DATA-DRIVEN DECISION MAKING AND STAKEHOLDERS INVOLVEMENT IN PUBLIC HEALTH. A FASCINATING CHALLENGE FOR A SUSTAINABLE DEVELOPMENT

Over the last 200 years, life expectancy has more than doubled in Western countries, from 40 years at the beginning of the 19th century to about 80, with improvement in health and life quality. The widest gain in life expectancy was between 1880 and 1920, mostly thanks to public health improvements like foods safety, clean water, sanitation, the large production and distribution of vaccines and the study and delivery of important educational topics like personal hygiene, air quality, or healthy housing. From 1920 to today, an epidemiological transition occurred, gradually displacing the pandemics of infection by chronic diseases. This led to a disruptive change in facing public health characterized by an increasing use of epidemiological tools, data and a lot of information about population, to use to guide intervention. Globalization further complicated the picture, creating connections and interdependence among countries, increasingly related one another regardless of national borders, in a growing context of economic integration, communication, cultural and travel diffusion. This played an unexpected role in the burden and distribution of determinants of health. Health care systems all over the world need a right governance and a high resilience to promote the positive determinants of health and limit the negative ones: indeed, their unmanaged distribution among the population seriously undermines the sustainability of the system itself. A system is said to be sustainable if it meets the needs of the present without compromising the ability of future generations to meet their own needs. Long-term sustainability of healthcare systems is not only about finance and affordability, nor about efficiency and effectiveness; it also depends on different, cross-sectoral factors that can rapidly change or interfere with one another. In the complexity described above, Public Health challenge may be faced through two essential tools: data-driven decision-making and stakeholders’ involvement. First, in the era of “Big Data”, healthcare organizations and systems have to deal with the current growing amount of healthcare data. This means having a wider picture of populations based on a broad set of variables. Consequently, on one hand Evidence Based Public Health (EBPH) uses the data coming from the best available evidence in order to standardize the public health decision making process in the intervention context. On the other, personalized public health (PPH), uses data to stratify the population, in order to address the right public health interventions to the right targets. Second, the engagement of stakeholders is proved to contribute to resilience and flexibility, to learning opportunities and innovation, to the identification of new opportunities, and to the improvement of sustainable performance. The WHO Global Strategy for Women’s, Children’s and Adolescents’ Health (2016- 2030) emphasizes the need to bring together many stakeholders as agents of change. Stakeholders’ involvement can be fostered in 6 steps: first of all, there is the need to identify stakeholders, secondly defining roles and resources per each of them; third, it is necessary to detect dynamics among stakeholders; fourth, the optimal stakeholder group must be identified; fifth, a stakeholder engagement plan must be created and, finally, the level of engagement must be continuously monitored. This way of working requires the ability to interact with many people, matching together different values and perspectives to achieve a common goal. That’s why public health experts’ leadership plays a fundamental role in health programs planning: leaders should have a vision of what can be reached and must be able to communicate it to the others; they also should motivate people and manage the team dynamics, being able to negotiate for support. Nowadays, it is proved that one of the most important stakeholders to involve in order to realize an effective public health intervention is the community itself. The importance of community participation was stated back in 1978 in the Alma Ata Declaration. Since then, it’s clear that communities need to play an active role in driving decisions to improve the quality of health services, access and equity. People and their communities should be at the center of healthcare systems, because this increases the effectiveness, decreases the costs, improves health literacy and patient engagement. Technology development must be considered, too. It changed the way human beings and data are connected. In fact, the current technological infrastructure allows for the storage and linkage of a huge amount of data: in the vision of EBPH, it means the smart access to the best available evidence on a specific topic; in the perspective of PPH, it means to integrate many population data to better tailor a health intervention on a specific population. It could be very helpful also to engage stakeholders: theoretically, there are no more physical barriers to isolate a possible partner, from an institutional organization to the most remote population. Community energies and knowledge is naturally on air, people who can access Information and Communication Technologies (ICT) share their opinion in every moment, without being asked about it. Today, engaged community using ICT, the so-called Smart Communities, are growing up in many places all over the world, supporting the implementation of numerous health promotion and prevention initiatives. The development of community programs can be a unique solution to address sustainability and innovation by generating a real community engagement. So, the two data clouds of EBPH and PPH become a trilogy: there is the cloud of community data related to lot of features such as population health data, community values, preferences, priorities and so on. In the portrait of this complex reality, Public Health should have an essential role in the regulation of light and shadow. There are available data, people, resources and ideas: public health professionals can be the enzyme which sparks the reaction among the chemicals.