EUR/03/5040052 ORIGINAL: ENGLISH UNEDITED
E80895
Fourth Futures Forum of
High-Level
Decision-Makers
Tools for decision-making in public health
World Health Organization Telephone +45 39 17 17 17 Regional Office for Europe Telefax +45 39 17 18 18
Telex: 12000 who dk Scherfigsvej 8
DK-2100 Copenhagen Ø Electronic mail: postmaster@euro.who.int
Denmark World Wide Web Address: http://www.euro.who.int
Brussels, Belgium 16–17 June 2003
2003
ABSTRACT
The Fourth Futures Forum brought together decision-makers and senior advisers from 14 western European countries. The focus of the meeting was on the scope, use and limitations of evidence-based recommendations as tools for decision-making in public health. Participants agreed that the need for informed decisions had never been greater. Public expectations, new technologies, growing public health challenges and the pressure for greater accountability require policy development to take evidence into account wherever this is feasible. Population health is determined by a wide range of social, economic and health service factors. As such, evidence-based recommendations must embrace an equally wide range of research methods, including qualitative studies, social surveys and process evaluation. In addition, despite the growing evidence base for effective public health, this is frequently not translated into clear recommendations for public health decision-making. It is proposed, therefore, that guidelines for evidence-based recommendations for policy should be further developed to inform public health decision-making.
Keywords
PUBLIC HEALTH
PUBLIC HEALTH ADMINISTRATION HEALTH POLICY
DECISION MAKING
DECISION SUPPORT TECHNIQUES EVIDENCE-BASED MEDICINE
SEVERE ACUTE RESPIRATORY SYNDROME VIRUS EUROPE
WORLD HEALTH ORGANIZATION
© World Health Organization – 2003
All rights in this document are reserved by the WHO Regional Office for Europe. The document may nevertheless be freely reviewed, abstracted, reproduced or translated into any other language (but not for sale or for use in conjunction with commercial purposes) provided that full acknowledgement is given to the source. For the use of the WHO emblem, permission must be sought from the WHO Regional Office. Any translation should include the words: The translator of this document is responsible for the accuracy of the translation. The Regional Office would appreciate receiving three copies of any translation. Any views expressed by named authors are solely the responsibility of those authors.
WHO Regional Office for Europe, Copenhagen
CONTENTS
Page
Executive Summary ...i
1. Conclusions ... i
2. Recommendations ... i
Background and purpose ...1
Introduction ...2
Sources of evidence for decision-making at the ministerial level ...2
The availability and evidence base of recommendations ...3
Practical Experience of the Utility of Evidence ...4
Breast cancer screening in Luxembourg ...4
Antibiotic use in Belgium ...5
SARS: Decision-making despite the absence of evidence...6
The Futures Fora series ...7
Annex 1. List of participants ...9
Annex 2. Programme...14
Executive Summary
1. Conclusions
Conclusions from the meeting relate to the production process, the utilization and limitations of evidence-based recommendations.
· The need for evidence-based decisions and, as a consequence, evidence-based recommendations, has never been greater.
· The use of evidence enables decision-makers to be transparent and explicit about the basis for decisions.
· The degree to which public health decisions are currently evidence-based is not known.
· Evidence changes with time and the utility of evidence-based recommendations is therefore time limited.
· The speed of decision-making does not always allow time for the generation and use of evidence.
· Evidence-based decisions may not always be acceptable to the public and this will inevitably be a consideration in taking public-health decisions and in determining policy.
· A lack of evidence about the effectiveness of an intervention does not mean that the intervention is necessarily ineffective; it may be that the research has yet to be undertaken.
· Interventions known to be successful in improving population health can fail if the necessary organizational capacity is not made available to ensure their success.
Implementation factors, such as finance, skills and organizational capacity, are therefore an essential part of the evidence review process.
2. Recommendations
The following recommendations are addressed to public health decision-makers, and some to the evidence generating community. These recommendations will require further consideration and review in the WHO Regional Office’s ongoing work related to evidence.
· It is essential to clarify roles in the public health decision-making process in countries.
Scientists should be responsible for building the evidence base, identifying conclusions and in some occasions identifying policy options. Civil servants should provide political decision-makers with policy options and recommendations, based upon the evidence and wider considerations. Ultimately, politicians are accountable for the final decision. The basis of this decision should be transparent, thereby enhancing the process of accountability.
· Priorities for the generation of evidence should be determined by the needs of decision- makers, not the academic community.
· The availability of evidence should be assessed routinely by health administrators and decision-makers as an integral part of public health policy development. This may require health administrators to acquire new skills.
· The format, presentation and dissemination of evidence should be of high(er) quality, which may require evidence producers to acquire new skills.
EUR/03/5040052 page ii
· An evidence database road map and a “grading system” for all public health research is needed to guide the user/decision-maker in his or her assessment of the quality of evidence.
· Each country should have a “focal point” or centre for the production and/or coordination of public health evidence.
· Stronger networks of evidence-generating institutions are required to avoid unnecessary duplication of effort and ensure the best use of the collective expertise available.
· Evidence has multiple consumers (politicians, professionals, the public and the mass media) and should be presented in a way that can be understood and utilized by all these audiences.
· Further thought is required to determine whether evidence should be expressed as
“guidelines”, “recommendations”, “protocols” or “mandatory requirements”.
· The WHO Regional Office is recommended to intensify its work in the field of evidence.
For example it is recommended that the European Advisory Committee of Health Research considers forming a subgroup for the development of guidelines for the production of evidence-based recommendations for policy.
Background and purpose
The fourth in the series of meetings for high-level decision-makers organized by the WHO Regional Office for Europe was held in Brussels from 16 to 17 June 2003. Hosted by the Belgian Federal Public Service of Health, Food Safety and Environment, the Futures Forum was held in the Palace des Acadamies.
The Fourth Futures Forum was designed as part of a continuing programme to provide practical tools for decision-making in public health. It focused on the scope, use and limitations of evidence-based recommendations in the decision-making process. Building on the experiences of participants, the meeting considered the availability, relevance and utility of evidence-based recommendations to policy. Deliberations at the meeting were assisted by a number of expert presentations on the definition, provision and application of evidence to decision-making. Two background papers were circulated to participants in advance of the meeting.
The Forum also included a special session on decision-making in the absence of evidence, using the recent outbreak of Severe Acute Respiratory Syndrome (SARS) as a practical case study. The meeting in Brussels coincided with WHO’s First Global Conference on SARS, which was being held in Kuala Lumpur. This provided an opportunity for interaction between the two events, including telephone interviews with key participants in Kuala Lumpur and a live audio- conference link.
The WHO Regional Office’s interest in qualifying evidence-based recommendations for decision-making in public health is covered by its mandate: to work with countries and assist them in meeting their specific health needs.
The Futures Forum is one of a range of mechanisms designed to help Member States without WHO Liaison Offices, essentially the western European countries, develop their public health policies and programmes. This service is designed as a series of policy-making meetings in which policy-makers are gathered together to explore the future health agenda of the Region. It aims to assist national policy-makers, and also contribute to the next phase of Health for All policy development within the European Region.
The European Advisory Committee for Health Research (EACHR) is another part of the general World Health Organization (WHO) advisory mechanism within its Regional Office for Europe.
Its primary role is to advise the Regional Director on priorities and policies for the development of research. The Committee’s current task is to help the Regional Office build a better process to support its role in giving evidence based advice to health policy-makers. The evaluation and implementation of the advice and recommendations provided by the EACHR is carried out through the programme on Evidence for Health Needs and Interventions within the Regional Office for Europe.
Two specific outcomes from the meeting were envisaged during the planning stage.
1. The meeting would be one of a number of inputs to a consensus paper on tools for decision-making in public health. This will feed into the 2005 revision of the European Region’s Health for All policy.
EUR/03/5040052 page 2
2. The development of guidelines for application in Member States within the European Region for the production of evidence-based recommendations to help inform decisions about public health policy and interventions.
Following an introduction, this report will summarize deliberations and findings of the forum in the consecutive order of the sessions held: sources of evidence for decision-making at the ministerial level; the availability and evidence base of recommendations; case studies on practical experiences of the utility of evidence; and the Futures Fora series.
Introduction
Evidence-based tools to aid decision-making are needed in the complex worlds of public health and health care. The potential health impact of globalization and the noticeable differences in health outcomes between rich and poor make high quality decision-making important. Cross- border collaboration in building the evidence base is essential in order to make the best use of the expertise and resources available. The interest in quality decision-making is high due to factors such as growing health expectations by the public; new technologies and increasing technical abilities; significant demographic changes with consequential pressures on service provision and resources; and the advent of new diseases, and the re-emergence of old diseases.
Making use of the best available knowledge when making public health decisions is perceived an ethical imperative. In most professional arenas, including medicine and surgery, professionals are more and more held to account if they fail to apply what is known to be best practice when taking decisions. Governments are also more and more held to account if they do not incorporate evidence and best practice into their legislative and executive public health decisions. The availability of evidence and the current state of knowledge requires rigorous and continuous assessment by health administrators or the institutions and professionals contracted to assist them. This may become an essential part of policy formulation and result in the need for health administrators to acquire additional skills. In particular, decisions need to be avoided where the evidence indicates a lack of effectiveness, or even worse, the potential for harm. This would make the decision-making process more open and transparent, and thereby enhance public accountability.
Yet, the following sections illustrates that evidence-based public health decision-making is not easy to achieve, partly because of substantial limitations on the availability, accessibility, relevance and utility of evidence-based recommendations as practical tools for public health decision-making.
Sources of evidence for decision-making at the ministerial level
The first session concentrated on sources of evidence for public health decision-making at the ministerial level. This highlighted the difficulty in defining “evidence”. Moreover, the nature of evidence changes with time. What was regarded as “good practice” in the past may well be viewed as inappropriate or indeed dangerous today. Similarly, contemporary “state of the art”
policies and procedures may become out of date as new evidence emerges or as circumstances change.
A further potential complication results from the numerous evidence databases now available through online access. Although Cochrane (http://www.cochrane.org/) and Medline (http://www.nlm.nih.gov/) are well known and credible, there is a burgeoning array of
“evidence” sources, with little standardization in approach. They range from databases providing
“guidelines” to those in the business of “systematic reviews”. Much better cooperation between the “evidence” providers is required and the newly established Health Evidence Network (HEN) at the WHO Regional Office, working in collaboration with the European Commission, may well have a key role to play in helping to navigate through the complex range of evidence sources now available. More robust networks are required.
Participants raised a number of key points.
· Informed high-level decision-makers will often undertake the equivalent of a “mental meta-analysis” as part of their decision-making processes. Consideration must be given as to how best to improve this analysis.
· Although randomized controlled trials (RCTs) might be appropriate for much clinical practice, new research paradigms are required for public health. Social surveys, educational research and qualitative methods all have a role in providing the evidence base for health improvement at the population level.
· By definition, decisions will invariably be based on “available” evidence, not “desirable”
evidence. However, the decision-making process may itself generate the need for further evidence.
· Researchers must develop a new type of relationship with policy-makers and practitioners that results in a better understanding of potential contribution that research can make.
The first session concluded with three key observations with respect to public health decision- making.
· The use of evidence enables decision-makers to be transparent and explicit about the basis for decisions.
· The nature and provision of “evidence” should start with the needs of the decision-maker, not with the evidence.
· The term “evidence” requires a common understanding in all languages, e.g. “gathering knowledge” as opposed to “scientific investigation”.
The availability and evidence base of recommendations
The findings from a review commissioned by the WHO Regional Office for Europe on the availability of evidence for public health interventions, including Health Technology Assessment (HTA), provided the basis for a debate on the evidence base and the availability of recommendations for public health decision-making.
HTA was used as a model methodology for the generation of evidence as it is primarily designed to inform policy decisions. HTA is much more than a systematic review. It follows a rigorous procedure, including external appraisal. It is used explicitly to support decision-making in prevention and public health policy formulation, as well as organizational development.
EUR/03/5040052 page 4
However, HTA only has value for decision-makers if there is a specific problem to be addressed or a policy question to be answered.
The following key points on the HTA process, targeted a decision-making, were voiced in the presentation of the review.
· There must be a policy question to answer, policy-makers and HTA experts must work in close collaboration to define the key questions to be addressed.
· The overall economic impact (not just cost) should be included as part of the HTA.
· The outcomes of the HTA should be expressed in two types of summary, a short executive summary that meets the needs of decision-makers and a scientific summary addressed to the research community.
· In considering the merits of evidence in any given situation, it is essential to know why the evidence review or HTA was undertaken; who commissioned the work; who will receive the report; how the findings will be presented, thereby ensuring that they are relevant to and understood by the different audiences and interested parties.
A vigorous debate resulted in three key concluding points from participants regarding decision- making based on HTA.
· The roles and division of labour between politicians, civil servants and those involved in undertaking HTAs must be clear and understood by all. This helps the process of accountability.
· Public opinion should be considered in conjunction with the conclusions drawn from evidence since public health interventions must be both understood by and acceptable to the population concerned.
· Ultimately politicians should be accountable through the ballot box for any policy decisions. It is for this reason that decisions should not be devolved to pressure groups or those representing special interests, e.g. scientists with a vested interest in continued funding for their research programmes.
Practical Experience of the Utility of Evidence
Two case studies, one from Luxembourg and the other from Belgium, provided a practical context for the use of evidence-based recommendations. A third case study focused on SARS:
decision-making despite the absence of evidence.
Breast cancer screening in Luxembourg
The case study from Luxembourg, a 10-year mammography programme was planned on the basis of the best knowledge available at the time. A review of the evidence provided the basis for a quality assurance assessment of the proposed programme. This quality review indicated that insufficient investment had been made to date in equipment and skills to ensure that the programme could be delivered successfully.
The Luxembourg case study highlighted a recurring theme, that of capacity building.
Interventions frequently fail to deliver the expected outcome, not because the intervention itself
is flawed, but because the facilities, equipment, skills or number of staff are inadequate for the task. As such, it is not possible to take decisions on the basis of evidence alone; judgements will always have to be made.
This study also illustrated the practical issues that have to be addressed in translating plans into practical programmes of work “on the ground”. In the case of the Luxembourg Mammography programme, for example, a financial incentive was required to encourage the radiologists to accept new screening procedures.
Another example was touched upon: the general public in Luxembourg is increasingly demanding osteoporosis screening. However, decision-makers are faced with uncertainty in evidence-based recommendations for effective interventions to prevent osteoporosis.
Participants felt that further thought was required to determine whether evidence should be expressed as “guidelines”, “recommendations”, “protocols” or “mandatory requirements”.
Antibiotic use in Belgium
The second case study focused on the application of evidence to decision-making about antibiotic use in Belgium. Following concerns raised by the Belgian Antibiotic Policy Coordination Committee about growing antibiotic resistance, it became clear that decisions would have to be taken about:
1. The design, content and delivery of a public campaign; and 2. The role and accountability of physicians.
There had been a growing movement in Belgium to underpin decision-making wherever possible with evidence, the intention being to “avoid making the same mistake twice”. This is the remit for the new Federal Health Care Knowledge Centre, which includes HTA and guidance; health care data analysis; and support for new financing systems
The Belgian experience demonstrated that evidence had helped to determine the most appropriate means of intervening, including the use of legislation and medical audit to control over-prescribing by doctors. A clear mechanism for monitoring inappropriate prescribing, together with sanctions where necessary, were at the heart of the initiative.
The discussion from the two national case studies on the utility of evidence concluded the following.
· The proximity of elections increases the desire for new initiatives and can increase the demands upon, and opportunities for, evidence producers.
· Mechanisms are needed to manage and resolve conflicting evidence.
· The importance of communication between evidence “providers” and evidence “users”
cannot be overstated.
· The need for evidence is often driven by financial constraints. As such, evidence production should be seen as an investment that will bring dividends, not as a cost.
EUR/03/5040052 page 6
SARS: Decision-making despite the absence of evidence
The meeting also considered a case study of decision-making in the absence of evidence. As the Forum was being held simultaneously with the WHO Global Conference on SARS (Severe Acute Respiratory Syndrome), this was used as the basis for discussion. The advent of SARS demonstrated the need to build an evidence base as rapidly as possible. The value of worldwide collaboration in collecting data and applying traditional epidemiological, laboratory and clinical techniques became increasingly apparent to all Member States as the SARS crisis continued to grow. In the interim, however, decision-makers had to consider the costs to their economies of
“doing nothing”.
The following points were shared with respect to national experiences in coping with the SARS infection.
· Within individual Member States, there had been difficulty involving all of the necessary ministries within the time available. This had resulted in the health ministries sometimes taking decisions without the full involvement of other government departments, and is an issue that requires attention for future “emergency response” planning. Coordination with the Transport and Immigration authorities should be a priority.
· Local authorities had clearly viewed their national ministries of health as the source of expertise on SARS. Even in federal countries with highly devolved health systems, the national ministry was clearly the conduit for linking with the international agencies. This had helped communication and reduced the likelihood of uncoordinated efforts in each Member States. It had also helped the process of communication with WHO.
· There had been a particular concern among many European countries about the potential and actual impact upon their economies. A number of European countries rely heavily on tourism, some of them doubling their population at certain times of the year, and their actions to control SARS were driven partly by a real concern for the potential economic effects. However, there was also a short term negative impact upon trade resulting from some of the decisions taken to achieve longer term benefits. High-level decision-makers were faced with the dilemma of “trading” health against both long and short term economic considerations.
· Some Member States are now defending litigation from private sector organizations for the impact of government action on their commercial activities. They are now being sued, for example, over the closure of Trade Conventions.
· The identification and control of SARS had been a classic example of good epidemiological science. However, there were concerns about the capacity of public health systems in virtually all countries to deal with not only SARS, but the full range of public health issues with which they were now having to cope. The weakness and under-capacity of most public health systems was highlighted.
· There was a strong view that the health services were ill prepared to deal with an outbreak such as SARS, even in western Europe where there are highly developed health care systems.
The SARS experience also provides a number of lessons for evidence production and public health decision-making.
· The public health part of the health system in virtually all countries is under-resourced and must be significantly reinforced and enhanced, and specifically with respect to
communicable diseases; surveillance systems should be strengthened; and infection control in hospitals should be reviewed and tightened.
· Good communication and rapid information transfer between international agencies, government departments, and with health professionals, the media and rapid information transfer between centres is essential.
· Networks of cooperative action produce infinitely better results than centres working in splendid isolation, and the value of a focal point for coordination cannot be over- emphasized and coordinated international action can result in rapid success.
· Evidence often needs to be made available rapidly; decision-makers do not always have the luxury of waiting for publication in peer reviewed journals.
The session concluded that, despite the shortcomings mentioned above, the identification and control of SARS represented a testimony to the power of internal collaboration and rapid decision-making. Participants recognized that SARS was not an isolated incident and that other such challenges would occur from time to time. SARS is an example of what can be achieved when the imperative of urgency replaces the traditional constraints involved in producing evidence. The lesson learned should be used to underpin emergency public health planning for the future.
The Futures Fora series
The Fifth Futures Forum will be held in early December 2003. It will continue the theme of the Fourth Forum and will focus on “Tools for Rapid Response decision-making”. The meeting will be supported by a synthesis of findings from previous Forum meetings and will pay particular attention to “surveillance” and “preparedness”. Risk management, uncertainty, scenario planning and disaster modelling will feature in the programme, supported by “real-life” case studies.
General feedback at the end of the Forum meeting indicated that the meetings are of increasing value. Future events should involve a mix of decision-makers with policy responsibilities and/or executive powers. This would help to determine the needs of high-level decision-makers and ensure that the development of practical tools would be both timely and relevant.
In order to provide a follow up to the findings and recommendations of this Futures Forum, participants suggested that the Regional Office should establish a small working group to take forward the development of guidelines for evidence-based recommendations for public health decision-making.
For subsequent meetings, participants at the Fourth Forum recommended the following.
· More use of the Forum members could be made between the half-yearly meetings. There is considerable opportunity to exchange information, problems and solutions. This would not only provide a support network, but would in effect offer some of the benefits of a
“learning set”. In this way, the Forum programme would have practical utility throughout the year.
· More time should be made available for participant discussion.
· A politician, or one recently out of office, should be invited to expand upon the dilemmas and considerations involved in high-level political decisions.
EUR/03/5040052 page 8
· The balance between theory and practice should place even greater emphasis on real, live decision-making situations.
· Participants should be asked to undertake a specific task prior to the Forum meeting, which would then feed into the discussion thereby ensuring greater interactivity.
Annex 1
L
IST OF PARTICIPANTSDr Margarita Coll Armangué
Responsable vigilance epidémiologique Service de surveillance épidémiologique Ministère de la santé et du bien-être Av. Princep Benlloch, 30, 4ème Andorre la Vielle, Andorra
Tel.:
Fax:
E-mail:
www:
+376 860 345 +376 861 933
mc.sies-gov@andorra.ad
Mrs Ragnhildur Arnljotsdottir Counsellor
Icelandic Mission to the European Communities Embassy of Iceland
Rue de Tréves 74
B-1040 Brussels, Belgium
Tel.:
Fax:
E-mail:
www:
+32 2 286 1787/00 +32 2 286 1770
ragnhildur.arnljotsdottir@utn.stjr.is stjr.is
Dr Yitzhak Berlovitz Associate Director-General Ministry of Health
29 Rivka Street P.O. Box 1176
Jerusalem 91010, Israel
Tel.:
Fax:
E-mail:
www:
+972 25681300 +972 26725823
berlo@moh.health.gov.il
Mr Alfred Berwaerts Directeur Général
Federal Public Service Health, Food Chain Security and Environment
Cité administrative de l’Etat Boulevard Pachéco, 19 – bte 5 B-1010 Brussels, Belgium
Tel.:
Fax:
E-mail:
www:
+32 2 210 44 67 +32 2 218 67 46
alfred.berwaerts@health.fgov.be
Dr Finn Børlum Kristensen
Head of Centre for Evaluation and Health Technology Assessment
National Board of Health (Sundhedsstyrelsen)
Islands Brygge 67, Postboks 1881
DK-2300 Copenhagen S, Denmark
Tel.:
Fax:
E-mail : www :
+45 7222 7727 +45 7222 7411 fbk@sst.dk
Dr Ray Busuttil
Director General, Health Ministry of Health Palazzo Castellania 15, Merchants Street
Valletta CMR 02, Malta
Tel.:
Fax:
E-mail:
www:
+356 22 992426 +356 21 2248 84 ray.busuttil@gov.mt
EUR/03/5040052 page 10
Dr Jean-Pierre Closon
Belgian Federal Health Care Knowledge Centre Résidence Palace A 10th floor
Wetstraat 155
1040 Brussels, Belgium
Tel.:
Fax:
E-mail:
www:
+32 2 287 3352
Dr Dirk Cuypers President
Federal Public service of Health, Food Safety and Environment
Esplanadebuilding
B-1010 Brussel, Belgium
Tel.:
Fax:
E-mail:
www:
+32 2 210 4427 +32 2 210 4463
dirk.cuypers@health.fgov.be
Dr Danielle Hansen-Koenig Directeur de la Santé Direction de la santé
Villa Louvigny, Allée Marconi
L-2120 Luxembourg, Luxembourg
Tel.:
Fax:
E-mail:
www:
+352 478 5550 +352 467 962 danielle.HANSEN- KOENIG@ms.etat.lu
Dr Catherine Le Galès
Scientific Advisor of the French Director-General of Health
National Institute of Health and Medcial Research/
Directorate General of Health (INSERM/DGS) Direction Générale de la Santé
Ministère de la santé 8 avenue de Segur
75350 Paris 07 SP, France
Tel.:
Fax:
E-mail:
www:
+33 1 40 56 57 88 (direct line) +33 1 40 56 40 56
catherine.legales@sante.gouv.fr
Dr Robert Maynard, CBE Senior Medical Officer Health Protection Division Department of Health Richmond House 79 Whitehall
GB-London SW1A 2NS, United Kingdom
Tel.:
Fax:
E-mail:
www:
+44 207 972 5118 +44 207 972 5167
Robert.Maynard@doh.gsi.gov.uk
Ms Leen Meulenbergs Advisor
Federal Public Service Health, Food Chain Security and Environment
Cité administrative de l’Etat Boulevard Pachéco, 19 – bte 5 B-1010 Brussels, Belgium
Tel.:
Fax:
E-mail:
www:
+32 2 210 44 62 +32 2 218 67 46
leen.meulenbergs@health.fgov.be
Dr Vesna-Kerstin Petric Head, WHO Liaison Office
c/o Ministry of Health of the Republic of Slovenia Stefanova 5
SL 1000 Ljubljana, Slovenia
Tel.:
Fax:
E-mail:
www:
+386 1 478 6099 +386 1 426 2115
versna-kerstin.petric@gov.si
Professor José Pereira Miguel
Director-General and High Commissioner of Health Ministry of Health
Al. D. Alfonso Henriques, 45 P-1049-005 Lisbon Cordex Portugal
Tel.:
Fax:
E-mail:
www:
+351 21 843 06 41 +351 21 843 06 55
jomiguel@dgsaude.min-saude.pt
Professor Dirk Ramaekers General Director
Belgian Federal Health Care Knowledge Centre Résidence Palace A 10th floor
Wetstraat 155
1040 Brussels, Belgium
Tel.:
Fax:
E-mail:
www:
Dirk.Ramaekers@kenniscentrum.fgov.be
Dr Nina Rehnqvist Executive Director
Swedish Council on Technology Assessment in Health Care (SBU)
Box 5650 Tyrgatan 7
114 86 Stockholm, Sweden
Tel.:
Fax:
E-mail:
www:
+46 8 412 3200 +46 8 411 3260 rehnqvist@sbu.se sbu.se
Professor Ernst W. Roscam Abbing Chief Inspector
Public Health and Disaster Medicine Netherlands Health Care Inspectorate P.O. Box 16119
2500 BC The Hague, The Netherlands
Tel.:
Fax:
E-mail:
www:
+31 70 340 5805 +31 70 340 5205
ew.roscamabbing@igz.nl
Dr Gaudenz Silberschmidt
Head of Division of International Affairs Swiss Federal Office of Public Health Schwarzenburgstrasse 165 – Postfach 2644 CH-3003 Bern, Switzerland
Tel.:
Fax:
E-mail:
www:
+41 31 322 6650 +41 31 324 9033
gaudenz.silberschmidt@bag.admin.ch
Dr Godfried Thiers Directeur
Institut Scientifique de Santé publique Rue Juliette Wytsman, 14
B-1050 Bruxelles, Belgium
Tel.:
Fax:
Email:
www:
+32 2 642 51 11 +32 2 642 50 01
godfried.thiers@iph.fgov.be
Dr Stefan Winter Director-General
Department of Prevention, Disease Control and Biomedicine
Federal Ministry of Health and Social Security House D, Am Propsthof 78 a
D-53108 Bonn, Germany
Tel.:
Fax:
E-mail:
www:
+49 228 941 30 01 +49 228 941 49 30 winter@bmg.bund.de
EUR/03/5040052 page 12
Other International Organizations
Mr Ronald Haigh Head of Unit
Communicable, rare and emerging diseases Directorate “Public Health”
European Commission EUROFORUM Building
Rue Alcide de Gasperi - Office EUFO-3269 L-292 Luxembourg, Luxembourg
Tel.:
Fax:
E-mail:
www:
+352 4301 43011
+352 4301 32734 (direct) +352 4301 33248
Ronald.Haigh@cec.eu.int
Additional experts Professor Reinhard Busse
Lehrstuhl Management im Gesundheitswesen Department of Health Care Management, EB2
Strasse des 17. Juni 145 10623 Berlin, Germany
Tel.:
Fax:
E-mail:
www:
+49 30 314 28420 +49 30 314 28433 mig.tu-berlin.de
Professor Richard Parish (Rapporteur) Public Health Consultant
Richard Parish Associates Action for Health
Gypsy Wood House, 2 St. Johns Road Moggerhanger, Bedford MK44 3RJ United Kingdom
Mobile:
Private:
Fax:
E-mail:
www:
+44 7713 255 972 +44 1767 640 516 +44 1767 641 146
richardparish28@aol.com richardparish.com
Mr Helmut Voigtländer Auf Staffel 34
D-53619 Rheinbreitbach Germany
Tel.:
Fax:
E-mail:
www:
+49 2224 4378
World Health Organization WHO Office at the European Union
Dr John Martin Executive Director
WHO Office at the European Union UN House, 1st Floor
14 Rue Montoyer
B-1000 Brussels, Belgium
Tel.:
Fax:
E-mail:
www:
+32 2 506 46 60/1 +32 2 506 4666
postmaster@who.eu.be
Regional Office for Europe Dr Marc Danzon
Regional Director
WHO Regional Office for Europe Scherfigsvej 8
DK-2100 Copenhagen Ø, Denmark
Tel.:
Fax:
E-mail:
www:
+45 3917 1371 +45 3917 1888 mda@euro.who.int euro.who.int
Dr Yves Charpak
Senior Policy Adviser to Regional Director WHO Regional Office for Europe
Scherfigsvej 8
DK-2100 Copenhagen Ø, Denmark
Tel.:
Fax:
E-mail:
www:
+45 39171610 +45 39171888 ych@euro.who.int euro.who.int
Dr Nata Menabde Director
Division of Country Support WHO Regional Office for Europe Scherfigsvej 8
DK-2100 Copenhagen Ø, Denmark
Tel.:
Mobile:
Fax:
E-mail:
www:
+45 3917 1535 +45 2331 9489 +45 3917 1818 nme@euro.who.int
Dr Josep Figueras
Head, European Centre for Health Policy c/o Service Publique Fédéral (SPF) Santé Publique,
Sécurité de la Chaîne Alimentaire et Environnement Bld. G, B. 302, Boulevard Pachéco 19, b.5
B-1010 Brussels, Belgium
Tel.:
Mobile Fax:
E-mail:
www:
www:
+32 2 2104983/+32 2 2105914 +32 473 864584
+32 2 2105037
josep.figueras@health.fgov.be euro.who.int/echp
observatory.dk
Dr Elke Jakubowski (Secretariat) Acting Regional Adviser, Futures Fora WHO Regional Office for Europe Scherfigsvej 8
DK-2100 Copenhagen Ø, Denmark
Tel.:
Fax:
E-mail:
www:
+45 3917 1225 +45 3917 1870 elj@euro.who.int euro.who.int
Dr P. Egon Jonsson Project Leader
Health Evidence Network
WHO Regional Office for Europe Scherfigsvej 8
DK-2100 Copenhagen Ø, Denmark
Tel.:
Fax:
E-mail:
www:
+45 3917 1274 +45 39171818 paj@euro.who.int euro.who.int
Mrs Janet L. Leifelt (Secretariat) Programme Assistant
Futures Fora
WHO Regional Office for Europe Scherfigsvej 8
DK-2100 Copenhagen Ø, Denmark
Tel.:
Fax:
E-mail:
www:
+45 3917 1539 +45 3917 1899 jan@euro.who.int euro.who.int
Ms Shubhada Watson
Regional Adviser, Evidence on Health Needs WHO Regional Office for Europe
Scherfigsvej 8
DK-2100 Copenhagen Ø, Denmark
Tel.:
Fax:
E-mail:
www:
+45 3917 1617 +45 3917 1818 shw@euro.who.int euro.who.int
EUR/03/5040052 page 14
Annex 2
P
ROGRAMMEMonday, 16 June
Morning Arrival of participants
12:30–13:00 Registration 13:00–13:30 Opening 13:30–13:45 Introduction
Dr Dirk Cuypers, President, Federal Public Service of Health, Food Safety and Environment, Belgium
Dr Marc Danzon, Regional Director, WHO
13:45–14:45 Session 1: Sources for evidence-based public health decision-making at the ministerial level
Presentation: Professor P. Egon Jonsson, WHO Chair: Dr Nina Rehnqvist, Sweden
14:45–15:15 Coffee/tea break
15:15–17:45 Session 2: Availability and evidence base of recommendations for public health decision-making
Presentation: Professor Reinhard Busse, Germany
Chair: Professor Ernst W. Roscam Abbing, The Netherlands
Tuesday, 17 June
9:00–10:30 Session 3: Experience on the utility of evidence-based recommendations for public health decision-making
Presentation: Dr Danielle Hansen-Koenig, Luxembourg and Professor Dirk Ramaekers, Belgium
Chair: Dr Ray Busuttil, Malta
10:30–11:00 Coffee/tea break
11:00–12:00 Session 4: Conclusion: guidelines from decision-makers for evidence- based recommendations
Presentation: Professor Richard Parish, Rapporteur, United Kingdom Chair: Dr Robert Maynard, CBE, United Kingdom
12:00–14:00 Lunch
Presentation: Dr Josep Figueras, Head, WHO European Centre for Health Policy, Belgium
14:00–15:30 Session 5: “One-off” topic
Severe Acute Respiratory Syndrome: Decision-making despite the absence of evidence
Presentation by telephone conference: Dr David Heymann, WHO Conference on SARS, Kuala Lumpur, Malaysia, 17–18 June 2003 Chair: Dr Nata Menabde, WHO
15:30–16:00 Coffee/tea break
16:00–17:15 Session 6: The futures fora series
Presentation: Dr Elke Jakubowski, WHO Chair: Dr Nata Menabde, WHO
17:15 Closure
EUR/03/5040052 ORIGINAL: ENGLISH UNEDITED
E80895
Fourth Futures Forum of
High-Level
Decision-Makers
Tools for decision-making in public health
World Health Organization Telephone +45 39 17 17 17 Regional Office for Europe Telefax +45 39 17 18 18
Telex: 12000 who dk Scherfigsvej 8
DK-2100 Copenhagen Ø Electronic mail: postmaster@euro.who.int
Denmark World Wide Web Address: http://www.euro.who.int
Brussels, Belgium 16–17 June 2003
2003
