Public Health Research & Practice最新文献

Objectives: This paper contributes to the literature about community engagement processes that effectively support wellbeing approaches in government. Type of program or service: The Victorian Council of Social Service's Voices of Victoria Listening Tour ('the Tour') was a state-wide engagement with communities, and focused on people experiencing disadvantage. Delivered in partnership with Neighbourhood Houses Victoria and other community organisations, it sought to hear from lesser-heard voices about what people need for the foundational conditions of a good life.

Methods: The Tour involved facilitated face-to-face sessions in community centres and targeted online sessions with underrepresented cohorts. Essential Media omnibus polling was conducted to test key findings with a wider participant group.

Results: The Tour illuminated a variety of community needs and priorities, many of which overlap with the World Health Organization's social determinants of health. It revealed that people experiencing disadvantage often face problems that do not fall neatly into traditional government departments or portfolios. This shows the value of a whole-of-government wellbeing approach when addressing genuine community need. Structurally, the most productive elements of the community engagement process involved deliberate consideration of the specific conditions that put community members at their ease and empowered them to engage and participate.

Lessons learnt: People experiencing disadvantage are rarely directly heard by policy makers. Designing and refining wellbeing approaches in partnership with diverse communities requires methods of engagement that are themselves contributors to community wellbeing. People are overwhelmingly appreciative of being listened to about what matters to them and of being active participants in decision making.

Objective and importance of study: Risk-stratified approaches to cancer screening aim to provide tailored risk advice to individuals, rather than the mostly one-size-fits-all approach designed for the average person that is currently used in Australia. Stratified cancer screening has the potential to increase the benefits and reduce the harms of screening. Initial risk assessment is a crucial first step for screening programs that use risk stratification. We report findings from a qualitative study exploring the views of the Australian public on how to best deliver risk-stratified cancer screening in the population to help inform future implementation.

Study type: Qualitative interview study.

Methods: We conducted semistructured interviews with participants from a previous study, half of whom had received personal genomic risk information and half of whom had not. We asked how and where they would like to see risk-stratified screening delivered and how they felt about different health professionals assessing their cancer risk. Data were analysed thematically.

Results: Forty interviews were conducted. The age range of participants was 21-68 years; 58% were female. Themes included: 1) Convenience is a priority; 2) General practice is a good fit for some; 3) Web-based technology is part of the process; and 4) "I would want to know why [I was being stratified]". Similar views were expressed by both groups. Our findings suggest that although health professionals were identified as having an important role, there were mixed preferences for delivery by general practitioners, medical specialists or nurses. Participants were less concerned about who undertook the risk assessment than whether the health professional had the appropriate skill set and availability. Clear communication and evidence of the need for change in screening eligibility and frequency were key factors in the successful delivery of risk-stratified screening.

Conclusion: We identified that convenience and good communication, including clear explanations to the public with convincing evidence for change, will enable the successful delivery of risk-stratified cancer screening in the population, including organised and opportunistic screening approaches. Health professional education and upskilling across disciplines will be key facilitators. Engagement and further consultation with primary care and other key stakeholders will be central.

Knowledge mobilisation aims to increase research impact in policy and practice. 'Mobilising' knowledge implies a social interaction and involves an iterative, collaborative process. We argue that this process is strengthened when underpinned by systems thinking. Previous research has integrated systems thinking with knowledge mobilisation. We built on this to develop an applied tool to support prevention researchers seeking to incorporate systems thinking into their knowledge mobilisation work. We refer to this tool as the 'systems thinking guide for knowledge mobilisation'. Our guide was developed through a stepwise process that included: 1) An inductive thematic synthesis of previous research in this area; 2) Reflexive deliberation to identify critical focus areas, drawing on the synthesis and the authors' experiences of applying systems approaches to knowledge mobilisation; 3) Development of a set of questions designed for end users to consider against the backdrop of their own research and contexts; 4) Trialling these questions through a series of workshops; and 5) Revision based on user feedback. The proposed systems thinking guide includes 13 questions and 18 subquestions to help researchers frame their knowledge mobilisation strategies using a systems perspective. Our next steps are applying this guide to other research projects and reviewing and reporting on its implementation and real-world use. In the meantime, we invite other research teams to test this tool and contribute constructive feedback on its usefulness and potential further development.

The world is experiencing multiple intersecting urgent and existential crises, which have profound and inequitable implications for population health. Arguably, the design of the current, dominant economic system and its antecedents is the root cause of these crises, as it externalises impacts on nature, climate and population health, exacerbates inequalities, and rewards extraction, rent-seeking and social hierarchy. A 'wellbeing economy', which aims to achieve social justice within planetary boundaries, has been proposed as an alternative approach to economic design. Many governments, businesses and organisations have expressed interest or commitment to this, but not at the required scale or with the required urgency. Indeed, there is the risk now that the radicalism of a wellbeing economy approach is undermined in its delivery thus far as it has either only been adopted in rhetoric or nascent form; or implemented only as isolated components rather than as part of a comprehensive shift. We, therefore, propose a series of criteria by which judgement can be made on whether progress towards a wellbeing economy is occurring: 1) Is the economy explicitly viewed by relevant actors as serving social, health, cultural, equity and nature outcomes, rather than the reverse?; 2) Is there a comprehensive and plausible pathway to design the economy in a way that achieves these outcomes?; 3) Is there a clear commitment to transitioning away from socially and ecologically damaging economic activities and doing so in a just way?; 4) Are there clear mechanisms that extend democracy over all sectors of the economy, including economic strategy and policy design, and in ownership of economic assets?; 5) Are negative externalities between policy areas or populations assessed and avoided, and positive externalities identified and promoted?; and 6) Are all the measures of economic success focused on social, health, cultural, equity and nature outcomes? We then apply these criteria using a series of examples to show contrasts between genuine wellbeing approaches and wellbeing economy 'window dressing'.

There are hundreds of sovereign nations covering the modern nation-state of Australia.1 Noting the inadequacy of many contemporary terms to encompass Indigenous ontology, Indigenous nations have long practised what is now being expressed as 'wellbeing frameworks' in many nation-states. Unlike the sentiment expressed in contemporary wellbeing frameworks, Country - the complex web of relationships between the human and other-than-human that underpins everything2 - and relationality are fundamental to Indigenous 'wellbeing'. The philosophy of mabu liyan (good feeling), intrinsic to the Yawuru nation of North Western Australia, is only one example of Indigenous governance where Country-centred planning and relational wellbeing are 'business as usual'. Layering elements that are critical to Indigenous expressions of wellbeing, specifically Country and relationality, when developing wellbeing frameworks would broaden and deepen contemporary approaches to wellbeing while accommodating differences at the local scale.

Several global challenges have emerged and coalesced in recent times, including climate change and environmental crises; growing health and social inequalities; geopolitical conflicts; and increasing rates of both communicable and noncommunicable and mental health diseases. The urgency and need for change has never been greater. In response, governments are paying increasing attention to the notion of wellbeing as an integrating concept to drive action to address these challenges. They are beginning to take action by introducing wellbeing indexes; wellbeing budgets; joined-up 'triple bottom line' approaches to policy making, and the inclusion of civil society in the decision-making processes. To date, these steps have been sporadic and localised; yet if these multiple social, environmental and economic crises are to be averted, coherent and systematic actions at the global, national and local levels are needed. The World Health Organization (WHO) and its 194 Member States have come together to map a path forward through the Geneva Charter for Well-being and the Well-being Framework. These aim to set the foundation and direction for action. They map the pathway towards a 'wellbeing society', a concept WHO brought to attention in the Geneva Charter. The intention is to support and galvanise nations to build on their nascent efforts to adopt a welbeing agenda, and move beyond rhetoric to take concerted action. To achieve the promise of 'wellbeing societies' will require developing new governance models,bringing all sectors together to define the problems and solutions, adopting new economic levers, and reorienting financing systems to focus on what is truly important. In this paper we describe the background and context for these initiatives, the concept of wellbeing societies and how WHO is advancing this global agenda.