Sumpter C, Bain M, McCartney G, Blair A, Stockton D, Frank J W
Public Health Consultant, NHS Lothian, UK.
Interim Deputy Chief Medical Officer, Scottish Government, UK.
Public Health Pract (Oxf). 2022 Oct 22;5:100327. doi: 10.1016/j.puhip.2022.100327. eCollection 2023 Jun.
Scotland has the lowest life expectancy in Western Europe and significant health inequalities. A national review of public health in 2015 found that there was a lack of coherent action across organisational boundaries, inhibiting progress. This paper describes a rapid (four-month) systematic approach to prioritisation of Scotland's public health challenges, which was evidence-based, transparent and made use of significant stakeholder engagement.
Cross-sectional survey of stakeholders in deliberative meetings.
An independent Expert Advisory Group (EAG) was formed to develop a typology of public health priorities, a long-list of potential priorities and ranking criteria. Deliberative stakeholder events were held at which the criteria were refined and priorities scored by participants from a wide range of stakeholder organisations.
The proposed typology identified three types of public health priorities: risk factors, social factors and system factors; medically defined disease entities were not used deliberately, to facilitate broad stakeholder participation. Fifteen criteria were identified to help identify priority issues, based on the scope of their burden, amenability to change, and multi-stakeholder preferences. Six public health priorities were selected by the EAG based on stakeholder scoring of a long-list against these criteria.
Prioritisation is important in modern public health but it is challenging due to limited data availability, lack of agreed evidence on effectiveness and efficiency of interventions, and divergent stakeholder views. The Scottish experience nevertheless shows that useful public health priorities can be agreed upon by a wide range of stakeholders through a transparent, participatory and logical process.
苏格兰在西欧的预期寿命最低，且存在严重的健康不平等问题。2015年的一项全国公共卫生审查发现，各组织边界之间缺乏协调一致的行动，阻碍了进展。本文描述了一种快速（四个月）的系统方法，用于确定苏格兰公共卫生挑战的优先次序，该方法基于证据、透明且利用了重要利益相关者的参与。
对审议会议中的利益相关者进行横断面调查。
成立了一个独立的专家咨询小组（EAG），以制定公共卫生优先事项的类型、潜在优先事项的长清单和排名标准。举行了利益相关者审议活动，在活动中对标准进行了完善，并由来自广泛利益相关者组织的参与者对优先事项进行评分。
提议的类型确定了三种公共卫生优先事项：风险因素、社会因素和系统因素；未刻意使用医学定义的疾病实体，以促进广泛的利益相关者参与。根据负担范围、可改变性和多利益相关者偏好，确定了15条标准来帮助确定优先问题。专家咨询小组根据利益相关者根据这些标准对长清单的评分，选择了六项公共卫生优先事项。
在现代公共卫生中，确定优先次序很重要，但由于数据可用性有限、缺乏关于干预措施有效性和效率的公认证据以及利益相关者观点不同，这具有挑战性。尽管如此，苏格兰的经验表明，通过透明、参与性和合乎逻辑的过程，广泛的利益相关者可以就有用的公共卫生优先事项达成一致。
