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ENHANCING HEALTH POLICY THROUGH EPIDEMIOLOGY

ENHANCING HEALTH POLICY THROUGH EPIDEMIOLOGY. R.A. Spasoff, MD University of Ottawa. Policy. A set of principles guiding decision-making Public Policy : policy of governments Health Policy : health promotion, health protection, health services (plus…). Healthy Public Policy.

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ENHANCING HEALTH POLICY THROUGH EPIDEMIOLOGY

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  1. ENHANCING HEALTH POLICY THROUGH EPIDEMIOLOGY R.A. Spasoff, MD University of Ottawa

  2. Policy • A set of principles guiding decision-making • Public Policy: policy of governments • Health Policy: health promotion, health protection, health services (plus…)

  3. 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

  4. Policy Instruments • Legislation and regulations • Taxation and financial incentives • Information and coordination • Provision of direct service

  5. The Basis of Policy • Values • Ideology • Politics • Evidence • Not usually the main influence on policy, but worth fighting for • The main contribution of epidemiology

  6. 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

  7. Policy Analysis • The process of predicting the impacts of possible policies and evaluating past policies • Epidemiology can make a major contribution to both steps

  8. Tugwell’s Iterative Loop • 1. Burden of illness • 2. Aetiology or causation • 3. Community effectiveness • 4. Efficiency • 5. Synthesis & Implementation • 6. Monitoring of Program • 7. Reassessment

  9. Policy Cycle • 1. Assessment of population health • 2. Assessment of potential interventions • 3. Policy choices • 4. Policy implementation • 5. Policy evaluation

  10. 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

  11. 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

  12. 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

  13. 4. Policy implementation • Help to set targets for the chosen policies • Inform needs-based resource allocation for health services • Guide development of information systems

  14. 5. Policy evaluation • Assess the impacts of policies • Monitor future health

  15. 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

  16. 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 policy-makers • Different values • Different time scales • Lack of credibility (often not “real MDs”)

  17. 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

  18. 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

  19. 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

  20. 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

  21. Epidemiology for Health Policy: Topics (2) • Disease Control • Disease Modelling • Priority-setting • Impact Assessment & Goal-setting • Resource Allocation • Policy Evaluation

  22. 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)

  23. 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

  24. 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

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