Prioritizing Children: Environmental Health Indicators for China
2.2 Overview of the methodology and process The proposed list of CEHIs is the result of systematic scientific literature analysis as well as substantial expert and stakeholder input.
the United States Centers for Disease Control and Prevention (US CDC), and UNICEF gave us a basis for assembling our initial list of CEH measures (for more information on the desktop research process, please refer to Annex A). Next,
Figure 3: Overview of CEHI development and prioritization
Consultations with project stakeholders
Internal ranking exercise
External consultations
Literature review
2nd internal ranking exercise
Final prioritized list
Seminal CEHI articles and reports, including by leading authorities (e.g., WHO, U.N., U.S. CDC).
Additions of indicators about climate, soil contamination, pesticide, children’s overweight and children’s screen time.
By UNICEF, Vital Strategies and NIEH, China CDC.
Using the Delphi method of consensus development and one-on-one interviews with local specialists.
Review of 7,527 published investigations of children’s environmental exposures and health outcomes.
By UNICEF; Vital Strategies; NIEH, China CDC; PRCEE, MEE. Exclusion of lowest-scoring and duplicate indicators.
By UNICEF, Vital Strategies and NIEH, China CDC. Top 22 indicators prioritized as core indicators for China.
70 Measures
80 Measures
50 Indicators
54 Indicators
57 Indicators
47 Indicators
22 Indicators
Desktop research
While there are hundreds of environmental health indicators that can be measured, we endeavored to create an initial list of 20-30 priority indicators that can be used to guide policy and outreach. These core CEHIs are intended to emphasize actionable environmental health risks to children and provide a proof-of-concept for further indicator development.
local and international experts suggested less traditional indicators to provide novel insights into associations between environmental hazards and health. We also used contextual socioeconomic measures to evaluate the relationship among indicators and explore ecologic associations. This led to a list of 80 measures (Annex B) that we prioritized for the next step.
As depicted in Figure 3, we conducted several rounds of development, review and evaluation to produce the list of indicators. From November 2019 to January 2020, we conducted formative desktop research about seminal reports, peer-reviewed journal articles and grey literature on CEHIs. Three seminal reports on children’s environmental health from the World Health Organization (WHO),
The project partners then ranked the 80 measures and identified relevant indicators to represent each measure (Annex C). Next, we consulted about the ranked indicators with national specialists using the Delphi methode of consensus development (Annex D). Finally, we consulted one-on-one with local topical experts to discuss specific indicators (Annex E).
e
Linstone HA, Turoff M, editors. The delphi method. Reading, MA: Addison-Wesley; 1975 Dec.
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