Taxing sugar-sweetened beverages: Knowledge, beliefs and where should the money go?

Background: The Sugar-Sweetened Beverage (SSB) industry consciously and subconsciously influences consumers to buy its products. Countering unhealthy messaging and behaviour could be tackled through the SSB levy and allocation of revenue toward healthy lifestyle programs. Given the limited information in the UAE on demographic and consumer knowledge and beliefs and allocation of SSB levy, we conducted a study to explore this further. The study objectives were to a) explore the association between demographic factors (nationality, income and education) with knowledge and beliefs for SSB and b) explore participants' views on allocating SSB levy toward healthy lifestyle programs. Methods: A cross-sectional study of adults in the United Arab Emirates. Results: The findings suggest knowledge was high for Sugar-Sweetened Beverages (SSB), obesity, and diabetes (1,231, 96.1%), and there was a high awareness of SSB tax (1,066, 83.2%). Knowledge and beliefs about Sugar-Sweetened Beverages were statistically significant for two demographic factors. There was support for the tax revenue to be spent on government programs and greater support for spending to be directed toward specific healthy lifestyle programs such as school health programmes (514, 39.8%), children's diet and nutrition programmes (497, 38.5%), physical activity programmes (480, 37.2%), among others. Conclusions: The findings shed light on the influence demographic factors have on knowledge and beliefs, public health gaps and potential areas for SSB levy expenditure. Further research is needed to understand how best to implement healthy lifestyle programs within the community to optimise coverage, cost-effectiveness, and health outcomes.

Review: Medical directors - Is there a need for reform?

Medical leadership remains integral to the health system amidst a growing burden of ill health and disease, rising patient expectations and medical and technological advancements. The study objectives were to (a) provide a perspective through a rapid review of medical director roles and responsibilities in public and private hospital settings across several Organisation for Economic Co-operation and Development (OECD) and Non-Organisation for Economic Co-operation and Development countries, and (b) provide recommendations on how health system performance could be strengthened. A rapid review of Medical Director job descriptions in public and private hospitals was carried out. Medical Directors are influential leaders in organisational decision-making and quality improvement; however, their role has shifted from clinical oversight to several managerial and leadership roles. We report some variation in their role and responsibilities, in the 'intensity of job requirements' and 'complexity of managing resources' dimensions. The changing expectations of medical directors and the variation in their roles and responsibiliteis may contribute to inefficiencies and misalignment within health systems. There may be a need to pursue reform to assure alignment with health system objectives, albeit reform may require different approaches to meet the needs of different health systems. Further research is needed to explore how reform of medical directors' roles and responsibilities can be quantified to demonstrate improvement within health systems.

Optimizing interventional cardiology services.

Cardiovascular disease (CVD) is a common and prominent cause of morbidity and mortality interventional cardiology (IC) remains an important noninvasive intervention to improve patient outcomes and life expectancy. Aim: The study objectives were to explore how IC services could be optimized. Methods: We adopted multiple methods, including policy analysis, literature review and interviews. Results: The most prominent themes were medical devices and service integration and management. IC Consultant interviews suggest the need to balance supply and demand, implement standards of practice and establish centres of excellence. Conclusion: Optimizing IC services requires a comprehensive approach, including regulatory and financial oversight, organizational management, adoption of clinical and technological best practices, ongoing training, multidisciplinary working and service integration.

Perspective: Telehealth - beyond legislation and regulation.

The World Health Organization describes health innovation as developing new or improved systems, policies, products, technologies, services or delivery approaches that improve health and well-being, specifically of vulnerable people. The study's objectives were to (a) explore the legislative and regulatory journey of telehealth across the Organisation for Economic Co-operation and Development and non-Organisation for Economic Co-operation and Development countries and (b) provide recommendations to strengthen health system performance. We reviewed information sources for Organisation for Economic Co-operation and Development and non-Organisation for Economic Co-operation and Development countries opportunistically, including government and medical board publications, media coverage and peer-reviewed papers, to provide a perspective on the legislative and regulatory telehealth journey. Our review of countries suggests that legislation and regulation remain essential for governance, accountability and assuring that healthcare professionals and technologies are safe and secure. However, there was no uniform approach to telehealth legislation and regulation, and the precautionary approach was observed in some countries. Different strategies appear to have been adopted for telehealth implementation. There is a need to go beyond legislation and regulation to strengthen health system performance and assure the future success of telehealth services. Health system decision makers should work with health system stakeholders to strategise and plan for telehealth services as it will have implications on the future delivery of healthcare services and the health system. Further research is needed to explore how policy frameworks may support innovations in healthcare, such as telehealth.

A Mixed-Methods Study to Explore the Impact of Hospital Accreditation.

There are several hospital accreditors globally but there is limited understanding of how accreditation impacts on hospital performance and the health system objectives. The objective of the study were to explore the impact of hospital accreditation and inform policy decision-making. We adopted a mixed-methods approach to include an online survey and 3 focus groups. We report 27 of 36 private hospitals who responded to the survey. Key reasons for accreditation were to improve quality (n = 23), implement evidence-based practice (n = 17), continuity of accreditation (n = 15), and popularity (n = 11). Reported improvements include quality of care (27), patient care (26), organizational processes (21), and patient satisfaction (19) among others. Average stakeholder satisfaction rate was 74%. Participants from the 3 focus group discussions felt that staff hours and stress levels were high during the accreditation process, and some standards were useful while others were deemed non-essential. There was support for a local accreditation body with an emphasis on best practice. The findings from the study suggest accreditation to have an impact on structure and process measures, but the gains in key areas were short-lived. There is a need to strengthen governance and develop performance measures to evidence outcome improvement, assure alignment with regulation and the health system objectives.

The nexus of Sugar-Sweetened Beverages: Insights on demographics, enablers and barriers.

Objectives: The study objectives were to a) explore the association between household income and nationality and Sugar-Sweetened Beverage (SSB) enablers and barriers, and b) inform public health policy and health promotion. Study design: A Cross-sectional Study in the UAE. Methods: Nationally representative population survey was used to capture demographic and SSB behaviour data. Results: We recruited 7500 participants into the study and received 1290 responses (17.2% participation rate). We report statistically significant associations between household income, nationality, and enablers and barriers. In some instances, similar enablers and barriers were reported by household income and nationality. Conclusions: There are several associations between household income, nationality and SSB enablers, and barriers. These associations should be considered for future public health policy and health promotion decision-making to reduce SSB consumption. In addition, further research is needed to explore how other demographic factors (modifying variables) are associated with SSB enablers and barriers.

Evaluation of the impact of a smoke-free home initiative in Rotherham, a deprived district in Northern England.

BACKGROUND: An evaluation of a smoke-free home initiative launched in Rotherham, northern England, in July 2009. METHODS: Two approaches were used: (i) a postal survey of participants 4 months after signing up as a SFH and (ii) a telephone consultation. The survey was sent to 620 households (of 654 who signed up to the scheme); 289 (46.6%) were returned. The telephone consultation involved 20 households before and 20 after signing up to the scheme. RESULTS: Of the households that permitted some smoking at home before the initiative, ~78% became smoke free after signing up (uncertainty due to missing replies). A high number of participants (169, 60.8%) were already informally smoke free. The most common reasons for participation concerned health, environment, and fire safety. Participants were motivated by, amongst other things, information given in a booklet and by the offer of a fire-safety referral. The most immediate benefits noted by participants were improvements in house hygiene. The most important hindrance to success seemed to be a lack of power to enforce the ban at home, particularly on the part of those living in smokers' homes. CONCLUSION: The Rotherham initiative succeeded in creating smoke-free homes. The results should help those planning similar initiatives. Important points include that: many participants had already instituted some rules regarding smoking at home; whether and how to include households that are already smoke-free; risk of fire and concern with house hygiene are important motivations; those living in smokers' homes may lack power to initiate smoke-free rules.

Implementing public health in secondary care: a Rotherham perspective on strategy development and implementation.

AIMS: This paper reports an approach to develop and implement a public health strategy in secondary care and uses smoking cessation as a means for measuring success. METHODS: Rotherham Foundation Hospital Trust recognized its unique role to promote, prevent and protect health and well-being in Rotherham. Following consultation across key departments, the trust developed a public health strategy encompassing five priorities. RESULTS: We report ongoing commitment and engagement following the launch of the public health strategy. Over a period of one year (April 2008 to March 2009) 269 front-line staff were trained on smoking cessation brief interventions. We report 890 referrals to smoking cessation, resulting in 414 setting a quit date and 143 four-week quitters (35% conversion rate). Despite progress in implementing smoking cessation, more communication is required to ensure that GPs and hospital staff continue to maximize patient outcomes through brief interventions. CONCLUSIONS: The paper provides an approach to implement public health in secondary care. The Commissioning for Quality and Innovation (CQUIN) payment framework would be a useful tool to ensure key public health areas such as smoking cessation are systemized in secondary care.

Smoke-free homes: outcomes of a local service development.

This paper aims to determine the impact of a smoke-free homes initiative in Doncaster. An evaluation was conducted via a self-reported semi-structured questionnaire and telephone survey in 2006. Numbers and types of smoke-free homes promises, self-reported smoking restrictions in the home and factors associated with smoke-free homes were measured. A total of 825 smoke-free home promises were received, of which 567 (69%) were 'gold', 221 (27%) 'silver' and 37 (4%) 'bronze'. Of these promises, 523 (63%) were from smokers. Non-smokers (95%) and smokers who had just stopped (91%) were more likely to opt in for a gold promise when compared to smokers (52%, p<0.001). Over half of smokers who opted for the gold promise reported not allowing smoking in the house (57%, p<0.001). Of 82 responses at follow up, 41 (50%) reported smoking outside the house or in the street. Engaging families in the implementation of smoke-free homes is an effective measure to reduce household second-hand smoke exposure. Further research is required to assess the long-term feasibility, sustainability and cost per quitter.