Population Health Data Science, Complexity, and
Health Equity: Reflections from a Local Health Official
Tom´as J. Arag´on, MD...
Overview
1 Introduction and background
2 Population health data science
3 Transforming complex social systems
4 Tackling p...
Introduction and background
Causes of Premature Deaths in Men & Women
San Francisco, 2003–2004 (How do we explain health i...
Introduction and background
Some definitions
Health (WHO 1946)
Health is a state of complete physical, mental and social we...
Introduction and background
Health includes the 8 dimensions of wellness
Source: http://www.samhsa.gov/wellness-initiative...
Population health data science
More definitions
Population Health (TJA 2015)
A systemsa framework for studying and improvin...
Population health data science
Population Health Data Science
Describe—Discover—Predict—Advise
Tom´as J. Arag´on, MD, DrPH...
Transforming complex social systems
Complexity and why it matters
What is a complex adaptive system?
1 A population of div...
Transforming complex social systems
Conceptualizing systems (selected approaches)
Causal loop diagrams
Agent-based models
...
Transforming complex social systems
Creating causal loop diagram (immunization example)
Incidence of Immunity
Inducing Inf...
Transforming complex social systems
Causal loop diagram of childhood immunization system
Number of
Vaccinations
Incidence ...
Transforming complex social systems
Networking modeling of epidemics using R
Source: http://www.reed.edu/reed_magazine/mar...
Transforming complex social systems
Public health tools for improving population health
Source:Tom´as J. Arag´on, MD, DrPH...
Transforming complex social systems
Population health tools for improving population health
Source:Tom´as J. Arag´on, MD, ...
Transforming complex social systems
Public health tools for improving population health
Source:Tom´as J. Arag´on, MD, DrPH...
Transforming complex social systems
Collective impact fulfills five criteria1
1 Common Agenda: All participants have a share...
Transforming complex social systems
What is Health Equity X (HEX) model
HEXa,b
is used for planning and managing
efforts to...
Transforming complex social systems
Public health tools for improving population health
Source:Tom´as J. Arag´on, MD, DrPH...
Transforming complex social systems
Public health tools for improving population health
Source:Tom´as J. Arag´on, MD, DrPH...
Tackling population health inequities
Causes of Premature Deaths in Men & Women
San Francisco, 2003–2004 (How do we explai...
Tackling population health inequities
Neural connections in early childhood
Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Comp...
Tackling population health inequities
Executive function and self-regulation
Depends on working memory, mental flexibility,...
Tackling population health inequities
Adverse Childhood Experiences (ACEs) Pyramid
Source: Center for Youth Wellness (http...
Tackling population health inequities
Trauma-informed, Intergenerational Life Course Model
The effects of trauma (toxic str...
Tackling population health inequities
Toxic Stress! Childhood Roots of Adult Health Inequities
Re-conceptualizing Early Ch...
Tackling population health inequities
Health Equity X (HEX) model
1 People (mental models, belief
systems, cultural norms,...
Tackling population health inequities
Ensuring the childhood roots of health equity
Trauma-Informed Public Health Approach...
Tackling population health inequities
Summary
1 Population health data science
Start backwards (understand individual and ...
Tackling population health inequities
The Raising of America (Documentary)
Early Childhood and the Future of Our Nation
ht...
Tackling population health inequities
Selected Bibliography
1 Trying Hard Is Not Good Enough: How to Produce Measurable Im...
of 30

Population Health Data Science, Complexity, and Health Equity: Reflections from a Local Health Official

Annual Population Health Sciences Colloquium at the Stanford Center for Population Health Sciences on October 26, 2015. This one-day program will showcase population health sciences research from the Stanford community and experts around the world. This one-day program will showcase population health sciences research from the Stanford community and experts around the world. The PHS Initiative aims to bring together basic, translational and clinical scientists, along with researchers from disciplines across the entire University, to provide resources and facilitate collaborations focused on population-level questions, data and approaches. We have an exciting full-day session with keynote speakers - Lloyd Minor, Dean of the Stanford School of Medicine; Muin Khoury, Associate Director of Epidemiology and Genomics Research Program at NCI; and Tomas Aragon, Director of Population Health Division at the San Francisco Department of Public Health - and some time to do the vital work of growing our center.
Published on: Mar 4, 2016
Published in: Health & Medicine      
Source: www.slideshare.net


Transcripts - Population Health Data Science, Complexity, and Health Equity: Reflections from a Local Health Official

  • 1. Population Health Data Science, Complexity, and Health Equity: Reflections from a Local Health Official Tom´as J. Arag´on, MD, DrPH Health Officer, City and County of San Francisco Director, Population Health Division (PHD) San Francisco Department of Public Health Adjunct Faculty, UC Berkeley School of Public Health Keynote Address: Stanford Center for Population Health Sciences Annual PHS Colloquium an October 26, 2015 Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Complexity, & Health Equity October 26, 2015 1 / 30
  • 2. Overview 1 Introduction and background 2 Population health data science 3 Transforming complex social systems 4 Tackling population health inequities Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Complexity, & Health Equity October 26, 2015 2 / 30
  • 3. Introduction and background Causes of Premature Deaths in Men & Women San Francisco, 2003–2004 (How do we explain health inequities and resilience?) Age-adjusted Expected Years of Life Lost (eYLL): Male (left), Female (right); Black (colored red), Latino, × Asian/PI, + White; Source: Arag´on TJ, et al. PubMed ID: 18402698 Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Complexity, & Health Equity October 26, 2015 3 / 30
  • 4. Introduction and background Some definitions Health (WHO 1946) Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Public Health (IOM 1988) Public health is what we, as a society, do collectively to assure the conditions in which people can be healthy. Population Health (TJA 2015) A systemsa framework for studying and improving the health of populations through collective action and learning. a Complexity or complex adaptive systems Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Complexity, & Health Equity October 26, 2015 4 / 30
  • 5. Introduction and background Health includes the 8 dimensions of wellness Source: http://www.samhsa.gov/wellness-initiative Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Complexity, & Health Equity October 26, 2015 5 / 30
  • 6. Population health data science More definitions Population Health (TJA 2015) A systemsa framework for studying and improving the health of populations through collective action and learning. a Complexity or complex adaptive systems Data science Data science is the art and science of transforming data into actionable knowledge. Population health data science (TJA 2015) Population health data science is the art and science of transforming health relevant data into actionable knowledge. Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Complexity, & Health Equity October 26, 2015 6 / 30
  • 7. Population health data science Population Health Data Science Describe—Discover—Predict—Advise Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Complexity, & Health Equity October 26, 2015 7 / 30
  • 8. Transforming complex social systems Complexity and why it matters What is a complex adaptive system? 1 A population of diverse agents, all of which are 2 connected, with behaviors and actions that are 3 interdependent, and that exhibit 4 adaptation and learning. Why do we care? Complex systems . . . are ambiguous, deceptive, unpredictable are difficult to direct and control (adaptation, resistance) can self-organize and locally optimize (silos, tribes) can evolve along divergent pathways (pathway dependence) can produce phase transitions (“tipping points”) (e.g., epidemics) can produce emergent phenomenon (e.g., herd immunity) Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Complexity, & Health Equity October 26, 2015 8 / 30
  • 9. Transforming complex social systems Conceptualizing systems (selected approaches) Causal loop diagrams Agent-based models Social network models Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Complexity, & Health Equity October 26, 2015 9 / 30
  • 10. Transforming complex social systems Creating causal loop diagram (immunization example) Incidence of Immunity Inducing Infection neg Community Immunity posBalancing feedback loop Delay Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Complexity, & Health Equity October 26, 2015 10 / 30
  • 11. Transforming complex social systems Causal loop diagram of childhood immunization system Number of Vaccinations Incidence of Vaccine Preventable Diseases neg pos Number of Vaccine Adverse Effects pos Complexity of the Immunization Schedule pos Demand for Vaccinations pos Parental Concerns About Vaccine Adverse Effects pos pos neg Community Immunity pos pos Parental and Community Concerns About Vaccine Preventable Diseases pos pos Providers Adhering to Recommended Immunization Schedule Delay Development, Approval, and Promulgation of New Vaccines pos pos pos pos pos pos Logistical Burden on Health Care System pos pos Demand for Reduced, Alternative Schedules pos neg pos Vaccine Advisory Boards Vaccine Manufacturers Professional Associations Academic Researchers Public Health Authorities Patient Advocacy groups Source: TJA Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Complexity, & Health Equity October 26, 2015 11 / 30
  • 12. Transforming complex social systems Networking modeling of epidemics using R Source: http://www.reed.edu/reed_magazine/march2012/articles/features/ morris/morris.html Network Modeling for Epidemics (Dr. Martina Morris, University of Washington): http://statnet.csde.washington.edu/EpiModel/nme/index.html Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Complexity, & Health Equity October 26, 2015 12 / 30
  • 13. Transforming complex social systems Public health tools for improving population health Source:Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Complexity, & Health Equity October 26, 2015 13 / 30
  • 14. Transforming complex social systems Population health tools for improving population health Source:Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Complexity, & Health Equity October 26, 2015 14 / 30
  • 15. Transforming complex social systems Public health tools for improving population health Source:Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Complexity, & Health Equity October 26, 2015 15 / 30
  • 16. Transforming complex social systems Collective impact fulfills five criteria1 1 Common Agenda: All participants have a shared vision for change including a common understanding of the problem and a joint approach to solving it. 2 Shared Measurement: Collecting data and measuring results consistently ensures efforts remain aligned and participants hold each other accountable. 3 Mutually Reinforcing Activities: Participant activities must be differentiated while still being coordinated through a mutually reinforcing plan of action. 4 Continuous Communication and Improvement: Consistent and open communication is needed across the many players to build trust, assure mutual objectives, and continuously improve. 5 Backbone Organization: Collective impact requires a separate organization(s) with staff to serve as the backbone for the entire initiative and coordinate participating organizations and agencies. 1 Adapted from http://www.fsg.org Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Complexity, & Health Equity October 26, 2015 16 / 30
  • 17. Transforming complex social systems What is Health Equity X (HEX) model HEXa,b is used for planning and managing efforts to achieve results for challenges and opportunities embedded in complex social systems, including for quality improvement, health equity, and collective impact. 1 People (mental models, belief systems, cultural norms, “isms”) 2 Policy (social, organizational) 3 Place (neighborhood, school, work, open space) 4 Program (program, agency, or service system) 5 Provider (teacher, doctor, priest) 6 Patron (patient, client, customer) Patron Program People Provider Place Policy Health Equity a HEX model was inspired by BARHII (http://www.barhii.org) and Dr. Tony Iton (See Pubmed ID: 25423053) b A hexateron is a geometric object with 6 vertices, 15 edges, 20 triangle faces, 15 tetrahedral cells Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Complexity, & Health Equity October 26, 2015 17 / 30
  • 18. Transforming complex social systems Public health tools for improving population health Source:Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Complexity, & Health Equity October 26, 2015 18 / 30
  • 19. Transforming complex social systems Public health tools for improving population health Source:Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Complexity, & Health Equity October 26, 2015 19 / 30
  • 20. Tackling population health inequities Causes of Premature Deaths in Men & Women San Francisco, 2003–2004 (How do we explain health inequities and resilience?) Age-adjusted Expected Years of Life Lost (eYLL): Male (left), Female (right); Black (colored red), Latino, × Asian/PI, + White; Source: Arag´on TJ, et al. PubMed ID: 18402698 Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Complexity, & Health Equity October 26, 2015 20 / 30
  • 21. Tackling population health inequities Neural connections in early childhood Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Complexity, & Health Equity October 26, 2015 21 / 30
  • 22. Tackling population health inequities Executive function and self-regulation Depends on working memory, mental flexibility, self-control Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Complexity, & Health Equity October 26, 2015 22 / 30
  • 23. Tackling population health inequities Adverse Childhood Experiences (ACEs) Pyramid Source: Center for Youth Wellness (http://www.centerforyouthwellness.org) Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Complexity, & Health Equity October 26, 2015 23 / 30
  • 24. Tackling population health inequities Trauma-informed, Intergenerational Life Course Model The effects of trauma (toxic stress) are transmitted from one generation to the next A newborn child rises to better health over his or her life course by multilevel, interdependent forces that promote safe, nurturing relationships for healthy neurodevelopment, prevent toxic stress, protect against unavoidable toxic stress, and prepare children to be resilient. Children ages 0 to 5 are totally dependent on adult caregivers for the 4Ps, and are most vulnerable to the lifelong effects of toxic stress that alter brain, body, and behavior leading to health inequities. Source: TJA 2015 Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Complexity, & Health Equity October 26, 2015 24 / 30
  • 25. Tackling population health inequities Toxic Stress! Childhood Roots of Adult Health Inequities Re-conceptualizing Early Childhood Policies and Programs to Strengthen Lifelong Health Source: Center for the Developing Child at http://developingchild.harvard.edu/ Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Complexity, & Health Equity October 26, 2015 25 / 30
  • 26. Tackling population health inequities Health Equity X (HEX) model 1 People (mental models, belief systems, cultural norms, “isms”) 2 Policy (social, organizational) 3 Place (home, neighborhood, schools, work, parks) 4 Program (programs, agencies, or service systems) 5 Provider (caregiver, teacher, doctor, priest) 6 Parents (clients, customers, patients) Parents Program People Provider Place Policy Child (age 0-5) a HEX model was inspired by BARHII (http://www.barhii.org) and Dr. Tony Iton (See Pubmed ID: 25423053) b A hexateron is a geometric object with 6 vertices, 15 edges, 20 triangle faces, 15 tetrahedral cells Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Complexity, & Health Equity October 26, 2015 26 / 30
  • 27. Tackling population health inequities Ensuring the childhood roots of health equity Trauma-Informed Public Health Approach for Adults and Children 1 Prevent (toxic stress) 2 Protect (from toxic stress) 3 Prepare (by building resiliency skills) 4 Promote (healthy/enrichment opportunities) Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Complexity, & Health Equity October 26, 2015 27 / 30
  • 28. Tackling population health inequities Summary 1 Population health data science Start backwards (understand individual and group decision-making!) Focus on actionable knowledge (Adivse–Predict–Discover–Describe) Focus on human-centered design (“precision public health”) 2 Transforming complex social systems Understand complex adaptive systems (requires humility) Transform self, teams, organizations, communities (in that order: requires continuous improvement, taking risks, learning from failures) 3 Tackling population health inequities Inter-generational transmission of trauma Toxic stress alters brain, body, and behavior Life course of trauma, racism, and discrimination 4Ps of public health: prevent, protect, prepare, promote 6Ps of HEX model: people, policy, place, program, provider, parents Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Complexity, & Health Equity October 26, 2015 28 / 30
  • 29. Tackling population health inequities The Raising of America (Documentary) Early Childhood and the Future of Our Nation http://www.raisingofamerica.org/ Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Complexity, & Health Equity October 26, 2015 29 / 30
  • 30. Tackling population health inequities Selected Bibliography 1 Trying Hard Is Not Good Enough: How to Produce Measurable Improvement of Customers and Communities (2009), by Mark Friedman (http://amzn.com/1439237867). Covers practical and tested framework for implementing and improving collective impact projects. 2 The Practice of Adaptive Leadership: Tools and Tactics for Changing Your Organization and the World (2009), by Ronald A. Heifetz et al. (http://amzn.com/1422105768). Covers practical, powerful, and inspiring approach to leading change in complex environments. 3 Complex Adaptive Systems: An Introduction to Computational Models of Social Life (2007), by John H. Miller, et al. (http://amzn.com/0691127026). 4 Network Modeling for Epidemics (2015), by Martina Morris, et al. (http://statnet.csde.washington.edu/EpiModel/nme/index.html). Online resource for learning how to use R for modeling social networks and epidemics. 5 Population Health Data Science with R (2015, manuscript in progress), by Tom´as J. Arag´on. (https://leanpub.com/u/medepi). Covers how to use R for population health analyses. Also visit http://medepi.com. Tom´as J. Arag´on, MD, DrPH (SFDPH) PHDS, Complexity, & Health Equity October 26, 2015 30 / 30

Related Documents