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Bridging the Research-Policy-Gap in Public Health

WHO Initiative to Estimate the Global Burden of Foodborne Diseases

Tanja Kuchenmer Department of Food Sa

Tanja Kuchenmüller

Department of Food Safety and Zoonoses

Bishkek, Kyrgyzstan – 10 October 2012

Structure

1. Background on evidence-informed policy-making in public health

2. Fostering evidence-informed policy-making in food safety 3. EVIPNet (Evidence-Informed Policy Networks)

“There is nothing a politician likes so little as to be well informed, it makes decision making so complex and difficult.”

John Maynard Keynes

Source: adatpted from Gray, J.A.M. 1997. Evidence-Based Health Care: How to Make Health Policy and Management. Decisions, New York and London, Churchill Livingstone, 1997

What is evidence-informed policy-making?

Increasing Pressure

Evidence-Informed Policy-Making

Opinion-Based Policy-Making

Evidence-informed policy: “helps people make well informed decisions

about policies, programmes and projects by putting the best available evidence from research at the heart of policy development and implementation’ (Davis, 2003) Davies (2004) ‘Is evidence-based government possible?’ Jerry Lee Lecture, presented at the 4th Annual Campbell Collaboration Colloquium, Washington DC.

Evidence is only one factor influencing policy-making

Why is evidence-informed policy-making important?

In the context of :

(a) Finite resources

(b) Raising costs of health services as % GDP

(c) Increasing pressure to justify choices

in expenditure

Decision-makers require guidance to improve global public health

Research not a "LUXURY": "If you are poor, actually you need more evidence before you

invest, rather than if you are rich.”

Know-Do Gap

* 264 years between James Lancaster’s discovery that lemon juice prevented scurvy and the British Navy’s decision to ensure an adequate supply of citrus fruits on navy ships. * 30–40% percent of patients in the United States and Europe fail to receive cost-effective interventions justified by the best-available scientific evidence. * 2–15% percent of African children sleep under bednets in 2001. (Sources for these numbers are given on the report web site: www.who.int/rpc/wr2004)

Two distinct communities

•‘Scientific’ (context free)

• Colloquial (contextual)

• Proven empirically

• Anything that

seems reasonable

• Theoretically driven

• Policy relevant

• As long as it takes

• Timely

• Caveats

• Clear Message

Evidence

Evidence

How to integrate research into policy ?

Researchers'

Policy-makers'

"...efforts by researchers and by decision makers seem to proceed largely

independently. Both have their own (often misplaced) ideas about the other's

environment. Opportunities for ongoing exchange and communication are few.

It is like two people trying to assemble a jigsaw

puzzle, each with half the pieces but each working in

a separate room."

Lomas J. Research and evidence-based decision making. Aust N Z J Public Health. 1997;21:439–441.

Researc

h

Pro

ble

ms

How to increase research up-take?

Some evidence…

• #1 facilitator of research use: personal contact between researchers between researchers and policy-makers (13/24)

• #1 barrier to research use: absence of personal contact between researchers and policy-makers (11/24)

Review of 24 studies that asked over

2000 policymakers what facilitated or

prevented their use of research evidence Innvaer et al. J Hlth Serv Res Pol 2002;7:241

Facilitators Personal contact (13/24) Timely & relevance (13/24) The inclusion of summaries with policy recommendations (11/24) Good quality research

Some additional evidence…

Innvaer et al. J Hlth Serv Res Pol 2002;7:241

Knowledge Translation is…

... a research process to promote the use of research evidence into policymaking, taking into account multiple factors ("political environment", resources, regulations/ legislation, tacit knowledge)

Source: Panisset U. “New methodologies and practices to improve evidence to policy in Low and Middle Income Countries”. Presentation at the FERG COUNTRY STUDIES TASK FORCE MEETING FAO, ROME 10-12 JUNE 2009.

14

Producers

/

purveyors

of

research

Users of

research

Approach 1: Push efforts

Producers /

purveyors

of research

Users of

research

Approach 2: User-pull efforts

Producers /

purveyors of

research

One group

of users of

research

Approach 3: Exchange efforts

Producers /

purveyors

of research

Users of

research

Knowledge

-translation

platforms

Approach 4: Integrated efforts

Approaches increasing research utilization

Source: Adapted from Lavis J, Lomas J, Hamid M, Sewankambo N. 2006. “Assessing country-level efforts to link research to action”. Bulletin of the World Health Organization. 84: 620-628.

WHO‘s Mission

„…shall be the attainment by all peoples of the highest possible level of health.“

Source: WHO‘s Consitution

It is responsible for:

• providing leadership on global health matters,

• shaping the health research agenda,

• setting norms and standards,

• articulating evidence-based policy options,

• providing technical support to countries, and

• monitoring and assessing health trends. Source:WHO

Structure



Bacteria Campylobacter: Guillain Barré Syndrome

Arthritis

Salmonella: Guillain Barré Syndrome

Arthritis

Septicaemia

Meningitis

Listeria: Meningitis

Septicaemia

Miscarriage

E.coli: Renal failure

Parasites Pork tapeworm: Epilepsy

Toxoplasma: Retinopathy

Trichinella: Multi-organ failure

Chemicals Acrylamide: Cancer

Arsenic: Cancer

Aflatoxin: Cancer

Lead: Mental retardation

Dioxins: Cancer

Other Allergens: Anaphylactic shock

• Commonly transmitted through food

• Can be caused by:

- pathogens (bacterial/viral)

- chemicals

- parasites

• Acute and chronic

• Long-term complications

• Morbidity, disability and mortality

What are "Foodborne Diseases"?

UN Millennium Development Goals (MDG)UN Millennium Development Goals

(MDGs)

4 out of 8 MDGs affected directly by progress with food safety

Foodborne diseases are a development issue

How big is the burden of foodborne diseases?

Reported human cases

What we know from

surveillance data

What we need to know

Actual human disease burden

Reported human cases

WHO's response: Initiative to Estimate the Global Burden of Foodborne Diseases

‘Pull’ from the food safety stakeholder community

‘Pull’ from the WHO Member States

Objectives of the Initiative to Estimate the

Global Burden of Foodborne Diseases

To strengthen the capacity of countries in conducting burden of foodborne disease assessments and to increase the number of countries who have undertaken a burden of foodborne disease study.

Objective 1 To provide estimates on the global burden of foodborne diseases according to age, sex and regions for a defined list of causative agents of microbial, parasitic, and chemical origin.

Encourage countries to use burden of foodborne disease estimates to set evidence-informed policies.

Objective 2

Objective 3

FERG (Foodborne Disease Burden Epidemiology Reference Group) = scientific

expert group appointed by & advising the WHO Director General

Capacity building

Modules

for conducting studies

Tools for systematic burden of FBD studies

Tools to increase research impact

on policy

Researchers Policy-makers

Efforts to increase the up-take of evidence in food safety policy-making

Trust

Understanding

Need to institutionalise

dialogue and exchange

Facilitate use

Within the

CSTF

(KTPG)

Country level

(Platforms)

Process?

Policy

context? Actors?

Capacity building

Modules

for knowledge translation

Capacity building

Modules




on policy



Exchange

Capacity building

Modules


Reliable

Data

Improving “usability”

(Relevance, time and simplicity)

Effective & targeted

communication

Effective access to

Data

Incentives to use Data

Increase BoD

understanding and

use Expected Results

(among others)

Expected results at country level

Input & activities

Protocol for

policy analysis/context

mapping

KTE tools and mechanisms

Training modules

Piloting in 4 countries

Outputs

Final protocols,

tools & training modules

Increased knowledge

on food safety policy-

making & KT

Burden

Report

Paper

series

Pathway of

influence

List of policy-

relevant research

needs

Infrastructure for

institutional

collaboration

Policy-relevant,

userfriendly research

results

Outcomes Impact

Improved

KT capacity

Continuous

dialogue

between

researchers &

research users

Increased research

access,

understanding

& utilisation

M & E of food

safety

measures

Assess the

cost-

effectiveness

intervention

Dev of new food

safety

standards

National leaders

publicly express

sustained

concern for food

safety

Governments

enacts policies

& implements

on the basis

of scientific food

safety evidence

Foodborne diseases

reduced

Socio-economic

development fostered

Quoted in Cook, E.T. (1913), The Life of Florence Nightingale, (London: Macmillan), volume 2, p.396, and cited

by J.Maindonald and A.M.Richardson, This Passionate Study: a Dialogue with Florence Nightingale, Journal of

Statistics Education ,Volume 12, Number 1 (2004).

I collected my figures with a purpose in mind, with the idea that they could be used to argue for change. Of what use are statistics if we do not know what to make of them? What we wanted at that time was not so much an accumulation of facts, as to teach the men who are to govern the country the use of statistical facts. (Florence Nightingale)

Structure



58th World Health Assembly 2005

Urges Member States

Source:WHO

EVIPNET is an innovative mechanism designed to strengthen health systems in LMIC in fostering the systematic use of evidence in policy-making in low and middle-income countries.

EVIPNET promotes partnerships between policy-makers, researchers and civil society at country level.

Vision

EVIPNet partners envision a world in which policy makers in low- and middle-income countries use the best scientific evidence, contextualized to the reality of their nation, to inform policy making and policy implementation

Country teams and

regional and global

support structures

Research synthesis,

policy options briefs

1:3:25 formats

Country policy

dialogues

(safe harbor)

Monitoring and evaluation - Development of new methodologies

Building blocks


Source: www.paho.org

More than 32 Country teams + Regional & Global Networks


WORLD HEALTH ORGANIZATION

REGIONAL OFFICE FOR EUROPE

Thank you!

Key KTPG products

• Input to CSTF work:

- Country application document

- Overview document for country studies

- BoD protocol

• Protocols for PSA/context mapping & related training materials (FERG4)

• Global context mapping

• KT tools (issue and policy briefs)

• Systematic reviews of interventions

The Global Burden

of Foodborne Diseases

Tanja Kuchenmüller. Food Safety and Zoonoses

World Health Organization (WHO)

Geneva

Albania

Uganda

Thailand

Japan

Piloted in four countries

Capacity building

Modules




on policy



Trust

Understanding

Need to institutionalise

dialogue and exchange

Facilitate use

Within the

CSTF

(KTPG)

Country level

(Platforms)

Process?

Policy

context? Actors?

Capacity building

Modules


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