Elsevier

Health Policy

Volume 62, Issue 3, December 2002, Pages 309-328
Health Policy

Rapid appraisal methodology for ‘health for all’ policy formulation analysis

https://doi.org/10.1016/S0168-8510(02)00053-2Get rights and content

Abstract

Background: Although in the last 20 years, the WHO ‘Health for All’ principles have been widely used in national, regional and local health policy documents, there is still a gap in the literature regarding how to appraise or compare them, which weakens the social accountability process. Methodology: A new, rapid approach to analyse the formulation of health policies is proposed. It is based on the selection of a small number of tracers and the development of a gold standard to be completed with input from a review of the literature, and opinions of expert panel members. This methodology has been empirically applied to the health strategies of two Spanish regions (Catalonia and Valencia). Results: A framework for analysis was produced containing three dimensions: timing (early or late policy options), action level (individuals or social focus) and equity (social class, gender and ethnic groups). The health problems selected as tracers were HIV/AIDS, traffic injuries and ageing-related disabilities. In the two regions studied, the policies formulated for HIV/AIDS and age-related disabilities provide interventions late in the evolution of the health problem. The strategy established in the region of Valencia is more community-oriented than in Catalonia. Neither region had implemented specific policies regarding social class, gender or ethnic groups. Interpretation: The methodology proposed here makes it possible to map the formulation of Health Strategies, compare different geographical areas and even forecast the policies’ usefulness. The simplicity of the method, together with the fact that citizens and politicians alike can easily understand its results are major advantages. For the framework to be fully useful, it will be necessary to build evidence-based policy databases.

Introduction

Over the last 20 years, many countries throughout the world have introduced explicit strategic tools in health policy influenced by the World Health Organisation's Health For All principles (WHO HFA) [1]. Many countries in the WHO European Region [2], [3], [4], and elsewhere [5], [6], have produced national HFA policy formulations. This process was then fuelled in the cities, by the creation of the WHO Healthy Cities network [7], as it was taken on board by regional governments [8]. As a result, a huge number of citizens, institutions, cities, regions and nations have been mobilised in line with the HFA principles and values. Health strategies, therefore, emerge as the results of the political selection of policy proposals from the range available to deal with health problems, once these have been prioritised.

Until now, most research into policy-making has concentrated in the scientific literature, which reflects the last steps of the policy cycle, namely, policy implementation and evaluation [9], [10], [11], [12], [13], [14]. However, this has led to a gap in information about other crucial areas, such as how a health problem is constructed by society or how institutions react to the perceived problems by formulating policies. To date, no methodology has been proposed to compare the different ways to prioritise issues and to forecast a policy's application in terms of results and outcomes. This, in turn, has had the effect of limiting social accountability in so far as the origin of the public actions has not been explored systematically. A possible approach to closing this gap uses methods to reduce the enormous amount of information available in strategy documents, shortening the time needed to produce an assessment, while improving a policy's value by comparing it with external models. In this paper we propose a theoretical framework developed with the explicit intention of covering these aspects.

Specifically, the objective of this paper is to report a rapid appraisal method to analyse policy formulation and to jointly assess HFA strategies developed in different geographical areas and administrative levels. To illustrate how the methodology works, we present empirical results after testing it in two Spanish Autonomous regions: Valencia and Catalonia, each with its own, independent healthcare budget.

Section snippets

Material and methods

A general outline of the methods used is presented in Fig. 1.

Development of reference framework

Fig. 2 describes the results obtained after adapting the model along a three-dimensional framework. One dimension refers to the time at which an intervention may take place, classifying the policy option according to the different stages of the natural history of the health problem: Health promotion and primary, secondary and tertiary prevention. This makes it possible to classify policy options in: mostly early, and late interventions over time. The second dimension refers to the action level

Discussion

The proposed methodology makes it possible to map the formulation of Health Strategies, compare policies in different geographical areas and even forecast their usefulness. The key to applying the methodology is using the reported framework for the rapid classification and comparison of health strategies. The method's major advantages reside in its simplicity, and the fact that the results it reflects can easily be understood by citizens and politicians alike.

From the Public Health perspective,

Acknowledgements

To all the experts in each of the topics: In HIV/AIDS: M. José Aviñó, Valencia Institute of Public Health, Valencia. Jesús Castilla, National Centre of Epidemiology, Madrid. Elia Dı́ez, Municipal Institute of Health, Barcelona. Joan Paredes, Centre of integrated studies, Valencia. Amparo Sánchez ‘Médicos del Mundo’ coordinator Valencian Community. In traffic injuries: Joan Benach, Pompeu Fabra University, Barcelona. Juan Carlos Gonzalez-Luque General Directorate of Traffic, Madrid. Marı́a

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