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Setting health priorities in a Swiss canton: what do different methods tell us?


STUDY OBJECTIVE Despite excellent mortality indicators, there is clear evidence that the health status of the population of Geneva could be improved if more attention and resources were devoted to prevention strategies. To identify a set of robust health priorities an original approach was used triangulating results between three methods.

METHODS The study calculated potential years of life lost, disability adjusted years of life lost, and conducted a Delphi survey to gather the opinion of health professionals and the general public.

MAIN RESULTS Several health conditions were unanimously selected by all three methods as top priorities: cardiovascular diseases, AIDS, respiratory cancer, breast cancer for women, suicide and traffic accidents. In addition, two determinants—alcohol abuse and tobacco abuse—for which a clear conceptual link could be established between all methods were chosen. Connections between priorities identified through the DALY and the Delphi method lead to further inclusion of chronic back pain and depression. Some issues solely identified through the Delphi survey were included as they were consistently considered important by professionals and the lay public alike—violence in the family, unemployment, social exclusion.

CONCLUSIONS These results indicate that health priorities, and by extension health care priorities, would benefit from using a mix of quantitative and qualitative research methods. The triangulation of results allows for a broader perspective and makes results more acceptable.

  • health priorities
  • DALYs
  • Delphi survey

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  • Funding: the study was totally funded by the Health department of the canton of Geneva within a mandate given to the Institute of social and preventive medicine.

  • Conflicts of interest: none.

  • * Three studies carried out in Geneva had examined the health status of the population and perception about health priorities: La santé des genevois. Les Cahiers de la Santé. No 1, Juin 1993. Etter JF. Rapport d'évaluation du CIPRET-Genève. IMSP, Université de Genève, 1996. La santé dans le canton de Genève, 1ère enquête Suisse sur la santé. ISP, Lausanne, 1996. General morbidity and mortality patterns for the European region were taken from: European Community atlas of avoidable deaths. 2nd ed. Vol 1. Oxford University Press, 1991.Investing in health. World Development Report 1993. Oxford University Press. In addition, a questionnaire developed for a similar Delphi study in Ile-de-France was used.