Dear all,

I remember there was a warm discussion in the evidence-based list about
'World Health 2000' at the time it was published by WHO.

Recently I came across an editorial by Prof Alan Williams in Health
Economics (Williams, A (2001). Science or marketing at WHO? a commentary
on 'World Health 2000'. Health Economics 10: 93-100)

Alan Williams has severely criticized the report. Here I'll phrase some
of the points in the paper and in the end I will have two questions. I
think the editorial is really worth looking and discussing. After all
health policy is supposed to be evidence-based!

Yours
Arash Rashidian

** A brief view of the editorial by A Williams: **

He has written the editorial in four parts. First there is an
introductory part which explains the WHO' ambitions and goals behind the
report and also this point that World Health 2000 has measured two
groups of variables: 'measures of overall attainment' of the health
systems and 'measures of health system performance' in attaining that
level of health.

        In second part, Williams criticizes mainly the methodology of measuring
the overall attainment:

        a. producing "weight"s for measures: He says: "a general problem here
is the use of rankings, scores and rating scales rather confronting
people directly with trade-off between potentially competing objectives"

        b. Then he discusses about weaknesses in measurement of the five key
goals in the report (health level, health distribution, responsiveness
level, responsiveness distribution and fair financing). At the end of
this part he adds: 'So looking back over the construction of the
composite index for attainment we see that it is based on very little
actual data, which is often heavily manipulated to make it usable, and
then subjected to a great deal of rather canvas of world health which
the report purports to cover. A more virtuosic display of skating on
thin ice you are unlikely ever to witness.'

        In third part, health system performance measuring in the report has
been discussed.
        In final part which is 'reflections' he says: 'at a technical level
there is much ingenious analytical work behind this report, but it is
not robust enough to support the flimsy structure that has been created
from it...  ...Its [Health 2000's] normative content is dangerously
opaque, its interpretation is unclear, its implications vague, and it
does not seem to focus at all on any practical course of action that
anyone could take.' Hence 'this does not do the cause of promoting
evidence-based policy much good.'


Here are the questions:

        1. First of all is A. Williams level of criticism of the report
scientifically sound and reliable? Any evidence?
I should admit that his editorial has influenced my opinion very
strongly and I agree with most of it, but I would rather know how do you
think about it.

        2. What is the consequence of this report (if it is not valid and
evidence-based) on the world health? Specifically on developing
countries?

Williams has considered two examples of Denmark and USA quite frequently
in the editorial. I am asking about a developing country -with low level
of national income- which is (say) in 100th place in the World Health
2000 league table (just as an example, I do not know which country is
the 100th!).
My assumption is that this country (probably and correctly) will not try
to produce a system similar to which is available in the Japan (with
best position in the report). No match of economic and other elements.
However, what if it does try to make its own system similar to another
country which has got a better position in the table (say 80 or 70)?
Does this report provide reliable background for these sorts of policy
transfers?

If not what is it for?

Yours
Arash rashidian
--
Arash Rashidian, MD
Health Services Research Scholar
Department of Health Sciences and Clinical Evaluation
Alcuin College, University of York
York, YO10 5DD, UK
Tel: +44 (0)1904 434498
Mob: +44 (0)7870466148
Fax: +44 (0)1904 434517
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