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Flashcards in 3 & 4 Deck (29)
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WHO Definition of Health

State of complete, physical, mental, and social well-being and not merely the absence of disease or infirmity


Measuring Population Health

1. Aggregating health outcome measurements made on people into summary statistics, such as population averages or medians: average life expectancy
2. Assessing the distribution of individual health outcome measures in a population and among specific population subgroups: infant mortality
3. Measuring the function and well-being of the population or society itself (as opposed to individual members): ?


Biometric vs. Psychosocial Measurements

Biometric: temperature, BMI
Psychosocial: social support, depression


Examples of population health outcome metrics (3)

-Health state: percentage of adults who report fair or poor health
-Psychological state: percentage of adults who are satisfied with their lives
-Ability to function: Percentage of adults who report a disability (limitations of vision or hearing, cognitive impairment, lack of mobility)


Attributes of a good health outcome metric (6)

1. Be valid and reliable
2. Be easily understood by people who use them
3. Be measurable over time
4. Be measurable for specific geographically or demographically defined populations
5. Be measurable with available data sources
6. Be sensitive to changes in factors that influence them, such as SES or environmental conditions


Why do we need to measure health and disease?

-Data to guide efforts toward reducing the consequences of disease and enhancing the benefits of good health
-Which interventions are most effective
-Set priorities
-Provide information for education to the public


Campaign Behavior Change Pathway

Perceived self-efficacy to (avoid) the behavior, perceived social norms about the behavior, attitudes and beliefs about the behavior > Intention toward the behavior > Doing the behavior


Demographic Transition

Transition from high birth and death rates to low birth and death rates as a country transitions from a pre-industrial to an industrialized economic system


Why is it so important to track
the spread of infectious disease
in real time?

-1918 flu
-Killed 20-40 million people
-Average life span in US decreased by 10 years
-Mortality rate: 2.5%
-Followed trade routes


Issues with HIS

-Need for information and ability to respond to that need: disconnect
-Separate, parallel, duplicative (donor-driven and disease specific)


Public Good

-Non-excludable: no withholding from users in public domain
-Non-rival: consumption doesn’t affect use for others
-Responsible: national government


HIS Challenges

-No comprehensive strategy for information
-Regulatory environment that supports HIS development
-Multiple ways to collect data


HIS: Predictors of success

-High-level commitment
-HIS reform champion
-Information architecture
-Investment in training for those who manage HIS


Investments in health information

-Enhance investments in country data sources and information systems
-Having a strong M & E plan for improving collaboration


common data architecture

-Norms/standards for common architecture
-Development of global health indicator registry
-Developing and promoting interoperability standards


performance monitoring and evaluation

-Coordination of monitoring to mitigate reporting
— -Fostering innovation in data collection
— -Ensuring that sources are transparent
— -Improving development of tools to support capacity —
-Supporting evaluations


Data access and use

— -Enhancing access in public domain
— -Code of conduct related to facilitation of data
— -Encouraging capacity to use available data


we need data to assess.... (3 general that have specific epi definitions)

importance (burden), frequency (incidence or prevalence) and severity (mortality or morbidity)


types of data( 4) and main data sources (5)

demographic data, mortality, morbidity, risk factors

household surveys, birth and death registration, census, health facility reproting system and surveillance, administrative sytesm


two types of evaluation - before and after

Prospective: evaluation are developed when the program is designed and are built into program implementation

retrospective: evaluations assess program impact after the program has been implemented, generating treatment and comparison groups ex-post (limited info that is difficult to analyze, usually depends on context)

-retro: disease perspective, identify disease and then look for exposure in the past or pros: follow a group that has been exposed to something and see if they develop disease

prospective more likely to produce strong and credible evaluation results because 1) baseline data can be collected to establish preprogram measures of outcomes of interest, 2)defining measures of program’s success in the program’s planning stage focuses the evaluation and the program on intended results, 3) the treatment and comparison groups are identified before the program is implemented
best chance to generate valid counterfactuals


Mixed methods data collection

qualitative (focus groups and interviews) and quantitative

qualitative data helpful when designing the evaluation, in the intermediate state before quant impact evaluation results are available, and in the analysis stage, provide context and explanations for the quant results



the counterfactual is an estimate of what the outcome (y) would have been for a program participant in the absence of the program (p)


valid comparison group

valid comparison group will have the same characteristics as the group of participants in the program (“treatment group”) except for the fact that the units in the comparison group do not benefit from the program

when comparision group is invalid, results are also invalid, it is biased


evaluation is internally valid if....

an evaluation is internally valid if it uses a valid comparison group


evaluation is externally valid if...

an evaluation is externally valid if the evaluation sample accurately represents the population of eligible units. the results are then generalizable to the population of eligible units


when can randomized assignment be used?

-when the eligible population is greater than the number of program spaces available
-when a program needs to be gradually phased in until it covers the entire eligible population


Prevalence and incidence

-Prevalence (proportion) and incidence (rate)
-low incidence but high prevalence: chronic disease, HIV in the US, high cost to treat
-tap and a sink: dripping into sink is incidence, water in the sink is


DALY def and challenges

-One DALY can be thought of as one lost year of "healthy" life
-DALYs for a disease or health condition are calculated as the sum of the Years of Life Lost (YLL) due to premature mortality in the population and the Years Lost due to Disability (YLD) for people living with the health condition or its consequences
-Challenges: lack of stats, defining morbidity, co-morbidities, age weighing (valuing a year of life if you are 18 vs. 60), who gets to define morbidity experts or those who live with it?


Selection bias

occurs when the reasons for which an individual participates in a program are correlated with outcomes