Program and public policy

This briefing note is the fourth in a series of six focused on the state of the practice of integrated impact assessment (IIA). These documents focus, respectively, on:

1. Overall situation and clarification of concepts
2. Example of the practice of IIA at the European Commission
3. Example of the practice of IIA in France
4. Example of the practice of IIA in the United Kingdom
5. Example of the practice of IIA in Northern Ireland
6. Main challenges and issues tied to IIA

Integrated Impact Assessment (IIA) is a decision-support mechanism increasingly being considered by public administrations in industrialized countries. The movement toward the adoption of evidence-based policy has given rise to many forms of impact assessment, reflective of governmental priorities. The need to combine the various impact assessment tools which have multiplied over the years within governments arises from the desire to red…

This briefing note is intended for all managers in the health and social services sectors, as well as for public health actors who would like to see this type of approach established within their government so that health can be better taken into account in all policies. Those who are called upon to manage programs, projects or public policies involving multiple sectors with a determinant impact on population health will find here an overview of the usefulness of the horizontal (intersectoral) approach as compared with traditional approaches. This document presents the challenges and benefits specific to the horizontal approach, along with a summary of current thinking on the subject. It also includes examples of common practices tied to this approach. This approach should make it possible to better integrate health into all policies and to develop and implement healthy public policies. Managers familiar with horizontal approaches will find here an up-to-date review of current devel…

How can we perceive and address ethical challenges in public health practice and policy? One way is by using ethical concepts to shed light on everyday practice. One does not have to be a specialist in ethics to do so. This document is part of a series of papers intended to introduce practitioners to some concepts, values, principles, theories and approaches that are important to public health ethics.

Many authors argue that public health interventions and programs are rooted in utilitarian ethics (Holland, 2007; Horner, 2000; Nixon & Forman, 2008; Rothstein, 2004; Royo‑Bordonada & Román-Maestre, 2015). For example, Royo-Bordonada and Román-Maestre write that “public health is in essence [...] utilitarian because it seeks to preserve the health status (something that contributes to the well-being of persons) of the maximum number of individuals possible, ideally the entire population” (2015, p. 3). Roberts and Reich (2002) also assert that the utilitarian p…

In this paper we will focus on principle-based approaches in public health ethics, comparing some of their features with those of principlism, the well-known and widely-used “four principles” approach in medical ethics.

We will first look at some of the main features of principlism and then with those features in mind we will turn to public health frameworks that rely on principles to see what they have in common as well as how they might differ.

Understanding and recognizing some of principlism’s main features can help practitioners to:

• Better situate their own ethical deliberations in public health by seeing both the differences and the similarities between various ethical approaches;
• Identify and make explicit principlist orientations guiding themselves or others in health care or in public health settings, whether in research or practice;
• Having identified those orientations, communicate more effectively; and
• Understan…

In this paper we will outline the concept of reciprocity as it may be applied in the ethics of public health. The goal of this paper is to present the concept as it has been developed and used in the literature.

Whether considered as a value or formulated as a principle to guide actions, reciprocity is commonly appealed to in public health to help ensure that certain obligations due to others – or to be expected from others – may be taken into account and acted upon by public authorities or by individuals. It is one of the values commonly considered when applying an ethical lens to decisions and actions linked to public health or healthy public policies.

We will consider how it has been used to date in public health ethics and then include some aspects of reciprocity drawn from other sectors and other disciplines. In addition to the various dimensions of reciprocity and its application to public health, one observation that will emerge from this paper is that di…

“The social determinants of health are the circumstances in which people are born,grow up, live, work and age, and the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics” (World Health Organization’s Commission on Social Determinants of Health [CSDH WHO], 2016).

“The underlying social structures and processes that systematically assign people to different social positions and distribute the social determinants of health unequally in society are the social determinants of health inequities” (VicHealth, 2015, p. 6).

This paper is part of a series of short documents based on the longer Briefing Note, Policy Approaches to Reducing Health Inequalities, published by the National Collaborating Centre for Healthy Public Policy in March, 2016. The series is meant to provide a brief discussion of each of the eight policy approaches discus…

This document is intended to enable public health actors to more easily distinguish between the most widespread policy approaches that have been proposed to reduce health inequalities. The approaches that we will discuss are:

• Political economy,
• Macro social policies,
• Intersectionality,
• Life course approach,
• Settings approach,
• Approaches that aim at living conditions,
• Approaches that target communities, and
• Approaches aimed at individuals.

Health inequalities¹ are understood to be unfair and systematic differences in health among and between social groups – differences which need to be addressed through action. These result from social and political circumstances and are therefore potentially avoidable.

With this document, we have set out to shed some light on the ways that various broad policy approaches attempt to account for and address health i…

This paper provides a very short summary of a longer paper of the same name. The longer work, including full references, is available online at:
http://www.ncchpp.ca/docs/2014_Ethique_Reciprocity_En.pdf.

Whether considered as a value or formulated as a principle to guide actions, reciprocity is commonly appealed to in public health to help ensure that certain obligations due to others – or to be expected from others – may be taken into account and acted upon by public authorities or by individuals. It is one of the values commonly considered when applying an ethical lens to decisions and actions linked to public health or healthy public policies.

Reciprocity can be applied in the ethics of public health to help us to

• Anticipate and respond appropriately to the contributions and needs of individuals and groups by thinking about their interests,
• Think about the obligati…

Decision making in healthy public policy,¹ as in all policy areas, increasingly involves taking economic efficiency into consideration. Efficiency is the extent to which sought-after benefits can be obtained for the lowest possible cost, and the tools that measure it are economic evaluations. Efficiency is, however, but one of the many possible criteria according to which policy options can be judged. There is a range of other values and objectives that we may want policies to fulfill. Deciding between at times divergent values is an ethical enterprise, and the use of economic evaluations can have profound ethical implications.

The first paper in this series introduced some of the general ethical issues that arise when economic evaluations are applied in healthy public policy.² While there are a number of diverse methods of economic evaluation, all of them share several fundamental, underlying assumptions that have…

The first document¹ in this series of briefing notes² began with the observation that public health practitioners often struggle with ethical decisions in their practice but may not have relevant tools and resources to deal with these challenges. An assumption underlying this third paper is that by providing public health practitioners and decision makers with some guidance about practical public health ethics frameworks, they will be supported in making difficult ethical decisions that are unique to public health practice. In part, the management of ethical challenges will be implicitly or explicitly based on the kind of philosophical perspective one holds in relation to ethical problems in public health and it is important for practitioners to sort out what perspective makes sense to them, so they are guided in their own ethical decision making. The second document in this series³ presents the major philosophical and theoretical perspectives that p…