The Tellus Institute is an American non-profit organization established in 1976 with the aim of bringing scientific rigor and systemic vision to critical environmental and social issues. Tellus has conducted thousands of projects throughout the world, and now focuses on the global future and how to shape it..
Attempting to do "Futures" research is beset with many scientific and mathematical problems. One major question is what does it really mean to develop useful scenarios for the future to help one understand the likely impact of key policy issues that a researcher wants to address? And if it is hard to create a believable projection for the relevant system to be studied in a "business-asusual" scenario, is creating other types of Futures scenarios any more likely to be scientifically valid for doing policy research? Furthermore, what kinds of alternative Futures scenarios make sense to create, and how should the methodologies used to create them depend on the policy issues being addressed? This paper will attempt to address these questions in the context of what doing good science, the key ingredient, implies for doing useful futures research. Another more technical issue which besets the creation of Futures scenarios is the question of to what extent can statistical methodologies be scientifically valid in their creation, and how are statistical methodologies often misused in doing futures research? Finally, the key issue of how one can make each scenario of the future internally consistent and plausible, if one can, is addressed.
Abstract Background Government-led, population-wide initiatives are crucial for advancing the management of hypertension − a leading cause of cardiovascular disease (CVD) morbidity and mortality. An urban population health initiative was conducted against this backdrop, focussing on hypertension in the primary health system in São Paulo, Brazil. Within the frame of the initiative and under the supervision and leadership of the municipal health authorities, a situational analysis was conducted on the needs in hypertension management, marking the first phase of a Design Thinking process. This article describes the situational analysis process and presents the identified elements to be strengthened considering hypertension diagnosis, treatment and control. Methods First, a mixed-methods approach was used, starting with a literature review of municipal hypertension data followed by meetings (N = 20) with the local public health administration to assess health system level components. To investigate activities on hypertension diagnosis, treatment and control, nine primary healthcare units were selected from two districts of São Paulo city– Itaquera and Penha– which received an online form addressed to managers, participated in conversation circles of staff and patients, and underwent shadowing of community health agents. Results Data gave rise to two main outputs: (i) a patient care journey map; and (ii) a matrix summarizing the identified needs at patient, healthcare professional and health system level for diagnosis, treatment and control of hypertension. Patient awareness and knowledge of hypertension was found to be insufficient and its management needs to be improved. For health professionals, disease awareness, technical training, more time dedicated to patients, and simplified guidelines and clinical decision-making tools for hypertension management were identified as principal needs. The situational analysis found that the healthcare systems efficiency might be improved by establishing defined treatment and care delivery goals with a focus on outcomes and implemented through action plans. Conclusions This situational analysis identified several needs related to hypertension control in São Paulo that are in line with global challenges to improve the control of CVD risk factors. Findings were also confirmed locally in an expansion phase of this situational analysis to additional primary care facilities. As a consequence, solutions were designed, promptly taken up and implemented by the municipal health secretariat.
Background The urban population health initiative was designed as a multidisciplinary, multisector programme to address cardiovascular (CV) disease, specifically hypertension and its underlying causes in the cities of Ulaanbaatar, Mongolia; Dakar, Senegal; and São Paulo, Brazil. This article aims to provide an overview of the history and dynamics of CV disease policy making in the three countries, to present the policy reform contributions of the initiative and its role in the policy agenda-setting framework/process in each country and to identify the enablers and challenges to the initiative for doing so. Methods A qualitative case study was conducted for each setting from November 2020 to January 2021, comprised of a document review, semi-structured in-depth interviews and unstructured interviews with stakeholders involved in the initiative. The literature review included documents from the initiative and the peer-reviewed and grey literature with a total of 188 documents screened. Interviews were conducted with 21 stakeholders. Data collection and thematic analysis was guided by (i) the Kingdon multiple streams conceptual framework with the main themes being CV disease problems, policy, politics and the role of policy entrepreneurs; and (ii) the study question inquiring on the role of the urban population health initiative at the CV disease policy level and enabling and challenging factors to advancing CV disease policy. Data were thematically analysed using the Framework Method. Results Each setting was characterized by a high hypertension and CV disease burden combined with an aware and proactive political environment. Policy outcomes attributed to the initiative were updating the guidelines and/or algorithms of care for hypertension and including revised physical and nutritional education in school curricula, in each city. Overall, the urban health initiative’s effects in the policy arena, were most prominent in Mongolia and Senegal, where the team effectively acted as policy entrepreneur, promoting the solutions/policies in alignment with the most pressing local problems and in strong involvement with the political actors. The initiative was also involved in improving access to CV disease drugs at primary health levels. Its success was influenced by the local governance structures, the proximity of the initiative to the policy makers and the local needs. In Brazil, needs were expressed predominantly in the clinical practice. Conclusions This multi-country experience shows that, although the policy and political environment plays its role in shaping initiatives, often the local priority needs are the driving force behind wider change.
A functional and reliable Health Information System (HIS) is vital for data-based decision-making in public health. Here we describe the assessment of data processes and general HIS principles by adapting a global approach to three cities. The assessments supported the data strategy of the CARDIO4cities initiative in each city aiming to improve urban population health by increasing the use of cardiovascular disease (CVD) data to inform decision-making. We aimed to explore data collection processes and entities, data availability and quality as well as data ownership and sharing regarding a set of identified key performance indicators (KPIs). KPIs were based on a global theory of change (ToC) and a global evaluation and indicator framework and were tailored to each location. By first assessing existing sources and processes regarding data, recommendations for changes and improvements are sure to build on current circumstances. To map the data, existing data collection, analysis and storage processes were investigated. A flow chart was created to visualize the data pathways and challenges for each system and findings were compared across cities to document differences and similarities. Data quality and interoperability of various separate systems were the most prominent challenges for all HISs. The observed dvata quality issues originated from incorrect, missing and incomplete data and were connected to the misunderstanding of indicators, incomplete data input forms or the lack of a systematic data routine in the workflow. Harmonization of the HISs to ensure interoperability can facilitate data collection and analysis of health data and can provide a solid basis for health management decision-making. Based on the presented HIS cases, we recommend to examine, map and verify current processes when conducting a HIS assessment, to visualize findings and to gauge the interest of government entities to ensure political support.
