title: Prioritizing investment in public health and health equity: what can commissioners do?
abstract: OBJECTIVE
  To explore commissioners' views on prioritizing for investment in health. This study reviewed: methods for decision support; their relevance for prioritizing health and health equity in principle; and their adoption by decision makers in practice.
  
  
  METHODS
  Decision makers' views were sought through semi-structured interviews and an online survey, and prioritization tools were reviewed. Interviews were held in 2008-2009 with a subsample followed up in 2009-2010. In late 2009, a national online survey was sent to 508 individuals across 146 primary care trusts (PCTs). The two phases of the interviews comprised 52 and 17 participants, respectively. Responses to the national survey were received from 138 decision makers in 95 (65%) PCTs. Prioritization tools were identified through interviews and the survey as above, a rapid review of literature and in consultation with health economists. A grounded theory approach was adopted for the qualitative interview analysis.
  
  
  RESULTS
  Although most PCTs used a prioritization framework, few of the tools identified in this review were used by public health commissioners. This was partly a consequence of limitations of priority-setting tools in the context of public health investment, and partly a lack of relevant skills and data. Tensions in relation to developing strategies for disinvestment and in prioritizing a long-term public health agenda in a context of economic austerity were evident.
  
  
  CONCLUSIONS
  The context for decision making appears to be more important than the deployment of specific tools and techniques. Commissioners need to recognize the limitations of priority-setting tools, but also know how to apply them to help maximize health gain and health equity over the longer term. Decision-support tools should be developed in collaboration with public health commissioners to ensure relevance and practicality of use.
authors: Centre for Public Policy and Health, School of Medicine, Pharmacy and Health, Durham University, Queen's Campus, Stockton on Tees, UK. linda.marks@durham.ac.uk
authors: L
authors: L
authors: Marks
authors: H
authors: H
authors: Weatherly
authors: A
authors: A
authors: Mason
mesh_terms: D003659:Decision Making, Organizational; D004470:Economics, Medical; D006292:Health Priorities; D054624:Health Status Disparities; D006801:Humans; D007449:Investments; D011634:Public Health / Q000191:economics*; D036301:Qualitative Research; D013222:State Medicine / Q000458:organization & administration*; D006113:United Kingdom