Joanna Kobza

Consideration on the health risk reduction related to attainment of the new particulate matter standards in Poland: A top-down policy risk assessment approach.

Policies can influence health of a population in various ways. Numerous epidemiological studies supported by toxicological investigations demonstrate a positive association between ambient concentrations of airborne particulate matter and increased adverse cardio-respiratory events, including morbidity and mortality. The aim of this paper was to present the concept of the top-down health policy risk assessment approach model developed to estimate the expected health risk reduction associated with policy aiming at attaining the new particulate matter ≤ 10 μm in diameter (PM10) standards in Poland. The top-down approach guides the analysis of causal chains from the policy to health outcomes. In this case study we tried to estimate the predicted health effects of the policy change over the past 20 years. Since Polish annual standard for PM10 changed from 50 μg/m³ in 1990 to 40 μg/m³ in 2010, we calculated the relative risk associated with decreasing PM10 in diameter to 10 μg/m3 in the annual level of PM10 for 6 adverse health effects. The relative risk slightly decreased for almost all adverse health effects, which means that the relative decrease in the incidence of health effects from the baseline incidence should range from about 0.5-0.6% for heart disease admissions to > 1% for respiratory admissions. The obtained results indicate that implementation of the new ambient air standards could influence improvement of the health status of Polish population. A top-down policy health risk assessment model can be one of the main tools in this process, providing harmonized guidance how to seek evidence-based information, which could serve policy-makers.

Top-Down Policy Risk Assessment

The primary aim of the Risk Assessment from Policy to Impact Dimension (RAPID) 2009–2012 EU project was to develop a methodological guidance for policy risk assessment. The main idea was that the systematic analysis of complex impact schemes requires the description of the “full chain” of causal pathways considering all levels of causality in an integrated manner. The analysis should proceed from the top to the bottom of the causal chain, i.e. from the cause, that is the policy, through health determinants and risk factors to the effect that are health outcomes. The top-down risk assessment approach follows a logical structure that can be readily applied in the risk appraisal phase of policy health impact assessments.

Explaining the Decrease in Deaths from Cardiovascular Disease in Poland. The Top-Down Risk Assessment Approach, from Policy to Health Impact.

OBJECTIVE The purpose of this paper was to assess the relations between policy and health outcome SETTING The CVD mortality rate in Poland over the past two decades has decreased by about 40%. It was the highest decrease among Central and Eastern European countries and also exceptional on a global scale. DESIGN Key determinants which can account for these phenomena include CVD-related life style factors, better environmental indicators, and better access to medical technologies and to pharmacological treatment. Health policy played a vital role. METHODS The study was based on an extensive literature review, documentation analysis and questionnaire survey research. The top-down risk assessment approach model was implemented, which followed the logical pathway between the policy, health determinants, risk factors and health outcome. RESULTS Several national public health programs have been implemented since the beginning of the 1990s. The National Health Fund has constantly increased the expenditures on cardiology treatment. The number of invasive cardiology units has increased, as has the number of coronarography and angioplasty procedures in the same period. CONCLUSIONS The significant mortality decrease can indicate to policy makers that it is necessary to prioritize policies to manage effective, innovative medical interventions. Topdown policy risk assessment is a useful methodological tool to present the full chain of interactions.

Możliwości wykorzystania oceny oddziaływania na zdrowie (Health Impact Assessment – HIA) przy rozwiązywaniu współczesnych dylematów polityki zdrowotnej

This paper focus on Health Impact Assessment (HIA) as an important approach in health policy and public health to evaluate policies, plans, projects, strategies and to determine their actual and potential impacts on health and distribution of health effects among general population. HIA provides decision makers, health professionals and the general public with evidence-based information resources on health effects of decision-making process. The aim of this consideration is to present the usefulness and need for HIA within policy and decision-making. Selected case studies concerning key areas of public authorities activities are presented based on projects findings and literature review. There are significant evidences of strong relations between health outcomes and policy-making process. Policy may influence the determinants of the health of the population through environmental, socio-economic, cultural, living and working conditions. The Health Impact Assessment is useful tool of identification and highlighting the health issues beyond the health-care sector, i.e.: urban planning, infrastructure, transport, housing, agriculture, industry, environment.

Exploring the Life Expectancy Increase in Poland in the Context of CVD Mortality Fall: The Risk Assessment Bottom-Up Approach, From Health Outcome to Policies.

Life expectancy at birth is considered the best mortality-based summary indicator of the health status of the population and is useful for measuring long-term health changes. The objective of this article was to present the concept of the bottom-up policy risk assessment approach, developed to identify challenges involved in analyzing risk factor reduction policies and in assessing how the related health indicators have changed over time. This article focuses on the reasons of the significant life expectancy prolongation in Poland over the past 2 decades, thus includes policy context. The methodology details a bottom-up risk assessment approach, a chain of relations between the health outcome, risk factors, and health policy, based on Risk Assessment From Policy to Impact Dimension project guidance. A decline in cardiovascular disease mortality was a key factor that followed life expectancy prolongation. Among basic factors, tobacco and alcohol consumption, diet, physical activity, and new treatment technologies were identified. Poor health outcomes of the Polish population at the beginning of 1990s highlighted the need of the implementation of various health promotion programs, legal acts, and more effective public health policies. Evidence-based public health policy needs translating scientific research into policy and practice. The bottom-up case study template can be one of the focal tools in this process. Accountability for the health impact of policies and programs and legitimization of the decisions of policy makers has become one of the key questions nowadays in European countries’ decision-making process and in EU public health strategy.

Public Health, Policy Analysis, Risk Assessment, and Impact Assessment

There is no common consensus on the meaning of public health and its future goals and there are different understandings among states about objectives and how public health services are organized. The new public health can be generally defined as an integrative approach to protect and promote the health status of the individuals and population. New public health focuses especially on disease prevention, health promotion, education and cross-sectoral action, including decisions and activities beyond the health system, well-being and health of society, communities, and individuals.

Bottom-Up Policy Risk Assessment

The top-down risk assessment that fits the classical HIA method and its application on policy was in depth presented in the previous chapter. Many public health experts find large policies difficult to assess as for their impact on health. People knowing health outcome and its societal burden well may find it easier to find proper policies starting from the bottom line—from health outcome. The use of complex causal process diagrams for analyzing health impacts of policy interventions was already described. The RAPID guidance based on bottom-up approach might be helpful to act more efficiently in reducing prevalence of health outcomes by identification and selection of proper policies for structural intervention. The health outcome was taken as a starting point and assessment through levels of risk factors and determinants of health lead to identification of policies needed to reduce burden of health outcome.

Capacity building for HIA

Background : To integrate health impact assessment (HIA) into existing decision-making processes requires not only methods and procedures but also well-trained experts, aware policy makers and appropriate institutions. Capacity building is the assistance which is provided to entities, which have a need to develop a certain skill or competence, or for general upgrading of performance ability. If a new technique is planned to be introduced there is a need for capacity building with no respect to levels (local, regional, national, international) or sectors (health, environment, finance, social care, education, etc.). As such, HIA is a new technique for most of the new Member States and accession countries of the European Union. Methods : To equip individuals with the understanding and skills needed to launch a HIA or be aware of the availability of this methodology and to access information, knowledge and training, we focused on the organization of workshops in participating countries. The workshops served also as pilot events to test a “curriculum” for HIA; a set of basic topics and presentations had been developed to be tested during workshops. In spite of classical in-class workshops we aimed to organize e-learning events as a way to over come the “busyness” problem of decision makers. Results : Throughout March – October 2006 we organized and ran 7 workshops in Denmark, Turkey, Lithuania, Poland, Bulgaria, Slovak Republic and Hungary. Participants came from the public health sector (141), non-public health decision makers (113) and public health students (100). A concise curriculum was developed and tested during these workshops. Participants developed a basic understanding of HIA, skills to develop and use their own screening tools as well as scoping.Within the workshop in Denmark we tested an online, real-time Internet based training method; participants highly welcomed this method as it allowed them to take part in training from their workplace, and it did not disturb their daily work. Conclusions : The workshops set a very good baseline for the introduction of HIA in participating countries. The training documents are being translated into their national languages and will be posted on the national HIA web pages of the participating countries. Participating countries have expressed an interest in continuing on with similar workshops on specific issues related to HIA, providing more in-depth training.