KISS for Self-Rated Health? July 26, 2009
Posted by Katelyn Mack in Research.Tags: health, public health, surveys
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KISS — the acronym widely recognized for the philosophy ‘Keep It Simple Stupid’ — has characterized the measurement of overall population health in many epidemiogical surveys, including some of the largest in the US. This measure: self-rated health.
The question: ”Would you say your health in general is excellent, very good, good, fair or poor?” Is asked in major nationally representative surveys such as the National Health Interview Survey (NHIS), the Behavioral Risk Factor Surveillance Survey (BRFSS), the National Health and Nutrition Examination Survey (NHANES), and the Current Population Survey (CPS). Many public health professionals and epidemiologists have relied on responses to this question to measure a groups’ overall health and wellbeing. It is clearly easier to ask someone to rate their own overall health than to take blood pressure, pulse, weight, height, and ask a slew of disease-specific questions.
The downfall to this type of measurement of health is obvious: it is impossible to know why someone rates their health as excellent vs. fair. Nonetheless, researchers have used this measure to track trends in health over time and as a stand-in when other more invasive health measures are not available. Often, those who respond to this questions are categorized as in either “excellent, very good, or good” health or “fair or poor” health.
The use of this binary categorization may be flawed according to a recent article in the American Journal of Epidemiology by J. Salomon and colleagues, which challenges the reliability and consistency of this question to measure trends in population health over time.
Salomon et al. present data from the 4 health surveys mentioned above with data from 1998 to 2007 and compares trends in self-rated health, breaking it down by gender, age, race/ethnicity, and education. They report conflicting trends across the surveys (e.g. NHIS shows an increase in fair/poor health over time, while CPS shows a decrease in fair/poor health). They also find that certain subgroups have a higher likelihood of having inconsistent reports across surveys: young people (20-49 years), Hispanics, and those who lack a high school education. Because fair/poor responses are mostly inconsistent across surveys when looking over time, the authors suggest using an “excellent” or “excellent/very good” if analyzing data using this measure.
With reliable, accurate information being at the heart of any social epidemiological study it is imperative that these inconsistencies be reviewed and improved upon. How might this impact social and behavioral research? We have used and relied upon this measure of ‘health’ for a long time and applaud the fact that it is ‘reliable’ and easy to administer (i.e. cheap). The authors highlight the implications that these inconsistencies might have on disparities research and studies on socioeconomic status — since those with the lowest education, and racial/ethnic minorities are less likely to have consistent trends across surveys.
A thought: Even though the authors break this data up by subgroups (gender, age, race, education) — might the differences in sampling methodology and design (even the timing, placement, and order of the question within the survey!) have the consequence of creating the inconsistencies that we see?
We need to keep it simple – for time and money’s sake. But let’s make sure we avoid acting stupid. What could be a better way to quickly and easily capture peoples’ overall health status? Do you have a different ‘favorite’ measure?
HHS Video Contest: Flu Prevention July 23, 2009
Posted by Katelyn Mack in Uncategorized.add a comment
Have you wanted to create a real PSA? Interested in public health? This is a great opportunity to get some hands on experience. (…I am so excited about this…)
According to an HSPH announcement:
Kathleen Sebelius, U.S. Department of Health and Human Services Secretary, has announced that the agency is running a contest on YouTube in which you can film and post a public service announcement about preventing H1N1 flu. The winner’s video will appear on television, and the winner will receive $2,500. The deadline is August 17, 11:59 pm EDT.
Listen to Secretary Sebelius and find out more at the Flu.gov site.
Put on your thinking caps and get to work — August 17 is just around the corner!
Health Reform Bills Collide: House vs. Senate July 17, 2009
Posted by Katelyn Mack in Disparities, Health Reform, Policymaking.4 comments
Yesterday APHA revised its comparison of the Senate HELP Committee and House Tri-Committee Bills for health reform. My last post highlighted how the Senate Bill incorporated aspects of the social determinants of health into the health reform agenda. How does the House Bill stack up in comparison? I used the APHA and Kaiser Family Foundation websites as guides and this is what I found:
- Only the House Bill actually creates a trust (Prevention and Wellness Trust) that will be the source of funding many of the prevention, wellness, and community-based activities it promotes. The Senate bill states that CDC and other public health agencies would be ‘directed’ to make changes.
- Both propose the creation of a prevention ‘task force’ that will provide an evidence-based review of community-based interventions to improve health. The House Bill also includes a specific authorization for a task force focusing on clinical preventive services.
- Both increase funding for prevention research. The House Bill specifies the amount of funding available from the Prevention Wellness Trust and suggest an increase from FY2010 to FY2019.
- Only the Senate Bill includes a Worksite Wellness promotion campaign. (I’m not sure this is actually necessary to include in the Bill…)
- Both include an annual report that would have indicators on the performance of the nation’s health and health care system. (YES!)
- The Senate Bill includes creation of a “National Prevention, Health Promotion and Wellness Council” that sounds grounded in social determinants of health. It will include Secretaries from agriculture and environment to transportation and education that will help create a national strategy for health promotion.
I was also glad to see attention being paid to health disparities in the Bills (though its presence is slightly underwhelming). Unfortunately while experts in public health agree that inequitable health (differences in health between the rich and poor, White and non-White, and by gender) is a major problem for our nation’s health the public has not caught on to that reality (at least that is what a KFF President and CEO, Drew Altman suggests).
I also noticed many public health workforce provisions in the Bills, which may help to quell the enormous exodus of physicians from primary/family care (…do medical students even think about a primary care career any more?) to specialized medical care. Obviously specialized medical care is great, but perhaps if we had better preventive and family care services we wouldn’t require so much of it!
It will be interesting to see how the Bills change as they go through the revision process. *Fingers crossed* that they make it through! There is a lot of potential with some of the community- and evidence-based decision making and fact-finding. Will it serve to deal with one of the biggest health reform issues — costs? Ummm…I’m not so sure.
Health Reform Jumps First Senate Hurdle July 15, 2009
Posted by Katelyn Mack in Disparities, Health Reform, Policymaking, Politics.1 comment so far
The Affordable Health Choices Act, legislation supported by the American Public Health Association, passed through the Senate Health, Education, Labor and Pensions (HELP) Committee this afternoon. Some of the most exciting aspects of the bill (…in terms of social determinants of health) are:
- Establishing a program at the Centers for Disease Control and Prevention to “facilitate the use of health impact assessments to gauge the public health implications of major decisions regarding the built environment, including housing, transportation systems, waste disposal sites and other land-use planning decisions.
- Establishing a grant program for state and local governmental and community-based organizations to implement evidence-based community preventive health activities to reduce chronic disease rates,address health disparities (including social determinants of health), and develop a stronger evidence base of effective prevention programs and interventions.
- Collecting data and conducting research on the health and healthcare of populations that have traditionally experienced health disparities…in efforts to improve the quality and effectiveness of health services.” (quotes are taken from an APHA e-mail blast, emphasis mine)
While many health reform advocates are hopeful at this point, the slim (partisan) margin by which this bill was passed is worrisome (13-10). Next, the Senate Finance Committee holds a markup of its version of the legislation and later their version is merged with the recently passed HELP Committee bill.
Up next — how do the House and Senate health reform legislation compare? Great question!
What does climate change have to do with it? July 13, 2009
Posted by Katelyn Mack in Climate Change, Disparities, Events, Violence.2 comments
An article on the intersection of climate change and social determinants of health (SDH) in Global Health Promotion recently caught my eye. Climate change interventions ought to consider the social context in which they (will) occur in order to prevent a widening of health inequalities.
How will climate change impact health? The authors cite the effects of climate change on the frequency and intensity of natural disasters, lessening of water and food security, and alterations in the geographical distribution of infectious diseases (such as malaria and other mosquito-driven diseases).
My attendance at the 2009 Humanitarian Action Summit at Harvard University brings one more health impact of climate change to mind; one that is inextricably linked to social determinants, as well: violence and war. As food security is threatened and resources become more scarce malnutrition and starvation are not the only consequences. This insecurity can easily manifest in social unrest. We are seeing it in humanitarian emergency settings. Children, adolescents, and men are joining militias and moving into new territory (wreaking havoc on whoever may live there and be most unprotected — often women and children). What results is gender-based violence, community chaos, and a survival mentality. Intense urbanization is also a common consequence, as the article discusses. (Read this article by Peter Walker from Tufts University for more on this topic – he presented at the Summit).
Climate change must be taken seriously in public health. We must at least include the food and water effects of climate change in our domestic and international agendas. Glad to see PAHO taking this seriously — perhaps they will get this stuff into AJPH soon…
UPDATE 07/21: I just got wind of a Working Paper on the Social and Governance Dimensions of Climate Change: Implications for Policy by Robert Foa (of Harvard!) as part of the 2010 World Development Report. The key recommendation is to create national policy environments that are amenable to environmental legislation. How? He suggests gender quotas and supporting civil society groups. Surprised? (…this is just taken from the abstract…I haven’t read it yet!)
