Public Health and Population-focused Interventions

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Public Health and Population-focused Interventions

• M9205
• November 21, 2000

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The goal of public health

• Preserve, promote and protect health of the
  public or community
• Create conditions within which people can become
  or remain healthy
• Individual assessment of health status (either
  singular individual or singular condition) not
  adequate

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Built on infrastructure

• Data and information
• Competent workforce
• Systems and relationships
• Resources, including space, budget, political
  capital

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Few health services research-style studies

• Data systems are non-standardized and un-linked
• Workforce is not identified
• Relevant system components have not been defined
• Resource monitoring limited to specific programs

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Current thinking includes

• Improving Health in the Community a Role for
  Performance Monitoring, IOM
• Guide to Community Preventive Services, CDC
• Healthy People 2010 Health Objectives for the
  Nation

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Performance Monitoring

• Health improvement based on a broad definition of
  health and a model of how health is produced
  within the community
• A CHIP should develop its own set of performance
  measures, linking entities to specific activities
  expected to lead to desired outcomes

Durch et al, Eds. (1997) Improving Health in the
Community a Role for Performance Monitoring
Washington, DC National Academy Press
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Community Health Profile

• Socio-demographic characteristics
• Health Status
• Health Risk Factors
• Health Care Resource Consumption
• Functional Status
• Quality of Life

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Socio-demographic indicators

• Age/race/ethnicity distribution
• Number/proportion of those with access/ resources
  problem
• Number/proportion gt25 with ltHS education
• Ratio of HS grads to those entering 9th grade 3
  years prior

• Median household income
• Proportion of children lt15 living ltpoverty level
• Unemployment rate
• Number/proportion of single-parent families
• Number/proportion lacking health insurance

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Health Status indicators

• Infant mortality rate by race/ethnicity
• Number of deaths (age-adjusted rate)for MV
  crashes, work injuries, suicide, homicide, lung
  breast CA, CV disease, and all causes by age,
  race and gender as appropriate

• Reported incidence of AIDS, measles, TB,
  syphilis, by age, race, gender as appropriate
• Births to adolescents as proportion of live
  births
• Number/rate of confirmed child abuse/neglect
  cases

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Health Risk Factors

• proportion of 2 yo with age-appropriate
  immunizations
• Proportion of adults gt65 with pneumococcal
  vaccine influenza vaccine in last year
• Proportion smokers, by age, race and gender

• Proportion 18 and older who are obese
• Number/type of U.S. EPA air quality standards not
  met
• Proportion of assessed rivers, lakes and
  estuaries that support beneficial uses (fishing,
  swimming)

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Health Care Resources

• Per capita health care spending for Medicare
  beneficiaries

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Functional Status

• Proportion of adults reporting that their general
  health is good toe excellent
• Average number of days during the last 30 days
  for which adults report that their physical or
  mental health was not good

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Quality of Life

• Proportion of adults satisfied with the health
  care system in the community
• Proportion of persons satisfied with the quality
  of life in the community

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Guide to Community Preventive Services

• provide information needed for informed decision
  making on the most effective and cost-effective
  public health strategies, policies, and programs
  for their communities
• target public health practitioners, community
  partners, policy makers
• companion to Guide to Clinical Preventive Services

web.health.gov/communityguide
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Chapter logic
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(No Transcript)
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Evidence on effectiveness

• the number of studies,
• the quality of study execution
• affecting the validity andaccuracy of findings

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Quality of study execution

• description and selection of study populations
• description of the intervention
• measurement of outcomes follow-up or
  completionrates
• presence or absence of important biases

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Execution, cont.

• appropriateness of data analysis
• ability to minimize the effect of confounding.
• Two reviewers read articles on individual studies
  and abstract information on these and other
  factors from the article using a standardized
  abstraction form.

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Evidence on effectiveness

• the number of studies
• the quality of study execution (affecting the
  validity andaccuracy of findings)
• the suitability of a study design to provide
  convincing evidence oneffectiveness for the
  particular issue

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Evidence on effectiveness summarized as

• strong,
• sufficient
• insufficient

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Study design factors

• the existence and type of comparison groups
• how subjects are allocated to (experimental) or
  categorized(observational) into study groups

• time order of exposure to the intervention
  andmeasurement of the outcome
• number of measurements made over time.

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Other analyses

• Information on possible and documented harms of
  interventions will be summarized.
• Methods to summarize cost effectiveness
  information are under development.

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Working Table of Contents
Changing Risk Behaviors Tobacco
Alcohol Other Addictive
Drugs Physical Activity
Nutrition Sexual Behavior
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Reducing Specific Diseases, Injuries, and
Impairments

• Chronic Disease
• Heart Diseases
• Cancer
• Stroke
• Lung Disease
• Diabetes
• Genetic and Biologic Counseling
• Infectious Diseases

• Vaccine Preventable Diseases
• Maternal, Infant, and Child Health
• Mental Impairment and Disability

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Contents, cont.
Occupational Health Oral Health Other Physical
Impairment and Disability Unintentional
Injuries - Motor Vehicle Occupant Injury
Prevention Violent and Abusive Behavior
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Environmental and Ecosystem Challenges

• Biologic Environment
• Physical Environment
• Sociocultural Environment

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Healthy People 2010
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(No Transcript)
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Postexposure Prophylaxis after Nonoccupational
HIV Exposure
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Public service announcement perceptions

• Goal identify if and how demographic/background
  variables affect perceptions of antiviolence
  PSAs.
• Method Survey of 1480 adolescents in midwestern
  public schools
• Constructed reels of PSAs and questionnaire

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PSA perceptions, cont.

• Issues
• representativeness of sample
• pretest population (California, below average
  ability
• question on comprehension The person or narrator
  in this video was understandable
• Maximum predictive value 10

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Cellular Phones

• Case-crossover analysis
• each person is own control
• matched time of collision with similar preceding
  time
• Cases
• drivers who had been in a collision
• reported owning a cell phone
• phone bill locatable

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Wagner et al (KFF)

• Evaluation of impact at a community level
• Based on model of community change leading to
  individual change
• Survey design
• Each program measured against its own selected
  targets