Pisani Elizabeth, Kok Maarten
a The Policy Institute , King's College London.
b Institute for Health Policy and Management , Erasmus University Rotterdam.
Glob Health Action. 2017 Jan-Dec;10(sup1):1266180. doi: 10.3402/gha.v9.32298.
A plethora of new development goals and funding institutions have greatly increased the demand for internationally comparable health estimates in recent years, and have brought important new players into the field of health estimate production. These changes have rekindled debates about the validity and legitimacy of global health estimates. This paper draws on country case studies and personal experience to support our opinion that the production and use of estimates are deeply embedded in specific social, economic, political and ideational contexts, which differ at different levels of the global health architecture. Broadly, most global health estimates tend to be made far from the local contexts in which the data upon which they are based are collected, and where the results of estimation processes must ultimately be used if they are to make a difference to the health of individuals. Internationally standardised indicators are necessary, but they are no substitute for data that meet local needs, and that fit with local ideas of what is credible and useful. In other words, data that are both technically and socially robust for those who make key decisions about health. We suggest that greater engagement of local actors (and local data) in the formulation, communication and interpretation of health estimates would increase the likelihood that these data will be used by those most able to translate them into health gains for the longer term. Besides strengthening national information systems, this requires ongoing interaction, building trust and establishing a communicative infrastructure. Local capacities to use knowledge to improve health must be supported.
近年来，大量新的发展目标和资助机构极大地增加了对具有国际可比性的健康评估的需求，并将重要的新参与者带入了健康评估生产领域。这些变化重新引发了关于全球健康评估的有效性和合法性的辩论。本文借助国别案例研究和个人经验来支持我们的观点，即评估的产生和使用深深植根于特定的社会、经济、政治和观念背景之中，而这些背景在全球健康架构的不同层面存在差异。总体而言，大多数全球健康评估往往是在远离其数据收集地的背景下进行的，而这些评估结果若要对个人健康产生影响，最终也必须在数据收集地使用。国际标准化指标固然必要，但它们无法替代满足当地需求、符合当地关于可信和有用数据观念的数据。换言之，对于那些做出关键健康决策的人而言，在技术和社会层面都可靠的数据。我们认为，让地方行为体（以及地方数据）更多地参与健康评估的制定、传播和解读，将增加这些数据被最有能力将其转化为长期健康收益的人使用的可能性。除了加强国家信息系统外，这还需要持续互动、建立信任并构建一个交流基础设施。必须支持地方利用知识改善健康的能力。
