Health needs mapping can identify where people with particular conditions live - down to a postcode. Healthcare professionals can then target specific health promotion messages.
[black right pointing small triangle] Mapping exercises make use of techniques more commonly associated with retail marketing.
[black right pointing small triangle] Combining this information with hospital episode statistics allows people at risk of diseases to be identified.
[black right pointing small triangle] This works at the level of postcodes, which on average cover just 14 addresses.
Have you ever wondered why your local supermarket stocks the food it does? How do its buyers know that speciality breads and a good deli will work in one area and not another?
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The chances are they are using advanced marketing techniques to understand the nature of their customers, what they are likely to buy and what they will leave on the shelves. Buyers often look at the population of their catchment area, not just in simplistic social class terms, but in terms of a more complicated set of sub-divisions such as 'upper floor families' and the 'low horizons' (see box overleaf).
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The information available on these sub-groups will tell the supermarket what they like to eat, the newspapers they read and how they spend their leisure time.
But can these sophisticated marketing techniques be used to plan health care and reach patients who are at greater risk of disease? Dr Foster - the healthcare information group - believes it can and is working with the NHS to make it happen.
The system links hospital episode statistics - which record why people are admitted to hospital and where they come from - with Mosaic, a system that offers detailed neighbourhood lifestyle data. On a national basis, Dr Foster can work out where people most likely to be admitted to hospital for certain conditions come from and then combine that information with Mosaic to predict the sub-groups who are at greater risk of admission. This works at postcode level, allowing much closer targeting than the electoral ward method, as the average postcode covers just 14 addresses.
For any defined area this allows the groups most at risk of admission to be identified-and the lifestyle information can help healthcare professionals plan a campaign that is aimed at exactly the right people.
Richard Forshaw, NHS media marketing manager with Dr Foster, says it is about understanding behaviour. 'We use market research data to plan public health intervention and service delivery. It can be used as a predictive tool. We can also track who is likely to become that lifestyle type in later life.'
For example, Dr Foster is working with a major pharmacist to identify groups of people who do not have coronary heart disease at the moment but who are at increased risk of developing it in later life.
On the whole, public messages produced by the NHS are aimed at everyone, Mr Forshaw points out. This can mean that resources are wasted on reaching people who are not at risk or who have already changed their lifestyle. These messages can also be ineffective at reaching those most at risk if they do not respond to the information.
Mr Forshaw says that these limitations are highlighted by market research in a particular area. For example, in Slough, focus groups offered an insight into how diabetes and a diabetes diagnosis were viewed in the south Asian community (see overleaf).
Dr Foster also worked with Brent Primary Care Trust in London and the borough council on a strategy to reduce teenage pregnancies. This included a lifestyle magazine for young people with information about sexual health interspersed between general features, making it more acceptable for them to take home.
A card attached to the front of the magazine allowed teenagers to collect free condoms from pharmacies, barbers' shops and nail bars.
'It is important to understand what people's behaviours are, but more crucially, why they behave as they do,' says Mr Forshaw. 'This knowledge informs how we speak to patients. Then you can devise a strategy that maximises reach. You can get the best bang for your buck.'
Traditional health needs analysis has tended to identify areas of poor health or particular problems. But Mr Forshaw says this method goes further.
There are implications for the siting of services too. For example, a primary care trust looking to place a new urgent care centre or diabetes clinic could use this system to find out where the heaviest users are most likely to live, and whether they have access to transport.
But the system does not come cheap. Initial analysis is likely to cost between £10,000 and £20,000. Many health professionals say it is worth the money because a detailed understanding of the population saves more than it costs.
A survey of senior NHS managers carried out by Dr Foster and the Department of Health showed that many felt they did not have enough information about their local population.
However, there are some who feel the NHS is overly concerned with gathering evidence about things that front line workers could tell them anyway, particularly if managers are unwilling to follow through with investment and strategies.
'It is about whether we have got the balance of investment right in terms of getting all the evidence to develop an initiative versus going with the social information we already have,' says one, who wished to remain anonymous. 'And there is no point in spending the money if you then do not use the information.'
More than a quarter of the population of Slough are of south Asian origin - a group known to have a high incidence of type 2 diabetes. But while around 7 per cent of south Asians in Slough were likely to have the disease, two years ago only 4 per cent were diagnosed.
This meant that hundreds of people were likely to have undiagnosed diabetes, with the consequent risk to their health.
Grace Vanterpool, pictured above, clinical lead for diabetes at Slough Primary Care Trust (PCT) and Nursing Standard Nurse of the Year 2006, knew that even some of those with diagnosed diabetes did not attend clinics for check ups, possibly because many faced a difficult journey to Windsor.
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At the same time, Dr Foster was developing its health mapping system and wanted to evaluate it in a real situation. The result was a short-term Action Diabetes campaign targeted at the south Asian community. By using health mapping techniques, the areas of Slough where members of this community were most likely to live were pinpointed and linked with local data. Mosaic information was used to discover the best way to approach this group. They were unlikely to be large users of telephone helplines, for example, and tended to shop at corner shops - therefore handing out leaflets outside supermarkets would not be effective.
A series of focus groups and lunch meetings was held. It emerged that many Sikh people were well informed about diabetes, whereas members of the Muslim community were less knowledgeable. There was also some stigma associated with diabetes in the Muslim community.
The four-week campaign featured a diabetes bus that visited streets where those with undiagnosed diabetes were most likely to live. The bus was also taken to temples, mosques, shopping centres and workplaces. Information and on-the-spot testing were offered.
A special celebrity-style magazine was produced, featuring cricketer Wasim Akram, who has diabetes, as well as information about living with the condition. While written information was produced in a variety of languages, a video and DVD were also needed to reach those who could not read the language they spoke, for example Asian women.
Actor Sayeed Jaffrey, who has diabetes, was interviewed on the video and lent his support to the campaign and there was considerable media interest. Community volunteers were recruited to encourage people to come forward for testing and help combat misconceptions.
Since the campaign last year, 96 per cent of the expected number of Asian people with diabetes in Slough have been identified, uptake of regular check-ups at diabetes clinics has improved and a new diabetes clinic has been set up.
The project, which is being formally evaluated, has been written up in a community health workbook that has been sent to all PCTs.
Key words: Health needs mapping; Dr Foster; Mosaic; Marketing techniques; Diabetes; Teenage pregnancy; Health promotion; Service provision
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