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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

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6Evidence 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

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6Why Evidence?

Why Now?

• Increased interest in “evidence-based policy making”

• Growing demand for health information/evidence for decision-making

• More complex information is produced

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6The 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

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6The 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.

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6Why 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

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6Europe: 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

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6Information 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

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6Evidence: Multiple meanings?

• “Evidence”: research, RCTs, outcomes

• “Evidence”: opinions, surveys, anecdotes

• Evidence- “based”...• Evidence- “informed”...• Evidence- “aware” ...

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6Evidence-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)

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6Factors influencing policy-making

process

• Experience, expertise and judgement • Resources • Values • Lobbyists, pressure groups and

consultants • Pragmatics and contingencies

Source: Modified from Davies P., 2004http://www.policyhub.gov.uk/home/JerryLeeLecture1202041.pdf

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Linking information and evidence to policy-making processes

Evidence

Other criteria

Evidence

Other criteria

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6Different 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

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6Operational 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

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6WHO 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

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6WHO 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)

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“The best is the enemy of the good”

Voltaire 1694-1778

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6The 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?

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6The 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)