The principles and practice of assessing population health on a routine and comprehensive basis: a case study

Begg, Stephen John (2012). The principles and practice of assessing population health on a routine and comprehensive basis: a case study PhD Thesis, School of Population Health, The University of Queensland.

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Author Begg, Stephen John
Thesis Title The principles and practice of assessing population health on a routine and comprehensive basis: a case study
School, Centre or Institute School of Population Health
Institution The University of Queensland
Publication date 2012-05
Thesis type PhD Thesis
Open Access Status Other
Supervisor Alan D. Lopez
Theo Vos
Jan Barendregt
Total pages 178
Total colour pages 20
Total black and white pages 158
Language eng
Subjects 1117 Public Health and Health Services
1402 Applied Economics
Formatted abstract
The ‘burden of disease’ methodology introduced by Murray and Lopez in the early 1990s represents a useful platform from which to develop insights into contemporary issues confronting health systems. However, it is often regarded as having limited value beyond what is generally accepted as the domain of public health. The central argument developed here is that while such an impression with respect to the underlying conceptual framework is largely unfounded, a substantial reinterpretation of Murray and Lopez’s original contributions may be required before this possibility achieves more general acceptance. Underlying this thesis is the proposition that with a new model of implementation, a number of practical impediments—which in the past have prevented the methods from being employed for other than a limited range of applications—can be overcome.

The setting in which to test this hypothesis presented itself in the form of a project undertaken by the University of Queensland in collaboration with the Australian Institute of Health and Welfare (AIHW). Commissioned by the Australian Government Department of Health and Ageing (DOHA) in early 2003 this project had as one of its objectives facilitating the routine use of the framework by government agencies such as AIHW and state and territory health departments. As such, simple program logic principles were adopted to assess the characteristics of an alternative implementation model with respect to both its range of outputs compared to what might be expected and its intended outcomes more broadly with respect to using the proposed model on a routine basis.

The main findings are presented in four parts. Part I comprises a critical evaluation of existing tools and methods, or inputs, before proposing alternative tools and workflows that make the underlying conceptual framework more internally consistent, efficient and flexible in practice. Parts II and III comprise a portfolio of four papers, or outputs, that serve as important links between the proposed model and the intended outcome by seeking to address several areas of contemporary policy concern. The final part is a commentary on the success or otherwise of the case study with respect to government use of the proposed model on a routine basis.

The key conclusion to draw from this thesis is that, with respect to outputs, the proposed model allowed for a much greater range of analyses than was attempted in the first ‘burden of disease study’ in Australia. The specific areas where these benefits were observed included i the ability disaggregate the primary results to a flexible range of geographic areas, the ability to fore- and back-cast these results while preserving internal consistency between parameters, the ability to generate a complete set of alternative results for various groupings of Australia’s Indigenous populations, and the ability to account for dependent and independent comorbidity in disability calculations. In addition, the model extended the range of secondary analyses regarded as feasible to areas not previously associated with ‘burden of disease’, such as health expenditure projections and causal decomposition analyses of health-adjusted life expectancy.

With respect to outcomes however, the conclusions are more circumspect. Certainly, the analysis demonstrated that three state governments successfully implemented the model on at least one occasion each to update the original case study outputs with more recent data. A delay in the release of critical data was the primary factor preventing more extensive use in these settings. Nevertheless, a more coordinated adoption of the model at a national level was not achieved in the five years since its development, despite efforts by Australia’s peak population health information advisory committee to facilitate this outcome. While there is emerging evidence of renewed interest in national forums to make further use of the Murray and Lopez framework in Australia, it is too early to predict what role design considerations will play in these developments.
Keyword Descriptive epidemiology
Burden of disease
Population health
Health economics

Document type: Thesis
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Created: Tue, 18 Sep 2012, 21:41:44 EST by Dr Stephen Begg on behalf of Scholarly Communication and Digitisation Service