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Canadian Evaluation Society Vancouver 2003 Fit Between Health of Populations, Individual Citizens and Publicly Funded Health Services Dr. Ronald A Dovell
Canadian Evaluation Society
Vancouver 2003
Fit Between Health of Populations, Individual Citizens and Publicly Funded Health Services
Dr. Ronald A Dovell
Policies and interventions at the individual and societal levels
Adpated from:Kindig and StoddartAJPH, 2003
Health outcomes and distribution in a population
(dependent variables)
Patterns of health determinants over
the life course (independent variables)
Measure Population
Health Status BaseDecisions
On Evidence•health status•determinants•interventions
IncreaseUpstream
Investments
MultipleStrategies
PublicInvolvement
IntersectoralCollaboration
Accountability for Outcomes
GOALS
Improve health of
populations
Decrease health status
inequities
Analysis of Health Issue
PrioritySetting
Taking Action
EvaluatingResults
Stronger Evidence / Knowledge Development
Population Health Key Elements
AnalyzeDeterminants
of Health
Population Health Key Elements Generic Process Steps
Raphael, 2003
Deaths in British Columbia: Year 2000
Cancer (malignant
neoplasms)28.2%
External Causes5.6%
Respiratory System Diseases
10.2%
All Other Causes12.7%
Digestive System Diseases
4.1%
Endocrine, Nutritional & Metabolic
3.3%
Cardio-vascular
Diseases36.0%
0 5 10 15 20
Cardiovascular
Mucoskeletal
Cancer
Injuries
Respiratory
Cost ($ Billion)
Direct costs
Indirect Costs
Cost by Diagnostic Category, Canada 1998
Top Five Risk Factors
Data: World Health Report, 2002DALY = disability adjusted life years
% DALYs Tobacco 12.2 Blood pressure 10.9 Alcohol 9.2 Cholesterol 7.6
Developed Countries
Overweight 7.4
Smoking Among Youth, Canada
05
101520253035404550
1981
1985
1989
1991
96/9
720
0020
02
Cu
rre
nt
Sm
ok
ers
(%
)
Age 11-15 females Age 11-15 males
Age 15-19 females Age 15-19 males
05
101520253035404550
1981
1985
1989
1991
96/9
720
0020
02
Cu
rre
nt
Sm
ok
ers
(%
)
Age 11-15 females Age 11-15 males
Age 15-19 females Age 15-19 males
Consistency of measurement
Safetypractices
Tobacco
Alcohol
Smoking Status & Been DrunkYouth ages 11-15, Canada
0%
20%
40%
60%
80%
100%
Never Once 2-3 times 4-10times
More
Frequency of Been Drunk
non-smoking former/experimental current smoking
N = 13,278 custom calculation from the HBSC survey, World Health Organization
Wearing A Bike Helmet
11 years 13 years 15 years
always often sometimes never
0
10
20
30
40
50
60
N = 13,278 custom calculation from the HBSC survey, World Health Organization
Logistic Regression of Four Behavioural Variables
Been drunk
tasted alcohol
use of bike helmet
use of seat belt
Nagelkerke
R square: .564
Note: The odds ratio for smoking and consuming hashish or marijuana = 61
N = 13,278 custom calculation from the HBSC survey, World Health Organization
Society and Health: Where are We Now?
Social Determinants of Health
Individual Health and Illness
“Individual Lifestyle Choices”
Raphael, 2003
Iceberg(s) Model
Observe and Measure
Context and Determinants
Dovell, RAPopulation Health Conference, 2002
Seat beltsTobaccoAlcohol
Iceberg(s) Model
Observe and Measure
Dovell, RAPopulation Health Conference, 2002
Seat beltsTobaccoAlcohol
Patterns of determinants
Tobacco
AlcoholSafety
Social context
Tobacco
AlcoholSafety
Social context
Data linkage
Popula
tion H
ealth
