Health Impact Assessment : Quantifying and Modeling to Better Decide Leonor Bacelar-Nicolau To cite this version: Leonor Bacelar-Nicolau. Health Impact Assessment : Quantifying and Modeling to Better Decide. Business administration. Conservatoire national des arts et metiers - CNAM, 2017. English. NNT : 2017CNAM1151. tel-01962947 HAL Id: tel-01962947 https://tel.archives-ouvertes.fr/tel-01962947 Submitted on 21 Dec 2018 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. ÉCOLE DOCTORALE Abbé-Grégoire Laboratoire Interdisciplinaire de Recherche en Sciences de l’Action FACULDADE DE MEDICINA DA UNIVERSIDADE DE LISBOA Instituto de Medicina Preventiva & Saúde Pública e Instituto de Saúde Ambiental THÈSE présentée par : Leonor BACELAR-NICOLAU soutenue le : 19 décembre 2017 pour obtenir le grade de : Docteur du Conservatoire National des Arts et Métiers Discipline : Sciences de Gestion / Spécialité : Économie de la Santé Doutor pela Universidade de Lisboa Disciplina: Ciências e Tecnologias da Saúde / Especialidade : Organização e Gestão em Saúde Health Impact Assessment: Quantifying and Modeling to Better Decide THÈSE dirigée par : SAPORTA Gilbert Professeur Emérite, Conservatoire National des Arts et Métiers PEREIRA MIGUEL José Professeur Emérite, Faculdade de Medicina da Universidade de Lisboa JURY : BLIEBERNICHT DUCLA Président du Jury, Professeur, Vice-Président du Conseil SOARES José Luís Scientifique de Faculdade de Medicina da Universidade de Lisboa RIBEIRO Ruy Professeur, Faculdade de Medicina da Universidade de Lisboa DAB William Professeur, Conservatoire National des Arts et Métiers COSTA PEREIRA Altamiro Professeur, Faculdade de Medicina da Universidade do Porto VAZ CARNEIRO António Professeur, Faculdade de Medicina da Universidade de Lisboa TORGAL DIAS GARCIA Professeur, Faculdade de Ciências Médicas da Universidade Jorge Manuel Nova de Lisboa (NOVA Medical School) Page ii/xlix Leonor Bacelar Nicolau PhD Thesis Universidade de Lisboa Conservatoire National des Arts et Faculdade de Medicina de Lisboa Métiers Avaliação de Impacte na Saúde: Quantificar e Modelizar para Melhor Decidir Évaluation d'Impact sur la Santé: Quantifier et Modéliser pour Mieux Décider Health Impact Assessment: Quantifying and Modeling to Better Decide Leonor Bacelar Valente da Costa Nicolau Orientadores / Encadrants/ Thesis Supervisors Prof. Doutor José Pereira Miguel Prof. Doutor Gilbert Saporta Tese especialmente elaborada para obtenção do grau de Doutor em Ciências e Tecnologias da Saúde com Especialidade em Organização e Gestão em Saúde pela Universidade de Lisboa Thèse élaborée pour l’obtention du grade de Docteur en Sciences de Gestion, Spécialité en Économie de la Santé au Conservatoire des Arts et Métiers Thesis prepared to obtain the degree of PhD in Sciences and Health Technologies, Specialty in Health Management from Universidade de Lisboa and Management Sciences, Specialty in Health Economics from Conservatoire National des Arts et Métiers Júri / Jury /Jury : Presidente/Président/President : Doutor José Luís Bliebernicht Ducla Soares, Professor Catedrático em regime de tenure e Vice-Presidente do Conselho Científico da Faculdade de Medicina da Universidade de Lisboa Vogais/Membres/Members : Doutor William Dab, Professeur titulaire de la chaire d’Hygiène et Sécurité ; responsable des enseignements de sécurité sanitaire du Conservatoire National des Arts et Métiers ; Directeur de l’École Sciences industrielles et technologies de l’information – SITI, Paris, França ; Doutor Gilbert Marc Vital Saporta, Professeur Émérite de Statistique Appliquée du Conservatoire National des Arts et Métiers, Paris, França ; (co-Orientador) Doutor Altamiro Manuel Rodrigues da Costa Pereira, Professor Catedrático da Faculdade de Medicina da Universidade do Porto; Doutor Jorge Manuel Torgal Dias Garcia, Professor Catedrático da Faculdade de Ciências Médicas da Universidade Nova de Lisboa; Doutor António Cândido Vaz Carneiro, Professor Associado com Agregação da Faculdade de Medicina da Universidade de Lisboa; Doutor Ruy Miguel Sousa Soeiro de Figueiredo Ribeiro, Professor Associado com Agregação da Faculdade de Medicina da Universidade de Lisboa. Partially funded by FCT, QREN, COMPETE (HMSP-ICT/0013/2011) through the CUTEHeart Project 2017 Leonor Bacelar Nicolau PhD Thesis Page iii/xlix Page iv/xlix Leonor Bacelar Nicolau PhD Thesis As opiniões expressas nesta publicação são da exclusiva responsabilidade da sua autora. Les opinions exprimées dans cette publication sont la responsabilité exclusive de l’auteur. The opinions expressed in this publication are the sole responsibility of its author. Leonor Bacelar Nicolau PhD Thesis Page v/xlix Page vi/xlix Leonor Bacelar Nicolau PhD Thesis À minha Família À ma Famille To my Family “Life is a travelling to the edge of knowledge, then a leap taken.” D. H. Lawrence “Sound policies rest on good information.” Frederick Mosteller “I find your lack of faith disturbing” Darth Vader Leonor Bacelar Nicolau PhD Thesis Page vii/xlix Foreword and acknowledgements Family legend says my first PhD jury was faced decades ago inside my mother’s belly in Paris. It also tells us that I was genetically conditioned to follow a professional life where multivariate data analysis would inevitably be present, both from my mother’s and my father’s side. Reality makes it obvious that I would be glad only to be half as brilliant as both my parents are regarding multivariate data analysis. However, one of the most important things I have definitively managed to learn from them was their love and drive to make multivariate statistics and data analysis related methods understandable and useful for all, to make it practical, data-focused, multidisciplinary: a truly visionary way of looking at something that is nowadays called data science. Through my parents I also had the wonderful opportunity of simultaneously falling in love with travelling and meeting some of the greatest statistical brains from our time. Being a teenager and accompanying them to scientific conferences, I would take advantage of them actually spending their time at the venue and use all their vouchers for the social programmes (usually very rich in every meeting at the time). Languages skills from the Lycée français Charles Lepierre at Lisbon were, from then on, a very useful tool. Meeting all these researchers, including Gilbert Saporta, both in a professional but casual environment, listening to their discussions, interacting and participating in some of the less scientific conversations was a privilege that I then took for granted, only truly valued later in my life, but that I now truly cherish. An economics “brain wash” at Nova Business School and brilliant teachers such as Pedro Pita Barros and José António Pinheiro confirmed me the power of numbers and statistics and their application to reality: macro and microeconomics settings joined marketing, opportunity costs and sustainability concerns, everything always measurable in terms of money-value, ROI, utilities, willingness-to-pay and risk expectations. The following professional experiences at INE and Metris (now GfK-Metris) gave me the privilege of understanding how to collect data and transform information into knowledge both in public and private statistical environments. Further experience in the private Page viii/xlix Leonor Bacelar Nicolau PhD Thesis sector, in my own firm, increased my certainty that data and statistics are most useful to non-statisticians, the more one is able to reach them and show them the added value of understandable, visual statistical results. In an era of Big Data, of secondary data more and more integrated with primary data, being able to apply reliable and accurate multivariate statistical methods to ever and faster growing amounts of data, generating useful and easy to understand results is of the utmost importance. The challenge is even bigger when one tries to explain all this complexity to non-statisticians and aims to convince them of its usefulness to their everyday professional practice. Disseminating the practical use of these methodologies within medical education settings is thus vital to guaranty an easier understanding of their value, encourage further research, increase its use in every-day life. Training and teaching statistics and economics to health professionals that so often have engraved an aversion to numbers into their minds and attitude is indeed a constant personal challenge. Since I began my work at FM UL, more than 13 years ago, few things though are more rewarding then one succeeding and suddenly watching understanding and interest illuminating students’ eyes, of finding old students, sometimes years later, acknowledging the usefulness of one’s classes and taught contents and case studies. Despite all these clues and professional tracks traveled, my PhD pathway only became clear though when José Pereira Miguel made me see the beauty of public health, health promotion, equity and health policies and interventions as ways to contribute to the wellbeing of many in one go