Public Health Informatics – New Opportunities for Public Health Practitioners

The Children’s Hospital of Philadelphia’s Seventh Annual Mid-Atlantic Healthcare Informatics Symposium

April 25, 2014Giridhar Mallya, MD, MSHP

Director of Policy and PlanningPhiladelphia Department of Public Health

Tobacco and obesity surveillance, research, and evaluation

Challenges• Chronic disease are the leading causes of death and disability• Robust surveillance systems don’t exist• Individual and environmental variables are critical

Solutions• Creating registries of food and tobacco retailers• Conducting geospatial analyses of retailers, built environment• Collecting primary data on tobacco/food/beverage ads, bike racks, food

purchases• Analyzing secondary data on food purchases, public health and health care

service use• Augmenting health behavior surveys• Modeling policy impacts

Registries and geospatial analysis – healthy food retailers

~61,000 fewer Philadelphians living in low-income neighborhoods with limited access to healthy foods

Registries and geospatial analysis – healthy food retailers

• There was a strong relationship between WIC/SNAP status and indoor and outdoor advertising for tobacco and sugary beverages.

Primary data – advertising at WIC/SNAP stores

Tobacco products Sugary beverages Tobacco products Sugary beveragesOutdoor Indoor

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

60.3%

52.6%

70.0% 68.2%69.1%65.5%

78.5%

71.2%75.6%

68.8%

86.5%

77.9%

Non-WIC/SNAP SNAP only WIC (&SNAP)

Philadelphia Department of Public Health, Penn Design, 2012.

Primary data – bike racks via smartphone app

Philadelphia Department of Public Health; Mayor’s Office of Transportation and Utilities.

ESRI data collector tool Inventory Center City bike racks and

assess their condition and use

Identify areas of further need

Identify and dispose of abandoned bikes

4 interns collected 2,084 points in summer 2013

Primary data – food purchase in restaurants – menu labeling evaluation

Customers in unlabeled

restaurants(n=321)

Customers in labeled

restaurants(n=327)

Adjusted difference*

P-value

Calories in food purchased

1,691 kcal 1,556 kcal -151 kcal(-270.0, -32.6)

0.013

Sodium in food purchased

3,315 mg 3,111 mg -224 mg(-457.0, 8.0)

0.059

Saturated fat in food purchased

36.5 g 33.5 g -3.7 g(-7.4,-0.1)

0.047

Carbohydrates in food purchased

131 g 115 g -14.7 g(-25.8,-3.6)

0.010

Auchincloss A et al. Customer responses to mandatory menu labeling at full-service restaurants. American Journal Preventive Medicine. 2013 Dec;45(6):710-9.

*Adjusted for age, race/ethnicity, income, education, day of the week, frequency of dining out, and body size

Secondary data – vending sales

• City of Philadelphia• Over 220 vending machines with healthier mix,

smaller sizes, calorie labeling, and healthy marketing, affecting 25,000 employees

• Nearly 100 machines with healthier snacks

Philadelphia Department of Public Health, Vending sales data.

Secondary data – height and weight collected in schools

Robbins et al, Preventing Chronic Disease, 2012Accompanying editorial from RWJF, “Philadelphia Freedom”

5% decrease

8% decrease 7% decrease

Secondary data – calls to PA Free Quitline

Start of state NRT giveaway

Start of City secondhand smoke media campaign

PA Department of Health, PA Free Quitline. Analysis by Philadelphia Department of Public Health.

Secondary data – hospital discharges

PA Health Care Cost Containment Council. Analysis by Philadelphia Department of Public Health, Office of Health Information and Improvement.

Augmenting health behavior surveys – SSB consumption in Philadelphia

CDC, Youth Risk Behavior Surveillance Survey; PHMC, Southeastern PA Household Health Survey.

20% reduction 5% reduction

Modeling – impact of $2/pack cigarette tax

Adapted from Stehr M. The Effect of Tobacco Control Policies and a City Wide $2 per Pack Cigarette Tax on Smoking, Health Care Costs, and Productivity in Philadelphia. LeBow College of Business, Drexel University, March 2012.

Over 5 years, a $2/pack local tax would result in an additional…

8,000 fewer adult smokers

$15 million in annual health care savings

$9 million in annual productivity gains

Smoking prevalence,

2010

Smoking prevalence,

2015

Annual health care savings,

2015

Annual productivity gains, 2015

Existing tobacco control efforts

25.2% 22.0% $33.2 million $19.1 million

Existing efforts + $2/pack tax

25.2% 21.3% $48.1 million $28.1 million

Thank you!

www.phila.gov/health www.phila.gov/gethealthyphilly

www.smokefreephilly.org www.foodfitphilly.org