What is counted counts

Making social determinants interventions visible

National Centre for Classification in Health

Richard Madden and Nicola Fortune

Insert Partner Logo - Delete if not required

2

WHO Family of Classifications

› International Classification of Diseases – ICD-10

› International Classification of Functioning, Disability and Health – ICF

› International Classification of Health Interventions – ICHI (under development)

Scope of ICHI

• Acute care — medicine, surgery, diagnostics

• Primary care

• Mental health

• Rehabilitation

• Assistance with functioning

• Public health

• Ancillary services

Interventions across all functional sectors of the health system:

What is counted, counts

4

ICHI definition of health intervention

An activity performed for, with or on behalf of a person or a population whose purpose is to improve, assess or modify health, functioning or health conditions

5

ICHI: Three axes

› Target — the entity on which the Action is carried out

› Action — the deed done by an actor to the Target

› Means — the processes and methods by which the Action is carried out

What is done to what target, and how

ICHI does not describe why the intervention is performed (reason), who performs it (provider), or where it is performed (setting)

Multiple use cases for ICHI

1. National applications for ICHI

a) ICHI as a national classification

b) National classification as an extension of ICHI

c) Subset of ICHI as replacement for ICD-9-CM

2. International comparisons

3. Patient safety and quality

4. Universal Health Coverage (WHO)

5. Public health applications

6. Casemix applications

6

7

Public health interventions in ICHI

› Interventions delivered to populations or population sub-groups

› Targeting health behaviours and environmental factors

› Includes campaign-style interventions, e.g., immunisation, screening and mass treatment programs

8

Public health interventions in ICHI

193 public health interventions, e.g.,

› Education about specific health issues or health-related behaviours

› Community engagement interventions to promote healthy eating

› Taxation of tobacco or alcohol

› Surveillance and enforcement of air quality standards

› Laws restricting the sale or use of products with associated health risks

› Environmental decontamination

9

Health behaviour Target categories

Health behaviors

• Alcohol use• Tobacco use• Diet• Physical activity• Illicit drug use• Pharmaceutical use• Sexual behaviours• Hygiene• Oral health behaviours• Breastfeeding• Sun exposure protective

behaviours

• Behaviours related to psychological health and wellbeing

• Social behaviours• Health service use • Immunisation behaviours• Screening behaviours• Road safety behaviours• Household safety behaviours• Workplace safety behaviours • Other safety behaviours• Other specified behaviours

10

Environmental Target categories

Environmental factors (physical, institutional and social/cultural)

• Indoor air quality• Outdoor air quality• Water quality• Land and soil quality• Flora and fauna• Food• Domesticated animals • Natural environment and

human-made changes to environment

• Health services, systems and policies

• Utilities services, systems and policies

• Population• Health professionals• Other professionals• Acquaintances, peers,

colleagues, neighbours and community members

• Societal attitudes• Individual attitudes of health

professionals

11

Example public health interventions

› Education concerning sun protection, delivered through the media (MAO PA PH)

Target: Sun exposure protective behaviors Action: Education Means: Media services, systems and policies

› Surveillance and enforcement of air quality standards (KBL XA PB)

Target: Outdoor air quality Action: Environmental standards and surveillance Means: Civil protection services, systems and policies

12

E.g., Polio immunisation campaign

› KBB VB PJ — Population immunization/vaccination

Target: PopulationAction: Population immunization/vaccinationMeans: Health services, systems and policies

Code also:

› FIB HM AE — Other immunization, not otherwise specified

› Z24.0 — ICD code ‘Need for immunization against poliomyelitis’

› Relevant ATC code

13

Primary care interventions in ICHI

› Current focus on expanding ICHI to ensure comprehensive coverage of interventions delivered to individuals, groups and communities in a primary care context:

› Health promotion

› Disease prevention

› Diagnosis

› Treatment

› Chronic disease management

› Routine healthcare services (e.g., antenatal care)

› Rehabilitation

› Palliative care

› Community development

14

Prevention and promotion

› Sets of interventions that target health behaviours, e.g.,

- Assessment of tobacco use

- Prescription for tobacco use

- Education about tobacco use

- Counselling about tobacco use

› Immunisation interventions

- Oral immunisation

- Other immunisation

Note: use ICD code to record diseaseand ATC code to record the vaccine

15

ICHI and social determinants

How is ICHI relevant to social determinants of health?

1. Interventions that target health behaviours and environmental factors associated with social disadvantage, e.g.,

- Alcohol and tobacco use, diet, sexual behaviours

- Air quality, water quality, food, social and attitudinal environment

2. Delivery of interventions to socially disadvantaged individuals and communities, e.g.,

- Use of ICHI alongside socioeconomic or geographic information to see who is receiving interventions, in relation to health needs

16

WHO’s Universal Health Coverage

› WHO’s Universal Health Coverage (UHC) initiative aims to ensure that all people obtain the health services they need without suffering financial hardship when paying for them

› ICHI will provide a basis for defining and reporting interventions to monitor progress in achieving UHC

17

Next steps …

› Review and test public health interventions in ICHIE.g., using ICHI to record interventions delivered, or mapping records/reports of interventions to ICHI

› Expand contentEnsure comprehensive coverage of interventions relevant to public health and primary care

› Explore use casesIdentify information applications for ICHIE.g., describing and reporting public health / primary care interventions delivered; analysis with measures of social disadvantage to look at equitability

18

Seeking your input

› Comments on the draft version of ICHI

› Field-testing, e.g.

recording interventions delivered using ICHI, or

mapping past records/reports of interventions delivered to ICHI

Input sought from health practitioners and researchers, to ensure

that ICHI is relevant and useful internationally

19

Download ICHI Alpha2

Contact us:

fhsncchadmin@sydney.edu.au

You can download the Alpha2 version of ICHI from the website of the National Centre for Classification in Health:

http://sydney.edu.au/health-sciences/ncch/about.shtml

Thank you