scholarly journals Public Health Interventions with Harms and Benefits: A Graphical Framework for Evaluating Tradeoffs

2020 ◽  
Vol 40 (8) ◽  
pp. 978-989
Author(s):  
Allison L. Pitt ◽  
Jeremy D. Goldhaber-Fiebert ◽  
Margaret L. Brandeau
Keyword(s):  
Public Health ◽  
Black Males ◽  
Health Interventions ◽  
Decision Makers ◽  
Net Benefit ◽  
Public Health Interventions ◽  
Meat Price ◽  
Life Years ◽  
Equity And Efficiency ◽  
Decision Alternative

Background Evaluations of public health interventions typically report benefits and harms aggregated over the population. However, benefits and harms are not always evenly distributed. Examining disaggregated outcomes enables decision makers to consider health benefits and harms accruing to both intended intervention recipients and others in the population. Methods We provide a graphical framework for categorizing and comparing public health interventions that examines the distribution of benefit and harm between and within population subgroups for a single intervention and compares distributions of harm and benefit for multiple interventions. We demonstrate the framework through a case study of a hypothetical increase in the price of meat (5%, 10%, 25%, or 50%) that, via elasticity of demand, reduces consumption and consequently reduces body mass index. We examine how inequalities in benefits and harms (measured by quality-adjusted life-years) are distributed across a population of white and black males and females. Results A 50% meat price increase would yield the greatest net benefit to the population. However, because of reduced consumption among low-weight individuals, black males would bear disproportionate harm relative to the benefit they receive. With increasing meat price, the distribution of harm relative to benefit becomes less “internal” to those receiving benefit and more “distributed” to those not receiving commensurate benefit. When we segment the population by sex only, this result does not hold. Conclusions Disaggregating harms and benefits to understand their differential impact on subgroups can strongly affect which decision alternative is deemed optimal, as can the approach to segmenting the population. Our framework provides a useful tool for illuminating key tradeoffs relevant to harm-averse decision makers and those concerned with both equity and efficiency.

scholarly journals More harm than good? Building a framework to identify adverse effects of public health interventions

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
J Stratil ◽  
K Oliver ◽  
P von Philipsborn ◽  
A Movsisyan ◽  
E A Rehfuess
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Adverse Effects ◽  
Adverse Events ◽  
Informed Decision ◽  
Health Interventions ◽  
Decision Makers ◽  
Informed Decision Making ◽  
Public Health Interventions ◽  
Integrate Framework

Abstract Background While the importance of adverse events of medical interventions is widely recognized, adverse effects of public health interventions remain a neglected topic. This project aims to develop a framework to guide researchers and decision-makers to systematically reflect on and identify potential adverse effects of public health interventions. Methods We conducted a mixed-method systematic review of theoretical and conceptual publications on adverse events of public health interventions to develop a preliminary framework employing best-fit framework synthesis. We used the WHO-INTEGRATE framework as a starting point for the synthesis, a multidimensional evidence-to-decision framework developed for complex interventions in complex systems. Results The framework includes two interlinked parts: The first maps domains in which potential adverse events might arise. Drawing on the WHO-INTEGRATE framework, these domains include aspects related to health, but also domains related to societal, economic, and environmental implications. The second part maps general mechanisms through which public health interventions can lead to adverse effects (e.g. reactive behaviour change, increase of labelling and stigmatization, and exposure to environmental risk-factors). Conclusions The framework will be advanced in the second phase of the project through empirical studies of harmful effects in public health interventions, which we will identify through an overview of systematic reviews. Adverse effects of public health interventions are currently not sufficiently considered in research and practice. Taking them into account is essential for informed decision-making and establishing appropriate countermeasures. Our framework could be a valuable asset for researchers and policy makers in developing, implementing and evaluating public health interventions. Key messages Awareness of the adverse effects of public health interventions is essential for informed decision-making and establishing countermeasures. This framework supports researchers and decision-makers in systematically reflecting on and identifying adverse events when developing, piloting, implementing or evaluating public health interventions.

scholarly journals Monsters in our food: Foodborne trematodiasis in the Philippines and beyond

2021 ◽  
Vol 19 (3) ◽  
pp. 467-485
Author(s):  
Jan Clyden B. Tenorio ◽  
◽  
Elizabeth C. Molina ◽  
◽  
◽  
...  
Keyword(s):  
Public Health ◽  
The Philippines ◽  
Health Interventions ◽  
Asia Pacific ◽  
Health Concern ◽  
Parasitic Infections ◽  
Public Health Interventions ◽  
Research Attention ◽  
Life Years ◽  
Foodborne Trematodes

Foodborne trematodiasis is a neglected tropical disease (NTD) caused by zoonotic trematodes that persist mainly in impoverished areas in the Asia-Pacific region. Globally, about 2 million disability life years (DALYs) are lost due to these parasitic infections. Four groups of foodborne trematodes are known to cause significant illness: fish-borne liver fluke infections caused by Opisthorchis and Clonorchis spp.; water vegetable-borne Fasciola spp. infections; crustacean-vectored paragonimiasis; and those caused by intestinal trematodes. In the Philippines, endemic foodborne trematodes of public health concern include Paragonimus westermani, some members of Heterophyidae and Echinostomatidae, and Fasciola hepatica/ F. gigantica. Opisthorchis viverrini and Clonorchis sinensis have also been reported in the country. Data on the epidemiology of these zoonotic illnesses remain scarce and in need of research attention in the Philippines. Culturally rooted eating behaviors in endemic areas are important risk factors to acquiring and perpetuating foodborne trematodiasis. The combination of mass drug administration (MDA), provision of clean water and maintenance of good sanitation and hygiene (WASH), community health education towards modification of risky behaviors, surveillance, and veterinary public health interventions have been shown to be effective in combatting these zoonotic parasitoses. An integrated control and prevention program anchored on the One Health paradigm is a must to address these illnesses. This paper aims to review the biology and epidemiology of, and public health interventions against zoonotic foodborne trematodiasis in the Philippines and its neighboring countries.

scholarly journals Economic evaluations of public health interventions for physical activity and diet: systematic review

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Gebreslassie ◽  
F Sampaio ◽  
C Nystrand ◽  
R Ssegonja ◽  
I Feldman
Keyword(s):  
Public Health ◽  
Physical Activity ◽  
Systematic Review ◽  
Dietary Habits ◽  
Cost Effective ◽  
Health Technology ◽  
Health Interventions ◽  
Decision Makers ◽  
Economic Evaluations ◽  
Public Health Interventions

Abstract Background Physical inactivity and unhealthy dietary habits are associated with an increased disease and economic burden. Despite the prevalence of different public health programs, decision-makers encounter a multitude of challenges in prioritizing interventions for optimal resource allocation. The aim of this systematic review, therefore, was to identify economic evaluations of public health interventions targeting physical activity and healthy diet, and assess the quality and transferability of the findings to the Swedish context. Methods A search of published economic evaluations was conducted through electronic databases including PubMed, Web of Science, PsycINFO, National Health Service Economic Evaluation Databases (NHS EED) and the Health Technology Assessment Database (HTA). An additional search was done using references of relevant systematic reviews and, websites of relevant organizations were checked to find grey literature. Quality and transferability of the economic evaluations were appraised using a quality assessment tool developed by the Swedish Agency for Health Technology Assessment. Preliminary Results Thirty-two economic evaluations of 178 interventions were included; thirteen studies targeting physical activity, thirteen targeting healthy diet and six targeting both. The interventions varied in terms of their content, setting, mode of delivery and target populations. A majority of the economic evaluations reported that the interventions were likely to be cost-effective; however, considerable variations in the methodological and reporting qualities were observed. Only half of the economic evaluations were rated to have a high probability of transferring to the Swedish context. Conclusions Most of the interventions were reported to be cost-effective. However, a variation in quality and transferability of the available evidence to the Swedish context were observed. Key messages Public health interventions targeting physical activity and dietary habits have a high potential to be cost-effective. Decision makers should consider transferability and suitability of findings of economic evaluation from a different context to a decision problem at hand.

From Beginning to End: The Importance of Evidence-Based Policymaking in Vaccination Mandates

2015 ◽  
Vol 43 (S1) ◽  
pp. 99-102 ◽  
Author(s):  
Daniel G. Orenstein ◽  
Y. Tony Yang
Keyword(s):  
Public Health ◽  
Social Contract ◽  
Communicable Disease ◽  
Health Interventions ◽  
Decision Makers ◽  
Childhood Vaccination ◽  
Evidence Based ◽  
Public Health Interventions ◽  
Norms And Values ◽  
The Social

Used appropriately, reliance on science distinguishes public health from policymaking driven more by theory and opinion and enhances trust in public health interventions. Evidence-based vaccine policymaking aims to control communicable disease by urging decision makers to base policies on the best available evidence rather than politics or personal views. The results of this approach, such as smallpox eradication, have been dramatic. Historically, mandatory childhood vaccination has been perhaps the most successful evidence-based tool in combating many epidemics. Philosophically, vaccination mandates correspond to the legal system’s dual role in codifying what society deems undesirable behavior (non-vaccination) and declaring beneficial social norms and values consistent with understandings of the social contract. Despite their effectiveness and philosophical grounding, vaccination mandates present serious legal and ethical questions. Public health policymakers have a continuing responsibility to rely on evidence not only as a basis for generating policy, but also for evaluating and improving elements of its legal design.

scholarly journals An analysis of COVID-19 clusters in India

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pooja Sengupta ◽  
Bhaswati Ganguli ◽  
Sugata SenRoy ◽  
Aditya Chatterjee
Keyword(s):  
Public Health ◽  
Cluster Analysis ◽  
Population Density ◽  
Case Studies ◽  
Compartment Model ◽  
Health Interventions ◽  
Disease Spread ◽  
Second Phase ◽  
Public Health Interventions ◽  
Homogeneous Groups

Abstract Background In this study we cluster the districts of India in terms of the spread of COVID-19 and related variables such as population density and the number of specialty hospitals. Simulation using a compartment model is used to provide insight into differences in response to public health interventions. Two case studies of interest from Nizamuddin and Dharavi provide contrasting pictures of the success in curbing spread. Methods A cluster analysis of the worst affected districts in India provides insight about the similarities between them. The effects of public health interventions in flattening the curve in their respective states is studied using the individual contact SEIQHRF model, a stochastic individual compartment model which simulates disease prevalence in the susceptible, infected, recovered and fatal compartments. Results The clustering of hotspot districts provide homogeneous groups that can be discriminated in terms of number of cases and related covariates. The cluster analysis reveal that the distribution of number of COVID-19 hospitals in the districts does not correlate with the distribution of confirmed COVID-19 cases. From the SEIQHRF model for Nizamuddin we observe in the second phase the number of infected individuals had seen a multitudinous increase in the states where Nizamuddin attendees returned, increasing the risk of the disease spread. However, the simulations reveal that implementing administrative interventions, flatten the curve. In Dharavi, through tracing, tracking, testing and treating, massive breakout of COVID-19 was brought under control. Conclusions The cluster analysis performed on the districts reveal homogeneous groups of districts that can be ranked based on the burden placed on the healthcare system in terms of number of confirmed cases, population density and number of hospitals dedicated to COVID-19 treatment. The study rounds up with two important case studies on Nizamuddin basti and Dharavi to illustrate the growth curve of COVID-19 in two very densely populated regions in India. In the case of Nizamuddin, the study showed that there was a manifold increase in the risk of infection. In contrast it is seen that there was a rapid decline in the number of cases in Dharavi within a span of about one month.

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