title: Decision support for risk prioritisation of environmental health hazards in a UK city.
abstract: BACKGROUND
  There is increasing appreciation of the proportion of the health burden that is attributed to modifiable population exposure to environmental health hazards. To manage this avoidable burden in the United Kingdom (UK), government policies and interventions are implemented. In practice, this procedure is interdisciplinary in action and multi-dimensional in context. Here, we demonstrate how Multi Criteria Decision Analysis (MCDA) can be used as a decision support tool to facilitate priority setting for environmental public health interventions within local authorities. We combine modelling and expert elicitation to gather evidence on the impacts and ranking of interventions.
  
  
  METHODS
  To present the methodology, we consider a hypothetical scenario in a UK city. We use MCDA to evaluate and compare the impact of interventions to reduce the health burden associated with four environmental health hazards and rank them in terms of their overall performance across several criteria. For illustrative purposes, we focus on heavy goods vehicle controls to reduce outdoor air pollution, remediation to control levels of indoor radon, carbon monoxide and fitting alarms, and encouraging cycling to target the obesogenic environment. Regional data was included as model evidence to construct a ratings matrix for the city.
  
  
  RESULTS
  When MCDA is performed with uniform weights, the intervention of heavy goods vehicle controls to reduce outdoor air pollution is ranked the highest. Cycling and the obesogenic environment is ranked second.
  
  
  CONCLUSIONS
  We argue that a MCDA based approach provides a framework to guide environmental public health decision makers. This is demonstrated through an online interactive MCDA tool. We conclude that MCDA is a transparent tool that can be used to compare the impact of alternative interventions on a set of pre-defined criteria. In our illustrative example, we ranked the best intervention across the equally weighted selected criteria out of the four alternatives. Further work is needed to test the tool with decision makers and stakeholders.
authors.affiliation: Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, OX11 0RQ, UK. mae.woods@ucl.ac.uk.|Department of Cell and Developmental Biology, University College London, London, WC1E 6BT, UK. mae.woods@ucl.ac.uk.
authors.forename: Mae
authors.initials: M
authors.lastname: Woods
authors.affiliation: Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, OX11 0RQ, UK. Helen.Crabbe@phe.gov.uk.
authors.forename: Helen
authors.initials: H
authors.lastname: Crabbe
authors.affiliation: Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, OX11 0RQ, UK. Rebecca.Close@phe.gov.uk.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Close
authors.affiliation: Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, OX11 0RQ, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: Studden
authors.affiliation: Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK. Ai.Milojevic@lshtm.ac.uk.
authors.forename: Ai
authors.initials: A
authors.lastname: Milojevic
authors.affiliation: Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, OX11 0RQ, UK. Giovanni.Leonardi@phe.gov.uk.|Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK. Giovanni.Leonardi@phe.gov.uk.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Leonardi
authors.affiliation: Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, OX11 0RQ, UK. Tony.Fletcher@phe.gov.uk.|Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK. Tony.Fletcher@phe.gov.uk.
authors.forename: Tony
authors.initials: T
authors.lastname: Fletcher
authors.affiliation: Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK. Zaid.Chalabi@lshtm.ac.uk.
authors.forename: Zaid
authors.initials: Z
authors.lastname: Chalabi
mesh_terms: D002947:Cities; D003661:Decision Support Techniques; D004782:Environmental Health; D006305:Health Status Indicators; D006801:Humans; D011634:Public Health; D006113:United Kingdom