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13. Tools for local health in all policies implementation: evidence from an explanatory case study of Kuopio, Finland.

Author

Guglielmin, Maria, Shankardass, Ketan, Bayoumi, Ahmed, O'campo, Patricia, Kokkinen, Lauri, and Muntaner, Carles

Subjects
*HEALTH policy, *PUBLIC health administration, *HEALTH services accessibility, *LOCAL government, *RESEARCH methodology, *GOVERNMENT regulation, *INTERVIEWING, *EXECUTIVES, *HUMAN services programs, *RESEARCH funding, *BUDGET, *PUBLIC officers, *FINANCIAL management, *HEALTH promotion
Abstract

Aims: This paper describes the use of three governance tools for health in all policies utilised to facilitate implementation in the municipality of Kuopio, Finland: impact assessments, a city mandate (the Kuopio strategy), and shared budgets. Methods: An explanatory case study was used. Data sources included semistructured interviews with 10 government employees and scholarly literature. Realist scientific methods were used to reveal mechanisms underlying the use of tools in health in all policies. Results: Strong evidence was found supporting initial and new theory/hypotheses regarding the use of each tool in achieving positive implementation outcomes. Impact assessments facilitated health in all policies by enhancing understanding of health implications. The Kuopio strategy aided in implementation by giving credence to health in all policies work via formal authority. Shared budgets promoted intersectoral discussions and understanding, and a sense of ownership, in addition to allowing time to be spent on health in all policies work and not financial deliberation. Conclusions: Findings confirm the efficacious use of three governance tools in implementing health in all policies in Kuopio. Knowledge and evidence-based guidelines on local health in all policies implementation are needed as this policy approach continues to be recognised and adopted as a means to promote population health and health equity. [ABSTRACT FROM AUTHOR]

Published
2023
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46. The association between contextual socioeconomic factors and prevalent asthma in a cohort of Southern California school children

Author

Shankardass, Ketan, McConnell, Rob S., Milam, Joel, Berhane, Kiros, Tatalovich, Zaria, Wilson, John P., and Jerrett, Michael

Subjects
Asthma in children -- Influence, Social classes -- Influence, Context effects (Psychology) -- Analysis, Health, Social sciences
Abstract

Spatial variation in childhood asthma and a recent increase in prevalence indicate that environmental factors play a significant role in the etiology of this important disease. Socioeconomic position (SEP) has been associated inversely and positively with childhood asthma. These contradictory results indicate a need for systematic research about SEP and asthma. Pathways have been suggested for effects of SEP on asthma at both the individual and community level. We examined the relationship of prevalent asthma to community-level indicators of SEP among 5762 children in 12 Southern California communities, using a multilevel random effects model. Estimates of community-level SEP were derived by summarizing census block group-level data using a novel method of weighting by the proportion of the block groups included in a community-specific bounding rectangle that contained 95% of local study subjects. Community characteristics included measures of male unemployment, household income, low education (i.e., no high school diploma) and poverty. There was a consistent inverse association between male unemployment and asthma across the inter-quartile range of community unemployment rates, indicating that asthma rates increase as community SEP increases. The results were robust to individual-level confounding, methods for summarizing census block group data to the community level, scale of analysis (i.e., community-level vs. neighborhood-level) and the modeling algorithm. The positive association between SEP and prevalent childhood asthma might be explained by differential access to medical care that remains unmeasured, by the hygiene hypothesis (e.g., lower SES may associate with higher protective exposures to endotoxin in early life), or by SEP acting as a proxy for unmeasured neighborhood characteristics. Keywords: USA; Neighborhood; Childhood asthma; Multilevel modeling; Socioeconomic position; Contextual factor

Published
2007

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