Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit From Evidence to Policy Munich, November 2010 Prof. Manfred Wildner, MPH LGL Dept. Health + PSPH, LMU Munich
Life Expectancy PH > 50%! Bayerisches Landesamt für Gesundheit Bayerisches und Landesamt Lebensmittelsicherheit für Gesundheit und Lebensmittelsicherheit 2
Health Impact Pyramide (mod. Nach Frieden, AJPH 100;2010:590-5) Counselling, Education, Clinical Intervention Health Protection Healthy Settings/ Environmental Health Socioeconomy and Culture Increasing Population- Impact Increasing individual need for Ressources Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit 3
Cartoon Hello... Can you tell me where I am? Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit 4
Cartoon Yes... You are 30 ft. above ground, 0.5 miles west of a river and you are moving with a speed of 4.2 mph eastwards! Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit 5
Cartoon... You must be a scientist! Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit 6
Cartoon Yes... How do you know? Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit 7
Cartoon... because you are telling me things that I don t want to know! Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit 8
Cartoon... and you must be a politician! Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit 9
Cartoon Yes how do you know? Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit 10
Cartoon... because you don t know where you are, You don t know where you are going, and you are blaming me for it! Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit 11
EbPH: Need for Bridges! connecting science and practice connecting professions and citizens connecting presence and future Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit 12
EbPH: Need for Bridges! connecting science and practice connecting professions and citizens connecting presence and future Aims: healthy cities and settings healthy (health) economy and services healthy viewpoints and decisions Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit 13
The Emergence of Translational Epidemiology Khoury et al., Am J Epidemiol 2010;172:517-24 Phases of Translation T0:...from description and discovery T1:...to health applications T2:...to evidence guidelines T3:...to health practice/programs T4:...to population health outcomes Knowledge synthesis (KS)* * Homogenous methods of Eb-KS across all phases? Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit 14
The Emergence of Translational Epidemiology Khoury et al., Am J Epidemiol 2010;172:517-24 Phases of Translation Actors T0:...from description and discovery research community T1:...to health applications clinical community T2:...to evidence guidelines expert organizations T3:...to health practice/programs experts, payors, reg. T4:...to population health outcomes experts, payors, regulators, other sectors and parties, translators/media Knowledge synthesis...plus ethics, support, lobbies, opportunities Heterogenous methods Varying actors Non-linear iterative processes Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit 15
Context matters - a Framework for EbPH Phases of Translation From Experiment to Evaluation to Evolution T0:...discovery Experimental Evidence T1:...applications Efficacy, Effectiveness T2:...guidelines Efficiency, Economic Benefits T3:...practice/programs Ethics T4:...outcomes Expectations, Evolution Individual(s), Ex post, controlled Group(s), Ex ante, context Varying perspective(s) Varying time horizon Control vs. Context Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit 16
EbPH: From information to new Norm(ality) Phases of Translation RCT From Experiment to Evaluation to Evolution T0:...discovery Information T1:...applications Knowledge T2:...guidelines Consciousness T3:...practice/programs Action T4:...outcomes New Norm(ality) Individual(s), Ex post, controlled Group(s), Ex ante, context EbPH... Is NO linear extrapolation of EbM EbPH...methods are dependent on system levels EbPH...success is context dependent Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit 17
Good Stewardship a (bio)divers garden? John F. Kennedy: Address at American University, Washington D.C. (10 June 1963) if we cannot end now our differences, at least we can help make the world safe for diversity! Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit 18