'Health in All Policies'-A Key Driver for Health and Well-Being in a Post-COVID-19 Pandemic World.

Policy in all sectors affects health, through multiple pathways and determinants. Health in all policies (HiAP) is an approach that seeks to identify and influence the health and equity impacts of policy decisions, to enhance health benefits and avoid harm. This usually involves the use of health impact assessment or health lens analysis. There is growing international experience in these approaches, and some countries have cross-sectoral governance structures that prioritize the assessment of the policies that are most likely to affect health. The fundamental elements of HiAP are inter-sectoral collaboration, policy influence, and holistic consideration of the range of health determinants affected by a policy area or proposal. HiAP requires public health professionals to invest time to build partnerships and engage meaningfully with the sectors affecting the social determinants of health and health equity. With commitment, political will and tools such as the health impact assessment, it provides a powerful approach to integrated policymaking that promotes health, well-being, and equity. The COVID-19 pandemic has raised the profile of public health and highlighted the links between health and other policy areas. This paper describes the rationale for, and principles underpinning, HiAP mechanisms, including HIA, experiences, challenges and opportunities for the future.

Ethics-based decision-making and health impact assessment.

To compare the use of health impact assessment (HIA) and the decision-making triangle (DMT) framework for evidence-informed, ethics-based decision-making and consider implications for practice. We compared HIA and the DMT approach with reference to: their use of evidence and theory; their application of ethical principles or values; and how they aid decision-making. A good fit between the HIA and DMT approaches was found. Ways in which they could be of benefit to each other were identified. The DMT approach and HIA are highly compatible: they are rooted in largely shared ethical principles or values; both involve appropriate use of evidence and theory; and both are concerned with enhancing the quality of decision-making in the interests of population health. The DMT approach and HIA are of potential value to each other: established HIA methods and tools can be of practical help in using the DMT approach; and the DMT framework provides insights to how HIA methods and processes could be improved and the vision of 'impacts that matter' widened.

'It's just a way of approaching things now': staff perspectives of an anticipatory care programme in Edinburgh.

BACKGROUND: Keep Well, an anticipatory care programme aimed at reducing health inequalities in Scotland, commenced in 2006. There is currently little evidence exploring how frontline staff respond to the delivery of anticipatory care. AIM: To understand how staff view changes in practice resulting from the implementation of Keep Well. METHODS: Qualitative interviews were conducted with a purposively selected sample of 12 Keep Well staff. Data were analysed using a thematic analysis approach. RESULTS: Keep Well was viewed positively, especially in terms of increased knowledge and skills for staff and the benefits of a holistic health check to patients. Staff believed that Keep Well has improved their practice beyond the project. Concerns were raised, relating to potential inconveniences for patients, staff turnover, increased workload and procedures. There was a view that anticipatory care should continue to be delivered to deprived communities, provided that there are adequate resources, such as staff and funding, to do so. CONCLUSION: Keep Well staff believe that the project should continue to be offered as a 40-minute holistic health check targeted at patients in deprived areas.

Assessing the unintended health impacts of road transport policies and interventions: translating research evidence for use in policy and practice.

BACKGROUND: Transport and its links to health and health inequalities suggest that it is important to assess both the direct and unintended indirect health and related impacts of transport initiatives and policies. Health Impact Assessment (HIA) provides a framework to assess the possible health impacts of interventions such as transport. Policymakers and practitioners need access to well conducted research syntheses if research evidence is to be used to inform these assessments. The predictive validity of HIA depends heavily on the use and careful interpretation of supporting empirical evidence. Reviewing and digesting the vast volume and diversity of evidence in a field such as transport is likely to be beyond the scope of most HIAs. Collaborations between HIA practitioners and specialist reviewers to develop syntheses of best available evidence applied specifically to HIA could promote the use of evidence in practice. METHODS: Best available research evidence was synthesised using the principles of systematic review. The synthesis was developed to reflect the needs of HIA practitioners and policymakers. RESULTS: Aside from injury reduction measures, there is very little empirical data on the impact of road transport interventions. The possibility of impacts on a diverse range of outcomes and differential impacts across groups, make it difficult to assess overall benefit and harm. In addition, multiple mediating factors in the pathways between transport and hypothesised health impacts further complicate prospective assessment of impacts. Informed by the synthesis, a framework of questions was developed to help HIA practitioners identify the key questions which need to be considered in transport HIA. CONCLUSION: Principles of systematic review are valuable in producing syntheses of best available evidence for use in HIA practice. Assessment of the health impacts of transport interventions is characterised by much uncertainty, competing values, and differential or conflicting impacts for different population groups at a local or wider level. These are issues pertinent to the value of HIA generally. While uncertainty needs explicit acknowledgement in HIA, there is still scope for best available evidence to inform the development of healthy public policy.

Variant Creutzfeldt-Jakob disease: costs borne by families.

The objectives of this study were: (1) to estimate the costs borne by families caring for patients with variant Creutzfeldt-Jakob disease (vCJD); (2) to contextualise results to recent policy initiatives, and (3) to consider the methodological problems of estimating costs of care. Semi-structured interviews and a follow-up postal questionnaire, eliciting costs to families both before and after the patient's death, were carried out. Participants included 19 families of patients with vCJD. Cost profiles were constructed, detailing key time and financial costs associated with their relative's illness and death accruing to families. Main outcome measures included total, median and ranges of relevant cost elements. Sensitivity analyses, comparing high and low cost estimates, were undertaken. The total time cost to families before patient's death ranged between 605 and 9230 hours (median 2006 hours). Applying low cost estimates, families incurred between pound 2616 and pound 39 588 (median pound 14 481) in forgone earnings and between pound 2699 and pound 18 558 (median pound 8049) in marginal sundry costs before the patient's death. The value of care provided by families ranged between pound 0 and pound 87 303 (median pound 9652) at low cost estimates. Many families continued to incur costs after the patient's death, with low cost estimates per week ranging between pound 0 and pound 176 (median pound 29). Costs to families associated with vCJD were substantial and greatly exceeded benefit entitlements. These costs were high even if patients received care in hospital, varied as the illness progressed and continued after patients' deaths. The National Carers Strategy does not consider fully the needs of some groups of carers or the full range or magnitude of potential costs to families associated with caring.