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Chapter 3

Public Health Data and Communications

Learning Objectives

Identify six basic types of public health data

Explain the meaning, use, and limitations of the infant mortality rate and life expectancy measurements

Explain the meanings and uses of HALEs and DALYs

Identify criteria for evaluating the quality of information presented on a website

Explain ways that perceptions affect how people interpret information

Learning Objectives

Explain the roles of probabilities, utilities, and the timing of events in combining public health data

Explain the basic principles for the construction of decision trees and their uses

Explain how attitudes, such as risk-taking attitudes, may affect decision making

Identify three different approaches to clinical decision making and their advantages and disadvantages

Vignette 1

You read that the rate of use of cocaine among teenagers has fallen by 50% in the last decade.

You wonder where that information might come from.

Vignette 2

You hear that life expectancy in the United States is now approximately 80 years.

You wonder what that implies about how long you will live and what that means for your grandmother, who is 82 and in good health.

Vignette 3

You hear on the news the gruesome description of a shark attack on a young boy from another state and decide to keep your son away from the beach.

While playing at a friend’s house, your son nearly drowns after falling into the backyard pool.

You ask why so many people think that drowning in a backyard pool is unusual when it is far more common than shark attacks.

Vignette 4

“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 I need to consider when balancing the harms and the benefits?” you ask.

Vignette 5

You are faced with a decision to have a medical procedure.

One physician tells you there’s no other choice and you must undergo the procedure, another tells you about the harms and benefits and advises you to go ahead and the third lays out the options and tells you it’s your decision.

Why are there such different approaches to making decisions these days?

Questions-to-Ask (1)

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?

How can we evaluate the quality of the presentation of health information?

What factors affect how we perceive public health information?

Questions-to-Ask (2)

What type of information needs to be combined to make health decisions?

What other data needs to be included in decision making?

How do we utilize information to make health decisions?

How can we use health information to make healthcare decisions?

Table 3-1 The 6 Ss of Quantitative Sources of Public Health Data (1/3)

Type	Examples	Uses	Advantages/ Disadvantages
Single case or small series	Case reports of one or a small number of cases, such as SARS, anthrax, mad cow disease, etc.	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
Statistics (“Vital Statistics”) and reportable diseases	Vital statistics: birth, death, marriage, divorce; reporting of key communicable and specially selected noncommunicable diseases	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

Table 3-1 The 6 Ss of Quantitative Sources of Public Health Data (2/3)

Type	Examples	Uses	Advantages/ Disadvantages
Surveys— sampling	NHANES; BRFSS	Drawing conclusions about overall population and subgroups from representative samples	Well-conducted surveys allow inferences to be drawn about larger populations; frequent delays in reporting data
Self-reporting	Adverse effect monitoring of drugs and vaccines as reported by those affected	May help identify unrecognized or unusual events	Useful when dramatic unusual events closely follow initial use of drug or vaccine; tends to be incomplete; difficult to evaluate meaning because of selective process of reporting

Table 3-1 The 6 Ss of Quantitative Sources of Public Health Data (3/3)

Type	Examples	Uses	Advantages/ Disadvantages
Sentinel monitoring	Influenza monitoring to identify start of outbreak and changes in virus type	Early warnings or warning of previously unrecognized events	Can be used for “real-time” monitoring; requires considerable knowledge of patterns of disease and use of services to develop
Syndromic surveillance	Use of symptom patterns to raise alert of possible new or increased disease	May be able to detect unexpected and subtle changes, such as bioterrorism producing commonly occurring symptoms	May be used for early warning even when no disease is diagnosed; does not provide a diagnosis and may have false positives

Table 3-2 Life Expectancy and Health Adjusted Life Expectancy for a Range of Large Countries

Data from World Health Organization. Healthy life expectancy (HALE) at birth (years). World health report 2009. http://www.who.int/whosis/whostat/EN_WHS09_Full.pdf. Accessed July 17, 2013.

Table 3-3 DALYs Lost by Disease Categories and Total of All Categories Per 1,000 Population

Data from World Health Organization. Global Burden of Disease Project 2004. Geneva: World Health Organization; 2004.

Table 3-4 Quality Standards for Health Information on the Internet (1/2)

Data from American Public Health Association. Criteria for Assessing the Quality of Health Information on the Internet. Available at http://www.apha.org/NR/exeres/412DDD11-42A0-46CB-8705-F9D47A073AF1.htm Accessed July 17, 2013.

Table 3-4 Quality Standards for Health Information on the Internet (1/2)

Figure 3-1 Public Health Data, Health Communication and the Flow of Information

Figure 3-2 Scale Used to Measure Utilities

Figure 3-3 Choice Node and Chance Node

Figure 3-4 Decision Tree

Figure 3-5 Decision Analysis with Utility of Blindness Equal to 0.5

Figure 3-6 Decision Analysis with Utility of Blindness Equal to 0.8

Insert Figure 3-6 here

Figure 3-7 Decision Analysis with Utility of Blindness Equal to 0.2

Insert Figure 3-7 here