Refocusing upstream: Operational Research for population health

Abstract

This paper examines the potential for the application of OR methods to ‘upstream’ problems in health sector planning. These address the underlying causes of ill health, and stand in contrast to ‘downstream’ health service planning which addresses the consequences of ill health. The paper reviews the emergence, globally and locally, of recognition of the importance of upstream planning and policy formation for the health sectors of both developed and developing countries. It presents examples of the use of OR techniques in upstream health planning, with particular illustrations taken from the area of health impact assessment. It argues for a fuller appreciation of the potential contribution of OR in this and in other areas of upstream health sector planning.

Keywords:

• health sector planning
• problem structuring methods
• health impact assessment

²Formerly, Department of Epidemiology & Public Health, University College Cork, Cork, UK.

²Formerly, Department of Epidemiology & Public Health, University College Cork, Cork, UK.

Acknowledgements

The case study presented in this paper is based on material which was commissioned by the Irish Health Research Board at the request of the Department of the Environment and Local Government. The views expressed in this paper reflect the views of the author and do not necessarily represent those of the Health Research Board or the Department of the Environment and Local Government. I acknowledge the support of the Health Research Board in undertaking the substantive study. The study was lead by a team from the Department of Public Health Medicine and Epidemiology from University College Dublin. The inputs of Dr Dominique Crowley, Dr Anthony Staines and Dr Claire Collins, in particular, are gratefully acknowledged. The author is also grateful to two anonymous referees whose recommendations and suggestions were most helpful.