Why it is difficult to evaluate the effectiveness and cost effectiveness of complex public health interventions in the community?
A branch of economics which is concerned with the problems related to effectiveness, value, behavior and efficiency in the consumption and production of health care. Talking in broader terms, the health economists are the ones that study the operation of the health care systems also the botched habits that are harmful for the health like smoking. (Waters et. al., 2006)
Economics is the science of insufficiency. The use of health economics emulates a universal wish to get the maximum possible worth of money only by ensuring the clinical influence, along with the cost-effectiveness of the provision of the healthcare. (Better Evaluation, 2004)
Dominated by a simple and direct theoretical and economical concept; cost-effectiveness, health economics becomes a major economic theory. What we mean here by ‘value of money’ is either a wish to obtain a predetermined goal at the least possible cost or a desire to enhance the benefit to the community of patients and also maximize it from a limited or scarce amount of resources. For this, it is required that the services are tested for the ‘cost-effectiveness’.
Along with effectiveness, there is another related field which is efficiency. Efficiency measures how good the scarce resources are used for the purpose of achieving a desired outcome (Mara et. al., 2010). Health economics can help us in informing and improving the decision-making through the objective and systematic application of something called the ‘applied common sense’. Such an ACS, which balances the benefits and the costs symmetrically, represents a mode of thought for the decision-makers, which is more valuable and pragmatic, irrespective of how formal or informal economic evaluation be undertaken.
Measuring and defining the health outcomes is equipped with a lot of difficulties, but these measures are very essential base of the health-economic evaluations/. While addressing these outcomes, what the economists talk is in terms of the utility, something that measures the strength of the individual’s preferences for particular objective outcomes. Outcomes are then assessed all in terms of the increased and enhanced survival which means adding years to the life and the better quality of life which is adding life to the years. (WHO, 2015)
It is very important to make a distinction between the economic and the financial concepts of cost. What the financial concepts relate to is mostly the monetary payments or the payments in made in cash, cheque, other means, etc. (Better Evaluation, 2004). these are generally associated with the price of the service or the good which is traded in the place of the market. On the other hand, the economic costs are something that have a much wider scope of the resource consumption, which is irrespective of the fact that whether these resources are traded in the a network of buyers and sellers or not. The economic concept is based on awareness that as and when the resources are consumed in certain order or way, all those same resources then become scanty or unavailable for the use in developing other services. In such a case, the benefits that would have arisen hence have to be foregone (Business Dictionary, n.d.).
The public health funders, decision makers, the public and the practitioners, are very much interested in the proofs that determines the public health and the decision making. The decisions in the public health cover a very wide range of different kind of activities. There is an ever increasing trend of the global volume of the primary knowledge, changes and the research of all the available research which is very much relevant to specific practices or the policy decisions which are an effective method to utilize or synthesize the research efforts. (Better Evaluation, 2004). The collaboration called the Cochrane collaboration includes a very well organized entity which has an objective to enhance the quantity or the quality of the public health analytical reviews through all the range of required activities. Cochrane reviews have very largely and widely paid botched attention to the problems related to the intervention inequalities and equities (Smith, 2010). The members of the collaboration involved in the child health, public health and the review groups with the particular skill in the research of the inequalities have had very different effects on the interventions in which there are particular methodological growths that are warranted. This would also include the growth and the development of abetment to synthesize and extract the primary data which helps reducing the population inequalities by describing the ability of the interventions. (Heyne, 2009).
The structural interventions pose a lot of difficult challenges in public health for the evaluation. They work through several indirect ways which are often cross-sectoral and very complex. They require programs further requiring the extended duration horizons so that the health effects can be well observed (Ross, Simkhada & Smith, n.d.). These also require the delivery at the zone of institutions, populations and the communities that carry large implications or effects for the purpose of sampling. Also, the issues that relate to fields like logistics, political feasibility and ethics may reduce the range or the limit of opportunities for the random assignment that inculcate the use of differentiated experimental designs. (Philips, 2009)
Nevertheless, the evaluation is really important for both the strengthening of the link or the relation between the sound policy and the valuable science, along with making sure of the public confidence as to how limitedly the resources are all deployed (Pronyk, Schaefer, Somers & Heise, 2012).
It is important to define the structural interventions in the public health sphere as these interventions which attempt to engage in the complexities of the social, political and the economic determinants of public health s a way of influencing many more outcomes. These kind of interventions work at the level of the populations or the groups and they generally attempt to figure out the risk of the disease of an individual through various indirect procedures or mechanisms. The diseases in the population is more of a kind of reflection of a certain level of risk in that community or society, instead of simply an object of cumulative, individual and independent choices. Such structural interventions try to influence such a level of risk by prepossessing the up-stream conditions and dynamics, with a very clear objective of figuring out or shaping up the norms, values, health outcomes and the behaviors of a large population at one single time. (Waters et. al., 2006)
He demand for the accountability and the decision making which is evident in the public health sphere is ever increasing and vital. The fact that the structural interventions in the past have been very poorly reckoned only in retrospect or not evaluated at all is very unfortunate. The paltriness of the evaluation literature, specifically and especially for very complex like interventions, means that the policy makers can be persuaded in the vacuum to make important decisions, not passing to make benefits from the learnt lessons of the successful interventions and also risking the repeated mistakes of the foregone. (Smith, 2010)
Hence it is clear that there is an extremely important need to improve concepts like the evidence base which is required for the structural interventions in the public health zone.
The program managers and the policy makers or the decision makers in the public health sphere are habitual of weighing, applying, and synthesizing new kinds of evidences in relatively consistent methods. These ways are then very heavily influenced by the interpretations of the technical, downstream and very discrete interventions. Although, for several reasons, the weighing evidence, the ones from the structural interventions can be very different. This is due to such high standard evaluations very often are not correct or even unavailable. (Haycoz, 2009).
The public health has a very distinguished and extended record in preventing the fatal diseases and also shielding the health of the individuals. Certain practices are very fundamental for the improvements in the health of the globe (Ross, Simkhada & Smith, n.d.). These include improvements in clean drinking water and other sanitation facilities, measures to immune the containment, also eradication of the fatal diseases, the growth and development in the well understanding of the etiology of infectious diseases. The record has continued till today, for example, the mouth and the foot disease, influenza and the sudden respiratory syndromes. Although, the contemporary health agendas continue the recent deviations from the focus on the fatal infectious diseases, and also into environmental, socio economic and the behavioral factors that influence the health conditions of the individuals. As an example we may say that the evaluation and the analysis of the health related influences and the interventions related to the urban environments and transport (Johns, n.d.). They call upon much differentiated forms of various interventions, although they are inevitably very vital determinants of the individuals’ health. The critical factor in enhancing of the public health in this vogue, far away from the fatal diseases and into further determinants of health conditions, has been the major kind of interpretation of the term called ‘public’. And, in the public health sphere, this is very often termed as ‘population’.
Haycox A. (2009). What is health economics? [Online] p. 1-8.
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Pronyk P., Schaefer J., Somers M.A. & Heise L. (2012) Evaluating structural interventions in public health: Challenges, options and global best-practice. [Online] Available from: https://www.millenniumvillages.org/uploads/ReportPaper/Pronyk-et-al-Evaluating-structural-interventions-in-public-health-2012.pdf. [Accessed: 12th June, 2015].
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