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Despite the highest ranks on pandemic preparedness assessments European welfare states encounter great difficulty in responding effectively to the COVID-19 outbreak. In this article we compare the governance of COVID-19 response in 48 Eurasian countries and a selection of European and SARS (2003) exposed Asian countries during the first wave of the COVID-19 outbreak until 1 June 2020, using data from the COVID-19 Health System Response Monitor and the Oxford COVID-19 Government Response Tracker, recent scientific literature and policy documents.Pandemic preparedness during the first wave of COVID-19 evolved from specialist infectious disease control to a broad governance of population mitigation, which in at least half of Eurasian countries lacked appropriate authority and capacity. In the directly operational response in Asian countries, preparedness encompasses a whole of government approach, an engaged and active community and private actors. Preparedness requires and reflects both vertical and horizontal coordination as well as policies that fit with the political economy of a country and region.

Background: In light of worrying public health developments such as declining life expectancy gains and increasing health inequalities, there is a heightened interest in the relationship between politics and health. This scoping review explores the possible welfare policy consequences of populist radical right (PRR) parties in Europe and the implications for population health. The aim is to map the available empirical evidence regarding the influence of PRR parties on welfare policy reforms and to understand how this relationship is mediated by political system characteristics in different countries. Methods and Analysis: A scoping review of peer-reviewed empirical literature addressing the relationship between PRR parties, political systems and welfare policy in Europe was performed using the methodology by the Joanna Briggs Institute. Data was charted on main study characteristics, concepts and relevant results, after which a qualitative content analysis was performed. The data was categorised according to the political system characteristics: constitution, political economy, interest representation and partisanship. Five expert interviews were conducted for validation purposes. Early evidence from 15 peer-reviewed articles suggests that exclusionary welfare chauvinistic positions of PRR parties are likely to have negative effects on the access to welfare provisions and health of vulnerable population groups. Differences in implementation of welfare chauvinistic policy reforms are partly explained by mediation of the constitutional order (judicial institutions at national and European Union [EU] level), political economy (healthcare system funding and European single market) and partisanship (vote-seeking strategies by PRR and mainstream parties). No clear evidence was found regarding the influence of interest representation on welfare chauvinistic policies. Discussion: While early evidence suggests that the welfare chauvinistic ideology of PRR parties is harmful for public health, the possible mediating role of political system characteristics on PRR welfare policy influence offers risk and protective factors explaining why the PRR ideology plays out differently across Europe.

Background Forty-three out of 53 of the WHO European Member States have set up political and institutional mechanisms to implement the United Nations (UN) 2030 Agenda for Sustainable Development. This includes governance and institutional mechanisms, engaging stakeholders, identifying targets and indicators, setting governmental and sectoral priorities for action and reporting progress regularly. Still, growing evidence suggests that there is room for advancing implementation of some of the Sustainable Development Goals (SDGs) and targets at a higher pace in the WHO European Region. This article proposes the E4A approach to support WHO European Member States in their efforts to achieve the health-related SDG targets. Methods The E4A approach was developed through a 2-year, multi-stage process, starting with the endorsement of the SDG Roadmap by all WHO European Member States in 2017. This approach resulted from a mix of qualitative methods: a semi-structured desk review of existing committal documents and tools; in-country policy dialogs, interviews and reports; joint UN missions and discussion among multi-lateral organizations; consultation with an advisory group of academics and health policy experts across countries. Results The E—engage—functions as the driver and pace-maker; the 4 As—assess, align, accelerate and account—serve as building blocks composed of policies, processes, activities and interventions operating in continuous and synchronized action. Each of the building blocks is an essential part of the approach that can be applied across geographic and institutional levels. Conclusion While the E4A approach is being finalized, this article aims to generate debate and input to further refine and test this approach from a public health and user perspective.

Background Do political parties matter to health? Do they affect population health either directly or through welfare states’ social policies and the eligibility, affordability and quality of health systems? And if they do, how? These are crucial questions if we are to understand health politics or shape public health policy, particularly given the changing landscape of political parties, party dominance in the executive and the mediating influence of the legislature. Methods Using a systematic approach, this review examines 107 peer-reviewed articles and books published after 1978 focusing on high-income countries asking the overarching question: Do political parties matter to health and the welfare state? Results The literature relating parties to health directly was surprisingly thin, thus, the welfare state was used as a ‘proxy’ variable. An overwhelming majority of the literature sample suggests that Left parties are inclined to expand the welfare state without cutting benefits, while the Right does not expand and tends to reduce benefits. There was an inflection in the 1980s when Left parties shifted from expansion to maintaining the status quo. Conclusion Considering current health trends in the form of measles outbreaks, the ‘Deaths of Despair’, the rise of previous eradicated infectious diseases and the declining health expectancy rates in some Western countries as well as the rise of Populist Radical Right parties in office we question the current partisanship thesis that political parties matter less and less.

Across many countries public health experts question to what extent are COVID-19 policies ‘evidence-based', driven by uncertainties and precautionary principle, and narrow disciplinary focus. The policy reflex in 2020 led to a State of Emergency in about half of the countries in the WHO Europe region and managing by decree without Parliamentary approval. Policy decision-making in many countries is persistently dominated by virologist medical expertise. Pandemic response organized by hierarchical, partisan or technical dominance has led to an overly dominant policy focus on curative services and disproportionate effects on vulnerable and minority groups. Now, after 1,5 years and even during electoral campaigns in many countries, the public lacks interest representation because of ‘Parliamentary paralysis': It has been suggested mainstream political parties do not want to question response policies for being associated with populist radical right, antivax and conspiracy theorists. However, policy mitigating and politically moderating options are available. Avoiding public litigation or electoral repercussions, rapid policy response can benefit from organizing quick consultations, rapid appraisals and fast feedback assessments. This will contribute substantially to the use, feasibility and acceptability of policies in society. Consequently, this may facilitate the actual implementation, organizational compliance and public adherence to regulations. In this workshop we aim to explore the needs, capacities and lessons learned so far by health policymakers themselves in the COVID-19 pandemic crisis, and draw implications for the public health community of scholars, professionals in support of policymaking. Rather than asking to what extent the policy responses have been evidence-based, we take the policymaker perspective and focus on the rapid exchanges and emerging processes of policy learning across different countries. There is evidence of policy learning across countries, but not so directly related to research evidence - how does learning take shape? Are public health experts and scientist trained to induce such learning? Three short presentations will share direct experiences with rapid pandemic response decision-making. A panel with politicians involved in pandemic decision-making will reflect on needs, capacities and conditions for well-informed and balanced pandemic response. Then the floor is opened for debate with the audience using Mentimeter and other facilities available for online interaction. The workshop ends with concrete recommendations for direct policy support by public health researchers, managers and professionals at regional, national and supranational levels. Key messages The COVID-19 pandemic has revealed the vulnerabilities in political and democratic systems under stress for decision-making with huge increases of socio-economic and health inequalities as a result. Learning from policymakers themselves will benefit the capacities of public health research and services to organise quick policy feedback preventing huge public health costs in the long run.

The decision-making is always a complex process that should be based on best available scientific evidence and experts judgments. COVID-19 pandemic has added more complexity to this process, demanding a fluid, accurate and rapid respond from public health experts and science. This panellist together with the rest of speakers will help us to revise this process to identify possible gaps and space of future improvement.

Planetary health is the health of human civilization and the state of the natural systems on which it depends. (The Lancet commission on planetary health). Climate change puts planetary health under considerable strain. Climate health adaptation is defined as ‘designing, implementing, monitoring, and evaluating strategies, policies and programs to manage the risks of climate-relevant health outcomes' (WHO 2014). This workshop focuses on the perspective of governance, focusing on three basic coordination issues. Firstly, since climate health adaptation is a relatively new issue, it has not (yet) been organised into laws and regulations assigning clear responsibilities, capacities and resources. As a result, proponents turn to the judiciary for litigation of nation states' compliance with international agreements. Secondly, since climate problems manifest themselves across national borders and continents, there is a need for multilevel governance that requires both local community-based action as well as supranational agreements in resolutions and programs (= vertical coordination). Thirdly, since climate change affects many environmental and social health determinants, such as food systems, migration and water management, climate health adaptation requires a Whole of Society/HiAP approach. Necessary action extends far beyond the health system across different policy sectors, large and small businesses, civil society organisations as well as community initiatives (= horizontal coordination). As a result of these complexities, climate health adaptation rarely reaches the stage of actual policy implementation and goal achievement. This workshop aims to: explore existing literature on planetary health for issues, experiences and possible solutions to the governance and organisation of health adaptation to climate change; introduce principles, methods and institutional examples of multilateral and multilevel governance for planetary health; present examples of early arrangements and strategies for the vertical and horizontal coordination of climate health adaptation to climate change. (EU Green Deal program; Climate Pact; regional climate platforms; climate diplomacy). The workshop consists of three short presentations followed by an interactive panel discussion. After 30 minutes the floor is opened by means of a Mentimeter with which the audience can actively engage in the debate, as well as entering their questions, comments and suggestions through available facilities for interaction. The workshop will end with identifying the current and future necessary roles, responsibilities, capacities of the public health researchers, policymakers, and professionals for climate health diplomacy, network management, and setting up arrangements that offer stable rules for integrative action across different sectors, levels and borders. Key messages We can learn from policy sciences about how climate health adaptation can be organised by multilevel governance (vertical coordination) and Whole of Society governance (horizontal coordination). Working transdisciplinary, public health workers needs to develop skills for climate health diplomacy, network management, and setting up arrangements that offer stable rules for integrative action.

Background In the city of Maastricht in the Netherlands, a highway crossing several deprived neighborhoods was tunneled in 2016. The vacant space on top of this tunnel was redesigned and prioritized for pedestrians and cyclists. The aim of this study was to evaluate the effect of this major infrastructural change, named the Green Carpet, on total and transport-based physical activity (PA) levels. Methods Participants (≥18 years) were part of one of three area-based exposure groups. The maximal exposure group lived in neighborhoods directly bordering the Green Carpet. The minimal exposure group consisted of individuals living at the other side of the city, and the no exposure group consisted of individuals living in a nearby city. Actual use of the new infrastructure was incorporated as a second measure of exposure. Data were collected before and 3-15 months after the opening of the Green Carpet. Device-based measurements were conducted to obtain PA levels and collect location data. Changes in PA over time and intervention effects were determined using linear mixed models. Results PA levels in the Green Carpet area increased for the maximal and minimal exposure groups, but did not lead to an increase in total or transport-based PA. For the no exposure group, transport-based MVPA decreased and transport-based SB increased. The significant interaction (time x exposure) for transport-based SB, indicated differences in trends between the no exposure and maximal exposure group (B=-3.59, 95% CI - 7.15; -0.02) and minimal exposure group (B= -4.02, 95% CI -7.85, -0.19). Trends in the results based on analyses focusing on actual use and non-use of the new infrastructure were similar to those of the area-based analyses. Conclusions Results suggest that the Green Carpet led to more PA in this specific area, but did not increase the total volume of PA. The area-based differences might reflect the differences between users and non-users, but we should be careful when interpreting these results, due to possible interference of selective mobility bias. This paper reflects that the relationship between infrastructure and PA is not unambiguous. Trial registration This research was retrospectively registered at the Netherlands Trial Register (NL8108).

Public health is about policy, power, and the public and as such might be thought necessarily political. That does not mean, however, that the place of political analysis and engagement in public health is uncontroversial, and there have been longstanding arguments that to discuss politics sullies the scientific nature of public health. This article, introducing a special issue on political science in public health, argues that rigorous use of middle-range theory can inform our analysis of public health problems and avoid the risks of politicization, excessive abstraction or excessive concreteness. It summarizes key political science concepts discussed in the papers: epistemic communities, interest groups, advocacy coalitions, political parties, institutions, legalism, discourse and the political economy of labour. We hope that the series will provide the public health community with some tools and methods for how to integrate public health knowledge into the sphere of decision making in an appropriate way.

Democratic institutions and state-society relations shape governance arrangements and expectations between public and private stakeholders about public health impact. We illustrate this with a comparison between the English Public Health Responsibility Deal (RD) and the Dutch ‘All About Health…’ (AaH) programme. As manifestations of a Whole-of-Society approach, in which governments, civil society and business take responsibility for the co-production of economic utility and good health, these programmes are two recent collaborative platforms based on voluntary agreements to improve public health. Using a ‘most similar cases’ design, we conducted a comparative secondary analysis of data from the evaluations of the two programmes. The underlying rationale of both programmes was that voluntary agreements would be better suited than regulation to encourage business and civil society to take more responsibility for improving health. Differences between the two included: expectations of an enforcing versus facilitative role for government; hierarchical versus horizontal coordination; big business versus civil society participants; top-down versus bottom-up formulation of voluntary pledges and progress monitoring for accountability versus for learning and adaptation. Despite the attempt in both programmes to base voluntary commitments on trust, the English ‘shadow of hierarchy’ and adversarial state-society relationships conditioned non-governmental parties to see the pledges as controlling, quasi-contractual agreements that were only partially lived up to. The Dutch consensual political tradition enabled a civil society-based understanding and gradual acceptance of the pledges as the internalization by partner organizations of public health values within their operations. We conclude that there are institutional limitations to the implementation of generic trust-building and learning-based models of change ‘Whole-of-Society’ approaches.

Understanding of public health adaptation (PHA) to climate change and implementation is limited. This study therefore focuses on one specific PHA issue: adaptation to the oak processionary moth (OPM). The aim is to examine the development of OPM adaptation in order to offer a problem description of the complexities involved in OPM adaptation. In this explorative case study, we investigate adaptation strategies based on semi-structured interviews with 26 actors involved in OPM adaptation in The Netherlands. The results indicate that the context of OPM adaptation is relatively complex, given the involvement of many interdependent actors. OPM adaptation was developed with limited knowledge and strategies were based on ad hoc approaches in which there was ambiguity about tasks and expertise. In addition, different actors have different perceptions and values concerning health, sustainability, risks and responsibilities influencing decision-making processes, while also posing a challenge to collaboration and the development of a coordinated approach. The generation of knowledge and its translation into practical strategies calls for interdisciplinary cooperation in knowledge development. PHA adaptation involves more than technical and organisational solutions alone. It also entails the development of a shared problem perception and solution space in which citizens are also engaged.

Early evidence suggests that populist radical right (PRR) parties and their exclusionary policy agenda could be a threat to population health. In the Netherlands, the Party for Freedom (Partij voor de Vrijheid, PVV) is the main PRR party. It has been closely involved in a national coalition government (2010–2012) under a Tolerance Agreement, in which the PVV supported the minority government without formally being part of it. The aim of this case study is to analyse the standpoints and influence of the PVV – and to a smaller extent the newer Forum for Democracy (FvD) – on health policy in the areas of elderly care, curative care, public health, and the COVID-19 pandemic. The PVV’s agenda on healthcare is welfare chauvinistic, favouring increased government spending (primarily for older adults) combined with the exclusion of certain immigrant groups. During its time supporting a centre-right coalition, the PVV faced a trade-off between pursuing its electoral agenda and maintaining its position in office. The party maintained a strong focus on immigration and elderly care but conformed to the coalition at the expense of its welfare chauvinistic healthcare agenda. This resulted in liberal chauvinistic health policy, in favour of cutting welfare spending in general, with a particular focus on minorities.

This study explored associations between perceived neighborhood walkability and neighborhood-based physical activity (NB-PA) and assessed possible moderation effects of the amount of time spent in the home neighborhood and individual characteristics (i.e., educational level and health-related problems). In 2016 to 2017, 509 Dutch adults, living in the South Limburg area, were included. Context-specific PA levels were measured using the Actigraph GT3X+ accelerometer and the Qstarz BTQ1000XT GPS-logger. Perceived neighborhood walkability, level of education, work status, and health-related quality of life were measured with validated self-report instruments. Results showed that individuals with a lower level of education or health-related problems spent more time in the home neighborhood. The perceived neighborhood walkability only affected NB-PA for individuals spending a relatively large amount of time in their home neighborhood. PA-facilitating features in the home neighborhood, for example, aesthetics, were only associated with more NB-PA for individuals without health-related problems or with a higher level of education.

Health initiatives are increasingly situated outside the institutionalised public health sector. The intersectoral character of societal initiatives, along with indirect relationships between initiatives and health, makes making projections of reach, impact and goal achievement complex. This scoping review of the peer-reviewed literature searches for appropriate methods to conduct quantitative health impact assessment for such initiatives. Database searches were done in PubMed and Web of Science, as well as a reference list search. Studies were then selected in a systematic manner. The review includes 64 studies. Most studies made estimates using simulation methods, notably with Monte Carlo, Markov and system dynamics modelling. Inputs for the models such as transition probabilities and price elasticities were taken from census, register and survey data, evidence from previous (scientific) studies and sometimes outcomes from stakeholder participation. Of different health outcome measures, the number of deaths was most frequently used, followed by QALYs and DALYs and life years. Health effect distribution is frequently mentioned, but not often estimated. Scientific methodological publications on HIAs focusing on civil society initiatives are relatively sparse, indicating possibilities for further methodological advancement. Estimating health effect distributions and incorporating stakeholder participation could make meaningful additions to standard practice.

While the political and social determinants of health have become accepted among academic researchers, health inequalities in the health policy and political arenas are still predominantly addressed as outcomes of citizens' lifestyle and behavioural choices. The rise of populist radical parties across Western countries brings renewed urgency to communicating with elected leaders and policy makers about the importance of tackling the social (as well as behavioral and medical) determinants of health. Recent publications such as 'Health in Hard Times. Austerity and Health Inequalities' (Clare Bambra, 2019) and 'Health Equity in England: The Marmot Review 10 Years On' (Marmot et al, 2020) find that financial and economic policies in large part contribute to stagnating and even reversing population health trends in the UK and across Western countries. The underlying political system of decision-making needs to be clarified in order to effectively engage and exert influence. This workshop aims to strengthen countervailing power and competence in understanding the policy trajectories that effectively target the larger ambitions of economic and social welfare including reduced health inequalities. We provide participants with basic knowledge, methods and tools to carry out practice-based comparative analysis of public health politics and policies across different countries. The workshop consists of: A 20-minute mini-lecture by Julia Lynch, who will present key findings and the underlying methodology of her recent book Regimes of inequality: The political economy of health and wealth. This book systematically used historical institutionalist-methods and process tracing to compare the policies and politics aimed at reducing health inequalities in Finland, France and the UK from the 1990s to the present.A 15-minute panel reflection: The panel, consisting of Clare Bambra, Karien Stronks, and Holly Jarman, will relate this to their own key research and impact.A 25-minute plenary discussion of examples, questions and contributions to tackling inequalities in political and social determinants of health. Examples are labour market participation policies, progressive fiscal policies or policies resolving illiteracy or household financial debt. Key messages Health inequalities are a political choice. Learning by comparison increases capacity to improve policies on the social determinants of health as well as capacity to increase political influence.

The current article presents an in-depth case study as part of a health impact assessment (HIA) on the effects of a major integrative infrastructural urban redesign project in Maastricht on physical activity and health; the Green Carpet project. In this 1.2 billion euro reconstruction project, a highway that crossed several neighborhoods was tunnelled and the space on top of this tunnel was redesigned and prioritized for pedestrians and cyclists, which is further elaborated on in paragraph 2. The aim of this paper is to explore and describe the role of context in explaining the developments within the integrated urban reconstruction project and its presumed health effects over time, and to draw implications for evaluation theory and methodology such as spatial or urban health impact assessment.

The primary goal of this special issue is to showcase novel, theory-driven, creative, and rigorous contributions to our understanding of the existence and development of a culture of prevention and readiness to prevent. The term "culture of prevention" is neither a set of practical guidelines nor a leading theory. Instead, it is a multidimensional term representing the general orientation and readiness of a group of people (be it a family, community, school, organization, nation, etc.) to deal with problems using a preventive, rather than a reactive, approach. The COVID-19 pandemic creates an opportunity for taking stock of the worldwide progress in creating a "culture of prevention." This special issue aims to stimulate this discourse by presenting six studies and three commentaries from international scholars focused on themes and approaches for creating a culture of prevention.

Background The political system is an important influencing factor for population health but is often neglected in the public health literature. This scoping review uses insights from political science to explore the possible public health consequences of the rise of populist radical right (PRR) parties in Europe, with welfare state policy as a proxy. The aim is to generate hypotheses about the relationship between the PRR, political systems and public health. Methods A literature search on PubMed, ScienceDirect and Google Scholar resulted in 110 original research articles addressing 1) the relationship between the political system and welfare state policy/population health outcomes or 2) the relationship between PRR parties and welfare state policy/population health outcomes in Europe. Results The influence of political parties on population health seems to be mediated by welfare state policies. Early symptoms point towards possible negative effects of the PRR on public health, by taking a welfare chauvinist position. Despite limited literature, there are preliminary indications that the effect of PRR parties on health and welfare policy depends on vote-seeking or office-seeking strategies and may be mediated by the political system in which they act. Compromises with coalition partners, electoral institutions and the type of healthcare system can either restrain or exacerbate the effects of the PRR policy agenda. EU laws and regulations can to some extent restrict the nativist policy agenda of PRR parties. Conclusions The relationship between the PRR and welfare state policy seems to be mediated by the political system, meaning that the public health consequences will differ by country. Considering the increased popularity of populist parties in Europe and the possibly harmful consequences for public health, there is a need for further research on the link between the PRR and public health.

Public health research aims to change the world, or at least contribute to the development of healthier and more equitable societies. However, the availability of health information does not inherently lead to its increased use in policy and decision-making. Significant gap remains between the knowledge of public health researchers and the actions taken by decision-makers. Various tools and mechanisms can help to increase the use of scientific evidence in policy development by making policymakers appreciate, understand and incorporate such scientific information into policy decisions. As part of this process, it is crucial that researchers and public health practitioners acquire the ability to translate their knowledge and become skilled on communicating the evidence effectively. To this aim, we will present firstly a WHO approach for that on the basis of EVIPNet Europe. Member countries have benefited of EVIPNet Europe’s capacity building efforts, its training workshops, coaching and mentoring schemes, leading to increased knowledge and skills in view of identifying, accessing, appraising, synthesizing and communicating the best available evidence. The presentation will focus on the ways to trigger tangible changes at policy and legislative levels. The second presentation will give more specific information about the process of real-life applications. Main question will be “How to advocate scientific evidence to decision-makers in the frame of evidence-informed policy-making?”. The presentation will help the participants to analyze to whom they are targeting, what their interests are and how to communicate scientific information to a decision-maker effectively. Last but not least, common challenges of evidence-informed policy-making process in health care and ways to tackle them will be presented. By doing so, special attention will be paid to the methodologies for joint fact-finding, responsive evaluation and citizen science. The workshop will engage participants interactively and leave time for answering their questions at the end. Key messages Public health professionals can influence health policies, if they learn strategies in communicating scientific evidence to decision-makers effectively. Providing correct skills to researchers when communicating about and advocating for the scientific evidence with policymakers will enhance the impact of evidence on policy making.

Background As coordination issues arise in an increasingly complex health domain with a growing number of stakeholders involved in health initiatives, WHO proposed a transformation towards a Whole of Society approach. However, this abstract approach lacks practical guidelines to tackle these issues. In domains such as the environmental policy sector, similar transformations were established by applying governance strategies. This study aims to answer, which conditions and arrangements are found in the governance literature for the coordination and evaluation of the transformation of health towards a Whole of Society approach? Methods A systematic search was conducted by combining ’governance’, with adjectives as ’collaborative’, ’adaptive’, ’experimentalist’ and ’reflexive’ in order to target relevant governance theories in JStor, Web of Science, EBSCO and Google Scholar. Based on inclusion criteria two reviewers independently selected articles following PRISMA. Results Analysis of 56 articles showed that transformation should be coordinated by stimulating favourable conditions such as learning and experimenting in networks that cut across traditional boundaries. These conditions and methods can be divided into three categories. First, establish collaborations with government as equal partner by making the inclusion and decision-making process open and transparent. Second, stimulating innovation by engaging local initiatives, and supporting learning, experimentation, reflection and adaptation. Third, ensuring the sustainability of innovation by enabling institutional change. Conclusions To coordinate and evaluate the transformation of health towards a Whole of Society approach, conditions may consist of a combination of collaboration, innovation and institutional change. Key messages To bring together the fragmented resources for public health, we present emerging conditions for the coordination of a Whole of Society approach as transformative governance strategy. The transformative capacity of governance can be found in the combination of the theories as adjectives: collaborative, adaptive, experimentalist and reflexive.

Background Do political parties matter to health? Do they affect population health either directly, or through welfare states’ social policies and the eligibility, affordability and quality of health systems? And if they do, how? These are crucial questions if we are to understand health politics or shape public health policy, particularly given the changing landscape of both political parties, party dominance in the executive, and the possibly mediating influence of the legislature. Methods This review using a systematic approach examines 107 peer-reviewed articles and books published after 1978 about high-income countries asking the overarching question: Do political parties matter to health and the welfare state? Results As the literature relating parties to health directly was surprisingly thin, the welfare state was used as a ‘proxy’ variable. An overwhelming majority of the literature sample suggests that Left parties are inclined to expand the welfare state and avoid cutting benefits if possible, while the Right does not expand and tends to reduce benefits. There is an inflection in the 1980s when Left parties shift from expansion to maintaining the status quo. Conclusions Considering current health trends in the form of measles outbreaks, the “Deaths of Despair”, the return of presumed eradicated infectious diseases and the declining health expectancy rates in some Western countries as well as the rise of PRR parties in office we question the current partisanship thesis that political parties matter less and less.

In this presentation, information about common challenges of evidence-informed policy-making process in health care and ways to tackle them will be given to the participants. By doing so, special attention will be paid to the methodologies for joint fact-finding, responsive evaluation and citizen science.

Contains fulltext : 145056.pdf (Publisher’s version ) (Closed access) Om processen van integrale actie voor gezondheid te kunnen monitoren is een methode nodig die gevoelig is voor de percepties en ervaringen van verschillende betrokken stakeholders en het soms onvoorspelbare, grillige karakter van dit soort processen. Responsieve evaluatie is een vorm van participatief onderzoek waarbij de onderzoeker actief inspeelt op de informatiebehoeften, verwachtingen en mogelijkheden van de belanghebbenden in kwestie. Doelen zijn om een gelijkwaardig overzicht te verschaffen over de diversiteit aan beelden, verwachtingen, waarden en veronderstellingen van belanghebbenden, en om wederzijds inzicht en begrip te bevorderen. Samen met gezondheidsadviseurs van de provincie Noord-Brabant werd een responsieve evaluatie van Integrale Actie (RIA) opgezet, uitgevoerd en geëvalueerd om in kaart te brengen hoe de twaalf grootste gemeenten in Brabant invulling geven aan een gezonde fysieke leefomgeving. Na twaalf groepsinterviews met verschillende functionarissen in de twaalf gemeenten is een interactieve stakeholderworkshop georganiseerd op het thema Gezonde Stad om een dialoog te faciliteren over al lopende initiatieven en acties, bevorderende en belemmerende factoren van integrale samenwerking en bestuurlijke en politieke randvoorwaarden voor een Gezonde Stad. RIA bleek een geloofwaardige methode om authentieke stakeholderinzichten uit te wisselen, die heeft geleid tot meer steun en draagvlak onder stakeholders en diverse spin off activiteiten. ---------------------------------------------------------------------------------------------------------------- Responsive evaluation of Integrated Action (RIA): a method for monitoring by stakeholder dialogues on health-related integrated action. Processes of integrated action to promote and protect health require a distinct method for monitoring and evaluation that is sensitive to the perceptions and experiences of different stakeholders and the often capricious and unpredictable course of events. Responsive evaluation is a method for participatory research in which the researcher actively builds on the information needs, expectations and capacities of the stakeholders. Goals consist of providing a balanced overview of the diversity of frames, expectations, values and assumptions, and facilitating mutual understanding. In collaboration with the health policy officers of the Province North-Brabant and an independent professional dialogue facilitator we developed, conducted and evaluated a responsive evaluation of integrated action (RIA). In group interviews with a diverse representation of policy officers, we first mapped the activities of the 12 largest municipalities in the province that they associate with a ‘Healthy City’. We then organised a stakeholder workshop based on the themes that resulted from the interviews. There the stakeholders identified current activities, enabling and disabling conditions for integrated action, and the political-administrative conditions for a Healthy City. Afterwards stakeholders valued the responsive evaluation as a credible method for exchanging authentic stakeholder experiences, which has led to more support among the stakeholders and a diversity of spin off activities and consolidation of health considerations in other provincial policy documents. 9 p.

Researchers are increasingly expected to deliver “socially robust knowledge” that is not only scientifically reliable but also takes into account demands from societal actors. This article focuses on an empirical example where these additional criteria are explicitly organized into research settings. We investigate how the multiple “accountabilities” are managed in such “responsive research settings.” This article provides an empirical account of such an organizational format: the Dutch Academic Collaborative Centres for Public Health. We present a cross-case analysis of four collaborative research projects conducted within this context. We build on (and extend) Miller’s notion of “hybrid management.” The article shows that the extended concept of hybrid management is useful to study the different accountabilities encountered in such settings. We analyze how the collaboration developed and which conflicts or dilemmas arose. We then focus on the different hybrid management strategies used in the collaboration. The empirical material shows how the different aspects of hybrid management feature in various configurations in the four projects. We highlight that hybrid management strategies may be used by different groups or at different moments, may reinforce or contradict each other, and may be more or less effective at different points in time.

Contains fulltext : 178380.pdf (Publisher’s version ) (Open Access) If public health is the field that diagnoses and strives to cure social ills, then understanding political causes and cures for health problems should be an intrinsic part of the field. In this article, we argue that there is no support for the simple and common, implicit model of politics in which scientific evidence plus political will produces healthy policies. Efforts to improve the translation of evidence into policy such as knowledge transfer work only under certain circumstances. These circumstances are frequently political, and to be understood through systematic inquiry into basic features of the political economy such as institutions, partisanship and the organization of labour markets. 10 oktober 2017 4 p.

Contains fulltext : 163305.pdf (Publisher’s version ) (Open Access) In 2015 heeft de Universiteit Maastricht in samenwerking met de Radboud Universiteit in opdracht van ZonMw een eerste analyse gemaakt van de bestuurlijk-organisatorische aanpak van het Nationaal Programma Preventie Alles is Gezondheid… Het programma markeert een uitbreiding van het beleidsinstrumentarium van het Rijksgezondheidsbeleid (regelgeving, financiële prikkels, onderzoek en ontwikkeling) met vrijwillige publiek-private netwerkvorming. Beoogd wordt hiermee de capaciteit voor bewustwording en gedragsverandering te vergroten met als doel bij de burger uiteindelijk een groter gezondheidseffect te realiseren. Snelle effecten kunnen redelijkerwijs niet worden verwacht. Een procesevaluatie met tussentijdse terugkoppeling is in dit stadium meer valide dan een evaluatie van uitkomsten. De probleemstelling in onze studie luidt: Hoe functioneert Alles is Gezondheid… als coördinatie-arrangement om samenhang te creëren in maatschappelijke activiteiten op het gebied van gezondheidsbevordering en preventie van diverse actoren in verschillende settings, deze activiteiten uit te breiden naar een maatschappelijke beweging, en daardoor bij te dragen aan een betere borging en verantwoording van het gezondheidsbelang in diverse maatschappelijke settings en een hogere doelmatigheid van de inzet? Hierbij vond een eerste analyse plaats op basis van een quick scan van vier gelijksoortige programma’s in binnen- en buitenland, archiefonderzoek bij het ministerie van VWS, meeloopdagen met het Programmabureau, verkennende gesprekken en interviews met pledgehouders en bureaumedewerkers, en een datascan van alle pledges. In deze bijdrage geven we een theoretische duiding aan dit programma en een eerste impressie op basis van de bevindingen en observaties tot nu toe. 3 p.

While much research utilisation literature shows an increasing emphasis on the added value of structural partnerships, which should facilitate prolonged interactions between researchers, policy makers and professionals, the question of how such collaborative structures develop over time and what consequences that has in terms of collaboration is usually neglected. This paper offers an empirical analysis of a Dutch partnership format developed over a period of four years, based on two interview rounds conducted between 2007 and 2010, supplemented with document analysis and a focus group. It focuses on changing challenges and dilemmas in different development stages and outlines which strategies are used.

textabstractPublic health policies and services are increasingly scrutinized for their quality and accountability and 'evidence-based' ways of working are becoming more important in most public sector activities. In the Netherlands this led to the development of academic collaborative centers (ACCs) for public health: formal, long-term collaborations between municipal health services, university departments and other stakeholders. In this paper we argue that discussing issues of research uptake or research utilization in terms of 'gaps' that need to be 'bridged' is unproductive when analyzing structural collaborations or partnerships between researchers, policy-makers and practitioners. Within collaborative settings such as the ACCs, the clear distinction between what counts as 'science' and what counts as 'policy' is only one side of the story. We use the notions of 'boundary organization' and 'front stage and back stage settings' to analyze a case study of a collaborative project conducted within one of the ACCs.

The use of evidence in health promotion has become the gold standard, and obliges rethinking how to increase the (often limited) use of evidence in public health policy. Recently calls have been made to reconceptualise science policy relations as dynamic, interactive and coconstructive practices. Building on a qualitative investigation of an information tool for the Dutch government, the authors show how the nature of evidence is closely linked to its usefulness for policy, and how a specific infrastructural organisation of science-policy interactions contributes to an effective participation and interaction between both scientists and policy makers and the translation of research findings.

Veel kennis over en ervaringen met IGB en KT was tot op heden gefragmenteerd, verspreid over diverse onderzoeksgroepen in Nederland. In het door het RIVM gecoordineerde consortium i4i komt deze kennis en ervaringen bij elkaar. Negen onderzoeksgroepen werken samen aan zowel conceptuele verheldering als praktische onderzoeksinstrumenten voor IGB en KT-BOP. De samenwerkingspartners zijn: RIVM, Erasmus Universiteit Rotterdam, AMC, Vrije Universiteit Amsterdam, TNO, Wageningen Universiteit – GGD Noord- en Oost Gelderland, Universiteit van Tilburg, Erasmus MC en Universiteit Maastricht-GGD Zuid Limburg. Het consortium i4i heeft een doorlooptijd van september 2012 tot september 2014. Het eerste jaar is gewerkt aan de uitwerking van theoretische noties en bijbehorende kwalitatieve en kwantitatieve instrumenten.

De introductie van een nieuw begrip van gezondheid door Huber et al in 20111 heeft geleid tot een opleving van de internationale discussie over de sociaal-politieke en collectieve aspecten van gezondheid. Deze worden in de Nederlandse discussie in TSG Spectrum 91(3) nauwelijks geadresseerd. Toch bieden die interessante aanknopingspunten voor een vertaling van het individugerichte begrip van Positieve Gezondheid naar het collectieve niveau van het overheidsbeleid. In de context van de huidige financieel-economische en sociaal-culturele uitdagingen biedt maatschappelijk aanpassingsvermogen, in de overgang van de verzorgingsstaat naar een kleinschalige sociale investeringsstaat, een bouwsteen voor de aanstaande decentralisaties van de AWBZ, Jeugdzorg en de Participatiewet. Dergelijk ‘gezondheidskapitaal’ biedt een nieuw ankerpunt voor integraal beleid.

Many authors in public health identify gaps between science, policy, and professional practice and seek to solve the problems by facilitating interactions between policymakers and researchers by creating partnership structures. Little empirical research indicates how these interactions contribute to use of research by policymakers, and under which conditions. We provide empirical information by analysing one project in an innovative partnership structure in the Netherlands. We show that although a partnership structure might facilitate interactions, it does not automatically render these interactions meaningful. To balance potential conflicts, careful issue management on a formal and informal level is needed. Partnership designs aiming to facilitate interactions between researchers and policymakers should pay attention to the role of knowledge brokers, expectations of science and policy actors, and the ways in which different perspectives can be helped to converge.

The call for ‘evidence-based health policy’ in the Netherlands has to date been accommodated by the consensual policy tradition in this country and by the institutionalised arrangements for research funding, researcher career development and research accountability systems. The aim of this paper is to describe and explain from a sociological perspective how these arrangements for two-way research–policy interactions enable the co-production of ‘useable knowledge’ for ‘doable problems’ in health policy making. We conclude that many arrangements function as boundary objects that allow for mediation between research and policy. This mediation occurs via both frontstage and backstage processes. The backstage processes are an essential precondition for the co-production of acceptable evidence, policy advice and policy in the frontstage. However, as a result of the increasing emphasis on evidence-based policy, and an accompanying instrumentalisation of research use in the policy process, some of the characteristic, and until now productive, elements of the Dutch system are threatened.

Een belangrijke uitdaging in de publieke gezondheidszorg is het coordineren van onderzoek, beleid, en praktijk. Het ZonMw programma Academische Werkplaatsen Publieke Gezondheid is erop gericht om deze coordinatie te verbeteren, om op die manier enerzijds het onderzoek binnen de gezondheidszorgsector lokaal relevant te maken, en anderzijds het beleid en de praktijk binnen de publieke gezondheidszorg meer op wetenschappelijk bewijs te stoelen. De negen Academische Werkplaatsen die inmiddels zijn opgestart, hebben verschillende (maar ook overlappende) thema’s, zoals Gezondheidsbevordering, Jeugdgezondheidszorg en Infectieziekten. Het instituut Beleid en Management Gezondheidszorg analyseert in opdracht van ZonMw de wijze waarop aan de interactie tussen wetenschap, beleid en praktijk binnen de Werkplaatsen wordt vormgegeven. De Academische Werkplaatsen worden in dit onderzoek geconceptualiseerd als grensorganisaties: organisaties die verschillende ‘sociale werelden’ coordineren en tegelijkertijd verantwoording naar iedere wereld blijven afleggen. Dit artikel beschrijft de eerste resultaten van het onderzoek. De organisatiestructuren, instrumenten, ervaren opbrengsten en genoemde randvoorwaarden van de Werkplaatsen worden vergeleken. Op basis van deze bevindingen worden de interessante spanningen en aandachtspunten in kaart gebracht die in een aantal verdiepende case studies nader worden onderzocht.

Binnen de openbare gezondheidszorg speelt de notie van op ’evidence’ gebaseerd beleid een steeds grotere rol. In dit artikel worden de rol en de betekenis van de VTV beschreven als kennisinstrument voor (overheids)beleid. Vanuit een wetenschapssociologische benadering is onderzocht op welke wijze de VTV zich positioneert als kennisinstrument binnen het gezondheidsbeleid. In hoeverre kunnen we hier spreken van ‘evidence-based policy’ en wat voor vorm neemt dat dan aan? De VTV fungeert, zoals blijkt uit onze analyse, als consensusplatform voor wetenschappelijke kennis waarbij steeds de juiste balans tussen wetenschap en beleid gezocht moet worden. De VTV heeft daarvoor een infrastructuur in het leven geroepen die de participatie van zowel wetenschappers als beleidsmakers in het proces van totstandkoming van de VTV coordineert, zonder dat beiden in elkaars vaarwater terechtkomen. De VTV manifesteert zich frontstage als een wetenschappelijk gefundeerd kennisinstrument met een duidelijke rol binnen het beleidsproces van de overheid. Anderzijds vergt deze rol backstage veel informeel overleg en onderhandeling tussen verschillende actoren uit alle lagen van de overheid en het centrum VTV in het VTV proces. De opzet van de VTV maakt deze twee posities mogelijk. De huidige ontwikkelingen binnen het zorgstelsel vereisen een grotere rol voor lagere overheden, provincies en gemeenten in het zorgdragen voor een goed functionerende openbare gezondheidszorg. Regionale en lokale overheden hebben daarvoor instrumenten nodig die vaak nog niet zijn ontwikkeld. De manier waarop de VTV vorm geeft aan haar gezaghebbende rol binnen het evidence based gezondheidsbeleid van de centrale overheid kan als ’good practice’ dienen voor de verdere ontwikkeling van beleidsinstrumenten voor lokale en regionale overheden, bijvoorbeeld bij het opzetten van lokale VTV’s. De belangrijkste les is dat bruikbare kennis alleen tot stand kan komen in de interactie tussen beleidsmakers en experts. Daarvoor vormen backstage coordinatie van informele contacten tussen experts en beleidsmaker een noodzakelijke voorwaarde voor evidence based gezondheidsbeleid.

Contains fulltext : 163359.pdf (Publisher’s version ) (Closed access) BACKGROUND: The National Prevention Program ‘Everything is Health' (EiH) 2014–2016) has adopted a ‘Whole of Society' (WoS) approach by engaging societal and business organisations as well as public authorities and services to pledge their commitment ‘to the realisation of the EiH goals by conducting specific focused activities'. Our two-year evaluation focuses on the governance and organisational conditions for the coherence, spread, consolidation and accountability of health promotion activities in the pledges, and the functioning of the EiH arrangements. METHODS: Three research stages consist of (1) a literature study and exploratory interviews of similar programs such as the UK Responsibility Deal, and the Dutch Corporate Social Responsibility program; (2) a qualitative monitoring of the Program Office and a selection of pledges; and (3) a responsive evaluation among and between program officers and pledgeholders in the EiH Platform. RESULTS: We consider EiH to be a governance experiment sharing responsibilities for health among public and private actors while developing a sustainable social order. One condition is to build an infrastructure for sharing knowledge, experience and feedback for peer review in an advanced pledgeholder community of practice. Another condition is to discourage non-compliance. There will be no sustainable health impact without such a consolidating infrastructure. Evaluating such a complex, ambiguous and uncertain approach requires a careful interaction between evaluators and program officers, pledgeholders and stakeholders. The EiH Platform can serve as a joint evaluative infrastructure. CONCLUSIONS: Evaluating the EiH program as a governance experiment is a necessary precondition to organising health impact. Building a consolidating infrastructure for a sustainable order of responsibilities and health impact takes time, effort and risk. Evaluation design can set an example of an infrastructure for sustainable health impact.

Contains fulltext : 145047.pdf (Publisher’s version ) (Closed access) In dit artikel staat de vraag centraal hoe draagvlak onder stakeholders voor integrale actie voor gezondheid tot stand komt. Daartoe hebben we in samenwerking met de provincie Noord-Brabant een responsieve evaluatie opgezet waarin 32 gemeentelijke ambtenaren van verschillende beleidsterreinen bevraagd zijn op hun percepties van een Gezonde Stad, en hun ervaringen met het agenderen van integrale actie. Percepties van een Gezonde Stad leveren een beeld op van een duurzame stad met een gezond vestigingsklimaat voor talentvolle ondernemers en werknemers, die in de openbare ruimte ontmoetingen faciliteert tussen verschillende sociale groepen, en bewegen en sporten aantrekkelijk maakt. Ondanks raakvlakken onderhouden de ambtelijke stakeholders geen beleidsmatige relaties met de gezondheidssector. Bij het agenderen van integrale initiatieven hebben ambtenaren vooral geleerd van wat er niet werkt: een activistische benadering, het uitsluitend vertrouwen op wetenschappelijke ‘bewijs’ of op de morele superioriteit van gezondheid. Een belangrijke agenderingsstrategie van ambtenaren bestaat uit het mobiliseren van externe invloedrijke actoren. Daarnaast lijkt de ontwikkeling van ‘lenigheid van geest’ van belang: de persoonlijke attitude om gegeven de institutionele kokers en verantwoordingsregels flexibel te kunnen opereren. Dat contrasteert met het top down concept van IGB. Een pragmatisch-flexibel concept als ‘adaptieve integrale actie’ lijkt ons voorlopig een beter passend concept voor de analyse en versterking van gezondheidsbevordering en bescherming. ----------------------------------------------------------------------------------------------------------------- The importance of flexible mindset. Setting the agenda for integrated action on a Healthy City. In this article we question how support among stakeholders for integrated action on health is built and maintained. In collaboration with health policy advisors at the province of North-Brabant and an independent professional dialogue facilitator we set up a responsive evaluation among 32 municipal policy officers from different policy domains, addressing their perceptions of a Healthy City and their experiences in agendasetting of integrated action in general. Perceptions consist of a ‘sustainable’ city with a ‘healthy climate for settlement of talented entrepreneurs and skilled labour force’, which facilitates ‘interactions between different social groups’, and attracts citizens to ‘engage in physical exercise and sports’. Despite the overlap in perceptions, policy officers do not maintain structural relationships with the health policy officer nor health services. Policy officers involved in integrated action on other topics have mostly learned from experience that which did not work: an activitst approach, relying solely on scientific evidence, or on the moral superiority of health over other policy topics. An important agendasetting strategy familiar to all policy officers consists of mobilising external influential actors. Furthermore, it seems crucial to develop a flexible mindset: the personal attitude and capacity –given the institutional pillarisation of policy sectors and accountability regimes– to operate in an adaptive and supportive manner. This contrasts with the top down concept of integrated health policy. The pragmatic and flexible concept of adaptive integrated action seems to be a more suitable concept for analysing and strengthening integrated health-related action. Keywords: responsive evaluation, integrated action, province North Brabant, Healthy City 7 p.

Like any policy-relevant research, HIA faces the risk of not being used by decisions-makers. This article addresses the questions: “How do policy decisions come about?” and “How does this affect HIA?” Current literature in political-administrative sciences identifies three ways for decision-making: rational, incremental and mixed model. These models define the relationship between the policy process at stake and the HIA. In incremental or mixed model decision-making, use of HIA evidence by policy-makers is heavily dependent on their values in the context, which may result in conceptual utilization or may extend to strategic utilization. In rational decision-making, HIA provides information independent from the context, which results in instrumental utilization. HIA practitioners need to optimise utilization and produce an appropriate HIA by mapping the policy process. They can do this by asking the questions ‘What? How? Who? and What context? and by maintaining continuous communication with the decision-makers. An appropriate HIA is policy-, time- and place-specific: reflecting the decision-making of the policy at stake. Furthermore, HIA concerns two policy fields with two different contexts and, in some cases, two different decision-making models. The administrative requirements for an appropriate HIA need further exploration.