Development of prevention targets

Status:

completed 12/2006

Aims:

An increasing need exists in Germany for agreement on prevention targets. Measures and services for primary prevention and the promotion of health are to be aligned to targets and delivered in a co-ordinated fashion in order for more visible success to be achieved in prevention. In consideration of the available resources, which are limited and in some cases diminishing even further, prevention activities are thereby to be targeted and concentrated more effectively. Prevention targets also enable the success or otherwise of preventive action to be assessed more accurately. One benefit of this is the sustainability of successful preventive action.

Activities/Methods:

No standardized procedure exists for the development of prevention targets. A general distinction can be drawn between scientific and participative methods. The proposed procedure involves committee decisions based upon scientific knowledge, thereby merging scientific and participative elements. During the process, certain steps are performed separately for the targets of primary prevention and those of health promotion, whereas others are applied in the same way to both target areas.

A hierarchical, morbidity-based target system is proposed for the area of primary prevention. This encompasses a small number of higher-level, non-quantified generic targets of direct relevance to disease, e.g. "reduction of diseases of the musculoskeletal system". Based upon these generic targets, specific targets are defined for relevant aspects of prevention: behaviour, conditions and target groups. During development of targets for primary prevention, the first stage therefore entails the definition of criteria by which diseases and accidents can be ranked as far as possible according to objective aspects. In order to assure the greatest possible objectivity, only criteria for which reliable data are available if at all possible are selected in this step. Such criteria include incapacity for work, mortality, costs, etc. These different criteria are intended to reflect the different facets of the relevance of the disease or accident type in question. In the second step, the data are then evaluated against the predefined criteria, and diseases and accidents thus ranked. The result of this step is therefore a ranked list showing the diseases and accidents which can be regarded as being the most severe across a range of criteria. This prioritization procedure is thus conducted as objectively as possible.

The procedure for the definition of targets in the area of health promotion differs fundamentally from this data-based approach. A hierarchical system of targets with a small number of key targets selected as priorities is not appropriate in this area. It is therefore proposed that targets of equal priority be defined for the area of health promotion. The first step involved setting out which health promotion concepts are relevant. Based upon the results, the values and strategies currently of the greatest importance for the world of work were selected in the second step.

Following the first two steps, which are scientific in their structure, the subsequent steps revealed that the ultimate definition of the generic and specific targets cannot be based exclusively upon objective aspects: further criteria exist which must be observed during selection of the generic targets, criteria for which, however, no correspondingly comprehensive data are available. Recourse must instead be made at this point to the estimation of experts. In addition, international initiatives have shown that in the main, targets are more readily accepted and implemented when relevant experts have been involved in the process of their definition. The third and fourth steps were therefore conducted in the context of discussions between experts: based upon the preliminary selection of diseases, and concepts and prioritized values for health promotion, the generic targets were then defined in the third step in consideration of additional criteria. In the fourth step, the experts defined and quantified the specific targets. For primary prevention, specific targets were formulated in relation to modes of behaviour, conditions and target groups. The discussions between experts required careful preparation. At the fifth step, a final decision is taken on a political committee which has yet to be formed for the purpose. The common prevention targets of the health and accident insurance institutions for the occupational sphere are adopted on this committee in the form of generic and specific targets.

The attainment of targets is to be subject to continual monitoring. At intervals yet to be defined, a feedback loop is to be created by regular review of whether the targets are still appropriate or require realignment.

Results:

The following target development processes were/are being monitored and supported by the IGA work and health initiative:

- Development of prevention targets for the statutory health insurance system
- Development of prevention targets for the BGs for the administrative and meat-processing sectors
- Identification of topics for a prevention campaign in 2010/2011
- Support for the common OH&S strategy during the development of OH&S targets

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