1. 1 Information into Action: Making the most of Public Health Data Jo Watson South East Public Health Observatory PBC Learning Exchanges 1 st November 2006

2. 2 This session aims to provide: A guide to public health indicators and information sources Some public health tools of the trade

3. 3 The determinants of health Dahlgren G, Whitehead M. Polices and strategies for promoting social equity in health. 1991.

4. 4 Summary – indicator sets & information sources covered NCHOD Compendium Audit Commission Quality of Life Indicators & Area Profiles Health Poverty Index Health Profiles Epidembase Neighbourhood Statistics Geodemographic profiles/Commercial data Practice data – QOF etc Resources from SEPHO

5. 5 National Centre for Health Outcomes Development (NCHOD)

6. 6 Audit Commission Quality of Life Indicators www.audit-commission.gov.uk/areaprofiles Set of 10 themes and 45 indicators developed in response to the DEFRA Sustainable Development Strategy and LAAs covering: people & place (1 indicator) – local resident defined priorities for improvement community cohesion & involvement (3 indicators) – eg. hate crime perception community safety (4 indicators) – eg. crime levels & perception of crime culture & leisure (2 indicators) – eg. proximity and perceptions of sports & cultural facilities

7. 7 Audit Commission Quality of Life Indicators (cont.) economic well-being (7 indicators) – eg. employment & benefit claimant rates education & life-long learning (4 indicators) – eg. school absences & educational attainment environment (9 indicators) – eg. pollution health & social well-being (5 indicators) – eg. mortality, morbidity, teenage pregnancy housing (6 indicators) – eg. unfit housing transport & access (4 indicators) – eg. method of travel to work

8. 8 Audit Commission Area Profiles

9. 9 Health Poverty Index

10. 10 Health Poverty Index – South East maps

11. 11 APHO Health Profiles Published in June 2006 Annual updates Available on: www.communityhealthprofiles.info

12. 12 Contains data on episodes of hospital care in England between Apr-99 and Mar-03 using the Hospital Episode Statistics (HES) database The HES database is ‘linked’ so can analyse both episode and person-based admission rates (ie. counts persons with multiple admissions once) Each atlas provides comparative maps, graphs and tables for all local authorities in England Over 50 atlases currently available online and over 100 more planned – includes admissions by age/sex, specialty, disease and operation Atlas of Hospital admissions

13. 13 Atlas of Hospital admissions

14. 14 ONS Neighbourhood Statistics www.neighbourhoodstatistics.gov.uk

15. 15 Geodemographic profiling using commercial sector data e.g. Health Needs Mapping (Dr Foster)

16. 16 Smoking maps from ASH www.ash.org.uk

17. 17 ONS Synthetic Estimates of Healthy Lifestyle Behaviours Prevalence of current smoking Obesity of adults Binge drinking for adults Five a day fruit & vegetables - adults 3 a day fruit & vegetables – children Data available at PCO and ward level (2000-02)

18. 18 Data from the New GMS: Quality and Outcomes Framework

19. 19

20. 20 Other data available at practice level Prevalence of chronic illnesses (QoF) Incidence of acute illnesses and symptoms Health promotion and disease prevention - smoking, alcohol and drug misuse, BMI data Socioeconomic status – deprivation payments, benefits Plus all the referrals/prescribing data/immunisations/screening etc

21. 21 Data for Neighbourhood Renewal http://www.data4nr.net/introduction/

22. 22 Information into action Health profilingTo identify the health priorities for action Health needs assessmentTo identify what can be done Health equity auditTo identify and act to reduce health inequalities Monitoring and evaluationTo ensure efficient and effective delivery

23. 23 Health needs assessment Improves the health of a population through: –choosing health priorities, using explicit criteria, identified from systematic review of information about the population systematically describes: –what the priority problem really is –what can be done about it –how this can be done

24. 24 Health needs assessment Guiding principles HNA systematically describes the ‘what and why’ before the ‘how’ the purpose of HNA is to improve health. So only problems or diseases for which something can be done are tackled i.e. changes are possible

25. 25 Elements of a needs assessment The size of the problem What helps the problem The services available

26. 26 Different perspectives Healthcare workers usually consider needs in terms of healthcare services that they can supply. The public may have a different view of what would make them healthier Health needs incorporate the wider social and environmental determinants of health, such as deprivation, housing, diet, education, employment.

27. 27 Methods of health needs assessment Qualitative (sometimes called Corporate): This integrates the views of interested parties Quantitative (or Epidemiological) This involves the estimation of the burden of disease or health determinant in the community, a review of the services available, and the identification of the effectiveness and cost effectiveness of services.

28. 28 Needs assessment for smoking cessation: what would this look like? At PCT levelAt practice level The size of the problemSmoking rates from local lifestyle surveys by different population groups and geographical areas. Data from the practice register. Practice staff’s local knowledge of different communities and of public places What helps the problemResearch evidence on the effectiveness and cost effectiveness of smoking cessation services Views of patients on what would help them. The services currently available A review of existing services in the PCT area, both within and outside the NHS. The national helpline. A review of the services available to the practice population. Practice staff and patient views

29. 29 Health Equity Audit: Definition Systematically review inequities in the causes of ill health, and in access to effective services, and their outcomes, for a defined population Ensure that action required is agreed and incorporated into local plans, services and practice Evaluate the impact of actions on reducing inequity

30. 30 Cycle of health equity audit 1 Agree priorities and partners 3 Identify local action to tackle inequalities 4 Agree local targets with partners 5 Secure changes in investment and service delivery 6 Review progress and impacts against targets 2 Equity profile

31. 31 Potential value of health equity audit Informs service commissioning Local performance management of public services Partnership working Resource allocation Community involvement

32. 32 Example: A health equity audit of heart failure management Equity profile The number of people living with heart failure was estimated by applying national prevalence rates to the local population. The numbers of patients with heart failure recorded at GP practices lower than expected. Hospital admission rate for heart failure was comparatively high. A review of practice registers found that there was under reporting of heart failure, in particular amongst ethnic minority groups. Local action Heart failure specialist nurse and a GP with a special interest in cardiology appointed. Review Audit repeated after 2 years. Patients with heart failure recorded at practices had increased by 50%, increase greatest in ethnic minority groups. Patients admitted to hospital reduced by 10%. Patients admitted via A&E had dropped by 20%.

33. 33 Where to go for help with information sources... Your public health department Your public health network PHeNet site South East Public Health Observatory www.sepho.org.uk

34. 34 Recent SEPHO and SEPHG reports

35. 35 Links Association of Public Health Observatories Interactive Mortality Atlas www.apho.org.uk/apho/interactiveatlas/atlas.htm Audit Commission Area Profiles www.areaprofiles.audit-commission.gov.uk/(c2m3c445ra0lvjm1pqnhlpvj)/StaticPage.aspx?info=25&menu=5 Audit Commission Quality of Life Indicators www.audit-commission.gov.uk/reports/NATIONAL-REPORT.asp?CategoryID=ENGLISH^573^SUBJECT^17^REPORTS- AND-DATA^AC-REPORTS&ProdID=0D488A03-8C16-46fb-A454-7936FB5D5589 European Community Health Indicators europa.eu.int/comm/health/ph_information/dissemination/echi/echi_en.htm National Centre for Health Outcomes Development Compendium of Clinical and Health Indicators nww.nchod.nhs.uk (NHS only) & www.nchod.nhs.uk (public version, but less content) Office for National Statistics Neighbourhood Statistics neighbourhood.statistics.gov.uk/dissemination/home.do SEPHO Coronary Heart Disease Atlas www.sepho.org.uk/extras/interactiveAtlas/reports/atlasIndex.aspx SEPHO/UHCE Epidemiological Database (Epidembase) www.uhce.ox.ac.uk/Epidembase2/ Yorkshire & Humber Public Health Observatory Indicator Search Tool www.yhpho.org.uk/indicatorsearchtool.aspx

36. 36 Links continued... Health Poverty Index www.hpi.org.uk APHO Health Profiles www.communityhealthprofiles.info Data for Neighbourhood Renewal www.data4nr.net/introduction/