1. Health profiles and (mental) health indicators in Norway:
Using the health information systems
Heidi Lyshol
Department of Health and Inequality

2. Overview 2012 Act on Public Health Data sources
Municipal, City District and County Public Health Profiles
Norhealth and Municipal Databank
Public health report(Facts about
User surveys: what do the municipalities think?

3. 19 counties, 426 municipalities, 5 million inhabitants
385,252 square kilometres (148,747 sq mi)

4. New Act on Public Health January 2012
Purpose
Contribute to societal development that promotes public health and reduces social inequalities in health.
Ensure that municipalities, county authorities and central government health authorities implement measures and coordinate their activities in the area of public health in a proper and adequate manner
Facilitate long-term, systematic public health work.
New Public Health Act entered into force on 1 January 2012

5. New Act on Public Health January 2012
Norwegian counties and municipalities required to have sufficient overview over health conditions and influencing factors

6. Central point of the PH Act: § 5
Overview based on:
a: Information made available by central health authorities and the county
b: Information from municipal health and care services
c: Knowledge about factors and trends in the environment and local community that may affect the health of the population
Central point of the PH Act: § 5
Norwegian Institute of
Public Health |

7. Main data sources: Registries (person identifiable)
Cause of Death Registry
Norwegian Patient Registry
Cancer registry of Norway
Medical Birth Registry of Norway
Childhood Vaccination Registry
Norwegian Prescription Database
The Registry of the Norwegian Armed Forces
Registries at Statistics Norway
Norwegian Labour and Welfare Administration
Norwegian Directorate for Education and Training
Water Works Registry

8. The 17
National
Health
Registries…

9. …and 50 + Quality Registries… (rarely useful for this purpose)

10. Other data sources Health surveys (mainly by phone; Statistics Norway)
State payment system for GPs and primary care (KUHR/KPR)
School surveys
Population records of different kinds

11. Criteria for selecting indicators:
Valid & reliable methods for measurement
Nationally/regionally representative data
Easy to understand
Available
Measured regularly
Preferably on ECHI-shortlist
(see European Core Health Indicators; )

12. Process Indicator selected and collected
Indicator standardised (age, gender etc)
Indicator put in MDB/NorHealth
Indicator extracted from databank for Public Health Profiles
Indicator extracted from databank for PH report

13. Municipal, City district and County Public Health Profiles

14. Public Health Profiles
Main features
More information on specific subjects, municipal figures
Public health barometer and tables

15. Public Health Profiles
Inspired by
the Public Health Observatories, Great Britain
I2SARE

16. The PH Profiles contain:
Easily accessible information about the health of the population:
Interpreted statistics
Visual depictions
Public health barometer
Figures/diagrams
Chosen annual topics
2017: antibiotic resistance, flu vaccinations 60+, drinking water quality/supply

17. Indicator overview (Municipal PHP) 2015
Health determinants
Smoking in women
Overweight in male recruits
Health and illness
Mental symptoms/illness, primary care
Mental illness, medication
High blood pressure, primary care
Cholesterol lowering drugs
Cardiovascular disease, hospital data
COPD/asthma, medication
Diabetes 2, medication
Diabetes 2, primary care
Cancer, new cases in total
Cancer of the bowel, new cases
Hip fractures, hospital data
Musculoskeletal symptoms, primary care
Vaccination coverage, MMR, 6-year-olds
Population background
Population growth
Percentage over age 80
Life expectancy, male and female
Single person households
Immigrants
Living conditions
Education level
Low income
Disability pensions
Children of single parents
Environment
Drinking water quality
Injuries/accidents
Schools
Pupils enjoying school
Bullying in schools
Reading ability
Percentage high school drop-outs

18. Indicator overview (Municipal PHP) 2016
Population background
Population growth
People living alone, 45+
Participation election 2015
Living conditions
Education level
Low income
Disability pensions
Children of single parents
Income inequality
Unemployment
Environment
Drinking water quality
Injuries/accidents
Loneliness, Satisfied local environment, Member organisation (school survey)
Schools
Pupils enjoying school
Reading, Mathematics ability
Percentage high school drop-outs
Health determinants
Smoking in women
Overweight (all) recruits
Physically inactive (school s.)
Alcohol use (school s.)
Health and illness
Life expectancy m/f (moved)
Educational difference life exp.
Mental symptoms/illness, primary care (15-29)
Mental illness, medication
Cardiovascular disease, hospital data
Diabetes 2, medication
Lung cancer, new cases in total
Musculoskeletal symptoms, primary care
Vaccination coverage, measles, 9-year-olds

19. Indicator overview (Municipal PHP) 2017
Population background
Population growth
People living alone, 45+
Population 80+
Living conditions
Education level
Low income
Disability pensions
Children of single parents
Income inequality
Environment
Drinking water quality/supply
Injuries/accidents
Loneliness, Satisfied local environment, Member organisation (school survey)
Schools
Pupils enjoying school
Reading, Mathematics ability
Percentage high school drop-outs
Health determinants
Smoking in women
Overweight (all) recruits
Physically inactive (school s.)
Alcohol use (school s.)
Health and illness
Life expectancy m/f
Educational difference life exp.
Satisfied own health, youth survey
Mental symptoms/illness, primary care (15-29, all users)
Mental illness, medication
Cardiovascular disease, hospital data
Diabetes 2, medication
Lung cancer, new cases in total
Musculoskeletal symptoms, primary care
Vaccination coverage, measles, 9-year-olds

20. The barometer: ~ 34 indicators
Shows municipality (etc) compared to the country, other municipalities in the same county, the spread of results in the county, and whether something is good, bad or neutral.

21. Significantly better than the country for this year or these years
Significantly worse than the country
Not significantly different (often due to population size/selection)
Significantly different from the country
Not tested for statistical significance
County average
Norwegian average
Spread between this county’s municipalities
The ten best municipalities in Norway

22. Presentation systems:
Public Health Profiles
Databanks

23. Inspired by WHO’s HfA Database

24. History NorHealth/Municipal Databank
1999 (autumn): Decision to have presentation system: Norgeshelsa. Steering group formed. 2000: Selection of indicators, writing metadata, entering data. Downloadable system only indicators. Introduction conference April : English translation: NorHealth. 2002: Online plus downloadable system. 2003: Downloadable system removed. Fewer, but better indicators selected – 2012: Small revisions, ECHI collaboration. Other NIPH databases following our lead. 2012: Municipal databank added : Revision NorHealth to increase resemblance NorHealth/Municipal databank.

25. Online Municipal Databank
Indicators at municipal level
Can create own tables and figures
Can compare municipalities with counties and country
Metadata – information about the data ( 25

26. Online Municipal Databank
Velg geografi
Select indicator
Select municipality

27. Municipal Databank – several choices
Type of medicine
Population groups
Year
Geography

28. Female users of anti-depressants, all municipalities in Møre og Romsdal

29. Developments over time. By gender. Age groups
Developments over time? By gender? Age groups? Same pattern rest of the country?

30. Norhealth (www.norgeshelsa.no)
In English!

31. Psychological distress, by gender, 16-24, 25-44, 45-64 and 65-79, EHIS 2012
men
women

32. Metadata Important to publish metadata with each indicator:
Indicator definition
Population
Units of measurement
Data source
Data collection
Data quality

33. Public Health Report (Fact sheets)
The NIPH website ( has around100 fact sheets describing health conditions, illnesses and risk factors (half translated into English)
Information on:
incidence and/or prevalence in Norway
trends over time
international comparisons
research from Norwegian Institute of Public Health
sources/literature
Fact sheets use data from Norhealth where possible
Direct linkage to data bank -> always updated figures
Fact sheets more hits than Norhealth (visible from search engines)
Selected Fact sheets + introduction: Public Health Report!
New format: Facts about…

34. Example Facts about…

35. Roughly follow EUphact model
Definition & scope
Reason for inclusion
Occurrence
Consequences for individual & society
Causes & risk factors
Data sources & quality
References

36. Facts about… have embedded figures

37. Statistics calendar

38. Who are our users, and how do we communicate?
Municipalities, counties (ref 2012 Act on PH)
Web pages, reports, articles
(Subscription) newsfeeds
Annual reminders, incl. to newspapers
Annual county tours
Conferences and meetings; exhibitions
Courses at MPH level + anywhere they invite us

39. What do the users think? User surveys (municipal PH coordinators etc):
2014 (qualitative (13 interviewed)) and quantitative (219 respondents))
2016 (quantitative (264 respondents)
very positive towards MPFs, very useful for municipal planning
users need more indicators about absolutely everything
why can’t NIPH provide indicators for the smallest municipalities
using the databanks is easy, though maps are tricky (but some haven’t tried the databanks at all => more courses)
THANKS for telling the users about the other parts of the toolset

40. Summing up: the presentation tools of the NIPH
Municipal public health profiles
City district public health profiles
County public health profiles
Municipal statistics bank
Norhealth
Public Health Report (Facts about…)
Statistics calendar

41. What kind of mental health indicators are available?
Prescription medicine (registry)
Use of primary health care (reimbursements)
Psychological distress (survey)
Social support (survey)
Someone to confide in (survey)
School surveys:
bullying, loneliness, close friend

42. Questions?