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Horgan D, Borisch B, Cattaneo I, Caulfield M, Chiti A, Chomienne C, Cole A, Facey K, Hackshaw A, Hendolin M, Georges N, Kalra D, Tumienė B, von Meyenn M. Factors Affecting Citizen Trust and Public Engagement Relating to the Generation and Use of Real-World Evidence in Healthcare. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031674. [PMID: 35162696 PMCID: PMC8835047 DOI: 10.3390/ijerph19031674] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/21/2022] [Accepted: 01/28/2022] [Indexed: 01/09/2023]
Abstract
The potential for the use of real-world data (RWD) to generate real-world evidence (RWE) that can inform clinical decision-making and health policy is increasingly recognized, albeit with hesitancy in some circles. If used appropriately, the rapidly expanding wealth of health data could improve healthcare research, delivery of care, and patient outcomes. However, this depends on two key factors: (1) building structures that increase the confidence and willingness of European Union (EU) citizens to permit the collection and use of their data, and (2) development of EU health policy to support and shape data collection infrastructures, methodologies, transmission, and use. The great potential for use of RWE in healthcare improvement merits careful exploration of the drivers of, and challenges preventing, efficient RWD curation. Literature-based research was performed to identify relevant themes and discussion topics for two sets of expert panels, organized by the European Alliance for Personalised Medicine. These expert panels discussed steps that would enable a gradual but steady growth in the quantity, quality, and beneficial deployment of RWE. Participants were selected to provide insight based on their professional medical, economic, patient, industry, or governmental experience. Here, we propose a framework that addresses public trust and access to data, cross-border governance, alignment of evidence frameworks, and demonstrable improvements in healthcare decisions. We also discuss key case studies that support these recommendations, in accordance with the discussions at the expert panels.
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Affiliation(s)
- Denis Horgan
- European Alliance for Personalised Medicine, 1040 Brussels, Belgium
- Correspondence: ; Tel.: +386-30-607-281
| | - Bettina Borisch
- Department of Histopathology, University of Geneva, 1202 Geneva, Switzerland;
| | | | - Mark Caulfield
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK;
| | - Arturo Chiti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy;
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Christine Chomienne
- Cell Biology-Hematology Department, Université de Paris INSERM, 75010 Paris, France;
| | - Amanda Cole
- Office of Health Economics, London SW1E 6QT, UK;
| | - Karen Facey
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh EH8 9YL, UK;
| | - Allan Hackshaw
- Faculty of Medical Sciences, University College London, London W1T 4TJ, UK;
| | - Minna Hendolin
- Sitra—The Finnish Innovation Fund, 00180 Helsinki, Finland;
| | | | - Dipak Kalra
- Faculty of Medicine and Health Sciences, University of Ghent, 9000 Ghent, Belgium;
| | - Birutė Tumienė
- Vilnius University Hospital Santariskiu Klinikos, 08661 Vilnius, Lithuania;
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Green L, Ashton K, Bellis MA, Clemens T, Douglas M. 'Health in All Policies'-A Key Driver for Health and Well-Being in a Post-COVID-19 Pandemic World. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9468. [PMID: 34574390 PMCID: PMC8468680 DOI: 10.3390/ijerph18189468] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 11/17/2022]
Abstract
Policy in all sectors affects health, through multiple pathways and determinants. Health in all policies (HiAP) is an approach that seeks to identify and influence the health and equity impacts of policy decisions, to enhance health benefits and avoid harm. This usually involves the use of health impact assessment or health lens analysis. There is growing international experience in these approaches, and some countries have cross-sectoral governance structures that prioritize the assessment of the policies that are most likely to affect health. The fundamental elements of HiAP are inter-sectoral collaboration, policy influence, and holistic consideration of the range of health determinants affected by a policy area or proposal. HiAP requires public health professionals to invest time to build partnerships and engage meaningfully with the sectors affecting the social determinants of health and health equity. With commitment, political will and tools such as the health impact assessment, it provides a powerful approach to integrated policymaking that promotes health, well-being, and equity. The COVID-19 pandemic has raised the profile of public health and highlighted the links between health and other policy areas. This paper describes the rationale for, and principles underpinning, HiAP mechanisms, including HIA, experiences, challenges and opportunities for the future.
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Affiliation(s)
- Liz Green
- Policy and International Health, WHO Collaborating Centre on ‘Investment in Health and Well-Being’, Public Health Wales, Cardiff CF10 45Z, UK; (K.A.); (M.A.B.)
- Department of International Health, Care and Public Health Research Institute—CAPHRI, Maastricht University, Duboisdomein 30, 6229 GT Maastricht, The Netherlands;
| | - Kathryn Ashton
- Policy and International Health, WHO Collaborating Centre on ‘Investment in Health and Well-Being’, Public Health Wales, Cardiff CF10 45Z, UK; (K.A.); (M.A.B.)
- Department of International Health, Care and Public Health Research Institute—CAPHRI, Maastricht University, Duboisdomein 30, 6229 GT Maastricht, The Netherlands;
| | - Mark A. Bellis
- Policy and International Health, WHO Collaborating Centre on ‘Investment in Health and Well-Being’, Public Health Wales, Cardiff CF10 45Z, UK; (K.A.); (M.A.B.)
- Department of Public Health and Life Sciences, Bangor University, Bangor LL57 2DG, UK
| | - Timo Clemens
- Department of International Health, Care and Public Health Research Institute—CAPHRI, Maastricht University, Duboisdomein 30, 6229 GT Maastricht, The Netherlands;
| | - Margaret Douglas
- Usher Institute, University of Edinburgh, Edinburgh EH16 4UX, UK;
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Cairney P, St Denny E, Mitchell H. The future of public health policymaking after COVID-19: a qualitative systematic review of lessons from Health in All Policies. OPEN RESEARCH EUROPE 2021; 1:23. [PMID: 37645203 PMCID: PMC10445916 DOI: 10.12688/openreseurope.13178.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 08/31/2023]
Abstract
Background: 'Health in All Policies' (HiAP) describes the pursuit of health equity. It has five main elements: treat health as a human right; identify evidence of the 'social determinants' of health inequalities, recognise that most powers to affect health are not held by health departments, promote intersectoral policymaking and collaboration inside and outside of government, and generate political will. Studies describe its potential but bemoan a major implementation gap. Some HiAP scholars learn from policymaking research how to understand this gap, but the use of policy theories is patchy. In that context, our guiding research question is: How does HiAP research use policy theory to understand policymaking? It allows us to zoom-out to survey the field and zoom-in to identify: the assumed and actual causes of policy change, and transferable lessons to HiAP scholars and advocates. Methods: Our qualitative systematic review (two phases, 2018 and 2020) identified 4972 HiAP articles. Of these, 113 journal articles (research and commentary) provide a non-trivial reference to policymaking (at least one reference to a policymaking concept). We use the 113 articles to produce a general HiAP narrative and explore how the relatively theory-informed articles enhance it. Results: Most articles focus on policy analysis (identifying policy problems and solutions) rather than policy theory (explaining policymaking dynamics). They report a disappointing gap between HiAP expectations and policy outcomes. Theory-informed articles contribute to a HiAP playbook to close that gap or a programme theory to design and evaluate HiAP in new ways. Conclusions: Few HiAP articles use policy theories for their intended purpose. Policy theories provide lessons to aid critical reflection on power, political dilemmas, and policymaking context. HiAP scholars seek more instrumental lessons, potentially at the cost of effective advocacy and research.
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Affiliation(s)
- Paul Cairney
- History, Heritage, and Politics, University of Stirling, Stirling, FK94LA, UK
| | - Emily St Denny
- Department of Political Science, University of Copenhagen, Copenhagen, DK-1353, Denmark
| | - Heather Mitchell
- History, Heritage, and Politics, University of Stirling, Stirling, FK94LA, UK
- Faculty of Health Sciences, University of Stirling, Stirling, FK94LA, UK
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Cairney P, St Denny E, Mitchell H. The future of public health policymaking after COVID-19: a qualitative systematic review of lessons from Health in All Policies. OPEN RESEARCH EUROPE 2021; 1:23. [PMID: 37645203 PMCID: PMC10445916 DOI: 10.12688/openreseurope.13178.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 08/31/2023]
Abstract
Background: 'Health in All Policies' (HiAP) describes the pursuit of health equity. It has five main elements: treat health as a human right; identify evidence of the 'social determinants' of health inequalities, recognise that most powers to affect health are not held by health departments, promote intersectoral policymaking and collaboration inside and outside of government, and generate political will. Studies describe its potential but bemoan a major implementation gap. Some HiAP scholars learn from policymaking research how to understand this gap, but the use of policy theories is patchy. In that context, our guiding research question is: How does HiAP research use policy theory to understand policymaking? It allows us to zoom-out to survey the field and zoom-in to identify: the assumed and actual causes of policy change, and transferable lessons to HiAP scholars and advocates. Methods: Our qualitative systematic review (two phases, 2018 and 2020) identified 4972 HiAP articles. Of these, 113 journal articles (research and commentary) provide a non-trivial reference to policymaking (at least one reference to a policymaking concept). We use the 113 articles to produce a general HiAP narrative and explore how the relatively theory-informed articles enhance it. Results: Most articles focus on policy analysis (identifying policy problems and solutions) rather than policy theory (explaining policymaking dynamics). They report a disappointing gap between HiAP expectations and policy outcomes. Theory-informed articles contribute to a HiAP playbook to close that gap or a programme theory to design and evaluate HiAP in new ways. Conclusions: Few HiAP articles use policy theories for their intended purpose. Policy theories provide lessons to aid critical reflection on power, political dilemmas, and policymaking context. HiAP scholars seek more instrumental lessons, potentially at the cost of effective advocacy and research.
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Affiliation(s)
- Paul Cairney
- History, Heritage, and Politics, University of Stirling, Stirling, FK94LA, UK
| | - Emily St Denny
- Department of Political Science, University of Copenhagen, Copenhagen, DK-1353, Denmark
| | - Heather Mitchell
- History, Heritage, and Politics, University of Stirling, Stirling, FK94LA, UK
- Faculty of Health Sciences, University of Stirling, Stirling, FK94LA, UK
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Horgan D, Kent A. EU Health Policy, Coherence, Stakeholder Diversity and Their Impact on the EMA. Biomed Hub 2017; 2:191-201. [PMID: 31988949 PMCID: PMC6945918 DOI: 10.1159/000481301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 09/05/2017] [Indexed: 11/24/2022] Open
Abstract
Innovation is a major pillar in bringing new, targeted medicines to patients. In the health arena, this means the translation of knowledge into what we can call “value.” The latter covers the value to patients but must also take into account value to healthcare systems, society and, of course, manufacturers. The EU has recognised that innovations in healthcare can contribute to the health and well-being of citizens and patients through access to new products, services and treatments with added value. It is also aware that in order to stimulate development, there is a need to facilitate the translation of scientific advances into innovative medicinal products that meet regulatory standards, accelerate patients' access to new therapies and are affordable to Member States' health systems. Early dialogue between technology developers, regulators, health technology assessment and, where relevant, pricing bodies will promote innovation and quicker access to medicines at affordable prices, for the benefit of patients. But while uncertainties in healthcare policy still exist, a request by the European Ombudsman to the European Medicines Agency to provide more information about its early dialogue procedures questions the above “early dialogue” principal. It raises the issue of what the EU aims to do with its health regulation in bringing innovation to the patient. Is this added uncertainty about the hereto trusted role of the EMA a welcome development? Not necessarily.
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Affiliation(s)
- Denis Horgan
- European Alliance for Personalised Medicine, Brussels, Belgium
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