Non-health Policies Research Articles

Evidence-informed process to identify policies that will promote a healthy food environment in the Pacific Islands

To implement a systematic evidence-informed process to enable Fiji and Tonga to identify the most feasible and targeted policy interventions which would have most impact on diet-related non-communicable diseases. A multisectoral stakeholder group of policy advisers was formed in each country. They used participatory approaches to identify the problem policies and gaps contributing to an unhealthy food environment. Potential solutions to these problems were then identified, and were assessed by them for feasibility, effectiveness, cost-effectiveness and side-effects. Data were gathered on the food and policy environment to support the assessments. A shortlist of preferred policy interventions for action was then developed. Sixty to eighty policy problems were identified in each country, affecting areas such as trade, agriculture, fisheries and pricing. Up to 100 specific potential policy solutions were then developed in each country. Assessment of the policies highlighted relevant problem areas including poor feasibility, limited effectiveness or cost-effectiveness and serious side-effects. A shortlist of twenty to twenty-three preferred new policy options for action in each country was identified. Policy environments in these two countries were not conducive to supporting healthy eating. Substantial areas of potential action are possible, but some represent better choices. It is important for countries to consider the impact of non-health policies on diets.

Prioritizing policy interventions to improve diets? Will it work, can it happen, will it do harm?

Policies from non-health sectors have considerable impacts on the food environment and in turn on population nutrition. Health impact assessment (HIA) methods have been developed to identify the potential health effects of non-health policies; however, they are underused both within and outside the health sector. HIA and other assessment methods and tools can be used more extensively in health promotion to assist with the identification of the best policy options to pursue to improve and protect health. A participatory process is presented in this paper which combines HIAs with feasibility and effectiveness assessments. The intention is to enable health promoters to more accurately identify which policy change options would be most likely to improve diets, considering both impact and likelihood of implementation. The process was successfully used in Fiji and Tonga and provided a more systematic way of understanding which policy interventions showed the most promise.

A review of health impact assessment frameworks

Consideration of health impacts of non-health sector policies has been encouraged in many countries, with health impact assessment (HIA) increasingly used worldwide for this purpose. HIA aims to assess the potential impacts of a proposal and make recommendations to improve the potential health outcomes and minimize inequalities. Although many of the same techniques can be used, such as community consultation, engagement or profiling, HIA differs from other community health approaches in its starting point, purpose and relationship to interventions. Many frameworks have been produced to aid practitioners in conducting HIA. To review the many HIA frameworks in a systematic and comparative way. Systematic review. The literature was searched to identify published frameworks giving sufficient guidance for those with the necessary skills to be able to undertake an HIA. Approaches to HIA reflect their origins, particularly those derived from Environmental Impact Assessment (EIA). Early HIA resources tended to use a biomedical model of health and examine projects. Later developments were designed for use with policy proposals, and tended to use a socio-economic or environmental model of health. There are more similarities than differences in approaches to HIA, with convergence over time, such as the distinction between 'narrow' and 'broad' focus HIA disappearing. Consideration of health disparities is integral to most HIA frameworks but not universal. A few resources focus solely on inequalities. The extent of community participation advocated varies considerably. It is important to select an HIA framework designed for a comparable context, level of proposal and available resources.

"We're not short of people telling us what the problems are. We're short of people telling us what to do": An appraisal of public policy and mental health

BackgroundThere is sustained interest in public health circles in assessing the effects of policies on health and health inequalities. We report on the theory, methods and findings of a project which involved an appraisal of current Scottish policy with respect to its potential impacts on mental health and wellbeing.MethodsWe developed a method of assessing the degree of alignment between Government policies and the 'evidence base', involving: reviewing theoretical frameworks; analysis of policy documents, and nineteen in-depth interviews with policymakers which explored influences on, and barriers to cross-cutting policymaking and the use of research evidence in decisionmaking.ResultsMost policy documents did not refer to mental health; however most referred indirectly to the determinants of mental health and well-being. Unsurprisingly research evidence was rarely cited; this was more common in health policy documents. The interviews highlighted the barriers to intersectoral policy making, and pointed to the relative value of qualitative and quantitative research, as well as to the imbalance of evidence between "what is known" and "what is to be done".ConclusionHealthy public policy depends on effective intersectoral working between government departments, along with better use of research evidence to identify policy impacts. This study identified barriers to both these. We also demonstrated an approach to rapidly appraising the mental health effects of mainly non-health sector policies, drawing on theoretical understandings of mental health and its determinants, research evidence and policy documents. In the case of the social determinants of health, we conclude that an evidence-based approach to policymaking and to policy appraisal requires drawing strongly upon existing theoretical frameworks, as well as upon research evidence, but that there are significant practical barriers and disincentives.

Health impact assessment: the state of the art

Health impact assessment (HIA) is being increasingly used due to governments' growing interest in putting health high on their agendas. HIA provides a structured framework to estimate the potential consequences of non-health sector policies in community health. The ultimate goal of this framework is to maximize health gains and, as far as possible, to reduce health inequalities. HIA is believed to have significant potential to address health determinants and to promote intersectorial action in health. Challenges for the future include the need to strengthen its methodological bases, particularly those concerning the process of impact prediction, and the need to promote its progressive incorporation into decision-making processes, either independently or integrated within other impact assessment tools. The strategic affinity of HIA with the European "Health in All Policies" strategy strengthens current opportunities for the implementation of this tool in Spain, especially in the context of the ongoing debate on the future of public health and the need to give public health higher priority in political-institutional agendas. To move forwards, we should promote debate on HIA, as well as research and the practice of this tool in Spain, where only some pioneer experiences exist. The public health sector should lead the development of HIA pilot studies in order to assess its current contribution to the formulation of healthy public policies. In addition, HIA should be promoted among policy makers and other stakeholders in order to facilitate its adoption and integration into strategic planning and relevant agencies and decision-making structures. The ultimate goal is to find new formats for intersectorial collaboration and new tools for putting the principles of Health in all Policies into practice, thus successfully achieving health and public health goals.

La evaluación del impacto en salud: el estado de la cuestión

Health impact assessment (HIA) is being increasingly used due to governments’ growing interest in putting health high on their agendas. HIA provides a structured framework to estimate the potential consequences of non-health sector policies in community health. The ultimate goal of this framework is to maximize health gains and, as far as possible, to reduce health inequalities. HIA is believed to have significant potential to address health determinants and to promote intersectorial action in health. Challenges for the future include the need to strengthen its methodological bases, particularly those concerning the process of impact prediction, and the need to promote its progressive incorporation into decision-making processes, either independently or integrated within other impact assessment tools.The strategic affinity of HIA with the European «Health in All Policies» strategy strengthens current opportunities for the implementation of this tool in Spain, especially in the context of the ongoing debate on the future of public health and the need to give public health higher priority in political-institutional agendas. To move forwards, we should promote debate on HIA, as well as research and the practice of this tool in Spain, where only some pioneer experiences exist. The public health sector should lead the development of HIA pilot studies in order to assess its current contribution to the formulation of healthy public policies. In addition, HIA should be promoted among policy makers and other stakeholders in order to facilitate its adoption and integration into strategic planning and relevant agencies and decision-making structures. The ultimate goal is to find new formats for intersectorial collaboration and new tools for putting the principles of «Health in all Policies» into practice, thus successfully achieving health and public health goals.

Training Health Educators for Social Change

Health education practice reflects the ideology of the social forces that support it. Currently, health educators approach their task from two divergent viewpoints: one group emphasizes changing individual behavior while the other focuses on organizing people to change health-damaging institutions, policies and environments. This report provides a rationale and examples of the latter approach. It then describes the kind of training program that would be necessary to prepare health educators to work effectively for social change. Specifically, it is suggested that graduate students in health education need more preparation in social epidemiology, environmental sciences and policy analysis, particularly the analysis of the impact of non-health policies on health status. Health education training programs also need new approaches to the process of learning. The social movement of the last decades, health education programs in developing and socialist countries and some projects in this country provide a rich source of case studies. Training programs also need to recruit students who will be prepared to serve populations most in need of help. This suggests attracting students who have in the past been excluded from graduate education. Finally, several methods are suggested by which students, faculty and practitioners can begin the process of transforming the institutions that prepare professional health educators.

Training Health Educators for Social Change

Health education practice reflects the ideology of the social forces that support it. Currently, health educators approach their task from two divergent viewpoints: one group emphasizes changing individual behavior while the other focuses on organizing people to change health-damaging institutions, policies and environments. This report provides a rationale and examples of the latter approach. It then describes the kind of training program that would be necessary to prepare health educators to work effectively for social change. Specifically, it is suggested that graduate students in health education need more preparation in social epidemiology, environmental sciences and policy analysis, particularly the analysis of the impact of non-health policies on health status. Health education training programs also need new approaches to the process of learning. The social movement of the last decades, health education programs in developing and socialist countries and some projects in this country provide a rich source of case studies. Training programs also need to recruit students who will be prepared to serve populations most in need of help. This suggests attracting students who have in the past been excluded from graduate education. Finally, several methods are suggested by which students, faculty and practitioners can begin the process of transforming the institutions that prepare professional health educators.