Abstract
This paper examines problems of assessment and decision-making that result from poor or inadequate communication of indicators among the disciplines of public health, the physical sciences, and economics. The specific examples used are drawn from climate impacts in the Americas although the issues are more general to environmental health. In terms of physical processes, problems arise in confusion about indicators at different steps along the DPSEEA framework of environmental health indicators and general scientific uncertainty about the underlying physical processes. Communication between public health and economics is hindered by a lack of understanding of economic costs used in making decisions and the presence of implicit value judgments in economic analysis. Organizational structures may further inhibit the effective use of indicators. Finally, the paper discusses the Pan American Health Organization proposal to enhance the communication of indicators by using information technology networking to support communication among program managers and decision-makers at the national and local levels. The aim of this initiative is to establish a better environment for making decisions. The problem of cholera in Peru is shown as an example of the need for better communication.
Résumé
L’article porte sur les difficultés de l’évaluation et de la prise de décisions liées à de mauvaises ou trop peu nombreuses communications au sujet des indicateurs entre les disciplines de la santé publique, des sciences physiques et des sciences économiques. Même si les enjeux sont d’ordre plus général sur le plan de l’hygiène de l’environnement, les exemples sont tirés des répercussions sur le climat des Amériques. Du point de vue des processus physiques sous-jacents, il y a confusion quant aux indicateurs de l’hygiène de l’environnement pour les diverses étapes du cadre DPSEEA, et il règne une incertitude générale chez les scientifiques. Le manque de compréhension des coûts économiques utilisés pour la prise de décisions et les jugements de valeur qu’on porte implicitement dans l’analyse économique font obstacle à la communication entre les intervenants du secteur de la santé publique et ceux du secteur économique. De plus, les structures organisationnelles peuvent nuire à l’utilisation efficace des indicateurs. Les auteurs analysent aussi la proposition de l’Organisation panaméricaine de la santé visant l’amélioration des communications sur les indicateurs au moyen du réseautage des technologies de l’information pour faciliter les échanges entre les gestionnaires de programmes et les décideurs à l’échelle nationale et régionale. L’objectif du projet est d’améliorer les conditions pour la prise de décisions. Le problème de choléra au Pérou est utilisé comme un exemple à illustrer le besoin de la meilleure communication.
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