Measuring the Health Impact of Lifestyles: Scientific Challenges

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Measuring the Health Impact of Lifestyles
Scientific Challenges

• Julie Louise Gerberding, MD, MPH
• Director
• Centers for Disease Control and Prevention
• Dec. 13, 2004

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Actual Causes of Death in the United States,
2000

• Update to published data for 1990
• Peer-reviewed
• Goal quantify modifiable behavioral risk
  factors that are the leading preventable
  contributors to mortality
• Unintentional computational error will reduce
  published estimate of deaths associated with poor
  diet and physical inactivity
• Controversial methods

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Scientific Challenge 1 Knowledge GapsHealth
Protection Research

• Determinants of risk behavior
• Impact of behavioral on health outcomes
• Valid measures of burden
• Interventions to change lifestyle
• Assessment of preventable fraction,
  cost-effectiveness of interventions
• Communications and marketing research to maximize
  diffusion and uptake of interventions

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Scientific Challenge 2Emerging Science

• Best initial outcome measures for assessing and
  comparing health impact?
• Mortality
• Morbidity
• Disability
• Hospitalization
• Increased risk for heart disease, arthritis,
• high blood pressure, diabetes
• Quality of Life
• Others (e.g., cost)
• Some combination of the above
• When and how should researchers make use of
  non-published, non-peer reviewed information?

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Science For An Emerging Health Issue

• Less than a decade of focused research into the
  health impact of obesity, physical inactivity,
  and poor diet
• Highly divergent views on
• methods and formulas
• effects of co-factors
• outcome and impact measures
• interaction

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Scientific Challenge 3 Scientific Synergy and
Collaboration

• Across disciplines
• Across life stages
• Across advocacy groups
• Across funding lines

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Scientific Challenge 4 Scientific diversity
vs. Scientific consensus

• Expectation for the right answer
• How to communicate differences in results
• disconcerting to non-scientists
• disconsensus interpreted as lack of knowledge,
  uncertainty, or ineptitude
• credibility suffers
• How do you productively and openly air different
  views and different results?
• When is there enough consensus to take action?

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Scientific Challenge 5 Translating estimates
(and scientific uncertainty) into helpful
information

• Estimates versus measures
• Scientific papers typically contain many caveats,
  qualifiers, and limitations. . .
• How should estimates and projections be framed
  and presented to journalists, policymakers,
  economists, and the public?
• How do you effectively communicate important
  limitations and assumptions to lay audiences?

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CDC Goals

• Improved methods, approaches, and outcome
  measures
• Accurate absolute and comparative estimates
• Strategies for effectively addressing a range of
  lifestyle-related risk factors
• Methods for effectively communicating estimates
  and science

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Our Hope

• Create and environment where the advancement of
  one health issue doesnt detract from the value
  and importance of another

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www.cdc.gov