The data for decision making project: assessment of surveillance systems in developing countries to improve access to public health information

OBJECTIVE: By using timely, high-quality information, ministries of health can identify and address priority health problems in their populations more effectively and efficiently. The Data for Decision Making (DDM) project developed a conceptual model for a data-driven health system. This model included a systematic methodology for assessing access to information to be used as a basis for improvement in national health surveillance systems. STUDY DESIGN AND METHODS: The DDM surveillance assessment methodology was applied to six systems in five countries by staff from the US Centers for Disease Control and Prevention (CDC). Ministry of health personnel at national, regional, district and local levels were interviewed using either informal conversation or an interview guide approach, and their methods for collecting and using data were reviewed. Attributes of timeliness, accuracy, simplicity, flexibility, acceptability and usefulness were examined. Problems and their underlying causes were identified. RESULTS: The problems preventing decision makers from having access to information are many and complex. The assessments identified no fewer than eight problem areas that impeded decision makers' access to information. The most common deficiencies were concerning the design of the system, ongoing training of personnel and dissemination of data from the system. CONCLUSIONS: To improve the availability of information to public health decision makers, it is recommended that: (a) surveillance system improvement begins with a thorough evaluation of existing systems using approaches outlined by the CDC and the Health Metric Network of the World Health Organization; (b) evaluations be designed to identify specific causes of these deficiencies; (c) interventions for improving systems be directly linked to results of the evaluations; and (d) efforts to improve surveillance systems include sustained attention to underlying issues of training and staff support. The assessment tool presented in this report can be used to facilitate this process.     

Using data to plan public health programs: experience from state cancer prevention and control programs.

In 1989 the National Cancer Institute funded the second round of Data-Based Intervention Research (DBIR) cooperative agreements with state health agencies to implement a four-phase cancer prevention and control planning model that would establish ongoing cancer prevention and control programs. Activities included identifying and analyzing relevant data to develop a state cancer control plan. The authors reviewed the data analysis and planning activities of five DBIR projects to understand: how states use different types of available data to make public health planning decisions, in what ways available data were sufficient or insufficient for this planning, and perceived costs and benefits of a data-based planning approach. Many of the sources of and ways in which health statistics and behavioral data were used were consistent across states. Sources and use of data on the availability and utilization of health services and on cancer control policies were less consistent. Data were most useful in making decisions to address specific cancers, to target populations or regions, to identify general barriers, and to influence policy makers and the public. Data were less influential in identifying specific barriers within target populations and determining what proven intervention components should be implemented and how. The process of pulling this information together and involving working groups and coalitions was considered very beneficial in establishing the credibility of the state health agency in addressing the state''s cancer problem. This process relied on a national infrastructure that provided financial resources, sources of data, and research results.     

The public health need for abortion statistics

As with the delivery of any medical service, abortion has definite public health effects that should be evaluated. The Center for Disease Control (CDC) has monitored the impact of abortion in three ways: (a) conducting epidemiologic surveillance of legally induced abortion beginning in 1969. (b) funding a multicenter study of abortion morbidity beginning in 1971, and (c) undertaking surveillance of abortion-related mortality beginning in 1972. These activities are intended to identify health problems related to abortion, to assess the magnitude of these problems, and to make recommendations directed at eliminating the problems. In addition to the Programmatic uses of abortion data, the CDC statistics have also provided a basis for both legislative and judicial decisions that have had national and local impact. The CDC and the National Center for Health Statistics are currently working collectively to strengthen the reporting of national abortion statistics so that the public health need for abortion statistics can be met.     

Identifying common enablers and barriers in European health information systems

European countries possess unique health information systems (HISs) and face similar health system challenges. Investigating common enablers and barriers across Europe pinpoint where HISs need improvements to address these challenges. This study aims to identify common enablers and barriers for optimal functioning of HISs across the European Union and associated countries, and to interpret what this means for the further development of HISs in Europe. A qualitative thematic analysis was carried out based on nine countries HISs assessments. Two main observations are made. Firstly, regardless of the differences between HISs, each HIS had its strengths and weaknesses and often the same barriers and enablers arose. Secondly, barriers were identified in all HIS areas. The five most important barriers are (i) fragmentation of data sources, limited accessibility, use and re-use of data, (ii) barriers in the implementation of EHR-systems, (iii) governance issues related to unclear responsibilities, discontinuous financing and weak intra- and inter-sectorial collaboration, (iv) legal gaps and General Data Protection Regulation (mis)interpretation, and (v) limited skilled staff. The enablers identified in this study lead to potential solutions to address these. Solutions can be implemented by national initiatives, but there is considerable added value in a joint European approach. Several international initiatives provide opportunities to improve HISs, but these need to be strengthened and better geared towards tackling the identified barriers.     

Identifying and strengthening the structural roots of urban health in Canada: participatory policy research and the urban health agenda

An urban health research agenda for health promoters is presented. In Canada, urban issues are emerging as a major concern of policy makers. The voices raising these issues are from the non-health sectors, but many of these issues such as increasing income inequality and poverty, homelessness and housing insecurity, and social exclusion of youth, immigrants, and ethno-racial minorities have strong health implications as they are important social determinants of health. Emphasis on these and other social determinants of health and the policy decisions that strengthen or weaken them is timely as the quality of Canadian urban environments has become especially problematic. We argue for a participatory urban health research and action agenda with four components: (a) an emphasis on health promotion and the social determinants of health; (b) community-based participatory research; and (c) drawing on the lived experience of people to influence (d) policy analysis and policy change. Urban health researchers and promoters are urged to draw upon new developments in population health and community-based health promotion theory and research to identify and strengthen the roots of urban health through citizen action on public policy.     

A priority rating system for public health programs

When resources are limited, decisions must be made regarding which public health activities to undertake. A priority rating system, which incorporates various data sources, can be used to quantify disease problems or risk factors, or both. The model described in this paper ranks public health issues according to size, urgency, severity of the problem, economic loss, impact on others, effectiveness, propriety, economics, acceptability, legality of solutions, and availability of resources. As examples of how one State can use the model, rankings have been applied to the following health issues: acquired immunodeficiency syndrome, coronary heart disease, injuries from motor vehicle accidents, and cigarette smoking as a risk factor. In this exercise, smoking is the issue with the highest overall priority rating. The model is sensitive to the precision of the data used to develop the rankings and works best for health issues that are not undergoing rapid change. Cost-benefit and cost-effectiveness analyses can be incorporated into the model or used independently in the priority-setting process. Ideally, the model is used in a group setting with six to eight decision makers who represent the primary agency as well as external organizations. Using this method, health agencies, program directors, or community groups can identify the most critical issues or problems requiring intervention programs.     

Peer Reviewed: Chronic Disease Surveillance Systems Within the US Associated Pacific Island Jurisdictions

In recent years, illness and death due to chronic disease in the US Associated Pacific Islands (USAPI) jurisdictions have dramatically increased. Effective chronic disease surveillance can help monitor disease trends, evaluate public policy, prioritize resource allocation, and guide program planning, evaluation, and research. Although chronic disease surveillance is being conducted in the USAPI, no recently published capacity assessments for chronic disease surveillance are available. The objective of this study was to assess the quality of existing USAPI chronic disease data sources and identify jurisdictional capacity for chronic disease surveillance. The assessment included a chronic disease data source inventory, literature review, and review of surveillance documentation available from the web or through individual jurisdictions. We used the World Health Organization''s Health Metric Network Framework to assess data source quality and to identify jurisdictional capacity. Results showed that USAPI data sources are generally aligned with widely accepted chronic disease surveillance indicators and use standardized data collection methodology to measure chronic disease behavioral risks, preventive practices, illness, and death. However, all jurisdictions need to strengthen chronic disease surveillance through continued assessment and expanded support for valid and reliable data collection, analysis and reporting, dissemination, and integration among population-based and institution-based data sources. For sustained improvement, we recommend investment and technical assistance in support of a chronic disease surveillance system that integrates population-based and institution-based data sources. An integrated strategy that bridges and links USAPI data sources can support evidence-based policy and population health interventions.     

中国卫生部门IHR(2005)公共卫生应急核心能力现状分析

目的：描述2012年中国部分地区《国际卫生条例（2005）》（International Health Regulations,IHR）（以下简称IHR）公共卫生应急核心能力建设现状,并分析其存在问题,从而提出相应的建议,为中国卫生部门IHR（2005）公共卫生应急核心能力建设提供参考。方法：采用分层抽样方法,选取中国7省、64地级市及140县（市、区）,分析省、市、县（市、区）级卫生部门IHR（2005）公共卫生应急核心能力要求的监测、应对、风险沟通、准备、实验室能力、感染控制以及物资和经费支持能力建设情况。结果：IHR（2005）公共卫生应急核心能力指标在中国具有一定的适用性;IHR（2005）公共卫生应急核心能力缺乏制度建设;省、市、县（市、区）三个层级在公共卫生应急核心能力方面呈逐级递减趋势。结论：加强IHR（2005）公共卫生应急核心能力的制度建设;重点支持县（市、区）级IHR（2005）公共卫生应急核心能力建设;加强IHR（2005）公共卫生应急核心能力指标中薄弱环节的建设;加强IHR（2005）公共卫生应急核心能力对中国适用性的研究。     

Tensions and opportunities in the roles of senior public health officials in Canada: A qualitative study

Although public health emergencies like the COVID-19 pandemic thrust senior public health officials into the spotlight, their day-to-day roles remain misunderstood and under-examined. In jurisdictions that follow the Westminster system of government such as Canada, the United Kingdom, and Australia, Chief Medical Officers of Health (CMOHs) are typically senior public servants who are simultaneously positioned as public health professionals with independent expertise, senior advisors to an elected government, and designated protectors of the public health interest. Using Canada's federal and provincial CMOHs as case studies of this role in Westminster governments, we analyzed in-depth key informant interview data to examine how CMOHs navigate the tensions among their duties to the government, profession, and public in order to maximize their public health impact. We demonstrate that CMOHs are variously called upon to be government advisors, public health managers, and public communicators, and that the different emphasis that jurisdictions place on these roles shapes the tools and pathways through which CMOHs can influence government action and public health. We also elucidate the tensions associated with having CMOHs positioned within the senior levels of the public service and the strategies these officials use to balance their internal- and external-facing roles. Finally, we highlight the trade-offs among different institutional design options to inform decisions about the structure of the CMOH position in different contexts.     

Variability in childhood allergy and asthma across ethnicity, language, and residency duration in El Paso, Texas: a cross-sectional study

Background

Decades of improper disposal of uranium-mining wastes on the Navajo Nation has resulted in adverse human and ecological health impacts as well as socio-cultural problems. As the Navajo people become increasingly aware of the contamination problems, there is a need to develop a risk-communication strategy to properly inform tribal members of the extent and severity of the health risks. To be most effective, this strategy needs to blend accepted risk-communication techniques with Navajo perspectives such that the strategy can be used at the community level to inform culturally- and toxicologically-relevant decisions about land and water use as well as mine-waste remediation.

Objective

The objective of this study was to develop GIS-based thematic maps as communication tools to clearly identify high risk exposure areas and offer alternatives to minimize public and ecological health impacts.

Methods

Thematic maps were produced that incorporated data derived from environmental sampling and public health surveys. The maps show the location and quality of unregulated water resources and identify regulated water sources that could be used as alternatives. In addition, the maps show the location of contaminated soil and sediment areas in which disturbance of surface deposits should be avoided. Preliminary feedback was collected from an informal Navajo working group to assess the clarity and efficacy of this proposed communication method.

Results

The working group found the maps to be both clear and effective, and made suggestions for improvements, such as the addition of more map features. The working group predicted that once the maps are presented to the public, water hauling and soil use behaviors will change, and dialogue with chapter officials will be initiated to accelerate further risk reduction efforts.

Implications

Because risk communication is complicated by language barriers, lack of infrastructure, and historical mistrust of non-Navajo researchers, mapping provides an easily interpretable medium that can be objectively viewed by community members and decision makers to evaluate activities that affect toxicant exposures.     

Model for coordination of community health services and health and welfare services offered by health insurance societies]

The purpose of this paper is to provide information for the development of health and welfare services being offered by health insurance societies (HIS). We analyzed examples of coordinated activities by HISs, the organizations under them (affiliated groups), and regional community self-regulating groups (communities), looking for the shape and direction such coordinated activities should take in the future. We chose 6 cases from public information available from August, 2000 to January, 2001 and visited the parties involved to conduct follow up surveys on the nature of their coordinated activities. Based on a survey conducted by the National Federation of Health Insurance Societies in March, 1999 (Survey of the Current Status of Health and Welfare Services), 36 HISs that were thought likely to be acting in coordination with the community were mailed questionnaires. Of these HISs, 7 that were found to actually be carrying out such coordinated activities were contacted in a telephone survey. We categorized the form and direction of coordinated activities into the following 5 category types: individualized, shared use of facilities, human exchange, shared health management information, and general coordination. The personnel, facilities and institutional capabilities of the affiliated groups are important resources for HISs to carry out health and welfare services, both in general and for coordinated services in the community. In areas where affiliated groups are lacking in resources, communities and other agencies have to actively seek out and make use of external resources. The coordination of services by affiliated groups and the community allows both to make the best use of the capabilities each has and effectively enables them to mutually compensate for their weak points.     

Financial cost analysis of a strategy to improve the quality of administrative vaccination data in Uganda

BackgroundHigh-quality vaccination data are critical to planning, implementation and evaluation of immunization programs. However, sub-optimal administrative vaccination data quality in low- and middle-income countries persist for heterogeneous reasons, though most relate to organizational factors and human behavior. The nationwide Data Improvement Team (DIT) strategy in Uganda aimed to strengthen human resource capacity to generate quality administrative vaccination data at the health facility.MethodsA financial cost analysis of the Uganda DIT strategy (2014–2016) was conducted from the program funder perspective. Activity-based micro-costing from funder financial and program monitoring records was used to estimate total and unit costs by program area (in 2016 US dollars). Hypothetical scenarios were developed to illustrate potential approaches to reducing costs.ResultsOver 25 months the DIT strategy was implemented in all 116 operational districts and 3443 (89%) health facilities in Uganda at a total financial cost of US $575 275. Training and deployment of DITs accounted for the highest proportion of expenditure across program areas (69%). Transport, per diems, lodging, and honoraria for DIT members and national supervisors were the main cost drivers of the strategy. Deployment of 557 DIT members cost US $839 per DIT member, US $4 030 per district, and US $136 per health facility. The estimated opportunity cost of government staff time wasn’t a major cost driver (2.5%) of total cost.ConclusionThe results provide the first estimates of the magnitude and drivers of cost to implement a national workforce capacity building strategy to improve administrative vaccination data quality in a low- or middle-income country. Financial costs are a critical input to combine with future outcome data to describe the cost of strategies relative to performance outcomes. The operational costs of the strategy were modest (0.5–1.6%) relative to the estimated operational costs of Uganda’s national immunization program.     

深圳市基本公共卫生服务工作中存在的问题及建议*

通过对深圳市基本公共卫生服务工作进行现场调查与资料查阅,梳理深圳市基本公共卫生服务工作中存在的问题并提出相关建议,旨在为深圳市基本公共卫生建设提供更全面、更有针对性的指导。分析发现,现阶段深圳市基本公共卫生服务工作中存在的问题包括:基层慢性病管理信息化程度不足,基本公共卫生服务各系统无法互联互通;现有社区健康中心整体布局与居民健康需求存在差距;基本公共卫生项目的考评与服务经费关联机制欠成熟;现行基本公共卫生服务项目年人均补助标准与基本公共卫生服务项目需求不匹配;基层公共卫生机构专业技术人员缺乏并且薪资待遇低。未来工作改进建议:加强基层公共卫生信息系统建设;加强社区健康中心服务能力建设;完善基本公共卫生服务经费保障机制;适当提高基本公共卫生服务经费补助标准;提高基层公共卫生医生待遇。     

Chronic disease surveillance systems within the US Associated Pacific Island jurisdictions

In recent years, illness and death due to chronic disease in the US Associated Pacific Islands (USAPI) jurisdictions have dramatically increased. Effective chronic disease surveillance can help monitor disease trends, evaluate public policy, prioritize resource allocation, and guide program planning, evaluation, and research. Although chronic disease surveillance is being conducted in the USAPI, no recently published capacity assessments for chronic disease surveillance are available. The objective of this study was to assess the quality of existing USAPI chronic disease data sources and identify jurisdictional capacity for chronic disease surveillance. The assessment included a chronic disease data source inventory, literature review, and review of surveillance documentation available from the web or through individual jurisdictions. We used the World Health Organization's Health Metric Network Framework to assess data source quality and to identify jurisdictional capacity. Results showed that USAPI data sources are generally aligned with widely accepted chronic disease surveillance indicators and use standardized data collection methodology to measure chronic disease behavioral risks, preventive practices, illness, and death. However, all jurisdictions need to strengthen chronic disease surveillance through continued assessment and expanded support for valid and reliable data collection, analysis and reporting, dissemination, and integration among population-based and institution-based data sources. For sustained improvement, we recommend investment and technical assistance in support of a chronic disease surveillance system that integrates population-based and institution-based data sources. An integrated strategy that bridges and links USAPI data sources can support evidence-based policy and population health interventions.     

Setting priorities for comparative effectiveness research: from assessing public health benefits to being open with the public

Medicine's current evidence base is insufficient for many of the decisions made daily by clinicians, patients, purchasers, and policy makers. The Patient-Centered Outcomes Research Institute represents an effort by the US government to address this shortcoming by funding comparative effectiveness research. Prioritizing that research will be a critical first step. To better understand components of an optimal process, we reviewed the literature and conducted interviews regarding the prioritization efforts of leading public and private health organizations in the United States and abroad. From this review, we propose a framework for prioritization, pose and answer key questions, and make recommendations regarding application of that framework. We also recommend that during the priority-setting process, there should be transparent conversations among those who make decisions about the priorities and the public.     

New forecasting methodology indicates more disease and earlier mortality ahead for today's younger Americans

Traditional methods of projecting population health statistics, such as estimating future death rates, can give inaccurate results and lead to inferior or even poor policy decisions. A new "three-dimensional" method of forecasting vital health statistics is more accurate because it takes into account the delayed effects of the health risks being accumulated by today's younger generations. Applying this forecasting technique to the US obesity epidemic suggests that future death rates and health care expenditures could be far worse than currently anticipated. We suggest that public policy makers adopt this more robust forecasting tool and redouble efforts to develop and implement effective obesity-related prevention programs and interventions.     

Pandemic H1N1 in Canada and the use of evidence in developing public health policies – A policy analysis

When responding to a novel infectious disease outbreak, policies are set under time constraints and uncertainty which can limit the ability to control the outbreak and result in unintended consequences including lack of public confidence. The H1N1 pandemic highlighted challenges in public health decision-making during a public health emergency. Understanding this process to identify barriers and modifiable influences is important to improve the response to future emergencies. The purpose of this study is to examine the H1N1 pandemic decision-making process in Canada with an emphasis on the use of evidence for public health decisions. Using semi-structured key informant interviews conducted after the pandemic (July–November 2010) and a document analysis, we examined four highly debated pandemic policies: use of adjuvanted vaccine by pregnant women, vaccine priority groups and sequencing, school closures and personal protective equipment. Data were analysed for thematic content guided by Lomas' policy decision-making framework as well as indicative coding using iterative methods. We interviewed 40 public health officials and scientific advisors across Canada and reviewed 76 pandemic policy documents. Our analysis revealed that pandemic pre-planning resulted in strong beliefs, which defined the decision-making process. Existing ideological perspectives of evidence strongly influenced how information was used such that the same evidentiary sources were interpreted differently according to the ideological perspective. Participants recognized that current models for public health decision-making failed to make explicit the roles of scientific evidence in relation to contextual factors. Conflict avoidance theory explained policy decisions that went against the prevailing evidence. Clarification of roles and responsibilities within the public health system would reduce duplication and maintain credibility. A more transparent and iterative approach to incorporating evidence into public health decision-making that reflects the realities of the external pressures present during a public health emergency is needed.     

Panel discussion on the application of MCDA tools

Prioritization in healthcare is particularly sensitive to subjective biases and data asymmetry. Yet making data-based and objective decisions are critical to optimizing long term individual and societal benefit. Multi-Criteria-Decision-Making-Analysis (MCDA) provides shared processes, structure, and language to enable this. This panel presented and discussed three examples of MCDA application to health technology assessment, national healthcare strategy and balancing the priorities of providers and customers.     

Factors of the innovation, organization, environment, and individual that predict the influence five systematic reviews had on public health decisions.

OBJECTIVE: To determine the extent to which systematic reviews of public health interventions influenced public health decisions and which factors were associated with influencing these decisions. METHODS: This cross-sectional follow-up survey evaluated the use of five systematic reviews in public health decision making. Independent variables included characteristics of the innovation, organization, environment, and individual. Primary data were collected using a telephone survey and a self-administered organizational demographics questionnaire. Public health decision makers in all 41 public health units in Ontario were invited to participate in the study. Multiple linear regression analyses on the five program decisions were conducted. RESULTS: The systematic reviews were perceived as having the greatest amount of influence on decisions related to program justification and program planning, and the least influence on program evaluation decisions. The greater the perception that one's organization valued the use of research evidence for decision making and that ongoing training in the critical appraisal of research literature was provided, the greater the perception of the influence the systematic review had on public health decisions. CONCLUSIONS: Organizational characteristics are important predictors of the use of systematic reviews in public health decision making. Future dissemination strategies need to promote the value of using systematic reviews for program decision making as well as promote ongoing training in critical appraisal among intended users in Ontario.