International Journal of Health Policy and Management最新文献

The pursuit of healthy societies has long been a global aspiration, yet the pathways to achieving them remain fraught with challenges. The paper "How to Build Healthy Societies: A Thematic Analysis of Relevant Conceptual Frameworks" provides an insightful thematic analysis, identifying key policy levers and enablers necessary for transformative change. This commentary critically examines the paper's approach, highlighting the need for a more profound engagement with political and economic structures. Additionally, the commentary highlights the role of civic engagement and evidence-based policy-making in overcoming systemic inertia. Ultimately, achieving healthy societies requires a paradigm shift-one that moves beyond technical solutions towards an equity-driven and justice-oriented framework.

Background: Blantyre city is among the jurisdictions in Malawi with the highest rates of people living with HIV and new HIV infections, driven by numerous structural factors. The Malawi National AIDS Commission hypothesized that local elected officials may be uniquely positioned to understand and address structural drivers of HIV infection in their communities. However, these leaders have been disengaged in HIV prevention efforts over time. This formative study aimed to explore city councillors' understanding of the HIV landscape in Blantyre, including structural drivers of HIV, and to identify opportunities for engaging elected city councillors to address these drivers.

Methods: Between November-December 2021, we conducted a descriptive qualitative study in Blantyre city, involving 59 purposively sampled participants: 23 city councillors, 14 technical experts, 7 implementing partners, and 15 community leaders. Data were collected through in-depth interviews and analysed thematically using MAXQDA software.

Results: HIV technical experts and implementing partners were generally knowledgeable about the current HIV epidemic in Blantyre while most councillors and community leaders were not. Nearly all participants referenced structural drivers of HIV transmission in the city, including migration between districts, poverty, substance abuse, and transactional sex. Councillors noted their successes in mobilizing people and identifying resources for projects. However, they reported limited knowledge and training in HIV, no involvement in related programmes in their wards, and had minimal access to HIV data. They suggested access to trainings and data would equip them to better engage with HIV programs.

Conclusion: Elected leaders in Blantyre have limited access to HIV data and training. However, they demonstrate well-established relationships with ward residents and possess motivation and interest in enhancing their knowledge and capacity to address structural and other drivers of HIV infection-key factors for designing interventions for local leaders.

Many low- and middle-income countries are designing or revising their health benefit packages (HBPs), with appraisal-prioritizing services for reimbursement-being a critical phase. This occurs in a complex landscape of multiple criteria, multiple stakeholders, limited evidence, budget constraints, and tight timelines, varying across countries. Existing guidance documents do not fully address these complexities, requiring analysts to balance methodological rigor with practical constraints. This editorial highlights four key themes in organizing appraisal: decision-making structures, trade-offs between criteria, final recommendations, and the use of cost-effectiveness evidence, thresholds, and budgets. These emerged as central challenges in HBP revisions in Iran, Kyrgyzstan, Liberia, Pakistan, and Rwanda. We emphasize cross-country learning to address these challenges pragmatically, recognizing that high-quality, legitimate appraisal is as much an art as a science. More detailed documentation of appraisal processes is needed to refine HBP revision guidelines and strengthen priority-setting in health systems.

Labonté offers important critical optimism around the idea of a well-being economy, which is gaining considerable international momentum and offers a much-needed alternative to the current political economic paradigm of neoliberal capitalism and its significant social and ecological consequences. Because of its focus on systems and structures that constitute "root causes" of poor health and health inequities at the population level, a well-being economy aligns strongly with stated tenets and value commitments of public health. It thus provides an important opportunity for public health communities to engage and mobilize as a collective around this important vision. For this to happen, however, public health communities must overcome a reluctance to engage with political economy and take seriously the field's commitment to the public's health. In this commentary I reflect on these opportunities and challenges in the Canadian public health context.

This commentary is in response to the paper titled "A Comparative Policy Content Analysis of National Policies to Address Musculoskeletal Health to Inform Global Policy Development" by Schneider et al. This well-done policy content analysis identifies key themes and transferable principles to guide policy development for musculoskeletal health. In this commentary, I argue that the findings of this policy analysis should be used to develop global policies within the current framing of non-communicable diseases (NCDs), especially considering the growing burden of multimorbidity. The second point concerns the application of the building blocks framework and limitations in the use of the framework. Lastly, in this paper, I miss the needed emphasis for a global health policy that specifies primary healthcare and universal health coverage for a life course approach and an equitable response.

Alcohol taxation is a key policy to reduce consumption and alcohol harm but evidence on tax design and indicators to assess taxation policy are lacking. Tax design and two indicators: tax as a share of lowest retail price and affordability, were investigated in eight high-income and nine middle-income jurisdictions. Collaborators populated the International Alcohol Control (IAC) study online Alcohol Policy Tool, providing measures of tax design, tax rates; and typical lowest prices available for retail take-away alcohol. These data were used to calculate tax/share of retail price. Affordability of alcohol was assessed against gross national income (GNI) per capita. High-income jurisdictions had higher tax/share and higher affordability on average compared with middle-income jurisdictions. Over the sample as a whole there was no association between these two indicators of tax policy. The tax designs used also varied with high-income jurisdictions more likely to use specific excise tax reflecting potency and middle-income jurisdictions more likely to utilise ad valorem and specific volume based taxes and to use more than one method across a beverage. Increased alcohol taxation to reduce alcohol consumption and harm is established as a high impact policy and is believed to work by affecting affordability. However, less is known about the best taxation methods to reduce affordability or the best measures to monitor and compare alcohol taxation between countries and over time. In this sample of high- and middle-income jurisdictions tax/price share was not found to predict affordability, suggesting the need to further research indicators of alcohol affordability.

Background: Successive government public health strategies in England have described structural influences of diet-related ill health, including obesity, while emphasising the solution of individual-level change in policy documents. This entrenchment of an individualistic policy paradigm, despite communicating a recognition of structural determinants of health on paper, has been termed "lifestyle drift." The 2020 government strategy, Tackling Obesity, included policies to address structural determinants of health like the physical and digital food environments but ultimately failed to shift responsibility for diet-related ill health onto structural factors. This study uses the contestation of calorie labelling (CL) in the out-of-home (OOH) sector, one of the strategy's only two implemented measures, in English newspapers to investigate how the policy is framed, and the potential role of media framing in facilitating lifestyle drift.

Methods: We systematically searched the Factiva database for articles from 12 UK national newspapers that discussed CL between January 2017 and May 2022, and assessed them relative to inclusion criteria. We then used a combination of reflexive thematic analysis (RTA) and framing theory to qualitatively analyse the framing of policy problems and the solutions meant to address them.

Results: A total of 177 articles met our criteria. We found that media framing often reinforced individualism, personal responsibility, and moralisation of behaviour. It also emphasised perceived mixed and inconclusive evidence of CL's effectiveness, unfairness to businesses, and unintended consequences, including negative impacts on the economy and people living with eating disorders.

Conclusion: Despite an initial shift towards framing interventions to address obesity through a structural lens in Tackling Obesity, CL legislation and accompanying news coverage reflected a drift back towards individualism. To enact effective, structural change to address diet-related public health issues, policy discourses and approaches need to move away from individualising and moralising framing of both public health problems and potential solutions.

Coproduction is not a new idea in implementation research, health research, or research in general. There is substantial scholarship that establishes its importance and provides guidance and examples for adoption. Given this, why do editorials like Rycroft-Malone and colleagues' recent paper, "Research Coproduction: An Underused Pathway to Impact," continue to be published, and also, necessary? In this commentary, we discuss the importance of equity-not equality-as the underlying paradigm of coproduction research. We argue that it is the incomplete understanding and adoption of this equity paradigm by researchers and their institutions that inhibit coproduction from being fully realized and thus, impactful. We offer examples of what such a paradigm shift might look like, including futures thinking that yields difficult questions that must be addressed to dismantle systemic barriers to power redistribution.

Background: As public policies have the potential to change the entire system of physical activity (PA) promotion and to create conducive environments, they are particularly relevant to address the persistently low levels of PA across the world. Furthermore, World Health Organization's (WHO's) Global Action Plan on Physical Activity highlights the relevance of local governments as important partners for policy action. However, our knowledge on how local PA promotion policy compares across countries remains limited.

Methods: We conducted an exploratory study as part of the LoGoPAS project to compare the status quo of local PA policies across five municipalities in five different countries. Using purposive sampling, Jyväskylä (Finland), Nice (France), Erlangen (Germany), Fujisawa (Japan), and Cluj-Napoca (Romania) were selected. Data were collected and analysed via desk research and expert consultation using the CAPLA-Santé, a validated tool designed to assess relevant aspects of local PA promotion policies.

Results: The analysis showed that the main responsibility for PA promotion varied between municipalities, resting either with the sport or the health sector. A total of 50 relevant PA policy documents were identified, focusing on multiple settings and target groups. Budgets for PA promotion differed across municipalities. Research on PA was reported to have informed policy development in some but not all cases. Across countries, political support was identified as a key driver of local PA promotion.

Conclusion: LoGoPAS is the first study to apply the CAPLA-Santé outside of France and the first to use it for an international comparative analysis. Results highlight the ability of the tool to provide insights into local PA policy development, contents, and implementation worldwide. While this study provided a cross-sectional in-depth analysis of the status quo in select municipalities, future research could also aim to assess policies at a large scale, ie, for multiple municipalities and/or on a regular basis.