1. Workshop on VHL and HEN, Sao Paulo, 10-11 April 2006 Workshop on VHL and HEN Sao 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

2. Workshop on VHL and HEN, Sao Paulo, 10-11 April 2006 Evidence 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

3. Workshop on VHL and HEN, Sao Paulo, 10-11 April 2006 Why Evidence? Why Now? Increased interest in “evidence-based policy making” Growing demand for health information/evidence for decision-making More complex information is produced

4. Workshop on VHL and HEN, Sao Paulo, 10-11 April 2006 The 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

5. Workshop on VHL and HEN, Sao Paulo, 10-11 April 2006 The 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.

6. Workshop on VHL and HEN, Sao Paulo, 10-11 April 2006 Why 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

7. Workshop on VHL and HEN, Sao Paulo, 10-11 April 2006 Europe: 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

8. Workshop on VHL and HEN, Sao Paulo, 10-11 April 2006 Information 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

9. Workshop on VHL and HEN, Sao Paulo, 10-11 April 2006 Evidence: Multiple meanings? “ Evidence”: research, RCTs, outcomes “Evidence”: opinions, surveys, anecdotes Evidence- “based”... Evidence- “informed”... Evidence- “aware”...

10. Workshop on VHL and HEN, Sao Paulo, 10-11 April 2006 Evidence-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)

11. Workshop on VHL and HEN, Sao Paulo, 10-11 April 2006 Factors influencing policy-making process Experience, expertise and judgement Resources Values Lobbyists, pressure groups and consultants Pragmatics and contingencies Source: Modified from Davies P., 2004 http://www.policyhub.gov.uk/home/JerryLe eLecture1202041.pdf

12. Workshop on VHL and HEN, Sao Paulo, 10-11 April 2006 Linking information and evidence to policy-making processes Eviden ce Other criteria Eviden ce Other criteria

13. Workshop on VHL and HEN, Sao Paulo, 10-11 April 2006 Different 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

14. Workshop on VHL and HEN, Sao Paulo, 10-11 April 2006 Operational 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

15. Workshop on VHL and HEN, Sao Paulo, 10-11 April 2006 WHO 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

16. Workshop on VHL and HEN, Sao Paulo, 10-11 April 2006 WHO 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)

17. Workshop on VHL and HEN, Sao Paulo, 10-11 April 2006 “The best is the enemy of the good” Voltaire 1694-1778

18. Workshop on VHL and HEN, Sao Paulo, 10-11 April 2006 The 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?

19. Workshop on VHL and HEN, Sao Paulo, 10-11 April 2006 The 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)