The Canadian Medical Association (CMA)has now released the report "Economic
Evaluation Across the Four Faces of Prevention: A Canadian Perspective"(May
2004) Laurie J. Goldsmith, Brian Hutchison, and Jeremiah Hurley of CHEPA,
commissioned by, and published by the CMA.  Their press release notes that
the authors examined "the effectiveness and efficiency of public health
programs. They found that although many gaps remain, there is a large body
of economic evaluation evidence that can inform decision-making by
identifying public health programs that are worthwhile investments in
prevention, some of which are cost-saving."

In their executive summary the authors comment:
"... most health care interventions have never been subject to an economic
evaluation and the interventions that have been assessed tend to be those
that are most easily studied (rather than those for which the need for such
evidence is most pressing). Many more economic evaluations exist for
clinical prevention interventions, for example, with more easily defined
populations, interventions, and settings, and more easily measured outcomes,
than for interventions drawn from the areas of health promotion, health
protection or healthy public policies."

Their literature review identified 672 economic evaluations of 154
preventive interventions. "The majority (55 percent) evaluated clinical
prevention interventions. The next largest group of evaluations assessed
health protection interventions (31 percent), a significant proportion of
which were universal or mandatory screening or immunization programs. Health
promotion interventions represented 12 percent of the evaluations and
healthy public policy interventions represented 2 percent."

Noting that "economic evaluation evidence is completely lacking for a
majority of recommended preventive interventions", the authors recommend
that:
"Requiring economic evidence as a mandatory input to decision making would,
in the short term, delay the implementation of preventive programs with
demonstrated large population health effects that had not yet been subjected
to economic evaluation. Perhaps more importantly, in the long term such a
requirement would discriminate against health promotion, health protection
and healthy public policy interventions whose costs and consequences are
often difficult to measure credibly because they are spread across multiple
health and social domains." (pp.vi-vii)

OF particular interest (and possibly concern) is the working definition that
the study uses for 'health promotion interventions'. They see prevention as
being made up of 4 approaches: clinical prevention, health promotion, health
protection, and healthy public policy, with health promotion described as:

"Health promotion interventions encourage individual behaviours believed to
produce positive
health effects and discourage behaviours that produce negative health
effects. Health promotion
interventions frequently take the form of public information campaigns.
While the decision to
undertake the health action is ultimately up to the individual, delivery of
health promotion
programs is targeted at a group or population. A media-based, anti-smoking
campaign is an
example of a health promotion intervention; taxing tobacco products to
reduce use is another." (p.3)


The report from the CMA is available in PDF format (133 pages, 3.5MB) using
the following link:
http://www.cma.ca/multimedia/staticcontent/CMA/Content_Images/Inside_cma/OPH
/economic-evaluation_e.pdf
This is a very large file to download. You can also order a hard copy from
the Office for Public Health, Canadian Medical Association, telephone
1-800-663-7336 x22996

OR
get a smaller PDF version (only 682k and 130 pages) from the Canadian Public
Health Association (CPHA) at http://www.cpha.ca/coalition/economic



[thanks to Dennis Raphael for pointing out this new release, and the working
definition of health promotion used in the study for the CMA]


Alison Stirling
co-facilitator, CLICK4HP health promotion listserv
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