Lane Jeff, Stergachis Andy
Department of Global Health, School of Public Health, University of Washington, Seattle, WA, United States.
Departments of Pharmacy and Global Health, Schools of Pharmacy and Public Health, University of Washington, Seattle, WA, United States.
Front Health Serv. 2024 Jan 9;3:1291183. doi: 10.3389/frhs.2023.1291183. eCollection 2023.
Laws and policies affecting access to medicines have been in the global health spotlight for decades, yet our understanding of their effects remains substantially underdeveloped. The emerging field of legal epidemiology combined with the methods of implementation science presents an opportunity to help address this gap. Legal epidemiology refers to the scientific study and deployment of law as a factor in the cause, distribution, and prevention of disease and injury in a population. Legal epidemiology studies consist of a systematic collection and coding of laws and policies relating to a particular topic. Quasi-experimental or observational research methods can then be applied to take advantage of natural experiments resulting from heterogenous adoption and/or implementation of laws and policies. Often legal epidemiology studies fail to account for heterogenous law implementation processes, presenting a need and opportunity to integrate implementation science methods. Researchers may face challenges in integrating these methods for access to medicines studies, including data access issues and a complex legal and implementation environment. Yet, the opportunities presented by increasingly transparent legal environments, improved monitoring of medicine availability, universal health coverage expansion, and electronic health and insurance records integration may facilitate overcoming these challenges. Improved collaboration and communication between researchers, health authorities, manufacturers, and health providers from public and private sectors will be critical. In spite of the challenges, combining the fields of legal epidemiology and implementation science may present an important strategy toward creating a legal and policy environment that supports global and equitable access to medicines.
几十年来，影响药品可及性的法律和政策一直处于全球卫生关注的焦点，但我们对其效果的理解仍相当有限。新兴的法律流行病学领域与实施科学方法相结合，为弥补这一差距提供了契机。法律流行病学是指将法律作为影响人群疾病和伤害的原因、分布及预防的一个因素进行科学研究和运用。法律流行病学研究包括对与特定主题相关的法律和政策进行系统收集和编码。然后可以应用准实验或观察性研究方法，利用因法律和政策的异质性采用和/或实施而产生的自然实验。法律流行病学研究往往没有考虑到法律实施过程的异质性，这就凸显了整合实施科学方法的必要性和机遇。研究人员在将这些方法整合到药品可及性研究中时可能会面临挑战，包括数据获取问题以及复杂的法律和实施环境。然而，日益透明的法律环境、对药品可及性监测的改善、全民健康覆盖范围的扩大以及电子健康和保险记录的整合所带来的机遇，可能有助于克服这些挑战。研究人员、卫生当局、制造商以及公共和私营部门的卫生服务提供者之间加强合作与沟通至关重要。尽管存在挑战，但将法律流行病学和实施科学领域结合起来，可能是营造支持全球公平药品可及性的法律和政策环境的一项重要战略。
