Population level data: some possibilities

PHIDUThe University of Adelaide

Tuesday 15 October 2013

healthfirst networkNational Population Health Symposium

Population Health Data:

A guide to its use for needs assessment by Divisions of General Practice

Introduction to population health

1.1 What is ‘population health’ in the context of general practice?

1.2 What determines the health and wellbeing of the Australian population?

1.3 Chronic diseases and their risk factors in Australia1.4 Role of Divisions in population health needs assessment 1.5 Principles underpinning needs assessment1.6 Engaging with other stakeholders1.7 Assessing a Division’s capacity to undertake needs

assessment1.8 Summary of the steps involved in undertaking a health

needs assessment

2.1 What are population-level health data?2.2 What uses can be made of these types of data?2.3 How to use population health data for needs assessment2.4 Possible barriers to the use of population health data2.5 Developing a population profile2.6 Population health data sources and their accessibility2.7 Examples of using data for population health needs

assessment

Using population-level health data

Population health, in the context of general practice, is thus defined as:

“The prevention of illness, injury and disability, reduction in the burden of illness and rehabilitation of

those with a chronic disease. This recognises the social, cultural and political determinants of health. This

is achieved through the organised and systematic responses to improve, protect and restore the health of

populations and individuals. This includes both opportunistic and planned interventions in the general

practice setting.”

A Joint Consensus Statement of the General Practice Partnership Advisory Council and the National Public Health Partnership Group (Joint Advisory Group on General Practice and Population Health 2001)

‘From a general practice perspective, (population health) can be seen as an extension and systemisation of the general practice’s existing

role in preventive care for individual patients. As well, it is the provision of more comprehensive preventive care that addresses the needs of the practice’s patients and local communities, that is,

including those not adequately accessing preventive care. It involves activities, such as immunisation, risk assessment and

management, patient education and screening, in which GPs are already engaged within their practice, it also involves notification of

diseases of public health importance to the relevant government agency … Population health represents an extension and expansion of existing clinical roles towards an emphasis on prevention and a focus on groups or populations rather than on individual patients. General Practice also has an important advocacy role around the structural issues that affect health status, especially for socially

disadvantaged groups. This role will vary according to the setting and may be appropriate at Division or other levels.’

(Joint Advisory Group on General Practice and Population Health 2001).

Key influences or determinants of health

Overall high level of health and wellbeing in Australia e.g., life expectancy and infant mortality rates.

However, there are substantial differences, or ‘inequalities’, in the health and wellbeing of specific groups within the population, e.g.,

- Aboriginal people; and

- other socioeconomically disadvantaged groups, such as single parents on low incomes, the long-term unemployed, recently arrived refugee families, people with significant long-standing mental health problems, and those who have a disability, or are homeless or have only temporary accommodation.

Health inequalities

The lower a person’s SES, the shorter their life expectancy and the more prone they are to a wide range of chronic diseases and conditions.

The link between SES and health begins at birth and continues through life, but the strength of the relationship varies at different life stages.

It is also likely that the health effects of SES through a person’s life are cumulative.

However, there is much more to the link between SES and health than the effects of poverty and adversity. In fact, health improves with each step up the SES ladder.

Socioeconomic inequalities in health

Socioeconomic inequalities in health

Socioeconomic inequalities in health

State/ Territory 1987 2007 Year in which rate in Quintile 5 fell below the 1987 Quintile 1 rate1

NSW 338.1 267.8 1998 Vic 348.8 270.3 1998 Qld 342.1 304.2 2003 SA 324.2 315.9 2006 WA 353.0 296.8 1998 Tas 407.8 334.6 1997 NT 325.7 792.8 Not yet achieved ACT 303.3 252.1 2000

Socioeconomic inequalities in health

Socioeconomic inequalities in health

In Australia, as elsewhere, the prevalence of chronic disease varies across the socioeconomic gradient for a number of specific diseases, as well as for important disease risk factors

However, the diseases with substantial disparities across the socioeconomic quintiles are different, for different stages in the life course.

Any health interventions to address the impact of chronic disease and associated risk factors, at a population level, need to take socioeconomic inequalities into account.

Chronic diseases and their risk factors

Prevalence of Type 2 diabetes

Rate ratios (Most/ Least disadvantaged)2001: 2.392011-12: 2.19

Source: ABS National Health Surveys

Smoking rates

Rate ratios (Most/ Least disadvantaged)2001: 1.872011-12: 2.33

Source: ABS National Health Surveys

Obesity rates

Rate ratios (Most/ Least disadvantaged)1995: 1.342007-08: 1.802011-12: 1.63

Source: ABS National Health Surveys

A ‘population’ may refer to:

- all the members of a particular group (such as, all Aboriginal children from birth to 12 years); or

- all Australian citizens; or

- all registered voters residing in a particular postcode; or

- all hypertensive patients attending a general practice clinic.

In general, a population is the number of people, by age and sex, living in a geographic area. A population’s size and age/sex composition impact upon the health status of a region and its need for health services

What are population-level data

For health needs assessment, a population can be identified as people sharing:

- Geographic location – e.g., living in a neighbourhood or catchment area); or

- Setting – e.g. school, workplace, prison or hospital; or

- Social experience – e.g. age, ethnicity, homelessness;

- Experience of a health condition – e.g. certain disease, mental illness or physical disability.

What are population-level data …cont

Major types of data (total pop, pop by age & sex; marital status; family type; labour force etc.)

Data characteristics

- Temporal: for selected years, a time period (e.g. a decade),projected demographic data to a future date or year

- Spatial: States and Territories, local government area or Statistical Local Area, GP Division etc.

- Resolution or level: National population; selected data by quintile of socioeconomic disadvantage or urban/rural residence; selected data by age and sex.

What are population-level data …cont

Data

- about the size of the population, which are used to calculate incidence, prevalence, mortality and morbidity rates, and so on

- about the socio-demographic make-up of a community, such as education, income and housing information, which are used to assess community risk and to determine the size of the target population for intervention programmes

- that identifies current service delivery mechanisms, capacity and demand, as well as areas where services are inadequate or non-existent

Population data that are useful in developing population health needs assessment

What uses can be made of these types of data

To describe a ‘comprehensive’ picture of what is already known about need, in order to identify priorities for further detailed work

To explore identified problem areas in depth to inform planning of service provision.

To encourage an evidence-based approach in providing effective clinical care to meet needs.

To encourage community involvement in health planning.

To explore and act on wider determinants of health and encourage liaison with other agencies.

To investigate and advocate for needs of vulnerable groups.

A population profile can assist in answering questions such as

- Who is in the community?

- What are the important determinants that impact on health andwellbeing?

- What are key inequities in health and wellbeing across different groups in the community?

- How does the catchment compare to other catchments in the State or Territory?

Developing a population profile

A socioeconomic, socio-demographic profile

Differences (between the MLs, LGAs and the comparators provided) in age and sex structure – leads to different demands on health services re health promoting activities, diseases, level of demand for services.  

Differences in SES – through number and proportion of single parent families, unemployment rates, education levels and the ABS Index of Relative Socio-Economic Disadvantage 

Differences in ethnic make-up of the population  

Proportion of Aboriginal and Torres Strait Islanders in the population

A health profile

Differences (between the MLs, LGAs and the comparators provided) in age-standardised rates of premature death, or age-standardised prevalence rates for selected chronic diseases and associated risk factors; and how these differences are likely to reflect the population’s characteristics (Indigenous or ethnic make-up, socioeconomic status).  

Differences in immunisation rates 

Differences in availability of GPs, other health professionals and community-based services  

Differences in rates of hospitalisations for ACS conditions

Examples

http://www.publichealth.gov.au/download/ML_double/atlas.html

Data access issues faced by PHIDU (and others) – provision of data to PHIDU is voluntary – lack of MBS (not unit record data, but SLA aggregates) – delay in deaths data (waiting on new system)

Timeliness – e.g., childhood immunisation data only just replaced 2008 – could be 2012/13; NHPA

Cell suppression – requirements vary (<5, incl. zero; <19, <26; Pop in specific

group to be a minimum of 300/ 1,000 in any area) – use template to get totals (LGA, ML, LHN, Cap city/ros,

State) when SLA data suppressed– new ABS geography

Population health data sources & their accessibility

IRSD 871 951 991 1002

Single parent families 36.9 27.9 23.6 21.3Jobless families 30.6 19.4 14.6 13.3Children in jobless families 32.3 20.8 15.2 13.9

16 year olds not participating full-time in secondary school education

24.7 19.9 16.2 20.9

School leavers not enrolled in higher education 80.4 76.3 71.3 71.2

Homeless people 11.3 9.4 9.7 12.5

Rent assistance from Centrelink, 2009 23.4 16.0 14.0 15.6Dwellings rented from Housing SA, 2011 12.0 7.7 6.4 4.1Housing stress - mortgage holders, 2011 12.7 10.2 8.4 10.5Housing stress - renters, 2011 31.9 28.5 26.9 25.2Dwellings with no motor vehicle, 2011 12.1 8.8 9.6 8.6

No Internet connection & children under 16 yrs 33.8 26.3 21.2 ..

Age pensioners 85.8 82.5 75.4 72.7Disability support pensioners 11.2 7.9 6.7 5.0Female sole parent beneficiaries 12.6 8.0 5.6 5.3Unemployment beneficiaries 8.7 5.5 4.4 4.1Long-term unemployment beneficiaries 6.4 3.9 3.0 2.7Youth unemployment beneficiaries 12.3 7.5 5.6 5.2Welfare-dependent families with children 21.0 13.0 9.3 9.6Children in welfare-dependent 39.3 28.4 22.0 20.3Health Care Card holders 13.4 10.0 8.4 8.0Pensioner Concession Card holders 30.4 24.7 22.6 19.3Total Concession Card holders 35.3 28.6 25.8 22.6

Playford NAML

Education, Per cent, 2011

Homelessness, Rate per 10,000 population, 2006

Indicators

Housing and Transport, Per cent

Internet access at home for children and young people, Per cent, 2006

Income support, Per cent, 2009

MetroAdelaide

Australia

Summary measure of disadvantage, Index score, 2011

Families with children under 15 years, Per cent, 2011