IHP news 512: Research

By on March 8, 2019

SS&M – The politics of institutionalizing preventative health

J Bosswell et al; https://www.sciencedirect.com/science/article/pii/S0277953619301248

« Prevention is an attractive idea to policymakers in theory, particularly in health where the burden of spending and care is increasingly taken up by complex and chronic conditions associated with lifestyle choices. However, prevention in general, and preventative health in particular, has proven hard to implement in practice. In this paper, we look to one tangible legacy of the recent rise of the prevention agenda: agencies with responsibility for preventative health policy. We ask how this form of institutionalizing preventative health happens in practice, and what consequences it has for the advancement of the prevention agenda. We draw on qualitative data to compare the trajectories of newly formed agencies in Australia, New Zealand and England. We find that building and maintaining legitimacy for such agencies may come at the expense of quick progress or radical action in service of the prevention agenda. »

BMJ Global Health Analysis – Investing in health R&D: where we are, what limits us, and how to make progress in Africa

V Simpkin et al; https://gh.bmj.com/content/4/2/e001047

Global research and development (R&D) pipelines for diseases that disproportionately affect African countries appear to be inadequate, with governments struggling to prioritise investment in R&D. This article provides insights into the sources of investment in health science research, available research capacity and level of research output in Africa. The African region comprises 15% of the world’s population, yet only accounted for 1.1% of global investments in R&D in 2016. There were substantial disparities within the continent, with Egypt, Nigeria and South Africa contributing 65.7% of the total R&D spending. In most countries of the Organisation for Economic Co-operation and Development, the largest source of R&D funding is the private sector. R&D in Africa is mainly funded by the public sector, with significant proportions of financing in many countries coming from international funding. Challenges that limit private sector investment include unstable political environments, poor governance and corruption. Evidence suggests various research output and research capacity limitations in Africa when considering a global context. Metrics that reflect this include university rankings, number of researchers, number of publications, clinical trials networks and pharmaceutical manufacturing capacity. Within the continent there are substantial regional disparities. Incentivising investment is crucial to foster current and future research output and research capacity. This paper outlines some of the many commendable initiatives under way. Innovative and collaborative financing mechanisms can stimulate further investment. Given the vast inequalities across Africa in R&D, strategies need to reflect the different capacities of countries to address this disparity.”

Implementation Science – Building capacity for Public Health 3.0: introducing implementation science into an MPH curriculum

R Ramaswamy et al; https://implementationscience.biomedcentral.com/articles/10.1186/s13012-019-0866-6

Many public health programs fail because of an inability to implement tested interventions in diverse, complex settings. The field of implementation science is engaged in developing strategies for successful implementation, but current training is primarily researcher-focused. To tackle the challenges of the twenty-first century, public health leaders are promoting a new model titled Public Health 3.0 where public health practitioners become “chief health strategists” and develop interdisciplinary skills for multisector engagement to achieve impact. This requires broad training for public health practitioners in implementation science that includes the allied fields of systems and design thinking, quality improvement, and innovative evaluation methods. At UNC Chapel Hill’s Gillings School of Global Public Health, we created an interdisciplinary set of courses in applied implementation science for Master of Public Health (MPH) students and public health practitioners. We describe our rationale, conceptual approach, pedagogy, courses, and initial results to assist other schools contemplating similar programs.”

Health Research Policy & Systems – Using narratives to impact health policy-making: a systematic review

R Fadlallah et al ; https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-019-0423-4

“There is increased interest in using narratives or storytelling to influence health policies. We aimed to systematically review the evidence on the use of narratives to impact the health policy-making process….”

“…We synthesised the findings narratively and presented the results stratified according to the following stages of the policy cycle: (1) agenda-setting, (2) policy formulation, (3) policy adoption, (4) policy implementation and (5) policy evaluation. Additionally, we presented the knowledge gaps relevant to using narrative to impact health policy-making….”

“…The existing evidence base precludes any robust inferences about the impact of narrative interventions on health policy-making….”

Third World Thematics (Introductory article of a Collection) – Studying the state: a Global South perspective

E Nicholls; https://www.tandfonline.com/doi/abs/10.1080/23802014.2018.1575769?journalCode=rtwt20#.XHzmWmyai1s.twitter

This introductory article presents an overview of the collection. It places its importance in relation to relevant literature and critically highlights the importance of and contributions to each of the articles in this collection. The introduction also stresses the importance of continuing to study the state, particularly from the perspective of the Global South. This entails looking at the state both as an real “thing” as an object of theory. The Introduction emphasizes the polycentric understanding of the state that the collection adopts and the diversity and complementarity between the articles presented. Above all the Introduction highlights the relevance, importance and originality of the collection of articles as a whole and as individual pieces of scholarship.”

Health Research Policy & Systems – Blending integrated knowledge translation with global health governance: an approach for advancing action on a wicked problem

K M Plamondon & J Pemberton; https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-019-0424-3

The persistence of health inequities is a wicked problem for which there is strong evidence of causal roots in the maldistribution of power, resources and money within and between countries. Though the evidence is clear, the solutions are far from straightforward. Integrated knowledge translation (IKT) ought to be well suited for designing evidence-informed solutions, yet current frameworks are limited in their capacity to navigate complexity. Global health governance (GHG) also ought to be well suited to advance action, but a lack of accountability, inclusion and integration of evidence gives rise to politically driven action. Recognising a persistent struggle for meaningful action, we invite contemplation about how blending IKT with GHG could leverage the strengths of both processes to advance health equity….”

Their conclusion: “Integrated learning between these two fields, adopting principles of GHG alongside the strategies of IKT, is a promising opportunity to strengthen leadership for health equity action.”

Health Research Policy & Systems – How have researchers defined and used the concept of ‘continuity of care’ for chronic conditions in the context of resource-constrained settings? A scoping review of existing literature and a proposed conceptual framework

L Meiqari et al ; https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-019-0426-1

Within the context of the growing burden of non-communicable diseases (NCDs) globally, there is limited evidence on how researchers have explored the response to chronic health needs in the context of health policy and systems in low- and middle-income countries. Continuity of care (CoC) is one concept that represents several elements of a long-term model of care. This scoping review aims to map and describe the state of knowledge regarding how researchers in resource-constrained settings have defined and used the concept of CoC for chronic conditions in primary healthcare….”

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