Session 2 What is public health intelligence?

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Session 2What is public health intelligence?
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What we hope to cover in this session

• Terminology
• Uses of public health intelligence
• Who does public health intelligence work?
• Knowledge and skills for public health
  intelligence work
• The effective public health analyst
• Epidemiology and PH Intelligence
• Incidence and Prevalence

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• Q. What is public health intelligence?

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Terminology

• Data ... is raw. It simply exists and has no
  meaning in itself.
• Information ... is data that has been processed
  in some way to make it (potentially) useful to
  somebody.
• Example 1 - data on the smoking status of 5000
  people in a one-off local survey covering several
  different areas
• Example 2 - data in a local maternity units
  system showing whether or not each baby breastfed
  at birth

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Terminology

• Data ... is raw. It simply exists and has no
  meaning in itself.
• Information ... is data that has been processed
  in some way to make it (potentially) useful to
  somebody.
• Intelligence ... is the appropriate, tailored
  collection and interpretation of information so
  as to be useful to a customer
• Fractures due to falls among elderly people seem
  to be a particular problem in this area. Is this
  the case and if so what can we do about it?
• Are our new teenage pregnancy initiatives
  cost-effective?

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you understand the users needs
Quality service
intelligence
other?
information
front-line knowledge
research publications
data
you know what to bring to the table and what it
all means
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http//en.wikipedia.org/wiki/DIKW
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Is it Public Health Data/Information?
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Wider Determinants of Health
Source Dahlgren G and Whitehead M (1991)
Policies and strategies to promote social equity
in health. Stockholm, Institute for Futures
Studies
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• Southern Derbyshire Health Survey
• Comments from survey respondents about their
  health and living conditions.
• Every problem I have can be traced directly back
  to work
• Man, aged 34
• The area is very poor. It is not very safe to
  leave your home unattended. There isnt much
  social life in this area for families
• Man, aged 35, disadvantaged area
• I feel a lot more pressure is on people these
  days. Although myself and partner earn a
  reasonable wage we still find money tight. If we
  have an argument it is always about money.
• Woman, aged 26
• It is unsafe around here for young children due
  to crime and vandalism. There is usually glass on
  play areas and on the streets. Ive found dirty
  needles on play parks.
• Woman, aged 28, disadvantaged area
• I dont have time to exercise much. My weight
  has risen. I smoke more. I worry about my heart.
• Woman, aged 31, disadvantaged area

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• Locally .
• Why do we need public health information and
  intelligence?
• What do we use it for?

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Why do we need public health information?

• Surveillance
• Forecasting/predicting
• Setting and monitoring health improvement targets
• Benchmarking - seeing how we compare with
  elsewhere
• Needs assessments
• what are the health problems in our area?
• where are these health problems worst?
• what services are available and how good are they
  (quality)?
• where is there unmet need or overcapacity?
• Planning interventions
• where shall we concentrate our resources?
• what capacity will be required?
• Evaluating interventions
• did we make a difference?

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Questions of Health

• 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 sexually
  transmitted diseases in my area, compared with
  the national average and what should we as a
  PCT/LA/CCG/etc be doing about it?
• How big a problem is alcohol-related domestic
  violence in this area and which localities need
  most help?
• How effectively have new vaccines been introduced
  in this area and which communities need
  additional attention to improve coverage?
• What are the health effects of living in areas
  with high levels of radon in the ground?

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Questions of Health

• How effective was our recent campaign to reduce
  alcohol-related road traffic accidents and has
  the benefit been sustained over time?
• Is specialist health care being provided
  equitably in this area?
• What are the health care needs of ethnic
  minorities in our inner city areas?
• 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?
• What can I as a mother do about my childs weight
  problem?

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Who does public health intelligence work?

• PH specialists whose broad training in public
  health includes working with PH information
• PH analysts - specialising in analysing,
  interpreting, presenting PH data
• PCTs/LAs/joint intelligence units
• ?CCGs/CSOs
• PHOs, Cancer Intelligence Teams, HPA
• Government and international organisations
• private companies, consultancies and freelancers
• Other analysts/knowledge managers/researchers
• other NHS and LA analysts
• librarians
• universities

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Local and Regional PHI Teams (examples)

• Local
• Tower Hamlets
• Halton and St Helens
• Bedfordshire and Hertfordshire
• South Staffordshire
• Doncaster
• Greater Manchester
• Regional
• EMPHO
• Trent Cancer Registry

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The Health Intelligence and Research Team
consists of a health intelligence specialist and
two researchers with quantitative and qualitative
research skills. The Team supports the health
inequalities agenda across the City and provides
all those working in this field with advice and
support in relation to the provision, analysis,
interpretation and use of health-related
information.

• Key Tasks
• To support the work of the City Council and the
  Primary Care Trusts in the City, including the
  production and development of a Health and
  Well-being Strategy and Implementation Plan as
  part of the Manchester Community Strategy. 
• To develop targets and indicators for monitoring
  local activities and strategies around health
  improvement and health inequalities reduction. 
• To provide information, support and advice to key
  agencies around the extraction, use and
  interpretation of public health data sources. 
• To provide advice and guidance on research design
  and methods, including project planning, data
  collection, analysis, evaluation and report
  writing. 
• To support Health Inequalities Impact Assessment
  (HIIA) activities across the City. 
• To improve the capacity and understanding of
  individuals and agencies around the use of public
  health information and the planning and
  implementation of research projects. 
• To ensure a local input into regional and
  national developments in public health
  information, intelligence and research. 
• Where possible, to provide a reliable and timely
  response to ad-hoc requests.

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Our current areas of focus are   joint strategic
needs assessment, commissioning strategy plan (to
inform needs in relation to Healthcare for London
pathways), annual public health report, locality
profiles, programme budgeting analysis, social
marketing segmentation, population estimates
validation (in partnership with the local
authority), evidence review support, analysis of
the Tower Hamlets healthy lifestyles survey,
and equity analysis of healthcare data (primary
and secondary care).
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HSJ May 27th 2010
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What sort of work does LHO do?
Support health practitionerand intelligence
networks
Enquiry serviceSignposting dataand information
Tools and methodsfor data analysis
Communication and advocacy for better public
health information. Widening access to data
In depth analysis/interpretation of health data
Public healthperformance monitoring
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• What is your focus . what would you like it to
  be?
• Intelligence - consultancy-style work -answering
  research questions
• vs
• Information - making and supporting the use of
  information tools
• Narrow - health and health care only
• vs
• Broad determinants of health

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Local Health Economy
Immunisation
National and international economic policy
Screening
Access to health services
Pollution and environmental change
Regulatory legislative frameworks
Communicable disease
Child health surveillance
Welfare policy
Health promotion
Emergency planning
Agricultural policy
Community development
Support services
Education
Trade policy
Employment
Build social networks
Leisure
Regeneration
Food
Welfare advice
Environmental improvement
Build social capital
Urban planning
Crime Disorder
Environmental health
Support services
Housing
Empowerment
Transport
With thanks to Neil Bendel, Health Intelligence
Manager, Manchester Joint Health Unit
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• Q. What is public health intelligence?
• over to you (again)

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• Knowledge and skills for public health
  intelligence work

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(NHS Staff) KSF Dimensions relevant for PH
intelligence posts

• IK1 Information Processing
• IK1 Information Collection and Analysis
• IK1 Knowledge and Information Resources
• Core 1 Communication
• Core 4 Service Improvement
• Core 5 Service Quality
• G5 Services and Project Management

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The Public Health Skills and Careers Framework

• Identifies skill sets needed by those working in
  public health including a skill set specific to
  public health intelligence
• A skills escalator for those working up through
  levels of competence to achieve practitioner,
  advanced practitioner and defined specialist
  registration with the UK Public Health Register
• http//www.phru.nhs.uk/Pages/PHD/public_health_car
  eer_framework.htm

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PHI Skills and Knowledge at Level 5 of PHSCF

• Skills
• 1. Collect and collate data from a wide range of
  different sources.
• 2. Ensure data are complete and valid for the
  purpose for which it is to be used.
• 3. Analyse and interpret routine data using
  appropriate analytical techniques .
• 4. Present the outcomes of data analysis.
• 5. Monitor and quality assure routine data
  collection, collation and analysis
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• Knowlledge
• a) Knowledge of statistical methods appropriate
  to health and health needs
• b) Awareness of the qualitative methodologies
  used in health intelligence and their
  contribution to the
• understanding of health and wellbeing.
• c) Awareness of health needs assessment methods
  and their use
• d) Knowledge of different sources of data and
  information relevant to health and health needs
  and how to access them.
• e) Awareness of the principles of Geographical
  Information Systems and the importance of
  demography on
• assessing population health and wellbeing needs
• f) Knowledge of use of geographically linked
  packages.
• g) Knowledge of the Data Protection Act and its
  implications for data disclosure.
• h) Knowledge of software and database packages
  and their use in manipulating data.
• i) Understand the importance of quality assurance

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Q.If you are asked to provide intelligence on
a particular topic what knowledge and skills will
you probably need?
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A. (not comprehensive)

• What information/data is already available to
  answer this question?
• What is its quality? can it be used for this
  purpose?
• If we cant have the data we need do we have a
  suitable proxy?
• Can I get information from another source to
  check my results?
• What is the correct method of analysis?
• What do the results mean?
• How can I best present them?
• How do I explain the limits of these findings,
  and give health warnings against inappropriate
  use?
• Etc ..

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Some qualities of an effective public health
analyst

• Inquisitive
• What data are available to answer this question?
• What is its quality? can it be used for this
  purpose?
• What is the best method of analysis?
• What does the literature say?
• Resourceful and innovative
• If we cant answer the question directly do we
  have a proxy measure?
• Can I get information from another source to
  check my results?
• Do we have to collect undertake some new data
  collection?
• Effective Communicator
• What does it mean?
• How can I best present it?
• How do I explain the limits of these findings,
  and give health warnings against inappropriate
  use?

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KNOWLEDGE SKILLS FOR PUBLIC HEALTH INTELLIGENCE
WORK
Communication Skills
Management Skills
Knowledge Foundations
Writing Presenting
Networking
Chairing Meetings

Project Management Partnership Working Negotiating
Influencing Facilitating Reflective Practice
Determinants of Health Organisations and
services Policy Context
Data Management
IT Skills
Confidentiality Disclosure Data Sharing
Spreadsheets Databases Web Publishing
Consultancy Skills Problem Solving
Skills Leadership
Statistics
Working with literature
Analysis of variations and trends
Literature Searches Critical Appraisal
Interpretation
Special Skills
Working with data
Applications
Record Linkage Qualitative
Research Evaluation HIA
Surveys Training
Sources and their limitations Coding Demographic
data Geography/GIS Standardisation Presentation
Tools
Surveillance Health/inequalities profiles
Equity profiles Resource Allocation
Healthcare Quality Effectiveness of
interventions
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• Steps to increasing your effectiveness
• technical knowledge and skills (incl IT and
  statistics)
• knowledge of wide range of data sources
• knowledge of data quality problems associated
  with each source
• use contacts and networks for accessing
  specialist advice
• keep in touch with best practice
• firm grasp of policy context and needs of
  customers
• core (generic) skills management,
  communication
• consultancy skills

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What you have learned

• What is public health intelligence?
• Data, information, intelligence
• Who does public health intelligence work?
• Knowledge and skills for public health
  intelligence work
• The effective public health analyst

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What is Epidemiology?

• the study of the distribution, frequency and
  determinants of health problems and disease in
  human populations
• The unit of interest is the population.

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Types of epidemiology and their uses

• Descriptive epidemiology
• Describing patterns and trends in health and
  disease in populations
• Analytical epidemiology
• Examining associations and causation
• Experimental epidemiology
• Testing population interventions

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In the news .. (descriptive epidemiology)

• UK C.Diff deaths 'rising sharply'
• There are 10 times more deaths across the UK
  from the superbug clostridium difficile among
  over 65-year-olds than in any other country in
  the world.

Blood pressure cases 'to top 1bn' High blood
pressure is out of control around the world, with
the number of sufferers expected to exceed a
billion within 20 years, experts warn.
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In the news .. (analytical epidemiology)
Sibling link to heart health risk Having a
brother or sister with cardiovascular disease
(CVD) is bad news for your own odds of developing
problems, research has found.
5-a-day doubts raised Eating more fruit and
vegetables has only a modest effect on protecting
against cancer, a study into the link between
diet and disease has found.
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In the news .. (experimental epidemiology)

• Grapefruit 'may cut gum disease'
• Researchers found people with gum disease who
  ate two grapefruits a day for a fortnight showed
  significantly less bleeding from the gums.

Smoking ban cutting heart attacks There were
1,200 fewer hospital admissions for heart attacks
in England in the year after the smoking ban was
introduced, a study suggests.
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Controlled Trials of Community Interventions
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Randomised Controlled Trial
Didgeridoo playing as alternative treatment for
obstructive sleep apnoea syndrome randomised
controlled trial. Reported in BMJ Dec 2005.

• 25 adults with obstructive sleep apnoea,
  randomised to didgeridoo instructions and daily
  practice for 4 months (14), or placing on the
  waiting list for lessons (11).
• Didgeridoo players reported less daytime
  sleepiness and their partners reported less night
  time disturbance , compared with waiting list
  group.

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Types of epidemiology and their uses

• Descriptive epidemiology
• Describing patterns and trends in health and
  disease in populations
• Analytical epidemiology
• Examining associations and causation
• Experimental epidemiology
• Testing population interventions

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Descriptive epidemiology

• .... allows the distribution of health and
  ill-health in a population to be described in
  terms of
• WHAT is the problem and its frequency?
• WHO is affected?
• WHERE and WHEN does it occur?
• WHY does it occur in this particular population?

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Descriptive epidemiology applications
studying the frequency and distribution of
disease

to inform local public health action (the service
focus)
to generate hypotheses about causes (the academic
focus)
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Extra Learning objective

• By the end of the session you will be able to
• Describe the difference between incidence and
  prevalence

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Measures of disease frequency

• The two main measures of disease frequency are
• Incidence
• Prevalence

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What is incidence?

The incidence is the number of NEW CASES of
disease that develop in a population during a
specified time period Often expressed as the
number of new cases per 100,000 population per
year.
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Example Measuring incidence

• Incidence of cervical cancer in a PCT during
  2009
• Number of new cases of cervical cancer during
  2009 45
• PCT Population in 2009 (mid-year estimate)
  500,000
• Incidence ...................................?

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What is prevalence?

• Prevalence is the total number of cases of
  disease in a population at one point in time,
  taken as a proportion of the total number of
  persons in that population.
• Also referred to as point prevalence
• N.B. Period prevalence is a variation which
  represents the number of persons who were a case
  at any time during a specified (short) period as
  a proportion of the total number of persons in
  that population.

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Example incidence and prevalence
Cases of cold infections in class 4J. Class size
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January
February
March
What is the incidence in February? What was the
prevalence on 1st March? When was the prevalence
at its peak?
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incidence and prevalence

• incidence
• the number of new cases of disease per n of
  population occurring in a specified time period
• prevalence
• the number of persons with disease at one point
  in time as a proportion of the total number of
  persons in that population.

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Why might the prevalence of a condition appear to
have changed?
Improved treatment resulting in longer survival
time
High profile case, raises awareness
Increased incidence following increased exposure
to a causal factor
New diagnostic technique
Changed surveillance system broadens the
definition of a case
Improved treatment resulting in cure for some