity, shared vision and political will. Advancing health 'for' all policies-generating evidence about best practices to identify and maximize co-benefits across sectors-is a next milestone.

Local government's roles in community health and wellbeing in Australia: Insights from Tasmania

ISSUE ADDRESSED

Local governments are well-placed to respond to communities' health and wellbeing needs. However, in the Australian state of Tasmania, the sector's roles in that respect are unclear.

METHODS

We interviewed 10 municipal personnel in Tasmania to understand their views on local governments' community health and wellbeing functions.

RESULTS

Participants had an integrative understanding of community health and wellbeing and recognised that collective effort from all tiers of government, community members, and other place-based stakeholders would improve outcomes. They identified several roles local governments have to support and drive such improvements, including in relation to diverse place-specific determinants of health and wellbeing. Capacity and capability to fulfil what is needed varied, with rural and remote councils generally less able than urban counterparts to respond consistently or comprehensively to community members' complex needs. However, in the presence of clear expectations and parameters, and appropriate support from other tiers of government, participants were eager for their councils to do more to improve their communities' health and wellbeing, including via a mandate in legislation.

CONCLUSION

Local governments have the potential to do more to improve health and wellbeing outcomes in Tasmania, and the greatest gains could be made by addressing spatial inequalities faced by the sector. That insight is extensible to other comparable jurisdictions. SO WHAT?: We argue the need both for a shared societal goal of equitable wellbeing supported by all tiers of government and for actions proportionate to the needs of council areas.

Public health practitioners as policy advocates: skills, attributes and development needs

Effecting policy change is a key strategy in tackling wider determinants of health. In England, public health sits within Local Authorities (LAs) and responsibility for ensuring health is considered across directorates increasingly falls to public health practitioners. While international professional standards expect competence in understanding policy processes, the advocacy role has been under-explored. This paper explores the professional skills, role characteristics and learning needs of practitioners advocating for the restriction of advertising high-fat, salt and sugar products in a region of England. A series of three interviews were conducted at three time points over 10 months with policy advocates leading this policy change from four LAs. Three focus groups were also held with 12 public health advocates from 10 LAs at the end of the 10-month period of data collection. Data were transcribed and analysed retroductively. Data showed that practitioners felt inexperienced as policy advocates and saw this work as different from other public health approaches. Successful advocates required interpersonal skills, knowledge of policy-making and local governance, determination, resilience, confidence, belief in their work's value and leadership. These skills were difficult to acquire through formal education, but advocacy training, mentorship and role modelling were seen as important for professional development. To successfully implement a Health in all Policies approach and address wider determinants of health, public health practitioners need to be equipped and supported as policy advocates. The advocacy role and the complex skills required need to be more fully understood by the public health profession and prioritized within workforce development at both local and national levels.