World Health Organization COMMISSION ON SOCIAL DETERMINANTS OF HEALTH Social Determinants of Health: measuring progress & evaluating evidence Santiago, Chile: March 21-24, 2005 Agenda Purpose of the meeting: to begin a consensus building process towards developing guidelines on assessing and evaluating programs and policies on social determinants that are integrated with and address health needs and the impact of SD on health and health inequities. Goals: 1. Begin discussions towards developing the assessment and evaluation guidelines, including identification of methods, tools, and best practice examples. 2. Design standard review process for the CSDH s Knowledge Networks. 3. Develop program of work for the CSDH s measurement knowledge network. Monday March 21 Session I: Commission on Social Determinants of Health: an Introduction 9:00 9:15am Welcome and introductions 9:15-9:30 Welcome Address 9:30-10:30 Background to the CSDH CSDH Knowledge Networks 10:30-10:45 Meeting goals and objectives Tim Evans, Assistant Director General, WHO and Jeanette Vega, Health Equity Team Leader, WHO Pedro García, Chilean Minister of Health Michael Marmot, Chair CSDH, University College London Hilary Brown, WHO Ichiro Kawachi, Special Advisor to Measurement KN, Harvard University 10:45-11:00 Break 1
Session II: Specifying the Objectives of Assessing the Impact of Interventions 11:00am 12:00 pm Moderator: Michael Marmot What should be examined when evaluating the impact of interventions? Ichiro Kawachi The average and/or distributional impact of the social determinants of health The impact of the SD intervention on health status The impact of the SD intervention on the distribution of health 12:00-1:00 Lunch Session III: Evaluating Evidence of the Impact of Social Determinants Interventions: Examining the Evidence-Base Moderator: Elizabeth Waters 1:00 2:45pm Methods Systematic reviews, the Cochrane Collaboration, and Grading the Quality of Evidence Andy Oxman, Norwegian Health Services Research Centre The Campbell Collaboration Approach to Assessing Evidence from Social Experiments with Health Outcomes Haluk Soydan, University of Southern California The UK Health Development Agency s Evidence Base Mike Kelly, Evidence and Guidance, Health Development Agency Qualitative Approaches to Assessing Evidence on Social Determinants Jennie Popay, Institute for Health Research, Lancaster University 2:45-3:30pm Examples Community-based Housing Intervention in New Zealand Philippa Howden Chapman, University of Otago, New Zealand Lessons from the PROGRESA trial in Mexico Paul Gertler, UC Berkeley 3:00-3:30pm 3:30-4:30pm Break Moderator: Ichiro Kawachi 1. Is it necessary and/or feasible in resource-constrained settings to implement randomized controlled trials or field trials to assess the impact of interventions on social determinants? 2. What is the gold standard for incorporating evaluation into government approaches to health improvement through policies and interventions on social determinants? 3. What are the best standards, tools and approaches for generating qualitative evidence in the field of social determinants? 2
4:30-5:30 Breakout sessions Questions for Breakout Groups In the absence of experimental designs to evaluate the impact of interventions on social determinants: 1. What is the spectrum of study designs available and which ones are best suited in response to evaluation/assessment needs? 2. In which instances are RCTs and field trials essential for producing valid evaluation results? What is the rationale behind implementing such trials in settings where the type of intervention and the context in which it is implemented is not necessarily amenable to such trials? 3. What is the appropriate balance between internal and external validity, when assessing the potential for scaling up an intervention? Tuesday March 22 Session IV: Evaluating the Impact of Social Determinants Interventions on Health Health Impact Assessments Moderator: Bobby Milstein 9-9:45am Methods Health Impact Assessment, evidence-based recommendations for informing the decision-making process Alex Scott-Samuel, University of Liverpool Equity-focused Health Impact Assessment Elizabeth Harris, Center for Health Equity Training Research & Evaluation (CHETRE), University of New South Wales, Australia. 9:45-11am 1. How can HIA be mainstreamed into global public health processes and approaches and specifically, be implemented by developing country governments, NGOs and the private sector? 2. What are the limitations of HIA and challenges to implementing them? 11-11:30 Break Moderator: Philippa Howden-Chapman 11:30-1pm Examples Evaluation of Policies to Reduce Socioeconomic Inequalities in Health Following the Acheson Inquiry Mark Exworthy, School of Management, Royal Holloway Regional Project on Evidence of the Effectiveness of Health Promotion in the Context of PAHO s Healthy Municipalities and Communities Project Ligia de Salazar, Centro para el Desarrollo y Evaluación de Tecnologías en Salud Pública (CEDETES), Universidad del Valle, Cali, Colombia and Maria Teresa Cerqueira, PAHO Qualitative Approaches to Evaluating Public Health Policy: The Case of Welfare-to- Work Policies Adam Coutts, Cambridge University HIA in Thailand 3
Decharut Sukkumnoed, HIA Program, Health Systems Research, Thailand 1-2pm Lunch Session V: Evaluating Public Health and Health Promotion Interventions 2-3:00 Moderator: Elizabeth Harris Methods The Cochrane Collaboration s Systematic Reviews of Health Promotion and Public Health Interventions, Elizabeth Waters, Deakin University The CDC Framework for Program Evaluation in Public Health Bobby Milstein, Office of Program Planning & Evaluation, Centers for Disease Control 3:00-4:00 4-4:30 Break 1. What are the motivating factors to engage decision makers in the process of evaluation, especially in developing countries, and to encourage them to value evaluation as a tool for policy? 2. What type of indicators should be used to reflect the effect of interventions on health, the distribution of health and programs on social determinants; and what are the best process and outcomes indicators? Should they be based on absolute or relative scales, or a change in trends? 4:30-5:30 continued Wednesday March 23 Session VI: Towards Guidelines for the Knowledge Networks Multisectoral & Multi-approach Reviews Moderator: Haluk Soydan 10-11am 1. What should be the focus of these reviews? The impact of the intervention on social determinants of health? The impact of the intervention on SD on health status? The impact of the intervention on SD on the distribution of health? 2. What type of information/knowledge should be collected (ie, grey literature, scientific evidence, government documents, etc) given the tension between the majority of examples coming from developed countries, and the goal of producing recommendations targeted at low to middle income countries? 3. What combination of collection methods should be implemented? 4
4. What is the appropriate balance between internal and external validity and what are the implications for scaling-up successful interventions? 5. How should the socioeconomic context of a country be taken into consideration when planning to implement a successfully proven program in a different country context (ie, what should be considered when implementing a program that is successful in Sweden in an African country)? 11-11:30am 11:30-1pm 1-2pm Break Continue group discussion Lunch 2-3:30 Continue group discussion 3:30-4 Break Session VII: Towards a Work Plan for the Measurement Knowledge Network 4-5:30pm Moderators: Jeanette Vega & Ichiro Kawachi What should be the focus of the measurement KN s review, the composition of its membership, anticipated outputs and timeline? 8:00-10:00pm Dinner Hosted by Chilean Minister of Health, Pedro García Venue TBD Thursday March 24 Session VIII: Bringing it all Together: Towards Developing Guidelines 9:00 11:00 Moderator: Ichiro Kawachi Discussion of Document in Progress Towards a consensus statement from the meeting s discussions 11-11:30 Break Session IX: Closing and Next Steps 11:30-12noon 5