Friday, September 30, 2011

[EQ] Setting priorities in health

Setting priorities in health

A study of English primary care trusts

Research report: Suzanne Robinson, Helen Dickinson, Iestyn Williams, Tim Freeman, Benedict Rumbold and Katie Spence

Health Services Management Centre, University of Birmingham and the Nuffield Trust

September 2011

Available online PDF [84p] at: http://bit.ly/nJstO4

The research reported in this document was designed to map the priority-setting activities taking place across the National Health Service (NHS) in England, and to explore and assess the effectiveness of these practices within specific local contexts.

The questions that provided the basis for the research were as follows:

• What priority-setting tools, processes and activities are practised currently as part of the commissioning processes of English primary care trusts (PCTs)?

• What barriers are experienced by PCTs seeking to implement explicit priority setting, and how are these being addressed?

• What other strengths and weaknesses can be identified in current priority-setting practice?

• What learning can be derived that will be instructive for future priority setting within the NHS and elsewhere?

Content:

Key messages from the research

1. Background and context

Understanding priority setting

Priority setting and commissioning

The challenges facing priority-setters

Research on local priority setting in England

Research scope and aims

2. Methodology

Stage 1: National survey

Stage 2: In-depth case studies

Data collection

Data analysis and reporting

Setting priorities in health: a study of English primary care trusts

3. Priority setting: the national picture

Developments in local priority-setting processes

Remit and scope of priority-setting arrangements

Stakeholder involvement in decision making

Use of evidence and decision tools

Use of decision tools in priority setting

Strengths and weaknesses of priority-setting processes

Disinvestment decisions

4. In-depth exploration of priority setting

Rationale for forming priority-setting processes

Key features of the case study priority-setting processes

Formal decision criteria

Decision processes

Role of discussion and deliberation

Technocratic approaches to aid priority setting: the evidence-based approach

Stakeholder involvement in priority setting

Engagement and involvement of health and social care organisations

Engagement and involvement of the public and patients

Implementation

Leadership

Overall coherence and ‘success’ of priority-setting processes

Response to the White Paper: the impact of government reforms on priority setting

5. Discussion

Decision tools

Outcomes of priority-setting work

Non-technical dimensions of priority setting

Engaging stakeholders and the public

Political dimensions of priority setting

Leadership

Information resources and expertise

Impact of government reforms on priority setting

6. Conclusions and recommendations

Key policy drivers

Governance

Technical challenges

System-wide approach to priority-setting

Political realities

Recommendations

References

Appendix: Different types of priority-setting activity to be considered

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Information Technology - Virtual libraries; Research & Science issues. [DD/ KMC Area]
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[EQ] Expert Review and Proposals for Measurement of Health Inequalities

Expert Review and Proposals for Measurement of Health Inequalities in the European Union

Spinakis A, Anastasiou G, Panousis V, Spiliopoulos K, Palaiologou S, Yfantopoulos J

Full Report. (2011) European Commission

Directorate General for Health and Consumers. Luxembourg. ISBN 978-92-79-18528-1

Full Report available online PDF file [202p.] at: http://bit.ly/n9mSVI

Summary PDF file [39p.] at: http://bit.ly/pLATPK

"…..Monitoring of inequalities in health is an important public health task. Interest in health inequalities among EU countries and their regions as well as among the various social clusters in the EU population is growing.

The search for the best appropriate "summary measure" of health inequality that can be observed individually or in terms of groups of individuals, is a task that occupies a lot the researchers involved in the fields of inequality research.

Lately in the EU, it has been recognized that a more focused effort is required. It is more natural to suggest and construct methodologies or indices that will be suitable for assessing trends in terms of mortality, morbidity and also self-perceived health. The selection of an appropriate indicator or an appropriate measurement methodology for health inequality across the EU-27 countries is a demanding task. Each available indicator has advantages and disadvantages.

Simple indicators are usually comprehensive but may not have some specific desirable characteristics. Other indicators are more technical and difficult to understand, apply and/or interpret, but can assist more in explaining significant components of the concept "health inequality". Complex indicators can also be very useful in the decomposition of inequality. Based on the above, it is reasonable to state that one main goal in the study of health inequalities is to,

- propose appropriate measurement methods in the form of indicators that "estimate" and "capture" the exact level of inequality in a population
(here the EU population).

The other very important goal of this study is to monitor the variation of health inequalities in all levels of analysis
(e.g. social groups, regions, individuals) through time. Thus, perform a trend analysis.

The main objective was to contribute in the area of "Monitoring Health Inequalities in the EU", by combining the best practices in health inequalities measurement with the most reliable data that can be used to calculate these measures.

The specific tasks of the project were:

- the review and analysis of the existing work done in the measurement of health inequalities in the EU.

- the review and analysis of the existing and planned data sets available across the EU, with an assessment of their suitability for the purposes of the analysis.

Content:

Executive Summary

1.Introduction

2. Measurement of Health & Health inequalities in the EU – Conceptual framework

2.1 Health data - Health Indicators

2.2 What is Health Inequality?

2.3 Measurement of health inequality in the EU – A historical review

2.4 Inequality Indicators - Definitions & Classifications

3. Most suitable summary measures for monitoring health inequalities in the EU

3.1 Which indicators do we need? - What do we need to measure?

3.2 Inequalities in mortality across the EU area, regions and time

3.2.1 Proposed Indicators

3.2.2 Inequalities in the EU - Analysis of trends

3.3 Inequalities in Perceived Health Status and other Self Assessed Morbidity by SES groups in the EU

3.3.1 Proposed Indicators

3.3.2 Inequalities in the EU - Analysis of trends

3.4 Inequalities in Disability & Activity Limitations by SES groups in the EU

4. Concluding Remarks

Bibliography

ANNEX I: Index of Tables & Figures

ANNEX II: Tables

ANNEX III: Figures

ANNEX IV: Conceptual Framework to Measurement and Monitoring Health Inequalities

ANNEX V: Classification of Health Inequalities Measurement Techniques

ANNEX VI: Preliminary Evaluation of health Inequality Indicators & Desirable Properties

ANNEX VII: Health Inequalities Measurement by Social Groups - Core Social Variables

ANNEX VIII: EU Survey Tools & Questions

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"Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
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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Thursday, September 29, 2011

[EQ] Return on Investment Mental Health Promotion and Mental Illness Prevention

Return on Investment Mental Health Promotion and Mental Illness Prevention

Canadian Policy Network at the University of Western Ontario

Canadian Institute for Health Information. CIHI 2011

Available online PDF file [76p.] at: http://bit.ly/o0cTEd

“….Mental health issues will be among the leading causes of disability in Canada by 2030, yet there is limited information about the costs of interventions for mental illness prevention and mental health promotion.
This scoping study found that there is research showing a return on investment for some mental health promotion/illness prevention interventions. The strongest evidence was for interventions targeting children and youth (such as those that focus on conduct disorders, depression, parenting, and suicide awareness and prevention), while the weakest evidence was from the workplace sector….”

Key Messages

· The evidence suggests that there is a return on investment (ROI) for some mental health promotion/illness prevention interventions.

· There are a number of high-quality systematic reviews and meta-analyses on the topics of ROI for mental health promotion and mental illness prevention; however, the number of randomized trials is low and there is an overall lack of evidence in Canada.

· There is more evidence for illness prevention activities, and most studies were found at the individual/organizational levels.

· The weakest evidence was from the workplace sector, due to a lack of high-quality research studies.

· The strongest ROI evidence was for children/adolescents in the areas of reducing conduct disorders and depression, parenting and anti-bullying/-stigma programs, suicide awareness and prevention, health promotion in schools and primary health care screening for depression and alcohol misuse.

· There is a lack of standard definitions in the areas of mental health, mental health promotion, mental illness prevention and economic analysis. A common lexicon that crosses sectors is required.

· Expenditure information on mental health is research-based and likely understated. There is a lack of expenditure information on mental health promotion/mental illness prevention.

· Returns from mental health promotion/illness prevention typically show up in a different sector from the one in which the investments are made— a “mental health–in-all-policies” approach should be considered.

· By 2030, mental health issues will be the leading cause of disability in Canada, but Canada appears to be a low spender on mental health.

· There is mounting evidence that the growing cost to society of mental illness is not sustainable—the total cost to society could be greater than the entire cost of the health care system in Canada.

· The solution lies in promoting mental health and preventing mental illness—we need to prevent more people from breaking down—and a long-range view is required…”

Table of Contents

Key Messages

Executive Summary

Introduction

Methodology

Search Protocol

Results

Health

Education

Workplace

Social Services and Criminal Justice

Discussion

Conclusion

Appendix A: Search Strategy Results

Appendix B: Glossary of Health Economic Terms

References

Bibliography

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[EQ] European review of social determinants of health

European review of social determinants of health

Interim second report on social determinants of health and the health divide in the European Region
WHO - EUR/RC61/Inf.Doc./5

Drafted by a team based at University College London and led by Sir Michael Marmot – 2011

Available online PDF [75p.] at: http://bit.ly/qwzKh0

“……This interim second report sets out the approaches to tackling health inequities that have emerged from the work undertaken since WHO published the Interim first report on social determinants of health and the health divide in the WHO European Region in September 2010 as part of the review. This report further describes some of the Region’s inequalities that were set out in the first report.

Key developments reported are:

• the review’s conceptual approach to the causes of health inequities and the policies and processes required to tackle these;
• analysis of recent time trends in the WHO European Region;
• identification of the key themes and issues that have emerged from the work of topic specific and cross-cutting task groups
so far and that will underpin the formulation of recommendations to be made by the review;
• emerging thinking on the role WHO, health ministers and other important actors can play in promoting health equity for
current and future generations by promoting fairer and more sustainable societies; and
• how the review fits into wider global action on the social determinants of health and the new European policy for health – Health 2020….”

Contents

Executive summary

1. Overview

1.1 Introduction

1.2 Scope of the review

1.3 The policy context

2. Health and its social determinants in the WHO European Region

2.1 Health and inequalities in Europe

2.2 Trends

2.3 Social gradient within countries

2.4 Conceptual framework

2.5 Applying the framework to understand the time trends in the WHO European Region

3. European review of the social determinants of health and the health divide

3.1 Structure of the review and the approach to be taken

3.2 Task groups

3.3 Activities

3.3.1 Promising practices and country experiences

3.3.2 Consultation

3.3.3 Examination of future trends in inequalities in health

4. Emerging themes

4.1 Emerging thinking on themes

4.2 Thematic areas and issues

4.2.1 Key concepts

4.2.2 Organizations and governance

4.2.3 Interventions and policies

4.2.4 Wider agendas

4.2.5 Economic issues

References

Annex 1. Key messages reported in phase 1 of the review

Annex 2. Review of systems, processes and contexts affecting action on the social determinants of health
Annex 3. Summaries of the interim reports of the task groups

First interim report on the European review of social determinants of health and the health divide

Report on the new health policy framework for the WHO European Region (Health 2020)

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Wednesday, September 28, 2011

[EQ] Tackling the global clean air challenge

Tackling the global clean air challenge

“……..- In many cities air pollution is reaching levels that threaten people's health according to an unprecedented compilation of air quality data released today by WHO. The information includes data from nearly 1100 cities across 91 countries, including capital cities and cities with more than 100 000 residents.

Over 2 million people die from indoor and outdoor air pollution

World Health Organization WHO - Press release September 2011: http://bit.ly/p90Y2g

Website: http://bit.ly/q2wM3T

Database: outdoor air pollution in cities at: http://bit.ly/oksxcp

WHO estimates more than 2 million people die every year from breathing in tiny particles present in indoor and outdoor air pollution. PM10 particles, which are particles of 10 micrometers or less, which can penetrate into the lungs and may enter the bloodstream, can cause heart disease, lung cancer, asthma, and acute lower respiratory infections. The WHO air quality guidelines for PM10 is 20 micrograms per cubic metre (µg/m3) as an annual average, but the data released today shows that average PM10 in some cities has reached up to 300 µg/m3.

Main findings

The main findings contained in the new compilation are:

· Persistently elevated levels of fine particle pollution are common across many urban areas. Fine particle pollution often originates from combustion sources such as power plants and motor vehicles.

· The great majority of urban populations have an average annual exposure to PM10 particles in excess of the WHO Air Quality guideline recommended maximum level of 20 µg/m3. On average, only a few cities currently meet the WHO guideline values.

· For 2008, the estimated mortality attributable to outdoor air pollution in cities amounts to 1.34 million premature deaths. If the WHO guidelines had been universally met, an estimated 1.09 million deaths could have been prevented in 2008. The number of deaths attributable to air pollution in cities has increased from the previous estimation of 1.15 million deaths in 2004. The increase in the mortality estimated to be attributable to urban air pollution is linked to recent increases in air pollution concentrations and in urban population size, as well as improved data availability and methods employed.

Greater awareness of health risks

WHO is calling for greater awareness of health risks caused by urban air pollution, implementation of effective policies and close monitoring of the situation in cities. A reduction from an average of 70 µg/m3 of PM10 to an annual average of 20 µg/m3 of PM10 is expected to yield a 15% reduction in mortality - considered a major public health gain. At higher levels of pollution, similar reductions would have less impact on reducing mortality, but will nevertheless still bring important health benefits.

"Solutions to outdoor air pollution problems in a city will differ depending on the relative contribution of pollution sources, its stage of development, as well as its local geography," said Dr Carlos Dora, WHO Coordinator for Interventions for Health Environments in the Department of Public Health and Environment. "The most powerful way that the information from the WHO database can be used is for a city to monitor its own trends in air pollution over time, so as to identify, improve and scale-up effective interventions."

Largest contributors to urban outdoor air pollution

In both developed and developing countries, the largest contributors to urban outdoor air pollution include motor transport, small-scale manufacturers and other industries, burning of biomass and coal for cooking and heating, as well as coal-fired power plants. Residential wood and coal burning for space heating is an important contributor to air pollution, especially in rural areas during colder months. …”

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Tuesday, September 27, 2011

[EQ] 5th Symposium on Global Health Diplomacy- The Future Agenda at the Interface of Public Health, innovation and Trade

5th High-Level Symposium on Global Health Diplomacy

Global Health Programme, at the Graduate Institute of International and Development Studies
Geneva, Switzerland

Ten Years After The Doha Declaration-
The Future Agenda at the Interface of Public Health, innovation and Trade- An Outlook on the Next Ten Years

Wednesday, 23 November 2011, 10:00-17:00 at World Trade Organization, Geneva

Website: http://bit.ly/od3UGg

“…..The annual high-level symposium of the Global Health Programme explores critical issues and new developments in global health with particular relevance to the intersection of health, foreign policy and trade.

Ten years have passed since the Doha Declaration on the TRIPS Agreement and Public Health, which was a paradigm shift towards a greater focus on issues related to intellectual property and public health. Significant achievements have been made to better recognise public health values in framing the intellectual property and international trading system, including the works of the WHO Global strategy and plan of action on public health, innovation and intellectual property and the WIPO Development Agenda. At the same time, major challenges remain: overcoming the main infectious diseases, increasing research for neglected diseases, the growing burden of non-communicable diseases, as well as other emerging public health threats and a changing economic climate.

The complex relationship between public health, innovation and trade necessitates a more holistic approach in the future, involving a wide range of actors. The symposium aims to review achievements and challenges in promoting access and innovation, to foster policy coherence between different international organisations, as well as other key stakeholders, and to discuss the remaining challenges and their future impact on a comprehensive work agenda.

Margaret Chan, Director-General of the World Health Organization, Pascal Lamy, Director-General of the World Trade Organization, and Francis Gurry, Director General of the World Intellectual Property Organization, will engage in a dialogue on these issues at the symposium.

The first part of the Symposium will review achievements since the Doha Declaration on the TRIPS and Public Health Agreement and highlight challenges that remain. We have been able to secure the participation of the Directors-General of WHO- Dr. Margaret Chan, of WIPO- Mr. Francis Gurry and of WTO- Mr. Pascal Lamy for the morning session.

The morning discussions will be informed by a joint trilateral study, prepared by the WHO, WIPO and WTO.
The afternoon sessions will focus on the future agenda at the interface of public health, innovation and trade and high-level speakers from other key organisations, academia, private sector and civil society will express their perspectives in a forward looking manner.

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