Chapter 3
Slide show developed by:
Richard C. Krejci, Ph.D.
Professor of Public Health
Columbia College of SC
1.18.2015
Introduction
• What is the scope of health communications?
• Where does Public Health data come from?
• How is Public Health information compiled to measure
the health of a population?
Introduction
• How can we evaluate the quality of the presentation of
health information?
• What factors affect how we perceive Public Health
information?
• What type of information needs to be
combined to make appropriate health decisions?
• How do individuals utilize health information to
make better lifestyle decisions?
Important Definitions…
• Health informatics (collecting/compiling data)
• Health communications (collection/use of
information)
• Public health surveillance (interviews, patient
records, etc.)
• Public health data bases (CDC, SCDHEC)
• Infant mortality rate (IMR) (deaths/births)
• Life expectancy (LE) (expected lifespan)
IMR & LE = population health status
More Definitions
• HALE
– Health-adjusted life expectancy
– Mobility, cognition, self-care, pain, mood, and sensory
organ function.
• DALY
– Disability-adjusted life year
– Measure of a population’s health
• GBD
– Global burden of disease
– Specific to a disease or condition
• Under-5 mortality
– Summary of the health of children
Public Health Data, Health Communication,
and the Flow of Information
Dear 16 year old me...
What are the Six Types of Sources
for Obtaining Public Health Data?
1.
2.
3.
4.
5.
6.
Single case or small series (next slide)
Statistics (vital)
Surveys (sampling)
Self-reporting
Sentinel monitoring
Syndromic surveillance
The 6 S’s of Sources of
Public Health Data
Type
Single
case or
small
series
Examples
Uses
Advantages/
Disadvantages
Case reports of one
or a small number of
cases, such as
SARS, anthrax, mad
cow disease and
new diseases (e.g.,
first report of AIDS)
Alert to new disease or
resistant disease; alert to
potential spread beyond
initial area
Useful for dramatic,
unusual, and new
conditions; requires alert
clinicians and rapid ability
to disseminate
information
The 6 S’s of Sources of
Public Health Data
Type
Examples
Uses
Advantages/
Disadvantages
Statistics
(“Vital
Statistics”)
and
reportable
diseases
Vital statistics:
birth, death, marriage,
divorce; reporting of
key communicable and
specially-selected noncommunicable
diseases (e.g. elevated
lead levels, child and
spouse abuse, etc.)
Required by law—sometimes
penalties imposed for
noncompliance; births and
deaths key to defining
leading causes of disease;
reportable disease may be
helpful in identifying changes
over time
Vital statistics very complete
because of social and
financial consequences;
reportable disease often
relies on institutional
reporting rather than
individual clinicians; frequent
delays in reporting data
The 6 S’s of Sources of
Public Health Data
Type
Examples
Uses
Surveys - National Health and Drawing conclusions
about overall population
sampling Nutrition
Examination Survey
(NHANES);
Behavioral Risk
Factor Surveillance
System (BRFSS)
and subgroups from
representative samples
Advantages/
Disadvantages
Well-conducted surveys
allow inference to be
drawn about larger
populations; frequent
delays in reporting data
The 6 S’s of Sources of
Public Health Data
Type
Examples
Adverse effect
Selfreporting monitoring of
drugs and vaccines
as reported by those
affected
Uses
Advantages/
Disadvantages
May help identify
unrecognized or
unusual events
Useful when unusual
events closely follow
initial use of drug or
vaccine; tends to be
incomplete; difficult to
evaluate meaning
because of selective
process of reporting
The 6 S’s of Sources of
Public Health Data
Type
Examples
Influenza
Sentinel
monitoring monitoring to
identify start of
outbreak and
changes in virus
type
Uses
Early warnings or
warning of previously
unrecognized events
Advantages/
Disadvantages
Can be used for “real
time” monitoring;
requires considerable
knowledge of patterns of
disease and use of
services to develop
2009 H1N1 Influenza Epidemic
The 6 S’s of Sources of
Public Health Data
Type
Syndromic
surveillance
Examples
Use of symptom
patterns (e.g.,
headaches,
cough/fever or
Gastrointestinal
symptoms, plus
increased sales of
over-the-counter
drugs) to raise alert
of possible new or
increased disease
Uses
May be able to detect
unexpected and subtle
changes, such as
bioterrorism or new
epidemic producing
common symptoms
Advantages/
Disadvantages
May be used for early
warning even when no
disease is diagnosed;
Does not provide a
diagnosis and may
include false-positive
cases.
Life expectancy and Health- Adjusted Life
Expectancy (HALE)
Country
Life expectancy
Health-adjusted life
expectancy (HALE)
Nigeria
48.8
41.5
India
62.8
53.5
Russian Federation
66.4
58.4
Brazil
71.7
59.8
China
73.4
64.1
United States
78.0
69.3
United Kingdom
79.2
70.6
Canada
80.6
72.0
Japan
82.6
75.0
World Health Organization. World Health Report 2004 Statistical Appendix 4. Geneva: World Health
Organization; 2004.
Disability-Adjusted Live Years (DALYs)
Lost by disease categories and total of all categories per 1000 population.
Country
DALYs lost due
To communicable
diseases;
maternal,
neonatal, and
nutritional
conditions
DALYs lost due
to NonCommunicable
diseases
DALYs lost due
to injuries
(unintentional +
intentional)
Total DALYs
Lost
Nigeria
41,251
10,279
4,815
56,345
India
12,958
11,824
3,793
28,575
Russian
Federation
2,189
18,752
6,411
27,352
Brazil
4,361
13,113
3,247
20,721
China
2,847
10,217
2,314
15,378
United States
941
11,939
1,387
14,267
United
Kingdom
855
11,192
744
12,791
Canada
585
10,256
967
11,808
Japan
588
8,791
1,051
10,430
World Health Organization. Global Burden of Disease Project 2004. Geneva: World Health Organization; 2004.
Disability-Adjusted Life Year
Global Burden of Disease
How Good is the Current Health
Information Offered on the Internet?
Quality Standards for Health
Information Found on the Internet
Criteria
Questions to Ask
Overall site quality
 Is the purpose of the site clear?
 Is the site easy to navigate?
 Are the site's sponsors clearly
identified?
 Are advertising and sales separated
from health information?
Authors
 Are the authors of the information
clearly identified?
 Do the authors have health
credentials?
 Is contact information provided?
Quality Standards for Health
Information Found on the Internet
Criteria
Questions to Ask?
Information
 Does the site get its information
from reliable sources?
 Is the information useful and easy
to understand?
 Is it easy to tell the difference
between fact and opinion?
Relevance
 Are there answers to your specific
questions?
Timeliness
 Can you tell when the information
was written?
 Is it current?
Quality Standards for Health
Information Found on the Internet
Criteria
Questions to Ask
Links
 Do the internal links work?
 Are there links to related sites for
more information?
Privacy
 Is your privacy protected?
 Can you search for information
without providing information about
yourself?
Chapter 3 Scenario:
Balancing the harms and benefits is essential to
making decisions, your clinician says. The
treatment you are considering has an 80% chance
of working but there is also a 20% chance of side
effects. What do you need to consider when
balancing the harms and the benefit, you ask?
How are Most Medical
Decisions Made Today?
Benefits vs. Harms
•
Utility Scale (a patient’s value placed on
an outcome)
•
Decision Trees (how likely is an outcome
going to occur?)
Utility Scale Used to Measure Utilities
Figure 3.2 p. 62
Choice Node and Chance Node
Figure 3-3 p. 64
Two possible outcomes
Decision Tree
Three possible outcomes
Figure 3-4 p. 64
Decision Analysis With Utility of
Blindness Equal to 0.5
Figure 3.5
p. 65
Decision Analysis With Utility of
Blindness Equal to 0.8
• Insert Figure 3-6 here
Figure 3.6
p. 65
Decision Analysis With Utility of
Blindness Equal to 0.2
• Insert Figure 3-7 here
Figure 3.7
p. 66
Chapter 3 Scenario:
You are faced with a decision to have a medical
procedure. One physician tells you there’s no
other choice and that you must undergo the
procedure; another tells you about the harms
and benefits and advises you to go ahead; the
third lays out the options and tells you it’s your
decision. Why, you ask, are there so many
different approaches to making decisions these
days?
How Can We Use Health Information to
Make Healthcare Decisions?
• Three basic approaches:
1. Inform of decision—clinician has all the essential
information and can make decisions that are in the
patient’s best interest
2. Informed consent—patients need to give their
permission before intervention
3. Shared decision making—clinician provides
information to the patient, with which he or she can
make a decision
Types of Individual Decision-making
Type of
Decision
making
Inform of
Decision
(Clinicianbased
Process/Roles
Clinician has all the essential
information to make a decision
that is in the patient’s best interest
Clinician aims to convey their
decision as a clear and
unambiguous action or order
Patients accept the clinician’s
recommendation without
necessarily understanding or
agreeing with the underlying
reasoning
Advantages
Disadvantages
May be efficient and
effective when patients
seek clear direction
provided by an
authoritative and
trusted source
Patient may not gain
information and
understanding of the
nature of the problem
or the nature of the
treatment
Patient may favor if
they do not seek out or
feel they cannot handle
independent decision
making responsibilities
Patient may not be
prepared to
participate in the
implementation of the
decision
Patient may not
accept responsibility
for the outcome of the
treatment
Types of Individual Decision-making
Type of
Decision
making
Process/Roles
Advantages
Disadvantages
Informed
consent
Clinician has the responsibility
to convey a recommendation to
the patient
Patient gains
information and
understanding of the
nature of the
problem or the
nature of the
treatment
Time consuming
compared to informing
of the decision
Harms and benefits of
treatment are weighed by the
clinician in making a
recommendation
Clinician has a responsibility
to provide information on the
aim of the recommendation,
the potential benefits, the
known harms, and the process
that will occur. The patient has
the right to ask additional
questions about the treatment
and the availability of other
alternatives
Patient may be
prepared to
participate in the
implementation of
the decision
Patient may accept
responsibility for the
outcome of the
treatment
May require elaborate
paper work to
implement formal
informed consent
process
May increase emphasis
on legal documents and
malpractice law
Types of Individual Decision-making
Type of
decision
making
Process/Roles
Advantages
Disadvantages
Shared
decision
making
Clinicians serve as a source of information for
patients including providing it directly or
identifying means of obtaining information
Patients can expect to be informed of the
existence of a range of accepted options and
be assisted in their efforts to obtain
information
Patients may seek information on
experimental or alternative approaches and
can discuss the advantages and
disadvantages of these approaches with a
clinician
Considerations besides benefits and harms
are part of the decision-making process,
including such considerations as cost, risktaking attitudes, and the distress/discomforts
associated with the treatment
Patients are often directly involved in the
implementation of care
May increase the control of the
patients over their own lives
May increase the types of
information considered in
decision making
May reduce the adversarial
nature of the relationship
between clinicians and patients
May improve the outcome of
care by increasing the patient's
understanding and
commitment to the chosen
course of care
May be time consuming for
patients and clinicians
May increase the costs of
health care
May increase the
stress/anxiety for patients
May shift the responsibility for
bad outcomes from the
clinician to the patient, i.e.,
takes the clinician off the
hook/clinician does not need
to do the hard work of thinking
through the decision and
making a recommendation
What Other Data Needs to Be
Included in Decision Making?
• How soon?
– When, on average, will the particular outcome
happen if it is going to happen?
• Characteristics of the decision maker
– risk taking attitude
How Do We Utilize Information
to Make Health Decisions?
• Risk-taking attitudes
– Influence how we favor taking actions or avoiding
actions that differ from the recommendations given
• Two key questions:
– How do our risk-taking attitudes affect the way we
make decisions?
– How do we incorporate information into our
decisions?
Public Health Framework for
Managing Disease and Disability
Summary
Healthy People and
Healthy Population
Videos
• TED Talk: Steven Johnson: How the “ghost
map” helped end a killer disease
• HealthMap
• Dear 16-year-old me (health communications
example)
• CDC: Tips from Former Smokers campaign
(health communications examples)
• AT&T: It Can Wait (health communications
examples)
The End
Slide show was developed by:
Richard C. Krejci, Ph.D.
Professor of Public Health
Columbia College of SC
All Rights Reserved