1. College of Public Health and Human Sciences
Public Health Policy Institute
Presenter: Stephanie Bernell
Date: August 21, 2013

2. Data is necessary
By the middle of the 21st century, the U.S. population is projected to reach 400 million
More than 20% of the population will be over 65 years, an increase from 12.5% in 2003
Approximately half the U.S. population in 2050 will be white; the largest increases will be seen in Hispanic and Asian populations.
November 24, 2018
Public Health Policy Institute

3. Data is necessary
In 2002, spending for health care in the United States was $1.6 trillion (adjusted for inflation)
this is a fivefold increase from 1970
The projections for prevalent cases of Alzheimer’s disease will more than double by 2030
November 24, 2018
Public Health Policy Institute

4. Current measures of the public’s health - mortality
Absolute numbers and death rates are common measures of disease burden
Chronic diseases—cardiovascular disease, cancer, chronic lung disease, and diabetes—are leading causes of death, followed closely by unintentional injuries and influenza
Age-specific mortality rates provide additional insights
infant deaths are dominated by congenital anomalies, short gestation, and sudden infant death syndrome (SIDS)
young adults are killed primarily by intentional and unintentional injuries
November 24, 2018
Public Health Policy Institute

5. Current measures of the public’s health - mortality
Stratification of mortality data by race and ethnicity helps to quantify health disparities
Blacks suffer higher rates of death for almost all leading causes
Hispanics and American Indians have lower rates than whites for the leading causes of death
Except for diabetes in Hispanics and unintentional injury in American Indians
Asians have the lowest rates for all major causes of death except cerebrovascular disease
November 24, 2018
Public Health Policy Institute

6. Designation of Categories
Designation of categories of death affects ranking
if we combine injuries across all causes (motor vehicle injuries, homicide, suicide, etc.), as cancer is combined across all sites, injuries would become the leading cause of premature mortality
November 24, 2018
Public Health Policy Institute

7. Current measures of the public’s health - morbidity
The number or rate of nonfatal outcomes is not used as often as mortality in assessing disease burden
The only chronic, non-infectious condition for which the United States has national data for incident cases is cancer
November 24, 2018
Public Health Policy Institute

8. Hospitalization rates are sometimes used to estimate disease burden
Hospitalization Data
Hospitalization rates are sometimes used to estimate disease burden
Heart disease is the leading cause of hospitalization entry, followed by childbirth, psychoses, pneumonia, cancer, and fractures
Hospitalization data advantage: relatively easy to obtain; useful for certain analyses
Hospitalization data disadvantage: biased indicators of burden for the majority of conditions
Ex, the increasing use of outpatient treatment for conditions previously requiring hospitalization can substantially affect the utility of these data
November 24, 2018
Public Health Policy Institute

9. Summary measures assess overall health status of a population
These measures combine morbidity, mortality, and disability data, but can also reflect perceived quality of life or functional status
Ex - physical functioning, mental and emotional well-being, social functioning, general health perceptions, pain, and energy
November 24, 2018
Public Health Policy Institute

10. Summary measures
Quality-of life measures are especially critical for conditions that cause considerable suffering but limited numbers of deaths
Quality-adjusted life years (QALY) combines quality and quantity of life (in years)
November 24, 2018
Public Health Policy Institute

11. Cost of illness information is available
Cost Data
Economic cost as a consequence of a health condition is a key summary measure of economic burden
Cost of illness information is available
Considerable variability in methods and data sources make comparisons difficult
Medical Expenditure Panel Survey (MEPS), provides estimates of national health care spending among the noninstitutionalized U.S. population
November 24, 2018
Public Health Policy Institute

12. Cost Data - Example
An analysis using 2000 MEPS data reveals that heart disease is the most costly condition, followed by trauma, cancer, pulmonary disease and mental disorders
The estimates do not provide a comprehensive measure of economic burden
The MEPS data do not include indirect costs and productivity loss
November 24, 2018
Public Health Policy Institute

13. Caution
A reliance on a single measure of public health burden may be misleading
Ex - suicide and homicide do not appear in leading causes for total mortality, but these events are very important as causes of premature death
Ex - depression may not be the cause of death, yet it responsible for the fourth largest source of disability
November 24, 2018
Public Health Policy Institute

14. Caution
Even the best measures of burden can not capture certain public health practice
emergency preparedness
effective preventive practices (e.g., immunization or fluoridation)
environmental quality (e.g., air- and water-quality monitoring), mental health, and socioeconomic status are limited in scope and precision
Ex, in most states, departments of the environment are administered separately from departments of health and public health
November 24, 2018
Public Health Policy Institute

15. CHARACTERISTICS OF USEFUL MEASURES OF THE PUBLIC’S HEALTH
Measures should detect either an absolute or a relative change in health status over time
Measures should be valid
Does the indicator measure what it purports to measure?
Measures should be able to evaluate major health policy changes
Ex: if taxation on tobacco is increased, youth initiation may be a more immediate measure of effect
Measures should be stable over time and equivalent across settings
Ex: self-rated health, while useful from a societal standpoint, may not be comparable from one population to another
November 24, 2018
Public Health Policy Institute