Summary of the event by Professor Pedro Pita Barros:
It took place on January 7, 2025, with the presentation of the ImpACT Knowledge Centre of the Escola Nacional de Saúde Pública, whose fundamental unifying element is the research developed and the knowledge produced on public policies in the health sector—from their definition to their evaluation.
The work programme for that morning’s presentation, officially described here, included interventions that provided an insight into the diversity of the work carried out.
Here I leave my summary of the various sessions, which naturally reflects my personal preferences.
Final notes of the “Presentation of Public Health Impact – Designing, Monitoring, and Evaluating, a Public Health Knowledge Centre, with Action-Oriented Research, including Public Policies”
In the opening by Rui Santana, it was mentioned that ENSP has a tradition of societal intervention. There is a constant search for new mechanisms to organize this intervention, currently less based on disciplinary areas and more oriented toward groups with diverse skills. The Knowledge Centre will be one of these new mechanisms.
Chris Millett, Lifestyles, from a Global Health Perspective
The new research centre is created with a solutions-oriented approach. Guiding toward solutions requires a framework of values to define what the appropriate solution is. This is different from merely documenting and increasing knowledge. The step from knowledge analysis to a solution and recommendation must clarify all stages. Changing policies is done within a value framework that must be clearly stated. The “political game” (in terms of influence on adopted policies) is part of the process. It is crucial to avoid conflicts of interest. Part of what was learned is that the affected entities react to the adopted policies.
The main question that arises is: how to include, in the design, monitoring, and evaluation of public policies, the expected adjustment of entities and agents?
The key word of this intervention is: impartiality.
André Peralta-Santos, Lifestyles, from a Global Health Perspective
He discussed how the Knowledge Centre can intervene, mentioning the issue of technical training and the modeling of health policies. In constructing policies, it is relevant to include structured discussions to support policy development.
In the evaluation of health policies, there are several challenges: in the way public administration acquires knowledge, in the capacity of academic centres to differentiate, in the creation of knowledge unsolicited by the public administration, and in the changing culture of data sharing by the Public Administration.
The main question that emerges from this intervention is: how to reconcile the time of action with the time of analysis?
The key word of this intervention is: time.
Joana Alves, Challenges of Economic Evaluation, from Clinical Added Value to Sustainability
The importance of recognizing the existence of different perspectives was discussed, with an example regarding cost determination. An example was given of calculating indirect costs attributable to obesity in Portugal, and direct costs associated with hospitalizations related to obesity in the adult population. Another line of analysis has focused on the costs and consequences of food insecurity.
Conducting cost-effectiveness studies, including systematic reviews, is one of the main activities in this area of the centre’s work.
The central question arising from this intervention is: how to transform the knowledge generated into public policies?
The key word of this intervention is: measurement.
Pedro Laires, Challenges of Economic Evaluation, from Clinical Added Value to Sustainability
The development of practice-based activities was presented. There was a focus on discussing the challenges of advanced therapies, which have a very high initial cost but yield health gains over time. The existence of benefits spread over time, with costs concentrated in the present, leads to the search for different mechanisms.
Two approaches were focused on:
i) disease-focused evidence (improving the knowledge of basic epidemiology, burden, and cost of the disease), which requires baseline conditions that are a “public good” (in the sense that everyone can benefit from that foundation);
ii) product-focused evidence. This includes clinical trials, cost-effectiveness studies, and outcomes research studies (as the basis for re-evaluation).
The central emerging question is: if the evaluation of health technologies emerges as a “battlefield,” how can there be space to create evidence that is accepted by all stakeholders, on the basis of which objectives and values can build health policies?
The key word of this intervention is: evidence.
Julian Perelman, Integration of Care in a Fragmented System
The perspective of health economics on the organization and effects of interventions in health services was presented. The participation of economists in a multidisciplinary issue was highlighted. An example given was the evaluation of the creation of USFs (Family Health Units) with performance-based payment, which improved the incentivized indicators in the short term. Another example is the contribution to a new payment system in the area of mental health, with comprehensive payment per patient, with risk adjustment, based on value. This is an example of moving from theory to practice.
The question that arises from this intervention is: how to establish the scope of the evaluation to be performed, in which context, and with what objective?
The key word of this intervention is: behavior.
Ricardo Mestre, Integration of Care in a Fragmented System
It was noted that evaluation contributes to good governance and to strengthening the democratic process. One of the future themes mentioned was the reorganization of the National Health Service carried out in 2022/2023.
The question that arises from this intervention is: what is the balance between internal evaluations (by the political decision-maker) and external evaluations, considering the capacity to have data, technical capacity, impartiality, dedication, and the available time to perform them (including the capacity to accept public scrutiny)?
The key word that emerges from this intervention is: puzzle.
From the combination of these interventions, seven generic questions arise for the intervention of the Knowledge Centre, which practice will reveal the answers it can provide:
- How to navigate the political aspect (politics) of health policies (policies)?
- How to manage the potentially confidential relationship in the discussion of certain policies (regardless of whether the entity is public or private)?
- How to manage the difference between opinion (as an expert) and advocacy (defending a position)?
- How to decide the intervention in terms of ex-ante evaluation (before the policy is adopted), ex-post evaluation (what happened following the policy), and real-time evaluation (what is known while the policy is being implemented)?
- How to use the advantage of the University—having the time for reflection—to contribute to designing, monitoring, and evaluating public policies through values, methodologies, and the capacity to act quickly?
- How to construct the “puzzle” of monitoring and partial evaluations?
- How to move from “lamenting” to “solutions”?
All the various interventions provided answers to some of these questions.
The summary, in one long sentence, of this morning is: intervening in public policies implies independence and impartiality (avoiding conflicts of interest), while maintaining a balance between the rapid pace of action and the slower pace of reflection, using an accumulated stock of knowledge generated in a way that is accepted by all relevant stakeholders, explicitly considering the behaviors of individuals and groups—foreseeing beforehand and learning afterward—to design, monitor, and evaluate.
(Image generated by AI instruments)