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Beyond crystal balls: crosscutting solutions in global health to prepare for an unpredictable future.

Alonso WJ, McCormick BJ, Miller MA, Schuck-Paim C, Asrar GR - BMC Public Health (2015)

Bottom Line: Predictive modeling is frequently used to assist planning, but outcomes depend heavily on a subset of critical assumptions, which are mostly hampered by our limited knowledge about the many factors, mechanisms and relationships that determine the dynamics of disease systems, by a lack of data to parameterize and validate models, and by uncertainties about future scenarios.This system should be able to reveal crosscutting solutions with the potential to address not only one threat, but multiple areas of vulnerability to future health risks.Actionable knowledge not based on a narrow subset of threats and conditions can better guide policy, build societal resilience and ensure effective prevention in an uncertain world.

View Article: PubMed Central - PubMed

Affiliation: Fogarty International Center, National Institutes of Health, Bethesda, Maryland, 20892, USA. alonsow@mail.nih.gov.

ABSTRACT

Background: Efforts in global heath need to deal not only with current challenges, but also to anticipate new scenarios, which sometimes unfold at lightning speed. Predictive modeling is frequently used to assist planning, but outcomes depend heavily on a subset of critical assumptions, which are mostly hampered by our limited knowledge about the many factors, mechanisms and relationships that determine the dynamics of disease systems, by a lack of data to parameterize and validate models, and by uncertainties about future scenarios.

Discussion: We propose a shift from a focus on the prediction of individual disease patterns to the identification and mitigation of broader fragilities in public health systems. Modeling capabilities should be used to perform "stress tests" on how interrelated fragilities respond when faced with a range of possible or plausible threats of different nature and intensity. This system should be able to reveal crosscutting solutions with the potential to address not only one threat, but multiple areas of vulnerability to future health risks. Actionable knowledge not based on a narrow subset of threats and conditions can better guide policy, build societal resilience and ensure effective prevention in an uncertain world.

No MeSH data available.


Related in: MedlinePlus

Suggested framework to analyze the fragility of public health systems given uncertainty about potential stressor with the goal of enabling more actionable and effective interventions
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Fig1: Suggested framework to analyze the fragility of public health systems given uncertainty about potential stressor with the goal of enabling more actionable and effective interventions

Mentions: We suggest identifying points at which a society is fragile to changes in broad causes of stress or inter-related family of stresses. We prefer to be deliberately inclusive in characterizing stressors that are capable of impacting negatively (directly or indirectly) the provision of public health. For example, one such stressor might be climate, another may be military conflict and another could be fluctuating economics. The practical outcome is a more immediately manageable picture for public health decision makers. Importantly, we do not suggest the common practice of devolving identification of actionable responses from model construction. Instead, the approach proposed is based on three layers shown in left hand side of the diagram of Fig. 1. Because focusing on the likelihood of a particular event might ignore the fragility of public health to more general classes of perturbation, preparedness plans focused on specific risks might do little to reduce the overall fragility of a health system to multiple stressors. Therefore, efforts should be biased toward identification of points of fragility associated with maximal cascading challenges for public health, and on the evaluation of cross-cutting and flexible solutions for an uncertain future. Greater societal resilience to known and unpredictable disease risks can be similarly achieved by the active identification and mitigation of fragilities to a wide range of stressors. A broader framework for policy and research should also enable trans-disciplinary collaboration, reducing public spending on multiple fronts by preventing of simultaneous efforts as much as possible.Fig. 1


Beyond crystal balls: crosscutting solutions in global health to prepare for an unpredictable future.

Alonso WJ, McCormick BJ, Miller MA, Schuck-Paim C, Asrar GR - BMC Public Health (2015)

Suggested framework to analyze the fragility of public health systems given uncertainty about potential stressor with the goal of enabling more actionable and effective interventions
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4581487&req=5

Fig1: Suggested framework to analyze the fragility of public health systems given uncertainty about potential stressor with the goal of enabling more actionable and effective interventions
Mentions: We suggest identifying points at which a society is fragile to changes in broad causes of stress or inter-related family of stresses. We prefer to be deliberately inclusive in characterizing stressors that are capable of impacting negatively (directly or indirectly) the provision of public health. For example, one such stressor might be climate, another may be military conflict and another could be fluctuating economics. The practical outcome is a more immediately manageable picture for public health decision makers. Importantly, we do not suggest the common practice of devolving identification of actionable responses from model construction. Instead, the approach proposed is based on three layers shown in left hand side of the diagram of Fig. 1. Because focusing on the likelihood of a particular event might ignore the fragility of public health to more general classes of perturbation, preparedness plans focused on specific risks might do little to reduce the overall fragility of a health system to multiple stressors. Therefore, efforts should be biased toward identification of points of fragility associated with maximal cascading challenges for public health, and on the evaluation of cross-cutting and flexible solutions for an uncertain future. Greater societal resilience to known and unpredictable disease risks can be similarly achieved by the active identification and mitigation of fragilities to a wide range of stressors. A broader framework for policy and research should also enable trans-disciplinary collaboration, reducing public spending on multiple fronts by preventing of simultaneous efforts as much as possible.Fig. 1

Bottom Line: Predictive modeling is frequently used to assist planning, but outcomes depend heavily on a subset of critical assumptions, which are mostly hampered by our limited knowledge about the many factors, mechanisms and relationships that determine the dynamics of disease systems, by a lack of data to parameterize and validate models, and by uncertainties about future scenarios.This system should be able to reveal crosscutting solutions with the potential to address not only one threat, but multiple areas of vulnerability to future health risks.Actionable knowledge not based on a narrow subset of threats and conditions can better guide policy, build societal resilience and ensure effective prevention in an uncertain world.

View Article: PubMed Central - PubMed

Affiliation: Fogarty International Center, National Institutes of Health, Bethesda, Maryland, 20892, USA. alonsow@mail.nih.gov.

ABSTRACT

Background: Efforts in global heath need to deal not only with current challenges, but also to anticipate new scenarios, which sometimes unfold at lightning speed. Predictive modeling is frequently used to assist planning, but outcomes depend heavily on a subset of critical assumptions, which are mostly hampered by our limited knowledge about the many factors, mechanisms and relationships that determine the dynamics of disease systems, by a lack of data to parameterize and validate models, and by uncertainties about future scenarios.

Discussion: We propose a shift from a focus on the prediction of individual disease patterns to the identification and mitigation of broader fragilities in public health systems. Modeling capabilities should be used to perform "stress tests" on how interrelated fragilities respond when faced with a range of possible or plausible threats of different nature and intensity. This system should be able to reveal crosscutting solutions with the potential to address not only one threat, but multiple areas of vulnerability to future health risks. Actionable knowledge not based on a narrow subset of threats and conditions can better guide policy, build societal resilience and ensure effective prevention in an uncertain world.

No MeSH data available.


Related in: MedlinePlus