A ssociation of Public Health Observatories

1. Association of Public Health Observatories CommunityHealthProfiles DrClaire Bradford Dr Alison Taylor

2. Wanless Report “Health data are essential for monitoring the health of the population and for evaluating the effects of health interventions. Yet the information collected nationally is often poor and there is no regular mechanism by which a PCT or LA can gather reliable information on its own population.”

3. Choosing Health - Priorities • Reducing the number of people who smoke • Reducing obesity and improving diet and nutrition • Increasing physical activity • Encouraging and supporting sensible drinking • Improving sexual health • Improving mental health

4. Delivering Choosing Health • ‘We will develop a standard set of local health information that can be linked to other local data sets for publication. Public Health Observatories will produce reports designed for local communities at local authority level which will support Directors of Public Health in promoting health in their area’.

5. Community Health Profiles • These reports will: • Include information on different groups • Provide information for communities based on local authority boundaries; • Assist in the production and comparison of Director of Public Health reports; • Provide consistent national reporting of key data, which would become comparable over time; • Include new public health data sets.

6. Community Health Profiles – the what To provide a consistent, concise, comparable and balanced overview of the population’s health that informs local needs assessment, policy, planning, performance management, surveillance and practice. A distillate of the absolutely key, most useful (currently available) indicators ( with a reference to new data/indicators and unavailable data/indicators).

7. Community Health Profiles – for whom To be primarily of use to joint efforts between local government and the health service to improve health and reduce health inequalities, but ultimately to empower the wider community

8. Domains/Indicators? At least 24 different sets of local regional and national sets of indicators have been identified No national stable community health profiles have been identified

9. Content and scope • Demography (population and age structure/trends, ethnic mix, migration) • Determinants of health • education, income, employment, housing, transport, etc • disease and lifestyle risk factor data (e.g. smoking, alcohol, obesity, physical activity rates) • service provision data • Health outcomes (e.g. SMRs, life expectancy, other summary measures, incidence and prevalence of tracker/marker conditions: diabetes, hypertension…) • Performance (e.g. data on progress against PSA targets)

10. ScottishCommunityProfiles • Population demographics • Health & Function • Behaviour • Social environment • Economy • Physical environment • Morbidity and Mortality • http://www.phis.org.uk/info/sub.asp?p=bb

12. Outputs targeted at professional audience March 2006 • Website – likely to be interactive SVG • Reports • Summarised indicators at LA level with interpretation • Audience – professional/public; LA • Action, e.g. • LAA & performance monitoring • Health Overview and Scrutiny Committees • Neighbourhood renewal

13. Outputs targeted at the public March 2006 • Communication with the public • Being led by the DH communications group • Central Office of Information undertaking research to identify best methods • Possibly linking to Prime and other health magazines

14. CommunityHealthProfilesProject Stage 3 Dissemination of Community Profile to professionals (with interpretation) toa) assist Professional response to Public report [below]b) assist in writing of any PCT/LA/DPH Annual Report2 c) reference to sources of interventional evidence (e.g. from NICE) where available and appropriate [Web/CD] Stage 2 Populating indicators and comparators over time and space ) [crunching] • Stage 1 • Indicator/Metadata design, definition and iteration year on year

15. Domains Who are we? (demography) What affects our health? (determinants) What we do (lifestyles) How we live, work and learn (society, environment) What organisations are doing (delivery) How healthy are we? (health outcomes) Health and illness Why and when we die

16. Criteria for choosing indicators • Important impact on the health of the population, • Supports local government and NHS management frameworks • Is valid, i.e. does it measure what it purports to measure • Is primarily based on existing indicators (although crucial to highlight non-existent and new data where important) • Is primarily available at Local Authority level (although sub-LA data will be explored) • Is amenable to meaningful comparison over time, place, person • Can be communicated easily to a wide audience.

17. Indicator name/title Creator Date Subject category/ domain(s) Indicator sets where found Definition Numerator definition Source of numerator Denominator definition Source of denominator Geographic coverage Dimensions of inequality available Timeliness Accuracy and completeness Data caveats Technical guidance Further information Metadata

18. Assessing indicators • Framework to assess indicators against criteria and • answer important questions, covering the following tasks: •    Define the indicator •    Decide on the domain(s) for the indicator •    Identify which criteria the indicator meets •    Identify whether data is available for the indicator •   Identify the levels of data that are reasonable/available •    Identify if there is an equivalent European indicator •    Identify if there is a relevant effective intervention •    Comment on whether practice/policy locally will be specifically helped by the indicator •    Identify indicator sets that include indicator •    Rationale for the indicator. • To project team by 21st October

19. Indicators from workshop (1) Demography Deprivation - Percentage of population in bottom quintile Ethnicity - Percentage non-white population Age structure Determinants Smoking Prevalence Obesity - Mean BMI Alcohol - Alcohol/week (binge drinking) Diet/nutrition - Percentage of people consuming 5/day; or mean number portions Education - Percentage young people not in further education/training Physical activity Primary Care services - Number of primary health care workers per 100,000 population Income - Income inequality Environment ?

20. Indicators from workshop (2) • Health Outcome – mortality • Life expectancy Life expectancy at birth • Circulatory disease mortality DSR <75; Years of life lost • Cancer mortality DSR <75 • Infant mortality • Alcohol attributable mortality • Smoking attributable mortality • Health Outcome – morbidity • Rating of good health Census question or HSE/GHS • Mental health QOF, admissions, prescribing or GHQ12 • Diabetes Prevalence – QOF or admissions • Respiratory disease QOF or hospital admissions • Frequent flyers? • Accidents

21. Indicators from workshop (3) Performance – partnership indicators Teenage pregnancy Drug treatment Enhanced CPA Performance – Prevention MMR Immunisation Breast screening Smoking cessation Performance – service activity CHD admissions Smoking status BMI recorded QMAS indicator? Other – global/ environment Carbon measure, Recycling, ? Other - cost Health expenditure? State of health in 20,30,50 years if we do nothing Other – inequities /social justice Physical disability, Mental health/ wellbeing, Children, Crime, Sexual Health

22. Other key indicators • Percentage of 11 year olds achieving the expected level 4 or above in Maths and English Key Stage 2  • Percentage of half days missed due to unauthorised absence  • GCSE Performance: grades A*-C  • Age-standardised mortality rate from suicide and undetermined injury  • Proportion of children under 16 living in 'low income households' (Child Poverty Index)  • Number of road traffic casualties per 1000 resident population  • Number of people killed or seriously injured in RTAs per 100,000 population  • Flu vaccinations  • Smoking rates during pregnancy  • Older people helped to live at home  • Intensive home care 

23. CommunityHealthProfilesProject Stage 3 Dissemination of Community Profile to professionals (with interpretation) toa) assist Professional response to Public report [below]b) assist in writing of any PCT/LA/DPH Annual Report2 c) reference to sources of interventional evidence (e.g. from NICE) where available and appropriate [Web/CD] Stage 2 Populating indicators and comparators over time and space ) [crunching] • Stage 1 • Indicator/Metadata design, definition and iteration year on year

24. Timing of work • Assessment of indicators 21st October 2005 • Indicator list - Steering Group 7th November 2005 • Number crunching November/December • Pulling data into reports January 2006 • Interpretation February 2006 • Publish reports End March 2006.

25. CommunityHealthProfilesProject • We want your views on: • What are the gaps in the workshop indicators? • Do you think some of the ‘review’ indicators should be included? • What process should we use to add/remove indicators from list? • What new data might be included? • What is the best way to organise the number-crunching work? • What is the best way of displaying the data? – ideas for web and paper formats (subgroup?)