Suchergebnisse

Life expectancy at birth is considered the best mortality-based summary indicator of the health status of the population and is useful for measuring long-term health changes. The objective of this article was to present the concept of the bottom-up policy risk assessment approach, developed to identify challenges involved in analyzing risk factor reduction policies and in assessing how the related health indicators have changed over time. This article focuses on the reasons of the significant life expectancy prolongation in Poland over the past 2 decades, thus includes policy context. The methodology details a bottom-up risk assessment approach, a chain of relations between the health outcome, risk factors, and health policy, based on Risk Assessment From Policy to Impact Dimension project guidance. A decline in cardiovascular disease mortality was a key factor that followed life expectancy prolongation. Among basic factors, tobacco and alcohol consumption, diet, physical activity, and new treatment technologies were identified. Poor health outcomes of the Polish population at the beginning of 1990s highlighted the need of the implementation of various health promotion programs, legal acts, and more effective public health policies. Evidence-based public health policy needs translating scientific research into policy and practice. The bottom-up case study template can be one of the focal tools in this process. Accountability for the health impact of policies and programs and legitimization of the decisions of policy makers has become one of the key questions nowadays in European countries' decision-making process and in EU public health strategy.

The RAPID project established, during the first period, a thematic network of risk assessment experts, including relevant partners in the ten countries involved, the "Risk assessor database". The project devoted a specific activity, a single work package, to the dissemination and discussion of the methodology developed during" first two years of the project. National workshops were planned in each country to facilitate integrated knowledge translation activity, using a participatory approach to increase potential knowledge-users awareness on the RAPID project, and to engage them in using the RAPID guidance. Workshops were conceived to present case studies and the RAPID guidance to a targeted audience, to discuss and collect further insights, and integrate different perspectives in the final version of the policy evaluation methodology. However, national workshops also actively contributed to develop evidence based methodological guidance and increase its quality and relevance for potential users by bridging know-do gap between researchers and stakeholders; by involving decision makers and potential users in the knowledge creation process; by facilitating diverse stakeholder participation from governmental, academic and private sectors, carefully identified by national RAPID surveys as having direct expertise in the field of risk assessment. The cultural and administrative differences existing in the countries involved in RAPID guarantee the inclusion of a wide range of perspectives. Results of the national workshops helped to identify barriers and solutions for using the guidance, for adapting necessary changes to it and for communicating results to other potential users. ; .

Public health has been defined as "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals"(Winslow 1920) or as "the art of applying science in the context of politics so as to reduce inequalities in health while ensuring the best health for the greatest number"(WHO1998). As the challenges of public health have evolved, from sanitary surveillance and infectious diseases in the past, to chronic diseases, lifestyle factors,socioeconomic conditions, occupational and environmental health determinants,health reforms and others, so have the methods of assessment advanced by research technologies development. The new health threats and epidemics, such as AIDS, SARS (Severe Acute Respiratory Syndrome), influenza H5N1, or emergencies like natural disasters or bioterrorism, effects of globalization and migration present new tasks to public health governance requiring new working methods. ; .

The assessment of health risks of policies is an inevitable, although challenging prerequisite for the inclusion of health considerations in political decision making. The aim of our project was to develop a so far missing methodological guide for the assessment of the complex impact structure of policies. The guide was developed in a consensual way based on experiences gathered during the assessment of specific national policies selected by the partners of an EU project. Methodological considerations were discussed and summarized in workshops and pilot tested on the EU Health Strategy for finalization. The combined tool, which includes a textual guidance and a checklist, follows the top-down approach, that is, it guides the analysis of causal chains from the policy through related health determinants and risk factors to health outcomes. The tool discusses the most important practical issues of assessment by impact level. It emphasises the transparent identification and prioritisation of factors, the consideration of the feasibility of exposure and outcome assessmentwith special focus on quantification. The developed guide provides useful methodological instructions for the comprehensive assessment of health risks of policies that can be effectively used in the health impact assessment of policy proposals.