1. Understanding the Role of Public Administration in Implementing Action on the Social Determinants of Health and Health Inequities
Gemma Carey; Sharon Friel
Int J Health Policy Manag, December 2015, 4(12), 795–798
Many of the societal level factors that affect health – the ‘social determinants of health (SDH)’ – exist outside the health sector, across diverse portfolios of government, and other major institutions including non-governmental organisations (NGOs) and the private sector. This has created growing interest in how to create and implement public policies which will drive better and fairer health outcomes. While designing policies that can improve the SDH is critical, so too is ensuring they are appropriately administered and implemented. In this paper, we draw attention to an important area for future public health consideration – how policies are managed and implemented through complex administrative layers of ‘the state.’ Implementation gaps have long been a concern of public administration scholarship. To precipitate further work in this area, in this paper, we provide an overview of the scholarly field of public administration and highlight its role in helping to understand better the challenges and opportunities for implementing policies and programs to improve health equity.
Social Determinants of Health (SDH); Health Equity; Public Policy; Implementation
2. Imagining Global Health with Justice: In Defense of the Right to Health
Eric A. Friedman, Lawrence O. Gostin
Health Care Analysis, December 2015, Volume 23, Issue 4, pp 308-329
Published online: October, 2015
The singular message in Global Health Law is that we must strive to achieve global health with justice—improved population health, with a fairer distribution of benefits of good health. Global health entails ensuring the conditions of good health—public health, universal health coverage, and the social determinants of health—while justice requires closing today’s vast domestic and global health inequities. These conditions for good health should be incorporated into public policy, supplemented by specific actions to overcome barriers to equity.
A new global health treaty grounded in the right to health and aimed at health equity—a Framework Convention on Global Health (FCGH)—stands out for its possibilities in helping to achieve global health with justice.
This far-reaching legal instrument would establish minimum standards for universal health coverage and public health measures, with an accompanying national and international financing framework, require a constant focus on health equity, promote Health in All Policies and global governance for health, and advance the principles of good governance, including accountability.
While achieving an FCGH is certainly ambitious, it is a struggle worth the efforts of us all. The treaty’s basis in the right to health, which has been agreed to by all governments, has powerful potential to form the foundation of global governance for health. From interpretations of UN treaty bodies to judgments of national courts, the right to health is now sufficiently articulated to serve this role, with the individual’s right to health best understood as a function of a social, political, and economic environment aimed at equity. However great the political challenge of securing state agreement to the FCGH, it is possible.
States have joined other treaties with significant resource requirements and limitations on their sovereignty without significant reciprocal benefits from other states, while important state interests would benefit from the FCGH. And from integrating the FCGH into the existing human rights system to creative forms of compliance and enforcement and strengthened domestic legal and political accountability mechanisms, the treaty stands to improve right to health compliance. The potential for the FCGH to bring the right to health nearer universal reality calls for us to embark on the journey towards securing this global treaty.
Right to Health; Justice; Equity; Universal Health Coverage; Social Determinants of Health; Health Systems; Global Health
3. Social determinants and inequalities in tuberculosis incidence in Latin America and the Caribbean
César V. Munayco,Oscar J. Mújica,Francisco X. León,Mirtha del Granado, Marcos A. Espinal
Rev Panam Salud Publica. 2015;38(3):177–85
Published online: November 2015
Objective. o identify key social determinants of tuberculosis (TB) incidence among countries in Latin America and the Caribbean (LAC), a geographic area regarded as one of the most socioeconomically unequal in the world.
Methods. An ecological study was conducted at the country level. Data were obtained from several institutional-based sources. Random-effects regression modeling was used to explore the relationship between several social determinants indicators and TB incidence rates in 20 LAC countries in 1995–2012. Standard gap and gradient metrics of social inequality in TB incidence among countries in 2000, 2005, and 2010 were then calculated.
Results. TB incidence rate trends were significantly associated with health expenditure per capita and access to improved sanitation facilities, as well as with life expectancy at birth and TB detection rate, after adjusting for other socioeconomic, demographic, and health services variables. Absolute and relative inequality in TB incidence remained mostly unchanged: countries at the bottom 20% of both health expenditure and sanitation coverage distributions concentrated up to 40% of all TB incident cases, despite a considerable decline in the overall TB incidence mean rate during the period assessed.
Conclusions. Along with the intensity of TB control (reflected by TB detection rate), both access to sanitation (as a proxy of quality of living conditions) and health expenditure per capita (either as an indicator of the level of resources and/or commitment to health care) appear to be key determinants of TB incidence trends in LAC countries. Inequalities in both health expenditure per capita and access to sanitation seem to define profound and persistent inverse gradients in TB incidence among LAC countries.
Objetivo. Establecer los determinantes sociales clave de la incidencia de tuberculosis (TB) en los países de América Latina y el Caribe (ALC), una zona geográfica consideraba como una de las más afectadas por las desigualdades socioeconómicas en el mundo.
Métodos. Se llevó a cabo un estudio ecológico a nivel de país. Los datos se obtuvieron de diversas fuentes institucionales. Mediante un modelo de regresión de efectos aleatorios se exploró la relación entre varios indicadores de determinantes sociales y las tasas de incidencia de TB en 20 países de ALC durante el periodo de 1995 al 2012. A continuación, se calcularon los valores ordinarios de la brecha y el gradiente de desigualdad social en la incidencia de TB entre países en el 2000, el 2005 y el 2010.
Resultados. Las tendencias en la tasa de incidencia de TB se asociaban significativamente con el gasto per cápita en salud y el acceso a mejores instalaciones de saneamiento, así como con la esperanza de vida al nacer y la tasa de detección de la TB, tras ajustar para otras variables socioeconómicas, demográficas y de servicios de salud. La desigualdad absoluta y relativa en la incidencia de TB se mantuvo prácticamente inalterada: los países que se distribuían en el 20% inferior del gasto en salud y la cobertura de saneamiento aglutinaban hasta un 40% de todos los casos nuevos de TB, a pesar de una considerable disminución de la tasa general media de incidencia de TB durante el período evaluado. Conclusiones. Junto con la intensidad de las actividades de control de la TB (reflejada por la tasa de detección de la TB), tanto el acceso al saneamiento (reflejo de la calidad de las condiciones de vida) como el gasto per cápita en salud (ya sea como indicador del nivel de recursos o del compromiso con la atención de salud) parecen ser determinantes clave de las tendencias en la incidencia de TB en los países de ALC. Las desigualdades tanto en el gasto per cápita en salud como en el acceso al saneamiento parecen definir los gradientes inversos profundos y persistentes en la incidencia de TB entre los países de ALC.
Tuberculosis; Social Determinants of Health; Social Inequality; Equity in Health; Latin America; Caribbean Region
4. The role of income inequality and social policies on income-related health inequalities in Europe
International Journal for Equity in Health (2015) 14:117
Published online: 31 October 2015
Introduction: The aim of the paper is to examine the role of income inequality and redistribution for income-related health inequalities in Europe. This paper contributes in two ways to the literature on macro determinants of socio-economic inequalities in health. First, it widens the distinctive focus of the research field on welfare state regimes to quantifiable measures such as social policy indicators. Second, looking at income differences completes studies on socio-economic health inequalities, which often analyse health inequalities based on educational differences.
Methods: Using data from the European Values Study (2008/2009), 42 European countries are available for analysis. Country characteristics are derived from SWIID, Eurostat, and ILO and include indicators for income inequality, social policies, and economic performance. The data is analysed by using a two-step hierarchical estimation approach: At the first step—the individual level—the effect of household income on self-assessed health is extracted and introduced as an indicator measuring income-related health inequalities at the second step, the country-level.
Results: Individual-level analyses reveal that income-related health inequalities exist all across Europe. Results from country-level analyses show that higher income inequality is significantly positively related to higher health inequalities while social policies do not show significant relations. Nevertheless, the results show the expected negative association between social policies and health inequalities. Economic performance also has a reducing influence on health inequalities. In all models, income inequality was the dominating explanatory effect for health inequalities.
Conclusions: The analyses indicate that income inequality has more impact on health inequalities than social policies. On the contrary, social policies seemed to matter to all individuals regardless of socio-economic position since it is significantly positively linked to overall population health. Even though social policies are not significantly related to health inequalities, the power of public redistribution to impact health inequalities should not be downplayed. Social policies as a way of public redistribution are a possible instrument to reduce income inequalities which would in turn lead to a reduction in health inequalities.
Health Inequalities, Income, Income Inequality, Social Spending, Europe, EVS
5. Health care financing and the sustainability of health systems
Lycourgos Liaropoulos; Ilias Goranitis
International Journal for Equity in Health 2015, 14:80
Published online: 15 September 2015
The economic crisis brought an unprecedented attention to the issue of health system sustainability in the developed world. The discussion, however, has been mainly limited to “traditional” issues of cost-effectiveness, quality of care, and, lately, patient involvement. Not enough attention has yet been paid to the issue of who pays and, more importantly, to the sustainability of financing. This fundamental concept in the economics of health policy needs to be reconsidered carefully. In a globalized economy, as the share of labor decreases relative to that of capital, wage income is increasingly insufficient to cover the rising cost of care. At the same time, as the cost of Social Health Insurance through employment contributions rises with medical costs, it imperils the competitiveness of the economy. These reasons explain why spreading health care cost to all factors of production through comprehensive National Health Insurance financed by progressive taxation of income from all sources, instead of employer-employee contributions, protects health system objectives, especially during economic recessions, and ensures health system sustainability.
Health Systems; Health Care
6. Community Participation in Health Systems Research: A Systematic Review Assessing the State of Research, the Nature of Interventions Involved and the Features of Engagement with Communities
Asha S. George, Vrinda Mehra, Kerry Scott, Veena Sriram
PLOS One, 2015, 10(10): e0141091
Published online: 23 October 2015
Background: Community participation is a major principle of people centered health systems, with considerable research highlighting its intrinsic value and strategic importance. Existing reviews largely focus on the effectiveness of community participation with less attention to how community participation is supported in health systems intervention research.
Objective: To explore the extent, nature and quality of community participation in health systems intervention research in low- and middle-income countries.
Methodology: We searched for peer-reviewed, English language literature published between January 2000 and May 2012 through four electronic databases. Search terms combined the concepts of community, capability/participation, health systems research and low- and middle-income countries. The initial search yielded 3,092 articles, of which 260 articles with more than nominal community participation were identified and included. We further excluded 104 articles due to lower levels of community participation across the research cycle and poor description of the process of community participation. Out of the remaining 160 articles with rich community participation, we further examined 64 articles focused on service delivery and governance within health systems research.
Results: Most articles were led by authors in high income countries and many did not consistently list critical aspects of study quality. Articles were most likely to describe community participation in health promotion interventions (78%, 202/260), even though they were less participatory than other health systems areas. Community involvement in governance and supply chain management was less common (12%, 30/260 and 9%, 24/260 respectively), but more participatory. Articles cut across all health conditions and varied by scale and duration, with those that were implemented at national scale or over more than five years being mainstreamed by government. Most articles detailed improvements in service availability, accessibility and acceptability, with fewer efforts focused on quality, and few designs able to measure impact on health outcomes. With regards to participation, most articles supported community’s in implementing interventions (95%, n = 247/260), in contrast to involving communities in identifying and defining problems (18%, n = 46/260). Many articles did not discuss who in communities participated, with just over a half of the articles disaggregating any information by sex. Articles were largely under theorized, and only five mentioned power or control. Majority of the articles (57/64) described community participation processes as being collaborative with fewer describing either community mobilization or community empowerment. Intrinsic individual motivations, community-level trust, strong external linkages, and supportive institutional processes facilitated community participation, while lack of training, interest and information, along with weak financial sustainability were challenges. Supportive contextual factors included decentralization reforms and engagement with social movements.
Conclusion: Despite positive examples, community participation in health systems interventions was variable, with few being truly community directed. Future research should more thoroughly engage with community participation theory, recognize the power relations inherent in community participation, and be more realistic as to how much communities can participate and cognizant of who decides that.
Health Systems; Community Participation; Research in Health; Low- and middle-income Countries
7. SDH-NET: a South–North-South collaboration to build sustainable research capacities on social determinants of health in low- and middle-income countries
Lucinda Cash-Gibson, German Guerra, V Nelly Salgado-de-Snyder
Health Research Policy and Systems (2015) 13:45
Published online: 22 October 2015
Background: It is desirable that health researchers have the ability to conduct research on health equity and contribute to the development of their national health system and policymaking processes. However, in low- and middle-income countries (LMICs), there is a limited capacity to conduct this type of research due to reasons mostly associated with the status of national (health) research systems. Building sustainable research capacity in LMICs through the triangulation of South–North-South (S-N-S) collaborative networks seems to be an effective way to maximize limited national resources to strengthen these capacities. This article describes how a collaborative project (SDH-Net), funded by the European Commission, has successfully designed a study protocol and a S-N-S collaborative network to effectively support research capacity building in LMICs, specifically in the area of social determinants of health (SDH); this project seeks to elaborate on the vital role of global collaborative networks in strengthening this practice.
Methods: The implementation of SDH-Net comprised diverse activities developed in three phases. Phase 1: national level mapping exercises were conducted to assess the needs for SDH capacity building or strengthening in local research systems. Four strategic areas were defined, namely research implementation and system performance, social appropriation of knowledge, institutional and national research infrastructure, and research skills and training/networks. Phase 2: development of tools to address the identified capacity building needs, as well as knowledge management and network strengthening activities. Phase 3: identifying lessons learned in terms of research ethics, and how policies can support the capacity building process in SDH research.
Results: The implementation of the protocol has led the network to design innovative tools for strengthening SDH research capacities, under a successful S-N-S collaboration that included national mapping reports, a global open-access learning platform with tools and resources, ethical guidelines for research, policy recommendations, and academic contributions to the global SDH discourse.
Conclusions: The effective triangulation of S-N-S partnerships can be of high value in building sustainable research capacity in LMICs. If designed appropriately, these multicultural, multi-institutional, and multidisciplinary collaborations can enable southern and northern academics to contextualize global research according to their national realities.
Capacity Building; Health Status Disparities; International Cooperation; Global Health; Research; Social Determinants of Health
8. Applying Modeling to Improve Health and Economic Policy Decisions in the Americas: The Case of Noncommunicable Diseases
Organisation for Economic Co-operation and Development
Pan American Health Organization
In the Region of the Americas, noncommunicable diseases (NCDs) are a clear threat not only to human health, but also to a country’s economic development and growth. The evidence on both of these counts is compelling. In 2012, cardiovascular disease, diabetes, cancers, chronic respiratory conditions including asthma, and other NCDs were the cause of 4.5 million deaths in the Americas. Of that total number, 1.5 million of them were premature, occurring among people aged 30-69 years. The financial impact of NCDs in the Americas is just as dismaying, with chronic diseases posing a growing threat to many nations’ economic stability. According to a 2007 Lancet article, without intensified NCD prevention efforts, countries around the world could expect their gross domestic product (GDP) to decline by billions of dollars. Over the 2006- 2015 period, from just three chronic illnesses—heart disease, stroke, and diabetes—the countries of Argentina, Brazil, Colombia, and Mexico together could face a cumulative combined GDP loss of US$ 13.5 billion.These health and financial losses are not inevitable.
Options exist today for actions that governments, civil society, and the private sector can take to substantially reduce these costs. Nevertheless, choosing the best health and economic policies can be a daunting task. Since 2011, both the Pan American Health Organization and the World Health Organization have been working with governments and such other partners as the Organisation for Economic Co-operation and Development, the Public Health Agency of Canada, and the Economic Commission for Latin America and the Caribbean to strengthen the capacities of countries to generate and use economic data in developing NCD interventions, with the aim of reducing mortality from these diseases. This publication, Applying Modeling to Improve Health and Economic Policy Decisions in the Americas: The Case of Noncommunicable Diseases is the product of this collaboration. The text is the first to exclusively present different economic models and illustrate their application to NCDs in the Region of the Americas. It aims to stimulate the use of economic modeling as a tool to support the decision-making process for NCD interventions, and to encourage investment in cost-effective strategies for healthy living and NCD prevention in the Region [… ]
A healthy population is an important factor for sustainable economic growth. All the persons who share that view—including public health practitioners, researchers, students, and officials framing and implementing health policies in the private and public sectors— could benefit from this text. Allocating existing resources and marshaling new ones are essential steps if health systems in the Region are to meet the evolving needs of their populations, particularly as it relates to NCD prevention and control. We firmly believe this book can help the nations of the Americas face that challenge.
Chronic Diseases; Health Economics; Public Health Policy; Inequalities; Health Systems; Decision Making; Latin America.
9. The Quest for Global Justice in Health: A Review of Global Health Law by Lawrence O. Gostin
Yale Journal of Health Policy, Law, and Ethics. Vol. 15: Iss. 2, Article 4.
Published online: October 2015
We are witnessing the emergence of a new world health order. Health occupies an increasingly relevant place in the global agenda. An unprecedented health transition is leading to a new model characterized by expanded international and national funding for health and the involvement of a growing pluralism of actors. During the twentieth century, the life expectancy of the world population increased more than it had in all previous centuries combined. In 1900, global life expectancy averaged just over a mere thirty years. By 1990, it had more than doubled to sixty-four years, and now may surpass seventy years. Of course, there are huge disparities among countries: life expectancy at birth in Japan is eighty-three years, while in Sierra Leone it is forty-five. We have also seen a major shift in the dominant patterns of disease. Chronic non-communicable disorders (NCDs) in adults have replaced acute infections in children as a relatively dominant cause of death globally. The increasing importance of chronic diseases explains another salient characteristic of thehealth transition: the rising role of disability in the global health profile. "Health problems," according to a recent Global Burden of Disease Report, "are increasingly defined not by what kills us, but what ails us. '' The prominence of health in the global agenda has changed as well. Health issues have moved from the realm of "low politics," commonly associated with development concerns, to that of high politics,"usually associated with national and global security issues."5 Health issues increasingly contribute to economic growth and development, national and global security, and human rights promotion […]
Given this complex context, it is critically important to use novel perspectives when discussing the nature and scope of global health. This is exactly what Lawrence O. Gostin achieves in his recent book, Global Health Law. This outstanding volume views global health through the lens of international law. However, its vast breadth and innovative approach allow it to transcend a strictly legal framework. It appeals not only to legal and public health specialists, but also to "the informed public that cares about global health with justice."' The book's launching is particularly timely since negotiations around the post-2015 Development Agenda are reaching their final stage. These negotiations intend to define a new development framework that will succeed the Millennium Development Goals…
Global Health; Health Legislation; Millennium Development Goals; Health Systems
10. Charting the evolution of approaches employed by the Global Alliance for Vaccines and Immunizations (GAVI) to address inequities in access to immunization: a systematic qualitative review of GAVI policies, strategies and resource allocation mechanisms through an equity lens (1999–2014)
BMC Publich Health, 2015, 15:1198
Published online: 30 November 2015
Background: GAVI’s focus on reducing inequities in access to vaccines, immunization, and GAVI funds, − both between and within countries - has changed over time. This paper charts that evolution.
Methods: A systematic qualitative review was conducted by searching PubMed, Google Scholar and direct review of available GAVI Board papers, policies, and program guidelines. Documents were included if they described or evaluated GAVI policies, strategies, or programs and discussed equity of access to vaccines, utilization of immunization services, or GAVI funds in countries currently or previously eligible for GAVI support. Findings were grouped thematically, categorized into time periods covering GAVI’s phases of operations, and assessed depending on whether the approaches mediated equity of opportunity or equity of outcomes between or within countries.
Results: Searches yielded 2816 documents for assessment. After pre-screening and removal of duplicates, 552 documents underwent detailed evaluation and pertinent information was extracted from 188 unique documents. As a global funding mechanism, GAVI responded rationally to a semi-fixed funding constraint by focusing on between-country equity in allocation of resources. GAVI’s predominant focus and documented successes have been in addressing between-country inequities in access to vaccines comparing lower income (GAVI-eligible) countries with higher income (ineligible) countries. GAVI has had mixed results at addressing between-country inequities in utilization of immunization services, and has only more recently put greater emphasis and resources towards addressing within-country inequities in utilization to immunization services. Over time, GAVI has progressively added vaccines to its portfolio. This expansion should have addressed inter-country, inter-regional, inter-generational and gender inequities in disease burden, however, evidence is scant with respect to final outcomes.
Conclusion: In its next phase of operations, the Alliance can continue to demonstrate its strength as a highly effective multi-partner enterprise, capable of learning and innovating in a world that has changed much since its inception. By building on its successes, developing more coherent and consistent approaches to address inequities between and within countries and by monitoring progress and outcomes, GAVI is well-positioned to bring the benefits of vaccination to previously unreached and underserved communities towards provision of universal health coverage.
11. National men’s health policies: can they help?
Published online: 2 December 2015
“Despite the many serious health problems facing men, few countries have national strategies. In this article, Peter Baker reviews the national men’s health strategy in Ireland and looks at how effective these policies have proved in some other countries […] Beyond Ireland, it is now increasingly understood that health policies and practices that take specific account of sex and gender differences are required. The World Health Organization (WHO) has stated that: ‘To respond to gender inequities in health, men’s health status and behaviour must be recognized as resulting as much from the social construction of gender as women’s … Violence, unsafe sexual contact, smoking, alcohol and drug consumption, and higher suicide rates contribute to premature death among men. Gender heavily influences these risk factors and the health sector is not considering it fully when designing policies and programmes.’[…] The evidence from all three countries with national men’s health policies suggests that they are certainly not a panacea, but that they can make a significant contribution. This has been summarised as: • Identifying men’s health as a priority area • Creating a vision and identity for ‘men’s health’ • Acting as a blueprint and resource for practitioners and ongoing health policy development • Providing the leverage for expanding men’s health work, particularly at an intersectoral and interdepartmental level • Acting as a catalyst for increased men’s health activity in other areas (eg health promotion, occupational and workplace health, community development projects) • Providing a platform for further action to deliver effective gender mainstreaming that embeds men’s health policy within the wider policy landscape…
Gender and Health; National Men’s Health; Public Health Strategy; Ireland; Australia; Brazil
12. Policy Brief – Impacts and Policy Options
The challenge of extending universal coverage to non-poor informal workers in low- and middle-income countries in Asia
Peter Leslie Annear, Liz Comrie-Thomson, Prarthna Dayal
World Health Organization - Regional Office for the Western Pacific. olicy Brief, v. 4, n. 3 2015.
Published online: November, 2015
Although universal coverage, in principle, means providing financial protection to the whole population, it requires the introduction of some form of prepayment for health service charges, especially in low- and middle-income income countries, where resources are constrained and per capita health expenditures are low. Prepayment mechanisms have been defined as a means of distributing the financial risk associated with different individuals’ health-care expenditures over time and across populations.
The implementation of prepayment mechanisms for non-poor informal workers in LMICs is a relatively new policy area and faces many challenges. There are concerns on whether compulsory schemes such as social health insurance are effective in covering non-poor informal workers, whether voluntary schemes such as community based health insurance can be used to scale-up coverage of non-poor informal workers, and whether complete subsidization of non-poor informal workers can create perverse incentives for remaining in or moving into informal employment. Approaches to coverage of non-poor informal workers vary depending on the political, economic or cultural context within each LMIC. In conceptual terms, there are three broad, practical approaches to providing coverage of non-poor informal workers: extend coverage downward from the formal sector; extend coverage upward from schemes subsidizing the poor; or use a combination of prepayment and tax-based subsidies.
What is the problem
In pursuing the goal of universal coverage, governments and policy-makers in low- and middle-income countries (LMICs) in Asia face a particular challenge in providing access to health services for non-poor informal workers through some form of prepayment (Tangcharoensathien et al., 2011; Lagomarsino et al., 2012). There is general recognition that providing coverage for the poor requires tax-funded subsidies, and many governments have begun to implement social health insurance (SHI) for the formally employed. Only a few LMICs have found the means to cover non-poor informal workers (Langenbrunner and Somanathan, 2011).
Informal workers have been defined as those outside formal employment, comprising all those employed informally whether in the formal, informal or household sectors (Bitran, 2014). Our special concern here is with the coverage of informal workers who are above the poverty line, that is, non-poor informal workers. In principle, universal coverage means providing financial protection to the whole population. In practice, universal coverage cannot be achieved at once, but involves progress along a path towards achieving full population coverage (Kutzin, 2013). This is especially true in low- and middle-income income countries, where resources are constrained and per capita health expenditures are low. Universal coverage requires the introduction of some form of prepayment for health service charges. Prepayment mechanisms have been defined as a means of distributing the financial risk associated with different individuals’ health-care expenditures over time and across populations (Acharya et al., 2012)…
13. Protocol for the development of a CONSORT- equity guideline to improve reporting of health equity in randomized trials
Vivian Welch , J. Jull, J. Petkovic, R. Armstrong, Y. Boyer, LG Cuervo, SJL Edwards, A. Lydiatt, D. Gough and 17 more
Implementation Science (2015) 10:146
First online: October 2015
Background: Health equity concerns the absence of avoidable and unfair differences in health. Randomized controlled trials (RCTs) can provide evidence about the impact of an intervention on health equity for specific disadvantaged populations or in general populations; this is important for equity-focused decision-making. Previous work has identified a lack of adequate reporting guidelines for assessing health equity in RCTs. The objective of this study is to develop guidelines to improve the reporting of health equity considerations in RCTs, as an extension of the Consolidated Standards of Reporting Trials (CONSORT).
Methods/design: A six-phase study using integrated knowledge translation governed by a study executive and advisory board will assemble empirical evidence to inform the CONSORT-equity extension. To create the guideline, the following steps are proposed: (1) develop a conceptual framework for identifying “equity-relevant trials,” (2) assess empirical evidence regarding reporting of equity-relevant trials, (3) consult with global methods and content experts on how to improve reporting of health equity in RCTs, (4) collect broad feedback and prioritize items needed to improve reporting of health equity in RCTs, (5) establish consensus on the CONSORT-equity extension: the guideline for equity-relevant trials, and (6) broadly disseminate and implement the CONSORT-equity extension.
Discussion: This work will be relevant to a broad range of RCTs addressing questions of effectiveness for strategies to improve practice and policy in the areas of social determinants of health, clinical care, health systems, public health, and international development, where health and/or access to health care is a primary outcome. The outcomes include a reporting guideline (CONSORT-equity extension) for equity-relevant RCTs and a knowledge translation strategy to broadly encourage its uptake and use by journal editors, authors, and funding agencies.
Randomized Controlled Trials; Cluster Randomized Control Trials; Health Equity; Reporting Guidelines; Methods; Health Systems; Policy
14. Bringing stakeholders together for urban health equity: hallmarks of a compromised process
Amy S. Katz, Rebecca M. Cheff, Patricia O’Campo
International Journal for Equity in Health, December 2015 14:38
First published online: 20 November 2015
There is a global trend towards the use of ad hoc participation processes that seek to engage grassroots stakeholders in decisions related to municipal infrastructure, land use and services. We present the results of a scholarly literature review examining 14 articles detailing specific cases of these processes to contribute to the discussion regarding their utility in advancing health equity. We explore hallmarks of compromised processes, potential harms to grassroots stakeholders, and potential mitigating factors. We conclude that participation processes often cut off participation following the planning phase at the point of implementation, limiting convener accountability to grassroots stakeholders, and, further, that where participation processes yield gains, these are often due to independent grassroots action. Given the emphasis on participation in health equity discourse, this study seeks to provide a real world exploration of the pitfalls and potential harms of participation processes that is relevant to health equity theory and practice.
Health Equity; Participatory Processes; Community Engagement; Stakeholder Engagement; Urban Health Equity; Urban Governance; Neoliberalism and Cities
15. Policy Brief
Anchoring universal health coverage in the right to health: What difference would it make?
World Health Organization
Publication date: November 2015
Universal Health Coverage UHC is a critical component of the new Sustainable Development Goals (SDGs) which include a specific health goal: “Ensure healthy lives and promote wellbeing for all at all ages”. Within this health goal, a specific target for UHC has been proposed: “Achieve UHC, including financial risk protection, access to quality essential health care services and access to safe, effective, quality and affordable essential medicines and vaccines for all”. In this context, the opportunity exists to unite global health and the fight against poverty through action that is focussed on clear goals For WHO, “UHC is, by definition, a practical expression of the concern for health equity and the right to health”(1); thus promoting UHC advances the overall objective of WHO, namely the attainment by all peoples of the highest possible standard of health as a fundamental right (3), and signal a return to the ideals of the Declaration of Alma Ata and the WHO Global Strategy for Health for All by the Year 2000 (4). Yet some argue that the “current discourse on UHC is in sharp contrast with the vision of Primary Health Care envisaged in the Alma Ata declaration of 1978” (5). The underlying assumption of this paper is that efforts towards achieving UHC do promote some, but not necessarily all, of the efforts required from governments for the realization of the right to health.
While this publication explores how efforts to advance towards UHC overlap with efforts to realize the right to health, its main focus is the gaps that exist between UHC efforts and right to health efforts.
Universal Health Coverage; Equity in Health; Right to Health