What is public health intelligence?

Contributors:

Dave Jenner, Helen Cooke, Margaret Eames, Neil Bendel

Session content

• What is public health intelligence?• Who does public health intelligence work?• Knowledge and skills for public health intelligence work• The effective public health analyst• Career paths

Data Information Intelligence - Hierarchy

Data ... is raw. It simply exists and has no meaning in itself.

Information ... is data that has been processed in some way to make it (potentially) useful to somebody.

Example 1 - data on the smoking status of 5000 people in a one-off local survey covering several different areas

Example 2 - data in a local maternity unit’s system showing whether or not each baby breastfed at birth

Data Information Intelligence - Hierarchy

• Data ... is raw. It simply exists and has no meaning in itself.

• Information ... is data that has been processed in some way to make it (potentially) useful to somebody.

• Intelligence ... is the appropriate, tailored collection and interpretation of information so as to be useful to a customer

• “Fractures due to falls among elderly people seem to be a particular problem in this area. Is this the case and if so what can we do about it?

data

you understand the data and what it can tell you

information

intelligence

quality service

you understand the user’s needs

Is it Public Health Data/Information?

Southern Derbyshire Health Survey 1999Comments from survey respondents about their health and living conditions.

• “Every problem I have can be traced directly back to work” Man, aged 34

• “The area is very poor. It is not very safe to leave your home unattended. There isn’t much social life in this area for families” Man, aged 35, disadvantaged area

• “I feel a lot more pressure is on people these days. Although myself and partner earn a reasonable wage we still find money tight. If we have an argument it is always about money.”

Woman, aged 26

• “It is unsafe around here for young children due to crime and vandalism. There is usually glass on play areas and on the streets. I’ve found dirty needles on play parks.” Woman, aged 28, disadvantaged area

• “I don’t have time to exercise much. My weight has risen. I smoke more. I worry about my heart.”

Woman, aged 31, disadvantaged area

• “This area is a good place for small children - plenty of open space and parks. But nothing for children from the age of 11-16 who only roam the streets”

Man, aged 31

• Why do we need public health information? • What do we use it for?

Why do we need public health information?

e.g. for ...

• Surveillance

• Monitoring progress towards health improvement targets

• Benchmarking - seeing how we compare with elsewhere

• “Needs assessments”

– what are the health problems in our area?

– where are these health problems worst?

– what services are available?

– where is there unmet need or overcapacity?

• Planning interventions

– where shall we concentrate our resources?

– what capacity will be required?

• Evaluating interventions

– did we make a difference?

Who does PHI work?

• PH specialists – have a broad training in public health including PHI

• PH analysts/information specialists – working in/for public health and specialising in analysing, interpreting, presenting data

– in PCTs - single-handed or as part of a team– in PHOs and other regional organisations– in PCT/local authority joint intelligence units– in national/international organisations– in private companies and consultancies– freelance

• Many different local arrangements for division of labour and collaboration.

– Specialisation may increase with larger teams– Blurred edges with other information functions

THE ROLE OF THE DONCASTER PUBLIC HEALTH INTELLIGENCE UNIT  

The Unit supports the public health function in Doncaster by:

Analysing, interpreting and presenting data from birth and mortality databases, hospital activity data, Census data and other ONS data, etc. Developing, managing and undertaking research projects to support epidemiological review, strategy development and service evaluation.

Supporting health needs assessment, policy development, health impact assessment, decisions and planning within the PCT.

Making epidemiological information available in a variety of formats to colleagues and public, for example through web sites, reports, profiles or posters on particular health issues.

Evaluating local health services to identify what action should be taken to improve them, including working with national performance indicators.

Providing a Library and Information Service within the PCTs, responding where appropriate to ad hoc queries and ensuring good access to the health knowledge base (journals, books, electronic databases, internet, etc), including research-based evidence on clinical effectiveness and sources of health-related information. Providing comparative information for general practices, particularly in support of practice-based commissioning. Supporting partnership projects with local authority colleagues, across the Doncaster Strategic Partnership. Producing Director of Public Health annual reports.

Supporting working groups within the Doncaster and wider health communities.

The Health Intelligence and Research Team consists of a health intelligence specialist and two researchers with quantitative and qualitative research skills. The Team supports the health inequalities agenda across the City and provides all those working in this field with advice and support in relation to the provision, analysis, interpretation and use of health-related information.

Key Tasks1.To support the work of the City Council and the Primary Care Trusts in the City, including the production and development of a Health and Well-being Strategy and Implementation Plan as part of the Manchester Community Strategy.  2.To develop targets and indicators for monitoring local activities and strategies around health improvement and health inequalities reduction.  3.To provide information, support and advice to key agencies around the extraction, use and interpretation of public health data sources.  4.To provide advice and guidance on research design and methods, including project planning, data collection, analysis, evaluation and report writing.  5.To support Health Inequalities Impact Assessment (HIIA) activities across the City.  6.To improve the capacity and understanding of individuals and agencies around the use of public health information and the planning and implementation of research projects.  7.To ensure a local input into regional and national developments in public health information, intelligence and research.  8.Where possible, to provide a reliable and timely response to ad-hoc requests.

About EMPHO

The East Midlands Public Health Observatory (EMPHO) is one of nine regional Public Health Observatories funded by the Department of Health in England.  EMPHO is the regional health intelligence organisation providing information and analysis to support those working to improve health and reduce health inequalities in the East Midlands.

EMPHO is a member of the Association of Public Health Observatories (APHO) which coordinates joint work across PHOs in the UK and Ireland.

The key overarching roles of PHOs are:

•promoting and delivering health intelligence to decision-makers to improve health and reduce health inequalities

•acting as advocates for population health information, ensuring that high-quality, relevant information is available to a range of stakeholders

•being a single port of call for those who need such information

•developing a skilled health intelligence workforce. 

We do this by:

•monitoring health and disease trends in the Region and highlighting areas for action;

•providing information about key health issues to support commissioning for health improvement and well-being;

•providing information and analysis to support PCTs, local government and local partnerships to promote local action and monitor its impact on health;

•supporting Local Area Agreements (LAAs) in the development of outcomes and indicators;

•producing and refreshing Health Profiles for each local authority area;

•providing a regional service for analysing Hospital Episode Statistics (HES) data;

•acting as a source of expertise in health intelligence, indicator development and inequalities measurement;

•undertaking national work on behalf of APHO, working with other government departments as appropriate;

•providing advice and information in support of our national lead areas of teenage pregnancy, food and health and renal health;

•providing advice on methodologies such as Health Equity Audit, Health Impact Assessment and inequality measurement;

•supporting local networks to maximise the use of health intelligence in decision-making;

•developing capacity and capability in the health intelligence workforce through teaching and training

what is public health intelligence?

• are there natural boundaries?– population health v health services– quantitative v. qualitative– data v. literature– new data collection v secondary analysis of existing

data– descriptive v. analytical & experimental epidemiology

• suggestion - if you’re interested in it AND it’s needed, follow your nose (preferably with the blessing of your manager!)

Knowledge and skills for public health intelligence work

KNOWLEDGE & SKILLS FOR PUBLIC HEALTH INTELLIGENCE WORK

Determinants of Health

Organisations and services

Policy Context

Communication Skills

Writing

Presenting

Networking

Chairing Meetings

Management SkillsProject Management

Partnership Working

Negotiating & Influencing

Facilitating

Reflective PracticeIT Skills

Spreadsheets

Databases

Web Publishing

Literature Searches

Critical AppraisalInterpretation

Data Management

Confidentiality

Disclosure

Data Sharing

Special Skills

Record Linkage

Qualitative Research

Evaluation

HIA

Surveys

Training

Sources and their limitations

Coding

Demographic data

Geography/GIS

Standardisation

Presentation Tools

Working with data

Statistics

Working with literature

Knowledge Foundations

Consultancy Skills

Problem Solving Skills

Leadership

Applications

Surveillance

Health/inequalities profiles

Equity profiles

Resource Allocation

Healthcare Quality

Effectiveness of interventions

Analysis of variations and trends

Qualities of a public health intelligence specialist

• Asks questions – inquisitive– What data are available to answer this question?– What is its quality? – can it be used for this purpose?– What is the best method of analysis?– What does the literature say?

• Resourceful and innovative– If we can’t answer the question directly do we have a proxy measure?– Can I get information from another source to check my results? – Do we have to collect undertake some new data collection?

• Effective Communicator– What does it mean?– How can I best present it?– How do I explain the limits of these findings, and give health warnings

against inappropriate use?

The Public Health Skills and Careers

Framework

• Identifies skill sets needed by those working in public health including a skill set specific to public health intelligence

• A “skills escalator” for those working up through levels of competence to achieve practitioner, advanced practitioner and defined specialist registration with the UK Public Health Register

• http://www.phru.nhs.uk/Pages/PHD/public_health_career_framework.htm

PHI Skills and Knowledge at Level 5 of PHSCF

Skills1. Collect and collate data from a wide range of different sources.2. Ensure data are complete and valid for the purpose for which it is to be used.3. Analyse and interpret routine data using appropriate analytical techniques .4. Present the outcomes of data analysis.5. Monitor and quality assure routine data collection, collation and analysis Knowldegea) Knowledge of statistical methods appropriate to health and health needsb) Awareness of the qualitative methodologies used in health intelligence and their contribution to theunderstanding of health and wellbeing.c) Awareness of health needs assessment methods and their used) Knowledge of different sources of data and information relevant to health and health needs and how to access

them.e) Awareness of the principles of Geographical Information Systems and the importance of demography onassessing population health and wellbeing needsf) Knowledge of use of geographically linked packages.g) Knowledge of the Data Protection Act and its implications for data disclosure.h) Knowledge of software and database packages and their use in manipulating data.i) Understand the importance of quality assurance

• IK1 Information Processing• IK1 Information Collection and Analysis• IK1 Knowledge and Information Resources

• Core 1 Communication• Core 4 Service Improvement• Core 5 Service Quality

• G5 Services and Project Management

(NHS Staff)KSF Dimensions relevant for PH intelligence posts

The effective public health analyst

technical knowledge and skills (incl IT)+

core (generic) skills+

firm grasp of policy context and needs of customers+

keeping in touch with best PHI practice+

consultancy skills

provider of high quality customer service

proactive change agent and leader

The public health analyst as change agent

Three Rivers D.C.: Male smoking cessation uptake v smoking attributable mortality for all males age 35 years and over

Before: services were in areas which had less need (inverse care law)

After: services re-configured to improve uptake in high need areas

AFTER

R2 = 0.41

0

2

4

6

8

10

12

14

40 60 80 100 120 140 160 180

smoking attributable SMR men 35+ 2002-4

smo

kin

g c

essa

tio

n u

pta

ke (

cou

nt)

35+

BEFORE

R2 = 0.12

0

2

4

6

8

10

12

14

40 60 80 100 120 140 160 180

smoking attributable SMR men 35+ 2002-4

smok

ing

cess

atio

n up

take

(co

unt)

35+

Source: Margaret Eames

Public Health intelligence as a career

• still a relatively small community

(300-400 nationally)

• trainee PH analyst (NHS Band 5)• analyst/practitioner• senior analyst/advanced practitioner• defined specialist

• the routemap - public health skills

and careers framework

What we have covered

• What is public health intelligence?• Who does public health intelligence work?• Knowledge and skills for public health intelligence work• The effective public health analyst• Career paths

What is public health intelligence?

• what’s the best analogy?

– detective work

– report assembly line

– illumination