ENHANCING HEALTH POLICY THROUGH EPIDEMIOLOGY

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ENHANCING HEALTH POLICY THROUGH EPIDEMIOLOGY

• R.A. Spasoff, MD
• University of Ottawa

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Policy

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

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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

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Policy Instruments

• Legislation and regulations
• Taxation and financial incentives
• Information and coordination
• Provision of direct service

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The Basis of Policy

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

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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

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Policy Analysis

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

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Tugwells Iterative Loop

• 1. Burden of illness
• 2. Aetiology or causation
• 3. Community effectiveness
• 4. Efficiency
• 5. Synthesis Implementation
• 6. Monitoring of Program
• 7. Reassessment

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Policy Cycle

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

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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

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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

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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

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4. Policy implementation

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

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5. Policy evaluation

• Assess the impacts of policies
• Monitor future health

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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

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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)

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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

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Towards a larger rolea 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

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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

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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

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Epidemiology for Health Policy Topics (2)

• Disease Control
• Disease Modelling
• Priority-setting
• Impact Assessment Goal-setting
• Resource Allocation
• Policy Evaluation

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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)

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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

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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