Transcript Document

The Public Health Knowledge Base
Using Public Health Data
Ron Bialek
Public Health Foundation
7/17/2015
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Preview
 Essential Public Health Services Does anybody really use these things?
 Healthy People 2010 - Our nation’s
prevention agenda
 Data and Information - The friends of
public health
 Using Data - Getting from here to there
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Essential Public Health Services
 Monitor health status to identify
community health problems
 Diagnose and investigate health problems
and health hazards in the community
 Inform, educate, and empower people
about health issues
 Mobilize community partnerships to
identify and solve health problems
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Essential Public Health Services
 Develop policies and plans that support
individual and community health efforts
 Enforce laws and regulations that protect
health and ensure safety
 Link people to needed personal health
services and assure the provision of
health care when otherwise unavailable
 Assure a competent public health and
personal health care workforce
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Essential Public Health Services
 Evaluate effectiveness, accessibility,
and quality of personal and
population-based health services
 Research for new insights and
innovative solutions to health
problems
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Public Health Scenario
substance
abuse
sexual assault
clinical depression
nutrition
suicide
pre-natal care
sexually transmitted
diseases
cardiovascular disease
domestic violence
environmental hazards
unintended injuries
family planning
post-partum
depression
infertility
HIV/AIDS
TB
eating disorder
breast cancer
communicable diseases
chronic diseases
cervical cancer
Quality Improvement
National Health Objectives
Performance Standards
Accountability
Workforce Competencies
Expenditures
Research
Evidence Base
National Healthy People
Initiative
 The nation’s
prevention agenda
 Set of measurable
objectives to improve
health of Americans
 A health improvement
framework that states
may adopt or adapt
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State Plans are All
Custom Made
“Taking the national Healthy People
framework and customizing it for local
needs is one of the hallmarks of this
initiative.”
— Dr. David Satcher
Surgeon General
June 24, 1998
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Significance of Healthy People
2000
 46 states created Healthy People plans
or used objectives in plans
 Data systems
 Community involvement
 Benchmarking
 Monitoring & reporting progress
 Funding
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6/00 Status of State*
Activities
*Based on PHF contact with 50 states, D.C., 3 territories
Not yet active
~25%
In planning process
~55%
(many preparing to plan)
Draft stage
~10%
Completed final plan
~10%
Opportunities for more
comprehensive plans
 States and territories that have or plan to have
2010 objectives in…
Mental Health
46%
Substance Abuse
53%
Environmental Health
52%
Occupational Health
37%
 Many left out these objectives in their 2000
plans (see “Chartbook”)
It’s like the lotto slogan...
“You can’t win
if you don’t play.”
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New Directions for 2010
 Sustain initiative beyond the plan
 Share responsibility, define accountability
 Capture and evaluate action
 Market achievements
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A Framework to Bring
Together ...
Policy
Science
Data
Data and Information
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Health indicators
Denominators
Demographics
Assets/Services
Statistical methods
Comparability
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“Best practices”
Stories
Focus groups
Tools
Technical reports
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Who needs science anyway?
 Science contributes to advances in public
health practice
 We need to know what and how things
work
- Make the right choice the first time
 Science influences policymakers
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How do we get good science?
…..good data certainly help!
 Health, social, and infrastructure
data from communities
 Sound research methods
 Descriptive research and “best
practices”
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A Dime a Day on Public Health
 That’s way too much money!!
 Can you prove otherwise???
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Connections with
Healthy People 2010
 Determining effective interventions for
attaining health objectives
 Identifying and learning from “best
practices”
 Involving the practice community in
population-based research
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Healthy People 2010 Objectives Categories

Essential Public Health Services
(Source: Public Health Functions Steering Committee)
Promote Health
Behaviors
Promote Healthy
and Safe
Communities
Improve
Systems for
Personal and
Public Health
Prevent and
Reduce Disease
and Disorders
Chapters
Objectives (singular or grouped)
1.
Monitor health status to identify community
health problems
2.
Diagnose and investigate health problems
and health hazards in the community
3.
Inform, educate, and empower people about
health issues
4.
Mobilize community partnerships to identify
and solve health problems
5.
Develop policies and plans that support
individual and community health efforts
6.
In each box….
Enforce laws and regulations that protect
health and ensure safety
7.
Link people to needed personal health
services and assure the provision of health
care when otherwise unavailable
8.
Assure a competent public
personal health care workforce
9.
Evaluate effectiveness, accessibility, and
quality of personal and population-based
health services
10.
health
Research for new insights and innovative
solutions to health problems
and
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What do we need to know to be effective — interventions, causes,
methodological research?
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What do we know?
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Info being used?
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Need to better disseminate?
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Need to better translate?
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What do we not know?
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What specific questions need to be answered?
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What research is underway and when will it be completed?
Priority setting…
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Take key dimensions of columns and rows
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How important to know to deliver EPHS?
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How doable? How easy to answer question?
New and improved
opportunities for 2010
 10 Leading Health Indicators
- Opportunities to focus systems on cross-cutting
issues, data needs
 Business and community partners
- Partnership for a Healthy Workforce
- Healthy People Consortium
 Commitment to eliminate disparities
- Broader players and strategies
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Leading Health
Indicators
 Physical Activity
 Mental Health
 Overweight & Obesity  Injury and Violence
 Tobacco Use
 Environmental Quality
 Substance Abuse
 Immunization
 Responsible Sexual
Behavior
 Access to Health Care
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Healthy People Data
 Tracking Healthy
People 2010
In Healthy People 2010
Conference Edit., Vol.II
 DATA2010
Online - HP 2010 site
 CHSI data sets
Online, print
 Other State/Local
Sources
“Chartbook” on PHF
web site, HP 2010
Assistance
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Resource Web Sites
 Healthy People 2010
www.health.gov/healthypeople/
 Healthy People 2010 Toolkit
www.health.gov/healthypeople/state/toolkit
 State Healthy People 2010 Tool Library
www.phf.org/HPtools/state.htm
 Healthy People 2010 Partners
www.health.gov/healthypeople/partners
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Community Health Status
Indicators (CHSI) Reports
 www.communityhealth.hrsa.gov
 3,082 reports/counties
 Source information
 Peer counties
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CHSI...
Profiles County Health
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Population characteristics
Vulnerable populations
Overall health
Leading causes of death
Important measures of birth and death
Environmental health
Preventive services use
Risk factors
Access to care
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CHSI...
Baseline for the Next Decade
 3, 5, or 10 Year period depending on
size
 Year 2000 standard for ageadjustment
 Period: 1988-98
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CHSI...
Where do the Data Come From?
 National Sources
-
Census
NCHS
CDC
HRSA
SAMHSA
EPA
 State and Local Health Departments
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CHSI Enumerates
Vulnerable Populations
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<H.S. education
Unemployed
Severe work-disability
Major depression
Recent drug use
No health insurance
Medicare eligible
(elderly and disabled)
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CHSI Includes HP 2010
Goals and Objectives
 Selected
objectives
- Birth measures
- Infant mortality
- Cause-specific
mortality
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HP 2010 target
US rate
Peer range
Icon
- Favorable
- Unfavorable
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CHSI...
Peer Communities
88 Peer groupings
Average of 34
peers
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Peers designated using:
Frontier status
Population size
Poverty
Age composition
Density
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Relative Health
Importance
Some Desirable Indicators
Are Not Available
–Children
• Indicators of children’s
preventive services use —
such as immunizations,
dental caries, and
prevalence of lead
screening — must be
obtained locally.
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CHSI…
Sparks a Conversation
 Discussing with Health Official
 Helping to engage leaders and
other members of the community
 Creating a forum with the media
 Providing support and resources
for filling data gaps
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CHSI Helps Engage
Several Audiences
 Policy makers
 Program managers
and planners
 Assessment and
evaluation staff
 Advocates and
consumers
 Other partners
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CHSI...
Who’s Using It?
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Local Boards of Health
Community Hospitals
U.S. Environmental Protection Agency
Anthem Alliance Health Insurance
Company
 Universities
 General Accounting Office
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“Best Practices”
 “Best judgment” has served us well
 “Best practices” will serve us better
 Rigor can be applied to
determination of “best practice”
 There is an immediate need to
identify and communicate successful
strategies
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The Catch
You have to know the practice
before you can know
the best practice
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Determining “Best Practice”
 Establish criteria
 Search literature, the Internet, and
query experts
 Apply criteria to identify “best
practices”
 Analyze and synthesize information
 Disseminate findings
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Health Improvement Progress
-- Breast Cancer, 1993-97
Improving
HP 2010 Met
HP 2010 Not
Met
Exemplary
350
11%
Progressing
928
30%
Not Improving
Maintaining
256
8%
Static
1548
50%
Toolkit - 7 Action Areas
- Building the Foundation: Leadership and Structure
- Identifying and Securing Resources
- Identifying and Engaging Community Partners
- Setting Health Priorities and Establishing Objectives
- Obtaining Baseline Measures, Setting Targets, and
Measuring Progress
- Managing and Sustaining the Process
- Communicating Health Goals and Objectives
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Each Action Area Includes...
 a brief explanation & rationale
 a checklist of major activities
 tips for success
 national and state examples
 recommended “hot picks" of resources
 planning tools - easy to adapt
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State Healthy People 2010
Tool Library
EXAMPLES: Setting
Health Priorities...
EXAMPLES:
Setting Targets...
 Priority Setting Options
handout and
presentation (DE)
 Process Guidance (MD)
 Facilitator “Survival Kit”
and Meeting Ground
Rules (IA)
 Target Setting Algorithm
and Worksheets (DE)
 Missouri Resource
Guide for Community
Assessment
 “Tools of the Trade”
data guides (PA)
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Mass Communication
Campaign for STD Prevention
Key Words - “sexually transmitted
diseases” and “media”
Healthy People 2010
Information Access Project
….an easy way to search
PubMed to find effective
strategies.
 Partners in Information Access for Public
Health Professionals
 National Library of Medicine, National
Network of Libraries of Medicine, and
Public Health Foundation
PIAPHP Home
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=PureSearch&db=PubMed&details_ter
m=%28%28%28%28%28%28%28%22united%20states%22%5BMeSH%20Terms%5D%20AND
%20%28%28%28%28%28%28%28%22education%2C%20medical%22%5BMeSH%20Major%2
0Topic%5D%20OR%20%22education%2C%20dental%22%5BMeSH%20Major%20Topic%5D%
29%20OR%20%22education%2C%20nursing%22%5BMeSH%20Major%20Topic%5D%29%20
OR%20%22education%2C%20pharmacy%22%5BMeSH%20Major%20Topic%5D%29%20OR%
20%22students%2C%20health%20occupations%22%5BMeSH%20Major%20Topic%5D%29%2
0OR%20%22schools%2C%20public%20health%22%5BMeSH%20Major%20Topic%5D%29%2
0OR%20allied%20health%20personnel/education%5BMeSH%20Major%20Topic%5D%29%20
OR%20physician%20assistants/education%5BMeSH%20Major%20Topic%5D%29%29%20AN
D%20%28%28%28%22minority%20groups%22%5BMeSH%20Major%20Topic%5D%20OR%20
%22hispanic%20americans%22%5BMeSH%20Major%20Topic%5D%29%20OR%20%22blacks
%22%5BMeSH%20Major%20Topic%5D%29%20OR%20%22indians%2C%20north%20america
n%22%5BMeSH%20Major%20Topic%5D%29%29%20AND%20%28%28%28%28%28%28%28%
28%28%28%28%28%22education%22%5BMeSH%20Terms%5D%20OR%20%22curriculum%2
2%5BMeSH%20Terms%5D%29%20OR%20%22student%20dropouts%22%5BMeSH%20Terms
%5D%29%20OR%20%22educational%20measurement%22%5BMeSH%20Terms%5D%29%20
OR%20%22career%20choice%22%5BMeSH%20Terms%5D%29%20OR%20%22training%20su
pport%22%5BMeSH%20Terms%5D%29%20OR%20%22school%20admission%20criteria%22
%5BMeSH%20Terms%5D%29%20OR%20%22cultural%20diversity%22%5BMeSH%20Terms%
5D%29%20OR%20%22mentors%22%5BMeSH%20Terms%5D%29%20OR%20%28affirmative
%5BAll%20Fields%5D%20AND%20action%5BAll%20Fields%5D%29%29%20OR%20%22preju
dice%22%5BMeSH%20Terms%5D%29%20OR%20recruitment%5BAll%20Fields%5D%29%20
OR%20%22staff%20development%22%5BMeSH%20Terms%5D%29%29%20NOT%20%22pati
ent%20education%22%5BMeSH%20Terms%5D%29%20NOT%20%22transcultural%20nursing
%22%5BMeSH%20Terms%5D%29%20AND%20English%5BLang%5D%29%20AND%20%28%
221996/03/24%2014.29%22%5BEDat%5D%20%3A%20%222001/03/23%2014.29%22%5BEDat
%5D%29%29
Search PubMed
Six Focus Areas/Chapters
 Access to Health
Services
- Mary E. Ryan
 Food Safety
- Marcia Zorn
- Mary E. Ryan
 PH Infrastructure
- Mary E. Ryan
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 Disability/Secondary
Conditions
- Ron Gordner
 Respiratory Diseases
- Anne Maria Baxter
 Environmental Health
- Stacey Arnesen
- Lucie Chen
- Deena Pers
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Source:
HUD
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Rural Empowerment Zones & Enterprise Communities
Round I EZ
Round I EC
Round II EZ
Source: USDA
Round II EC
January 1999
Health Capacity Factor 1:
Interest and commitment to health
 Half of EZ/ECs would
use their own staff
and more than a
quarter would use
both staff and
financial resources for
health improvement
activities
Interested but not top
priority
Interest level
 Many EZ/EC
respondents (88%)
reported interest in
health issues and 39%
consider them a top
priority
Figure 9. Interest in addressing health issues
in the EZ/EC (n=119) Q7.
49%
Interested and among top
priorities
39%
4%
No opinion
1%
Not interested
7%
No response
0%
10%
20%
30%
Percent
40%
50%
60%
What is the Science Base?
 Apply scientific rigor
to quantitative and
qualitative
information
 Apply reasonable
and appropriate
scientific standards
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Yogi Berra New York Yankees
“90% of this game is half mental”
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"The
time has come. The time is
now. Just go. Go. GO! I don’t care
how.”
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