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Workshop on VHL and HEN Sao Paulo, 10-11 April 2006

Workshop on VHL and HEN Sao Paulo, 10-11 April 2006. Anca Dumitrescu, M.D. WHO Regional Office for Europe Evidence work in WHO/EURO Health Evidence Network (HEN) HEN sources of evidence HEN methodology. Evidence work in the WHO Regional Office for Europe. Outline

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Workshop on VHL and HEN Sao Paulo, 10-11 April 2006

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  1. Workshop on VHL and HENSao Paulo, 10-11 April 2006 Anca Dumitrescu, M.D. WHO Regional Office for Europe Evidence work in WHO/EURO Health Evidence Network (HEN) HEN sources of evidence HEN methodology

  2. Evidence work in the WHO Regional Office for Europe Outline Why evidence? Why now? Europe: a changing context Operational definition of evidence WHO/EURO as evidence-based organization

  3. Why Evidence?Why Now? • Increased interest in “evidence-based policy making” • Growing demand for health information/evidence for decision-making • More complex information is produced

  4. The rise of evidence • UK conviction politics 1997 – “what matters is what works” • Increasing public scepticism towards actions of government • Increasing public and political scepticism towards the actions of health professionals • Increasing recognition of the need for dialogue

  5. The rise of evidence-based Public Health practice • Growth of well-educated and informed public • Increasing availability of information and access • Growth in size and capabilities of the research community • Increasing emphasis on productivity and international competitiveness • Increasing emphasis on accountability of governments • Recent emergence of organizations for health technology assessment, Cochrane and Campbell collaborations, etc.

  6. Why evidence? • Need to know that a proposed strategy or technology has a reasonable chance of improving health • Public health cannot be a matter merely of belief • Activities “evidence-based” have developed to systematically gather the information arising from the available research and within the field

  7. Europe: a changing context,pressures for change • Increase expectations in relation to health care services and science • From “curative medicine” to “welfare medicine” • Spreading awareness of the need for evidence base decision making

  8. Information overload • 20.000 medical journals • 30.000 new studies/month • Thousands of databases • 10.000 related websites Decision-makers can find arguments for virtually any decision

  9. Evidence: Multiple meanings? • “Evidence”: research, RCTs, outcomes • “Evidence”: opinions, surveys, anecdotes • Evidence- “based”... • Evidence- “informed”... • Evidence- “aware” ...

  10. Evidence-based policy • “What works” (emphasis on outcomes) • Emphasis on research evidence to support policy and other decisions • Marking an (apparent) retreat from the cult of the expert, from the dominance of professional interests, and from public policy driven by political ideology (Davies et al., 2000)

  11. Factors influencing policy-making process • Experience, expertise and judgement • Resources • Values • Lobbyists, pressure groups and consultants • Pragmatics and contingencies Source: Modified from Davies P., 2004 http://www.policyhub.gov.uk/home/JerryLeeLecture1202041.pdf

  12. Evidence Evidence Other criteria Other criteria Linking information and evidence to policy-making processes

  13. Different views of what constitutes evidence • Producers’ criteria : evidence that is rigorous, comprehensive and can be generalized • Users’ criteria: information that is relevant, specific, fit-for-purpose, concise and easy to understand

  14. Operational definition of evidence • findings from research, whenever possible • also other knowledge that may serve as a useful basis for decision making in public health and health care

  15. WHO Regional Office for Europe aims to support countries • developing their own health policies, health systems • preventing and overcoming health threats • anticipating future challenges • advocating public health

  16. WHO as an evidence-based organization To ensure that the Regional Office uses the best available evidence in providing advice and recommendations (not the best possible evidence)

  17. “The best is the enemy of the good” Voltaire 1694-1778

  18. The WHO/EURO approach to evidence work • There is a lot of evidence, of different sorts “out there” • What do we do with it all? How do we manage it?

  19. The WHO/EURO approach to evidence work (2) • Identify information and evidence needs • Appropriate analysis and interpretation - offering viable options for public health decisions • Enhance capacity of technical advisers to provide valid, timely, essential information and to communicate clearly • Provide Member States with answers to concrete questions (e.g. Health Evidence Network)

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