Generating Political Priority to Tackle Health Disparities: A Case Study in the Dutch City of The Hague

Schmidt, Mélodi; Joosen, Isabel; Kunst, Anton E.; Klazinga, Niek; Stronks, Karien

doi:10.2105/ajph.2009.168526

Cited by 16 publications

(12 citation statements)

References 11 publications

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“…Similarly SDHI policy entrepreneurs in the Dutch City of The Hague were described as “credible communicators” because of their “expertise, trustworthiness, and good will” (p. 214). 52 …”

Section: Resultsmentioning

confidence: 99%

What Enables and Constrains the Inclusion of the Social Determinants of Health Inequities in Government Policy Agendas? A Narrative Review

Baker

Friel

Kay

et al. 2017

Int J Health Policy Manag

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Background: Despite decades of evidence gathering and calls for action, few countries have systematically attenuated health inequities (HI) through action on the social determinants of health (SDH). This is at least partly because doing so presents a significant political and policy challenge. This paper explores this challenge through a review of the empirical literature, asking: what factors have enabled and constrained the inclusion of the social determinants of health inequities (SDHI) in government policy agendas? Methods: A narrative review method was adopted involving three steps: first, drawing upon political science theories on agenda-setting, an integrated theoretical framework was developed to guide the review; second, a systematic search of scholarly databases for relevant literature; and third, qualitative analysis of the data and thematic synthesis of the results. Studies were included if they were empirical, met specified quality criteria, and identified factors that enabled or constrained the inclusion of the SDHI in government policy agendas. Results: A total of 48 studies were included in the final synthesis, with studies spanning a number of country-contexts and jurisdictional settings, and employing a diversity of theoretical frameworks. Influential factors included the ways in which the SDHI were framed in public, media and political discourse; emerging data and evidence describing health inequalities; limited supporting evidence and misalignment of proposed solutions with existing policy and institutional arrangements; institutionalised norms and ideologies (ie, belief systems) that are antithetical to a SDH approach including neoliberalism, the medicalisation of health and racism; civil society mobilization; leadership; and changes in government. Conclusion: A complex set of interrelated, context-dependent and dynamic factors influence the inclusion or neglect of the SDHI in government policy agendas. It is better to think about these factors as increasing (or decreasing) the ‘probability’ of health equity reaching a government agenda, rather than in terms of ‘necessity’ or ‘sufficiency.’ Understanding these factors may help advocates develop strategies for generating political priority for attenuating HI in the future.

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Section: Resultsmentioning

confidence: 99%

What Enables and Constrains the Inclusion of the Social Determinants of Health Inequities in Government Policy Agendas? A Narrative Review

Baker

Friel

Kay

et al. 2017

Int J Health Policy Manag

View full text Add to dashboard Cite

show abstract

“…This leads to policy decisions to address that problem followed by the development of programmes backed with political support and resources. This model has been used previously by researchers in assessing political priorities and analysing agenda-setting in different contexts [ 12 , 18 - 21 ].…”

Section: Methodsmentioning

confidence: 99%

The emergence of maternal health as a political priority in Madhya Pradesh, India: a qualitative study

Jat

Deo

Goicolea

et al. 2013

BMC Pregnancy Childbirth

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BackgroundPolitics plays a critical role in agenda setting in health affairs; therefore, understanding the priorities of the political agenda in health is very important. The political priority for safe motherhood has been investigated at the national level in different countries. The objective of this study was to explore why and how maternal health became a political priority at sub-national level in the state of Madhya Pradesh in India.MethodsThis study followed a qualitative design. Data were collected by carrying out interviews and review of documents. Semi-structured interviews were carried out with twenty respondents from four stakeholder groups: government officials, development partners, civil society and academics. Data analysis was performed using thematic analysis. The analysis was guided by Kingdon’s multiple streams model.ResultsThe emergence of maternal health as a political priority in Madhya Pradesh was the result of convergence in the developments in different streams: the development of problem definition, policy generation and political change. The factors which influenced this process were: emerging evidence of the high magnitude of maternal mortality, civil society’s positioning of maternal mortality as a human rights violation, increasing media coverage, supportive policy environment and launch of the National Rural Health Mission (NRHM), the availability of effective policy solutions, India’s aspiration of global leadership, international influence, maternal mortality becoming a hot debate topic and political transition at the national and state levels. Most of these factors first became important at national level which then cascaded to the state level. Currently, there is a supportive policy environment in the state for maternal health backed by greater political will and increased resources. However, malnutrition and population stabilization are the competing priorities which may push maternal health off the agenda.ConclusionsThe influence of the events and factors evolving from international and national levels significantly contributed to the development of maternal health as a priority in Madhya Pradesh. This led to several opportunities in terms of policies, guidelines and programmes for improving maternal health. These efforts were successful to some extent in improving maternal health in the state but several implementation challenges still require special attention.

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“…These social and political leaders (henceforth, local actors) play key roles in the social and economic patterning of health through the selection of policy alternatives, allocation of public resources, and other decisions that shape living conditions, including access to protective resources and exposure to risks. [7][8][9] Globally, there is increased attention to understanding the health implications of social and economic policies at municipal, state, and national levels. 10 However, in Colombia, as in other middle-and lowincome countries, there is a paucity of research on how local actors who shape these policies view the contribution of living conditions to health in their jurisdiction.…”

Section: Introductionmentioning

confidence: 99%

Local Actors’ Frames of the Role of Living Conditions in Shaping Hypertension Risk and Disparities in a Colombian Municipality

2016

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Conditions in the social and physical environment influence population health and risk for CVD, including hypertension. These environmental conditions are influenced by the decisions of public officials, community leaders, and service providers. Examining the frames that local decision makers bring to understanding hypertension can provide important insights into the decisions that they make about strategies for addressing this problem in their jurisdiction. The goal of this study was to examine the frames that local decision makers in Quibdó, Colombia, bring to understanding hypertension risk, and in particular, whether and how they use frames that encompass associations between living conditions and hypertension risk. Data for this qualitative study were collected using a stratified sampling strategy. Semi-structured interviews were conducted in 2012 with 13 local decision makers and analyzed using a framework approach. Participants linked the structural conditions experienced in Quibdó, including displacement, limited economic opportunities, and the infrastructure of the city, to hypertension risk through multiple pathways, including behavioral risk factors for hypertension and physiologic responses to stress. They described the social patterning of these factors across socioeconomic, racial/ethnic, and gender hierarchies. Although several conditions associated with hypertension risk are widely distributed in the city's population, social processes of marginalization and stratification create additional disadvantages for those on the lower rungs of the social hierarchy.

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Generating Political Priority to Tackle Health Disparities: A Case Study in the Dutch City of The Hague

Abstract: The project in The Hague shows that political priority for tackling health disparities can be generated at a local level. Key factors included framing the issue in the light of shared values and framing the problem and the solution as in line with existing policy principles.

Cited by 16 publications

References 11 publications

What Enables and Constrains the Inclusion of the Social Determinants of Health Inequities in Government Policy Agendas? A Narrative Review

What Enables and Constrains the Inclusion of the Social Determinants of Health Inequities in Government Policy Agendas? A Narrative Review

The emergence of maternal health as a political priority in Madhya Pradesh, India: a qualitative study

Local Actors’ Frames of the Role of Living Conditions in Shaping Hypertension Risk and Disparities in a Colombian Municipality

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