Public Health Information

1
Public Health Information Data and
analysis Robert Nelder Public Health
Development Unit Plymouth Teaching Primary Care
Trust February 2007
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- What is public health? - What do we need to
know? - Boundaries and geography - Public Health
and related datasets - Measuring health - Useless
quotes
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What is Public Health?
Public health is the science and art of
preventing disease, prolonging life and promoting
health through the organised efforts of society.
(Donald Acheson, 1988) is the science and art
of preventing disease, prolonging life and
promoting health through the organised efforts
and informed choices of society, organisations,
public and private, communities and individuals.
(Derek Wanless, 2004)
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What is Public Health?
It is about the health of populations or
communities - geographical (e.g.
neighbourhood), - a client group (e.g. elderly),
or - people with a particular health problem
(e.g. CHD). There are a number of
strands - health protection (e.g.
immunisation), - health promotion (e.g.
determinants), and - maintaining or restoring
health (e.g. screening).
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What is Public Health?
It needs to work at many (population)
levels - neighbourhood - electoral
ward - general practice - city, - hospital
catchment - etc. It involves a wide range of
people and organisations - some specialise in
public health (e.g. medical and non- medical
specialists) - others influence it through the
work that they do (e.g. primary care staff, the
community and voluntary sector, EHOs, local
authority planners, etc.)
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What is Public Health?
It involves epidemiology (study of illness in
populations) - causes, - which groups are
affected, - changes over time, - effectiveness of
programmes (evaluation) It uses this
understanding to (attempt to) bring about change.
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What is Public Health?
Summary - Public Health works across
communities and populations rather than at the
level of the individual. - it emphasises
collective responsibility for health, its
protection and disease prevention. - key to
this is a concern for the underlying wider
determinants of health (as well as
disease) - partnership working is a main aim of
Public Health action at all levels.
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What is Public Health?
Summary (cont.) Therefore Public Health is not
one activity, but many activities carried out in
many settings by many different people, all aimed
at improving health.
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What do we need to know?
Informing healthier choices Information and
intelligence for healthy populations A
consultation (June 2006) The strategy supports
wider health priorities such as action on health
inequalities, health protection and effective
commissioning of health and wellbeing. It aims to
improve the availability and quality of health
information and intelligence across England and
to increase its use to support population health
improvement, health protection and work on care
standards and quality. The strategy will support
the delivery of Choosing Health and the new
White Paper Our health, our care, our say a new
direction for community services by making
information and knowledge available to local
communities to inform their decisions.
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What do we need to know?
- how many teenagers smoke in my local area and
how can we, as a school, have an impact on
this? - what are the main health problems for
materially deprived communities in my
town? - what is happening to rates of STDs in my
area compared with the national average and
what should we, as a PCT, be doing about
this? - What are the health effects of living in
areas with high levels of radon in the
ground? - How effective was our recent campaign
to reduce alcohol-related road traffic accidents
and has the benefit been sustained over
time? - Where in this town should a new mental
health clinic be sited to maximise its
impact? - What are the most pressing unmet
health needs among patients in this practice?
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What do we need to know?
The main determinants of health
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Boundaries and geography
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Boundaries and geography
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Boundaries and geography
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Boundaries and geography
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Boundaries and geography
Plymouth geographies 823 Output
areas 160 Lower layer super output
areas 32 Middle layer super output
areas 20 Electoral wards 1 Local
Authority 43 Neigbourhoods 6 PBC
sub-localities
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Boundaries and geography
Development of the Plymouth neighbourhoods - re
cognition by partners that traditional boundaries
may not always be appropriate. - deprived
neighbourhoods were often hidden and never
stood out in official statistics. - area-based
initiatives tend to be targeted at neighbourhood
areas (rather than electoral wards). - need for
a geography that all partners could adopt and use
for planning, service delivery, monitoring and
evaluation.
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Boundaries and geography
Development (cont.) - group drawn from
statutory, community and voluntary sectors met
to devise a neighbourhood map. - took into
account natural boundaries, population size, and
existing A.B.I.s. - extensive consultation
(100 comments) and revision. - neighbourhood
map officially adopted by Plymouths Local
Strategic Partnership (P2020) in January
2003. - define real areas which can be
identified as natural neighbourhoods
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Boundaries and geography
20
Boundaries and geography
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Boundaries and geography
Neighbourhoods are places where people live.
They imply a sense of belonging and of community,
with some shared educational, shopping and
leisure activities that provide a focus for
social life. For many people, especially old and
young people and less affluent and less mobile
people, the neighbourhood can provide a network
of friendship and of mutual support. Such
networks are recognized as being important to
happiness and health. (Barton, H. Tsourou, C.
(2000) Healthy urban planning)
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Boundaries and geography
Postcode translation

http//nww.connectingforhealth.nhs.uk/nacs/downloa
ds/officenatstats
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Public Health and related datasets
Types of data 1) Person-based (individual
records) - each line in the dataset represents
one event (i.e. birth, hospital admission,
death, etc) 2) Aggregate - vital statistic
about areas
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Public Health and related datasets
Main sources of data 1) Population
register 2) Births extract 3) Public health
births file 4) Mortality extract 5) Public
health mortality file 6) Information from local
registrars 7) Inpatient and outpatient hospital
data
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Public Health and related datasets
Main sources of data (contd.) 8) Health
Visitor data 9) Compendium of clinical and
health indicators 10) Census data 11) Data
shared with NHS partners 12) Data from non-NHS
partners 13) Surveys 14) Data from the Cancer
Intelligence Service (CIS)
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Public Health and related datasets
1) Population register - Person-based dataset
maintained by the Patient and Practitioner
Services Agency (PPSA), based in
Exeter - Contains one record for every person
registered with a GP. The data items include
name, address, date of birth, postcode, GP
practice, etc). - The PHDU receives an
anonymised download from this dataset in
November each year (data available from
1991-2006). - Used to generate population
estimates (output area and neighbourhood) and to
monitor changes in Plymouths population
structure over time. - Used as the denominator
data when rates of specific events are
calculated (e.g teenage conceptions).
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Public Health and related datasets
2) Births extract - Person-based dataset
produced annually by ONS and made available to
PCTs. - Contains one record for every birth to
a mother (resident in the relevant area) that is
registered in the particular year. The data
items include date of birth, sex, birthweight,
mothers postcode of residence (doesnt include
mothers age). - For Plymouth, the dataset for a
particular year contains approximately 2,600
records. Births extracts are available from
1988-2005. - Used to generate information on
birth rates and low birthweight births at
sub-PCT level.
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Public Health and related datasets
3) Public health birth file (PHBF) - Person-base
d dataset produced monthly by ONS and made
available to PCTs (i.e. more timely than births
extract). - Contains all of the information
available in the births extract as well as a
number of coded and validated data items which
are added by ONS (includes the NHS
number). - Greater potential value than births
extract as it contains each individual childs
NHS number.
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Public Health and related datasets
4) Mortality extract - Person-based dataset
produced annually by ONS and made available to
PCTs. - Contains one record for every death of
a resident that is registered in the particular
year. The data items include date of birth,
date of death, place of death, cause of death
(ICD9/ICD10 coded), sex, postcode of
residence. - For Plymouth, the dataset for a
particular year contains approximately 2,800
records. Mortality extracts are available from
1981-2005. - Used to generate information on
mortality rates by age/sex/cause at sub-PCT
level.
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Public Health and related datasets
5) Public health mortality file
(PHMF) - Person-based dataset produced monthly
by ONS and made available to PCTs (i.e. more
timely than mortality extract). - Contains all
of the information available in the mortality
extract as well as all that given to the
registrar when the death was registered. It
also contains a number of coded and validated
data items which are added by ONS (includes the
NHS number). - Has been used extensively to
inform the PCTs suicide audit as it contains
more detailed information than the mortality
extract.
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Public Health and related datasets
6) Information from local registrars - Electroni
c copies of birth and death registrations are
processed on behalf of Plymouth PCT by the South
West Devon Health Informatics
Team. - Information is used for the monitoring
of key causes of death and is further processed
to enable health and social care service
providers to update their databases (e.g. to
remove people from waiting lists). - This
person-based dataset is not coded, but is simply
a record of the information given when the event
is registered.
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Public Health and related datasets
7) Hospital activity information - PHTs
Corporate Information team make available views
of their (person-based) inpatient and outpatient
datasets. - Annually approx 75,000 new OP
referrals and 57,000 inpatient admissions
(25,000 elective and 32,000 emergency). - For
each individual there is information on the
referral, patient demographics, diagnoses and
procedures. - PHTs Performance Information Team
is able to provide aggregate information (i.e.
numbers of events by neighbourhood and age
group) in response to ad-hoc requests for
information.
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Public Health and related datasets
8) Health Visitor data - Covered separately.
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Public Health and related datasets
9) Compendium of clinical and health
indicators - Aggregate dataset which brings
together information on topics such as
population size and structure, births, deaths,
cancer registration and hospital activity. Some
lifestyle information from Health Survey for
England. - Numbers of events by age and sex
are given as well as crude and age-standardised
rates. - Data is provided for England and
Wales, England, Government Office Areas, ONS
area groupings, all Health Authorities, all Local
Authorities and all PCTs. - Good source of
comparative information on health and disease,
but less comprehensive on determinants of
health. (nww.nchod.nhs.uk or www.nchod.nhs.uk)
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Public Health and related datasets
10) Census information - Aggregate dataset
based on data collected every 10 years. Next
Census will be in 2011. - Local agreement with
Plymouth City Council with regard to provision
of Census information that is not readily
available from the National Statistics website.
- 2001 census contained information on
accommodation and facilities, car ownership,
demographics (age, sex, date of birth etc),
health, carers, qualifications and economic
activity.
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Public Health and related datasets
11) Data shared with NHS partners - Links exist
with PHTs Performance Information
Team. - Provide aggregate datasets in standard
format derived from their person-based hospital
information systems (e.g. AE attenders,
outpatient referrals, circulatory disease
admissions, births, terminations and
miscarriages). - Tend to provide tables of
events by neighbourhood and age group.
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Public Health and related datasets
12) Data from non-NHS partners - Public Health
work is focussed on addressing the wider
determinants of health. - Much of this
determinant information is not held within the
NHS. - Data sharing protocols exist in Plymouth
to allow aggregate data to be shared covering
topics such as educational attainment, housing
crime, referrals to social services, etc.
- Plymouth Analysts Network has just been
established.
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Public Health and related datasets
13) Surveys - Occasionally there is a need to
carry out specific (person-based) surveys if the
required data is not routinely available. These
result in the production of aggregate area-based
reports. - MORI health and lifestyle survey 2000
(questions on general health, lifestyle, food
cooking, local involvement social networks,
stress and support from others, dental health,
health social services, environment, and
demographics). - Oral health survey
2000 - Healthy weight survey 2005 - Surveys
tend to be carried out to establish baselines and
to enable resources to be targeted more
effectively on the basis of evidence.
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Public Health and related datasets
14) Data from the Cancer Intelligence Service
(CIS) - CIS provide analysis of information
gathered by the Cancer Registry.
- Periodically there is need to liaise with the
CIS to commission specific analyses. Recent
examples include a review of leukaemia
incidence in Plymouth, and an equity profile of
cancer incidence and mortality in Plymouth.
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Public Health and related datasets
15) Others - Deprivation - Immunisation - Lif
estyle - Screening - Practice
prevalence - Prescribing Analysis and
CosT - Infectious diseases - Substance misuse
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Public Health and related datasets
Quality and Outcomes Framework (QOF) - April
2004 most UK GPs moved to a new contract. - Aim
was to pay GPs for quality of care rather than
list sizes. - QOF was the mechanism devised to
enable this. - There are 1,050 points up for
grabs (of which 550 for clinical achievement and
420 for organisation). Each of these is further
sub-divided. - There are 11 disease areas in
the clinical indicators section.
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Public Health and related datasets
Clinical indicators - Secondary prevention of
CHD (12) - Left ventricular dysfunction
(3) - Stoke or TIA (10) - Hypertension
(5) - Diabetes (18) - Chronic obstructive
pulmonary disease (8) - Epilepsy
(4) - Hypothyroidism (2) - Cancer (2) - Mental
health (5) - Asthma (7)
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Public Health and related datasets
Hypertension (5 indicators) 1) The practice can
produce a register of patients with established
hypertension (9 points). 2) The percentage of
patients with hypertension whose notes record
smoking status at least once (10 points).
3) The percentage of patients with hypertension
who smoke, whose notes contain a record that
smoking cessation advice has been offered at
least once (10 points). 4) The percentage of
patients with hypertension in which there is a
record of the blood pressure in the past 9
months (20 points). 5) The percentage of
patients with hypertension in whom the last blood
pressure (measured in the last 9 months) is
150/90 or less (56 points).
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Public Health and related datasets
QOF data and QMAS - The Quality Management and
Analyis System is a national web- based software
tool developed in response to the new GP
contract. - Its aim is to extract data from GP
practice systems - The national QMAS databse
currently holds data for 8,575 practices in
England. - Data from practices is aggregated (to
maintain patient confidentiality) and for every
practice a set of QOF scores is calculated.
- Information is collected on the number of
patients with a particular chronic disease
condition and the care they receive.
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Public Health and related datasets
QOF limitations - Not able to calculate
age-standardised prevalence rates. - Not able to
adjust for socio-economic and ethnicity
differences in the underlying population. Furth
er information www.gpcontract.co.uk
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Public Health and related datasets
Further information 1) Informing healthier
choices Information and intelligence for
healthy populations A consultation (June
2006). Appendix 2 Health and healthcare data
sources relevant to public health available in a
PCT with a well developed information
function. 2) A users guide to data collected in
primary care in England (published by the
Eastern Region Public Health Observatory,
January 2006). 3) Compendium of clinical and
health indicators user guide 2006 (from
www.nchod.nhs.uk). 4) Neighbourhood statistics
analysis toolkit (2007).
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Measuring health
Standardisation - Disease and mortality rates
can vary widely by age. - This variation
complicates comparisons between areas that have
different age structures (e.g. Plymouth and
Torbay). - Rates are therefore age-standardised
to provide a summary figure for populations that
take into account their age structures.
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Measuring health
Direct standardisation The rate of events that
would occur in a chosen standard population is
found by applying the age-specific rates of the
subject population (e.g. Plymouth) to the age
structure of the standard popualtion (e.g. the
European standard population).
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Measuring health
Indirect standardisation The age-specific
rates of a chosen standard population (usually
the relevant national or regional population) are
applied to the age-structure of the subject
population. This gives an expected number of
events against which the observed number of
events can be compared.
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Measuring health
Deaths Rate Rate (no.) (crude) (DASR)
Plymouth UA 2,390 971.0 662.7 Torbay
UA 1,820 1,370.4 620.3
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Measuring health
Standardised mortality ratios (SMRs)
2003-2005 Males Females Persons England
and Wales 100 100 100 South West
SHA 91 92 92 Plymouth 108 101 104
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Measuring health
Standardised mortality ratios (SMRs) This
measure summarises the cumulative social and
health experience of people living in an area and
is a sensitive indicator of their general health
and healthcare needs as well as being a powerful
predictor of community health care use. Its
advantage over other variables which are derived
from the census is that it is available routinely
on a regular basis and is not manipulable.
(T.A. Sheldon, BMJ, Vol.315, October 1997)
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Measuring health
Number of deaths and death rate (all causes, all
ages) in 2005 Popln. Deaths Rate Rate
(crude) (A.S.) Most deprived 96,704 824 852
.1 722.8 Least deprived 73,136 823 1,125.3 5
78.7 Plymouth city 256,817 2,390 930.6 619.1

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Measuring health
Years of life lost Years of life lost (YLL) is
a measure of premature mortality. Its primary
purpose is to compare the relative importance of
different causes of premature death within a
particular population and it can therefore be
used by health planners to define priorities for
the prevention of such deaths. The concept of
YLL is to estimate the length of time a person
would have lived had they not died prematurely.
The calculation is an attempt to better quantify
the burden, or impact, on society from the
specified cause of mortality.
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Measuring health
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Measuring health
Life expectancy Life expectancy at birth for
an area in a given period is an estimate of the
number of years a new-born baby would survive,
were he or she to experience the particular
areas age-specific mortality rates for that time
period throughout his or her life. It is NOT a
guide to the remaining expectancy of life at any
given age. For example if female life expectancy
at birth was 80 years for a particular area, life
expectancy for women aged 75 years in that area
would exceed five years. This reflects the fact
that survival from a particular age depends only
on the mortality rates beyond that age, whereas
survival from birth is based on mortality rates
for all ages.
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Measuring health
Life expectancy at birth (2003-2005)
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Useless quotes
Information is like water. It must be
gathered from where it falls, channelled,
cleaned, treated and tested before being stored
in reservoirs. It must be made available on tap
to those who need it, wherever and whenever they
need it. (Taken from Informing Healthier
Choices, Information and Intelligence for healthy
populations)
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Useless quotes
Statistics are like a lamp post to a drunk
man, more for support than illumination. David
Brent, The Office.