scholarly journals Efficiency of the primary health care policy in Brazilian municipalities: an application of the Pearl’s Structural Causal Model

2021 ◽  
Author(s):  
Darlan Christiano Kroth ◽  
Raquel Rangel de Meirelles Guimarães
Keyword(s):  
Health Policy ◽  
Health Outcomes ◽  
Health Care Policy ◽  
Causal Model ◽  
Causal Effect ◽  
Vulnerability Index ◽  
Future Research ◽  
Policy Performance ◽  
Unified Health System ◽  
Health Vulnerability

ABSTRACT Background In recent years, public health policies and their effects on improving health outcomes have been gaining prominence in the economic literature and on the agenda of international organizations. Objective This study aims to evaluate the causal effect of the “Pacto pela Saúde” (Pact for Health) program on health policy performance in terms of a Health Vulnerability Index (HVI) of Brazilian municipalities from 2006 to 2013. The “Pacto pela Saúde” program is the current operational standard of the Brazilian Unified Health System (SUS). One of the main guidelines of this program was to improve health policy governance. Method The effect resulting from efficiency gains of the participation of municipalities in the health policy on the HVI was estimated by the Pearl’s Structural Causal Model. Results The results indicate a positive and significant impact of efficiency management on the reduction of health vulnerability in the municipalities. The Pearl’s Causal Model and the back-door criterion of causal identification were employed to calculate the effects of the “Pacto pela Saúde” program on the HVI. Conclusion The use of Pearl’s method in this study contributed to a more comprehensive analysis of the effects of the “Pacto pela Saúde” program on health outcomes and, therefore, its use in future research on the analysis of public policies is recommended.

scholarly journals Measuring Health Vulnerability: An Interdisciplinary Indicator Applied to Mainland Portugal

2019 ◽  
Vol 16 (21) ◽  
pp. 4121 ◽  
Author(s):  
Oliveira ◽  
Vidal ◽  
Ferraz ◽  
Cabeda ◽  
Pontes ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Progress Monitoring ◽  
Statistical Tests ◽  
Composite Index ◽  
Reference Method ◽  
Vulnerability Index ◽  
Health Determinants ◽  
Life Conditions ◽  
Mainland Portugal ◽  
Health Vulnerability

Health promotion and inequality reduction are specific goals of the United Nations 2030 Agenda, which are interconnected with several dimensions of life. This work proposes a composite index SEHVI—socioeconomic health vulnerability index—to address Portuguese population socioeconomic determinants that affect health outcomes. Variables composing SEHVI are aligned with the sustainable development goals considering data and times series availability to enable progress monitoring, and variables adequacy to translate populations’ life conditions affecting health outcomes. Data for 35 variables and three periods were collected from official national databases. All variables are part of one of the groups: Health determinants (social, economic, cultural, and environmental factors) and health outcomes (mortality indicators). Variables were standardized and normalized by “Distance to a reference” method and then aggregated into the SEHVI formula. Several statistical procedures for validation of SEHVI revealed the internal consistency of the index. For all municipalities, SEHVI was calculated and cartographically represented. Results were analyzed by statistical tests and compared for three years and territory typologies. SEHVI differences were found as a function of population density, suggesting inequalities of communities’ life conditions and in vulnerability to health.

scholarly journals Policy Implementation Science to Advance Population Health: The Potential for Learning Health Policy Systems

2021 ◽  
Vol 9 ◽  
Author(s):  
April Oh ◽  
Ali Abazeed ◽  
David A. Chambers
Keyword(s):  
Public Health ◽  
Health Policy ◽  
Policy Implementation ◽  
Health Outcomes ◽  
Implementation Science ◽  
Population Health ◽  
Health Care Policy ◽  
Time Lag ◽  
Health Policies ◽  
Policy System

Many health policies are designed with the intention of improving health outcomes for all. Yet implementation of policies are variable across contexts, potentially limiting its impact on population health outcomes. The potential impact of a policy to advance health equity depends both on the design and its implementation, requiring ongoing evaluation and stakeholder engagement. Despite the importance of health policies in shaping public health, health care policy implementation science remains underrepresented in research. We argue that enhanced integration of policy questions within implementation science could reduce the time lag from policy to practice and improve population health outcomes to build a body of evidence on effective policy implementation. In this commentary, we argue that approaches to studying policy implementation science should reflect the dynamic and evolving policy context, analogous to the “learning healthcare system,” to better understand and respond to systematic and multilevel impacts of policy. Several example opportunities for a learning health policy system are posed in building a broader agenda toward research and practice in policy implementation science in public health.

scholarly journals Diversity, Inclusive Leadership, and Health Outcomes

2020 ◽  
Author(s):  
Elizabeth H. Bradley
Keyword(s):  
Health Policy ◽  
Health Outcomes ◽  
Ethnic Diversity ◽  
Healthcare Workers ◽  
Future Research ◽  
Management Research ◽  
Inclusive Leadership ◽  
Wide Range ◽  
Role Definitions ◽  
Speak Up

In this time of polarization and divisiveness across increasingly diverse communities, health policy and management research offers an important insight: engaging diversity meaningfully through inclusive leadership—that embraces staff across hierarchies and engages difference perspectives so that all healthcare workers of all kinds feel they can speak up and participate—can save lives. In multiple studies of quality in cardiovascular care, top performing hospitals have been shown to exhibit the capacity to embrace staff across hierarchies and engage differences so that healthcare workers of all kinds feel they can speak up and participate meaningfully in improvement efforts. Most recently, in the two-year, longitudinal Leadership Saves Lives study of 10 hospitals, the ability to adopt a culture of improvement rather than blaming was linked to significant reductions in risk-standardized mortality rates. Moreover, the guiding coalitions (ie, quality improvement teams) in six of the 10 hospitals that were most successful were distinguished in three ways that give insight about effective modes of engaging differences: (1) including staff from difference disciplines and levels in the organizational hierarchy, (2) encouraging authentic participation by the members, and (3) using constructive patterns of managing conflict (ie, having clear role definitions, working to surface minority viewpoints, and collectively revisiting the shared goal of saving lives). Based on this literature, adequately engaging a wide range of diverse viewpoints and staff roles can have a marked impact on health outcomes. Although the studies reviewed do not examine racial/ethnic diversity per se, they do lend insight into effectively navigating environments with extensive diversity of perspectives, professional identities, and experiences. Future research may assess whether these insights have application to other forms of diversity as well. In this time of extreme polarization and division globally and locally, health policy and management research has an opportunity to share evidence that could help navigate an increasingly diverse environment, at least within the field of healthcare, towards a more inclusive, humane, and life-giving approach to our collective future.

Habit and Routine Interventions with Emerging Adults with Diabetes: An Integrative Review

2021 ◽  
pp. 019394592110322
Author(s):  
Kathleen M. Hanna ◽  
Jed R. Hansen ◽  
Kim A. Harp ◽  
Kelly J. Betts ◽  
Diane Brage Hudson ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Health Outcomes ◽  
Emerging Adults ◽  
Text Messaging ◽  
Integrative Review ◽  
Self Management ◽  
Future Research ◽  
Medical Librarian

Although theoretical and empirical writings on habits and routines are a promising body of science to guide interventions, little is known about such interventions among emerging adults with type 1 diabetes. Thus, an integrative review was conducted to describe interventions in relation to habits and routines, their influence on outcomes, and users’ perspectives. A medical librarian conducted a search. Teams screened titles, abstracts, and articles based upon predefined criteria. Evidence from the final 11 articles was synthesized. A minority of investigators explicitly articulated habits and routines theoretical underpinnings as part of the interventions. However, text messaging or feedback via technology used in other interventions could be implicitly linked to habits and routines. For the most part, these interventions positively influenced diabetes self-management-related behaviors and health outcomes. In general, the interventions were perceived positively by users. Future research is advocated using habit and routine theoretical underpinnings to guide interventions.

scholarly journals Assessing the indirect effects of COVID-19 on healthcare delivery, utilization and health outcomes: a scoping review

2021 ◽  
Author(s):  
Charlotte M Roy ◽  
E Brennan Bollman ◽  
Laura M Carson ◽  
Alexander J Northrop ◽  
Elizabeth F Jackson ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Health Effects ◽  
Scoping Review ◽  
Cardiovascular Health ◽  
Healthcare Delivery ◽  
Final Analysis ◽  
High Income ◽  
Future Research ◽  
Published Data ◽  
Local Health

Abstract Background The COVID-19 pandemic and global efforts to contain its spread, such as stay-at-home orders and transportation shutdowns, have created new barriers to accessing healthcare, resulting in changes in service delivery and utilization globally. The purpose of this study is to provide an overview of the literature published thus far on the indirect health effects of COVID-19 and to explore the data sources and methodologies being used to assess indirect health effects. Methods A scoping review of peer-reviewed literature using three search engines was performed. Results One hundred and seventy studies were included in the final analysis. Nearly half (46.5%) of included studies focused on cardiovascular health outcomes. The main methodologies used were observational analytic and surveys. Data were drawn from individual health facilities, multicentre networks, regional registries, and national health information systems. Most studies were conducted in high-income countries with only 35.4% of studies representing low- and middle-income countries (LMICs). Conclusion Healthcare utilization for non-COVID-19 conditions has decreased almost universally, across both high- and lower-income countries. The pandemic’s impact on non-COVID-19 health outcomes, particularly for chronic diseases, may take years to fully manifest and should be a topic of ongoing study. Future research should be tied to system improvement and the promotion of health equity, with researchers identifying potentially actionable findings for national, regional and local health leadership. Public health professionals must also seek to address the disparity in published data from LMICs as compared with high-income countries.

scholarly journals Do Commodity Price Shocks Cause Armed Conflict? A Meta-Analysis of Natural Experiments

2021 ◽  
pp. 1-8
Author(s):  
GRAEME BLAIR ◽  
DARIN CHRISTENSEN ◽  
AARON RUDKIN
Keyword(s):  
Causal Effect ◽  
Meta Analysis ◽  
Resource Curse ◽  
Civil Conflict ◽  
Commodity Price ◽  
Future Research ◽  
Natural Experiments ◽  
Price Changes ◽  
Price Increases ◽  
Commodity Price Shocks

Scholars of the resource curse argue that reliance on primary commodities destabilizes governments: price fluctuations generate windfalls or periods of austerity that provoke or intensify civil conflict. Over 350 quantitative studies test this claim, but prominent results point in different directions, making it difficult to discern which results reliably hold across contexts. We conduct a meta-analysis of 46 natural experiments that use difference-in-difference designs to estimate the causal effect of commodity price changes on armed civil conflict. We show that commodity price changes, on average, do not change the likelihood of conflict. However, there are cross-cutting effects by commodity type. In line with theory, we find price increases for labor-intensive agricultural commodities reduce conflict, while increases in the price of oil, a capital-intensive commodity, provoke conflict. We also find that price increases for lootable artisanal minerals provoke conflict. Our meta-analysis consolidates existing evidence, but also highlights opportunities for future research.

Are Discount Rates Too High? Population Health and Intergenerational Equity

2021 ◽  
Vol 41 (2) ◽  
pp. 245-249
Author(s):  
R. Scott Braithwaite ◽  
Mark S. Roberts
Keyword(s):  
Health Policy ◽  
Cost Effectiveness ◽  
Decision Theory ◽  
Health Outcomes ◽  
Societal Perspective ◽  
Environmental Damage ◽  
Healthy Population ◽  
Discount Rates ◽  
Policy Decisions ◽  
Effectiveness Analysis

Increasing attention is being paid to policy decisions in which shorter-term benefits may be eclipsed by longer-term harms, such as environmental damage. Health policy decisions have largely been spared this scrutiny, even though they too may contribute to longer-term harms. Any healthy population or society must sustain itself through reproduction, and therefore, transgenerational outcomes should be of intrinsic importance from a societal perspective. Yet, the discount rates typically employed in cost-effectiveness analyses have the effect of minimizing the importance of transgenerational health outcomes. We argue that, because cost-effectiveness analysis is based on foundational axioms of decision theory, it should value transgenerational outcomes consistently with those axioms, which require discount rates substantially lower than 3%. We discuss why such lower rates may not violate the Cretin-Keeler paradox.

A Systematic Review of Multi-Component Comprehensive School Physical Activity Program (CSPAP) Interventions

2021 ◽  
pp. 089011712110132
Author(s):  
Ann Pulling Kuhn ◽  
Peter Stoepker ◽  
Brian Dauenhauer ◽  
Russell L. Carson
Keyword(s):  
Physical Activity ◽  
Physical Education ◽  
Health Outcomes ◽  
Academic Outcomes ◽  
English Language ◽  
Comprehensive School ◽  
Physical Activity Program ◽  
School Level ◽  
Future Research ◽  
Activity Program

Objective: To identify, review, and describe multicomponent physical activity (PA) interventions in terms of: (a) number and combination of Comprehensive School Physical Activity Program (CSPAP) components, (b) study characteristics, and (c) primary outcomes. Data Source: Five electronic databases (i.e., PubMed, PsychInfo, Physical Education Index, Sport Discus, and ERIC). Study Inclusion and Exclusion Criteria: Included articles were peer-reviewed, written in English language, published since 1987, and included multicomponent school-based interventions. Data Extraction: Data items extracted were: school level, setting, CSPAP component description, health outcomes, academic outcomes, main conclusion, and reference. Data Synthesis: Included articles were synthesized by: (1) CSPAP components utilized, and (2) research outcome measured (i.e., health or academic). Results: Across 32 studies, 11 included physical education plus 1 additional CSPAP component (PE + 1); 10 included PE + 2 additional CSPAP components; 8 included PE + 3 additional CSPAP components; and 1 included all 5 CSPAP components. Two other studies included 2 or 3 CSPAP components without PE. Most interventions targeted health outcomes (94%) rather than academic outcomes (6%). Conclusions: Multicomponent approaches aligned with CSPAPs are effective in promoting PA and other positive outcomes for youth in schools. Future research should seek to understand effects of CSPAP components on a variety of outcomes and settings.

scholarly journals Updated systematic review and meta-analysis of studies examining the relationship between reported racism and health and well-being for children and youth: a protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e043722
Author(s):  
Naomi Priest ◽  
Kate Doery ◽  
Mandy Truong ◽  
Shuaijun Guo ◽  
Ryan Perry ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Outcomes ◽  
Research Policy ◽  
Meta Analysis ◽  
Well Being ◽  
Children And Youth ◽  
Effect Sizes ◽  
Future Research ◽  
Critical Determinant ◽  
Health And Well Being

IntroductionRacism is a critical determinant of health and health inequities for children and youth. This protocol aims to update the first systematic review conducted by Priest et al (2013), including a meta-analysis of findings. Based on previous empirical data, it is anticipated that child and youth health will be negatively impacted by racism. Findings from this review will provide updated evidence of effect sizes across outcomes and identify moderators and mediators of relationships between racism and health.Methods and analysisThis systematic review and meta-analysis will include studies that examine associations between experiences of racism and racial discrimination with health outcomes of children and youth aged 0–24 years. Exposure measures include self-reported or proxy reported systemic, interpersonal and intrapersonal racism. Outcome measures include general health and well-being, physical health, mental health, biological markers, healthcare utilisation and health behaviours. A comprehensive search of studies from the earliest time available to October 2020 will be conducted. A random effects meta-analysis will examine the average effect of racism on a range of health outcomes. Study-level moderation will test the difference in effect sizes with regard to various sample and exposure characteristics. This review has been registered with the International Prospective Register of Systematic Reviews.Ethics and disseminationThis review will provide evidence for future research within the field and help to support policy and practice development. Results will be widely disseminated to both academic and non-academic audiences through peer-review publications, community summaries and presentations to research, policy, practice and community audiences.PROSPERO registration numberCRD42020184055.

scholarly journals Attachment and relationships: Milestones and future directions

2010 ◽  
Vol 27 (2) ◽  
pp. 173-180 ◽  
Author(s):  
Jeffry A. Simpson ◽  
W. Steven Rholes
Keyword(s):  
Health Outcomes ◽  
Attachment Theory ◽  
Adult Attachment ◽  
Future Research ◽  
Future Directions ◽  
The Past

Adult attachment researchers have made important strides during the past 25 years in testing and applying attachment theory to multiple personal and interpersonal domains. We highlight some of the major milestones and then propose several directions for future research. Some of the most important and promising directions include testing additional normative processes implied by attachment theory, developing and testing critical connections between attachment theory and other major interpersonal theories, and identifying pathways between attachment processes and long-term health outcomes.

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