Pierre L.-J. Ritchie

1
Session 8

• Pierre L.-J. Ritchie
• Co-Chair

2
Principles

• Promotion of Informed Choice
• Managing Change
• Inter-sectoral / Interdisciplinary
• Health dynamics / Biosphere dynamics/ Urban
  dynamics
• Include evolutionary historic knowledge /
  perspectives
• What works as well as problems
• Integration / Promote Connections Synergies
• Setting Priorities Value added that has not
  been done / requires a new science plan organized
  within a systems analysis framework
• Normative (in Context)

3
Issues / Problématiques (1)

• What do local planners, city / national
  politicians need want?
• What makes for informed choice by these policy
  makers?
• Definition of Health Well-being Adopt WHO
  definition?
• Definition of Health System Adopt PAHO
  definition?
• Define Urban
• Ethical / values implications resolution of
  dilemmas
• Is development of Standards (gold or minimal) a
  goal?
• Identify Targets of Opportunity
• Identifying the Drivers
• Identify existing data bases

4
Issues / Problématiques (2)

• How to cope with Everything re inclusion in
  whole or in part the State of the Science topics
• How to create an inventory of models (including
  choice of models) / build on existing work
• How to mobilize trans-disciplinarity
• How to address access
• How to address intra-urban heterogeneity /
  inequities
• Limit or not the focus on cities of particular
  sizes in particular, informal components and
  whether to include mega-cities
• How to include evaluation of outcomes in the
  Health Science Plan, including unintended
  consequences

5
Issues / Problématiques (3)

• Science / Cities partnerships
• Private / Public partnerships
• Professional Association partnerships
• Local National Science Academy partnerships

6
WHO definition

• Health is a state of complete physical, mental
  and social well-being and not merely the absence
  of disease of infirmity.

7
PAHO definition

• Group of public and private for/non-profit
  national and sub-national institutions that
  endeavor to protect the health of the people.
  Essentially, the health system is the health
  sector categorized (with linkages) according to
  core functions (financing, provision of inputs
  and service delivery/coverage), main actors
  (government and consumers/households) and
  outcomes (health, fairness in financing and
  responsiveness. WHO defines the goals of health
  systems as (i) Improving the health of the
  population they serve (ii) Responsiveness, i.e.,
  responding to peoples legitimate expectations
  and (iii) Fair financing, i.e., providing
  financial protection against the costs of
  ill-health.

8
Session 8

• Dov Jaron
• Co-Chair

9
Why systems analysis

• Integration rather than reduction
• Cannot predict output by separate analysis of
  individual elements
• Understand interactions
• Eliminate unimportant factors
• Make informed predictions
• Propose changes, remediation to influence health
• Allow for powerful visual presentations

10
System Properties

• Nonlinear
• Stochastic (non deterministic)
• Multifactorial interrelationships between
  factors
• e.g. hurricane/resources/policy
• e.g. spending 75 of income on health leads to
  greater poverty
• Multidimensional (health/wealth)
• e.g. changes not along curve but curve changes
  position what is the extra dimension?

11
Different vantages

• Hierarchical
• Individual family neighborhood city -
  -region global
• Each hierarchical level may interact with other
  levels
• Differences between developed and developing
  countries
• Each level influenced by personal and social
  behavior, cultural and spiritual background,
  education
• Each level influenced by external factors
• Factorial, time dependent
• Nutrition, obesity, water, waste, crime,
  accidents, war etc.
• Factors at each level may be different
• Influenced by historical information and
  perspective

12
Requirements

• What other analyses are there
• Can they assist in our task?
• Can they be integrated into ours
• How not to duplicate other efforts?
• Sensitivity analysis
• Which are the important factors (may not be
  obvious from the start)

13
Next?

• What to focus on
• Agree on definition of health
• Agree on initial set of parameters to be included
• Agree on basic needs for health
• Agree on goals of program, on target audience
• Factors that can make significant change to
  improve health
• Factors that can influence (policy makers,
  practitioners)
• Do we have quality data? What data can be
  included in a systems approach? What are the
  gaps, what new data should we seek?
• Outcome measures (monitoring)
• Have we made a difference