The case for investment in tobacco control: lessons from four countries in the Americas.

Objective: To synthesize learnings from four national tobacco control investment cases conducted in the Americas (Colombia, Costa Rica, El Salvador, Suriname) under the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) 2030 project, to describe results and how national health authorities have used the cases, and to discuss implications for the role of investment cases in advancing tobacco control. Methods: We draw on findings from four national investment cases that included 1) a cost-of-illness analysis calculating the health and economic burden of tobacco use, 2) a return-on-investment analysis of implementing key tobacco control demand reduction measures, and 3) a subsidiary analysis of one tobacco control topic of national interest (e.g., equity implications of cigarette taxation). Co-authors reported how cases have been used to advance tobacco control. Results: In Colombia, Costa Rica, El Salvador, and Suriname, tobacco use causes social and economic losses equivalent to between 1.0 to 1.8 percent of GDP. Across these countries, implementing WHO FCTC demand reduction measures would save an average of 11 400 lives per year over the next 15 years. Benefits of the measures would far outweigh the costs of implementation and enforcement. Governments are using the cases to advance tobacco control, including to improve tobacco control laws and their enforcement, strengthen tobacco taxation, prioritize tobacco control planning, coordinate a multisectoral response, and engage political leaders. Conclusions: National investment cases can help to strengthen tobacco control in countries, including by increasing public and political support for implementation of the WHO FCTC and by informing effective planning, legislation, coordination and financing.

Is patient-centred care for women a priority for policy-makers? Content analysis of government policies.

BACKGROUND: Considerable research shows that women experience gendered disparities in healthcare access and quality. Patient-centred care (PCC) could reduce inequities by addressing the patient's clinical and personal needs. Healthcare policies can influence service delivery to optimise patient outcomes. This study assessed whether and how government policies recognise and promote PCC for women (PCCW). METHODS: We analysed the content of English-language policies published in Canada from 2010 to 2018 on depression and cardiac rehabilitation - conditions featuring known gendered inequities - that were identified on government websites. We extracted data and used summary statistics to enumerate mentions of PCC and women's health. RESULTS: We included 30 policies (20 depression, 10 cardiac rehabilitation). Of those, 20 (66.7%) included any content related to PCC (median 1.0, range 0.0 to 5.0), most often exchanging information (14, 46.7%) and making decisions (13, 43.3%). Less frequent domains were enabling self-management (8, 26.7%), addressing emotions (6, 20.0%) and fostering the relationship (4, 13.3%). No policies included content for the domain of managing uncertainty. A higher proportion of cardiac rehabilitation guidelines included PCC content. Among the 30 policies, 7 (23.3%) included content related to at least one women's health domain (median 0.0, range 0.0 to 3.0). Most frequently included were social determinants of health (4, 13.3%). Fewer policies mentioned any issues to consider for women (2, 28.6%), issues specific to subgroups of women (2, 28.6%) or distinguished care for women from men (2, 28.6%). No policies included mention of abuse or violence, or discrimination or stigma. The policies largely pertained to depression. Despite mention of PCC or women's health, policies offered brief, vague guidance on how to achieve PCCW; for example, "Patients value being involved in decision-making" and "Women want care that is collaborative, woman- and family-centered, and culturally sensitive." CONCLUSIONS: Despite considerable evidence of need and international recommendations, most policies failed to recognise gendered disparities or promote PCC as a mitigating strategy. These identified gaps represent opportunities by which government policies could be developed or strengthened to support PCCW. Future research should investigate complementary strategies such as equipping policy-makers with the evidence and tools required to develop PCCW-informed policies.

How do we define the policy impact of public health research? A systematic review.

BACKGROUND: In order to understand and measure the policy impact of research we need a definition of research impact that is suited to the task. This article systematically reviewed both peer-reviewed and grey literature for definitions of research impact to develop a definition of research impact that can be used to investigate how public health research influences policy. METHOD: Keyword searches of the electronic databases Web of Science, ProQuest, PubMed, EMBASE, CINAHL, Informit, PsycINFO, The Cochrane Database of Systematic Reviews and Google Scholar were conducted between August 2015 and April 2016. Keywords included 'definition' and 'policy' and 'research impact' or 'research evidence'. The search terms 'health', public health' or 'mental health' and 'knowledge transfer' or 'research translation' were used to focus the search on relevant health discipline approaches. Studies included in the review described processes, theories or frameworks associated with public health, health services or mental health policy. RESULTS: We identified 108 definitions in 83 publications. The key findings were that literature on research impact is growing, but only 23% of peer-reviewed publications on the topic explicitly defined the term and that the majority (76%) of definitions were derived from research organisations and funding institutions. We identified four main types of definition, namely (1) definitions that conceptualise research impacts in terms of positive changes or effects that evidence can bring about when transferred into policies (example Research Excellence Framework definition), (2) definitions that interpret research impacts as measurable outcomes (Research Councils UK), and (3) bibliometric and (4) use-based definitions. We identified four constructs underpinning these definitions that related to concepts of contribution, change, avenues and levels of impact. CONCLUSION: The dominance of bureaucratic definitions, the tendency to discuss but not define the concept of research impact, and the heterogeneity of definitions confirm the need for conceptual clarity in this area. We propose a working definition of research impact that can be used in a range of health policy contexts.

The case for investment in tobacco control: lessons from four countries in the Americas / El caso de la inversión en el control del tabaco: las enseñanzas de cuatro países de la Región de las Américas / Em defesa do investimento no controle do tabaco: lições de quatro países das Américas

ABSTRACT Objective. To synthesize learnings from four national tobacco control investment cases conducted in the Americas (Colombia, Costa Rica, El Salvador, Suriname) under the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) 2030 project, to describe results and how national health authorities have used the cases, and to discuss implications for the role of investment cases in advancing tobacco control. Methods. We draw on findings from four national investment cases that included 1) a cost-of-illness analysis calculating the health and economic burden of tobacco use, 2) a return-on-investment analysis of implementing key tobacco control demand reduction measures, and 3) a subsidiary analysis of one tobacco control topic of national interest (e.g., equity implications of cigarette taxation). Co-authors reported how cases have been used to advance tobacco control. Results. In Colombia, Costa Rica, El Salvador, and Suriname, tobacco use causes social and economic losses equivalent to between 1.0 to 1.8 percent of GDP. Across these countries, implementing WHO FCTC demand reduction measures would save an average of 11 400 lives per year over the next 15 years. Benefits of the measures would far outweigh the costs of implementation and enforcement. Governments are using the cases to advance tobacco control, including to improve tobacco control laws and their enforcement, strengthen tobacco taxation, prioritize tobacco control planning, coordinate a multisectoral response, and engage political leaders. Conclusions. National investment cases can help to strengthen tobacco control in countries, including by increasing public and political support for implementation of the WHO FCTC and by informing effective planning, legislation, coordination and financing.

RESUMEN Objetivo. Resumir las enseñanzas de cuatro casos nacionales de inversión en el control del tabaco llevados a cabo en la Región de las Américas (Colombia, Costa Rica, El Salvador y Surinam) en el marco del proyecto 2030 del Convenio Marco de la Organización Mundial de la Salud para el Control del Tabaco (CMCT), describir los resultados y cómo las autoridades nacionales de salud han empleado los casos, y abordar las implicaciones para la función de los casos de inversión en el avance del control del tabaco. Métodos. Este estudio está basado en los hallazgos de cuatro casos de inversión nacional que incluían 1) un análisis del costo de la enfermedad que estima la carga sanitaria y económica del consumo de tabaco, 2) un análisis del rendimiento de la inversión de la ejecución de medidas clave de reducción de la demanda en el control del tabaco, y 3) un análisis subsidiario de un tema de interés nacional sobre el control del tabaco (por ejemplo, el impacto en la equidad de los impuestos sobre los cigarrillos). Los coautores notificaron cómo se han utilizado los casos para avanzar en el control del tabaco. Resultados. En Colombia, Costa Rica, El Salvador y Surinam, el consumo de tabaco causa pérdidas sociales y económicas equivalentes a entre el 1,0 y el 1,8 por ciento del PIB. En todos estos países, la aplicación de las medidas de reducción de la demanda recogidas en el CMCT de la OMS salvaría una media de 11 400 vidas al año en los próximos 15 años. Los beneficios de estas medidas superarían con creces los costos de ejecución y cumplimiento. Los gobiernos están utilizando los casos para avanzar en el control del tabaco, como para mejorar las leyes de control y su aplicación, reforzar los impuestos sobre el tabaco, priorizar la planificación del control del tabaco, coordinar una respuesta multisectorial e involucrar a los líderes políticos. Conclusiones. Los casos de inversión nacional pueden ayudar a fortalecer el control del tabaco en los países, por ejemplo, al aumentar el apoyo público y político a la aplicación del CMCT de la OMS y al informar sobre una planificación, legislación, coordinación y financiación eficaces.

RESUMO Objetivo. Sintetizar as lições aprendidas com quatro casos de investimento nacional no controle do tabaco nas Américas (Colômbia, Costa Rica, El Salvador e Suriname) no âmbito do projeto Convenção-Quadro para o Controle do Tabaco da Organização Mundial da Saúde (CQCT-OMS) 2030, descrever os resultados e as formas como as autoridades sanitárias nacionais utilizaram os casos e discutir as implicações para o papel dos casos de investimento no avanço do controle do tabaco. Métodos. O presente estudo recorre aos achados de quatro casos de investimento nacional, incluindo: 1) análise de custo da doença, com o cálculo da carga do tabagismo para a saúde e a economia; 2) análise do retorno sobre o investimento na implementação de medidas fundamentais de redução da demanda para controle do tabaco; e 3) análise secundária de um tópico de controle do tabaco de interesse nacional (por exemplo, implicações da tributação de cigarros para a equidade). Os coautores relatam como os casos foram utilizados para promover o controle do tabaco. Resultados. Na Colômbia, na Costa Rica, em El Salvador e no Suriname, o tabagismo provoca perdas sociais e econômicas que equivalem a 1,0 a 1,8% do produto interno bruto. Nesses países, a implementação de medidas de redução da demanda da CQCT-OMS pouparia em média 11.400 vidas por ano nos próximos 15 anos. Os benefícios dessas medidas superariam em muito os custos de implementação e fiscalização. Os governos estão usando esses casos para promover o controle do tabaco, inclusive para melhorar as leis de controle do tabaco e sua fiscalização, reforçar a tributação do tabaco, priorizar o planejamento do controle do tabaco, coordenar uma resposta multissetorial e envolver líderes políticos. Conclusões. Casos de investimento nacional podem ajudar a fortalecer o controle do tabaco nos países, aumentando o apoio político e do público para a implementação da CQCT-OMS e contribuindo para um planejamento, legislação, coordenação e financiamento efetivos.

Síntese de evidências para políticas de saúde: cuidado orientado para a família na atenção primária à saúde / Evidence synthesis for health policy: family oriented primary health care

Introdução: A política de saúde no Brasil adotou a Estratégia Saúde da Família (ESF), no âmbito da atenção básica, com o intuito de facilitar o acesso ao sistema de saúde, mudar o modelo assistencial tradicional, racionalizar o uso dos demais âmbitos de atenção à saúde e estender a cobertura assistencial em áreas de maior risco social. São insuficientes os documentos governamentais que contribuem com a discussão sobre a complexidade do perfil atual das famílias brasileiras, o conceito de família, instrumentos para a avaliação e intervenção em famílias e evidências quanto à efetividade de intervenções, como a ESF, para atender necessidades em saúde de famílias. Considerações teóricas: a partir do campo da saúde coletiva, compreende-se que, no contexto neoliberal, a família, lócus de reprodução social, tem sido responsabilizada por atender as necessidades em saúde de seus membros, com o Estado cada vez mais ausente da proteção social. Objetivo geral: Sintetizar as melhores evidências para políticas de saúde orientadas para a família, no âmbito da Atenção Primária à Saúde (APS). A expressão APS foi adotada por ser de uso internacional. Procedimentos metodológicos: estudo de síntese de evidências para políticas, que utilizou a ferramenta SUPPORT, criada pela OMS. Foram etapas do estudo: 1) Definição do problema, por meio de reuniões com estudantes e orientadoras do Programa de Mestrado Profissional em Enfermagem da Atenção Primária à Saúde no SUS da Escola de Enfermagem da USP, e pesquisadoras do Instituto de Saúde do Estado de São Paulo; 2) Levantamento e seleção de evidências voltadas a famílias, no âmbito da APS, realizadas por duas pesquisadoras independentes nas fontes de dados: PubMed, Scopus, Applied Social Sciences Index and Abstrats (ASSIA, ERIC e Sociological Abstracts); Health Systems Evidence (HSE); JBI DataBase of Systematic Review and Implementation Reports; Cochrane Library; Campbell Collaboration; Google Acadêmico e portal BVS, a partir dos descritores Atenção Primária à Saúde e Família, usando variações e booleanos, de acordo com as várias bases pesquisadas; Extração de dados relevantes das revisões sistemáticas selecionadas e avaliação da qualidade metodológica, com a aplicação do instrumento AMSTAR; Seleção e descrição das opções com as informações mais relevantes para abordar a família, com prioridade para estratégias, programas e políticas; 5) Considerações sobre implementação e equidade das opções encontradas. Resultados: Foram identificados 2.131 estudos; a seleção realizada após leitura de títulos e resumos reduziu esse total para 84; após leitura na íntegra, foram incluídas 27 revisões sistemáticas. Este relatório trata das seguintes opções: Programas e estratégias para a juventude, e Estratégias centradas no cuidado à família, elaboradas a partir de 17 revisões incluídas. A primeira opção baseia-se em intervenções com famílias que têm membros jovens usuários de drogas ou famílias com crianças, adolescentes e jovens com outros problemas nas relações sociais, envolvendo comprometimento das dimensões emocional e comportamental. A segunda opção está ancorada em intervenções baseadas em abordagens para melhorar a qualidade de vida e o bem- estar de pacientes e seus familiares, bem como a relação com os profissionais de saúde. Conclusões: As intervenções que compõem essas opções apresentam limitações para atender necessidades em saúde das famílias, no âmbito da APS, com a responsabilização das famílias pelo cuidado de saúde de seus membros; as intervenções grupais com várias famílias são criticadas em favor de terapias destinadas a cada família individualmente. As potencialidades estão associadas àquelas intervenções que propõem terapêuticas com as famílias, em relacionamento cooperativo com os profissionais de saúde, o que estabelece novas formas de interação e aprendizado e potencializa mudanças, como é o caso da intervenção centrada na família com sessões educativas e de aconselhamento. Produto: Opções para a implementação de políticas em resposta às necessidades em saúde de famílias, no âmbito da APS.

Introduction: Health policy in Brazil has adopted the Family Health Strategy (FHS) in Basic Health Attention, with the purpose of facilitating access to the health system, changing the traditional care model, rationalizing the use of other health care services and extending health care coverage in areas of higher social risk. To date, governmental documents have given little input on the complexity of Brazilian families profiles, the concept of family and the definition of instruments for evaluation and intervention in families, like FHS, to meet families health care needs. Theoretical considerations: From the field of collective health, it is understood that, in the neoliberal context, the family, the locus of social reproduction, has been held responsible for meeting the health needs of its members, with the State increasingly absent from social protection. Objective: to synthesize the best evidence for family-oriented health policies, in the context of PHC. The expression APS was adopted due to its international use. Methodological procedures: Evidence synthesis study for policies using the SUPPORT tool created by the World Health Organization (WHO). The study stages were: 1) Definition of the problem through meetings with students and advisors of the Professional Master\'s Program in Primary Health Nursing at SUS at the School of Nursing at USP, and researchers from the Institute of Health of the State of São Paulo; 2) Survey and selection of family-oriented evidence, within PHCs scope, conducted by two independent researchers, in the data sources: PubMed, Scopus, Applied Social Sciences Index and Abstracts (ASSIA, ERIC and Sociological Abstracts); Health Systems Evidence (HSE); JBI DataBase of Systematic Review and Implementation Reports; Cochrane Library; Campbell Collaboration; Google Scholar and VHL portal, from the descriptors Primary Health Care and Family, utilizing variations and booleans, according to the various bases searched; 3) Extraction of relevant data from selected systematic reviews and assessment of methodological quality, with the application of the AMSTAR instrument; 4) Selection and description of options with the most relevant information to address the family, with priority for strategies, programs and policies; 5) Implementation and equity considerations of the options found. Results: 2,131 studies were identified; the selection after reading titles and abstracts reduced this total to 84; After full reading, 27 systematic reviews were included. This report addresses the following options: Programs and strategies for youth, and Strategies focused on family care, drawn from 17 included reviews. The first option is based on interventions with families that have young drug users or families with children, adolescents and young people with other social relations problems, involving impairment of the emotional and behavioral dimensions. The second option is anchored in approach- based interventions to improve the quality of life and well-being of patients and their families, as well as the relationship with health professionals. Conclusions: The interventions that make up these options have limitations to meet families health needs, within PHC, with families being responsible for the health care of their members; group interventions with several families are criticized in favor of therapies for each family individually. The potentialities are associated with those interventions that propose therapies with families, in cooperative relationship with health professionals, which establishes new forms of interaction and learning and allow for stronger changes, such as family- centered intervention with educational and counseling sessions. Output: Options for implementing policies in response to family health needs under PHC.