Complex tools To aid public health decision making

Dave Jephson, EMPHO

Adapted from slides produced by:

Helen Cooke, SWPHO May 2008

• Health Poverty Index

• Health Profiles

• APHO Inequalities Toolkits– Spearheads– Internal inequalities in all Local Authorities

• Prevalence models

For each model:

• Understand its philosophy

• Understand the main ways you can use it

• Understand its strengths and weaknesses

• Understand how it might help your organisation

Health Poverty Index

• Commissioned by DH in 2000. Work done by University of St Andrews, the South East Public Health Observatory (SEPHO), the University of Oxford, and Oxford Consultants for Social Inclusion (OCSI)

• 2003 data currently most recent• 2001 has data for different ethnic groups• 2005 data are being prepared

• Data are old, but things don’t change very fast• Good on wider determinants

• Located at www.hpi.org.uk

 

HPI indicatorsRoot causes Regional prospects GVA

    Change in job supply

    Educational resourcing

  Local Conditions Social Capital

    Education quality

  Household conditions Income

    Wealth

    Human capital

Intervening Factors Resourcing to support health Local government resourcing

    Preventative care resourcing

  Healthy areas Recreation facilities

    Effective preventative healthcare

  Behaviours and environments Lifestyle

    Home environments

    Work & local environments

Situation of Health Resourcing for health & social care Health care resourcing

    Social care resourcing

  Appropriate Care Effective primary care

    Access to secondary care

    Access to social care

    Quality of social care

  Health status Psychological morbidity

    Health capital

    Physical morbidity

    Premature mortality

Example: Chesterfield & England, 2003

Example: Chesterfield, 2001: Bangladeshi & All Ethnic Groups

Exercise• Open Internet Explorer and go to www.hpi.org.uk• Click “The HPI tool” on the left hand side• Select Nottingham as the main group• Compare Nottingham in 2003 with:

– England– Nottingham’s ONS supergroup

• What are the obvious patterns?

• Change to ranked data & compare Nottingham to England - What does it tell you?

• Go to the Indicators page. Explore meanings of: – Health Capital, Human Capital, Psychological morbidity

• Go to Tabled Data• Could you use these data for further exploration?

HPI strengths

• Compact data presentation

• Comparative data• Innovative

indicators• Helpful for

partnership working

HPI weaknesses

• Timeliness • Absolute data• Some data

definitions are not intuitive

• No interpretation of PH significance of some indicators

Health Profiles• Funded by Department of Health and produced

annually (since 2006) by the Association of Public Heath Observatories

• Compact 4-page document (also available online) • Document for all Local Authorities

(District/Borough, Unitary Authority and County)• Contains

– Maps of SOA level deprivation– Trends in Life Expectancy, and early mortality from

cancer and heart disease & stroke– Ethnicity breakdown

• Includes 31 indicators on wider determinants of health in a “Health Summary”

• Interpretation provided• Also visualised through Instant Atlas – available at

http://www.communityhealthprofiles.info/

Some of the indicators

Health Profiles - examplesMansfield Rushcliffe

Exercise• Open Internet Explorer and go to

www.communityhealthprofiles.info• Open the Health Profile for Mansfield.• Using the Health Summary:

– How many under 18 conceptions occurred?– What was the under 18 conception rate? What sort of

rate is this?– How did this rate compare to the England rate?– What years does this data represent?

• Answer the same questions for infant deaths

Inequalities Intervention Tool for Spearhead areas

The tool was developed by London Health Observatory and Yorkshire and Humber Public Health Observatory on behalf of the Association of Public Health Observatories for the Department of Health.

This tool provides information on the following: ● The current life expectancy in Spearhead local authorities ● The current gap in life expectancy between the Spearhead local

authorities and England ● A breakdown of the causes of the life expectancy gap by disease type and

age It allows Spearhead areas to estimate the effect on their life expectancy gap if

certain interventions are increased, specifically: ● Interventions to reduce infant mortality ● Smoking cessation ● Antihypertensive prescribing in people without diagnosed cardiovascular

disease ● Statin prescribing in people without diagnosed cardiovascular diseaseThese interventions are chosen because they can be influenced by PCT

and LA commissioning

Spearhead Group areas (Local Authority Districts)

In the East Midlands:

• Bolsover

• Corby

• Leicester

• Lincoln

• Nottingham

Exercise• Copy the file “model_v35_for_web.xls” from the shared

drive to your desktop• Go to the Desktop and open the Excel file

“model_v35_for_web.xls”• Select “Enable Macros”• Click on “Go to instructions”• Click on “Go to model”• Select Leicester UA from the drop down list• Look at the current Local Authority information – what is

the percentage life expectancy gap for males and females?

• Tick the box next to Smoking Cessation – see how the results change by altering the number of quitters to 5000 (remember to click “Calculate Results”)

• Click “View your Gap”• Which disease groups had the biggest contribution to the

gap for males and females?

APHO inequalities tool for all Local Authorities

• COMING SOON!

• Models the life expectancy gap between the most deprived quintile of any Local Authority and: – The local authority as a whole – The least deprived quintile in the local authority – The remainder of the local authority (ie the local authority without the

most deprived quintile) – England as a whole – England's least deprived quintile

• You can then model interventions either across the most deprived quintile or the authority as a whole as with the Spearhead tool

Breakdown of life expectancy gap between the most deprived quintile of Northampton CD and the local authority average by cause of death

Life expectancy years gained if the most deprived quintile in Northampton CD had the same mortality rate as the local authority average for each cause of death.

Prevalence models

• Models from research of expected prevalence of the diseases measured in the Quality Outcome Framework (QOF)

• Currently, diabetes, CHD, COPD, hypertension

• Search on APHO website to find.

Prevalence models

• Comparisons of national prevalence data from the Health Survey for England (HSE) and recorded prevalence from the Quality & Outcomes Framework (QOF) suggest that there is considerable under-diagnosis (in terms of IT system recording) of risk factors and diseases.

• This is probably due to under-recording of cases already known to practices, and lack of information in a proportion of cases, where patients may have been diagnosed previously by other practices or hospital consultants.

JSNA interactive mapping tool

• Many JSNA indicators for all Local Authorities in England

http://www.swpho.nhs.uk/tools/35106/atlas.swf

http://www.swpho.nhs.uk/tools/35106/atlas.swf

What you should have learnt

• Major models to support decision making

• Their philosophy

• Their strengths and weaknesses

• How you might use them