Public Health and Population-focused Interventions M9205 November 21, 2000

Public Health and Population-focused Interventions

M9205November 21, 2000

Columbia University School of Nursing M9205, Fall, 2000

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


Built on infrastructure

Data and information Competent workforce Systems and relationships Resources, including space,

budget, political capital


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


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


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


Community Health Profile

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


Socio-demographic indicators

Age/race/ethnicity distribution

Number/proportion of those with access/ resources problem

Number/proportion >25 with <HS education

Ratio of HS grads to those entering 9th grade 3 years prior

Median household income

Proportion of children <15 living <poverty level

Unemployment rate Number/proportion of

single-parent families Number/proportion

lacking health insurance


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


Health Risk Factors

proportion of 2 yo with age-appropriate immunizations

Proportion of adults >65 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)


Health Care Resources

Per capita health care spending for Medicare beneficiaries


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


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


Guide to Community Preventive Services

web.health.gov/communityguide

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


Chapter logic



Evidence on effectiveness:

the number of studies, the quality of study execution

• affecting the validity andaccuracy of findings


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


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.


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


Evidence on effectiveness summarized as

strong, sufficient insufficient


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.


Other analyses:

Information on possible and documented harms of interventions will be summarized.

Methods to summarize cost effectiveness information are under development.


Changing Risk Behaviors Tobacco Alcohol Other Addictive Drugs Physical Activity Nutrition Sexual Behavior

Working Table of Contents


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


Contents, cont.

Occupational Health Oral Health Other Physical Impairment and Disability Unintentional Injuries - Motor Vehicle Occupant Injury Prevention Violent and Abusive Behavior


Environmental and Ecosystem Challenges

Biologic Environment Physical Environment Sociocultural Environment


Healthy People 2010

Increase Qualityand Years

of Healthy Life

Healthy People in Healthy

Communities

EliminateHealth

Disparities

GoalsGoals


Increase Qualityand Years

of Healthy Life

Healthy People in Healthy

Communities

Policy Policy Health Intersectoral

Determinants of HealthDeterminants of Health

Health Promotion

Care andTreatment

Disease Prevention

Community InterventionsHealth

Protection

Health Status Health Status Life Expectancy Burden of Illness Quality of Life

EliminateHealth

DisparitiesGoalsGoals

Behaviors

Biology

IndividualPhysical

EnvironmentSocial

Environment

Individual and Environmental Interactions


Postexposure Prophylaxis after Nonoccupational HIV Exposure

Probability Of TransmissionExposure Frequency Low Medium HighSporadic Inform, but do not

recommendConsider Recommend

Continuing Inform, but do notrecommend; considerreferral to riskreduction services

Inform, but do notrecommend; refer torisk reduction services

Inform, but do notrecommend; refer torisk reduction services


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


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%


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


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

Documents

Public Health and Population-focused Interventions M9205 November 21, 2000