Module 3: Identifying Determinants of Determinants of PopHlth Flashcards
1
Q
What is socio-economic position (SEP)
A
The social and economic factors that influence what positions individuals or groups hold within the structure of a society
2
Q
Socio-economic position aka…
A
Socioeconomic status
Social class
Social stratification
All have diff theoretical bases and interpretations
3
Q
Socio-economic determinants must be…
A
Objective
Measurable
Meaningful
4
Q
Purpose of measuring SEP
A
Quantify level of inequality within or between societies
Highlight changes to pop structures over time, e.g. between Census periods and generations
Help understand relationship between health and other social variables
5
Q
Types of SEP measurements for individuals
A
Education Income Occupation Housing Assets and wealth
6
Q
Types of SEP measurements for populations
A
Area measures:
- Deprivation
- Access
Population measures:
- Income inequality
- Literacy rates
- Gross Domestic Product (GDP) per capita
7
Q
SEP: Dahlgren & Whitehead Model - Individual lifestyle factors
A
YOUR education, occupation, income You and the decisions you make influence your opportunities: Education --> knowledge Income --> material goods Occupation --> status, power
8
Q
SEP: Dahlgren & Whitehead Model - Social and community influences
A
Your parents’ education, occupation, income etc
Commonly used to measure SEP in studies of children and adolescents
Some evidence that parents’ SEP is associated with individuals’ SEP
9
Q
SEP: Dahlgren & Whitehead Model - Living and working conditions
A
Area-based measures of SEP:
- NZ Index of Deprivation (NZDep) - most common in NZ
- Index of Multiple Deprivation (IMD) - allows you to explore drivers of area deprivation
Other measures e.g. social fragmentation and accessibility indices:
- difference between potential and realised access
10
Q
Define deprivation
A
A state of observable and demonstrable disadvantage relative to the local community, wider society or nation to which an individual, family or group belongs
11
Q
Area-level deprivation measurement
A
Measures people’s relative position in society, but reports this based on where they live, not who the people are themselves
Focuses on material deprivation - refers to what residents living in particular areas don’t have (deficit model – easier to ask than what people have)
12
Q
What should deprivation be applied to
A
Conditions and quality of life that are of a lower standard than is ‘ordinary’ in a particular society
13
Q
Deprivation – poverty
A
Living in poverty refers to a lack of income and resources to obtain the normative standard of living
14
Q
Variables included in NZDep2013
A
Communication - people aged <65 with no access to internet at home
Income - people aged 18-64 receiving a means tested benefit
Income - people living in equivalised households with income below an income threshold
Employment - people aged 18-64 unemployed
Qualifications - people aged 18-64 without any qualifications
Owned home - people not living in own home
Support - people aged <65 living in a single parent family
Living space - people living in equivalised households below a bedroom occupancy threshold
Transport - people with no access to a car
15
Q
Equivalisation
A
Methods used to control for household composition
A form of standardisation
16
Q
Deciles and quintiles
A
Deciles: 10 groups
Quintiles: 5 groups
Least deprived of pop = 1, most deprived = 10
17
Q
SEP: Dahlgren & Whitehead Model - General socio-economic, cultural and environmental conditions
A
Group populations with similar SEP levels together
Cross sectional or longitudinal studies
NZ Census mortality study
Integrated Data Infrastructure
18
Q
SEP: Dahlgren & Whitehead Model - Global determinants
A
Income inequality
National income - GDP
Literacy rates
Free trade agreements – how well our economy is veering between diff markets and how that relates to health outcomes
19
Q
Causes of causes: access to health care
A
Belonging to a marginalised group --> Discrimination --> Access to education --> Educational attainment --> Employment status --> Income --> Access to health care
20
Q
Equivalised households
A
Demonstrates differences between a 2 person and 20 person household
21
Q
Population data - measures (trends in)…
A
Births
Mortality/deaths (all-cause, cause-specific)
Morbidity/illness (general, specific condition)
Migration
22
Q
Population data - can be applied to…
A
Unemployment/benefit claimants/pensions
Crime (broad and detailed classes of offence)
Health service utilisation (where to provide and who uses them)
Voter turnout, political party voted for
Education pathways
23
Q
Main pop data sources for epidemiology
A
The Census Estimated Resident Populations (ERP) Vital events Health service utilisation and outcomes (HSU) Integrated Data Infrastructure (IDI) Nationally representative surveys Ad hoc surveys
24
Q
Data source - Census
A
Traditionally, people were employed as ‘enumeration officers’ to contact individual households to ensure census data collection:
- deliver and collect census form
- check fully completed
- country divided into small areas (meshblocks) with ~100 people on average - designed to be manageable for enumeration officers
2018: went online
25
Data source - Estimated Resident Populations (ERP)
An estimate of all people who usually live in NZ at a given date
Doesn't typically break down by ethnic group
26
Data source - Vital Events
Births, deaths and marriages
| Department of Internal Affairs maintain, but Stats NZ prepares report
27
Data source - Health Service Utilisation and Outcomes (HSU)
Ministry of Health record and report publicly funded health information
e.g. hospitalisations, blood tests, pharmaceutical dispensing
Reflects pop that interacted with health system in last 2 years prior to March 2013
Ethnicity collected from PHO
28
Data source - Integrated Data Infrastructure (IDI)
Large data repository that links de-identified data about people that have used government services (and some other agencies) e.g. health, education, tax, ACC
Strict rules in place to preserve confidentiality
29
Data source - Nationally representative surveys
e.g. NZ Health Survey:
- Ministry of Health manages survey with key topics and 'spotlight' coverage on less common issues
Self-reported health and health behaviours
30
Data source - Ad hoc surveys
Student satisfaction survey, market research companies etc
| May not always be generalisable to wider pop
31
Denominators and age-structure
Census < HSU < IDI
32
HSU distribution - older age groups
Generally at older age groups, populations are quite similar
33
HSU distribution - students
Students less likely to visit doctors --> may not have visited doctors in past 2 years --> not included in HSU population
However, most would have paid taxes / enrolled in education --> included in IDI population
34
Data considerations
Ethics and data privacy/confidentiality
Purpose of data collection vs use in analysis
Pop vs pop samples
Are participants representative of NZ pop?
Objective vs subjective measures of health
35
Demographic terminology: Population by attributes
Population (counts or %) by attributes (variables):
- age
- sex: male/females (biological) vs gender (behavioural)
- other attributes
36
Population pyramids
X-axis: males on left, females on right
Y-axis: age (single year or grouped in 5 year bands, young at bottom, old at top)
Bars: either count or % of people in each age-sex group
37
Population structure
Age and sex
Function of previous trends of fertility, migration and mortality events
Changes in fertility and infant mortality rates can be dramatic but will have time lag
Changes in adult mortality rates less dramatic and less variable over time - spread over wider age range
Migration can have dramatic effect, especially if trend is age/sex specific
38
Population composition
Other attributes apart from age and sex
39
Population structure - how it affects events
Crucial influence
Fertility, mortality and migration not evenly distributed across pop by age and sex
Fertility: women only, concentration in young adults
Mortality: highest among very young and elderly
Migration: varies with sex and stage in life cycle
40
Demographic history of an area - time period
1920 - 1945: Mortality decline and increased life expectancy
1960 - 1970: Baby boom
1975 - 1985: Baby bust
1990 - 1995: Baby boom echo
41
Dependency ratios - age groups
```
Child:
0-14 years / working age x 100
Elderly:
>=65 / working age x 100
Total:
(youth + elderly) / working age x 100
```
Where working age is 15 - 64 y/o - this is a limitation as it is assuming those in working age group are 15-64 y/o
42
What does ethnic composition of NZ depend on
Data sources for numerator and denominator
| Ethnicity coding protocol used
43
Prioritised output - advantages
Ensure that where some need exists to assign people to a single ethnic group, ethnic groups of policy importance or of small size aren't swamped by NZ European ethnic group
Produces data that is easy to work with - sum of ethnic group pop adds up to total NZ pop
44
Prioritised output - disadvantages
May over-represent some groups at expense of others
| Externally applied single ethnicity which is inconsistent with concept of self-identification
45
Total response output - advantages
Has potential to represent people who don't identify with any given ethnic group, depending on level of detail reported
46
Total response output - disadvantages
Creates complexities in distribution of funding based on pop numbers or in monitoring changes in ethnic composition of a pop in health
Creates issues in interpretation of data where comparisons between groups include overlapping data
47
Types of ageing
Numerical ageing
| Structural ageing
48
Numerical ageing
The absolute increase in the pop that is elderly
- reflects previous demographic patterns
- improvements in life expectancy
49
Structural ageing
The increase in proportion of pop that is elderly
| - driven by decreases in fertility rates
50
Population impacts of ageing
Natural decline of population
| Absolute decline of population
51
Natural decline of population
Occurs when there are more deaths than births in a pop
- combination of absolute and structural ageing
- more elderly = more deaths
52
Absolute decline of population
Occurs when there is insufficient migration to replace the 'lost' births and increased deaths
- not expected to happen in NZ for 70+ years
- happening in some European/Asian countries
53
Main causes of death in NZ
```
Cancer
Ischaemic heart dis-ease
Stroke
Chronic lower respiratory dis-ease
Other forms of heart dis-ease
```
54
Parts of demographic transition
1. Pre-transitional / pre-industrial
2. Declining mortality, birth rates remain high
3. Fertility rates begin to decline
4. Low fertility and low mortality
55
Inequities - political
Pop health is laden with politics
| All governments want to improve health and well-being of society, but how improvements can be approached differs widely
56
Inequalities
Measurable differences in health
Differences in health experience and outcomes between diff pop groups according to SEP, area, age, disability, gender, ethnic group
i.e. the 'social gradient'
57
Inequities
Inequalities deemed to be unfair or stemming from some form of injustice
Health inequities are differences in distribution of rss/services across pop's which don't reflect health needs
Relations of equal and unequal power - political, social, economic, as well as justice and injustice
58
Equity - MoH definition
In NZ, people have differences in health that are not only avoidable but unfair and unjust
Equity recognises diff people with diff levels of advantage require diff approaches and rss to get equitable health outcomes
59
Te Tiri o Waitangi
Focus of all health policy in NZ
Manawhenua
Mataawaka
60
Privilege
An important part of pop health, but is hard to measure
61
Association and causality
Association does NOT mean causality
62
PROGRESS
```
Place of residence
Race/ethnicity/culture/language
Occupation
Gender/sex
Religion
Education
Socioeconomic status
Social capital
```
+ Disability
63
Rate difference
i.e. risk difference (RD) - absolute measure
| EGO - CGO
64
Rate ratio
i.e. risk ratio / relative risk (RR) - relative measure
| EGO/CGO
65
Who is CGO
The group being compared to, usually:
- high income group
- NZ European group
Common practice is to use the 'most advantaged' group
66
Measures of association/effect
No association:
Rate diff = 0
Rate ratio = 1
Negative association:
Rate diff < 0
Rate ratio < 1
Positive association:
Rate diff > 0
Rate diff > 1
67
Why reduce inequities?
They are unfair
They are avoidable
They affect everyone
Reducing inequities can be cost-effective
68
Unmet needs
Asks survey pop if they've been to the gp, and if there's been a time in the past 12 months they haven't been able to see a gp in a primary healthcare setting and why they couldn't
e.g. unmet need for gp services due to cost, unmet need for after-hours services due to transport
69
Inequities in health outcomes result from...
Inequities in opportunities
70
Income inequalities in NZ
Widened over time
71
What does a Lorenz curve show
The distribution of wealth in a population
72
How to draw a Lorenz curve
1. Order pop from lowest to highest and ask:
- What % of wealth is owned by poorest 10% pop? Then 20% etc.
2. Draw line of absolute equality (45°)
3. Draw line based on available data (concave)
4. The more concave, the greater the income inequality in a pop
73
Lorenz Curve - Gini Co-efficient
The ratio of the area between the line of perfect equality and observed Lorenz curve (A) to the area between the line of perfect equality and line of perfect inequality (B)
Gini = A / (A+B)
where 0 = very equal society and 1 = very unequal society
74
Implications of (income) inequities
```
Unequal society
Less social cohesion
Less trust between groups
Increased stress
Reduced economic productivity
Poorer health outcomes
```
75
How can reducing inequities be achieved?
Through redistribution of rss according to need, or
| Using examples of best practice, it's possible to improve performance of others and thus reduce inequities
76
Examples of interventions to promote health
Bike lanes (e.g. along Northwestern motorway)
Queen Street - increased walkability
Walking school buses
77
Exercise in daily routine
If already walking/cycling to and from work/home, exercise is already incorporated into daily routine
78
Health benefits of cycling
```
Reduce stress
Build stamina
Promote weight loss
Promote muscle strength
Increase cardiovascular fitness
Aids in heart disease prevention
Boost immune system
```
79
Health risks of cycling
Accidents
| Air pollution exposure
80
Analysing air pollution
Rather than just looking at exposure/conc, also look at dose - take into account travel time and how active the mode of transport is; more active --> breathing more --> increased dose
81
Separation of modes of transport for equal dose/exposure of air pollution
Cyclists increased by ~3m away from center line
| Pedestrians increased by ~2m from center line
82
Walking school bus - levels of air pollution
Diff levels of air pollution on diff sides of the road
| More pollution on side closest to busy side of road
83
Urban streets vs green space
Urban street - high air pollution exposure
| Green space - low air pollution exposure
84
Sustainability and health
Sustainability --> safety --> providing health environment
85
Exercise and air pollution
Exercise outweights any negative associations with air pollution - put into perspective
86
More people will cycle in neighbourhoods with...
Low traffic volume with low vehicle speed on residential streets
Separate cycleways on high-traffic roads
Mixed land use so destinations and walkable/cyclable from home
87
Domains included in NZ Index of Multiple Deprivation (IMD)
```
Employment (28%)
Income (28%)
Crime (5%)
Housing (9%)
Health (14%)
Education (14%)
Access (2%)
```
88
NZ IMD: Domain - employment
Measures degree to which working age people are excluded from employment
89
NZ IMD: Domain - income
Captures extent of income deprivation in a data zone by measuring state-funded financial assistance to those with insufficient income
90
NZ IMD: Domain - crime
Measures risk of personal and material victimisations; damage to person or property
91
NZ IMD: Domain - housing
Proportion of people living in overcrowded housing and proportion living in rented accommodation
92
NZ IMD: Domain - health
Identifies areas with a high level of ill health or mortality
93
NZ IMD: Domain - education
Captures youth disengagement and proportion of working age population without a formal qualification
94
NZ IMD: Domain - access
Measures cost and inconvenience of travelling to access basic services
e.g. supermarkets, GPs, primary and intermediate schools
95
Neighbourhood deprivation can be seen as a measure of...
socio-economic position
96
NZDep - principle component analysis
Where the 9 dimensions are combined to create a map showing levels of deprivation by decile (10%) or quintiles (20%)
97
Difference between access for NZDep and IMD
NZDep: internet access
IMD: geographic access
98
NZ IMD - grouping of domains
7 domains grouped together using weights (%) --> create overall IMD score for each neighbourhood, which is ranked to create the overall IMD rank
99
Correlation between NZDep and IMD
Generally quite a strong correlation
100
Appropriate uses of NZDep2013
Planning and resource allocation
Research
Advocacy
101
Appropriate interpretation of NZDep2013
"People living in the most deprived neighbourhoods..."
| NOT "the most deprived people..."
102
The ecological fallacy
The error that arises when info about groups of people is used to make inferences about individuals
Neighbourhood values can't be ascribed to the individual
103
Variations in health
Upstream interventions can target individual, family and community, or environment
e.g. fluoridation of water, green prescriptions
104
Elements of healthy environments include...
```
Clean air and water
Appropriate housing
Access to wholesome food
Safe community spaces
Access to transport
Opportunities to incorporate exercise as part of daily life
```
Required to maintain good health among pop
105
Build environment
All buildings, spaces and products that are created, or at least significantly modified by people
Includes:
Structures - homes, schools, workplaces
Urban design - parks, business areas and roads (above and below ground, and across land)
106
How can built environment be measured
Often context-specific - depends on research question / health outcome of interest
Urban density - pop and/or employment density
Land-use mix - residential, commercial, industrial, wasteland
Street connectivity - 'lollipop' neighbourhoods (one main road in and out) vs well-connected streets
Community rss - access to recreation facilities or health foods (*note: measures POTENTIAL access)
107
Community Resources Accessibility Index
```
36 facilities representing 6 domains:
Recreational - parks
Public transport - bus
Educational - childcare
Shopping facilities - dairy, banks
Health - GP, pharmacy
Social - marae, church
```
108
Urban design: Improving active travel and physical activity - Street connectivity
Grid-like pattern
Reduces distance between destination, encouraging use of 'active transport'
Increases access, as well as access to efficiency to get around
109
Urban design: Improving active travel and physical activity - Traffic calming and other street design features
Street width, cycle lanes, traffic management, pedestrian crossings
Facilities that encourage walking/cycling and discourage driving
110
Urban design: Improving active travel and physical activity - Mix of residential, commercial and business uses
Diff uses of land within a given zone
| Increases opportunities for active transport
111
Urban design: Improving active travel and physical activity - Public open spaces and physical activity spaces
Open spaces in close proximity to residents; pools, parks
| Increase opportunities for physical activity
112
Access - definition
The end result of a process flowing from pre-disposing characteristics and enabling resources (potential access) through need (perceived and evaluated) to ultimate health outcomes (health status and satisfaction)
113
Dimensions of access - 5As
Access is viewed as a set of more specific areas of fit between the patient and healthcare system
Look at relationship between patient and healthcare system perspective
All interlinked
```
Availability - existence of services barriers
Accessibility - geographic barriers
Accommodation - organisational barriers
Affordability - financial barriers
Acceptability - psychosocial barriers
```
114
Dimensions of access: Availability
The relationship of the volume and type of existing services/rss to clients' volume and type of needs
Not only about whether services are provided, but also if people know they exist
Is there enough services/rss?
115
Dimensions of access: Accommodation
The relationship between the manner in which supply rss are organised and expectations of clients
How things are organised so services are provided in an efficient and effective way
116
Dimensions of access: Acceptability
Relationship between clients' and providers' attitudes to what constitutes appropriate care
Whether patients were treated fairly (not discriminated)
Health beliefs; what is a 'serious injury'
117
Dimensions of access: Accessibility
Relationship between location of supply and location of clients, taking account of client transportation, rss, travel time, distance and cost
118
Dimensions of access: Affordability
The cost of provider services in relation to client's ability and willingness to pay for these services
119
Potential vs realised access
Availability
Potential - services potentially available for people
Realised - when these services are actually utilised
120
Direct vs indirect cost
Affordability
Direct - where you see and pay the doctor (healthcare service)
Indirect - time required to visit doctor (e.g. annual or sick leave), car parking cost etc.
121
Maori health is exemplified by systemic disparities in...
Health outcomes
Exposure to determinants of health
Health system responsiveness
Representation in health workforce
122
Maori health - examples of disparities can be seen in...
```
Unequal access to SDH
Cardiovascular disease
Cancer
Injury
Diabetes
Mental health including self-harm (particularly youth suicide)
Infectious disease
Disability
Participation in the health workforce
```
123
Lessons from the 'Titanic'
Disparities, inequalities, or inequities?
Why?
Important factors; structural issues, societal issues
Interventions; leveling or privileging
124
Interventions - structural and social
Structural:
More 'lifeboats', no barriers
Power, rss and opportunities of NZ society are organised by ethnicity and class
Social:
Rights-based approach, commitment to review and level 'playing field'
Values and assumptions widely held in NZ society about the deservedness of diff groups of people
Not aimed at individual behaviour
Historical and contemporary underpinnings
125
Maori health - questions to ask
Why these disparities exist
What is implicated in this additional effect of ethnicity
Is it internal (within the person) or external (expressed by persons after external influences)
126
Determinants of ethnic inequities in health
Differential access to health determinants or exposures leading to differences in disease incidence
Differential access to healthcare
Differences in quality of care received
127
Maori health: International evidence - minorities report...
Less likely to feel they've been listened to
Less time spent with healthcare provider
Less likely to have received adequate explanations
More likely to have unanswered questions
More dissatisfaction with health service/system
128
Maori Health: History
Early contact:
Official engagement:
Colonisation
Treaty implications (also of colonisation)
129
Maori Health: History - early contact
Initially flourished - economically, socially
| Beginning of complex changes
130
Maori Health: History - official engagement
Colonisation; Declaration of Independence, Treaty of Waitangi
Heralding an era of depopulation, disease and dispossession
131
Maori Health: History - Colonisation
```
Not value-free
Assumptions held by colonisers
Notions of superior and inferior people
Notions of civilisation, especially religious but also economic and scientific conservation
Notions of deserving and understanding
Still seen today - societal barriers
```
132
Maori Health: History - treaty implications
Creation of government - art I & II:
Art I - construction of state sector- justice system, education, health, welfare
Constitution Act 1852 - created settler government
Who got to vote
Laws and policies - disregard for Maori voice despite Art II
Maori land:
Historical basis of settler wealth
Pre-emption clause of ToW
Maori Land Court (1860s) - individual title
133
Maori Health: Relationship to health - land alienation
```
Social disruption of community
Breakdown of political power and alliances
Economic resource depletion and poverty
Resentment by indigenous people
Goes hand-in-hand with infant mortality
```
134
Maori Health: Treaty implications - diff or denied citizenship - Art III
```
Pensions - Old age pensions (1898):
Equal provisions for Maori and pakeha
Asians particularly excluded
Maori access difficult - must go through Maori Land Court
Maori regularly removed from rolls
Reduced amount paid to Maori
```
Social security Art (1938):
Underpayment continued until after WWII
135
Maori Health: Relationship to health - unequal (inferior) citizenship
Entrenchment of poverty and dependency
Increased barriers to development
Acceptance of inequity by non-indigenous groups
Resentment, frustration, anger
Social breakdown, crime, high-risk behaviours
136
For Maori health development, we need to address...
The structural barriers to equitable access to determinants of health and the attitudes in society that stigmatises one group
137
Maori population
Maori have a more youthful population --> careful with data that hasn't been age-standardised
138
Maori life expectancy
Currently, life-expectancy diff between Maori and non-Maori is 7-8 years, highly affected by high rates of pre-mature mortality in Maori
139
Disparities, inequalities, inequities
Disparities - differences
Inequalities - unequal
Inequities - unjust/unfair
140
Gender and death rates
Differences in death for gender is maintained and is amplified for Maori
High level of death for Maori males in high level deciles
141
Declaration of independence
Declared Maori were the sovereign people of NZ, which was given up during signing of ToW, which had significant differences between English and Maori version --> implications on health?
142
What are Sustainable Development Goals (SDGs)
A global call to action to end poverty, protect the planet and improve lives and prospects of everyone, everywhere
Member states address inequities in their location, with vision of a global reduction in inequities
143
SDG - overall goal
2030 agenda for sustainable development; 15-year plan to achieve goals
144
SDG - goals
1. No poverty
2. Zero hunger
3. Good health and well-being
4. Quality education
5. Gender equality
6. Clean water and sanitation
7. Affordable and clean energy
8. Decent work and economic growth
9. Industry, innovation and infrastructure
10. Reduced inequalities
11. Sustainable cities and communities
12. Responsible consumption and production
13. Climate action
14. Life below water
15. Life on land
16. Peace, justice and strong institutions
17. Partnerships for the goals
145
Goals, targets and indicators
Each goal has a number of targets and indicators
| Overall, 100 targets and 232 indicators across the 17 goals
146
SDGs: Level of influence - top to bottom
17 - Partnerships for goals
Economy: 8, 9, 10, 12
Society: 1, 11, 16, 7, 3, 4, 5, 2
Biosphere: 15, 14, 6, 13
147
SDGs and Dahlgren and Whitehead model
Generally, SDG targets and indicators are focused on upstream determinants of D&W model
Since D&W model is v permeable, each country sets goals to improve specific targets, but relies on individuals changing at the local level
Need strong leadership across the world to achieve goals
148
SDG - domains
```
Demographic: 5
Economic: 1, 2, 8, 9, 10
Neighbourhood: 6, 7, 11, 12
Environmental effects: 13, 16
Social and cultural: 4
```
149
SDGs Panel A: NZ Living Standards Framework (LSF)
```
Income and consumption
Housing
Jobs
Health
Knowledge and skills
Leisure and recreation
Cultural identity
Safety and security
Environmental quality
Civic engagement and governance
Social connections
Subjective well-being
```
150
SDGs Panel B: LSF four capitals
Physical/financial
Human
Social
Natural
151
What are big data
Includes:
Large/complex datasets
Large amounts of info at a population, regional or local level, or span diff geographical areas
Combining data from multiple sources to explore pop health outcomes
152
Characteristics of big data
Volume - computing capacity required to store and analyse data
Velocity - speed at which data are created and analysed
Variety - types of data sources available
Veracity - accuracy and credibility of data
153
Data - Vs of relevance
Variability - internal consistency of data (e.g. reproducible research)
Value - costs required to undertake big data analysis should pay dividends for your organisation and their patients
Visualisation - use of novel techniques to communicate patterns that would otherwise be lost in big tables of data
154
IDI data
```
All interlinked
People and communities data
Education and training data
Income and work data
Housing data
Justice data
Benefits and social services data
Health data
Pop data
```
155
B4SchoolCheck aims to identify and address...
Any health, behavioural, social or developmental concerns which could affect a child's ability to get the most benefit from school, e.g. hearing problem, communication difficulty
156
B4SC - intention
Intended to be universal
| 12th core contact in Well Child Tamariki Ora Schedule
157
B4SC - MoH
One of the NZ MoH indicators used to track progress in Universal Periodic Review (UPR) commitment to health for people in NZ
158
B4SC compares...
Inequities between most and least deprived groups, between Pacific and NZEuropean children to determine whether NZ had an improved access to primary health for Pacific children
RR calculated specific to quintiles
159
B4SC - causes of causes
The more deprivation a family experiences, the less likely the health checks are completed
Pacific families with low maternal education complete fewer tests than Pacific families with higher maternal education
European families in overcrowded homes complete more tests than Pacific families in overcrowded homes
Each factor contributes independently to likelihood of completing a health check --> children experiencing multiple deprivations are especially unlikely to get their checks completed
160
B4SC - tests
VHT
Nurse check
SDQT
161
Auckland DHB and SDGs
Auckland DHB recently completed an assessment of how diff aspects of their organisation can contribute to improving health outcomes while also addressing the SDGs
162
Which SDGs does ADHB have control on direct impacts
3, 4, 8, 10, 12, 17
163
Stakeholders
All directed towards ADHB / Nhati Whatua
```
Iwi
Patients and whanau
Community
Staff
Leadership/strategy
Planning and funding
Youth
Unions
Council/government
Public health
Pacific/Maori health
Suppliers
Tertiary
Other DHBs
```
164
Stakeholders and Organisational SDG priorities
Multiple stakeholders
Survey and workshops
Education was key - workshops, video and online
165
Materiality matrix
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A tool to engage strategy for longer term thinking
Executive led
>400 responses
Stakeholder driven
Raised awareness
Quality assured
Communicated
```
166
Materiality matrix - graph
Priority SDGs: 3, 10, 1, 11, 6, 4 (top right)
| Good/increasing alignment between stakeholders and strategic focus
167
Alignment - re-prioritised core SDGs
Core: 3/17 - health/partnerships
What we can control - 4 (good education), 8 (decent work), 10 (equity), 12 (procurement and consumption)
What are the outcomes - 1 (reduced poverty), 2 (better nutrition), 6 (safe water), 11 (sustainable communities), 13 (climate action)
168
Alignment
ADHB --> NZ Health Strategy --> NZ and Global Goals
ADHB:
Patient care / health equity
Partnerships / Procurement and consumption
Good employer and education
NZ Health Strategy:
Strategy well-being outcomes
Sustainable delivery
NZ Wellbeing Dashboard (LSF)
169
ADHBs next steps
Work with each directorate on A3s and aligning SDGs
Review plans with an SDG lens
Plan for complete integration/measurement by 2023
170
More visible organisation means...
More public awareness
