scholarly journals Values are not enough: qualitative study identifying critical elements for prioritization of health equity in health systems

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Thea van Roode ◽  
Bernadette M. Pauly ◽  
Lenora Marcellus ◽  
Heather Wilson Strosher ◽  
Sana Shahram ◽  
...  
Keyword(s):  
Public Health ◽  
Health System ◽  
Health Systems ◽  
Health Equity ◽  
Health Inequities ◽  
System Capacity ◽  
Comparative Approach ◽  
Structural Level ◽  
Critical Elements ◽  
Health Authorities

Abstract Background Health system policies and programs that reduce health inequities and improve health outcomes are essential to address unjust social gradients in health. Prioritization of health equity is fundamental to addressing health inequities but challenging to enact in health systems. Strategies are needed to support effective prioritization of health equity. Methods Following provincial policy recommendations to apply a health equity lens in all public health programs, we examined health equity prioritization within British Columbia health authorities during early implementation. We conducted semi-structured qualitative interviews and focus groups with 55 senior executives, public health directors, regional directors, and medical health officers from six health authorities and the Ministry of Health. We used an inductive constant comparative approach to analysis guided by complexity theory to determine critical elements for prioritization. Results We identified seven critical elements necessary for two fundamental shifts within health systems. 1) Prioritization through informal organization includes creating a systems value for health equity and engaging health equity champions. 2) Prioritization through formal organization requires explicit naming of health equity as a priority, designating resources for health equity, requiring health equity in decision making, building capacity and competency, and coordinating a comprehensive approach across levels of the health system and government. Conclusions Although creating a shared value for health equity is essential, health equity - underpinned by social justice - needs to be embedded at the structural level to support effective prioritization. Prioritization within government and ministries is necessary to facilitate prioritization at other levels. All levels within health systems should be accountable for explicitly including health equity in strategic plans and goals. Dedicated resources are needed for health equity initiatives including adequate resourcing of public health infrastructure, training, and hiring of staff with equity expertise to develop competencies and system capacity.

scholarly journals Rational trust in resilient health systems

2019 ◽  
Vol 34 (7) ◽  
pp. 553-557 ◽  
Author(s):  
Sonja Kristine Kittelsen ◽  
Vincent Charles Keating
Keyword(s):  
Public Health ◽  
Health System ◽  
Health Systems ◽  
The Public ◽  
Public Health Emergencies ◽  
Health Authorities ◽  
Cast Doubt ◽  
Public Health Authorities ◽  
System Resilience ◽  
Relevant Component

AbstractThe 2014–15 Ebola epidemic in West Africa highlighted the significance of trust between the public and public health authorities in the mitigation of health crises. Since the end of the epidemic, there has been a focus amongst scholars and practitioners on building resilient health systems, which many see as an important precondition for successfully combatting future outbreaks. While trust has been acknowledged as a relevant component of health system resilience, we argue for a more sustained theoretical engagement with underlying models of trust in the literature. This article takes a first step in showing the importance of theoretical engagement by focusing on the appeal to rational models of trust in particular in the health system resilience literature, and how currently unconsidered assumptions in this model cast doubt on the effectiveness of strategies to generate trust, and therein resilience, during acute public health emergencies.

scholarly journals The Containment Scouts: First Insights into an Initiative to Increase the Public Health Workforce for Contact Tracing during the COVID-19 Pandemic in Germany

2021 ◽  
Vol 18 (17) ◽  
pp. 9325
Author(s):  
Dunja Said ◽  
Simon Brinkwirth ◽  
Angelina Taylor ◽  
Robby Markwart ◽  
Tim Eckmanns
Keyword(s):  
Public Health ◽  
Health System ◽  
Health Workforce ◽  
System Capacity ◽  
World Health ◽  
Public Health Workforce ◽  
Contact Tracing ◽  
Short Term ◽  
The Public ◽  
Health Authorities

The COVID-19 pandemic in Germany has demanded a substantially larger public health workforce to perform contact tracing and contact management of COVID-19 cases, in line with recommendations of the World Health Organization (WHO). In response, the Robert Koch Institute (RKI) established the national “Containment Scout Initiative” (CSI) to support the local health authorities with a short-term workforce solution. It is part of a range of measures for strengthening the public health system in order to limit the spread of SARS-CoV-2 in Germany. The CSI is an example of how solutions to address critical health system capacity issues can be implemented quickly. It also demonstrates that medical or health-related backgrounds may not be necessary to support health authorities with pandemic-specific tasks and fulfil accurate contact tracing. However, it is a short-term solution and cannot compensate for the lack of existing qualified staff as well as other deficits that exist within the public health sector in Germany. This article describes the structure and process of the first phase of this initiative in order to support health policymakers, public health practitioners, and researchers considering innovative and flexible approaches for addressing urgent workforce capacity issues.

scholarly journals Health inequities and technological solutions during the first waves of the COVID-19 pandemic in high-income countries

2021 ◽  
pp. 175797592098418
Author(s):  
Muriel Mac-Seing ◽  
Robson Rocha de Oliveira
Keyword(s):  
Public Health ◽  
Health Equity ◽  
Vulnerable Populations ◽  
Health Inequities ◽  
High Income ◽  
Control Measures ◽  
Health Priorities ◽  
Economic Systems ◽  
And Control ◽  
Political Decisions

The COVID-19 pandemic has resulted in massive disruptions to public health, healthcare, as well as political and economic systems across national borders, thus requiring an urgent need to adapt. Worldwide, governments have made a range of political decisions to enforce preventive and control measures. As junior researchers analysing the pandemic through a health equity lens, we wish to share our reflections on this evolving crisis, specifically: (a) the tenuous intersections between the responses to the pandemic and public health priorities; (b) the exacerbation of health inequities experienced by vulnerable populations following decisions made at national and global levels; and (c) the impacts of the technological solutions put forward to address the crisis. Examples drawn from high-income countries are provided to support our three points.

The Role of Citizen Science in Promoting Health Equity

2021 ◽  
Vol 43 (1) ◽  
Author(s):  
Lisa G. Rosas ◽  
Patricia Rodriguez Espinosa ◽  
Felipe Montes Jimenez ◽  
Abby C. King
Keyword(s):  
Public Health ◽  
Citizen Science ◽  
Health Equity ◽  
Healthy Eating ◽  
Mobile Applications ◽  
Health Inequities ◽  
Annual Review ◽  
Publication Date ◽  
Scientific Process

While there are many definitions of citizen science, the term usually refers to the participation of the general public in the scientific process in collaboration with professional scientists. Citizen scientists have been engaged to promote health equity, especially in the areas of environmental contaminant exposures, physical activity, and healthy eating. Citizen scientists commonly come from communities experiencing health inequities and have collected data using a range of strategies and technologies, such as air sensors, water quality kits, and mobile applications. On the basis of our review, and to advance the field of citizen science to address health equity, we recommend ( a) expanding the focus on topics important for health equity, ( b) increasing the diversity of people serving as citizen scientists, ( c) increasing the integration of citizen scientists in additional research phases, ( d) continuing to leverage emerging technologies that enable citizen scientists to collect data relevant for health equity, and ( e) strengthening the rigor of methods to evaluate impacts on health equity. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

scholarly journals The concept of public health. Types of health systems. Parallel between the Romanian and the Australian health system

2021 ◽  
Vol 68 (1) ◽  
pp. 17-21
Author(s):  
Dorel Dulău ◽  
◽  
Simona Bungău ◽  
Lucia Daina ◽  
Camelia Buhaş ◽  
...  
Keyword(s):  
Public Health ◽  
Health System ◽  
Health Systems ◽  
Medical Management ◽  
Local Authority ◽  
Public Health System ◽  
Point Of View ◽  
The Public ◽  
Australian Health ◽  
Centralization And Decentralization

Medical management is a field that combines, both in theory and in practice, two somewhat different domains, administration and the medical domain, creating a third area of activity, namely that of medical management. This review is part of a study of health services management, which seeks to find solutions to improve the efficiency of the the management and administration of the medical system, both locally and nationally. In order to be able to study and evaluate, from a scientific point of view, the concepts of centralization and decentralization of the public health system in Romania, it is absolutely pertinent, but also mandatory, to focus on defining the notion of health system. Only later can we approach and research the process of decentralization of health, the political and economic context in which it can be initiated, as well as how to activate and carry it out. Decentralization, as a phenomenon of the transfer of rights and obligations, from the level of the central authority to the level of the local authority, can take various forms. From a theoretical and practical point of view, the forms of decentralization can be studied, evaluated and concluded by emphasizing the strengths and weaknesses. Also important to study are the ways of putting health systems into practice, which from the point of view of the source of funding are divided into state-funded health systems (Semashko, Beveridge and Bismarck) and privately funded health systems.

The ‘other’ within: Striving for health equity in the Maldives Eva-Maria

2021 ◽  
Vol 16 (2) ◽  
pp. 18-38
Author(s):  
Eva-Maria Knoll
Keyword(s):  
Public Health ◽  
Health Equity ◽  
Spatial Organization ◽  
Health Inequities ◽  
The Other ◽  
National Consciousness ◽  
The Public ◽  
Making Sense ◽  
Blood Disorder ◽  
Anthropological Fieldwork

Relations within are quintessential in anthropological fieldwork — and in archipelagos in particular. The domestic sea is incorporated in the national consciousness connecting an archipelagic nation but distinguishing individual islands with a strong emphasis on the centre. The Maldivian archipelago displays this spatial organization of a socio-political and economic centre and a dependent island periphery. In the national consciousness, the capital island, Male', contrasts with “the islands” — a distinction which is particularly evident in the public health sphere, where striving for health equity encounters geographical and socio-political obstacles. Using the topic of the inherited blood disorder thalassaemia as a magnifying lens, this paper asks how different actors are making sense of health inequities between central and outer islands in the Maldivian archipelago. Intra-archipelagic and international mobilities add to the complexities of topological relations, experiences, and representations within this multi-island assemblage. Yet, my study of archipelagic health relations is not confined to a mere outside look at the construction of the ‘island other’ within the archipelagic community. It is a situated investigative gaze on disjunctures, connections, and entanglements, reflecting my methodological-theoretical attempt to unravel my own involvement in island–island relations and representations — my being entangled while investigating entanglements.

Who Counts Where? COVID-19 Surveillance in Federal Countries

2021 ◽  
Author(s):  
Philip Rocco ◽  
Jessica A. J. Rich ◽  
Katarzyna Klasa ◽  
Kenneth A. Dubin ◽  
Daniel Béland
Keyword(s):  
Public Health ◽  
Data Quality ◽  
Health System ◽  
Case Studies ◽  
Fiscal Decentralization ◽  
Public Health System ◽  
System Capacity ◽  
Democratic Institutions ◽  
Subnational Governments

Abstract Context: While the World Health Organization (WHO) has established guidance on COVID-19 surveillance, little is known about implementation of these guidelines in federations, which fragment authority across multiple levels of government. This study examines how subnational governments in federal democracies collect and report data on COVID-19 cases and mortality associated with COVID-19. Methods: We collected data from subnational government websites in 15 federal democracies to construct indices of COVID-19 data quality. Using bivariate and multivariate regression, we analyzed the relationship between these indices and indicators of state capacity, the decentralization of resources and authority, and the quality of democratic institutions. We supplement these quantitative analyses with qualitative case studies of subnational COVID-19 data in Brazil, Spain, and the United States. Findings: Subnational governments in federations vary in their collection of data on COVID-19 mortality, testing, hospitalization, and demographics. There are statistically significant associations (p<0.05) between subnational data quality and key indicators of public health system capacity, fiscal decentralization, and the quality of democratic institutions. Case studies illustrate the importance of both governmental and civil-society institutions that foster accountability. Conclusions: The quality of subnational COVID-19 surveillance data in federations depends in part on public health system capacity, fiscal decentralization, and the quality of democracy.

Measuring and Combatting Health-Related Inequalities

2021 ◽  
pp. 184-204
Author(s):  
James Wilson
Keyword(s):  
Public Health ◽  
Lived Experience ◽  
Health Systems ◽  
Health Equity ◽  
Power Structures ◽  
Health Related ◽  
Break Up ◽  
Pluralist Approach

This chapter examines how health systems should measure, and respond to, health-related inequalities. Health equity is often taken to be a core goal of public health, but what exactly health equity requires is more difficult to specify. There are indefinitely many health-related variables that can be measured, and variation in each of these variables can be measured in a number of different ways. Given the systemic interconnections between variables, making a situation more equal in some respects will tend to make it less equal in others. The chapter argues for a pluralist approach to health equity measurement, which takes its cue from the lived experience of individuals’ lives. Reflection on the deepest and most resilient causes of health-related inequalities shows that they are often the result of intersecting structural concentrations of power—structures which it is vital, but very difficult, to break up.

Health Systems and Public Health Thinking

Pained ◽  
2020 ◽  
pp. 67-68
Author(s):  
Michael D. Stein ◽  
Sandro Galea
Keyword(s):  
Public Health ◽  
Blood Pressure ◽  
Medication Adherence ◽  
Health System ◽  
Public Good ◽  
Health Systems ◽  
High Blood Pressure ◽  
Good Health ◽  
Appointment Keeping

This chapter addresses how homelessness affects health. The disordered lives of homeless patients disrupt appointment-keeping and medication adherence, even as they generate need for more treatment by driving health challenges like depression, high blood pressure, and hospitalizations. As such, some health systems have begun to address the link between homelessness and health. One Boston health system, for example, announced plans to subsidize housing for the patients for whom it is accountable, to give this population some measure of the shelter and stability necessary for good health. As a society, people tend to forget that health is a public good supported by their collective investment in resources such as education, the environment, and, indeed, housing. Health systems can help people remember, by investing in these resources, to improve the health of patients. Indeed, health systems can direct people toward a better understanding of what truly shapes health, but it is ultimately the people’s responsibility to act on that knowledge and build a world that generates health.

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