Academic journal article Bulletin of the World Health Organization

Health Information Systems: The Foundations of Public Health

Academic journal article Bulletin of the World Health Organization

Health Information Systems: The Foundations of Public Health

Article excerpt

Measurement and public health

"Nothing exists until it is measured" the physicist Niels Bohr famously stated in 1930. He was referring to quantum mechanics, but the idea is also relevant to public health. The definition of public health suggested by Beaglehole et al. as "collective action for sustained population-wide health improvement" presupposes the ability to measure and monitor the health of populations (1). Epidemiology, demography and biostatistics are the key disciplines of public health.

The work of John Snow during the cholera epidemics that ravaged London in the mid-1800s is an early example of an epidemiological investigation (2). Snow's groundbreaking work was made possible by the registers of births and deaths maintained by local authorities in every English parish from the early 1880s. Without information on numbers of deaths from cholera and the street address of each victim, Snow's mapping of mortality in relation to the siting of water pumps would not have been possible. Thanks to the almost universal coverage of death registration in countries such as Denmark, England and Wales, the Netherlands, Norway and Sweden, the study of changing patterns of death became possible during the nineteenth century and led directly to the development of the endeavour of public health (see, for example, 3-5).

A century and a half on, comprehensive registration of deaths and their causes is undertaken in some 78 countries covering around one-third of the world's population. The countries with comprehensive registers are generally the more developed countries in the Americas, parts of Asia and Europe. In low-income countries, efforts to better document and count basic demographic events have increased over the past two decades. Some 150 countries now produce estimates of child mortality based on empirical data collected in the previous 5 years. Advances in information technology enable large volumes of data to be processed and analysed in ever shorter periods of time. Population-based surveys have become the predominant mode for collection of data on health and progress is being tracked using indicators measurable through surveys. Examples include the 30 cluster-sample surveys of the Expanded Programme on Immunization (EPI) and the family planning and maternal and child health-oriented Demographic and Health Surveys (DHS).

Nonetheless, there is much that remains unknown, especially about adult mortality, causes of death and the burden of suffering associated with non-fatal health outcomes.

A basic prerequisite of any health programme is its ability to state unequivocally how many deaths it will avert and what proportion of the global burden of disease it will address. To fill missing data gaps, there has been a proliferation of model-based approaches to generating global, regional and national estimates of mortality, morbidity and burden of disease. Some of these models are relatively simple, others are complex and based on debatable assumptions and underlying philosophical frameworks. The complexity of such models often masks a stark reality: most people are born and die uncounted, the reasons for their deaths unknown.

Health information systems

Counting deaths is one component of the health information system, an "integrated effort to collect, process, report and use health information and knowledge to influence policy-making, programme action and research" (6). The health information system is heavily biased towards quantitative data--descriptions of health status and mortality of populations over time, analysis of causation of health problems, quantification of associations between health outcomes and risk or protective factors, and assessment of the effectiveness of public health interventions. Thus it is clearly distinguishable from health-care information for professionals or more general health-related knowledge (see, for example, 7).

The word "system" implies a connected whole or organized process. …

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