22 August 2006
The review includes the version of the determinants of health diagram developed by Goran Dahlgren and Margaret Whitehead that has been adapted by Barton and Grant to include a planning perspective. What I think is missing from the model is the important role health services still play in determining health outcomes, though their absence may be understandable given the audience for whom the diagram was adapted (land use planners, social planners, local government, etc).
I'm reminded of McKee's (2002) observation that McKeown's influence on public health was to popularise the view that improvements in mortality were mostly due to improvements in living conditions (McKeown 1979). Mackenbach and his colleagues refuted this, at least in part, by demonstrating the decline in deaths from conditions that could be altered through health care represented a major part of overall improvement in life expectancy in The Netherlands between 1950 and 1984 (Mackenbach et al 1988).
I think there's still an important role for health services in contributing to a reduction in health inequalities and ensuring population health gains. What do you think?
Mackenbach J, Looman C, Kunst A, Habbema D, van der Maas (1988) Post-1950 mortality trends and medical care: gains in life expectancy due to declines in mortality from conditions amenable to medical interven-tion in The Netherlands. Social Science and Medicine 27:889-894.
McKee M (2002) What can Health Services Contribute to the Reduction of Inequalities in Health?, Scandanavian Journal of Public Health, 30(Supplement 59) p 54-58.
McKeown T (1979) The role of medicine: dream, mirage or nemesis? Oxford: Blackwell.
17 August 2006
An excellent introduction to monitoring and evaluation has been released by the World Bank:
Monitoring and Evaluation Report
This is a useful resource for anyone considering monitoring and evaluation approaches, tools and strategies as part of their HIA (or broader work). The booklet covers performance indicators, the logical framework approach, theory surveys, rapid appraisal methods, participatory methods, public expenditure tracking surveys, cost-benefit and cost-effectiveness analysis, and impact evaluation. Each has a section to itself that covers what each is, what each is used for, advantages, disadvantages, costs, skills and time required, and links to other websites and resources. Using the booklet would certainly help people to quickly and concisely scope the most appropriate approach to the monitoring and evaluation stage of their HIA (the least well covered stage in the HIA guidance literature).