ORIGINAL_ARTICLE
Legalizing and Regulating Marijuana in Canada: Review of Potential Economic, Social, and Health Impacts
Notwithstanding a century of prohibition, marijuana is the most widely used illicit substance in Canada. Due to the growing public acceptance of recreational marijuana use and ineffectiveness of the existing control system in Canada, the issue surrounding legalizing this illicit drug has received considerable public and political attentions in recent years. Consequently, the newly elected Liberal Government has formally announced that Canada will introduce legislation in the spring of 2017 to start legalizing and regulating marijuana. This editorial aims to provide a brief overview on potential economic, social, and public health impacts of legal marijuana in Canada. The legalization could increase tax revenue through the taxation levied on marijuana products and could also allow the Government to save citizens’ tax dollars currently being spent on prohibition enforcement. Moreover, legalization could also remove the criminal element from marijuana market and reduce the size of Canada’s black market and its consequences for the society. Nevertheless, it may also lead to some public health problems, including increasing in the uptake of the drug, accidents and injuries. The legalization should be accompanied with comprehensive strategies to keep the drug out of the hands of minors while increasing awareness and knowledge on harmful effects of the drug. In order to get better insights on how to develop an appropriate framework to legalize marijuana, Canada should closely watch the development in the neighboring country, the United States, where some of its states viz, Colorado, Oregon, Washington, and Alaska have already legalized recreational use of marijuana.
https://www.ijhpm.com/article_3208_35275c05312a123630205db0eae53265.pdf
2016-08-01
453
456
10.15171/ijhpm.2016.63
Legalization of Marijuana
Economic Effect
Social Effects
Health Effects
Canada
Mohammad
Hajizadeh
m.hajizadeh@dal.ca
1
School of Health Administration, Dalhousie University, Halifax, NS, Canada
LEAD_AUTHOR
Ben Amar M. Cannabinoids in medicine: A review of their therapeutic potential. J Ethnopharmacol. 2006;105(1-2):1-25. Doi:10.1016/j.jep.2006.02.001
1
Cayer A. The “High” Economic Benefits of Legalizing Marijuana in Canada. http://www.ruor.uottawa.ca/bitstream/10393/25386/1/2010_cayer_aaron.pdf. Published 2010.
2
Adler JN, Colbert JA. Medicinal Use of Marijuana — Polling Results. N Engl J Med. 2013;368(22):e30. Doi:10.1056/nejmclde1305159
3
Rotermann M, Langlois K. Prevalence and correlates of marijuana use in Canada, 2012. Health Rep. 2015;26(4):10-15.
4
George T, Vaccarino F. Substance Abuse in Canada. Ottawa, ON; 2015.
5
Morse T. Decriminalization Versus Legalization of Marijuana. http://uspolitics.about.com/od/warondrugs/fl/Decriminalization-Versus-Legalization-of-Marijuana.htm. Published 2016.
6
Caulkins JP, Kasunic A, Kleiman M, Lee MAC. Understanding drug legalization. Int Public Health J. 2014;6(3):283-294.
7
Svrakic DM, Lustman PJ, Mallya A, Lynn TA, Finney R, Svrakic NM. Legalization, decriminalization & medicinal use of cannabis: a scientific and public health perspective. Mo Med. 2012;109(2):90-99.
8
Joffe A, Yancy WS. Legalization of marijuana: potential impact on youth. Pediatrics. 2004;113(6):e632-e638. Doi:10.1542/peds.113.6.e632
9
Salomonsen-Sautel S, Sakai JT, Thurstone C, Corley R, Hopfer C. Medical marijuana use among adolescents in substance abuse treatment. J Am Acad Child Adolesc Psychiatry. 2012;51(7):694-702. Doi:10.1016/j.jaac.2012.04.004
10
Thurstone C, Lieberman SA, Schmiege SJ. Medical marijuana diversion and associated problems in adolescent substance treatment. Drug Alcohol Depend. 2011;118(2-3):489-492. Doi:10.1016/j.drugalcdep.2011.03.031
11
COMPAS Inc. Canada: Two-Thirds Favour Decriminalizing Pot. Toronto, Ontario; 2000.
12
Savas D. Public Opinion and Illicit Drugs Canadian Attitudes towards Decriminalizing the Use of Marijuana. Vancouver, BC; 2001.
13
SES Research. Perceptions on Marijuana Decriminalization. Toronto, Ontario; 2005. http://www.sesresearch.com/news/press_releases/PR February 28 2005.pdf.
14
Angus Reid. Half of Canadians Support the Legalization of Marijuana. Vancouver, BC; 2010. http://angusreidglobal.com/wp-content/uploads/2010/11/2010.11.29_Drugs_CAN.pdf.
15
Forum Research Inc. More than Two Thirds Support Decriminalization/legalization of Marijuana. Toronto, Ontario; 2013. http://www.forumresearch.com/forms/News Archives/News Releases/50140_Federal_Trudeau_-_Marijuana_(24082013)_Forum_Research.pdf.
16
Froum Research Inc. Support for Marijuana Legalization Steady at More than Half. Toronto, Ontario; 2015. http://poll.forumresearch.com/post/1362/just-one-tenth-think-current-laws-are-appropriate.
17
Evans P. 20% of Canadians smoked pot last year, but more than 30% would if legal, poll suggests. CBC News. November 10, 2015. http://www.cbc.ca/news/business/marijuana-pot-poll-survey-1.3312151.
18
Armstrong J. Majority of Canadians support decriminalizing marijuana: poll. Global News. August 19, 2015. http://globalnews.ca/news/2173919/majority-of-canadians-support-decriminalizing-marijuana-poll/.
19
Smith J. Marijuana legislation coming to Canada next spring. The Star. April 20, 2016. http://www.thestar.com/news/canada/2016/04/20/marijuana-legislation-coming-to-canada-next-spring.html.
20
Blanchfield M. Legalizing pot in Canada wil run afoul of global treaties, Trudeau warned. CBC News. January 5, 2016. http://www.cbc.ca/news/politics/trudeau-legalizing-pot-global-treaties-1.3390745.
21
Glauser D. The economic effects of legalizing marijuana. http://content.lib.utah.edu/utils/getfile/collection/etd3/id/1880/filename/1882.pdf. Published 2012.
22
Government of Colorado. Colorado Marijuana Tax Data. https://www.colorado.gov/pacific/revenue/colorado-marijuana-tax-data. Accessed April 20, 2016. Published 2016.
23
Government of Colorado. Marijuana Taxes, Licenses, and Fees Transfers and Distribution. https://www.colorado.gov/pacific/sites/default/files/1215 Marijuana Tax%2C License%2C and Fees Report.pdf. Published 2015.
24
Canadian Center on Substance Abuse. Cannabis. Ottawa, Canada; 2016. http://www.ccsa.ca/Resource%20Library/CCSA-Canadian-Drug-Summary-Cannabis-2016-en.pdf
25
Shenfeld A. Economic Insights: The Winter of Our Discontent. Toronto, Ontario; 2016. http://research.cibcwm.com/economic_public/download/eijan16.pdf.
26
Cotter A, Greenland J, Karam M. Drug-Related Offences in Canada, 2013. Ottawa, Canada; 2015.
27
Nolin PC, Kenny C. Cannabis: Our Position for a Canadian Public Policy. Ottawa, ON; 2002.
28
Crépault J. Cannabis Policy Framework - CAMH. Toronto, Canada; 2014. http://www.camh.ca/en/hospital/about_camh/influencing_public_policy/documents/camhcannabispolicyframework.pdf.
29
UNICEF Office of Research. Child Well-Being in Rich Countries: A Comparative Overview. Florence, Italy; 2013.
30
Ruschmann P. Legalizing Marijuana. New York, USA: Infobase Publishing; 2009.
31
Bronskill J. Legalizing marijuana: Health Canada flags 9 factors for Liberals to consider. The Canadian Press. March 5, 2016.
32
Esposito G, De Filippis D, Cirillo C, et al. Cannabidiol in inflammatory bowel diseases: a brief overview. Phyther Res. 2013;27(5):633-636. Doi:10.1002/ptr.4781
33
Moore TH, Zammit S, Lingford-Hughes A, et al. Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet. 2007;370(9584):319-328. Doi:10.1016/s0140-6736(07)61162-3
34
Meier MH, Caspi A, Ambler A, et al. Persistent cannabis users show neuropsychological decline from childhood to midlife. Proc Natl Acad Sci. 2012;109(40):E2657-E2664. Doi:10.1073/pnas.1206820109
35
Volkow ND, Baler RD, Compton WM, Weiss SR. Adverse health effects of marijuana use. N Engl J Med. 2014;370:2219-2227.
36
World Health Organization (WHO). Management of substance abuse: Cannabis. http://www.who.int/substance_abuse/facts/cannabis/en/. Accessed May 5, 2016. Published 2016.
37
Imtiaz S, Shield KD, Roerecke M, et al. The burden of disease attributable to cannabis use in Canada in 2012. Addiction. 2016;111(4):653-662.
38
Fischer B, Imtiaz S, Rudzinski K, Rehm J. Crude estimates of cannabis-attributable mortality and morbidity in Canada-implications for public health focused intervention priorities. J Public Health (Oxf). 2016; 38(1):183-188. Doi:10.1093/pubmed/fdv005
39
Center for Disease Control and Prevention. Behavioral Risk Factor Surveillance System (BRFSS) Survey. USA: CDC; 2014.
40
Rocky Mountains HIDTA. Legalization of Marijuana in Colorado: The Impact. http://www.rmhidta.org/html/august%202014%20legalization%20of%20mj%20in%20colorado%20the%20impact.pdf. Published 2015
41
Monte AA, Zane RD, Heard KJ. The implications of marijuana legalization in colorado. JAMA. 2015;313(3):241-242. Doi:10.1001/jama.2014.17057.
42
ORIGINAL_ARTICLE
Defining and Acting on Global Health: The Case of Japan and the Refugee Crisis
What counts as global health? There has been limited discourse to date on the ways in which country-level contexts may shape positioning in global health agendas. By reviewing Japan’s response to the refugee crisis, we demonstrate a clash between rhetoric and action on global responsibility, and suggest that cultural and historical factors may be related to the ways of perceiving and acting upon global health.
https://www.ijhpm.com/article_3210_16d3583654cb3bccd92ce868b87a0459.pdf
2016-08-01
457
460
10.15171/ijhpm.2016.68
Japan
Global Health
Refugees
Displacement
Claire
Leppold
cleppold@gmail.com
1
Department of Research, Minamisoma Municipal General Hospital, Fukushima, Japan
LEAD_AUTHOR
Akihiko
Ozaki
ozakiakihiko@gmail.com
2
Department of Surgery, Minamisoma Municipal General Hospital, Fukushima, Japan
AUTHOR
Yuki
Shimada
smd.yuki@gmail.com
3
Department of Neurosurgery, Minamisoma Municipal General Hospital, Fukushima, Japan
AUTHOR
Tomohiro
Morita
t.morita526@gmail.com
4
Department of Internal Medicine, Soma Central Hospital, Fukushima, Japan
AUTHOR
Tetsuya
Tanimoto
tetanimot@yahoo.co.jp
5
Department of Internal Medicine, Jōban Hospital, Tokiwa Foundation, Fukushima, Japan
AUTHOR
UNDP Support to the Implementation of the 2030 Agenda for Sustainable Development. United Nations Development Programme (UNDP) website. http://www.undp.org/content/undp/en/home/librarypage/sustainable-development-goals/undp-support-to-the-implementation-of-the-2030-agenda/. Accessed May 21, 2016.
1
Abe S. Japan's vision for a peaceful and healthier world. Lancet. 2015;386:2367-2369. Doi:10.1016/S0140-6736(15)01172-1
2
Gostin LO, Roberts AE. Forced migration: the human face of a health crisis. JAMA. 2015;314:2125-2126. Doi:10.1001/jama.2015.14906.
3
Adapting to migration as a planetary force. Lancet. 2015;386:1013. doi:10.1016/S0140-6736(15)00190-7
4
Morabia A, Benjamin GC. The Refugee Crisis in the Middle East and Public Health. Am J Public Health. 2015;105(12):2405-2406. Doi:10.2105/AJPH.2015.302929
5
Rousseau C, ter Kuile S, Muňoz M, et al. Health Care Access for Refugees and Immigrants with Precarious Status: Public Health and Human Right Challenges. Can J Public Health. 2008;99(4):290-292.
6
Kupferschmidt K. Refugee crisis brings new health challenges. Science. 2016;352(6284):391-392. Doi:10.1126/science.352.6284.391
7
Chen L, Narasimhan V. Human security and global health. J Hum Dev. 2003;4(2):181-190. doi:10.1080/1464988032000087532
8
Activity Report. Japan Association for Refugees website. https://www.refugee.or.jp/jar/report/2015/03/12-0000.shtml. Accessed May 26, 2016. (Japanese Language).
9
Takenaka K, Wildon T, Funakoshi M, et al. Asylum seekers in Japan reach record 7,586 in 2015. Reuters. January 23, 2016. http://www.reuters.com/article/us-japan-immigrants-idUSKCN0V10E7. Accessed May 26, 2016.
10
UNICEF chief urges Japan to open its doors to more refugees. The Japan Times. October 18, 2015. http://www.japantimes.co.jp/news/2015/10/18/national/politics-diplomacy/unicef-chief-urges-japan-open-doors-refugees/#.VmqsM781p8V. Accessed May 26, 2016.
11
Rowson M, Willott C, Hughes R, et al. Conceptualising global health: theoretical issues and their relevance for teaching. Global Health. 2012;8(1):36. doi:10.1186/1744-8603-8-36
12
Koplan JP, Bond TC, Merson MH, et al. Towards a common definition of global health. Lancet. 2009;373(9679):1993-1995. Doi:10.1016/S0140-6736(09)60332-9
13
Llano R, Kanamori S, Kunii O. Re-invigorating Japan's commitment to global health: challenges and opportunities. Lancet. 2011;378(9798):1255-1264. Doi:10.1016/S0140-6736(11)61048-9
14
Tsuchida T. 50 years of universal health care (Japanese language). Social Security Research Quarterly. 2011;47:3.
15
Ikegami N, Yoo BK, Hashimoto H, et al. Japanese universal health coverage: evolution, achievements, and challenges. Lancet. 2011;378(9796):1106-1115.
16
Ravishankar N, Gubbins P, Cooley RJ, et al. Financing of global health: tracking development assistance for health from 1990 to 2007. Lancet. 2009;373(9681):2113-24. Doi:10.1016/S0140-6736(09)60881-3
17
Takahashi K, Kobayashi J. Lessons from the field count more than ever: the new era of global health. Trop Med Health. 2015;43(4):243-245.
18
Goodman R. Making Majority Culture. In: Robertson J, ed. A Companion to the Anthropology of Japan. Malden: Blackwell Publishing; 2005:59-72.
19
Creighton M. Soto Other and Uchi Others: Imaging Racial Diversity, Imagining Homogeneous Japan. In: Weiner M, ed. Japan’s Minorities: The Illusion of Homogeneity. London: Routledge; 1997:211-38.
20
Bachnik J. Uchi/Soto: Challenging our conceptualizations of self, social order, and language. In: Bachnik J, Quinn C, eds. Situated Meaning: Inside and Outside in Japanese Self, Society, and Language. Princeton: Princeton University Press; 1994:3-37.
21
Robertson J. Blood talks: Eugenic modernity and the creation of new Japanese. Hist Anthropol. 2002;13(3):191-216. doi:10.1080/0275720022000025547
22
Robertson J. Hemato-nationalism: The Past, Present, and Future of “Japanese Blood”. Med Anthropol. 2012;31(2):93-112. doi:10.1080/01459740.2011.624957
23
Dean M, Nagashima M. Sharing the burden: the role of government and NGOs in protecting and providing for asylum seekers and refugees in Japan. J Refug Stud. 2007;20(3):481-508. doi:10.1093/jrs/fem009
24
Flowers PR. Failure to Protect Refugees? Domestic Institutions, International Organizations, and Civil Society in Japan. J Jpn Stud. 2008;34(2):333-361. doi:10.1353/jjs.0.0028
25
Ogata S. Asylum policy reform: Embracing a literal perspective. Message to the Japan Federation of Bar Associations Symposium on Japan’s Refugee Protection System, Tokyo. http://www.unhcr.or.jp/html/protect/pdf/nov02ms_ogata.pdf. Accessed May 20, 2016. Published November 16, 2002.
26
Mie A. Japan to take in 150 Syrians as exchange students after criticism of harsh refugee policy. The Japan Times. May 20, 2016. http://www.japantimes.co.jp/news/2016/05/20/national/japan-take-150-syrians-exchange-students-criticism-harsh-refugee-policy/#.V0P2FOTEIqt. Accessed May 24, 2016.
27
Parkinson SE, Behrouzan O. Negotiating health and life: Syrian refugees and the politics of access in Lebanon. Soc Sci Med. 2015;146:324-331. Doi:10.1016/j.socscimed.2015.10.008.
28
ORIGINAL_ARTICLE
Assessing Patient Participation in Health Policy Decision-Making in Cyprus
Although the importance of patient participation in the design and evaluation of health programs and services is well-documented, there is scarcity of research with regard to patient association (PA) participation in health policy decision-making processes. To this end, the present study aimed to validate further a previously developed instrument as well as to investigate the degree of PA participation in health policy decision-making in Cyprus. A convenient sample of 114 patients-members of patients associations took part in the study. Participants were recruited from an umbrella organization, the Pancyprian Federation of Patient Associations and Friends (PFPA). PA participation in health policy decision-making was assessed with the Health Democracy Index (HDI), an original 8-item tool. To explore its psychometric properties, Cronbach α was computed as regards to its internal consistency, while its convergent validity was tested against a self-rated question enquiring about the degree of PA participation in health policy decision-making. The findings revealed that the HDI has good internal consistency and convergent validity. Furthermore, PAs were found to participate more in consultations in health-related organizations and the Ministry of Health (MoH) as well as in reforms or crucial decisions in health policy. Lower levels were documented with regard to participation in hospital boards, ethics committees in clinical trials and health technology assessment (HTA) procedures. Overall, PA participation levels were found to be lower than the mid-point of the scale. Targeted interventions aiming to facilitate patients’ involvement in health policy decision-making processes and to increase its impact are greatly needed in Cyprus.
https://www.ijhpm.com/article_3227_b2ea687d43cc1afeb4e8687076b64fb7.pdf
2016-08-01
461
466
10.15171/ijhpm.2016.78
Patient Participation
Health Policy
Decision-Making
Kyriakos
Souliotis
info@ksouliotis.gr
1
Faculty of Social and Political Sciences, University of Peloponnese, Corinth, Greece
LEAD_AUTHOR
Eirini
Agapidaki
eagapidaki@gmail.com
2
Centre for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece
AUTHOR
Lily Evangelia
Peppou
lilly.peppou@gmail.com
3
University Mental Health Research Institute, Athens, Greece
AUTHOR
Chara
Tzavara
htzavara@med.uoa.gr
4
Centre for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece
AUTHOR
George
Samoutis
samoutis.g@unic.ac.cy
5
Medical School, University of Nicosia, Nicosia, Cyprus
AUTHOR
Mamas
Theodorou
m.theodorou@ouc.ac.cy
6
Faculty of Economics and Management, Open University of Cyprus, Nicosia, Cyprus
AUTHOR
Eliasoph H, Monaghan B, Beaudoin R, et al. "We are all in this together": integrated health service plans in Ontario. Healthc Q. 2007;10(3):82-87.
1
Elwyn G, Edwards A, Mowle S, et al. Measuring the involvement of patients in shared decision-making: a systematic review of instruments. Patient Educ Couns. 2001;43(1):5-22.
2
Arnetz JE, Winblad U, Arnetz BB, Hoglund AT. Physicians' and nurses' perceptions of patient involvement in myocardial infarction care. Eur J Cardiovasc Nurs. 2008;7(2):113-120. doi:10.1016/j.ejcnurse.2007.05.005
3
Entwistle VA, Watt IS. Patient involvement in treatment decision-making: the case for a broader conceptual framework. Patient Educ Couns. 2006;63(3):268-278. doi:10.1016/j.pec.2006.05.002
4
Elwyn G, O'Connor A, Stacey D, et al. Developing a quality criteria framework for patient decision aids: online international Delphi consensus process. BMJ. 2006;333(7565):417. doi:10.1136/bmj.38926.629329.AE
5
Entwistle VA, Quick O. Trust in the context of patient safety problems. J Health Organ Manag. 2006;20(5):397-416. doi:10.1108/14777260610701786
6
Holman H, Lorig K. Patients as partners in managing chronic disease. Partnership is a prerequisite for effective and efficient health care. BMJ. 2000;320(7234):526-527.
7
Florin D, Dixon J. Public involvement in health care. BMJ. 2004;328(7432):159-161. doi:10.1136/bmj.328.7432.159
8
Bieber C, Muller KG, Blumenstiel K, et al. Long-term effects of a shared decision-making intervention on physician-patient interaction and outcome in fibromyalgia. A qualitative and quantitative 1 year follow-up of a randomized controlled trial. Patient Educ Couns. 2006;63(3):357-366. doi:10.1016/j.pec.2006.05.003
9
Bowie C, Richardson A, Sykes W. Consulting the public about health service priorities. BMJ. 1995;311(7013):1155-1158.
10
Bowling A, Jacobson B, Southgate L. Explorations in consultation of the public and health professionals on priority setting in an inner London health district. Soc Sci Med. 1993;37(7):851-857.
11
Bruegel RB. Patient empowerment--a trend that matters. J AHIMA. 1998;69(8):30-33.
12
Souliotis K. Looking for Health Democracy in times of financial crisis: citizen participation in health policy decision making. In: Souliotis K, ed. Greek I, trans. Democracy, Citizens and Health Policy. Athens, Greece: Papazisis Publications; 2014.
13
Dicker A, Armstrong D. Patients' views of priority setting in health care: an interview survey in one practice. BMJ. 1995;311(7013):1137-1139.
14
Goold SD, Biddle AK, Klipp G, Hall CN, Danis M. Choosing Healthplans All Together: a deliberative exercise for allocating limited health care resources. J Health Polit Policy Law. 2005;30(4):563-601.
15
Longtin Y, Sax H, Leape LL, Sheridan SE, Donaldson L, Pittet D. Patient participation: current knowledge and applicability to patient safety. Mayo Clin Proc. 2010;85(1):53-62. doi:10.4065/mcp.2009.0248
16
Mitton C, Smith N, Peacock S, Evoy B, Abelson J. Public participation in health care priority setting: A scoping review. Health Policy. 2009;91(3):219-228. doi:10.1016/j.healthpol.2009.01.005
17
Oliver S, Clarke-Jones L, Rees R, et al. Involving consumers in research and development agenda setting for the NHS: developing an evidence-based approach. Health Technol Assess. 2004;8(15):1-148.
18
Sheridan SL, Harris RP, Woolf SH. Shared decision making about screening and chemoprevention. a suggested approach from the U.S. Preventive Services Task Force. Am J Prev Med. 2004;26(1):56-66.
19
Wiseman V, Mooney G, Berry G, Tang KC. Involving the general public in priority setting: experiences from Australia. Soc Sci Med. 2003;56(5):1001-1012.
20
O'Connor AM, Stacey D, Entwistle V, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2003;(2):CD001431. doi:10.1002/14651858.CD001431
21
Legare F, O'Connor AM, Graham ID, et al. The effect of decision aids on the agreement between women's and physicians' decisional conflict about hormone replacement therapy. Patient Educ Couns. 2003;50(2):211-221.
22
Van de Bovenkamp H, Trappenburg M. Government influence on patient organizations. Health Care Anal. 2010;19(4):329-351.
23
Baggott R, Allsop J, Jones K. Speaking for Patient and Carers: Health Consumer Groups and the Policy Process. Hampshire: Palgrave Macmillan; 2005.
24
Van de Bovenkamp HM, Trappenburg MJ, Grit K. Patient participation in collective health care decision-making: the Dutch model. Health Expect. 2010;13:73-85.
25
Tyler S. Comparing the campaigning profile of maternit iser groups in Europe – can we learn anything useful? Health Expect. 2002;5:136-147.
26
Baggott R, Forster R. Health consumer and patients’ organizations in Europe: towards a comparative analysis. Health Expect. 2008;11:85-94.
27
Souliotis K. The concept of health democracy: documentation of a new approach in health policy decision making. The Health Democracy Index. 41 Pan Hellenic Medical Conference; 2015.
28
Carman K, Dardess P, Maurer M, et al. Patient and family engagement: a framework for understanding the elements and developing interventions and policies. Health Aff (Millwood). 2013;32(2):223-231. doi:10.1377/hlthaff.2012.1133
29
Sullivan M. The new subjective medicine: taking the patient's point of view on health care and health. Soc Sci Med. 2003;56(7):1595-1604.
30
Tattersall RL. The expert patient: a new approach to chronic disease management for the twenty-first century. Clin Med. 2002;2(3):227-229.
31
Oliver SR, Rees RW, Clarke-Jones L, et al. A multidimensional conceptual framework for analysing public involvement in health services research. Health Expect. 2008;11(1):72-84. doi:10.1111/j.1369-7625.2007.00476.x
32
Rutter D, Manley C, Weaver T, Crawford MJ, Fulop N. Patients or partners? Case studies of user involvement in the planning and delivery of adult mental health services in London. Soc Sci Med. 2004;58(10):1973-1984. doi:10.1016/S0277-9536(03)00401-5
33
ORIGINAL_ARTICLE
Motivation and Retention of Physicians in Primary Healthcare Facilities: A Qualitative Study From Abbottabad, Pakistan
Background Workforce motivation and retention is important for the functionality and quality of service delivery in health systems of developing countries. Despite huge primary healthcare (PHC) infrastructure, Pakistan’s health indicators are not impressive; mainly because of under-utilization of facilities and low patient satisfaction. One of the major underlying issues is staff absenteeism. The study aimed to identify factors affecting retention and motivation of doctors working in PHC facilities of Pakistan. Methods An exploratory study was conducted in a rural district in Khyber Puktunkhwa (KP) province, in Pakistan. A conceptual framework was developed comprising of three organizational, individual, and external environmental factors. Qualitative research methods comprising of semi-structured interviews with doctors working in basic health units (BHUs) and in-depth interviews with district and provincial government health managers were used. Document review of postings, rules of business and policy actions was also conducted. Triangulation of findings was carried out to arrive at the final synthesis. Results Inadequate remuneration, unreasonable facilities at residence, poor work environment, political interference, inadequate supplies and medical facilities contributed to lack of motivation among both male and female doctors. The physicians accepted government jobs in BHUs with a belief that these jobs were more secure, with convenient working hours. Male physicians seemed to be more motivated because they faced less challenges than their female counterparts in BHUs especially during relocations. Overall, the organizational factors emerged as the most significant whereby human resource policy, career growth structure, performance appraisal and monetary benefits played an important role. Gender and marital status of female doctors was regarded as most important individual factor affecting retention and motivation of female doctors in BHUs. Conclusion Inadequate remuneration, unreasonable facilities at residence, poor work environment, political interference, inadequate supplies, and medical facilities contributed to lack of motivation in physicians in our study. Our study advocates that by addressing the retention and motivation challenges, service delivery can be made more responsive to the patients and communities in Pakistan and other similar settings.
https://www.ijhpm.com/article_3181_2a076ad977ace4d7e51572f982425dbf.pdf
2016-08-01
467
475
10.15171/ijhpm.2016.38
Motivation
Retention
Physicians
Rural Postings
Qualitative
Sayed
Shah
sayed.masoom@yahoo.com
1
Relief International, Gaziantep, Turkey
AUTHOR
Shehla
Zaidi
shehla.zaidi@aku.edu
2
Department of Community Health Sciences and Women and Child Health Division, Aga Khan University, Karachi, Pakistan
AUTHOR
Jamil
Ahmed
jamilmga@agu.edu.bh
3
Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
LEAD_AUTHOR
Shafiq
Rehman
shafiq.rehman80@gmail.com
4
UNICEF, Quetta, Pakistan
AUTHOR
World Health Organization (WHO). The World Health Report 2000: Health Systems: Improving Performance. Geneva: WHO;2000.
1
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47
ORIGINAL_ARTICLE
Developing Leadership in Managers to Facilitate the Implementation of National Guideline Recommendations: A Process Evaluation of Feasibility and Usefulness
Background Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers’ leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention’s potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation. Methods Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a fourmonth leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention. Results Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation. Conclusion Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers’ behaviors or clinical practice at the units. Future interventions directed towards managers should have a stronger focus on developing leadership skills and behaviors to tailor implementation plans and support implementation of CPG recommendations.
https://www.ijhpm.com/article_3183_5015382bcf9183a74ef7e79b0a941f65.pdf
2016-08-01
477
486
10.15171/ijhpm.2016.35
Evidence-Based Practice (EBP)
Facilitation
Implementation
Leadership
Management
Stroke
Rehabilitation
Malin
Tistad
mti@du.se
1
School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
LEAD_AUTHOR
Susanne
Palmcrantz
susanne.palmcrantz@ki.se
2
Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
AUTHOR
Lars
Wallin
lwa@du.se
3
School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
AUTHOR
Anna
Ehrenberg
aeh@du.se
4
School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
AUTHOR
Christina B.
Olsson
christina.b.olsson@sll.se
5
Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
AUTHOR
Göran
Tomson
goran.tomson@ki.se
6
International Health Systems Research, Departments of Learning, Informatics, Management, Ethics and Public Health Sciences, Karolinska Institutet, Solna, Sweden
AUTHOR
Lotta Widén
Holmqvist
lotta.holmqvist@ki.se
7
Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
AUTHOR
Wendy
Gifford
wgifford@uottawa.ca
8
Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
AUTHOR
Ann Catrine
Eldh
anncatrine.eldh@ki.se
9
School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
AUTHOR
Cummings GG, Estabrooks CA, Midodzi WK, Wallin L, Hayduk L. Influence of organizational characteristics and context on research utilization. Nurs Res. 2007;56:S24-S39. doi:10.1097/01.NNR.0000280629.63654.95
1
Gifford W, Davies B, Edwards N, Griffin P, Lybanon V. Managerial Leadership for Nurses’ Use of Research Evidence: An Integrative Review of the Literature. Worldviews on Evidence‐Based Nursing. 2007;4:126-145. doi:10.1111/j.1741-6787.2007.00095.x
2
Dannapfel P, Peolsson A, Nilsen P. What supports physiotherapists’ use of research in clinical practice? A qualitative study in Sweden. Implement Sci. 2013;8:31. doi:10.1186/1748-5908-8-31
3
Kristensen HK, Borg T, Hounsgaard L. Aspects affecting occupational therapists’ reasoning when implementing research-based evidence in stroke rehabilitation. Scand J Occup Ther. 2012;19:118-131. doi:10.3109/11038128.2011.556197
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Birken SA, Lee SY, Weiner BJ. Uncovering middle managers’ role in healthcare innovation implementation. Implement Sci. 2012;7:28. doi:10.1186/1748-5908-7-28
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Davies BL. Sources and models for moving research evidence into clinical practice. J Obstet Gynecol Neonatal Nurs. 2002;31:558-562.
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Gifford W, Davies B, Tourangeau A, Lefebre N. Developing team leadership to facilitate guideline utilization: planning and evaluating a 3-month intervention strategy. J Nurs Manag. 2011;19:121-132. doi:10.1111/j.1365-2834.2010.01140.x
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Palmcrantz S, Tistad M, Eldh AC, et al. Assessing feasibility and acceptability of study procedures: getting ready for implementation of national stroke guidelines in out-patient health care. BMC Health Serv Res. 2015;15:517.
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Graham ID, Logan J, Harrison MB, et al. Lost in knowledge translation: time for a map? J Contin Educ Health Prof. 2006;26:13-24. doi:10.1002/chp.47
29
Seers K, Linck P, McCarthy G, McCormack B, et al. FIRE (Facilitating Implementation of Research Evidence): a study protocol. Implement Sci. 2012;7:25. doi:10.1186/1748-5908-7-25
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Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A. Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005;14:26-33. doi:10.1136/qshc.2004.011155
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37
Ovretveit J. Leading improvement. J Health Organ Manag. 2005;19:413-430. doi:10.1108/14777260510629661
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Morrow E, Robert G, Maben J. Exploring the nature and impact of leadership on the local implementation of the Productive Ward Releasing Time to Care. J Health Organ Manag. 2014;28:154-176. doi:10.1108/JHOM-01-2013-0001
39
Collins DB, Holton EF. The effectiveness of managerial leadership development programs: A meta-analysis of studies from 1982 to 2001. Human Resource Development Quarterly. 2004;15:217-48. doi:10.1002/hrdq.1099
40
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41
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42
Eldh AC, Fredriksson M, Halford C, et al. Facilitators and barriers to applying a national quality registry for quality improvement in stroke care. BMC Health Serv Res. 2014;14:354. doi:10.1186/1472-6963-14-354
43
Kristensen HK, Hounsgaard L. Implementation of coherent, evidence-based pathways in Danish rehabilitation practice. Disabil Rehabil. 2013;35:2021-2028. doi:10.3109/09638288.2013.768301
44
ORIGINAL_ARTICLE
The Trans-Pacific Partnership: Is It Everything We Feared for Health?
Background Negotiations surrounding the Trans-Pacific Partnership (TPP) trade and investment agreement have recently concluded. Although trade and investment agreements, part of a broader shift to global economic integration, have been argued to be vital to improved economic growth, health, and general welfare, these agreements have increasingly come under scrutiny for their direct and indirect health impacts. Methods We conducted a prospective health impact analysis to identify and assess a selected array of potential health risks of the TPP. We adapted the standard protocol for Health impact assessments (HIAs) (screening, scoping, and appraisal) to our aim of assessing potential health risks of trade and investment policy, and selected a health impact review methodology. This methodology is used to create a summary estimation of the most significant impacts on health of a broad policy or cluster of policies, such as a comprehensive trade and investment agreement. Results Our analysis shows that there are a number of potentially serious health risks associated with the TPP, and details a range of policy implications for the health sector. Of particular focus are the potential implications of changes to intellectual property rights (IPRs), sanitary and phytosanitary measures (SPS), technical barriers to trade (TBT), investor-state dispute settlement (ISDS), and regulatory coherence provisions on a range of issues, including access to medicines and health services, tobacco and alcohol control, diet-related health, and domestic health policymaking. Conclusion We provide a list of policy recommendations to mitigate potential health risks associated with the TPP, and suggest that broad public consultations, including on the health risks of trade and investment agreements, should be part of all trade negotiations.
https://www.ijhpm.com/article_3186_741c0738f19120039415d58aedff5602.pdf
2016-08-01
487
496
10.15171/ijhpm.2016.41
Social Determinants of Health
Trade and Investment Policy
Population Health
Global Governance for
Health
Ronald
Labonté
rlabonte@uottawa.ca
1
Faculty of Medicine, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
AUTHOR
Ashley
Schram
ashleylgrau@gmail.com
2
Faculty of Medicine, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
AUTHOR
Arne
Ruckert
aruckert@uottawa.ca
3
Faculty of Medicine, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
LEAD_AUTHOR
Stoller M. Trans-Pacific Partnership: The biggest trade deal you’ve never heard of. Salon. http://www.salon.com/2012/10/23/everything_you_wanted_to_know_about_the_trans_pacific_partnership/. Accessed May 12, 2014. Published October 2012.
1
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2
Dollar D. Is globalization good for your health? Bull World Health Organ. 2001;79(9):827-833.
3
Baker P, Kay A, Walls H. Trade and investment liberalization and Asia’s noncommunicable disease epidemic: a synthesis of data and existing literature. Glob Health. 2014;10(1):66.
4
Friel S, Gleeson D, Thow AM, et al. A new generation of trade policy: potential risks to diet-related health from the trans pacific partnership agreement. Glob Health. 2013;9(1):46.
5
Friel S, Hattersley L, Snowdon W, et al. Monitoring the impacts of trade agreements on food environments. Obes Rev. 2013;14:120-134. doi:10.1111/obr.12081
6
Labonte R, Sanger M. Glossary of the World Trade Organisation and public health: part 1. J Epidemiol Community Health. 2006;60(8):655-661. doi:10.1136/jech.2005.037895
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Labonte R, Sanger, M. Glossary on the World Trade Organisation and public health: part 2. J Epidemiol Community Health. 2006;60(9):738-744. doi:10.1136/jech.2005.038950
8
Schram A, Labonté R, Sanders D. Urbanization and international trade and investment policies as determinants of noncommunicable diseases in Sub-Saharan Africa. Prog Cardiovasc Dis. 2013;56(3):281-301.
9
Schram A, Labonté R, Baker P, Friel S, Reeves A, Stuckler D. The role of trade and investment liberalization in the sugar-sweetened carbonated beverages market: a natural experiment contrasting Vietnam and the Philippines. Glob Health. 2015;11(1):1.
10
Thow AM, Snowdon W, Labonté R, et al. Will the next generation of preferential trade and investment agreements undermine prevention of noncommunicable diseases? A prospective policy analysis of the Trans Pacific Partnership Agreement. Health Policy. 2015;119(1):88-96.
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Thow AM. Trade liberalisation and the nutrition transition: mapping the pathways for public health nutritionists. Public Health Nutr. 2009;12(11):2150-2158.
12
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13
Hirono K, Haigh F, Gleeson D, Harris P, Thow AM. Negotiating Healthy Trade in Australia: A Health Impact Assessment of the Proposed Trans-Pacific Partnership Agreement. Liverpool, NSW: Centre for Health Equity Training Research and Evaluation; 2015. http://hiaconnect.edu.au/research-and-publications/tpp_hia/. Accessed March 11, 2015.
14
Faunce TA. The Trans-Pacific Partnership Agreement: challenges for Australian health and medicine policies. Med J Aust. 2011;194(2):83-86.
15
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Lee K, Ingram A, Lock K, McInnes C. Bridging health and foreign policy: the role of health impact assessments. Bull World Health Organ. 2007;85(3):207-211. doi:10.2471/BLT.06.037077
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Khan U, Pallot R, Taylor D, Kanavos P. The Transatlantic Trade and Investment Partnership: International Trade Law, Health Systems and Public Health. London, United Kingdom: London School of Economics and Political Science; 2015. http://www.epha.org/IMG/pdf/LSE_study-TTIP_International_Trade_Law_Health_Systems_and_Public_Health_website.pdf. Accessed February 21, 2016.
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Kelsey J. New-generation free trade agreements threaten progressive tobacco and alcohol policies. Addiction. 2012;107(10):1719-1721. doi:10.1111/j.1360-0443.2012.03874.x
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Kelsey J. Trans-Pacific Partnership agreement: a gold-plated gift to the global tobacco industry. Am J Law Med. 2013;39:237-264.
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Ruckert A, Schram A, Labonté R. The Trans-Pacific Partnership Agreement: Trading away our health? Can J Public Health. 2015;106(4):e249-e251.
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Schram A, Labonte R, Khatter K. The Trans-Pacific Partnership agreement and public health: why we should be concerned. Open Med. 2014;8(3):e100.
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Buse K. Addressing the theoretical, practical and ethical challenges inherent in prospective health policy analysis. Health Policy Plan. 2008;23(5):351-360.
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The Cost of Cancer Drugs. 60 Minutes. CBC news website. http://www.cbsnews.com/news/cost-of-cancer-drugs-60-minutes-lesley-stahl-health-care/. Accessed December 9, 2015. Published October 2014.
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Sachgau O. The price of being pain free: Why are life-changing biologics out of reach for so many? The Globe and Mail website. http://www.theglobeandmail.com/life/health-and-fitness/health/the-price-of-being-pain-free-why-are-biologics-out-of-reach-for-so-many/article26332629/. Published September 13, 2015. Accessed December 9, 2015.
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Mauldin W. U.S., Australia Agree on Complicated Compromise on Biologic Drugs. Wall Street Journal. October 4, 2015. http://www.wsj.com/articles/u-s-australia-agree-on-complicated-compromise-on-biologic-drugs-1443988019. Accessed February 21, 2016.
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Beall R, Kuhn R. Trends in compulsory licensing of pharmaceuticals since the Doha Declaration: a database analysis. PLoS Med. 2012;9(1):e1001154. doi:10.1371/journal.pmed
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Gleeson D. Commentary on the Leaked TPP Transparency Chapter Annex on Transparency and Procedural Fairness for Pharmaceutical Products and Medical Devices; 2015. https://wikileaks.org/tpp/healthcare/Dr-Deborah-Gleeson-Analysis-on-TPP-Transparency-for-Healthcare-Annex.pdf. Accessed December 15, 2015.
28
Lexchin J, Mintzes B. A compromise too far: A review of Canadian cases of direct-to-consumer advertising regulation. Int J Risk Saf Med. 2014;26(4):213-225.
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Appellate Body. EC Measures Concerning Meat and Meat Products (hormones). World Trade Organization; 1998. https://www.wto.org/english/tratop_e/dispu_e/hormab.pdf. Accessed February 21, 2016.
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Suppan S. The TPP SPS Chapter: Not a “Model for the Rest of the World.” Institute for Agriculture and Trade Policy; 2015. http://www.iatp.org/documents/the-tpp-sps-chapter-not-a-%E2%80%9Cmodel-for-the-rest-of-the-world%E2%80%9D. Accessed December 9, 2015.
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Terry S. The Environment under TPPA Guidance. New Zealand Law Foundation; 2016. https://tpplegal.files.wordpress.com/2015/12/tpp-environment.pdf. Accessed February 21, 2016.
32
Palmberg E. The Insider List. Sojourners website. https://sojo.net/articles/insider-list. Accessed December 9, 2015. Published June 29, 2012
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United Nations Conference on Trade and Development. Recent Trends in IIAs and ISDS. Geneva, Switzerland: United Nations Conference on Trade and Development; 2015. http://unctad.org/en/PublicationsLibrary/webdiaepcb2015d1_en.pdfq. Accessed December 9, 2015.
34
Van Harten G. Sovereign Choices and Sovereign Constraints: Judicial Restraint in Investment Treaty Arbitration. United Kingdom: Oxford University Press; 2013.
35
Chapman S. Australian government’s $50m investment in defending against Big Tobacco legal thuggery. The Conversation website. http://theconversation.com/australian-governments-50m-investment-in-defending-against-big-tobacco-legal-thuggery-45427. Accessed January 29, 2016. Published July 2015.
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Mann H. International Investment Agreements, Business and Human Rights: Key Issues and Opportunities. International Institute for Sustainable Development; 2008. http://www.iisd.org/pdf/2008/iia_business_human_rights.pdf. Accessed February 21, 2016.
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Eberhardt P, Olivet C. Profiting from Injustice: How Law Firms, Arbitrators and Financiers Are Fuelling an Investment Arbitration Boom. Brussels/Amsterdam: Corporate Europe Observatory and the Transnational Institute; 2012. http://www.tni.org/briefing/profiting-injustice. Accessed March 25, 2014.
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Bernasconi-Osterwalder N, Cosbey A, Johnson L, Vis-Dunbar D. Investment Treaties & Why They Matter to Sustainable Development: Questions and Answers. International Institute for Sustainable Development; 2012. http://www.iisd.org/sites/default/files/pdf/2011/investment_treaties_why_they_matter_sd.pdf.
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Johnson L, Sachs J. The TPP’s Investment Chapter: Entrenching, rather than Reforming, a Flawed System. New York City: Columbia Center on Sustainable Investment; 2015. http://ccsi.columbia.edu/files/2015/11/TPP-entrenching-flaws-21-Nov-FINAL.pdf. Accessed April 11, 2016.
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Clayton and Bilcon v Government of Canada. (International Court of Justics). http://www.international.gc.ca/trade-agreements-accords-commerciaux/assets/pdfs/disp-diff/clayton-13.pdf. Accessed December 9, 2015.
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Frenk J, Moon S. Governance challenges in global health. N Engl J Med. 2013;368(10):936-942. doi:10.1056/NEJMra1109339
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Kickbusch I, Gleicher D. Governance for Health in the 21st Century. Geneva, Switzerland: WHO; 2012. http://www.euro.who.int/en/publications/abstracts/governance-for-health-in-the-21st-century. Accessed April 11, 2016.
44
Petri PA, Plummer MG. The Trans-pacific Partnership and Asia-Pacific Integration: Policy Implications. http://www.iie.com/publications/pb/pb12-16.pdf. Accessed May 26, 2014. Published June 2012.
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Capaldo J, Izurieta A, Sundaram J. Trading down: Unemployment, Inequality and Other Risks of the Trans-Pacific Partnership Agreement. Medford, MA: Tufts University; 2016. http://ase.tufts.edu/gdae/. Accessed January 20, 2016.
46
Schram A, Ruckert A, Miller B, Labonté R. Media and Neoliberal Hegemony: Canadian Newspaper Coverage of the Trans-Pacific Partnership Agreement. Stud Polit Econ. Forthcoming.
47
ORIGINAL_ARTICLE
Priority Setting Meets Multiple Streams: A Match to Be Further Examined?; Comment on “Introducing New Priority Setting and Resource Allocation Processes in a Canadian Healthcare Organization: A Case Study Analysis Informed by Multiple Streams Theory”
With demand for health services continuing to grow as populations age and new technologies emerge to meet health needs, healthcare policy-makers are under constant pressure to set priorities, ie, to make choices about the health services that can and cannot be funded within available resources. In a recent paper, Smith et al apply an influential policy studies framework – Kingdon’s multiple streams approach (MSA) – to explore the factors that explain why one health service delivery organization adopted a formal priority setting framework (in the form of programme budgeting and marginal analysis [PBMA]) to assist it in making priority setting decisions. MSA is a theory of agenda-setting, ie, how it is that different issues do or do not reach a decision-making point. In this paper, I reflect on the use of the MSA framework to explore priority setting processes and how the framework might be applied to similar cases in future.
https://www.ijhpm.com/article_3204_2c1bbe8abc13300e14fdf8239ada6623.pdf
2016-08-01
497
499
10.15171/ijhpm.2016.58
Priority Setting
Resource Allocation
Programme Budgeting and Marginal Analysis (PBMA)
Canada
Jacqueline Margaret
Cumming
jackie.cumming@vuw.ac.nz
1
Health Services Research Centre, Victoria University of Wellington, Wellington, New Zealand
LEAD_AUTHOR
Organisation for Economic Co-Operation and Development. Fiscal Sustainability of Health Systems: Bridging Health and Finance Perspectives. Paris: Organisation for Economic Co-Operation and Development; 2015.
1
Donaldson C, Mooney G. Needs assessment, priority setting and contracts for health care: an economic view. British Medical Journal. 1991;303:1529-1530.
2
Donaldson C, Walker A, Craig N. Programme Budgeting and Marginal Analysis: A Handbook for Applying Economics in Health Care Purchasing. Glasgow: Scottish Needs Assessment Programme, Scottish Forum for Public Health Medicine; 1995.
3
Mooney G, Gerard K, Donaldson C, Farrar S. Priority Setting in Purchasing: Some Practical Guidelines (Research Paper No. 6). Birmingham: National Association of Health Authorities and Trusts; 1992.
4
Posnett J, Street A. Programme budgeting and marginal analysis: an approach to priority setting in need of refinement. J Health Ser Res Policy. 1996;1(3):147-153.
5
Scott A, Donaldson D, Scott S. Programme budgeting and marginal analysis: pragmatism and policy. J Health Ser Res Policy. 1999;4(1):1-2.
6
Mitton C, Donaldson C. Twenty-five years of programme budgeting and marginal analysis in the health sector, 1974–1999. J Health Ser Res Policy. 1999;6:239-248.
7
Mitton C, Donaldson C. Priority Setting Toolkit: A Guide to the Use of Economics in Health Care Decision Making. London: BMJ Books; 2004.
8
Tsourapas A, Frew E. Evaluating ‘success’ in programme budgeting and marginal analysis: a literature review. J Health Serv Res Policy. 2011;16(3):177-183. doi:10.1258/jhsrp.2010.009053
9
Edwards RT, Charles JM, Thomas S, et al. A national Programme Budgeting and Marginal Analysis (PBMA) of health improvement spending across Wales: disinvestment and reinvestment across the life course. BMC Public Health. 2014;14:837. doi:10.1186/1471-2458-14-837
10
Smith N, Mitton C, Dowling L, Hiltz MA, Campbell M, Gujar SA. Introducing new priority setting and resource allocation processes in a Canadian healthcare organization: A case study analysis informed by multiple streams theory. Int J Health Policy Manag. 2016;5(1):23-31. Doi:10.15171/ijhpm.2015.169
11
Kingdon JW. Agendas, Alternatives and Public Policies. 2nd ed. New York: Harper Collins; 1995.
12
Sabatier P, Weibel C. Theories of the Policy Process. 3rd ed. Boulder, Colorado: Westview Press; 2014.
13
Birkland TA. An Introduction to the Policy Process. 3rd ed. Armonk, New York: M E Sharpe; 2010.
14
Patten S, Mitton C, Donaldson C. Using participatory action research to build a priority setting process in a Canadian Regional Health Authority. Soc Sci Med. 2006;63(5):1121-1134. Doi:10.1016/j.socscimed.2006.01.033
15
Mitton C, Mackenzie J, Cranston L, Teng F. Priority setting in the Provincial Health Services Authority: case study for the 2005/06 planning cycle. Healthcare Policy. 2006;2(1):91-106.
16
Urquhart B, Mitton C, Peacock S. Introducing priority setting and resource allocation in home and community care programs. J Health Serv Res Policy. 2008;13(suppl 1):41-45. doi:10.1258/jhsrp.2007.007064
17
Dionne F, Mitton C, Smith N, Donaldson C. Evaluation of the impact of program budgeting and marginal analysis in Vancouver Island Health Authority. J Health Serv Res Policy. 2009;14(4):234-242. doi:10.1258/jhsrp.2009.008182
18
Mitton C, Dionne F, Damji R, Campbell M, Stirling B. Difficult decisions in times of constraint: Criteria-based Resource Allocation in the Vancouver Coastal Health Authority. BMC Health Serv Res. 2011;11:169.
19
Cornelissen E, Mitton C, Davidson A, et al. Changing priority setting practice: The role of implementation in practice change. Health Policy. 2014;117(2):266-274. doi:10.1016/j.healthpol.2014.04.010
20
Lavis JN, Robertson D, Woodside JM, McLeod CB, Abelson J. How can research organizations more effectively transfer research knowledge to decision makers? Milbank Q. 2003;81(2):221-248. doi:10.1111/1468-0009.t01-1-00052
21
Rogers EM. Diffusion of Innovation. 5th ed. New York: Free Press; 1995.
22
Greenhalgh T, Robert G, Macfarlane F, Bates P, Kryriakidou O. Diffusion of Innovations in Service Organizations: Systematic Review and Recommendations. Milbank Q. 2004;82(4):581-629.
23
Sabatier PA. Top-down and bottom-up approaches to implementation research: a critical analysis and suggested synthesis. J Public Policy. 1986;6(1):21-48.
24
ORIGINAL_ARTICLE
HTA – Algorithm or Process?; Comment on “Expanded HTA: Enhancing Fairness and Legitimacy”
Daniels, Porteny and Urrutia et al make a good case for the idea that that public decisions ought to be made not only “in the light of” evidence but also “on the basis of” budget impact, financial protection and equity. Health technology assessment (HTA) should, they say, be accordingly expanded to consider matters additional to safety and cost-effectiveness. They also complain that most HTA reports fail to develop ethical arguments and generally do not even mention ethical issues. This comment argues that some of these defects are more apparent than real and are not inherent in HTA – as distinct from being common characteristics found in poorly conducted HTAs. More generally, HTA does not need “extension” since (1) ethical issues are already embedded in HTA processes, not least in their scoping phases, and (2) HTA processes are already sufficiently flexible to accommodate evidence about a wide range of factors, and will not need fundamental change in order to accommodate the new forms of decision-relevant evidence about distributional impact and financial protection that are now starting to emerge. HTA and related techniques are there to support decision-makers who have authority to make decisions. Analysts like us are there to support and advise them (and not to assume the responsibilities for which they, and not we, are accountable). The required quality in HTA then becomes its effectiveness as a means of addressing the issues of concern to decisionmakers. What is also required is adherence by competent analysts to a standard template of good analytical practice. The competencies include not merely those of the usual disciplines (particularly biostatistics, cognitive psychology, health economics, epidemiology, and ethics) but also the imaginative and interpersonal skills for exploring the “real” question behind the decision-maker’s brief (actual or postulated) and eliciting the social values that necessarily pervade the entire analysis. The product of such exploration defines the authoritative scope of an HTA.
https://www.ijhpm.com/article_3203_97b9c7ff92a3846b058f14facf360f34.pdf
2016-08-01
501
505
10.15171/ijhpm.2016.59
Deliberation
Economic Evaluation
Equity
Extended Cost-Effectiveness
HTA Processes
Quality-Adjusted Life-Year (QALY) Algorithm
Reference Case
Anthony J.
Culyer
tony.culyer@york.ac.uk
1
Department of Economics & Related Studies and Centre for Health Economics, University of York, York, UK
LEAD_AUTHOR
Office of Technology Assessment. Development of Medical Technology: Opportunities for Assessment. Washington DC: US Government Printing Office; 1976.
1
Banta D. The development of health technology assessment. Health Policy. 2003;63:121-132.
2
Daniels N, Porteny T, Urrutia J [correction of Urritia J]. Expanded HTA: enhancing fairness and legitimacy [published correction appears in Int J Health Policy Manag. 2016;5(5):347]. Int J Health Policy Manag.2016;5(1):1–3. doi:10.15171/ijhpm.2015.187
3
Culyer AJ, Podhisita C, Santatiwongchai B. A Star in the East: A Short History of HITAP. Bangkok: Health Intervention and Technology Assessment Program; 2016.
4
Culyer AJ. The Dictionary of Health Economics. 3rd ed. Cheltenham: Edward Elgar; 2014.
5
Hoffman BM. Toward a procedure for integrating moral issues in health technology assessment. Int J Technol Assess Health Care. 2005;21(3):312-318.
6
Hofmann BM. Why ethics should be part of health technology assessment. Int J Technol Assess Health Care. 2008;24:423-429. doi:10.1017/S0266462308080550
7
Hoffman BM. Why not integrate ethics in HTA: identification and assessment of the reasons. GMS Health Technol Assess. 2014;10:Doc04. doi:10.3205/hta000120.
8
Daniels N, Sabin J. The ethics of accountability in managed care reform. Health Affairs. 1998;17:50-64.
9
Brouwer WB, Culyer AJ, Job N, van Exel A, Rutten FF. Welfarism vs. extra-welfarism. J Health Econ. 2008; 27: 325–338. Reprinted in Cookson R, Claxton K, eds. The Humble Economist: Tony Culyer on Health, Health Care and Social Decision Making. London: Office of Health Economics; 2012:67-78.
10
Gold MR, Siegel JE, Russell LB, Weinstein MC, eds. Cost-effectiveness in Health and Medicine. New York: Oxford University Press; 1996.
11
National Institute for Health and Care Excellence. Guide to the Methods of Technology Appraisal. London: NICE; 2013.
12
Bill and Melinda Gates Foundation Methods for Economic Evaluation Project (MEEP). Final Report and Appendices.London: NICE; 2014.
13
Bill and Melinda Gates Foundation Methods for Economic Evaluation Project (MEEP). The Gates Reference Case: What it is, why it's important, and how to use it. London: NICE; 2014.
14
Culyer AJ. Are there really ten good arguments for a societal perspective in the economic evaluations of medical innovations? In: Culyer AJ, Kobelt G, eds. Portrait of a Health Economist: Festschrift in Honour of Bengt Jönsson. Lund: Institute of Health Economics; 2014:33-38.
15
Culyer AJ, Bombard Y. An equity framework for health technology assessments. Med Dec Making. 2012;32:428-441.
16
Norheim OF, Baltussen R, Johri M, et al. Guidance on priority setting in health care (GPS-Health): the inclusion of equity criteria not captured by cost-effectiveness analysis. Cost Eff Resour Alloc. 2014;12:18. doi:10.1186/1478-7547-12-18
17
Johri M, Norheim OF. Can cost-effectiveness analysis integrate concerns for equity? Systematic review. Int J Technol Assess Health Care. 2012;28(2):125-132. doi:10.1017/S0266462312000050
18
Cookson R, Drummond M, Weatherly H. Explicit incorporation of equity considerations into economic evaluation of public health interventions. Health Econ Policy Law. 2009;4(Pt 2):231-245. doi:10.1017/S1744133109004903
19
Wailoo A, Tsuchiya A, McCabe C. Weighting must wait: incorporating equity concerns into cost effectiveness analysis may take longer than expected. Pharmacoeconomics. 2009;27:983-989.
20
Epstein DM, Chalabi Z, Claxton K, Sculpher M. Efficiency, equity, and budgetary policies: informing decisions using mathematical programming. Med Dec Making. 2007;27:128-137.
21
Baltussen R, Niessen L. Priority setting of health interventions: the need for multi-criteria decision analysis. Cost Eff Res Alloc. 2006;4:4.
22
Culyer AJ, Lomas J. Deliberative processes and evidence-informed decision-making in health care – do they work and how might we know? Evidence and Policy. 2006;2:357-371. (Reprinted in Cookson R, Claxton K, eds. The Humble Economist: Tony Culyer on Health, Health Care and Social Decision Making. London: Office of Health Economics; 2012: 283-300).
23
Culyer AJ. Deliberative Processes in Decisions about Health Care Technologies: Combining Different Types of Evidence, Values, Algorithms and People. London: Office of Health Economics; 2009.
24
Asaria M, Griffin S, Cookson RA, Whyte S, Tappenden P. Distributional cost-effectiveness analysis of health care programmes: A methodological case study of the UK bowel cancer screening programme. Health Econ. 2015;24:742-754.
25
Robson M, Asaria M, Tsuchiya A, Ali S, Cookson R A. Eliciting the level of health inequality aversion in England (CHE Research Paper no. 125). York: Centre for Health Economics, University of York; 2016.
26
Verguet S, Laxminarayan R, Jamison DT. Universal public Finance of tuberculosis treatment in India: an extended cost‐effectiveness analysis. Health Econ. 2015;24:318-332.
27
Culyer AJ. Equity and Equality, in Henk ten Have ed. International Encyclopaedia in Global Bioethics. Berlin: Springer; 2016. http://link.springer.com/referenceworkentry/10.1007/978-3-319-05544-2_176-1. Accessed April 8, 2016.
28
Culyer AJ. The bogus conflict between efficiency and equity. Health Econ. 2006;15:1155-1158.
29
Culyer AJ, Wagstaff A. Equity and equality in health and health care. J Health Econ. 1993;12:431-457. (reprinted in Barr N, ed. Economic Theory and the Welfare State, Cheltenham: Edward Elgar; 2001:231-257 and in Culyer AJ, ed. Health Economics: Critical Perspectives on the World Economy. London: Routledge; 2006:483-509).
30
ORIGINAL_ARTICLE
Governance in Health – The Need for Exchange and Evidence; Comment on “Governance, Government, and the Search for New Provider Models”
Governance in health is cited as one of the key factors in balancing the concerns of the government and public sector with the interests of civil society/private players, but often remains poorly described and operationalized. Richard Saltman and Antonio Duran look at two aspects in the search for new provider models in a context of health markets signalling liberalisation: (i) the role of the government to balance public and private interests and responsibilities in delivering care through modernised governance arrangements, and (ii) the finding that operational complexities may hinder well–designed provider governance models, unless governance reflects country-specific realities. This commentary builds on the discussion by Saltman and Duran, and argues that the concept of governance needs to be clearly defined and operationalized in order to be helpful for policy debate as well as for the development of an applicable framework for performance improvement. It provides a working definition of governance and includes a reflection on the prevailing cultural norms in an organization or society upon which any governance needs to be build. It proposes to explore whether the “evidence-based governance” concept can be introduced to generate knowledge about innovative and effective governance models, and concludes that studies similar to the one by Saltman and Duran can inform this debate.
https://www.ijhpm.com/article_3205_7cf9e9806ec57a2b0d0a9941a6b2a97c.pdf
2016-08-01
507
510
10.15171/ijhpm.2016.60
Governance
Evidence
Operationalization
Decision-Making
Tata
Chanturidze
tata.chanturidze@opml.co.uk
1
Oxford Policy Management Ltd, Oxford, UK
LEAD_AUTHOR
Konrad
Obermann
obermannk@gmx.de
2
Mannheim Institute of Public Health, Universität Heidelberg, Heidelberg, Germany
AUTHOR
Lewis M, Pettersson G. Governance in Health Care Delivery. Raising Performance. Policy Research Working Paper 5074. Washington: The World Bank; 2009.
1
Saltman RB, Duran A. Governance, Government, and the Search for New Provider Models. Int J Health Policy Manag. 2015;4:1-10. doi:10.15171/ijhpm.2015.198
2
Duran A, Dubois HFW, Saltman RB. The evolving roles of hospitals and recent concepts of public sector governance. In: Saltman RB, Duran A, Dubois HW, eds. Governing Public Hospitals: Recent Strategies and the Movement Toward Institutional Autonomy. Brussels: European Observatory on Systems and Policies; 2011:15-34.
3
Magretta J. What Management Is. New York: The Free Press; 2003:4.
4
Kooiman J. Societal governance: levels, models, and orders of socialpolitical interaction. In: Pierre J, ed. Debating Governance: Authority, Steering and Democracy. Oxford: Oxford University Press;2000:138-166.
5
Mossialos E, Permanand G, Baeten R and Hervey T. Health systems governance in Europe: the role of European Union law and policy. In: Health Systems Governance in Europe: The Role of EU Law and Policy. Cambridge University Press; 2010:3. http://www.euro.who.int/__data/assets/pdf_file/0007/138148/E94886_ch01.pdf?ua=1
6
Dwyer J, Eagar K. Options for reform of Commonwealth and State governance responsibilities for the Australian health system. Commissioned paper for the National Health and Hospitals Reform Commission. Canberra; 2008.
7
Savedoff WD. Governance in the health sector. A strategy for measuring determinants and performance. Policy Research Working Paper 5655. Washington: The World Bank; 2011.
8
Rawls J. A Theory of Justice. Cambridge, MA: Belknap Press; 1971.
9
Greer SL, Wismar M, Figueras J, McKee C. Governance: a framework. In: Greer SL, Wismar M, Figueras J, eds. Strengthening Health System Governance. Better Policies, Stronger Performance. Maidenhead: Open University Press; 2016:27-56
10
Jowett M, Kutzin J. Raising revenues for health in support of UHC: strategic issues for policy makers. Health Financing Policy Brief No. 1. Geneva: World Health Organization; 2015.
11
Kramer W. Why Aren’t State Exchanges Embracing Prudent Purchasing Strategies? HealthAffairs Blog, March 19, 2012. http://healthaffairs.org/blog/2012/03/19/why-arent-state-exchanges-embracing-prudent-purchasing-strategies/. Accessed February 19, 2016.
12
Woolhandler S, Ariely D. Will Pay For Performance Backfire? Insights From Behavioral Economics. HealthAffairs Blog. October 11, 2012. http://healthaffairs.org/blog/2012/10/11/will-pay-for-performance-backfire-insights-from-behavioral-economics/. Accessed February 19, 2016.
13
Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996;312(7023):71-2. doi:10.1136/bmj.312.7023.71
14
Pfeffer J, Sutton RI. Evidence-Based Management. Harvard Business Review. January 2006. https://hbr.org/2006/01/evidence-based-management.
15
Gwatkin DR, Wagstaff A, Yazbeck A. Reaching the Poor. What Works, What Doesn't, and Why. Washington: The World Bank; 2005. doi:10.1596/978-0-8213-5961-7
16
Saltman RB, Duran A, Dubois HF, eds. Governing Public Hospitals: Recent Strategies and the Movement Toward Institutional Autonomy. Brussels: European Observatory on Systems and Policies; 2011.
17
Rhodes RAW. The new governance: governing without government. Political Studies. 1996;XLIV:652-667. doi:10.1111/j.1467-9248.1996.tb01747.x
18
Alvarez-Rosete A. Modernising policy making. In: Hann A, ed. Health Policy and Politics. Aldershot: Ashgate; 2007:41-57.
19
Moretti F, Pestre D. Bankspeak. The Language of World Bank Reports. New Left Review. 2015;92:75-99.
20
ORIGINAL_ARTICLE
Risks and Opportunities of Reforms Putting Primary Care in the Driver’s Seat; Comment on “Governance, Government, and the Search for New Provider Models”
Recognizing the advantages of primary care as a means of improving the entire health system, this text comments on reforms of publicly funded primary health centers, and the rapid development of private forprofit providers in Sweden. Many goals and expectations are connected to such reforms, which equally require critical analyses of scarce resources, professional trust/motivation and business logic in the wake of freedom and control of ownership and management. In line with Saltman and Duran, this article calls for research and a methodologically developed approach to capture everyday practice in-depth and how regulation, market incentives and patient demands are met by professionals and primary care leaders.
https://www.ijhpm.com/article_3207_bb3fedeac2289e8cbf752f42539cb3c6.pdf
2016-08-01
511
513
10.15171/ijhpm.2016.64
Health System Governance
Primary Care Reform
Swedish Primary Health Center
Monica
Andersson Bäck
monica.andersson.back@gu.se
1
Department of Social Work, University of Gothenburg, Gothenburg, Sweden
LEAD_AUTHOR
Saltman RB, Duran A. Governance, government, and the search for new provider models. Int J Health Policy Manag. 2016;5(1):33-42. doi:10.15171/ijhpm.2015.198
1
Anell A. Choice and privatisation in Swedish primary care. Health Economics, Policy and Law. 2011;6:549-569. doi:10.1017/s1744133110000216
2
Anell A, Glenngard AH, Merkur SM. Sweden: Health system review. Health Syst Transit. 2012;14(5):1-159.
3
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