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Life and Death Matters: Data for Public Health Policy. Katrina Hedberg, MD, MPH Oregon State Epidemiologist. June 9, 2014. “ The flip side of democracy is bureaucracy: if everyone counts, everyone must be counted.” Kathryn Schulz, New Yorker , April 7, 2014. Public Health Division.
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Life and Death Matters:Data for Public Health Policy Katrina Hedberg, MD, MPH Oregon State Epidemiologist June 9, 2014
“ The flip side of democracy is bureaucracy: if everyone counts, everyone must be counted.” Kathryn Schulz, New Yorker, April 7, 2014 Public Health Division
Recording Births and Deaths • Historically realm of the church • Birth: baptism, christening • Death: burial and afterlife Public Health Division
Black Death in Europe • 1350’s • Italy: quarantine to track living • England: track the dead Public Health Division
Causes of Death • 1500’s: Bill of Mortality periodically published • 1600’s: • Weekly • Deaths other than plague Public Health Division
Dr. William Farr: 1807-83 • Modern Vital Statistics • Disease classification • Creation of ICD in 1860 Public Health Division
Dr. John Snow: 1807-83 • Modern Epidemiology • Mapping of cholera deaths Public Health Division
Deaths from Cholera, London 1850’s • Miasma theory • Focused around the Broad Street Pump • Water intake from the Thames Public Health Division
The Broad Street Pump Removing pump handle decreased cholera cases Public Health Division
Birth Certificates • Documentation of birth: Ancient China, Egypt, Greece, Rome, Persia • Purpose: taxation, military service Public Health Division
Types of Vital Record Data • Birth • Death • Marriages; divorce • Domestic partnership; dissolution • Fetal death; induced abortion • Other? Surveys… Public Health Division
Vital Records: Dual Purpose • Legal documents • Birth: document age, nationality for school, health care, job, marriage, driver’s license, etc • Death: settling the estate after death • Health Status of the population • Birth: trends; prenatal care; etc • Death: causes; contributing factors Public Health Division
Vital Records: Competing Issues • Legal documents • Privacy; identify theft; access to public services • Health Statistics • Complete picture • Accurate data • Timely data Focus on Vital Statistics for Public Health
Vital Statistics & Public Health • Monitor Health:trends in births, deaths • Diagnose and Investigate: work with ME’s; data on contributing factors • Inform, educate: issue annual reports/ briefs • Mobilize partnerships: funeral directors; licensing boards • Develop plans, policies: provide data to target appropriate interventions
Vital Statistics & Public Health (2) • Enforce laws: Real ID Act; same-sex marriage • Link people to service: data for Medicaid; paternity determination • Assure competent workforce: vital stats basics for epidemiologists • Evaluate effectiveness/ health services quality: prenatal care; tobacco use • Research innovative solutions: death with dignity, out-of-hospital births
Mortality Statistics Public Health Division
Leading Causes of Death 2000 heart disease cancer stroke lung disease diabetes 1900 pneumonia influenza tuberculosis Public Health Division
Death Rates for Selected Diseases, Oregon, 1980-2005 ICD-9 ICD-10
Motor Vehicle Occupant and Opioid Overdose Deaths Deaths per 100,000 population
Drug Overdose Policies • Providers: education; dosing guidelines • Patients: screening; monitoring; education; storage • Regulatory: Board of Pharmacy, DEA • E-prescribing; FDA black box warnings • Law Enforcement ( diversion) • Drug take-back • Public Health • Naloxone for overdoses; • Prescription Drug Monitoring Programs Public Health Division
Contributing Factors Public Health Division
Modifiable Factors assoc with DeathsU. S. 2000 Number of deaths
Behaviors that kill Oregonians Public Health Division
Tobacco Public Health Division
Cigarette smoking prevalence by year, Oregon 1996 – 2011
Smoking-Attributable DeathsOregon Rate per 100,000 Public Health Division
Tobacco Control:Community Interventions • Limit access • Vending machines • Placement of cigarettes • Cost: taxes • Smoke-free air policies • Media Public Health Division
Alcohol Public Health Division
Binge Drinking in Adultsby Age; Oregon, 2011 Public Health Division
Alcohol Policies • Dram shop liability • Limiting hours of sale • Regulate outlet density • Increase price • Enhanced enforcement prohibiting sales to minors • No privatization of sales
Pandemic Influenza Public Health Division
Influenza Hospitalization Rates by Age & Sex; Oregon, 2009 80 60 Rates per 100,000 40 20 Age (yrs)
Influenza Immunization Rates, Oregon, 2013-2014 Source: Oregon Immunization Program, Oregon Health Authority
Birth Statistics Public Health Division
Oregon Teen Pregnancy (15-17 yrs) Rate per 1,000 females Public Health Division
Data on Birth Certificate to Inform Policy • Tobacco use during pregnancy: • 1990: 22%; 2012: 11% • Unmarried mothers age 20-24 yrs: 25% • Married mothers >40 yrs: 2% • Receipt of prenatal care • Early: 76%; inadequate: 24%; no care: 1% Public Health Division
Objective Data to Inform Societal Debates • Death with Dignity • Out-of-hospital Births Public Health Division
Oregon’s Death with Dignity Act • Citizens' initiative, passed in 1994, 1997 • Allows: terminally-ill Oregonians; prescription for lethal dose of meds; self-administered • Public Health Division: monitor / report participation • Debate: who chooses DWDA? poor? less-educated?
Oregon DWDA Prescriptions and Deaths Public Health Division