Health Equity: 07/30/12

Monday, July 30, 2012

[EQ] A systems science perspective and transdisciplinary models for food and nutrition security

A systems science perspective and transdisciplinary models for food and nutrition security

Ross A. Hammond a, and Laurette Dubé b

A Center on Social Dynamics and Policy, The Brookings Institution, Washington, DC; USA
b McGill World Platform for Health and Economic Convergence, McGill University, Montreal, Canada
Edited by Prabhu Pingali, Bill and Melinda Gates Foundation, Seattle, WA

PNAS Proceedings of the National Academy of Sciences of the United States of America

Doi: 10.1073/pnas.0913003109 -PNAS July 23, 2012

Available online PDF [8p.] at: http://bit.ly/PceIuV

“….Food and nutrition security remains a pressing global problem, with most countries experiencing one or both of the twin challenges of malnutrition and obesity. We have argued that the drivers of food and nutrition security are complex, multilevel, multisectoral, and heterogeneous.

This paper reviewed structural components, feedback loops, and linkages between agrifood, health and disease, and environmental systems, which are key underlying drivers of sustainable food and nutrition security for smallholders and worldwide.

These complex interconnections pose challenges for design of effective policy and for scientific study using many standard tools…”

KMC/2012/FCH
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[EQ] The challenges confronting clinicians in rural acute care settings

The challenges confronting clinicians in rural acute care settings:
a participatory research project

Paliadelis PS, Parmenter G, Parker V, Giles M, Higgins I
Rural Remote Health. 2012 ; vol. 12(2) pp. 2017

Available online PDF [12p.] at: http://bit.ly/QZiMVe

INTRODUCTION: In Australia, as in many other developed countries, the current healthcare environment is characterised by increasing differentiation and patient acuity, aging of patients and workforce, staff shortages and a varied professional skills mix, and this is particularly so in rural areas.
Rural healthcare clinicians are confronted with a broad range of challenges in their daily practice. Within this context, the challenges faced by rural acute care clinicians were explored and innovative strategies suggested.
This article reports the findings of a study that explored these challenges across disciplines in acute healthcare facilities in rural New South Wales (NSW), Australia.

METHODS: A mixed method approach, involving a consultative, participatory 3 stage data collection process was employed to engage with a range of healthcare clinicians from rural acute care facilities in NSW. Participants were invited to complete a survey, followed by focus group discussions and finally facilitated workshops using nominal group technique.

RESULTS: The survey findings identified the respondents' top ranked challenges.
These were organised into four categories:
(1) workforce issues;
(2) access, equity and opportunity;
(3) resources; and
(4) contextual issues.
Participants in the focus groups were provided with a summary of the survey findings to prompt discussion about the challenges identified and impact of these on their professional and personal lives. The results of the final workshop stage of the study used nominal group process to focus the discussion on identifying strategies to address identified challenges.

CONCLUSIONS: This study builds on research conducted in a large metropolitan tertiary referral hospital. While it was found that rural clinicians share some of the challenges identified by their metropolitan counterparts, some identified challenges and solutions were unique to the rural context and require the innovative solutions suggested by the participants. This article provides insight into the working world of rural healthcare clinicians and offers practical solutions to some of the identified issues. The findings of this study may assist rurally based healthcare services to attract and retain clinical staff.

KMC/2012/HSS
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[EQ] From efficacy to equity: Literature review of decision criteria for resource allocation and healthcare decisionmaking

From efficacy to equity:
Literature review of decision criteria for resource allocation and healthcare decisionmaking

Guindo LA, Wagner M, Baltussen R, Rindress D, van Til J, Kind P, Goetghebeur MM
Cost effectiveness and resource allocation : C/E. 2012 Jul 18; vol. 10(1)

Available online PDF [27p.] at: http://bit.ly/Nf4BEY

Objectives:
Resource allocation is a challenging issue faced by health policy decisionmakers requiring careful consideration of many factors.
Objectives of this study were to identify decision criteria reported in the literature on healthcare decisionmaking.

Method:
An extensive literature search was performed in Medline and EMBASE to identify articles reporting healthcare decision criteria. Studies conducted with decisionmakers (e.g., focus groups, surveys, interviews), conceptual and review articles and articles describing tools were included. Criteria were extracted, organized using a classification system derived from the EVIDEM framework and applying multicriteria decision analysis (MCDA) principles, and the frequency of their occurrence was measured.

Results:
Out of 3146 records identified, 2790 were excluded. Out of 356 articles assessed for eligibility, 39 were included in the study. Criteria were identified from studies performed in several regions of the world involving decisionmakers at micro, meso and macro levels of decision and from studies reporting on multicriteria tools. Large variations in terminology used to define criteria were observed and 338 different terms were identified.

These were assigned to 58 criteria which were classified in 9 different categories including: health outcomes; types of benefit; disease impact; therapeutic context; economic impact; quality of evidence; implementation complexity; priority, fairness and ethics; and overall context.
The most frequently mentioned criteria were:
equity/fairness (33 times),
efficacy/effectiveness (28),
healthcare stakeholder interests and pressures (28),
cost-effectiveness (24),
strength of evidence (20),
safety (19),
mission and mandate of health system (18),
need (16),
organizational requirements and capacity (18) and
patient-reported outcomes (16).

Conclusion:
This study highlights the importance of considering both normative and feasibility criteria for fair allocation of resources and optimized decisionmaking for coverage and use of healthcare interventions. This analysis provides a foundation to develop a questionnaire for an international survey of decisionmakers on criteria and their relative importance. The ultimate objective is to develop sound multicriteria approaches to enlighten healthcare decisionmaking and priority-setting.

KMC/2012/HSS
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