An important new health policy voice

In the 10 years since its founding, the Israel Journal of Health Policy Research has established itself as an important voice in Israeli and international health policy. The Journal’s ability to combine national and international perspectives on key issues in health services delivery and health systems analysis has developed a valuable new arena for academic research about the increasingly complex post-COVID future of health care systems.

A Qualitative Analysis of Burn Injury Patient and Caregiver Experiences in Kwazulu-Natal, South Africa: Enduring the Transition to a Post-Burn Life

Over 95% of fire-related burns occur in low- and middle-income countries (LMICs), an important and frequently overlooked global health disparity, yet research is limited from LMICs on how survivors and their caregivers recover and successfully return to their pre-burn lives. This study examines the lived experiences of burn patients and caregivers, the most challenging aspects of their recoveries, and factors that have assisted in recovery. This qualitative study was conducted in KwaZulu-Natal, South Africa at a 900-bed district hospital. Participants (n = 35) included burn patients (n = 13) and caregivers (n = 22) after discharge. In-depth interviews addressed the recovery process after a burn injury. Data were coded using NVivo 12. Analysis revealed three major thematic categories. Coded data were triangulated to analyze caregiver and patient perspectives jointly. The participants’ lived experiences fell into three main categories: (1) psychological impacts of the burn, (2) enduring the transition into daily life, and (3) reflections on difficulties survivors face in returning for aftercare. The most notable discussions regarded stigma, difficulty accepting self-image, loss of relationships, returning to work, and barriers in receiving long-term aftercare at the hospital outpatient clinic. Patients and caregivers face significant adversities integrating into society. This study highlights areas in which burn survivors may benefit from assistance to inform future interventions and international health policy.

The American Roots of Social Epidemiology and its Transnational Circulation. From the African-American Hypertension Enigma to the WHO’s Recommendations

In 2008, the Commission on Social Determinants of Health at the World Health Organisation published a report demonstrating the existence of a socio-economic gradient for health. Though health inequalities had been apparent since at least the 19th century, the report introduced a bio-psycho-social aetiological model that was absent from 19th century social medicine, as well as from former WHO documents. To bio-psycho-social epidemiologists stress associated with social status is the main cause of morbidity and death. Here I begin by noting that the history social epidemiologists have written for their fi eld tends to inscribe their work in continuity with 19th century social medicine. This contributes towards minimizing the epistemological and contextual transformations that led bio-psycho-social epidemiology to initiate a profound transformation in international health policy. Adopting an epistemological and transnational perspective, I fi rstly argue that bio-psycho-social epidemiology emerged from René Dubos’ historical and epistemological critique of the foundation of 19th century social medicine. I secondly show how the political and epistemological research program elaborated by Dubos developed in the US context, which was characterized both by a growing concern for chronic diseases and for racial inequalities. Finally, I show that through its transnational circulation in the United Kingdom, bio-psycho-social epidemiology was “de-racialized”. This step was a prerequisite for its aetiological model to be integrated into international public health strategies and to transform them.

Assessing Performance in Health Care Using International Surveys: Are Patient and Clinician Perspectives Complementary or Substitutive

Background: Over the last decade, international surveys of patients and clinicians have been used to compare health care across countries. Findings from these surveys have been extensively used to create aggregate scores and rankings. Objective: To assess the concordance of survey responses provided by patients and clinicians. Methods: Analysis of 16 pairs of questions that focused on coordination, organizational factors, and patient-centered competencies from the Commonwealth Fund International Health Policy Survey of older adults (2014) and of primary care physicians (2015). Concordance was assessed by comparing absolute rates and relative rankings. Results: In absolute terms, patients and clinicians gave differing responses for questions about coordination of care (patients were more positive) and provision of after-hours care (patients were less positive). In relative terms, country rankings were positively correlated for 5 of 16 question pairs (Spearman ρ > .6 and P < .05). Conclusion: Patterns of concordance between patient and clinician perspectives provides information to guide the use of survey data in performance assessment. However, this study highlights the need to assess the complementarity and substitutive nature of patients’ and clinicians’ perspectives before combining them to create aggregate assessments of performance.

We Need to Talk About Corruption in Health Systems

The health sector consistently appears prominently in surveys of perceived corruption, with considerable evidence that this has serious adverse consequences for patients. Yet this issue is far from prominent in the international health policy discourse. We identify five reasons why the health policy community has been reluctant to talk about it. These are the problem of defining corruption, the fact that some corrupt practices are actually ways of making dysfunctional systems work, the serious challenges to researching corruption, concerns that a focus on corruption is a form of victim blaming that ignores larger issues, and a lack of evidence about what works to tackle it. We propose three things that can be done to address this situation. First, seek consensus on the scale and nature of corruption. Second, decide on priorities, taking account the importance of the particular problem and the feasibility of doing something about it. Third, take a holistic view, drawing on a wide range of disciplines.

Health in All Policies (HiAP) governance: lessons from network governance

The Health in All Policies (HiAP) approach requires formal and sustained governance structures and mechanisms to ensure that the policies of various non-health sectors maximize positive and minimize negative impacts on population health. In this paper, we demonstrate the usefulness of a network perspective in understanding and contributing to the effectiveness of HiAP. We undertook an exploratory, qualitative case study of a HiAP structure in Iran, the Kerman province Council of Health and Food Security (CHFS) with diverse members from health and non-health sectors. We analyzed relevant policy texts and interviewed 32 policy actors involved in the CHFS. Data were analyzed using within-case analysis and constant comparative methodology. Our findings suggest that CHFS governance from a network perspective drew in practice on elements of two competing network governance modes: the network administrative organization (NAO) and the lead organization mode. Our results also show that a shift from a hierarchical and market-based mode of interaction to a network logic within CHFS has not yet taken place. In addition, CHFS suffers from large membership and an inability to address complex ‘wicked problems’, as well as low trust, legitimacy and goal consensus among its members. Drawing on other HiAP studies and commentaries, insights from organization network theory, and in-depth findings from our case study, we conclude that a NAO may be the most effective mode of governance for tackling complex social problems in HiAP structures. Since similar studies are limited, and our single case study may not be transferable across all contexts, we suggest that further research be undertaken to explore HiAP structures from a network perspective in different institutional and cultural settings. With increasing emphasis given to HiAP approaches in national and international health policy discourse, it is important that comparative knowledge about the effectiveness of HiAP governance arrangements be developed.