Health Status Report and GIS Applications in Public Health

Health Status Report and GIS Applications in Public Health 7 December 2010 Joanne Stares Public Health Officer (Epidemiologist) Public Health Agency of Canada/Eastern Health Health Status Report 1

Health Status Report - Overview Project to date What is a health status report? Strengths and limitations of a health status report Rationale and objectives Results of the environmental scan Next steps Public Health Agency of Canada Agence de la santé publique du Canada 3 Project to date 1) Drafted rationale and work plan 2) Completed an environmental scan of health status reports to identify what health status indicators are being used and how they are constructed Public Health Agency of Canada Agence de la santé publique du Canada 4 2

What is a health status report? Health is Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. - WHO (1948) Health Status is The degree to which a person (or specified group) can fulfill usually expected roles and functions physically, mentally, emotionally, and socially. Any departure from the usually expected health status is an indication that disease is present. -J.M. Last Public Health Agency of Canada Agence de la santé publique du Canada 5 What is a health status report? Health status can be assessed in a number of ways: 1) Clinically by asking questions or conducting a physical exam 2) Health measurement scales - Activities of daily living scale, Glasgow coma scale, Apgar score, Likert scales, etc. 3) Health status indicators - Any criterion that can be used to assess the health status of a person or group - Symptoms, test results, disease prevalence or incidence (morbidity), mortality rates, potential years of life lost (PYLL), disability adjusted life years (DALY), life expectancy at birth, vital statistics, health measurement scales, etc. Public Health Agency of Canada Agence de la santé publique du Canada 6 3

What is a health status report? A health status report uses the best available health indicators to describe the health of a specified population or populations Health status reports may focus on specific topics (e.g. child and maternal health, chronic disease, health disparities, etc.) and may be created in series Alternatively, health status reports may focus on specific population or populations (e.g. First Nations or Inuit populations, populations served by a local health authority, population within a city or an entire country, etc.) Or health status reports may be more comprehensive and outline multiple aspects of community or population health for a specific population or populations Public Health Agency of Canada Agence de la santé publique du Canada 7 Strengths of a health status report 1) Improves accessibility and availability of health data - Increased awareness of sources of health information 2) Dissemination of information - Figures and interpretations of population health data is readily accessible to researchers, health practitioners, policy makers, community groups, program developers and the public alike - Application to community health practice, policy, service delivery, etc. 3) Increased familiarity with health organizations - Functions and processes of the organization in light of health indicator data 4) Many sources of data are internal and can be built upon - Needs assessments, regional communicable disease surveillance, other reports 5) Simplification of processes for gathering information from external sources Public Health Agency of Canada Agence de la santé publique du Canada 8 4

Limitations of a health status report 1) Health is a multifaceted entity and can be difficult to measure 2) Has the potential to be a very complex undertaking 3) Information will eventually become outdated and will need to be updated periodically 4) Many sources of indicator data are external - Statistics Canada, Canadian Institute for Health Information, Newfoundland and Labrador Centre for Health Information, Newfoundland and Labrador Statistics Agency Public Health Agency of Canada Agence de la santé publique du Canada 9 Rationale Rationale: A comprehensive health status report will serve as a one serve as a one-stop-shop for pertinent health information in the form of health indicator data. Information will be readily available to stakeholders, thereby facilitating evidence based decision making as it applies to community health practice and service delivery. In addition, there is a possibility to centralize standard requests for information from external sources. - Stakeholders: groups within Eastern Health, the community, community groups, researchers, policy makers, program developers, and the community. Public Health Agency of Canada Agence de la santé publique du Canada 10 5

Objectives Project Objective: To produce a useful health status report for the population living within the Eastern Regional Health Authority s catchment area. Public Health Agency of Canada Agence de la santé publique du Canada 11 Results of the environmental scan MPH summer student, Siva Savudan Examined health status reports available online Selected seven for review Examined indicators used, layout, data sources, and any unique features Public Health Agency of Canada Agence de la santé publique du Canada 12 6

Results of the environmental scan 1) Survey Says: A report on Health Indicators from the Canadian Community Health Survey, NLCHI (2007) 2) Health Status Report - Regina Qu'Appelle Health Region (2004) 3) A Picture of Health: A Comprehensive Report on Health in Peel (2008) 4) Health Status Report: Sudbury & District Health Unit (2008) 5) City of Ottawa Health Status Report (2006) 6) Health Status Indicators in British Columbia - British Columbia Vital Statistics Agency, Ministry of Health Planning (2001) 7) Regional Health Status Indicators Report, Massachusetts Department of Public Health (2007) Public Health Agency of Canada Agence de la santé publique du Canada 13 Results of the environmental scan Survey Says: A report on Health Indicators from the Canadian Community Health Survey, NLCHI (2007) Indicators: -Heath Utility -Physical Activity -Fruit and Vegetable Consumption -Body Mass Index -Labor Force -Tobacco Use -Measured Body Mass Index -Exposure to Second-Hand Smoke -Patient Satisfaction, Access to Health Care -Self-Rated Health Services -PAP Smear Testing -Wait Times -Mammogram Testing -Changes Made to Improve Health -Health Care Utilization -Breast Self Examination -Influenza Vaccination -Prostate Cancer Screening, -Dental Visits -Colorectal Cancer Exams *All data taken from Canadian Community Health Survey (CCHS) at Statistics Canada Public Health Agency of Canada Agence de la santé publique du Canada 14 7

Results of the environmental scan Health Status Report - Regina Qu'Appelle Health Region (2004) - Rural vs. urban comparisons Indicators: -Demographics -Registered Indian Population -Population Projections, -Natural Rate of Increase -Crude birth Rates -General Fertility Rates -Age-Specific Pregnancy Rates -Age-Specific Abortion Rates -Gross Reproduction Rates -Household Composition -Mobility -Language/Ethnicity -Hospitalization Rates -Incidence of Communicable Diseases -Cancer incidence -Mortality Statistics -Tobacco Use -Substance Abuse -Nutrition -Physical Activity -Sexual Health -Immunization Coverage -Seatbelt Usage -Income -Poverty -Housing Affordability -Housing Characteristics -Social Support Networks -Education -Healthy Children -Crime Trends -Outdoor Air Quality -Drinking Water Quality -Cancer Screening Public Health Agency of Canada Agence de la santé publique du Canada 15 Results of the environmental scan A Picture of Health: A Comprehensive Report on Health in Peel (2008) -Indicator breakdown by selected health determinants -Use of maps Indicators: -Developmentally Vulnerable Children -Immigration Status -Tobacco Use -Alcohol Use -Illicit Drug Use -Body Mass Index -Physical Inactivity -Eating Habits -Hypertension -Birth Control Utilization -Population Characteristics -Income -Education -Lone Parent Families -Language -Ethnicity -Religion -Self-Reported Health -Self-Reported Illness -Life Expectancy at Birth -Health Adjusted Life Expectancy -Mortality Rates -Potential Years of Life Lost -Hospitalizations and ED Visits -Birth Rates -Therapeutic Abortion Rate -Rate of Neural Tube Defects -Infant Mortality Rate -Infant Feeding Method -Mental Health -Dental Health -Physical Environment -Incidence Rates Public Health Agency of Canada Agence de la santé publique du Canada 16 8

Results of the environmental scan Health Status Report: Sudbury & District Health Unit (2008) - Indicator breakdown by health determinants, Did you know? section, indicator definitions and sources provided Indicators: -Mortality Rates -Rates of Morbidity -Pregnancy Rate -Live Birth Rate -Perinatal Mortality Rate -Infant Mortality Rate -Low Birth Weight -Breastfeeding -Children s Dental Health -Substance Abuse -Overweight and Obesity -Physical Activity -Nutrition -Sun Safety -Artificial Tanning -Sexual Health -Injuries -Cancer Screening -Drinking Water Quality -Boil Water Advisories -Recreational Water Quality -Air Quality -Alcohol Use -Tobacco Use -Influenza Immunization Public Health Agency of Canada Agence de la santé publique du Canada 17 Results of the environmental scan City of Ottawa Health Status Report (2006) Indicators: -Life Expectancy -Infant and Perinatal Mortality -Leading Causes of Death -Standardized Mortality Ratios -Premature Mortality (PYLL) -Hospitalization Rates -Standardized Hospitalization Ratios -Chronic Disease Incidence Rates -Tobacco Use -Body Mass Index -Physical Activity -Active Transportation -Energy Balance -Nutrition -Alcohol Use -Sun Safety -Injuries -Injury Prevention -Birth Rate -Infant Outcomes -Maternal Characteristics -Children s Health -Oral Health -Immunization Status -Communicable Disease Incidence -Air Quality -Drinking Water Quality Well and Municipal Water -Recreational Water Quality -Zoonotic Disease -Extreme Weather -Animal Immunization -Health Determinants Public Health Agency of Canada Agence de la santé publique du Canada 18 9

Results of the environmental scan Health Status Indicators in British Columbia - British Columbia Vital Statistics Agency, Ministry of Health Planning (2001) - Use of maps, geographical breakdowns and summaries, detailed temporal breakdowns, breakdowns by age and sex - Significant amount of detail on fewer topics Indicators: -Fertility Rates -Mortality Rates -Socio-Demographics Public Health Agency of Canada Agence de la santé publique du Canada 19 Results of the environmental scan Regional Health Status Indicators Report, Massachusetts Department of Public Health (2007) - Focus on race and ethnicity Indicators: -Health Determinants -Socio-Demographics -Access to Care -Fertility Rates -Infant Outcomes -Leading Causes of Death -Mortality Rates -Chronic Disease Incidence -Hospitalization Rates -Substance Abuse -Injury -Emergency Department Visits -Communicable Disease Incidence -Self-Reported Health -Oral Health -Premature Mortality Rates -Disability -Violence -Occupational Health -Blood Lead Poisoning -Mental Health Public Health Agency of Canada Agence de la santé publique du Canada 20 10

Next steps? -Determine the scope - This will be a comprehensive report, profiling many different aspects of population health -Construct a list of topics to cover - Contents are due to be discussed in mid-december -Scan for publically accessible data - Will be discussed in mid-december -Determine availability and accessibility of data from reports completed by Eastern Health and update where possible - Will be discussed in mid-december -Collect and compile data within the framework of the report -Flesh out the report with interpretation and finalize report for release Stay Tuned! Public Health Agency of Canada Agence de la santé publique du Canada 21 GIS Applications in Public Health 11

GIS Applications in Public Health - Overview An introduction to geographic information systems The role of geographic information systems in public health practice Applications of geographic information systems to public health Public Health Agency of Canada Agence de la santé publique du Canada 23 An introduction to GIS Geographic information systems (GIS) are computer-based systems for integrating and analyzing spatial data A GIS can store a vast amount of complex information, perform analytical operations, and make meaningful maps In mere fractions of the time it would take without involving a computer! Public Health Agency of Canada Agence de la santé publique du Canada 24 12

An introduction to GIS There are five main components to a GIS: 1) Network: GIS relies heavily on the internet or intranets for rapid communication and sharing of digital information (i.e. information on geography, topology and other information specific to the environment, road systems, buildings, railways, etc.) 2) Hardware: Desktop or laptop computer, PDA s, cellular telephones 3) Software: Programs that run locally a web browser if working remotely off of servers, or a software package such as ArcGIS, SPRING GIS, ERDAS, or MapWindow on a computer 4) Database: Data that make up a digital representation of selected aspects of some specific area of the Earth s surface or near-surface. Can range from a simple database of a few megabytes to complex database of several terabytes 5) Management: Procedures, lines of reporting, data quality and control, control points and other mechanisms so that the GIS may meet the needs of its creator Public Health Agency of Canada Agence de la santé publique du Canada 25 An introduction to GIS The history of GIS began in the mid- 1960 s with the first real GIS, the Canada Geographic Information System (CGIS). -This system was developed for the Canada Land Inventory as a measuring tool Public Health Agency of Canada Agence de la santé publique du Canada 26 13

An introduction to GIS Since then, GIS has evolved to incorporate many sources of data, through the use of many different software programs, by many different people of many different disciplines, to solve many different problems in many different areas of human life -Housing -Transportation -Economic Development -Taxation -Marketing -Infrastructure -Law Enforcement -Parks and Recreation -Environmental Monitoring -Emergency Management -Land-use planning -Sociodemography -Health -Human Services Public Health Agency of Canada Agence de la santé publique du Canada 27 An introduction to GIS Geographic information systems characterize what happens by where it happens Knowing where things happen can be critically important Public Health Agency of Canada Agence de la santé publique du Canada 28 14

The role of GIS in public health practice 1) Outbreak investigations 2) Spatial trends in disease 3) Emergency preparedness and response 4) Service delivery 5) Access to health services 6) Locating health services 7) Needs assessments 8) Spatial trends in health determinants Thus GIS has a role to play in planning, assessment, population profiling, monitoring and surveillance, investigations and more! Public Health Agency of Canada Agence de la santé publique du Canada 29 Applications of GIS to public health Outbreak investigations The first steps in an outbreak investigation are to establish the existence of an outbreak, verify the diagnoses, define and identify the cases of the disease At which point one would want to orient the information in terms of person, time and place Public Health Agency of Canada Agence de la santé publique du Canada 30 15

Applications of GIS to public health Outbreak investigations An oldie but a goodie John Snow (a Victorian era physician, a miasma theory critic, and a founding father of modern epidemiology) undertook an investigation of a major cholera outbreak, among a series of cholera outbreaks, in London in 1854 With the use of statistics and by thinking about the data in a geospatial manner, he was able to identify the source of a major outbreak in one particular location as being due to sewage contaminated water from the Broad Street pump Derived evidence supporting the notion that cholera can be caused by sewage contaminated water, when the miasmatic theory of disease was the style of the time and the germ theory of disease was still in its infancy Public Health Agency of Canada Agence de la santé publique du Canada 31 Public Health Agency of Canada Agence de la santé publique du Canada 32 16

Applications of GIS to public health Emergency preparedness and response 1) Prevention/Mitigation: Reduction or elimination of long-term impact and risks associated with natural or human-induced catastrophes 2) Preparedness: The process of developing effective policies, procedures, and plans for how to best manage an emergency situation 3) Response: Actions taken immediately before during, or after an emergency. Response actions reduce or eliminate the immediate and short-term social, human, environmental, and other effects of the emergency 4) Recovery: Measures and actions taken to repair and/or restore communities after an emergency Public Health Agency of Canada Agence de la santé publique du Canada 33 Applications of GIS to public health Emergency preparedness and response Tom Cova, a contemporary GIS and emergency management expert, has spent much of his career examining issues that arise between transportation and evacuation -Advocate for the development of appropriate community evacuation plans His early work was influenced by the evacuation of Oakland Hills, California in 1991 where traffic congestion became a major problem during the evacuation of the area Knowing where issues like these may arise, prior to the emergence of an emergency situation, can allow for appropriate planning ahead of time, and can save lives in a crisis Public Health Agency of Canada Agence de la santé publique du Canada 34 17

Public Health Agency of Canada Agence de la santé publique du Canada 35 Applications of GIS to public health Health Determinants There are many different things in life that can have a significant impact on an individual s health status and some of them may result in health inequities The health status of a population is dependant upon the health status of the individuals and groups that make up the population 1) Income and Social Status 2) Social Support Networks 3) Education and Literacy 4) Employment/Working Conditions 5) Social Environments 6) Physical Environments 7) Personal Health Practices and Coping Skills 8) Healthy Child Development 9) Biology and Genetic Endowment 10) Health Services 11) Gender 12) Culture Public Health Agency of Canada Agence de la santé publique du Canada 36 18

Applications of GIS to public health Health Determinants The Canadian Population Health Initiative is part of the Canadian Institute for Health Information The program s mission is to 1) foster a better understanding of factors that affect the health of individuals and communities; and 2) to contribute to the development of policies that reduce inequities and improve the health and well-being of Canadians http://www.cihi.ca/cihi-ext-portal/internet/en/document/factors+influencing+health/environmental/cphi Public Health Agency of Canada Agence de la santé publique du Canada 37 Applications of GIS to public health Health Determinants Public Health Agency of Canada Agence de la santé publique du Canada 38 19

Comments, Questions or Concerns? Joanne Stares Public Health Officer (Epidemiologist), PHAC Eastern Health, Community Services Mount Pearl Square 760 Topsail Road, Mount Pearl, NL A1N 3J5 (709) 752-4564 Joanne.Stares@easternhealth.ca Public Health Agency of Canada Agence de la santé publique du Canada 39 20