Wanless 1 and 2

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Wanless 1 and 2

• John Powles
• Spring Training Workshop
• Eastern Deanery Public Health Training Programme

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Wanless Report(s), UK 2002-

• March 2001 Chancellor asks Derek Wanless to
  report by April 2002 on
• technological, demographic and medical trends
  over the next two decades that may affect the
  health service
• In the light of 1. needs for resources

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http//www.hm-treasury.gov.uk/Consultations_and_Le
gislation/wanless/consult_wanless_final.cfm?
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time
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Main influences on resource requirements

• Commitments already made
• Changing expectations
• Advances in medical technologies
• Changing health needs
• Prices
• Productivity improvement

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3 scenarios

• Solid progress
• Slow uptake
• Fully engaged

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Lubitz et al, NEJM, 2003
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Projected spending on health services (including
private)
Chancellor One of these please
Wanless part 2 Securing good health for the
whole population
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Public engagement with health and the level of
medical expenditure

• But suppose public engagement with health
  matters, leads (of itself) to greater use of
  medical services.

Public engagement
Levels of health
Medical expenditure
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Broadens definition of public health

• The science and art of preventing disease,
  prolonging life and promoting health through the
  organised efforts and informed choices of
  society, organisations, public and private,
  communities and individuals

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Provides some useful road maps

• Ch 2 lesssons
• Actually a chronological narrative
• Ch 3 delivery
• Useful summaries of organisations involved,
  workforce etc
• Ch 4 case studies
• Smoking, inequalities, salt, obesity, inactivity,
  falls

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Ch 5 PH evidence

• Weakness of evidence base, under-investment
  (and lack of capacity in) ph research
• the paucity of health economists and
  mathematical modellers within the public health
  sciences has been of specific concern. (5.48)

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Ch 6 Investing in ph

• Issues in economic evaluation
• Inc discounting
• Case study of diabetes

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Ch 7 Roles and responsibilities

• Authodox economic liberalism
• (maximising utility based on individual choice)
  
• stretched by addition of social context
  failures
• Becker is cited but Sen is not

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Ch 8 Government levers

• Information
• Taxes / subsidies
• Regulation / voluntary agreement
• Regionalism?
• Democratic process?

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Ch 9 Recommendations

• Public health policy making
• Needs consistent framework
• Review of Arms length bodies
• Research and evaluation
• Need for a strong overall public health research
  strategy
• Full engagement
• Weak on democratic deliberation and iteration
• Structure and roles
• Strategic coordination

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Overall

• Part of the gathering momentum around public
  health
• Emphasises weakness of knowledge base
• Despite review of other countries experience
  actually draws little from outside UK
• Though notes that Netherlands and Australia more
  advanced in economic evaluation

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Limitations

• Little discussion about how to deal better with
  uncertainty (ie need to quantify it)
• Little real clarification of issues around
  attributing risks and costs
• Eg of the need to be clear about counterfactuals
• No reference to concept of avoidable risk
• Only partly grasps importance of time in public
  health analysis

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Some other perspectives
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Using data from Peto et al, http//www.ctsu.ox.ac.
uk/tobacco/
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WHO Five basic principles to inform the
generation and dissemination of evidence (in
public health)

• Validity
• Quantified reliability
• Comparability
• Consultation
• Explicit data audit trail
• Murray CJL, Mathers C, Salomon JA. Towards
  evidence-based public health. In Murray CJL,
  Evans DB, eds, editors. Health systems
  performance assessment debates, methods and
  empiricism. Geneva World Health Organization
  2003 p. 715-26.
• http//whqlibdoc.who.int/publications/2003/924
  1562455_(part4)_(chp50-60).pdf

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http//www.health.gov.au/pubhlth/publicat/document
/metadata/roi_eea.htm
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