Health Policy Issues Research Articles

Home Ambient Temperature and Self-reported Attention in Community-Dwelling Older Adults.

Climate change is expected to disrupt weather patterns across the world, exposing older adults to more intense and frequent periods of hot weather. Meanwhile, lab-based studies have established a causal relationship between ambient temperature and cognitive abilities, suggesting the expected rise in temperature may influence older adults' cognitive functioning. Nevertheless, it is not clear whether, and to what extent, the temperature variations in older adults' own homes - which unlike lab settings is under their control - influence their cognitive functioning. Our objective was to provide proof-of-concept that home ambient temperature influences self-reported ability to maintain attention in older adults. We conducted a longitudinal observational study; continuously monitoring the home ambient temperature and self-reported difficulty keeping attention for 12 months in a cohort of community-dwelling older adults living in Boston, MA. 47 adults aged 65 and older. We observed a U-shaped relationship between home ambient temperature at the time of assessment and the odds ratio (OR) of reporting difficulty keeping attention such that the OR was lowest between 20 - 24 ˚C and doubled when moving away from this range by 4 ˚C in either direction. Our results suggest that even under the current climate a considerable portion of older adults encounter indoor temperatures detrimental to their cognitive abilities. Climate change may exacerbate this problem, particularly among low-income and underserved older adults. Addressing this issue in public health and housing policy is essential to building climate-resiliency in this vulnerable population.

Centering equity, diversity, and inclusion in youth digital mental health: findings from a research, policy, and practice knowledge exchange workshop.

Youth mental health service organizations continue to rapidly broaden their use of virtual care and digital mental health interventions as well as leverage artificial intelligence and other technologies to inform care decisions. However, many of these digital services have failed to alleviate persistent mental health disparities among equity-seeking populations and in some instances have exacerbated them. Transdisciplinary and intersectional knowledge exchange is greatly needed to address structural barriers to digital mental health engagement, develop and evaluate interventions with historically underserved communities, and ultimately promote more accessible, useful, and equitable care. To that end, the Digital, Inclusive, Virtual, and Equitable Research Training in Mental Health Platform (DIVERT), the Maritime Strategy for Patient Oriented Research (SPOR) SUPPORT (Support for People and Patient-Oriented Research and Trials) Unit and IWK Mental Health Program invited researchers, policymakers, interprofessional mental health practitioners, trainees, computer scientists, health system administrators, community leaders and youth advocates to participate in a knowledge exchange workshop. The workshop aimed to (a) highlight local research and innovation in youth-focused digital mental health services; (b) learn more about current policy and practice issues in inclusive digital mental health for youth in Canada, (c) participate in generating action recommendations to address challenges to inclusive, diverse and equitable digital mental health services, and (d) to synthesize cross-sector feedback to inform future training curriculum, policy, strategic planning and to stimulate new lines of patient-oriented research. Eleven challenge themes emerged related to white-colonial normativity, lack of cultural humility, inaccessibility and affordability of participating in the digital world, lack of youth and community involvement, risks of too much digital time in youth's lives, and lack of scientific evidence derived from equity-deserving communities. Nine action recommendations focused on diversifying research and development funding, policy and standards, youth and community led promotion, long-term trust-building and collaboration, and needing to callout and advocate against unsafe digital services and processes. Key policy, training and practice implications are discussed.

Sleep health across the life cycle: an unmet and neglected public health priority

Abstract The presentation will set the stage on the central role of sleep health across the life cycle. Despite the large body of evidence on the importance of poor sleep behaviors as a modifiable risk factor for several adverse health outcomes, sleep health is still an unmet and neglected issue in public health policy, especially in the European context. Sleep problems are widespread and potentially affect everyone, from childhood to adult age. In addition, sleep health disparities represent a major source of health inequities across marginalized and high-risk population subgroups, such us people from low socio-economic status, women, refugees and immigrants, shift workers, people living with physical and mental illness. There is an urgent need to promote evidence-based health promotion and public health policy to enhance sleep health both in the general population and high-risk subgroups.

How do health systems and health contribute to the sustainable development goals?

Abstract While there is considerable research and policy interest into how factors outside the health system (i.e. social determinants) influence health outcomes, there has historically been less interest in how health and health systems affect other economic and societal objectives. Such evidence can be useful to health policymakers making the case for investing in health systems to demonstrate that health systems do more than just improve health. The European Observatory on Health Systems and Policies has put together a special issue of the journal Health Policy to explore the evidence on how health and health systems advance the Sustainable Development Goals (SDGs), which provides a helpful conceptual framework for considering economic and societal objectives. The articles each consider a particular SDG and review relevant literature with an emphasis on causal studies to explore the ways in which health and health systems have causal effects on key societal objectives such as poverty reduction, gender equality, climate change, and responsible consumption. In this presentation we will provide a summary of the findings from the special issue, highlighting areas with the strongest (and weakest) evidence and discuss how this work can be factored into budget negotiations and decisions about resource allocation.

Implications of the 2024 Election Outcome for U.S. Health Policy

On the basis of 28 national opinion polls, the authors summarize Democrats’ and Republicans’ views on health policy issues and discuss the implications of the 2024 election outcome for U.S. health policy.

Twenty-five years of addressing cutting-edge scientific, policy, and regulatory issues through collaboration: The Forum for Collaborative Research.

Developing safe and effective drugs and other medical products is a complex and costly process. Drug development has been, historically, commonly competitive and uncollaborative, and this tendency toward a lack of interaction between stakeholders-the pharmaceutical industry, academia, regulatory agencies, healthcare providers, and communities, among others-can lead to missed opportunities to improve efficiency and, ultimately, public health. The Forum for Collaborative Research was established in 1997 to address current scientific, policy, and regulatory issues in global health through multistakeholder engagement and dialogue. By providing a neutral and safe space for discussion, the Forum's model has impacted how clinical trials in diverse health areas are conducted, supported broader and more equitable clinical trial participation, and accelerated delivery of new drugs. The Forum's focus and directions have shifted over time, and this responsiveness to the needs of the global health community will be critical to ensure that the Forum continues to support collaboration in global health. In this article, we present lessons learned from this innovative model of collaborative research and regulatory science, pioneered by the Forum for over 25 years, including the importance of collective ownership and governance by all stakeholders, and emphasis on common goals and advantages of collaboration.

Parliamentarily speaking: A thematic analysis of Kerala Legislative Assembly questions relating to health from 2016 to 2021.

Legislative assemblies often provide a platform for legislators to question the government during question hours, which are crucial for governance However, question hours remain understudied, especially when addressing health policy and systems related issues in lower- and middle-income countries. This study assesses the 14th Kerala Legislative Assembly questions, focusing on health-related areas to provide insights for health policy formulation and decision-making processes. We sourced and transcribed all starred questions (346) related to health that were answered by the health minister in the 14th Legislative Assembly between 2016 and 2021 from the archives of the assembly website. We conducted a thematic analysis of these questions and mapped them into various themes, guided by the World Health Organization building blocks framework. About 7.8% of all questions (N = 4404) were related to health (N = 346). Of these questions, the majority were directly related to service delivery (43.4%), followed by health information (16.5%). Health financing, food safety, and human resources were the least discussed topics throughout the assessed period within the state. The legislators primarily focussed on health services and health information, with less attention given to health financing, food safety, and human resources regardless of constituency or political affiliation. This study underscores the need for a balanced approach to public health issues, highlighting the importance of legislators to priortizing health services and information, while also addressing health financing, food safety, and human resources. This would enable a robust and resilient public health system to effectively address diverse health concerns.

Looking inside the lab: a systematic literature review of economic experiments in health service provision

Experimental economics is, nowadays, a well-established approach to investigate agents’ behavior under economic incentives. In the last decade, a fast-growing number of studies have focused on the application of experimental methodology to health policy issues. The results of that stream of literature have been intriguing and strongly policy oriented. However, those findings are scattered between different health-related topics, making it difficult to grasp the overall state-of-the-art. Hence, to make the main contributions understandable at a glance, we conduct a systematic literature review of laboratory experiments on the supply of health services. Of the 1248 articles retrieved from 2011, 56 articles published in peer-review journals have met our inclusion criteria. Thus, we have described the experimental designs of each of the selected papers and we have classified them according to their main area of interest.

How perceptions of voter control affect politicians’ evaluations of expertise in the news: a survey experiment on the role of accountability beliefs

Background:Political scientists have repeatedly argued that politicians’ behaviour can be influenced by their beliefs about their constituents’ ability to hold them accountable. Yet, how such accountability beliefs affect politicians’ information processing or behaviour remains understudied. Aims and objectives:I investigate how accountability beliefs influence information processing of members of parliament (MPs). I analyse whether MPs, who believe that their voters can hold them accountable, evaluate expertise in the news differently than their colleagues, who perceive less voter control. Method:I rely on original data from a survey experiment carried out among 1,191 Swiss MPs. In the experiment, MPs evaluated expert statements in the news on health policy issues that varied regarding the source, the evidence base and the degree of advocacy. I then analyse how these evaluations vary, depending on MPs’ accountability beliefs. Findings:Accountability beliefs indeed affect evaluations of expert credibility: MPs with strong accountability beliefs tend to be not only more sceptical about experts, who may be deemed biased (corporation experts), they also perceive experts advocating for specific policy solutions less negatively. However, contrary to expectations, MPs with strong accountability beliefs prefer experts using an opinion-based instead of an evidence-based language, at least on some issues. Discussion and conclusion:This paper highlights the importance of accountability beliefs when seeking to understand how MPs evaluate and eventually use expertise in the news. However, it also suggests that these relationships warrant further investigation across different political issues and geopolitical contexts.

Reframing divorce as a mental health policy issue in the Philippines

Reframing divorce as a mental health policy issue in the Philippines

EVALUATING AGING IN PLACE LONG-TERM CARE REFORMS: A SCOPING REVIEW

Abstract There is a global trend of reforming long-term care to enable aging in place making it one of the most pressing health policy issues in both high- and low-middle income countries. However, there is no agreement on what is a successful aging in place reform. A holistic perspective that includes clinical, social and economic indicators is required to evaluate these reforms. In this scoping review, we aim to determine the extent of literature on evaluating aging in place reforms. We used the guidance of the JBI Scoping Review Methodology Group to conduct the scoping review. Articles on evaluation of aging in place reform and reporting on any outcome, process or structure quality indicator were eligible for inclusion. The search strategy was performed in Ovid Medline, Ovid Embase, and Ebscohost Academic Search Premier. There were no restrictions on publication year, language, and study design. The search identified 8,107 records. A total of 84 articles met the inclusion criteria and were included in the scoping review. Most studies were quantitative, observational studies from high income countries, using national population level data or larger cohorts. Frequently reported indicators were: total expenditures on long-term care, program spending per capita, hospitalization rates, length of stay, and home care utilization. Less reported were older adult and informal caregiver related indicators like: health, well-being, informal caregiver hours, and sleeping hours. Policy makers can use our findings to develop appropriate strategies to evaluate and monitor their own aging in place reforms.

Statement from the Asia Summit: Current state of arrhythmia care in Asia

AbstractOn May 27, 2022, the Asia Pacific Heart Rhythm Society and the Heart Rhythm Society convened a meeting of leaders from different professional societies of healthcare providers committed to arrhythmia care from the Asia Pacific region. The overriding goals of the meeting were to discuss clinical and health policy issues that face each country for providing care for patients with electrophysiologic issues, share experiences and best practices, and discuss potential future solutions. Participants were asked to address a series of questions in preparation for the meeting. The format of the meeting was a series of individual country reports presented by the leaders from each of the professional societies followed by open discussion. The recorded presentations from the Asia Summit can be accessed at https://www.heartrhythm365.org/URL/asiasummit‐22. Three major themes arose from the discussion. First, the major clinical problems faced by different countries vary. Although atrial fibrillation is common throughout the region, the most important issues also include more general issues such as hypertension, rheumatic heart disease, tobacco abuse, and management of potentially life‐threatening problems such as sudden cardiac arrest or profound bradycardia. Second, there is significant variability in the access to advanced arrhythmia care throughout the region because of differences in workforce availability, resources, drug availability, and national health policies. Third, collaboration in the area already occurs between individual countries, but no systematic regional method for working together is present.

PERENCANAN AGENDA BERITA BERORIENTASI KESEHATAN LINGKUNGAN PENGALAMAN DARI PERISTIWA PANDEMI COVID-19

News planning is the process of planning and managing all aspects of news production. It involves the steps an editor, reporter or editorial team takes to decide on the topic, story, sources, style and format to use in preparing the story. The goal of news planning is to ensure that news is presented in a way that is clear, accurate, balanced and attractive. The news agenda refers to the list of topics or issues that the media chooses to cover in a certain period of time. The focus of health news refers to the approach or point of view taken in preparing and covering health issues. Health news can cover a wide range of topics, from the latest medical developments, health policy issues, healthy lifestyles, medical research, pandemics, medicines, and more. This Community Service (PKM) was carried out by a combination of lecturers from two private universities (PTS), after observing the Covid-19 Pandemic and its impact on society. Held at the People's Editorial Office of New Makassar City, against journalists and editors. There were obstacles related to the busyness of the editors, but managed to provide an understanding of the importance of news in maintaining environmental health for the editors

Factors associated with regional retention of physicians: a cross-sectional online survey of medical students and graduates in Japan

BackgroundPhysician shortage and maldistribution is an urgent health policy issue requiring resolution. Determination of factors associated with regional retention and development of effective policy interventions will help to solve this issue. The purpose of the present study was to identify factors associated with regional retention and discuss their policy implications.MethodsWe conducted a cross-sectional online survey from February to March of 2022 for graduates from regional quotas (special quotas for medical schools to select students engaged in community medicine) and Jichi Medical University (JMU) and students at 10 medical schools including JMU. Completed surveys were obtained from 375 graduates and 1153 students. Questions included intention to continue to work in their home prefecture in the future, as well as background information and potential factors associated with regional retention. In the analyses, regional quotas and JMU were referred to as community medicine-oriented programs and schools (CMPS). We performed logistic regression analyses to identify factors associated with regional retention.ResultsAmong the students, scholarship-bonded obligatory service, satisfaction with current life, intention to belong to ikyoku (a traditional physician allocation/training system in Japanese medical schools), and interest in general practice/family medicine were significantly positively associated with regional retention. Among the graduates, satisfaction with training environment, intention to belong to ikyoku, and recommending their program to high school students were significantly positively associated with regional retention. For students of CMPS, satisfaction with the career development program was positively associated with future regional retention. For graduates, this association was observed only in the crude analysis.ConclusionsIn addition to known factors such as interest in general practice/family medicine, intention to belong to ikyoku had a substantial impact on regional retention. The present results suggest that the career support system represented by ikyoku as well as a career development program are of potential importance for increasing regional retention through the mechanisms of a sense of belonging and a life-long education system. These findings provide useful information for the development of further policy interventions that interweave traditional and new systems to maximize their effectiveness.

Prospects for Expansion of Universal Newborn Screening in Bulgaria: A Survey among Medical Professionals.

Determining the scope of a newborn screening program is a challenging health policy issue. Our study aimed to explore the attitudes of specialists in pediatrics, neonatology, medical genetics, and biochemistry regarding the prospects for expanding the panel of diseases for universal newborn screening in Bulgaria. We conducted an online survey in March-May 2022. The questionnaire listed 35 disorders that could potentially be included in the Bulgarian panel for universal newborn screening. If endorsing a specific condition, participants had to justify their position by judging its performance against the ten principles of Wilson and Jungner. We found a high degree of knowledge about the current universal newborn screening program in Bulgaria. An overwhelming majority (97.4%) supported the expansion of the panel to include more conditions. Four disorders obtained more than 50% approval for inclusion: cystic fibrosis (87.0%), thalassemia (72.7%), spinal muscular atrophy (65.6%), and classical galactosemia (59.1%). The perception of the condition as an important health problem was the most significant factor in this support. The costs of diagnosis and treatment appeared to be the main source of concern. We recommend country-specific economic evaluations and research on the views of other stakeholders, including the government, payers, and patient organizations, to better understand and manage the complex nature of newborn screening policymaking.

Global health trends of human papillomavirus‐associated oral cancer: A review

AbstractOral cancer is a malignant neoplastic disease, it constitutes the most common cancer in the head‐and‐neck region, and it is the 16th most common and 15th deadliest cancer type affecting humans. Despite the global efforts channelled towards global cancer control, the burden of oral cancer is still increasing. Every year, several thousands of people across 195 countries/territories die of oral cancer, and only about 40%–50% of the victims of oral cancer barely survive for 5 years after diagnosis. Within the past few decades, there has been a paradigm shift in the epidemiological trend of oral cancer risk factors. Oral sex – a major route of transmission of human papillomavirus (HPV) – was found to be increasing at an alarming rate, whereas tobacco and alcohol use had been on the decline. This narrative review critically discussed the contemporary challenges facing the global eradication of HPV‐associated oral cancer, with reasonable recommendations. The challenges discussed in this review are major, ranging from clinical to public health policy issues, which include the lack of validated and inexpensive oral HPV screening and diagnostic tools, high global public illiteracy on oral HPV infection, diverse sociocultural factors, weak global research capacity on oral HPV infection and HPV‐associated oral cancer and the absence of policies across different countries on national preventive programmes on HPV‐associated oral cancer. This review also identified the need for more attention towards the prevention and control oral HPV infection and HPV‐associated oral cancers globally.

Toward an emerging model of healthcare access: A theoretical framework.

To conceptualize an emerging framework of healthcare access for foreign-born persons based on well-known access models in the United States. The COVID-19 outbreak significantly impacted all global communities, disproportionately affecting people of color and highlighting preexisting health disparities. Health and immigration policies concerning healthcare access for foreign-born people were examined. Regarding access to social benefits in the United States, the Affordable Care Act underscored initial restrictions imposed by the Deficit Reduction Act of 2005 and the Personal Responsibility and Work Opportunity Reconciliation Act in 1996 on certain underserved groups. Guided by the study's aim, electronic databases, including Scopus, PubMed, Web of Science, and CINAHL, were queried for relevant nursing-related literature published on Penchansky's and Andersen's models from 1968 to 2022. Compared with Penchansky's model, Andersen's model outcome measures have evolved over the years in response to dynamic health policy issues. Penchansky's model has five constructs in its original form, whereas Andersen's model has three. The current study shows that each existing access model provides a unique method for evaluating various policies. In some cases, the studies are limited to a simple application of the original model with few modifications in studies specific to foreign-born groups in the United States. There is a dearth of systematic theorization of access that incorporates social justice and health equity. Health disparities were further explained using metrics from existing access models. An emerging access model conceptualizing existing access models was proposed, using constructs framed within the basic tenets of health equity and social justice. Applying the emerging model's constructs to future studies is anticipated to highlight opportunities for stakeholders such as policymakers, healthcare providers, nursing professionals, and community leaders to support programs that could further reduce health disparities.

A critical analysis of COVAX alliance and corresponding global health governance and policy issues: a scoping review

IntroductionThe COVAX alliance is a novel approach to international partnership in global health intended to achieve the worthy goal of ‘COVID-19 vaccine equity’. This study aimed to identify the implementation...

Statement from the Asia Summit: Current state of arrhythmia care in Asia

On May 27, 2022, the Asia Pacific Heart Rhythm Society and the Heart Rhythm Society convened a meeting of leaders from different professional societies of healthcare providers committed to arrhythmia care from the Asia Pacific region. The overriding goals of the meeting were to discuss clinical and health policy issues that face each country for providing care for patients with electrophysiologic issues, share experiences and best practices, and discuss potential future solutions. Participants were asked to address a series of questions in preparation for the meeting. The format of the meeting was a series of individual country reports presented by the leaders from each of the professional societies followed by open discussion. The recorded presentations from the Asia Summit can be accessed at https://www.heartrhythm365.org/URL/asiasummit-22. Three major themes arose from the discussion. First, the major clinical problems faced by different countries vary. Although atrial fibrillation is common throughout the region, the most important issues also include more general issues such as hypertension, rheumatic heart disease, tobacco abuse, and management of potentially life-threatening problems such as sudden cardiac arrest or profound bradycardia. Second, there is significant variability in the access to advanced arrhythmia care throughout the region due to differences in workforce availability, resources, drug availability, and national health policies. Third, collaboration in the area already occurs between individual countries, but no systematic regional method for working together is present.

Public Spending, Governance, and Mortality Probability in the Indian Subnational: A Two-Level Random Intercept Analysis

ABSTRACT: One of the most fundamental yet unresolved health policy issues is whether public expenditure on healthcare leads to improved health outcomes. Given that health reflects one of the critical aspects of human capital, having implications for economic growth and other development goals, there has been enormous advocacy towards investing significantly in the health systems across the countries to improve the overall health status. However, the effect of public spending on health outcomes remains inconclusive. The present paper analyses the impact of public health spending on mortality probability, taking into account the role of governance while treating public spending as an endogenous variable. The study uses individual level data from the National Family Health Survey (NFHS) Round 5 and a few state-level characteristics. For estimation purpose, it uses a two-level mixed effect model to capture the benefit incidence of public spending on Individual mortality probability. The findings reveal that public spending has a significant but differential impact on mortality across the Indian States, whereas the quality of governance is found to be a mediator. Given a level of public spending, States with better government effectiveness and rule of law can translate public health spending more effectively in reducing mortality at the individual level. The study also found heterogeneous mortality status across gender, location of stay, wealth status, and age groups with a differential impact of public spending across gender, wealth, and age groups. The variation in average distance of mortality probability level in each state from the overall mean mortality probability indicates that the states are very different in terms of health challenges that they are facing. The policy options call for state-specific health interventions to reduce the mortality rather than one-size-fits-all health policies. There needs to more unconditional grants/transfers from the Union Government to the States so that states will be able to tailor policy responses to address the unique challenges faced by the respective states. At the same time, states need to adopt output-based conditions with greater flexibility to deliver services and greater accountability to improve transparency, governance quality, and implementation capacity.