Students of Change: Health Policy in Action

Background and Objectives: Health policy is more impactful for public health than many other strategies as it can improve health outcomes for an entire population. Yet in the “see one, do one, teach one” environment of medical school, most students never get past the “see one” stage in learning about the powerful tools of health policy and advocacy. The University of New Mexico School of Medicine mandates health policy and advocacy education for all medical students during their family medicine clerkship rotation. The aim of this project is to describe a unique health policy and advocacy course within a family medicine clerkship. Methods: We analyzed policy briefs from 265 third-year medical students from April 2016 through April 2019. Each brief is categorized by the level of change targeted for policy reform: national, state, city, or university/school. Implemented policies are described. Results: Slightly less than one-third of the policies (30%) relate to education, 36% advocate for health system change by addressing cost, access, or quality issues, and 34% focus on public health issues. Fourteen policies have been initiated or successfully enacted. Conclusions: This curriculum gives each medical student a health policy tool kit with immediate opportunities to test their skills, learn from health policy and advocacy experts, and in some cases, implement health policies while still in medical school. A 1-week family medicine policy course can have impact beyond the classroom even during medical school, and other schools should consider this as a tool to increase the impact of their graduates.

Comparing student motivations for and emotional responses to national standardised tests and internal school tests: The devil in the detail

National testing of students has become an increasingly prevalent policy tool, often implemented to drive improvement through increased accountability and heightened competition between schools. Such testing has been found to generate negative emotional responses among students, including increased stress and anxiety . However, there is little examining whether such responses are associated specifically with national testing regimes or are more general responses to testing situations. This study surveyed 206 students in Australian secondary schools to compare responses to NAPLAN and internal school tests. Students reported higher expectations for their performance in internal school tests than for NAPLAN, higher levels of boredom for NAPLAN and greater levels of confidence for their internal school tests. While most students reported low levels of negative emotional responses to NAPLAN, a small group of students reported strong negative emotional responses to both NAPLAN and internal school tests, suggesting that negative responses to national testing programs may be more dependent on the individual student.

Education as a Social Policy Tool and Educational Policies of Azerbaijan for Youth

Young people should present a future, create a human resource for the progress of societies, and protect young people against social risks. At this point, the protection of youth through public policies is one of the main areas of Azerbaijani public policies. The problems faced by young people in access to education and the problems experienced by educated young people in gaining a place in the labor market are some of the main youth problems. In this respect, it is of academic importance to examine the social policies offered by the Government of Azerbaijan for young people. The main framework of the study is the educational status of young people, the general framework of policies for young people, and social policies presented in the face of educational problems.

TRIPS to Where? A Narrative Review of the Empirical Literature on Intellectual Property Licensing Models to Promote Global Diffusion of Essential Medicines

Governed through the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) since 1995, the current medical R&D system requires significant trade-offs between innovation and high monopoly prices for patented drugs that restrict patient access to medicines. Since its implementation, few amendments have been made to the original TRIPS agreement to allow low- and middle-income countries (LMICs) to facilitate access by generic manufacturers through flexible provisions, such as compulsory licensing and parallel import. Although a useful policy tool in theory, the routine use of TRIPS flexibilities in LMICs in the procurement of new essential medicines (EMs) is regarded as a ‘last resort’ due to strong political response in high-income countries (HICs) and new trade agreements’ restrictions. In this context, access-oriented biomedical Public-Private Partnerships (PPPs) have emerged. More recently, leading multilateral health organizations have recommended different types of intellectual property (IP) interventions, voluntary biomedical patent pools, as strategies to reduce prices and increase the diffusion of novel EMs in LMICs. Nevertheless, the recent Ebola and COVID-19 outbreaks highlight growing concerns regarding the use of TRIPS flexibilities and the limited success of voluntary mechanisms in promoting access to medicines in the Global South amidst health crises. This review aims at describing the state-of-the-art empirical research on IP-related options and voluntary mechanisms applied by emerging PPPs to guarantee timely and affordable access to EM in LMICs and reflect on both models as access paradigms. Some suggestions are put forward for future research paths on the basis of these analyses and in response to contemporary debates on waiving key IP rights on COVID-19 therapies, diagnostics, and vaccines.

Is Green Credit a Good Tool to Achieve “Double Carbon” Goal? Based on Coupling Coordination Model and PVAR Model

China attaches importance to the combination of credit policy and environmental protection, tries to use credit policy tools to protect ecology and pollution prevention, and prevent environmental credit risk. With the proposal of the goal of “carbon peak and carbon neutralisation” (“double carbon”), green credit is also regarded as an important policy tool to achieve this goal. Firstly, this paper selects the time series data of green credit at the national level from 2013 to 2019 according to the official statistics and evaluates the coupling and coordinated development of credit system and environmental system based on the coupling coordination model. The results show that the two systems show well-coordinated development, but the interaction has annual fluctuations. Secondly, by calculating the provincial carbon emissions and green credit panel data from 2005 to 2019, the dynamic internal mechanism is analysed based on Panel Vector Autoregression (PVAR) model. It is found that green credit has a significant inhibitory effect on carbon emissions. The research results of this paper provide an overall evaluation of the quantity and quality of green credit for China’s banking industry. It also provides reasonable and effective support for green credit as a policy tool to promote realising the “double carbon” goal. In addition, China should maintain the consistency, stability and durability of green credit policy and continue to contribute to the low-carbon transformation of the economy and society.

Visualising policy responses during health emergencies. Learning from the COVID-19 policy trackers

Data visualisations are intimately connected to the emergence of public health as a discipline and policy area. Besides the mapping of cases and deaths, the COVID-19 pandemic has seen an explosion of attempts to track policy responses. They have come from actors sometimes initially unfamiliar with public and global health. In this paper, we analyse seven of the most successful tracker initiatives that have sought to map governments’ reactions to COVID-19 and reflect on our own. When not led by international organisations, the trackers primarily rely on networks of volunteer country expert contributors (who need to be incentivised in the medium term). The vertical crowdsourcing approach means that, despite good intentions, contributors have a relatively limited agency in shaping the trackers. Maps and timelines comparing countries are the most popular visualisations; they suggest that (some) policy solutions can be found abroad and rely on policy taxonomies established by the trackers’ core teams. We contend that such taxonomies, which compete with each other, constitute attempts to frame the complex issue of which policies matter in responding to COVID-19. All the projects are large and complex and often without a well-defined intended audience. We hypothesise that the popularity (in terms of backlinks) of the most successful tracker arises from the fact that it sums up COVID-19 policies in one easily visualisable indicator. We suggest that the trackers are a more helpful emergency policy tool when they provide contextual information, keep policy details or refer to them (rather than only reduce them to categories), and suggest ways to link different elements—including the relationship between health or societal outcomes and policies.

How can solar geoengineering and mitigation be combined under climate targets?

So far, scientific analyses have mainly focused on the pros and cons of solar geoengineering or solar radiation management (SRM) as a climate policy option in mere isolation. Here, we put SRM into the context of mitigation by a strictly temperature-target-based approach. As the main innovation, we present a scheme that extends the applicability regime of temperature targets from mitigation-only to SRM-mitigation analyses. We explicitly account for one major category of side effects of SRM while minimizing economic costs for complying with the 2 ∘C temperature target. To do so, we suggest regional precipitation guardrails that are compatible with the 2 ∘C target. Our analysis shows that the value system enshrined in the 2 ∘C target leads to an elimination of most of the SRM from the policy scenario if a transgression of environmental targets is confined to 1/10 of the standard deviation of natural variability. Correspondingly, about half to nearly two-thirds of mitigation costs could be saved, depending on the relaxation of the precipitation criterion. In addition, assuming a climate sensitivity of 3 ∘C or more, in case of a delayed enough policy, a modest admixture of SRM to the policy portfolio might provide debatable trade-offs compared to a mitigation-only future. Also, in our analysis which abstains from a utilization of negative emissions technologies, for climate sensitivities higher than 4 ∘C, SRM will be an unavoidable policy tool to comply with the temperature targets. The economic numbers we present must be interpreted as upper bounds in the sense that cost-lowering effects by including negative emissions technologies are absent. However, with an additional climate policy option such as carbon dioxide removal present, the role of SRM would be even more limited. Hence, our results, pointing to a limited role of SRM in a situation of immediate implementation of a climate policy, are robust in that regard. This limitation would be enhanced if further side effects of SRM are taken into account in a target-based integrated assessment of SRM.

Social Workers in Primary Care Increase Access to Palliative Care

Clinical trials show that palliative care improves patient experiences and reduces costs, and use of palliative care and hospice care have been increasing over the past three decades. In the Veterans Administration health care system (VA), Veterans may receive palliative care concurrently with other treatments. However, many barriers exist to the use of palliative care, such as patients’ misperceptions. Social workers in primary care teams may increase use of this valuable service by establishing trust between patient and care team, educating patients and caregivers, and coordinating services. Leveraging a national social-work-staffing program as a natural experiment, we evaluated the effect of hiring one or more social workers to the primary-care team on use of palliative or hospice care among Veterans with a recent hospital stay. Our data included 91,675 episodes of care between 2016 and 2018. 1.45 percent of episodes were followed by use of palliative care or hospice within 30 days. The addition of one or more social workers through the staffing program was associated with an increase of 0.53 percentage points (p<0.001) in the probability of any palliative or hospice care, i.e., a more than 30% increase relative to the mean. Policy makers and health system leaders who seek to improve patient experience and reduce costs through increased access to palliative and hospice care could consider social work staffing as a policy tool to achieve those aims.