XI HIA INTERNATIONAL CONFERENCE, Granada, April 14 15, 2011‐

Bottom-up risk assessment of asthma bronchiale in Slovakia

Kallayova, D., Majdan, M., O´Mullane M., Bosak, L., Kvakova, M., Gallova,E.

Trnava UniversityPublic Health Department

XI HIA INTERNATIONAL CONFERENCE, Granada, April 14 15, 2011‐

RAPID project Risk Assessment from Policy to Impact

Dimension • Case study from Slovakia is a part of RAPID project• The main aim of the project is to develop, pilot test

and implement risk assessment methodology for full chain risk assessment

• Methodology- how to develop full chain R.A. • Find feasible methodology for risk assessment which

can be used then in HIA from policy -> determinants of health - > risk

factors - > health effect (full chain)

XI HIA INTERNATIONAL CONFERENCE, Granada, April 14 15, 2011‐

Specific project aim

• Conduct risk assessment case studies from policy to health effect and from health effect to policy

• Bottom-up: check if there’s any policy that can affect asthma

• The project acknowledges funding by the European Commission Health & Consumer Protection Directorate-General via Executive Agency for Health and Consumers, Grant agreement no 20081105

XI HIA INTERNATIONAL CONFERENCE, Granada, April 14 15, 2011‐

Policy level

Health determinants

Health outcome

Bottom-up risk assessment of asthma bronchiale in Slovakia: FULL CHAIN

Health outcome data sources relevant to Slovakia (1)

XI HIA INTERNATIONAL CONFERENCE, Granada, April 14 15, 2011‐

Global level

European level

National levelLocal level

• WHO report 2004• Global WHO

mortality database

• WHO European databases (HFA, Mortality and Hospital Morbidity databases)

• National health information center -National registry of patients with chronic lung disease

• Medical records

XI HIA INTERNATIONAL CONFERENCE, Granada, April 14 15, 2011‐

From health outcome to risk factors (2)

• Methodology should be based on literature reviews - for the purpose of risk assessment phase we strongly recommend using review articles

• Findings from Reviews: Strongest risk factors for developing asthma are a combination of genetic predisposition with environmental exposure (higher outdoor air levels of priority pollutants such as particulates, ozone, sulfur and nitrogen oxides and carbon monoxide.)

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Electronic Information Source Key words (number) Number of publicationsPub Med Asthma, Slovakia (2)

Asthma (1)

risk factors, asthma (2)

environmental risk factors, asthma (3)

42 (including 6 reviews)

11 8167

8 278

2592

Current Contents Connect® Asthma, Slovakia (2)

Asthma (1)

risk factors, asthma (2)

environmental risk factors, asthma (3)

7

54 998

4 504

1 137 (including 151 reviews)

XI HIA INTERNATIONAL CONFERENCE, Granada, April 14 15, 2011‐

Findings from Review: From risk factor to health determinants

• Genetics and physical environment are crucial within the process of initiation of asthma (plus exacerbation of asthma)…

• The most important determinants we have identified environment (air pollution) and health care -in case of asthma exacerbations (management of asthma/asthma control)

• There are very few publication focused on asthma and risk factors research which has been done in Slovakia.

XI HIA INTERNATIONAL CONFERENCE, Granada, April 14 15, 2011‐

From determinants to policy in Slovakia

• The Government approved the State Health Policy Resolution No. 910 on 8 November 2000.

• Ministry of Environment has created Environment Strategy for protecting and enhancing the health of citizens SR based on State health Policy.

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• Strategy documents - Declaration of Ministers and Action Plan for Environment and Health children for Europe (CEHAPE) and updating of Action plan for environment and human health SR for the years 2006 - 2010 (NEHAP III)

Environmentinitiation

• Primary health care policies should be oriented on asthma guidelines implementation in health system (guidelines not compulsory) Health care

exacerbation

From determinants to policies in Slovakia

XI HIA INTERNATIONAL CONFERENCE, Granada, April 14 15, 2011‐

Conclusion

• Pilot for how full chain R.A. can be done, starting with health outcome..

• case study on possible risk assessment methodology taking into account whole pathway from health outcome to risk factor, from risk factor to health determinants and from health determinants to policy could be the starting point to processes of ‘‘healthier” policy choices

• Difficulty is the gap in research..• The outlines options for the future risk appraisal

methodology must be further discussed and improved