Health Indicators PDF

 Health is defined as “a state of complete physical, mental & social wellbeing, and not merely an absence of disease or infirmity”  This statement has been amplified to include the ability to lead a “socially and economically productive life”  Health cannot be measured in exact measurabl...

 Health is defined as “a state of complete physical, mental & social wellbeing, and not merely an absence of disease or infirmity”  This statement has been amplified to include the ability to lead a “socially and economically productive life”  Health cannot be measured in exact measurable forms WHO defines Indicators as “variables which measure change”  Measurement of the health of the community.  Description of the health of the community.  Comparison of the health of different communities.  Identification of health needs and prioritizing them.  Concurrent evaluation and terminal evaluation of health services.  Planning and allocation of health resources.  Measurement of health successes.  Valid - They should actually measure what they are supposed to measure  Reliable – The answers should be the same if measured by different people in similar circumstances  Sensitive - They should be sensitive to changes in the situation concerned  Specific - They should reflect changes only in the situation concerned  Feasible - They should have the ability to obtain data needed ( example: availability of data to measure the indicator  Relevant - They should contribute to the understanding of the phenomenon of interest ( Example: Anthropometric indicators to assess nutritional status)  Health is multidimensional  Each dimension is influenced by numerous factors  Economic, occupational, cultural, educational, social  Measurements Ratio Proportion Rate What, who is in the denominator ? ??? Ratio: value obtained by dividing one quantity by another. The ratio of male to female birth in U.S. in 1979: 1,791,000 / 1,703,000 = 1.052  Proportion: a ratio where the numerator is always part of denominator The proportion of males among all birth in 1979: 1,791,000 / 3,494,000 = 51.3%  A Rate is a quantity in one dimension divided by a quantity in (usually) another dimension, with an indication of time Observed in 2008 2 ----- = 0.02 / year 100 1. Mortality indicators 2. Morbidity indicators 3. Disability rates 4. Nutritional status indicators 5. Health care delivery indicators 6. Utilization rates 7. Indicators of social and mental health 8. Environmental indicators 9. Socio-economic indicators 10. Health policy indicators 11. Indicators of quality of life 12. Other indicators  Crude Death Rate  Is considered a fair indicator of the comparative health of the people.  It is defined as the number of deaths per 1000 population per year in a given community, usually the mid-year population  The usefulness is restricted because it is influenced by the age-sex composition of the population, socioeconomic and socio-cultural environment of the communities.   Expectation of life is the average number of years that will be lived by those born alive into a population if the current age specific mortality rates persist.  It is a statistical abstraction based on existing age- specific death rates.  Estimated for both sexes separately.  Good indicator of socioeconomic development  Positive health indicator of long time survival  Infant mortality rate  The ratio of deaths under 1yr of age in a given year to the total number of live births in the same year, usually expressed as a rate per 1000 live births  Indicator of health status of not only infants but also whole population & socioeconomic conditions  Sensitive indicator of availability, utilization &effectiveness of health care, particularly perinatal care.  The number of deaths under 5yrs in a given year, per 1000 children in that age group at the mid-point of the year.  Correlates with inadequate MCH services, malnutrition, low immunization coverage and environmental factors  Other indicators are Perinatal mortality rate, Neonatal mortality rate, Stillbirth rate, etc.  Correlates with inadequate antenatal care and perinatal care  Maternal Mortality Rate Ratio of number of deaths arising during pregnancy or puerperal period per 1000 live births Accounts for the greatest number of deaths among women of reproductive age in developing countries  Disease Specific Death Rate Mortality rate which is computed for specific diseases. E.g. TB mortality is 23 per 100000 population per year.  Proportional Mortality Rate Proportion of all deaths attributed to the specific disease E.g. Coronary heart disease causes 25 to 30 % of all deaths in developed world.  Morbidity Indicators reveal the burden of ill health in a community, but do not measure the subclinical or inapparent disease states. 1. Incidence  The number of new events or new cases of a disease in a defined population, within a specified period of time. 2. Prevalence  The total number of all individuals who have disease at a particular time divided by population at risk of having disease at this point of time  Reflects the chronicity of the disease.  DALYs: Disability Adjusted Life Years  DALYs: Disability Adjusted Life Years.  It is defined as the number of years of healthy life lost due to all causes whether from premature mortality or disability.  It is the simplest and the most commonly used measure to find the burden of illness in a defined population and the effectiveness of the interventions  Two things needed to measure DALYs are - Life table of that country, to measure the losses from premature deaths - Loss of healthy life years resulting from disability; the disability may be permanent (polio) or temp(TB, leprosy), physical / mental.  Uses of DALYs  To assist in selecting health service priorities  To identify the disadvantaged groups  Targeting health interventions  Measuring the results of health interventions  Providing comparable measures for planning & evaluating programs  To compare the health status of different countries  DALY express years of life lost to premature death and years lived with disability for the severity of the disability  One DALY is one lost year of healthy life  Nutritional Status is a positive health indicator.  Newborns  i. Birth–weight ii. Length iii. Head circumference  They reflect the maternal nutrition status  Pre-school children Anthropometric  Weight – measures acute malnutrition  Height – measures chronic malnutrition  Mid-arm circumference - measures chronic malnutrition  Growth Monitoring of children  Measuring weight-for-age, height-for-age, weight-for- height, head & chest circumference and mid-arm circumference.  Adults  Underweight, Obesity and Anemia are generally considered reliable nutritional indicators.  These indicators reflect the equity of distribution of health resources in different parts of the country and of the provision of health care  Doctor – population ratio  Doctor – Nurse ratio Population – bed ratio Population per dentist Population per nurse  Population per health center  Population per TBA  Utilization Rates is expressed as the proportion of people in need of a service who actually receive it in a given period, usually a year  It depends on availability & accessibility of health services and the attitude of an individual towards health care system 1. Proportion of infants who are fully immunized 2. Proportion of pregnant women who receive ANC care or have institutional deliveries 3. Percentage of population who adopt family planning 4. Bed occupancy ratio, bed-turn over ratio, etc.  Rates of suicide, homicide, other crime, road traffic accident, juvenile delinquency, alcohol and substance abuse, domestic violence etc.  These indicators provide a guide to social action for improving the health of people.  Social and mental health of the children depend on their parents. E.g. Substance abuse in orphan children, smoking  These reflect the quality of physical and biological environment in which diseases occur and people live.  The most important are those measuring the proportion of population having access to safe drinking water and sanitation facilities.  These indicators explains the prevalence of communicable diseases in a community  The other indicators are those measuring the pollution of air and water, radiation, noise pollution, exposure to toxic substances in food and water  These do not directly measure health but are important in interpreting health indicators.  Per capita income  Level of unemployment  Literacy rate  Per capita caloric availability  Population  Total Fertility Rate (TFR)  Family size  Population increase rate  Contraceptive use  The single most important indicator of political commitment is allocation of adequate resources  The relevant indicators are  Proportion of GDP spent on health Proportion of GDP spent on health related activities like water supply and sanitation & housing and nutrition  Proportion of total health resources devoted primary health care  Life expectancy is no longer important  The Quality Of Life has gained its importance Physical Quality of Life Index  It consolidates Infant mortality, Life expectancy at age of 1yr and Literacy.  For each component the performance of individual country is placed on a scale of 1- 100.  The composite index is calculated by averaging the three indicators giving equal weight to each  The resulting is placed on the 0 to 100 scale. Human Development Index  Life expectancy at birth  Literacy rate  Income- GDP per capita income The resulting is placed on the 0 to 1 scale