Public Health Intelligence. Dr Barry Borman Director Public Health Intelligence Ministry of Health New Zealand

Transcription

1 Public Health Intelligence Dr Barry Borman Director Public Health Intelligence Ministry of Health New Zealand

2 Since 1983 Waitemata Helensville Muriwai Beach Waitakere City Km North Shore City Auckland Manukau City Waiheke Island Counties Manukau Pukekohe The Auckland DHB includes Great Barrier and the Islands of the Hauraki Gulf Populated Centres Public Hospitals DHB Boundaries State Highways Urban Areas Conservation Land Major Lakes Tertiary Secondary Sub-Acute Westport Kaitaia Northland Dargaville Kerikeri Kaikohe Waitara Warkworth Waitemata Auckland North Shore City Manukau City Thames Waiuku Waihi Huntly Waikato Te Aroha Raglan Matamata Te Puke Kawerau Te Awamutu Putaruru Te Kuiti Lakes Taumarunui Taranaki Stratford Whanganui Marton Foxton Otaki Takaka Capital and Coast Carterton Mapua Picton Porirua Wakefield Nelson Marlborough Hawera Whangarei Wanganui Counties Manukau Hutt Taupo Dannevirke Opotiki Turangi Hawkes Bay Wairoa Wairarapa Napier MidCentral Bay of Plenty Tairawhiti Gisborne Waitangi The Chathams form part of the Hawke's Bay DHB 1 Department of Health 29 Hospital Boards 14 Area Health Boards 1 Public Health Commission 4 Regional Health Authorities 23 Crown Health Enterprises Te Anau Arrowtown Winton Southland Bluff Cromwell Twizel Wanaka Waimate Gore Alexandra West Coast Otago Milton Balclutha Hokitika Waikouaiti Greymouth Methven Darfield Leeston Ashburton Temuka Canterbury South Canterbury Dunedin Oamaru Amberley Oxford Lincoln Kaikoura Kilometres Capital and Coast Porirua Wellington Kapiti Otaki Hutt Upper Hutt Km MidCentral Carterton Greytown Featherston Wairarapa 1 Transitional Health Authority 1 Health Funding Authority 21 District Health Boards 1 Ministry of Health RJK_PHI 01/2003

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4 connectedness Wisdom Understanding principles Knowledge Understanding patterns Information Understanding relationships Data understanding

5 Public Health Intelligence New Zealand Charting our Health The Epidemiology Group of the Ministry of Health 35 epidemiologists, statisticians and health survey experts A semi-academic Business Unit

6 Public Health Intelligence Delivering The right information To the right people At the right time

7 Dissemination All work is publishable, nationally and internationally peer reviewed Occasional bulletins Monitoring reports Papers in peer reviewed journals

8 Public Health Intelligence Charting our Health Carries out the Ministry s statutory responsibility for monitoring the health of the NZ population

9 Delivers epidemiological evidence for health policy and decision making Examines inequalities in health across areas and population groups Analyses health outcomes, risks and determinants PHI Measures the health of the population

10 Spatial Analysis Health Metrics PHI Health Surveys Sector Capability

11 New Zealand Health Monitor National Population-based survey programme Routinely and regularly collect, analyse, interpret, and disseminate information not available from other sources relating to How healthy are we? How healthy is the health system?

12 New Zealand Health Monitor Serial cross sectional surveys NZ Health Survey (adult and children) - 3yrs/12,000/5000 Nutrition Surveys 5yrs/5000 NZ Tobacco Use Survey annual/6000 NZ Drugs and Alcohol Use Survey- 2yrs/7000 NZ Oral Health Survey NZ Mental Health and Wellbeing Survey Serial cohort studies NZ Census Mortality Study NZ Birth Linkage Study

13 Small Area Estimation Working with international experts to develop and apply methods to estimate health status at the regional and local level from national data (from surveys) First example, data from NZ Health Survey 2007/08 at DHB level.

14 NZ Census Mortality Study A study of the relationship between socioeconomic factors and mortality in New Zealand Based on the probabilistic linkage of anonymised census records with mortality records A joint project with University of Otago/Wellington and Statistics New Zealand

15 NZ Birth Linkage Study Anonymised linkage of antenatal care, delivery, birth and postnatal records Provides longitudinal information on antenatal exposure and reproductive outcomes Two examples: the impact of mothers smoking during pregnancy on birth weight the effect of complications during delivery on child development

16 Population Health Metrics Monitors the level, distribution, trends in summary measures of population health, health status, disease and injury patterns, biological and behavioural risk and protective factor profiles and social, cultural, demographic and environmental determinants Used to model health outcomes and project health futures

17 Diabetes

18 Diabetes Forecasting

19 Life Expectancy by DHB Scatter plot of LE against HIIs, after standardisation Low average level of health Fair distribution of health 2.5 HII High average level of health Fair distribution of health Possible goal Hutt Otago Waitemata 1.0 Nelson-Marlborough Taranaki Tairawhiti Capital and Coast 0.5 Canterbury MidCentral Southland Whanganui South Canterbury West Coast Bay of Plenty Hawke's Bay Auckland -0.5 Waikato LE -1.0 Wairarapa -1.5 Lakes Northland -2.0 Counties Manukau Low average level of health Unfair distribution of health -2.5 High average level of health Unfair distribution of health Source : Martin Tobias, Craig Wright, Paul White, PHI

20 Lung Cancer Projections

21 Problem Gambling Percentage of NCGMs and TABs by NZDep01 decile Percent age (%) NCGMs TABs NZ Dep01 decile Source, Kylie Mason, PHI (1=least deprived, 10=most deprived)

22 Population Per Fast Food Outlet NZ Dep Meshblock Count Food Outlet Count Population Count Population Per Outlet Source : Dyfed Thomas, PHI

23 Fast Food Outlets & NZDep Counties Manukau DHB Fast Food Outlet, Dairy & Service Station Distribution by NZ Deprivation Number of Fast Food Outlets, Dairies & Service Stations Meshblock NZDep Census Area Unit NZDep Source : Dyfed Thomas, PHI New Zealand Deprivation 2001

24 Suicide, District Health Board Age-standardised rate per 100,000 District Health Board Age-standardised rate per 100,000 Auckland 8.0 Otago 11.6 Bay of Plenty 15.5 South Canterbury 10.4 Canterbury 12.5 Southland 13.9 Capital & Coast 10.4 Tairawhiti 16.9 Counties Manakau 11.7 Taranaki 8.6 Hawkes Bay 18.0 Waikato 10.9 Hutt Valley 10.0 Wairarapa 14.2 Lakes 12.6 Waitemata 11.5 MidCentral 13.2 West Coast 8.2 Nelson-Marlborough 14.3 Whanganui 17.3 Northland 13.2

25 Suicide, Auckland West Coast Taranaki Hutt Valley Capital & Coast South Canterbury Waikato Waitemata Otago Counties Manukau Canterbury Lakes Northland MidCentral Southland Wairarapa Nelson-Marlborough Bay of Plenty Tairawhiti Whanganui Hawkes Bay Age-standardised rate (per 100,000) District Health Board

26 Suicide, District Health Board Age-standardised rate per 100,000 Auckland West Coast Taranaki Hutt Valley Capital & Coast South Canterbury Waikato Waitemata Otago Counties Manakau Canterbury Lakes Northland MidCentral Southland Wairarapa Nelson-Marlborough Bay of Plenty Tairawhiti Whanganui Hawkes Bay

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29 Drill-down increased resolution

30 Partnerships University of Wollongong (Australia) statistics, surveys Centre for Public Health Research (Massey) epidemiology University of Otago/Wellington Social Epidemiology Centre for Health Services Research (Victoria) health services research University of Canterbury spatial epidemiology GeoHealth Lab health sciences Crop and Food Research Institute nutrition, nutritional epidemiology

31 Using Information Need to upskill policy developers and decision makers to actually use information Epidemiology for managers and Board members Ask the right question and understand the answer Epidemiology for analysts Carry out the right analyses to answer the right question

32 PHI Assist You Technical advisory services Health needs assessment Indicators and outcome measurements Strategic project advice Dissemination of epidemiologic evidence & information products Assistance with high quality value added analysis Provision of analytical tools, database sharing, and datasets Training and knowledge transfer Workshops, secondments,

33 MOUs, SLA, Secondments Signed Hawkes Bay, Tairawhiti, Whanganui, Lakes, Northland DHBs To be signed Midcentral & Hutt Valley DHBs TAS? Contract for epidemiological analyses Nelson-Marlborough, South Canterbury, West Coast DHBs Accountability document for HNA Secondments: Rebecca Rippon, Lee Tan (CCDHB) Public Health Registrar placements (HVDHB)

34 Public Health Intelligence New Zealand Charting our Health Helping You to Better Measure What You Have to Manage

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36 Monitoring Indicators of NZ Health (annual) Environmental health indicators suicide, diabetes CVD, birth defects, diabetes, CVD, injury, occupational diseasse Tobacco, problem gambling

37 Thank you

38 NZ Health Survey Topic areas Chronic diseases, biological and behavioural risk factors, reported health status, health service utilisation, sociodemographics Frame All New Zealanders Sample size Approximately 12,000 adults and approximately 5,000 children Mode Face to face, computer-assisted (CAPI) questionnaire plus anthropometric measurements in respondent s home Frequency Every 3 years, 2006/07, 2009/10

39 NZ Adult Nutrition Survey Topic areas Food and nutrient intake, factors influencing dietary intake, nutritional status and nutrition-related status Frame New Zealand adults (15 years+) Sample size Approximately 5000 Mode 24-hour dietary recall and food frequency questionnaire (FFQ), selfadministered questionnaire, plus examination, in respondent s home Frequency Every 10 years (next 2007/08)

40 NZ Children s Nutrition Survey Topic areas Food and nutrient intake, factors influencing dietary intake, nutritional status and nutrition-related status Frame New Zealand children (5-14 years) Sample size Approximately 4000 Mode 24-hour dietary recall and FFQ, caregiver-administered questionnaire in home, and examination component at school Frequency Every 10 years (next 2012)

41 Visualisation of Data Analysis Reveal trends, patterns and relationships Communication Is intuitive, can simplify workload Empowerment More people can do more things Information can be shared Most health data is spatial

42 NZ Tobacco Use Survey Topic areas Tobacco use and the psychosocial correlates of smoking behaviours (prevalence, consumption data from NZHS 3 rd yr) Frame New Zealand adults (15-64 years) Sample size Approximately 4000 to 6000 Mode Face-to-face CAPI questionnaire in respondent s home Frequency Two out of every three years (2005, 06, 08, 09 etc)

43 NZ Oral Health Survey Topic areas Oral health status, oral health beliefs, attitudes, knowledge and practices Frame All New Zealanders Sample size Approximately 6000 to 8000 Mode Face-to-face CAPI questionnaire and examination in respondent s home Frequency In planning for 2007/08 to be repeated every 10 year

44 NZ Alcohol and Drug Use Survey Topic areas Alcohol and illicit drug use, and the behaviours associated with alcohol and drug use Frame New Zealand adults (16-64 years) Sample size Approximately 6000 to 8000 Mode Face-to-face CAPI questionnaire in respondent s home Frequency Every two years (next 2007)

45 Contact Dr Barry Borman Director Public Health Intelligence Ministry of Health Wellington, New Zealand Tel: +64 (4) Mobile: +64 (21)

46 Work in Health Metrics Determine life expectancy by socio-economic position and ethnicity Calculate attributable mortality burden of nutrition and related risk factors Monitor health expectancy (a generalisation of life expectancy that combines both fatal and nonfatal outcomes into a single unit of health) Examine trends and disparities in avoidable mortality in relation to small area deprivation and ethnicity