A Study Of The Population Health Assessment Index System For The Chinese Urban Communities

BackgroundHealth used to be thought as freedom from disease. However, with the transition of the biomedical model to the bio-psycho-social-environmental model, the definition of health also changes to the'health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity'. People's conception of health shifts gradually from the negative to the positive, and also from the simply focus on the disease status to the importance of the health determinates and the consequences of poor health. However, at the same time, our current health assessment still focuses on the description of the death or disease information. Therefore, health assessment/surveillance, the basic responsibility of the public health administration, needs a new set of indicators system, which can match the new health definition better, to evaluate the population's health, not only the disease status, but also the determinates of health and the health consequences, including the physical environment, social environment, behavior factors and so on, and to comprehensively understand the characteristics of people's health and the variation trend. Then, the information can help to identify the potential problems of health, guide the policy-making and finally improve people's health.Objectives1. To establish a unified, standardized, and feasible population health assessment framework for the Chinese urban communities.2. To evaluate the population's health of Chaoyang district, Beijing by using the health assessment index system.3. To test the feasibility of the health assessment index system. MethodsA three phase, qualitative and quantitative epidemiological approach is used in this study. First, a framework for the population health assessment framework for the Chinese urban communities is established based on the literature and government documents review, combining with the preliminary analysis of China's existing health condition. Second, a two-round Delphi expert consultation method is used to analyze and screen the indicators in the framework. Third, the experts consensed index system is used to assess the population's health in Chaoyang district, Beijing to find out the current health problems and their potential determinates hope to propose some suggestions to policy-maker and provide valuable information to the health promotion.Results1. Through literature and government documents review, combining with the analysis of China's existing health conditions, a preliminary framework interlinked for the population health assessment is established. The framework consists of three aspects: health determinants, health status and health consequence with 26 measurable indicators.2. A group of 27 experts are chose from 13 provinces, municipalities or autonomous regions in China. The average length of service in public health of the experts was 24.11±6.73 years. The response rates of the two rounds consultations were 96.30% and 88.89%. The average response time of the two rounds were 5.38±4.77 days and 6.91±5.05 days, the t-test shows no statistic significance. The average coefficient of experts'authorities Cr was (0.86±0.05). Kendall's coefficient were 0.207(χR2=182.6, p <0.05) and 0.357(χR2=260.7, p<0.05), the Chi-square test showed the statistic significance. The opinions among experts have been toward consistent from the 1st round to the 2nd round.3. After the two-round consultation, the index system was established, including 3 first-layer indicators (health determinate, health status and health consequences),9 second-layer indicators and 27 third-layer indicators,30 measurable indicators in total. 4. Using the index system to evaluate the population health in Chaoyang district, Beijing the following results are found:At health determinates level, the population in Chaoyang district increases very fast with high quality, however, it demonstrates an aging population structure. The environment resource of the city faces severe challenges, such as resource shortage and pollution. The health risk factors including smoke, alcohol use, and lack of exercise, with high incidence rate. At health status level, the incidence of virus hepatitis and pulmonary tuberculosis have a gently upward trend; mortality is relatively stable, and the main cause of death is chronic diseases; the life expectancy keeps steady growth. At health consequence level, chronic diseases and injury are the main causes of the years of life lost.5. Through the application of the population health assessment index system in Chaoyang district, Beijing there are easily obtainable data for 19 indicators, and relatively easily obtainable data for 6 indicators, accounting for 63.33% and 20.00%, respectly. It implies that the index system has a good feasibility.ConclusionsThe comprehensive literature and government documents review, good representation of the experts, Delphi approach to obtain expert consensus are the advantages of this study. Furthermore, the application of the expert consensed index system to Chaoyang district, Beijing proves the feasibility of this index system. The population health assessment result of Chaoyang district is comprehensive, including health determinates, health status and health consequences. Chinese urban communities'population health assessment index system might be helpful to the public health administrations and policy-makers in China.