Understanding the unintended consequences of public health policies: the views of policymakers and evaluators

BACKGROUND: Public health policies sometimes have unexpected effects. Understanding how policies and interventions lead to outcomes is essential if policymakers and researchers are to intervene effectively and reduce harmful and other unintended consequences (UCs) of their actions. Yet, evaluating complex mechanisms and outcomes is challenging, even before considering how to predict assess and understand outcomes and UCs when interventions are scaled up. We aimed to explore with UK policymakers why some policies have UCs, and how researchers and policymakers should respond. METHODS: We convened a one-day workshop with 14 people involved in developing, implementing or evaluating social and public health policies, and/or evaluating possible unintended effects. This included senior evaluators, policymakers from government and associated agencies, and researchers, covering policy domains from public health, social policy, poverty, and international development. RESULTS: Policymakers suggested UCs happen for a range of reasons: poor policy design, unclear articulation of policy mechanisms or goals, or unclear or inappropriate evidence use, including evaluation techniques. While not always avoidable, it was felt that UCs could be partially mitigated by better use of theory and evidence, better involvement of stakeholders in concurrent design and evaluation of policies, and appropriate evaluation systems. CONCLUSIONS: UCs can be used to explore the mechanisms underpinning social change caused by public health policies. Articulating these mechanisms is essential for truly evidence-informed decision-making, to enable informed debate about policy options, and to develop evaluation techniques. Future work includes trying to develop a holistic stakeholder-led evaluation process

The health outcomes and physical activity in preschoolers (HOPP) study: rationale and design

<p>Abstract</p> <p>Background</p> <p>The early years are the period of growth for which we know the least about the impact of physical activity. In contrast, we know that more than 90 % of school-aged Canadian children, for example, are not meeting physical activity recommendations. Such an activity crisis is a major contributor to recent trends in childhood obesity, to which preschoolers are not immune. The World Health Organization estimated that more than 42 million children under the age of 5 years were overweight world-wide in 2010. If an activity crisis exists during the preschool years, we should also be concerned about its broader impact on health. Unfortunately, the relationship between physical activity and health during the early years is poorly understood. The goal of the Health Outcomes and Physical activity in Preschoolers (HOPP) study is to describe how the prevalence and patterns of physical activity in preschoolers are associated with indices of health.</p> <p>Methods</p> <p>The HOPP study is a prospective cohort study. We aim to recruit 400 3- to 5-year-old children (equal number of boys and girls) and test them once per year for 3 years. Each annual assessment involves 2 laboratory visits and 7 consecutive days of physical activity monitoring with protocols developed in our pilot work. At visit 1, we assess body composition, aerobic fitness, short-term muscle power, motor skills, and have the parents complete a series of questionnaires related to their child’s physical activity, health-related quality of life and general behaviour. Over 7 consecutive days each child wears an accelerometer on his/her waist to objectively monitor physical activity. The accelerometer is programmed to record movement every 3 s, which is needed to accurately capture the intensity of physical activity. At visit 2, we assess vascular structure and function using ultrasound. To assess the associations between physical activity and health outcomes, our primary analysis will involve mixed-effects models for longitudinal analyses.</p> <p>Discussion</p> <p>The HOPP study addresses a significant gap in health research and our findings will hold the potential to shape public health policy for active living during the early years.</p

Basidiomycete mycelia in forest soils : dimensions, dynamics and roles in nutrient distribution

Basidiomycete mycelia are ubiquitous in forest soils where they fulfil a range of key ecological functions. Population studies, based largely on basidiome collections, indicate that mycelia of many ectomycorrhizal and saprotrophic basidiomycetes can spread vegetatively for considerable distances through soil, but the extent to which these become physically or physiologically fragmented is unclear. This review considers aspects of the distribution, dynamics and translocatory activities of individual basidiomycete mycelia in forest soil, highlighting current gaps in our understanding and possible ways to address these

Pisolithus : death of the pan-global super fungus

In 1977, D. H. Marx's oft-cited review, 'Tree host range and world distribution of the ectomycorrhizal fungus Pisolithus tinctorius', was published. Based on literature citations, herbarium records and personal communications, Marx (1977) concluded that P. tinctorius (Pers.) Coker and Couch occurred in 33 countries on six continents and formed mycorrhizas with some 51 tree species. P. tinctorius, it seemed, was something of a pan-global super fungus that might enhance forest production world-wide. Reasonable conclusions from the available information but, as recent work has revealed, it is not quite that straightforward. P. tinctorius sensu lato represents a complex of species, and P. tinctorius sensu stricto is far more limited in both its host range and geographical distribution than was envisaged by Marx

Ectomycorrhizal fungi : the symbiotic route to the root for phosphorus in forest soils

Many forest trees have evolved mutualistic symbioses with ectomycorrhizal (ECM) fungi that contribute to their phosphorus (P) nutrition. Forest productivity is frequently limited by P, a phenomenon that is likely to become more widespread under future conditions of elevated atmospheric CO2 concentration [CO2]. It is thus timely that this review considers current understanding of the key processes (absorption, translocation and transfer to the plant host) in ECM fungus-mediated P nutrition of forest trees. Solubilisation of inorganic P (Pi) and hydrolysis of organic P by ECM fungi in soil occurs largely at the growing mycelial front, where Pi absorption is facilitated by high affinity transporters. While large gaps remain in our understanding of the physiological and molecular mechanisms that underpin movement of P in ECM mycelia in soil and P transfer to the plant, host P demand seems likely to be a key driver of these processes. ECM fungi may make considerable contributions to meeting the likely increased P demand of trees under elevated [CO2] via increased colonization levels, shifts in ECM fungal community structure and changed patterns of EMM production