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Purpose: This paper aims to use systems mapping as a tool to develop an organisation-wide approach to public mental health to inform strategic direction within a national public health agency. Design/methodology/approach: Two workshops were facilitated with internal staff from a wide range of public health policy teams working in small groups to produce paper-based maps. These were collated and refined by the project team and digitised. Findings: The approach engaged a range of teams in forming a shared understanding and producing a complex system map of the influences on population mental health and well-being, where current policy initiatives were addressing them and what the gaps and priorities were. Participants valued the approach which led to further study and organisational commitment to the whole system working as part of national public mental health strategy. Research limitations/implications: The approach was limited to internal stakeholders and wider engagement with other sectors and community members would help further the application of complex system approaches to public mental health. Originality/value: It was a valuable process for developing a whole-organisation approach and stimulating thinking and practice in complex system approaches. The paper provides a practical example of how to apply systems mapping and its benefits for organising public mental health practice. [ABSTRACT FROM AUTHOR]

Reducing social inequalities in health has been an important aim in the development of the Nordic welfare states. This Commentary presents the development of Norwegian policies in this area from 1987 to 2021. Social inequalities entered the political agenda in Norway in the 1980s, but were mostly defined as a problem for selected marginalised groups. The World Health Organization project led by Michael Marmot was an inspiration for Norwegian policy-makers and the concept of the social gradient was introduced. From 2005, levelling the social gradient in health became a central strategy in Norwegian policy-making and culminated in the Public Health Act 2012. This Act focuses on the structural determinants of health and the municipalities have a central role in its implementation. However, the municipalities are mostly responsible for services providing downstream measures and have little control over social determinants such as tax or labour market policies. The Public Health Act is important because it institutionalises social inequalities as a policy field within public health. Not only the municipalities, but all administrative levels have to contribute to meet the aim of reducing the social gradient. [ABSTRACT FROM AUTHOR]

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]

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]

The article explains the role of policy-making for the promotion of population health. Topics covered include some of the medieval and renaissance approaches to policing disease outbreaks, the implication of the current challenges faced by the public health community in relation to the anti-vaxxers and the objective of the field of health political science.

Policy PointsFaced with urgent threats to human health and well‐being such as climate change, calls among the academic community are getting louder to contribute more effectively to the implementation of the evidence generated by our research into public policy.As interest in knowledge translation (KT) surges, so have a number of anxieties about the field's shortcomings. Our paper is motivated by a call in the literature to render useful advice for those beginning in KT on how to advance impact at a policy level.By integrating knowledge from fields such as political science, moral psychology, and marketing, we suggest that thinking and acting like marketers, lobbyists, movements, and political scientists would help us advance on the quest to bridge the chasm between evidence and policy. [ABSTRACT FROM AUTHOR]

Background and Aims: The Transformative Research on the Alcohol industry, Policy and Science (TRAPS) programme investigates the alcohol industry, with an innovative focus on public health sciences. TRAPS adds to an under‐developed literature on the study of alcohol industry influence on alcohol science and policymaking. This paper provides a synthesis of TRAPS findings to inform future research. Methods: We conducted an interpretive review of TRAPS research findings across its component studies, identifying and integrating the key contributions made by individual studies to the literature on alcohol policymaking and science, and identifying areas where TRAPS progress was limited. This produced themes for consideration in future research agenda setting. Results: TRAPS explored the interventions of the alcohol industry in science and policymaking using various methods, including systematic reviews and qualitative interviews. These studies identified the industry's activities in several key areas, such as the debate over minimum unit pricing (MUP), cardiovascular health and alcohol research and a long‐running public relations programme developed in close connection with the tobacco industry. Collectively, the research shows that alcohol policymaking has involved a contest between the research community and alcohol industry actors about whether and how science should be used to inform policy. Conclusions: The TRAPS programme demonstrates the need for a transdisciplinary approach to understand the nature of corporate political activity; the crucial role industry involvement in science plays in the development of corporate political power; and how public health actors have successfully overcome industry opposition to evidence‐based policies. Advances in alcohol policy should be underpinned by strong, reflexive public health sciences, alert to the role of industry in the alcohol harms under study and thorough in their investigation of the alcohol industry as an object of study in itself. [ABSTRACT FROM AUTHOR]

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]

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]

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]

Objective: Parliamentary inquiries into health-related issues empower everyday Australians to contribute to the development and reform of health policy. We explored how patient and family/carers concerns are translated by this process, using a less well-known disease, narcolepsy, as an example. Methods: Written submissions made to the Parliamentary Inquiry into Sleep Health Awareness in Australia 2018 by self-identified patients or family/carers with narcolepsy (n = 13) were extracted and thematically analysed using the Framework Approach. Each submission was systematically coded and abstracted into emergent themes before being evaluated against the final policy recommendations. Results: Although patients and their family/carers prioritised issues that affected their daily lives (i.e. mental health sequela, workplace accommodations), the policy recommendations in the report focused mainly on issues of healthcare infrastructure, funding and engagement. Our analysis highlighted several barriers that patients and their family/carers face when contributing to this part of healthcare policy formation. Conclusions: Our findings suggest that the parliamentary inquiry process in its current form is not an ideal vehicle by which patients and family/carers can contribute or influence healthcare policy. Despite calling for submissions from patients and their family/carers, the final report and subsequent health policy recommendations made by the inquiry do not appear to be patient-centric or reflective of the submissions written by these stakeholders. Increased transparency, development of processes to balance stakeholder priorities and improved accessibility for stakeholders to participate are needed if health-related parliamentary inquiries are to produce healthcare policy that ultimately meets the needs of patients and family/carers. What is known about the topic? Parliamentary inquiries are rare instances where patients and their families/carers can contribute to high-level health policy development. What does this paper add? While healthcare and health policy development have become increasingly patient-centric, stakeholder engagement is often driven by other, more powerful stakeholder groups (e.g doctors, non-government organisations etc.). A parliamentary inquiry represents a unique approach towards engaging stakeholders, allowing for direct contribution and empowerment of everyday Australians. This is the first study that explores the translation of patient and family/carer concerns by the parliamentary inquiry process and the extent these concerns are addressed by policy reform. What are the implications for practitioners? Parliamentary inquiries have the potential to develop and reform high-level healthcare policy, yet lack transparency and processes for balancing stakeholder perspectives. This may lead to misaligned stakeholder priorities and inefficient healthcare policy, programs and services that do not adequately meet the needs of patients or family/carers. [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]

Background and Aims: This study explores the role of the public health advocacy coalition in alcohol policy development in Ireland. Compared with industry actors, much less is known about the membership, activities and influence of public health advocates in alcohol policymaking. To address this gap, this paper identifies several advocacy strategies, drawn from the advocacy coalition framework and other policy theories, and then analyses them in the context of recent Irish developments. Methods: The study used theory‐building process‐tracing to construct a record of the public health advocacy coalition and its campaign to promote the Public Health (Alcohol) Act 2018 in Ireland. Specifically, we drew upon 131 primary documents produced by advocates, 464 newspaper articles and 18 semi‐structured interviews with key advocates, public health experts and elected officials to undertake a thematic analysis. Results: Public health advocates in Ireland have developed sophisticated political strategies to foster major alcohol policy change. First, public health advocates led the formation of a broad‐based advocacy coalition that helped members to effectively pool their limited resources as well as coordinate their strategy and messaging. Secondly, issue‐framing and message discipline played a key role in the coalition's success. Advocates strategically focused upon the policy problem, specifically health harms, rather than the detailed content of the proposed measures. Finally, there is evidence of political learning, where advocates' prior experiences and knowledge of the political system in Ireland spurred innovations in campaigning. These strategies were interdependent and mutually reinforcing, and succeeded in building support for public health advocates' preferred policies among politicians and the general public. Discussion/conclusion: There are distinct capabilities that public health actors can mobilize in the policy process to win alcohol policy debates and capitalize on the constraints on industry influence on alcohol policymaking. [ABSTRACT FROM AUTHOR]

The paper examines the conception, implementation and abolition of the GP fundholding scheme, all within 10 years, for evidence of a changed style of health care policy-making. A health care policy community, in which the interests of the medical profession were prominent, existed between 1948 and the mid-1980s. The paper highlights the important factors in the breakdown of the policy community and traces the effect through to the negotiation, implementation and abolition of the GP fundholding scheme. In particular, the role of evidence in health care policy-making has changed significantly. A consequence of the collapse of the policy community has been that a ‘folk psychology’ rather than evaluative evidence has guided some aspects of health care policy since the 1990s. [ABSTRACT FROM AUTHOR]

Street‐level bureaucracy is an increasingly useful way to understand how strategic policy is implemented in day‐to‐day practice. This approach has uncovered the ways that individual health and social care practitioners work within institutional constraints to influence policy implementation at the micro‐level. Nonetheless, despite the diversity of settings where these street‐level bureaucrats (SLBs) work, little attention has been focused on the impact of place on policy delivery. This paper draws on empirical research to examine the ways that delivering government domestic abuse policy in the intimate space of the family home shapes the delivery of strategic policy in the everyday. Drawing on qualitative research with Health Visitors (HVs) in the UK in 2016, the study findings illuminate the ways that the material, socio‐spatial and idealised boundaries of the family home shape the implementation of policy. Key themes in the HV's narratives emerged as they described themselves as both a danger and in danger in the family home. In challenging the ontological security of the home (Giddens 1990) – privacy, security and control are key concepts here – HVs described how they shape their actions to achieve policy outcomes while simultaneously managing threats to the home, to professional identity and to self. [ABSTRACT FROM AUTHOR]

Major service change in healthcare – whereby the distribution of services is reconfigured at a local or regional level - is often a contested, political and poorly understood set of processes. This paper contributes to the theoretical understanding of major service change by demonstrating the utility of interpreting health service reconfiguration as a biopolitical intervention. Such an approach orients the analytical focus towards an exploration of the spatial and the population – crucial factors in major service change. Drawing on a qualitative study from 2011–12 of major service change in the English NHS combining documentary analyses of historically relevant policy papers and contemporary policy documentation (n = 125) with semi-structured interviews (n = 20) we highlight how a particular 'geography of stroke' in London was created building upon multiple types of knowledge: medical, epidemiological, economic, demographic, managerial and organisational. These informed particular spatial practices of government providing legitimation for the significant political upheaval that accompanies NHS service reconfiguration by problematizing existing variation in outcomes and making these visible. We suggest that major service change may be analysed as a 'practice of security' – a way of redefining a case, conceiving of risks and dangers, and averting potential crises in the interests of the population. • Foucault's work on biopolitics is applied to analyse major service change. • The reconfiguration of stroke services in London is explored. • Empirical and theoretical implications are discussed. [ABSTRACT FROM AUTHOR]

Due to a significant increase in the complexity of the care demands of older people having multiple care needs, the necessity for integrated care is increasingly acknowledged. Proposing a qualitative approach based on a secondary literature analysis and an empirical survey, this paper explores the integration policy of health and social care for older people having complex needs in two European countries – France and Sweden – where various policy measures aiming at developing and delivering integrated care can be identified: at the national level, through the supportive measures of organisational, institutional and/or professional integration from central government, and at the local level, with the implementation of concrete integrative initiatives. Using a comparative qualitative approach, the authors investigate both of these levels, as well as the interplay between them. They show the importance of this double – local and national – approach of the issue of integration and highlight the continuous negotiation process which underlies the integration activities. Local integration initiatives are in fact constantly reshaped by top-down and bottom-up dynamics which appear to be strongly interconnected. [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]

In England, policy piloting has become firmly established in almost all areas of public policy and is seen as good practice in establishing ‘what works’. However, equating piloting with evaluation can risk oversimplifying the relationship between piloting and policy-making.Using three case studies from health and social care – the Partnerships for Older People Projects (POPP) pilots, the Individual Budgets pilots and the Whole System Demonstrators (WSD) – the paper identifies multiple purposes of piloting, of which piloting for generating evidence of effectiveness was only one. Importantly, piloting was also aimed at promoting policy change and driving implementation, both in pilot sites and nationally. Indeed, policy makers appeared to be using pilots mainly to promote government policy, using evaluation as a strategy to strengthen the legitimacy of their decisions and to convince critical audiences. These findings highlight the ambiguous nature of piloting and thus question the extent to which piloting contributes to the agenda of evidence-based policy-making. [ABSTRACT FROM PUBLISHER]

Attention to health policies in Southern regional organisations reveals a new ‘social turn’ in the regional political economy of international cooperation. The aims of this paper are twofold. First, it aims to establish the extent to which the Union of South American Nations (UNASUR) has adopted and sustained policy interventions committed to addressing social inequities and asymmetries in relation to health, as indicated by regional policy agendas, policy development processes and resourcing. Second, it seeks to understand how UNASUR is mobilising national and regional actors in support of such policies. Our analysis of documentary sources and interviews leads us to draw the following conclusions. First, we argue that the UNASUR regional framework has a committed social equity/rights focus in relation to access to health care and medicines, with a clear focus on reducing asymmetries between countries. Second, although UNASUR does not enforce national commitments on health and medicines, it nonetheless plays a role in expanding domestic policy horizons and policy capacities. In this respect, we find that UNASUR interventions lead to initiatives and actions aimed at implementing reforms, setting targets and defining goals nationally. Third, in global arena, UNASUR enhances the visibility and ‘voices’ of the member states. [ABSTRACT FROM AUTHOR]

Much public health research considers interventions that influence and are influenced by both individuals’ health and the society around them; this can be described as a complex system. We consider the role of explanation alongside statistical inference as crucial to obtaining credible and useful insights, particularly in light of concerns about a ‘crisis of replication’, and reflect on the difficulty in researching complex systems. In this paper, we make a connection with Lipton’s philosophy of inference to the best explanation, and offer some tentative practical recommendations, extending suggestions from different fields. An extended hypothetical example is given on introducing ‘sugar tax’ in England. [ABSTRACT FROM PUBLISHER]

Aim This paper aims to describe and disseminate the process and initial outcomes of the first National Health Assembly (NHA) in Thailand, as an innovative example of health policy making. Setting The first NHA, held in December 2008 in Bangkok, brought together over 1500 people from government agencies, academia, civil society, health professionals and the private sector to discuss key health issues and produce resolutions to guide policy making. It adapted the approach used at the World Health Assembly of the World Health Organization. Method Findings are derived from a literature review, document analysis, and the views and experiences of the authors, two of whom contributed to the organization of the NHA and two of whom were invited external observers. Results Fourteen agenda items were discussed and resolutions passed. Potential early impacts on policy making have included an increase in the 2010 public budget for Thailand's universal health coverage scheme as total public expenditure has decreased; cabinet endorsement of proposed Strategies for Universal Access to Medicines for Thai People; and establishment of National Commissions on Health Impact Assessment and Trade and Health. Discussion The NHA was successful in bringing together various actors and sectors involved in the social production of health, including groups often marginalized in policy making. It provides an innovative model of how governments may be able to increase public participation and intersectoral collaboration that could be adapted in other contexts. Significant challenges remain in ensuring full participation of interested groups and in implementing, and monitoring the impact of, the resolutions passed. [ABSTRACT FROM AUTHOR]

This paper examines the dynamics of condom policymaking in Malawi by analyzing debates, which took place in the Malawi National Assembly between the year 2000 and 2004. Using content analysis and key informant interviews, and situating the overall discussion within policy and science literature, we examine how scientific evidence is being applied in the policymaking process as it relates to the place of condoms within the context of HIV/AIDS prevention. The study not only shows the extent to which the policymaking process on condoms in Malawi largely embodies a tendency to blur the conventional divide between science and politics, but also demonstrates why controversy around condoms still persists at the highest level of government in a country with one of the highest HIV prevalence rates in the world. It was found that even when people are dying, consensus in HIV/AIDS policymaking can be difficult to achieve in a policy climate characterized by a binary perspective to social problems, and where different actors compete for control over the policy terrain. The paper makes recommendations that may be helpful in facilitating a more inclusive HIV/AIDS policymaking process in Malawi. [ABSTRACT FROM AUTHOR]

In this paper two disparate areas of social science theory, actor–network theory and policy networks, will be brought to bear on the problem of explaining the rapid development of an area of medical science and health policy in the UK. There has been a surge of interest in the treatment and management of personality disorder from within both the psychiatric profession and government ministries, and particularly those personality disorders deemed to be severe or dangerous. This has resulted in the development of a new psychiatric classification, the ‘dangerous and severe personality disorder’ (DSPD), and the funding and development of a new service to deal with it. Major new mental health legislation has been set in train to provide legal backing for the pre–emptive detention of patients with such a diagnosis, despite widespread uncertainty over its status, reliability or predictive capability. In the process of presenting and analysing this development, actor–network theory and policy networks will themselves be reviewed and compared, and common and incompatible elements, foci and mechanisms identified. [ABSTRACT FROM AUTHOR]

Long-range temporal choices are built into contemporary policy-making, with policy decisions having consequences that play out across generations. Decisions are made on behalf of the public who are assumed to give much greater weight to their welfare than to the welfare of future generations. The paper investigates this assumption. It briefly discusses evidence from sociological and economic studies before reporting the findings of a British survey of people's intergenerational time preferences based on a representative sample of nearly 10,000 respondents. Questions focused on two sets of policies: (i) health policies to save lives and (ii) environmental policies to protect against floods that would severely damage homes, businesses and other infrastructure. For both sets of policies, participants were offered a choice of three policy options, each bringing greater or lesser benefits to their, their children's and their grandchildren's generations. For both saving lives and protecting against floods, only a minority selected the policy that most benefited their generation; the majority selected policies bringing equal or greater benefits to future generations. Our study raises questions about a core assumption of standard economic evaluation, pointing instead to concern for future generations as a value that many people hold in common. [ABSTRACT FROM AUTHOR]

This paper is a statement of the American Geriatrics Society's (AGS) core policy priorities and the Society's positions on federal programs and policies that support older Americans as articulated to the new administration. Among the AGS priorities discussed in this paper are health reform, Medicare, and Medicaid. The AGS is committed to leveraging its expertise to inform regulatory and legislative policy proposals. [ABSTRACT FROM AUTHOR]

INTRODUCTION Smokeless tobacco (ST) remains poorly regulated in Bangladesh. This study describes the prevalence and trends of ST use in Bangladesh, presents ST-related disease burden, identifies relevant policy gaps, and highlights key implications for future policy and practice for effective ST control in Bangladesh. METHODS We analyzed secondary data from the two rounds (2009 and 2017) of The Global Adult Tobacco Survey, estimated ST-related disease burden, and conducted a review to assess differences in combustible tobacco and ST policies. In addition, we gathered views in a workshop with key stakeholders in the country on gaps in existing tobacco control policies for ST control in Bangladesh and identified policy priorities using an online survey. RESULTS Smokeless tobacco use, constituting more than half of all tobacco use in Bangladesh, declined from 27.2% (25.9 million) in 2009 to 20.6% (22 million) in 2017. However, in 2017, at least 16947 lives and 403460 Disability-Adjusted Life Years (DALYs) were lost across Bangladesh due to ST use compared to 12511 deaths and 324020 DALYs lost in 2010. Policy priorities identified for ST control have included: introducing specific taxes and increasing the present ad valorem tax level, increasing the health development surcharge, designing and implementing a tax tracking and tracing system, standardizing ST packaging, integrating ST cessation within existing health systems, comprehensive media campaigns, and licensing of ST manufactures. CONCLUSIONS Our analysis shows that compared to combustible tobacco, there remain gaps in implementing and compliance with ST control policies in Bangladesh. Thus, contrary to the decline in ST use and the usual time lag between tobacco exposure and the development of cancers, the ST-related disease burden is still on the rise in Bangladesh. Strengthening ST control at this stage can accelerate this decline and reduce ST related morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: Generally, public health policy-making is hardly a linear process and is characterized by interactions among politicians, institutions, researchers, technocrats and practitioners from diverse fields, as well as brokers, interest groups, financiers and a gamut of other actors. Meanwhile, most public health policies and systems in Africa appear to be built loosely on technical and scientific evidence, but with high political systems and ideologies. While studies on national health policies in Africa are growing, there seems to be inadequate evidence mapping on common themes and concepts across existing literature. Purpose: The study seeks to explore the extent and type of evidence that exist on the conflict between politics and scientific evidence in the national health policy-making processes in Africa. Methods: A thorough literature search was done in PubMed, Cochrane Library, ScienceDirect, Dimensions, Taylor and Francis, Chicago Journals, Emerald Insight, JSTOR and Google Scholar. In total, 43 peer-reviewed articles were eligible and used for this review. Result: We found that the conflicts to evidence usage in policy-making include competing interests and lack of commitment; global policy goals, interest/influence, power imbalance and funding, morals; and evidence-based approaches, self-sufficiency, collaboration among actors, policy priorities and existing structures. Barriers to the health policy process include fragmentation among actors, poor advocacy, lack of clarity on the agenda, inadequate evidence, inadequate consultation and corruption. The impact of the politics–evidence conflict includes policy agenda abrogation, suboptimal policy development success and policy implementation inadequacies. Conclusions: We report that political interests in most cases influence policy-makers and other stakeholders to prioritize financial gains over the use of research evidence to policy goals and targets. This situation has the tendency for inadequate health policies with poor implementation gaps. Addressing these issues requires incorporating relevant evidence into health policies, making strong leadership, effective governance and a commitment to public health. [ABSTRACT FROM AUTHOR]

Background: Public health systems in Canada have undergone significant policy renewal over the last decade in response to threats to the public's health, such as severe acute respiratory syndrome. There is limited research on how public health policies have been implemented or what has influenced their implementation. This paper explores policy implementation in two exemplar public health programs -chronic disease prevention and sexually-transmitted infection prevention - in Ontario, Canada. It examines public health service providers', managers' and senior managements' perspectives on the process of implementation of the Ontario Public Health Standards 2008 and factors influencing implementation.Methods: Public health staff from six health units representing rural, remote, large and small urban settings were included. We conducted 21 focus groups and 18 interviews between 2010 (manager and staff focus groups) and 2011 (senior management interviews) involving 133 participants. Research assistants coded transcripts and researchers reviewed these; the research team discussed and resolved discrepancies. To facilitate a breadth of perspectives, several team members helped interpret the findings. An integrated knowledge translation approach was used, reflected by the inclusion of academics as well as decision-makers on the team and as co-authors.Results: Front line service providers often were unaware of the new policies but managers and senior management incorporated them in operational and program planning. Some participants were involved in policy development or provided feedback prior to their launch. Implementation was influenced by many factors that aligned with Greenhalgh and colleagues' empirically-based Diffusion of Innovations in Service Organizations Framework. Factors and related components that were most clearly linked to the OPHS policy implementation were: attributes of the innovation itself; adoption by individuals; diffusion and dissemination; the outer context - interorganizational networks and collaboration; the inner setting - implementation processes and routinization; and, linkage at the design and implementation stage.Conclusions: Multiple factors influenced public health policy implementation. Results provide empirical support for components of Greenhalgh et al's framework and suggest two additional components - the role of external organizational collaborations and partnerships as well as planning processes in influencing implementation. These are important to consider by government and public health organizations when promoting new or revised public health policies as they evolve over time. A successful policy implementation process in Ontario has helped to move public health towards the new vision. [ABSTRACT FROM AUTHOR]

Policies can influence health of a population in various ways. Numerous epidemiological studies supported by toxicological investigations demonstrate a positive association between ambient concentrations of airborne particulate matter and increased adverse cardio-respiratory events, including morbidity and mortality. The aim of this paper was to present the concept of the top-down health policy risk assessment approach model developed to estimate the expected health risk reduction associated with policy aiming at attaining the new particulate matter ≤ 10 μm in diameter (PM10) standards in Poland. The top-down approach guides the analysis of causal chains from the policy to health outcomes. In this case study we tried to estimate the predicted health effects of the policy change over the past 20 years. Since Polish annual standard for PM10 changed from 50 μg/m³ in 1990 to 40 μg/m³ in 2010, we calculated the relative risk associated with decreasing PM10 in diameter to 10 μg/m3 in the annual level of PM10 for 6 adverse health effects. The relative risk slightly decreased for almost all adverse health effects, which means that the relative decrease in the incidence of health effects from the baseline incidence should range from about 0.5-0.6% for heart disease admissions to > 1% for respiratory admissions. The obtained results indicate that implementation of the new ambient air standards could influence improvement of the health status of Polish population. A top-down policy health risk assessment model can be one of the main tools in this process, providing harmonized guidance how to seek evidence-based information, which could serve policy-makers. [ABSTRACT FROM AUTHOR]

Introduction: With the rapid growth of urbanization globally and in the UK, increasing attention is now being directed towards urban green spaces (UGS). The appeal of UGS to policymakers lies in their capacity to address multiple policy objectives, including improving physical and mental wellbeing, mitigating noncommunicable diseases (NCDs), combating climate change through carbon sequestration, providing climate adaptation measures, and enhancing biodiversity. Method: This narrative review gives an overview of the current literature and UK policy relating to urban green and blue spaces, with a particular focus on the use of UGS to increase physical activity levels. Results: UGS have a profound impact on public health, with evidence indicating their positive effect on both physical and psychological health. Thirty‐eight percent of adults in the UK do not live within 15 minutes of UGS, so policy makers at national and international level are aiming to address this gap. One reason for the health benefits of UGS is associated increased physical activity, a vital component needed to address the burden of non‐communicable disease. To effectively harness UGS to promote physical activity various factors must be considered; proximity and diversity of urban green spaces, and the presence of suitable infrastructure features. Tailoring UGS to meet the needs and preferences of different population demographics is essential, as is ensuring safety, and addressing barriers to access particularly for lower socio‐economic groups. The careful planning of UGS must avoid potential gentrification effects and displacement of vulnerable communities, whilst utilising the equigenic nature of UGS. Conclusions: To create a brighter future and capitalize on the potential of UGS, a collaborative approach is needed, involving communities, local governments, and national authorities. Primary‐care professionals, represented by organizations like the Royal College of General Practitioners (RCGP), can play a crucial role in advocating for UGS and physical activity, promoting their use, and providing guidance and support. [ABSTRACT FROM AUTHOR]

Aims and design The historical and economic involvement of Brazil with tobacco, as a major producer and exporter, was considered an insurmountable obstacle to controlling the consumption of this product. Nevertheless, the country was able to achieve significant progress in implementing public policies and to take an international leadership position, meeting its constitutional commitment to protect public health. In this paper we provide a brief historical overview of tobacco control ( TC) in Brazil, and analyse the factors that contributed to the major decline in tobacco consumption in the country over the last 20 years, as well as identify the challenges that had to be overcome and those still at play. Findings The Brazilian case demonstrates how cross-sectorial collaborations among health-related groups that capitalize on their respective strengths and capacities can help to influence public policy and overcome industry and population resistance to change. Although Brazil still lags behind some leading TC nations, the country has an extensive collaborative TC network that was built over time and continues to focus upon this issue. Conclusions The tobacco experience can serve as an example for other fields, such as alcoholic beverages, of how networks can be formed to influence the legislative process and the development of public policies. Brazilian statistics show that problems related to non-communicable diseases are a pressing public health issue, and advocacy groups, policy-makers and government departments can benefit from tobacco control history to fashion their own strategies. [ABSTRACT FROM AUTHOR]

This paper explores the role of social movements in the policy process and, in particular, the ways in which movements interact with, access, and deploy expert knowledge. In the technocratic model, citizens are conceptualized as undifferentiated, rather than considered in terms of distinctive identities or interests. Their inclusion in policy-making is viewed as a technical problem to be 'solved' through forms of citizen engagement, rather than viewing citizens as active agents in the mobilization of distinctive knowledges. Citizens, we argue, are more than the undifferentiated lump that appears in the technocratic model under the guise of citizen engagement. Drawing on a case study of autism activism in Canada and the US, we demonstrate the range of ways in which civil society actors both deploy and contest expert knowledge in the policy process, and discuss the implications for how we conceptualize knowledge mobilization in policy processes. [ABSTRACT FROM AUTHOR]

This article analyses and compares disability policies for working-age individuals in Canada with a focus on the mode of policy provision and type of measure to determine the degree to which direct funding is used in this country. To consider policy diversity in this federal system, policies are compared using a mixed-methods approach. Using quantitative methods, federal, provincial and territorial policies are first compared using hierarchical cluster analysis. This provides evidence of three distinct clusters in Canada according to policy provision and measure type. In a second, qualitative analysis, the disability strategies of four provinces' (British Columbia, Ontario, Newfoundland and Labrador and Quebec) are compared, to determine over arching policy orientations. Findings indicate that policy provision in Canada largely favours money over services. Furthermore, most provinces emphasize either health or integration measures over substantive measures. Despite these commonalities, significant variation persists across Canada. This extends to poverty and disability reduction strategies with two of the four provinces having a broader orientation while the other two provinces focus specifically on employment as a means of social inclusion. The article concludes with a discussion on the state of employment policies for individuals with a disability in Canada. [ABSTRACT FROM AUTHOR]

Background: Victoria was the first Australian state to legalize voluntary assisted dying (elsewhere known as physician-assisted suicide and euthanasia). Some institutions indicated they would not participate in voluntary assisted dying. The Victorian government issued policy approaches for institutions to consider Objective: To describe and analyse publicly available policy documents articulating an institutional objection to voluntary assisted dying in Victoria. Methods: Policies were identified using a range of strategies, and those disclosing and discussing the nature of an institutional objection were thematically analysed using the framework method. Results: The study identified fifteen policies from nine policymakers and developed four themes: (1) extent of refusal to participate in VAD, (2) justification for refusal to provide VAD, (3) responding to requests for VAD, and (4) appeals to state-sanctioned regulatory mechanisms. While institutional objections were stated clearly, there was very little practical detail in most documents to enable patients to effectively navigate objections in practice. Conclusion: This study demonstrates that despite having clear governance pathways developed by centralized bodies (namely, the Victorian government and Catholic Health Australia), many institutions' public-facing policies do not reflect this guidance. Since VAD is contentious, laws governing institutional objection could provide greater clarity and regulatory force than policies alone to better balance the interests of patients and non-participating institutions. [ABSTRACT FROM AUTHOR]

Increasing public participation has the potential to inform better alcohol policy. One method for increasing participation is the citizens' jury – a strategy that has been both touted as a panacea for issues of democratic representation and dismissed as ineffective in impacting policy. Seeking to look past both hype and cynicism, we reflect on two Australian juries with an aim to identify both the potentials and pitfalls of the use of citizens' juries in alcohol policy. Using public documentation, we analyse two alcohol-related citizens' jury processes – one in Adelaide, SA, and one in Sydney, NSW – with respect to their implications for alcohol policy development. We reflect on matters of participation, deliberation, authority, remit, and impact of recommendations. The case studies indicate the importance of clear aims; whether these are instrumental and focussed on developing specific alcohol policy recommendations or focussed on broader epistemic democratic effects. Jury composition, the notion of vested interests, and the extent of juries' authorising power are key considerations for juries deliberating on alcohol policy. Due to the nature of policy-making, no single strategy can be a democratic panacea. However, we find that carefully considered and situationally aware elements of citizens' juries may be useful in alcohol policy development. [ABSTRACT FROM AUTHOR]

'What does 'The Public' think?' is a question often posed by researchers and policy makers, and public values are regularly invoked to justify policy decisions. Over time there has been a participatory turn in the social and health sciences, including health technology assessment and priority setting in health, towards citizen participation such that public policies reflect public values. It is one thing to agree that public values are important, however, and another to agree on how public values should be elicited, deliberated upon and integrated into decision-making. Surveys of public values rarely deliver unanimity, and preference heterogeneity, or plurality , is to be expected. This paper examines the role of public values in health policy and how to elicit, analyse, and present values, in the face of plurality. We delineate the strengths and weaknesses of aggregative and deliberative methods before setting out a new empirical framework, drawing on Sunstein's Incompletely Theorised Agreements, based on three levels: principles, policies and patients. The framework is illustrated using a recognised policy dilemma – the provision of high cost, limited-effect medicines intended to extend life for people with terminal illnesses. Application of the multi-level framework to public values permits transparent consideration of plurality, including analysis of coherence and consensus, in a way that offers routes to policy recommendations that are based on public values and justified in those terms. Using the new framework and eliciting quantitative and qualitative data across levels of abstraction has the potential to inform policy recommendations grounded in public values, where values are plural. This is not to suggest that one solution will magically emerge, but rather that choices between policies can be explicitly justified in relation to the properties of public values, and a much clearer understanding of (in)consistencies and areas of consensus. • Public values are important for priority setting in health. • Public values are plural but we do not know how to account for plurality in policy. • Counting, coherence and consensus are relevant to resolving value plurality. • This paper presents a new empirical framework for analysis of public values. • The framework has potential to account for value plurality in health policy making. [ABSTRACT FROM AUTHOR]

Policies concerned with illicit drugs vex governments. While the 'evidence-based policy' paradigm argues that governments should be informed by 'what works', in practice policy makers rarely operate this way. Moreover the evidence-based policy paradigm fails to account for democratic participatory processes, particularly how community members and people who use drugs might be included. The aim of this paper is to explore the political science thinking about democratic participation and the potential afforded in 'deliberative democracy' approaches, such as Citizens Juries and other mini-publics for improved drug policy processes. Deliberative democracy, through its focus on inclusion, equality and reasoned discussion, shows potential for drug policy reform and shifts the focus from reliance on and privileging of experts and scientific evidence. But the very nature of this kind of 'deliberation' may delimit participation, notably through its insistence on authorised modes of communication. Other forms of participation beyond reasoned deliberation aligned with the ontological view that participatory processes themselves are constitutive of subject positions and policy problems, may generate opportunities for considering how the deleterious effects of authorised modes of communication might be overcome. [ABSTRACT FROM AUTHOR]

The two reclassifications of cannabis in England & Wales in 2004 and 2009 have been subjected to a series of academic analyses which have largely been centred on either the relationship to evidence, or in terms of the implications and realities of policing and health under the changes. However, despite the wealth of attention on this area, there have been relatively few attempts to understand these policy movements through broader criminological theoretical frameworks. One recent exception is Shiner's (2015) utilisation of Garland's (2001) concept of 'structured ambivalence'. This paper seeks to test this application through drawing upon an alternative source of evidence, namely, a series of 'elite' qualitative interviews, and using Kingdon's (1995) Multiple Streams model to make sense of the policy processes. In doing so, it largely corroborates Shiner's conclusions whilst also further illuminating particular agentic aspects and their intertwining with other structural and cultural forces which led to the reclassifications. These findings demonstrate the value of triangulating evidential sources and advances knowledge about the role of individuals in pursuing policy agendas within a broader shifting political climate. This provides greater scope to further test and understand how structured ambivalence manifests itself in other cultural contexts and policy domains. [ABSTRACT FROM AUTHOR]

The connection between patient care and health policy is often difficult for health care practitioners from all disciplines to see. In this introductory chapter, we present a rationale for health professional in all disciplines, whether students or seasoned clinicians, to engage in health policy work. [ABSTRACT FROM AUTHOR]

This review argues that history merits a place amongst the subjects which constitute interdisciplinary public health. It claims that three aspects of historical study can inform the contemporary thinking of public health practitioners. First, demographic trends over the very long term yield insights into fundamental drivers of human longevity and wellness. Second, the history of medicine in public health teaches us that medical science is not simply a progression of therapeutic discoveries, but a type of knowledge always situated in a social and cultural context. Third, the history of policy-making for health alerts us to issues of power and vested interest that surround attempts to advance public health goals in the political arena. This last contention is then illustrated through a case study which examines a historical puzzle peculiar to Poland. What were the reasons for the striking decline in cigarette consumption that followed the fall of the Berlin Wall, when all expectations were that the opposite should occur? [ABSTRACT FROM AUTHOR]

Policy PointsLocal governments are increasingly adopting policies that earmark taxes for mental health services, and approximately 30% of the US population lives in a jurisdiction with such a policy.Policies earmarking taxes for mental health services are heterogenous in their design, spending requirements, and oversight.In many jurisdictions, the annual per capita revenue generated by these taxes exceeds that of some major federal funding sources for mental health. Context: State and local governments have been adopting taxes that earmark (i.e., dedicate) revenue for mental health. However, this emergent financing model has not been systematically assessed. We sought to identify all jurisdictions in the United States with policies earmarking taxes for mental health services and characterize attributes of these taxes. Methods: A legal mapping study was conducted. Literature reviews and 11 key informant interviews informed search strings. We then searched legal databases (HeinOnline, Cheetah tax repository) and municipal data sources. We collected information on the year the tax went into effect, passage by ballot initiative (yes/no), tax base, tax rate, and revenue generated annually (gross and per capita). Findings: We identified 207 policies earmarking taxes for mental health services (95.7% local, 4.3% state, 95.7% passed via ballot initiative). Property taxes (73.9%) and sales taxes/fees (25.1%) were most common. There was substantial heterogeneity in tax design, spending requirements, and oversight. Approximately 30% of the US population lives in a jurisdiction with a tax earmarked for mental health, and these taxes generate over $3.57 billion annually. The median per capita annual revenue generated by these taxes was $18.59 (range = $0.04‐$197.09). Per capita annual revenue exceeded $25.00 in 63 jurisdictions (about five times annual per capita spending for mental health provided by the US Substance Abuse and Mental Health Services Administration). Conclusions: Policies earmarking taxes for mental health services are diverse in design and are an increasingly common local financing strategy. The revenue generated by these taxes is substantial in many jurisdictions. [ABSTRACT FROM AUTHOR]

While there is widespread agreement as to the importance of increasing participation in drug policy design, drug policy literature contains limited reflection on the practices that may support inclusion and collaboration amongst policy actors, particularly when disagreement and difference are an intrinsic part of participation. Drawing on qualitative interviews and ethnographic fieldwork with actors engaged in an Australian illicit drug policy reform campaign, this paper examines how particular modes of personal connection mattered in establishing and maintaining working relationships between a range of differently situated actors. Through engagement with this case study, we argue that modes of personal connection marked by qualities such as being frank; engaged; not forcing consensus; enacting respect; listening in order to understand; and acting in ways that respected the obligations and limits that came with people's roles while also recognising one another as more than those roles, were particularly important qualities that supported connection across difference. Such personal connections seem to have been even more important for the engagement of people representing more marginal positionalities. Arguing that personal connection is already an element of both inclusion and exclusion in drug policy creation, we suggest that policy actors interested in contributing to a more diverse and rigorous policy participation space attend to how people connect, with whom, and with what space for disagreement, while also taking seriously the labour of such connection across difference. [ABSTRACT FROM AUTHOR]

Objective: Community colleges face challenges to becoming smoke-free and have higher smoking prevalence rates than four-year colleges. This case study examines how Sacramento Taking Action Against Nicotine Dependence (STAND), a community-based organization's project, achieved tobacco-free policies at California's second largest community college district. Methods: Data sources describing the STAND policymaking activities (2001–2016) include evaluation reports and key informant interviews (n = 9) with community college nursing staff, former STAND staff, and other Sacramento tobacco control partners. Reports and interview transcripts were analyzed using content analysis. Results: Collecting campus data and engaging campus champions were key strategies to demonstrate internal support for stronger policies, as STAND faced resistance from the District leadership. External momentum encouraged the campuses to adopt 100% smoke, tobacco and vape-free policies. Conclusion: Community-based organizations can facilitate long-term support for smoke and tobacco-free campus policymaking efforts at community colleges, as internal and external support is demonstrated for more comprehensive policies. [ABSTRACT FROM AUTHOR]

Background: In this paper we capture and synthesize the unique knowledge of experts so that choices regarding policy measures to address methamphetamine consumption and dependency in Australia can be strengthened. We examine perceptions of the: (1) influence of underlying factors that impact on the methamphetamine problem; (2) importance of various models of intervention that have the potential to affect the success of policies; and (3) efficacy of alternative pseudoephedrine policy options.Methods: We adopt a multi-criteria decision model to unpack factors that affect decisions made by experts and examine potential variations on weight/preference among groups. Seventy experts from five groups (i.e. academia (18.6%), government and policy (27.1%), health (18.6%), pharmaceutical (17.1%) and police (18.6%)) in Australia participated in the survey.Results: Social characteristics are considered the most important underlying factor, prevention the most effective strategy and Project STOP the most preferred policy option with respect to reducing methamphetamine consumption and dependency in Australia. One-way repeated ANOVAs indicate a statistically significant difference with regards to the influence of underlying factors (F(2.3, 144.5)=11.256, p<.001), effectiveness of interventions (F(2.4, 153.1)=28.738, p<.001) and policy options (F(2.8, 175.5)=70.854, p<.001).Conclusion: A majority of respondents believed that genetic, biological, emotional, cognitive and social factors are the most influential explanatory variables in terms of methamphetamine consumption and dependency. Most experts support the use of preventative mechanisms to inhibit drug initiation and delayed drug uptake. Compared to other policies, Project STOP (which aims to disrupt the initial diversion of pseudoephedrine) appears to be a more preferable preventative mechanism to control the production and subsequent sale and use of methamphetamine. This regulatory civil law lever engages third parties in controlling drug-related crime. The literature supports third-party partnerships as it engages experts who have knowledge and expertise with respect to prevention and harm minimization. [ABSTRACT FROM AUTHOR]

Background: Despite the wealth of frameworks on social determinants of health (SDOH), two current limitations include the relative superficial description of factors affecting health and a lack of focus on measuring health equity. The Health Equity Measurement Framework (HEMF) addresses these gaps by providing a more encompassing view of the multitude of SDOH and drivers of health service utilisation and by guiding quantitative analysis for public health surveillance and policy development. The objective of this paper is to present the HEMF, which was specifically designed to measure the direct and indirect effects of SDOH to support improved statistical modelling and measurement of health equity. Methods: Based on a framework synthesis, the HEMF development involved initially integrating theoretical components from existing SDOH and health system utilisation frameworks. To further develop the framework, relevant publications on SDOH and health equity were identified through a literature review in major electronic databases. White and grey literatures were critically reviewed to identify strengths and gaps in the existing frameworks in order to inform the development of a unique health equity measurement framework. Finally, over a two-year period of consultation, scholars, health practitioners, and local policy influencers from municipal and provincial governments provided critical feedback on the framework regarding its components and causal relationships. Results: This unified framework includes the socioeconomic, cultural, and political context, health policy context, social stratification, social location, material and social circumstances, environment, biological factors, health-related behaviours and beliefs, stress, quality of care, and healthcare utilisation. Alongside the HEMF's self-exploratory diagram showing the causal pathways in-depth, a number of examples are provided to illustrate the framework's usefulness in measuring and monitoring health equity as well as informing policy-making. Conclusions: The HEMF highlights intervention areas to be influenced by strategic public policy for any organisation whose purview has an effect on health, including helping non-health sectors (such as education and labour) to better understand how their policies influence population health and perceive their role in health equity promotion. The HEMF recognises the complexity surrounding the SDOH and provides a clear, overarching direction for empirical work on health equity. [ABSTRACT FROM AUTHOR]