Download ENHANCING HEALTH POLICY THROUGH EPIDEMIOLOGY

ENHANCING HEALTH
POLICY THROUGH
EPIDEMIOLOGY
R.A. Spasoff, MD
University of Ottawa
1
Policy
• A set of principles guiding
decision-making
• Public Policy: policy of
governments
• Health Policy: health promotion,
health protection, health
services (plus…)
2
Healthy Public Policy
• From health promotion
movement
• Use of policy in all sectors to
promote health
• Policy can also contribute to
disease prevention and
treatment at all levels
3
Policy Instruments
• Legislation and regulations
• Taxation and financial
incentives
• Information and coordination
• Provision of direct service
4
The Basis of Policy
•
•
•
•
Values
Ideology
Politics
Evidence
– Not usually the main influence on
policy, but worth fighting for
– The main contribution of
epidemiology
5
Premise of this
presentation
• Decisions must be made,
regardless of the quality of the
supporting evidence
• Some evidence is better than no
evidence
• Epidemiology can provide much
of the important evidence
6
Policy Analysis
• The process of predicting the
impacts of possible policies and
evaluating past policies
• Epidemiology can make a major
contribution to both steps
7
Tugwell’s Iterative Loop
•
•
•
•
•
•
•
1.
2.
3.
4.
5.
6.
7.
Burden of illness
Aetiology or causation
Community effectiveness
Efficiency
Synthesis & Implementation
Monitoring of Program
Reassessment
8
Policy Cycle
• 1. Assessment of population
health
• 2. Assessment of potential
interventions
• 3. Policy choices
• 4. Policy implementation
• 5. Policy evaluation
9
1. Assessment of
population health
• Demography, population dynamics
• Descriptive epidemiology:
–
–
–
–
–
Measure the health of the population
Identify trends and patterns
Assess health risks
Assess health needs
Identify priority targets for policy
development
• Analytical epidemiology
–
Individual-level and population-level
causes
10
2. Assessment of
potential interventions
• Identify potential policy
interventions
• Synthesize existing knowledge
regarding their effectiveness
• Contribute relevant new
research
• Assess the potential of each
approach
11
3. Policy choices
• Project impact of potential
interventions on the health of
the population
– Computer simulations of different
interventions
• Assist the process of consensus
development
12
4. Policy implementation
• Help to set targets for the
chosen policies
• Inform needs-based resource
allocation for health services
• Guide development of
information systems
13
5. Policy evaluation
• Assess the impacts of policies
• Monitor future health
14
Epidemiology & Health
Policy: three examples
• Healthy People 2010 (and Health
21)
– goal-setting, targets
• Global Burden of Disease
– ethical basis, DALYs
• Public Health Status and
Forecasts in the Netherlands
– integrated process
15
Why epidemiology has
had a limited influence
• Our fault
–
–
–
Emphasis on aetiologic research
Grime avoidance
Focus on individual-level risk actors
• Not our fault
–
Different backgrounds from policymakers
– Different values
– Different time scales
– Lack of credibility (often not “real MDs”)
16
Towards a larger role:
relevant expertise
•
•
•
•
•
•
•
•
Policy and its formation
Descriptive epidemiology
Population health data
Social determinants of health
Health and disease modelling
Geographical information systems
Multilevel modelling
Population dynamics
17
Towards a larger role:
a developing discipline
•
•
•
•
Teaching (see course description)
Professional societies
Broadened role for journals
Policy-relevant research
–
–
–
–
Inequalities in health
Measuring health needs
Multilevel analyses of health
Health and disease modelling
• Communication skills, research
transfer
• Working with policy-makers
18
Epidemiology for Health
Policy: Objectives
• To provide students with:
• 1. knowledge of how health policy is
developed and used;
• 2. knowledge of epidemiologic
methods relevant to the development
of health policy; and
• 3. the skills to use that knowledge, in
collaboration with policy-makers
19
Epidemiology for Health
Policy: Topics (1)
•
•
•
•
•
•
•
Policy and Health Policy
Policy Formulation
Ethics, Politics & Communication
Measuring Population Health
Health Burden and Health Needs
Assessing Causation
Assessing Interventions
20
Epidemiology for Health
Policy: Topics (2)
•
•
•
•
Disease Control
Disease Modelling
Priority-setting
Impact Assessment & Goalsetting
• Resource Allocation
• Policy Evaluation
21
Policy-relevant thesis
topics
•
•
•
•
Small-area estimation of health
Adapting “Prevent” to Ontario
Small-area variations in health care
Evaluating a restricted driver
licensing policy
• Modelling mammographic screening
beyond age 69
• Economic burden of breast-feeding
• Income inequality and health (two
theses, one using multilevel analysis)
22
Relevant resources:
Books
• Spasoff, Epidemiologic Methods for
Health Policy, 1999
• Brownson/Petitti, Applied
Epidemiology, 1998
• Young, Population Health, 1998.
• Petitti, Meta-Analysis, Decision
Analysis, and Cost-effectiveness
Analysis (2nd ed), 2001
• Gray, Evidence-based Healthcare,
1997
23
Relevant resources:
Journals
• International Journal of Epidemiology
• Journal of Epidemiology and
•
•
•
•
Community Health
British Medical Journal
Journal of Public Health Policy
Public Health Reports
American Journal of Public Health
24