Reducing health inequalities in priority public health conditions: using rapid review to develop proposals for evidence-based policy
Reducing health inequalities in priority public health conditions: using rapid review to develop proposals for evidence-based policy
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DOI：
10.1093/pubmed/fdq028
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发表时间：
2010-12-01
影响因子：
4.4
通讯作者：
Maryon-Davis, Alan
中科院分区：
文献类型：
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作者：
Bambra, Clare;Joyce, Kerry E.;Maryon-Davis, Alan
2008年11月，英国卫生大臣委托进行了一项独立审查，以提出减少健康不平等的有效战略。审查工作组只有3个月的时间提出初步的循证建议。在本文中，我们描述了所使用的方法，并提出了建议，由小组负责不平等的优先公共卫生conditions.Methods一系列快速文献回顾的政策相关的国际证据基础进行。审查了旨在解决选定的公共卫生优先条件的社会决定因素的干预措施对健康不平等、社会梯度或总体人口健康影响的任何设计的定量研究。采用德尔菲法对建议进行了提炼。结果提出了五项关键的政策建议：减少最贫困群体的吸烟;改善低收入群体获得健康食品的机会;改善疾病的早期发现和治疗;结论快速回顾法与德尔菲蒸馏法相结合，在分配的时间框架内编制了一份循证建议短名单。缺乏强有力的证据来证明我们所研究的干预措施的有效性和成本效益：我们的建议必须基于对一般人群健康影响的外推。迫切需要广泛、具体和有力的证据来指导政策和方案。与此同时，我们的方法为循证决策提供了合理和务实的基础。
Background In November 2008, the Secretary of State for Health (England) commissioned an independent review to propose effective strategies for reducing health inequalities. Review task groups were given just 3 months to make preliminary evidence-based recommendations. In this paper, we describe the methodology used, and the recommendations made, by the group tasked with inequalities in priority public health conditions.Methods A series of rapid literature reviews of the policy-relevant international evidence base was undertaken. Quantitative studies of any design, which looked at the effects on health inequalities, the social gradient or overall population health effects, of interventions designed to address the social determinants of selected public health priority conditions were examined. Recommendations were distilled using a Delphi approach.Results Five key policy proposals were made: reduce smoking in the most deprived groups; improve availability of and access to healthier food choices amongst low income groups; improve the early detection and treatment of diseases; introduce a minimum price per unit for alcohol and improve the links between physical and mental health care.Conclusion The combination of rapid review and Delphi distillation produced a shortlist of evidence-based recommendations within the allocated time frame. There was a dearth of robust evidence on the effectiveness and cost-effectiveness of the interventions we examined: our proposals had to be based on extrapolation from general population health effects. Extensive, specific and robust evidence is urgently needed to guide policy and programmes. In the meantime, our methodology provides a reasonably sound and pragmatic basis for evidence-based policy-making.