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ISSUES AND CHALLENGES: The Global Evidence Debate in Health Promotion ' London, HDA 10 March 2003 Da

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Title: ISSUES AND CHALLENGES: The Global Evidence Debate in Health Promotion ' London, HDA 10 March 2003 Da


1
ISSUES AND CHALLENGES The Global Evidence
Debate in Health Promotion. London, HDA 10
March 2003David V. McQueenAssociate Director
for Global Health Promotion, National Center for
Chronic Disease Prevention and Health Promotion,
Atlanta, GA, USAIUHPE Global Vice-President for
Scientific and Technical Development Global
Programme Leader, Global Programme on Health
Promotion Effectiveness (GPHPE)
2
The International Union for Health Promotion and
Education
The IUHPE aims to connect and support everyone
committed to health promotion and health
education wherever they are in the world. IUHPE
Headquarters 2, rue Auguste Comte - 92170 Vanves
- France TEL 33 1 46 45 0059 - FAX 33 1 46 45
00 45 - EMAIL mclamarre_at_iuhpe.org
3
  • Mission
  • Promote and develop global health
  • Seek equity in health
  • Between countries
  • Within Countries

4
  • Non-governmental organisation
  • Founded 1951
  • 2,000 members, over 90 countries
  • Headquarters in Paris
  • Seven Regional Offices around the globe

5
  • Europe (France)
  • South East Asia (India)
  • North America (USA)
  • Latin America (Puerto Rico)
  • Northern Part of Western Pacific(Japan)
  • Southwest Pacific (Australia)
  • Africa (Kenya)

6
Communications
  • Promotion Education
  • Health Education Research
  • Health Promotion International
  • Reviews of Health Promotion Education Online
  • The Evidence of Health Promotion Effectiveness
    Shaping Public Health in a New Europe
  • Website www.iuhpe.org

7
  • Projects
  • Global Programme, Health Promotion Effectiveness
  • Essential Readings in Health Promotion
  • The Growing Tobacco Crisis, Francophone Africa
  • And many others

8
IUHPE Global Programme on Health Promotion
Effectiveness GPHPE
Global Programme on Health Promotion
Effectiveness Coordinated by the International
Union for Health Promotion and Education In
collaboration with the World Health
Organization And supported by the African Medical
and Research Foundation Australian
International Health Institute Health Canada
Health Development Agency, England the
Netherlands Institute for Health Promotion and
Disease Prevention the US Centers for Disease
Control and Prevention (an agency of the
Department of Health and Human Services) the
Voluntary Health Association of India Health
Promotion Switzerland, and other partners.
9
Global Programme on Health Promotion
Effectiveness (GPHPE)Coordinated by the
International Union for Health Promotion and
EducationIn collaboration with the World Health
OrganizationAnd supported by the African Medical
and Research Foundation Australian
International Health Institute Health Canada
Health Development Agency, England Health
Promotion Switzerland the Netherlands Institute
for Health Promotion and Disease Prevention
the US Centers for Disease Control and
Prevention (an agency of the Department of Health
and Human Services) the Voluntary Health
Association of India, and other partners.
  • Members of Global Steering Group (GSG)
  • Hiram Arroyo, Latin American Region
  • Scott Broughton, Health Canada
  • Anne Bunde-Birouste, Australian International
    Health Institute
  • Spencer Hagard,  European Project Leader
  • Saroj Jha, Consultant, South-east Asia Region
  • Catherine Jones, Effectiveness Programme
    Coordinator
  • Hans Krosse, NIGZ
  • David McQueen, Global Programme Leader
  • Maurice Mittelmark, IUHPE President
  • Rob Moodie, VicHealth, South West Pacific Region
  • Alok Mukhopadhyay, VHAI, South-East Asia Region
  • David Nyamwaya, WHO/AFRO
  • Pekka Puska, WHO Headquarters
  • Hans Saan, NIGZ
  • KC Tang, WHO Headquarters
  • Pat Youri, African Region
  • Ex-officio members of GSG
  • Marie-Claude Lamarre, Executive Director, IUHPE
  • Desmond O'Byrne, WHO Headquarters
  • Michel ONeill, Quebec, Canada

10
The GPHPE aims to raise standards of health
promoting policy-making and practice worldwide by
  • - reviewing evidence of effectiveness in terms of
    health, social, economic and political impact
  • - translating evidence to policy makers,
    teachers, practitioners, researchers
  • - stimulating debate on the nature of evidence of
    effectiveness.

11
Global Programme on Health Promotion
Effectiveness (GPHPE)Coordinated by the
International Union for Health Promotion and
EducationIn collaboration with the World Health
OrganizationAnd supported by the African Medical
and Research Foundation Australian
International Health Institute Health Canada
Health Development Agency, England Health
Promotion Switzerlandthe Netherlands Institute
for Health Promotion and Disease Prevention
the US Centers for Disease Control and
Prevention (an agency of the Department of Health
and Human Services) the Voluntary Health
Association of India, and other partners.
12
REGIONS WILL FOCUS ON DEVELOPING THEIR OWN
PRIORITIES AND DEFINITIONS OF EVIDENCE AND
EFFECTIVENESS
  • Regions should move at their own pace
  • Regions should take into account their own
    context and develop plans accordingly
  • Regions should feel ownership, while at the same
    time being full partners in the global programme

13
Summary of GPHPE REGIONAL COMPONENTS
  • Africa - capacity building, research,
    documentation, dissemination, advocacy
  • Europe - chapter updates in Mental Health and
    Tobacco plus new areas of Policy,
    Infrastructures, Models and Methodologies
  • Latin America - development of a conceptual
    framework creation of a network of projects and
    practices to serve as the Region's priorities for
    action systematic reviews of effectiveness
    studies from databases, grey literature and other
    publications
  • North America - social determinants, with key
    interim products of a synthesis report and
    toolbox
  • North Western Pacific - translation and
    dissemination potential special focus on
    alternative, Eastern medicine
  • South-East Asia - HIV/AIDS, womens health,
    childrens health, population health, community
    development initiatives and health promotion,
    mental health, vaccine and immunisation delivery
    programmes
  • South West Pacific - preliminary interest has
    been expressed in looking at the effectiveness of
    health promotion in light of the impact of
    globalisation (equity, social welfare, etc.)

14
GPHPE African Region
  • Being developed in close collaboration with
    WHO/AFRO, the African Medical Research
    Foundation, the African Population and Health
    Research Center and other major institutions and
    organisations in the Region.
  • A consultative process. All institutions involved
    will make equitable contributions to the project,
    bringing either knowledge and/or funding and/or
    materials and/or expertise relevant to the
    specific interests and capacities of each
    institution.
  • The first is the development of a concept paper
    to form the basis of the discussion at the
    Regional consultation and to build consensus on
    the project's focus and content.
  • The Regional Consultation will be held at the
    AMREF International Training Centre in May 2003
    where a work-plan will be developed based on the
    conceptual framework in collaboration with 15
    participants including representatives of partner
    organisations.

15
GPHPE European Region
  • Currently updating and extending the original
    effectiveness project
  • Three new and two re-written chapters
  • Policy and Infrastructures will be new
  • New chapters on i) outcome models and ii)
    methodologies (particularly on how to do reviews
    of reviews in HP and related areas of PH)
  • Mental Health and Tobacco will be re-written
  • Exploring embedding the next stage of development
    of GPHPE/Euro as a sub-project within a bigger
    project package on 'getting evidence into
    practice' in HP
  • Aim to greatly extend the reach of the project
    through additional chapters, translations and
    dissemination processes

16
GPHPE Latin American Region
  • After a regional consultation in Brazil in
    November 2002, a small technical group was
    established to develop a conceptual framework.
  • A questionnaire was mailed to 345 contacts,
    allowing the team to scan the Latin American
    Region and account for other initiatives and
    health promotion evaluation experiences. This
    will help create a network of projects and
    practices.
  • A systematic review of effectiveness studies from
    databases, grey literature, documents, reports
    and articles from the Centre for Development and
    Technology Evaluation in Public Health is being
    conducted.
  • A meeting is planned for April 24-26, 2003, to
    pursue planning for further Regional Project
    work.
  • A monthly update on the project's progress is
    disseminated, and an electronic group list serve
    has been established (efectividad_ps_al_at_yahoo.co
    m)

17
GPHPE PAHO Regional Efforts (tied to work with
Latin American Region, Health Canada, CDC)
  • Focus is on evaluation of effectiveness of
    healthy municipalities in Latin America
  • Mayors toolkit released at Health Promotion
    Forum in Chile in Oct 2002
  • Advocacy document for politicians and policy
    makers of municipalities to persuade them of the
    importance of evaluation (due in March 2003)
  • Participatory Evaluation Toolkit and Guide
    action-based, participatory step-by-step guide
    (due in March 2003)

18
GPHPE North American Region
  • The main effort of NARO is on the evaluation of
    the effectiveness of intersectoral community
    action towards the determinants of health
  • To synthesize knowledge from the NARO region
  • To increase capacity in the NARO region for
    evaluating the effectiveness of community action
    directed at the broader determinants of health.
  • To produce both a big document with
    details/knowledge chunks for policy analysts and
    practitioners and a smaller summary document for
    policy-makers
  • Starting with general logic model/conceptual
    framework with literature reviews and assembly of
    best evidence for each part of the model

19
GPHPE North Western Pacific Region
  • Translations The original European Effectiveness
    books have been translated into Japanese and are
    pending verification and publication. A process
    is also underway to translate the publication
    into Chinese.
  • A Regional Conference on Effectiveness is in the
    planning stages. IUHPE membership development is
    a major priority linked to the development of
    this project. The establishment of the IUHPE
    Pearl River Liaison Office, co-ordinated by
    Professor Albert Lee at the Chinese University of
    Hong Kong is seen as a new means to facilitate
    the achievement of this goal.
  • The Australian International Health Institute and
    the Australian Centre for Health Promotion are
    working with people in mainland China, in
    particular the Chinese Health Education
    Association, concerning possible project
    development work although this is in early
    stages.

20
GPHPE South-East Asia Region
  • The Voluntary Health Association of India has
    secured funds for a regional round table on
    HIV-AIDS to be held in New Delhi in 2003.
    Information on the outcome is to follow.
  • A regional project focussing on HIV/AIDS, Womens
    Health, Childrens Health (under 6) and
    Population Health, has been designed and is ready
    for implementation, pending the procurement of
    funds.
  • The Australian International Health Institute is
    currently working with collaborating partners to
    further identify pertinent work within the
    region. A feasibility study on this aspect is to
    be conducted in the second quarter of 2003.
  • Potential areas covered might include community
    development initiatives and health promotion,
    mental health, vaccine and immunisation delivery
    programmes.

21
GPHPE South West Pacific Region
  • A draft report was prepared based on the results
    of a small survey of senior bureaucrats in NSW to
    establish the extent to which evidence of the
    effectiveness of health promoting interventions
    influences their decision-making regarding policy
    and program development.
  • The current team responsible for coordination is
    working with the New South Wales government
    offices on the potential development of a
    national/New Zealand project. Meetings to be held
    in March 2003.

22
GPHPE WHO (Geneva) Collaboration
  • A two-pronged approach in the collection of the
    evidence of HP effectiveness (1) the collection
    of evidence through literature reviews, and (2)
    the building of evidence through documentation of
    projects that have been evaluated with rigour and
    show evidence of health promotion effectiveness.
  • The identification of projects for GPHPE 30
    projects from 20 countries have been identified,
    of these some 20 projects from 15 countries
    agreed to take part in the GPHPE.
  • Building capacity among project teams Workshops
    on effective HP practice will be given to project
    teams in select countries.
  • Evidence-based HP technical meeting An
    evidence-based HP technical meeting is planned to
    be held in Hong Kong in June 2003 to preview and
    examine evidence of HP effectiveness from
    selected GPHPE projects in preparation for the
    IUHPE Conference in Melbourne.

23
GPHPE
  • Now to aspects of the global component of the
    programme

24
The Global Monograph of the GPHPE
  • Provides a broad overview of issues of evidence,
    evaluation and effectiveness in health promotion.
  • Compares and contrasts regional variations
  • Codifies commonality where warranted and
    emphasizes differences where indicated
  • Emphasizes some areas, providing key chapters,
    that are considered critical to health
    promotions development throughout the world
  • Provides a companion document to each of the
    regional documents.

25
Global Programme on Health Promotion
Effectiveness (GPHPE)Coordinated by the
International Union for Health Promotion and
EducationIn collaboration with the World Health
OrganizationAnd supported by the African Medical
and Research Foundation Australian
International Health Institute Health Canada
Health Development Agency, England Health
Promotion Switzerland the Netherlands Institute
for Health Promotion and Disease Prevention
the US Centers for Disease Control and
Prevention (an agency of the Department of Health
and Human Services) the Voluntary Health
Association of India, and other partners.
26
Chapter on Globalization Urbanization/Urbanisation
GPHPE
  • As an example of a global problem area

27
Issues in urbanization major public health
concern of an urbanizing world
  • Population
  • Pollution
  • Degradation (environment)
  • Migration
  • Destruction
  • Desertification

28
Example
  • Physical activity, sprawl, pollution, built
    environment and health consequences

29
How might sprawl affect health?
  • ? air pollution
  • climate change contribution
  • ? car crashes
  • ? pedestrian injuries
  • ? physical activity
  • water quantity and quality
  • ? heat island effect
  • mental health impact
  • ? social capital

Related to automobile dependency Related to land
use Related to social processes
30
Air pollution
  • Major pollutants of concern
  • ozone lead
  • NOx SOx
  • CO air toxics
  • particulates allergens
  • hydrocarbons

31
Air pollution
  • Major pollutants of concern
  • ozone lead
  • NOx SOx
  • CO air toxics
  • particulates allergens
  • hydrocarbons

Produced by cars and trucks
32
Ozone, where I live
33
(No Transcript)
34
Ozone health effects
  • Respiratory effects (ozone gt PM)
  • Airway inflammation
  • Decreased air flow
  • Increased symptoms, ER visits, medication use,
    hospitalizations
  • Cardiovascular effects (PM gt ozone)
  • Increased mortality
  • Immune effects
  • Increased susceptibility to infection

35
Ozone health effects
  • Susceptible subgroups include
  • Asthmatics
  • Children
  • The elderly
  • Those with certain underlying diseases

36
Asthma and Equity
  • Asthma prevalence twice as high, and mortality
    three times as high, in blacks as in whites
  • Asthma prevalence 3x higher in Hispanic than
    non-Hispanic children
  • Asthma hospitalization among Medicaid children
    93 ? in blacks, 34 ? in Hispanics, compared to
    whites

37
Sprawl and climate change
  • Forest loss (350,000 acres in metro Atlanta over
    30 years)
  • CO2 emissions from motor vehicles

New York Times, Nov 27 2001
38
(No Transcript)
39
Physical Activity
  • ? population density
  • ? employment density
  • ? trip distances
  • ? vehicle trips
  • ? walking

? overweight ? obesity
40
Physical activity
  • A sedentary lifestyle increases the risk of
  • overall mortality (2 to 3-fold)
  • cardiovascular disease (3 to 5-fold)
  • The effect of low physical fitness is comparable
    to that of hypertension, high cholesterol,
    diabetes, and even smoking.

Sources Wei et al., JAMA 1999 Blair et al.,
JAMA 1996
41
(No Transcript)
42
GLUTTONY or SLOTH?
Source Prentice and Jebb. Obesity in Britain
gluttony or sloth? British Med J 1995311437-439
43
Overweight
  • Increasing weight associated with
  • ? risk of overall mortality (up to 2.5-fold in
    the 30-44 age group, less at older ages)
  • ? risk of cardiovascular mortality (up to 4-fold
    in the 30-44 age group, less at older ages)
  • ? risk of diabetes (up to 5-fold)
  • ? risk of hypertension
  • ? risk of some cancers
  • ? risk of gall bladder disease
  • Source Willett et al., New Eng J Med, 1999

44
Evidence, evaluation and Effectiveness
  • GLOBAL EFFORTS IN HEALTH PROMOTION EVALUATION
    UPDATE AND RELATIONSHIP TO GPHPE
  • FOCUS ON THE ISSUES ARISING

45
The three Es
Evidence
Evaluation
Effectiveness
46
Evidence Iceberg in Health Promotion
RCT
Companion Studies
Observational Studies
Observational Studies
Participation Designs Fugitive Literature Hearsay
47
Evidence Iceberg in Health Promotion
RCTs Comparison Studies Observational Studies
Less Formal Observational Studies Participatory
Studies Fugitive Literature Hearsay
dvmcq 2001
48
The production of evidence in the West
49
Evidence Evaluation
  • Limited term
  • Implies rigor
  • Strict rules
  • Proof difficult
  • Scientific literature
  • Comprehensive term
  • Anything can be evaluated
  • Loose rules

50
Rules of Evidence
  • Scientific disciplines, e.g. physics, biology,
    etc. have developed their standards for what
    constitutes proof of causation, effect, etc. in
    observation and experiment
  • The appropriate scientific method is both a
    product of historical development and the
    characteristic observables in the discipline,
    culturally bound
  • Many community-based public health prevention and
    health promotion projects are not
    discipline-based, but represent a field of
    action
  • There is no discipline-based epistemological
    structure underlying the evaluation of effort in
    health promotion

51
Hierarchy of Evidence The idea in HP
  • Cannot prioritize types of evidence in a linear
    hierarchy
  • No consensus on any hierarchy of evidence
    between researchers and practitioners in the
    field
  • Need to document this lack of consensus consider
    pros and cons of consensus in the context of
    community prevention and suggest directions for
    the future
  • Global dimensions of evidence debate further
    questions the notion of a hierarchy of evidence

52
Complexity and Evidence
  • Most community-based health promotion/public
    health interventions include a complex mixture of
    many disciplines, many variables of varying
    decrees of measurement difficulty, and dynamic
    changing contexts
  • Understanding multi variate fields of action
    requires a mixture of complex methodologies and
    considerable time to unravel any causal and/or
    meaningful relationships
  • Need to recognize the complexity issue as it
    pertains to community interventions and suggest
    better analytical approaches
  • Culture of communities is important

53
Health Promotion and Effectiveness
  • Effectiveness is a broad, loosely defined term,
    generally linked to the notion of outcomes
  • Notion that effective health promotion leads to
    changes in the determinants of health
  • Underlying epistemology of outcomes remains
    complicated

54
Examples of efforts to produce evidence
  • CPSTF USA, Community Preventive Services Task
    Force, also called the Community Guide
  • E(EURO)WG Europe/Canada/USA
  • IUHPE EU, GPHPE
  • Cochrane Collaboration
  • WHO
  • Many others

55
  • Systematic Reviews and Evidence-Based
    Recommendations

56
The Community Guide Is
  • A set of recommendations
  • Recommendations based on scientific evidence
  • Evidence gleaned from systematic reviews
  • Reviews coordinated by CDC scientists
  • Recommendations determined by independent Task
    Force

57
Reviews Address How to Reduce Disease, Injury
and Impairment Selected Chosen Areas
  • Vaccine Preventable Disease
  • Cancer
  • Diabetes
  • Mental Health
  • Improving Pregnancy Outcomes
  • Oral Health
  • Injury Due to Violence
  • Motor Vehicle Occupant Injury
  • Sociocultural environment

58
Method for Conducting Systematic Reviews Consists
of Five Steps
  • Develop conceptual framework
  • Search for and retrieve evidence
  • Rate quality of evidence
  • Summarize evidence
  • Translate strength of evidence into
    recommendation

59
Physical Activity
60
Objectives
  • Provide chapter update
  • Definitions and frameworks for
  • Community-scale urban design
  • Street-scale urban design
  • Transportation policy and practices

61
Literature Searches
  • Most articles in non-traditional public health
    literature
  • Sample journals
  • American Planning Association Journal
  • Landscape and Urban Planning
  • Transportation Research Record

62
Developing Intervention Categories
  • Too much diversity among interventions for a
    single category

63
Developing Intervention Categories
  • Conceptualized interventions (e.g., urban design
    land use, transport)
  • Dissected the whole set of papers
  • Identified 15 specific intervention components
  • Grouped components to form 3 interventions and
    carefully crafted definitions

64
Developing Intervention Categories Intervention
Components
  • Connectivity
  • Land use mix
  • Density
  • Grid/cul-de-sac
  • Walkability
  • Aesthetics
  • Cleanliness
  • Continuity
  • Lighting
  • Social dynamics
  • Safety/crime
  • Safety/traffic
  • UPASS
  • Bike lanes
  • Bike racks

65
Community-scale Urban Design and Land Use
Policies and Practices
  • Urban design and land use policies and practices
    that support physical activity in geographic
    areas, generally several square kilometers in
    area or more.

66
Intervention Characteristics
  • Zoning regulations, building codes, and roadway
    design standards
  • Policies that promote proximate placement of
    residential, commercial, and school properties
  • Improved connectivity of streets and sidewalks
  • Increase population density while preserving
    green spaces

67
Street-scale Urban Design and Land Use
  • Urban design and land use policies that support
    physical activity in small geographic areas,
    generally limited to a few blocks.

68
Intervention Characteristics
  • The interventions use policy instruments such as
    building codes, roadway design standards, and
    environmental changes
  • Improved lighting
  • Ease and safety of street crossing
  • Sidewalk continuity
  • Presence of traffic calming structures
  • Making aesthetic enhancements

69
Transportation Policies and Practices
  • Transportation policies and practices that
    encourage and facilitate walking and bicycling
    for transportation

70
Intervention Characteristics
  • Policy measures such as roadway design standards
  • Expanding public transportation services
  • Subsidizing public transportation
  • Providing bicycle lanes and racks
  • Increasing the cost of parking

71
Discussion
  • Do the intervention taxonomy, definitions, and
    analytic frameworks work?
  • Would a body of evidence be convincing if all the
    studies were cross-sectional and self-selection
    couldnt be ruled out?

72
Evaluating Health Promotion Recommendations to
Policy-makers
  • WHO-EURO Working Group on Health Promotion
    Evaluation

The working group met many times over a ten
year period, with membership from Europe, Canada
and the USA
73
Objectives
  • provide guidance to policy-makers and
    practitioners to foster the use of appropriate
    methods
  • examine current range of methods
  • provide guidance to policy-makers and
    practitioners to increase quality of health
    promotion evaluations

74
Major publication of the EWG was the Yellow
BookEvaluation in health promotion Principles
and perspectives
This monograph, edited by Rootman, Goodstadt,
Hyndman, McQueen, Potvin, Springett and
Ziglio Published by WHO in 2001, contains 23
chapters by 55 authors. 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.
75
EWG Principles for Evaluation of Health Promotion
Initiatives
  • Participation
  • Multiple methods
  • Capacity-building
  • Appropriateness

76
IUHPE Report to the EU (the Blue and Yellow
Books)A Report for the European Commission by
the International Union for Health Promotion and
Education
  • Title The Evidence of Health Promotion
    Effectiveness Shaping Public Health in a New
    Europe (1999)
  • A core document, 30 pages
  • An Evidence Book, 164 pages

77
IUHPE ReportThree Components of Working Group
  • International Project Advisory Group
  • Lead project Authors
  • A Witness Group of Political Experts

78
IUHPE Report to the EU (1999) Core Document
included a chapter on the political challenges in
mental health
  • Call for a major investment in mental health
    promotion
  • Mental health promotion has shown to be effective
    and cost-effective
  • Interventions early in childhood and adolescence
    need priority
  • Dissemination and implementation of
    evidence-based interventions should be enhanced
  • Guidelines for effective management should be
    identified

Chapter Three by Clemens Hosman and Eva Jane
Lopis
79
IUHPE Report Key General Recommendations
  • Commission urged to develop appropriate
    infrastructure for the development of successful
    health promotion programs
  • The impressive body of evidence in health
    promotion best practice needs to be made
    available widely and systematically updated

80
Characteristics of Working Groups on Evidence and
Evaluation
  • Multi-disciplinary
  • Often multi-cultural/multiple nations
  • Large endeavors
  • Time consuming
  • Raising many questions
  • Reviewing published, Western sources

81
Solutions to improve and carry on this work
Build on Past
Develop New
  • Emphasize THEORY/PRACTICE base of health
    promotion
  • Model on sciences
  • Evaluate sub-components of initiatives
  • Recognize complexity
  • Find models of best practice
  • Develop rules of evidence for the whole
    knowledge base of health promotion
  • Bring in the less economically developed world

82
Key Unresolved Issues in the Evidence Discussion
  • Methods
  • Time
  • Attribution of Effect
  • Universality

83
Useful Strategies of EWG
  • Start from HP Principles
  • Focus on Community
  • Focus on Participation
  • Broad definition of evidence
  • Recognize need to persuade policy makers

A working group jointly supported by EURO,
Health Canada, and CDC Major publication in 2001
by WHO Evaluation in health promotion Principles
and perspectives Edited by, Rootman, Goodstadt,
McQueen, Potvin, Springett and Ziglio
84
EWG Threefold Approach
  • Marshalling the evidence an academic book
  • Showing the practice a practitioners guide
  • Convincing those with resources a policy
    document

85
In Conclusion
  • Some general observations if there is time

86
Three Paradigm Questions
  • Ontological What is the nature of the knowable?
    Or, what is the nature of reality?
  • Epistemological What is the nature of the
    relationship between the knower (the inquirer)
    and the known (or knowable)?
  • Methodological How should the inquirer go about
    finding out about the world?

(adapted from Guba, 1990)
87
Underlying Theoretical Orientations for Methods
in Health Promotion
  • Positivist Emphasis on natural science
    methodology, quantitative methods, hypothesis
    testing, and objectivity.
  • Idealist Emphasis on personal meanings and
    constructions, qualitative methods, emergent
    design, and making values explicit. A tendency
    towards individual-level focus with some emphasis
    on system-level issues.
  • Realist Emphasis on system-level models of
    underlying process. Issues of power and control
    frequently made explicit. Critical tradition adds
    action component.
  • Participatory/Action A concern with power and
    control. Frequently overtly political in values
    and orientation.

88
Ednas Challenge
Upon this gifted age, in its dark hour, Rains
from the sky a meteoric shower Of facts...they
lie unquestioned, uncombined. Wisdom enough to
leech us of our ill Is daily spun but there
exists no loom To weave it into fabric... Edna
St. Vincent Millay (1892-1950) Huntsman, What
Quarry? New York Harper Brothers, 1934
89
  • Upcoming IUHPE conferences
  • Equity, solidarity and responsibility for health.
    VIth European Conference on Health Promotion and
    Health Education, Perugia, Italy, June 18-21,
    2003
  • Valuing diversity reshaping power exploring
    pathways for health and well-being. XVIIIth
    World Conference on Health Promotion and Health
    Education,
  • Melbourne, Australia, April 25-29, 2004
  • www.iuhpe.org

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www.iuhpe.org
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