Health Policy Arena Research Articles

Why is Lived Experience Absent from Social Security Policymaking?

Abstract Processes of public engagement in decision-making and research are increasingly discussed as ways of addressing democratic deficits in high-income countries. In this paper, we explore why these processes of engagement and involvement in the UK have been less successfully incorporated into social security policymaking aimed at the out-of-work by drawing a comparison with health policy, a sphere in which these processes have now become orthodox (albeit imperfect). There is, for example, no formal or institutionalised imperative to involve people with lived experience of out-of-work social security benefits in processes of policy development. Government departments might focus group new policies with members of the public or hold periodic discussions with beneficiaries but in recent years there have been a number of major reforms to out-of-work social security which have been developed almost entirely without involving those affected. This would have been unacceptable in the health policy arena. We argue that this difference is rooted in structural differences in how the field of power for this form of social policy is organised, in the different social imaginaries which construct patients and out-of-work beneficiaries, and in the limited scope for solidarity and collective action around resisting the stigmatisation of out-of-work beneficiaries.

Sleep and Cardiovascular Disease.

Sleep is essential for optimal health,1 yet more than one-third of US adults report insufficient sleep2 and 50 to 70 million people in the United States experience 1 or several sleep disorders.3 Both short and long sleep (<7 or >7 hours per night, respectively) have been associated with a greater risk of all-cause mortality and cardiovascular disease (CVD).4 Evidence links hypertension, coronary heart disease, and cerebrovascular disease to both ends of the sleep duration continuum (<5–6 hours or >8–9 hours).5,6 In addition to sleep duration, irregular sleep timing is associated with cardiovascular events.7 Irregular sleep timing (differing bedtimes and rise times for 1 week)7 represents the potential for circadian misalignment. Evidence has emerged demonstrating increased CVD risk among shift workers,8 as well as rise in cardiac events after daylight saving time,9 and in individuals who have longer sleep times on weekends compared with weekdays (called social jetlag).10,11 Populations at Risk Some populations may be at a greater risk for sleep-related CVD risk. Many factors, such as the social determinants of health and lifestyle behaviors, influence sleep. Hale and colleagues12 observed that living in disadvantaged neighborhoods was associated with poor sleep quality, sleep disruptions, and insufficient sleep. Individuals with lower income and education levels experience a shorter sleep duration,13 of which occupational characteristics may play a role.14 Living arrangements and family structure have also been noted to affect sleep. Living alone and living with high levels of environmental noise contribute to sleep deficits.12,15 Adults with children report shorter sleep than those without children living in the home.12 Lifestyle behaviors, such as smoking, alcohol consumption, and physical inactivity, also influence an individual's sleep. Those who smoke report shorter sleep durations than nonsmokers and experience more insomnia symptoms than light smokers or nonsmokers.16 Alcohol consumption in nonalcoholics may promote sleep during the first half of the sleep period but disrupts sleep during the second half, leading to impaired sleep homeostasis.17 Binge drinking further disrupts sleep homeostasis.17 Women may be at a greater risk for cardiovascular effects of sleep restriction than men. Covassin and colleagues18 reported that 9 consecutive nights of sleep restriction resulted in elevated ambulatory blood pressure, impaired endothelial function, and stimulated sympathetic response among healthy adults. Of note, elevated blood pressure occurred only in women. The COVID-19 pandemic has altered lifestyles resulting in sleep disturbances. Sleep problems continue to be common during this pandemic, affecting roughly 40% of the general and healthcare populations.19 A longitudinal study demonstrated that midsleep times (the midpoint between bedtime and wake time), which are indicative of the circadian system, were delayed, whereas midsleep variability and resting heart rate decreased.20 Healthcare workers are the most vulnerable population in the fight against COVID-19 and its variants because they are on the front lines. Approximately 40% of physicians and 35% of nurses reported sleep disturbances,21 and 36% to 41% of nurses experienced insomnia symptoms.22 The Society of Behavioral Sleep Medicine has issued objectives and recommendations for managing sleep problems during a pandemic. These guidelines include many resources for clinicians.23 Implications Healthy sleep requires adequate duration, regularity of timing, daytime alertness, absence of sleep disorders, and good subjective quality.1 Sleep is a potentially modifiable behavior that is critical to the promotion of health and reduction of cardiovascular risk. The American Academy of Sleep Medicine issued a position statement in June 2021. The Academy recommended that healthcare providers routinely assess sleep habits, sleep symptoms, and sleep patterns and timing during patient encounters. They recommend that sleep health be “targeted by public health and workplace interventions to improve health-related outcomes, and behaviors that help people attain healthy sleep.”24(p2) The Academy also places a major emphasis on sleep health education in schools, in community and healthcare settings, in the workplace, and in public health policy arenas. The evidence-based recommendations issued by the Academy provide a “call to action” for nurses and nursing underscoring the importance of quality and quantity of sleep across the life course of individuals. Cardiovascular nurses are well positioned in clinical and community-based settings to implement the recommendations and advocate for the promotion of sleep health for patients, healthcare providers, and the public.

7.D. Workshop: Optimal development and interactions between cancer policy tools at the EU and national level

Abstract Cancer planning is a public health activity that has taken an important place in the health policy arena over the past 35 years. Cancer plans, programmes and strategies were mostly presenting with the challenges of inadequate comprehensiveness, uncertainties on implementation, insufficient resources and missing evaluation. EU launched its Europe Against Cancer Programme in 1985 and it was running successfully until 2003, falling short of the date of the biggest enlargement of the EU. The revival of the EU activities followed with Slovenia's Presidency to the Council of the EU bringing cancer back to the top of the agenda. This resulted in triggering several activities that strongly involved Member States (MSs): Establishment of the European Partnership for Action Against Cancer. EC call on the MSs to develop their national cancer control programmes (NCCPs) by 2013. Launch of several joint actions (JAs) - EPAAC, CanCon, JARC, iPAAC, policy projects to support the development of cancer policy both in MSs as well as in the EU Launch of the European Reference Networks (ERNs) All of these activities raised the expectations that the EU should take a more important role in steering activities in cancer control across the entire Union. Adoption of the Europe's Beating Cancer Plan (EBCP) marks a special moment in EU activities in cancer policy. It is the first time there is a comprehensive agenda on cancer, which includes both the classical preventative activities as well as cancer care and the challenges related to survivorship. The workshop is intended to present the main flagships in the EBCP, how they are to be implemented at the EU level and at the level of the MSs. Special reflection will be given to the role of research in cancer at all aspects of the disease. As research and innovation are an important component of the EBCP, the Mission on Cancer by DG RTD is prepared in close alignment and with the Mission Board acting as an independent advisory board to the EBCP, proposing a set of research and other policy actions and assist in its implementation. During the workshop, an assessment will be presented on how the recommendations of the work of the Mission on Cancer are incorporated into the EBCP. Finally, there will be a moderated discussion with the panellists and the audience on: what will be the challenges of developing national cancer policy priorities in response to the flagships of the EBCP, how these actions are going to be reflected in NCCPs, how can cancer policy development become a model for other NCDs. Participants are expected to gain more insight into the key policy priorities and public health actions related to the EBCP, how they are going to be supported by the MSs and what should be jointly undertaken to tackle the challenges related to the full implementation of EBCP across the EU. Key messages Cancer policy needs to be developed at the EU and country levels in a coordinative process. Comprehensiveness is necessary in addressing all public health challenges of the 21st century.

The socioeconomic burden and disability linked with mental illnesses: findings from the National Mental Health Survey of India 2015-16 in Uttar Pradesh

BACKGROUND: Mental health problems can lead to a substantial disability, financial loss, and a caregiver burden globally. The national mental health survey of India (NMHS) 2015-16 attempted to estimate the disability and socio-economic impact of mental morbidities in India and the representative state level. This paper reports the socio-economic impact and disability due to mental morbidity in Uttar Pradesh, India, by NMHS-2015-16, which will help the policymakers address the mental healthcare needs of the community.METHODS: This was a cross-sectional study done in the community setting. The investigators estimated socio-economic impact due to mental morbidities by using a structured questionnaire and applying the Sheehan Disability Scale.RESULTS: A total of 3,508 adults were interviewed, of which 282 individuals had a lifetime prevalence of mental health problems (excluding tobacco use disorder). Disability was reported: 27.3% at work, 31.9% in family life and 28.4% in social settings. Disability due to mental health problems were more evident in those with common and severe mental illnesses. The median monthly expense for the illness was found to be about 1,000 rupees INR (10 GBP). The individuals with mental health issues found in this study had 10 days of absentism from work and 20 days of reduced efficiency in work in the past 30 days.Conclusion: Disabilities related to mental health illness are having significant socio-economic impact across India. There is a need for early intervention and more adequate addressing of these issues across the national mental health policy and programming arena.

Improving health policy competency through collaboration and enhanced curriculum delivery.

Health policy is a key criterion for the academic preparation of nurse practitioners. To meet this criterion, faculty frequently utilize standard passive learning assignments that leave students feeling ill prepared to create and advocate for health policy upon graduation. To meet this need, faculty at two independent schools of nursing created curriculum to enhance health policy education for nurse practitioners. Using a variety of techniques based on real-world experience, nurse practitioner students gained increased retention of knowledge and increased activation in the health policy arena upon graduation. This finding supports that active learning increases retention and utilization in the area of health policy.

21.I. Round table: Comparing and designing the politics and policies for better economic and social welfare

Abstract While the political and social determinants of health have become accepted among academic researchers, health inequalities in the health policy and political arenas are still predominantly addressed as outcomes of citizens' lifestyle and behavioural choices. The rise of populist radical parties across Western countries brings renewed urgency to communicating with elected leaders and policy makers about the importance of tackling the social (as well as behavioral and medical) determinants of health. Recent publications such as 'Health in Hard Times. Austerity and Health Inequalities' (Clare Bambra, 2019) and 'Health Equity in England: The Marmot Review 10 Years On' (Marmot et al, 2020) find that financial and economic policies in large part contribute to stagnating and even reversing population health trends in the UK and across Western countries. The underlying political system of decision-making needs to be clarified in order to effectively engage and exert influence. This workshop aims to strengthen countervailing power and competence in understanding the policy trajectories that effectively target the larger ambitions of economic and social welfare including reduced health inequalities. We provide participants with basic knowledge, methods and tools to carry out practice-based comparative analysis of public health politics and policies across different countries. The workshop consists of: A 20-minute mini-lecture by Julia Lynch, who will present key findings and the underlying methodology of her recent book Regimes of inequality: The political economy of health and wealth. This book systematically used historical institutionalist-methods and process tracing to compare the policies and politics aimed at reducing health inequalities in Finland, France and the UK from the 1990s to the present.A 15-minute panel reflection: The panel, consisting of Clare Bambra, Karien Stronks, and Holly Jarman, will relate this to their own key research and impact.A 25-minute plenary discussion of examples, questions and contributions to tackling inequalities in political and social determinants of health. Examples are labour market participation policies, progressive fiscal policies or policies resolving illiteracy or household financial debt. Key messages Health inequalities are a political choice. Learning by comparison increases capacity to improve policies on the social determinants of health as well as capacity to increase political influence.

Corrected and Republished: Global Health Diplomacy Fingerprints on Human Security.

Human security is a concept that challenges the traditional notion of national security by placing the ‘human’ as the central referent of security instead of the 'state.’ It is a concept that encompasses health and well-being of people and prioritizes their fundamental freedoms and basic livelihoods by shielding them from acute socioeconomic threats, vulnerabilities and stress. The epicenter of “health security” is located at the intersection of several academic fields or disciplines which do not necessarily share a common theoretical approach. Diverse players in the “health security” domain include practitioners in such fields as security studies, foreign policy, international relations, development theory, environmental politics and the practices of the United Nations system and other multilateral bodies like the World Health Organization (WHO) and the Pan American Health Organization (PAHO). Improvements in health are not only dependent on continued commitments to enhance the availability of healthcare and to strengthen disease prevention systems; they are very much enhanced by that intersection between global security and global health. What is emerging is global health diplomacy paradigm that calls for strengthening of core capacities in the public health and foreign policy arenas aimed at advancing human security through the strengthening of global health diplomacy practices. Human security in its broadest sense embraces far more than the absence of violence and conflict. It encompasses human rights, good governance, access to education and health care, and ensuring that each individual has opportunities and devices to fulfill his or her potential. Every step in this direction is a step towards reducing poverty, achieving growth and preventing conflict. Freedom from want, freedom from fear and the freedom of future generations to inherit a natural environment – these are the interrelated building blocks of human- and therefore national security.

Public Health from the Middle-Out: A New Analytical Perspective.

Obstacles to collaborative public health frameworks such as Health in All Policies continue to emerge. Partnership-based public health programs present opportunities to study how public servants and practitioners address these barriers in real time. To this end, we utilized “Middle-Out,” a socio-technical analytical approach that highlights the importance of Middle Actors-stakeholders positioned between policymakers and grassroots—to policy diffusion, innovation and collaboration in public health. We conducted participatory observation in administrative settings of Israel’s National Program to Promote Active, Healthy Lifestyle, 30 stakeholder interviews and document analysis. We examined two dimensions of impact from the Middle-Out: Directions of Influence—Middle-Up, Middle-Down and Sideways, and Modes of Influence—Enabling, Mediating and Aggregating. Through Middle-Out’s lens, our analysis transcends visible benchmarks such as legislation and macro-level resource-allocation, focusing, instead, on elusive administrative spaces within which Middle Actors shape policies, steer funding and facilitate continuity. Incorporating Middle-Out into public health’s conceptual toolbox, we conclude, can improve understanding of complex public health policy arenas, increase recognition of critical socio-technical changemakers and catalyze more effective design of policy tools and strategies that specifically harness Middle Actors’ strengths and qualities.

Skills building seminar: Young policy voices for our future - building intergenerational bridges

Abstract Building bridges in policymaking is a vital concept to facilitate intersectoral collaboration and bring about change in many areas such as health workforce skill-mix, social and commercial determinants of health, or urgent health and environmental challenges with input from a wide spectrum of stakeholders. Yet, beyond breaking up horizontal silos, another issue urgently needs to be addressed: strengthening intergenerational bridges within the health policy arena. While valuing the younger generation’s new ways of communicating and sharing innovative knowledge, systems which encourage intergenerational partnerships and foster a reciprocal exchange need to be facilitated. This will allow for young voices to be increasingly heard and considered in policymaking. Though young professionals in public health and beyond are ideally placed to move this collaboration forward with a perspective that is passionate, inquisitive, dedicated and unbound by paths already taken, these often hierarchical systems usually offer limited incentive and room for experimentation and innovation. The objective of this interactive workshop is to highlight the need for incentivising intergenerational relations in policymaking and for young voices to be heard. We hope to inspire a fruitful intergenerational debate by presenting three case studies that display effective cross-generational work. These insights will be followed by a participatory format allowing the participants to jointly consider and develop concrete suggestions on how increased intergenerational cooperation in the policymaking arena could be reached for the benefit of all, and to leave the room with innovative ideas to take home to implement in their work environments. The debate will not shy away from also critically reflecting the benefit of youth involvement and whether “young voices” can even be seen as one entity. The three international cases showcased in this workshop will highlight how alternative non-hierarchical intergenerational models can be organised without threatening existing systems and enabling system transformation. Each case will focus on one of the headings: Unexpected learning from intergenerational collaborationForming alliances for a stronger youth voiceRemoving barriers for true intergenerational connection The presentations will be followed by active audience involvement using the World Café, involving topic champions and allowing for participants to share their own experience, connect to current and future needs, and jointly develop ideas for action to be taken at different levels. The workshop will conclude with a 15 min plenary, where participants will share insights from their conversations. A graphic harvest will take place during the workshop to visually capture the spirit of the conversations, support knowledge sharing and inspire action. Key messages Developing alternative non-hierarchical inter-generational models. Building intergenerational bridges as a vital concept for future policymaking.

The process of prioritization of non-communicable diseases in the global health policy arena.

Although non-communicable diseases (NCDs) are the leading cause of morbidity and mortality worldwide, the global policy response has not been commensurate with their health, economic and social burden. This study examined factors facilitating and hampering the prioritization of NCDs on the United Nations (UN) health agenda. Shiffman and Smith’s (Generation of political priority for global health initiatives: a framework and case study of maternal mortality. The Lancet 370: 1370–9.) political priority framework served as a structure for analysis of a review of NCD policy documents identified through the World Health Organization’s (WHO) NCD Global Action Plan 2013–20, and complemented by 11 semi-structured interviews with key informants from different sectors. The results show that a cohesive policy community exists, and leaders are present, however, actor power does not extend beyond the health sector and the role of guiding institutions and civil society have only recently gained momentum. The framing of NCDs as four risk factors and four diseases does not necessarily resonate with experts from the larger policy community, but the economic argument seems to have enabled some traction to be gained. While many policy windows have occurred, their impact has been limited by the institutional constraints of the WHO. Credible indicators and effective interventions exist, but their applicability globally, especially in low- and middle-income countries, is questionable. To be effective, the NCD movement needs to expand beyond global health experts, foster civil society and develop a broader and more inclusive global governance structure. Applying the Shiffman and Smith framework for NCDs enabled different elements of how NCDs were able to get on the UN policy agenda to be disentangled. Much work has been done to frame the challenges and solutions, but implementation processes and their applicability remain challenging globally. NCD responses need to be adapted to local contexts, focus sufficiently on both prevention and management of disease, and have a stronger global governance structure.

Public Health Policy Simulation.

Historically, nursing curricula have not offered opportunities for students to develop hands-on political competence. A public health policy simulation can improve students' ability to be change agents for health policy through advocacy. The public health policy simulation was a combination of didactic preparation and hands-on application of advocacy training. At the simulation, held at the State Capitol, students visited legislators, gave an oral testimony before a mock hearing committee, and received feedback from legislators. In general, students expressed being more knowledgeable and confident about the legislative process, advocacy for public health issues, communication with legislators, and the role of nursing in the public health policy arena. Students reported increased likelihood of advocacy for public health issues. Public health policy simulation should be part of nursing curricula to help to create a culture that dictates that public health policy is an integral component of the nursing profession. [J Nurs Educ. 2019;58(3):178-181.].

Global Health Diplomacy Fingerprints on Human Security.

Human security is a concept that challenges the traditional notion of national security by placing the ‘human’ as the central referent of security instead of the 'state.’ It is a concept that encompasses health and well-being of people and prioritizes their fundamental freedoms and basic livelihoods by shielding them from acute socioeconomic threats, vulnerabilities and stress. The epicenter of “health security” is located at the intersection of several academic fields or disciplines which do not necessarily share a common theoretical approach. Diverse players in the “health security” domain include practitioners in such fields as security studies, foreign policy, international relations, development theory, environmental politics and the practices of the United Nations system and other multilateral bodies like the World Health Organization (WHO) and the Pan American Health Organization (PAHO). Improvements in health are not only dependent on continued commitments to enhance the availability of healthcare and to strengthen disease prevention systems; they are very much enhanced by that intersection between global security and global health. What is emerging is global health diplomacy paradigm that calls for strengthening of core capacities in the public health and foreign policy arenas aimed at advancing human security through the strengthening of global health diplomacy practices. Human security in its broadest sense embraces far more than the absence of violence and conflict. It encompasses human rights, good governance, access to education and health care, and ensuring that each individual has opportunities and devices to fulfill his or her potential. Every step in this direction is a step towards reducing poverty, achieving growth and preventing conflict. Freedom from want, freedom from fear and the freedom of future generations to inherit a natural environment – these are the interrelated building blocks of human- and therefore national security.

Perceived barriers to early detection of breast cancer in Wakiso District, Uganda using a socioecological approach

BackgroundEarly detection of breast cancer is known to improve its prognosis. However, women in most low and middle income countries, including Uganda, do not detect it early hence present at an advanced stage. This study investigated the perceived barriers to early detection of breast cancer in Wakiso district, Uganda using a multilevel approach focused through a socioecological framework.MethodsUsing qualitative methods, participants were purposively selected to take part in the study. 5 semi-structured interviews were conducted among the community members while two focus groups were conducted amongst women’s group and community health workers (CHWs) in Ssisa sub county, Wakiso district. In addition, 7 key informant interviews with health professionals, policy makers and public health researchers were carried out.ResultsFindings from the study revealed that barriers to early detection of breast cancer are multifaceted and complex, cutting across individual, interpersonal, organizational, community and policy barriers. The major themes that emerged from the study included: knowledge, attitudes, beliefs and practices (KABP); health system and policy constraints; and structural barriers. Prominent barriers associated with KABP were low knowledge, apathy, fear and poor health seeking behaviours. Barriers within the health systems and policy arenas were mostly centred around competing health care burdens within the country, lack of a cancer policy and weak primary health care capacity in Wakiso district. Distance, poverty and limited access to media were identified as the most prominent structural barriers.ConclusionBarriers to early detection of breast cancer are complex and go beyond individual behaviours. These barriers interact across multiple levels of influence such as organizational, community and policy. The findings of this study could provide opportunities for investment in multi-level interventions.

A scoping approach to systematically review published reviews: Adaptations and recommendations.

Knowledge translation is a central focus of the health research community, which includes strategies to synthesize published research to support uptake within health care practice and policy arenas. Within the literature concerning review methodologies, a new discussion has emerged concerning methods that review and synthesize published review articles. In this paper, our multidisciplinary team from family medicine, nursing, dental hygiene, kinesiology, occupational therapy, physiology, population health, clinical psychology, and library sciences contributes to this discussion by sharing our experiences in conducting 3 scoping reviews of published review studies. A brief discussion of Cochrane Collaboration overview reviews and Joanna Briggs Institute umbrella reviews foreshadows a discussion of insights from our experiences of conducting the 3 scoping reviews of published reviews. We address 6 adaptations along with our recommendations for each, which may guide other researchers with designing scoping review approaches to synthesize published reviews. The ability of researchers to publish research findings is growing, and our ability to effectively transfer findings into useful evidence for health care practice and policy is imperative to our work.

LONG-TERM SERVICES AND SUPPORTS POLICY IN THE UNITED STATES AND CANADA: COMPARATIVE POLICY LESSONS

This session will explore recent developments in long-term services and supports (LTSS) policy in Canada and the United States in light of a aging demographic in both nations. Based on the findings of a qualitative research study that included in-depth interviews with policymakers, advocates, researchers and other policy elites in the health and aging policy arena, this session will specifically explore the way current economic and political forces are shaping long-term services and supports policy in both countries. The findings suggest that political institutions, culture and cost concerns are key drivers of policy outcomes in both the United States and Canada, and in particular policy outcomes relating to the financing of long term services and supports.

Cocreation or Collusion: The Dark Side of Consumer Narrative in Qualitative Health Research

Health, mental health, and social care policy are dominated by the imperative of employing person-centered approaches. Such involvement of the “consumer” is generally claimed to provide a counter-narrative to the psychiatric and medical paradigm of illness. Taking a critical and reflexive standpoint, we find ourselves asking: Is there a dark side to employing person-centered approaches and potential loss and risk to participants themselves? To explore these questions further, we undertook a condensed critique of the current mental health, health, and social care policy arena. We then move to methodological concerns about ways in which person-centered research, including our own, can inadvertently reproduce the neoliberalist agenda. To conclude, we offer our own lived experiences as a cautionary tale. We also posit that a post-Foucauldian governmentality framework can assist researchers to avoid contributing to the very problems we wish to resolve.

The Human Capital of Knowledge Brokers: An analysis of attributes, capacities and skills of academic teaching and research faculty at Kenyan schools of public health.

BackgroundAcademic faculty involved in public health teaching and research serve as the link and catalyst for knowledge synthesis and exchange, enabling the flow of information resources, and nurturing relations between ‘two distinct communities’ – researchers and policymakers – who would not otherwise have the opportunity to interact. Their role and their characteristics are of particular interest, therefore, in the health research, policy and practice arena, particularly in low- and middle-income countries. We investigated the individual attributes, capacities and skills of academic faculty identified as knowledge brokers (KBs) in schools of public health (SPH) in Kenya with a view to informing organisational policies around the recruitment, retention and development of faculty KBs.MethodsDuring April 2013, we interviewed 12 academics and faculty leadership (including those who had previously been identified as KBs) from six SPHs in Kenya, and 11 national health policymakers with whom they interact. Data were qualitatively analyzed using inductive thematic analysis to unveil key characteristics.ResultsKey characteristics of KBs fell into five categories: sociodemographics, professional competence, experiential knowledge, interactive skills and personal disposition. KBs’ reputations benefitted from their professional qualifications and content expertise. Practical knowledge in policy-relevant situations, and the related professional networks, allowed KB’s to navigate both the academic and policy arenas and also to leverage the necessary connections required for policy influence. Attributes, such as respect and a social conscience, were also important KB characteristics.ConclusionSeveral changes in Kenya are likely to compel academics to engage increasingly with policymakers at an enhanced level of debate, deliberation and discussion in the future. By recognising existing KBs, supporting the emergence of potential KBs, and systematically hiring faculty with KB-specific characteristics, SPHs can enhance their collective human capital and influence on public health policy and practice. Capacity strengthening of tangible skills and recognition of less tangible personality characteristics could contribute to enhanced academic–policymaker networks. These, in turn, could contribute to the relevance of SPH research and teaching programs as well as evidence-informed public health policies.

Quantifying Burden of Disease to Measure Population Health in Korea.

Quantitative assessments of the health status of a population are essential to make decisions and set priorities in the field of public health. Changing epidemiologic patterns increase the demand for comprehensive estimates of population health across the full health spectrum, including non-communicable diseases and injuries. Burden of disease (BoD) analysis has helped meet this need. With the success of the Global Burden of Disease (GBD) Study, the BoD technique has become predominantly associated with the GBD approach and its methodology using disability-adjusted life year (DALY) has been rapidly disseminated and generally accepted over the last several years. The first Korean BoD study using the DALY metric was presented in 2002. Various BoD studies have since been conducted, but the DALY concept has remained primarily academic and has not yet been actively utilized in the health policy arena. Here, we review the DALY metric and population-based Korean BoD studies using national health data, with the intent of increasing the understanding of their value and their potential role in strengthening future assessments of the Korean population’s health status.

Concepts and interests in twentieth-century health policy

Chronic disease has a long history as a general category in medical knowledge, defined broadly in contrast to acute disease. Its usefulness diminished in the nineteenth century as the emphasis in explanations of disease shifted from constitutional factors to specific disease entities and diminished further with the advance of medical specialisation in the early twentieth century and the requirement for more detailed death certificates. As chronic disease has lost its utility in explanations of disease, however, it has gained prominence as a health problem of great social significance. In this context, the category chronic disease encompasses medical conditions ranging from ‘a cancer that may kill you within months, diabetes that requires lifelong management and senility in old age’, a multiplicity of health and welfare services and medical and paramedical forms of knowledge. What holds such a commodious concept together? One explanation emphasises the alterations in patterns of disease and causes of death following the conquest of infectious disease around the turn of the twentieth century. Another, more critical account, emphasises the medicalisation of aspects of social life previously managed by social welfare institutions, and the identification of an expanding range of conditions through pervasive forms of screening. George Weisz excavates more deeply into the history underlying these generalisations to make a case for finding an answer to this question in the national health policy environment of the USA from the 1920s onwards, and in the influence of American medicine in the international health policy arena in the second half of the twentieth century. The book is divided into two parts. Part one is concerned with health policy in the USA since World War I to the end of the twentieth century. Part two offers a comparative perspective through an examination of health policy in England and France over the same period. A short epilogue carries the story briefly into the

The changing role of health-oriented international organizations and nongovernmental organizations.

Apart from governments, there are many other actors active in the health policy arena, including a wide array of international organizations (IOs), public-private partnerships and non-governmental organizations (NGOs) that state as their main mission to improve the health of (low-income) populations of low-income countries. Despite the steady rise in numbers and prominence of NGOs, however, there is lack of empirical knowledge about their functioning in the international policy arena, and most studies focus on the larger organizations. This has also caused a somewhat narrow focus of theoretical studies. Some scholars applied the 'principal-agent' theory to study the origins of IOs, for example, other focus on changing power relations. Most of those studies implicitly assume that IOs, public-private partnerships and large NGOs act as unified and rational actors, ignoring internal fragmentation and external pressure to change directions. We assert that the classic analytical instruments for understanding the shaping and outcome of public policy: ideas, interests and institutions apply well to the study of IOs. As we will show, changing ideas about the proper role of state and non-state actors, changing positions and activities of major stakeholders in the (international) health policy arena, and shifts in political institutions that channel the voice of diverging interests resulted in (and reflected) the changing positions of the health-oriented organizations-and also affect their future outlook. Copyright © 2015 John Wiley & Sons, Ltd.