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