CiteULike: Tag health-policy

Representation or Reason: Consulting the Public on the Ethics of Health Policy.

Caroline Mullen — 2007-10-10T21:52:09-00:00

Health Care Anal (6 October 2007)

Consulting the public about the ethical approaches underlying health policies can seem an appealing means of addressing concerns about limited public participation in development of health policy. However ambiguity surrounds questions of whether, or how consultation can really contribute to more defensible decisions about ethical aspects of policy. This paper clarifies the role and limits of public consultation on ethics, beginning by separating different senses of defensibility in decisions on ethics. Defensibility of ethical decisions could be understood either in the sense of legitimacy in virtue of reflecting the opinions of the public whose interests are affected, or in the sense of being able to withstand and respond to challenges presented in ethical debate. The question then is whether there are forms of consultation which have the potential to realise more defensible decisions in either of these senses. Problems of adequately accounting for the views of those affected by policy decisions casts doubt on the plausibility of using consultation as a means of determining the opinions of the public. Consultation can have a role by bringing new ideas and challenges to debate, although it is uncertain whether this will increase the defensibility of any decision on ethics.

Towards evidence-based, GIS-driven national spatial health information infrastructure and surveillance services in the United Kingdom

Maged Boulos — 2007-12-29T16:30:00-00:00

International Journal of Health Geographics, Vol. 3, No. 1. (2004)

The term "Geographic Information Systems" (GIS) has been added to MeSH in 2003, a step reflecting the importance and growing use of GIS in health and healthcare research and practices. GIS have much more to offer than the obvious digital cartography (map) functions. From a community health perspective, GIS could potentially act as powerful evidence-based practice tools for early problem detection and solving. When properly used, GIS can: inform and educate (professionals and the public); empower decision-making at all levels; help in planning and tweaking clinically and cost-effective actions, in predicting outcomes before making any financial commitments and ascribing priorities in a climate of finite resources; change practices; and continually monitor and analyse changes, as well as sentinel events. Yet despite all these potentials for GIS, they remain under-utilised in the UK National Health Service (NHS). This paper has the following objectives: (1) to illustrate with practical, real-world scenarios and examples from the literature the different GIS methods and uses to improve community health and healthcare practices, e.g., for improving hospital bed availability, in community health and bioterrorism surveillance services, and in the latest SARS outbreak; (2) to discuss challenges and problems currently hindering the wide-scale adoption of GIS across the NHS; and (3) to identify the most important requirements and ingredients for addressing these challenges, and realising GIS potential within the NHS, guided by related initiatives worldwide. The ultimate goal is to illuminate the road towards implementing a comprehensive national, multi-agency spatio-temporal health information infrastructure functioning proactively in real time. The concepts and principles presented in this paper can be also applied in other countries, and on regional (e.g., European Union) and global levels.

What is the relationship between income inequality and health? Evidence from the BHPS

Paula Lorgelly — 2008-01-05T14:10:01-00:00

Health Economics, Vol. 9999, No. 9999. (2007), n/a.

Income inequality hypotheses propose that income differentials and/or income distributions have a detrimental effect on health. This previously well accepted relationship between inequality and health has recently come under scrutiny; some claim that it is a statistical artefact, arguing that aggregate level data are not sophisticated enough to adequately test for (and discriminate between) their existence. Supporters argue that it is a question of estimating the relationship using, amongst other things, an appropriate geographical scale. This paper adds to the debate by estimating the relationship between income inequality and health using individual panel data, exploring the relationship at the regional as well as the national level, while attempting to discriminate between the competing hypotheses. Pooled, random and fixed effects ordered probit models are exploited to estimate the relationship between self-reported health and household income, income inequality and relative income. While the estimating regressions find support for the absolute income hypothesis, there is no support for the income inequality hypothesis or relative income hypothesis, and as such we argue that there is limited evidence of an effect of income inequality on health within Britain. Copyright © 2007 John Wiley & Sons, Ltd.

Understanding the limited impact of economic evaluation in health care resource allocation: A conceptual framework

Iestyn Williams — 2008-01-03T18:00:25-00:00

Health Policy, Vol. 80, No. 1. (January 2007), pp. 135-143.

Concern has increasingly been expressed at the low level of impact that economic evaluations have on the priority setting decisions they are designed to inform. The concern to maximise the impact of economic evaluation in health care is reminiscent of research utilisation debates rehearsed in the various policy studies disciplines. This paper draws on selected themes and frameworks from this literature in order to explore issues and map out an agenda relating to the uptake and use of cost effectiveness analysis in health policy decisions. The authors consider the implications for health economics, and other policy-related research and evaluation, of adopting either a rational or interactive model of research utilisation. Economic evaluations can be normative or descriptive decision tools. The choice of approach will reflect the assumed model of research utilisation and has implications for overcoming barriers to impact on policy. There is an underlying conceptual link between the rational model of research utilisation, the normative approach to economic evaluation and a focus on barriers to the accessibility of published analyses. In contrast, acknowledgement of an interactive and incremental policy process predisposes the analyst to a more descriptive approach and suggests the importance of broader systems, process and ethical barriers to the use of economic evaluation. We address the crucial issue of the importance of establishing objectives and discuss how this issue effects how those seeking to influence policy should proceed. Finally, we discuss indirect or `enlightenment' models of research utilisation and the implications of these for the community of health economists.

Incorporating geographies of health into public policy debates: The GeoHealth Laboratory

Pearce — 2007-07-09T23:56:20-00:00

New Zealand Geographer, Vol. 63, No. 2. (August 2007), pp. 149-153.

Programme costs in the economic evaluation of health interventions

Benjamin Johns — 2007-12-20T19:58:07-00:00

Cost Effectiveness and Resource Allocation, Vol. 1, No. 1. (2003)

Estimating the costs of health interventions is important to policy-makers for a number of reasons including the fact that the results can be used as a component in the assessment and improvement of their health system performance. Costs can, for example, be used to assess if scarce resources are being used efficiently or whether there is scope to reallocate them in a way that would lead to improvements in population health. As part of its WHO-CHOICE project, WHO has been developing a database on the overall costs of health interventions in different parts of the world as an input to discussions about priority setting.Programme costs, defined as costs incurred at the administrative levels outside the point of delivery of health care to beneficiaries, may comprise an important component of total costs. Cost-effectiveness analysis has sometimes omitted them if the main focus has been on personal curative interventions or on the costs of making small changes within the existing administrative set-up. However, this is not appropriate for non-personal interventions where programme costs are likely to comprise a substantial proportion of total costs, or for sectoral analysis where questions of how best to reallocate all existing health resources, including administrative resources, are being considered.This paper presents a first effort to systematically estimate programme costs for many health interventions in different regions of the world. The approach includes the quantification of resource inputs, choice of resource prices, and accounts for different levels of population coverage. By using an ingredients approach, and making tools available on the World Wide Web, analysts can adapt the programme costs reported here to their local settings. We report results for a selected number of health interventions and show that programme costs vary considerably across interventions and across regions, and that they can contribute substantially to the overall costs of interventions.

Arsenic poisoning in Bangladesh: spatial mitigation planning with GIS and public participation

Manzurul Hassan — 2007-12-13T17:31:45-00:00

Health Policy, Vol. 74, No. 3. (November 2005), pp. 247-260.

A PPGIS (Public Participatory Geographical Information System) has recently been developed in combination with PRA (Participatory Rural Appraisal) and GIS (Geographical Information Systems) methodologies to utilise GIS in the context of the needs of communities that are involved with, and affected by development programmes. The impact of arsenic poisoning in Bangladesh is `tragic and painful' on patients' health and their social life what was described as the `worse mass poisoning in human history' in a WHO report. Deep tubewell is said to be a source of arsenic-free safe drinking water and people are mainly interested in deep tubewell water rather than rainwater harvesting, dug-wells, and pond-sand-filters (PSF) approved by the BAMWSP (Bangladesh Arsenic Mitigation Water Supply Project). This paper mainly explores the application and suitability of GIS with local community participation in deep tubewell planning for arsenic mitigation. The relevant data for this study were collected from the field survey. The PRA methods were used to obtain social and resource information; while a GIS was used to organise, analyse, and display the information. Participants from three different focus-groups were asked to determine their `own priorities' for spatial planning of deep tubewell for arsenic-free water. The study results valuable community perspectives on deep tubewell planning and reveals the suitability of PPGIS in spatial planning for arsenic mitigation with local community mapping overlay. The process of dialogue and preparation of mental mapping within each focus-group participants lead to enhance information about community needs of deep tubewell in the study area.

Analyzing Location-Based Accessibility to Dental Services: An Ohio Case Study

Mark Horner — 2007-12-28T21:09:51-00:00

Journal of Public Health Dentistry, Vol. 67, No. 2. (2007), pp. 113-118.

Abstract Oral health is important to overall health. Therefore, dental services should be available and accessible in order for patients to receive care. Objective: This study aims to identify regional inequities in dental provider location and suggest an innovative methodology that could be useful in establishing new dental facilities that are geographically accessible. Methods: Using a census of dentist locations for the state of Ohio in 1998, geographical accessibility to dental care was analyzed. A geographic information systems (GIS)-based model to evaluate the regional distribution of dentists was developed. In this article, it is applied to estimate the number of new dental facilities needed based on the geographical proximity or distance to nearest dentist or dental facility. Results are interactively displayed and mapped with GIS for visualization. Results: Four hundred thirteen of 1,008 zip codes in Ohio did not have dentists. Using a service standard of S=5 (all zip codes without dentists must be within 5 miles of a zip code with a dentist), 307 zip codes were not served by dentists. With a standard of S=10, only 45 zip codes in Ohio were not served by dentists, with only 24 additional offices needed to be located to allow accessibility to a dentist within 10 miles. Conclusions: Using GIS and geographical techniques to reveal and solve the potential locational inequities in accessibility to dental care, this work links oral health policy with geographical techniques.

Visual localisation of community health needs to rational decision-making in public health services

Yoshihiro Kaneko — 2007-12-29T04:09:03-00:00

Health & Place, Vol. 9, No. 3. (September 2003), pp. 241-251.

The objectives were to visualise the locations of community health needs and to develop a community health needs assessment geographic information system (GIS) for rational decision-making in public health services. We compiled census data, digital data of basic planning maps, digital data of topographic maps, contents of registers of medical and welfare facilities, and statistics of establishments into a geographical database; visualised geographical distributions of specific community health needs by integrating sets of indicators to reflect individual needs; and quantified their clustering by the nearest neighbour method. The database aggregated 3400 items of demographic, life and environmental factors. Thematic maps and clustering values showed different patterns of geographical distribution of the individual community needs. Means to match needs with services in smaller geographical units were discussed. This GIS will support appropriate resource allocation, intersectoral collaboration and greater transparency in planning and implementing services, by visualising locations of community health needs.

Policy at the margins: developing community capacity in a rural Health Action Zone

Joyce Halliday — 2005-06-25T11:49:29-00:00

Area, Vol. 37, No. 2. (June 2005), pp. 180-188.

Data mining and visualization for decision support and modeling of public health-care resources

Nada Lavrac — 2007-12-02T03:18:13-00:00

Journal of Biomedical Informatics, Vol. 40, No. 4. (August 2007), pp. 438-447.

This paper proposes an innovative use of data mining and visualization techniques for decision support in planning and regional-level management of Slovenian public health-care. Data mining and statistical techniques were used to analyze databases collected by a regional Public Heath Institute. We also studied organizational aspects of public health resources in the selected Celje region with the objective to identify the areas that are atypical in terms of availability and accessibility of public health services for the population. The most important step was the detection of outliers and the analysis of availability and accessibility deviations. The results are applicable to health-care planning and support in decision making by local and regional health-care authorities. In addition to the practical results, which are directly useful for decision making in planning of the regional health-care system, the main methodological contribution of the paper are the developed visualization methods that can be used to facilitate knowledge management and decision making processes.

Disease Mongering Is Now Part of the Global Health Debate

Ray Moynihan — 2008-05-28T12:13:03-00:00

PLoS Medicine, Vol. 5, No. 5. (1 May 2008), e106.

Health Action Zones and the problem of community

Paul Crawshaw — 2007-12-29T16:52:35-00:00

Health & Social Care in the Community, Vol. 11, No. 1. (2003), pp. 36-44.

Abstract Health Actions Zones (HAZs) have been identified as initiatives reflecting the 'third way' policies espoused by the UK New Labour Government. Like other area-based or zone initiatives, HAZ programmes are designed to tackle inequalities and exclusion in some of the most deprived areas of the UK. This is to be achieved through partnerships between the public, private and voluntary sectors, and most significantly, communities themselves. Health Action Zones embrace communities and attempt to foster involvement in health improvement, often using established community development models. The present paper uses the findings of an ongoing process study into the development of one zone in the north-east of England to consider community involvement in practice. The benefits and challenges of involving communities in the HAZ process are presented, and the relevance of this for future programmes and policy are discussed.

Health Action Zones: the 'third way' of a new area-based policy?

Martin Powell — 2007-12-29T16:50:14-00:00

Health & Social Care in the Community, Vol. 9, No. 1. (2001), pp. 43-50.

Abstract The notion of the action zone has emerged as a key feature of New Labour's approach to social policy. There is some debate about whether Labour's area-based policies reflect the Old Left, the New Right or the 'third way'. This paper critically examines these issues for Health Action Zones (HAZs). First, it outlines the development of HAZs and their main features. It then examines the themes that may have underpinned the HAZ strategy. Finally it examines critiques of HAZs in the light of wider debates about area-based strategies. It is concluded that HAZs fit well with some of New Labour's key themes, and may have some characteristics of a third way in that they incorporate features of both the 'Old Left' of the Black Report and the New Right of competitive, bidding exercises. Moreover, they have addressed some of the main criticisms of earlier area-based policies, arguably being based on place rather than people poverty. However, some of the issues regarding their designation illustrate unresolved problems.

Science and society: Ensuring the appropriate use of genetic tests

Wylie Burke — 2004-12-06T02:32:03-00:00

Nature Reviews Genetics, Vol. 5, No. 12. (01 December 2004), pp. 955-959.