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To analyse the process for the development and implementation of mandatory nutritional warning labels in Uruguay, in order to inform future nutrition policy making and strategic engagement by public health actors.
The study design drew on policy analysis methodology and case study research methodology. Two main sources of information were selected and analysed for the current study: eighteen official documents from the Uruguayan government and 259 news reports, published between June 2017 and February 2021.
Uruguay, Latin America.
The Uruguayan Ministry of Public Health led a cross-sectoral working group composed of diverse governmental stakeholders, international organisations and the academia to develop the front-of-package nutrition labelling policy. A robust evidence-based approach, based on rigorous scientific knowledge generated in the country, was followed. However, changes in the systemic governing coalition as a consequence of a change in government led to a delay in the entry into force and changes in the regulation. The food industry was the main opponent to the warning label regulation and relied on widely reported corporate political activities to influence the policy process: information and messaging, legal action, policy substitution, opposition, fragmentation and destabilisation.
Key insights to inform future policy action in Uruguay and other jurisdictions were derived. Results stressed the importance of an evidence-based approach for policy design and the early engagement with actors from all the political system.
To analyse the content of the marketing of commercial foods for infants and young children on packages and social media.
Commercial foods targeted at children, regarded as potential breast-milk substitutes according to the Uruguayan breast-feeding standard, were considered: dairy products; teas, juices and bottled waters; glucose solutions; cereals and mixtures of fruits and vegetables. All the products sold at forty-four retail outlets were purchased. A Facebook search was performed to identify accounts of these products. For each account, all the content posted by the brands between July 2017 and July 2019 was recorded. The visual and textual information included in the packages and Facebook posts was analysed using content analysis. Products were classified using the nutrient profile model of the Pan American Health Organization.
Seventy-six unique commercial foods targeted at infants and young children were identified, 96 % of which were excessive in sugar. Packages frequently included textual and visual elements to convey health-related associations, including images of fruits and vegetables, nutrient content claims and endorsement logos. Ten Facebook accounts were identified, which generated 302 posts. Parents and caregivers were the main target audience of the posts, which mainly included content related to fun and social aspects of food consumption. Additionally, the posts frequently conveyed the idea that products would contribute to children’s growth and development.
Results suggest the need to implement comprehensive regulations on the marketing of commercial foods targeted at children, regarded as potential breast-milk substitutes according to the Uruguayan breast-feeding standard.
To explore adolescents’ views about the foods they consume and to identify their ideas about strategies to encourage healthier eating habits.
Individual questionnaires based on open-ended questions and group discussions (6–8 participants) were used to address the objectives. Data were analysed using content analysis based on deductive-inductive coding.
Montevideo and its metropolitan area (Uruguay, Latin America).
Totally, 102 adolescents (aged between 11 and 15 years, 52 % female) recruited at two educational institutions.
Adolescents reported frequently consuming ultra-processed products and fast food although they were perceived as bad for their health, whereas they reported an infrequent consumption of fruits and vegetables. Multifaceted strategies to promote healthy eating habits emerged from adolescents’ accounts, including public awareness campaigns, nutrition education programmes, nutrition label standards and regulations, and changes in food availability and affordability.
Results from the present work suggest that co-creation with adolescents may be an effective way to inform the development of strategies to promote healthier eating habits. The strategies suggested by adolescents were mainly focused on behaviour change communication, who emphasised the importance of social media and the involvement of celebrities and influencers. The need for educational and communication strategies to raise awareness of the social and environmental drivers of eating patterns among adolescents was identified.
In 1959–62, relations between Greece and the USSR entered a new phase. The tactics of the Soviet Union regarding Cyprus in 1955–9 did not pay off, as the rift between Greece, Turkey, and NATO was largely bridged in the aftermath of the 1959 Cyprus agreements. However, the search for a Cold War détente engendered pervasive insecurity in a frontline state like Greece, always afraid that its larger allies might abandon it. Nuclear intimidation, Greek anti-communism on the one hand; on the other, the impressive development of trade relations, created a complex environment. This article, based on the archives of the Greek Foreign Ministry, and the personal archive of the Greek prime minister, Constantine Karamanlis, discusses Athens’ response to the new Soviet policy.
There is a paucity of scientific analysis that has examined spatial heterogeneities in the socioeconomic vulnerabilities related to coronavirus disease 2019 (COVID-19) risk and potential mitigation strategies at the sub-national level in India. The present study examined the demographic, socioeconomic, and health system-related vulnerabilities shaping COVID-19 risk across 36 states and union territories in India.
Using secondary data from the Ministry of Health and Family Welfare (MoHFW), Government of India; Census of India, 2011; National Family Health Survey, 2015-16; and various rounds of the National Sample Survey, we examined socioeconomic vulnerabilities associated with COVID-19 risk at the sub-national level in India from March 16, 2020, to May 3, 2020. Descriptive statistics, principal component analysis, and the negative binomial regression model were used to examine the predictors of COVID-19 risk in India.
There persist substantial heterogeneities in the COVID-19 risk across states and union territories in India. The underlying demographic, socioeconomic, and health infrastructure characteristics drive the vulnerabilities related to COVID-19 in India.
This study emphasizes that concerted socially inclusive policy action and sustained livelihood/economic support for the most vulnerable population groups is critical to mitigate the impact of the COVID-19 pandemic in India.
A qualitative interpretive-systemic focus group study was conducted to examine the developmental and implementational underpinnings of Asia's first national Advance Care Planning (ACP) programme constituted in Singapore.
63 physicians, nurses, medical social workers, and allied health workers who actively rendered ACP were purposively recruited across seven major public hospitals and specialist centers.
Framework analysis revealed 19 themes, organized into 5 categories including Life and Death Culture, ACP Coordination, ACP Administration, ACP Outcomes, and Sustainability Shift. These categories and themes formed an Interpretive-Systemic Framework of Sustainable ACP, which reflects the socio-cultural, socio-political, and socio-spiritual contexts that influence ACP provision, highlighting the need to adopt a public health strategy for enhancing societal readiness for end-of-life conversations.
Significance of results
The Interpretive-Systemic Framework of Sustainable ACP underscores the importance of health policy, organizational structure, social discourse, and shared meaning in ACP planning and delivery so as to support and empower care decision-making among terminally ill Asian patients and their families facing mortality.
The 2019 coronavirus disease (COVID-19) pandemic has led to physical distancing measures in numerous countries in an attempt to control the spread. However, these measures are not without cost to the health and economies of the nations in which they are enacted. Nations are now looking for methods to remove physical distancing measures and return to full functioning. To prevent a massive second wave of infections, this must be done with a data-driven methodology. The purpose of this article is to propose an algorithm for COVID-19 testing that would allow for physical distancing to be scaled back in a stepwise manner, which limits ensuing infections and protects the capacity of the health care system.
One of the good practice principles for health technology assessment (HTA) is having a clear link between the assessment and decision making. The objective of the 2019 Latin American Policy Forum (LatamPF) of Health Technology Assessment International was to explore different models of connection between HTA and decision making and to discuss the potential applicability of such models in Latin America.
This paper is based on a background document and the deliberations of the members of the LatamPF (fifty-four participants from twelve countries) where a design-thinking methodology was used.
The participants agreed that insufficient links between HTA and decision making undermine the legitimacy of decisions, expose the HTA process to excessive political and judicial influence, and promote the exclusion of some stakeholders from participating in the assessment process and decision making. High priority aspects of the HTA process that could feasibly be improved and which hold the greatest potential to generate positive changes in the health systems in the region were identified. The majority of these aspects were associated with the appropriate institutionalization of HTA, a greater degree of participation by different stakeholders, and improved transparency in the HTA process.
The LatamPF identified barriers and recommended actions to strengthen the link between HTA and decision making. Participants emphasized that there is now a window of opportunity in the region as many societal actors see this as a priority. For this reason, health system stakeholders must take this opportunity to increase efforts toward strengthening the link between HTA and decision making.
This article describes the characteristics of the health system and reviews the history of health technology assessment (HTA) in Iran, including its inception, processes, challenges, and lessons learned. This study was conducted by analyzing existing documents, reports, and guidelines related to HTA and published articles in the field. HTA in Iran has been established since the late 2000s and was first introduced as a secretariat by the Deputy of Health at the Ministry of Health and Medical Education. The mission of the HTA office is to systematically assess technologies to improve evidence-informed decision making. Despite its 10 years of existence, HTA in Iran still faces some challenges. The most pressing problems currently facing HTA in Iran include conflicts of interest among researchers performing the HTAs, the absence of a systematic structure for identifying and introducing new technologies, the lack of interest in HTA results among high-level policy makers, and the lack of external oversight for HTA projects.
Chapter 4 on Australia presents a pioneering, quantitative analysis of the summary details of consultancies and other contracts over the past three decades, as these were listed in mandatory reporting systems of the national government. Using text analysis and keyword searches, the chapter focuses on consultancies and other contracts that appeared to be oriented, or at least relevant, to policy matters and programme content, as distinct from ‘neutral’ corporate services. In contrast to a reduction in the level of in-house staffing, it reveals strong long-term growth in spending on these policy-relevant contracts across each of the three decades. It also establishes that this overall pattern of growth was replicated right across Commonwealth departments. In regard to market share on the supply side, it finds a polarized distribution in each of the three decades: a corporate end where a very small proportion of suppliers get much of the spending, and a huge array of sundry operators undertaking very small amounts of work. It argues that the long-term market share of successful consultants and contractors put them in a position to influence many aspects of programme development.
Many Western countries have seen an increase in the volume and importance of external consultants in the public policy process. This book is the first to investigate this phenomenon in a comparative and interdisciplinary way. The analysis shows who these consultants are, how widely and for what reasons they are used in Britain, the United States, Canada, Australia, The Netherlands and Sweden. In doing so, the book addresses the positive and negative implications of high levels of external policy consultancy, including its implications for the nature of the state (transforming into a contractor state?) and for democratically legitimized and accountable decision-making (transforming into consultocracy?). It provides valuable new insights for students and practitioners in the fields of public administration, public policy, public management, political science and human resource management.
After years of pension policy drift in a broader context of global austerity, the Canada Pension Plan (CPP) was enhanced for the first time in 2016 to expand benefits for Canadian workers. This article examines Ontario's central role in these reforms. The deteriorating condition of workplace plans, coupled with rising retirement income insecurity across the province's labour force, generated new sources of negative feedback at the provincial level, fuelling Ontario's campaign for CPP reform beginning in the late 2000s. The political limits of policy drift and layering at the provincial level is considered in relationship to policy making at the national level. As shown, a new period of pension politics emerged in Canada after 2009, in which the historical legacy of CPP's joint governance structure led to a dynamic of “collusive benchmarking,” shaped in large part by political efforts of the Ontario government, leading to CPP enhancement.
The aim of this chapter is two-fold. First, the authors present a practical application of multidisciplinary research based on the experience of editing a book comprised of multidisciplinary cases and focusing on two chapter cases. There are many theoretical accounts of how one may approach multidisciplinary research, but here the authors aim to offer a practical account of how the theoretical goal of multidisciplinary research can play out in the ‘real world’. After addressing the current conceptual understanding of multidisciplinary versus interdisciplinary research, the authors will explain how useful these concepts, in fact, are when applied to the typical constraints that many academics face today in conducting joint research. The authors, who are both editors of the book, will provide lessons for future multidisciplinary collaboration and suggestions for developing methods of multidisciplinary research.
The final chapter presents responses to the content of the entire book by policy practitioners who have dealt with the realities of constructing and implementing policies. They include essays by Emily Shuckburgh, OBE, deputy head of the Polar Oceans Team at the British Antarctic Survey; John Deutch, currently Institute Professor at the Massachusetts Institute of Technology and former Deputy Secretary of Energy in the United States; and Lord Ronald Oxburgh, who is a British parliamentarian, member of the House of Lords, a former chairman of Shell and himself a geologist and geophysicist. These ‘technologists’ offer three different perspectives on the topic of ‘good energy policy’. Finally the editors provide the main lessons learned from the book and offer suggestions for future directions of multidisciplinary research in energy policy.
Ebola is a high consequence infectious disease—a disease with the potential to cause outbreaks, epidemics, or pandemics with deadly possibilities, highly infectious, pathogenic, and virulent. Ebola’s first reported cases in the United States in September 2014 led to the development of preparedness capabilities for the mitigation of possible rapid outbreaks, with the Centers for Disease Control and Prevention (CDC) providing guidelines to assist public health officials in infectious disease response planning. These guidelines include broad goals for state and local agencies and detailed information concerning the types of resources needed at health care facilities. However, the spatial configuration of populations and existing health care facilities is neglected. An incomplete understanding of the demand landscape may result in an inefficient and inequitable allocation of resources to populations. Hence, this paper examines challenges in implementing CDC’s guidance for Ebola preparedness and mitigation in the context of geospatial allocation of health resources and discusses possible strategies for addressing such challenges. (Disaster Med Public Health Preparedness. 2018;12:563–566)
This article discusses how the Lebanese state has responded to displacement from Syria (2011–17), and how the resulting policy formulation processes and discourses have constructed the relationship between the hosting state and the refugee. It focuses especially on how this small state has negotiated its politics of reception and choice of policy tools amid dysfunctional institutions and political disputes. To this end, it uses the lens of Lebanon's model of sectarian power sharing to understand the polity's response to mass displacement. This process has been structured by the defining dynamics of the country's politics of sectarianism: slack governance, an elite fractured model, and a politics of dependence on external and domestic nonstate actors. The Lebanese model offers broader insights into types of coping mechanisms that emerge in the context of forced migration, notably when a formal refugee regime is absent. The article contends that states lacking a legal asylum framework and grappling with various governance hurdles are likely to draw on the repertoire of their political regime to deal with displacement.
The use of proportionality and balancing by the European Court of Human Rights (ECtHR) is inconsistent and does not provide clear guidelines from which policies can be drafted that could strike a fair balance between individual rights and public interests while not impairing the essence of the rights at stake. While ad hoc and unprincipled balancing may be justified on the theoretical level, on the practical level a policymaker seeking to understand which infringements constitute clear violations of the European Convention on Human Rights (ECHR) is left confused. This article adds clarity to this state of bewilderment by breaking down several aspects of the ECHR rights to a fair trial into clear-cut ‘red lines’, or minimum thresholds of protection. Overstepping those could result in a violation of the right concerned. Identifying these red lines is intended to assist legislators and policymakers in drafting laws and policies that conform with the obligations of their states under the ECHR, and to instruct policymakers outside the member states of the Council of Europe. Because of its unique characteristics, as well as the volume and breadth of its case law, the jurisprudence of the ECtHR can be a lodestone for the consolidation of an international human rights community based on shared values. The unique contribution of this article is the assessment of ECtHR jurisprudence not only on its own merits, but also in comparison with the jurisprudence of other international courts.
Disaster responders are frequently emergency physicians (EPs). Effective response is enhanced by the strong support of home institutions and clear policies for backfill of regular duties. A group of disaster medicine responders and researchers worked with an academic department of emergency medicine to create a policy that addresses concerns of deploying physicians, colleagues remaining at the home institution, and administrators. This article describes the process and content of this policy development work.
KahnCA, KoenigKL, SchultzCH. Emergency Physician Disaster Deployment: Issues to Consider and a Model Policy. Prehosp Disaster Med. 2017;32(4):462–464.