Pub Date : 2021-11-01DOI: 10.1093/med/9780198816805.003.0034
P. Craig
Natural experiments, defined as events or processes outwith the control of a researcher, which divide a population into exposed and unexposed groups, have long been used in epidemiology and public health. Evaluation methods that rely on observational rather than experimental data are classified as second best in conventional hierarchies of evidence. Natural experimental approaches have attracted renewed interest from public health researchers and decision-makers because they widen the range of interventions that can usefully be evaluated beyond those that are politically, ethically, or practically amenable to testing in randomized controlled trials. This chapter argues for seeing trials and natural experiments as part of a common toolkit for producers and users of evidence about the effectiveness of policies and programmes. It describes the most commonly used natural experimental approaches to evaluating population health interventions, and provides examples of their use in a wide range of countries and policy settings.
{"title":"Natural and quasi-experiments","authors":"P. Craig","doi":"10.1093/med/9780198816805.003.0034","DOIUrl":"https://doi.org/10.1093/med/9780198816805.003.0034","url":null,"abstract":"Natural experiments, defined as events or processes outwith the control of a researcher, which divide a population into exposed and unexposed groups, have long been used in epidemiology and public health. Evaluation methods that rely on observational rather than experimental data are classified as second best in conventional hierarchies of evidence. Natural experimental approaches have attracted renewed interest from public health researchers and decision-makers because they widen the range of interventions that can usefully be evaluated beyond those that are politically, ethically, or practically amenable to testing in randomized controlled trials. This chapter argues for seeing trials and natural experiments as part of a common toolkit for producers and users of evidence about the effectiveness of policies and programmes. It describes the most commonly used natural experimental approaches to evaluating population health interventions, and provides examples of their use in a wide range of countries and policy settings.","PeriodicalId":206715,"journal":{"name":"Oxford Textbook of Global Public Health","volume":"95 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131350186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01DOI: 10.1093/med/9780198816805.003.0056
David Koh, R. Lin
Risk-based decision-making increasingly has global dimensions, extending from the international management of chemical risks to the sustainable development of our planet. Environmental risk analysis is firmly based on toxicological sciences with input from other public health disciplines. Increasing understanding of how the human genotype and phenotype affects absorption, distribution, metabolism, and excretion of xenobiotics (compounds foreign to a living organism), is providing insight into answers to the oldest human question about disease: ‘Why me?’ The risk paradigm components of hazard assessment, dose–analysis, exposure assessment, risk characterization, risk management, and risk communication, and the toxicological concepts on which they are based, have proven durable in approaching increasingly complex environmental hazards. Newer approaches to managing risk, such as the precautionary principle, and newer challenges, such as nanotechnology and genetically modified organisms, necessitate further systematic thinking on how best to protect human health and the environment.
{"title":"Toxicology and environmental risk analysis","authors":"David Koh, R. Lin","doi":"10.1093/med/9780198816805.003.0056","DOIUrl":"https://doi.org/10.1093/med/9780198816805.003.0056","url":null,"abstract":"Risk-based decision-making increasingly has global dimensions, extending from the international management of chemical risks to the sustainable development of our planet. Environmental risk analysis is firmly based on toxicological sciences with input from other public health disciplines. Increasing understanding of how the human genotype and phenotype affects absorption, distribution, metabolism, and excretion of xenobiotics (compounds foreign to a living organism), is providing insight into answers to the oldest human question about disease: ‘Why me?’ The risk paradigm components of hazard assessment, dose–analysis, exposure assessment, risk characterization, risk management, and risk communication, and the toxicological concepts on which they are based, have proven durable in approaching increasingly complex environmental hazards. Newer approaches to managing risk, such as the precautionary principle, and newer challenges, such as nanotechnology and genetically modified organisms, necessitate further systematic thinking on how best to protect human health and the environment.","PeriodicalId":206715,"journal":{"name":"Oxford Textbook of Global Public Health","volume":"155 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134401556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01DOI: 10.1093/med/9780199661756.003.0107
N. Weiss, R. Detels, R. Beaglehole, M. Lansing, M. Gulliford
Case–control studies compare ill or injured individuals (cases) with those at risk of the illness or injury (controls) with regard to prior exposures or characteristics, and so appear to proceed backwards, from consequence to potential cause. They have the potential to identify associations that are not causal, either because of chance, or because of the influence of some other factor associated with both the exposure and outcome. However, if a case–control study is able to enrol cases and controls from the same underlying population at risk of the outcome, and can measure exposure status of these persons in a valid manner, the results obtained will closely resemble those of a properly performed cohort study.
{"title":"Case–control studies","authors":"N. Weiss, R. Detels, R. Beaglehole, M. Lansing, M. Gulliford","doi":"10.1093/med/9780199661756.003.0107","DOIUrl":"https://doi.org/10.1093/med/9780199661756.003.0107","url":null,"abstract":"Case–control studies compare ill or injured individuals (cases) with those at risk of the illness or injury (controls) with regard to prior exposures or characteristics, and so appear to proceed backwards, from consequence to potential cause. They have the potential to identify associations that are not causal, either because of chance, or because of the influence of some other factor associated with both the exposure and outcome. However, if a case–control study is able to enrol cases and controls from the same underlying population at risk of the outcome, and can measure exposure status of these persons in a valid manner, the results obtained will closely resemble those of a properly performed cohort study.","PeriodicalId":206715,"journal":{"name":"Oxford Textbook of Global Public Health","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133743238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01DOI: 10.1093/med/9780198816805.003.0002
S. Szreter
It has been conventional to locate the origins of public health in early efforts to combat epidemics and to regulate the sanitary environment accompanying urban life and to trace its history in the gradual evolution of such measures in relation to politics, administrative practices, public laws, and medical science’s changing aetiology. Such an historical account provides important insights and understanding but it is also de-limited in one significant sense. Public health is cast in a responsive role in relation to the processes of economic development. However, the nature of the relationship between public health and global economic development can appear very differently when it is viewed over the long-term, encompassing the whole process of modern economic transformation from the singular matrix of its origins in the early modern society and economy of England, c.1600–1800. This chapter will show that state policies to promote the social order, security, and health of the population in fact pre-date and crucially underpinned the process through which the modern world’s economic transformation originated—in early modern England.
{"title":"The history and development of public health in developed countries","authors":"S. Szreter","doi":"10.1093/med/9780198816805.003.0002","DOIUrl":"https://doi.org/10.1093/med/9780198816805.003.0002","url":null,"abstract":"It has been conventional to locate the origins of public health in early efforts to combat epidemics and to regulate the sanitary environment accompanying urban life and to trace its history in the gradual evolution of such measures in relation to politics, administrative practices, public laws, and medical science’s changing aetiology. Such an historical account provides important insights and understanding but it is also de-limited in one significant sense. Public health is cast in a responsive role in relation to the processes of economic development. However, the nature of the relationship between public health and global economic development can appear very differently when it is viewed over the long-term, encompassing the whole process of modern economic transformation from the singular matrix of its origins in the early modern society and economy of England, c.1600–1800. This chapter will show that state policies to promote the social order, security, and health of the population in fact pre-date and crucially underpinned the process through which the modern world’s economic transformation originated—in early modern England.","PeriodicalId":206715,"journal":{"name":"Oxford Textbook of Global Public Health","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133840291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01DOI: 10.1093/med/9780198816805.003.0009
F. Lenthe, J. Mackenbach
Socioeconomic inequalities in health have been studied extensively in the past decades. In all high-income countries with available data, mortality and morbidity rates are higher among those in less advantaged socioeconomic positions, and as a result differences in health expectancy between socioeconomic groups typically amount to 10 years or more. Good progress has been made in unravelling the determinants of health inequalities, and a number of specific determinants (particularly material, psychosocial, and lifestyle factors) have been identified which contribute to explaining health inequalities in many high-income countries. Although further research is necessary, our understanding of what causes health inequalities has progressed to a stage where rational approaches to reduce health inequalities are becoming feasible. Evidence of a reduction of health inequalities via interventions and policies based on the underlying causes remains scarce, and point to a need to increase efforts.
{"title":"Socioeconomic inequalities in health in high-income countries","authors":"F. Lenthe, J. Mackenbach","doi":"10.1093/med/9780198816805.003.0009","DOIUrl":"https://doi.org/10.1093/med/9780198816805.003.0009","url":null,"abstract":"Socioeconomic inequalities in health have been studied extensively in the past decades. In all high-income countries with available data, mortality and morbidity rates are higher among those in less advantaged socioeconomic positions, and as a result differences in health expectancy between socioeconomic groups typically amount to 10 years or more. Good progress has been made in unravelling the determinants of health inequalities, and a number of specific determinants (particularly material, psychosocial, and lifestyle factors) have been identified which contribute to explaining health inequalities in many high-income countries. Although further research is necessary, our understanding of what causes health inequalities has progressed to a stage where rational approaches to reduce health inequalities are becoming feasible. Evidence of a reduction of health inequalities via interventions and policies based on the underlying causes remains scarce, and point to a need to increase efforts.","PeriodicalId":206715,"journal":{"name":"Oxford Textbook of Global Public Health","volume":"94 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124044380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01DOI: 10.1093/med/9780198816805.003.0036
S. Greenland, T. VanderWeele
Some of the major concepts of validity and bias in epidemiological research are outlined in this chapter. The contents are organized in four main sections: Validity in statistical interpretation, validity in prediction problems, validity in causal inference, and special validity problems in case–control and retrospective cohort studies. Familiarity with the basics of epidemiological study design and a number of terms of epidemiological theory, among them risk, competing risks, average risk, population at risk, and rate, is assumed. Despite similarities, there is considerable diversity and conflict among the classification schemes and terminologies employed in various textbooks. This diversity reflects that there is no unique way of classifying validity conditions, biases, and errors. It follows that the classification schemes employed here and elsewhere should not be regarded as anything more than convenient frameworks for organizing discussions of validity and bias in epidemiological inference. Several important study designs, including randomized trials, prevalence (cross-sectional) studies, and ecological studies, are not discussed in this chapter. Such studies require consideration of the validity conditions mentioned earlier and also require special considerations of their own. A number of central problems of epidemiological inference are also not covered, including choice of effect measures, problems of induction, and causal modelling.
{"title":"Validity and bias in epidemiological research","authors":"S. Greenland, T. VanderWeele","doi":"10.1093/med/9780198816805.003.0036","DOIUrl":"https://doi.org/10.1093/med/9780198816805.003.0036","url":null,"abstract":"Some of the major concepts of validity and bias in epidemiological research are outlined in this chapter. The contents are organized in four main sections: Validity in statistical interpretation, validity in prediction problems, validity in causal inference, and special validity problems in case–control and retrospective cohort studies. Familiarity with the basics of epidemiological study design and a number of terms of epidemiological theory, among them risk, competing risks, average risk, population at risk, and rate, is assumed. Despite similarities, there is considerable diversity and conflict among the classification schemes and terminologies employed in various textbooks. This diversity reflects that there is no unique way of classifying validity conditions, biases, and errors. It follows that the classification schemes employed here and elsewhere should not be regarded as anything more than convenient frameworks for organizing discussions of validity and bias in epidemiological inference. Several important study designs, including randomized trials, prevalence (cross-sectional) studies, and ecological studies, are not discussed in this chapter. Such studies require consideration of the validity conditions mentioned earlier and also require special considerations of their own. A number of central problems of epidemiological inference are also not covered, including choice of effect measures, problems of induction, and causal modelling.","PeriodicalId":206715,"journal":{"name":"Oxford Textbook of Global Public Health","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128154010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01DOI: 10.1093/med/9780198816805.003.0008
R. Labonté, F. Baum, D. Sanders
Poverty has long been a concern in public health with people living in poor circumstances generally suffering higher burdens of disease. Understanding the persistence of poverty, and of its impacts on health, unavoidably intersects with analyses of how inequalities arise in the distribution of income and wealth, and of the material and psychosocial resources these socioeconomic privileges accord. This chapter reviews different definitions of poverty, trends in the distribution of absolute and relative poverty, and strengths and weaknesses of the different concepts. It touches briefly on how poverty (by whatever definition) influences health, citing natural/social selection, cultural/behavioural, and materialist/structural explanations; and discusses how, in some instances, there is reverse causality with poor health worsening individual or household poverty, particularly in low-income countries suffering high disease burdens and weak health systems. The chapter then turns to a review of major theories of justice and how these argue for interventions, and the role that international human rights might play in furthering actions to reduce poverty-related health inequalities. It concludes with a short discussion of different sociopolitical approaches to poverty reduction, providing three examples of intervention policies.
{"title":"Poverty, justice, and health","authors":"R. Labonté, F. Baum, D. Sanders","doi":"10.1093/med/9780198816805.003.0008","DOIUrl":"https://doi.org/10.1093/med/9780198816805.003.0008","url":null,"abstract":"Poverty has long been a concern in public health with people living in poor circumstances generally suffering higher burdens of disease. Understanding the persistence of poverty, and of its impacts on health, unavoidably intersects with analyses of how inequalities arise in the distribution of income and wealth, and of the material and psychosocial resources these socioeconomic privileges accord. This chapter reviews different definitions of poverty, trends in the distribution of absolute and relative poverty, and strengths and weaknesses of the different concepts. It touches briefly on how poverty (by whatever definition) influences health, citing natural/social selection, cultural/behavioural, and materialist/structural explanations; and discusses how, in some instances, there is reverse causality with poor health worsening individual or household poverty, particularly in low-income countries suffering high disease burdens and weak health systems. The chapter then turns to a review of major theories of justice and how these argue for interventions, and the role that international human rights might play in furthering actions to reduce poverty-related health inequalities. It concludes with a short discussion of different sociopolitical approaches to poverty reduction, providing three examples of intervention policies.","PeriodicalId":206715,"journal":{"name":"Oxford Textbook of Global Public Health","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129297656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01DOI: 10.1093/med/9780199218707.003.0022
N. Kass
Public health ethics considers moral dimensions of public health practice and research. While medical ethics dates back hundreds of years, and bioethics writings emerged in the 1960s and 1970s, ‘public health ethics’, articulated as such, did not appear significantly in the literature for several more decades. There has been great interest recently in defining public health ethics, examining how it resembles or differs from medical ethics or bioethics, outlining frameworks and codes, and providing conceptual and practical guidance on how ethics can inform public health practice and research. This chapter describes the emergence of public health ethics; work in bioethics with relevance for public health; the relevance of social justice theory in addressing public health problems; and discusses literature on ethics and public health research, including whether public health research ethics might differ from ethical guidance for other human research. The chapter concludes with an overview of ethics issues related to genetic research and emerging technologies.
{"title":"Ethical principles and ethical issues in public health","authors":"N. Kass","doi":"10.1093/med/9780199218707.003.0022","DOIUrl":"https://doi.org/10.1093/med/9780199218707.003.0022","url":null,"abstract":"Public health ethics considers moral dimensions of public health practice and research. While medical ethics dates back hundreds of years, and bioethics writings emerged in the 1960s and 1970s, ‘public health ethics’, articulated as such, did not appear significantly in the literature for several more decades. There has been great interest recently in defining public health ethics, examining how it resembles or differs from medical ethics or bioethics, outlining frameworks and codes, and providing conceptual and practical guidance on how ethics can inform public health practice and research. This chapter describes the emergence of public health ethics; work in bioethics with relevance for public health; the relevance of social justice theory in addressing public health problems; and discusses literature on ethics and public health research, including whether public health research ethics might differ from ethical guidance for other human research. The chapter concludes with an overview of ethics issues related to genetic research and emerging technologies.","PeriodicalId":206715,"journal":{"name":"Oxford Textbook of Global Public Health","volume":"161 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127292223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01DOI: 10.1093/med/9780198816805.003.0043
Elizabeth Rose Mayeda, Alexandra M. Binder, L. Kobayashi
Life course epidemiology approaches disease aetiology and prevention from the perspective of risk and protective factors that influence health and disease throughout the lifespan. The integration of a life course approach to epidemiologic research is central for identifying effective policies and programmes to promote population health and health equity. This chapter will introduce life course concepts and models and analytical approaches for research on life course determinants of health. It will discuss threats to causal inference, approaches for overcoming these difficulties, and future directions in life course epidemiology. For example, in addition to expanding epidemiologic research with a life course perspective to include people with diverse life experiences, new areas of development include life course research extending beyond one human lifespan to include intergenerational and transgenerational life course research, as well as the application of innovative methods.
{"title":"Life course epidemiology and analysis","authors":"Elizabeth Rose Mayeda, Alexandra M. Binder, L. Kobayashi","doi":"10.1093/med/9780198816805.003.0043","DOIUrl":"https://doi.org/10.1093/med/9780198816805.003.0043","url":null,"abstract":"Life course epidemiology approaches disease aetiology and prevention from the perspective of risk and protective factors that influence health and disease throughout the lifespan. The integration of a life course approach to epidemiologic research is central for identifying effective policies and programmes to promote population health and health equity. This chapter will introduce life course concepts and models and analytical approaches for research on life course determinants of health. It will discuss threats to causal inference, approaches for overcoming these difficulties, and future directions in life course epidemiology. For example, in addition to expanding epidemiologic research with a life course perspective to include people with diverse life experiences, new areas of development include life course research extending beyond one human lifespan to include intergenerational and transgenerational life course research, as well as the application of innovative methods.","PeriodicalId":206715,"journal":{"name":"Oxford Textbook of Global Public Health","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115453985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-02-01DOI: 10.1093/MED/9780199661756.003.0129
D. Parkin, S. Morris, N. Devlin
This chapter is an introduction to economic appraisal. It explains underlying concepts, describes methods used, and discusses the application to public health. Economic appraisal comprises techniques that weigh up the costs of an action, such as providing a public health intervention to an at-risk population group, against the benefits that it provides. Important underlying principles are opportunity cost, social versus private costs and benefits, marginal costs and benefits, efficiency, and equity. There are different types of economic appraisal, each of which measures the costs and benefits of options being compared. Measuring costs involves identifying and describing resource use changes, quantifying them in physical units and valuing them. Issues in cost measurement include use of macro or micro-costing and dealing with inflation and time preference. There are several approaches that can be used to measure benefits depending on the type of economic appraisal being used; a measure of special interest is quality-adjusted life years (QALYs). Modelling is often used in economic appraisal to combine data on the costs and benefits of an intervention. Given the inherent uncertainties involved in economic appraisal it is good practice to undertake sensitivity analyses that investigate the impact of uncertainty. Methodological challenges in undertaking economic appraisals of public health interventions include the importance of equity and inequality considerations, establishing robust evidence of the effect of public health programmes, the relevance of QALYs, and accounting for multisectoral costs and benefits.
{"title":"Economic appraisal in public healthcare: assessing efficiency and equity","authors":"D. Parkin, S. Morris, N. Devlin","doi":"10.1093/MED/9780199661756.003.0129","DOIUrl":"https://doi.org/10.1093/MED/9780199661756.003.0129","url":null,"abstract":"This chapter is an introduction to economic appraisal. It explains underlying concepts, describes methods used, and discusses the application to public health. Economic appraisal comprises techniques that weigh up the costs of an action, such as providing a public health intervention to an at-risk population group, against the benefits that it provides. Important underlying principles are opportunity cost, social versus private costs and benefits, marginal costs and benefits, efficiency, and equity. There are different types of economic appraisal, each of which measures the costs and benefits of options being compared. Measuring costs involves identifying and describing resource use changes, quantifying them in physical units and valuing them. Issues in cost measurement include use of macro or micro-costing and dealing with inflation and time preference. There are several approaches that can be used to measure benefits depending on the type of economic appraisal being used; a measure of special interest is quality-adjusted life years (QALYs). Modelling is often used in economic appraisal to combine data on the costs and benefits of an intervention. Given the inherent uncertainties involved in economic appraisal it is good practice to undertake sensitivity analyses that investigate the impact of uncertainty. Methodological challenges in undertaking economic appraisals of public health interventions include the importance of equity and inequality considerations, establishing robust evidence of the effect of public health programmes, the relevance of QALYs, and accounting for multisectoral costs and benefits.","PeriodicalId":206715,"journal":{"name":"Oxford Textbook of Global Public Health","volume":"88 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126761457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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