Date of Award
12-1-1989
Document Type
Dissertation
Degree Name
Doctor of Education
Department
Center for the Advancement of Education
Advisor
Ronald A. Newell
Committee Member
Philip L. Woolf
Committee Member
Philip H. DeTurk
Keywords
assessment, attributable mortality, behavioral risk factors, chronic diseases, community, computer model, consensus, data, death, diabetes mellitus, disease prevention, diseases of the heart, epidemiology, health planning, indicators, interventions, malignant neoplasms, management teams, mortality rates, outcomes, population, prevalence, procedures, public health, relative risk, risk factor assessment, simulation, statewide use, Virginia, years of potential life lost
Abstract
The traditional concerns of public health have been the promotion of health, the prevention of disease, and the prevention of premature death. As death from communicable diseases and conditions of pregnancy and early infancy decrease, public health interests are being expanded toward the prevention of premature death from chronic diseases.
Mortality rates were the most common indicators used to describe the burden of chronic disease problems in the community. Mortality rates are based on the number of incidences per 100,000 population. A relatively newer indicator is called Years of Potential Life Lost. Years of Potential Life Lost represent the number of years of life lost when a death occurs before age sixty-five. Each death occurring before age sixty-five is ·a premature death. Even though the descriptive power of Years of Potential Life Lost was known, it was not widely used. The tedium of calculating Years of Potential Life Lost and the lack of general knowledge about the availability of district data to calculate Years of Potential Life Lost contributed greatly to the lack of use of this valuable indicator.
The purpose of this MARP was to describe the scope and magnitude of chronic disease problems in a community using Years of Potential Life Lost as an indicator, to demonstrate the usefulness oof Years of Potential Life Lost to plan public health interventions, and to use the experience to build consensus for statewide use of Years of Potential Life Lost. A computerized program was developed to compute years of potential life lost for the major causes of death from chronic diseases and to calculate years of potential life lost associated with selected risk factors. The computer model included a simulation section that calculated years of potential life lost saved when risk factors were reduced. information obtained through the use of this model has the potential to generate support for public health programs and direct public health activities.
The conceptual framework for the use of the computer model was popular based health planning. The computer model itself was based on principles of epidemiology. Relative risk values and behavioral risk factor prevalence data were used to calculate attributable mortality for the chronic diseases that caused the greatest number of years of potential life lost. The effect of changes in prevalence on attributable mortality was used as the means of stimulating outcomes of public health interventions.
Part one of the research project was the development of the computer model. The research questions were: what are the chronic diseases that cause the greatest number of years of potential life lost, what are relative risk and prevalence values of the behavioral risk factors associated with each condition, and what are the common risk factors? Part two of the project was the development of procedures to use the computer model for selecting the direction of chronic disease prevention in the community.
The procedure for the development of the computer model was as follows. Years of potential life lost were calculated for the major classification of chronic disease deaths in Virginia from 1982 to 1986; malignant neoplasms, diseases of the heart, cardiovascular diseases, chronic obstructive pulmonary disease, chronic liver disease, and diabetes mellitus. Behavioral risk factors, relative risk values and prevalence data were obtained from a review of the literature. Common risk factors were identified. Chronic diseases that caused the greatest number of years of potential life lost and were associated with a common risk factor, or a risk factor with a high relative risk and high prevalence were selected for inclusion in the computer model.
The development of a procedure for the use of the computer model for health planning was based on the risk factor assessment model. A manual was prepared to outline the procedure. Two communities were selected to demonstrate the use of the computer model for health planning. One community had a population over 100,000, the other had a population of 50,000. Following an orientation, the management teams of the community health departments participated in the risk factor assessment process. Following the assessment, each member of the management team evaluated the computer model and risk factor assessment process.
The recommendations were that: 1) years of potential life lost be used as an indicator of need in the eastern region of Virginia; 2) the computer model be used as the minimal standard for community assessment for the need for chronic disease risk reduction programs; 3) the risk factor assessment be used to determine the accessibility and feasibility of risk reduction efforts; 4) the simulation portion of the computer model be used to predict the outcome of public health actions on risk reduction; and 5) the model be implemented within the next two years and the utilization of the risk factor health planning process as a standard for community assessment.