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Klepac B, Mowle A, Riley T, Craike M. Government, governance, and place-based approaches: lessons from and for public policy. Health Res Policy Syst 2023; 21:126. [PMID: 38031069 PMCID: PMC10685506 DOI: 10.1186/s12961-023-01074-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Place-based approaches are increasingly applied to address the determinants of health, many of which are complex problems, to ultimately improve population health outcomes. Through public policy, government actions can affect the effectiveness of place-based approaches by influencing the conceptualisation, development, implementation, governance, and/or evaluation of place-based approaches. Despite the important role of public policy, there has been limited examination of public policy related to place-based approaches. We add to the limited knowledge base by analysing Australian national public policy, to explore: (1) the definitions, conceptualisations, and characteristics of place-based approaches in public policy; (2) the government's perception and communication of its role in place-based approaches; and (3) the extent to which government policy reflects the necessary conditions for successful place-based governance developed by Marsh and colleagues, namely localised context, embedded learning, and reciprocal accountability. METHODS This research was underpinned by the Theory of Systems Change and methodologically informed by the READ approach to document analysis. Ritchie and Spencer's framework method was utilised to analyse the data. RESULTS We identified and reviewed 67 policy documents. In terms of conceptualisation, common characteristics of place-based approaches related to collaboration, including community in decision-making, responsiveness to community needs, and suitability of place-based approaches to address complex problems and socio-economic determinants of health. Three roles of government were identified: funder, partner, and creator of a supportive policy environment. From the three criteria for successful place-based governance, localised context was the most dominant across the documents and reciprocal accountability the least. CONCLUSIONS Based on our findings, we drew key implications for public policy and research. There was a disproportionate emphasis on the bottom-up approach across the documents, which presents the risk of diminishing government interest in place-based approaches, potentially burdening communities experiencing disadvantage beyond their capacities. Governments engaged in place-based approaches should work towards a more balanced hybrid approach to place-based approaches that maintain the central functions of government while allowing for successful place-based governance. This could be achieved by promoting consistency in conceptualisations of 'place-based', employing an active role in trust building, advancing the creation of a supportive policy environment, and embedding 'learning' across place-based approaches.
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Affiliation(s)
- Bojana Klepac
- Mitchell Institute for Education and Health Policy, Victoria University, Footscray Park Campus, Pathways in Place, Melbourne, VIC, Australia.
| | - Amy Mowle
- Mitchell Institute for Education and Health Policy, Victoria University, Footscray Park Campus, Pathways in Place, Melbourne, VIC, Australia
| | - Therese Riley
- Mitchell Institute for Education and Health Policy, Victoria University, Footscray Park Campus, Pathways in Place, Melbourne, VIC, Australia
| | - Melinda Craike
- Mitchell Institute for Education and Health Policy, Victoria University, Footscray Park Campus, Pathways in Place, Melbourne, VIC, Australia
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
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Krist AH, South Paul JE, Hudson SV, Meisnere M, Singer SJ, Kudler H. Rethinking Health and Health Care: How Clinicians and Practice Groups Can Better Promote Whole Health and Well-Being for People and Communities. Med Clin North Am 2023; 107:1121-1144. [PMID: 37806727 DOI: 10.1016/j.mcna.2023.06.001] [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] [Indexed: 10/10/2023]
Abstract
A new National Academies of Sciences, Engineering, and Medicine report, "Achieving Whole Health: A New Approach for Veterans and the Nation," redefines what it means to be healthy and creates a roadmap for health systems, including the Veterans Health Administration and the nation, to scale and spread a whole health approach to care. The report identifies 5 foundational elements for whole health care and sets 6 national, state, and local policy goals for change. This article summarizes the report, emphasizes the importance of preventive medicine, and identifies concrete actions clinicians and practices can take now to deliver whole health care.
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Affiliation(s)
- Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Wright Regional Center for Clinical and Translational Science, Inova Health System.
| | | | - Shawna V Hudson
- Department of Family Medicine and Community Health, Robert Wood Johnson Medical School
| | - Marc Meisnere
- National Academies of Sciences, Engineering, and Medicine
| | - Sara J Singer
- Department of Medicine, Stanford University School of Medicine
| | - Harold Kudler
- Department of Psychiatry and Behavioral Sciences, Duke University; Department of Psychiatry, Uniformed Services University of the Health Sciences
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Khatri RB, Erku D, Endalamaw A, Wolka E, Nigatu F, Zewdie A, Assefa Y. Multisectoral actions in primary health care: A realist synthesis of scoping review. PLoS One 2023; 18:e0289816. [PMID: 37561811 PMCID: PMC10414560 DOI: 10.1371/journal.pone.0289816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/27/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Multisectoral actions (MSAs) on health are key to implementation of primary health care (PHC) and achieving the targets of the Sustainable Development Goal 3. However, there is limited understanding and interpretation of how MSAs on health articulate and mediate health outcomes. This realist review explored how MSAs influence on implementing PHC towards universal health coverage (UHC) in the context of multilevel health systems. METHODS We reviewed published evidence that reported the MSAs, PHC and UHC. The keywords used in the search strategy were built on these three key concepts. We employed Pawson and Tilley's realist review approach to synthesize data following Realist and Meta-narrative Evidence Syntheses: Evolving Standards publication standards for realist synthesis. We explained findings using a multilevel lens: MSAs at the strategic level (macro-level), coordination and partnerships at the operational level (meso-level) and MSAs employing to modify behaviours and provide services at the local level (micro-level). RESULTS A total of 40 studies were included in the final review. The analysis identified six themes of MSAs contributing to the implementation of PHC towards UHC. At the macro-level, themes included influence on the policy rules and regulations for governance, and health in all policies for collaborative decision makings. The meso-level themes were spillover effects of the non-health sector, and the role of community health organizations on health. Finally, the micro-level themes were community engagement for health services/activities of health promotion and addressing individuals' social determinants of health. CONCLUSION Multisectoral actions enable policy and actions of other sectors in health involving multiple stakeholders and processes. Multisectoral actions at the macro-level provide strategic policy directions; and operationalise non-health sector policies to mitigate their spillover effects on health at the meso-level. At micro-level, MSAs support service provision and utilisation, and lifestyle and behaviour modification of people leading to equity and universality of health outcomes. Proper functional institutional mechanisms are warranted at all levels of health systems to implement MSAs on health.
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Affiliation(s)
- Resham B. Khatri
- School of Public Health, the University of Queensland, Brisbane, Australia
- Health Social Science and Development Research Institute, Kathmandu, Nepal
| | - Daniel Erku
- Centre for Applied Health Economics, School of Medicine, Griffith University, Nathan, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Australia
| | - Aklilu Endalamaw
- School of Public Health, the University of Queensland, Brisbane, Australia
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Eskinder Wolka
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Frehiwot Nigatu
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Anteneh Zewdie
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, the University of Queensland, Brisbane, Australia
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Yang Y, Tang J, Li Z, Wen J. How effective is the health promotion policy in Sichuan, China: based on the PMC-Index model and field evaluation. BMC Public Health 2022; 22:2391. [PMID: 36539758 PMCID: PMC9764584 DOI: 10.1186/s12889-022-14860-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Many countries around the world highlight the health in all policies (HiAP). However, most of the related research focused on the influential factors and implementation strategies, with less concern on the evaluation of HiAP. In response to HiAP's call, the Chinese government has proposed health promotion policies (HPPs) in counties or districts, the evaluation of HPPs in sample counties or districts of Sichuan province in China is an essential basis for optimizing policy content, improving policy implementation, and ensuring health promotion's continuous and efficient operation. METHODS This paper established an evaluation system for HPPs based on the PMC-Index model and then quantitatively analyzed 37 representative HPPs from the pilot areas in Sichuan province. In addition, a team of experts conducted a field assessment. RESULTS The results showed that the average PMC index of 37 HPPs was 7.091, and correlation analysis showed that there was a significant correlation between the PMC index and expert score. CONCLUSIONS This study indicates that the overall consistency of HPPs was good and proves a connection between the formulation and implementation of HPPs.
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Affiliation(s)
- Yanlin Yang
- grid.412901.f0000 0004 1770 1022Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, 610041 China
| | - Jing Tang
- grid.412901.f0000 0004 1770 1022Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, 610041 China
| | - Zhixin Li
- grid.419221.d0000 0004 7648 0872Sichuan Center for Disease Control and Prevention, Chengdu, 610041 China
| | - Jin Wen
- grid.412901.f0000 0004 1770 1022Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, 610041 China
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Such E, Smith K, Woods HB, Meier P. Governance of Intersectoral Collaborations for Population Health and to Reduce Health Inequalities in High-Income Countries: A Complexity-Informed Systematic Review. Int J Health Policy Manag 2022; 11:2780-2792. [PMID: 35219286 PMCID: PMC10105187 DOI: 10.34172/ijhpm.2022.6550] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 01/30/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND A 'Health in All Policies' (HiAP) approach has been widely advocated as a way to involve multiple government sectors in addressing health inequalities, but implementation attempts have not always produced the expected results. Explaining how HiAP-style collaborations have been governed may offer insights into how to improve population health and reduce health inequalities. METHODS Theoretically focused systematic review. Synthesis of evidence from evaluative studies into a causal logic model. RESULTS Thirty-one publications based on 40 case studies from nine high-income countries were included. Intersectoral collaborations for population health and equity were multi-component and multi-dimensional with collaborative activity spanning policy, strategy, service design and service delivery. Governance of intersectoral collaboration included structural and relational components. Both internal and external legitimacy and credibility delivered collaborative power, which in turn enabled intersectoral collaboration. Internal legitimacy was driven by multiple structural elements and processes. Many of these were instrumental in developing (often-fragile) relational trust. Internal credibility was supported by multi-level collaborations that were adequately resourced and shared power. External legitimacy and credibility was created through meaningful community engagement, leadership that championed collaborations and the identification of 'win-win' strategies. External factors such as economic shocks and short political cycles reduced collaborative power. CONCLUSION This novel review, using systems thinking and causal loop representations, offers insights into how collaborations can generate internal and external legitimacy and credibility. This offers promise for future collaborative activity for population health and equity; it presents a clearer picture of what structural and relational components and dynamics collaborative partners can focus on when planning and implementing HiAP initiatives. The limits of the literature base, however, does not make it possible to identify if or how this might deliver improved population health or health equity.
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Affiliation(s)
- Elizabeth Such
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | | | - Petra Meier
- MRC/CSA Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Hu C, Tkebuchava T. Health in All Laws: A better strategy for global health. J Evid Based Med 2022; 15:10-14. [PMID: 35416434 DOI: 10.1111/jebm.12469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 03/18/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Chunsong Hu
- Department of Cardiovascular Medicine, Hospital of Nanchang University, Jiangxi Academy of Medical Science, Nanchang University, Nanchang, Jiangxi, China
| | - Tengiz Tkebuchava
- Office of the President/CEO, Boston TransTec, LLC, Boston, Massachusetts
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Baum F. How can health promotion contribute to pulling humans back from the brink of disaster? Glob Health Promot 2021; 28:64-72. [PMID: 34711103 DOI: 10.1177/17579759211044074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Health promotion has evolved over the last decades from a primary focus on behaviour change to establishing an ambitious goal of creating healthy, fair and sustainable environments in a manner which realises the rights of all people to health and well-being while protecting the health of our planet and its ecosystems. This paper argues that in order to contribute to this ambitious goal, health promotion must address three key tasks. The first is the need to take planetary health more seriously and move away from reductionist thinking to an approach that sees the planet as a complex system and values more harmony with nature, protects biodiversity and prevents global warming. The second task is to advocate and support governments to govern for health. The key to doing this is putting health and equity before profit, creating healthy urban environments, encouraging participatory decision-making, advocating for healthy economic models and assessing the ways in which corporate determinants of health operate. The third task is to ensure that moves to professionalise health promotion do not come at the expense of health promotion advocacy to powerful people and organisations. Health promotion is well placed to support civil society movements arguing for social and economic change that will benefit health such as the Black Lives Matter and environment movements.
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Affiliation(s)
- Fran Baum
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
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Green L, Ashton K, Bellis MA, Clemens T, Douglas M. 'Health in All Policies'-A Key Driver for Health and Well-Being in a Post-COVID-19 Pandemic World. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9468. [PMID: 34574390 PMCID: PMC8468680 DOI: 10.3390/ijerph18189468] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 11/17/2022]
Abstract
Policy in all sectors affects health, through multiple pathways and determinants. Health in all policies (HiAP) is an approach that seeks to identify and influence the health and equity impacts of policy decisions, to enhance health benefits and avoid harm. This usually involves the use of health impact assessment or health lens analysis. There is growing international experience in these approaches, and some countries have cross-sectoral governance structures that prioritize the assessment of the policies that are most likely to affect health. The fundamental elements of HiAP are inter-sectoral collaboration, policy influence, and holistic consideration of the range of health determinants affected by a policy area or proposal. HiAP requires public health professionals to invest time to build partnerships and engage meaningfully with the sectors affecting the social determinants of health and health equity. With commitment, political will and tools such as the health impact assessment, it provides a powerful approach to integrated policymaking that promotes health, well-being, and equity. The COVID-19 pandemic has raised the profile of public health and highlighted the links between health and other policy areas. This paper describes the rationale for, and principles underpinning, HiAP mechanisms, including HIA, experiences, challenges and opportunities for the future.
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Affiliation(s)
- Liz Green
- Policy and International Health, WHO Collaborating Centre on ‘Investment in Health and Well-Being’, Public Health Wales, Cardiff CF10 45Z, UK; (K.A.); (M.A.B.)
- Department of International Health, Care and Public Health Research Institute—CAPHRI, Maastricht University, Duboisdomein 30, 6229 GT Maastricht, The Netherlands;
| | - Kathryn Ashton
- Policy and International Health, WHO Collaborating Centre on ‘Investment in Health and Well-Being’, Public Health Wales, Cardiff CF10 45Z, UK; (K.A.); (M.A.B.)
- Department of International Health, Care and Public Health Research Institute—CAPHRI, Maastricht University, Duboisdomein 30, 6229 GT Maastricht, The Netherlands;
| | - Mark A. Bellis
- Policy and International Health, WHO Collaborating Centre on ‘Investment in Health and Well-Being’, Public Health Wales, Cardiff CF10 45Z, UK; (K.A.); (M.A.B.)
- Department of Public Health and Life Sciences, Bangor University, Bangor LL57 2DG, UK
| | - Timo Clemens
- Department of International Health, Care and Public Health Research Institute—CAPHRI, Maastricht University, Duboisdomein 30, 6229 GT Maastricht, The Netherlands;
| | - Margaret Douglas
- Usher Institute, University of Edinburgh, Edinburgh EH16 4UX, UK;
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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.
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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
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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.
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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
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Smith JA, Williams C. Bridging boundaries: Health promotion leadership in the context of Health-In-All-Policies. Health Promot J Austr 2021; 32:369-371. [PMID: 34270151 DOI: 10.1002/hpja.519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- James A Smith
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Australia
| | - Carmel Williams
- Centre for Health-in-All-Policies Research Translation, South Australian Health and Medical Research Institute, Adelaide, Australia
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Roesler A, Musolino C, van Eyk H, Flavel J, Freeman T, Fisher M, MacDougall C, Baum F. Conducting a rapid health promotion audit in suburban Adelaide, South Australia: Can it contribute to revitalising health promotion? Health Promot J Austr 2021; 33:488-498. [PMID: 34174013 DOI: 10.1002/hpja.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/24/2021] [Indexed: 11/09/2022] Open
Abstract
ISSUES ADDRESSED How health promotion is implemented varies and it is often not clear what activities are in place in a region. Understanding the extent of health promotion activities helps planning activities. METHODS This research involved a rapid audit of the types of health promotion activities in a suburban region of South Australia. This analysis was guided by the WHO Ottawa Charter's principles. To better understand population needs and which health promoting activities may help, an epidemiological, demographic and social determinants of health profile of southern Adelaide described disease patterns and health inequities. RESULTS While there was evidence of a range of health promoting activities, most concerned individual or behavioural services. A key finding was the small number of activities that the state health department and local health system were responsible for. Alongside local government, NGOs provided the bulk of health promotion activities. In addition, there were no overarching health promotion strategies or coordinating bodies to evaluate the activities. The epidemiological, demographic and social determinants of health profile found persistent health and social inequities. CONCLUSION This rapid audit of health promotion in a region enabled a quick assessment of the current health promotion situation and provided evidence of gaps and areas where policy change should be advocated. SO WHAT?: The key findings distilled from this research were designed to inform policy priorities to shift health promotion in southern Adelaide onto a trajectory consistent with the Ottawa Charter and prevent further focus on individualised behaviour change strategies known as 'lifestyle drift'.
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Affiliation(s)
- Anna Roesler
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Connie Musolino
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Helen van Eyk
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Joanne Flavel
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Toby Freeman
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Matt Fisher
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Colin MacDougall
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Fran Baum
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia
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Brüchert T, Quentin P, Baumgart S, Bolte G. Barriers, Facilitating Factors, and Intersectoral Collaboration for Promoting Active Mobility for Healthy Aging-A Qualitative Study within Local Government in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3807. [PMID: 33917335 PMCID: PMC8038700 DOI: 10.3390/ijerph18073807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/28/2021] [Accepted: 04/02/2021] [Indexed: 11/16/2022]
Abstract
The promotion of walking and cycling to stay active and mobile offers great potential for healthy aging. Intersectoral collaboration for age-friendly urban planning is required in local government to realize this potential. Semi-structured interviews were conducted with the heads of planning and public health departments in city and district administrations of a Metropolitan Region in Germany to identify factors influencing action on the cross-cutting issue of active mobility for healthy aging. Although some administrations are working on the promotion of active mobility, they consider neither the needs of older people nor health effects. A lack of human resources and expertise, mainly due to the low priority placed on the issue, are described as the main barriers for further strategic collaboration. Furthermore, the public health sector often focuses on pathogens as the cause of morbidity and mortality, reducing their acceptance of responsibility for the topic. Facilitating factors include the establishment of new administrative structures, projects with rapid results that create awareness and credibility among citizens and politicians, additional staff with expertise in health promotion, and political commitment. In the future, new administrative structures for intersectoral collaboration are needed in order to consider various perspectives in complex developments, such as healthy aging, and to benefit from synergies.
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Affiliation(s)
- Tanja Brüchert
- Institute of Public Health and Nursing Research, Department of Social Epidemiology, University of Bremen, Grazer Str. 4, 28359 Bremen, Germany; (T.B.); (S.B.)
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
| | - Paula Quentin
- Faculty of Spatial Planning, Department of Urban and Regional Planning, TU Dortmund University, August-Schmidt-Straße 10, 44227 Dortmund, Germany;
| | - Sabine Baumgart
- Institute of Public Health and Nursing Research, Department of Social Epidemiology, University of Bremen, Grazer Str. 4, 28359 Bremen, Germany; (T.B.); (S.B.)
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
- ARL—Academy for Territorial Development in the Leibniz Association, 30179 Hannover, Germany
| | - Gabriele Bolte
- Institute of Public Health and Nursing Research, Department of Social Epidemiology, University of Bremen, Grazer Str. 4, 28359 Bremen, Germany; (T.B.); (S.B.)
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
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Ron S, Dimitri N, Ginzburg SL, Reisner E, Martinez PB, Zamore W, Echevarria B, Brugge D, Martinez LS. Health Lens Analysis: A Strategy to Engage Community in Environmental Health Research in Action. SUSTAINABILITY 2021; 13. [PMID: 33981451 DOI: 10.3390/su13041748] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Health Lens Analysis is a tool to facilitate collaboration among diverse community stakeholders. We employed HLA as part of a community based participatory research (CBPR) and action study to mitigate the negative health effects of TRAP and ultrafine particles (UFPs) in Somerville, MA. HLA is a Health in All Policies tool with previously limited implementation in a North American context. As part of the HLA, community and academic partners engaged residents from across near-highway neighborhoods in a series of activities designed to identify health concerns and generate recommendations for policies and projects to improve health over an 18-month planning period. Noise barriers, which may reduce TRAP exposure among residents in addition to reducing traffic noise, were seen as an acceptable solution by community stakeholders. We found HLA to be an effective means to engage stakeholders from across sectors and diverse community residents in critical discourse about the health impacts of near-roadway exposures. The iterative process allowed the project team to fully explore the arguments for noise barriers and preferred health interventions, while building a stakeholder base interested in the mitigation of TRAP, thus, creating a shared language and understanding of the issue.
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Affiliation(s)
- Sharon Ron
- Metropolitan Area Planning Council 60 Temple Place, Boston, MA, 02111, USA
| | - Noelle Dimitri
- Boston University School of Social Work 264 Bay State Rd., Boston, MA 02215, USA
| | - Shir Lerman Ginzburg
- UConn Health, Department of Public Health Sciences 263 Farmington Ave., Farmington, CT 06032, USA
| | - Ellin Reisner
- Somerville Transportation Equity Partnership, Somerville, MA 02145, USA
| | - Pilar Botana Martinez
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Ave., Boston, MA 02118, USA
| | - Wig Zamore
- Somerville Transportation Equity Partnership, Somerville, MA 02145, USA
| | - Ben Echevarria
- The Welcome Project, 530 Mystic Ave., Somerville, MA, 02145, USA
| | - Doug Brugge
- Department of Public Health Sciences, University of Connecticut School of Medicine 263 Farmington Ave., Farmington, CT 06030, USA
| | - Linda Sprague Martinez
- Macro Department, Boston University School of Social Work, 264 Bay State Rd., Boston, MA 02215, USA
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Smith JA, Wells L, Gelbart L, Lawson T. Beyond COVID-19: Consumers call for greater focus on health equity. Health Promot J Austr 2021; 32:3-5. [PMID: 33448086 PMCID: PMC8013688 DOI: 10.1002/hpja.450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- James A. Smith
- Wellbeing and Preventable Chronic DiseasesMenzies School of Health ResearchCasuarinaAustralia
| | - Leanne Wells
- Consumer Health Forum of AustraliaDeakinAustralia
| | - Lisa Gelbart
- Consumer Health Forum of AustraliaDeakinAustralia
| | - Tony Lawson
- Consumer Health Forum of AustraliaDeakinAustralia
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van Eyk H, Delany-Crowe T, Lawless A, Baum F, MacDougall C, Wildgoose D. Improving child literacy using South Australia's Health in All Policies approach. Health Promot Int 2020; 35:958-972. [PMID: 31529057 DOI: 10.1093/heapro/daz013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The Health in All Policies (HiAP) approach aims to create coherent policy across government that will improve population health, wellbeing and equity while progressing the goals of other sectors. The quest to achieve policy coherence across government has focused interest on processes that facilitate collaboration between health and many other sectors. Health and education sectors have long been seen as natural partners with mutually beneficial goals. This article focuses on a case study of HiAP work, undertaken between health and education in South Australia to increase parental engagement in children's literacy among lower socio-economic families. It draws on a document analysis of 71 documents, seven in-depth interviews with senior policy actors and a programme logic model. The project began with the intention of using policy levers to improve long-term health outcomes through addressing child literacy, a proven social determinant of health. Because of the context in which it was operating, the project extended from a focus on policy to working directly with four schools implementing strategies to facilitate parental engagement, with the intention of finally influencing system-wide education policy. We use an institutional framework to support our analysis through a discussion of ideas, actors and institutions and how these influenced the project. The article provides insight into the facilitators and impediments to intersectoral efforts to progress shared educational and health goals and achieve sustainable change, and identifies lessons for others intending to use this approach.
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Affiliation(s)
| | | | | | - Fran Baum
- Southgate Institute for Health, Society and Equity
| | - Colin MacDougall
- Southgate Institute for Health, Society and Equity.,College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, South Australia 5001, Australia
| | - Deborah Wildgoose
- Health Determinants and Policy, SA Department for Health and Wellbeing, PO Box 6, Rundle Mall, Adelaide, South Australia 5000, Australia
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Damari B, Heidari A, Rahbari Bonab M, Vosoogh Moghadam A. Designing a toolkit for the assessment of Health in All Policies at a national scale in Iran. Health Promot Perspect 2020; 10:244-249. [PMID: 32802761 PMCID: PMC7420168 DOI: 10.34172/hpp.2020.38] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 03/26/2020] [Indexed: 11/09/2022] Open
Abstract
Background: Equitable promotion of health indicators requires cooperation among different sectors more than ever. The "Health in All Policies" (HiAP) approach contributes to this process through strengthening intersectoral collaboration. To implement this approach at a national scale, indicators of health-oriented performance from various organizations, and their measurement methods, need to be precisely defined. The aim of present study was to design a toolkit for implementing HiAP in Iran. Methods: A review of literature and documents, as well as conducting semi-structured interviews and focus group discussions were undertaken to collect data for this qualitative study. Content analysis was applied to the collected data and the results were placed in three categories: criteria, sub-criteria and indicators; implementation processes; and implementation requirements. Results: The toolkit aims to achieve various objectives, including intersectoral excellence and the systematic development of intersectoral collaboration. In the process section, reports on measures taken by organizations are assessed by a three-member audit committee. The top three organizations, in terms of intersectoral cooperation in achieving public health goals, are introduced in a Health Week. Requirements for success in achieving the HiAP approach include financial resources to implement the HiAP, a database, an electronic method for submitting reports, training courses, monitoring and annual reporting of relevant indicators, and formulating regulations in order to assess organizations. Conclusion: Justification and training in various organizations to support the implementation of health-oriented measures, providing an annual ranking of organizations, and encouraging the organizations can contribute to the institutionalization of the toolkit through the SupremeCouncil for Health and Food Security. It is recommended that a Secretariat of sustainable development to be established under the Plan and Budget Organization (PBO) of the Islamic republic of Iran to monitor portfolio indicators.
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Affiliation(s)
- Behzad Damari
- Department of Governance and Health, Institute of Neuroscience, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Heidari
- Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, Iran.,School of Public Health, Golestan University of Medical Sciences, Gorgan, Iran
| | - Maryam Rahbari Bonab
- Community-Based Participatory Policy Making, Islamic Parliament Research Center of the Islamic Republic of Iran, Tehran, Iran
| | - Abbas Vosoogh Moghadam
- Secretariat of Supreme Council for Health and Food Security, Ministry of Health and Medical Education, Tehran, Iran
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Legitimising Inter-Sectoral Public Health Policies: A Challenge for Professional Identities? Int J Integr Care 2019. [DOI: 10.5334/ijic.4641] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Creating a whole-of-government approach to promoting healthy weight: What can Health in All Policies contribute? Int J Public Health 2019; 64:1159-1172. [PMID: 31606749 DOI: 10.1007/s00038-019-01302-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 09/17/2019] [Accepted: 09/18/2019] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES This paper examines the opportunities and barriers that the South Australian Health in all Policies (SA HiAP) approach encountered when seeking to establish a whole-of-government response to promoting healthy weight. METHODS The paper draws on data collected during 31 semi-structured interviews, analysis of 113 documents, and a program logic model developed via workshops to show the causal links between strategies and anticipated outcomes. RESULTS A South Australian Government target to increase healthy weight was supported by SA HiAP to develop a cross-government response. Our analysis shows what supported and hindered implementation. A combination of economic and systemic framing, in conjunction with a co-benefits approach, facilitated intersectoral engagement. The program logic shows how implementation can be expected to contribute to a population with healthy weight. CONCLUSIONS The HiAP approach achieved some success in encouraging a range of government departments to contribute to a healthy weight target. However, a comprehensive approach requires national regulation to address the commercial determinants of health and underlying causes of population obesity in addition to cross-government action to promote population healthy weight through regional government action.
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Zeeb H, Hilderink H, Forberger S. [Environment and the "Health in All Policies" approach-an overview]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 61:729-736. [PMID: 29691595 DOI: 10.1007/s00103-018-2733-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND One quarter of the global disease burden could be avoided with management strategies for environmental risk factors such as air and water pollution, food contamination, injuries and poor road safety. Many decisions influencing health are made outside the health sector; thus, the joint consideration and implementation of health and environmental factors in the relevant policies are becoming increasingly important. MATERIALS AND METHODS By means of a selective literature search, we identified important policy documents and selected research articles as a basis for the introduction and current discussion of the Health in All Policies (HiAP) approach. Parallels with the Environment in All Policies (EIAP) approach are debated. RESULTS AND CONCLUSIONS The consideration and reinforcement of environmental topics in HiAP and the link with health in the EiAP approach increase the chances of policies with mutually positive effects, especially with regard to the significance of social factors for health and the environment. The UN Sustainable Development Goals provide a good starting point for a joint strategy for reinforcing health and environmental aspects. Health and Environmental Impact Assessments are accepted procedures in many countries. The HiAP strategy implemented in South Australia provides a well-documented institutional approach to the integration and linkage of health and environmental issues. These examples can be used as well-established starting points for a definition of HiAP incorporating the equitable involvement of environmental issues. Barriers to this goal relate, for example, to the particular interests of the various participating sectors.
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Affiliation(s)
- Hajo Zeeb
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Achterstraße 30, 28359, Bremen, Deutschland. .,Health Sciences Bremen, Universität Bremen, Bremen, Deutschland.
| | - Henk Hilderink
- National Institute for Public Health and the Environment, RIVM, Bilthoven, Niederlande
| | - Sarah Forberger
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Achterstraße 30, 28359, Bremen, Deutschland
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Baum F, Delany-Crowe T, MacDougall C, van Eyk H, Lawless A, Williams C, Marmot M. To what extent can the activities of the South Australian Health in All Policies initiative be linked to population health outcomes using a program theory-based evaluation? BMC Public Health 2019; 19:88. [PMID: 30658616 PMCID: PMC6339362 DOI: 10.1186/s12889-019-6408-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/07/2019] [Indexed: 11/21/2022] Open
Abstract
Background This paper reports on a five-year study using a theory-based program logic evaluation, and supporting survey and interview data to examine the extent to which the activites of the South Australian Health in All Policies initiative can be linked to population health outcomes. Methods Mixed-methods data were collected between 2012 and 2016 in South Australia (144 semi-structured key informant interviews; two electronic surveys of public servants in 2013 (n = 435) and 2015 (n = 483); analysis of state government policy documents; and construction of a program logic model to shape assessment of the feasibility of attribution to population health outcomes). Results Multiple actions on social determinants of health in a range of state government sectors were reported and most could be linked through a program logic model to making some contribution to future population health outcomes. Context strongly influences implementation; not all initiatives will be successful and experimentation is vital. Successful initiatives included HiAP influencing the urban planning department to be more concerned with the health impacts of planning decisions, and encouraging the environment department to be concerned with the health impacts of its work. Conclusions The theory-based program logic suggests that SA HiAP facilitated improved population health through working with multiple government departments. Public servants came to appreciate how their sectors impact on health. Program logic is a mechanism to evaluate complex public health interventions in a way that takes account of political and economic contexts. SA HiAP was mainly successful in avoiding lifestyle drift in strategy. The initiative encouraged a range of state government departments to tackle conditions of daily living. The broader underpinning factors dictating the distribution of power, money and resources were not addressed by HiAP. This reflects HiAP’s use of a consensus model which was driven by (rather than drove) state priorities and sought ‘win-win’ strategies.
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Affiliation(s)
- Fran Baum
- Society and Equity, Southgate Institute for Health, Flinders University, GPO Box 2100, Adelaide, 5001, Australia.
| | - Toni Delany-Crowe
- Society and Equity, Southgate Institute for Health, Flinders University, GPO Box 2100, Adelaide, 5001, Australia
| | - Colin MacDougall
- Society and Equity, Southgate Institute for Health, Flinders University, GPO Box 2100, Adelaide, 5001, Australia.,College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, 5001, Australia
| | - Helen van Eyk
- Society and Equity, Southgate Institute for Health, Flinders University, GPO Box 2100, Adelaide, 5001, Australia
| | - Angela Lawless
- College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, 5001, Australia
| | - Carmel Williams
- Health Determinants and Policy, SA Department for Health and Wellbeing, PO Box 6, Rundle Mall, Adelaide, 5000, Australia
| | - Michael Marmot
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
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Holt DH. Rethinking the Theory of Change for Health in All Policies Comment on "Health Promotion at Local Level in Norway: The Use of Public Health Coordinators and Health Overviews to Promote Fair Distribution Among Social Groups". Int J Health Policy Manag 2018; 7:1161-1164. [PMID: 30709095 PMCID: PMC6358656 DOI: 10.15171/ijhpm.2018.96] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 09/22/2018] [Indexed: 11/25/2022] Open
Abstract
This commentary discusses the interesting and surprising findings by Hagen and colleagues, focusing on the role of the public health coordinator as a Health in All Policies (HiAP) tool. The original article finds a negative association between the employment of public health coordinators in Norwegian municipalities and consideration of a fair distribution of social and economic resources between social groups in local policymaking and planning. The commentary contemplates whether this surprising negative association should be interpreted as a failure of implementation, as suggested by the authors, or whether it might be the theory of change that has failed. On this basis, it is suggested that the very notion of HiAP could be flawed by the assumption that health should function as an overarching aim across government sectors. Potentially, the social determinants of health (SDH) might be more efficiently addressed by means of sectoral action by the corresponding sectors, emphasizing equity rather than health.
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Affiliation(s)
- Ditte Heering Holt
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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