International Journal of Health Policy and Management最新文献

The Health System Impact (HSI) Fellowship program in Canada offers a transformative approach to health services and policy research (HSPR) training, preparing PhD graduates for diverse career pathways and leadership roles within learning health systems. This commentary builds on Kasaai and colleagues' evaluation of the HSI Fellowship to discuss the diverse career paths of alumni and highlight the multifaceted benefits of the program. Further, we emphasize the need for future research and knowledge mobilization to better understand and evaluate embedded research roles. Developing a robust evaluation framework is essential to capture the unique impacts of embedded research, fostering a culture that prioritizes and integrates it, thereby driving the transformation towards learning health systems.

Background: Takeaway food is often high in calories and served in portion sizes that exceed public health recommendations for fat, salt and sugar. This food is widely accessible in the neighbourhood food environment. As of 2019, of all local authorities in England (n=325), 41 had adopted urban planning interventions that can allow them to manage the opening of new takeaway outlets in "takeaway management zones around schools" (known elsewhere as "exclusion zones"). Before adoption, local authorities undertake mandatory public consultation where responses objecting to proposals can be submitted. Evidence on common objections could be insightful for practitioners and policy-makers considering this intervention.

Methods: We included 41 local authorities that adopted a takeaway management zone around schools between 2009 and 2019. We identified and analysed objections to proposals submitted by or on behalf of food retailers and local authority responses to these. We used reflexive thematic analysis with a commercial determinants of health lens to generate themes, and investigated if and how objections and responses changed over time.

Results: We generated four themes: The role of takeaways in obesity, Takeaway management zone adoption, Use and interpretation of evidence, and managing external opinions. Despite not being implicated by the adoption of takeaway management zones around schools, planning consultants objected to proposals on behalf of transnational food retailers, however, independent takeaways did not respond. Objections attempted to determine the causes of poor diet and obesity, suggest alternative interventions to address them, undermine evidence justifying proposals, and influence perspectives about local authorities and their intervention. Objections consistently raised the same arguments, but over time became less explicit and expressed a willingness to partner with local authorities to develop alternative solutions.

Conclusion: Objections to local authority proposals to adopt an urban planning intervention that can stop new takeaways opening near schools featured strategies used by other industries to delay or prevent population health intervention adoption. Practitioners and policy-makers can use our findings when developing proposals for new takeaway management zones around schools. By using knowledge about their local context and addressing arguments against specific aspects of the intervention, they can pre-empt common objections.

Background: Unhealthy commodity industries (UCIs) engage in political practices to influence public health policy, which poses barriers to protecting and promoting public health. Such influence exhibits characteristics of a complex system. Systems thinking would therefore appear to be a useful lens through which to study this phenomenon, potentially deepening our understanding of how UCI influence are interconnected with one another through their underlying political, economic and social structures. As such this study developed a qualitative systems map to depict the complex pathways through which UCIs influence public health policy and how they are interconnected with underlying structures.

Methods: Online participatory systems mapping workshops were conducted between November 2021 and February 2022. As a starting point for the workshops, a preliminary systems map was developed based on recent research. Twenty-three online workshops were conducted with 52 geographically diverse stakeholders representing academia, civil society (CS), public office, and global governance organisations (CGO). Analysis of workshop data in NVivo and feedback from participants resulted in a final systems map.

Results: The preliminary systems map consisted of 40 elements across six interdependent themes. The final systems map consisted of 64 elements across five interdependent themes, representing key pathways through which UCIs impact health policy-making: (1) direct access to public sector decision-makers; (2) creation of confusion and doubt about policy decisions; (3) corporate prioritisation of commercial profits and growth; (4) industry leveraging the legal and dispute settlement processes; and (5) industry leveraging policy-making, norms, rules, and processes.

Conclusion: UCI influence on public health policy is highly complex, involves interlinked practices, and is not reducible to a single point within the system. Instead, pathways to UCI influence emerge from the complex interactions between disparate national and global political, economic and social structures. These pathways provide numerous avenues for UCIs to influence public health policy, which poses challenges to formulating a singular intervention or limited set of interventions capable of effectively countering such influence. Using participatory methods, we made transparent the interconnections that could help identify interventions in future work.

The rapid advancement of technology in healthcare is creating new competency requirements for professionals, such as skills for data management and the adoption of new technologies, understanding the effect of digitalisation on clinical processes, and evaluating clinical safety and ethics within the context of digitalisation. These requirements call for improved educational curricula and ongoing continuing education in digital skills. This study, as part of the Digital Skills Training for Health Care Professionals in Oncology (DigiCanTrain) project, aims to map and describe the existing continuing education in digital skills for healthcare professionals (HCPs) in European Union (EU) Member States. Using a mapping study methodology, data was collected from experts in 25 EU countries through surveys and from online sources. Qualitative content analysis was used for categorising the data. The results show variations between countries in policy strategies, training organisation, and funding mechanisms. Educational institutions, employers, third parties, and national/regional authorities were found to be the main organisers of the digital skills training. Comprehensive accreditation systems seemed to be scarce, and practices also varied between countries. The study highlights the importance of adopting a systematic approach to enhancing continuous professional development in digital skills, which would ensure that professionals have equitable access to education, resulting in consistent, quality patient care across countries and regions. The findings offer valuable insights for policymakers, educators, healthcare institutions, and professionals.

Background: Medical professionals experienced high rates of burnout and moral distress during the COVID-19 pandemic. In Canada, burnout has been linked to a growing number of family physicians (FPs) leaving the workforce, increasing the number of patients without access to a regular doctor. This study explores the different factors that impacted FPs' experience with burnout and moral distress during the pandemic, with the goal of identifying system-based interventions aimed at supporting FP well-being and improving retention.

Methods: We conducted semi-structured qualitative interviews with FPs across four health regions in Canada. Participants were asked about the roles they assumed during different stages of the pandemic, and they were also encouraged to describe their well-being, including relevant supports and barriers. We used thematic analysis to examine themes relating to FP mental health and well-being.

Results: We interviewed 68 FPs across the four health regions. We identified two overarching themes related to moral distress and burnout: (1) inability to provide appropriate care, and (2) system-related stressors and buffers of burnout. FPs expressed concern about the quality of care their patients were able to receive during the pandemic, citing instances where pandemic restrictions limited their ability to access critical preventative and diagnostic services. Participants also described four factors that alleviated or exacerbated feelings of burnout, including: (1) workload, (2) payment model, (3) locum coverage, and (4) team and peer support.

Conclusion: The COVID-19 pandemic limited FPs' ability to provide quality care to patients, and contributed to increased moral distress and burnout. These findings highlight the importance of implementing system-wide interventions to improve FP well-being during public health emergencies. These could include the expansion of interprofessional team-based models of care, alternate remuneration models for primary care (ie, non-fee-for-service), organized locum programs, and the availability of short-term insurance programs to cover fixed practice operating costs.

Health system resilience has become a desirable health system attribute in the current permacrisis environment. The article by Saulnier and colleagues reviews the literature on health system resilience and refines the concept, pinpointing dimensions of resilience governance that have not reached consensus, or that are missing from the literature. In this commentary we complement the findings by discussing different conceptual frameworks for understanding resilience and introducing resilience testing, a method to assess health system resilience using a hypothetical shock scenario. Resilience testing is a mixed-methods approach that combines a review of existing data with a structured workshop, where health system experts collaboratively assess the resilience of their health system. The new method is proposed as a tool for policy-making, as the results can identify attributes of the current health system that may hinder or boost a resilient response to the next crisis.

Systematic public monitoring of the practices of corporations that harm health is a necessary but not sufficient measure to reduce the adverse impact of these practices. By supporting social movements and health activist campaigns that seek to modify the corporate structures, systems and practices that harm health, public health professionals and researchers can bring powerful new voices into this crucial public health task. Partnerships between the public health organizations and social movements and activists who seek to make human and planetary well-being more important objectives than higher corporate profits can help to achieve this aim. Public health professionals can play an important role in supporting such partnerships.

Background: A now extensive literature has documented political strategies of health-harming industries (HHIs), but little is known about their engagement with parliamentary select committees. Recent investments by trans-national tobacco corporations (TTCs) in electronic nicotine delivery systems (ENDS) has raised concerns that industry actors may be using these to re-engage policy-makers in ways precluded by the Framework Convention on Tobacco Control (FCTC) Article 5.3.

Methods: This article examines tobacco industry engagement with the United Kingdom House of Commons Science and Technology Committee (STC) inquiry into e-cigarettes. It draws on a qualitative analysis of semi-structured interviews with committee members and support staff (n=4) triangulated against written and oral evidence submissions.

Results: TTCs featured prominently in the STC inquiry via written and oral submissions. Opportunities existed for industry engagement, and potential influence, at each stage of the process. There was an absence of oral testimony from those sceptical about the potential health benefits of ENDS. The governance mechanisms in place for select committees appear inadequate for protecting committee work from industry influence. As it relates to TTCs, this has implications for the UK's commitments under FCTC Article 5.3, yet understanding of the FCTC and the requirements of Article 5.3 compliance within the committee were limited.

Conclusion: The governance of select committees requires urgent reform in order to balance norms of openness and participation with the need to protect their work from power of economic actors with conflicts of interest (COI). This is particularly the case in relation to TTCs and adherence to FCTC Article 5.3. These findings are of relevance to other select committees whose work affects the interests of HHIs. Further research is needed on other committees and sectors.