Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

9. peter hill


Published on

  • Be the first to comment

  • Be the first to like this

9. peter hill

  1. 1. Aligning research with policy: the Evidence for Health Policy in Viet Nam (VINE) project <ul><li>Ass Prof Peter S Hill </li></ul><ul><li>School of Population Health </li></ul><ul><li>The 2 nd International Conference on Public Health </li></ul><ul><li>among Countries in the Greater Mekong Sub-Region: 30 August 2010 </li></ul>
  2. 2. Evidence-based policy: the global call <ul><li>Limited resources, escalating costs, increasing demand, epidemiological shifts </li></ul><ul><ul><li>Particular issues for Viet Nam as a MIC </li></ul></ul><ul><ul><li>Need for equitable resource allocation, effective and efficient interventions </li></ul></ul><ul><li>Global demand for evidence to guide policy, to link research, policy, outcomes </li></ul><ul><li>Confidence that evidence can drive change </li></ul>
  3. 3. Evidence for Health Policy In Viet Nam (VINE) Project <ul><li>The VINE project: UQ and MOH collaboration </li></ul><ul><ul><li>Funded through the Atlantic Philanthropies </li></ul></ul><ul><ul><ul><li>Health Strategy and Policy Institute </li></ul></ul></ul><ul><ul><ul><li>Can Tho Medical University </li></ul></ul></ul><ul><ul><ul><li>Hanoi Medical University </li></ul></ul></ul><ul><ul><ul><li>Hanoi School of Public Health </li></ul></ul></ul><ul><ul><ul><li>HCMC University of Medicine and Pharmacy </li></ul></ul></ul><ul><ul><ul><li>Hue University of Medicine and Pharmacy </li></ul></ul></ul><ul><ul><ul><li>Thai Nguyen Medical University </li></ul></ul></ul>
  4. 4. Four ‘branches’ of VINE <ul><ul><li>Reliable mortality and cause of death data </li></ul></ul><ul><ul><ul><li>By age, gender, cause, using Verbal Autopsy </li></ul></ul></ul><ul><ul><li>Burden of Disease analysis </li></ul></ul><ul><ul><ul><li>Combine mortality with morbidity to calculate combined health burden and to compare </li></ul></ul></ul><ul><ul><li>Cost-effective Analyses </li></ul></ul><ul><ul><ul><li>Select key BOD issues and examine most cost effective policy interventions </li></ul></ul></ul><ul><ul><li>Policy analysis </li></ul></ul>
  5. 5. Building the Evidence <ul><li>The evidence is increasingly clear: </li></ul><ul><ul><li>Validated data on mortality and causes </li></ul></ul><ul><ul><li>Initial BOD completed </li></ul></ul><ul><ul><ul><li>Injury, stroke, mental health, cancer, NCDs </li></ul></ul></ul><ul><ul><li>CEA on Tobacco control completed </li></ul></ul><ul><ul><li>CEA on Alcohol, Hypertension, Diabetes, HIV, Mental health soon available </li></ul></ul><ul><li>But translation into policy faces challenges </li></ul>
  6. 6. Policy analysis: the challenges <ul><li>But the policy process is not rational: it is complex and depends on multiple factors </li></ul><ul><li>VINE policy process faces 5 challenges: </li></ul><ul><ul><li>The challenge of chronology </li></ul></ul><ul><ul><li>The challenge of priority </li></ul></ul><ul><ul><li>The challenge of persuasion </li></ul></ul><ul><ul><li>The challenge of adequacy </li></ul></ul><ul><ul><li>The challenge of sustainability </li></ul></ul>
  7. 7. The policy process: a theoretic framework <ul><li>Kingdon (1994) suggests policy action happens when 3 streams converge: </li></ul><ul><ul><li>The ‘problem’ stream: the issue is on the agenda </li></ul></ul><ul><ul><li>The ‘policy’ stream: there are solutions available </li></ul></ul><ul><ul><li>The ‘politics’ stream: there is a will for change </li></ul></ul><ul><li>The evidence cycle needs to coincide with the policy cycle to influence change </li></ul><ul><li>VINE project is now entering ‘policy’ stream </li></ul>
  8. 8. The challenge of chronology: getting our timing right <ul><li>Media analysis on helmet legislation </li></ul><ul><ul><li>Using media to understand the policy process </li></ul></ul><ul><li>Tobacco CEA available for proposed legislation </li></ul><ul><ul><li>Costings based on pre-determined interventions </li></ul></ul><ul><ul><ul><li>Able to demonstrate cumulative effects </li></ul></ul></ul><ul><ul><ul><li>But can also demonstrate potential for choices not made </li></ul></ul></ul><ul><li>Alcohol CEA currently examined by Hue Uni </li></ul><ul><ul><li>‘ Problem’ stream: scale of issues not yet recognized </li></ul></ul>
  9. 9. The challenge of priority: getting new issues on the agenda <ul><li>Burden of Disease analysis directly compares combined mortality/morbidity </li></ul><ul><li>Calculates priority listings for policy, but: </li></ul><ul><ul><li>Mental health – high on BOD, but not on agenda </li></ul></ul><ul><ul><li>Tobacco – recognized risk factor, complex politics </li></ul></ul><ul><ul><ul><li>State-owned industry – short term economic perspective </li></ul></ul></ul><ul><ul><ul><li>Projected impact: exposure, gender, aging population </li></ul></ul></ul><ul><ul><li>Alcohol – dynamic social, economic context </li></ul></ul>
  10. 10. The challenge of persuasion: right arguments for right audiences <ul><li>Some interventions directed at individual at risk: </li></ul><ul><ul><li>‘ Quit’ campaigns for smokers </li></ul></ul><ul><ul><li>Brief interventions for ‘hazardous’ drinkers </li></ul></ul><ul><li>Some need population shift for individual action: </li></ul><ul><ul><li>Mandatory helmet legislation </li></ul></ul><ul><li>Some need whole population strategies for effect: </li></ul><ul><ul><li>Legislation to decrease salt content of foods </li></ul></ul><ul><ul><li>Smoke-free public areas to reduce passive exposure </li></ul></ul>
  11. 11. The challenge of adequacy: getting ‘enough’ evidence for action <ul><li>There are crucial time-frames for policy action </li></ul><ul><ul><li>Definitive evidence takes time to provide </li></ul></ul><ul><ul><li>‘ Good-enough’ evidence is sometimes enough </li></ul></ul><ul><ul><li>May need to construct from international experience </li></ul></ul><ul><ul><li>Enough evidence may never be ‘enough’ </li></ul></ul><ul><li>Tobacco: current smoking impact in 30 years </li></ul><ul><li>Sex ratio at birth: once confirmed, too late to act </li></ul><ul><li>Mental health: interaction with aging population </li></ul>
  12. 12. The challenge of sustainability: translating the evidence into action <ul><li>Initiate identified interventions and measure change </li></ul><ul><ul><li>Standardize medical certification in hospitals against VA </li></ul></ul><ul><li>Evaluate current interventions, measure effectiveness </li></ul><ul><ul><li>Savings from decreased TBI from helmet legislation </li></ul></ul><ul><li>Identify synergies from potential interventions </li></ul><ul><ul><li>Breath alcohol enforcement and alternative transportation </li></ul></ul><ul><li>Advocate new policy alternatives and project CEA </li></ul><ul><ul><li>Plain packaging for cigarettes </li></ul></ul><ul><ul><li>Salt reduction legislation </li></ul></ul>
  13. 13. <ul><li>Thank you and our partners: </li></ul><ul><ul><li>Health Strategy and Policy Institute </li></ul></ul><ul><ul><li>Government Statistics Office </li></ul></ul><ul><ul><ul><li>Can Tho Medical University </li></ul></ul></ul><ul><ul><ul><li>Hanoi Medical University </li></ul></ul></ul><ul><ul><ul><li>Hanoi School of Public Health </li></ul></ul></ul><ul><ul><ul><li>HCMC University of Medicine and Pharmacy </li></ul></ul></ul><ul><ul><ul><li>Hue University of Medicine and Pharmacy </li></ul></ul></ul><ul><ul><ul><li>Thai Nguyen Medical University </li></ul></ul></ul>