ROUND TABLEROUND TABLE – Evaluation of – Evaluation of Health Promotion Effectiveness*Health Promotion Effectiveness*

PromotingPromoting Effective Health Effective Health Promotion: The IUHPE BlueprintPromotion: The IUHPE Blueprint

*Rio de Janeiro May 2005*Rio de Janeiro May 2005David V. McQueenDavid V. McQueen

IUHPE, VP for Science and IUHPE, VP for Science and Technical DevelopmentTechnical Development

Evaluation of Evaluation of effectiveness is part of effectiveness is part of

the ongoing debate the ongoing debate around evidencearound evidence

The “evidence debate” The “evidence debate” Why is evidence so important? Why is evidence so important? Many believe that the success of health promotion Many believe that the success of health promotion

will depend upon its ability to demonstrate will depend upon its ability to demonstrate scientifically that it is an that it is an effective field of public field of public health actionhealth action

In contrast, many believe that evidence, the very In contrast, many believe that evidence, the very word, is word, is inappropriate for the field of health for the field of health promotionpromotion

Between these two extremes are those who question Between these two extremes are those who question the appropriateness of the various the appropriateness of the various forms of forms of evidenceevidence and look at the basic issues of knowledge and look at the basic issues of knowledge development in the field of health promotiondevelopment in the field of health promotion

EvidenceEvidence

EvaluationEvaluation

EffectivenessEffectiveness

The three ‘Es’*The three ‘Es’*

*very different animals

EffectivenessEffectiveness

Effectiveness is a broad, loosely defined Effectiveness is a broad, loosely defined term, generally linked to the notion of term, generally linked to the notion of “outcomes”“outcomes”

Tied to the notion that effective health Tied to the notion that effective health promotion leads to changes in the promotion leads to changes in the determinants of healthdeterminants of health

Raises the “spectre” of costsRaises the “spectre” of costs Underlying epistemology of “outcomes” Underlying epistemology of “outcomes”

remains complicatedremains complicated

Search for evidence depends on

Your point of viewYour point of view Your trainingYour training Your view of “science’Your view of “science’ Your view of “knowledge”Your view of “knowledge” Your contextYour context Your way of workingYour way of working

Evidence does not exist as a “Thing in itself”

Where is the evidence found?

Refereed science literature Refereed science literature

General published literatureGeneral published literature

Fugitive literatureFugitive literature

InternetInternet

The communityThe community

OtherOther

There have been and are many There have been and are many efforts to efforts to produce evidenceproduce evidence for health promotion for health promotion

and the IUHPE GPHPE is part of this effortand the IUHPE GPHPE is part of this effort

E(EURO)WG Europe/Canada/USA E(EURO)WG Europe/Canada/USA CPSTF USA, CPSTF USA, Community Preventive Community Preventive

Services Task Force, also called the Services Task Force, also called the “Community Guide“Community Guide””

IUHPE EUIUHPE EU CochraneCochrane GPHPEGPHPE Many othersMany others

Finding Evidence Is Difficult Finding Evidence Is Difficult Databases and keywords are Databases and keywords are

typically not well suited to find typically not well suited to find intervention studies efficientlyintervention studies efficiently

Interventions are not categorized Interventions are not categorized systematicallysystematically

Requires Requires – Database searchesDatabase searches– Reviews of reference listsReviews of reference lists– Consultation with experts Consultation with experts

Over the years the “evidence Over the years the “evidence search” has expanded beyond search” has expanded beyond the randomized controlled trialthe randomized controlled trial

Every design has strengths and Every design has strengths and limitations limitations

Randomization often not appropriate Randomization often not appropriate or feasible or feasible

Many other intervention and Many other intervention and research approaches prove to be research approaches prove to be more appropriatemore appropriate

Concerted efforts by the Concerted efforts by the IUHPE to deal with IUHPE to deal with

evidence, evaluation evidence, evaluation and effectiveness have and effectiveness have

continued for many continued for many yearsyears

IUHPE ReportIUHPE ReportA Report for the European Commission by the A Report for the European Commission by the International Union for Health Promotion and International Union for Health Promotion and

EducationEducation

Title: The Evidence of Health Title: The Evidence of Health Promotion Effectiveness: Shaping Promotion Effectiveness: Shaping Public Health in a New EuropePublic Health in a New Europe

A core document, 30 pagesA core document, 30 pages

An Evidence Book, 164 pagesAn Evidence Book, 164 pages

The approach for the IUHPE The approach for the IUHPE Report was uniqueReport was unique

Three Components of Working Three Components of Working GroupGroup

International Project Advisory GroupInternational Project Advisory Group Lead project AuthorsLead project Authors A Witness Group of Political ExpertsA Witness Group of Political Experts

General Comments on the efforts General Comments on the efforts to evaluate health promotion to evaluate health promotion

interventionsinterventions

What appears to be a relatively What appears to be a relatively straightforward task is not so straightforward task is not so simplesimple

Despite more than a decade of Despite more than a decade of efforts, we are still in early stagesefforts, we are still in early stages

Many considerationsMany considerations

Quantitative and Quantitative and Qualitative Factors in Qualitative Factors in

Decision MakingDecision Making

How big is the problem?How big is the problem? How much of the problem can be How much of the problem can be

prevented?prevented? How much of the problem will an How much of the problem will an

intervention prevent?intervention prevent? What are the benefits and What are the benefits and

harms?harms? What does the intervention cost?What does the intervention cost? How do benefits compare to How do benefits compare to

costs?costs? How much do I gain compared to How much do I gain compared to

what is already happening?what is already happening?

Is it health Is it health promotingpromoting

Is it feasible?Is it feasible? Is it acceptable?Is it acceptable? Is it appropriate?Is it appropriate? Is it equitable?Is it equitable?

Quantitative Factors Qualitative Factors

Expanding to a globalperspective and effort

GPHPE

The Global Programme on The Global Programme on Health Promotion EffectivenessHealth Promotion Effectiveness

David V. McQueenDavid V. McQueenGPHPE Programme LeaderGPHPE Programme Leader

Catherine JonesCatherine JonesGPHPE CoordinatorGPHPE Coordinator

International Union for Health Promotion International Union for Health Promotion and Educationand Education

cjones@iuhpe.orgcjones@iuhpe.org

A global effort, the IUHPE Global A global effort, the IUHPE Global Programme on Health Promotion Programme on Health Promotion

EffectivenessEffectiveness GPHPEGPHPE

Coordinated by the International Union for Health Promotion and Education

In collaboration with the World Health OrganizationAnd supported by the African Medical and Research Foundation;

PHAC, Canada; NICE, England; the Netherlands Institute for Health Promotion and Disease Prevention; the CDC, USA: the Voluntary Health Association of

India: Health Promotion Switzerland, and other partners.

A primary goal of the A primary goal of the GPHPEGPHPE is to is to raise standards of health

promotion practice worldwide by :

- stimulating debate on the nature of - stimulating debate on the nature of evidence of effectiveness; evidence of effectiveness;

- reviewing evidence of effectiveness - reviewing evidence of effectiveness in terms of health, social, economic in terms of health, social, economic and political impact;and political impact;

- translating evidence to policy - translating evidence to policy makers, teachers, practitioners, makers, teachers, practitioners, researchers; researchers;

REGIONS FOCUS ON DEVELOPING THEIR OWN REGIONS FOCUS ON DEVELOPING THEIR OWN PRIORITIES AND DEFINITIONS OF EVIDENCE PRIORITIES AND DEFINITIONS OF EVIDENCE

AND EFFECTIVENESSAND EFFECTIVENESS

Regions move at their own paceRegions move at their own pace

Regions take into account their own Regions take into account their own context and develop plans accordinglycontext and develop plans accordingly

Regions feel ownership, while at the same Regions feel ownership, while at the same time being full partners in the global time being full partners in the global programmeprogramme

GPHPE : Products (translations)GPHPE : Products (translations)The Evidence of Health Promotion Effectiveness: The Evidence of Health Promotion Effectiveness:

Shaping Public Health in a New Europe Shaping Public Health in a New Europe (IUHPE, 1999)(IUHPE, 1999)

English Spanish French Russian

Chinese Japonese Korean Mongolien

GPHPE : Products (regional level)GPHPE : Products (regional level)

Europe : new publication covering mental Europe : new publication covering mental health, policy into practice, tobacco and health, policy into practice, tobacco and infrastructuresinfrastructures

Latin America : report on state of the art of the Latin America : report on state of the art of the evidence of health promotion effectiveness, evidence of health promotion effectiveness, rapid evaluation guide, and numerous articlesrapid evaluation guide, and numerous articles

Africa : conceptual frameworkAfrica : conceptual framework North America : evaluation tool kitNorth America : evaluation tool kit

GPHPE : Distinguishing aspectsGPHPE : Distinguishing aspectsThe GPHPE:The GPHPE: Is a worldwide programme.Is a worldwide programme. Advocates the importance of effectiveness to Advocates the importance of effectiveness to

researchers, practicitioners and decision-makers.researchers, practicitioners and decision-makers. Will support regional approaches, given the different Will support regional approaches, given the different

stages of the development of the field.stages of the development of the field. Is about drawing into the programme what can be Is about drawing into the programme what can be

learned and valued from each region while giving the learned and valued from each region while giving the opportunity for regions to learn from each other.opportunity for regions to learn from each other.

GPHPE : Value addedGPHPE : Value added

The value added of the GPHPE’s global vision is The value added of the GPHPE’s global vision is not only about being able to identify the not only about being able to identify the differences between regions with respect to their differences between regions with respect to their approaches to measuring the effectiveness of approaches to measuring the effectiveness of health promotion, but is really about being able to health promotion, but is really about being able to draw out the common threads and support the draw out the common threads and support the strengthening of those linkages and interactive strengthening of those linkages and interactive sharing of this growing body of knowledge.sharing of this growing body of knowledge.

GPHPE : Global VisionGPHPE : Global Vision

The GPHPE is a programme intended to uncover The GPHPE is a programme intended to uncover and find evidence for effectiveness. This may and find evidence for effectiveness. This may translate into various approaches in regions given translate into various approaches in regions given their current capacity to carry out this kind of their current capacity to carry out this kind of research or related activities. However, the GPHPE research or related activities. However, the GPHPE is not a project to do interventions. The intention is not a project to do interventions. The intention and goal is to find answers and solutions based on and goal is to find answers and solutions based on best practice in order to be able to advise on how best practice in order to be able to advise on how interventions could be better carried out based interventions could be better carried out based upon the evidence.upon the evidence.

GPHPE : Products (regional level)GPHPE : Products (regional level)

Europe : new publication covering mental Europe : new publication covering mental health, policy into practice, tobacco and health, policy into practice, tobacco and infrastructuresinfrastructures

Latin America : report on state of the art of the Latin America : report on state of the art of the evidence of health promotion effectiveness, evidence of health promotion effectiveness, rapid evaluation guide, and numerous articlesrapid evaluation guide, and numerous articles

Africa : conceptual frameworkAfrica : conceptual framework North America : various reports and website North America : various reports and website

GPHPE : Regional involvement and GPHPE : Regional involvement and contributionscontributions

Enlargement and/or strengthening of regional Enlargement and/or strengthening of regional initiativesinitiatives

Increased networking and exchange across Increased networking and exchange across regionsregions

Communications and advocacyCommunications and advocacy Contributions to the Global Monograph to be Contributions to the Global Monograph to be

released in 2007released in 2007

GPHPE : Published Products (global GPHPE : Published Products (global level)level)

Special global issue of proceedings from the Special global issue of proceedings from the Francophone seminar on health promotion Francophone seminar on health promotion effectivnesseffectivness

Special global issue on mental health promotionSpecial global issue on mental health promotion Special global issue on urbanisationSpecial global issue on urbanisation Articles and less formal updates published on the Articles and less formal updates published on the

GPHPE, its aims and goalsGPHPE, its aims and goals Global monographGlobal monograph

The Global Monograph of The Global Monograph of the the GPHPEGPHPE

Provides a broad overview of issues of evidence, evaluation and effectiveness in health promotion.

Compares and contrasts regional variations Codifies commonality where warranted and

emphasizes differences where indicated Emphasizes some key areas considered

critical to health promotion throughout the world

Provides a background and companion document to the regional documents.

For more information :For more information :

Contact Catherine Jones at Contact Catherine Jones at cjones@iuhpe.orgcjones@iuhpe.org Visit the IUHPE at Visit the IUHPE at www.www.iuhpeiuhpe..orgorg