PUB - Publikationen an der Universität Bielefeld

The top-down risk assessment that fits the classical HIA method and its application on policy was in depth presented in the previous chapter. Many public health experts find large policies difficult to assess as for their impact on health. People knowing health outcome and its societal burden well may find it easier to find proper policies starting from the bottom line—from health outcome. The use of complex causal process diagrams for analyzing health impacts of policy interventions was already described. The RAPID guidance based on bottom-up approach might be helpful to act more efficiently in reducing prevalence of health outcomes by identification and selection of proper policies for structural intervention. The health outcome was taken as a starting point and assessment through levels of risk factors and determinants of health lead to identification of policies needed to reduce burden of health outcome. The present chapter illustrates through eight case studies conducted in seven different countries a bottom-up policy risk assessment model aiming to describe casual pathways upstream, from a single health outcome (effect) up through risk factors and health determinants leading to a list of policies. The purpose of this approach is to emphasize that results in health outcomes are related to many different policies at the same time, bringing up the need to adopt proactive inter-sectoral negotiations and putting health in the agenda of non-health sectors. Special interest was put on identifying the type of information needed for the description of the full-chain, possible discrepancies in defining health outcomes, risk factors or health determinants, the availability of data, the designation of possible scenarios related to political options, and the characterization of uncertainties.