Political economy analysis of health taxes (tobacco, alcohol drink and sugar-sweteened beverage): qualitative study of three provinces in Indonesia.

OBJECTIVE: Efforts to implement health tax policies to control the consumption of harmful commodities and enhance public health outcomes have garnered substantial recognition globally. However, their successful adoption remains a complex endeavour. This investigates the challenges and opportunities surrounding health tax implementation, with a particular focus on subnational government in Indonesia, where the decentralisation context of health tax remains understudied. DESIGN: Employing a qualitative methodology using a problem-driven political economy analysis approach. SETTING: We are collecting data from a total of 12 focus group discussions (FGDs) conducted between July and September 2022 in three provinces-Lampung, Special Region of/Daerah Istimewa Yogyakarta and Bali, each chosen to represent a specific commodity: tobacco, sugar-sweetened beverages (SSBs) and alcoholic beverages-we explore the multifaceted dynamics of health tax policies. PARTICIPANT: These FGDs involved a mean of 10 participants in each FGD, representing governmental institutions, non-governmental organisations and consumers. RESULTS: Our findings reveal that health tax policies have the potential to contribute significantly to public health. Consumers understand tobacco's health risks, and cultural factors influence both tobacco and alcohol consumption. For SSBs, the consumers lack awareness of long-term health risks is concerning. Finally, bureaucratic complexiting and decentralised government hinder implementation for all three commodities. CONCLUSION: Furthermore, this study underscores the importance of effective policy communication. It highlights the importance of earmarking health tax revenues for public health initiatives. It also reinforces the need to see health taxes as one intervention as part of a comprehensive public health approach including complementary non-fiscal measures like advertising restrictions and standardised packaging. Addressing these challenges is critical for realising the full potential of health tax policies.

Political factors and arrangements influencing primary health care financing and resource allocation: A scoping review protocol.

INTRODUCTION: Primary health care is a key element in the structuring and coordination of health systems, contributing to overall coverage and performance. PHC financing is therefore central in this context, with variations in sufficiency and regularity depending on the "political dimension" of health systems. Research that systematically examines the political factors and arrangements influencing PHC financing is justified from a global and multidisciplinary perspective. The scoping review proposed here aims to systematically map the evidence on this topic in the current literature, identifying groups, institutions, priorities and gaps in the research. METHODS AND ANALYSIS: A scoping review will be conducted following the method proposed by Arksey and O'Malley to answer the following question: What is known from the literature about political factors and arrangements and their influence on and repercussions for primary health care financing and resource allocation models? The review will include peer-reviewed papers in Portuguese, English or Spanish published between 1978 and 2023. Searches will be performed of the following databases: Medline (PubMed), Embase, BVS Salud, Web of Science, Scopus and Science Direct. The review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Inclusion and exclusion criteria will be used for literature screening and mapping. Screening and data charting will be conducted by a team of four reviewers. REGISTRATION: This protocol is registered on the Open Science Framework (OSF) platform, available at https://doi.org/10.17605/OSF.IO/Q9W3P.

Impact of prolonged social crisis on resilience and coping indicators.

The current study examines, longitudinally, (i.e., on the same sample), to what extent an acute political/social crisis in Israel affected the resilience, distress, and additional psychological indicators of the Jewish population, along with three repeated measurements: The first was conducted shortly before the last elections (in October 2022), the second in February 2023, about two and a half months after the elections, following the formation of a right-wing government, and the third measurement about nine months after the election (August 7-10, 2023). The main results indicated the following: (a) the mean societal resilience among coalition voters increased significantly throughout the three measurements, while it declined significantly among opposition voters. (b) significant differences were identified between coalition and opposition voters, mostly at T2 and T3: opposition supporters reported significantly lower levels of societal resilience and hope, and higher levels of distress symptoms and sense of danger, compared to those of coalition supporters. We concluded that the continued social/political conflict in Israel is multidimensional and impacts diverse areas such as values, perspectives, and supporting as well as suppressing coping indicators. The differences between the two voter groups may be primarily the result of political radicalization and polarization processes, that aim to widen gaps to achieve political power. As many countries are currently facing acute political crises and similar radicalization, similar studies should be conducted in varied societies to investigate the generalizability of the findings.

India Hypertension Control Initiative: decentralization of hypertension care to health wellness centres in Punjab and Maharashtra, India, 2018-2022.

INTRODUCTION: The India Hypertension Control Initiative (IHCI) emphasizes decentralized patient-centric care to boost hypertension control in public healthcare facilities. We documented the decentralization process, enrolment pattern by facility type, and treatment outcomes in nine districts of Punjab and Maharashtra states, India, from 2018-2022. METHODS: We detailed the shift in hypertension care from higher facilities to Health and Wellness Centres (HWCs) using the World Health Organization (WHO) health system pillar framework. We reviewed hypertension treatment records in 4,045 public facilities from nine districts in the two states, focusing on indicators including registration numbers, the proportion of controlled, uncontrolled blood pressure (BP), and missed visits among those under care. RESULTS: The decentralization process involved training, treatment protocol provision, supervision, and monitoring. Among 394,038 individuals registered with hypertension from 2018-2021, 69% were under care in 2022. Nearly half of those under care (129,720/273,355) received treatment from HWCs in 2022. Care of hypertensive individuals from district hospitals (14%), community health centres (20%), and primary health centres (24%) were decentralized to HWCs. Overall BP control rose from 20% (4,004/20,347) in 2019 to 58% (157,595/273,355) in 2022, while missed visits decreased from 61% (12,394/20,347) in 2019 to 26% (70,894/273,355) in 2022. This trend was consistent in both states. HWCs exhibited the highest BP control and the lowest missed visits throughout the study period compared to other facility types. CONCLUSION: We documented an increase in decentralized access to hypertension treatment and improved treatment outcomes over four years. We recommend operationalizing hypertension care at HWCs to other districts in India to improve BP control.

Generating Political Priority for the Health Needs of the 21st Century: A Qualitative Policy Analysis on the Prioritization of Rehabilitation Services in Uganda.

BACKGROUND: Few low- or middle-income countries (LMICs) have prioritized the expansion of rehabilitation services. Existing scholarship has identified that problem definition, governance, and structural factors are influential in the prioritization of rehabilitation. The objective of this study was to identify the factors influencing the prioritization and implementation of rehabilitation services in Uganda. METHODS: A case study design was utilized. The Prioritization of Rehabilitation in National Health Systems framework guided the study. Data sources included 33 key informant interviews (KIIs) with governmental and non-governmental stakeholders and peer-reviewed and grey literature on rehabilitation in Uganda. A thematic content analysis and concept map were conducted to analyze the data. RESULTS: Rehabilitation is an unfunded priority in Uganda, garnering political attention but failing to receive adequate financial or human resource allocation. The national legacy of rehabilitation as a social program, instead of a health program, has influenced its present-day prioritization trajectory. These include a fragmented governance system, a weak advocacy coalition without a unified objective or champion, and a lack of integration into existing health systems structures that makes it challenging to scale-up service provision. Our findings highlight the interactive influences of structural, governance, and framing factors on prioritization and the importance of historical context in understanding both prioritization and implementation. CONCLUSION: Our findings demonstrate challenges in prioritizing emerging, multi-sectoral health areas like rehabilitation. Strategic considerations for elevating rehabilitation on Uganda's policy agenda include generating credible indicators to quantify the nature and extent of the population's need and uniting governmental and non-governmental actors around a common vision for rehabilitation's expansion. We present opportunities for strengthening rehabilitation, both in Uganda and in similar contexts grappling with many health sector priorities and limited resources.

Why Was the Policy Idea on the Health Benefits Package Advisory Panel Gazetted in Kenya? A Retrospective Policy Analysis.

BACKGROUND: In 2018, Kenya's Ministry of Health (MoH) gazetted the Health Benefits Package Advisory Panel (HBPAP) to develop a benefits package for its universal health coverage (UHC) programme. In this study, we examine the political process that led to the gazettement of the HBPAP. METHODS: We conducted a case study based on semi-structured interviews with 20 national-level participants and, reviews of documents such as organizational and media reports. We analyzed data from the interviews and documents thematically using the Braun and Clarke's six step approach. We identified codes and themes deductively using Kingdon's Multiple Streams Theory which postulates that the successful emergence of a policy follows coupling of three streams: the problem, policy, and politics streams. RESULTS: We found that the problem stream was characterized by fragmented and implicit healthcare priority-setting processes that led to unaffordable, unsustainable, and wasteful benefits packages. A potential policy solution for these problems was the creation of an independent expert panel that would use an explicit and evidence-based healthcare priority-setting process to develop an affordable and sustainable benefits package. The political stream was characterized by the re-election of the government and the appointment of a new Cabinet Secretary for Health. Coupling of the problem, policy, and political streams occurred during a policy window that was created by the political prioritization of UHC by the newly re-elected government. Policy entrepreneurs who included health economists, health financing experts, health policy analysts, and health systems experts leveraged this policy window to push for the establishment of an independent expert panel as a solution for the issues identified in the problem stream. They employed strategies such as forming networks, framing, marshalling evidence, and utilizing political connections. CONCLUSION: Applying Kingdon's theory in this study was valuable in explaining why the HBPAP policy idea was gazetted. It demonstrated the crucial role of policy entrepreneurs and the strategies they employed to couple the three streams during a favourable policy window. This study contributes to the body of literature on healthcare priority-setting processes with an unusual analysis focused on a key procedural policy for such processes.

Decentralisation of the Health System Derailed by Organisational Inertia in Machinga, Malawi.

BACKGROUND: Managing the transition of a health system (HS) from a centralised to a decentralised model has been touted as a panacea to the complex challenges in developing countries like Malawi. However, recent studies have demonstrated that decentralisation of the HS has had mixed effects in service provision with more dominant negative outcomes than positive results. The aim of this study was to develop a substantive grounded theory (GT) that elaborates on how activities of central decision-makers and local healthcare mangers shape the process of shifting the HS to a decentralised model in Machinga, Malawi. METHODS: The study was qualitative in nature and employed the Straussian version of GT. Some participants were interviewed twice, and a total of 36 semi-structured interviews were conducted with 25 purposively selected participants using an interview guide. The interviews were conducted at the headquarters of the Ministry of Health (MoH) and other ministries and agencies, and in Machinga District. Data were analysed using open, axial, and selective coding processes of the GT methodology; and the conditional matrix and paradigm model were used as data analysis tools. RESULTS: The findings of this study revealed seven different activities, forming two opposing and interactional sub-processes of enabling and impeding patterns that derailed the decentralisation drive. The study generated a GT labelled "decentralisation of the HS derailed by organisational inertia," which elaborates that decentralisation of the HS produced mixed results with more predominant negative outcomes than positive effects due to resistance at the upper organisational echelons and members of the District Health Management Team (DHMT). CONCLUSION: This article concludes that organisational inertia at the personal and strategic levels of leadership entrusted with decentralising the HS in Malawi, contributed immensely to the derailment of shifting the HS from the centralised to the decentralised model of health service provision.

The political (a)symmetry of metacognitive insight into detecting misinformation.

Political misinformation poses a major threat to democracies worldwide, often inciting intense disputes between opposing political groups. Despite its central role for informed electorates and political decision making, little is known about how aware people are of whether they are right or wrong when distinguishing accurate political information from falsehood. Here, we investigate people's metacognitive insight into their own ability to detect political misinformation. We use data from a unique longitudinal study spanning 12 waves over 6 months that surveyed a representative U.S. sample (N = 1,191) on the most widely circulating political (mis)information online. Harnessing signal detection theory methods to model metacognition, we found that people from both the political left and the political right were aware of how well they distinguished accurate political information from falsehood across all news. However, this metacognitive insight was considerably lower for Republicans and conservatives-than for Democrats and liberals-when the information in question challenged their ideological commitments. That is, given their level of knowledge, Republicans' and conservatives' confidence was less likely to reflect the correctness of their truth judgments for true and false political statements that were at odds with their political views. These results reveal the intricate and systematic ways in which political preferences are linked to the accuracy with which people assess their own truth discernment. More broadly, by identifying a specific political asymmetry-for discordant relative to concordant news-our findings highlight the role of metacognition in perpetuating and exacerbating ideological divides. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The presence of diversity initiatives leads to increased pro-White hiring decisions among conservatives.

Despite the push and pull between pro-diversity advocates and conservative resistance, most organizations have implemented diversity initiatives in an effort to promote equitable and fair organizational practices. Past work has shown that these diversity initiatives may not be as effective as expected and may instead result in unintended negative consequences for the very individuals they are meant to support. In three novel experiments (total N = 3,664), we investigated whether and when the presence of pro-diversity messages in organizational job recruitment materials might facilitate versus hinder the hiring of underrepresented racial minorities. Participant race and political ideology were also investigated as predictors of hiring recommendations. Findings indicate that pro-diversity messages facilitate politically motivated hiring bias. Specifically, in the presence of pro-diversity messages, White and some Black, Indigenous, and people of color (BIPOC) conservatives tend to display a pro-White shift in their hiring recommendations, whereas liberals tend to display a pro-minority shift. The present research underscores the importance of organizational awareness regarding the potential for hiring managers to react, whether consciously or subconsciously, against pro-diversity efforts because of political ideology. The present research also highlights the need for organizations to move beyond just espousing pro-diversity values and actually investigate the impact diversity initiatives have on hiring, retention, and promotion of diverse employees. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Malleable national collective memories among Black and White Americans.

How do groups remember their shared past? Are there individual differences within a group? How easy is it to change collective memories? The present article addresses these questions by focusing on differences within national subgroups, exploring how national collective memories might differ for Black and White Americans, how individual differences and external influences might moderate or alter any differences, and the temporal extent of any changes that might occur due to external influences. Across four studies, participants were asked to identify the five "most important" events in U.S. history and then asked about their political ideology and racial and national identification, though not in every study. Although individual differences emerged, Black and White participants differed in the types of events they identified as important in U.S. history, with Black participants identifying more race-relevant events than White participants and White participants identifying more traditional founding events than Black participants. As to changes in collective memory, in response to a minimal identity salience manipulation, the murder of George Floyd, and July 4th celebrations, national collective memories evidenced malleability only after the murder of George Floyd. In this instance, the mention of race-relevant events increased, even as the frequency of mention of traditional founding events remained stable. The observed increase in race-relevant events was temporary, however. Findings are discussed in relation to contemporary discussions on collective memory, especially with respect to group differences, individual differences within groups, and mnemonic inertia. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Politicization of the COVID-19 Pandemic.

Political actors and institutions are largely responsible for effectively implementing the latest scientific and medical information in the form of public health measures. However, when politicians' judgments and decision-making are not founded on scientific facts or when scientific findings are misrepresented to further political goals, global crises such as pandemics may be even more galvanized. Like other scientific topics that entered public debate before 2020 (e.g., the debate on climate change), the COVID-19 pandemic has been heavily politicized worldwide. Consequently, COVID-19-related outcomes were strongly affected by politicization-a process of making a non-political issue political, i.e., debating it in the public sphere as an issue of public contestation. The present chapter presents a condensed overview and synthesis of the literature on the politicization of the COVID-19 pandemic in high- and low-income countries. In addition, we discuss several mechanisms explaining why, to some extent universally, conservatives (the right-wing oriented public) were less likely to follow public health recommendations, were more COVID-19 vaccine-hesitant, and had increased infection rates, poor health outcomes, and increased mortality compared to left-wing oriented public. The mechanisms explaining the links include the media, trust, cognitions, and values. We conclude the chapter with lessons learned during the COVID-19 pandemic and future research directions on the pandemics' politicization.

Exploring the Nexus: Personality Disorders and Their Impact on Violent Extremism, Radicalism, and Activism.

The escalating global concerns surrounding radicalization and violent extremism necessitate a comprehensive understanding and explanation. Identifying the risk factors associated with radicalism and violent extremism is critical to the development of risk assessment, prevention, and intervention strategies. It is imperative to distinguish these risks from civic responsibilities (i.e., activism) to safeguard individual rights. This study aims to examine the association between well-established risk factors for violence-personality disorder symptoms-and violent extremist attitudes, radicalism, and activism. Findings indicate that antisocial personality disorder symptoms were linked to violent extremist attitudes and radicalism, whereas obsessive-compulsive disorder symptoms were related to activism. This suggests that obsessive-compulsive personality disorder may signify a readiness for legal and nonviolent political action; in contrast, antisocial personality disorder symptoms signify a readiness for extremist violence and illegal political action.

New government must prioritise veterinary legislative reform.

Now that the General Election is over, and a new government is in place, BVA is continuing its campaigning efforts to maintain momentum towards reform of the Veterinary Surgeons Act.

Faster and farther towards the abyss: global health accelerators instead of tangible changes.

Global health accelerators have become the leading expression of global health engagement and policy. While accelerators seem to be the strategy of the moment, the term is meaningless and devoid of any statement of content. Moreover, acceleration can make social processes too fast to be subject to rational control or governance, especially in an era of (un-)social media, which makes the pace of communication and information. Under the dominance of neoliberalism, acceleration and accelerators pose a particular risk because they encounter a situation in which mankind is moving away from solving vital challenges and addressing their root causes. The fashionable emergence of accelerators cannot inspire confidence in the future trends in global health unless they actually result in tangible change and new approaches to tackling systemic challenges.

Health, human rights and freedom at stake? A critical discourse analysis of the Swedish media debate on the national COVID-19 pandemic strategy.

PURPOSE: The aim of this study is to, in the Swedish media debate, explore the discursive constructions of challenges in human rights and freedoms following the national spatial strategy for health and survival during the COVID-19 pandemic. METHODS: The study, inspired by a critical discourse analytic approach, focused particularly on the issues addressed, subject positions, relations and rhetoric. Seventeen opinion articles published in Swedish national newspapers December 2019 - February 2022 were analysed. RESULTS: The main contents were threats to democracy, threats to the freedom and rights of specific groups, and threats to the debate itself. Contents were expressed through three discourse dichotomies: contribution vs interjection, documented vs alarmistic, and active on the stage vs commenting from the balcony. CONCLUSIONS: Striking about the results is the absence of dialogue, the one-way communication, and the absent politicians. It seems that the analysed debate on the challenges of the Swedish COVID-19 pandemic strategy, based on its impact on overall freedoms and rights, has not been the focus of decision-makers during the pandemic. They have neither addressed the threats highlighted in the articles, nor contributed to the discourse. This is worrying for the long-term maintenance and development of a healthy democracy.

The impact of deep learning based- psychological capital with ideological and political education on entrepreneurial intentions.

The aim of this study is to investigate the influence of psychological capital on college students' entrepreneurial intentions. Through a combination of relevant analysis and linear regression, the primary focus is on exploring the relationship between psychological capital and its four dimensions with entrepreneurial intentions. Firstly, the items in the psychological capital questionnaire were revised to align more closely with entrepreneurial contexts. Subsequently, the average deviations and standard deviations of each dimension of psychological capital were analyzed. Then, the correlation between psychological capital and entrepreneurial intentions was examined to explore the extent of their relationship. Finally, regression analysis was conducted on both psychological capital and entrepreneurial intentions, and utilizing a recurrent neural network model, the covariant relationship between entrepreneurial psychological capital and intentions was explored. The results indicated that the average scores for entrepreneurial self-efficacy, optimism, hope, and resilience were 3.91, 4.27, 4.19, and 4.15, respectively. The average value of psychological capital was 4.13, indicating a moderately high level. The correlation analysis between psychological capital and entrepreneurial intentions yielded a result of 0.562, indicating a moderate degree of correlation. The correlation coefficients of the four dimensions with entrepreneurial intentions were 0.390, 0.494, 0.531, and 0.467, respectively. The standardized coefficients for psychological capital and its four dimensions were 0.564, 0.382, 0.510, 0.536, and 0.468, all of which were statistically significant. Overall, psychological capital exhibited better predictive power for entrepreneurial intentions than its individual dimensions. The results from the deep learning model similarly demonstrated the positive role of psychological capital in entrepreneurial intentions, though the influence of ideological and political education (IPE) factors was relatively weaker. In conclusion, both psychological capital and IPE have a promotive effect on entrepreneurial intentions. This study provides a reference for the accurate evaluation of college students' entrepreneurial intentions.

Building a Systems Map: Applying Systems Thinking to Unhealthy Commodity Industry Influence on Public Health Policy.

BACKGROUND: Unhealthy commodity industries (UCIs) engage in political practices to influence public health policy, which poses barriers to protecting and promoting public health. Such influence exhibits characteristics of a complex system. Systems thinking would therefore appear to be a useful lens through which to study this phenomenon, potentially deepening our understanding of how UCI influence are interconnected with one another through their underlying political, economic and social structures. As such this study developed a qualitative systems map to depict the complex pathways through which UCIs influence public health policy and how they are interconnected with underlying structures. METHODS: Online participatory systems mapping workshops were conducted between November 2021 and February 2022. As a starting point for the workshops, a preliminary systems map was developed based on recent research. Twenty-three online workshops were conducted with 52 geographically diverse stakeholders representing academia, civil society (CS), public office, and global governance organisations (CGO). Analysis of workshop data in NVivo and feedback from participants resulted in a final systems map. RESULTS: The preliminary systems map consisted of 40 elements across six interdependent themes. The final systems map consisted of 64 elements across five interdependent themes, representing key pathways through which UCIs impact health policy-making: (1) direct access to public sector decision-makers; (2) creation of confusion and doubt about policy decisions; (3) corporate prioritisation of commercial profits and growth; (4) industry leveraging the legal and dispute settlement processes; and (5) industry leveraging policy-making, norms, rules, and processes. CONCLUSION: UCI influence on public health policy is highly complex, involves interlinked practices, and is not reducible to a single point within the system. Instead, pathways to UCI influence emerge from the complex interactions between disparate national and global political, economic and social structures. These pathways provide numerous avenues for UCIs to influence public health policy, which poses challenges to formulating a singular intervention or limited set of interventions capable of effectively countering such influence. Using participatory methods, we made transparent the interconnections that could help identify interventions in future work.