Areas Of Health Policy Research Articles

PLoS Medicine Issue Image | Vol. 8(1) January 2011

On 25 January 2011, World Health Organization (WHO) and PLoS Medicine announce a call for papers to inform the World Health Report 2012, which will be a groundbreaking report focusing for the first time on research for better health. Entitled "No Health Without Research," the report will be published by WHO in May 2012. In advance of this landmark publication, WHO and PLoS Medicine jointly invite submission of papers to PLoS Medicine related to strengthening national health research systems (see the Editorial [e1001008]). Research papers, case studies, and non-research papers will all be considered. A joint WHO/PLoS panel will select papers for inclusion in an ongoing special WHO/PLoS Collection leading up to the report's publication. The impetus behind the report is the need to emphasize the importance of research evidence in health care decision-making, and particularly so in the areas of health policy and health systems; the collection will showcase examples of the best research underpinning practice and policy worldwide. Image Credit: David Bleasdale , flickr.com

WHO/PLoS Collection “No Health Without Research”: A Call for Papers

It seems astonishing that in the 21st century decisions on health care can still be made without a solid grounding in research evidence. This is true even in clinical research, whether for simple or complex interventions [1], where systematic reviews time and time again conclude that the evidence base is inadequate [2]. It is even more true in the areas of health policy and health systems, where quality research is hampered further by a lack of shared definitions, a lack of consensus on guiding principles, poor capacity (especially in low-resource regions), and methodological challenges [3],[4]. The World Health Report (WHR) for 2012 will be on the theme of “No Health without Research”. This flagship report from WHO will, for the first time in its history, focus on research for better health. The primary target audience of the report will be ministers of health in the WHO member states, and the goal of the report is to provide new ideas, innovative thinking, and pragmatic advice for member states on how to strengthen their own health research systems. The report will have the three following aims. To show that research is important for meeting health needs and improving health outcomes; To encourage countries to therefore invest more resources in developing and strengthening their national health research systems; To argue that countries should not see research as an expense or as an afterthought, but as an investment for a better, healthier future. The WHR 2012 aims to provide impetus for a change to the problematic state of affairs of health research. Given the stated goals of the report, of particular importance is the documentation and sharing of real experiences from the countries where the research has been done. We therefore wish to invite the submission of articles, especially from low- and middle-income countries, on topics related to the strengthening of key functions and components of national health research systems [5]. We would then aim to publish a WHO/PLoS Collection culminating in 2012 to coincide with the release of the WHR. Thus, we welcome examples of research and/or case studies in the following areas. Experience with setting and implementing health research priorities; Experience with building, strengthening, and retaining research capacity, at both the individual and institutional levels; National research and development initiatives and experiences to produce needed medical products, including development of national pharmaceutical production capabilities, using TRIPS (trade-related aspects of intellectual property rights) flexibilities for essential medicines, technology transfer, etc.; Examples of appropriate use of evidence in health policy development; Models of how to organize research within a country, including the establishment of effective research networks and sustainable governance mechanisms; Standards and mechanisms to ensure the responsible conduct of research (e.g., ethics review, access to research results, codes of conduct, etc.); Exercises to evaluate the impact of research investments; Experiences with external foreign aid for research. Ideally, studies or reports should not be merely descriptions of activities but should include evaluation of the impact of initiatives after their implementation. Special consideration will also be given to systematic and well-performed multi-country comparative studies on the topics mentioned above, including systematic reviews, in selected topic areas. In addition to primary research (both quantitative and qualitative) and well-developed case studies, we also invite the submission of review and policy articles on how national health research systems contribute to the broader international research endeavor, especially in the context of the following areas. Global health research governance; Inequitable access to the benefits and products of research; Global standards for responsible research conduct; Future research trends with implications for the developing world. All papers should be submitted to PLoS Medicine, noting that they are intended for this collection. An initial decision will be made about their potential suitability for either PLoS Medicine or another PLoS journal. The authors will be informed of this decision and papers will be peer-reviewed according to the specific journal's policies. PLoS will retain all control over editorial decisions. Once a paper is accepted for publication in a PLoS journal it will then be forwarded to the selection panel for the collection. This panel, which will comprise PLoS and WHO staff, will decide on the articles for inclusion in the collection. Further information on this process is available at the collections page (http://www.ploscollections.org/whr2012). This is new initiative for PLoS and WHO. We look forward to collaborating on this initiative and hope it will encourage researchers to submit to PLoS the very best examples of research underpinning health care.

Biopolicy after three decades

Thirty years ago there were at most only a handful of political scientists who were interested in or publishing about policy issues in the life sciences, concentrated primarily in the health or environmental policy areas. As a result, political science was notably absent as a discipline either in the literature, at conferences, or as members of state or national commissions, advisory bodies, or institutional review boards involving the life sciences.

Biopolicy after three decades

Thirty years ago there were at most only a handful of political scientists who were interested in or publishing about policy issues in the life sciences, concentrated primarily in the health or environmental policy areas. As a result, political science was notably absent as a discipline either in the literature, at conferences, or as members of state or national commissions, advisory bodies, or institutional review boards involving the life sciences.

Comparare le politiche sanitarie: una valutazione delle tipologie di sistemi sanitari

Typologies have been central to the comparative turn in public policy and this paper contributes to the debate by assessing the capacity of typologies of health systems to capture the institutional context of health care and to contribute to explaining health policies across countries. Using a recent comparative study of health policy and focusing on the concept of the health care state the paper suggests three things. First, the concept of the health care state holds as a set of ideal types. Second, as such the concept of the health care state provides a useful springboard for analyzing health policy, but one which needs to be complemented by more specific institutional explanations. Third, the concept of the health care state is less applicable to increasingly important, non-medical areas of health policy. Instead, different aspects of institutional context come into play and they can be combined as part of a looser ‘‘organizing framework’’.

Comparing health policy: An assessment of typologies of health systems

Typologies have been central to the comparative turn in public policy and this paper contributes to the debate by assessing the capacity of typologies of health systems to capture the institutional context of health care and to contribute to explaining health policies across countries. Using a recent comparative study of health policy and focusing on the concept of the health care state the paper suggests three things. First, the concept of the health care state holds as a set of ideal types. Second, as such the concept of the health care state provides a useful springboard for analyzing health policy, but one which needs to be complemented by more specific institutional explanations. Third, the concept of the health care state is less applicable to increasingly important, non-medical areas of health policy. Instead, different aspects of institutional context come into play and they can be combined as part of a looser ‘‘organizing framework''.

An exploration of evidence-based policy in Ireland: health and social inclusion

Ireland is a small country with a history of a social partnership approach to policy making. This paper considers how the ambition of government to utilise an evidence-based approach to policy making plays out against this partnership agenda. Drawing on the authors’ experiences and personal reflections, the paper considers how these issues operate within a number of health and social inclusion policy areas, and it explores the role of stakeholders’ expectations and involvement in generating evidence for policy.

The interface between residential aged care and the emergency department: a systematic review

emergency care for older people living in residential aged care facilities (RACF) is a complex area of health policy. The epidemiology of patient transfer between RACF and hospital emergency departments (ED), clinical outcomes and costs associated with transfer and efficacy of programs aiming to reduce transfer are not well known. systematic review based on a comprehensive literature search in three electronic databases and published article reference lists. the incidence of transfer from RACF to ED is >30 transfers/100 RACF beds/year in most studies. The casemix from RACF is varied and reflects that of the broad elderly population, with some risk difference. At least 40% of transfers are not admitted to hospital. There is insufficient data to fully address our other questions; however, hospitalisations from RACF can be reduced through advanced care planning, use of management guidelines for acute illnesses and improved primary care. residents of RACF have a high annual risk of transfer to ED. The clinical benefit and cost effectiveness of ED care, and alternate programs to reduce ED transfer, cannot be confidently compared from published work. Further research is required to accurately describe these and to determine their comparative worth.

Devolution by Degrees

This regular legal column reflects on legal issues which are relevant to health and social care policy in general, and integrated care in particular. Policy developments do not take place in a vacuum and need to take account of the legal framework and the latest case law; equally, changes in policy drive changes in the legal framework, so the law never stands still. Recent articles in this journal have compared the English and Scottish experiences (Vol 16 issue 5; Vol 17 issue 1) and reflected on the experience in Northern Ireland (Vol 17 issue 5) but there has not been so much attention to the implications of devolution in Wales. This article offers a legal perspective on the changes that have taken place over the last ten years, and looks ahead to Wales making its own legislation in a wide area of health and social care policy.

Contingent valuation studies and health policy

I am glad to have the opportunity to respond to the fine paper by Professors Smith and Sach (2009). They raise both foundational questions concerning the justification of contingent valuation studies in the health policy area, and important implementation questions concerning the appropriate design of such studies. I will focus my attention on the question of justification. The debate about contingent valuation in health policy is part and parcel of the debate between those who favour cost–benefit analysis (CBA), and those who favour cost-effectiveness analysis (CEA) (Adler, 2006: 1–17). CBA values all well-being impacts, including health and longevity, in dollar terms, and aggregates. Technically, CBA evaluates policies by aggregating willingness-to-pay/willingnessto-accept amounts (WTPs). Standard techniques for estimating WTPs are twofold: revealed preference techniques, which estimate them based on market behaviour (such techniques have been widely used to estimate WTPs for fatality risk reduction, known as the ‘value of statistical life’); and survey techniques. ‘Contingent valuation’ is just the technical term for such survey techniques. CEA, like CBA, values non-health impacts (‘costs’) in dollar terms; but it values health impacts on some non-monetary ‘effectiveness’ scale. It then examines the incremental cost-effectiveness ratios of policies in order to determine which policies to adopt. Techniques for estimating WTPs for health impacts – in particular, contingent valuation studies of health effects – therefore have no direct role in CEA. So one can take a first crack at the question of justification for health care contingent valuation studies by asking, should CBA or CEA be used to evaluate health policies? Now, this question is often seen in the health policy literature as just a choice between ‘welfarism’ and ‘extrawelfarism’. Welfarism favours CBA, extrawelfarism favours CEA – or so it is often assumed. I think the assumption is doubly mistaken. First – although I cannot pursue the point at length here – I think that CEA should be seen by extrawelfarists as little better than CBA. To adequately develop the point, we would need to get clear about the content of extrawelfarism – a large task (Brouwer et al., 2008).

Quantifying the impact of community quarantine on SARS transmission in Ontario: estimation of secondary case count difference and number needed to quarantine

BackgroundCommunity quarantine is controversial, and the decision to use and prepare for it should be informed by specific quantitative evidence of benefit. Case-study reports on 2002-2004 SARS outbreaks have discussed the role of quarantine in the community in transmission. However, this literature has not yielded quantitative estimates of the reduction in secondary cases attributable to quarantine as would be seen in other areas of health policy and cost-effectiveness analysis.MethodsUsing data from the 2003 Ontario, Canada, SARS outbreak, two novel expressions for the impact of quarantine are presented. Secondary Case Count Difference (SCCD) reflects reduction in the average number of transmissions arising from a SARS case in quarantine, relative to not in quarantine, at onset of symptoms. SCCD was estimated using Poisson and negative binomial regression models (with identity link function) comparing the number of secondary cases to each index case for quarantine relative to non-quarantined index cases. The inverse of this statistic is proposed as the number needed to quarantine (NNQ) to prevent one additional secondary transmission.ResultsOur estimated SCCD was 0.133 fewer secondary cases per quarantined versus non-quarantined index case; and a NNQ of 7.5 exposed individuals to be placed in community quarantine to prevent one additional case of transmission in the community. This analysis suggests quarantine can be an effective preventive measure, although these estimates lack statistical precision.ConclusionsRelative to other health policy areas, literature on quarantine tends to lack in quantitative expressions of effectiveness, or agreement on how best to report differences in outcomes attributable to control measure. We hope to further this discussion through presentation of means to calculate and express the impact of population control measures. The study of quarantine effectiveness presents several methodological and statistical challenges. Further research and discussion are needed to understand the costs and benefits of enacting quarantine, and this includes a discussion of how quantitative benefit should be communicated to decision-makers and the public, and evaluated.

Public Health Advocacy in the Courts: Opportunities for Public Health Professionals

This installment of Law and the Public’s Health considers the role of the judiciary in advancing public health goals. Typically, public health policy advocacy efforts aim to affect the regulation and legislation produced by the executive and legislative branches of federal, state, and local government bodies. But one branch of government—the judiciary—is less frequently considered as a venue, which is a missed opportunity for public health. The goal of this article is to demonstrate the need and identify the strategies for what we call “public health advocacy in the courts,” defined as actions by public health professionals that inform and affect how courts approach matters that affect the public’s health. We first review the court’s traditional roles in defining and deciding public health-related matters and consider judicial actions in the areas of constitutional and administrative law, civil litigation, and criminal law. Within criminal law, we highlight the recent expansion of problem-solving courts as a new opportunity for public health professionals to engage with the criminal justice community in advancing prevention strategies to address public health issues such as substance abuse and intimate partner violence (IPV). We then discuss specific strategies by which public health professionals can engage as advocates in the criminal and civil judicial processes. We conclude by presenting public health advocacy in the courts as a natural extension of existing public health advocacy, and offer strategies for overcoming the obstacles that public health professionals may encounter when they engage in these efforts. The courts, both state and federal, have a profound influence on public health policy and practice. This installment of Law and the Public’s Health examines the nature and power of the judiciary in the area of public health law and policy, discussing some of the landmark cases that together both define and test the limits of governmental powers and the rights of individuals and private interests.

Adapting to European Integration? Kaliningrad, Russia and the European Union – Edited by S. Gänzle, G. Müntel and E. Vinokurov

Adapting to European Integration? Kaliningrad, Russia and the European Union , edited by S. Gänzle, G. Müntel and E. Vinokurov ( Manchester : Manchester University Press , 2008 , ISBN 9780719079016 ); xviii + 276pp. , £60.00 hb . The Kaliningrad region is an unknown place for the majority of EU citizens, though this Russian exclave is located almost in the geographical heart of the EU. Even if Kaliningrad is an unknown region, it can hardly be called ‘a double peripher’, since this region has received more attention from the Kremlin and the European Commission than any other Russian region since the disintegration of the USSR, excluding Chechnya. Despite the fact that the administrations both in Russia and the EU are fully aware of the recent developments and the challenges faced by the Kaliningrad region, the wider public might have difficulty in placing the Kaliningrad region in the correct place in a map of Europe. This multi-perspective book on Kaliningrad helps in this task and several others. The book is a result of many years' collaboration between the academics in the Kaliningrad region and leading western researchers. Altogether more than 20 experts have dealt with strategic issues essential for the future development of the Kaliningrad region, including security, the environment, public health policy, education, border management, economy and many other essential themes. Logistics and energy supply-related issues should have received more attention in the book due to the special geographical location of the Kaliningrad region. The following quotation answers the main questions of the book: ‘Despite intensive co-operation, Kaliningrad's Europeanization proceeds only within very narrow margins – the impact of “Europe” on the governance of this Russian enclave inside Europe is surprisingly modest. Clearly, this overall conclusion has to be examined very carefully, taking into account the results of the policy areas studied in this book: some modest EU impact on Kaliningrad was observed in the fields of economic and education policy. In turn, in the fields of environmental policy, social policy, and border management, only a low degree of change and adaptation took place; and there was none to be observed in the area of public health policy’ (p. 250). If the aforementioned conclusion is correct, one faces a very pragmatic question: what should be done differently both in Russia and in the EU in order to prevent the Kaliningrad region becoming an isolated problem zone ‘within the EU’? Can the Kaliningrad region truly become ‘a pilot zone’, aiding currently weak relations between Russia and the EU, or will the region merely act as a thermometer of EU–Russia relations? Although edited publications seldom form a united entity, this book is a rare exception, and hence it would be a perfect resource for students and researchers specializing in regional co-operation in the Baltic Sea region and EU–Russia relations in general.

From the Editor

This issue presents Professor Ross Garnaut’s acceptance speech for his Economic Society of Australia’s Distinguished Fellow award for 2009. Congratulations from Economic Papers to Professor Garnaut for his well-deserved award. It then features a number of articles on a single theme, specifically, the ‘Global Financial Crisis and its Aftermath’. There are a wide range of views here – from those of central bankers and industry practitioners to economists concerned with the implications of the crisis for the development of the discipline of economics. Economic Papers is very interested in publishing issues on a single theme – whether they be in microeconomics, macroeconomics or on economic aspects of the environment, agriculture, health and other public policy areas. If you are organising workshops or symposia in applied economic areas or in areas of theory that are not highly technical and wish to have articles published in a single issue of Economic Papers, please present a proposal to the Editor. May I remind readers too that Economic Papers is very interested in publishing shorter notes on specific issues and letters or shorter articles which comment on published articles.

Using a biopsychosocial approach to address health disparities—One person’s vision

This paper will present one person’s vision of how best to address health disparities. A vision that transported Dr. Lovell A. Jones from the safe confines of a research laboratory in the Department of Obstetrics, Gynecology & Reproductive Sciences at the University of California San Francisco Medical School in 1980, to the area of health policy and community-based participatory research, and ultimately into health disparities research. These efforts began with the Biennial Symposium on Minorities & Cancer in 1987, followed by the Intercultural Cancer Council (ICC) in 1995, and ultimately the establishment of the Center for Research on Minority Health (CRMH) in 1999. The goal of this paper is to share those experiences in addressing health disparities in America. This paper will also touch on the problems of immigrants in the United States, their needs as human beings, the issue of access to education, job market, family, health care–related issues, as well as, other multicultural issues and how these problems should be addressed. We have not only taken a government and health systems approach, but focused on individual and community challenges and how creating approaches that address these challenges can facilitate societal adaptation and forward development. All of these became a part of the fabric that created the Biennial Symposium Series, the Intercultural Cancer Council and the Center for Research on Minority Health. The authorship of this paper is shared with some of those this journey has impacted. There are important lessons learned from my experiences in creating the Biennial Symposium Series, the ICC and the first center mandated by the US Congress outside of Washington, DC. These lessons focus primarily on minority health and health disparities. The identified initiatives are independent, yet must be integrated to effectively address health disparities through political, national, community, and educational/research advocacy. It is our hope that you will understand why Dr. Jones has come to the conclusion that the scientific approaches used in the 20th century will not work in the 21st century.

Gender Gaps in Policy Making: Evidence from Direct Democracy in Switzerland

This paper exploits a natural experiment to investigate the consequences of women making politics at large scale. Our analysis focuses on Switzerland, the world leader in direct democracy, where all citizens can directly decide on a broad range of policies in referendums and initiatives. Exploiting surveys on individual voting behavior for all federal votes held between 1983 and 2003, we show that there are large gender gaps in the areas of health, environmental protection, defense spending and welfare policy which typically persist even conditional on socio-economic characteristics. We also find that female policy makers have a substantial effect on the composition of public spending, but a small effect on the overall size of government.

Gender Gaps in Policy Making: Evidence from Direct Democracy in Switzerland

In spite of increasing representation of women in politics, little is known about their impact on policies. Comparing outcomes of parliaments with different shares of female members does not identify their causal impact because of possible differences in the underlying electorate. This paper uses a unique data set on voting decisions to sheds new light on gender gaps in policy making. Our analysis focuses on Switzerland, where all citizens can directly decide on a broad range of policies in referendums and initiatives. We show that there are large gender gaps in the areas of health, environmental protection, defense spending and welfare policy which typically persist even conditional on socio-economic characteristics. We also find that female policy makers have a substantial effect on the composition of public spending, but a small effect on the overall size of government.

Social Inequalities, Public Policy, and Health

Social inequalities are a key issue for modern welfare states in the post-industrial globalized economy. The extent of social inequalities within nations is directly related to the size and nature of the welfare state. The welfare state was the mechanism by which governments in developed economies intervened in health and social public policy areas to ensure access to health care and social services. Public policy has a significant impact on social and health inequalities. The specific public policies that influence these are government provision of income and housing security, program support for individuals and families, and poverty reduction. Much of this involves governmental transfers of national wealth among the citizenry. This paper presents and discusses some of the key differences among advanced nations in terms of governmental transfers in broad policy areas as well as the specific areas of health care, old age, incapacity, and families. These issues tie into the political ideology of governments, the nature of the political and electoral systems of countries, and how public policies can reduce inequalities between different groups.

Slipping through the Net: Social Vulnerability in Pandemic Planning

Slipping through the Net:Social Vulnerability in Pandemic Planning Anna C. Mastroianni (bio) In the spring of 2009, a number of U.S. schools closed in response to government health directives designed to prevent the transmission of the contagious respiratory influenza virus known as H1N1. Thousands of children were asked to stay home and avoid congregating in groups. Public health authorities asked ill workers to stay home. As spring stretched into summer, camps sent symptomatic children home. The traditional public health containment strategy known as "social distancing" has rippled throughout affected communities. Parents have been forced to risk their jobs, take unpaid leave, or use limited sick leave to care for housebound children. Children who typically rely on school or camp meal programs have gone without. Local businesses have suffered when workers and shoppers stayed home. These experiences are now being repeated in the southern hemisphere as H1N1 moves south, but with the added burdens and complications that come with the more limited infrastructures and fewer resources of the developing world. The public health efforts to stem a flu outbreak have potentially serious social ramifications. More importantly—and seemingly overlooked in pandemic planning for a virus such as H1N1—social context has major implications for the potential effectiveness of public health strategies to minimize morbidity and mortality and prevent the further spread of disease. For example, an undocumented restaurant worker receiving low wages and lacking job security and health benefits may have no real choice but to continue working through an illness, and may avoid seeking medical attention that he cannot afford and fears might lead to deportation. The worker's life situation makes it both impractical and inadvisable to respond to well-intentioned but unrealistic public health directives, putting both restaurant workers and diners at risk of infection. Policies that fail to take into account the realities of individuals' lives and the social contexts in which they live cannot hope to succeed. The accomplishment of the public health goal of minimizing the effects of outbreaks may depend in significant part on social vulnerabilities that affect an individual's or community's capacity to respond to public health directives. Vulnerabilities and Social Contexts Little attention has been given to the impact of social vulnerabilities on the effectiveness of public health preparedness strategies, a shortcoming in both policy-making and in how we think about the ethics of public health. How should we incorporate thinking about social vulnerability into pandemic planning? How should we account for social capacity to respond to directives designed to prevent the spread of disease? Whose responsibility is it to address those social barriers? Failure to account for social vulnerability may doom a prevention effort and may lead to long-lasting distrust of the public health system and of government generally in the affected population. As in other areas of health policy, pandemic flu planning may acknowledge vulnerability, but by using a categorical approach based on membership in an identifiable population subgroup. For instance, policy guidelines and scholarly work have referenced readily identifiable subgroups as more vulnerable in determining priorities for distribution of scarce vaccines and antivirals. In shortages of seasonal flu vaccine, those over sixty-five years of age typically receive priority in vaccine distribution because of their vulnerability to severe medical consequences. More recently, antivirals were recommended for treatment of H1N1-infected pregnant women as a priority group. While this categorical approach may be well meaning, the broad grouping of populations may mask social vulnerabilities that require special attention, such as improved access to health care and appropriately targeted directives. Broadly defined categories of vulnerability tend both to exclude people who belong in them and include people who do not. Groupings are necessary, though, as public health policy-making must focus on the population level; it cannot operate efficiently or effectively if it focuses on every individual at risk. The difficulty is that policies risk failure if they cannot identify and address those at risk of contracting or spreading disease. In any community, there are individuals who cannot afford to practice social distancing—undocumented workers, for instance, and those who rely on community settings for their livelihood or for their day-to-day existence (as...

Between Public Opinion and Public Policy: Human Embryonic Stem-Cell Research and Path-Dependency

In bioethics as in other areas of health policy, historical institutional factors can shape policy independently of interests or public opinion. This article finds policy divergence among countries with similar national moral views of stem cell research, and explains that divergence as the product of path-dependency.