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Economic evaluation is increasingly used to provide a formal, explicit and transparent framework for informing decisions about allocating public funds in the health care sector. By utilizing economic evaluation in the field of public health, it is possible to address questions about the efficiency of allocating resources to fund interventions aimed at improving public health. Economic evaluation of medical interventions and programmes within the health care sector typically utilizes a framework that aims to maximize health outcomes subject to the health sector budget constraint (an ‘extra welfarist’ perspective). This chapter discusses whether this extra welfarist normative framework can be extended to the evaluation of public health interventions, which may have objectives other than health maximization, and may operate across multiple sectors and budget constraints. The extensions to the framework that would enable intersectoral comparisons and a consideration of equity are considered, as well as frameworks used in other areas of policy evaluation (e.g. cost-benefit analysis based on conventional ‘welfarist’ normative principles). The chapter considers how the current elements of economic evaluation — such as statistical analysis of individual patient data, systematic review, evidence synthesis, and decision-analytic modelling — can be applied to evaluate public health interventions with the view to informing policy. Methods for valuing health outcomes are considered in order to determine the need to move beyond the quality adjusted life year (QALY), and to reflect concerns about equity, and the determinants of health and health inequalities. Methods for evaluating the opportunity costs of allocating resources from multiple sectors to a particular intervention are examined, with a view to calculating the net benefits of alternative interventions. The chapter concludes by considering whether methodological standards for the economic evaluation of public health interventions can be established.

Once a particular intervention—a program or policy—has been identified, sound planning techniques can ensure that the program is implemented effectively. This chapter focuses on action planning—that is, planning for a defined program or policy with specific, time-dependent outcomes compared with ongoing planning that is a regular function within an organization. The chapter is organized in five main sections, designed to highlight ecologic frameworks, give examples of behavioral science theories that can increase the likelihood of carrying out effective interventions, review key principles of planning, outline steps in action planning, and describe important aspects of coalition-based interventions.

This chapter summarizes some of the conclusions and recommendations that were published in the report Public health: ethical issues in November 2007. The context to the public health debate is set out in the first section, and the ‘stewardship model’ is presented and the role of evidence is considered. This model outlines the legitimate goals and constraints of liberal states in pursuing public health measures. The next section describes the ‘intervention ladder’, which is a tool that helps use of the stewardship model in practice. It enables an assessment of the acceptability of different interventions in terms of their level of intrusiveness and evidence that is required. The final section considers the case of obesity, which illustrates the role of both the stewardship model and the intervention ladder in policy and practice. The discussion emphasizes the need to consider in particular the situation of vulnerable groups such as children and the socio-economically disadvantaged, and underlines that public health issues concern not only tensions between the individual and the state, but also require consideration of the role of third parties such as industries.

This introductory chapter describes the book's four sections: 1) Anthropological understandings of public health problems, 2) Anthropological design of public health interventions, 3) Anthropological evaluations of public health initiatives, and 4) Anthropological critiques of public health policy. It then surveys underlying premises of the discipline of anthropology; outlines basic methods of anthropology in public health; and describes some of the challenges of incorporating anthropological approaches within public health institutions and public health practice.

Complex interventions are widely used in the health service, in public health practice, and in areas of social policy that have important consequences for population health, such as education, transport, and housing. They present a number of problems for evaluators, in addition to the practical and methodological difficulties that any successful evaluation must overcome. In 2008, the Medical Research Council (MRC) published revised and updated guidance to help researchers and research funders recognize and adopt appropriate methods. This chapter summarizes key messages for the evaluation of public health interventions, and discusses some of the issues that have been raised since the guidance was published.

This chapter presents a selected overview of the latest evidence for population approaches for increasing physical activity and reducing sedentary behaviour in different population segments (e.g., children, adolescents, young adults, mid-life adults, and older adults). It considers this evidence within a social ecological context. Emerging issues and directions in the field are also presented.

A central challenge for public health is to articulate and act upon a broad definition of public health—one that incorporates a multidisciplinary approach to the underlying causes of premature death and disability. To implement an evidence-based process within this framework, numerous program and policy options become apparent. Identifying and choosing among these options are not simple, straightforward tasks. After options are identified, priorities need to be set among various alternatives. This chapter is divided into four main sections. The first describes some broad-based considerations to take into account when examining options and priorities. The next section outlines analytic methods and models that have been applied when setting clinical and community priorities in health promotion and disease prevention. The third part is an overview of the concepts of innovation and creativity in option selection. The final section describes the development and uses of analytic frameworks in developing and prioritizing options.

Targeted interventions to improve population health have long been a feature of public health practice in high-income nations. Area-based interventions focused on improving the health of deprived communities have been a particularly important part of government policy since 1997. Such an approach has coincided with an increasing recognition of the role of ‘context’ in shaping individual health outcomes. The idea that risk factors for poor health and health inequality are not just properties of the individual but are also properties of neighbourhoods, schools, workplaces, and other environmental settings, is a welcome one. However, the challenge for researchers, practitioners, and policy makers is to populate a sparse evidence base for the effectiveness of environmental interventions targeted at specific communities. Drawing on the evaluation of a ‘natural’ community experiment to improve diet in Glasgow — the Glasgow Superstore Project — this chapter outlines some of the challenges of generating evidence for the effectiveness of area-based strategies for heath improvement.

This chapter explores the economics of obesity prevention, particularly the available evidence on the cost-effectiveness of interventions and how the economic credentials for obesity prevention might be developed. It begins with a discussion of the contribution that the discipline of economics can make to an understanding of obesity prevention, explaining the separate but related tasks of description, prediction, and evaluation. Using these concepts, the chapter then explores what is known about the economics of obesity prevention. First, the depth and quality of the available economic literature on obesity is reviewed, and then Australia is used as a case study to illustrate the application of economic methods to describe the disease burden and to evaluate options for change.

This chapter introduces social marketing approach and its possible applications in the field of obesity prevention. Because social marketing approaches to obesity are just beginning to emerge, it draws on the social marketing approaches in the public health literature more generally. It shows that several features of social marketing thinking have already been successfully included in public health planning processes. However, although social marketing shares many features with other related public health planning processes, it is distinguished by the systematic emphasis marketers place on the strategic integration of the elements in marketing's conceptual framework.

Medical ethics, as it has developed across the last twenty-five years, has concentrated almost entirely on clinical ethics. It has focussed on the ethically acceptable provision of healthcare to individual patients, assuming that healthcare is like a consumer good. But there are serious and difficult questions about the tensions between the rights and interests of individuals, and the rights and interests of communities. Public health provision is a public good and can be provided for some only by providing it for many. Clean air, water, and freedom from infection are not consumer goods, and there is little to be achieved by pretending that they are. A convincing ethics of public health therefore needs to draw on political philosophy and its long tradition of considering the limits of just compulsion, and to think through which public health interventions may or must be provided on a compulsory basis.

This chapter presents a conceptualization of the causes of population obesity, discusses the implications of this conceptualization for public health interventions, and reviews empirical work that has attempted to address obesity treatment and prevention in entire populations. Youth interventions have been delivered primarily through schools. Adult interventions have used heterogeneous delivery modes. All have relied heavily on educational messages encouraging greater physical activity and a more healthy diet. The overall outcomes of these interventions are thought to be very modestly positive, with the strongest results seen in programmes for children that have high physical activity requirements. Unfortunately, the sizes of the overall effect seen in these studies are considerably smaller than the rate of increase in population obesity.

Communities have been highlighted as key settings for obesity-prevention interventions. Community-based obesity-prevention interventions can target individual behaviour, e.g., through the provision of information, advice, support, and feedback at a group or personal level. These interventions can also target the environment of a community, sometimes through policy changes, so that healthy changes can be made more easily. This chapter provides an overview of the issues and challenges in developing and implementing community-based obesity-prevention intervention programmes. It briefly discusses the quality of available evidence, describes current community-based initiatives and the challenges in designing and managing them, and discusses the nature of the evidence required to inform policy and practice.

This chapter aims to describe all the main interventions that are believed to promote smoking cessation, show why statements about effectiveness will always require semi-quantitative judgements that go beyond the current ‘hard’ evidence, and give estimates of effectiveness based on that evidence. It includes population level interventions such as tax increases, and clinical interventions such as use of nicotine replacement therapy. The chapter also presents a model describing how smoking cessation interventions work. It begins with examination of why developing and implementing smoking cessation interventions is such a major public health priority.

Evaluation is an essential part of the evidence-based public health process, answering questions about program needs, the process of implementation, and tracking of outcomes. It can (1) help to plan programs in a way to enhance the likelihood that they will be effective; (2) allow for midcourse corrections and changes; (3) help determine if the program or policy has been effective; and (4) provide information for planning the next program or policy. This chapter reviews some of the key issues to consider in conducting an evaluation and provides linkages to a diverse literature (within and outside public health) for those wishing to go beyond these basics.

The second major pathway through which social inequality affects public health is through the cumulative effects of advantage and disadvantage on broad population groups. This chapter presents a theoretical model for this, showing how in the presence of social inequalities, even interventions designed to improve health can widen health disparities between groups. For example, requiring cancer screening at medical examinations might be a laudable public health intervention, but in a society where not everyone is covered by health insurance, it tends to widen health disparities even as it improves overall health. The chapter also examines the inverse care law which states that ‘the availability of good medical care tends to vary inversely with the need for it in the population served’.

This chapter discusses the demographic aspects of chronic pain. Topics covered include age distribution, gender distribution, socioeconomic status distribution, and implications for prevention and management.

Developing countries have about 80% of the world's diabetic population. In India the prevalence rates for diabetes in urban areas now approach figures reported for the more affluent migrant Indians living abroad. The epidemic is now shifting to rural areas, where diabetes care is neither available, accessible, nor affordable. This chapter describes the present status of quality of diabetes care and how it can be measured in the context of developing countries. It assesses the prevention and control activities for diabetes and highlights some successful prevention strategies at the community level in India that can be used as a model for prevention of diabetes in other developing nations.

Turning to practices of persuasion as techniques of governance, Chapter 4, Mistaken by Design: Biopolitics in Practice, examines how RHI addresses rural publics in the Upper East region. Through an ethnography of public health educational film screenings, I try to understand how RHI’s work is persuasive even though it eschews translation and mobilizes misrepresentations. Rather than interpreting these as indicators of a lack of knowledge or tying them to failure, I suggest that they constitute deliberate, tactical refusals of translation. Medical anthropologists tend to emphasize and critique what is said in public health and development interventions, and how it is said, but I want suggest that what is done and how power is materialized matters much more. My analysis of the place of knowledge in NGO interventions shows that NGOs like RHI know how to make knowledge matter, but also recognize that more than knowledge is needed for the production of authority. Claims about the harms of cutting become “true” when presented in visual spectacles that materialize governmental power and set the conditions and constraints on which knowledge about reproduction, health, and society is socially productive.

This chapter looks at how the country’s health investment remains resolutely focused on curative care. Perhaps people spend more on cure than they do on prevention because they believe keeping people healthy is too expensive. But is this true? An analysis set out to assess the return on investment for high-income countries that adopt efforts to improve health. The authors found that the median return on investment for public health interventions was 14 to 1—that is, for every dollar invested, it yields the same dollar back and another 14. They also found that the more these interventions were established at the wider, national level, the higher the return, rising up to about 40 to 1 for the best investments. These interventions include vaccination programs, taxes on sugar-sweetened beverages, building better cities to reduce falls, and early youth interventions to limit teenage pregnancy and delinquency. In other words, these are classic efforts to promote the public’s health by shaping the conditions in which people live.