A new definition of health technology assessment (HTA), developed by an International Joint Task Group claims to be a “milestone,” “an historic achievement,” and “a cornerstone reference”—claims that we think to be unjustified. We too favor clear definitions, especially when confusion abounds. However, the Task Group seems to have developed a definition without the help of usual conventions regarding definitions and, in our view, through an ill-described process. A definition ought to differentiate the entity defined from other entities. This one fails to do so. It states traits that are true of HTA (e.g., that is interdisciplinary) but HTA is not alone in this. There are other concerns: examples of HTA’s use are embodied in the definition, precluding other uses; the adjectives used, although generally true of HTA, are not differentiating features; and attributing to HTA specific purposes, thereby excluding other purposes. We have sympathy for these purposes but cannot consider them HTA’s only purposes or even, its main purpose. A newcomer to HTA, on reading this definition, will have no idea of HTA’s true potential. These numerous failings, we feel, send all the wrong signals, and could ultimately weaken, rather than strengthen perceptions of HTA’s legitimacy and objectivity. The production of a good definition remains, therefore, a work in progress.

This contribution marks a dual milestone at the intersection of public health law and JLME: my 50th publication of a substantive manuscript in the 50th anniversary of the Journal in 2022. In recognition of these coinciding landmarks, this installment of the Public Health Law column for JLME features observations and reflections of the field based largely on prior publications.

Aggressive behaviour in psychiatric inpatients was assessed before and after a training course for staff members. The Social Dysfunction Aggression Scale (SDAS) was used to report and assess aggressive behaviour over time, and the Staff Observation Aggression Scale (SOAS) to report and assess single aggressive incidents. In addition, the numbers of nursing staff members who were on sick leave because of injuries in the periods before and after the course were recorded and compared. No statistically significant reduction was found in the number of aggressive patients or in the number of staff members on sick leave. One interesting finding was a lower reporting on the SOAS of perceived aggressive incidents after the training course in comparison with the SDAS reports. Directed verbal aggressiveness and violence towards things were found to be predictors of violence.

No one, not even those of us who sat at the center, can or will know the full outreach impact of IPY. If one remembers and trusts public reaction one can deduce that, for a short moment, IPY research and outreach worked together to put a good face on science.

The principal goal of research relative to disasters is to decrease the risk that a hazard will result in a disaster. Disaster studies pursue two distinct directions: (1) epidemiological (non-interventional); and (2) interventional. Both interventional and non-interventional studies require data/information obtained from assessments of function. Non-interventional studies examine the epidemiology of disasters. Interventional studies evaluate specific interventions/responses in terms of their effectiveness in meeting their respective objectives, their contribution to the overarching goal, other effects created, their respective costs, and the efficiency with which they achieved their objectives. The results of interventional studies should contribute to evidence that will be used to inform the decisions used to define standards of care and best practices for a given setting based on these standards. Interventional studies are based on the Disaster Logic Model (DLM) and are used to change or maintain levels of function (LOFs). Relief and Recovery interventional studies seek to determine the effects, outcomes, impacts, costs, and value of the intervention provided after the onset of a damaging event. The Relief/Recovery Framework provides the structure needed to systematically study the processes involved in providing relief or recovery interventions that result in a new LOF for a given Societal System and/or its component functions. It consists of the following transformational processes (steps): (1) identification of the functional state prior to the onset of the event (pre-event); (2) assessments of the current functional state; (3) comparison of the current functional state with the pre-event state and with the results of the last assessment; (4) needs identification; (5) strategic planning, including establishing the overall strategic goal(s), objectives, and priorities for interventions; (6) identification of options for interventions; (7) selection of the most appropriate intervention(s); (8) operational planning; (9) implementation of the intervention(s); (10) assessments of the effects and changes in LOFs resulting from the intervention(s); (11) determination of the costs of providing the intervention; (12) determination of the current functional status; (13) synthesis of the findings with current evidence to define the benefits and value of the intervention to the affected population; and (14) codification of the findings into new evidence. Each of these steps in the Framework is a production function that facilitates evaluation, and the outputs of the transformation process establish the current state for the next step in the process. The evidence obtained is integrated into augmenting the respective Response Capacities of a community-at-risk. The ultimate impact of enhanced Response Capacity is determined by studying the epidemiology of the next event.

Birnbaum ML, Daily EK, O’Rourke AP. Research and Evaluations of the Health Aspects of Disasters, Part VII: The Relief/Recovery Framework. Prehosp Disaster Med. 2016;31(2):195–210.

For the purposes of research and/or evaluation, a community/society is organized into 13 Societal Systems under the umbrella of an overall Coordination and Control System. This organization facilitates descriptions of a community/society or a component of a community for assessment at any designated time across the Temporal Phases of a disaster. Such assessments provide a picture of the functional status of one or more Systems that comprise a community. Since no system operates in isolation from the other systems, information of the concomitant status of several Societal Systems is crucial to gaining a complete understanding of compromised functions, as well as the effects and side effects of any intervention directed at restoring the functional state of the affected community or risk-reduction interventions of a community-at-risk. The 13 Societal Systems include: (1) Public Health; (2) Medical Care; (3) Water and Sanitation; (4) Shelter and Clothing; (5) Food and Nutrition; (6) Energy Supply; (7) Public Works and Engineering; (8) Social Structures; (9) Logistics and Transportation; (10) Security; (11) Communications; (12) Economy; and (13) Education. Many functions and sub-functions of the Systems overlap, or share some common sub-functions with other systems. For the purposes of research/evaluation, it is necessary to assign functions and sub-functions to only one of the Societal Systems.

Birnbaum ML, Daily EK, O’Rourke AP. Research and Evaluations of the Health Aspects of Disasters, Part IV: Framework for Societal Structures: the Societal Systems. Prehosp Disaster Med. 2015;30(6):633–647.

During responses to disasters, the credibility of humanitarian agencies can be threatened by perceptions of poor quality of the responses. Many initiatives have been introduced over the last two decades to help address these issues and enhance the overall quality of humanitarian response, often with limited success. There remain important gaps and deficiencies in quality assurance efforts, including potential conflicts of interest. While many definitions for quality exist, a common component is that meeting the needs of the “beneficiary” or “client” is the ultimate determinant of quality. This paper examines the current status of assessment and accountability practices in the humanitarian response community, identifies gaps, and recommends timely, concise, and population-based assessments to elicit the perspective of quality performance and accountability to the affected populations. Direct and independent surveys of the disaster-affected population will help to redirect ongoing aid efforts, and generate more effective and comparable methods for assessing the quality of humanitarian practices and assistance activities.

Kirsch TD, Perrin P, Burkle FM Jr, Canny W, Purdin S, Lin W, Sauer L. Requirements for independent community-based quality assessment and accountability practices in humanitarian assistance and disaster relief activities. Prehosp Disaster Med. 2012;27(3):1-6.

Scholars have long understood that linkages between the identities of actors and the design of their actions in interaction constitute one of the central mechanisms by which social patterns are produced. Although a range of empirical approaches has successfully grounded claims regarding the significance of various forms or types of identity (gender, sex, race, ethnicity, class, familial status, etc.) in almost every form of social organization, these analyses have mostly focused on aggregated populations, aggregated interactions, or historical periods that have been (in different ways) abstracted from the particulars of singular episodes of interaction. By contrast, establishing the mechanisms by which a specific identity is made relevant and consequential in any particular episode of interaction has remained much more elusive. This article develops a range of general analytic resources for explicating how participants in an interaction can make relevant and consequential specific identities in particular courses of action. It then illustrates the use of these analytic resources by examining a phone call between two friends, one of whom relevantly embodies “grandparent” as an identity. The conclusion offers observations prompted by this analysis regarding basic contingencies that characterize self-other relationships, and the role of generic grammatical resources in establishing specific identities and intimate relationships.

This is a summary of the presentations and discussion of Panel 2.14, Contribution of Non-Governmental Actors, of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related to the role of media and communication as pertaining to the responses to the damage created by the Tsunami. It is presented in six sections: (1) Background; (2) Key questions; (3) Discussion; (4) What have we learned?; (5) Conclusions; and (6) Recommendations. The what have we learned section is presented in the categories of: (1) needs assessments; (2) coordination; (3) filling gaps; and (4) capacity building.

This is a summary of the presentations and discussion of Panel 2.7, First 30 Days: Organizing Rapid Response of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed inc included issues related to organizingrapid responses as pertain to the responses to the damage created by the created Tsunami. It is presented in the following major sections: (1) issues; (2) key questions; and (3) recommendations.

This is a summary of the presentations and discussion of Panel 2.1 of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related to assessing needs and measuring impact as pertaining to the responses to the damage created by the Tsunami. It is presented in the following major sections: (1) key questions; (2) assessing needs; (3) measuring impact; and (4) lessons learned and recommendations.