Smoking is the single biggest cause of preventable death in the Uited Kingdom (UK) and is a major cause of coronary heart disease, some cancers, and respiratory disease, including chronic obstructive pulmonary disease. At the time of initiating the project, smoking prevalence had not changed across four local government areas in South Yorkshire for some years. Most spending had been focussed on helping people quit, an intervention where there was clear evidence of effectiveness. A number of changes occurred in public health structures and targets, requiring a reappraisal of the range of interventions offered. This was challenging due to a lack of clear evidence for some of the areas' alternative interventions. The aim of this paper is to describe the use of a multi-criteria decision analysis (MCDA) approach to support the health priority setting in local authorities to reduce smoking prevalence. There were three phases to this process: (1) problem structuring; (2) the multiple criteria decision analysis; (3) and using the MCDA results to influence decision making at the local government level. The MCDA approach was used to collate information in a consistent and transparent manner, using expert, stakeholder and public opinion to fill known gaps in evidence. Fifteen interventions (such as stop smoking support services, smoke-free spaces, communication and marketing exercises, and increased investment in enforcement) were ranked across eight criteria (relating to reductions in prevalence across relevant groups, as well as aspects relating to equity and feasibility), allowing a range of relevant concerns to be incorporated. Subsequent steps were taken to translate the results of this stage into workable policy options. The results differed significantly from current practice. Sensitivity analysis showed that the findings were robust to changes in preference weights. These results informed subsequent changes to the interventions offered across the four boroughs. The ability of MCDA techniques to incorporate data and both qualitative and quantitative judgements in a formal manner mean that they are well suited to support public health decision making, where evidence is often only partially available and many policies are value driven. MCDA methods, if used, should be chosen carefully based on their resource/time constraints, scientific validity, and the significance and broader context of the decision problem.Keywords MCDA Á Public health policy Á Health economics Á Tobacco interventions Á Evidence-based decision making BackgroundSmoking is the single biggest cause of preventable death in the United Kingdom (UK). Smoking is a major cause of coronary heart disease, some cancers and respiratory disease, including chronic obstructive pulmonary disease. These diseases have the greatest impact on the least well off in society and it is estimated that up to half the difference in premature death between the most and least affluent groups is explained by different patterns in smoking (Jarvis and Wardle 1999). Despi...
One might be forgiven for suppressing a groan on reading the title of this work -Fontane, women and humanity, surely old hat? The study itself pleasantly disappoints the reader's expectations. The first third is devoted to a wellinformed discussion of current thinking on realism in literature, not dry theory, but an account laced with well-chosen quotations and lively argument. Frei also considers contemporary reception of Fontane's works, bringing out the significance of late nineteenth-century views of literature and society and pointing up Fontane's position as an unconventional thinker in a conventionridden milieu. He examines carefully Fontane's concept of realism, distinguishing between 'Wirklichkeit' (reality) and 'Wahrheit' (truth). He points out, as others have before, that the human being is the novelist's central concern, and other aspects of reality are only of interest in so far as they impinge upon man and shape his life. H. Ohl has pursued a similar argument with regard to the role of natural settings in the works. The background milieu which Fontane represents is seen in terms of the scope for development and selfrealization it affords or withholds from individual characters. To this extent, in terms of the development of the essential human qualities of naturalness, human warmth and openness to the world, political reality is an important issue, for it in turn influences social behaviour. Frei traces in precise terms the nature of Fontane's criticism of his milieu. For example, he refers to &dquo;die Unmenge der Klagen Fontanes uber die markische Enge und die Unentwickeltheit Berlins wahrend der 50er und 60er Jahre. Dem Beobachtungsdrang, 'ganz besonders' auf 'das Gesellschaftliche' gerichtet, entsprach die preuf3ische Nuchternheit und
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