Description of urban health indicator system

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Description of urban health indicator system

• Professor Ioan Stelian Bocsan
• Iuliu Hatieganu University of Medicine and
  Pharmacy
• Department of Epidemiology and Primary Health
  Care
• Cluj-Napoca
• Romania
• and WP 10 team

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WP 10 T e a m

• I S Bocsan, Maria Irina Brumboiu, Doina Azoicai,
  Doina Petri
• Iuliu Hatieganu University of Medicine and
  Pharmacy
• Department of Epidemiology and Primary Health
  Care
• Cluj-Napoca
• Romania
• Christopher Birt, Jude Robinson, Matthieu
  Pegorie,
• Angela Pilkington
• Universities of Liverpool, and Manchester, UK
• Jurate Klumbiene, University of Vilnius,
  Lithuania
• Igor Krampac, University of Maribor, Slovenia
• Iveta Rajnikova, Bratislava, Slovakia
• Jana Brozova, Daniela Simonova, Prague, Czech
  Republic
• Heidi Lyshol, Norway

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WP10 Objectives

• To describe the methodology to implement a
  self-sustainable urban health database model
• Linked to EURO-URHIS specific objectives 2 and
  4
• To summarise individual member states current
  use of measures of urban health, in order to
  compile a cross-EU inventory, which will allow
  trans-national comparisons and benchmarking.
• To disseminate the project results.

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Expectations

• Development of a comprehensive and sustainable
  urban health information and knowledge system
• Involvement of a wide range of states
• Contribution to the implementation of ECHI list
• Providing timely information for the publication
  of urban health status reports in areas of
  interests
• Trans-national comparisons and time trend
  analysis to support health policy and planning.
• Support the development of advocacy,
  communication and education strategy

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Links to other WPs

• All WPs!
• Particularly linked to
• WP 7 Data collection
• WP 8 Country summary reports
• WP 5 Definition of urban areas and populations
• WP 2 Project dissemination
• WP 4 Literature review

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Steps

• The work has been carried out as scheduled
• The analysis of data collected already (WP 7)
• Comparisons of results between member states to
  identify the gaps
• Describing
• the data to be collected
• the methods/instruments to be used
• the gaps in data that require more work
• how best to collect information routinely (e.g.
  using health examination / interview survey
  modules)
• how to enable self-sustainability

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Methodology (1)

• Two preparatory meetings (Cluj-Napoca, Romania,
  October and December 2007)
• Final workshop (Bistrita, Romania, February 2008)
  
• Small working groups, each group analysing 9 of
  the 45 UHIs during a four-days workshop (2008)
• The groups studied the following questions and
  issues
• Had all respondents understood the UHI similarly?
  If not, what were the variations in
  interpretation of it?
• How many respondents had access to the
  appropriate data?

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Methodology (2)

• Was the UHI definition provided appropriate, or
  were other definitions in use? If so, did a
  substantial proportion of respondents use one
  particular alternative definition?
• Did respondents generally find this UHI relevant,
  in the context of urban health?
• Was there evidence that an alternative indicator
  (in the same public health domain) is generally
  preferred?
• If substantial numbers of respondents reported
  absence of appropriate data, how might this (or
  comparable data) be obtained in future? Would
  use of random sample population surveys (e.g. by
  use of questionnaires on a regular basis be
  relevant)?

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Questions, issues, concerns (1)

• Should each/this UHI be retained?
• If so, should we consider its retention in an
  amended form (e.g. by adopting an alternative
  definition)?
• How might data most satisfactorily be obtained in
  respect of the preferred definition?
• If there appear to be no satisfactory answers to
  these questions, should we agree that this
  particular UHI is unsuitable for further use or
  development?

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Questions and issues (2)
Questions, issues, concerns (2)

• After completion of this process for all UHIs,
  the following next series of issues were
  addressed, as follows
• Which UHIs from the original 45 survive?
• Do these contribute to a comprehensive,
  meaningful and relevant dataset of UHIs?
• If not where are the gaps, what new UHIs /
  areas of data may be in need of development?

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Questions and issues (3)
Questions, issues, concerns (3)

• Of surviving recommended UHIs, which methods of
  data collection or retrieval should be
  recommended for use in further work
• As assumed within EURO URHIS 1 methodology (i.e.
  from existing routine sources of data)?
• By use of routine submission of questionnaires to
  random samples of urban populations?
• Other means, to be defined?

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Questions, issues, concerns (4)

• Negative experiences
• losing team members (Czech Republic, UK)
• lack of intermediate communication with other WP
  leaders before the final WP10 workshop.
• Positive experiences
• newcomers while the project was running (UK)
• teleconferences
• managerial committed and efficient assistance and
  support

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The next stage (1)

• To note that these UHIs were found not suitable
  for further work in their present form and as
  currently defined
• Populations projections
• Migration to the urban area, internal migration
  and EU migration (maintaining only non-EU
  migration)
• Homelessness
• Depression prevalence
• Use of cannabis
• Damp housing

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The next stage (2)

• To indicate the agenda for future research and
  service development
• a. research-related matters
• Identification of gaps in the surviving
  recommended dataset in need of being filled.
• Indications relating to indicators required, data
  requirements for such indicators, methods of data
  collection, etc., and the development and
  piloting of instruments.

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The next stage (3)

• b. service-related matters
• Development of an improved data collection
  instrument based upon that used for EURO-URHIS.
• Development of improved guidance for completion
  of this instrument (including translation in
  other languages?).
• Identification of a core instrument for use in
  random population surveys.
• Arrangements for translation of such a core
  survey instrument, and the piloting of translated
  versions.
• Refinement of the definition of metropolitan
  urban areas (conurbations).
• Development of the most up-to-date available
  user-friendly IT applications to assist data
  collection of all types.

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Subjects to be considered for inclusion in any
future population survey instrument

• Employment, unemployed status, etc.
• Homelessness (e.g. ever homeless for more than a
  week).
• Asthma diagnosis prevalence.
• COPD diagnosis prevalence.
• Self-perceived general health.
• Health-related limitations of activities.
• Tobacco use.
• Alcohol consumption.
• Fruit and vegetable consumption.
• Quality of housing (e.g. damp housing prevalence,
  etc.).

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Gaps in the remaining recommended dataset the
development agenda

• Acceptable methodologies for population
• projections.
• Means of monitoring migration into / out of urban
  areas.
• Indicators of mental health and illness.
• Indicators of quality of housing.
• Prevalence of chronic disease registers (perhaps
  in primary care).

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Conclusions

• The report of this work package became possible
  only by the excellent work carried out in all
  earlier EURO-URHIS work packages.
• It indicates that, while a robust system of
  European urban health indicators almost certainly
  can be constructed, such construction remains
  very much work in progress.
• This report does also provide indications for the
  direction of the next stages of this development
  work.

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• Thank you for your attention
• Presentation open for discussions