Clarifying approaches to: health needs assessment, health impact assessment, integrated impact assessment, health equity audit, and race equality impact assessment

Planners, policy makers and practitioners across all sectors in England use a range of approaches to assess health needs, inform decisions and assess impact. Use of these approaches can lead to improved health outcomes and reduced inequalities through auditing provision, access and outcomes. Five main approaches are used by local, regional and national government, voluntary agencies and the NHS: ۢ Health needs assessment (HNA) ۢ Health impact assessment (HIA) ۢ Integrated impact assessment (IIA) ۢ Health equity audit (HEA) ۢ Race equality impact assessment (REIA)

Practical lessons for dealing with inequalities in health impact assessment

This publication is a companion to Addressing inequalities through health impact assessment (Taylor et al., 2003a), which described what a focus on inequalities could achieve, offered case study examples, and outlined promising practice. This bulletin discusses recent publications and presents a further two case studies that attempt to address health inequalities through the use of HIA. .

Improving Health and Reducing Inequalities: A Practical Guide to Health Impact Assessment

(WHIASU) A basic guide to conducting a HIA. 1. Health impact assessment is a tool that can help organisations to assess the possible consequences of their decisions on people۪s health and well-being, thereby helping to develop more integrated policies and programmes. 2. This document has been developed as a practical guide to health impact assessment. It is designed to meet the needs of a variety of organisations by explaining the concept, the process and its flexibility, and by providing templates that can be adjusted to suit. 3. The Welsh Assembly Government is committed to developing the use of health impact assessment in Wales as a part of its strategy to improve health and wellbeing and to reduce health inequalities. This practical guide has been prepared by the Welsh Health Impact Assessment Support Unit, which was established by the Welsh Assembly Government to encourage and support organisations and groups in Wales to use the approach. 4. The development and use of health impact assessment will contribute to the ongoing development and implementation of local health, social care and wellbeing strategies, which is a joint statutory responsibility for Local Health Boards and local authorities. It can also contribute to Community Strategies which, given their overarching nature and breadth and depth, can address social, economic and environmental determinants of health, and to the implementation of Communities First, the Welsh Assembly Government۪s crosscutting regeneration programme. 5. The development of Health Challenge Wales as the national focus for improving health in Wales reinforces efforts to prevent ill health. Tools such as health impact assessment can help organisations and groups in all sectors to identify ways in which they can help people to improve their health.

Public health impact of statin prescribing strategies based on jupiter

Texte intégral: http://www.springerlink.com/content/3q68180337551r47/fulltext.pdf

Public health impact of statin prescribing strategies based on JUPITER Modeling study from a population-based study.

OBJECTIVE: To evaluate the public health impact of statin prescribing strategies based on the Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin Study (JUPITER). METHODS: We studied 2268 adults aged 35-75 without cardiovascular disease in a population-based study in Switzerland in 2003-2006. We assessed the eligibility for statins according to the Adult Treatment Panel III (ATPIII) guidelines, and by adding "strict" (hs-CRP≥2.0mg/L and LDL-cholesterol <3.4mmol/L), and "extended" (hs-CRP≥2.0mg/L alone) JUPITER-like criteria. We estimated the proportion of CHD deaths potentially prevented over 10years in the Swiss population. RESULTS: Fifteen % were already taking statins, 42% were eligible by ATPIII guidelines, 53% by adding "strict", and 62% by adding "extended" criteria, with a total of 19% newly eligible. The number needed to treat with statins to avoid one CHD death over 10years was 38 for ATPIII, 84 for "strict" and 92 for "extended" JUPITER-like criteria. ATPIII would prevent 17% of CHD deaths, compared with 20% for ATPIII+"strict" and 23% for ATPIII + "extended" criteria (+6%). CONCLUSION: Implementing JUPITER-like strategies would make statin prescribing for primary prevention more common and less efficient than it is with current guidelines.

Health Impact Assesment: Hints and Cautions from Critical Epidemiology

Under the format of this conference, to convey the possibilities for health impact assessment of Latin American Critical Epidemiology, sometimes referred to under the tautological designation of “social epidemiology”, I will try to sum up in the next few minutes some reflections based on them.

Global-scale climate impact functions: the relationship between climate forcing and impact

Although there is a strong policy interest in the impacts of climate change corresponding to different degrees of climate change, there is so far little consistent empirical evidence of the relationship between climate forcing and impact. This is because the vast majority of impact assessments use emissions-based scenarios with associated socio-economic assumptions, and it is not feasible to infer impacts at other temperature changes by interpolation. This paper presents an assessment of the global-scale impacts of climate change in 2050 corresponding to defined increases in global mean temperature, using spatially-explicit impacts models representing impacts in the water resources, river flooding, coastal, agriculture, ecosystem and built environment sectors. Pattern-scaling is used to construct climate scenarios associated with specific changes in global mean surface temperature, and a relationship between temperature and sea level used to construct sea level rise scenarios. Climate scenarios are constructed from 21 climate models to give an indication of the uncertainty between forcing and response. The analysis shows that there is considerable uncertainty in the impacts associated with a given increase in global mean temperature, due largely to uncertainty in the projected regional change in precipitation. This has important policy implications. There is evidence for some sectors of a non-linear relationship between global mean temperature change and impact, due to the changing relative importance of temperature and precipitation change. In the socio-economic sectors considered here, the relationships are reasonably consistent between socio-economic scenarios if impacts are expressed in proportional terms, but there can be large differences in absolute terms. There are a number of caveats with the approach, including the use of pattern-scaling to construct scenarios, the use of one impacts model per sector, and the sensitivity of the shape of the relationships between forcing and response to the definition of the impact indicator.

Reliability and validation of a Brazilian version of the Oral Health Impact Profile for assessing edentulous subjects

The aims of this study were to evaluate the reliability and to validate a Brazilian version of Oral Health Impact Profile for assessing edentulous subjects (OHIP-EDENT), an inventory for measuring oral health-related quality of life of edentulous subjects. The sample comprised 65 complete denture wearers (23 men, mean age of 69.1 +/- 10.3 years). The translated OHIP-EDENT was applied on two occasions with a washout period of 3 months. Reliability was assessed by an internal consistency analysis and a test-retest approach. A preliminary validation process was conducted by a qualitative approach/interview. Results of internal consistency showed a Cronbach's alpha of 0.86 or 0.90 for the first or second appointment respectively. Through the test-retest analysis, an intra-class correlation coefficient of 0.57 was found, and individual answers reflected a broad range of agreement. Interviewed volunteers (n = 6) comprehended most questions well. In conclusion, the Brazilian version of OHIP-EDENT is adequate for assessing the oral health-related quality of life for edentulous subjects.

Psychometric Properties of the Oral Health Impact Profile and New Methodological Approach

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Reducing the Public Health Impact of Bovine Tuberculosis by Controlling Disease Transmission Between Cattle and White-Tailed Deer in Northwestern Minnesota

Bovine tuberculosis, caused by infection with Mycobacterium bovis, is a re-emerging zoonotic disease. It has staged a comeback by establishing infections in wildlife and cattle, creating the potential for human disease in locations where it was thought to be under control. In northwestern Minnesota, infected cattle and white-tailed deer were first discovered in 2005. A major bovine tuberculosis eradication campaign is underway in the state, with multiple efforts employed to control M. bovis infection in both cattle and deer populations. In order to effectively eradicate bovine tuberculosis in Minnesota, there is a need for better understanding of the factors that increase the risk of deer and cattle interacting in a way that facilitates tuberculosis transmission. By reducing the risk of disease transmission within the animal populations, we will also reduce the risk that bovine tuberculosis will again become a common disease in human populations. The purpose of this study is to characterize the risk of interactions between cattle and white-tailed deer in northern Minnesota in order to prevent M. bovis transmission. A survey originally developed to assess deer-cattle interactions in Michigan was modified for use in Minnesota, introducing a scoring method to evaluate the areas of highest priority at risk of potential deer-cattle interaction. The resulting semi-quantitative deer-cattle interaction risk assessment was used at 53 cattle herds located in the region adjacent to the bovine tuberculosis “Core Area”. Two evaluators each scored the farm separately, and then created a management plan for the farm that prioritized the areas of greatest risk for deer-cattle interactions. Herds located within the “Management Zone” were evaluated by Minnesota Board of Animal Health staff, and results from these surveys were used as a point of comparison.

Public health impact of statin prescribing strategies based on JUPITER

To evaluate the public health impact of statin prescribing strategies based on the Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin Study (JUPITER).

Operational short term health impact assessment of air pollution modelling system over Europe

The last decade, scientific studies have indicated an association between air pollution to which people are exposed and wide range of adverse health outcomes. We have developed a tool which is based on a model (MM5-CMAQ) running over Europe with 50 km spatial resolution, based on EMEP annual emissions, to produce a short-term forecast of the impact on health. In order to estimate the mortality change (forecasted for the next 24 hours) we have chosen a log-linear (Poisson) regression form to estimate the concentration-response function. The parameters involved in the C-R function have been estimated based on epidemiological studies, which have been published. Finally, we have derived the relationship between concentration change and mortality change from the C-R function which is the final health impact function.

Looking twice at the gender equity index for public health impact

Background: It has been shown that gender equity has a positive impact on the everyday activities of people (decision making, income allocation, application and observance of norms/rules) which affect their health. Gender equity is also a crucial determinant of health inequalities at national level; thus, monitoring is important for surveillance of women’s and men’s health as well as for future health policy initiatives. The Gender Equity Index (GEI) was designed to show inequity solely towards women. Given that the value under scrutiny is equity, in this paper a modified version of the GEI is proposed, the MGEI, which highlights the inequities affecting both sexes. Methods: Rather than calculating gender gaps by means of a quotient of proportions, gaps in the MGEI are expressed in absolute terms (differences in proportions). The Spearman’s rank coefficient, calculated from country rankings obtained according to both indexes, was used to evaluate the level of concordance between both classifications. To compare the degree of sensitivity and obtain the inequity by the two methods, the variation coefficient of the GEI and MGEI values was calculated. Results: Country rankings according to GEI and MGEI values showed a high correlation (rank coef. = 0.95). The MGEI presented greater dispersion (43.8%) than the GEI (19.27%). Inequity towards men was identified in the education gap (rank coef. = 0.36) when using the MGEI. According to this method, many countries shared the same absolute value for education but with opposite signs, for example Azerbaijan (−0.022) and Belgium (0.022), reflecting inequity towards women and men, respectively. This also occurred in the empowerment gap with the technical and professional job component (Brunei:-0.120 vs. Australia, Canada Iceland and the U.S.A.: 0.120). Conclusion: The MGEI identifies and highlights the different areas of inequities between gender groups. It thus overcomes the shortcomings of the GEI related to the aim for which this latter was created, namely measuring gender equity, and is therefore of great use to policy makers who wish to understand and monitor the results of specific equity policies and to determine the length of time for which these policies should be maintained in order to correct long-standing structural discrimination against women.