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During the last decade, Health Impact Assessment (HIA) has been discussed worldwide as being an important tool for the development of healthy public policy. In Sweden, the Swedish Federation of County Councils and the Swedish Association of Local Authorities have taken the initiative to and are responsible for the development of an HIA tool concerning proposed policy decisions at local and regional levels. The HIA tool was developed as three different templates to be adapted to local conditions and needs: the Health Question, the Health Matrix and the Health Impact Analysis. In this paper we present a feasibility study of the experiences of implementing this HIA tool at regional level in a Health Care District (SWHCD) of Stockholm County Council, based on an inductive approach and on principles of data triangulation. The main findings include the need for continuous revision of the HIA templates during the pilot period. The following factors were instrumental in successfully using the HIA tool in local policy making and management: political consensus, agreement between politicians and public officials on political intentions, a clear- cut decision from management, and offering an opportunity for training. Respondents felt that all public officials should use the HIA as part of their normal work routines. In conclusion, the HIA tool has to be locally adapted and the implementation process has to include close collaboration between politicians and public officials and be followed by continuing education, providing possibilities for a dialogue around the HIA tool, in order to ensure the quality of the instrument. Implications of the study are that the process of developing the tool has worked well but that the possible impacts of its use in this case remain an open question. However, this was not the focus of our study.  相似文献
Recent sociological analyses of contemporary emergency planning foreground a potential break between preparedness plans animated by the spectre of an imaginary future catastrophe and classical public health efforts that are anchored in close knowledge of populations and efforts to prevent the transmission of disease. Whilst scholarly analysis to date suggests that the distinct rationales of public health governance underpinning these different approaches are likely to be entwined and to work in productive tension with each other, less attention has been paid to how this tension plays out in practice. Using 27 semi-structured interviews with public health experts involved in the development or implementation of Australia’s pandemic influenza plan, this paper examines how preparedness efforts established in anticipation of a catastrophic threat were reconfigured during the Australian 2009 (H1N1) pandemic influenza. Specifically, one Australian state broke with the national plan and rapidly inserted an entirely new pandemic phase – which became known as ‘Protect’ – into their response, thereby providing a critical reorientation in the ‘fog of pandemic’. Our analysis indicates that classical population health efforts interrupted not only the vision of catastrophe embedded within the plans, but the actual plans and their implementation, forcing the public health response in a new direction.  相似文献
WHO reform has become a perennial subject of debate that has seen familiar issues raised time and again by incumbent director-generals and member states. This paper begins by reflecting on the distinct nature of WHO reform debates since the 1990s and the global factors behind the pressures to change. It then argues for a shift in focus, from fixing a single UN organization, to the collective health needs of a rapidly globalizing world. The achievement of effective global health governance will require more fundamental changes, beginning with recognition of the shared responsibility for reform. The challenge in the twenty first century will require an even greater willingness to delegate authority and resources to a supranational entity. The compromise may be that the mandate and powers of a global health organization may need to be more carefully circumscribed, but more meaningful in terms of effectively delivering the essential functions needed to protect and promote health in a globalized world.  相似文献
This article takes a historical perspective on the changing position of WHO in the global health architecture over the past two decades.  相似文献


The premise that good governance will ultimately lead to better health outcomes has been central to the proliferation of work in this area over the past decade.


To consolidate and align literature on governance by presenting an overview of efforts to define, describe and operationalize the health governance function.


A targeted review of governance literature.


(1) A variety of terms have been assigned to precede health governance definitions. These terms commonly describe governance ideals (e.g. good, democratic) or characteristics of the organization of actors in governance arrangements (e.g. hierarchical, networked). (2) Dimensions of governance are defined from different perspectives and in varied combinations, capturing values, sub-functions and/or outcomes of governance. (3) Tools used to govern remain to be cataloged, however, measures can be aligned according to dimensions of governance or their ability to create specific relationships between actors.


Resolving the conceptual confusion around health governance requires recognition for the differences in the premise and approaches taken to defining governance, as well as specifying core dimensions and aligning applicable tools.


Despite a growing literature base, a concerted effort is needed for a more accessible understanding of health governance that is both practical at present and actionable for policy-makers.  相似文献
In this article, we identify pathways that link the global financial crisis to health equity. We distinguish between direct and indirect channels of influence, and develop a conceptual model that builds on the literature analyzing the impacts of globalization on social determinants of health. The most pertinent direct pathways discussed are economic contraction, health budget cutbacks, rise in unemployment, and qualitative transformations of health systems. We also outline how other indirect channels of influence are likely to affect health equity, including cutbacks to welfare programs, labor market transformations, the emergence of an ideological climate conducive to austerity politics, and reductions in official development assistance. We conclude by suggesting that the current intensification of neoliberal policy implementation is likely to undermine health equity, and that a different path toward economic recovery is required to ensure equitable access to health care.  相似文献
目的探讨中国卫生检疫在全球卫生治理背景下的发展策略。方法分析传染病在中国和全球间的互动和影响,以及全球卫生治理的必要性,从全球视野和体系建设、健康促进、卫生公平等方面探讨卫生检疫的未来发展趋势。结果中国加入全球化进程导致传染病风险具有全球化特征,全球卫生治理是适应全球传染病控制的有效进路。中国卫生检疫在跨国传染病防控中起到了重要作用。结论中国卫生检疫应从全球理念出发进行战略和机制调整,加大多部门、多组织参与的平台建设,促进全球监测和控制体系建设步伐,同时充分利用健康促进和公平促进更好的发挥传染病防控职能,以在未来的全球卫生中更好的发挥自己的作用。  相似文献
While nongovernmental organizations (NGOs) can potentially strengthen valuable citizen political engagement, NGOs that are increasingly oriented towards donor and government contracts may instead contribute to depoliticizing development. Amidst competing pressures, NGO experiences and agency in managing multiple roles require examination. We present a qualitative case study of an NGO implementing a government‐designed intervention to strengthen Village Health, Sanitation, and Nutrition Committees (VHSNCs) in rural north India. Despite a challenging context of community scepticism and poor government services, the NGO did successfully form VHSNCs by harnessing its respected interlocutor status, preexisting relationships, and ability to “sell” the VHSNC as a mechanism for improving local well‐being. While the VHSNC enabled community members to voice concerns to government officials, improvements often failed to meet community expectations. NGO staff endured community frustration on one hand and rebuffs from lower‐level officials on the other, while feeling undersupported by the government contract. Consequently, although contracted to strengthen a community institution, the NGO increasingly worked alongside VHSNC members to try to strengthen the public sector. Contrary to assumptions that NGOs become “tamed” through taking government contracts, being contracted to deliver inputs for community participation was intertwined with microlevel political action, though this came at a cost to the NGO.  相似文献
The public health and development communities understand clearly the need to integrate anti-poverty efforts with HIV/AIDS programs. This article reports findings about the impact of the Poverty Reduction Strategy Paper (PRSP) process on Malawi’s National HIV/AIDS Strategic Framework (NSF). In this article we ask, how does the PRSP process support NSF accountability, participation, access to information, funding, resource planning and allocation, monitoring, and evaluation?  相似文献
There is an emerging research agenda to analyse empirically the forces driving changes in global health governance. This study applies analytical tools from international relations research to explain the formation of international health regimes. The study utilizes two explanatory perspectives: individual leadership, and the interests of key non-state actors in the formation process, using the case of the formation of the Global Alliance for Vaccines and Immunization (GAVI) from 1995 to 1999. The case study is based on material from interviews with key actors, an archival review of documents from the Children’s Vaccine Initiative (CVI), and published literature. Findings show that the regime formation process was initiated by individuals who were primarily affiliated to scientific communities and who led to the World Bank and the Gates Foundation becoming champions of a new coordinating mechanism for new vaccine introduction. Negotiations in the regime formation process were between a small group of founding agencies with divergent interests regarding immunization priorities. The case also sheds light on the authority of the WHO and the resources of the Gates Foundation in driving the process towards the final structure of the alliance. The paper discusses the potential contribution of the international relations approach compared to policy research as a way of understanding the institutional dynamics of global health, particularly in respect of relations between countries and non-state actors.  相似文献
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