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Semelhante a Jan Mos RIVM 22-4-2010
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Jan Mos RIVM 22-4-2010
- 4. What may citizens expect from their government? What is the responsibility of the federal government? What is the role of state and local authorities?
- 5. Government responsible for public health
- 6. Government responsible for safe environment
- 10. Political responsibility Research & policy support The ministries have political responsibilities RIVM: independent scientific responsibility (air quality) Risk-assessment (RIVM, ECDC) Risk-management (Government, EU, RIVM ) Clear separation of responsibilities
- 15. Public Health Questions: Emerging Infections (Zoonoses)
- 16. Public Health Questions: Problems in the air? particulate matter electromagnetic fields public threat?
- 17. Public Health Questions: Legionella (environment) Legionella in cooling-towers
- 18. Public Health Questions: Behaviour, trends and concerns for the future physical inactivity excessive alcohol use severe obesity Overweight smoking stable stable Stable bad stable good bad bad bad bad bad bad stable good good youth Females Males Trend
- 20. Transform information into wisdom (science)
- 21. Understand risk assessment and communication Risk on premature death power lines benzene disasters legionella noise passive smoking airpollution Radon traffic accidents alcohol accidents at home fat food lack of physical activity obesity mobile phone base station smoking 10 -2 10 -10 10 -9 10 -8 10 -7 10 -6 10 -5 10 -4 10 -3
- 23. DALYs in the Netherlands, 1980 - 2020 0 5000 10000 15000 20000 25000 1980 2000 2010 1980 2000 2020 1980 2000 2020 1980 2000 2020 1980 2000 2020 PM10 long- term Noise Radon UV Traffic accidents DALYs per million people
- 24. Relative burden: 7 infectious diseases in Europe
- 27. Conceptual model for the Dutch PHSF
- 28. Develop models to get grip on reality
- 29. Need to develop knowledge-model ‘ Sources’ ‘ Effects’ ‘ Systems’ ‘ Intervention laboratory and field research, modeling desk research and (inter)national networks Chain Communication
- 30. NIPH owner Customers Sister institutes Research centers citizens professionals Budget-holder Need to develop stake-holder model
- 35. Conceptual model for the Dutch PHSF
- 36. PHSF in The policy cycle (Anderson and Hussey) Preparation (agendasetting) Implementation (programme implementation) Evaluation Development (policy formulation)
- 37. Preparation (agendasetting) Implementation (programme implementation) Evaluation Development (policy formulation) Min. Health: Policy-document (2006/2007) Municipalities: Policy-documents (2008/2009) RIVM: PHSF-report (2010) Healthcare-inspectorate (2009)
- 43. More disease, but more health More years, with more chronic diseases But also in good health (trend will continue)
- 47. Less smokers, but still 27% smokes
- 48. Overweight stabilizes at high level
Notas do Editor
- This slide needs no further text.
- How is the relationship between the government and our institute? Minister of Health in The Hague (here at the left), has the political responsibility. He takes the strategic decisions. Our institute (here on the right located in Bilthoven) performs state of the art research and provides knowledge for policy support underpinning these strategic decisions. There is a clear separation between research and policy support which is done at RIVM and political decisions making at the Ministry.
- This slide needs no further text.
- Two other societal problems/ These pictures show the problems of modern societies. Particulate matter, fine dust or air pollution is a major source of morbidity. It kills people and increases the burden of disease. But do we really change our behaviour? The more we live down-town the more 4-wheel cars are popular. However, at the same time society forces the politicians to investigate the health effects of power lines on health. The question is how to handle public concern and how to stimulate people to take their own responsibility regarding the climate change.
- An example of modern society, using air-conditioning. Scanning patterns is for example needed for Legionella outbreaks. In Amsterdam we had last summer such an outbreak. In this outbreak Google earth pictures were used to locate cooling water equipment on top of buildings. By carefully searching for patterns the source of infection has been traced. All infected people had walked past this building!
- It’s clear that there are a lot of detrimental trends and that behaviour plays a crucial role! Trends in Spain? Information regarding these aspects? Any strategy to change these bad trends?
- Most important is that we are able to transform information info meaningful information or in other words wisdom. Here you see geographic information about rubella vaccination rate. Blue areas show low vaccination rate. They coincide with what we call the Bible belt (strict protestants). This group of people refuses vaccination for religious reasons. On the right hand side you see cases of confirmed rubella virus infections. It is clear that the outbreak is related to a low vaccination-rate area. We need this background to evaluate outbreaks. As soon as there are increasing infection rates outside the known danger areas the alarm bell should ring.
- In order to answer the societal questions we need to assess the risks and to communicate about these risks. The slide is not useful for public information, because many fail to understand logarithmic scales. But you can easily see that the risk of premature death from power lines is much lower than the risk of smoking or accidents at home. Unfortunately knowing the risks doesn’t always change the behavious.
- It is not possible to do everything. Therefore it is extremely important to set priorities. Question if what do we take into account and how do we weight all the aspects. How do we assess the economic burden of a disease? Do we take into account the risk perception of the general public? In The Netherlands people are concerned about the mast for mobile telephones. Some people are convinced that it will cause cancer, or at least head ache. The Dutch government decided to start a huge investigation.
- Politicians have to decide how to spend their limited budgets. First they need to know to impact of the different subjects. Second question is how much it will cost in order to reduce the burden. This slide illustrates the use of DALY’s. Daily adjusted life years. Health impact effects are compared for different sources.
- In order to solve all the problems we need power… is the reply of the regional health centers Is the reply of the Nat Institute? This has to do with formal power. Even in a small country like the netherlands we have many debats concerning regional and national power. There are many examples where we are asked to give an expert opinion on scientific issues. Therefore we need good scientific knowledge that covers the areas needed to take sound decisions. Even if we do not have all of the evidence that should be available for decisions, we must have such strong positions that our advice to professionals, politicians and citizens does make a difference. Authority does not come without scientific knowledge and we need authority because we often lack formal power. Nevertheless authority can be quite powerful.
- However there is a need for better preparedness and outbreakmanegement In order to control Communicable diseases our minister has decided that it makes no sense to divide risk assessment and risk management. So, regarding the control of Comm Dis our institute is responsible for both aspects, although the minster of health has the final political responsibility. This is definitely not the case of air quality. Essential is that people need a mental map to imagine how their work fits into a bigger concept.
- We need to understand the real word, how things work. In order to do so we need to construct a model of that complex reality. Our minister wants to lower the burden of diabetes mellitus. What kind of measurements could he take and how will that affect the health system. In order to predict these changes of policy you need to use a model.
- I see a gradual but steady change in Public Health: we used to focus on sources and effects, like communicable diseases, air pollution and radiation. But now we have grown from relatively simple risk assessment to risk-benefit analysis of systems. So we need to have system knowledge in order to support effective interventions. However, the closer you get to the interventions, the more you need to communicate. What I see as the challenge for NPHI is to interconnect all expertise for the benefit of the public. I see this as one of my special responsibilities.
- We have become more explicit about our customers. We are a Public Institute, at least financially, but our societal contribution goes further: professionals and the public are our customers.
- 24-04-10
- 24-04-10