What is public health intelligence?

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What is public health intelligence?

• Contributors
• Dave Jenner, Helen Cooke, Margaret Eames, Neil
  Bendel

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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

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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 units
  system showing whether or not each baby breastfed
  at birth

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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?

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you understand the users needs
quality service
intelligence
information
data
you understand the data and what it can tell you
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Is it Public Health Data/Information?
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• Southern Derbyshire Health Survey 1999
• Comments 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 isnt 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. Ive found dirty
  needles on play parks.
• Woman, aged 28, disadvantaged area
• I dont have time to exercise much. My weight
  has risen. I smoke more. I worry about my heart.
• Woman, aged 31, disadvantaged area

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

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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?

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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

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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.
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• 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

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• 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 youre interested in it AND its
  needed, follow your nose (preferably with the
  blessing of your manager!)

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• Knowledge and skills for public health
  intelligence work

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KNOWLEDGE SKILLS FOR PUBLIC HEALTH INTELLIGENCE
WORK
Communication Skills
Management Skills
Knowledge Foundations
Writing Presenting
Networking
Chairing Meetings

Project Management Partnership Working Negotiating
Influencing Facilitating Reflective Practice
Determinants of Health Organisations and
services Policy Context
Data Management
IT Skills
Confidentiality Disclosure Data Sharing
Spreadsheets Databases Web Publishing
Consultancy Skills Problem Solving
Skills Leadership
Statistics
Working with literature
Analysis of variations and trends
Literature Searches Critical Appraisal
Interpretation
Special Skills
Working with data
Applications
Record Linkage Qualitative
Research Evaluation HIA
Surveys Training
Sources and their limitations Coding Demographic
data Geography/GIS Standardisation Presentation
Tools
Surveillance Health/inequalities profiles
Equity profiles Resource Allocation
Healthcare Quality Effectiveness of
interventions
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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 cant 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?

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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_car
  eer_framework.htm

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PHI Skills and Knowledge at Level 5 of PHSCF

• Skills
• 1. 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
•  
• Knowldege
• a) Knowledge of statistical methods appropriate
  to health and health needs
• b) Awareness of the qualitative methodologies
  used in health intelligence and their
  contribution to the
• understanding of health and wellbeing.
• c) Awareness of health needs assessment methods
  and their use
• d) 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 on
• assessing population health and wellbeing needs
• f) 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

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(NHS Staff) KSF Dimensions relevant for PH
intelligence posts

• 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

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• 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

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The public health analyst as change agentThree
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
Source Margaret Eames
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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

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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

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What is public health intelligence?

• whats the best analogy?
• detective work
• report assembly line
• illumination