Research Evidence Building for Advocacy

1. Research & Evidence Building for Advocacy Dr. Rajesh Kumar Prof. & Head PGIMER School of Public Health Chandigarh

2. 2 Socio-Economic Transition During last century, rural agrarian communities have given way to urban industrial societies in the western world. Similar process is also underway in the developing countries. This social and economic transition has accelerated in last few decades due to rapid expansion of global trade and commerce. Greater collaboration of global organizations, better knowledge and technology sharing practices, and advances in economic status have definitely improved the health status and enhanced life expectancy in many communities. On the other hand some aspects of globalization are proving to be a greater risk for health of the communities. Erosion of social and environmental conditions, increasing gaps between the haves and have-nots, and increasing culture of consumerism have led on to a compromise in the conditions in which people live and work. Ssubstantial changes are occurring in the health status of populations. As a result of this health transition, under nutrition and communicable diseases are declining and chronic non-communicable diseases are on the rise. During last century, rural agrarian communities have given way to urban industrial societies in the western world. Similar process is also underway in the developing countries. This social and economic transition has accelerated in last few decades due to rapid expansion of global trade and commerce. Greater collaboration of global organizations, better knowledge and technology sharing practices, and advances in economic status have definitely improved the health status and enhanced life expectancy in many communities. On the other hand some aspects of globalization are proving to be a greater risk for health of the communities. Erosion of social and environmental conditions, increasing gaps between the haves and have-nots, and increasing culture of consumerism have led on to a compromise in the conditions in which people live and work. Ssubstantial changes are occurring in the health status of populations. As a result of this health transition, under nutrition and communicable diseases are declining and chronic non-communicable diseases are on the rise.

3. 3 Causes of Deaths in South-East Asian Region, 2005 Non-Communicable Diseases (NCDs) cause 7.9 million deaths every year Major NCDs Heart Disease Stroke Cancers Respiratory Diseases Diabetes

4. 4 Causes of Death Trends in South-East Asian Region Deaths due to Non-communicable Diseases Rising

5. 5 NCD Deaths South-East Asia Region, 2005 Distribution Pre-mature : 57% (<70 yrs) Men : 52% Women : 48%

6. 6 Social Status & NCD Risk Factors NCD Risk Factors becoming common among poor people

7. 7 NCD Determinants & Risk Factors

8. 8 Decline in Coronary Heart Disease Mortality in Finland

9. 9 Decline of Cardiovascular Diseases Mortality in USA

10. 10 NCD Epidemic Control Strategy

11. 11 NCD Epidemic Control Strategy

12. 12 Evidence Scientific research methods Epidemiology Needs/ Prioritization Public health intervention Efficacy Effectiveness

13. 13 Evidence-based health care The scientific use of current best research evidence in making decisions about patient care or the delivery of health services Different forms of health care Potential for harm from exposure to interventions Accuracy of diagnostic tests Predictive power of prognostic factors

14. 14 Evidence-based public health Approach to decision-making in which current best evidence is used to decide the best option available for promotion of population health Conscientious, explicit and judicious use of current best evidence in making decisions about public health

15. 15 Evidence to Advocacy Knowledge Relevant and localized Valid Reflect the severity Proposes solution

16. 16 Evidence-based advocacy Advocacy that aims to present evidence for policy change Policy Makers direct social change by planning the policy Allocating the resources

17. 17 Policy Change Steps Problem Perception Credible Solutions Communication A step by step approach can be followed to create a favorable policy environment. Different dimensions of NCD problem needs to be recognized, evidence-based credible policy measures that can solve the problem in the local context also need to be identified, and above all causes of the problem and its solution have to be communicated to relevant people at right time. A step by step approach can be followed to create a favorable policy environment. Different dimensions of NCD problem needs to be recognized, evidence-based credible policy measures that can solve the problem in the local context also need to be identified, and above all causes of the problem and its solution have to be communicated to relevant people at right time.

18. 18 Problem Perception NCD Mortality/Morbidity/Risk Factors Trends Geographic Areas & Population Groups Economic & Social Burden Health Inequality & Equity Step surveillance has been initiated for mapping NCD risk factors in different socio-economic, demographic and geographical areas in most of the countries of the region. The economic impact of NCD on poor people and health systems also needs to be valuated. Countries which finance health service completely can realize the importance of NCD prevention easily as healthcare cost of NCDs will increasingly require a major share of state budgets. However, in countries where most of the health expenditure is born by the people out-of-pocket, government may not be concerned unless it is apparent that rise in NCD may increase poverty and enhance the existing health inequality in the society which may give rise to social unrest threatening peace. Step surveillance has been initiated for mapping NCD risk factors in different socio-economic, demographic and geographical areas in most of the countries of the region. The economic impact of NCD on poor people and health systems also needs to be valuated. Countries which finance health service completely can realize the importance of NCD prevention easily as healthcare cost of NCDs will increasingly require a major share of state budgets. However, in countries where most of the health expenditure is born by the people out-of-pocket, government may not be concerned unless it is apparent that rise in NCD may increase poverty and enhance the existing health inequality in the society which may give rise to social unrest threatening peace.

19. 19 Credible Solutions Health Damaging/Enhancing Products Supply � Demand Education/Regulation/Legislation/Health care Several strategies exist for prevention of NCDs but which ones are relevant in the local/ national context need to be identified. Socio-political context and law enforcement capacity of the administration are important consideration.Several strategies exist for prevention of NCDs but which ones are relevant in the local/ national context need to be identified. Socio-political context and law enforcement capacity of the administration are important consideration.

20. 20 Communication Advocacy Professional Groups Community Mobilization NGO/CBOs/Media Existence of the problem and availability of solution is not enough but innovative communication strategy is required for placing NCDs in the policy arena. Advocacy with the policy makers and mobilization of the public opinion creates conducive environment for policy change. Energetic professional groups, NGOs and media can play important role in raising policy debate. Ultimate aim is to have a policy framework approved by appropriate government authority with financial allocation and monitoring mechanisms. Existence of the problem and availability of solution is not enough but innovative communication strategy is required for placing NCDs in the policy arena. Advocacy with the policy makers and mobilization of the public opinion creates conducive environment for policy change. Energetic professional groups, NGOs and media can play important role in raising policy debate. Ultimate aim is to have a policy framework approved by appropriate government authority with financial allocation and monitoring mechanisms.

21. 21 Challenges Trade liberalization and globalization �Market� oriented policies Weak law enforcement capacity We know that changing policies is not easy particularly in the current socio-political environment of globalization; liberalization, and �free market� regime. �choice of consumers�, and �individual responsibility� are becoming dominant ideologies. Governments often cite �weak law enforcement capacity� to avoid undertaking regulatory and legislative measures. The traditional oriental culture of collective social action is getting eroded. In order to overcome these challenges special initiatives need to be planned. We know that changing policies is not easy particularly in the current socio-political environment of globalization; liberalization, and �free market� regime. �choice of consumers�, and �individual responsibility� are becoming dominant ideologies. Governments often cite �weak law enforcement capacity� to avoid undertaking regulatory and legislative measures. The traditional oriental culture of collective social action is getting eroded. In order to overcome these challenges special initiatives need to be planned.

22. 22 Evidence-based Programs decisions with empirical evidence �best practices� by comparison Innovations in health program delivery

23. 23 Verbal Autopsy Causes of Death, 2001-2003, India

24. 24 Chandigarh Healthy Heart Project1 Million Population Awareness - community mobilization (media coordination committee) Advocacy for policy changes (public health coordination committee) Primary care (Training of Medics and Para-Medics)

25. 25 Program Evaluation Input: Resource allocations Outputs: Program services Outcomes: Client behaviors Impacts: Improvements in health status

26. 26 NCD Prevention & Control Programs Seek to promote health of populations Access: Availability of services geographically, economically Efficiency: Maximization of outcomes at a given resource level Quality: Appropriateness and competency of services Impact: Improvements in health

27. 27 Experiment /Intervention Randomization- yes/no Pre-test Post-test control group design is a true experimental design. The intervention is assigned randomly. It helps to assure a that the two groups will be equal before the programme intervention is introduced.Pre-test Post-test control group design is a true experimental design. The intervention is assigned randomly. It helps to assure a that the two groups will be equal before the programme intervention is introduced.

28. 28 Effect of CVD Risk Reduction Package Primary Health Care Settings, Chandigarh

29. 29 Experiment /Intervention Pre-test Post-test control group design is a true experimental design. The intervention is assigned randomly. It helps to assure a that the two groups will be equal before the programme intervention is introduced.Pre-test Post-test control group design is a true experimental design. The intervention is assigned randomly. It helps to assure a that the two groups will be equal before the programme intervention is introduced.

30. 30 Effect of User-charges on Indoor Admissions in Haryana

31. 31 Experiment /Intervention Pre-test Post-test control group design is a true experimental design. The intervention is assigned randomly. It helps to assure a that the two groups will be equal before the programme intervention is introduced.Pre-test Post-test control group design is a true experimental design. The intervention is assigned randomly. It helps to assure a that the two groups will be equal before the programme intervention is introduced.

32. 32 Quasi-Experimental DesignTime Series Time series design is similar to the non experimental pre test post test design except that it has the advantage of repeated measurement observation before and after the programme. Time series design is similar to the non experimental pre test post test design except that it has the advantage of repeated measurement observation before and after the programme.

33. 33 Program Evaluation Requires Collaboration Managers: responsible for decision parameters and desired outcome Researchers: responsible for recommending and implementing research techniques

34. 34 Research to Policy Identify problem which decision makers can solve Generate solutions Test intervention to solve the problem Disseminate solution Advocate for change

35. 35 Successful Research and Advocacy Involves policy makers/managers and stakeholders Effectively disseminates results to decision makers Moves interventions to routine program The success criteria for OR the amount of programme change that results from the research. It means that the OR process must include steps that maximize the potential for using the results. The OR researcher must have access to decision makers and should be able to communicate the results of OR effectively to them. It is important to involve mangers and other stakeholders from the very beginning of the OR process so that the successful programme interventions are moved from OR to the routine programme. The success criteria for OR the amount of programme change that results from the research. It means that the OR process must include steps that maximize the potential for using the results. The OR researcher must have access to decision makers and should be able to communicate the results of OR effectively to them. It is important to involve mangers and other stakeholders from the very beginning of the OR process so that the successful programme interventions are moved from OR to the routine programme.

36. Thanks