Public Health Intelligence
Dr Barry Borman
Director
Public Health Intelligence
Ministry of Health
Since 1983
1 Department of Health 29 Hospital Boards
14 Area Health Boards 1 Public Health Commission
1 Transitional Health Authority 1 Health Funding Authority 4 Regional Health Authorities
23 Crown Health Enterprises
21 District Health Boards 1 Ministry of Health ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( !( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( Æ PÆPÆP Æ P Æ P Æ P Æ P Æ P Æ P Æ P Æ P Æ P Æ P Æ P Æ P Æ P Æ P Æ P Æ P Æ P Æ P Æ P Æ P Æ P Æ P Æ P Æ P Æ P Æ P Æ PÆP Æ P Æ P Æ P Æ P Æ P Æ P ÆP Æ P Æ P Æ P Æ P Æ P Æ P Æ P Æ P Æ P Æ P Æ P Æ P ÆP Æ P Æ P Æ P Æ P Æ P Æ P Æ P Æ P Æ P Æ P Æ P Æ P Hutt Otago Lakes Waikato Taranaki Auckland Southland Wairarapa Whanganui Waitemata Northland Canterbury West Coast Hawkes Bay MidCentral Tairawhiti Bay of Plenty South Canterbury Counties Manukau
Capital and Coast
Nelson Marlborough Gore Otaki Waihi Bluff Mapua Huntly Waiuku Thames Marton Foxton Wairoa Temuka Picton Wanaka Raglan Winton Milton Oxford Takaka Twizel Kawerau Te Puke Waitara Kaitaia Kaikohe Opotiki Turangi Waimate Lincoln Te Anau Leeston Methven Matamata Kerikeri Te Kuiti Putaruru Westport Te Aroha Hokitika Cromwell Kaikoura Darfield Amberley Greymouth Stratford Alexandra Balclutha Carterton Warkworth Arrowtown Wakefield Dannevirke Taumarunui Dargaville Waikouaiti Taupo Oamaru Hawera Porirua Wanganui Gisborne Whangarei Ashburton Te Awamutu Napier Dunedin Manukau City North Shore City
Waitangi
The Chathams form part of the Hawke's Bay DHB
´
02550 100 150 200 Kilometres ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( Æ P Æ P Æ P Æ P Æ P ÆP Æ P Æ P Æ P Auckland Waitemata Counties Manukau Helensville Muriwai Beach Waiheke Island Pukekohe Manukau City Waitakere CityNorth Shore City
! ( Populated Centres DHB Boundaries State Highways Urban Areas Conservation Land Major Lakes Public Hospitals Æ P Tertiary Æ P Secondary Æ P Sub-Acute ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( ! ( Æ P Æ P Æ P Hutt Otaki Greytown Carterton Featherston Kapiti Porirua Upper Hutt Wellington 0 510 20 30 40 Km 0 510 20 30 40 Km Capital and Coast Wairarapa MidCentral The Auckland DHB includes Great Barrier
and the Islands of the Hauraki Gulf
Information
Knowledge
Wisdom
Understanding relationships Understanding patterns Understanding principles understanding connectednessData
Public Health Intelligence New Zealand
)
The Epidemiology Group of the
Ministry of Health
)
35 epidemiologists, statisticians
and health survey experts
)
A semi-academic Business Unit
Public Health Intelligence
Delivering
The right information
To the right people
Dissemination
)
All work is publishable, nationally and
internationally peer reviewed
º
Occasional bulletins
ºMonitoring reports
Public Health Intelligence
Carries out the Ministry’s statutory
responsibility for monitoring the health of the
NZ population
PHI
Analyses health
outcomes, risks
and
determinants
Measures the
health of the
population
Examines
inequalities in
health across
areas and
population
groups
Delivers
epidemiological
evidence for health
policy and decision
making
Spatial
Analysis
Health
Metrics
Sector
Capability
Health
Surveys
PHI
New Zealand Health Monitor
National Population-based survey programme
Routinely and regularly collect, analyse, interpret, and
disseminate information not available from other sources
relating to
How healthy are we?
New Zealand Health Monitor
Serial cross –sectional surveys
NZ Health Survey (adult and children) - 3yrs/12,000/5000 Nutrition Surveys – 5yrs/5000
NZ Tobacco Use Survey – annual/6000
NZ Drugs and Alcohol Use Survey- 2yrs/7000 NZ Oral Health Survey - 7000
NZ Mental Health and Wellbeing Survey
Serial cohort studies
º NZ Census Mortality Study º NZ Birth Linkage Study
Small Area Estimation
)
Working with international experts to develop and
apply methods to estimate health status at the
regional and local level from national data (from
surveys)
)
First example, data from NZ Health Survey 2007/08
NZ Census Mortality Study
A study of the relationship between socioeconomic factors and
mortality in New Zealand
Based on the probabilistic linkage of anonymised census
records with mortality records
A joint project with University of Otago/Wellington and
NZ Birth Linkage Study
Anonymised linkage of antenatal care, delivery, birth and
postnatal records
Provides longitudinal information on antenatal exposure and
reproductive outcomes
Two examples:
the impact of mothers smoking during pregnancy on birth weight
Population Health Metrics
)
Monitors
º
the level, distribution, trends in summary measures of
population health, health status, disease and injury patterns,
º
biological and behavioural risk and protective factor profiles
and social, cultural, demographic and environmental
determinants
)
Used to model health outcomes and project health
Life Expectancy by DHB
Bay of Plenty Waitemata Hawke's Bay Southland Wairarapa Lakes Northland Counties Manukau Waikato West Coast South Canterbury MidCentral Taranaki Hutt Nelson-Marlborough CanterburyCapital and Coast Possible goal Auckland Whanganui Tairawhiti Otago -2.5 -2.0 -1.5 -1.0 -0.5 0.0 0.5 1.0 1.5 2.0 2.5 -2.5 -2.0 -1.5 -1.0 -0.5 0.0 0.5 1.0 1.5 2.0 2.5
Scatter plot of LE against HIIs, after standardisation
Low average level of health Fair distribution of health
High average level of health Fair distribution of health
High average level of health Unfair distribution of health Low average level of health
Unfair distribution of health
HII
LE
Problem
Gambling
Source, Kylie Mason, PHI
Percentage of NCGMs and TABs by NZDep01 decile
0 5 10 15 20 25 30 1 2 3 4 5 6 7 8 9 10 NZ Dep01 decile
(1=least deprived, 10=most deprived) Percent age (%)
NCGMs T ABs
Population Per Fast Food Outlet
987
166776
169
1104
8 - 10
1127
71019
63
513
5 – 7
2811
137748
49
942
1 – 4
Population Per Outlet Population Count Food Outlet Count Meshblock Count NZ DepFast Food Outlets & NZDep
Counties Manukau DHB
Fast Food Outlet, Dairy & Service Station Distribution by NZ Deprivation 2001
0 10 20 30 40 50 60 70 80 1 2 3 4 5 6 7 8 9 10
New Zealand Deprivation 2001
N u m b e r of Fa s t Food O u tl e ts , D a ir ie s & Se rv ic e St a ti ons Meshblock NZDep Census Area Unit NZDep
Suicide, 2001-03
13.2 Northland 17.3 Whanganui 14.3 Nelson-Marlborough 8.2 West Coast 13.2 MidCentral 11.5 Waitemata 12.6 Lakes 14.2 Wairarapa 10.0 Hutt Valley 10.9 Waikato 18.0 Hawkes Bay 8.6 Taranaki 11.7 Counties Manakau 16.9 Tairawhiti 10.4 Capital & Coast13.9 Southland 12.5 Canterbury 10.4 South Canterbury 15.5 Bay of Plenty 11.6 Otago 8.0 Auckland
District Health Board District Health Board
Age-standardised rate per 100,000 Age-standardised rate
Suicide, 2001-03
8.0 8.2 8.6 10.0 10.4 10.4 10.9 11.5 11.6 11.7 12.5 12.6 13.2 13.2 13.9 14.2 14.3 15.5 16.9 17.3 18.0 0 2 4 6 8 10 12 14 16 18 20 Au ckla n d We s t C o a s t Tar a n a k i H u tt Val le y Cap it a l & C o as t S outh C a nte rb u ry Wa ik a to W a it em at a Ot ag o C ountie s M a nuka u Can ter b u ry La ke s No rt h la n d Mi d C e n tr a l S outhla n d W a ir ar ap a N e ls o n -M a rlbor ough B a y o f Pl en ty Tai raw h it i W h a nga nui Haw k es B a yDistrict Health Board Age-standardised rate (per 100,000)
Suicide, 2001-03
8.0 8.2 8.6 10.0 10.4 10.4 10.9 11.5 11.6 11.7 12.5 12.6 13.2 13.2 13.9 14.2 14.3 15.5 16.9 17.3 18.0 Auckland West Coast Taranaki Hutt Valley Capital & Coast South Canterbury Waikato Waitemata Otago Counties Manakau Canterbury Lakes Northland MidCentral Southland Wairarapa Nelson-Marlborough Bay of Plenty Tairawhiti Whanganui Hawkes Bay Age-standardised rate per 100,000Partnerships
University of Wollongong (Australia)
statistics, surveys
Centre for Public Health Research (Massey)
epidemiology
University of Otago/Wellington
Social Epidemiology
Centre for Health Services Research (Victoria)
health services research
University of Canterbury
spatial epidemiology – GeoHealth Lab
health sciences
Crop and Food Research Institute
Using Information
)
Need to upskill policy developers and decision
makers to actually use information
)
Epidemiology for managers and Board members
º
Ask the right question and understand the answer
)
Epidemiology for analysts
PHI Assist You
)
Technical advisory services
º Health needs assessment
º Indicators and outcome measurements º Strategic project advice
)
Dissemination of epidemiologic evidence & information
products
)
Assistance with high quality value added analysis
)
Provision of analytical tools, database sharing, and datasets
)
Training and knowledge transfer
MOUs, SLA, Secondments
)
Signed
º Hawkes Bay, Tairawhiti, Whanganui, Lakes, Northland DHBs
)
To be signed
º Midcentral & Hutt Valley DHBs º TAS?
)
Contract for epidemiological analyses
º Nelson-Marlborough, South Canterbury, West Coast DHBs
)
Accountability document for HNA
)
Secondments: Rebecca Rippon, Lee Tan (CCDHB)
Public Health Intelligence New Zealand
Charting our Health
Helping You
to Better Measure
What You
Have to Manage
Monitoring
)
Indicators of NZ Health (annual)
)
Environmental health indicators
)
suicide, diabetes CVD, birth defects, diabetes, CVD,
injury, occupational diseasse
NZ Health Survey
)
Topic areas
º Chronic diseases, biological and behavioural risk factors, reported health status, health service utilisation, sociodemographics
)
Frame
º All New Zealanders
)
Sample size
º Approximately 12,000 adults and approximately 5,000 children
)
Mode
º Face to face, computer-assisted (CAPI) questionnaire plus anthropometric measurements in respondent’s home
)
Frequency
NZ Adult Nutrition Survey
)
Topic areas
º Food and nutrient intake, factors influencing dietary intake, nutritional status and nutrition-related status
)
Frame
º New Zealand adults (15 years+)
)
Sample size
º Approximately 5000
)
Mode
º 24-hour dietary recall and food frequency questionnaire (FFQ), self-administered questionnaire, plus examination, in respondent’s home
)
Frequency
NZ Children’s Nutrition Survey
)
Topic areas
º Food and nutrient intake, factors influencing dietary intake, nutritional status and nutrition-related status
)
Frame
º New Zealand children (5 - 14 years)
)
Sample size
º Approximately 4000
)
Mode
º 24-hour dietary recall and FFQ, caregiver-administered questionnaire in home, and examination component at school
)
Frequency
Visualisation of Data
)
Analysis
º Reveal trends, patterns and relationships
)
Communication
º Is intuitive, can simplify workload
)
Empowerment
º More people can do more things º Information can be shared
NZ Tobacco Use Survey
)
Topic areas
º Tobacco use and the psychosocial correlates of smoking behaviours (prevalence, consumption data from NZHS 3rd yr)
)
Frame
º New Zealand adults (15 - 64 years)
)
Sample size
º Approximately 4000 to 6000
)
Mode
º Face-to-face CAPI questionnaire in respondent’s home
)
Frequency
NZ Oral Health Survey
)
Topic areas
º Oral health status, oral health beliefs, attitudes, knowledge and practices
)
Frame
º All New Zealanders
)
Sample size
º Approximately 6000 to 8000
)
Mode
º Face-to-face CAPI questionnaire and examination in respondent’s home
)
Frequency
NZ Alcohol and Drug Use Survey
)
Topic areas
º Alcohol and illicit drug use, and the behaviours associated with alcohol
and drug use
)
Frame
º New Zealand adults (16 - 64 years)
)
Sample size
º Approximately 6000 to 8000
)
Mode
º Face-to-face CAPI questionnaire in respondent’s home
)
