Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 8 2018 08 01 Framing the Health Workforce Agenda Beyond Economic Growth 678 682 3500 10.15171/ijhpm.2018.45 EN Remco Van De Pas Maastricht Centre for Global Health, Maastricht University, Maastricht, The Netherlands Institute of Tropical Medicine, Antwerp, Belgium 0000-0002-6098-334X Linda Mans Wemos Foundation, Amsterdam, The Netherlands Marielle Bemelmans Wemos Foundation, Amsterdam, The Netherlands Anja Krumeich Maastricht Centre for Global Health, Maastricht University, Maastricht, The Netherlands Department of Health Ethics and Society, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands Journal Article 2018 02 17 The fourth Global Forum on Human Resources (HRH) for Health was held in Ireland November 2017. Its Dublin declaration mentions that strategic investments in the health workforce could contribute to sustainable and inclusive growth and are an imperative to shared prosperity. What is remarkable about the investment frame for health workforce development is that there is little debate about the type of economic development to be pursued. This article provides three cautionary considerations and argues that, in the longer term, a perspective beyond the dominant economic frame is required to further equitable development of the global health workforce. The first argument includes the notion that the growth that is triggered may not be as inclusive as proponents say it is. Secondly, there are considerable questions on the possibility of expanding fiscal space in low-income countries for public goods such as health services and the sustainability of the resulting economic growth. Thirdly, there is a growing consideration that economic growth solely expressed as increasing gross domestic product (GDP) might have intrinsic problems in advancing sustainable development outcomes. Economic development goals are a useful approach to guiding health workforce policies and health employment but this depends very much on the context. Alternative development models and policy options, such as a Job Guarantee scheme, need to be assessed, deliberated and tested. This would meet considerable political challenges but a narrow single story and frame of economic development is to be rejected.

https://www.ijhpm.com/article_3500_e2065cb56f5533494522c46a72f1dfb0.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 8 2018 08 01 Contextual Factors Influencing Cost and Quality Decisions in Health and Care: A Structured Evidence Review and Narrative Synthesis 683 695 3470 10.15171/ijhpm.2018.09 EN Iestyn Williams Health Services Management Centre, University of Birmingham, Birmingham, UK 0000-0002-9462-9488 Hilary Brown Health Services Management Centre, University of Birmingham, Birmingham, UK Paul Healy NHS Confederation, London, UK Journal Article 2017 05 04 Background Decisions affecting cost and quality are taken across health and care but investigation of the mediating role of context in these is in its infancy. This paper presents a synthesis of the evidence on the contextual factors that influence ‘decisions of value’ – defined as those characterised by having a significant and demonstrable impact on both quality and resources – in health and care. The review considers the full range of resource/quality decisions and synthesises knowledge on the contextual drivers of these. Methods The method involved structured evidence review and narrative synthesis. Literature was identified through searches of electronic databases (HMIC, Medline, Embase, CINAHL, NHS Evidence, Cochrane, Web of Knowledge, ABI Inform/Proquest), journal and bibliography hand-searching and snowball searching using citation analysis. Structured data extraction was performed drawing out descriptive information and content against review aims and questions. Data synthesis followed a thematic approach in accordance with the varied nature of the retrieved literature. Results Twenty-one literature items reporting 14 research studies and seven literature reviews met the inclusion criteria. The review shows that in health and care contexts, research into decisions of value in health and care is in its infancy and contains wide variation in approach and remit. The evidence is drawn from a range of service and country settings and this reduces generalisability or transferability of findings. An area of relative strength in the published evidence is inquiry into factors influencing coverage and commissioning decisions in health care systems. Allocative decisions have therefore been more consistently researched than technical decisions. We use Pettigrew’s (1985) distinction between inner and outer context to structure analysis of the range of factors reported as being influential. These include: evidence/information, organisational culture and governance regimes, and; economic and political conditions. Conclusion Decisions of value in health and care are subject to range of intersecting influences that often lead to a departure from narrow notions of rational decision-making. Future research should pay greater attention to the relatively under-explored area of technical, as opposed to allocative, decision-making.

https://www.ijhpm.com/article_3470_73fed7fd472e502d8908794430511f4d.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 8 2018 08 01 “First, Do No Harm”: Have the Health Impacts of Government Bills on Tax Legislation Been Assessed in Finland? 696 698 3490 10.15171/ijhpm.2018.39 EN Natassa Aaltonen Faculty of Social Sciences, University of Tampere, Tampere, Finland Miisa Chydenius Faculty of Social Sciences, University of Tampere, Tampere, Finland Lauri Kokkinen Faculty of Social Sciences, University of Tampere, Tampere, Finland Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada Finnish Institute of Occupational Health, Tampere, Finland. Journal Article 2017 12 07 As taxation is one of the key public policy domains influencing population health, and as there is a legal, strategic, and programmatic basis for health impact assessment (HIA) in Finland, we analyzed all 235 government bills on tax legislation over the years 2007–2014 to see whether the health impacts of the tax bills had been assessed. We found that health impacts had been assessed for 13 bills, bills dealing with tobacco, alcohol, confectionery, and energy legislation and that four of these impact assessments included impacts on health inequalities between social classes. Based on our theoretical classification, the health impacts of 40 other tax bills should have been evaluated.

https://www.ijhpm.com/article_3490_72f67e70f6b7cdc4cc893edaddf0c4c6.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 8 2018 08 01 Inequities in Antenatal Care, and Individual and Environmental Determinants of Utilization at National and Sub-national Level in Pakistan: A Multilevel Analysis 699 710 3458 10.15171/ijhpm.2017.148 EN Ambreen Sahito Department of Community Medicine, Isra University, Hyderabad, Pakistan Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan Zafar Fatmi Department of Community Medicine, Isra University, Hyderabad, Pakistan Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan 0000-0001-7212-6858 Journal Article 2017 01 14 Background Nationally representative surveys are vital for gauging progress in health and planning health services. However, often marred with inadequate analysis to provide any guidance to health policy and planning. Most recent Pakistan Demographic and Health Survey (PDHS) 2012-2013 is an inclusive nationally representative investigation. Nonetheless, its published report offers limited evidence regarding antenatal care (ANC). Furthermore, after 18th constitutional amendment, policies are principally made at provincial level in Pakistan; therefore, it is imperative to have contextual evidence at sub-national level to feed programs and policies. Methods We analysed 7142 women with a recent birth, to assess the individual and environmental determinants of ANC, adapting Andersen’s model of healthcare utilization, by multilevel analysis. Separate models of determinants were developed for the national level and five provinces using survey command in Stata version 12.1. Results Besides that the recommended ANC coverage (≥4 visits) is low in Pakistan (36%), gross inequities exist predominantly across provinces (12% to 82%). Small differences exist between urban and rural localities. Education, health literacy and socio-economic status of women were strong predictors, while communities with high concentration of literate women very strongly predict ANC use (odds ratio [OR] = 12). Determinants of ANC vary at national and at sub-national level. For example, women’s education had no influence on ANC utilization in Khyber Pakhtunkhwa (KPK) and Baluchistan (BC) provinces. Notably, husband’s education was significantly associated with ANC utilization in KPK only. Significant positive interaction exists between urban areas and larger provinces (Punjab, Sindh, and KPK). Also, very strong positive interaction occurs when women have secondary or particularly higher level of education and living in urban areas or larger provinces. Conclusion This study highlights conspicuous contextual differences which determine maternal care at national and sub-national level. It identified contextual factors which are important for planning maternal health services between and within provinces. High positive interaction for ANC utilization between women education, urban areas and larger provinces highlights the inequities which need to be addressed. It also identified factors at the community level (cluster) which relates to overall contex and influence individual behavior and highlights the diminishing urban-rural gap in service utilization in Pakistan.

https://www.ijhpm.com/article_3458_e3ea33961a7c5b1ec04d6c97aa3b5379.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 8 2018 08 01 Reporting of Financial and Non-financial Conflicts of Interest in Systematic Reviews on Health Policy and Systems Research: A Cross Sectional Survey 711 717 3463 10.15171/ijhpm.2017.146 EN Lama Bou-Karroum Center for Systematic Reviews for Health Policy and Systems Research, American University of Beirut, Beirut, Lebanon Maram B. Hakoum Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon Mira Z. Hammoud Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Assem M. Khamis Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon 0000-0002-5567-7065 Mounir Al-Gibbawi Faculty of Medicine, American University of Beirut, Beirut, Lebanon Sanaa Badour Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon Faculty of Medicine, American University of Beirut, Beirut, Lebanon Divina Justina Hasbani Faculty of Medicine, American University of Beirut, Beirut, Lebanon Luciane Cruz Lopes Pharmaceutical Science Master Course, University of Sorocaba, São Paulo, Brazil Hebah M. El-Rayess Faculty of Medicine, American University of Beirut, Beirut, Lebanon Fadi El-Jardali Center for Systematic Reviews for Health Policy and Systems Research, American University of Beirut, Beirut, Lebanon Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada 0000-0002-4084-6524 Gordon Guyatt Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada Elie A. Akl Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada Department of Internal Medicine, American University of Beirut, Beirut, Lebanon Journal Article 2017 01 10 Background Systematic reviews are increasingly used to inform health policy-making. The conflicts of interest (COI) of the authors of systematic reviews may bias their results and influence their conclusions. This may in turn lead to misguided public policies and systems level decisions. In order to mitigate the adverse impact of COI, scientific journals require authors to disclose their COIs. The objective of this study was to assess the frequency and different types of COI that authors of systematic reviews on health policy and systems research (HSPR) report. Methods We conducted a cross sectional survey. We searched the Health Systems Evidence (HSE) database of McMaster Health Forum for systematic reviews published in 2015. We extracted information regarding the characteristics of the systematic reviews and the associated COI disclosures. We conducted descriptive analyses. Results Eighty percent of systematic reviews included authors’ COI disclosures. Of the 160 systematic reviews that included COI disclosures, 15% had at least one author reporting at least one type of COI. The two most frequently reported types of COI were individual financial COI and individual scholarly COI (11% and 4% respectively). Institutional COIs were less commonly reported than individual COIs (3% and 15% respectively) and non-financial COIs were less commonly reported than financial COIs (6% and 14% respectively). Only one systematic review reported the COI disclosure by editors, and none reported disclosure by peer reviewers. All COI disclosures were in the form of a narrative statement in the main document and none in an online document. Conclusion A fifth of systematic reviews in HPSR do not include a COI disclosure statement, highlighting the need for journals to strengthen and/or better implement their COI disclosure policies. While only 15% of identified disclosure statements report any COI, it is not clear whether this indicates a low frequency of COI versus an underreporting of COI, or both.

https://www.ijhpm.com/article_3463_73c03186765e199c116224b68adc5fa0.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 8 2018 08 01 “It’s About the Idea Hitting the Bull’s Eye”: How Aid Effectiveness Can Catalyse the Scale-up of Health Innovations 718 727 3464 10.15171/ijhpm.2018.08 EN Deepthi Wickremasinghe IDEAS Project, London School of Hygiene & Tropical Medicine, London, UK Meenakshi Gautham IDEAS Project, London School of Hygiene & Tropical Medicine, London, UK Nasir Umar IDEAS Project, London School of Hygiene & Tropical Medicine, London, UK Della Berhanu IDEAS Project, London School of Hygiene & Tropical Medicine, London, UK Joanna Schellenberg IDEAS Project, London School of Hygiene & Tropical Medicine, London, UK Neil Spicer IDEAS Project, London School of Hygiene & Tropical Medicine, London, UK Journal Article 2017 06 07 Background Since the global economic crisis, a harsher economic climate and global commitments to address the problems of global health and poverty have led to increased donor interest to fund effective health innovations that offer value for money. Simultaneously, further aid effectiveness is being sought through encouraging governments in low- and middle-income countries (LMICs) to strengthen their capacity to be self-supporting, rather than donor reliant. In practice, this often means donors fund pilot innovations for three to five years to demonstrate effectiveness and then advocate to the national government to adopt them for scale-up within country-wide health systems. We aim to connect the literature on scaling-up health innovations in LMICs with six key principles of aid effectiveness: country ownership; alignment; harmonisation; transparency and accountability; predictability; and civil society engagement and participation, based on our analysis of interviewees’ accounts of scale-up in such settings. Methods We analysed 150 semi-structured qualitative interviews, to explore the factors catalysing and inhibiting the scale-up of maternal and newborn health (MNH) innovations in Ethiopia, northeast Nigeria and the State of Uttar Pradesh, India and identified links with the aid effectiveness principles. Our interviewees were purposively selected for their knowledge of scale-up in these settings, and represented a range of constituencies. We conducted a systematic analysis of the expanded field notes, using a framework approach to code a priori themes and identify emerging themes in NVivo 10. Results Our analysis revealed that actions by donors, implementers and recipient governments to promote the scale-up of innovations strongly reflected many of the aid effectiveness principles embraced by well-known international agreements - including the Paris Declaration of Aid Effectiveness. Our findings show variations in the extent to which these six principles have been adopted in what are three diverse geographical settings, raising important implications for scaling health innovations in low- and middle-income countries. Conclusion Our findings suggest that if donors, implementers and recipient governments were better able to put these principles into practice, the prospects for scaling externally funded health innovations as part of country health policies and programmes would be enhanced.

https://www.ijhpm.com/article_3464_51e6d6e679953c6311757004d8cbbba9.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 8 2018 08 01 The Economic Impact of Clinical Research in an Italian Public Hospital: The Malignant Pleural Mesothelioma Case Study 728 737 3467 10.15171/ijhpm.2018.13 EN Roberto Ippoliti Scientific Promotion, General Hospital of Alessandria, Alessandria, Italy Department of Management, University of Turin, Turin, Italy. Greta Falavigna Research Institute on Sustainable Economic Growth, National Research Council of Italy, Moncalieri, Italy Federica Grosso Oncology Unit, General Hospital of Alessandria, Alessandria, Italy Antonio Maconi Scientific Promotion, General Hospital of Alessandria, Alessandria, Italy Lorenza Randi Scientific Promotion, General Hospital of Alessandria, Alessandria, Italy Gianmauro Numico Oncology Unit, General Hospital of Alessandria, Alessandria, Italy Journal Article 2017 02 23 Background The current economic constraints cause hospital management to use the available public resources as rationally as possible. At the same time, there is the necessity to improve current scientific knowledge. This is even more relevant in the case of patients with malignant pleural mesothelioma (MPM), given the severity of the disease, its dismal prognosis, and the cost of chemotherapy drugs. This work aims to evaluate the standard cost of patients with MPM, supporting physicians in their decision-making process in relation to budget constraints, as well as policymakers with respect research policy. Methods The authors conducted a retrospective cost analysis on all the patients with MPM who were first admitted to a reference hospital specialized in MPM care between 2014 and 2015, collecting data on their diagnostic pathways and active treatments, as well as on the related official fees for each procedure. Then, using a multiple regression model, we estimated the overall expected cost of a patient with MPM treated in our hospital, to be born by the Regional Healthcare System based on the chosen clinical pathway. Results According to results, the economic impact of caring for a patient with MPM is mostly related to the selected active treatments, with drug and hospitalization costs as main drivers. Our analysis suggests that the expected reimbursed fee to care for a patient with MPM is equal to € 18 214.99, with chemotherapy and monitoring costs equal to € 12 861.43 and hospitalization cost equal to € 5353.55. This cost decreases to € 320.18 in the case of enrollment in an experimental trial of first-line treatment. In the other cases (second-line or third-line trials), the expected cost borne by the healthcare system for treating patients grows exponentially (€ 40,124.18 and € 59 839.94, respectively). Conclusion Experimental trials might be a solution to decrease the economic burden for the public healthcare system only in the case of first-line treatments, where the cost of chemotherapy is relevant. Nevertheless, policy-makers have to accept the sharing of this economic burden between society and the pharmaceutical industry to broaden the current scientific knowledge.

https://www.ijhpm.com/article_3467_2a2717956118b4d223ceca17ce3865e2.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 8 2018 08 01 How and Where Do We Ask Sensitive Questions: Self-reporting of STI-associated Symptoms Among the Iranian General Population 738 745 3471 10.15171/ijhpm.2018.18 EN Maryam Nasirian Epidemiology and Biostatistics Department, Health School; and Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran 0000-0002-8365-3845 Samira Hosseini Hooshyar HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Ali Akbar Haghdoost Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran 0000-0003-4628-4849 Mohammad Karamouzian HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada 0000-0002-5631-4469 Journal Article 2016 12 31 Background Reliable population-based data on sexually transmitted infections (STI) are limited in Iran and selfreporting remains the main source of indirect estimation of STI-associated symptoms in the country. However, where and how the questions are asked could influence the rate of self-reporting. In the present study, we aimed to assess what questionnaire delivery method (ie, face-to-face interview [FTFI], self-administered questionnaire [SAQ], or audio self-administered questionnaire [Audio-SAQ]) and setting (ie, street, household or hair salon) leads to more reliable estimates for the prevalence of self-reported STI-associated symptoms. Methods This cross-sectional study was conducted in winter 2014 on a gender-balanced (50.0% men) sample of 288 individuals aged 18–59 years old in Kerman, Iran. Respondents were recruited in (a) crowded public places and streets, (b) their households, and (c) hair salons. Data was collected on history of current and 6-month (ie, past 6 months) STI-associated symptoms. Three different methods including FTFI, SAQ and or Audio-SAQ were applied randomly in households and non randomly in streets and hair salons to collect data among the respondents. Generalized estimating equation (GEE) was used to compare the settings and methods separately. Results A total of 2.8% of men and 9.4% of women self-reported at least one STI-associated symptom. Respondents were significantly more likely to report STI-associated symptoms when completing questionnaires on the street compared to their household (P = .0001). While women were less likely to report symptoms in FTFI compared to SAQ (P = .036), no significant differences were found between men’s responses across different methods (P = .064). Conclusion Further research is needed to evaluate the effect of different combinations of methods and settings to find the optimal way to collect data on STI-associated symptoms.

https://www.ijhpm.com/article_3471_735143e9ff8c47def504f1ba0442df98.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 8 2018 08 01 Swiss-CHAT: Citizens Discuss Priorities for Swiss Health Insurance Coverage 746 754 3472 10.15171/ijhpm.2018.15 EN Samia A. Hurst Institute for Ethics, History, and the Humanities, Geneva University Medical School, Geneva, Switzerland 0000-0002-1980-5226 Mélinée Schindler Institute for Ethics, History, and the Humanities, Geneva University Medical School, Geneva, Switzerland Susan D. Goold Department of General Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA Marion Danis Department of Bioethics, National Institutes of Health, Bethesda, MD, USA 0000-0002-4749-4568 Journal Article 2017 08 26 Background As universal health coverage becomes the norm in many countries, it is important to determine public priorities regarding benefits to include in health insurance coverage. We report results of participation in a decision exercise among residents of Switzerland, a high-income country with a long history of universal health insurance and deliberative democracy. Methods We adapted the Choosing Healthplans All Together (CHAT) tool, an exercise developed to transform complex healthcare allocation decisions into easily understandable choices, for use in Switzerland. We conducted CHAT exercises in twelve Swiss cities with recruitment from a range of socio-economic backgrounds, taking into account differences in language and culture. Results Compared to existing coverage, a majority of 175 participants accepted greater general practice gatekeeping (94%), exclusion of invasive life-sustaining measures in dying patients (80%), longer waiting times for non-urgent episodic care (78%), greater adherence to cost-effectiveness guidelines in chronic care (66%), and lower premium subsidies (51%). Most initially chose greater coverage for dental care (59%), quality of life (57%), and long-term care (90%). During group deliberations, participants increased coverage for out-of-pocket costs (58%) and mental health to current levels (41%) and beyond current levels for rehabilitation (50%), and decreased coverage for quality of life to current levels (74%). Following group deliberation, they tended to change their views back to below current coverage for help with out-of-pocket costs, and back to current levels for rehabilitation. Most participants accepted the plan as appropriate and fair. A significant number would have added nothing. Conclusion Swiss participants who have engaged in a priority setting exercise accept complex resource allocation tradeoffs in healthcare coverage. Moreover, in the context of a well-funded healthcare system with universal coverage centered on individual choice, at least some of our participants believed a fully sufficient threshold of health insurance coverage was achieved.

https://www.ijhpm.com/article_3472_2974788b53f73e7950e8aa49f3a306db.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 8 2018 08 01 Ideas for Extending the Approach to Evaluating Health in All Policies in South Australia; Comment on “Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia” 755 757 3480 10.15171/ijhpm.2018.25 EN Ketan Shankardass Wilfrid Laurier University, Waterloo, ON, Canada Centre for Urban Health Solutions, Li Ka Shing Knowedge Institute, Toronto, ON, Canada 0000-0002-8410-2201 Patricia O’Campo Centre for Urban Health Solutions, Li Ka Shing Knowedge Institute, Toronto, ON, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada Carles Muntaner Bloomberg School of Nursing, University of Toronto, Toronto, ON, Canada Ahmed M. Bayoumi Centre for Urban Health Solutions, Li Ka Shing Knowedge Institute, Toronto, ON, Canada Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada Lauri Kokkinen Faculty of Social Sciences, University of Tampere, Tampere, Finland Finnish Institute of Occupational Health, Tampere, Finland Journal Article 2018 01 31 Since 2008, the government of South Australia has been using a Health in All Policies (HiAP) approach to achieve their strategic plan (South Australia Strategic Plan of 2004). In this commentary, we summarize some of the strengths and contributions of the innovative evaluation framework that was developed by an embedded team of academic researchers. To inform how the use of HiAP is evaluated more generally, we also describe several ideas for extending their approach, including: deeper integration of interdisciplinary theory (eg, public health sciences, policy and political sciences) to make use of existing knowledge and ideas about how and why HiAP works; including a focus on implementation outcomes and using developmental evaluation (DE) partnerships to strengthen the use of HiAP over time; use of systems theory to help understand the complexity of social systems and changing contexts involved in using HiAP; integrating economic considerations into HiAP evaluations to better understand the health, social and economic benefits and trade-offs of using HiAP.

https://www.ijhpm.com/article_3480_e8e0dd181e4ee545195120626098bfba.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 8 2018 08 01 How Do We Evaluate Health in All Policies?; Comment on “Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia” 758 760 3481 10.15171/ijhpm.2018.31 EN Ditte Heering Holt National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark Nanna Ahlmark National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark Journal Article 2018 01 15 It is well-established that population health is influenced by a multitude of factors, many of which lie outside the scope of the health sector. In the public health literature it is often assumed that intersectoral engagement with nonhealth sectors will be instrumental in addressing these social determinants of health. Due to the expected desirable outcomes in population health, several countries have introduced Health in All Policies (HiAP). However, whether this systematic, top-down approach to whole-of-government action (which HiAP entails) is efficient in changing government policies remains unclear. A systematic evaluation of HiAP is therefore much needed. Lawless and colleagues present an evaluation framework for HiAP in their article: “Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia.” This work is an important endeavor in addressing this problem (of uncertainty as to whether HiAP is effective) and represents an essential contribution to the HiAP literature. Nonetheless, in the spirit of encouraging ongoing reflection on this topic, we wish to highlight some challenges in the presented framework, which may pose difficulties in operationalization. We find that the evaluation framework faces two main limitations: its unclear causal logic and its level of complexity. We argue that in order to function as a tool for evaluation, the framework should be explicit about the mechanisms of change and enable us to trace whether the assumed causal relations resulted in changes in practice. Developing manageable evaluation frameworks, albeit simplified, may then be an important part of cumulating the theoretical insights aspired in theory-based evaluation. On this basis, we highlight how HiAP processes and healthy public policies respectively involve different mechanisms, and thus argue that different program theories are needed.

https://www.ijhpm.com/article_3481_3fb04953d95a94367bb133f862402bce.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 8 2018 08 01 Evaluating Health in All Policies; Comment on “Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia” 761 762 3482 10.15171/ijhpm.2018.33 EN Sebastián Peña Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland 0000-0002-2555-4179 Journal Article 2018 02 04 Health in All Policies (HiAP) has gained attention as a potential tool to address complex health and societal challenges at global, regional, national and subnational levels. In a recent article, Lawless et al propose an evaluation framework developed in the context of the South Australia HiAP initiative. Strategies, mediators, activities and impacts identified in the framework could potentially be useful for evaluating HiAP in other settings. Creating and sustaining political will, managing conflicts of interest and achieving financially, politically and conceptually sustainable HiAP initiatives are challenges that could be further strengthened in the current framework.

https://www.ijhpm.com/article_3482_b7fede84c2be02ccb9c77107956560eb.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 8 2018 08 01 Policy, Theory, and Evaluation: Stop Mixing the Fruit Salad; Comment on “Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia” 763 765 3486 10.15171/ijhpm.2018.35 EN Evelyne De Leeuw Centre for Health Equity Training Research and Evaluation (CHETRE), University of New South Wales, Sydney, NSW, Australia South Western Sydney Local Health District, Liverpool, NSW, Australia Ingham Institute, Liverpool, NSW, Australia 0000-0003-3434-1439 Journal Article 2018 02 24 The study of Health in All Policies (HiAP) is gaining momentum. Authors are increasingly turning to wide swathes of political and social theory to frame (Program) Theory Based (or Informed) Evaluation (TBE) approaches. TBE for HiAP is not only prudent, it adds a level of elegance and insight to the research toolbox. However, it is still necessary to organize theoretical thinking appropriately. A commentary on a recent Int J Health Policy Manag paper argued that the framing of context and causality were hard to establish. This paper argues that this is not the most pressing issue. Rather, it claims we need to go back to basics to establish an appropriate HiAP evaluation paradigm. Such a basic paradigm would hinge on an understanding of power.

https://www.ijhpm.com/article_3486_ab4f2b5fd96ca65349119909c1eada2d.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 8 2018 08 01 A Plea for Harm Reduction Policing Involving People Who Use Drugs 766 767 3483 10.15171/ijhpm.2018.29 EN Ehsan Jozaghi The British Columbia Centre for Disease Control, Vancouver, BC, Canada The School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada Lorna Bird Vancouver Area Network of Drug Users, Vancouver, BC, Canada Sex Workers United Against Violence, Vancouver, BC, Canada Journal Article 2017 12 22

https://www.ijhpm.com/article_3483_cb953f6ca5923f7517125db46ed1293d.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 8 2018 08 01 The Knowledge Translation Complexity Network (KTCN) Model: The Whole Is Greater Than the Sum of the Parts - A Response to Recent Commentaries 768 770 3506 10.15171/ijhpm.2018.49 EN Alison Kitson College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia Green Templeton College, University of Oxford, Oxford, UK 0000-0003-3053-8381 Rebekah O’Shea University of Adelaide, Adelaide, SA, Australia Alan Brook Adelaide Dental School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia Institute of Dentistry, Queen Mary University of London, London, UK Gill Harvey Adelaide Nursing School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia Alliance Manchester Business School, University of Manchester, Manchester, UK 0000-0003-0937-7819 Zoe Jordan The Joanna Briggs Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia Rhianon Marshall Independent Clinical Psychologist David Wilson Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia Journal Article 2018 05 16

https://www.ijhpm.com/article_3506_e0126439e08ddfbdf4faa952dc910590.pdf