Si Ying Tan
National University of Singapore, Lee Kuan Yew School of Public Policy, Graduate Student
Most governments have enacted physical or social distancing measures to control COVID-19 transmission. Yet little is known about the socio-economic trade-offs of these measures, especially for vulnerable populations, who are exposed to... more
Most governments have enacted physical or social distancing measures to control COVID-19 transmission. Yet little is known about the socio-economic trade-offs of these measures, especially for vulnerable populations, who are exposed to increased risks and are susceptible to adverse health outcomes. To examine the impacts of physical distancing measures on the most vulnerable in society, this scoping review screened 39,816 records and synthesised results from 265 studies worldwide documenting the negative impacts of physical distancing on older people, children/students, low-income populations, migrant workers, people in prison, people with disabilities, sex workers, victims of domestic violence, refugees, ethnic minorities, and people from sexual and gender minorities. We show that prolonged loneliness, mental distress, unemployment, income loss, food insecurity, widened inequality and disruption of access to social support and health services were unintended consequences of physica...
Research Interests: Management, Public Administration, Social Policy, Food Security and Insecurity, Social Care For Older People, and 15 morePublic Health, Health Policy, Multidisciplinary, Social vulnerability, Children, Older people, Inequality, Loneliness, Social distance, Distancing, Ethnic Group, Social Distancing, Nature Communications, Public Policy, and CoVid
Autonomous systems have been a key segment of disruptive technologies for which data are constantly collected, processed, and shared to enable their operations. The internet of things facilitates the storage and transmission of data and... more
Autonomous systems have been a key segment of disruptive technologies for which data are constantly collected, processed, and shared to enable their operations. The internet of things facilitates the storage and transmission of data and data sharing is vital to power their development. However, privacy, cybersecurity, and trust issues have ramifications that form distinct and unforeseen barriers to sharing data. This paper identifies six types of barriers to data sharing (technical, motivational, economic, political, legal, and ethical), examines strategies to overcome these barriers in different autonomous systems, and proposes recommendations to address them. We traced the steps the Singapore government has taken through regulations and frameworks for autonomous systems to overcome barriers to data sharing. The results suggest specific strategies for autonomous systems as well as generic strategies that apply to a broader set of disruptive technologies. To address technical barriers, data sharing within regulatory sandboxes should be promoted. Promoting public-private collaborations will help in overcoming motivational barriers. Resources and analytical capacity must be ramped up to overcome economic barriers. Advancing comprehensive data sharing guidelines and discretionary privacy laws will help overcome political and legal barriers. Further, enforcement of ethical analysis is necessary for overcoming ethical barriers in data sharing. Insights gained from this study will have implications for other jurisdictions keen to maximize data sharing to increase the potential of disruptive technologies such as autonomous systems in solving urban problems.
Research Interests: Business, Management, Artificial Intelligence, Public Administration, Technology, and 15 moreRegulation And Governance, Singapore, Public Health, Disruptive Innovation, Public Policy Analysis, Disruptive Technologies, Singapore Studies, Autonomous Vehicles, Robots, Data Sharing, Big Data, Autonomous Systems, Industrial Robots, Drones, and Public Policy
Smart city initiatives are viewed as an input to existing urban systems to solve various problems faced by modern cities. Making cities smarter implies not only technological innovation and deployment, but also having smart people and... more
Smart city initiatives are viewed as an input to existing urban systems to solve various problems faced by modern cities. Making cities smarter implies not only technological innovation and deployment, but also having smart people and effective policies. Cities can acquire knowledge and incorporate governance lessons from other jurisdictions to develop smart city initiatives that are unique to the local contexts. We conducted two rounds of surveys involving 23 experts on an e-Delphi platform to consolidate their opinion on factors that facilitate policy transfer among smart cities. Findings show a consensus on the importance of six factors: having a policy entrepreneur; financial instruments; cities' enthusiasm for policy learning; capacity building; explicit regulatory mechanisms; and policy adaptation to local contexts. Correspondingly, three policy recommendations were drawn. Formalizing collaborative mechanisms and joint partnerships between cities, setting up regional or international networks of smart cities, and establishing smart city repositories to collect useful case studies for urban planning and governance lessons will accelerate policy transfer for smart city development. This study sheds light on effective ways policymakers can foster policy learning and transfer, especially when a jurisdiction's capacity is insufficient to deal with the uncertainties and challenges ahead.
Research Interests: Business, Management, Public Administration, Delphi Methodology, Regulation And Governance, and 15 moreCorporate Governance, Regulation, Policy learning, Public Policy Analysis, City Branding, ASEAN, Cities, Policy Transfer, City and Regional Planning, Smart Cities, Smart City, Delphi, Enthusiasm, Delphi method, and Public Policy
Additional file 2. The population size of age 15 years and the sample population by country.
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Summary The World Health Organization defines health promotion as process of enabling people to increase control over their health and its determinants, and thereby improve their health. As the world transitions into the information age,... more
Summary The World Health Organization defines health promotion as process of enabling people to increase control over their health and its determinants, and thereby improve their health. As the world transitions into the information age, incorporating digital technologies into health promotion is becoming commonplace. This article discusses current applications of digital health promotion (DHP) and addresses its potential benefits, challenges, as well as how differences in cultures, governance models and digital readiness across the globe will shape the implementation of DHP differently in each society. The benefits include expanding access to health information and health promoting services, lowering scaling up costs, personalizing health advice and real-time ‘nudging’ toward healthier options. Key challenges would involve privacy control, appropriate use of data including secondary usage beyond the original intention, defining the limits of ‘nudging’ and the right of free choice, ...
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Supplemental Material for Implementation of provider payment system reforms in the age of universal health coverage: a realist review of evidence from Asian developing countries by Si Ying Tan, GJ Melendez-Torres and Tikki Pang in Journal... more
Supplemental Material for Implementation of provider payment system reforms in the age of universal health coverage: a realist review of evidence from Asian developing countries by Si Ying Tan, GJ Melendez-Torres and Tikki Pang in Journal of Health Services Research & Policy
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PURPOSE Long-distance caregiving (LDC) technologies play a significant role in enabling distant care and facilitating living-alone older adults to keep socially connected. However, there is scarce research exploring the older adults'... more
PURPOSE Long-distance caregiving (LDC) technologies play a significant role in enabling distant care and facilitating living-alone older adults to keep socially connected. However, there is scarce research exploring the older adults' attitudes towards and intention to use such technologies. This paper is based on a systematic review of existing literature to explore the multifarious factors influencing independent community-living older adults' attitudes towards and intention to use LDC technologies. METHODS Articles published in English between 2006 and 2020 were reviewed by searching electronic databases of PubMed, ProQuest, EBSCOhost. The inclusion criteria were limited to quantitative, qualitative, or mixed-methods studies that involved: 1) distant caregiving; 2) older adults aged 60 years or above, who were living alone or with only their spouse in the community (even though the samples might also involve other non-older adults); 3) technologies including ICT-based devices, systems, or programs enabling data transmission were used; 4), intention to use or behavioral usage in regard to the technologies were reported or discussed. RESULTS In total, 41 out of 8674 articles were included. Both determinants and moderators of affecting the use of the ICT-based LDC technologies were identified with theoretical guidance. To summarize, there are personal factors involved, such as personality, concerns regarding security and privacy, health conditions, requisite knowledge, financial conditions, and influence from significant others, encompassing formal and informal caregivers; and factors related to the devices, in terms of their user-friendliness and functionality. CONCLUSION This review highlights the importance of striking a good balance between functionality and privacy concerns, besides considering the direct and indirect cost to users. LDC technology education should be promoted at the societal level to facilitate older adults' better understanding of the device utilities by enhancing their technological literacy. Implications for various stakeholders to cope with the challenges of an aging population are also discussed.
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Additional file 1.
Background Conceptual and theoretical links between politics and public health are longstanding. Internationally comparative systematic review evidence has shown links between four key political exposures – the welfare state, political... more
Background Conceptual and theoretical links between politics and public health are longstanding. Internationally comparative systematic review evidence has shown links between four key political exposures – the welfare state, political tradition, democracy and globalisation – on population health outcomes. However, the pathways through which these influences may operate have not been systematically appraised. Therefore, focusing on child and maternal health outcomes, we present a realist re-analysis of the dataset from a recent systematic review. Methods The database from a recent systematic review on the political determinants of health was used as the data source for this realist review. Included studies from the systematic review were re-evaluated and those relating to child and/or maternal health outcomes were included in the realist synthesis. Initial programme theories were generated through realist engagement with the prior systematic review. These programme theories were adj...
Research Interests: Health Sciences, Medical Sciences, Public Administration, Social Policy, Social Sciences, and 15 moreChild health, Political Science, Public Health Policy, Globalisation and Development, Public Health, Health Policy, Medicine, Maternal and Child Health, International Public Health, Smoking, Realist Synthesis, Infant Mortality, International health, International Health, and Public Policy
Covid-19 has spread globally, with cases rising daily at an unprecedented rate. Governments have resorted to strict measures to contain the virus, mainly through social distancing, to curb people-to-people transmission with varying... more
Covid-19 has spread globally, with cases rising daily at an unprecedented rate. Governments have resorted to strict measures to contain the virus, mainly through social distancing, to curb people-to-people transmission with varying degrees of success. To date, a systematic review of social distancing measures’ impact on vulnerable populations is yet to be undertaken. Following a systematic review approach, this study examines the negative/disproportionate impacts of social distancing on vulnerable populations and the ringfence measures to reduce those unintended consequences. The literature search from ten academic databases generated 31,827 records, and 12,541 records remained after removing duplicates. After data screening, 100 studies were eventually included for this review analysis. Findings show that 1) social distancing negatively affects mental health of the elderly people; 2) school closures lead to concerns about children’s learning loss and decreased social interactions w...
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Female sex work accounts for about 15% of the global HIV burden in women. Asia is the region with the second highest attributable fraction of the HIV epidemic after sub-Saharan Africa. This review synthesises studies that depict the... more
Female sex work accounts for about 15% of the global HIV burden in women. Asia is the region with the second highest attributable fraction of the HIV epidemic after sub-Saharan Africa. This review synthesises studies that depict the barriers and facilitators encountered by sex workers in Asia when negotiating consistent condom use. A total of 18 studies published between January 1989 and May 2015 were included in the review. Data were extracted, critically appraised and analysed using a thematic analysis approach. Individual-level factors related to sex workers' knowledge, perception and power, as well as interpersonal-level factors that encompassed dynamics with clients and peer-related factors, presented as both barriers and facilitators to sex workers' condom negotiation process. In addition, the structural environment of sex work, access to resources, poverty, stigma, the legal environment and the role of media were also identified as factors in influencing the condom negotiation process of sex workers. A multisectoral interventional approach that addresses the multilevel barriers encountered by sex workers in condom negotiation is needed. Awareness of safe-sex practice should be collectively enhanced among sex workers, clients and brothel managers.
Research Interests: Cultural Studies, Multiculturalism, Poverty, Gender and Sexuality, Social Capital, and 15 moreQualitative Research, Sex Work, Medicine, HIV, Humans, Social Intervention, Asia, Sex Workers, Social Environment, Evidence Based Health Care, Negotiating, Condoms, Safe Sex, Health Services Accessibility, and HIV infections
Employment sustainability is one of the most pressing issues inflicting people living with HIV (PLHIV). A qualitative approach was used to elucidate the perceived challenges in sustaining their employment and the perceived barriers in... more
Employment sustainability is one of the most pressing issues inflicting people living with HIV (PLHIV). A qualitative approach was used to elucidate the perceived challenges in sustaining their employment and the perceived barriers in re-entering the workforce for HIV patients. In-depth interviews were conducted with 16 patients from an acute hospital in Singapore. The main challenges raised in sustaining employment were: (1) ability to ensure secrecy of diagnosis from employers, (2) ability to secure financial resources for treatment and sustenance, (3) ability to ensure stable health to meet job requirements, (4) ability to cognitively sit with the concerns of uncertainty and limitations in career, and (5) ability to work through discriminatory workplace practices. The perceived barriers in gaining workforce re-entry were: (1) fear of pre-employment medical screening and potential discriminatory practices at workplace, (2) concerns over health (frequent hospital admissions, physical weakness, and existing medical co-morbidities), and (3) psychosocial challenges (unstable accommodation, older age, financial issues, and trade skills limitation). The overarching factor that influences the success of sustaining and securing an employment among HIV patients is secrecy of the diagnosis. The individuals' health status, financial status and access to healthcare, and other psychosocial challenges further compound the issue.
Research Interests: Social Determinants of Health, Singapore, Qualitative Research, Employment, Medicine, and 15 moreComorbidity, Social Stigma, Humans, Disclosure, Qualitative, Female, Male, Confidentiality, Middle Aged, Hiv Aids, Adult, Social Discrimination, Health Services Accessibility, Interviews as topic, and HIV infections
While policy study of smart city developments is gaining traction, it falls short of understanding and explaining knowledge transfers across national borders and cities. This article investigates how transboundary learning occurs through... more
While policy study of smart city developments is gaining traction, it falls short of understanding and explaining knowledge transfers across national borders and cities. This article investigates how transboundary learning occurs through the initiation and development of a regional smart cities network: the ASEAN Smart Cities Network (ASCN). The article conducts an in-depth case study from data collected through key informant interviews and document analysis. Spearheaded by Singapore in 2017, ASCN is seen as a soft power extension for Singapore, a branding tool for ASEAN, and a symbiotic platform between the private sector and governments in the region. Most transboundary knowledge transfers within the ASCN are voluntary transfers of policy ideas. Effective branding, demand for knowledge, availability of alternative funding options, enthusiasm from the private actors, and heightened interest from other major economies are highlighted as facilitators of knowledge transfer. However, t...
Research Interests: Business, Management, Information Technology, Law, Public Administration, and 15 moreSoutheast Asian Studies, Regulation And Governance, Political Science, Singapore, Knowledge Transfer, Regional development, Policy learning, Platform Studies, ASEAN, Policy Transfer, Smart Cities, Elements, Smart City, Sustainability, and Public Policy
Research Interests: Business, Management, Robotics, Information Technology, Law, and 15 moreEconomics, Public Administration, Ethics, Long Term Care, Governance, Management of Innovation, Science and Technology Policy, Public Health, Medicine, Engineering Ethics, Elements, Risks, Autonomous Systems, Systematic review, and Public Policy
Assisted living (AL) is an emerging model of care in countries where long-term care needs are escalating, with emphasis given to promoting independence and autonomy among the residents to achieve active and healthy ageing. Unlike... more
Assisted living (AL) is an emerging model of care in countries where long-term care needs are escalating, with emphasis given to promoting independence and autonomy among the residents to achieve active and healthy ageing. Unlike established nursing homes, the governance of AL is nebulous due to its novelty and diverse nature of operations in many jurisdictions. A comprehensive understanding of how AL is governed globally is important to inform regulatory policies as the adoption of AL increases. A systematic literature review was undertaken to understand the different levels of regulations that need to be instituted to govern AL effectively. A total of 65 studies, conducted between 1990 to 2020, identified from three major databases (PubMed, Medline, and Scopus), were included. Using a thematic synthesis analytical approach, we identified macro-level regulations (operational authorisation, care quality assessment and infrastructural requirements), meso-level regulations (operationa...
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Background The availability of various types of COVID-19 vaccines and diverse characteristics of the vaccines present a dilemma in vaccination choices, which may result in individuals refusing a particular COVID-19 vaccine offered, hence... more
Background The availability of various types of COVID-19 vaccines and diverse characteristics of the vaccines present a dilemma in vaccination choices, which may result in individuals refusing a particular COVID-19 vaccine offered, hence presenting a threat to immunisation coverage and reaching herd immunity. The study aimed to assess global COVID-19 vaccination intention, vaccine characteristics influencing vaccination acceptance and desirable vaccine characteristics influencing the choice of vaccines. Methods An anonymous cross-sectional survey was conducted between 4 January and 5 March 2021 in 17 countries worldwide. Proportions and the corresponding 95% confidence intervals (CI) of COVID-19 vaccine acceptance and vaccine characteristics influencing vaccination acceptance were generated and compared across countries and regions. Multivariable logistic regression analysis was used to determine the factors associated with COVID-19 vaccine hesitancy. Results Of the 19,714 responses...
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Research Interests: Management, Robotics, Artificial Intelligence, Information Technology, Law, and 15 morePublic Administration, Ethics, Long Term Care, Political Science, Autonomous Robotics, Governance, Singapore, Risk Management, Public Health, Health Care Management, Medicine, Health and Social Care, Risks, Autonomous Systems, and Public Policy
Research Interests: Business, Management, Robotics, Artificial Intelligence, Information Technology, and 15 moreLaw, Public Administration, Autonomous Robotics, Governance, Singapore, Intelligent Transportation Systems, Disruptive Innovation, Disruptive Technologies, Library and Information Studies, Smart Cities, Autonomous Vehicles, Smart City, Technology Adoption, Autonomous Systems, and Public Policy
The second King’s College London Symposium on Ageing and Long-term Care in China was convened from 4 to 5th July 2019 at King’s College London in London. The aim of the Symposium was to have a better understanding of health and social... more
The second King’s College London Symposium on Ageing and Long-term Care in China was convened from 4 to 5th July 2019 at King’s College London in London. The aim of the Symposium was to have a better understanding of health and social challenges for aging and long-term care in China. This symposium draws research insights from a wide range of disciplines, including economics, public policy, demography, gerontology, public health and sociology. A total of 20 participants from eight countries, seek to identify the key issues and research priorities in the area of aging and long-term care in China. The results published here are a synthesis of the top four research areas that represent the perspectives from some of the leading researchers in the field.
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Robotics and autonomous systems have been dubbed as viable technological solutions to address the incessant demand for long-term care (LTC) across the world, which is exacerbated by ageing populations. However, similar to other emerging... more
Robotics and autonomous systems have been dubbed as viable technological solutions to address the incessant demand for long-term care (LTC) across the world, which is exacerbated by ageing populations. However, similar to other emerging technologies, the adoption of robotics and autonomous systems in LTC pose risks and unintended consequences. In the health and LTC sectors, there are additional bioethics concerns that are associated with novel technology applications. Using an in-depth case study, we examined the adoption of novel technologies such as robotics and autonomous systems in LTC to meet the rising social care demand in Singapore consequent to its ageing population. We first described the LTC sector in Singapore and traced the development of robotics and autonomous systems deployed in the LTC setting. We then examined technological risks and ethical issues that are associated with their applications. In addressing these technological risks and ethical concerns, Singapore has adopted a regulatory sandbox approach that fosters experimentation through the creation of a robotics test-bed and the initiation of various robotics pilots in different health clusters. The stakeholders largely envision positive scenarios of human-robot coexistence in the LTC setting. When robots can take over routine and manual care duties in the future, human care workers can be freed up to provide more personalised care to the care recipients. We also highlighted existing gaps in the governance of technological risks and ethical issues surrounding the deployment of robotics and autonomous systems in LTC that can be advanced as future research agendas.
Research Interests: Management, Robotics, Artificial Intelligence, Information Technology, Law, and 15 morePublic Administration, Ethics, Long Term Care, Political Science, Autonomous Robotics, Governance, Singapore, Risk Management, Public Health, Health Care Management, Medicine, Health and Social Care, Risks, Autonomous Systems, and Public Policy
Rapid demographic shifts and socio-economic changes are fuelling concerns over the inadequate supply of informal care – the most common source of care-giving for older people in China. Unmet long-term care needs, which are believed to... more
Rapid demographic shifts and socio-economic changes are fuelling concerns over the inadequate supply of informal care – the most common source of care-giving for older people in China. Unmet long-term care needs, which are believed to cause numerous adverse effects on health, continue to increase. Drawing data from the 2015 wave of the China Health and Retirement Longitudinal Survey, this study explores the relationship between informal care provision and unmet long-term care needs among older people in China. We first examine the availability of informal care among older people with disabilities. We then analyse whether a higher intensity of informal care leads to lower unmet needs. Our findings suggest that the majority of older people with disabilities receive a low intensity of care, i.e. less than 80 hours per month. Besides, a higher intensity of informal care received could significantly lower the probabilities of unmet needs for the disabled older adults who have mainly inst...
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Objective Launched to assist in achieving universal health coverage, provider payment reform (PPR) is one of the most important policy tools deployed to transform incentives within a health system that is plagued with allocative... more
Objective Launched to assist in achieving universal health coverage, provider payment reform (PPR) is one of the most important policy tools deployed to transform incentives within a health system that is plagued with allocative inefficiency and high out-of-pocket payments to one that is able to deliver basic services and be cost-efficient. However, the black box of such reform – that is, the contexts in which reform operates, the mechanisms by which it changes health systems and behaviour within health systems, and the outcome patterns that arise from – remains unexplored. This review aims to examine the implementation mechanisms underlying PPR in Asian developing countries. Methods A realist synthesis approach was employed to tease out the configurative elements of PPR in developing countries. A multimethod and retrospective search was conducted to locate the evidence. A programme theory and data extraction framework were developed. Data were analysed using thematic synthesis to i...
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While moving towards unified social health insurance (SHI) is often a politically popular policy reform in countries where rapid expansion in health insurance coverage has given rise to the segmentation of SHI systems as different SHI... more
While moving towards unified social health insurance (SHI) is often a politically popular policy reform in countries where rapid expansion in health insurance coverage has given rise to the segmentation of SHI systems as different SHI schemes were rolled out to serve different populations, the potential impacts of reform on service utilisation and health costs have not been systematically studied. Using data from the Chinese Health and Retirement Longitudinal Study (CHARLS), we compared the mean costs incurred for both inpatient and outpatient care under different health insurance schemes, and the impact of different SHI schemes on treatment utilisation and health care costs using a two-part model. Our results show that Urban Employee Medical Insurance, which offers the most generous benefits, incurs the highest total costs prior to reimbursement when compared to other SHI schemes. Our analysis also shows that utilisation of SHI did not show significant reduction in out-of-pocket pa...
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Smart cities that make broad use of digital technologies have been touted as possible solutions for the population pressures faced by many cities in developing countries and may help meet the rising demand for services and infrastructure.... more
Smart cities that make broad use of digital technologies have been touted as possible solutions for the population pressures faced by many cities in developing countries and may help meet the rising demand for services and infrastructure. Nevertheless, the high financial cost involved in infrastructure maintenance, the substantial size of the informal economies, and various governance challenges are curtailing government idealism regarding smart cities. This review examines the state of smart city development in developing countries, which includes understanding the conceptualisations, motivations, and unique drivers behind (and barriers to) smarty city development. A total of 56 studies were identified from a systematic literature review from an initial pool of 3928 social sciences literature identified from two academic databases. Data were analysed using thematic synthesis and thematic analysis. The review found that technology-enabled smart cities in developing countries can onl...
Research Interests: Business, Management, Information Technology, Technology, Regulation And Governance, and 15 morePolitical Science, Sustainable Development, Governance, Developing Countries, Risk Management, China, Environmental Sustainability, India, Literature Review, Public Private Partnerships, Smart Cities, Infrastructure, Smart City, Sustainability, and Public Policy
The dwindling informal care support structure for the older population and the shortage of skilled nursing care staff propelled the rise of robotics and autonomous systems as potential solutions to meet the rising demands in long-term... more
The dwindling informal care support structure for the older population and the shortage of skilled nursing care staff propelled the rise of robotics and autonomous systems as potential solutions to meet the rising demands in long-term care. However, the nascent development in the governance of their applications could predispose older people to the negative ramifications of technological risks and ethical issues. This systematic review maps out four technological risks and five ethical issues in the deployment of robotics and autonomous systems in long-term care. Safety, privacy, liability, and adverse employment consequences to the existing nursing care workers were identified as major technological risks; while loss of autonomy, loss of human interaction and social connectedness, objectification and infantilisation, deception and social justice were identified as five major ethical issues related to the deployment of robotics and autonomous systems in long-term care. This review also identified antagonistic interactions between some of the technological risks and ethical issues that could offset each other. Findings from the review have implications for advancing knowledge on the governance of robotics in long-term care. Policy formulations and implementations would need to account for intricate issues that could arise from technological risks, ethical issues and their paradoxical interactions.
Research Interests: Business, Management, Robotics, Information Technology, Law, and 15 morePublic Administration, Ethics, Technology, Long Term Care, Governance, Management of Innovation, Science and Technology Policy, Public Health, Medicine, Systematic Reviews, Risks, Autonomous Systems, Systematic review, Long-Term Care, and Public Policy
Background: Conceptual and theoretical links between politics and public health are longstanding. Internationally comparative systematic review evidence has shown links between four key political exposures – the welfare state, political... more
Background: Conceptual and theoretical links between politics and public health are longstanding. Internationally comparative systematic review evidence has shown links between four key political exposures – the welfare state, political tradition, democracy and globalisation – on population health outcomes. However, the pathways through which these influences may operate have not been systematically appraised. Therefore, focusing on child and maternal health outcomes, we present a realist re-analysis of the dataset from a recent systematic review.
Methods: The database from a recent systematic review on the political determinants of health was used as the data source for this realist review. Included studies from the systematic review were re-evaluated and those relating to child and/or maternal health outcomes were included in the realist synthesis. Initial programme theories were generated through realist engagement with the prior systematic review. These programme theories were adjudicated and refined through detailed engagement with the evidence base using a realist re-synthesis involving two independent reviewers. The revised theories that best corresponded to the evidence base formed the final programme theories.
Results: Out of the 176 included studies from the systematic review, a total of 67 included child and/or maternal health outcomes and were included in the realist re-analysis. Sixty-three of these studies were ecological and data were collected between 1950 and 2014. Six initial programme theories were generated. Following theory adjudication, three theories in revised form were supported and formed the final programme theories. These related to a more generous welfare state leading to better child and maternal health especially in developed countries through progressive social welfare policies, left-of-centre political tradition leading to lower child mortality and low birth weight especially in developed countries through greater focus on welfare measures, and increased globalisation leading to greater child and infant mortality and youth smoking rates in LMECs through greater influence of multinational corporations and neoliberal trade organisations Conclusion: We present a realist re-analysis of a large systematically identified body of evidence on how four
key political exposures – the welfare state, democracy, political tradition and globalisation – relate to child and maternal health outcomes. Three final programme theories were supported.
Keywords: Child health, Maternal health, Health policy, International health, Politics, Realist synthesis
Methods: The database from a recent systematic review on the political determinants of health was used as the data source for this realist review. Included studies from the systematic review were re-evaluated and those relating to child and/or maternal health outcomes were included in the realist synthesis. Initial programme theories were generated through realist engagement with the prior systematic review. These programme theories were adjudicated and refined through detailed engagement with the evidence base using a realist re-synthesis involving two independent reviewers. The revised theories that best corresponded to the evidence base formed the final programme theories.
Results: Out of the 176 included studies from the systematic review, a total of 67 included child and/or maternal health outcomes and were included in the realist re-analysis. Sixty-three of these studies were ecological and data were collected between 1950 and 2014. Six initial programme theories were generated. Following theory adjudication, three theories in revised form were supported and formed the final programme theories. These related to a more generous welfare state leading to better child and maternal health especially in developed countries through progressive social welfare policies, left-of-centre political tradition leading to lower child mortality and low birth weight especially in developed countries through greater focus on welfare measures, and increased globalisation leading to greater child and infant mortality and youth smoking rates in LMECs through greater influence of multinational corporations and neoliberal trade organisations Conclusion: We present a realist re-analysis of a large systematically identified body of evidence on how four
key political exposures – the welfare state, democracy, political tradition and globalisation – relate to child and maternal health outcomes. Three final programme theories were supported.
Keywords: Child health, Maternal health, Health policy, International health, Politics, Realist synthesis