In this chapter
In the third phase, the focus is on options for actions that target the challenges identified in Phase 2. These options are then meant to either bend trends into a more desirable direction, or to be better prepared for the challenges.
To address identified challenges, it is essential to develop a range of options for action—ranging from specific policy interventions (like anti-smoking programs) to broader strategies (such as promoting healthy lifestyles). These options should specify who needs to act, when, and at what level (local to international), though abstraction may vary. There is no single systematic method for identifying such options, so literature reviews, practitioner input, and databases like EVIPNet or RIVM are valuable resources. Once options are identified, their potential impacts should be assessed using qualitative and quantitative methods, such as cost-benefit analysis or health impact assessments, to inform robust decision-making under uncertainty.
| Steps: Actions and Objectives | Method |
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5.1.1 What is it and why is it important?
To make a change and target the challenges as identified in Phase2, options for actions are needed. These options for actions can be seen as policy interventions or policy strategies, to indicate that they can be concrete (e.g. antismoking policies) and also more abstract (promote healthy life styles). For all actions to be undertaken you ideally want to identify who should do what and when, This can be easily be applied to the concrete options, but also for the abstract ones you can formulate this, though this is then also more abstract. Options for action can be seen as health intervention which is defined as “an act performed for, with or on behalf of a person or a population whose purpose is to assess, improve, maintain, promote or modify health, functioning or health conditions”.
We use the term options for actions since it is not only addressing policy makers while the term policy strategies would, and secondly, they are options, not advice. It is up to actors (including policy makers) to choose between all options what they prefer. This is obviously linked again to the normative perspective (group of) actors have.
5.1.2 Methods
As far as we know, no systematic methods or framework exist that can support you in selecting options for action. This is mostly due to the multi-dimensional nature of the options for action, as listed above. However, we can provide some heuristics that help you to consider important aspects and characteristics in the selection process.
The options for action can classified by various characteristics. Some of these are: the level of abstraction (varying from concrete policy interventions as smoking cessation programmes, to more general policy strategies aiming at improving healthy life styles, points of engagement (primary, secondary and tertiary prevention, cure or care), the geographical level involved (from international to local ), the actor involved (policymakers, citizen groups, companies), or the nature of the option (from more general information campaigns to legal options). An important facet to consider is the level of abstraction of the options for actions. The more concreter the better interventions link to the policy making process, such as an intervention that stimulates quitting smoking. However, a foresight study often is more far reaching than only targeting one risk factor. Stimulating healthy behaviour in more general terms might be the level that fits a foresight study more. Instead of specific interventions, you might then think of policy strategies. There is no all-encompassing framework that supports a systematic consideration of all these characteristics. A framework that could be of help is the interventions wheel . Originating from nursing practices, it outlines the scope of public health practice based on the type of intervention and the level of practice—whether it is at the individual/family, community, or systems level.
The selection of options for action is not an easy process since a systematic overview of all interventions for a particular challenge is often lacking. Using various sources to find information is required. It might start with literature searches, including grey literature, but also input from practitioners to know more about context and potential success, is very valuable. A good example of possible source is the Evidence-informed Policy Network (EVIPNet) . EVIPNet is a global WHO initiative that promotes the systematic use of health-research evidence in policy-making. At the European level, there is the Best Practices Portal which is meant to help find reliable and practical information on implemented practices recognised as best or promising in the area of public health. Another good example is the intervention database provided by RIVM . This database contains information pertaining to the quality and effectiveness of all kinds of lifestyle interventions.
The table below can be useful to list the options for action. For all options, the Challenge, sub-challenge and associated goal can be specified. Not all options for action might further specified in who and when, or the target group. Those can of course be left open.
| What challenge to target? | What Sub-challenge to target | What are the associated Goals | Option for action | Who has to take action | Time frame / when | Geographical level / Target group(s) |
|---|---|---|---|---|---|---|
5.1.3 Example from the PHFS-2018
In the table below the options for action of the PHFS-2018 are presented. As you can see, the sub-challenges and goals are combined. Also, not for alle actions the who and when are specified. Sometimes, the (high) abstraction level does not allow this, or it is still to be considered.
| Challenge | Sub challenge / goals | Options of action |
|---|---|---|
| Cardiovascular diseases and cancer are health conditions that continue to occur frequently, will still be the cause of the majority of deaths in 2040, and have a major impact on patients’ lives. | Working on integrative prevention measures | • Integrative programmes targeting lifestyle as well as the physical and social environment. • Collaboration between government ministries, especially in the context of the physical and social environment. • Focus on underlying social issues in vulnerable groups. |
| Other health care resulting from technology and different organisational structures | • Ensuring better utilisation of options for self-diagnostics and genetic testing. • Effective management of tensions between diverse interests (ethical, legal, health care) in the context of genetic information, for instance via laws and regulations. • Working with all stakeholders to determine which care can be provided at home. • Responding more effectively to the demand for health care in cases of multimorbidity by means of increased and more wide-ranging collaboration. • Developing more knowledge about gender-specific differences in the expression, presentation and treatment of diseases and implementing that knowledge more quickly into medical practice. | |
| Dealing more effectively with physical, mental and societal consequences | • Focusing more attention on the long-term effects of diseases, both within the health care sector and beyond. • Training patients and health care providers in self- management, and in putting it into practice. • Offering support to people who are unwilling or unable to manage their own care process, e.g. by using case managers. |
5.2.1 What is it and why is it important?
As a next step in the foresight study, you might want to assess the possible future impact of the options for action on most important outcome indicators. What is the expected impact of for example a healthy diet policy strategy on the disease burden in the future. This demands quite a lot of information and knowledge to assess these impacts properly. The following aspects are then rather essential: Effectiveness: How well does the intervention achieve its intended goals? and the efficiency: What are the costs and benefits associated with the intervention? Additional aspects to be considered might be for example equity: How does the intervention impact different groups within society? These kinds of impact analysis aim at evaluating the potential impacts of each option within the context of the different scenarios. Its importance lies mainly in making concrete what the possible room to manoeuvre is regarding modifying future trends, and have a realistic expectation of certain action put in place. It is good to realize that all these are ex-ante evaluations, e.g. they are conducted before policy implementation to assess the potential impacts and feasibility of the proposed policy and are subjected to the uncertainties mentioned before.
5.2.2 Methods and outcome
To do impact analysis of the options for action, both qualitative and quantitative methods can be applied. There is a wide range of methods available to do this. such as expert judgment, modelling, simulations, surveys and interviews. Approaches that are then more commonly applied are
Cost-Benefit Analysis (CBA) Cost-Benefit Analysis (CBA) is a systematic approach used to evaluate the economic pros and cons of different policy options, projects, or investments. The primary goal of CBA is to determine whether the benefits of a particular action outweigh its costs, thereby aiding decision-makers in choosing the most efficient and effective option.
Social Cost-Benefit Analysis (SCBA) is an extension of traditional Cost-Benefit Analysis (CBA) that incorporates a broader range of costs and benefits, including those that affect society as a whole, rather than just the direct stakeholders. SCBA aims to evaluate the overall impact of a policy, project, or program, taking into account both market and non-market effects.
Health impacts assessment. Health Impact Assessment (HIA) is a systematic process used to evaluate the potential health effects of a policy, program, project, or plan on a population, particularly focusing on how it may affect different groups within the population. The goal of HIA is to provide evidence-based recommendations to enhance positive health outcomes and minimize adverse health effects, thereby informing decision-makers and stakeholders. A HIA approach has many similarities with a foresight study.
These approaches have gained a strong (academic) position to support policy evaluations. However, the combination of these approaches with a foresight study is relatively unexplored territory. That is caused by the high capacity and knowledge demanding process of doing a HIA or a SCBA, similar to doing a foresight study. Secondly, the foresight approach might have a wider objective and a stronger focus on uncertainty that are not always compatible with the other ones. Nevertheless, it is worthwhile to invest in exploring how to cross-pollinate by exchanging different techniques, insights and methods.
A more simple but helpful framework withing the field of health is the Nuffield Intervention Ladder (Figure x). The options for action list as a result from the previous step might be mixed bag of kinds of actions, listing from proving information about choices, guide choices to eliminate choices. To back these options with scientific evidence about the effectiveness and efficiency is difficult, especially if they are also combined. Expert judgement might then be needed to assess possible impacts.