The 988 suicide hotline-Lifeline or letdown? A pre-post policy analysis.

Suicide has emerged as an urgent threat in recent years as COVID-19 impaired the health and economic wellbeing of millions of Americans. According to the Centers for Disease Control and Prevention, the impact of COVID-19 and the ongoing opioid epidemic has "taken a mental, emotional, physical, and economic toll on individuals, families, and communities," increasing the need for innovative solutions to prevent suicide on a national scale. The National Suicide Hotline Designation Act of 2020 established 988 as the universal telephone number for suicide prevention and represents a key federal intervention to address this crisis. However, research on 9-8-8's effectiveness is limited, given the Act's recent enactment and implementation at the federal and state levels. This policy analysis investigates how and to what extent the mental health crisis system in Georgia has improved since the implementation of the 2020 Act as well as the implications of state law on population-level mental health outcomes. Georgia is used as a nationally representative case study for two reasons: (1) Georgia had a robust statewide suicide hotline prior to 2020, providing solid infrastructure on which federal expansion of a suicide hotline number could be built, and (2) the conflicting characteristics of Georgia's mental health system represent several different pockets of the U.S., allowing this analysis to apply to a broad range of states and locales. The paper draws on takeaways from Georgia to propose state and national policy recommendations for equitable interventions to prevent and respond to this form of violence.

The role of governance in shaping health system reform: a case study of the design and implementation of new health regions in Ireland, 2018-2023.

BACKGROUND: Effective governance arrangements are central to the successful functioning of health systems. While the significance of governance as a concept is acknowledged within health systems research, its interplay with health system reform initiatives remains underexplored in the literature. This study focuses on the development of new regional health structures in Ireland in the period 2018-2023, one part of a broader health system reform programme aimed at greater universalism, in order to scrutinise how aspects of governance impact on the reform process, from policy design through to implementation. METHODS: This qualitative, multi-method study draws on document analysis of official documents relevant to the reform process, as well as twelve semi-structured interviews with key informants from across the health sector. Interviews were analysed according to thematic analysis methodology. Conceiving governance as comprising five domains (Transparency, Accountability, Participation, Integrity, Capacity) the research uses the TAPIC framework for health governance as a conceptual starting point and as initial, deductive analytic categories for data analysis. RESULTS: The analysis reveals important lessons for policymakers across the five TAPIC domains of governance. These include deficiencies in accountability arrangements, poor transparency within the system and vis-à-vis external stakeholders and the public, and periods during which a lack of clarity in terms of roles and responsibilities for various process and key decisions related to the reform were identified. Inadequate resourcing of implementation capacity, competing policy visions and changing decision-making arrangements, among others, were found to have originated in and continuously reproduced a lack of trust between key institutional actors. The findings highlight how these challenges can be addressed through strengthening governance arrangements and processes. Importantly, the research reveals the interwoven nature of the five TAPIC dimensions of governance and the need to engage with the complexity and relationality of health system reform processes. CONCLUSIONS: Large scale health system reform is a complex process and its governance presents distinct challenges and opportunities for stakeholders. To understand and be able to address these, and to move beyond formulaic prescriptions, critical analysis of the historical context surrounding the policy reform and the institutional relationships at its core are needed.

Exploring evidence use and capacity for health services management and planning in Swiss health administrations: A mixed-method interview study.

BACKGROUND: Health administrations require evidence, meaning robust information, data, and research, on health services and systems. Little is known about the resources and processes available within administrations to support evidence-informed policymaking. This study assessed Swiss health administrations' capacity for evidence use and investigated civil servants' needs and perspectives regarding the role and use of evidence in health services management and planning. METHODS: In this mixed-method study, we interviewed civil servants from Swiss German-speaking cantonal health administrations. We quantitatively assessed administrations' organization-level capacity by applying six structured interviews using an existing measurement tool (ORACLe). Individual-level needs and perspectives regarding evidence use and capacity were qualitatively explored with twelve in-depth interviews that were analyzed using the framework method. FINDINGS: Respondents indicated moderate evidence-use capacity in all administrations. Administrations displayed a similar pattern of high and low capacity in specific capacity areas, generally with considerable variation within administrations. Most administrations indicated high capacity for producing or commissioning evidence and close relationships with research. They showed limited capacity in the documentation of processes and availability of tools, programs, or training opportunities. Administrations place the responsibility for engagement with evidence at the level of individual civil servants rather than at the organizational level. Although administrations highly value evidence-informed policymaking and consider it vital to effective health services management and planning, they face significant constraints in accessing evidence-specific resources and receive little organizational support. Administrations rely on external capacity to compensate for these limitations and engage with evidence pragmatically. CONCLUSION: Our findings indicate moderate and improvable capacity for evidence use in Swiss health administrations that place limited value on organizational support. Besides strengthening organizational support, leadership buy-in, particular staff needs, and balancing the implementation of specific measures with the provision of more general resources should be considered to unlock the potential of strengthened engagement with evidence.

Road To Deceased Donor Transplantation in Egypt.

In Egypt, there is presently a growing need to have a deceased donor transplant program. Egypt conducted its first kidney transplant from a living donor in 1976 and a first partial liver transplant in 2001. Since 2009, the Egyptian Health Authorities Combat Transplant Tourism in concordance with ethics codes and the Declaration of Istanbul Custodian Group has been in place. The Egyptian Transplantation Law of 2011 mentions that organs could be procured from deceased donors based on a will and on family consent. This law has had many critics, including religious authorities who have stressed that organs cannot be taken from a person with brain death because, in their view, life ends with death of all organs. Many intensivists disagree over the definition of death. In addition, the media has communicated contradicting and sometimes misleading health care information. Mummification is rooted in pharos practice and linked to religious beliefs. The ancient Egyptians believed that, by burying the deceased with their organs, they may rejoin with them in the afterlife. Since 2019, the transplant community in Egypt has started collaborations with international transplant organizations and campaigns with doctors and celebrities to donate their organs after death, which have stressed that a deceased donor program could help against end-stage organ mortality. In November 2022, after communications with politicians, President Abdelfattah El Sisi directed the government to establish a regional center for organ transplantation, which aimed to be the biggest in the Middle East and North Africa region. The new center will be part of a new medical city that would replace Nasser Medical Institution in Cairo, Egypt. The Ministry of Health issued an official form to be signed by a person before his death, accepting use of organs, to give hope and support to other patients in need.

Tackling the non-communicable disease epidemic: a framework for policy action in low- and middle-income countries.

Health policy frameworks for the prevention and control of non-communicable diseases have largely been developed for application in high-income countries. Limited attention has been given to the policy exigencies in lower- and middle-income countries where the impacts of these conditions have been most severe, and further clarification of the policy requirements for effective prevention is needed. This paper presents a policy approach to prevention that, although relevant to high-income countries, recognizes the peculiar situation of low-and middle-income countries. Rather than a narrow emphasis on the implementation of piecemeal interventions, this paper encourages policymakers to utilize a framework of four embedded policy levels, namely health services, risk factors, environmental, and global policies. For a better understanding of the non-communicable disease challenge from a policy standpoint, it is proposed that a policy framework that recognizes responsible health services, addresses key risk factors, tackles underlying health determinants, and implements global non-communicable disease conventions, offers the best leverage for prevention.

Challenges of determining the relative contribution of determinants of health on population health: a Canadian perspective.

This article investigates the source of frequently cited data regarding the relative contribution of determinants of health to population health in Canada. It critically discusses the imperative for such national or regional data in policymaking, and the challenges and limitations of this approach.

Environmental Modifications for People With Intellectual and Developmental Disabilities: A Policy Analysis of Medicaid Home- and Community-Based Services.

IMPORTANCE: Environmental modifications are targets for occupational therapy intervention because they support activities of daily living, self-efficacy, personal control, independence, and community living for people with intellectual and developmental disabilities (IDDs). OBJECTIVE: To examine how environmental modifications were provided to people with IDDs through Medicaid home- and community-based services (HCBS) waivers across the United States in fiscal year (FY) 2021. DESIGN: Using a mixed-methods policy analysis, we examined FY 2021 Medicaid HCBS 1915(c) waivers from across the United States to examine whether, and how, states provided environmental modifications to people with IDDs. RESULTS: In FY 2021, 35 states projected spending $68.8 million on environmental modifications for 12,671 people with IDDs. The purpose of environmental modifications was most often to promote the health, welfare, and safety of people with IDDs (82.68%), and to promote their independence (69.29%). The most common examples of environmental modifications included ramps and/or lifts (70.08%), widening doorways and/or hallways (61.42%), bathroom modifications (58.27%), specialized electrical and/or plumbing for medical equipment (54.33%), and grab bars and/or handrails (53.54%). CONCLUSIONS AND RELEVANCE: HCBS waiver data on environmental modifications for people with IDDs enhances an understanding of this funding source and provides a foundation of advocacy for occupational therapy practitioners to support people with IDDs with living, as well as aging, in the community rather than in institutions. An expansion of environmental modifications in HCBS for people with IDDs aligns with the aim of Medicaid HCBS waivers to promote community integration, self-determination, and independence, which are all benefits of environmental modifications. Plain-Language Summary: This study can help occupational therapy practitioners determine what funding sources are available in their state to help their clients with intellectual and developmental disabilities access environmental modifications. The findings can also help guide advocacy and lobbying efforts to expand access to environmental modifications.

Research outcomes informing the selection of public health interventions and strategies to implement them: A cross-sectional survey of Australian policy-maker and practitioner preferences.

BACKGROUND: A key role of public health policy-makers and practitioners is to ensure beneficial interventions are implemented effectively enough to yield improvements in public health. The use of evidence to guide public health decision-making to achieve this is recommended. However, few studies have examined the relative value, as reported by policy-makers and practitioners, of different broad research outcomes (that is, measures of cost, acceptability, and effectiveness). To guide the conduct of research and better inform public health policy and practice, this study aimed at describing the research outcomes that Australian policy-makers and practitioners consider important for their decision-making when selecting: (a) public health interventions; (b) strategies to support their implementation; and (c) to assess the differences in research outcome preferences between policy-makers and practitioners. METHOD: An online value-weighting survey was conducted with Australian public health policy-makers and practitioners working in the field of non-communicable disease prevention. Participants were presented with a list of research outcomes and were asked to select up to five they considered most critical to their decision-making. They then allocated 100 points across these - allocating more points to outcomes perceived as more important. Outcome lists were derived from a review and consolidation of evaluation and outcome frameworks in the fields of public health knowledge translation and implementation. We used descriptive statistics to report relative preferences overall and for policy-makers and practitioners separately. RESULTS: Of the 186 participants; 90 primarily identified as policy-makers and 96 as public health prevention practitioners. Overall, research outcomes of effectiveness, equity, feasibility, and sustainability were identified as the four most important outcomes when considering either interventions or strategies to implement them. Scores were similar for most outcomes between policy-makers and practitioners. CONCLUSION: For Australian policy-makers and practitioners working in the field of non-communicable disease prevention, outcomes related to effectiveness, equity, feasibility, and sustainability appear particularly important to their decisions about the interventions they select and the strategies they employ to implement them. The findings suggest researchers should seek to meet these information needs and prioritize the inclusion of such outcomes in their research and dissemination activities. The extent to which these outcomes are critical to informing the decision of policy-makers and practitioners working in other jurisdictions or contexts warrants further investigation.

An Anticipatory Approach to Ethico-Legal Implications of Future Neurotechnology.

This paper provides a justificatory rationale for recommending the inclusion of imagined future use cases in neurotechnology development processes, specifically for legal and policy ends. Including detailed imaginative engagement with future applications of neurotechnology can serve to connect ethical, legal, and policy issues potentially arising from the translation of brain stimulation research to the public consumer domain. Futurist scholars have for some time recommended approaches that merge creative arts with scientific development in order to theorise possible futures toward which current trends in technology development might be steered. Taking a creative, imaginative approach like this in the neurotechnology context can help move development processes beyond considerations of device functioning, safety, and compliance with existing regulation, and into an active engagement with potential future dynamics brought about by the emergence of the neurotechnology itself. Imagined scenarios can engage with potential consumer uses of devices that might come to challenge legal or policy contexts. An anticipatory, creative approach can imagine what such uses might consist in, and what they might imply. Justifying this approach also prompts a co-responsibility perspective for policymaking in technology contexts. Overall, this furnishes a mode of neurotechnology's emergence that can avoid crises of confidence in terms of ethico-legal issues, and promote policy responses balanced between knowledge, values, protected innovation potential, and regulatory safeguards.

Beyond the average effect of the innovation subsidies: Using case selection via matching to break impasse in delivering useful advice to policy makers.

Experts and stakeholders promote the combined use of counterfactual and theory-based approaches in program evaluation. We illustrated combined application of these two approaches in a single evaluation study of innovation subsidies, using "case selection via matching" and follow-up in-depth interviews. We conducted interviews in contrasting pairs of companies-one successful and one unsuccessful-which were otherwise similar on a defined set of covariates. Our procedure helped to reveal factors, which might be overlooked or simply not available in data at hand and hence not accounted for in analyses of the intervention effects. As such it extends beyond the average effect estimate to highlight causes of an intervention success or failure.

How are health systems in sub-Saharan Africa adapting to protect human health from climate change threats? A scoping review and case study.

BACKGROUND: Sub-Saharan Africa stands out as one of the regions most affected by the climate crisis, while it has contributed to the problem only marginally. The foreseen negative effect on health adds great stress to the already overburdened health systems. Health systems' adaptation to climate change is, therefore, urgently needed to better protect human health. There is, however, scant evidence on how adaption is being planned and implemented in Africa. The aim of this study was to review the literature on health system adaptation in sub-Saharan Africa. METHODS: In this scoping review and case study, we first carried out the scoping review, searching for publications on adaptation measures using the PubMed, Science Direct, and Web of Science databases on July 1, 2023. We included papers in English and French that addressed the adaptation of health systems in countries in sub-Saharan Africa without time limit. Second, we did a case study of the design and implementation of the National Adaptation Plan of Benin, with a specific focus on the policy-making process underlying the plan, whereby we used the health policy triangle as a policy analysis framework. Data were collected through a document review of national policy plans, reports, and evaluations. FINDINGS: A total of 14 papers met the inclusion criteria, showing that climate change adaptation remains a niche in the literature for sub-Saharan Africa. Most included papers were authored by individuals from high-income countries. Health system adaptation measures cover seven domains: health systems strengthening; policy and planning; financing and implementation; information and capacity building; societal resilience; disaster risk prevention, preparedness, response, and recovery; and mitigation. The review found that the dominant role of global agencies in supporting or steering health system adaptation planning contributes to policy mimicry across countries, as confirmed by the case study of the adaptation plan in Benin. Benin's National Adaptation Plan prioritised three climate hazards: heat, drought, and flooding. Although the financial and technical inputs of international agencies effectively support Benin's adaptation planning, these inputs might induce a more narrow focus that does not fully respond to Benin's needs in terms of climate shocks and adaptation priorities. INTERPRETATION: Health systems in sub-Saharan Africa are already adapting to climate change. Future research could focus on how national governments could develop adaptation plans that are responsive to local needs by making the needs analysis and priority-setting processes more inclusive of local stakeholders. FUNDING: The Belgian Directorate-General for Development Cooperation and Humanitarian Aid.

Science-informed Policy Making for Protecting People and the Environment from Radiation.

ABSTRACT: The process to arrive at the radiation protection practices of today to protect workers, patients, and the public, including sensitive populations, has been a long and deliberative one. This paper presents an overview of the US Environmental Protection Agency's (US EPA) responsibility in protecting human health and the environment from unnecessary exposure to radiation. The origins of this responsibility can be traced back to early efforts, a century ago, to protect workers from x rays and radium. The system of radiation protection we employ today is robust and informed by the latest scientific consensus. It has helped reduce or eliminate unnecessary exposures to workers, patients, and the public while enabling the safe and beneficial uses of radiation and radioactive material in diverse areas such as energy, medicine, research, and space exploration. Periodic reviews and analyses of research on health effects of radiation by scientific bodies such as the National Academy of Sciences, National Council on Radiation Protection and Measurements, United Nations Scientific Committee on the Effects of Atomic Radiation, and the International Commission on Radiological Protection continue to inform radiation protection practices while new scientific information is gathered. As a public health agency, US EPA is keenly interested in research findings that can better elucidate the effects of exposure to low doses and low dose rates of radiation as applicable to protection of diverse populations from various sources of exposure. Professional organizations such as the Health Physics Society can provide radiation protection practitioners with continuing education programs on the state of the science and describe the key underpinnings of the system of radiological protection. Such efforts will help equip and prepare radiation protection professionals to more effectively communicate radiation health information with their stakeholders.

Australian healthy retail policies in hospital settings - a policy analysis and scoping review of potential impacts on dietary behaviours.

Objectives and importance of study: This study analyses Australian healthy hospital retail policies to identify the similarities and differences in the policies and policy implementation processes. The potential impact of the different policy components on dietary behaviours were examined via a scoping review. STUDY TYPE: Policy analysis and scoping review. METHODS: Healthy retail policy documents and policy implementation guidelines were identified via a grey literature search on Department of Health websites of all Australian jurisdictions. Policy components and policy implementation processes were extracted and analysed for similarities and differences. The potential effectiveness of the different policy components on purchasing and/or dietary behaviour were identified via a scoping review of the academic literature, conducted in March 2023 across seven electronic databases and Google Scholar. The scoping review included studies reporting the impacts of healthy food retail interventions implemented in hospitals. No timeframe restriction was applied for both the grey literature search and the scoping review. RESULTS: All Australian jurisdictions, except Tasmania, have implemented jurisdiction specific healthy retail policies in public hospital settings. There are similarities and difference in the policy components and implementation design across the jurisdictions. Similarities included the policy scope, use of a traffic light system to classify the nutritional healthiness of food and beverages for sale, and the standards used to determine the mix of healthy and unhealthy food availability. These similarities allowed sharing of resources across some jurisdictions. There is limited evaluation of policy impacts on purchase and/or consumption behaviours. Twenty of 27 studies identified via the scoping literature review examined interventions similar to the Australian policies and showed that these policies could result in increased purchase of healthier products among staff and visitors. Key implementation success factors include strong support for the policy from all stakeholders, practical implementation support resources, and impacts on retailer profitability. CONCLUSIONS: The healthy hospital retail policies implemented across Australian jurisdictions could encourage healthier food and beverage purchases among staff and visitors. Evaluation of the policies could facilitate further refinement to enhance effectiveness and translation of learnings to international contexts.

Meeting the challenges of the 21st century: the fundamental importance of trust for transformation.

BACKGROUND: This paper is one of a collection on challenges facing health systems in the future. One obvious challenge is how to transform to meet changing health needs and take advantage of emerging treatment opportunities. However, we argue that effective transformations are only possible if there is trust in the health system. MAIN BODY: We focus on three of the many relationships that require trust in health systems, trust by patients and the public, by health workers, and by politicians. Unfortunately, we are seeing a concerning loss of trust in these relationships and, for too long, the importance of trust to health policymaking and health system functioning has been overlooked and under-valued. We contend that trust must be given the attention, time, and resources it warrants as an indispensable element of any health system and, in this paper, we review why trust is so important in health systems, how trust has been thought about by scholars from different disciplines, what we know about its place in health systems, and how we can give it greater prominence in research and policy. CONCLUSION: Trust is essential if health systems are to meet the challenges of the 21st century but it is too often overlooked or, in some cases, undermined.

From bench to policy: a critical analysis of models for evidence-informed policymaking in healthcare.

Background: The use of research evidence in policy making is a complex and challenging process that has a long history in various fields, especially in healthcare. Different terms and concepts have been used to describe the relationship between research and policy, but they often lack clarity and consensus. To address this gap, several strategies and models have been proposed to facilitate evidence informed policy making and to identify the key factors and mechanisms involved. This study aims to critically review the existing models of evidence informed policy making (EIPM) in healthcare and to assess their strengths and limitations. Method: A systematic search and review conducted to identify and critically assess EIPM models in healthcare. We searched PubMed, Web of Science and Scopus databases as major electronic databases and applied predefined inclusion criteria to select the models. We also checked the citations of the included models to find other scholars' perspectives. Each model was described and critiqued each model in detail and discussed their features and limitations. Result: Nine models of EIPM in healthcare were identified. While models had some strengths in comprehension, flexibility and theoretical foundations, analysis also identified limitations including: presupposing rational policymaking; lacking alternatives for time-sensitive situations; not capturing policy complexity; neglecting unintended effects; limited context considerations; inadequate complexity concepts; limited collaboration guidance; and unspecified evidence adaptations. Conclusion: The reviewed models provide useful frameworks for EIPM but need further improvement to address their limitations. Concepts from sociology of knowledge, change theory and complexity science can enrich the models. Future EIPM models should better account for the complexity of research-policy relationships and provide tailored strategies based on the policy context.

Legislative Health Notes: Preliminary Learnings From Piloting a New Policy Analysis Tool.

CONTEXT: In 2018, the Health Impact Project (the Project) developed and tested a new health in all policies (HiAP) tool called "legislative health notes" to provide state and local legislators with peer-reviewed evidence, public health data, and local data that illustrate potential positive and negative health and equity effects of proposed bills. OBJECTIVES: The Project sought to refine the health note methodology while piloting the tool in the Colorado and Indiana General Assemblies, and with the Council of the District of Columbia, and worked with affiliates to introduce them in North Carolina, Ohio, and California. DESIGN AND PARTICIPANTS: External partners solicited feedback on health notes via semistructured interviews and surveys from legislators, legislative staff, and expert reviewers who were familiar with health notes in each of these jurisdictions. RESULTS: Respondents shared that health notes were nonpartisan, were easy for nonexperts to understand, and would be more effective if delivered earlier in the legislative process. CONCLUSION: In response to informant feedback, practitioners can explore adding high-level summaries, increasing focus on health equity implications and the potential to work with legislators during the policy formulation phase. Data from this pilot suggest that legislative health notes are a promising nonpartisan and standardized tool to better understand the health and equity implications of proposed legislation.

Misrepresenting Pragmatism: Response to Greenhalgh and Engebretsen.

The Covid-19 pandemic has engendered intense public debate about the nature and place of a "science-driven" approach to decision making in such contexts, with contributions by a range of scientific authors critical of actual policy decisions. In a recent article in this journal, Greenhalgh and Engebretsen (TGEE) propose that science-driven policymaking should be abandoned in favour of a "Pragmatist turn". We critically analyze their portrayal of Pragmatism and demonstrate that their characterization is historically inaccurate, particularly focusing on the neglect of its strong commitment to scientific method and related evidential requirements. We conclude that Pragmatism's caution and respect for standards of evidence are a valuable corrective to the pandemics of fear and action that bias responses to any pandemic infection.