Intelligence for Health Governance: Innovation in the Monitoring of Health and Well-Being

  • Ildefonso Hernández-Aguado
  • Lucy Anne Parker


Good health governance requires appropriate health intelligence, and consequently, health information needs to be reshaped in order to foster health policy innovation. Several key aspects should pervade the new approaches to the management of health information: advocacy, monitoring broad health determinants, accountability, and transparency. Strong advocacy is needed if we wish to convince non-health sectors of the relevance of health in their policies. Successful advocacy is based on new and innovative ways of framing health information which contributes to moving health higher up the media, public, and policy agendas. The goal is to put across the effects that all societal sectors have on health and well-being. Advocacy in the terms mentioned is also required to transform public health from an underfunded pyramidal bureaucracy into a strengthened public health with higher-profile leadership. This represents a shift of approach from an individual-centred prevention linked to health services to a public health that makes healthy choices easier and is capable of promoting multifaceted policies from diverse sectors emerging through network governance.

We also propose the monitoring of the social determinants which have an established relationship with health. Health outcomes are usually the long-term effects of exposures that act during the whole life course. Consequently, in order to measure the effects of policies which take decades to manifest, we need to assess the evolution of health determinants addressed by these policies. In fact, responsibility for health is now so diffused at various levels and different sectors that it is very important to point out through appropriate information who is accountable for relevant health issues such as inequalities.

Health-related information should be produced and framed in a way that is suited to the relevant level of governance in order to target accountability and transparency. The aim is to identify what part of government (local, national, regional, or global) is accountable for any health-related issue. Recent innovations such as health impact assessment are the starting point for the development of policy-linked indicators: “avoidable burden of disease by policies” or “health expectancy gained through policy.” These indicators may be estimated at every governance level and are understandable to policy makers and to the public. Transparency and intelligibility of health information is a keystone for population engagement that brings about demands for political actions in health, and consequently should guide innovation in health monitoring.

Although, as far as possible, new policies must be evidence based, the absence of evidence is a stimulus to innovation. Future advances in the monitoring of health and well-being must combine research and implementation. The challenges are evaluation of complex social programs; proper surveillance of new policies with health effects; provision of good data on the economic and social effects of health investment; assurance of a high societal visibility of health issues; and engagement of all stakeholders in the call for accountability and transparency.


Health Information Health Impact Assessment Public Health Surveillance Health Determinant Health Investment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Marinker M, editor. Targets in Europe. Polity, Progress and Promise. London: BMJ Books; 2002.Google Scholar
  2. 2.
    Kickbusch I. Perspectives in health governance in the 21st century. In: Marinker M, editor. Targets in Europe. Polity, Progress and Promise. London: BMJ Books; 2002. p. 206–29.Google Scholar
  3. 3.
    Marinker M. Health policy and the constructive conversationalist. In: Marinker M, editor. Constructive Conversations About Health. Policy and Values. Oxon: Radcliffe Publishining Ltd; 2006. p. 1–16.Google Scholar
  4. 4.
    Carlsson P, Garpenby P. Democracy. In: arinker M, editor. Constructive Conversations About Health. Policy and Values. Oxon: Radcliffe Publishing Ltd; 2006. p. 63–74.Google Scholar
  5. 5.
    World Health Organisation. Healthy Cities Around the World: An Overview of the Healthy Cities Movement in the Six WHO Regions. Published on the Occasion of the 2003 International Healthy Cities Conference, Belfast, Northern Ireland, United Kingdom, 19–22 October 2003. Copenhagen, Denmark: WHO Regional Office; 2003.Google Scholar
  6. 6.
    Ottawa Charter for Health Promotion. In: Health Promotion. Vol. 1. Geneva: World Health Organization; 1986. p. iii–v.Google Scholar
  7. 7.
    Rose G. The Strategy of Preventive Medicine. Oxford, England: Oxford University Press Inc; 1992.Google Scholar
  8. 8.
    WHO. Second International Conference on Health Promotion. Adelaide Recommendations on Healthy Public Policy [Online], 1988 [cited 15th Mar 2008]. Available from:
  9. 9.
    Berkman LF, Kawachi I, editors. Social Epidemiology. New York: Oxford University Press; 2000.Google Scholar
  10. 10.
    Kawachi I, Kennedy BP, Wilkinson RG, editors. The Society and Population Helath Reader. Vol. 1: Income Inequality and Health. New York: The New Press; 1999.Google Scholar
  11. 11.
    Marmot MM, Wilkinson RG, editors. Social Determinants of Health. New York: Oxford University Press; 1999.Google Scholar
  12. 12.
    Kawachi I, Berkman LF, Neighbourhoods and Health. New York: Oxford University Press; 2003.CrossRefGoogle Scholar
  13. 13.
    Mackenbach J, Bakker M. Reducing Inequalities in Health: A European Perspective. London: Routledge; 2002.Google Scholar
  14. 14.
    Leon D, Walt G. Poverty Inequality and Health: An International Perspective. New York: Oxford University Press; 2001.Google Scholar
  15. 15.
    Kawachi I, Kennedy BP. The Health of the Nations: Why Inequality is Harmful to Your Health. New York: The New Press; 2002.Google Scholar
  16. 16.
    Ståhl T, Wismar T, Ollila E, Lahtinen E,Leppo K. Health in All Policies, Prospects and Potentials. Helsinki: Ministry of Social Affairs and Health; 2006.Google Scholar
  17. 17.
    Kickbusch I. Tackling the political determinants of global health. BMJ. 2005;331:246–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Sakellarides C. Stewardship. In: Marinker M. Constructive Conversations About Health. Policy and Values. Oxford: Radcliffe Publishing, 2006. p. 76–90.Google Scholar
  19. 19.
    Boerma JT, Stansfield SK. Health statistics now: are we making the right investments? Lancet 2007;369:779–86.PubMedCrossRefGoogle Scholar
  20. 20.
    Murray CJL. Towards good practice for health statistics: lessons from the Millennium Development Goal health indicators. Lancet 2007;369:862–73.PubMedCrossRefGoogle Scholar
  21. 21.
    Walker N, Bryce J, Black RE. Interpreting health statistics for policymaking: the story behind the headlines. Lancet 2007;369:956–63.PubMedCrossRefGoogle Scholar
  22. 22.
    AbouZahr C, Adjei S, Kanchanachitra C. From data to policy: good practices and cautionary tales. Lancet 2007;369:1039–46.PubMedCrossRefGoogle Scholar
  23. 23.
    Health at a Glance 2007 – OECD Indicators. [Online] OECD; 13 Nov 2007 [cited 10th Jan 2008]. Available from: = 2288030/cl = 13/nw = 1/rpsv/health2007/index.htm
  24. 24.
    Kramers PGN. The ECHI project. health indicators for the European Community. Eur J Public Health 2003;13(Suppl. 3):101–6.PubMedGoogle Scholar
  25. 25.
    Eurostat. Structural indicators. [Online] Eurostat; 2007 [cited 10th Jan 2008]. Available from: = 1133,47800773,1133_47802588&_dad = portal&_schema = PORTAL
  26. 26.
    Lundgren B. 2004. Indicators for Monitoring the New Swedish Public Health Policy. Stockholm, Sweden: Unit Public Health Policy Anal., Natl. Inst. Public Health.Google Scholar
  27. 27.
    National Centre for Health Statistics. Healthy People 2010. Leading Health Indicators at a Glance. [Online] National Centre for Health Statistics: 2007 [cited 10th Jan 2008]. Available from:
  28. 28.
    European Commission Public health. Health strategy. [Online] European Commission; 2007? [cited 14th Mar 2008]. Available from: health_strategy_en.htm
  29. 29.
    Loue S. Community health advocacy. J Epidemiol Community Health. 2006;60:458–63.PubMedCrossRefGoogle Scholar
  30. 30.
    Boarini R, Johansson A, Mira d’Ercole M. Alternative Measures of Well-Being. OECD Statistical Brief No. 11. Paris: Statistical Directorate of the OECD; 2006 May.Google Scholar
  31. 31.
    Diener E. Happiness Accounts for Policy Use. Keynote Speech in International Conference: Is Happiness Measurable and What do Those Measures Mean for Policy? Rome, 2–3 April 2007. University of Rome “Tor Vergata” Italy. OECD; 2007Google Scholar
  32. 32.
    Canoy M. Well-Being and Policy Making. Presentation in International Conference: Is Happiness Measurable and What do Those Measures Mean for Policy? Rome, 2–3 April 2007. University of Rome “Tor Vergata” Italy. OECD; 2007Google Scholar
  33. 33.
    Veenhoven R. Measures of Gross National Happiness. Presentation in International Conference: Is Happiness Measurable and What Do Those Measures Mean for Policy? Rome, 2–3 April 2007. University of Rome “Tor Vergata” Italy. OECD; 2007Google Scholar
  34. 34.
    WHO Commission on the Social Determinants of Health. A Conceptual Framework for Action on the Social Determinants of Health. [Online] CSDH; April 2007 Draft. [cited 15th Jan 2008]. Available from: framework_action_05_07.pdf.
  35. 35.
    Nolte E, McKee M. Measuring the health of nations: updating an earlier analysis. Health Aff 2008; 27:58–71.CrossRefGoogle Scholar
  36. 36.
    Raffle AE, Alden B, Quinn M, Babb PJ, Brett MT. Outcomes of screening to prevent cancer: analysis of cumulative incidence of cervical abnormality and modelling of cases and deaths prevented. BMJ. 2003;316:901–5.CrossRefGoogle Scholar
  37. 37.
    Danzon M. The values of values. In: Marinker M, editor. Constructive Conversations About Health. Policy and Values. Oxon: Radcliffe Publishining Ltd; 2006. p. 17–29.Google Scholar
  38. 38.
    Society at a glance 2005 – OECD Social Indicators. [Online] OECD; 2006? [cited 14th Mar 2008]. Available from:,3343,en_2825_497118_ 2671576_1_1_1_1,00.html
  39. 39.
    Bauer G, Davies JK, Pelikan J on behalf of the EUPHID theory working group and the EUPHID community. The EUPHID health development model for the classification of public health indicators. Health Promot Int. 2006;21:153–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Agren G. Sweden’s new public health policy. National public health objectives for Sweden. Report 2003:58. Stockholm, Sweden; Swedish National Institute of Public Health; 2003.Google Scholar
  41. 41.
    UNDP: United Nations Development Programme. Technical note 1: Calculating the Human Development Indices. United Nations Development Report 2006 [Online] UNDP; 2006 [cited 5th Sept 2007]. Available from: technical_note_1.pdf
  42. 42.
    Cobb C, Halstead T, Rowe J. The Genuine Progress Indicator: Summary of Data and Methodology. San Francisco: Redefining Progress; 1995.Google Scholar
  43. 43.
    Diener E. A value based index for measuring national quality of life. Soc Indic Res 1995;36:107–27.CrossRefGoogle Scholar
  44. 44.
    Save the Children. The State of the World’s Mothers 2002: Mothers and Children in War and Conflict. A Save the Children Publication. Westport: Save the Children; 2002.Google Scholar
  45. 45.
    Emes J, Hahn T. Measuring Development: An Index of Human Progress. A Fraser Institute Occasional Paper. (No. 36) Vancouver: The Fraser Institute; 2001.Google Scholar
  46. 46.
    Estes, R. Table 1: The Index of Social Progress (ISP2000, WISP2000). [Online] University of Pennsylvania [cited 5 Sept 2007]. Available from:∼restes/WISP2000/ Table%201%20Indicators.pdfGoogle Scholar
  47. 47.
    Prescott-Allen R. The Well-Being of Nations: A Country-by-Country Index of Quality of Life and the Environment. IDRC/Island Press; 2001.Google Scholar
  48. 48.
    Boelhouwer J, Stoop I. Measuring well-being in the Netherlands: the SCP index from 1974 to 1997. Soc Indic Res 1999;48(1):51–75.CrossRefGoogle Scholar
  49. 49.
    EUSI: European System of Social Indicators. Calculation of Composite Index of Individual Living Conditions. European System of Social Indicators [Online] GESIS German Social Sciences Infrastructure Services, ZUMA. Page last updated 2007 July 20 [cited 5 Sept 2007]. Available from: pdf_files/Doku_Index_Constr.pdf
  50. 50.
    Miringoff M and Miringoff M. The Social Health of the Nation: How America is Really Doing. New York: Oxford University Press; 1999.Google Scholar
  51. 51.
    Atkinson Foundation. Canadian Index of Well-being: Measuring What Matters. CIW [Online] The Atkinson Charitable Foundation [cited 5 Sept 2007]. Available from:
  52. 52.
    Miringoff ML, Opdycke S. America’s Social Health. Putting Social Issues Back on the Public Agenda. New York: ME Sharpe; 2008.Google Scholar
  53. 53.
    Desjardins and T. Schuller, editors. Measuring the Effects of Education on Health and Civic Engagement: Proceedings of the Copenhagen Symposium. OECD Directorate of Education, Centre for Educational Research and Innovation. Paris: OECD; 2006Google Scholar
  54. 54.
    Huisman M, Kunst AE, Bopp M et al. Educational inequalities in cause-specific mortality in middle-aged and older men and women in eight western European populations. Lancet 2005;365:493–500.PubMedGoogle Scholar
  55. 55.
    Pensola T, Martikainen P. Life-course experiences and mortality by adult social class among young men. Soc Sci Med 2004;58:2149–70.PubMedCrossRefGoogle Scholar
  56. 56.
    Steenland K, Henley J, Thun M. All-cause and cause-specific death rates by educational status for two million people in two American Cancer Society cohorts, 1959–1996. Am J Epidemiol 2002;156:11–21.PubMedCrossRefGoogle Scholar
  57. 57.
    Kuh D, Ben-Shlomo Y, Lynch J, Hallqvist J, Power C. Life course epidemiology. J Epidemiol Community Health 2003;57:778–83.PubMedCrossRefGoogle Scholar
  58. 58.
    Ezzati M, Lopez AD, Rodgers A, Hoorn SV, Murray CJL and the Comparative Risk Assessment Collaborating Group. Selected major risk factors and global and regional burden of disease. Lancet 2002;360:1347–60.PubMedCrossRefGoogle Scholar
  59. 59.
    McDowell I, Spasoff RA, Kristjansson B. On the classification of population health measures. Am J Public Health. 2004;94:388–93.PubMedCrossRefGoogle Scholar
  60. 60.
    WHO European Centre for Health Policy. Health Impact Assessment. Main concepts and suggested approach. Gothenburg Consensus paper, Dec 1999. Copenhagen; WHO Regional Office for Europe: 1999.Google Scholar
  61. 61.
    Mindell J, Ison E, Joffe M. A glossary for health impact assessment. J Epidemiol Community Health 2003;57:647–51.PubMedCrossRefGoogle Scholar
  62. 62.
    European Observatory on Health Systems and Policies, Wismar M, Blau J, Ernst K, Figueras J, editors. The Effectiveness of Health Impact Assessment. Scope and Limitations of Supporting Decision-Making in Europe. Copenhagen: Regional Office for Europe, World Health Organization; 2007.Google Scholar
  63. 63.
    Wismar M, Blau J, Ernst K et al. Implementation and institutionalizing HIA in Europe. In: European Observatory on Health Systems and Policies. The Effectiveness of Health Impact Assessment. Scope and Limitations of Supporting Decision-Making in Europe. Copenhagen: Regional Office for Europe, World Health Organization; 2007. p. 57–78.Google Scholar
  64. 64.
    Veerman L, Bekker M, Mackenbach J. Health impact assessment and advocacy: a challenging combination. Soz Praventivmed 2006;51:151–2.PubMedCrossRefGoogle Scholar
  65. 65.
    European Commission. WHITE PAPER. Together for Health: A Strategic Approach for the EU 2008–2013. Brussels: Commission of the European communities; 2007Google Scholar
  66. 66.
    Seymour JD, Yaroch AL, Serdula M, Blanck HM, Khan LK. Impact of nutrition environmental interventions on point-of-purchase behavior in adults: a review. Prev Med. 2004;39(Suppl. 2):S108–36.PubMedCrossRefGoogle Scholar
  67. 67.
    Fewtrell L, Kaufmann R, Prüss-Üstün A. Lead: assessing the environmental burden of disease at national and local level. Geneva, World Health Organization, 2003 (WHO Environmental Burden of Disease Series, No. 2)Google Scholar
  68. 68.
    Cole BL, Fielding JE. Health impact assessment: a tool to help policy makers understand health beyond health care. Annu Rev Public Health. 2007;28:393–412.PubMedCrossRefGoogle Scholar
  69. 69.
    Boyd DR, Genuis SJ. The environmental burden of disease in Canada: Respiratory disease, cardiovascular disease, cancer, and congenital affliction. Environ Res. 2008 Feb;106(2): 240–9. Epub 2007 Sep 29. PMID: 17904543 [PubMed – in process]Google Scholar
  70. 70.
    Mindell J, Joffe M. Predicted health impacts of urban air quality management. J Epidemiol Community Health. 2004;58:103–13.PubMedCrossRefGoogle Scholar
  71. 71.
    Valent F, Little D, Bertollini R, Nemer LE, Barbone F, Tamburlini G. Burden of disease attributable to selected environmental factors and injury among children and adolescents in Europe. Lancet. 2004;363:2032–9.PubMedCrossRefGoogle Scholar
  72. 72.
    Stafford M, Cummins S, Ellaway A, Sacker A, Wiggins RD, Macintyre S. Pathways to obesity: identifying local, modifiable determinants of physical activity and diet. Soc Sci Med. 2007;65:1882–97.PubMedCrossRefGoogle Scholar
  73. 73.
    Frank LD, Saelens BE, Powell KE, Chapman JE.Stepping towards causation: do built environments or neighborhood and travel preferences explain physical activity, driving, and obesity? Soc Sci Med. 2007;65:1898–914.PubMedCrossRefGoogle Scholar
  74. 74.
    Gauvin L, Riva M, Barnett T, Richard L, Craig CL, Spivock M, Laforest S, Laberge S, Fournel MC, Gagnon H, Gagné S. Association between neighborhood active living potential and walking. Am J Epidemiol. 2008 Jan 27; [Epub ahead of print] PMID: 18227097 [PubMed – as supplied by publisher]Google Scholar
  75. 75.
    Kelly CM, Schootman M, Baker EA, Barnidge EK, Lemes A. The association of sidewalk walkability and physical disorder with area-level race and poverty. J Epidemiol Community Health. 2007;61:978–83.PubMedCrossRefGoogle Scholar
  76. 76.
    Murray CJL, Lauer JA, Hutubessy RCW et al. Effectiveness and costs of interventions to lower systolic blood pressure and cholesterol: a global and regional analysis on reduction of cardiovascular-disease risk. Lancet. 2003;361;717–25.PubMedCrossRefGoogle Scholar
  77. 77.
    Asaria P, Chisholm D, Mathers C, Ezzati M, Beaglehole R. Chronic disease prevention:health effects and financial costs of strategies to reduce salt and control tobacco use. Lancet. 2007;370:2044–53.PubMedCrossRefGoogle Scholar
  78. 78.
    Haby M, Vos T, Carter R et al. A new approach to assessing the health benefit from obesity interventions in children and adolescents. Int J Obesity 2006;30:1463–75.CrossRefGoogle Scholar
  79. 79.
    Segal L, Daziel K. Economic evaluation of obesity interventions in children and adults. Int J Obesity 2007;31:1183–4.CrossRefGoogle Scholar
  80. 80.
    McPherson K, Marsh T, Brown M. Foresight Tackling Obesities: Future Choices – Modelling Future Trends in Obesity and the Impact on Health (2nd ed.). UK: Department of Innovation Universities and Skills, Government Office for Science; 2007.Google Scholar
  81. 81.
    Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006;367:1747–57.PubMedCrossRefGoogle Scholar
  82. 82.
    Powles J, Day N. Interpreting the global burden of disease. Lancet. 2002;360:1342–3.PubMedCrossRefGoogle Scholar
  83. 83.
    Roosli M, Künzli N, Braun-Fahrländer C, Egger M. Years of life lost attributable to air pollution in Switzerland: dynamic exposure-response model. Int J Epidemiol, 2005;34: 1029–35.PubMedCrossRefGoogle Scholar
  84. 84.
    Bere E, Veierod M, Skare O, Klepp KI. Free school fruit – sustained effect three years later. Int J Behav Nutr Phys Act. 2007;4:5–11.PubMedCrossRefGoogle Scholar
  85. 85.
    Rodgers A, Ezzati M, Vander Hoorn S et al. Distribution of major health risks: Findings from the global burden of disease study. PLOS Med. 2004;1(1. e27):44–55.Google Scholar
  86. 86.
    Künzli N, Perez L. The Public Health Benefits from Reducing Air Pollution in the Barcelona Metropolitan Area. Barcelona: Centre recerca en epidemiologia ambiental (CREAL) Publication. 2007.Google Scholar
  87. 87.
    Suhrcke M, McKee M, Sauto Arce R, Tsolova S, Mortensen J. The Contribution of Health to the Economy in the European Union. Luxembourg: Office for Official Publications of the European Communities; 2005.Google Scholar
  88. 88.
    Mills PR, Kessler RC, Cooper J, Sullivan S. Impact of a health promotion program on employee health risks and work productivity. Am J Health Promot. 2007;22:45–53.PubMedCrossRefGoogle Scholar
  89. 89.
    Miller P, Murphy S. Demonstrating the economic value of investments in health at work: not just a measurement problem. Occup Med (London) 2006;56:3–5.CrossRefGoogle Scholar
  90. 90.
    Madon T, Hofman KJ, Kupfer L, Glass RI. Implementation science. Science 2007;318:728–9CrossRefGoogle Scholar
  91. 91.
    Cohn D. Jumping into political fray: academics and policy making. IRPP Policy Matters 2006;7(3):1–36.Google Scholar

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© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Department of Public HealthFacultad de Medicina, Universidad Miguel HernándezCampus de San JuanSpain

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