Measuring Health and Wellbeing

John Harvey, Vicki Taylor, John Harvey, Vicki Taylor

• Publisher: Learning Matters
• Year: 2013
• ISBN:
  9780857254344
• Edition: 1
• Topic: Médecine
• Subtopic: Santé publique, administration et soins

Building on the core competences for public health, this book focuses on key areas of surveillance and assessment of the population?s health and wellbeing. It is concerned with assessing and describing the needs, health and wellbeing of specific populations, communities and groups. The authors also look at how to monitor these aspects of public health and explore qualitative and quantitative methods for measuring, analysing and interpreting health and wellbeing, needs and outcomes. Case studies, activities and research summaries are used throughout the book to help the reader understand how to apply theory to practice.

Chapter 1 Basic Concepts

John Harvey

Meeting the Public Health Competences

This chapter will help you to evidence the following competences for public health (Public Health Skills and Career Framework):

• Level 5(g): Understanding of basic terms and concepts used in epidemiology and how rates are calculated;
• Level 5(5): Interpret data on health and wellbeing within own area of expertise or practice;
• Level 6(d): Understanding of links between, and relative importance of, the various determinants of health and wellbeing and needs;
• Level 7(1): Assess and describe the health and wellbeing and needs of specific populations and the inequities in health and wellbeing experienced by populations, communities and groups.
• This chapter will also assist you in demonstrating the following National Occupational Standard for public health:
• Collect and link data and information about the health and wellbeing and related needs of a defined population (PHP10).

This chapter will also be useful in demonstrating Standard 6 of the Public Health Practitioner Standards.

Standard 6

Obtain, verify, analyse and interpret data and/or information to improve the health and wellbeing outcomes of a population/community/group – demonstrating:

• b. knowledge of the main terms and concepts used in epidemiology and the routinely used methods for analysing quantitative and qualitative data.

Overview

This chapter will help you to understand links between, and relative importance of, the various determinants of health and wellbeing and need. It will also give you an understanding of basic terms and concepts used in epidemiology and how rates are calculated.

After reading this chapter you will be able to:

• define health and wellbeing, and needs assessment;
• understand that there are links between social determinants and health;
• describe what is involved in a joint strategic needs assessment (JSNA);
• define some key epidemiological and health economics concepts.

Introduction

One of the most important tasks we have as a society is to promote the health and wellbeing of our population, looking to improve their long-term quality of life. To do this we must have a good understanding of the needs of that population, whether children and young people, younger or older adults.

It is not just about ‘data’. We also must involve people in a meaningful dialogue about their perceptions of need. It has been said that:

experts and professionals can put their own interest before the wellbeing of their clients and research subjects. Often too they will be so ignorant of the reality of life for ordinary people that their proposals can be counter productive or just plain stupid.

(Gough, 1992)

So we need to answer three basic questions. What is health and wellbeing? What determines health and wellbeing? What is need? We will answer the second question in discussing need and need assessment.

In addition, in this chapter we will review basic epidemiological and health economics principles and concepts so that you can assess the usefulness of all the available data.

What is Health and Wellbeing?

The World Health Organization (WHO) defined health as a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity (WHO, 1948).

In 1986 this definition was revised for the Ottawa Charter for Health Promotion: health is seen as a resource for everyday life, not an object of living. It is a positive concept emphasising social and personal resources as well as physical capabilities – the extent to which an individual or group of individuals is able, on the one hand, to realise aspirations and satisfy needs, and on the other hand to change or cope with the environment (WHO, 1986).

Wellbeing is a term that is used increasingly in UK government policy. This may be to distinguish between the responsibilities of the health service and the wider joined-up approach to improving the status of the population. It is included in the original WHO definition to indicate much more than just a state of physical health. It also encompasses emotional stability, clear thinking, the ability to love, create, embrace change, exercise intuition and experience a continuing sense of spirituality. However wellbeing is defined in many ways in different contexts.

It has been suggested that the first and most important way to make sense of how wellbeing is used in contemporary policy is this: wellbeing is a social construct. There are no uncontested biological, spiritual, social, economic or any other kind of markers for wellbeing. The meaning of wellbeing is not fixed – it cannot be. It is a primary cultural judgement; just like what makes a good life? (Ereaut and Whiting, 2008).

What is Need and Needs Assessment?

Need, in terms of healthcare, has been defined as the population's ability to benefit from health (and social) care interventions (Stevens and Raftery, 1994). Chapter 3 discusses needs assessment in more detail.

There are many models for the assessment of need in a population and health needs in particular. In this book, two approaches are recognised. The first approach starts with information gathered from different sources – these may be routine data from health surveillance, or local service use or applied rates from epidemiological studies in other populations – to identify aspects which are important or unusual in that population. In contrast, the second approach starts with a theoretical model which identifies the main factors that determine health and describes the local picture in the light of this. Both approaches will make use of the same sources of information (see Chapter 2 on measures of health) but the second aims to present the information in a way that illustrates the public health model. Taking this approach to assessment of need, there are two key models that have credibility and are mutually complementary: these are the life course and social determinants models.

The first is based on life course theory. Life course theories were developed to explain observations such as the way that the health of adults is influenced significantly by what they experienced during development both in the mother's womb and in their early years. The framework is described in a report entitled Childhood Disadvantage and Adult Health: A Lifecourse Framework (Graham and Power, 2004).

What's the Evidence?

The life course framework provides an explanation for the persistence and worsening of inequalities by describing the ways in which health is transmitted from generation to generation. In the preface to the report (Graham and Power, 2004, pv), Kelly (then Director at the Health Development Agency) states that it is

through economic, social and developmental processes, and the advantages and disadvantages are reinforced in adult life. A ‘life-course approach’ focuses on the different elements of the experience of health, from the moment of conception through childhood and adolescence to adulthood and old age.

There is very good evidence underpinning the importance and positive long-term outcomes of promoting early child development, through a range of services and interventions. The body of knowledge built up through longitudinal studies, based on life course theory, and informed by the understanding of developmental neurology (how the brain develops, for example) should be the basis of needs assessment.

The determinants of physical health and health behaviour are summed up in the preface to the report. Kelly goes on to say:

disadvantaged childhood conditions have a direct impact on child health. So children from poorer circumstances tend to be affected in a number of ways: slower foetal growth, lower birth weight, shorter height and leg length, and more disease. Adolescence is critical in determining behaviour such as cigarette consumption, dietary behaviour, exercise and alcohol use, and while there is much evidence to show that children from all social groups tend to experiment with smoking and alcohol as well as drugs, the potentially damaging long-term use of drugs and alcohol, as well as consumption of fat, sugar and salt, are established in adolescence.

(Graham and Power, 2004, pvi)

An example of the evidence to support this approach comes from the Northern Swedish Cohort Study (Gustafsson et al., 2011). This study is a prospective cohort study comprising all adolescents who entered or should have entered the ninth (last) grade of compulsory school in 1981 in a Swedish town. The influence of socioeconomic status (SES) on health over the life course is complex. Contrasting findings suggest that the enduring effect of childhood SES on adult body mass is largely independent of adult social class. This is known as the sensitive (or critical) period life course model, which suggests that exposure during particular periods of life (e.g. childhood/adolescence) results in long-term health effects, independently of later exposure. To understand the mediating factors and to determine how far this is true, a cohort study is the best method.

The Swedish study examined whether body mass index (BMI) at the age of 16, 21, 30 and 43 years, and 27-year BMI change, are explained by past and present socioeconomic disadvantage in women (and men), and if the SES-body mass association is explained by health behaviours. The results showed that, in women but not in men, associations between SES and body mass across the life course correspond to both the cumulative risk (persistently living in low SES) and sensitive period (in adolescence) models, and that health behaviours do not seem to mediate this association.

This important finding has implications: that to reduce social inequality in obesity in women, efforts should be directed at the early life course and not limited to targeting unhealthy behaviours.

However it is not only physical health but also social wellbeing which is explained by the life course framework. There are...