International Council of Nurses: putting nurses at the centre of the world’s policymaking has benefits for us all

This year’s International Council of Nurses Congress in Singapore was an opportunity for nurses from around the world to discuss and shape policy and practice around the world. The World Health Organization recognises ICN’s unique ability to influence its policies, represent nursing and help with the challenges that lie ahead, including a potential shortfall of nine million nurses by 2030. All nurses can get involved in efforts to raise the profile of the profession and attract a new generation who will continue to maintain the high standards expected of registered nurses for decades to come.     

影响药物政策制定的因素分析

目的:探讨药物政策制定过程中的各种影响因素。方法:采用系统的思维对可能影响药物政策制定的各种因素进行举例分析。结果与结论:列举了影响药物政策制定的8种因素,分别是政治经济环境、法律环境、社会舆论、突发事件、国际经验、历史经验、领导意志和利益群体等,在政策制定过程中要充分重视这些影响因素。     

Technology assessment in healthcare: A means for pursuing the goals of biomedical engineering

The goals of biomedical engineering include the improvement of health and life quality of mankind. However, the contribution of biomedical engineering to those worthy ends must be more clearly related. Biomedical engineers should become more active in demonstrating to policymakers and other parties in healthcare the value of the contributions of healthcare technology. Technology assessment (TA) is a form of investigation designed to identify and evaluate the implications of technologies so as to inform policymaking. Among the important trends in TA that should be of special interest to biomedical engineers are the increasingly higher methodological standards for accepting evidence from clinical investigations, and the use of quality-of-life measures for determining how technologies affect people's lives.     

Public health in the genomic era: will Public Health Genomics contribute to major changes in the prevention of common diseases?

The completion of the Human Genome Project triggered a whole new field of genomic research which is likely to lead to new opportunities for the promotion of population health. As a result, the distinction between genetic and environmental diseases has faded. Presently, genomics and knowledge deriving from systems biology, epigenomics, integrative genomics or genome-environmental interactions give a better insight on the pathophysiology of common diseases. However, it is barely used in the prevention and management of diseases. Together with the boost in the amount of genetic association studies, this demands for appropriate public health actions. The field of Public Health Genomics analyses how genome-based knowledge and technologies can responsibly and effectively be integrated into health services and public policy for the benefit of population health. Environmental exposures interact with the genome to produce health information which may help explain inter-individual differences in health, or disease risk. However today, prospects for concrete applications remain distant. In addition, this information has not been translated into health practice yet. Therefore, evidence-based recommendations are few. The lack of population-based research hampers the evaluation of the impact of genomic applications. Public Health Genomics also evaluates the benefits and risks on a larger scale, including normative, legal, economic and social issues. These new developments are likely to affect all domains of public health and require rethinking the role of genomics in every condition of public health interest. This article aims at providing an introduction to the field of and the ideas behind Public Health Genomics.     

Research evidence supports cancer policymaking but is insufficient for change: Findings of key informant interviews from five countries

Evidence-based policymaking values the use of research in the process of developing, implementing and evaluating policy. However, there is limited research attempting to understand how cancer policymaking occurs and the role of evidence in this process. Our study aimed to provide a deeper understanding of levers and challenges to the development and implementation of large-scale, health service policies or programs in cancer care. Within a realist framework, we conducted a thematic analysis of interviews with 13 key informants from five countries: Australia, Canada, Scotland, Denmark and New Zealand. Results identified a complex array of program mechanisms and contextual factors influencing cancer health-service policymaking. Research evidence was important and could form a rationale for change, such as by identifying unwarranted variation in cancer outcomes across or within countries. However, other factors were equally important in driving policy change, including advocacy, leadership, stakeholder collaboration, program adaptability, clinician and consumer involvement, and the influential role of context. These findings resonate with political science theories and health service reform literature, while offering novel insight into specific factors that influence policymaking in cancer care, namely clinical engagement, consumer input and policy context. Although research evidence supports policymaking, the complex ways in which cancer policies are developed and implemented requires recognition and should be considered when designing new programs and promoting the use of evidence in policymaking.     

社会控制理论视角下的药品监管决策研究

目的：为了解决药品监管决策的制定、执行和反馈过程中诸多的困惑与难题,探讨如何在矛盾中寻求科学的监管决策。方法：运用社会控制理论分析药品监管决策过程,结合我国药监决策的实际情况,从影响因素角度展开探讨。结果与结论：为了保证药品监管决策系统稳定、动态地运行,药监部门应当改变监管理念,充实决策主体;建立信息的评价和反馈制度,选择恰当的监管手段,合理投放监管力量,做出科学决策。     

Ontario’s COVID-19 Modelling Consensus Table: mobilizing scientific expertise to support pandemic response

SettingCOVID-19 has highlighted the need for credible epidemiological models to inform pandemic policy. Traditional mechanisms of commissioning research are ill-suited to guide policy during a rapidly evolving pandemic. At the same time, contracting with a single centre of expertise has been criticized for failing to reflect challenges inherent in specific modelling approaches.InterventionThis report describes an alternative approach to mobilizing scientific expertise. Ontario’s COVID-19 Modelling Consensus Table (MCT) was created in March 2020 to enable rapid communication of credible estimates of the impact of COVID-19 and to accelerate learning on how the disease is spreading and what could slow its transmission. The MCT is a partnership between the province and academic modellers and consists of multiple groups of experts, health system leaders, and senior decision-makers. Armed with Ministry of Health data, the MCT meets once per week to share results from modelling exercises, generate consensus judgements of the likely future impact of COVID-19, and discuss decision-makers’ priorities.OutcomesThe MCT has enabled swift access to data for participants, a structure for developing consensus estimates and communicating these to decision-makers, credible models to inform health system planning, and increased transparency in public reporting of COVID-19 data. It has also facilitated the rapid publication of research findings and its incorporation into government policy.ImplicationsThe MCT approach is one way to quickly draw on scientific advice outside of government and public health agencies. Beyond speed, this approach allows for nimbleness as experts from different organizations can be added as needed. It also shows how universities and research institutes have a role to play in crisis situations, and how this expertise can be marshalled to inform policy while respecting academic freedom and confidentiality.     

The contribution of nurses to health policy and advocacy requires leaders to provide training and mentorship

At this crucial stage in nursing’s development, key organizations around the world are voicing the need for nurses to become more involved in leadership, advocacy and policymaking. The importance of leadership and health policy training cannot be overemphasized. However, the widespread education and training of nurses about policy is yet to be realized. Moving nurses from being the recipients and implementers of health policy decisions to being leaders with a strong voice in the development or reform of policy will take concerted, strategic effort into the future. We argue that for nurses around the world to take their place at decision‐making tables and to be rightfully engaged in policy, health reform and advocacy, nurse leaders need to provide them with access to well‐thought‐out policy training programmes. This access needs to be wide‐ranging, from exposure to policy knowledge in undergraduate education to more specialized graduate programs focused in every specialization on some aspects of policy, through to a variety of continuing educational opportunities.     

The barriers to govern long-term care innovations:: The paradoxical role of subsidies in a transition program

This study deals with the governance of a transition program (2007–2011) that tried to radically change a fragmented, supply-driven long-term care system into an integrated, demand-driven system to deal with an aging population. The transition program was subsidized by the healthcare ministry and enabled 26 projects throughout the Netherlands. The idea was to first experiment with innovative long-term care practices outside the system and then to scale-up these innovations to change the system. However, previous research does not highlight examples of long-term care innovations that scaled-up. Hence, the goal is to explore the barriers to govern the scaling-up of the long-term care innovations. The barriers were identified by participating in the program and interviewing ministry, program and project actors. The core barrier was the lack of commitment to the empowerment. It resulted from the subsidy focus of the projects and the lack of protection of the innovations, and from conflicts of interests and power struggles on the ministry-level. A transition program requires more than providing a subsidy. Policymakers have to learn from innovations outside the system in order to change it. Simultaneously, projects should not be entirely subsidized, otherwise there are no incentives to scale-up the innovations.