How the World Health Organization is using data visualisation to present information on inequalities in health system performance across the European Union
The World Health Organization (WHO) embarked on a project to improve the availability of and access to evidence on inequalities in health system performance, including quality of care and the structural determinants of these inequalities. The project’s initial focus was on countries in the European Union.
The aim was to take into account the geographical nature of the regional data and not just to reflect national averages. The WHO team was led by Dr Claudia Stein and also included Drs Enrique Loyola, Ivo Rakovac and Anatoliy Nosikov who are based in Denmark. Dr Loyola explains that the intention was to use data at the regional (NUTS2) level that was already available and avoid requests for further information. “Part of what we were hoping to achieve was to show that there is already a lot of data out there and that it is often not fully analysed.”
Once the team started to look at the data, they realised the first step was to resolve issues around standardisation and coverage. “We wanted to see health inequalities in a different dimension – not just in terms of health outcomes. Being able to understand the impact of disease but also explore other aspects of healthcare systems was an important prerequisite for us.”
“How health is affected by other environment elements is a complex question and we wanted to have a tool that would allow us to show the pattern of contributory factors so that we could suggest associations between them and stimulate discussion about their plausibility,” says Dr Loyola.
Dr Loyola is familiar with GIS systems having used them on other projects. He acknowledges that they can be powerful statistical tools allowing users to analyse the relationship between many different types of information and geography. However, the WHO team recognised that they needed something the target audience could use without getting into difficulty. “Policy makers and public health analysts do not often have the skills needed to manipulate GIS systems,” says Dr Enrique.
“In addition they require a robust IT platform which would have added significant cost. We have previously developed a GIS that was tailored to health and found that it couldn’t be used in a web environment which was also an important feature we were looking for.”
The team started to look for different ways to present the data they would be working with. They tested various solutions that were affordable and could be used to present data online. This included InstantAtlas and they were impressed with its ease of handling and decided it would meet their needs.
The WHO team convened a large group of technical experts and policy makers to show how they had organized three different types of atlases planned to present the data. Each atlas would enable the user to answer a number of different questions from straightforward regional comparison within the EU to more complex comparison across different socio-economic groups. The feedback was very positive and helped to improve the final product.
Meeting the need
The team has now produced a series of atlases using, publicly available socioeconomic and health-related indicators from EUROSTAT databases. Variables displayed in maps, graphs and tables represent more than 600 individual indicators available for 281 regions in the European Union.
The atlases aim to provide more visibility to the sub-national patterns of health and their determinants. The WHO team now have an integrated information system with its underlying data and an information resource on policy options (developed by colleagues from the WHO Office in Venice that can be used to better inform policy across European countries. Dr Loyola says: “The added value is to: improve insight into the regional dimension of socially determined inequalities in health across counties; provide a tool for increased engagement of the public and the media in the dialogue with the competent authorities on health policy and action; and provide a pilot for a more regular monitoring and assessment of the magnitude of social inequalities in health and the impact of the relevant policies, interventions and services.”
Dr Loyola says the user response has been very encouraging. “The technical people love it because it is compact and the politicians like it because they not only want an element of diagnostics but hey want to know what to do next,” he says. “People want to know what interventions work and the web-based resource of examples of health systems actions on socially determined health inequalities this is helping them to find real-life case studies which to give them a useful starting point.”
Dr Loyola says that WHO is very pleased with the atlases and is now looking forward to a second phase of the project. This will involve presenting data in such a way that users can start to assess the impact of a particular intervention by including time series analysis. “We want to give users the ability to see change over time so they can follow up potential effects of their policies,” he says.
The team is also moving towards presenting the data around themes rather than by a list of individual indicators. So for example indicators could be grouped into one theme around traffic – including information on the number of accidents and density of traffic.
Use of product names in this article do not in any way imply an endorsement, certification, warranty of fitness or recommendation by WHO of any company or product for any purpose, and does not imply preference over products of a similar nature that are not mentioned.
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