Health impact assessment (HIA) of political proposals at the local level: successful introduction, but what has happened 15 years later?

2017 ◽  
Vol 24 (2) ◽  
pp. 43-51 ◽  
Author(s):  
Karin Berensson ◽  
Per Tillgren
Keyword(s):  
Public Health ◽  
Local Level ◽  
Health Impact ◽  
Political Agenda ◽  
The Political ◽  
Adoption Process ◽  
Second Phase ◽  
Health Issues ◽  
Health Impact Assessments ◽  
National Public Health

Health impact assessments (HIAs) were first introduced in Sweden in the mid-to-late 1990s, with the aim of placing health issues on the political agenda and helping to reduce health inequalities. In the early 2000s, HIAs entered a second phase and the Swedish Parliament adopted a national public health policy. A national survey conducted in 2001 showed that 10/289 municipalities had begun to use HIA and 55/289 had decided to use HIA or had initiated an adoption process. In a 2013 follow-up study based on a strategic sample of municipalities, 9/36 municipalities reported using HIA and/or similar tools. Corresponding figures for the 21 Swedish regions were 10 regions in 2001 and four in 2013. HIA and similar tools (sustainability analyses, child impact assessments, and others) were applied to the same extent as HIA. Fifteen years after implementation began, HIA is still being used. Regions show a clear decrease in the use of HIA. There are several explanations for this development. One is the political context, and other explanations are shifts in which actors are responsible for HIA and for public health at the local/regional levels.

Public health terminology: Hindrance to a Health in All Policies approach?

2017 ◽  
Vol 46 (1) ◽  
pp. 68-73 ◽  
Author(s):  
Ellen S. Synnevåg ◽  
Roar Amdam ◽  
Elisabeth Fosse
Keyword(s):  
Public Health ◽  
Systematic Approach ◽  
Local Level ◽  
Health Policies ◽  
Health In All Policies ◽  
Health Work ◽  
Cross Sectional ◽  
Public Health Policies ◽  
National Public Health ◽  
The One

Aim: National public health policies in Norway are based on a Health in All Policies (HiAP) approach. At the local level, this means that public health, as a cross-sectional responsibility, should be implemented in all municipal sectors by integrating public health policies in municipal planning and management systems. The paper investigates these local processes, focusing on the use of public health terminology and how this terminology is translated from national to local contexts. We ask whether the terms ‘public health’ and ‘public health work’ are suitable when implementing an HiAP approach. Methods: A qualitative case study based on analyses of interviews and planning documents was performed in three Norwegian municipalities. Results: The results present dilemmas associated with using public health terminology when implementing an HiAP approach. On the one hand, the terms are experienced as wide, complex, advanced and unnecessary. On the other hand, the terms are experienced as important for a systematic approach towards understanding public health ideology and cross-sectional responsibility. One municipality used alternative terminology. Conclusions: This paper promotes debate about the appropriateness of using the terms ‘public health’ and ‘public health work’ at the local level. It suggests that adaptation is suitable and necessary, unless it compromises knowledge, responsibility and a systematic approach. This study concludes that the use of terminology is a central factor when implementing the Norwegian Public Health Act at the local level.

The Political Economy of Health: Revisiting Its Marxian Origins to Address 21st-Century Health Inequalities

2020 ◽  
pp. e1-e8
Author(s):  
Michael Harvey
Keyword(s):  
Public Health ◽  
Political Economy ◽  
Public Health Research ◽  
The Political ◽  
Health Issues ◽  
Race And Racism ◽  
The Public ◽  
Critical Theories ◽  
Political Economy Of Health ◽  
Marxian Political Economy

The “political economy of health” is concerned with how political and economic domains interact and shape individual and population health outcomes. However, the term is variously defined in the public health, medical, and social science literatures. This could result in confusion about the term and its associated tradition, thereby constituting a barrier to its application in public health research and practice. To address these issues, I survey the political economy of health tradition, clarify its specifically Marxian theoretical legacy, and discuss its relevance to understanding and addressing public health issues. I conclude by discussing the benefits of employing critical theories of race and racism with Marxian political economy to better understand the roles of class exploitation and racial oppression in epidemiological patterning. (Am J Public Health. Published online ahead of print December 22, 2020:e1–e8. https://doi.org/10.2105/AJPH.2020.305996 )

scholarly journals When evidence alone is not enough: the problem, policy and politics of water fluoridation in England

2021 ◽  
Author(s):  
Gary Lowery ◽  
Matthew Flinders ◽  
Barry J. Gibson
Keyword(s):  
Public Health ◽  
Policy Change ◽  
Hospital Admissions ◽  
Exchange Process ◽  
Political Agenda ◽  
The Political ◽  
Water Fluoridation ◽  
Sociopolitical Context ◽  
Health Policymaking

Background: Tooth extractions are the most common cause of hospital admissions for children in England. Water fluoridation has the potential to reduce this number by 60%, is backed by the scientific and public health communities, and yet is currently consumed by only 10% of the population.Aims and objectives: This ‘evidence-policy gap’ is explored through Kingdon’s ‘multi-streams approach’ which provides insights into the circumstances under which water fluoridation has made it onto the political agenda, the rationale underpinning opponent and advocate policy positions, and the role of the political arena in fostering or hindering policy action.Methods: Over 100 primary documents were reviewed to develop an understanding of the scientific and ethical arguments for and against water fluoridation, as well as to identify how they have all historically sought to mobilise their policy preferences. Eleven consultations were also conducted with stakeholders as part of the knowledge exchange process.Findings: The key finding of this research is that evidence is only likely to trigger policy change if it emerges into a receptive sociopolitical context. In substantiating this claim we identify evidence not of an ‘evidence-policy gap’ but of a more complex and multidimensional ‘evidence-policy-politics gap’.Discussion: The findings contribute to a range of debates in relation to: (1) the apparent irreconcilability of background ideas about what ought to form the basis of public health policymaking; (2) the presence of differing evidential standards that create an uneven playing field; and (3) the central underpinning role of politics in public health policymaking.<br />Key points<br /><ul><li>Water fluoridation in England is characterised by a disconnect between the evidence base and the policies enacted.</li><br /><li>This is attributable to a complex, multidimensional and dialectical ‘evidence-policy-politics gap’.</li><br /><li>Evidence is only likely to trigger policy change if located within a receptive sociopolitical context.</li><br /><li>These insights feed into broader debates surrounding blame-avoidance behaviour and the existence of evidential biases.</li></ul>

scholarly journals Keeping up with the times: how national public health and governmental organizations communicate about cannabis on Twitter

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Jenna van Draanen ◽  
Tanvi Krishna ◽  
Christie Tsang ◽  
Sam Liu
Keyword(s):  
Public Health ◽  
National Level ◽  
Limited Information ◽  
Health Issues ◽  
Medical Cannabis ◽  
The Public ◽  
Governmental Organizations ◽  
National Public Health ◽  
Health Related ◽  
The Times

Abstract Background Public health and governmental organizations are expected to provide guidance to the public on emerging health issues in accessible formats. It is, therefore, important to examine how such organizations are discussing cannabis online and the information that is being provided to the public about this increasingly legal and available substance. Methods This paper presents a concise thematic analysis of both the volume and content of cannabis-related health information from selected (n = 13) national-level public health and governmental organizations in Canada and the U.S. on Twitter. Results There were eight themes identified in Tweets including 1) health-related topics; 2) legalization and legislation; 3) research on cannabis; 4) special populations; 5) driving and cannabis; 6) population issues; 7) medical cannabis, and 8) public health issues. The majority of cannabis-related Tweets from the organizations studied came from relatively few organizations and there were substantial differences between the topics covered by U.S. and Canadian organizations. The organizations studied provided limited information regarding how to use cannabis in ways that will minimize health-related harms. Conclusions Authoritative organizations that deal with public health may consider designing timely social media communications with emerging cannabis-related information, to benefit a general public otherwise exposed to primarily pro-cannabis content on Twitter.

scholarly journals The Swedish national public health policy and its achievements after ten years

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
N Lindqvist
Keyword(s):  
Public Health ◽  
Health Policy ◽  
Health Inequalities ◽  
Public Health Policy ◽  
Policy Framework ◽  
Political Agenda ◽  
Health Work ◽  
Public Health Perspective ◽  
National Public Health ◽  
The Government

Abstract Public health issues and their equality aspects have been on the political agenda in Sweden since the early 1980s. Already in the 1990s, the Government presented the first public health policy bill. This highlighted the conditions for a sustainable development from a public health perspective. Increased equality was set to be the overriding objective in prioritizing public health work and that priority should be given to efforts that would improve the situation of the most disadvantaged. The foundation of today’s public health policy was laid in 2003 when the parliament decided on a new bill in which an overall goal for national public health policy was established: ‘Creating social conditions for good health on equal terms for the entire population’. The bill also established a cross-sectoral target structure for the overall public health work with eleven target areas. It also pointed out that public health policy is cross-sectoral and must be a part in all policy areas. In June 2008, the parliament adopted the bill A Renewed Public Health Policy. Changes made were (among other things) a rewording of the target areas, but many of the starting points were kept. The Swedish Commission for Equity in Health was set up in 2015 and given two main tasks, to produce a proposal that can help to reduce the health inequalities in society and to work for raised awareness of health inequalities in society and among stakeholders. The work of the commission was finished in 2017 and presents an analysis of how the public health policy works in practice, with regard to the intentions of policy framework. A number of problems or areas of development appear which the Commission considers need to be addressed. The presentation will first give a short overview of the Swedish public health policy from 2008 and will then present the commission’s conclusions and proposals for development areas.

Emergent Democracy

2020 ◽  
pp. 19-73
Author(s):  
Lucy Atkinson ◽  
Andrew Blick ◽  
Matt Qvortrup
Keyword(s):  
Political Thought ◽  
Local Level ◽  
Political Agenda ◽  
The Political ◽  
Political Landscape ◽  
Winston Churchill

Chapter 1 considers how the idea of using referendums came onto the political agenda, and how on a number of occasions its imminent entry into use seemed plausible but did not take place. Important figures such as Albert Venn Dicey, Joseph Chamberlain, Arthur Balfour, Stanley Baldwin, Herbert Henry Asquith, and Winston Churchill played a part in events. Even without being held, the prospect of referendums had an impact on British political thought, words, and actions. There was also practical use of the device: at local level, and as part of external initiatives in which Britain played a part. The referendum could come to the forefront of political attention, recede and then return to it again. Though the extent of its prominence varied, once it appeared on the political landscape the referendum was, in some form, a continual presence.

scholarly journals Health Impact Assessment (HIA) of a Fluvial Environment Recovery Project in a Medium-Sized Spanish Town

2020 ◽  
Vol 17 (5) ◽  
pp. 1484
Author(s):  
Cristina Casajuana Kögel ◽  
Tània Rodríguez Peña ◽  
Isabel Sánchez ◽  
Montserrat Tobella ◽  
José Alonso López ◽  
...  
Keyword(s):  
Public Health ◽  
Impact Assessment ◽  
Health Impact Assessment ◽  
Local Level ◽  
Health Agency ◽  
Health Impact ◽  
City Council ◽  
Health Impacts ◽  
Health Determinants ◽  
Health In All Policies

Introduction: The Interdepartamental Public Health Plan of Catalonia (2014) seeks to enforce Health in All Policies (HiAP) at the regional and local levels. Within this context, the City Council of Sant Andreu de la Barca (SAB), the Metropolitan Area of Barcelona (MAB), and the Public Health Agency of Catalonia started a Health Impact Assessment (HIA) of an urbanistic redesign of the Llobregat fluvial area in SAB, the results of which are presented in this paper. Methodology: In 2018, after a HIA screening, a prospective nonquantitative HIA was conducted. Politicians, professionals, and citizens participated in identifying potential impacts. Impacts were prioritized and linked to health determinants, scientific evidence, and potentially affected social groups. Afterwards, recommendations were formulated in order to improve the health impacts of the project. Finally, indicators were selected to evaluate HIA implementation. Results: The HIA was successfully implemented with the participation of technicians and citizens of SAB. The health impacts identified were mainly related to environmental, public safety, lifestyle, socioeconomic, and political contexts. Ten recommendations were defined to minimize the potential negative health impacts of the project, with six of them directly included and only one dismissed due to incompatibility. Conclusion: A HIA was successfully carried out in the medium-sized town of Catalonia, promoting Health in all Policies at a local level and improving health impacts of an urbanistic project.

The Health in All Policies (HiAP) Approach and the Law: Preliminary Lessons from California and Chicago

2015 ◽  
Vol 43 (S1) ◽  
pp. 52-55 ◽  
Author(s):  
Claudia Polsky ◽  
Kendall Stagg ◽  
Maxim Gakh ◽  
Christine T. Bozlak
Keyword(s):  
Public Health ◽  
Health Impact ◽  
Determinants Of Health ◽  
Ecological Approach ◽  
Health In All Policies ◽  
Health Work ◽  
Socioeconomic Determinants ◽  
Health Impact Assessments ◽  
The Law ◽  
Distinct Approach

“Health in All Policies” (HiAP) is the latest manifestation of an ecological approach to public health enhancement — one that recognizes connections between health and other sectors, and that socioeconomic determinants of health are significant. HiAP is related to other holistic, prevention-oriented approaches to collective health, such as the use of Health Impact Assessments to evaluate the health externalities of pending government decisions. Yet HiAP is unique. It goes beyond evaluation of specific projects and policies, and embodies a distinct approach to cross-sectoral public health work.

scholarly journals Political analysis of the neonatal screening for severe combined immunodeficiency - Curitiba, Brazil

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
D R L Lima ◽  
P F I Goiozo ◽  
A Sanches ◽  
E De Carvalho ◽  
H A Carvalho ◽  
...  
Keyword(s):  
Public Health ◽  
Public Policy ◽  
Policy Analysis ◽  
Neonatal Screening ◽  
Severe Combined Immunodeficiency ◽  
Political Agenda ◽  
The Political ◽  
Combined Immunodeficiency ◽  
Term Survival ◽  
Wide Range

Abstract Severe Combined Immunodeficiency (SCID) is the most aggressive form of primary immunodeficiencies, being able to death within 2 years after birth. In the USA, the screening found that the incidence of SCID was double that previously stipulated, before screening. Israel, Taiwan, Spain and others European countries are also testing for SCID. The long-term survival of patients diagnosed and treated before 4 months of life reaches 94%. Brazil does not perform neonatal screening for SCID through the Public Health System (SUS), numbers are unknown and under-diagnosed, even the treatment for SCID is funded by SUS. Analyze the political dimensions of the bill that aims to implement neonatal screening for SCID in Curitiba, Brazil. Participatory research was carried out between March - October 2019 and, bibliographic research on policy analysis in the context of emerging countries, to understand the criteria are taken into account for the political agenda, the influence of interest groups and the influence of the political arena in the implementation of a public policy through policy analysis. The project is pending in the municipal legislature of Curitiba and faces issues related to the financing of the implementation - a wide range of dependent variables act in the construction of a public policy. Its materialization, although important for public health, must consider real possibilities of implementation. In parallel, independent of the bill, a screening pilot project is under preparation by doctors, academics, and civil society. Brazil has a feasible technique that can be implemented on a large scale for neonatal SCID screening. However, although strongly recommended by the medical community, the implementation of this policy can be unviable by political and financial issues. Key messages The implementation of a public policy involves decisions between institutions, rules of the game and political forces. Early diagnosis may reduce treatment costs, requiring public policies for SCID.

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