Illustrating the impact of commercial determinants of health on the global COVID-19 pandemic : thematic analysis of 16 country case studies

Previous research on commercial determinants of health has primarily focused on their impact on non-communicable diseases. However, they also impact on infectious diseases and on the broader preconditions for health. We describe, through case studies in 16 countries, how commercial determinants of health were visible during the COVID-19 pandemic, and how they may have influenced national responses and health outcomes. We use a comparative qualitative case study design in selected low- middle- and high-income countries that performed differently in COVID-19 health outcomes, and for which we had country experts to lead local analysis. We created a data collection framework and developed detailed case studies, including extensive grey and peer-reviewed literature. Themes were identified and explored using iterative rapid literature reviews. We found evidence of the influence of commercial determinants of health in the spread of COVID-19. This occurred through working conditions that exacerbated spread, including precarious, low-paid employment, use of migrant workers, procurement practices that limited the availability of protective goods and services such as personal protective equipment, and commercial actors lobbying against public health measures. Commercial determinants also influenced health outcomes by influencing vaccine availability and the health system response to COVID-19. Our findings contribute to determining the appropriate role of governments in governing for health, wellbeing, and equity, and regulating and addressing negative commercial determinants of health

Which Australian secondary school students are at risk of illicit drug use?

This is the peer reviewed version of the following article: [Freeman, T., White, V., & Roche, A.M. (2011) Which Australian secondary school students are at risk of illicit drug use? : A nationwide survey. Drug and Alcohol Review, 30, 589-596], which has been published in final form at [DOI: 10.1111/j.1465-3362.2010.00246.x]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.Introduction and aims: Over recent years, numerous school-based preventive strategies have been explored as possible options to address illicit drug use by young people. However, there is scope to extend current knowledge of which school students are most at risk of illicit drug-related harm. To investigate potential differential risk, the prevalence and patterns of illicit drug use of Australian secondary school students were examined according to demographic, school, economic, and licit drug use factors. Design and methods: Analyses were conducted on the 2005 Australian Secondary Students’ Alcohol and Drug (ASSAD) survey. A total of 21,805 secondary school students aged 12-17 from 376 schools completed the pencil and paper classroom questionnaire. Results: The greatest risk factors for students using illicit drugs were tobacco and alcohol use. Students with self-rated below average academic achievement, with more than $20 a week of disposable income, and who were Indigenous were more likely to report illicit drug use. Discussion and conclusions: While causal pathways could not be examined in the current data, and these relationships are likely to be complex and multi-directional, the findings indicate potentially at-risk populations who warrant extra support to address illicit drug-related harm

Hazardous alcohol use interventions with emergency patients: Self-reported practices of nurses, and predictors of behaviour

This is the peer reviewed version of the following article: [Freeman, T., Roche, A.M., Williamson, P., & Pidd, K. (2011) Hazardous alcohol use interventions with emergency patients: Self-reported practices of nurses, and predictors of behaviour. Emergency Medicine Australasia, 23, 479-489.], which has been published in final form at [DOI:10.1111/j.1742-6723.2011.01416.x]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.Objectives. This study examined Australian Emergency Department (ED) nurses’ practices in asking patients about alcohol and assisting them to manage their alcohol consumption. It also investigated strategies to support ED nurses in these interventions. Methods. A two stage survey was administered to ED nurses. The first questionnaire measured theoretical and organisational predictors of behaviour, and underlying beliefs, and the subsequent questionnaire explored rates of asking and assisting patients. Results. A total of 125 nurses returned the first questionnaire. Participants held generally positive attitudes, perceived norms, feelings of legitimacy, and perceived ability to ask about and intervene for alcohol, but lower role adequacy. The 71 ED nurses who completed the second questionnaire had intervened with almost 500 patients concerning alcohol in the previous week. Participants asked approximately one in four patients about alcohol (median = 26.3% of patients, 1095/4279 total patients asked). The Theory of Planned Behaviour did not predict rates of asking or assisting patients. Several strategies were identified that may increase rates: identify environmental factors that prevent nurses acting on their intentions to ask and intervene, raise confidence and skills, make asking about alcohol part of routine assessment, make supports such as drug and alcohol units or nurses available, and implement organisational policies on alcohol. Conclusions. Nurses appear positively disposed to engage with patients in regard to alcohol. However, greater support is needed to achieve the considerable significant public health benefits from this engagement. The findings point to several practical strategies that could be pursued to provide this support

What Factors Need to be Addressed to Support Dental Hygienists to Assist Their Patients to Quit Smoking?

This is a pre-copyedited, author-produced PDF of an article accepted for publication in NICOTINE AND TOBACCO following peer review. The version of record [Freeman, T., Roche, A.M., Williamson, P., & Pidd K (2012). What factors need to be addressed to support dental hygienists to assist their patients to quit smoking? Nicotine & Tobacco Research, 14, 1040-1047.] is available online at: http://ntr.oxfordjournals.org/content/early/2012/02/16/ntr.ntr329Dental hygienists are well placed to assist their patients to quit smoking. Smoking affects oral health and dental treatments, and hygienists report greater time with patients than dentists with more focus on prevention. However, there has been little research into the extent to which hygienists assist patients to quit smoking, and strategies to support them in this role. Methods. A two stage survey of Australian dental hygienists was conducted. The first survey measured potential predictors of asking patients about smoking and assisting patients to quit smoking using the Theory of Planned Behaviour as a framework. The second survey measured these behaviours in the past week. Structural equation modelling was used to examine predictors of the two behaviours. Results. A total of 362 hygienists returned the first questionnaire. Intentions to ask and assist patients were high. The 273 hygienists who returned the second questionnaire assisted an estimated total of 1,394 patients to quit smoking in one week. Predictors within the Theory of Planned Behaviour framework explained significant variance in asking (11%) and assisting (29%) behaviours, with self-efficacy the most critical predictor in both cases (β =.27, .32 respectively). Conclusions. Dental hygienists may be a viable and willing avenue for addressing smoking. Hygienists may be best supported in this role through increasing skills and confidence around asking sensitively about smoking, building rapport, and assisting patients to quit smoking. . Incorporation of smoking status into general history taking and adoption of organisational policies on assisting patients to quit smoking could also be encouraged

Australia’s systems of primary healthcare: The need for improved coordination and implications for Medicare Locals

Copyright © 2011 Royal Australian College of General Practitioners. Published version of the paper reproduced here with permission from the publisher.Background In Australia, primary healthcare is largely delivered through two parallel systems: Medicare supported primary care delivered by fee-for-service general practitioners, and state funded and managed community health services. Methods Semistructured interviews with 18 GPs to investigate the current links between GPs and local primary healthcare providers. Results Barriers to links include: communication and information, access and availability of services, GP lack of awareness and understanding of services provided in the state funded sector, and lack of time to gain information. Discussion General practitioners reported dealing with more complex and challenging patients. However, this did not appear to increase their likelihood of engaging with state funded primary healthcare services in case management. Medicare Locals are a once-in-a-generation chance to establish a genuinely coordinated and multidisciplinary primary healthcare sector. To be successful, Medicare Locals will need to bring together two parallel systems of care and improve integration and coordination

Developing a good practice model to evaluate the effectiveness of comprehensive primary health care in local communities

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise statedBackground: This paper describes the development of a model of Comprehensive Primary Health Care (CPHC) applicable to the Australian context. CPHC holds promise as an effective model of health system organization able to improve population health and increase health equity. However, there is little literature that describes and evaluates CPHC as a whole, with most evaluation focusing on specific programs. The lack of a consensus on what constitutes CPHC, and the complex and context-sensitive nature of CPHC are all barriers to evaluation. Methods: The research was undertaken in partnership with six Australian primary health care services: four state government funded and managed services, one sexual health non-government organization, and one Aboriginal community controlled health service. A draft model was crafted combining program logic and theory-based approaches, drawing on relevant literature, 68 interview s with primary health care se rvice staff, and researcher experience. The model was then refined through an iterative process involving two to three workshops at each of the six participating primary health care services, engaging health service staff, regional health executives and central health department staff. Results: The resultant Southgate Model of CPHC in Australia model articulates the theory of change of how and why CPHC service components and activities, based on t he theory, evidence and values which underpin a CPHC approach, are likely to lead to indivi dual and population health outcome s and increased health equity. The model captures the importance of context, the mechanisms of CPHC, and the space for action services have to work within. The process of development engendered and supported collaborati ve relationships between researchers and stakeholders and the product provide d a description of CPHC as a whole and a framework for evaluation. The model was endorsed at a research symposium involving inv estigators, service staff, and key stakeholders. Conclusions: The development of a theory-based program logi c model provided a framework for evaluation that allows the tracking of progress towards desired outcomes and exploration of the particular aspects of context and mechanisms that produce outcomes. This is important because there are no existing models which enable the evaluation of CPHC services in their entirety

Evaluating the effectiveness of comprehensive primary health care in local communities: how do general practitioners work with and perceive primary health care services directly funded by government. Report to SA Health.

The South Australian Community Health Research Unit (SACHRU), Flinders University, was contracted by SA Health in 2009-2010 to conduct the study 'Evaluating the effectiveness of comprehensive primary health care in local communities: how do general practitioners work with and perceive primary health care services directly funded by government'. This research study focuses on the links between primary health care (PHC) services directly funded and managed by government and services provided by general practitioners (GPs). It complements research funded under an NH&MRC project grant that is examining evaluation of comprehensive primary health care (CPHC) by working with five PHC service sites in South Australia and one service in Alice Springs

The potential for multi-disciplinary primary health care services to take action on the social determinants of health: actions and constraints

The Commission on the Social Determinants of Health and the World Health Organization have called for action to address the social determinants of health. This paper considers the extent to which primary health care services in Australia are able to respond to this call. We report on interview data from an empirical study of primary health care centres in Adelaide and Alice Springs, Australia.This study was funded by an NH&MRC Project Grant 535041 and FB’s time is funded by an ARC Federation Fellowship. RL is funded by the Canada Research Chair program

Change management in an environment of ongoing primary health care system reform: A case study of Australian primary health care services

Introduction/Background Globally, health reforms continue to be high on the health policy agenda to respond to the increasing health care costs and managing the emerging complex health conditions. Many countries have emphasised PHC to prevent high cost of hospital care and improve population health and equity. The existing tension in PHC philosophies and complexity of PHC setting make the implementation and management of these changes more difficult. This paper presents an Australian case study of PHC restructuring and how these changes have been managed from the viewpoint of practitioners and middle managers. Methods As part of a 5-year project, we interviewed PHC practitioners and managers of services in 7 Australian PHC services. Findings Our findings revealed a policy shift away from the principles of comprehensive PHC including health promotion and action on social determinants of health to one-to-one disease management during the course of study. Analysis of the process of change shows that overall, rapid, and top-down radical reforms of policies and directions were the main characteristic of changes with minimal communication with practitioners and service managers. The study showed that services with community-controlled model of governance had more autonomy to use an emergent model of change and to maintain their comprehensive PHC services. Conclusions Change is an inevitable feature of PHC systems continually trying to respond to health care demand and cost pressures. The implementation of change in complex settings such as PHC requires appropriate change management strategies to ensure that the proposed reforms are understood, accepted, and implemented successfully