The application of risk assessment methods in making veterinary public health and animal health decisions.

The newly emerging discipline of quantitative risk assessment has wide application in the field of veterinary public health and animal health. Regulatory authorities are increasingly faced with public policy decisions that must assess the risks of new technology or practices relative to the potential benefits, thereby establishing a level of acceptable risk. The elements of risk are a choice of action, a probability of loss and a magnitude of loss. Perceived risk and actual risk are seldom equivalent; adoption of the methodologies used in technological and human health risk assessments will allow veterinary regulators to make better decisions. Determination of levels of acceptable risk are increasingly dependent on quantitative models, and examples are presented for evaluation of different post-mortem meat inspection systems, estimating disease risks associated with animal embryo transfer and formulating national border protection strategies. All models have some degree of subjectivity, and the decisions made by regulators and risk managers should incorporate a wide knowledge of the risk assessment process, as well as the conditions of use that will occur in the real world.     

National exposure measurements for decisions to protect public health from environmental exposures

Protecting public health from environmental exposures requires four steps: detection of exposures known or expected to cause disease, assessment of health risk from exposure, implementation of an exposure intervention, and assurance that the exposure intervention is effective. To prioritize efforts in these four areas one must consider the size of the population affected, the seriousness of health effects, and the availability of cost-effective exposure interventions. Population exposure data is critical to each of these steps for protecting health. Biomonitoring data for the US population is now available to assist public health scientists and physicians in preventing disease from environmental exposures, and it complements that available for levels of chemicals in environmental media. The Second National Report on Human Exposure to Environmental Chemicals provides for the US population serum, blood and urine levels for 116 environmental chemicals over the years 1999 and 2000, with separate analyses by age, sex, and race/ethnicity. This national exposure information identifies which chemicals get into Americans in measurable quantities; determines whether exposure levels are higher among population subgroups; determines how many Americans have levels of chemicals above recognized health threshold levels (for chemicals with such threshold levels); establishes reference ranges that define general population exposure so unusual exposures can be recognized; assesses the effectiveness of public health efforts to reduce population exposure to selected chemicals; and tracks over time trends in US population exposure. Blood lead measurements in the population were important in identifying lead in gasoline as a significant source of human lead exposure and documenting the reduction in blood lead levels in the population as a result of removing lead from gasoline and other products in the United States. Serum cotinine levels in the early 1990s found more widespread exposure to environmental tobacco smoke (ETS) in the United States than previously thought and additional measurements in 1999 and 2000 documented major declines in exposure to ETS as a result of public health actions in the 1990s. A new biomonitoring assessment of the exposure of the US population will be released every 2 years as the "National Report on Human Exposure to Environmental Chemicals." These reports will include the current 116 chemicals and new chemicals added to monitor priority exposures of the population.     

Contribution of simulation models to public health decisions: the influenza pandemic

The influenza pandemic threat had led to an increased awareness and several countries have used models to assess the impact of control measures on the influenza pandemic. We reviewed the publications related to simulation models since 2003 and discuss their contribution to public health decision in France. The studies conclude that rapid control measures with a high coverage can stop a nascent pandemic. This can be applied to a community with a limited importation of cases but the quantity of antiviral drug needed would become rapidly prohibitive in case of further multiple foci. Both prophylactic and curative use of antiviral drugs can reduce the number of hospitalizations and the incidence during a pandemic. Finally, if a single strategy is sufficient to limit an outbreak in case of a moderate reproductive number, a combination of control measures is mandatory in case of highly transmissible strains. The results of these studies were taken in account to implement guidelines concerning antiviral drug use, in France.     

A framework for involving the public in health care coverage and resource allocation decisions

Coverage and resource allocation decisions are a very important area for public engagement because of their direct impact on the public's access to care and because the affected services are publicly funded. We present a framework that guides decision-makers through key questions they must address when deciding on, structuring, evaluating and disseminating the results of public engagement exercises, particularly as they relate to coverage and resource allocation decisions. The framework will enable decision-makers to better conduct viable and meaningful citizen engagement around these issues.     

Applying the balanced scorecard to local public health performance measurement: deliberations and decisions

Background  

All aspects of the heath care sector are being asked to account for their performance. This poses unique challenges for local public health units with their traditional focus on population health and their emphasis on disease prevention, health promotion and protection. Reliance on measures of health status provides an imprecise and partial picture of the performance of a health unit. In 2004 the provincial Institute for Clinical Evaluative Sciences based in Ontario, Canada introduced a public-health specific balanced scorecard framework. We present the conceptual deliberations and decisions undertaken by a health unit while adopting the framework.     

The need for better public health decisions on chemicals released into our environment

Protecting the health of the public-particularly the most vulnerable groups, such as children-requires rethinking current approaches to reducing environmental risks. We review the evolving understanding of the relationship between exposure to chemicals in the environment and disease, as well as the current state of managing those chemicals. We present recommendations to improve current approaches, including changing the burden of proof so that chemicals are not presumed safe in the absence of scientific data. We also propose modernizing approaches to assessing health risks.     

Risk assessment to underpin food regulatory decisions: an example of public health nutritional epidemiology

The approach used by food regulation agencies to examine the literature and forecast the impact of possible food regulations has many similar features to the approach used in nutritional epidemiological research. We outline the Risk Analysis Framework described by FAO/WHO, in which there is formal progression from identification of the nutrient or food chemical of interest, through to describing its effect on health and then assessing whether there is a risk to the population based on dietary exposure estimates. We then discuss some important considerations for the dietary modeling component of the Framework, including several methodological issues that also exist in research nutritional epidemiology. Finally, we give several case studies that illustrate how the different methodological components are used together to inform decisions about how to manage the regulatory problem.     

Teaching evidence-based public health to public health practitioners

PURPOSE: The purpose of the Evidence Based Public Health (EBPH) course is to train public health practitioners to utilize a comprehensive approach for program development and evaluation from a scientific perspective, including principles of scientific reasoning and systematic uses of data and information systems. The increasing technical sophistication of public health problems and approaches emphasizes the importance for an evidence-based approach to developing policy and interventions. METHODS: The training methods used highlight the linkages between data systems and program/policy initiatives. Participants learn to access and interpret existing data systems and methods of using data to impact specific policies or decision-makers. From 1992 through mid-2004 the EBPH course was offered a total of 20 times, in Missouri, nationally and internationally. In March 2002, the workshop was taped and pressed into a 16-CD set that public health workers can use as a self-teaching program in their own homes and offices. The group exercises from the classroom workshop have been adapted into individual self-guided applications, and background readings are included in the set. RESULTS: Compiled results of course evaluations indicate average ratings for course satisfaction ranging from 8.50 to 10.00 on a scale from 1 to 10. Satisfaction with course instructors ranged between 8.00 and 10.00 on the same scale. Ninety-four to ninety-six per cent of participants reported that they would use the course in their day-to-day work. Qualitative comments from participants at the time of and after the course show that the material is applied in a variety of ways. CONCLUSIONS: The EBPH course is making a valuable contribution in strengthening the application of scientific methods to public health practice. To expand the offerings of this training, a train-the-trainer component for the EBPH course is being developed, to be made available in 2005.     

公共卫生和公共卫生突发事件

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