Health Equity: 03/07/12

Wednesday, March 7, 2012

[EQ] Guidance for Evidence-Informed Policies about Health Systems: Rationale for and Challenges of Guidance Development

Guidance for Evidence-Informed Policies about Health Systems:
Rationale for and Challenges of Guidance Development

In the first paper in a three-part series on health systems guidance, Xavier Bosch-Capblanch and colleagues examine how guidance is currently formulated in low- and middle-income countries, and the challenges to developing such guidance.

Xavier Bosch-Capblanch 1,2*, John N. Lavis 3, Simon Lewin 4, Rifat Atun 5, John-Arne Røttingen 4,6, Daniel Dröschel 1,2, Lise Beck 1,2, Edgardo Abalos 7, Fadi El-Jardal i8, Lucy Gilson 9, Sandy Oliver 10, Kaspar Wyss 1,2, Peter Tugwell 11, Regina Kulier 12, Tikki Pang 12, Andy Haines 13

1 Swiss Tropical and Public Health Institute, Basel, Switzerland, 2 University of Basel, Basel, Switzerland, 3 McMaster Health Forum, Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, and Department of Political Science, McMaster University, Hamilton, Ontario, Canada, 4 Norwegian Knowledge Centre for the Health Services, Oslo, Norway, and Health Systems Research Unit, Medical Research Council of South Africa, Cape Town, South Africa, 5 Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland, 6 Harvard Kennedy School, Cambridge, Massachusetts, United States of America, 7 Centro Rosarino de Estudios Perinatales, Rosario, Argentina, 8 Department of Health Policy and Management, American University of Beirut, Beirut, Lebanon, and McMaster Health Forum, McMaster University, Hamilton, Ontario, Canada, 9 School of Public Health, University of Cape Town and Department of Global Health and Development, London School of Hygiene and Tropical Medicine, United Kingdom, 10 EPPI-Centre, Social Science Research Unit, Institute of Education, London, United Kingdom, 11 Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada, 12 Innovation, Information, Evidence and Research, World Health Organization, Geneva, Switzerland, 13 Departments of Social and Environmental Health Research and of Nutrition and Public Health Research, London School of Hygiene & Tropical Medicine, London, United Kingdom

PLoS Med 9(3): e1001185. doi:10.1371/journal.pmed.1001185 - March 6, 2012

Available online at: http://bit.ly/zQJ4NU

Summary Points

Weak health systems hinder the implementation of effective interventions; policies to strengthen such systems need to draw on the best available evidence.

Health systems evidence is best delivered in the form of guidance embedded in policy formulation processes, but health systems guidance is poorly developed at present.

The translation of research on problems, interventions, and implementation into decisions and policies that affect how systems are organised is one challenge facing the development of health systems guidance.

The development of guidance that is timely and usable by the broad range of health systems stakeholders, and of methods to appraise the quality of health systems guidance, are additional challenges.

Further research is needed to adapt existing approaches (e.g., those used in clinical guidelines) to produce meaningful advice that accounts for the complexity of health systems, political systems, and contexts.

This is the first paper in a three-part series in PLoS Medicine on health systems guidance.

This is one paper in a three-part series that sets out how evidence should be translated into guidance to inform policies on health systems and improve the delivery of clinical and public health interventions.

This paper, which is the first in a three-part series on health systems guidance aims to:

- Assess to what extent the need for health systems guidance is part of national policies and plans and
how guidance is currently formulated by analyzing strategic health sector documents from LMICs;

- Describe the methodological challenges in outlining the approaches to produce health systems guidance and to suggest ways to address these challenges.

The second article in this series explores the challenge of linking guidance development and policy development at global and national levels and examines the range of factors that can influence policy development

The third article explores the challenge of assessing how much confidence to place in evidence on health systems interventions

Lavis JN, Røttingen JA, Bosch-Capblanch X, Atun R, El-Jardali F, et al. (2012)
Guidance for evidence-informed policies about health systems: linking guidance development to policy development.
PLoS Med 9: e1001186. doi:10.1371/journal.pmed.1001186.

Lewin S, Bosch-Capblanch X, Oliver S, Akl EA, Vist GE, Lavis J, Ghersi D, Røttingen JA, Steinmann P, Gulmezoglu M, Tugwell P, El-Jardali F, Haines A (2012) Guidance for evidence-informed policies about health systems: assessing how much confidence to place in the research evidence.
PLoS Med 9: e1001187. doi:10.1371/journal.pmed.1001187.

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[EQ] Online Seminar: Incorporating Equity in Health Technology Assessment & Evidence-based Decision Making

Free Upcoming Webinar on:

Incorporating Equity in Health Technology Assessment & Evidence-based Decision Making

When is equity important? How do you address it your systematic review?

Join Erin Ueffing from the Canadian Cochrane Centre for this interactive webinar

WHO Collaborating Center for Knowledge Translation and Health Technology Assessment in Health Equity

March 12th 2012 at 13:00-14:45 (GMT-4), will be broadcast from the University of the West Indies in Kingston, Jamaica.

To check you local time - the World Clock at: http://www.timeanddate.com/worldclock/meeting.html

“….Examples of equity-oriented reviews will be given, along with strategies and methods for considering the effects of interventions
in vulnerable and disadvantaged populations.

This webinar will be presented as a segment of a workshop on Health System Strengthening: Systematic Reviews and Health Technology Assessment,
which will be hosted by the University of the West Indies Clinical Epidemiology Unit, and conducted in collaboration with its partners and sponsors,
The Canadian Society for International Health, the Pan American Health Organization PAHO/WHO, the Cochrane Collaboration,
the University of Ottawa WHO Collaborating Centre, and Health Canada….”

WHO Collaborating Center for Knowledge Translation and Health Technology Assessment in Health Equity:

Website: http://bit.ly/wxili0

How to participate online: No registration is required

To login to the Elluminate session, use the link below and type your name on the sign in page:

http://bit.ly/wM0jYB

To sign-in to the webinar, click on the corresponding URL at least 10 minutes before the scheduled start time.

The webinar room will be open as of 30 minutes before the start time; there is not need to log in before 12:30 pm.

Contact information: Kimberly Manalili at kmanalili@csih.org

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[EQ] Socioeconomic Factors and All Cause and Cause-Specific Mortality among Older People in Latin America, India, and China

Socioeconomic Factors and All Cause and Cause-Specific Mortality among Older People in
Latin America, India, and China: A Population-Based Cohort Study

Academic Editor: Peter Byass, Umea° Centre for Global Health Research, Sweden
Cleusa P. Ferri1*, Daisy Acosta2, Mariella Guerra1,3, Yueqin Huang4, Juan J. Llibre-Rodriguez1,5, Aquiles Salas6,7, Ana Luisa Sosa1,8, Joseph D. Williams9, Ciro Gaona10, Zhaorui Liu4, Lisseth Noriega-Fernandez11, A. T. Jotheeswaran12, Martin J. Prince1

PLoS Med 9(2): e1001179. doi:10.1371/journal.pmed.1001179 February 2012

Available online at: http://bit.ly/A2U1mI

“……Even in low and middle income countries most deaths occur in older adults. In Europe, the effects of better education and home ownership upon mortality seem to persist into old age, but these effects may not generalise to LMICs. Reliable data on causes and determinants of mortality are lacking.

Methods and Findings: The vital status of 12,373 people aged 65 y and over was determined 3–5 y after baseline survey in sites in Latin America, India, and China. We report crude and standardised mortality rates, standardized mortality ratios comparing mortality experience with that in the United States, and estimated associations with socioeconomic factors using Cox’s proportional hazards regression.

Cause-specific mortality fractions were estimated using the InterVA algorithm. Crude mortality rates varied from 27.3 to 70.0 per 1,000 person-years, a 3-fold variation persisting after standardisation for demographic and economic factors. Compared with the US, mortality was much higher in urban India and rural China,

much lower in Peru, Venezuela, and urban Mexico, and similar in other sites. Mortality rates were higher among men, and increased with age. Adjusting for these effects, it was found that education, occupational attainment, assets, and pension receipt were all inversely associated with mortality, and food insecurity positively associated. Mutually adjusted, only education remained protective (pooled hazard ratio 0.93, 95% CI 0.89–0.98). Most deaths occurred at home, but, except in India, most individuals received medical attention during their final illness. Chronic diseases were the main causes of death, together with tuberculosis and liver disease, with stroke the leading cause in nearly all sites.

Conclusions: Education seems to have an important latent effect on mortality into late life.
However, compositional differences in socioeconomic position do not explain differences in mortality between sites.
Social protection for older people, and the effectiveness of health systems in preventing and treating chronic disease, may be as important as economic and human development…..”

1 King’s College London Institute of Psychiatry, Section of Epidemiology, Health Service and Population Research Department, London, United Kingdom,
2 Internal Medicine Department, Universidad Nacional Pedro Henriquez Uren˜ a, Santo Domingo, Dominican Republic,
3 Department of Psychiatry, Universidad Peruana Cayetano Heredia, Lima, Peru,
4 Peking University, Institute of Mental Health, Beijing, China,
5 Medical University of Havana, Havana, Cuba,
6 Medicine Department, Caracas University Hospital, Caracas, Venezuela,
7 Faculty of Medicine, Universidad Central de Venezuela, Caracas, Venezuela,
8 National Institute of Neurology and Neurosurgery of Mexico, Autonomous National University of Mexico, Mexico City, Mexico,
9 Community Health Department, Voluntary Health Services, Chennai, India,
10 Clinica Loira, Caracas, Venezuela,
11 Mental Health Community Centre of Marianao, Havana, Cuba,
12 Indian Institute of Public Health, Hyderabad, India

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[EQ] Disparities in Primary Health Care Experiences Among Canadians With Ambulatory Care Sensitive Conditions

Disparities in Primary Health Care Experiences Among Canadians
With Ambulatory Care Sensitive Conditions

Canadian Institute for Health Information (CIHI). Mar 6, 2012

Available online PDF [22p.] at: http://bit.ly/yUukXu

“……This analytical product focuses on disparities in primary health care by examining differences in access, use and appropriateness of primary health care for Canadians who have ambulatory care sensitive conditions according to their income, geography, health conditions and sex.

The results will assist in identifying barriers to and difficulties in accessing primary health care services and assessing whether all Canadians are receiving an appropriate level of care according to their needs. ….”

“………Ambulatory care sensitive conditions cause considerable illness, hospitalization and death among Canadians and result in a high use of health care services. They affect an estimated 6.8 million Canadians age 20 to 74, and they result in an estimated 95,000 hospitalizations and almost 13,000 deaths annually. Examples of ambulatory care sensitive conditions are asthma, chronic obstructive pulmonary disease, diabetes, high blood pressure and some heart diseases. These conditions can generally be managed with adequate primary health care on an outpatient basis.

The burden of ambulatory care sensitive conditions is not shared equally among all population groups. For example, those who live in rural or disadvantaged areas experience a higher burden from these conditions, compared with those living in urban and less disadvantaged areas. Disparities in hospitalization and mortality rates by socio-economic and geographic conditions are greater than disparities in the underlying prevalence of these conditions in the community

This suggests that the treatment and management of these conditions through primary health care or in acute care settings may not be as appropriate or as effective for some groups of the population. This is supported by various studies that have related an individual’s health and social conditions to use of primary health care and/or need for hospitalization….”

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