Decision Making for Enhanced Health Security: Managing Emerging Health Threats, Making Reasoned Choices, and Allocating Scarce Resources ... Research & Management Science, 328)

Health threats pose significant dangers to humankind and form a major source of human suffering and sorrow. Responsible leadership and reasoned decision making can significantly improve the arenas that are affected by health threats, through establishing a better allocation of very scarce resources for building health capabilities and for increasing health preparedness, responsiveness and resilience. This book examines how public health leaders can use the cutting-edge research from Decision Sciences to better manage emerging and re-emerging health threats, with a focus on enhancing health security. While these decisions must be informed by the best available evidence, they must also address competing priorities and key uncertainties and must mitigate critical risks, albeit in a cost-effective manner which seeks to maximize societal value. This is a book about how decisions on health security can be improved, both in terms of the content that is utilized in a health decision analysis and the decision processes that are employed in reaching a decision. This decision-focused perspective can help public health leaders and public health experts to increase the health preparedness of health systems, the task of which involves improving health capabilities, increasing the robustness of health systems against health threats, as well as strengthening health resilience and the responsiveness of these systems against disease outbreaks. Foreword Preface Prologue: The Very First Health Decision Analysis Acknowledgments Contents About the Author Chapter 1: Making Health Security Decisions: Challenges and Complexities 1.1 Improving Health Security and Preparedness Against Emerging Health Threats 1.1.1 Emerging Health Threats and Health Security Decisions 1.1.2 Improving Preparedness Against Emerging Health Threats 1.2 Coping with Complexities in Health Security Decisions 1.2.1 Coping with Complexities in the Decision Context 1.2.2 Coping with Complexities in the Decision Process 1.3 Evaluating Health Threats and Health Security Actions in Practice 1.3.1 Level 1: Ad Hoc Assessments 1.3.2 Level 2: Holistic Assessments 1.3.3 Level 3: Simple Scoring Assessments 1.4 Conclusions: Making Health Security Decisions – Challenges and Complexities References Chapter 2: Making Reasoned Health Security Decisions: Key Concepts and Main Benefits 2.1 Researching Decision Making – Approaches in Decision Sciences 2.1.1 Understanding How Decisions Should Be Made: Decision Theory 2.1.2 Understanding How Decisions Are Made: Behavioral Decision Research 2.1.3 Understanding How Decisions Could Be Better Made: Decision Analysis 2.2 Distinguishing Between Decision Processes and Decision Outcomes 2.3 Making Reasoned Health Security Decisions 2.3.1 Framing Health Security Decisions 2.3.2 Specifying Relevant Objectives and Consequences for Health Security Decisions 2.3.3 Assessing Impacts of Threats and Health Security Actions 2.3.4 Defining Risk Limits, Marginal Value, and Trade-Offs in Health Security Decisions 2.3.5 Developing Decision Alternatives for Enhanced Health Security 2.3.6 Evaluating Health Threats and Actions, and Selecting Best Options 2.3.7 Deciding and Implementing Health Security Actions and Promoting Systematic Learning 2.4 Assessing the Quality of Health Security Decision Processes 2.5 Conclusions: Making Reasoned Health Security Decisions – Concepts and Benefits References Chapter 3: Framing Health Security Decisions 3.1 Identifying Relevant Problems 3.1.1 Assessing the Relevance of Health Security Problems 3.1.2 Predicting and Acting: Health Security Threats 3.2 Defining the Health Security Decision Problem 3.2.1 Taking an Objectivist View of Problems 3.2.2 Taking a Constructivist View of Problems 3.3 Identifying Key Stakeholders 3.3.1 Identifying Stakeholders’ Interest and Power 3.3.2 Managing Levels of Engagement with Stakeholders 3.4 Managing Health Security Teams 3.5 Managing Power Dynamics in Health Security Decisions 3.6 Clarifying the Decision Context 3.6.1 Identifying the Decision Purpose 3.6.2 Delineating the Scope of the Decision 3.7 Conclusions: Framing Health Security Decisions References Chapter 4: Specifying Relevant Objectives and Consequences in Health Security Decisions 4.1 Identifying Relevant Objectives in Health Security Decision 4.1.1 Neglecting Relevant Decision Objectives 4.1.2 Specifying Decision Objectives 4.1.3 Eliciting Relevant Decision Objectives with Probes 4.1.4 Eliciting Decision Objectives with Causal Maps 4.2 Structuring Decision Objectives in Health Security Decisions 4.2.1 Identifying Fundamental Objectives Within the Decision Frame 4.2.2 Verifying the Properties of Fundamental Objectives 4.2.3 Organizing Fundamental Objectives Using a Value Tree 4.3 Structuring Objectives for the Prioritization of Low-Moisture Food Categories (FAO/WHO) 4.3.1 Identifying Relevant Objectives 4.3.2 Structuring Decision Objectives 4.4 Conclusions: Specifying Fundamental Objectives and Relevant Consequences References Chapter 5: Assessing Impacts of Health Threats and Health Security Actions 5.1 Structuring the Health Decision Analysis 5.2 Structuring a Health Decision Analysis for the Ranking of Emerging Animal Health Threats (DEFRA) 5.3 Assessing Relevant Consequences 5.3.1 Defining the Type of Attribute 5.3.2 Defining Constructed Attributes for the Ranking of Emerging Animal Health Threats (DEFRA) 5.3.3 Checking the Properties of Attributes 5.4 Identifying and Characterizing Uncertainties in Health Security Decisions 5.4.1 Identifying Key Uncertainties 5.4.2 Characterizing Key Uncertainties 5.5 Assessing Impact of Health Threats and Actions 5.5.1 Assessing Dispersion of Impacts 5.5.2 Assessing Dispersion of Impacts of Bio-Security Threats (DEFRA) 5.5.3 Assessing Dynamic Impacts 5.5.4 Assessing Long-Term Impacts 5.5.5 Assessing Long-Term Impacts of Low-Moisture Food Categories (FAO/WHO) 5.6 Conclusions: Assessing Impacts of Health Threats and Health Security Actions References Chapter 6: Defining Risk Limits, Marginal Value, and Trade-Offs in Health Security Decisions 6.1 Identifying Critical Risks 6.1.1 Measuring Critical Risks 6.1.2 Defining Risk Limits 6.2 Identifying Marginal Value Over Consequences 6.2.1 Eliciting Marginal Value Functions 6.2.2 Avoiding Mistakes in the Definition of Value Functions 6.3 Defining Trade-Offs Among Conflicting Objectives 6.3.1 Defining Trade-Offs in the Choice of Alternatives 6.3.2 Prioritizing Conflicting Objectives 6.3.3 Avoiding Mistakes in the Prioritization of Objectives 6.4 Making Judgments in Health Security Decisions 6.4.1 Defining Value Functions and Trade-Offs for the Ranking of Low-Moisture Food Categories (FAO/WHO) 6.4.2 Defining Value Functions Over Impacts Caused by Emerging Animal Health Threats (DEFRA) 6.5 Conclusions: Defining Risk Limits, Marginal Value, and Trade-Offs References Chapter 7: Developing Decision Alternatives for Enhanced Health Security 7.1 Designing Decision Alternatives: Biases and Properties of Good Options 7.1.1 Identifying Barriers against the Development of High-Value Alternatives 7.1.2 Verifying Properties of Potentially High-Value Decision Alternatives 7.2 Developing Decision Alternatives: Managing Relevant Consequences 7.2.1 Generating Decision Options 7.2.2 Identifying Health Security Actions for Managing Emerging Animal Health Threats (DEFRA) 7.2.3 Structuring Health Security Actions into Decision Alternatives 7.2.4 Formulating a Strategy Table for the Design of Malaria Rapid Test Kits (Malaria Consortium/USAID) 7.3 Developing Decision Alternatives: Managing Uncertainties 7.3.1 Managing Uncertain Impacts: Continuous Distributions 7.3.2 Influencing Uncertainties: Continuous Distributions 7.3.3 Managing Uncertain Impacts and Influencing Uncertainties: Discrete Distributions 7.4 Developing Decision Alternatives: Improving Preparedness, Robustness, Resilience, and Responsiveness 7.4.1 Improving the Preparedness of Health Systems 7.4.2 Enhancing the Robustness of Health Systems 7.4.3 Increasing the Resilience of Health Systems 7.4.4 Improving the Responsiveness of Health Systems 7.5 Conclusions: Developing Decision Alternatives for Enhanced Health Security References Chapter 8: Evaluating Health Threats and Health Security Actions with Multiple Consequences 8.1 Screening Decision Alternatives for the Evaluation 8.2 Evaluating the Value of Decision Alternatives with Two Consequences 8.3 Evaluating the Value of Decision Alternatives with Multiple Consequences 8.3.1 Defining a Multi-Attribute Value Model 8.3.2 Testing Independence Conditions for the Attributes 8.4 Evaluating the Value of Health Security Actions with Multiple Consequences 8.4.1 Defining the Evaluation Model 8.4.2 Defining Attributes and Value Functions 8.4.3 Defining Weights for Objectives and Attributes 8.4.4 Assessing the Performance and Value of Decision Alternatives 8.4.5 Analyzing the Sensitivity of the Solutions to Priorities 8.4.6 Improving the Value of Decision Alternatives 8.5 Evaluating the Impacts of Emerging Animal Health Threats (DEFRA) 8.5.1 Evaluating Actual Impacts Caused by Emerging Animal Health Threats 8.5.2 Evaluating Perceived Impacts from Emerging Animal Health Threats 8.5.3 Evaluating Emerging Animal Health Threats 8.6 Conclusions: Evaluating Health Threats and Health Security Actions with Multiple Consequences References Chapter 9: Evaluating Health Threats and Health Security Actions Under Uncertainty 9.1 Assessing Expected Value with a Single Consequence 9.1.1 Defining the Expected Value Rule 9.1.2 Identifying the Benefits of the Expected Value Rule 9.2 Assessing Expected Value with Multiple Consequences and Discrete Distributions 9.2.1 Calculating Expected Value with Multiple Consequences 9.2.2 Calculating Expected Value with Multiple Consequences for the Prioritization of Low-Moisture Food Categories (FAO/WHO) 9.2.3 Calculating Expected Dis-Value with Multiple Consequences of Emerging Animal Health Threats (DEFRA) 9.3 Assessing Expected Value with Multiple Consequences and Continuous Distributions 9.3.1 Assessing Expected Value with Single Consequences and Continuous Distributions 9.3.2 Assessing Expected Value with Multiple Consequences and Continuous Distributions 9.3.3 Simulating the Performance of Decision Alternatives 9.4 Conclusions: Evaluating Health Threats and Health Security Actions Under Uncertainty References Chapter 10: Selecting the Best Options for Enhanced Health Security 10.1 Gathering Evidence About Impacts and Performances 10.1.1 Employing Evidence from Surveillance Systems and from Scientific Studies 10.1.2 Employing Outputs from Predictive Models 10.1.3 Employing Estimates from Experts 10.1.4 Designing the Involvement of Experts 10.2 Identifying the Type of Health Security Decision Situation 10.2.1 Identifying the Type of Decision Situation: Health Security Actions 10.2.2 Identifying the Types of Decision Situations: Health Threats 10.3 Conducting a Health Decision Analysis for Each Type of Decision Situation 10.3.1 Selecting a Single Health Security Option or Targeting a Single Threat 10.3.2 Ranking of Health Security Options or Health Threats 10.3.3 Categorizing Health Security Options or Health Threats 10.3.4 Conducting Recurrent Health Security Evaluations with Decision Support Systems 10.3.5 Selecting Portfolios of Health Security Projects 10.4 Conclusions: Selecting the Best Options for Enhanced Health Security References Chapter 11: Deciding and Implementing Health Security Actions and Promoting Systematic Learning 11.1 Facilitating Choices in Health Security Teams 11.1.1 Observing Dysfunctional Group Dynamics and Biases in Health Security Decisions 11.1.2 Establishing Rules and Responsibilities for Group Interactions 11.1.3 Minimizing Group Dysfunctionalities and Judgment Biases 11.1.4 Facilitating Group Decision Making with Decision Analysis 11.2 Implementing Successfully Selected Options 11.3 Systematic Learning in Decision Making Processes 11.3.1 Learning from the Identification of Objectives and the Development of Alternatives 11.3.2 Learning from the Assessment of Impacts and the Definition of Risk Limits 11.3.3 Learning from the Evaluation of Threats and of Health Security Actions 11.3.4 Learning from Implementation Efforts 11.4 Undertaking the Complexities in Health Security Decisions 11.5 Conclusions: Deciding and Implementing Health Security Actions and Promoting Systematic Learning References Index