Health Forecasting at UCLA

June 2011


In This Edition:

 

New Twitter Account

 

Forecast 2020: Diabetes Prevalence in California

 

Health Impact Assessments: An Informative Tool to Maximize Public Benefits

             

Civic Engagement & Improving Health-related Outcomes

 

The Effect of Air Quality in The California Endowment Healthy Communities

 

Conference Presentations

 

New Team Members

 

About Us

 

Current Projects

 

 

Download Newsletter


Health Forecasting Quarterly Newsletter •  June 2011

Making informed policy and programmatic public health decisions today means preparing and planning for what the population health landscape will look like tomorrow. Health Forecasting examines the long-term impact of public health program interventions and policies. 

 

The Health Forecasting Tool provides government and elected officials as well as grant writers and community health advocates with data and analysis to support their efforts to anticipate, prepare, and plan for healthier communities. Our model accounts for the changing population shifts and includes some of today’s most salient public health issues.

 

The tool allows users to generate customizable data and graphs to assess long-term public health outcomes associated with changes in population, risk factors, and interventions.

 

We invite you to learn more about the Health Forecasting Tool:

www.health-forecasting.org


New Twitter Account

Health Forecasting has joined the public health Twitterverse.

Follow us online on Twitter and join the conversation to help build healthier communities:

 

 

Twitter Profile Name: HealthForecast

 

 

Forecast 2020: Diabetes Prevalence in California

Health Forecasting’s article “Forecasting Diabetes Prevalence in California: A Microsimulation” has been published in the July 2011 issue of the journal Preventing Chronic Disease.  The study examines whether reducing the prevalence of diabetes by 2020 can be achieved by modifying levels of obesity and physical activity in the California population.

 

Methods

The microsimulation model takes into account California’s changing ethnic makeup, aging population, and growing proportion of high-risk demographic groups. These predictors are important quantifiers for accurate prediction of health trends, particularly in such a dynamic state as California.

 

The following four scenarios included in the microsimulation model explore the feasibility of diabetes prevention:

 

Scenario 1: Baseline

                      No further increase in average BMI for cohorts entering adolescence after 2003

 

Scenario 2: Childhood BMI Decrease

                      Gradual BMI decrease for children entering adolescence after 2010

 

Scenario 3: Childhood and Adult BMI Decrease

Adds to the assumption of Scenario 2 and includes a gradual BMI decrease for people aged 13 to 65

 

Scenario 4: BMI Decrease & Physical Activity Increase

                      Builds upon Scenario 3 by eliminating racial/ethnic disparities in physical activity

 

Findings

The model shows that the diabetes rate will increase, but at varying degrees. For the next ten years, behavioral risk factor modifications are more likely to affect obesity prevalence, life expectancy, and the obesity prevalence among diabetic patients, rather than to alter the diabetes prevalence in the general population. The model results suggest setting more specific goals for reducing the health burden of diabetes, such as reducing obesity-related diabetes complications, which could be more feasible and easier to evaluate than the omnibus goal of lowering prevalence by 2020.

 

Diabetes data, analysis and forecasts are available online in the Get Started section: California HP2020-Diabetes (PCD)

 

Health Impact Assessments: An Informative Tool to Maximize Public Health Benefits

Public health officials, researchers and advocates are increasingly looking beyond the traditional boundaries of public health for opportunities to improve the public's health, especially to address the growing burden of chronic diseases.  This is a return to the roots of public health, a field that in its formative years in the late 19th century, before the rise of modern medicine, worked closely with city planners, civil engineers, social reformers and others to improve the underlying living and working conditions that shaped people's health.  Today, public health experts often refer to these conditions as the "upstream determinants of health," which include everything from the design of our cities and transportation systems to agriculture, economic and education policies.

 

One tool that can help decision-makers and the public better understand these upstream determinants of health and provide concrete guidance on how to maximize potential health benefits and minimize potential harm is health impact assessment (HIA).  Like health forecasting, HIA is an informational tool meant to help policy-makers make more informed decisions. 

 

HIA Basics

The starting point of any HIA is a proposed policy or project, usually outside the purview of health care and public health. Available evidence on the potential health effects of the policy or project is assembled then analyzed to assess the magnitude, likelihood and distribution of potential health effects. The HIA concludes with a set of recommendations to modify and supplement the proposal in a way that best benefits the public's health.  Of course, policy-makers are confronted by many, often competing goals and interest groups, and difficult trade-offs.  A health impact assessment is another tool for decision-makers to assure that the public health implications of decisions are recognized and understood early in the policy-making process.

 

Real World Applications

There has been a profusion of HIAs conducted in the U.S.

in the past couple of years.  In Oregon, a public health advocacy group is working with state and local officials, schools, and agricultural researchers to assess the potential health effects of proposed "farm-to-school" legislation and identify changes in the legislation that would maximize potential health benefits in a way that maintains benefits for farmers and takes into account the severe resources limits faced by schools' food service programs. 

In Los Angeles, a coalition of public health advocates, universities and public agencies are working on a health impact assessment of new zoning rules that would limit certain kinds of fast food sales and advertising.  In San Francisco the public health department is assessing the health effects of "congestion pricing" to limit automobile traffic in certain high congestion areas during certain times.   Other HIAs are being conducted around the country on issues ranging from urban redevelopment projects to light rail and subway systems to mining and oil drilling. 

 

 

For more information about HIA's: 

 

Civic Engagement & Improving Health-related Outcomes

The California Endowment's Building Healthy Communities Initiative is a 10 year project aimed at improving health and safety conditions for 14 communities in the state of California through behavioral, environmental, policy, and system changes. The California Endowment is committed to supporting and developing civic participation in these communities to empower residents to collectively address social and public health issues. Several studies have demonstrated a relationship between measures of civic engagement or participation and health and safety outcomes, including crime, self-reported health, health behaviors, mental health, and mortality.

 

In the U.S., civic engagement has generally been declining and this decline has been attributed to demographic, economic, social, and other factors.  In partnership with the California Endowment, UCLA Health Forecasting will estimate current civic engagement, add scenarios affecting the population, and health-related outcomes for the 14 communities. This research will inform current and future efforts.

 

As part of this project, the UCLA Health Forecasting is conducting research to assess the relationship between various indicators of civic engagement and socio-demographic factors in small California urban areas. Civic measures to be assessed include:

  • the number of civil and social organizations per person;
  • high or positive civil and social membership determined from the number of reported affiliations per person;
  • voter registration; and
  • voter turnout in presidential and general elections. 

 

 

The Effect of Air Quality & Health in The California Endowment Healthy Communities

Poor air quality is a public health concern affecting many Americans. Studies have shown links between air pollution and numerous chronic conditions including respiratory conditions, coronary heart disease, cancer, lung disease, and increased risk of mortality. Understanding the consequences of poor air quality and the resulting adverse health consequences is a key component in developing effective public health policy.

 

Health Forecasting recently added estimates of future air quality and related impact for the 14 communities in The California Endowment's Building Healthy Communities Initiative using current population demographics and historical air quality trends. Although air quality in these areas has improved, the American Lung Association's 2011 State of the Air report define these figures as failing to meet adequate standards. Figure 1 illustrates the levels of fine particulate matter of 2.5 micrometers or less (PM2.5). The figures are significantly higher than levels considered non-hazardous.

 

The Health Forecasting Tool focuses upon the impact of air quality on various health outcomes and can be aggregated by Census year, gender, ethnicity, and age.

 

The results of this research can be used to:

  1. prioritize efforts and to work towards reducing inequalities between places;
  2. set goals based on the anticipated quantified impact; and
  3. inform programs and policies based on the expected burden.

Data and graphs for this study available online at the Health Forecasting Tool:

TCE Places (May 2011)

 

Conference Presentations

Dr. Lu Shi attended the Westlake Forum, "Healthcare Reform in China and the US:  Similarities, Differences and Challenges", April 10-12th at Emory University. He authored a poster abstract entitled "Preventing Smoking Initiation vs. Enhancing Smoking Cessation: A Comparative Effectiveness Study." The study examines the effectiveness of smoking interventions within a county population. The findings revealed that halving smoking initiation among young people achieves lower smoking prevalence than doubling the reach of a smoking cessation program.

 

Dr. Jeroen van Meijgaard attended the International Health Impact Assessment Conference, "In Crisis Times, Healthier Ways", in Granada, Spain on April 14th and 15th. He presented his work "Simulating Changes in the Retail Food Environment, Health and Economic Outcomes, Using Sensitivity Analysis"and "Comprehensive Modelling to Assess the Health Impact of Proposed Policies and Programs: The Impact of U.S. Smoking Trends on Cause Specific Mortality". Both presentations can be found on the conference website, Health Impact Assessment Conference.

 

Donglan Zhang participated in the 2011 Institute on Systems Science and Health (ISSH) at the University of Pittsburgh May 22nd-27th. The special training centered on selected systems science methodologies used to study behavioral and social dimensions of public health. Donglang's training focused on agent-based modeling methodology.

 

The abstract, "Long-term Implications of Quitline Reach on Smoking Prevalence in Arkansas" written by researcher Lu Shi has been accepted for oral presentation at the 139th Annual Meeting of the American Public Health Association in Washington, DC. Colleague's Donglan Zhang and Kara E. MacLeod's abstract "Association of Neighborhood Economic Status with Adults' Physical Inactivity in Los Angeles County" was also accepted for poster presentation.

 

New Team Members

Rebecca Pizzitola, research associate, is the newest addition to the UCLA Health Forecasting team. Prior to coming to UCLA, she diverged from a premedical track at Cornell to attain her MPH from SUNY Albany in New York. Since, she has analyzed health policy in order to find and promote strategies that improve the quality of health care and cover more of the uninsured for the Rockefeller Institute of Government, the New York State Laborers Union and Insure the Uninsured Project. Rebecca will use her experience to further inform health policy by facilitating Health Forecasting research efforts that identify clinical and public health interventions that have a significant impact on long-term health outcomes.

 

Peggy J. Vadillo joined the Health Forecasting team as a research associate. She works with the UniHealth Foundation and partner hospitals to assess the impact of policy interventions within hospitals catchment areas. She is also Health Forecasting's communications specialist and manages the quarterly newsletter. As a specialist she develops and implements dissemination strategies to provide salient, evidence-based research to drive informed public health policy decisions. Peggy completed her bachelor's degree in political science and advertising from the University of Southern California (USC). Following graduation she received a health policy fellowship at the National Association of Latino Elected and Appointed Officials. She received her master's degree in public policy from the School of Policy, Planning, and Development at USC, where she specialized in strategic communication of policy and program evaluation.

 



 

About Us

Health Forecasting is based at the UCLA School of Public Health, and is a collaborative effort with the California Department of Public Health and the Los Angeles County Department of Public Health.

 


Current Projects

 

The California Endowment

Expanding the capabilities of the UCLA Health Forecasting Tool by incorporating education and income, two critical social determinants of health, and focusing on interventions relevant to underserved individuals and communities in California.

 

 

 

National Institute of Environmental Health Sciences

Examining drivers of health and longevity among Latinos in California and understanding the effects of interventions focusing on diabetes and cardiovascular disease for this population. 

 

 

 

Robert Wood Johnson Foundation

Incorporating additional risk factors (i.e. smoking) and disease outcomes (i.e. lung cancer) into the forecasting model and applying the model to other states, beginning with Arkansas and Wisconsin.

 

 

 

UniHealth Foundation

Supporting local not-for-profit hospitals in assessing current and future characteristics of the populations they serve and identifying long-term planning needs of local communities.  Providing information on future health and health disparities among subpopulations in the absence of additional effective health promotion and disease prevention efforts.



  Evidence-based model to support advocacy of public health, research, and programs