Tackling the politics of intersectoral action for the health of people and planet

Buse, Kent; Tomson, Göran; Kuruvilla, Shyama; Mahmood, Jemilah; Alden, Anastasia; Meulen, Maarinke van der; Ottersen, Ole Petter; Haines, Andy

doi:10.1136/bmj-2021-068124

Cited by 13 publications

(7 citation statements)

References 28 publications

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“…Three influences are key to understanding policy decisions: ideologies, beliefs that underlie political positions and actions; interests, motivations for stakeholders to pursue advantages and institutions, the structures guiding policy processes ( Buse et al. , 2022 ).…”

Section: Discussionmentioning

confidence: 99%

“…Constraints to the uptake of economic evaluation evidence within a single sector are exacerbated when the most cost-effective intervention requires cross-sectoral collaboration to implement. In many contexts, there is a lack of political interest in establishing cross-sectoral goals, let alone collaboration to realize these goals ( Buse et al. , 2022 ).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Whole of government approaches to accelerate adolescent success: efficiency and financing considerations

Desmond,

Watt,

Rudgard

et al. 2023

Health Policy and Planning

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The multiple domains of development covered by the Sustainable Development Goals (SDGs) present a practical challenge for governments. This is particularly acute in highly resource-constrained settings which use a sector-by-sector approach to structure financing and prioritization. One potentially under-prioritized solution is to implement interventions with the potential to simultaneously improve multiple outcomes across sectors, what United Nations Development Programme refer to as development ‘accelerators’. An increasing number of accelerators are being identified in the literature. There are, however, challenges associated with the evaluation and implementation of accelerators. First, as accelerators have multiple benefits, possibly in different sectors, they will be undervalued if the priority setting is conducted sector-by-sector. Second, even if their value is recognized, accelerators may not be adopted if doing so clashes with any of the multiple competing interests policymakers consider, of which efficiency/social desirability is but one. To illustrate the first challenge, and outline a possible solution, we conduct a cost-effectiveness analysis comparing the implementation of three sector-specific interventions to an accelerator, first using a sector-by-sector planning perspective, then a whole of government approach. The case study demonstrates how evaluating the cost-effectiveness of interventions sector-by-sector can lead to suboptimal efficiency rankings and overlook interventions that are efficient from a whole of government perspective. We then examine why recommendations based on a whole of government approach to evaluation are unlikely to be heeded. To overcome this second challenge, we outline a menu of existing and novel financing mechanisms that aim to address the mismatch between political incentives and logistical constraints in the priority setting and the economic evaluation evidence for cost-effective accelerators. These approaches to financing accelerators have the potential to improve efficiency, and in doing so, progress towards the SDGs, by aligning political incentives more closely with recommendations based on efficiency rankings.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Whole of government approaches to accelerate adolescent success: efficiency and financing considerations

Desmond,

Watt,

Rudgard

et al. 2023

Health Policy and Planning

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“…In principle, there is broad support among policy makers, academics, and society for taking into account the environmental and sustainability implications of healthcare interventions and technologies in the development of HTAs and guidelines (48)(49)(50). In practice, there are many questions yet to be answered before this can be implemented widely.…”

Section: Discussionmentioning

confidence: 99%

Incorporating environmental and sustainability considerations into health technology assessment and clinical and public health guidelines: a scoping review

Pinho-Gomes

Yoo

Allen

et al. 2022

Int J Technol Assess Health Care

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Healthcare systems account for a substantial proportion of global carbon emissions and contribute to wider environmental degradation. This scoping review aimed to summarize the evidence currently available on incorporation of environmental and sustainability considerations into health technology assessments (HTAs) and guidelines to support the National In stitute for Health and Care Excellence and analogous bodies in other jurisdictions developing theirown methods and processes. Overall, 7,653 articles were identified, of which 24 were included in this review and split into three key areas – HTA (10 studies), healthcare guidelines (4 studies), and food and dietary guidelines (10 studies). Methodological reviews discussed the pros and cons of different approaches to integrate environmental considerations into HTAs, including adjustments to conventional cost-utility analysis (CUA), cost–benefit analysis, and multicriteria decision analysis. The case studies illustrated the challenges of putting this into practice, such as lack of disaggregated data to evaluate the impact of single technologies and difficulty in conducting thorough life cycle assessments that consider the full environmental effects. Evidence was scant on the incorporation of environmental impacts in clinical practice and public health guidelines. Food and dietary guidelines used adapted CUA based on life cycle assessments, simulation modeling, and qualitative judgments made by expert panels. There is uncertainty on how HTA and guideline committees will handle trade-offs between health and environment, especially when balancing environmental harms that fall largely on society with health benefits for individuals. Further research is warranted to enable integration of environmental considerations into HTA and clinical and public health guidelines.

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“…Global health issues are on the top of international political summits and integrated into the majority of the United Nations (UN) Sustainable Development Goals (SDGs) adopted by 193 member states in 2015 [ 5 ]. Still the world lacks trusted, transparent and effective global bodies for global health diplomacy [ 6 , 7 , 8 ]. It is urgent to strengthen the UN health diplomacy since no progress was registered up to Summer 2023 in achieving the agreed 17 SDG targets for the 17 SDGs [ 5 , 9 , 10 ].…”

Section: Historical Notes On Global Healthmentioning

confidence: 99%

Strengthening Global Health Research

Gustafsson

2023

Global Health Action

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Global Health is a young discipline with equity of health and services as its core value. The discipline has a tradition of close links between practice and research in line with the ‘Health for All’ declaration launched by the World Health Organization (WHO) in 1978. The multitude of existential health crises facing mankind require a research agenda in line with Global Health Research core values and methods, such as transdisciplinary collaboration, long time series of population-based observations and multifaceted interventions. Knowledge gaps cover climate effects on health and mechanisms for global spread and control of antibiotic resistance across species. Such health threats are preferably studied at Health and Demographic Surveillance Sites, a scientific infrastructure for Global Health Research in Africa and Asia, that gains to expand and monitor climate parameters and include sites in the northern hemisphere. Global Health Scientists together with science societies can ensure long-term funding of a global network of population-based health-climate sites. Global Health Scientists and scientific journals should jointly provide data and evidence on global health to governance bodies on regional, national and global levels, in particular to WHO and United Nations in charge of the programme with Sustainable Development Goals.

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Tackling the politics of intersectoral action for the health of people and planet

Abstract: Kent Buse and colleagues argue that unlocking the potential for intersectoral action on climate and health requires thinking politically about its facilitators and barriers

Cited by 13 publications

References 28 publications

Whole of government approaches to accelerate adolescent success: efficiency and financing considerations

Whole of government approaches to accelerate adolescent success: efficiency and financing considerations

Incorporating environmental and sustainability considerations into health technology assessment and clinical and public health guidelines: a scoping review

Strengthening Global Health Research

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