Transcript Association of Public Health Observatories

Association of Public
Health Observatories
Community Health Profiles
Dr Claire Bradford
Dr Alison Taylor
Wanless Report
“Health data are essential for monitoring the health
of the population and for evaluating the effects of
health interventions. Yet the information collected
nationally is often poor and there is no regular
mechanism by which a PCT or LA can gather
reliable information on its own population.”
Choosing Health Priorities
• Reducing the number of people who smoke
• Reducing obesity and improving diet and
nutrition
• Increasing physical activity
• Encouraging and supporting sensible
drinking
• Improving sexual health
• Improving mental health
Delivering Choosing
Health
‘We will develop a standard set of local health
information that can be linked to other local
data sets for publication. Public Health
Observatories will produce reports designed
for local communities at local authority level
which will support Directors of Public Health in
promoting health in their area’.
Community Health
Profiles
These reports will:
• Include information on different groups
• Provide information for communities based on
local authority boundaries;
• Assist in the production and comparison of
Director of Public Health reports;
• Provide consistent national reporting of key
data, which would become comparable over
time;
• Include new public health data sets.
Community Health
Profiles – the what
To provide a consistent, concise, comparable and
balanced overview of the population’s health that
informs local needs assessment, policy, planning,
performance management, surveillance and
practice.
A distillate of the absolutely key, most useful
(currently available) indicators ( with a reference to
new data/indicators and unavailable
data/indicators).
Community Health
Profiles – for whom
To be primarily of use to joint efforts between
local government and the health service to
improve health and reduce health inequalities,
but ultimately to empower the wider
community
Domains/Indicators?
At least 24 different sets of local regional and
national sets of indicators have been identified
No national stable community health profiles have
been identified
Content and scope
Demography (population and age structure/trends,
ethnic mix, migration)
Determinants of health
o education, income, employment, housing, transport, etc
o disease and lifestyle risk factor data (e.g. smoking,
alcohol, obesity, physical activity rates)
o service provision data
Health outcomes (e.g. SMRs, life expectancy, other
summary measures, incidence and prevalence of
tracker/marker conditions: diabetes, hypertension…)
Performance (e.g. data on progress against PSA targets)
Scottish Community
Profiles
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Population demographics
Health & Function
Behaviour
Social environment
Economy
Physical environment
Morbidity and Mortality
http://www.phis.org.uk/info/sub.asp?p=bb
Outputs targeted at
professional audience
March 2006
• Website – likely to be interactive SVG
• Reports
Summarised indicators at LA level with
interpretation
Audience – professional/public; LA
• Action, e.g.
LAA & performance monitoring
Health Overview and Scrutiny Committees
Neighbourhood renewal
Outputs targeted at the
public March 2006
Communication with the public
• Being led by the DH communications group
• Central Office of Information undertaking
research to identify best methods
• Possibly linking to Prime and other health
magazines
Community Health
Profiles Project
Stage 1
Stage 2
Indicator/Metadata
design, definition
and iteration year
on year
Populating
indicators and
comparators over
time and space )
[crunching]
Stage 3
Dissemination of Community
Profile to professionals (with
interpretation) to
a) assist Professional response
to Public report [below]
b) assist in writing of any
PCT/LA/DPH Annual Report2
c) reference to sources of
interventional evidence (e.g.
from NICE) where available
and appropriate
[Web/CD]
Domains
Who are we? (demography)
What affects our health? (determinants)
What we do (lifestyles)
How we live, work and learn (society,
environment)
What organisations are doing (delivery)
How healthy are we? (health outcomes)
Health and illness
Why and when we die
Criteria for choosing
indicators
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Important impact on the health of the population,
Supports local government and NHS management
frameworks
Is valid, i.e. does it measure what it purports to measure
Is primarily based on existing indicators (although crucial
to highlight non-existent and new data where important)
Is primarily available at Local Authority level (although
sub-LA data will be explored)
Is amenable to meaningful comparison over time, place,
person
Can be communicated easily to a wide audience.
Metadata
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Indicator name/title
Creator
Date
Subject category/
domain(s)
Indicator sets where
found
Definition
Numerator definition
Source of numerator
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Denominator definition
Source of denominator
Geographic coverage
Dimensions of inequality
available
Timeliness
Accuracy and
completeness
Data caveats
Technical guidance
Further information
Assessing indicators
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Framework to assess indicators against criteria and
answer important questions, covering the following tasks:
Define the indicator
Decide on the domain(s) for the indicator
Identify which criteria the indicator meets
Identify whether data is available for the indicator
Identify the levels of data that are reasonable/available
Identify if there is an equivalent European indicator
Identify if there is a relevant effective intervention
Comment on whether practice/policy locally will be specifically
helped by the indicator
Identify indicator sets that include indicator
Rationale for the indicator.
To project team by 21st October
Indicators from
workshop (1)
Demography
Determinants
Deprivation - Percentage of population in bottom quintile
Ethnicity - Percentage non-white population
Age structure
Smoking
Prevalence
Obesity - Mean BMI
Alcohol - Alcohol/week (binge drinking)
Diet/nutrition - Percentage of people consuming 5/day;
Education
or mean number portions
- Percentage young people not in further
education/training
Physical activity
Primary Care services - Number of primary health care
Income
Environment ?
workers per 100,000 population
- Income inequality
Indicators from
workshop (2)
Health Outcome – mortality
•Life expectancy
Life expectancy at birth
•Circulatory disease mortality
DSR <75; Years of life lost
•Cancer mortality
DSR <75
•Infant mortality
•Alcohol attributable mortality
•Smoking attributable mortality
Health Outcome – morbidity
•Rating of good health
Census question or HSE/GHS
•Mental health
QOF, admissions, prescribing or GHQ12
•Diabetes
Prevalence – QOF or admissions
•Respiratory disease
QOF or hospital admissions
•Frequent flyers?
•Accidents
Indicators from
workshop (3)
Performance – partnership indicators
Teenage pregnancy
Drug treatment
Enhanced CPA
Performance – Prevention
MMR Immunisation
Breast screening
Smoking cessation
Performance – service activity
CHD admissions
Smoking status
BMI recorded
QMAS indicator?
Other – global/ environment
Carbon measure, Recycling, ?
Other - cost
Health expenditure?
State of health in 20,30,50 years if we do nothing
Other – inequities /social justice
Physical disability, Mental health/ wellbeing, Children, Crime, Sexual Health
Other key indicators
•Percentage of 11 year olds achieving the expected level 4 or above in Maths
and English Key Stage 2
•Percentage of half days missed due to unauthorised absence
•GCSE Performance: grades A*-C
•Age-standardised mortality rate from suicide and undetermined injury
•Proportion of children under 16 living in 'low income households' (Child
Poverty Index)
•Number of road traffic casualties per 1000 resident population
•Number of people killed or seriously injured in RTAs per 100,000 population
•Flu vaccinations
•Smoking rates during pregnancy
•Older people helped to live at home
•Intensive home care
Community Health
Profiles Project
Stage 1
Stage 2
Indicator/Metadata
design, definition
and iteration year
on year
Populating
indicators and
comparators over
time and space )
[crunching]
Stage 3
Dissemination of Community
Profile to professionals (with
interpretation) to
a) assist Professional response
to Public report [below]
b) assist in writing of any
PCT/LA/DPH Annual Report2
c) reference to sources of
interventional evidence (e.g.
from NICE) where available
and appropriate
[Web/CD]
Timing of work
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Assessment of indicators
Indicator list - Steering Group
Number crunching
Pulling data into reports
Interpretation
Publish reports
21st October 2005
7th November 2005
November/December
January 2006
February 2006
End March 2006.
Community Health
Profiles Project
We want your views on:
1. What are the gaps in the workshop indicators?
2. Do you think some of the ‘review’ indicators should
be included?
3. What process should we use to add/remove
indicators from list?
4. What new data might be included?
5. What is the best way to organise the numbercrunching work?
6. What is the best way of displaying the data? – ideas
for web and paper formats (subgroup?)