Population level data: some possibilities PHIDU The University of Adelaide Tuesday 15 October 2013 healthfirst network National Population Health Symposium

Population Health Data: A guide to its use for needs assessment by Divisions of General Practice

Introduction to population health 1.1What is ‘population health’ in the context of general practice? 1.2What determines the health and wellbeing of the Australian population? 1.3Chronic diseases and their risk factors in Australia 1.4Role of Divisions in population health needs assessment 1.5Principles underpinning needs assessment 1.6Engaging with other stakeholders 1.7Assessing a Division’s capacity to undertake needs assessment 1.8Summary of the steps involved in undertaking a health needs assessment

2.1What are population-level health data? 2.2 What uses can be made of these types of data? 2.3How to use population health data for needs assessment 2.4Possible barriers to the use of population health data 2.5Developing a population profile 2.6Population health data sources and their accessibility 2.7Examples 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

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: : 2.19 Source: ABS National Health Surveys

Smoking rates Rate ratios (Most/ Least disadvantaged) 2001: : 2.33 Source: ABS National Health Surveys

Obesity rates Rate ratios (Most/ Least disadvantaged) 1995: : : 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 and wellbeing? - 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

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