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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]

Policy PointsThe health care sector is increasingly investing in social conditions, including availability of safe, reliable, and adequate transportation, that contribute to improving health.In this paper, we suggest ways to advance the impact of transportation interventions and highlight the limitations of how health services researchers and practitioners currently conceptualize and use transportation.Incorporating a transportation justice framework offers an opportunity to address transportation and mobility needs more comprehensively and equitably within health care research, delivery, and policy. [ABSTRACT FROM AUTHOR]

Personal recovery is central to Australian mental health standards, but promoting recovery-oriented practice remains a wicked problem (ie complex, with definitions and appropriate interventions impacted upon by context and values), with limited evidence regarding effective implementation. This case study re-examines a statewide initiative to enhance recovery-oriented practice in older people's mental health services in New South Wales from the perspective of complex adaptive systems. The initiative consisted of three key strategies: (1) statewide collaborative leadership and practice resources; (2) locally determined and led improvement projects; and (3) evaluating, disseminating and sustaining initiative outcomes. Published outcomes of the initiative, related policy and benchmarking materials and author reflections are used to propose lessons for other services and policy makers. From a systems perspective, a relatively small investment from a state policy unit to enhance a facilitating environment resulted in the emergence of local leaders and voluntary participation of services within 80% of local health districts without funding incentives. Local leaders and activities informed statewide policies and models of care to sustain practice change. Limitations included variability in project scopes and the involvement of people with lived experience, as well as the level of refinement in change management approach. Self-audit and consumer-rated experience suggest resilience of practice and culture change. The outcomes are consistent with conceptualisations of mental health services being complex adaptive systems requiring distributive leadership. Established mechanisms encouraging statewide cooperation between clinicians, service managers and policy makers may have been significant facilitators of engagement in practice change. What is known about this topic?: Recovery remains an important concept for older people with mental ill health, with implementation of recovery-oriented practice a wicked problem. What does this paper add?: Central policy investment in a collaborative facilitatory environment can stimulate the emergence of local leadership and investment in actions to enhance recovery orientation. As predicted by complex adaptive systems theory, the impact of the leaders developed may be broader than the sum of individual project outcomes. What are the implications for practitioners?: A start where you can message can engage and enable leaders in feasible and locally relevant changes consistent with a statewide strategy. This may be a feasible approach to improving recovery orientation in mental health care services for and beyond older people, with potential implications for addressing other wicked problems in health care. [ABSTRACT FROM AUTHOR]

The National Disability Policy was launched in Zimbabwe in June 2021 and includes a range of commitments for the provision of disability-inclusive health services and rehabilitation. Fulfilment of these pledges is important, as at least 7% of the population have disabilities, and people with disabilities face greater challenges accessing healthcare services and experience worse health outcomes. However, it will require financial investment which is challenging as the needs of people with disabilities are set against a background of widespread health systems failures in Zimbabwe, exacerbated by the COVID-19 pandemic. Zimbabwe currently faces an epidemic of TB and HIV and a growing burden of non-communicable diseases (NCDs) with a lack of investment, healthcare staff or infrastructure to provide the necessary care. Urgent action is therefore needed to strengthen the health system and 'build back better' after both the pandemic and the regime change. The Zimbabwean government may face the dilemma, common in many low-resource settings, of whether to focus on disability or to wait until the health system has been strengthened for the majority. This paper proposed four complementary arguments why it is important to focus on people with disabilities. First, this focus respects the rights of people with disabilities, including those specified in the new National Disability Policy. Second, it will be challenging to reach the Sustainable Development Goals, including those on health and other global health targets, without including people with disabilities. Third, there is a growing rationale that disability-inclusive health systems will work better for all, and fourth, that they will create cost savings. Everyone will therefore benefit when the health systems are designed for inclusion. In conclusion, a focus on disability may help to strengthen health systems for all as well as helping to achieve human rights and global development goals. [ABSTRACT FROM AUTHOR]

An introduction is presented to a series of papers focused on the scientific dialogue between sectors on health and economics, with topics including constitutional right to health, advancements in mental health as part of a well-being economy, and health taxonomy development to guide sustainable investment decisions.

Despite the strong evidence of prevention as a prime defence against the disease, the majority of cancer research investment continues to be made in basic science and clinical translational research. Little quantitative data is available to guide decisions on the choice of research priorities or the allocation of research resources. The primary aim of the mapping of the European cancer prevention research landscape presented in this paper is to provide the evidence-base to inform future investments in cancer research. Using bibliometric data to identify funders that are active in prevention research in Europe and in the world, we have identified that 14% of cancer research papers had a focus on prevention research and those were funded by 16% of all the European cancer research funders. An important finding of our study is the lack of research on primary prevention with primary prevention funders accounting for 25% of European cancer prevention funders, meaning that less than 4% of all European cancer research funders identified show an interest in primary prevention. An additional analysis revealed that 7% of European cancer prevention research papers are categorised as implementation projects, meaning that only 1% of all cancer research publications are implementation research in cancer prevention. This paper highlights that the narrow focus on biology and treatment in Europe needs to be widened to include such areas as primary prevention and secondary prevention and a larger concentration on implementation research. These data can help support a more policy-focused cancer research agenda for individual European governments and charitable and philanthropic organisations and stimulate joining efforts across Europe to create a more systematic and structured approach to cancer prevention. • 14% of European cancer research papers have a focus on prevention research. • Only 7% of those papers are categorised as implementation research. • 16% of all European cancer research funders show an interest in prevention research. • Less than 4% of them show an interest in primary prevention. • These data can help support more policy-focused cancer research agenda. [ABSTRACT FROM AUTHOR]

Purpose: In this article, we outline our views on the appropriateness and utility of Return on Investment (ROI) for the evaluation of the value of healthcare quality improvement (QI) programmes. Design/methodology/approach: Our recent research explored the ROI concept and became the genesis of our viewpoint. We reflect on our findings from an extensive research project on the concept of ROI, involving a multidisciplinary global systematic literature review, a qualitative and Delphi study with mental healthcare leaders from the United Kingdom National Health Service. Research participants included board members, clinical directors and QI leaders. Our findings led to our conclusions and interpretation of ROI against the broad QI governance. We discuss our views against the predominant governance frameworks and wider literature. Findings: ROI is in-line with top-down control governance frameworks based in politics and economics. However, there is evidence that to be of better utility, a tool for the assessment of the value of QI benefits must include comprehensive benefits that reflect broad monetary and non-monetary benefits. This is in-line with bottom-up and collaborative governance approaches. ROI has several challenges that may limit it as a QI governance tool. This is supported by wider literature on ROI, QI as well as modern governance theories and models. As such, we question whether ROI is the appropriate tool for QI governance. A more pragmatic governance framework that accommodates various healthcare objectives is advised. Practical implications: This article highlights some of the challenges in adopting ROI as a QI governance tool. We signal a need for the exploration of a suitable QI governance approach. Particularly, are healthcare leaders to be perceived as "agents", "stewards" or both. The evidence from our research and wider literature indicates that both are crucial. Better QI governance through an appropriate value assessment tool could improve clarity on QI value, and thus investment allocation decision-making. Constructive discussion about the utility and appropriateness of ROI in the evaluation of healthcare QI programmes may help safeguard investment in effective and efficient health systems. Originality/value: The article raises awareness of QI governance and encourages discussions about the challenges of using ROI as a tool for healthcare QI governance. [ABSTRACT FROM AUTHOR]

If ZIP code is more important than genetic code in determining one's health and opportunities, how can pediatricians enable healthy and opportunity-rich environments for all children? This paper introduces a broad network of organizations, policies, and financial resources that are working to improve ZIP codes by tackling poverty at the neighborhood level. The mission-driven US community development sector began with the War on Poverty in the 1960s and 70s and comprises a network of finance, real estate, and community-based organizations working together to overturn decades of racially motivated disinvestment, revitalize persistently marginalized, low-income communities, and enhance the lives of the people who live in them. Across the country, thousands of community development corporations, community development financial institutions, affordable housing developers, and regulated for-profit banks together invest over $300 billion annually in affordable housing, childcare and early learning facilities, recreation centers, community clinics, grocery stores, small businesses, and financial services for low-income families and neighborhoods. We present successful examples of community development efforts targeting child health and opportunity and highlight opportunities for pediatricians to advise, collaborate, and partner in order to accelerate and maximize the impact of billions of dollars invested in support of healthier neighborhoods where all children can grow and thrive. [ABSTRACT FROM AUTHOR]

Purpose: The investigation goal is the analysis of the relation between healthcare expenditures and other resources, and COVID-19 fatality rates among European countries to design effective health policies for crisis management. Design/methodology/approach: Research methodology is based on descriptive statistics and various parametric methods, also including a linear model of regression to analyze basic relationships of variables under study. Findings: Results show that a lower COVID-19 fatality rate is associated with higher levels of health expenditure (% GDP), of healthcare expenditure per capita, health expenditure in preventive care (% GDP), hospitals per million inhabitants, physicians, nurses, hospital beds and curative acute care beds per 1,000 inhabitants. Regression analysis shows that a 1% increase in healthcare expenditures per capita of countries, it reduces the level of COVID-19 fatality rate by 0.74%. In fact, many countries in Eastern Europe with low healthcare expenditures per capita in 2019 (e.g., Bulgaria, Romania, Hungary, Poland, Latvia, Slovakia, Lithuania, etc.), they have experienced high COVID-19 fatality rates. Instead, a lot of countries in Western Europe, with high healthcare expenditures per capita, such as Germany, Denmark, Austria, and the Netherlands, they had resilient health systems to face pandemic crisis and lower COVID-19 fatality rates. Practical implications: These findings suggest strategies of systematic and continuous investments in healthcare, medical technologies, and ICT infrastructures to support effective health policy of crisis management in countries to face future pandemic crisis and other emergencies in society. Originality/value: The explanation of critical role of high health expenditure (% GDP) and healthcare expenditure per capita to support robust health systems that bolster the resilience in nations to face health emergencies and worldwide crises. [ABSTRACT FROM AUTHOR]

Objective. Examine the distribution of funding for suicide prevention in Australia from 2021-22 to 2026-27. Methods. Government websites were reviewed to locate budget documents related to suicide prevention funding. Information was extracted on the program/service to be funded, and the funder entity, duration, and year allocation. Extracted data was reviewed to identify commonly targeted sub-populations. Results. The majority of suicide prevention-related funding was allocated to aftercare for persons who have attempted suicide, consistent with the effectiveness of these services, followed by programs targeting the general population. Little funding was allocated to other specific sub-populations, such as young people and Aboriginal and Torres Strait Islander peoples. The amount of funding allocated to suicide prevention varied across jurisdictions, which is only partially explained by suicide rates. Conclusions. There is a need for greater investment in care for specific sub-populations who are at higher risk of suicide. This study provides a baseline for comparing future investments in suicide prevention in Australia. [ABSTRACT FROM AUTHOR]

Background: South Africa uses government-funded return-of-service (RoS) schemes to train, recruit and retain skilled health professionals in underserved areas. These educate health professionals locally or internationally in return for a commitment to serve in a specified area for an agreed period. While such schemes are used widely and are funded by substantial public funds, their exact makeup differs across jurisdictions, and little is known about why these differences have emerged or how they influence their effectiveness or impact on the health system. We aimed to fill these gaps through an analysis of the origins, architecture, and evolution of RoS schemes in South Africa. Methods: A multimethod research study including a policy review, a literature review, and semi-structured interviews of policymakers was undertaken between October 2020 and August 2022. The included policy documents and literature were analysed using the Walt and Gilson framework and narrative synthesis. Qualitative data were analysed using inductive, thematic analysis in NVIVO 12. Results: RoS schemes are used as a recruitment and retention strategy and a mechanism to address equity in access to medical education. Whilst there is evidence of RoS schemes existing in 1950, no evidence of beneficiaries was found in databases until 1989. The impact of these schemes is likely being limited by sub-optimal institutional arrangements and poor transparency in their design and implementation. Conclusion: Despite rigorous research methods, the origins of RoS policies in South Africa could not be established due to poor preservation of institutional memory. Opportunities to monitor the value of public investment into RoS programs are being missed and often the underlying objective of the programs has not been well-specified. Policies were found to have been developed and operate in isolation from other health workforce planning activities and thus may not be maximising their impact as a retention and training tool. [ABSTRACT FROM AUTHOR]

Considered investment in health and medical research (HMR) is critical for fostering a healthcare system that is sustainable, effective, responsive, and innovative. While several tools exist to measure the impact of research, few assess the research environment that nurtures and supports impactful research and the strategic alignment of research with societal needs. This perspective article discusses the limitations of existing assessment tools and presents a novel Research Impact Assessment Framework designed to enable more strategic and targeted investment towards HMR, having the potential for significant public benefit. [ABSTRACT FROM AUTHOR]

Policy PointsThis Perspective connects the dots between the polarization in US states' policy contexts and the divergence in population health across states.Key interlocking forces that fueled this polarization are the political investments of wealthy individuals and organizations and the nationalization of US political parties.Key policy priorities for the next decade include ensuring all Americans have opportunities for economic security, deterring behaviors that kill or injure hundreds of thousands of Americans each year, and protecting voting rights and democratic functioning. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) is often characterised as a 'crisis', requiring action by public, private, and third-sector stakeholders to achieve strategic change. Crisis narratives are powerful and may be co-opted to privilege solutions promoted by influential groups. In relation to AMR, this applies particularly to the pharmaceutical and medical diagnostics industries. Given the associated risk of inefficient use of public funds, critical attention must be paid to how the promoted 'solutions' to the AMR crisis are constructed, and their symbolic and material effects on health policy. We conducted a critical discourse analysis (CDA) of the seventy-one written submissions to the UK House of Commons Health and Social Care Committee's 2018 inquiry into AMR. Two researchers collaboratively coded the findings and categorised the submissions. We applied the Policy Dystopia Model to further analyse the proposed solutions and ascertain the discursive and instrumental arguments in the industry submissions to the Committee. We found that industry submissions deployed economic and governance discursive strategies, articulating three main 'market paradoxical' arguments: (i) interference but non-interference; (ii) power but powerlessness; and (iii) for-profit but not-for-profit. The industry submissions also drew upon instrumental strategies including: coalition management, information management, and direct involvement and influence in policymaking. Our analysis suggests that commercial interests deploy crisis narratives to advocate for solutions involving market deregulation and industry subsidies. Thus, the solutions presented to the Committee were heavily shaped by a technocratic-industrial complex. This contributes to influencing what is seen as possible and acceptable in the global AMR policy landscape. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) has the potential to improve public health's ability to promote the health of all people in all communities. To successfully realize this potential and use AI for public health functions it is important for public health organizations to thoughtfully develop strategies for AI implementation. Six key priorities for successful use of AI technologies by public health organizations are discussed: 1) Contemporary data governance; 2) Investment in modernized data and analytic infrastructure and procedures; 3) Addressing the skills gap in the workforce; 4) Development of strategic collaborative partnerships; 5) Use of good AI practices for transparency and reproducibility, and; 6) Explicit consideration of equity and bias. [ABSTRACT FROM AUTHOR]

The increasing number of regions have begun to construct age‐friendly medical institutions to further promote the "successful aging" of the elderly in mainland China. This study deeply analyzes the development status of age‐friendly medical institutions abroad and describes the policies, research, evaluation, and certification of different countries. This study focuses on the current construction status of age‐friendly medical institutions in mainland China. With the issuing of several national policies, mainland China has established a top‐down system for the construction of age‐friendly medical institutions, which has been gradually implemented in the actions of medical institutions. On the whole, the goal and evaluation standard are clear and the action is rapid. However, it also faces many challenges and problems. This study puts forward various suggestions for the construction of age‐friendly medical institutions, such as increasing manpower and financial investment and carrying out evidence‐based research. In particular, we should pay attention to promoting a bottom‐up construction system, understand the actual needs of the elderly, pay attention to the personal experience of the elderly, and fully mobilize the active and full participation of the whole society. [ABSTRACT FROM AUTHOR]

This article examines the political economy of health inequalities and inequities in the public health care system in India and identifies potential areas for interventions to promote equal and equitable health care for marginalized people. Drawing on the Political Economy of Health Model of Research, this article reiterates the inadequacy of policy frameworks and programs in ensuring accessible, affordable, and quality public health care services to all. We argue that for policies to be successful, policymakers should consider the diverse social registries of class, caste, religion, gender, region, ethnicity, and age, as well as their intersections. We also argue that health care policies and programs need to be: (a) dynamic and flexible, (b) intersectional and backed up by sufficient grassroots research, and (c) equitable at every stage of policy formulation, implementation, and evaluation. [ABSTRACT FROM AUTHOR]

Thailand is an exemplar of the challenges faced in addressing the increasing dual demands of aging populations and increasing incidence of non-communicable disease (NCDs). By understanding the dilemmas and solutions posed by Thailand, we propose a framework of key factors to be addressed in order to accelerate capacity in addressing the NCDs challenges in aging populations. Methods proposed by world health organizations to improve population health could impact NCDs if Quality Adjusted Life Years (QALYs) are increased as well as life expectancy through these measures. Four recommendations for achieving these objectives are discussed: expand investments in health care infrastructure for NCDs prevention and early detection; expand public health policies to full population health goals; expand to universal coverage for health care access; engage multi-sectoral constituencies in policy and strategic implementation programs for health. With the emergence of an aging population and the inevitable rise in NCDs, the Thai government is engaging each element of our recommendations and grappling with the policy trade-offs in the context of broader economic and other strategic goals. The experience of Thailand in achieving its goal of population health is a case study of focus, perseverance, and consistent policy strategies. [ABSTRACT FROM AUTHOR]

Policy Points Investments in early childhood education can have long‐lasting influence on health and well‐being at later stages of the life course. Widespread public support and strategies to counter opposition will be critical to the future political feasibility of enhancing early childhood policies and programs. Simple advocacy messages emphasizing the need for affordable, accessible, high‐quality childcare for all can increase public support for state investments in these policies. Policy narratives (short stories with a setting, characters, and a plot that unfolds over time and offers a policy solution to a social problem) that describe structural barriers to childcare and policy solutions to address these barriers may be particularly effective to persuade individuals inclined to oppose such policies to become supportive. Inoculation messages (messages designed to prepare audiences for encountering and building resistance to opposing messages) may protect favorable childcare policy attitudes in the face of oppositional messaging. Context: Early childhood education (ECE) programs enhance the health and social well‐being of children and families. This preregistered, randomized, controlled study tested the effectiveness of communication strategies to increase public support for state investments in affordable, accessible, and high‐quality childcare for all. Methods: At time 1 (August‐September 2019), we randomly assigned members of an online research panel (n = 4,363) to read one of four messages promoting state investment in childcare policies and programs, or to a no‐exposure control group. Messages included an argument‐based message ("simple pro‐policy"), a message preparing audiences for encountering and building resistance to opposing messages ("inoculation"), a story illustrating the structural nature of the problem and solution ("narrative"), and both inoculation and narrative messages ("combined"). At time 2 (two weeks later) a subset of respondents (n = 1,436) read an oppositional anti‐policy message and, in two conditions, another narrative or inoculation message. Ordinary least squares regression compared groups' levels of support for state investment in childcare policies and programs. Findings: As hypothesized, respondents who read the narrative message had higher support for state investment in childcare policies than those who read the inoculation message or those in the no‐exposure control group at time 1. Among respondents who were initially opposed to such investments, those who read the narrative had greater support than respondents who read the simple pro‐policy message. Those who received the inoculation message at time 2 were more resistant to the anti‐policy message than respondents who did not receive such a message, but effects from exposures to strategic messages at time 1 did not persist at follow‐up. Conclusions: Results offer guidance for policy advocates seeking to increase public support for early childhood policies and programs and could inform broader efforts to promote high‐value policies with potential to improve population health. [ABSTRACT FROM AUTHOR]