Assessing School Wellness Policies and Identifying Priorities for Action: Results of a Bi‐State Evaluation

BACKGROUND

Obesity is a complex health problem affecting more than one‐third of school‐aged youth. The increasing obesity rates in Kansas and Missouri has been particularly concerning, with efforts being made to improve student health through the implementation of school wellness policies (SWPs). The primary purpose of this study was to conduct a rigorous assessment of SWPs in the bi‐state region.

METHODS

SWPs were collected from 46 school districts. The Wellness School Assessment Tool (WellSAT) was used to assess comprehensiveness and strength. Additionally, focus group discussions and an online survey were conducted with school personnel to identify barriers and supports needed.

RESULTS

Assessment of the SWPs indicated that most school districts failed to provide strong and specific language. Due to these deficiencies, districts reported lack of enforcement of policies. Several barriers to implementing the policies were reported by school personnel; supports needed for effective implementation were identified.

CONCLUSIONS

To promote a healthful school environment, significant improvements are warranted in the strength and comprehensiveness of the SWPs. The focus group discussions provided insight as to where we need to bridge the gap between the current state of policies and the desired beneficial practices to support a healthy school environment.

     

How actors,processes, context and evidence influenced the development of Malawi's Health Sector Strategic Plan II

Health sector strategic plans are health policies outlining health service delivery in low- and middle- income countries, guiding health sectors to meet health needs while maximizing resources. However, little research has explored the formulation of these plans. This study utilized qualitative methods to explore the formulation of Malawi's Health Sector Strategic Plan II, including processes utilized, actors involved, important contextual factors and the use of evidence-based decision-making. Thirteen semi-structured key informant interviews with health policy actors were conducted to explore perceptions and experiences of formulating the policy. Data analysis used an inductive-deductive approach and interpretation of the data was guided by an adapted version of the Walt and Gilson Health Policy Triangle. Our results indicate that HSSP II formulation was complex and inclusive but that the Ministry of Health may have given up ownership of the formulation process to development partners to ensure their continued involvement. Disagreements between actors centered around inclusion of critical services in the Essential Health Package and selection of performance-based financing as purchasing strategy. Resource constraints and the Cashgate Scandal are critical contextual elements influencing the formulation and content of the policy. Evidence-based decision-making contributed to the plan's development despite respondents' divergent opinions regarding evidence availability, quality and the weight that evidence carried. The study raises questions regarding the roles of policy actors during health policy formulation, the inclusivity of health policy processes and their potential influence on government ownership of health policy, as well as the use of evidence in developing health sector strategic plans.     

Partnerships and joined-up working: the millennium key?

Fresh challenges for occupational health in the new millennium include the European dimension and a series of frame shifts about what our specialty actually comprises. This paper encourages a proactive commitment to engaging with Europe and European law-making. A similar proactive approach involving professional, employer and workforce participation is urged for the development of occupational health. The need for prioritization and economic justification is required for underpinning this approach.     

The future of public health nutrition: a critical policy analysis of Eat Well Australia

Objective: To better understand how public health nutrition has been represented during the past decade in Australia this paper critically analyses Eat Well Australia: An Agenda for Action for Public Health Nutrition 2000 – 2010 and its accompanying National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan. Method: The paper uses an interpretive approach, drawing on Bacchi's method of problem representation, to examine the strategies being offered within the policy. It uses this framework to uncover how public health nutrition has been represented and examines if the representation provided considers all aspects of the issue. The paper also considers how contextual factors affected policy development through examination of publicly available documents. Results: The problem is represented as being both an individual one and one due to social, structural and economic circumstances. There is a large focus on collaboration, research and capacity building. The context of the policy's development has affected the solutions contained within. Conclusion: The policy's proposed actions reflect the policy‐making environment in which it was conceived. A manifestation of this was unclear division of roles and responsibilities, lack of dedicated resources and inadequate focus on the social determinants of health. Implications: As the policy's timeframe is drawing to its end, critical reflection on how the problem of nutrition has been represented over the previous decade provides greater insight and awareness to direct future public health nutrition work.     

Association between Increased Emergency Contraception Availability and Risky Sexual Practices

ObjectiveWe studied whether increased emergency contraception availability for women over age 18 was associated with a higher probability of risky sexual practices.DataA total of 34,030 individual/year observations on 3,786 women aged 18 and older were extracted from the National Longitudinal Survey of Youth, 1997 from October 1999 through November 2009.FindingsWe found different results when estimating the state and federal changes separately. The national change was associated with a reduction in the probability of sexual activity, a reduction in the likelihood of reporting multiple partnerships, and there was no relationship between the national policy change and unprotected sexual activity. There was no relationship between the probability of sexual activity or multiple partnerships for women in states with their own policy changes, but we did find that women in these states were more likely to report unprotected sex.     

什么是"好"的卫生政策

医药卫生体制改革已进入攻坚和关键阶段,宏观、前瞻、科学的卫生政策指导与深厚社会关怀、社会健康理论支持已成为继续深化卫生体制改革发展战略措施和战略议题。如何科学民主决策,如何创造性地制定优秀的卫生政策框架,是卫生改革发展成功的前提。     

A retrospective public health analysis of the Republic of Ireland's Food Harvest 2020 strategy: absence,avoidance and business as usual

The concept of an Ecological Approach to health and including Health in All Policies warrants inter-sectoral and transdisciplinary collaboration to improve health determinants and reduce health inequities. Agriculture policies, which greatly influence food production and its environmental impacts as well as food availability and dietary consumption, are therefore of interest to public health. Increasing rates of non-communicable diseases linked to diets containing high levels of processed foods, increasing numbers of households unable to access nutritious food and the environmental consequences of the food system are amongst the major health challenges of today, both globally and in Ireland. In 2010, Ireland’s Department of Agriculture, Food and Fisheries published Food Harvest 2020 a roadmap for Irish agriculture for the subsequent decade prepared against a backdrop of rising diet-related ill-health and increasing environmental concerns. This article critically analyses the process of consultation and stakeholder involvement in the development of Food Harvest 2020 from a public health perspective. Publically available documents including submissions to the Food Harvest 2020 consultation process were the primary source of data. This study highlights a distinct absence of public health representation in the process, an avoidance of some key public health challenges and the dominance of a ‘business as usual’ approach.     

Developing programmes to achieve a healthy society: creating healthy workplaces in Northern Ireland

Healthy workplaces help to prevent occupational disease and injury as well as promoting positive healthy lifestyle behaviours. The concept of creating healthy workplaces through workplace health promotion has been identified as a legitimate area of activity for public health policy in Northern Ireland, supporting as it does, the settings approach as a means of improving the health and well-being of the population at large. Benefits accrue to businesses, organizations and individuals from the enhancement of positive healthy lifestyle messages in addition to reinforcing the principles of good occupational health practices. Developing a framework for the creation of healthy workplaces is part of a joint initiative between the Northern Ireland Health Promotion and Health and Safety Agencies. Commitment to delivering the concept is required from all the key players who include: employers, employees, trade union groups and health and safety professionals. A healthy workplace model needs to be created which is flexible and adaptable to suit all types of business and in particular the needs of small businesses which predominate in Northern Ireland. The principles underpinning the Business Excellence Model may be a useful vehicle for delivering workplace health promotion onto an organization's agenda.     

农村县乡卫生机构的功能定位及调整政策研究

农村卫生问题是我国卫生工作的重点,长期以来作为农村卫生工作基本载体的县、乡、村三级卫生保健网在保障农村居民健康、促进农村经济发展等方面发挥了巨大作用。但随着农村经济体制的变革、农民生活水平的提高以及小城镇建设的发展,农村三级卫生机构在布局和功能上都出现了一些新的亟待解决的问题。因此对农村县乡两级卫生机构进行调整与改革,明确职责,减少交叉与重叠,加强服务功能,是促进县乡两级卫生机构运行机制步入良性循不的关键所在。报告分为两部分,第一部分为县级卫生机构功能定位及调整政策研究,第二部分为乡镇卫生院功能定位及调整政策研究。     

The Relationship Between School Policies and Youth Tobacco Use*

BACKGROUND: The school setting is frequently used both to educate youth about risks involved in tobacco use and to implement tobacco prevention and cessation programs. Given that school‐based programs have resulted in limited success, it is necessary to identify other setting‐level intervention strategies. School tobacco policies represent a type of universal intervention that might have some promise for preventing or reducing tobacco use. METHODS: Hierarchical linear modeling was used to assess whether school tobacco policies were related to observations of tobacco use and current smoking among 16,561 seventh through twelfth graders attending 40 middle and high schools in Illinois. RESULTS: Results indicated that the enforcement of school tobacco policies, but not the comprehensiveness of those policies, was associated with fewer observations of tobacco use by minors on school grounds as well as lower rates of current smoking among students. CONCLUSIONS: The school setting is a key system to impact youth tobacco use. Findings underscore the need to train school personnel to enforce school tobacco policy.