Thursday, January 31, 2008

[EQ] Evidence-informed health policy report

Evidence-Informed Health Policy: Using Research to Make Health Systems Healthier

 

Report from Kunnskapssenteret  (Norwegian Knowledge Centre for the Health Services)

No 1–2008 A Multimethod Study

Moynihan R, Oxman AD, Lavis JN, Paulsen E. A Multi-method Study.

 

The full report can be downloaded as a PDF file at http://www.kunnskapssenteret.no/filer/Rapport_08_01_EIHP.pdf

 

The video documentaries can be found at http://www.kunnskapssenteret.no/index.php?artikkelid=1030&back=2

 

Background

Over the past several years there has been a great deal of international discussion about how to harness health research more effectively to achieve the United Nations’ Millennium Development Goals (MDGs) as well as other national health goals in low- and middle-income countries (LMICs). In November 2004, country delegations at the Ministerial Summit on Health Research held in Mexico City backed calls for establishing mechanisms to support the use of research evidence in policy and practice, as did the World Health Assembly in May 2005 when it approved a resolution arising from the Mexico Summit. We sought to inform  deliberations about next steps by identifying organisations around the world, and especially in LMICs, which are in some way successful or innovative in supporting the use of research evidence in the development of clinical practice guidelines (CPGs), health technology assessments (HTAs), and health policy, and by describing their experiences.

 

Key messages

The study’s seven main implications for those establishing or administering organisations to produce clinical practice guidelines or health technology assessments or organisations to support the use of research evidence in developing health policy include:

1. Collaborate with other organisations

2. Establish strong links with policymakers and involve stakeholders in the work

3. Be independent and manage conflicts of interest among those involved in the work

4. Build capacity among those working in the organisation

5. Use good methods and be transparent in the work

6. Start small, have a clear audience and scope, and address important questions

7. Be attentive to implementation considerations even if implementation is not a remit

 

 

The study’s four main implications for the World Health Organisation and other international organisations include:

1. Support collaborations among organisations

2. Support local adaptation efforts

3. Mobilize support

4. Create knowledge-related global public goods, including methods and evidence syntheses

 

Video documentaries

Case study

Brief description

Length of the video

(minutes)

Introduction

A short introduction to the eight case studies

01:30

REACH Policy
Initiative, East
Africa

An initiative to create a multi-national unit that will act as a bridge between research and policy in the East African Community (comprising Kenya, Tanzania, and Uganda)

08:26

Thailand

A constellation of research units that informed the development and evaluated the implementation of Thailand’s nascent universal health insurance program, known popularly as the 30 Baht scheme

07:46

Free State, South Africa

A set of long term relationships between provincial policy-makers and researchers and the tensions that can arise in these relationships

09:55

Pharmaceutical Benefits Scheme, Australia & South Africa

An evidence-based drug assessment and pricing scheme in Australia and South Africa

09:18

Philippines

An initiative to address conflicts of interest and inequity in the production of clinical practice guidelines

09:01

Chile

An initiative to use clinical practice guidelines to make the best use of scarce resources

07:48

National Institute of Clinical Excellence (NICE), United Kingdom

A unit producing guidelines and health technology assessments with a new focus on producing evidence-based pubic health guidelines to address health inequalities

06:12

Mexico

A comprehensive effort to draw on research evidence to inform the development, implementation and evaluation of the new Popular Health Insurance scheme

 

08:41

 

 

EXECUTIVE SUMMARY

Background

Methods

Results

Evidence-Informed Health Policy: Using research to make health systems healthier Discussion


Tables - Survey results

Table 1: Description of the units

Table 2: Organisation and establishment

Table 4: Focus

Table 5: People involved in producing a product or delivering a service

Table 6: Methods used in producing a product or delivering a service

Table 7: Products and implementation

Table 8: Evaluation and update procedures


Case descriptions

Case description 1: East Africa – An initiative to create a multi-national organisation that will act as a bridge between research and policy in the East African Community (comprising Kenya, Tanzania, and Uganda)

Case description 2: Thailand – A constellation of research organisations that informed the

development and evaluated the implementation of Thailand’s nascent universal health insurance

program, known popularly as the 30 Baht scheme

Case description 3: Free State, South Africa – A set of long-term relationships between

provincial policymakers and researchers and the tensions that can arise in these relationships

Case description 4: Australia and South Africa – An evidence-based drug assessment and

pricing scheme in Australia and South Africa

Case description 5: Philippines – An initiative to address conflicts of interest and inequity in

the production of clinical practice guidelines

Case description 6: Chile – An initiative to use clinical practice guidelines to make the best

use of scarce resources

Case description 7: United Kingdom – An organisation producing guidelines and health

technology assessments with a new focus on producing evidence-based public health guidelines

to address health inequalities

Case description 8: Mexico - A comprehensive effort to draw on research evidence to inform

the development, implementation and evaluation of the new health insurance scheme

 


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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
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Wednesday, January 30, 2008

[EQ] Equitable access: Research challenges for health in developing countries

Global Forum Update on Research for Health Volume 4:

Equitable access: Research challenges for health in developing countries

 

Global Forum for Health Research and Pro-Brook Publishing

 

Available online as PDF file [180p.] at: http://www.globalforumhealth.org/filesupld/global_update4/GlobalUpdate4Full.pdf


Order hard copy here, free of charge: http://www.globalforumhealth.org/hide/common/forms/orderpub/orderform.php

 

"All countries need to step up efforts to increase investment in health research, to organize strong systems for innovative research and to bring value products from scientific research into production. At the same time, full use should be made of scientific evidence, and we should also work to bridge gaps between decision-making and scientific research." Chen Zhu, Minister of Health, People's Republic of China


Article at: http://www.globalforumhealth.org/filesupld/global_update4/chapt/GlobalUpdate4_StrengtheningHealthSystems_Zhu.pdf

 

In the fourth volume of Global Forum Update on Research for Health, 30 of the leading institutions and public health professionals from across the world reflect about the current state of research for health in ensuring equitable access.

 

TABLE OF CONTENTS

 

Pramilla Senanayake, Foreword

 

Stephen A Matlin, Introduction

 

                       

Access to health

 

Chen Zhu, Strengthening health systems towards better health outcomes

 

Davidson R Gwatkin, Recent trends in research on health equity

 

Lucy Gilson and Helen Schneider, Understanding health service access: concepts and experience

 

Syed Masud Ahmed, Combining health and social protection measures to reach the ultra poor: experiences of BRAC

 

Trudo Lemmens and Ron A Bouchard, Mandatory clinical trial registration: rebuilding public trust in medical research

                       

Rodrigo A Salinas, Open access to research protocols and results: intellectual property and the right to health               

 

Sharon Friel, Ruth Bell, Tanja AJ Houweling and Sebastian Taylor, A social determinants approach to health equity

           

Leslie London, Making human rights work for the public's health: equity and access

 

Lenore Manderson, Inequality, marginalization and poor health

           

Graham Thornicroft, Discrimination as a barrier to accessing mental health care  

           

Maud MTE Huynen, Pim Martens and Henk BM Hilderink, The diverse pathways from globalization to health

 

 

Innovation

 

Glaudina Loots, Towards the development of a Health Innovation Strategy for South Africa

 

Anatole Krattiger, Using the power of intellectual property to strengthen equitable access

 

Paul Wilson and Robert Hecht, Financing of vaccine R&D – gaps and opportunities for innovation

 

Alan R Gillespie, Child immunization: accelerating equitable access through innovative financing

 

Andrew Y Kitua, Being healthy: the role of research

 

Ariel Pablos-Méndez and Ramesh Shademani, The role of Knowledge Translation in bridging the “know-do gap

 

 

Research resources

 

Gustavo Kourí, María G Guzmán, José Luis Pelegrino, Alicia Reyes, Luis Estruch, Niviola Cabrera, Research impact on equitable access in health: the Cuban experience

 

Judith A Oulton and Patricia Caldwell, Nursing research: meeting today’s health challenges – perspectives from the International Council of Nurses

 

Mary Ann D Lansang and Rodolfo J Dennis, The need to develop research capacity

 

Kirsten M Vogelsong, Henry L Gabelnick and Eberhard Nieschlag, Partnerships offer promise in developing systemic methods of male fertility regulation

 

Stefanie Meredith and Elizabeth Ziemba, A new landscape of partnerships

 

Gunvanti Goding, Michael Chew and Jimmy Whitworth, Capacity strengthening for global health research

 

Mary Moran, Anne-Laure Ropars and Javier Guzman, Partnership dynamics, issues and challenges

 

 

Decision-making

 

Sara Bennett, Delivering evidence to inform health system strengthening: the role of systematic reviews

 

Robert Wells and Judith Whitworth, Equitable access: good intentions are not enough

 

Tikki Pang, Using evidence for policy-making in health

 

Manuel M Dayrit, Mario Roberto Dal Poz, Hugo Mercer and Carmen Dolea,
Towards evidence-informed policy-making in human resources for health: the state of research

 

Alan Lopez and Colin Mathers, Inequities in health status: findings from the 2001 Global Burden of Disease study

 

Selemani S Mbuyita, The potentials of involving communities in health research

 

 

 


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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
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[EQ] Inequalities in mortality during and after restructuring of the New Zealand economy

Inequalities in mortality during and after restructuring of the New Zealand economy:
repeated cohort studies

Tony Blakely, research professor1, Martin Tobias, principal adviser2, June Atkinson, senior analyst and  team leader1
1 Health Inequalities Research Programme, University of Otago, Wellington, Wellington, New Zealand , 2 Epidemiology, Public Health Intelligence, Ministry of Health, Wellington, New Zealand  
BMJ, doi:10.1136/bmj.39455.596181.25 - published 24 January 2008

Available online at:
http://www.bmj.com/cgi/content/full/bmj.39455.596181.25v1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=new+zealand+and+inequalities&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

Abstract:
http://www.bmj.com/cgi/content/abstract/bmj.39455.596181.25v1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=new+zealand+and+inequalities&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

 Abstract
 Introduction
 Methods
 Results
 Discussion
 References

Objectives To determine whether disparities between income and mortality changed during a period of major structural and  macroeconomic reform and  to estimate the changing contribution of different diseases to these disparities.

Design Repeated cohort studies Data sources 1981, 1986, 1991, 1996, and  2001 censuses linked to mortality data
Population Total New Zealand  population, ages 1-74 years.

Methods Mortality rates stand ardised for age and  ethnicity were calculated for each census cohort by level of household income. Standardised rate differences and  rate ratios, and  slope and  relative indices of inequality (SII and  RII), were calculated to measure disparities on both absolute and  relative scales.

Results All cause mortality rates declined over the 25 year study period in all groups stratified by sex, age, and  income, except for 25-44 year olds of both sexes on low incomes among whom there was little change. In all age groups pooled, relative inequalities increased from 1981-4 to 1996-9 (RIIs increased from 1.85 (95% confidence interval 1.67 to 2.04) to 2.54 (2.29 to 2.82) for males and  from 1.54 (1.35 to 1.76) to 2.12 (1.88 to 2.39) for females), then stabilised in 2001-4 (RIIs of 2.60 (2.34 to 2.89) and  2.18 (1.93 to 2.45), respectively).

Absolute inequalities were stable over time, with a possible fall from 1996-9 to 2001-4. Cardiovascular disease was the major contributor to the observed disparities between income and  mortality but decreased in importance from 45% in 1981-4 to 33% in 2001-4 for males and  from 50% to 29% for females. The corresponding contribution of cancer increased from 16% to 22% for males and  from 12% to 25% for females.

Conclusions During and  after restructuring of the economy disparities in mortality between income groups in New Zealand  increased in relative terms (but not in absolute terms), but it is difficult to confidently draw a causal link with structural reforms. The contribution of different causes of death to this inequality changed over time, indicating a need to re-prioritise health policy accordingly.

 

 

 


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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ IKM Area]

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and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.

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