Public Health Lessons from Population Health Research - Prof. Dr. Alan Katz, University of Manitoba

1 Manitoba Centre for Health Policy
Straw to Gold :Public
Health Lessons from
Population Health
Research
Alan Katz MB ChB MSc CCFP
Director, Manitoba Centre for Health Policy
Professor Family Medicine and Community Health Sciences
April 5 2017

Overview
• Context of Health Care in Canada with a Public Health Focus
• Manitoba Centre for Health Policy (MCHP)
• Public health challenges in Canada/Manitoba
• MCHP and public health policy

Canadian Population 36
million
Manitoba population 1.2
million

0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Percent
Year
At Birth, Canada
At Birth, Bangladesh
At Age 60, Canada
At Age 60, Bangladesh
Change in Life Expectancy for Canada and Bangladesh, 2000 - 2015
Per capita
expenditure
31 vs 5292
US dollars

Canadian Health Care System
• 11% ( 2.8-3.7%) of GDP spent on healthcare Bangladesh Med J. 2015 Jan; 44
70% (3.6%) of financing is public (single payer for medically necessary
services)
• Canada Health Act

Provincial government has primary
responsibility for
• Health care
• Education
• Regulating professionals
• Managing the system
• Areas not included under Canada Health Act (e.g. public
health, home care, outpatient medications)
• Finances hospitals, physicians, other health care workers,
drug plans for seniors and those on public assistance

Common themes for health reform
(Fooks and Lewis, CPRN, 2002)
• Population health/illness prevention
• Financing the health care system
• Primary care reform
• Regionalization of service delivery
• Pharmaceutical policy (costs and access)
• Health human resources (planning)
• Measuring quality (and information systems)
• Governance and accountability mechanisms
• Home care
• Mental health
• Wait times

To deliver our mission, we have
developed a strategic plan that
focuses on three pillars of work to
support our data Repository, our
Research, and Knowledge
Translation activities that require a
strong foundation of funds, skills,
and accountability

Funding
• Academic unit in department of Community Health Sciences
• Series of 5 year contracts with government: ~50% of annual budget
– Repository maintenance and growth: Research ready
– 5 research studies/year
– Knowledge translation activities
• Investigator driven peer reviewed research grants

Manitoba Centre for Health Policy
25+ years of building relationships with
• Governments
• System managers
• Regional health authorities
• Clinicians
• Researchers

Public Health Definition
• … “the organized efforts of society to keep
people healthy and prevent injury, illness and
premature death. It is a combination of
programs, services and policies that protect
and promote the health of all Canadians”.
• Last, J. (2001). A Dictionary of epidemiology. 4th Edition. Oxford University Press

Ten Great Public Heath Achievements of the
20th Century
• Vaccination
• Motor vehicle safety
• Safer workplaces
• Control of infectious disease
• Decline in death from cardiovascular disease
• Food safety
• Improvement in maternal and child health
• Family planning
• Fluoridation
• Reduction in tobacco use
https://www.cdc.gov/about/history/tengpha.htm

Haddon Matrix
Host
(person affected)
Agent or vehicle
Physical
environment
Social environment
Pre-event
(→ primary
prevention)
Driving skill;
Time pressures
(in a rush to get
home?);
Inebriated?
Car design &
handling;
Anti-lock brakes,
etc;
Maintenance of car
Road design;
Speed limits
Reliance on private,
rather than public
transportation raises
traffic load;
Compliance with
seatbelt laws
During the event
(→ secondary
prevention)
Wearing seatbelt?
Air bags working?
Size of car & crash
resistance
Weather conditions;
ice on road?
Quality of emergency
assistance;
Assistance from
bystanders
Post-event
(→ tertiary
prevention)
Ability to call for
help
(phone available?);
Knows first aid?
Tendency of car to
catch on fire
Emergency vehicle
access to collision
site
Continued funding for
emergency services
Haddon W. A J. Trauma 1972;12:193-207

• The Obesity Epidemic:
A Misplaced Focus on Individual Risk Factors
http://www.bu.edu/sph/2017/01/14/avoiding-the-public-health-
triple-fail/
Sandro Galea, MD, DrPH
Dean and Professor, Boston University School of Public Health

slide curve
over 1/2 a
Standard
Deviation
50% less healthy (i.e., below the mean)
Only 31% less healthy
An approach for only
the very high risk –
limited overall
population effects
HEALTHIERLESS HEALTHY
The importance of a population-based approach: Rose 1981
MEAN

Great Food
• Right Ingredients
• Combination of
ingredients
• Thoughtful Menu
• Creative Presentation
• Dining experience
• Interpretation
• Accessible data
• Data linkage
• Relevant questions
• Information
• Knowledge
• Wisdom
Great Research

Great Food
• Combination of
ingredients
• Thoughtful Menu
• Dining experience
• Interpretation
• Accessible data
• Data linkage
• Information
• Knowledge
• Wisdom
Great Research

Great Food
• Combination of
ingredients
• Thoughtful Menu
• Accessible data
• Data linkage
• Knowledge translation
Great Research

MCHP Houses the De-Identified
Population Health Research Data Repository
Hospital
Physician
Services
Nursing Home
Home Care
Immunization
Vital Statistics
Emergency
Department
Clinical
Health
Surveys
Medical
Laboratory
CancerCare
Education
Family
Services
Income
Assistance
Healthy Child
MB
Social
Housing
Justice
• Families First
• Healthy Baby
• EDI
• ICU
• FASD
• Pediatric
Diabetes
• Cardiac
Surgery
• K to Grade 12
• Post-Secondary
(UofM)
Census Data
at Area Level
Pharmaceuticals
Population-Based
Health Registry

Great Food
• Combination of
ingredients
• Thoughtful Menu
• Accessible data
• Data linkage
• Knowledge translation
Great Research

Lessons
• Determinants of Vaccination
• Cost of Smoking
• Social determinants of health
• Projecting personal care home (nursing home) and hospital bed requirements
• Social Housing
• Obesity
• SES (map)

Hilderman, Katz et al 2011

Martens, Nickel et al 2015

Katz et al 2016

Social Complexities

Chartier et al 2015
Brownell 2010

Projected
Growth of
Manitobans
With
ESKD

Males:76 ,Females:82
Males:78.8 ,Females:83.7
Change in Male and Female Life Expectancy South-North
following Pembina Hwy (rte 42) and Main St (rte 52)
Legend
Premature Mortality
1.86 - 3.07
3.08 - 4.28
4.29 - 5.49
5.50 - 6.70
6.71 - 7.91Manitoba RHA Indicators Atlas 2009
Fransoo R, Martens P, Burland E, The Need to Know Team, Prior H, Burchill C
Life Expectancy at birth
(in years):
South Pembina Highway:
Males: 81 years
Females: 87 years
Downtown:
Males: 67 years
Females: 71 years

Who is in Care?
Year First Nations Metis Non-Indigenous Total*
Count Percent Count Percent Count Percent
2002 4,083 74.3% 362 6.6% 1,046 19.0% 5,495
2014 7949 77.2% 988 9.6% 1,333 13.0% 10,293
Information taken from Manitoba Family Services Annual Reports, showing
count of children in care on March 31 of given year.
*Inuit children included in total: 4 children in 2002; 23 children in 2014

0%
5%
10%
15%
20%
25%
30%
35%
<1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Percent of Children in Care by Age at First Care Episode
Children in care , 2009/10 to 2011/12
Age (Years)

Public Health Lessons from Population Health Research - Prof. Dr. Alan Katz, University of Manitoba

Recommended

Recommended

More Related Content

Recently uploaded

Recently uploaded (20)

Featured

Featured (20)

Public Health Lessons from Population Health Research - Prof. Dr. Alan Katz, University of Manitoba