health promotion: key issues on evaluation and … · the historical development of health ......

Health Promotion: Key issues on Health Promotion: Key issues on evaluation and evidence of its evaluation and evidence of its

effectivenesseffectivenessDavid V. McQueenDavid V. McQueen

Associate Director for Global Health Associate Director for Global Health PromotionPromotion

Santiago de Santiago de CaliCali, Colombia June 14, 2005, Colombia June 14, 2005

Greetings Greetings

Health Promotion: Key issues on Health Promotion: Key issues on evaluation and evidence of its evaluation and evidence of its

effectivenesseffectiveness

Seminar on Evaluation and Public Seminar on Evaluation and Public Health Policies: Responding to Health Policies: Responding to

Health DeterminantsHealth DeterminantsSantiago de Santiago de CaliCali, Columbia June 14, , Columbia June 14,

2005; Intercontinental Hotel2005; Intercontinental Hotel

Today’s TalkToday’s Talk

The concept of evidenceThe concept of evidenceMethodological effortsMethodological effortsCritical elements of the debateCritical elements of the debateStrategic alliancesStrategic alliances

A digression (first)A digression (first)

History and Theory of Public Health:History and Theory of Public Health:Slowly Changing ParadigmsSlowly Changing ParadigmsSanitary Era (when we knew it)Sanitary Era (when we knew it)

Germ TheoryGerm Theory

Infectious & Chronic Disease Infectious & Chronic Disease Epidemiology Epidemiology (individual risk factor epidemiology(individual risk factor epidemiology----“social” Epidemiology)“social” Epidemiology)

* * Health Promotion (finding it again)Health Promotion (finding it again)

The Historical Development of Health The Historical Development of Health Promotion in the 20Promotion in the 20thth Century: Two Traditions, Century: Two Traditions,

Two OriginsTwo Origins-- Both WesternBoth Western

The continentThe continent North AmericaNorth America

Framed by concernswith the social,economic and political roots of health

Focus on the sociopolitical

Framed by the enlargementof the traditional scope ofhealth education

Focus on the individual

The Historical Development of Epidemiology The Historical Development of Epidemiology in the 20in the 20thth Century: Two Traditions, One Old, Century: Two Traditions, One Old,

One RecentOne RecentEpidemiologyEpidemiology Social Social

EpidemiologyEpidemiology

Framed by concerns with etiology, traditional bio-medical model and a developed disciplinary base in scientific method

Framed by the enlargementof the traditional scope ofepidemiology

Focus on the individual plusfocus on the sociopolitical

Dominant Patterns of WorkDominant Patterns of Work

MethodsMethodsActionActionTheoryTheoryConcerned Concerned with CAUSEwith CAUSE

ActionActionConcepts and Concepts and PrinciplesPrinciplesMethodsMethodsConcerned Concerned with CHANGE with CHANGE in a in a CONTEXTCONTEXT

Epidemiology Health Promotion

Thus evidence takes on a different meaning ;In epidemiology it is often associated with etiologyIn health promotion it is associated with what works

Health Promotion Perspective: Health Promotion Perspective: The Components of The Components of ContextContext

LIFELIFESTYLESTYLE: Collective pattern of life conduct: Collective pattern of life conductLIFE LIFE CONDUCTCONDUCT: Pattern of behavior of an : Pattern of behavior of an individual in their dayindividual in their day--toto--day livesday livesLIFE LIFE CONDITIONSCONDITIONS: Patterns of resources of an : Patterns of resources of an individual or group (including health status)individual or group (including health status)LIFE LIFE SITUATIONSITUATION: Collective pattern of life : Collective pattern of life conditions conditions LIFE LIFE CHANCESCHANCES: Structural: Structural--based probability of based probability of correspondence of lifestyle and life situationcorrespondence of lifestyle and life situation

Adapted from Adapted from RuttenRutten, A. (1995). The implementation of health , A. (1995). The implementation of health promotion: a new structural perspective. promotion: a new structural perspective. Social Science & MedicineSocial Science & Medicine, , 41(2), 162741(2), 1627--1637.1637.

The concept of evidence The concept of evidence in health promotionin health promotion

You cannot look at the concept of You cannot look at the concept of evidence without taking into account evidence without taking into account the history of public health over the the history of public health over the past century that we just reviewedpast century that we just reviewedPart of the history during the latter Part of the history during the latter part of the 20part of the 20thth Century was the rise Century was the rise of evidence as a critical ideaof evidence as a critical idea

EvaluationEvaluation

EffectivenessEffectiveness

The three ‘Es’*The three ‘Es’*

*very different animals

Evidence

EffectivenessEffectiveness

Effectiveness is a broad, loosely defined Effectiveness is a broad, loosely defined term, generally linked to the notion of term, generally linked to the notion of “outcomes”“outcomes”Tied to the notion that effective health Tied to the notion that effective health promotion leads to changes in the promotion leads to changes in the determinants of healthdeterminants of healthRaises the “spectre” of costsRaises the “spectre” of costsUnderlying epistemology of “outcomes” Underlying epistemology of “outcomes” remains complicatedremains complicated

The concept of and search for The concept of and search for evidence depends onevidence depends on

Your point of viewYour point of viewYour trainingYour trainingYour view of “science’Your view of “science’Your view of “knowledge”Your view of “knowledge”Your contextYour contextYour way of workingYour way of working

Evidence does not exist as a “Thing in itself”

Where is the evidence found? This is both Where is the evidence found? This is both a conceptual problem and a a conceptual problem and a

methodological problemmethodological problem

Refereed science literature Refereed science literature

General published literatureGeneral published literature

Fugitive literatureFugitive literature

InternetInternet

The communityThe community

OtherOther

Finding Evidence Is Difficult Finding Evidence Is Difficult Databases and keywords are Databases and keywords are typically not well suited to find typically not well suited to find intervention studies efficientlyintervention studies efficientlyInterventions are not categorized Interventions are not categorized systematicallysystematically

Over the years the “evidence search” Over the years the “evidence search” in health promotion has expanded in health promotion has expanded

beyond looking for beyond looking for RCTsRCTs

Every design has strengths and Every design has strengths and limitations limitations

Randomization rarely appropriate or Randomization rarely appropriate or feasible feasible

Many other intervention and Many other intervention and research approaches prove to be research approaches prove to be more appropriatemore appropriate

General Comments on the efforts to General Comments on the efforts to evaluate health promotion interventionsevaluate health promotion interventions

What appears to be a relatively What appears to be a relatively straightforward task is not so straightforward task is not so simplesimpleDespite more than a decade of Despite more than a decade of efforts, we are still in early efforts, we are still in early stagesstagesMany considerations, methods a Many considerations, methods a key problemkey problem

Methodological approaches Methodological approaches to evaluate effectiveness in to evaluate effectiveness in

health promotionhealth promotion

Quantitative and Qualitative Factors in Deciding on Quantitative and Qualitative Factors in Deciding on Methods: Statistics and valuesMethods: Statistics and values

How big is the problem?How big is the problem?How much of the problem can be How much of the problem can be prevented?prevented?How much of the problem will an How much of the problem will an intervention prevent?intervention prevent?What are the benefits and harms?What are the benefits and harms?What does the intervention cost?What does the intervention cost?How do benefits compare to How do benefits compare to costs?costs?How much do I gain compared to How much do I gain compared to what is already happening?what is already happening?

Is it health Is it health promotingpromotingIs it feasible?Is it feasible?Is it acceptable?Is it acceptable?Is it appropriate?Is it appropriate?Is it equitable?Is it equitable?

Quantitative Factors Qualitative Factors

Why Systematic Reviews of Health Why Systematic Reviews of Health Promotion Interventions are seen Promotion Interventions are seen

as Usefulas UsefulMethods first developed by social Methods first developed by social scientists Distill and summarize scientists Distill and summarize large and diverse bodies of large and diverse bodies of evidenceevidenceReduce errors and biases in Reduce errors and biases in interpretationinterpretationMake assumptions explicitMake assumptions explicit

Systematic Reviews Are Not: Systematic Reviews Are Not: Limited to randomized controlled Limited to randomized controlled trials trials Limited to healthcare interventionsLimited to healthcare interventionsRestricted to a “biomedical model” of Restricted to a “biomedical model” of healthhealthWithout serious limitationsWithout serious limitations

Logic Models are often used Logic Models are often used to Organize Large Numbers to Organize Large Numbers

of Variable and Complex of Variable and Complex Intervention OptionsIntervention Options

Methods and models – the hope that models will clarify methods

Sociocultural Environment Logic Framework

Determinants

SOCIALRESOURCESstandard of livingculture and historysocial institutionsbuilt environmentspolitical structureseconomic systemstechnology

Neighborhood Living Conditions

Community, Development,& Employment Opportunities

Opportunities for Learning andDeveloping Capacity

Community Customs,Norms, & Processes

Civic Engagement & Participationin Decision-Making

Strategic Points for Interventions

Health Outcome

Health Promotion, Prevention,& Care Opportunities

PHYSICALENVIRONMENTnatural resourcessustainable

development

EQUITY ANDSOCIALJUSTICE

HEALTHIER COMMUNITIES

Consumer Demand•Household resources•Nutrition knowledge •Cultural practices •Psychosocial characteristics •Taste and preferences•Advertising and marketing

LOGIC FRAMEWORK NUTRITION & COMMUNITY HEALTH

Modifiable DeterminantsFood Supply Factors•Agriculture policy•Nutrition policy•Science and technology •Food production, processing, storage and distribution

•Food fortification•Food safety

Environmental Factors•Food Availability & Price•Neighborhoods•Schools•Worksites •Homes•Local, state & national food assistance programs

POPULATION FOOD INTAKEFood Consumption Patterns

(e.g. fruits, vegetables)Intake of Nutrients and

Food Components: VitaminsMinerals

FiberFats

Other food constituentsDietary supplements

AlcoholEnergy balance

Life StageRequirements

Pregnancy Lactation Childhood

AdolescenceAdulthood

Older Adulthood

IntermediateOutcomes

Community Health

Outcomes

Physiologic Indicators:

GrowthAdipose tissue

MusculoskeletalGastrointestinal

MetabolicCardiovascularReproductive

ImmunologicalNeurological

Genetics,Co-morbidities

• Morbidity• Mortality

• Measures of Health & Fitness• Quality of Life

PhysicalActivityPatterns

INTERVENTI

ONS

No Two Community No Two Community Interventions Are IdenticalInterventions Are Identical

Carefully combining information Carefully combining information about related but not identical about related but not identical interventions helps to interventions helps to •• Fully represent an intervention Fully represent an intervention

constructconstruct•• Enhance external validity and Enhance external validity and

usefulnessusefulness•• Identify common aspects of effective Identify common aspects of effective

interventionsinterventions

Defining Suitability of Study Defining Suitability of Study Design?Design?

GreatestGreatest•• Prospective with concurrent Prospective with concurrent

comparison comparison ModerateModerate•• Multiple beforeMultiple before--andand--after after

measurements but no concurrent measurements but no concurrent comparison ORcomparison OR

•• RetrospectiveRetrospectiveLeastLeast•• Single group beforeSingle group before--andand--afterafter•• CrossCross--sectionalsectional

What Factors Determine What Factors Determine Quality of Execution?Quality of Execution?

Description of intervention and Description of intervention and study populationstudy populationSampling proceduresSampling proceduresExposure and outcome Exposure and outcome measurementsmeasurementsApproach to data analysisApproach to data analysisInterpretation of resultsInterpretation of resultsOther issues Other issues

Drawing an Overall Conclusion About the Drawing an Overall Conclusion About the Strength of EvidenceStrength of Evidence-- a Complicated Taska Complicated Task

Number of studiesNumber of studiesDesign suitabilityDesign suitabilityQuality of executionQuality of executionConsistencyConsistencyEffect sizeEffect sizeOther Factors Other Factors ––zone of zone of complexitycomplexity

SmallSmallNoNoToo fewToo fewInsufficient design or Insufficient design or executionexecution

3. 3. InsufficientInsufficient

SufficientSufficientYesYes>> 55Greatest, Greatest, Moderate Moderate or Leastor Least

Good or Good or FairFair

SufficientSufficientYesYes>> 33Greatest or Greatest or ModerateModerate

Good or Good or FairFair

SufficientSufficient----11GreatestGreatestGoodGood

2. Sufficient2. Sufficient

LargeLargeMeet criteria for sufficient evidenceMeet criteria for sufficient evidence

SufficientSufficientYesYes>> 55GreatestGreatestGood or Good or FairFair

SufficientSufficientYesYes>> 55Greatest or Greatest or ModerateModerate

GoodGood

SufficientSufficientYesYes>> 22GreatestGreatestGoodGood

1. Strong1. Strong

Effect Effect SizeSize

ConsistentConsistentNumber Number of of StudiesStudies

Design Design SuitabilitySuitability

Quality of Quality of ExecutionExecution

Evidence of Evidence of EffectivenesEffectivenesss

Broad Participation in the Broad Participation in the Process Improves the ProductProcess Improves the Product

Multiple perspectives and Multiple perspectives and backgrounds backgrounds •• Improve completeness and Improve completeness and

accuracy of information accuracy of information •• Reduce impact of individual or Reduce impact of individual or

institutional perspectivesinstitutional perspectives•• Enhance usefulness of productsEnhance usefulness of products

Identifying appropriate change processes

HighCertainty about what works

Low

High

Low

Agreement about how to do it

Standards Guidance

Political compromise

Experiment

Innovation

Creativity

“Zone of Complexity”

Trial & Error

• Focus on areas with high certainty and high agreement

• Understand and utilze effective change processes

Critical elements of the Critical elements of the evidence debateevidence debate

Evaluation of effectiveness Evaluation of effectiveness is part of the ongoing is part of the ongoing

debate around evidencedebate around evidence

The “evidence debate” The “evidence debate” Why is evidence so important?Why is evidence so important?

Many believe that the success of health Many believe that the success of health promotion will depend upon its ability to promotion will depend upon its ability to demonstrate demonstrate scientificallscientificallyy that it is an that it is an effectiveeffective field of public health actionfield of public health action

In contrast, many believe that evidence, the In contrast, many believe that evidence, the very word, is very word, is inappropriateinappropriate for the field of for the field of health promotionhealth promotion

Between these two extremes are those who Between these two extremes are those who question the appropriateness of the various question the appropriateness of the various forms of evidenceforms of evidence and consider the basic and consider the basic issues of knowledge development in the field of issues of knowledge development in the field of health promotionhealth promotion

Finding Evidence Is Difficult Finding Evidence Is Difficult Databases and keywords are Databases and keywords are typically not well suited to find typically not well suited to find intervention studies efficientlyintervention studies efficientlyInterventions are not categorized Interventions are not categorized systematicallysystematicallyRequires Requires •• Database searchesDatabase searches•• Reviews of reference listsReviews of reference lists•• Consultation with experts Consultation with experts

Critical questionsCritical questions

How do you convince decision How do you convince decision makers to use evidence?makers to use evidence?How do you convince decision How do you convince decision makers that you have evidence?makers that you have evidence?How much evidence do you need?How much evidence do you need?What to do with insufficient What to do with insufficient

evidence?evidence?

Insufficient Evidence as Insufficient Evidence as Applied by the Task Applied by the Task

ForceForce

85 (56%) of 153 completed 85 (56%) of 153 completed reviewsreviewsOnly 2 (1.3%) “Only 2 (1.3%) “Recommend Recommend AgainstAgainst””

Insufficient Evidence Applied in the Tobacco ReviewsInsufficient Evidence Applied in the Tobacco Reviews

XXStudent AdvocacyStudent Advocacy

XXSchool policySchool policy

XXXXSchoolSchool--based educationbased education

XXRetailer EducationRetailer Education

XXRetailer Education+Retailer Education+

(X)(X)

XX

Serious Serious FlawsFlaws

XXActive EnforcementActive Enforcement

XXRetailer LawsRetailer Laws

XXYouth Access LawsYouth Access Laws

XXProvider FeedbackProvider Feedback

XXXXProvider EducationProvider Education

XXCessation ContestsCessation Contests

XXCessation SeriesCessation Series

XXCommunity EducationCommunity Education

Inconsist. Inconsist. EffectsEffects

Qualifying Qualifying StudiesStudies

Too Few Too Few StudiesStudies

Interventions with Interventions with Insufficient EvidenceInsufficient Evidence

Reasons for Insufficient Reasons for Insufficient EvidenceEvidence

(n=52 intervention reviews)(n=52 intervention reviews)Too few studies: 33 (63%) Too few studies: 33 (63%) Too few qualifying studies: 7 (13%)Too few qualifying studies: 7 (13%)Inconsistent effects: 8 (15%)Inconsistent effects: 8 (15%)Applicability: 2 (3.8%)Applicability: 2 (3.8%)Serious flaws: 8 (15%)Serious flaws: 8 (15%)

Strategic alliances as an Strategic alliances as an international response: international response: Focus on the IUHPEFocus on the IUHPE

There have been and are many There have been and are many efforts to efforts to produce evidenceproduce evidence for health promotion for health promotion

and the IUHPE GPHPE is part of this effortand the IUHPE GPHPE is part of this effort

E(EURO)WG Europe/Canada/USA E(EURO)WG Europe/Canada/USA CPSTF USA, CPSTF USA, Community Preventive Community Preventive Services Task Force, also called the Services Task Force, also called the “Community Guide“Community Guide””

IUHPE EUIUHPE EUCochraneCochraneGPHPEGPHPEMany othersMany others

A strategic questionA strategic questionWhat contribution can an What contribution can an

international organization make international organization make to the body of knowledge on the to the body of knowledge on the

effectiveness of community based effectiveness of community based healthhealth--related interventions, related interventions,

given the context of community given the context of community based funding programs?based funding programs?

Examples of efforts to Examples of efforts to produce evidence:produce evidence:

CPSTF USA, Community CPSTF USA, Community Preventive Services Task Force, Preventive Services Task Force, also called the “Community Guide”also called the “Community Guide”E(EURO)WG Europe/Canada/USA E(EURO)WG Europe/Canada/USA IUHPE EU, GPHPEIUHPE EU, GPHPEPAHOPAHOWHOWHOMany othersMany others

Evaluating HealthEvaluating Health Promotion: Promotion: Recommendations to Recommendations to

PolicyPolicy--makersmakers

WHOWHO--EURO Working Group* on EURO Working Group* on Health Promotion EvaluationHealth Promotion Evaluation

*The working group met many times over a *The working group met many times over a ten year period, with membership from Europe,ten year period, with membership from Europe,

Canada and the USACanada and the USA

ObjectivesObjectivesprovide guidance to policyprovide guidance to policy--makers makers and practitioners to foster the use of and practitioners to foster the use of appropriate methodsappropriate methods

examine current range of methodsexamine current range of methods

provide guidance to policyprovide guidance to policy--makers makers and practitioners to increase quality and practitioners to increase quality of health promotion evaluationsof health promotion evaluations

Major publication of the EWG was the Major publication of the EWG was the “Yellow Book”:“Yellow Book”:

Evaluation in health promotion: Principles Evaluation in health promotion: Principles and perspectives*and perspectives*

*This monograph, edited byRootman, Goodstadt, Hyndman, McQueen, Potvin, Springett and Ziglio

Was published by WHO in 2001 and contains critical articles in valuationfrom 55 authors, comprising 23 chapters.

The monograph was the product of an extensive series of discussions and reviews, setting a standard for addressing the issues involved in evidence and evaluation.

**This monograph, edited byThis monograph, edited byRootman, Rootman, GoodstadtGoodstadt, Hyndman, McQueen, Potvin, Springett and Ziglio, Hyndman, McQueen, Potvin, Springett and Ziglio

Was published by WHO in 2001 and contains critical articles in vWas published by WHO in 2001 and contains critical articles in valuationaluationfrom 55 authors, comprising 23 chapters. from 55 authors, comprising 23 chapters.

The monograph was the product of an extensive series of discussiThe monograph was the product of an extensive series of discussions and reviews, ons and reviews, setting a standard for addressing the issues involved in evidencsetting a standard for addressing the issues involved in evidence and evaluatione and evaluation.

EWG Principles for EWG Principles for Evaluation of Health Evaluation of Health Promotion InitiativesPromotion Initiatives

ParticipationParticipationMultiple methodsMultiple methodsCapacityCapacity--buildingbuildingAppropriatenessAppropriateness

IUHPE ReportIUHPE ReportA Report for the European Commission by the A Report for the European Commission by the

International Union for Health Promotion and International Union for Health Promotion and EducationEducation

Title: The Evidence of Health Title: The Evidence of Health Promotion Effectiveness: Shaping Promotion Effectiveness: Shaping Public Health in a New EuropePublic Health in a New Europe

A core document, 30 pagesA core document, 30 pages

An Evidence Book, 164 pagesAn Evidence Book, 164 pages

IUHPE ReportIUHPE ReportThree Components of Working GroupThree Components of Working GroupInternational Project Advisory GroupInternational Project Advisory GroupLead project AuthorsLead project AuthorsA Witness Group of Political ExpertsA Witness Group of Political Experts

IUHPE ReportIUHPE ReportKey General RecommendationsKey General Recommendations

11 Commission urged to develop Commission urged to develop appropriate infrastructure for the appropriate infrastructure for the development of successful health development of successful health promotion programs promotion programs

22 The impressive body of evidence The impressive body of evidence in health promotion best practice in health promotion best practice needs to be made available widely needs to be made available widely and systematically updatedand systematically updated

Characteristics of Working Characteristics of Working Groups on Evidence and Groups on Evidence and

EvaluationEvaluationMultiMulti--disciplinarydisciplinaryOften multiOften multi--cultural/multiple nationscultural/multiple nationsLarge endeavors Large endeavors Time consumingTime consumingRaising many questionsRaising many questionsReviewing published, Western Reviewing published, Western sourcessources

The Global Programme on The Global Programme on Health Promotion Health Promotion

Effectiveness (GPHPE)Effectiveness (GPHPE)A programme coordinated by the International Union for Health Promotion and Education in collaboration with the

World Health Organization, the US Centers for Disease Control and Prevention and many other partners:

African Medical and Research Foundation; Health Promotion Switzerland; National Institute for Health and Clinical Excellence, England; The Netherlands

Institute for Health Promotion and Disease Prevention; Pan-American Health Organization; Public Health Agency of Canada; Victorian Health Promotion

Foundation; Voluntary Health Association of India, among other international and regional partners.

The GPHPE aims to raise the standards of health promotion The GPHPE aims to raise the standards of health promotion policy and practice worldwide by:policy and practice worldwide by:

Reviewing evidence of effectiveness in Reviewing evidence of effectiveness in terms of health, economic, social and terms of health, economic, social and political impact;political impact;Translating evidence to policyTranslating evidence to policy--makers, makers, teachers, practitioners and researchers;teachers, practitioners and researchers;Stimulating the debate on the evidence of Stimulating the debate on the evidence of health promotion effectiveness.health promotion effectiveness.

GPHPE : Products (global level)GPHPE : Products (global level)

Special global issue of proceedings from the Francophone Special global issue of proceedings from the Francophone seminar on health promotion effectiveness (available)seminar on health promotion effectiveness (available)Special global issue on mental health promotion Special global issue on mental health promotion effectiveness (available)effectiveness (available)Special global issue on health promoting schools and Special global issue on health promoting schools and effectiveness (in development)effectiveness (in development)Special global issue on urbanisation (under Special global issue on urbanisation (under consideration)consideration)Articles published on the GPHPE, its aims and goalsArticles published on the GPHPE, its aims and goalsGlobal monograph to be released in Vancouver, 2007Global monograph to be released in Vancouver, 2007

GPHPE : Products (regional level)GPHPE : Products (regional level)

Europe : new publication on the challenges of Europe : new publication on the challenges of getting evidence into practicegetting evidence into practiceLatin America : report on state of the art of the Latin America : report on state of the art of the evidence of health promotion effectiveness, rapid evidence of health promotion effectiveness, rapid evaluation guide, and numerous articles and toolsevaluation guide, and numerous articles and toolsAfrica : conceptual framework and working paper, Africa : conceptual framework and working paper, publication commissionedpublication commissionedNorth America : evaluation tool kit, website, North America : evaluation tool kit, website, framework for community efforts to create framework for community efforts to create conditions that promote healthconditions that promote health

GPHPE : Operational structureGPHPE : Operational structure

Global and Regional Leaders/CoordinatorsGlobal and Regional Leaders/CoordinatorsGlobal Steering GroupGlobal Steering GroupPartners, interested parties, collaborators, and Partners, interested parties, collaborators, and independent scientific consultants across the independent scientific consultants across the globeglobePotential for creating interPotential for creating inter--regional forum regional forum around particular areas of interestaround particular areas of interest

GPHPE : Regional projectsGPHPE : Regional projects

Regions focus on developing their own Regions focus on developing their own priorities and definitions of evidence of priorities and definitions of evidence of effectiveness:effectiveness:•• Regions move at their own pace;Regions move at their own pace;•• Regions take into account their own context Regions take into account their own context

and develop plans accordingly;and develop plans accordingly;•• Regions feel ownership, while at the same Regions feel ownership, while at the same

time being full partners in the global time being full partners in the global programme.programme.

GPHPE: Distinguishing aspectsGPHPE: Distinguishing aspects

The GPHPE:The GPHPE:Is a worldwide programme.Is a worldwide programme.Advocates the importance of effectiveness to Advocates the importance of effectiveness to researchers, practicitioners and decisionresearchers, practicitioners and decision--makers.makers.Will support regional approaches, given the different Will support regional approaches, given the different stages of the development of the field.stages of the development of the field.Is about drawing into the programme what can be Is about drawing into the programme what can be learned and valued from each region while giving learned and valued from each region while giving the opportunity for regions to learn from each other.the opportunity for regions to learn from each other.

GPHPE : VisionGPHPE : VisionThe GPHPE is a programme intended to uncover The GPHPE is a programme intended to uncover and find evidence for effectiveness. This may and find evidence for effectiveness. This may translate into various approaches in regions given translate into various approaches in regions given their current capacity to carry out this kind of their current capacity to carry out this kind of research or related activities. The intention and research or related activities. The intention and goal is to find answers and solutions based on goal is to find answers and solutions based on best practice in order to be able to advise on how best practice in order to be able to advise on how interventions could be better carried out based interventions could be better carried out based upon the evidence.upon the evidence.

GPHPE : Next stepsGPHPE : Next steps

Enlargement and strengthening of regional Enlargement and strengthening of regional initiativesinitiativesDevelopment of content for the Global Development of content for the Global Monograph series Monograph series Increased networking and exchange across Increased networking and exchange across regions, increasing synergy to develop regions, increasing synergy to develop capacitycapacity

Some indicators of achievement by Some indicators of achievement by the GPHPE will be :the GPHPE will be :

1.1. RepresentativenessRepresentativeness

the extent to which health promotion initiatives the extent to which health promotion initiatives from a diversity of countries, cultures and from a diversity of countries, cultures and peoples is represented in the project;peoples is represented in the project;how complete it is in identifying all the potential how complete it is in identifying all the potential health promotion projects that should be health promotion projects that should be included;included;the extent to which health promotion the extent to which health promotion interventions are distinctively recognised.interventions are distinctively recognised.


2. Quality of reflection2. Quality of reflection

the ability of the analytical review framework(s) the ability of the analytical review framework(s) developed to distinguish the features of effective developed to distinguish the features of effective projects;projects;the ability of an adequate number of reviews to the ability of an adequate number of reviews to take place.take place.


3. Relevance of knowledge for use3. Relevance of knowledge for use

the extent to which the knowledge obtained from the extent to which the knowledge obtained from the project is translated into use by practitioners;the project is translated into use by practitioners;the extent to which the knowledge obtained the extent to which the knowledge obtained influences research priorities as well as policy influences research priorities as well as policy and decision makers;and decision makers;the general improvement in the knowledge, the general improvement in the knowledge, education and training of health promotion education and training of health promotion professionals. professionals.

Summing upSumming up

Evaluation is a critical hallmark of Evaluation is a critical hallmark of good public health and health good public health and health promotionpromotion

Need to understand the Need to understand the complications and dimensions of the complications and dimensions of the task we are undertakingtask we are undertaking

Summary with regard to concepts, Summary with regard to concepts, methods, and alliancesmethods, and alliances

Conceptualization of evidence must relate Conceptualization of evidence must relate to the concepts of health promotionto the concepts of health promotionMethods are many and varied; context is Methods are many and varied; context is related to methodrelated to methodAlliances promote a synergy among Alliances promote a synergy among efforts that add valueefforts that add valueInvestment in evaluation for Investment in evaluation for evidence has been seen as critical by evidence has been seen as critical by governments, international governments, international organizations and the general field of organizations and the general field of public health researcherspublic health researchers

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