Health and Home:
A Panel of Place-Based Inquiries
about Health Issues
Friday, May 9, 2014
Tennessee Public Health Association
Annual Meeting
September 10, 2014
Learning Objectives
• To describe purposes, use and key points
about blending quantitative and qualitative
methods to describe place-based population
health issues
• To describe three examples of placed-based
population health issues inquiry
• To discuss findings and summarize key
principles
Our Process
• Follow TPHA annual theme
• Regional sessions with examples “from the
field”
• Invited proposals for presentation at
annual meeting panel
• TPHA committee selection of best
presentations
Many health conditions are
influenced by place
Think about differences in risk, morbidity (illness) and mortality (death)
Use assessment methods to explore,
document, and describe the condition
Many health conditions are
influenced by place
Think about differences in risk, morbidity (illness) and mortality (death)
Quantitative
data
Qualitative
approaches
Identify types of numbers
(rates, percentages, counts)
that would help to verify placebased differences
Select some questions and
methods used to collect
“stories” about why the
differences may exist
Use assessment methods to explore,
document, and describe the condition
Questions to Consider
• What makes the places in the three case
different?
– The communities and patients
– The health services and systems
– The interaction between them
• How do presenters identify
– The numbers?
– The stories?
• What can we learn from three cases about
influence of place on health?
One more case:
Appalachia: Where Place Matters
• Qualitative studies in TN, KY and VA
• Why cancer mortality rates higher where incidence
rates lower
• Finding: it’s the mix of population, health services and
place
– Education levels - That people don’t know about cancer
can hurt them
– The tobacco heritage dilemma - Tobacco is risk factor but
also a regional economic driver
– The role of religion – Seen as fatalism or comforting factor?
– Rural - Low population density affects service availability
– Trust of healthcare - communication is the pivotal factor
Behringer B and Friedell GH. (2006). Appalachia: Where place matters in health. Preventing Chronic Disease [serial online]
October. Available from: http://www.cdc.gov/pcd/issues/2006/oct/06_0067.htm.
Place-based influences on health:
Two ways to explore any health issue
Quantitative (Numbers)
• Compare risk, morbidity and
mortality rates with others
• Units of analysis: state, regions,
counties, cities, neighborhoods
• Many sources and layers of data to
tap
• Epidemiology strategies
Qualitative (Stories)
• Getting behind the numbers
• Use mix of approaches:
community meetings, panels of
experts (focus groups),
surveys/interviews
• Community/patient engagement
strategies
• “Am I asking the right questions?”
Useful approach: Start with the numbers and use
qualitative methods to ask “why?”
No numbers without stories,
no stories without numbers!