HLTC24H3 Chapter Notes - Chapter 5: International Health Regulations, Rhinitis, Summary Statistics

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8 Apr 2012
Introduction to health data
The current proliferation of health program means the demand for reliable data is greater than
Challenges to health data
-Global life expectancy in 2006 was estimated at 67 years with average life expectancy
at both ranging from 40 years in Siena Leone to 8.3 in Japan.
-summary statistics do not reflect variations within countries by social class, geographic
location, occupation, and other important factors
- i.e. in Egypt the under-5 mortality rate in 2005 was 74.6/1,000 live births amongst the
poorest 20% of the population,
- Despite increasing recognition of the influence of social, political, and economic
factors on both illness and death, in most settings these variables are insufficiently
captured by routine health statistics collection.
-Many variables that directly influence health-such as rainfal1, poI1ution, living
conditions, and transportation do not typically qualify as health statistics, although they
may be vital in uncovering and addressing the multiple underlying causes of ill health
- Much of the data available is brought together by estimations and guestimation.
- most underdeveloped countries, where the need for health and social services is acute
and resources are perpetually inadequate, the funds allocated for collection and analysis
of data fall short of requirements
Assumptions Related to Health Data
-use of health statistics rests on two assumptions: first, that disease and death are
medicalized processes that are-or should be-certified by trained medical practitioners
and publicly recorded, tabulated, and gauged over time; second, that there is an
agreed-upon nosology-a disease classification process universally applied by doctors
through common diagnostic procedures Although the International Classification
Diseases (lCD) has been revised and agreed upon at periodic international
conferences since its development in the 18905, cultural and economic factors
sometimes limit its adoption
-Even where allopathy is widely practiced, political and economic circumstances
often limit the distribution and affordability of health services, in turn impeding the
collection of health and mortality data
-Health data are commonly used health services planning, detecting outbreaks, and
monitoring and complying with international health regulations
-Health statistics, including the infant mortality rate, cases of notifiable illnesses,
numbers and causes of deaths, and certain health services, such as immunization
coverage, together with a few socioeconomic, geographic, and other measures,
typically make up the raw material for various health policy decisions.
Health Services Planning and legislation
- Statistical data about health are also needed by branches of government at municipal,
regional, and national levels
Gouging Trends and Needs
-A primary reason to track trends in population health status at the level of countries,
geographic regions, and subpopulations (such as particular age groups OI marginalized
populations) Local, regional, and national governments, nongovernmental sponsors of
health and welfare programs, as well as insurance companies and other businesses,
employ health data to gauge the success and limitations of particular medical or health
promotion interventions of social and economic policies writ large.
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-Health improvements can server to legitimize political decisions, while a deteriorating
in health status can demonstrate the failures of particular economic or public health
- health impact assessment (HIA)
-HIA explicitly considers the health impact of both public and private sector policies in
diverse arenas including zoning, transportation, labor, energy, and education
-The HIA approach also calls for action and accountability on the part of
decisionmakers for the promotion of health and reduction of health disparities
Monitoring Diseases and Complying with International Health Regulations
-Under the WHO's constitution, member countries are obligated to provide certain
information in the form of regular reports, They must also report annually on the
actions taken and progress achieved in improving the health of their people. Member
states must keep the WHO informed of important laws, regulations, official reports,
and statistics pertaining to health, and provide statistical and epidemiological reports as
determined by the World Health Assemblies In addition, the International Health
Regulation (lHR) require that national governments notify the WHO of cases outbreaks
of certain diseases, and of measures taken to prevent their spread.
In 2005, WHO member states agreed on a revision of the IHR to ensure a broader
scope and consistent application.
- a public health emergency is considered to be of international concern if it
(a) constitutes a public health risk to other
states through the international spread of
disease; and
(b) potentially requires a coordinated
international response
Early Detection of Health Problems and Outbreaks
- Routine and continuous monitoring of health data is essential, as prompt detection of
outbreaks can lead to knowledge of their cause, and important steps can be taken to
minimize hazards
- i.e. in the 19608, a syndrome of eye, ear, and heart damage was described in children
whose mothers contracted rubella during pregnancy
Limitations of Health Data
- one should always be cautious in interpreting health-related data, as it is difficult to define the
metrics, hard to get the numbers right, and there maybe pressure on local and regional officials
and ministries of health to distort figures
- i.e. to overestimate the number of inoculations given or to minimize reported rates of sickness
or death
- Health statistics are sometimes provided to officials and to the public by the advocates of a
particular cause, who may release biased or selective information in an attempt to attract money
and public attention to their cause.
- The basic categories of health-related data are:
-Population data: The number, of people in a
population and their attributes, such as age, sex,
ethnicity, religion, urbanization, geographic
distribution, and similar fundamental characteristics
- vital statistics: live births; deaths (including fetal deaths) by sex, age, and cause; and
marriage. In some countries, migration (internal and
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adoptions and similar categories are also recorded by
vital statistics agencies
-Health statistic: Morbidity by type, severity, and
outcome (of illness or accident) data on notifiable
diseases, blindness, impairment, incapacity; cancer
registries and so forth, this category is not as clearly
defined as the previous 2 and varies from one
jurisdiction to another.
-Health services statistics: Numbers and types of
facilities and services available; distribution,
qualifications, and functions of personnel; nature of
the services and their utilization rates; hospital and
health center operations; Organization of government
and private health care systems; costs, payment
mechanisms and related information
-Data on social inequalities in health: Social factors
that lead to inequalities in health-rates of absolute
and relative poverty, levels at education, and
occupational conditions, among others; population
groups categorized by social class, race and ethnicity,
religion, and sex/gender in order to identify how
equally or unequally health (and health care services)
are distributed in a population
Societal variables-including those that measure
social welfare and social security, distribution of
power and resources are increasingly considered vital
to health related decision-making, although they are
not collected to the same extent as other, more
discrete indicators.
- A high degree of inter national cooperation is required to assure that definitions,
terminology, diagnostic techniques, certification practices, data-handling methods, and
reporting schemes are sufficiently standardized for comparative purposes but flexible
enough to take into account diverse national circumstances throughout the world.
Population Data
- Population data are usually obtained in two ways: enumeration and registration
Enumeration is done by means of a census of the population, ideally every 10 years
Registration involves collecting vital statistics such as births, marriages and deaths.
- government institutionalization of these systems is the only way to guarantee routine
and comprehensive collection
-In an effort to better measure social inequalities in health and their consequences to
health status, the WHO's Commission on the Social Determinants of Health
recommends that additional information be included in routine data collection (see Box
5-1, pg 203)
The essential features of a national population census are as follows:
Sponsorship: A legal basis must be established, with administrative machinery
to ensure compliance and confidentiality
Defined territory: The boundaries of national and subnational territorial divisions
Must be clear
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