Building the capacity - examining the impact of evidence-based public health trainings in Europe: a mixed methods approach.

OBJECTIVE: Since 2002, a course entitled 'Evidence-Based Public Health (EBPH): A Course in Noncommunicable Disease (NCD) Prevention' has been taught annually in Europe as a collaboration between the Prevention Research Center in St Louis and other international organizations. The core purpose of this training is to strengthen the capacity of public health professionals, in order to apply and adapt evidence-based programmes in NCD prevention. The purpose of the present study is to assess the effectiveness of this EBPH course, in order to inform and improve future EBPH trainings. METHODS: A total of 208 individuals participated in the European EBPH course between 2007 and 2016. Of these, 86 (41%) completed an online survey. Outcomes measured include frequency of use of EBPH skills/materials/resources, benefits of using EBPH and barriers to using EBPH. Analysis was performed to see if time since taking the course affected EBPH effectiveness. Participants were then stratified by frequency of EBPH use (low v. high) and asked to participate in in-depth telephone interviews to further examine the long-term impact of the course (n = 11 (6 low use, 5 high use)). FINDINGS: The most commonly reported benefits among participants included: acquiring knowledge about a new subject (95%), seeing applications for this knowledge in their own work (84%), and becoming a better leader to promote evidence-based decision-making (82%). Additionally, not having enough funding for continued training in EBPH (44%), co-workers not having EBPH training (33%) and not having enough time to implement EBPH approaches (30%) were the most commonly reported barriers to using EBPH. Interviews indicated that work-place and leadership support were important in facilitating the use of EBPH. CONCLUSION: Although the EBPH course effectively benefits participants, barriers remain towards widely implementing evidence-based approaches. Reaching and communicating with those in leadership roles may facilitate the growth of EBPH across countries.

Contribution des acteurs régionaux à la réduction des inégalités sociales de santé : le cas de la France.

Depuis le rapport de la Commission sur les Déterminants Sociaux de la Santé, plusieurs pays ont commencé à intégrer à leurs plans de santé la question des déterminants et de leur impact sur les inégalités de santé. En France, la création des Agences Régionales de Santé en 2009 est considérée comme une opportunité pour agir sur les inégalités sociales de santé (ISS) avec les instances régionales, départementales et locales qui détiennent les leviers appropriés. A la suite d'une analyse thématique des projets régionaux de santé, visant à identifier l'intégration des ISS ainsi que les approches retenues pour les aborder, quatre régions ont été étudiées plus finement. Des entretiens collectifs et individuels ( N = 45 interviewés) ont été menés auprès d'acteurs de terrain et institutionnels, afin de mieux comprendre et identifier les types de programmes et processus pour réduire les ISS. Nos analyses font ressortir une prise en compte généralisée des ISS dans les documents de planification et de programmation des instances régionales, des stratégies régionales qui restent centrées sur les populations vulnérables avec une faible considération du gradient social, l'existence d'instances de concertations intersectorielles dans les quatre régions qui constituent un potentiel de gouvernance important à mieux exploiter, l'existence de modalités de suivi et d'évaluation des ISS qui restent à consolider, et une forte mobilisation de plusieurs secteurs dans les processus régionaux de consultation des publics et des acteurs, mais des résultats variables, souvent reliés au niveau de ressources investies et des approches privilégiées. L'analyse de ces expériences françaises démontre un intérêt croissant pour l'action sur les déterminants sociaux de la santé et les ISS ; mais leur opérationnalisation, toujours en cours, appelle à des analyses plus fines qui permettront de mieux éclairer les politiques publiques.

The use of potential years of life lost for monitoring premature mortality from chronic diseases: Canadian perspectives.

Given that chronic diseases account for 88% of all deaths in Canada, robust surveillance and monitoring systems are essential for supporting implementation of health promotion and chronic disease prevention policies. Canada has a long tradition of monitoring premature mortality expressed as potential years of life lost (PYLL), dating back to the seminal work by Romeder and McWhinnie in the late 1970s, who pioneered the use of PYLL as a tool in health planning and decision-making. The utility of PYLL for monitoring progress was expanded in the 1990s through the national comparable Health Indicators Initiative, following which PYLL has been monitored for several decades nationally, provincially, regionally and locally as part of health systems' performance measurement. Yet the potential for using PYLL in health promotion and chronic disease prevention has not been maximized. Linking PYLL with public health programs and initiatives aimed at health promotion and chronic disease prevention, introduced starting in the 1990s, would inform whether these efforts are making progress in addressing the burden of premature mortality from chronic diseases. Promoting the use of PYLL due to chronic diseases would contribute toward providing a more complete picture of chronic diseases in Canada.

Prevention and control of noncommunicable diseases through evidence-based public health: implementing the NCD 2020 action plan.

The control of noncommunicable diseases (NCDs) was addressed by the declaration of the 66th United Nations (UN) General Assembly followed by the World Health Organization's (WHO) NCD 2020 action plan. There is a clear need to better apply evidence in public health settings to tackle both behaviour-related factors and the underlying social and economic conditions. This article describes concepts of evidence-based public health (EBPH) and outlines a set of actions that are essential for successful global NCD prevention. The authors describe the importance of knowledge translation with the goal of increasing the effectiveness of public health services, relying on both quantitative and qualitative evidence. In particular, the role of capacity building is highlighted because it is fundamental to progress in controlling NCDs. Important challenges for capacity building include the need to bridge diverse disciplines, build the evidence base across countries and the lack of formal training in public health sciences. As brief case examples, several successful capacity-building efforts are highlighted to address challenges and further evidence-based decision making. The need for a more comprehensive public health approach, addressing social, environmental and cultural conditions, has led to government-wide and society-wide strategies that are now on the agenda due to efforts such as the WHO's NCD 2020 action plan and Health 2020: the European Policy for Health and Wellbeing. These efforts need research to generate evidence in new areas (e.g. equity and sustainability), training to build public health capacity and a continuous process of improvement and knowledge generation and translation.

Raising the priority of preventing chronic diseases: a political process.

Chronic diseases, especially cardiovascular diseases, diabetes, cancer, and chronic obstructive respiratory diseases,are neglected globally despite growing awareness of the serious burden that they cause. Global and national policies have failed to stop, and in many cases have contributed to, the chronic disease pandemic. Low-cost and highly effective solutions for the prevention of chronic diseases are readily available; the failure to respond is now a political, rather than a technical issue. We seek to understand this failure and to position chronic disease centrally on the global health and development agendas. To identify strategies for generation of increased political priority for chronic diseases and to further the involvement of development agencies, we use an adapted political process model. This model has previously been used to assess the success and failure of social movements. On the basis of this analysis,we recommend three strategies: reframe the debate to emphasise the societal determinants of disease and the interrelation between chronic disease, poverty, and development; mobilise resources through a cooperative and inclusive approach to development and by equitably distributing resources on the basis of avoidable mortality; and build one merging strategic and political opportunities, such as the World Health Assembly 2008­13 Action Plan and the high level meeting of the UN General Assembly in 2011 on chronic disease. Until the full set of threats­which include chronic disease­that trap poor households in cycles of debt and illness are addressed, progress towards equitable human development will remain inadequate.

Can the Canadian Heart Health Initiative inform the population Health Intervention Research Initiative for Canada?

OBJECTIVES: The aim of the Population Health Intervention Research Initiative for Canada (PHIRIC) is to build capacity to increase the quantity, quality and use of population health intervention research. But what capacity is required, and how should capacity be created? There may be relevant lessons from the Canadian Heart Health Initiative (CHHI), a 20-year initiative (1986-2006) that was groundbreaking in its attempt to bring together researchers and public health leaders (from government and non-government organizations) to jointly plan, conduct and act on relevant evidence. The present study focused on what enabled and constrained the ability to fund, conduct and use science in the CHHI. METHODS: Guided by a provisional capacity-building framework, a two-step methodology was used: a CHHI document analysis followed by consultation with CHHI leaders to refine and confirm emerging findings. RESULTS: A few well-positioned, visionary people conceived of the CHHI as a long-term, coherent initiative that would have impact, and they then created an environment to enable this to become reality. To achieve the vision, capacity was needed to a) align science (research and evaluation) with public health policy and program priorities, including the capacity to study "natural experiments" and b) build meaningful partnerships within and across sectors. CONCLUSION: There is now an opportunity to apply lessons from the CHHI in planning PHIRIC.

The role of surveillance and data use in the development of public health policies.

Decision makers consider numerous factors besides surveillance data in establishing public health policies and programmes. In an evidence-informed system, it is important to collect, interpret, and present information that has maximum impact on the broader policy agenda.Successful policies and programmes are rational, feasible, and practical, with wide public support. Surveillance systems must align and interact with the other parts of the policy infrastructure. There must be continuous links between data providers, collectors, and users. Data must be representative of population variations.For chronic diseases, the major challenge is multiple risks. Surveillance systems must capture many factors from many sources. Data must be presented in plain language and tailored to the needs of various users - politicians, policy makers, health providers, researchers, and the public. Data must be linked to other policy areas such as taxation. Economic arguments, including modelling, strongly influence decisions. Broad data ownership through alliances also has significant impact.

Training practitioners in evidence-based chronic disease prevention for global health.

Too often, public health decisions are based on short-term demands rather than long-term research and objectives. Policies and programmes are sometimes developed around anecdotal evidence. The Evidence-Based Public Health (EBPH) programme trains public health practitioners to use a comprehensive, scientific approach when developing and evaluating chronic disease programmes. Begun in 2002, the EBPH programme is an international collaboration. The course is organized in seven parts to teach skills in: 1) assessing a community's needs; 2) quantifying the issue; 3) developing a concise statement of the issue; 4) determining what is known about the issue by reviewing the scientific literature; 5) developing and prioritizing programme and policy options; 6) developing an action plan and implementing interventions; and 7) evaluating the programme or policy. The course takes an applied approach and emphasizes information that is readily available to busy practitioners, relying on experiential learning and includes lectures, practice exercises, and case studies. It focuses n using evidence-based tools and encourages participants to add to the evidence base in areas where intervention knowledge is sparse. Through this training programme, we educated practitioners from 38 countries in 4 continents. This article describes the evolution of the parent course and describes experiences implementing the course in the Russian Federation, Lithuania, and Chile. Lessons learned from replication of the course include the need to build a "critical mass" of public health officials trained in EBPH within each country and the importance of international, collaborative networks. Scientific and technologic advances provide unprecedented opportunities for public health professionals to enhance the practice of EBPH. To take full advantage of new technology and tools and to combat new health challenges, public health practitioners must continually improve their skills.

Can scientists and policy makers work together?

This paper addresses a fundamental question in evidence based policy making--can scientists and policy makers work together? It first provides a scenario outlining the different mentalities and imperatives of scientists and policy makers, and then discusses various issues and solutions relating to whether and how scientists and policy makers can work together. Scientists and policy makers have different goals, attitudes toward information, languages, perception of time, and career paths. Important issues affecting their working together include lack of mutual trust and respect, different views on the production and use of evidence, different accountabilities, and whether there should be a link between science and policy. The suggested solutions include providing new incentives to encourage scientists and policy makers to work together, using knowledge brokers (translational scientists), making organisational changes, defining research in a broader sense, re-defining the starting point for knowledge transfer, expanding the accountability horizon, and finally, acknowledging the complexity of policy making. It is hoped that further discussion and debate on the partnership idea, the need for incentives, recognising the incompatibility problems, the role of civil society, and other related themes will lead to new opportunities for further advancing evidence based policy and practice.

Evidence-based public health, community medicine, preventive care.

The use of evidence-based reasoning and decision-making theory and practice is becoming increasingly commonplace in most of the health sciences. Public health, which encompasses health protection, disease prevention and health promotion, has traditionally been more evidence-based than clinical medicine. However, more must be done to grade evidence in the absence of classical clinical trials or other experimental proof. Decisions in public health also rely on economical, social and political considerations, but how can evidence in these fields be graded for the best possible decision-making in public health? Moreover, evidence is often unequally distributed in relation to different focus groups. For example, evidence in the area of women's health should be as extensive as it is in the area of men's health. Medicine has traditionally been more ethically inclined than many other fields of human endeavour. In light of this, should we require all decision makers involved in health policies (i.e. politicians, economists, and other stakeholders) to be equally ethically minded? Decisions made without using the best evidence in setting the priorities of health programs and health policies may be ethically questionable. However, the burden and responsibility no longer lie exclusively on the shoulders of physicians and nurses. Evidence-based problem solving and decision-making in health sciences are only approximately a decade old. As a result, the already impressive, but still incomplete accomplishments of the evidence-based medical world require further advancements.