1. What is public health intelligence? © Association of Public Health Observatories Acknowledgements: Dave Jenner Helen Cooke Margaret Eames Neil Bendel delivered by Helen Cooke

2. What we hope to cover What is public health intelligence? Data, information, intelligence hierarchy Who does public health intelligence work? The effective analyst PHI as a career – knowledge and skills

3. What is Public Health Intelligence? detective? Illumination? Assembly?

4. Can we measure what we really want to know? Excerpts from The Unknown Citizen W.H. Auden (To JS/07/M/378 This Marble Monument Is Erected by the State) He was found by the Bureau of Statistics to be One against whom there was no official complaint, ………………….. Except for the War till the day he retired He worked in a factory and never got fired, But satisfied his employers, Fudge Motors Inc. Yet he wasn’t a scab or odd in his views, For his Union reports that he paid his dues, (Our report on his Union shows it was sound) ………………… Was he free? Was he happy? The question is absurd: Had anything been wrong, we should certainly have heard. http://www1.umn.edu/humanrts/education/literatureandpoetry.htm

5. The ideal world of data linkage? Link all records of health, education, social services housing etc throughout life How do you feel about this? What are our responsibilities as epidemiologists?

6. Data Information Intelligence - Hierarchy Data... is raw. It simply exists and has no meaning in itself. Information... is data that has been processed in some way to make it (potentially) useful to somebody. Intelligence... is the appropriate, analysed, collection and interpretation of information, selected and presented so as to be useful

7. Southern Derbyshire Health Survey 1999 Free text comments from survey respondents about their health and living conditions “Every problem I have can be traced directly back to work” Man, aged 34 “The area is very poor. Children cannot play in the park as it has been vandalised. It is also not very safe to leave your home unattended. There isn’t much social life in this area for families” Man, aged 35, disadvantaged area “I feel a lot more pressure is on people these days. Although myself and partner earn a reasonable wage we still find money tight. If we have an argument it is always about money.” Woman, aged 26 “It is unsafe around here for young children due to crime and vandalism. There is usually glass on play areas and on the streets. I’ve found dirty needles on play parks.” Woman, aged 28, disadvantaged area “I don’t have time to exercise much. My weight has risen. I smoke more. I worry about my heart.” Woman, aged 31, disadvantaged area

8. Why do we need public health information? (1) What are the main reasons we might need public health information? What are potential applications?

9. Why do we need public health information? (2) Monitoring progress towards targets Community profiling Benchmarking Needs assessments –what are the health problems in our area? –where are these health problems worst? –what services are available? –where is there unmet need or overcapacity? Planning interventions –developing strategies –where shall we concentrate our resources? –what capacity will be required? Evaluating interventions –did we make a difference? Health equity audits Director of Public Health Annual Report

10. Who does PHI work? PH generalists – a broad training across the wide public health field PH intelligence analysts/specialists/scientists – good public health background, but specialising in analysing, interpreting, presenting data –in PCTs, alone or as part of a team –within PHOs and other regional organisations –National, international teams, private companies, consultancies, freelancers, etc –We need to encourage more PHI skills in local authorities Almost all collaborate with a wide range of agencies

11. The Health Intelligence and Research Team consists of a health intelligence specialist and two researchers with quantitative and qualitative research skills. The Team supports the health inequalities agenda across the City and provides all those working in this field with advice and support in relation to the provision, analysis, interpretation and use of health- related information. Key Tasks 1.To support the work of the City Council and the Primary Care Trusts in the City, including the production and development of a Health and Well-being Strategy and Implementation Plan as part of the Manchester Community Strategy. 2.To develop targets and indicators for monitoring local activities and strategies around health improvement and health inequalities reduction. 3.To provide information, support and advice to key agencies around the extraction, use and interpretation of public health data sources. 4.To provide advice and guidance on research design and methods, including project planning, data collection, analysis, evaluation and report writing. 5.To support Health Inequalities Impact Assessment (HIIA) activities across the City. 6.To improve the capacity and understanding of individuals and agencies around the use of public health information and the planning and implementation of research projects. 7.To ensure a local input into regional and national developments in public health information, intelligence and research. 8.Where possible, to provide a reliable and timely response to ad-hoc requests.

12. Local Health Economy Community development Regeneration Food Immunisation Communicable disease Health promotion Access to health services Child health surveillance Welfare advice Emergency planning Crime & Disorder Screening NHS Local Government Community Sector Empowerment Build social networks Support services Build social capital Environmental improvement Employment National and international economic policy Welfare policy Pollution and environmental change Regulatory & legislative frameworks Housing Urban planning Transport Leisure Education Environmental health Trade policy Agricultural policy Support services With thanks to: Neil Bendel, Health Intelligence Manager Manchester Joint Health Unit

13. When you are asked to provide intelligence on a public health topic what skills will you need?

14. Your skills - 1 What data are available to answer this question? What is its quality? – can it be used for this purpose? If we can’t answer the question directly do we have a proxy measure? Can I get information from another source to check my results? Do we have to do a special data collection?

15. Your skills - 2 What is the research evidence ? What is the correct method of analysis? What does it mean? How can I best present it? How do I explain the limits of these findings, and give health warnings against inappropriate use?

16. KNOWLEDGE & SKILLS FOR PUBLIC HEALTH INTELLIGENCE WORK Determinants of Health Organisations and services Policy Context Communication Skills Writing Presenting Networking Chairing Meetings Management Skills Project Management Partnership Working Negotiating & Influencing Facilitating Reflective Practice IT Skills Spreadsheets Databases Web Publishing Literature Searches Critical Appraisal Interpretation Data Management Confidentiality Disclosure Data Sharing Special Skills Record Linkage Qualitative Research Evaluation HIA Surveys Training Sources and their limitations Coding Demographic data Geography/GIS Standardisation Presentation Tools Working with data Statistics Working with literature Knowledge Foundations Consultancy Skills Problem Solving Skills Leadership Applications Surveillance Health/inequalities profiles Equity profiles Resource Allocation Healthcare Quality Effectiveness of interventions Analysis of variations and trends

17. Steps to increasing your effectiveness technical knowledge and skills (including IT) + core (generic) skills + firm grasp of policy context and needs of customers + additional/specialist technical knowledge and skills consultancy/problem solving skills provider of high quality customer service...... and proactive change agent... and developing leadership

18. The effective analyst: using evidence to stimulate change Three Rivers LA: Male smoking cessation uptake v smoking attributable mortality for all males age 35 years and over: health equity audit carried out Before services were in areas which had less need (inverse care law) After services were re-configured to improve uptake in areas with high need Source: Margaret Eames

19. Where are you on the journey? mainly reactive proactive 1 - preparing for improved reactivity in future o do you know your CE’s personal/professional objectives? o do you know your DPH’s personal/professional objectives? o do you know what’s round the corner work-wise? proactive 2 – influencing agendas, informing change

20. Public Health intelligence as a career Practitioner advanced practitioner defined specialist the routemap - public health skills and careers framework –a set of skills devised for those working in public health, a subset of which are specific to public health intelligence –http://www.phru.nhs.uk/Pages/PHD/public_health_career_fra mework.htm

21. What you should have learned What is public health intelligence? Hierarchy of data, information, intelligence Who does public health intelligence work? The effective analyst PHI as a career – knowledge and skills

22. Helen Cooke Senior Analyst South West Public Health Observatory 0117 970 6474 ext 327 Helen.cooke@swpho.nhs.uk