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EPA Community Health Roundtable: Health Data Collecting Committee

This is a working-resource page for the EPA Community Health Roundtable: Health Data Collecting Committee

A broader introduction to the work of the EPA Health Roundtable and previous efforts to collect health data are featured on a web page accessible by clicking here. We are setting our meeting schedule for 2009. If interested, please participate in the Doodle poll on the very bottom of this page.

"If you don't measure it, it doesn't count." -John Kenneth Galbraith

The Community Indicators Movement is now a nationwide movement. See the excellent report, "Good Health Counts, A 21st Century Approach to Health and Community for California" prepared by the Prevention Institute in Oakland, California by clicking here.

"We need citizens-not consumers, but citizens-who will think about how our buildings are designed, whether our children can walk safely to school, what kind of food we want in our school and worksite cafeterias, where people should be allowed to smoke and drink, and what kind of images we should see on our movie screens. Those citizens need to goad our democratic leaders to use their powers to make the world a healthier place." - Tom Farley and Deborah Cohen Prescription for a Healthy Nation.

The issue of health inequities is one the affects the entire Bay Area and the nation. For more information, review the work of the Bay Area Health Inequities Initaitve by clicking here. The BARHII Report on Health Inequities in the Bay Area is excellent resource. This report includes the following statement:

Social policy is health policy.
Economic policy is health policy.
Education policy is health policy.

Data can show us some of the underlying causes of health problems such as obesity:

 food access in EPA

Working agenda for the Health Data Collecting Committee:

  1. Review Health Data Resources that we already have access to (e.g. EPA Health Profile, etc.)
  2. Establish goals and scope of this work group, and draft a timeline for achieving these goals
  3. Review model(s) of community based, comprehensive health impact assessment, including the HDMT and possibly other models that have been successfully implemented in communities similar to East Palo Alto
  4. Identify technical resources, experts, etc. who will be able to inform our efforts
  5. Identify who should be at the table, and a plan for getting them there
  6. Identify possible funding sources that might be needed to develop and sustain this effort, and identify lead partners that might be interested in serving as fiscal agents (applicants)
  7. Set a meeting schedule: this is likely to require a sustained year-round effort
  8. Identify a group of organizations and individuals that might have a formal role in gathering data in each of the community health indicators.
  9. Explore six key areas of community health indicators in the HDMT model
  10. Identify a group of potential formal advisors to this project (community based as well as health professionals). These advisors may not be able to attend meetings, but will be asked to help interpret data and help shape the findings produced.

One of the best frameworks for looking at community indicators that impact health is the Healthy Development Measurement Tool (HDMT). This working group is focusing on this tool and the process and partnerships it requires as an approach for our work in East Palo Alto. Here are some reference points:

"HIA processes in many countries incorporate active participation of interested stakeholders. Advantages of such participation include promoting social equity and environmental justice, identifying locally relevant issues, improving transparency of decision making, providing information for estimating or mitigating impacts, and facilitating community empowerment. Local participants also may help promote HIA recommendations to decision makers. Community participants may be individuals or representatives of organizations, such as service providers, business or neighborhood associations, or advocacy groups." -Growing the Field of Health Impact Assessment in the United States: An Agenda for Research and Practice    

"The Gothenburg Consensus Document (1999), a seminal document in the Health Impact Assessment (HIA) field, states that participation is a core value underpinning HIA. As HIA has its origins in both impact assessment and healthy public policy, the source of tension is linked to these rather than HIA per se. The ideals of participatory democracy underpinning healthy public policy clash with broader goals of impact assessment which acknowledges multiple ways in which a community may be engaged with an impact assessment process. A typology for community involvement in HIA is proposed which adopts a pragmatic approach to the reality of engaging with communities, is clear about the intentions of each level of involvement and the outcomes that can be expected by both assessors / practitioners and the community. The review of published papers which focus on participation in HIA indicates that there is a need to explore new ways of engaging with communities." -TAKING IT TO THE STREETS: Health Impact Assessment as a Health Promoting Activity to Reduce Inequalities within the Community

In the Gothenburg Consensus Document, it is suggested that in addition to promoting the maximum health of the population, four values are particularly important for HIA:

  1. democracy, emphasizing the right of people to participate in a transparent process for the formulation, implementation and evaluation of policies that affect their life, both directly and through the elected political decision makers;
  2. equity, emphasizing that HIA is not only interested in the aggregate impact of the assessed policy on the health of a population but also on the distribution of the impact within the population, in terms of gender, age, ethnic background and socio-economic status;
  3. sustainable development, emphasizing that both short term and long term as well as more and less direct impacts are taken into consideration; and
  4. ethical use of evidence, emphasizing that the use of quantitative and qualitative evidence has to be rigorous, and based on different scientific disciplines and methodologies to get as comprehensive assessment as possible of the expected impacts.  

Relevant Resources and Links

Public Health Resources and Partners

  • San Jose State University Health Sciences Department http://www.sjsu.edu/healthscience/
    To enrich the lives of students and contribute to public health through innovative and contemporary education in the principles and skills of health science, contributions to the intellectual foundations of community health, leadership in the public health profession, and collaborations with community partners. The Health Sciences Department offers a Master of Public Health Degree (MPH) in Community Health Education.
  • Stanford University School of Medicine Office of Community Health http://och.stanford.edu/
    The Office of Community Health is the home in the School of Medicine for informed, committed, and sustained community engagement in local health issues. We are developing an innovative national model to train future leaders in community health, disseminate community health scholarship, and enhance local health via community-academic partnerships.
  • UC Berkeley School of Public Health http://sph.berkeley.edu/index.html
    The mission of the University of California, Berkeley, School of Public Health is to conduct world class, rigorous research, apply knowledge to prevent disease and injury and promote the health of individuals and communities in California, the United States and the world, develop diverse leaders for professional and research careers through undergraduate, masters and doctoral programs, and enhance the knowledge and skills of the public health workforce through continuing education and technical assistance.
  • American Public Health Association http://www.apha.org/
    The American Public Health Association (APHA) is the oldest, largest and most diverse organization of public health professionals in the world.

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We are seeking data specific to East Palo Alto that will help us describe:

  • health disparities that are most evident (by population and pathology) and present the most risk
  • at risk populations and a quantification of the risk level (i.e. childhood obesity)
  • comparison of health conditions (in East Palo Alto) to the county at large (San Mateo County) and to the state at large
  • trends in the population with respect to disease

We seek specific data that will help us understand, contrast, and prioritize the leading health issues in the City of East Palo Alto. Examples:

  • The leading health problems in East Palo Alto are ________________________.
  • Diabetes Type II now ranks as the _______________ most significant disease among residents of East Palo Alto, and has been rising each year since __________.
  • The primary health problems among Latinos (African Americans, Tongans, Whites, etc.) are: 1. _______________ 2. _____________________ 3.____________________.
  • The leading causes of death in East Palo Alto are (rank in order of significance): (violence, car accidents, cancer, diabetes, etc.).
  • The average life span in East Palo Alto is ________________ as compared with the county wide average of ____________________.
  • Obesity/Diabetes II/Hypertension/Asthma affect all segments of the population, but is most prevalent among ______________________ and ________________________.
  • The leading causes of disease and death in East Palo Alto are (ranked in order of importance): social, environmental, dietary, etc.
  • Is there a correlation between leading health issues and income and ethnicity/race?
  • Is there a difference in the general health between home owners and renters? Between residents of EPA and the rest of the county? Between women and men? Adults and children? Employed and unemployed?
  • Is the general population of East Palo Alto getting healthier or sicker?
  • Are newer residents healthier or sicker than longer term residents? Does length of residence in the city have any correlation to prevalence of disease or life expectancy?
  • Is there a "cancer strip" in the EPA?
  • What are the most significant environmental threats to human health?
  • What behaviors are the most significant threats to human health?
  • What are the leading health indicators in East Palo Alto?

Is there any data on significant health trends in East Palo Alto?

We are looking for the "headlines" (data that shows a slice in time picture) as well as any data that might point to health concerns that aren't so obvious to the general public, yet based upon trends, are becoming significant concerns. What are the leading factors in the community that are impacting these trends?

One question above asks what the leading health problems in East Palo Alto are.  Defined by the San Mateo County Health Department in terms of years of potential life lost (*YPLL), the leading “health problems” in East Palo Alto are homicide, ancer, heart disease, unintentional injury, and other causes.1 See the chart below for life lost due to these causes. Note the spike in life lost due to an increase in homicides in 2005. This is indicative of how deaths among younger people heavily impact (and potentially skew) overall trends in death data. Few deaths among a younger population amount to a large number of YPLL, whereas a greater number of deaths among an elderly population with few remaining years of life expectancy amounts to a relatively small number of YPLL.

YPLL - East Palo Alto

*Years of potential life lost (YPLL) or potential years of life lost (PYLL), is an estimate of the average years a person would have lived if he or she had not died prematurely.It is, therefore, a measure of premature mortality. As a method, it is an alternative to death rates that gives more weight to deaths that occur among younger people. Another alternative is to consider the effects of both disability and premature death using disability adjusted life years.

Public Health Resources

  • San Mateo County Health Department
  • UC Berkeley Center for Public Health Practice
  • San Jose State Health Sciences
  • Stanford University Office of Community Health

Funding and Collaboration

In November 2008, a collaborative proposal supporting this initiative was been submitted by Collective Roots on behalf of this effort. While no funding is yet secured, there appears to be a range of opportunities supporting efforts like this. This work offers creative opportunities for partnership and collaboration. If you or your organization are interested in participating in our efforts, please email Wolfram Alderson by clicking here.

Our next planning meeting will be held in March 2009. Here is a Doodle calendar scheduler for this meeting:

 

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Some definitions in terms associated with this work:

Health 

WHO glossaries present at least three definitions of health:  

  1. "Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity" (WHO constitution). The glossary of WHO/EURO's Health21 refers to this definition but suggests that it "expresses an ideal, which should be the goal of all health development activities (i.e. health as a fundamental human right and a worldwide social goal)", and "does not lend itself to objective measurement, and for working purposes a narrower definition is required."
  2. A second definition is therefore suggested for this purpose: "Health is the reduction in mortality, morbidity and disability due to detectable disease or disorder, and an increase in the perceived level of health."  
  3. Finally, following the Fourth International Conference on Health Promotion, the following definition was given (WHO, Health Promotion Glossary): "Health is a resource for everyday life, not the object of living. It is a positive concept emphasizing social and personal resources as well as physical capabilities."  

Equity in health  

Equity in health implies that everyone should have a fair opportunity to attain his or her full health opportunity, and that no one should be disadvantaged from achieving this potential.  This term has clear moral and ethical dimensions.  

Health determinants  

Health determinants are the personal, social, cultural, economic and environmental factors  that influence the health status of individuals or populations. These include a range of factors such as income, employment, education, social support, to name but a few.

Health status  

The state of health of a person or population assessed with reference to morbidity, impairments, anthropological measurements, mortality, and indicators of functional status and quality of life.  

Health outcomes  

Changes in current or future health status of individuals or communities that can be attributed to antecedent actions or measures.  

Policy  

A set of statements or commitments to pursue courses of action aimed at achieving defined goals of public or private institutions.  

Programs, projects  

In order to implement policies, any number of programs and projects may be developed. A program is usually a set of actions/projects designed for a specific purpose (for example a child welfare program, or tobacco control program). A  project is usually more narrowly defined, although in terms of resources used it may be  larger or smaller than a program (for example, the building of an oil refinery, or a small  training course might both be defined as projects).  

Values  

Values denote worth or desirability.  In policy terms, "solidarity" or "democracy" would be examples of values.  

Participation  

In the policy field, participation relates to the active involvement of all interested parties in the planning, operation and control, monitoring and evaluation of the use of measures and resources.  

Monitoring  

The regular observation, surveillance, or checking of changes in a condition or situation, or changes in activities.  

Evaluation  

The systematic assessment of the relevance, adequacy, progress, efficiency or effectiveness of a policy, program or project, in relation to its intended aims and objectives.

Impact assessment 

The dictionary definition of an impact is an "effect or influence" and of assessment is the "estimation of size, quality, value".  It has been said that public sector policymaking draws on two general categories of assessment and evaluation traditions: policy analysis and evaluation, and impact assessment. Policy analysis and evaluation is described as being part of the policymaking process whereby an attempt is made to explore whether or not policies are meeting their defined objectives, whereas