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In 2006, the National Institutes of Health (NIH) initiated the Clinical and Translational Science Awards (CTSAs) as part of the NIH Roadmap Initiative, in order to improve the conduct and impact of NIH's clinical and translational research portfolio. The CTSA program is intended not only to transform the training programs and research infrastructure at individual academic institutions, but also to create a nation-wide collaborative consortium to transform the biomedical research enterprise. In January 2009, the NIH CTSA National Consortium adopted Strategic Goals to maximize the CTSAs' impact on the Nation's healthcare and health. Of these, the CTSA Strategic Goal 4 is to promote the translation of the results of clinical and translational research into practice and public policy. To advance this goal, a committee was constituted to focus on the organization and development of the CTSA Consortium's comparative effectiveness research (CER) capacity, an increasingly important component of research translation into practice and policy. This Committee's Workgroups took on a number of deliverables in service of this objective, including producing this White Paper on how the CTSA Consortium might best facilitate CER, for NIH's Institutes and Centers (ICs), other Federal agencies, outside stakeholders, and the healthcare system overall. This White Paper offers some specific suggestions for how the CTSA Consortium might support this emerging and crucial national effort to generate, synthesize, and disseminate CER in order to improve healthcare decision-making and health outcomes. Important points of reference for this White Paper are two Congressionally mandated reports on CER released at the end of June 2009, one by the Institute of Medicine (IOM) and another by the Federal Coordinating Council for CER (FCC-CER). The definitions of CER by each report, and their recommendations for the CER enterprise, are highly germane to the purpose of this CTSA Consortium White Paper. The CER definition used in the IOM Report was, "The generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care. The purpose of CER is to assist patients, clinicians, purchasers, policy makers, and the public to make informed decisions that will improve health care at both the individual and population levels."… [ABSTRACT FROM PUBLISHER]

Background: Removing user fees in primary health care services is one of the most critical policy issues being considered in Africa. User fees were introduced in many African countries during the 1980s and their impacts are well documented. Concerns regarding the negative impacts of user fees have led to a recent shift in health financing debates in Africa. Kenya is one of the countries that have implemented a user fees reduction policy. Like in many other settings, the new policy was evaluated less that one year after implementation, the period when expected positive impacts are likely to be highest. This early evaluation showed that the policy was widely implemented, that levels of utilization increased and that it was popular among patients. Whether or not the positive impacts of user fees removal policies are sustained has hardly been explored. We conducted this study to document the extent to which primary health care facilities in Kenya continue to adhere to a 'new' charging policy 3 years after its implementation. Methods: Data were collected in two districts (Kwale and Makueni). Multiple methods of data collection were applied including a cross-sectional survey (n = 184 households Kwale; 141 Makueni), Focus Group Discussions (n = 12) and patient exit interviews (n = 175 Kwale; 184 Makueni). Results: Approximately one third of the survey respondents could not correctly state the recommended charges for dispensaries, while half did not know what the official charges for health centres were. Adherence to the policy was poor in both districts, but facilities in Makueni were more likely to adhere than those in Kwale. Only 4 facilities in Kwale adhered to the policy compared to 10 in Makueni. Drug shortage, declining revenue, poor policy design and implementation processes were the main reasons given for poor adherence to the policy. Conclusion: We conclude that reducing user fees in primary health care in Kenya is a policy on paper that is yet to be implemented fully. We recommend that caution be taken when deciding on how to reduce or abolish user fees and that all potential consequences are carefully considered. [ABSTRACT FROM AUTHOR]

The article explores the challenges and risk for the potential development of a new public health system in England in 2011. It says that the decision to implement a radical change in the system is due to several indicators and facts such as the dependency of 1.6 million people on alcohol. It also mentions that the change is in line with the aim of government to address the problems regarding long-term poor mental health in the country. According to the author, the improved health system is expected to enhanced the lifestyle of families in the poorest areas.

The article focuses on the guidelines released by the Food & Drug Administration (FDA), which demonstrates the flexibility and willingness of the department to engage regulated entities in the U.S. It provides specific definitions for source documentation and direct data entry, and recommendations on how to use computerized systems in clinical investigations. It also includes advice for clinical sites, analytical laboratories, and central laboratories. INSET: FDA Regulations vs Guidances.

Background: Rare diseases pose immense challenges for healthcare systems due to their low prevalence, associated disabilities, and attendant treatment costs. Advancements in gene therapy, such as treatments for Spinal Muscular Atrophy (SMA), have introduced novel therapeutic options, but the high costs, exemplified by Zolgensma® at US$2.1 million, present significant financial barriers. This scoping review aimed to compare the funding approaches for rare disease treatments across high-performing health systems in Australia, Singapore, South Korea, the United Kingdom (UK), and the United States (US), aiming to identify best practices and areas for future research. Methods: In accordance with the PRISMA-ScR guidelines and the methodological framework by Arksey and O'Malley and ensuing recommendations, a comprehensive search of electronic databases (Medline, EMBASE, and Cochrane) and grey literature from health department websites and leading national organizations dedicated to rare diseases in these countries was conducted. Countries selected for comparison were high-income countries with advanced economies and high-performing health systems: Australia, Singapore, South Korea, the UK, and the US. The inclusion criteria focused on studies detailing drug approval processes, reimbursement decisions and funding mechanisms, and published from 2010 to 2024. Results: Based on a thorough review of 18 published papers and grey literature, various strategies are employed by countries to balance budgetary constraints and access to rare disease treatments. Australia utilizes the Life Saving Drugs Program and risk-sharing agreements. Singapore depends on the Rare Disease Fund, which matches public donations. South Korea's National Health Insurance Service covers specific orphan drugs through risk-sharing agreements. The UK relies on the National Institute for Health and Care Excellence (NICE) to evaluate treatments for cost-effectiveness, supported by the Innovative Medicines Fund. In the US, a combination of federal and state programs, private insurance and non-profit support is used. Conclusion: Outcome-based risk-sharing agreements present a practical solution for managing the financial strain of costly treatments. These agreements tie payment to actual treatment efficacy, thereby distributing financial risk and promoting ongoing data collection. Countries should consider adopting and expanding these agreements to balance immediate expenses with long-term benefits, ultimately ensuring equitable access to crucial treatments for patients afflicted by rare diseases. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the leading cause of death from cancer in women and is a major public health problem worldwide. Despite the lower incidence rates of breast cancer in resource-limited settings, especially sub-Saharan Africa, there is a higher mortality rate compared to high-resource countries where the disease has a higher incidence. This makes breast cancer the second deadliest cancer in African women. These poor results reflect the weakness in public health policies. The aim of this paper is to contribute to the effective control of breast cancer by designing a framework for a comprehensive and systemic analysis of these policies in Sub-Saharan Africa. Methods: This research is based on a literature review that adopted a systematic approach followed by a modified policy Delphi involving breast cancer experts in Sub-Saharan Africa. We included narrative reviews and systematic reviews/meta-analyses published between 2015 and 2022 as well as official documents in the analysis. We integrated the World Health Organization's health system building blocks with Walt and Gilson's policy analysis triangle to analyse the information collected and develop our analytical framework. Results: A total of 22 reviews and documents were included in the study. Sixteen breast cancer experts from Sub-Saharan Africa participated in the first Delphi round, and nine participated in the second round. The different components identified for a comprehensive and systemic analysis of effective breast cancer policies can be classified into policy content divided according to the health system building blocks and related policy processes; individual, organized national and international policy stakeholders; and policy contexts. Conclusion: This study enabled the design of a framework suitable for the comprehensive and systemic analysis of breast cancer control policies in Sub-Saharan Africa. This framework can be used as a checklist for stakeholders to guide the planning, implementation and evaluation of policies and specific breast cancer control programmes at the national and facility levels. [ABSTRACT FROM AUTHOR]

As we learn to co-exist with COVID-19, this Research Topic highlights significant research contributions that examine the interaction of COVID-19 and the social determinants of health. To emphasize the impactful research in this area, this Research Topic features scholarly contributions in the fields of Epidemiology, specifically Aging and Life-course Epidemiology, and Public Health, specifically Public Health Policy. This theme is intentionally broad in scope, and our editorial provides an overview of the key findings of the papers published in the Research Topic on COVID-19 pandemic and the social determinants of health. The types of articles received in response to this Research Topic are summarized below. [ABSTRACT FROM AUTHOR]

Over the past decade, there has been a growing trend towards the use of 'big qualitative data' in applied health research, particularly when used as part of mixed methods evaluations of health policy in England. These 'big qualitative' studies tend to be longitudinal, complex (multi-site and multi-stakeholder) and involve the use of multiple methods (interviews, observations, documents) and large numbers of participants (n = 100+). Despite their growing popularity, there is no methodological guidance or methodological reflection on how to undertake such studies. Qualitative researchers are therefore faced with a series of unknowns when designing large qualitative studies, particularly in terms of knowing whether existing qualitative sampling and analysis methods are appropriate in this context. In this paper, we use our experience of undertaking a big qualitative study, as part of a national mixed methods evaluation of a health policy in England to reflect on some of the key challenges that we faced in our qualitative study, which broadly related to: sample size, data analysis and the role of patient and public engagement. Underpinning these difficulties was the challenge of being flexible and innovative within the largely positivist research climate of applied health research and being comfortable with uncertainty relating to the three issues outlined. The reflections we present are not to be viewed as a method 'how to' guide, but rather as a platform to raise key issues relating to the qualitative methods that we found challenging, in order to stimulate discussion and debate amongst the qualitative community. Through this paper, we therefore hope to demystify what it is like to undertake such a study and hope to spark much needed discussion and innovation to support the future design and conduct of qualitative research at scale. [ABSTRACT FROM AUTHOR]

Data-intensive research, including policy modelling, poses some distinctive challenges for efforts to mainstream public involvement into health research. There is a need for learning about how to design and deliver involvement for these types of research which are highly technical, and where researchers are at a distance from the people whose lives data depicts. This article describes our experiences involving members of the public in the SIPHER Consortium, a data-intensive policy modelling programme with researchers and policymakers working together over five years to try to address health inequalities. We focus on evaluating people's experiences as part of Community Panels for SIPHER. Key issues familiar from general public involvement efforts include practical details, careful facilitation of meetings, and payment for participants. We also describe some of the more particular learning around how to communicate technical research to non-academic audiences, in order to enable public scrutiny of research decisions. We conclude that public involvement in policy modelling can be meaningful and enjoyable, but that it needs to be carefully organised, and properly resourced. Plain English summary: Actively involving members of the public is less common in 'data-intensive health research' (health research which does not create new data but focuses on analysing big existing datasets of statistics) than in conventional health research. 'Computational policy modelling' is an example of data-intensive health research where public involvement is not yet standard practice. This article describes our experiences involving members of the public in the SIPHER Consortium, a policy modelling programme with researchers and policymakers working together over five years to try to address health inequalities. This paper focuses on evaluating people's experiences as part of Community Panels for SIPHER. We brought together people with lived experience of health inequalities into three Community Panels, and we met for half a day 3-4 times a year to discuss and give feedback on the research. At first, it was difficult for Panel members to understand the research. Researchers had to try harder to avoid jargon, explain their work in plain English, and focus on the impact of the research in the 'real world'. Both the researchers and the Panel members learned how to communicate better over repeated meetings. Over time, we managed to have meaningful discussion of the choices researchers were making, so Panels could see their impact on the research. It was important that details of the meetings – planning meetings carefully so everyone feels welcome and valued, providing support with digital technology, financially rewarding people for their time – were taken seriously. We conclude that public involvement in policy modelling can be meaningful and enjoyable, but that it needs to be carefully organised, and takes time and money to get right. [ABSTRACT FROM AUTHOR]

"Building back better" post-pandemic, as advocated by the Organisation for Economic Co-operation and Development, could advance the realization of health as a human right. However, the COVID-19 pandemic is more likely to represent a tipping point into a new and even more unequal normal, nationally and internationally, that represents a hostile environment for building back better. This paper begins with a brief explanation of the tipping point concept. It goes on to describe the mechanisms by which the pandemic and many responses to it have increased inequality, and then identifies three political dynamics that are inimical to realizing health as a human right even in formal democracies, two of them material (related to the unequal distribution of resources within societies and in the global economy) and one ideational (the continued hegemony of neoliberal ideas about the proper limits of public policy). Observations about the unequal future and what it means for health conclude the paper. [ABSTRACT FROM AUTHOR]

The article focuses on the alteration in health care model for elderly people in Great Britain. The need for the change in treatment approach emerged due to diminishing younger workforce and rapidly growing number of elderly people. The effectiveness of all advances in care for the elderly is undermined by government policies and particularly due to the ways of spending money.

While the terms 'sex' and 'gender' represent distinct concepts, their influence may intersect as important determinants of health. Despite their influence in shaping individual health outcomes, there is often inaccuracy and inconsistency in the degree to which sex and gender considerations are integrated in the health policymaking process. This primary aim of this paper is to fill the gap in the current understanding of how sex and gender considerations are integrated in this process. A scoping review methodology was used with the objective of assessing the extent to which sex and gender were considered inclusively and comprehensively in established examples of health policy planning and development. One hundred seventy-five documents from the academic and grey literature were found to meet the inclusion criteria for this scoping review. The authors charted the data from these publications, assessing the ways in which sex and gender were incorporated in their policy development process. Five key findings were ascertained from this review: (1) the terms sex and gender are often used interchangeably; (2) the terms sex and gender are often used with a limited and binary scope; (3) the most inclusive and comprehensive documents included transgender and gender diverse populations; (4) there are significant variations in the degree of inclusivity and comprehensivity of these documents based on geographic distribution; and (5) documents published within the last 5 years were more inclusive than older documents. This paper concludes with an acknowledgment of the limitations of the study design, a summary of the findings, future research directions, and implications for policymakers. [ABSTRACT FROM AUTHOR]

Background: Tunisia has been engaged in the Societal Dialogue (SD) for Health process since 2012, a participatory health governance process aimed at bringing in people's voice into health policy-making. Its first success was the recently released National Health Policy 2030. This paper aims to document the SD process and to bring out the lessons learned to inspire other countries. Methods: This study was based essentially on a qualitative analysis of semi-structured interviews with citizen jury members and health experts that took place from May to September 2018. The qualitative analysis adopted an inductive-deductive approach according to a cross-matrix between the themes of the interview of the two groups of interviewees. Results: The qualitative analysis of the data highlighted that the Societal Dialogue created a health democracy dynamic with inclusive dialogue spaces for the population, communities, and civil society to participate in health system design. It constituted a multi-actor and multidisciplinary coordination platform to increase consensus building among actors. Initial government support and high levels of volunteer commitment allowed the process to achieve a certain level of sustainability. However, this process faced and still faces many challenges such as overreliance on volunteers; a crisis of trust; political instability and the lack of an effective communication strategy. These challenges negatively influence the policy uptake of recommendations made by the Societal Dialogue for Health. Conclusion: The Tunisian societal dialogue experience highlights both the successes and challenges of a structured participatory platform, as well as the effort and perseverance it takes to keep such a process functional and relevant. A key lesson from this study is that this model of participatory health governance eventually reaches a stage where population, community, and civil society participation needs to be more institutionalized within the government routine so that it can credibly feed into health policy review processes and inform decision-makers on a regular basis. [ABSTRACT FROM AUTHOR]

This paper reports on the design of a study to examine the policy landscape relevant to sugar-sweetened beverage taxation in seven sub-Saharan African countries. The study responds to the need for strong policy to address the rising burden of non-communicable diseases in the region. Sugar-sweetened beverage taxation has been widely recommended as a key component of a comprehensive policy approach to NCD prevention. However, it has proved a contentious policy intervention, with industry strongly opposing the introduction of such taxes. The aim was to identify opportunities to strengthen sugar-sweetened beverage taxation-related policy for the prevention of nutrition-related NCDs in a subset of Eastern and Southern African countries: Kenya, Tanzania, Botswana, Rwanda, Namibia, Zambia, Uganda. The study was conducted as a collaboration by researchers from nine institutions; including the seven study countries, South Africa, and Australia. The research protocol was collabora-tively developed, drawing on theories of the policy process to examine the existing availability of evidence, policy context, and stakeholder interests and influence. This paper describes the development of a method for a policy landscape analysis to strengthen policies relevant to NCD prevention, and specifically sugar-sweetened beverage taxation. This takes the form of a prospective policy analysis, based on systematic documentary analysis supplemented by consultations with policy actors, that is feasible in low-resource settings. Data were collected from policy documents, government and industry reports, survey documentation, webpages, and academic literature. Consultations were conducted to verify the completeness of the policy-relevant data collection. We analysed the frames and beliefs regarding the policy 'problems', the existing policy context and understandings of sugar-sweetened beverage taxation as a potential policy intervention, and the political context across relevant sectors, including industry interests and influence in the policy process. This study design will provide insights to inform public health action to support sugar-sweetened beverage taxation in the region. [ABSTRACT FROM AUTHOR]

Background: Due to an increasingly elderly population, a higher incidence of chronic diseases and higher expectations regarding public service provision, healthcare services are under increasing strain to cut costs while maintaining quality. The importance of promoting systems of co-produced health between stakeholders has gained considerable traction both in the literature and in public sector policy debates. This study provides a comprehensive map of the extant literature and identifies the main themes and future research needs.Methods: A quantitative bibliometric analysis was carried out consisting of a performance analysis, science mapping, and a scientific collaboration analysis. Web of Science (WoS) was chosen to extract the dataset; the search was refined by language, i.e. English, and type of publication, i.e. journal academic articles and reviews. No time limitation was selected.Results: The dataset is made up of 295 papers ranging from 1994 to May 2019. The analysis highlighted an annual percentage growth rate in the topic of co-production of about 25%. The articles retrieved are split between 1225 authors and 148 sources. This fragmentation was confirmed by the collaboration analysis, which revealed very few long-lasting collaborations. The scientific production is geographically polarised within the EU and Anglo-Saxon countries, with the United Kingdom playing a central role. The intellectual structure consists of three main areas: public administration and management, service management and knowledge translation literature. The co-word analysis confirms the relatively low scientific maturity of co-production applied to health services. It shows few well-developed and central terms, which refer to traditional areas of co-production (e.g. public health, social care), and some emerging themes related to social and health phenomena (e.g. the elderly and chronic diseases), the use of technologies, and the recent patient-centred approach to care (patient involvement/engagement).Conclusions: The field is still far from being mature. Empirical practices, especially regarding co-delivery and co-management as well as the evaluation of their real impacts on providers and on patients are lacking and should be more widely investigated. [ABSTRACT FROM AUTHOR]

This paper investigates the interrelationships among local government debt, fiscal decentralization, and public health. The investigation begins by constructing a theoretical model to analyze the inherent connections between these variables. Subsequently, an empirical analysis is conducted using data from China between 2015 and 2021. The findings demonstrate a bidirectional relationship between fiscal decentralization, local government debt, and public health. Specifically, it is observed that an increase in local government debt has adverse effects on both fiscal decentralization and public health, while fiscal decentralization has a positive impact on public health. These insights are consistently validated through rigorous regression methodologies, affirming the robustness and significance of these relationships. [ABSTRACT FROM AUTHOR]

Background: A series of Community Pharmacy Agreements (Agreements) between the Federal government and a pharmacy-owners' body, the Pharmacy Guild of Australia (PGA) have been influential policy in Australian community pharmacy (CP) since 1990. While ostensibly to support the public's access and use of medicines, the core elements of the Agreements have been remuneration for dispensing and rules that limit the establishment of new pharmacies. Criticism has focused on the self-interest of pharmacy owners, the exclusion of other pharmacy stakeholders from the Agreement negotiations, the lack of transparency, and the impact on competition. The objective of this paper is to determine the true nature of the policy by examining the evolution of the CPA from a policy theory perspective. Methods: A qualitative evaluation of all seven Agreement documents and their impact was undertaken using policy theories including a linear policy development model, Multiple Streams Framework, Incremental Theory, the Advocacy Coalition Framework, the Theory of Economic Regulation, the Punctuated Equilibrium Framework, and Elite Theory. The Agreements were evaluated using four lenses: their objectives, evidentiary base, stakeholders and beneficiaries. Results: The PGA has acted as an elite organisation with long-standing influence on the policy's development and implementation. Notable has been the failure of other pharmacy stakeholders to establish broad-based advocacy coalitions in order to influence the Agreements. The incremental changes negotiated every 5 years to the core elements of the Agreements have supported the publics' access to medication, provided stability for the government, and security for existing pharmacy owners. Their impact on the evolution of pharmacists' scope of practice and through that, on the public's safe and appropriate use of medication, has been less clear. Conclusions: The Agreements can be characterised predominantly as industry policy benefiting pharmacy owners, rather than health policy. An emerging issue is whether incremental change will continue to be an adequate policy response to the social, political, and technological changes that are affecting health care, or whether policy disruption is likely to arise. [ABSTRACT FROM AUTHOR]

Background: For people with disabilities to live a good life, it is essential that funded research in health and social care addresses their interests, meets their needs, and fills gaps in our understanding of the impact that services, systems, and policies may have on them. Decisions about research funding should be based on an understanding of the research priorities of people with disabilities, their supporters and allies, disability researchers, service providers, and policy makers working in the field. Objective: The aim of this protocol is to describe the research design and methods of a large-scale, disability research agenda--setting exercise conducted in 2021 in Australia. Methods: The research agenda--setting exercise involves 3 integrated phases of work. In the first phase, a previous audit of disability research in Australia is updated to understand previous research and continuing gaps in the research. Building on this, the second phase involves consultation with stakeholders--people with disabilities and their supporters and family members, the disability workforce, and people working within services and connected sectors (eg, aging, employment, education, and housing), academia, and public policy. Data for the second phase will be gathered as follows: a national web-based survey; a consultation process undertaken through the government and nongovernment sector; and targeted consultation with Aboriginal and Torres Strait Islander people, children with disabilities and their families, people with cognitive disability, and people with complex communication needs. The third phase involves a web-based survey to develop a research agenda based on the outcomes of all phases. Results: We have started working on 2 parts of the research prioritization exercise. Through the research-mapping exercise we identified 1241 journal articles and book chapters (referred to as research papers) and 225 publicly available reports (referred to as research reports) produced over the 2018-2020 period. Data collection for the national survey has also been completed. We received 973 fully completed responses to the survey. Analysis of these data is currently underway. Conclusions: This multi-method research agenda--setting study will be the first to provide an indication of the areas of health and social research that people across the Australian disability community consider should be prioritized in disability research funding decisions. Project results from all phases will be made publicly available through reports, open-access journal publications, and Easy Read documents. [ABSTRACT FROM AUTHOR]

Background: Client-centred care serves as the foundation for healthcare policy. Indeed, various instruments for assessing clients' experiences of care and support are increasingly used to provide insights into the quality, and client-centred nature, of the care and support provided, which, in turn, aids the development of subsequent improvements. The unique characteristics of care and support for people with intellectual disabilities (ID), such as the need for both lifelong and life-wide care and support across all aspects of clients' lives, led to an initiative within Dutch ID care to jointly develop a range of instruments to assess the experiences of clients receiving ID care and support. Individual clients' experiences and suggestions for improvement, which are embedded in clients' care plan cycles, constitute the foundation of this Range of Instruments. This paper provides a unique, bottom-up, exhaustive account of the process of developing the Range of instruments used to assess the experiences of clients in the field of Dutch ID care.Methods: Relevant documents at three levels (i.e. 1) national documents, such as policy papers and governmental reports, 2) documents and reports from the Dutch Association of Healthcare Providers for People with Disabilities (VGN) along with minutes from the meetings of the expert Committee who assessed the instruments, and 3) correspondence between the Committee and developers as well as the forms used in the assessment process for each instrument) were qualitatively analysed by two researchers who had no affiliation with the development of the Range of instruments used to assess clients' experiences in ID care and support. All of the documents were inductively coded using a thematic analytical approach. Informants who were either currently or previously involved in the development of these instruments were asked to provide clarification over the documents themselves and to explain the context in which they were produced.Results: The development of the range of instruments can be classified into four phases, namely: 1) supporting the bottom-up development of initiatives to assess clients' experiences, 2) focusing on learning and further development, 3) stimulating exchange between the developers and users of the instruments and the Committee responsible for assessing them, and 4) further development in response to the changing times and new landscape.Conclusions: The range of instruments were found to be appropriate for a variety of clients in ID care and support, specifically in terms of assessing their individual experiences and gaining insight into their suggestions for improvement, and effective in terms of collaboratively improving the quality of ID care and support. In so doing, these instruments potentially provide an avenue through which clients' experiences can be embedded in the process of ID care and support. Other specific features in the development of these instruments, namely their incremental adoption, ongoing evaluation and strong practice orientation, were also found to be suitable for other care contexts' attempts to respond to the top-down policy objectives of client-centeredness and translating outcomes into direct care practice. [ABSTRACT FROM AUTHOR]

Introduction: Over the last decade in the United States (US), the burden of chronic disease, health care costs, and fragmented care delivery have increased at alarming rates. To address these challenges, policymakers have prioritized new payment and delivery models to incentivize better integrated health and social services. Policy practice: This paper outlines three major national and state policy initiatives to improve integrated health and social care over the last ten years in the US, with a focus on the Medicaid public insurance program for Americans with low incomes. Activities supported by these initiatives include screening patients for social risks in primary care clinics; building new cross-sector collaborations; financing social care with healthcare dollars; and sharing data across health, social and community services. Stakeholders from the private sector, including health systems and insurers, have partnered to advance and scale these initiatives. This paper describes the implementation and effectiveness of such efforts, and lessons learned from translating policy to practice. Discussion and Conclusion: National policies have catalyzed initiatives to test new integrated health and social care models, with the ultimate goal of improving population health and decreasing costs. Preliminary findings demonstrated the need for validated measures of social risk, engagement across levels of organizational leadership and frontline staff, and greater flexibility from national policymakers in order to align incentives across sectors. [ABSTRACT FROM AUTHOR]

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INTRODUCTION JUUL is a high-nicotine pod-based vaping device that is popular among adolescents and young adults. On 23 June 2022, the US Food and Drug Administration (FDA) denied authorization to market JUUL, and ordered JUUL Labs to remove products from the US market. The next day, a US federal appeals court temporarily suspended the ban. The mixed public discourse surrounding the FDA ban warrants further investigation. METHODS This study examined Twitter data to describe public reaction to these announcements. Posts containing terms 'JUUL' and/or '#JUUL' (N=97548 unique tweets) were collected from 23 June to 3 July 2022, from Twitter's Streaming Application Programming Interface (API). After removing retweets, we used an inductive approach to become familiar with the data, generated a codebook, and conducted a content analysis on a random sample of n=4000 tweets. RESULTS A total of 2755 (68.9%) tweets discussed JUUL in the context of the FDA ban. News (n=1425/2755; 51.7%) about the JUUL ban, government distrust (n=588; 21.3%), and individual rights (n=253; 9.2%) were the most prevalent themes. Less commonly discussed themes included inconsistencies between policies (n=174; 6.3%), mentions of switching to other products (n=162; 5.9%), smoking cessation (n=99; 3.6%), and craving for JUUL (n=94; 3.4%). Sentiment analysis of JUUL ban-related posts (n=2755) demonstrated that 1989 (72.2%) tweets were categorized as neutral, while anti-ban posts (n=566; 20.5%) were more prevalent than pro-ban posts (n=200; 7.3%). CONCLUSIONS Besides straightforward announcements of the JUUL ban and its suspension, Twitter posts discussed government distrust, individual rights, and policy inconsistencies. While most posts conveyed neutral sentiments, anti-ban posts were almost three times more prevalent than pro-ban posts. Our findings suggest that text-based social media platforms like Twitter may be an effective instrument to understand opinions, attitudes, and beliefs regarding the FDA's JUUL ban. [ABSTRACT FROM AUTHOR]

This paper aims to illustrate the tension between public health and civil liberties through the case study of the UK government's emergency response to the Covid-19 pandemic. In the area of public health, this tension is predominantly approached by reference to two theories: liberalism and communitarianism. This paper studies these positions and how they are manifested in evidence-based policymaking by combining a study of public health policy with a study of public health ethics. The studies help demonstrate the UK government's framing of health policy relating to Covid-19 in terms of liberalism and communitarianism. The paper concludes that in the initial UK government response to Covid-19, the government discourse evoked communitarian values and framed its policies as being evidence-led and as prioritising public health. However, the policy measures themselves manifested liberal values: they had the underlying concern of not infringing excessively on civil liberties, and individuals were given autonomy of decision making within the measures that were taken. The article concluded that emergency times require a communitarian response based on preventative action. This article is the first to combine public health policy with public health ethics to demonstrate how values form a key part of decision making. [ABSTRACT FROM AUTHOR]

Subnational disparities in most health systems often defy 'one-size-fits-all' approach in policy implementation. When local authorities implement a national policy in a decentralized context, they behave as a strategic policy actor in specifying the central mandates, selecting appropriate tools and setting key implementation parameters. Local policy discretion leads to diverse policy mixes across regions, thus complicating evidence-based evaluations of policy impacts. When measuring complex policy reforms, mainstream policy evaluation methodologies have tended to adopt simplified policy proxies that often disguise distinct policy choices across localities, leaving the heterogeneous effects of the same generic policy largely unknown. Using the emerging 'text-as-data' methodology and drawing from subnational policy documents, this study developed a novel approach to policy measurement through analysing policy big data. We applied this approach to examine the impacts of China's Urban Employee Basic Medical Insurance (UEBMI) on individuals' out-of-pocket (OOP) spending. We found substantial disparities in policy choices across prefectures when categorizing the UEBMI policy framework into benefit-expansion and cost-containment reforms. Overall, the UEBMI policies lowered enrollees' OOP spending in prefectures that embraced both benefit-expansion and cost-containment reforms. In contrast, the policies produced ill effects on OOP spending of UEBMI enrollees and uninsured workers in prefectures that carried out only benefit-expansion or cost-containment reforms. The micro-level impacts of UEBMI enrolment on OOP spending were conditional on whether prefectural benefit-expansion and cost-containment reforms were undertaken in concert. Only in prefectures that promulgated both types of reforms did UEBMI enrolment reduce OOP spending. These findings contribute to a comprehensive text-mining measurement approach to locally diverse policy efforts and an integration of macro-level policy analysis and micro-level individual analysis. Contextualizing policy measurements would improve the methodological rigour of health policy evaluations. This paper concludes with implications for health policymakers in China and beyond. [ABSTRACT FROM AUTHOR]

Background: Tobacco-related morbidity and mortality is a global public health challenge. India is the second largest consumer of tobacco in the world. The present paper synthesises the data from qualitative interviews of experts working in the field of tobacco control alongside a critical analysis of the national tobacco control policy of India. Methods: The research methods adopted for the present work included the following: 1) qualitative in-depth interview of experts and analysis of the qualitative data using thematic analysis; 2) searching existing literature and secondary data on the national tobacco policy and analysing the same using the methodological orientation of qualitative content analysis; and 3) health policy analysis of the national tobacco policy. Themes and subthemes obtained from the two approaches were compared to generate meaning. Results: Nine experts (three women and six men) participated in the in-depth qualitative interviews from a variety of professional backgrounds (preventive oncology researcher, tobacco cessation specialist, public health expert, clinicians and human rights activists). The systematic and comprehensive literature search resulted in finding 14 research papers, reviews, policy documents and commentaries on the tobacco epidemic in India. The various themes that emerged from the qualitative interviews that found support from secondary data as well were: ‘Conflicting policies of Government: Promoting tobacco production and at the same time restricting its use’, ‘Failure to shield from influence of tobacco industry’, ‘Demand reduction proposals through taxation and pricing’, ‘Legislation to protect from and reduce the harm of second-hand smoking’, ‘Health warning on packaging and labelling of tobacco products’, ‘Promotion and advertisement of tobacco products’, ‘Prohibiting production by and sale to minors’. Discussion: The control of a tobacco epidemic has multiple structural and functional challenges embedded in the complexity of the public–private interfaces, socio-economic forces, conflicting interests of the stakeholders and diverse nature of the problem. Any intervention planned to reduce the tobacco usage at a population level needs to take these factors into consideration. [ABSTRACT FROM AUTHOR]

Policy PointsThe commercial determinants of health (CDoH) concept, which currently focuses on markets that harm health, should be expanded to refer to the interface between commerce and health, which can sometimes have positive public health consequences.The regulatory stances framework helps us classify public health preferences for regulating specific markets related to CDoH, based on the intended effects of regulations on market size. The regulatory stances a jurisdiction can adopt can be classified as ranging from prohibitionist through contractionist, permissive, and expansionist, to universalist.The regulatory stances framework increases the usefulness of the CDoH concept by expanding the conversation beyond negative determinants of health and providing a fuller view of the tools at the disposal of society to alter markets and improve health. Context: The effects of commerce on the public health are omnipresent. The commercial determinants of health (CDoH) represent a burgeoning area of scholarly debate and activist policymaking to redress markets that adversely affect public health. The CDoH debate is a logical extension of the tobacco control movement, but, to its detriment, the CDoH conversation remains primarily focused policies and proposals that are analogous to historical tobacco control strategies. Methods: This paper argues that for the CDoH to develop further and broaden its appeal, it should expand to cover markets with conditional and positive impacts on health. To explain and order this conversation, a comparative framework for regulatory policy is introduced: the regulatory stances. The regulatory stances classify a regulatory policy based on the intended effect of policy on the size of a market in the future relative to the present. Findings: Some markets that interface between commerce and health do not inherently harm health. Regulatory policy toward these markets should be different in intent than regulatory policy for markets with negative health effects. Conclusions: By using the regulatory stances framework to encompass markets that have positive or conditional effects on health as well as those that have adverse health effects, the CDoH conversation can shift away from the exclusive focus on strategies to shrink markets with adverse health impacts to consider a wider array of policy options. [ABSTRACT FROM AUTHOR]

In January 2014, Mexico introduced a soda tax of 1 Mexican Peso (MXP) per litre. The aim of this paper is to examine the political context out of which this policy emerged, the main drivers for the policy change, and the role of stakeholders in setting the policy agenda and shaping the policy design and outcomes. Thirty-one semi-structured interviews were conducted with key stakeholders, and 145 documents, including peer-reviewed papers, policy briefs, press releases, industry, government, and CSO reports, were analysed. An iterative thematic analysis was conducted based on relevant theories of the policy process using a complementary approach, including Stages Heuristic Model, Policy Triangle Framework, and Multiple Streams Model. Results showed that a major motivation was the new administration seeking funds as they entered government. The soda tax was supported by a key group of legislators, civil society actors and by academics promoting evidence on health effects. However, the policy measure was challenged by the food and beverage industries (F&BI). Non-state actors were both formally and informally involved in setting the agenda, regardless of some of them having opposing interests on the soda tax policy. Approaches used by non-state actors to influence the agenda included: calls for action, marketing strategies, coalition building, challenging evidence, and engaging in public-private partnerships (PPPs). The effectiveness of the soda tax was highly debated and resulted in public polarization, although the framing of the outcomes was instrumental in influencing fiscal policies elsewhere. This study contributes to the debate around implementing fiscal policies for health and how power is exercised and framed in the agenda-setting phase of policy development. The article examines how the F&BI sought to influence the national strategy for obesity prevention. It argues that the experience of the soda tax campaign empowered policy advocates, strengthening national and international civil society networks. [ABSTRACT FROM AUTHOR]

This paper offers the Eastern Mediterranean Region (EMR) viewpoint with Qatar as a case for lasting transformation of health systems. The Qatar case study illustrates the importance of research in the development of health policy. It provides description of a series of projects that have been undertaken in relevant national areas such as autism, dementia, genomics, palliative care and patient safety. The paper discourse draws attention to investment requirement in health research systems to respond to country national health priorities and to strengthen public health policies for improving health and social outcomes by narrowing the gap between research and politics. In short, the discussion highlights the following: i) health is a human right marching towards universal health care, with research underpinning every advance in health care and quality medical services; ii) evidence-based research is emerging as a critical tool to aid policy- and decision-makers; iii) investment necessity in healthcare research/systems to enable responding to a country's national health priorities and to strengthen public health policies; and iv) need for multi-sectoral involvement of stakeholders to bridge the gap between research and politics. Finally, atypical stakeholders' engagement and bond to politics is a prerequisite to achieve healthcare objectives and policy success so as to reap the benefits of public health results. [ABSTRACT FROM AUTHOR]

INTRODUCTION We used a simulation model to assess the feasibility of reaching the tobacco endgame target (reducing the smoking prevalence to below 5% by 2050) and explored potential implementation strategies. METHODS The impact of strengthened tobacco-control policies on smoking prevalence was analyzed using Korea SimSmoke, a discrete-time Markov process. We considered the effects of various scenarios from 2023 and predictions were conducted until 2050. To confirm the stability of the results, deterministic and probabilistic sensitivity analyses were carried out by increasing and decreasing parameter estimates. RESULTS The implementation of tobacco-control policies in accordance with the WHO MPOWER (Monitor tobacco use and prevention policies; Protect people from tobacco smoke; Offer help to quit tobacco smoking; Warn of the dangers of tobacco; Enforce bans on tobacco advertising, promotion, and sponsorship; Raise taxes on tobacco) measures were insufficient to achieve the tobacco endgame objective of 5% by 2050. The overall predicted smoking prevalence in 2050 is 4.7% if all policies are fully implemented in accordance with the FCTC guidelines together with a complete ban on the sale of cigarettes to people born after 2003 and annual 10% increases in price. Sensitivity analyses using the varying policy effect assumptions demonstrated the robustness of the simulation results. CONCLUSIONS For a substantive reduction in smoking prevalence, it is essential to strongly implement the MPOWER strategy. Beyond this foundational step, the eradication of smoking requires a paradigm shift in the perception of conventional tobacco-control policies, including a tobacco-free generation strategy and radical increases in the price of tobacco products. [ABSTRACT FROM AUTHOR]

Background: Despite growing evidence on the social determinants of health and health equity, political action has not been commensurate. Little is known about how political will operates to enact pro-equity policies or not. This paper examines how political will for pro-health equity policies is created through analysis of public policy in multiple sectors. Methods: Eight case studies were undertaken of Australian policies where action was either taken or proposed on health equity or where the policy seemed contrary to such action. Telephone or face-to-face interviews were conducted with 192 state and non-state participants. Analysis of the cases was done through thematic analysis and triangulated with document analysis. Results: Our case studies covered: trade agreements, primary healthcare (PHC), work conditions, digital access, urban planning, social welfare and Indigenous health. The extent of political will for pro-equity policies depended on the strength of path dependency, electoral concerns, political philosophy, the strength of economic and biomedical framings, whether elite interests were threatened and the success or otherwise of civil society lobbying. Conclusion: Public health policy actors may create political will through: determining how path dependency that exacerbates health inequities can be broken, working with sympathetic political forces committed to fairness; framing policy options in a way that makes them more likely to be adopted, outlining factors to consider in challenging the interests of elites, and considering the extent to which civil society will work in favour of equitable policies. A shift in norms is required to stress equity and the right to health. [ABSTRACT FROM AUTHOR]

Background: Decision-makers tend to make connections with researchers far too late in the game of public policy, expecting to find a retail store in which researchers are busy filling shop-front shelves with a comprehensive set of all possible relevant studies that a decision-maker might some day drop by to purchase. This linear type of relation between research and policy needs to be replaced by a more interactive model that facilitates both researchers obtaining a better understanding of policy processes and policymakers being more aware and involved in the conceptualisation and conduct of research. This paper explores the role of governance in facilitating the research-policy nexus, testing a typology of research utilisation based on Murray's (Soc Policy Society 10(4):459-70, 2011) analysis that considers various degrees of researcher-policymaker deliberation in decision-making processes. The projects were all part of various evaluation efforts carried out by the researchers to explore the use of governance in health promotion activities.Methods: Three case studies were chosen to provide some specific examples that illustrate each level of Murray's typology. The examples involve intersectoral health promotion collaborations that combine evidence-based research in health policy initiatives with various levels of researcher involvement. For all three projects, interview data was collated in the same way, coded thematically and analysed to consider the relationship between researchers and policymakers.Results: Comparing the three models and their applicability to health promotion interventions, it could be observed that all programmes demonstrated successful examples of research translation. Strong governance imperatives structuring relationships led to more successful outcomes, whereby research was successfully translated into a public policy initiative that also led to improved health outcomes. The key idea across all of these models was that strong governance arrangements mitigated some of the barriers evidenced by the varying degrees of deliberation and researcher involvement in processes.Conclusions: The paper demonstrates that successful research utilisation is related to strong governance agendas and that early and ongoing involvement of relevant decision-makers and researchers in the governance processes, that is both the conceptualisation and conduct of a study, tend to be the best predictors of success. [ABSTRACT FROM AUTHOR]

BACKGROUND: Both public health, and the health of the natural environment, are affected by policy decisions made across portfolios as diverse as finance, planning, transport, housing, education, and agriculture. A response to the interdependent character of public health has been the "health in all policies" (HiAP) approach. OBJECTIVES: With reference to parallels between health and environment, this paper argues that lessons from HiAP are useful for creating a new integrated environmental management approach termed "environment in all polices" (EiAP). DISCUSSION: This paper covers the theoretical foundations of HiAP, which is based on an understanding that health is strongly socially determined. The paper then highlights how lessons learned from HiAP's implementation in Finland, California, and South Australia might be applied to EiAP. It is too early to learn from evaluations of HiAP, but it is apparent that there is no single tool kit for its application. The properties that are likely to be necessary for an effective EiAP approach include a jurisdiction-specific approach, ongoing and strong leadership from a central agency, independent analysis, and a champion. We then apply these properties to Victoria (Australia) to demonstrate how EiAP might work. CONCLUSIONS: We encourage further exploration of the feasibility of EiAP as an approach that could make explicit the sometimes surprising environmental implications of a whole range of strategic policies. CITATION: Browne GR, Rutherfurd ID. 2017. The case for "environment in all policies": lessons from the "health in all policies" approach in public health. Environ Health Perspect 125:149-154; http://dx.doi.org/10.1289/EHP294 [ABSTRACT FROM AUTHOR]

Aims: In 2014, in response to evidence that Canada's tobacco use would lead, inexorably, to substantial morbidity and mortality for the foreseeable future, a group of experts convened to consider the development of a "Tobacco Endgame" for Canada. The "Tobacco Endgame" defines a time frame in which to eliminate structural, political, and social dynamics that sustain tobacco use, leading to improved population health. Strategies: A series of Background Papers describing possible measures that could contribute to the creation of a comprehensive endgame strategy for Canada was prepared in advance of the National Tobacco Endgame Summit hosted at Queen's University in 2016. At the summit, agreement was reached to work together to achieve <5% tobacco use by 2035 (<5 by '35). A report of the proceedings was shared widely. Achievements: Progress since 2016 has been mixed. The Summit report was followed by a national forum convened by Health Canada in March 2017, and in 2018, the Canadian Government adopted "<5 × '35" tobacco use target in a renewed Canadian tobacco reduction strategy. Tobacco use has declined in the last 5 years, but at a rate slower than that which will be needed to achieve the <5 by '35 goal. There remain > 5 million smokers in Canada, signaling that smoking-related diseases will continue to be an enormous health burden. Furthermore, the landscape of new products (e-cigarettes and cannabis) has created additional risks and opportunities. Future directions: A bold, reinvigorated tobacco control strategy is needed that significantly advances ongoing policy developments, including full implementation of the key demand-reduction policies of the WHO Framework Convention on Tobacco Control. Formidable, new disruptive policies and regulations will be needed to achieve Canada's Endgame goal. [ABSTRACT FROM AUTHOR]

A brief summary of the five papers published in this issue is provided. These papers deal with diverse topics that include: optimal betting behavior in the presence of ambiguity; public policy on screening for breast cancer; product line design; and value of information. [ABSTRACT FROM AUTHOR]

National and international organizations recommend creation of environments that support physical activity where people live, work, play, study, and travel. Policy changes can lead to activity-supportive environments and incentives. Research on environmental and policy influences on physical activity is well underway in many countries. An important use of the research is to inform policy debates, but the “translation” of research to policy is an emerging science. The papers in this supplement were presented at the 2008 Active Living Research Conference whose theme was “Connecting Active Living Research to Policy Solutions.” The papers include evaluations of policy initiatives and research that suggests promising new policies. Commentaries propose principles for improving the translation of research to policy. Improving the rigor of research, asking policy-relevant questions, presenting country-specific data, and effectively communicating findings to policy makers are likely to contribute to greater impact of research on policy processes.Journal of Public Health Policy (2009) 30, S1–S15. doi:10.1057/jphp.2008.59 [ABSTRACT FROM AUTHOR]

OBJECTIVES: The involvement of individuals and communities in health decision‐making is enshrined in WHO policies. However, migrant groups are under‐represented in health decision‐making processes. Our aim was to explore migrants' involvement in health policy, service development and research in the WHO European Region to identify levers for inclusive and meaningful practice. METHODS: We conducted a narrative review of grey literature and peer‐reviewed research on migrants' involvement in health decision‐making across the 53 countries in WHO Europe. We searched for articles published in English between 2010 and the present in two electronic databases (PubMed, Scopus), IOM MIPEX Health Strand country reports, the EU SOPHIE project and using a Google advanced search. Findings were analysed descriptively and using Normalisation Process Theory to investigate levers and barriers to implementation of policy into practice. RESULTS: Of 1,444 articles retrieved, 79 met the inclusion criteria. We identified 20 policies promoting migrants' involvement, but national‐level policies were present in only two countries. We identified 59 examples of migrants' involvement in practice from half of the WHO Europe countries (n = 27). Our Normalisation Process Theory (NPT) analysis of 14 peer‐reviewed empirical papers found that participatory research approaches are a lever to putting policy into practice in a meaningful way. CONCLUSIONS: Migrants' involvement in health decision‐making requires explicit national policies that are implemented evenly across policymaking, service provider and research activities in all countries in the WHO European Region. Participatory approaches to involvement activities are encouraged because they are a lever to perceived barriers to migrants' involvement. [ABSTRACT FROM AUTHOR]

Background: As a result of the growing number of interventions that are now performed in the context of maternity care, health authorities have begun to examine the possible repercussions for service provision and for maternal and neonatal health. In Spain the Strategy Paper on Normal Childbirth was published in 2008, and since then the authorities in Catalonia have sought to implement its recommendations. This paper reviews the current provision of maternity care in Catalonia. Methods: This was a descriptive study. Hospitals were grouped according to their source of funding (public or private) and were stratified (across four strata) on the basis of the annual number of births recorded within their respective maternity service. Data regarding the distribution of obstetric professionals were taken from an official government survey of hospitals published in 2010. The data on obstetric interventions (caesarean, use of forceps, vacuum or non-specified instruments) performed in 2007, 2010 and 2012 were obtained by consulting discharge records of 44 public and 20 private hospitals, which together provide care in 98% of all births in Catalonia. Proportions and confidence intervals were calculated for each intervention performed in all full-term (37-42 weeks) singleton births. Results: Analysis of staff profiles according to the stratification of hospitals showed that almost all the hospitals had more obstetricians than midwives among their maternity care staff. Public hospitals performed fewer caesareans [range between 19.20% (CI 18.84-19.55) and 28.14% (CI 27.73-28.54)] than did private hospitals [range between 32.21% (CI 31.78-32.63) and 39.43% (CI 38.98-39.87)]. The use of forceps has decreased in public hospitals. The use of a vacuum extractor has increased and is more common in private hospitals. Conclusions: Caesarean section is the most common obstetric intervention performed during full-term singleton births in Catalonia. The observed trend is stable in the group of public hospitals, but shows signs of a rise among private institutions. The number of caesareans performed in accredited public hospitals covers a limited range with a stable trend. Among public hospitals the highest rate of caesareans is found in non-accredited hospitals with a lower annual number of births. [ABSTRACT FROM AUTHOR]

Since the outbreak of the novel coronavirus disease (COVID-19) at the beginning of December 2019, there have been more than 28.69 million cumulative confirmed cases worldwide as of 12th September 2020, affecting over 200 countries and regions with more than 920,463 deaths. The COVID-19 pandemic has been sweeping worldwide with unexpected rapidity. In this paper, a hybrid modelling strategy based on tessellation structure- (TS-) configured SEIR model is adopted to estimate the scale of the pandemic spread. Building on the data pertaining to the global pandemic transmission over the last six months around the world, key impact factors in the transmission and control procedure have been analysed, including isolation rate, number of the infected cases before taking prevention measures, degree of contact scope, and medical level, so as to capture the fundamental factor influencing the pandemic. The quantitative evaluation allowed us to illustrate the magnitude of risks of pandemic and to recommend appropriate national health policy of prevention measures for effectively controlling both intra- and interregional pandemic spread. Our modelling results clearly indicate that the early-stage preventive measures are the most effective action to be taken to contain the pandemic spread of the highly contagious nature of the COVID-19. [ABSTRACT FROM AUTHOR]

This paper presents reflections about 'waiting' for healthcare, in particular outpatient 'waiting' for specialist orthopaedic surgical appointments. Waiting for healthcare is a substantial and growing problem across the globe. There is significant interest from Western governments to make waiting time for services publicly available and measured against defined targets. As yet there is little consistency in how waiting is defined and monitored, and therefore little is understood about the impact of waiting on patients, in defined targets. As yet there is little consistency in how waiting is defined and monitored, and therefore little is understood about the impact of waiting on patients, in terms of health, social and financial aspects. This paper explores current understandings of waiting list impacts for patients with an orthopaedic complaint, drawing on initiatives to manage orthopaedic waiting lists from one Australian public hospital. Abbreviations: CDC - Consumer Directed Care; GP - General Practitioner; THC - The Canberra Hospital. [ABSTRACT FROM AUTHOR]

Rare diseases are an important public health issue with high unmet need. The introduction of the EU Regulation on orphan medicinal products (OMP) has been successful in stimulating investment in the research and development of OMPs. Despite this advancement, patients do not have universal access to these new medicines. There are many factors that affect OMP uptake, but one of the most important is the difficulty of making pricing and reimbursement (P&R) decisions in rare diseases. Until now, there has been little consensus on the most appropriate assessment criteria, perspective or appraisal process. This paper proposes nine principles to help improve the consistency of OMP P&R assessment in Europe and ensure that value assessment, pricing and funding processes reflect the specificities of rare diseases and contribute to both the sustainability of healthcare systems and the sustainability of innovation in this field. These recommendations are the output of the European Working Group for Value Assessment and Funding Processes in Rare Diseases (ORPH-VAL), a collaboration between rare disease experts, patient representatives, academics, health technology assessment (HTA) practitioners, politicians and industry representatives. ORPH-VAL reached its recommendations through careful consideration of existing OMP P&R literature and through a wide consultation with expert stakeholders, including payers, regulators and patients. The principles cover four areas: OMP decision criteria, OMP decision process, OMP sustainable funding systems and European co-ordination. This paper also presents a guide to the core elements of value relevant to OMPs that should be consistently considered in all OMP appraisals. The principles outlined in this paper may be helpful in drawing together an emerging consensus on this topic and identifying areas where consistency in payer approach could be achievable and beneficial. All stakeholders have an obligation to work together to ensure that the promise of OMP's is realised. [ABSTRACT FROM AUTHOR]

Background: Evidence-based health workforce policies are essential to ensure the provision of high-quality health services and to support the attainment of universal health coverage (UHC). This paper describes the main characteristics of available health workforce data for 74 of the 75 countries identified under the 'Countdown to 2015' initiative as accounting for more than 95% of the world's maternal, newborn and child deaths. It also discusses best practices in the development of health workforce metrics post-2015.Methods: Using available health workforce data from the Global Health Workforce Statistics database from the Global Health Observatory, we generated descriptive statistics to explore the current status, recent trends in the number of skilled health professionals (SHPs: physicians, nurses, midwives) per 10 000 population, and future requirements to achieve adequate levels of health care in the 74 countries. A rapid literature review was conducted to obtain an overview of the types of methods and the types of data sources used in human resources for health (HRH) studies.Results: There are large intercountry and interregional differences in the density of SHPs to progress towards UHC in Countdown countries: a median of 10.2 per 10 000 population with range 1.6 to 142 per 10 000. Substantial efforts have been made in some countries to increase the availability of SHPs as shown by a positive average exponential growth rate (AEGR) in SHPs in 51% of Countdown countries for which there are data. Many of these countries will require large investments to achieve levels of workforce availability commensurate with UHC and the health-related sustainable development goals (SDGs). The availability, quality and comparability of global health workforce metrics remain limited. Most published workforce studies are descriptive, but more sophisticated needs-based workforce planning methods are being developed.Conclusions: There is a need for high-quality, comprehensive, interoperable sources of HRH data to support all policies towards UHC and the health-related SDGs. The recent WHO-led initiative of supporting countries in the development of National Health Workforce Accounts is a very promising move towards purposive health workforce metrics post-2015. Such data will allow more countries to apply the latest methods for health workforce planning. [ABSTRACT FROM AUTHOR]

The policy capacity framework offers relevant analytical ideas that can be mobilized for health system strengthening. However, the employment of this framework in the health field constitutes a relevant interdisciplinary gap in knowledge. This themed issue explores the relationships between the policy capacity framework and health system strengthening, in a multidimensional and interdisciplinary way, in high-income and low-middle-income countries. This introduction unpacks the dynamic interrelationships between the policy capacity framework and health system strengthening, bringing together common and distinct elements from both fields and summarizing possible relationships between them. The analysis shows that both fields together can increase our knowledge on health policies and system's critical themes and reforms. This challenge could be followed by exploring the convergences between them, as far as concepts/themes (types of capacities and other themes) and levels of analysis are concerned. Although in varied ways, papers in this issue (based on European countries, China, Canada, New Zealand, India, Australia, and Brazil) advance the use of the policy capacity framework for health policy or system strengthening. They give two main interdisciplinary contributions. Critical capacities can be incorporated into the policy capacity framework for the analysis of system strengthening--capacity to adapt, contexts of mixed and complex systems, dynamic view of policy capacity, and policy capacity as a relational power. Policy capacity is contextually interpreted (relative to the problem frame) and dynamic and adaptive (processual and relational), in relation to the properties of a health system, particularly with regard to the existing and developing mixed and complex systems. [ABSTRACT FROM AUTHOR]

INTRODUCTION Transitions between different tobacco products are frequent among tobacco users in Bangladesh; however, the reasons leading to such transitions and why they quit are not well researched. The aim of the study is to examine perceptions and reasons reported by tobacco users in Bangladesh to transition to other products or quit. METHODS Data from four waves (2009-2015) of the International Tobacco Control (ITC) Bangladesh Survey were used. Repeated data on perceptions and reasons for exclusive cigarette (n=520), bidi (n=130), and SLT users (n=308) to either start using other products or quit were analyzed with sampling weights. The percentages of responses across waves were used to calculate the pooled proportion data using a meta-analysis approach. RESULTS Common reasoning for respondents switching to other tobacco products were influence of friends/family (73.8-86.0%), and curiosity (44.4-71.3%). The perceived calming effect of smoking cigarettes and bidis (43.2-56.9%), and the impression that bidis were less harmful (52.3%) and taste better (71.2%) were major reasons for exclusive SLT users to switch products. Health concerns (16.5-62.7%) and disapproval from friends/family (29.8-56.4%) were generally the main reasons for quitting. For smoked tobacco users, doctor's advice (41.6%), package warning labels (32.3%), and price (32.4%) seemed to be the major driving factors to quit. CONCLUSIONS Results highlight that the reasons for switching between tobacco products and quitting include social factors (e.g. friends/family) and (mis) perceptions regarding the products. Tobacco control policy could emphasize cessation support, increased price and education campaigns as key policies to reduce overall tobacco use in Bangladesh. Data from four waves (2009-2015) of the International Tobacco Control (ITC) Bangladesh Survey were used. Repeated data on perceptions and reasons for exclusive cigarette (n=520), bidi (n=130), and SLT users (n=308) to either start using other products or quit were analyzed with sampling weights. The percentages of responses across waves were used to calculate the pooled proportion data using a meta-analysis approach. [ABSTRACT FROM AUTHOR]

INTRODUCTION Preventing youth from tobacco use is a priority for tobacco control in China, and the government has taken many measures such as introducing tobacco control in the health education curriculum, banning smoking in school, promoting smoke-free household, and advocacy campaigns. The objective of this study was to understand the availability and affordability of cigarettes for middle school (MS) and high school (HS) students in China. METHODS The data were extracted from the 2019 China National Youth Tobacco Survey, which was a school-based cross-sectional survey with a nationally representative sample of 288192 MS and HS students. The survey employed a randomized multistage stratified cluster sampling design with probability proportional to size sampling method and used an anonymous self-administrated questionnaire to collect data. The availability and affordability of cigarettes were analyzed, and all parameter estimates were weighted to account for the complex sampling design. RESULTS In 2019, an estimated 80.5% of current smokers who were aged <18 years bought cigarettes in the past 30 days. Among them, 83.3% (83.0% of males and 85.2% of females; and 76.5% in MS and 87.6% in HS) had not been refused purchase of cigarettes because they were underage, with 84.1% in urban and 82.9% in rural areas, and 87.3% in central, 83.4% in eastern, and 80.5% in western regions of China. Among current smokers who bought cigarettes in the past 30 days, 77.3% had bought a pack of cigarettes (20 cigarettes) costing >10 RMB and at least 61.4% had more pocket money per week than the cost of a pack of cigarettes. Although 84.2% of current smokers bought cigarettes by the pack, 9.2% of current smokers reported that they bought cigarettes as sticks. CONCLUSIONS Although the youth smoking rate dropped down from 2014 to 2019, the proportion of youth smokers that bought cigarettes was still high in China. Due to the high amount of pocket money, the current cigarette price was not an effective price barrier to prevent youth smoking. Selling cigarettes by the stick worsens the situation. Strengthening the enforcement of the 2021 Law on the Protection of Minors, increasing tobacco taxes and prices, and forbidding the selling of cigarette sticks, might assist the progress in youth tobacco control. [ABSTRACT FROM AUTHOR]

Background: Rural Australian populations experience an increased burden of ischaemic heart disease (IHD) compared to their metropolitan counterparts, similar to other developed countries, globally. Policy and other efforts need to address and acknowledge these differences in order to reduce inequalities in health burden. This paper examines rural health policy makers’ perceptions and use of evidence in efforts to reduce the burden of IHD in rural areas. Methods: Policy makers and government advisors (n = 21) who worked with, or advised on, rural health policy at local, state and federal government levels, with specific focus on the state of Victoria (n = 9) were identified from publicly available documents and subsequent snowball sample. Semi-structured qualitative interviews were conducted in regards to the use of evidence in policy to prevent IHD and thematic analysis undertaken applying two theoretical perspectives: context-based evidence-based policy making and the conceptual framework for understanding rural and remote health. Results: The rural context, particularly low resourcing, was seen as limiting potential for evidence based policy at local government (LG) level. Lower levels of political pressure and education were seen as constraints to evidence-based policy in rural communities. Participants described the potential for policy to have a greater impact on reducing heart disease in rural areas though they felt under-resourced and out of touch with the scientific evidence. Scientific studies were less valued than local anecdote to prioritise specific policy. At all levels (local, state and federal) low self-efficacy in interpreting evidence and perceived lack of relevance inhibited development of evidence informed policy. Conclusion: The rural context constrains the use of scientific evidence in policy making for the prevention of heart disease in rural areas in Australia with multiple factors influencing the capacity for evidenced based health policy. This is similar to findings at the international scale and is for consideration across other developed countries that experience inequalities in IHD disease burden between rural and urban populations. [ABSTRACT FROM AUTHOR]

Aim This paper briefly reviews the history of alcohol policy development in Europe leading to the current consensus in the health field on strategic priorities. There is a review of recent policy developments in selected European countries, both EU and non-EU members. Methods Narrative review of published journal articles, publications from WHO, and other health organisations and government publications. Results The implementation of the WHO policy priorities has been variable across Europe. At EU level, there has been a recent pattern of trade considerations taking priority over health and a disinvestment in alcohol research and advocacy. Among EU member states new implementation of WHO strategies have been limited to a few smaller countries and regions. In Russia, there have been considerable falls in mortality following the introduction of controls on price, availability and marketing. Conclusion The implementation of WHO strategy at national level in Europe is highly dependent on the local political circumstances. Where there is concern about alcohol harm and political will, the WHO strategic priorities have been highly influential. In order to build public and political support for prevention, alcohol policy advocates should ensure that there is good data on trends within age, gender, and income groups and develops policies to respond to these trends. The concept of proportionate universalism, where interventions are understood to have a broad population effect but the effect is greater on the groups most in need, may be more useful than the traditional alcohol policy field conceptualisations of whole population and targeted measures. [ABSTRACT FROM AUTHOR]

Efforts to improve the effectiveness of global health aid rarely take full account of the micro-politics of policy change and implementation. South Africa's HIV/AIDS epidemic is a case in point, where the US President's Emergency Plan for AIDS Relief (PEPFAR) has provided essential support to the national AIDS response. With changing political context, PEPFAR has shifted focus several times-most recently reversing the policy of 'transition' out of direct aid to a policy of re-investing in front-line services in priority districts to improve aid effectiveness. However, this policy shift has not led to the expected impact on health services. This paper reports the findings of a study on the implementation of the recent policy through interviews at randomly selected sites in high HIV-burden districts of South Africa that capture the experiences of public-sector health leaders. We find little evidence to support the explanation that the new aid policy displaced government staff and resources. Instead, our findings suggest that legacies of the previous policy remained as local aid managers did not shift funding and practice at sufficient scale to drive the planned service delivery expansion. Human resource support, the main PEPFAR contribution to service delivery at front-line facilities, was not adequate or distributed based on the size of the HIV programme, leaving notable gaps in outreach, defaulter tracing, and community service delivery. Instead, services that better fit the previous policy paradigm, like training and data-sharing, are common at site-level but provide diminishing returns. Together, our findings suggest opportunities for PEPFAR South Africa to revisit its model and increase service delivery intensity, in particular through community-based services. More broadly, this case illustrates the need for greater attention to the multiple actors with discretion in the policy system of health aid and the mechanisms through which political priority is translated into programming as policy shifts are made. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to explore the service and policy structures that impact open disclosure (OD) practices in New South Wales (NSW), Australia. Participants and methods: An explorative study using semi-structured interviews was undertaken with 12 individuals closely involved in the implementation of OD in hospitals at policy or practice levels within the state of NSW, Australia. Interviews explored the service and policy structures surrounding OD and the perceived impact of these on the implementation of the OD policy. These data were thematically analyzed to understand the factors facilitating and creating barriers to openness after adverse events. Results: The data identified three key areas in which greater alignment between OD policy and the wider service and policy structures may enhance the implementation of OD practice: 1) alignment between OD and root cause analysis processes, 2) holistic training that links to other relevant processes such as communicating bad news, risk management, and professional regulation and insurance, and 3) policy clarification regarding the disclosure of incidents that result in no or low-level harm. Conclusion : Evidence from this study indicates that formal OD processes are not routinely applied after adverse events in NSW, despite clear guidelines for OD. The reasons for this are unclear as the service-level and policy-level phenomena that support or hinder OD are understudied. This knowledge is critical to addressing the policy-practice gap. Our paper provides insights regarding the influence of current service-level and policy-level phenomena on the delivery of OD and how policy clarification may contribute to addressing some of the challenges for implementing OD policy. The principles of virtue ethics – specifically, openness and the involvement of service users – may contribute to progressing in this area. [ABSTRACT FROM AUTHOR]

This paper addresses the major developments in primary care in the Russian Federation under the evolving Semashko model. The overview of the original model and its current version indicates some positive characteristics, including the financial accessibility of care, focus on prevention, patient lists, and gatekeeping by primary-care providers. However, in practice these characteristics do not work according to expectations. The current primary-care system is inefficient and has low quality of care by international standards. The major reasons for the gap between the positive characteristics of the model and the actual developments are discussed, including the excessive specialization of primary care, weak health-workforce policy, the delay in the shift to a general practitioner model, and the dominance of the multispecialty polyclinic, which does not prove advantageous over alternative models. Government attempts to strengthen primary care cover a wide range of activities, but they are not enough to improve the system and cannot do this without more a systematic and consistent approach. The major lesson learnt is that the lack of generalists and coordination cannot be compensated for by the growing number of specialists in the staff of primary-care facilities. Big multispecialty settings (polyclinics in the Russian context) have the potential for more integrated service delivery, but to make it happen, action is needed. Simple decisions, like merging polyclinics, do not help much. [ABSTRACT FROM AUTHOR]

In 1856, the mayor of Brussels proposed the establishment of a municipal laboratory with a chemist to analyse food and beverages to restrain fraud. His proposal was accepted and a laboratory – possibly one of the first municipal laboratories in Europe – was set up. The laboratory still exists today. This paper aims at tracing the conditions in which it emerged, situating it within the laissez-faire context of the time. It was brought into existence by a liberal administration, in a period of little interventionism replete with unencumbered private interests (those of bakers, butchers, grocers, millers, pharmacists, doctors and so on). What will be considered here is the general mood with regard to food fraud, fair trade, correct price, and the quality of food in the first half of the nineteenth century. On a broader level, this contribution addresses the frictions between private and public initiative, while focusing on the process of construction of expertise. The paper makes use of contemporary documents such as reviews, newspapers, association reports and city council chronicles. [ABSTRACT FROM PUBLISHER]