ABSTRACT
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.
Subject(s)
Capacity Building/methods , Evidence-Based Practice/methods , Noncommunicable Diseases/prevention & control , Public Health/education , Chronic Disease , Cross-Sectional Studies , Decision Making , Europe/epidemiology , Evaluation Studies as Topic , Health Impact Assessment/methods , Health Promotion/methods , Health Services Research , Humans , Intersectoral Collaboration , Knowledge , Leadership , Program Evaluation/statistics & numerical data , Surveys and Questionnaires , Time FactorsABSTRACT
Despite positive trends, life expectancy in Serbia is well below the average for the WHO European Region.The probability of dying from one of the main noncommunicable diseases (NCDs) between the ages of30 and 69 years is 20%. This has significant socioeconomic consequences for the development of thecountry and calls for an immediate strengthening of the health system to respond to the growing burdenof NCDs. Despite significant progress and political commitment in Serbia, the outcomes of NCDs couldstill be improved. This report reviews the challenges and opportunities facing the health system in Serbiain scaling up core services for the prevention, early diagnosis and management of NCDs. The report alsoprovides examples of good practice in care. Policy recommendations are made for further action, based onthe assessment.
Subject(s)
Chronic Disease , Noncommunicable Diseases , Cardiovascular Diseases , Delivery of Health Care , Universal Health Insurance , Primary Health Care , SerbiaABSTRACT
Уровень преждевременной смертности от неинфекционных заболеваний (НИЗ) в Казахстане – одиниз наиболее высоких среди стран Европейского региона ВОЗ; в 2012 г. он составил 648,31 на 100 000человек населения в возрасте от 30 до 69 лет. Значительные социально-экономические последствияэтой ситуации для развития страны обусловливают необходимость срочного укрепления потенциаласистемы здравоохранения для эффективного реагирования на растущее бремя НИЗ. В Казахстанев этом направлении уже достигнут значительный прогресс, имеется также прочная политическаяприверженность, однако показатели по контролю НИЗ все еще нуждаются в улучшении. В настоящемдокладе приведен обзор проблем и возможностей системы здравоохранения Казахстана применительнок наращиванию основных услуг профилактики, ранней диагностики и лечения НИЗ. Также освещеныпримеры передовой практики в оказании помощи пациентам с инсультом, онлайновом использованиимедицинской информации и ведении регистров. По результатам оценки сформулированы рекомендациидля дальнейших действий.
Subject(s)
Primary Health Care , Kazakhstan , Universal Health Care , Noncommunicable DiseasesABSTRACT
Kazakhstan has one of the highest rates of premature mortality due to noncommunicable diseases (NCDs) in the WHO European Region: the rate in 2012 was 648.31 per 100 000 population aged 30–69 years. This has signifi cant socioeconomic consequences for the development of the country and calls for immediate strengthening of the health system to respond to the growing burden of NCDs. Despite signifi cant progress and political commitment in Kazakhstan, the outcomes of NCDs could still be improved. This report reviews the challenges and opportunities of the health system in Kazakhstan for scaling up core services for the prevention, early diagnosis and management of NCDs. The report also provides examples of good practice in the care of stroke patients and online health information and registries. Policy recommendations are made for further action, based on the assessment.
Subject(s)
Noncommunicable Diseases , Universal Health Care , Kazakhstan , Primary Health CareABSTRACT
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.
Subject(s)
Healthcare Disparities/organization & administration , Female , France , Health Promotion , Humans , Male , Program EvaluationABSTRACT
В 2013 году Кыргызстан принял программу и план реализации программы по профилактике и контролюнеинфекционных заболеваний (НИЗ) на 2013–2020 гг. Страна обратилась к Региональному бюро ВОЗ за помощью впроведении среднесрочной оценки реализации программы с целью мониторинга прогресса в достижении целей,выявления проблем и возможностей для улучшения реализации программы и внедрения инноваций на второмэтапе. Проведение оценки программы и плана реализации программы по НИЗ руководствовалось всеобъемлющиммеханизмом, основанным на логической матрице цепочки результатов. Ключевые рекомендации, разработанныеи согласованные с Министерством здравоохранения, касались следующих направлений: активизации усилий вотношении контроля факторов риска НИЗ; наращивания потенциала в области мониторинга и оценки; повышенияэффективности распределения ресурсов; укрепления координации и подотчетности в целях наращиванияпотенциала
Subject(s)
Chronic Disease , National Health Programs , Program Evaluation , KyrgyzstanABSTRACT
Kyrgyzstan adopted a NCD programme and an action plan on noncommunicable diseases (NCDs) for 2013–2020 in 2013. The country requested support from the WHO Regional Office for Europe in conducting a mid-term review on its implementation to monitor progress towards the targets and to identify challenges and opportunities for improvement and innovation in the second part of the term. A comprehensive framework guided the review of the programme and action plan on NCDs based on the logical result-chain matrix. Key recommendations have been identified and discussed with the Ministry of Health in the following areas: accelerating efforts to control the NCD risk factors; increasing capacity in monitoring and evaluation; improving allocative efficiency; and strengthening coordination and accountability to ensure increased capacity.
Subject(s)
Chronic Disease , National Health Programs , Program Evaluation , KyrgyzstanABSTRACT
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.
Subject(s)
Chronic Disease/mortality , Life Expectancy , Mortality, Premature , Population Surveillance/methods , Adult , Aged , Canada/epidemiology , Female , Humans , Male , Middle AgedABSTRACT
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.
Subject(s)
Evidence-Based Practice/methods , Preventive Medicine/methods , Health Policy , Humans , United Nations , World Health OrganizationABSTRACT
Like many countries Armenia is facing a growing noncommunicable disease (NCD) burden. This report examinesthe opportunities and challenges for Armenia to accelerate improvement in cardiovascular and diabetesoutcomes. Significant progress on population-level prevention is required and eff orts and enforcement modalities for alcohol and tobacco control could be stepped up. Obesity is a growing challenge yet interventions to improve diet and physical activity are limited. A multisectoral platform backed up by targets, monitoring and accountability would help overcome sectoral segmentation in the public administration. Organization of general practitionerservices create a good platform for the detection and management of NCDs, although fragmentation of patientcare between providers needs to be overcome. Nurses could be better used throughout the system particularly in counselling and management of patients with chronic conditions. Public spending on health care is relativelylow. Increasing health care spending requires raising more funds to be spent on health services, for examplethrough earmarked taxes, and freeing up resources through more efficient and effective use of existing resource.
Subject(s)
Chronic Disease , Noncommunicable Diseases , Cardiovascular Diseases , Delivery of Health Care , Primary Health Care , ArmeniaABSTRACT
We have reviewed the health system challenges and opportunities in the former Yugoslav Republic of Macedonia for improving core services for the prevention, early diagnosis and management of noncommunicable diseases(NCDs). The outcomes of most of these diseases have been improving, while mortality from diabetes has been increasing, and there are significant regional differences in the rates of premature mortality. The success achieved is partly due to progress in core population interventions (e.g. tobacco control) and individual services, although these could be further strengthened. It is recommended that, to further strengthen the health system response to NCDs, the Government should consider the following areas: strengthening governance and coordination mechanisms; investing in strengthening the evidence base and using evidence-based actions; empowering the population and patients; and optimizing models of care, aligning incentives and establishing mechanisms for continuous quality improvement.
Subject(s)
Chronic Disease , Delivery of Health Care , Universal Health Care , Health Promotion , Primary Health Care , Social Determinants of HealthABSTRACT
In Croatia, noncommunicable diseases (NCDs) account for 93% of all deaths. They aff ect mainly the populationof working age, with an 18% probability of premature mortality from four leading NCDs. This has signifi cantsocioeconomic consequences on the development of the country, indicating that immediate action must betaken to strengthen the capacity of the health system to respond. Much progress has been made, with politicalcommitment to health reform; however, NCDs were targeted only recently. The assessment reported here,conducted by the WHO Regional Offi ce for Europe in collaboration with the Ministry of Health, will form thebasis for integrated approaches to addressing the burden of cardiovascular diseases and diabetes in Croatia. Theauthors analysed the current capacity of the health system to prevent and control these NCDs and identifi edmajor health system challenges; the document also reports good practice in using information technology forintegrating patient information. On the basis of the assessment, recommendations are made for further policiesand action.
Subject(s)
Chronic Disease , Universal Health Care , Health Promotion , Primary Health Care , Social Determinants of Health , Croatia , Delivery of Health CareABSTRACT
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.
Subject(s)
Chronic Disease/prevention & control , Global Health , Health Priorities , Chronic Disease/epidemiology , Economic Development , Humans , Politics , Resource Allocation , Socioeconomic FactorsABSTRACT
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.
Subject(s)
Evidence-Based Medicine , Heart Diseases/prevention & control , Public Health Administration , Public Health , Public-Private Sector Partnerships/organization & administration , Research Support as Topic , Canada , Community-Based Participatory Research , Decision Making, Organizational , Health Promotion , Humans , Information Dissemination , Interdisciplinary Communication , Leadership , Policy Making , Professional Competence , Public Health/education , Voluntary Health AgenciesABSTRACT
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.
