Violence against healthcare workers in the middle of a global health crisis: what is it about policy and what to learn from international comparison?

Introduction: Violence against healthcare workers is a global health problem threatening healthcare workforce retention and health system resilience in a fragile post-COVID 'normalisation' period. In this perspective article, we argue that violence against healthcare workers must be made a greater priority. Our novel contribution to the debate is a comparative health system and policy approach. Methods: We have chosen a most different systems comparative approach concerning the epidemiological, political, and geographic contexts. Brazil (under the Bolsonaro government) and the United Kingdom (under the Johnson government) serve as examples of countries that were strongly hit by the pandemic in epidemiological terms while also displaying policy failures. New Zealand and Germany represent the opposite. A rapid assessment was undertaken based on secondary sources and country expertise. Results: We found similar problems across countries. A global crisis makes healthcare workers vulnerable to violence. Furthermore, insufficient data and monitoring hamper effective prevention, and lack of attention may threaten women, the nursing profession, and migrant/minority groups the most. There were also relevant differences. No clear health system pattern can be identified. At the same time, professional associations and partly the media are strong policy actors against violence. Conclusion: In all countries, muchmore involvement from political leadership is needed. In addition, attention to the political dimension and all forms of violence are essential.

The 2022 restructure of Aotearoa New Zealand's health system: Will it succeed in advancing equity where others have failed?

Aotearoa New Zealand has restructured its health system with the objective of addressing inequitable access to health services and inequitable health outcomes, particularly those affecting the indigenous Maori population. In July 2022, two new organisations were created to centralise planning, funding and provision responsibilities for publicly funded health services in Aotearoa New Zealand. Health New Zealand and the Maori Health Authority have been created to drive transformational change within the national health system and monitor and improve the health and wellbeing of Maori. At the local level, new Localities are to be formed with the aim of integrating services between government and non-government health and social services providers, while incorporating local Maori and local communities in co-design of services. These changes will be of interest to those in many other countries who are grappling with their own colonial histories and struggling to provide health services in ways that are equitable and contribute to positive health outcomes for their whole population. Although key aspects of the reforms are well supported within the health sector, the ambitious scope and timing of their introduction in the context of the COVID-19 pandemic and health workforce shortages can be expected to generate significant implementation challenges.