A Population Health Impact Pyramid for Health Care

Policy Points

• To meaningfully impact population health and health equity, health care organizations must take a multipronged approach that ranges from education to advocacy, recognizing that more impactful efforts are often more complex or resource intensive.
• Given that population health is advanced in communities and not doctors’ offices, health care organizations must use their advocacy voices in service of population health policy, not just health care policy.
• Foundational to all population health and health equity efforts are authentic community partnerships and a commitment to demonstrating health care organizations are worthy of their communities’ trust.

     

Priority setting with Health Inequality Impact Assessment

The imperative to reduce health inequalities whilst keeping within budget means that Health Authorities must prioritise to gain maximum benefit from available resources. Health Inequality Impact Assessment (HIIA) rapid appraisal has been developed by Bro Taf Health Authority to ensure that planning produces positive effects for disadvantaged people. HIIA rapid appraisal consists of assessing the effect of deprivation on the planning topic, examining the relevant evidence, defining opportunities for action and rating these relative to their likely impact on health inequalities. The process is best carried out by a multidisciplinary team including health authority, local authority, voluntary sector and community representatives. This paper describes a HIIA rapid appraisal process, that resulted in a Trust that serves a highly disadvantaged locality agreeing to try a new method of working and to collaborate in research on breaking the cycle of deprivation.     

Population Toxicokinetic Modeling of Cadmium for Health Risk Assessment

Background

Cadmium is a widespread environmental pollutant that has been shown to exert toxic effects on kidney and bones in humans after long-term exposure. Urinary cadmium concentration is considered a good biomarker of accumulated cadmium in kidney, and diet is the main source of cadmium among nonsmokers.

Objective

Modeling the link between urinary cadmium and dietary cadmium intake is a key step in the risk assessment of long-term cadmium exposure. There is, however, little knowledge on how this link may vary, especially for susceptible population strata.

Methods

We used a large population-based study (the Swedish Mammography Cohort), with repeated dietary intake data covering a period of 20 years, to compare estimated dietary cadmium intake with urinary cadmium concentrations on an individual basis. A modified version of the Nordberg-Kjellström model and a one-compartment model were evaluated in terms of their predictions of urinary cadmium. We integrated the models and quantified the between-person variability of cadmium half-life in the population. Finally, sensitivity analyses and Monte Carlo simulations were performed to illustrate how the latter model could serve as a robust tool supporting the risk assessment of cadmium in humans.

Results

The one-compartment population model appeared to be an adequate modeling option to link cadmium intake to urinary cadmium and to describe the population variability. We estimated the cadmium half-life to be about 11.6 years, with about 25% population variability.

Conclusions

Population toxicokinetic models can be robust and useful tools for risk assessment of chemicals, because they allow quantification and integration of population variability in toxicokinetics.     

环境因子对人群健康影响的测量与评估方法

目的建立评价环境因子对人群健康影响的一种新方法。方法按照WHO的可比较风险评估(comparative risk assessment,CRA)框架中对环境因素的评估部分,发展符合我国实际的环境污染物风险评估的框架和指标,通过对各个暴露水平的覆盖率和各暴露水平相应的RR的估计以及对理想场景的选取估算潜在影响分值(potential impact fraction,PIF);并将该方法应用于我国某地区水污染对肝癌发生的风险测量和估计,以受污染的水为环境因子,以肝癌死亡为健康指标,使用空间插值、反事实分析理论以及可比较风险评估(CRA)理论进行分析。结果使用普通Kriging插值法估计了该地区的COD水平,并且根据历年河流中COD水平的变化趋势估计了累积COD暴露水平,计算相应的暴露人口;根据不同的污染等级和相应的肝癌标化死亡率计算RR值,结果显示RR值随累积COD暴露水平的增加而呈单调上升趋势;PIF值显示,如果水污染程度降至对照区水平,将有75.72%的男性和66.39%的女性避免死于肝癌。结论综合使用可比较风险评估(CRA)、反事实理论、空间分析等技术可以较好地评估环境因子对人群健康的影响。     

Health Impact Assessment of Free Immunization Program in Jinju City,Korea

Objectives

This study was conducted to assess the potential health impacts and improve the quality of the free immunization program in Jinju City by maximizing the predicted positive health gains and minimizing the negative health risks.

Methods

A steering committee was established in September 2010 to carry out the health impact assessment (HIA) and began the screening and scoping stages. In the appraisal stage, analysis of secondary data, a literature review, case studies, geographic information systems analysis, a questionnaire, and expert consultations were used. The results of the data collection and analyses were discussed during a workshop, after which recommendations were finalized in a written report.

Results

Increased access to immunization, comprehensive services provided by physicians, the strengthened role of the public health center in increasing immunization rates and services, and the ripple effect to other neighboring communities were identified as potential positive impacts. On the other hand, the program might be inaccessible to rural regions with no private clinics where there are more at-risk children, vaccine management and quality control at the clinics may be poor, and vaccines may be misused. Recommendations to maximize health gains and minimize risks were separately developed for the public health center and private clinics.

Conclusions

The HIA provided an opportunity for stakeholders to comprehensively overview the potential positive and negative impacts of the program before it was implemented. An HIA is a powerful tool that should be used when developing and implementing diverse health-related policies and programs in the community.     

A programme for Health Impact Assessment in Brighton and Hove

HIA is based on the theory of health determinants, which recognizes that well-being is determined by a wide range of economic, social and environmental factors, by heredity and medical intervention. The intended HIA procedure represents a new approach to the evaluation of all local authority policies in order to assess their potential health impacts and to improve the quality of governmental decisions, through recommendations to enhance predicted positive health impacts and minimize negative ones.     

A programme for Health Impact Assessment in Brighton and Hove

HIA is based on the theory of health determinants, which recognizes that well-being is determined by a wide range of economic, social and environmental factors, by heredity and medical intervention. The intended HIA procedure represents a new approach to the evaluation of all local authority policies in order to assess their potential health impacts and to improve the quality of governmental decisions, through recommendations to enhance predicted positive health impacts and minimize negative ones.