The Influence of Educational Determinants on Children's Health: A Scoping Review of Reviews.

Objectives: Education is one of the most important social determinants shaping the development and wellbeing of children. The purpose of this review of reviews is to inform policymakers, practitioners and public health stakeholder involved in developing child-friendly policies outside of the healthcare system. Methods: We carried out a scoping review of reviews. It included 32 reviews. Results: We identified four main categories of educational determinants in relation to children's health: 1) the organization and structure of educational activities, 2) the interpersonal relations in the educational facilities and structures, 3) the spatial environment of educational facilities and structures, 4) social inequalities in the educational facilities and structures. This last category highlighted the capacity of education system to act on inequalities derived from the way social structures are organized. Conclusion: We suggest a conceptual framework for action which distinguishes structural determinant (gender, race, social class, etc.) and structuring determinant (public policy, systems of governance, organization of cultures/values consideration). Finally, we discuss on how these social structures and structuring determinants influence the intermediary educational determinants collated in the review.

The lived experience of receiving and providing antenatal care during the Covid-19 crisis in Southern Europe: An exploratory qualitative study.

OBJECTIVE: The Covid-19 pandemic led to a reorganization of antenatal care including the cancellation or shift into telemedicine of consultations and restrictions to the presence of an accompanying person. The aim was to explore healthcare professionals' and women's lived experience of such reorganisation consequences on the quality of care and specific challenges they faced, with a particular emphasis on telemedicine and equity. METHODS: Exploratory qualitative study using semi-structured interviews and focus group discussions of women and healthcare providers in New Aquitaine (France) and in the Basque Country (Spain). We collected data from a purposive sampling of women (n = 33) and professionals (n = 19) who had received or provided antenatal care in hospitals and ambulatory facilities between March 2020 and December 2021. Participants' narratives were thematically analysed to identify themes that were subsequently contextualised to the two territories. RESULTS: Antenatal care professionals and pregnant women experienced strong emotions and suffered from organizational changes that compromised the quality and equity of care. The pandemic and associated restrictions were sources of emotional distress, fear and loneliness, especially among more disadvantaged and isolated women. Among professionals, the lack of adequate means of protection and the multiple changes in caring protocols generated burnout, feeling of abandonment and emotional distress. CONCLUSIONS: The Covid-19 experience should serve to critically consider the unexpected consequences of reorganising healthcare services and the need to meet patients' needs, with a particular consideration for disadvantaged groups. Future scenarios of telemedicine generalisation should consider a combination of in presence and remote consultations ensuring antenatal care quality and equity.

La participation citoyenne dans les évaluations d'impact sur la santé en France.

OBJECTIVE: Citizen participation is one of the core values of Health Impact Assessment (HIA). Nevertheless, there is a gap between the ideal described in HIA foundational texts and its current practice as reported in the international literature. In the light of HIA recent development in France, this article provides some insights to better understand this concept and the challenges associated to its actual implementation in France. METHODS: This exploratory study is based on semi-structured interviews, on-site observations and document analysis of a panel of 11 HIAs carried out in 8 French regions between 2011-2018. Citizen participation is analyzed according to 5 dimensions: stakeholders’ perceptions and expectations, scope of participation, scale, methods of engagement, constraints. RESULTS: As reported in other studies published abroad, the concept of citizen participation remains unclear in France. Despite some progress observed in more recent HIAs, its actual implementation remains incomplete due to political, financial and human constraints and to competition with other existing mechanisms for public participation at a local level. CONCLUSION: While accumulated experience may contribute to effectively integrate citizen participation in HIA, this study shows that in order to better bond this practice to health promotion values, it is important to clearly define the objectives of such participation, to sensitize city counselors in advance, to strengthen HIA practitioners’ capacities, and to rely on participation specialists.

L'efficacité de l'évaluation d'impact sur la santé : leçons tirées d'une expérience dans l'agglomération bordelaise.

INTRODUCTION: This work presents the results of an impact evaluation applied to an HIA of an urban development project. The purpose of the evaluation was to assess the direct effects of the HIA procedure on the decision making by the implementation of the recommendations as well as its indirect effects in terms of stakeholders’ appropriation and use of the information produced throughout the process. METHODS: 12 semi-structured interviews were conducted with HIA stakeholders including regional public health directors and professionals, local elected officials, and technical staff from the engaged local authorities. RESULTS: Data collected confirmed HIA indirect impacts in terms of interviewees’ enhanced values and beliefs according to a holistic model of health, changes in professional practices through appropriation of the knowledge generated throughout the process and strengthening of intersectoral collaborations for health. More modest results were identified regarding HIA direct effects on decision making through the consideration of the proposed recommendations because of their redundancy with technical teams’ routine practices and their late timing. Nevertheless, interest in capitalizing on these recommendations for future municipal and metropolitan projects suggests deferred effects on decision making that should not be neglected. CONCLUSIONS: This study provides new data on the effectiveness, to varying degrees, of one of the first HIAs conducted in the region of Nouvelle Aquitaine. Other evaluations should be promoted in France to demonstrate HIA value and to draw useful lessons to inform its further development and consolidation in the coming years.

[Lessons from abroad. Current and previous crisis in other countries. SESPAS report 2014]. / Lecciones desde fuera. Otros países en ésta y otras crisis anteriores. Informe SESPAS 2014.

The evidence available on the impact of previous crises on health reveals different patterns attributable to study designs, the characteristics of each crisis, and other factors related to the socioeconomic and political context. There is greater consensus on the mediating role of government policy responses to financial crises. These responses may magnify or mitigate the adverse effects of crises on population health. Some studies have shown a significant deterioration in some health indicators in the context of the current crisis, mainly in relation to mental health and communicable diseases. Alcohol and tobacco use have also declined in some European countries. In addition, this crisis is being used by some governments to push reforms aimed at privatizing health services, thereby restricting the right to health and healthcare. Specifically, action is being taken on the three axes that determine health system financing: the population covered, the scope of services, and the share of the costs covered. These measures are often arbitrarily implemented based on ideological decisions rather than on the available evidence and therefore adverse consequences are to be expected in terms of financial protection, efficiency, and equity.

[Health impact assessment of the San Fernando street renewal project in Alcalá de Guadaíra (Seville, Spain)]. / Evaluación del impacto en la salud del proyecto de reurbanización de la calle San Fernando en Alcalá de Guadaíra (Sevilla).

OBJECTIVES: This study describes the design and implementation of a health impact assessment (HIA) conducted in 2010 of the regeneration project of San Fernando Street, the main avenue crossing the San Miguel-El Castillo neighborhood in Alcala de Guadaíra (Seville, Spain). This project is part of the wider URBAN Plan aimed at the social, urban and economic regeneration of the city's historic center. METHODS: This experience followed the standard HIA stages and procedures. The review of published evidence was complemented with new qualitative information gathered by means of a participative workshop with the local population and interviews with social and health workers involved in the neighborhood. RESULTS: During the building stage of the project, the adverse impacts were related to a worsening of the air quality, increased noise pollution, mobility restrictions and a higher risk of accidents, particularly among older or disabled people. Once the building stage was finished, the health benefits were associated with significant improvements in physical accessibility and the population's access to health services and other goods and services. Other positive effects were the enhanced safety and attractiveness of the neighborhood and the new opportunities for socializing, social cohesion and increasing the community's self-esteem. CONCLUSIONS: This is the first HIA experience in Andalusia whose results have been integrated into a formal cycle of decision making in the local community. This experience has provided new evidence of the potential of HIA and its applicability and acceptance at the municipal level and has has also facilitated a learning process and the piloting of new methods and tools associated with the HIA process.

[Toward a new organization of public health services in Spain. 2008 SESPAS Report]. / Hacia una nueva organización de los dispositivos de salud pública en España. Informe SESPAS 2008.

Public health in Spain shows significant weaknesses. Spanish public health services respond reasonably well in crisis situations but tend to be invisible and occupy a marginal position in political agendas and in relation to health services. The organization of the public health subsystem is clearly out of date in terms of its ability to promote and protect community health, to prevent diseases, and to cope effectively with the new public health threats and challenges related to the physical and social environment in today's globalized world. Consequently, there is broad consensus on the need to rethink functions, strategies and the organization of public health in Spain, in line with European and international trends. Thus, public health reform is currently a pending challenge and a strategic priority. Indeed, some Autonomous Communities have initiated a process of modernization and change. Empowerment of public health in the political agendas and in relation to the health services is strongly recommended by promoting intersectorial approaches, the Health in All Policies strategy and Health Impact Assessment. There is also a need for a specific law that would update public health functions, organization and structures, allocate competencies by facilitating alliances and partnership, and regulate coordination and intersectorial intervention. The following key elements related to this reform are described: 1) a participatory leadership in public health; 2) the generation of intelligence and evidence in public health; 3) improvement of professional education and development; 4) the importance of transparent, independent and competent performance and communication, and 5) new and flexible organization coherent with the new strategies and close to the local level and primary health care services. Coordination between the State and the Autonomous Communities should involved a functional and intelligent relationship by building up common spaces, alliances, networks and shared initiatives for public health.

[Health impact assessment: the state of the art]. / La evaluación del impacto en salud: el estado de la cuestión.

Health impact assessment (HIA) is being increasingly used due to governments' growing interest in putting health high on their agendas. HIA provides a structured framework to estimate the potential consequences of non-health sector policies in community health. The ultimate goal of this framework is to maximize health gains and, as far as possible, to reduce health inequalities. HIA is believed to have significant potential to address health determinants and to promote intersectorial action in health. Challenges for the future include the need to strengthen its methodological bases, particularly those concerning the process of impact prediction, and the need to promote its progressive incorporation into decision-making processes, either independently or integrated within other impact assessment tools. The strategic affinity of HIA with the European "Health in All Policies" strategy strengthens current opportunities for the implementation of this tool in Spain, especially in the context of the ongoing debate on the future of public health and the need to give public health higher priority in political-institutional agendas. To move forwards, we should promote debate on HIA, as well as research and the practice of this tool in Spain, where only some pioneer experiences exist. The public health sector should lead the development of HIA pilot studies in order to assess its current contribution to the formulation of healthy public policies. In addition, HIA should be promoted among policy makers and other stakeholders in order to facilitate its adoption and integration into strategic planning and relevant agencies and decision-making structures. The ultimate goal is to find new formats for intersectorial collaboration and new tools for putting the principles of Health in all Policies into practice, thus successfully achieving health and public health goals.