جستجوی مقالات مرتبط با کلیدواژه « public policy » در نشریات گروه « پزشکی »

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

Powell and Mannion’s review of reviews maps the landscape of health policy research, showing a number of problematic and longstanding features. This commentary focuses on the extent to which health parochialism is good for the scientific development of the literature, the extent to which a “tournament of theories” actually develops our understanding of health policy process, and, finally, whether circumscribed theories of the policy process might be missing some of the most important and useful findings of broader comparative politics, which focus on the ways policies create politics over time. It concludes that health parochialism and focus on a circumscribed policy process is not likely to be helpful because it distracts attention from the ways in which coalitions and institutions over time shape politics and policy, a finding explored by scholars of many sectors whose findings should influence health policy research.

The analysis of health policy processes in low- and middle-income countries (LMICs) emerged as a research area in the early 1990s. In their recent editorial Powell and Mannion argue that such research can be deepened by applying public policy theory. In response, we raise three questions to consider: are public policy models fit for purpose in today’s world in LMICs (and what other theory can be used)? Is using theory the most important factor in deepening such research? Why do we, as researchers, do this work? Ultimately, we argue that the value of simple models, such as those already used in health policy analysis, lies in their enduring relevance and widespread use. They are supporting the development of the shared understandings that can, in turn, provide the basis for collective action addressing inequities in health and well-being.

The paper by Guglielmin and colleagues1 examines the implementation of Health in All Policies (HiAP) in a local government context in Kuopio Finland. The authors use a realist explanatory case study design to explore what has supported HiAP implementation with a focus on two specific hypotheses on what leads to success: common goals and committed leadership and staff. The paper is well argued using appropriate methodology and their findings support the importance of the success factors tested by their two hypotheses. However, the narrowed focus on just two hypotheses underrepresents the complexity of implementing HiAP at any level of government, including local government. Given its local government focus, the paper would have been strengthened by referencing the lessons gained from the Healthy Cities movement. Local government is a critical setting for action to address health and health equity and there is great potential to continue research that adds to the knowledge base on how to successful implement HiAP. Finally, it is important to acknowledge that Finland has a unique HiAP history. It is recognised as a global leader in the field, and the role of local government in Finland differs from many other countries. These factors may impact on the transferability of the case study findings.

Powell and Mannion’s recent editorial discusses how different ‘models’ of the policy process have been applied within the health policy field. They present two ways forward for scholarship: more ‘home grown’ development of health-specific models, or deeper engagement with broader public policy scholarship. In this paper I argue for the latter approach for several reasons. First, health policy analysis is a social, not a natural science – and as such is not exceptional to other forms of policy scholarship. Second, many ‘health policy models’ are often grounded in conceptual work from elsewhere (or may not be health specific). Finally, there has been significant work to develop more nuanced understandings of theories, models, and frameworks available to particular analytical tasks and questions. As such, the growing body of global health policy scholarship may find it can benefit more from deeper engagement with existing conceptual work than constructing its own new models in most cases.

Powell and Mannion suggest that ‘health policy process’ research should draw more lessons from ‘the wider policy process literature.’ While health research could continue with sector specific models, the wider literature is ‘conceptually stronger.’ In that context, I clarify how and why health researchers should use policy theories. I describe a review of the use of policy theories in public health research to show that many researchers use them to not only understand policy-making but also influence policy and policy-making. Most policy theories are not designed for that purpose, but it is still possible to produce practical lessons. I outline the issues that arise when repurposing theory-informed insights, such as that policy change takes a long time, and the scale of policy-making is potentially overwhelming. I then highlight the valuable role of theories in raising dilemmas in relation to modes of governance and evidence production.

The paper by Forde et al provides a useful qualitative consideration of marketing responses to the implementation of the 2018 Soft Drinks Industry Levy (SDIL) in the United Kingdom. This commentary discusses that paper and its conclusions and seeks to place them in a broader context for marketing, fiscal measures and health and public policy. It suggests that modern conceptualisations of marketing and wider considerations of market and non-market strategies could provide a valuable lens to understand the ways in which companies and sectors respond to the threats they perceive and the constantly changing sectoral opportunities. It is important that fiscal measures introduced have the desired effects, and that not only positive behaviours (whether of companies or consumers) are incentivised, but that adverse behaviours are actively disincentivised.

This paper describes the access to care for mental health problems in Afghanistan, according to the nature of the mental health problems and the service provider. Following the Andersen model, it evaluates the respective roles in access to care of “predisposing,” “needs,” “enabling” factors, and other “environmental” factors such as exposure to traumatic events and level of danger of the place of residence.

Trans-sectional probability survey in general population by multistage sampling in 16 provinces, nationally representative: N = 4445 (15 years or older), participation rate of 81%. Face to face interviews using standardized measures of mental health (CIDI, Composite International Diagnostic Interview). Different logistic regression models are presented.

The 12-month rate of mental health help-seeking was 6.56% with substantial regional variation (2.35% to 12.65%). Providers were mainly from the health sector; the non- health sector (religious and healers) was also prevalent. Most consultations were held in private clinics (non-governmental organisation, NGO). The severity of mental health disorders as well as the perceived impairment due to mental health were independently very important: odds ratio (OR) = 6.04 for severe disorder, OR = 3.79 for perceived impairment. Living in a dangerous area decreased access to care: for high level of danger and for very high level: OR = 0.22. Gender, education and ethnicity were not associated with mental health help-seeking after controlling for exposure to trauma.

Access to care for mental health problems depended mainly on the needs as defined as disorder severity level and impairment, and on environmental factors such as exposure to traumatic events. The system seems equitable; however, this is counterbalanced by a very challenging environment. This survey is a testimony to the hardship experienced by the Afghan population and by health professionals, and to the efforts to deliver organized mental healthcare in a challenging situation. This research may inform and support policy-makers and NGOs in other countries undergoing similar challenges.

The nature of population policies in the field of health, especially population, fertility, and childbearing is complicated, so the families’ and policymakers’ decision on the quantity and quality of the reproduction and the childbearing process has been controversial. This paper was conducted to identify and explain the adverse effects of population policies on reproductive health and childbearing in 1978-2020.

This study has a  cross-sectional descriptive-analytical design. The study participants were 30 managers and specialists who studied in the fields of policy, demography, sociology, and health at university of medical sciences in Khuzestan in 2019-2020. Delphi method was used and the data collection tool was a researcher-made questionnaire that was standardized by calculating the validity and reliability using the Cronbach's alpha coefficient. The authors analyzed  data  using descriptive and inferential statistics,. The main question was whether the population policies adopted after the Islamic Revolution have challenged decision-making on reproductive health and childbearing at both levels of operational managers and the society? The main hypothesis allocated the answer "yes" to itself. However, since policymakers still do not frequently use policy-making knowledge as a criterion for public policy, there is dissatisfaction and mistrust among families who have to implement the policies.. Thereforethe new message of the researchis that in the future, any decision and manipulation on health and population should be all-inclusive and comprehensive along with conservatism and maturity.

The significance level was observed in 18 items, and it indicates that population policies on reproductive health and childbearing in the studied variables have been facing challenges. The main challenges  included lack of experts in reproductive health policymaking, lack of sufficient evidence to make decisions, lack of attention to spatial planning infertility policy making, lack of a coordinated system between the Ministry of Health and other ministries, lack of ideological-based reproductive health policymaking, lack of attention to the socio-economic evaluation of population policies, and lack of long-term strategic and sustainable vision in health-based policymaking.

Population policies on reproductive health and childbearing after the revolution are not adequate for the country's decision-making system to achieve a proportionate and balanced population. Therefore, practical work and special responsibility accomplish the most promising demographic result

Based on the recommendations of the World Health Organization, we investigated the feasibility of oral health interventions (OHIs) as part of Health Promoting Schools (HPS) program in Karaj city elementary schools.

OHIs were accepted to be integrated into the components of HPS program by using the nominal group technique (NGT) and semi-structured interviews. Three NGT meetings were held with the faculty members of the School of Dentistry, Tehran University of Medical Sciences, and Karaj elementary school health care providers. Semi-structured interviews were held with school health executives of the Ministry of Health and Medical Education. The expert panel edited the OHIs and corrected the fragmentations, overlaps, and duplications. OHIs were sent to 24 individuals in six multi-stakeholder groups (faculty members of pediatric dentistry and community oral health departments, elementary school administrators, executive managers of Ministry of Health and Medical Education, elementary school dean and school healthcare providers). They were asked to score the feasibility of each intervention on a scale of 0 to 10.

Based on the mean score of feasibility (threshold: 8) the OHIs were divided into two groups of feasible and infeasible. Eighty-six interventions were feasible, with a total mean score of 8.83±0.59 out of 10. The highest feasibility score was related to “comprehensive school health education”.

Integration of OHIs in HPS program is acceptable and feasible. The results can help policy-makers support the integration of OHIs in HPS program and encourage them to implement the program at the national level.

This study aimed to analyze national and institutional trends in shoulder arthroplasty utilization basedon patient race. The Nationwide Inpatient Sample (NIS) was employed to determine racial trends in shoulder arthroplastyutilization at a national level. An institutional database was then utilized to retrospectively identify all patients, undergoingshoulder arthroplasty within 2011-2013. Descriptive statistics were used to compare self-identified black and non-blacksubpopulations. The NIS identified 256,832 primary shoulder arthroplasties within 2005-2011. Black patients constituted3.92% (n=10,074) of cases. Utilization increased from 3.36% in 2005 to 4.49% in 2011. Locally, a total number of1,174 primary shoulder arthroplasties were performed, the recipients of 5.96% (n=70) of which were black. Femalesaccounted for 48/70 (68.6%) of black patients. Black patients had a higher body mass index (33.6 vs. 30.1, P<0.0001)and were younger (62.6 vs. 67.2 years, P<0.0001), compared to the non-black patients. Regarding insurance type,1,074 patients (i.e., 65 black and 1,009 non-black) had comprehensive insurance data. Chi-square analysis of fivemajor insurance categories, including private, Medicare, Medicaid, workers’ compensation, and personal injury,indicated no difference in insurance patterns (χ2=3.658, P=0.454). The findings revealed significant racial disparity in shoulder arthroplasty utilization both at national andinstitutional levels. This disparity exists despite the similar rates of osteoarthritis in both white and black patients. Blackpatients in our institution had similar clinical, demographic, and socioeconomic characteristics as in our non-blackpatients. The obtained results highlighted the need for the expansion of black patients’ access to care services relatedto major joint reconstruction.Level of evidence: III

Corruption in the health sector has been a “dirty secret” in the health policy and international development community, but recent global activities point to a day when it will no longer be neglected as a key determinant of health. To further explore next steps forward, this commentary applies the Kingdon’s multiple-streams framework (MSF) to assess what opportunities are available to mobilize the global agenda to combat health corruption. Based on this analysis, it appears that Kingdon’s problem, policy, and political streams are coalescing to create a policy window opportunity that can be leveraged based on recent developments in the global health and international development community around corruption. This includes the recent formation of the Global Network on Anti-Corruption, Transparency and Accountability (GNACTA) led by the World Health Organization (WHO), the Global Fund, and the United Nations Development Programme in 2019. It also includes bridging shared goals of addressing corruption in order to make progress towards health-specific goals in the United Nations (UN) Sustainable Development Goals (SDGs) and for achieving universal health coverage.

Health and striving to maintain and promote it has always been an important priority in governments, communities, and public policies. To implement health objectives through the Fifth Five-Year National Development Plan of Iran, the health system reform plan with three approaches to the financial protection of the public, creating equity in access to health services, and improving the quality of services has been on the government's agenda since 05.05.2014. Investigations revealed that the lack of a comprehensive and scientific model for evaluating this national program is evident. This study aimed to design a comprehensive model of health reform plan evaluation in Iran. What distinguishes this study from previous studies is the simultaneous attention to the challenges of performance evaluation, social responsibility, and examining them in a comprehensive and coherent model.

The present study considered as descriptive-survey research in terms of strategy. The research method was a combination that conducted from 2018 to 2019. The sample size of the qualitative part of the research consisted of 17 academic and executive health experts selected by purposive non-random sampling. In the quantitative part of the study, 400 health service providers selected by stratified random sampling. In this study, content analysis and Delphi technique, and Expert choice v24, SPSS V22 and AMOSV14 software were used to collect, classify, deduce and exploit data, and questionnaires.

The findings of this study resulted in the design of a 900-scorecard model of the comprehensive evaluation of the health system reform plan in Iran based on 5 dimensions (finance, social responsibility, growth and learning, clients and internal processes), 17 components and 70 indicators.

The findings of the quantitative section of the study showed that the indicators, dimensions and levels of the comprehensive evaluation model for health system reform plan in Iran (CEHSRP-IR) qualified for evaluation of the effectiveness of this national program at different organizational levels and executing units of health system reform plan in Iran.

The article by Susanne Hagen and colleagues on Health Promotion at Local Level in Norway discusses actions by municipal governments to assess and address heath inequities within their respective regions, as required under the Norwegian Public Health Act (PHA). Although the broad intent of the Norwegian government is to encourage action on social determinants of health (SDH), Hagen et al find that many of the initiatives undertaken by municipalities ‘tend to cash out as single, targeted initiatives,’ and focus on individual behaviours. In this commentary, I use the concept of place-based policy and ideas from policy theory on the institutional behaviours of public policy agencies and services, to discuss reasons behind this narrowing of perspective and policy action. I argue in favour of an alternative approach involving public agencies and services supporting processes of community-led action and social change.

Lawless et al provide a valuable narrative of using program logic to develop an evaluation of Health in All Policies (HiAP) in South Australia. In this commentary I argue that the paper and analysis is an extremely useful example of navigating the supposed black box of policy-making. However the original makes the reader work too hard and is distracting from the main narrative of explaining the logic behind the HiAP approach in South Australia. My response covers avoiding epistemological traps and weighing up the pragmatics of collaborative policy research with more complex institutional policy issues like power.

The health effects of economic resources (eg, education, employment, and living place) and psychological assets (eg, self-efficacy, perceived control over life, anger control, and emotions) are well-known. This article summarizes the results of a growing body of evidence documenting Blacks’ diminished return, defined as a systematically smaller health gain from economic resources and psychological assets for Blacks in comparison to Whites. Due to structural barriers that Blacks face in their daily lives, the very same resources and assets generate smaller health gain for Blacks compared to Whites. Even in the presence of equal access to resources and assets, such unequal health gain constantly generates a racial health gap between Blacks and Whites in the United States. In this paper, a number of public policies are recommended based on these findings. First and foremost, public policies should not merely focus on equalizing access to resources and assets, but also reduce the societal and structural barriers that hinder Blacks. Policy solutions should aim to reduce various manifestations of structural racism including but not limited to differential pay, residential segregation, lower quality of education, and crime in Black and urban communities. As income was not found to follow the same pattern demonstrated for other resources and assets (ie, income generated similar decline in risk of mortality for Whites and Blacks), policies that enforce equal income and increase minimum wage for marginalized populations are essential. Improving quality of education of youth and employability of young adults will enable Blacks to compete for high paying jobs. Policies that reduce racism and discrimination in the labor market are also needed. Without such policies, it will be very difficult, if not impossible, to eliminate the sustained racial health gap in the United States.

Written by a group of political science researchers, this commentary focuses on the contributions of political science to public health and proposes research avenues to increase those contributions. Despite progress, the links between researchers from these two fields develop only slowly. Divergences between the approach of political science to public policy and the expectations that public health can have about the role of political science, are often seen as an obstacle to collaboration between experts in these two areas. Thus, promising and practical research avenues are proposed along with strategies to strengthen and develop them. Considering the interdisciplinary and intersectoral nature of population health, it is important to create a critical mass of researchers interested in the health of populations and in healthy public policy that can thrive working at the junction of political science and public health.

Background Government policy measures have a key role to play in the prevention and control of noncommunicable diseases (NCDs). The Caribbean, a middle-income region, has the highest per capita burden of NCDs in the Americas. Our aim was to examine policy development and implementation between the years 2000 and 2013 on NCD prevention and control in Barbados, and to investigate factors promoting, and hindering, success.
Methods A qualitative case study design was used involving a structured policy document review and semistructured interviews with key informants, identified through stakeholder analysis and ‘cascading.’ Documents were abstracted into a standard form. Interviews were recorded, transcribed verbatim and underwent framework analysis, guided by the multiple streams framework (MSF). There were 25 key informants, from the Ministry of Health (MoH), other government Ministries, civil society organisations, and the private sector.
Results A significant policy window opened between 2005 and 2007 in which new posts to address NCDs were created in the MoH, and a government supported multi-sectoral national NCD commission was established. Factors contributing to this government commitment and funding included a high level of awareness, throughout society, of the NCD burden, including media coverage of local research findings; the availability of policy recommendations by international bodies that could be adopted locally, notably the framework convention on tobacco control (FCTC); and the activities of local highly respected policy entrepreneurs with access to senior politicians, who were able to bring together political concern for the problem with potential policy solutions. However, factors were also identified that hindered multi-sectoral policy development in several areas, including around nutrition, physical activity, and alcohol. These included a lack of consensus (valence) on the nature of the problem, often framed as being predominantly one of individuals needing to take responsibility for their health rather than requiring government-led environmental changes; lack of appropriate detailed policy guidance for local adaptation; conflicts with other political priorities, such as production and export of alcohol, and political reluctance to use legislative and fiscal measures.
Conclusion The study’s findings indicate mechanisms to promote and support NCD policy development in the Caribbean and similar settings.