Using Epidemiology Data for Public Health Policy-making: Approving Activities and Investments

1. Using epidemiology data for approving activities and investments in public health for policy makers Anna Kontsevaya National research center for preventive medicine

2. Policy cycle in the areas of health R.A. Spasoff

3. 1. Assessment of population health • Demography, population dynamics • Descriptive epidemiology: • Measure the health of the population • Identify trends and patterns • Assess health risks • Assess health needs • Identify priority targets for policy development • Analytical epidemiology • Individual-level and population-level causes R.A. Spasoff

4. 2. Assessment of potential interventions • Identify potential policy interventions • Synthesize existing knowledge regarding their effectiveness • Contribute relevant new research • Assess the potential of each approach R.A. Spasoff

5. 3. Policy choices • Project impact of potential interventions on the health of the population • Computer simulations of different interventions • Assist the process of consensus development R.A. Spasoff

6. 4. Policy implementation • Help to set targets for the chosen policies • Inform needs-based resource allocation for health services • Guide development of information systems R.A. Spasoff

7. 5. Policy evaluation • Assess the impacts of policies • Monitor future health R.A. Spasoff

8. Epidemiology data: economic using

9. Economic burden of NCD/CVD and its risk factors • Official statistics do not allow to evaluate the risk factors economic burden • Economic burden demonstration is a very good argument for investment in prevention • Economic burden numbers allow to rank the priorities.

10. Economic burden of CVD risk factors in UK billion £ Scarborough P. Theeconomicburdenofillhealthduetodiet, physicalinactivity, smoking, alcoholandobesityinthe UK: anupdateto 2006–07 NHS costs J Public Health (2011) doi: 10.1093/pubmed/fdr033

11. When epidemiology is really useful tool for policy making? • Regular standardized epidemiology monitoring • Supported and financed by government • Used in every day practice for making decision

12. Good example: NHANES in US Biannually

13. Good example: Finland Epidemiology monitoring every 5 years Total cholesterol levels 7,5 7 North Karelia Kuopio 6,5 Turku/Loimaa Helsinki/Vantaa Oulu 6 Lapland 5,5 5 1972 1977 1982 1987 1992 1997 2002 2007 Puska, P Pekka Puska, Director General

14. What we have in Russia? • We do not have epidemiology monitoring as a system. • We have some epidemiology surveys, the recent and biggest one is ESSE-RF • Sometimes the results is difficult to compare because of the methodological differences.

15. ESSE-RF • 2012-2013 • 13 regions • More than 25 000 participants aged 25-64 • Prospectivedesign

16. Question N 1 • What is happening with smoking prevalence in Russia? In males and females?

17. Smoking prevalence in Russian Federation Antismoking law BalanovaYu., Shalnova S., 2015

18. Public health questions on smoking • What are the reasons of smoking prevalence decreasing? • Did antismoking law had any influence? • If smoking decreasing in any case how to show the additional effect of the law and prove that it works? • How to approve the need and economic rationale for implementation of all elements of WHO framework convention on tobacco control?

19. What happens with obesity prevalence in Russia?

20. Obesity prevalence in Russia Obesity prevalence, 2013 (ESSE without Samara) In Russia the rate of obesity increase was 0,4% per year in 2000-2012, but in males there was substantial fasten of obesity prevalence in 2005-2012 (0,61% per year) (Martinchik AM, 2014)

21. Public health questions on obesity? • Why obesity increased? • What can we do in order to stop or delay it?

22. No reasons for optimism on obesity • The simultaneous increases in obesity in almost all countries seem to be driven mainly by changes in the global food system, which is producing more processed, affordable, and effectively marketed food than ever before [Swinburn BA]. • Unlike other major causes of preventable death and disability, such as tobacco use, injuries, and infectious diseases, there are no exemplar populations in which the obesity epidemic has been reversed by public health measures [Swinburn BA]. • Authors recommend to concentrate on the blood pressure and lipids

23. Effective lifestyle intervention in DM patients (mainly weight reduction) – no effect on the endpoints Look AHEAD Research group , NEJM, 2013

24. What about hypertension in recent 20 years? • What happens with its prevalence? • What happens with hypertension treatment?

25. Prevalence of hypertension in Russian population *1994 – национальная выборка; 2004, 2006, 2008,2010 – Мониторинг АД; 2012 – ЭССЕ РФ Шальнова СА и соавт.1999, 2006; Оганов РГ и соавт 2011, ЭССЕ-РФ 2014

26. ЭССЕ – РФ

27. Public health questions on hypertension • Why hypertension prevalence is increasing? • What we can do in order to stop its increasing and stimulate decreasing? • Why hypertension control improved? • What were the most effective actions? • What can be done for further improvements of hypertension control?

28. Finland: example of reverse hypertension Salt Intake in Finland 1977–2002 Systolic Blood Pressure in Men Aged 30–59 Years Sources: Karvonenet al. 1977, Nissinen et al. 1982, Pietinen et al. 1981, Pietinen et al. 1990, Valsta 1992, KTL/Nutrition Report 1995, KTL/ FINDIET 1997 and FINDIET2002 Studies, KTL/unpublished information

29. Example of modeling for decision making based on epidemiology data

30. Population model of some risk factors changes in Russia • What will be if the number of smokers will decrease on 25%, 50% and100% • What will be if patients with hypertension which do not achieve blood pressure goals will achieve it (25%, 50%, and100%, respectively)

31. Prognosis on CVD risk decreasing in deferent prevention models Males “ESSE» Females“ESSE» (%) (%) Boytsov S., Shalnova S., Kontsevaya A., 2016, in press

32. Social and economic effects of prevention scenarios on whole Russian population Boytsov S., Shalnova S., Kontsevaya A., 2016, in press

33. MI Study: objective • Objectives: To describe the current practice of MI treatment in different regions of Russian and in medical facilities at different levels within the health system in order to identify barriers to effective treatment, including: • difficulties in achieving continuity of care at different stages of the patient journey (prior to admission, within the departments of the hospital, following discharge to policlinic cardiologists, and therapeutists). • The ultimate purpose of this study is to identify ways of improving treatment, and thus outcomes, of MI in Russia.

34. What is the ratio or share of males and females among MI patients, hospitalized in clinics? • Official statistics will not able to answer! • We do not have the patients’ portrait! • Studies and registries can help