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Published on March 14, 2008

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ISSUES AND CHALLENGES: The Global Evidence Debate in Health Promotion . London, HDA 10 March 2003 David V. McQueen Associate Director for Global Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA IUHPE Global Vice-President for Scientific and Technical Development; Global Programme Leader, Global Programme on Health Promotion Effectiveness (GPHPE) :  ISSUES AND CHALLENGES: The Global Evidence Debate in Health Promotion . London, HDA 10 March 2003 David V. McQueen Associate Director for Global Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA IUHPE Global Vice-President for Scientific and Technical Development; Global Programme Leader, Global Programme on Health Promotion Effectiveness (GPHPE) The International Union for Health Promotion and Education:  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@iuhpe.org Slide3:  Mission Promote and develop global health Seek equity in health Between countries Within Countries Slide4:  Non-governmental organisation Founded 1951 2,000 members, over 90 countries Headquarters in Paris Seven Regional Offices around the globe Slide5:  Europe (France) South East Asia (India) North America (USA) Latin America (Puerto Rico) Northern Part of Western Pacific(Japan) Southwest Pacific (Australia) Africa (Kenya) Slide6:  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 Communications Slide7:  Projects Global Programme, Health Promotion Effectiveness Essential Readings in Health Promotion The Growing Tobacco Crisis, Francophone Africa And many others IUHPE Global Programme on Health Promotion Effectiveness GPHPE:  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. Global Programme on Health Promotion Effectiveness (GPHPE) 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; 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. :  Global Programme on Health Promotion Effectiveness (GPHPE) 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; 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 O’Neill, Quebec, Canada The GPHPE aims to raise standards of health promoting policy-making and practice worldwide by : :  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. Global Programme on Health Promotion Effectiveness (GPHPE) 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; 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. :  Global Programme on Health Promotion Effectiveness (GPHPE) 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; 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. REGIONS WILL FOCUS ON DEVELOPING THEIR OWN PRIORITIES AND DEFINITIONS OF EVIDENCE AND EFFECTIVENESS :  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 Summary of GPHPE REGIONAL COMPONENTS:  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, women’s health, children’s 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.) GPHPE African Region:  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. GPHPE European Region:  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 GPHPE Latin American Region:  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@yahoo.com) GPHPE PAHO Regional Efforts (tied to work with Latin American Region, Health Canada, CDC):  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 Mayor’s 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) GPHPE North American Region:  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 GPHPE North Western Pacific Region :  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. GPHPE South-East Asia Region:  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, Women’s Health, Children’s 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. GPHPE South West Pacific Region :  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. GPHPE WHO (Geneva) Collaboration :  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. GPHPE:  GPHPE Now to aspects of the global component of the programme The Global Monograph of the GPHPE:  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 promotion’s development throughout the world Provides a companion document to each of the regional documents. Global Programme on Health Promotion Effectiveness (GPHPE) 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; 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. :  Global Programme on Health Promotion Effectiveness (GPHPE) 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; 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. Chapter on Globalization Urbanization/Urbanisation:  Chapter on Globalization Urbanization/Urbanisation As an example of a global problem area GPHPE Issues in urbanization: major public health concern of an urbanizing world:  Issues in urbanization: major public health concern of an urbanizing world Population Pollution Degradation (environment) Migration Destruction Desertification Example :  Example Physical activity, sprawl, pollution, built environment and health consequences How might sprawl affect health?:  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 Air pollution:  Air pollution Major pollutants of concern: ozone lead NOx SOx CO air toxics particulates allergens hydrocarbons Air pollution:  Air pollution Major pollutants of concern: ozone lead NOx SOx CO air toxics particulates allergens hydrocarbons Produced by cars and trucks Ozone, where I live:  Ozone, where I live Ozone health effects:  Ozone health effects Respiratory effects (ozone > PM): Airway inflammation Decreased air flow Increased symptoms, ER visits, medication use, hospitalizations Cardiovascular effects (PM > ozone) Increased mortality Immune effects Increased susceptibility to infection Ozone health effects:  Ozone health effects Susceptible subgroups include: Asthmatics Children The elderly Those with certain underlying diseases Asthma and Equity:  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 Sprawl and climate change:  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 Physical Activity:  Physical Activity  population density  employment density  trip distances  vehicle trips  walking  overweight  obesity Physical activity:  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 Slide42:  Source: Prentice and Jebb. Obesity in Britain: gluttony or sloth? British Med J 1995;311:437-439 GLUTTONY or SLOTH? Overweight:  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 Evidence, evaluation and Effectiveness :  Evidence, evaluation and Effectiveness GLOBAL EFFORTS IN HEALTH PROMOTION EVALUATION: UPDATE AND RELATIONSHIP TO GPHPE FOCUS ON THE ISSUES ARISING Slide45:  Evidence Evaluation Effectiveness The three ‘Es’ Evidence Iceberg in Health Promotion:  Evidence Iceberg in Health Promotion RCT Companion Studies Observational Studies Observational Studies Participation Designs Fugitive Literature Hearsay Slide47:  Evidence Iceberg in Health Promotion Less Formal Observational Studies Participatory Studies Fugitive Literature Hearsay RCTs Comparison Studies Observational Studies dvmcq 2001 The production of evidence in the West:  The production of evidence in the West Evidence & Evaluation:  Evidence & Evaluation Limited term Implies rigor Strict rules Proof difficult Scientific literature Comprehensive term Anything can be evaluated Loose rules “Rules of Evidence”:  “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 Hierarchy of Evidence: The idea in HP:  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 Complexity and Evidence:  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 Health Promotion and Effectiveness:  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 Examples of efforts to produce evidence::  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 Slide55:  Systematic Reviews and Evidence-Based Recommendations The Community Guide Is::  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 Reviews Address How to Reduce Disease, Injury and Impairment: Selected Chosen Areas:  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 Method for Conducting Systematic Reviews Consists of Five Steps:  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 Physical Activity:  Physical Activity Objectives:  Objectives Provide chapter update Definitions and frameworks for: Community-scale urban design Street-scale urban design Transportation policy and practices Literature Searches:  Literature Searches Most articles in non-traditional public health literature Sample journals American Planning Association Journal Landscape and Urban Planning Transportation Research Record Developing Intervention Categories:  Developing Intervention Categories Too much diversity among interventions for a single category Developing Intervention Categories:  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 Developing Intervention Categories: Intervention Components:  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 Community-scale Urban Design and Land Use Policies and Practices:  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. Intervention Characteristics:  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 Street-scale Urban Design and Land Use:  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. Intervention Characteristics:  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 Transportation Policies and Practices:  Transportation Policies and Practices Transportation policies and practices that encourage and facilitate walking and bicycling for transportation Intervention Characteristics:  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 Discussion:  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 couldn’t be ruled out? Evaluating Health Promotion: Recommendations to Policy-makers:  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 Objectives:  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 Major publication of the EWG was the “Yellow Book”: Evaluation in health promotion: Principles and perspectives* :  Major publication of the EWG was the “Yellow Book”: Evaluation 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. EWG Principles for Evaluation of Health Promotion Initiatives:  EWG Principles for Evaluation of Health Promotion Initiatives Participation Multiple methods Capacity-building Appropriateness 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:  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 IUHPE Report Three Components of Working Group:  IUHPE Report Three Components of Working Group International Project Advisory Group Lead project Authors A Witness Group of Political Experts IUHPE Report to the EU (1999) Core Document included a chapter on the political challenges in mental health*:  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 IUHPE Report Key General Recommendations:  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 Characteristics of Working Groups on Evidence and Evaluation:  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 Solutions to improve and carry on this work:  Solutions to improve and carry on this work 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 Build on Past Develop New Key Unresolved Issues in the Evidence Discussion:  Key Unresolved Issues in the Evidence Discussion Methods Time Attribution of Effect Universality Useful Strategies of EWG*:  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 EWG Threefold Approach :  EWG Threefold Approach Marshalling the evidence – an academic book Showing the practice – a practitioner’s guide Convincing those with resources – a policy document In Conclusion:  In Conclusion Some general observations if there is time Three Paradigm Questions*:  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) Underlying Theoretical Orientations for Methods in Health Promotion :  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. Edna’s 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 Edna’s Challenge Slide89:  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 Slide90:  www.iuhpe.org

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