Nutrition and public health economic evaluations under the lenses of post normal science. (September 2019)

• Record Type: Journal Article
• Authors: Lo Piano, Samuele; Robinson, Marguerite
• Is Part Of: Futures. Volume 112(2019)
• Publication Date: 2019-09
• Subjects: DALY disability adjusted life years -- iTFA industrially produced Trans fatty acid -- MC Monte Carlo -- NCD non-communicable disease -- NICE National Institute for Health and Care Excellence -- NUSAP numeral unit spread assessment pedigree -- PNS post-normal science -- TFA Trans fatty acid -- YLD years lost for disability -- YLL years of life lost; Sensitivity analysis -- Sensitivity auditing -- Ethics of quantification -- Post-normal science -- Health economics -- Cost-benefit analysis; Economic forecasting -- Periodicals; Technological forecasting -- Periodicals; Economic policy -- Periodicals; Prévision économique -- Périodiques; Prévision technologique -- Périodiques; Politique économique -- Périodiques; Economic forecasting; Economic policy; Technological forecasting; Periodicals; Electronic journals; 330.0112
• DOI: 10.1016/j.futures.2019.06.008
• Languages: English
• ISSNs: 0016-3287

Abstract

Highlights: Tools from post-normal science inspiration such as sensitivity auditing were applied to health-economics models. Room for improvement has been identified in several respects. Modelling practices adopted in engineering and environmental modelling are suggested as new standard for the field. The adoption of these practices could imply the ultimate benefit to foster transparency and regain citizens trust. Abstract: The emerging scientific field of public health economics, considering health-related behaviours such as physical activity and smoking, is establishing itself as an important component in assessing the impact of policy interventions on preventing disease. Epidemiological evidence points to links between diet, lifestyle and non-communicable diseases (NCDs). Policy decisions aimed at preventing or reducing the burden of NCDs need credible, reliable and evidence-based scientific information. In this context, facts are uncertain and values are contested, while decisions are often urgent and the stakes are high, a typical setting for post-normal science (PNS). Therefore, this work applies quality tools developed in the context of PNS to models used in nutrition and public health economics, using as a guide the seven-point checklist of sensitivity auditing. This analysis has identified scope for improvement in a number of areas, such as the definition of the modelling exercise scope, the justification of the choice of family of models adopted, comprehensively framing the issue by including the perspective of relevant stakeholders and the exertion of more care in justifying assumptions. Addressing these dimensions may even result in refraining from producing a quantitative assessment when the circumstances do not hold. This would conflict with the common imperative to quantify in regulatory policies - often requested by policy guidelines - and with the dynamics of the policy cycle. For this reason, we discuss the implied trade-offs, contradictions and way forward with an eye to achieving progress in the practice.