Transcript Chapter 2 Understanding and Measuring Health

Public Health:
What It Is and How It Works,
Fourth Edition
• Chapter-by-Chapter Power Point Slides
• Links to Internet-based resources
Chapter 2
Understanding and
Measuring Health
Chapter 2 Will Help You To:
• articulate several different definitions of health
• identify 4 or more categories of factors that influence health and, for
each of the these categories, specify 3 or more factors that influence
health
• identify several categories of commonly used measures of health
status and, for each of these categories, identify 3 or more commonly
used measures
• describe major health status trends over the past 100 years
• access and utilize comprehensive and current national data on
health status and factors influencing health in the U.S.
• utilize information on factors that influence health and measures of
health to develop community health priorities and effective
interventions for improving community health status
Health in the U.S.
• Health status improving
– Life expectancy at birth
– Birth outcomes better
– Years of healthy life increasing
• Disease trends changing
– Shift from infectious to chronic diseases
• Disparities increasing
– Ethnic and racial groups
U.S. Infant Mortality Rates by Race
Deaths under 1 year per 1,000 live births
80
60
Black
40
All races
20
0
White
1940 1950
1960
1970
1980
1990
NOTE: Infant deaths are classified by race of decedent.
2001
American Life Expectancy
85
White women
80
Black women
75
Years
White men
70
Black men
65
60
55
1970
1975
1980
1985
1990
1995
2001
Leading Causes of Death Among
U.S. Children
Deaths per 100,000 children Ages 1-4 year, 2000
14
12
10
8
6
4
2
0
Unintentional Injury
Birth Defects
Cancer
Homicide
Heart Disease
Pneumonia/Influenza
Health, Illness and Disease
• Definitions of health also changing
– From absence of disease
– To a state of complete physical, mental, and
social well-being (WHO)
– Health and disease not opposites
• Definition drives measures used
– Shift from mortality based measures to
indicators of functionality and healthy lifespan
Americans’ Views of Health Problems, 2001
“Issue is 1 of 2 or 3 most
important health problems” (%)
“Issue is 1 of 2 or 3 most
urgent health problems” (%)
Bioterrorism/Anthrax/Smallpox
Cancer
22%
50%
Healthcare costs/Insurance
Heart Disease
19%
24%
Cancer
HIV/AIDS
19%
23%
Other
Diabetes
17%
11%
AIDS
7%
Obesity
Heart Disease
7%
6%
Smoking
7%
1% Alcohol/Drug abuse
Health problems from terrorist attacks
1% Smoking
6%
0
10
20
30
40
50
0
10
20
30
40
Note: Sums up to more than 100% because each
respondent was asked to give up to three different
answers.
HSPH/RWJF/ICR poll, November/December 2001
Gallup poll, November 8–11, 2001
50
Health Problems in the U.S.
Actual Causes of Death†
United States, 2000
Leading Causes of Death*
United States, 2000
Heart Disease
Tobacco
Cancer
Poor diet/physical inactivity
Stroke
Chronic lower
respiratory disease
Alcohol consumption
Microbial agents
(e.g., influenza, pneumonia)
Toxic agents
Unintentional injuries
(e.g., pollutants, asbestos)
Diabetes
Motor vehicles
Pneumonia/influenza
Firearms
Alzheimer’s disease
Sexual behavior
Kidney disease
Illicit drug use
0 5 10 15 20 25 30 35
0
5
10
15
20
Percentage (of all deaths)
Percentage (of all deaths)
*Minino AM, Arias E, Kochanek KD, Murphy SL, Smith BL. Deaths: final data for 2000. National Vital Statistics Reports
2002; 50(15):1-20.
†Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA.
2004;291 (10): 1238-1246.
Discussion
• Based on data in the article Actual Causes of
Death in the United States, 2000 (this is an
update of 1990 information provided in Table 2-4
on page 60 of the text), identify three causes of
death that you believe are given more media
attention and coverage than they deserve based
on their importance as an indicator of health
status (and then three causes that you believe
receive less attention than they deserve).
• What are the implications of such over- or undercoverage on public policy and on public opinion?
Measuring Health
• Mortality based measures
– Crude, adjusted, and specific mortality rates
– Composite measures: life expectancy and
years of life lost
• Morbidity, disability and quality measures
– Disease prevalence
– Days lost from work or school
– Self reported health status
Life Expectancy at Birth by Gender and Ranked,
Selected Countries, 2001*
Crude and Age-Adjusted Mortality Rates,
U.S., 1950-2003
Deaths per 100,000 Population
1500
1446
Crude Mortality Rate
Age-Adjusted Mortality Rate
1400
1339
1300
1223
1200
1100
1039
1000
900
964
955
939
945
800
869
878
864
854
842 833
1980
1990
2000
2003
700
1950
1960
1970
Year
Total Life Expectancy and Years Healthy Life be
Race and Hispanic Origin, U.S., 1998
Influences on Health
• Ecological perspective
– Multiple factors and pathways
• Risk factors
– Increase likelihood of condition or disease
• Social and cultural determinants
– Social status and standing
• Global health influences
– Population, pollution, poverty and more
HIPPOCRATES
– Observed that the health of a people
could be understood in terms of:
• THE WINDS AND THE CHARACTER
OF THE AIR
• THE WATER THAT THEY DRINK
• THE LAY OF THE LAND
• THE HABITS OF THE PEOPLE
c 600 BCE
Determinants of Disease
Lack of Access to
Medical Care
11%
Behavior/ Protecting A govern Policies a
48%
16%
47%
27%
Environment
16%
Genetic
Composition
25%
Behavior/Lifestyle
48%
Evans & Stoddart Field Model of Health and Well-Being
Social
Environment
Physical
Environment
Genetic
Endowment
Individual
Response
- Behavior
- Biology
Health
&
Function
Disease
Well-Being
Health
Care
Prosperity
Source: RG Evans & GL Stoddart, "Producing Health, Consuming Resources" Chapter in
Why Are Some People Healthy and Not Others, Ed. RG Evans, ML Barer, and TR Marmor.
Discussion
• Population, poverty, and pollution are
sometimes cited as the 3 most important
factors influencing global health status
today. After examining the World Health
Organization (WHO) web site, briefly cite
your reasons for agreeing or disagreeing
with this assertion using a specific country
or region of the world as an example.
Determining Causative Factors
• Determinants
– Proven to influence level of health problem
• Direct contributing factors
– Affect the level of a determinant
• Indirect contributing factors
– Affect the level of direct contributing factors; more
likely to be controllable and basis for intervention
• Health problem analysis model
Discussion
• After reviewing the Tobacco Use achievement
from the Century of Progress in Public Health
case study site, select a specific health outcome
(other than lung cancer) related to tobacco use
and analyze that health problem for its
determinants and contributing factors, using the
method described in the text. Identify at least
two major determinants for that problem. For
each determinant, identify at least two direct
contributing factors, and for each direct
contributing factor, identify at least two indirect
contributing factors.
Annual Adult Per Capita Cigarette Consumption and
Major Smoking and Health Events—
United States, 1900-1998
Economic Dimensions of Health
• Cost benefit analysis
– Assesses ratio of costs to benefits
• Cost effectiveness analysis
– Cost to achieve a specific outcome
• Cost utility analysis
– Cost to achieve a quality adjusted outcome
Healthy People 2010
• Healthy People 1990 and 2000
– Earlier national efforts to promote health and
prevent disease
• Healthy People 2010 Goals
– Increase quality and years of healthy life
– Eliminate health disparities
– 28 focus areas
– Leading Health Indicators
– Use in community health improvement
Discussion
• Review the list of leading health indicators for
Healthy People 2010 (Exhibit 2-2 on page 76 of
the text) and the list of proposed indicators for
community health profiles (Exhibit 2-3 on page
77 of the text). Your governor has directed you to
use these panels of health indicators to guide a
new statewide health improvement initiative in
your state, but to modify or tailor the final list of
indicators to reflect the special needs or
circumstances in your state. Identify three
changes (modifications, additions, deletions)
that you would make and provide a brief
rationale for your decisions.
Discussion
• Your agency administrator is speaking to a
community group on bioterrorism
preparedness. She asks you for
information on the number of cases of
anthrax and smallpox that occur each
year, and on complications related to
smallpox vaccinations, that occur
nationally and in your state. What
information source(s) would you use to
compile this information?
Discussion
• Compare the Public Health Achievements in TwentiethCentury America presented in Chapter 1 (Control of
Infectious Diseases, including Advances in Childhood
Immunizations) and Chapter 2 (Tobacco Use). Both are
available at the Century of Progress in Public Health
case study site.
• Which of these achievements (infectious disease
reduction or tobacco use reduction), in your opinion, has
had the greater impact on the heath status and quality of
life of Americans living in the year 2000? Identify three
specific criteria you used to compare these
accomplishments and provide data for each criteria for
both accomplishments.
Discussion
• The state legislature recently passed a law that would
reduce the information related to the cause of death that
has been collected on the death certificate. Only one
item, to be determined by the State Board of Health, will
now be reported as the official cause of death. The State
Board of Health is considering two options as to the type
of information that will be collected and you have been
asked to offer brief testimony in support of one of these
two options:
– Position A: only disease entities can be listed as the cause of
death.
– Position B: only underlying risk and contributing factors can be
listed as the cause of death.
Internet Resources
• Healthfinder a DHHS-sponsored gateway site that provides links to
hundreds of other useful sites, as well as links to frequently asked
questions on health issues, and links to databases and web search
engines by topic and agency
• Fedstats a gateway to a variety of federal agency data and
information, including health statistics
• National Center for Health Statistics, an invaluable resource for data
and information. Visit its Health United States 2005 Web Site where
you can find and download the very useful publication, Health
United States 2005 with Trends in the Health of Americans Chart
Book.
• CDC Mortality and Morbidity Weekly Reports and MMWR morbidity
and mortality data by time and place
• CDC WONDER system
• IPLAN data set for Illinois counties and communities (IPLAN =
Illinois Project for Local Assessment of Needs)
• US census data---the best general denominator data anywhere
Additional Resources
•
•
•
•
•
•
•
•
•
•
Actual Causes of Death in the United States, 2000. (also available as PDF document)
Mokdad AH, Marks JS, Stroup DF, Gerberding JL. JAMA 2004;291(10)1238-1245.
Community Indicators of Health-Related Quality of Life--United States, 1993-1997.
MMWR 2000;49(13):281-285
Consuming Research, Producing Health. Evans RG and Stoddart DL. AJPH
2003;93(3):371-379
Health United States 2005 Web Site. National Center for Health Statistics.
Washington DC; DHHS-PHS-CDC-NCHS; 2005. Includes access to Health United
States 2005 (with Trends in the Health of Americans Chart Book)
Healthy People 2000 web site for information on both Healthy People 2000 and
Healthy People 2010. Office of Disease Prevention and Health Promotion, USDHHS;
2001
Healthy People 2010: Understanding and Improving Health. US Department of Health
and Human Services. Washington DC; DHHS-PHS; 2000
Healthy People 2010; Leading Health Indicators. US Department of Health and
Human Services. Washington DC; DHHS-PHS; 2000
Leading Health Indicators for Healthy People 2010, Final Report. Institute of
Medicine. Washington DC; National Academy Press; 1999
State Health Facts. Kaiser Family Foundation
What Are Public Health Data? Public Health Data Standards Consortium