International Journal of Health Policy and Management

America First and Global Health Last: Assessing the Policy’s Ripple Effects on Tropical Disease Control and Health Sovereignty in Sub-Sahara Africa

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Economic Burden of Non-medicinal Poisoning From Healthcare Provider Perspective in 2020: A Prevalence-Based Cost-of-Illness Study in Thailand

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Background  Between 2010 and 2019 in Thailand, hospital admissions due to toxic effects of non-medicinal substances (International Classification of Diseases 10th Revision [ICD-10] codes: T51-T65) ranged from 59.78 to 87.47 per 100 000 population. The objective of this study was to estimate the costs of non-medicinal poisoning from healthcare provider perspective, and identify factors associated with the costs in Thailand for the year 2020. Methods  This was a prevalence-based cost-of-illness study conducted from healthcare provider perspective, analysing data from five hospitals (four regional and one provincial) across the Central, North, and Northeast regions of Thailand. We included all patients diagnosed with non-medicinal poisoning (ICD-10 codes: T51-T65) during the fiscal year 2020. Direct medical costs were calculated from hospital databases, estimating the cost per outpatient/emergency visit and the cost per hospital admission. Multiple regression analysis was used to determine the factors affecting these costs. All total costs were converted to international dollar (Int$) for 2020. Results  A total of 3260 patients were included (2472 outpatient visits and 788 admissions). The mean age was 39 years, with 51% being male. The mean cost per outpatient visit was Int$ 47, and the mean cost per admission was Int$ 896. Key factors significantly associated with higher costs included patient type (outpatient vs admission), length of stay (LOS), age, insurance scheme, diagnosis group, and the presence of comorbidities. Conclusion  This study provided critical, updated data that can inform health policy by emphasizing the economic burden of non-medicinal poisoning. These findings underscore the need for strengthening poisoning prevention and early intervention services and offer essential data for conducting future economic evaluation studies of relevant interventions in Thailand.

United Nations Partnerships With the Alcohol Industry

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Background  The alcohol industry builds engagement with United Nations (UN) organisations to enhance its corporate image and influence policy, supported by the UN’s endorsement of public-private partnerships (PPPs). However, the extent of the alcohol industry’s relationships with the UN remains unclear due to limited reporting. Methods  We searched the websites of 57 UN-affiliated entities and 18 transnational alcohol corporations (TNACs) for evidence of partnerships or relationships between the UN and the alcohol industry. We summarised the UN entities and TNACs involved in formal partnerships, membership of alliances or stakeholder networks, financial contributions, sponsorship of programmes or projects, sponsorship of events, event participation, and personal relationships with conflicts of interest. Results  We identified examples of all the above relationships between various UN entities and the world’s largest TNACs, including an alcohol industry donation towards the World Health Organization (WHO) Foundation, which was created to maximise private sector donations to WHO. The focus of these engagements aligned closely with the alcohol industry’s corporate social responsibility (CSR) initiatives, including drink-driving prevention, education, sustainability, and philanthropy. These activities frequently involved support for low- and middle-income countries (LMICs) and women, which are emerging markets for the TNACs. Sponsorship and participation in intergovernmental events allowed the TNACs privileged access to policy-makers. Limited disclosure by UN entities meant that our findings provided an incomplete picture of relationships with the alcohol industry. Conclusion  The UN’s wide-ranging relationships with the TNACs highlight the power of these large corporations in building political influence and the UN’s failure to acknowledge the alcohol industry’s conflicting interests with health. These relationships undermine WHO’s mandate to promote health, placing the integrity and impartiality of the UN system at risk. On top of adequate resources from member states and enhanced transparency measures, the UN requires effective safeguards against alcohol industry influence, in line with those for the tobacco industry.

Multiple Chronic Conditions, Delayed Medical Care and Hospitalization: A Comparison Between the United States and Taiwan

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Background  Delays in medical care can be especially critical for individuals with multiple chronic conditions (MCCs). The United States and Taiwan, with vastly different healthcare systems, offer contrasting contexts for access to care. This study aims to examine the relationship between MCCs, delayed medical care and hospitalization in the US and Taiwan. Methods  This analysis used data from the US National Health Interview Survey (NHIS) 2021 (n = 29 482) and the Taiwan Social Change Survey (TSCS) 2021 health module (n = 1604). We estimated multivariable logit regression models and calculated differential effects of MCCs status (no chronic conditions, one chronic condition, MCCs) on outcomes. Precision measures were estimated with delta method. All analyses for the US population incorporated applicable complex survey design and weighting, and for the Taiwan population incorporated weighting when appropriate. Results  Compared to those with no chronic conditions, individuals in the US with one chronic condition (2.0 percentagepoints, P < .001) or MCCs (3.6 percentage-points, P < .001) had a higher likelihood of delayed care due to costs. In Taiwan, delayed care was less likely among individuals with one chronic condition (5.6 percentage-points, P = .08) or MCCs (9.5 percentage-points, P = .02), compared to individuals with no chronic conditions. Furthermore, individuals with MCCs or one chronic condition are associated with higher hospitalization in both the US (6.1 percentage-point, P < .001; 1.6 percentage-point, P = .001, respectively) and Taiwan (15.7 percentage-point, P < .001, 3.8 percentage-point, P = .08, respectively), although the differential effect of one chronic condition in Taiwan did not reach statistical significance. Conclusion  Analyzing data from two national health systems, this analysis shows differing relationships between MCC status and delayed care, suggesting a possible bidirectional effect. As both regions undergo reforms—US efforts to improve coordination and Taiwan’s rising risk of fragmented care—these findings offer insights relevant to policymakers and health system leaders beyond each country’s context.

Can Prevention-Oriented Communication Via Health Organization Websites Affect Adherence to Breast and Cervical Cancer Screening? An Exploratory Study in Italy

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Background  Public organizations in healthcare are progressively adopting digital tools to disseminate information regarding the benefits of screening. Nevertheless, no research has hitherto been conducted to investigate the link between the website-based health communications and cancer screening uptake. This study addresses this gap by assessing whether health communications conveyed via the websites of local health organizations improve adherence to breast and cervical cancer screening. Methods  We performed thematic content analysis of 97 websites belonging to Italian health organizations based on the OSEC-p model. This latter was developed to measure the compliance of prevention-oriented health communication with the effectiveness requirements indicated in the model. Next, correlation and regression analyses were performed to examine the relationship between the average regional OSEC-p scores and the regional breast and cervical cancer screening adherence rates reported by the National Centre for Screening Monitoring in 2022. Results  The findings show that the prevention-oriented health communication via health organizations’ websites can explain the 45% of the variance in female cancer (breast and cervical) screening uptake. Patient engagement tools and information on preventive cancer initiatives are key web-based communication elements that enhance cancer screening adherence. Conclusion  This exploratory study is one of the first to highlight the importance of digital health communications for improving cancer screening and public health. It offers insights both for national health policy-makers to optimize health economics through screening campaigns and health organizations managers to enhance the compliance of health communication on websites with the effectiveness requirements defined in the OSEC-p model.

How Does Supermarket Category Management Shape What Is on Supermarket Shelves and Influence Diet and Health? Secondary Analysis of Qualitative Interviews With Retailers and Suppliers

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Background  Unhealthy diets drive high rates of non-communicable diseases. Many food environments are dominated by foods high in fat, salt, and sugar (HFSS). Supermarkets are a predominant source of groceries, and the relationships between retailers and their suppliers determine the foods displayed on their shelves. The disproportionate display of less healthy foods suggests that existing regulatory frameworks are sub-optimal for public health. We aimed to investigate the nature of relationships between supermarkets and their suppliers in the UK, and their implications for dietary public health. Methods  We undertook secondary analysis of in-depth interviews with UK retailers and suppliers (n = 19), using inductive and deductive approaches to thematic analysis, underpinned by our quest to understand how food retailing drives less healthy diets. Codes and themes were generated and refined, then mapped diagrammatically and are presented in an explanatory narrative. Results  Large suppliers are critical to the supplier-retailer relationship, dominating category management and supermarket shelves. The relationship brings mutual benefits for supplier and retailer. Category managers from large suppliers engender indebtedness among retailers by building rapport and trust, and investing financially and materially in retailers. Reciprocity by retailers is enacted with preferential contracts and the award of leading roles in category management (“category captaincy”). Large suppliers thus gain competitive advantage, with preferential access to premium shelf space, driving greater sales. Important positive reinforcing feedback loops maintain the relationship, described as a “virtuous circle.” Yet, there are also countering forces, which act as negative feedback loops. Conclusion  Where the retailer-supplier relationship involves the largest manufacturers, it drives the product mix and volumes on supermarket shelves, resulting in a disproportionate dominance of the largest, processed food brands. The nature of this relationship is likely a key factor preventing movement towards an overall healthier food offer to consumers and remains a public health concern.

The International Advanced Practice Nurse Integration Model: A Response to Recent Commentaries

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Institutional Decoupling in China’s Blood Donation Reform: Bridging the Gap Between Policy Intentions and Implementation Realities

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Stakeholder Perspectives on the Structural Causes of Drug Shortages in Korea: A Mixed-Methods Study

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Background Drug shortages are a persistent global challenge. In South Korea, shortages occur within a distinct context characterized by high import dependence, inflexible pricing structures, and a hospital-centric distribution system. This study examined how frontline pharmacists and policy stakeholders perceive the structural causes of drug shortages across policy, supply-chain, and frontline pharmacy practice levels.Methods We employed a sequential mixed-methods design to triangulate institutional perspectives with frontline realities, comprising six focus group interviews (FGIs) (n = 35) with policy stakeholders and a national web-based survey of 223 licensed pharmacists. Qualitative data explored institutional perspectives on structural causes and policy responses, whereas survey data quantified recent shortage experiences, impacts on patient care, and perceived causes.Results Qualitative findings indicated that stakeholders attributed shortages to structural vulnerabilities, including unprofitable drug prices, dependence on imported raw materials, and distribution rigidities. These perceptions were supported by survey findings and aligned with frontline pharmacists’ reported experiences: 97.3% of pharmacists experienced shortages in the past three months, most frequently involving cold medicines and analgesics. Respondents identified raw material shortages (51.1%) and supply chain imbalances (17.5%) as primary drivers. Although pharmacists used coping strategies such as drug substitution, these adaptations were associated with substantial patient inconvenience (49.3%) and increased pharmacist workload (23%), indicating that individual-level responses are insufficient to address systemic failures.Conclusion Drug shortages in Korea reflect systemic vulnerabilities compounded by distribution constraints rather than temporary disruptions. To address these perceived barriers, we propose a graded policy approach: short-term measures should prioritize administrative flexibility and information sharing, medium-term measures should focus on reforming pricing incentives, and long-term measures should strengthen supply chain sovereignty.

Religion, Politics, and Vaccines: Elaborating the Integrative Public Policy Acceptance (IPAC) Framework Through HPV Vaccine Program Acceptance Among Religious Leaders in Bangladesh

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Background  In October 2023, Bangladesh introduced a free, single-dose human papillomavirus (HPV) vaccine for girls aged 9–14 through its national vaccination program to prevent cervical cancer, the second most common cancer among Bangladeshi females, caused by the HPV. Although vaccine hesitancy was not a significant issue before the COVID-19 pandemic, experiences from that pandemic and global literature suggest that the population’s uptake of this vaccine may face barriers due to concerns related to reproductive health, fertility, and cultural and religious beliefs. This is particularly relevant in a country where Islam is the state religion, 91% of the population is Muslim, and religious leaders hold significant influence over public opinion. Methods  Building upon the recently developed Integrative Public Policy Acceptance (IPAC) framework, this qualitative study explores the factors shaping religious leaders’ support for the HPV vaccine informing their potential role in promoting it. Semi-structured interviews with leaders from Bangladesh’s five main Islamic traditions were thematically analysed using NVivo 14 with inductive and deductive coding. Results  Islamic religious leaders’ varying support for HPV vaccinations in Bangladesh was influenced by their limited awareness of cervical cancer, as well as their religious and social concerns about ingredients, side effects and a fear of promoting promiscuity. Political ideologies also played a significant role, as leaders were less supportive of the program when they perceived the government as ideologically opposed to the beliefs or practices of their specific religious tradition. Conclusion  The study’s contribution to the IPAC framework highlights the importance of political consensus in policy acceptance, explaining how partisanship and ideological differences impact public policy compliance. The findings underscore the need for health systems in Muslim majority countries to engage with religious authorities, build political inclusivity and consensus, and align health policies with religious and cultural values.