Health Equity: 06/28/11

Tuesday, June 28, 2011

[EQ] Systematic Review of Environmental Burden of Disease in Canada

Systematic Review of Environmental Burden of Disease in Canada

National Collaborating Centre for Environmental Health

Vancouver, BC Canada – 2010

Available online PDF [68p.] at: http://bit.ly/lPhvXB

“…..Potentially preventable illnesses and deaths resulting from exposure to environmental contaminants have been estimated to account for approximately $3.6 to $9.1 billion dollars in annual health care costs in Canada (Boyd and Genuis 2008). These statistics are driven by several primary disease categories (e.g., cardiovascular and respiratory diseases) that may be caused or exacerbated by population exposures to different environmental contaminants (e.g., indoor and outdoor air pollution, lead).

Concerns have also been raised about environmental exposures and potential adverse pregnancy outcomes and childhood diseases in Canada, as well as the economic and social costs attributable to the environmental burden of childhood diseases (Bérubé 2007). According to a recently published report from the United States President’s Cancer Panel, scientific evidence on individual and multiple environmental exposure effects on disease initiation and outcomes, and consequent health system and societal costs, are not being adequately integrated into national policy decisions and strategies for disease prevention, health care access, and health system reform (DHHS 2010).

The concept that the world's disease burden is attributable to a range of environmental and other (e.g., lifestyle, occupational) risk factors has been recognized for many years. Some of the earliest efforts to link specific risk factors, particularly environmental risk factors, to health outcomes initially focused on cancer as an endpoint.

A landmark study by Doll and Peto (1981) estimated the percentage of avoidable cancer deaths in the United States attributable to lifestyle and environmental factors, representing one of the first attempts to quantify the relationship between risk factors and health outcomes. Since then, a number of studies have been conducted (particularly during the 1990s) that have attempted to quantify the burden of disease globally and for different regions or countries.

Specifically, these studies describe public health (mortality and/or morbidity) in terms of disease burden for various categories of disease (e.g., cancer, heart disease, injuries) and risk factors. Most of these studies were not focused on environmental risk factors, however, with the exception of possible environmental pollution in developing countries.

The widely cited Global Burden of Disease (GBD) study was one of the first global efforts of this kind, which evaluated premature mortality and disability from a large number of diseases and injuries due to a variety of population exposures (Murray and Lopez 1996). Health outcomes included in the 1990 GBD study were attributed to eight major risk factors (few of which were specifically related to the environment): malnutrition, poor water sanitation/personal hygiene, unsafe sex, alcohol, occupation, tobacco, hypertension, and physical activity.

A subsequent 2001 GBD study targeted a greater number of risk factors, including several specifically related to environmental exposures (e.g., unsafe water, sanitation, and hygiene; urban air pollution, indoor smoke from household use of solid fuels) (Lopez et al. 2006a).

Because historical burden of disease assessments typically did not address issues specific to environmental health, additional studies have attempted to identify and quantify the environmental burden of disease (EBD) globally and for different countries or regions. These studies have generally been based on or build off of the historical burden of disease approach, and include many different definitions of the environment. The current recommended framework for EBD studies is based on a causal web structure that links environmental hazards and risk factors to disease burden……….”

TABLE OF CONTENTS

1.0 Introduction

2.0 Methods

3.0 Background Information

3.1 Original Burden of Disease Studies

3.2 Methodological Approaches to Estimating EBD

4.0 Results

4.1 Global, Regional, and National EBD Studies

4.1.1 Global/Regional EBD Studies

4.1.2 EBD Studies Conducted in the United States

4.1.3 EBD Studies Conducted in Europe

4.2 Canada-Specific EBD Studies

4.2.1 Canadian EBD Studies

4.2.2 Studies Conducted in Canada Related to Specific Environmental Risk Factors and/or Health Outcomes

4.2.3 Other Programs and Workshops in Canada Related to Health and the Environment

5.0 Discussion

5.1 Data Gaps and Research Needs

5.2 Recommendations

6.0 References and Bibliography

*Production of this report has been made possible through a financial contribution from
the Public Health Agency of Canada through the National Collaborating Centre for Environmental Health.

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[EQ] Universal health coverage: friend or foe of health equity?

Universal health coverage: friend or foe of health equity?

Davidson R Gwatkin a, Alex Ergo b

a Results for Development Institute, Washington, DC USA

b Broad Branch Associates, Washington, DC, USA

The Lancet, Volume 377, Issue 9784, Pages 2160 - 2161, 25 June 2011
doi:10.1016/S0140-6736(10)62058-2

Website: http://bit.ly/mJpecA

“…..Once again, calls for universality are being heard from health advocates and planners. Last time around, such calls were for achieving the health-for-all goal at the 1978 Alma-Ata conference. Now they are re-emerging, as more limited but nonetheless stirring appeals to seek universal coverage or access in a wide range of health-related areas such as HIV/AIDS,1 reproductive health,2 health insurance,3 and free health services, particularly for women and children.4 Reflecting such interest, universal coverage will figure as the organising theme of a large WHO research meeting on Nov 16—19 2010.5

This quest for universal coverage is often advocated as a way of improving health equity. If fully achieved, it would clearly do so. Everyone—rich and poor, men and women, ethnic or religious majorities and minorities—would enjoy full equal access to the services concerned.

Such an achievement would obviate both the stigma thought to accompany use of services designed specifically for people who are poor, and the possibility that such services might be of low quality.

But beware—universal coverage is much more difficult to achieve than to advocate. And people who are poor could well gain little until the final stages of the transition from advocacy to achievement, if that coverage were to display a trickle-down pattern of spread marked by increases first in better-off groups and only later in poorer ones. Should the resulting rise in inequality endure for an extended time—or worse, become permanent as a drive for universal coverage falls short of fully realising its goal—the result would be to reduce rather than enhance health equity….”

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[EQ] Method for Synthesizing Knowledge about Public Policies

Method for Synthesizing Knowledge about Public Policies

Public Health Agency of Canada through funding for the
National Collaborating Centre for Healthy Public Policy (NCCHPP) 2010

Available online PDF [65p.] at: http://bit.ly/dRO8Y3

“…………The objective of this document is to propose a knowledge synthesis method that is applicable to public policies and takes into account not only data linked to their effectiveness, but also data on issues related to their implementation, with the aim of identifying the policies that are most likely to succeed in the specific context in which their implementation is being considered.

The proposed knowledge synthesis method draws inspiration from political science, policy analysis, literature on evidence-informed decision making in public health, literature on evaluation, and theoretical developments related to deliberative processes. Having integrated these various foundational elements, the proposed methodological approach:

· applies an analytical framework that takes into consideration not only the effectiveness of public policies, but also their unintended effects, their effects on equity, and the issues related to their implementation (cost, feasibility, and acceptability); and

· considers a range of quantitative and qualitative data from scientific and non-scientific sources.

Our knowledge synthesis method includes four steps.

· The first involves compiling an inventory of public policies that could address the targeted health problem, and choosing the policy on which the knowledge synthesis will focus.

· The second step is devoted to making explicit the intervention logic (logic model), that is, the sequence of effects expected to link the policy under study to the targeted problem.

· The third step, carried out through means of a literature review, involves synthesizing data on the effects of this policy in contexts in which it has already been implemented (effectiveness, unintended effects, effects related to equity) and on the issues related to its implementation (cost, feasibility, acceptability).

· Finally, the fourth step aims at enriching and contextualizing the data drawn from the literature, through deliberative processes that bring together actors concerned by the targeted health problem and working within the context in which implementation of the policy is being considered.

The aim of the deliberative processes is to have these actors discuss the data drawn from the literature, enrich analysis of the data with their own knowledge, and assess the extent to which the data apply to their own context.

To illustrate the use of this method and to verify its relevance, our team tested it by applying it to a public policy option aimed at addressing obesity. Because of this case study, some of the methodological references used refer to obesity; nevertheless, they are equally applicable to public policies concerned with other issues….”

Content

INTRODUCTION

1_ FRAMEWORK FOR ANALYZING PUBLIC POLICIES

1.1_ Dimensions Related to the Effects of Public Policies

1.1.1_ Effectiveness

1.1.2_ Unintended Effects

1.1.3_ Equity

1.2_ Dimensions Related to the Implementation of Public Policies

1.2.1_ Cost

1.2.2_ Feasibility

1.2.3_ Acceptability

1.3_ Relationships Between the Six Dimensions for Analysis

2_ TYPES AND SOURCES OF DATA TO BE CONSIDERED

3_ KNOWLEDGE SYNTHESIS METHOD

3.1_ Inventory of Policies and Selection of the Subject of the Knowledge Synthesis

3.1.1_ Exploration of the Grey Literature

3.1.2_ Survey of the Scientific Literature

3.1.3_ Selection of the Subject of the Knowledge Synthesis

3.2_ Explication of the Intervention Logic of the Public Policy Being Studied

3.3_ Synthesis of Data Drawn From the Literature

3.3.1_ Documentary Search

3.3.2_ Appraisal of the Quality of Data

3.3.3_ Data Perusal and Extraction

3.3.4_ Synthesis of Data Drawn From the Literature

3.4_ Enrichment and Contextualization of Data / Deliberative Processes

3.5_ Synthesis _ Integration of the Different Types of Knowledge Gathered

BIBLIOGRAPHY

APPENDIX 1: List of Selected Websites of Relevance to Public Policy and Health

APPENDIX 2: List of Databases Proposed by the Cochrane Health Promotion and Public Health Field

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