This paper explores whether constitutional litigation contributes to sustaining the equity element of the right to health. Equity entails a fair distribution of the burden of healthcare financing across the different socio-economic groups of the population. A shift towards uncontrolled private healthcare provision and financing raises equity challenges by disproportionately benefitting those who are able to afford such services. The extent to which equity is enforced is an indicator of the strength of the right to health. However, do domestic constitutional courts second-guess, based on equity, policy decisions that impact on healthcare financing? Is it the task of constitutional courts to scrutinize such policy decisions? Under what conditions are courts more likely to do so? The paper addresses these questions by focusing on the case of Hungary, where the right to health has been present in the Fundamental Law adopted in 2010 and the Constitutions preceding it. While the Hungarian Constitutional Court has been traditionally cautious to review policy decisions pertaining to healthcare financing, the system has been struggling with equity issues and successive government coalitions have had limited success in tackling these. The paper discusses the role of constitutional litigation in addressing such equity concerns. In doing so, it contributes to the discussion on the role of domestic constitutional courts in the protection of social and economic rights.
MULTIFILE
Reducing social inequalities in physical activity (PA) has become a priority for public health. However, evidence concerning the impact of interventions on inequalities in PA is scarce. This study aims to develop and test the application of a strategy for re-analyzing equity-specific effects of existing PA intervention studies in middle-aged and older adults, as part of an international interdisciplinary collaboration. This article aims to describe (1) the establishment and characteristics of the collaboration; and (2) the jointly developed equity-specific re-analysis strategy as a first result of the collaboration. To develop the strategy, a collaboration based on a convenience sample of eight published studies of individual-level PA interventions among the general population of adults aged ≥45 years was initiated (UK, n = 3; The Netherlands, n = 3; Belgium, n = 1; Germany, n = 1). Researchers from these studies participated in a workshop and subsequent e-mail correspondence. The developed strategy will be used to investigate social inequalities in intervention adherence, dropout, and efficacy. This will allow for a comprehensive assessment of social inequalities within intervention benefits. The application of the strategy within and beyond the collaboration will help to extend the limited evidence regarding the effects of interventions on social inequalities in PA among middle-aged and older adults.
BACKGROUND: The INHERIT (INtersectoral Health and Environment Research for InnovaTion) project has evaluated intersectoral cooperation (IC) in 12 European case studies attempting to promote health, environmental sustainability, and equity through behavior and lifestyle changes. These factors are the concerns of multiple sectors of government and society. Cooperation of health and environmental sectors with other sectors is needed to enable effective action. IC is thus essential to promote a triple win of health, sustainability, and equity.OBJECTIVE: This paper describes the design of a qualitative study to gain insights into successful organization of IC, facilitators and barriers, and how future steps can be taken to improve IC in the evaluated case studies.METHODS: Each case study was assessed qualitatively through a focus group. A total of 12 focus groups in 10 different European countries with stakeholders, implementers, policymakers, and/or citizens were held between October 2018 and March 2019. Five to eight participants attended each focus group. The focus group method was based on appreciative inquiry, which is an asset-based approach focusing on what works well, why it is working well, and how to strengthen assets in the future. A stepped approach was used, with central coordination and analysis, and local implementation and reporting. Local teams were trained to apply a common protocol using a webinar and handbook on organizing, conducting, and reporting focus groups. Data were gathered in each country in the local language. Translated data were analyzed centrally using deductive thematic analysis, with consideration of further emerging themes. Analyses involved the capability, opportunity, motivation-behavior (COM-b) system to categorize facilitators and barriers into capability, motivation, or opportunity-related themes, as these factors influence the behaviors of individuals and groups. Web-based review sessions with representatives from all local research teams were held to check data analysis results and evaluate the stepped approach.RESULTS: Data collection has been completed. A total of 76 individuals participated in 12 focus groups. In December 2019, data analysis was nearly complete, and the results are expected to be published in fall 2020.CONCLUSIONS: This study proposes a stepped approach that allows cross-country focus group research using a strict protocol while dealing with language and cultural differences. The study generates insights into IC processes and facilitators in different countries and case studies to filter out which facilitators are essential to include. Simultaneously, the approach can strengthen cooperation among stakeholders by looking at future cooperation possibilities. By providing knowledge on how to plan for, improve, and sustain IC successfully to deal with today's multisectoral challenges, this study can contribute to better intersectoral action for the triple win of better health, sustainability, and equity. This protocol can serve as a tool for other researchers who plan to conduct cross-country qualitative research.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/17323.
Het kabinet heeft 25 missies geformuleerd om maatschappelijke uitdagingen aan te pakken. Ambitieuze missies die ondernemers en onderzoekers uitdagen tot baanbrekende oplossingen en die bijdragen aan de gezondheid en zorg voor mensen. Om burgers langer in goede gezondheid te laten meedoen zijn systeemveranderingen noodzakelijk. Zorg moet zoveel als mogelijk worden voorkomen, worden georganiseerd in de eigen leefomgeving van mensen alsook worden vernieuwd. De missie Gezondheid en Zorg opent deuren voor nieuwe start-ups, zorgorganisaties, het maatschappelijke middenveld en burgers. Het realiseren van de missies vraagt om samenwerking buiten de gebaande paden dat bijdraagt aan het voorkomen, verplaatsen en vervangen van zorg. In Deventer werken de Hogescholen Saxion en HAN, wijkbewoners, zorggroep Solis, welzijnsorganisaties SV Helios/Wijk voor Elkaar (WvE), De Klerk GO/Verbindingscentrum de 5Hoek (5Hoek) met elkaar samen om intra- en extramurale zorg te de-implementeren. Zij bundelen de krachten om wijkbewoners met een lage SES te ondersteunen door verschillende e-health applicaties succesvol te gebruiken en hen daardoor meer te laten participeren en hun zelfregie te verhogen voor een gezonder en betekenisvoller leven. De ambitie is e-health te koppelen aan een wijkplatform dat matching mogelijk maakt tussen ondersteuningsbehoefte van wijkbewoners en aanbod van preventie, van professionele organisaties en informele aanbieders, in de wijk. Het samenwerkingsverband ontwikkelt daarbij een nieuw businessmodel dat voor alle consortiumpartners en de wijkbewoners leidt tot win-win, voor een preventieaanbod dat volgend is aan de behoeften, vragen en mogelijkheden van wijkbewoners met een lage SES en met een ondersteuningsbehoefte. Dit vindt plaats in een learning community, gebaseerd op wederkerigheid en samen leren in een dynamisch proces waarvan de opbrengsten telkens doorwerken naar het beroepsonderwijs, de beroepspraktijk en de state-of-the-art van de onderzoekspraktijk.
