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1

Population Health Assessment

Learning Outcomes

LO1 - Identify appropriate information sources to describe the health status and health determinants of a local population.

LO2 - Outline a systematic process to identify, characterise and quantify a specified health issue or problem, health needs, or health impacts.

2

LO1 - Identify appropriate information sources to describe the health status and health determinants of a local population.

  1. What does a Population Health Assessment aim to do? Give an example
  2. A structured appriach is essential. What can PHAs been used for?

  1.  to identify, characterise and quantify specified health issues experienced by a given population. This process is fundamental to many public health activities E.g. Undertaking a needs assessment, planning and implementing policies, evaluating interventions and making decisions about resource allocation.
  2.  
  • To describe the relative health within population (areas or social groups)
    • identify inequalities and potential ‘unmet’ need.
  • To enable comparison with other populations - ‘benchmarking’.
  • To establish a baseline - compare health trends over time.
  • To estimate burden of potentially preventable health problems.
  • To describe health impact of environmental and social factors.
  • To describe the populations’ experience, perception, views + value of health problem or issues.

3

LO1 - Identify appropriate information sources to describe the health status and health determinants of a local population.

​Data sources

  1. Give examples of the many different data sources available
  2. Data may be...
  3. What are the issues to be considered with regard to potential data sources?

  1. Routine sources e.g. census, Ad-hoc sources e.g. cross-sectional surveys aiming to answer a specific question.
  2. Local or regional, Quantitative or qualitative

3. 

  • Completeness/consistency – is the data reliable? Are there any population groups missing
  • Accuracy – how was the data collected? Quality assurance measures in place?
  • Relevance – is the study population sufficiently representative of the target population for the purpose of proposed actions
  • Accessibility – e.g. census statistics are published online
  • Timeliness – is the data up to date (N.B. census takes place every 10 years)

4

What are the issues to be considered with regard to potential data sources?

Completeness/consistency – is the data reliable? Are there any population groups missing

Accuracy – how was the data collected? Quality assurance measures in place?

Relevance – is the study population sufficiently representative of the target population for the purpose of proposed actions

Accessibility – e.g. census statistics are published online

Timeliness – is the data up to date (N.B. census takes place every 10 years)

5

LO1 - Identify appropriate information sources to describe the health status and health determinants of a local population.

Demographic data

  1. Give examples of this type of data
  2. What are these usually from?
  3. How does age structure have implications for health?
  4. What is an advantage of this type of data?
  5. What is a disadvantage of this type of data?

  1. population size, age structure, dynamics (migration, births, deaths). 
  2. Usually from censuses (N.B. these are snapshots and populations are dynamic.)
  3. e.g. ageing populations are likely to have greater demand for treatment and services for conditions associated with later life e.g. stroke.
  4. Representative of all households, easily accessible
  5. Timeliness – only undertaken at 10 year intervals, completeness – omits very young children/homeless, accuracy: difficult to assess, poor information on morbidity (can be subjective)

6

LO1 - Identify appropriate information sources to describe the health status and health determinants of a local population.

  1. What is Mortality?
  2. What is the CRUDE DEATH RATE?
  3. What is the STANDARD MORTALITY RATIO (SMR)?
    1. ​What are the advantages of this?
    2. What are the disadvantages of this?

  1. the death experience of a population (Usually expressed as a rate; allowing comparisons between populations)
  2. number of deaths in a given population time period, usually expressed per 100,000 population per year.                                                         Differences in the age structure of populations affect crude rates therefore useful to standardise i.e. adjusted for differences in age composition between the region under study and a standard population
  3. a measure of study population mortality relative to the standard reference population (( observed count / expected count ) x 100) 
  4. Clear outcome, generally readily accessible and relatively complete (legal requirement for death certification)
  5. Fails to estimate disease burden for non-fatal conditions that may have significant morbidity, recording may not be accurate (especially in elderly patients with multiple health problems). 

7

LO1 - Identify appropriate information sources to describe the health status and health determinants of a local population.

What is MORBIDITY?

the health/illness experience of a population

  • May be incomplete (not all individuals with disease/illness will seek medical attention)
  • Can be difficult to classify/define.

8

LO1 - Identify appropriate information sources to describe the health status and health determinants of a local population.

Health related characteristics or risk factors 

Where can these be available from?                                               

 

may be available from census, surveys, data sets from non-health sector organisiations

9

LO2 - Outline a systematic process to identify, characterise and quantify a specified health issue or problem, health needs, or health impacts.

What are the following?

  1. Normative Needs
  2. Felt Needs
  3. Expressed Needs
    1. Comparative Needs?

  1. Defined by experts or professional group
  2. Defined by clients, patients, relatives or service users
  3. when felt needs become a demand
    1.  when people, groups or areas fall short of an established standard 

10

LO2 - Outline a systematic process to identify, characterise and quantify a specified health issue or problem, health needs, or health impacts.

 

What are the Steps in Health Status Assessment?

  1. Define:
    1. Purpose of assessment
    2. Target population
    3. Aspect of health to be considered
  2. Obtain data
  3. Analyse and interpret data => information
  4. Communicate and disseminate results
  5. Evaluate

11

LO2 - Outline a systematic process to identify, characterise and quantify a specified health issue or problem, health needs, or health impacts.

Health Needs Assessment

  1. What is this?
  2. What is 'need'?
  3. Name 3 types of needs assessments

  1. A systematic method of identifying the unmet health and health care needs of a population and implementing the optimal solution.
  2. the capacity to benefit from an intervention (differences between need, demand and supply)
  3. Epidemiology based needs assessment Comparative needs assessment                     Corporate needs assessment

12

LO2 - Outline a systematic process to identify, characterise and quantify a specified health issue or problem, health needs, or health impacts.

Health Needs Assessment

Outline the following needs assesments...

  1. Epidemiology based needs assessment
  2. Comparative needs assessment

  3. Corporate needs assessment

  1. Combines epidemiologic approaches (including health status assessments) with assessment of the effectiveness and cost effectiveness of interventions. May be limited by inadequate data on incidence, prevalence, severity as well as inadequate data on effectiveness and cost-effectiveness, or lack of agreement on thresholds for intervention (evidence based practice and health technology assessment help). Rarely straightforward – multiple factors interact & impact on health and health care pathways.

  2. compares service uptake in different populations e.g. NI vs rest of UK

  3. Based on demands and wishes of professionals, patients, politicians, policy makers, service providers and the public

 

13

LO2 - Outline a systematic process to identify, characterise and quantify a specified health issue or problem, health needs, or health impacts.

Health Needs Assessment

What are the steps involved?

  1. Identify the health issues and prioritise (may arise from a population health assessment)
  2. Assess size & nature of the problem
    1. How many people, common characteristics, how many already receiving intervention, identify unmet needs
  3. Review current services available
  4. Consult stakeholders
    1. Professionals, patients,government agencies, voluntary groups.
  5. Review the most appropriate and cost effective interventions
  6. Consider resource implications
  7. Collate, analyse and present findings
    1. May take the form of a report
  8. Proposals with practical implementation plan
  9. Audit and evaluation

14

LO2 - Outline a systematic process to identify, characterise and quantify a specified health issue or problem, health needs, or health impacts.

Health Impact Assessment

  1. What does this aim to assess?
  2. What is used to make decisions?

  1. to assess the potential effects of proposals (e.g. relocating A&E services, or building a new factory) on the health of a population, and the distribution of those effects within the population.
  2. Evidence based information - decisions as to how to maximise benefits and minimise negatives of a proposal to inform decision making.