Public Health Policy Analysis Research Articles

Global public health policy analysis: During the COVID-19 pandemic

The emergence of Covid 19 at the start of 2020 set the alarm for a new pandemic around the world following the turning century. Global efforts to fight against infectious diseases focus on protecting citizens from the virus, preventing the spread of the virus within and through a country, and promoting the idea of the dangers of the virus and ways of self-preservation. On a neurophysiological scale, ideal and effective strategies such as initiating quarantine around the world, in which a limit to the outside world is set, gradually stagnate the spread of the virus and maintain the optimum environment for the sick to recover. The mandatory policy and consensus around the world of wearing a mask and maintaining a six-foot distance substantially curbed the spread of the virus in public. On a microbiological scale, the technological advancement the world experienced in recent years resulted in the rapid development of public preventative treatment, such as vaccines, marking the turning point regarding the gradual decrease in the spread and, subsequently, the rate of death throughout the world. The methods of preventing the spread of disease, as well as protecting the citizens from further damage, have led to an exponential decay of cases regarding the coronavirus.

A Study on the Institutional Context and Dynamics Surrounding the Emergence of SARS-CoV-2

This dissertation presents an in-depth analysis of the institutional context and dynamics surrounding the emergence of SARSCoV-2, the virus responsible for the COVID-19 pandemic. Focusing on the case of Brazil, the study employs a multi-disciplinary approach that integrates mathematical economics, epidemiology, and public health policy analysis. Key aspects include examining the initial outbreak in Wuhan, the virus's rapid global spread, and the specific impacts and responses in Brazil. The research employs mathematical models to understand the dynamics of virus transmission, the effectiveness of various public health interventions, and the socio-economic consequences of the pandemic. Special attention is given to Brazil's vaccination campaigns and their role in pandemic control. The findings offer valuable insights into the complexities of managing a public health crisis in a socio-economically diverse country like Brazil and underscore the importance of timely and coordinated responses to global health emergencies.

Health Policy Analysis Requires Attending to Institutions Comment on "Modelling the Health Policy Process: One Size Fits All or Horses for Courses?"

Powell and Manion present an important review of reviews about health and policy research. They zero in on theories of the policy process as the most likely to unearth what is really going on in health policy. Here I contend that their analysis insufficiently attends to institutions. Powell and Manion situate 'institutions' (with 'Ideas' and 'Interests') as a 'health policy process models' that 'tend to' list factors rather than connect them. Rather, I show how there is a rich history of considering institutions in the political science literature that is under considered by Powell and Manion. By necessity for a Public Health audience I quickly pull back the covers on 'rigour' and 'causation' to demonstrate what is 'fit for purpose' in rigorous institution focussed policy analysis. I conclude by arguing how institutionally focussed public health policy analysis is vital for understanding and addressing heath inequities. That focus necessitates research that provides better, explicit, conceptualisations of power in health policy: especially drawing out the roles played by structure and agency. I offer some recent examples.

Expanding Public Health Policy Analysis for Transformative Change: The Importance of Power and Ideas Comment on "What Generates Attention to Health in Trade Policy-Making? Lessons From Success in Tobacco Control and Access to Medicines: A Qualitative Study of Australia and the (Comprehensive and Progressive) Trans-Pacific Partnership".

It is increasingly recognised within public health scholarship that policy change depends on the nature of the power relations surrounding and embedded within decision-making spaces. It is only through sustained shifts in power in all its forms (visible, hidden and invisible) that previously excluded perspectives have influence in policy decisions. Further, consideration of the underlying neoliberal paradigm is essential for understanding how existing power dynamics and relations have emerged and are sustained. In their analysis of political and governance factors, Townsend et al have provided critical insight into future potential strategies for increasing attention to health concerns in trade policy. In this commentary we explore how incorporating theories of power more rigorously into similar political analyses, as well as more explicit critical consideration of the neoliberal political paradigm, can assist in analysing if and how strategies can effectively challenge existing power relations in ways that are necessary for transformative policy change.

Between health needs and agenda-setting: a procedural analysis of the compositional layers of space

Abstract Background This study aims to offer a view of the current situation arising in the Brazilian Health System (SUS) regarding the relationship between the health needs of its users and the health policies developed by the system. Methods The qualitative analysis was organised in two stages: 1) Comparative analysis of the social representations of health needs in which the data were analysed by the Health Needs Taxonomy (Matsumoto, 1999), as an instrument to assess health needs, format the interview guide and organise the empirical data; the Theory of Social Representations (Jovchelovitch, 2000) to capture health needs, and Content Analysis (Bardin, 2004), as an instrument of analysis and comparison of perceived needs. 2) Analysis of the agenda-setting in which the data were obtained and analysed by the Grounded Theory (Strauss; Corbin, 1990), Narrative Analysis (Taylor, 1979), and the Procedural Analysis Model (Ferreira; Alencar; Pereira, 2011) for contextual analysis of public health policies. The fieldwork was a Brazilian municipality and 39 representatives of civil society organisations and stakeholders were interviewed. Results The data showed a complex social fabric made of a plot that alternates between conceptual knots and structural voids which has been sewn by many actors and has served multiple purposes. It also showed that an insufficient institutional capacity for assessing needs, professional turnover, managers' personal decision and the manipulation of actors and institutions according to the interests at stake have kept the health needs unmet. Conclusions A positive representation of SUS will only be achieved through both the intertwining between biomedical knowledge to the determinants of health and the strengthening of a democratic culture. Without this perspective, the health system will remain fragile, plentiful in structural knots and voids, and unable to relocate people's health needs from the fringes to the main layers of this social fabric. Key messages An insufficient institutional capacity for assessing needs, managers' personal decision and the manipulation of institutions according to the interests at stake have kept the health needs unmet. A positive representation of SUS will only be achieved through both the intertwining between biomedical knowledge to the determinants of health and the strengthening of a democratic culture.

Employability and career experiences of international graduates of MSc Public Health: amixed methods study.

This article aims to describe the public health career experiences of international graduates of a Master of Science in Public Health (MSc PH) programme and to contribute to developing the evidence base on international public health workforce capacity development. A sequential mixed methods study was conducted between January 2017 and April 2017. Ninety-seven international graduates of one UK university's MSc PH programme were invited to take part in an online survey followed by semistructured interviews, for respondents who consented to be interviewed. We computed the descriptive statistics of the quantitative data obtained, and qualitative data were thematically analysed. The response rate was 48.5%. Most respondents (63%) were employed by various agencies within 1 year after graduation. Others (15%) were at different stages of doctor of philosophy studies. Respondents reported enhanced roles after graduation in areas such as public health policy analysis (74%); planning, implementation and evaluation of public health interventions (74%); leadership roles (72%); and research (70%). The common perceived skills that were relevant to the respondents' present jobs were critical analysis (87%), multidisciplinary thinking (86%), demonstrating public health leadership skills (84%) and research (77%). Almost all respondents (90%) were confident in conducting research. Respondents recommended the provision of longer public health placement opportunities, elective courses on project management and advanced statistics, and 'internationalisation' of the programme's curriculum. The study has revealed the relevance of higher education in public health in developing the career prospects and skills of graduates. International graduates of this MSc PH programme were satisfied with the relevance and impact of the skills they acquired during their studies. The outcomes of this study can be used for curriculum reformation. Employers' perspectives of the capabilities of these graduates, however, need further consideration.

“Competency for public health policy analysis”: a case study of Pakistan

“Competency for public health policy analysis”: a case study of Pakistan

Methodological guidelines to evaluate public health policies, and assessment of food and nutritional security policies

To evaluate the Food and Nutrition Security Policy of Colombia (PSAN by its acronym in Spanish). A qualitative formative evaluation was applied, based on an academic focus, to validate the methodology established by the "Methodological guidelines for the assessment and analysis of public health policies." This evaluation inquired about the following aspects: Does the design of the Food and Nutrition Security Policy comply with the coherence between the problem, the proposed solutions and the proposed measures? What is the progress in objective compliance during the implementation? The Nutritional Food Security Policy (PSNP in Spanish) is pertinent and consistent with the diagnosis. Its objectives and strategies correlate, and aim to solve the problem of food and nutrition insecurity of the entire population of the country, especially, the poorest and more vulnerable. This policy is relevant because the activities programmed in the action plan of the National Plan for Food and Nutrition Security 2012-2019 are aligned with the needs and priorities of the territory, and with the institutional offer of the entities that participate in the development of the policy. Redesigning PSAN according to the current dynamics of the country in terms of international commitments, the objectives of sustainable development, the right to food, sovereignty and governance in food and nutrition security, and the approach of social determinants in health.

Observatorio de políticas públicas en salud universidad de chile: experiencia local de control social en políticas públicas

Los Observatorios de Políticas Públicas en Salud son organismos dedicados al monitoreo, seguimiento y evaluación de sistemas y políticas públicas, a través de revisión analítica de proyectos y/o estrategias establecidas a nivel nacional. En la Universidad de Chile, el Observatorio de Políticas Públicas en Salud (OPPS) se conforma el año 2011 al alero de las movilizaciones estudiantiles de la Facultad de Medicina, donde se concluye que las universidades públicas deben aportar al control social en las políticas públicas de salud, a través de la deliberación y empoderamiento ciudadano. Con este horizonte, se conforma la organización y se establecen sus objetivos y orgánica. El trabajo desarrollado hasta la fecha abarca cuatro ejes: 1) Revisión y análisis bibliográfico de políticas públicas de salud, 2) Formación en políticas y sistemas de salud, 3) Promoción del debate en torno a políticas públicas y 4) Articulación con actores del sector salud. Dada su composición estudiantil, sus principales limitantes corresponden a la ausencia de formación crítica efectiva en los currículos de las carreras de la salud, y la sobrecarga académica de los estudiantes, que en el contexto de su carácter de actividad extracurricular, dificulta el cumplimiento de los objetivos. La réplica y fortalecimiento de estas instancias requieren la participación de todos los actores de la comunidad universitaria, haciendo converger sus conocimientos, experiencias y perspectivas en torno a los temas estudiados. Además, su inclusión en la estructura institucional formalizaría el compromiso universitario con la formación estudiantil crítica, contribuyendo al debate nacional en políticas públicas.

Economics and obesity policy.

This paper elucidates the challenges surrounding the economics of some popular obesity-related policy proposals. Solid economic justifications for anti-obesity policies are often lacking, and evidence suggests policies like fat and soda taxes or restrictions on food stamp spending are unlikely to substantively affect obesity prevalence. In short, many of the same factors that make obesity such a complicated and multifaceted issue extend to the economic analysis of public health policies.

Use of Comparative Case Study Methodology for US Public Health Policy Analysis: A Review.

There is growing recognition that policies influence population health, highlighting the need for evidence to inform future policy development and reform. This review describes how comparative case study methodology has been applied to public health policy research and discusses the methodology's potential to contribute to this evidence. English-language, peer-reviewed articles published between 1995 and 2012 were sought from 4 databases. Articles were included if they described comparative case studies addressing US public health policy. Two researchers independently assessed the 20 articles meeting review criteria. Case-related characteristics and research design tactics utilized to minimize threats to reliability and validity, such as the use of multiple sources of evidence and a case study protocol, were extracted from each article. Although comparative case study methodology has been used to analyze a range of public health policies at all stages and levels, articles reported an average use of only 3.65 (out of 10) research design tactics. By expanding the use of accepted research design tactics, public health policy researchers can contribute to expanding the evidence needed to advance health-promoting policies.

Building the nation's body: The contested role of abortion and family planning in post-war South Sudan

This paper offers an ethnographic analysis of public health policies and interventions targeting unwanted pregnancy (family planning and abortion) in contemporary South Sudan as part of wider ‘nation-building’ after war, understood as a process of collective identity formation which projects a meaningful future by redefining existing institutions and customs as national characteristics. The paper shows how the expansion of post-conflict family planning and abortion policy and services are particularly poignant sites for the enactment of reproductive identity negotiation, policing and conflict. In addition to customary norms, these processes are shaped by two powerful institutions - ethnic movements and global humanitarian actors - who tend to take opposing stances on reproductive health. Drawing on document review, observations of the media and policy environment and interviews conducted with 54 key informants between 2013 and 2015, the paper shows that during the civil war, the Sudan People's Liberation Army and Movement mobilised customary pro-natalist ideals for military gain by entreating women to amplify reproduction to replace those lost to war and rejecting family planning and abortion. International donors and the Ministry of Health have re-conceptualised such services as among other modern developments denied by war. The tensions between these competing discourses have given rise to a range of societal responses, including disagreements that erupt in legal battles, heated debate and even violence towards women and health workers. In United Nations camps established recently as parts of South Sudan have returned to war, social groups exert a form of reproductive surveillance, policing reproductive health practices and contributing to intra-communal violence when clandestine use of contraception or abortion is discovered. In a context where modern contraceptives and abortion services are largely unfamiliar, conflict around South Sudan's nation-building project is partially manifest through tensions and violence in the domain of reproduction.

Biomedical health care in Angola and in the Companhia de Diamantes de Angola, circa 1910-1970

The scope of this paper is to analyze the provision of biomedical care in Angola during the activities of the Companhia de Diamantes de Angola. A comparative analysis of public health policies and practices of various colonial actors, such as the health services of the Company, its state counterpart and other colonial companies, will reveal differences in investment in health, namely in health facilities, personnel and treatment. This survey as well as the living conditions highlight the idiosyncratic and central nature of the health services of the Company in terms of morbidity and mortality in Angola, and the importance of these representations for a caregiving empire.

O modelo dos múltiplos fluxos de Kingdon na análise de políticas de saúde: aplicabilidades, contribuições e limites

O presente trabalho teve como objetivos identificar as produções científicas sobre análise de políticas de saúde que utilizaram o modelo dos múltiplos fluxos de Kingdon e examinar as contribuições e os limites do modelo no estudo das políticas públicas de saúde, no contexto do SUS. Realizou-se uma revisão integrativa de publicações disponíveis nas bases de dados ProQuest, Portal de Periódicos e Banco de Teses e Dissertações da Capes e Scientific Electronic Library Online, com uso das palavras-chave Kingdon Model, multiple streams model (modelo dos múltiplos fluxos) e políticas públicas de saúde. Os critérios de inclusão foram: estudos completos em português e inglês, disponíveis on-line nas bases de dados; e análises de políticas públicas de saúde com uso do modelo Kingdon em experiências nacionais ou internacionais. Foram excluídos estudos de revisão e relatos de experiência. Foram levantados 4 teses de doutorado, 6 artigos e 2 dissertações de mestrado, publicados entre 1994 a 2009. O modelo de Kingdon mostrou-se aplicável a análises de políticas de saúde em diferentes sistemas políticos nacional e internacional, em períodos prolongados de tempo e na atuação dos governos. As contribuições desse modelo de análise para o SUS incluem: a) a incorporação da ambiguidade nas decisões; b) a valorização da consistência das ideias contidas nas propostas; c) a análise das diferentes interpretações sobre os problemas complexos da saúde brasileira pelos tomadores de decisão. Dentre os limites, aponte-se a ênfase na atuação dos atores em detrimento do marco institucional que delimita suas decisões.

Paradigmas en el análisis de políticas públicas de salud: limitaciones y desafíos

Research on health policies is considered essential to ensure the effectiveness and efficiency of public policies. Analyses of public health policies have various objectives, including helping to solve the problems for which the policy was originated. That objective faces two large obstacles: (1) the ambiguity and heterogeneity of the models applied for the analysis of public policies, conditions that hinder the selection of analytical methods and the assessment of the scope of the objective; and (2) the traditional methodological approaches that limit the capacity of analyses to help solve the problems detected. This paper reviews the epistemology of the predominant models of public health policy analysis in order to assess their scope and limitations. It concludes that the development of new conceptual approaches could improve the quality of research on public policies and their ability to favorably impact decisions.

Heroin Treatment May Help Difficult-to-Treat Opioid Addicts

Heroin Treatment May Help Difficult-to-Treat Opioid Addicts

Non‐parametric bounds on treatment effects with non‐compliance by covariate adjustment

Consider a clinical trial where subjects are randomized to two treatment arms but compliance to the assignment is not perfect. Concerning this problem, this paper derives non-parametric bounds on treatment effects by making use of the observed covariates information. The new bounds are narrower and more informative than the existing ones. In addition, a new non-parametric point estimation approach is proposed based on stratified analysis. Furthermore, to examine the accuracy of estimating the proposed bounds, we provide variance estimators for the proposed approach. The results of this paper can yield credible information on treatment effects, which will be useful for medical research and public health policy analysis.

UT1 Trade-Off Preferences for Pharmaceutical Development, Marketing, And Outcomes Evaluation

In this workshop the presenters discuss limitations of standard QALY estimates for evaluating health-care treatments and outcomes. As a solution, they demonstrate developing, administering, analyzing, and applying a recent stated-preference (SP) or conjoint-analysis health survey. The authors are among a small group of heath economists who recently have begun to employ this approach to elicit preferences for risk-benefit trade-offs, public-health benefits of reduced pollution exposures, benefits of increased longevity, and quality-of-life differentials among various cardio-pulmonary symptoms. SP encompasses a variety of multiattribute preference-elicitation survey techniques widely used by market researchers to evaluate potential new products and new markets for existing products. The SP technique is based on the principle that products are composed of various attributes or features. SP allows respondents to systematically rate, rank, or choose trade-offs among attributes usig a fractional-factorial experimental design. The attributes of these health outcomes may include symptoms, daily activities, number of episodes, and costs or adverse side effects associated with treatment alternatives. Respondents' trade-offs among outcomes, treatments, or other health-care options indicate the relative importance of various attributes. The workshop will help participants to identify salient attributes for pharmacoeconomic decisions and to construct appropriate experimental designs. Administration of a computerized survey also will be demonstrated. The presenters will show how responses elicited from this survey are employed to develop a measure of health-state preference. Such survey results are useful for a wide variety of pharmaceutical and health-outcome applications, including pharmaceutical development strategies, formulary decisions, managed-care insurance coverage, new drug market share forecasting, patient-satisfaction assessment, information dissemination and labeling evaluation, public health policy analysis, and cost-effectiveness comparisons across diverse outcomes.

CORONARY HEART DISEASE: INTERPLAY BETWEEN CHANGING CONCEPTS OF AETIOLOGY, RISK DISTRIBUTION, AND SOCIAL STRATEGIES FOR PREVENTION

Epidemic diseases move in grand cycles, accompanying changes in culture, social organization, and environment. Coronary heart disease (CHD), a mass disease of twentieth century industrialized society, has a predominantly environmental aetiology. Although the major biomedical risk factors appear to have been identified over the past 40 years of epidemiological research, we are not certain why CHD is now on the wane in most Western nations. In Australia, CHD death rates have, since 1968, declined much more in professional and white‐collar men than in blue‐collar men.Any substantial reduction in CHD rates will require a generalized population shift towards a lower CHD risk profile. Numerically, the greatest gains should come from reducing the CHD risk of the bulk of the population, who are currently at medium risk of CHD. Notions of risk need, in the first instance, to be based on up‐to‐date knowledge of biomedical risk factors and mechanisms in order to develop optimal intervention strategies.A population‐based strategy can be achieved via community education and structural modification of the social environment. The latter approach will require public health research into broader questions of the social‐environmental influences on population cardiovascular health: for example, research into the social, political, and economic determinants of national food and nutrition policies; and into the various environmental (including workplace) changes that will facilitate risk‐lowering behaviour. Hopefully, intervention strategies in such areas, set within a community development context, will be developed within the incipient National Program for Better Health. Public health research should be extended and adapted to enable evaluation of these various social interventions, and to contribute to public health policy analysis.