What is counted counts
Making social determinants
interventions visible

Richard Madden and Nicola Fortune
National Centre...
WHO Family of Classifications
› International Classification
of Diseases – ICD-10

› International Classification
of Funct...
Scope of ICHI
Interventions across all functional sectors of the health system:
• Acute care — medicine, surgery, diagnost...
ICHI definition of health intervention

An activity performed for, with or on behalf of a
person or a population whose pur...
ICHI: Three axes
› Target — the entity on which the Action is carried out

› Action — the deed done by an actor to the Tar...
Multiple use cases for ICHI
1. National applications for ICHI
a) ICHI as a national classification
b) National classificat...
Public health interventions in ICHI
› Interventions delivered to
populations or population
sub-groups
› Targeting health b...
Public health interventions in ICHI
193 public health interventions, e.g.,
› Education about specific health issues
or hea...
Health behaviour Target categories
Health behaviors
•
•
•
•
•
•
•
•
•
•
•

Alcohol use
Tobacco use
Diet
Physical activity
...
Environmental Target categories
Environmental factors (physical, institutional and social/cultural)
•
•
•
•
•
•
•
•

Indoo...
Example public health interventions
› Education concerning sun protection, delivered through the
media (MAO PA PH)
Target:...
E.g., Polio immunisation campaign
› KBB VB PJ — Population immunization/vaccination
Target: Population
Action: Population ...
Primary care interventions in ICHI
› Current focus on expanding ICHI to ensure comprehensive
coverage of interventions del...
Prevention and promotion
› Sets of interventions that target
health behaviours, e.g.,
-

Assessment of tobacco use
Prescri...
ICHI and social determinants
How is ICHI relevant to social determinants of health?
1. Interventions that target health be...
WHO’s Universal Health Coverage
› WHO’s Universal Health Coverage (UHC) initiative
aims to ensure that all people obtain t...
Next steps …
› Review and test public health interventions in ICHI
E.g., using ICHI to record interventions delivered, or ...
Seeking your input
Input sought from health practitioners and researchers, to ensure
that ICHI is relevant and useful inte...
Download ICHI Alpha2
You can download the Alpha2 version of ICHI from the
website of the National Centre for Classificatio...
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Richard Madden & Nicola Fortune, USYD: What is Counted Counts – Making Social Determinants Interventions Visible

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Professor Richard Madden, Director, National Centre for Classification in Health and Nicola Fortune, Research Fellow, National Centre for Classification in Health, The University of Sydney delivered this presentation at the 2013 Social Determinants of Health conference. The conference brough together health, social services and public policy organisations to discuss how social determinants affect the health of the nation and to consider how policy decisions can be targeted to reduce health inequities. The agenda facilitated much needed discussion on new approaches to manage social determinants of health and bridge the gap in health between the socially disadvantaged and the broader Australian population. For more information about the event, please visit the conference website: http://www.informa.com.au/social-determinants.

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  • Public health interventions in ICHI are not intended for use in individual record data collections, such as hospital databases.Applications are likely to be quite different in nature to those envisaged for individual interventions in the other chapters of ICHI.Could characterise a public health system in terms of the interventions delivered: e.g., interventions employing legislative/regulatory mechanisms, public health education, interventions targeting environmental factors; could break down by health condition/disease areas targeted (e.g. chronic diseases, infectious diseases, injury) using ICHI and ICD together.
  • Public health interventions in ICHI are not intended for use in individual record data collections, such as hospital databases.Applications are likely to be quite different in nature to those envisaged for individual interventions in the other chapters of ICHI.Could characterise a public health system in terms of the interventions delivered: e.g., interventions employing legislative/regulatory mechanisms, public health education, interventions targeting environmental factors; could break down by health condition/disease areas targeted (e.g. chronic diseases, infectious diseases, injury) using ICHI and ICD together.
  • Public health interventions in ICHI are not intended for use in individual record data collections, such as hospital databases.Applications are likely to be quite different in nature to those envisaged for individual interventions in the other chapters of ICHI.Could characterise a public health system in terms of the interventions delivered: e.g., interventions employing legislative/regulatory mechanisms, public health education, interventions targeting environmental factors; could break down by health condition/disease areas targeted (e.g. chronic diseases, infectious diseases, injury) using ICHI and ICD together.
  • Demonstration of ICHI 2013 (Alpha2 as available on website and CD)
  • Richard Madden & Nicola Fortune, USYD: What is Counted Counts – Making Social Determinants Interventions Visible

    1. 1. What is counted counts Making social determinants interventions visible Richard Madden and Nicola Fortune National Centre for Classification in Health
    2. 2. WHO Family of Classifications › International Classification of Diseases – ICD-10 › International Classification of Functioning, Disability and Health – ICF › International Classification of Health Interventions – ICHI (under development) 2
    3. 3. Scope of ICHI Interventions across all functional sectors of the health system: • Acute care — medicine, surgery, diagnostics • Primary care • Mental health • Rehabilitation • Assistance with functioning • Public health • Ancillary services What is counted, counts
    4. 4. ICHI definition of health intervention An activity performed for, with or on behalf of a person or a population whose purpose is to improve, assess or modify health, functioning or health conditions 4
    5. 5. ICHI: Three axes › Target — the entity on which the Action is carried out › Action — the deed done by an actor to the Target › Means — the processes and methods by which the Action is carried out What is done to what target, and how ICHI does not describe why the intervention is performed (reason), who performs it (provider), or where it is performed (setting) 5
    6. 6. Multiple use cases for ICHI 1. National applications for ICHI a) ICHI as a national classification b) National classification as an extension of ICHI c) Subset of ICHI as replacement for ICD-9-CM 2. International comparisons 3. Patient safety and quality 4. Universal Health Coverage (WHO) 5. Public health applications 6. Casemix applications 6
    7. 7. Public health interventions in ICHI › Interventions delivered to populations or population sub-groups › Targeting health behaviours and environmental factors › Includes campaign-style interventions, e.g., immunisation, screening and mass treatment programs 7
    8. 8. Public health interventions in ICHI 193 public health interventions, e.g., › Education about specific health issues or health-related behaviours › Community engagement interventions to promote healthy eating › Taxation of tobacco or alcohol › Surveillance and enforcement of air quality standards › Laws restricting the sale or use of products with associated health risks › Environmental decontamination 8
    9. 9. Health behaviour Target categories Health behaviors • • • • • • • • • • • Alcohol use Tobacco use Diet Physical activity Illicit drug use Pharmaceutical use Sexual behaviours Hygiene Oral health behaviours Breastfeeding Sun exposure protective behaviours • Behaviours related to psychological health and wellbeing • Social behaviours • Health service use • Immunisation behaviours • Screening behaviours • Road safety behaviours • Household safety behaviours • Workplace safety behaviours • Other safety behaviours • Other specified behaviours 9
    10. 10. Environmental Target categories Environmental factors (physical, institutional and social/cultural) • • • • • • • • Indoor air quality Outdoor air quality Water quality Land and soil quality Flora and fauna Food Domesticated animals Natural environment and human-made changes to environment • Health services, systems and policies • Utilities services, systems and policies • Population • Health professionals • Other professionals • Acquaintances, peers, colleagues, neighbours and community members • Societal attitudes • Individual attitudes of health professionals 10
    11. 11. Example public health interventions › Education concerning sun protection, delivered through the media (MAO PA PH) Target: Action: Means: Sun exposure protective behaviors Education Media services, systems and policies › Surveillance and enforcement of air quality standards (KBL XA PB) Target: Action: Means: Outdoor air quality Environmental standards and surveillance Civil protection services, systems and policies 11
    12. 12. E.g., Polio immunisation campaign › KBB VB PJ — Population immunization/vaccination Target: Population Action: Population immunization/vaccination Means: Health services, systems and policies Code also: › FIB HM AE — Other immunization, not otherwise specified › Z24.0 — ICD code ‘Need for immunization against poliomyelitis’ › Relevant ATC code 12
    13. 13. Primary care interventions in ICHI › Current focus on expanding ICHI to ensure comprehensive coverage of interventions delivered to individuals, groups and communities in a primary care context: › Health promotion › Disease prevention › Routine healthcare services (e.g., antenatal care) › Diagnosis › Rehabilitation › Treatment › Palliative care › Chronic disease management › Community development 13
    14. 14. Prevention and promotion › Sets of interventions that target health behaviours, e.g., - Assessment of tobacco use Prescription for tobacco use Education about tobacco use Counselling about tobacco use › Immunisation interventions - Oral immunisation - Other immunisation Note: use ICD code to record disease and ATC code to record the vaccine 14
    15. 15. ICHI and social determinants How is ICHI relevant to social determinants of health? 1. Interventions that target health behaviours and environmental factors associated with social disadvantage, e.g., - Alcohol and tobacco use, diet, sexual behaviours - Air quality, water quality, food, social and attitudinal environment 2. Delivery of interventions to socially disadvantaged individuals and communities, e.g., - Use of ICHI alongside socioeconomic or geographic information to see who is receiving interventions, in relation to health needs 15
    16. 16. WHO’s Universal Health Coverage › WHO’s Universal Health Coverage (UHC) initiative aims to ensure that all people obtain the health services they need without suffering financial hardship when paying for them › ICHI will provide a basis for defining and reporting interventions to monitor progress in achieving UHC 16
    17. 17. Next steps … › Review and test public health interventions in ICHI E.g., using ICHI to record interventions delivered, or mapping records/reports of interventions to ICHI › Expand content Ensure comprehensive coverage of interventions relevant to public health and primary care › Explore use cases Identify information applications for ICHI E.g., describing and reporting public health / primary care interventions delivered; analysis with measures of social disadvantage to look at equitability 17
    18. 18. Seeking your input Input sought from health practitioners and researchers, to ensure that ICHI is relevant and useful internationally › Comments on the draft version of ICHI › Field-testing, e.g.  recording interventions delivered using ICHI, or  mapping past records/reports of interventions delivered to ICHI 18
    19. 19. Download ICHI Alpha2 You can download the Alpha2 version of ICHI from the website of the National Centre for Classification in Health: http://sydney.edu.au/health-sciences/ncch/about.shtml Contact us: fhsncchadmin@sydney.edu.au Thank you 19
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