An action-oriented public health framework to reduce financial strain and promote financial wellbeing in high-income countries.

BACKGROUND: Perceived financial security impacts physical, mental, and social health and overall wellbeing at community and population levels. Public health action on this dynamic is even more critical now that the COVID-19 pandemic has exacerbated financial strain and reduced financial wellbeing. Yet, public health literature on this topic is limited. Initiatives targeting financial strain and financial wellbeing and their deterministic effects on equity in health and living conditions are missing. Our research-practice collaborative project addresses this gap in knowledge and intervention through an action-oriented public health framework for initiatives targeting financial strain and wellbeing. METHODS: The Framework was developed using a multi-step methodology that involved review of theoretical and empirical evidence alongside input from a panel of experts from Australia and Canada. In an integrated knowledge translation approach, academics (n = 14) and a diverse group of experts from government and non-profit sectors (n = 22) were engaged throughout the project via workshops, one-on-one dialogues, and questionnaires. RESULTS: The validated Framework provides organizations and governments with guidance for the design, implementation, and assessment of diverse financial wellbeing- and financial strain-related initiatives. It presents 17 priority actionable areas (i.e., entry points for action) likely to have long-lasting, positive effects on people's financial circumstances, contributing to improved financial wellbeing and health. The 17 entry points relate to five domains: Government (All Levels), Organizational & Political Culture, Socioeconomic & Political Context, Social & Cultural Circumstances, and Life Circumstances. CONCLUSIONS: The Framework reveals the intersectionality of root causes and consequences of financial strain and poor financial wellbeing, while also reinforcing the need for tailored actions to promote socioeconomic and health equity for all people. The dynamic, systemic interplay of the entry points illustrated in the Framework suggest opportunities for multi-sectoral, collaborative action across government and organizations towards systems change and the prevention of unintended negative impacts of initiatives.

A Policy-Ready Public Health Guidebook of Strategies and Indicators to Promote Financial Well-Being and Address Financial Strain in Response to COVID-19.

INTRODUCTION: The COVID-19 pandemic has adversely affected the financial well-being of populations globally, escalating concerns about links with health care and overall well-being. Governments and organizations need to act quickly to protect population health relative to exacerbated financial strain. However, limited practice- and policy-relevant resources are available to guide action, particularly from a public health perspective, that is, targeting equity, social determinants of health, and health-in-all policies. Our study aimed to create a public health guidebook of strategies and indicators for multisectoral action on financial well-being and financial strain by decision makers in high-income contexts. METHODS: We used a multimethod approach to create the guidebook. We conducted a targeted review of existing theoretical and conceptual work on financial well-being and strain. By using rapid review methodology informed by principles of realist review, we collected data from academic and practice-based sources evaluating financial well-being or financial strain initiatives. We performed a critical review of these sources. We engaged our research-practice team and government and nongovernment partners and participants in Canada and Australia for guidance to strengthen the tool for policy and practice. RESULTS: The guidebook presents 62 targets, 140 evidence-informed strategies, and a sample of process and outcome indicators. CONCLUSION: The guidebook supports action on the root causes of poor financial well-being and financial strain. It addresses a gap in the academic literature around relevant public health strategies to promote financial well-being and reduce financial strain. Community organizations, nonprofit organizations, and governments in high-income countries can use the guidebook to direct initiative design, implementation, and assessment.

Animal Protection, Law Enforcement, and Occupational Health: Qualitative Action Research Highlights the Urgency of Relational Coordination in a Medico-Legal Borderland.

Across Canada and internationally, laws exist to protect animals and to stop them from becoming public nuisances and threats. The work of officers who enforce local bylaws protects both domestic animals and humans. Despite the importance of this work, research in this area is emergent, but growing. We conducted research with officers mandated to enforce legislation involving animals, with a focus on local bylaw enforcement in the province of Alberta, Canada, which includes the city of Calgary. Some experts regard Calgary as a "model city" for inter-agency collaboration. Based on partnerships with front-line officers, managers, and professional associations in a qualitative multiple-case study, this action-research project evolved towards advocacy for occupational health and safety. Participating officers spoke about the societal benefits of their work with pride, and they presented multiple examples to illustrate how local bylaw enforcement contributes to public safety and community wellbeing. Alarmingly, however, these officers consistently reported resource inadequacies, communication and information gaps, and a culture of normalized disrespect. These findings connect to the concept of "medico-legal borderlands," which became central to this study. As this project unfolded, we seized upon opportunities to improve the officers' working conditions, including the potential of relational coordination to promote the best practices.

Hegemony or health promotion? Prospects for reviving England's lost discipline.

Since 1997, health promotion has been steadily disappearing from public health in England. This is not only true of the phrase, but also of the concepts and the discipline it represents. Given the undoubted increase in health-promoting policies and programmes during this period, we consider whether this situation could represent a welcome mainstreaming of health promotion. However, on the basis of a detailed historical and contemporary review of health promotion and public health theory and practice, we conclude that this is not in fact the case. Rather, health promotion in England should be seen as the subject of a hegemonic absorption by an increasingly individualistic public health discourse. The currently increasing focus on well-being could, however, represent an opportunity for health promotion in England to be revived and reinvented.

From rhetoric to reality: A systemic approach to understanding the constraints faced by Health For All initiatives in England.

The increased appreciation of the effects socio-ecological factors have on health, witnessed over the last few decades, has given rise to many international, national, and local Health For All (HFA) initiatives tasked with addressing them. However, such initiatives have had to operate within environments which were not specifically designed for them or for the new social (rather than medical) perspective on health they were based upon. As a result, they have been facing significant barriers and constraints to fulfilling their mission. This paper explores the constraints which are imposed on such initiatives by the various environments within which they are nested. Drawing upon our experience in evaluating European Healthy City (HC) projects and English Health Action Zones (HAZs), we develop a dynamic conceptual model which shows how the national, governmental policy, interorganisational, organisational, and initiative environments relate with each other and their cumulative effects on initiatives. We argue that this model, and the principles on which it is based, can be used constructively to identify constraints facing HFA-type initiatives in many countries. We use our case study of English HCs and HAZs to illustrate the applicability of the model in a particular national context. We, first, interpret the model to reflect differences and similarities between their respective environments and trace the sources of the different constraints they encountered. We, then, show how an alternative structural configuration could enable some of these constraints to be eliminated. We argue that what is needed for HFA initiatives to be able to fulfill their brief in full is for governments to rethink existing organisational structures and update them to match the evolution of ideas on health which have emerged over the last decades.

Evaluation in health promotion: principles and perspectives

Policy-makers, professionals of all kinds and the general public increasingly recognize social and economic factors as important determinants of health. Because health promotion approaches address these factors, they can play a valuable role in protecting and improving health. At the same time, funding sources demand evidence that initiatives give value for money. Health promotion initiatives need effective evaluation to realize their potential: both to prove their value as investments and to increase their effectiveness in achieving their aims. To help meet this need, the WHO European Working Group on Health Promotion Evaluation examined the current range of qualitative and quantitative evaluation methods to provide guidance to policy-makers and practitioners. This book is the result. It comprises an extensive compilation and discussion of the theory, methodologies and practice of evaluating health promotion initiatives in Europe and the Americas. The book takes three perspectives in examining the issues. It includes a retrospective examination of the evolution of health promotion evaluation. This provides the context for assessing and understanding the current state of evaluations of initiatives addressing settings, policies and systems for promoting health. Finally, the authors and the Working Group make many recommendations for improvement that provide a look into the future. This book shows how a health promotion approach offers a comprehensive framework for planning and implementing interventions that can effectively address today’s major health-related problems.