Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Room 3.09f, South Cloisters, St Luke's Campus, Heavitree Rd, Exeter, EX1 2LU, UK.
Evidence Synthesis and Modelling for Health Improvement (ESMI), University of Exeter Medical School, Room 3.09f, South Cloisters, St Luke's Campus, Heavitree Rd, Exeter, EX1 2LU, UK.
BMC Public Health. 2021 Jan 12;21(1):127. doi: 10.1186/s12889-021-10176-2.
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.
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.
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.
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.
政治与公共卫生之间的概念和理论联系由来已久。国际比较系统评价证据表明，福利国家、政治传统、民主和全球化这四个关键政治因素与人口健康结果之间存在联系。然而，这些影响的作用途径尚未得到系统评估。因此，我们聚焦于儿童和孕产妇健康结果，对最近系统评价数据进行了现实主义再分析。
利用最近关于健康政治决定因素的系统评价数据库作为本现实主义评价的数据源。对系统评价中重新评估的研究，以及与儿童和/或孕产妇健康结果相关的研究，纳入现实主义综合分析。通过与先前系统评价的现实主义接触，生成初始项目理论。通过与证据基础的详细接触，使用涉及两名独立审查员的现实主义再综合，对这些项目理论进行裁决和完善。与证据基础最相符的修订理论构成了最终的项目理论。
在系统评价中纳入的 176 项研究中，共有 67 项研究涉及儿童和/或孕产妇健康结果，纳入现实主义再分析。其中 63 项研究为生态学研究，数据收集时间为 1950 年至 2014 年。生成了 6 个初始项目理论。经过理论裁决，有 3 个经过修订的理论得到支持，并构成了最终的项目理论。这些理论涉及更慷慨的福利国家通过进步的社会福利政策导致更好的儿童和孕产妇健康，特别是在发达国家；左倾政治传统通过更关注福利措施导致更低的儿童死亡率和低出生体重，特别是在发达国家；全球化程度提高通过更多地受到跨国公司和新自由主义贸易组织的影响导致中低收入国家的儿童和婴儿死亡率以及青年吸烟率更高。
我们对大量系统确定的关于四个关键政治因素（福利国家、民主、政治传统和全球化）与儿童和孕产妇健康结果之间关系的证据进行了现实主义再分析。支持了三个最终项目理论。
