Table 1

Examples of work on health and its determinants in relation to policy

(a)Policy analysisAnalysis of a policy, in an area that affects healthDescription of EU tobacco subsidies in terms of the commercial value of the crop and the success of the policy in supporting farming jobs,17 and of the fruit and vegetables regimen of the Common Agricultural Policy.18
(b)Needs assessmentDescription of a prevailing health problem and (sometimes) the current policies that apply, but without any developed connection with a specific interventionA survey of the mental health of children and adolescents in Great Britain, the impacts of mental disorders on affected children and other people, and on use of services.19 A study of end stage renal failure secondary to diabetes mellitus in Asian groups in the UK20
(c)Burden of diseaseEstimation of the number of cases attributable to a particular exposure or risk factorAttribution of the proportion of DALYs (disability adjusted life years) to different causes, eg, 4.5% to poor nutrition, 3.7% to obesity and 1.4% to physical activity in the EU,21 and of deaths worldwide to tobacco.22
(d)Social contextExploration of the socioeconomic and cultural antecedents of people's exposure to a set of risk factorsAnalysis of the underlying factors that influence the proximate determinants of child disease in the Philippines, for example, maternal education on diarrhoea.23 Analysis of socioeconomic determinants of women's smoking status.24 Mapping of price and availability of healthy food in a deprived area.25
(e)AdvocacyPresentation of a health problem that is structured so as to try and influence policy developmentDescription of the health impacts of transport,26 the potential health gain from increased vegetable and fruit consumption in the EU,27 or the effects of relatively low taxation on hand rolled cigarettes.28
(f)Health effects of attaining targetsEstimation of the health impacts of reaching policy targets for exposure levels, without specifying the policy options used to achieve themModelling the expected health benefits of reducing ambient air pollution to meet national standards.29(Mindell and Joffe, submitted for publication) Estimating the effects on cardiovascular disease of achieving of smoking prevalence targets.30
(g)Health effects of a single optionAssessing prospectively or retrospectively the health effects of a single course of action (or of a set of measures without evaluating the contribution of individual elements)Modelling the expected health gain from convergence in tobacco taxation in EU Member States.31 Estimation of the effects of salt reduction in Norway following a package of four measures.32
(h)Health effects of a single option with mitigationAs (f), but with proposals for mitigating possible adverse effectsAssessment of the potential health impacts of a proposed dam development project, with costed suggestions for mitigation of adverse health effects.33 Retrospective assessment of a housing strategy, with recommendations.34 Prospective assessment of the combined effects of community safety projects in regenerating part of Merseyside.35
(i)Comparison of health effects of optionsComparison of the health impacts of different policy options, or contrasting retrospectively the effects that followed different interventionsProspective comparison of different tobacco control policies (and of their combined effect) in the UK36 and of different transport proposals in Edinburgh.37 Retrospective analysis of the contributions of medical treatment (40%) and known risk factor reduction (51%) to the observed decline in CHD.38