A conceptual framework for public health: NICE's emerging approach

Abstract

This paper outlines the National Institute for Health and Clinical Excellence's (NICE) emerging conceptual framework for public health. This is based on the experience of the first 3 years of producing public health guidance at NICE (2005-2008). The framework has been used to shape the revisions to NICE's public health process and methods manuals for use post 2009, and will inform the public health guidance which NICE will produce from April 2009. The framework is based on the precept that both individual and population patterns of disease have causal mechanisms. These are analytically separate. Explanations of individual diseases involve the interaction between biological, social and related phenomena. Explanations of population patterns involve the same interactions, but also additional interactions between a range of other phenomena working in tandem. These are described. The causal pathways therefore involve the social, economic and political determinants of health, as well as psychological and biological factors. Four vectors of causation are identified: population, environmental, organizational and social. The interaction between the vectors and human behaviour are outlined. The bridge between the wider determinants and individual health outcomes is integration of the life course and the lifeworld.

Patients’ and health professionals’ views and experiences of atrial fibrillation and oral-anticoagulant therapy: A qualitative meta-synthesis

“…[39] The model of mixed evidence enables a holistic approach to evidence-based health care that contextualizes the biomedical data by also making sense of the social determinants of health which are critical when designing interventions for individuals leading complex lives. [40] This meta-synthesis clearly identifies the key challenges facing AF patients and healthcare professionals who manage their treatment, namely the importance of an early and accurate diagnosis, necessity of sufficient education pertaining to AF and available treatment, particularly OAC, and identification of patient barriers to treatment to improve adherence. This qualitative meta-synthesis highlights that central to all these I confirm all patient/personal identifiers have been removed or disguised so the patient/person(s) described are not identifiable and cannot be identified through the details of the story.…”

Theories of practice and public health: understanding (un)healthy practices

“…Eating, physical activity and alcohol consumption can all be analysed in the same way, as can forms of personal hygiene, occupational practices, and the myriad of things that create lifeworlds and patterns of inequalities in health (Kelly & Doohan, 2012;Kelly et al, 2009). From this it follows that health inequalities and epidemics of NCDs are the product of the lived experiences of social disadvantage.…”

Synthesizing diverse evidence: the use of primary qualitative data analysis methods and logic models in public health reviews

“…27 Briefly, the development of NICE public health guidance is informed by conceptual understanding of the causal pathways that influence health 27 and this understanding provides a theoretical rationale for potential interventions for improving health. The conceptual model is based on two premises.…”

“…The conceptual model distinguishes four causal vectors of population, environment, organisation and society and describes the interaction between these four vectors and human experience. 27 Following the limited findings using the conventional systematic review method, it was proposed to pilot a new approach to review by further developing the use of conceptual modelling. The four vector model was applied to conceptualise the factors associated with workplace mental wellbeing, based on initial searching and assessment of literatures in the field of occupational medicine, organisational psychology, organisational management and development as well as public health.…”