Faculty of Health and Wellbeing, Centre for Social and Health Care Research, Sheffield Hallam University, Sheffield, UK,
J Urban Health. 2013 Oct;90 Suppl 1(Suppl 1):62-73. doi: 10.1007/s11524-012-9763-x.
This article summarizes a process which exemplifies the potential impact of municipal investment on the burden of cardiovascular disease (CVD) in city populations. We report on Developing an evidence-based approach to city public health planning and investment in Europe (DECiPHEr), a project part funded by the European Union. It had twin objectives: first, to develop and validate a vocational educational training package for policy makers and political decision takers; second, to use this opportunity to iterate a robust and user-friendly investment tool for maximizing the public health impact of 'mainstream' municipal policies, programs and investments. There were seven stages in the development process shared by an academic team from Sheffield Hallam University and partners from four cities drawn from the WHO European Healthy Cities Network. There were five iterations of the model resulting from this process. The initial focus was CVD as the biggest cause of death and disability in Europe. Our original prototype 'cost offset' model was confined to proximal determinants of CVD, utilizing modified 'Framingham' equations to estimate the impact of population level cardiovascular risk factor reduction on future demand for acute hospital admissions. The DECiPHEr iterations first extended the scope of the model to distal determinants and then focused progressively on practical interventions. Six key domains of local influence on population health were introduced into the model by the development process: education, housing, environment, public health, economy and security. Deploying a realist synthesis methodology, the model then connected distal with proximal determinants of CVD. Existing scientific evidence and cities' experiential knowledge were 'plugged-in' or 'triangulated' to elaborate the causal pathways from domain interventions to public health impacts. A key product is an enhanced version of the cost offset model, named Sheffield Health Effectiveness Framework Tool, incorporating both proximal and distal determinants in estimating the cost benefits of domain interventions. A key message is that the insights of the policy community are essential in developing and then utilising such a predictive tool.
本文总结了一个过程，该过程说明了市政投资对城市人口心血管疾病（CVD）负担的潜在影响。我们报告了在欧洲制定基于证据的城市公共卫生规划和投资方法（DECiPHEr），这是一个由欧盟部分资助的项目。它有两个目标：第一，为政策制定者和政治决策者开发和验证职业教育培训包；第二，利用这个机会迭代一个强大且用户友好的投资工具，以最大限度地提高“主流”市政政策、计划和投资对公共卫生的影响。谢菲尔德哈勒姆大学的一个学术团队和来自世界卫生组织欧洲健康城市网络的四个城市的合作伙伴共同经历了七个发展阶段。该过程产生了五个模型迭代。最初的重点是 CVD，因为它是欧洲最大的死亡和残疾原因。我们最初的“成本抵消”原型模型仅限于 CVD 的近端决定因素，利用改良的“Framingham”方程来估计人群心血管风险因素降低对未来急性住院需求的影响。DECiPHEr 的迭代首先将模型的范围扩展到远端决定因素，然后逐步关注实际干预措施。在模型中引入了六个影响人群健康的地方关键领域：教育、住房、环境、公共卫生、经济和安全。通过发展过程，采用现实主义综合方法，模型将 CVD 的远端和近端决定因素联系起来。现有的科学证据和城市的经验知识被“插入”或“三角测量”，以详细说明从域干预到公共卫生影响的因果途径。一个关键产品是改良的成本抵消模型，称为谢菲尔德健康效果框架工具，它将近端和远端决定因素纳入到估计域干预成本效益的模型中。一个关键信息是，政策界的观点对于开发和利用这种预测工具至关重要。
